Management of Traumatic Unstable Thoracolumbar Spine: Conservative versus Operative Treatment

Traumatic thoracolumbar spine injury result in significant instability of the spine and leads to an acute on delayed neurological deficit. Objective of the study is to find a better option in the management of unstable traumatic thoracolumbar spine with incomplete neurological lesion. This was quasi-experimental study. The study was carried out at National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh from January 2006 to December 2008. A total number of 40 patients with traumatic thoracolumbar spine injuries with incomplete neurological lesion were selected purposively. Out of 40 cases 1 patient missed from final follow up. Rest of 39 patients was included in this study. All patients were admitted within 3 weeks of injury. Most were referred from peripheral hospital & some were admitted in emergency and outpatient department of NITOR. Among those 25 patients were conservatively treated and 14 were operatively treated. Neurological status improvement was assessed by Frankel grading; it was remarkable in operative group. In 56% of the conservative group improved by one grade but 21.42% of operative group had of similar improvement. This one-grade improvement has been classified as fair. Whereas two grade improvement was termed as good. So, good result was obtained in 40% of conservatively treated patients and 57.16% in operatively treated patients. In this study, an overall result was classified as excellent, good, fair andll poor. Three grade upper shifts were categorized as excellent. In excellent result was obtained by operative procedures and it was 21.42%. On the other ward, no patient showed excellent result in conservatively treated group. In Celbeti et al. reported that 16(33.3%) patients had excellent results, 23(57.9%) had good, 70(4.58%) had fair and 20(4.36%) Patients had poor results.

An illicit economy: scavenging and recycling of medical waste

This paper discusses a significant illicit economy, including black and grey aspects, associated with medical waste scavenging and recycling in a megacity, considering hazards to the specific group involved in scavenging as well as hazards to the general population of city dwellers. Data were collected in Dhaka, Bangladesh, using a variety of techniques based on formal representative sampling for fixed populations (such as recycling operatives) and adaptive sampling for roaming populations (such as scavengers). Extremely hazardous items (including date expired medicines, used syringes, knives, blades and saline bags) were scavenged, repackaged and resold to the community. Some HCE employees were also observed to sell hazardous items directly to scavengers, and both employees and scavengers were observed to supply contaminated items to an informal plastics recycling industry. This trade was made possible by the absence of segregation, secure storage and proper disposal of medical waste. Corruption, a lack of accountability and individual responsibility were also found to be contributors. In most cases the individuals involved with these activities did not understand the risks. Although motivation was often for personal gain or in support of substance abuse, participants sometimes felt that they were providing a useful service to the community.

Microneurosurgical management of temporal lobe epilepsy by amygdalohippocampectomy (AH) plus standard anterior temporal lobectomy (ATL): a report of our initial five cases in Bangladesh

Patient presenting as a case of Temporal Lobe Epilepsy (TLE) are usually resistant to antiepileptic drugs and surgery is the treatment of choice. This type of epilepsy may be due to Mesial Temporal Sclerosis (MTS), tumors [i.e. low grade glioma, Arterio-Venous Malformation (AVM) etc], trauma, infection (Tuberculosis) etc. Here we report five cases of surgically treated TLE that were due to a MTS, MTS with arachnoid cyst, low grade ganglioglioma, high grade ganglioglioma and a tuberculoma in the department of neurosurgery, Dhaka Medical College Hospital and Islami Bank Central Hospital, Dhaka, Bangladesh from August 2009 to February 2010. In all cases the only presenting symptoms was complex partial seizures (psychomotor epilepsy) for which all underwent scalp EEG (Electro Encephalogram) and MRI (Magnetic Resonance Imaging) of Brain. All patients were managed by amygdalohippocampectomy plus standard anterior lobectomy. One patient with high grade ganglioglioma recurred within two months of operation and expired within five months. The rest of the cases are seizure and disease free till the last follow up.

Novel technique for estimating cerebrovascular permeability demonstrates capsazepine protection following ischemia-reperfusion

OBJECTIVE

There has been some discussion as to whether the pial vasculature behaves in the same way as the blood-brain barrier as a whole. Recent studies have shown that capsazepine protects these vessels from the effects of ischemia-reperfusion. We have now used a new method to examine this protection in the whole brain.

METHODS

Horseradish peroxidase concentrations were measured in brain sections and plasma, following starch microsphere induced ischemia, which lasted from 20 to 60 minutes, with 30 minutes reperfusion. The PS product was calculated from the Crone-Renkin equation.

RESULTS

Permeability increase, which depended on duration of ischemia, was considerably greater in the pia than the parenchyma. The increase was also greater in tissue surrounding large radial venules of the cortex. Single vessel studies showed that these differences mirror those between small and large pial venules. Capsazepine treatment protected the parenchymal blood-brain barrier by limiting the post-ischemic permeability increase to about one third, but had no effect on the pia or radial vessel permeability.

CONCLUSIONS

Permeability has been estimated in tissue sections with good spatial resolution using this new technique, which has demonstrated that the TRPV1 receptor plays an important role in the whole brain, not confined to small pial venules.

The role of guanylyl cyclases in the permeability response to inflammatory mediators in pial venular capillaries in the rat

Inflammatory mediators have a role in the formation of cerebral oedema and there is evidence that cGMP is an important signal in vascular permeability increase. We have investigated the role and the source of cGMP in mediating the permeability response to acutely applied bradykinin and the histamine H(2) agonist dimaprit on single cerebral venular capillaries, by using the single vessel occlusion technique. We found that 8-bromo-cGMP applied acutely resulted in a small and reversible permeability increase with a log EC(50) -7.2 +/- 0.15 M. KT 5823, the inhibitor of cGMP-dependent protein kinase, abolished the permeability responses to both bradykinin and dimaprit, while zaprinast, an inhibitor of type 5 phosphodiesterase, potentiated the response to bradykinin. On the other hand, L-NMMA blocked the response to dimaprit, but not that to bradykinin. Inhibitors of soluble guanylyl cyclase, LY 85353 and methylene blue, also inhibited the permeability response to dimaprit, but not bradykinin. The permeability responses to the natriuretic peptides ANP and CNP were of similar magnitude to that of bradykinin with log EC(50) -10.0 +/- 0.33 M and -8.7 +/- 0.23 M, respectively. The natriuretic peptide receptor antagonist HS-142-1 blocked permeability responses to bradykinin as well as to ANP, and leukotriene D(4) blocked the responses to CNP and bradykinin, but not to dimaprit. In conclusion, the histamine H(2) receptor appears to signal via cGMP that is generated by a NO and soluble guanylyl cyclase, while bradykinin B(2) receptor also signals via cGMP but through particulate guanylyl cyclase.

Acute effects of bradykinin on cerebral microvascular permeability in the anaesthetized rat

1. The permeability response to acutely applied bradykinin and [des-Arg9]-bradykinin on single cerebral venular capillaries has been investigated using the low molecular mass fluorescent dyes Lucifer Yellow and Sulforhodamine B with the single vessel occlusion technique. 2. When bradykinin was applied repeatedly for up to 2 h, the permeability increase was small and reversible for concentrations that ranged from 5 nM to 50 microM. 3. The logEC50 of the permeability response to bradykinin was -5.3 +/- 0.15 (logM; mean +/- s.e.m.). This was reduced to -6.37 +/- 0.24 with the angiotensin-converting enzyme inhibitor captopril, to -6.33 +/- 0.19 with the neutral endopeptidase inhibitor phosphoramidon and to -7.3 +/- 0.20 with captopril and phosphoramidon combined. 4. The permeability response to bradykinin was blocked by the bradykinin B2 receptor antagonist HOE 140, by inhibition of the Ca2+-independent phospholipase A2, by the scavenging of free radicals, or by inhibition of both cyclo-oxygenase and lipoxygenase in combination. Block of Ca2+ entry channels with SKF 96365 had no effect on the response. 5. Application of [des-Arg9]-bradykinin also increased permeability over the concentration range 5 nM to 50 microM, with a logEC50 of -5.6 +/- 0. 37. This response was not affected by free radical scavenging, but was completely blocked by the histamine H2 receptor blocker cimetidine. 6. These results imply that the acute permeability response to bradykinin is mediated via the release of arachidonic acid, which is acted on by cyclo-oxygenase and lipoxygenase resulting in the formation of free radicals, and that the response to [des-Arg9]-bradykinin is mediated via histamine.

Regulation of cerebral microvascular permeability by histamine in the anaesthetized rat

1. The permeability response of slightly leaky pial venular capillaries to histamine was investigated using the single microvessel occlusion technique. 2. Histamine dose-response curves showed that concentrations between 5 nm and 5 microM increased permeability, while concentrations from 50 microM to 5 mM reduced it. 3. The H2 receptor antagonist cimetidine (2 microM) blocked the effects of lower concentrations of histamine, while the H1 receptor antagonist mepyramine (3 nM) blocked those of higher concentrations of histamine. 4. The effects of lower doses of histamine were mimicked by the H2 receptor agonist dimaprit, and the effects of higher doses of histamine were mimicked by the H1 receptor agonist alpha-2-(2-aminoethyl)pyridine (AEP). 5. Low concentrations of histamine, which normally increase the permeability of Lucifer Yellow (PLY), reduced it when co-applied with the phosphodiesterase 4 (PDE4) inhibitor rolipram. Rolipram also potentiated the response to AEP, but had no effect on that to dimaprit. 6. The effects of dimaprit were blocked by reducing extracellular Ca2+ from 2.5 mM to nominally Ca2+ free, or by applying the calcium entry blocker SKF 96365.

Two components of blood-brain barrier disruption in the rat

1. Permeability of pial venular capillaries to Lucifer Yellow (PLY) was measured using the single microvessel occlusion technique. 2. PLY was extremely low, when measured shortly after the removal of the meninges, consistent with an intact blood-brain barrier, but rose spontaneously to (1.65 +/- 0.60) x 10(-6) cm s-1 (mean +/- S.D.) within 20-60 min. This first phase of spontaneous disruption lasted 44-164 min. A second phase started when PLY rose sharply, and was characterized by rapid permeability fluctuations with a mean of (12.31 +/- 15.14) x 10(-6) cm s-1. 3. The first phase could be mimicked by applying the divalent cation ionophore A23187 in the presence of Ca2+, when PLY rose by (1.47 +/- 0.25) x 10(-6) cm s-1 (mean +/- S.E.M.). Application of histamine (10 microM) to tight vessels increased PLY by (2.41 +/- 0.22) x 10(-6) cm s-1. 4. Substances that raised intraendothelial cAMP of vessels during the first phase of disruption reduced PLY to the initial blood-brain barrier level. 5. The second phase could be prevented by applying catalase. Similar high and fluctuating PLY values could be produced reversibly by applying arachidonic acid or NH4Cl. 6. This is the first report of two distinct types of permeability increase in the cerebral microvasculature, and reasons for this are discussed.

Cerebral microvascular permeability and CSF pH in anaesthetized rats

The idea that the blood-brain barrier (BBB) may be made slightly permeable by an acid load on the brain side was tested in single pial venular capillaries of anaesthetized young rats. The fluorescent dye, Lucifer Yellow (457 Da), was used as a fluid-phase marker to measure permeability in the presence of a free radical scavenger. Tight microvessels were unresponsive to pH changes of 0.3-0.5 units. Vessels that were permeable showed small, significant increases in permeability with decreasing pH (2.19 +/- 0.562 x 10(-6) cm s-1 (pH unit)-1). This effect increased with increasing permeability.

Occupation and blood pressure: a study in rural and urban communities in Dhaka

One thousand six hundred and ninety six males and females living in Dhaka city and a nearby village were grouped according to their age and occupation. The subjects blood pressure and occupation were recorded. The study revealed that occupation had a significant effect on both diastolic and systolic blood pressure, specially in relation to social status, Age, smoking, BMI appeared to modulate the blood pressure.

Pathological characteristics of surgically removed craniopharyngiomas: analysis of 131 cases

Pathological specimens of 131 surgically removed craniopharyngiomas were obtained from the registry of the National Institute of Neurosurgery, Budapest between 1977 and 1991. The cases were reviewed statistically with reference to their gross and microscopic features and clinical characteristics. Macroscopically, 34% of the tumours were cystic, 23% solid and 43% mixed. Histologically, 38% of the cases belonged to the adamantinous group, 26% were squamous epithelial type, 15% were combined, that is expressing the characteristics of both. In 21% of the cases the surgically removed samples did not contain enough material for correct histopathologic classification. There was no recurrence in the group with the squamous epithelial type tumours, while 59% of the adamantinous, and 36% of the combined craniopharyngiomas recurred. The 5-year survival proportion was 73% at the squamous epithelial, 60% in the adamantinous, and 55% at the combined histological types.

Study of proteinuria in a community

Proteinuria of more than 500 mg/dl were present in 3% of all age groups in the village Pandhua. It is directly correlated with hypertension, scabies and recurrent history of tonsillitis. If any body suffers from hypertension, pyoderma and scabatic lesion the chances to have proteinuria is 86%.