The microsurgical management of a brainstem compression resulted from an embolized cerebral tentorial dural arteriovenous fistula

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal connections between an arterial feeder and a dural venous sinus or leptomeningeal vein with the nidus located within the dural leaflets. In this article we report an uncommon event which is a hematoma inside a dilated draining vein formed after embolization of tentorial DAVF causing pressure on the brain stem and removed surgically. A 47 years old male with a history of ventriculoperitonial (V-P) shunt 2 years ago and embolization of arteriovenous malformation 15 years ago, presented to our hospital having symptoms due to tentorial dural arteriovenous fistula (TDAVF) fed from branches of external and internal carotid arteries. Two sessions of transarterial embolization were performed with total occlusion. Six months later, he was admitted to the hospital with gait unsteadiness, swallowing difficulties and confusion. Brain MRI revealed a hyperintense heterogenous mass like a pouch from thrombosed draining veins with a localized hematoma compressing the brainstem and causing these symptoms. A small hematoma was seen and removed microsurgically. The patient was improved clinically and was discharged home after 5 days. Neurointerventionalist must be aware when deciding to occlude TDAVMs as there is a risk of venous varix formation and rupture if incompletely occluded. Surgical intervention is sometimes needed to alleviate the hazardous compression on the brain stem and other vital structures. © 202

Short-term efficacy of epidural injection of triamcinolone through translaminar approach for the treatment of lumbar canal stenosis

Background: Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy. Objectives: In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis. Methods: In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI). Results: The study population included 32 (28.8) males and 79 (71.2) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r =-0.400, P < 0.001) and BMI (r =-0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r =-0.569, P < 0.001). Conclusions: Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis. © 2020, Anesthesiology and Pain Medicine

Treatment of post-traumatic direct carotid�cavernous fistulas using flow diverting stents: Is it alone satisfactory?

Background: Direct carotid cavernous fistula (CCF) occurs between the internal carotid artery (ICA) and the cavernous sinus. Carotid cavernous fistulas (CCFs) frequently present with chemosis, pulsatile proptosis, ocular bruit, vision loss, and occasionally intracerebral hemorrhage or seizure. In this article, we share our experience in endovascular treatment of six patients having this pathology with intracranial flow diverting stents with review of literatures. Case description: All six patients had posttraumatic direct CCF, most of their signs and symptoms were visual disturbance, chemosis, orbital bruit, headache, paralysis of extraocular muscles. They were treated with flow diversion stents with or without coils or liquid embolizing material; transvenous and transarterial routes were used. Most of them underwent multiple sessions, and their conditions were improved dramatically. Conclusion: The best and most effective method is to start the procedure by coiling to convert the high-flow fistula to an aneurysmal pouch with the smallest possible size in the cavernous sinus, and then close the defect site with one or two flow diversion devices (FDDs). © 2021 Elsevier Lt

Identification of Leishmania species isolated from human cutaneous Leishmaniasis in Gonbad-e-Qabus city using a PCR method during 2006-2007

&quot;n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1&quot;:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Cutaneous Leishmaniasis is endemic in plenty of Iranian provinces. This study aimed to determine the epidemiological status of the cutaneous Leishmaniasis outbreak, isolation and identification of the parasite using a PCR method in burden rural areas of Gonbad-e-Qabus County, north Iran. &quot;n&quot;nMethods: Data was collected on the prevalence of scars and ulcers over a period of three months among 6990 inhabitants of five villages around Gonbad-e-Qabus county, north Iran, during 2006-2007. Cultured promastigotes were identified using PCR technique. ITS1 and ITS2 of Non Coding Transcribed region at ribosomal DNA of 46 Leishmania isolates were amplified and the PCR products were separated by electrophoresis in 1.5% agarose gel (200 mA, 140 V), visualized by staining with ethidium bromide, and photographed. To confirm the PCR findings, six Leishmanis isolates were injected individually into two BALB/c mice.&quot;n&quot;nResults: Among 6990 inhabitants of the five villages, 62.9% had scars and 0.5% had active lesions. The most highly infected age group was 0-10 years and nobody was infected in individuals more than fifty years of age. Individuals 11 to 20 years of age were the most highly infected age group. The results showed that from 46 isolates, all (100%) were L. major in comparison to reference strains and all of them could produce ulcer at the base tail of BALB/c mice, 4-12 weeks after inoculation.&quot;n&quot;nConclusions: According to this study, cutaneous Leishmaniasis due to Leishmania major is endemic in Gonbad-e-Qabus county, north Iran. The results were confirmed by active lesions induced in BALB/c mice

Drought stress effects on photosynthesis, chlorophyll fluorescence and water relations in tolerant and susceptible chickpea (Cicer arietinum L.) genotypes

In order to evaluate morphological and physiological traits related to drought tolerance and to determine the best criteria for screening and identification of drought-tolerant genotypes, we grew two tolerant genotypes (MCC392, MCC877) and two sensitive genotypes (MCC68, MCC448) of chickpea under drought stress (25% field capacity) and control (100% field capacity) conditions and assessed the effect of drought stress on growth, water relations, photosynthesis, chlorophyll fluorescence and chlorophyll content in the seedling, early flowering and podding stages. Drought stress significantly decreased shoot dry weight, CO2 assimilation rate (A), transpiration rate (E), and PSII photochemical efficiency (Fv/Fm) in all genotypes. In the seedling and podding stages, PSII photochemical efficiency was higher in tolerant genotypes than in sensitive genotypes under drought stress. Water use efficiency (WUE) and CO2 assimilation rate were also higher in tolerant than in sensitive genotypes in all investigated stages under drought stress. Our results indicated that water use efficiency, A and Fv/Fm can be useful markers in studies of tolerance to drought stress and in screening adapted cultivars of chickpea under drought stress