BackgroundLimb loss occurs due to different causes and has been increased in many countries. It has without exception, great economic, psychological and social impacts.ObjectivesThis study assesses the demographics of amputees in one city of Iran.Patients and MethodsThis retrospective study was undertaken on all of the amputees between April 2002 and December 2011. Patients’ demographics including age, sex, the amputated limb, etiology of limb loss and level of amputation were recorded.ResultsWe had 216 patients in the study. The average number of amputations was 21.6 per year and varied from 14 to 32. The mean age of amputation was 39.26± 12.6 years. Of the patients, 172 were male (79.62%) and 44 female (20.37%); 119 of the amputations (55.09 %) were major and 97 minor (44.9 %). The most common cause of amputation was trauma and the most common was the toe. In trauma patients the mean age was 38.12± 10.25 years and 98 (83.7%) were male.ConclusionsIn contrast to similar studies in developed countries, trauma was found to be the major cause of all types of amputations. Results of this study may be used in prevention planning.

Background:Gasretention in the peritoneal cavity plays an important role in inducing postoperative pain after laparoscopy, which is inevitably retained in the peritoneal cavity.Objectives:The aim of this study was to detect the relation between the volume of residual gas and severity of shoulder and abdominal pain.Patients and Methods:In this Prospective study 55 women who were referred for laparoscopic cholecystectomy, were evaluated for the effect of residual pneumoperitoneum on postlaparoscopic cholecystectomy pain intensity. The pneumoperitoneum was graded as absent, mild (1-5 mm), moderate (6-10 mm) and severe (> 11 mm). Patients were followed for postoperative abdominal and shoulder pain using visual analogue scale (VAS), postoperative analgesic requirements, presence of nausea and vomiting, time of unassisted ambulation, time of oral intake and time of return of bowel function in the recovery room and at 6, 12 and 24 hours after operation.Results:At the end of the study, 17 patients (30.9%) had no residual pneumoperitoneum after 24 hours; which 23 (41.81%) had mild residual pneumoperitoneum, eight (14.54%) had moderate pneumoperitoneum and seven (12.72%) had severe pneumoperitoneum. Patients with no or mild residual pneumoperitoneum had significantly lower abdominal and shoulder pain scores than whom with moderate to severe pneumoperitoneum (P = 0.00) and need less meperidine requirements (P = 0.00). Patients did not have any significant difference in time of oral intake, return of bowel function, nausea and vomiting percentages.Conclusions:We conclude that volume of residual pneumoperitoneum is a contributing factor in the etiology of postoperative pain after laparoscopic cholecystectomy.

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Background:Laparoscopic cholecystectomy is associated with shorter hospital stay and less pain in comparison to open surgery. The aim of this study was to evaluate the effect of intraperitoneal hydrocortisone on pain relief following laparoscopic cholecystectomy.Methods:Sixty two patients were enrolled in a double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 250 ml normal saline (n=31) or 100 mg hydrocortisone in 250 ml normal saline (n=31) before insufflation of CO2 into the peritoneum. Abdominal and shoulder pain were evaluated using VAS after surgery and at 6, 12, and 24 hours postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function.Results:Sixty patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal and shoulder pain scores (10.95 vs 12.95; P<0.01). The patients were similar regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than the saline group (151.66 (±49.9) mg vs 61.66 (±38.69) mg; P=0.00). The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group.Conclusion:Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after laparoscopic cholecystectomy with no adverse effects.

BackgroundTo survey genitourinary (GU) organ injury following general trauma, we performed an epidemiologic study of urogenital injuries in trauma patients referred to our hospital (a teaching hospital affiliated with the Zahedan University of Medical Sciences).ObjectivesWe aimed to assess the epidemiology of urogenital system injuries in southeastern Iran.Patients and MethodsFrom April 2009 to November 2011, all patients with GU injuries referred to our hospital were studied. The data including age, sex, type of injury, mechanism of trauma, and prognosis of patients was collected and analyzed.ResultsFrom a total of 3450 patients, 66 (1.91%) had injuries of the urogenital system; 49(74.24%) were male and 17(25.75%) female. The patients’ mean age was 23 ± 12 years (range 2 to 75 years). Of these 66 patients, 61 (94.24%) had blunt trauma, and 5 (7.57%) had penetrating trauma. Motor vehicle accidents were the most common cause of trauma (63.63%). The most common injured organs were kidneys in 41 (62.12%) and the bladder in 9 (13.6%); 47 patients (71.21%) had associated intra-abdominal injuries, and 42 (63.63%) had other accompanying injuries; 23(34.84%) patients required surgical intervention. Three patients (4.54%) died due to the severity of injuries (Injury Severity Score > 12).ConclusionsIn our assessment, blunt trauma including road traffic accidents were the main cause of urogenital injuries. Most patients with urogenital trauma had multiple injuries, and required a multidisciplinary approach for management.

Background:Postoperative pain is a major complaint following laparoscopic cholecystectomy.Objectives:The aim of this study was to compare the impact of intraperitoneal hydrocortisone with intraperitoneal bupivacaine on pain relief after laparoscopic cholecystectomyPatients and Methods:In a double blind clinical trial, 63 candidates for laparoscopic cholecystectomy were randomly allocated to receive intraperitoneal instillation of either 100 mg bupivacaine in 250 mL normal saline (n = 32) or 100 mg hydrocortisone in 250 mL normal saline (n = 31) before insufflation of CO2 into the peritoneum for postoperative pain relief. Patients were investigated regarding abdominal and shoulder pain using (visual analog scale) VAS in recovery room and at 6, 12 and 24 hours postoperatively. Patients were also followed regarding postoperative analgesic requirements, nausea and vomiting, and return of bowel function.Results:Sixty patients completed the study. Patients in the hydrocortisone group had no statistically significant abdominal and shoulder pain scores compared to the bupivacaine group. The patients were similar regarding postoperative analgesic requirements, return of bowel function, nausea and vomiting. No adverse effect was detected in either group.Conclusions:Intraperitoneal administration of hydrocortisone is as effective as bupivacaine to reduce pain and analgesic requirements after laparoscopic cholecystectomy.

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