Cerebellopontine angle epidermoid with ipsilateral external ear atresia: an embryological association or a coincidence?

The cerebellopontine angle (CPA) is the most common site for intracranial epidermoids. They may have varied presentations viz facial pain, hemifacial spasms, headache and uncommonly features of raised intracranial pressure. Their association with external ear atresia has not been reported in literature to date. We present a very rare case of CPA epidermoid with ipsilateral external ear atresia.

Fluorescein sodium fluorescence: role in stereotactic brain biopsy.

BACKGROUND: Stereotactic brain biopsy for eloquent area brain tumours is associated with complications like hemorrhage due to multiple sampling and increased operative time due to dependence on neuropathologist for frozen section assessment. In order to curb these limitations, we investigated the use of Fluorescein sodium fluorescence in confirming pathological tissue samples in stereotactic brain biopsy of gadolinium-enhancing tumours. METHODS: This prospective observational study included 23 consecutive patients who underwent stereotactic biopsy of gadolinium-contrast-enhancing brain lesions with intravenous fluorescein sodium administration. 93 specimens were obtained and examined for the presence of fluorescence using a microscope with fluorescence visualisation capability. Later the nature of the samples was confirmed on histopathology. The sensitivity and specificity of flourescein sodium fluorescence were calculated based on histopathological confirmation. RESULTS: 58 (62.3%) fluorescent and 35 (37.6%) nonfluorescent samples were obtained. All fluorescent specimens contained diagnostic tissue appropriate for tumor grading. Of 35 nonfluorescent specimens, 12 (34.3%) did not contain tumor, 11 (31.4%) contained minor hypercellularity or gliosis, and 12 (34.3%) contained tumor with a high proportion of necrosis. The sensitivity and specificity for fluorescein fluorescence were 83% and 100%, respectively. CONCLUSIONS: Fluorescein fluorescence is a handy tool to detect the pathological tissue in stereotactic brain biopsy and may improve its diagnostic accuracy and expedite the procedure.

Spontaneous extradural hematoma: a rare entity.

Spontaneous onset extradural hematoma (EDH) is a very rare entity and has been seen mostly to be associated with adjacent infective pathologies, dural vascular malformations, extradural metastasis, or coagulopathies. We report a series of two such cases and review the literature. One case presented with spontaneous EDH that was managed conservatively and was diagnosed to have chronic kidney disease later; the other had deranged coagulation profile and liver function secondary to drug induced hepatitis and was operated. Both patients were discharged in a stable condition and were improving on follow up.

Penetrating head injury due to angle grinder: an occupational hazard.

Penetrating head injury is a life threatening condition. In the workplace, these are mostly non missile type, low velocity civilian injuries caused by sharp objects. Angle grinders are used to cut stones, metal etc, and cause penetrating head injuries due to shattered rotating discs from the grinder at home and workplaces. We report a series of three cases of penetrating head injuries due to unsafe use of angle grinders. The relevant literature is reviewed and management of such cases is discussed.

Effect of process and machine parameters on physical properties of extrudate during extrusion cooking of sorghum, horse gram and defatted soy flour blends.

Extrusion cooking of sorghum (Sorghum vulgaris), horse gram (Dolichos biflorus) and defatted soy (Glycine max) flour blends was done to prepare snacks by using a Brabender single-screw laboratory extruder. The combined effect of moisture content, blend ratio of feed, barrel temperature and screw speed of extruder on physical parameters of extrudate was studied. It was observed that 15% moisture content of feed, 80:10:10 (sorghum flour: horse gram flour: defatted soy flour) of blend ratio, 130 °C barrel temperature and 130 rpm of screw speed gave the highest sectional expansion index and longitudinal expansion index of extrudate, while 12% moisture content, 75:15:10 of blend ratio of feed, 135 °C of barrel temperature and 135 rpm of screw speed gave lowest bulk density of extrudate. A central composite rotable design (CCRD) of response surface methodology was used to develop prediction model. Second order quadratic regression model fitted adequately in the variation. The significance was established at p ≤ 0.05. It was also observed that increasing feed moisture content results in a higher density and lower expansion of extrudate. Increasing barrel temperature and screw speed reduced density but increased expansion of extrudate.

Predictors of Outcome After Traumatic Brain Injuries: Experience of a Tertiary Health Care Institution in Northwest India.

BACKGROUND AND OBJECTIVE: Traumatic brain injury (TBI) is a major health issue in developing nations such as India along with underreporting of TBI data because of a lack of major studies targeting the population with TBI. Various lacunae from field to tertiary centers are responsible for this significant burden of TBIs. We studied the epidemiologic profile of 1150 patients with TBI including the predictors of the outcome of TBIs in a tertiary health care institution in North India to identify the modifiable factors that could be used to improve the outcome and reduce the TBI burden. METHODS: Patients presenting with TBI to a level I trauma center were identified and enrolled in the study. Data regarding patient information from accident to discharge or death were collected as per designed format and analyzed to determine outcome predictors. RESULTS: Mean age was 36 ± 15.8 years and 84.6% of patients were male; road traffic accident was the mode of injury in 64.26% of cases. Lack of adequate prehospital care was seen in our study. Glasgow Coma Scale score on admission, Injury Severity Score, and Rotterdam CT score were found to be the 3 statistically significant predictors of outcome in patients with TBI. CONCLUSIONS: Knowledge about the causes, pattern, and distribution of patients with TBI from this study is helpful in policy making, research, health management, and rehabilitation at the national level in ours and in other nations.

Preoperative Diffusion Tensor Imaging: A Landmark Modality for Predicting the Outcome and Characterization of Supratentorial Intra-Axial Brain Tumors.

BACKGROUND AND OBJECTIVE: In view of the few large prospective studies available on the role of preoperative diffusion tensor imaging (DTI), and the potential of DTI in showing the relationship between tumor and white matter tracts, we studied the role of preoperative DTI in planning a safe surgical corridor, predicting the neurologic and surgical outcome and tumor characterization in supratentorial intra-axial brain tumors. METHODS: We included 128 cases. Preoperative neurologic status and tumor volume were assessed. A magnetic resonance imaging (MRI)-based surgical plan was decided and reviewed for changes after DTI (site of corticotomy or limit of resection) by senior faculty of neurosurgery and neuroradiologist. Tracts were classified as displaced, infiltrated, or disrupted. Postoperative neurologic and surgical outcome was assessed along with evaluation of association of DTI with tumor type. RESULTS: DTI-based change in surgical corridor was seen in 60 patients (47%). Sixty-six patients harbored low-grade gliomas, 48 had high-grade gliomas, and 14 had metastastic lesions. Resectability (maximum safe resection) was higher in patients with displaced fibers and lower in those with disrupted/infiltrated fibers, which was statistically significant. Fewer patients had neurologic deterioration in the displaced category (7.1%) compared with the disrupted/infiltrated category (13.9%). Although no significant association could be established between neurologic outcome and fiber type, displaced fibers were associated mainly with low-grade glioma (71%), whereas disrupted/infiltrated fibers were associated mainly with high-grade glioma (66%); this correlation was significant. CONCLUSIONS: Preoperative DTI is a landmark tool for planning a safe surgical corridor and predicting the tumor type along with neurologic and surgical outcome of patients.

Negative ion FAB mass spectroscopy of some ribose alkylated 5'-UMP derivatives.

Characteristic fragment ions obtained in Fast atom bombardment (FAB) mass spectroscopy of ribose alkylated Uridine 5'-monophosphate (5'-UMP) derivatives in negative ion mode are described. All the compounds examined exhibited either [M]- or quasimolecular ion [M - H]- the fragmentations can be used to characterize these nucleotides.

Tubercular thyroid abscess.

We encountered a patient who presented with neck swelling, difficulty in swallowing, voice change along with systemic features such as evening rise of temperature, chronic cough and weight loss. Ultrasonography of the thyroid gland revealed two cystic swellings. An ultrasound guided fine needle aspiration cytology was suggestive of tubercular abscess. The patient responded well to antigravity aspiration of the swellings and antitubercular treatment.