lateral intra-ventricular brain tumors: evaluation of different surgical modalitis and outcome

BACKGROUND: tumors of the lateral ventricle are rare lesions in general neurosurgical practice; they account for < 1% of intracranial tumors. Complete microsurgical resection has been the treatment of choice for these lesions, either via the trans-cortical or trans-callosal route. The surgeons must choose the way that will cause least morbidity, provide adequate working space, and achieve a complete resection by surgery for these deep lesions

AIM OF THE WORK: was to evaluate the available different surgical modalities for the management of difference lateral intra-ventricular tumour types in various locations within the lateral ventricles

PATIENTS AND METHODS: this study was carried out on 23 patients with different lateral intra-ventricular tumour types in various locations within the lateral ventricles, the two approaches were transcallosal and trancortical approaches

RESULTS: regarding Intra-operative complications in the two groups, injury to adjacent vital structure was the most common complication [9, out of 23 patients= 39.13%], followed by bleeding [8 out of 23 patients 34.78%], and lastly brain edema [6 out of 23 patients= 26.09%]. Regarding tumour resection, total resection was achieved in 15 out of 23[65.2%], partial resection was performed in 8 out of 23 [34.8%] and was due to bleeding in 3 patients, brain edema in another 3 patients, and vicinity to a vital structure or eloquent area in the last 2 patients. Regarding postoperative complications in the two groups, seizure was the striking post-operative complication in patients operated via the transcortical approach [10 out of 14 patients = 71.4%]. Likewise, the post-operative brain edema was prominent among the patients of transcortical approach [7 out of 14 patients 50%]. On the contrary, the post-operative complication of obstructive hydrocephalus was the hallmark among the transcallosal approached patients [6 out of 9 patients= 66.7%]

CONCLUSIONS: tumor location within the lateral ventricle was the main factor for choosing the most pppropriate operative approach. However, the chosen operative corridor should optimize tumor access and protect vulnerable neurovascular structures

Adherence to medications in a group of Bahraini and Egyptian patients with bipolar mood disorder

The aim of this study was to identify predictors of non-adherence to medications in a group of bipolar mood disorder patients as well as the trans-cultural differences in non-adherence among them. Participants were 51 Bahraini and 53 Egyptians patients with bipolar mood disorder who had been prescribed medications within the past 12 months. Treatment adherence was evaluated by self-report of these patients. There was a distinction between intentional non-adherence [e.g., alteration of medication regimen to fit one's needs] and unintentional non-adherence than developing manic episodes for getfuiness]. No cultural group differences in intentional non-adherence were suggested. Egyptian patients reported significantly more unintentional non-adherence than Bahraini patients. however, once other predictors were entered into the model, cultural difference did not remain a significant predictor. After controlling for cultural factor and medication type, intentional non-adherence was associated with perceiving medication as less important, concerns about the side effects of medications and the stigma associated with medications. Unintentional non-adherence was associated with co-morbidity of drug abuse and development of manic episodes. results suggest no cultural difference in terms of barriers to adherence to medications. Interventions to increase adherence the bipolar patients. Drug education and information about the illness and its co-morbidity with drug abuse might help the patients and families

Diagnostic value of antisoluble liver antigen/ liver pancreas antigen [SLA/LP] and other autoantibodies in the diagnosis of patients with autoimmune liver disease

This study aimed to evaluate the role of auto antibody profile in the diagnosis of patients with suspected autoimmune liver disease and their ability to define the putative type 3 autoimmune hepatitis [AIH]. Forty adult patients with abnormal liver function, elevated serum IgG and negative hepatitis markers were chosen from those attending the Hepatology Clinic and Internal Medicine Clinic of Alexandria Main University Hospital and Armed Forces Hospital. According to the results of liver biopsy, 36 patients were diagnosed as AIH, one patient as primary biliary cirrhosis [PBC] and the other 3 patients were still undiagnosed. Also, 10 patients with documented diagnosis of non-immune hepatitis B virus in addition to 10 age and sex matched healthy controls were enrolled in this study. Autoantibody profile of ANA, ASMA, AMA, LKM and p-ANCA was measured by indirect immunofluorescent technique [IF] and anti SLA/LP, LKM-1, LC-1 and AMA-M2 autoantibodies were detected by western blot assay. The sensitivity of ANA, ASMA, AMA, LKM, p-ANCA, SLA/LP and LC-1 were 48.6%, 51.4%, 2.7%, 8.1, 56.8%, 18.9% and 10.8% respectively with high specificity [100% for all auto-antibodies except that for ANA 95.7% and ASMA 87%]. However, the overall sensitivity of the complete profile was increased to 100% and specificity was 91.3% from this study we conclude that a complete profile of autoantibodies can be used as a useful tool for the diagnosis of patients with suspected autoimmune liver disease. Anti SLA/LP is an additional specific and diagnostic marker for the diagnosis of AIH type 1 and it remains to be seen whether the seropositivity of SLA/LP may characterize the patients who are more likely to relapse after corticosteroid therapy

Diagnostic value of PRO C global test in patients with deep vein thrombosis

This study was carried out to evaluate pro C Global [PCG] test in clinical routine with special regard to its sensitivity and specificity for factor V [FV] leiden as well as the deficiency of protein C [PC] and protein S [PS]. 70 adult patients with documented diagnosis of deep vein thrombosis [DVT] by Doppler ultrasonography were chosen from those were attending the emergency unit of Alexandria main university hospital and Alexandria armed forces hospital in addition to 30 age and sex matched healthy controls were evaluated for PCG test in relation to gold standard tests i.e. PC activity, PS activity and activated protein C resistance [APCR]. Also determination of lupus anticoagulants [LA] was done for all subjects under study. The sensitivity and specificity of PCG test were [100% and 100%] for FV leiden, [87.5% and 82.3%] for PC and [80% and 78.5%] for PS. The negative predictive value was [100%, 98.1% and 98.1%] for FV leiden, PC and PS respectively. The positive predictive value was [100%, 38.9% and 22.2%] for FV leiden, PC and PS respectively. Also, the diagnostic accuracy was [100%, 82.9% and 78.6%] for FV leiden, PC and PS respectively. The results of LA were negative in all patients and controls. However, the normalized ratio [NR] of PCG test was decreased in [14.8%] of patients group without any detectable defect in PC system and their results were significantly lower than control group [P=0.000]. On the other side, the results were considerably higher than those for the patients with a proven defect in PC system. Pro C Global test is sensitive, specific, less time consuming and can be performed on a routine base. Because of the high negative predictive value, we recommend the use of Pro C Global test in the screening of thrombophilic patients and further determination of F V leiden, PC activity and PS activity is only indicated in case of abnormal Pro C Global results

Clinical evaluation of 2 years experience of epidural analgesia for labor: a retrospective study

The use of epidural analgesia [EA] for labour was introduced to clinical practice in 1931 hesitantly. By time, this method of pain relief has become the first choice for many labouring women. This retrospective study was planned to assess the degree of patient's satisfaction and the incidence of side effects related to EA for labour which was done in United Doctors Hospital in Jeddah over 2 years period. The study demonstrated that maternal satisfaction was affected by maternal age, weight, the source of information about EA, previous experience with epidurals before and the length of delivery. AE did not affect the rate of caesarean delivery and the fetal outcome was excellent. Side-effects recorded included: backache, itching, shivering and vomiting. The overall satisfaction with EA was 93.3% which was comparable to results from other institutions. Epidural analgesia for labour is a well established method of pain relief during labour and should be encouraged to be practiced by anesthetists and to be accepted by more patients as well