Percutaneous microwave ablation versus partial splenic embolization for treatment of hypersplenism in patients with liver cirrhosis

Background and study aim: In patients suffering from portal hypertension as result of liver cirrhosis, hypersplenism was ranged from 11 to 55%. The aim of our work was to compare between percutaneous microwave ablation (MWA) and partial splenic artery embolization (PSE) in the management of hypersplenism in patients with liver cirrhosis as regard efficacy and safety. Patients and Methods: Sixty patients with liver cirrhosis complicated with splenomegaly and hypersplenism were divided randomly into three groups; Group (1): Twenty patients were underwent one session of MW ablation of splenic parenchyma with target ablation volume about 20%, Group (2): Twenty patients were underwent two sessions of MW ablation of splenic parenchyma with 1 week interval with target ablation up to 40%, Group (3): Twenty patients were underwent PSE. Results: There was an improvement in the hemoglobin, platelet and leucocyte levels in three groups, which was 9.47± 2.14 gm/dl, 42.75 ± 15.4 x103/ mm3 and 2.6±0.5 x103/mm3 before the procedure respectively and become 9.95 ± 2.29 gm/dl, 313.5±99.6 x103/mm3 and 6.88± 1.89 x103/mm3 after one month as regard PSE group. As regard one session of MWA was 9.73±2.02 gm/dl, 45.57±11.2 x103/mm3 and 2.8±0.85 x103/mm3 and become 11.83±0.74 gm/dl, 152±26.43 x103/mm3 and 5.85±1.01 x103/mm3 after one month. As regard two sessions of MWA group; was 9.2±2.15 gm/dl, 40.6± 11.5 x103/mm3 and 2.4±0.55 x103/mm3 and become 12.74±1.2 gm/dl, 183.4± 26.43 x103/mm3 and 6.29±1.17 x103/mm3 after one month. PSE was significantly more effective in the elevation of platelets and leucocytes than other two groups (p=0.00), and two sessions of MWA more than one session of MWA. The two sessions MWA group was significantly higher than other two groups while one session of MWA group was more than PSE group in the elevation of hemoglobin (p=0.00). No mortality occurred in the three groups, but PSE was associated with more serious complications than the other two groups. Conclusion: MWA and PSE were effective in treatment of hypersplenism in patients with liver cirrhosis, while percutaneous MWA has less serious complications than PSE

Botulinum toxin: could it be an effective treatment for chronic tension - type headache?

Several clinical trials suggest that botulinum toxin type-A [BTX-A] may be an effective treatment options for patients with chronic tension-type headache; however, controversy remains as how botulinum toxin optimally should be used for treating headache and which patients profile that fit for this treatment. The objective of this study was to evaluate the efficacy and tolerability of BTX-A for the prophylactic treatment of chronic tension-type headache in Egyptian patients. This was a randomized, single-blind, placebo-controlled study of botulinum toxin type-A for the treatment of patients aged 25 to 50 years old with chronic tension-type headache. Following a 30-day screening; headache parameters and severity assessed by the standard visual analogue scale [VAS] and the 25-item Henry Ford Hospital Headache Disability Inventory [HDI] were recorded as a baseline. Then, injection was done with either BTX-A or with saline by a combination of two methods for detecting injection sites [the fixed-site approach and follow-the-pain approach]. Our study showed significant improvement after one month of BTX-A injection regarding headache days/month, severity measured by VAS and HDI in headache severity. There was significant reduction of prophylactic medications, and there were minor complications but these reversed spontaneously without further treatment. BTX-A was an effective and well-tolerated prophylactic treatment in Egyptian patients with chronic tension-type headache

Clinical and radiological patterns of cerebral venous sinus thrombosis in children

Cerebral venous thrombosis is a rare disease in children, but it is considered an important cause of infarction due to its potential morbidity. Since magnetic resonance imaging [MRI] and magnetic resonance venography [MRV] are widely used, the reports with confirmed diagnosis are increased. To identify the common clinical presentations and radiological findings of cerebral venous sinus thrombosis [CVST] in pediatric age group, and to investigate thoroughly the underlying predisposing conditions. This study included 13 children with CVST confirmed by MRI and MRV. Patients were submitted to complete general and neurological examination, Electroencephalography [EEG], and routine laboratory tests in addition to complete coagulation profiles including protein C, protein S, and Anti thrombin III, hemoglobin electrophoresis, Anticardiolipin autoantibodies, and antinuclear antibodies. Screening tests for homocystein, lactate, pyruvate and ammonia serum levels were done and Factor V Leiden was done for 5 cases only. Headache was the main presenting clinical picture of cases, followed by nausea, vomiting, seizures and papilledema. MRI brain was done prior to MRV and most patients 12/13 [92.3%] showed loss of normal signal void pattern of involved sinuses. Ten patients [76.9%] showed cerebral parechymal changes, and MRV showed that superior sagittal sinus [SSS] was the most common vessel to be involved [84.4%] either alone or in combination with other dural sinuses, followed by transverse and sigmoid sinuses either alone or in combination with SSS [53.8%]. Ten cases [76.9%] had detectable identifiable factors which included dehydration, prothrombotic disorders either hereditary or acquired disorders, and we had one patient with recurrent CVST and Moya-Moya disease. MRI in conjunction with MRV are both sensitive and specific enough to provide the best non-invasive method of diagnosing CVST in pediatric patients, in whom hereditary or acquired prothrombotic risk factors should be tested carefully

study of postictal sleep architecture in epileptic patients

The relationship between sleep and epilepsy is complicated and reciprocal; an understanding of the influences of each on the other has important clinical implications. The post-ictal state precisely could produce profound changes in the sleep-wake cycle, and it frequently causes disruption in sleep architecture. To assess sleep architecture postictally, within a maximum period of 48 hours in epileptic patients. Post-ictal assessment of sleep architecture using polysomnographic recording and long-term video EEG monitoring was applied for twenty epileptic patients with non-symptomatic generalized or localization-related epilepsies as well as for 10 age and gender matched controls. All patients were submitted to full clinical, laboratory and radiological assessment. Epileptic patients had significantly less number of awakenings, higher percentages of S2, lower percentages of SWS from total sleep time and shorter latency to SWS as compared to the control. Patients with generalized epilepsies had significantly higher periods of sleep latency to S2 as compared to patients with focal seizures and those on polytherapy had significant shorter sleep latency to S2, with significant higher apnea index in NREM sleep compared to those on monotherapy. Post-ictal state appears to disrupt the regulation of sleep architecture, which mainly recognized in the NREM sleep