Computed tomography and magnetic resonance angiography in cervicocranial vascular disease.

Although catheter angiography, or digital subtraction angiography (DSA), is still regarded as the gold standard for imaging of cervicocranial vascular disease, its morbidity, cost, and time-consuming features have prompted the development of noninvasive techniques based on computed tomography (CT) and magnetic resonance imaging. With the advent of powerful software, CT and magnetic resonance angiography are complementing and, in some cases, even replacing DSA in the diagnostic evaluation of carotid atherostenosis, unruptured aneurysms, dissections, stroke, penetrating trauma to the neck, and dural venous sinus occlusive disease. They offer advantages over DSA not only in reduced morbidity and time-saving but also in assessment of brain parenchyma, quantitative perfusion, and abnormalities of vessel walls. In the evaluation of blunt neck injuries and intracranial vascular malformations, fistulas, and vasculitis, CT and magnetic resonance angiography still do not provide as much information as DSA.     

Prediabetes

The burden of diabetes is expected to rise from 415 million individuals in 2015 to 642 million individuals by 2040. Most individuals pass through a phase of prediabetes before developing full-blown diabetes. Insulin resistance, impaired incretin action, and insulin hypersecretion are central to the pathophysiology of prediabetes. Individuals older than 40 years of age and other high-risk individuals should be screened for diabetes with fasting plasma glucose and/or hemoglobin A1c. For those diagnosed with prediabetes, the goal of treatment should be restoring euglycemia, because there are data showing that restoring normoglycemia during prediabetes and early diabetes can produce lasting remission. The preferred approach for this is intensive lifestyle intervention, which besides reducing progression to diabetes, has also been shown to reduce all-cause mortality in a long-term follow-up study. The best evidence for a pharmacological approach is with metformin. Other drugs that have shown efficacy include thiazolidinediones, alpha-glucosidase inhibitors, orlistat, basal insulin, and valsartan. However, except for metformin, none of these drugs are currently recommended for this purpose. Newer agents such as glucagon-like peptide-1 agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors also have considerable promise in this area. Bariatric surgery can be offered to patients with metabolic syndrome and body mass index of 30-35.     

Pancreatic acinar cell carcinoma: A comprehensive review

Acinar cell carcinoma (ACC) is a rare pancreatic malignancy with distinctive clinical, molecular, and morphological features. The long-term survival of ACC patients is substantially superior to that of pancreatic adenocarcinoma patients. As there are no significant patient series about ACCs, our understanding of this illness is mainly based on case reports and limited patient series. Surgical resection is the treatment of choice for patients with the disease restricted to one organ; however, with recent breakthroughs in precision medicine, medicines targeting the one-of-a-kind molecular profile of ACC are on the horizon. There are no standard treatment protocols available for people in which a total surgical resection to cure the condition is not possible. As a result of shared genetic alterations, ACCs are chemosensitive to agents with activity against pancreatic adenocarcinomas and colorectal carcinomas. The role of neoadjuvant or adjuvant chemoradiotherapy has not been established. This article aims to do a comprehensive literature study and present the most recent information on acinar cell cancer.     

Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center

Background and purpose

Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs.

Adult respiratory distress syndrome in the tropics

Today ARDS is more frequently recognized and managed in tropical countries, although published data from most locations is meager. The spectrum of disorders causing ARDS in tropical countries includes virtually all conditions encountered in the West. Additionally, tropical infections and other disorders are seen far more commonly. In particular, malaria and TB are important infections that predispose patients to ARDS in the tropics. Both of these illnesses give lead to severe forms of disease, such as falciparum malaria, acute miliary TB or TB bronchopneumonia, and may cause ARDS. Awareness of the complications helps in early recognition and differential diagnosis from several similar manifestations. Although earlier reports painted a gloomy picture of the outcome of these patients in general--mainly due to financial and logistic constraints--the scenario is improving quickly with better and wider availability of newer diagnostic and management tools.     

Role of a Dentist in Comprehensive Management of a Comatose Patient with Post Traumatic Head Injury and Neuropathological Chewing

Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response. The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.