Assessment and management of coagulopathy in neurocritical care

Coagulopathy may be defined as the loss of balance between hemostatic and fibrinolytic processes resulting in excessive bleeding, intravascular thrombosis or abnormalities in coagulation testing. It is frequently encountered across a wide range of conditions seen in the neurocritical care unit and can contribute to poor outcomes. Early recognition and appropriate management are key, with traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage presenting unique challenges to the neurointensivist. We will discuss techniques to assess coagulopathies as well as treatment strategies for the brain injured patient.

Subchronic toxicity of propyl paraben in adult male rats

In the current study, daily per os administration of propyl paraben [n-propyl-p-hydroxybenzoate] to adult male rats for four consecutive weeks induced severe hepatotoxicity as revealed by the significant elevation in serum marker enzymes along with a significant decrease in serum protein and its fractions. Furthermore, propyl paraben administration disturbed steroid hormones balance by suppressing serum testosterone level, with a concomitant increase in serum estradiol and an ultimate decrease in testosterone/estradiol ratio. Hepatic and testicular toxicity was furtherly attributed to oxidative stress induction, since propyl paraben altered the oxidant/antioxidant balance in both tissues. Signs of toxicity and histopathological changes in the liver and testes were observed by light microscopy of haematoxylin and eosin-stained sections. In conclusion, our data demonstrate the potency of propyl paraben as an endocrine disruptor to induce disturbances in normal steroid balance in adult male rats. In addition, the induced oxidative stress represents a common mechanism of propyl paraben toxicity in hepatic and testicular tissues

Intracranial tuberculoma: diagnosis treatment and outcome

Intracranial tuberculomas are conglomerate caseous foci within the substance of the brain that develop from deep-seated tubercles acquired during recent or remote hematogenous dissemination. In this study twenty four patients 10 male and 14 female with intracranial tuberculomas were treated and followed up in the neurosurgery and neurology departments in Al-Azhar University Hospitals and Nasr City Health Insurance Hospital in the period between January 1994 and July 2000. The age of the patients ranged between 6 and 48 year with a mean age of 30.1 year. The data were analyzed for presenting symptoms, its duration, physical findings, investigations and treatment. Half of the patients had past history of pulmonary tuberculosis. Fourteen patients had surgical excision. Four patients had stereotactic biopsy. Six patients had medical antituberculous treatment without excision or biopsy but one of these patients had ventriculo-peritoneal, shunt to treat the associated hydrocephalus all the patients were followed up every 6 months for a period ranged between 6-30 months with a mean period of 23.5 months. Thirteen out of the 24 patients showed improvement of their disability score on the 1st follow up after 6 months while the other 11 has the same disability score. Five out of these 11 patients showed improvement on the next follow up after 12 months while the other 6 had the same disability level. Three out of the non improved cases did not show improvement of their disability level till the end of the study, while the other 3 had improved disability level after 18 months for the 1st 2 cases and after 24 months for the 3rd patient. Ten out of the 14 patients who had craniotomy or craniectomy and tuberculoma excisions reached to disability level 0 while 2 had partial improvement and the last 2 had the same disability level as before management. Four of our patients had stereotactic biopsy and medical treatment. Three out of them reached to disability level 0 on follow up while 1 patient had partial improvement. patients who had only medical treatment were 6. Three out of them reached to disability level 0 on follow up while 2 patients had partial improvement and the 6th case had the same disability level as before management. The clinical picture of intracranial tuberculoma simulates an intracranial neoplasm, so it becomes necessary for physicians in countries where tuberculosis is common to search for any concomitant evidence of tuberculosis in every case of suspected intracranial tumor. Intracranial tuberculoma could be treated medically unless we are not sure of the diagnosis or if the tuberculoma is associated with mass effect which threatens the life of the patient

predictive and clinical value of acne valgaris in the diagnosis and follow-up of polycystic ovary syndrome: a controlled study

Forty-two females with abnormal menstrual cycle and acne vulgaris and 20 healthy acne free females served as controls were selected for this study. Complete gynecological and dermatological evaluation were done with special investigations including pelvic US and hormonal assay for free and total testosterone hormones [FT and T] and gonadotropin hormones including follicular stimulating hormone [FSH] and luteinizing hormone [LH]. Cases were divided into two subgroups [PCO and normal ovary] according to US findings. This study revealed that US PCO morphology was significantly increased in cases than controls with significant increase in mean ovarian volume, mean level of serum FT hormone and FSH. LH/FSH ratio was significantly increased in cases compared with controls. LH/FSH >2 was present in 27% of cases versus 0% of the controls. Comparing the two subgroups, it was found that there was a significant increase in mean ovarian volume, mean level of serum FT and T hormones, LH and FSH in PCO group than normal ovary group. LH/FSH >2 was present in 32% of PCO group versus 10% of normal ovary group

Parasagittal meningiomas diagnosis, surgical treatment and follow-up

Twenty two cases harbouring parasagittal meningiomas were admitted, diagnosed and operated upon in the period between Jan. 1991 -Feb. 1995 in Al-Azhar university and Nasr city H.I. Hospitals. Brain CT scan was the main diagnostic procedure. Surgical excision was performed for all cases. Postoperative clinical improvement was achieved in most of them. All the patients were clinically and radiologically followed up