Role of simvastatin in prevention of vasospasm and improving functional outcome after aneurysmal sub-arachnoid hemorrhage: a prospective, randomized, double-blind, placebo-controlled pilot trial.

BACKGROUND: Vasospasm plays a major role in the morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The preliminary studies suggest that statins protect against cerebral vasospasm. OBJECTIVE: The aim of the study was to determine the role of simvastatin in preventing clinical vasospasm and improving functional outcome in patients with aSAH. METHODS: All patients with aSAH admitted within 96 h of ictus were randomized to receive either Simvastatin or placebo - 80 mg/day for 14 days. Thirty eight patients were recruited in the study- 19 received Simvastatin and 19 placebo. All the patients underwent surgical clipping of the aneurysm. The primary outcome of the study was the development of clinical cerebral vasospasm. The secondary outcomes included Glasgow Outcome Score (GOS), Modified Rankin Scale (MRS) and Barthel Index Score (MBI) at follow-up at 1, 3 and 6 months. RESULTS: 16% of the patients in the simvastatin group had high Middle Cerebral Artery velocities (> 160 cm/sec) on transcranial Doppler on one or more than one day during the study duration as compared to 26% of the patients in the placebo group (p = 0.70). Neurological deterioration occurred in 26% and 42% of the patients in simvastatin group versus placebo group, respectively (p = 0.31). There was an improvement in the functional outcome in the simvastatin group at 1, 3 or 6 months in the follow-up; however, this difference was not statistically significant. CONCLUSIONS: There was benefit of simvastatin in terms of reduction in clinical vasospasm, mortality or improved functional outcome, however, this was not statistically significant.

Structural studies of racecadotril and its process impurities by NMR and mass spectroscopy.

Three unknown impurities in racecadotril bulk drug at levels below 0.5% were detected by simple reverse phase isocratic high performance liquid chromatography (HPLC). Structures for these impurities were proposed by molecular ion information and their fragmentation pattern obtained by LC-MS and these impurities were confirmed by NMR spectroscopy. The impurities I, II and III were characterized as benzyl 2-methyl carboximido acetate, benzyl 2-phenyl ethyl carboximido acetate, and benzyl 2-(1-benzyl vinyl carboximido) acetate. These structures were further confirmed by co-injecting of synthetic standards of impurities with racecadotril. The mechanism of the formation of these process related impurities is discussed.

Aminoglycoside antibiotics. 7. Dihydrostreptomycin analogues.

Dihydrostreptomycin analogues with structural variations in their guanidino groups were prepared. The analogue with a methyl group on the guanidine at C-1 was nearly as active as dihydrostreptomycin against bacteria. However, the 2-imidazolin-2-ylamino substituent at C-1 eliminated activity. No analogue with a substituent on the C-3 guanidino group was active.

Posterior fossa dermoid in association with Klippel-Feil syndrome--a short report.

A posterior fossa dermoid cyst in association with the Klippel-Feil syndrome, in a 4 year old child is reported. Early diagnosis to prevent complications like neural compression, cyst rupture and staphylococcal meningitis justifies investigation for posterior fossa dermoids in cases of Klippel-Feil syndrome. Their embryological basis is discussed.

Childhood colorectal carcinoma: a case series.

Colorectal carcinoma (CRC) is rare in children, except for a few sporadic reports there is not much information about it in the literature. It is important for pediatricians and paediatric surgeons to be aware that CRC does occur in children, and it should not be excluded only on the basis of the patient's age. Its rarity in children has meant a poor understanding of its biological nature and the treatment modalities to be followed.

Brain abscess caused by Cladophialophora Bantiana in an immunocompetent host: need for a novel cost-effective antifungal agent.

We report a 53-year-old male who presented with headache, tremor and memory disturbance. Radiological evaluation was suggestive of brain abscess. He underwent gross total excision of the cerebral abscess. The histopathological examination and pus culture was suggestive of brain abscess caused by Cladophialophora bantiana. Authors report a rare case of biopsy and culture proven Cladophialophora bantiana brain abscess in an immunocompetent host. The authors review the relevant literature and current treatment options while emphasizing the need for a cost-effective novel antifungal drug to salvage a subset of patients suffering from this rare but increasingly frequent condition.

Frontal intraparenchymal schwannoma: an unusual presentation.

CASE REPORT: A 13-year-old male with an 11-year history of a seizure disorder presented with recent onset raised intracranial pressure symptoms and no obvious phakomatosis. CT revealed a heterogeneous, frontal, intra-axial, densely enhancing, solid lesion with intense perilesional oedema and mass effect. Total microsurgical excision resulted in cure. Histopathological examination showed characteristic Antoni A and B areas and occasional Verocay bodies consistent with the diagnosis of an intraparenchymal schwannoma. DISCUSSION: The authors present a very rare, entirely solid manifestation of this highly uncommon lesion seen mostly in young adults and children with symptoms suggestive of raised intracranial pressure and associated seizure disorders. The possible developmental origins are discussed.