Sexual performances after mild and moderate head injury in Indian adult males: An institutional experience.

Background: Traumatic brain injury (TBI) is one of the most common causes of morbidity and mortality worldwide than any other injuries. Disorders in sexual functions constitute one of the most prevalent and least discussed problems following head injury, which need to be studied in detail. Objective: To find out the intensity of sexual dysfunction following head injury in Indian adult males. Methods and materials: Prospective cohort study was conducted among 75 adult Indian males with mild and moderate head injury with Glasgow Outcome Scale (GOS) 4 or 5. Arizona sexual experience (ASEX) scale was used to evaluate sexual changes in these male patients following TBI. Results: Most of the patients experienced satisfactory sexual changes (P < 0.0001) in terms of sex drive, sexual arousal, erection, ease of orgasm and orgasm satisfaction. Most of the patients (77.3%) showed a total individual score of ≤18 on ASEX scale. A score of <5 on any one item on ASEX scale was seen in majority (80%) of the patients. In our study, sexual changes experienced following TBI were significantly (P < 0.0001) of mild severity as compared with moderate and severe sexual disability. Type of head injury was not associated with significant (P > 0.05) sexual changes experienced following TBI. Conclusions: In this study, some patients experienced mild sexual disability. Addressing those sexual issues, sexual education and rehabilitation programmes following head injury should be an integral part of follow-up care in such patients.

Contralateral Hearing Loss After Resection of Vestibular Schwannoma in a Patient with Neurofibromatosis 2: Case Report and Literature Review.

BACKGROUND: Resection of a vestibular schwannoma may result in facial paralysis and hearing loss on the side of the tumor. We evaluated clinical, audiologic, and intraoperative events and radiologic parameters in a case of contralateral side sensorineural hearing loss. We also performed a literature search using PubMed. CASE DESCRIPTION: A 25-year-old woman with neurofibromatosis 2 developed contralateral side sensorineural hearing loss immediately after resection of vestibular schwannoma. The patient regained partial hearing with a short course (2 months) of steroid therapy over 6 months. CONCLUSIONS: Literature search yielded 20 cases. We evaluated possible etiology, pattern, extent, recovery, and final outcome in these patients with management options. Several etiologies have been proposed, including development of endolymphatic hydrops, vascular phenomenon, mechanical injury, barotrauma, and autoimmune cochleolabyrinthitis. Sudden release of cerebrospinal fluid seemed to be the most likely explanation in the present case. There is no way to predict this complication beforehand. Operating in supine position, slow release of cerebrospinal fluid, irrigation of the operating field, maintenance of normotension, and judicious use of the drill may help in prevention. A short course of corticosteroids and vasodilators helped in spontaneous recovery in most of the cases.

Medulloblastoma with myogenic and/or melanotic differentiation does not align immunohistochemically with the genetically defined molecular subgroups.

The World Health Organization classification of central nervous system neoplasms (2016 update) recognizes 4 histological variants and genetically defined molecular subgroups within medulloblastoma (MB). MB with myogenic differentiation is one of the rare variants, which is usually recognized as a pattern alongside the known histological variants. Because of its rarity, less is known about its molecular landscape and importantly about its placement in the current molecular schema. We aimed to analyze this rare variant for expression of 3 immunohistochemical markers conventionally used in molecular stratification of MB. Demographic profile and imaging details with survival outcome were also analyzed. Sixty-five MB cases were molecularly stratified using immunohistochemical markers (YAP1, GAB1, ß-catenin). MB with myogenic differentiation and MB cases showing variable immunoreactivity with the above 3 antibodies were further evaluated for smooth muscle actin, desmin, myogenin, and HMB45. Seven cases were categorized as MB with myogenic and/or melanotic differentiation. Age ranged from 2 to 40 years with a male-to-female ratio of 1:1.3. In 4 cases, myogenic or melanotic differentiation was evident on histology, whereas in 3, differentiation was highlighted only with muscle markers. Interestingly, all 7 cases showed variable immunoreactivity with 3 molecular markers and did not follow the conventionally accepted algorithm used for molecular stratification. Follow-up period ranged from 9 to 57 months. Overall survival revealed a varied pattern, with 3 deaths and 4 patients being alive with no evidence of disease at last follow-up. Our results provide evidence that these variants are distinct and do not align immunohistochemically with the currently recognized genetic subgroups.

Sporadic intra-abdominal desmoid: a rare presentation as a hepatic mass.

We report an unusual presentation of a sporadic intra-abdominal desmoid tumour, possibly arising from the diaphragm, masquerading as a hepatic mass in a young female without any history of surgery or trauma. Histopathology ruled out a hepatic origin of the tumour as was inferred from pre- and intraoperative evaluation. Immunohistochemistry showed positivity of lesional fibroblastic cells for ß-catenin and negativity for CD34, CD117, EMA, SMA, desmin, vimentin, cytokeratin, and ALK1 thereby confirming the diagnosis of a desmoid tumour. There exist only a few reports in the literature on desmoids related to the diaphragm, but only one on a diaphragmatic desmoid that is possibly primary.

Ascaris lumbricoides: an unusual aetiology of gastric perforation.

Gastrointestinal (GI) infestation with Ascaris lumbricoides is common in the tropical countries, particularly in children. A wide range of clinical presentations are reported for GI ascariasis in both adults and children. We report a case of gastric perforation due to Ascaris, a rare presentation.