Clinical Significance of Serum Biomarker S100B to Predict Outcome After Traumatic Brain Injury in Adults

Background Traumatic brain injury (TBI) is a common cause of death and disability, worldwide. Early recognition of patients with brain cellular damage allows for early rehabilitation and patient outcome improvement. Serum protein S-100B determinations have been widely suggested the most promising biomarker for TBI. It has been proposed that this marker is useful in a Neurointensive Care Unit (NICU) as a monitoring parameter. The main objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for brain death after severe TBI. Material and methods In this prospective study, the clinical conditions of patients with mild to moderate TBI were assessed and patient serum S100B levels measured within 24h of injury were eligible for inclusion in the study using by electro chemi luminescence (ECL). Patients were admitted to The Govt. Trauma Centre, P.B.M. Hospital, Bikaner in NICU and followed up one month later and evaluated for level of consciousness, presence or absence of post-traumatic headache, and daily activity performance (using the Barthel scale). Student's t-test and the chi-square test were used for the data analysis, which was performed using SPSS software. Result and discussion The mean serum S100B value was significantly lower for patients with minor TBI than for patients with moderate TBI (20.4 ± 12.6 ng/dl and 124.0 ± 235.0 ng/dl, respectively). Patients with normal CT scans also had statistically significantly lower serum S100B levels than patients with abnormal CT findings. The mean S100B value was statistically significantly higher for patients with suspected diffused axonal injury (596.18 ± 502.1 ng/dl) than for patients with other abnormal CT findings (p=0.000): 20.97 ± 19.9 ng/dl in patients with normal CT results; 39.56 ± 21.7 ng/dl in patients with skull bone fracture; 50.38 ± 22.9 ng/dl in patients with intracranial haemorrhage; and 70.23 ± 31.3 ng/dl in patients with fracture plus intracranial haemorrhage. Conclusion Serum S100B levels increase in patients with minor to moderate TBIs, especially in those with diffused axonal injury. However, serum S100B values cannot accurately predict one-month neuropsychological outcomes and performance.

Intraosseous angiolipoma of the frontal bone with a unique location: A clinical and pathological case illustration and review of the literature.

Here, we report a case of a 16-year-old female patient was referred with scalp swelling and headache. Her neurological examination was normal and imaging of the skull revealed a well-defi ned lytic lesion measuring 15 mm × 6 mm to the right of the frontal bone. She was operated on with a prediagnosis of Langerhans cell histiocytosis. A wide excision with negative margins was made and the defect was reconstructed with a titanium plate. Subsequently, the lesion was histopathologically diagnosed as an angiolipoma of the frontal bone. The postoperative period was uneventful and she remained well during 1-year follow-up with no evidence of recurrence. Angiolipomas are rare benign lipomatous lesions located mostly in subcutaneous tissue of the forearm or trunk and frequently occur before puberty or in young adults. They are not common in bones. To the best of our knowledge, this is the fi rst angiolipoma of the frontal bone reported.

Prenatal stress caused by movement restriction induces changes in the development of skull bone in CF-1 mice progeny / El estrés prenatal causado por restricción de movimiento induce cambios en la anatomía ósea de cráneo en la progenie de ratones CF-1

Prenatal stress is associated with changes in body weight and size, and with disorders of the skeletal bone development process. However, there is a lack of documentation on the impact of prenatal stress on skull bone anatomy during the gestation period. Therefore, this research focuses on the short-term effects of prenatal stress on the skull bone anatomy of CF-1 mice on the day of birth. Methodology: Gestating females were divided at random into two groups (control and stressed). The experimental group was subjected to the stress of movement restriction during the final week of gestation. Upon birth the body weight of the progeny was evaluated (control group, n=34; stressed group, n=29). They were then cleaned and stained with alizarin red in order to evaluate the length, width and suture spaces of the skull bone anatomy from superior and inferior views. Results: Gestational stress significantly altered the skull bone anatomy (p<0.05) of the offspring at birth in comparison with the control group. Conclusion: Prenatal stress alters the skull bone anatomy of the CF-1 mouse at birth.

El estrés prenatal se ha asociado con alteraciones en el peso y tamaño corporal, además de trastornos en el proceso de osificación del esqueleto en desarrollo. Sin embargo, existen escasos antecedentes acerca del impacto del estrés prenatal sobre la anatomía ósea craneal durante el periodo de gestación. Por lo tanto, la presente investigación estudió los efectos a corto plazo del estrés prenatal sobre la anatomía ósea craneal del ratón CF-1 en el día de nacimiento. Las hembras gestantes fueron divididas aleatoriamente en dos grupos (control y estresado), el grupo experimental fue sometido a estrés por restricción de movimiento durante la última semana de gestación. Al nacimiento se evaluó el peso corporal de la progenie (grupo control n:34; grupo estresado n:29), para posteriormente diafanizar y teñir con alizarina roja, evaluando dimensiones longitudinales, anchos y espacios suturales de la anatomía de los huesos de cráneo por la vista superior e inferior. El estrés gestacional alteró significativamente la anatomía de los huesos de cabeza ósea (p<0,05) de las crías en el momento del nacimiento con respecto a los controles. El estrés prenatal altera la anatomía de los huesos craneales del ratón CF-1 evaluado al nacer.

Intravascular Papillary Endothelial Hyperplasia (Masson tumor) of the Skull : Case Report and Literature Review

A 10-year-old female patient presented with a rapidly growing nodular mass lesion on her right frontal area. On skull radiography and computed tomography (CT) imaging, this mass had a well-demarcated punch-out lesion with a transdiploic, exophytic soft tissue mass nodule on the frontal scalp. Magnetic resonance (MR) imaging revealed the presence of a 1.5x1.2x1 cm sized calvarial lesion. This lesion was hypointense on T1 and heterogenous hyperintense on T2 weighted MR images, and exhibited heterogeneous enhancement of the soft tissue filling the punch-out lesion after intravenous administration of gadolinium. En block removal of the tumor with resection of the rim of the normal bone was performed. The pathological diagnosis was intravascular papillary endothelial hyperplasia (IPEH). After surgery, no recurrence was found for 8 months. IPEH is a rare and benign reactive lesion usually found in thrombosed subcutaneous blood vessels. Involvement of skull bone is rare. In this article, we present a case of IPEH involving the calvarium, in a 10-year-old woman.

Disseminated tuberculosis and skull involvement in a non-immunocompromised child.

An unusual presentation of disseminated tuberculosis with lymphadenopathy, cutaneous lesions and skull bone involvement in a non-immunocompromised child.

Plastic surgery for managing skull bone defects using “infost-2”carbone composite in St Paul Hospital

From October 1997 to December 1998, 64 patients with defect of skull vault bone were divided into 2 groups. The 1st group of 33 patients underwent an orthopedic surgery to recreate the defect using their self exploited bone and the 2nd using the carbone composite flap. The technique of use of carbone composite was not complicated and can be applied in any surgical institution which had used to conduct emergency surgery of skull and brain. The priorities in indication must be given to large and very large defect.

Case of Tuberculosis of the Skull, Presenting as Osteolytic Lesion: Case Report

Tuberculosis of the skull bone tuberculosis is a very rare disease. We report a case occurring in a 52 year-old male was referred to us because of headache and painful swelling in the right frontal area. Plain chest x-ray revealed fibrous, streaky, nodular, patchy opacities in the LUL together with pleural effusion. Plain skull x-ray and CT scan demonstrated osteolytic lesion in the right frontal bone; scanning showed hot uptake by the right frontal area, and this corresponding to skll findings revealed by plain film. After frontal craniotomy the involved bone flap and epidural abscess were removed. Pafthologically, typical granulomatous inflammation was seens; this was composed of caseation necrosis, epithelioid cells and surrounding lymphocytes and plasma cells.

A Case of Skull Bone Tuberculosis: Case Report

Tuberculosis originating in the skull bone is rare. We report a case of skull bone tuberculosis. A 72 year-old female was referred to us because of headache, swelling and tenderness in the left parietal area. She has been treated interstitial pulmonary fibrosis and pleural effusion at the department of internal medicine. Plain skull X-ray and CT scan revealed a 1.5x1.5 cm sized osteolytic lesion in the left parietal bone. Bone scan demonstrated a lesion of hot uptake in the left parietal region. After a left parietal craniotomy was performed, the involved bone flap and granulation tissue that attached to the dura mater were removed. Pathologic findings showed granulomatous inflammation with central caseous necrosis and peripheral collar of epithelioid cell interspersed with lymphocytes. A brief review of the literature was given.

A Case of Cylindroma

Cylindroma has been called dermal eccrine cylindroma and turban tumor since it was first described by Ancell in 1842. These tumor usually begin as small nodules and continue to grow slowly up to serveral centimeters. The tumor most commonly appears on scalp and face. They have been given the name turban tumor because they sometimes have covered the entire scalp like a turban. The tumor rarely undergone malignant degeneration. We have found a case of cylindroma that have malignant change with skull bone involvement, thus we present this case with review of the other reports.