Medical Journal Of the Islamic Republic of Iran
Volume:23 Issue: 3, Autumn 2009

Despite being the largest rotator cuff tendon of the shoulder, the function and clinical relevance of subscapularis pathology has been largely ignored in the literature. Although many studies have focused on subscapularis tears recently, majority of them reported techniques for open repair. The advent of arthroscopy and arthroscopic repair techniques has opened new frontiers in the diagnosis and repair of torn rotator cuff tendons, including the subscapularis. In this article, we review shortterm results of arthroscopic subscapularis repair.

Ten patients with subscapularis tendon tear of the rotator cuff were studied prospectively including 8 men and 2 women with an average age of 49.7±12.8 years and an average delay in treatment of 23.3 months. Clinical outcomes, including the UCLAscore were assessed in all patients after 3 months of the surgery.

6 patients were followed regularly for more than 6 months, while other 4 patients had a follow-up period of more than a year. The pain score improved from 1.75 to 9 and the UCLA score from 8.8 to 30.6.

Arthroscopic repair of subscapularis tendon tear results in significant subjective and objective improvement and high levels of patient satisfaction

To improve the debilitating features of Parkinson disease (PD) different medical and surgical approaches are available. Subthalamic nucleus deep brain stimulation (STN-DBS) was appeared to be a promising method during last two decades. This study aimed to evaluate early motor outcomes of this procedure in first trial of Iranian patients.

Thirty-seven consecutive patients with advanced Parkinson disease with poor response to common medical agents underwent bilateral STN-DBS. For assessment of motor function parameters Unified Parkinson Disease Rating scale III (UPDRS III) was used. We compared total scores and subscores in three measurements performed as 1) preoperative off-medication, 2) preoperative on-medication and 3) six months postoperative on stimulation and on medication. Reduction in drug consumption was assessed with regard to administered doses of L-Dopa before and after surgery in stable states.

26 men and 10 women with mean age of 50 years were evaluated (one person expired before 6-month follow-up). Mean total scores of UPDRSIII were calculated as 5.2±54.52, 2.88±18.22 and 3±12.8 in three measurements, respectively (p=0.003). PostHoc analyses showed significant improvement among all measurements. Analysis of subscores also revealed significant amelioration in rigidity, resting tremor, hand movement, leg agility, finger tap and rapid alternating movement in on-medication phases of pre- and post-operation (all with p<0.01). The mean administered L-Dopa were224±1296 mg/d and 174±782 mg/d before and after surgery, with significant decline (p<0.001) in administered L-dopa dose.

The results indicate that bilateral STN-DBS can lead to significant short-term improvement of the motor symptoms especially in some debilitating symptoms such as rigidity and tremor in advanced PD. It also accompanies with remarkable reduction in needed doses of drugs. The findings support other studies with similar follow - up interval; however, continuous evaluations are needed for long-lasting effects.

The tibial diaphyseal fractures are the most common type of long bone fractures encountered by most orthopedic surgeons. In accordance with descriptive indices of tibia fractures on the basis of their location in the bone, distal tibia fractures have the second incidence of all tibia fractures after the middle tibia fractures. The purpose of the study was to assess the complications and treatment outcome of closed extra-articular distal tibia fracture.

The results of the management for 76 patients with closed extra-articular distal tibia fracture by intramedullary nailing and plating were reviewed retrospectively. The variables included AO (Arbeitsgemeinschaft fur Osteosynthesefragen) classification of tibia fracture, the mean duration of union, malunion, and nonunion.

Twenty seven and forty nine patients were treated by intramedullary (IM) nailing and plating respectively. The most common type of fractures was A1 which was observed in twenty five patients. Initial union and nonunion occurred in sixty three and thirteen patients respectively. Eight patients had nonunion in plating group and five of twenty seven patients in IM nailing group. Eleven of twenty seven patients in IM nailing group suffered from malunion while only four patients in the other group had this complication.

The plating Technique in comparison with IM nailing has a satisfactory functional outcome. The technique has a lower incidence of malunion and nonunion, and it should be recommended as a good treatment option for the management of extra-articular closed fracture of distal tibia.

Iatrogenic airway injury after endotracheal intubation and tracheotomy remains a serious clinical problem. In this study we reviewed post-intubation and traumatic tracheal stenosis in 47 patients with a special attention to the cause, hense surgical treatment of the stenosis was performed and the results compared with the literatures.

Since February 1995 through January 2005 a total of 47 patients with tracheal stenosis and subgllotic as a result of tracheostomy or intubation in a single institution, were explored in this study and examined for the outcomes of stenosis management. There were 39 tracheal and 8 infraglottic stenosis. Our management strategy for stenosis was end-to-end anastomosis, and cartilage graft tracheoplasty.

Our management strategy for treatment of tracheal stenosis with resection and end-to-end anastomosis was associated with good outcomes. Patients were treated by tracheal or partial laryngotracheal resection. The overall success rate was 93% with the complication rate of 18%. A second operation was required on 2 patients (4%).

Long term tracheal tubes or intubation tubes and poor quality material tubes were the most common causes of these respiratory strictures. Our current procedures of choice for tracheal stenosis is sleeve resection with end- to -end anastomosis for short- segment stenoses (up to six rings). Cartilaginous homograft was performed when the loss the cartilage limited to the anterior part of trachea. The most common late complication was the formation of the granulations at the suture line. Granulation tissues can usually be managed with Laser or bronchoscopic removal.

To evaluate proximal junctional segment changes in Adolescent Idiopathic Scoliosis(AIS) the posterior spinal fusion and also instrumentation also and finding of probable risk factors, were all considered in this study.

We retrospectively reviewed radiographs of 121 consecutive patients who underwent posterior spinal fusion for AIS from T3 or below, with a mean follow- up of 32.8 months(range,24-83). All coronal and sagittal measurements including the proximal junctional kyphosis (PJK)angle recorded on standing anteroposterior and lateral radiographs preoperative, early postoperative and on follow-up radiographs. The data were analyzed using the Spss 10.0 software. Dependent(paired) samples student t-test was used for analysis between the groups

There was PJK angle above normal for the same junctional segment preoperatively in 13 patients (10.7%) and the incidence of the PJK postoperatively was 7.4% (9 patients, 7 female and 2 male), all detected until 2 years postoperation.The mean increase in the PJK angle from pre-operation until 6 weeks postoperation was 5.9° (range,0-13°)(P=0.02) and until 2 years post operation was 14.3° (range, 2- 16°)(p=0.000). The mean proximal junctional angle increased 1.6° until 2 years postoperation in non-PJK group(n=112).

The prevalence of Proximal Junctional Kyphosis was low and a silent radiographic problem. In some cases is preventable with perfect pre-operative planning. There is no specific demographic or radiographic variables or instrumentation types associated with developing PJK.

The quality of life and standard of health care in a society is measured by its preterm infants'' mortality rate. The popularity and credibility of alternative treatment such as touch therapy may be effective in preterm and low birth weight infants in order to increase their survival rate. The aim of this study was to determine the effect of touch intervention on the weight gain of preterm infants who were admitted to the Neonatal Intensive Care Unite(NICU).

This study was a randomized controlled trial performed in NICU of Emamreza hospital, Mashhad, Iran, from July 2007 to November 2007. There were two groups (the control group and the case group) and one response variable (weight gain). Infants in the control group received routine nursing care. Infants in the case group, in addition to the routine care, received stroking/passive limb movement therapy for three 15 minute sessions per day for a 10 day period. Then weight gaining was compared between the two groups.

The weight gain data was analyzed by SPSS software. Over the 10 day study period, the case group gained significantly more weight compared to the control group (p<0.001 (.

The data suggest that stroking/passive limb movement can be an efficient and cost effective way of enhancing growth in stable preterm infants.

Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and up to 25% of visits to pediatric gastroenterologists. However, little is known about the prevalence of childhood constipation in developing countries and the frequency of its causes. We proposed to determine the frequency and causes of constipation in children presented to a gastroenterology clinic of a teaching pediatric hospital located in Tehran, Iran.

All five hundred and fifty six children referred to a pediatric gastroenterology clinic were evaluated for gastrointestinal problems including difficulties in defecation. After the detection of constipated children, a questionnare was completed including baseline characteristics, physical examination, paraclinic laboratory data and determination of the cause of constipation (organic or non-organic).

Out of all 556 children, constipation was diagnosed in 87 individuals (15.64%). Among children with constipation, 53% were girls and 47% were boys and only in 13% organ problems was the main cause. Urinary incontinence and encopresis were detected in 16.2% and 27% of constipated children, respectively. The prevalence of urinary tract infection in children with constipation was significantly higher in girls than boys (P<0.05).

The results of our study show that the prevalence of constipation among Iranian children is high enough to emphasize it''s importance.

Testicular torsion is a medical emergency appearing at any age, the prevalence of which in the neonatal period comprises 10% of the whole cases occurring at any point in life. Among all the cases being diagnosed at birth, 70% has occurred in the prenatal period and 30% in the neonatal period. Generally, the most common symptoms of testicular torsion during postnatal period include acute pain and swelling of the testis, but in the neonatal period it is often manifested by firmness and swelling of the testicle. Accordingly, careful attention of the physician and the medical staff while examining the newborn results in quick diagnosis and timely medical treatment of the torsion. This medical intervention prevents irreversible necrosis of the affected testis-the main consequence of the torsion-and helps to restore its function. The major purpose of this study was to draw the attention of physicians and medical teams to prompt diagnosis of testicular torsion. This study presents two newborn babies with testicular torsion, diagnosed at early hours after delivery, who underwent surgical treatment within first 8-10 hours after birth.

Acase of 48-year-old male, hepatitis B cirrhosis, hepatic hydatid cyst, jaundice, fever, chills suffered from severe abdominal pain in the right upper quadrant. He was suffered from acute cholangitis and spontaneous bacterial peritonitis, and received intravenous antibiotics but his condition rapidly deteriorated to sepsis and severe hepatic failure. The presence of dilated Common Bile Duct (CBD) containing small cystic lesions suggesting daughter cysts on ultrasonography, which was further verified by Endoscopic Retrograde Cholangiopancreatography (ERCP), along with significant eosinophilia and positive serology test for hydatid cyst, made the diagnosis of intrabiliary rupture of hydatid cyst definite. We performed a delayed endoscopic sphincterotomy which resulted in complete resolution of the clinical picture. The patient was treated with Albendazol and Lamivudin and was referred for surgery

A solitary plasmacytoma of bone occurs in approximately 2-5% of patients with myeloma. The lesion mostly found in the axial skeleton and have infrequently been reported to arise in the hand, and usually occur in the distal phalanges. We report the interesting case of a 75-year-old man who developed a solitary lytic lesion of the thumb proximal phalanx. This lesion was explored through MR imaging and histologic examination, and then a final diagnosis of plasmacytoma was determined. He was treated with fractionated radiotherapy and no complication was detected with this procedure. The clinical, imaging, and histologic findings of this case are presented here.