Seyed Mohammad Javad Mortazavi, MD.
Vol 4, No 2 (2018)
The world has changed and many beliefs and values have been modifying subsequently. Our country even though by more possibly religious and moral based culture, and its medical atmosphere should not be an exception. Which experienced physician could be accounted as a role model for a beginner like a resident that spends life in more challenging and stuff environment? And the role modeling is only for universities, or graduated doctors may change their criteria of success after step in the business of medicine after graduation?
Functional and Quality of Life Outcomes of Surgery for Degenerative Cervical Myelopathy: A Quality Improvement Study
Background: This study aimed to determine the outcome of surgical treatments in patients with degenerative cervical myelopathy (DCM). During one-year follow-up period, we evaluated patient-reported functional and quality of life (QOL) measures.
Methods: In a retrospective single-center study, we collected data of patients with DCM who underwent cervical fusion surgeries in Imam Khomeini Hospital, Tehran, Iran, from 2011 to 2015. Patients underwent single or multi-level anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or posterior laminectomy and fusion. We utilized patient-reported assessments including Short Form 36 (SF-36), Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Nurick grade. Follow-up was performed at 6 weeks, 3 months, 6 months, and 12 months post-operatively to assess the outcome of the surgery.
Results: Ninety patients (56 men, 34 women) with a mean age of 54.1 (27-87) years were included. Comparison of pre- and post-operative scores showed significant improvement in SF-36 parameters, VAS, NDI, and Nurick grade (P < 0.001). Also, women’s VAS scores improved more than men's VAS scores during the follow-up period (P < 0.050). Age and type of surgery did not significantly affect the SF-36 parameters, VAS, NDI, and Nurick grade (P > 0.05).
Conclusions: Cervical surgeries in patients with different severity of DCM can improve different aspects of QOL during one-year after surgery.
Comparing the Effectiveness of Intra-Articular Injection of Bupivacaine, Dexmedetomidine Vs. 0.9% Saline on Pain Control after Arthroscopic Anterior Cruciate Ligament Reconstruction
Background: In different ways, drugs are administered to reduce postoperative analgesia after arthroscopic anterior cruciate ligament (ACL) reconstruction. The purpose of this study is to compare the dexmedetomidine (DEX) intra-articular injection with bupivacaine hydrochloride and sterile 0.9% saline administration following arthroscopic ACL reconstruction.
Methods: Sixty cases who underwent ACL reconstruction were randomly divided into three groups. The first group received intra-articular DEX; the second group received intra-articular bupivacaine, and the final group received intra-articular 0.9% saline. Postoperative pain was measured by the Visual Analogue Scale (VAS).
Results: The mean VAS scores at 6 and 24 hours after surgery were lower in the bupivacaine group, compared to the other groups. The pain was more severe in the control group (0.9% saline), with higher VAS scores reported at 1, 6, and 24 hours after surgery.
Conclusions: Bupivacaine has more significant effects than DEX in postoperative pain management after arthroscopic ACL reconstruction.
Glomus Tumor on the Volar Aspect of the Distal Phalanx, an Unusual Presentation for an Unusual Neoplasm: A Case Report
Background: In the fingertips, the glomus tumors usually involve the subungual areas with typical triad symptoms including pain, tenderness to palpation, and cold sensitivity. The glomus tumor of volar aspect of digits is rare.
Case Presentation: A case of glomus tumor was presented at the volar side of the distal phalanx of the ring finger of a 52-year-old woman. The tumor was painful and tender to palpation, yet insensitive to cold. The atypical location and insensitivity to cold led to a 4-year delay in diagnosis. After the surgical excision of the lesion, the extracted mass was sent for histologic evaluation and the diagnosis of glomus tumor was confirmed. One-year follow-up of the patient was event-free.
Conclusions: Atypical glomus tumor should be considered in the differential diagnosis of finger pain, even in the absence of characteristic diagnostic features
Background: Osteoid osteoma (OO) is a benign osteoblastic neoplasm, mostly occurring in long bones of lower extremity. Its manifestation in unusual locations can be a diagnostic challenge and distressing for patients. OO in carpal bones is uncommon; its occurrence in triquetrum is even more so.
Case Presentation: This study reports on a nineteen-year-old female with history of wrist pain for 4 years. She had sustained trauma to the same wrist before commencing of pain. Patient's pain was unresponsive to conservative treatments. Her routine x-rays were mostly interpreted as normal and obtaining further imaging helped us in diagnosis of OO of triquetrum. Surgical resection of the nidus was performed.
Conclusions: Manifestation of OO in small carpal bones may not be typical; identifying the lesion or nidus could be challenging. Whatever unusual the location or presentation of such lesions may be, obtaining advanced imaging can be of significant help; therefore, we suggest clinicians to have low threshold in ordering advanced imaging specifically in patients suffering from chronic pain. Also, persistent history of nocturnal pain is a sign which is worth attention.
Septic arthritis in pediatric population is a serious condition that needs to be diagnosed and dealt with immediately to avoid major and irreversible complications. Most researches through past 30 years focus on finding an accurate and rapid way in the diagnosis of septic arthritis in children, but the studies failed to find a single rapid and accurate diagnostic test to distinguish between transient synovitis and septic arthritis in children.
Trauma to the wrist joint is one of the most common causes of referral to orthopedic emergencies. Due to the anatomical complexity of this joint, interpretation of its plane radiography is not as simple as it looks. A stepwise approach may help in the diagnosis of the pathologies of this joint and reduce the risk of missing a pathologic condition, especially in the trauma background.