Babak Haghpanah

Clinical course of ulcerative colitis in patients with and without primary sclerosing cholangitis

Background and Aim: We noticed in our practice that patients with ulcerative colitis (UC) who have developed primary sclerosing cholangitis (PSC) experience a milder course of colonic disease. Our objective in this study was to define whether or not there is any difference between UC activity and its course in patients with and without PSC.

Clinical and histological features of nonalcoholic steatohepatitis in Iranian patients

BackgroundAlthough several studies have been performed on risk factors and natural course of NASH, it seems that NASH tends to be more than a disease confined to strict boundaries. The objective of this study was to assess the clinical and paraclinical features and risk factors for non-alcoholic steatohepatitis (NASH) patients in an Iranian populationMethodsPatients with histologically confirmed NASH who had elevated liver aminotransaminases, negative serologic markers of viral or autoimmune hepatitis and no findings in favor of metabolic liver disease were enrolled. A careful history was taken regarding alcohol intake.Results53 patients consisting of 32 male and 21 female entered the study. The mean age was 37.8 ± 11.3 years. Twenty-six patients (55.3%) were overweight, 15 (31.9%) obese, 40 (75.5%) dyslipidemic, and three patients (5.7%) were diabetic. Liver biopsy showed mild steatosis in 35.7%, moderate steatosis in 53.6%, and severe forms in 10.7%. In 80.2% of patients, portal inflammation was present, and 9.4% had cirrhosis. The amount of increase in liver enzymes bore no relationship with fibrosis, portal inflammation, and degree of steatosis.ConclusionsThe patients in our study showed a male predominancy and were somewhat younger than other studies.

Functional outcome of total knee arthroplasty in patients with haemophilia

Haemophilic arthropathy (HA) is a debilitating complication of haemophilia which leads to TKA in severe cases.

Simultaneous bilateral total knee arthroplasty in patients with haemophilia: a safe and cost-effective procedure?

Haemophilic arthropathy of the knee is usually a bilateral affliction. The patients usually refer for treatment in young ages and do not have major comorbidities, being fit for bilateral simultaneous total knee arthroplasty.

The Transforming Face of Fracture Epidemiology

Skeletal trauma has been influencing the productive life of population, especially in more developed urban areas. During the past few years, most skeletal trauma registries throughout the world have been reporting an increase in incidence and a change in pattern of fractures (1, 2). The most prevalent cause of skeletal fracture in younger population is road traffic accident. Although the development of modern passenger restraint systems has led to decreased mortalities from cerebral and spine trauma, it may have indirectly been increasing the non-fatal patterns of skeletal fractures, which includes the fractures induced by the restraint system itself (3, 4). Older people have traditionally been suffering from low-energy traumas like falling. Modernization of the society, shifting age distribution of the population, changing life style, and alteration in the attitude and culture of different age groups have influenced the pattern of epidemiology of skeletal trauma. With the increasing pace of modern life, high-energy traumas are seen more frequently and in the age groups that were traditionally not “high-energy type of people”, e.g. children and the elderly. Women and children are more frequently participating high-energy athletic and recreational activities. One of the most pronounced alterations in fracture epidemiology has been seen in higher-aged females. The increase in the prevalence of fractures in elderly women, reported in some databases, is partly due to the increase in overall population age and partly because of the changes in the activity level of this age group -they may suffer from the fractures that were once specific to the younger population. Apart from the high-energy accidents, the fractures caused by the most common metabolic disease of the bone, the osteoporosis, are rising and imposing an increasing burden on both the individual and society. A study by Cauley et al. (5) showed that the projected number of women who will experience a fracture in one year, exceeded the combined number of women who would experience invasive breast cancer or a broad category of cardiovascular events. Such a large increase in incidence and burden has been reported in some studies in our own country (6, 7). On the other hand, some studies show that the majority of orthopedic surgeons lack sufficient training in management of osteoporosis in our country (8). Iran is a large country with an exceptional climatic, cultural and ethnic diversity. Knowledge of patterns of skeletal injuries and their epidemiology will undoubtedly improve prevention and care of such patients and plays a major role in decreasing burden on the growing economy. Such a goal will not be reachable except on a background of a nationwide orthopedic trauma registry system.

Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report

Spinal cord injury is a well-known predisposing factor for development of heterotopic ossification around the joints especially hip and elbow. Heterotopic ossification about the knee is usually located medially, laterally or anteriorly; besides, the knee is generally fixed in flexion. There are only a few reports of heterotopic bone formation at the posterior aspect of the knee (popliteal space) and fixation of both knees in extension; so, there is little experience in operative management of such a problem.Here, we present a 39-years old paraplegic man who was referred to us five years after trauma with a request of above knee amputation due to sever impairment of his life style and adaptive capacity for daily living because of difficulties in using wheelchair. The principle reason for the impairment was fixed full extension of both knees as the result of bilateral large heterotopic ossification masses in popliteal fossae. The bony masses were surgically resected with acceptable outcome. The anatomic position of the ossified masses as well as ankylosis of both knees in full extension, and the acceptable functional outcome of surgery which was done after a long period of five years following injury makes this case unique.