Situation analysis of trauma based on Arizona trauma center standards in university hospitals of Tehran, Iran

Objective: Injuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global standards.This study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma centers.Methods: Forty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clini-cal capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. Relative frequencies and percentages were calculated and Student's t test was used to compare the mean values.Results: Forty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum standards.Conclusions: On the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.     

Psychosocial repercussions of the the treatment of Hodgkin's disease. Assessment by questionnaire with 150 patients

One hundred and fifty patients, treated for Hodgkin's disease (stages I-IIIA) in a cooperative trial and remaining in complete remission after 2 to 7 years, answered a questionnaire dealing with psychosocial status and quality of life. Many informations were gathered and studied by multiparametric methods. Quality of life of patients appears determined by three kinds of parameters: patients' characteristics (age, sex, family and work status); stage of the disease determining the intensity and duration of treatment; practical conditions of treatment. These last parameters may be improved by therapeutic team and all care-takers to decrease bad consequences of disease and treatment and also to increase quality of life after cure.     

Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials.

BACKGROUND: Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. PATIENTS AND METHODS: We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. RESULTS: Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). CONCLUSIONS: Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies.     

Distinctive clinical features between lymphoblastic and immunoblastic non-Hodgkin's malignant lymphomas (Kiel's classification) in a series of 141 patients

Out of a series of 427 NHML based on the Kiel classification and without previous treatment, 186 were of high grade malignancy and among them were 83 lymphoblastic (LB) and 58 immunoblastic (IB) lymphomas which were included in this study. The LB and IB, which represent the majority of high grade NHML, were compared regarding their clinical features and courses. Eight main criteria were significantly different between these two groups: age of patient, immunological history, mediastinal and pleural involvement, primary or secondary involvement of the bone marrow, secondary leukaemia, secondary meningeal involvement, and involvement of the facial region. Some of these differences (mediastinum and meningeal involvement) are related to subtypes within LB. The differences between these two groups suggest that different treatment programs may be warranted.     

Decreased collagen gene expression and absence of fibrosis in thyroid hormone-induced myocardial hypertrophy. Response of cardiac fibroblasts to thyroid hormone in vitro.

The regulatory effects of thyroid hormone on biosynthesis of myocardial proteins that originate from cardiac myocytes are well established. Little is known, however, of regulatory effects of thyroid hormone on interstitial proteins. In this study we examined the effects of thyroid hormone on collagen gene expression in thyroid hormone-induced myocardial hypertrophy and the response of cardiac fibroblasts to thyroid hormone in culture. Adult male Sprague-Dawley rats were treated intraperitoneally with L-thyroxin (10 micrograms/100 g body wt) for 2 hours or 1, 2, 3, 6, 12, or 14 days. Northern blot analysis of RNA from total ventricular tissue showed that after 2 hours of treatment, the abundance of mRNA for pro alpha 2(I) collagen decreased by 53% (p less than 0.05) and reached the lowest level (60% decrease, p less than 0.02) at day 1, remained diminished at day 3, and then gradually returned toward normal levels. After transient transfection of chimeric DNA containing collagen type I promoter-chloramphenicol acetyl transferase (CAT) gene into the thyroxin-treated cardiac fibroblasts, the level of CAT activity decreased significantly. Treatment of cardiac fibroblasts in culture (10 nM L-thyroxin) resulted in a 33% (p less than 0.005) decrease in the abundance of mRNA for pro alpha 2(I) collagen. The stability of the mRNA for pro alpha 2(I) collagen in cardiac fibroblasts, as measured by mRNA half-life, was slightly (16.6%) decreased by thyroid-hormone treatment. Collagen synthesis as shown by immunofluorescent staining of intracellular collagen in cultured fibroblasts and in frozen sections of myocardium was also diminished.(ABSTRACT TRUNCATED AT 250 WORDS)     

Semen analysis and cryoconservation before treatment in Hodgkin's disease

Background:The prophylaxis of the late effects of chemotherapyand radiotherapy has become one of the major concerns in the management ofHodgkin's disease (HD). Unlike other complications, male sterility could bemanaged by prior semen preservation (SP). Patients and methods:To evaluate the semen quality of patientswith HD and the outcome of insemination, we reviewed spermograms of patientswho underwent SP before any treatment. The following criteria were necessary:1) age >16 and <50; 2) HD of any stage; 3) informed about male sterilityafter HD treatment; 4) fully consenting. Results:Such a proposal was made to 316 men, and 94 fulfilled thecriteria. All patients underwent an initial chemotherapy. Mean age of thecohort was 27.5 years (range 16–48 years). Pretherapeutic staging of HDrevealed 38 stage I (40%), 38 II (38%), 14 III (15%) and4 IV (4%). Semen analysis before cryoconservation showed an overall53% of normal or subnormal cases (50 cases). The analysis of semenquality and spermatozoid amount according to various parameters failed to finda correlation with stage, B symptoms, age, or biologic data (LDH, WBC,platelets, ESR). The use of cryopreserved semen was requested by 13 patients;88 inseminations were performed leading to 9 pregnancies and 2 births. Conclusions:The low rate of success with cryopreserved semen inthese cases suggests the need for a more careful design of non-toxicchemotherapy regimens in combined modality treatment.     

Efficacy of nebulized L‐epinephrine for treatment of croup: a randomized,double‐blind study

The objective of this study was to compare the effect of L‐epinephrine plus dexamethasone vs. dexamethasone for treatment of croup in children. A randomized, double‐blind clinical trial was implemented on 174 patients with croup, aged from 6 months to 6 years, and admitted to the Amir Kabir Pediatric Hospital (Arak, Iran). After randomized allocation, patients were administered dexamethasone, and then, they received either saline or L‐epinephrine. Westley croup scores, heart rate, respiratory rate, and blood pressure were recorded every half an hour for a total of 120 min. There was a significant difference in mean of croup scores between two groups (P < 0.009). In addition, a significant difference was seen on mean of heart rate between two groups (P < 0.026). Our results showed a considerable difference in reduction of velocity of croup scores in patients who received nebulized L‐epinephrine compared to patients who received placebo.