Haysjoensen3326

Vertebrobasilar junction (VBJ) aneurysms are uncommon posterior circulation aneurysms. The treatment of VBJ aneurysms is challenging and in most cases, endovascular management is preferred over neurosurgery.

We describe two patients with VBJ aneurysms who underwent successful neuro-interventional procedures. The first patient had concomitant basilar fenestration and was treated with balloon-assisted coiling. The second patient had difficult vascular anatomy and an anterior inferior cerebellar artery-posterior inferior cerebellar artery variant arising from the neck of the aneurysm. Braided stent-assisted coiling was done with transradial access. Both patients had a good neurologic recovery.

Endovascular management of VBJ aneurysms is often complicated by anatomic difficulties like basilar fenestration, tortuosity of proximal vessels, atheromatous changes, and vascular stenosis. We achieved good post-procedure outcomes in both the patients. Optimal management of complex VBJ aneurysms often requires some modification to the usual interventional technique.

VBJ aneurysms are generally treated with endovascular techniques. The transradial access, although rarely used by neurointerventionalists, has some distinct advantages over the transfemoral access, especially when dealing with right-sided VBJ aneurysms with marked tortuosity of proximal great vessels.

VBJ aneurysms are generally treated with endovascular techniques. The transradial access, although rarely used by neurointerventionalists, has some distinct advantages over the transfemoral access, especially when dealing with right-sided VBJ aneurysms with marked tortuosity of proximal great vessels.

The conventional techniques for management of complex duodenal injuries are duodenal diverticularisation, pyloric exclusion or triple tube decompression. We here present a salvage technique of primary reinforcement with pedicled rectus abdominis muscle flap (RAMF) for a tenuous post traumatic duodenal perforation (PTDP). The majority of the studies in the literature are on the use RAMF for the secondary repair of peptic duodenal perforations.

A 38 year old male presented with an acute abdomen, three days after sustaining a blunt abdominal trauma. The clinical and radiological findings in the abdomen were subtle and not contributory. An emergency laparotomy with a high index of suspicion revealed a large perforation in the anterolateral wall of the second portion of the duodenum with a friable unhealthy wall and shearing of the serosa around the perforation site. The entire omentum was unhealthy, contused with areas of gangrene and omentectomy done. The perforation site was closed using 3.0 vicryl and reinforced with a pedicled right RAMF based on the superior epigastric artery. The patient recovered uneventfully and was discharged.

The addition of conventional diversion techniques to primary duodenorrhaphy is sophisticated, time consuming and adds morbidity.

RAMF is a good tissue substitute to buttress tenuous duodenal injuries presenting late with inflamed, friable perforation sites and associated tissue loss, where duodenorrhaphy alone may not be successful. RAMF is a valuable salvage technique when the omentum is not available and the local tissue condition negates the effectiveness of other simpler techniques.

RAMF is a good tissue substitute to buttress tenuous duodenal injuries presenting late with inflamed, friable perforation sites and associated tissue loss, where duodenorrhaphy alone may not be successful. RAMF is a valuable salvage technique when the omentum is not available and the local tissue condition negates the effectiveness of other simpler techniques.

Primary diaphyseal tuberculosis has very low occurrence. With no systemic signs and specific radiographic features, there exists low index of suspicion, which may delay the diagnosis of tuberculosis.

A female aged 15 years presented with chronic leg pain and swelling for past 7 months. There was no significant history of tuberculosis present. On investigations ESR was 44 mm and positive mantoux test. check details Chest radiograph was normal. On x-ray (R) fibula intramedullary eccentric lytic lesion and on MRI (R) leg intramedullary lytic lesion was present suggestive of ewing's sarcoma. On histopathology epitheloid granulomas with langhans giant cells were present. Category 1 antitubercular drug regimen was started and lesion healed with alleviations of signs & symptoms.

Tuberculosis presents with typical signs and symptoms in adults compared with children in whom cystic tubercular lesions in shaft of long bones presents mostly as a single solitary intramedullary lytic lesion on MRI, which corresponds with other more common differentials. This clinical and radiological heterogeneity warrants lesional biopsy and culture to determine the right diagnosis to aid in early starting of correct treatment and recovery of the patient.

With atypical presentation of diaphyseal tuberculosis in children, a high index of suspicion with unexplained pain and swelling of the bone could help to establish the diagnosis.

With atypical presentation of diaphyseal tuberculosis in children, a high index of suspicion with unexplained pain and swelling of the bone could help to establish the diagnosis.

Multilocular thymic cyst (MTC) is a rare condition of an acquired multilocular cystic lesion caused by inflammation and often associated with autoimmune diseases or malignant tumors. We present a patient with MTC and asymptomatic rheumatoid arthritis (RA), which is termed preclinical RA.

A 60-year-old man underwent a computed tomography scan, which revealed an 8.5 cm multilocular cystic lesion in the anterior mediastinum. The tumor had a lower intensity on T1-weighted imaging and a higher intensity on T2-weighted imaging. The imaging did not only suggest an MTC, but also the possibility of a thymoma with cystic degeneration, or lymphoma. We performed an extended thymectomy via median sternotomy. The lesion was diagnosed as MTC based on histopathological findings. Laboratory tests were performed for the purpose of screening for autoimmune diseases. He was diagnosed with preclinical RA, since the anti-cyclic citrullinated peptide antibody (ACPA) was positive.

Specificity of ACPA is recorded in over 90% of patients with RA; ACPA is positive in about 40% of patients with preclinical RA.