Biomedical subjects

A K Mahapatra

Publications and source records attributed to A K Mahapatra.

At least 37 records · Page 2Linked to original sources

PubMed2005

Spinal ossifying lipoma.

A case of ossifying spinal lipoma is reported. The patient presented with a large swelling over the lumbar region with a dermal sinus in the centre. Imaging revealed an intradural lipoma connected with a large subcutaneous lipoma in which there was a prominent island of bone. The lipoma was excised and there were no postoperative neurological deficits. To the best of our knowledge, this is the first report of a spinal ossifying lipoma associated with a dermal sinus.

Child↗

PubMed2005

Pediatric pituitary adenoma: a series of 42 patients.

Pituitary adenomas are uncommon in childhood. This report describes the presentation, endocrinological profile, management and outcome of 42 children with pituitary adenomas. The majority of the tumors were functioning adenomas (40/42, 95.2%). Only two patients (4.8%) had non-functioning tumors. Amongst the functioning tumors, there were 20 patients (47.6%) with prolactinomas, 11 patients (26.2%) with Cushing's disease and nine patients (21.4%) with growth hormone (GH)-secreting adenomas. The most common presenting features were endocrinopathy and visual disturbances. The majority of tumors were macroadenomas, with only eight patients (all with Cushing's disease) having a microadenoma. Transsphenoidal tumor decompression was performed in most cases (71.4%). Complications following transcranial surgery were more frequent when compared to transsphenoidal surgery. There was one death following surgery. Response to radiotherapy was satisfactory. Overall, 67.6% of patients achieved endocrinological remission. Of these, 89% of the children with GH-secreting tumors and 100% of the children with Cushing's disease achieved remission. We conclude that the transsphenoidal approach is effective and safe in surgery for pituitary adenomas in children and is the procedure of choice if there is no contraindication. The combination of surgery and radiotherapy, as well as medical therapy with bromocriptine, achieves good results in the management of these uncommon tumors.

Adenoma↗

PubMed2004

Cerebellopointine angle medulloblastoma.

Cerebellopontine angle (CPA) medulloblastoma is a rare tumour. To date, only 19 cases have been reported over a period of 8 years, we have treated 14 cases of CPA medulloblastomas. This is first and the largest series of CPA medulloblastomas reported in the world literature.

Adolescent↗

PubMed2004

Giant mucoceles of the frontal sinus: a series and review.

Giant mucoceles of the frontal sinus are a rare pathology but their recognition is important in the differential diagnosis of paediatric proptosis and fronto-orbital lesions. Four patients with giant mucoceles of the frontal sinus were retrospectively analyzed. All the patients were females in the paediatric age group presenting with massive cosmetically unacceptable bony swelling in the frontal region along with unilateral extra-axial proptosis. Radiological imaging revealed giant mucoceles of the frontal sinus with extracranial, orbital and anterior cranial fossa extension. One patient had co-existent craniofacial fibrous dysplasia. Single stage surgery was performed in three patients and two-stage surgery in one. Fronto-orbital craniotomy, removal of the posterior wall of the sinus, obliteration of the sinus and its ostium, dural repair and remodeling cranioplasty were performed. Histopathological examination revealed mucoceles in all, and co-existant fibrous dysplasia in one patient. All the patients made excellent cosmetic recoveries with complete resolution of their visual symptoms. Their clinical presentation, radiological manifestations and treatment modalities are analyzed and an extensive review of the literature is presented. Our case of giant frontal mucocele associated with fibrous dysplasia is furthermore the first such report in the existing medical literature.

Adolescent↗

PubMed2004

Primary plasma cell granuloma of petrous bone.

Plasma cell granulomas are rare intracranial lesions that can mimic a variety of intracranial tumours. As they are usually benign lesions, their identification assumes importance. We report a case of plasma cell granuloma in a 52-year-old man presenting with features of left sided V, VII and bilateral VIII nerve involvement who underwent subtotal excision of the lesion. The relevant literature is reviewed.

Bone Diseases↗

PubMed2004

Unusual presentation of petro-clival chondrosarcoma: short report.

Skull base chondrosarcoma is a rare neoplasm. Our patient presented with acute onset of diplopia along with symptoms of lower cranial nerve palsies in 1997. She showed complete resolution of symptoms following a short course of antibiotics and remained quiescent for three years. However, remission of symptoms in chondrosarcoma is unusual. An unusual case of a patient with petroclival low grade chondrosarcoma, who presented with relapse of symptoms after three years and was treated with surgery and radiotherapy, is presented.

Adult↗

PubMed2004

Pituitary abscess associated with prolactinoma.

We present a 37-year-old female, who was admitted with a long standing history of menstrual abnormalities and galactorrhoea followed by progressive visual loss. X-ray of the skull showed an enlarged sella with destruction of the floor. CT scan of the head revealed a giant pituitary adenoma with sellar and parasellar extension. At surgery, through a transsphenoidal approach, solid tissue and cystic areas containing pus from which Escherichia coli was cultured were encountered. She had an uneventful postoperative recovery. At 2 years follow up, she was doing well.

Abscess↗

PubMed2004

Superatentorial intracerebral hemorrhage following infratentorial surgery.

Supratentorial hematoma following infratentorial surgery is rare. We present two such patients with remote site supratentorial hematoma after posterior fossa surgery. In one patient, a supratentorial hematoma developed following surgery for an acoustic tumor. The supratentorial hematoma was located near where a supratentorial meningioma was excised five days before. No hematoma was seen on the immediate postoperative CT scan. In another patient there were two tumors, one in the pons and the other in the basal ganglia. This patient developed a basal ganglia hematoma following brain stem surgery. In both the patients, hematological profile revealed a coagulation abnormality following the posterior fossa surgery. Our first case stabilized conservative management, whereas the second required surgical evacuation of the hematoma. The differential diagnosis of declining level of consciousness after posterior fossa surgery must include supratentorial intracerebral hemorrhage and CT scan of the head is the diagnostic test of choice.

Adult↗

PubMed2004

Unusual neuro-ophthalmic presentation of anterior communicating artery aneurysm with third nerve paresis.

Paresis of the oculomotor nerve associated with subarachnoid haemorrhage is considered a hallmark of aneurysms located at the junction of the internal carotid artery and posterior communicating artery. Third nerve palsy can also be caused by those aneurysms located in the intracavernous part of the internal carotid artery, basilar artery, posterior cerebral artery and superior cerebellar artery. However, oculomotor nerve paresis caused by an anterior communicating artery aneurysm is a very uncommon occurrence. We report a case of an elderly female with sudden severe headache who developed an acute third nerve paresis. Angiography revealed an anterior communicating artery aneurysm. Management and the pertinent literature are reviewed along with the mechanism of third nerve compression.

Aged↗

PubMed2004

Primary central nervous lymphoma presenting as bilateral cerebellopontine angle lesions: a rare case report.

The authors describe a rare case of primary central nervous system (CNS) lymphoma presenting as bilateral cerebellopontine angle lesions. Imaging showed bilateral cerebellopontine angle lesions and also a small mass in right lateral ventricle and anterior third ventricle region. The right cerebellopontine angle mass was surgically excised and radio- and chemotherapy given for the remaining lesions. This is the second case reported in the world literature. The case is discussed and the literature is reviewed.

Adult↗

PubMed2004

Increased hMSH2 protein expression in glioblastoma multiforme.

hMSH2 and hMLH1 are the most commonly studied mismatch repair proteins and their absence is associated with microsatellite instability (MSI) especially in hereditary non-polyposis colorectal cancer, and also in some sporadic tumors. However, there are some tumors, namely, urothelial neoplasms and salivary gland tumors, where overexpression of the proteins has been reported, though the implications of these findings are not very clear. There is no report on the expression of these proteins in different grades of human astrocytic tumors. We have studied the expression pattern of hMSH2 and hMLHI in high (Grade IV, glioblastoma multiforme (GBM)) and low (Grade II, astrocytoma (AS)) grade primary human gliomas by immunohistochemistry. We observed that there was a significantly higher expression of hMSH2 protein in 28 GBM (mean 703.07 +/- 236.28) as compared with 27 AS (mean 307.03 +/- 204.71), p = 1.47 x 10(-8) by a two-tailed t-test of unpaired samples. However, for hMLH1 no such difference was observed, mean counts being 543.29 +/- 320.35 for 27 GBM and 505.92 +/- 342.37 for 26 AS, p = 0.67. A small proportion of tumors was observed to be immunonegative for either of the proteins in both high- and low-grade tumors. While MSI has been shown previously to be infrequent in human astrocytic tumors, the implications of the overexpression of hMSH2 in GBM are not clear.

Adaptor Proteins, Signal Transducing↗

PubMed2003

Brain abscess--an unusual complication of ventriculo-peritoneal shunt.

The authors report a case of a 10-year-old boy, who was operated for a craniopharyngioma with hydrocephalus. He succumbed to delayed development of brain abscess and its consequence, secondary to incompletely treated shunt tract infection. This unfortunate complication developed, despite the fact that conventional steps (removal of VP shunt and intravenous antibiotics) recommended for the treatment of VP shunt infection were adopted. The pathogenesis, management and review of literature of this extremely rare clinical entity is presented.

Brain Abscess↗

PubMed2003

Diabetes insipidus in sellar-suprasellar tuberculoma.

Tuberculoma involving the sellar and suprasellar region is extremely rare. Sellar region tuberculoma usually presents with endocrinopathy of hypofunction, rarely hyperfunction or normal function of the anterior pituitary. However, sellar-suprasellar tuberculoma presenting with diabetes insipidus (DI) is very rare. We report the case of a 32 year old housewife presenting with DI and secondary amenorrhea, who had a sellar-suprasellar mass on MRI. She underwent a transnasal transsphenoidal surgical removal of the pituitary mass, which was tubercular in nature on histology. She received antitubercular treatment and hormonal replacement therapy. She was well at last follow-up, 3 years after surgery.

Adult↗

PubMed2003

Pituitary apoplexy and inappropriate ADH secretion.

Pituitary apoplexy may be associated with visual deterioration that may be severe in some cases. Misdiagnosis of this condition is not uncommon, resulting in delayed treatment, which may adversely affect the outcome and visual prognosis. We present a case of pituitary apoplexy, who presented with features of syndrome of inappropriate anti-diuretic hormone secretion (SIADH) and monocular blindness. He had remarkable improvement to normal vision along with normalisation of serum sodium following emergency trans-sphenoidal surgery.

Decompression, Surgical↗

PubMed2003

Tension pneumocephalus following transsphenoid surgery for pituitary adenoma - report of two cases.

Occurrence of symptomatic pneumocephalus following transsphenoid surgery is a rare event. Two cases of symptomatic pneumocephalus were observed in our series of 480 transsphenoidal surgeries. The first case reported presented with a head injury 4 years earlier and had a left frontotemporal haematoma evacuation. He underwent surgery for sellar mass extending into suprasellar region. He developed postoperative CSF rhinorrhea and in spite of conservative therapy, developed progressive visual deterioration necessitating a re-exploration and repair leading to resolution of the neurological deficits. The second case presented with delayed CSF rhinorrhea leading to rapid alteration in sensorium, requiring external ventricular drainage. The leak subsided without any further surgical intervention.

Accidents, Traffic↗

PubMed2003

Delayed optic nerve decompression for indirect optic nerve injury.

OBJECTIVE: To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury. STUDY DESIGN: Critical analysis of Proforma-based, prospectively accrued data of all cases with injury to surgery interval of greater than 2 weeks. METHODS: Thirty-five cases with a median injury to surgery interval of 56 days (range, 16-374 d). Surgical decompression was undertaken only in cases that continued to have poor vision after treatment with steroids in conventional doses (1 mg/kg prednisolone). Pre- and postoperative visual acuity measurements were converted to the logMAR scale of visual acuity and the percentage of visual improvement was calculated. RESULTS: Surgery was universally unrewarding in all 9 cases with persistent and complete blindness of greater than 2 weeks and no response to steroid therapy. Of the cases with some residual vision, 20 of 26 cases improved (mean percentage improvement, 41.0 +/- 5.7%). Cases were categorized on the basis of the injury to surgery interval into groups of 2 weeks to 2 months, 2 months to 4 months, and greater than 4 months. No significant difference was demonstrated in the probability or quantum of improvement in these groups (P =.97). CONCLUSIONS: Optic nerve decompression remains useful as a salvage procedure for conventional dose steroid failed cases of traumatic optic neuropathy. In cases that are not completely blind, vision can be improved even when surgery is undertaken a few months after the injury.

Adolescent↗

PubMed2003

Recurrent bradycardia and delayed recovery in a neonate following repair of nasofrontal encephalocoele with holoprosencephaly and single cerebral ventricle.

Holoprosencephaly and single cerebral ventricle are uncommon congenital anomalies that are associated with a high rate of perinatal mortality. We describe a neonate who developed recurrent bradycardia along with delayed recovery following frontal craniotomy for the repair of a nasofrontal encephalocoele associated with holoprosencephaly and a single cerebral ventricle. The neonate, however, recovered following elective ventilation. Etiopathogenesis and management of such complications are discussed.

Anesthesia Recovery Period↗

PubMed2003

Presacral neurenteric cyst in an infant.

Intraspinal neurenteric cysts are rare congenital cystic lesions, formed due to displacement of elements forming the alimentary canal. We report an 11-month-old infant presenting with a soft, fluctuant and transilluminant swelling posterior to the anus since birth; the size of the swelling varied with alterations in intraspinal pressure subsequent to crying, coughing, or sneezing. MRI showed a multiloculated lesion anterior to the sacrum and coccyx. Near total excision was carried out without any worsening in the neurological status.

Humans↗