History and Objectives: Due to epidemiology of Tuberculosis in Iran and the consequent mortality and diagnostic therapeutic surgical measures and in order to determine the status of patients and the various diagnostic and surgical techniques, this study was carried out in patients referring to Imam Khomeini hospital in Tehran in the years 1367-1376.

Materials and Methods: This study was performed by existing data recorded in the records of patients undergone surgical pulmonary resection and/or diagnostic procedures. Tuberculosis was diagnosed by sputum culture and tissue pathology. Age, sex, occupation residential place during these ten years, clinical manifestations and paraclinical examinations type of resection and complication of the surgery were evaluated.

Results: During 10 years a total of 500 patients with pulmonary and thoracic Tuberculosis were studied 44% of patients were female and the other 56% were male. The patients were 15-20 years old. Complications of Tuberculosis were 5 times more common in males as females and pericardial involvement was twice in men than women. The most common occupations were house-keeping and workers. The most common clinical manifestations were pleuritic chest pain (82%), dyspnea (80%) and cough (78%). PPD was negative in 50% of patients. The differential leukocyte count was neutrophils 73%, lymphocytes 24% and the remainder were eosinophils and basophiles. ESK was abnormally elevated in 88% of the patients. Pulmonary resection was done in 34% of patients. Total pericardiectomy and pericardial window were performed in 18% and 6% of patients respectively. Limited diagnostic thoracotomy for hilar lymphadenopathy and SPN was performed in 24% of the cases. All paraclinical examinations were negative in these patients despite the presence of pulmonary Tuberculosis. Clavicular resection was performed in 6% of patients. Eloesser flap in 6% and superior vena cave obstruction in 2% diagnostic thoracotomy was performed in these cases.

Conclusion: complication in men aged 15-20 years were five times the women. Pericardial involvement was also twice more common in men than women. The patients were often housekeeper or workers. In 24% of patients who were suspicious to have Tuberculosis all paraclinical examinations were negative but limited thoracotomy confirmed Tuberculosis. One patient in this group had upper lobe Tuberculosis accompanied by squamous cell carcinoma of the lung. Therefore thoracotomy is recommended in these cases and lung cancer should be considered whenever Tuberculous involvement of the upper lobe especially its anterior segment is present. In our series mortality and morbidity were 4% and 12% respectively that are compatible with foreign reports.

History and Objectives: Due to prevalence of superficial and cutaneous fungal diseases in the society and also with the hypothesis that it is more common among addicts and since there is few research in this regard, this study has been performed to define the rate of superficial and cutaneous fungal infections among addicts at recreational center of addicts in Tehran during the year 1376.

Materials and Methods: In this study total addicts at the center that were 1320 individuals were physically examined and sampling was performed from the suspicious cases. Direct examination and culture of the specimens were performed in the laboratory.

Results: There were 114 (8.6%) positive specimens among the 1320 evaluated addicts. The various superficial and cutaneous fungal infections were in order of frequency: Tinea versicolor (6.9%), trichomycosis axillaris (1.4%), erythrasma (0.15%) and tinea apris (0.23%). There were three cases with tinea due to trichophyton mentagrophytes.
Conclusion: It seems that some factors contributes to the relatively high prevalence of superficial and cutaneous fungal diseases in this group. Further investigation and treatment of the affected patients are recommended.

History and Objectives: Considering the incidence of ulcer infection within incision area and its complications and a similar condition in perforated and gangrenous appendicitis and the efficacy of local application of antibiotics in reduction of infection, this study was carried out to evaluate the effect of ampicillin washing in incision area.

Materials and Methods: The clinical trial strategy of this study was performed on two groups for patients incised with McBorni method. All of the patients received intravenous injection of metronidazole and gentamicin one day before operation and for 7 consecutive days therefore received ciprofloxacin and were followed up for a period of 1 month. For healing, control group was washed with normal saline and experimental group washed with saline solution and ampicillin.

Results: A total of 74 patients in two groups (n=37) were studied and they were alike regarding age and gender. The incidence rate in control and experimental group was 13.5% and 10.8% respectively that was non-significant statistically. In addition, age, gender and type of complication played no role in infection. Meanwhile, a thickness greater than 2cm for subcutaneous tissue can increase the incidence rate.

Conclusion: It is concluded that ampicillin washing in comparison to saline itself can not affect the incidence of infection. It is recommended to perform more studies on ulcers with a subcutaneous thickness greater than 2cm.

Background: Educational media have utmost importance however, their proper application is not clarified for faculty members. The present study was performed to determine the role of educational media on knowledge, attitude and practice of Kashan faculty members.

Materials and methods : All Kashan faculty members have enrolled. Their knowledge was assessed based on subjects' knowledge towards educational media, while their attitude was evaluated by Likert test. Meanwhile, their practice was evaluated by direct observation of their usage of media. Finally, subjects were assigned in 3 groups of poor, moderate, and good.

Results : The study population included 38 clinicians and 59 basic scientists. Good knowledge, attitude, and practice was reported in 12, 11.3, and 25.3% of faculty members, respectively. However, 34, 40.2, and 44.3% revealed to have poor knowledge, attitude and practice, respectively.

Conclusion : Results have revealed that Kashan faculty members have poor knowledge, attitude and practice of educational media. Thus, they are strongly candidated for educational programs

History and Objective: Human hydati d disease has been world widely spread and its frequency ,clinical presentation, diagnostic methods, treatment and recurrence rate were reported variously. For determining the frequency, surgical results, and recurrence rate, this study was performed in Kashan area.

Material and Methods: A cross-sectional study on patients with hydatid disease was caried out. Age,sex,living side, clinical loboratory , imaging finding, anatomic location. and operation procedure, were all considered.At the end of the investigation for recurrency, chest X-rey pA Ultra sonography of abdomen and indirect hemagglotination test IHT was performed.

Finding: From 135cases (62.2%) were female,FM/M:1.6/1 the incidence pick was in (2-30). 58. % living in rural area 68% of cyst was in abdomen (liver) and 30% pulmonary, caught and then sputum was the most frequent symptom in pulmonary hydatid disease, abdominal pain and fever in liver hydatid disease was more frequent.  Casoni test in 85.3% pre-operation was positive and indirect hemagglotination test IHT serology after 5years 90% was positive Diagnosis of liver cyst was confirmed by ultra sonography in 98% in lung with chest X ray and CT scan 88.9 and 100% respectively.The most common procedure in liver was cystectomy and omentoplasy ,in lung was systectomy.   We did not use any scolocidall agent and had 4 patients recurrence in liver 3% but no any patient had pulmonary Recurrent. indirect hemagglotination test IHT after 5 years operation in 88.4 was positive

Conclusion: It seams that after perfect surgery no scolocidal drug administration is necessary and indirect hemagglotination test IHT is an excellent sero diagnostic means

Background: Ascite is one of the most important symptoms of underlying diseases that a complete evaluation of it makes the suitable treatment possible. Because of neumerous procedures in diagnosis of ascitic fluid and inauthenticity of the information in this regard, this study was performed to evaluate the nature of ascitic fluid with two ascite-serum albumin gradient and transudate-exudate methods on hospitalized ascitic patients admitted to Shaheed Beheshti Hospital during the 1994-2003.

Materials and Methods: Descriptive study with diagnostic value was performed on ascitic patients hospitalized in all age ranges. Firstly, all patients with absolute ascite, diagnosed through CT scan, sonography and parasynthesis were evaluated and then necessary demographic data and the ascitic causes i.e. cirrhosis, heart failure, nephrotic syndrome, multiple ascite with various reasons or pancreas diseases were recorded. After taking consent, Patients were parasynthesied. Ascite liquid (50-100CC) and arm citrated blood (5CC) were taken and sent to laboratory. Total protein of ascite fluid, serum and ascitic liquid albumin were determined cytologic study, staing and acid fast and culturing were also done. After taking answers, was each case with ascite liquid protein of ≥2.5 mg/dI and the ones with the protein of <2.5 mg/dI was classified in exudates and transudate group respectively. To determine the gradient, albumin of ascite liquid subtracted from serum albumin. The patients with the result of ≥ 1.1 were put in high gradient group and those with the result of < 1.1 were classified in low gradient one. Also, sensitivity and characteristic , means, standard deviation of the two methods along with the were obtained. By sensitivity .

Results: 100 patients with ascitic were studied, 56 of whom were male with average age of (X ± SD) 55.2 ± 16.4 and the rest were female with average age of (X ± SD) 54.9 ± 15.4 61% of the patients were more than 60. The most common reason of ascite (65%) was cirrhosis. Heart failure (14%) and malignancies (11%) were classified in 2nd and 3rd ranks. The sensitivity of transude-exuda and gradient albumin 47% and 73% respectively and the characteristic of transude-exuda method to gradient albumin was 80.3%. Also agreement coeficiency was 44% (K=0.44). The highest rate of conformity and transude-exude and gradient albumin method in recognizing infectious peritonite and multiple ascite were variable reasons (100%) and hepatitic cirrhosis (89.2%). The least rate of agreement was conjestive heart failure (21.4%).

Conclusion: The most common cause of ascite was hepatitic cirrhosis and the most agreement of two transudate-exudate and albumin gradient method, was infectious peritonitis and Mixed ascite, mean while, sensitivity and specifity of albumin gradient and specifity of transudate-exudate to albumin gradient had the highest agreement.

Background: Trauma is the most common cause of death between the ages of 1 and 44. Chest trauma as a potentially life threatening injury is increasing with increased number of high-speed accidents in Iran.

Materials and Methods: 282 patients were treated for chest trauma in our center between March 2003 and September 2007. Data including the patients' age and gender, blood pressure, respiratory rate on admission, Glasgow Coma Scale (GCS) scores, Revised Trauma Score, types of trauma, the extent of intra thoracic injury, types of associated injuries, length of hospital and ICU stay, morbid conditions, and deaths were recorded and analyzed.

Results: 237 patients were male (84%), and 45 female (16%). Mean age was 37.67±19.14 with the age range of 6 months to 84 years. 222 patients (78.7%) had blunt and 60 (21.3%) penetrating chest trauma. Motorcycles and car accidents were the most common etiologic causes in 167 (59.3%). Rib fracture was the most common thoracic injury with 178 (63%) and pelvic and limb injuries the most frequent extra-thoracic injury with 93 (33%). Seventy percent of patients were treated with either closed thoracostomy drainage or clinical observation while 71 (25%) needed surgical intervention during the first 24 hours. The most common operation was laparotomy. Mean duration of hospital stay was 7± 9.6 (range: 1-70) and ICU stay 1.9days. Out of 282 patients overall mortality was 33 (11.7%) and pulmonary infection 12 (4.2%).

Conclusion: Chest trauma is a major preventable cause of mortality and morbidity in our country. Systolic blood pressure ≤90, pulse rate ≥120, respiratory rate >29, GCS <8 at the time of admission, and blunt type of trauma were found as the predictors of mortality and morbidity.

Bacground: There are different methods for surgical management of sacrococcygeal pilonidal disease (SPD), each a different outcome. The present study compares the outcome of surgical excision and simple suture with that of rhomboid excision and the Limberg flap procedure in patients with primary SPD.

Materials and Methods: One hundred SPD patients were randomly allocated to undergo either surgical excision and simple suture (group 1, n=50) or rhomboid excision and the Limberg flap procedure (group 2, n=50). Duration of operation, postoperative pain, time for first mobilization, postoperative complications, time for disease recurrence were recorded for all patients.

Results: Duration of operation was longer in group 2 patients compared to group 1 (P< 0·001). However, postoperative pain was less (P<0·001), mobilization earlier (P<0·001) and postoperative complications fewer (P<0·001) in group 2.

Conclusion: Because of its low complication and acceptable long-term results, rhomboid surgical excision and Limberg flap procedure is preferable for simple surgical excising and suturing in the treatment of SPD.

Background: Meckel's diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but could also be symptomatic with complications such as bleeding, intestinal obstruction, and inflammation.

Case Report: Two weeks after gangrenous appendectomy of a 44 years old man in Shahid Beheshti Hospital in Kashan city, Iran, he complained of abdominal pain, nausea, bilious vomiting and constipation. Considering him as a suspicious case of intestinal obstruction, we performed laparatomy in which torsion of 10 cm. length of Meckel's diverticulum was confirmed.

Conclusion: Since the complications of Meckel's diverticulum are rane in adults, this diagnosis is supposed to be considered as one of the probable reasons of acute abdomen surgery. Although, the common place of Meckel's diverticulum is at 40-60 cm away from ileal operculum, it is recommended to assess ileum at a 100 cm distance from it.

Background: Trauma is the most common cause of mortality for people aged 1 through 44 years. Traffic accidents are the leading cause of severe injuries among young people in most countries. This study was conducted to determine the frequency of traffic accident injuries in victims referred to Kashan Trauma Center during 2007-8.

Materials and Methods: This cross-sectional descriptive study was carried out on 1004 trauma cases referred to Kashan Shahid Beheshti Trauma Center during the year during 2007-8. Data including age, sex, type of trauma, and type of intra- and/or extra-thoracic injury were recorded and analyzed.

Results: Sixty-six per cent of the cases were male, and the most frequently observed trauma cases were between the ages 21 and 30, followed by 10 and 20. The frequency of trauma in urban and rural areas was 62.5% and 37.5%, respectively. Motorcycle accidents are the most common traffic accidents followed by car accidents.

Conclusion: Considering the large number of trauma cases secondary to the traffic accidents and lower levels of education in those cases, appropriate educational programs may be helpful to decrease the mortality rates and other undesirable consequences of accidents.

Background: Acute and chronic cholecystitis and cholangitis are common cases in general surgical diseases. Considering the role of infections in pathogenesis of these diseases, prescribing appropriate antibiotics is important to control the biliary tract infections. The aim of this study was to recognize the biliary pathogens as well as evaluate their antibiotic susceptibility in cholecystectomized patients.

Materials and Methods: This cross-sectional study was performed on 288 cholecystectomized patients with acute and chronic cholecystitis and cholangitis. During the operation, a sterile bile sample was aspirated from the gallbladder which was sent to the laboratory for culture and antibiogram evaluation.

Results: Sixty-two (21.5%) patients were positive for bile culture. There were more positive cultures in cholangitis cases (64.7%) than the acute and chronic cholecystitis (22.8%, 12.2%, respectively P=0.001). Thirty-six isolated pathogens were E.coli (58%) and 8 Klebsiella (12.9%). Moreover, the most effective antibiotics against the gram-negative bacteria: imipenem (100%), amikacin (98.1%) and gentamicin (90.4%) and for gram-positive bacteria: imipenem, vancomycin, rifampcin and clindamycin.

Conclusion: The third-generation cephalosporins, as an empirical treatment for biliary tract infections, lack the effective antibiotic susceptibility. Considering the high susceptibility (more than 90%) and the reasonable price of amikacin and gentamicin, cephalosporins are recommended as the first line treatment for biliary tract infection. Imipenem, an expensive broad-spectrum antibiotic, is not recommended as the first line treatment to avoid drug resistance.

Background: Although laparoscopic cholecystectomy is the preferred method for cholecystectomy, performing routine drainage after laparoscopic cholecystectomy is an issue of considerable debate. Therefore, the present study aimed to evaluate the effect of using a drain on complications following an uncomplicated laparoscopic cholecystectomy.

Materials and Methods: In this study, 86 patients with biliary colic were candidates for laparoscopic cholecystectomy. The patients were randomly divided into two (the intervention and control) groups. In the intervention group, a drain was placed postoperatively, but the control group did not receive any intervention. The amount of fluid collection, length of hospital stay, recovery rate and the visual analog scale (VAS) for pain were recorded in all patients.

Results: Mean age of patients was 46.33±12.53 and 45.88±10.66 years in the drain and non-drain groups. The drain group was hospitalized 0.76 days more than the non-drain group (P=0.001). Complications were seen in the drain (7%) and non-drain (4.7%) groups. VAS was significantly higher in the drain group than the non-drain group (P=0.001).

Conclusion: Drainage does not have a positive effect on the postoperative abdominal secretions, recovery and the probable complications. Moreover, it can cause a significant increase in both length of hospital stay and pain score.