Clinicoradiological presentation, management options and a review of sellar and suprasellar tuberculomas.

Clinicoradiological presentation and management of patients with sellar and suprasellar tuberculomas (SST) were reviewed. The SSTs of eight patients were divided into five radiological subgroups: a sellar-suprasellar mass (n=3); multiple coalescing ring enhancing granulomas (n=2); an intrasellar abscess (n=1); pachymeningitis with suprasellar extension (n=1); and skull-base lesion involving the sella (n=1). The predominant endocrinopathies were hypogonadism, hypothyroidism and diabetes insipidus. The management options included surgery utilizing the frontotemporal, transylvian approach (n=4) or the transsphenoidal approach (n=1), stereotactic biopsy and ventriculoperitoneal shunt (n=1); endoscopic transsphenoidal biopsy (n=1); and antituberculous therapy (ATT) without surgery (n=1). All patients received ATT for 15-18 months. Patients with rapid visual deterioration (n=2) or with associated intramedullary tuberculoma (n=2) also received steroids for 2 weeks. At follow-up (range 10 months to 5.5 years; mean 3.2 years), the radiological response to ATT was evaluated. MRI after ATT showed resolution of SST in all except two patients with solid lesions. However, these lesions were smaller and had reduced contrast enhancement on imaging. Thus, SST may present with five radiological subtypes. Surgery is useful in obtaining histology. Short-term steroid therapy with ATT may reduce edema and adhesions around the optic nerve when rapid visual deterioration occurs and relieve symptoms of raised intracranial pressure. The often-associated hypopituitarism indicates the requirement for preoperative hormonal evaluation.

Choroid plexus papilloma in children: Diagnostic and surgical considerations.

BACKGROUND: Choroid plexus papilloma (CPP) is a benign neoplasm that arises from the ventricular choroid plexus. The clinical features, radiological characteristics, and treatment have been discussed in this study for a pediatric population. METHODS: Over an eight-year period, seven pediatric (≤12 years) CPP patients were treated. Tumors were located in the lateral ventricle (n = 4), IVth ventricle (n = 2), and in both the lateral and IIIrd ventricles (n = 1). The patients presented predominantly with features of raised intracranial pressure. Total microsurgical excision was carried out in all cases. RESULTS: There was complete relief of symptoms at follow-up in six patients. A 2.5 year-old child with a large trigonal CPP with hydrocephalus leading to complete visual impairment, died due to postoperative hypokalemia that caused ventricular fibrillation. One of our patients required a postoperative, permanent CSF diversion procedure while another required a subduroperitoneal shunt for persisting postoperative subdural CSF collection. CONCLUSIONS: Coagulation of the tumor under constant irrigation to shrink and excise it in toto, avoids excessive bleeding during surgery. The vascular pedicle supplying the tumor should be adequately dealt with during the last part of tumor removal as retraction of a bleeding pedicle may result in ventricular hemorrhage and brain edema. Following surgery, an external ventricular drain for three days helps in preventing the development of acute hydrocephalus in lateral ventricular lesions, and the color of the drained CSF gives an estimate of the ventricular hemostasis achieved. Total excision is usually possible in these cases with excellent postoperative outcomes.

A study on the delivery practices in riverine & non-riverine blocks of the district of South 24-Parganas, West Bengal.

A cross sectional study was undertaken in three riverine and two non-riverine blocks of South 24 Parganas district, West Bengal to study the delivery practices and compare between two locality. During the reference period of one year, of 3073 total deliveries, 89.36% were home deliveries. Home deliveries were higher in the riverine blocks (95.07%) compared to non-riverine blocks (81.64%). 'Dai' conducted 58.36% and 90.62% of home deliveries in riverine and non-riverine blocks respectively. Only 18.4% of the 'Dai' were trained.

Teenage primigravidae: a comparative study.

A review of history sheets of obstetric cases recorded in a district hospital in 1992 was done to compare the obstetric outcome in 200 teenage first pregnancies (Study group) with that in Control group i.e. 20 years to 29 years. It revealed that incidence of complications of pregnancy like anaemia, pregnancy induced hypertension (PIH) and preterm labour were significantly higher among teenage mothers. The normal mode of delivery was commoner in teenagers (82.5%) in comparison to control group (76.5%), probably because of higher number of low birth weight babies. The fetal outcome was significantly worse in teenage mothers with high incidence of perinatal mortality (8%) and low birth weight babies (35%). There was not a single newborn with birthweight above 3500 gms, in teenage group, whereas, control group had 5 babies (2.5%) in the category.

Sensory dysfunction in GB syndrome: a clinical and electrophysiological study of 100 patients.

Studies of sensory system involvement in Guillain Barre' (GB) Syndrome are sparse in the literature. This communication presents the clinical and electrophysiological data of 100 patients of GB Syndrome evaluated over 5 years at NIMHANS, Bangalore, India. Sensory symptoms or signs were present in 45% and 59% of patients in upper and lower limbs respectively and were distal and symmetrical. Impairment of joint position and vibration sense was the commonest finding and was associated with a greater need for ventilatory support and autonomic disturbances. Sensory nerve conduction studies involved median, ulnar and sural nerves and electrophysiological evidence of abnormality was present in at least one sensory nerve in 80% of cases. These were: absent sensory nerve action potential (SNAP) in 19%-41%, reduced SNAP amplitude in 28-34% and reduced conduction velocity in 8%-15%. "Abnormal Median and normal Sural response", the pattern characteristic of demyelinating neuropathy, was noted in 29% of the cases. While sensory symptoms and signs were more frequent in lower limbs, electrophysiological abnormalities were more frequent in median and ulnar nerves. There was good association between motor and sensory conduction parameters in median and ulnar nerves. The time of performance of nerve conduction studies did not influence the results. Electro-clinical study of sensory system adds to our understanding of GB Syndrome.

Acute inflammatory demyelinating neuropathy: a critical evaluation of diagnostic criteria for demyelination.

There is agreement on the clinical diagnostic criteria for acute inflammatory demyelinating polyneuropathy (AIDP/GBS) however, there is lack of consensus for detection of demyelination. In order to critically evaluate the prevailing criteria, sixty-six patients who fulfilled NINCDS criteria and had typical features of GBS were studied for electrophysiological abnormalities of peripheral nerves by using standard methods (median, common peroneal, sural and ulnar) between 1 to 12 weeks after the onset of symptoms. The commonest abnormality on motor nerve conduction study was prolonged distal latency (75%-83%) followed by reduction in CMAP amplitude (63%-82%), decreased velocity (48%-62%), conduction block (17%-39%) and f-wave abnormalities (37.8%-59%). Sensory conduction abnormalities were detected in over 20% of median, 25% of ulnar and 33% of sural nerves. All the patients had abnormality of at least two motor conduction parameters in one nerve when values beyond 2 SD of the mean were considered abnormal and over 70% of patients had three abnormalities in two nerves or two abnormalities in three nerves. Comparison with the prevailing criteria for demyelination revealed that the number of patients fulfilling them varied widely: Albers et al. (1985): 74.2%, Albers et al. (1989): 40.9% and Cornblath: 30.3%. We believe that the current criteria for detection of demyelination in acute neuropathy are too strict, underestimate the underlying pathology in GBS and need reassessment.

Recurrent Guillain Barre' Syndrome: a clinical, electrophysiological and morphological study.

Of the 220 patients of acute idiopathic demyelinating polyneuritis (AIDP/GBS) seen over a seven year period, 15 patients (M:F:11:4) had a relapsing course (6.8%). Their ages ranged from 8 yrs to 70 yrs. They had 36 episodes at a variable interval of 3 months to 25 yrs. Relapse rate varied from one to four. Antecedent events were noted during 16 episodes in 9 patients but the triggering factors were varied. Clinical features of individual episodes were similar to the acute monophasic illness, although they differed inseverity from one episode to the other. Autonomic disturbances were rare. Albuminocytological dissociation was observed during 19 of the 24 episodes. Electrophysiological abnormalities were observed during 19 of the 24 episodes. Electrophysiological abnormalities were present in all and were comparable with patients of non-recurrent illness. Sural nerve biopsy in 3 patients showed evidence of demyelination, remyelination, Wallerian degeneration and myelin breakdown but none had features of inflammation. With the exception of one death, functional recovery was complete in the majority of patients, irrespective of the type of therapeutic intervention. Acute onset, frequent facial involvement, brief clinical course, near complete recovery and very long asymptomatic periods may distinguish these patients of acute relapsing demyelinating polyneuropathy (ARDP) from chronic relapsing demyelinating polyneuropathy. Relapses in GBS are however unpredictable and recurrent GBS is indistinguishable clinically, electrophysiologically and morphologically from the more frequently seen non-recurrent form of monophasic GB Syndrome. A biochemical or immunological marker may help in this distinction.

Clinical profile of sexual transmitted diseases in cuttack.

Out of total 2330 patients, 516 patients with STD i.e., 22.14%, were analysed during the period 1993 to 1994. Frequency of different STDs observed in order were herpes progenitalis (21.89%), syphilis (16.27%), chancroid (11.82%) and granuloma inguinale (7.55%), gonococcal urethritis and genital warts (3.87% each). L G V was found in 0.58% of cases, HIV infection in 3 cases only (0.56%). Other miscellaneous infections like candidiasis (13.75%), trichomoniasis (2.7%) and molluscum (2.14%) were responsible in 18% as a whole and nonspecific infection in 14%. Most of the patients were married, were from low socio-economic status and there was always a male preponderance with a peak age between 20 to 30 years.

Acute inflammatory demyelinating polyradiculopathy in children : a clinical and electrophysiological study.

Over a period of eight years (1985-1992) 79 children who fulfilled NINDS criteria for GB Syndrome were evaluated at National Institute of Mental Health and Neuro Sciences, (NIMHANS), Bangalore, India. There were 58 boys and 21 girls constituting 29.2percent of the total cases of GB Syndrome seen during the same period. One third of them were below 5 years of age. Antecedent events were noted in 41.9 percent and peak motor deficit was reached in over 90 percent cases within tow weeks. At admission besides quadripareresis and hyproflexia, facial (49.4 percent), bulbar (32.9 percent) and respiratory muscle weakness(8.9 percent) sensory disturbances (32.1 percent) and autonomic dysfunction (11.5 percent) of varying severity were also noted. Two elve patients needed ventilators assistance at the peak of illness and there were five deaths. Albuminocytological dissociation was present in 61.7 percent. Electrophysiological abnormalities were almost universal, involved motor and sensory nerves and were observed even in first week of illness. Comparison with adults with GB Syndrome revealed that bulbar and respiratory muscle weakness and sensory and autonomic disturbances were more common in adults, however CSF and electrophysiological abnormalities were equally frequent in both the groups. GB Syndrome constitute an important cause of flaccid paralysis in children. Clinical profile in children, but for minor variations is essentially the same as in adults. High incidence of sensory conduction abnormalities even during early part of illness may be useful in differentiating it from other causes of neuroparalytic illness in childhood.

Acrokeratosis paraneoplastica of Bazex.

Bazex disease is one of the rarer cutaneous paraneoplastic syndromes. It is characterized by psoriasiform changes on the digits, and in some patients spread to the ears, nose and in later stages to the limbs and trunk. The associated malignancy is typically a squamous cell carcinoma of the upper aerodigestive tract. We review the literature regarding acrokeratosis paraneoplastica of Bazex and report three cases which illustrate both the typical and some of the less common changes that are seen in the condition.

Acute respiratory infections in children admitted in a hospital of Calcutta.

Analysis of records of admitted children (0-12 years) in Chittaranjan Sishusadan Hospital, Calcutta during 1987 revealed that acute respiratory infections contributed 20.1% of all admissions. Lower respiratory infections were common. 93.7% of children were below 5 years of age. Case fatality rate due to ARI was the highest (17.6%) during infancy. Higher number of admissions were observed during the monsoon months.

Discoid Lupus Erythematosus Resembling Lupus Vulgaris.

A case of discoid lupus erythematosus (DLE) in a 20 year old female patient is presented. The, case clinically resembled lupus causing bilateral ectropion and exposure keratitis in both eyes.