The modified endoscopic Lothrop procedure in the treatment of complicated chronic frontal sinusitis

The purpose of this study was to evaluate the modified endoscopic Lothrop procedure in the management of complicated frontal sinus disease which has breached the confines of the sinus walls and extended into the cranial cavity or orbit. Fourteen patients with radiological evidence of 17 complications of frontal sinus disease presented over a 23-month period. CT scan and MRI scans revealed the presence of posterior table erosion and extension of the frontal sinus disease into the anterior cranial fossa in 10 patients. In addition, seven patients had intraorbital complications, with three patients having both intracranial and orbital complications. All patients underwent a modified endoscopic Lothrop procedure as part of the management of the complication. In addition, one patient required an orbital abscess drainage and repair of an encephalocele, with a second patient requiring drainage of an orbital subperiosteal abscess. At follow-up, all patients were asymptomatic and had patent frontal sinus ostia. Follow-up ranged from 8 months to 38 months with a median of 25 months. Three patients required a revision of their frontal ostium. Two patients had allergic fungal sinusitis with aggressive polyp recurrence and ostial re-stenosis while one patient developed recurrent orbital infections from a retained frontal sinus cell. Currently, all have patent ostia, with an average size of 14.6 x 11 mm. The modified endoscopic Lothrop procedure is an effective form of treatment in the management of complicated frontal sinus disease. The results are comparable to those achieved with other surgical approaches such as the osteoplastic flap with obliteration.

Liponeurocytoma of the cerebellum--a case report

We report the characteristic neuropathological features of a rare case of cerebellar liponeurocytoma in a 62-year-old female. The tumor has a low proliferative potential and carries a favorable prognosis.

Cerebellar hemisphere, an uncommon location for pleomorphic xanthoastrocytoma and lipidized glioblastoma multiformis

Lipidized glioblastoma multiformis (LGB) and pleomorphic xanthoastrocytoma (PXA) are often supratentorial in location and occur in the second to fourth decade. This report presents two young patients, one having LGB and the other having PXA in the cerebellum. Histological differentiation between LGB and PXA is discussed.

Rhabdoid tumor of the thalamus

Rhabdoid tumors of the central nervous system are uncommon tumors. About 188 cases have been reported in the literature so far. In this report, we describe a case of a rhabdoid tumor of the thalamus in a 35-year-old male patient. Light microscopic and immunohistochemical features are discussed and the relevant literature reviewed.

Should non-patient volunteers donate eggs?

Egg donation is associated with medical and surgical risks regardless of the source of eggs, be it through commercial, altruistic or more recent egg-share donors. Egg sharing is the only system that does not turn a healthy woman (the donor) into a patient. Using carefully selected egg-share donors, pregnancy rates for both donor and recipient are as good as any egg-donation programme, with one cohort of eggs being used with more efficiency. We propose that anonymous egg sharing, as licensed by the Human Fertilisation and Embryology Authority (HFEA), minimizes risk, is ethically sound and should be considered as the only acceptable form of anonymous egg donation.

False aneurysm of cavernous carotid artery and carotid cavernous fistula: complications following transsphenoidal surgery

We present two cases of carotid injury during transsphenoidal surgery for pituitary adenoma. While in one of the cases it resulted in the formation of a false aneurysm of cavernous carotid artery, in the other patient, a carotid cavernous fistula (CCF) formed. The false aneurysm was managed by surgical trapping and the patient had an uneventful recovery. The CCF was initially managed with balloon embolization. The balloon got deflated and resulted in a false aneurysm with persistent CCF. This was occluded with Guglielmi Detachable Coils (GDC). The management options are discussed and relevant literature is reviewed. We emphasize the importance of an early cerebral angiography to know the status of the injured carotid artery and formation of false aneurysm / fistula.

Intracranial aneurysmal bone cyst manifesting as a cerebellar mass

A 17-year-old boy presented with symptoms of raised intracranial pressure for a month. Investigations revealed a large extra-cerebellar mass. The lesion was radically resected. It arose from the petrous bone. Histology revealed that the lesion was an aneurysmal bone cyst [ABC].

Septic arthritis in an infant with vesicoureteral reflux and urinary tract infection

A 4-week-old boy with previous urinary tract infection and documented vesicoureteral reflux presented with urosepsis and septic arthritis of the right hip. Compliance with prophylactic antibiotic therapy had been poor at home. Complications such as bone and joint infection are known to occur after urinary tract infection in children with urologic abnormalities. However, previous similar reports describe discovery of the urinary tract anomalies only as part of an evaluation performed after the systemic complications have occurred. The purpose of this report is to stress the importance of defining urinary tract abnormalities in a case of antenatal hydronephrosis or at the time of the first urinary tract infection in infants so that appropriate investigations, management, and support of parental compliance can be undertaken to avoid systemic complications.

Bacterial growth efficiency in the tropical estuarine and coastal waters of Goa, southwest coast of India

Bacterial growth efficiency (BGE) is an index of organic carbon passing through bacteria in an aquatic system. BGE values of natural bacterioplankton assemblages were measured in tropical estuarine and adjacent coastal waters in Goa along the southwest coast of India. The BGE values for estuarine and coastal waters were 18 (+/-7.84%) and 11 (+/-4.19%), respectively. BGE in these waters were at the lower end of what is usually found in productive systems. This may be due to the high respiration rates. Further, it was observed that grazers also influenced BGE. As BGE was positively correlated with bacterial productivity, the observed variation in BGE was attributed to bacterial productivity. BGE was inversely related to C:N ratio, indicating a close coupling between the nature of the substrates and BGE. Being system-dependent, the variations in BGE at the two locations were dynamic and were regulated by the quality of the substrates. Therefore, a constant value for BGE would lead to error in carbon budgets in these waters.

Validation of biokinetic models of Cs and I using their daily dietary intakes and organ contents in an adult Indian population

The daily dietary intakes and total contents of Cs and I in skeletal muscle and thyroid, respectively, for an average Indian adult were estimated by determining their concentrations in the total cooked diet and tissue samples using instrumental neutron activation analysis. These data were then used to predict the biological half-lives of Cs and I and their radioactive counterparts for the Reference Indian Man. The predicted biological half-lives of Cs and I for Reference Indian Man were found to be comparable with the reported values for the ICRP Reference Man.

Minimizing risk in anonymous egg donation

Assisted conception carries with it known and putative medical and surgical risks. Exposing healthy women to these risks in order to harvest eggs for donation when a safer alternative exists is morally and ethically unacceptable. Egg sharing minimizes risk and provides a source of eggs for donation. Anonymity protects all parties involved and should not be removed.

Identification and mapping of an AFLP marker linked to Gm7, a gall midge resistance gene and its conversion to a SCAR marker for its utility in marker aided selection in rice

We have identified an AFLP marker SA598 that is linked to Gm7, a gene conferring resistance to biotypes 1, 2 and 4 of the gall midge ( Orseolia oryzae), a major dipteran pest of rice. A set of PCR primers specific to an RFLP marker, previously identified to be linked to another gall midge resistance gene Gm2, also amplified a 1.5-kb (F8LB) fragment that is linked to Gm7. Gm7 is a dominant gene and non-allelic to Gm2. Hybridization experiments with clones from a YAC library of Nipponbare, a japonica variety, a BAC library of IR-BB21, an indica variety, and cosmid clones encompassing Gm2 from Phalguna, an indica variety, with F8LB and SA598 as probes, revealed that Gm7 is tightly linked to Gm2 and is located on chromosome 4 of rice. SA598 was sequenced and the sequence information was used to design sequence-characterized amplified region (SCAR) primers. The potential use of these SCAR primers in marker-aided selection of Gm7 in a rice breeding program has been demonstrated.

Diversity of azospirillum strains isolated from rice plants grown in saline and nonsaline sites of coastal agricultural ecosystem

The diversity of indigenous Azospirillum spp. associated with rice cultivated along the coastline of Tamil Nadu was analyzed. Twelve sites with varying soil characteristics such as salinity, texture, and the host variety were chosen. Of the 402 strains isolated using NFB media, 302 were confirmed to be Azospirillum spp. and subjected to DNA polymorphism analysis using PCR-RFLP of 16S rDNA. They were also screened for their salt tolerance and microaerobic N2-fixing-dependent growth. On species identification, all the strains were found to be A. brasilense, A. lipoferum, or unidentified. On comparing the influence of the previously noted variability on the indigenous population, soil salinity was found to play a dominant role. This was revealed by PCR-RFLP studies and salt tolerance studies. A high association between soil salinity and the distribution of Azospirillum genotypes reveals that soil salinity should be taken into consideration while developing biofertilizers specifically for the coastal agricultural ecosystem.

Directional genome walking using PCR

We describe here a PCR-based "directional genome walking" protocol. The basic procedure for the amplification consists of two rounds of PCR. A primary PCR was performed, on the genomic DNA using a biotinylated primer specific to a known sequence in the genome along with four universal walker primers that were designed with partial degeneracy. The biotinylated primary PCR products were immobilized on streptavidin-linked paramagnetic beads. This step removed all nonspecific amplification products, and the purified template was used for the second PCR using a nested primer and the walker primer-2 to increase specificity. This technique is potentially useful for cloning promoter regions and has been successfully used to isolate 5'-flanking genomic regions of many cDNA clones previously isolated by us.

Spectrum of inherited bleeding disorders from Western India

OBJECTIVE

The study was undertaken to assess the magnitude and diversity of different bleeding disorders in Western India.

MATERIALS AND METHODS

768 cases referred to our Institute for evaluation of an underlying bleeding diathesis were investigated appropriately to detect the cause of the abnormal hemostatic function.

RESULTS

630 patients were diagnosed to have hereditary bleeding diathesis. Amongst these, 598 patients had a coagulation disorder while only 32 patients had a platelet function abnormality. Amongst the coagulation disorders, hemophilia A (70.5%) was the most common disorder followed by hemophilia B (14%) and VWD (10.8%). Glanzman's thrombasthenia (84.3%) was the most common platelet function disorder followed by Bernard-Soulier syndrome (12.5%). Some rare disorders have also been diagnosed.

CONCLUSION

In spite of their apparent rarity, India has a substantial number of cases of inherited bleeding disorders. A large number of these patients is referred to many tertiary care institutions. It is therefore desirable that district hospitals must develop their laboratories to detect most of these disorders so that the patients need not travel long distances to get an appropriate diagnosis and proper management. All 1st degree female relatives of severe and moderate hemophilia must get factor assays done because some of them may be vulnerable to post-procedural or post-traumatic bleeding.

Multi-slice 3D-CTA - an improvement over single slice helical CTA for cerebral aneurysms

BACKGROUND AND OBJECTIVE

The aim of this study was to demonstrate the utility of volume rendered multi-slice helical three-dimensional CT angiography in patients with cerebral aneurysm when compared with single slice CT angiography and formal digital subtraction angiography.

METHODS

A prototype Toshiba Aquilon multi-slice CT scanner was employed with the following scan conditions: voltage 135 kV; current 300 mA; slice thickness 0.8 mm; scan speed 0.75 sec/cycle; couch speed 1 mm/sec; range 50 mm from foramen magnum; scan pitch 3; three dimensional images were reconstructed using multiple image projections and integral volume rendering algorithms on a Xlink/Xtension workstation. 80 cases of multi-slice CTA for cerebral aneurysm carried out at Fujita University from January 1999 to January 2001 were reviewed.

RESULTS

The advantages of multi-slice imaging are illustrated with representative cases of cerebral aneurysm - good demonstration of three dimensional anatomy, appreciation of perforators down to 1 mm in size, delineation of the vessels around the aneurysm complex, relationship between the aneurysm and skull base, information on calcification, thrombus and blebs in the wall and eleven routine views for perusal.

CONCLUSION

Multi-slice CTA is a significant improvement over single slice CTA for cerebral aneurysms. It is our experience the superior and precise images produced by multi-slice technology displays anatomical information not readily available from standard DSA. Multislice 3D-CTA is relatively non-invasive and provides better and adequate detail for surgical planning. The basis of multi-slice CT angiography is described. Multi slice CTA is changing the way cerebral aneurysms are being managed nowadays. New advances in the technology of multi-slice CTA resulting in increased image resolution are outlined.

Grasses and gall midges: plant defense and insect adaptation

The interactions of two economically important gall midge species, the rice gall midge and the Hessian fly, with their host plants, rice and wheat, respectively, are characterized by plant defense via R genes and insect adaptation via avr genes. The interaction of a third gall midge species, the orange wheat blossom midge, with wheat defense R genes has not yet exhibited insect adaptation. Because of the simple genetics underlying important aspects of these gall midge-grass interactions, a unique opportunity exists for integrating plant and insect molecular genetics with coevolutionary ecology. We present an overview of some genetic, physiological, behavioral, and ecological studies that will contribute to this integration and point to areas in need of study.

Infrasellar craniopharyngioma mimicking a clival chordoma: a case report

An unusual case of entirely infrasellar craniopharyngioma mimicking a clival chordoma is described. Only 22 cases of craniopharyngioma with nasopharyngeal extension have been reported in the literature. Of the reported cases, most were primarily intracranial with secondary downward extension; only two were thought to originate from an infrasellar location. The present case is another example of an entirely infrasellar craniopharyngioma, with extensive clival destruction, mimicking a clival chordoma. Relevant literature on the subject is reviewed.

Mutation analysis of the BRCA1 gene in Malaysian breast cancer patients

Thirty patients with early onset breast cancer or familial breast cancer from Malaysia were analysed for germline mutation in the early onset breast cancer I gene (BRCA1). Direct sequencing of the entire coding region of BRCA1 identified a frameshift mutation, c.5447-5448insC (insC5447) (codon 1776 of exon 21) in a patient aged 32 of the Malay ethnic origin, who had no family history of breast and/or ovarian cancer. Eight polymorphisms (2201C > T, 2430T > C, P871L, E1038G, K1183R, 4427T > C, S1613G and IVS8-57delT) were identified in the samples tested.

Diversity of Pseudomonas spp. isolated from rice rhizosphere populations grown along a salinity gradient

Along the coastline of Tamil Nadu, five sites were chosen to assess the diversity of Pseudomonas populations isolated from rice (Oryza sativa) cultivated along a salinity gradient. One of these sites was under organic farming while the other four were under inorganic farming. A total of 256 Pseudomonas strains isolated from these five sites were analyzed using both phenotypic (substrate utilization patterns and antibiotic resistance assay) and genotypic (PCR-RFLP of 16S rDNA) characteristics. The results derived from this study indicate that soil salinity affects rhizosphere Pseudomonas populations. It was observed that increasing salinity led to decreasing diversity. Fluorescent pseudomonads were the dominant species found in the non-saline site, while in the saline sites they were replaced by salt-tolerant species, in particular Pseudomonas alcaligenes and P. pseudoalcaligenes. An interesting observation was the increase in diversity found in the saline site under organic farming. Organic farming was found to be capable of mitigating the harmful effects of saline stress to a large extent, and restoring the Pseudomonas diversity, thereby making it comparable with the diversity encountered in the non-saline site.

Acoustic neurinomas during pregnancy: report of two cases and review of literature

Though infrequent, acoustic neurinomas have been described during pregnancy and represent a therapeutic challenge for excision without producing any problem for the mother and the foetus. First Author experienced two cases of acoustic neurinomas presenting during pregnancy. One patient presented in the terminal stages of the third trimester of pregnancy and underwent caesarean section, followed by retromastoid craniectomy and excision of the tumour. Operative management of the pregnancy and tumour in the same sitting has not been reported in the literature. Second patient who presented during 2nd trimester of pregnancy, was operated on for the tumour and had a successful continuance of pregnancy. Details of the management are discussed and the relevant literature reviewed. In addition to causing aggravation of symptoms, the larger size and increased vascularity of these tumours during pregnancy, makes them more vulnerable to acute bleeding, which in turn may initiate new or exacerbate pre-existing symptoms, as noted in one of the cases presented in this report.