Fourth Ventricular Lesions in Metastatic Gliomas: A Rare Predilection?

Over the course of five years, a total of ten cases were collected of glioma patients in whom a distant lesion at the fourth ventricle was noted. A ‘distant lesion’ was defined as a lesion with a normal appearing tissue bridge at imaging between the primary and secondary locations. Previous imaging of these patients was reviewed along with clinical history, course of therapy, and available histology. A review of the literature was performed with respect to present knowledge on patterns of glioma proliferation and dissemination. This case series is the first to describe the fourth ventricle as a location that may be prone to secondary lesions in glioma patients. Further investigation on this subject may yield deeper insights into the mechanisms by which glial tumors spread within the brain, with the hope of developing or improving therapeutic targets.

Pattern of facial gunshot and blast injuries amongst law enforcing forces

Objective: To assesses the pattern of maxillofacial gunshot and blast injuries amongst law enforcing forces personnel

Study Design: Descriptive Study

Place and Duration of Study: Combined Military Hospital Lahore from Jan 2010 to Dec 2010

Materials and Methods: This prospective study evaluated 52 patients from Jan 2010 to Dec 2010 at Combined Military Hospital [CMH], Kohat Pakistan. All patients in this study were males as fighting corps of law enforcing forces comprises only male soldiers and officers. Patients aged from 18 to 50 years with mean age 29.12 years +/- 8.56 years

They were assessed for presence of gunshot and ballistic injuries by clinical examination and evaluation of necessary radiographic investigations

Results: Nineteen patients out of total 52 patients had no other injury which accounts for about 36.9%. In maxillofacial area upper third of face was most frequent site to receive gunshot and ballistic injuries as 10 patients received injuries to upper face which measures about 19.2%. Along with maxillofacial area upper limbs were most common site affected as 14 patients received injuries to upper limbs which is 26.9% of all patients

Conclusion: Gunshot wounds present a great challenge to oral and maxillofacial surgeons and a multidimensional team approach is required to rehabilitate the victims of gunshot injuries

Efficacy of greater auricular nerve block in eliminating pain during mandibular third molar extraction

Pain during mandibular third molar tooth surgery following conventional inferior alveolar nerve block [IANB] is quite common because of sub-optimal analgesia. A double- blind randomized controlled trial was done to evaluate the efficacy of extraoral greater auricular nerve block [GANB] as preemptive analgesia in patient undergoing surgical extraction of mandibular third molar class 2, 3 position B and C. This Study was conducted in minor oral surgical department at Armed Forces Institute of Dentistry from 6th Aug, 2012 to, 5th Feb 2014. A total of sixty patients were divided into two equal groups. Group A received conventional IANB along with GANB while group B was administered IANB only. In group A, 23[76.7%] patients experienced no pain while only 7[23.3%] patients experienced mild pain. While in group B, 6[20.0%] patients experienced no pain, 22[73.3%] experienced mild pain, 2[6.7%] patients experienced moderate pain. The difference was statistically significant [p-value0.0001].Based on this study it was concluded that perioperative pain can be eliminated by preemptive GANB analgesia in deep seated mandibular third molar extractions

Management of obstructive sleep apnea and facial asymmetry by distraction osteogenesis of mandible

Micrognathia and obstructive sleep apnea syndrome [OSAS] are problems subsequent to temporomandibular joint ankylosis [TMJa] in growing patients. For patients with micrognathia and OSAS secondary to TMJa, it is important to restore proper mandibular form and posterior facial height, achieve occlusal stability and satisfactory mouth opening. We report a 2-year follow-up of a patient with Micronesia and OSAS secondary to unilateral TMJ ankylosis of the right side. The patient had an operation of TMJa before she reported to us but mouth opening was limited. The treatment involved vertical ramus osteotomy, coronoidectomy and external distraction osteogenesis of her mandible. After the treatment of micrognathia oropharyngeal airway space was increased, patient was followed up for 2 years and the results remain uneventful

Diagnostic role of EEG in children having unprovoked seizures, experience at the neurophysiology department, The children's hospital, Lahore

Although advances in imaging technology offer ever-increasing diagnostic accuracy, the electroencephalogram [EEG] retains its importance and is the cornerstone for the diagnosis and treatment of epilepsy. A cross-sectional descriptive study was conducted at Neurophysiology Department of The Children's Hospital, Lahore. Our aims were to find out the different types of epilepsies diagnosed on EEG in children referred for interictal EEG with recent clinical diagnosis of epilepsy. Out of 645 children referred for EEG after seizures, 415 [64%] were males and 230 [36%] were females, 21% had their first seizure before one year of age, 54% of them were between the ages of 1-5 years and 46% of them were more than 5 years of age. We found normal interictal EEGs in 54% whereas 46% children had abnormal EEGs. So in addition to supporting the diagnosis of epilepsy, EEG has significant potential to classify epileptic seizures

Neurofibromatosis type II: a rare neurocutaneous syndrome

Neurocutaneous syndromes are heterogeneous group of disorders with abnormalities of central as well as peripheral nervous system. Neurofibromatosis type II [NF-II] is an autosomal dominant neurocutaneous syndrome rarely diagnosed in pediatric population. Diagnosis is based on clinical history and radioimmaging. We present a 14 years old boy with headache and decreased hearing, who turned to be a case of neurofibromatosis type II

Clinical spectrum of typhoid fever in children

One of the most important health problem in Pakistan and other developing countries is Enteric Fever. As the definitive diagnosis of typhoid fever requires certain laboratory tests, emphasis must be given to clinical diagnosis of typhoid fever especially in communities where laboratory services are not available, so that a rapid diagnosis can be made and appropuate treatment started on clinical grounds without waiting for laboratory investigations. A descriptive study was carried out on 80 patients admitted in Paeds Ward Jinnah Hospital Lahore from June 2003 to June 2004 with strong suspicion of typhoid fever. These patients were either blood culture or widal test positive. Out of 80 admitted patients,29 were female and 51 were male. Maximum incidence was seen in children between 5-15 years of age Fever was the most consistent feature in all patients which was mostly high grade and remittent. The important physical findings were coated tongue and hepatosplenomegaly

Hyper IgE syndrome

Hyper immunoglobulin E syndrome is a rare disease. We report a case of a 2, 1/2 years old girl of consanguineous parents who presented with recurrent staphylococcal infections, failure to thrive and death of four siblings with similar illness. CBC revealed a peripheral eosinophilia and serum IgE level was markedly, raised which led to the diagnosis of hyper IgE syndrome

Myotonia congenita in a brother and sister

Myotonia congenita is a rare channelopathy and carries a good prognosis. Two cases of young siblings are presented detected with difficulty in gait and motor activities. Both had typical hypertrophied body musculature. EMG was diagnostic

Tranverse myelitis: Unusual site of involvement

Transverse myelitis is defined as an acute inflammation of spinal cord leading to abrupt onset of weakness of lower limb. In majority of cases, mid thoracic spine is involved. We present a ten year old girl whose cervical spinal cord was involved which is rare. MRI of spine is the investigation of choice

Clinical spectrum of typhoid fever in children

One of the most important health problem in Pakistan and other developing countries is Enteric Fever. As the definitive diagnosis of typhoid fever requires certain laboratory Tests, emphasis must be given to clinical diagnosis of typhoid fever especially in communities where laboratory services are not available, so that a rapid diagnosis can be made and appropriate treatment started on clinical grounds without waiting for laboratory investigations. A descriptive study was carried out on 80 patients admitted in Paeds ward Jinnah Hospital Lahore from June 2003 to June 2004 with strong suspicion of typhoid fever. These patients were either blood culture or widal test positive. Out of 80 admitted patients, 29 were female and 51 were male. Maximum incidence was seen in children between 5-15 years of age. Fever was the most consistent feature in all patients which was mostly high grade and remittent. The important physical findings were coated tongue and hepatosplenomegaly