Biomedical subjects
Publications and source records attributed to K S Mann.
Surgical excision followed by radiotherapy has been the recommended treatment for paraplegia due to extramedullary hematopoiesis in patients with beta-thalassemia. The authors report the successful treatment of such a case by partial excision and repeated blood transfusions.
Retrospective analysis of 12,072 pediatric head injury cases revealed 1,297 skull fractures. Patients with skull fractures were divided into four age groups according to the fusion of skull sutures and other developmental radiological skull changes. Results revealed that the patients with open skull sutures (aged less than 2 years) and with linear skull fractures alone had a negligible chance of developing intracranial hematomas. With the fusion of metopic and mendosal sutures associated with other skull changes (greater than 2 years), the children became progressively more susceptible to developing intracranial hematomas if they had a skull fracture. The risk of developing intracranial hematomas was the highest among those patients (much greater than 11-15 years) whose paranasal sinuses had reached adult size and spheno-occipital synchondrosis had begun to fuse.
A prospective study was undertaken to treat all intracranial hematomas in hemophiliac A children under a uniform protocol. Patient selection was obtained by early CT scan of all hemophiliacs presenting with neurological symptoms and routine hematological screening for coagulopathies of all pediatric intracranial hematomas, spontaneous or traumatic. Nine patients, of whom seven came under category 1 and two under category 2, were entered into this study. There were eight subdural hematomas, one epidural hematoma, and one intracerebral hematoma. Surgery was required in every patient. Human factor VIII concentrate was used for replacement up to 100% just before and 3 days after surgery. Thereafter, it was maintained at 50% up to the 10th postoperative day. There was no operative or late mortality. At 6-month follow-up, eight of nine patients had recovered completely with no residual neurological deficit. We conclude that early diagnosis, prompt surgical intervention, and perfect normalization of hemostatic defect are essential in improving the outcome of these patients.
A patient with intracerebral chloromas is reported, highlighting the computed tomography appearance and the response to surgery and radiotherapy. The various forms of central nervous system leukemic infiltration and the differential diagnosis of mass lesions are discussed.
We report a patient with large intracerebral chloromas while in systemic remission from acute myelogenous leukemia. A favourable outcome resulted from surgical debulking and radiotherapy. Review of other reported cases in the literature showed a uniform female occurrence. We believe that intracerebral chloromas represent reactivation of sanctuary deposits in the central nervous system. The treatment of intracerebral chloroma is discussed.
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A case of mucocele of the posterior ethmoid sinus presenting as unilateral blindness without pain, proptosis, or diplopia is reported. Computerized tomography (CT) demonstrated the precise anatomical relationship of the mucocele to the optic nerve inside the optic canal. It is proposed to use the term "optic canal syndrome" for patients with such clinical and CT presentation. Combined transcranial excision and transnasal drainage resulted in dramatic recovery of vision.
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Traumatic acute arterial subdural hematomas are rare and are associated with a high mortality rate. The authors report a case in which the initial computed tomographic (CT) scan examination failed to reveal a hematoma. Within the subsequent 4 hours, while recovering from anesthesia given so that hemostasis of bleeding soft tissue injuries could be obtained, the patient suddenly developed bilaterally dilated pupils, both nonreactive to light. A repeat CT scan then revealed large subdural and intracerebral hematomas. The case is discussed and the pertinent literature is reviewed.
A 50-year-old man was admitted with complaints of difficulty in walking, urinary incontinence, and a lump over the lumbosacral region. X-ray examination of the lumbosacral spine revealed bizarre vertebral anomalies, including a hole in the L-5 vertebral body. At operation an enterogenous cyst in association with diastematomyelia, cutaneous fistula, and a lipoma was encountered. Post-operatively, some improvement ensued. The case is discussed and pertinent literature reviewed with particular reference to the etiopathology of the cyst.
Aneurysms of the pericallosal-callosomarginal junction are rare and carry a high mortality and morbidity rate. We report a series of 11 cases that were operated upon by one surgeon using modern available methods of treatment. There were six women and five men. Average age was 40.6 years. Only two patients had additional unruptured aneurysms. There was no operative mortality, but the morbidity was formidable (27.3%).
Fifty patients suffering from advanced cervical spondylotic myelopathy were surgically treated to eliminate compression of the cord. All disc protrusions demonstrated by positive-contrast myelography that measured larger than 1.5 mm were excised. Each patient was operated on in a single-stage procedure by anterior discectomy, without bone fusion, for protrusions between 2 and 4 mm, and by vertebral trephination and intercorporeal iliac bone-graft fusion for protrusions larger than 4 mm. There were no serious complications. Improvement by one clear disability grade (as defined by the authors) was observed in 36% of the cases, by two grades in 56%, and by three grades in 8%. No patient showed an improvement of four grades. During a follow-up period varying from 2 to 5 years, none of the patients showed clinical evidence of progression of myelopathy; however, 44% of patients showed definite radiological evidence of progression of cervical spondylosis. This indicates that myelopathy may be arrested and may regress, but the process of cervical spondylosis continues unabated in almost half of the cases.
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During an eleven year period, 123 patients with acute subdural haematoma were treated in our unit. The first 63 patients were managed by general surgeons with a mortality rate of 80.9 per cent. Good recovery among survivors was 4.7 per cent. The subsequent 60 patients were managed by neurosurgeons. The mortality rate then dropped to 60 per cent and the rate of good recovery rose to 21.6 per cent. This improvement in outcome is statistically significant (P less than 0.02 and P less than 0.05 respectively). Early operation plus thorough evacuation of haematoma by craniectomy or craniotomy were the main factors found responsible for the improvement.
Eleven cystic lesions comprising four craniopharyngiomas, six astrocytomas, and one pinealoma, which at operation were presumed to be unamenable to radical excision, were treated by partial resection, insertion of a sump drainage, and postoperative radiotherapy. As a consequence of this relatively simple operative procedure there were no serious complications, and every patient recovered fully from preoperative neurologic deficit. Whenever the symptoms recurred the subcutaneous reservoir provided a readily available access for needle puncture to relieve the raised intracranial pressure. On each occasion, after aspiration of the accumulated cyst fluid, each patient showed marked improvement within 48 hours. Pertinent literature is reviewed and possible other applications of sump drainage are discussed.
Extradural haematoma complicating head injury still has a formidable mortality despite recent advances in neurological surgery. The experience of 60 cases of extradural haematoma treated in a general surgical unit was reviewed retrospectively. The mortality was 35%. Analysis of the 21 deaths showed that 13 (62%) of them were possibly avoidable. Lack of index of suspicion, delay in instituting surgical treatment and inadequate surgical intervention were the main causes of the avoidable mortality.
A case of posttraumatic epidural hygroma is reported. This child presented with occipital injury. Slowly but progressively he developed bilateral Wallenberg's syndrome and retrocollis. Correct preoperative diagnosis was made with the aid of computerized tomography. The case is discussed with emphasis on the mechanism of formation of an epidural hygroma and its clinical presentation.