Endothelial dysfunction in patients with subclinical hypothyroidism and the effects of treatment with levothyroxine.

BACKGROUND: Subclinical hypothyroidism (SHT) may increase the risk of cardiovascular disease. We compared endothelial function between SHT patients and euthyroid individuals, and evaluated the effects of levothyroxine therapy on endothelial function in the patients. MATERIALS AND METHODS: In a quasi-experimental study, flow-mediated dilatation (FMD) and intima-media thickness (IMT) were assessed in SHT patients and healthy controls (n = 25 in each group). Patients then received levothyroxine (50 µg/day) for 2 months, and the FMD and IMT assessments were repeated. RESULTS: Patients and controls were similar in IMT (0.56 ± 0.09 vs. 0.58 ± 0.08 mm, P = 0.481), but FMD was lower in patients than in controls (4.95 ± 2.02 vs. 6.50 ± 2.57%, P = 0.011). A significant increase was observed in FMD (4.11 ± 2.37%, P = 0.001), but not in IMT (-0.004 ± 0.020 mm, P = 0.327), after levothyroxine therapy among the patients. CONCLUSIONS: Patients with SHT have endothelial dysfunction which responds to levothyroxine therapy. Randomized placebo-controlled trials are needed to confirm these findings.

Relationship of knowledge about osteoporosis with education level and life habits.

AIM: To assess possible relationships of knowledge and related factors with educational level and osteoporosis-related life habits. METHODS: This was a cross sectional study conducted on 268 women (≥ 35 years old) from June 2011 to August 2011. The sample collection was done in outpatient clinics in three university hospitals in Isfahan, Iran. We used a demographic questionnaire containing questions that evaluated osteoporosis-related life habits, including exercise, smoking, intake of calcium and vitamin D supplements and so on. We also used the Osteoporosis Knowledge Assessment Tool to measure osteoporosis knowledge of women. RESULTS: The mean level of knowledge about awareness of osteoporosis, its risk factors and preventive factors were 56, 55 and 22, respectively. The relationship of education level and awareness of osteoporosis, its risk factors and preventive factors was significant, with R = 0.76, R = 0.73 and R = 0.83, respectively (P < 0.001). The relationship of education level and osteoporosis-related life habits was not significant (R = 0.03 and P = 0.56). The relationship of osteoporosis-related life habits and awareness of osteoporosis and its risk factors was significant, with R = 16%, P = 0.006 and R = 16%, P = 0.008, respectively, but the relationship of osteoporosis-related life habits and preventive factors was not significant (R = 0, P = 0.99). CONCLUSION: Iranian women with a higher education level have significantly better knowledge about osteoporosis than women with a lower educational level but they do not use this knowledge in their life.

First report on body image and weight control in a nationally representative sample of a pediatric population in the Middle East and North Africa: the CASPIAN-III study.

INTRODUCTION: This study explores the associations of weight perceptions with actual body mass index (BMI) and attempts to lose weight in a nationally representative sample of a pediatric population. MATERIAL AND METHODS: Data were collected from school students of 27 provinces in Iran, as part of "the national survey of school student high risk behaviors". We used t-test for continuous data and chi square test for categorical data. The correlation between categorical variables was assessed by Cramer's phi test. A multiple nominal logistic regression model was fitted to data to assess the association between perceived body weight and gender by adjusting for potential confounding variables. RESULTS: The study participants consisted of 5570 (2784 girls, 70% urban) students with mean age of 14.7 ±2.4 years. Overall, 17.3% of students were underweight, and 17.7% were overweight or obese. Nearly 25% and 50% of participants reported themselves as appropriate weight and very obese, respectively. In both genders, the strength of association between perceived weight and actual BMI was quite high (Cramer's phi coefficient = 0.5, p < 0.0001), and that of perceived body weight with trying to lose weight was moderate (Cramer's phi coefficient = 0.2, p < 0.0001). Overweight students were more likely than their obese peers to try to lose weight. After adjusting for possible confounders, the chance of perceiving oneself as very obese compared to perceiving oneself as very thin was 1.56-fold higher in girls than in boys, i.e. OR (95% CI): 1.56 (1.27-1.91). CONCLUSIONS: This study revealed a considerably frequent "mismatch" between actual weight status and body shape dissatisfaction, which supports the necessity of increasing public awareness in this regard.

Hour glass constriction in advanced carpal tunnel syndrome.

BACKGROUND: Compressive neuropathy of median nerve is relatively common but development of an hourglass like constriction is a rare phenomenon. The purpose of this study is to show morphologic changes of median nerve in advances carpal tunnel syndrome. METHODS: Eighty patients with thenar atrophy, anesthesia and paresthesia of first, second and third finger and severe changes of EMG-NCV were chosen for surgery. All the cases were operated by classic approach. RESULTS: At ten cases, nerve was constricted in point and in six patients' area constriction was seen. Internal and external neurolysis was performed in all the cases. In two of them because of the wide and severe constriction, resection and end-to-end repair was performed. All the patients have been examined periodically. Mean follow-up was 12 month (8-40). According to grading, pain degree (from 8-9 pre operation to 3-4 post operation) and two point discrimination (from the mean of 14 mm (13-20 mm) to 8 mm (6-10 mm)) decreased. Grip power was increased from the mean of 10 kg to 21 kg. In 15 cases return of sensation, and in 13 cases improvement of opposition power was seen. CONCLUSION: We recommend epineurolysis for mild to moderate constriction and also end-to-end repair may be needed if extensive and severe constriction was found. It means that if we manage mild to moderate constriction sooner, it can prevent the need for further surgical procedure because of sever constriction.

Translation and cultural adaptation of the oxford hip score for Iranian population.

INTRODUCTION: In recent years, outcome assessment related to orthopedic surgeries has increasingly focused on patient-reported questionnaires. The Oxford Hip Score (OHS), self-administered questionnaire, is a reliable, valid, and responsive instrument for assessing hip in patients undergoing Arthroplasty. METHODS: The study involved 105 adult Persian-speaking patients admitted for primary Total Hip Arthroplasty in two hospitals in Isfahan in Iran from September 2009 until April 2011. All of them filled out their scales (Persian OHS, WOMAC, and SF12) in preoperative examination. RESULTS: Mean scores of OHS in first administrations was 42.7 ± 12.7. The Persian OHS overall score demonstrated high reproducibility (ICC,0.93, P < 0.001) and internal consistency (CA, 0.94). PersianOHS had high correlations with WOMAC total score (r = 0.86), function score (r = 0.86), and pain score (r = 0.79), the relationship between the Persian OHS and the WOMAC stiffness subscale was somewhat lower (r = 0.69). The correlation coefficient between the Persian OHS and the PCS of the SF-12 in our study was moderate (r = 0.58). Persian OHS had low correlation with MCS of the SF-12 (r = 0.40). DISCUSSION: Persian OHS had high correlations with WOMAC total score, function score, and pain score. It had moderate correlation with PCS of the SF-12 and low correlation with MCS of the SF-12. CONCLUSIONS: Our study demonstrated the trans-cultural adaptation and validation of the Persian OHS is a reliable and practicable instrument for assessment of function and pain in Iranian patients with hip osteoarthritis.

Left atrial appendage occlusion.

Left atrial appendage (LAA) occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC), it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC) and mitral valve replacement (MVR) too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS) and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

Recurrent Hydatosis at the Site of Non-union Humerus Fracture.

Hydatid disease is still endemic in several regions of the world and is caused by two species of tapeworms, Echinococcus granulosus and Echinococcus alveolaris. It primary involves liver and lung, and bone involvement is relatively rare (0.2-4%), where it is most commonly seen in the spine. The skeletal involvement is usually due to secondary extension such as hematogenous spread. The disease has usually a silent manifestation until a complication exists; so, many cases are diagnosed intraoperatively. Treatment of hydatid disease because of its bone involvement and spillage of fluid with subsequent contamination seeding is difficult, so it has a high mortality rate and many cases will recur. Therefore, we can prevent these occurrences if we treat hydatid disease completely and in the primary stage. Adjuvant medical treatment, if the diagnosis is known, prevents systemic spread and recurrence. Here, we present a primary recurrent hydatosis at the site of non-union humerus fracture. We have pointed out osseous hydatosis as one of the important differential diagnoses in destructive bone lesions and the necessity of its radical resection.

Intraosseous ganglion cyst of olecranon.

Intraosseous ganglia are benign cysts that usually can be seen in lower extremity; especially around ankle. These cysts have fewer incidences in upper extremity, mainly around the wrist. They are extremely rare in olecranon. These lesions are often asymptomatic. Patient was a 75-year-old man who had trauma many years ago. When he came to our clinic, he complained of severe pain around his elbow that he could not do ordinary activity. He had local tenderness in elbow and 30 degree limitation in extension. In radiography, lytic, multiloculated lesion existed in region of olecranon. After excisional biopsy was done, cavity was cleaned completely with curette and was filled with autogenous bone. At 10-year follow-up, the patient was completely asymptomatic. Control radiograph showed cavity filled completely by bone; there was no evidence of relapse.

Efficacy of tibial proximal osteotomy in correction of lower limb alignment indexes in patients with osteoarthritis in medial compartment of knee.

NTRODUCTION: Tibial proximal osteotomy is one of the treatments for patients with knee compartment osteoarthritis. Studies showed 80% good prognosis in five years follow up after osteotomy. Almost always this method is used for pure medial knee compartment osteoarthritis that has a varus deformity. THE AIM of all methods is reforming varus deformity and lower limb alignment to gain 3 to 5 degree extra reformation and take knee in 10 degree valgus. One of the main etiologies for patients inconvenience and no decreasing in their pain is overcorrection or undercorrection, but unfortunately these can't be noticed. Therefore we must make sure that additional stress on the medial joint line was eliminated and regeneration of cartilage was facilitated or at least occurrence of osteochondritis was decreased. So we aimed to determine the efficacy of tibial proximal osteotomy in lower limb alignment indexes in patients with osteoarthritis in medial compartment of knee. MATERIAL AND METHODS: This study is a clinical trial study that has done in Alzahra University Hospital of Isfahan Medical Science University in Iran since June 2010 till February in 2011. Patients had pain, pure medial knee compartment osteoarthritis and varus deformities were determined for study. Patients who wouldn't come for control, those who had no convenience for giving their data or osteoarthritis of all three compartments were excluded from study. Number of patients has determined 40 persons according to previous studies. Sampling occurred convenient. Before any surgical processes, the AP x-ray radiography was applied for alignment view. The demographic and radiographic data was registered. Six months later we applied AP x-ray radiography again and obtained data and analysis them with SPSS software and T-Paired statistical method. RESULTS: The mean of anatomical limb angle before and after surgical process were 5.1 +/- 3.4 varus and 11.9 +/- 3.4 degree valgus, respectively,so with T-test there was a significant difference between them (P < 0.001). The mean of mechanical limb angle before and after surgical process were 12.6 +/- 3.4 varus and 4.75 +/- 3.5 degree valgus, respectively. Therefor with T-test, there was significant difference between them (P < 0.001). CONCLUSION: Results were achieved from this study showed that Tibial proximal osteotomy is appropriate treatment for young and middle age patients with progressive deformity, symptomatic varus knee. Key words: Tibial proximal osteotomy, Knee, Osteoarthritis, Varus deformity.

Sinus of Valsalva aneurysm: An uncommon presentation.

BACKGROUND: Sinus of Valsalva aneurysm (SVA) may be congenital or acquired. They could mimic ventricular tumor symptoms and cause signs and symptoms of ventricular outflow tract obstruction. They may also involve the conduction system and cause palpitations or syncopal episodes. Both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) serve as quick, noninvasive methods to provide information on size and location of aneurysmal dilatation and cardiac chamber involvement. These methods can identify any associated anomalies or complications. This study presents a patient with unruptured SVA. CASE REPORT: A 46-year-old man, who had been suffering from nonspecific symptoms such as exercise intolerance and weakness for a few months, referred to our clinic in Isfahan (Iran). In TTE, a large mass was observed in the right ventricle. SVA was suspected after meticulous probing. This diagnosis was confirmed by TEE and computed tomography angiography. At open heart surgery, an SVA with a lot of clots it was removed. CONCLUSION: SVA must be kept in mind when a tumor-like mass is observed in the right ventricle. Detailed evaluation would thus be necessary to rule out SVA and to prevent wrong diagnosis and treatment that can sometimes be catastrophic.

Comparison of anterior subcutaneous and submuscular transposition of ulnar nerve in treatment of cubital tunnel syndrome: A prospective randomized trial.

BACKGROUND: This study was designed to compare two methods of surgery, anterior subcutaneous transposition (ASCT) and anterior submuscular transposition (ASMT) of the ulnar nerve in treatment of cubital tunnel syndrome. MATERIALS AND METHODS: This randomized trial study was conducted from October 2008 to March 2009 in the Department of Orthopedic Surgery at University Hospital. Forty-eight patients with confirmed cubital tunnel syndrome were randomized in two groups, and each patient received one of two different surgical treatment methods, either ASCT (n = 24) or ASMT (n = 24). In the ASCT technique, the ulnar nerve was transposed and retained in the subcutaneous bed, whereas in the ASMT, the nerve was retained deep in the transected muscular complex, near the median nerve. Patient outcomes, including pain, sensation, muscle strength, and muscle atrophy were compared between groups. RESULTS: The two groups were similar in baseline characteristics. However, those treated with ASMT had a statistically significant reduction in their pain levels compared with ASCT (21 (87.5%) vs 8 (33.3%), P < 0.05). There were no statistically significant differences between the two groups relative to sensation (11 (45.8%) vs 12 (50%)), muscle strength (17 (70.8%) vs 15 (62.5%)), or muscle atrophy (15 (62.5%) vs 17 (70.8%)) (P > 0.05). CONCLUSIONS: Our results indicate that ASMT are more efficient than ASCT for managing cubital tunnel syndrome. In patients who had ASMT, there were significant reductions of pain compared with ASCT.