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

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. 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. 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]. Persian OHS 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]. 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. 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

Hour glass constriction in advanced carpal tunnel syndrome

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. 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. 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. 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

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

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