limb-Girdle Muscular dystrophy (LGMD) is a rare hereditary myopathy which involves pelvic and shoulder muscles. Anesthesia management could be a challenge in these patients considering the choice of technique and potential complications in perioperative period. Since it is a rare disease, clinical trials are scarce and most of the information about anesthetic considerations obtained from case reports. Here we have a short review of the disease and the report the choice of spinal anesthesia in a 28 year old lady suffering LGMD undergoing caesarian section. There was no perioperative complication.

Retaliation is a punishment which it has been in humanity society and its first and most important property is that the guilty person is punished whit the same crime that he/she has committed. Also in Islamic punishment if someone kills or hurt another will be commanded to his retaliation. But in a case, this condition hasn,t observed, and that is the amputation of the hand of a criminal who for some reasons has no hand at all, by the complainant. If so, how the amputation of the hand punishment is done? What should we done? The jurisprudences have disagreement among themselves about this case. If so some deem the amputation of the criminal foot instead of his/her hand necessary, and some others also command to be reduced the retaliation and turned into bloodmoney. Islamic republic legislator also in article number 275 has been commanded to the limb equality necessity and in article note number of it has ordered to amputate the criminal,s foot. In this article after searche about limb retaliation and equality of the limbs, the amputation of foot instead of hand had researched. after observig two jurisprudence,s teoreis and the pros and con-proofs of criminal amputation of the foot is concluded that pros proofs failed to prove this claimer about the criminal retaliation and the necessity of his/her amputation of the foot. Then the note of article number 275 is needed to reviewing.

Phocomelia, ie the absence or severe hypoplasia of the long tubular bones with more or less intact hands and or feet, is widely known to be the most spectacular finding of thalidomide embryopathy. It may be complete in the form that proximal and distal bones of limb are absent or may be incomplete when either proximal or distal bones are missing. It is known to occur in some familial syndromes such as Roberts’s syndrome, the DK Phocomelia syndrome and in a few other extremely rare syndromes.Phocomelia syndromes are multiple malformations syndrome that includes skeletal, genitourinary such as renal agenesis, gastrointestinal system, eye abnormalties eg cloudy corneas, craniofacial abnormalities including silvery blonde hair, extensive hemangiomas and hypoplastic nasal cartilage. These syndromes include autosomal recessive form of VACTERL hydrocephaly syndrome (David-O’Callaghan syndrome), X-linked recessive form (Hunter Mac Murray) syndrome, DK-phocomelia (von Voss-Cherstvoy) syndrome and Laurin-Sandrow Syndrome (LSS).

Objective To determine the frequency of phantom limb sensation (PLS) and phantom limb pain (PLP) in children and young adults suffering landmine-related amputation.Materials & Methods All youths with amputation due to landmine explosions participated in this study. The proportions of patients with phantom limb sensation/pain, intensity and frequency of pain were reported. Chi square test was used to examine the relationship between variables. Comparison of PLP and PLS between upper and lower amputation was done by unpaired t-test.Results There were 38 male and 3 female with the mean age of 15.8±2.4yr. The mean interval between injury and follow-up was 90.7±39.6 months. Twelve (44.4%) upper limb amputees and 11 (26.8%) lower limb amputees had PLS. Nine (33.3%) upper limb amputees and 7 (17.1%) lower limb amputees experienced PLP. Of 27 upper limb amputees, 6 (14.6%) and among 15 lower limb amputees, 6 (14.6%) had both PLS and PLP. One case suffered amputation of upper and lower limbs and was experiencing PLS and PLP in both parts. PLS had a significant difference between the upper and lower amputated groups.Significant relationship was observed between age of casualty and duration of injury with PLP.Conclusion Phantom limb sensation and pain in young survivors of landmine explosions appear to be common, even years after amputation.

Objectives: This study aims to determine the prevalence of knee osteoarthritis (OA) and associated risk factors in the contralateral limb after lower limb amputation. Methods: This cross-sectional survey included 500 lower limb amputees using prostheses for at least 1 year using convenience sampling from the Pakistan Institute of Prosthetic and Orthotic Sciences (PIPOS), Peshawar City, Pakistan rehabilitation services program (PRSP) and its satellite centers across Khyber Pakhtunkhwa. A sample included either gender aged 20 to 80 years. A basic demographic sheet and risk factors questionnaire and American College of Rheumatology (ACR) guidelines diagnostic knee OA criteria, such as using history, physical examination, and radiographic findings were used to collect data. Data were analyzed using SPSS software, version 21. T-test and analysis of variance (ANOVA) statistics were utilized to observe any relationship with P<0.05 as significant.  Results: The current study revealed the prevalence of OA in 131 people (26.2%) with a higher prevalence in 86 married men (65.5%) aged 51-80 years (99[75.6%] and 99[75.6%]) with the predominance of 87 trans-tibial amputees (TTA) (66.4%). Sustained knee bending was the most prevalent risk factor in 127 people (96.9%, 31.07), followed by the history of a painful knee injury in 117 people (89.3%, 12.00), sitting on the floor for home activities in 106 people (80.9%, 8.00) and occupation with knee use in 129 people (98.5%, 7.25). Discussion: The high prevalence of 26.2% of OA in the sound limb in lower limb amputees is more common in married men aged 51-80 years with trans-tibial amputation on the contralateral side. Common risk factors include sustained knee bending, a history of a painful knee injury, sitting on the floor for home activities, and occupations with knee use.

Embolectomy has long been the gold standard for treating limbs acutely threatened by arterial occlusion. Delayed embolectomy has not been investigated adequately due to the belief that accompanying mortality and morbidity render the case futile. Following our previous experience with late arterial repair for leg or knee salvagel we applied the same principle to limbs threatened with prolonged ischemia as a result of missed emboli. In this study the response of patients with delayed embolectomy in a 2-year interval is evaluated. All of the patients who presented to Shohada Tajrish Medical Center, Tehran, Iran between 2001 to 2003 with prolonged ischemia of the lower limb (more than 12 hours) were selected for this study. All underwent embolectomy and prior to reinstitution of blood to the ischemic leg; all those with calf rigor underwent simultaneous venotomy and irrigation of the arterial tree with heparinized solution and were studied accordingly. Of the total 76 patients 20% had muscle rigor on admission who underwent simultaneous venotomy and irrigation. The limb was salvaged in 45% of patients with above knee sensory deficit and 40% of those with above knee motor deficit. The salvage rates of the limb for below knee sensory and motor deficits were 79% and 85% respectively. We were able to save the knee in 20% of our patients. The short term mortality rate in the whole was 9.2%. We had only one operative mortality in this high risk group of patients & our figures are lower than those reported in the literature, while at the same time we were able to salvage their limbs or knees.      

Introduction. limb length discrepancy is a disabling anomaly that has many causes including congential, traumatic and paralytic. This study was designed to evaluate results and complications of Wagner's technique in lower limb lenghtening.Methods. In this retrospective study results of the Wagner's technique in seventy paiteints during ten years were studied. Patients were followed for 1 to 9 years after operation with mean of 6 years. Results of operation, complications and paitients statisfaction were recorded.Results. Among the 70 paitents 71% were male and 29% were female. The average time of paitients hospitalization was 6 days for each of first and second satges. The tibial and femoral lengthening were performed in the 84% and 16% respectively. limb lengthening achieved minimally 4-5 cm and maximally 10 cm (mean=6.6cm). In 73%, the cause of discrepancy was paralytic and the other causes were traumatic and congenital anomalies. Complications rate were 47% totally. The most common complication was pin tract infection that was threated conservatively. Results of operation and satisfaction of the patients were good in 85% and fair in 15%.Discussion. The Wagner's method of limb lengthening is a safe and simple method, with low complications and we recommend it for the treatment of lower limb discrepancy yet.

The aim of the present study was to investigate the effect of upper limb exhaustive activity on corticospinal excitability and motoneuron responsiveness of lower limb. Ten active males (Age 28. 1 ± 2. 99yr, Height 1. 77 ± 4. 1 cm, Weight 75. 7 ± 4. 98) volunteered to participate in this study and visited the laboratory on three different occasions. After measuring anthropometric features and familiarization with the pull up (exhaustive task) and magnetic and electrical stimulations in the session one, in the second and third visits, motor evoked potential (MEP), cervicomedullary motor evoked potential (CMEP) and maximum direct motor response (Mmax) were assessed immediately, 10 and 20 minutes after the termination of the exhaustive protocol ( perform pull ups until exhaustion, 7 sets with 1min rest intervals), by the use of magnetic stimulation over the motor cortex and spinal routes and electrical stimulation of peripheral nerve, respectively. The results showed that MEP in the Tibialis Anterior muscle (remote muscle) significantly decreased immediately (P₌ 0. 001) and 10 minutes (P₌ 0. 001) after performing the fatiguing task compared to the resting values. Also, no significant changes in CMEP and Mmax were observed in Tibialis Anterior muscle at any time points relative to the baseline (P= 0. 5, P= 0. 07). Based on the data obtained in this study, it looks that supraspinal centers account for the spreading of fatigue from the upper limb to the lower limb. Besides, such a supraspinal fatigue needs a considerable time to be recovered.