Tehran University Medical Journal
Year:2007 | Volume:65 | Issue:5|Papers Count:21

Background: Failed endotracheal intubation is one of the principal causes of morbidity and mortality in anesthetized patients. If the anesthetist can anticipate which patients may be more difficult to intubate, can reduce the risks of anesthesia greatly and be more prepared for any difficulties that may occur. The aim of this study was to investigate the inability of patients to protrude the lower jaw in predicting difficult intubation.Methods: In this prospective study, we enrolled 300 patients, above 16 years of age or older, who were scheduled for elective surgery. For all of the patients, before each operation, a single anesthesiologist measured the temporomandibular mobility, which was defined as the difference between the distances, from the lower incisors to the upper incisors in a neutral position and at maximum mandibular protrusion. At the time of intubation, another anesthesiologist, blinded to the preoperative airway assessment test, performed a laryngoscopy in which the laryngoscopic view of the larynx was determined according to the Cormack and Lehane scoring system. Difficult intubation was defined as laryngoscopic views of grade III and IV.Results: Twenty-one patients were identified as having difficult intubation. Only one patient could not be intubated. The forward movement of the mandible was significantly greater in patients with easy intubation compared to those with difficult intubation (6.42±1.95 mm vs. 3.58±1.26 mm respectively, P<0.001). The use of a cut-off point of less than 5 mm for prediction of difficult intubation showed a sensitivity of 92.86% and a specificity of 70.43%.Conclusion: The forward movement of the mandible is significantly greater in patients with easy intubation compared those with difficult intubation Although infrequent difficulties may arise, most patients that do not have indicators of difficult intubation will be easy to intubate under anesthesia.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease with several factors that contribute to its manifestation and continuation. One of the factors that initiate RA is emotional stress, which is in direct relationship with the sufficiency or insufficiency of the neuro-endocrine axis. Therefore, any stress that is not resolved in the neuro-endocrine axis might lead to RA and, as the stress continues, it causes the continuation of the disease. The aim of this study is to determine the effect of stress on continuation of RA and to find curative methods and, ultimately, the best method for treatment.Methods: One hundred rheumatoid arthritic patients (80 females and 20 males), having a final diagnosis of RA based on the guidelines of the American College of Rheumatology and onset of disease within the last 12-36 months, were studied as case and control subjects. Data was collected using interviews and questionnaires that reflected their life events with stress as a serious factor in their disease. The patients were divided into two groups: group A with stable stress and group B with unstable stress. The same treatment method was given to both groups. The results of the treatment were evaluated and compared after two years of follow up.Results: There was significant improvement in the patients in group B with unstable stress over that of the patients in group A with stable stress (P<0.0001).Conclusion: The present study shows that a considerable number of RA patients suffer from serious stress that affects their clinical path and improvement, and is quite visible in the health indexes and continuity of the disease. The results further showed that stress can play an important role in the initiation and continuation of RA. Therefore, by identifying and making efforts to remove the stress factors using anti-anxiety drugs, the disease can be better controlled.

Background: Cow’s milk protein allergy (CMPA) is the most common food allergy during the first year of life. Strict avoidance of specific foods is the only accepted treatment for food-induced allergic reactions. This is often an unrealistic therapeutic option, since cow’s milk is a basic food that is extensively used in infant formula. The recent preliminary experience of oral desensitization to cow’s milk by Meglio & Patriarca seems promising. The object of this study was to investigate the desensitization of children with CMPA to cow’s milk.Methods: All the patients referred to the Allergology Department of the Children’s Medical Center Hospital, Tehran from March 2004 to November 2005 suspected to have CMPA were evaluated. The patients were included in the intervention or control groups of the study. For the intervention group, Meglio’s protocol was performed. We observed and examined the control group for at least 6 months. Eventually both groups were reevaluated for the symptoms and persistence of positive specific IgE for cow milk proteins.Results: We enrolled 20 patients for oral desensitization and 13 patients were enrolled in the control group. Both groups were similar with regard to the mean age, sex and clinical symptoms. In 18 (90%) of the intervention subjects, oral desensitization with cow’s milk was successfully performed. The entire protocol was completed by 14 (70%) of the intervention subjects. At the end of the six-month observation period, all the patients in the control group were still symptomatic after ingestion of cow’s milk. The levels of specific IgE for cow’s milk in the intervention group decreased significantly, which was not observed in the control group.Conclusion: We successfully desensitized 90% of our CMPA patients. Considering that all the patients in the control group remained symptomatic after the period of observation and our promising results in oral desensitization with cow’s milk, we can safely propose this protocol as a hopeful alternative in the treatment of CMPA. We speculate that oral desensitization to cow’s milk does not alter the natural outcome of CMPA, but substantially increases the threshold dose necessary to elicit allergic symptoms.

Background: Vulvovaginal candidiasis, the most common type of vaginitis, is usually caused by Candidia albicans. Patients experience a variety of symptoms. There are many types of vulvovaginal candidiasis with various microbial causes, symptoms, host circumstances, recurrence rates, and responses to treatment. The purpose of this study was to find the best method of treatment of complicated vaginitis as determined by its high prevalence, varying symptoms and signs and patient complaints.Methods: In this open clinical trial without placebo control, we studied all patients aged 18 to 65 years, suffering from vaginitis symptoms that presented at the gynecological clinic of Arash Hospital, Tehran, Iran, during the year 2004. After obtaining informed consent, we assessed the response to a treatment of single 150 mg dose of fluconazole in one group, and sequential 150 mg doses of fluconazole in the other. The analysis was performed using SPSS statistical software (version 11).Results: With regard to symptom severity, no significant difference was found between the groups. The rate of excoriation and fissure formation demonstrated significant difference between the two groups (p=0.048). Assessment of clinical and mycological response proved that patients with severe vaginitis treated with sequential doses of fluconazole had a better general status than those in the other group. The difference between the severity of vaginitis and positive response to the treatment in culture was not significant among patients with recurrent vaginitis.Conclusion: Patients with mild to moderate recurrent vaginitis show better response to treatment. The high rate of positive culture on day 35 reconfirms the limitation of fluconazole and other azoles as fungistatic drugs.

Background: Bone marrow transplantation (BMT) is the treatment of choice for many patients with malignant and nonmalignant diseases. Long-term complications such as osteoporosis should be considered, because it is directly associated with the morbidity and mortality. The purpose of this study is to assess the bone mineral density after allogenic or autologous bone marrow transplantation in patients with leukemia or lymphoma.Methods: We prospectively investigated 63 patients undergoing BMT for acute and chronic leukemia and lymphoma. At the end of the study, a total of 28 patients were assessed. Bone mineral density (BMD) was measured prior BMT, and 6 and 12 months after BMT. Osteocalcin, bone alkaline phosphatase and C-terminal telopeptides of type 1 collagen (ICTP) were assessed. Serum concentration of calcium, phosphorous, vitamin D, PTH and sex hormones (FSH, LH, testosterone and estradiol) were also measured.Results: There was a significant decrease in the bone mineral density of the femoral neck six months after BMT (p<0.001), 1.01±0.13g/cm² prior to BMT and 0.96±0.13 g/cm² at six months, but no considerable changes were seen in lumbar vertebrae. Bone loss between the 6th and 12th months was not observed. The levels of ICTP and phosphorus increased significantly by the 12th month (p=0.04). The level of calcium was higher at the 6th month (p=0.002) but the level of vitamin D and PTH decreased by the end of the study (p=0.04 and p=0.01, respectively) and the average of osteocalcin did not increase significantly. In women, the level of estradiol decreased by the 6th month (p=0.01), but the testosterone changes were not significant.Conclusion: The risk of bone loss in both allogeneic and autologous BMT is higher in the femoral neck than the lumbar vertebrae, occurring mainly in the first six months after BMT. Preventive and clinical procedures should be considered.

Background: Septic arthritis in neonates can be difficult to diagnose and may be associated with severe morbidity and even mortality. A majority of apparent septic arthritis cases may have a negative culture, thereby creating a dilemma regarding treatment. The present study investigates demographic, laboratory and clinical variables of septic arthritis in neonates hospitalized over a period of 17 years.Methods: The medical files of all neonates hospitalized in Imam Khomeini and Vali-e- Asr Hospitals in Tehran, Iran, from 1989 to 2005 were assessed and the files of 59 neonates with a diagnosis of septic arthritis were further evaluated. Variables such as age, sex, gestational age, birth weight, history of hospitalization, body temperature, involved joints, blood and joint fluid cultures, ESR, CRP, and WBC count were evaluated in this group of hospitalized patients.Results: Of the 59 neonates, 39 cases were male and 20 cases were female. At the time of hospitalization, 45.8% of the neonates were 20-28 days old and 52.2% were 10-20 days old, and 67.7% and 35.6% of cases had been preterm and had low birth weight, respectively.Histories of hospital admission were found for 30.5% of patients. The two most common joints involved were hip (30.5%) and knee (23.72%). The mean body temperature was 36.6oC. ESR was elevated in all patients (mean 85 mm/h) and CRP was positive in all cases. The WBC count was >15,000/mm3 in 39% of the neonates and was in the range of 10,000-15,000/mm3 for 47.4%. Blood and joint fluid cultures were positive in 51% and 91.5% of cases, respectively. The organisms isolated from joint fluid culture were Klebsiella (54%), S. aureus (37%) and E. coli (9%).Conclusion: Due to the rarity of septic arthritis in neonates and paucity of signs and symptoms, all neonates with a high index of suspicion should be examined carefully with septic arthritis in mind.

Background: Vaginal vault prolapsed is a significant longer-term complication in patients undergoing hysterectomy. An important cause is generally acknowledged to be weakness in the uterosacral and cardinal ligaments. Vaginal delivery is known to be a risk factor, and obesity and menopause are predisposing factors. Urogynecologists are constantly looking for simple, safe and effective ways to cure vaginal apex prolapsed. Infracoccygeal sacropexy, also known as posterior intravaginal slingplasty, is a useful and less-invasive procedure, with low morbidity. The aim of this study is to confirm the efficacy, safety and long-term outcome of infracoccygeal sacropexy for the treatment of vault prolapse.Methods: In a prospective observational study, we performed infracoccygeal sacropexy to treat 26 patients who had at least grade 3 symptomatic vault prolapse secondary to transvaginal hysterectomy. Data collection included anatomic outcome, and intra- and post-operative complications.Results: The mean patient age was 67 years. The mean operation time was 30 minutes and mean blood loss was 130 ml. No intraoperative rectal perforation was seen, and all patients were discharged within 24 hours of surgery. The symptomatic cure of prolapse rate, urgency, nocturia and pelvic pain was 96.2%, 88.8%, 92.6% and 77% orderly. Only one tape rejection occurred in one of the 26 patients.Conclusion: Our initial experience with infracoccygeal sacropexy shows an efficacy similar to other more established surgical techniques for the cure of vault prolapse, but with less surgical morbidity. Therefore, the procedure is found to be efficient and safe, with shorter operation times, reduced postoperative complication and shorter hospital convalescence.

Background: Rapid tissue growth and development during puberty increases the need for energy and nutrients. On the other hand, the prevalence of obesity is accelerating among adolescents. Controversies exist regarding meal frequency, obesity and adequacy of nutrients; in particular, a more frequent snacking pattern has been associated with overconsumption of calories in children and adolescents and also with greater body weight. We investigated the meal frequency of adolescents in relation to meeting nutrient requirements.Methods: This cross-sectional study, in the framework of the Tehran Lipid and Glucose Study (TLGS), included 367 boys and girls aged 10-19 years that were randomly selected. Dietary recalls for 48 hours were gathered and participants divided to three groups according to meal frequency; group 1, 2 and 3 with <4 meals, 4-6 meals and  ³ 7 meals, respectively. The nutrient intakes were compared with the dietary reference intake (DRI).ANCOVA, Bonferroni and partial correlation by adjusting total energy intake were used for statistical analyses.Results: The mean age of these 169 boys and 198 girls was 14±3 years old. The weight of the first group was higher by one-third in boys (54±18 vs. 45±13 kilogram, p<0.05). There were no other significant differences in anthropometric indices of the studied subjects, nor was there any difference in the vegetable and meat intake between the groups. But the first group had lower intake of fruits and milk groups (p<0.01). Individuals in all three groups had inadequate intake of calcium, zinc, copper, magnesium, pyridoxine compared with the DRI, although the vitamin C and riboflavin intakes were adequate. Higher meal frequency was associated with sufficient intake of magnesium, vitamin C, riboflavin and pyridoxine.Conclusion: Adolescents tend to have inadequate intakes of calcium, pyridoxine, zinc, copper, all of which are essential for health and proper growth. Increasing the number of meals per day, without increasing energy intake could help to boost the quality of the diet.

Background: Propofol and Thiopental are intravenous anesthetics having relatively different hemodynamic influences and adverse effects. In addition, there is significant pain on intravenous injection of propofol. This study was performed to examine the effects of Propofol-Thiopental admixture on hemodynamic variables, pain on injection and hypnotic dose at the time of induction of general anesthesia.Methods: One hundred and twenty-five ASA I or II patients scheduled for elective surgery were randomized into four groups for induction of anesthesia in a double-blinded manner. With an original concentration of Propofol of 1% and that of Thiopental of 2.5%, we used these drugs in each group as follows: group P100: Propofol alone; group P75: ¾ Propofol and ¼ thiopental (volume/volume); group P50: ½ Propofol and ½ thiopental; group T100: Thiopental alone (control group). Hemodynamic variables (before and after induction), score of pain on injection and hypnotic doses were recorded and statistically analyzed.Results: Admixture of Thiopental and Propofol reduces the injection pain of Propofol, as admixtures P75 and P50 were significantly less painful on injection than P100. Induction of hypnosis was significantly more rapid in group T100 than in groups P100 and P75. The interaction of Propofol and Thiopental with regard to their hypnotic effect is additive.Therefore a reduction in the dose of one was compensated by proportional increase in the dose of the other drug for a hypnotic effect. After anesthesia induction, systolic and diastolic blood pressures were significantly lower in group P100 than in groups P75, P50 and T100. The heart rate after laryngoscopy and tracheal intubation was significantly lower in group P100 than in groups P50 and T100.Conclusion: Propofol-Thiopental admixture causes minimal pain on injection for intravenous induction of anesthesia with modified hemodynamic effects in comparison with each drug when used separately.

Background: Dialysis access procedures and complications are important causes of morbidity and hospitalization for chronic hemodialysis patients. Ideally, any patient undergoing hemodialysis should receive an autogenous fistula that can be accessed throughout the patient's life. In patients with primarily unsuitable or secondarily surgically-exhausted veins, a prosthetic graft can be performed. Several recently published studies report the outcome of prosthetic grafts. The conclusions of these studies differ dramatically. The aim of this prospective study was to determine the patency, infection and thrombosis rates using Poly-tetrafluoroethylene (PTFE) in grafts for vascular access in hemodialysis patients.Methods: During this three-year prospective study, 84 patients underwent placement of vascular access graft at the Vascular Surgery Department of Sina Trauma and Surgery Research Center in Tehran. Demographics, complications, and subsequent treatment were recorded. Primary patency rates were estimated using the Kaplan-Meier method. Logrank tests were used to evaluate the statistical differences in survival distribution.Results: The mean patient age was 55 years (±12 years). Hypertension, diabetes and smoking were considered to be risk factors for atherosclerosis in 45, 26 and 19 cases, respectively. The patients were followed up for at least 24 months. The primary patency rates were 78%, 63.3% and 54.9% at 6, 12 and 18 months, respectively. There were 39 (46.4%) access failures, which were related to infection in five cases (6%), thrombosis in 30 cases (35.7%) and bleeding in two cases (2.4%). The patency rate in patients without hypertension and with hypertension were 62.2% and 29.7%, respectively (P<0.03). Patency rates for upper extremity and lower extremity grafts were 60% and 26%, respectively (P<0.05).Conclusion: A PTFE vascular graft seems to be an appropriate vascular_access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, good care and educating patients can further decrease the rate of complication and morbidity, thereby resulting in a better patency rate.

Background: Laparoscopic hernioplasty is a standard technique with increasing interest of patients and surgeons. Bilateral hernioplasty can be performed by laparoscopy as well. The aim of this study is to show laparoscopic bilateral hernioplasty is an acceptable method and use of eye-shaped mesh getting the best result.Methods: In 54 cases with bilateral inguinal hernia, under general anesthesia laparoscopic reconstruction with eye-shaped prolene mesh performed. All cases of recurrent, big, direct, indirect and femoral hernia were entered in the study.Results: Seven of 54 cases were female. Four cases (male) had direct hernia, four female had femoral hernia and remaining of the study group had indirect form. Direct hernia 4 case (male), femoral hernia 4 (female) and remaining were indirect hernia. Operation performed without any complications in all cases. In 12 cases sac of hernia was too much enlarged so technique of bridge at the base of sac used. In five cases diameter of defect was more than 2 centimeter. In three of them defect repaired by suture before mesh insertion. Postoperative complications were seroma at distal of mesh in 23 cases (absorbed during 3 weeks spontaneously), reaction to mesh in one case (mesh and protack removed after 3 months of operation. Conservative management was ineffective and anterior repair performed), recurrence in one case (after 2 months of operation due to displacement of mesh in big direct hernia). Post operative hospital stay was 1.3 day (mean time). Painless movement and mobilization was obvious after 48 hours.Conclusion: Laparoscopic bilateral hernioplasty using eye-shaped prolene mesh is an acceptable method with good results especially in indirect hernia. In direct hernia, repair of defect by suturing and fixation of mesh is preferred.

Background: Tonsillectomy is the second most common pediatric surgery. Despite improvements in anesthetic and surgical technique, post-tonsillectomy pain continues to be a significant clinical concern for the patient, family, and physician. Young patients undergoing tonsillectomy experience postoperative pain and vomiting resulting in delays in oral feeding and in discharge from the hospital. Reduction of these side effects will lead to the improved quality of postoperative care. This study was performed to compare the efficacies of local Bupivacaine and intravenous Dexamethasone with that of a placebo on post-tonsillectomy pain and vomiting.Methods: This clinical trial included 120 ASA I children, aged 3-15 years, undergoing tonsillectomy. The patients were randomly categorized into three groups: 1- local infiltration of 2 ml normal saline into the tonsillar pillar as a placebo; 2- IV Dexamethasone (0.5 mg/kg, with a maximum of 16 mg); 3- local infiltration of 2 ml 0.5% Bupivacaine into the tonsillar pillar. After the operation, patients were observed regarding vomiting and pain at 0.5, 4, 24, 120 hours postextubation.Results: Of 120 patients, 70 were male and 50 were female. The mean age of patients was 8.4 years. Three patients were missed in follow up. The questionnaire was completed for 117 patients. The mean duration of operation was longest in the placebo group (55 minutes) and shortest in Dexamethasone group (50 minutes). We noticed significant reduction in postoperative pain only in the Bupivacaine group and at the fourth postoperative hour. In the Dexamethasone group, during the first 24 hours, we could not statistically analyze the effect on vomiting. Since Bupivacaine and Dexamethasone reduce postoperative pain and vomiting, respectively, and are safe, cost-effective and available, we recommend using these drugs for tonsillectomy patients.Conclusion: Considering the greater efficacy of Dexamethasone in the reduction of vomiting and that of Bupivacaine in pain reduction in other studies, we recommend further study to assess the use of these two drugs together.

Background: Cardiovascular problems including arterial hypertension, coronary artery diseases, congestive heart failure are prevalent among chronic hemodialyzed patients Ultrafiltration of hemodialyzed patient's serum, which culminating in intravascular volume reduction, is frequently used during hemodialysis. One of the restrictions of the echocardiographic evaluation of the diastolic heart function is the intravascular volume dependency of some echocardiographic parameters. In this study we have evaluated the volume dependency of certain echocardiography parameters in chronically hemodialyzed patients.Methods: Thirteen patients undergoing chronic hemodialysis in Ghaem Hospital Hemodialysis Center in Mashhad, Iran, were evaluated one hour before and immediately after hemodialysis for the following: all diastolic echocardiographic parameters, left ventricular function, left ventricular systolic function, inferior vena cava (IVC) diameter and IVC collapsibility with inspiration, and systolic and diastolic blood pressure. The echocardiographic parameters were analyzed using the paired Student’s t-test. Results: With hemodialysis, there was no significant change in left ventricular function, A wave amplitude and E/F slope, however, there was a significant reduction of the E wave amplitude, increment in E wave deceleration time (p= 0.001, t=-4.14) and a decrease in the E/A ratio (p=0.03, t=2.46). Tissue Doppler echocardiography showed no significant change in mitral annular diastolic motion, E'/A' waves, with hemodialysis (p=0.728, t= -0.356), although there was a reduction of the E/E' ratio.Conclusion: Tissue Doppler imaging and color M-mode echocardiographic parameters are independent of the intravascular value status. With no change associated with hemodialysis, these parameters can be used as reliable criteria for evaluating ventricular diastolic function even when the volume status varies.

Background: Multiple sclerosis is the most common demyelinating disease of central nervous system. We prepared this study to find its epidemiologic pattern in the Iranian society.Methods: This case-series study involved 70 patients diagnosed with multiple sclerosis according to the McDonald criteria and admitted to the Iranian Center of Neurological Research at Imam Khomeini Hospital from 2002 to 2004. Informed consent was obtained prior to patients completing a questionnaire, which included age, gender, age of onset of clinical symptoms, home location, familial history, education level, smoking habits and the season during which the disease occurred, was exacerbated or relapsed. SPSS 11 statistical software was used to analyze the data.Results: The mean age of the patients was 32.6 years. Approximately one-third of our patients were male, 92.9% resided in urban areas, 14.3% had an academic education, and 14.3% were cigarette smokers. The average age of onset of disease was 27.55±10.42 years, and 8.6% had positive a familial history for multiple sclerosis. The symptoms most commonly started in the spring (31.4%).Conclusion: The alternation of temperature and sunlight may be one reason for the high incidence of multiple sclerosis in spring and autumn. It seems that multiple sclerosis epidemiologic patterns in Iran are the same as those of other countries. Thus, applying the common diagnostic and treatment methods in used in other countries may raise our patients' quality of life.

Background: Dental amalgam, a mixture of approximately 50% mercury with silver, tin, zinc and copper in varying ratios, is a major source of mercury pollution in the general population not occupationally exposed. The toxicity of mercury is enhanced because it is so readily absorbed, with around 90-100% of mercury vapor being absorbed through the oral mucosa. The aim of the current study is to examine the mercury levels in hair and nails in subjects with amalgam fillings.Methods: For a sample of forty university students reporting infrequent fish consumption, with their only known exposure to mercury from amalgam fillings, mercury levels were measured in hair and nail samples using the LECO AMA 254 Advanced Mercury Analyzer (USA), according to the ASTM standard No. D-6722 test method.Results: Mercury concentration in hair ranged from 0.09 to 3.11 mg/kg, and in nail from zero to 1.35 mg/kg. We found that subjects with five or more amalgam fillings had significantly higher levels in their hair than subjects with zero to 5 amalgam fillings (CI 95% P=0.003). However, the number of amalgam fillings had no effect on the mercury concentration in nails in these two groups (P=0.26). There was no significant difference between the levels of mercury of males and that of females tested (P=0.26 for nail and P=0.15 for hair).Conclusion: The mercury amount in hair was 1.5 times as much as that of the nail samples, may be due to the differences in the chemical compounds, particularly those with sulfur, or the deposition of those compounds that would be affected by blood circulation during formation of hair and nails. Although the amounts of mercury found in this study were below the WHO maximum acceptable level of 6 mg/kg for mercury in human hair, the levels were sufficient to warrant the use of other dental materials such as composites in order to decrease the overall rate of exposure to mercury.

Background: Pigmented villonodular synovitis is a tumor that arises from the synovial membrane of the joint or tendon sheaths. Two main forms include a diffuse form that involves the whole synovial lining of a joint, bursa, or tendon sheath, and a less common localized form. The diffuse form typically involves the large joints, while the localized one typically occurs around the small joints of the hands and feet. Usually involving the knee joint, the occurrence of pigmented villonodular synovitis in the foot, especially in the metatarsophalangeal joint of the great toe, is very rare, and is therefore often mistaken for other foot pathologies. Although it seems histopathologically benign, it has a known tendency to recur after surgery.Case report: Here, we report a 42 year old woman who had experienced pain in the right great toe for 1.5 years. She was treated conservatively with shoe modification and NonSteroidal Anti-Inflammatory Drugs, and two injections of Corticosteroid.Results: The failure of long-term conservative therapy and the bony erosion revealed in her radiograph led us to surgically excise the lesion of the first metatarsophalangeal joint. Histopathological examination revealed the diagnosis of pigmented villonodular synovitis. For the 18 months following surgery, she had no complaint except minimal pain in her toe after activity. No sign of recurrence was observed either clinically or radiologically.Conclusion: We conclude that pigmented villonodular synovitis should be noted in the differential diagnosis of chronic monoarticular synovitis in order to provide an earlier diagnosis and more effective treatment.