[Comparing open and closed wedge high tibial osteotomy in osteoarthritis of medial compartment of the knee]

High tibial osteotomy is an accepted procedure to reduce the progress of osteoarthritis of medial compartment of the knee and also to decline the patient's complaints such as pain or limitation of physical activities. The aim of this study was to compare two methods of lateral closed wedge and medial open wedge in osteoarthritis of medial compartment of the knee. This study was a prospective clinical trial, performed on 59 patients [37 females and 22 males] at Rasul-e-Akram Hospital in Tehran during 2006 and 2008. The mean follow-up time of the patients after surgery was 27 +/- 6 months. Femorotibial angle, pain, joint's function as well as limitation of motion, total score of Lysholm criteria, and stability of the medial collateral ligament were assessed and recorded before and after surgery. Data were analyzed statistically using Chi-square test, t-test, and Mann-Whitney test. The angles of correction were 9.8 and 9.6 in closed and open wedge, respectively. Seven cases [24.1%] of post-surgery complications were seen in closed wedge and 8 cases [21.1%] in open one among those 4 cases in closed and only 1 case in open wedge needed reoperation. The mean times of the healing process were 3.1 +/- 1.7 and 2.8 +/- 1.2 months after closed and open wedge osteotomy, respectively. There was no significant difference between two methods. Both methods resulted in remarkable decrease in pain along with increased function and Lysholm score after surgery yet no significant distinction was demonstrated between two techniques. In addition, while the stability of medial collateral ligament considerably increased in open wedge method, it slightly decreased in closed wedge technique following surgery. Considering the increased stability of medial collateral ligament by open wedge method and slight instability after closed wedge method, it seems that the instability of the medial collateral ligament before surgery to be one of the most noteworthy indications of medial open wedge osteotomy

[Evaluation of complication after treatment of femoral neck fracture by method of internal fixation]

The incidences of femoral neck fracture are increasing. According to its high complication and lack of enough study about this subject in our country, we decided to perform this study. In this cross-sectional observational study, we evaluated 80 patients with femoral neck fracture who referred to Hazrat-e-Rassol hospital and underwent Internal Fixation from 1383-85. The patients were followed at least one year after surgery. [15%] non-union, 3 patients [3.75%] infection, and 28 patients [35%] pain and claudication. The co: 29 patients [36.3%] had at least one complication: 19 patients a vascular necrosis [23.8%] AVN, 12 patients mplication rate was lower in base fractures than subcapital and transcervical. [p=0.019] In patients without displacement, there was not any complication but 29 of 65 patients with displacement had complication [p=0.001]. The rate of complication became higher when the quality of reduction and fixation was poor [p=0.000]. According to results of this and previous studies, we recommend more attention about the quality of reduction and fixation. Also because the rate of complication was high in group with displacement, the hip arthroplasty should be considered in these patients and patients above 65-year-old with displace fracture

[Prevelance of adynamic bone disease among dialysis patients reffer to Tehran Dialysis Center]

Background: during the last few years the spectrum of renal osteodystrophy [ROD] in dialysis patients has been studied thoroughly and the prevalence of the various types of ROD has changed considerably. Whereas until a decade ago most patients presented with secondary hyperparathyroidism [HPTH], adynamic bone [ABD] has become the most common lesion within the dialysis population over the last few years

Materials and Methods: in this study [n=127], the prevalence of ABD in the memorialized patients [more than 3 months dialysis] was evaluated by means of these biochemical markers [especially PTH<100]. Clinical data on the patients included were recorded at the moment of blood sampling

Results: HPTH was found in only15% of the patients, whereas ABD appeared to be the most frequent renal bone disease as it was observed in 44% of the cases. There was no significant difference between groups in age, sex and serum Albumin, Hb levels. Patients with ABD had significantly higher serum calcium and phosphor levels, whilst HPTH patients were associated with higher serum Alp level

Conclusion: ABD is the most prevalent type of ROD in this population

[Evaluating demographic factors influencing outcome of ACL reconstruction using patellar and medial hamstring tendons]

Background: since anterior cruciate ligament [ACL] reconstruction become more frequently carried out, expectation of less morbidity and earlier return to activities become higher; for this reason defining influencing factors on outcome for selecting patients is valuable. The aim of this study is to investigate demographic factors influencing outcome of ACL reconstruction

Materials and Methods: we evaluate the clinical results of 187 patients who underwent patellar and hamstring techniques for ACL reconstruction, considering height, weight, BMI, gender, and age as assessed by history, instability tests, KT 1000 knee arthrometer, Lysholm and IKDC score, and MRI and compare them. Majority of patients were followed and evaluated 6 months [92%] and 3 years [84%] after arthroscopic reconstruction

Results: there were no differences between the study groups considering these two surgical techniques and demographic factors preoperatively. Our comparison has shown less satisfaction in the results while BMI was increased, but there were no differences between male and female in the outcome. However, results of reconstruction in the patients over 40 years old were favorable, but there were more complications in the patellar tendon group

Conclusion: obesity was a factor resulted in more complications and unsatisfactory. Gender was not a reason for making any difference between patients, and outcomes of both male and female were the same. Results of patients over 40 years old were a good reason for performing reconstruction at these ages, but since complications of patellar technique were noticeable, it is a good reason for surgeons to prefer hamstring technique in elderly

[Granulocyte macrophage colony-stimulating factor as an adjuvant for hepatitis B vaccination]

Background: chronic dialysis patients often fail to produce protective antibodies to hepatitis B virus surface antigen after vaccination towards hepatitis B virus [HBV]. The aim of this study was to evaluate efficacy and safety of GM-CSF as adjuvant to hepatitis B vaccine in patients with ESRD

Materials and Methods: 41 consecutive patients with chronic renal failure [CRF], commenced on dialysis, were stratified to receive either 40 mg HBV vaccine at 0, 1, 2 and 6 months [group A, n = 19] or 3 mg kg-1 GM-CSF on day 1 followed by the vaccination schedule described above [group B, n = 22]. All patients were negative for Hepatitis B surface antigen [HBsAg], antibodies to hepatitis C virus [anti-HCV] and human immunodeficiency virus [HIV] serology. Titres of antibody to HBsAg [HBsAb] were quantitatively assayed, using enzyme-linked immunosorbent assay [ELISA], at 1, and 7 months from the first dose of vaccination

Results: only 42.1% of the patients in group A developed protective antibody levels [mean HBsAb: 24.8 IU l-1] after first month and 63.2% of responders developed protective antibody levels [HBsAb >10 IU l-1] only after the senventh dose of vaccination. In contrast, 72.7% of patients in group B developed protective levels of HBsAb at the end of first month [mean HBsAb: 41.8 IU l-1] [P < 0.05]. 72.7% of the responders were protected after third dose of vaccination [P = 0.374]. No serious adverse effects of GM-CSF were observed in group B

Conclusion: our study showed improved seroprotection rates with HBV vaccine after GM-CSF administration

[Evaluation of nasal polyps relapse after fess in comparison with its non-endoscopy surgery]

Background: nasal polyps are benign tumor that has yellow gray color similar to mole form, and commonly are bilateral, pedenculated, multiple and, mobile that original from nasal, sinus mucosa and lateral wall of nasal. Mostly of polyps has tendency to relapse because polyps polyps has manifestation of allergy and underlying allergy is not controllable.treatment has chemical and surgery method. endoscopic surgery of polyp is a new technique that was done primarily 100 years ago bye hirchmann and subside with past surgery method and this surgery was done on baghiyatallah hospital sinus end of 1376 on this technique polyps remove polyps from puncturing middle meatus and reduce the recurrence ratio

Method: on this study that was a retrospective study the prevalence of recurrence ratio of nasal polyp after sinus endoscopic surgery that was done during 1380- 1384 on baghiyatallah hospital followed this result compared with non -endoscopic study. Overall 200 patient selected randomized that minimal age of ratio was 3 years and maximal age was 89 years. On this group 100 patients operated with endoscopic surgery and 100 patient with non -endoscopic surgery

Result: the average of age in this patients was 40 years and most of them were male.recurrence of nasal polyp on non endoscopic group was 75 patient [75%] and 25 patient [25%] was without relapse until 1382. and on the sinus endoscopic surgery 36 patient [36%] had recurrence and 52 patient [52%] had not recurrence and is not present information about residual patient. The mean time of survival on the non surgical endoscopy was 60 month and on the sinus endoscopy surgery group was 41 month and 24 month survival was 95% and 36 month survival was 36 month and 60 month survival was 50% and 84 month survival was 25%. 95% of patient who had surgical operation with non - endoscopic procedures they remained at least 12 month without recurrence and with endoscopic procedure they remained at least 24 month without recurrence. 50% of patient, who had non - endoscopic sinus procedures, remained at least 66 month without recurrence and in endoscopic this time was at least 72 month

Conclusion: in this study that did in baghiyatalla hospital. Recurrence ratio of patient after sinus endoscopic surgery] was less and life time [remission] without recurrence was the more

[Evaluating diagnostic value of clinical symptoms and signs for sinusitis by CT scan at milad hospital]

Background: chronic sinusitis is defined by the presence of a characteristic group of symptoms, with no radiologic imaging as part of the diagnosis. Nevertheless, many clinicians currently use the sinus CT scan for two important clinical purposes: [1] as a diagnostic test confirming the presence of chronic sinusitis and [2] as an indicator of disease severity. In the present study, we examined radiologic correlates of the patients symptoms for rhinosinusitis

Materials and methods: two hundreds consecutive patients undergoing computed tomography [CT] scans of the sinuses were studied at Milad hospital University. Patients were evaluated prospectively with a questionnaire based on their symptoms, and their CT scans were graded according to the Lund-Mackay scoring system

Results: of the 198 patients, 111[56.1%] had positive scans [Lund-McKay score, >1]. The most sensitive and specific symptoms were nasal congestion [78.4%] and recurrent cough [69%] respectively. The Kappa coeffi-cient for nasal discharge and nasal congestion were 0.171 and 0.181 indicating poor agreement between them and CT positivity. The patients suffering from nasal congestion and recurrent cough significantly had more severe sinusitis according to their Lund- McKay score than who didn't

Conclusion: based on this study, it appears that the specificity and predictive value of nasal discharge, nasal congestion and recurrent cough are more significant than others. Additional validating data may provide guidance for improving the sensitivity and specificity of symptom-based diagnostic instruments for sinusitis

[Comparison of ACL reconstruction using patellar tendon and hamstring allograft]

Background: since anterior cruciate ligament [ACL] reconstruction become more frequently carried out, expectation of less morbidity and earlier return to activities become higher; for this reason graft selection become more important. The purpose of this randomized clinical study is to compare the outcomes of ACL arthroscopic reconstruction when using either patellar tendon [PT] and tendons of medial hamstring muscle [HS]

Materials and Methods: we evaluate the clinical results of 187 patients who underwent these techniques, as assessed by history, instability tests, KT 1000 knee arthrometer, Lysholm and IKDC score, and MRI and compare them. Majority of patients were followed and evaluated 6 months [92%] and 3 years [84%] after arthroscopic reconstruction

Results: there were no differences between the study groups preoperatively. Our comparison has shown significant kneeling pain and anterior knee pain in the PT with respect to HS technique. Although, extension deficits were significantly greater in the PT group, Flexion deficits were not significantly different between the groups. Clinical results according to the Lysholm scale and IKDC score between these techniques were the same, except Lysholm score was worse in PT group than HS group at 3 year follow up. About radiologic evaluation, the tibial tunnel enlargement was significantly higher in HS technique in comparison with PT technique

Conclusion: the use of both grafts had a good and equal outcome and the only difference is their long-term complications. Anterior knee pain, kneeling pain, and more extension deficit could be good reasons for a surgeon to prefer tendons of medial hamstring muscle as graft for performing ACL reconstruction

[Surveying the effect of cotoneaster spp. [shir khesht] on neonatal jaundice]

Jaundice is one of the most common problems in the neonatal period usual management of neonatal jaundice includes phototherapy, drug therapy, and exchange transfusion. In some countries, people use herbs for the treatment of jaundice. In Iran, cotoneaster spp. named shir khesht is used as a remedy for jaundice. We prepared a 16% solution of shir khesht from the original plant. After controlling for contamination with pathogenic bacteria, the mixture, [5 gram of shir khesht in 30 ml. of distilled water], was given in three divided doses to 32 icteric newborns, for one day. 30 ml. of placebo mixture in three divided dose was given to 32 controls. Both groups received phototherapy as well. Serum bilirubin was checked prior to, and after prescription in each group every 12 hr for 36 hours. Decline in the level of bilirubin in cases, i.e. those receiving shir khesht, was greater in comparison with controls reduction was significant at 12 hours, [mean=11.89 +/- 1.34 vs, 13.96 +/- 2.8], p=0.001, 24 hours, [mean=8.34 +/- 3.19 vs 11.66 +/- 2.33], p<0.001, and at 36hours [mean=3.90 +/- 2.48 vs 10.26 +/- 2.67], p<0.001. The duration of hospital stay in cases was much less than controls, [mean admission in days=3.98 +/- 2 vs. 4.59 +/- 1.93, respectively], p<0.001. In this study shir khesht was found to be effective in the treatment of neonatal hyperbilirubinemia resulting in a rapid decline in serum bilirubin, thus reducing duration of hospital stay. We suggest that further studies should be done so that it could be dispensed as a standard formula and used for neonatal jaundice