Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window.

BACKGROUND AND PURPOSE: Randomized trials in the late window have demonstrated the efficacy and safety of endovascular thrombectomy in large-vessel occlusions. Patients with M2-segment MCA occlusions were excluded from these trials. We compared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6-24 hours after symptom onset. MATERIALS AND METHODS: Analyses were on pooled data from studies enrolling patients with stroke treated with endovascular thrombectomy 6-24 hours after symptom onset. We compared 90-day functional independence (mRS ≤ 2), mortality, symptomatic intracranial hemorrhage, and successful reperfusion (expanded TICI = 2b-3) between patients with M2 and M1 occlusions. The benefit of successful reperfusion was then assessed among patients with M2 occlusion. RESULTS: Of 461 patients, 367 (79.6%) had M1 occlusions and 94 (20.4%) had M2 occlusions. Patients with M2 occlusions were older and had lower median baseline NIHSS scores. Patients with M2 occlusion were more likely to achieve 90-day functional independence than those with M1 occlusion (adjusted OR = 2.13; 95% CI, 1.25-3.65). There were no significant differences in the proportion of successful reperfusion (82.9% versus 81.1%) or mortality (11.2% versus 17.2%). Symptomatic intracranial hemorrhage risk was lower in patients with M2-versus-M1 occlusions (4.3% versus 12.2%, P = .03). Successful reperfusion was independently associated with functional independence among patients with M2 occlusions (adjusted OR = 2.84; 95% CI, 1.11-7.29). CONCLUSIONS: In the late time window, patients with M2 occlusions treated with endovascular thrombectomy achieved better clinical outcomes, similar reperfusion, and lower symptomatic intracranial hemorrhage rates compared with patients with M1 occlusion. These results support the safety and benefit of endovascular thrombectomy in patients with M2 occlusions in the late window.

Amiodarone pigmentation, eye and thyroid alterations.

Amiodarone is an effective cardiac antiarytmic drug. Long-term, high dose use of the drug is associated with skin discolouration, corneal deposition and alterations in thyroid hormone levels. We present the case of a 61-year-old woman suffering from the combination of these three side-effects.

Dermatophytosis in healing herpes zoster lesions.

Fungal infection of the face is frequently misdiagnosed, since the typical ringworm, erythematous, slightly scaling, indistinct borders are only uncommonly seen on the face. Herpes zoster is a common infection caused by the varicella-zoster virus that transmits varicella (chickenpox). Granulomatous reactions such as granuloma annulare, pseudolymphoma, sarcoidal reaction, and eruptive keratoacanthoma have been described in herpes zoster scars. We describe here the first reported case of dermatophytosis occurring in healing herpes zoster lesions. This condition has not been previously reported.

The anesthetic management of a patient with pemphigus vulgaris--a case report.

The anesthetic management of a patient with pemphigus vulgaris who required general anesthesia and endotracheal intubation for craniotomy operation is described. The anesthesia was assured with Diprivan. Vecuronium bromide/isoflurane/nitrous oxide in oxygen and fentanyl when necessary. No anesthetic and surgical complication occurred.

Iododerma: an unusual side effect of iodide ingestion.

A 13-month-old girl developed multiple pruritic, 1- to 7-cm, vegetating and ulcerative masses on the neck, extremities, and trunk after a one-week course of an antibiotic and an expectorant that contained potassium iodide, prescribed for treatment of a respiratory tract infection. Clinical and histopathologic findings were consistent with the diagnosis of iododerma. A thorough search for an underlying disease was negative. On cessation of potassium iodide and administration of oral prednisolone 1 mg/kg/day, a dramatic response was achieved.

Efficacy and safety of oral fluconazole in the treatment of patients with tinea corporis, cruris or pedis or cutaneous candidosis : a multicentre, open, noncomparative study.

The efficacy, safety, required duration of treatment, and patient preference for oral fluconazole 150 mg/week in the treatment of 521 patients with cutaneous candidosis, tinea corporis, tinea cruris or tinea pedis were assessed in an open, multicentre, noncomparative trial. Patients received weekly doses of fluconazole 150mg for an average of 4.65 weeks. Cultures were examined microscopically at baseline, at 2-week intervals, at study end, and at long term follow-up (4 to 6 weeks after the last dose). All adverse events were recorded and rated; patients with laboratory findings outside normal values were monitored. Forms regarding patient preference for oral or topical medication type were assessed from 19 centres at study end. Clinical evaluation demonstrated an overall success rate (cure plus improvement) of 96% at the end of therapy, and 92% overall success rate at long term follow-up. Eradication of pathogens based on culture was equally high, with 92% eradicated at the end of therapy and 89% eradicated at long term follow-up. Patient tolerability was good; only 7 patients (1.3%) discontinued therapy because of adverse events, in 2 cases because of laboratory abnormalities. These findings suggest that oral fluconazole therapy is safe. This study demonstrated that weekly oral doses of fluconazole 150mg were effective in the treatment of tinea corporis, tinea cruris, tinea pedis and cutaneous candidosis. Furthermore, there was a high patient preference for oral fluconazole over previous topical therapy.