Initial experience with Scepter Mini dual lumen balloon for embolization of cerebrovascular diseases

Objective@#Endovascular treatment of cerebrovascular diseases is often challenging due to small caliber, tortuous distal vessels. Several devices and techniques have evolved to overcome these challenges. Recently, a low profile dual lumen microballoon catheter, specifically designed for distal navigation is employed for neurovascular procedures. Due to its recent advent, scarce data is available on clinical utility and safety of Scepter Mini. The aim of this case series is to report our initial experience with Scepter Mini in the management of various cerebrovascular diseases. @*Methods@#All interventional neurovascular cases performed using Scepter Mini between January 2020 till April 2021 were included. Data regarding patient demographics, procedural details and complications was retrospectively collected from patient’s electronic medical record and procedure reports. @*Results@#Total twelve embolization procedures were performed in eleven patients, including six brain arteriovenous malformation, two dural arteriovenous fistula, one vein of Galen malformation and three hyper-vascular glomus tumor embolizations. All procedures were successfully performed with adequate penetration of the embolic agent. Complete embolization was performed in six procedures, while intended partial embolization was performed in the rest of procedures. Scepter Mini was solely used in ten procedures, however in the other two embolization procedures it was used as an additional conjunct tool to complete the intended embolization. No balloon related complication was observed in any procedure. @*Conclusions@#Scepter Mini dual lumen microballoon catheter is safe and feasible for delivery of liquid embolic agents for cerebrovascular embolization procedures.

Spectral analysis, in vitro cytotoxicity and antibacterial studies of bioactive principles from the leaves of Conocarpus lancifolius, a common tree of Jazan, Saudi Arabia

Abstract The objective of the present study was to analyse the bioactive compounds of the leaves of Conocarpus lancifolius (C. lancifolius). The GC-MS analysis of the hot methanolic extract of the leaves (HMEL) of C. lancifolius exhibited the bioactive compounds such as 1-(3-Methoxy-2-nitrobenzyl) iso quinoline, morphin-4-ol-6,7-dione, 1-bromo-N-methyl-, phytol, hexadecanoic acid, 2,3-dihydroxypropyl ester, 2,2':4',2-terthiophene, ethyl iso-allocholate, caryophyllene oxide, campesterol, epiglobulol, cholestan-3-ol, 2-methylene-, (3á,5à)-, dasycarpidan-1-methanol, acetate (ester) and oleic acid, eicosyl ester. The FT-IR analysis of HMEL of C. lancifolius showed a unique peak at 3184, 2413, 1657 cm-1 representing coumaric acid, chlorogenic acid and ferulic acid. The HMEL of C. lancifolius was actively inhibiting the proliferation of breast cancer cells MCF-7 ATCC at the concentration of 72.66 ± 8.21 µg/ml as IC50 value. The HMEL of C. lancifolius also revealed a good spectrum of activity against Gram-positive and Gram-negative bacterial cultures screened in this work. The activity observed has shown more or less similar effects against screened bacteria. However, the magnitude of potentiality was significantly lesser compared to standard ciprofloxacin disc at p 0.001 level (99% confidence intervals). Furthermore, the study demonstrating the bioactive compounds can be isolated from the leaves of C. lancifolius.

Resumo O objetivo do presente estudo foi analisar os compostos bioativos das folhas de Conocarpus lancifolius (C. lancifolius). A análise por GC-MS do extrato metanólico quente das folhas (HMEL) de C. lancifolius exibiu os compostos bioativos como 1- (3-Metoxi-2-nitrobenzil) isoquinolina, morfina-4-ol-6,7- diona, 1-bromo-N-metil-, fitol, ácido hexadecanoico, 2,3-di-hidroxipropil éster, 2,2 ': 4', 2 - tertiofeno, isoalocolato de etil, óxido de cariofileno, campesterol, epiglobulol, colestano -3-ol, 2-metileno-, (3á, 5à) -, dasycarpidan-1-metanol, acetato (éster) e ácido oleico, éster eicosílico. A análise FT-IR de HMEL de C. lancifolius mostrou um pico único em 3184, 2413, 1657 cm-1 representando ácido cumarico, ácido clorogênico e ácido ferúlico. O HMEL de C. lancifolius inibiu ativamente a proliferação de células de câncer de mama MCF-7 ATCC na concentração de 72,66 ± 8,21 µg / ml como valor de IC50. O HMEL de C. lancifolius também revelou bom espectro de atividade contra culturas de bactérias Gram-positivas e Gram-negativas rastreadas neste trabalho. A atividade observada mostrou efeitos mais ou menos semelhantes contra bactérias rastreadas. No entanto, a magnitude da potencialidade foi significativamente menor em comparação com o disco de ciprofloxacina padrão em nível de p 0,001 (intervalos de confiança de 99%). Além disso, o estudo demonstrando os compostos bioativos pode ser isolado das folhas de C. lancifolius.

Spectral analysis, in vitro cytotoxicity and antibacterial studies of bioactive principles from the leaves of Conocarpus lancifolius, a common tree of Jazan, Saudi Arabia / Análise espectral, citotoxicidade in vitro e estudos antibacterianos de princípios bioativos das folhas de Conocarpus lancifolius, uma árvore comum de Jazan, Arábia Saudita

Abstract The objective of the present study was to analyse the bioactive compounds of the leaves of Conocarpus lancifolius (C. lancifolius). The GC-MS analysis of the hot methanolic extract of the leaves (HMEL) of C. lancifolius exhibited the bioactive compounds such as 1-(3-Methoxy-2-nitrobenzyl) iso quinoline, morphin-4-ol-6,7-dione, 1-bromo-N-methyl-, phytol, hexadecanoic acid, 2,3-dihydroxypropyl ester, 2,2':4',2"-terthiophene, ethyl iso-allocholate, caryophyllene oxide, campesterol, epiglobulol, cholestan-3-ol, 2-methylene-, (3á,5à)-, dasycarpidan-1-methanol, acetate (ester) and oleic acid, eicosyl ester. The FT-IR analysis of HMEL of C. lancifolius showed a unique peak at 3184, 2413, 1657 cm-1 representing coumaric acid, chlorogenic acid and ferulic acid. The HMEL of C. lancifolius was actively inhibiting the proliferation of breast cancer cells MCF-7 ATCC at the concentration of 72.66 ± 8.21 µg/ml as IC50 value. The HMEL of C. lancifolius also revealed a good spectrum of activity against Gram-positive and Gram-negative bacterial cultures screened in this work. The activity observed has shown more or less similar effects against screened bacteria. However, the magnitude of potentiality was significantly lesser compared to standard ciprofloxacin disc at p< 0.001 level (99% confidence intervals). Furthermore, the study demonstrating the bioactive compounds can be isolated from the leaves of C. lancifolius.

Resumo O objetivo do presente estudo foi analisar os compostos bioativos das folhas de Conocarpus lancifolius (C. lancifolius). A análise por GC-MS do extrato metanólico quente das folhas (HMEL) de C. lancifolius exibiu os compostos bioativos como 1- (3-Metoxi-2-nitrobenzil) isoquinolina, morfina-4-ol-6,7- diona, 1-bromo-N-metil-, fitol, ácido hexadecanoico, 2,3-di-hidroxipropil éster, 2,2 ': 4', 2 " - tertiofeno, isoalocolato de etil, óxido de cariofileno, campesterol, epiglobulol, colestano -3-ol, 2-metileno-, (3á, 5à) -, dasycarpidan-1-metanol, acetato (éster) e ácido oleico, éster eicosílico. A análise FT-IR de HMEL de C. lancifolius mostrou um pico único em 3184, 2413, 1657 cm-1 representando ácido cumarico, ácido clorogênico e ácido ferúlico. O HMEL de C. lancifolius inibiu ativamente a proliferação de células de câncer de mama MCF-7 ATCC na concentração de 72,66 ± 8,21 µg / ml como valor de IC50. O HMEL de C. lancifolius também revelou bom espectro de atividade contra culturas de bactérias Gram-positivas e Gram-negativas rastreadas neste trabalho. A atividade observada mostrou efeitos mais ou menos semelhantes contra bactérias rastreadas. No entanto, a magnitude da potencialidade foi significativamente menor em comparação com o disco de ciprofloxacina padrão em nível de p < 0,001 (intervalos de confiança de 99%). Além disso, o estudo demonstrando os compostos bioativos pode ser isolado das folhas de C. lancifolius.

Wound-healing and cytokine-modulating potential of medicinal oil formulation comprising leaf extract of Murraya koenigii and olive oil / Potencial de cicatrização de feridas e modulação de citocinas de formulação de óleo medicinal compreendendo extrato de folhas de Murraya koenigii e azeite de oliva

The study investigated the wound healing effect of medicinal oil (MO) formulation prepared from Murraya koenigii leaves extract (methanolic) incorporated in olive oil. The MO was visually transparent, homogenous, smooth in texture, the viscosity grade was observed as 140 cP and easily spreadable. Pro-inflammatory cytokines IL-1ß, IL-6, and TNF-α were significantly reduced to 82.3 ± 3.5, 156 ± 6.2, 137.3. ± 5.5 pg/ml, respectively after treatment with MO when compared to disease control animals that showed IL-1ß, IL-6, and TNF-α levels of 170 ± 6, 265 ± 7, and 288.6 ± 11, pg/ml respectively. The level of pro-inflammatory cytokine in povidone iodine solution (PIS) group was 95.3 ± 3, 162 ± 6, 177.6 ± 8.9 pg/ml of IL-1ß, IL-6, and TNF-α respectively. Interestingly, the wound-healing efficacy of MO was found better as compared to povidone iodine treated standard group and concluded that MO has excellent wound healing effect.

O estudo investigou o efeito cicatrizante da formulação de óleo medicinal (MO) preparado a partir do extrato de folhas de Murraya koenigii (metanol) incorporado ao azeite de oliva. O MO era visualmente transparente, homogêneo, de textura lisa, o grau de viscosidade observado foi de 140 cP e facilmente espalhável. As citocinas pró-inflamatórias IL-1ß, IL-6 e TNF-α foram significativamente reduzidas para 82,3 ± 3,5, 156 ± 6,2, 137,3. ± 5,5 pg/ml, respectivamente, após o tratamento com MO quando comparados aos animais controle da doença que apresentaram níveis de IL-1ß, IL-6 e TNF-α de 170 ± 6, 265 ± 7 e 288,6 ± 11, pg/ml, respectivamente . O nível de citocina pró-inflamatória no grupo solução de iodopovidona (PIS) foi de 95,3 ± 3, 162 ± 6, 177,6 ± 8,9 pg/ml de IL-1ß, IL-6 e TNF-α, respectivamente. Curiosamente, a eficácia de cicatrização de feridas de MO foi encontrada melhor em comparação com o grupo padrão tratado com iodopovidona e concluiu que a preparação de MO tem efeito de cicatrização de feridas.

Salvage flow diverter stent across the posterior communicating artery for persistent retrograde filling of a giant internal carotid artery aneurysm after parent vessel occlusion

Giant internal carotid artery (ICA) aneurysms are complex vascular lesions which are difficult to treat with open as well as endovascular surgery. Parent vessel occlusion is a well-established treatment option for such aneurysms. However, there have been a few reported cases of ruptured aneurysms related to the persistent retrograde filling after parent vessel occlusion. We report a case which highlights the usage of the flow diverter stent as a potential treatment strategy for the management of retrograde filling of aneurysms. A 54-year-old female was found to have a giant left ICA aneurysm on a brain magnetic resonance imaging during workup for headaches. She underwent occlusion of the left ICA proximal to the aneurysm using multiple coils. However, follow up angiograms after 6 months and 2 years demonstrated persistent retrograde filling of the left ICA aneurysm through the posterior communicating (PCOM) artery. Eventually, she was successfully treated with a flow diverter stent across the PCOM artery into the distal ICA. Follow up angiogram after 6 months showed patent flow in the PCOM artery and the distal ICA. with complete occlusion of the aneurysm. Using a flow diverter stent after insufficient parent vessel occlusion for giant intracranial aneurysms may be a feasible treatment option and an addition to the neurovascular treatment armamentarium.

Salvage flow diverter stent across the posterior communicating artery for persistent retrograde filling of a giant internal carotid artery aneurysm after parent vessel occlusion

Giant internal carotid artery (ICA) aneurysms are complex vascular lesions which are difficult to treat with open as well as endovascular surgery. Parent vessel occlusion is a well-established treatment option for such aneurysms. However, there have been a few reported cases of ruptured aneurysms related to the persistent retrograde filling after parent vessel occlusion. We report a case which highlights the usage of the flow diverter stent as a potential treatment strategy for the management of retrograde filling of aneurysms. A 54-year-old female was found to have a giant left ICA aneurysm on a brain magnetic resonance imaging during workup for headaches. She underwent occlusion of the left ICA proximal to the aneurysm using multiple coils. However, follow up angiograms after 6 months and 2 years demonstrated persistent retrograde filling of the left ICA aneurysm through the posterior communicating (PCOM) artery. Eventually, she was successfully treated with a flow diverter stent across the PCOM artery into the distal ICA. Follow up angiogram after 6 months showed patent flow in the PCOM artery and the distal ICA. with complete occlusion of the aneurysm. Using a flow diverter stent after insufficient parent vessel occlusion for giant intracranial aneurysms may be a feasible treatment option and an addition to the neurovascular treatment armamentarium.

Evaluation of topoisomerase II, ki-67, and P53 expression in non-muscle-invasive urothelial carcinoma and their clinical significance

Background: Transurethral resection of tumor is the main treatment of non-muscle-invasive urothelial carcinoma, but it is associated with high rate of recurrence and/or progression and this arouses the need for adjuvant therapy. Topoisomerase II (Top II), KI-67, and P53 are proliferation and cell cycle regulation markers that may predict tumor response to therapy. Aim: This study aimed to assess Top II, KI-67, and P53 expression and their effect on clinical outcome and response to therapy of non-muscle-invasive urothelial carcinoma. Materials and Methods: Fifty cases of non-muscle invasive urothelial carcinoma were collected; Top II, KI-67, and P53 expression was evaluated. Patients received treatment then tumor recurrence was correlated with the expression of previous markers. Results: There was a significant association between high Top II score, P53, and KI-67 and high tumor grade (P = 0.0001, 0.001, and 0.0001), submucosal infiltration (P = 0.0001 and 0.01), and recurrence (P = 0.01, 0.001, and 0.001). Conclusion: Top II, P53, and KI-67 may predict tumor response to therapy and the clinical outcome in non-muscle-invasive urothelial carcinoma.

Unilateral maxillary distomolar with multiple abnormalities in a young patient: A rare case report with mini systemic review

Supernumerary teeth are those teeth present in addition to the normal number of teeth and are mostfrequently seen in the maxillary incisors and molar regions. In the molar regions, supernumerary teethare divided into two types depending on their location: distomolars and paramolars. Distomolarsusually occur in the form of a fourth molar distal to the third molar. Distomolars are a developmentalanomaly and have been argued to arise from a combination of genetic and environmental factors.Therefore, distomolar management should be part of a comprehensive treatment plan. This articlepresents a case report of an unusual occurrence of a rare unilateral distomolar in the right of themaxilla with multiple abnormalities in a 21-year old healthy subject. In addition, a mini literaturereview includes the definition, types, prevalence, classification, etiology, complications, diagnosis,and therapeutic strategies, which may be adopted in the occurrence of distomolars.

Evaluation of undergraduate dental students in typodont preparation for all-ceramic crowns

Background: All-ceramic crown (ACC) preparations are widely used in day-to-day dentalclinical practice. Objectives: This study aimed to evaluate all-ceramic crown preparationsperformed by pre-clinical dental students at the College of Dentistry, Jazan University inSaudi Arabia and to compare the quality of the preparations between male and female groups.Materials and Methods: A total of 95 ivory teeth were prepared by fourth-year dentalstudents (44 males, 51 females). The students prepared a maxillary right central incisor forACC after mounting in the Frasaco typodont arches. Two silicone putty indexes for maxillaryanterior were obtained that extended to cover one or two teeth on either side. The facial indexwas used to provide information about the facial reduction mesio-distally. Another index wasprepared by cutting the silicone in half along the faciolingual midline of the prepared tooth,providing us with incisal, buccal, palatal, and axial reductions, in addition to biplanereduction. The data were encoded into a Statistical Package for Social Sciences program andanalyzed accordingly using Chi-square test. Results: The preparations of ACC for maxillaryanterior teeth were acceptable, ranging within 60%-85% in all criteria, which includedstructural durability, retention, and resistance. The male group was more excellent in incisalreduction (41.0%), whereas the female group was more excellent in axial taper preparations(59.1%), resulting in significant differences between genders in this preparation criteria. Allgender groups showed acceptable tooth preparations in shoulder reductions and location offinish lines, ranging within 57%-89%. Conclusion: The preparations for ACC achieved bythese dental students were considered clinically acceptable. The students clearly understoodthe principles of crown preparation. However, they still require more practice in order tomaster the art of crown preparation.

Disease-modifying drug possibly linked to placental insufficiency: Severe placental complications in a pregnant woman with multiple sclerosis

Disease-modifying drugs [DMDs] such as interferon [IFN]-? and glatiramer acetate are often prescribed to slow disability progression in patients with multiple sclerosis [MS]. However, adverse pregnancy outcomes have been reported with these medications. We report the rare occurrence of severe placental complications in a 30-yearold pregnant woman with MS who continued to take IFN-? during her first trimester. She presented at the Tawam Hospital, Al Ain, United Arab Emirates, in 2013 with early-onset fetal growth restriction. At 30 gestational weeks, she developed severe pre-eclampsia. The baby was delivered via emergency Caesarean section and was discharged at the age of two months. Continuation of IFN-? during pregnancy may have contributed to the development of placental insufficiency in this patient. Increased education regarding the risks of DMDs for pregnant patients with MS is very important to ensure successful pregnancy outcomes

Study of Serum Insulin Level in Hypertensive Patients.

Background and aims: Hypertension is a frequent and almost ubiquitous health disorder, prevalent both in developed and developing countries. Hyperinsulinemia and insulin resistance have been suggested to be closely associated with the pathogenesis of essential hypertension. However there is considerable controversy in this regards. The present study was designed to explore the relationship between serum insulin and serum ionized calcium in non diabetic and diabetic hypertensive subjects. Subjects and Methods: A total of 57 hypertensive and diabetic hypertensive patients attending out patients department of the BIRDEM and NICVD were included in the study. Fasting serum glucose was measured by glucose oxidase method, lipid profile was measured by enzymatic method. Serum insulin was measured by Enzyme Linked Immunosorbent assay (ELISA) method and serum ionized calcium by the Ion Sensitive Electrode (ISE) technique. Results: Glucose-insulin ratios were calculated as the index for insulin. Serum insulin (pmol/ml), Mean ± SD, 147 ± 48 in DC and 170 ± 80 in DH groups vs 118 ± 21 in NC and 120 ± 41 in EH groups, p= 0.023 and p= 0.031 respectively. Although, from the serum insulin results, the diabetic groups seemed to have insulin resistance, the glucose-insulin ratios in the two groups were significantly lower compared to nondiabetic groups (Glucose-insulin ratio, mmol/pmol, 0.066 ± 0.025 in DC, 0.074 ± 0.025 in DH vs 0.044 ± 0.11 in NC, 0.043 ± 0.012 in EH, p= 0.005 - 0.0001). The serum ionized calcium in the healthy subject, first time reported in the country by an up to date method (1.17 ± 0.05 M ± SD), were within the range found in healthy subjects of the other populations. No significant difference in the serum Ca2+ could be found between any of the study groups. Also, serum Ca2+ did not correlate with blood pressure, glucose or insulin in any of the study groups or with all the patients as a whole. Serum total cholesterol, triglyceride, HDLc and LDLc levels in the DC, EH and DH group did not show any significant difference compared to NC group and among the groups. The lipid abnormality as reflected by the mean LDL-HDL cholesterol ratios was the highest in the DH group but the differences were not statistically significant compared to the NC, DC and EH group. Conclusions: The data suggest the following conclusions: a) Serum ionized calcium level in our population is similar to that reported for other population. b) Serum glucose and insulin by themselves do not have any direct influence on serum ionized calcium. c) Non obese diabetes mellitus subjects in our population do not show insulin resistance as the primary defect. Rather, there is significant decompensation of the insulin secretory capacity in the subjects. d) Insulin resistance should be measured directly in relation to blood pressure and Ca2+ in appropriate groups of subjects to explore the relationship between insulin resistance, hyperinsulinemia and serum ionized calcium.

Mycological aspects of ostrich meat products with special reference to toxigenic moulds

Ostrich luncheon meat and frankfurter samples were produced locally in Egypt, and relatively highly contaminated by both moulds and yeasts and aflatoxin residues. The most frequently encountered fungi from the tested samples were yeasts genera [Candida, Rhodotorula, Torulopsis, Cryptococcus and Trichosporon] and moulds genera [Aspergillus, Penicillium and Cladosporium], less common were [Sacchromyces and Pichia] and [Fusarium and Mucor] Neither A.flavus nor A. Parasiticus were aflatoxin producer .Three ostrich meat product samples out of 30 analyzed were positive for aflatoxin Bl and Gl while all samples were negative for aflatoxin B2 and G2. Aflatoxin Bl was detected only in two and one samples out of 15 analyzed from each of ostrich luncheon meat and frankfurter respectively. The highest detectable level, 4.80 ppb, was recorded in luncheon meat sample and the least detectable level, 2.78 ppb was record in frank furter sample. Aflatoxin Gl at a concentration of 2.60 ppb was detected in only one sample while aflatoxin Bl contaminated two samples of ostrich luncheon meat; this sample also had the highest level of aflatoxin Bl. The hazardous potential of such contamination will be discussed

Fetal macrosomia greater than or equal to 4000 grains. Comparing maternal and neonatal outcomes in diabetic and nondiabetic women

To compare maternal and neonatal outcomes of fetal macrosomia in diabetic and nondiabetic women. A retrospective case-control study was conducted at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from January 2004 to December 2006. A total of 766 macrosomic newborns met the inclusion criteria. We compared maternal and neonatal characteristics and outcomes between diabetic [group 1, n=207] and nondiabetic [group 2, n=559] women. There were significantly more macrosomic newborns in nondiabetic women; 73% versus 27% in diabetic women, p=0.0001. Cesarean deliveries were significantly higher in diabetic women compared to nondiabetic women [30.4% versus 19.5%, p=0.002]. There were no significant differences between either group in total maternal morbidity [12.6% versus 14.1%, p=0.7]. There were significantly more severe cases of shoulder dystocia occurring in newborns of diabetic women compared to nondiabetic women [1.9% versus 0.2%, p=0.03]. Elective cesarean delivery for estimated fetal weight >/= 4500g for nondiabetic women and >/= 4250 g for diabetic women may avoid severe shoulder dystocia without increasing maternal morbidity rates

Percutaneous nephrostomy versus retrograde ureteric stenting in decompression of acutely obstructed and infected system

To compare the efficacy of percutaneous nephrostomy [PCN] with uretcral catheterizatin for renal drainage in cases of obstruction and infection. 42 patients were randomized between the two methods. The results of both groups were compared [procedural parameters, patient outcome, failure rate. etc]. Both methods effectively relieved obstruction and infection. The decision of which mode of drainage to be used may be based on surgeon preference

Cardiopatía isquémica con severo deterioro de la función ventricular: alternativas quirúrgicas / Ischemic cardiomyopathy with poor ventricular function: surgical options

El objetivo de este estudio fue evaluar los resultados de la cirugía de revascularización miocárdica y el trasplante cardíaco ortotópico en pacientes con cardiomiopatía isquémica y fracción de eyección de ventrículo izquierdo menor o igual 25 por ciento. Noventa y cuatro pacientes, con edad media de 55,4 ñ 20 años (27-74), 87 (92 por ciento) de sexo masculino, fueron evaluados por el Servicio de Trasplante e Insuficiencia Cardíaca. Se analizaron dos grupos: 48 pacientes (51 por ciento) pertenecientes al grupo de cirugía de revascularización miocárdica y 46 (49 por ciento) al grupo de trasplante cardíaco ortotópico (17 por ciento, 8 pacientes; p= 0,09). No hubo diferencias en la mortalidad hospitalaria y la supervivencia a 3 años en ambos grupos. Ambos métodos mejoraron la clase funcional de disnea y la función ventricular izquierda. La cirugía de revascularización miocárdica debería ser considerada el método de primera elección. Los pacientes con pobre clase funcional de disnea, mayor diámetro diastólico de ventrículo izquierdo y menor fracción de eyección no son buenos candidatos para la revascularización miocárdica. La cantidad de territorios viables predijo la mejoría de la función ventricular

Detection of venous valvular incompetence in primary varicose veins by the bi-directional doppler

Twenty patients, 15 males and 5 females, with primary varicose veins in 27 lower limbs were included in this study. Their ages ranged between 20 and 45 years. All patients were examined clinically and by the bi-directional Doppler to search for venous valvular incompetence in the communicating and superficial venous systems. At the saphenofemoral junction, clinical examination showed 3 limbs [11.1%] with false negative competent saphenofemoral valves, as proved by Doppler study. At the saphenopopliteal junction, this clinical examination showed only 2 limbs [4.7%] with false negative competent valves. As for the communicating venous valves, clinical examination showed 5 limbs [18.5%] with false negative competent communicating veins, as proved by the bi-directional Doppler to have one or more incompetent communicating veins below the saphenofemoral junction. Also clinical examination showed 4 false negative limbs [14.8%] having competent valves of the saphenous system proved by the bi-directional Doppler to have incompetent valves. The bi-directional Doppler showed a sensitivity of 92.6% in detecting incompetent communicating veins and 96.3% in detecting venous valvular incompetence along the saphenous veins, a result which is superior to the clinical assessment

Incidence of genital tuberculosis in infertile women

A retrospective analysis of the case records of patients attending the University Hospital, Tabriz, showed that over a period of 16 months, 91 patients consulted for treatment of infertility. Genital tuberculosis was diagnosed at laparotomy and confirmed histopathologically in 21 [23.08%] of these patients. Genital tuberculosis is rare in Western Europe and U.S.A. but is still an important factor in causing infertility and sterility in the developing countries. It is therefore suggested that every patient consulting for infertility in developing countries, should be investigated for tuberculosis of the genital tract by means of Laparoscopy histopathological and bacteriological studies