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1.
J Med Imaging Radiat Sci ; 51(4): 689-693, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32888857

RESUMO

INTRODUCTION: Ependymomas represent approximately 2%-8% of all primary intracranial brain tumors. The occurrence of extra-axial posterior fossa ependymomas in adults is rare. CASE AND OUTCOMES: We report a case of extra-axial cerebellopontine (CP) angle ependymoma in an adult patient, managed through gross total resection (GTR) and adjuvant radiotherapy. At her one-year postoperative visit, the patient remained clinically stable without any symptoms or focal neurological deficit and a follow up MRI showed no evidence of tumor recurrence. DISCUSSION: Only six cases of adult cerebellopontine angle ependymomas have been reported in the English literature, with the left side affected more commonly. Including this case, the mean age of the reported cases of adult extra-axial CP angle ependymoma is 44.14 years (range 22-66 years). Men accounted for five out of seven cases (71.4%). Maximal surgical resection is the mainstay of treatment in extra-axial CP angle ependymomas. Among seven reported cases, five received GTR and two had subtotal resection (STR). Patients were followed an average of 13.6 months (range 2-30 months) and only two patients with STR died during the follow-up period (6 weeks and 2 months after surgery). Six of the seven reported cases (including this one) received adjuvant radiotherapy. CONCLUSION: Although rare, extra-axial CP angle ependymomas should be considered as a differential diagnosis to other lesions of the CPA. Radical resection, whenever possible, is usually associated with a good outcome. Adjuvant radiotherapy remains an optional treatment with an unknown impact on overall and progression-free survival.


Assuntos
Neoplasias Cerebelares/radioterapia , Neoplasias Cerebelares/cirurgia , Ângulo Cerebelopontino/efeitos da radiação , Ângulo Cerebelopontino/cirurgia , Ependimoma/radioterapia , Ependimoma/cirurgia , Adulto , Neoplasias Cerebelares/diagnóstico por imagem , Ângulo Cerebelopontino/diagnóstico por imagem , Cisterna Magna/diagnóstico por imagem , Cisterna Magna/efeitos da radiação , Cisterna Magna/cirurgia , Diagnóstico Diferencial , Ependimoma/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Radioterapia Adjuvante , Resultado do Tratamento
2.
Surg Neurol Int ; 11: 49, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32257575

RESUMO

BACKGROUND: Electrocardiography (ECG) changes after subarachnoid hemorrhage (SAH) are well described. However, concurrent myocardial infarction (MI) and SAH are rarely reported, and its management remains a dilemma. We report a patient with traumatic SAH concurrent with acute MI that managed successfully by endovascular intervention and dual antiplatelet therapy. CASE DESCRIPTION: A 47-year-old man was admitted to the emergency department with a complaint of severe headache. Diffuse SAH, with a Hunt and Hess score of 5, was noticed. ECG showed ST elevation in anterior leads, and cardiac troponin became positive. On brain computed tomography angiogram, a 6 mm anterior communicating artery aneurysm was seen. Considering the possibility of MI and SAH simultaneously, endovascular obliteration of the aneurysm was done, and then, the patient received dual antiplatelet medications until coronary angiography was done. Coronary angiography revealed normal epicardial coronary arteries. The patient was discharged with a Glasgow Coma Scale score of 15 and was visited 2 months after discharge without any new episodes of intracranial hemorrhage with a modified Rankin scale score of 2. CONCLUSION: Cerebral aneurysm coiling could be considered as the first choice of treatment in the case of acute MI with hemodynamic stability, before carrying out cardiac endovascular intervention or antiplatelet medication to reduce the risk of rebleeding from a brain aneurysm.

3.
Bull Emerg Trauma ; 7(4): 416-419, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31858006

RESUMO

Sheno-occipital diastasis happens more frequently in children and is accompanied with neural and vascular injuries leading to a high rate of mortality. We present a rare type of clival fracture in a 21 years old man who could survive without any deficit even though the fracture extended widely from left Asterion to the right orbit accompanied by widespread damage of the skull base air sinuses in 3D CT scan. To the best knowledge of the authors, neither this type of fracture, nor the clinical presentation, has been reported in relevant literature.

4.
Asian J Neurosurg ; 13(3): 754-759, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30283539

RESUMO

BACKGROUND AND OBJECTIVES: Stabbing the head is a rare event. It may occur following an assault or self-inflicted injury. We intend to report our experience with four such cases and review narratively the relevant literature. A treatment algorithm will be delivered. MATERIALS AND METHODS: We have reviewed four of our cases; three were stabbed to the orbit and one to the head. RESULTS: Enucleation was performed in one case. Vision could be preserved in the other two and brain abscess developed in the other cases due to a retained piece of knife. We made a comparison between our cases and those limited reports in the literature to reach an algorithm. CONCLUSION: The temporal region and the orbit are the targets mostly attacked in the craniofacial stabs. Since knives have a sharp and thin edge, they may break when penetrating the skull. The damage to the brain tissue and the retained piece of knife may be missed easily by overlooking the small injury to the scalp. The suggested algorithm would be a contrast-enhanced computed tomography scan of the skull and brain and a kind of brain vascular study are necessary, considering the location of the knife in the skull and brain passing the area with crowded vasculature. The best treatment protocol is surgery accompanied by antibiotic therapy.

5.
Avicenna J Phytomed ; 8(1): 43-50, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29387573

RESUMO

OBJECTIVES: A correlation between hyperhomocysteinemia, and depression has been reported. Saffron (Crocus sativus) is recommended for treatment of depression; hence, in this study the effect of co-administration of saffron and fluoxetine on plasma homocysteine and depression was evaluated. MATERIAL AND METHODS: This was a 4-week randomized and double-blind clinical trial which was conducted from March 2013 to February 2014. In this trial, 40 male and females (20-55 years old) diagnosed with severe depression were selected and following filing the Beck form, were randomly divided into two groups. Experimental group was treated with fluoxetine 20 mg/day and saffron 30 mg /day and the control group received placebo and fluoxetine 20 mg/day for four weeks. Before treatment and at the end of the study, fasting blood samples were collected. For females, blood samples were collected on the third day of their menstrual cycle. RESULTS: A significant reduction of homocysteine levels was observed in both sex in the experimental group compared to before treatment (p<0.04), while no such significant change was observed in the control group. A Beck questionnaire value showed lower level in both groups on the last day of treatment as compared to before treatment. There was no significant difference between the two groups in Beck value neither before nor after treatment. CONCLUSION: Saffron has beneficial effects on depression and homocysteine level in patients with major depression.

6.
J Stroke Cerebrovasc Dis ; 27(6): e89-e91, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29370979

RESUMO

Abnormal elongation of styloid process (Eagle syndrome) may cause compression of the adjacent structures in the neck, the most important of which is the carotid artery. This condition may cause damage to the wall of carotid artery and result in cerebrovascular ischemic event. Bilateral carotid artery damage and cerebral stroke because of overgrown styloid processes at both sides is a rare condition. In this article, we report a case of bilateral ischemic stroke because of carotid compression by elongated styloid process at both sides treated by surgical resection of both processes.


Assuntos
Isquemia Encefálica/etiologia , Doenças das Artérias Carótidas/complicações , Ossificação Heterotópica/complicações , Acidente Vascular Cerebral/etiologia , Osso Temporal/anormalidades , Adulto , Isquemia Encefálica/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Lateralidade Funcional , Humanos , Masculino , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia
8.
Breast Cancer ; 24(6): 742-747, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28382590

RESUMO

BACKGROUND: Breast cancer is the leading type of cancer in Iranian women and affects them at least one decade younger than their counterparts in developed countries. Breast tumor progression and metastasis is accompanied by a decrease in the membranous expression of Syndecan-1 and an increase in its shedding. We measured the level of soluble Syndecan-1 in the sera of Iranian patients with breast cancer. METHODS: The study population included 61 chemotherapy-naïve breast cancer patients and 30 age/sex-matched healthy individuals. Blood was collected by venipuncture method and serum was separated, aliquoted and kept at -40 °C until used. A commercial ELISA was used to detect Syndecan-1 levels in the sera. RESULTS: Soluble Syndecan-1 levels were increased in the sera of patients with breast cancer compared to healthy controls (87.89 ± 89.29 vs. 47.57 ± 46.46 ng/ml, p = 0.005). There was a positive correlation between soluble Syndecan-1 levels and tumor size (p = 0.017). The serum level of Syndecan-1 in patients without calcification showed a trend of increase compared to that of patients with calcification (108.80 ± 101.76 vs. 59.82 ± 57.13 ng/ml). CONCLUSION: The positive correlation between soluble Syndecan-1 levels and tumor size in the present study highlights the importance of different varieties (cell-bound and soluble) of this molecule in the breast tumor progression and their significance as tumor biomarkers.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias da Mama/sangue , Neoplasias da Mama/patologia , Sindecana-1/sangue , Adulto , Idoso , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Carga Tumoral
9.
Iran J Allergy Asthma Immunol ; 15(4): 317-327, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27921413

RESUMO

Allergic rhinitis is one of the most common health problems with a major effect on the quality of life. We intended to treat Allergic Rhinitis (AR) in patients who are either unresponsive to antihistamines or their job requires optimal alertness that may be disturbed by antihistamine's side effects and those who do not comply with the regular use. We tried short term phototherapy and evaluated its effect on AR. As phototherapy is effective in the treatment of atopic dermatitis (AD) and the same allergens can produce both AD and AR, phototherapy is proposed as a new tool in the AR treatment. In AD, phototherapy causes induction of apoptosis in infiltrating T cells and other immunomodulatory effects. We performed a randomized single-blind study to investigate the effect of low-dose phototherapy in AR patients. Among AR patients who did not respond to local and systemic therapy, we chose 62 allergic patients all above 25 years of age with moderate to severe AR whose disease was verified by allergy skin test or specific IgE to allergens; then, they were randomly divided into 31 patients as treatment group and 31 patients as control group. In treatment groups, we used a mixture of UVA, UVB and visible light. In the control group, we used visible light alone as placebo. Then we evaluated the level of response to treatment in two groups and compared them according to Total Nasal Symptom scores (TNSS) and Global Severity Scores (GSS) and Rhinoconjunctivitis Quality of Life Questionnaires (RQLQ) symptom scores. We found out that phototherapy in the treatment group in comparison with placebo was effective in treatment of AR (p-value <0.001). However, we recommend that for substantiation of the claim, further investigations are still required.


Assuntos
Resistência a Medicamentos/efeitos da radiação , Rinite Alérgica/terapia , Raios Ultravioleta , Terapia Ultravioleta/métodos , Adulto , Dermatite Atópica/sangue , Dermatite Atópica/imunologia , Dermatite Atópica/terapia , Feminino , Humanos , Imunoglobulina E/imunologia , Masculino , Pessoa de Meia-Idade , Rinite Alérgica/sangue , Rinite Alérgica/imunologia
10.
Asian J Psychiatr ; 22: 174-6, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26611571

RESUMO

UNLABELLED: Depression is a one of the most prevalent psychiatric disorder. Despite several pharmacological treatments, still treating depression is a challenge. Herbal medicine that is better culturally accepted may play an important role in treatment of depression. In this double blind placebo controlled clinical trial, 40 patients that were suffering from major depression according to DSM-IV criteria were randomly allocated to take either fluoxetine and saffron (20 patients) or fluoxetine and placebo (20 patients). The patients of the two groups were evaluated with Beck depression scale at the beginning of the study and after four weeks. Lipid profile (total Triglyceride (TG) level, total cholesterol level, low density lipoprotein (LDL) level and high density lipoprotein (HDL) level) of the patients also was measured at the beginning and end of the trial. 30 patients (19 in saffron group and 11 in placebo group) completed the study. The two groups improved significantly in depression severity at the end of the study without significant difference (P: 0.560). The lipid profile of the two groups did not change significantly. Our study did not demonstrate antidepressive effects for saffron. We did not observe any lipid lowering effect in saffron group too. Of note is that our study is preliminary and larger studies with more patients and longer duration are needed to prove our results. CLINICAL TRIAL REGISTRATION NUMBER: IRCT 2013110915334.


Assuntos
Crocus , Transtorno Depressivo Maior/sangue , Transtorno Depressivo Maior/tratamento farmacológico , Extratos Vegetais/farmacologia , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Adolescente , Adulto , Método Duplo-Cego , Feminino , Fluoxetina/administração & dosagem , Fluoxetina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagem , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Resultado do Tratamento , Adulto Jovem
11.
Emerg (Tehran) ; 2(4): 170-3, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-26495375

RESUMO

INTRODUCTION: rauma has been recognized as one of the leading causes of death in many countries for decades. Reduction in mortality and morbidity rate of trauma cases is one of the most important attitudes in this field. Evaluation of different risk factors have been considered as the main goal of some studies. The purpose of this study was determining potential risk factors of death in trauma patients. METHOD: In a retrograde study, data of 740 patients admitted during three years (2009-2011) were studied. Demographic data (sex and age), clinical factors (blood pressure, pulse rate, respiratory rate, Glasgow coma scale (GCS)), trauma characteristics (location, type of injury, etc.), as well as outcome of patients were evaluated. Data analyses was done using SPSS 18.0. Stepwise multivariate regression analysis was used for recognition of independent predictive factors of death in multiple trauma patients. RESULTS: Of those admitted, majority of patients were male (81.4%), 68% between 18 to 60 years, and 11.2% of them died during the course of treatment. Age; type of trauma; abnormal respiration rate, pulse rate, blood pressure; total GCS ≤8; abnormal pupil size; and head and neck; vertebral, and extremities fractures were obtained as significant predictive factor of death. GCS≤8, head and neck fracture, and abnormal pulse rate were independent death predictors. CONCLUSION: We identified GCS≤8, head and neck fracture, and abnormal pulse rate as predictive factors of mortality after trauma, which remained independent in the presence of all other factors and potentially treatable.

12.
Bull Emerg Trauma ; 2(3): 133-5, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27162883

RESUMO

Burkitt lymphoma of stomach is among the most rapidly growing gastric cancersassociated with several gasterointestinal  symptoms  including  hematemesis,  anorexia,  vomiting  and  etc. Gastric perforation  in patients with Burkitt lymphoma of stomach is a very rare condition especially after chemotherapy. We herein present a 21-year old man who was kwon case of gastric Burkitt lymphoma who had undergone chemotherapy and presented with acute onset gastric pain and tenderness. He was diagnosed to suffer from perforated gastric lymphoma for which laparotomy and total gastrectomy was performed. Treatment was continued by chemotherapy. Closed observation is thus recommended for those patients with gastric Burkitt lymphoma undergoing chemotherapy.

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