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The reported occurrence of ICMAs is 1.2 per cent to 5 per cent of cases. Streptococci and S.aureus account for 50 per cent and 10 per cent of cases, respectively, and are seen with increased frequency among IVDA patients with IE. The distal middle cerebral artery branches are most often involved, especially the bifurcations. ICMAs are multiple in 20 per cent of cases. Mortality rates are similar for multiple or single distal ICMAs. The overall mortality rate among IE patients with ICMAs is 60 per cent. Among those without rupture, the mortality rate is 30 per cent; this approaches 80 per cent if rupture occurs. Clinical presentation is variable Headache, altered sensorium, FND, SAH or IVH. CSF is sterile and contains erythrocytes, leucocytes and elevated protein. Imaging procedures to detect ICMAs are indicated in IE patients with localized or severe headaches, "sterile" meningitis, or focal neurological signs. Contrast-enhanced CT may provide useful initial information. This technique has a 90 per cent to 95 per cent sensitivity for intracerebral bleed and may thus indirectly identify the location of the MA. Magnetic resonance angiography is a promising new technique for the detection of ICMAs, although its sensitivity for aneurysms smaller than 5 mm is inferior to conventional 4-vessel cerebral angiography.
Conventional angiography remains the diagnostic imaging of choice. ICMAs may heal with medical therapy: ICMAs resolved between an initial and follow-up angiogram in 52 per cent of patients treated with effective antibiotic therapy. A decrease in ICMA size was seen in an additional 29 per cent. In 19 per cent of patients, however, the ICMA increased in size by the time of the second angiogram, and a new ICMA was discovered in 10 per cent. Currently, there are no data that precisely identify at risk for imminent rupture, and decisions concerning medical versus surgical therapy must be individualized. It is generally felt that a Single ICMA distal to the first bifurcation of a major artery (e.g., middle cerebral artery) and Multiple ICMAs should be monitored with frequent serial angiograms and excised promptly if the aneurysm enlarges or bleeds.
Interferon alfa In about one third of adults and children with chronic hepatitis B, treatment with interferon alfa-2b leads to loss of HBeAg, return to normal aminotransferase
Technique : The suitability of the pulmonary autograft for aortic valve replacement has to be studied by accurate measurement by echocardiogram of the aortic and pulmonary annuli.
Extraradicular Infections Whatever the cause of post endodontic disease we should do proper diagnosis to determine what is the cause; is it intra or extraradicular infection ,
What are halophile, thermoacidophile and methanogen archaebacteria? There are three peculiar parts of archaebacteria. The halophile archaebacteria only survive in salt-rich env
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SPLEEN Largest lymph gland, also with myeloid tissue is an important specialized reticuloendothelial organ in vertebrates, as the site of erythropoiesis. Splenic tissue i
Explain about the Conjugated proteins? The phospho proteins and the metallo proteins are loose (as with phosphate carrying protein) or tight (as with the phosphate in casein or
Denaturation: With respect to the nucleic acids, refers to the conversion from the double-stranded to single-stranded state, many times achieved by heating or alkaline conditions.
Cohesion-adhesion theory describes the properties of water which help move it through the plant. Cohesion is the property of water molecules to stick together (held by hydrogen bo
Evolution of Horse - Credit to Prof. C. Marsh (1879) of Yale University for complete work. S.No Fo ssil/Genus Period
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