Simultaneous Bilateral Carotid Thrombectomies: A Technical Note.

BACKGROUND: Although extremely rare, acute bilateral large vessel occlusion (LVO) is a morbid condition that requires prompt intervention. OBJECTIVE: To report the technique used to achieve recanalization of bilateral internal carotid artery (ICA) terminus occlusions. METHODS: This is a case of bilateral ICA terminus occlusions managed with simultaneous bilateral thrombectomies with poor collateral circulation. RESULTS: Recanalization of bilateral ICA with thrombolysis in cerebral infarction (TICI) grade 0 to left TICI 2b flow with distal left A1 occlusion and right TICI 3 flow was achieved in 32 min with the use of simultaneous catheterization and aspiration thrombectomies. CONCLUSION: The described technique offers an efficient and feasible means to reduce time to recanalization and radiation in cases of bilateral LVO.

Pneumocephalus following Dorsal Laminectomy: An Unusual Complication.

A 16-year-old male presented at Bangur Institute of Neurosciences Neurosurgery Outpatient Department with history of gradually progressive paraparesis for 5 months associated with stiffness, urinary hesitancy, and urge incontinence for last 2 months. Magnetic resonance imaging spine was done which showed cystic intradural extramedullary space occupying lesion at D4/D5 to D9. Patient had 2 episodes of generalized tonic-clonic seizure on the day 4. Computed tomography scan showed pneumocephalus. Histopathological examination report was that of nonspecific inflammatory cyst.

Stroke Caused by Atherosclerosis of the Major Intracranial Arteries.

Our goal in this review is to discuss the pathophysiology, diagnosis, and treatment of stroke caused by atherosclerosis of the major intracranial arteries. References for the review were identified by searching PubMed for related studies published from 1955 to June 2016 using search terms intracranial stenosis and intracranial atherosclerosis. Reference sections of published randomized clinical trials and previously published reviews were searched for additional references. Intracranial atherosclerotic disease is a highly prevalent cause of stroke that is associated with a high risk of recurrent stroke. It is more prevalent among blacks, Hispanics, and Asians compared with whites. Diabetes mellitus, hypertension, metabolic syndrome, smoking, hyperlipidemia, and a sedentary lifestyle are the major modifiable risk factors associated with intracranial atherosclerotic disease. Randomized clinical trials comparing aggressive management (dual antiplatelet treatment for 90 days followed by aspirin monotherapy and intensive management of vascular risk factors) with intracranial stenting plus aggressive medical management have shown medical management alone to be safer and more effective for preventing stroke. As such, aggressive medical management has become the standard of care for symptomatic patients with intracranial atherosclerotic disease. Nevertheless, there are subgroups of patients who are still at high risk of stroke despite being treated with aggressive medical management. Future research should aim to establish clinical, serological, and imaging biomarkers to identify high-risk patients, and clinical trials evaluating novel therapies should be focused on these patients.

The unusual volvulus : a five year retrospective analysis of nine cases.

The ileosigmoid knot is a rare surgical emergency. It is an unusual type of bowel obstruction in which the ileum usually wraps around the base of the sigmoid colon and forms a pseudoknot. It is usually associated with difficult preoperative diagnosis and poor surgical outcome. To analyze the clinical presentations, operative findings, management, postoperative complications and outcome of patients with ileosigmoid knotting. A retrospective analysis of nine cases of ileosigmoid knotting over a 6-year period from July 2005 to May 2011. Ileosigmoid knotting was common in males in the fifth decade. Mean duration of symptoms prior to admission was 42.67 h. Both the ileum and the sigmoid colon were gangrenous in all the patients. Mortality was 22.22 %. The mean duration of hospital stay was 13.67 days. To conclude, ileosigmoid knotting, though a rare cause of intestinal obstruction, carries a significant risk of mortality. In our study, ileostomy along with colorectal anastomosis seemed to be a better and safer alternative than primary repair in the management of ileosigmoid knotting. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.

Combination therapy of intravenous glycoprotein IIB/IIIA inhibitors and tissue plasminogen activator for acute ischemic stroke.

OBJECTIVES: Retrospective pooled analysis of data from published prospective studies and randomized phase 1 and 2 trials was done to assess efficacy and safety profile of intravenous combination therapy [glycoprotein IIb/IIIa inhibitors and IV tissue plasminogen activator (tPA)] in management of acute ischemic stroke. MATERIALS AND METHODS: We searched Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, and EMBASE databases; two reviewers independently selected studies reporting safety endpoints and outcome measures in acute ischemic stroke patients treated with combination therapy. tPA arm of the National Institute of Neurological Disorders and Stroke (NINDS) tPA trial was included in tPA-only group. Weighted means and proportions were calculated for numeric and categorical variables respectively. Bivariate analysis using Fisher's exact test was done to compare baseline descriptors, safety endpoints, and outcome measures. RESULTS: Combination therapy arm included 188 patients and IV tPA arm had 218 patients. Mean National Institutes of Health Stroke Scale (NIHSS) in two groups were 12.8 and 14.6, respectively. Mean time-to-treatment was 2.3 hours in combination therapy arm and 2.55 hours in tPA arm. Treatment with combination therapy was associated with significant reduction in rate of symptomatic intracranial hemorrhage (sICH) [odds ratio (OR) 0.26, 95% cumulative incidence (CI) 0.07 0.83, P value 0.01). Difference in better functional outcome at 90 days (OR 0.87, 95% CI 0.59-1.30, P value 0.54) and death at 90 days (OR 1.16, 95% CI 0.69-1.93, P value 0.60) were not significantly different in two groups. CONCLUSION: Combination of low dose IV TPA with glycoprotein IIb/IIIa inhibitors is associated with reduction in sICH rates in patients with acute ischemic stroke as compared to standard dose of IV tPA.

Comparative study between omentopexy and omental plugging in treatment of giant peptic perforation.

Giant peptic perforation is a life threatening surgical emergency with high mortality.. This study aims to compare the success rate between omental plugging and standard omentopexy in the emergency management of giant perforations. A prospective non-randomized study of 23 patients with giant peptic perforation (≥2 cm in diameter) was carried out over a period of 18 months. The highest incidence was seen in the age group of 41-50 years. Intestinal fistula occurred in 23.08% of the omentopexy group compared to none in the omental plugging group. The mean hospital stay was slightly higher in the omentopexy group. Three patients died in the omentopexy group post operatively after 24 h compared to none in the omental plugging group and this was statistically significant (p < 0.05). Omental plugging is associated with lesser morbidity and mortality compared to omentopexy in the management of giant peptic perforations.