Medical Journal Of the Islamic Republic of Iran
Volume:22 Issue: 1, Spring 2008

Resection of the distal end of the radius is indicated in the treatment of locally aggressive primary benign and malignant bone tumors. The aim of this study was to evaluate the technique of osteoarticular allograft reconstruction of the distal radius after wide excision of a giant-cell tumor. We analyzed 15 patients retrospectively who had reconstruction of the distal aspect of the radius with use of an osteoarticular allograft, between 1981 and 2005 after excision of a giant-cell tumor with a minimum follow-up of 2 years (range: 26–125 months, median: 45 months). 15 consecutive patients with a Campanacci grade 3 giant-cell tumor of the distal radius formed the study population. Three patients had a local recurrence at 8, 14 and 18 months. Non-union of the osteotomy line was diagnosed 6 months after surgery in one case and needed bone grafting. Distal radio–ulnar joint instability was observed in nine cases. Subchondral bone alterations and joint narrowing were present in all cases but were painful in only one patient. Five patients needed a revision of the osteoarticular allograft, at an average of 5.4 years (range: 0.8 to 12 years) after the initial reconstruction. The reason for the revision was a fracture of the allograft in four patients and recurrence of the tumor in one. Of the fifteen patients in whom the osteoarticular allograft survived, five patients reported no functional limitation, eight had limitation in the ability to perform strenuous activities, and two had limitation in the ability to perform moderate activities. The average range of motion of the wrist was 35 degrees of dorsiflexion, 30 degrees of volar flexion, 10 degrees of radial deviation, 14 degrees of ulnar deviation, 55 degrees of supination, and 70 degrees of pronation. Reconstruction of the distal aspect of the radius with use of an osteoarticular allograft was associated with a low rate of recurrence of the tumor, a moderately high rate of revision, and little pain in association with common activities, good function, and a moderate range of motion.

The pathophysiology of carpal tunnel syndrome is associated with increased intracarpal canal pressure. Recently, palmaris longus has been introduced as an independent risk factor for the development of carpal tunnel syndrome. The purpose of this study was to assess the association of carpal tunnel syndrome with the presence of palmaris longus tendon and functional superficial flexor of the fifth finger. Fifty-four patients with severe and bilateral carpal tunnel syndromes that had indications for carpal tunnel release, and underwent surgery, were enrolled prospectively in this study. Seventy patients as control group were selected on a basis of age, gender, occupation, diabetes mellitus, thyroid disease, and rheumatoid arthritis. The presence or absence of the palmaris longus tendon and functional superficial flexor tendon to the little finger were assessed in both groups clinically. The prevalence of palmaris longus agenesis was significantly lower in the carpal tunnel group but there was no association between carpal tunnel syndrome and presence of functional superficial flexor to the little finger. The presence of the palmaris longus tendon is associated with the development of carpal tunnel syndrome.

Over the past 20 years, the minimally invasive endoscopic approach has gained widespread acceptance. The study was performed to evaluate the diagnostic method and the success rate of endoscopically diagnosed and treated CSF rhinorrhea, and also investigations such as leakage site and etiologic factor. This retrospective CSF leakage management review of patients experiencing CSF rhinorrhea made from 1999-2006 included data regarding leakage etiology, preoperative assessment, intraoperative techniques and postoperative followup. Sixty-five patients were managed endoscopically. CSF rhinorrhea etiology was traumatic in 30 cases, iatrogenic in 23 and spontaneous in 12. We used nasal endoscopy and high resolution computed tomography (HRCT) in all 65 cases while CT metrizamide cisternography was used in 5 specifically and magnetic resonance imaging for 5 others. Intrathecal fluorescein was used for intraoperative assessment without complications, and only one case of meningismus was noted. Several imaging methods were effective in diagnosing CSF leakage sites. Endoscopic management and autografts were successful in repairing anterior skull defects in 90.76% of the cases.

Backround: The first episode of an afebrile seizure is a common cause of admission of children to emergency departments. Alot of tests are routinely performed for these patients. The cost of such an evaluation is high and benefits are doubtful. We conducted this study in order to evaluate the results of the tests and find out what tests are necessary for children with first unprovoked seizure. In a 7-year retrospective study files of 150 children aged between 1 month and 14 years admitted with first afebrile seizure to the pediatric ward of Rasool Akram hospital were reviewed. Reports of the brain neuroimaging studies (Ct-scan & MRI) and laboratory tests were extracted. 150 patients with a mean age of 53 ± 48 months qualified for inclusion in the study. 143 (95%) of 150 children with first afebrile seizure were imaged. Ninety percent (128/143) had normal neuroimaging. Emergent computed tomography as the initial study was performed in 90% (128/143) and MRI in 10% (15/143). Sixty patients had both MRI and CT-scans. Clinically significant neuroimaging abnormalities were reported in only 9.7% (14/143). There was a significant relation (P<0.001) between focal seizures and abnormal neuroimaging. Children under 24 months of age were also more prone to have abnormal imaging (p<0.002). Laboratory tests including complete blood count (CBC) and chemistry panel (Na, K, Ca, BUN, Cr) were performed for all. Only two patients had low serum calcium level, later diagnosed as vitamin D resistant rickets. The most important aspect of management of a child after a first afebrile seizure is careful history taking and physical examination. Laboratory tests should be requested in very limited situations. Emergent brain CT-scans are recommended for children with focal seizures, abnormal findings on physical examination, presence of any predisposing factors and those under 24 months of age.

Hysterectomy is the second most common major surgery procedure done after cesarean section by gynecologists in many countries and the most common procedure is total abdominal hysterectomy (TAH). The incidence of laparoscopically assisted vaginal hysterectomy (LAVH) performed for benign lesions has progressively increased in recent years. Our objective was to compare the relative advantages and disadvantages of LAVH and TAH procedures. A clinical trial was performed on patients who were candidates for hysterectomy with benign reasons in Arash hospital from March 2006 to April 2007. By simple randomization, 90 patients (30 for LAVH and 60 for TAH) were selected. Demographic details and intra-operative and post-operative complications were recorded by the staff and were compared between the two groups. On average, LAVH operations took significantly longer than TAH operations (100.17 ± 39.35 minutes; 145.83 ± 41.55 minutes; P< 0.0001). The total length of hospital stay was significantly shorter after LAVH than after TAH (3.43 ± 0.90 days; 3.94 ± 1.02; P= 0.025). Although the hemoglobin (gr/dl) drop in LAVH was significantly higher than TAH (1.22 ± 0.94 and 0.58 ± 0.82, P=0.0012), blood transfusions were more common in TAH (1 case versus 3 cases). The drug requirement to control pain during hospitalization after the two surgeries was not significantly different between the two groups. Fever was observed more often in the TAH group (P = 0.051). Finally, Intra-operative and post-operative complications were lower in LAVH than TAH. Although operation length is significantly higher in LAVH, this procedure is safer and more comfortable for patients and health care providers.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and is an important health economic problem. Since 1960, there has been an increase in mortality associated with COPD, especially in men. Acute exacerbations form a major component of the socioeconomic burden of COPD which mainly results in long-term hospitalization. Despite the high number of COPD-related hospitalizations, relatively little is known about the mortality rate and related determinants of patients hospitalized for this acute deterioration in the clinical course of COPD. The aim of this study was to evaluate the factors affecting duration of hospitalization in Iranian patients with COPD. This cross-sectional study was performed on 68 COPD patients who were hospitalized in Rasool-e-Akram hospital in Tehran, Iran for the period 2005-2006. During hospitalization, patients’ chief complaint, symptoms and signs, results of physical examinations,spirometry, arterial blood gas (ABG) and ICU admission were recorded. Data were analyzed using Independent T-test, One Way ANOVAand Correlation tests. The patients were 41(60.3%) males and 27(39.7%) females with the mean age of 69.7(SD=13.52) years. The mean duration of hospitalization was 11.82(SD=5.49) days and 3(4.4%) patients died. The family history of pulmonary disease (P=0.018), habitual snoring (P=0.031), and mean baseline arterial PaO2 (P=0.010, r= -0.361) were determined as factors affecting duration of hospitalization. On the other hand, other factors such as smoking (P=0.992), patient’s gender (P=0.735) and spirometric indices did not significantly associate with duration of hospitalization. The fact that people hospitalized with COPD have a subsequently increased risk of death compared with those not hospitalized suggests the former are an atrisk group and shows the importance of factors affecting duration of hospitalization. Our results show that more attention must be paid on habitual snoring and low arterial pO2 which may have potential effects on duration of hospitalization in COPD patients.

Due to the high incidence of breast cancer and the effect of its early diagnosis on decreasing morbidity and mortality, we used the Gail model to study breast cancer risk in Iranian women. This study was done in a simple randomized way. Participants were 2000 Iranian women older than 35 years old. The questionnaire consisted of demographic data such as age, race (optional) marriage status, level of education and standard questions of the Gail model. Gathered data were given in http://bcra. nci. nih.gov/brc. The breast cancer risk was calculated within the next 5 years and within the 90 years life span. The statistical analysis was done by SPSS software. Mean age of women in the study was 47.95 years. 50% of women had their menarche at/older than fourteen years of age. 50% of women had first childbirth in their twenties. 87% had a negative family history of breast cancer. 94% had no history of breast biopsy. Of the remaining 6%, no tissue atypia was reported. In the present study, breast cancer risk within 5 years was 0.92% and the breast cancer risk within 90 years of life was 9.14%. 7% showed risk of more than 1.67% in the Gail model. The age ranged between 55-65 years in this high risk group. In our study of breast cancer risk in Iranian women, breast cancer risk was lower than the control group in the Gail model estimate for 5 years and a 90-year life span. (0.92% versus 1.02%, 9.14% versus 11.21%). The differences were statistically significant (p<0.001).

Amyotrophic lateral sclerosis (ALS) is a progressive neurological disorder with high mortality and morbidity. Some risk factors have been implicated for ALS such as exposure to high magnetic fields, and trace elements like selenium, cadmium and lead. Afew studies have been carried out throughout the world to evaluate the prevalence of ALS among veterans. This study was aimed to evaluate ALS frequency among Iran – Iraq war veterans. Medical records of 52580 veterans were studied and those with suspected neuromuscular disorders were referred to a blind neurologist. ALS was verified according to World Federation of Neurology criteria. Student t-test and chi-square test were used for analysis and a P value less than 0.01 was considered significant. Eleven definite ALS and two possible ALS cases were identified among the subjects. The mean age of onset of the disease was 43.7±9.7 years. All subjects had a record of at least three months involvement in action and symptoms began to show up after 16.5±3.6 years. The mean interval between exhibition of symptoms and the definitive diagnosis of the disease was 16.5 months. The prevalence of ALS in our population was significantly greater than that of international surveys (P<0.01). The onset of the disease occurred at a significantly lower age than typical ALS (P<0.01). Military service might therefore be a risk factor for ALS.

Malacoplakia is a rare chronic inflammatory disease associated with infection and immunosuppression, and very few occurrences have been reported in the bone. The authors describe the case of a 22-year-old woman with paraplegia and urinary and fecal incontinence whose thoracic spine Magnetic Resonance Imaging suggested a tumoral or extensive inflammatory process in the body of the 8th, 9th and 10th thoracic vertebrae. On histology, however, the area turned out to be malacoplakia of bone. Although microbiologic cultures and polymerase chain reaction were negative for Mycobacterium tuberculosis, the lesion demonstrated regression following treatment with anti-TB regimen which had been started because of clinical suspicion.