Acta Medica Iranica
Volume:40 Issue: 4, July - Aug 2002

The majority of osseous tumors of the hand are benign. The surgeon who evaluates and treats osseous tumors of the hand has to be familiar with limb anatomy, tumor biology, various presentations of the tumors and the range of treatment possibilities and their limitations. Lesions in the hand more often present earlier in their course than those at other sites, just because they are more likely to superficial and easily noticed. A review of all cases of osseous tumors of the hand, seen by a hand surgeon over the last 10 years, at Imam Khomeini hospital was performed. Among 55 cases with osseous tumors of hand, 48 primary benign bone tumors, 3 primary malignant bone tumors, and 4 metastatic bone tumors were found. Enchondroma was the most common benign bone tumor followed by osteoid osteoma, osteoblastoma, aneurismal bone cyst, giant cell tumor, epidermoid cyst, and osteochondroma. There were two chondrosarcoma and one Ewing’s sarcoma as primary malignant bone tumors. Metastasis to the hand from colon, esophagus, and breast were also found. There were also two cases with Brown tumor secondary to hyperparathyroidism, we conclude that a variety of osseous tumors could occur in the hand, and usually they are benign. Although malignant neoplasms in the hand that arise from tissues other than the skin are very rare, the hand may be the site of distant breast, lung, kidney, esophagus, or colon adenocarcinoma metastases, most of which have a predilection for the distal phalanges.

Accessory pathways (AP) are abnormal myocardial connections between atria and ventricles with electrical conductive properties. We performed radio frequency (RF) catheter ablation in 66 patients with manifest AP at Dr.Shariati Hospital during 5 years. Bipolar mapping was used in 48 patients and unipolar mapping in 18 patients of find the best site for RF energy delivery. We calculated total duration of the procedures, mean of RF energy dosage and delivery time, number of the lesions, and the success rate in each mode. We found that unipolar mode was preferred one for RF catheter ablation of the free wall accessory pathways.

Footdrop is a relatively common deficit among the neurological disorders, which has different causes with various levels of involvement in neuromuscular system, including central nervous system (brain cortex, spinal cord), fifth lumbar root, peripheral nerves and muscles. Peroneal nerve injury at the fibular head has been reported to the most common cause of foot drop, which can be due to infarct, tumor or leprosy but the vast majority of lesions are traumatic. In this article, we report seventeen patients with foot drop in farmers. All of the patients except one, were male with age ranges between 15 to 25 years. They had been doing certain farming activities (harvesting or weeding) for 1-5 days before developing foot drop. Electrophysiological studies have been done in only seven of them due to patient’s unwillingness. Nerve conduction velocity and amplitudes distal to the fibular head were normal, but stimulation above the fibular head showed reduced nerve conduction velocity and amplitudes (mean 22.4 m/s in the abnormal side versus 51.5 m/s in the normal side, mean peak to peak amplitude 3.6 mv in the symptomatic side versus 10.4 in the contralateral side respectively). Forty-three percent of patients had also conduction block. F wave latency increased on the affected side in comparison to the normal side (mean 4.7 m/s). The new and perhaps interesting findings in our cases are unilateral involvement and occurrence of peroneal palsy on the side of dominant hand, indicating that type of the hand activity is probably more important in inducing foot drop than the position of seating during harvesting or weeding. We suggest further investigation in this setting in order to find the mechanisms of nerve injury and prophylactic measures.

Labor induction despite an unriped cervix is one of the most common indications of the use of prostaglandines. This clinical trial was performed to compare the effectiveness of oxytocin with misoprostol for induction of labor in Bahonar Hospital, Kerman/Iran from 1999 to 2000. Sixty pregnant women with indication for labor induction were randomly assigned to receive misoprostol or oxytocin. Misoprostol in tablet form. 25 µg, was placed in the posterior fornix and was repeated every four hours in the first group (to a maximum of 100 µg). The second group received intravenous oxytocin (21 µm/min). The results showed that 83.3% of women in the misoprostol group were delivered vaginally within 3.5-21 hours of the initiation of induction versus 76.7% within 4.5-17.5 hours in oxytocin group and there was no significant difference between them. The total cesarean rate was between them. The total cesarean rate was approximately similar in the two groups. Women receiving oxytocin had higher rate of cesarean for distocia (5 versus 1). The mean and median interval from induction to delivery were not significantly different between the two groups, (685±223 and 710 minutes in the first group compared with 685±198 and 690 minutes in the second group, respectively). There were no significant differences in Apgar score and meconium staining between the two groups. Hyperstimluation was seen in a patient in the first group with neither low Apgar score nor adverse neonatal outcomes. This study showed that the outcome of induction was not significantly different in the two groups. Therefore regarding the advantages of misoprostol, it is recommended as an alternative to oxytocin.

Lymph node dissection is of prime importance for accurate staging of colorectal carcinomas. Since a great number of small lymph nodes are missed in the traditional method, several fat clearing solutions have been introduced for easier detection of smaller lymph nodes. In this study we evaluated the efficacy of a new fat clearing solution so-called lymph node revealing solution (LNRS) in colectomy specimens of patients with colorectal carcinoma from year 2000 till 2002, thirty five colectomy specimens with less than 4 metastatic lymph nodes received in the pathology department of IKMC, were selected and re-evaluated using the LNRS. By using this solution 456 additional lymph nodes and 16 more metastatic lymph nodes were detected resulting in upstaging of 3 patients from Duke’s B to C. In all patients categorized as Nx (regional lymph nodes not assessed) by the traditional method, lymph nodes were detected after employment of LNRS. The mean diameter of dissected lymph nodes was significantly smaller than the traditional method (0.268 versus 0.429, P<0.000001). LNRS in comparison with previous solutions is inexpensive, rapid and easy to use. We propose use of this solution in all Duke’s B and patients with no lymph node detection by traditional method.

Doppler-derived myocardial performance index (MPI), defined as the sum of isovolumetric contraction and relaxation durations divided by ejection time, is an easily measured and reproducible index that shows both systolic and diastolic myocardial function. The goal of this study was to define normal values of right ventricular (RV) MPI in neonates in the first 48 to 72 hours of life. Fifty-one quiet of asleep healthy and term neonates underwent complete M-mode, two-dimensional color-Doppler echocardiographic examination and RV MPI was calculated in them. Statistical analysis was performed, using a SPSS software, P value less than 0.05 was considered as significant. RV MPI was 0.23±0.14 in healthy neonates. There was no correlation between RV MPI and either age or weight of the newborn infants. RV MPI in healthy neonates was 0.23±0.14 in our study. While this closely resembles the results of some researchers, is lower than those previously reported by the other investigators in healthy children. The lower value of RV MPI in neonates may be possibly explained by its relation to the higher pulmonary arterial pressure of the lower ventricular mass in the first few days of life in neonates. Further study to evaluate the effect of pulmonary arterial pressure and right ventricular mass on RV MPI is recommended.

The chronobiology of the acute myocardial infarction (AMI) is an interesting matter for recognition of the biological mechanism that might trigger AMI. The present study was aimed to investigate the circadian, seasonal and circannual variation of the AMI occurrence with solar, lunar, and Christian months. A retrospective study of 1174 cases with diagnosis of AMI was conducted. All cases included in our study were admitted to the coronary care unit of Shahid Beheshti and Yahyanejad Hospitals in Babol, the north of Iran, between 1990 and 2000. The data was extracted by the day and month of diagnosis based on the solar, lunar and Christian calendar from hospital charts. The chi-square test was used to test the uniformity of the observed frequencies of AMI onset in relation of the time factors based on solar, lunar, Christian and the days of week. The results showed that there was a significant trend toward higher rate of MI at the beginning of the week, on the Saturday (18.1%) and the least (12.3%) on Friday. Although, the observed frequency of AMI tended to be higher month than other months, the monthly variation was not statistically significant (P>0.05). However, there was significant difference in MI occurrence in Christian months with high peak in November (P<0.05). Also, we did not found as significant seasonal variation of AMI were 26.2%, 23.1%, 26.8% and 23.9% of MI occurred in the spring, summer, fall, and winter respectively (P>0.05). The average number of AMI occurrence, was significantly greater in three days of full moon phase in lunar months than other days (P<0.05). Our results indicated a significant day of week variation in AMI occurrence with higher peak on Saturday and full moon phase of lunar month. With regard the lunar and solar month variation, more investigation, with larger sample sizes is still necessary but in Christian months, MI occurrence was significantly increased in November.

During two years study about mitochondrial disease (Sep 1999-Agu 2001), 15 cases of Leigh syndrome (LS) were diagnosed, that consisted of 11 boys and 4 girls aged between 6 to 156 (mean: 40.5) months. Most of the patients (46.7%) became symptomatic between 1-5 years of age. Triggering factors were reported in 66.6% of the patients and 40% of them became symptomatic after infections. The most frequent presenting symptoms of the patients were somnolence and lethargy (40%), developmental regression (20%) and seizure (13.3%). The most common neurologic findings were developmental regression or arrest (93.3%), seizure (93.3%) abnormal tone (86.7%) and abnormal movements (53.3%). Blood lactate increased in 93.3% and blood ammonia elevated in 26.7% of the cases. Symmetric striatal necrosis (100%) and caudate nucleus involvement (73.3%) were the most frequent neuroimaging findings of the patients.

Goiter is common among growing children and adolescents but thyrotoxicosis is a rare thyroid disorder in this age prevalence of thyrotoxicosis and clinical presentation in prevalence of thyrotoxicosis and clinical presentation of the disease among children and adolescents of the disease among children and adolescents presenting for goiter at the clinics of pediatric presenting for goiter at the clinics of pediatric Endocrinology of Tehran and Iran University of medical sciences and private offices. In a retrospective study the medical records of 424 patients with goiter were studied of whom 384 (285F, 99M) and goiter and records available for review. All patients were examined by pediatric endocrinologist and their goiters were classified according to WHO criteria. Total T4, TSH, T3 and T3RU were measured. Out of the 384 cases that were diagnosed as goiter, 320 were euthyroid (83.4%), 49 were hypothyroid (12.7%) and 15 were hyperthyroid (3.9%). Ninety-three percent of the hyperthyroid patients had graves’ disease and seven percent of them had toxic adenoma. The most common presenting feature in thyrotoxic patients was goiter. Sustained remission with medical treatment alone was attained in 46% with a mean treatment duration of 2.9 years. The comparison was made between the findings of this study and those of western countries indicating that the incidence of hyperthyroidism in Iranian pediatric population is not as high as in North America but is higher than in Europe. Clinical presentation, response to treatment and etiologic causes of the disease in our study was similar to other studies.

Ventilation tube (VT) insertion is the most common otologic operations performed in children, which has great importance in recovery and prevention of hearing loss in children with Eustachian tube dysfunction in critical ages of growth development. The location of the VT insertion varies in different studies; the differences are in recovery rates and sequelae of VT insertion. This study is performed to compare results of various locations of VT insertion in hearing recovery rate and postoperative sequelae in the Booali Hospital from 1999 to 2000 (one-year period). This investigation is a clinical trial in 34 patients with Eustachian tube dysfunction; cases were selected according to history, otologic examination, adenoid radiography, audiometry (SRT, PTA-GAP) and tympanometry. The operating time consumed in the VT insertion and postoperative sequelae were recorded. Recovery rates of SAR and PTA-Gap were 25.14 dB and 18.41 dB in anterosuperior (AS) versus 18/67 dB and 14/85 dB in anteroinferior (AT) VT insertion respectively. Obstruction and otorrhea after VT insertion were 0, 4 and 13, 11 in AS and AI, respectively. Time difference in the AS versus AI was not significant. The assessment confirmed that anterosuperior VT insertion has better hearing recovery rate and lower postoperative sequelae.

Citric acid and tetracycline HCl are the most common clinical root demineralization agents used in periodontal practice. In this comparative in vitro study the effects of Nd: YAG laser radiation on root surface was compared to that of citric acid and tetracycline HCl using SEM. A total of twenty-one freshly extracted periodontally diseased single rooted premolar teeth were root planned in vitro. The proximal surface of each root was sectioned and divided to two equal surfaces of experimental and control. In group “A” Nd: YAG laser a power of 2 watts was used for 2 minutes at 0 pps. In group “B” citric acid PH=1 was applied for 3 minutes & in group “C” 5% tetracycline HCl solution PH=3.3 was applied for 5 minutes. SEM results showed removal of smear layer, changes in surface characteristics and opening of dentinal tubules in all 3 groups when compared to controls. Nd: YAG laser group signs of surface cracking, pits and craters were observed and removal of smear layer was not complete at 2 watts power and tubular opening was minimal. In group “B” smear layer was completely removed, micro fractures were seen and large opening of tubules were observed. In group “C”, more numbers of tubules were opened but openings were not large as in group B”, smear layer completely removed and experimental surfaces were smooth and no micro fractures were seen. This study showed that Nd:Yag laser could be used for the purpose of root demineralization but it needs further investigations with modification in factors influencing laser effectiveness to be used as a common method of root surface demineralization.

Angiofibromas are the most common benign tumors of the nasopharynx, Intracranial extension has been reported in approximately 20-25% of cases. Intracranial extension may be difficult to treat because of poor exposure that may lead to recurrence. A 16-year-old male patient presented with a 6-month history of nasal obstruction, intermittent epistaxis, right superior orbital fissure syndrome, and proptosis. Imaging studies revealed a large right sinonasal mass with significant intracranial and infratemporal extensions. The tumor was resected by Le fort I technique because of dissatisfaction with other approaches. Postoperative period was uneventful and follow-up visits showed marked improvement in proptosis and ophthalmologic symptoms, without the evidence of tumor recurrence. Commonly used to treat facial deformities. The Le Fort I osteotomy with down fracturing of the entire palate has been adopted as a surgical option in the management of some angiofibromas. Compared with other popular techniques, it provides excellent exposure for angiofibromas. The merits and limitations of this approach as well as its details are discussed.

Grave’s disease is a clinical syndrome consisting of hypermetabolism, diffuse thyroid enlargement and exophthalmos. Which has ocular complications. Due to the high incidence of these complications and the risk of blindness special attention is needed. Many therapeutic methods including medical surgical and radiotherapy for ocular complications are suggested. In cases of medical therapy failure, surgery is recommended. One of its methods is orbital decompression and if needed optic nerve decompression by transnasal endoscopy. A Graves’ patient with bilateral exophthalmos and severe visual loss was operated. With this method. After surgery in addition to return of normal eye appearance and eye movements, visual acuity of left eye improved significantly. This article describes this method, its results and complications.