Choroid plexus papilloma of cerebellopontine angle with extension to foramen magnum

A case of choroid plexus papilloma resembling meningioma of cerebellopontine (CP) angle with its extension to foramen magnum is presented. Occurrence of this tumour in CP angle is very rare. Its extension towards foramen magnum is further rare. It was a real diagnostic enigma preoperatively as the tumour was resembling meningioma upto some extent on radiological study. Retromastoid craniectomy with microsurgical excision of tumour and its extension was achieved in toto. Tumour was attached to few rootlets of lower cranial nerves which were preserved. Attachment of the tumour with lower cranial nerves again caused diagnostic confusion with neurofibroma intraoperatively.

Third ventricle choroid plexus papilloma with head tremors

A rare case of third ventricular choroid plexus papilloma is reported. A two year male child presented with clinical features of raised intracranial pressure, meningismus, gait ataxia and abnormal head tremors. Abnormal head tremor is an extremely uncommon presenting feature of a choroid plexus papilloma of third ventricle.

Solitary mastocytoma in an adult

A 24-year old female developed late onset solitary mastocytoma on the left forearm. She complained of intense pruritus off and on which was not associated with flushing of face and blister formation over the nodule. Darier's sign was positive. Excisional biopsy was done and histopathology confirmed the diagnosis.

A Software programme for data analysis of cerebral aneurysms

Research by traditional methods of collection of data from case files, proformas, registers and master charts is laborious and cumbersome process. Case files in the hospital record section are often not easily accessible and can get lost. Moreover manually recorded and analysed data occupies lot of space. This entire tedious business is highly simplified by using computer software for record keeping and its analysis. We describe the development of a comprehensive, user friendly software programme for neurosurgeons using FoxPro to analyse data of cerebral aneurysm patients. Data entry is done with the help of prompted picklist instead of codes, the selection of which is tapping a key without the need to type it. This entered data is automatically converted into a computer database which generates more than 75 tables and graphs of predetermined nature and covers most of the parameters a neurosurgeon would be interested in. This coded database also generates a discharge summary in a flowing text. The prototype of programme has been used in our first hundred patients of cerebral aneurysm and debugged while analysing the next fifty.

Keratoderma hereditaria mutilans (vohwinkel's syndrome)

We report two cases of Vohwinkel's syndrome in son and mother presenting with a progressive palmoplantar keratoderma with 'honeycomb' appearance associated with constricting bands encircling digits of hands and feet along with keratotic plaques on dorsum of hands and feet. Both had associated sensorineural deafness.

Serum lipid profile in leprosy

Serum lipids and lipoproteins were assessed in 40 patients of leprosy and 20 healthy controls (age & sex matched). The leprosy cases included 20 cases each of paucibacillary and multibacillary leprosy.

Corpectomy for multi-level cervical spondylosis and ossification of the posterior longitudinal ligament

The choice of a surgical approach for multi-level cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) is still a controversial issue. While most of the surgeons are still performing decompression by laminectomy, some are doing multi-level anterior decompression. Few neurosurgeons are performing decompression by corpectomy. We have treated 26 patients by median cervical corpectomy during the last 4 years. These patients were followed up for a mean period of 25 months. Twenty one (80%) patients had a good outcome, 2 patients remained unchanged and 3 expired. Review of the literature and our experience indicates that patients with CSM and OPLL should be operated by median cervical corpectomy (anterior approach).

Adenosine deaminase activity in serum and lymphocytes of multibacillary leprosy patients

Adenosine deaminase (ADA) activity was measured in serum and lymphocytes of 25 untreated patients with multibacillary leprosy. Both serum and lymphocyte ADA levels were significantly high in multibacillary leprosy patients compared to healthy controls. The results obtained did not establish any significant relationship between ADA activity and the type of leprosy.

Growth hormone-producing pituitary tumours: clinical profile and results of surgery

BACKGROUND

Growth hormone-producing pituitary tumours present with a wide variety of manifestations. The optimum diagnostic work up, management and follow up of such patients is complex and involves a multidisciplinary approach. There is paucity of data from India with regard to the clinical presentation and results of surgery for growth hormone-producing tumours.

METHODS

We studied the first 50 patients presenting during 1989-94 with growth hormone-producing pituitary tumours to our centre. The work up included detailed endocrine and radiological assessment. The surgical outcome was analysed for 35 patients who were operated (trans-sphenoidal 29, transcranial 6) at our centre.

RESULTS

All the patients had macroadenomas [mean (SD) diameter 3.12 (0.87) cm]. Seventy-five per cent of the patients had supra- and/or parasellar extension and 57% had visual field defects. Tumour size correlated with the preoperative basal (r = 0.57) and glucose-suppressed (r = 0.54) growth hormone levels. Thirty-three of the 35 patients operated at our centre (trans-sphenoidal 28, transcranial 5) were available for follow up (median duration 34 months). After trans-sphenoidal surgery alone, 12 of the 28 (43%) patients had normalization of growth hormone levels (post-glucose growth hormone < 5 ng/ml), and 9 of 11 (82%) showed improvement in visual fields.

CONCLUSION

In India, growth hormone-producing pituitary tumours are usually large in size. The growth hormone levels correlate with the size of the tumour. These tumours can be effectively treated by trans-sphenoidal or transcranial surgery.

Giant cell tumor of sphenoid-diverse presentation: report of two cases

Two rare cases of giant cell tumors of the sphenoid bone are presented. We discuss their imaging, unpredictable biological behavior and management together with a review of the pertinent literature.

A double-blind comparison of 2% ketoconazole and 1% clotrimazole in the treatment of pityriasis versicolor

Forty adult patients of pityriasis versicolor were treated with either topical 2% ketoconazole cream (20 patients) or topical 1% clotrimazole cream (20 patients). In global assessment of treatment after 2 weeks, 18 (90%) out of 20 patients treated with ketoconazole cream were cured while 2 cases had considerable residual lesions. In clotrimazole treated group, 17 (85%) out of 20 patients were cured and 3 still had considerable lesions. No significant difference was observed in response rates in the two groups. No side effects were reported in either groups.

Immunoglobulin M immunoblot for diagnosis of Borrelia burgdorferi infection in patients with acute facial palsy

We used immunoblotting to improve the specificity of the serologic diagnosis of Lyme borreliosis in cases of acute facial palsy. Twelve of 15 patients (80%) with suspected Lyme borreliosis, versus 0 of 10 controls, were positive by immunoglobulin M immunoblotting of acute-phase sera and 3 were negative, including 2 with borderline enzyme immunoassay results. Immunoglobulin M immunoblotting is a useful test to confirm Borrelia burgdorferi infection in patients with acute facial palsy and a positive enzyme immunoassay result.

Effects of locus of control, occupational stress, and psychological distress on job satisfaction among nurses

This study evaluated the effects of locus of control, occupational stress, and psychological symptom distress on reported job satisfaction in a sample of 34 practicing nurses. As predicted, greater work-related stress and higher psychological symptom distress were significantly negatively correlated with job satisfaction. External locus of control was also negatively associated with job satisfaction.

Nurses' personality types based on the Myers-Briggs Type Indicator

One personality type was common for 15 of 34 nurses administered the Myers, Briggs Type Indicator.

Chelation in metal intoxication. XXXVIII: Effect of structurally different chelating agents in treatment of nickel intoxication in rat

Some structurally different chelating agents viz. alpha-mercapto-beta-(2-furyl) acrylic acid (MFA), alpha-mercapto-beta-(2-thienyl) acrylic acid (MTA), meso 2,3-dimercaptosuccinic acid (DMSA), 2,3-dimercaptopropane-1-sulfonate (DMPS), diethyl dithiocarbamate (DE-DTC), and N-benzyl-D-glucamine dithiocarbamate (NBG-DTC) were evaluated for their efficacy to mobilized nickel and reverse some nickel-induced biochemical alterations in experimental nickel intoxication. MFA, DMSA, and NBG-DTC appear more effective than their corresponding homologs, MTA, DMPS and DE-DTC, respectively, in enhancing urinary and fecal excretion of nickel and lowering tissue burden of nickel in nickel preexposed rats. These, particularly NBG-DTC, appear promising in the treatment of nickel (II) poisoning. However, there seems no definite relationship between the structure of the chelating agents examined and their ability to counteract the effects of nickel.

Posterior occipitoaxial fusion for atlantoaxial dislocation associated with occipitalized atlas

Between 1989 and 1994, 50 patients suffering from congenital atlantoaxial dislocation with either an assimilated atlas or a thin or deficient posterior arch of the atlas were treated with occipitocervical fusion using the technique described by Jain and colleagues in 1993 with a few modifications. An artificial bridge created from the occipital bone along the margin of the foramen magnum was fused to the axis using sublaminar wiring and interposed strut and lateral onlay bone grafts. Ten patients (20%) also underwent atlantoaxial lateral joint fusion by intraarticular instillation of bone chips. In 22 patients (44%) with irreducible dislocation, posterior fusion was preceded by transoral odontoidectomy. In seven patients (14%) with ventral compression, who showed marked clinical improvement on traction despite radiological evidence of persisting atlantoaxial dislocation, occipitocervical fusion was performed without ventral decompression. Seven patients (14%) underwent a single-stage transoral odontoidectomy and posterior fusion. There was no perioperative mortality and the osseous fusion rate was 88%. Of the 43 patients available at follow-up examination (range 3-12 months), 31 patients (72.09%) improved, seven (16.28%) remained the same, and five (11.6%) deteriorated in comparison with their preoperative status. Hence, this technique achieves a stable occipitocervical arthrodesis without supplemental external orthoses and facilitates early postoperative mobilization.

Dual use of silver for management of chronic bone infections and infected non-unions

Broad spectrum antibacterial effect of electrically generated silver ions has been fully established. Present work consists of clinical evaluation of beneficial antibacterial effect of silver ions liberated electrically with the help of locally manufactured power pack in 920 proved cases of chronic osteomyelitis with or without pathological fractures and septic non-unions. Wound debridement, silver iontophoresis, proper immobilisation and subsequent wound care yielded not only control of bone infections in 85% cases, but also produced healing of pathological fractures in 83% patients. Results remained unaffected by age or sex of patient, type of bone involved, duration of previous illness or type of previous treatment. Follow-up varied from 6 months to 10 years. This technique is likely to open a new chapter in treatment of chronic resistant bone infections and septic non-unions due to open fractures particularly in developing countries of the world.

Transfusion of donor buffy coat cells in the treatment of persistent or recurrent malignancy after allogeneic bone marrow transplantation

BACKGROUND

Patients who experience relapse after allogeneic bone marrow transplantation have a poor prognosis. However, preclinical and clinical data have strongly suggested the existence of an immune-mediated anti-tumor effect of allogeneic bone marrow transplantation. This effect, termed graft-versus-leukemia, may be harnessed purposefully in patients with posttransplant relapses by the administration of immune cells obtained by leukapheresis of the original bone marrow donor.

STUDY DESIGN AND METHODS

Thirteen patients with persistent or recurrent hematologic malignancy after HLA-matched sibling-donor allogeneic bone marrow transplantation were treated with transfusion of buffy coat cells collected from the original bone marrow donors. Mononuclear cell dose ranged from 1.18 to 4.28 x 10(8) per kg. Alpha-interferon (1.5-3 x 10(6) U/m2 3-5x/week) was given to seven patients. Patients were observed for the development of graft-versus-host disease and disease response.

RESULTS

Three of five patients with chronic myelogenous leukemia had complete remissions. One of five patients with active acute leukemia attained complete remission. A sixth acute leukemia patient treated with buffy coat transfusion after the induction of remission with chemotherapy relapsed 12 months later. One patient with myeloma had a complete but transient response. A patient with Hodgkin's disease did not respond. Four patients remain in remission 4, 16, 17, and 29 months after attaining complete remission. Graft-versus-host disease occurred in eight patients, including all of those with a complete response. One patient developed transient pancytopenia.

CONCLUSION

The transfusion of donor buffy coat cells has significant anti-tumor activity in patients with relapsed hematologic malignancy after allogeneic bone marrow transplantation. This effect is strongly associated with graft-versus-host disease.