Tehran University Medical Journal

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This is a report of 30 cases of pediatric functional endoscopic sinus surgery (FESS). 28 of these children had chronic sinusitis and 2 had acute sinusitis the most common chief complaints were: 1) Chronic Rhinorea 2) Nasal obstruction 3) Chronic cough. Systemic predisposing conditions were allergy in 7 pts and immotile cilliasyndrome in 2 pts, all of the procedures were performed under general anesthesia. The most common procedures were: 1) Resection of lateral part of the middle turbinate. 2) Antrostomy of the maxillary sinus. 3) Turbinoplasty of the inf turbinate. 4) Anterior erhnoidectomy, (Messerklinger, Approach). There were no kajor complication and only 3 cases of minor complication (2=regeneration of polipoid tissues, 1 synechia) occurred. The duration of follow up was from 6-18 mths recovery occurred in 26 pts. Two of the pts didn't respond because of severe allergy and were referred to immunologist for further therapy 2 others didn't respond appropriately because of immotile cilliasyndrome

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A case-control study was performed by the Research Center of Isfahan University, to determine the predisposing factors of early atherosclerosis. Children of cases admitted to a university hospital in Isfahan with early myocardial infarction (MI) were considered for the study. The affeckted cases (n=116), had 120 children aged 2-14 years. The control group were selected from children of the neighbors of the cases. The two groups were similar in age of parents, children and socio-economic status. Mean cholesterol and triglyceride levels and the frequency of hypercholesterolemia and hypertriglyceridemia were significantly higher in the children of MI cases. The mean lipid concentration of the controls was significantly higher than standard levels. These results emphasize the importance of evaluating children of high risk cases for risk factors of MI.

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It is generally assumed that local muscular fatigue predisposes the individual to injury. Despite the significance of muscular fatigue and endurance, there are not much dynamic endurance studies for trunk muscles in the literature. Most of them have used isokinetic dynamometer which keeps the velocity of movement constant. In this studies with the help of an isoinertial dynamometer we have assessed the effect of repetitive and fatiguing flexion-extension movements patterns and motor output. 38 female subjects with no history of low-back pain for the 6 months volunteered for the study. A triaxial dynamometer was used that simultaneously provided measurement of torque, angular position, velocity impulse, work and power of each axis. Resistance were set independently for each axis by an interfaced computer. The subjects performed trunk flexion and extension movement against a saggital plane resistance equal to 50% of their maximum isometric extension strength in the upright position. The minimum resistance in the coronal and transverse planes were set-up at 5-7 Newton meters. The subjects were asked to perform trunk movement as quickly and as accurately as possible while exerting the maximum efforts until exhaustion. Immediately after dynamic test another isometric test was performed. A paired T-test procedure was performed among the selected parameters of the 1st middle and last 3 repetition cycles. The selected parameters are range of motion, velocity, torque, impulse, work, power, time interval and time of movement. Also, a paired T-test was performed between maximum isometric strength before and after dynamic test. All the selected parameters were significantly reduced in the saggital plane. Subjects displayed significantly less motor control and greater range of motion in the coronal and transverse planes in performing the primary task of flexion and extension. The reduction of the functional capacity of the primary muscles performing the required task is compensated by secondary muscle groups and the spinal structures is located in a more injury prone position, as identified by finite element models. In addition it is suggested that the fatigued muscles would be less able to compensate any perturbation in the load or position of the trunk. The repetitive loading results in a weakening of the viscoelastic passive elements of the spineless structure. The loss of ability to protect these weakened passive elements makes the spine susceptible to industrial and recreational injuries.

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Thalassemia is the most prevalent genetic disorder in Iran and around the world and these patients need regular careful care. The present study reports results of routine examination of patients visited Thalassemia clinic of Tehran. Data about clinical and laboratory examinations of 413 Thalassemic were extracted and analyzed. The prevalence of heart complications, diabetes, growth retardation, delayed puberty and primary and secondary amenorrhea was 9%, 8%, 21.3%, 3.1% and 6.3%, respectively. 44% didn't have secondary sex characteristics. Splenectomy had been done for 67.2% of cases. HBsAg, HBsAb and HBcAb were positive in 1.9%, 57.4% and 43%, respectively. We concluded that blood transfusion standards in this clinic was acceptable, whereas because of poor knowledge, iron chelating is unfavorable.

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Introduction: It is suggested that quadriceps muscle has an important role in stability & mobility of Knee joint in athletics and normal individuals therefore, the purpose of this study was evaluation of the strength in Power Athletics (PA) and Normal Un-trained Individuals (NUI) groups.

Methods and Materials: 31 Females (20 NUI & 11 PA) participated in this study. For measuring the strength, each individual performed 5 continuous concentric-eccentric maximal contraction at angular velocities of 90°/s, 135°/s. Twenty five percent of each individual (Maximum Voluntary Isometric Contraction) MVIC was determined and used as Pre-load force.

Results: Averages concentric & eccentric torques were greater in PA group in comparison with NUI group. The significant difference (P<0.02) existed between PA and NUI groups. Average concentric torques of quadriceps muscle decreased (with increasing of speed from 90°/s to 135°/s) and average eccentric torques increased. Average eccentric torques were greater (P<0.01) in PA & NUI groups in comparison with average concentric torques.

Conclusion: PA group strength was greater in comparison with NUI group. This is possibly due to the type of muscle fibers in this group have (greater type II fibers). Accordingly, it is critical to consider the role of eccentric exercise in PA group for preventing sport injury.

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The main purpose of this study was to evaluate the prevalence of overweight and obesity among guidance-and high school students and its relation to modifiable environmental factors.
Materials and Methods: The subjects have been 1000 girls and 1000 boys aged between 11-18 years, selected by multi-stage random sampling, their parents (2000 subjects) and their school staffs (500 subjects) in urban and rural areas of two provinces in Iran. Data have been analyzed by SPSSV10/ Win software.
Results: The prevalence of 85th < BMI<95th percentile and BMI>95th percentile in girls was significantly higher than boys (10.67±1.1%, 2.9±0.1% VS. 7.37±0.9%, 1.87±0.1% respectively, p<0.05). The mean BMI value was significantly different between urban and rural area (25.38±5.2 VS. 23.25±7.1, P< 0.05). BMI > 85th percentile was more prevalent in those with lower educated mothers (9.2+2.1 vs. 11.5+2.4 years of mothers education respectively). The mean of the total energy intake was not different between overweight or obese and normal- weight subjects (1825±90Kcal VS. 1815±85Kcal, P>0.05) but the percent of energy derived from carbohydrates was significantly higher in former than the latter (69.4% VS. 63.2%, P<0.05). Regular out-school sport activities were significantly lower and the time spent on television watching was significantly higher in overweight or obese than non-obese subjects (300±20 VS. 240±30 minutes/day, P<0.05). Significant linear association was shown between the consumption frequency of rice, bread, pasta, fast foods and fat/salty snack and BMI (p=0.05-0.06, p<0.05). A significant correlation was shown between BMI percentiles with serum triglyceride, high density lipoprotein-cholesterol and systolic blood pressure (Pearson r=0.38,-0.32 and 0.47 respectively).

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Background: Patellofemoral joint disorders are the most common cause of anterior knee pain in patients who referred to orthopedic clinics. Patellar lateralization cause anterior knee pain due to weakness of vastus medialis oblique muscle or tightness of lateral structures like lateral retinaculum or iliotibial band muscle.

Materials and Methods: For evaluation of this abnormality, plane radiography, CT scan and MRI are useful. In plane radiography only one view in a single joint position can be obtained, because of that it is not a good method to detect abnormal tracking during knee range of motion. The purpose of this study was to evaluate patellar tracking by kinematics MRI during five serial degrees of knee range of motion (40, 30, 20, 10, 0 degrees) in 30 patients with patellar lateralization and 10 normal subjects, aged 18-30 years.

Results and Conclusion: tistical analysis showed that in patients group, patella had the most stability in 40 degree of knee flexion and this stability reduced when knee reached to full extension. At this point, patella moved laterally and the most instability was seen during 20 to 0 degree of knee extension.

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Background and Aim: Spasticity is a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex. The measurement of spasticity is necessary to determine the effect of treatments. The Modified Ashworth Scale is the most widely used method for assessing muscle spasticity in clinical practice and research. The purpose of this study was to investigate the interrater reliability of Modified Ashworth Scale in hemiplegic patients.

Materials and Methods: Thirty subjects (16 males, 14 females) with a mean age of 59.40 (SD =14.013) recruited. Shoulder adductor , elbow flexor , wrist dorsiflexor , hip adductor , knee extensor and ankle plantarflexor on the hemiplegic side were tested by two physiotherapists.

Results: In the upper limb, the interrater reliability for shoulder adductor and elbow flexor muscles was fair (0.372 and 0.369, respectively). The reliability for the wrist flexors was good (0.612). The difference in Kappa value for the proximal muscle (shoulder adductor 0.372) and the distal muscle (wrist flexor 0.612) was significant (²X=33.87, df=1, p<0.05). In the lower limb, the reliability for the hip adductor was fair (0.350), but for the knee extensor and ankle plantar flexor was moderate (0.518 and 0.542, respectively). The Kappa value for the proximal muscle (hip adductor: 0.350) and distal muscle (ankle plantar flexor0.542) had no significant difference (²X =1.35, df=1, p >0.05). The mean value for the upper limb (0.505) and the lower limb (0,.516) was not significantly different (²X=0.1407, df=1, p>0.05).

Conclusion: The interrater reliability of Modified Ashworth Scale was not good . The limb, upper or lower, had no significant effect on the reliability. In the upper limb, the reliability for the proximal and distal muscle was significantly different. However. The difference in the lower limb was not significant.When using the scale, one should consider it&aposs limitation.

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Background: Cerebral palsy is the term used to describe a movement disorder though to be the result of nonprogressive brain damage. Due to damage to CNS, it is associated with articulation disorder and abnormal feeding reflex. Lack of oral function control and coordination following feeding reflex disorders. Articulation disorders are seen in most of the cerebral palsied patients.This research aimed to determine the relationship between feeding reflexes and articulation in cerebral palsy (spasticchildren).

Methods: This study was cross sectionally carried out on 52 children with cerebral palsy, 5 to 10 yrs old, in rehabilitation centers and private clinics. The information related to feeding reflexes was collected through direct observation of patient and evaluation of sound articulation through phonetic information test.

Results: Statistical analysis carried out by SPSS and chi-square and fisher exact tests. Abnomal chewing and tongue reflex are more prevalent than other feeding reflexes.The relationship between lip reflex and articulation of p/m/r/y/f/č and chewing reflex with articulation of/z/š/ is meaningful. The relationship between biting reflex with articulation of /z/j/l/š/ is meaningful. The relationship between tongue reflex and rooting reflex with articulation of sound is not meaningful.

Conclusion: With regard to the result of this research, it can be suggested that in children with cerebral palsy following feeding reflex disorders, abnormal posture during speech occurs that could have effect on articulation.

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Background: We aimed to demonstrate the mechanism of fracture and functional outcome of patients with hip injury in our clinical setting.
Methods: In a historical cohort, all women 50 years of age and older admitted to three university hospitals of Tehran University of Medical Sciences (Shariati, Imam Khomeini and Sina) with the diagnosis of hip fracture from 21 March 2003 to 21 March 2004 were included in this study (n=115). Follow up was conducted via telephone post and even home visit to record the functional status of the patients at the time of study (5 Jan 2005) measured with Barthel index in addition to the exact mechanism of injuries.
Results: The mean and standard deviation of age were 76.3 ± 10.6 years. About 88.7% of injuries had occurred at home (65.2% on the carpet), the remaining happening in the streets. Mean length of hospitalization was 11 ± 7.9 days. Among our patients, 71% could mobilize spontaneously without aids before injuries. This had reduced to 20% at the time of follow-up. The mean Barthel index was 97.2 ± 8.2 before fracture and 75 ± 21.1 at the present. Among our patients, five cases died during hospitalization and 29 of them died afterwards (total: 34 or 29.6%).
Conclusion: The most common external cause of injuries in our cases was stumbling at home especially on carpeted surfaces. This necessitates preventive measures aimed at physical standards of houses and education of elderly on healthy locomotion, indoors.

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Background: The purpose of this study was to measure isokinetic maximum and average peak torque of internal and external rotators of glenohumeral joint in volley ball and tennis players
Methods: This study was performed on 17 professional female athletes (7 tennis players &10 volleyball players) with age ranged 18-28 years. The subjects had played in a skilled team for more than 3 years. They were free from injury to their dominant shoulder in the past year. Subjects performed a five minute warm up by shoulder wheel and Maximum average Peak Torque (APT) were obtained unilaterally by a Biodex System 3 with the arm of players in 90 degree abduction at 120,180 & 210 o/s. Players performed five trails of concentric movements with 30 second rest between them.
Results: Maximum and average of maximum torques of shoulder rotator, in both groups, expect for internal rotators of tennis players, reduced by increase of movement speed (P<0.05). There are not significant difference between two groups in maximum, average of maximum torques and normalized data (ratio of maximum torque to weight). There is significant difference between two groups in percentage of APT of External rotator / Internal rotator ratio at 210 o/s (P<0.05).
Conclusion: Volleyball and tennis have no effect on isokinetic strength of shoulder rotators. In high speed, ratio of External rotator / Internal rotator is reduced. This indicates that increase in movement speed increase internal rotator in comparison to external rotator in these professional female athletes.

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Background: Malaria is still one of the main health problems in south and southeast provinces of Iran and recently on average 10,000-30,000 malaria cases were reported annually. Mosquitoes of Anopheles superpictus are one of the main malaria vectors in Iran and have been reported from all areas of the country including central plateau and plains of Alborz and Zagrous Mountains chains, and with low numbers in shore plains of the Persian Gulf and Caspian Sea. There are variations in larval and adult morphological characters and also in vectorial capacity of this species in different areas of Iran.
Methods: This study has been conducted to investigate rate of mtDNA variation among various populations of this species in Iran. The sequence variation of an 1512 bp length of mitochondrial DNA (mtDNA) cytochrome oxidase subunits 1 and 2 (COI-COII) and an 708 bp sequences of COI gene were analyzed by PCR-RFLP and PCR-direct sequencing respectively.
Results: This study showed that there are considerable variations between and within populations. Rate of variation was 12.3 % between populations and this was 2-5% for within Baluchistan population. Totally 4 haplotypes were observed between populations where 3 occur in Baluchistan and one in other places.
Conclusion: This is the first report on existence of various haplotypes in An. superpictus in science, and presumably this species comprising siblings and is a species complex. Further studies need to confirm this result and to determine the relationship between mtDNA haplotypes and their role in malaria transmission in each locality.

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Background: The changes in motor control after the use of a supportive belt can contribute to the understanding of its effects on performance. The aim of this study is to quantify motion pattern values relative to the spinal column during the use of a lumbosacral belt.
Methods: For fifty healthy female volunteers, the range of motion, maximum isometric torque and changes of phase angle of maximum torque and velocity in two positions, standing and sitting, in two directions, flexion and extension, following the use of a lumbosacral belt were measured using an isoinertial dynamometer (Isostation B200) and compared.
Results: Range of motion in both directions in both positions was reduced significantly (P<0.05). Significant reduction of maximum isometric torque was observed in flexion while sitting and in extension while standing and sitting (P<0.05). Phase angle of maximum torque and velocity also changed significantly in both directions and both positions (P<0.05).
Conclusion: The lumbosacral belt can act in different ways to prevent injury. It reduces the forces applied to lumbar vertebra and, by changing the maximum torque and velocity phase angles at the onset of range of motion, provides greater stability for joints. Furthermore, the belt can reduce stress imposed on the posterior joints of the spine and limits several momentary forces at the onset of joint movement. Under these conditions, joint injuries can be reduced and prevent some of the mechanical stress that causes lumbar joint disease.

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Background: Psychosocial stressors and the quality of the support system are important factors in attempted suicide. This research has studied these stressors and the condition of the support system in suicide attempt cases in Karaj, Iran. Methods: This is a part of the Iranian section of the widest multisite study on suicide prevention (SUPRE-MISS) proposed and directed by the WHO in eight countries, including Iran. Here we present data obtained from 632 suicide attempters presenting in emergency centers over a period of ten months.
Results: According to the time lapse from the stressor to the suicide attempt, proximal stressors are considered to be precipitating while distal stressors are considered to be perpetuating factors. Although, family conflicts were found to increase the risk of suicide one year after the conflict, conflicts with family (25%) and spouse (35%) were the most frequent stressors one month before the attempt, acting as proximal factors. Conflict with spouse was more prominent for people who had been married less than seven years. Conflict with family was the most important stressors for 15-25 year-old attempters. Though it is not clear which areas of conflict are more crucial in a suicide attempt, especially considering gender differences, educational and financial problems were more prominent one year before the suicide attempt. The support system was more crucial for female attempters: Although they received more practical support than males, females complained more of deficiencies in support.
Conclusions: The roles of different psychological stressors in attempted suicide vary according to the time lapse from the stressor until the suicide. Family and marital conflicts can be precipitating and perpetuating factors, while educational and financial problems appear to be perpetuating factors. Family is considered to be an important support system for a great number of attempted suicide cases, especially since it offers practical support. Support systems are crucial in preventive programs for suicide, especially among women.

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Background: Anopheles superpictus is one of the main malaria vectors in Iran. The mosquitoes of this species are found throughout the Iranian plateau up to 2000 meters above sea level in the Alborz Mountains, south of the Zagros Mountains, and in the plains near the Caspian Sea and Persian Gulf. It has been reported that different geographical populations of An. superpictus play different roles in malaria transmission. Based on the presence or absence of a black spot/band on the apical segment of the female maxillary palpi, two morphological forms have been reported in this species. This work has been conducted to study other morphological features as well as the genetic structure of these two forms of An. superpictus in Iran.

Methods: The different morphological characteristics of 35 different populations were observed and recorded. An 887 bp portion of the mitochondrial DNA (mtDNA) cytochrome oxidase subunit I (COI) was amplified and assayed by restriction fragment length polymorphism (RFLP) using 18 enzymes and PCR-direct sequencing techniques.

Results: Among the morphological characteristics studied, there are significant differences between the two forms with regard to the length of the palp light band (p<0.01), wing length (p<0.5), and the distance from the branching point of the II/IV veins to the tip of the wing (p<0.05). Results also revealed that these two forms are sympatric in most localities of Iran. RFLP analysis and sequences of about 710 bp of the gene showed that there was great variation between and/or within the populations, but these variations were not associated with the morphological forms.

Conclusion: This is the first comprehensive study on the morphological and molecular characteristics of An. superpictus in the literature. To determine the role of these morphological forms or genetic haplotypes in malaria transmission, further molecular, cytological, morphological, and epidemiological studies are necessary.

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Background: The risk of atherosclerosis and cancer is high in hemodialysis (HD) patients. There is evidence that HD causes oxidative stress. However, the causative factors of oxidative stress are unknown. It has been suggested that HD imposes an additional oxidative stress on patients with chronic renal failure by activation of granulocytes on dialyzer membranes resulting in an imbalance between oxidants and antioxidants. In this regard, a number of reports, either measuring specific analytes or enzymes, or estimating the total antioxidant activity of the plasma have given contradictory and inconclusive results. To investigate the oxidative stress status in Iranian HD patients, in this study, we evaluated GSH and FRAP levels along with Ca and pH in the blood of these patients.

Methods: Along with 20 healthy age and gender matched control subjects, 24 patients underwent dialysis, three times per week, for four hours in each session. Before and after dialysis, blood was taken for biochemical and liver function tests and to evaluate oxidative stress markers and measure Ca and pH levels.

Results: There was a significant decrease in FRAP and GSH levels after dialysis compared to those before treatment. Dialysis caused an increase in pH and Ca levels compared to levels in control subjects after dialysis.

Conclusion: In general, before dialysis, there is a balance between oxidants and antioxidants however, due to higher levels of oxidants as well as the possible binding of antioxidants to the dialyzer membrane during dialysis, an imbalance occurs. The instability in the balance of oxidants and antioxidants may be the major cause of cellular oxidative damage found in HD patients. This study indicates that there is a significant level of oxidative stress in renal chronic patients and this stress is augmented by dialysis. Antioxidant therapy should be considered in these patients.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Stromal tumors of the gastrointestinal tract (GISTs) are uncommon and the cell of origin is actually mesenchymal. Stemming from smooth muscle, 90% of GISTs, or leiomyomas, are found in the lower two thirds of the esophagus. Typically solitary, multiple tumors (leiomyomatosis) are occasionally reported. Remaining intramural during their growth, most of their bulk protrudes toward the esophageal outer wall, with a freely-movable, normal-looking overlying mucosa. In this study, we report a rare case of esophageal leiomyomatosis treated by esophagectomy.
Case Report: A 70-year-old man presented with discomfort upon swallowing, dysphagia, nausea, belching and weight loss. After a barium swallow, only dilatation of the esophagus from the retained food and saliva was seen. CT scan revealed a 10-cm dilatation of the thoracic esophagus. An endoscopy and upper GI series was performed, but no pathology was found. Esophageal manometry and pH monitoring for gastroesophageal reflux were normal. Upon endoscopic ultrasonography, a thickening of the esophageal wall was identified 20-30 cm from the dental arch. The patient was diagnosed with a GIST, referred to surgeon and a transhiatal esophagectomy was performed. The patient was discharged from the hospital in good condition and has had no problem during the one-year period of follow up. 

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Background: Penetrating thoracoabdominal stab wounds may cause diaphragmatic and abdominal organ laceration. However, 15-20% of these cases who are stable and managed by conservative treatment might have hidden diaphragmatic injuries, which could ultimately lead to chronic diaphragmatic hernia. Therefore, a safe and exact diagnostic method for the detection of occult diaphragmatic injuries is very valuable. In this study we have assessed the diagnostic value of thoracoscopy in occult diaphragmatic injuries resulting from penetrating thoracoabdominal stab wounds.

Methods: From March 2005 to October 2007, 30 hemodynamically stable patients with penetrating thoracoabdominal injuries, not requiring emergent exploration, were enrolled in this study. All subjects underwent thoracoscopy to evaluate probable diaphragmatic injury. Diaphragmatic injuries were repaired via thoracoscopy or laparatomy. All patients were evaluated for chronic diaphragmatic hernia by CT-scan six months later.

Results: The mean patient age was 26.2 years, with a male/female ratio of 5:1. Using thoracoscopic exploration, we observed five (16.7%) hidden diaphragmatic injuries, three (9.9%) of which were repaired using the thoracoscopic approach and two (6.6%) by laparatomy. Lung parenchymal laceration was seen in two patients (6.6%), for whom the repair was performed using thoracoscopy. Intra-abdominal injury was seen in one patient (3.3%), which was repaired by laparatomy. After thoracoscopy, there were no complications or evidence of chronic diaphragmatic hernia in the chest and abdominal CT-scans performed six months later. Therefore, the diagnostic accuracy of thoracoscopy in occult diaphragmatic injuries in our study was 100%.

Conclusion: With its high degree of diagnostic accuracy, low degree of invasiveness, as well as its utility in treatment, we recommend thoracoscopy for all clinically stable patients with penetrating thoracoabdominal stab wounds.

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Background: Many studies have shown that about 45-65% of multiple sclerosis (M.S) patients suffer from cognitive impairments. Semantic memory as one of the subcategories of cognition is quite important for effective communication. In the present study, category-semantic memory was studied in order to evaluate the semantic memory organization in normal individuals and MS patients.

Methods: Ninety voluntaries participated in this study. Participants comprise of 45 MS patients and 45 normal individuals. All participants were matched in terms of age, sex and education. Variables such as the reaction time and the number of correct responses for retrieval (recognition) of natural (animal and fruit) and artifact (object) words were measured in both groups by presentation software. Data analyzed by t-paired and One-Way ANOVA tests. Ethical committee of Tehran University of Medical sciences approved the study.

Results: The results of current study showed significant differences in reaction time and correct responses of artifact and natural categories between the MS and normal individuals (p<0.05). Furthermore, there was significant difference between reaction time and number of correct responses to natural and artifact categories in each group (p<0.05).

Conclusions: This study showed that the organization of semantic categorization as natural and artifact categories is still preserved in multiple sclerosis patients. However, the processing of semantic categorization was different in term of reaction time and number of correct responses between MS patients and normal subjects and the processing of semantic-memory is slower than normal individuals.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Post-intubation tracheal stenosis is a serious problem and surgical resection is the method of choice in long segment tracheal stenosis treatment. The aim of this study was to review the results of surgical treatment of long segment post intubation tracheal stenosis and the role of bilateral hyoid bone cutting in supra- hyoid release technique.
Methods: Between 2004 to 2008, 14 patients with proximal long segment tracheal stenosis with resection of more than 40% of trachea length were evaluated regarding surgical technique and post-operative results.
Results: The mean age of patients was 22.2±0.4 years. Etiology in all patients were head trauma and prolonged intubation and all patients had tracheostomy at the time of trearment. Average time between surgery and first admission was 4.5±0.5 months. Average length of stenosis and resected segment were 3.6±0.5 and 4.3±0.5cm respectively. Average increased length of trachea after bilateral hyoid bone cutting was 1.1±0.3cm. Postoperative complications occurred in one patient with wound infection, and 4 patients had stenosis recurrence which was treated in 3 patients using multiple dilation. Quality of life 2 years after surgery in 71% of patients were classified in good and excellent group. We didn't have any mortality.
Conclusion: Based on the fact that surgery is the best method of treatment in long and multi segment tracheal stenosis and tension in suture line is a serious problem, we recommend extended releasing technique including bilateral hyoid cutting in surgical treatment of these patients.