The efficacy of Back School on chronic low back pain of workers of a pharmaceutical company in a Tehran suburb. COPCORD stage II study

Aim: Low back pain (LBP) is the second most frequent reason for seeking medical advice. Various treatments are proposed from no intervention, to analgesics, rest, exercises, local interventions and surgical procedures. Results and outcomes are differently reported. Back School (BS), a combination of patient education and physical exercises, seems to have good results. The aim of this study was to check the effect of BS in factory workers. Patients and Methods: All (70) workers were interviewed and 26 of them (37.1%) had chronic LBP. Secondary causes were excluded. Anatomy, physiology, biomechanics of the spine, correct postures at work and back exercises were taught. Pain on a visual analog scale (VAS) of 0–100, and Short Form (SF)‐36 health survey were applied, before, at the end of BS sessions, and 3 months after BS. Analysis was done by t‐test, Wilcoxon and Pearson’s correlation test. Results: The mean VAS on pain before BS was 43.4 ± 22.3, improving to 38.6 ± 17.5 at the end of BS. The difference was not significant (P = 0.19). The mean VAS improved to 27.5 ± 20 at 3 months after BS. The difference was significant compared to before BS (P = 0.001). The quality of life measured by the SF‐36 questionnaire, did not improve significantly, except for two of its eight subgroups (Role Physical, Social Functioning) at the end of BS, and two of its subgroup (Mental Health, Social Functioning) at 3 months after BS. Conclusion: Among industrial workers, BS is mainly effective on pain, but is less evident on SF‐36.     

Correction of bone marrow failure in dyskeratosis congenita by bone marrow transplantation

Dyskeratosis congenita is recognized by its dermal lesions and constitutional aplastic anemia in some cases. We report successful allogeneic bone marrow transplantation in two siblings with this disease from their sister, and their long term follow-up. We used reduced doses of cyclophosphamide and busulfan for conditioning instead of total body irradiation. Also, we report late adverse effects of transplantation which are not distinguishable from the natural course of disease.     

Iatrogenic biliary tract complications: radiologic features and clinical significance.

Thirteen intrahepatic and 22 extrahepatic biliary tract complications were detected radiologically in 35 adult patients who had undergone cholecystectomy and bile duct exploration. Intraoperative usage of Fogarty balloon catheters to extract biliary calculi without fluoroscopic guidance resulted in focal ectasia or rupture of intrahepatic radicles in two and seven cases, respectively. Metallic surgical instruments such as Bakes dilators and biliary forceps or clamps accounted for most of the common duct injuries; these were manifested as submucosal dissection (two cases), transmural laceration (four cases), or localized trauma with subsequent stricture (three cases). Technical mishaps during T-tube placement led to common duct perforation (four cases) and extraluminal malposition of T tubes (three cases). The remaining complications included choledochoduodenal fistula (three cases), biliovenous fistula (two cases), biloma (three cases), and retained intraductal fragments of biliary drainage catheters (two cases). Knowledge about radiologic features and causal factors of such iatrogenic processes can play a crucial role in their prevention, correct diagnosis, and management.     

Diffuse cavernous hemangioma of the colon in the Klippel-Trenaunay syndrome.

Large, infiltrative cavernous hemangiomas of the distal colon were present in 3 children with the Klippel-Trenaunay syndrome, 2 of whom are the subject of this report. The lesion is manifested clinically as intermittent rectal bleeding starting in the first 5 years of life. The radiographic features include (a) varicose lesions in the wall of the rectosigmoid, ranging from a network of distended submucosal veins to nodular defects, (b) narrowing of the rectum by the surrounding extramural portion of the hemangioma, and (c) phleboliths within the lesion. Inferior mesenteric angiography and sigmoidoscopy are useful for preoperative confirmation. The occurrence of visceral hemangiomas in the Klippel-Trenaunay syndrome and its relevant diagnostic and therapeutic implications are discussed.     

Esophago-gastric invagination in patients with sliding hiatus hernia.

Intussusception of the distal esophagus into a reducible hiatus hernia is described in nine female and three male patients. The main radiographic feature is demonstration of a lobulated fundal mass of changeable size and configuration surrounding the narrowed distal esophageal segment. This pseudotumor is produced by inversion of the hiatus hernia into the stomach, and may be mistaken for a neoplasm. Disinvagination invariably occurs when maneuvers directed toward demonstration of a sliding hernia are utilized during upper gastrointestinal fluoroscopy. It is emphasized that esophago-gastric invagination frequently accounts for masses shown in the cardia of older women with intermittent dysphagia and crampy epigastric pain.