Journal of Research in Medical Sciences
Volume:13 Issue: 5, Sep & Oct 2008

Most experts accept the use of curettage, phenol, and cement as the best treatment to prevent recurrence of giant-cell tumors. The purpose of this investigation was to analyze the effect of cement as a filling material and compare it with bone graft and the effect of high-speed burr in local recurrence of giant cell tumor after curettage. We retrospectively reviewed 168 consecutive patients diagnosed with giant cell tumor at the three most common sites (distal femur, proximal tibia, and distal radius) to determine the pattern of local tumor recurrence. Only patients who had intralesional excision of primary tumor by curettage without a surgical adjuvant were included. A total of 168 patients with primary giant cell tumor were treated with curettage. The female to male ratio was 1.4: 1 and the mean age was 34 years (range: 17-68 years). The minimum follow-up was 24 months and the median follow up was 75 months. The knee region was involved in 135 (80.4%) patients. There were 10 (5.9%), 130 (77.4%) and 28 (16.7%) patients in Campanacci grade I, II and III, respectively. Tumor surgery was supplemented with high speed burring in 88 (52.4%), bone cement in 82 (48.8%) and bone grafting, either autograft or allograft in 86 (51.2%) patients. The recurrence rates were 18.2% and 37.5% for curettage with or without high speed burring, respectively. For 46 (27%) recurrent lesions treated by curettage, the recurrence rate was 35%. The nature of the filling material used did not show any significant impact on the outcome of recurrence rate. Despite the high rates of recurrence after treatment of giant-cell tumor with curettage, the results of the present study suggested that the high-speed burr is effective in reducing the rate of recurrence. The risk of local recurrence after curettage with a high-speed burr and reconstruction with bone graft is similar to that observed after using cement. It is likely that the adequacy of the removal of the tumor rather than the use of adjuvant modalities is what determines the risk of recurrence.

Over 40 millions pregnant women are suffering from iron deficiency (ID) and it’s consequences in developing countries presently. If the effects of twice weekly iron supplementation on hemoglobin (Hb) and serum ferritin (SF) to be shown comparable to daily iron supplementation in pregnancy, it will reduce the cost, will diminish the side effects, will increase the compliance and will prevent the potential harmful effects of extra iron supplement. A total of 152 pregnant women were enrolled in the study in two different clinics in Isfahan, Iran. The inclusion criteria were 2nd trimester pregnant women aged between 18-38 years with the initial Hb >= 110 g/L. They were randomized into two treatment groups, either the twice weekly (TW) taking iron group (two 45-mg ferrous sulfate tablets per week) or daily taking iron group (45 mg ferrous sulfate tablet). The age, weight, education and employment status of pregnant women along with their parity distributions and gestational age at onset of treatment in the two groups were comparable. Sixty nine and fifty three pregnant women of daily group and TW group, respectively, could be followed up regularly at 4 weekly intervals until 16 weeks of supplementation. Side effects, compliance and the number of tablets consumed were noted for each group. Blood was sampled at 15-16 and 37-39 weeks of pregnancy and blood indices were evaluated to see the effect of iron supplementation. The mean initial Hb concentrations were 133 ± 11 g/L and 130 ± 12 g/L in daily and TW groups, respectively, which were not significant. The mean final Hb concentrations were 127 ± 15 g/L in daily group and 120 ± 13 g/L in TW group (p < 0.05). The decrease of Hb from the start to the end of therapy was significant in both groups and the decrements significantly were less in daily group. The SF increased non-significantly in daily group and decreased nonsignificantly in TW group but, there was no difference in ferritin values of the two groups at near term. Daily regimen was more effective than TW regimen in preventing Hb decrement at near term in our study.

Ifosfamide (IFO) is an alkylating cytostatic agent with nephrotoxic properties. Most often it causes disturbances in proximal tubular function manifesting as glycosuria, albuminuria, hyperphosphaturia with hypophosphatemia, tubular acidosis, and hypokalemia. Impairment of renal glomerular function is less frequent and manifests as reduced glomerular filtration or distal tubulopathy along with the symptoms of diabetes insipidus. A significant percentage of patients also develop neurotoxic side effects. The aim of this study was to assess the incidence of side effects in patients treated with IFO for neoplastic diseases. This was a prospective study on all admitted patients that received Ifosfamide for chemotherapy. After full physical examination and performing necessary paraclinical examinations (sodium, potassium, calcium, BUN, creatinine, uric acid, SGOT, SGPT, bilirubin and ECG), information forms for all of them were filled out at admission and in follow up visits to be used in final assessment. Renal function was assessed at the beginning of chemotherap and then regularly during subsequent cycles. Sixty-six cases were male and 34 cases were female. Mean age was 36.4 years. Alopecia was recorded in 70 cases (70%) and nausea and vomiting in 43 cases (43%). Nephropathy (increased BUN and creatinine, gross hematuria, phosphaturia, glucosuria) was not observed in any patient. In 8 patients, microscopic hematuria was detected. Twentythree patients had bone marrow suppression, and 7 cases showed severe neutropenia and broad spectrum antibiotics were prescribed for them. I did not find any culture positive infection. Serum electrolyte imbalance, diarrhea and severe allergic reactions were not observed. Ifosfamide may potentially produce both mild and severe renal side effects. Side effects of IFO should be evaluated in different populations with different genomic profiles.

Nerve injury is a serious complication of intramuscular injections. About 12 billion injections are administered worldwide annually among which 50% are unsafe and 75% are unnecessary. Three hundred and ten patients with post-injection nerve injury attended the Department of Orthopedics, Government Medical College Srinagar (India) from Jan 2002 to Dec 2007. All patients were evaluated for the drug injected, site of injection, indication for injection and person who injected the drug. Severity of neurodeficit and socioeconomic and educational status of the patient was also noted. A total of 278 patients had sciatic nerve injury, 29 had radial nerve injury and 3 had axillary nerve injury. One hundred and forty one were male and 169 were female patients. Injections were administered by unqualified persons in 258 patients (83%). Patients’ age ranged from 1 to 98 years (mean 37 years) and they were followed for 24 to 60 months (mean follow up 36.6 months). This alarming situation of unsafe injection practice needs an urgent check by preventing unauthorized personnel from injecting medicines, organizing compulsory update and refresher courses for all health service staff and educating the patients.

The aim of this study was to investigate whether the lipid peroxidation levels and activities of erythrocytecytoprotective enzymes can be affected by iron deficiency anemia (IDA) in menstruating women. In this case-control study, 43 women with IDA, 43 women with iron deficiency (ID) and 43 healthy controls were included. Lipid peroxidation levels were assessed by measuring the concentrations of plasma malondialdehyde (MDA) (as byproduct of lipid peroxidation). We also evaluated the activities of erythrocyte cytoprotective enzymes by measuring activities of copper zinc-superoxide dismutase (CuZn-SOD), glutathione peroxidase (GPX) and catalase (CAT) in selected groups. Furthermore, total antioxidant capacity (TAC) of plasma was assessed for each subject.Comparisons between continuous variables across groups were performed by the calculation of one-way analysis of variance (ANOVA). Mean plasma concentration of MDA was significantly higher in IDA group than that in ID group (3.49 ± 0.84 vs. 2.76 ± 0.59,? mol/L, respectively, p < 0.01) and healthy group women (3.49 ± 0.84 vs. 2.94 ± 0.71? mol/L, respectively, p < 0.01). No significant difference was observed between ID and healthy groups in plasma MDA concentration (2.76 ± 0.59 vs. 2.94 ± 0.71, respectively). The mean erythrocyte CuZn-SOD activity in IDA group was significantly lower than that in healthy group women (674 ± 89 vs. 796 ± 82, respectively, p < 0.01). Furthermore, erythrocyte CAT activity was significantly lower in IDA group compared to both ID (162 ± 52 vs. 193 ± 72, respectively, p < 0.01) and healthy women groups (162 ± 52 vs. 234 ± 68, respectively, p < 0.001). No significant difference was observed between study groups in erythrocyte GPX activity. In addition, plasma TAC levels were significantly lower in IDA and ID groups compared to healthy women group (1.97 ± 0.42 and 2.16 ± 0.64 vs. 3.76 ± 0.86, respectively, p < 0.01). Our findings showed that activities of erythrocyte cytoprotective enzymes decrease and lipid peroxidation increases in women with IDA. The consequence of the low activity of the cytoprotective enzymes in human is progressive tissue damage, which may eventually lead to atherosclerosis and other degenerative diseases.

Inflammatory cells in the tumor stroma have gained increasing interests recently. We aimed to study the prognostic impact of the presence of stromal mast cells in invasive breast carcinomas. Tissue sections of 108 cases with invasive breast cancers were prepared and stained with Giemsa. The presence of stromal mast cells were evaluated and its correlation with tumor’s grade, tumor size, positivity for estrogen and progesterone receptors (ER and PR, respectively), HER2/neu positivity and lymph node metastasis was analysed. The median age was 52.3 years (range 28-85 years). Grading was done according to the Nottingham Modification of the Bloom-Richardson system. Fifty-four (50%) women had grade 1, 16 (14.8%) had grade 2 and 38 (35.2%) had grade 3 tumor. The presence of stromal mast cells correlated significantly to low grade tumors (p = 0.004) and ER Positivity (p = 0.04). There was no correlation between the presence of stromal mast cells and the PR positivity, HER2/neu positivity, tumor size and lymph node metastasis (p > 0.05). Our results indicated that the presence of mast cells in breast cancer is correlated with a much lower grade of this tumor. Also in our study, there was a positive correlation between ER receptor positivity and the presence of mast cells in the stroma of breast cancer.

Tibial shaft fracture is the most common type of long bone fractures, and intramedullary nailing is the treatment of choice. Anterior knee pain (AKP) is the most common complication of tibial nailing. The exact etiology of AKP is unknown, and the reported incidence is between 10-86%. Since many activities of daily living of Iranians need kneeling, squatting, and tailor position, knee pain can effectively limit these activities. We decided to evaluate knee pain in patients with tibial shaft fractures treated with unreamed intramedullary nailing in our hospital. We evaluated 232 patients between 16-77 year-old with tibial shaft fractures treated with intramedullary nailing from 2005 to 2007 with six months follow up period. According to visual analogue scale (0-10), 165 (71.1%) patients had no pain. Anterior knee pain was mild in 54 (28.9%) cases; 12 (5.2%) cases had moderate pain, and one patient (0.4%) experienced severe pain. The most severe pain was felt in kneeling position and the mildest pain was felt in resting position. The incidence of moderate to severe AKP in patients who had intramedullary nailing for tibial shaft fractures was relatively low. In view of medicolegal litigation, patients should be aware of this complication.

This research is aimed at determining the efficacy of intravenous dexamethasone and metoclopramide for treatment of acute migraine. Dexamethasone is a well-known drug for treatment of long lasting and recurrent migraine headaches. Metoclopramide is also used singularly or as an adjunct to treat the migraine attacks. In a simple randomized study, patients with acute migraine were administered either intravenous dexamethasone and metoclopramide or intramuscular dihydroergotamine. Headache and concurrent symptoms were rated at baseline and 1, 2, 4 and 24 hours post-injection.. Analysis of headache severities indicated significant alleviation in both groups with time (p < 0.001). Side effects and concurrent symptoms did not show any significant difference between the two studied groups. In emergency department, intravenous dexamethasone and metoclopramide may be considered as an effective and available treatment with few side effects especially for patients with long-lasing and intractable migraine attacks; however, it must be used limitedly.

Stroke is a common and serious disease, with over a half million new cases per year and 150,000 deaths annually in US. In recent years, the nihilism toward the care of stroke patients has been replaced by a remarkable understanding of the underlying stroke mechanism leading to significant improvement in its management. The aim of this article is to introduce stroke units and at the end, recommendations for stroke unit establishment in Isfahan, the second greatest city of Iran.

Multiple sclerosis (MS) is a chronic neurological disease with different presenting symptoms. We introduce a case of MS presented with hoarseness. A 38-year-old man complaining of hoarseness was referred to our clinic for a sudden palsy of right IX and X cranial nerves. Neurological examination showed signs of right IX and X cranial nerves paralyses, hoarseness, fine unidirectional horizontal nystagmus to the left and bilateral loss of cutaneous abdominal reflexes. Brain MRI revealed McDonald criteria for diagnosing MS. Pulse therapy was started and he recovered in 2 months. Beta interferon 1a began for him and in 9 months follow up, no relapse occurred.

Michael Moore has a knack for locating and highlighting the plights of the nameless, faceless ordinary people who are virtually ignored by the mass media and most politicians, and who have few if any opportunities to tell their stories. Although nearly 50 million Americans have no health insurance and thousands will die every year because they are uninsured, his 2007 film ‘Sicko’ is also about the 250 million citizens who do have health insurance, but for whom the system is tragically malfunctioning. Most of the first part of the film focuses on numerous case studies of patients and their problems with the health care system and insurance companies, and Moore has a unique ability in telling these stories to elicit both tears and laughter from the audience. The first case makes the immediate point of the film by showing a man who accidentally sawed off the tips of two fingers, but who was given the option to repair the middle finger for 60,000USD or the ring finger for 12,000USD. He next profiles a late middle aged couple who were driven to bankruptcy and had to sell their home because their insurance would not cover the costs of their medical treatments, giving them no choice but to move in with their children. Then there is the woman who was in a serious car accident and who was sent a bill by her insurance company for the ambulance ride to the hospital because she did not seek ‘pre-approval’ from the insurance company prior to the accident...