Fariborz Ghaffarpasand; Mohammad Reza Saki; Nazanin Dadashpour; Zahra Ghahramani; Shahram Paydar
Volume 8, Issue 3 , July 2020, , Pages 133-134
Abstract
The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) was first reported in Wuhan, China in December 2019 [1, 2] and was rapidly spread all over the world, being announced as a pandemic on March 11th, 2020 by the World Health Organization ...
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The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) was first reported in Wuhan, China in December 2019 [1, 2] and was rapidly spread all over the world, being announced as a pandemic on March 11th, 2020 by the World Health Organization (WHO) [3]. Approaching the mid of August, approximately 20 million people are infected worldwide and 720,000 have died due to the infection and its complications [4]. The virus causes respiratory infection and involves both the upper and lower respiratory tract as well as the gastrointestinal tract, hepatic, neurologic and renal systems [5].
Fariborz Ghaffarpasand; Hamid Reza Abbasi; Shahram Paydar; Shahram Bolandparvaz; Maryam Dehghankhalili
Volume 8, Issue 2 , April 2020, , Pages 53-55
Keyvan Eghbal; Abbas Rakhsha; Arash Saffarrian; Abdolkarim Rahmanian; Hamid Reza Abdollahpour; Fariborz Ghaffarpasand
Volume 6, Issue 4 , October 2018, , Pages 367-371
Abstract
Atlantoaxial rotatory subluxation (AARS) is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck ...
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Atlantoaxial rotatory subluxation (AARS) is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck pain and torticollis after a car turn- over. There was C1-C2 rotatory subluxation with left side locked facet and C1 rotation about 40 degrees relative to C2 on computed tomography without evident of ligamentous injury in magnetic resonance imaging (MRI). However, during the first 48 hours, two tries of close reduction using Gardner cervical traction under fluoroscopy were failed. Thus, the patient underwent open reduction of the subluxation and atlantoaxial fixation (Harm’s technique) with subsequent relief of pain and torticollis. This a rare case of traumatic AARS type A with unilateral locked facet joint in an adult patient which needed surgical manipulation for reduction. The management of the AARS in adults should be individualized in each patient.
Shahram Paydar; Mohammad Yasin Karami; Hosseinali Khalili; Maryam Dehghankhalili; Golnar Sabetian; Fariborz Ghaffarpasand
Volume 5, Issue 3 , July 2017, , Pages 141-142
Hosseinali Khalili; Amin Niakan; Fariborz Ghaffarpasand; Arash Kiani; Reza Behjat
Volume 5, Issue 3 , July 2017, , Pages 190-196
Abstract
Objective: To investigate the determinants of outcome in patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC) in a large level I trauma center in southern Iran.Methods: This retrospective cross-sectional study was conducted during an 18-month period from 2013 to 2014 in ...
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Objective: To investigate the determinants of outcome in patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC) in a large level I trauma center in southern Iran.Methods: This retrospective cross-sectional study was conducted during an 18-month period from 2013 to 2014 in Shahid Rajaei hospital, a Level I trauma center in Southern Iran. Patients with TBI who had undergone DC were included and the medical charts were reviewed regarding demographics, clinical, radiological and outcome characteristics. The outcome was determined by extended Glasgow outcome scale (GOS-E) after one year of surgery. The variables were compared between those with favorable and unfavorable outcome to investigate the outcome determinants. Results: Overall 142 patients with mean age of 34.8 ± 15.5 (ranging from 15 to 85) years were included. There were 127 (89.4%) men and 15 (10.6%) women among the patients. After 1-year, the mortality rate was 58 (40.8%) and 8 (5.6%) patients were persistent vegetative state. The final outcome was found to be unfavorable in 77 (54.2%) patients. Unfavorable outcome was associated with lower GCS on admission (p<0.001) as well as occurrence of postoperative hydrocephalus (p=0.011). Formation of the postoperative subdural hygroma after the operation was found to be associated with favorable outcome (p=0.019).Conclusion: DC in patients with TBI is associated with favorable outcome in most of them. On admission GCS, postoperative hydrocephalus and presence of postoperative subdural hygroma are among the important predictors of outcome in TBI patients undergoing DC.
Fariborz Ghaffarpasand; Maryam Dehghankhalili
Volume 5, Issue 2 , April 2017, , Pages 67-69
Hosseinali Khalili; Amin Niakan; Fariborz Ghaffarpasand
Volume 4, Issue 4 , October 2016, , Pages 248-249
Fariborz Ghaffarpasand; Mostafa Shahrezaei; Maryam Dehghankhalili
Volume 4, Issue 3 , July 2016, , Pages 134-140
Abstract
Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, ...
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Objective: To determine the effects of platelet rich plasma PRP on healing rates of long bone non-union fracture.Method: This was a randomized double-blind placebo controlled clinical trial being performed in a 12-month period. We included 75 adult (>18 years) patients suffering from long bone (Femur, Tibia, Humerus and Ulna) non-union fracture who were randomly assigned to receive 5mL PRP (n=37) or 5mL normal saline as placebo (n=38) in the site of fracture after intramedullary nailing or open reduction and internal fixation (ORIF) along with autologous bone graft. Patients were followed each 45 days till 9 months and were evaluated both clinically and radiologically in each visit. The healing rate, failure rate, incidence of infection, mal-union and limb shortening were recorded and compared between groups after 9 months of follow-up.Results: The healing rate was significantly higher in PRP group compared to placebo (81.1% vs. 55.3%; p=0.025). The limb shortening was significantly higher in those who received placebo (2.61±1.5 vs. 1.88±1.2mm; p=0.030). Injection of PRP was also associated with lower pain scores (p=0.003) and shorter healing duration (p=0.046). The surgical site infection (p=0.262) and mal-union rate (p=0.736) were comparable between groups.Conclusion: Application of PRP along with autologous bone graft in the site of non-union of long bone after intramedullary nailing or ORIF results in higher cure rate, shorter healing duration, lower limb shortening and less postoperative pain. Higher infection rate might be a complication of PRP application.Keywords: Non-union; Long bone Fracture; Platelet rich plasma (PRP); Intramedullary nailing; Open reduction and internal fixation (ORIF).Clinical Trial Registry: This trial is registered with the Iranian Clinical Trials Registry (IRCT201208262445N1; www.irct.ir).
Shahram Paydar; Golnar Sabetian; Hosseinali Khalili; Javad Fallahi; Mohammad Tahami; Bizhan Ziaian; Hamid Reza Abbasi; Shahram Bolandparvaz; Fariborz Ghaffarpasand; Zahra Ghahramani
Volume 4, Issue 1 , January 2016, , Pages 1-7
Abstract
Deep vein thrombosis (DVT) and pulmonary embolism (PTE) are known as venous thromboembolism (VTE). DVT occurs when a thrombus (a blood clot) forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT ...
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Deep vein thrombosis (DVT) and pulmonary embolism (PTE) are known as venous thromboembolism (VTE). DVT occurs when a thrombus (a blood clot) forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury.
Hosseinali Khalili; Aydin Omidvar; Fariborz Ghaffarpasand; Golnaz Yadollahikhales
Volume 4, Issue 1 , January 2016, , Pages 24-28
Abstract
Objective: To determine the effects of application of anti-adhesive films (OrthoWrap™) in traumatic decompressive craniectomy on prevention of adhesion formation and facilitation of subsequent cranioplasty.Methods: This was a retrospective cohort study being performed in Shahid Rajaei hospital (Shiraz ...
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Objective: To determine the effects of application of anti-adhesive films (OrthoWrap™) in traumatic decompressive craniectomy on prevention of adhesion formation and facilitation of subsequent cranioplasty.Methods: This was a retrospective cohort study being performed in Shahid Rajaei hospital (Shiraz Level I trauma center) during a 12-month period (from March 2012 to April 2013) including 93 patients undergoing traumatic decompressive craniectomy. Patients who received OrthoWrap™ during the initial craniectomy (n=44) were compared to those who did not (n=49). Two study groups were matched regarding the baseline characteristics. The perioperative indices including the surgical time, amount of bleeding, transfusion and 6-month Glasgow Outcome Scale (GOS) were compared between two study groups.Results: There was no significant difference between two study groups regarding the baseline characteristics. We found that the cranioplasty duration (113.3±33.2 vs. 146.9±34.9 minutes; p<0.001) and amount of intraoperative bleeding (182.1±98.3 vs. 270.6±77.6 mL; p=0.043) was significantly lower in those who had OrthoWrap™ compared to control group. The final GCS (p=0.052) as well as GOSE (p=0.653) was comparable between groups. The infection rate was comparable between two study groups (p=0.263).Conclusion: Application of OrthoWrap™ during decompressive craniectomy in those with severe traumatic brain injury is associated with shorter duration of operation and less intraoperative bleeding in subsequent cranioplasty. Infection rate and neurologic outcome was comparable between study groups.
Abdolkarim Rahmanian; Ali Haghnegahdar; Abdolvahab Rahmanian; Fariborz Ghaffarpasand
Volume 3, Issue 1 , January 2015
Abdolkarim Rahmanian; Ali Haghnegahdar; Abdolvahab Rahmanian; Fariborz Ghaffarpasand
Volume 2, Issue 4 , October 2014, , Pages 151-155
Abstract
Objective: To investigate the effects of intracranial pressure (ICP) monitoring on mortality rate and functional outcome of patients with severe traumatic brain injury (TBI).Methods: This was historical cohort study being performed in Nemazee hospital of Shiraz during a 4-year period (from 2006 to 2010) ...
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Objective: To investigate the effects of intracranial pressure (ICP) monitoring on mortality rate and functional outcome of patients with severe traumatic brain injury (TBI).Methods: This was historical cohort study being performed in Nemazee hospital of Shiraz during a 4-year period (from 2006 to 2010) including those patients with severe TBI who had undergone care based on ICP monitoring (case group) or clinical evaluation (control group).Patients and controls were matched regarding the age, sex, initial GCS, initial pupils, and CT findings. The functional outcome, complications and mortality rate were recorded and compared between those who underwent ICP monitoring and those who did not.Results: There was no significant difference between two study groups regarding the baseline characteristics. The rate of meningitis was significantly higher in those who underwent Ventriculostomy and ICP monitoring when compared to those who were managed without ICP monitoring. [14 (23.3%) vs. 7 (11.6%); p=0.041]. We found that the mortality rate (28.3% vs. 11.6%; p=0.172) as well as the frequency of persistent vegetative state (5.0% vs. 5.0%; p=0.998) were comparable between two study groups. However the frequency of severe disability was higher in control group compared to case group (26.7% vs. 15.0; p=0.046). In the same way, the frequency of good recovery (26.7% vs. 15.0; p=0.046) and favorable outcome (51.7% vs. 33.3%; p=0.021) was significantly higher in case group.Conclusion: Care based on ICP monitoring in patients with severe TBI was associated with increased frequency of good recovery and favorable outcome and decreased frequency of moderate disability. However higher meningitis rate was associated with Ventriculostomy and ICP monitoring.
Mousa Taghipour; Nima Derakhshan; Fariborz Ghaffarpasand
Volume 2, Issue 4 , October 2014, , Pages 166-169
Abstract
Syringobulbiais very rare condition defined as slit-like fluid cavity in the brain stem. Several conditions have been reported to be associated with syringobulbia including neoplasms, spinal cord traumas or lesions such as tethered cord, hind-brain herniation, infections such as meningitis and in isolation.Although ...
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Syringobulbiais very rare condition defined as slit-like fluid cavity in the brain stem. Several conditions have been reported to be associated with syringobulbia including neoplasms, spinal cord traumas or lesions such as tethered cord, hind-brain herniation, infections such as meningitis and in isolation.Although post-traumatic syringomyelia has been wieldy described previously, traumatic brain injury has not been reported as the mechanism and etiology of isolated syringobulbia. We herein report a 24-year old man with previous history of severe traumatic brain injury who presented with recent onset inability to walk or coordinate movements, ataxia, dysphonia, dysarthria, bilateral third nerve palsy with fixed dilated pupils and eyes deviated outward and downward.He was further diagnosed to have isolated syringobulbia extending to upper pons and lower midbrain.Isolated post-traumatic syringobulbia is extremely rare condition presenting insidiously with cranial nerve palsies, ataxia and dysarthria.
Shahram Paydar; Pouya Farhadi; Fariborz Ghaffarpasand; Ali Taheri; Arash Farbood; Gholamreza Dabiri; Zahra Ghahramani; Shahram Bolandparvaz; Hamid Reza Abbasi
Volume 2, Issue 4 , October 2014, , Pages 170-171
Fariborz Ghaffarpasand; Ali Razmkon; Hosseinali Khalili
Volume 2, Issue 3 , July 2014, , Pages 101-102
Hosseinali Khalili; Nima Derakhshan; Zahed Malekmohammadi; Fariborz Ghaffarpasand
Volume 2, Issue 2 , April 2014, , Pages 92-95
Abstract
Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency ...
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Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure (ICP) monitoring and for a second time due to hydrocephalus following decompressive craniectomy. He developed fulminant meningitis and ventriculitis during his hospital course. A bulged pulsatile lesion under the frontotemporal scalp resulted into the suspicion to underlying vascular pathology. Six-vessel angiography of brain was done which revealed mycotic aneurysm of external carotid artery. The patient underwent a two-week course of a combination of intravenous antibiotics. Follow-up angiography was performed which confirmed successful treatment of mycotic aneurysm of ECA. Mycotic aneurysm of ECA is extremely rare. To our knowledge, this is the first report of mycotic aneurysm of ECA following severe TBI which was successfully treated with antimicrobial therapy.
Shahram Bolandparvaz; Hamid Reza Abbasi; Fariborz Ghaffarpasand
Volume 2, Issue 1 , January 2014, , Pages 1-2
Hamid Reza Kamravan; Ali Haghnegahdar; Shahram Paydar; Mohamad Khalife; Mahsa Sedighi; Fariborz Ghaffarpasand
Volume 2, Issue 1 , January 2014, , Pages 32-37
Abstract
Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran.Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 ...
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Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran.Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 to March 2012 to our level I trauma center in Shiraz. We recorded the patients’ characteristics including age, sex, marital status, mechanism of injury, level of injury, concomitant injury, treatment(non-operative or operative) and clinical outcome. The data were described and compared with the international literature.Results: Among 261 patients referred with impression of spinal cord injury, the diagnosis of spinal column injury (with or without spine cord injury) was confirmed in 206 patients. The mean age of patients was 37.2±15.9 years with Male/Female ratio of 3:1. Car turn-over and car-collisions were the leading causes of injury. The most common spine fracture was C6 vertebra involving 60 (29.1%) patients. Fracture of upper and lower extremities were the most concomitant fractures observed in 31(15.1%) patients. Open surgery was performed in 65(31.6%).Mortality rate was 7.3% (15 patients).Patients with brain, lung and cord injuries had increased risk of death, among 15 deaths,9 patients had brain injury, 5 individuals had lung injury and 10 patients suffered from cord injury.Conclusion: Cervical spine injuries mostly affect young males, and comprise 206 (10%) cases out of 2100 spine injuries in our country. Preventive measures should be taken to reduce cervical spine injuries especially in young age group.
Fariborz Ghaffarpasand; Ali Razmkon; Maryam Dehghankhalili
Volume 1, Issue 4 , October 2013, , Pages 135-136
Fariborz Ghaffarpasand; Maryam Dehghankhalili; Mostafa Shahrezaei
Volume 1, Issue 3 , July 2013, , Pages 99-101
Shahram Paydar; Parisa Javidi Parsijani; Armin Akbarzadeh; Alireza Manafi; Fariborz Ghaffarpasand; Hamid Reza Abbasi; Shahram Bolandparvaz
Volume 1, Issue 3 , July 2013, , Pages 123-126
Abstract
Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz ...
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Objectives: To evaluate the short-term outcome of open appendectomy, the rate of negative appendectomy as well as pathology reports after surgery in patients with suspected acute appendicitis.Methods: This was a retrospective cross-sectional study being performed in Nemazee hospital affiliated with Shiraz University of Medical Science during a 2-year period between 2008 and 2010. The medical records of all consecutive patients who underwent open appendectomy in our center due to acute appendicitis were included in the study. The elective and laparoscopic appendectomies were excluded. The demographic information, clinical findings, laboratory investigations and the histopathological examination of the appendix were recorded and reported.Results: A total of 337 patient including 137 (36.4%) females, and 240 (63.6%) males with the mean age of 16.26 ± 9.81 (range 3 to 76) years were stduied. Anorexia (64.7%) and fever (20.7%) were more prevalent symptoms. The mean duration between pain initiation and operation ranged from 0 to 14 days with mean 1.88 ± 1.63 days. Right lower quadrant (RLQ), periumbilical, epigastria, left lower quadrant (LLQ), and Right upper quadrant (RUQ), pain were manifest in 78.8%, 41.6%, 12.2%, 3.2%, and 1.3% of patients, respectively. Pathological evaluation of the appendix showed appendicitis in 70.4% of patients.Conclusion: The higher rate of negative appendectomy accounts for wasteful tapping of medical resources and causing further complication in patients. Therefore it is essential to conduct more accurate studies to detect the root cause of the disease. This would help improve the management of appendicitis which is an emergency condition with high incidence.
Khalil Zarrabi; Parsa Ravanfar; Azimeh Azimifar; Fariborz Ghaffarpasand
Volume 1, Issue 3 , July 2013, , Pages 130-132
Abstract
Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of ...
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Proximity of the vagus nerve to a patent ductus arteriosus (PDA) can cause traction or entrapment of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of the vagal trunk by the end of operation. The patient was managed by re-opening the chest, lung retraction and removal of mediastinal pleura sutures. The vagal trunk entrapped in the suture line was released immediately. Heart rate accelerated and hemodynamic restored after a short period of observation. The operation terminated as routine, patient extubated in OR and discharged within 24 hours with no further complication. This irritation of vagus results in vagal bradycardia during or by the end of operation. Awareness of a surgeon of this issue can minimize the risks and complications of the open closure of PDA.
Fariborz Ghaffarpasand; Maryam Dehghankhalili
Volume 1, Issue 1 , January 2013, , Pages 1-2
Shahram Paydar; Sedigheh Shokrollahi; Shahram Jahanabadi; Fariborz Ghaffarpasand; Zahed Malekmohammadi; Armin Akbarzadeh; Shahram Bolandparvaz; Hamid Reza Abbasi
Volume 1, Issue 1 , January 2013, , Pages 38-42
Abstract
Objective: To determine the epidemiology and pattern of emergency operating room workload in Nemazee hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran.Methods: All surgical emergency operations which were performed in Nemazee hospital, Shiraz, Iran were collected over twelve ...
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Objective: To determine the epidemiology and pattern of emergency operating room workload in Nemazee hospital affiliated with Shiraz University of Medical Sciences, Shiraz, Iran.Methods: All surgical emergency operations which were performed in Nemazee hospital, Shiraz, Iran were collected over twelve months (September 2007 to September 2008). The data obtained included indications, presenting symptoms the services provided and the demographic information of the patients.Results: Overall number of recorded emergency operations in this cross sectional descriptive study was 3946, with males constituting 72% of the patients. The highest male/female ratio reported in trauma patients was 6.4:1 with the median age of 23 years, and the mean age of the operated patients was 27.8 years. Second to neurosurgery (19.64%) the general surgery was the busiest discipline in emergency operations (59.14%). Appendectomy (11.77%), double/triple lumen/central venous catheter insertion (9.4%), and fiber optic/rigid bronchoscopy (3.27%) were the commonest general surgical operations. Among trauma patients, neurotrauma was the commonest reason for operation (10%).Conclusion: Based on a new approach toward emergency operating room workload, in our country and centre, we showed that it is necessary to devote particular and individualized attention to the fields of agenda and hospital management of emergency operations. This is due to a high emergency operating room workload and its unique characteristics in our centre in contrast to other hospitals and departments. Although a decision making and operational strategy is recently seen to improve the quality and quantity of emergency services available to our patients, there is still a gap between present and optimal emergency healthcare which should be provided for our residents.
Reza Nikandish; Alireza Zareizadeh; Siavash Motazedian; Sam Zeraatian; Habib Zakeri; Fariborz Ghaffarpasand
Volume 1, Issue 1 , January 2013, , Pages 43-45
Abstract
Bilateral vocal cord paralysis is a rare and preventable complication of anterior cervical discectomy and fusion. Herein, we report a fatal case of bilateral vocal cord paralysis after anterior cervical discectomy and fusion (ACD/F). A 65-year-old man with cervical spine trauma and anterior cord syndrome, ...
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Bilateral vocal cord paralysis is a rare and preventable complication of anterior cervical discectomy and fusion. Herein, we report a fatal case of bilateral vocal cord paralysis after anterior cervical discectomy and fusion (ACD/F). A 65-year-old man with cervical spine trauma and anterior cord syndrome, following car overturn presented to our emergency department. The patient had C6-T10 prolapsed discs for which ACD/F was performed. In the recovery room he developed stridor and respiratory distress immediately after extubation, and was reintubated. Otolaryngological evaluation revealed bilateral vocal cord paralysis. He later required a tracheostomy but finally died in a rehabilitation center after an acute coronary event. Awake fibroptic intubation is recommended in patients at high risk for preoperative recurrent laryngeal nerve injury. Intraoperative tracheal tube cuff pressure monitoring and modification of surgical approach to neck are recommended to prevent bilateral nerve damage.
