Study of Post Traumatic Stress Symptomatology in Adolescent Girls.

Background: Exceptionally stressful life events are known to cause severe psychological symptoms especially in the more vulnerable women and children. Objective : The psychological morbidity of students of secondary school victims of stampede were studied. Methods : Students of secondary school victims of stampede were assessed during their admission at tertiary care teaching hospital and cross-sectional assessment was done after eight weeks of the trauma. Using General Health Questionnaire (GHQ), Child’s Reaction to Traumatic Events Scale-Revised (CRTES-Revised). Results : Four (30%) of the admitted children developed acute stress disorder. 22 children were in high distress group and 5 in moderate distress group on CRTESQ-R on assessment after eight weeks. The preliminary findings of the study suggest high levels of psychological morbidity in stampede victims and its implications are being discussed. Conclusions: The high levels of psychological morbidity in stampede victims suggest the need for immediate intervention by mental health professionals in terms of providing both non pharmacological - individual and family counseling, psychotherapy and pharmacological interventions.

Immune reconstitution inflammatory syndrome in acquired immunodeficiency syndrome.

A 33-year-old male presented with a history of fever and cough and was diagnosed to have pulmonary tuberculosis and acquired immunodeficiency syndrome (AIDS). He was started on antituberculosis therapy (ATT) followed by highly active anti-retroviral treatment (HAART) after one week. He developed an immune reconstitution inflammatory syndrome (IRIS) leading to an exacerbation of the tuberculosis disease. After HAART was stopped his condition improved dramatically.

Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases

OBJECTIVE: Analyze the success rate, complications and overall benefit of ultrasound guided percutaneous nephrostomy (PCN) for the relief of obstructive uropathy in benign and malignant diseases. MATERIALS AND METHODS: PCN was performed in 50 kidneys of 32 patients. It was performed in emergency rooms totally under ultrasound guidance by general surgeons. Seldinger technique was used in all cases. Changes in renal function after the procedure were analyzed using paired t-test. RESULTS: The procedure was successfully completed in 42 out of 50 kidneys (84 percent). There has been no major complication and 28 percent minor complications. The renal function improved significantly when PCN was performed for benign conditions (mean creatinine 3.52 mg/dL before and 2.18 mg/dL after PCN), however in malignancy there has been no significant improvement in renal function (before PCN mean creatinine 6.39 mg/dL and after PCN 5.41 mg/dL). CONCLUSION: We conclude that PCN can be effectively performed under ultrasound guidance and should be the initial procedure in acutely obstructed kidneys with pyonephrosis and poor renal function. In malignant cases, however, improvement in renal function is possible only if the procedure is carried out at an early stage.

Spinal congenital dermal sinus: an experience of 23 cases over 7 years.

Spinal congenital dermal sinus is a rare entity, which supposedly results from the failure of neuroectoderm to separate from the cutaneous ectoderm during the process of neurulation. The present study was undertaken to know the clinical profile of these patients, to study associated anomalies and to assess the results of surgical intervention. We had 23 patients with male : female ratio of 9:16. Only 2 patients were below 2 years of age and most cases (16) were between 2-16 years (mean age =10.2 years). Lumbar region (17 cases) was most frequently involved, followed by lumbosacral and thoracic region in 3 patients each. Only three patients were asymptomatic at the time of presentation. Most of the cases presented with evidence of neural compression or tethered cord syndrome. Only one case presented with spinal abscess. The motor, sensory and autonomic deficits were seen in 20, 11 and 12 patients respectively. Scoliosis and CTEV (congenital talipus equino varus) were the common associated anomalies. MRI revealed associated dysraphic state of spinal cord in 21(>90%) cases. All patients underwent surgical exploration and repair of dysraphic state and excision of the sinus. None of the asymptomatic patients deteriorated. Overall 8 patients improved, 14 got their neurological status stabilized, including 3 asymptomatic cases. Only one patient deteriorated. Postoperative wound infection was seen in 2 cases. As age advances, the chance of developing neurological deficit increases. Associated dysraphic state should be looked for and treated simultaneously, using microsurgical technique, whenever possible. It is better to treat all these cases with aggressive surgical intervention before the neurological deficits appear.

Split cord malformations--a clinical study of 48 cases.

OBJECTIVE: To determine the clinical profile of split cord malformations and to evaluate the results of surgery. DESIGN: Retrospective. SUBJECTS: Forty-eight patients of split cord malformation operated during a six years period were studied clinically and radiologically. RESULTS: The mean age of symptomatic patients was more than that of asymptomatic ones (6.85 years vs 2.03 years). The dorsolumbar and lumbar regions were most frequently involved and in three cases the cervical spine was affected. Weakness of lower limbs (n=37), muscle atrophy (n=23) and gait disturbance were the most common indicators of motor system involvement. The sensory complaints were mainly hypoesthesia (n=16), trophic ulcer (n=4) and autoamputation (n=3). Hypertrichiosis was the most common cutaneous marker present alone or in combination with other markers in 21 cases. MRI, done in all cases, correctly established the diagnosis. Additional lesions causing tethering were seen in 50% cases and were simultaneously treated. Associated Chiari malformation was seen in 12%. Of the 42 symptomatic patients, 21 improved, in 17 (40%) the neurological deficits stabilized and 4 showed deterioration. CSF leak occurred in 4 patients and 3 had wound infections. Among the asymptomatic patients none had neurological deterioration postoperatively. CONCLUSIONS: Split cord malformations are rare spinal cord disorders. Complete neural axis should be scanned at the first instance to determine associated lesions. Good results can be expected in about 90% patients with minimal complications.

Spinal lipomatous malformations.

Spinal lipomatous malformations (SLM) include all the closed neural tube defects (NTD) with excessive lipomatous tissue in the spinal cord or filum terminale. We evaluated 65 cases of SLM seen & operated at our department in the last 7 years. Of these only 9 were asymptomatic and 8 were below 2 years of age. There were more males than females. In addition to subcutaneous lipoma many patients also had hypertrichiosis and dermal sinus as cutaneous makes. Twenty patients had foot deformity and 5 had unilateral limb shortening. Sixty-two patients had MRI and 3 had CT myelogram for evaluation. These revealed 7 patients with Chiari malformations, 10 with focal syrinx and 2 patients underwent VP shunt for hydrocephalus. Sacral agenesis was seen in 5 patients. Clinical features were similar to other cases of spinal dysraphism except that sensory loss and trophic ulcer were more frequent. Intradural lipoma and tethering was seen in 18 cases whereas intramedullary lipoma & conus lipoma was seen in 40 & 7 cases respectively. Additional tethering lesion was seen in 1/3 cases and was treated simultaneously. Preoperative deficits improved in 28 cases and stabilized in 33 cases. Three patients developed fresh deficits after surgery. We observed 8 CSF leaks and 4 wound infections in postoperative period. It is very clear from our data that a patient has about 95% chances that his neurological status may improve or stabilize following surgery and the risk of developing fresh deficits is about 5%. We, therefore, suggest that all patients of SLM should be treated with aggressive surgical management for best results.

Spinal dysraphism.

Spinal dysraphism (SD) is characterized by maldevelopment of neural tube, notochord, mesoderm and cutaneous ectoderm. Incidence of SD is 2-4/1000 live births. One hundred and nineteen patients operated from January 1991-June 1996 at Department of Neurosurgery, All India Institute of Medical Sciences, were studied. Only 21 patients (17.6%) presented when they were less than one year old and 17 patients came in adult age group (> 16 years). Lumbar and lumbosacral region was the commonly involved site in 81 patients (74.7%). Weakness of lower limbs (74%), difficulty in walking (54%), muscle atrophy (41.2%) were the commonest indicators of motor system involvement. Loss of sensation, trophic ulcer, backache were seen in 45, 14, 10 patients respectively. Cutaneous lipoma (26%), hypertrichiosis (20%), dermal sinus (13.4%), midline dimples (7%) were the important cutaneous markers. Foot and limb deformity was seen in 25% cases. Tethering of cord, syringomyelia & split cord malformation were the most common radiological findings. Only 10% of our patients had hydrocephalus that required shunt. Out on 119 cases operated, 43 improved, Twenty had sensory improvement and 18 showed motor improvement. Fifteen patients regained continence. Twelve patients were lost to follow-up. Sixty-seven patients had no change in neurological status, post-operatively. Six cases deteriorated in terms of motor or sensory deficit and one patient lost continence. CSF leak (8%) and wound infection (6%) were the common complications. Six patients required second surgery as T.P. Shunt (4), rotation flap (1), reexploration and duraplasty (1).

Brain stem glioma--a study of 111 patients.

The study analyses 111 patients of brain stem glioma; seen in neurosurgery Dept., AIIMS, N. Delhi, India, from Jan '83 to March '97; 60% of the patients were under the age of 15 years, with two peaks in age distribution, 6-10 years & 36-45 years & there was slight male preponderance in all age groups. Most common site of tumour was pons both in adults & children. Pyramidal & cerebellar signs were more frequently seen in children. Duration of symptoms was usually less than six months (in 65.5% of cases). Surgical management was attempted in 72 patients with post of radiotherapy & chemotherapy, rest of the 39 cases were treated with radiotherapy, chemotherapy & antitubercular treatment (if indicated). Improvement was seen in 30% patients postoperatively. Outcome was better in patients who were treated surgically. Astrocytoma was most common histological diagnosis (62%) & glioblastoma was not uncommon & was seen in 10 (13.8%) cases.] We conclude that the patients with brainstem glioma can be helped by surgical decompression, followed by adjuvant radiotherapy & chemotherapy.

Unusual complication--VP shunt coming out per rectum and brain abscess.

VP shunt is the most common pediatric neurosurgical procedure. It has been shown to result in variety of complications, which may have devastating consequences. Discussed below is one of the rare complications and the strategy to manage it successfully.

Injection induced nerve injury : an iatrogenic tragedy.

11 patients with injection induced nerve injury were evaluated. There were 9 adults and 2 children, 8 had radial nerve injury and 3 sciatic nerve injury. 6 had evidence of severe involvement with active denervation. Nature of the drug was not known in 81%, thus faulty site of injection was the most important factor responsible. The need to discourage indiscriminate use of intramuscular injections and choice of a proper site of selection is stressed.

Genetic marker profile of primitive Kutia Kondh tribal population of Phulbani district (Orissa).

Blood samples from 330 Kutia Kondhs (a primitive tribal population of Orissa) were subjected to a battery of tests for genetic markers to find out the incidence of various blood group polymorphisms (ABO, MN, Duffy, JKa), serum proteins, sickling and G-6-PD deficiency. Predominance of O (39.09%) blood group for ABO, N blood group (53.44) for MN and Fya+b+ (55.72) for Duffy blood group, were observed. High incidence of Hp2-1 (39.33), SS (70.43) and CC (96.65) for haptoglobulin, C3 and transferrin respectively were seen. The overall frequency of sickling was observed to be 16.36 per cent. The sex-wise distribution of G-6-PD was 13.71 per cent for males and 1.84 for females.