Anthracosis, a Distinct Cause of Vocal Fold Paralysis: Case Series.

Vocal fold paralysis (VFP) can happen in various conditions due to mediastinal LADs, however no study has proposed anthracosis as an etiology. Here we discussed the chest CT features of anthracosis related LADs causing VFP. Among 41 cases of pulmonary anthracosis, 10 had VFP that all were presented with hoarseness. The paralysis was unilateral (left side) in all cases. Extra-nodal infiltration and conglomeration of lymph nodes were significantly higher in patients with paralysis. Left paratracheal, pre-vascular, and aortopulmonary window lymph nodes were seen in all patients. We propose that mediastinal LADs secondary to anthracosis could be a reason for left side VFP.

Comparison of endovascular coiling and surgical clipping for the treatment of intracranial aneurysms: A prospective study.

BACKGROUND: Management of intracranial aneurysms has made debates about the best treatment modality in recent years. The aim of this study was to compare the interventional outcomes between two groups of patients, one treated with endovascular coiling and the other treated with surgical clipping. METHODS: This prospective study included 48 patients with intracranial aneurysms who underwent endovascular coiling (27 patients) or surgical clipping (21 patients) from July 2011 to August 2013. A neurologist examined patients in admission and followed them by phone call 1-year after intervention. RESULTS: Mean modified Rankin Scale (MRS) score at the time of admission in endovascular group was 2.86 ± 0.974 whereas it was 3.81 ± 1.078 in surgical clipping group (P = 0.0040). Focal neurologic signs were higher in clipping during procedures (P = 0.0310). Of 37 patients who followed up for a year, 19 were in endovascular group and 18 in surgical clipping group. At 1 year follow-up, MRS improvement was statistically significant in coiling group (P = 0.0090), but not in clipping group (P = 0.8750). Mean difference of MRS score at the time of admission and at one year later, was 0.947 ± 1.224 in endovascular group and 0.111 ± 2.083 in surgical group (P = 0.3000). CONCLUSION: There was no statistically significant difference at 1 year outcome between two groups. We recommend further interventional studies with larger sample sizes for better evaluation of the modalities.

Mechanical thrombectomy for cerebral venous sinus thrombosis: a comprehensive literature review.

BACKGROUND: Endovascular treatment of cerebral venous sinus thrombosis (CVST) includes pharmacological and mechanical thrombolysis. METHODS: The authors searched the English literature on CVST from 1990 to 2012 for all case reports or case series of mechanical thrombectomy. RESULTS: A total of 64 patients were treated in all published studies. The techniques for mechanical thrombectomy included rheolytic thrombectomy with an AngioJet device (46.9%), clot retraction with the Penumbra system (4.7%), clot retraction with a Fogarty catheter (1.6%), clot retraction with a microsnare (3.1%), balloon venoplasty without stenting (18.7%), balloon venoplasty with stenting (4.7%), and an amalgam of techniques (18.7%). Nine (16.1%) patients died. At the most recent follow-up, 40 (62.5%) patients had no disability or minor disability and 7 (10.9%) patients had major disability. CONCLUSION: Randomized multiinstitutional clinical trials with larger number of participants are needed to sufficiently compare the effect of intrasinus thrombolysis and mechanical thrombectomy to standard-of-care anticoagulation therapy.

Age-related frontal hyperactivation observed across different working memory tasks: an fMRI study.

PURPOSE: To evaluate patterns of activation, convergence and divergence of three functional magnetic resonance imaging (fMRI) Working Memory (WM) tasks in two different age groups. We want to understand potential impact of task and subjects' age on WM activations as well as most important areas with regard to WM functions. MATERIALS AND METHODS: Thirty-five healthy volunteers completed visual, verbal, and novel auditory WM tasks. The subjects were selected from age extremes to depict possible impact of normal aging. The General Linear Model was used to report significant activations and the effect of age group. Contrasts revealed differences in activation between tasks, and Combined Task Analysis was performed to determine common regions of activation across tasks. RESULTS: Most of the observed differences between the tasks were seen in areas that were responsible for feature processing. Frontal regions were mainstay activation areas, regardless of the utilized stimulus. We found an age-related reduction in activity of visual (in visually-presented tasks) and auditory (in auditory task) cortices but an age-related increase in prefrontal cortex for all tasks. CONCLUSION: Regardless of the type of the task stimuli, frontal regions are the most important activation areas in WM processing. These areas are also main targets of age-related changes with regard to activation patterns. Our results also indicate that prefrontal overactivity in working memory might be a compensatory effort to mask age-related decline in sensory processing.

Developing optimized fMRI protocol for clinical use: comparison of different language paradigms.

PURPOSE: To compare the potential of five functional magnetic resonance imaging (fMRI) language paradigms in activating language areas in Persian-speaking volunteers in order to optimize these tasks for clinically useful protocol. MATERIALS AND METHODS: 16 healthy right-handed Persian-speaking volunteers were studied. Each individual performed five tasks during the fMRI scan: word generation (WG), object naming (ON), word reading (WR), word production (WP), and reverse word reading (RWR). The ability of each task to activate classical language areas was assessed using group analysis. In addition, the lateralization index (LI) for each subject-task was calculated and compared. RESULTS: We found that WP, RWR, and WG robustly activated language-related areas in the dominant hemisphere. ON and WR failed to sufficiently delineate these activation areas. Highest activation intensities in the frontal lobe (including Broca's area) were seen with WP, whereas RWR showed the highest LI among all examined tasks. CONCLUSION: Our results demonstrated that the Persian version of WG and newly presented WP and RWR tasks can be reliably used for localization of language-related areas in Persian speakers. This type of language evaluation may be used in presurgical planning of neurosurgical procedures in the Persian population. We recommend application of WP and RWR in future researches establishing the optimized protocol for other language speakers.

Noninvasive temperature estimation using sonographic digital images.

OBJECTIVE: The purpose of this study was to develop and evaluate a speckle-tracking method for tissue temperature estimation due to heating fields using digital sonographic images. METHODS: The temperature change estimation method is based on the thermal dependence of the ultrasound speed and the thermal expansion of the medium. Local changes in the speed of sound due to changes in the temperature produce apparent displacement of the scatterers, and the expansion introduces physical displacement. In our study, a new technique has been introduced in which the axial physical displacements were obtained from digital sonographic images. The axial speckle pattern displacement was determined with a cross-correlation algorithm. The displacement data were then used for computing the temperature changes. To monitor the temperature in real time, the computational time was decreased by restricting the search region in the cross-correlation algorithm and carrying out the cross-correlation function in the frequency domain via a fast Fourier transform algorithm. RESULTS: Experiments were performed on tissue-mimicking phantoms. The imaging probe was a commercial linear array working at 10 MHz. In addition, the temperature changes during heating were measured invasively by negative temperature coefficient thermistors. There was good agreement between ultrasonic temperature estimations and invasive temperature measurements. CONCLUSIONS: The proposed method verifies the capability of the speckle-tracking algorithm for determining both the magnitude and direction of displacement. The average error was 0.2 degrees C; the maximum error was 0.53 degrees C; and the SD was 0.19 degrees C. Therefore, the proposed algorithm is capable of extracting the temperature information from sonographic digital images.