Relative Frequency of Spinal Cord Tumors in Neurosurgery Ward of Poursina Hospital, Rasht (2002-2007)

Introduction: Despite relative low incidence of spinal cord tumors, they have significant importance as a result of their critical location and being potential for spinal cord compression. Also a large group of these tumors would be completely curable if be diagnosed on time and treated well. Objective: The aim of this study was assessment of spine and spinal cord tumors relative frequency in neurosurgery ward of Poursina Hospital in Rasht from 2002 to 2008. Material and Methods: In a descriptive study, we studied medical documents of admitted patients in neurosurgery ward of Poursina Hospital in Rasht whom suffered from spine or spinal cord tumor. We collected necessary data including age, sex, tumor's type, involveded segment and location of tumor related to dura and analysed them with SPSS 14 software. Results: Out of 55 studied patients, 28 (50.9%) were male and 27 (49.1%) female. The youngest patient was 4 and the oldest one was 74 years old. Mean age was 46.22 years of age. Fifth decade of life was the most frequent decade with 13 cases (23.6%). Extradural tumors with 22 cases (40%) were the most common types of tumors. Then, 21 cases (38.2%) had intradural extramedullary tumors and 12 cases (21.8%) intramedullary. Moreover, 27 tumors (49.1%) were in thoracic segment of spine. Cervical, lumbar and sacrococcigeal region of spine had 14, 13 and 1 tumors, respectively. According to the study Schwannoma was the most common type of tumor with 11 cases (20%) followed by meningioma and small round cell tumors with 8 cases (14.5%). Conclusion: Although most results of this study are relatively similar to previous ones, there are several differences among some parameters such as the most frequent decade and the most involved segment of spine in intramedullary tumors. Many of spinal tumors versus brain tumors with timely diagnosis and prompt treatment will have good prognosis, therefore obtaining knowledge about epidemiology of these tumors and applying them in differential diagnosis are of high importance

Variability of Phenytoin Serum Level in prophylaxis of Seizures in TBI Patients

Introduction: Traumatic brain injury (TBI) is one of the most common causes of seizure and about 10% of patients with severe and moderate trauma develop seizure. Phenytoin is an anti-seizure medicine which is widely prescribed to prevent seizure in TBI patients. Even it has non-linear pharmacokinetics in therapeutic concentrations, the prescription of which necessitates continuous evaluation of plasmatic level of medicine and regulating the dosage. Objective: This study aimed at surveying the variability of Phenytoin serum level in TBI patients in Poursina Teaching Hospital to determine the dosage of medicine more precisely to reach the Prophylactic level. Materials & Methods: In a descriptive longitudinal study, 90 patients of Trauma Ward of Poursina Hospital were studied. Phenytoin serum level was estimated in first, second, and seventh day after hospitalization by using RAN DOX kits, the results were then analyzed by SPSS software (ver16). Exact Test, Fisher, and Pearson T-test were utilized to analyze the data. Results: Out of 90 studied patients, 79 (87.7%) were men and 11(12.3%) women. Mean age was estimated 36.3&plusmn;15.6 for men and 41.7&plusmn;16 for women. There was no significant difference between the Phenytoin level in first and third day in two groups. The Phenytoin serum level in 24 first hrs didn&rsquo;t reach therapeutic level in 75.6% of patients. The average of Phenytoin serum level was in therapeutic level in third day and Phenytoin serum level didn&rsquo;t reach therapeutic level only in 5% of patients (p&ge;0.05). This average figure was 20-30 mg/dl in more than half of the patients on seventh day, during which all patients reached therapeutic level (p&ge;0.05). A significant relationship was observed between age and Phenytoin serum level in all three levels (p<0.05). Conclusion: Phenytoin is considered as an anti-seizure medicine which is vastly used in TBI victims. Using Phenytion requires exact monitoring due to its limited therapeutic range and linear pharmacokinetics. Since the changes of medicine dosage can lead to blood poisoning and make the medicine ineffective, its prescription needs much more attention regarding its gender, age, and needed dosage