Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure.

OBJECTIVE: The optic nerve is part of the central nervous system, and a rise in intracranial pressure (ICP) can directly affect the perioptic nerve space, leading to an increase in nerve diameter. Transorbital sonography is a safe and easy-to-perform method to measure optic nerve diameter for rapid diagnosis of increased ICP. METHODS: The optic nerve diameter was measured in 3 individual occasions by transorbital sonography in the transverse view, 3 mm posterior to the papilla in both eyes, and the mean was calculated. Two groups were examined: a control group of children with normal ICP and normal ophthalmologic and optic nerve examination results and a case group with increased ICP as determined by an alternative method. RESULTS: The sample consisted of 156 children, of which 78 (50%) were in the case group and 78 (50%) were in the control group. Eighty-four subjects (53.7%) were male, and 72 (46.1%) were female. The mean +/- SD ages were 6.9 +/- 5.6 years in the case group and 6.8 +/- 5.5 years in the control group. The mean optic nerve diameters were 5.6 +/- 0.6 mm (range, 4.55 +/- 0.7 to 7.6 +/- 0.6 mm) in the case group and 3.3 +/- 0.6 mm (range, 2 +/- 0.6 to 4.35 +/- 0.6 mm) in the control group. The difference in the means was significant at P < .001. CONCLUSIONS: Optic nerve diameter, measured by transorbital sonography, was significantly greater in pediatric patients with increased ICP compared with a control group. Transorbital sonography can be used to identify pediatric patients with raised ICP.     

A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collection

Objective: To determine the need for suction drainage after elective thyroid and parathyroid surgery. Design: Randomised controlled trial. Setting: University teaching hospital. Participants: Patients requiring elective thyroid or parathyroid surgery were recruited and informed consent was obtained (n = 100). Before wound closure, patients were randomised into either group A (to remain without suction drainage) or group B (to receive suction drainage). Excluded patients were those requiring associated neck dissection and those with bleeding diatheses, all of whom would necessarily require drainage in our unit. Main outcome measures: Primary – ultrasound evaluation of any collection in the thyroid bed, performed 1‐day postoperatively. Secondary – postoperative complications; length of in‐patient stay. Results: One hundred patients completed the study, and groups A and B comprised 50 patients each. Patients in each group exhibited a mean age of 49 years, and a male to female ratio of 1 : 9. Both groups were also well‐matched regarding type of operation, size of tumour and histopathological diagnosis. Modal and median postoperative neck collection volume on ultrasound examination was 0 and 0 cm³ respectively (range 0–16 cm³) in group A and was 0 and 0 cm³ (range 0–70 cm³) in group B. This difference was not statistically significant, but three patients with a haematoma were all in the suction drainage group. Difference in complication rates between groups was also not statistically significant. Modal and median length of in‐patient stay was 2 and 2 days respectively (range 2–3 days) in group A and 3 and 3 days (range 2–4 days) in group B, and this difference was statistically significant (P = 0.0006). Conclusion: Routine suction drainage after uncomplicated elective thyroid and parathyroid surgery appears unnecessary, and prolongs in‐patient stay.     

Systemic sclerosis: demographic, clinical and serological features in 100 Iranian patients

To evaluate demographic, clinical and laboratory features associated with scleroderma-specific auto-antibodies. Sera of 100 patients with systemic sclerosis (SSc) were analyzed by an indirect immunofluorescence technique with HEp-2 cells as a substrate. Specific ANA such as anti-centromere antibodies (ACA), anti-topoisomerase (TOPO), anti-RNA polymerase III (Pol 3), anti-U3-RNP (U3-RNP), anti-Th/To (Th/To) and anti-PM/Scl (PM/Scl) were detected by line immunoassay and anti-U1-RNP (U1-RNP) by ELISA. Frequency of clinical features associated with a specific antibody group was reported cumulatively over the follow-up period. Frequency of specific clinical features was compared across the two disease subtype including limited cutaneous (lcSSc) or diffuse cutaneous (dcSSc) as well as the auto-antibody groups. Ninety-four percent of patients were ANA positive with significant higher skin score, Raynauds and digital ulcer/gangrene. Anti-TOPO was detected in 71 % of all patients, in 90.5 % of dcSSC and in 65.8 % of lcSSc. Anti-TOPO was significantly associated with dcSSc, higher skin score, digital ulcer/gangrene, pulmonary fibrosis, DLCO <70 %. U1-RNP antibody was associated with lower fibrosis in lung. ACA was positive in 7 % of patients and exclusively in those with lcSSc. We did not find association between gender and presence of auto-antibodies. Anti-TOPO antibody had a high prevalence in contrast to low prevalence of ACA antibody. There were no differences in clinical subtypes of the disease in patients with positive anti-TOPO and positive ACA. Differences in prevalence of auto-antibodies are suggestive of further genetic study.     

Allergic fungal sinusitis presenting as a paranasal sinus tumor

We present a case of allergic fungal sinusitis (AFB) in a 20-year old man with few months' history of bilateral nasal obstruction and discharge with unilateral proptosis that underwent maxillary antrostomy due to the mass in paranasal sinuses. Histological examination of tissue showed branching fungal hyphae interspersed with allergic mucin without fungal invasion to soft tissue. The patient received local steroid for 4 months and had no problem during follow up. Fungal culture was performed and Bipolaris fungus grew. Although most dematiaceous fungal infections occur in immunocompetent patients, the incorrect diagnosis and insufficient treatment may be life threatening.     

Personal factors affecting ethical performance in healthcare workers during disasters and mass casualty incidents in Iran: a qualitative study

In emergencies and disasters, ethics are affected by both personal and organizational factors. Given the lack of organizational ethical guidelines in the disaster management system in Iran, the present study was conducted to explain the personal factors affecting ethics and ethical behaviors among disaster healthcare workers. The present qualitative inquiry was conducted using conventional content analysis to analyze the data collected from 21 in-depth unstructured interviews with healthcare workers with an experience of attending one or more fields of disaster. According to the data collected, personal factors can be classified into five major categories, including personal characteristics such as age and gender, personal values, threshold of tolerance, personal knowledge and reflective thinking. Without ethical guidelines, healthcare workers are intensely affected by the emotional climate of the event and guided by their beliefs. A combination of personal characteristics, competences and expertise thus form the basis of ethical conduct in disaster healthcare workers.