Craniopharyngioma in a patient with acromegaly due to a pituitary macroadenoma

We present the first reported case of a craniopharyngioma as a second primary tumor in a patient with acromegaly due to a growth hormone [GH]-secreting pituitary adenoma. The patient was lost for follow-up for 18 years after trans-sphenoidal pituitary surgery for a GH-secreting pituitary adenoma. She presented with headaches and decreased visual acuity, and showed unsuppressed GH in an oral glucose load test with high IGF-1 levels. Brain MRI showed a suprasellar cystic mass and the patient underwent surgery for cyst drainage resulting in postoperative improvement in her vision. Biopsy of the mass confirmed the diagnosis of a craniopharyngioma. We stress the need for close follow-up of patients with acromegaly with adequate control of GH and IGF-1 levels

Oxidant/antioxidant status and immunoglobulin levels in patients with primary brain tumors before and after surgical intervention

To assess serum level of malondialehyde [MDA], total antioxidant status [TAS] as a representative of oxidative stress, with immunoglobulin levels [IgG, IgA, IgM] in patients with primary brain tumors at diagnosis and one month after surgical resection in comparison to healthy controls. The study was conducted in Iben-Seena Hospital in Mosul city Iraq. Thirty-seven patients with primary brain tumors were included in the study, later proved by histopathology to be cases of meningioma [24 cases] and glioma [13 cases]. Also included 32 apparently healthy, age and sex matched subjects as a control group. Initially, blood samples were taken from both the patients and controls and assessment of serum MDA, TAS and immunoglobulin levels [IgG, IgA, IgM] were done, later for the patients group one month after surgical resection of the tumor another blood samples were taken and assessment of the same parameters mentioned above were done again. Serum MDA was found to be significantly higher [p<0.001] and serum TAS was significantly lower [p<0.001] in patients with primary brain tumors [both meningioma and glioma] prior to surgical resection in comparison to controls. Postoperatively, there was a significant reduction [p<0.001] in serum MDA levels with an increase in TAS [which was slightly significant in gliomas and insignificant with meningiomas]. With regard to serum immunoglobulin levels, there was a significant increase in serum IgG [gliomas p<0.05; meningioma p<0.001] preoperatively compared with controls, with a significant reduction [p<0.001] in the serum levels of IgG, IgA and IgM postoperatively in comparison to preoperative values. Primary brain tumors [both meningioma and glioma] as a disease carry a substantial effects on oxidant/antioxidant status and on serum immunoglobulin levels as part of the humoral immunity so as the surgical removal of the tumor mass as a way of therapy

Outcome of anterior cervical discectomy with cage in cervical disc degeneration

This study evaluates the efficiency and outcome of interbody polyetheretherketone [PEEK] cage implantation in 50 consecutive cases treated, for cervical disc degeneration. This work was conducted in Assiut University Hospital, Neurosurgery Department over 3 ears duration from 2006 to 2009. Fifty patients with cervical disc disease, were treated with cervical discectomy and Cervical interbody fusion using a PEEK cage. PEEK cages were packed with demineralised bone grafts or synthetic bone grafts. Additional plating was not used in any case. The median duration of follow-up was 12 Months [range, 6-36 months]. Cervical x-rays were routinely used in the follow-up to assess the fusion pseudoarthrosis, kyphosis, cage migration, subsidence or breakage. There were 39 male and 11 female patients and the mean age 45 years [range, 30-60 years]. No implant insufficiency or significant complications was observed in any case. The use of a cervical PEEK cage seems to be a good way that does not require additional anterior plating and bone graft harvesting/or achieving cervical interbody replacement. Anterior cervical discectomy and interbody fusion is an effective treatment for radicular pain in selected patients with cervical disc disease after six months follow up. Because of similar clinical outcomes and lack of donor site morbidity when using PEEK, we now prefer fusion with PEEK cage to autologous iliac crest graft

Prevalence of dyslipidemia in patients with type 2 diabetes in Jordan

To determine the frequency and patterns of dyslipidemia in patients with type 2 diabetes mellitus [DM] and to estimate the effects of sociodemographic and clinical variables on dyslipidemia. The setting took place in The National Center for Diabetes, Endocrinology and Genetics [NCDEG] at the University of Jordan, Amman, Jordan. The NCDEG is the only referral center in the country; therefore, the patients represent the population in different parts of the country. A cross-sectional design was used. A total of 702 patients with DM from the NCDEG aged >/= 20 years were consecutively enrolled between June 2005 and July 2006. Medical record abstraction of sociodemographic, clinical, and laboratory data was performed. The frequency of hypercholesterolemia was 77.2%, low high-density lipoprotein [HDL] was 83.9%, high low-density lipoprotein [LDL] was 91.5%, and hypertriglyceridemia was 83.1%. Females had greater abnormalities in lipid profiles. High LDL-cholesterol was the most common dyslipidemia in combination [91.5%] and in isolation [12.8%]. Gender and hemoglobin A1C [HbA1c] predicted high total cholesterol; age and hypothyroidism predicted low HDL-cholesterol, gender predicted high LDL-cholesterol; and use of beta-blockers predicted high triglycerides. Over 90% of patients with type 2 DM had one or more types of dyslipidemia. The most common dyslipidemia in our study was high LDL-cholesterol and high triglycerides as reported in the literature. We recommend aggressive drug management, education, counseling, and behavioral interventions

Diabetes mellitus: the leading cause of haemodialysis in Jordan

This study aimed to define the role of diabetes mellitus as a cause of end-stage renal disease requiring haemodialysis in Jordan, and to compare diabetic and nondiabetic patients. All patients on haemodialysis in Jordan at the time of the survey in 2003 [n = 1711] were personally interviewed and additional data were obtained from medical records. Diabetes mellitus was the most common cause of end-stage renal disease [29.2% of cases]. The mean age of patients was higher in diabetics [57.5 years, standard deviation [SD] 12.3] than nondiabetics [45.4 years, SD 17.1]. Duration on haemodialysis was significantly shorter in diabetics compared to nondiabetic patients

Septic arthritis of the hip in childern - Aga Khan University Hospital experience in Pakistan

To present clinical, radiological and bacteriological features and short term outcome of septic arthritis of the hip in children. There were 23 male and 16 female children, including 6 neonates and 10 infants with a mean age of 3.9 years. Diagnosis of septic hip was made on clinical grounds, supplemented by X-rays, leukocyte count and the erythrocyte sedimentation rate [ESR]. Thirty nine patients with 40 hips were followed for a mean time period of 76 weeks. All patients had a positive joint aspirate [pus] and underwent surgical decompression alongwith intravenous antibiotic therapy. Symptoms of pain, fever and restricted range of hip motion were common to all patients. The mean leukocyte count was 14,000 and the mean ESR was 63 mm. Cultures of blood and joint aspirate were positive in 9 and 28 patients respectively. Staphylococus Aureus was the commonest organism [14 patients] identified, and only one patient had Hemophilus Influenzae. Seven patients had a mixed osteoarticular infection. Positive clinical response was noted in the mean time period of 8.6 days. In follow-up, four cases developed myositis ossificans and 2 cases showed signs of partial growth plate destruction. Our findings of the absence of H. Influenzae and the presence of a number of gut organisms are different from the previous studies. Duration of symptoms was an important prognostic factor and correlated well with the final outcome. Early surgical decompression was found to be the treatment of choice. A combined osteoarticular infection should be kept in mind in cases which show a poor response after the initial joint debridement

CT-guided percutaneous biopsies of parapharyngeal space lesions

Fine needle aspiration biopsy [FNA] of superficial and deep-seated lesions of the head and neck has been used extensively with high sensitivity and specificity. Several articles have stressed the role of computed tomography in detecting and staging head and neck tumors. FNA has been paired with imaging guided localization for the cytologic assessment of lesions in the parapharyngeal space. This work presented a series of 30 CT-guided percutaneous biopsies performed between January 1997 and January 2000 at Assiut University Hospital. The age of the patients ranged from 13 to 60 years [mean 37] with 21 males and 9 females. Analysis of the results showed 8 inflammatory lesions, 12 benign tumors and 10 malignant neoplasms. Correlation with histopathology of true-cut needle or incisional biopsy showed a diagnostic accuracy of 88.0% but certain lesions could not be diagnosed by this procedure. FNA can replace incisional biopsy, which may be hazardous in this area. Surgery can be avoided for inflammatory lesions