Dissection of the intracranial internal carotid artery producing isolated oculomotor nerve palsy with sparing of pupil

Dissection of the internal carotid artery usually occurs in the cervical segment, but rarely may involve the artery in the intracranial course (1). The clinical course of intracranial dissection is often catastrophic, with rapid onset of profound neurological deficit, as a result of middle and/or anterior cerebral artery involvement. When this occurs the mortality rate is generally considered high. We describe a case of intracranial internal carotid artery dissection following trivial trauma presented with an isolated painful pupillary sparing oculomotor nerve palsy.     

Benign lesions of larynx—A clinical study

Objective  A climical study was undertaken to analyze the age, sex distribution and symptomatology, sites of involvement and the prognosis of the common types of benign lesions of larynx. Study Design  A five year retrospective study from 1997 to 2002. Setting  KMC Hospital Attavar —A tertiary referral hospital. Patients  A total of 42 patients with benign laryngeal lesions were included based on symptomatology such as hoarseness of voice, foreign body sensation, throat pain, neck mass and cough and with positive clinical findings on indirect laryngoscopy and neck examination. The patients ranged from 7–80 years. All non-operative cases and malignant cases were excluded. Diagnostic hematological and radiological investigations and therapeutic microlyryngoscopic procedures were employed. Results  A male preponderance with M:F ratio of 3∶1 was observed. Majority of the patients were in the 30–40 age group. Vocal polyps were the commonest type of lesion. In our study, hoarseness of voice, cough, foreign body sensation and throat pain proved to be the commonest symptoms. Conclusions  Micro laryngeal surgery and voice rest offer a cost effective, useful and safe method for management of benign laryngeal lesions.     

Juvenile nasopharyngeal angiofibromas: A study of recurrence pattern and role of pre-Operative embolization - ‘a decade’S experience’

This study is a retrospective analysis of 30 consecutive cases of Juvenile Nasopharyngeal Angiofibroma (JXA) operated at. Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology Bangalore, India: la tertiary referral centre) after prior emohilization by an interventional neuro-radiologisl (1996-2002). This study discusses critically the planning of surgical approach, based on anatomico-radiological factors and highlights the efficacy of preoperalive embolization in expediting total re moral of the tumor in 25 out of JO cases with advanced stage JNA. Objectives: To analyze the utility of pre-operatire embolisation in surgical extirpation of large JNAs; planning of the surgical approaches based on CT topography of the tumor; to study the various complications of embolisation and surgery associated with JXA & lastly to evaluate the puttern and location of recurrent tumor thus correlating with the original topography. Setting: Tertiary care cancer referral centre. Patients: Patients ranged in age from ’)- 24 years. all being males. Interventions: Majority of them were accessed by transfacial surgical approach(26). and in the recent past via midfacial degloving(4) within 4H hours of angioembolisation. Results: Complete removal of the tumor was achieved in 25 out of 30 cases with advanced stage JNA. Post surgical CT scans revealed tumor residua in 5 individuals, where the tumor was documented in - the temporal fossa 12), para-cavernous sinus region (I), cavernous sinus! I) and pterygo palatine fossa (I). Only the lesion in pterygopalaline fossa was successfully re-i>xcised & this alongwith the recurrence at para-cavernous & cavernous sinus & another were treated with radiotherapy; the 2 cases in the temporal fossa are under observation. The average blood loss during the procedure was 546.60 ml. Conclusions: Today, advances in radiologie imaging-complemented by interventional neuro-radiological expertise in angio-embolisation have expedited complète excision with minimal morbidity and acceptable recurrence rate. This study has justified pre-operative embolisation and M currently the standard of care for advanced JXA.     

Utilizing optical tomography with ultrasound localization to image heterogeneous hemoglobin distribution in large breast cancers

PURPOSE: Angiogenesis in advanced breast cancers is highly distorted and heterogeneous. Noninvasive imaging that can monitor angiogenesis may be invaluable initially for diagnosis and then for assessing tumor response to treatment. By combining ultrasound (US) and near-infrared (NIR) optical imaging, a reliable new technique has emerged for localizing and characterizing tumor angiogenesis within the breast. METHODS: This new technique employs a commercial US transducer coupled with an array of NIR optical fibers mounted on a hand-held probe. The US image is used for lesion localization and for guiding optical imaging reconstruction. Optical sensors are used for imaging tumor total hemoglobin distribution, which is directly related to tumor angiogenesis. RESULTS: Six large breast carcinomas were studied and microvessel density count was then performed on tissue samples obtained from these cancers. Two patients had locally advanced breast cancers and received neoadjuvant chemotherapy for 3 months. In one patient, before chemotherapy, the total hemoglobin distribution showed a high concentration at the cancer periphery; the distribution was later confined to the core area after 3 months of treatment. In another patient, as treatment progressed, the maximum hemoglobin concentration decreased from 255.3, to 147.5, to 76.9 micromol/l with an associated reduction in spatial extension. The other four patients had cancers of 2.0 to 3.0 cm in size and were imaged either at the time of core biopsy or definitive surgery. The histologic microvessel density counts from these tumor samples correlate to hemoglobin distributions with a correlation coefficient of 0.64 (P < .05). CONCLUSION: These initial results suggest that this new imaging technique may have great potential in imaging the heterogeneous vascular distribution of larger breast cancers in vivo and in monitoring treatment-related changes in angiogenesis during chemotherapy.     

Comparative study of perioperative infusion of diltiazem and nicorandil on myocardial protection during OPCAB surgery

We compared the effects of continuous intravenous infusions of nicorandil and diltiazem on left ventricular function, haemodynamics and as anti-ischaemic and anti-arrhythmic agents in 50 patients undergoing off pump coronary artery bypass surgery using arterial conduits. The patients were randomized into two equal groups to receive diltiazem or nicorandil. Both the drugs were given as a continuous infusion in the dose of 1microg/kg/min starting at induction and continued for 24 hours postoperatively. Haemodynamic parameters, cardiac enzyme levels and use of vasoactive agents were studied and compared using ANOVA, unpaired "t" and Fisher's exact tests. The two groups did not differ with respect to preoperative and operative data. Diltiazem group showed lower cardiac index (2.66+/-0.8 and 2.27+/-0.89 L/min/m2) as compared with nicorandil group (3.16+/-0.79 and 2.97+/-1.01 L/min/m2) during revascularisation of anterior (P=0.03) and inferior (P=0.01) circulation respectively. The systemic vascular resistance index was higher (2290+/-699 and 2545+/-911 dync.sec.cm-5.m2) in diltiazem group as compared with nicorandil group (1822+/-532 and 1877+/-548 dyne. sec.cm-5.m2) during revascularization of anterior (P=0.01) and inferior (P=0.002) circulation respectively. The mean pulmonary artery pressure was significantly higher in nicorandil group as compared with diltiazem group during revascularisation of anterior circulation (22.5+/-4.9 and 18.1+/-6.8 mmHg, P=0.01). The patients in the diltiazem group maintained a lower heart rate throughout the study period, but the difference was not statistically significant. None of the patients exhibited any arrhythmia except one in nicorandil group, who developed supraventricular arrhythmia 24 hours postoperatively. Cardiac enzyme levels were found to be similar in the two groups. The present study demonstrates that the anti-ischemic and antiarrythmic effects of diltiazem and nicorandil are comparable, but diltiazem causes a decrease in cardiac index and increase in systemic vascular resistance index during revascularization of anterior and inferior circulation.     

Endogenous human cytomegalovirus gB is presented efficiently by MHC class II molecules to CD4+ CTL

Human cytomegalovirus (HCMV) infects endothelial, epithelial, and glial cells in vivo. These cells can express MHC class II proteins, but are unlikely to play important roles in priming host immunity. Instead, it seems that class II presentation of endogenous HCMV antigens in these cells allows recognition of virus infection. We characterized class II presentation of HCMV glycoprotein B (gB), a membrane protein that accumulates extensively in endosomes during virus assembly. Human CD4+ T cells specific for gB were both highly abundant in blood and cytolytic in vivo. gB-specific CD4+ T cell clones recognized gB that was expressed in glial, endothelial, and epithelial cells, but not exogenous gB that was fed to these cells. Glial cells efficiently presented extremely low levels of endogenous gB--expressed by adenovirus vectors or after HCMV infection--and stimulated CD4+ T cells better than DCs that were incubated with exogenous gB. Presentation of endogenous gB required sorting of gB to endosomal compartments and processing by acidic proteases. Although presentation of cellular proteins that traffic into endosomes is well known, our observations demonstrate for the first time that a viral protein sorted to endosomes is presented exceptionally well, and can promote CD4+ T cell recognition and killing of biologically important host cells.