Comparison of analgesic effect of femoral nerve block and continuous intravenous infusion pump, after anterior cruciate ligament reconstruction in first postoperative day

Incidence of anterior cruciate ligament [ACL] tearing is especially high in athletes, and reconstruction surgery is often required, associated with severe post-operative pain requiring active interventions. In the present study we compared the continuous intravenous morphine infusion technique with femoral nerve block regarding efficacy of pain management and patients' satisfaction, so that the best post-operative pain management for ACL reconstruction can be decided. We recruited 54 patients for this study and divided them randomly in 2 equal groups; Group-A [continuous intravenous morphine infusion] and Group-B [femoral nerve block]. Femoral block for coded subjects was performed at the end of the surgery right before shifting the patient. For patients in the other group, catheter was inserted for continuous infusion after extubation and transfer to recovery room. Pain intensity was assessed and recorded in recovery service and right after complete consciousness, and then every 4 hours by trained nurses of the department, using visual analogue scale [VAS]. After complete consciousness and every 12 hours, patients' satisfaction from post-operative analgesia was questioned and recorded, using five Likert scale items. Post-operative complication were recorded. The pain in Group-A [the continuous infusion pump group] at 20 and 24 hours after surgery was significantly lower than Group-B [nerve block group][p<0.05]. Post-operative complications [especially nausea] in femoral nerve block was lower. Analgesic degree of nerve block is comparable with the impact of continuous infusion pump at least during 20 hours after anterior cruciate ligament reconstruction surgery

Ocular involvement of brucellosis

A 29-year-old male diagnosed with brucellosis a week earlier was referred to the ophthalmology clinic with visual complaints. On examination, visual acuity was 20/25, he had conjunctival injection on slit lamp examination. There was also bilateral optic disk swelling plus retinal hyperemia [optic disc hyperemia and vascular tortuosity] and intraretinal hemorrhage on funduscopy. The patient was admitted and treated with cotrimoxazole, rifampin, doxycycline and prednisolone for 2 months. Ocular manifestations subsided gradually within 6 months after treatment. Brucellosis can affect the eye and lead to serious ocular complications. Early diagnosis and prompt treatment should be considered in endemic areas

Congenital anomalies in infant with congenital hypothyroidism

Congenital hypothyroidism is characterized by inadequate thyroid hormone production in newborn infants. Many infants with CH have co-occurring congenital malformations. This is an investigation on the frequency and types of congenital anomalies in infants with congenital hypothyroidism born from May 2006-2010 in Hamadan, west province of Iran. The Iranian neonatal screening program for congenital hypothyroidism was initiated in May 2005. This prospective descriptive study was conducted in infants diagnosed with congenital hypothyroidism being followed up in Pediatric Endocrinology Clinic of Besat Hospital, a tertiary care centre in Hamadan. Cases included all infants with congenital hypothyroidism diagnosed through newborn screening program or detected clinically. Anomalies were identified by clinical examination, echocardiography, and X-ray of the hip during the infant's first year of life. A total of 150 infants with biochemically confirmed primary congenital hypothyroidism [72 females and 78 males] were recruited during the period between May 2006-2010. Overall, 30 [20%] infants had associated congenital anomalies. The most common type of anomaly was Down syndrome. Seven infants [3.1%] had congenital cardiac anomalies such as: ASD [n=3], VSD [n=2], PS [n =1], PDA [n=1]. Three children [2.6%] had developmental displasia of the hip [n=3]. The overall frequency of Down syndrome, cardiac malformation and other birth defect was high in infants with CH. This reinforces the need to examine all infants with congenital hypothyroidism for the presence of associated congenital anomalies

[Three times hip fracture in a child with primary hyperoxaluria]

kidney stones and renal failure in low age groups. Changes in structure of bone in these patients included two types: bone oxalosis and renal osteodystrophia. The patient was a child aged 10 years old under dialysis due to renal failure. He had a fracture of femoral neck and two times subtrochanteric fracture. One of the most places for fracture in these patients is proximal of femur. Because of bone fragility in these patients, they should avoid heavy activities. Occurrence of fracture should be managed and followed carefully after surgery in these patients

[Residual shortening of limb after Legg-Calve-Perthes disease with different treatment modalities]

The residual shortening of limb is the major cause of gait disturbances in Legg-Calre-Perthes [LCP] disease. This study was a probing of limb length discrepancy after puberty by perfect method of teteroentgenogram in these patients. Residual shortening was measured by above method following completion of skeletal maturity in 46 patients and then the data were analyzed by computerized method. The patients were divided into three equal groups that they were treated by varus femoral osteotomy [FVO], abduction orthosis [AO] and untreated, respectively. The residual shortening was significantly more in AO group than FVO group and it was surprisingly a little more than the untreated group. The length of femur was identical in three groups [12.5, 11.1 and 10.4 millimeters, respectively]. The length of ipsilateral tibia was significantly different [2.8 mm shortening for AO group, 1.6 mm lengthening for FVO group and 1 mm lengthening for untreated group]. Overgrowth of ipsilateral tibia seems to be the leading cause of less limb discrepancy in FVO group and disuse atrophy seems to be the major reason for significant discrepancy in AO group which was somehow worse than untreated patients

influence of tourniquet use and timing of its release on blood loss after total knee arthroplasty

To determine the influence of tourniquet use and the timing of its release on amount of bleeding during total knee arthroplasty. Clinical trial. Department of Orthopedics, School of Medicine Hamadan University of Medical Sciences and Health Services, Hamadam, Iran From 2005 to 2008. Eighty four patients [96 knees] who underwent total knee arthroplasty were randomly assigned into three groups: group I: tourniquet not applied, group II: the tourniquet deflated intraoperatively, group III: the tourniquet released after the wound closure. Mean blood drainage and transfusions required, hemoglobin and hematocrit values and operation time were compared among the groups. Hemoglobin and hematocrit, tourniquet time [for groups II and III] and number of blood transfusions given, were similar in all the groups. The operation time was significantly long for group I [p 0.012]. Using tourniquet does not reduce blood loss in total knee asrthroplasty however it reduces operation time significantly