Effect of surgical delay on perioperative complications and need for open reduction in supracondylar humerus fractures in children

This retrospective study examined whether a delay of greater than 12 hours is associated with an increased risk of perioperative complications in the operative treatment of supracondylar humerus fractures in children. Of 150 consecutive children with supracondylar fractures, 50 underwent surgery in less than 12 hours and 100 underwent surgery greater than 12 hours after injury. There was no significant difference between groups in rate of open reduction (P = 0.55), pin tract infection (P = 1.0), iatrogenic nerve injury (P = 1.0), vascular complication (P = 0.33), or compartment syndrome (P = 1.0), including when Gartland type III fractures were analyzed independently. There was no iatrogenic nerve injury, no compartment syndrome, and one pin tract infection in 150 patients. The study confirms previous retrospective studies finding no significant difference in perioperative complications or rate of open reduction in children undergoing early versus delayed surgical treatment of supracondylar humerus fractures.     

Low prevalence of restless legs syndrome in patients with advanced chronic renal failure in the Indian population: a case controlled study

BACKGROUND: Restless legs syndrome (RLS) is reported to occur in 20-70% of uremic patients. There is no study from India regarding the prevalence of RLS in chronic renal failure (CRF) patients. Studies from other Asian countries have shown a much lower prevalence compared to the West. This study investigated the prevalence of RLS in patients with advanced CRF in the Indian population. Patients and METHODS: Sixty-five CRF patients and 99 controls were evaluated using a predesigned standard questionnaire. The control group consisted of prospective renal donors. RESULTS: The mean age of our patients was 42.4 +/- 14.9 years as compared to 43.7 +/- 11.2 years (p = NS). The distribution of cause of CRF was as follows: diabetes 38.5%, hypertension 13.9%, chronic interstitial nephritis 29.2% and chronic glomerulonephritis 18.4%. RLS was present in 1 patient (1.5%) and none of the controls. CONCLUSION: The prevalence of RLS in CRF patients in India is very low as compared to the Western population.     

High-resolution computed tomography of temporal bone: Part IV: Coronal postoperative anatomy

The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200 micro isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this, the fourth part, and the third part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same coronal (article IV) and axial (article III) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.     

Sleep disorders in children with cerebral palsy and its correlation with sleep disturbance in primary caregivers and other associated factors

Aims:

To observe prevalence of sleep disturbance (SD) in cerebral palsy (CP) children in a specific age-group and its correlation with SD in primary caregivers and other associated factors.

Materials and Methods:

This was a prospective cross-sectional study. SD assessed using Sleep Disturbance Scale for Children (SDSC) in CP children and Pittsburgh Sleep Quality Index (PSQI) in caregivers. Fifty cases of clinically diagnosed CP [27 females, mean age: 107.9 ΁ 29.5 months (range: 78-180 months)] fulfilling criteria were included.

Results:

Eighteen (36%) children had pathological sleep total score (TS) and Disorders of Initiating and Maintaining Sleep (DIMS) was the commonest SD (n = 25, 50%). All primary caregivers were mothers. Twenty-five (50%) mothers had SD on PSQI scale. DIMS, Disorders of Excessive Somnolence (DES), and TS had significant correlation with PSQI (P < 0.05). Disorders of Arousal (DA) and TS had significant correlation with seizures (P < 0.05) in CP children. Bed-sharing had significant correlation with SD in caregivers (P < 0.001) but not with CP children. No significant correlation was observed between SD in CP and gross motor function (Gross Motor Function Classification System), use of orthoses, and dental caries.

Interpretation:

Children with CP have underreported significant SD, which negatively impacts caregiver''s sleep also. Seizure disorders and medications contribute significantly to SD.     

Converging early responses to brain injury pave the road to epileptogenesis

Epilepsy, characterized by recurrent seizures and abnormal electrical activity in the brain, is one of the most prevalent brain disorders. Over two million people in the United States have been diagnosed with epilepsy and 3% of the general population will be diagnosed with it at some point in their lives. While most developmental epilepsies occur due to genetic predisposition, a class of “acquired” epilepsies results from a variety of brain insults. A leading etiological factor for epilepsy that is currently on the rise is traumatic brain injury (TBI), which accounts for up to 20% of all symptomatic epilepsies. Remarkably, the presence of an identified early insult that constitutes a risk for development of epilepsy provides a therapeutic window in which the pathological processes associated with brain injury can be manipulated to limit the subsequent development of recurrent seizure activity and epilepsy. Recent studies have revealed diverse pathologies, including enhanced excitability, activated immune signaling, cell death, and enhanced neurogenesis within a week after injury, suggesting a period of heightened adaptive and maladaptive plasticity. An integrated understanding of these processes and their cellular and molecular underpinnings could lead to novel targets to arrest epileptogenesis after trauma. This review attempts to highlight and relate the diverse early changes after trauma and their role in development of epilepsy and suggests potential strategies to limit neurological complications in the injured brain.     

Surgical management of giant intracranial aneurysms

OBJECTIVES: The natural history of giant intracranial aneurysms is generally morbid. Mortality and morbidity associated with giant aneurysms is also higher than for smaller aneurysms. This study was carried out to assess the demographic profile, presenting features, complications, and outcome after surgical treatment of giant intracranial aneurysms. PATIENTS AND METHODS: A retrospective review of the medical records of all patients with giant intracranial aneurysms treated in the Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, from January 1995 through June 2007 was performed. The demographic profiles, presenting features, radiological findings, surgical treatments, and outcomes were assessed. RESULTS: A total of 1412 patients harboring 1675 aneurysms were treated. Out of these, 222 patients had 229 (13.7%) giant aneurysms, and of those, 181 aneurysms in 177 patients were managed surgically while 48 were treated with endovascular therapy. In the patients treated with surgery, common clinical presentations included subarachnoid hemorrhage (SAH) in 110 (62%) cases followed by mass effect in 57 (32%) cases. In patients who presented with SAH, the Hunt and Hess SAH grading was: grade I in 43 (39%), grade II in 40 (36%), grade III in 23 (21%), grade IV in two (2%), and grade V in 2 (2%) patients. One hundred and seven aneurysms (in 103 patients) were treated using direct surgical clipping. Forty-six patients with good collateral circulation were treated by gradual occlusion and ligation of the internal carotid artery (ICA) in the neck with a Silverstone clamp. Another nine patients with good collateral circulation, but persisting symptoms after ICA ligation, required trapping for obliteration of the aneurysm. Eleven patients with poor collateral circulation required extracranial-intracranial (EC-IC) bypass before proximal ICA ligation. A post-operative digital subtraction angiography (DSA) was performed in 118 patients and revealed well-obliterated aneurysm in 106 patients. The total treatment mortality rate was 9%. In the last 5 years, 117 patients were operated on with four operative deaths. Overall, the outcome was excellent in 131 (74.0%), good in 22 (12.4%), and poor in eight (4.5%) cases. CONCLUSIONS: It is concluded that 14% of all intracranial aneurysms are giant. The most common clinical presentation is SAH followed by features of an intracranial mass lesion. The cavernous ICA is the most common portion of the ICA affected. Direct surgical clipping is a safe and effective method of treatment and should be considered the first line of treatment whenever possible. With proper case selection, optimal radiological evaluation, and appropriate surgical strategy, it is possible to achieve a favorable outcome in almost 90% of the cases.     

An Efficient Corpus-Based Stemmer

Word stemming is a linguistic process in which the various inflected word forms are matched to their base form. It is among the basic text pre-processing approaches used in Natural Language Processing and Information Retrieval. Stemming is employed at the text pre-processing stage to solve the issue of vocabulary mismatch or to reduce the size of the word vocabulary, and consequently also the dimensionality of training data for statistical models. In this article, we present a fully unsupervised corpus-based text stemming method which clusters morphologically related words based on lexical knowledge. The proposed method performs cognitive-inspired computing to discover morphologically related words from the corpus without any human intervention or language-specific knowledge. The performance of the proposed method is evaluated in inflection removal (approximating lemmas) and Information Retrieval tasks. The retrieval experiments in four different languages using standard Text Retrieval Conference, Cross-Language Evaluation Forum, and Forum for Information Retrieval Evaluation collections show that the proposed stemming method performs significantly better than no stemming. In the case of highly inflectional languages, Marathi and Hungarian, the improvement in Mean Average Precision is nearly 50% as compared to unstemmed words. Moreover, the proposed unsupervised stemming method outperforms state-of-the-art strong language-independent and rule-based stemming methods in all the languages. Besides Information Retrieval, the proposed stemming method also performs significantly better in inflection removal experiments. The proposed unsupervised language-independent stemming method can be used as a multipurpose tool for various tasks such as the approximation of lemmas, improving retrieval performance or other Natural Language Processing applications.