Background: Determining the prevalence of degenerative changes by MRI in patients with low back pain (LBP) and Lumbar canal stenosis is valuable for better understanding of important LSS issue.Objective: This study was designed to determine the prevalence of disc degeneration changes through MRI images obtained from patients with low back pain and Lumbar spinal stenosis.Methods: This was a cross sectional study in which 53 patients (selected through examining 200 MRI images from patients seeking medical care because of low back pain (LBP) and referred to our MRI imaging center) with MRI findings compatible with Lumbar canal stenosis (LSS), were investigated between June 2003 to September 2004. Intervertebral disc conditions such as normal status, bulging, and herniation were evaluated in patient’s MRI images.Findings: In 53 patients with Lumbar canal stenosis, 34% were women and 66% men (P<0.005). Degenerative disc disorders (especially herniation) were found in 51% of our patients and 49% shown to have isolated bony canal stenosis occasionally with bulging discs. The isolated or combined anteroposterior (AP) diameter narrowing between patients with LBP was 94.35% in the current study compared to the previous estimation in our imaging center (80%) found in 1998. There was 5.65% isolated LR narrowing and 7.5% AP and LR narrowing in our study.Conclusion: Based on our results, 51% of patients had degenerative disc disorder in the form of disc herniation associated with spinal canal stenosis 24.5% with no disc pathology, and 24.5% with bulging discs. disc degeneration was more prevalent in stenotic group compared to non-stenotic group (51% versus 34% p>0.03).

Introduction: Lumbar disc herniation is the most common specific cause of chronic low back pain and exercise therapy is one of the goals of its management. The aim of this study was to investigate the effect of core stability exercises on activation of abdominal muscles and flexibility of Lumbar in men with disc herniation. Methods: The subjects of this clinical trial study were 20 young and middleaged men with Lumbar disc herniation referred to physiotherapy in rasht in first half of year 1399 who were randomly divided into two groups of core stability exercises (n=10) and control (n=10). The electrical activity of the internal oblique, external oblique, and rectus abdominis muscles was measured by electromyography and abdominal muscle strength by straight leg raising test and flexibility by sit and reach test. Training protocol of intervention group included 8 weeks of core stability exercise, while the control group was only followed up. Statistical analysis was performed using paired t test an analysis of covariance test with SPSS software. Results: Activation of 3 muscles and strength and flexibility after 8 weeks of exercise had a significant improvement(p<0/05) but changes were not significant in control group. However, analysis of covariance showed a difference between two groups in activation of all three muscles and flexibility(p<0/05) But no significant difference was observed in muscle strength. Conclusion: Our findings showed, people with disc herniation experience greater activation, strength, and flexibility in trunk muscles after core stability exercise thus can be considered in rehabilitation.

Introduction: Lumbar disc herniation is the most common specific cause of chronic low back pain and exercise therapy is one of the goals of its management. The aim of this study was to investigate the effect of core stability exercises on activation of abdominal muscles and flexibility of Lumbar in men with disc herniation. Methods: The subjects of this clinical trial study were 20 young and middleaged men with Lumbar disc herniation referred to physiotherapy in rasht in first half of year 1399 who were randomly divided into two groups of core stability exercises (n=10) and control (n=10). The electrical activity of the internal oblique, external oblique, and rectus abdominis muscles was measured by electromyography and abdominal muscle strength by straight leg raising test and flexibility by sit and reach test. Training protocol of intervention group included 8 weeks of core stability exercise, while the control group was only followed up. Statistical analysis was performed using paired t test an analysis of covariance test with SPSS software. Results: Activation of 3 muscles and strength and flexibility after 8 weeks of exercise had a significant improvement(p<0/05) but changes were not significant in control group. However, analysis of covariance showed a difference between two groups in activation of all three muscles and flexibility(p<0/05) But no significant difference was observed in muscle strength. Conclusion: Our findings showed, people with disc herniation experience greater activation, strength, and flexibility in trunk muscles after core stability exercise thus can be considered in rehabilitation.

Right-sided heart failure may occur during or after cardiac and noncardiac surgeries. One reason for right-sided heart failure in noncardiac surgeries is pulmonary hypertension (PH). In this report, we describe a 51-year-old man suffering from complications of right-sided heart failure, with an unknown cause. The patient had dyspnea (WHO functional class III), abdominal pain, anorexia, weight loss, bilateral lower limb swelling, icteric sclera, and elevated jugular venous pressure. Echocardiography showed mild enlargement and systolic dysfunction of the left ventricle, moderate enlargement and dysfunction of the right ventricle, and a systolic pulmonary arterial pressure of 60 mm Hg. After several workups, it was diagnosed that his previous Lumbar disc surgery had resulted in an arteriovenous fistula and the consequent PH, leading to right-sided heart failure. After the occlusion of the arteriovenous fistula, all signs and symptoms were resolved. Accordingly, iatrogenic arteriovenous fistulae should be considered a reversible cause of right-sided heart failure.

Background: Lumbar disc degeneration is a multifactorial degenerative disease which is affected by genetic inheritance and environmental factors. Type XI collagen is important for organization of the extracellular matrix and cartilage collagen construction. Rs1676486 is a SNP that causes the conversion of C-T, resulting in a change in the expression of the collagen 11 alpha chain. The T allele reduces the alpha 1 chain transcription of collagen 11 and ultimately leads to an imbalance in gene expression. Methods: This study aims to determine the genetic variant of alpha1 type11 collagen is associated with the progress of intervertebral disc degeneration. All patients were selected from the AL-Zahra Hospital of medical university of Isfahan, Iran, between April 2016 and September 2017. SNP rs1676486 of alpha1 type11 collagen was genotyped in 100 patients and 100 healthy controls. The inclusion criteria for patients were: individuals who had typical clinical and imaging symptoms and signs of intervertebral disc degeneration. Exclusion criteria were: patients with trauma, metabolic and neuromuscular diseases, and congenital disorder of the spine. The Genomic DNA was extracted from peripheral blood samples by a Whole Blood Genomic DNA Extraction Kit. The chi-square test and fisher’ s exact test were evaluated to determine differences of genotype and allele distributions between intervertebral disc degeneration patients and healthy controls. To compare the relationship between genotypes and clinical features the Mann-Whitney U test was used. Results: The mean age was 39. 54± 9. 52 years for the patients and 28. 14± 5. 32 years for the controls, respectively. The mean BMI were 26. 3± 3. 18 kg/m2 and 27. 3± 3. 52 kg/m2 for the patients and the controls, respectively. In addition, the results showed that the prevalence of surgical disc in patients with L4-L5 levels was 52. 1% and L5-S1, with 31. 1%. This study showed, rs1676486 in alpha1 type11 collagen gene was associated with modified intervertebral disc degeneration at age ≤ 50 years and this gene increases intervertebral disc degeneration risk at age >50 years. SNP rs1676486 had the significant association with the intervertebral disc degeneration (P=0. 019), and patients were found to have higher frequency of AA than the controls. Conclusion: This observation shows that type XI collagen is related to age and genetic factor in intervertebral disc degeneration disease.

Churg-Strauss syndrome (CSS) or allergic granulomatosis is a necrotizing vasculitis with different presentations. In this case highlights the anesthetic management of a known case of CSS who underwent posterior spinal fixation surgery. Our patient fulfilled the ACR diagnosis criteria because of showing asthma, paranasal sinusitis, positive skin biopsy and eosinophilia. Before anesthesia induction, laryngeal nerves block by lidocaine was conducted. Fiber-optic bronchoscopy was preceded by inserting a No. 7. 5 spiral cuffed endotracheal tube.

BACKGROUND: Low back pain (LBP) and radicular leg pain (RLP) are among the most common types of pain in human beings. Although magnetic resonance imaging (MRI) is very sensitive for diagnosis of discopathy, some factors, such as overestimation of pathology, expensiveness, unavailability, and using it for patients with cardiac pacemaker or metal foreign bodies, limit the utility. The present study is designed to evaluate the efficacy of computed tomography scan (CTS) in patients with disc herniation in each level of Lumbar spine versus MRI findings at the same level.METHODS: In a prospective trial, 100 consecutive patients with LBP and RLP and signs and symptoms of discopathy referred to our private clinic from September 2004 to April 2005 were studied. CTS and MRI and their data were compared level by level; i.e. CTS of the patients analyzed according to clinical signs and symptoms and compared with MRI at the same level in axial view.RESULTS: Thirty-two patients had clinically S1 root signs and symptoms, in all of them CTS and MRI showed disc herniation at L5/S1 level in axial view. For L5/S1 level, positive predictive value (PPV) of CTS was 100%. In upper Lumbar region, CTS findings were less reliable than MRI. CTS showed the pathology at 14.2% of upper Lumbar, 27.2% at L3/L4 and 46.3% at L4/L5. In nine cases with more than one level involved, CTS confirmed the diagnosis in 11.1% of the cases.CONCLUSIONS: MRI is the gold standard for diagnosis of Lumbar disc herniation, but CTS is sensitive in 100% for L5/S1, 68% for L4/L5, 60% for L3/L4, 0% for upper Lumbar discopathies and finally 78% for multilevel involvement. Therefore, the higher the level of disc herniation is, the lower the sensitivity of CTS.