Serum sonic hedgehog (SHH) and interleukin-(IL-6) as dual prognostic biomarkers in progressive metastatic breast cancer.

Serum from one hundred and ten breast cancer patients and thirty healthy female volunteers, were prospectively collected and evaluated for serum levels of Shh and IL-6 using human Shh and IL-6 specific enzyme-linked immunoassays. All patients were regularly monitored for event free survival (EFS) and overall survival (OS). Overall outcome analysis was based on serum Shh and IL-6 levels. In patients with progressive metastatic BC, both serum Shh and IL-6 concentrations were elevated in 44% (29 of 65) and 63% (41 of 65) of patients, respectively, at a statistically significant level [Shh (p = 0.0001) and IL-6 (p = 0.0001)] compared to the low levels in healthy volunteers. Serum levels tended to increase with metastatic progression and lymph node positivity. High serum Shh and IL-6 levels were associated with poor EFS and OS opposite to the negative or lower levels in serum Shh and IL-6. The elevated levels of both serum Shh and IL-6 were mainly observed in BC patients who had a significantly higher risk of early recurrence and bone metastasis, and associated with a worse survival for patients with progressive metastatic BC. Further studies are warranted for validating these biomarkers as prognostic tools in a larger patient cohort and in a longer follow-up study.

Clinical Presentation and Outcome of Impalement Craniocerebral Injuries - A CASE SERIES.

Non-missile, low-velocity penetrating craniocerebral injuries are uncommon among civilians and unlike missile injuries, are associated with localized brain injury and subsequent good outcome if managed appropriately. Penetrating injuries to the brain caused by a retained, relatively blunt or sharp object that perforate the brain along its longitudinal axis producing a wound track corresponding to its length of penetration, are called impalement injuries. Most of the impalement craniocerebral injuries are accidental and varying objects have been reported. We report our experience with the management of seven cases of impalement craniocerebral injuries. Five of the patients were adult male while two female children were involved. One case was from assault, others resulted from accidental injury. Left side of the cranium was more commonly involved. The impaled objects in this study included a lead pencil, a screw driver, a branch of a tree, and other metallic objects. Most of the patients had craniectomy and water tight dura repair during remover of the impaled object. All patients made good recovery following surgical intervention. Management principles entail early recognition, deliberate and careful debridement, and judicious antibiotic therapy. The surgical approach to these injuries varies, depending on the route of entry.

Recurrent depressive illness or craniopharyngioma: a diagnostic dilemma.

BACKGROUND: Brain tumors have been associated with various psychiatric and neurological manifestations. However in some patients with brain tumors psychiatric symptom might be the only clinical presentation for various lengths of time. As such they would be treated as straight forward psychiatric disorders. OBJECTIVE: To report a case of craniopharyngioma presenting as recurrent depressive illness in a 42 years old man. METHODS: Clinical follow up of a patient presenting with recurrent depressive illness till death RESULTS: recurrent severe depressive illness in the absence of focal neurological deficit that is unresponsive to anti-depressant might be due to intracranial neoplasm. CONCLUSION: Brain tumors can sometime present as psychiatric disorders and be difficult to detect in the absences of focal neurological deficit and Neuro-imaging studies.

Fetal head injury from intentional penetrating abdominal trauma in pregnancy.

A male fetus was extruded from the uterus following multiple lower abdominal stab wounds to the mother. He was brought to the emergency room at 8 hours of age. He had sustained a compound skull fracture with brain contusion. There was no neurological deficit. Debridement and primary wound closure were undertaken. His mother had multiple lacerations to the uterus and a laceration of the fundus of the bladder. Following resuscitation, she had repair of the uterus and bladder and made an uneventful recovery. At 3 years of age, the boy is developing normally.

Pott's puffy tumour: a case report.

A 10-year-old girl presented with an episode of seizure following oste omyelitis of the frontal bone and subperiosteal abscess due to frontal sinusitis. CT scan confirmed osteomeyelitis of the frontal bone and subperiosteal abscess. At surgery, the subperiosteal abscess and contiguous subdural abscess was drained and sequestrectomy of the affected frontal bone done. Broad spectrum antibiotics and anticonvulsant were given for 4 weeks. The patient recovered without residual problems and has remained well at 5 years of follow up. Pott's puffy tumor is now relatively uncommon and associated seizure is unusual. Early diagnosis and prompt treatment is necessary to avoid severe neurological complications and sequelae.

Carotid occlusion and cerebral infarction from camel bite: case report.

A 30-year-old farmer was bitten by his camel on the left side of the neck. He suffered immediate loss of consciousness but recovered three days later with right-sided hemiplegia and complete aphasia. He bled minimally from the neck. CT scan of the brain and carotid Doppler ultrasonography confirmed left parietal lobe infarction and partial occlusion of the left carotid artery respectively. He was managed conservatively with physiotherapy and low dose aspirin. At six months of follow up, his speech remains slurred but comprehensible and is able to walk with a walking stick.

Preoperative high resolution CT and MR imaging in cochlear implantation.

INTRODUCTION: Accurate preoperative imaging of the temporal bone in patients receiving cochlear implants is important. High resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are the 2 preoperative imaging modalities that provide critical information on abnormalities of the otic capsule, pneumatisation of the mastoid, middle ear abnormalities, cochlear ducts patency and presence of cochlear nerve. MATERIALS AND METHODS: The HRCT and MR imaging in 46 cochlear implant patients in our department were reviewed. RESULTS: Majority of our patients [34 patients (73.9%)] showed normal HRCT of the temporal bone; 5 (10.9%) patients had labyrinthitis ossificans, 2 (4.3%) had Mondini's abnormality and 2 (4.3%) had middle ear effusion. One patient each had high jugular bulb, hypoplasia of the internal auditory canal and single cochlear cavity, respectively. CONCLUSION: The above findings contribute significantly to our surgical decisions regarding candidacy for surgery, side selection and surgical technique in cochlear implantation.

The different faces of facial nerve schwannomas.

Facial nerve schwannomas are rare benign tumors. The tumor can arise anywhere along the course of the facial nerve. The most common presentation for this tumor is a slowly progressive facial nerve paralysis. Sensorineural hearing loss (SNHL) and tinnitus are later symptoms. The symptoms and signs depend on the site of tumor along the nerve. We report three cases of facial nerve schwannomas with different clinical presentations. Appropriate management of a facial nerve schwannoma should be based on the site and extent of the tumor and status of the nerve function.