History and Objectives: Due to the prevalence of blunt abdominal trauma and availability, relative ease, economic consideration of sonographic applications, and current controversy regarding sonography on diagnosis of intraabdominal injury, the present study was carried on blunt abdominal traumatic patients at Rasul Hospital in 1997-98 in order to assess the diagnostic power of sonography on intraabdominal injury. Materials and Methods: A clinical diagnostic experimental study was performed and patient's information and characteristics of the injury was recorded. Definite diagnosis of injuries was based on CT scan and laparotomy findings. PPV and NPV of sonography were defined. Results: Study covered 94 patients (76.6% male and 23.4% female) with age of 26.9±14.8 years. Car accident was the major cause of trauma. PPV and NPV of sonography for diagnosis of intraabdominal organs injury were 76.5 and 84.8 respectively and for diagnosis of intraabdominal free fluid were 100 and 96.6 respectively. Conclusions: Sonography has sufficient power for diagnosis of intraperitoneal free fluid however it does not have sufficient power for diagnosis of intraabdominal organs injury. Further study regarding the cause of low power is recommended.      

Background and Objectives: This cross-sectional study was conducted to determine the prevalence of glaucoma due to hyphema in patients suffering blunt trauma. Materials and Methods: We reviewed the medical records of 310 patients (257 men and 53 women), admitted to Nikoukari hospital between 1995-1999 with a diagnosis of hyphema due to blunt trauma, with respect to age, sex, hyphema grading and intraocular pressure. Results: Out of the total patients enrolled in the study, 37% of them were under 10 years of age and 67% had hyphema less than or equal to one third of anterior chamber depth (Grade1). Initial visual acuity was less than 20/100 in 180 (58%) patients that improved to 20/40 or better at discharge in 204 (66%) patients. 48 (15.5%) eyes developed intraoculor pressure greater than 21/mmHg, that was accompained by total hyphema (Grade4) in 50% of cases. Conclusions:Preventive measures for ocular trauma are recommended especially in children.

Background: This article is to verify mortality rate, cause of death, severity of injury (ISS),GCS, patient fate in hospital, pattern of specific organ injuries and some other characteristics among injured pedestrians and car occupants referred to three trauma centers in Tehran (Sina hospital, Shohada Tajrich hospital, Fayazbakhsh hospital) from May 1996 until May 1997. Materials and Methods: 57367 patients were admitted to emergency department of these centers among which, 6027 victims of motor-vehicle accidents were included in this study.Results: 71% of cases were pedestrians and rest was car occupants. M/F ratio was 1.8/5. Mean age was 29y. Motor vehicle accidents occurred most commonly during nights. The patients GCS at arrival in emergency department had similar distribution in both groups. The most commonly injured organs in both groups were: integument, head and neck, extremities and bony pelvis. Thoracic and spinal injuries were more common among car occupants. Extremities and boney pelvis injuries were more common among pedestrians. The mortality rate was the same between both groups. Mortality rate was affected by GCS at arrival and severity of injury. Mortality rate among the old was 4 times the rate among the children. The accidents most commonly occurred on metropolitan roads and streets. The most common cause of death between both groups was head injury. Surprisingly head injury was a more common cause of death among the car occupants. Conclusion: Pattern of specific organ injuries was different form the pattern in previous studies as the pattern was virtually the same between both groups except for spinal and thoracic injuries were more common among the car occupants.

Introduction: Tracheobronchial injuries are uncommon but potentially fatal complication of blunt thoracic trauma harboring a high morbidity and mortality if not diagnosed early. A recent series gleaning cases from four major Trauma Center in Los Angeles nine cases in a seven- year period, but the incidence of these injuries has been increasing recently.This has been attributed to improvement in hospital care and advanced Trauma Centers and earlier diagnosis of such injuries. Disruption of tight main bronchus is more common, such injuries are often associated with rib or clavicular fractures.Findings: Clinical and paraclinical data gathered from records of three ,patients referred with tracheobronchial injuries during the recent ten years have been reviewed .These include clinical manifestations, diagnostic findings, treatment modality and clinical course. The outcome has been satisfactory in all three patients who have undergone operation 2-5 hours after sustaining the injury. We have not had any mortality.Conclusion: These results are similar to those of. other series emphasizing over early diagnosis and treatment of such injuries.

Background and Objective: Ocular traumas are major cause of morbidity. There is lack of comprehensive data about epidemiology aspects of eye injuries. The objective of this study is the description of hospitalized cases of eye injuries at Farabi Hospital in the period of October 2002 to march 2003.Materials and Methods: The study was based on existing data and Records of all of the hospitalized ocular trauma cases during the specified period were reviewed and demographics and injury characteristics were extracted.Results: 400 cases were evaluated. Male to female ratio was 3.8: 1.Mean age was 23 ±15.7 years; 46% were younger than 20. Cornea was the most common site of injury (66.7%). The nature of injury was penetrating in 305 (75/7%) of the cases. Metallic foreign bodies were the most common agents in penetrating injuries (74%) and stones were the most common agents in blunt injuries (17.3%). 22% of the cases had visual acuities equal or better than 7/10 and 58.7% had acuities of hand motion or worse. 57% of the cases were undergone primary repair and 9 cases of enucleations were performed.Conclusion: The mean age of the injured is significantly lower than that of the other reports. Penetrating injuries were more common and cornea was the most common site of injury.

Introduction: Blunt abdominal trauma is one of the most common mechanisms of trauma especially in motor vehicle accidents. Diagnostic problems are the matter of concern in these patients. There are many reports about the accuracy of diagnostic tools considering the decrease in the rate of negative laparotomies at the same time.Materials and methods: In this study all emergency laparotomies of a referral hospital are evaluated in a 5 years period retrospectively (1996-2000).Results: There were 61 positive and 14 negative (18.7%) laparotomies in 75 patients. 4 patients underwent nontherapeutic laparotomy because of retroperitoneal hematoma. Sonography was done in 34 cases with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) as 84.3%, 50%, 96.4% and 16.6%, respectively. Diagnostic peritoneal lavage (DPL) which was done for 16 patients had 100% sensitivity, 66.7% 5pecificity, 92.8% PPVand 100% NPV. There were 9 negative laparotomies (32.2%) in 28 patients whom were operated on the basis of clinical findings merely.Discussions: We concluded that sonography is a valuable tool for initial assessment of blunt abdominal trauma. Of course, more accurate tests should be in mind whenever clinical findings are incompatible with sonographic data, considering its low specificity and NPV. DPL still, is a safe and accurate method for evaluating blunt abdominal trauma victims. Laparotomy without any diagnostic procedure yields more negative results.

Purpose: To report a case of enophthalmos secondary to complete globe dislocation into the maxillary sinus due to orbital fracture.Patient and Findings: An 18-year-old man was referred to Labafinejad hospital, one week after a car accident. At initial examination, the globe was not seen within the right orbit. A large floor fracture and globe luxation into the right maxillary sinus was confirmed on CT scan. Repair of the fracture using Medpore implant and globe repositioning were performed. Visual acuity following surgery was no light perception without improvement during follow-up.Conclusion: Visual impairment in this case was most probably due to traumatic optic neuropathy and delayed surgical intervention and medical therapy with systemic corticosteroid.    

Background: Trauma is the most common cause of death, admission and disability in all age groups ranging between 1-40 years. The present study was conducted to survey the frequency of chest trauma (blunt and penetrating) in Air Force Hospital in a two-year period, 2002–2004.Materials and methods: A retrospective study was conducted at Surgery and Emergency departments of Air Force hospital on all consecutive (blunt and penetrating) chest trauma patients treated between March 2002 and March 2004.Results: Totally, 814 cases referred with chief complain of chest trauma. Blunt chest trauma was reported in 78.1% of cases (636 patients) and penetrating chest trauma in the remaining 21.9% (178 patients). Totally, 84.7% were males and 76.4% aged 14-40 years. The most common site of injury was chest wall (90.3%) and soft tissue injury was the most prevalent form of trauma (31.6%). Extremities were the most common site of co-injury (13.3%). Car accident was by far the most frequent cause of trauma (57.9%). The mortality rate was 3.8% (31 patients).Conclusion: Car accident was the most common cause of chest trauma. Meanwhile, soft tissue injury was the most frequent type of injury.

Background and Objectives: Diaphragmatic ruptures are often associated with severe injuries. Delayed presentation can be life threatening due to organ herniation and strangulation. The aim of this descriptive study was to identify pitfalls in the diagnosis and treatment of diaphragmatic rupture. Materials and Methods: Medical records of 117 patients admitted to Imam Khomeini hospital from 1994 to 2003 with diaphragmatic rupture were evaluated according to the type of injuries, diagnostic methods, associated organ injury, surgical findings, morbidity and mortality.Results: Of patients with diaphragmatic rupture (101 male and 16 Female) 41 suffered from blunt trauma, 74 from penetrating injuries and 2 from iatrogenic traumas. With blunt trauma the rupture was in the left diaphragm in 73.2% 0f injuries, in the right diaphragm in 24.4% and bilateral in 2.4% of injuries. The diaphragm was delayed in 6 (5%) patients, 43 (37%) diaphragmatic ruptures were diagnosed before operation and 74 (63%) during operations. The most common associated injuries with diaphragmatic rupture were the liver (38.46%), spleen (35.04%) and colon (5.98%). Sixteen patients (14%) died due to accompanying injuries.Conclusion: It is important to combine a high index of suspicion with radiological diagnostic tests in patient at risk. Palpation and/or visualization of diaphragm during laparotomy is extremely important in detecting these injuries when they are not under suspicion preoperatively.