Traumatic diaphragmatic rupture (TDR) is a life-threatening condition that is quite uncommon and often results from either blunt or penetrating trauma. This entity may be diagnosed late. The purpose of study was to review experiences about diaphragmatic rupture and diagnostic defects that would be helpful in rapid DIAGNOSIS and treatment of these patients. A retrospective case note analysis was performed on the five patients treated for TDR between October 1997 and October 2011. Five patients (4 men and 1 woman) between 13 and 63 years of age (mean age 37) were included in the study. Total five cases had diaphragmatic rupture in left side. One patient had penetrating injuries and 4 patients had blunt injuries. The DIAGNOSIS was done preoperatively in 3 cases and postoperatively in 2 cases. As a consequence in 2cases TDR had not been diagnosed even by intraoperative exploration in others centers. In four cases, the DIAGNOSIS was DELAYED from three days to four years. TDR is a relative uncommon event and represents a diagnostic challenge and It also may be missed during operation. A high index of suspicion combined with repeated and selective radiologic evaluation, thorough examination of abdomen and both the hemi diaphragms during emergency laparotomy can help surgeons in accurate DIAGNOSIS.

Introduction: The most common cause of short DELAYED arousal is due to “overdose of a sedative-hypnotic” medication after general anesthesia and it is not of clinical importace. However, long term DELAYED arousal is due to several important conditions that can confuse anesthesiologists.Case report: The patient was a 28 years old woman with mucormycosis, candidate for sinuses drainage by endoscopic intervention .One months before surgery, while she was in 18-19 weeks of gestational age, she suddenly felt dyspnea and fatigue. In further investigations, severe anemia was diagnosed and in bone marrow biopsy AML-M5 was detected. Physicians decided to end her pregnancy by D&C. After one week of chemotherapy with Cytosar (Cytarabine) and Idarubicin, pneumonia and sepsis occured. Therapy with Vancomycin and Amphotericin B and Imipenem leads to epistaxis and rhinorrhea. CT Scan of sinuses demonstrated mucormycosis. She was alert and awake before general anesthesia with Fentanyl and Cisatracurium and Propofol for induction and maintenance. At the end of operation she could not be awake .Her DELAYED arousal had been continued for one day, then awakened spontaneously and discharged from hospital.Conclusion: Several factors such as chemotherapy drugs (affects on liver and brain),length of operation, imbalance in levels of electrolytes and low proteins due to malnutrition caused by cancers are the possible causes of the condition. Use of BIS maybe a good offer to decrease anesthetic drug doses during general anesthesia.

Objective(s): To determine application of the PRECEDE model for increasing coping behaviors against anxiety in Tehran firemen.Methods: This was a quasi experimental study. 118 firemen (59 in experimental group and 59 in control group) from Tehran fire stations were selected as the subjects of the study through a multistage sampling. Data collection tool was a questionnaire developed by author including demographic characteristics and PRECEDE model components.Results: Comparing to the control group, after educational intervention in the study group, the mean scores of knowledge, attitude, self efficacy (predisposing factors), skill of the relaxation (enabling factor), behavior increased significantly (P<0.0001) and use of 3 educational resources (enabling factor) in area of relaxation increased significantly (P<0.03). Also, verbal persuasion and positive experiences after doing relaxation (reinforcing factors) were reported by experimental group.Conclusion: The finding of the study illustrates effective application of PRECEDE model in increasing predisposing, enabling, reinforcing factors and coping behaviors against anxiety in Tehran firemen.

Complications of B.C.G. immunization are mostly benign. The most common one is adenitis (0.5- 5%) especially in axillary area (1,2). The cause of B.C.G. adenitis is unknown.Probably DELAYED hypersensitivity reaction playing the major role. This study was in two groups of infants with and without adenitis in post immunization period. This study was designed in order to determine the lymphocyte proliferating activity in two patient groups (with and without adenitis).Using both B.C.G. and some other mitogens including PHA and Con A (phytohemagglutinin and Concanavalin A). High lymphocyte proliferation was noticed in-groups who were tested with RC.G. +ConA or ConA alone (10).Results shown that lymphocyte in patient group (Adenitis group) highly stimulated with Con A, therefore C.M.I. (cell mediated immunity) activity most probably is the cause of BCG adenitis (8,19).

Background: Women 35-39 years old have a 2–3 fold higher risk of pregnancy-related death than women in their twenties, and the risk is even more dramatic for women 40 years and older.Objective: The aim of this study was to investigate the association of maternal age with risk of adverse pregnancy and mother outcomes in our setting, Tehran, Iran.Materials and Methods: In this retrospective observational hospital-based study, 538 nulliparous women were assessed. The association between maternal age and various pregnancy and neonatal outcomes were reported. Data were extracted from the database of Akbar Abadi hospital in Tehran from 2001-2006 records. Univariate and multiple logistic regression analyses were preformed to investigate the association between maternal age and various relevant outcomes. Results: Women aged 35 years or older had an increased percentages of gestational hypertension (18.8% vs 9.6%; p=0.02) and diabetes in pregnancy (3.7% vs 1.4%; p=0.08) compared with women younger than 35 years. There were no differences between the two age groups in Apgar score at 1 min, antepartum hemorrhage, preterm labor, PROM, fetal distress, perinatal death, and postpartum hemorrhage. Conclusion: Advanced maternal age was shown to be independently associated with low birth weight, preterm labor and rate of cesarean delivery.

Background: The esophageal perforation can be fatal unless diagnosed promptly and treated effectively. The high mortality rate related to DELAYED treatment is due to an inability to effectively close the perforation site to prevent leakage and ongoing sepsis.Materials and Methods: This study was performed on patients who were referred to three hospitals of Shaheed Beheshti and Tehran Universities of Medical Sciences during two years. All patients admitted in these hospitals with esophageal perforation lasting for more than 24 hours were studied.Result: There were 24 patients (12 males, 12 females) with the mean age of 37.5 yrs. The most frequent symptoms and signs were: Chest and abdominal pain in 11 cases (45.83%), empyema in 11 cases (45.83%), fever in 10 cases (41.66%), pleural effusion in 8 cases (33.33%) and emphysema in 3 cases (12.5%). The most common causes of esophageal perforation were use of devices during esophagoscopy and foreign bodies in 13 cases (54.17%), iatrogenic trauma in 4 cases (16.67%), Boerhaave's syndrome in 4 cases (16.67%), ingestion of burning chemicals in 2 cases (8.33%) and esophageal cancer in 1 case (4.17%).Four (16.66%) of all patients died while others were discharged with no significant complication in long time.Conclusion: This study was performed on patients referred to university hospitals; therefore, the results are different from those of community. Most of the perforations were due to intraoperative negligence or device manipulation. The outcomes of the whole procedures were good concluding that late diagnosed esophageal perforations can be managed surgically with good results but with a longer period of hospitalization.