Intraspinal neurenteric cysts--report of three paediatric cases

BACKGROUND

Neurenteric cysts are rare congenital lesions of the spine and are lined with entodermal epithelium. They result from anomalous endodermal-neuroectodermal adhesion in the 3rd week of embryonic life with persistence of canal of Kovalevsky. The nature of the eventual abnormality depends on the extent to which this adhesion subsequently disappears. Persistence of the entire tract results in the extreme form of combined anterior and posterior spina bifida with dorsal enteric fistula and persistence of only a part of the tract producing the isolated intraspinal cyst. The most common location is the cervico-dorsal region, and usually it lies ventral to the spinal cord. The lumbosacral location is uncommon. Associated vertebral anomalies, gut cysts, bowel duplication, the presence of keratin markers and mucin-secreting cuboidal or columnar intestinal epithelium in their walls confirm their entodermal origin.

PATIENTS

We describe here three unusual cases of neurenteric cysts in patients aged 5-18 years who had already had symptoms for some time. One of these had a cyst sited predominantly in the sacral canal, another presented with a lumbar neurenteric cyst, and the third patient had an intradural extramedullary thoracic lesion. Two of these children had associated anomalies, the one with lumbar cyst also having a lipomeningomyelocele and spina bifida while the other also had deformed vertebrae. All three patients underwent laminectomy and gross excision of the cysts through a posterior approach.

RESULTS AND CONCLUSION

The diagnosis of neurenteric cysts was confirmed by demonstrating mucin-producing cuboidal or columnar epithelium lining the cystic cavity.

Pregnancy induced hemolytic anemia: an unexplained entity

We present the case of a young primigravida who developed severe life threatening hemolytic anemia in the last trimester of three successive pregnancies with spontaneous recovery after each delivery and remained normal during the entire nongravid state. Corticosteroid and high-dose intravenous immunoglobulin therapy, although reported as useful, was ineffective in our case. She was managed only with the support with top-up blood transfusions. Extensive investigations were carried out to determine the cause of hemolysis, but these proved unfruitful. Fewer than two scores of such cases have been described in the literature. The paucity of such cases merits its presentation. It is suggested that this anemia should be referred to as "pregnancy-induced hemolytic anemia."

Successful management of infantile hypertrophic pyloric stenosis with atropine sulfate

OBJECTIVE

To evaluate the effectiveness of atropine sulfate in management of infantile hypertrophic pyloric stenosis (IHPS).

DESIGN

Prospective observational.

SUBJECT

Patients attending the hospital with complaints of persistent vomiting and later clinically and sonographically diagnosed as cases of IHPS were selected for the trial.

METHODS

Atropine was initially administered intravenously in a dose of 0.06 mg/kg/day in eight divided doses, increased by 0.15 mg/kg/day till vomiting ceased and remained so for a period of 24 hours at a stretch and ultrasonography showed a transit time (of gastric contents through pyloric canal) of less than 1 minute. Intravenous atropine was then substituted by oral atropine at double the effective IV dose for 3 weeks. Ultrasonographic evaluation of pyloric muscle thickness and length was done at the commencement of IV treatment, after completion of oral treatment and at 3,6,9,12 and 15 months follows up. Transit time of gastric contents was measured at the commencement of intravenous treatment and then daily after the vomiting stopped for more than 24 h at a stretch.

RESULTS

Medical treatment of IHPS with atropine was successful in 50/52 (96.2%) cases. Vomiting ceased in 1-3 days in all patients with mild hypertrophy and in 4-7 days in all the cases with moderate hypertrophy. In all except 2 patients with severe hypertrophy, vomiting ceased in 8-12 days. These two cases continued to vomit at least once daily even after 2 weeks of IV treatment and ultimately opted out for pyloromyotomy. All the 50 medically treated children made uneventful recovery during oral therapy except 3 cases (6%) in whom vomiting recurred during the follow-up. These 3 children later responded by increasing the dose of oral atropine. All of them began to gain weight by the time oral therapy was commenced and ultrasonographic evidence of normalization of pylorus was observed in all these children 3-15 months after completion of oral therapy.

CONCLUSION

Atropine sulfate proved to be an effective and safe treatment option for IHPS.

Lipase-catalyzed chemo- and enantioselective acetylation of 2-alkyl/aryl-3-hydroxypropiophenones

The chemo- and enantioselective capabilities of porcine pancreatic lipase (PPL) in tetrahydrofuran, and Candida rugosa lipase (CRL) in diisopropyl ether have been investigated for the acetylation of racemic 2-alkyl/aryl-3-hydroxypropiophenones, which are important precursors in the synthesis of biologically active chromanones and isoflavanones. A highly chemoselective acetylation of primary hydroxy group in preference to phenolic hydroxy group leading to the formation of enantiomerically enriched monoacetates has been observed.

Semi-solid-state fermentation of Eicchornia crassipes biomass as lignocellulosic biopolymer for cellulase and 3-glucosidase production by cocultivation of Aspergillus niger RK3 and Trichoderma reesei MTCC164

An aquatic weed biomass, Eicchornia crassipes, present in abundance and leading to a threatening level of water pollution was used as substrate for cellulase and beta-glucosidase production using wild-type strain Aspergillus niger RK3 that was isolated from decomposing substrate. Alkali treatment of the biomass (10%) resulted in a 60-66% increase in endoglucanase, exoglucanase, and beta-glucosidase production by the A. niger RK3 strain in semi-solid-state fermentation. Similarly, the alkali-treated biomass led to a 45-54% increase in endo- and exoglucanase and a higher (98%) increase in beta-glucosidase production by Trichoderma reesei MTCC164 under similar conditions. However, the cocultivation of A. niger RK3 and T. reesei MTCC164 at a ratio of 3:1 showed a 20-24% increase in endo- and exoglucanase activities and about a 13% increase in the beta-glucosidase activity over the maximum enzymatic activities observed under single culture conditions. Multistep physical (ultraviolet) and chemical (N-methyl-N'-nitrosoguanidine, sodium azide, colchicine) mutagenesis of the A. niger RK3 strain resulted in a highly cellulolytic mutant, UNSC-442, having an increase of 136, 138, and 96% in endoglucanase, exoglucanase, and beta-glucosidase, activity, respectively. The cocultivation of mutant UNSC-442 along with T. reesei MTCC164 (at a ratio of 3:1) showed a further 10-11% increase in endo- and exoglucanase activities and a 29% increase in beta-glucosidase activity in semi-solid-state fermentation.

Intellectual problems shown by 11-year-old children whose mothers had postnatal depression

The aim of the study was to examine long-term sequelae in the children of mothers who were depressed at 3 months postpartum. In a community sample from two general practices in South London. 149 women were given psychiatric interviews at 3 months postpartum and 132 of their children (89 %) were tested at 11 years of age. The children of women who were depressed at 3 months postpartum had significantly lower IQ scores. They also had attentional problems and difficulties in mathematical reasoning. and were more likely than other children to have special educational needs. Boys were more severely affected than girls, with the sex difference most pronounced on Performance IQ. The links between postnatal depression and the children's intellectual problems were not mediated by parental IQ and were not accounted for by measures of social disadvantage nor by the mother's later mental health problems. Breastfeeding did not remove the effect of the mother's illness on Full Scale IQ, but exerted its own influence on Verbal IQ and appeared to mediate the link with mathematical ability. The findings show that adverse experiences in infancy predict cognitive ability and academic performance a decade later.

Quantitative structure-activity relationship study of novel alpha1a-selective adrenoceptor antagonists

Two series of compounds were recently reported as novel alpha1a-selective adrenoceptor antagonists. In the first series, a dihydropyrimidone moiety is attached to a 4-phenyl piperidine containing side chain, while in the second, it is linked to a 4-substituted phenyl piperazine containing side chain. These compounds having potential for the treatment of benign prostatic hyperplasia, a urological disorder in the older age male population, were subjected to a quantitative structure-activity relationship study. The analysis has helped to ascertain the role of different substituents in explaining the observed binding potencies of these analogues. In the first category of compounds, three sites R1, R2, and X were varied and from the quantitative structure-activity relationship, it emerged that X- and R1-substituents having respectively, the high values of field and resonance effects may lead to more potent alpha1a-antagonists. The substituent of R2, being either CH3 or C2H5, does not add to improve the activity and thus the site, at present, becomes redundant. This site may, however, be explored for some additional substituents in future. In the second series of compounds, the phenyl ring, linked to a piperazine moiety at the end of a side chain, was substituted with various groups onto different positions. From derived significant correlations, it appeared the less polar and/or bulky substituents at the meta- and para-positions and a more hydrophobic substituent at the para-position are advantageous.

The role of HER2 in angiogenesis

Recent studies have established that growth factors and their receptors play an essential role in regulating the proliferation of epithelial cells. Abnormalities in the expression, structure, or activity of their proto-oncogene products contribute to the development and maintenance of the malignant phenotype. For example, c-erbB2 encodes the human epidermal growth factor receptor 2 (HER2), which is overexpressed or amplified or both in several human malignancies including breast, ovarian, and colon cancers. Tumor cells must use the process of vascularization (angiogenesis) for productive growth and metastasis. Overexpression of HER2 in human tumor cells is closely associated with increased angiogenesis and expression of vascular endothelial growth factor (VEGF). Indeed, when the VEGF pathway is inhibited, tumor growth is suppressed. The anti-HER2 blocking antibody trastuzumab has been shown to inhibit tumor cell growth and VEGF expression. Cancer cell invasiveness can be promoted, even in the absence of HER2 overexpression, by transregulation of HER2 by heregulins that bind to HER3 and HER4. Accordingly, heregulin beta1 regulates the expression and secretion of VEGF in breast cancer cells, and trastuzumab inhibits heregulin-mediated angiogenesis both in vitro and in vivo. Thus, potential upregulation of VEGF in cancer epithelial cells likely supports angiogenesis, sustaining and promoting survival and metastasis of tumor cells.

Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease

BACKGROUND

Increased neuronal activity in the subthalamic nucleus and the pars interna of the globus pallidus is thought to account for motor dysfunction in patients with Parkinson's disease. Although creating lesions in these structures improves motor function in monkeys with induced parkinsonism and patients with Parkinson's disease, such lesions are associated with neurologic deficits, particularly when they are created bilaterally. Deep-brain stimulation simulates the effects of a lesion without destroying brain tissue.

METHODS

We performed a prospective, double-blind, crossover study in patients with advanced Parkinson's disease, in whom electrodes were implanted in the subthalamic nucleus or pars interna of the globus pallidus and who then underwent bilateral high-frequency deep-brain stimulation. We compared scores on the motor portion of the Unified Parkinson's Disease Rating Scale when the stimulation was randomly assigned to be turned on or off. We performed unblinded evaluations of motor function preoperatively and one, three, and six months postoperatively.

RESULTS

Electrodes were implanted bilaterally in 96 patients in the subthalamic-nucleus group and 38 patients in the globus-pallidus group. Three months after the procedures were performed, double-blind, crossover evaluations demonstrated that stimulation of the subthalamic nucleus was associated with a median improvement in the motor score (as compared with no stimulation) of 49 percent, and stimulation of the pars interna of the globus pallidus with a median improvement of 37 percent (P<0.001 for both comparisons). Between the preoperative and six-month visits, the percentage of time during the day that patients had good mobility without involuntary movements increased from 27 percent to 74 percent (P<0.001) with subthalamic stimulation and from 28 percent to 64 percent (P<0.001) with pallidal stimulation. Adverse events included intracranial hemorrhage in seven patients and infection necessitating removal of the leads in two.

CONCLUSIONS

Bilateral stimulation of the subthalamic nucleus or pars interna of the globus pallidus is associated with significant improvement in motor function in patients with Parkinson's disease whose condition cannot be further improved with medical therapy.

Differentiation of calcification from chronic hemorrhage with corrected gradient echo phase imaging

PURPOSE

The purpose of the current study was to prospectively evaluate the role of corrected gradient echo phase imaging in differentiation of calcified granuloma from chronic hemorrhage.

METHOD

Eighty-five patients with single/multiple calcifications and hemorrhages irrespective of their location were studied with corrected gradient echo phase imaging. In all the cases, CT was used as the gold standard for the presence/absence of calcification.

RESULTS

All calcified lesions showed positive phase, whereas chronic hemorrhages showed negative phase in all cases. Five calcified lesions showed no phase shift at TE =15 ms and positive shift at TE = 35 ms. Heterogeneous phase shift was observed in three calcified lesions at TE = 35 ms; all three lesions showed positive phase shift at TE = 15 ms. There was no site-specific problem in differentiation of calcification from chronic hemorrhage including in the basal ganglia.

CONCLUSION

We conclude that calcified granuloma can be easily differentiated from chronic hemorrhage with corrected gradient echo phase imaging, which may obviate the need for CT for its confirmation.

Evidence for clustered mannose as a new ligand for hyaluronan- binding protein (HABP1) from human fibroblasts

We have earlier reported that overexpression of the gene encoding human hyaluronan-binding protein (HABP1) is functionally active, as it binds specifically with hyaluronan (HA). In this communication, we confirm the collapse of the filamentous and branched structure of HA by interaction with increasing concentrations of recombinant-HABP1 (rHABP1). HA is the reported ligand of rHABP1. Here, we show the affinity of rHABP1 towards D-mannosylated albumin (DMA) by overlay assay and purification using a DMA affinity column. Our data suggests that DMA is another ligand for HABP1. Furthermore, we have observed that DMA inhibits the binding of HA in a concentration-dependent manner, suggesting its multiligand affinity amongst carbohydrates. rHABP1 shows differential affinity towards HA and DMA which depends on pH and ionic strength. These data suggest that affinity of rHABP1 towards different ligands is regulated by the microenvironment.

Cognitive interference is associated with neuronal marker N-acetyl aspartate in the anterior cingulate cortex: an in vivo (1)H-MRS study of the Stroop Color-Word task

The neurobiology of cognitive interference is unknown. Previous brain imaging studies using the Stroop Color-Word (SCW) task indicate involvement of the cingulate cortex cognitive division. The present study examines interrelationships between regional brain N-Acetyl aspartate (NAA) levels (as identified by in vivo proton magnetic resonance spectroscopy in the right and left anterior cingulate cortex (ACC), dorsolateral prefrontal cortex, orbitofrontal cortex and thalamus) and cognitive interference (as measured by the SCW task) in 15 normal subjects. The results show that brain chemistry depends on cognitive interference levels (high vs low). Reduction of NAA levels was demonstrated in the right ACC (ie, cognitive midsupracallosal division) of high interference subjects, as compared to the low interference group (P < 0.01, two-tailed t-test). Chemical-cognitive relationships were analyzed by calculating correlations between regional NAA levels and the SCW task scores. Cognitive interference was highly correlated with the right anterior cingulate NAA (r = 0.76, P < 0.001), and was unrelated to other studied regional NAA, including the left ACC (P < 0.025; comparing the difference between r values in the right and left ACC). The interrelationships between NAA across brain regions were examined using correlation analysis (square matrix correlation maps), which detected different connectivity patterns between the two groups. These findings provide evidence of ACC involvement in cognitive interference suggesting a possibility of neuronal reorganization in the physiological mechanism of interference (most likely due to genetically predetermined control of the number of neurons, dendrites and receptors, and their function). We conclude that spectroscopic brain mapping of NAA, the marker of neuronal density and function, to the SCW task measures differentiates between high and low interference in normal subjects. This neuroimaging/cognitive tool may be useful for documentation of interference in studying cognitive control mechanisms, and in diagnosis of neuropsychiatric disorders where dysfunction of cingulate cortex is expected.

Resistance to treatment in Kala-azar: speciation of isolates from northeast India

Kala-azar in India is becoming increasingly difficult to treat, which may be due to the presence of species other than Leishmania donovani; Leishmania tropica was reported to cause the same clinical syndrome in the area. Over the past 3 years, we have collected samples from 241 patients with visceral leishmaniasis from across the region. Of the 189 isolates that grew on diphasic medium, 159 were successfully transferred to liquid medium for typing. Clinically, 80% of these were resistant to antimony. Lipophosphoglycan-specific monoclonal antibodies were used to distinguish the 2 species by agglutination of promastigotes; all 159 were shown to be L. donovani. Eighty-three isolates were confirmed to be L. donovani by isoenzyme analysis, by amplification of kinetoplast DNA, or both, in comparison with multiple reference strains; none were L. tropica. Thus, the rising incidence of clinical resistance to treatment is unlikely to be due to a different species causing kala-azar in north Bihar.

Assessment of imidacloprid in Brassica environment

Imidacloprid was applied as seed treatment (Gaucho 70 WS, 5 and 10 g ai kg(-1) seed) and foliar spray (Confidor 200 SL, 20 and 40 g ai ha(-1)) at 50% pod formation stage on mustard (Brassica campestris Linn.) to control mustard aphid, Lipaphis erysimi Kalt. It was detectable upto 82 and 96 days in plants after sowing from lower and higher doses of seed treatment. However, it dissipated faster and became nondetectable after 7 and 15 days of foliar treatments from lower and higher rates of application, respectively. The dissipation models yielded the rate constants of 0.0209 and 0.0230 and 0.0736 and 0.0779 day(-1) from seed and foliar treatment. The corresponding half-lives of 14.40 and 13.07 and 4.09 and 3.86 days were recorded. This suggested that the dissipation was independent of initial doses and followed a first order rate kinetics. The projected TMRC of imidacloprid from seed (0.136 and 0.225 mg person(-1) day(-1)) and foliar (0.069 and 0.1497 mg person(-1) day(-1)) treatments were found lower than the MPI (3.135 mg person(-1) day(-1)). At harvest mustard grains did not contain imidacloprid residues. The absence of imidacloprid in 0-10 and 10-20 cm soil layers indicated no leaching of insecticide. Therefore, imidacloprid treatments could be taken as safe for crop protection, consumption of leaves and environmental contamination point of view.

Specific inhibition of human immunodeficiency virus type 1 (HIV-1) integration in cell culture: putative inhibitors of HIV-1 integrase

To study the effect of potential human immunodeficiency virus type 1 (HIV-1) integrase inhibitors during virus replication in cell culture, we used a modified nested Alu-PCR assay to quantify integrated HIV DNA in combination with the quantitative analysis of extrachromosomal HIV DNA. The two diketo acid integrase inhibitors (L-708,906 and L-731,988) blocked the accumulation of integrated HIV-1 DNA in T cells following infection but did not alter levels of newly synthesized extrachromosomal HIV DNA. In contrast, we demonstrated that L17 (a member of the bisaroyl hydrazine family of integrase inhibitors) and AR177 (an oligonucleotide inhibitor) blocked the HIV replication cycle at, or prior to, reverse transcription, although both drugs inhibited integrase activity in cell-free assays. Quercetin dihydrate (a flavone) was shown to not have any antiviral activity in our system despite reported anti-integration properties in cell-free assays. This refined Alu-PCR assay for HIV provirus is a useful tool for screening anti-integration compounds identified in biochemical assays for their ability to inhibit the accumulation of integrated HIV DNA in cell culture, and it may be useful for studying the effects of these inhibitors in clinical trials.

Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MR spectroscopy and magnetization transfer MR imaging

BACKGROUND AND PURPOSE

MR imaging features are nonspecific with respect to the causative organism for patients with brain abscesses. On the basis of the hypothesis that the biochemical environment depends on the infecting organism and might be different in tuberculous compared with pyogenic brain abscesses, this study attempted to determine whether pyogenic brain abscesses can be differentiated from tuberculous brain abscesses by use of magnetization transfer (MT) MR imaging and in vivo proton MR spectroscopy.

METHODS

Twenty-seven patients with a total of 33 pyogenic brain abscesses and three patients with a total of 12 tuberculous abscesses were evaluated with in vivo MR spectroscopy and MT MR imaging. The diagnosis in all cases was based on the culture of the causative organisms and histopathology whenever done as a part of clinical management.

RESULTS

All 27 patients with pyogenic brain abscesses had lipid and lactate levels of 1.3 ppm and amino acid levels of 0.9 ppm with or without the presence of succinate, acetate, alanine, and glycine, while the three patients with tuberculous abscesses showed only such lipid and lactate levels. The MT ratio from the wall of the pyogenic abscesses was significantly higher (P <.001) than that from the tuberculous abscess wall.

CONCLUSION

It might be possible to differentiate tuberculous abscesses from pyogenic abscesses by using MT MR imaging and in vivo MR spectroscopy, which could be of value in influencing the management of such cases.

Interspecific hybridization in Brassica juncea and Brassica tournefortii through embryo rescue and their evaluation for biotic and abiotic stress tolerance

Interspecific hybrids were obtained in an otherwise incompatible cross Brassica juncea x Brassica tournefortii through in vitro culture of hybrid embryos. The best response was observed from culture of embryos excised 20 days after pollination on MS medium supplemented with kinetin, alpha-naphthylacetic acid, gibberellic acid, glutamine and casein hydrolysate. One hybrid plant had many distinct or intermediate characters. It was tolerant to aphid attack, exhibited irregularities in meiotic events and was partially fertile. The F2 open pollinated and BC1 progenies showed a large diversity in their morphological traits and some promising plants with less aphid infection, drought tolerance and high yield were selected.

Mirthful laughter induced by subthalamic nucleus stimulation

High-frequency stimulation of the subthalamic nucleus (STN) improves the motor signs of Parkinson's disease (PD). The three main components (motor, associative, and limbic) of the cortical-basal ganglia-cortical circuits pass through the STN. It is not known whether STN stimulation can influence the limbic loop. We present two PD patients in whom acute stimulation of an electrode located in the STN using high stimulation parameters (50% higher than therapeutic) induced funny associations, leading to infectious laughter and hilarity, whereas the therapeutic parameters induced a hypomanic behavior and marked improvement of akinesia. Our report suggests that the STN, with its sensorimotor, cognitive, and limbic parts is not only involved in motor, but also in psychomotor regulation.

Suppression of mosquito (Diptera: Culicidae) and black fly (Diptera: Simuliidae) blood feeding from Hereford cattle and ponies treated with permethrin

The blood feeding of mosquitoes and black flies from Hereford cattle and ponies treated with commercial formulations of permethrin was evaluated using an animal enclosure trap sample system that allowed comparison of insect blood-feeding levels between treated and nontreated animals. Blood feeding of both Aedes dorsalis Meigen and A. melanimon Dyar from heifers treated with pour-on concentrate and whole body spray treatments was reduced significantly by 79-88% at 4 d posttreatment, with apparent but not significant reductions of 61-68% at 11 d posttreatment. Simulium bivittatum Malloch and S. griseum Coquillett blood feeding was reduced significantly by 96% to >99% at 4 d posttreatment, but apparent reductions of 30-87% at 11 d posttreatment were not significant. Blood feeding of S. bivittatum from ponies treated with a permethrin fly wipe was reduced significantly by 98 and 87% at 1 and 7 d posttreatment, respectively. No evidence of treatment-induced mortality was observed for recently blood-fed female mosquitoes or black flies captured from treated animals and held for 24 h. The potential benefit of using permethrin to protect livestock from insect-transmitted pathogens was estimated with a model based on level of host attack, pathogen infection rate in the vector, and suppression of blood feeding. Suppression of blood feeding by 90% is predicted to prevent the exposure of a host to a pathogen for up tolO d at 1,000 insect feedings per d when the vector population infection rate is one insect per 1,000. If insect feedings are lower (100/d) and the insect infection rate remains at one per 1,000, protection is predicted for 100 d. In contrast, a 90% suppression of blood feeding is predicted to provide protection for less than 1 d at 1,000 feeding per day and a vector infection rate of one insect per 100.

Glucocorticoid-induced osteoporosis

Glucocorticoid-induced osteoporosis is a significant problem in patients receiving glucocorticoids after transplantation and for the treatment of parenchymal renal disease and rheumatological disorders. Frequently, patients are not evaluated or treated appropriately for glucocorticoid-induced osteoporosis. Bone loss occurs early after the administration of high-dose glucocorticoid therapy. Elderly patients with low bone densities before the initiation of glucocorticoid therapy are at particular risk of developing significant bone loss that could result in fractures. New information is now available concerning the mechanisms by which glucocorticoid-associated bone disease occurs. New therapies with anti-resorptive agents such as bisphosphonates and with anabolic agents such as parathyroid hormone offer the prospect of effective treatment of glucocorticoid-induced osteoporosis.

Uncommon presentation of medulloblastoma

INTRODUCTION

Medulloblastoma commonly occurs in children as a midline posterior fossa mass arising from the vermis, which appears as a hyperdense, homogeneously enhancing mass on CT scan and is associated with the clinical profile of posterior fossa syndrome. This unique clinico-radiological pattern is considered 'typical', but then medulloblastomas do not follow the typical clinico-radiological pattern in a significant number of cases.

PATIENTS

Out of the 42 cases of medulloblastoma operated on at SGPGIMS from 1988 to 1998, 29 cases were retrospectively and 13 cases were prospectively studied to detect the atypical clinico-radiological features. The typical radiological feature of a hyperdense homogeneously enhancing mass was seen in only 23 of the 42 patients, while 5 patients had hypodense nonenhancing masses, 13 had cystic changes, and 6 patients had calcifications in their tumours. Three patients presented with tumours in a very unusual location, i.e. the cerebellopontine angle cistern.

RESULTS

During follow-up, which ranged from a minimum period of 1 year to a maximum of 9 years, patients came back with metastases at very unusual sites. There were 5 cases of metastases in the frontal and subfrontal area (developed between 5 months and 5 years following surgery), and 1 patient developed a cervical intramedullary metastasis. Two patients developed abdominal metastases and ascites 2 years after definitive surgery and ventriculo-peritoneal shunting. Each of these 2 patients, however, had received a full course of craniospinal irradiation following surgery. Thus, we had a number of cases with an unusual clinical, radiological and metastatic pattern.