amir kamalifar

Ancient schwannoma is one of the rarest subtypes of typical schwannoma, and just two cases of codaequina involvement with this tumor have been reported so far. This type of tumor has large areas without cells (Antony B) and a small part of pericellular areas (Antony A), which in the case of typical schwannoma, it is opposite. The pathological form of this tumor indicates the slow growth of the soft consistency and the benign course of these types of tumors.

Traumatic brain injury (TBI) is one of the causes of death wherein thyroid hormone concentrations are abnormally altered. This study aimed to assess thyroid function tests and the effect of levothyroxine on TBI and its outcome.

In this randomized clinical trial study, the TBI group Levothyroxine (50 mg) was administered twice daily for three days; the control group received a placebo in a similar pattern. The serum levels of T3, T4, and TSH were evaluated in 100 TBI patients on days 1 and 7. A questionnaire related to Disability was assessed using both Disability Rating Scale (DRS) and Glasgow Outcome Scale (GOS) scores. The obtained data were analyzed by SPSS version 20.

The mean levels of T3 and TSH in both groups were not significantly different. T4 levels of the patients receiving levothyroxine were significantly higher than the control group. The mean DRS scores at the time of discharge were lower in the levothyroxine group compared to the placebo group.

Our results showed that levothyroxine is effective in improving patients suffering moderate head trauma. Furthermore, the T4 serum level can be used as a prognostic factor in these patients.

Pituitary adenoma (PA) is a frequent intracranial lesion, that needs surgical evacuation. In this study, we  evaluated the surgical outcome of PA treated via endoscopic and microscopic  trans-sphenoidal approach

In this retrospective cross-sectional study, we evaluate ten years of PA surgery experience  in the northwest of Iran. 721 patients underwent trans sphenoidal surgery of PA. Complication of the surgery, extension of tumors resection, demographic and clinical findings (gender, age , tumor type ,..) were reviewed in this study. SPSS version 25 and statistical tests including chi square and T-test were used. P-value ˂0.5 was considered as statistically significant.

483 males (58.9%) and 336 females (41.02%) were included in this study. Mean age of patients was 47.3±1.96 years.The most common initial complaints were deterioration of vision (n=528, 64.4%) and headache (n=343, 41.88%), followed by accelerated development (n=254, 31.01%), amenorrhea and galactorrhea (n=253, 30.8%). 57 (6.95%) patients had symptoms of Cushing’s disease. 105 (12.8%) patients had acromegaly. TR was achieved in 87.5% of cases and sub-TR in 103 (12.5%) cases and no patient had a partial or insufficient resection. After surgery, the endocrine function was normalized in 76 (31.7%) patients who had preoperative hyper hormonal levels. 36 (4.3%) patients developed postoperative CSF leakage; of which, 4 (0.48 %) patients did not improve by lumbar drainage and other conservative treatments  and needed reoperation for reconstruction of the skull base.

The combination of microscopic and endoscopic trans-sphenoidal approach in PA surgery can be lead to total resection of tumors.

L5 Sacralization is normal variation in lumbar anatomy, but many authors believed this condition because of concentration of pressure in L4/ L5 level can speed up degenerative process (disk degeneration or listhesis…). However no study was compare spondylolisthesis radiological parameters in patient with and without sacralization of L5, our purpose is evaluation of radiological parameters in spondylolistesisL4/L5 in patient with and without L5 sacralization.

In cross sectional study we divided 78 patient with spondylolisthesis of L4/L5 in two group with (n=24) and without (n=54) L5 sacralization and evaluated facet osteoarthritis, degree of listhesis (%), disk degeneration, and facet orientation in two group and result was compared,

There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02±6.21 versus 16.65±4.87, p=0.809), facet orientation (54.99±12.18 versus 56.23±4.35, p=0.642), facet osteoarthritis (3.43±0.59 versus 3.53±0.37, p=0.527), or disc degeneration (4.50±0.51 versus 4.35±0.61, p=0.340) between the two groups

There is no significant relation between radiological parameters in two group and we thought influence of L5 sacralization on degenerative process of L4/L5 less significant than previously expected, but future study with large number of patient need to clarify the role of fixed L5 on degenerative process in lumbar spine.

Intraoperative spinal cord and nerve root monitoring is used to identify an insult to the neural elements with the goal of preventing injury,beacause of high rate of neurological deficit in spinal surgery, the use of intraoprative neuromonitoring can detect the iatrogenic neural deficit  in surgery and help the surgeon to review the operation. We introduced the 51 years old women with a cervical cord meningioma to be operated under intraoprative neuromonitoring.

Neuroblastoma is a nervous system malignancy. The extension of intra-abdominal neuroblastoma to the spinal canal is a rare condition. In this case report, we present a patient with monoplegia and a huge intra-abdominal mass with intra spinal extension and cord compression.

Secondary complications management of Subarachnoid Hemorrhage (SAH) is one of the therapeutic challenging issues during Intensive Care Unite (ICU) admission. The complications of patients with SAH admitted to the ICU of Imam Khomeini Hospital of Urumia were investigated in this study. Methods and Materials/Patients: In this descriptive study, the clinical complications of the patients with SAH admitted to ICU including anemia, fever, hyperglycemia, hypertension, electrolyte imbalance, and cardiac arrhythmia were collected from their medical records within a 7-year period. The collected data were analyzed using Chi-squared test and t-test by SPSS.  In total, 483 records of patients with SAH were explored. Moreover, 183 (37.9%) samples had anemia, 174 (36%) suffered from fever, 204 (42.2%) patients were diagnosed with hypertension. A total of 111 (23%) patients had hyperglycemia, 54 (11.2%) individuals suffered from sodium disorders. Additionally, 131 (27.1%) individuals had cardiac arrhythmias. The obtained results suggested that the most prevalent complications following SAH are hypertension, anemia and fever. Furthermore, there was a significant correlation between cardiac arrhythmias, as well as sodium and hyperglycemia disorders, and the treatment outcome of patients. Patients admitted to ICU should be under intensive care to reduce the mortality rate associated with SAH.

Spontaneous Spinal Epidural Hematoma (SSEH) is a rare spinal condition. Early surgical intervention is generally indicated to prevent serious permanent neurological deficits. We encountered a case of spontaneous spinal epidural hematomas associated with motor weakness that was treated successfully by surgical evacuation.

The aim of this study was to evaluate the incidence of aberrant phenotypes and possible prognostic value in peripheral and bone marrow blood mononuclear cells of Iranian patients with AML. 56 cases of de novo AML (2010-2012) diagnosed by using an acute panel of monoclonal antibodies by multiparametric flowcytometry. Immunophenotyping was done on fresh bone marrow aspirate and/or peripheral blood samples using the acute panel of MoAbs is stained with Phycoerythrin (PE) /fluorescein isothiocyanate (FITC), Allophycocyanin (APC) and Peridinin-chlorophyll protein complex (perCP). We investigated Co-expression of lymphoid-associated markers CD2, CD3, CD7, CD 10, CD19, CD20 and CD22 in myeloblasts. Out of the 56 cases, 32 (57.1%) showed AP. CD7 was positive in 72.7% of cases in M1 and 28.5% in M2 but M3 and M4 cases lacked this marker. We detected CD2 in 58.35 of M1cases, 21.40% of M2 cases, 33.3 of M3 and 20% of M5; but M4 patients lacked this marker. The CBC analysis demonstrated a wide range of haemoglobin concentration, Platelet and WBC count which varied from normal to anaemia, thrombocytopenia to thrombocytosis and leukopenia to hyper leukocytosis. Our findings showed that CD7 and CD2 were the most common aberrant marker in Iranian patients with AML. However, we are not find any significant correlation between aberrant phenotype changing and MRD in our population. Taken together, this findings help to provide new insights in to the investigation of other aberrant phenotypes that may play roles in diagnosis and therapeutic of AML.

Depending on the response to standard steroid therapy، nephrotic syndrome it is classified to steroid-sensitive and steroid-resistant nephrotic syndrome (SRNS). Mutations in several genes including NPHS2 have been implicated in SRNS. Gene R229Q polymorphism (p. R229Q) of NPHS2 is associated with adolescent- or adult-onset SRNS in European and South American populations. We investigated this polymorphism among a group of Iranian-Azeri patients with primary SRNS. All participants had the primary late-onset form of focalsegmental glomerulosclerosis (FSGS) and their clinical feature was steroid unresponsiveness. They were compared with a group of age- and sex-matched individuals without any renal disease for NPHS2 gene as controls. The R229Q polymorphism (p. R229Q) was investigated in the case and control groups. A total of 25 patients (mean age، 26. 6 ± 8. 0 years) with primary FSGS and 35 controls (mean age، 26. 0 ± 8. 7 years) were studied. Serum creatinine of patients and their 24-hour protein excretion at the time of study were 2. 4 ± 1. 94 mg/dL and 2830 ± 981 mg/dL، respectively. Molecular study showed no p. R229Q polymorphism، neither in patients nor in controls. In this preliminary study، we showed that NPHS2 gene p. R229Q polymorphism does not present in Iranian-Azeri population with SRNS. Larger studies are needed to confirm our results and other mutated genes should also be considered in these patients.