Medical Journal of The Islamic Republic of Iran (MJIRI)

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In a retrospective study the clinical presentations, neurological findings, contrast studies, operative findings, and the follow-up results of 314 patients with disc herniation were studied over a 10-year period. This disease was most frequent between the ages of 30 to 40 and mostly in males. Low back pain with or without radicular pain was the most frequent symptom, involving the left leg in the majority of patients and the average duration of pain was more than a year. In this study L4 -L5 disc herniation had the highest frequency (50%). The most encouraging sign to perform myelography was motor deficit (57%). Postoperatively, our patients were followed for an average of 12 months with excellent to good results noted in 96% of them. Reherniation of a previously resected disc was noted only in two patients (0.6%). It is concluded that with precise selection wecould have more than 90% good results in a conventional method of disc surgery and the chances of recurrence are negligible.

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Bulbospinal noradrenergic pathways are shown to have an important role in descending inhibition of pain sensation. Locus ceruleus (LC), as a rich noradrenergic nucleus in the brain stem which has projections into the dorsal horn of the spinal cord, was evaluated for antinociceptive activity by using tonic and phasic pain models in the rat. LC-lesioned rats demonstrated moderate increase in both phases of the formalin test, but did not show any effect to thermal noxious stimuli, applied in the tail-flick test. These results indicate the relative involvement of LC in inhibition of tonic, but not phasic, pain.

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Lead-based paint is an important cause of lead poisoning. This report describes our observation of excessive lead absorption among employees in a paint factory in which lead naphthenate and lead oxalate were used as drying agents in paint. In this study, blood levels of lead were compared between nineteen paint factory employees and twenty normal controls. The nineteen paint factory employees had a mean blood lead concentration of 50.71 µg/dL which was significantly (P<0.01) higher than that of controls (20.44 µg/dL). There was a good correlation between blood lead levels and job tenures of the employees [r= 0.55, confidence= 95% (0.13-0.81)]. Lumbar pain (47.37%), abdominal pain (42.1% ), renal complications (21 %), anxiety (39.1 %), nervousness (52.63%), headache (42.4%), peripheral pain (36.8%) and anemia (10.5%) were the chief complaints of these employees. The use of lead naphthenate and lead oxalate in paint is clearly associated with excessive air-borne exposure to lead. Technical and medical protective control of occupational exposures is needed in paint industries.

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During a period of 10 months from May to February 1995, 120 children (72 girls, 48 boys) with an age range of 4-16 years (mean age 10.87, S.D.±2.7) with chronic abdominal pain who had an abnormal endoscopy (gastroduodenal mucosal defect) and positive urease test were treated for H. pylori. Patients were treated randomly with either metronidazole and amoxicillin (double therapy, group A) or metronidazole, amoxicillin and bismuth subsalicylate (triple therapy, group B), each for two weeks. 6-8 weeks after completion of treatment, patients were reevaluated by endoscopy and urease test. Endoscopy was normal in 75 cases (63 % ). Of the 45 cases with abnormal endoscopy, 37 patients (82%) were in group A and 8 patients (18%) in group B (p<0.00 l ). The urease test was positive in 44 cases (70%) of group A and 12 cases (20%) of group B (p<0.001). It is concluded that double therapy is relatively ineffective in eradication of H. pylori and triple therapy is less effective in this area compared with reports from industrialized countries. This difference is most probably due to greater drug resistance in this part of the world.

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Autoerythrocyte sensitization syndrome CABS) is a rare purpuric disorder of women characterized by inflammatory and painful ecchymotic lesions unrelated to blood clotting or vascular abnormalities. Gastrointestinal bleeding, hematuria, headache or syncopal attacks may also be observed. Our patient is a 33-year-old woman presenting with recurrent severe painful ecchymotic lesions on both lower extremities associated with headache, palpitation and weakness. The diagnosis of AES was confirmed by skin testing with autologous washed red blood cells. No internal bleeding was detected. She was treated with vitamin C with some success.

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The purpose of this study was to compare the effect of intraperitoneal bupivacaine and lidocaine administration on pain reduction after diagnostic laparoscopy. In this randomized, double blind, placebo controlled study, diagnostic laparoscopy was done for one-hundred and ninety-six infertile women with unexplained infertility. Patients were randomized to 4 groups (A, B,C, and D). At the end of the procedure, 30 mL of 0.125% bupivacaine, 30 mL of 5% lidocaine and 30 mL of normal saline was instilled in the pelvic cavity and 15 mL of the same solution over the diaphragmatic vault in group A, B and C, respectively. Group D received no intraperitoneal substance. The verbal pain scale questionnaire was used for assessment of postoperative pain. In conclusion, when instilled intraperitoneally after diagnostic laparoscopy, bupivacaine significantly decreases postoperative pain for a long period. It also reduces the rate of analgesic needed, increases the rate at which patients were discharged 2 hours after surgery, and decreases hospital stay. It is highly effective compared to lidocaine and placebo.

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The purpose of this study was to evaluate the therapeutic result of CT -guided celiac plexus block for managing intractable upper abdominal pain due to pancreatic carcinoma or chronic pancreatitis. We treated 22 cancer patients who were on regular narcotic medication. After an IV infusion of 10mLlkg Ringer's lactate solution, all patients were rolled onto prone position, and lidocaine was used to infiltrate the skin and subcutaneous tissues. Then CT guided injection of the celiac plexus was performed with 25 mL 50% ethyl alcohol with 0.25% bupivacaine. Vital signs, quality of analgesia and any adverse effects were recorded. The age range of our patients was 68.63± 7.48 years and weight was 64.68± 7.54 kg (mean±SD).All patients had a history of abdominal operation due to disease and also a history of morphine injection due to pain. In 100% of our patients, sedation in the first hour was gained excellent pain relief was achieved in 86.4% of cases during the first 24 hours after the procedure. No serious complications occurred in the study, a 30% drop in systolic blood pressure or even more was found in 13.6% of the cases, while nausea and transient orthostatic hypotension requiring no treatment developed in 31.8% and 100% of the cases respectively, and mild diarrhea was reported in 18.1 % of the cases for two weeks. CT-guided neurolytic celiac block appears to be a safe and effective technique for relieving abdominal pain due to cancer.

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 ABSTRACT

 Study design: A cross-sectional non-experimental study. Objectives: To collectively detect the reliability and feasibility of the five types of clinical tests that have been used to measure endurance of the trunk muscles in subjects with and without low back pain (LBP) and identifY the sensitivity of each test to predict the probability of the occurrence ofLBP.

 Background: Testing spinal muscle endurance seems to be very important in prediction, prevention and rehabilitation ofLBP. Several types of methods of static endurance testing such as: Sorensen test, prone isometric chest raise test, prone double straight-leg raise test, supine isometric chest raise test and supine double straight-leg raise test regarding their utilization have been reported in the literature. However, identification ofthe tests that have more dominant sensitivity on assessment ofLBP has not yet been determined. Information regarding the sensitivity of each test is needed for effective prevention and appropriate treatment strategies.

 Methods: A total of200 subjects pmiicipated in this study. Subjects were categorized into four groups: asymptomatic males (N= 50, mean age= 38+ 12 years), asymptomatic females (N= 50, mean age= 43+ 11 years), males with LBP (N= 50, mean age= 39+ 12 years), and females with LBP (N= 50, mean age= 43+ 12 years). Five clinical tests were measured in each group and the relative association of each test on LBP was assessed.

 Results: Among all the performed tests, the prone double straight-leg raise test had the highest association with LBP. Other tests such as the prone isometric chest raise test, Supine isometric chest raise test and Supine double straight-leg raise test had low association with LBP in comparison with the prone double straight-leg raise test.

 Conclusion: It seems that the prone double straight-leg raise test has more association with LBP than other tests and could be used as a useful method for testing spinal muscle endurance, prediction of the probability of the occurrence of LBP, and prevention and rehabilitation of LBP.

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 ABSTRACT

 Background: Nowadays there is an attempt to perform lateral internal sphincterotomy (LIS) operation on an ambulatory basis under local anesthesia. This study aimed to compare postoperative outcome in local anesthesia with spinal anesthesia.

 Methods: A randomized, double blinded, controlled trial was performed on 62 patients divided into group A (Local Anesthesia) and Group B (Spinal Anesthesia) with n=31 equally. To achieve adequate anesthesia a cocktail, 6cc of Lidocaine 2% and Marcaine 0.5% with the addition of some bicarbonate was injected into subcutaneous tissue and 20 cc of this was injected into the intersphincteric space before LIS. Postoperative pain was assessed by a 10 cm VAS.

 Results: Needle pain scores in group A and B were: 2.29 􀁲 1.40 vs. 16.1 􀁲 0.88 but pain scores, 6 hours after LIS, before leaving hospital and at the first week after the operation were significantly lower in group A than B (1.90 􀁲 1.07 vs. 3.77 􀁲 1.25, 0.90 􀁲 0.47 vs. 1.65 􀁲 0.75, 0.71 􀁲 0.46 vs.1.06 􀁲 0.51 respectively). Need of opioid and codeine in the first 24 hours after the operation in group A was significantly less than the other group. Also nausea and vomiting in group A was significantly lower than group B.

 Conclusion: The study showed that LIS under local anesthesia is a less painful technique in office surgery.

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  Abstract

  Background: Sacroiliac joint (SIJ) dysfunction is a widely known but poorly defined

  cause of low back pain. To our knowledge, few published studies have been

  conducted to evaluate systematically the prevalence and significance of concomitant

  sacroiliac joint dysfunction in patients with herniated lumbar discs. As concomitant

  SIJ dysfunction in low back pain patients is likely to respond to particular noninvasive

  interventions such as manipulation, improved understanding of the relationship

  between these two diagnoses would improve clinical decision making and research.

  Methods: This study was designated to estimate the prevalence of concomitant

  sacroiliac joint dysfunction in sub acute low back pain patients with image proven

  discopathy and evaluate the theory that sacroiliac joint dysfunction can be a source of

  pain and functional disability in discopathy. A total of 202 patients with sub acute

  radicular back pain and MRI proven herniated lumbar discs underwent standardized

  physiatrist history and physical examination, specified for detection of concomitant

  sacroiliac joint dysfunction.

  Results: Sacroiliac joint dysfunction is a concomitant finding in 72.3% of evaluated

  patients. There was significantly higher SIJ dysfunction prevalence in female

  patients (p <0.001), patients with recurrent pain (p <0.005) and in patients with positive

  straight leg raising provocative test (p <0.0001).

  Conclusion: SIJ dysfunction is a significant pathogenic factor with high

  possibility of occurrence in low back pain. Thus, in the presence of

  radicular and sacroiliac joint symptoms, SIJ dysfunction, regardless of

  intervertebral disc pathology, must be considered in clinical decision

  making.

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  Abstract

  Background: The purpose of this study was to evaluate the significance of the Q

  angle with respect to the patella position. We assess the correlation between the Q angles (calculated by clinical exam) in different positions and CT indices (with more

  impression on TTTG).

  Method: Atotal number of 68 knee joints of 50 cases entered the study. Clinical

  examination was used to measure Q angle (in 3 positions of sitting, standing and

  supine). CT scan performed in 2 axial view of proximal tibia, and distal femor for

  measurement of Tibial tuberosity-trochlear groove distance (TTTG) and other CT

  indices. Correlation between main variables calculated.and analysed with spss.

  Results: Supine Q angle were strongly correlated with standing Q angles and

  moderately with sitting Q angle. Sitting Q angle was moderately correlated with

  supine and standing Q angle and weakly with PTA. we found no other significant correlation between Q angle and CT indexes.

  Discussion: Our findings suggest that Q angle is not a valuable index for predicting

  the presence of patelofemoral malalignment.

 

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  Abstract

  Background: Osteoarthritis (OA) is the most common joint disease occuring after middle age. Because of the high mobility of the neck, OA is common in the cervical spine. The purpose of this study was to determine and compare the effects of intermittent traction on patients with mild and moderate cervical OA. Therefore, 32 patients with cervical OA were recruited.

  Methods: Aclinical trial study was designed for patients with cervical OA that were randomly assigned in two equal groups. Control group received a routine physical therapy protocol which included moist heat, transcutaneous electrical nerve stimulation (TENS), and an exercise for neck and shoulder girdle. Experimental group received a routine physical therapy protocol plus intermittent traction (IT).

  Results: Pain and mobility improved in both groups. There was significant difference in

  interaction of the improvement of cervical pain between the two groups, the rate of pain reduction sleep ease, medicine taking and range of motion (ROM) improvement in the experimental group were higher than that of the control group.

  Conclusion: The results justify the efficacy of IT, therefore it can be concluded that the

  IT is an effective modality for patients with mild and moderate cervical OA.

 

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Abstract

Background

entity. It is hypothesized to result from abnormal patellar tracking caused by altered motor

control. Deficit in neuromotor control of the core may be a remote contributing factor to the

development of PFP. Application of reliable EMG measures would be helpful to handle this

theory. Therefore, the purpose of this study was to determine the test-retest reliability of the

core and vasti EMG onsets, while ascending/descending stairs.

: Patellofemoral pain (PFP) is a common affliction and complex clinical

Methods

and Core EMG onsets during stair stepping were assessed two times a day. Intraclass correlation

coefficients (ICCs) and standard errors of measurement (SEMs) were calculated.

: Ten males with PFP and ten healthy controls participated in this study. Vasti

Results

onsets of control cases (ICC 3,1 ≥ 0.70) except Quadratus Lumborum (QL) which showed

a moderate reliability (ICC for ascending=0.59 and for descending = 0.61). In controls,

Vasti in both tasks showed the highest absolute reliability. During ascending, high

reliability (ICC ≥ 0.70) in PFP group was demonstrated for all EMG onsets except Gluteus

maximus (GMAX) and QL which showed a moderate reliability (ICC = 0.69 and 0.63 respectively).

In this group while descending stairs, all EMG onsets showed high relative

reliability (ICC ≥ 0.70). Moderate to high absolute reliability was obtained for onset times

while ascending/descending stairs in PFP group.

: During both ascending/descending, high reliability was found for all EMG

Conclusion

reliability.

: Most EMG onsets during stair ascending/descending had moderate to high

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  Abstract

  Background: Low Back Pain (LBP) is still a medical problem in 21 st century. Having back pain and being

  disabled by it are not the same thing. It is common to come across with patients who have simple back pain but surprisingly totally disabled and vice versa. In clinical practice, it is important to have a proper evaluation of disability and making a clear distinction between pain and disability. During the past two decades several selfreport measures and questionnaires have been developed to evaluate disability in LBP patients, however most of these questionnaire were designed in English language and based on European or American studies. The aim of this study was to develop and validate a translated and culturally adapt “Pain Disability Index (PDI)” and “Pain Disability Questionnaire (PDQ)” among Iranian patients with low back pain.

  Methods: The Persian versions of the PDI, PDQ were created through systematic translation and crosscultural adaptation of the original questionnaires. The Oswestry Disability Index and Visual Analogue Scale were used for validation studies. Patients were asked to complete these questionnaires initially and also at 7 days later as retest.

  Results: A total of 304 patients with acute and chronic LBP completed the Persian versions of PDI, PDQ,

  “Oswestry Disability Index” (ODI) and “Visual Analogue Scale” (VAS). Among patients 111 patients participated for retest after seven days. The Cronbach’s alpha (coefficient of reliability) for the PDI and PDQ was satisfactory. The PDI and PDQ showed high and very high test-retest reliability (ICC=0.8 and 0.92 respectively). The Pearson correlation coefficient among PDI, PDQ with ODI was 0.64 and 0.72, and for PDI, PDQ, ODI with VAS was 0.36, 0.47 and 0.57, respectively (P<0.001).

  Conclusion: The Persian version of the PDI and PDQ questionnaires are reliable and valid instruments to evaluate generic perceived disability in Persian-speaking patients with LBP. It is shown that PDI and PDQ are capable of measuring the disability in LBP patients. They could be used in clinical and research encounters with acceptable confidence.

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  Abstract

  Background: Lead toxicity is caused by ingestion, inhalation, or contact with particles or vapors containing lead. It can present with nonspecific signs and symptoms such as abdominal pain, constipation, irritability, difficulty concentrating, and anemia. In this study, we have tried to find a relationship between lead poisoning and drug abuse.

  Methods: In a cross sectional study, drug addicts presenting with abdominal pain referring to GI center of

  Imam Khomeini hospital in 2008 were observed. Patients having occupational contact with lead were excluded from the study. Required data included age, sex, clinical findings, Para clinic results and blood lead level. Results were analyzed through SPSS-15 software.

  Results: 42 patients (all male) with average age of 46.9 ± 10.1 years were included in the study. Average

  blood lead level was 51.17±27.96µg/dl. 22 patients (52.6%) had lead toxicity. A significant relation was found between lead toxicity and mode of opium drug use however relation between lead toxicity and duration of addiction was not significant. Similarly, a meaningful relation was found between lead toxicity and abnormal liver function test, urine tests, ECG, presence of basophilic stippling and hyperuricemia.

  Conclusion: There seems to be a significant relation between opium drug abuse and lead toxicity. Further

  studies with more cases and ethnicities are needed.

 

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 Background: Myocardial infarction is the major cause of morbidity and mortality in industrialized countries. Platelet count and the mean platelet volume (MPV), a simple and reliable indicator of platelet size which correlates with platelet activation, might associate with troponin in acute chest pain.

 Methods: We analyzed MPV of 851 patients who were admitted to Rasoul-e-Akram Hospital with acute chest pain during the year 2010. Two blood samples were taken from each patient within 4 hours of their arrival for routine hematology, including platelet count and MPV, and cardiac troponin T. Also, electrocardiograms of the patients were recorded. Association of MPV and platelet count with troponin was observed.

 Results: The patients in troponin positive group, who had also ischemic electrocardiographic changes, had higher MPV values than non- acute coronary syndrome (ACS) patients with normal cardiac troponin T levels (9.9 vs 9.5 fl with p< 0.001). In troponin negative group, the mean of platelet count was higher than that in the positive group (221683 vs 198814/μl with p< 0.001).

 Conclusion: MPV and platelet count are inexpensive laboratory tests which can be measured in association with other laboratory biomarkers in patients presenting with acute chest pain. This could help to lower hospitalization rates and also avoid misdiagnosis and having complications of patients with ACS.

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 Background: Chronic pain is a frequent disability that negatively affects patient’s quality of life. Understanding of the possible relation between sociodemographic and medical variables with Health Related Quality of Life (HRQL) may help identifying the multidimensionality of pain and risk factors that limit physical and psychological adjustment of the patients. The present study was done to find these possible relationships, based on using Medical Outcomes Survey-Short Form (SF-36).

 

Methods: Among the patients who were referred to pain clinic of Iranian Pain Society, 101 consecutive outpatients were select based on the defined inclusion and exclusion criteria. All the participants in this study orally satisfied and were fully informed by a check list and SF-36 questionnaire. The possible impact of demographic variables, characteristics, diagnosis, analgesic use, smoking and opium addiction were collected as the first part of a routine pretreatment evaluation.

 Results: Our findings showed significant relation between HRQL and gender (P<0.05), the rate of chronic pain in female was higher than male, and same results found for elderly patients compared to younger ones. Our findings also showed significant relation between employment and intensity of pain (p=0.001) as, employed patients showed less physical and psychotic problems than unemployed ones. The mean average of intensity of pain in these patients was 7.5±2.2 few patients used alcohol (4%), opium (1%) and cigarette (10%). Large number of participants used analgesic (%78.2). No significant difference between sociodemographic features with pain duration and quality of life was found. In contrast our data showed significant difference between pain intensity and quality of life (p<0.001).

 

Conclusion: Based on our findings it could be concluded that chronic pain in Iranian patients certainly leads to poor HRQL, the state is more serious in the elderly and female patients. Thus, in order to re-socialize the patients suffering chronic pain and decrease the impact of their pain on their life, these findings should be considered in any kind of pain relief therapy.

 

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  Background: Office workers spend a long period of time behind a computer during working hours. The relation between the posture of sitting during work with computer and neck pain is still debatable. Even though some researchers claim a significant difference in head posture between patients with neck pain and pain-free participants, the FHP (forward head posture) has not always been associated with neck pain in literature. So, the purpose of this study was to discover the relationship between neck pain and improper posture in the head, cervicothoracic spine and shoulders.

  Methods : This was a cross-sectional study to explore the relationships between neck pains, sagittal postures of cervical and thoracic spine and shoulders among office workers in two positions, straight looking forward and working position. 46 subjects without neck pain and 55 subjects with neck pain were evaluated using a photographic method. Thoracic and cervical postures were measured by the HT (High Thoracic), CV (Craniovertebral) angles respectively. Shoulder’s posture was evaluated in the sagittal plane by the acromion protrusion.

  Results : HT and CV angles were positively correlated with the presence of neck pain only in working position (p< 0.05). In straight looking forward position there was no significant difference between the two groups statistically (p>0.05). The difference of shoulder protrusion between symptomatic and asymptomatic groups was not significant.

  Conclusion : FHP and thoracic kyphosis were accompanied with neck pain. But shoulder posture was not correlated with neck pain.

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 Background: Neuropathic pain (NP) is one of the most suffering medical conditions that often fail to respond to certain pain therapy. Although its exact etiology is still unknown the role of reactive oxygen species (ROS) and oxidative stress were explored by many researchers. Neuropathies either central or peripheral lead to painful condition as well as social and economic isolation, thus various therapies were used to treat or reduce the pain. Laser therapy and antioxidant drugs have separately considered as treatment for NP, but the combination of them have not been used yet. In order to study the combination effects of Low Level Laser Therapy (LLLT) and Coenzyme Q10 (CoQ10) the present study was designed.

 Methods: Sixty adult male rats (230-320g) were used in this experimental study that divided into six groups (n=10). Chronic constriction injury (CCI) was used to induce neuropathic pain. The CoQ10 or vehicle, a low level laser of 980nm was used for two consecutive weeks. Thermal and mechanical paw withdrawal thresholds were assessed before and after surgery on 7th and 14th days.

 Results: As we expected CCI decreased the pain threshold, whereas CoQ10 administration for two weeks increased mechanical and thermal threshold. The same results obtained for laser therapy using the CCI animals. Combination of laser 980nm with CoQ10 also showed significant differences in CCI animals.

 Conclusion: Based on our findings the combination of CoQ10 with LLLT showed better effects than each one alone. In this regard we believe that there might be cellular and molecular synergism in simultaneous use of CoQ10 and LLLT on pain relief.

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  Background : To determine the role of Letrozole, an aromatase inhibitor,in the treatment of endometriotic pain.

  Methods: In this prospective, randomized, controlled clinical trial in minimallyinvasive surgery research center,51 women with pelvic endometriosis and endometriotic pain (dyspareunia, dysmenorrhea, pelvic pain) score of 5 or more (for at least one of these endometriotic pain), after laparoscopic diagnosis and conservative laparoscopic surgery were treated with either Letrozole plus OCP (n=25) or only OCP (n=26) for 4 months continuously.

  Results: Using VAS test, the score of dyspareunia, dysmenorrhea and pelvic pain 4 months after the laparoscopic surgery declined significantly in both groups but the difference between results of the two groups was not significant.

  Conclusion: Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis and in comparison with OCP, Letrozole did not affect the outcome.