Efficacy of core decompression of femoral head to treat Avascular Necrosis in intravenous drug users

Core decompression [CD] of the femoral head is one of the effective treatments of avascular necrosis [AVN], especially in the early stages of the disease. To investigate further the value of CD in treating the AVN, this study was performed on patients with symptomatic AVN with different etiologies who were treated with CD. This study was carried out on 25 patients [with the total number of 37 femoral head] who were diagnosed AVN using X-Ray and MRI. The CD treatments for these patients were started soon after the diagnosis. The results were considered as a success if there was no progression of disease confirmed by X Ray or no subsequent operation was required. Modified Ficat staging was used to record changes before and 2 years after CD treatment. Twenty five patients were participated in this study in which 68% [n=17] were female, 32% [n=8] were male, and the average of the age of the patients were 29.58 +/- 4.58. Eight of these patients had systemic lupus erythematous [SLE] [32%], 4 rheumatoid arthritis [RA] [16%], 3 with kidney transplant [12%], 1 Takayasu's vasculitis [4%] and 1 Wegner vasculitis [4%]. Eight of patients had a history of intravenous injection of Temgesic [32%]. In patients using Temgesic the changes in Modified Ficat staging were significantly different before and after CD treatment [P=0.03] in comparison with other groups. And in all 8 Temgesic users AVN progressed to the stage 3 and 4 after CD treatment. This study demonstrated that CD treatment to prevent the changes in the femoral head has been more effective in patients with collagen vascular diseases and kidney transplant than patients using intravenous Temgesic. These patients, in spite of early operation, showed no benefit of CD to prevent the changes in the femoral head

Pattern of rheumatic diseases in two outpatient clinics in Iran: Similarities with some different features.

Background: Rheumatic diseases are among the most prevalent diseases recognized in the world. Musculoskeletal disorders are one of the main causes of disability around the world and expend a large amount of health care and social resources and have a substantial impact on the quality of life of those affected. To identify preventable risk factors and to gain insights into the burden of the diseases, it is important to know the prevalence and demographics of them. Herein we are to describe the pattern of different rheumatic disorders and characteristics of the patients attending in rheumatology clinics in Yazd, Iran, with addressing some different points of views in this regards. Materials and Methods:In this retrospective study, medical records of all patients referred to two main referral rheumatology clinics in Yazd from March 2009 to February 2010 were reviewed. A questionnaire including sex, age, chief complaint, diagnoses, and co-morbid diseases was used for gathering the data. Results:All medical records were reviewed, of whom 5187 patients had specific diagnoses. The mean age of the patients was 38.57 year ± 19.4 SD. 70.81% were females and 29.19% were males. The most common diagnoses were: degenerative joint disease (58.33%), autoimmune disorders (17.88%), and soft tissue rheumatism (12.47%). The most frequent complaints were knee pain (32%). 55.6% of the patients were overweight (BMI >29) and 923 (17.8 %) of the patients had diabetes mellitus. Conclusion: Our findings were similar to other studies from Iran and the other countries in most features. The prevalence of autoimmune disorders was rather higher than the other studies; this is perhaps due to our belief that some of periarthritis conditions were part of systemic autoimmune diseases by careful history taking and using pertinent laboratory investigations.

[Wiscott-Aldrich syndrome [WAS]]

Wiscott-Aldrich syndrome [WAS] is an x-linked immune-deficiency disorder associated with eczema, recurrent infections, and increased frequency of autoimmune diseases, malignancy and thrombocytopenia with small size platelet. Our case is an 11 year old from a non- related parent, who was admitted with abdominal pain [hematoma], lower extremities bleeding [ecchymosed] and vomiting. Also, he had many admition cause bleeding in different areas. Lastly, he had retinal bleeding associated with blindness from 1 year ago

Bone mineral density in kidney transplant recipients and patients on hemodialysis. A comparison with healthy individuals

We measured bone mineral density [BMD] before and after transplantation to determine the frequency and severity of preoperative and postoperative osteoporosis and compare them with the BMD in healthy individuals. We determined the BMD at the lumbar spine and femoral levels in 22 men and 18 women who were on long-term dialysis in Yazd, Iran, and a group of kidney transplant recipients including 43 men and 18 women. They were compared with each other and healthy individuals studied in a recent study in Iran. Factors potentially associated with alterations of the BMD were studied in each group. The frequency of osteoporosis in the vertebrae and femoral neck was higher in the kidney transplant recipients than the healthy population [21.3% versus 4.9%; P = .001; odds ratio, 5 and 9.8% versus 2.4%; P = .02; odds ratio, 5.4, respectively] but not significantly different from those in the patients on dialysis [17.9% and 17.5%, respectively]. In transplantation group, multivariate analysis showed that there was a significant negative correlation between the lumbar BMD and the cumulative prednisolone dose [r = -0.36, P = .003]. No correlation was found between BMD of lumbar or femoral neck and the body mass index, age, and cumulative cyclosporine level. Osteoporosis is more frequent in patients on dialysis and kidney transplant recipient than in general population. However, there is no difference in osteoporosis frequency between transplanted patients and those on dialysis. In the lumbar spine, a higher cumulative prednisolone dose results in decreased BMD among kidney transplant recipients