Replacing Alteplase with Tenecteplase: Is the Time Ripe? / 대한뇌졸중학회지

Thrombolysis for acute ischemic stroke has predominantly been with alteplase for over a quarter of a century. In recent years, with trials showing evidence of higher rates of successful reperfusion, similar safety profile and efficacy of tenecteplase (TNK) as compared to alteplase, TNK has now emerged as another potential choice for thrombolysis in acute ischemic stroke. In this review, we will focus on these recent advances, aiming: (1) to provide a brief overview of thrombolysis in stroke; (2) to provide comparisons between alteplase and TNK for clinical, imaging, and safety outcomes; (3) to focus on key subgroups of interest to understand if there is an advantage of using TNK over alteplase or vice-versa, to review available evidence on role of TNK in intra-arterial thrombolysis, as bridging therapy and in mobile stroke units; and (4) to summarize what to expect in the near future from recently completed trials and propose areas for future research on this evolving topic. We present compelling data from several trials regarding the safety and efficacy of TNK in acute ischemic stroke along with completed yet unpublished trials that will help provide insight into these unanswered questions.

Circulation remodeling after flow diversion of an anterior communicating artery aneurysm: A case report

Anterior communicating artery aneurysms are the most common intracranial aneurysm and have a high risk of rupture which can lead to morbidity and mortality. Traditionally, intracranial aneurysms were treated by clipping with neurosurgical access. However, certain patients may prefer less invasive approaches or not represent open surgical candidates. Flow diverters, including flow-redirection endoluminal devices (FRED), are new-generation stents that are placed endovascularly by transfemoral or transradial access. Recent studies have demonstrated that FRED is both safe and effective, with complete occlusion of aneurysms in over 90% of patients. This case highlights an interesting phenomenon of post-flow diversion circulatory remodeling, where flow diverter treatment can alter the circle of Willis anatomy and physiology.

Long Vascular Sheaths for Transfemoral Neuroendovascular Procedures in Children / 신경중재치료의학

Purpose@#To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children. @*Materials and Methods@#A retrospective evaluation of transfemoral neuroendovascular procedures in children 15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications. @*Conclusion@#Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionist.

Long Vascular Sheaths for Transfemoral Neuroendovascular Procedures in Children / 신경중재치료의학

Purpose@#To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children. @*Materials and Methods@#A retrospective evaluation of transfemoral neuroendovascular procedures in children 15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications. @*Conclusion@#Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionist.

Contact Aspiration versus Stent-Retriever Thrombectomy for Distal Middle Cerebral Artery Occlusions in Acute Ischemic Stroke: Meta-Analysis / 신경중재치료의학

PURPOSE: The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus contact aspiration for M2 occlusions. MATERIALS AND METHODS: Study selection included cohorts of patients with distal MCA occlusions in acute ischemic strokes treated with an endovascular approach including stent-retrieval or contact aspiration. Twelve studies were selected for meta-analysis for a total of 835 cases. Meta-analysis by proportions was conducted on parameters including baseline and procedural characteristics, thrombolysis in cerebral infarction (TICI) 2b–3 outcomes, and 90-day modified Rankin scale (mRS) outcomes. RESULTS: Hypertension and hyperlipidemia were more prevalent in stent-retriever patients. Pooled baseline National Institute of Health Stroke Scale scores and Alberta Stroke Program Early Computed Tomography Score imaging scores were similar. Pooled time onset of symptoms to door arrival was higher for the stent-retrieval group (154 vs. 97.4 minutes, P=0.01), as was time to groin puncture (259.9 vs. 156.2 minutes, P=0.02), but there was no difference in procedure time. The TICI 2b–3 recanalization rate was similar (80.5% vs. 86.8%, P=0.168). The frequency of mRS 0–2 at 90-day was also similar (74.5% vs. 59.9%, P=0.120), and an excellent mRS 0–1 was lower for stent-retrievers (39.9% vs. 65.6%, P=0.003). A significant negative correlation was found between onset to groin puncture time and the proportion of patients with a good mRS (r=-0.71, P=0.048). CONCLUSION: Both endovascular techniques achieved recanalization rates greater than 80% and 90-day outcomes of minimal disability with similar complication rates. The literature is skewed by aspiration cases being performed sooner after onset of stroke compared to stent-retriever cases.

Cure of post Kala-azar dermal leishmaniasis with paromomycin/sodium stibogluconate combination: a proof of concept.

Background: Post kala-azar dermal leishmaniasis (PKDL) is a recognized dermatologic complication of successfully treated visceral leishmaniasis (VL). PKDL lesions are suspected to be important reservoirs for VL transmission in Sudan. Prolonged treatment schedules, feeling of general well-being and the social stigmata of PKDL prevent most patients seeking treatment. The mainstay of treatment is cardiotoxic sodium stibogluconate (SSG) for 60-120 days. Recently, liposomal amphotericin B (Ambisome®) and immunochemotherapy gave promising results. Ambisome® is expensive and difficult to prepare under field conditions. Paromomycin/SSG combination has been shown to be safe, efficacious and can save time in VL treatment. This study aims to prove that Paromomycin/SSG combination can cure and reduce PKDL treatment duration. Methods: We are reporting nine cases of patients with PKDL lesions of ≥6 months duration who were diagnosed by clinical signs, histopathological/immunohistochemical and PCR. Results: Patients’ mean age was 11.7 ± 4.3 years. A third of the patients (3/9; 33.3%) who failed previous SSG treatment of 2-3 months duration responded completely to 40 days of paromomycin/SSG combination. The majority of patients (5/9; 55.6%) responded completely to 30 days of the combination. One patient (1/9; 11.1%) relapsed following 30 days paromomycin/SSG combination. Conclusion: It was concluded that paromomycin/SSG combination for 30 days is time-saving, safe and efficacious for PKDL treatment.

Does Measurement of Esophagogastric Junction Distensibility by EndoFLIP Predict Therapy-responsiveness to Endoluminal Fundoplication in Patients With Gastroesophageal Reflux Disease?

BACKGROUND/AIMS: In patients with gastroesophageal reflux disease (GERD), an increased esophagogastric junction (EGJ) distensibility has been described. Assessment of EGJ distensibility with the endoscopic functional luminal imaging probe (EndoFLIP) technique might identify patients responsive to transoral incisionless fundoplication (TIF), whereas postoperative measurement of EGJ distensibility might provide insight into the antireflux mechanism of TIF. Therefore, we investigated the value of the EndoFLIP technique in GERD patients treated by TIF. METHODS: Forty-two GERD patients underwent EGJ distensibility measurement before TIF using the EndoFLIP technique. In a subgroup of 25 patients, EndoFLIP measurement was repeated both postoperative and at 6 months follow-up. Treatment outcome was assessed according to esophageal acid exposure time (AET; objective outcome) and symptom scores (clinical outcome) 6 months after TIF. RESULTS: Multiple logistic regression analysis showed that preoperative EGJ distensibility (OR, 0.16; 95% CI, 0.03-0.78; P = 0.023) and preoperative AET (OR, 0.62; 95% CI, 0.42-0.90; P = 0.013) were independent predictors for objective treatment outcome but not for clinical outcome after TIF. The best cut-off value for objective outcome was 2.3 mm2/mmHg for preoperative EGJ distensibility and 11% for preoperative AET. EGJ distensibility decreased direct postoperative from 2.0 (1.2-3.3) to 1.4 (1.0-2.2) mm2/mmHg (P = 0.014), but increased to 2.2 (1.5-3.0) at 6 months follow-up (P = 0.925, compared to preoperative). CONCLUSIONS: Preoperative EGJ distensibility and preoperative AET were independent predictors for objective treatment outcome but not for clinical outcome after TIF. According to our data, the EndoFLIP technique has no added value either in the preoperative diagnostic work-up or in the post-procedure evaluation of endoluminal antireflux therapy.

Electrical Stimulation Therapy for Gastroesophageal Reflux Disease

Electrical stimulation therapy (EST) of the lower esophageal sphincter is a relatively new technique for the treatment of gastroesophageal reflux disease (GERD) that may address the need of GERD patients, unsatisfied with acid suppressive medication and concerned with the potential risks of surgical fundoplication. In this paper we review available data about EST for GERD, including the development of the technique, implant procedure, safety and results from open-label trials. Two short-term temporary stimulation and long-term open-label human trials each were initiated to investigate the safety and efficacy of EST for the treatment of GERD and currently up to 2 years follow-up results are available. The results of EST are promising as the open-label studies have shown that EST is a safe technique with a significant improvement in both subjective outcomes of symptoms and objective outcomes of esophageal acid exposure in patients with GERD. However, long-term data from larger number of patients and a sham-controlled trial are required before EST can be conclusively advised as a viable treatment option for GERD patients.

Antimicrobial Susceptibility Patterns of Gonococcal Isolates in Pretoria; South Africa; over a 20-Year Period (1984-2004)

This paper reviews the susceptibility profiles of Neisseria gonorrhoeae over a 20-year period in the Pretoria region. Endourethral specimens were collected from adult men with symptoms of urethritis attending primary health care clinics and private medical practitioners. These swabs were plated on enriched media for isolation of N. gonorrhoeae. Antimicrobial susceptibility of the organisms was performed using the disc diffusion and agar dilution methods. Plasmid analyses were performed on beta-lactamase-producing isolates. Penicillase-producing N. gonorrhoeae strains increased from 4to 16; whilst chromosomally mediated penicillin-resistant strains increased dramatically from 0to 16from 1984 to 2004. There was an equal distribution of the 3.2 MDa African and 4.4 MDa Asian plasmids. High-level tetracycline-resistant strains (36) were detected for the first time in 2004. Ciprofloxacin resistance emerged at 7in the same year. Gonococcal isolates remained susceptible to cefoxitin; ceftriaxone; cefpodoxime; and spectinomycin. However; the minimum inhibitory concentration values for spectinomycin were very close to the breakpoint. We have shown a continuing increase in resistance to penicillin (plasmid and chromosomal); the emergence of high-level tetracycline resistance and an emergence of resistance to ciprofloxacin. Susceptibility testing is essential for successful therapeutic outcomes and needs to be performed in an ongoing basis

Antimicrobial Susceptibility Patterns of Gonococcal Isolates in Pretoria; South Africa; Over a 20-Year Period (1984-2004)

Abstract:This paper reviews the susceptibility profiles of Neisseria gonorrhoeae over a 20-year period in the Pretoria region. Endourethral specimens were collected from adult men with symptoms of urethritis attending primary health care clinics and private medical practitioners. These swabs were plated on enriched media for isolation of N. gonorrhoeae. Antimicrobial susceptibility of the organisms was performed using the disc diffusion and agar dilution methods. Plasmid analyses were performed on beta-lactamase-producing isolates. Penicillase-producing N. gonorrhoeae strains increased from 4 to 16; whilst chromosomally mediated penicillin-resistant strains increased dramatically from 0 to 16 from 1984 to 2004. There was an equal distribution of the 3.2 MDa African and 4.4 MDa Asian plasmids. High-level tetracycline-resistant strains (36) were detected for the first time in 2004. Ciprofloxacin resistance emerged at 7 in the same year. Gonococcal isolates remained susceptible to cefoxitin; ceftriaxone; cefpodoxime; and spectinomycin. However; the minimum inhibitory concentration values for spectinomycin were very close to the breakpoint. We have shown a continuing increase in resistance to penicillin (plasmid and chromosomal); the emergence of high-level tetracycline resistance and an emergence of resistance to ciprofloxacin. Susceptibility testing is essential for successful therapeutic outcomes and needs to be performed in an ongoing basis

Les cancers du sein masculin à Niamey

Moins frequent que chez la femme; le cancer du sein existe aussi chez l'homme. A partir d'une serie hospitaliere a Niamey au Niger; nous avons entrepris une etude retrospective afin d'en analyser les particularites epidemiologiques cliniques et therapeutiques. Durant la periode d'etudes (1992-2006); nous avons collige 18 cas microscopiquement confirmes. La majorite des malades etaient d'origine rurale. Ils se sont presentes a des stades avances : T3 et T4. Toutes les malades ont ete operees; seules 4 parmi elles ont eu un traitement complementaire adjuvant. Le carcinome canalaire infiltrant a ete le type histologique le plus frequent (55;5). L'evolution n'a pu etre evaluer car tous les malades etaient perdues de vue 6 mois apres l'acte operatoire

Manual de pediatria / Handbook of pediatrics

Este livro oferece uma fonte adequada e atual de informações práticas sobre os cuidados com a criança, desde a primeira infância até a adolescência. Princípios fisiológicos e farmacológicos dão substancial apoio às variadas informações clínicas contidas neste texto. Satisfaz às necessidades de todos os profissionais de saúde envolvidos nos cuidados do dia-a-dia de pacientes pediátricos. Os estudantes de medicina e os residentes que trabalham em hospitais ou em ambulatórios irão apreciar a descrição concisa das doenças e a acessibilidade das informações aqui apresentadas. As enfermeiras e os médicos práticos, particularmente os de cuidados primários, encontrarão uma rápida referência oferecendo largo espectro de informações: são incluídos capítulos sobre dermatologia, cardiologia, otorrinolaringologia, além de outras importantes especialidades pediátricas. O livro proporciona uma síntese atualizada dos conhecimentos pediátricos. A equipe de editores e de colaboradores continuou a revisar, a reorganizar e modernizar os assuntos para facilitar sua utilização na prática diária. São incluídos os mais recentes avanços médicos e recomendações terapêuticas. Os editores continuam a esforçar-se para apresentar o máximo possível de dados sob a forma de quadros e figuras, tornando o texto mais compreensível. Foi dada nova disposição aos capítulos de modo a oferecer uma apresentação mais fluente. No final do livro foram agrupados capítulos sob Terapia medicamentosa e Formulário, Emergências pediátricas, Procedimentos pediátricos e o Apêndice contendo os valores laboratoriais normais. Os novos capítulos incluíram os seguintes tópicos: Medicina desportiva; Pediatria comportamental, picossocial e psiquiátrica; Genética; Cuidados com o recém-nascido; O recém-nascido: doenças e distúrbios. Muitos capítulos sofreram importante revisão. Incluindo amplas alterações nos: Fluídos e eletrólitos; Distúrbios neurológicos e musculares.

Plasma cholesterol levels in eviscerated rats

Se utilizaron en este trabajo modelos experimentales consistentes en ratas evisceradas con hígado funcional y cuyos riñones o páncreas podían dejarse in situ o resecarse. La remoción del tracto gastrointestinal resultó en una elevación significativa de los niveles plasmáticos de colesterol. En ausencia del hígado el colesterol esterificado disminuyó. La esterificación es primariamente una función hepática, ya que la ausencia de riñón no afectó este parámetro. Sólo en presencia de páncreas, hígado y riñones funcionales se observó una recuperación completa de los niveles circulantes de colesterol de ratas evisceradas. Estos resultados indican que la ausencia del tracto gastrointestinal no modifica significativamente los niveles plasmáticos de colesterol, y que los reguladores principales del metabolismo del colesterol son el hígado y el páncreas endocrino