Esophageal burn injuries with alkali in children: A four year comprehensive analysis study

Introduction: The incidence of caustic ingestion injuries in developed countries has been decreasing, while it still remains a great concern in developing countries including Iran. In this study we focused on alkali esophageal injuries in children which occur frequently in southern Iran, due to both, unsafe products and unfamiliarity of families with the alkali consumption hazards.Materials and Methods: In a cross-sectional study, sixty four children who were admitted due to alkali ingestion atNemazee hospital, Shiraz, Iran during a 4 year period, were evaluated for hospital stay, hospital charges and number of admissions. Data were obtained from medical records and through a phone survey.Results: All ingestions were unintentional. Children had a prolonged hospital stay (m=13.2 day) and needed multiple admissions (m=7.8 admission). The mean hospital charge was $14,580.00 USD for each patient.Conclusion: High incidence and complications of alkali ingestion in south of Iran suggests a need for prompt preventive actions to stop the production of highly concentrated alkali and educating families for proper use of these substances

Management of Blunt Trauma to the Spleen (Part 1)

AbstractSpleen is the most frequent solid organ to be injured in bluntabdominal trauma. Considering its important role in providingimmunity and preventing infection by a variety of mechanisms,every attempt should be made, if possible, to salvagethe traumatized spleen at any age particularly in children. Afterprimary resuscitation, mandatory requirements for nonoperativemanagement include absence of homodynamic instability,lack of associated major organ injury, admission inthe intensive care unit for high-grade splenic injury and in theward for milder types with close monitoring. About two thirdof the patients would respond to non-operative management.In most patients, failure of non-operative measures usuallyoccur within 12 hours of management. Determinant role ofabdominal sonography or computed tomography, and in selectedcases, diagnostic peritoneal lavage, for appropriate decisioncannot be overemphasized. However, the high status ofclinical judgment would not be replaced by any paraclinicalinvestigations. When operation is unavoidable, if possible,spleen saving procedures (splenorrhaphy or partial splenectomy)should be tried. In case of total splenectomy, autotransplantation,preferably in the omental pouch, may lead toreturn of immunity, at least partially, to prevent or reduce thechance of subsequent infection. Although total splenectomywith autograft is immunologically superior to total splenectomy-only procedure, these patients should also be protectedby vaccination and daily antibiotic for certain period of time.The essential steps for prevention of overwhelming infectionafter total splenectomy are not only immunization and administrationof daily antibiotic (up to 5 years of age or one year inolder children), but include education and information aboutthis dangerous complication. When non-operative managementis successful, the duration of activity restriction (inweeks) is almost equal to the grade of splenic injury plus 2.Iran J Med Sci 2010; 35(2): 79-94

Appendicitis Caused by Metallic Foreign Body in the Appendix

Although uncommon, different kinds of foreign bodies, mostof which metallic, have been reported to enter the appendix.The present report describes a case with a metallic foreignbody-induced appendicitis, and makes suggestion in regards tothe diagnosis and management of the problem. A metallic foreignbody was accidentally observed in the right lower quadrantregion in an abdominal X-ray taken after blunt trauma ina 6-year-old boy. After 4 months of persistent presence of foreignbody not related to trauma, the patient was apparentlyasymptomatic, and there was a mild to moderate Mc-Burneytenderness. Exploration revealed the presence of an air-riflebuckshot in the proximal part of the appendix causing appendicitisdue to luminal obstruction. Histopathologic study of theappendix revealed inflammation and serositis.Iran J Med Sci 2010; 35(4): 335-338

Demonstrating the importance of criteria and sub-criteria in building assessment methods

Building assessment methods have become a popular research field since the early 1990s. An international tool which allows the assessment of buildings in all regions, taking into account differences in climates, topographies and cultures does not yet exist. This paper aims to demonstrate the importance of criteria and sub-criteria in developing a new potential building assessment method for Saudi Arabia. Recently, the awareness of sustainability has been increasing in developing countries due to high energy consumption, pollution and high carbon foot print. There is no debate that assessment criteria have an important role to identify the tool’s orientation. However, various aspects influence the criteria and sub-criteria of assessment tools such as environment, economic, social and cultural to mention but a few. The author provides an investigation on the most popular and globally used schemes: BREEAM, LEED, Green Star, CASBEE and Estidama in order to identify the effectiveness of the different aspects of the assessment criteria and the impacts of these criteria on the assessment results; that will provide a solid foundation to develop an effective sustainable assessment method for buildings in Saudi Arabia. Initial results of the investigation suggest that each country needs to develop its own assessment method in order to achieve desired results, while focusing upon the indigenous environmental, economic, social and cultural conditions. Keywords: Assessment methods, BREEAM, LEED, Green Star, CASBEE, Estidama, sustainability, sustainable buildings, Environment, Saudi Arabia

Esophageal Atresia: Migration of the gastrostomy tube into the bronchus

A 2-day-old baby boy, 38 weeks gestation, weight 2000 g was brought due to hypersalivation and imperforate anus with gasless abdomen on plain X-ray. He underwent a gastrostomy tube insertion and colostomy. In contrast study of the stomach, on the 5th postoperative day, the dye spilled into the tracheo bronchial tree and the catheter was seen, entering the right main bronchus. The patient underwent right thoracotomy and the presence of fistula and catheter were confirmed. The fistula and distal esophagus were closed and fixed to the prevertebral fascia because of a long gap. He is under follow-up and recieving home care for a later delayed primary anastomosis

A Huge Gastric Trichobezoar in a Teenage Girl

A 13-year-old girl presented with a history of not being wellduring the past six months. The ultrasound examinationshowed an epigastric mass, which was diagnosed as a bezoarwithin the stomach in upper gastrointestinal endoscopy. Thepatient was managed by operative evacuation. It was interestingthat such a large bezoar did not cause any significant obstructionfor the patient

Limb Loss Caused by Thrombosis led to the Diagnosis of Ulcerative Colitis

Arterial thrombosis associated with ulcerative colitis usuallyoccurs in the postoperative period with a good response to anticoagulanttherapy and embolectomy. Our patient was a 14-yearoldgirl with ulcerative colitis who presented with bilateral pulslessextremities, which did not respond to medical treatmentand embolectomy. Subsequent colectomy did not save herlimbs. The repeated thrombosis caused gangrene of extremitiesin the below knee region leading to bilateral amputation.Thrombosis can be the first presentation of ulcerative colitis

Xerografting as a Novel Procedure in the Management of Syngnathia

Congenital fusion of the maxilla and the mandible is a rarecondition. The extent of the problem ranges from simple mucosaladhesion (synechia) to severe bony fusion (syngnathia).Here we present a patient with zygomatico-mandibular fusionwho was treated at neonatal and infancy periods at three differentstages without tracheostomy. Having had recurrence fortwo times, porcine grafting was performed as a novel procedureto increase the chance of success. Ultimately the patienthad uneventful outcome for 6 months after the last operation