Posterior fossa tumor in children

Primary brain tumors are the most common solid neoplasms of childhood, representing 20% of all pediatric tumors. The best current estimates place the incidence between 2.76 and 4.28/100,000 children per year. Compared with brain tumors in adults, a much higher percentage of pediatric brain tumors arise in the posterior fossa. Infratentorial tumors comprise as many as two thirds of all pediatric brain tumors in some large series. Tumor types that most often occur in the posterior fossa include medulloblastoma, ependymoma, cerebellar astrocytoma and brainstem glioma. All pediatric cases of posterior fossa tumor that were considered for surgery from 1981 to 2011 were selected and the demographic data including age, gender and tumor characteristics along with the location and pathological diagnosis were recorded. The surgical outcomes were assessed according to pathological diagnosis. Our series consisted of 84 patients [52 males, 32 females]. Cerebellar symptoms were the most common cause of presentation [80.9%] followed by headache [73.8%] and vomiting [38.1%]. The most common histology was medulloblastoma [42.8%] followed by cerebellar astrocytoma [28.6%], ependymoma [14.3%], brainstem glioma [7.2%] and miscellaneous pathologies [e.g., dermoid, and tuberculoma] [7.2%]. The diagnosis of brain tumors in the general pediatric population remains challenging. Most symptomatic children require several visits to a physician before the correct diagnosis is made. These patients are often misdiagnosed for gastrointestinal disorders. Greater understanding of the clinical presentation of these tumors and judicious use of modern neuroimaging techniques should lead to more efficacious therapies

Head Injury

This article aims to provide an overview of the epidemiology, medical and rehabilitation issues and recent advances and emerging practices. We also intended to assess the validity of trials in head injury and find the generalized concepts according to their results. All randomized controlled trials on the treatment and rehabilitation of patients with head injury published before November 2010 was surveyed. Data was extracted on the number of participants, use of blinding, loss to follow up, and types of participants, interventions, and outcome measures. Until November 2010, using several search engines, 479 reports were identified. The average number of participants per trial was 92. No trials were large enough to detect reliably a 5% absolute reduction in the risk of death or disability. Of 226 trials assessing disability, 211 reported the number of patients followed up, and average loss to follow up was 19%. Of trials measuring disability, 26% reported that outcome assessors were blinded. Randomized trials in head injury are too small and poorly designed to detect or refute reliably moderate but clinically important benefits or hazards of treatment. Limited funding for injury research and unfamiliarity with issues of consent may have been important obstacles

Neuropsychological disorders in patients with brain tumor

Very few studies have utilized specific criteria to assess mental disorders in brain tumor patients. This study aimed to diagnose mental disorders in this population using DSM-IV [depression, sleep, and mood] criteria. From March 2007 to July 2009, the surgically treated patients with intracranial neoplasm were included in the study. These patients were examined in an ambulatory neuro-oncology clinic setting using a structured psychiatric interview which followed current DSM-IV diagnostic criteria. This study is based on the clinical data of 89 patients with brain tumor. The mean age was 42.2 years old. Fifty five percent [55%] of the patients were male. In our study, the prevalence of mild depression was about 30% for males and 38% for females. Before tumor operation, severe anxious as well as severe obsessivecompulsive symptoms were present in 14% of males. In females, 29% of the subjects had reported to have severe anxiousness and 25% severe obsessive symptoms. Depressive symptoms as well as anxious and obsessive psychopathology were shown to be prevalent signs among patients with brain tumor. The associated factors are tumor location, patient's premorbid psychiatric status, cognitive symptoms and adaptive or maladaptive response to stress

Depression in the nurses of the special wards versus nurses of the general wards, a comparative study

Depression is one of the most common and serious disorders that threaten human physical and psychological health. The incidence of depression in nurses who work in special wards compared to general wards has been debated for a longtime. In this study, we planned to compare the rate of depression and related factors between these two groups. Questionnaires about demographic factors, duration of daily work time and marital status were distributed randomly among 200 nurses working in special wards and 200 nurses working in general wards in 3 hospitals affiliated to Shahid Beheshti University [Modarres, Taleghani, Shohadaye Tajrish hospitals] in the summer and autumn 2006. The causes of admission of the patients were determined to assess their role in the occurrence of depression. To analyze depression, Beck depression inventory [BDI] score was used and the related intervening factors were compared between the two groups. The two groups were similar in sex [p=0.12], duration of daily work time [p=0.18] and marital status [p=0.23]. The major cause of admission in special wards was malignancy [33.3%] which was significantly higher than the rate of cancer patients in general wards [7.8%, p=0.03] [Table 1] Mean BDI score in special wards' nurses and in general wards' nurses was 9.3 +/- 7.36 and 1 +/- 6.66, respectively. All nurses had some degrees of anxiety and stress, but there was no significant difference in the incidence of depression; however, it seems that exposure to numerous stressful experiences over a life time of nursing and a lack of control over these experiences contributed to the high level of anxiety and depression seen in all nursing groups. Although the intensive wards' nurses were more involved with cancer patients compared to general wards' nurses, the rate of depression did not show any significant differences in the two groups. Therefore, dealing with hopeless cancer patients did not increase the rate of depression in intensive wards' nursing stuff and the intensive care environment does not seem to be more stressful for nursing staff in comparison with general care units

[Lateral sacral meningocele presentation as a gluteal mass]

Lateral meningocele is a rare spinal dysraphism known to occur in patients with neurofibromatosis or Marfan's syndrome. Although this commonly occurs in the thoracic or sometimes in the cervical region, localization at the sacral spine is very infrequent. In this paper we present our case with isolated lateral sacral meningocele with spinal communication through iliac bone. In addition, a review of literature associated with this entity is presented

Disproportionate correlation between imaging and outcome in an infant with cerebral abscess

Brain abscesses represent organized foci of suppuration within the parenchyma. Here we report a 3 month-old girl with a very huge complicated cerebral abscess, and the course of treatment given. The patient's recovery was excellent. The follow up MRI showed only subtle porencephalic changes as the only parenchymal sequelae, which may be due to CNS plasticity in infants

Pediatric head injury

Minor trauma to the head is common in childhood and does not require any medical or surgical treatment. Nevertheless, head injury in infancy and childhood is the single most common cause of death and permanent disability. Measurable deficits occur even after mild to moderate head injury but are markedly greater after severe injury. They include impaired cognition, motor impairments, disruption of attention and information processing, and psychiatric disturbances. Despite the frequency of the sequelae of head injury in childhood, there is relatively little information about the structural basis of the clinical deficits. Classical literature suggests that the immature brain and its coverings, at a time when it is rapidly acquiring new information, respond differently from the adult brain when subjected to an equivalent amount of mechanical force, whether mediated by contact or inertial loading. Identification of different patterns of injury in different age groups has resonance in clinical practice and now provides a reference point for future clinical and neuropathological studies. This work not only provides the basis for the future management of patients, but also serves to remind us of the continuing value of the autopsy and the proper examination of retained organs using modern standardized techniques

Assessment of medical education quality in Tehran University of medical sciences and health services

Teaching assessment is a process of collecting and analyzing data in order to make a judgment on merits and limitations of a teaching program. Thus, assessment would be an important and practical instrument to improve teaching quality. The main objective of the research is quality improvement of medical education, and specific objectives are set as study of output factors of the educational system, management of educational planning, trainees [students, stagers, interns and residents], faculty members, educational facilities and equipment, educational environments and graduates' satisfaction. This study was designed as a cross sectional and an analytical descriptive survey. Research and development method as well as survey research have been used in this study. Of all graduated general practitioners, 82% were male and 18% were female. The course average score was between 15 and 16 for 48.1% of the subject graduates. Of graduated GPs, 38.1% consider the basic sciences courses as the strength points in their studies, and 60.8% consider internship course as a weak period in their education. Of all graduated GPs, 81% were satisfied with their education in the School of Medicine