Clinical Pulmonary Infection Score to Diagnose Ventilator-associated Pneumonia in Children.

Background: There is a need to validate and suggest easy clinical method for diagnosis of ventilator-associated pneumonia (VAP) in developing countries. Objectives: To validate the use of simplified Clinical Pulmonary Infection Score (CPIS) for the diagnosis of VAP. Design: Prospective study. Setting: Pediatric intensive care unit of a tertiary care teaching hospital. Subjects: 30 children receiving mechanical ventilation for more than 48 hours and with simplified CPIS6. Methods: All patients underwent flexible bronchoscopy to obtain bronchoalveolar lavage which was analyzed quantitatively. Colony count 104cfu/mL was considered reference standard for definite VAP. Results: Of the five variables used for simplified CPIS, only patient’s temperature (P=0.013) and PaO2/ FiO2 ratio were significant (P<0.001) to differentiate the presence of definite VAP. Patients with definite VAP (BAL colony count 104cfu/mL) had CPIS of 8.4 while in no definite VAP group it was 6.4 (P= 0.007). CPIS of 8 was found to have sensitivity of 80%, specificity 80%, PPV 86.9%, NPV 70.5% and accuracy 80%. The area under Receiver operating characteristic curve of CPIS against reference standard was 0.81± 0.069 (P=0.001). Conclusion: Simplified CPIS is useful in patients on mechanical ventilation to diagnose ventilator- associated pneumonia.

Malignant astrocytoma following radiotherapy for craniopharyngioma.

Radiation induced gliomas are uncommon. Occurrence of glioma following radiotherapy for craniopharyngiomas is extremely uncommon and only eight case reports have been so far published. We present our experience with one similar case of temporal gliomas occurring twelve years following radiotherapy for a sub totally excised craniopharyngioma. Although the exact mechanism of gliomas formation is unclear, their occurrence following conventional radiotherapy is a distinct possibility and signifies a poor prognosis.

Cerebellar hemisphere, an uncommon location for pleomorphic xanthoastrocytoma and lipidized glioblastoma multiformis.

Lipidized glioblastoma multiformis (LGB) and pleomorphic xanthoastrocytoma (PXA) are often supratentorial in location and occur in the second to fourth decade. This report presents two young patients, one having LGB and the other having PXA in the cerebellum. Histological differentiation between LGB and PXA is discussed.

False aneurysm of cavernous carotid artery and carotid cavernous fistula: complications following transsphenoidal surgery.

We present two cases of carotid injury during transsphenoidal surgery for pituitary adenoma. While in one of the cases it resulted in the formation of a false aneurysm of cavernous carotid artery, in the other patient, a carotid cavernous fistula (CCF) formed. The false aneurysm was managed by surgical trapping and the patient had an uneventful recovery. The CCF was initially managed with balloon embolization. The balloon got deflated and resulted in a false aneurysm with persistent CCF. This was occluded with Guglielmi Detachable Coils (GDC). The management options are discussed and relevant literature is reviewed. We emphasize the importance of an early cerebral angiography to know the status of the injured carotid artery and formation of false aneurysm / fistula.

Germinoma of the basal ganglia: a case report and review of literature.

Germs cell tumors of extrapineal region are extremely uncommon. The clinicopathological features of germinoma in the basal ganglia, in a 21 year old male are presented in this report. Post-operative radiotherapy is advocated, in view of the good radiosensitivity of these tumors.

Dissecting intracranial vertebral artery aneurysms.

Dissecting aneurysms of the intracranial arteries are exceedingly rare vascular lesions that can produce acute cerebral or brain stem infarction in young healthy adults. They carry a high mortality rate. Two cases of dissecting vertebral artery aneurysms that presented with bleed, were successfully operated by trapping and excision of the dissecting segment. Both dissecting aneurysms were located distal to PICA origin. Both the patients developed post operative lower cranial nerve paresis and one developed lateral medullary syndrome, which improved subsequently. Dissecting aneurysms presenting with bleed should be surgically managed by trapping and excising the involved segment sparing the PICA origin or by interventional radiological techniques. Revascularisation procedures should be considered in addition to trapping of the main vertebral segment if PICA is involved in the trapped segment. The diagnostic and therapeutic difficulties associated with dissecting vertebral artery aneurysms and the controversies regarding their management have been reviewed.

Mixed tumour of schwannoma and meningioma in a patient with neurofibromatosis-2 : a case report.

The co-existence of schwannoma and meningioma as a mixed intracranial tumour is uncommon and so far only eight cases have been published in the literature. Because of rarity, we report a unique case of mixed tumour having schwann cell and meningeal components, in a patient with neurofibromatosis type -2 (NF-2). The possible mechanisms for the occurrence of these mixed tumours are discussed.

Age at marriage and cervical cancer incidence.

Cancer of the uterine cervix is the commonest cancer among Indian women accounting for 1/5 of the total cancer incidence. It is the estimated that by the turn of century 139,000 women in India would be developing cervical cancer. Age at marriage has been recognised as a major risk factor associated with cervical cancer. Over the past 8 decades there has been a rise in age at marriage varying from 14 years in 1901 to 18 years in 1981. Consequently the proportion of women married in the age group 15-19 years has fallen from 88% in 1941 to 45% in 1981. The present paper has attempted to study the effect of change in proportion married below 17 years on cervical cancer incidence for the year 1985 in India. The proportion of married women in the age group 15-19 years was constant around 88% from 1901-41 and from 1951 onwards the reduction in the proportion married has been observed. During the last 35 years, after the start of reduction in the proportion married in the age group (15-19) years, a reduction of 2097 cervical cancer cases or 6.3 percent reduction in the incidence of invasive cervical cancer is observed. It may be postulated that it will take a long time to expect a significant reduction in the incidence of cervical cancer if the primary prevention of rising the age at marriage above 18 years is adopted as a strategy for control of cervical cancer.

Cryptococcosis: involvement of more than one system.

We report a 37-year-old female patient with pulmonary cryptococcosis who presented with a one week old history of cough and fever. Within a week of admission, she developed cryptococcal meningitis and 5 months later cryptococcomas of the brain were detected. She was successfully treated with 2 courses of amphotericin-B at an interval of 5 months. 5-flucytosine was also administered initially along with amphotericin-B. The pulmonary lesions resolved completely whereas the cryptococcomas reduced in number.

Epidermal water permeation in vertebrates: an in vitro study using tritiated water.

Structural lipids play an important role in the water holding property of the skin. beta emitters are known to pass through the skin barrier. A permeability cell was constructed and tritiated water was used to determine the rate of in vitro water permeation through the epidermis. The epidermal sheets from different classes of vertebrates were compared for water permeation. Some of the samples were treated with solvents, surfactants and conditioners, to fathom permeability changes of the epidermis after these treatments, at various time intervals. Solvent treated epidermal sheets show very high degree of permeation, both in rat pup skin and pigeon skin. Glycerol, Brij 99 and beewax treated skin shows negligible permeation; or rather, helps in retention of water compared to normal and solvent treated skin. Comparison of water permeation in rat, pigeon and lizard skin shows that the reptilian integument is more efficient, as it allows very less permeation of water compared to the avian and mammalian epidermis. These observations suggest that tritiated water could be used for determining in vitro water permeation through the epidermis.

Pneumoconiosis in an Indian slate-pencil factory worker.

A male slate-pencil factory worker who inhaled dust for 10 years came to our hospital with complaints of breathlessness of two months duration. He developed massive fibrotic lesions in both lungs but was not diagnosed earlier due to the absence of symptoms.

Midtrimester termination of pregnancy--search for a better method continues.

Every day a new method of termination of second trimester pregnancy clearly indicates that we have still not found a simple, safe, effective and economic method of termination of pregnancy in second trimester. Present study of 855 cases aims at searching out something better from available modalities. Age old hypertonic saline and ethacridine lactate were used with adjuvants like hyaluronidase and a preparation containing isapgol husk to reduce injection abortion interval and failures. Life threatening dangers of hypertonic saline are known. Ethacridine lactate seems to be safe. By giving it intra-amniotically with these adjuvants its major disadvantages could be minimised. There was no mortality. However, there was morbidity in the series.