Publications by authors named "Majid Rezvani"

20 Publications

  • Page 1 of 1

Postoperative complications of Goel-Harms C1-C2 screw-rod fixation technique for C1-C2 instability after C2 nerve sacrifice, a prospective study over two years follow up.

J Clin Neurosci 2021 Jun 31;88:52-56. Epub 2021 Mar 31.

Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Atlantoaxial instability is mainly caused by trauma. C2 nerve is usually needed to be sacrificed for adequate exposure of the lateral mass and screw insertion.

Objectives: This study aimed to investigate the clinical outcome of postoperative complications of C1 and C2 screw-rod fixation using the Goel-Harms technique for C1-C2 instability after sacrificing the C2 nerve root.

Methods: Amongst forty patients with C1-C2 pathology, twenty-seven cases were enrolled into the study, then variables, including age, sex, primary pathology, operation duration, postoperative pain, paresthesia, anesthesia, and other specific conditions, were documented. Data analyzed by an expert biostatistician. p-value < 0.05 was considered significant.

Results: Regardless of gender, the most postoperative adverse effect was occipital anesthesia (81.5%). Most of the patients (63%) had both occipital pain and anesthesia one-month post-surgery. At 3- and 6-months post-surgery, occipital pain and anesthesia were seen in 40.7% and 14.8%, respectively.

Conclusion: The most common postoperative adverse effect of C2 nerve root scarification after C1-C2 fixation is occipital anesthesia followed by occipital paresthesia and pain, which are reduced in severity over time.
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http://dx.doi.org/10.1016/j.jocn.2021.03.012DOI Listing
June 2021

Outcome of patients with lumbar spinal canal stenosis due to discogenic under percutaneous laser disc decompression.

Am J Neurodegener Dis 2020 15;9(1):1-7. Epub 2020 Dec 15.

Department of Research, School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran.

Background: The Percutaneous laser disc decompression (PLDD) method was first described by Daniel Choy in Australia in 1987. Therefore, in this study, we examined the clinical signs and symptoms of patients with spinal canal stenosis due to disc protrusion after PLDD surgery.

Methods: In this clinical trial study, 43 patients with spinal canal stenosis due to lumbar disks who referred to Kashani and Zahra Marzieh educational hospitals from 2006 to 2016 were entered the study. The patients were divided into two groups as discogenic canal stenosis (3 females and 9 males) and complex degenerative disorder (canal stenosis due to discogenic and ligamentos) (16 females and 15 males). Patients underwent PLDD surgery and the clinical manifestations such as back and radicular pain, claudication, and complications of the surgery (hematoma, reoperation, and neurological symptoms) in patients were evaluated until one year after the operation.

Results: After one year of surgery, the mean of back and radicular pains significantly decreased in both groups (P<0.05). All patients with claudication in the discogenic group improved and 35.5% of patients with complex degenerative disorder were not claudication after one year of surgery. The outcomes of treatment in patients with discogenic canal stenosis were 91.7% excellent, and 8.3% fair and in the complex degenerative disorder group were 64.5% excellent, 19.4% good and 16.1% fair (P=0.16). None of the patients had new neurological symptoms, and 12.9% of the complex degenerative disorder group patients needed reoperation.

Conclusion: The PLDD method is a better procedure for discogenic canal stenosis than complex degenerative disorder. Therefore, more studies are required in this field for long time.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811930PMC
December 2020

Decreased Emergency Department Overcrowding by Discharge Lounge: A Computer Simulation Study.

Int J Prev Med 2020 17;11:13. Epub 2020 Feb 17.

Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: In the past decade, factors such as population growth, increased environmental incidents, and substance abuse have caused patient-overcrowding in emergency departments (EDs). Our main objective was to assess the effects of a discharge lounge on decreasing the patient waiting time and ED overcrowding by computer simulation.

Methods: In this cross-sectional retrospective study, the statistical population consisted of 39264 persons referred to the ED of Al-Zahra Hospital. The sample size was calculated as 1275 through systematic random sampling at 99% confidence. To increase research accuracy, the number of patients was increased to 2515. Data were collected by standardized checklists and hospital information systems.

Results: Mean waiting time for level 2 patients who left the ED against medical advice after completing the treatment was declined from 56 min to 44 min and before completing the treatment process from 80 min to 50 min. Average waiting time for level 3 patients for personal satisfaction after completing the treatment process decreased from 15 min to 13 min and before the completion of the treatment process from 67 min to 41 min; the number of discharged patients awaiting discharge was decreased at level 2 from 3 to 2 and at level 3 from 2 to 1. The number of patients waiting for admission at triage stations reduced from 44 to 39%, and the average number of patients discharged from emergency room was increased from 7 to 12.

Conclusions: ED overcrowding is the hallmark of a mismatch between the availability of health care resources and patient demand for emergency care. Among major factors contributing to these situations are hindrances in patient flow and occupation of ED beds by nonurgent patients. The establishment of a discharge unit in the ED could be a practical solution to ED overcrowding.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_582_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050226PMC
February 2020

Evaluation of glucose-6-phosphate dehydrogenase serum level in patients with multiple sclerosis and neuromyelitis optica.

Iran J Neurol 2019 Oct;18(4):150-153

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Multiple sclerosis (MS) and neuromyelitis optica (NMO) are both demyelinating disorders and oxidative stress is suggested to have a role in their pathogenesis. Glucose-6-phosphate dehydrogenase (G6PD) produces nicotinamide adenine dinucleotide phosphate (NADPH) via the pentose phosphate pathway. NADPH is not only involved in the synthesis of fatty acids necessary for myelination, but also it is involved in the defense against oxidative stress. Prescribing supplementary vitamin D as a part of the MS treatment plan can increase G6PD gene expression. The aim of this study was to determine the serum level of G6PD in patients with MS and NMO and its relationship with vitamin D, since it is yet to be explored thoroughly. In this case-control study, subjects were divided into three experimental and control groups. The experimental groups comprised 50 patients with relapsing-remitting MS (RRMS) who had a history of vitamin D consumption, 50 newly-diagnosed MS patients, and 50 patients with NMO. Control group included 65 healthy individuals. Serum level of G6PD was measured and compared among these groups. No significant difference was seen between the G6PD level in patients with MS and NMO, but it should be noted that this level was significantly lower than the healthy group. G6PD serum level was significantly higher in patients with MS who had previously consumed supplementary vitamin D compared to those who had not. G6PD deficiency is observed in patients with MS and NMO. Also, supplementary vitamin D may induce favorable results on the G6PD level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036045PMC
October 2019

Spinal Intradural Extramedullary Dermoid Cyst.

World Neurosurg 2020 Feb 20;134:448-451. Epub 2019 Nov 20.

Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Dermoid cysts are benign congenital tumors that develop early in life. These tumors are classified by the presence of all 3 germ layers. Spinal intradural extramedullary teratoma is a rare disease, which is more common in children under 5 years of age than in adults.

Case Description: A 12-year-old girl with a dermoid cyst at the lower lumbar level presented with 2-month low back pain and intermittent lower extremity radicular symptoms on the right side. Magnetic resonance imaging scan of the spine revealed an intradural extramedullary mass lesion at L4-5. Surgical excision of the cyst was successfully performed. Surgical and histopathologic findings confirmed extramedullary ruptured matured teratoma. Postoperatively, the patient had remarkable clinical improvement.

Conclusions: Although dermoid cysts are uncommon, they should be considered in the differential diagnosis of spinal lesions in patients with lower back pain. It can be successfully treated with surgical excision.
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http://dx.doi.org/10.1016/j.wneu.2019.11.073DOI Listing
February 2020

Association Study between Functional Polymorphisms of Gene Promoter and Multiple Sclerosis Susceptibility in an Iranian Population.

Iran J Public Health 2019 Sep;48(9):1697-1703

Isfahan Neurosciences Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Matrix metalloproteinase-9 () polymorphisms, C-1562 T and -90 (CA) n repeats, which influence transcriptional activity of this gene, are proposed to play a role in MS susceptibility and its development. In the present study, the possible association of polymorphisms in Iranian MS patients is studied.

Methods: Association of mentioned gene polymorphisms with MS susceptibility was evaluated in unrelated Iranian subjects referred to Al-Zahra Hospital, Isfahan, Iran during 2014 to 2017.

Results: -1562 T allele of was associated with increased MS risk. However, we found no overall significant effect of -90 (CA)n repeat on MS susceptibility.

Conclusion: For as much as molecule is a potential target for MS therapy, to determine whether any of polymorphisms influence MS susceptibility in Iranian MS patients or not, concerning the significant influence of T allele on MS susceptibility and the non-significant association regarding CA repeats, further research is needed before proposing any definite conclusion.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825667PMC
September 2019

Bifrontal Epidermoid Cyst.

Adv Biomed Res 2018 23;7:77. Epub 2018 May 23.

Department of Neurosurgery, Isfahan University of Medical Sciences, Alzahra Hospital, Isfahan, Iran.

In this paper, we will present a case of a 63-year-old female with bifrontal epidermoid tumor who has gone under bilateral craniotomy. In a case report study, a 63-year-old female with a chief complaint of progressive headache that has been admitted to Department of Neurosurgery was studied. Magnetic resonance imaging was performed for better evaluation. After detection of bifrontal epidermoid cyst, the patient underwent surgery, and following the surgery, a cut of the tumor has been excised, sent for pathology sampling and reviewed for detection of cyst. Microscopic review of the resected part reported normal brain tissue along with sections containing parts of cyst wall covered by squamous epithelium and huge amount of irregularly stratified keratin within its lumen, which clearly emphasizes on diagnosis of a typical epidermoid tumor. Bifrontal epidermoid cyst is rare, and according to our study, the clinical symptoms and patients imaging were consistent with other studies.
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http://dx.doi.org/10.4103/abr.abr_107_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991290PMC
May 2018

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery.

Asian Spine J 2018 06 4;12(3):459-465. Epub 2018 Jun 4.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Study Design: Randomized clinical trial.

Purpose: In this study, we evaluated the effect of mechanical evacuation of the bowels prior to operation on intraoperative bleeding.

Overview Of Literature: Bleeding is the most significant complication in patients undergoing spinal surgery.

Methods: We randomly divided 108 individuals planned to undergo spinal surgery into two age-, sex-, and co-morbidity (especially preoperative hemoglobin [Hb])-matched groups of 54. The treatment group was administered polyethylene glycol (PEG) before the operation, whereas the control group was not. The exact amount (mL) of bleeding during operation, operative time, and approximate amount of blood transfused were recorded. The volume of bleeding and Hb level were also recorded 24 and 48 hours postoperatively.

Results: -tests revealed that intraoperative bleeding, the volume of transfusion, and operative time were significantly lower in the treatment group than in the control group. Statistically significant correlations of intraoperative bleeding with age, body mass index (BMI), preoperative Hb levels, operative time, the volume of transfusion, hospitalization time, and 24- and 48-hour postoperative bleeding were observed ( =0.001, all). Repeated measures analysis of covariance after adjusting the covariate variables revealed that the volume of bleeding showed a near-significant trend in the treatment group compared with that in the control group ( =0.056). Diabetic females had the highest bleeding amount between the groups ( =0.03). Bleeding was higher in patients with higher BMI ( =0.02) and was related to operative time ( =0.001) in both the groups.

Conclusions: Preoperative gastrointestinal tract evacuation by PEG administration can decrease intraoperative bleeding in spinal surgeries; however, more research is imperative regarding PEG administration in surgical procedures for this purpose.
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http://dx.doi.org/10.4184/asj.2018.12.3.459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002161PMC
June 2018

Preventive Effects of Pre- and Intra-operative Marcaine, Lidocaine, and Marcaine Plus Lidocaine on Pain Relief in Lumbar Disc Herination Open Surgery.

Adv Biomed Res 2018 22;7. Epub 2018 Jan 22.

Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: As marcaine is administered to a great extent due to minor complications and reasonable expenses and as discectomy is prevalently used in Iran, this study makes a comparison between effect of marcaine alone, lidocaine alone, and marcaine plus lidocaine on pain relief of patients undergoing lumbar disc open surgery.

Materials And Methods: In a clinical trial study, 192 patients were selected and randomly divided into four groups. Patients in Groups 1-4 received 0.5 ml marcaine during surgery, 5 ml lidocaine 2% before incision, 5 ml lidocaine 2% before incision plus 5 ml marcaine during surgey and normal saline, respectively. After patients gained knowledge of visual analog scale (VAS) criteria, their severity of pain was measured and was recorded in their profiles, along with demographic details and history of diseases. After surgery and their transfer to their rooms, their severity of pain was measured and recorded again by using VAS criteria. Finally, difference between the four groups was compared by SPSS software.

Results: The mean (±standard deviation) of postoperative pain in marcaine + lidocaine, marcaine, lidocaine, and normal saline was 3.5 ± 1.3, 3.5 ± 1.6, 36.1.9, and 4.2 ± 1.8, respectively, and we did not observe any significant difference in severity of pain after surgery in these groups ( = 0.15). The highest and lowest degree of satisfaction occurred in marcaine-lidocaine group and control group, respectively, (40 patients [83.3%] vs. 25 patients [52.1%]).

Conclusion: Lidocaine-marcaine treatment reduces the need to opiates in cases of postoperative pain relief of discectomy and provides patients with great satisfaction.
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http://dx.doi.org/10.4103/abr.abr_161_15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812105PMC
January 2018

The Effect of a Single dose Dantrolene in Patients with Vasospasm Following Aneurysmal Subarachnoid Hemorrhage.

Adv Biomed Res 2017 14;6:83. Epub 2017 Jul 14.

Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Cerebral vasospasm is a prolonged, occasionally severe, but reversible narrowing of the cerebral arteries that begins 3 to 5 days after the hemorrhage becomes maximal at 14 days. This study is designed to evaluate the effect of dantrolene on the reduction of vasospasm following aneurysmal subarachnoid hemorrhage (SAH).

Materials And Methods: This randomized controlled clinical trial was conducted on 32 patients with proven aneurysms in AL-Zahra hospital during 2011-2013. They were randomly divided into two groups. In all patients, daily transcranial Doppler sonography was performed and as soon as the diagnosis of vasospasm onset in the first group, in addition to conventional treatment of vasospasm 2.5 mg/kg Dantrolene infusion within 60 minutes and while the blood pressure and heart rate of patient monitored, and arterial flow velocity changes such as PSV and MFV were measured by transcranial Doppler sonography in 45, 90 and 135 minutes. Data was analyzed by SPSS 22 and Chi-square, Student , Mann-Whitney and ANOVA tests with repeated observations.

Results: There was no significant difference in the site of the aneurysm in the two groups. The mean of PSV index prior to treatment and the 45 minute was not different but at 90 and 135 minutes it was significantly lower in the Dantrolene receiving group ( < 0.05). The mean of MFV index prior to intervention and in the 45 minute was not different between two groups, but at 90 and 135 minutes was significantly lower in the target group.

Conclusion: Using dantrolene in patients with artery vasospasm significantly reduced artery spasm and increased the patient recovery.
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http://dx.doi.org/10.4103/2277-9175.210660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539667PMC
July 2017

Effects of Mannitol 20% on Outcomes in Nontraumatic Intracerebral Hemorrhage.

Adv Biomed Res 2017 27;6:75. Epub 2017 Jun 27.

Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: A large number of stroke patients are not the perfect candidate for craniotomy and invasive procedures, so providing an alternative and noninvasive method, which is applicable in terms of costs and facilities, is necessary. Thus, the present study aimed to determine the effects of mannitol 20% on outcome of the patients with nontraumatic intracerebral hemorrhage (ICH) in patients admitted to Isfahan's Al-Zahra Hospital during 2012 and 2013.

Materials And Methods: This is a clinical trial study which is conducted during 2012-2013 in Isfahan's Al-Zahra Hospital. In this study, 41 patients suffering from ICH received mannitol 20% for 3 days, and volume of hemorrhage and Glasgow Coma Scale (GCS) of patients were controlled every 12 h. The collected data were analyzed via SPSS software.

Results: The mean ICH volume was 22.1 ± 6.3 ml in pre intervention and 38.4 ± 19.3 ml in post intervention, and according to the -paired test, before and after treatment the difference was significant ( < 0.001). Hemorrhage volume was stable in nine patients (22%), it increased in 25 patients (61%), and decreased in seven patients (17.1%). The mean index of GCS before and after treatment was 11.85 ± 1.6 and 9.37 ± 2.65, respectively. Moreover according to -paired test, the difference was significant before and after treatment ( < 0.001). During using mannitol, the GCS index was stable in eight patients (19.5%), it increased in eight patients (19.5%) and decreased in 25 patients (61%).

Conclusions: Mannitol injection was not effective in reducing hemorrhage size, and its use is not recommended, also, further studies in this field have been proposed.
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http://dx.doi.org/10.4103/2277-9175.192628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501019PMC
June 2017

Comparison of open surgical discectomy versus plasma-laser nucleoplasty in patients with single lumbar disc herniation.

J Res Med Sci 2015 Dec;20(12):1133-7

Departmentt of Epidemiology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Intervertebral disc herniation is a major cause of low back pain. Several treatment methods are available for lumbar disc herniation including Chemonucleolysis, open surgery, nucleoplasty, laser disc decompression, and intradiscal electrothermal therapy. The high prevalence of lumbar disc herniation necessitates a minimally invasive yet effective treatment method. In this study, we compared the outcomes of open surgery and nucleoplasty method in patients with single lumbar disc herniation.

Materials And Methods: This study was a noninferiority randomized clinical trial conducted in one of the University Hospitals of Isfahan Medical University; The Alzahra Hospital. About 200 patients with the diagnosis of lumbar disc herniation were recruited and were assigned to either the treatment or control groups using block randomization. One group received open surgery and the other group received nucleoplasty as the method of treatment. Patients were revisited at 14 days, 1, 2, 3 months, and 1-year after surgery and were assessed for the following variables: Lower back pain, lower limb pain, common complications of surgery (e.g., discitis, infection and hematoma) and recurrence of herniation.

Results: The mean (standard deviation) severity of low back pain was reduced from 6.92 (2.5) to 3.43 (2.3) in the nucleoplasty group (P = 0.04) and from 7.5 (2.2) to 3.04 (1.61) in the discectomy group (P = 0.73). Between group difference was not statistically significant (P = 0.44), however, time and treatment interaction was significant (P = 0.001). The level of radicular pain evaluated 1 year after treatment was reduced from 8.1 (1.2) to 2.9 (1.2) (P = 0.004) and from 7.89 (2.1) to 3.6 (2.5) (P =0.04) in the discectomy and the nucleoplasty groups respectively, significant interaction between time and treatment options was observed (P < 0.001) while there was no significant difference between two treatment groups (P = 0.82).

Conclusion: Our results show that while nucleoplasty is as effective as open discectomy in the treatment of lumbar disc herniation, it is also less invasive with higher patient compliance. Taking factor such as decreased cost and duration of the surgery, as well as faster recovery in patients into account; we suggest considering nucleoplasty as an effective method of treatment in patients with single-level disc herniation.
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http://dx.doi.org/10.4103/1735-1995.172979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766818PMC
December 2015

Effects of progesterone and vitamin D on outcome of patients with acute traumatic spinal cord injury; a randomized, double-blind, placebo controlled study.

J Spinal Cord Med 2016 05 17;39(3):272-80. Epub 2015 Dec 17.

d Department of Psychiatry , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.

Background: Steroid hormones offer promising therapeutic perspectives during the acute phase of spinal cord injury (SCI) while the role of progesterone and vitamin D remain controversial. The aim of the current study was to investigate the effects of progesterone and vitamin D on functional outcome of patients with acute traumatic SCI.

Methods: This was a randomized clinical trial including 64 adult patients with acute traumatic SCI admitted within 8 hours of injury. All the patients received methylprednisolone on admission according to standard protocol (30 mg/kg as bolus dose and 15 mg/kg each 3 hours up to 24 hours). Patients were randomly assigned to receive intramuscular injection of 0.5 mg/kg progesterone twice daily and 5µg/kg oral vitamin D3 twice daily up to 5 days (n = 32) or placebo (n = 32). Patients were visited 6 days, 3 and 6 months after injury and motor and sensory function was assessed according to American Spinal Injury Association (ASIA) score.

Results: There was no significant difference between two study groups regarding age (P = 0.341), sex (P = 0.802) and therapy lag (P = 0.609). The motor powers and sensory function increased significantly after 6 months in both study groups. Those who received progesterone and vitamin D had significantly higher motor powers and sensory function after 6 months of therapy. Those who received the therapy within 4 hours of injury, had significantly higher motor powers and sensory function 6 months after treatment in progesterone and vitamin D group. Therapy lag was negatively associated with 6-month motor powers and sensory function in progesterone and vitamin D group.

Conclusions: Administration of progesterone and vitamin D in acute phase of traumatic SCI is associated with better functional recovery and outcome.
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http://dx.doi.org/10.1080/10790268.2015.1114224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073761PMC
May 2016

Can we define severity of carpal tunnel syndrome by ultrasound?

Adv Biomed Res 2015 27;4:138. Epub 2015 Jul 27.

Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Diagnosis of CTS is usually based on a combination of clinical symptoms and electrodiagnostic study (EDS). Ultrasonography (US) also has been shown to be a useful diagnostic tool in CTS and is based on an increase in the median nerve cross-sectional area (CSA) at the level of the pisiform bone. In this study we assessed findings in US in correlation with severity of CTS.

Materials And Method: This was a cross-sectional case-control study, which was carried out on November 2012 to July 2013. Subjects were chosen from patients who referred to the Alzahra Hospital (Isfahan, Iran). Patients were classified as having mild, moderate, and severe CTS according to EDS and high-resolution US was performed for CSA measurement at the tunnel inlet.

Results: A total of 87 individuals screened and 52 subjects (81 hands) met all inclusion and no exclusion criteria. The mean ± SD of the CSA was 0.12 ± 0.03 cm(2) (range, 0.08-0.18) in mild, 0.15 ± 0.03 cm(2) (range, 0.08-0.19) in moderate, and 0.19 ± 0.06 cm(2) (range, 0.11-0.32) in severe CTS. We detected a significant correlation between MN CSA and the severity of CTS (P < 0.001).

Conclusion: In conclusion it is expected that sonography may serve as an additional or complementary method which is useful and reliable in assessing the severity of CTS.
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http://dx.doi.org/10.4103/2277-9175.161537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544117PMC
August 2015

The effect of irrigation of intracisternal papaverine on cerebral blood flow in subarachnoid hemorrhage.

Adv Biomed Res 2013 29;2:45. Epub 2013 Jun 29.

Department of Neurosurgery, Al-Zahra Hospital, Isfahan University Of Medical Science, Isfahan, Iran.

Background: Despite different treatments, cerebral vasospasm is still the most important cause of death in patients after subarachnoid hemorrhage. This study was conducted to explore the effect of intracisternal washing with papaverine on cerebral blood flow.

Materials And Methods: This study was performed on 40 patients and totally 120 arteries in 2010. Then, variations in cerebral blood flow before and after washing with papaverine were measured and analyzed.

Results: Twenty (20) patients with aneurysm of the anterior communicating artery (ACOM) and 20 patients with aneurysm of the middle cerebral artery (MCA) were assessed. Mean blood flow before aneurysm and before washing in ACOM and MCA was 70.68 ± 14.8 cm/s and 65.66 ± 9.3 cm/s, respectively, which reached 23.25 ± 5.17 cm/s and 34.1 ± 4.7 cm/s, respectively after washing (P value = 0.016 and 0.024). Mean blood flow after aneurysm and before washing in ACOM and MCA was 95.12 ± 13.9 cm/s and 67.44 ± 15.16 cm/s, respectively, which reached 35.69 ± 6.2 cm/s and 38.01 ± 8.28 cm/s, respectively after washing (P value = 0.001 and 0.01).

Conclusion: Washing with papaverine significantly reduces cerebral blood flow and relieves vasospasm.
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http://dx.doi.org/10.4103/2277-9175.114184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905341PMC
February 2014

Assessment of electromyograghic findings in peroneus tertius, tibialis posterior and dorsal interoseous pedis muscles in patients with axonal polyneuropathy.

Adv Biomed Res 2013 30;2:41. Epub 2013 Mar 30.

Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Axonal polyneuropathy (APN) is a common kind of neurologic disorders, which is normally diagnosed by electrodiagnostic methods. Different muscles were studied to find a muscle, which can be considered as a reliable site for early diagnosis of mild APN; this muscle should be easily activated by patient, has the highest sensitivity to EMG changes of APN, and has the lowest rate of false positive results in normal subjects.

Materials And Methods: Based on the inclusion and exclusion criteria, 32 patients were recruited, and all of them underwent needle EMG of 3 different muscles including Peroneus tertius (PT), tibialis posterior (TP), and dorsal interoseous pedis (DIP). EMG Findings of different muscles [Motor Unite Action Potential (MUAP) duration, MUAP amplitude, polyphasic MUAP, fibrillation potential (FP), and the ability of subjects to contract special muscle] were recorded and compared.

Results: Mean of MUAP amplitude was significantly different between all 3 muscles (P-values < 0.001). PT showed a significantly higher frequency of polyphasic MUAP than others (P-value: 0.001). The frequency of FP was significantly lower in TP than PT and DIP (P-values: 0.03 and 0.001, respectively). DIP showed significantly shorter MUAP duration than PT and TP (P-values 0.002 and 0.003, respectively). All cases were able to activate TP and PT voluntarily though only 20 patients could activate DIP (P-value < 0.0001).

Conclusion: The higher frequency of polyphasic MUAP, the higher frequency of FP, and finally, the ability of all patients in activation of PT voluntarily, all support the usefulness of PT for EMG studies in APN patients.
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http://dx.doi.org/10.4103/2277-9175.109753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905343PMC
February 2014

Oral prednisolone in the treatment of cervical radiculopathy: A randomized placebo controlled trial.

J Res Med Sci 2013 Mar;18(Suppl 1):S43-6

Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Steroids are commonly used in the treatment of cervical radiculopathy (CR), but there is limited information in this regard. We evaluated the efficacy of oral prednisone in the treatment of CR.

Materials And Methods: This randomized, double-blinded, placebo-controlled trial was conducted on adult patients with neck/shoulder pain for at least 1 month with no alarm symptoms/sings of malignancy, infection, or severe myelopathy, and no contraindication for corticosteroid use. Patients were allocated to receive prednisolone 50 mg/day for 5 days that was tapered within the following 5 days, or placebo. All patients also received acetaminophen 325 mg three times a day and ranitidine 150 mg two times a day. Neck disability index (NDI) and the verbal rating scale (VRS) were used to evaluate the outcomes.

Results: A total of 59 patients (31 female, mean ± SD age = 46.2 ± 9.0 years) completed the study. A significant decrease was observed regarding the NDI and VAS scores from baseline to the end of study in both groups (P < 0.001). However, for both the NDI (35.7 ± 21.4 vs. 12.9 ± 10.2) and VRS (4.4 ± 2.7 vs. 1.6 ± 1.2), the amount of decrease was greater in the prednisone compared with the placebo group (P < 0.001). Based on the clinically important change in NDI, pain was improved in 75.8% (22/29) of the prednisolone and 30% (9/30) of the placebo group (P < 0.001).

Conclusion: A short course of oral steroid therapy with prednisolone is highly effective in reducing pain in patients referring with uncomplicated CR. Further studies are warranted on dosing, duration, and long-term efficacy and safety of oral steroid therapy, compared with injection approach.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743318PMC
March 2013

The value of provocative tests in diagnosis of cervical radiculopathy.

J Res Med Sci 2013 Mar;18(Suppl 1):S35-8

Department of Neurology, Isfahan Neuroscience Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: This study was aimed at assessing the accuracy of provocative tests in diagnosis of acute or chronic Cervical Radiculopathy (CR) based on an electrodiagnostic reference criterion.

Materials And Methods: Shoulder Abduction Test (SAT), Spurling Test (ST), Upper Limb Tension Test (ULTT), and electromyography were done on 97 patients who referred to Electrodiagnostic center in the university hospital from January 2010 to March 2011. All of the participants had neck and radicular pain for at least 3 weeks. They were classified according to electrodiagnostic findings. Then diagnostic values of provocative tests were assessed in diagnosis of acute or chronic CR on the basis of reference criterion.

Results: SAT and ST were more specific (85%) compared to ULTT, while ULTT was more sensitive (60.46% in acute and 35.29% in chronic) than the other two. SAT and ST had a significant accuracy for comparison between acute and chronic CR (P < 0.05).

Conclusion: ULTT is suitable for screening of CR, while SAT and ST can support diagnosis. SAT and ST are good diagnostic tests for comparison between acute and chronic CR.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743316PMC
March 2013

Comparison of the administration of progesterone versus progesterone and vitamin D in improvement of outcomes in patients with traumatic brain injury: A randomized clinical trial with placebo group.

Adv Biomed Res 2012 28;1:58. Epub 2012 Aug 28.

Department of Neurosurgery, Isfahan University Of Medical Sciences, Isfahan, Iran.

Background: Due to the heterogeneity of traumatic brain injury (TBI), many of single treatments have not been successful in prevention and cure of these kinds of injuries. The neuroprotective effect of progesterone drug on severe brain injuries has been identified, and recently, the neuroprotective effect of vitamin D has also been studied as the combination of these two drugs has shown better effects on animal samples in some studies. This study was conducted to examine the effect of vitamin D and progesterone on brain injury treatment after brain trauma.

Materials And Methods: This study was performed on patients with severe brain trauma (Glasgow Coma Scale (GCS) ≤ 8) from April to September, 2011. The patients were divided to 3 groups (placebo, progesterone, progesterone-vitamin D), each with 20 people. Upon the patients' admission, their GCS and demographic information were recorded. After 3 months, they were reassessed, and their GCS and GOS (Glasgow outcome scale) were recorded. The collected data were analyzed using SPSS 18 software (SPSS Inc., Chicago IL, USA).

Results: Before intervention, GCS mean of the placebo, progesterone, and progesterone-vitamin D groups were 6.3 ± 0.88, 6.31 ± 0.87, and 6 ± 0.88, respectively. They increased to 9.16 ± 1.11, 10.25 ± 1.34, and 11.27 ± 2.27, respectively 3 months after intervention. There was a significant difference among GCS means of the 3 groups (P-value = 0.001). GOS was classified to 2 main categories of favorable and unfavorable recovery, of which, favorable recovery in placebo, progesterone, and progesterone-vitamin D was 25%, 45%, and 60%, respectively which showed a statistical significant difference among the groups (P-value = 0.03).

Conclusion: The results showed that recovery rate in patients with severe brain trauma in the group receiving progesterone and vitamin D together was significantly higher than that of progesterone group, which was in turn higher than that of placebo group.
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http://dx.doi.org/10.4103/2277-9175.100176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544099PMC
January 2013

Is Chiari malformation a cause of systemic hypertension and sinus bradycardia? A case report and literature review.

J Res Med Sci 2011 Jan;16(1):115-8

Department of Neurology, Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

A middle aged woman, having a history of diastolic hypertension and sinus bradycardia since one year ago, was referred to our center with a sudden occipital headache after shouting. To evaluate the cause of headache the brain MRI was performed reporting a slight cerebellar tonsillar herniation of about one centimeter below the foramen magnum. After the patient was diagnosed to have type I Chiari malformation, a surgery procedure was done and the symptoms were recovered after that.Type I Chiari malformation is a disease mostly caused by congenital displacement of cerebellar tonsils through the foramen magnum. The most common symptom is headache, rarely reported with hypertension or sinus bradycardia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063427PMC
January 2011