amir kasraianfard

Diagnosis of diaphragmatic rupture following thoracoabdominal penetrating trauma is very challenging in asymptomatic patients with stable vital signs. This study aimed to evaluate the diagnostic accuracy of focused assessment with sonography for trauma (FAST) in this regard. This cross-sectional study was performed on patients referring to emergency department due to left thoracoabdominal stab wound during 2 years. All patients initially underwent ultrasonography and the screening performance characteristics of FAST in detection of diaphragmatic injuries were calculated, considering the findings of diagnostic laparoscopy as the gold standard test. Twenty-four patients with the mean age of 33 ± 10.64 years (16-61 years) were studied (100% male). The mean chest wall laceration size was 2.7 ± 2.7 cm (1-10 cm) and the most frequent location of wounds was posterior chest wall (42%) and in the 6th and 7th intercostal space (50%). Diaphragmatic rupture was seen in 4 (16.7%) patients based on diagnostic laparoscopy. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratio of FAST in detection of diaphragmatic raptures were 50% (95% CI: 9.18 – 90.8), 100% (95% CI: 79.9 – 100.0), 100% (95% CI: 19.8 – 100.0), 9.1% (95% CI: 1.5 – 30.6), Infinity, and 0.1 (95% CI: 0.02 – 0.37), respectively. The overall accuracy of FAST in this regard was 75.0% (95% CI: 42.3 – 100.0). In patients with penetrating trauma to the left thoracoabdominal region, FAST cannot be the definitive alternative to diagnostic laparoscopy to detect diaphragm rupture.

The known early and late complications following splenectomy increase the tendency to preserve splenic tissue after splenic trauma.

This study was conducted to determine the safety and feasibility of auto-transplantation of splenic fragments in patients with severe splenic injury.

Nineteen patients with severe splenic blunt trauma, who underwent total splenectomy and autotransplantation of splenic fragments at Besat hospital, Hamadan University of Medical Sciences, Iran during years 2015 and 2016, were enrolled in the study. Complete blood counts, blood smear for Howell-Jolly bodies, and phagocytic function tests were performed just before, at 3 months, and 6 months after surgery.

The means of red blood cell counts increased significantly at both 3 and 6 months after surgery (P = 0.01 and 0.049, respectively) and the means of hemoglobin, hematocrit, and the percentage of lymphocytes increased significantly at 3 months after surgery (P = 0.001, 0.046, and 0.01 respectively) while this increase was not significant 6 months after surgery (P = 0.52, 0.15, and 0.34, respectively). The Howell-Jolly bodies were present in 5 patients (26.3%) at 3 months after surgery, which was significantly reduced to 3 (15.8%), at 6 months after surgery (P = 0.042). The median of splenic phagocytic function significantly increased from 3 ± 1.2 hotspots (range = 2 to 6) at 3 months after surgery to 4 ± 1.4 (range = 2 to 8) at 6 months after surgery (P = 0.044).

Auto-transplantation of splenic fragments may be feasible and safe and a suitable option for splenic tissue salvage in patients with severe splenic lesions, who require total splenectomy.

Confirmed evidences on superiority of subcuticular suturing compared to interrupted suturing method, in terms of postoperative complications such as wound infection, size of scar, or abscess formation is few.
The present study aimed to compare absorbable subcuticular suturing supported with Steri-Strips™ to interrupted nonabsorbable suturing method after appendectomy.
In a randomized controlled trial, seventy patients with the diagnosis of acute appendicitis at Besat hospital, Hamadan University of Medical Sciences, Iran in the year 2016 were enrolled in the study and were randomly assigned into two groups. In the case group (n = 35), the wound suturing was done using subcuticular suturing supported by Steri-Strips™ and in the control group (n = 35), suturing was performed using interrupted mattress suture. All patients were visited at postoperative day one, seven, thirty and ninety.
The width of the scar and the mean of severity of pain score at postoperative day seven in the case group were significantly shorter and lower than the control group (1.05 ± 0.66 vs. 3.62 ± 1.77 mm, P Skin closure using absorbable subcuticular suturing supported by Steri-Strips™ method in patients with uncomplicated appendicitis may be safe and feasible and may result in higher levels of patient satisfaction.

The current organ shortage has prompted the use of marginal organs. We conducted this retrospective study to present our experience with transplanting deceased donor livers with elevated levels of serum transaminases and to explain whether elevated levels of serum transaminases in donors affect allograft function and survival of the recipients..
Data of deceased donor livers and patients, who underwent liver transplantation from March 2013 to March 2015 at Shiraz center for organ transplantation, was reviewed. Liver donors with aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) level of more than 500 IU/l and their related recipients were considered as the case group (n = 24) and the others were considered as the control group (n = 834)..
In the case group, the medians of levels of serum AST and ALT of donors were 834 ± 425 IU/L (range: 250 - 2285) and 507 ± 367 IU/L (range: 100 - 1600), respectively. Recipients were followed for a median of 13.6 ± 9 months (range: 7 - 28.4). Post-transplant complications were acute rejection (n = 5), infection (n = 3), portal vein thrombosis (n = 3), bile duct stricture (n = 1), and hepatic artery stenosis (n = 1). The one-year survival rate of the patients was 91.7%. Demographics, post-transplant complications and one-year survival rates were not significantly different between the two study groups..
Transplanting deceased donor livers with markedly elevated liver enzymes may be an acceptable choice for expanding the donor pool..