Successful selection of patients with intractable extratemporal epilepsy using non-invasive investigations

PURPOSE: Patients with intractable epilepsy, operated for extratemporal epileptogenic foci, have often been found to have poorer surgical outcome compared with those with temporal lobe foci. The objective of this study is to assess the surgical outcome in patients with extratemporal foci, operated at the All India Institute of Medical Sciences (AIIMS), New Delhi. METHODS: Patients of intractable epilepsy with extratemporal foci on detailed investigation constituted the study group. They were evaluated by the 'Comprehensive Epilepsy Care Team' at the AIIMS with detailed clinical assessment, interictal EEGs, video-EEG studies, magnetic resonance imaging (MRI) with special sequences tailored for evaluation of the temporal lobes and for cortical dysplasias and single photon emission computerised tomography (SPECT) studies. Intraoperative electrocorticography was obtained in some patients. Outcome was assessed on follow-up, and graded according to Modified Engel's Grading System. RESULTS: Twenty-five patients (18 males, 7 females) with a mean age of 19.7 years (age range 7-45 years) were operated and assessed during the study period, for surgical outcome with a mean follow-up of 16.8 months (range 3 months to 6.5 years). Twenty patients (87%) were found to have a good outcome (Modified Engel's grades I and II), while three had poor outcome, one died and one was lost to follow-up. CONCLUSION: We found a good seizure outcome in patients who underwent resection of extratemporal epileptogenic foci, one of the reasons being presence of a lesion in all patients. Careful patient selection even with non-invasive investigations can aid in obtaining a good outcome in this group of patients.     

Cushing's disease: Pituitary imaging

Fourteen patients with adrenocorticotropic hormone (ACTH)-dependent hypercortisolism underwent pituitary scanning with computed axial tomography (CT) and magnetic resonance imaging (MRI). Computed tomography revealed pituitary macroadenomas in two patients, pituitary hyperplasia in one and a suspicion of pituitary microadenoma in one. Thirteen patients underwent MRI. One with a macroadenoma diagnosed on CT did not undergo MRI. The MRI revealed a pituitary macroadenoma in one, microadenoma in three and hyperplasia in two cases. Magnetic resonance imaging following gadolinium diethylene triamine penta acetic acid (gd-DTPA) enhancement revealed four more pituitary microadenomas. All patients who had pituitary adenomas (micro and macro) and hyperplasia underwent trans-sphenoidal pituitary surgery. One of the two patients, who had an enlarged pituitary on imaging but no demonstrable adenoma, was found to have a microadenoma at surgery. Patients with ACTH-dependent hypercortisolism should undergo MRI of the pituitary gland to identify/localize corticotroph pituitary adenomas. The study should include gd-DTPA enhancement in cases where the scan is normal.     

The Impact of Sociodemographic and Socioeconomic Factors on the Burden of Cataract in Small Island Developing States (SIDS) in the Caribbean from 1990 to 2016

ABSTRACT

Purpose

To study the impact of sociodemographic and socioeconomic factors on the cataract burden in Caribbean small island developing states (SIDS) using disability-adjusted life-years (DALYs).     

CORD BLOOD HAEMOGLOBIN, IRON AND FERRITIN STATUS IN MATERNAL ANAEMIA

ABSTRACT. Maternal and cord blood haemoglobin, serum iron, transferrin saturation and ferritin were studied in sets of 30 anaemic (haemoglobin <110 g/l) and 21 nonanaemic (haemoglobin ≧110 g/l) mothers. The cord serum iron, transferrin saturation and ferritin concentrations had significant correlation with maternal haemoglobin. The significant low levels of these parameters suggested that maternal anaemia adversely affected the iron status including iron stores of the newborns. The cord serum iron of 15.2±4.35 μmol/l and ferritin of 29.7±10.93 ng/ml seem to be effective to maintain cord haemoglobin levels. Thus, anaemic mothers with reasonably maintained ferritin and trasferrin saturation levels provide sufficient iron for maintenance of cord haemoglobin, although foetal iron stores are likely to be depleted.     

FAMILIAL ATAXIC DIPLEGIA

Abstract. Subrahmanyam, G., Tripathi, A. M. and Agarwal, K. N. (Department of Paediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India). Familial ataxic diplegia. Acta Paediatr Scand, 63: 472, 1974.–A family with ataxic diplegia, mental and physical growth retardation in two generations is presented. The disease was limited to male members, suggesting a sex-linked transmission.     

MILITANCY TRAUMA : PENETRATING AND NONPENETRATING CARDIAC INJURY

Two hundred and eighty patients with serious chest injuries were treated at a service hospital during a period of 41 months. Out of 9 patients who suffered cardiac trauma S had penetrating cardiac injuries, 2 had penetrating pericardial injury and 2 patients had myocardial contusions. Myocardial contusions simulated myocardial infarction. All patients except one had polytrauma, associated injury to the lung or intra-abdominal organs. Early evacuation, resuscitation, high index of suspicion for cardiac injury and prompt surgical intervention were the keys to successful management in these patients. Thoracotomy was performed to repair the myocardial perforation and lacerated lung injuries. Associated infra-abdominal injuries were managed with laparotomy. Two patients died due to lack of cardiopulmonary bypass facilities and resistant cardiac arrhythmias. Seven patients had uneventful recovery.KEY WORDS: Heart injuries, Thoracic injuries, Traumatology, Wounds, gunshot, Wounds, nonpenetrating, Wounds, penetrating     

Bacteriology of the Cervix in Cases of Infertility: Effect on Human and Animal Spermatozoa and Role of Elastase

ABSTRACT: Microorganisms such as Bacillus subtilis, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans isolated from cervices of infertile human females inhibited motility and agglutinated human, cow bull, buffalo bull, and rat spermatozoa in vitro. Fifty percent of the infertile females studied carried elastase-positive microorganisms. Cell-free culture supernatants of 72-hr-old elastase-positive cultures were spermicidal within 60 min of contact with sperm, while elastase-negative cultures were spermicidal in 4–6 hr. Cultures of all the cervical isolates were spermicidal and agglutinated human, cow bull, buffalo bull, and rat spermatozoa, and these activities increased with age of the culture. Human sperm showed only tail-to-tail agglutination, while cow bull, buffalo bull, and rat spermatozoa showed mainly head-to-head agglutination. Spermicidal activity was also attributable to elastase, which was present more in 72-hr-old cultures than in 24-hr-old cultures.     

Bacteriology of Cervix in Cases of Infertility: Effect on Human Sperm

ABSTRACT: Microorganisms such as Escherichia coli, Pseudomonas aeruginosa, and Bacillus subtilis isolated from cervices of infertile females possessed spermicidal activity. They also agglutinated the human spermatozoa in vitro and showed tail-to-tail agglutination. Cell-free supernatant of these organisms was found to be spermicidal but did not agglutinate spermatozoa in vitro. Spermicidal activity was increased with increase in age of the culture.