BACKGROUND: The treatment of combined anterolateral POSTEROLATERAL rotary instability has been done by correcting knee alignment, anterior cruciate ligament (ACL) reconstruction plus repair or reconstruction of the POSTEROLATERAL COMPLEX. Because of the technical difficulties encountered in these operations and the need for more than two stages, and considering the controversy among the role of POSTEROLATERAL COMPLEX (PLC) in valgus knees, this study was designed to observe the results of treating this instability by ACL-reconstruction alone, after correction of varus, without reconstruction of the POSTEROLATERAL COMPLEX or further extra-articular manipulation.METHODS: This was a clinical trial performed on 29 patients (29 knees) with combined anterolateral POSTEROLATERAL rotary instability. Subjective and objective instability signs were recorded. Arthroscopy was then performed and a valgus osteotomy was done to correct alignment. Then in a second stage, an ACL-reconstruction was carried out. Results, after a mean of 23 months follow-up, were compared to the conditions before surgery. Fisher exact test, X2 and Wilcoxon tests were used to analyze the data. P<0.05 was considered to be meaningful.RESULTS: Pain was relieved in more than half and locking was improved in all of the patients. Giving way of the knee was diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery (P<0.001). Most of the patients returned to the preinjury level of work or sports.CONCLUSIONS: Based on the results of this study, ACL-reconstruction alone, after correction of varus, can be sufficient to address this combined knee instability without farther procedures on extra-articular structures and POSTEROLATERAL COMPLEX, thus avoiding unnecessary complications and longer rehabilitation.

Introduction: Carney COMPLEX is an autosomal dominant syndrome that is defined with different tumors including myxoma in different organs, endocrine tumors and lentiginosis lesions. This is the first case report of this syndrome from Iran.Case: The patient is a 27 year old girl, referred with flank pain. Physical examination revealed hirsutism, truncal obesity, hyperpigmantasion and hypertension; Cushing's syndrome was suggested and confirmed with related classic biochemical tests. She had history of cardiac myxoma during her childhood and had been operated twice.Pituitary microadenoma and right adrenal adenoma were reported on MRI and CT-scan, respectively. Initially laparascopic right adrenalectomy was done; as expected, no remission in signs of Cushing's syndrome was observed after surgery. By laparoscopic adrenalectomy of the other site, Cushing's syndrome resolved. Pathologic report of 1st operation was adrenal adenoma with surrounding pigmented micronodular hyperplasia and of the 2nd one was just pigmented micronodular hyperplasia.Conclusion: We have reported a patient with Carney syndrome along with Cushing's syndrome due to bilateral adrenal hyperplasia and an adenoma in contralateral adrenal and microadenoma of the pituitary as an incidentaloma. This is a new presentation of Carney syndrome.

Background and Aim: Combined anterolateral and POSTEROLATERAL rotary instability are treated by correcting knee alignment, Anterior Cruciate Ligament (ACL) reconstruction and repair or reconstruction of the POSTEROLATERAL COMPLEX (PLC). Because of technical difficulties encountered in these operations and the need for more than tow stages, and considering the controversy among the importance of POSTEROLATERAL COMPLEX (PLC) in valgue knee, this study was performed to treat this instability by ACL reconstruction alone, after correction of varus, without reconstruction of the POSTEROLATERAL COMPLEX and further extra-articular manipulation. Methods: This clinical trial was performed on 29 patients (29 knees) with combined anterolateral and POSTEROLATERAL rotary instability. Subjective and objective instability signs were recorded. Arthroscopy was then performed. To correct alignment, a valgus osteotomy was done and then an ACL reconstruction carried out. Results after a mean of 23 months follow-up, were compared to the ones of before surgery. Fisher Exact test, 2 and Wilcoxon tests were used to analyze data. Results: Pain was relieved in more than half and locking disappeared in all of the patients. giving way diminished from 79.3% to 6.9%. Special instability tests showed a significant improvement after surgery (P<0.001). Most of the patients returned to the preinjury level of work or sports. Conclusion: Based on the results of this study, after correcting varus, ACL-reconstruction alone, without further invasive procedures on extra-articular structures and POSTEROLATERAL COMPLEX, is sufficient to cure this instability, avoiding unneeded complications and longer rehabilitation.

Thymic epithelial neoplasms are commonly aetiology of the anterior mediastinum masses in adults. It represents 20– 30% of all mediastinal tumours in adults. Ectopic thymomas usually affect the neck, mediastinal compartments, lung, and pleura, arising from aberrant thymic tissue. For giant thymoma, there is still no consensus on the surgical approach. We herein report a patient with a giant thymoma that was successfully resected through a large right POSTEROLATERAL thoracotomy. We report a rare case of a giant thymoma in the posterior mediastinal. Our patient underwent a conventional POSTEROLATERAL thoracotomy to remove the mass. This latter was histologically diagnosed as a WHO classification type AB thymoma and Masaoka stage I. The choice of surgical approach of mediastinal tumor is based on the tumour topography, the assessment of tumour extension and extirpation, the surgeon's experience and clinical symptomatology. A multidisciplinary approach is mandatory to achieve good results.

Pain control is a major concern in post-thoracotomy patients. The current prospective randomized double-blind study was designed to evaluate the analgesic effects of morphine and fentanyl given interpleurally after POSTEROLATERAL thoracotomy. Thirty patients undergoing elective POSTEROLATERAL thoracotomy in a teaching hospital in Tehran were divided into 3 groups with equal number of patients. Patients in group IPM, IPF1 and IPF2 received 0.1 mg/kg morphine sulfate, 5mg/kg fentanyl and 2.5mg/kg fentanyl in a total volume of 40 ml injected via an intrapleural catheter placed in the pleural space before the closure of chest. Subsequent doses of interpleural injections were administered at 4 and 8 h after operation. The intensity of pain was evaluated at rest and with coughing just before each interpleural injection and 30 min afterwards using a 10 point visual analogue scale (VAS). If patients needed additional analgesia, indomethacin suppository and intravenous morphine were given during the 20-h postoperative study period. In all of the 3 study groups VAS scores were significantly reduced 30 min after interpleural administration of the study solutions (p<0.05). However, inter-group comparisons revealed no significant differences for VSA scores, supplemental analgesic usage and systemic side effects. Briefly, interpleural morphine and fentanyl following thoracotomy produce equal analgesia without major side effects.

Background: Degenerative spondylolisthesis is a common disease of the lumbar spine especially in older ones. The disease represents a challenge to the treating physician. At present, for those patients that deteriorate clinically, there are many proposed algorithms for the surgical treatment. This before and after study was undertaken to assess the surgical results of decompression and instrumented POSTEROLATERAL fusion in these patients.Methods: The study population consisted of 23 patients who had undergone no prior surgery for degenerative spondylolisthesis on the lumbar spine. These patients were treated by decompression, bilateral POSTEROLATERAL fusion, and segmental (pedicle screw) instrumentation with mean follow-up of 29 months (range, 13-73 months). Finally, the clinical results were evaluated for all patients by means of an Oswestry Disability Index (ODI) version 2.1, the Henderson’s functional capacity, and persistence of leg symptoms, low back pain or claudication. Mann-Whitney and Chi-Square tests were used to assess the average values and comparison, respectively.Results: Henderson’s functional capacity at the last visit session was excellent in 14 (60.9%), good in 7 (30.4%), fair in 2 (8.7%) cases. ODI decreased from 72.2% (50-88%) preoperatively to 14.4% (0-54%) at the latest follow-up visit. A history of leg pain or claudication was correlated significantly with the amount of decline in ODI score and Henderson’s functional capacity (p<0.05).Conclusion: In spite of limited number of our patients, decompressive surgery plus instrumented POSTEROLATERAL fusion is a safe, reliable, and satisfactory procedure for treating degenerative lumbar spondylolisthesis. This procedure may be done when conservative treatment was failed and psychological problems can be ruled out.

Background: POSTEROLATERAL rotatory instability is one of the most COMPLEX problems in ligamentous injuries of the knee. It represents a challenging diagnostic and therapeutic problem for the orthopaedic surgeon. We present the results of biceps tenodesis in chronic POSTEROLATERAL rotatory instabilily of the knee.Methods: In this case series we included all of the patients with positive reverse pivot shift test and prone external rotation test at least 3 weeks after their trauma. We excluded the patients with varus malalignment of the knee and concomitant anterior cruciate ligament (ACL) rupture. Biceps tenodesis (Clancy method) was performed. We did not reconstruct posterior cruciate ligament (PCL) if its insufficiency was diagnosed in addition to POSTEROLATERAL rotatory instability. Knee scoring scale of Lysholm was used during and after follow ups. The results were statistically compared using Wilcoxon signed rank test (WSRT), paired samples t-test and friedman test. Data analysis was done using SPSS (version 11.5) and Stata (version 8) computer software’s.Results: Our series consists of 13 patients (12 male and one female). 31% of the patients had isolated POSTEROLATERAL injury and 69% of the patients had combined POSTEROLATERAL and PCL injuries. The patients were between 17 to 45 years old (mean 30.25 years). Follow up was between 4 to 44 months (mean: 31 months). At the end of follow up 85% of patients had negative reverse pivot shift test. Prone external rotation test at 30o of knee flexion was negative in 92% of patients. In 92% of patients giving way was negative and in 77% of patients pain was decreased. Before operation the average Knee scoring scale of Lysholm was 73 and at the end of the follow up it increased to 85 (p value<0.001).Conclusions: Biceps tenodesis using Clancy method is a safe, effective and reliable method in management of chronic POSTEROLATERAL rotatory instability of the knee. During surgery careful exploration of the common peroneal nerve is recommended. Although we found this method effective in combined POSTEROLATERAL and PCL injuries the results are much better in the cases with isolated POSTEROLATERAL injuries.