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Search Results: 1 - 10 of 494 matches for " Jalal Jalal Shokouhi "
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CSF Leakage "Radiology, Neuroradiology and Head and Neck, ENT"
Jalal Jalal Shokouhi
Iranian Journal of Radiology , 2009,
Abstract: Introduction: Leak of CSF is a relatively common complication in skull base fractures and it is rarely seen during skull base tumors and pituitary gland pathologies "Adenomas and empty sellae syndrome"."nThe common site of CSF leakage is related to the site of fracture but it is more common in cribriform plate fractures. Other sites are frontal sinus fractures and rarely sphenoid sinus lesions related to pituitary gland site pathology. Evaluation of the cribriform plate and the posterior wall of the frontal sinus is an imaging key point."nOther rare conditions of CSF leak are related to temporal bone fractures leading to otorrhea and in a paradoxical feature with rhinorrhea "intact tympanic membrane with temporal bone fracture and eustachian tube transmission of fluid"."nEthiology "nTrauma and skull base fractures epecially in the cribriform plate."nParanasal sinus fractures specially in the frontal and sphenoidal sinuses."nTemporal bone fractures."nEmpty sellae and intrasellar tumors."nPost-op stage in the skull base tumors."nDiagnosis"nNasal CSF leakage laboratory."nRadioneucleid imaging: This way is sensitive but non-specific."nMethylen blue injection into CSF via lumbar puncture "non-specific" and rarely used."nHigh resolution axial, coronal and sagittal reconstructed images of skull base as a modality of choice"nIn case of positive CSF leak but negative spiral ultra-high resolution CT in PNS, ethmoidal region and cribriform plate also temporal bone cuts we need linear and pleuridirectional X-ray tomography."nIn case of positive CSF leakage and negative radiology and imaging it needs exploration surgery to direct vision of anterior fossa floor bones for fracture."n-Companion complication could be recurrent meningitis."n- No 3D-CT or MRI is necessary for bone fractures but MRI could be"nnecessary for related brain contusion or soft tissue lesions and tumor."nX-ray CT-cisternography"nAlthough more than 90% of fractures could be detected by multidirectional ultra-high resolution bone CT of the skull base, CT-cisternography is used to show the CSF leak point and CSF reservoir in sinuses or ethmoidal cells."n- In our experiments all positive cases diagnosed by CT-cisternography were detected by UHRCT of the bone and no positive cisternography was detected after negative plain UHRCT."nCoronal UHRCT is the more important and sensitive method mode for the diagnosis of the leak point."nInjection of 15cc non-ionic contrast media like ultravist 300 into CSF via lumbar puncture increases about 100-110 hounsfield units density of leaked CSF via active leak point
Brain Tumors and Neurosurgeon Neuroradiologist Relations
Jalal Jalal Shokouhi
Iranian Journal of Radiology , 2009,
Abstract: "nToday the modality of choice for brain tumors is MRI with and without GD. "nGD injection needs during to stage T1, before injection and after injection for image subtracts to see the enhancement degree, detecting crystallized calcification, colloid and fat material also methemoglubin inside the tumor. "n- In case of thin layer seeding, GD MRI could be positive but T2 and FLAIR images could be negative "no mass effect". "n- For meningiomas if you do not want to inject contrast media please request plain CT SCAN that is stronger than non-contrasted MRI but GD MRI is the choice and better than both. "n- For small or micro-vestibular schwannoma do not request CT please request MRI with GD. "n- In craniopharyngioma request non-contrast CT with combination of MRI with and without GD. "n- For micro-adenoma request dynamic MRI "better than Dynamic CT" "n- please do not use axial CT and non-contrasted coronal CT for micro-adenoma". "n- Few infiltrative non-enhancing tumors need serial MRI to be differentiated from CVA. "n- For differentiation of tumor recurrency from radiotherapy necrosis MRS is necessary. "nOther lecture notes will be discussed in the round table.
Medical and Radiological Economy
Jalal Jalal Shokouhi
Iranian Journal of Radiology , 2009,
Abstract: Economy ride ahead of the world. "nAll human activities lead to financial problems. "nEconomy has two dimensions in usual daily commercial problems but medical and radiological economy is a tridimensional phenomenon. "nIn the two-dimensional economy, both sides, see their own benefits and fair "gains" but in the medical and radiologic economy, the patient gives us money and gets health. We protect the patient’s benefits by controlling the complications and consequently his/her future. This means we are not looking for our benefits only. "n19% of WHO payments are by private insurance companies, 25% by social insurance companies, 18% out of packet or with no payment, 34% by governments and 4% by others. "nIn undeveloped countries 20-25% of health payments are dedicated for 1% of the people, 60%of the payment for 10% of the people and 20% for the other 89% of the nation. Today most of our people are young but after 3-4 decades our people or the Iranian society turns into a gray category or old population. "nPercentage increase in health budget from 1960 to1997 was 12% in Japan, 10% in Germany, 9.5% in France, 9.4% in the USA, 8.5% in Canada, 8.2% in England and 7.5% in Newzealand. "nThe number of physicians for 1000 population is 3.4 in Germany, 2.9 in France, 2.6 in the USA, 2.1 in Canada, 1.8 in Japan and 1.7 in the UK. "nHospital beds for 1000 population in year 2003 was minimum 3.1 in Finland and maximum 12.3 in Japan. "nBy 1996: Number of X-ray CT scan for 1000.000 population is 69.7 in Japan, 26.9 in USA, 18.4 in Australia, 16.04 in Germany,9.4 in France, 7.9 in Canada and 6.3 in England. "nFrom 1995 to 1996: Number of MRI for 1000.000 population is 18.8 in Japan, 16 in the USA, 5.7 in Germany, 3.4 in the UK, 2.9 in Australia, 2.3 in France and 1.3 in Canada. "nFee for service is very low in our country and any investment or business is better than medical investment, especially radiology investment. "nPrescriptions for the future in developed countries or future humanity are: "nComputerized physician order entry "nEstablishing and increasing document imaging "nIndividual health registry "nSale systems should be clear and useful "nNational and innovation roles for patients "nUsing information and information technology "I.T" for balance and increase quality of health. "nUsing bar codes in the health system.
CNS Cavernous Hemangioma; Imaging, Clinical Presentation and Related Anatomophysiology
Jalal Jalal Shokouhi,Aliakbar Ameri
Iranian Journal of Radiology , 2009,
Abstract: "nClinical and imaging judgement or decision: "n- Is it a CH “CM, CA“? "n- Is it solitary, multiple or familial? "n- Is there an associated venous malformation? "n- Are there risks and consequences of hemorrhage? "n- Is the anatomic location critical and life threatening? "nCavernous malformation is a low pressure, slow flowing malformation and composes 10 – 15 % of vascular malformations. Cavernous angioma consists of enlarged sinusoidal vascular spaces, a compact mass in the brain and spinal cord, the endothelial lining is weak and blood element leakage is frequent.Calcification is possible "X – ray CT ". 75% located in the brain and 25 % in the posterior fossa and brain stem. "nAll 50% of cases are multiple and this form is familial in 80 % of cases “possibility combined with cord cavernoma“. "nExtra – medullary and extra – paranchymal forms are rare. "n- 40-60 % of the patients demonstrate seizure because of hemorrhage inside the cavernoma. "n10 – 15 % of complicated patients show significant clinical signs especially in the brain stem."n Imaging: "n1- X-ray CT: Isodense or hyperdense with frequent and heavy calcification . "nEnhanced CT may show the degree of enhancement. "n2 – By MRI: T1 may be isointense but in case of hemorrhage there is bright methemoglobin inside. By T2 and flair a thin capsule and a rim of hemosiderin – ferritin "popcorn or mulberries" and shows enhancement "GD-GRE-MRI pulse". "nCompanion of venous angioma and cavernoma is possible. "nBleeding is more likely from cavernous malformations during pregnancy. "nConclusion: CT and MRI demonstrate all forms and sites of brain and spinal cord cavernomas. "nAttention is necessary for brain stem lesions especially during pregnancy."n Treatment: 1- Medial and serial MRI controls. "n2- Radiosurgery "Gama-knife", rare. "n3- Microsurgery, very rare Multiple forms of these lesions are demonstratable in 55 patients.
Orbit as a Mirror of Systemic Disease; '' Epidemiologic, Clinical and Imaging ''
Aliakbar Ameri,Jalal Jalal Shokouhi
Iranian Journal of Radiology , 2009,
Abstract: "n1- Infectious: toxoplasmosis , toxocariasis ,TB , syphilis , leprosy , HIV , CMV. "n2- Non infectous: endocrine, diabetes, thyroid, connective tissue disease ''RA, SLE, wegeners, PAN, systemic sclerosis'', vasculitides, GCA'', sarcoidosis, behcet's disease, vogt koyangi harada syndrome, phakomatoses. "nAll diseases should be demonstrated by clinical images and imaging slides. "n-imaging "nX-RAY, high frequency US and color doppler, 2D and 3D X-RAY CT, MRI: "n1- X-RAY: in fractures, foreign bodies, skull combined anomalies and few other cases. "n2-High-frequency ultrasound for posterior chamber and ciliary body micro-anatomic changes '' tumors granulations''. "nColor Doppler study for vascular lesions, central retin artery, tumors in the globe and retrobulbar region. "n3- X-RAY CT for tumors, 2D and 3D for fractures, 3D for bone anatomy, foreign body '' modality of choice is 2directional 2D CT scan '', sino-nasal diseases, CT-angiography or phlebography in large vessel evaluation, DSA for small vessel anatomy. "n4- MRI for tumors and infection also granulation process. "nMRI and MRV in large vessel anatomy, functional – MRI for the visual pathway, tractography. "nConclusion : "nModality of choice : "n1- CT for foreign bodies '' MRI is contra-indicated in the first step specially in metallic fragments ''. CT for micro-calcification '' retinoblastoma '',CT for fractures. "n2- MRI for tumors, biometry, soft tissue disease and functional imaging. "n3- DSA for vascular disease of the eye. "n4- U.S for biometery, posterior Chamber, iris and ciliary body lesions. 5- Fluorescein angiography for the retina.
Black, White and Grey
Nasrin Nooshfar,Jalal Jalal Shokouhi,Shahryar Pashae
Iranian Journal of Radiology , 2011,
Abstract: Background/Objective: Development of science and"nart achieved with saving independence, separation"nclassification and studying their details. The other hand"nis combination of these to create a new world with"nwide dimensions and take a place to human needs."nMaterials and Methods: Our attempt is to make"nhealth-care places pleasant and attractive for patients."nWe offer best services, but they are not comfortable"nand happy in these places. They are afraid of the staff,"nequipment and the environment. For this purpose"nwe mixed the brightness and darkness of radiologic"nimages with white and black photographs or paintings"ncomplementary to create analog artistic images that"ncould be converted to digital printing by DICOM"ninterfaces on hard copies."nConclusion: Fear, pictures a bad memory in the"npatient's mind forever. We mixed radiology and"nimaging with photography as a science and art mixture"nto conflict with these problems, it is more effective in"nchildren who are suffering from social and known"ndiseases and can not adapt themselves with their"nsituations. This could create a good memory between"nthe human body image and sentimental experience."nIn the literature, printed radiologic images were used"nas fine art on glass and paper, metal and flowers were"nemployed to mix.* *Wim Delvoye (born 1965 ,Wervik)"nand Steven N.Meyers and Merille Raikes
Evidence-Based Radiology: A New Approach to the Practice of Radiology
Kombiz Steadie Seifi,Jalal Jalal Shokouhi,Abdolrasul Sedaghat,Mansoor Fatehi
Iranian Journal of Radiology , 2011,
Abstract: Over the past three decades, the medical community"nhas increasingly supported the principle that clinical"npractice should be based on critical evaluation of the"nresults obtained from medical scientific research."nEvidence-based medicine (or health care) involves the"nmore formal integration of the best research evidence"nwith clinical expertise and explicit acknowledgement of"npatient values in clinical decision making, as compared"nwith conventional practice. Today this evaluation is"nfacilitated by the internet which provides instantaneous"nonline access to the most recent publications even"nbefore they appear in print form. More and more"ninformation is solely accessible through the internet"nand through quality- and relevance-filtered secondary"npublication (meta-analyses, systematic reviews and"nguidelines)."nThis principle - a clinical practice based on the results"n(the evidence) given by research - has engendered a discipline, evidence-based medicine (EBM), which is"nincreasingly expanding into healthcare and bringing a"nstriking change in teaching, learning, clinical practice"nand decision making by physicians, administrators"nand policy makers. In radiology practice, including"ndiagnostic and interventional aspects, this discipline"nhas received limited attention. EBM has entered"nradiology with a relative delay, but a substantial impact"nof this is expected in the near future."nThe aim of this article was to provide an overview of"nEBM in relation to radiology and to suggest a policy for"nthis principle in the Iranian radiology community for"nresidential education, research and at last conventional"npractice.
CT-Guided Trigeminal Neuralgia in MS
Jalal Jalal Shokouhi,Abdolhamid Hosseinnia,Reza Bakhshandehpour,Shahryar Pashae
Iranian Journal of Radiology , 2011,
Abstract: Background/Objective: Multiple sclerosis has nonspecific"nsigns in MR images and clinic and also has pain,"none of the pain syndromes in MS cases is trigeminal"nneuralgia. 12 patients of our 38 trigeminal neuralgic"npatients etiology were known as MS cases. All of them"nwere young (20-40 years old)."nIntroduction: Multiple sclerosis diagnosis is by clinic,"nMRI, CSF electrophoresis and evocked potensial tests."nImaging diagnostis is not suggestive and specific but in"nthis article we show imaging help not only in diagnosis"nalso in treatment of complications. Trigeminal neuralgia"nis the worse clinical condition in M.S patients and may"npush them to addiction or suicide."nMaterials and Methods: X-ray CT machine is used for"nguidance of L.P or coaxial 10cm needle with 22G, local"nanesthesia and ethanol injection. One time treatment"nmade for all patients and they were pain free after"ninterventional drug injection. 5-6 cc bupivicain 0.5%"nand 3-4cc ethanol 96% are used for treatment."nResults: All patients were pain free and very happy"nafter treatment. One of them had pain for 12 years"nand had tried all the other treatments with no good"nresponse. No complication was seen in our treatments."n15 to 20 minutes time is needed for each examination"nor treatment."nConclusion: Despite known MS cases and relative"ndrug therapies for patients it is not possible to treat"ntrigeminal paint except using interventional therapy"nand CT-guidance is exactive and easy. There was"nno complication except irritation in the middle ear"nbecause of Eustachian tube compression by injected"nvolume of drugs
Image Guided Clinical Correlation of CDH and Calve-Legg-Perthes Disease
Mohammad Hossein Herischi,Jalal Jalal Shokouhi,Shahyar Pashae,Hamid Mirbagheri
Iranian Journal of Radiology , 2011,
Abstract: Background/Objective: Anatomic condition and"nvascularization of the femoral head leads to Calve-"nLegg-Perthes disease (avascular necrosis in children)"nand primary condition of acetabulum and coverage"nof hip joint as a defect, cause CDH or congenital"ndislocation of the hip joint. Early diagnosis of these"ndiseases in clinic, confirmation by imaging (US, Xray,"nX-ray CT and MRI) help better treatment and less"ncomplication or sequel."nPatients and Methods: By two decade evaluation and"ntreatment we used clinical assessments by pediatric"northopedic surgeons and radiologic examinations like"nfrog-leg, AP X-rays, ultrasound examinations, 2D"nand 3D X-ray CT and 1.5 tesla MR-machine images."nTreatments were with fixation (using cast and elizarov"nvariant fixators), surgery and controlling by imaging."nResults: Ultrasound and MRI were the best methods"nin diagnosis, image guided treatment (medical or"nsurgical) and treatment controlling. Many patients"nare treated with minor complications. Complications"nare rare in CDH but some complications have been"nmentioned for CLP disease."nConclusion: Image guidance in diagnosis and treatment"nalso treatment control of pediatric CDH and CLP"ndisease give the pediatric orthopedic surgeon a good"noutcome of the disease and its treatment. Ultrasound"nand MRI using highly sophisticated probes, coils and"nprotocols with new machines gives us the best result"nin diagnosis, treatment and post-op controls.
Vertigo Imaging; Clinical Radiology'
Jalal Jalal Shokouhi,Abdolhamid Hosein Nia,Aliakbar Ameri
Iranian Journal of Radiology , 2009,
Abstract: "n- Dizziness that patients complain from are rotational vertigo, sense of instability, ataxia of gait, disturbance of vision, loss of contact with surroundings, nausea, loss of memory, loss of confidence, epileptic convulsion and dizziness that is considered by medical staff are: "n1- Vertigo as a sense of feeling the environment moving when it does not persist in all positions, aggravated by head movement. "n2- Disequilibrium as a feeling of unsteadiness or insecurity without rotation, standing and walking are difficult. "n3- Light headedness as swimming, floating, giddy or swaying sensation in the head or in the room. "nTaking the history from a vertigo patient:* "n What the patient means by vertigo?- "n- Time of onset "n-Temporal pattern "n-Associated signs and symptoms '' tinnitus, hearing loss, headache, double vision, numbness and difficulty in swallowing ''. "n- Precipitating, aggravating and relieving factors. "n- If episodic: sequence of events, activity at onset, aura, severity and amnesia. "n*Examination of the vertigo patient checking: "nSpontaneous nystagmus, positional nystagmus, optokinetic nystagmus, posture and balance control like romberg's test, blind walking, untenberger and barany's test, stimulation of labyrinth, caloric test '' cold, warm water '' and the rotational test. "nEtiology : "n*Spontaneous nystagmus: "nPosture and balance control is positive with nausea , vomiting , sweating and anxiety : harmonic vestibular sy with loss of hearing , tinnitus , vestibular neuronitis , meniere disease and with otologic origin and dysharmmonic vestibular sy , with numbness , double vision , dysarthria in brain stem infarct and with a neurological origin. "nNonspontaneous nystagmus :Posture and balance negative with nausea, vomiting in GI disorders and internal medicine , sweating and trachycardia by chest pain in angina , M.I '' cardiology '' and anxiety in psychiatry. "n- Clinical differentiating of peripheral and central vestibular lesion should be done by separating harmonic and disharmonic vestibular syndrome. "n- Examination of the patient with vertigo '' laboratory and imaging'' "n Electronystagmography "n Video-oculography "n Audiometry "n BAEP "n CT "n MRI "n - Common cause of vertigo '' all by image '' "nPeripheral: Physiological '' motion sickness'', benign paroxysmal positional vertigo , vestibular neuronitis , labyrinthitis , meniere disease , perilymph fistula. "nCentral: Brain stem TIA/infarct , post. fossa tumors , M.sclerosis, syringobulbia ,Arnold -chiari , temporal lobe epilepsy and basilar migraine. "nOther
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