Uncommon craniospinal dysraphism

The uncommon variants amongst 619 cases of craniospinal dysraphism have been studied between 1987 to 1993. Lateral cervical meningocele is an extremely rare condition as to date only ten cases are traceable in the world literature. Its pathogenesis is discussed in detail. Similarly, this case of lateral frontal encephalocele is the second such example. Orbital meningocele may be congenital or following trauma to the orbital roof. Besides other unusual locations like the vertex, posterior fontanelle and anterior sacral are also encountered. Thus this paper focuses on the aetiology, clinical presentation and management of uncommon types of craniospinal meningo-encephaloceles.

An epidemic of viral acute haemorrhagic conjunctivitis in Delhi in 1994

An epidemic of acute haemorrhagic conjunctivitis affecting persons of all ages and both sexes occurred in Delhi and surrounding areas during the monsoon season of 1994. The symptoms lasted on an average for 4-5 days. In some of the patients corneal involvement was observed. Conjunctival swabs from the affected patients were processed for viral antigen detection, virus isolation and bacterial culture and sensitivity. Viral antigen was detected in 62% (31/50) of the smears tested by indirect immunofluorescence assay. In 22 (44%) of the specimens Coxackie A 24 (Cox A 24) virus antigen and in 9 (18%) of the specimens Entero Virus 70 (EV 70) antigen were detected. In confluent monolayers of Hep 2 cells cytopathic virus was isolated in 10 (30.30%) of the 33 specimens processed. The isolated viruses were identified as either Cox A 24 (7 isolates) or EV 70 (3 isolates) using indirect immunofluorescence assay. Super added bacterial infection was observed in 33% (89/270) of the cases, Staphylococcus albus being the predominant bacteria isolated.

Study of tumour ploidy in early stages of buccal mucosa cancer

The purpose of this study was to determine whether a tumour's DNA content is a prognostic factor in screening out the biologically aggressive varieties of early buccal mucosa cancer. Seventy-eight cases of early squamous cell carcinoma of the buccal mucosa were studied, including 73 with aneuploid and diploid tumours. T1 and T2 tumours, pathological differentiation, vascular and perineural invasion, and the recurrence and disease-free survival rate in relation to aneuploid and diploid content were ascertained. The recurrence rate in aneuploid tumours is 72%, whereas in diploid tumours it is 6% (P<0.001). A Cox regression analysis demonstrated that tumour ploidy was a prognostic factor in disease-free survival, independent of other clinico-pathological characteristics examined. Aneuploidy is the most accurate predictor of biological aggressiveness of cancer of the buccal mucose. Aneuploid early buccal mucosa cancers should be treated by multimodal therapy to achieve a cure.

Development of an antigen capture enzyme immuno assay using genus specific monoclonal antibodies for detection of Chlamydia in clinical specimens

An antigen capture enzyme immuno assay (EIA) for Chlamydia antigen detection was developed using polyclonal rabbit immunoglobulins against C. trachomatis, a genus specific antichlamydial murine monoclonal antibody (IgG) against major outer membrane protein (MOMP) antigen of C. trachomatis and a commercial anti mouse IgG immunoglobulin conjugated with HRPO. The test was evaluated against a direct immunofluorescence assay (DFA). Conjunctival specimens from 178 patients with follicular conjunctivitis and cervical specimens from 82 patients with cervicitis were tested for Chlamydia antigen detection by both the tests. Chlamydia antigen was detected in 69/178 (38.76%) and 68/178 (38.20%) of the conjunctival specimen by using EIA and DFA tests respectively. It could also be detected in 24/82 (29.27%) and 22/82 (26.83%) of the cervical specimens by EIA and DFA tests respectively. The sensitivity of the EIA test was 92.64 per cent and 86.36 per cent for the conjunctival and cervical specimens respectively against the reference DFA test. The specificity of the EIA test was found to be 94.54 and 91.66 per cent respectively against the reference DFA test.

Emotion-specific processing deficit in focal brain-damaged patients

Focal brain-damaged patients (left hemisphere damage, right hemisphere damage) and hospitalized general medical patients were asked to sort test photographs into target expressions of four facial emotions, happy, sad, fear and anger. In a second task, patients were asked to match neutral photographs with these target emotion expressions in a forced-choice format. Patients were also asked to rate their mood state on a two-dimensional affect grid. Right hemisphere-damaged patients were significantly inaccurate in matching the test-target expressions of facial emotions in comparison to left hemisphere-damaged or general medical patients. Analysis of error scores indicated a bias toward negative emotions by left hemisphere-damaged patients. Congruent to their mood state, left hemisphere-damaged patients also attributed "sadness" on neutral state of expression significantly more often than in right hemisphere-damaged patients.

Neonatal treatment with 5-HT antiserum alters 5-HT metabolism and function in adult rats

Adult rats were studied for serotonin and its metabolite in basal ganglia, nociceptive responses to electric current and tremor induced by 5-methoxy-N,N-dimethyltryptamine (5-MeODMT) to assess the effects of a single systemic injection of serotonin antiserum given at 1 day old. Antiserum-treated animals showed no overt behavioural abnormalities, but tremor induced by 5-MeODMT was augmented. Basal nociceptive thresholds for tail withdrawal and vocalization were unaffected, whereas vocalization after-discharge was significantly reduced. Significantly decreased serotonin levels and increased turnover were found in nucleus caudatus putamen, nucleus accumbens and tuberculum olfactorium of adult rats treated as neonates with serotonin antiserum. These results demonstrate long-lasting functional alterations and neurochemical suppression of the central serotoninergic system following neonatal administration of serotonin antiserum.

Hepatic trauma: an Indian experience

Over a five year period, between January 1989 and December 1993, a total of 230 patients with confirmed hepatic injuries were treated at a major urban trauma center. The mechanism of injury was blunt in 154 patients (67%). Nonoperative treatment was given in 18 patients (8%). All operated patients were explored through a midline incision. A "T" extension over the right hypochondrium was required in 24 patients (10%), while a right thoracotomy extension was needed in 16 patients (7%). Simple hepatorrhaphy, use of topical hemostatic agents or peritoneal drainage alone were performed in 151 (66%) patients. Extensive hepatorrhaphy, hepatotomy with selective vascular ligation, resection with debridement or resection alone, perihepatic packing and major vascular ligation were undertaken, often in combination in 61 (26%) patients. Percutaneous arterial embolization was carried out in one patient. The mortality rate was 19%. The most frequent postoperative complications related to hepatic injury were intraabdominal abscesses (6%) and coagulapathy (5%). Prolonged biliary leak (3%), late hemorrhage (1%) and hepatic necrosis (1%) were also observed.

Mixed meningitis: association of Acinetobacter calcoaceticus var lwoffi and Streptococcus faecium

We describe mixed bacterial meningitis in a young man due to Acinetobacter calcoaceticus var lwoffi and Streptococcus faecium. The combination of A calcoaceticus var lwoffi and S faecium as aetiology of mixed bacterial meningitis has not been previously reported. The patient recovered completely without neurologic sequelae on chloramphenicol and penicillin.

Effectiveness of alpha,beta-arteether in acute falciparum malaria

With the emergence of widespread chloroquine resistance and a world-wide scarcity of quinine, a search for newer antimalarial drugs has become imperative. Different derivatives of qinghaosu have been successfully tried. alpha,beta-Arteether, an ethyl derivative of qinghaosu, was administered to 51 patients with Plasmodium falciparum malaria, in a dose of 150 mg intramuscularly once a day on 3 consecutive days. Complete parasite clearance from the peripheral blood was observed in 80% of the patients at 48 h and in 98% at 72 h. The median parasite clearance time was 2 d (range 1-4 d). 65% of the patients became afebrile within 48 h and 81% by 72 h. The mean fever clearance time was 52.04 h (standard deviation 27.09). No side effect was seen. Patients were followed-up for 4 weeks; 7 were readmitted with P. falciparum infection but it could not be ascertained definitely whether these cases were reinfections or recrudescences. alpha-beta Arteether was a safe, effective and convenient drug for treating P. falciparum malaria. This is the first clinical study with arteether in falciparum malaria.

Mating propensity of Indian Drosophila melanogaster populations with D. simulans: a nonadaptive latitudinal cline

Crosses were investigated between a single strain of Drosophila simulans and 28 natural Indian populations of D. melanogaster. In each case, a mass culture and 10 isofemale lines of D. melanogaster were studied. Crosses were much easier between D. melanogaster females and D. simulans males than in the reciprocal case. Also, hybrid offspring were easier to obtain by using D. melanogaster flies (either males or females) from isofemale lines than from mass cultures. Finally, the crossability, estimated by progeny production, showed a clear-cut latitudinal cline: hybrids were easier to obtain with D. melanogaster populations from higher latitudes. As D. simulans does not occur in India, this cline does not reflect an evolutionary interaction between the two sibling species.

Vascular clogging, mononuclear cell margination, and enhanced vascular permeability in the pathogenesis of human cerebral malaria

To document histopathologic evidence on the pathogenic mechanism of human cerebral malaria, we used light microscopy to study brain specimens from 23 patients who died of central nervous system involvement with Plasmodium falciparum. Sequestration of parasitized red blood cells (PRBCs) leading to cerebral capillary clogging was seen. In a few specimens, vascular clogging by PRBCs was associated with margination of mononuclear cells. In others, capillaries were virtually empty and lymphocytes and monocytes were seen in apposition (marginated) to the capillary endothelial surface. The endothelial cells appeared plump, hypertrophied, and prominent. The capillary wall appeared thickened by fibrinous material. Massive intercellular brain edema along with extravasated red blood cells, mononuclear cells, and plasmatic fluid was also noticed. In addition to hypoxia induced by PRBC-mediated vascular clogging, marginating mononuclear cells may contribute to the pathogenesis of cerebral malaria. The precise role played by this phenomenon needs further evaluation.

Inversion polymorphism and extra bristles in Indian natural populations of Drosophila ananassae: joint variation

Five Indian natural populations of Drosophila ananassae were analysed for chromosome inversions and the presence of individuals with extra scutellar bristles in the F1 progeny of isofemale lines initiated from naturally impregnated females. Three commonly occurring inversions were found in these populations with varying frequencies as was the number of individuals with extra bristles (e.b.). Female individuals were more often found to carry extra scutellar bristles than were males. This result reveals that polygenic loci responsible for the determination of e.b. are widespread in Indian natural populations of D. ananassae. A significant positive correlation between the inversion frequency and the number of individuals with e.b. was detected in the isofemale lines of all the five populations. The 2L inversion, alpha, was found to be closely associated with individuals with the e.b. phenotype. The observed results are compared with earlier results obtained for D. melanogaster. The association of the alpha inversion with the e.b. phenotype is discussed in relation to chromosomal evolution in the melanogaster species group.

Sequential 1H NMR assignment of the complex of aponeocarzinostatin with ethidium bromide and investigation of protein-drug interactions in the chromophore binding site

Two-dimensional 1H NMR spectroscopy has been used to investigate the binding site, binding interactions, and the conformation of a 1:1 complex of aponeocarzinostatin (apo-NCS) with ethidium bromide in solution. The protein component in the complex has been sequence-specifically assigned using information derived from coherence transfer and two-dimensional homonuclear 1H NOESY experiments. The conformation of the protein in the complex has been found to be similar to the free form of the apoprotein, and intermolecular NOEs between the residues of the protein to protons on the ethidium bromide suggest that the ethidium bromide is bound to the protein in the same cleft in which the neocarzinostatin chromophore binds. Protons on ethidium show NOE interactions to the following protein residues: Trp-39, Leu-45, Cys-47, and Gln-94 which interact with the phenanthridine ring system of ethidium, Gly-102 and Asn-103 which interact with the alkyl chain of ethidium, and Phe-52 which interacts with the phenyl ring of ethidium. The orientation of ethidium in the cleft of apo-NCS is compared and contrasted to orientation of the chromophore as determined by high-resolution NMR and X-ray diffraction studies.

Development & use of antichlamydial monoclonal antibodies for rapid diagnosis of follicular conjunctivitis

We developed four independent murine hybrid clones producing IgG class and genus specific monoclonal antibodies against the major outer membrane protein (MOMP) of Chlamydia trachomatis, L2 serovar. All antibodies reacted with a single epitope of MOMP. In indirect immunofluorescence assay using one of the antibodies chlamydiae could be detected in 12 of 23 conjunctival scrapings from patients of follicular conjunctivitis. Giemsa staining could detect classical inclusion bodies in only 5 of these 23 smears. Antigen detection using these monoclonal antibodies may be used as a rapid diagnostic test in clinical and epidemiological screening for chlamydial infection.

Plasma antioxidants and lipid peroxidation products in falciparum malaria

To investigate the influence of Plasmodium falciparum malaria on plasma antioxidants and lipid peroxidation, plasma ascorbate, urate, total protein and albumin, ceruloplasmin and malondialdehyde (MDA) were determined in two groups of 42 patients each, one with mild and the other with severe falciparum malaria, and in an equal number of age- and sex-matched control subjects. Plasma MDA was found to be significantly higher in malaria patients, and the increase was proportional to the severity of the disease. Of the antioxidants, ascorbate and albumin decreased with severity of disease while urate and ceruloplasmin increased. Only ascorbate correlated inversely with MDA both in mild (r = -0.341, P < 0.05) and severe malaria (r = 0.545, P < 0.01). While plasma albumin correlated inversely (r = -0.442, P < 0.01), urate and ceruloplasmin correlated directly (r = 0.419, P < 0.01 and r = 0.349, P < 0.05, respectively) only in patients with severe malaria. These antioxidants also correlated well with markers of disease severity, indicating the influence of disease severity in regulating their levels in plasma. The presence of significant quantities of ascorbate and albumin, along with increases in some of the other antioxidants and MDA, indicates ineffectiveness of the antioxidant defense system in controlling plasma lipid peroxide content. Increased amounts of thiobarbituric acid-reactive material could have been the result of spillover from increased tissue peroxidation or the presence of pro-oxidants in malarial plasma.

The affinity-labelling of cathepsin S with peptidyl diazomethyl ketones. Comparison with the inhibition of cathepsin L and calpain

Since peptidyl diazomethyl ketones are useful irreversible inhibitors for inactivating cysteinyl proteinases in vitro and in vivo and in order to reveal their role, we set out to obtain selective and effective reagents for cathepsin S. A number of such derivatives with hydrophobic amino acid residues, such as valine, leucine and tryptophane in positions adjacent to the primary specificity site were synthesized and these provided inhibitors rapidly acting at high dilution. For example, 1 nM Z-Leu-Leu-Nle-CHN2 inactivates cathepsin S with k2nd = 4.6 x 10(6) M-1 x s-1 at pH 6.5, 25 degrees C. Similarities to the specificities of cathepsin L and calpain were evident. However, Z-Val-Val-NleCHN2 is over 300 times more effective in inactivating S than L. On the other hand, Z-Phe-Tyr(t-Bu)CHN2 is about 10(4) more effective against L than S. Reagents are thus now available for a clear discrimination between these proteases.

Mixed vascular malformations of the brain: clinical and pathogenetic considerations

The clinical relevance of any scheme for classification of vascular malformations of the brain remains controversial. Widely accepted pathologic classifications include discrete venous, arteriovenous, capillary, and cavernous malformations. Of 280 cases of possible vascular malformations evaluated by a single cerebrovascular service during a 5-year period, 14 were instances of mixed vascular malformations including definite features of more than one pathologically discrete type of malformation within the same lesion. There were six instances of mixed cavernous and venous malformations in the same lesion; in all instances, the cavernous malformation accounted for the clinical presentation. There were three cases of mixed venous and arteriovenous malformations (arterialized venous malformations), presenting with the typical histoarchitectural appearance of a venous malformation, but with arteriovenous shunting; all cases were symptomatic, two with hemorrhage and one with focal neurological symptoms. There were five cases of predominantly cavernous malformations with features of arteriovenous malformation or capillary telangiectasia in the same lesion. These five cases presented clinically as angiographically occult lesions indistinguishable from a cavernous malformation. Lesions including a venous malformation were recognizable preoperatively because of characteristic imaging features of the venous malformation. Other mixed vascular malformations were indistinguishable on diagnostic studies from pure cavernous malformations. Of the 14 mixed vascular malformations, 11 included a cavernous malformation that was usually responsible for the symptomatic presentation. In the other three cases, manifestations of clinical lesions were due to arteriovenous shunting within a venous malformation. We conclude that mixed vascular malformations of the brain are rare entities with distinct clinical, radiological, and pathological profiles. Their identification generates several hypotheses about common pathogenesis or causation-evolution among different types of lesions.

Herniation of calcified cervical intervertebral disk in children

Childhood intervertebral disk calcification is a rare clinical entity and usually has a benign course, generally undergoing spontaneous resolution. However, rapid neurologic deterioration due to herniation, found in both of our cases of calcified cervical intervertebral disks, required urgent anterior discectomy and fusion, resulting in excellent recovery.

Altered plasma lipid pattern in falciparum malaria

Plasma levels of HDL, LDL, total cholesterol and triglycerides were measured in 60 patients with falciparum malaria (37 severe cases and 23 mild) and in 83 healthy individuals, to study malaria-induced changes in plasma lipids. Triglyceride levels were lower in the patients than in the controls but the difference was significant only for those with severe malaria (P < 0.001). In contrast, the levels of all the other plasma lipids were significantly higher (P < 0.001) in those with severe malaria than in those with mild malaria, and in the mild malaria cases compared with the controls. Initially LDL cholesterol was estimated by the Friedwald formula, but this gave negative values in a few cases of severe malaria. Plasma lipoproteins were therefore also measured by nephelometry; the estimated levels of S particles, corresponding to LDL, were then found to be lower in all malaria cases than in the controls (P < 0.001) but never negative. Interestingly, levels of L particles in the patients with severe malaria were significantly elevated compared with the other patients and controls (P < 0.001), indicating impaired metabolism of chylomicrons. Plasma albumin, considered a negative acute phase protein (i.e. its level decreases as a consequence of the acute phase response), was reduced significantly and was directly correlated to HDL cholesterol levels (r = 0.715 and r = 0.895, respectively) in both mild and severe malaria. Follow-up of 22 of the severe malaria cases three weeks after treatment indicated that, while triglycerides had returned to similar levels to those in the controls, total cholesterol levels were still elevated and could give misleading results if lipid profiles were used, immediately after malaria infection, to assess an individual's risk of developing atherosclerosis.

Hepatic changes in P. falciparum malaria

Liver function tests were performed in 165 hospitalized patients suffering from P. falciparum malaria with complications. Serum bilirubin was found increased in 33 patients, and 22 of them had unconjugated hyperbilirubinaemia. Serum alanine aminotransferase was increased in 5 patients, but only to mild to moderate levels. Serum alkaline phosphatase was increased in 11 patients, gamma-glutamyl transpeptidase in 3 patients. Serum total protein and albumin were significantly decreased but these were considered more as indicator of acute phase response. Liver cell necrosis was observed in one patient, and oedema and mononuclear cell infiltration in two patients. Though hepatomegaly and mild elevation of enzymes can be observed in a significant proportion of patients, involvement of liver leading to acute hepatitis or liver cell necrosis is a relatively uncommon complication in P. falciparum malaria.

Bilateral traumatic extradural haematomas: report of 12 cases with a review of the literature

We are reporting 12 cases of traumatic bilateral extradural haematomas. The incidence was 4.8% of all cases of extradural haematomas. The most common site was the frontal region. CT scan examination was necessary for early diagnosis. Ten patients were operated upon while one patient was treated conservatively. Two patients died. The relevant literature is reviewed.

Influence of serum albumin & total protein on fructosamine measurement

To assess the effect of serum albumin and total protein on the fructosamine level 57 hypoalbuminaemic patients (serum albumin less than 30 g/1), of whom 44 were nondiabetics and 13 were diabetics, were studied. Fructosamine levels of hypoalbuminaemic diabetics was increased only marginally in comparison to healthy controls (P greater than 0.05) whereas in 122 other normalbuminaemic diabetics, the level was found to be significantly higher (P less than 0.001). In control subjects, the correlation between fructosamine and serum albumin (r = 0.69, P less than 0.001) was better than that of total protein (r = 0.42, P less than 0.01) whereas in hypoalbuminaemic patients the pattern was reversed (r = 0.51 and 0.59 respectively), indicating substantial contribution by the globulins. A working formula suggesting approximate contribution of each gram of albumin and globulin in healthy subjects was calculated. It is inferred that the use of serum fructosamine for assessment of glycaemic status could be misleading in patients with lower albumin values. Calculating serum fructosamine values from serum albumin alone in these patients is likely to be inaccurate, as it ignores the contribution of globulins which can be substantial in certain disease conditions. A gross idea regarding the glycaemic status can be obtained by comparing actual and calculated values of fructosamine from the formula.

Effect of directional selection on spontaneous male recombination in Drosophila ananassae

Artificial selection was carried out for high and low spontaneous male recombination values in D. ananassae for nine generations by using cu b se marker (second chromosome) and wild stocks which were free from heterozygous chromosome inversions. The mean crossing-over frequency of nine generations was 2.22, 0.70 and 1.20% in high, low and control lines respectively. The values of regression coefficient and realized heritability also indicated that male recombination was affected by selection. However, response to selection was more pronounced in high line as compared to low line. This provides evidence that spontaneous male crossing-over in D. ananassae is under polygenic control.

Increased cerebrospinal fluid protein and lipid peroxidation products in patients with cerebral malaria

Membrane lipid peroxidation by reactive oxygen species leading to increased capillary permeability is considered an important event in the pathogenesis of severe malaria. A significant decrease in plasma albumin and increases in cerebrospinal fluid (CSF) protein and malondialdehyde (MDA) were observed in 73 patients with cerebral malaria, compared to values in 23 control patients. The greatest effect was noticed in the most severely ill patients. The ratio of CSF protein to plasma albumin was increased in the patients compared to the controls, and in fatal cases of cerebral malaria compared to non-fatal cases. Brain necropsies showed oedema, fibrin deposits and mononuclear cell infiltration. It is proposed that cerebral oedema due to enhanced permeability of vascular endothelium induced by increased lipid peroxidation plays a crucial role in the causation of cerebral malaria.

Intra-and interchromosomal effects of heterozygous inversions on recombination in the third chromosome of Drosophila ananassae

In order to study intra-and interchromosomal effects of heterozygous inversions on recombination in the third chromosome of D.ananassae, experiments were conducted using Stw-pr marker stock and five wild stocks with known karyotypes. The stocks used were homozygous for standard or inverted gene sequence in 2L, 3L, and 3R. Recombination was investigated in both sexes. There was complete absence of crossing-over in males in all the experiments which appeared to be the characteristic of marker stock as spontaneous male crossing-over was reported earlier with the same wild stocks when the second chromosome markers were used. Based on the data of karyotypically homozygous F1 females, the map distance between stw-pr was 36.55 map units. The heterozygosity due to a lengthy inversion in 2L increased the level of crossing-over between stw-pr genes of the third chromosome indicating interchromosomal effect. There was a considerable reduction in the rate of recombination between the same markers due to inversion heterozygosity in 3R indicating intrachromosomal effect. However, 3L inversion heterozygosity had no effect on crossover rate. These results provide evidence for intra-and interchromosomal effects of inversions on crossing-over in the third chromosome of D. ananassae.

Lack of correlation between crossing-over and chromosome distance between inversions in Drosophila ananassae

Two linked inversions, AL and ZE, located in the opposite limbs of the second chromosome of Drosophila ananassae are separated from each other by nearly 32% of the total length of the second chromosome. Crossing-over between these inversions when heterozygous was studied in females and males by the salivary-gland smear technique using karyotypically homozygous stocks. The results of recombination experiments show that there is a strong suppression of recombination between inversions when heterozygous, in spite of a large euchromatic distance available for crossing-over between them. Thus there is no correlation between chromosome distance and crossing-over between heterozygous inversions in the second chromosome of D. ananassae when studied cytologically.

Hydrocephalus induced by cyclophosphamide in chick embryos

Cyclophosphamide was injected into the yolk sac of chick embryos for 6 days (Days 0-5). Embryos collected on the 21st day of incubation had a 37% incidence of hydrocephalus. Agenesis or stenosis of the aqueduct, as well as hypertrophy of the choroid plexus, was observed in 20% of the embryos.

Brain abscess: with special reference to infection by pseudomonas

Eighty cases of brain abscess treated in the University Hospital, BHU, Varanasi, India have been reviewed. Chronic suppurative otitis media was the commonest cause, followed by compound injuries. The overall mortality was 15%. In seven cases the causative organism was pseudomonas, resistant to most antibiotics. Prior to the availability of CT the mortality was 23.3%; after the routine use of CT for diagnosis the mortality fell to 10%. A high mortality (57%) was observed in patients who had pseudomonas. The best results were in patients who had been managed by excision of the abscess capsule.

Role of histamine in traumatic brain edema. An experimental study in the rat

The possibility that histamine plays a role in the formation of traumatic brain edema was investigated in the rat. A 3 mm deep and 3 mm long stab injury was performed in the right parietal cortex under urethane anaesthesia. The brain water content and histamine levels in plasma and brain were measured at the end of 1, 2 and 5 h periods after trauma. There was a 3.46% increase in brain water content in the traumatized hemisphere from the value in the control group at 5 h. The histamine content was increased by 107% in plasma and 51% in the traumatized brain hemisphere from the control value at this time period. The increased brain water content as well as the elevated plasma and brain histamine levels were prevented by prior treatment with the histamine H2-receptor antagonist cimetidine. Mepyramine (a histamine H1-receptor antagonist) failed to reduce the increased brain water content and the histamine levels in plasma and brain remained high. The results strongly indicate that histamine has a role in the formation of early traumatic brain edema and that this reaction can be influenced by pharmacological procedures.

Hypoglycaemia in severe falciparum malaria

The incidence of hypoglycaemia and the role of quinine in its causation was assessed in 46 patients with severe Plasmodium falciparum malaria. Plasma glucose and immunoreactive insulin were estimated before, during and after quinine therapy. In 5 patients the plasma glucose was in the hypoglycaemic range, the lowest value being 0.67 mmol/litre (12 mg/dl) in a pregnant patient. Most of the remaining patients showed a significant fall in plasma glucose (P less than 0.05), but not to the hypoglycaemic range, and an increase in plasma insulin after quinine (P less than 0.01). A good correlation was found between these changes (r = 0.79, P less than 0.01). Patients with severe P. falciparum malaria, particularly those on quinine therapy, should be watched carefully for developing hypoglycaemia.

Intramedullary neurofibroma of the cervical spinal cord: case report with review of the literature

A case of cervical intramedullary neurofibroma diagnosed and surgically treated is reported. This patient, a 27-year-old man, had no evidence of von Recklinghausen's disease. The case is discussed, and a review of literature is presented.

Recurrence of pituitary adenomas after transcranial operation

A series of 289 pituitary adenomas operated upon transcranially have been assessed for the frequency of recurrence. Ten patients died in the postoperative period, and nine patients have been lost to follow up. Follow up data is therefore available in a series of 270 cases for a period extending up to 30 years after the initial operation. There have been 13 histologically verified recurrences (4.8%), and a further six cases are known from CT scan or air study evidence to have residual or recurrent tumour which has not necessitated re-exploration. The total recurrence or residual tumour rate could therefore be regarded as 7.4%. The large majority (77%) of recurrences have been within 10 years of the first operation, and the rest between 10 and 20 years. Histologically, all were chromophobe adenomas, and the average age of their initial presentation was lower than the peak incidence of pituitary adenoma as a whole. Two patients showed frank malignant change in the second biopsy. In recurrent tumours, most had had only subtotal excision with some macroscopic evidence of invasion or degeneration, such as cystic change, haemorrhage or necrosis. Microscopic evidence of aggressive growth and capsular invasion by tumour cells also was relatively frequent. Postoperative radiotherapy decreased and delayed recurrence, although the vast majority of cases in the series received radiotherapy. Surgery for recurrence appeared an effective method of treatment, and no patient died following repeated operation. Initial transcranial excision in more recent years using the operating microscope followed by uniform radiotherapy, appears to have considerably reduced the already small recurrence rate of pituitary adenoma.

Haemorrhage in pituitary tumours

Evidence of haemorrhage was found in 58 of 320 verified pituitary adenomas (18.1%). Haemorrhage occurred as acute or subacute apoplexy and recent or old silent haemorrhages. The differentiation was based on the predominant clinical features, the operative findings and the length of the history. There was a relatively high incidence of giant or large recurrent adenomas, invasiveness, malignant change, increased vascularity and sinusoidal characteristics on histology among the haemorrhagic tumours. The majority (53.4%) were hypopituitary but 39.6% had no obvious endocrine defect. CT scan has helped in the early preoperative diagnosis of haemorrhage in pituitary adenoma. Transcranial surgery appeared a most effective mode of treatment in the current series.