Giant cell reparative granuloma of the base of the skull presenting as a parapharyngeal mass

Giant cell reparative granuloma is an infrequent non-tumoral lesion affecting the maxillary and mandibular bones and only rarely, the cranial bones. We report a case of giant cell reparative granuloma of the base of the skull in a 12-year-old female who presented with a parapharyngeal mass. Computerized Tomography (CT) showed the intracranial extension and destruction of surrounding bones.

Prevalence of initial drug resistance to M. tuberculosis in new sputum positive RNTCP patients

There is an increased prevalence of drug resistant M. tuberculosis strains and of these, multi drug resistant organisms are of particular concern. With the implementation of Revised National Tuberculosis Control Programme (RNTCP) allover the state of Delhi, Initial drug resistance (IDR) to Isoniazid and Rifampicin assumes great importance and needs to be monitored on a regular basis. We undertook to study the IDR against the first line essential drugs i.e. Isoniazid (H), Rifampicin (R), Ethambutol (E) and Streptomycin (S) from April 1999 to March 2000 in newly diagnosed sputum positive cases of pulmonary tuberculosis attending TB clinics under RNTCP in Delhi. A total of 157 consecutive new smear positive patients attending TB clinics under RNTCP were taken into the study. All sputum samples were subjected to culture and drug sensitivity tests on LJ medium after decontamination of samples by Petroff's method. Resistance was expressed as the percentage of colonies that grow on critical concentration of the drugs. To determine the proportion of resistance, the number of colonies on the control and the number of colonies on the drug medium were determined. A total of 94.77% samples were sensitive to the four first line essential drugs and IDR to any drug was 5.22%. The resistance to Rifampicin alone was nil but the resistance to Isoniazid alone was 2.24%. Combined resistance to both Rifampicin and Isoniazid was 2.98 %. The incidence of resistance to first line drugs in tuberculosis is not very high among new sputum positive patients attending TB clinics under RNTCP.

Antibiotic resistance pattern in uropathogens

Uropathogenic strains from inpatient and outpatient departments were studied from April 1997 to March 1999 for their susceptibility profiles. The various isolates were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Acinetobacter baumanii and Enterococcus faecalis. Antibiotic susceptibility pattern of these isolates revealed that for outpatients, first generation cephalosporins, nitrofurantoin, norfloxacin/ciprofloxacin were effective for treatment of urinary tract infection but for inpatients, parenteral therapy with newer aminoglycosides and third generation cephalosporins need to be advocated as the organisms for nosocomial UTI exhibit a high degree of drug resistance. Trimethoprim and sulphamethoxazole combination was not found to be effective for the treatment of urinary tract infections as all the uropathogens from inpatients and outpatients showed high degree of resistance to co-trimoxazole. Culture and sensitivity of the isolates from urine samples should be done as a routine before advocating the therapy.

Study of resistance against some ionophores in Eimeria tenella field isolates

Three Eimeria tenella field isolates from Gurgaon district of Haryana (north India) were studied in a battery test for evaluating drug resistance against two currently used ionophores; maduramicin (5ppm) and salinomycin (60ppm). Broiler birds (Ross strain) were infected with 10(5) sporulated oocysts each at the age of 2 weeks and prophylactic medication commenced 2 days prior to infection. Drug resistance was assessed by calculating the global index for individual ionophore compounds based on weight gain, feed conversion ratio, oocyst index, lesion score and mortality. Present studies revealed no resistance of the ionophores in any of the field isolates. Both the drugs showed varying degree of efficacy, e.g. maduramicin exhibited limited efficacy against all the three field isolates, whereas salinomycin showed limited efficacy against Gurgaon isolate (GrI)-I, good efficacy against GrI-II and partial resistance against GrI-III.

Posterior fossa dermoid in association with Klippel-Feil syndrome--a short report

A posterior fossa dermoid cyst in association with the Klippel-Feil syndrome, in a 4 year old child is reported. Early diagnosis to prevent complications like neural compression, cyst rupture and staphylococcal meningitis justifies investigation for posterior fossa dermoids in cases of Klippel-Feil syndrome. Their embryological basis is discussed.

Posterior sagittal approach for repair of rectourethral fistula occurring after perineal surgery for imperforated anus at birth

PURPOSE

Posterior sagittal approach was used for the repair of 11 cases of rectourethral fistula between 1992 and 1998.

METHODS

All these patients had rectourethral fistula as a result of perineal procedure performed for imperforate anus at the time of birth. In addition to the fistula repair, an associated anorectal stenosis (3 cases) and urethral stricture 11 case) also were corrected with this approach. All the patients underwent surgery under cover of a protective colostomy.

RESULTS

Successful repair was achieved in all patients, and the follow-up period ranged from 10 months to 7 years. As far as bladder and bowel control, urinary control was normal in all 11 patients, whereas bowel control was normal in 10 cases. One patient who had severe scarring of anal sphincters caused by infection in the previous surgery still suffers occasional perianal soiling after 18 months of follow-up.

CONCLUSIONS

Posterior sagittal approach not only gives adequate exposure but also suits the basic principles of fistula repair, namely, completely separating the rectum from urethra and leaving normal rectal wall behind the urethral sutures thus eliminating the possibility of recurrence. In addition to fistula repair, one can also correct associated problems like anorectal stenosis or urethral stricture, and a mislocated rectum can be relocated within the sphincter complex.

Glioblastoma multiforme in a mature ovarian teratoma with recurring brain tumours

AIMS

We report a case study to highlight the occurrence of glioblastoma multiforme in an ovarian teratoma.

METHODS AND RESULTS

A 10-year-old girl presented with a left frontal lobe primitive neuroectodermal tumour which was successfully treated. After 6 uneventful years, she developed glioblastoma multiforme located posterior to the site of the initial tumour. Six years later, she presented with a mature cystic teratoma containing glioblastoma multiforme.

CONCLUSIONS

Glioblastoma in an ovarian teratoma is an exceptional event, which might have an initial clinical presentation as a metastatic brain tumour. Alternatively, recurring glial tumours may occur in a genetically predisposed person; the role of radiation and chemotherapy in this context remains to be elucidated.

An ab initio study of histamine agonists

A systematic theoretical study on histamine agonists and their interaction with H1 and H2 receptor models has been carried out utilizing ab initio molecular orbital technique. The effect of substituents on histamine agonists' charge distribution and their agonistic activity has been studied in detail. Drug-receptor interaction models have been studied at the Hartree Fock level of theory with a split valence basis set keeping the cost and efficiency of the calculation in mind. The study indicates that the agonistic activity is controlled either by receptor conformation or by steric hinderances caused by the substituents. The monocationic form of histamine does not appear to be a necessity for a proton relay process which is similar to the one proposed earlier by Weinstein and coworkers. The study also indicates some importance of common cellular ions in neurotransmitter properties of histamine.

Clinical dysautonomia in diabetes mellitus--a study with seven autonomic reflex function tests

Thirty-eight patients of NIDDM, 12 of IDDM and 10 healthy age matched controls were subjected to seven standardised autonomic reflex function tests. A scoring criteria was utilised for diagnosing and grading the severity of dysautonomia. Eight patients of IDDM and 24 of NIDDM had dysautonomia. One-third of the patients in each group had grade IV autonomic dysfunction. Severity of autonomic dysfunction was directly related to the duration of disease in NIDDM whereas in IDDM this relation was not seen. Peripheral neuropathy was almost always associated with dysautonomia in NIDDM. On the contrary, in IDDM dysautonomia was independent of peripheral neuropathy. Charcot's arthopathy, dysphagia, constipation and nocturnal diarrhea were always associated with evidence of dysautonomia. Other symptoms viz. gustatory sweating, postural dizziness and impotence did not necessarily indicate dysautonomia.

Comparison of biochemical parameters in pleural effusion

A comparison of various biochemical parameters used in differentiation of nature of pleural effusion in transudate and exudate was done in 84 patient of pleural effusion. Pleural fluid (P) cholesterol and bilirubin which have gained an importance in recent years were compared with pleural fluid protein, LDH, P/S protein, P/S LDH and Light's criteria. It was seen that Light's criteria is still the best in differentiation. Sensitivity of individual test was nearly same for Pl. protein (94.11%), P/S Protein (94.11%), Pl. LDH (95.5%), P/S LDH (92.75%). Pl cholesterol (88.3%) and P/S cholesterol (91.42%) had slightly lower sensitivity. Pl. Protein and P/S LDH had 100% specificity. Lights criteria had 100% specificity and sensitivity % of cases misclassified by various criteria were Pl Protein 5.95%, P/S protein 5.95%, PLDH 4.76%, P/S LDH 4.76% P. Cholesterol 13% and P/S Cholesterol 9.52% Measurement of Bilirubin did not provide any correlation in classifying the effusion and thus did not hold any value.

Clean intermittent catheterisation for the neuropathic bladder

Clean intermittent catheterisation (CIC) has been used as the effective method of bladder drainage in paraplegics for over a decade in our centre. In 27 acute spinal cord injury (SCI) patients managed by CIC from day one, symptomatic urinary infection occurred in 5 with a follow up period of 10 days to 3 months. No prophylactic/suppressive antibiotics were used. In 21 patients on long term CIC (1-12 years) symptomatic infections occurred during a 6 month follow up at a rate of 0.07 episodes per patient per month. Urine cultures proved positive in 26%. The types of bacteria and their sensitivity towards antibiotics were different in both groups.

Value of osteomedullography in the early diagnosis of non-union in tibial diaphyseal fractures

Osteomedullography was performed in 17 diaphyseal fractures of the tibia at ten to 12 weeks from injury to assess the reliability and sensitivity of the procedure in predicting non-union. It was found to be accurate in more than 80% of cases in predicting the ultimate outcome early in the course of fracture healing.

Posterior cervical spine stabilization under local anesthesia

A technique is described for posterior cervical stabilization with spinous process wiring and fusion performed with the patient under local anesthesia and using corticocancellous demineralized bone matrix allograft. In patients with unstable cervical spines, posterior stabilization and fusion with local anesthesia allowed patient interaction with the surgeon during crucial parts of the operation. The technique was well tolerated and no untoward complications occurred. The technique has not been described for the neurologically intact patient with cervical spine trauma. The purpose of this report is to document the facility and advantages of this technique over traditional general anesthesia with autograft use. Nineteen patients were treated surgically at the author's institution. Local anesthesia was used in 12, and general anesthesia was used in 7. Allograft was used in 12 and autologous iliac crest graft was used in 7 patients. The indications for surgery were instability or neurologic deficit. Blood loss and operative times were favorable when compared with general anesthesia and autograft. The fusion extended by one level in 6 of 19 patients. One patient had preoperative neurologic deficit. All 19 follow-up patients were Frankel grade E. There is no need for endotracheal intubation, the patient serves as his or her own spinal cord monitor, and the surgeon is able to be aware immediately of any threat to neurological function. Demineralized bone matrix allograft has been shown to effectively induce osteogenesis by osteoinduction as well as osteoconduction. Its use eliminates the need for autograft harvesting and permits the use of local anesthesia alone for cervical spine posterior stabilization. The more neurologically intact the patient, the more this technique is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)

Dyslipidemia and Superoxide Dismutase Activity in Children with Down Syndrome

Introduction: Down Syndrome (trisomy 21) provides an interesting natural model to study atherosclerosis, since these individuals appear to be protected from plaque formation. Methodology: We assessed the lipid levels, and superoxide dismutase (SOD) activity in 32 clinically diagnosed children of Down syndrome and 34 children matched for age and sex as controls. Results: SOD activity was found to be significantly higher (p=0.004) in children with Down Syndrome (mean=313.7 IU/ml) than in controls (mean140.2 IU/ ml). Significantly higher levels of serum triglyceride (154.7 mg/dl) and VLDL (33.9 mg/dl) were observed in Down Syndrome as compared to healthy controls (119.6 mg/dl and 23.9 mg/dl respectively; p<0.05 for each). However, the two groups did not show any significant difference in levels of serum HDL-C, LDL-C. Conclusion: The raised antioxidant activity of SOD, because of over expression of genes situated non chromosome 21, probably offers some protection against the development of atherosclerosis despite the occurrence of dyslipidemia. Key words: Chromosome 21; Down Syndrome; Trisomy 21; Superoxide dismutase.  DOI: 10.3126/jnps.v30i3.3919J Nep Paedtr Soc 2010;30(3):160-163