Scepter-Mini Balloon Assisted Coil Embolization of an Intracranial Arterial Aneurysm in a Child with PHACE Syndrome via a Persistent Trigeminal Artery / 신경중재치료의학

Cerebral vascular malformations constitute one of the key abnormalities in children with PHACE syndrome, which is characterized by Plaque like cutaneous hemangiomas, Posterior fossa abnormalities, arterial Cerebrovascular and Eye abnormalities, with or without Sternal clefts (PHACES when sternal clefts are present), and associated midline anomalies. Both moyamoya arteriopathy and intracranial aneurysms have been reported in children with this syndrome. Herein, we report the successful treatment of a growing left posterior-communicating artery aneurysm arising from an aberrant left internal carotid artery (LICA) with balloon assisted coiling (BAC) in a child with PHACE syndrome. We circumvented the limitations posed by the narrow caliber of the proximal LICA, by successfully navigating a coiling microcatheter from the basilar artery into the LICA via a persistent trigeminal artery. BAC was then achieved using a Scepter Mini balloon microcatheter for aneurysm neck remodelling.

Scepter-Mini Balloon Assisted Coil Embolization of an Intracranial Arterial Aneurysm in a Child with PHACE Syndrome via a Persistent Trigeminal Artery / 신경중재치료의학

Cerebral vascular malformations constitute one of the key abnormalities in children with PHACE syndrome, which is characterized by Plaque like cutaneous hemangiomas, Posterior fossa abnormalities, arterial Cerebrovascular and Eye abnormalities, with or without Sternal clefts (PHACES when sternal clefts are present), and associated midline anomalies. Both moyamoya arteriopathy and intracranial aneurysms have been reported in children with this syndrome. Herein, we report the successful treatment of a growing left posterior-communicating artery aneurysm arising from an aberrant left internal carotid artery (LICA) with balloon assisted coiling (BAC) in a child with PHACE syndrome. We circumvented the limitations posed by the narrow caliber of the proximal LICA, by successfully navigating a coiling microcatheter from the basilar artery into the LICA via a persistent trigeminal artery. BAC was then achieved using a Scepter Mini balloon microcatheter for aneurysm neck remodelling.

Evaluation of the Causes of Erectile Dysfunction in Patients Undergoing Penile Doppler Ultrasonography in Pakistan

PURPOSE: In patients with erectile dysfunction, it is important to differentiate psychogenic from organic causes. Penile Doppler ultrasonography is a relatively inexpensive and minimally invasive tool for this purpose. This study was conducted to evaluate the causes of erectile dysfunction in an adult male population, using penile Doppler ultrasonography. MATERIALS AND METHODS: A retrospective study was conducted in a single center. All patients who presented with complaints of erectile dysfunction and underwent penile Doppler ultrasonography between July 2014 and June 2016 were included in this study. All examinations were performed using GE Voluson S6 and GE Logiq P5 devices. Following baseline scans, an intracavernosal injection of 20 µg of prostaglandin E1 was given. Peak systolic and end diastolic velocities were measured in each cavernosal artery. Patients with a peak systolic velocity of 5 cm/s was considered to indicate venous incompetence. RESULTS: Out of 97 patients (mean age, 37.09±11.59 years; range, 19~69 years), 50 patients (51.5%) had normal findings, 24 patients (24.7%) had arterial insufficiency, 15 patients (15.5%) had a venous leak, and 8 patients (8.2%) patients had arterial insufficiency with a venous leak. Psychogenic erectile dysfunction was significantly higher among patients aged ≤40 years, while arterial insufficiency with or without a venous leak was significantly higher among patients aged >40 years (p=0.022). CONCLUSIONS: A majority of the studied individuals demonstrated no organic cause of erectile dysfunction, thus confirming a high prevalence of the psychogenic etiology, particularly in relatively young individuals.

Effect on blood pressure and pulse rate after administration of an epinephrine containing dental local anaesthetic in hypertensive patients.

OBJECTIVE: To document safety for use, through recording changes in blood pressure and pulse rate, after administering 3.6 ml of a 2% lignocaine with 1:100,000 epinephrine dental local anaesthetic in a group of hypertensive patients. METHODOLOGY: The present study was conducted at Shaikh Zayed Medical Complex, Lahore, from May to December 2008, using a convenience sampling technique. The first 60 walk-in patients in the dental outpatient department planned for tooth extraction were enrolled in the study. Out of these 60 patients, 10 had pre-hypertension (BP = 130/90), 10 had stage 1 hypertension (BP =140-159/90-99) and 10 study subjects were suffering from stage 2 hypertension (BP = 160-179/100-109). Thirty age and sex matched normo-tensive patients requiring tooth extraction acted as the control group. All patients were administered two cartridges each of 1.8 ml of dental local anaesthesia containing 2% Lignocaine with 1:100,000 epinephrine. Blood pressure and pulse rate (PR) were the risk indicators that were measured thrice; pre-injection, 2 minutes and 5 minutes after injection. RESULTS: A decrease in systolic in stage 2 hypertension patients after 2 and 5 minutes of injections was noted. The diastolic BP (DBP) fell in all the groups after injections. Mean pulse rate increased from three to four beats per minute in all groups except in stage 2 hypertension patients where it slightly decreased. CONCLUSION: Epinephrine containing dental local anaesthesia decreased systolic blood pressure in stage 2 hypertension patients included in this study. There was an observed decrease of 21 mm Hg in systolic blood pressure hypertension patients but with no adverse effects.

Comparison of the plaque-removing efficacy of toothpaste and toothpowder.

BACKGROUND: Removing dental plaque may play a key role in maintaining oral health. Methods for oral hygiene vary from country to country and from culture to culture. Chewing sticks (miswak) and toothpowders are popular oral hygiene tools in Pakistan. OBJECTIVE: To compare the plaque-removing efficacy of toothpaste and toothpowder with and without manual toothbrushes. MATERIALS AND METHODS: The study was designed as an examiner-blind crossover study. The Silness and Löe plaque index was used to evaluate the plaque distribution. Thirty-six volunteer dental students were recruited for the experiment. After scoring, the subjects were randomly divided into two groups. The first group was asked to brush with toothpaste or toothpowder according to a split mouth protocol. The second group was asked to follow the same protocol except they were asked to use their finger instead of the brush. The remaining plaque was scored again. RESULTS: Plaque-removing efficacy of the toothpowder was higher whether it was used with brush or with finger. There was a significant difference between paste and powder users (p = 0.009). CONCLUSION: The results of this study indicate that toothpowder is an effective means to remove plaque with a brush.

Estimating the burden of head and neck cancers in the public health sector of Pakistan.

This study was designed to establish the burden of head and neck cancers (HNCA) in public sector based cancer centres of Pakistan. Data were obtained from the central body governing all the cancer centres in the country. The frequency of treated HNCAs out of the total body cancers treated across Pakistan was found to be 14.5%. Highest prevalence rates amongst all cancers were noted in Sind, notably in Karachi and Jamshoro, followed by Multan in Punjab and a much lower frequency in Peshawar in the North West Frontier Province. This variation presumably reflects levels of betel quid consumption but more data are needed to be gathered in a comprehensive way if the findings are to be applicable for improvement of the national cancer control program.

Helicobacter pylori in dental plaque and gastric mucosa: correlation revisited.

Helicobacter pylori (H. pylori) related gastric infection is highly prevalent in developing countries. Prevalence of bacterium in dental plaque from these regions is also reported to be high, but association between simultaneous colonization of H. pylori in both these sites has not been established yet. Aim of this paper is to review possible association between simultaneous oral and gastric H. pylori colonization in dyspeptic patients. Pertinent literature was reviewed and all available evidence collected from Medline and PakMedinet. Studies conducted in the developing world show conflicting results. Some report a positive relation between oral and gastric H. pylori colonization while others deny any association. This may be due to the population sampled or methodology applied. Further studies are recommended to confirm the association between concurrent presence of H. pylori in dental plaque and gastric mucosa of dyspeptic patients using sensitive and specific tests for detection of bacterium in oral samples.