Severe neonatal pulmonary artery hypertension rescued with vasopressin.

An inborn term neonate weighing 2600 g developed meconium aspiration syndrome at birth. Baby had respiratory failure requiring high-frequency oscillatory ventilation support at 15 hours of life. He additionally developed hypotension with left ventricular dysfunction noted on point-of-care echocardiography (POCE), which required dopamine and epinephrine infusions.

Small Intracranial Aneurysms and Subarachnoid Hemorrhage: Is the Size Criterion for Risk of Rupture Relevant?

The current understanding is that small intracranial aneurysms (<7 mm) are not at a significant risk for rupture. However, there have been several published series of rupture and subarachnoid hemorrhage from aneurysms <5 mm. Three cases of intracranial aneurysms rupturing at <3 mm are presented in this paper.

Transcranial Color-Coded Duplex Ultrasound for Assessing Cerebrovascular Reserve in Intracranial Dissection with Aneurysm.

Intracranial artery dissection (IAD) is an uncommon cause of cerebral ischemia. It may lead to symptoms due to rupture of subadventitial aneurysms or thromboembolism from subintimal disruption. Severe stenosis may lead to reduced cerebrovascular reserve (CVR).

Transcranial Doppler in the Detection and Management of Arterial Vasospasm after Aneurysmal Subarachnoid Haemorrhage.

Delayed cerebral ischaemia (DCI) and cerebral infarction is a much-feared complication of aneurysmal subarachnoid haemorrhage (aSAH). It has been largely attributed to focal hypoperfusion from reversible cerebral arterial narrowing, "vasospasm," from the effects of prolonged exposure of the arteries to perivascular blood and oxy-haemoglobin. Transcranial Doppler (TCD) provides a non-invasive method for detecting and monitoring vasospasm.

Limb-Shaking Transient Ischemic Attacks in a Patient with Previous Bilateral Neck Irradiation: The Role of Collateral Flow.

Nasopharyngeal carcinoma (NPC) is commonly treated with bilateral neck radiation, which is closely associated with the complication of carotid-occlusive disease. This leads to cerebral hemodynamic compromise and possible ischemic stroke. Another manifestation is limb-shaking transient ischemic attacks (LS-TIAs), characterized by rhythmic jerks which can be easily mistaken as a focal motor seizure.

Isolated Focal Basilar Artery Stenosis with Acute Stroke Treated with Emergency Thrombectomy and Stenting.

Strokes due to basilar artery (BA) stenosis/occlusion are devastating. As it is an uncommon cause of stroke, its optimal management is not clearly defined. We present the case of a 68-year-old male with a background history of hypertension, hyperlipidaemia, and smoking who developed a sudden onset of reduced consciousness, myoclonic jerks, generalised weakness, and nausea due to an occluded mid-segment BA with right occipital and left cerebellar infarcts.

Renal nutcracker syndrome in a young lady: unusual findings and endovascular management.

Nutcracker syndrome (NCS) is caused by compression of left renal vein (LRV), usually between the aorta and the superior mesenteric artery (SMA). This can lead to obstruction of flow into the inferior vena cava and secondary left renal venous hypertension. Despite potential serious consequences, diagnosing NCS is often challenging, circuitous and commonly delayed.

Population Pharmacokinetics of Fixed Dose Combination of Ceftriaxone and Sulbactam in Healthy and Infected Subjects.

Increased antibacterial resistance (ABR) and limited drug discovery warrant optimized use of available antibiotics. One option is to rationally combine two antibiotics (fixed dose combination (FDC)) that may delay or prevent emergence of ABR in notorious pathogen. Major concern with FDC is the mutual interaction of its components that might influence their pharmacokinetic (PK) profile, requiring reassessing of whole formulation (adding cost and time).

Acute free-floating carotid artery thrombus causing stroke in a young patient: unique etiology and management using endovascular approach.

Atherosclerotic disease accounts for 20%-30% of strokes in the general population. In young adults, it is an unexpected event and its causes involve diverse pathologies. Herein, we describe a unique case of acute embolic stroke in a young adult patient due to the presence of a large clot in the right common and internal carotid arteries, as a result of an extrinsic cause.

L-asparginase administration reduces white blood cell count and prevents tumor lysis syndrome in children with hyperleukocytic acute lymphoblastic leukemia.

Background: The management of hyperleukocytosis currently involves intensive supportive care for preventing tumor lysis syndrome (TLS)-associated metabolic abnormalities as well as cytoreduction procedures to reduce the white blood cell (WBC) count. These procedures are often equipment-intensive and may not be practised in developing countries with limited resources. Hence, it is not clear what would be the most effective strategy to manage hyperleukocytosis and prevent TLS.

Single centre experience of transjugular liver biopsy in 152 patients.

Introduction: Liver biopsy is considered the definitive investigation in the diagnosis and management of liver disease. This study describes the experience of performing transjugular liver biopsy (TJLB) over the last 9 years in a local single centre.

Materials And Methods: A retrospective review of consecutive TJLB procedures performed at our institution was conducted.

Posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula treated by a direct access cavernous sinus approach.

Dural arteriovenous fistulas (dAVFs) represent approximately 10-15% of all cerebral vascular malformations. Although dAVFs can occur anywhere in the brain, they occur most frequently in the cavernous and transverse-sigmoid sinuses. Posterior fossa dAVFs presenting clinically as carotid-cavernous fistulae (CCF) are rarely encountered in clinical practice.

Posterior fossa dural arteriovenous fistula presenting clinically as a carotid-cavernous fistula treated by a direct access cavernous sinus approach.

Dural arteriovenous fistulas (dAVFs) represent approximately 10-15% of all cerebral vascular malformations. Although dAVFs can occur anywhere in the brain, they occur most frequently in the cavernous and transverse-sigmoid sinuses. Posterior fossa dAVFs presenting clinically as carotid-cavernous fistulae (CCF) are rarely encountered in clinical practice.

Repair of a complex post-EVAR type III endoleak using a chimney aortouniiliac stent graft and femorofemoral crossover bypass.

Post-EVAR type III endoleaks present a particular challenge as they carry a significant risk of rupture. We present a case of an 81-year-old gentleman, 10 years post-EVAR, with complex type III endoleak with component separation that was successfully treated with a combination of left renal artery chimney, aortouniiliac stent grafting and femorofemoral crossover bypass.

Modification of the sandwich technique to preserve flow in the hypogastric artery after endovascular repair of aortoiliac aneurysmal disease: our initial experience with two cases.

Background: To describe modification of the sandwich technique to preserve flow in the hypogastric artery after endovascular repair of aortoiliac aneurysmal disease in patients with challenging anatomy.

Methods And Results: The sandwich technique has been proposed as an option in patients with aortoiliac aneurysmal disease, in whom standard iliac branch device may not be technically feasible. We feel that even with the sandwich technique, there are issues with adequately treating these aneurysms in patients with short common iliac arteries with critical landing zones and in those with narrow-caliber external iliac arteries.

Cone beam computed tomography for vascular interventional radiology procedures: early experience.

Introduction: Cone beam computed tomography (CBCT) is a relatively new technological innovation that utilises fl at-panel detector technology to obtain CT-like images. The key strength of a CBCT system is that cross-sectional imaging can be obtained using the angiographic fl at panel unit without having to move the patient, allowing the radiologist to obtain soft tissue imaging during the procedure. This allows treatment planning, guidance, and assessment of outcome to be performed in one interventional suite.

Embolization of carotid-cavernous fistula via direct percutaneous puncture of the inferior ophthalmic vein.

Carotid-cavernous fistulas (CCFs) are anomalous connections between the carotid circulation and the cavernous sinus, and may cause significant morbidity. Endovascular treatment of these lesions can be challenging if typical transvenous routes are inaccessible. We describe a case of a Barrow type D carotid-cavernous fistula in which transvenous embolization was attempted via the inferior petrosal sinus (IPS).

Potential contribution of oxidative stress and inflammation to anxiety and hypertension.

Previously, we have published that pharmacological induction of oxidative stress causes anxiety-like behavior in rats and also is associated with hypertension in these animals. Here, we report that sub-chronic induction of oxidative stress via pharmacological induction leads to i) reduction in glyoxalase (GLO)-1 and glutathione reductase (GSR)-1 expression; ii) calpain mediated reduction of brain derived neurotrophic factor (BDNF) levels; iii) NFκB mediated upregulation of proinflammatory factors interleukin (IL)-6 and tumor necrosis factor (TNF)-α and elevated angiotensin (AT)-1 receptor levels in hippocampus, amygdala and locus coeruleus regions of the brain. Acute oxidative stress has opposite effects.

Exercise prevents sleep deprivation-associated anxiety-like behavior in rats: potential role of oxidative stress mechanisms.

Our previous work suggests that pharmacological induction of oxidative stress causes anxiety-like behavior in rats. Interestingly, sleep deprivation is reported to cause oxidative damage in the brain and is also reported to be anxiogenic. Minimal mechanistic insights are available.

Novel role of RGS2 in regulation of antioxidant homeostasis in neuronal cells.

Regulator of G-protein signaling protein (RGS)-2 is a modulator of anxiety and dysregulation of oxidative stress is implicated in anxiety. Also, RGS2 expression is reported to be induced by oxidative stress. Thus, if oxidative stress induces RGS2 expression and lack of RGS2 causes anxiety, then mechanisms that link RGS2 and oxidative stress potentially critical to anxiety must be revealed.

Differential effects of inescapable stress on locus coeruleus GRK3, alpha2-adrenoceptor and CRF1 receptor levels in learned helpless and non-helpless rats: a potential link to stress resilience.

Exposure of rats to unpredictable, inescapable stress results in two distinct behaviors during subsequent escape testing. One behavior, suggestive of lack of stress resilience, is prolonged escape latency compared to non-stressed rats and is labeled learned helplessness (LH). The other behavior suggestive of stress resilience is normal escape latency and is labeled non-helpless (NH).

Bare nitinol stent enabled recanalization of long-segment, chronic total occlusion of superficial femoral and adjacent proximal popliteal artery in diabetic patients presenting with critical limb ischemia.

Purpose: To evaluate our experience of limb salvage with bare nitinol stent enabled recanalization of long length occlusions of superficial femoral artery (SFA) and adjacent proximal popliteal artery (PPA) in diabetic patients.

Methods: A total of 573 patients underwent 842 lower limb interventions from August 2006 to September 2008 at our institute. A retrospective review was done of diabetic patients undergoing recanalization of long length SFA/adjacent PPA (>10 cm) occlusions with self expanding bare nitinol stents evaluating their impact on limb salvage.