Object Osteoporotic vertebral compression fractures (VCFs) are a major cause of increased morbidity in older patients. This randomized controlled trial compared the efficacy of percutaneous vertebroplasty (PV) versus optimal medical therapy (OMT) in controlling pain and improving the quality of life (QOL) in patients with VCFs. Efficacy was measured as the incidence of new vertebral fractures after PV, restoration of vertebral body height (VBH), and correction of deformity. Methods Of 105 patients with acute osteoporotic VCFs, 82 were eligible for participation: 40 patients underwent PV and 42 received OMT. Primary outcomes were control of pain and improvement in QOL before treatment, and these were measured at 1 week and at 2, 6, 12, 24, and 36 months after the beginning of the treatment. Radiological evaluation to measure VBH and sagittal index was performed before and after treatment in both groups and after 36 months of follow-up. Results The authors found a statistically significant improvement in pain in the PV group compared with the OMT group at 1 week (difference −3.1, 95% CI −3.72 to −2.28; p < 0.001). The QOL improved significantly in the PV group (difference −14, 95% CI −15 to −12.82; p < 0.028). One week after PV, the average VBH restoration was 8 mm and the correction of deformity was 8°. The incidence of new fractures in the OMT group (13.3%) was higher than in the PV group (2.2%; p < 0.01). Conclusions The PV group had statistically significant improvements in visual analog scale and QOL scores maintained over 24 months, improved VBH maintained over 36 months, and fewer adjacent-level fractures compared with the OMT group.

BackgroundMalignant cerebral infarction is a well-recognized disease, comprising 10-15% of all cases with cerebral infarction and causing herniation and death in 80% of cases. In this study, we compare the effects of decompressive craniectomy versus conventional medical treatment on mortality rate and functional and neurological outcome in patients with malignant MCA infarction.MethodsWe performed a prospective case–control study on 60 patients younger than 80years of age suffering malignant MCA cerebral infarction. The case group underwent decompressive craniectomy in addition to routine aggressive medical care; while the control group received routine medical treatment. Patient outcome was assessed using Glasgow outcome scale and modified Rankin scale within three months of follow-up. The data were analyzed by SPSS version 16.0 software using Chi Square, One-way ANOVA and Mann–Whitney tests.ResultsThere were 27 male and 33 female patients with a mean age of 60.6 years (SD = 12.3). Glasgow outcome scale score averaged 2.93 in the surgical versus 1.53 in the medical group; this difference was significant (p = 0.001). Outcome in modified Rankin scale was also significantly lower in the surgical (3.27) versus medical (5.27) group (p < 0.001). Surgery could decrease the mortality rate about 47%.ConclusionIn this study, decompressive craniectomy could decrease mortality rate, and improve neurological and functional outcome, and decrease long-term disability in patients with malignant MCA infarction.

VSIAs are difficult to treat because of their small sizes; therefore, with a double-clip technique, one can reduce complications related to the treatment of small aneurysms.

Background and Objectives: The incidence of subarachnoid hemorrhage (SAH) has been very low in earlier studies conducted at Shiraz University compared with reports in the literature. We determined the incidence in our study and compared it to an earlier study and international statistics. In the other part of our study, we examine the factors that contribute to the rerupture of cerebral aneurysms.Method: During 3 years from 2006 to 2009 (1385 to 1388), we handled 230 subarachnoid hemorrhage patients referring to Namazi hospital and recorded their data of age, GCS, count and size and location of aneurysms, and abnormal CT findings. We examined the effect of these factors on early rebleeding with w 2 and t tests.Results: The incidence of SAH in a earlier study conducted at Shiraz University 10 years ago was 0.7 per 100,000 persons per year. Incidence has risen in our study to 1.3 per 100,000 persons per year, which is still much lower than the incidence reported in developed countries, which is nearly 10 per 100,000 persons per year. Of 162 patients with aneurysmal SAH 17 patients rebled before surgery within 48 hours of admission. We found a significant relationship between GCS on admission, size of aneurysm, and intracerebral hemorrhage in first CT scan and early aneurysm rebleeding (P-values less than 0.05).Conclusions: Our lower incidence compared with developed countries could be owing to our younger population, fewer diagnostic facilities distributed in the regions, and a very larger geographic area we are sampling from with 1 referral center. On the other aspect, we suggest paying particular attention to those patients who have large aneurysms, who present with intracerebral hemorrhage in CT scan, and who are in poor clinical grade on admission. Surgery must be done on an emergency basis for these patients to prevent mortality and morbidity.

This is the first study to report the safety, efficacy and outcome of the direct (STA-MCA bypass) and indirect (EMS) revascularization in patients with MMD in the Iranian population. As the prevalence of MMD is low in Iranian population, the experience and technique remains in its infancy and further advancements in the field is required.