فهرست مطالب mohammad reza shahmohammadi

Blood product transfusion is a double-edged sword; it can be lifesaving in many circumstances, yet life-threatening serious complications may occur. Although transfusion-related reactions have decreased over the years as a result of hemovigilance networks all over the world, human errors still remain an important concern. In this case report, we describe a patient undergoing elective spinal surgery who received an incompatible blood product. Then we will describe measures to mitigate such errors.

 Accompaniment of meningioma with other tumors especially cerebral tumors is quite rare. In some institutes, cases of simultaneous meningioma and glioma are seen and reported previously.

 We reported a meningioma with the accompaniment of scalp basal cell carcinoma (BCC) with no signs and symptoms of Gorlin syndrome and no history of radiation.

 Expression of some adjacent cancerous lesions might have a local cancerous induction effect.

Vestibular schwannoma (VS) is an extra-axial, benign tumor mostly located in the cerebellopontine angle. The goal of VS surgery is gross total resection of the tumor along with preservation of the cranial nerves’ function. Intraoperative nerve monitoring is mainly rewarding in VS surgery.

This Cohort study was done retrospectively and prospectively from 2011-2021. Patients were divided into two groups; group one (n=19) underwent resection of the tumor with intraoperative neuromonitoring and group two underwent resection of the tumor without neuromonitoring based on patients’ ability to economically afford neuromonitoring. In the neuromonitoring group, Somatosensory Evoked Potential (SSEP) was evaluated and recorded throughout the whole surgery. Motor Evoked Potential (MEP) was recorded at regular intervals as well. We compared tumor size, hemorrhage volume during surgery, length of surgery, and facial nerve preservation (HB score), with one-year follow-up.

Facial nerve (FN) anatomical preservation rates were 100% and 75% in the neuromonitoring and control groups, respectively. The Gross Total Resection (GTR) rate in group one was 78.9%. The Subtotal Resection (STR) and Partial Resection (PR) rates in procedures without neuromonitoring were 50.0% and 12.5%, respectively. The House-Brackman (HB) level was good in all patients in group one, while 68.8% of patients in the control group had poor HB.

Intraoperative Neuromonitoring (IONM) in VS surgery helps increase anatomical nerve preservation rate and FN outcome. The coordination of a anatomically trained neurophysiologist along with real-time video-assisted nerve monitoring avoids and lowers any delay in nerve recognition.

The lifestyle and learning of trainees from different surgical specialties have been severely affectedby the COVID-19 pandemic. Despite the growing body of research, the extent to which their surgical or educa-tional performance is affected is not yet well-understood. We investigated the Iranian multi-specialty surgicalresidents nationwide to clarify the extent this new pandemic’s has affected their surgical and educational activ-ities.

Our specialized board designed a questionnaire which was sent to residents fromthe 18th of May to 12th of Jun 2020. The questionnaire comprised demographic data, questions on the clinical,surgical, and educational activities during and before the pandemic.

Out of 700 eligible residents, 543(77%) submitted their answers to all questions. 417 (76.8%) of the respondents declared they had spent theirresidency program at a hospital that was the main referral center for patients with COVID-19 infection. Theweekly number of the outpatient and emergent visits decreased by one third (P<0.001) and one-half (P<0.001),respectively, following the pandemic. Also, the amount of surgeries has dramatically decreased (P<0.001). Themedian weekly hours devoted to face-to-face activities decreased, while the study time increased and the shareof virtual education has a five-fold increase (P<0.001).

This pandemic had a significant impact onmany aspects of training in surgical specialties’ residency program in Iran. Increasing the time available to studyis an opportunity, and online education, despite its challenges, has been effective.

Myelomeningocele is a condition caused by the disjunction of neuroectoderm and ectoderm during embryogenesis. It can lead to neuronal structure disorders such as kyphosis and scoliosis, with scoliosis being more common. Kyphosis is found in 10-15% of these patients and can cause poor clinical consequences. The annual progression of Kyphosis is approximately 8 to 12 degrees.  Kyphosis is a limiting factor in rehabilitation due to the inability of the patients to sit in wheelchairs and in the apex of the kyphotic region. This study aims to report a similar condition in a 14-year-old Iranian boy who underwent surgery for posterior kyphectomy. In the majority of cases with kyphosis, anterior wedging occurs in the vertebral body where the apex of the deformity is located. In the studied patient, the deformity had a round curve with no definite apex to mark out. These deformities need special surgical approaches and postoperative care.

Context:

 The most common type of brain tumors are gliomas, among which glioblastoma multiforme is the most life-threatening. In spite of the existing treatments, malignant gliomas often do not respond to treatment.

 The aim of this study was to investigate the antitumor activity of vitamin D3 in malignant gliomas through the study of in vitro and in vivo articles.
Data Sources: The electronic databases, including PubMed, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Central Register of Clinical Trials (last updated April 12th, 2019) were searched, using medical subject headings (MeSH) keywords “vitamin D AND brain malignancy”.

Data Extraction: 

There was no limitation on the date and language of the articles. A review of all the found articles at the level of titles and abstracts was made to find eligible articles. Our work is in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The quality of the articles was judged in accordance with the GRADE tool for in vitro studies and CIRCLEs RoB tool for in vivo studies.

 Totally, 88 articles were identified and after careful examination, 16 eligible articles meeting the inclusion criteria were selected. These studies showed that vitamin D3 and its analogs suppress self-renewal ability, cell viability and/or cell growth, migration rate, and invasive capacity; in addition, they induce autophagy and cell death. They also reduce tumor size in animal models. Evidence was mainly of moderate to high quality.

 Based on the in vitro and in vivo evidence of this systematic review, vitamin D3, compared to the control group, induced cell death and reduced cell growth, invasion, and migratory capacity in gliomas cell culture. As well as, vitamin D analogs were able to show the same effects without the hypercalcemic effect in vivo. We suggest performing future high-quality studies with the aim of shedding light on the relevant mechanisms and the effects of vitamin D3 derivatives and its analogs on health status and clinical outcomes in patients with malignant gliomas.
 

Intrathecal Fluorescein has been used widely for detection of cerebrospinal fluid (CSF) leakage. After administration of fluorescein many serious complications may happen. Pulmonary edema is one of the most serious complications that require emergency responses. In this study, we report a complicated case of pulmonary edema following Intrathecal fluorescein injection.

Secondary central nervous system lymphoma (SCNSL) is known as a rare disease. The risk factor of developing SCNSL is primary lymphoma type and site of involvement. We present a patient with an altered mental status known case of breast diffused large B-cell lymphoma (DLBCL) who underwent stereotactic biopsy because of a left periventricular mass lesion, which diagnosed as secondary brain lymphoma after pathologic typing. Because of limited data about the secondary central nervous system, lymphoma and it is a risk factor, we reported an aggressive breast DLBCL with brain involvement.

Background and There has been no report in which preoperative evaluation of ADC for prediction of post therapeutic outcome was presented. The aim of our study was to retrospectively evaluation the use of the apparent diffusion coefficient (ADC) for the prediction of malignancy and the outcome of malignant astrocytic tumors.
We reviewed MRI of 26 male and 14 female patients with a pathologic diagnosis of a malignant astrocytic tumor.
There was a relatively significant correlation between Ki-67 LI and minimum ADC was noted for the asterocitoma group (r=−0.701, P The ADC analysis could be considered as one of the clinically accessible techniques used for prediction of outcome of malignant astrocytic tumors, and it might be useful for planning primary treatment modality in patients with these malignant tumors.

A case of a 3-year-old patient with osteolytic lesion in the lumbar region is presented. The clinic-radiological suspicion was infection, primary or metastatic tumor of spine. Subsequently, a CT guided biopsy proved an eosinophilic granuloma of bone. Following medical treatment after two month, there was improvement in patient medical status.

In this article, we report a 49-year-old woman with simultaneous meningioma and astrocytoma occurrence in the same patients without radiotherapy, phacomatosis, or any genetic disorders. We aimed to define surgical management and the etiopathogenic correlations of meningioma with glioblastoma.

Coagulase-negative staphylococci (CNS) are a common cause of nosocomial infections. In recent years, an increase in the incidence of methicillin-resistant coagulase-negative staphylococci (MRCNS) has led to the severity of the disease. The aim of this study was to isolate and identify MRCNS strains by oxacillin disk agar diffusion, oxacillin agar screening, and polymerase chain reaction (PCR) and to evaluate their antibacterial resistance patterns.Patients and Totally, 122 CNS isolates were collected from the clinical specimens of four hospitals in Iran. Susceptibility testing was performed by disk agar diffusion against 15 antimicrobial agents. Then, disk agar diffusion, agar screening, and PCR were applied to determine susceptibility to oxacillin. Out of the 122 isolates, 92 isolates were found to be MRCNS by PCR. The sensitivities and specificities of disk agar diffusion and agar screening were 89.2% and 69% and 93.8% and 96.3%, respectively. Also, 93 CNS isolates were resistant to Methicillin according to disk agar diffusion. Our results indicated that agar screening was superior to oxacillin disk agar diffusion. A comparison between the antibiotic sensitivity patterns of the MRCNS and the Methicillin-Susceptible Coagulase-Negative Staphylococci (MSCNS) showed that the MRCNS were predominantly multiple-drug resistant isolates as the simultaneous resistance rate to 4 or more antibiotics in the MRCNS and MSCNS was 93% and 56%, respectively.

Cerebral aneurysms are the major cause of subarachnoid hemorrhage. Common ascribed etiologies are hemodynamic factors such as atherosclerosis, hypertension, infection, trauma, polycyctic kidney disease, connective tissue disorders like Ehlers-Danlos disease, Marfan syndrome, and familial predisposition. However, its association with ankylosing spondylitis (AS) is not clear. Here, we report 2 patients with AS who presented with subarachnoid hemorrhage which was finally confirmed to be due to cerebral aneurysms, one in posterior communicating artery and the other in basilar artery tip). The patients had no history of hypertension or any other disease. Our data may not strongly suggest that vascular changes due to AS are etiological factors for developing intracranial aneurysm, but this report may show the possibility for existence of an association between these diseases, which has to be confirmed by more genetic and pathologic studies.