Randomized prospective study of outcome of short term antiepileptic treatment in small single enhancing CT lesion in brain

The study was conducted in 81 patients of epilepsy with small single enhancing CT (SSECT) lesion in brain to determine the clinical profile and duration of antiepileptic drugs (AEDs) treatment. The patients were randomly divided into group A (41 cases) and group B (40 cases). Group A patients were treated for 6 months and group B for 1 year with AEDS without cysticidal drugs. The most common mode of presentation was simple partial motor seizures with secondary generalization in both the groups. Repeat imaging of brain (CT/MRI) at 6 months showed disappearance of lesion in 82.94% in group A and 87% in group B, while persistence of lesion was present only in 4.87% in group A and 5% in group B. 87.81% patients in group A and 87.17% in group B were seizure free. The recurrence of seizure occurred in 12.19% cases in group A, and 12.82% in group B. 80% of these patients had calcified lesion in both the groups. This study reveals that SSECT lesion with epilpesy is a benign self-limiting disease. It also reveals that 6 months AED treatment is as effective as one year treatment. Patients having calcified lesion or persistence of lesion might require long term AED treatment.     

Pakistan National Diabetes Survey: Prevalence of Glucose Intolerance and Associated Factors in Shikarpur,Sindh Province

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and their relationship to age and obesity was estimated in the rural town of Shikarpur in Sindh Province, Pakistan by a population-based survey in 1994. Oral glucose tolerance tests were performed in a stratified random sample of 967 adults (387 men, 580 women) aged 25 years and above. The diagnoses of diabetes and IGT were made on the basis of WHO criteria. The response rate was 71% for men and 80% for women. The prevalence of diabetes was 16.2% (9.0% known, 7.2% newly diagnosed) in men, and 11.7% (6.3% known, 5.3% newly diagnosed) in women. The prevalence rose with age to a peak of 30% and 21% in 65–74 year-old men and women respectively. IGT was detected in 8.2% of men and 14.3% of women. Thus, total glucose intolerance (diabetes and IGT combined) was present in 25% of subjects examined. These results indicate that glucose intolerance in South Asians can no longer be regarded as a problem confined to migrant communities. Of the 72 subjects previously known to have diabetes, none was using insulin treatment, but 57 (79%) took oral hypoglycaemic agents. Central obesity and positive family history were strongly associated with diabetes, as was prevalence of hypertension. The association with central obesity was greater for women than for men, and suggests important, modifiable risk factor(s) related to lifestyle.     

Surgical treatment of thoracic empyema in HIV-infected patients: severity and treatment modality is associated with CD4 count status

OBJECTIVES: Patients infected with HIV have an increased propensity for developing thoracic empyemas secondary to their susceptibility to polymicrobial pulmonary infections. We performed an assessment of the clinical outcomes of HIV patients undergoing surgical treatment of thoracic empyemas and reviewed the microbiology of these infections. METHODS: We completed a retrospective analysis of the patients who had been referred for surgical treatment of thoracic empyemas over an 11-year period, ending in 2002. The patients were treated at a major metropolitan medical teaching facility that cares for a substantial number of HIV-positive patients. RESULTS: Twenty-one HIV-infected patients underwent surgical treatment of thoracic empyemas. There were no immediate deaths. Sixty-two percent of the patients had CD4 counts of < 200 cells/microL. Eight patients had postoperative complications. Six of the patients with complications had CD4 counts of < 200 cells/microL. Patients with lower CD4 counts were at risk for mycobacterial and fungal infections. Additionally, they often had complex empyemas that were not favorable for treatment by video-assisted thoracic surgery. Therefore, these patients often required surgery with lung resection, which necessitated longer periods of postoperative chest tube drainage. CONCLUSIONS: Surgeons can obtain satisfactory operative outcomes when treating thoracic empyemas in HIV patients; however, the treatment strategy should be individualized. Patients with CD4 counts of < 200 cells/microL more commonly have complex empyemas that require surgery with open decortication and drainage. Although these patients have a higher incidence of postoperative complications, we think that HIV patients with thoracic empyemas can be safely and effectively treated with surgical techniques.     

Congenital diaphragmatic eventration associated with massive hiatal hernia

Congenital eventration of the diaphragm is uncommon. Its association with a hiatal hernia has not been reported earlier. We report a case of such an association in a 2-month-old boy who presented with tachypnea aggravated by feeding and recurrent vomiting. Diagnostic uncertainty and a unique course of postoperative recovery complicated by gastric volvulus are described. The patient underwent surgical plication of the right diaphragm, followed by an emergency hiatal repair on the first postoperative day. Timely recognition, and repair of the hiatal hernia averted a fatal complication.     

Second branchial cleft anomaly presenting as a rudimentary pinna in the nasopharynx of a newborn

We describe the case of a 4-day-old girl who presented with an epiglottic cyst that was later identified as a rudimentary pinna attached to the soft palate.     

Ibuprofen inhibits survival of bladder cancer cells by induced expression of the p75NTR tumor suppressor protein

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and as analgesics by inhibition of cyclooxygenase-2. At higher concentrations, some NSAIDs inhibit proliferation and induce apoptosis of cancer cells. Although several molecular mechanisms have been postulated to explain the anticancer effects of NSAIDs, they do not involve merely the inhibition of cyclooxygenase-2, and a more proximate initiator molecule may be regulated by NSAIDs to inhibit growth. The p75 neurotrophin receptor (p75NTR) is a proximate cell membrane receptor glycoprotein that has been identified as a tumor and metastasis suppressor. We observed that NSAID treatment of cell lines from bladder and other organs induced expression of the p75NTR protein. Of the different types of NSAIDs examined, ibuprofen was more efficacious than aspirin and acetaminophen and comparable with (R)-flurbiprofen and indomethacin in induction of p75NTR protein expression. This rank order NSAID induction of the p75NTR protein correlated with the ability of these NSAIDs to reduce cancer cell survival. To examine a mechanistic relationship between ibuprofen induction of p75NTR protein and inhibition of survival, bladder cancer cells were transfected with ponasterone A-inducible vectors that expressed a death domain-deleted (DeltaDD) or intracellular domain-deleted (DeltaICD) p75NTR product that acts as a dominant negative antagonist of the intact p75NTR protein. Expression of DeltaDD and DeltaICD rescued cells from ibuprofen inhibition of growth. These observations suggest that p75NTR is an important upstream modulator of the anticancer effects of NSAIDs and that ibuprofen induction of the p75NTR protein establishes an alternate mechanism by which ibuprofen may exert an anticancer effect.     

General anesthesia occurs frequently in elderly patients during propofol-based sedation and spinal anesthesia

Study ObjectiveTo test the hypothesis that sedation in elderly patients is often electrophysiologically equivalent to general anesthesia (GA).DesignProspective, observational study.SettingOperating room of a university medical center.Patients40 elderly patients (≥65 yrs of age) undergoing hip fracture repair with spinal anesthesia and propofol-based sedation.InterventionsIn the routine practice group (RP; n = 15), propofol sedation was administered per the usual routine of the anesthesiologist. In the targeted sedation group (TS; n = 25), sedation was titrated to an observer's assessment of alertness/sedation (OAA/S) score of 4 (ie, lethargic in response to name called) to 5 (ie, awake and alert).MeasurementsBoth patient groups underwent processed electroencephalographic monitoring using bispectral index (BIS) intraoperatively. BIS levels were compared between groups to determine amount of surgical time spent in GA (BIS ≤ 60).Main ResultsIn the RP group, subjects spent 32.2% of surgical time at BIS levels consistent with GA. Although averaged BIS values during surgery increased from (mean ± SD) 71 ± 16 to 88 ± 9 (P < 0.001), GA was still observed during 5% of surgical time in the TS group. Overall, 13 of 15 (87%) RP group patients and 11 of 25 (44%) TS group patients (P < 0.010) experienced some period of GA.ConclusionsBIS levels consistent with GA occur frequently in elderly patients during propofol-based sedation for spinal anesthesia. Altering routine practice such that sedation is titrated to a targeted clinically-determined sedation level reduces – but does not eliminate – this incidence.