Surgical repair of congenital diaphragmatic eventration in a septugerian lady / Reparo cirúrgico de eventração diafragmática congênita em paciente septuagenária

Congenital diaphragmatic eventration in an elderly is a rare anomaly. We describe a case of congenital diaphragmatic eventration causing respiratory insufficiency in a 72 year lady who underwent successful surgical repair.

A eventração diafragmática congênita em um idoso é uma anomalia rara. Descrevemos um caso de eventração diafragmática congênita que causava insuficiência respiratória em uma idosa de 72 anos, que passou, com sucesso, por uma cirurgia de reparo.

Spine revisited: principles and parlance redefined.

A revised appreciation of the evolution and the nature of bone in general and of vertebrae in particular, allows revisiting the human spine to usher in some new principles and more rational parlance, that embody spine's phylogeny, ontogeny, anatomy and physiology. Such an approach accords primacy to spine's soft-tissues, and relegates to its bones a secondary place.

Ocular side effects of antitubercular drugs - a focus on prevention, early detection and management.

Given the increasing prevalence of tuberculosis, antitubercular drugs frequently used are also associated with ocular toxicity. Ethambutol is the most commonly implicated drug. It is generally well tolerated, but known to cause optic neuritis, more specifically retro bulbar neuritis causing blurred vision, decreased visual acuity, central scotomas, and loss of red-green color vision. The exact mechanism of toxicity is not understood. Though optic neuritis due to ethmabutol is generally considered to be reversible upon prompt discontinuation of the drug, there are reports of reversible toxicity, particularly in the elderly population. Isoniazid can rarely cause retro bulbar neuritis. Dose relationship is usually not seen. Streptomycin is known to cause pseudo tumorcerebri. Thiacetazone can produce severe cutaneous reactions including Steven Johnson Syndrome affecting the skin and mucosa including conjunctiva. Educating the patients for early detection of the ocular manifestations and regular follow-ups are very essential.

Non-Hodgkin's lymphoma of the brainstem with atrial septal mass.

Simultaneous occurrence of cardiac and central nervous system tumors have been rarely reported. A 23 years male presented to us with right cerebello-pontine (CP) angle symptoms and signs. Cranial imaging showed a mass lesion in the right pons infiltrating into the right and middle cerebellar peduncles. There was also a cardiac-atrial septal mass. The brainstem lesion was found to be a non-Hodgkin's lymphoma where as the cardiac lesion was not accessible. Central nervous system lymphomas are reported rarely and the prognosis is poor. The chances of the cardiac lesion in this patient also being a lymphoma are high, as it was a infiltrative cardiac mass, infiltrating the atrial septum.

Unimicrobial appendicitis due to non-vaccine serotype of streptococcus pneumoniae: Implications for and management and prevention.

The aetiology of appendicitis is usually polymicrobial. We report a rare case of appendicitis caused by Streptococcus pneumoniae as the only causative organism. The case assumes significance because it occurs in the absence of any predisposing factor for invasive pneumococcal infection, it is unimicrobial, it may lead to the misdiagnosis of primary peritonitis due to pneumococcus, and it undermines the efficacy of polyvalent pneumococcal vaccine.

Percutaneous trigeminal ganglion balloon compression: experience in 40 patients.

Forty patients of trigeminal neuralgia were treated with percutaneous trigeminal ganglion balloon compression. Symptoms had been present since six months to twenty years. The age ranged between 23 years and 73 years. All the patients had immediate relief from pain. Two had already undergone trigeminal cistern rhizolysis. One patient had foramen ovale stenosis. After the procedure, all the patients had mild to moderate degree of ipsilateral facial sensory loss which included buccal mucosa and anterior 2/3rd of the tongue. Facial dysaesthesia (anaesthesia dolorosa) was seen in only one case, who had mild involvement lasting one week. Thirty patients had altered taste sensation, probably due to general somatic sensory loss. Five patients had herpes perioralis. In this study group, two patients had already undergone microvascular decompression. All the patients were followed for a period ranging from one to eighteen months. Balloon compression technique seems to be better than injection of alcohol, glycerol or radio frequency lesion. Recurrence of pain was noted in 3 patients after one year.

Throat carriage of pneumococci in healthy school children in the Union Territory of Pondicherry.

BACKGROUND & OBJECTIVES: Colonisation of Streptococcus pneumoniae in the throat is common among children the world over. Little is known about the relationship of nasopharyngeal carriage and invasive disease or the way it spreads within the households and close confines. There is a paucity of data on the colonization of Strep. pneumoniae in the throat of healthy children in India. To determine the prevalence of pneumococcal carriage in school children of urban and rural Pondicherry, a study was undertaken. METHODS: Throat swabs of healthy school-going children between 5-10 yr of age were examined for pneumococcal carriage, by standard bacteriological techniques. RESULTS: A prevalence rate of 24.3 per cent was noted. There was no difference in the carriage rate among the rural children when compared to urban children. No age, sex or geographical predilection of pneumococcal carriage was noted. A statistically significant seasonal variation, however, was seen. Carriage rate increased during the colder months and was found to be the highest in the months of March and November. INTERPRETATION & CONCLUSIONS: Strep. pneumoniae circulates in the community among healthy children. Carriage rate is influenced by seasonal variation.

Bacterial contamination of anterior chamber during IOL surgery.

PURPOSE: To study the nature and frequency of bacterial contamination during cataract surgery. METHODS: The preoperative smears from the conjunctiva and anterior chamber (AC) fluid aspirates during extra-capsular cataract surgery (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in 40 eyes were analysed for aerobic and anaerobic bacteria. Any change in the bacterial strains isolated before and after cataract surgery was also studied. RESULTS: AC fluid aspirates were positive for bacteria in 15 eyes (37.5%). Coagulase-negative Staphylococcus was the most common aerobe (39.4%) and Propionibacterium acnes the most common anaerobe. Of the 15 cases with positive AC fluid cultures, 6 showed an organism in the AC aspirate different from the conjunctival smear. CONCLUSION: Clinically there was no endophthalmitis in any of the eyes. Factors such as preoperative antibiotic use, the antibacterial properties of aqueous, or low inoculum size could explain this. The preoperative conjunctival smear may not be useful in predicting the AC fluid contamination or outcome of cataract surgery.

Chemotherapy trial in paucibacillary leprosy using clofazimine.

In a double blind study, 300 PB patients (smear negative, indeterminate, tuberculoid and borderline tuberculoid) were randomly allotted to two regimens, the control subjects (150 patients) receiving the standard WHO multidrug regimen of six doses of once a month rifampicin with daily dapsone therapy for six months, while the study group (150 patients) receiving 50 mg of clofazimine daily for six months in addition to the WHO regimen. After stoppage of therapy all the patients were followed up on placebo. The regimens were well tolerated. In 7.5% of patients on clofazimine containing regimen, the lesions showed persisting activity at the time of stoppage of therapy, compared with 16% on the control regimen. This activity subsided spontaneously, more rapidly, in the study group (80% compared with 30% in the control group) in six months. Two patients in the control group and one patient in the study group developed late reaction. There were no relapses in the study group, whereas, two patients have relapsed in the control group during a follow-up of 2.5 to 3.5 years.

Biomechanics and head injury outcome.

On the basis of biomechanical principles, common head injuries can be classified into acceleration injuries characterised by a predominant diffuse cerebral injury and contact injuries characterised by a predominant focal injury. In a follow-up of 174 head injured patients, it was found that patients with acceleration injuries evinced a longer duration of coma, lengthier post-traumatic amnesia, and less number of skull fractures. Organic behaviour syndromes were seen mostly in acceleration injuries. During the prospective follow-up of 141 patients for a period of 18 months, there were differences in cognitive recovery. But, late behaviour changes and psychosocial outcome were not different in both groups.

Isolation and characterization of cultivable mycobacteria from leprosy skin.

Attempts were made to isolate cultivable mycobacteria from 129 biopsies/slit-skin scrapings from the skin of leprosy patients (73 multibacillary-BB/BL/LL and 56 paucibacillary-TT/BT/I) as well as 50 healthy controls. Among the 19 isolates obtained, 17 were from specimens from leprosy cases whereas two were from healthy controls. 14 of the 17 isolates were from multibacillary cases and three were from paucibacillary patients. The mycobacteria isolated were: M.scrofulaceum (4 = all LL cases); M.avium (3 = 2 from LL cases and 1 from healthy control); M.avium-intracellulare complex (1 LL); M.gordonae (2 = 1 from BT and BB each); M.flavescens (1 BL); M.smegmatis (2 = both LL); M.phlei (4 = 1 LL, 1 BL, 1 BT and 1 healthy control); M.fortuitum (1 BL); and M.chelonei (1 BT relapse). The results of this study suggest a preferential colonization of skin of lepromatous leprosy cases by M.scrofulaceum and M.avium. As such isolates have been reported by the investigators from other parts of the world, independent confirmation of such trends in Indian patients is significant and casual relationship (if any) between such colonization and development of lepromatous disease merits further investigation.

Studies on microbial aerobic flora of skin in leprosy patients.

This study reports the isolation and identification of aerobic organisms from biopsies/slit-skin smears/scrapings from 129 leprosy patients and 50 healthy controls. These include 56 paucibacillary (PB) and 73 multibacillary (MB) cases. Thirty-six isolates from the specimens from 21 patients and 15 healthy controls were grown. The non-mycobacterial isolates from clinically PB leprosy (TT/BT/I) patients were: (1) Gram-positive cocci: Staphylococcus aureus(1), Staphylococcus albus(1); (b) Gram-positive bacilli: Bacillus subtilis(1), Corynebacterium xerosis(1); (c) Gram-negative bacilli: Escherichia coli(1), Proteus mirabilis(2), Klebsiella pneumoniae(1) and Pseudomonas aeruginosa(1). The isolates from clinically MB leprosy (BB/BL/LL) patients were: (a) Gram-positive cocci: Micrococci(1), Staphylococcus aureus(1) and Staphylococcus albus(1); (b) Gram-positive bacilli: Corynebacterium xerosis(1); Corynebacterium hofmanni(1) and Bacillus cereus(1). (c) Gram-negative bacilli: Escherichia coli(2), Klebsiella pneumoniae(1) and Proteus mirabilis(2). The specimens from healthy controls yielded similar organisms. These were (a) Gram-positive cocci: Staphylococcus albus(2), Staphylococcus aureus(2) and Micrococci(2); (b) Gram-positive bacilli: Corynebacterium xerosis(1), Bacillus subtilis(2), Corynebacterium hofmanni(1) and Bacillus cereus(1); (c) Gram-negative bacilli: Escherichia coli(3), Proteus vulgaris(1) and Proteus mirabilis(1). While these results show no significant differences in the species types of non-mycobacterial aerobic organisms isolated from healthy skin and PB/MB types of leprosy, these isolates need to be characterized by immunological/molecular methods to find out subtypes if any.

Reduction in CD1 positive epidermal Langerhans cell numbers in leprosy lesions following epicutaneous application of 2:4 dinitrochlorobenzene.

A study was made on Langerhans cells (LC) in the dermal lesions of leprosy after epicutaneous application of 2:4 dinitrochlorobenzene (DNCB) to the lesion. LC were quantitated with OKT6 monoclonal antibody and indirect immunofluorescence. A depletion or reduction in the numbers of CD1+ epidermal LC was observed at both 4 and 24 hours after the application of DNCB in the lesions of both tuberculoid and lepromatous leprosy, compared to untreated lesions.

Long-term outcome following head injury.

In a perspective study of follow-up of 141 head-injured patients, neurological, behavioural, neuropsychological and psychosocial parameters of outcome were used to measure the patient's functional status for 18 months. Neurophysical sequelae including seizure disorders were seen in 29 patients. Cortical functional disturbances observed were nominal difficulties in 5 patients, perseveration in 5 patients, disturbed kinetic melodies in 9 patients, frontal acalculia in 4 patients, constructional apraxia in one patient and left side neglect in one patient. These deficits were reversed except in 13 cases. Only 32 patients (22.7%) did not suffer from any behavioural changes. The role of compensation as an aetiologic factor was found in 5 patients. Out of 94 patients in whom scores in memory test was done, 11 patients performed better than their age and education-related norms. Scores in Raven's matrices for level of intellectual performance were done in 71 patients. The score was below 25th percentile in majority (58 cases). Among 130 patients with some jobs, 56 patients (43%) were fully restored. Out of 105 married patients, 45 patients (43%) had disturbed relations after head injury. Seven patients had separation of marriage. Compared to neurological deficits, behavioural and neuropsychological impairments were more prevalent and disabling. Psychosocial outcome, particularly vocational restoration was adversely affected by behavioural changes and cognitive deficits. Need for a multidisciplinary intervention to minimise the avoidable morbidity is emphasised.

Treatment of paucibacillary leprosy with a regimen containing rifampicin, dapsone and prothionamide.

Ninety paucibacillary leprosy patients having indeterminate (I), tuberculoid (TT) and borderline tuberculoid (BT) type of leprosy with bacterial index (BI) of less than two on the Ridley scale were treated with rifampicin (RFM) 600 mg once a month, dapsone (DDS) 100 mg daily and prothionamide (PTH) 250 mg daily. Treatment was stopped at the end of six months. The patients tolerated the drugs fairly well and in only two patients the drugs had to be stopped (in one due to jaundice and in the other due to gastric intolerance). About 6% of patients had early reactions which subsided with additional steroid therapy. The inactivity rate was 60% at six months and this improved to 96% at 12 months. No cases of late reactions and relapses were encountered in the limited follow-up period of six months; and a longer follow-up is necessary for ascertaining the relapse rates. The preliminary results however suggest that the addition of prothionamide to the standard WHO paucibacillary regimen is well-tolerated with increased inactivity rate and fewer instances of late reactions.

Immune response to purified chick embryo cell culture rabies vaccine manufactured in India.

The immunogenic efficacy of the first batch of indigenous purified chick embryo cell culture grown (PCEC) rabies virus vaccine has been measured in ten subjects. All of them were immunologically naive to rabies virus, and were given 5 doses of the vaccine in the post-exposure regime of injections on days 0, 3, 7, 14 and 30. On day 7, four subjects had developed very low levels of rabies virus neutralizing antibody, as detected and measured in the suckling mouse neutralization test. On day 14, all subjects had protective levels of antibody, which were maintained or enhanced by day 30. With the limited data presented here, the immunogenic efficacy of this batch of vaccine appeared similar to that of a batch of imported PCEC vaccine investigated earlier.