A Young Case with Endolymphatic Sac Tumors Presented with Right-sided Hearing Loss and Facial Hemi-paralysis

Background: Endolymphatic sac tumors (ELSTs) are uncommon low-grade, locally invasive epithelial tumor that originates from the endolymphatic sac of the inner ear and temporal bone. It is a rare event with less than 300 cases worldwide. In this article, we present a case of ELTS who presented with facial asymmetry and hearing loss. In this article, we present a case of ELTS who presented with facial asymmetry and hearing loss.                    Case presentation: A 15-year-old female was admitted to our hospital with right-sided facial hemiplegia and hearing loss in her right ear which was started and progressed within two years. Except for facial hemiparalysis, other physical examinations were normal. In her audiological investigations, severe hearing loss of her right ear was evident. Imaging studies were indicative of ELSTs. This diagnosis was confirmed by histopathological investigations. Discussion: ELST is an aggressive papillary tumor that arises from the endolymphatic sac. In most cases, this tumor presents as a solitary growth. It usually presents with hearing loss but can be associated with other symptoms like tinnitus, vertigo and nerve VII paralysis. Imaging studies play a crucial role in the diagnosis of ELST, as it can reveal a characteristic soft-tissue mass involving the temporal bone, with bony erosion and extension into adjacent structures. Surgery is considered as the main form of treatment for ELSTs. Conclusion: ELSTs are exceedingly rare events. Here we presented a case of ESLT with right facial hemiplegia and right ear deafness

Surgical Protocol and Outcome of 60 Cases With Intracranial Aneurysm

Background and Aim: This study aimed to present the results of early and delayed operation on patients with ruptured brain aneurysms. In addition to comparing the results and rates of morbidity and mortality in the surgical procedure and identifying the effective factors, this study aimed to provide methods to improve the treatment of brain aneurysm. Methods and Materials/Patients: This was a retrospective study on 60 patients with a definitive diagnosis of brain aneurysm admitted to Neurosurgery Ward of Poursina Hospital, Rasht, Iran from 2009 to 2013.  Results: 7(11.7%) patients on the first 3 days and 37(61.7%) patients on the days 4-14 and 16(26.7%) after 2 weeks and selectively underwent surgery. In total, 11.7% of patients died and 15% developed severe complications. In the group underwent surgery on the first 3 days, 2(28.5%) patients died and 2 experienced severe complications. In the second group (in 4-14 days), 4(10.8%) patients died and 5(13.5%) suffered from severe complications, and in the group (16 patients) with delayed surgeries, 1(6.2%) patient died and 2(12.5%) suffered from severe complications. Neurological grading and operation time were important factors in complications and mortality of patients. Conclusion: This study showed that Hunt and Hess neurological grading score has a direct relationship with increased morbidity and mortality rates, while delayed operation is associated with a reduction in morbidity and mortality. Given the complications of early aneurysm surgery (during the first 3 days) compared with delayed surgery, and also most of these patients die due to vasospasm or recurrent hemorrhage before the onset of a delayed phase, performing early surgery in these patients requires further evaluation. According to this study, the reduction of each episode of occlusion with temporary clipping will result in fewer complications

Evaluation of Personal Shields Used in Selected Radiology Departments

Introduction The purpose of this study was to evaluate personal shields in radiation departments of hospitals affiliated to Mashhad University of Medical Sciences. Materials and Methods First, the information related to 109 personal shields was recorded and evaluated by imaging equipment. Afterwards, the equivalent lead thickness (ELT) of 62 personal shields was assessed, using dosimeter and standard lead layers at 100 kVp. Results In this study, 109 personal shields were assessed in terms of tears, holes and cracks. The results showed that 18 shields were damaged. Moreover, ELT was evaluated in 62 shields. As the results indicated, ELT was unacceptable in 8 personal shields and lower than expected in 9 shields. Conclusion According to the results, 16.5% of personal shields had defects (tears, holes and cracks) and 13% of them were unacceptable in terms of ELT and needed to be replaced. Therefore, regular quality control of personal shields and evaluation of new shields are necessary at any radiation department

Evaluation of Personal Shields Used in Selected Radiology Departments

Introduction The purpose of this study was to evaluate personal shields in radiation departments of hospitals affiliated to Mashhad University of Medical Sciences. Materials and Methods First, the information related to 109 personal shields was recorded and evaluated by imaging equipment. Afterwards, the equivalent lead thickness (ELT) of 62 personal shields was assessed, using dosimeter and standard lead layers at 100 kVp. Results In this study, 109 personal shields were assessed in terms of tears, holes and cracks. The results showed that 18 shields were damaged. Moreover, ELT was evaluated in 62 shields. As the results indicated, ELT was unacceptable in 8 personal shields and lower than expected in 9 shields. Conclusion According to the results, 16.5% of personal shields had defects (tears, holes and cracks) and 13% of them were unacceptable in terms of ELT and needed to be replaced. Therefore, regular quality control of personal shields and evaluation of new shields are necessary at any radiation department

Simulation of a Quality Control Jaszczak Phantom with SIMIND Monte Carlo and Adding the Phantom as an Accessory to the Program

Introduction Quality control is an important phenomenon in nuclear medicine imaging. A Jaszczak SPECT Phantom provides consistent performance information for any SPECT or PET system. This article describes the simulation of a Jaszczak phantom and creating an executable phantom file for comparing assessment of SPECT cameras using SIMIND Monte Carlo simulation program which is well-established for SPECT. Materials and Methods The simulation was based on a Deluxe model of Jaszczak Phantom with defined geometry. Quality control tests were provided together with initial imaging example and suggested use for the assessment of parameters such as spatial resolution, limits of lesion detection, and contrast comparing with a Siemens E.Cam SPECT system. Results The phantom simulation was verified by matching tomographic spatial resolution, image contrast, and also uniformity compared with the experiment SPECT of the phantom from filtered backprojection reconstructed images of the spheres and rods. The calculated contrasts of the rods were 0.774, 0.627, 0.575, 0.372, 0.191, and 0.132 for an experiment with the rods diameters of 31.8, 25.4, 19.1, 15.9, 12.7, and 9.5 mm, respectively. The calculated contrasts of simulated rods were 0.661, 0.527, 0.487, 0.400, 0.23, and 0.2 for cold rods and also 0.92, 0.91, 0.88, 0.81, 0.76, and 0.56 for hot rods. Reconstructed spatial tomographic resolution of both experiment and simulated SPECTs of the phantom obtained about 9.5 mm. An executable phantom file and an input phantom file were created for the SIMIND Monte Carlo program. Conclusion This phantom may be used for simulated SPECT systems and would be ideal for verification of the simulated systems with real ones by comparing the results of quality control and image evaluation. It is also envisaged that this phantom could be used with a range of radionuclide doses in simulation situations such as cold, hot, and background uptakes for the assessment of detection characteristics when a new similar clinical SPECT procedure is being simulated

Optimization of Parameters in 16-slice CT-‌‌scan Protocols for Reduction of the Absorbed Dose

Introduction In computed tomography (CT) technology, an optimal radiation dose can be achieved via changing radiation parameters such as mA, pitch factor, rotation time and tube voltage (kVp) for diagnostic images. Materials and Methods In this study, the brain, abdomen, and thorax scaning was performed using Toshiba 16-slice scannerand standard AAPM and CTDI phantoms. AAPM phantom was used for the measurement of image-related parameters and CTDI phantom was utilized for the calculation of absorbed dose to patients. Imaging parameters including mA (50-400 mA), pitch factor (1 and 1.5) and rotation time (range of 0.5, 0.75, 1, 1.5 and 2 seconds) were considered as independent variables. The brain, abdomen and chest imaging was performed multi-slice and spiral modes. Changes in image quality parameters including contrast resolution (CR) and spatial resolution (SR) in each condition were measured and determined by MATLAB software. Results After normalizing data by plotting the full width at half maximum (FWHM) of point spread function (PSF) in each condition, it was observed that image quality was not noticeably affected by each cases. Therefore, in brain scan, the lowest patient dose was in 150 mA and rotation time of 1.5 seconds. Based on results of scanning of the abdomen and chest, the lowest patient dose was obtained by 100 mA and pitch factors of 1 and 1.5. Conclusion It was found that images with acceptable quality and reliable detection ability could be obtained using smaller doses of radiation, compared to protocols commonly used by operators

The Evaluation of Perioperative Safety of Local Anesthesia with Lidocaine Containing Epinephrine in Patients with Ischemic Heart Disease

The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study.  All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2±10.4, 74.8.±14.4 kg and 164.5± 8 cm respectively. Twelve patients (37.5%) were diagnosed with systemic hypertension and 10 patients with diabetes (31.2%). The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable (P=0.044). The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes

Cerebellar repetitive transcranial magnetic stimulation (rTMS) for essential tremor: A double-blind, sham-controlled, crossover, add-on clinical trial

BACKGROUND:There is controversial evidence about the effect of cerebellar low-frequency stimulation in patients with essential tremor (ET). OBJECTIVES:In this study we assessed safety and effectiveness of 1 Hz (low-frequency) cerebellar repetitive transcranial magnetic stimulation (rTMS) on tremor severity in patients with essential tremor in a sham-controlled crossover trial. METHODS:A total of 23 patients assigned into two groups to receive either sham (n = 10) or rTMS (n = 13) treatment, with crossing over after a two-month washout period. Intervention consisted of 900 pulses of 1 Hz rTMS at 90% resting motor threshold or the same protocol of sham stimulation over each cerebellar hemisphere for 5 consecutive days. Tremor severity was assessed by Fahn-Tolosa-Marin (FTM) scale at baseline and at days 5, 12 and 30 after intervention. The FTM consists of 3 subscales including tremor severity rating, performance of motor tasks, and functional disability. Carry-over and treatment effects were analyzed using independent samples t-test. RESULTS:There was no significant improvement in the total FTM scores in rTMS compared to the sham stimulation on day 5 (p = 0.132), day 12 (p = 0.574), or day 30 (p = 0.382). Similarly, FTM subscales, including tremor severity rating, motor tasks, and functional disability did not improve significantly after rTMS treatment. Mild headache and local pain were the most frequent adverse events. CONCLUSION:Although cerebellar rTMS seems to have acceptable safety when used in ET patients, this study could not prove any efficacy for it in reduction of tremor in these patients. Larger studies are needed to evaluate efficacy of this therapeutic intervention and to provide evidence about the optimal stimulation parameters