Surgical Outcome of Cauda Equina Syndrome Secondary to Disc Herniation Presenting Late in Developing Countries.

Cauda equina syndrome (CES) is a serious neurologic state in which neurological dysfunction affects the lumbar and sacral nerve roots within the vertebral canal. The nerves of the cauda equine provide the muscles that manage the bladder, bowel and the legs and the dysfunction producing impairment of bladder, bowel or sexual function and perianal or saddle numbness. Identification of CES is not only important to neurosurgeons and spine surgeons, but also to prime care practitioners, emergency room physicians, physiotherapists and allied health care professionals concerned in management of back pain. It is a significant diagnosis from a clinical and medico-legal outlook. Early surgical decompression is endorsed by most authors to best support patient's revival and trim down long term disability. This cross sectional observational study was conducted at Shaheed Suhrawardy Medical College Hospitals, Dhaka, Bangladesh from January 2015 to January 2021 and the aim of this study was to find the predictors and the clinical outcome of cauda equina syndrome after spinal decompression with delayed presentation. Among 680 patients of degenerative disc diseases; 32 cases (4.7%) had CES, those presenting late in course of disease. Time interval between bladder and bowel dysfunction and admission to hospital varied from 2-64 days with mean delay of 15.4 days. The average follow-up was 22.6 months, ranging from 12 to 34 months. There was significant positive correlation (p<0.05) between duration taken for total recovery and delay in surgery and between delayed decompression and a poor outcome. Also there was a clear correlation between the presence of complete perineal anaesthesia and absence of anal wink as both univariate and multivariate predictors of a poor outcome. There was significant association between a slower onset of CES and a favourable outcome. There was no significant correlation found between initial motor function loss, bilateral sciatica and level of the lesions as predictors of a poor outcome.

Evaluation of antinociceptive and anti-inflammatory activity of hydromethanol extract of Cocos nucifera L.

Cocos nucifera L. (family: arecaceae) is generally straight unbranched plant, traditionally cultivated for its fruit (coconut) in home gardens. In the present study, anti-inflammatory and antinociceptive (analgesic) activity of hydromethanol extract of Cocos nucifera L. (HECN) was evaluated in animal models. HECN showed significant (p < 0.05) and dosedependent anti-inflammatory activity in carrageenan induced paw oedema models of inflammation and the result was comparable with the standard drug diclofenac. In addition, the extract also showed highly significant (p < 0.01) antinociceptive activity. HECN treated group showed increase in the reaction time in hot plate method and decrease the writhing induced by acetic acid in mice when compared with control group animal. The anti-inflammatory and antinociceptive activity observed in the present study could be attributed largely to the presence of its antioxidant phytoconstituents such as flavonoid, saponin and polyphenols.

Anterior cervical discectomy and fusion without instrumentation for cervical spondylosis.

This prospective study included 50 patients receiving anterior cervical discectomy and fusion (ACDF) was conducted at Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The study period was 1st July 2006 to 30th June 2010. This study was done to see the functional outcome of surgery in relation to duration of symptoms and age of the patient. The clinical information and relevant imaging of 50 consecutive patients, 41 male and 9 female, was reviewed at 1 year after surgery. All surgery was performed at no more than 2 contiguous levels, by one surgeon. After anterior discectomy alone, or combined with posterior vertebral body margin osteophytectomy, anterior bone grafting was performed at each level using a tricortical autogenous iliac crest bone block inserted under compression. All surgery was completed without internal fixation. A postoperative semirigid cervical collar was prescribed for 2 months. In 50 patients, there were 4 pseudarthroses (8%). Only 4% of the 50 patients had pain related to the donor site. The functional outcome was excellent to good (87.5%) when duration of symptoms less than 1 year and outcome was excellent to good (85.29%) when the age less than 50 years. These results tend to confirm published reports of most expected outcome related to young age and short duration of symptoms. Patients with technically successful fusions were less likely to have postoperative neck pain. Donor site pain was not a significant postoperative complication. ACDF is a safe, cheap and effective procedure for cervical spondylosis. In this series no major operative complications have occurred. No extra expenditure for plate and screw in this procedure.

Antitumor potential of Castanopsis indica (Roxb. ex Lindl.) A. DC. leaf extract against Ehrlich's ascites carcinoma cell.

Methanol extract of C. indica (MECI) leaves showed direct cytotoxicity on Ehrlich ascites carcinoma (EAC) cell in a dose dependant manner and there was significant decrease in the tumor volume, viable cell count, tumor weight and elevated the life span of EAC tumor bearing mice. Hematological profile and biochemical estimations were significantly restored to normal levels in MECI treated as compared to EAC control mice. MECI treatment significantly modulated the tissue antioxidant assay parameters as compared to the EAC control mice. The results revealed that MECI possesses significant dose dependent antitumor potential which may be due to its cytotoxicity and antioxidant properties.

Large calcified subdural empyema.

Subdural empyema is a known disease entity; however, calcified subdural empyema is uncommon. The authors present a case of an 11-year-old boy in whom there was diagnosed a chronic calcified subdural empyema 10 years after an attack of meningitis. The patient had suffered from generalized tonic clonic seizures occurring 2-6 times in a month. A large fronto-temporo-parietal craniotomy was carried out and the subdural empyema filled with numerous uncharacteristic tissue fragments with thick pus together with the partially calcified and ossified capsule was removed. The empyema mass was found to be sterile for bacteria. After the operation, no epileptic seizure occurred and the boy is on sodium valporate. We must emphasize the unusual occurrence of the chronic subdural empyema presenting with calcification-ossification and large size as observed in our case.

Maternal over weight and obesity: its effect on pregnancy outcome.

Obesity in pregnancy remains a significant health problem that result in physiological, emotional, social and economic consequences on woman, their families and society. Obesity is considered one of the nutritional problems complicating pregnancy in our country. This study was conducted in antenatal clinic at out patient department of Obstetrics & Gynecology, BIRDEM Hospital, one of the countries largest tertiary level hospitals, during January 2007 to December 2008. During the study period of two years, a total no. of 100 cases were enrolled in two groups. Out of this 50 were control and 50 were over weight and obese. In this study, Mean of height, weight and BMI of the over weight and obese group were 5.21±0.21, 79.35±13.66, 32.36±4.76 respectively. The Mean of birth weight, APGAR score after 1 min and after 5 min of the over weight and obese group were 3.07±0.75, 7.10±1.11, 9.92±0.98 respectively and in normal weight group were 2.74±0.55, 7.40±1.56, 9.92±1.83 respectively. There was significant difference in birth weight, APGAR score after 1 min between the groups (p<0.05) but there was no significant difference in APGAR score after 5 min between groups (p>0.05). Regarding the fetal outcome in this study, 20% of the over weight and obese group delivered macrosomic baby in comparison to only 4% in the normal weight group. On the other hand 46% of the case group had to refer their babies to the neonatal unit in comparison to only 12% in the control group. Gestational Diabetes Mellitus (GDM) (46%) and Preeclampsia (44%) developed more in obese group. Eighty eight (88%) of obese and overweight mother experienced in caesarean delivery. Asphyxia, Respiratory Distress Syndrome (RDS), congenital anomaly and prenatal death were more in the over weight and obese group than normal weight group. Thus, overweight and obesity has got significant deleterious effect on maternal and perinatal outcomes of pregnancy.

A primary intracranial ependymal cyst.

A case of a giant ependymal cyst in the fronto-parieto-temporal region in a 9 months old male baby, who presented with recent onset epilepsy, drowsiness and loss of vision. Neurosurgical intervention of this cystic lesion was curative. Interesting clinical and neuroimaging features are presented. This ependymal and primary intracranial cystic lesion which is rare. These are congenital, benign ependyma lined, commonly intraparenchymal and uncommonly extraparenchymal cysts in leptomeningeal location of variable size. Surgical intervention is warranted in cysts, which produce a mass effect and raised intracranial pressure.

Fibrous dysplasia on the skull.

A young rickshaw puller admitted in Neurosurgery ward of Mymensingh Medical College Hospital due to ugly looking skull swelling on right side and iatrogenic ulceration on the postero-superior surface of the swelling. He also mentioned that he was not socially well-excepted and facing difficulty in getting married for that ugly lesion and was very unhappy at that time. CT scan was suggestive of fibrous dysplasia of skull bone and no other abnormalities were present on other part of the body. Then complete excision of the mass was done and fibrous dysplasia was confirmed by histopathological study. Two months after surgery he got married and expressed his happiness. In fibrous dysplasia, normal bone is replaced by fibrous connective tissue with varying degrees of osseous metaplasia. It is a benign disorder of bone commonly seen from childhood to the third decade. Virtually any bone in the body can be affected. Regarding investigations, plain radiography in the first line study. CT may be required to assess complex region such as the spine, pelvis, chest and facial skeleton. Histologically, fibrous dysplasia appears as multiple areas of fibrous tissue contained within islands of bone with evidence of both blastic and clastic activity.

Clinical picture of craniopharyngioma in childhood.

This cross sectional and observational study was carried out among the admitted patients of the department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of 1st March 2004 to 31st March 2005. Among the all intracranial tumours, 2.5-04% are Craniopharyngiomas. Although there is a bi-modal age distribution-1st peak at 5-10 years and the 2nd peak at 55-65 years, the common patients are children (9% of childhood tumour). A typical child with Craniopharyngioma (CP) is short, obese and half blind and has a poor school record. The study has been undertaken to know in details, how child patients with Craniopharyngiomas in Bangladesh present their disease at the hospital. Earlier diagnosis and management may improve the quality of life and longivity. The average age of the patients was 13 years ranging from 07 to 17 years. The vast majority patients were admitted with visual problems as their presenting complaints. Among the patients 33% had total blindness of which 03 had primary optic atrophy and 1 has secondary optic atrophy. Among the remaining 08 patients, 75% were found to have field defect. All patients showed fundal changes ranging from early papilloedema to optic atrophy. We found major endocrinological deficiency in child patients with Craniopharyngioma in 17% cases. Raised Prolactin level may not be significant, because it could be due to stalk effect. Although 25% patients were of short stature, their hormonal profile was within normal range according to age and sex.

Clinico-pathological study in large posterior fossa midline tumors.

This cross sectional analytic study was carried out among the admitted patients of the department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of 1st July 2002 to 31st December 2004. The age ranged from 2.5 years to 70 years. The size of all posterior fossa tumors at presentation were more than 3 cm and the mean size of posterior fossa tumor was 4.38 cm. 62% of posterior fossa mid-line tumors were mixed density in NECT (non-contrast CT). Regarding enhancement characteristics, mild-moderate enhancement and marked heterogeneous enhancement was equally distributed 46% followed by marked homogeneous enhancement only 08%.. The calcification was present only in 07 (14%) patients and most of them were ependymoma. Histopathologically, medulloblastoma was the common variety (32%). The CT scan diagnostic modality sensitivity, accuracy and positive predictive value were 100%, 84.78% and 84.78% respectively but in MRI diagnostic modality 100%, 91.30% and 91.30% respectively.

Antiinflammatory evaluation of leaves of Plumeria acuminata.

BACKGROUND: [corrected] Plumeria acuminata belonging to the family Apocynaceae is commonly known as 'perungalli' in Tamil and is widely distributed throughout the Southern parts of India. In traditional medicinal system different parts of the plant have been mentioned to be useful in a variety of diseases. The plant material is widely used as a purgative, remedy for diarrhoea and cure for itch. The milky juice is employed for the treatment of inflammation and rheumatism. The bark has been reported to be useful in hard tumors, diarrhoea and gonorrhoea. The objective of the present study was to evaluate the antiinflammatory activity of methanol extract of leaves of Plumeria acuminata on carrageenan, dextran, histamine and serotonin-induced inflammation in rat hind paw oedema models. METHODS: Acute and chronic inflammation models were used to evaluate the anti-inflammatory activity of the extract. Wistar albino rats of either sex weighing 180-200 g were used. In acute model carrageenan, dextran, histamine and serotonin models were used to induce inflammation in rat hind paw and cotton pellet-induced granuloma method was used for chronic inflammation model. In each model four groups of six animals were used. In all the models Group I served as control (0.9% normal saline, 5 mlkg(-1) b.w) and group IV as standard (Indomethacin 10 mgkg(-1) b.w). Group II and III received extract at the doses of 250 and 500 mgkg(-1) b.w respectively. RESULTS: The methanol extract of Plumeria acuminata exhibited significant anti-inflammatory activity on the tested experimental animal models. The extract (500 mgkg(-1) b.w) exhibited maximum antiinflammatory effect i.e., 30.51, 47.06, 34.48 and 32.50% (P < 0.001) at the end of 3 h with carrageenan, dextran, histamine and serotonin respectively. Administration of MEPA (500 mgkg(-1) b.w) and indomethacin (10 mgkg(-1) b.w) significantly reduced the formation of granuloma tissue induced by cotton pellet method at a rate of 45.06 and 51.57% respectively. The effect produced by the extract was comparable to that of indomethacin a prototype of a nonsteroidal antiinflammatory agent. CONCLUSION: The results obtained in this study indicated that the methanol extract of Plumeria acuminata possess potent antiinflammatory activity in both acute and chronic models.

In vitro antioxidant activity of Diospyros malabarica Kostel bark.

Antioxidant activity of defatted methanol extract of D. malabarica bark was studied for its free radical scavenging property on different in vitro models e.g. 1,1-diphenyl-2-picryl hydrazyl (DPPH), nitric oxide, superoxide, hydroxyl radical and lipid peroxide radical model. The extract showed good dose-dependent free radical scavenging property in all the models except in hydroxyl radical inhibition assay. IC50 values were found to be 9.16, 13.21, 25.27 and 17.33 microg/ml respectively in DPPH, nitric oxide, superoxide and lipid peroxidation inhibition assays. In hydroxyl radical inhibition assay 1000 microg/ml extract showed only 10% inhibition with respect to the control. Measurement of total phenolic compounds by Folin-Ciocalteu's phenol reagent indicated that 1 mg of the extract contained 120.7 microg equivalent of pyrocatechol. The results indicate that the antioxidant property of the extract may be due to the high content of phenolic compounds. However, the underlying mechanism may not involve hydroxyl radical scavenging property.

Anti-inflammatory, analgesic and antipyretic effects of methanol extract from Bauhinia racemosa stem bark in animal models.

In this study, the anti-inflammatory, analgesic, and antipyretic effects of 50, 100 and 200 mg/kg body weight of methanol extract obtained from Bauhinia racemosa stem bark, the so-called MEBR, were investigated. The effects of MEBR on the acute and chronic phases of inflammation were studied in carrageenan, dextran and mediators (histamine and serotonin)-induced paw oedema and cotton pellet-induced granuloma, respectively. Analgesic effect of MEBR was evaluated in acetic acid-induced writhing and hotplate tests. Antipyretic activity of MEBR was evaluated by yeast-induced hyperpyrexia in rats. The anti-oedema effect of MEBR was compared with 10 mg/kg of indomethacin orally. In acute phase of inflammation, a maximum inhibition of 44.9, 43.2, 44.8 and 45.9% (P<0.001) was noted at the dose of 200 mg/kg b.w. after 3h of treatment with MEBR in carrageenan, dextran, histamine and serotonin-induced paw oedema, respectively. Administration of MEBR (200 mg/kg b.w.) and indomethacin (10 mg/kg b.w.) significantly (P<0.05) decreased the formation of granuloma tissue induced by cotton pellet method at a rate of 50.4 and 56.2%, respectively. The extract also inhibited peritoneal leukocyte migration in mice. The MEBR also produced significant (P<0.01) analgesic activity in both models. Further, the MEBR potentiated the morphine- and aspirin-induced analgesic in mice. Treatment with MEBR showed a significant (P<0.01) dose-dependent reduction in pyrexia in rats. The results suggest that MEBR possess potent anti-inflammatory, analgesic and antipyretic activity.

Anti-ulcer activity of ethanol extract of Terminaliapallida Brandis. in Swiss albino rats.

Ethanol extract of Terminalia pallida Brandis. (EETP) was evaluated for its anti-ulcer activity against various models of ulcers, such as drug-induced ulcers, histamine-induced ulcers and ethanol-induced ulcers in Swiss albino rats. The EETP at the doses of 250 and 500 mg/kg per os (p.o.) exhibited significant protection against ulcers produced by indomethacin, histamine and the effect was comparable to that of the reference drug famotidine (30 mg/kg b.w) orally. The extract also afforded significant protection against ethanol-induced gastric ulceration. Meanwhile, EETP significantly lowered the elevated lipid peroxide level (thiobarbituric acid reactive substances (TBARS)) and restored the altered glutathione level in ethanol-induced gastric ulceration. The present investigation revealed that the EETP exhibited significant anti-ulcer activity by enhancing antioxidant potential of the gastric mucosa, thereby reducing mucosal damage.

Evaluation of analgesic, antipyretic activity and toxicity study of Bryonia laciniosa in mice and rats.

Analgesic, antipyretic activity and toxicity study of the leaves of Bryonia laciniosa Linn. (Family: Cucurbitaceae) was evaluated in the standard animal models. The methanol extract of Bryonia laciniosa (MEBL) was evaluated by hot plate and acetic acid-induced writhing methods to assess analgesic activity. The antipyretic activity of the extract was also evaluated by normal body temperature and yeast-induced hyperpyrexia. The extract showed significant analgesic and antipyretic activity. The MEBL was further evaluated for toxicity at the doses of 125 and 250 mg/kg administered orally for 14 days in rats. At the end of experiments, the blood, liver function and kidney metabolism were observed. The hematological profile and different biochemical parameters such as SGOT, SGPT and ALP were estimated. The present study revealed that MEBL exhibited significant analgesic and antipyretic activity in the tested experimental animal models. The toxicity study indicates that the extract is not toxic at the tested doses.

Anti-steroidogenic activity of the two Indian medicinal plants in mice.

The chloroform extract of Croton roxburghii bark (CECR, Euphorbiaceae) and ethyl acetate extract of Zizyphus jujuba bark (EAZJ, Rhamnaceae) were evaluated for anti-steroidogenic activity in the adult female mouse. This study was designed to assess the effects of CECR and EAZJ on ovarian steroidogenisis. Antifertility activity was evaluated by observing the estrus cycle, body weight, wet weight of ovaries, steroidogenic enzymes, and substrates. Blood profiles were estimated to find out the toxic manifestations of the extracts. CECR and EAZJ each arrested the normal estrus cycle of adult female mouse at diestrus stage and reduced the wet weight of ovaries significantly. Cholesterol and ascorbic acid content in ovaries of crude extract-treated mice were significantly elevated. The significant inhibition of delta(5)-3beta-hydroxysteroid dehydrogenase (delta(5)-3beta-HSD) and glucose-6-phosphate dehydrogenase (G-6-PDH), the two key enzymes involved in ovarian steroidogenisis, were also observed in mouse after 18 days of treatment. Hematological profiles, biochemical estimations of whole blood and serum remains unaltered in extract-treated mouse. Normal estrus cycle and ovarian steroidogenisis were restored after withdrawal of treatment with CECR and EAZJ on average 27 and 32 days, respectively. Antifertility activities of crude extracts were found to be reversible.

Onset of puberty and ovarian steroidogenesis following adminstration of methanolic extract of Cuscuta reflexa Roxb. stem and Corchorus olitorius Linn. seed in mice.

The effect of methanolic extract (ME) of Cuscuta reflexa stem Roxb. and Corchorus olitorius Linn. seed on the onset of reproductive maturity and the ovarian steroidogenesis was studied by means of biochemical techniques. ME of Cuscuta reflexa stem and Corchorus olitorius seed treatment causes a remarkable delay in sexual maturation as evidenced by the age at vaginal opening and appearance of first estrus (cornified smear). The same treatment also results in a significant diminution of Delta(5)-3beta-hydroxysteroid dehydrogenase (HSD) and glucose-6-phosphate dehydrogenase (G-6-PD) activity along with a reduction in the weight of ovary, uterus and pituitary. On the basis of above data, it is assumed that the probable cause of delayed maturation in ME of Cuscuta reflexa stem and Corchorus olitorius seed treated mice is due to the suppressed ovarian steroidogenesis.

Evaluation of antipyretic potential of Vernonia cinerea extract in rats.

The methanol extract of the whole plant of Vernonia cinerea (MEVC) was evaluated for its antipyretic potential on normal body temperature and yeast-induced pyrexia in rats. MEVC significantly reduced the normal body temperature at doses of 250 and 500 mg/kg body weight p.o. MEVC also lowered the elevated body temperature in the case of yeast-induced pyrexia in a dose dependent manner. The antipyretic effect of the extract at a dose of 500 mg/kg was identical to that of the standard drug paracetamol.

Evaluation of anti-inflammatory activity of Vernonia cinerea Less. extract in rats.

The methanol extract of the whole plant of Vernonia cinerea Less. was evaluated for its anti-inflammatory activity in acute (carrageenin, histamine and serotonin induced rat paw edema) and a chronic model (cotton pouch induced granuloma). The methanol extract (250 and 500 mg/kg(-1) p.o.) exhibited significant activity (p < 0.001) against all phlogistic agents used in a dose dependant manner. In the chronic model (cotton pouch granuloma method) the methanol extract exhibited significant anti-inflammatory activity. All these effects were compared with standard drug phenylbutazone (100 mg/kg(-1) p.o.).

Antibacterial activity of Vernonia cinerea.

The benzene extract of Vernonia cinerea showed a broad spectrum of antibacterial activity.