Search

The recently adopted terminology of "Noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) reflects the indolent behavior of these tumors. In contrast to conventional papillary thyroid carcinomas, NIFTP can be managed conservatively. The purpose of this study was to investigate changes in surgical and pathologic practice patterns at our institution since the introduction of the NIFTP diagnosis in 2016. A retrospective analysis of all thyroid specimens received in our laboratory between January 2015 and April 2017 was performed. The final cohort consisted of 1508 thyroidectomy specimens from 1508 patients (1153 (76.5%) women and 355 (23.5%) men), of which 1011 (67%) were total thyroidectomies and 497 (33%) were partial thyroidectomies. There were 558 (69.2%) total thyroidectomies and 248 (30.8%) partial thyroidectomies performed prior to introduction of the NIFTP diagnosis and 453 (64.5%) and 249 (35.5%) total and partial thyroidectomies, respectively, after the change in nomenclature. Within a year following the initial use of this diagnosis, 67 NIFTP cases were identified (9.5% of all thyroidectomies), whereas compared with the year preceding it, malignant diagnoses decreased from 54.5 (439) to 44.6% (313), and the benign category remained unchanged from 44.5 (367) to 45.9% (322). For the entirely submitted 67 NIFTP cases, the mean number of blocks submitted was 14.7 (0.98 blocks/g); for malignant lesions 17.7 (0.92 blocks/g); and for benign lesions 16.6 (0.75 blocks/g). The results of our study suggest that NIFTP are encountered in almost 10% of thyroidectomies at our institution with expected shifts in cytology and surgical pathology diagnoses as a result of the change in nomenclature. During this time period, significant shifts towards less aggressive surgical management were not observed. All 67 NIFTP nodules were submitted entirely with no significant difference in the number of cassettes submitted for NIFTP nodules as compared with follicular variant papillary thyroid carcinoma (PTC), classic variant PTC, or follicular adenoma.

The Papanicolaou (PAP) test is widely used to screen for cervical cancer. All high-grade lesions such as atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), and high-grade squamous intraepithelial lesion, identified on a PAP test should be followed-up by a confirmatory cervical biopsy. In this review, we discuss the challenges in interpreting cervical tissue specimens and the various ancillary techniques used in the evaluation of cervical dysplasia. Ancillary studies include deeper levels, p16 immunohistochemistry (IHC), human papillomavirus (HPV) testing, and, importantly, cyto-histologic correlation. Of these, p16 IHC is consistently sensitive and specific for detecting HSIL. HPV RNA in situ hybridization (ISH) is a newer technique with excellent sensitivity and specificity for detecting virally infected cells and it may be more broadly applicable to both low- and high-grade squamous intraepithelial lesions.

Yolk sac tumors occur at both gonadal and extra-gonadal sites. A recent case of ovarian endometrioid-pattern yolk sac tumor with strong diffuse expression of TTF-1 illustrated the potential for misdiagnosis due to divergent expression of endodermal lineage markers. The aim of this study was to investigate the expression of four divergent endodermal lineage markers, TTF-1, CDX2, Hep Par 1, and Napsin A, in gonadal and extra-gonadal yolk sac tumors of differing age, sex, and location (excluding foci of overt hepatoid differentiation). We identified 26 cases (5 ovarian, 15 testicular, and 6 extra-gonadal) containing yolk sac tumor as identified by typical histology and confirmed by positive immunohistochemical staining for alpha-fetoprotein and glypican-3. Mixed or ambiguous foci were confirmed by immunohistochemistry (SALL4 positive and Oct-4 negative). The relative proportion of three histologic patterns: reticular/cystic, solid/myxoid, and glandular was estimated. Percent positivity for the four divergent endodermal lineage markers was compared within yolk sac tumor areas according to site, age group, and histologic pattern. High-level (>25%) staining for one or more divergent endodermal lineage markers was seen in eleven cases: Hep Par 1 in seven cases, all post-pubertal, TTF-1 in four cases, two ovarian and two extra-gonadal, and CDX2 in three cases, with no age or site predilection. No case highly expressed all three divergent endodermal lineage markers, but four co-expressed high levels of two markers: two ovarian yolk sac tumors with TTF-1 and Hep Par 1, one testicular yolk sac tumor with CDX2 and Hep Par 1, and one extra-gonadal yolk sac tumors with TTF-1 and CDX2. While no absolute correlation of high-level divergent endodermal lineage marker expression with histologic subtype was observed, TTF-1 and CDX2 expression was predominantly seen in reticular/cystic and glandular areas while Hep Par 1 was most frequent in myxoid/solid and glandular areas.

Background Malignant ovarian germ cell tumors are rare, and often treatable with surgery and chemotherapy. Few data are available for treatment of platinum-resistant tumors. Case A 31 year old gravida 0 with a 20 cm pelvic mass was found to have a malignant ovarian germ cell tumor after she underwent debulking surgery. She initially responded to chemotherapy; however her AFP began to rise before all cycles were completed. She underwent additional debulking surgery that was again suboptimal. She was then referred for salvage therapy with high-dose chemotherapy with stem cell transplant, which was successful and she has had no evidence of disease for over two years. Conclusion High-dose chemotherapy with stem cell transplant is a viable salvage therapy for patients with platinum-resistant germ cell tumors., Highlights • Malignant ovarian germ cell tumors are rare. • These tumors are often treatable with surgery and adjuvant chemotherapy. • High-dose chemotherapy and stem cell rescue should be considered for platinum-resistant disease.

The aim of this study was to determine the strength of the correlation between colposcopic impression according to Reid colposcopic index (RCI) done by Gynecology residents and biopsy histology in a university hospital. Colposcopy was performed on 260 women. According to RCI, the scores zero, one, or two were given to each of four standardized colposcopy patterns (acid staining, iodide staining, margin of lesion, and vascular pattern) and the total score was calculated. In those with multiple lesions, the patterns with the highest score were considered. Then the biopsy was obtained from the lesion and put in formalin for pathological evaluation. There was a statistically significant association between colposcopy findings and histopathology findings and the score was increased as parallel as malignancy grade (r = 0.680, P

Aim The objective of this study was to compare the histological findings of dilatation and curettage (D&C) with those on subsequent hysterectomy in patients with abnormal uterine bleeding. Methods Between October 1998 and September 2003 a retrospective clinical study of 311 patients was conducted, including all patients who underwent D&C and within 2 months, hysterectomy because of histological findings on D&C or persistence of symptoms. The sensitivity, specificity, positive and negative predictive value and accuracy of D&C were studied. Results The mean age of our patients was 46.6 years. In 164 of 311 patients (52.7%), D&C failed to detect intrauterine disorders subsequently found at hysterectomy. The sensitivity was 30.2%, the specificity was 72.3%, the positive predictive value was 77.1%, and the negative predictive value was 25.1%. The accuracy was 40.5% overall. Conclusion D&C is an inadequate diagnostic tool for uterine focal lesions, but the accuracy of D&C in the detection of endometrial hyperplasia and carcinoma is relatively high (92.1%).

To translate the Locomotor Capabilities Index (LCI-5) to Persian and to assess its psychometric properties when applied to a sample of people with lower limb amputation (LLA). The LCI-5 was administered to 106 Persian speaking people with LLA to determine its internal consistency, item-subscale correlation, test–retest reliability and floor and ceiling effects. To assess the construct validity, each participant’s performance was measured using the Timed Up and Go (TUG) and 2-Minute Walk Test. Minimum Cronbach’s alpha of 0.70 was exceeded by LCI-5 subscales. Item-subscale correlations after correction for overlap were higher than the cuff-off point of 0.40. The intraclass correlation coefficient was 0.96 for LCI-5 total index in test–retest reliability. LCI-5 showed significant correlation with TUG (r = −0.65, P

Background: A Pap test result of atypical squamous cells of undetermined significance (ASCUS) presents a clinical challenge. Only 5–10% of women with ASCUS harbour serious cervical disease. Methods: We screened 3619 women, who attended to Mirza Koochak Khan Hospital at Tehran University of Medical Sciences with Pap smears, of whom 100 returned with ASCUS. After six months, each subject underwent a standard cytology (conventional Pap smear), human papillomavirus (HPV) DNA testing (identifying high-risk HPV types with polymerase chain reaction) and colposcopy with multiple cervical biopsies. Results: Mean age was 44.09 ± 8.6 years. The estimated prevalence of cervical intraepithelial neoplasia (CIN) II or higher was 4%. When histologically verified high-grade lesions (≥ CIN II) were observed, the relative sensitivity of HPV DNA testing was 100% compared with conventional Pap smear, which performed 75% versus 100% relative sensitivity, respectively, using cytological diagnosis high-grade squamous intraepithelial lesion, or low-grade squamous intraepithelial lesion (LSIL) as the cut-off. Negative and positive predictive values (NPV and PPV) of Pap test were 98.9% and 100%. The NPV and PPV of HPV DNA testing were 100%. Conclusions: Although less complicated than colposcopy, the repeat Pap smear triage algorithm for ASCUS may underdiagnose some women with high-grade CIN, when compared with colposcopy. Considering the high sensitivity of HPV testing, it may be useful as an alternative to the current policy of six-month repeat cytology for women with ASCUS results.

Background:There are therapeutic dilemmas regarding fertility-preserving treatment among young women with well-differentiated endometrial carcinoma.Materials and Methods:Twenty-one patients with stage IA well-differentiated endometrial adenocarcinoma were enrolled in a prospective study. The treatment initiated with 160 mg/d of megestrol acetate. The patients underwent dilatation and curettage and hysteroscopy after 3 months, and in cases of normal pathology, the therapy continued for another 3-month period. In patients who did not respond to treatment, the dosage of the drug was doubled (320 mg/d), and the therapy continued for another 3 months. At the second time, patients who did not respond to treatment were recommended for hysterectomy, and in patients who responded to treatment, an additional 3 months of treatment with megestrol acetate (320 mg/d) was administered.Results:Our results showed a response rate of 85.71% (18 patients), and 3 patients underwent hysterectomy. The mean (SD) treatment duration was 8.85 (2.00) months (range, 6-12 months). The response to therapy was observed in 5 patients (27.78%) with a dosage of 160 mg/d, and the remaining patients with 320 mg/d. Pregnancy occurred in 5 patients (27.78%). Recurrence happened in 3 (16.67%) of 18 patients who responded to treatment who did not give a permit to undergo hysterectomy and received medication again. Two (66.67%) of these patients experienced remission again, whereas the other one was candidate for hysterectomy.Conclusions:The results of this study show that, when an initial response is not achieved or when disease recurs, use of 320 mg/d seems to be associated with a better therapeutic response. Furthermore, serious complications were not observed with this dosage.

To alert health professionals on presence and extent of phantom pain and sensation following bilateral upper limb amputation.Of a total of 140 war-related bilateral upper limb amputees in Iran, 103 subjects were thoroughly examined in this cross-sectional study by a physical medicine specialist. The patients were questioned for the presence of phantom pain and sensations, and frequency and intensity of the feeling were recorded.At 17.1 +/- 6.1 years after injury, 82.0% of the 103 amputees suffered from phantom sensation, including varying degrees of phantom limb pain in 53.9% of stumps. Phantom phenomena had a higher frequency in the right extremities, but this was not statistically significant (p0.01). Of those amputees who had phantom pain or sensation, 51.2% reported that they 'always' had phantom limb sensation; and approximately one-fourth of the subjects (24.6%) 'always' had phantom pain. Among the stumps who reported phantom pain (N=112), the pain was excruciating (38.5%), distressing (34.9%) or discomforting (25.6%). A significant statistical relation between phantom limb sensation and level of amputation was observed (p0.01).At this time there is no healing for phantom pain; medical and surgical modalities only bring temporary relief, and less than 1% of the respondents achieve permanent relief through different treatment methods.

Background: Ovarian neoplasms are an important cause of morbidity and mortality in women. The surgical management of ovarian neoplasms depends on their correct categorisation as benign, borderline and malignant. Aim: The aim of this study was to determine the clinical benefits of intraoperative frozen section analysis into the surgical management policy of women referred with an adnexal mass suspicious of ovarian cancer. Methods: A retrospective study of 106 ovarian frozen section results was examined to determine the accuracy of frozen section diagnosis. The accuracy, sensitivity, specificity, and positive and negative predictive value of frozen section were studied. Results: The overall accuracy to determine the status of malignancy was 93.3%. Sensitivity of the test was highest in the benign groups at 97.4% and lowest in the borderline groups at 25%. The accuracy of frozen section was 80% in serous tumours and 60% in mucinous. There were two (2.5%) false positive, three (10.7%) false negative and two overestimated diagnosis in frozen section examination. Eight malignancies (30.7%) were of metastatic origin, all of which (100%), were correctly identified on frozen section. Conclusion: Frozen section appears to be an accurate technique for the histopathological diagnosis of ovarian tumours. Some limitations were observed among borderline and mucinous tumours. This emphasises the great value of frozen section in the diagnosis of ovarian tumours.

To compare the efficacy of methotrexate and actinomycin D as single agents in first-line chemotherapy for women with low-risk gestational trophoblastic neoplasia (LR-GTN).A total of 131 women with LR-GTN were randomized to receive a weekly pulsed dose of 30 mg/m(2) of methotrexate intramuscularly (n=81) or a pulsed intravenous bolus of 1.25 mg/m(2) of actinomycin D every 2 weeks (n=50). An additional cycle was administered as consolidation treatment following normalization of the serum level of beta-human chorionic gonadotropin (5 IU/L).Complete remission was achieved in 48.14% of patients in the methotrexate group and 90.00% in the actinomycin D group (P0.001). The mean number of treatment cycles needed to achieve response was lower in the actinomycin D group (4.8 vs 6.8). The risk of treatment failure was 26.4 greater with methotrexate than with actinomycin D (95% confidence interval, 5.7-22.6; P0.001).Actinomycin D may be a better option than methotrexate as a first-line chemotherapy agent for patients with LR-GTN.

To determine the curative effect of a repeat uterine evacuation in patients with low-risk gestational trophoblastic neoplasia.Patients with low-risk gestational trophoblastic neoplasia (GTN)(N=12), diagnosed according to the International Federation of Gynecology and Obstetrics 2002 guidelines, were enrolled in a prospective cohort study. Primary outcomes were need for chemotherapy after second uterine evacuation and number of chemotherapy courses needed to achieve complete remission.Ten patients (83%) did not require chemotherapy and were cured bya second curettage. Two patients failed to respond to the second curettage and received single-agent chemotherapy with actinomycin-D (1.25 mg/m2 biweekly, slow intravenous administration). Both patients responded to chemotherapy as second-line therapy. A 100% remission rate was achieved, with no recurrence at the 1-year follow-up. One patient (8%) had a uterine perforation.Second curettage has a favorable response rate. It seems reasonable to perform a second curettage in patients with low-risk GTN in settings where serum beta-hCG assay follow-up is highly reliable and available. However, its potential complications and inconvenience must be discussed critically with each patient.

Introduction Cellular angiofibroma is a rare benign mesenchymal tumour that occurs in the subepithelial myxoid stromal zone of the vulvovaginal region. We report a case of painful angiofibroma in a 52-year-old morbidly obese female, in the left labia. Case report A 52-year-old morbidly obese (body mass index of 67) female was referred to our gynaecologic oncology clinic with a 3-year history of a large, painful, pendulous left vulvar mass. Magnetic resonance imaging of the lesion helped confirm that the mass did not represent a hernia and was fibrous in nature. Resection revealed a 12 × 12 × 9 cm, a 187-gram encapsulated mass. Histologically, it was a well circumscribed tumour composed of hyalinised blood vessels and collagen bundles, exhibiting characteristic immunohistochemical features of a cellular angiofibroma. Conclusion Angiofibroma of the vulva is a rare benign encapsulated mass, yet hypervascular. Its diagnosis in a morbidly obese patient is challenging and necessitates magnetic resonance imaging or CT scan. Its surgical removal needs precision and meticulousness especially in a patient with multiple comorbidities.

e17019Background: CIP2A is a newly elucidated oncogene that demonstrates high expression in many human cancers. CIP2A may not only serve as a drug target, but may play a role as a biomarker, predic...

Background: The goal of this study was to evaluate the results of the expression of p16INK4a in normal uterine cervical epithelium, low-grade cervical intraepithelial neoplasia (CIN), high-grade CIN, squamous cell carcinoma (SCC), and adenocarcinoma of the cervix, in order to help draw a distinction between low risk and high risk patients with cervical lesions. Materials ans Methods : P16INK4a expression was evaluated by immunohistochemistry in 78 paraffin-embedded tissue samples including 39 normal cervical tissues, 11 low-grade CINs, 11 high-grade CINs, 22 cervical SCCs and 8 cervical adenocarcinomas. Two parameters in immunohistochemical p16 expression were evaluated: percentage of p16-positive cells, and reaction intensity. Results: The p16INK4a expression rate was 81.8% in low-grade CINs, 91% in high-grade CINs, 90% in SCCs and 75% in cervical adenocarcinomas. 10% of normal cervical samples expressed p16. Moreover, there was a significant relationship between the histological diagnoses and percentage of positive cells and reaction intensity of p16 (p < 0.005). The intensity of the reaction was the best parameter to evaluate the positivity of p16. Conclusions: Over-expression of the p16INK4a was typical for dysplastic and neoplastic epithelia of the uterine cervix. However, p16INK4a-negative CINs and carcinomas did exist. Although negative p16INK4a expression does not definitely exclude the patient with cervical lesion from the high-risk group, immunohistochemical study for p16INK4a may be used as a supplementary test for an early diagnosis of cervical cancers.

Objective To determine the effectiveness of 2 standard chemotherapy regimens for low-risk gestational trophoblastic disease according to the International Federation of Gynecology and Obstetrics (FIGO) staging system. Methods From 2008 until 2010, 75 women with low-risk gestational trophoblastic disease received either pulsed actinomycin D (n = 50) or 5-day methotrexate (n = 25). The primary remission rate, the duration of treatment, the number of treatment courses, and the adverse effects were compared. Results The complete remission rates were 90% for the actinomycin D group and 68% for the methotrexate group ( P = 0.018). The mean number of chemotherapy courses administered to achieve complete remission (including courses of second-line therapy) was 3.1 in the methotrexate group and 5.3 in the actinomycin D group ( P = 0.01). No major adverse effects were experienced in either treatment group and there were no significant differences in terms of adverse effects. Second-line chemotherapy was indicated for 11 patients. Conclusion Based on the present study, pulsed actinomycin D seems to be an appropriate first-line treatment for patients with low-risk gestational trophoblastic disease.

The most effective treatment of well-differentiated endometrial carcinoma is surgery. The aim of this study is the evaluation of megestrol acetate on young patients with well-differentiated endometrial cancer who wish to preserve their fertility, with regard to the receptors.16 patients were treated initially with 160 mg/d of megestrol acetate and continued with 320 mg/d for non-responsive cases. All patients followed with FDC and hysteroscopy. The responsive patients were referred to IVF group.Response rate to hormonal therapy was 10/16 (62.5%). The mean time of responding was 7.5 months. Other six (37.5%) patients underwent total abdominal hysterectomy (TAH). Of 10 patients who responded to hormonal therapy, one exited of the study because of her husband's infertility. Two patients are under IVF. Three patients did not get pregnant and four patients became pregnant and finally underwent TAH. All patients had progesterone receptors. Only one patient lacked estrogen receptors; who also responded to treatment.Progestins treatment of these patients who want to have child may be useful, but close long-term follow-up is necessary. The evaluation of estrogen and progesterone receptors assay may be useful in predicting response to the treatment.

Objective. Chronic pain after spinal cord injury (SCI) is a common and considerable complication and may continue for a long time. Design. During a 2-year survey, 13.9 ± 3.0 years after injury, a total of 1,295 war-related spinal cord injury survivors were thoroughly examined by physical and rehabilitation specialists and all relevant data, consisting of type and site of pain as well as exacerbating or palliative factors, were recorded. Patients. The mean age of the survivors was 35.9 ± 7.2; 98.5% were male and 1.5% were female. The level of injury was cervical in 9.3%, thoracic in 67%, and lumbosacral in 23.7%, with 8.1% tetraplegic and 89.1% paraplegic. About 89.8% had complete spinal cord injuries and 10.2% had incomplete spinal cord injuries, based on sensory and motor testing. Results. Spinal cord related pain was reported in 64.9% of the subjects; 8.8% reported a history of pain but had no complaint at the time of examination, and 26.3% had never suffered from any pain. Patients suffering from lumbar spinal cord injury reported the highest percent of pain perception, with pain detected in 83.5% of these patients. Common sites of reported pain were the distal lower extremities (46.5%), proximal lower extremities (40.9%), pelvic girdle (24.5%), and upper limbs (5.7%). Conclusion. Spinal cord injury-related pain interferes with daily activities of patients and significantly influences their quality of life.

All urethral reconstruction for hypospadias involving use of local tissue, flaps or substitution has an inherent incidence of complications, including fistula, meatal stenosis and urethral restenosis with time, and recurrence of chordee. To avoid these complications, we developed a technique for urethral mobilization and advancement with distal triangular urethral plate flap to repair distal and select cases of mid shaft hypospadias with or without chordee. We present a description of the procedure and results based on a 10-year experience.A total of 251 boys 2 to 16 years old underwent repair of glanular (62 patients), subglanular (128), mid shaft (28) and recurrent (33) hypospadias. Ventral curvature was present in 201 patients.Followup ranged from 6 months to 10 years (mean 7.4 years). No patient had a urethrocutaneous fistula or meatal stenosis. There were 2 cases of recurrent curvature in mid shaft hypospadias, due to inappropriate case selection. One patient had a hematoma that resolved after emptying under general anesthesia. Cosmetic results were excellent.This procedure is one of the most appropriate and preferable operations in all distal and select cases of mid shaft hypospadias with or without chordee, due to the minimal complications and excellent cosmetic results.

e16594 Background: PP2A is a widely conserved phosphatase that functions as a major tumor suppressor. Inhibition of PP2A is a necessary prerequisite for the transformation of cancer cells. Dephosph...

In a cross-sectional study, 132 male veterans with spinal cord injury (average age 37.4 years; injuries sustained from 5 to 23 years ago), underwent dual-energy x-ray absorptiometry, by LUNAR, to define bone mineral density (BMD) in second to fourth lumbar vertebrae and the neck of the right femur (g/cm(2)). The results showed that bone minerals in the lumbar area are reserved better than in the femoral neck. The study on the femoral neck revealed that 81.5% of subjects had osteoporosis and 13.1% osteopenia. Evaluation of lumbar spines also showed that 16.7% of the veterans had osteoporosis and 18.2% osteopenia. A significant difference was observed between vertebral bone density (mean 1.23 g/cm(2)) and the neck of the right femur (mean 0.66 g/cm(2)). There was also a slight negative correlation between bone density and risk of bone fracture in vertebrae and femoral neck. No significant relation between bone density and age, level of injury, spasm, occupation, and postinjury period was reported. A slight negative correlation between weight and bone mineral density and a slight positive correlation between height and bone mineral density were found.

The continuous interplay between cancer cells and immune system allows an opportunity to identify cancer-specific biomarkers in immune cells. Here, we compare the transcriptomes of peripheral blood mononuclear cells (PBMCs) obtained from advanced stage ovarian cancer patients and healthy donors in a proof-of-concept study to identify ovarian cancer-specific biomarkers. PBMCs were collected from patients undergoing surgery with the gynecologic oncology service. RNA was extracted from the PBMCs of five patients (training set) with confirmed diagnosis of epithelial ovarian cancer and 4 health donor blood samples. Microarray analysis using Illumina platform was conducted and analyzed using the R statistical package. After data normalization, differentially expressed genes in the two cohorts were identified controlling for false discovery rate at 5 and 10%. The top ten up- and downregulated genes were selected. Gene ontology and pathway analysis led to identification of a Candidate Biomarker Panel (CBP) comprising of five of the ten genes that were most likely to serve as biomarkers for ovarian cancer. Validation of the CBP was achieved using PBMCs isolated from a separate group of six patients and healthy donors (test set) was performed using qPCR and flow cytometry and in vitro culture experiments. Bioinformatics analysis identified 391 genes that were up-regulated and 599 that were down-regulated. A set of five genes with high biomarker potential and were included in the CBP. All of the CBP genes were differentially expressed by 3-5 fold (p Citation Format: Shitanshu Uppal, Arvinder Kapur, Mildred Felder, Erin Medlin, Hadi Shojaei, Jesus Gonzalez-Bosquet, Manish S. Patankar. Mining the circulating immune cell transcriptome for ovarian cancer-specific biomarkers: A proof of concept study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 893. doi:10.1158/1538-7445.AM2014-893

Background Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. Methods The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered. Results The most common level of amputation was the finger or wrist level (108, 52.4 %). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6 %), rotator cuff injury (24, 11.7 %), bicipital tendonitis (69, 33.5 %), shoulder drop (42, 20.4 %) and muscle atrophy (19, 9.2 %). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3 %) and unilateral brachial plexus injury in 1 (1 %). Fifty-three (51.5 %) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1 %), both left and right sides. The back was the most common site of pain (71.8 %). Conclusion The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.