Objective Assessment of Arterial Steal Phenomenon in Direct Carotid Cavernous Fistula Using 2D Parametric Parenchymal Blood Flow Analysis / 신경중재치료의학

The aim of the study is to evaluate the hemodynamic changes and the parenchymal perfusion associated with carotid cavernous fistulas before and after embolization using two-dimensional (2D) parenchymal blood flow analysis. A 15-year-old boy presented with 2-month history of progressive right eye proptosis, chemosis, and diplopia after a motor vehicle accident. Intracranial liquid embolization using Onyx-18 through the inferior petrosal approach was done with balloon protection at the opening of the fistula in the internal carotid artery, resulting in complete occlusion of the fistula. Parenchymal blood flow analysis was done before and immediately after embolization. 2D parametric parenchymal blood flow analysis is newly introduced software that can provide data cannot be conveyed by conventional digital subtraction angiography alone. The software allows for objective assessment of the arterial steal and the parenchymal perfusion both pre, and post-embolization. Pre-embolization assessment may influence the therapeutic decision, while post-embolization assessment can evaluate the treatment efficacy.

First Human Evaluation of Endothelial Healing after a Pipeline Flex Embolization Device with Shield Technology Implanted in Posterior Circulation Using Optical Coherence Tomography / 신경중재치료의학

A 64-year-old female presented with an incidentally-discovered right posterior inferior cerebral artery (PICA) aneurysm, initially treated in 2015 by simple coiling. Follow-up demonstrated significant coil compaction that required retreatment. Retreatment was done uneventfully using a Pipeline embolization device (PED) shield deployed starting from the basilar artery and ending at the V4 segment of the vertebral artery. Eight-weeks post-deployment, a follow-up digital subtraction imaging (DSA) and intravascular imaging with optical coherence tomography were obtained. The intravascular imaging demonstrated that the flow diverter had good wall apposition and concentric neointimal growth over the braid with exception to the areas that the PED was not in contact with the endothelial wall, such as at the right PICA ostium and at the vertebrobasilar junction. The entire procedure was safe, and the patient had no complications. In this article, we describe for the first time the assessment of the status of endothelial “healing” of the PED shield at 8-weeks.

Presepsin as a novel diagnostic marker in neonatal septicemia

Neonatal septicemia is a serious life-threatening condition with high mortality. The accurate diagnosis of sepsis is one of the main challenges in emergency medicine. A great effort to reduce the neonatal mortality rate is put into looking for new reliable biomarkers. Among biomarkers, presepsin could be one of the most promising and reliable biomarker for early diagnosis of sepsis. We aimed to evaluate the diagnostic value of presepsin in the early diagnosis of neonatal sepsis. By chemiluminescent enzyme immunoassay [CLEIA], the level of presepsin was assessed in 40 full term neonates with suspected sepsis [Proven sepsis group: 23 patients with +ve blood culture and Probable sepsis group: 17 patients with -ve blood culture] and15 healthy full term neonates. Presepsin level was found to be significantly higher in patient group than control group as well as in proven sepsis group than probable sepsis group. The cut off value for presepsin was 875pg/ml at which the sensitivity and specificity of presepsin were [95.7%, 87.5%] respectively. Presepsin level was found to be significantly higher in females than males. There was no significant difference in the presepsin level as regard mode of delivery nor onset of sepsis. Presepsin is a novel biomarker with high sensitivity and good specificity for sepsis and its measurement can be useful for early diagnosis of neonatal sepsis

Phenotypic and genotypic methods for detection of metallobeta-lactamase [MbetaL] producing pseudomonas aeruginosa

The occurrence of a MbetaL-positive isolate in a hospital setting represents a therapeutic problem, as well as a serious concern for infection control management. The accurate identification and reporting of MbetaL-producing P. aeruginosa will aid infection control practitioners in preventing the spread of these multidrug-resistant isolates. This study aimed to detect and characterize MbetaL producing P. aeruginosa in Benha and to evaluate IMP- EDTA CDT as phenotypic screening method for MbetaL detection. This study was conducted on 100 P.aeruginosa strains isolated from 220 different clinical specimens collected from patients admitted to Benha University Hospital and Benha Teaching Hospital. The isolated P. aeruginosa strains were subjected to antibiotic susceptibility testing by disc diffusion test and MbetaL detection both phenotypically by IMP- EDTA CDT and genotypically by multiplex PCR. Out of 100 P.aeruginosa isolates, 25 strains [25%] were imipenem resistant and 15 strains of them [60%] were carrying genes responsible for MbetaL production [15% of the total number of P.aeruginosa]. Thirteen strains [13%] were carrying VIM gene while two strains [2%] were carrying both VIM and SPM genes together. IMP, GIM-1, SIM-1 genes were not detected. None of the imipenem sensitive strains were carrying genes of MbetaL production. Nearly all MbetaL producers were resistant to most antibiotics used while all strains were sensitive to colistin and polymyxinB. There is very good strength of agreement between IMP-EDTA CDT and PCR. The sensitivity and specificity of the IMPEDTA CDT in relation to PCR was 93.3% and 100% respectively. MbetaL producers is a serious problem as they are highly resistant to most antibiotics used making treatment options very limited, VIM gene is the most prevelant one in comparison with other genes of MbetaL production and IMP-EDTA CDT is a good and sensitive test in detecting MbetaL production

Histopathological lesions of apparently normal skin in leprosy patients

This study was carried out on 50 patients with different clinical types of leprosy 38 males [76% and 12 females [24%], ages ranged from 14 -70 years with a mean age +/- SD 49.22 +/- 12.97 years. Mean disease duration was 5.65 years +/- SD = 9.27 selected to study a group of leprosy patients and compare the clinical parameters with histopathological findings and bacteriologic status of the skin to evaluate the relevance of their patients. Patients were subjected to full medical history taking including disease duration, type and duration of previous or current therapies. Complete clinical examination, for the determination of the clinical type of leprosy. Skin slit smear [SSS] and skin biopsies were taken and examined after staining for histopathological assessment and Acid fast bacilli [AFB]. SPSS package version [statistical Package for Social Sciences] was used for data analysis. The biopsy of normally looking skin showed classic histopathological features of leprosy in more than half of the cases [26 cases, 52%]. The histopathological types of leprosy diagnosed in such cases were as follows: indeterminate leprosy [IL] in 4 cases [15.38%], Tuberculoid leprosy [TL] in 2 cases [7.69%], Borderline tu-berculoid [IL] in 4 cases [15.38], Borderline Borderline [BB] i.e Query in 8 cases [30.76%], Borderline Lepromatous [BL] in 7 cases [26.92%] and Lepromatous leprosy [LL] in a patient [3.84%]. Other 24 cases showed either no evidence of leprosy in [9 cases, 37.5%], or query findings [in the form of sweat gland changes either alone or in combination with thickened nerves and superficial and deep perivascular lymphohistiocytic infiltrate] in 15 cases [62.5%]. Histopathology of skin lesion biopsies showed TL in 3 cases [6%], BT in 8 cases [16%], BB in 8 cases [16%], BL in 14 cases [28%], LL in 12 cases [24%] and leprosy in reaction in 5 cases [10%]. In 16 cases [32%], histopathological type of leprosy detected by microscopical examination of biopsies from skin lesions differed from that diagnosed by clinical examination