Enzymatic degradation study of 111In-labeled minigastrin peptides using cathepsin B enzyme and AR42J cancer cell line for the development of neuroendocrine tumor imaging radiopharmaceuticals

Neuroendocrine tumors [NET] are the rare tumors which often impose graveyard threat. These tumors are characterized by the overexpression of various G-protein coupled receptors including cholecystokinin [CCK] receptors-1 and 2 [A or B]. Minigastrin peptides are being investigated for theranostic purposes of CCK-2 receptor positive NET. The minigastrin analogue [APHO70] was modified by engineering enzyme susceptible tetrapeptide sequence into APHO70 peptide to reduce the random degradation by lysosome enzymes which pave the way to random trafficking in patient's body and dipeptide addition at c-terminus. All the four modified minigastrin peptides [MG-CL1-4] were investigated for lysosome cathepsin B [catB] enzyme susceptibility and fate into AR42J cancer cell line. The indium-111 labeled MG-CL1-4 peptides were also studied for target [tumor] and non-target saccumulation by using tumor induced mice. The RP-HPLC analysis result showed nonspecific cleavage of standard 111In-APH070 and 111In-MGCL1 while specific cleavage was noted in case of 111In-MGCL [2-4]. The effect of specific and non-specific cleavage on biodistribution in tumor induced nude mice model indicates the promising accumulation of 111In-MGCL2, 111In-MGCL3, and 111In-MGCL4 radiotracers while 111In-MGCL1 showed less accumulation. 111In-MGCL2 and 111In-MGCL3 showed highest target-to-kidney ratio [T/K] i.e. 1.71 and 1.72, respectively whereas standard compound showed T/K 1.13. In conclusion, the two indium-111 labeled analogues i.e. 111In-MGCL2 and 111In-MGCL3 showed promising sensitivity for tumor and could be tested for further investigation to reach pre-clinical studies

Imminent pathology in microvascular decompression for idiopathic trigeminal neuralgia

Objective: to know about the impending pathology in microvascular decompression for idiopathic trigeminal neuralgia

Methodology: this was a prospective observational study conducted in the Department of Neurosurgery, Lady Reading Hospital Peshawar, from 20[th] August 2012 to 25[th] august 2013. The clinical and the operative records of the patients were noted and demographics such as the age, sex, side of the lesion as well as the per-operative impending pathology i.e. compression by an artery, vein or distortion by adhesions or a combination of them compressing upon the trigeminal nerve root was recorded on a predesigned proforma. All patients undergoing surgery for idiopathic trigeminal Neuralgia were included in the study. Patients who had trigeminal neuralgia secondary to a mass lesion were excluded from the study. The data was expressed in percentages and was analyzed through SPSS version 16

Results: total of 55 patients in the study period fulfilled the criteria. There were 28 males and 27 females with a male to female ratio approaching 1:1. The age range was from 28 to 73 years with a mean age of 54.6 years. In 56.4% the pathology was right sided and in 34.5% it was left sided while in 9.1% it was bilateral [operated unilateral at the time]. The impending pathology was compression by an artery in 76.6%, by a vein in 21.6% or purely by adhesions in 1.6% of cases

Conclusion: compression by an artery is the most common pathology en-countered in the microvascular decompression for trigeminal neuralgia

Spectrum of intramedullary spinal cord tumours: case series of 30 patients

Objective: to assess the frequency of intramedullary spinal cord tumours based on clinical and histological features

Materials and methods: this descriptive study was performed at the Department of Neurosurgery Lady Reading Hospital Peshawar, from 20[th] Jan 2003 to 19[th] Jan 2009. Treatment charts of patients with spinal tumours were reviewed and patients operated for spinal tumours were identified. A total of 30 patients out of 480 cases of spinal tumours with different intramedullary spinal tumours were considered in this study. Their frequency, clinical features, and histological reports were analyzed in different aspects

Results: there were total of 30 patients with mean age of 36 years and a wide range beginning as young as 6years. Seventeen patients [56%] were male and 13[43%] were female. Common presenting complaints were loss of sensation in 24 patients [80%], paresis in 20 patients [66%], altered sensation in 12 patients [40%], back pain 11 patients [36%] and sphincteric disturbances 9 patients [30%]. MRI spine was the main diagnostic tool and was done in 30 [100%] cases. Cervical spine was involved in 12 patients [40%], cervicothoracic 6 patients [20%], thoracic 10 patients [32%], conus 2 patients [08%]. Ependymoma was the most common intramedullary spinal cord tumour 20 patients [60%], while 07 [21%] patients had astrocytoma and 03[09%] had haemangioblastoma. We had follow up of 1 year with follow up visit after every 3 months. Superficial wound infection in 2 [6.66%] patients, CSF leak in 3[10%] cases.Worsening of neurodeficit in 3[10%] patients

Conclusion: ependymoma and astrocytoma constituted majority of cases. Intramedullary spinal cord tumours peak during 3[rd] to 4[th] decade of life

Neurological improvement after cervical traction in patients with cervical spine injury

To estimate frequency of neurological improvement after cervical traction in patients with cervical spine injury. This observational study was conducted at Department of Neurosurgery, Lady Reading Hospital, Peshawar - Pakistan from December 2010 to November 2011. The medical record of all cases, in which cervical traction was applied for cervical spine injury, was checked from record room. Documentation was done according to proforma designed, indicating age, sex, neurological status before and after cervical traction and investigations with findings on X-rays, CT and MRI. The data was analyzed from different angles in SPSS software. A total of 30 patients were included in this study. There were 20 males and 10 females. The age of the patients ranged from 13 to 80 years [mean= 31.07 +/- 15.45]. Majority of the patients [83.3%] were young, in the age range of 13- 40 years. Neurological improvement was noted in 14 [46.7%] patients. It was more in age group of 13-20 years [66.7%] and in those who presented with weakness of Frankle grade "B" and "C" [66.7% each]. The improvement was more in patients in whom anatomical alignment of spine was achieved. Skeletal cervical traction is safe and effective means of early decompression of spinal cord with neurological improvement. It is more effective in young individuals and those presenting with Frankle grade B and C weakness

Immediate symptomatic relief after microvascular decompression for hemifacial spasm: a case series

Hemifacial spasmis a movement disorder characterized by intermittent, involuntary clonic or tonic clonic contractions of muscles innervated by the ipsilateral facial nerve. It is commonly caused by vascular compression of the facial nerve at its Root Exit Zone [REZ] from the brainstem. Anterior inferior cerebellor artery, posterior inferior cerebellor artery, vertebral artery commonly compress the facial nerve. Usual symptoms are progressive involuntary facial twitching. MRI brain and MRA are advised to know about neurovascular compression. Four case of hemifacial spasm are reported diagnosed on clinical grounds, and MRI brain and MRA are advised. Our objective is to assess the surgical outcome of microvascular decompression [MVD] for Hemifacial spasm [HFS]

Unilateral approach for bilateral decompression of lumbar spinal stenosis: a minimal invasive surgery

To assess the feasibility and efficacy of a novel, minimally invasive spinal surgery technique for the correction of lumbar spinal stenosis involving unilateral approach for bilateral decompression. Cross-sectional observational study. Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from January to December 2010. A total of 60 patients with lumbar stenosis were randomly assigned to undergo either a conventional laminectomy [30 patients, Group A], or a unilateral approach [30 patients, Group B]. Clinical outcomes was measured using the scale of Finneson and Cooper. All the data was collected by using a proforma and different parameters were assessed for a minimum follow-up period of three months. Data was analyzed by descriptive statistics using SPSS software version 17. Adequate decompression was achieved in all patients. Compared with patients in the conventional laminectomy group, patients who received the novel procedure [unilateral approach] had a reduced mean duration of hospital stay, a faster recovery rate and majority of the patients [88.33%] had an excellent to fair operative result according to the Finneson and Cooper scale. Five major complications occurred in all patient groups, 2 patients had unintended dural rent and 2 wound dehiscence each and fifth patient had worsening of symptoms. There was no mortality in the series. The ultimate goal of the unilateral approach to treat lumbar spinal stenosis is to achieve adequate decompression of the neural elements. An additional benefit of a minimally invasive approach is adequate preservation of vertebral stability, as it requires only minimal muscle trauma, preservation of supraspinous/intraspinous ligament complex and spinous process, therefore, allows early mobilization. This also shortens the hospital stay, reduces postoperative back pain, and leads to satisfactory outcome.

unusual cause of traumatic brain injury in Khyber Pakhtunkhwa: a case report

Penetrating head injuries can be the result of numerous intentional or unintentional events, including missile wounds, stab wounds, motor vehicle and occupational accidents [nails, iron rods] or assaults [screw-drivers]. Penetrating head injuries caused by screw-drivers constitute only a small part of the total number of traumatic head injuries seen in casualty. We report a case of neuro-trauma who was operated in our institution. A 25 years gentleman presented in casualty on with a screw-driver penetrating into the skull, as an unusual case of violence

Influence on visual deficit after transsphenoidal hypophysectomy for pituitary adenomas

Background: Transsphenoidal surgical exision of pituitary tumor in widely used route

Objective: To determine the effects on visual symptoms after transsphenoidal hypophysectomy for pituitary adenomas

Patients and Methods: This retrospective study was conducted in the department of neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. All patients from January 2006 to January 2011, who underwent transsphenoidal surgery for pituitary adenomas, were included for visual deterioration

Results: During the five years time a total of 65 patients were operated for transsphenoidal adenomas. Four patients were excluded due to various reasons. There were 44 [72.13%] male and 17 [27.87%] female patients. The age ranged from 31 years to 62 years. The mean age was 44 years. There was improvement in visual symptoms in 39 [63.93%] patients immediately after surgery, 13 [21.31%] patients showed improvement in four weeks time, while there was no improvement in 9 [14.75%] patients

Conclusion: The improvement in visual symptoms occurs in majority of the patients after transsphenoidal hypophysectomy. There are several factors which influence the outcome, like duration and size of the lesion