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Treatments via the minor papilla is effective where the deep cannulation via the major papilla is impossible in such cases as [1] the Wirsung’s duct is inflammatory narrowed, bent or obstructed by impacted stones [2] pancreatic duct divisum (complete or incomplete) [3], maljunction of pancreatico-biliary union with stones [4], pancreatic stones in the Santorini’s duct. In [1,2] cases, the pancreatic juice flow via the major papilla decreases, while that of the minor papilla increases. Then the size of minor papilla and its orifice shows corresponding enlargement. This substitutional mechanism is an advantage when undertaking our new method. Since the pancreatic juice flow is maintained via the minor papilla in these cases, accurate and careful endoscopic skills are necessary to prevent pancreatitis due to the occlusion of the Santorini’s duct after this procedure. We have experienced 135 cases treated via minor papilla in these 27 years, so we would like to report about its safety and efficacy.

In many sectors, ranging from sports and military operations to professional settings (notably cognitive enhancement); human performance augmentation has been an enduring ambition. The idea behind this movement, known as human enhancement, has evolved over time from simple means of training to the improvement or augmentation of physical ability through recent developments in fields such as pharmaceuticals and implantable devices that can enhance natural abilities. They span from pharmaceutical agents to wearable technologies used for sophisticated self-experimentation, which offer promise but also present ethical, health, and societal risks Performance-Enhancing Drugs are used to enhance the performance of humans in one way or another as a basic idea. The categories of Performance Enhancing Drugs (PEDs) included are Stimulants: Stimulant drugs, including amphetamines and caffeine (in the form of coffee) have been used for thousands of endeavours and physical stamina for decades. There have been many sources of controversy in the sporting world due to use or misuse and side-effectual restrictions. The release of neurotransmitters such as dopamine and allowing muscles to grow big, and fast. Nevertheless, the consumption of anabolic steroids is strictly controlled because it has side effects and complications such as liver damage, hormonal imbalances, and greater aggression. Erythropoietin EPO is a hormone that produces red blood cells, and increased oxygen delivery to muscle. EPO Athletes and even more notably endurance athletes (such as cyclists) have a storied history of abusing this performance-enhancing agent to build stamina. However, the misuse of this drug can be very hazardous, as it causes complications such as blood clotting and heart issues.

A 21-y-old recreationally active male lacking the last 30° of elbow extension from a fractured and dislocated elbow sustained while wakeboarding came to our clinic November of 2015. A regimen was applied of 20-minutes of pulsed shortwave diathermy (PSWD) treatments delivered at 100 watts to heat the affected tissue prior to approximately 40°C followed by 10 minutes of joint mobilizations. This was followed by application of an ice pack to the area for 30 minutes. Measurements and treatments were given on Nov 3,5 and 10. The changes in AROM extension were as follows: Nov 3, from 30° to 20°; Nov 5, from 24° to 10°; Nov 10, from 10° to 0°. Over the course of the treatment the PSWD/ joint mobilizations improved extension AROM of the elbow 30° (full AROM) in just 3 treatments. There was also no post-treatment pain.

The case is that of 83 year-old African American man with hypertension, hepatitis C induced decompensated cirrhosis with ascites, end-stage renal disease (ESRD) on hemodialysis, fluid overload with peripheral edema and chronic hypotension. The patient was referred to the dialysis access center of Pittsburgh, PA for evaluation of his prolonged bleeding from the left upper arm brachial-basilic arterial-venous fistula (BBAVF).

In this study, the authors systematically examined the anatomical and biomechanical properties of the ligaments in the normal rat knee. These biomechanical data will facilitate the use of the rat knee model for future studies of knee ligament injury, repair, and reconstruction. Fifty-six fresh cadaver male Sprague-Dawley rats, aged 16 weeks, were used for this study, with 48 rats for biomechanical testing and 8 for micro-CT and histological evaluation. Our findings suggest that the gross anatomy of the rat knee joint and ligaments is very similar to humans despite some minor differences and features unique to the rat knee. The patella tendon and ACL are the two strongest soft tissue structures in the rat knee joint, with the highest failure force and stiffness, and both play a role in the anterior stability of the knee. In comparison, the failure force and stiffness of the LCL is half of the MCL, suggesting that other structures, such as the popliteal tendon, may play some role in lateral knee stabilization besides the LCL. In addition, our data suggest that anterior knee stability was improved after ACL reconstruction, but was not fully restored to intact ACL function. In conclusion, our study indicates the anatomical and biomechanical properties of the knee joint and ligaments of rat knees. Then we could confirm a reproducible and realistic rat model of knee ligaments like the clinical cases, and provide a basis for the study of knee ligament biology that simulates techniques used in humans.

In addition to conventional cyclones, direct-flow cyclones are often used in industry to separate dust and gas systems, despite the fact that in some cases they are inferior to other types of cyclones in their characteristics. 

NMDA receptor encephalitis is a rare disease first described in 2007. Anti-NMDA receptor encephalitis affects mostly young women as neoplasms, mostly ovarian teratomas, are the underlying cause. The disease is caused by antibodies binding to extracellular epitopes of neuronal cell-surface, which leads to an internalization of NMDA-receptors. The characteristic syndrome of patients with anti-NMDAR as well as its recovery follows a certain pattern. Treatment includes immunotherapy and removal of the immunologic trigger. This case report describes a young woman with anti-NMDA receptor encephalitis caused by an ovarian teratoma. 

Objective: Current guidelines favour radial access (TRA) over femoral access (TFA) for percutaneous coronary interventions due to lower bleeding risks and quicker patient recovery. This study compares patient satisfaction and complications between the two methods to identify the most suitable access route in coronary angiography (CAG).Materials and methods: A total of 152 patients who underwent CAG between February and June 2024 at our clinic were included. The operator and patient made access site decisions. Patients were surveyed 24 hours post-procedure, and complications were tracked for one month. The primary endpoint was patient satisfaction, while complications were classified as minor and major bleeding, pseudoaneurysm, hematoma, and spasm.Results: Of the 152 patients, 33% (n = 50) underwent TRA and 67% (n = 102) underwent TFA. Minor bleeding occurred in 16% (n = 24) and major bleeding in 0.02% (n = 3) patients. Pre-procedure anxiety, satisfaction with the access method, and awareness of TRA showed no significant differences between groups. However, post-procedure pain was higher in the TRA group (46% vs. 15%, p < 0.001), and systolic blood pressure was slightly elevated in the TRA group. Anxiety was more common in females, while elderly and obese patients showed no significant differences in bleeding or complications.Conclusion: Despite TRA’s benefits, no significant difference in satisfaction between TRA and TFA was observed. Patient preferences, radial artery spasms in females, and improved TFA techniques may influence outcomes. A shared decision-making process between operator and patient seems optimal for access site choice, with further investigation into patient satisfaction factors warranted.

Objective: The aim of the study was to determine the compliance to infection control of various dental laboratories in Durban. Study design: This was a qualitative survey. Setting: Dental laboratories in Durban area, South Africa. Subject: Registered laboratory technicians. Study methodology: Convenient random sampling method was used. Results: There was poor compliance to infection control procedures by most dental laboratories. Majority, 66.67%, of the dental laboratories relied on dental clinics for disinfection of dental impressions; therefore, they did not disinfect the impressions. On the other hand, only 33.33% carried out disinfection of dental impressions on their own. A high number (53.3%) of the respondents had disinfection areas within their dental laboratories, 6.7% had no disinfection areas while 40% depended upon dental clinics for all disinfections. About 60% of the dental technicians had valid vaccinations against Hepatitis B Virus while 40% had no vaccination against HBV. Conclusion: The results of this study indicated that there was substantial nonconformity to infection control measure in all dental laboratories. There should be comprehensive inspection of dental laboratories prior to licensing and thereafter by the South African Dental Technician Council’s inspectors to ensure that all dental laboratories comply with the various infection control measures.

Several articles have been written about hyper inflated sinus structures. Never before, however, a complete overview of all possible pressure induced variations of sinus anatomy have been published. The aim of this study was to make an inventory of the most common CT signs of hyper inflated paranasal sinus structures. During a period of 2 years all CT-scans of the paranasal sinuses made in an ENT-department were studied and the most typical shapes of hyper inflated sinus structures were recorded. The authors documented 9 different anomalies of the anterior paranasal sinus complex (frontal sinus, frontal and supra-orbital recess and anterior ethmoid), 8 of the ethmoid and 1 of the sphenoidal sinus. These hyper inflated paranasal sinus structures can only be generated by high positive intranasal pressures. The nose blowing manoeuvre is the only manoeuvre that generates extremely high pressures and as such it might be the driving force in the generation of these hyper inflated paranasal structures and consequently play a role in the pathophysiology of chronic sinusitis. Pneumatisation of the sinuses starts at birth and is a lifelong process. Sometimes, however, pneumatisation can be extreme and will result in facial deformities. Pneumosinus dilatans, is such a condition, characterized by an abnormal dilatation of a paranasal sinus cavity, containing air only. Most reports describe pneumosinus dilatans of the frontal sinus, but also other sinuses can show this phenomenon: maxillary sinus and in one case a unilateral pneumosinus dilatans of nearly all sinuses (maxillary, ethmoid, and sphenoid sinus) was described. Recently Kalavagunta et al., described a less dramatic expansion of the maxillary sinus and named it “Extensive Maxillary Sinus Pneumatisation” (EMSP). They were surprised to see that EMSP has received little attention in the literature. Neuner et al., described 9 different atypical pneumatisation abnormalities of the paranasal sinus anatomy. Most of deformities of the sinus pneumatisation are growth deformities of the thick bones that make up the frame of the sinuses. Only a few articles, deal with specific deformities of thinner bone structures such as “wavy orbital floor” and “frontal cells”. Never before, however, an article was published that studied all possible deformities due to increased pressures and tried to make a classification. So the aim of this study was to make an inventory of the most obvious pressures related deformities that can be seen on CT-scans of patients with rhinosinusitis.