Moyamoya Disease was initially reported in 1957 as vessels resembling a puff of smoke, alongside hypoplasia of bilateral internal carotids. The true incidence remains elusive. Genetic studies point to familial occurrence of the disease, however some studies refute this, claiming that environmental factors are to blame. The treatment strategies remain an enigma, more so in our country where data is scarce. We present a case of an asymptomatic Moyamoya disease incidentally diagnosed in the work - up of Subarachnoid Hemorrhage. The basis of the management is being provided.
Headache

PURPOSE: To assess the pain intensity of patients administered midazolam and fentanyl citrate before undergoing transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: This was a study in patients with different indications for prostate biopsy in whom 5 mg of midazolam and 50 microg of fentanyl citrate was administered intravenously 3 minutes before the procedure. After biopsy, pain was assessed by use of a visual analogue scale (VAS) in three stages: VAS 1, during probe introduction; VAS 2, during needle penetration into prostate tissue; and VAS 3, in the weeks following the exam. Pain intensity at these different times was tested with stratification by age, race, education, prostate volume, rebiopsy, and anxiety before biopsy. Pain was ranked according to the following scores: 0 (no pain), 1-3 (mild pain), 4-7 (moderate pain), and 8-10 (severe pain). Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon two-tailed tests with a significance of 5%. RESULTS: Pain intensity was not influenced by any risk factors. The mean VAS 1 score was 1.95+/-1.98, the mean VAS 2 score was 2.73+/-2.55, and the mean VAS 3 score was 0.3+/-0.9, showing greater pain at the time of needle penetration than in other situations (VAS 2>VAS 1>VAS 3, p=0.0013, p=0.0001, respectively). Seventy-five percent of patients reported a VAS pain scale of less than 3.1 or mild pain. CONCLUSIONS: Intravenous sedation and analgesia with midazolam and fentanyl citrate is a good method for reducing pain caused by prostate biopsy, even during probe insertion.
Analgesia ; Anesthesia and Analgesia ; Anxiety ; Biopsy* ; Biopsy, Needle ; Continental Population Groups ; Education ; Fentanyl* ; Humans ; Midazolam* ; Needles ; Pain Measurement ; Prostate* ; Risk Factors ; Ultrasonography*

PURPOSE: We evaluated the utility of 10-, 12-, and 16-core prostate biopsies for detecting prostate cancer (PCa) and correlated the results with prostate-specific antigen (PSA) levels, prostate volumes, Gleason scores, and detection rates of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). MATERIALS AND METHODS: A prospective controlled study was conducted in 354 consecutive patients with various indications for prostate biopsy. Sixteen-core biopsy specimens were obtained from 351 patients. The first 10-core biopsy specimens were obtained bilaterally from the base, middle third, apex, medial, and latero-lateral regions. Afterward, six additional punctures were performed bilaterally in the areas more lateral to the base, middle third, and apex regions, yielding a total of 16-core biopsy specimens. The detection rate of carcinoma in the initial 10-core specimens was compared with that in the 12- and 16-core specimens. RESULTS: No significant differences in the cancer detection rate were found between the three biopsy protocols. PCa was found in 102 patients (29.06%) using the 10-core protocol, in 99 patients (28.21%) using the 12-core protocol, and in 107 patients (30.48%) using the 16-core protocol (p=0.798). The 10-, 12-, and 16-core protocols were compared with stratified PSA levels, stratified prostate volumes, Gleason scores, and detection rates of HGPIN and ASAP; no significant differences were found. CONCLUSIONS: Cancer positivity with the 10-core protocol was not significantly different from that with the 12- and 16-core protocols, which indicates that the 10-core protocol is acceptable for performing a first biopsy.
Adult ; Aged ; Cell Proliferation ; Endosonography/*methods ; Equipment Design ; Follow-Up Studies ; Humans ; Image-Guided Biopsy/*instrumentation ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Prospective Studies ; Prostate/metabolism/pathology ; Prostate-Specific Antigen/metabolism ; Prostatic Intraepithelial Neoplasia/metabolism/*pathology ; Prostatic Neoplasms/metabolism/*pathology ; Rectum ; Reproducibility of Results