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Biomedical subjects

A Nanda

Publications and source records attributed to A Nanda.

At least 37 records · Page 2Linked to original sources
PubMed2001

Type III occipital condylar fracture presenting with hydrocephalus, vertebral artery injury and vasospasm: case report.

Occipital condylar fractures (OCF) are rare and have a high mortality rate. We report a patient with OCF who presented with acute hydrocephalus and died from diffuse vasospasm secondary to vertebral artery injury. A 45-year-old man fell 20 feet from a deer stand and landed on his head. CT showed a type III OCF continuing to the anterior rim of the foramen magnum on the left, with a bone fragment pushing into the medulla, causing hydrocephalus. The patient was stabilized, and a four-vessel arteriogram showed diffuse vasospasm with complete occlusion of the left vertebral artery at the level of the OCF. To our knowledge, this is the first documented case of the conjunction of OCF, hydrocephalus, and vasospasm.

Accidental Falls↗
PubMed2001

Persistent primitive trigeminal artery associated with posterior communicating artery aneurysm and hypoplastic vertebral artery.

We report a patient who presented with headache due to diffuse subarachnoid hemorrhage. A four-vessel angiogram revealed a left posterior communicating artery aneurysm with fetal origin, persistent primitive trigeminal artery and hypoplastic vertebral artery on the same side. This association was considered coincidental and co-existence of a saccular aneurysm with an anatomical variation of intracranial vasculature is briefly discussed.

Female↗
PubMed2001

Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression. A cost-benefit analysis retrospective study.

BACKGROUND: After decompression of cervical and lumbar nerve roots for radicular pain, pathological evaluation of the extracted disc material is commonly performed. Although histological examination rarely detects clinically significant unsuspected disease, it remains a common practice in most hospitals in the United States. To determine the cost-effectiveness of this routine practice, we conducted a retrospective study. The results are contained within this report. METHODS: Using the University Neurosurgery database, we retrospectively identified 1,387 patients who had spinal decompression surgery (laminectomy and/or discectomy). These cases were broadly classified into routine and non-routine cases depending on the preoperative diagnosis. Benign and noninfectious cases were classified as routine; malignant and all other cases were classified as nonroutine. We reviewed the medical records and pathology reports of these routine and nonroutine cases in an attempt to study the efficacy of the pathological evaluation of the disc material. The cost-benefit value of histopathology in these cases was analyzed, retrospectively. RESULTS: In all routine cases, the histopathology was consistent with benign disc disease and yielded no additional information that could have altered the treatment plan. In the nonroutine cases, however, histopathology was significant in the management of the patient. The cost factor for pathological study was the same for both case groups. CONCLUSIONS: Pathological study of intervertebral disc specimens is cost beneficial only in cases with significant preoperative clinical diagnoses. Pathological evaluation of routine herniated nucleus pulposus extracted during decompressive surgeries is not warranted.

Cervical Vertebrae↗
PubMed2001

Results of surgical treatment of intrasylvian hematomas due to ruptured intracranial aneurysms.

In this retrospective study, the surgical outcome of patients with intrasylvian hematomas due to rupture of intracranial aneurysms was analyzed. The authors studied ten patients who underwent aneurysm surgery and evacuation of the hematoma within 12 h of the onset of bleeding. All patients had an intrasylvian hematoma classified with computerized tomography and all patients underwent pre-operative angiography. In all patients, the origin of bleeding was a middle cerebral artery aneurysm, with the exception of one patient whose bleeding originated from a posterior communicating artery aneurysm. Three patients achieved good recovery without any significant neurological deficit and four achieved good recovery with moderate disabilities. One patient died due to pneumonia and two were in a vegetative state. Notably, three patients who were comatose (Hunt and Hess Grade V) at the time of presentation achieved good recovery following surgery. In this study, neurological status at presentation did not predict the outcome. The only significant prognostic factor in those patients who had intrasylvian hematoma was early surgery within 12 h of the bleeding. We suggest that early surgical treatment be performed in patients with intrasylvian hematoma, regardless of the neurological findings and grade on admission. Pre-operative angiography seems to be essential in identifying the source of bleeding.

Adult↗
PubMed2001

Validation of dizziness as a possible geriatric syndrome.

OBJECTIVE: While dizziness has traditionally been considered solely as a symptom of discrete diseases, recent findings from population-based studies of older persons suggest that it may often be a geriatric syndrome with multiple predisposing risk factors, representing impairments in diverse systems. To validate these findings, we identified predisposing risk factors for dizziness in a clinic-based population. DESIGN: Cross-sectional study. SETTING: Geriatric assessment center. PARTICIPANTS: 262 consecutive, eligible patients. MEASUREMENTS: Medical history and physical examination data were ascertained and characteristics of patients with and without a report of dizziness were compared. RESULTS: Seven factors were independently associated with a report of dizziness, namely depressive symptoms, cataracts, abnormal balance or gait, postural hypotension, diabetes, past myocardial infarction, and the use of three or more medications. Of patients with none of these risk factors, none reported dizziness. This proportion rose from 6% among patients with one factor, to 12%, 26%, and 51% among patients with two, three, and four or more factors, respectively. CONCLUSIONS: The finding of similar factors associated with dizziness in previous community-based cohorts and the present clinic-based cohort supports the possibility of a multifactorial etiology of dizziness in many older persons. A multifactorial intervention targeting the factors identified in these studies may be effective at reducing the frequency or severity of dizziness in older patients.

Aged↗
PubMed2001

Burr-hole versus twist-drill drainage for the evacuation of chronic subdural haematoma: a comparison of clinical results.

BACKGROUND: Most neurosurgeons remove clinically symptomatic subdural haematomata, but the techniques they choose remain controversial. METHOD: The results from sixty-two patients diagnosed with chronic subdural haematoma were evaluated for technique, postoperative computerized tomography (CT) scan results, and complications. RESULTS: Eleven patients had haematomata evacuated using twist-drill plus drain, 37 patients had haematomata evacuated with burr-hole only, and 14 patients were evacuated with burr-hole plus drain. Of the patients who underwent twist-drill and closed system drainage (CSD), 43% had smaller lesions on CT follow-up scans, as compared with 74% of those who underwent the burr-hole only procedure, and 65% with burr-holes with drains. Clinical outcome results showed that 64% of twist-drill and CSD patients deteriorated as compared with 16% of those with burr-hole only and 7% with burr-holes and CSDs. Sixty-four per cent of twist-drill patients required repeat evacuations as compared with 11% of those with burr-holes only, and 7% with burr-holes plus drains. CONCLUSION: The results at our institution indicate that burr-hole evacuation for chronic subdural haematoma is superior to twist-drill evacuation with respect to clinical outcomes and complications.

Adolescent↗
PubMed2001

Microsurgical and endoscopic approaches to the basilar bifurcation: quantitative comparison of combined pterional/anterior temporal and orbitozygomatic extended approaches.

To determine the most effective route to the upper third of the basilar artery, 10 cadaver dissections were performed comparing the exposure gained using the combined pterional/anterior temporal approach and the orbitozygomatic extended approach. Endoscopic evaluation through an eyebrow incision in each dissection helped determine whether any advantage was conferred by the cranial base approach. This also served to assess the benefit of using the endoscope as an adjunct to open procedures in evaluating the opticocarotid and retrocarotid routes to the basilar artery. The results of cadaveric dissections suggest that compared with the exposure afforded by the combined pterional/anterior temporal approach, the orbitozygomatic extended approach yields an increase of 8 cm in the anteroposterior axis and 10 cm in the superoinferior axis. Furthermore, as expected, the increases in visibility were directed anteriorly and posteriorly. When employed through the craniotomy site during aneurysm clipping, endoscopy was found to be potentially useful in assessing the contralateral elements of the upper basilar complex.

Journal Article↗
PubMed2001

Cauda equina compression by malignant lymphoma: long-term survival following multimodality therapy.

Malignant lymphoma compression of the cauda equina is rare. In the literature only a few cases have been described with occasional long term survivors. We report another case of non-Hodgkin's lymphoma presenting with cauda equina compression. Significant palliation and long-term survival were achieved after therapy by decompressive, cytoreductive surgery; local irradiation; and chemotherapy.

Adult↗
PubMed2001

Management of good-grade intracranial aneurysms.

In this retrospective study over a 6-year period, 205 patients in good neurological condition with aneurysms were treated at Louisiana State University Health Sciences Center--Shreveport. Of the 205 patients, there were 120 patients in Hunt and Hess Grade I, 52 patients in grade II, and 32 patients in grade III; 84 aneurysms were unruptured. Ninety-six patients reached the hospital within 3 days of subarachnoid hemorrhage, 77 on the first day. The majority underwent surgery within 3 days of presentation (N = 141). A good outcome was observed in 190 patients; 3 patients died (1 in grade II and 2 in grade III). The outcome was significantly influenced by Hunt & Hess Grade at admission, location of the aneurysm, and size of the aneurysm. Aneurysms of the posterior circulation and aneurysms with larger sacs had significantly worse outcomes than aneurysms in the anterior circulation. No patients in grade I died, and there was no mortality in the patients with unruptured aneurysms. The overall mortality was 1.5% and the morbidity was 4.5%.

Adolescent↗
PubMed2001

Cauda equina compression in breast cancer--incidence and treatment outcome.

PURPOSE: To determine the incidence and treatment outcome of compression of the cauda equina by metastatic disease in patients with breast cancer. METHODS: A retrospective study of individuals diagnosed with breast cancer at a single institution during a 16-year period was undertaken. RESULTS: Of the 1,283 patients studied, 15 (1.2%) developed cauda equina syndrome from metastatic disease. The median survival was eight months; ten (67%) survived for at least six months. Among the evaluable patients, pain was completely relieved in eight of ten women; complete resolution of neurologic deficits was observed in five of nine patients. CONCLUSION: Metastatic breast cancer compression of the cauda equina and long-term survival of patients are infrequent occurrences. Beneficial responses can be mediated by radiotherapy.

Adult↗
PubMed2001

Delayed diagnosis of intracranial aneurysms: confounding factors in clinical presentation and the influence of misdiagnosis on outcome.

The initial presentation of intracranial aneurysm can be missed in routine clinical practice. An underlying aneurysm may have a subtle presentation that warrants definitive diagnostic procedures. A retrospective review of 270 patients with aneurysms at our institution revealed 40 patients (14.8%) with a significant delay in diagnosis before definitive treatment. The delay due to missed diagnosis varied from 2 days to a few months. In retrospect, 58% had a Hunt and Hess grade I clinical presentation at readmission. Clinical status was rated as grade 0-I in the majority of patients (65%), grade II in 20%, and grade III in 12.5%. One patient had grade IV status. These grades are significantly different from the initial grade at which each of the patients first sought medical attention. The second admission significantly affected the outcome. A delay in diagnosis of aneurysmal subarachnoid hemorrhage resulting in poor clinical grade influenced neurologic outcome significantly.

Adolescent↗
PubMed2000

Poly (ADP-ribose) polymerase induction is an early signal of apoptosis in human neuroblastoma.

Poly (ADP-ribose) polymerase (PARP) is an abundant chromatin associated protein important in DNA repair, maintenance of chromosomal stability and programmed cell death. Here we report that an increase in caspase 3-activity and cleavage of PARP serves as an early execution phase signal in human neuroblastoma. Human neuroblastoma SK-N-SH cells were exposed to a protein kinase inhibitor, staurosporine, or a topoisomerase II inhibitor, etoposide, at various concentrations and time points. Cells exposed to staurosporine (0.1 microM) for 30 min showed an increase in caspase 3-activity and by 1 h an increase in PARP 116-kDa band and an 85-kDa cleavage product, which further increased in density with time after treatment. Quantitative analysis for condensed chromatin material using bisbenzimide, and DNA fragmentation enzyme immunoassays showed a significant increase in apoptosis 5 h after staurosporine treatment. This was further confirmed with a Klenow fragment of DNA polymerase I assay which primarily detects single-stranded DNA breaks. A significant decrease in mitochondrial metabolism occurred within 8-12 h after treatment. Studies using Trypan Blue exclusion, and lactic dehydrogenase (LDH) release revealed a significant increase in membrane permeability 8 h after staurosporine (0.1 microM) or etoposide (10 microM) treatments. Cleavage of lamin B1, a protein important in maintaining the nuclear envelope integrity was observed 12 h after staurosporine treatment. Our results show that activation of caspase 3 followed by PARP cleavage occur at much earlier time point than any other morphological or biochemical parameters of apoptosis or cytotoxicity.

Apoptosis↗
PubMed2000

Use of fluorodeoxyglucose-positron emission tomography for the differentiation of cerebral lesions in patients with acquired immune deficiency syndrome.

Intracranial mass lesions comprise approximately half of all acquired immune deficiency syndrome (AIDS)-related neurological complications. Although toxoplasmosis and lymphoma are the most common causes of these lesions, diagnosis and treatment can be delayed because computerized tomography and magnetic resonance imaging studies cannot accurately differentiate between them. The authors retrospectively studied nine patients with AIDS in whom, after a 6-hour fast, [18F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) scanning demonstrated intracranial mass lesions. The FDG uptake within each lesion was classified as either increased or not increased. In six patients there was no increase in FDG uptake, which suggested a diagnosis of toxoplasmosis, and lymphoma was suggested in two patients in whom increased FDG uptake was demonstrated. In a patient with two lesions, one lesion was shown to have increased FDG uptake whereas the other was shown to have no increased FDG uptake. All patients in whom a diagnosis of toxoplasmosis was made were started on antimicrobial therapy. Two patients died of other AIDS-related complications before repeated neuroimaging could be performed to assess treatment response, one patient refused to undergo further treatment or follow up, and two patients responded well to treatment. One patient with toxoplasmosis did not respond to the drugs. Analysis of a biopsy sample of the lesion confirmed the diagnosis; however, the patient died shortly thereafter. The two patients with FDG-PET-diagnosed lymphoma began corticosteroid therapy and improved considerably. In the patient in whom PET demonstrated two different FDG uptakes, a biopsy sample was obtained that confirmed the diagnosis of lymphoma; this patient was started on corticosteroid therapy and improved. A safe and reliable diagnostic tool, FDG-PET scanning can be used to differentiate causes of human immunodeficiency virus-related intracranial mass lesions. When available, this diagnostic study should be conducted before initiating empirical treatment or obtaining a stereotactically guided brain biopsy sample.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases.

BACKGROUND: Ventriculoperitoneal shunt surgery is the most widely used procedure in the treatment of hydrocephalus. However, this invasive procedure has been associated with several delayed abdominal complications. Perforation of the bowel is a very rare complication occurring in less than 0.1% of cases. Although infrequent, this delayed complication can be fatal if it goes unrecognized. CASE DESCRIPTION: This report presents an adult patient who had undergone ventriculoperitoneal shunt surgery and later presented with rectal protrusion of the shunt tube after asymptomatic perforation of the bowel wall. The shunt was removed without complication and the patient remained asymptomatic. CONCLUSIONS: Forty-five similar cases have been reported in the literature. The information provided within this report examines the case at hand, as well as provides an analysis of the literature as it relates to bowel perforation through symptomatic presentation, diagnosis, cultures, management with or without laparotomy, and outcome.

Adult↗
PubMed2000

Eosinophilic granuloma of spine in adults: a case report and review of literature.

A rare case of eosinophilic granuloma in an adult is reported. Eosinophilic granuloma (EG) is a lesion observed more frequently in adults. CT and MRI showed a lytic lesion of the T11 vertebral body. A transpedicular excisional biopsy of the lesion revealed EG. Spinal EG in adults is rare and differs from the childhood disease by the spinal level involvement. Vertebra plana, a condition of spondylitis in which the body of the vertebra is reduced to a sclerotic disc, is not a roentgenographic feature in the 14 cases reported in literature. It should be included in the differential diagnosis of the solitary lytic lesion of vertebrae in adults.

Eosinophilic Granuloma↗
PubMed2000

Salient features and HLA markers of childhood psoriasis in Kuwait.

A total of 305 consecutive Kuwaiti children with psoriasis were studied for clinical features and 50 children were tissue typed for HLA class I and class II antigens. The salient features of psoriasis in these children included: female preponderance (M : F ratio, 1:1.5); peak age of onset between 2 and 8 years; scalp as the most common site of onset (30%); scalp and extensors of legs as commonly affected sites (52.5% each); plaque psoriasis the most common clinical type (89%); and a positive family history of psoriasis in 34% of the patients. Kuwaiti children with psoriasis showed a significant association with HLA-A3, Cw1, and DR7 antigens and those with a positive family history of psoriasis had a significant association with HLA-DR8 antigen.

Biomarkers↗
PubMed2000

Milia en plaque: a new site.

A 35-year-old Kuwaiti field worker presented with a history of an asymptomatic, erythematous plaque on the right side of the nasal bridge. It soon extended to the malar area, being studded with multiple yellowish papules (Fig. 1). He denied any history of photosensitivity, drug intake, local trauma, topical applications, or ionizing radiations to that area. Examination revealed an erythematous, 1.5 x 3 cm plaque on the right nasal fold, extending to the malar area, overlain by a group of tiny yellowish papules (15-20 in number). He also had a few discrete milia on the right cheek. The histology (Fig. 2) revealed multiple keratin-filled cysts, surrounded by a dense lymphocytic infiltrate, findings consistent with milia; 0.05% tretinoin was prescribed twice daily for 1 month without improvement; minocycline, 100 mg daily, was then employed, and at 1 month of follow-up there was a significant decrease in erythema and milia count.

Adult↗