Medical Journal Of the Islamic Republic of Iran
Volume:23 Issue: 1, Spring 2009

In the recent decade, many primary total knee arthroplasties have been carried out in Iran and the number of revision cases is expected to rise with the aging population. The aim of this study was to report the outcome of revision surgery in the country and make a comparison between the outcome of revision and that of the primary arthroplasty. Retrospectively, each case of 19 consecutive revision total knee arthroplasties was matched individually with two cases of primary total knee arthroplasty based on gender and age (within 5 years) in order to compare the outcome in the two groups of revision and primary arthroplasties. Detailed demographic data, underlying diagnosis, patient-reported pain severity, and Knee Society score were recorded pre-operatively and in the third month after the surgery for each patient in the two groups. Using chi-square, fisher''s exact, one-way ANOVA, independent, and paired t-tests, we compared the outcomes in two groups as well as in each group before and after the arthroplasty. Knee pain was significantly decreased after the surgery in the two groups of revision (p = 0.031) and the primary (p < 0.001) arthroplasty. There was no statistically notable difference of post-operative pain between the two groups of revision and primary TKA. The Knee Society score remarkably increased in both groups after the surgery (both ps < 0.001). The differences of Knee Society scores before and after the surgery were calculated separately in each group and compared to show that the primary group had a better outcome (p < 0.001) rather than the revision arthroplasty group. Satisfactory outcomes were obtained in our revision total knee arthroplasties; however, the primary arthroplasties had better results. The results of surgery appear to be closely related to the technical demands placed on surgeon. Because we have to deal with more cases of revision total knee arthroplasty in near future, more comprehensive risk factor assessment studies with large sample size are required for gaining better results.

Recently, small dense low density lipoprotein (sdLDL) has been highlighted as a new risk factor for the coronary artery disease (CAD).Small dense LDLs are believed to be atherogenic since these particles are taken up more easily by arterial wall. They are readily oxidized and have reduced affinity for low density lipoprotein (LDL) receptor and increased affinity for arterial proteoglicans. LDL cholesterol is only a measure of the cholesterol level in the LDL whereas apolipoprotein B(apo B) is a measure of the cholesterol levels of all the atherogenic particles, including very low density lipoprotein, intermediate density, and low density lipoproteins. Therefore, it might be a better marker than other traditional lipids. The aim of the present study was to evaluate the association between serum small dense LDL, apolipoprotein B, apolipoprotein A1 (apo A1) and apoB/apoA1 ratio and the coronary stenosis. 86 patients with coronary stenosis, 35 patients without coronary stenosis identified by angiography who were referred to Rajaii Heart Center, and 30 healthy individuals were studied. SdLDL was measured by a direct homogenous LDL-C assay in the supernatant of serum which remained after heparin-magnesium precipitation. Serum apolipoprotein A1 and apolipoprotein B were measured by using immunoturbidimetric method. The results showed that the sdLDL levels were higher in patients with coronary stenosis than patients without coronary stenosis and healthy individuals (21.54±7.1, 16.88±4.4 and 15.45±5mg/dl, p=0.001, respectively). In addition the level of apoB (with stenosis: 113.71±21.8, without stenosis:100.88±18.7 and healthy: 102.30±9.6, p=0.003) and apoB/apoA1 ratio (with stenosis:1.100±0.24, without stenosis: 0.589±0.26 and healthy:0.751±0.16, p=0.001) were significantly higher in patients with coronary stenosis. SdLDL levels were positively correlated with the level of apoB(r=0.589), apoB/apoA1 ratio(r=0.416), triglyceride(r=0.494), LDL-C (r=0.749), Total cholesterol(r=0.354) and were inversely correlated with the level of HDL-C (r = -0.586)(p<0.01). The elevated levels of small dense LDL, apoB and apoB/apoA1 ratio were associated with coronary artery stenosis.

obesity is directly related to dyslipidemia which contributes significantly to the risk of coronary heart disease، a major cardiovascular disease and a serious health problem. The aim of this study was to compare the effects of low calorie diet and those of lovastatin on serum lipoproteins، apo B، homocysteine، and total antioxidant capacity (TAC) in hyperlipidemic obese patients. In a randomized clinical trial، 41 obese patients were stratified by BMI، serum triglyceride (TG) and total cholesterol (TC) and randomly allocated to one of these groups: 1- Lovastatin tablet (40mg) 2-1200 calorie diet per day according to the therapeutic lifestyle change (TLC) dietary pattern for 8 weeks. Serum lipoprotein، apo B، homocysteine، and TAC were measured enzymatically، immunoturbidometrically، via EIA، and colorimetrically respectively. There were a significant decrease in mean of the serum TC (P=0. 0001)، LDL- c (p=0. 0001)، TG/HDL-c (p=0. 03)، apoB (p=0. 0001) and significant increase in TAC (p=0. 0001) in diet group at the end of the study compare to lovastatin group. TC، LDL-c، TG، LDL-c/HDL-c، TC/HDL-c، TG/HDL-c، homocysteine and apo B showed significant decrease but TAC showed significant increase in the diet group at the end of the study compared to beginning values (p=0. 0001، p=0. 0001، p=0. 0001، p=0. 001، p=0. 0001، p=0. 0001، p=0. 0001، p=0. 0001 and p=0. 002، respectively). But in the lovastatin group only TC، LDL-C، TG، LDL-c/HDL-c، TC/HDL-c and apo B had significant decrease at the end of the study compared to beginning values (P=0. 0001، P=0. 0001، P=0. 0001، P=0. 01، P=0. 02، P=0. 002، respectively) The study revealed that when compared to levostation 1200 kcal diet according to TLC dietary pattern had more beneficial effects on serum lipoproteins، apo B، homocysteine and TAC، so it may decrease CVD risk factors and mortality in hyperlipidemic obese patients.

Sacroiliac joint (SIJ) dysfunction is a widely known but poorly defined cause of low back pain. To our knowledge, few published studies have been conducted to evaluate systematically the prevalence and significance of concomitant sacroiliac joint dysfunction in patients with herniated lumbar discs. As concomitant SIJ dysfunction in low back pain patients is likely to respond to particular noninvasive interventions such as manipulation, improved understanding of the relationship between these two diagnoses would improve clinical decision making and research. This study was designated to estimate the prevalence of concomitant sacroiliac joint dysfunction in sub acute low back pain patients with image proven discopathy and evaluate the theory that sacroiliac joint dysfunction can be a source of pain and functional disability in discopathy. A total of 202 patients with sub acute radicular back pain and MRI proven herniated lumbar discs underwent standardized physiatrist history and physical examination, specified for detection of concomitant sacroiliac joint dysfunction. Sacroiliac joint dysfunction is a concomitant finding in 72.3% of evaluated patients. There was significantly higher SIJ dysfunction prevalence in female patients (p <0.001), patients with recurrent pain (p <0.005) and in patients with positive straight leg raising provocative test (p <0.0001). SIJ dysfunction is a significant pathogenic factor with high possibility of occurrence in low back pain. Thus, in the presence of radicular and sacroiliac joint symptoms, SIJ dysfunction, regardless of intervertebral disc pathology, must be considered in clinical decision making.

Traumatic or congenital events can result in injury and functional deficiency in the hand and we need to reconstruct the fingers at times. Studies are available in the pediatric and adult age groups to assess the length of the thumb. But to the best our knowledge no measurement of the relative clinical length of all fingers has been reported in the literature. We performed this study to assess the clinical relative lengths of the fingers of the human hand by using surface landmarks. Fifty male and fifty female healthy participants were involved in the study. We assessed the distances between the tips of fingers from the distal wrist crease while the thumb and other fingers were held in adducted position. We also assessed the ratio of all fingers including the thumb to the middle finger. One hundred normal hands in 100 healthy volunteers were included in the study, 50 women and 50 men; the average age was 32(20- 50) years. The distance of tips of fingers from distal wrist crease were 93.6(86-120), 156.4 (142-185), 166.9 (150-200), 156.3(150-188), 132.4(114-168) millimeter in females respectively for the first to the fifths fingers and the same figures for male participants were 107.9(102-121),170.6(153-191),182.6(166-204),172.2(158-193),144.1(129-168) millimeter. The ratios of first, second, fourth and fifth fingers to the middle finger were 60 %, 94 %, 95 %, 79 % for males respectively and 59 %, 94 %, 94 %, 78 % for females. The authors believe that, the relative length of fingers can help the surgeon to decide confidently in the reconstruction of hand and fingers because this method is simple and easy use.

Hydronephrosis is the most common congenital condition that is detected by prenatal ultrasonography. Moreover, the widespread use of prenatal ultrasonography results in an increased recognition of fetal hydronephrosis. Prenatal hydronephrosis is diagnosed at an incidence of 1:100 to 1:500 by ultrasonographic studies. The presence of hydronephrosis is not synonymous with obstruction. Obstruction signifies impairment of urinary flow, which if left untreated will cause progressive deterioration of renal function. Approximately 10-20% patients with obstruction show progression of hydronephrosis or worsening renal functions. The study population consisted of 72 patients who were referred to the Division of Pediatric Nephrology, Mofid Children''s Hospital, Tehran, IRAN for evaluation and treatment of pyelonephritis. All patients underwent two-dimensional ultrasonography (2D US) of the urinary tract; immediately afterward. Diagnosis of pyelonephritis has been based on clinical and paraclinical findings and abnormal 99mTc- demercaptosuccinic acid scan (DMSA scan). Glomerular filtration rate was in normal range in all of them. The children were classified in two groups as having normal kidney ultrasonography and abnormal ultrasonography. Fresh random urine samples were obtained on the admission time and at 48th hour of treatment. Urine samples were tested for N-acetyl-beta- D-glucosaminidase (NAG) (ELISA colorimetric, DIAZYME, USA) and creatinine. All of our patients were treated with same medication. We also evaluated our patients with voiding cyctoureterography (VCUG), renal scintigraphy and biochemical studies. In this study 73.6% of the patients had normal ultrasonography and 26.4% abnormal ultrasonography. In patients with abnormal kidney ultrasonography, condition such as stasis, moderate to severe hydronephrosis, decreased cortical thickening and urinary stone were seen in 47.4%, 26.3%, 5.3% and 21.17%, respectively. The mean for urinary NAG/Creatinine before antibiotic therapy was 36.79 ± 42.24 U/g creatinine in patients with normal ultrasonography, and 46.22 ± 57.53 U/g creatinine in abnormal group. Patients with hydronephrosis had the highest level of urinary NAG (p-value<0.043) and patients with urinary stone, had the lowest level of urinary NAG (p-value<0.004). The urinary NAG was elevated in children with urinary tract abnormality with or without infection. Hense this protein could be a useful marker in prediction of hydronephrosis and its renal damage in pediatric group, although studies with greater numbers of patients are needed to establish this opinion.

The goal of this report is to show our results with extension block technique for treatment of mallet fracture. The indications for this technique were the presence of a large bone fragment, and palmar subluxation. We retrospectively assessed the results of treatment in 14 mallet fractures which have been treated by extension block technique to determine the range of motion in distal interphalangeal joint and associated complications. According to the Crawford criteria there were 6 excellent, 4 good and 4 fair results. At an average follow-up period of 19 months, the average extension lag and the average final active flexion of distal interphalangeal joint were 6° and 54° respectively. We have found that this technique effective and minimally invasive and it does not disrupt the remaining extensor mechanism. This technique requires percutaneous transarticular pin, which does not allow early joint mobilization and requires meticulous pin care with regular dressings. In our opinion, joint transfixation is probably the commonest reason for incomplete restoration of the joint range of motion.

Hydatid cysts are endemic hooknoses in Iran. It may involve various organs of body. Liver is involved in 80% and lung in 10- 15%of cases. 25% of pulmonary hydatid cyst is bilateral. Before any transplantations eradication of infection is necessary. In a 26-year old man with renal failure referred for kidney transplantation. On initial preoperative evaluation of this patient hydatid cyst lesion was found in two lungs, left side operated, and right side left in place. Under treatment with albendazole kidney transplantation was performed. After two-year of follow-up, patient was in good condition and the size of right cyst did not increased.

Pseudoxanthoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. Renal involvement is uncommon. We describe two cases of pseudoxanthoma elasticum (PXE) in two women with distinctive skin lesions and nephrocalcinosis that renal ultrasonography showed a characteristic pattern of dotted increased echogenicity in the corticomedullary junction. One of them had IgA nephropathy that was proven by kidney biopsy. Skin biopsy and fundus examination confirmed the diagnosis. Early diagnosis of PXE is important for minimizing systematic complications and informing the other family members through genetic counseling. Our case with PXE and IgA nephropathy is the first case report.