Tehran University Medical Journal

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Acute Pyelonephritis (APN) is one of the most common bacterial infections seen in children that may lead to renal scarring. Vesicoureteral reflux (VUR) is an important risk factor of renal damage but not the only one.

Materials and Methods: In order to determine the association between dimercaptosuccinic acid (DMSA) scintigraphic and voiding cystourethrographic findings, a retrospective study was performed on 50 children (100 renal units) with APN that had been admitted to Bahrami Hospital from 1995 through 1998. Voiding cystourethrography (VCUG) and DMSA scan were performed in all patients within 1 to 2 weeks after termination of treatment and a second scan was performed 6 months later in patients whose kidneys showed cortical defects in the first one. The grade of reflux was based on international reflux classification (I-V). The DMSA scans were considered abnormal if one or more areas of decreased cortical uptake were noted (cortical defect). The scar was defined as persistence of these defects in the second scan. DMSA cortical defect and VUR were demonstrated in 42 (42%) and 26 (26%) of renal units respectively.
Results: Fourteen out of 26 renal units (54%) with reflux had cortical defects and 28 out of 74 renal units (38%) without reflux had cortical defects (P=0.15). Permanent renal scarring was noted in 25/ 42 of renal units (62 %) in second scan.

Conclusion: It seems that VCUG alone is insufficient as a screening modality to identity those kidneys at risk of damage and DMSA scan may provide additional information about this.

 

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Background: The purpose of this study was to evaluate the effect of treatment with radioactive iodine on the function of gonads in males and females with follicular and papillary thyroid carcinoma.

Materials and Methods: Consenting patients in the reproductive age were grouped according to the cumulative dose of received radioiodine and followed for at least 12 months. For all men, serum levels of FSH, LH, and testosterone were measured some (53 cases) were also studied by semen analysis. For women, tests for serum levels of LH, FSH, estrogen, and progesterone were performed.

Results: Overall, 246 patients (159 females, 87 males) were studied. In 87.4% of men, there was an increase in serum FSH level after radioiodine therapy, in 20.7% of whom the level remained high during follow-up period. The average serum level of FSH after each course of treatment was significantly higher than the level before treatment (p<0.01), and there was a meaningful correlation with the cumulative dose of received iodine (p<0.001). Reduced number of sperms was shown in 35.8% of male patients, among whom 73.7% also showed reduced motility. In 36.8% of the patients with reduced sperm number (13.2% of the total), this finding was persistent during the follow-up period. Increased level of FSH was correlated with reduced sperm counts in all doses (p 

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Background: The damaging effect of exposure to loud noise on the structures of internal ear has been studied from many years ago. The effect of drill-generated noise on the non-operated ear is one of the problems that are less discussed. This study aims to evaluate the hearing loss that occurs in the non-operated ear in patients who undergo mastoidectomy by use of PTA (pure tone audiometery) and DPOAE (distortion product otoacoustic emission).

Materials and Methods: In this descriptive- analytic study, 49 patients who underwent mastoidectomy in Amir-Alam and Iman Khomeini hospitals, were evaluated for noise trauma generated by drilling on the non-operated ear. Patients were between 9-55 years old (mean age= 29) and they consisted of 25 males and 24 females. The patient's preoperative state were measured by PTA and DPOAE on the opposite ear also the postoperative state were re-evaluated by PTA and DPOAE.

Results: As a result, in 4 cases a significant change in PTA thresholds were observed, while two of them showed recovery after one month. Seven cases showed significant change in DPOAE amplitudes, of whom five cases recovered later.

Conclusion: In conclusion, the drill-induced hearing loss on the non-operated ear occurs in a few patients and it is often reversible.

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Background: There has been a little attention to pediatrics esophagus problems until recent years. The term esoghagitis can be used to described chemical, infectious, inflammatory, ischemic, immunologic and degenerative abnormalities. Prevalence of reflux esophagitis varies between 2 to 5 percent of general population but little data about its incidence in pediatric age groups. The aim of this study was to evaluate the epidemiology and prevalence of esophagitis and study of symptom, diagnostic measures, therapeutic intervention and prevention of its complication.

Materials and Methods: In this prospective and cross sectional study 500 patient under16 years with upper digestive complaints or alteration of their state of health under went upper endoscopy, with special attention paid to esophagus.

Results: Among 500 children (205 male, 207 female), pathology reported esophagi is in 325 cases. Majority of the patient were 8 to12 years. Most common complaints was abdominal pain (45/7%) and the second complaints was vomiting (13%), but most common complaints in severe esophagitis was melena (66%) and hematemes(18/8%). Most of patient (63% ) had a mild grade of esophagitis. When difference between endoscopy and pathology compared: Mild esophagitis in endoscopy (67%) ,but in pathology was (63%), moderate esophagitis (14/7%) in endoscopy was (17%) in pathology and severe form 2/8% in endoscopy but (4/9%)in pathology.

Conclusion: According to results of our study in children age group with chronic abdominal pain ,vomiting ,excessive regurgitation, failure to thrive, we noticed that esophagitis is common etiologic factor. Histological esophagitis frequently occur in the absence of gross endoscopic findings and we need biopsy and histological examination to confirm diagnosis.

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Background: Many recent studies have examined potential risk factors of H. pylori gastritis to improve our understanding of the early events in gastric carcinogenesis. We evaluated the extent and topography of chronic gastritis in a high risk area for gastric cardia cancer and investigated the critical role of H.pylori, risk index and age in its pathogenesis.

Materials and Methods: During a national population-based endoscopic survey, we enrolled 508 participants aged ≥40 from urban and rural areas of Meshkin-Shahr, Ardebil province of Iran. After informed consent, all underwent complete upper GI endoscopy. At least one mucosal biopsy was obtained from 6 standard sites: three of antrum (sites 1, 2, 3), two of corpus (sites 4, 5) and one of cardia (site 6). Severity, activity and combined inflammatory scores (CIS) of chronic gastritis and H.pylori infection status were assessed according to modified Sydney Classification of Gastritis. Statistical effects of H.pylori, age, gender, and residency place on mean gastritis severity, activity and CIS were separately calculated in each site.

Results: Total of 508 participants with mean age (±SD) of 54.6(±SD) were enrolled. 234(46.1%) were male and 274(53.9%) were female. Histologically 80.5% of cases were H.pylori positive. Mean activity scores of all sites except for site 5 are significantly (P<0.01) higher in H.pylori + cases. Mean CIS of all sites was significantly (P<0.01) higher in H.pylori + patients. In 44% of infected subjects, CIS of the corpus was at least equally as severe as that in antrum. Also in 54% of H.pylori + cases, cardia’s CIS was ≥ than antral CIS. Age had a significant (P<0.01) negative relationship with CIS of antral site, but this relationship in cardia was positive and more potent.

Conclusion: H.pylori is the main cause of gastritis activity in all sites of stomach this causality is more potent in antrum and cardia. Continuous cardia inflammation in advanced age may contribute to high incidence of gastric cardia cancer in this region.

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Background: To evaluate the ability of Ankle/Brachial Index (ABI), that is a sensitive and specific test for detection of PAD, to foretell the possibility of ischemic heart diseases in diabetic patients.

Materials and Methods: All of diabetic patients who visited in our diabetes research center between May 2000 and May 2001 and were confirmed diabetics since 2 or more years ago were enrolled in the study. The ABI was calculated for all of the patients and their demographic specifications and ischemic heart disease risk factors were recorded. All of the patients refer to perform an exercise test, but 279 patients were conferred to performing stress test. They were containing: 127 patients with ABI =<1.1(group I) and 47 patients with ABI>=1.4(group III) as case groups and, 105 patients with 1.1 60 years (P = 0.02). 238 patients were in group I (25.1 %), 625 patients in group II (65.9 %) and 85 patients in group III (9 %). 52.8% of 125 patients in Group I, 19.6% of 107 patients in group II, and 44.7% of 47 patients in Group III had positive exercise test. I, II (P  0.00)- II , III (P = 0.05) A total of 108 patients from among the 279 patients had positive exercise test (38%), and most of them were from groups I &III. 72.2% of group I , and 52.5% of group II had high blood pressure (P  0.00). Both hypertensive and normotensive patients with ABI =<1.1 & >=1.4 had positive exercise test significantly more than patients with 1.1=1.4 is an independent predictor of coronary artery diseases in diabetic patients especially in those who are hypertensive.

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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: This research was conducted for the purpose of determining the effect of hormonal and non-hormonal contraception on the mother milk and infants growth among lactating women received by south Tehran’s Health Centers. In this regard a broad spectrum study from December 2000 until February 2001 was done by Tehran university.

Materials and Methods: By sampling method, 200 lactating women were chosen randomly. They were divided into two groups according to their preferred method of contraception: 67 women chose hormonal method and 133 women chose non –hormonal method.

Results&Conclusion: During the time of the study on infants growth (increase in head circumstances, increase in height, increase in weight), There was no significant difference between the two groups. If we take the effect of contraceptive methods into consideration, the Triglyceride levels in non-hormonal group were increased considerably compared to the other group. Other ingredients were almost the same.

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Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm.

Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following

Results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms.

Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

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Background: Many of hospital acquired infections that cause so much morbidity and mortality and have great economical burden are transmitted via contaminated hands of health care workers (HCW).Prevalence of these infections can decrease up to 30% with hygienic measures. In this study we assessed the prevalence of careers and microbial spectrum of HCW,s hand and relation between detergent used for washing and reduction of microbial load of HCW, s hand.

Materials and Methods: This study was done in two part: Descriptive part (cross sectional) and analytical part (before –after). Cases were Consist of all staff Working in wards of center of pediatrics hospital (Including attends, residents, interns, nurses and workers). In first part ,we assess hand microbial spectrum and contamination load of 72 staff and in second part, we assessed and compared hand microbial spectrum and load before and after of washing with four detergent : plain soap (60 staff ), liquid soap (60 staff ) , betadin scrub in ward (60 staff ) and betadin scrub in operating room manner (26 staff).

Results: %87.5 of personnel had positive cultures-.The most prevalent bacteria were staph. epidermidis (%79.4), staph. oreus (%42.9), klebsiella (%12.7), E-coli (%12.7). The rate of reduction or negative cultures in groups used betadin were greater than the first two group (P-value <0/05).Thirty staff (10 with plain soap,10 with liquid soap and 10 with operating room betadin scrub ) dried their hands after washing. Forty percent of first, fifty percent of second and ninety percent of third group have negative culture after drying. Also 11 samples were drawn from faucets that all of them were positive.

Conclusion: Prevalence of careers is high among HCWS and drying of hands can an important role in hospital infection rate. Faucets have heavy contamination and can transmit bacteria to hands after washing. For theses reasons education and of staff to correct hand washing and drying before every contact with patients and used of faucets without direct hand touching can play a great role in lowering hospital infections.

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Background: To evaluate the accuracy of 5node sampling as an alternative to classic axillary dissection in operable breast cancer(stage I and II )     Method and Material: 5 largest nodes of level one were sampled in 26 consecutive patient with breast cancer undergoing modified radical mastectomy and axillary clearance between june 2002 to march 2004.

Result: False negative rate for 5 node sampling was 7.7%, of 14 cases with negative 5 node sampling 2 (7.7%) were found to have disease elsewhere in the axilla.

Conclusion: Sampling of 5 largest nodes accurately (92%) identifies patients with metastatic nodes.

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Background: The aim of this study is to describe the mental health and social profile of adolescent thalassemic patients through self-report and GHQ-12 test.

Materials and Methods: With convenience sampling, 156 consecutive adolescent thalassemic patients, recruited during a 20month period, filled in a semi-structured self-administered questionnaire in addition to a GHQ-12 questionnaire.

Results: 100 cases (64.1%) denied having health problems. 71 patients (45.5%) described their health status as not bad and 39 cases (25%) as good. The average GHQ-score was 6.12 (0.95 CI- 5.69-6.56). Nine cases (5.8%) scored low (0-1) and 21 cases (13.5%) scored borderline (2-3), while the score of 124 patients (79.5%) was favorable (4-12). There was a significant difference between mean scores in different age groups (p= 0.036) and 78 percent of those with low scores were in their late adolescent period (18-21 yrs). 15 patients (9.6%) had quit school due to their health problems. Mean GHQ score for quitters was significantly lower than those going on with their studies (p= 0.017).

Conclusion: These adolescent thalassemic patients seemed to have coped properly with their disease. Possibility of denial should also be considered. Further studies for detection of high-risk groups for psychosocial derangements can help us in applying appropriate and timely preventive and supportive measures.

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Background, Materials and Methods: In order to evaluation the newborn’s nutrintional status in Bojnoard, 566 healty, Single full term newborn were examined. In this examination, the indicators of weight for age, height for age, weight for height and head circumference for age in the beginning of birth were calculated and compared to National Center of Health Statistics Standards (NCHS), with making use of fifth percentile of reference society for malnutrition edge, was specified that, nutritional status in above newborn’s is better than reference society’s newborns. Results&Conclusion: The data analysis of this research showed that between mother’s near delivery weight (P = 0.037) and mother’s nutritional attitude (P= 0.004) and numbers of family( P = 0.006 ) with height for age, between newborn’s sex (P= 0.004), mother’s age(P= 0.038), mother’s near delivery weight(P = 0.042) and mother’s nutritional practice during pregnancy (P= 0.041) with weight for height and between mother’s age (P= 0.043), mother’s near delivery weight (P= 0.048), mother’s height (P= 0.025), mother’s nutritional knowledge (P = 0.046) with head circumference for age, there is significant statistic connection. Also there was a weak statistic connection between newborn’s nutritional status and grade of birth (P= 0.09), but there is no significant meaningful connection between wanted or unwanted newborn and mother’s nutritional knowledge.

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Background: One of the disturbing complications of propofol is pain on venous injection. Some investigators had reported that corticosteroids effectively induce and prolong the duration of local anesthetics. The aim of this study was to assess and comparing the efficacy of propofol pretreatment with dexamethasone in prevalence and severity of its pain on injection.

Materials and Methods: In a randomized, double-blinded, placebo-controlled prospective study, 90ASA I and II, 20 to 60 years-old patients scheduled for elective surgery under general anesthesia were enrolled. In all patients, one of the veins of both hands was catheterized with a 20 G catheter. Then randomly, and simultaneously 2 ml dexamethasone (8 mg) was injected to one of them and 2 ml of normal saline was injected to other. After 30 seconds, 2 ml propofol (20 mg) was injected to both hands, at the same time in 30 seconds. Pain intensity was measured using VAS system.

Results: The age mean was 32.87±5.61. Twenty nine patients were male (32.2%). The mean of pain during propofol injection was significantly lower in dexamethasone group than normal saline group (1.61 vs.4.21 respectively, p< 0.05). Also the pain incidence was significantly lower in dexamethasone group compared to normal saline group (20% vs. 57.78% respectively, p> 0.05).

Conclusion: Intravenous administration of 8 mg dexamethasone before propofol IV injection significantly decreases the pain on injection of propofol.

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Background: Bacterial meningitis is one of the most serious infections in infants and children. Three organisms include S.PneumoN.meningH.Influ are the most common cause of meningitis in children between 2M-14y age.Etest is a new method for determination the MIC of some antimicrobial drugs in agarose .This method is useful for some organisms like as S .Pneumo N.mening H.Influsensitive Streptococcus and anaerobic aerobic gram negative.

Materials and Methods: In this descriptive cross sectional study In 57 suspected meningitis children organisms isolated from blood CSF or other sterile boy fluid after culturing and antibiogram. .MIC of someorganisms detected by Etest method.

Results: Streptococcuswas the most prevalent ( 70%) and S.pneumon( 90% of all Streptococcus) H.infl 2%N.mening 4%and L.monocyt 6%(more than expected)Gram negative (Ecoli Klebsiella entrobacter and psudomona) 18%. There was significant difference (P =0.01)in type of organisms between age groups. S.pneumonia was more frequent in children > 2 year N.meningitis in>4yr old .Site of isolation :blood CSF (35.8*28.3%)other sterile site 18.4%concomitant positive culture in two site:17%.Mean age in Streptococcus was significantly different with Listeria (p=0.05) N.meningitis (p=0.04)H.influ (p=0.04).but no difference with StaphylococcusKlebsiella and E.coli Two type of H.inf were sensitive to Ampici or chloram both of them were sensitive to ceftiaxon. GBS were sensitive to PNC or Ampici Strep.nonAnonBnon- Cotrimoxazol>32mic/ml /PNC >256mic/ml/ Vanco>256mic/ml Strep.D: Cotrimoxazol>0.062mg/ml/ /PNC >0.016mic/ml/Imipenem>0.032mic/ml. Strep Pneumonia: All fo them were sensitive except 3 cases /Cotrimoxazol>2ic/ml /PNC =0.01mic/ml/Vanco>0.125mic/ m Vanco>0. 25mic/ ml/.Cotrimoxazol>2ic/ml / PNC =0.01mg/ml Vanco>0.125mic/ ml / Cotrimoxazol>2mic/ml /MIC-PNC >0.016mic/ml Therefore high dose of PNC is adequate for S.pneu because of Interm resistance to PNC All 3 N.menin were sensitive to PNCChloraCeftria and vanco Resistant to all drugs and high MIC for cefotaximeCIPRO>32mic/ml. E coli: Pseudomona Aerogenosa:: Ceftriaxon>256mic/ml/ /Genta>0.038mg/ml Imipenem>32mic/ml. Klebsiella only Sensitive to Cipro Staph .Aureous:Sensitive to ClindaCiproChloraResistant toCeftPNCand Cotri

Conclusion: Most type of N.meningitidisH.inf and S.pneumonia were sensitive to many drugs. Only minority of them were resistant to Ampicillin but sensitive to chloramphenicol and vice versa. limited number of pneumococcal resistance to penicillin is medium resistance( MIC:0.1-1) .we can treat this resistant type by increasing of penicillin dosage .The others were sensitive to all drugs. Therefore ampicillin and chloramphenicol are the drug of choice in empiric treatment of bacterial meningitis after neonatal period.

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Background: Blood culture is the criterion standard for identifying children with bacteremia. However, elevated false-positive rates are common and are associated with substantial health care costs. The aims of this prospective study were to: 1) determine the rate of blood culture contamination 2) determine variety and frequency of contaminant bacteria 3) compare the duration of hospital stay and antibiotic administration in patients with true bacteremia vs those have false positive blood culture.

Materials and Methods: Cross-sectional study conducted April through July 2004 among patients aged 14 years or younger who were admitted at Doctor Garib Children Medical Center of Tehran and had a blood culture obtained as part of their care. Bacterial isolates were identified to species level and medical records were reviewed in all cases with a positive blood culture. A number of clinical and laboratory criteria were used to deciding whether a blood isolate is a pathogen or a contaminant. These include the identify of the micro-organism itself, clinical features such as fever and leukocytosis the proportion of blood culture sets positive as a function of the number of sets obtained and to have an indwelling vascular catheter or prosthetic device.

Results: During the study period, 2877 sets of blood culture were evaluated and the rates of positive blood cultures associated with significant bacteremia and contamination were 1.04% and 5.4% respectively. Among the positive blood cultures, over the 84% of isolates were due to contamination and only 15.95% of isolated strains associated with true infection. The frequency of isolated bacteria with respect to true infection and contamination are as following: S. Aureus (infect: 9.0%, contam: 0.0%), S. Epidemidis (infec: 0.0%, contam: 13.3%), Micrococcus sp. (infec: 0.0%, contam: 4.3%), pseudomonas and related species other than P. aeruginosa (infec: 2.1%, contam: 60.6%), viridans group of streptococci (infec: 1.1%, contam: 2.1%), E.coli (infec: 1.06%, contam: 0.0%), Klebsiella pneumoniae (infec: 0.53%, contam: 0.0%), Enterobacter cloacae (infec: 0.53%, contam: 0.0%), and Acinetobacter baumannii (infec: 0.25%, contam: 0.53%). The mean of hospital stay for patients with true bacteremia, 14.83 days, was not significantly higher than that for patients with false-positive blood cultures (10.08 days). 43 patients had administrated one to three antibiotics after false-positive blood cultures.

Conclusion: The findings indicate that blood culture contamination rate in studied hospital is higher than standard levels, and very high rate of contamination with environmental pseudomonas species shows an unusuall epidemic condition. The findings also suggests high resource utilization and prolong patients stay due to pseudobacteremia.

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Background: This study was conducted to evaluate results of urethroscopic management of iatrogenic urethral injuries due to gynecological operations.

Materials and Methods: From November 2001 till November 2003, 12 iatrogenic urethral injuries which were managed with mean time 12 hours (Range= 6-72) after gynecological operations were included in this study. 3 months after urethroscopy and distending, patients were evaluated with IVP. Mean time of clinical follow up was 12 months (range= 4-29).

Results: 7 patients with urethral stricture were found and considering fluoroscopy guided urethral dilatation with balloon in 2 of them, urethroscopy and distending was successful in 6 patients (85/7%). In 5 patients with complete dissection of urethra, urethroscopy and distending was successful only in 1 of them (20%). All patients were discharged after 24 hours and in follow up IVP after 3 months. Results were satisfactory in 6 of 7 patients. One of patients needed re-distending due to stricture.

Conclusion: Urethroscopic approach as first step in management of iatrogenic urethral injuries seems reasonable and cost benefit, specially in ligating lesions.

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Background: Patients with type 2 diabetes are often obese and require large dose of insulin to achieve glycemic control. Insulin therapy often cause weight gain and results in increasing insulin requirements. This study was conducted to evaluate the efficacy of metformin in combination with insulin in patients with type 2 diabetes poorly controlled with insulin therapy alone.

Materials and Methods: In a randomized clinical trial in outpatient diabetes clinic at university medical center, 39 patients with poorly controlled type 2 diabetes who were receiving insulin therapy were randomly assigned to receive metformin in combination with inslin or insulin alone for six months.

Results: Hemoglobin A1C levels decreased by 1.56 percentage (95% cl, 0.77 to 2.34 percentage point) in metformin group, a significantly greater change (P=0.008) than the increase of 0.03 percentage points in the insulin alone group. Average final hemoglobin A1C levels were 7.96% in the metformin group and 10.32% in the insulin alone group (difference 17%). For patients who did not received metformin, the insulin dose increased 9.37 units (95% cl 6 to 12 units) or 37% more than did the dose for patients who received metformin. (P<0.0005): for these patients, the insulin dose decreased 6.6 units (95% cl-1.24 to –11.96) Patients in insulin alone group gained an average of 3.08 kg of body weight (95% cl 1.56 to 4.58 kg) patient in the metformin group gained an average of 1.8 kg (95% cl 0.21 to 3.36 kg) Difference (1.9%) was not meaningful. Change of total cholesterol, low density lipoprotein cholestrol and triglyceride levels was not significant.

Conclusion: The addition of metformin to insulin therapy resulted in hemoglobin A1C concentrations that were 17.8% lower than those achieved by insulin therapy alone. This improvement occurred with use of 37% less insulin. Metformin is an effective adjunct to insulin therapy in patients with type 2 diabetes.

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Background: Low back pain (LBP) is a one of the most common symptoms of vertebral column diseases. Spinal muscles have a outstanding role in maintaining vertebral column function in daily life. But proper function and motion of hip and knee joints also has an important role in performing smooth, fine and nonstressed movements of lumbar spin. Where as accurate and fine motions of hip and knee joints in cooperate with lumbar spin can improve translation and summation of forces and increase performance of movements. The aim of this research is to indicate the amount of interventions of lower limb joints on lumbar spin function in patients with LBP, and attention to physical treatment (PT) of them.

Materials and Methods: Fifty females with LBP due to osteoarthritis ( OA) of lumbar spin participated in this study and divided in two groups randomly with similar number of cases: a) ordinary treatment or control group and b) complementary treatment group. Patients in control group treated by routine PT approach ( superficial heat, ultrasound, TENS, forward flexion and back extension exercises ) and patients in complementary or test group received routine treatment similar to control group and also strength and stretching exercises of hip and knee joint muscles ( latisimous dorsi, gluteous maximus, iliopsoas, quadriceps and hamstring ) bilaterally. Range of motion (ROM) of lumbar, hip and keen joints by valid goniametere and pain of lumbar in motions at all of axis by visual analog scale measured before, after five and ten sessions of treatments in both groups.

Results: In control group with non parametric tests there was not significant difference of MMT of muscles and ROMs of hip and knee joints. Lumbar pain in motion after ten sessions of PT in this group reduced significantly ( P< 0.05 ). Increase of lumbar motion in all of axis after PT was significant at this patients ( P< 0.05 ). In second group that received complementary treatments ROM of joints, lumbar pain had significant differences between onset of treatments and five and ten sessions later ( P< 0.05 ), but there was not significant findings in MMT of muscles. There were significant differences between percentages of reduce of pain and increase of ROM in comparison of two groups ( P< 0.05 ). Where as patients that received ordinary PT and strength and stretching of muscles around of hip and knee indicated better recovery signs.

Conclusion: Reduce of lumbar pain with improve of motion and flexibility of muscles such as quadriceps, hamstring, gluteus maximus, iliopsoas and latisimous dorsi in a complete physical therapy approach indicate there are a great correlation between lumbar pain and functionality of lower limb joints. Therefore concentration to flexibility and extensibility of muscles of lower limbs is a basis aim in treatment of patients with lumbar OA.