Clinical outcomes following surgical management of brain abscess in a tertiary care centre: retrospective analysis of 56 cases

Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse.

Microneurosurgical aspects in the management of posterior cranial fossa epidermoids: experience of 24 cases

Background: There is considerable debate in the surgical management of epidermoid cyst, whether gross total or subtotal resection yields better long term outcomes. We present our institutional experience in evaluating the clinical presentation, diagnosis, and surgical strategy and extent of resection in the management of posterior cranial fossa epidermoid cyst.Methods: A retrospective review of 24 patients diagnosed with posterior cranial fossa epidermoid tumors surgically treated at the institution between January 2010 and July 2019.Results: A total of 24 patients who underwent surgery for intracranial epidermoid lesions were identified. Of these 13 were in the Cerebellopontine angle region, eight were in the fourth ventricle, and three in lateral cerebellar convexity. The mean duration from onset of symptoms to surgery was 1.6 years. Cranial nerve dysfunction was noted in 73% of patients preoperatively, most of them being the CPA epidermoids. Total removal was achieved in 16 patients, near-total resection in 6 patients, and subtotal removal in 2 patients. Three patients developed recurrence radiologically of them only one patient became symptomatic. The mean duration of follow-up was 3.8 years. The content of the tumor was pearly white material in all cases. Complications noted in the present series were not related to the completeness of excision. Mortality was noted in one patient.Conclusions: The present study highlights various precautions to be taken intraoperatively in the prevention of development of aseptic meningitis and concludes that total removal of epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection of lesions that are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence. An endoscope can be used to assess the completeness of surgery.

A comparative study on placebo and trenaxamic acid for the prophylaxis is of post-partum hemorrhage: a randomised double-blind control study

Background: Obstetric haemorrhage accounts for 20-25% of maternal mortality and morbidity. Anti-fibrinolytics are being widely used in field of surgery. It is also used to reduce heavy menstrual blood loss. The aim of this study was to analyse the effectiveness of TXA in reducing blood loss during normal vaginal delivery.Methods: The randomized double-blind control study was done in the Labour ward. It was conducted on 100 women undergoing Normal vaginal delivery. They were allocated to either Study or Control group by randomization. TXA was given during the Third stage of delivery in study group in addition to the routine care whereas the control group had routine care alone. Blood loss was measured in both groups by bag method.Results: The significant of reduction in blood loss calculated from placental delivery to 2hrs. 141.9 ml in study group versus 270.4 ml in control group. Among primi patients, the control group average blood loss was 325ml, the study group avg blood loss was 169ml. Among G2 patients, the control group average blood loss was 248.5ml. The study group average blood loss was 128.25ml. Among G3 patients, the control group average blood loss was 203ml, the study group average blood loss was 115ml.Conclusions: TXA significantly reduced the amount of blood loss during normal vaginal delivery. Thus, TXA can be used safely and effectively in subjects undergoing normal vaginal delivery.

Effect of roscovitine on developmental competence of small follicle-derived buffalo oocytes

Background & objectives: The lower recovery of competent oocytes in buffalo species limits the commercialization of in vitro embryo production technology in field condition. In this context, pre-maturation of small follicle (SF)-derived oocytes with meiotic inhibition may be a promising alternative to obtain more number of competent oocytes. Thus, the present study was conducted with an objective to enhance the developmental potential of less competent SF-derived buffalo oocytes. Methods: All the visible follicles (used for aspiration) from buffalo ovaries were divided into two categories: large follicle (LF) (follicles having diameter ?6 mm) and SF (follicles of diameter <6 mm). The competence of LF and SF oocytes was observed in terms of brilliant cresyl blue (BCB) staining, cleavage rate, blastocyst rate and relative gene expression of oocyte and blastocyst competence markers. Thereafter, less competent SF oocytes were treated with 0, 12.5, 25, 50 and 100 mM doses of roscovitine (cyclin-dependent kinase inhibitor) to enhance their developmental potential. Results: Based on parameters studied, LF oocytes were found to be more competent than SF oocytes. Pre-maturation incubation of SF oocytes with roscovitine reversibly arrested oocyte maturation for 24 h to ensure the proper maturation of less competent oocytes. A significantly higher number of BCB-positive oocytes were noted in roscovitine-treated group than SF group. Cleavage and blastocyst rates were also higher in roscovitine-treated group. The relative messenger RNA expression of oocyte (GDF9, BMP15, GREM1, EGFR, PTGS2 and HAS2) as well as blastocyst (INF-?, GLUT1 and POU5F1) competence markers was significantly greater in roscovitine-treated group relative to SF group. Again, on comparison with LF group, these parameters depicted a lower value in the treatment group. Interpretation & conclusions: The findings of this study has revealed that pre-maturation incubation of SF-derived oocytes with 25 ?M roscovitine can improve its developmental competence and thus can be utilized to get maximum number of competent oocytes for better commercialization of in vitro embryo production technology in buffalo.

Evaluation of thyroid functions in critically ill infants.

The degree to which thyroid functions are affected by non-thyroid illness and an assessment of its correlation with mortality was evaluated. Thirty infants (20 M, 10 F) with a mean age of 433 +/- 3.28 months (+/- 1 SD), with severe acute systemic illness and 30 healthy controls, age and sex matched, were studied for total serum T3, T4 and TSH levels at admission and recovery or before death. Serum thyroid hormones were measured using standard techniques. There was no significant change in thyroid indices with age, sex, nutritional status, serum protein and C-reactive protein. Serum T3 levels in infants were significantly lower (0.62 +/- 0.63 ng/ml) than the controls (1.90 +/- 0.62) (p < 0.001), with normal T4 and TSH levels at admission. Both serum T3 and T4 levels increased with recovery. Out of 30 infants studied, 14 died whereas 16 were discharged. It was noticed that T3 and T4 values were significantly reduced at or near death when compared with the admission levels (p < 0.001). Prognosis could not be determined at the time of admission, as thyroid indices at admission of patients who died, when compared to infants who were discharged, showed no significant difference in T3, T4 or TSH levels. The above mentioned changes in thyroid indices probably occur as a temporary adaptive mechanism to limit catabolism in states of stress such as infection. Hence, it is suggested that thyroid function tests be interpreted with caution in patients with non-thyroid illness.

Torsional Kestenbaum in congenital nystagmus with torticollis.

Surgery in idiopathic congenital nystagmus to correct an abnormal head posture is based on the shifting of neutral point. Torsional Kestenbaum has been done in cases of congenital nystagmus with torticollis, without definite localisation of null point and sustained improvement of head posture subsequent to surgery has been attributed to presumed shift of the null point. We present a 6 year-old boy with congenital horizontal nystagmus with marked head tilt towards the left shoulder. Electronystagmography showed dampening of nystagmus on left tilt. Recession/advancement of all four oblique muscles was done to shift the null point and nystagmus dampened in the primary position eliminating the head tilt. This report emphasises the significance of electronystagmography in critical decision of horizontal/torsional Kestenbaum and documentation of innervational changes following surgery and subsequent followup.

Angiotensin induced changes in blood glucose level.

Angiotensin given by intravenous route in rabbits caused a marked rise in blood glucose within 45 min. Guanethidine, bretylium, alpha methyl DOPA, adrenalectomy and reserpinization significantly influenced the changes in blood glucose induced by angiotensin II. It is suggested that the rise in blood glucose level induced by angiotensin II appears to be mediated by facilitation of catecholamine release or due to inhibition of reuptake.

Modification of vascular response to synthetic oxytocin by oestrogen in rabbit.

Intravenously administered oxytocin caused a dose-related fall in blood pressure of the rabbit. When oxytocin was administered in oestrogen-primed animals, the depressor response was converted to a pressor one "Oxytocin reversal". The "oxytocin reversal." was abolished after treatment with dihydroergotamine, hexamethonium or adrenalectomy. The "oxytocin reversal" did not appear in reserpinized animals.

Effect of insulin on blood cholesterol.

The effect of plain insulin was studied in normal mongrel dogs on blood cholesterol level. Intravenous administration of plain insulin in different doses on different groups of dogs does not cause any significant change in blood cholesterol level over a period extending upto 5 hrs. Exogenous insulin neither has any direct nor indirect effect on cholesterol metabolism in dogs.

Role of catecholamines in angiotensin induced hyperglycaemia.

The effects of angiotensin II were studied on blood sugar level in dogs. Intracerebroventricular administration of pressor dose of angiotensin caused a rise in blood sugar level. The hyperglycaemia and pressor response was not affected by bilateral vagotomy and was less marked in adrenalectomized dogs. The hyperglycaemic effect and pressor response was not observed in reserpinized and spinal vagotomized dogs. It is suggested that centrally administered angiotensin stimulates the hypothalamic or medullary accelerator neurons (central sympathetic structures) to cause a marked release of catecholamines from peripheral stores specially adrenal medulla. This excessive release of catecholamines is responsible for hyperglycaemia and pressor response of angiotensin II in dogs.