Compartment syndrome: an unusual course for a rare disease

We report a case of compartment syndrome of the left upper limb following hemorrhage due to Crimean-Congo hemorrhagic fever in a 45-year-old man. As far as we know, there is not such a report in the literature. We discuss clinical manifestations, electrophysiologic findings, differential diagnosis, and management of the patient. A high degree of awareness for an early diagnosis may participate to improve the poor prognosis.     

Urinary calcium to creatinin ratio in children

Due to difficulty of 24hr urine collection in children for detection of hypercalciura, random urine calcium to creatinin ratio (U Ca/Cr) has been used for screening hypercalciuria. The purpose of this study was to determine normal U Ca/Cr ratio in primary school age children in North of Iran. This study was performed on 590 healthy school-age children, aged between 7–11 years. Early morning random urine samples from all children were analyzed for calcium and creatinine. Mean value and 95^th percentile for U Ca/Cr ratio were 0.155 ±0.095 and 0.36, respectively. A negative correlation observed between age and U Ca/Cr ratio was R=-0.101, P=0.014. With regard to variations in U Ca/Cr ratio among different studies, it is recommended to determine this ratio in every geographic area.     

A pilot study of a randomized controlled trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors

BACKGROUND: Shoulder dysfunction remains a frequent complication after neck dissection procedures for head and neck cancer. METHODS: We conducted a pilot study to evaluate the effects of progressive resistance exercise training (PRET) on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in patients with head and neck cancer. Twenty patients (mean age, 61 +/- 7.7 years) were randomly assigned to PRET or standard care intervention. Subjects assigned to the PRET group exercised three times per week for 12 weeks. The goal of the exercise program was to enhance scapular stability and strength of the upper extremity. The resistance-training program was progressive in terms of number of sets and repetitions performed, as well as the amount of weight lifted, depending on performance status. RESULTS: The completion rate for the trial was 85% (17 of 20). The exercise group completed 93% of scheduled exercise sessions. Significant improvements were found in favor of the PRET group in active shoulder external rotation (p =.001), shoulder pain (p =.038), and overall score for shoulder pain and disability (p =.045). CONCLUSIONS: The study results demonstrate a high rate of completion and adherence with our PRET program among patients with head and neck cancer. The preliminary findings, although limited, also suggest a potential therapeutic role for resistance exercise as an adjunct to standard physical therapy treatment.     

Effects of a noncompressive hematoma on free flap viability

Microvascular free tissue transfer has become an integral component of head and neck reconstructive surgery and historically has a greater than 95% success rate. Hematomas have long been known to cause skin flap necrosis by a variety of mechanisms including direct pressure necrosis, cellular damage secondary to the effects of free radicals, and inflammation. Compression from a hematoma is known to cause free flap compromise. To our knowledge, however, there have been no studies documenting the effect of a noncompressive hematoma surrounding the vascular pedicle on free flap viabiliry. This animal study was designed to assess the effects of a noncompressive hematoma on free flap survival. A right groin cutaneous free flap was created in 32 male Spraque Dawley rats. The rats were then divided into three groups: (1) 10 rats had no fluid added to the anastomotic compartment; (2) 11 rats had 0.5 cc of blood, taken from the femoral artery at the time it was cut, instilled in the anastomotic compartment via the 18-gauge angiocath; and (3) 11 rats had 0.5 cc of pentastarch instilled in the anastomotic compartment via the 18-gauge angiocath. There was 100% free flap survival in all three groups. All vessels examined at the time of sacrifice revealed intact anastomoses and no evidence of luminal clots. This study strongly suggests that in the cutaneous groin free flap model, a perianastomotic noncompressive hematoma has no effect on free flap survival.     

Orbital osteoma arising adjacent to a foreign body

A 27-year-old man sustained a blast injury to the face in April 1996, with a resultant foreign body at the right medial orbital wall. He refused to undergo surgical removal of the foreign body at that time and was discharged on oral antibiotics. Five years later, he presented because of recurrent attacks of swelling, redness, and pain at the right medial canthal area. A repeat computed tomography (CT) scan revealed fragmentation of the original orbital foreign body and an adjacent radiodense lesion that appeared to blend smoothly with the orbital bone from which it arose. This lesion was not present on the initial CT scan done 5 years earlier immediately following the blast. The patient was started on oral antibiotics and surgical exploration was carried out. Three fragments of the foreign body were removed in addition to the adjacent orbital lesion, which proved to be an ivory-type osteoma on histopathology. We briefly review previously suggested factors in the pathogenesis of osteoma and present further evidence in favor of both traumatic and infectious factors.     

Women's rights in Pakistan: a forensic perspective

Pakistan is a large and an important West Asian country which came into being in the name of Islam and therefore Islamic tenets remain the core of its constitution. The laws of the state have to conform to Islamic law so that they can have a positive impact on the society. Unfortunately, in Pakistan today not all men enjoy the rights and facilities to which they are entitled and women are doubly disadvantaged by poverty and gender. With their own political agendas, various governments have promulgated laws which affect the society in various ways. The laws which directly influence women's rights merit mention, as women comprise more than 50% of the population of Pakistan and are still kept on the sidelines by the male dominant society. The Muslim Family Law Ordinance, 1961, and the Hudood Ordinance, 1979 were both promulgated by military dictators with different visions. The former codified the rights of women bestowed by Islamic law; the latter repealed laws for sexual offences according to the injunctions of Islam and had a negative impact. Both laws need the assistance of forensic medicine as age estimation and medical examinations are necessary if they are to be followed in the right perspective. However, a legal need for an examination by an expert in forensic medicine is sadly lacking in both laws. This has happened due to lack of training of forensic physicians and therefore a lack of research in important areas of forensic medicine in the country. This paper examines these laws and the interaction they have with forensic medicine and proposes that the laws need revision in accordance with modern science, incorporating forensic sciences as well as the injunctions of Islam.     

Medicolegal impact of the new hurt laws in Pakistan

The penal laws in Pakistan went through sweeping reforms in 1979 with intent to bring them in line with the Islamic Jurisprudence. The introduction of these laws repealed the definitions as well as punishments of various types of injuries. Besides that these laws also redefined and reclassified the crime of murder. The laws required that the injuries be identified and documented by an authorized physician. The new classification of injuries and deaths, lack of proper forensic training of the emergency room physicians, performance of medicolegal work by doctors at the earliest stages of their careers and theoretical methods of undergraduate teaching in forensic medicine are matters of concern as they adversely affect the quality of medicolegal work performed in the country. This article gives an overview of the medicolegal system of Pakistan. It also reviews the current laws, their impact on the medical and legal systems of the country and offers some recommendations to correct the existing situation of forensic training and work standards.