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"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The insertion depth of tracheal tube differs based on sex, age, position of head and neck, type of surgery, and anatomical consideration. The aim of this study was to determine the airway related distances in Iranian patients with a non-invasive, and accurate method, the computerized reconstruction of High Resolution CT (HRCT); Virtual Bronchoscopy."n"n Methods: A total of 140 Iranian patients who became candidate for sinus and chest tomography, were enrolled in a cross- sectional study in Imam Khomeini Hospital Complex, Tehran, Iran, from 2006 to 2008. After reconstruction of airway related distances, Incisor- Vocal cord (IVD), Vocal cord- Carina (VCD) and Incisor- Carinal (ICD) Distances were determined."n"n Results: A total of 140 patients were evaluated, while 70(50%) were male. There was no statistically significant difference between age groups, sex and BMI in study patients. The measured IVD were 145.5±9.7 (males), 127.29±6.3 (females) and 136.43±12.29mm (total). For VCD, the distances were 131±13.99 (males), 122.59±11.7 (females), and 127.09±13.65mm (total). The measures for ICD in males, females, and total of patients were 277.17±16.63, 249.88±11.54, and 263.52±19.66mm respectively."n"n Conclusion: The insertion depth for fixation of endotracheal tube in Iranian adult patients is the same as that of anesthesia textbooks. There were no statistically significant difference between our study data and previously measured distances using invasive and less accurate methods. Virtual bronchoscopy is a noninvasive and accurate method based on reconstruction of computed tomographic images and the reconstructed images of tomography could be useful in measuring and assessment of airway anatomy.

Background: Imaging abnormalities in the paranasal sinuses are regularly noted as incidental findings on MRI, however, little is known about their prevalence in the Iranian population. The purpose of this study was to classify these findings in the paranasal sinuses as seen on MRI and to investigate the prevalence, according to site and type of paranasal abnormality. Methods: In this cross-sectional study, the T2-weighted axial MRI of 256 patients with diseases unrelated to their paranasal sinuses were reviewed between May 2002 and June 2003. The findings were categorized according to the anatomic location and the imaging characteristics of the abnormality. The abnormalities recorded included total sinus opacification, mucoperiosteal thickening >5mm, air fluid levels and retention cysts or polyps. Unilateral or bilateral involvement and septal deviation were also noted. A sinus was considered normal if it was fully aerated and no soft-tissue density was apparent within the cavity. Results: Among our cases, 111 (43.5%) were male and 145 (56.5%) were female. Of these patients, abnormalities in one or more of the sinus groups were found in 110 subjects (42.9%), 55.5% of which were male and 44.5% were female (P=0.001). Maxillary sinus abnormalities were observed in 66.4% of the patients, while ethmoid sinus abnormalities were found in 63.6%. Of the ethmoid abnormalities, 21% were found in the anterior section, 9% in the middle ethmoid, and 8% in the posterior ethmoid. The most common abnormality found was mucosal thickening. Among our cases, 23.4% had septal deviation, which was significantly higher among those with sinusitis (29% versus 19.1%; P

Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm. Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms. Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

The nodular thyroid diseas is one of the most common disturbances o the thyroid gland wheras malignant tumors are among the most unusual entities of it. Not only differentiation of these two spectra but also the problems to achieve early diagnosis and treatment, have been a matter of concern, research, and controversy. Two hundred patients were assessed at the Cancer institute of Imam Khomeini Hospital as a retrospective research, considering the aim of evaluating and comparing the results of ultrasound and fine needle aspiration cytology with the postoperative histopathologic report. The ultrosound findings included location, number, size, feature, echogenicity, and presence of calcification; and those of the fine needle aspiration cytology consisted of benign, malignant, and suspicious samples. The cases mentioned as recurrent cancer or metastases of previous thyroid cancer were omitted from the study. In this research we found a sensitivity, specificity, accuracy of 92.3% , 76.4% and 88.1%, respectively , for fine needle aspiration cytology and also showed that the sensitivity and accuracy of fine needle aspiration cytology in diagnosis of malignant lesions of solid nodules was more than in cystic or mixed nodules of thyroid. Moreover, the incidence of false negatives in malignant cases of the studied sample was 7.7% (11/43). This rate was very higher in mixed and cystic lesions compared to benign ones (20% versus 5.7%). According to ultrasound findings, we showed that micro-calcificantion had a significant higher frequency in malignant nodules in comparision with the benign ones (4% in benign lesions versus 35% in malignant ones). The rate of malignancy in solid lesions revealed a significant increment compared to cystic and mixed nodules (P

Low back pain is among the most frequent medical complaints and a major public health problem. 1.7 percent of cases are caused by herniated disc, 20 percent of which require interventional treatment. Percutaneous laser disc decompression (P.L.DD) can be considered as an effective therapeutic alternative in certain cases."nMaterials and Methods: To determine the efficacy of this method in Iran in patient's with low back pain due to disc herniation, 40 patients according to medical history, physical examination and MRI findings were selected for this study. Patients who had canal stenosis, marginal, osteophyte, advanced disc dehydration, ruptured posterior ligament and other contraindication were excluded. CT scan was used only for needle navigation. After proper positioning of needle, nucleous pulposus was evapourated with Nd-YAG laser. Total energy was 1200-1600j. The procedure was done out patient and follow up has been done at 1 day, 1 week, 1,3, 6 and 12 months."nResults: There was no serious complication. 80 percent of patients in one-year follow up showed significant clinical improvement."nConclusion: Our findings suggests that percutaneous laser disc decompression can be considered as an effective alternative method of treatment for disc herniation and patient selection is the critical factor which determines success rate.

CT image quality has been affected by many factors such as KVP, ma, exposure time, alogorithm and section thickness. Gantry tilt has the main role in visualization of the temporal bone anatomic structures. In this study, we tried to optimize these factors to determine the best gantry tilt. This study was performed on the human skull phantom and then extended to 15 patients. The phantom was made by inserting a normal human dry skull into a water- filled radiolucent cylindrical container. A lateral scout view was obtained and the OMBL (orbitomeatal baseline) was used as the anatomical landmark.The phantom was scanned in 9, 15 , 30 , 45, 60 , 75, 90,105, 120 degree in relation to OMBL and 24 important anatomical structures were evaluated in each. Kilovoltage of 80, 120, 140 millimeters of 40, 70, 100, 120, 140, 170, 200, 240, exposue time of 2, 2, 4 second , algorithm of smooth, soft, standard, detail, bone adge and section thickness of 1.5, 3,5 millimeter were studied separately. In general, most of the anatomical structures are well demonstrated in 0 or 30 degrees of axial scans and 90 or 105 degrees in coronal scans. The best imaging techniques in Kv=140, Ma=100, S=2 seconds, algorithm of edge or bone, section thickness of 1.5 millimeter for small structures and 3 millineters for greater ones.The best 3-D image is provided by 3 millimeter slice thickness without overlapping but they couldn’t assist in diagnosis of our patient’s diseases. In indirect sagital reformatted images, the greater anatomical structures such as vestibule and cochlea are also shown, but they are recommended due to the slight degradation of the images and some loss of resolution.

Recently, it has been showed that gadolinium oxide nanoparticles can provide high-contrast enhancement in magnetic resonance imaging (MRI). Moreover, liposomes due to high biocompatibility have shown unique model systems, with the most successful application being the drug delivery system. As a suitable cell-tracking contrast agent (CA) in molecular MRI (mMRI), the synthesis and optimisation characteristic of a novel paramagnetic liposomes (PMLs) based on gadolinium nanoparticles, essentially composed of a new complex of gadolinium oxide-diethylene glycol (Gd2O3-DEG) loaded in liposomes have been determined in this research. Gd2O3-DEG was prepared by a new supervised polyol method and was encapsulated with liposome by the film hydration method. The paramagnetic liposome nanoparticle (PMLN) sizes ranged from 65 to 170 nm. The r1 of PMLNs and Gd2O3-DEG were much higher than that of Gd-diethylenetriamine penta-acetic acid (Gd-DTPA). In MC/9 cell lines, the experiments showed similar results as in water. PMLNs with lower T1 than Gd-DTPA are sensitive, positive MRI CA that could be attractive candidates for cellular and molecular lipid content targets such as diagnostic applications. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to report our experience about endovenous laser treatment (EVLT) for lower extremity varices in our centre which was followed by ultrasonography during the 6-month period. Methods: During a 1-year period, 46 patients who were treated by EVLT with the 940-nm diode laser for venous insufficiency enrolled in the study. The diagnosis of greater saphenous vein (GSV) incompetence with reflux was made by clinical evaluation and duplex Doppler examinations. Clinical outcomes, complications and duplex ultrasound of the GSV were assessed within 1 week, 1 month, 3 months and 6 months, after the endovascular laser treatment. Results: The mean age of our patients was 44 ± 11 years (24-70), and among them, 23 (50%) were male. Improvement in visible varicosity was seen in 39 (84.8%) patients after 6 months (P value = 0.011). The baseline mean diameter of GSV was 4.9 ± 1.6 mm and it dropped to 3.5 ± 1.3 after 6 months (P < 0.0001). After 6 months, 95.7% of our patients were satisfied and recommended this procedure to others. Conclusions: Endovascular laser ablation seems to be a safe and effective method for the treatment of lower limb varices. [ABSTRACT FROM AUTHOR]

Antidepressant effects of magnetic resonance imaging (MRI) based stimulation have been reported in animal studies, but no human studies are available on subjects with major depressive disorder. Here, the efficacy of two diagnostic MRI protocols (echo-planar diffusion-weighted imaging (DWI) and T1-weighted imaging) was assessed in patients with major depressive disorder. In this double-blind randomized clinical trial, 51 patients with clinically proven major depressive disorder were randomly enrolled into three equal groups. All patients were receiving a selective serotonin reuptake inhibitor as the only antidepressant treatment. The first group received echo-planar DW stimulation (DWI group), the second group received T1-weighted stimulation (T1 group), and the third group experienced a similar condition without receiving any magnetic stimulation (sham group). The Hamilton rating scale for depression (HAMD24) and Beck depression inventory (BDI) were used to assess the effect of MR stimulation on depressive symptoms. In comparison to baseline, mean HAMD24 and BDI scores significantly ( p < 0.001) decreased in the DWI (by 35% and 39%) and T1 (by 38% and 39%) groups 2 weeks after MR stimulation. In the sham group, reduction in HAMD24 (19%, p = 0.04) and BDI score (15%, p = 0.07) were lower than the MR stimulation groups. Two weeks after the MR experiments, changes in mean HAMD24 score and BDI score were significantly ( p < 0.05) higher in subjects treated with MR stimulation (DWI or T1) vs. sham group. In conclusion, this study demonstrated the antidepressant effects of DWI and T1 MRI protocols. Our results may point to usefulness of MR stimulation for clinical use in patients with major depressive disorder. [ABSTRACT FROM AUTHOR]

Objective: Evaluation of the efficacy of black tea as the negative oral contrast agent in MRCP.Materials and Methods: MRCP was performed before and 5 and 15 min after tea consumption for 35 patients. Depiction of the gall bladder (GB), cystic duct (CD), proximal and distal parts of the common bile duct (CBD), intrahepatic ducts (IHD), ampulla of vater (AV), main pancreatic duct (MPD) and signal loss of stomach and three different segments of the duodenum were investigated according to VAS and Likert scores.Results: Twenty-one of the patients (60%) were female (mean age, 50.3  ±  19.2 years). Regarding visibility of different anatomical parts of the pancreatobiliary tree, the post procedure images were better visualized in the distal part of CBD, AV and MPD in Likert and VAS scoring (all P  ≤  0.001). Regarding obliteration of high signal in the stomach and three different parts of the duodenum, all post procedure images showed significant disappearance of high signal in Likert and VAS scoring systems (all Ps ≤ 0.001).Conclusion: Black tea is a simple and safe negative oral contrast agent which reduces the signal intensity of gastrointestinal tract fluid and provides improved depiction of the MPD, the distal CBD and the ampulla during MRCP. Key Points •Tea is an effective negative oral contrast agent for gastrointestinal MRI •Ingestion of black tea improves conspicuity of the distal CBD in MRCP. [ABSTRACT FROM AUTHOR]

Background/Objective: The accurate anatomic mapping and determination of the severity of arterial disease, an important health problem of the elderly, is of great significance. We aimed to determine the diagnostic value of 64-multislice CT angiography (MSCTA) in run-off and cut-off sites of arterial disease. Patients and Methods: Throughout the study, MSCTA followed by an operative intervention was carried out on a total of 38 patients with clinical signs and symptoms suggestive of arterial disease (AD) all of whom had the indication for vascular surgery. The mean age of patients was 34±15.86 (range, 23 to 93) years. MSCTA was executed using a 64-slice CT scanner, during the arterial phase of injecting the nonionic, contrast medium with a power injector at the rate of 5 ml/sec into the antecubital vein and exploration and revascularization of peripheral arterial disease was performed intraoperatively. Results: Atherosclerosis and arterial disease, the most common causes of vascular occlusion, were more common in the lower extremities. According to MSCTA findings, the most frequent site of stenosis was the superficial femoral artery. Spearman's correlation coefficient showed a high degree of agreement amongst the raters. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy of MSCTA compared to surgery were 83.8%, 96%, 96.8%, 81.3% and 89%, respectively. MSCTA findings were compared with surgery as a standard of reference, which showed concordance in the majority of cases (81.6%). Cut-off sites were correctly identified by MSCTA in 97.3% of the patients and the most common sites of discordance were the run-off sites (18.2%). Conclusion: MSCTA angiography as a novel diagnostic modality may be a suitable alternative and a viable choice for routine clinical diagnosis. [ABSTRACT FROM AUTHOR]

The pseudo-aneurysms of thoracic aorta are rare and a life-threatening complication of aortic surgery and blunt chest trauma. This article demonstrates a case report of a traumatic aortic arch dissection and formation of a false aneurysm after blunt chest trauma in Iran. A 23-year-old man was referred complaining of chest pain and exertional cough. He had a history of chest and abdominal trauma five months ago after a car accident, resulting in acceleration-deceleration injury. The trauma resulted in an extensive injury on the left side of the chest and abdomen associated with multiple rib fractures, hemopneumothorax and splenic rupture. Splenectomy and left chest tube drainage was performed. The patient was admitted for 15 days. Finally, he recovered to normal and was discharged in satisfactory condition. However, his chest pain and cough restarted and its severity gradually increased. In chest x-ray, a left upper mediastinal mass was detected, which was later confirmed by 64 multi-slice chest CT scan as a false aortic arch aneurysm and aortic dissection. It seems endovascular stent-graft technique for the treatment of thoracic aorta aneurysm may present a good treatment choice with a low risk and less invasive approach. [ABSTRACT FROM AUTHOR]

The authors reported a patient with unilateral blindness of the left eye after trauma. Apart from paralysis of the 4th cranial nerve and mild optic nerve edema, there was no structural problem during the ophthalmologic examination. Brain CT scan, CT angiography and MRI demonstrated aneurysm in the left pericavernous region. The patient underwent angiography for coiling of the aneurysm, which detected large carotid cavernous fistula (CCF) mainly draining into the petrous sinus. Therapeutic embolization was performed with balloon and the CCF vanished completely. The most important points of this case are the blindness without exophthalmia as the only presentation of CCF which has not been reported as the only symptom and failure of CT-angiography and MRI evaluation for the diagnosis of CCF. [ABSTRACT FROM AUTHOR]

One of the most frequent primary malignant tumors in the world is hepatocellular carcinoma (HCC). Currently, the optimal treatment methods for HCC are hepatic resection and liver transplantation. Unfortunately, surgical therapies are suitable for 20% of patients and those who are not eligible for surgery should undergo interventional therapies. In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma (HCC) including transcatheter arterial chemoembolization (TACE) and many tumor ablation techniques, such as percutaneous ethanol injection (PEI), radio-frequency ablation (RFA), percutaneous microwave coagulation therapy (PMC), laser-induced interstitial thermotherapy (LITT), cryoablation, and acetic acid injection. By development of new technologies in imaging and drug delivery, it is likely that in the future patients with HCC will be treated by combination therapies to improve patient survival. Computed tomography (CT) and magnetic resonance imaging (MRI) have a crucial role in diagnosis and also follow-up of HCC patients treated by interventional procedures, by which the treatment efficacy, recurrence of disease and certain complications are evaluated. In this review article, we discuss the imaging modalities and also tailoring of interventional procedures for HCC patients. [ABSTRACT FROM AUTHOR]

Background/Objective: Accurate delineation of the fistula tract anatomy is necessary for surgical management of anal fistulas. Among different ways to do this, endoanal ultrasound (EUS) is being increasingly used to evaluate patients with anal fistula. In this study we assessed the accuracy of hydrogen peroxide-enhanced EUS in detecting the internal orifice and the type of the fistula. Patients and Methods: Patients with history and physical examination compatible with fistulain- ano underwent an injection of 1 ml hydrogen peroxide into the external orifice and then EUS with a 7.5 MHz probe was carried out prior to surgery. The location of the internal orifice, presence of the abscess and the type of the fistula were examined and the results were compared with surgical findings. Results: Thirty-two patients entered the study. The fistula type could be identified in 29 patients (90.6%). Twenty-two (75.8%) of these patients had trans-sphincteric and seven (24.2%) had inter-sphincteric fistulas. In 11 (34.3%) patients, an abscess was found uring EUS. The fistula type was identified surgically in 29 patients, in which 26 were trans-sphincteric (89.8%), two were inter-sphincteric (6.8%), and one was extra-sphincteric (3.4%). There was a difference between detected sites of internal orifices during EUS and surgery (p value<0.001). Hydrogen peroxide-enhanced EUS had an appropriate agreement in detecting transsphincteric fistulas with surgery. Conclusion: Hydrogen peroxide-enhanced EUS is a suitable method for detecting the internal orifice of anal fistulas. It can be used for detecting trans-sphincteric fistulas, which are the most common type. [ABSTRACT FROM AUTHOR]

Background/Objective: The aim of this study was to assess the frequency of significant carotid artery stenosis and its association with the cardiovascular risk factors in a group of Iranian candidates for CABG. Patients and Methods: Three hundred and one patients with critical coronary artery disease, who were candidates for coronary artery bypass graft (CABG) were evaluated by internal carotid Doppler study. The relations between age, gender, hypertension, diabetes mellitus, smoking, lipid profile, left main coronary stenosis greater than 50% by diameter and coronary artery disease with carotid stenosis were assessed. Results: Significant carotid stenosis greater than 70% was detected in 13 patients (4.3%). According to the meaningful relationship between significant carotid stenosis and low HDL serum level (lower than 45 in women and lower than 35 in men, p=0.028), hypertension (p=0.021), history of smoking (p=0.026) and left main coronary artery stenosis greater than 50% (p=0.035), they were identified as risk factors valuable enough to guide for selective screening. Conclusion: Among all cardiovascular risk factors, it seems that serum HDL, smoking, left main coronary stenosis and hypertension could be associated with significant carotid artery stenosis in CABG candidates. [ABSTRACT FROM AUTHOR]

Background/Objective: The problem of localization of speech associated cortices using noninvasive methods has been of utmost importance in many neuroimaging studies, but the results are difficult to resolve for specific neurosurgical applications. In this study, we used fMRI to delineate language-related brain activation patterns with emphasis on the Broca's area during the execution of two Persian language tasks. Patients and Methods: The subjects comprised of nine healthy right-handed men who participated voluntarily in this study. They performed two consequent fMRI paradigms namely; "Word Production" and "Reverse Word Reading". The fMRI data were collected and analyzed. Then, functional images were registered to anatomical images using FSL software. The laterality indices were also calculated in regions of interest with different threshold levels. Results: The results indicate that Broca's area, as the classical language-production center, was robustly activated while performing these two tasks. In eight out of nine subjects, the left hemisphere dominancy and Broca's area activation were observed and in one case activation was prominent in the homologous area in the right hemisphere. Conclusion: Similar pattern of cortical activation during Persian word production and Anglophone languages such as English was revealed. fMRI is a valuable means for brain mapping in language studies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the use of bilateral inferior petrosal sinus sampling (BIPSS) in the diagnosis of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome in Iran.

Abstract Background Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. Methods 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (3, T4 and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection. Results Average pre-treatment nodule volume [18.2 ± 12.7 ml] decreased to 5.7 ± 4.6 ml at 6 months follow-up [P < 0.001]. All patients had normal thyroid hormone levels at 3 and 6 months follow-up [P < 0.001 relative to baseline]. sTSH levels increased from 0.09 ± 0.02 μIU/ml to 0.65 ± 0.8 μIU/ml at the end of therapy [P < 0.05]. Only 3 patients had persistent sTSH suppression at 6 months post-therapy. T4 and sTSH did not change significantly between 6 months and 2 years [P > 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia. Conclusion Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules.