Mustafa Yassin

Cryotherapy of Musculoskeletal Tumors — From Basic Science to Clinical Results

Combined modality treatment of musculoskeletal tumors led to improved patient survival. As survival improves, more consideration is given to the functional outcome of treatment, and interest is focused on the development of less mutilating and extensive surgery. One modality that can reduce patient disability significantly is cryosurgery, as it allows minimally invasive surgery based on marginal resection and tumor interface sterilization instead of wide resection of certain neoplasms. Classical cryosurgery as developed by Marcove involves pouring of liquid nitrogen into the tumor bed. This approach revolutionized the treatment of some tumors such as giant cell tumor of bone, allowing intra-lesional resection to substitute the wide-resection method used up to that time. However, complications of this method of treatment are common, including nitrogen emboli, fractures of the bone due to extensive necrosis and damage to neurovascular elements. A recent development in the field of cryosurgery has been the argon-based system allowing controlled formation of an ice-ball surrounding a metallic probe. The system is computer controlled and allows precise evaluation of the tumor bed interface as well as surrounding structures that need to be protected. Prior to application of this method in humans it is important to ensure that interface sterilization is indeed achieved using cryosurgery. To evaluate this question, a Swarm rat chondrosarcoma was used. Cell viability was assessed following ice-ball formation. Histological evaluation indicated that cell death occurs up to 5 millimeters from the ice-ball if temperatures of −40° Celsius at the metallic probe are achieved. A further evaluation was performed on samples obtained from patients during surgery. A minimum of two freezing cycles was shown to be necessary to achieve tissue viability similar to that of boiled tissue. Twenty-seven patients were operated to date using an argon-based cryosurgery system. The patients included 7 cases of grade I chondrosarcoma, 5 cases of giant cell tumor of bone, 14 cases of a metastatic lytic bone lesion and a single case of osseous-fibrous dysplasia. None of the patients suffered nerve injury during the operation. After a minimal follow-up period of 2 years only two of the surviving patients had a recurrence (a giant cell tumor of the proximal fibula, and the patient with the osseous-fibrous dysplasia whose tumor recurred as a frankly malignant adamantimoma). There were no pathological fractures. This method appears practical and allows close monitoring of the surrounding tissue to reduce the chances of recurrence.

Maxillary and Frontal Bone Simultaneously Involved in Brown Tumor due to Secondary Hyperparathyroidism in a Hemodialysis Patient

Brown tumors are rare focal giant cell lesions of the bone caused by primary hyperparathyroidism (HPT). Brown tumor was reported in 1891; it presents as the end-stage findings of HPT. Common involvements are skull and pelvic girdle. We describe a case of 46-year-old female hemodialysis patient, with secondary HPT in whom multiple masses lesions of the left maxillary sinus and frontal bone were radiologically suspected to be brown tumor. This unusual manifestation of secondary HPT can be expected to occur with increased longevity of patients with renal failure and illustrates the need to include brown tumor in the differential diagnosis.

The detrimental danger of water-pipe (Hookah) transcends the hazardous consequences of general health to the driving behavior

ObjectiveTo determine whether the consumption of tobacco used in Water-Pipe by drivers increases the risk of a motor vehicle collision as a consequence of hypoxia.DesignAnalytical case–control study.Data sourcesSeventy exclusive Water-Pipe smokers (Experimental Group - EG) - mean age ± SD: 29.47 ± 10.45 years; mean number of weekly WPS, (6.9 ± 3.7); mean duration of WPS (WPS) is (7.5 ± 2.1 years) - and thirty non-smoker (Control Group – CG; mean age ± SD: 36.33 ± 13.92 years) were recruited during 2011 from two Arab villages located in the Galilee, northern Israel.MethodsWe performed a case–control study exclusively among Water-Pipe smokers with an appropriate non smokers control group. Demographic questionnaire, Pulse Oxymeter for blood oxygenation measure and a driver simulator for measuring various participants driving behaviors were utilized. Statistical analysis for analyzing the different variables, Pearson’s x2 analysis for the comparison of categorical variables, continuous variable is compared using Student’s t-test and for testing the correlation between the different variables and bivariate correlation analysis were applied.ResultsIn the (EG) following WPS, we observed increase in the pulse rate - from 80 to 95 (t = 11.84, p < 0.05) and decrease in saturation level from 97.9 to 97.32, the decrease is statistically significant (t = 3.01, p < 0.05) versus no change in (CG). An increased number of accidents among EG (OR is 1.333 with CI of 1.008–1.776), while in CG, an insignificantly decrease (t = 3.08, p < 0.05). In EG an increase in centerline crossings (OR is 1.306 with CI of 1.016–1.679), also the total time not being within the lane was increased and the estimated (OR: 1.329; CI: 1.025–1.722). WPS increases the number of accidents by 33% and Hypoxia can cause driving behavioral turbulences.ConclusionThe results show that WPS has a significant impact on driving behavior and on the risk of being involved in road accidents and causing driving to become riskier and less careful and stable. To the best of our knowledge, this is the first time such relationships have been tested. After WPS the total number of traffic accidents and driving violations increase. The results show a significant increase in the pulse rate immediately after WPS with a decrease in the saturation rate (the level of blood oxygenation); these changes continue half an hour after WPS.

Treatment of anterior tarsal tunnel syndrome through an endoscopic or open technique

Anterior tarsal tunnel syndrome is often underdiagnosed, due to lack of clinical awareness and vague clinical presentation. Most often patients complain of pain located to the dorsum of the foot. The present study is a consecutive series of 13 patients treated according to a fixed protocol followed for a minimum of 24 months. A total of 12/13 cases presented with a bulge in the anterior part of the ankle or the dorsal foot and Tinels sign was positive over it. Only half had decreased sensation. Surgical technique was either endoscopic or open. Endoscopy is preferable when compression is due to an osteophyte (4/13) or an isolated ganglion 2/13). In other cases presenting with synovitis (5/13) or unknown etiology (2/13) performing open surgery was deemed as safer. The American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores improved from an average of 55 ± 8 to 83 ± 11 at 12 months after surgery and 88 ± 10 at 24 months after surgery. The anterior tarsal tunnel syndrome accounts for approximately 5% of cases complaining of feet numbness, which undergo electromyographic and nerve conduction testing. Reports in the scientific literature are scarce, perhaps due to underdiagnosis, while it is amenable to surgical management. Clinical diagnosis supported by imaging studies demonstrated osteophytes, ganglions or localized synovitis. Endoscopic treatment can be performed safely provided a clear-cut single compressing element is identified.

Traditional and Modern Medicine Harmonizing the Two Approaches in the Treatment of Neurodegeneration (Alzheimer’s Disease – AD)

© 2012 Abdalla et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Traditional and Modern Medicine Harmonizing the Two Approaches in the Treatment of Neurodegeneration (Alzheimer’s Disease – AD)

Retentive Cup Arthroplasty in Selected Hip Fracture Patients—A Prospective Series With a Minimum 3-Year Follow-Up:

Objective: To evaluate the efficacy of the use of retentive cup primary total hip replacement (THR) in high-dislocation risk subcapital fracture patients. Methods: During the years 2008 to 2012, 354 patients with displaced subcapital fracture were operated at our institute. The patients were selected to undergo primary constrained THR according to the following criteria: (1) a preinjury grade 4 or more on the Functional Independence Measure mobility item “5. Locomotion: walking/wheelchair” and grade 4 is defined as “4. Minimal assistance Requiring incidental hands-on help only” (patient performs >75% of the task) and (2) a disease leading to poor motor control. Exclusion criteria were normal muscular control and known infection of the involved joint. Results: Of the 354 patients, 87 fulfilled the inclusion criteria and underwent constrained total hip. Average age was 78 years with a female predominance (73%). Fifteen patients had prior hemiparesis, 19 had Parkinson disease, and 35 had generalized sarcopenia. Eighty-five patients had an uneventful recovery, with an average Hip Disability and Osteoarthritis Outcome Score (HOOS) of 76 ± 7 at 2 years. In 2 patients, the prostheses dislocated. In both cases, the dislocation was due to ring displacement and the inner head dislocated. One case was infected and the patient was treated by a Girdlestone procedure. In the other case, the prosthetic head was revised. The patient remained asymptomatic and at 4-year follow-up had an HOOS of 85. Discussion: It appears that constrained prosthesis is a suitable treatment for patients with poor muscular control having subcapital fractures. The functional results appear to be superior to those of bipolar arthroplasty and similar to the results of primary total hip arthroplasty while the dislocation risk is <3%. Conclusion: Semielective total hip arthroplasty using a retentive cup liner appears to offer good functional results with a low dislocation rate in patients with poor muscular control.

The Topaz Micro-Radiofrequency Ablation Achieves Similar Results to Endoscopic Plantar Fascia Release

Plantar fasciitis lifetime prevalence is approximately 10% of the US population creating a significant burden to the health care delivery system. Approximately 90% of patients diagnosed with plantar fasciitis respond to nonsurgical therapy and do not require surgical intervention [1]. However plantar fasciitis has a significant deleterious effect on both foot function and general health overall functional score [2]. Suspected etiologies [3-5] include obesity, overuse due to walking or running or standing, excessive subtalar pronation, seronegative arthritis, and limited dorsiflexion of the ankle joint. Conservative therapy usually entails the use of foot orthoses, stretching exercises, local corticosteroid injection, oral nonsteroidal anti-inflammatory drugs and other physical therapy modalities, and nonweight-bearing status and rest.

Fracture of the Greater Trochanter during Hip Replacement A Retrospective Analysis of 29/688 Cases

Nonunion of the greater trochanter occasionally occurs following trochanteric osteotomy [1] without major consequences. The information regarding the incidence and the consequences of unintended trochanteric fracture is limited. Specifically, it is not clear whether trochanteric non-union or long term trochanteric pain is consequences of such fractures. Trochanteric nonunion may also increase the risk of prosthesis dislocation [2]. Fracture of the greater trochanter rarely occurs after THR surgery without osteotomy [3]. In the current comparative study, the incidence and clinical relevance of iatrogenic greater trochanter fractures in connection with the lateral Hardinge approach [4] were analyzed depending on the patient’s position during the surgery in order to define whether the incidence varies depending on patient positioning.

Effect of Adding Medical Cannabis Treatment (MCT) to Analgesic Treatment in Patients with Low Back Pain related to Fibromyalgia: An Observational Cross-over Single Center Study

Introduction: Low Back Pain (LBP) occurs in many patients with fibromyalgia (FM). The current study aimed to assess the possible pain and function amelioration associated with Medical Cannabis Therapy (MCT) in this setting. Methods: 31 patients were involved in an observational cross-over study. The patients were screened, treated with 3 months of Standardized Analgesic Therapy (SAT): 5 mg of oxycodone hydrochloride equivalent to 4.5 mg oxycodone and 2.5 mg naloxone hydrochloride twice a day and duloxetine 30 mg once a day. Following 3 months of these therapies, the patients could opt for MCT and were treated for a minimum of 6 months. Patient Reported Outcomes (PROs) included: FIQR, VAS, ODI and SF-12 and lumbar Range of Motion (ROM) was recorded using the modified Schober test. Results: While SAT led to minor improvement as compared with baseline status, the addition of MCT allowed a significantly higher improvement in all PROs at 3 months after initiation of MCT and the improvement was maintained at 6 months. ROM improved after 3 months of MCT and continued to improve at 6 months. Discussion: This observational cross-over study demonstrates an advantage of MCT in FM patients with LBP as compared with SAT. Further studies randomized clinical trials should assess whether these results can be generalized to the FM population at large.

Effect of Medicinal Cannabis Therapy (MCT) on Severity of Chronic Low BackPain, Sciatica and Lumbar Range of Motion

Background: Anecdotal evidence indicates the possible efficacy of cannabis use as an adjunctive treatment in chronic low back pain. The purpose of the current study was to assess the results of treatment of patients suffering from chronic low back pain by medicinal cannabis (MCT). Methods: A cohort of 46 patients was followed for a minimum of twelve months. They were evaluated at baseline prior to MCT, 3 months later when MCT was begun and up to 12 months of MCT by patient reported outcome questionnaire (SF-12), visual analogue scale (VAS) and the Brief Pain Inventory (BPI), back specific function was assessed using the Oswestry score, range of motion was measured using the Saunders digital inclinometer. Opiate use was assessed using pharmacy dispensation records at baseline and after 12 months of MCT. Inclusion criteria included: Age over 25 years, sciatica with documented treatment for at least 12 months, evidence on CT or MRI scan of disc herniation or spinal stenosis, failure of at least two narcotic drugs, and consent to use medicinal cannabis. Exclusion criteria included evidence of bone cancer, evidence of diabetic neuropathy, and evidence of prior psychotic reactions. Treatment protocol: Cannabis usage was at a fixed dosage of 20 grams per month, dose increase was considered at least after 6 months of treatment. The cannabis was smoked at a recommended rate of 4 dosages per day. Results: After 12 months of MCT BPI VAS decreased from 8.4 ± 1.4 to 2.0 ± 2.0; SF12-PCS improved from 47 ± 14 to 55 ± 12; SF12-MCS improved from 44 ± 6 to 50 ± 10; and sagittal plane active range of motion improved from 34o ± 8o degrees to 48o ± 8o, Conclusion: Short term usage of smoked medicinal cannabis appear to improve both physical and mental function while decreasing pain levels of chronic low back pain sufferers.