Paraplegia due to aspergillosis. Successful conservative treatment of two cases

Aspergillus infection of the spine is rare; for it to lead to paraplegia is still more rare. When this does occur it is usually treated by decompression and antifungal agents, but the results have usually been poor. We report two cases of successful conservative treatment of Aspergillus paraplegia in patients with chronic granulomatous disease.     

Survival rates after enucleation of eyes with malignant melanoma.

We investigated the rates of mortality for several types of malignant melanomas for evidence that surgery accelerates metastasis. Additionally, we reanalyzed uveal melanoma survival rates from the Armed Forces Institute of Pathology. Our computations showed higher death rates in years two to five after diagnosis than in years one or six to ten. The same pattern of a peak mortality in the early years after diagnosis and lower rates six to ten years thereafter was seen in all tumor types studied. Our analysis of survival rates produced no evidence to alter the existing pattern of treatment for malignant melanoma of the uvea.     

Neuropeptide Y: Role in light-dark cycle entrainment of hamster circadian rhythms

Microinjection of neuropeptide Y (NPY) into the suprachiasmatic region of the hypothalamus (SCN) phase shifted the circadian activity rhythm of hamsters housed in constant light. NPY advanced the phase when injected during the 12 h that preceded the daily onset of activity and tended to phase delay the activity cycle when injected during the 12 h after activity onset. In contrast, injection of saline into the SCN or NPY into the ventricular system had no effect on circadian phase. These and other data suggest that NPY functions as a chemical messenger important for the light-dark cycle entrainment of circadian rhythms.     

Scale for assessing quality of life of children survivors of cranial posterior fossa tumors

Background Evaluation of quality of life of survivors of brain tumors is an important aspect of outcome that must be included in clinical studies.Methods We have developed a new scale for assessing quality of life (QL) of pediatric long-term survivors of posterior fossa tumors based on their physical, psychointellectual, and endocrine/growth status. We have studied 39 patients, with a median follow-up of 9 years. Twenty-five had cerebellar astrocytoma (CA), 6 medulloblastoma (MDB), 5 brain-stem glioma (BSG) and 3 ependymoma of IV ventricle (EPD).Results Sixty-six percent of children showed neurologic and/or visual sequelae. Little or no significant disability (Bloom's levels I–II) were present in 66%. Psychointellectual dysfunction was present in 44%, with an IQ < 90 in 39%. Endocrine and growth disorders were found in 26%, mostly stature anomalies. According to our scale, QL scores were high in 19 patients (49%), intermediate in 8 (20%), and low in the remaining 12 (31%). Unfavourable outcomes were related to age of less than 4 years, tumors other than CA (MDB, BSG, EPD), incomplete tumoral resection, and employment of radiotherapy and chemotherapy.     

NATIONAL TUBERCULOSIS CONTROL STRATEGY IN THE POST HIV PERIOD

The tuberculosis situation in the country is a matter of great concern since the disease has not been contained. The problem has been further compounded by the emerging problem of HIV infection in the country together with development of multi-resistant tubercle bacilli. There is, therefore, a need to change our National Tuberculosis Control Strategy without disturbing the basic infrastructure of the National Tuberculosis Programme. Changes such as reinforcement of the District Tuberculosis Centre, HIV and drug sensitivity testing, giving up of long term chemotherapy, BCG vaccination policy, chemoprophylaxis policy and involvement of Non-Governmental Organisations and general practitioners are suggested.KEY WORDS: Human immunodeficiency virus, TuberculosisDespite existence of the National Tuberculosis Programme for over 3 decades, the situation of tuberculosis is grim in the country. Tuberculosis is responsible for 500,000 deaths annually in India [1]. According to an estimate, there were 10 million radiologically active cases of pulmonary tuberculosis in India in 1981 of which 2.5 million were infectious and as many as 50% people in India are infected by tubercle bacilli although they may appear healthy [2]. As per the estimates, there are more than 4 million people, mostly in developing countries, who have been infected with both HIV and tuberculosis [3]. HIV infection, by progressively impairing cell mediated immunity, appears to be the highest risk factor for reactivation of tuberculosis into an active disease [4]. It is a well known fact that HIV infection is spreading unabated throughout the length and breadth of the country and as per the estimates, by 2000 AD, 400,000 HIV infections will have occurred in the country. Thus tuberculosis can be considered as the most important candidate as an opportunistic infection in HIV infected individuals in the country. There is every possibility of the problem being compounded by infections or reinfections occurring with multi-drug resistant strains of tubercule bacilli [5]. As it is, the problem of drug resistant strains throughout the country remains unmapped and any emergence of such new strains may lead to their spread both among HIV infected persons as well as the general population. In such a complicated scenario it has become imperative to take a second look at our National Tuberculosis Programme and make changes consistent with the emerging problems. Suggested changes are as following: