homayoun tabesh

Surgical Site Infection (SSI) after neurosurgical procedures is one of the most common types of hospital infection, on which different results have been reported regarding the effect of antibiotic use. This present study investigated the effect of vancomycin and cefazolin in preventing SSI after elective craniotomy.

The present double-blind interventional clinical trial. Which was done among 126 participants (63 vancomycin group and 63 cefazolin group). The criterion for measuring wound infection was CRP (C-reactive protein) and ESR (Erythrocyte sedimentation rate) on the first and fifth day after surgery, patient's clinical symptoms and wound. Data were analyzed with Chi-square and Independent t-test.

In total, two groups of 9 people got infections after surgery, among which 6 people (67%) were in the cefazolin group and 3 people (33%) were in the vancomycin group. The mean CRP on the first and fifth days in the cefazolin group was significantly higher than the vancomycin group. There were no significant differences in the study groups in terms of length of hospitalization after infection, interval between surgery and time of infection, ESR at the time of infection, length of operation (hours), type of infection and type of organism.

According to the results, there was no difference between the use of cefazolin and vancomycin in reducing the rate of surgical site infection. The rate of surgical site infection in in this study was higher compared to the results of other studies.

lumbar disc degeneration is a multifactorial degenerative disease which is affected by genetic inheritance and environmental factors. Type XI collagen is important for organization of the extracellular matrix and cartilage collagen construction. Rs1676486 is a SNP that causes the conversion of C-T, resulting in a change in the expression of the collagen 11 alpha chain. The T allele reduces the alpha 1 chain transcription of collagen 11 and ultimately leads to an imbalance in gene expression.

This study aims to determine the genetic variant of alpha1 type11 collagen is associated with the progress of intervertebral disc degeneration. All patients were selected from the AL-Zahra Hospital of medical university of Isfahan, Iran, between April 2016 and September 2017. SNP rs1676486 of alpha1 type11 collagen was genotyped in 100 patients and 100 healthy controls. The inclusion criteria for patients were: individuals who had typical clinical and imaging symptoms and signs of intervertebral disc degeneration. Exclusion criteria were: patients with trauma, metabolic and neuromuscular diseases, and congenital disorder of the spine. The Genomic DNA was extracted from peripheral blood samples by a Whole Blood Genomic DNA Extraction Kit. The chi-square test and fisher’s exact test were evaluated to determine differences of genotype and allele distributions between intervertebral disc degeneration patients and healthy controls. To compare the relationship between genotypes and clinical features the Mann-Whitney U test was used.

The mean age was 39.54±9.52 years for the patients and 28.14±5.32 years for the controls, respectively. The mean BMI were 26.3±3.18 kg/m2 and 27.3±3.52 kg/m2 for the patients and the controls, respectively. In addition, the results showed that the prevalence of surgical disc in patients with L4-L5 levels was 52.1% and L5-S1, with 31.1%. This study showed, rs1676486 in alpha1 type11 collagen gene was associated with modified intervertebral disc degeneration at age ≤50 years and this gene increases intervertebral disc degeneration risk at age >50 years. SNP rs1676486 had the significant association with the intervertebral disc degeneration (P=0.019), and patients were found to have higher frequency of AA than the controls.

This observation shows that type XI collagen is related to age and genetic factor in intervertebral disc degeneration disease.

The aim of this study was to compare the PID with bare skin (without PID) regarding bacterial recolonization and bacterial regrowth of the adjacent skin of surgical incision in lumbar spine surgery patients.

This quasi‑experimental study was conducted from February to May 2018 on 88 patients who were candidate for lumbar spine surgery. Patients were assignedto one of two groups, treatment (with PID) and control (without PID). Skin sampling (adjacent of surgical incision) for bacterial culture was done in two steps, immediately after surgical skin prep (IASSP) and immediately after surgical wound closure (IASWC) by researcher. Finally, samples were sent to the laboratory. </span

The mean total bacterial count of patient’s skin in stage IASSP was not significantly different between treatment and control groups (0.34 vs 0.27, P = 0.68). However, mean total bacterial count in stage IASWC in treatment group wassignificantly higher than control group (2.2 vs 0.93, P = 0.03). The frequency distribution of S. aureus (P = 0.04) and S. epidermidis (P = 0.02) was significantly higher in treatment group compared with control group in stage IASWC.

The results showed that using PID is unable to reduce recolonization and regrowth of bacteria on patients’ skin adjacent to surgical wound in clean lumbar spine surgeries. However, making a definite decision about using or notusing of PID requires further studies.

Several factors are involved in susceptibility to multiple sclerosis (MS)and alterations in disease activity. A full understanding regarding the mechanism which causes the disease is still lacking. Several factors have been considered to be associated, positively or negatively, with the onset, course, progression, and relapse rates of MS. However, the level of consensus on each factor is different. These factors are either genetic (including polymorphisms in human leukocyte antigen, microRNAs genes, etc) or environmental (such as serum levels of circulating vitamin D, helicobacter pylori, Epstein-Barr virus, human cytomegalovirus, human herpes virus type 6, human endogenous retrovirus infections, and latitude). Vitamin D sufficiency is a major protective factor on which there is a decisive consensus and has known interactions with many factors affecting MS onset/severity. Vitamin D therapy is speculated to exert beneficial effects on patients, the efficacy of which, along with the etiology of MS, is reviewed in this article.

The aim of this study was to investigate the effect of the incise drape (ID) on surgical wound bacterial contamination during lumbar spine surgical procedures in treatment group (with ID) and control group (without ID).

The present study was conducted on 88 patients who were a candidate for lumbar spine surgery. The patients were randomly assigned to one of the two groups, treatment and control. The ID was only used in the treatment group. The surgical wound sampling for bacterial culture was done in two steps, immediately after surgical incision (IASI) and immediately prior to the surgical wound closure (IPSWC). The samples were then sent to the laboratory.

The mean total bacterial count of the surgical wound in the stage IASI was not significantly different between treatment and control groups (0.09 vs. 0.02, P = 0.31). However, this means in the stage IPSWC in treatment group was significantly more than the control group (18.6 vs. 0.41, P = 0.04). The frequency distribution of Staphylococcus aureus (25% vs. 3%, P = 0.02) and Staphylococcus epidermidis (36.4% vs. 9.1%, P = 0.002) was significantly higher in the treatment group compared with control group in the stage IPSWC.

The results suggest that the use of ID is unable to reduce surgical wound bacterial contamination in clean lumbar spine surgery. Therefore, based on the results obtained in our study, the application of ID is not recommended as an essential action for the prevention of surgical wound contamination.

Bleeding during surgery is one of the most common surgical complications. In this study, we decided to determine the effect of Tranexamic Acid (TA) in reducing blood loss in patients undergoing spinal surgeries.

In this clinical trial, 100 patients undergoing spinal surgeries were randomly divided into two groups. One group received TA and the other was selected as the control group. Patients in the treatment group received 1 gram of intravenous TA and another 250 milligram intravenously, one hour after the beginning of the surgery. Bleeding during the surgery, in the first 24 hours and the first 48 hours were recorded separately. The need for transfusion and its volume, as well as the hospital stay length were compared in the two groups. 

Bleeding during surgery in TA group was significantly lower than that in the control group (433 ml vs. 522 ml respectively, P=0.009). Also, during the first 24 hours after surgery, bleeding in TA group was significantly less than that in the control group (P=0.011). During the second 24 hours after surgery, bleeding was similar between the two groups (P=0.112). The values of hemoglobin in both groups slowly decreased and the trend of decrease was not significantly different between them (P=0.154).

In spinal surgeries, TA administration in the beginning of the process reduces surgical bleeding during surgery and in the first 24 hours after surgery. Considering the possible complications, TA administration is suggested for patients with hemoglobin less than 12 g/dl. Future studies are needed to conclude the advantages and disadvantages of TA administration in spinal surgeries.

Traumatic spinal injuries are the main cause of patients' morbidity and the underlying health costs. The first step in prevention of these injuries is to recognize their epidemiologic factors. The aim of this study was to identify the demographic and some other risk factors of traumatic spinal injuries in Isfahan Province. This cross-sectional study was conducted on 510 patients with traumatic spinal injuries referred to two main hospitals of Isfahan University of Medical Sciences during 2012-2018. Demographic data of the patients including age, sex, mechanism of injury, level of injury, type of fracture and the need for surgery were recorded. The mean age of the patients was 42.31±14.52 years and 30.4% were female. Seventeen percent of the patients had neck injury, 26.9% had thoracic damage, 56.1% had the lumbar region damage, and 13.3% suffered spinal cord injury. Also, 18% were surgically treated for spinal fracture. The most common type of fracture was compression fracture (29.4%), followed by burst fracture (28%). The most common mechanism of trauma was car accident. Considering the high prevalence of traffic accidents in this country and the following occurrence of spinal cord injury, more studies need to be conducted regarding factors affecting the spinal cord injuries and the ways of preventing these injuries, and as a result we can reduce social and financial burden of these injuries on society.

This study aimed to investigate the differences in pelvic incidence (PI) between three standing, maximal anterior and maximal posterior pelvic rotation. This cross-sectional study was done on 150 healthy subjects. Lateral spine radiography was taken in 3 different positions in the same standard radiographic protocol. Sacral slope (SS) pelvic tilt (PT), lumbar lordosis (LL) and lumbosacral junction angle were measured by two independent, experienced spine surgeons. PI was calculated as sum SS and PT. The mean of PI in standing positions was 52.6±5.1, in anterior position was 52.6±5.5 and in posterior position was 52.3±5.2 degree. The mean of PI, PT, and SS in total and between male and female subjects was not statistically significant in three different positions (P>0.05). PI in 136 subjects (90.7%) is changed when the position was changed from standing to the posterior position, by mean of 2.06 degree. When the position was changed from standing to an anterior position, the change in PI degree was observed in 126 subjects (84%) by mean of 2.12 degree. Despite the none, significant value of PI in three different positions, a large number of subjects with a change in their PI when the position was changed to anterior or posterior (90.1%) position, show that PI can be varied by pelvic rotation in healthy adult subjects.

The aim of this study was to investigate the effect of incise drape (ID) on the incidence of surgical site infection (SSI) following lumbar vertebrae surgeries. This quasi-experimental study was conducted on 88 patients who were candidates for lumbar vertebrae surgery at Alzahra hospital in Isfahan, Iran. The patients were randomly assigned to two equal groups of with and without incise drape. Surgical site was evaluated for the incidence of superficial and deep infections on days 2, 14, and 30 after surgery according to criteria defined by the American Centers for Disease Control and Prevention. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) tests, and bacterial culture of discharges of patient's wounds were done. Findings: Of 44 patients in group with incise drape, only 3 cases (6.8%), and of 44 in group without incise drape, only 2 cases (4.5%) had superficial infection at the second day after surgery, and there was no significant difference in the incidence of infection between the two groups (P = 0.50). In addition, at 14 and 30 days after surgery, no infection was observed in two groups. There is no significant difference in the incidence of surgical site infection between the two groups, and making a definite decision about using or not using of incise drape requires further studies

As marcaine is administered to a great extent due to minor complications and reasonable expenses and as discectomy is prevalently used in Iran, this study makes a comparison between effect of marcaine alone, lidocaine alone, and marcaine plus lidocaine on pain relief of patients undergoing lumbar disc open surgery.

In a clinical trial study, 192 patients were selected and randomly divided into four groups. Patients in Groups 1–4 received 0.5 ml marcaine during surgery, 5 ml lidocaine 2% before incision, 5 ml lidocaine 2% before incision plus 5 ml marcaine during surgey and normal saline, respectively. After patients gained knowledge of visual analog scale (VAS) criteria, their severity of pain was measured and was recorded in their profiles, along with demographic details and history of diseases. After surgery and their transfer to their rooms, their severity of pain was measured and recorded again by using VAS criteria. Finally, difference between the four groups was compared by SPSS software.

The mean (±standard deviation) of postoperative pain in marcaine + lidocaine, marcaine, lidocaine, and normal saline was 3.5 ± 1.3, 3.5 ± 1.6, 36.1.9, and 4.2 ± 1.8, respectively, and we did not observe any significant difference in severity of pain after surgery in these groups (P = 0.15). The highest and lowest degree of satisfaction occurred in marcaine-lidocaine group and control group, respectively, (40 patients [83.3%] vs. 25 patients [52.1%]).

Lidocaine-marcaine treatment reduces the need to opiates in cases of postoperative pain relief of discectomy and provides patients with great satisfaction.

Cerebral aneurysms are a kind of cardiovascular diseases which are accompanied with high morbidity and mortality due to rupturing and causing subarachnoid hemorrhages. The current study aimed to determine epidemiologic and demographic features and prognosis of patients with cerebral aneurysms.

In this cross‑sectional study, 465 patients with cerebral aneurysms hospitalized in Al‑Zahra Hospital were studied. The required information including demographic, epidemiologic, and clinical features of the disease were extracted from their records. The obtained data were analyzed using SPSS software and the factors associated with the prognosis of the disease were determined.

Four hundred and sixty‑five cases with cerebral aneurysm undergoing surgery were investigated. The mean age of the patients was 48 ± 14 years whereas 216 cases (46.5%) were male and 249 (53.5%) were female. Two hundred and thirty‑seven patients (51%) remitted completely while the disease caused moderate disability in 84 cases (18.1%), severe disability in 24 ones (5.2%) and vegetative state in 9 cases (1.9%) and mortality in 57 ones while it was unknown in 54 cases (11.6%). In terms of the age of patient, WFNS index, anatomical position of aneurysm, type of aneurysm lesion, the incidence season of the disease, type of postoperative complications, family history and operative approach, the disease outcome had a significant difference while gender, ethnicity, and risk factors had no significant effect on the disease outcome.

According to the type of aneurysm, the incidence position of the aneurysm and other epidemiologic, demographic, and clinical features, providing the prevention and treatment strategies is necessary

Surgical Site Infection (SSI) is one of the most important complications after spine surgeries. Different methods have been proposed to prevent this type of infection. The present study was performed to evaluate the effect of applying topical vancomycin powder on prevention of SSI in patients undergoing spinal surgery using implants in Al-Zahra Hospital, Isfahan, Iran from February 2015 to June 2016.
Methods and Materials/Patients: In this clinical trial, 100 patients candidate for spinal surgery with implants were divided into two groups using randomization technique including 50 patients in each group. Vancomycin powder solved in 20cc N/S serum was flushed over all layers of the surgical wound in the case group and in the control group sterile normal saline solution was used. Patients were examined at discharge and three months after surgery for ruling out surgical site infection. SSIs following spine surgery can be superficial, characterized by obvious wound drainage and erythema or it can be deep infections disseminating under the fascia which may lead to discitis, epidural abscess, and spondylitis.
One case of SSI was observed in the control group who was 83 years old. The mean age of all patients was 51.9±14.5 years old. The duration of surgery in this patient was 5 hours. The mean duration of surgery was 3.41±0.73 hours. The length of implant, BMI, sex, underlying diseases and other risk factors (diabetes and hypertension) did not affect the rate of infection.
Even though topical antibiotics seem to be effective on controlling SSI but our finding did not support this hypothesis. The authors would like to suggest that keeping routine strict sterility strategies during spine operations is effective enough in preventing surgical site infection.

A large number of stroke patients are not the perfect candidate for craniotomy and invasive procedures, so providing an alternative and noninvasive method, which is applicable in terms of costs and facilities, is necessary. Thus, the present study aimed to determine the effects of mannitol 20% on outcome of the patients with nontraumatic intracerebral hemorrhage (ICH) in patients admitted to Isfahan’s Al-Zahra Hospital during 2012 and 2013.

This is a clinical trial study which is conducted during 2012–2013 in Isfahan’s Al-Zahra Hospital. In this study, 41 patients suffering from ICH received mannitol 20% for 3 days, and volume of hemorrhage and Glasgow Coma Scale (GCS) of patients were controlled every 12 h. The collected data were analyzed via SPSS software.

The mean ICH volume was 22.1 ± 6.3 ml in pre intervention and 38.4 ± 19.3 ml in post intervention, and according to the t-paired test, before and after treatment the difference was signifi cant (P < 0.001). Hemorrhage volume was stable in nine patients (22%), it increased in 25 patients (61%), and decreased in seven patients (17.1%). The mean index of GCS before and after treatment was 11.85 ± 1.6 and 9.37 ± 2.65, respectively. Moreover according to t-paired test, the difference was signifi cant before and after treatment (P < 0.001). During using mannitol, the GCS index was stable in eight patients (19.5%), it increased in eight patients (19.5%) and decreased in 25 patients (61%).

Mannitol injection was not effective in reducing hemorrhage size, and its use is not recommended, also, further studies in this fi eld have been proposed.

We planned a study to investigate the effect of spinal anesthesia in producing low back pain (LBP) in women following Cesarean section.
During a prospective cohort study, 100 women who underwent spinal anesthesia and Cesarean operation were compared with 100 women who underwent general anesthesia and Cesarean operation during a 3-months follow-up as developing later low back pain.
Findings: During 3-months follow-up, 25 and 43 patients in general and spinal anesthesia groups developed low back pain, respectively, which was statistically different according to chi-square test (P = 0.007). So, the prevalence of low back pain was 1.99 times more in spinal anesthesia group. It is important to note that the infant's weight had strong effect in producing low back pain; as increasing every 1 kg in weight increased the chance of low back pain for 2.1 times.
There incidence low back pain was higher in women who underwent Cesarean operation under spinal anesthesia; this high incidence not only depended on the type of anesthesia, but on other factors such as the infant's birth weight. Thus, when planning Cesarean operation, it is necessary to consider the underlying factors in mother and child which can be effective in producing later low back pain and then accept the type of anesthesia.

Hematoma is the most serious complication of head trauma and if we are capable to prevent the increment in size of hematoma, not only the mortality and morbidity but also the need of surgical intervention will decrease in management of head trauma. The aim of this study was to evaluate the effect of Tranexamic acid on traumatic brain hematomas.
In a double blind clinical study, 190 head injured patients in whom the primary brain Computed tomography scan (CT scan) had confirmed the existence of one of the different kinds of hematoma were selected and randomly divided in two groups, the first group received Tranexamic acid and the second group received placebo (normal saline). For all patients another brain CT scan was performed 24 hour after receiving the medication for detecting new bleeding or a change in size of the previously existing hematoma and the CT scans were reported by an expert radiologist. The collected data was analyzed by SPSS software.
Findings: Before the intervention the mean volume of the hematoma in the case and control group was 4.7 ± 4.9 and 5.0 ± 4.2, respectively and there was not statistically difference between the two groups (P = 0.64). The mean change in the volume of hematoma after intervention in the case and control group was -0.01 ± 3.71 and -0.13 ± 2.48, respectively and no statistically significant difference between the two groups were observed but considering the type of hematoma, the study showed meaningful decrease in the size of brain contusions in the case group.
The effect of Tranexamic acid in traumatic brain injuries depends on the type of the lesion so that its effect on brain contusions was more prominent, although further studies are recommended to determine the overall effect of medication.

Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation. This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation. The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82). Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.

The main objective of this study was to determine the incidence, time to event, and risk factors for posttraumatic seizures (PTS) following traumatic brain injury (TBI) in a five-year follow-up survival design.

In a cohort study, between September 2008 and October 2013, 411 traumatic brain injury patients referring to the Emergency Units (EUs) of the Isfahan University Hospitals, who met the inclusion criteria, entered the study. Follow-up evaluations were conducted by telephone conversation or clinical examination, if needed. The patients were followed for up to five years after TBI or until a first seizure event if it occurred prior to the five-year anniversary. The survival rate data were collected and measured for all patients under follow-up. Survival analysis on PTS and its related predictors was done using the Kaplan-Meier curves and the Cox proportional hazards regression. All analyses were done using STATA and SPSS statistical software, and P-values smaller than 0.05 were considered to be statistically significant.

The median duration of follow-up was 36 months (Interquartile range: 23-50). A significantly greater number of first seizures occurred in the first year after injury than all other years (57.7%). The overall incidence of posttraumatic seizures, in this study population, was 6.33% (95% CI: 3.96-8.69). Among the participants, the incidence rates for early and late posttraumatic seizures were 1.95 and 4.38%, respectively. The result of the Cox regression analysis showed that the Glasgow Coma Scale (GCS) score and trauma severity were associated with PTS.

All in all, the present study highlighted the role of the trauma severity and GCS as effective factors in the incidence of seizure in patients with TBI. Particular care is advised for patients with these risk factors during the primary handling in the Emergency Units.

Ninety percent of all people sometimes during their lives experience low back pain, and 30-40% develops radicular leg pain with the sciatica characteristics. Although for clinical diagnosis of lumbar disc herniation (LDH) straight leg raising (SLR) test in 85-90% of cases indicates LDH, but in our practice with LDH patients this test is frequently negative despite radicular leg pain due to LDH. Hence, we decided to evaluate this test in LDH in different age groups. All patients with leg pain referring to neurosurgery clinic were enrolled. Those with a history of pain other than sciatica excluded and SLR test and magnetic resonance imaging (MRI) of the lumbosacral spine performed. The patients with negative MRI findings excluded and finally 269 patients with true sciatica and positive MRI were included. SLR tests were performed for different age groups. Of 269 patients, 167 were male. The age range was 16-80 years. The most involved levels were L5-S1 47%) and L4-L5 (42%), respectively. The rate of positive SLR result, which was 100%, 87% and 82% for 10-19, 20-29 and 30-39 years age group respectively. With an increment of age, the rate of positive test regularly declined. The chance of positive SLR in men is 1.3 times the women (odds ratio [OR] 2.4; 95% confidence interval [CI] = 1.265-4.557; P = 0.007). Increasing the age has suppression effect in positivity of SLR so that for each 1-year the chance of SLR become 0.27 times less to become positive and this is also statically meaningful (OR = 0.271;95% CI = 0.188-0.391; P,0.001). The chance of positive SLR for patients under 60 is 5.4 folds more than patients above 60 years old (OR = 5.4; 95% CI = 4-8.3; P, 0.001). Age, sex (male), and disk level had statistically the effect on SLR positive test.

Low Back Pain (LBP) and radicular leg pain (RLP) after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT) with acetate on reduction of late postoperative pain after spinal anesthesia. This study was performed on lumbar disc surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group1), methylprednisolone acetate (group2) and normal saline (control group). The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS). Of 66 patients, 53% were female and 47% male. The average (SE) LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery.

Bilateral Intracranial hematoma is an uncommon sequela of closed head injury. Approach to this complicated problem is poorly defined. The present study tries to find out the incidence, and possible markers for the earlier detection of the problem. In this descriptive study all head trauma patients undergoing surgical decompression from September 2006 to October 2008 in Kashan Beheshti Hospital, were included. Cases were studied for age, sex, cause of trauma, skull fracture, Glasgow Coma Scale Score, pre-operative CT findings, and the number of surgical procedures. Using SPSS software, the obtained data was analyzed through descriptive statistics, Chi Square and t-test. During a 24-month period, for 96 admitted patients with traumatic injuries, 121 surgical procedures were performed. Due to the hematomas, 73 (75.3%) and 23 (24.7%) cases had one and more than one surgical operation, respectively. In addition, the age range was between 6 months and 83 years in the former and 17 and 66 years in the latter with a mean of 40.7±24.1 and 33.7±15.9, respectively. Male/female ratio was 13.7/1 in unilateral cases and 22/ 1 in bilateral cases. In 31 (43%) out of 73 unilateral hematomas and 12 (52%) out of 23 bilateral cases various types of skull fractures were seen. While no significant difference was seen between the groups in terms of age, sex, cause of trauma, skull fracture, and GCSS, it was significant for subdural hematoma (P=0.004). No specific marker could be found for early detection of bilateral intracranial hematoma. The high incidence of hematomas in our centre may be an incidental finding secondary to the high number of intracranial hematomas.

Traumatic brain injury (TBI) is the leading cause of death in traumatic injuries. The aim of this prospective study was to estimate the incidence of hospitally-treated TBI and to describe the severity of brain injuries and related outcome among such patients. Data was collected from all hospitalized cases of head traumas in Kashan hospitals during a 2-year period (2004-2005). The initial severity of TBI was measured by the Glasgow Coma Scale. Age, gender, initial neurological state, lesions on computed tomographic scan mechanisms of injury and the subsequent outcome were recorded. During a 24-month study, a number of�4290 patients were enrolled in the study. The mean age was 27.8 ±19.14 years and male to female ratio 3:1. The highest incidence of TBI was found in 20-29 years range (27.7%). The annual incidence of TBI was 429/100,000. Vehicle accidents (69.7%), falls (21.3%), and assaults (5%) were among the leading causes of TBI. Motorcycle accidents were the main cause of TBI among vehicle accidents (64.5%). Regarding the severity, 3962 cases (92.7%) were considered mild, 108 (2.5%) moderate, and 205 (4.8%) severe. Death occurred in only 148 (3.4%) cases. Our data suggest that the incidence of TBI in Kashan was higher and the age range of casualties was lower than other studies. In this study vehicle accidents were responsible for the majority of TBI. These findings can be used to develop prevention-directed programs in Kashan.

Injury is one of the most important non-contagious epidemiological phenomena dominant in this century contributing to a high rate of mortality in the world. The present study converses the epidemiologic aspect of trauma in Kashan during a 30 months period. �In a cross sectional study from March 2004 to September 2006 all victims of injuries admitted to hospitals of Kashan were classified in four groups consisting of domestic, traffic, occupational, and sport ones. External causes of the injuries were also recorded under the code of ICD 10. The data collected was then computerized by means of SPSS software and analyzed afterwards. A total of 18166 patients were studied during 30 months. The female to male ratio stood at 1:3.25. The average age of patients was 29.23±19.5 years, with 27.54±17.74 for men and 34.81±25.04 for women. The most common age range of the patients was 20-29 and 10-19 years with 26.5% and 23.6% respectively. Traffic injuries were the predominant type (50.5%), and in terms of external causes, the majority was involved in driving injuries and falls. Motor-cycle crashes (58.3%) were the main causes of accidents. A group of 231(1.3%) injured patients died in the hospital. Traffic accidents were the predominant cause of injuries followed by domestic causes along with occupational ones in the second stand. The injuries happened at a lower age range than those abroad which may lead to a loss of more fruitful length of life and imposition of expenses on the society.

Compound depressed skull fracture (CDF) is a complication of trauma to head. In spite of many decades of studies on the management of CDF there is yet disagreements regarding primary repair or discarding the bone fragments and late repair. This study has conducted to evaluate infection rate in primary repair of CDF. This study included 60 patients with blunt trauma to head and CDF admitted to Naghavi hospital of Kashan University of Medical Sciences (KAUMS), from 1997 to 2005. Age, sex, the interval between admission and operation, severity of trauma, duration of hospital stay, and infections were recorded and analyzed with descriptive statistics. Male to female ratio was 7.6:1, and mean age 19±12.4 years. It was most common in the age range of 11-20 (19 patients, 31.7%). Motorcycle was the most common cause of the problem (45 patients, 75%). Tirty nine patients (65%) had dural laceration. The most common site of fracture was frontal bone (37 and 61.7%). Twenty eight cases (46.6%) had mild, 13 (21.7%) moderate, and 19 (31.7%) severe head injury. Fifty four patients (90%) underwent operation in less than 24 hours of their arrival to hospital and had primary bone replacement. In 6 months follow up there was no infection in either the wound or bone. In the absence of heavy contamination, and by carrying debridment as soon as possible there will be excellent outcome with primary replacement of bone fragments in CDF patients, excluding the need for another operation and the apprehension about infection.

Head injury is a major cause of traumatic death and disability. However, there is no definite and unified strategy in the management of mild head injury victims. All cases of head injury in a 24-month interval between April 2003 and March 2005 were included to the study, and those with Glasgow Coma Scale Score (GCSS) of 14 or 15, without associated trauma were analyzed. Of 4290�victims�3894 (90.8%) had mild head injury with GCSS of 14 or 15. The incidence of head injury in our region is 429 for each 100,000 people. Of 1629 (48%) of the patients with skull X-ray 200 (12.2%) had a fracture. From 400 (10.3%) head CT scans, 118 were abnormal. Of all the patients, 2676 had only head injury. The cost for only one night of hospitalization on the base of the expenses in 2003 was 326,654 Rls for each patient, while at the same time the charge for a brain CT scan was 150,000 Rls. It is recommended that, at least in neurosurgical centers, all patients with head injury screened and candidate for admission, undergo a head CT scan study after their early evaluations and only those with abnormal findings on CT scan be admitted for further observation. With this strategy, we predict an at least 50% decrease in the costs compared with hospital admission and observation of all patients.

Number of neurosurgery patients is increasingly high. With respect to controversies about morbidity and mortality in these patients and lack of any information about these cases in our university this study was carried out in Kashan Naghavi hospital during 1999-2001. This�descriptive study was performed on medical files of all neurosurgery ICU cases during the study period. Demographic information, morbidity & mortality rates and their causes were assessed. Descriptive statistics was used for analysis. Of 280 cases, 267 cases were enrolled the study. Rate of mortality in 1990 was 43. 1% that reduced during the years of study (P<0.02). With increase of duration of hospitalization, urinary tract infection rate increased. Low GCS and high mortality are matter of concerns. We suggest further studies on the causes. Preventive interventions are also recommended.