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Objective: To evaluate the role of heart rate variability (HRV) in predicting pre-operative severity of appendicitis., Methods: In this cross-sectional study, 171 cases of acute appendicitis who underwent appendectomy were enrolled. Pre-anesthetic pulse rate of included patients were documented while the severity of appendicitis was determined by intra-operative evidences reported by two independent surgeons. Demographic characteristics, laboratory variables, and Alvarado criteria were recorded., Results: The mean age of patients was 28.75±4.21 years; 54% were men. HRV negatively associated the severity of appendix inflammation. A positive association was found between HRV and omental wrapping and Alvarado score ( p <0.01). The receiver operating characteristic (ROC) curve analysis demonstrated that HRV could differentiate simple and complicated appendicitis with a sensitivity of 78.5% and specificity of 97.2%., Conclusion: The present findings revealed that HRV may predict the pre-operative severity of appendicitis and help differentiate simple and complicated appendicitis., Competing Interests: The authors declared that they have no conflict of interest.

Objective: To determine the effects of intravenous Acetaminophen (Apotel®)  on pain severity and clinical findings of peritonitis in patients with acute appendicitis., Methods: This randomized  cross-over clinical trial was carried out duringa 6-month  period from August 2012 to February 2013 and comprised 107 patients diagnosed with acute appendicitis. Patients were randomly assigned to received placebo (n=54) or Apotel® (n=53). Patients were evaluated before, 30 minutes, 1 hour and 4 hours after administration  of Apotel®  or placebo,and were told to fill in two forms. The first form required patientsto measure their painintensityaccording to visual analogue scale (VAS). The second form was filled by a surgeon who examined the patients and recorded his or her findings using Alvarado score criteria for diagnosis of acute appendicitis at foregoing time points., Results: Of 72 patients, 37 (51.4%) were men and 35 (48.6%) were women. The mean age of the patients was 34.1±13.5 years. The mean pain score in 107 patients included in this study was 7.96±2.3. Those who received Apotel®  had significantly lower pain scores when compared to placebo at 30 minutes (p<0.001), 1 hour (p<0.001) and 4 hours of administration. There was no significant difference between two study groups regarding the frequency of Alvarado score; however the frequency of fever was significantly lower in those who received Apotel® (p<0.001). We found that Apotel® was not associated with resolved physical findings of acute appendicitis in different time intervals., Conclusion: Apotel® does not affect the clinical findings of acute appendicitis and dos not interfere with the accurate diagnosis. Therefore, it could safely be used as a reliable pain relieving agent, in patients with acute appendicitis.

Objective: To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury., Methods: This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure., Results: Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration., Conclusion: Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.