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Purpose To describe a patient with a history of pre-B cell acute lymphoblastic leukemia (pre-B ALL) in remission, who developed recurrent alternating intraocular pre-B ALL manifesting with pseudohypopyon, uveal mass, and serous retinal detachment. In multiple instances this constellation of ocular findings preceded systemic leukemia recurrence. Method Case report. Results A 29-year old man with history of pre-B cell acute lymphoblastic leukemia, in remission following a hematopoietic stem cell transplant, presented with pseudo-hypopyon, uveal lesions, and serous retinal detachment of the right eye. Comprehensive workup for infectious and inflammatory etiologies was unremarkable, and a bone marrow biopsy revealed systemic recurrence of leukemia. One year later, while again in remission, the patient developed a pseudo-hypopyon, uveal mass, and serous retinal detachment of the other eye. Repeat bone marrow biopsy showed impending leukemia relapse, which occurred 1 month later. Orbital radiation resulted in complete ocular resolution. Conclusions The constellation of pseudohypopyon, serous retinal detachment, and uveal mass (pseudo-panuveitis) should be recognized as a harbinger for systemic pre-B ALL recurrence.

Background Anabolic steroids are commonly abused by body builders and athletes aiming to increase their strength and muscle mass but unfortunately, the long-term use of AS may lead to serious side effects. Our research was directed to assess the toxic effects of anabolic steroids on cardiac and skeletal muscles in male albino rats and to evaluate the potential ameliorative effects of fenugreek seeds extract and silymarin. Methods Our research was done on 120 male albino rats that were allocated into 6 groups; group I: Served as a control group, group II: Received the anabolic steroid Nandrolone Decanoate, group III: Received silymarin orally, group IV: Received fenugreek seeds extract orally, group (V): Received the anabolic steroid Nandrolone Decanoate and silymarin and group (VI): Received the anabolic steroid Nandrolone Decanoate and fenugreek seeds extract. By the end of the study, rats were sacrificed, and blood samples were collected for biochemical analysis and autopsy samples for histopathological examination. Results The anabolic steroids toxic effects on rats showed a significant decrease in serum HDL level and increase in cholesterol, triglycerides, and LDL levels. There was a significant elevation in cardiac troponin level. As regards to histopathological examination of the cardiac and skeletal muscles, the study showed marked degenerative changes and necrosis. Both silymarin and fenugreek seeds extract provided a protective effects on the biochemical and histopathological changes. Conclusions Anabolic steroids have a toxic effect on the cardiac and skeletal muscles of albino rats with improvement by treatment with fenugreek seeds extract and silymarin.

Background New imaging modalities such as IVUS had improved results of stenting of the unprotected left main coronary artery (UPLM). The results of stenting UPLM without these new modalities but with meticulous care need to be studied more. Methods We analyzed data from 120 patients with UPLMD of > 50% subjected to stenting. All were stented by drug-eluting stents and followed for six months. Results 92 patients (77.3%) presented with ACS, of which 65 patients (54.6%) had no Previous Intervention, and 27 patients (22.7%) had a previous PCI. Left ventricular ejection fraction significantly correlates with complication, at 6 months follow up; all 16 patients with reported complications (100%) had baseline LVEF of Syntax score: 11 patients (55%) with a high score of more than 32 had adverse events, P = 0.004. Residual syntax shows a less significant correlation with a mean value of 7.3 in the complication group versus 4.9 in the other group (P = 0.016). Final kissing balloon inflation shows no statistically significant difference. Conclusions PCI in UPLM is a safe, feasible option with a high technical success rate and acceptable outcome at follow-up even without the utilization of IVUS

Aim Functional Mitral regurge in advanced Heart failure dilated cardiomyopathy patients is a strong predictor to mortality, this arouses studying the impact of Cardiac resynchronization therapy on functional MR in DCM. Methods and results This is a prospective observational study of Twenty-five patients with advanced heart failure DCM with sinus rhythm LBBB wide QRS≥ 130 ms with at least moderate MR, subjected to CRT implantation at Alexandria main university Hospital and followed up by Echocardiography after CRT by 1 week and 10 weeks and comparing between improved MR (Group 1) and stable MR group patients (Group 2). FMR improvement was observed in 15 patients (60%) ‘Group 1’ (p value Conclusions CRT improves the degree of severity of functional MR among DCM patients. Improvement of MR severity is significantly associated with baseline QRS width and percent of reduction in QRS width. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Aim The aim of this study was to determine the major contributors to reperfusion delay in ST- elevation myocardial infarction (STEMI) patients in Alexandria University hospitals and the adherence to ESC clinical practice guidelines. Methods and results Prospective cohort of all patients presented with ST-elevation myocardial infarction (STEMI) with chest pain or discomfort between March 2020 and February 2021 in Alexandria university hospitals. A total of 436 patients were enrolled, 280 patients (64.2%) underwent PPCI, 32 patients (7.3%) had thrombolytic therapy and 124 patients (28.4%) had conservative strategy. In regard to the demographics and risk factors, the mean age of our cohort was 55.2 years. The majority were males (80.9%) and smokers (72.2%). Hypertension was a risk factor in 41.5% of our population, diabetes in 33.5%, and a family history was present in 14.2%, while 7.3% had renal impairment. The median pre-hospital delay was 360 minutes; mainly due to delay in seeking medical care which was the cause in 45.6%, whereas the mean ER time delay was 48.24 ± 89.30 minutes. The median time from CCU admission to wire crossing was 40.0 minutes with a mean value 53.86 ±49.0 minutes. The total ischemic time was 372 minutes (6.2 hours) with a mean ischemic time of 408 minutes (6.8 hours). The rate of reperfusion therapy (PPCI or thrombolysis) was 71.5 percent among all STEMI patients who presented within 12 hours, with achievement of timely reperfusion according to ESC guidelines for management of STEMI in 35.0%. The majority of our patients (70.7%) had door to wire crossing time of less than 90 minutes. In-hospital overall mortality was 5.5%. The PPCI group had a mortality rate of 2.9 percent, whereas the conservative management group had a mortality rate of 12.9 percent, with a statistically significant difference (P Conclusions Regardless of the financial and technical limitations in our center, timely reperfusion rate and performance are not far from meeting ESC 2017 guidelines for the management of STEMI. Primary PCI was the most frequently used treatment modality, and the associated total in- hospital mortality was below 5%. An enormous increase in the total ischemic time is a major concern due. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Uveitis is a heterogeneous collection of diseases. We tested the hypothesis that despite the diversity of uveitides, there could be common mechanisms shared by multiple subtypes, and that evidence of these common mechanisms may be detected as gene expression profiles in whole blood.Cohort study.Ninety subjects with uveitis including axial spondyloarthritis (n = 17), sarcoidosis (n = 13), inflammatory bowel disease (n = 12), tubulointerstitial nephritis with uveitis (n = 10), or idiopathic uveitis (n = 38) as well as 18 healthy controls were enrolled, predominantly at Oregon HealthScience University. RNA-Seq data generated from peripheral, whole blood identified 19,859 unique transcripts. We analyzed gene expression pathways via Kyoto Encyclopedia of Genes and Genomes and Gene Ontology (GO). We validated our list of upregulated genes by comparison to a previously published study on peripheral blood gene expression among 50 subjects with diverse forms of uveitis.Both the Kyoto Encyclopedia of Genes and Genomes and GO analysis identified multiple shared pathways or GO terms with a P value of.0001. Almost all pathways related to the immune response and/or response to an infection. A total of 119 individual transcripts were upregulated by at least 1.5-fold and false discovery rate.05, and 61 were downregulated by similar criteria. Comparing mRNA from our study with a false discovery rate.05 and the prior report, we identified 10 common gene transcripts: ICAM1, IL15RA, IL15, IRF1, IL10RB, GSK3A, TYK2, MEF2A, MEF2B, and MEF2D.Many forms of uveitis share overlapping mechanisms. These data support the concept that a single therapeutic approach could benefit diverse forms of this disease.

Background Cerebral arterial stenosis (CAS), in the absence of a structural lesion, can result in cognitive impairment that represents an ongoing contention among studies. Accordingly, we investigated cognitive functions in asymptomatic patients with CAS, using P300 which is a neurophysiological tool. We also compared cognition in intracranial stenosis (ICS) and extracranial stenosis (ECS). Methods Asymptomatic patients with CAS (≥ 70%) in the absence of structural brain lesions were categorized into ICS and ECS groups of 15 patients each, in addition to 15 normal controls. MRI, MRA, CT angiography, P300 analysis, Mini-Mental State examination (MMSE), Wisconsin Card Sorting Test (WCST), and Wechsler Memory Scale Test-Revised (WMST) were performed to all patients. Results Impairment on all cognitive scales ranged from 70 up to 100% among CAS group. Prolonged p300 latency and reaction time correlated with worse performance on WMST (p = 0.02), while lower amplitude and decreased accuracy correlated with more errors on WCST (p = 0.01). ICS scores on WCTS were lower than those of ECS group (p = 0.001), while ECS had a longer reaction time (p = 0.02) and lower scores on MMS and WMST than those of ICS group (p = 0.03). Conclusion Patients with asymptomatic CAS had a high prevalence of cognitive dysfunction which places them at risk of higher morbidity. ICS group showed impairment on executive functions, while the ECS group showed predilection to memory and information processing dysfunction.

The Global Registry of Acute Coronary Events (GRACE) study showed that admission HF is associated with longer hospital stay and higher mortality in ST-elevation myocardial infarction (STEMI) patients. No data are available on the effect of heart failure (HF) on the length of cardiac care unit (CCU) stay and in-hospital major adverse cardiac events (MACEs). The link between the severity of HF and the in-hospital prognosis is not established. Therefore, we aimed to investigate the unstudied outcomes in HF patients as well as to compare the outcomes across the spectrum of HF presentations.We studied 210 STEMI patients presenting to a single primary percutaneous coronary intervention (PPCI) center in a retrospective cohort pattern. We excluded those who received fibrinolysis, those who had chest pain for more than 24 h and those with previous stents and presenting with stent thrombosis. All the procedures followed the ethical standards of Alexandria University and the Helsinki Declaration.STEMI patients with HF had significantly longer CCU stay (mean value of 3.6 vs. 2.87 days, P = 0.009), higher in-hospital MACE (55% vs. 4.7%, P0.001) and higher mortality (15% vs. 0.53%, P0.001). Multivariate logistic regression analysis revealed that HF is an independent predictor of in-hospital mortality (odds ratio (OR) = 9.11, 95% confidence interval (CI): 1.66 - 49.9, P = 0.01). The patients with severe HF on admission (Killip III and IV) tended to stay longer in the CCU (4.13 ± 1.89 days vs. 3.25 ± 1.54 days, P = 0.069) and the hospital (5.88 ± 3.09 vs. 4.42 ± 2.47 days, P = 0.077), compared to those with mild HF (Killip II). There was a tendency for a higher incidence of in-hospital MACE (75% vs. 33%, P = 0.068) and mortality (16.7% vs. 12.5%, P = 0.798) in the former group compared to the latter. The differences among HF subgroups did not reach the point of statistical significance though.The presence of HF on the admission of STEMI patients undergoing PPCI is associated with longer CCU stay, higher in-hospital MACE and mortality.

PURPOSE: To test the hypothesis that idiopathic uveitis can be categorized into subtypes based on gene expression from blood. DESIGN: Case control study METHODS: We applied RNA-Seq to peripheral blood from patients with uveitis associated with one of four systemic diseases, including axial spondyloarthritis (n=17), sarcoidosis (n=13), inflammatory bowel disease (n=12), tubulo-interstitial nephritis with uveitis (n=10), or idiopathic uveitis (n=38) as well as 18 healthy controls evaluated predominantly at Oregon Health & Science University. A high dimensional negative binomial regression model implemented in the edgeR R package compared each disease group against the controls. The 20 most distinctive genes for each diagnosis were extracted. Out of 80 genes, there were 75 unique genes. A classification algorithm was developed by fitting a gradient boosting tree with 5-fold cross-validation. mRNA from subjects with idiopathic uveitis was analyzed to see if any fit clinically and by gene expression pattern with one of the diagnosable entities. RESULTS: For uveitis associated with a diagnosable systemic disease, gene expression profiling achieved an overall accuracy of 85% (balanced average of sensitivity plus specificity, p-value < 0.001). Although the majority of patients with idiopathic uveitis presumably have none of these four associated systemic diseases, gene expression profiles helped to reclassify 11 of 38 subjects. CONCLUSIONS: Peripheral blood gene expression profiling is a potential adjunct in accurate differential diagnosis of the cause of uveitis. Validation of these results and characterization of the gene expression profile from additional discrete diagnoses could enhance the value of these observations.

Female patients show poorer outcomes after coronary interventions compared to males. This study aims to investigate the role of enhanced inflammatory response in female ST-elevation myocardial infarction (STEMI) patients in poor outcomes post primary percutaneous coronary intervention (PPCI).This study included 120 STEMI patients who went to PPCI in two tertiary cardiac centers over 6 months. All STEMI patients who are eligible for PPCI are included. We excluded those who had previous coronary artery bypass grafting (CABG) with venous grafts, previous PCI with in-stent restenosis (ISR), and those who had signs of infection on admission. These are then divided into two groups according to sex (males and females). Impaired coronary flow (also known as no-reflow) is defined as a coronary TIMI (thrombolysis in myocardial infarction) flow less than 3 after PCI in the absence of mechanical coronary occlusion.The studied groups included 88 males and 32 females. The median age in females was higher than males (62 vs. 57.5 years respectively, P = 0.005). The prevalence of hypertension (34 vs. 21 patients, P = 0.01), non-insulin-dependent diabetes mellitus (NIDDM) (22 vs. 16 patients, P = 0.01) and smoking (61 vs. 0 patients, P0.001) was higher in male patients. The incidence of impaired coronary flow did not differ significantly between the two groups (10 males and six females, P = 0.363). The median neutrophil to lymphocyte (N/L) ratio showed to be non-significantly higher in females (5 in males vs. 6 in females, P = 0.342). However, the mean N/L ratio was significantly higher in female patients with impaired coronary flow compared to males (9.35 vs. 5.79, P = 0.003).The enhanced inflammatory response in female STEMI patients may be responsible for poorer outcomes after PPCI. Larger-scale studies are required to define immune mechanisms as a potential target to improve outcomes in STEMI patients.

Aim of the work To compare transradial and transfemoral approaches in 1ry and rescue PCI for STEMI. Methods This prospective observational study was done at Alexandria University Hospital and International Cardiac Center from January 2020 to August 2020 by recruiting every patient had met our inclusion criteria (the third universal definition of MI) admitted to the coronary care unit after doing primary or rescue PCI 200 patients were involved. Exclusion criteria were (Thrombophilia and thrombocytopenia, known hematological abnormalities, and patients with known sever peripheral vascular disease. Randomization made by a computer-generated program into two equal parallel groups that were randomly assigned to either Radial access approach or femoral access approach for primary or rescue PCI. Chest pain to time of first medical contact (FMC), and the procedural time were computed. Coronary angiography and PCI procedure were described including materials used and the intra-procedure complications. MACE (Major Adverse Cardiac Events) or other hemodynamic complications were documented. All the patients were contacted for follow up to 6 months after the procedure by interviewing with the patients via telephone or the responsible physician to determine the outcomes procedure. Results The distribution of demographic variables and risk factors were similar among 200 patients in the radial and femoral groups. There had been significant differences between the groups concerning the primary end point MACE after 6 months in favor of radial group patients with p value (0.004), there was significant deference between the two studied groups concerning the total bleeding complication with higher risk in femoral group 11% compared to radial group 3% with P value (0.02). Despite the nearly equal mean time from pain to FMC (9.01 hours in radial group and 9.2 hours in femoral group), the total procedural time was significantly longer in radial group compared to femoral group with (p value 0.037). However the rate of non-culprit vessel revascularsation was significantly higher in radial group 17% compared to 6% in femoral group with p value of (0.015). In-hospital stay was significantly shorter in the radial group patients P value (0.02). Conclusion Transradial approach is safe, and effective with a high procedural success rate as the transfemoral approach but with lower risk for bleeding vascular complications and other access site complications as hematoma especially for patients where aggressive antiplatelet and anticoagulation therapy is needed, or patients who are expected to suffer from access site complications as those who need rescue PCI. Transradial approach has major additional advantages of decreasing the incidence of MACE compared to transfemoral approach. Transradial approach has another advantages of decreasing the in hospital stay.

Background: Adenotonsillectomy is considered one of the most common surgical procedures in preschool age children. Postoperative emergence agitation (EA) is a major problem that faces anesthesiolog...

Background: Pacemaker-induced cardiomyopathy (PICM) is reported in different articles but with variable incidence. Aim: The aim of the study is to determine the validity of speckle tracking echocardiography as a predictor of the deleterious effect of right ventricular (RV) pacing on left ventricular (LV) function, using two-dimensional guided global and segmental longitudinal strain. Materials and Methods: Fifty patients with conventional indications for permanent pacemaker implantation were studied; they were classified to Group A (37 = 74%) patients who didn't show a significant reduction of ejection fraction (EF) (>10%) and Group B (13 = 26%) represent patients who showed a significant reduction of EF. Group C constituted 25 healthy persons (control group). We defined PICM when EF is reduced >10%. Results: The incidence of pacemaker-induced ventricular dysfunction was 26%. Statistical analysis revealed that left atrial volume index (LAVI), global longitudinal strain (GLS), native-QRS duration, and ischemic heart disease were significant predictors of reduction of LV function, however, on multivariate regression analysis, only the LAVI and GLS were independent predictors of reduction of LVEF after permanent pacing. Conclusions: Speckle tracking echocardiography is a new, unique and evolving tool to assess the myocardial deformation which can detect LV systolic dysfunction much earlier than can be reflected in LVEF. The importance of defining predictors is to predict whom patient will be at risk for the deleterious effect of RV pacing on LV function, and who will need observation with possible upgrading to biventricular pacing.

Funding Acknowledgements Type of funding sources: None. Background No reflow has detrimental outcomes in STEMI patients undergoing primary PCI (PPCI). It leads to poor post PCI LV function and higher mortality. The protective effect of ischemic pre-conditioning ( clinically manifested as pre-infarction angina) was controversial in the literature. Purpose Our aim was to study the effect of pre-infarction angina on the occurrence of no-reflow phenomenon and in-hospital major adverse cardiac events (MACE) in PPCI patients. Methods After obtaining ethical approvals and informed consents, we prospectively studied 120 STEMI patients admitted for PPCI in a consecutive manner. Patients with history of CABG or previous PCI and in-stent restenosis were excluded. The definition of in-hospital MACE included cardiac death, myocardial reinfarction, stent thrombosis, or target vessel revascularization. The data were analysed by professional statisticians using SPSS software. Results 15 patients ( 12.5%) had no-reflow, 5 patients ( 4.2%) had cardiac death and one patient had both(0.8 %). The admission characteristics of the studied groups are presented in table 1. Pre-infarction angina was present in 43 patients in the normal flow group and 6 patients in the no-reflow/MACE group. The odds ratio for no-reflow/MACE in those who had pre-infarction angina was 0.52 (95% CI 0.19-1.45, P = 0.21). Conclusion In our studied group, pre-infarction angina has not shown to be protective against no-reflow and in-hospital MACE in PPCI patients. The loss of the protective effect of ischemic pre-conditioning might be secondary to higher admission random plasma glucose levels in our patients compared to those included in similar studies. Similar effect was previously shown in studies on mice. Further in-human studies are needed to confirm the negative effect of hyperglycemia on ischemic pre-conditioning. Characteristics of studied groups Normal flow (n = 99) No-reflow/MACE(n = 21) P value Age (mean ± SD) 56.3 ± 10.3 62.3 ± 7.9 0.014 Male sex (n) 75 13 0.19 Diabetes (n) 37 12 0.094 Hypertension (n) 48 7 0.21 Smokers (n) 52 9 0.42 Dyslipidemia (n) 54 15 0.16 Family history of IHD (n) 17 2 0.52 Pre-infarction angina 43 6 0.21 Admission random plasma glucose in mg/dl(mean ± SD) 186.4 ± 84.7 275.3 ± 104.1 0.001

Introduction: Data assimilated for coronary arteries angiography by MDCT with retrospective (ECG) gating could be used for LV function without the need to repeat examination. Aim of the work: Is to study left ventricular segmental motility and global function using MDCT compared to MRI. Patients and methods: Fifty patients had cardiac MDCT and MRI studies within the same hour. LVEDV and LVESV volumes were measured. Consequently, the (EF) was calculated, for wall motion analysis, cine loops evaluated by two radiologists. Results: Excellent correlation between MDCT and MRI for the measurement of EDV (r2 = 0.962; p

Background The role of stent post dilatation (SPD) during primary percutaneous intervention (PPCI) is controversial. Currently there are no clear guidelines or consensus regarding when to perform SPD and it is left to the operator decision. Purpose The aim of this study was to evaluate the procedural and long terms outcomes of SPD during PPCI. Methods We collected retrospectively data of 614 STEMI patients who presented to two tertiary centers during one year period. All patients underwent PPCI. We excluded patients with cardiogenic shock, prior CABG, severe LM disease. Patients were divided into two groups according to SPD procedure. Group 1: who had SPD included 424 patients (69.1%). Group 2: no SPD included 190 patients (30.9%). Both groups were well matched with regard to demographic data and lesion characteristics. Procedural outcomes and clinical outcomes at one year were collected. Results SPD patients had significantly higher incidence of no reflow during the procedure (33.7% in group 1 vs. 21.6% in group 2, P=0.026), but the final TIMI flow was similar between two groups. Also, there was no significant difference between two groups regarding other procedural outcomes as dissection, perforation, or cardiac death. After one year follow up SPD patients had significantly higher incidence of reinfarction (5.6% of group 1 vs. 1.5% in group 2, P=0.03) and significantly more target vessel revascularization (TVR) (16.7% in group 1 vs. 4.7% in group 2 P Conclusion Our study shows that SPD during PPCI is associated with an increased risk of procedural no reflow and increased risk of reinfarction as well as need for TVR after 1 year follow up. Finally, SPD did not improve clinical outcomes after 1 year follow up. Nonetheless, large-scale randomized trials are required to establish the role of SPD during PPCI. Funding Acknowledgement Type of funding sources: None.

The development of the photoreceptors of human embryos and fetuses dating from 7 weeks to term were studied. The outer segments of rods and cones began to form at the seventh month. The arrangement of the newly formed discs were not regular, but at term they were arranged parallel to each other and perpendicular to the long axes of the outer segments. At the 9th month, no phagosome containing discs was seen in the pigment epithelial cells, but they were discerned in those of the term fetuses.

Incidence of multivessel disease (MVD) among patients presented with non ST segment elevation acute coronary syndrome (NSTE ACS) is very high and the optimum revascularization strategy still unclear. The aim of this study is to evaluate the different patterns of percutaneous revascularization (PCI)

Objective: To study the prevalence of cutaneous disorders in patients with diabetes mellitus. Subjects and Methods: All diabetic patients attending the Department of Dermatology, Al-Farwaniya Hospital, Kuwait, and diabetic in-patients with skin disorders were examined over a period of 18 months from March 2004 to August 2005. A total of 106 diabetic patients displaying 1 or more dermatological manifestations were identified and thoroughly examined for any skin disorder. The diabetic profile of the patients was obtained from medical records. Results: Of the 106 patients, 69 had only 1 cutaneous manifestation, 27 had 2, 6 had 3 and 4 had 4. Infections (68.0%) were the major cutaneous manifestations with fungal infection occurring in 41 patients followed by bacteria in 27. The second most common presenting symptom was pruritus. Hypertension (74%) was the most common systemic complication, and most of the diabetic patients who developed cutaneous manifestations were in the 40- to 60-year age group. Conclusions: The data show that infections were the most common cutaneous manifestation and hypertension the most common systemic complication.

Coronary angioplasty using 6 Fr guiding catheters has been described. This study was based on matching a prospective 105 coronary angioplasty procedures performed using 6 Fr guiding catheters (group I) with 100 other prospectively collected procedures performed through 8 Fr catheters (group II). Procedural variables such as quantity of contrast injected, total duration of the angioplasty, and vessel opacification were collected, as well as the success rate and local vascular complications. The two groups were identical regarding the baseline clinical and angiographic characteristics (age, sex, clinical indication, type of the lesion, and the size of the artery attempted). Success rate was similar between both groups (94.2% and 95% for groups I and II, respectively). Cross-over from 6 Fr to 8 Fr system was needed in two cases (one for inadequate back-up support, the other for a long dissection and inadequate vessel opacification). The use of 6 Fr guiding catheters was possible in such acute situations as myocardial infarction or scent delivery for coronary dissections. The quantity of contrast injected through the 6 Fr catheters (164 ± 74 mL) was significantly less than through the 8 Fr ones (217 ± 92 mL; P ± 0.01). On the other hand, the mean duration of the procedure was slightly longer using the 6 Fr system (40 ± 18 min vs 34.4 ± 18 min for groups I and II, respectively; P < 0.02). There was no difference between the two groups regarding the local vascular complications. This study demonstrates the feasibility of PTCA using 6 Fr guiding catheters in a variety of clinical indications, with a smaller quantity of contrast than in the 8 Fr ones, but a slightly longer duration. The other potential advantages of 6 Fr guiding catheters (lower rate of local complications, less blood loss) have not been proven in this study. (J Interven Cardiol 1996;9:373–379)

A 54-year-old male presented with a sudden generalized eruption of itchy violaceous papules, annular plaques, superficial vesicles, and erosions involving his trunk, limbs, oral cavity, and genitalia. The biopsy showed features of lichen planus (LP). Direct and indirect immunofluorescence (IF) was negative. Systemic treatment with oral corticosteroids in the form of 10 tablets of betamethasone 0.5 mg in a single dose was given after breakfast on 2 consecutive days every week. Complete arrest of progression, control of itching, and flattening of lesions was achieved within 3 weeks allowing tapering of the dose of corticosteroid by 0.5 mg every 2 weeks over next 10 weeks. No side effects of corticosteroid therapy were noted and the patient is in remission.

A 42-year-old healthy Thai male presented with a 1-week history of painful swelling of the penis following self-injection of two tablets of vitamin A dissolved in 10 mL of tap water with an unsterilized syringe, in order to achieve a more prolonged erection for sexual intercourse, on a friend's advice. He injected himself all around the penile shaft “just under the skin.” Eight hours after injection, the penis started to become progressively swollen and painful, but it was a further 2 days before he presented to our clinic. He denied a history of any urinary obstructive or irritative symptoms. There was no history of genital ulceration or urethral discharge or any similar acts of self-injection in the past. Physical examination revealed a markedly edematous, erythematous, and tender penis with multiple yellowish pus discharge points and small superficial ulcerations all around the shaft. The scrotum also showed mild edema and tenderness. There was tender bilateral inguinal lymphadenopathy. The patient was febrile (temperature, 39 °C) and was admitted. Complete blood count revealed a raised white blood cell count of 19.1 × 109/L. Urinalysis was normal. Ultrasonography of the genitalia revealed soft tissue thickening and multiple small collections of pus in the subcutaneous penile tissue; the corpora cavernosa and corpus spongiosum were normal. The patient declined urethrography. Cultures of blood and urine were sterile. Pus culture revealed Staphylococcus aureus. Microscopic examination of the discharge did not show any granular material. A biopsy was deferred at this stage considering the pyogenic nature of the patient's presentation. Parenteral antimicrobials, including ceftazidime, gentamicin, and metronidazole, were started. The patient's temperature rapidly fell to normal and, over a period of 10 days, the pus discharge points and pain and swelling of the penis resolved (Fig. 1) and the inguinal lymphadenopathy subsided. The patient was discharged with advice for regular follow-up for any late sequelae. The patient refused to undergo psychiatric evaluation and counseling. Figure 1. Edema and induration of the penis after 10 days of therapy. Resolving superficial erosions are also seen Download figure to PowerPoint

Analysis of 325 patients (182 males, 143 females) of mycologically proven tinea capitis (TC) seen over a period of two years from January 2001--December 2002 in the Farwaniya region of Kuwait is presented in this study. The age range was 8 months to 17 years. Peak incidence was observed in the 3-14 year age group (79.6%). Positive family history and contact with pets were noted in 22% and 36.7% of the cases, respectively. The non-inflammatory 'gray patch' variety was the most common clinical type, seen in 163 (50.2%) children, followed by the black-dot variant in 100 (30.2%) patients. A significant proportion of the cases (16.6%) had the uncommonly reported seborrheic dermatitis or dandruff like pattern. Highly inflammatory kerion was encountered infrequently (2.5%). Seven species of dermatophytes were isolated; Trichophyton violaceum in 135 (41.5%), followed by Microsporum canis in 89 (27.4%), Microsporum audouinii in 48 (14.8%), Trichophyton mentagrophytes var. mentagrophytes in 31 (9.5%), Trichophyton verrucosum in 15 (4.6%), Trichophyton tonsurans in 6 (1.9%) and Microsporum gypseum in 1 (0.3%) patient. T. violaceum was the most common fungus responsible for the black-dot variety (89/100) and kerion (4/8) patients. Three cases of kerion (33.3%) grew T. verrucosum. M. canis was the most common species isolated from the 'gray patch' cases (79/163; 48.5%) followed by almost equal prevalences of T. violaceum (16.6%), M. audouinii (15.3%), and T. mentagrophytes var. mentagrophytes (12.3%). Among the seborrheic type of cases, M. audouinii was the most common fungus isolated in 20/54 (37%) followed by T. violaceum in 15 (27.8%), T. mentagrophytes var. mentagrophytes in 9 (16.7%), M. canis in 8 (14.8%) and T. verrucosum and T. tonsurans in one (0.3%) patient each. The results are significantly different from those in earlier studies in Kuwait.

Background: To evaluate the usefulness of 64-slice multidetector computed tomography (MDCT) in assessing the patency of CABG and to compare MDCT with conventional selective bypass graft angiography (SGA), the gold standard for such assessment. Methods: A total of 131 bypass graft (80 left internal mammary artery grafts, 42 great saphenous vein grafts, two right internal mammary artery grafts, and seven radials artery grafts) in 47 patients (41 men, six women; mean age, 64.1 years; range, 39–85 years; mean heart rate, 67.3 bpm, range 46–98 bpm) were studied with MDCT and SGA, 5 days to 20.3 years (average 364.1 days, median 15.0 days) after CABG procedures. In these grafts, 172 sites of graft anastomosis were evaluated by both MDCT and SGA. Electrocardiogram-gated MDCT was performed with a Somatom Sensation 64 scanner (Siemiens) with a slices of 0.6-mm width at a pitch of 0.2 and gantry rotation of 330 ms. Based on volume-rendered 3D and multiplanar reformation images, anastomoses or bypass grafts were evaluated for patency, high-grade stenosis (≥50% diameter reduction), and occlusion. Results of MDCT and SGA were compared. Results: Of 172 anastomoses, SGA showed that 161 were patent, three were high-grade stenotic, and eight were occluded. Of these, MDCT demonstrated correctly 136 of 161 patent, two of three high-grade stenotic, and eight of eight occluded anastomoses. MDCT demonstrated one stenotic anastomosis to be occluded. According to these results, the overall sensitivity, specificity, and accuracy of the patency of graft anastomoses were 84.5% (136/161), 100% (11/11), and 85.5% (147/172), respectively. Of the 161 patent anastomoses, MCDT was unable to identify 13 because of metallic clip and misdiagnosed one as high-grade stenosis and eleven as occlusion. The major causes of the misdiagnosis on MDCTwere competing flow from and the small diameter of the native coronary arteries at the sites of anastomosis. Conclusions: Sixty four-slice MDCT is useful in assessing the patency of CABG and its use can obviate the use of conventional angiography if the technique demonstrates patency of graft anastomosis.