Transcranial Focused Ultrasound in Functional Neurosurgery for Essential Tremor and Parkinson’s Disease: A Review Article

PURPOSE: Transcranial magnetic resonance guided focused ultrasound (MRgFUS) is a new development in the field of functional neurosurgery. A comprehensive review of the current literature was performed to evaluate of transcranial MRgFUS in treatment of essential tremor (ET) and Parkinson’s disease.METHODS: Articles available in electronic databases of PubMed, and Web of Science, as of July 2016 were reviewed. The strategy included a combination of key words 'MRgFUS', 'tremor', 'Parkinson', 'brain', ' head ', 'tumor', 'transcranial' and 'focused ultrasound' in the title and abstract of the manuscripts. In addition transcranial MRgFUS systems and cost-effectiveness of treatment were assessed. Finally, the major findings are summarized.RESULTS: Fifty-eight articles met the inclusion criteria for review. Among these, 15 studies eligible for inclusion in this review. The synthesis of the data demonstrated that, transcranial MRgFUS have been successfully used for treatment of essential tremor and Parkinson’s disease. Lesions were created under real-time MRI guidance, with peak temperatures of between 52° C and 63° C. Adverse events during transcranial MRgFUS reported such as headache, dizziness, vertigo, lip paresthesia, and hypogeusia. However, there were no significant treatment-related complications or side effects. At present, one of the limitations of transcranial MRgFUS is high price of treatment. However, continued advances in technology can be expected to further refine the high price market of transcranial MRgFUS.CONCLUSION: The findings showed that essential tremor and Parkinson’s disease can be effectively treated with transcranial MRgFUS method. Long-term clinical data are forthcoming

Accuracy and complications of pedicle screw insertion for lumbar and thoracolumbar fractures

 Background: The accuracy of pedicle screw placement is essential for lumbar and thoracolumbar spine fracture fixation.Purpose: The aim of the present study was to assess the accuracy of the pedicle screw placement with conventional C-arm fuoroscopy-guided in these patients.Methods: A retrospective review identified patients who underwent operative management with thoracolumbar instruments at our hospital between June 2012 and August 2013. Clinical data were acquired from medical records and final screw positions were graded based on a classification of Gertzbein and Robbins.Results: A total of 216 pedicle screws in 52 patients (34 males, mean age 32.6±5.8 years) were evaluated. They were instrumented with transpedicular posterior fixation technique within 72 hours. The follow-up time was 6.1 months (ranging from 1 to 14 months). The screws were graded A (n=43 [19.9%]), B (n=89 [41.2%]), C (n=62 [28.7%]), D (n=21 [9.7%]), and E (n=1 [0.5%]). One of the screws was revised on the second day after surgery due to screw malposition.Conclusion: Based on existing facilities, the findings showed that the pedicle instrumentation screws with transpedicular posterior fixation technique in patients with lumbar and thoracolumbar fractures can be done with acceptable complication rate. However, more advanced equipment as CT navigation (O-arm) is recommended for higher accuracy

Outcomes of Phosphorus-32 Intracavitary Irradiation for Craniopharyngiomas: A Review of The Literature

Purpose: To review on outcomes of Phosphorus-32 (32P) intracavitary irradiation for Craniopharyngiomas.Methods: A literature review of all full publications in English biomedical journals (1981-2014) was performed. The search strategy included a combination of key words “phosphorus-32”, “craniopharyngioma”, “intracystic treatment”, “brain”, “cyst”, “tumor”, “brachytherapy”, “intracavitary irradiation”, “isotope” in the title and abstract of the manuscripts using the PubMed. The major findings were summarized, with a focus on outcome as visual acuity, complications, cyst volume, and irradiation dose delivered to the cyst wall in Gy. Finally, the future of 32P intracavitary irradiation for Craniopharyngiomas was explored.Results: A total of 25 citations were identified and screened. In all, 19 citations were eligible for inclusion. The synthesis of the data showed several benefits and adverse events for 32P intracavitary. Overall benefits included improvements in visual, endocrinological, and neurological outcomes, while adverse effects included complications such as III palsy and diabetes insipidus.Conclusion: In general 32P intracavitary irradiation was found to be a reasonable option in treatment of highly selected patients with newly diagnosed or recurrent cystic craniopharyngioma. This approach can be expected to overcome some limitations introduced by other approaches with a relatively low complication rates

Data analysis and the relationship between doctors and patients with type-2 diabetes in the treatment process

Background & Objective: Doctor-patient relationship plays an important role in adherence of patients to treatment instructions. This study tries to examine the relationship between physicians and patients with type 2 diabetes in the treatment process by the grounded theory. Materials and Methods: Eleven physicians and 9 diabetic patients in both sexes were selected from among all type 2 diabetic patients referred to physicians' offices in Shahid Beheshti University of Medical Sciences and Health Services. A semi-designed interview was used to gather information. Results: The factor influencing the physician's lived experiences in dealing with the patient and the patient's lived experiences in dealing with the physician was named as the "physician-patient discourse" factor. This factor included 9 categories in 2 central codes "physician-centered" and "patient-centered" in the physician's lived experiences with the patient and 4 categories in 2 central codes "awareness" and "confidence-building" in the patient's lived experiences in dealing with the physician. Conclusion: A discourse in which the physician allocates adequate time to efficiently convey training and information, and to take a complete history of the patient, and to establish an effective, friendly, and respectful relationship ultimately lead to the patient's trust. These factors can persuade the patient to adherence to the prescribed treatment

Validation of the Iranian Version of the ECOS-16 Questionnaire in Patients with Osteoporotic Vertebral Fractures

Study DesignProspective clinical study.PurposeTo translate and validate the Quality of Life Questionnaire of the European Foundation for Osteoporosis (ECOS-16) in patients with osteoporotic vertebral fractures in Iran.Overview of LiteratureIt is important to assess the psychometric properties of instruments measuring patient-reported outcomes.MethodsThe translation was performed using the backward-forward translation method. The final version was generated by consensus among the translators. Every woman who had a T-score of 0.70 for all scales. Test-retest reliability as indicated by intraclass correlation coefficient was found to be 0.85 (0.68–0.91). Additionally, the correlation of each item with its hypothesized domain of the ECOS-16 showed acceptable results, suggesting that the items had a substantial relationship with their own domains. Further analysis also indicated that the questionnaire was responsive to change (effect size, 0.85; standardized response mean, 0.93) (p<0.001). Significant correlations existed between scores of similar subscales of ECOS-16 and SF-36 (p<0.001).ConclusionsECOS-16 is an acceptable, reliable, valid, and responsive measure to assess the quality of life in patients with osteoporotic vertebral fractures

The role of routine transanastomotic T tube ostomy in jejunoilealatresia:A prospective, randomized study

Introduction: Jejunoileal atresia (JIA) is a common cause of neonatal intestinal obstruction and is a common surgical emergency. The aim of this study was to compare primary anastomosis without resection of the dilated segment with transanastomotic T tube jejunostomy (TATTO) versus resection of the dilated segment without T tube as the control group for treatment of patients with JIA.Material and Methods: During 2008 to 2013, 105 patients were diagnosed with JIA at the time of surgery and were recruited for this study. Data relating to efficacy and procedural complications were compared among patients. The criteria for exclusion were duodenal obstruction, colonic atresia, intestinal perforation, malrotation, and also JIA patients with associated other anomalies like meconium ileous, gastroschisis and anorectal malformation.Results: A total of 125 patients were diagnosed and 16 patients were excluded. Our patients were divided into a control group (n=52) and a TATTO group (n=57). The TATTO group had a significantly shorter postoperative hospital stay (12 vs. 23 days, p=0.001) and time to start feeding (9 vs. 13 days, p=0.003) compared with the control group. Sepsis (12.0% vs. 32.7% p=0.004), other complications (3.6% vs. 15.4% p=0.001) and the associated morbidity were significantly lower in the TATTO group.Conclusion: The findings suggest that the TATTO technique was a better method for the treatment of children with JIA, as study showed lesser morbidity and mortality rates.

Preliminary Results of Relationship between Preoperative Walking Ability and Magnetic Resonance Imaging Morphology in Patients with Lumbar Canal Stenosis: Comparison between Trefoil and Triangle Types of Spinal Stenosis

Study DesignCross-sectional.PurposeTo examine the relationship between magnetic resonance imaging (MRI) morphology stenosis grades and preoperative walking ability in patients with lumbar canal stenosis (LCS).Overview of LiteratureNo previous study has analyzed the correlation between MRI morphology stenosis grades and walking ability in patients with LCS.MethodsThis prospective study included 98 consecutive patients with LCS who were candidates for surgery. Using features identified in T2-weighted axial magnetic, stenosis type was determined at the maximal stenosis level, and only trefoil and triangle stenosis grade types were considered because of sufficient sample size. Intraobserver and interobserver reliability were assessed by calculating weighted kappa coefficients. Symptom severity was evaluated via the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Walking ability was assessed using the Self-Paced Walking Test (SPWT) and JOABPEQ subscales. Demographic characteristics, SPWT scores, and JOABPEQ scores were compared between patients with trefoil and triangle stenosis types.ResultsThe mean patient age was 58.1 (standard deviation, 8.4) years. The kappa values of the MRI morphology stenosis grade types showed a perfect agreement between the stenosis grade types. The trefoil group (n=53) and triangle group (n=45) showed similar preoperative JOABPEQ subscale scores (e.g., low back pain, lumbar function, and mental health) and were not significantly different in age, BMI, duration of symptoms, or lumbar stenosis levels (all p>0.05); however, trefoil stenosis grade type was associated with a decreased walking ability according to the SPWT and JOABPEQ subscale scores.ConclusionsThese findings suggest preoperative walking ability is more profoundly affected in patients with trefoil type stenosis than in those with triangle type stenosis

Rheumatoid Arthritis Flare-ups Following Immunization with Sinopharm Inactivated Virus-based COVID-19 Vaccine

Introduction: This study aimed to investigate the incidence of rheumatoid arthritis (RA) flare-ups following immunization with the Sinopharm COVID-19 inactivated virus-based vaccine. Methods: We conducted a retrospective observational study at the Rheumatology Clinic of Imam Hossein Hospital, incorporating 200 RA patients in remission undergoing non-biologic Disease-Modifying Antirheumatic Drugs (DMARDs) treatments. A rheumatologist confirmed a flare-up based on patients complain of arthralgia and joint stiffness and complete examination of joints over a three-month period following vaccination. Results: Twelve percent of all included patients experienced symptom recurrence. The average age of patients with flare-ups was significantly higher, but no gender-based differences were observed (p&lt;0.001 and p=0.071, respectively). The second vaccine dose resulted in a higher number of symptom flares compared to the first dose (9.30% vs. 3.0%, p &lt; 0.001). No significant differences were observed between patients experiencing flare-ups after the first dose and the second dose in terms of the number of involved joints (p=0.321) and the time gap from vaccination to symptom recurrence (p=0.526). No patients required hospitalization, and prednisolone dosage adjustments effectively managed symptoms. Conclusion: The occurrence of flare-ups was relatively low after the Sinopharm COVID-19 vaccination in RA patients undergoing treatment with DMARDs during remission. The majority of these flares were mild and no hospitalizations were required