Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke

Introduction  

Quicker recanalization results in better clinical outcomes in patients with acute ischemic strokes. We describe our experience with the use of a self-expanding, fully retrievable stent in acute intracranial occlusions.     

Poncet’s disease (reactive arthritis associated with tuberculosis): retrospective case series and review of literature

The primary objective of this study is to describe the demographics and clinical characteristics of patients with Poncet’s disease (PD) in the Makkah region in Saudi Arabia, where tuberculosis is on the rise. The secondary objective is conducting a PD systematic literature review to compare our findings. We studied seven patients who presented with arthritis within the first 3?years from diagnosis of active tuberculosis in two centers in the Makkah region: King Faisal Specialist Hospital and King Fahad Hospital in Jeddah from January 2005 to December 2011. We conducted a literature review on PD in multiple biomedical/pharmaceutical databases up to December 2011. We detected a new pattern of reactive arthritis associated with tuberculosis (TB). We identified this as PD or tuberculous rheumatism, which is a sterile reactive arthritis that can emerge during any stage of acute TB infection. Seven cases of Poncet’s disease were identified in our study. The most common presentation was extrapulmonary with involvement of multiple sites. Six out of seven patients developed arthritis after initiation of anti-TB drugs; one patient developed polyarthritis after completion of anti-TB medication. Asymmetrical polyarthritis was the most common presentation and the resolution of the arthritis was with symptomatic treatment and continuation of anti-TB drugs except in one case. PD may manifest in a variable pattern during the course of active tuberculous infection. Physicians should be aware of this rare complication associated with a common disease to prevent delay in diagnosis and initiation of appropriate treatment.     

Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment

Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.     

Robotic partial cystectomy for lymphangioma of the urinary bladder in an adult woman

Lymphangioma of the urinary bladder is a very rare tumour in adulthood. Robotic partial cystectomy is evolving for treatment of a limited number of bladder tumours. We describe a case of an adult woman with a bladder dome lymphangioma for which robotic partial cystectomy was carried out.     

Iatrogenic extreme corneal decompensation treated by sequential Descemet's Stripping Endothelial Keratoplasty surgeries six months apart

Descemet’s stripping endothelial keratoplasty (DSEK) is now the most common surgical procedure to treat endothelial dysfunction although it is known that endothelial cell survival is an issue of concern. We present a case whereby severe iatrogenic corneal decompensation caused by Descemet’s membrane detachment following premature disconnection of an infusion tube at the end of a trans pars plana vitrectomy and epiretinal membrane peel was successfully treated with two staged DSEK procedures six months apart. The patient was counselled that due to the severity of his extreme corneal oedema more than one DSEK procedure may be needed and the procedure was planned from the outset as a two-stage procedure. There was a measurable decrease in corneal thickness and increase in visual acuity following both the first and second procedures, which may be due to reinvigoration of the endothelial cell count following each procedure. We suggest that repeating the DSEK procedure, even when the first operation has gone well and the graft appears healthy, may be beneficial in obtaining further improvement in cases of severe corneal oedema.     

Influence of Humans on Evolution and Mobilization of Environmental Antibiotic Resistome

The clinical failure of antimicrobial drugs that were previously effective in controlling infectious disease is a tragedy of increasing magnitude that gravely affects human health. This resistance by pathogens is often the endpoint of an evolutionary process that began billions of years ago in non–disease-causing microorganisms. This environmental resistome, its mobilization, and the conditions that facilitate its entry into human pathogens are at the heart of the current public health crisis in antibiotic resistance. Understanding the origins, evolution, and mechanisms of transfer of resistance elements is vital to our ability to adequately address this public health issue.     

Antagonistic Effect In Vivo of Zinc on Inhibition of δ -Aminolevulinic Acid Dehydratase by Lead

δ-aminolevulinic acid dehydratase (ALAD) is an enzyme involved in the biosynthesis of heme, in which it catalyzes the condensation of two molecules of δ-aminolevulinic acid to one molecule of porphobilinogen. It is a sulfhydryl enzyme, which means, among other tilings, that its activity is inhibited by many heavy metals. In the present investigation rabbits were given either zinc or lead or both. Zinc had a strong activating effect on ALAD in vivo, and the inhibitory effect of lead was almost completely eliminated. A close positive correlation was found between ALAD in the red blood cells and zinc in the plasma, but there was no correlation between ALAD and zinc in the red blood cells. These observations are of particular interest in the light of recent findings, suggesting that zinc is an essential metal for ALAD.