Guillain-barré syndrome in pregnancy: an unusual case.

Guillain-Barré syndrome (GBS) is rare in pregnancy with an estimated incidence between 1.2 and 1.9 cases per 100,000 people annually, and it carries a high maternal risk. We report a 29-year-old primigravida who had pain and progressive heaviness of both lower limbs in her third trimester of pregnancy. The attending gynecologist ascribed these symptoms to ongoing pregnancy. The intrapartum period (lower segment caesarian section) passed uneventfully. On third postpartum day, the patient developed weakness of all the four limbs. A detailed history and physical examination pointed toward GBS although there was no antecedent infective episode. Subsequent nerve conduction velocity studies and cerebrospinal fluid analysis confirmed GBS. All other investigations including electrolytes were normal. The patient improved without the introduction of immunomodulating therapy.

Physico-chemical characteristics of groundwater in and around Surat City (India).

Groundwater samples were collected from different locations of Surat city, Gujarat (India). These samples from 32 locations of Surat city were analysed for their physico-chemical characteristics involving pH, colour, odour, hardness, chloride, alkalinity, COD, sulfate, TDS, SS, iron, Cu, boron, chromium, temperature and Langelier Saturation Index. On comparing the results against drinking water quality standards laid by Indian Council of Medical Research (ICMR) and World Health Organization (WHO), it is found that most of the water samples are non-potable. Most of the samples indicated Total Alkalinity, Hardness, Chloride and TDS values much higher than the permissible level stipulated by ICMR and WHO. Even at some places Langelier Saturation Index values found higher too. The high values of these parameters may have health implications and therefore these need attention.

Peritoneal dialysis for adults with acute renal failure: an underutilized modality.

In order to evaluate the effects of peritoneal dialysis as a modality of renal replacement therapy for adults with acute renal failure (ARF) of varied etiologies, we studied 43 ARF patients who underwent peritoneal dialysis at our hospital from April 2004 to November 2005. The age of the patients ranged from 18 to 75 years with a mean of 35 years. There was no significant difference in the incidence of ARF between males and females. Acute tubular necrosis secondary to acute gastroenteritis was the cause of ARF in 32 (80%) patients; four (10%) patients expired secondary to ARF. There was an average fall of around 60% in the S. creatinine at the end of PD. We did not notice any significant complications related to the procedure. We conclude that peritoneal dialysis is still a good option for the treatment of patients with ATN.

Historical perspective on the Department of Neurosurgery at the Henry Ford Hospital.

The Henry Ford Hospital (HFH) was founded in 1915 as a philanthropic gift from Henry Ford, the automobile magnate and inventor of the Model T. The hospital and its organizational structure represented a nonsectarian facility that would provide care for all members of society. The system was patterned after the newest and most modern medical centers at the time in Europe, Canada, and the United States, including the German Krankenhauser, the Johns Hopkins Hospital, the Mayo Clinic, and the Peter Bent Brigham Hospital in Boston. The HFH grew into the Henry Ford Health System in the 1970s to 1990s, with the acquisition of other hospitals, the development of a multiple-region-based clinic system through southeastern Michigan, and the development of comprehensive, vertically integrated health care systems. The Division of Neurosurgery at HFH was established by Albert Crawford in 1926. The tradition of training residents in neurosurgery began in 1946, and the residency training program was accredited by the American Board of Neurosurgery in 1954. In 1970, the Division of Neurosurgery of the Department of Surgery was combined with the Division of Neurology to create the joint Department of Neurology and Neurosurgery. A separate Department of Neurosurgery was established in 1981. Four individuals have served as chairmen of the Department of Neurosurgery at HFH, i.e., Albert Crawford (1926-1952), Robert Knighton (1952-1978), James Ausman (1978-1991), and Mark Rosenblum (1992 to the present). During the 1980s and 1990s, HFH evolved into the vertically integrated, regionally distributed Henry Ford Health System. Under the current direction of Dr. Rosenblum, the Department of Neurosurgery at HFH has grown to include 11 full-time neurosurgeons, 2 neuro-oncologists, and 3 investigators with Ph.D. degrees and has recently expanded into three additional hospitals in southeastern Michigan, paralleling the growth of the system. The faculty annually treats more than 2,000 cases in all neurosurgical subspecialties, ranging from neuro-oncological surgery, cranial base surgery, radiosurgery, cerebrovascular surgery, epilepsy surgery, treatment of movement disorders, pain and spasticity surgery, pediatric neurosurgery, and neurotrauma treatment to complex instrumentation of the spine. This article chronicles the history of the Henry Ford Health System and the Department of Neurosurgery, its research endeavors, and its residency training program.

Language hemispheric dominance in patients with congenital lesions of eloquent brain.

OBJECTIVE: In 90% of normal subjects, the left hemisphere is dominant for language function. We investigated whether congenital lesions of the left perisylvian regions altered cortical language representation in right-handed individuals. METHODS: Using functional magnetic resonance imaging, we studied language hemispheric dominance in five right-handed adult patients with congenitally acquired arteriovenous malformations (AVMs) originating from left hemispheric cortical language regions. The AVMs had not caused neurological symptoms during early development, but patients presented as adults with migraine, seizure, or minor hemorrhage. Results obtained from the AVM patients were contrasted to those from right-handed brain-injured stroke patients recovering from aphasia and to those from right-handed normal subjects. RESULTS: During silent picture naming and verb generation tasks, cortical language networks lateralized primarily to the right hemisphere in the AVM group, compared with the left hemisphere in the normal group. This right hemisphere-shifted language network in the AVM group exceeded the shifts toward right hemispheric dominance found in the stroke group. CONCLUSION: Patients with AVMs affecting the left perisylvian regions recruited the right hemisphere into language processing networks during early development, presumably in response to congenitally aberrant circulation. This early right hemisphere recruitment in the AVM patients exceeded the similar process in the brains of stroke patients whose left cortical language networks were damaged in adulthood. Our data provide evidence of effective plasticity in the developing human brain compared with the mature brain response to injury. Knowledge of cortical language representation should assist presurgical planning in patients with developmental anomalies affecting apparently language-dominant brain regions.

Gastric cancer profile in kashmiri population with special dietary habits.

The present study is a comprehensive retrospective analysis of 1341 gastric neoplasms out of 10 733 individuals subjected to upper gastrointestinal endoscopy at the main teaching cum referral hospital in the Kashmir Valley. Of these 78% were males and 22% females, majority being in the age group of 41-60 years with 60% of the patients being smokers. On endoscopy, the commonest site of cancer was the body of stomach 40.7%, followed by the antrum 35.5% and the cardiac region 23.8%. Endoscopic features revealed nodular masses 39%, polypoid masses 21%, malignant ulcers 11%, infiltrative masses 12%, rounded tumor masses 9%, linitus plastica 5% and early gastric carcinoma 3%. Histology revealed adenocarcinoma 91%, (including mucoid carcinoma 9%, and schirrous carcinoma 7%), leiomyosarcoma 7%, and reticulum cell sarcoma 2%. No significant association between Helicobacter pylori infection and gastric cancer was observed in a short study out of these patients. The peculiar geography and some special dietary habits with a possible familial predisposition may have a bearing on the high risk of gastric cancer in the valley.

Association of cerebral arteriovenous malformations and spontaneous occlusion of major feeding arteries: clinical and therapeutic implications.

OBJECTIVE: The spontaneous occlusion of a cerebral arteriovenous malformation (AVM) occurs rarely. Occlusion of a parent artery feeding the AVM is even more rare, and its incidence is unknown. We undertook this study to determine the incidence of occlusion of a major artery feeding an AVM and to recommend a management strategy for such an AVM. METHODS: We identified AVMs associated with an occluded artery by performing a retrospective angiographic analysis of 500 patients with AVMs who presented to Henry Ford Hospital from 1976 to 1998. RESULTS: A review of the angiograms revealed that 7 (1.4%) of 500 patients with an AVM had occlusion of one or more major arteries feeding the nidus. In four patients, an internal carotid artery and its bifurcation were occluded; in two patients, the M1 segment of the middle cerebral artery was occluded, and in one patient, a vertebral artery was occluded. Pial collaterals and/or a moyamoya pattern of anastomoses developed in all patients, with the exception of one who had vertebral artery occlusion. Five patients underwent definitive treatment: one received radiosurgery, and four underwent surgical excision. One of the surgically treated patients died of complications from excessive blood loss and coagulopathy, but the other three had no postoperative complications. CONCLUSION: The occlusion of a major artery feeding an AVM occurs rarely (1.4%). These AVMs are moderate to large in size (>3 cm). To prevent collateral flow-related complications of cortical "steal" and hemorrhage, as well as the usual risk of hemorrhage from the AVM itself, surgical management should be considered for these AVMs.

Spontaneous angiographic obliteration of cerebral arteriovenous malformations.

OBJECTIVE: The factors associated with spontaneous angiographic obliteration of cerebral arteriovenous malformations (AVMs) are not well understood. We present a review of the literature and a report of our experience with six cases (four with no previous treatment intervention and two postoperative residual malformations) that were identified as having occurred during a 20-year period and describe the clinical and lesion features associated with this rare phenomenon. We present the first detailed histological study of a spontaneously thrombosed AVM specimen, including immunohistochemical analysis of angiogenesis factor expression. METHODS: A combined experience in the management of approximately 700 AVMs during 20 years identified six cases of spontaneous angiographic obliteration of cerebral AVMs. A literature review revealed another 24 cases with angiographic documentation of the initial AVMs and follow-up data showing nonfilling of the lesions. Histological analysis of a recently excised lesion included immunostaining with monoclonal antibodies to the antigens of Factor VIII, Tie, vascular endothelial growth factor, and its receptors, Flt-1 and Flk. RESULTS: A single draining vein was a feature in each of our 6 cases and in 12 of 14 (86%) cases from the literature. Hemorrhage as the presenting symptom was identified in 5 of our 6 (83%) cases and in 17 of 24 (71%) of the literature cases. The size of the AVM was less than 6 cm in each of our 6 cases and in 22 of 24 (92%) of the literature cases. A histological examination of a thrombosed AVM surgical specimen revealed persistent patent vascular channels within the lesion. Immunohistochemical analysis with angiogenesis and endothelia-specific factors showed expression of these factors within the lumen of the thrombosed nidus vessels. CONCLUSION: We propose that the occlusion of a single draining vein may lead to total venous outflow obstruction and lesion thrombosis. Hemorrhagic presentation and small nidus may also predispose to this phenomenon. Immunohistochemical analysis of a thrombosed AVM revealed possible ongoing angiogenic changes within the AVM vessels 1 month after angiographically documented thrombosis. It is possible that neovascularization within a thrombosed AVM may lead to lesion recanalization; however, this phenomenon seems to be clinically exceedingly rare.

Helicobacter pylori Infection in Endoscopic Biopsy Specimens of Gastric Antrum: Laboratory Diagnosis and Comparative Efficacy of Three Diagnostic Tests.

Aims and objectives The present study was undertaken to compare the diagnostic yield of three available test procedures for detecting Helicobacter pylori (H. pylori) infection in endoscopic biopsies.Methods H. pylori infection was sought in 150 patients referred for upper gastrointestinal (GI) endoscopy. Multiple (about six) biopsy specimens were taken from pyloric antrum in each patient. Two biopsy specimens were subjected to one minute endoscopy room test - OMERT (a modified form of urease test), two were sent for histopathological analysis, where multiple sections were subjected to Giemsa staining and two were sent for microbiological evaluation after Gram's staining of heat fixed biopsy material.Results H. pylori positivity using histology, microbiology and OMERT was observed to be 33%, 30% and 27% respectively. However, overall 40% patients were infected when the results from three test procedures were combined, as H. pylori positivity was repeated more than once by these procedures separately. Histology was found to be superior to other two tests in our study, especially when multiple sections were examined, for the distribution of the organism was patchy. Amongst the infected, H. pylori was seen in only 30% of all 3-8 sections cut from a biopsy, whereas in 70% it was noted in a single section only.Conclusion The study revealed that histology has the highest detection rate and can be chosen as the "gold standard" amongst the three low cost test procedures available at present in our setup.

Prevalence of Helicobacter pylori Infection in Peptic Ulcer Patients of Highly Endemic Kashmir Valley.

Objective This study aimed to find out prevalence of Helicobacter pylori (H. pylori) in peptic ulcer disease (PUD) which is highly endemic disease in Kashmir.Method This study consisted of 50 PUD patients and 30 asymptomatic volunteers. Peptic ulcer was diagnosed by endoscopic examination and H. pylori was detected by histology (using Giemsa stain), one minute endoscopy room test (OMERT) and modified Gram's staining. Positive results from OMERT plus histology were considered as the "gold standard" for the presence of H. pylori.Results Out of 50 patients, 46 had duodenal ulcer (DU), 2 had benign gastric ulcer (GU) and 2 had both DU and GU. The sensitivity and specificity of OMERT were 94% and 96.70%, histology 97.90% and 96.90% and Gram's staining 91.30% and 85.30%, respectively, as compared to our gold standards. H. pylori was present in 76.09% of DU, 50% of GU, whereas patients with duodenitis, channel ulcers, chronic active DU and those with multiple ulcers were 100% H. pylori positive. H. pylori was present in 10 (33.33%) of healthy volunteers.Conclusion A significant association between H. pylori infection and PUD was found in this study. However, there seem to be other causative factors as well which contribute for this highly endemic disease.

High serum calcium in human brucellosis: a case-control study.

In a retrospective case-control study of 58 cases of human brucellosis, adjusted mean serum calcium levels were found to be significantly higher in patients with brucellosis compared with controls: mean (95% confidence interval) = 2.39 (2.35-2.42) mmol/L versus 2.30 (2.26-2.34) mmol/L (P = 0.0012). The possible mechanisms underlying the cause of hypercalcemia in human brucellosis are discussed.

Early clinical response to different therapeutic regimens for human brucellosis.

Seventy-three cases of acute brucellosis were studied in relation to fever duration and hospital stay following different drug combinations, including gentamicin plus cotrimoxazole, rifampicin plus doxycycline, rifampicin plus cotrimoxazole, rifampicin plus tetracycline, streptomycin plus doxycycline, doxycycline plus cotrimoxazole, tetracycline plus cotrimoxazole, and tetracycline plus streptomycin. No statistical significant difference was found between these combinations regarding early clinical response in human brucellosis.

Clinical aspects of malaria in the Asir Region, Saudi Arabia.

Three hundred and thirty-four cases of confirmed malaria seen in the Asir Central Hospital, Abha, in southwestern Saudi Arabia, were studied retrospectively. Two hundred and eighty-two of these (84.4%) were Saudis and the majority (72.2%) were living in the lowlands of Tihama. Transmission was found to occur throughout the year, with peaks following the rainy season and in the summer. In Saudis, falciparum malaria is more common than vivax (97.2% vs. 2.8%), while vivax malaria is more commonly seen in expatriates (46.2%). Poor response of falciparum malaria to chloroquine was more prevalent in expatriates than in Saudis (46.4% vs. 23%). Most of the expatriates gave a history of recent travel to countries known to be endemic with resistant malaria. The possibility of the emergence of chloroquine-resistant malaria in the southwestern region of Saudi Arabia was discussed.