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Introduction: People living in many parts of the world have limited access to diagnostic studies and therapies for rheumatologic, musculoskeletal, and connective tissue diseases. The challenge has been particularly poignant for rural areas of low- and middle-income countries. Objectives: We report on the implementation of a telemedicine program in Iran for the evaluation and treatment of patients with rheumatologic and musculoskeletal diseases. More than 4,800 patients were seen remotely over a span of 5 years by a rheumatologist in the United States. The remote rheumatologist was aided by a general physician and a nurse at a local charity hospital in northeastern Iran that has a catchment area that includes rural regions extending to the border of Afghanistan. Seventy to 90 patients were evaluated online by the remote rheumatologist 3 days a week. A subset of patients was evaluated by the rheumatologist in person every 4 months. Materials and Methods: The population of rheumatology patients was evaluated using descriptive statistics. Information collected included demographic information consisting of age, gender, and primary rheumatologic diagnosis. Results: The average age of patients who were seen was 52 years and 89% of patients were women. Approximately 50% of patients were Afghan refugees. The most common disorders included osteoarthritis (1,149, 23.6%), rheumatoid arthritis (653, 13.4%), axial spondyloarthropathies (647, 13.3%), lumbar spinal stenosis (427, 8.8%), meniscal tear of the knee (326, 6.7%), and psoriatic arthritis (217, 4.5%). Certain conditions were lower than expected such as lupus (19, 0.4%) and fibromyalgia (169, 3.5%). Diagnostic tests included serologic tests (1,328, 27.3%), plain radiographs (946, 19.5%), magnetic resonance imaging (899, 18.5%), bone densitometry (147, 3.0%), and electromyography and nerve conduction study (132, 2.7%). The most common medications prescribed were non-steroidal anti-inflammatory drugs (791, 16.3%), methotrexate (764, 15.7%), pregabalin (234, 4.8%), duloxetine (230, 4.7%), sulfasalazine (177, 3.6%), etanercept (97, 2.0%), tofacitinib (64, 1.3%), adalimumab (18, 0.4%), and infliximab (9, 0.2%). Conclusions: Telemedicine is becoming more prevalent. We report the successful use of this service in evaluation and management of rheumatic diseases in a region with limited access to rheumatologic care. We have shown that patients can be seen, evaluated, and successfully treated with a variety of medications, including biologic agents.

Objective To evaluate the long‐term safety of rituximab in an observational cohort of patients with rheumatoid arthritis (RA) who had an inadequate response to ≥1 anti–tumor necrosis factor therapy in the US (SUNSTONE [Study of the Safety of Rituxan in Patients With Rheumatoid Arthritis After an Inadequate Response to Previous Anti‐TNF Therapy] registry). Methods In this prospective, observational cohort study, patients received rituximab according to their physician's standard practice and were evaluated at standard‐of‐care follow‐up visits at least every 6 months. The primary outcome was the incidence of protocol‐defined significant infections. Secondary outcomes included serious adverse events potentially associated with rituximab, cardiovascular or thrombotic events, seizures, deaths, and pregnancies. Post hoc analyses assessed outcomes by concomitant medication use. Results Overall, 989 patients (safety‐evaluable population) received ≥1 dose of rituximab, with a total follow‐up of 3,844 patient‐years (mean duration 3.9 years). In total, 341 significant infections occurred in 197 patients (19.9%). The incidence rates (95% confidence intervals [95% CIs]) for significant infections, cardiovascular or thrombotic events, and seizures were 8.87 (95% CI 7.98–9.86), 1.95 (95% CI 1.56–2.45), and 0.18 (95% CI 0.09–0.38) per 100 patient‐years, respectively. The incidence of significant infections did not increase with time or with cumulative rituximab exposure. During the study, 64 patients died (crude mortality rate 1.66 per 100 patient‐years [95% CI 1.30–2.13]). The most common causes of death were infections (n = 19), malignancy (n = 14), and cardiovascular events (n = 13). Eight pregnancies were reported in 7 patients. Conclusion In patients with RA treated with rituximab for up to 5 years, the rates of significant infections were stable over time and higher in patients who received long‐term systemic steroid treatment.

The present study was conducted to investigate the effect of ethanolic extract of Otostegia persica on bone loss in streptozotocin (STZ)-treated diabetic rats. Forty male Wistar rats were randomly divided into five equal groups and treated as follows: group 1 (control); group 2 (STZ group), received STZ 50 mg/kg by a single IP injection; groups 3, 4, and 5 treated with STZ as mentioned above +200 mg/kg, 300 mg/kg, and 450 mg/kg of O. persica extract per day by oral gavage, respectively. On day 29, sera harvested and left femoral and tibiofibular bones were dissected for histomorphometric study, while right femoral and tibiofibular bones as well as L4 vertebrate were removed for determination of ash weight. Obvious hyperglycemia was seen in the STZ group as compared to the control. Administration of O. persica extract at the dosage of 300 mg/kg reversed the hyperglycemia. Alkaline phosphatase activity was markedly increased in all experimental groups as compared to control. Epiphyseal and metaphyseal trabecular width as well as epiphyseal bone area/tissue area significantly decreased in STZ group. O. persica extract at the dosage of 200 mg/kg reversed all these parameters to the control level. Marrow area/cortical area in rats treated with 450 mg/kg O. persica extract were highest among groups. No significant difference observed in osteoid thickness among different groups. Although the ash weights of both compact and cancellous bones in STZ group had no significant difference with control, ash weight of L4 vertebrate in rats treated with 300 and 450 mg/kg of extract was significantly lower than other groups. In conclusion, ethanolic extract of O. persica has bone protective effects in STZ-treated rats irrespective to its glucose lowering properties.

Aim: Metabolic bone disorders and reduced bone mass are common complications in patients with biliary cirrhosis. As a result of there being no clear etiology, no specific therapy has been established yet. Previous studies have reported that quercetin, a plant-derived flavonoid, might improve bone quality. The present study was designed to investigate the effect of quercetin on bone strength of biliary cirrhotic rats. Methods: Twenty-four male Sprague–Dawley rats aged 6–7 months were randomized into three groups of eight. One group served as control (sham operated), while the other two groups underwent a complete bile duct ligation (BDL). Four weeks after the operation, serum bilirubin, alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase were measured in animal blood samples to confirm the occurrence of cirrhosis in the BDL rats. Then, one of the BDL groups received placebo and the other one was injected once a day with 150 µmol/kg of quercetin for 4 weeks. At the end of the study, femora were removed and tested for bone strength and histomorphometric parameters. The serum levels of osteocalcin, C-terminal cross-linked telopeptide of type I collagen, calcium and phosphorus were determined as bone turnover markers. Results: Femur breaking strength was dramatically lower in the BDL group compared with control. However, receiving quercetin could reverse the deteriorating effect of cirrhosis on bone strength of BDL rats. Quercetin could noticeably elevate osteocalcin as a bone formation marker. Conclusion: These data suggest that quercetin can significantly improve bone strength particularly due to increasing bone formation in biliary cirrhosis.

An experiment was conducted to study the effects of xylanase and citric acid on the performance, nutrient retention, jejunal viscosity, and size and pH of the gastrointestinal tract of broilers fed a low-P wheat-based diet. The experiment was conducted as a 2 × 3 factorial arrangement with 2 levels of xylanase (0 and 200 mg/kg) and 3 levels of citric acid (0, 20, and 40 g/kg). Each of the 6 dietary treatments was fed to 4 replicate pens (17 birds/pen) from 0 to 24 d of age. Chromium oxide (3 g/kg) was added to the diets as an indigestible marker to determine the apparent nutrient retention. No interaction effect was observed between xylanase and citric acid in any measured response. Xylanase did not affect feed intake but significantly increased BW gain by 3.6% (P < 0.05) from 1 to 24 d of age and improved G:F by 3.9% (P < 0.01). The inclusion of 40 g/kg of citric acid decreased (P < 0.01) BW gain and feed intake by 8.6 and 12.5%, respectively. The inclusion of 20 and 40 g/kg of citric acid improved G:F by 2.3 and 4.5% (P < 0.05), respectively. Xylanase significantly decreased the viscosity of digesta and improved the retention of DM, CP, and energy, but did not have a significant effect on the retention of fat and P. Inclusion of 20 and 40 g/kg of citric acid in the diets increased P retention by 15.8 and 16.3% (P < 0.01), respectively. Citric acid significantly decreased the pH of crop contents (P < 0.05). In conclusion, citric acid, at the 40 g/kg inclusion level, reduced feed intake and BW gain but improved G:F and P retention. Xylanase decreased digesta viscosity, increased nutrient retention, and consequently improved the performance of broilers fed the low-P wheat-based diet. Thus, adding 20 g/kg of citric acid, especially in the starter period, and 200 mg/kg of xylanase to low-P wheat-based diets can be helpful.

Problem statement: Uterine cervix which separates the uterus from the vagina, shows remarkable anatomical and histological differences among mammalian species. Since no cleared observations have been found in regards with the Ca spian miniature horses' cervix, the aim of the pres ent study was to supplement this missing information which could be helpful for providing a stricter basis in detecting reproductive diseases and abnormalities i n this valuable species. Approach: Cervices from 4 female adult healthy Caspian miniature horses disse cted immediately after death and samples of 1cm thickness from 3 regions of cervix (endocervix, mid cervix and exocervix) fixed with 10% buffered formalin. Routine histological laboratory methods w ere used and 6 µm paraffin slides stained with hematoxylin-eosin, Periodic acid-Schiff, Masson's t richrome and verhoeff methods and studied under light microscope. Heights of primary, secondary and tertiary folds and mucosal glands measured with computer software. Results: The cervix comprised of primary, secondary and ter tiary fold with Simple columnar epithelium in endocervix and midcervix and most cranial part of the exocervices and changes into the non keratinized stratified squamou s and a transitional form with stratified squamous with columnar cells, near the vagina. Lamina propri a and sub mucosa made of collagenous dense connective tissue with abundant arterial and venues plexus. Simple tubular glands observed at the base of secondary folds of endocervix and midcervix. The muscularis layer contained of inner circular and outer longitudinal smooth muscles. Serous layer cov ered the cervix from the outside. Conclusion: Our finding showed that the cervix uteri in Caspian min iature horse, like other horses and ruminants, are a collagenous structure, with tall longitudinal fold throughout the length. Secretion of mucus from the mucosal glands is less obvious than ruminant.

Cecum, the largest part of chicken’s large intestine, has an important role in liquid absorption and cellulose digestion. It acts as a defensive organ as well due to the presence of large masses of diffuse and nodular lymphatic tissue in lamina propria and sub mucosa. The cecal tonsil activity has been proved to be depended on the activity of bursa of fabricious and thymus. As the bursa of fabricious and the thymus are exposed to involution through these ages, finding the changes (if any) occur in the caecal tonsil has been our aims. Eighteen (18) healthy white leghorn chickens of 16, 20 and 24 weeks old were selected and fixed the samples of their caecal tonsils, thymuses and bursas of fabricious in 10% buffered formalin, immediately after slaughter. Routine histological laboratory methods were used and 6 I¼m sections were stained with hematoxylin- eosin staining method and studied under light microscope. The nodular units (ND) width and height, ND fossulae’s lumen width, distribution areas of the lymphatic nodules and crypts of lieberkuhn /mm2 in the caecal tonsils, cortices and medullas diameters of the thymuses and the cortices and medullas diameters of lymphatic nodules, heights of plicas and No of nodules/ plica in the bursas of fabricious of all ages were measured and then analyzed with one way ANOVA test. In the cecal tonsils, the most important changes regarding with involution process was significant decline of lymphatic nodules/ mm2 of mucosal wall and nodular evacuation at 6 months ones, while thymuses decrease the cortical diameter at 5 months. No significant changes in regarding with involution process were shown in the bursas of fabricious through these ages and no changes in the sub epithelial lymphoid tissues of the cecal tonsils as well. By the results of this study, we come to know that the cecal tonsil growth can be depended on thymus and bursa of fabricious activity, since involution process is first begun in thymus at 5 months of age and then it occurs in thymic dependant areas of the cecal tonsil at 6 months of age. As no involution occurred in bursa of fabricious through these ages, cecal sub- epithelial lymphatic tissue dependant on bursa of fabricious remained unchanged.

Summary Histology of the tongue, including apex, root and body, in four adult Caspian miniature horses was examined. Serial sections with 6 μm thickness were stained with haematoxylin–eosin and Masson trichrome and studied under light microscope. The tongue was covered by stratified squamous epithelium. It was thick and keratinized bearing numerous lingual papillae on the dorsum, mostly filiform with a very fine keratinized thread projecting above the surface and bending backward. The fungiform papillae were sparsely scattered among the filiform papillae and covered with keratinized squamous epithelium. Few taste buds were detected on it. The two very large vallate papillae were detected on the dorsum, just rostral to the root, which were covered with stratified squamous epithelium with relatively high amounts of taste buds in the epithelium of the surrounding grooves. The foliate papillae were present near the palatoglossal arch and had a few taste buds. The epithelium covering the ventral surface of the tongue was thin and keratinized. The lingual muscle core consisted of transverse, longitudinal and perpendicular bundles of skeletal muscle fibres. Clusters of minor salivary glands were present between the muscle fibres and lamia propria. Most of the lingual glands were mucous and most of the gustatory ones were serous type. The mid-dorsal special structure of the tongue (dorsal lingual cartilage) contained sparse skeletal muscle fibres and was rich in white adipose tissue. Hyaline cartilage, routinely observed in this structure in the horses, was not detected in Caspian miniature horse.

Preparing avian tissue samples in histology laboratories involves a problem we usually confronted with: the process, although the same in the case of all other animals, usually results in widespread artifacts, which requires us to repeat the test, usually without the desired result. Considering the artifact types, the major problem seems to result from an inefficient fixation process of the samples. Therefore, to modify the process, samples of kidney, lung, skin, proventriculus, esophagus, duodenum, jejunum, ileum, cecum, spleen, and bursa of fabricious of healthy mature native hens were taken immediately after slaughter and fixed with buffer formalin at 5%, 7.5%, lo%, and 15%. Then, other histological laboratory procedures were similarly performed for all samples and the 6-μm sections were stained with hematoxylin–eosin and studied under light microscope. The repeated tests on new samples of the same organs in the same conditions and with the same procedures for a sure and reliable result proved ...

The effects of inclusion of cellulose or inulin as a source of dietary fiber and CP content of the diet on hepatic fat deposition were investigated in hens fed restricted or close to ad libitum consumption. There were 12 dietary treatments forming a 2 × 3 × 2 factorial with 2 feeding regimens [restricted and liberal (close to ad libitum consumption; LIB)], 3 fiber sources (control, 3% inulin, and 3% cellulose), and 2 levels of CP (14.5 and 17.4%). Hens were assigned in groups of 6 to 60 floor pens. From 43 to 55 wk of age, hens fed LIB showed increased activity of the hepatic malic enzyme (MalE; P < 0.01), which led to an increase (P < 0.001) in liver weight and hepatic lipid deposition and was associated with enhancements (P < 0.05) in plasma levels of glucose, triglyceride, total cholesterol, and low-density lipoprotein cholesterol. Abdominal fat deposition and BW of the hens increased (P < 0.001) with liberal feeding. Inclusion of inulin in the diet reduced (P < 0.05) liver and abdominal fat weight, whereas cellulose inclusion decreased (P < 0.05) feed intake, abdominal fat, and BW. An increase in CP content of the diet from 14.5 to 17.4% reduced MalE activity (P < 0.001), liver weight (P < 0.001), and the accumulation of lipids and cholesterol in the liver, as well as plasma triglyceride concentration and abdominal fat pad weight (P < 0.05). It is concluded that fiber inclusion reduced abdominal fat and liver weight, with effects being more pronounced with cellulose than with inulin. An increase in dietary CP reduced MalE activity and alleviated hepatic and plasma lipid concentration; therefore, it might be a practical approach to reduce the incidence of obesity-linked problems in broiler breeder hens. The combination of high-CP diets and the inclusion of a fiber source did not suppress liver lipid content over that observed with the high-CP diet, exclusively.

A 12-wk experiment was conducted to study the effects of feeding regimen, inclusion of a fiber source, and CP content of the diet on performance of broiler breeder hens. In total, 360 hens and 60 males, 43 wk of age, were assigned to 60 floor pens (6 hens and 1 male each). There were 12 treatments arranged factorially with 2 feeding regimens [restricted (R) and liberal feeding (close to ad libitum consumption; LIB)], 3 sources of fiber (0, 3% inulin, and 3% cellulose), and 2 levels of CP (14.5 and 17.4%). No interactions among main effects were observed for any of the traits studied, and therefore, only main effects are presented. Body weight, liver weight, and abdominal fat weight were higher (P < 0.001) for the LIB than for the R-fed hens. However, egg production (P < 0.001), fertility index (P < 0.05), and percentage of hatch (P < 0.01) were lower for LIB than for R hens. The weights of ovaries (P < 0.05) and the size of the first preovulatory follicle (P < 0.05) were higher for the LIB than for the R hens. Also, egg yolk, egg weight, and BW of the hatching chicks were higher (P < 0.001) for the LIB hens. The inclusion of a fiber source in the diet decreased (P < 0.05) feed intake, BW gain, absolute liver and abdominal fat weight, and egg yolk weight, with effects being more pronounced (P < 0.05) with cellulose than with inulin. Hens fed additional fiber produced more (P < 0.05) eggs that were more fertile (P < 0.05) than control hens. Crude protein content of the diet did not affect hen performance but reduced (P < 0.01) the relative weight of the liver, ovary, and abdominal fat. It is concluded that the inclusion of inulin or cellulose in the diet improved hen performance and that an increase in dietary CP reduced obesity in broiler breeder hens.

Forty-six rats fed a Zn-deficient diet for 18 days, were divided into three groups and treated with Zn-deficient diet (GI), a normal (Zn-adequate) diet (GII) or a pharmacological Zn therapy diet (GIII) for 3 days. For light and electron microscopy, samples were taken at times 0, 8, 12, 24 and 72 h after treatment. In treatment GI, at all times, all rats had esophageal parakeratosis. With treatment GII, there was a variable progression toward normalization of the epithelium at 12 and 24 h. At 72 h there was almost complete recovery of normal epithelium. In treatment GIII at 8 h, large, light cells in the basal layer were shown to be present between dark cylindrical cells, a finding which was transitionary and disappeared at 12 h. Also, a thin keratinized layer was observed above the granular layer at 12 h. Recovery had progressed at 24 h and was complete after 72 h. The results are discussed in terms of a potential role of Zn in the sequence of cytochemical events in epithelial differentiation.

Background Toxoplasmosis is a worldwide endemic disease. In congenitally infected infants and AIDS patients, toxoplasmosis causes high rates of morbidity and mortality. In these cases antibody detection is difficult; so detection of parasite or its components could be useful tool for early detection and following treatment of the infection. Methods Sixty-three BALB/c mice were injected intra-peritoneal with 5×103 tachyzoites of Toxoplasma gondii RH strain, nine mice were sacrificed daily for 7 days. Fourteen mice were injected with phosphate buffer saline as control group. Dot–ELISA was performed for detection of T.gondii antigen in mice sera and capture – ELISA was done as golden standard assay too. Results Toxoplasma gondii antigen was detected from day 2 in mice sera; 22% of mice sera on day 2, 33% on day 3,77% on day 4 and 100% on day 5 till their death on day 7 had shown antigenemia by dot – ELISA, no positive result was detected in control mice by dot- ELISA. Conclusion Dot-ELISA is a sensitive method for diagnosis of T. gondii infection in the animal model; also, this technique is more rapid and easy to perform method in comparison with capture-ELISA.

The present study was conducted to investigate the effects of eicosapentaenoic acid on glucocorticoid-induced bone changes in rats, and to compare them with those of alendronate. Thirty six male Wistar rats, 2.5 months of age, were divided into six groups (n = 6 each) and treated with 0.9% NaCl (control), methylprednisolone 7 mg/kg, once a week subcutaneously, methylprednisolone + alendronate 20 microg/kg, twice a week subcutaneously and methylprednisolone + 80 or 160 or 320 mg/kg eicosapentaenoic acid, per day orally, for 6 weeks. At the end of the experiment, serum and urinary parameters of bone metabolism determined and bone histomorphometric analyses performed on cancellous bone of femoral epiphysis and metaphysis and cortical bone of tibial diaphysis. There were no significant differences in serum and urinary parameters among groups. Decrease of epiphyseal and metaphyseal trabecular width, epiphyseal bone area/tissue area and increase of epiphyseal trabecular separation observed in the methylprednisolone group compared to control. Alendronate restored all of these parameters except metaphyseal trabecular width, which increased significantly by eicosapentaenoic acid at the doses of 80 and 160 mg/kg. Effects of alendronate and 160 mg/kg eicosapentaenoic acid on bone area/tissue area, alendronate and eicosapentaenoic acid at the doses of 80 and 160 mg/kg on trabecular separation and alendronate and eicosapentaenoic acid at doses of 160 and 320 mg/kg on epiphyseal trabecular width were statistically similar. Methylprednisolone did not significantly change cortical bone parameters including cortical width and marrow area/cortical area. Eicosapentaenoic acid, especially, at the dose of 160 mg/kg exerts beneficial effects on methylprednisolone-induced bone changes in rats; these effects are similar or sometimes even better than alendronate.

The cecum is a great cul-de sac intercalated between the small intestine and the colon. It has a remarkable size in the equine and digestion of more than 30% of total cellulose and production of volatile fatty acids by anaerobic metabolism of cellulose by its micro flora were made on it. It has also a substantial number of lymphatic nodules, which in horses are located near the apex. Topographically, cecum is situated chiefly to the right of the median plane and occupies around the whole volume of there in the abdominal cavity. The histological structure of the lymphatic follicles and their distributions pattern throughout the cecum in five healthy mature miniature horses (an special species of horses lives only in north of Iran) were studied (Fig. 1a). Each cecum was divided into three parts, namely, the base, body and apex, and samples were taken from each part immediately after slaughter and fixed with 10% buffered formalin. Routine histological laboratory techniques were made and 6 μm ?sections were cut and stained with haematoxylin and eosin staining and studied under light microscope. Lymphatic nodules were mostly found in the submucosa, but they disrupted the muscularis mucosa and merged into the lamina propria (Fig. 1c). The thickness of the mucosa and submucosa at these sites was smaller, and the epithelium that covered the mucosa was here modified into simple squamous or low cuboidal epithelia with dark and flattened nuclei (Figs 1b,d). The large and small lymphatic nodules were extensively accumulated in the apex, forming a nearly continuous layer in lamina propria and submucosa. However, they were less prominent at the base and least in the body of the cecum. (1 A) [ Abdominal viscera of miniature horse: right view. The right lateral wall is removed, right ventral part of colon (thick arrow), cecum (thin arrow). B: Photomicrograph from the apex of cecum in miniature horse, large numbers of lymphatic nodules were seen in lamina propria and sub mucosa (arrows) , H&E, 32x. C: Photomicrograph from the base of cecum in miniature horse, lymphatic nodule (thin arrow), discontinues muscularis mocusa (thick arrow), H&E, 100x. D: Photomicrograph from the epithelium covering the base of cecum in miniature horse, normalepithelia (thick arrow) ]

The blood platelet, derived from megakaryocytes, and participate in the initial stages of the blood coagulation process. Although there have been a few reports presenting values for a number of blood constituents in Asian elephants (Elephas Maximus), which is now an endangered species, there is a scarcity of information available on aspects of normal fine structure of its platelet.Blood was collected from six healthy adult asian elephants and platetlcts were prepared with method used by Gentry, et al. PGEi was added to a plasma rich in protein to a final concentration of 1μM/10ml to inhibit platelet activation. Platelets were fixed with 2.5% gluteraldehyde in 1.0 M phosphate buffer at PH 7.2. Stained with tanic acid using stenberg method, and post fixed in 2.0% osmium tetroxide in the phosphate buffer. The samples were routinely processed for transmission electron microscopy.

Embryological aetiology of anomaly of the dens of the axis discussed. The previous literature of this subject is briefly reviewed. A case of complete absence of dens of the axis with severe torticollis and spastic tetraplegia is presented. This 6-year-old patient recovered fully following occipito-cervical fusion.

An attempt by using Marcaine epidural anaesthesia has been made to prevent the central cord necrosis of the spinal cord injured dog. Details of the technique and the results are described.

The goal of successful treatment of spinal injury is to achieve a stable pain-free spine with no deformity and also the complete anterior decompression of the cord for maximum neurological recovery, the minimum bed-ridden time and hospitalization, and reduction of complications and expenses. A special ‘spinal fixator’ has been developed to fulfill these aims. It is a small apparatus with two components: a stabilizer to fix the adjacent vertebrae and a turn-buckle part to produce compression. Extensive biomechanical tests on cadavers confirmed that this appliance produced secure stability on the broken spine. It will simply replace the broken bodies through an anterolateral approach, restore the height of the body vertebrae for normal weight-bearing, and securely stabilize the broken spine for early mobility and rehabilitation; and finally, it will provide the chance to decompress the cord anteriorly for a better recovery. In this way the patient will be able to sit one day after the operation, to stand (with or without brace) in two to three weeks, and leave the hospital in three to six weeks after the operation. Details of engineering rational bases of this technique are described.

A new type of external fixator bas been designed for absolute fixation and prevention of lateral migration of fragments of bone. The apparatus has been used for leg lengthening. The apparatus and the technique are described and results of the first 24 cases are presented. Complications were minimal. The technique proved to be simple to apply, and painless to the patient with his ambulation from the start. And less expense are involved because of a very short period of hospitalization.

The effect of medical sympathetic blockage with reserpine was studied in 48 rats following crushing of the cord. Control experiments were carried out with reserpined and unreserpined groups. Marked sensory-motor improvement was found in the reserpined group.

A latex agglutination slide test for Toxoplasma antibodies was used on serum samples collected from various animals (111 cats, 113 dogs, three jackals, 393 sheep, 272 goats, 69 cows) in different parts of Iran. The sero-positive rate in titres 1:2-1:256 in different animals ranged from 12.6 to 56.0%; the highest (56.0%) was found in the stray dogs. Suspensions of the brains of 120 sero-positive animals (17 cats, 14 dogs, one jackal, 66 sheep, 22 goats) as well as 13 sero-negative animals (11 dogs, two jackals) and four black kites (Milvus migrans) not serologically tested were inoculated intraperitoneally into mice for isolation of Toxoplasma gondii. Altogether 16 strains of T. gondii were isolated from cats (47.0%) dogs (14.2%), sheep (7.5%) and a bird (black kite).

It is now 60 years since the late Dr. Walter E. Dandy wrote the paper that called the attention of the medical world to the entity of herniation of the lumbar intervertebral disc [1]. From that time until the present, there has been a neverending outpouring of papers giving details of surgical techniques used in the effort to correct the back and sciatic pain, associated with neurological involvement including motor weakness, sensory impairment, and reflex changes in the lower extremities, together with the varying responses of the patient to the modalities of treatment employed. Even so, few basic changes have emerged from all the papers on the surgical treatment of protruded lumbar discs.

Retrospective studies were carried out on 314 patients who underwent oil-based or water-soluble myelography between July 1981 and July 1982 in two community hospitals. Morbidities and efficacies were compared and it was concluded that metrizamide myelography is a preferable method.

Two cases of complete and permanent paraplegia following lumbar myelography using iophendylate are reported. Both patients had had syphilis many years earlier.

This is a report of long-term results and complications in 62 patients. Closed tibial osteotomy, direct tibial distraction, and simultaneous indirect proximal fibular epiphyseal distraction are the essential features of this new technique. Fibular osteotomy and complications from tibiofibular synostosis are eliminated. Bone graft and plating procedures have been proven to be unnecessary. The patient is ambulated immediately. Hospitalization has been reduced to a few days.