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Kalhor M.,Tehran University of Medical Sciences | Gharehdaghi J.,Tehran University of Medical Sciences | Gharehdaghi J.,Legal Medicine Research Center | Schoeniger R.,Tehran University of Medical Sciences | And 2 more authors.
Bone and Joint Journal | Year: 2015

The modified Smith-Petersen and Kocher-Langenbeck approaches were used to expose the lateral cutaneous nerve of the thigh and the femoral, obturator and sciatic nerves in order to study the risk of injury to these structures during the dissection, osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular osteotomy. Injury of the lateral cutaneous nerve of thigh was less likely to occur if an osteotomy of the anterior superior iliac spine had been carried out before exposing the hip. The obturator nerve was likely to be injured during unprotected osteotomy of the pubis if the far cortex was penetrated by > 5 mm. This could be avoided by inclining the osteotome 45° medially and performing the osteotomy at least 2 cm medial to the iliopectineal eminence. The sciatic nerve could be injured during the first and last stages of the osteotomy if the osteotome perforated the lateral cortex of ischium and the ilio-ischial junction by > 10 mm. The femoral nerve could be stretched or entrapped during osteotomy of the pubis if there was significant rotational or linear displacement of the acetabulum. Anterior or medial displacement of < 2 cm and lateral tilt (retroversion) of < 30° were safe margins. The combination of retroversion and anterior displacement could increase tension on the nerve. Strict observation of anatomical details, proper handling of the osteotomes and careful manipulation of the acetabular fragment reduce the neurological complications of Bernese peri-acetabular osteotomy. © 2015 The British Editorial Society of Bone & Joint Surgery.


Soltaninejad K.,Legal Medicine Research Center | Fluckiger A.,Hoffmann-La Roche | Shadnia S.,Shahid Beheshti University of Medical Sciences
Journal of Substance Use | Year: 2011

Background: Exposure to lead is usually considered only when a patient's history points to well-known traditional sources of lead. Although the incidence of lead poisoning has declined, the new forms of this type of poisoning still exist. Recently, unusual causes of chronic lead poisoning such as substance abuses have been described. The aim of this article is to present patients with lead poisoning and positive history of opium addiction. Patients and Method: In this study, we evaluated 25 patients seen from 2002 to 2007 with lead poisoning in the Loghman Hakim Hospital Poison Center, Tehran, Iran. Data such as age, sex, causes of intoxication, route of poisoning, clinical manifestations on admission, duration of hospitalization, blood lead level and history of addiction were extracted from the patients' files. Results: Seven of the patients had a history of opium addiction as the only probable source of lead poisoning, and none of them had occupations known to involve exposure to lead. The average age of these patients was 38.7 ± 9.3 years. The average blood lead level in these patients was 109 ± 37.6 μg/dL. Conclusion: Lead poisoning should be considered in patients with a history of opium abuse who present with non-specific clinical manifestations. © 2010 Informa UK, Ltd.


Soltaninejad K.,Legal Medicine Research Center | Beyranvand M.-R.,Shahid Beheshti University of Medical Sciences | Momenzadeh S.-A.,Shahid Beheshti University of Medical Sciences | Shadnia S.,Shahid Beheshti University of Medical Sciences
Journal of Forensic and Legal Medicine | Year: 2012

Aluminium phosphide (AlP) poisoning has a high mortality due to cardiovascular involvement. In this study, we evaluated the frequency of cardiac manifestations and electrocardiographic (ECG) findings in 20 patients with acute AlP poisoning, who were admitted to the intensive care unit (ICU) in Tehran, Iran, over a period of 6 months (between October 2008 and April 2009). The sex, age, cause and manner of ingestion, number of ingested AlP tablets, cardiac and ECG manifestations, creatine phosphokinase (CPK), CPK-myocardial band (CPK-mb) and troponin-T (TnT) were extracted from the patients' files. All data were analysed with Statistical Package for the Social Sciences (SPSS) software. The majority (60%) of patients were male. The mean age was 27 ± 8.7 years. The mortality rate was 40%. In all of the patients, the cause of poisoning was intentional suicide and ingestion was the route of exposure. The mean number of ingested AlP tablets per patient was 2.2 ± 1.1. The average time interval between admission and cardiovascular manifestations or ECG findings was 168.8 ± 116.2 min. The range of systolic (SBP) and diastolic blood pressure was 60-130 mmHg and 40-70 mmHg, respectively. Dysrhythmia was observed in nine (45%) cases. Elevation of the ST segment was seen in nine cases (45%). Seven patients (35%) had prolonged QTc intervals. Bundle branch block (BBB) was observed in four (20%) patients. In nine (45%) patients, the serum cardiac TnT qualitative assay was positive. There were no significant differences between normal and abnormal ECG groups according to sex, age, number and manner of ingested AlP tablets and SBP. There was a significant correlation between cardiac manifestations and ECG findings and TnT-positive results with mortality in acute AlP poisoning. © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.


Kalhor M.,Tehran University of Medical Sciences | Horowitz K.,Texas Childrens Hospital | Gharehdaghi J.,Legal Medicine Research Center | Beck M.,University of Bern | Ganz R.,University of Bern
HIP International | Year: 2012

The purpose of this cadaveric study was to clearly define the blood supply to the femoral head to help further reduce the incidence of iatrogenic avascular necrosis (AVN). Thirty-five hips of twenty-eight fresh cadavers were injected with colored silicone. Anterior and posterior dissection was performed to assess the vessels contributing to femoral head vascularity. The medial femoral circumflex artery (MFCA) was found to be the main blood supply to the hip in twenty-nine specimens; the inferior gluteal artery (IGA) was found to be the main blood supply in six. The MFCA consistently provided at least one smaller-calibre inferomedial retinacular artery. The foveal artery provided no significant vascular contribution in any specimen. The quantity and calibre of superior retinacular vessels demonstrated their dominance in head vascularity, although inferior retinacular arteries were consistently present. To reduce the risk of iatrogenic AVN, branches of both the IGA and MFCA traversing the interval between the quadratus femoris and piriformis muscles must be protected during surgery. Since all intracapsular vessels penetrated the capsule near its distal attachment, distal capsulotomy carries a significantly higher risk of AVN than proximal capsulotomy, particularly posterolaterally and inferomedially. © 2012 Wichtig Editore.


Kalhor M.,Tehran University of Medical Sciences | Horowitz K.,Baylor College of Medicine | Beck M.,University of Bern | Nazparvar B.,Legal Medicine Research Center | Ganz R.,University of Bern
Journal of Bone and Joint Surgery - Series A | Year: 2010

Background: The acetabular labrum plays an important role in hip joint stability and protection of the articular cartilage of the hip. Despite this, few investigators have evaluated its microscopic vasculature and, to our knowledge, none has assessed its macroscopic blood supply. The purposes of this study were to identify the origin and course of the vascular supply to the acetabular labrum to determine if this blood supply is affected by a labral tear. Methods: Colored silicone was injected into the vascular tree proximal to thirty-five hips in twenty-eight fresh cadavers. Twenty-four hours after injection, anatomic dissection was performed and the vessels supplying the labrum were followed from their origin to their final distribution. Additionally, labral segments of fifteen randomly selected hips were resected to assess the acetabular rim's vascular contribution, and fifteen hips were dislocated for complete intra-articular inspection of the labrum. Results: Radial branches of a previously described periacetabular periosteal vascular ring were identified as the source of labral blood supply in all thirty-five hips. These branches coursed toward the hip joint on the periosteal surface, penetrated the joint capsule near its innominate insertion, and continued within a loose connective-tissue layer on the capsular surface of the labrum. No contribution from the hip capsule, synovial lining, or osseous acetabular rim could be demonstrated. An intact vascular supply was identified in all seven hips with a labral tear. Conclusions: The acetabular labrum receives its blood supply from radial branches of a periacetabular periosteal vascular ring that traverses the osseolabral junction on its capsular side and continues toward the labrum's free edge. The hip capsule, the synovial lining, and the osseous acetabular rim do not appear to provide substantial contributions to the labral blood supply. Clinical Relevance: The blood supply to the acetabular labrum probably remains intact in the majority of hips with labral tears, which are typically partial-thickness tears on the articular side. An improved understanding of labral vasculature may have implications for the surgical treatment of labral tears and associated osseous abnormalities. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.

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