Pial arteriovenous fistula (AVFs) are a rare, although clinically significant, vascular anomaly affecting the pediatric population, consisting of a high-flow connection between one or more pial arteries and the venous. In children, the clinical presentation varies according to age, can present with high output cardiac failure, macrocrania, neurodevelopmental delay, seizures, venous infarctions due to venous stenosis or hemorrhage secondary to venous thrombosis. The treatment, is a multimodal approach, most commonly endovascular, is effective in the obliteration of AVF. A case is presented of a previously healthy infant boy with neurological deficit arising from pAVF of the middle and posterior cerebral artery. The pAVF was successfully treated with endovascular occlusion.

Objective: The present studies objective was to evaluate the percentage of endotoxin diminution after mechanical instrumentation of asymptomatic necrotic teeth with apical periodontitis using three mechanical systems. Materials and Methods: One hundred and eighty patients between 18 and 65 participated in this research. Thirty-five of 140 teeth were selected for the four enlargement techniques. Control group, TFA, WOG, and PTN groups received final flushing with 6oC 17% EDTA solution gently administered to the WL through a cold (6oC) sterile metallic micro-cannula attached to the Endovac system (Kerr Endo) for one minute. Two samples of the canal were obtained using a sterile paper cone (size 30) introduced into the canals full length. Results: Results showed a statistically significant difference between the two groups in the percentage reduction of endotoxin levels (P-value <0.001, Effect size = 0.598). Group PTN showed a statistically significantly lower median % reduction in endotoxin quantities than Group WOG and TFA. Conclusion: Under this studys conditions, it can be concluded that the PTN system was more effective in endotoxins reduction in teeth with necrotic pulps. When the RCT is correctly instrumented, single visit RCT can be as effective as a multiple visit treatment.

Given that the importance of stabilization of the agency theory as a base to organize the relationship between the shareholders the origin and the management the agent in the business environment nowadays, this study aimed to identify the impact of the chief executive officer CEO power on the agency costs in the Libyan private banks. To achieve this goal the study underlying the scarcity of related previous studies has stated its hypotheses. The study sample consists of private banks for years; then the study relied upon the multiple regression technique, which has been used to examine the fourth sub-hypotheses of the main one. As a result, the study became able to state that there is a positive significant relationship between the CEO ownership in the bank shares and the agency costs, while that there is no significant relationship between the duality of CEO role, the duration of CEO in his position, the independency of the board of directors and the agency costs in the Libyan private banks.

Chronyc lymphosytic inflammation with pontine perivascular enhacement responsive to steroids (CLIPPERS), described for the first time in 2010 by Pittock and collaborators, is a rare inflammatory disease of the central nervous system (SNC) characterized by the presence of punctuate or curvilinear lesions described like “salt and pepper” appearance on the magnetic resonance imaging (MRI), that enhance with Gadoliniumn administration; this lesions show an exquisite response to corticosteroid therapy. The etiology of this disease remains unknown. However, the existing articles suggest an autoimmune component, which may or may not be related to other autoinmmune, infectious or malignant pathologies. Due to the above, it is generally considered that in order to reach the diagnosis of CLIPPERS, the possibility of other more common or aggressive pathologies must first be ruled out through extensive investigation. However, if the clinical and imaging presentation are typical and there is a very high suspicion of CLIPPERS, early initiation of glucosteroid therapy may be recommended. There is no unanimous therapy plan due to the few cases reported worldwide thus far. In cases of severe relapses or atypical behavior, both clinical and radiological, it is recommended to consider a stereotactic biopsy of the lesion to integrate the definitive diagnosis. Because it is a rare disease, it is relatively unknown to first- contact medical personnel; in our particular case, this leads to referral to the neurosurgery department who, thanks to their experience, have considered a demilinizing disease as a diagnostic possibility and requested an assessment by the neurology department. Here, we report the evolution and management of three diagnosed cases of CLIPPERS at a single Third-level Medical Center in México; based on clinical, radiological and neuropathological findings; as well as highlighting the importance of lesion biopsy in selected cases.