Dumbell atypical teratoid/rhabdoid tumour (AT/RT) of the cervical spine.

Spinal Atypical Teratoid/Rhabdoid Tumour (AT/RT) is a highly malignant tumour, and its prognosis is dismal especially for very young patients. In this article, we present the case of a teenage boy with AT/RT in the cervical spine and its multimodality management. A review of the literature on ATRT of the spine is also presented.

Multicentric high grade oligodendroglioma: a rare entity.

A 74 year old male presented with 1 month history of weakness in right upper limb and motor aphasia for 15 days. Magnetic resonance imaging (MRI) of the brain showed three discrete ring enhancing lesions. An image guided awake craniotomy and biopsy of a lesion was performed. The histopathological examination revealed it to be a grade III Oligodendroglioma. This was a rare case of multicentric high grade oligodendroglioma has never been reported in literature. We report such a case with relevant review of literature.

Peripheral nerve stimulation by 'sandwich' paddle leads: technical note.

BACKGROUND: Recently, there has been a burgeoning interest in the utility of peripheral nerve stimulation (PNS) for a variety of chronic focal neuropathic, musculoskeletal and visceral pain conditions. If the source of pain is directly related to a single peripheral nerve, surgical exposure and placing a paddle lead on the nerve are most effective. METHODS: In this report, we describe a novel technique that optimizes the peripheral nerve stimulation by two paddle leads placed on either side of the nerve with their stimulating surfaces in contact with the nerve. After appropriate prepping and draping, the selected nerve is localized and circumferentially dissected free from the adjacent soft tissue. There should be enough length of nerve to accommodate two On-Point quadripolar leads (Medtronic, MN) along the length of the nerve in the same direction. RESULTS: This 'sandwich' technique provides a wider interface of contacts with nerve fibers. It reduces the chance of migration and provides an opportunity for 'crosstalk.' CONCLUSION: In selected cases where an open surgical PNS lead needs to be placed, the 'sandwich' technique can be used to augment the stimulation without additional morbidity. Although occasionally used in practice, this technique is still unreported.

Doppler in High-Risk Pregnancy and Its Correlation With Feto-Maternal Outcomes: A Prospective Study.

INTRODUCTION: In the current times, fetal growth monitoring has become readily available with the help of Doppler ultrasound. Identification of pregnancies that are at risk for perinatal morbidity and mortality has been a primary goal of obstetric care. Doppler study is a fast, non-invasive test that provides significant information about the hemodynamic status of the fetus. It is an efficient diagnostic modality to assess fetal compromise, which helps in timely intervention in high-risk pregnancies for better perinatal outcomes. OBJECTIVES: The objectives of this study were to know the correlation between antenatal Doppler findings and perinatal outcomes, including preterm labor, cesarean section, birth weight, and rate of admission of neonates in the neonatal intensive care unit (NICU). Admission to NICU was taken as the primary outcome. METHODS: This is a tertiary care hospital-based prospective study done at Maharaja Agrasen Medical College, Agroha, India. A hundred high-risk pregnant women with oligohydramnios, intrauterine growth restriction (IUGR), pregnancy-induced hypertension (PIH), diabetes mellitus (DM), anemia, or Rh incompatibility were included. Pregnancies in the first and second trimesters and congenital anomalies in babies were excluded from the study. The patients were examined for a Doppler study of the umbilical artery, fetal middle cerebral artery (MCA), and both maternal uterine arteries. Parameters in the form of a resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) of all the arteries were taken. Details of delivery and fetal outcomes were recorded. Data were correlated with Doppler findings. For comparing categorical data, the chi-square (X2) test and Fisher's exact test were performed. The comparison of continuous data between the two groups was done using an independent t-test. All statistical calculations were done using the computer program IBM SPSS Statistics for Windows, version 25 (released 2015; IBM Corp., Armonk, New York, United States). RESULTS: All the 100 cases with either normal or abnormal Doppler were comparable in terms of maternal age and parity. The prevalence of oligohydramnios was 27% (N = 27), PIH was seen in 20% (N = 20), anemia in 19% (N = 19), IUGR in 12% (N = 12), and oligohydramnios with IUGR in 13% (N = 13). In oligohydramnios, maternal anemia, Rh incompatibility, and DM, Doppler was found to be normal. In PIH, IUGR, and oligohydramnios with IUGR, abnormal Doppler was seen in four (20%), two (16%), and 10 (76%) cases, respectively. Among 84 candidates with normal Doppler, 49 (58%) got delivered by the vaginal route. Out of 16 abnormal Doppler cases, five were vaginally delivered (31%). Among 16 patients with abnormal Doppler, 15 patients, i.e., 93.75%, had low birth weight (LBW, <2.5 kg) (p-value < 0.001), 93.75% (N = 15) delivered before 37 weeks, and 13 (81.25%) newborns were admitted in the nursery. CONCLUSION: Abnormal Doppler was associated with an increased rate of low birth weight and admissions to the NICU with no effect on preterm delivery or cesarean section rates. The study strengthens the fact that Doppler studies in mothers can be used to plan the mode of delivery, predict the need for resuscitation, and anticipate the outcome of newborns.

The impact of physicochemical features of carbon electrodes on the capacitive performance of supercapacitors: a machine learning approach.

Hybrid electric vehicles and portable electronic systems use supercapacitors for energy storage owing to their fast charging/discharging rates, long life cycle, and low maintenance. Specific capacitance is regarded as one of the most important performance-related characteristics of a supercapacitor's electrode. In the current study, Machine Learning (ML) algorithms were used to determine the impact of various physicochemical properties of carbon-based materials on the capacitive performance of electric double-layer capacitors. Published experimental datasets from 147 references (4899 data entries) were extracted and then used to train and test the ML models, to determine the relative importance of electrode material features on specific capacitance. These features include current density, pore volume, pore size, presence of defects, potential window, specific surface area, oxygen, and nitrogen content of the carbon-based electrode material. Additionally, categorical variables as the testing method, electrolyte, and carbon structure of the electrodes are considered as well. Among five applied regression models, an extreme gradient boosting model was found to best correlate those features with the capacitive performance, highlighting that the specific surface area, the presence of nitrogen doping, and the potential window are the most significant descriptors for the specific capacitance. These findings are summarized in a modular and open-source application for estimating the capacitance of supercapacitors given, as only inputs, the features of their carbon-based electrodes, the electrolyte and testing method. In perspective, this work introduces a new wide dataset of carbon electrodes for supercapacitors extracted from the experimental literature, also giving an instance of how electrochemical technology can benefit from ML models.

Pneumorrhachis with pneumocranium: an unusual complication of intra-abdominal sepsis.

We present this unusual case of a 60-year-old gentleman who presented with meningism and reduced conscious level. Imaging demonstrated a perforated sigmoid colon with retroperitoneal air associated with pneumorrhachis and pneumocranium. He required a Hartmann's procedure and broad spectrum intra-thecal antibiotics which led to resolution of the pneumorrhachis and pneumocranium.

A comparative study of bilateral subthalamic nucleus DBS in Parkinson's disease in young versus old: A single institutional study.

To compare outcome between young [<65 yrs] and old [>65 yrs] patients of Parkinson's disease who underwent bilateral STN DBS a non-randomized retrospective study was done. 20 young (Young group) and 20 elderly (Old group) patients with matched baseline UPDRS were selected and followed up for 2 years after deep brain stimulation (DBS) surgery. The total and motor UPDRS, before, one year and two years after surgery was compared. PDQ39 a quality of life questionnaire and MMSE were also recorded. Zarit care burden interview (ZCBI) was used to analyse caregiver burden. Analysis of data was done using Mann-Whitney Test as the data was ordinal. The difference was not statistically significant at 1st and 2nd year of follow up in total and motor UPDRS. A significant reduction in Levodopa equivalent daily dose was seen in young and old group from preoperative period to 1st & then 2nd year of follow up. The difference was not statistically significant (P = 0.946) at 1st (P = 0.946) and at 2nd year (P = 0.989). Both the groups showed improvement in their PDQ39. The difference was not statistically significant at 1st (P = 0.636) and at 2nd year of follow up (P = 0.417). Caregiver burden (ZCBI) improved in both the groups and the difference was not statistically significant at 1st (P = 0.105) and at 2nd year of follow up (P = 0.078).In this study STN DBS didn't lead to any cognitive decline (MMSE) whatever is the age of patient during follow up. Bilateral STN DBS for Parkinson's disease is equally effective in young and elderly patients.

Intrathecal baclofen trial using a temporary indwelling intrathecal catheter - A single institution experience.

Intrathecal baclofen infusion trial is a sophisticated tool for selecting patients for permanent intra thecal baclofen infusion therapy We report our clinical experience of fifteen patients with refractory spasticity who underwent a continuous ITB trial using a temporary intraspinal indwelling catheter prior to permanent pump implantation. Patients underwent placement of a temporary intrathecal catheter that was connected to an external pump. Multisource feedback was obtained from the various healthcare professionals involved (Staff Nurse, Specialist nurse, physiotherapist, Doctor, family members, patient) regarding progress of test over 48-72 h. Average Modified Ashworth score after the trial was less than 2. Some degree of dose related minor adverse events (AEs) occurred in 8 patients, with the most common being nausea, constipation, urinary retention and hypotension. 10 patients received pump implant. 5 patients did not receive a pump because of AEs or because the goals were not met. 1 patient had pump removed after 4 years because of infection.

Factors affecting the survival following surgical treatment of chronic subdural haematoma: Single institutional experience.

BACKGROUND: Chronic subdural haematoma (CSDH) is one of the most commonly treated condition in neurosurgery. It affects elderly populations who often have significant medical co-morbidities resulting in poor prognosis. The study aimed at identifying clinical factors influencing the survival following surgical management of CSDH. METHODS: Retrospective study included 267 cases that underwent surgery for CSDH and followed over 5-year period (2010-2015); data retrieved with reference to operation details, radiology reports and discharge. Using logistic and Cox regression analysis, the patient survival data was analysed with respect to patient demographics, type of surgery, co-morbidities, anticoagulation treatment, and discharge destination. RESULTS: The overall survival in the cohort was 37.0months (IQR: 20.0-60.0). The median age of the patients was 76years (IQR: 66-82) and the median length of hospital stay was 10days (range 1-126days; IQR: 6-17days). The recurrence rate was 6.37% (n=17). Fifty-three (19.85%) patients recorded deceased on the IPM database as of October 2016 and of those 11 died in hospital. Univariate Cox-regression analysis revealed increased age (HR: 1.80; 95%CI: 1.04-3.11), length of hospital stay (HR: 2.50; 95%CI: 1.41-4.41) and number of co-morbidities (HR: 2.19; 95%CI: 1.26-3.79) were associated with poor prognosis. Glasgow coma scale (GCS) at discharge was found to be significantly associated with survival whilst anticoagulation treatment did not. Multivariate analysis confirmed similar findings significant statistically. CONCLUSION: Age at admission, median length of hospital stay, number of co-morbidities, GCS at discharge and discharge destination have been found to influence survival significant statistically.

Correlation among anatomic landmarks, location of subthalamic deep brain stimulation electrodes, stimulation parameters, and side effects during programming monopolar review.

BACKGROUND: Clinical benefits of deep brain stimulation can be limited by the presence of side effects produced by current spread to adjacent structures. OBJECTIVE: To identify a correlation between coordinates for each individual contact, neighboring structures, and pattern of side effects. METHODS: Coordinates of the electrodes and anatomic landmarks were obtained with a stereotactic surgical planning software and were correlated with stimulation-related side effects by using univariate and multivariable analyses. RESULTS: Monopolar stimulation elicited capsular side effects (CSEs) in 208 of 316 contacts (65.8%) and noncapsular side effects (NCSEs) in 223 of 316 contacts (70.6%). The occurrence of CSEs was correlated with contact number (P = .009) and with the "Z" (P = .03), whereas voltage threshold to CSEs exhibited correlation with the internal capsule angle (P = .035). The occurrence of NCSEs was correlated with contact number (P = .005), "X" (P = .03), "Y" (P = .004), and the distance to the red nucleus (P = .001 and P = .003). There was correlation between voltage threshold to NCSEs and the internal capsule angle (P = .006), electrode's coronal angle (P = .02), "X" (P = .001), "Y" (P < .001), "Z" (P < .001), and the distances to the internal capsule (P = .02) and to the red nucleus (P = .004 and P < .001). CONCLUSION: A better understanding how patient anatomy, stimulation parameters, and lead location in relation to neighboring structures influence the occurrence of side effects can be useful to inform targeting strategies.

Long-term outcomes after replacement of percutaneous leads with paddle leads in a retrospective cohort of patients with spinal cord stimulation systems.

BACKGROUND: Although the long-term outcomes for spinal cord stimulation (SCS) have been reported, long-term outcomes of patients who underwent revisions of the SCS with paddle leads are lacking. OBJECTIVE: To report the long-term outcomes of 39 patients who had percutaneous SCS revised with a new paddle lead. METHODS: Baseline and follow-up mail-in questionnaires assessed pain and disability levels with numerical rating scales, somatotopical overlap between SCS-related paresthesias and areas of chronic pain, and overall satisfaction. Analysis was performed with regard to age, sex, diagnosis, duration of disease, number of surgical revisions, complications, and interval between surgeries. RESULTS: After surgical revision, 20 patients (50%) had at least a 3-point reduction in the numerical rating scale. Greater pain reduction was correlated with better coverage (P = .001). Coverage area was greater in patients with a single revision than in patients with multiple revisions (P = .01). Good satisfaction was reported by 25 patients (62.5%) who indicated that they would undergo the procedure again in order to achieve the same results. These patients had significantly greater pain reduction (P = .001) and better coverage (P = .002) than patients who reported otherwise. No other major complication occurred. CONCLUSION: Revision of percutaneous SCS systems with implantation of a new paddle lead is safe and more effective in patients who have undergone not more than 1 prior revision.

Cutis laxa: a report of two interesting cases.

Cutis laxa is a rare disease that may be either inherited or acquired. The acquired form is rarer than the inherited form. Pathogenesis of this disease is largely unknown. Two cases of acquired cutis laxa are reported here and neither of them had any systemic involvement or any history of drug intake. One of them had localized disease with history of preceding cutaneous inflammation. The other patient with generalized lesion lacked any history of preceding illness. The patient with localized lesion was treated satisfactorily by reconstructive surgery. The other patient had generalized involvement, for which no satisfactory treatment could be offered.