Tinospora cordifolia modulates the seminal parameters, leakage of intracellular enzymes and seminal antioxidants in equilibrated and cryopreserved semen of Sahiwal bulls.

The present study was undertaken to assess the effects of stem extract of Tinospora cordifolia (Giloy or Guduchi) in the semen extender on seminal parameters, leakage of intracellular enzymes and antioxidants in semen of Sahiwal bull. A total of 48 ejaculates from four bulls were selected for the study. Spermatozoa of 25 × 106 were incubated in 100, 300 and 500 µg of stem extract of Guduchi as Gr II, III and IV, respectively, and pre-freeze and post-thaw semen samples were analysed for seminal parameters [motility, viability, total sperm abnormality (TSA), plasma membrane integrity (PMI) and acrosomal integrity (AcI)], intracellular enzymes [aspartate aminotransferase (AST) and lactate dehydrogenase (LDH)] and seminal antioxidants [superoxide dismutase (SOD) and catalase] in comparison with an untreated control group (Gr I). The results revealed that stem extract-treated semen had significantly (p < .05) higher motility, viability, PMI, AcI, SOD and catalase and had significantly (p < .05) lower TSA, AST and LDH compared to those in untreated control group at pre-freeze and post-thaw stages. Semen treated with 100 µg stem extract/25 × 106 spermatozoa had significantly (p < .05) higher motility, viability, PMI, AcI, SOD and catalase and had significantly (p < .05) lower TSA, AST and LDH compared to those in control, 300- and 500-µg-treated groups at pre-freeze and post-thaw stages. Further, these seminal parameters and antioxidants were showing decreasing trend and TSA and leakage of intracellular enzymes were showing increasing trend from Gr II to Gr IV at pre-freeze and post-thaw stages. Thus, 100 µg/25 × 106 spermatozoa were optimum or suitable dose for cryopreservation of Sahiwal bull semen. The study concluded that T. cordifolia stem extract 100 µg/25 × 106 spermatozoa in the semen extender can be effectively utilized to reduce the oxidative stress and improve the pre-freeze and post-thaw seminal parameters in Sahiwal bull. However, further studies on effects of different concentrations of stem extract on in vitro or in vivo fertility trials are to be conducted to assess the impact of the stem extract supplementation in the semen extender on field pregnancy outcomes in bovine species.

Dynamic change in cortisol levels associated with severity, progression, and survival of patients with traumatic brain injury.

BACKGROUND: Cortisol levels are elevated in severe traumatic brain injury (TBI) and gradually decrease during patient recovery. Thus, dynamic changes in cortisol levels may serve as a prognostic biomarker of TBI. AIM: This study aimed to examine the relationship between serum cortisol levels and outcomes in TBI patients. METHODS: In this prospective case-cohort study, 238 patients with TBI were enrolled. Demographic, clinical, and radiological data were recorded within the first 24 h of hospitalization. Serum cortisol levels were measured using chemiluminescence assay (Immunoassay i1000). The association between cortisol levels and outcome (Glasgow Outcome Scale score) was evaluated at discharge from the hospital and after six months of follow-up. RESULTS: The mean age of the patients was 35.03 ± 17.68 years and the male: female ratio was 4.3:1. At the time of admission(day-1), cortisol levels in the TBI patients were significantly higher than those on day-7 (9.81 ± 4.20 µg/dl versus 23.41 ± 11.83 µg/dl; p<0.001). There was a significant relationship between cortisol levels and Glasgow Coma Scale (GCS) (p = 0.018). Moderate head injury (GCS;9-12) was observed in 108(45.4 %) patients and 130(54.6 %) patients with severe head injury (GCS;3-8) at presentation. CGS was significantly associated with the survival of patients with TBI; alive(n = 143) vs. dead (n = 77); p < 0.001. At 6 months follow-up of patients (n = 184), the findings revealed that the Glasgow Outcome Scale (GOS) and GCS score were significantly associated(p = 0.018). One-way ANOVA showed a significant difference in cortisol levels on day-1, day-7 and six months of sampling (p < 0.0001). Based on the GOS E score, the cortisol levels in the unfavorable and favorable groups significantly differed from those in the GOSE groups (p = 0.05). Similarly, cortisol levels were significantly associated with survival in patients with TBI (p = 0.04). With increasing cortisol levels, the GOSE score was poor and at > 50 µg/dl, no patient has survived. CONCLUSIONS: Day 1 and 7 cortisol, correlated with the outcomes at 6 months, had predictive value post-TBI.

Management of multiloculated hydrocephalus in children with emphasis on role of CT ventriculography.

OBJECTIVE: The authors performed a retrospective review of children diagnosed with multiloculated hydrocephalus (MLH) in our institute. The goal was to analyze the different diagnostic and therapeutic modalities used with special emphasis on CT ventriculography (CTV). METHODS: Male and female patients below the age of 18 years diagnosed with MLH were included. Cases of uniloculated hydrocephalus like entrapped temporal horn or isolated fourth ventricle were excluded. We used iohexol for CTV and gadodiamide for MR ventriculography. Neuroendoscopic procedures performed were endoscopic fenestration, endoscopic third ventriculostomy (ETV), endoscopic septostomy, endoscopic aqueductoplasty, or a combination of the above. The cohort was divided into two groups (endoscopic or shunt) based on initial surgical intervention. RESULTS: A total of 52 patients were included, with 43 boys and 9 girls. The average age of presentation was 7.7 months. The most common predisposing factor for MLH was neonatal meningitis seen in 30 patients. Mean duration of follow-up was 39 months. CTV was used in 26 patients and MR ventriculography in three patients. In one patient, the diagnosis of MLH was ruled out after ventriculography. Patients who underwent ETV only had the best outcome with 71.4% success rate. At the end of follow-up, 14 patients (27%) were shunt independent. CONCLUSIONS: The present study indicates that CTV helps to accurately define the anatomy of the ventricles and determine the site of physiological CSF obstruction. This helps in therapeutic planning and in avoiding misdiagnoses. Further, neuroendoscopy has the potential to lead to shunt independence in some patients.

Penetrating orbital trauma leading to trans-orbital brain herniation.

INTRODUCTION: Development of a posttraumatic herniation of brain parenchyma through the orbit is a rare complication of orbital roof fracture. Mostly, the injury is due to a direct impact to the frontal region resulting in orbital roof fracture with dural defect and herniation of cerebrospinal fluid or brain parenchyma. These patients present with acute or gradually progressive proptosis with impending risk of loss of vision and mandate surgical decompression of optic nerve with watertight closure of the dural defect. Bony reconstruction may be required to achieve normal contour of the orbit. MATERIALS AND METHODS: We encountered an interesting pediatric patient who presented to us with altered sensorium and progressive proptosis 3 days after a penetrating trauma to his left orbit by falling on the handle of a bicycle. The plain computerized tomography of the head (NCCT) showed a left orbital roof defect with herniation of brain matter into the orbit displacing the globe inferolaterally. A craniotomy was performed and watertight closure of the dural rent was achieved with use of autologous bone to cover the defect. CONCLUSIONS: The child improved gradually, and at 6 months follow-up, he had good cosmetic outcome with improvement of vision.

Spontaneous Umbilical CSF Fistula Due to Migration of the Peritoneal End of VP Shunt: A Case Report and Review of Pathogenesis.

Abdominal complications after ventriculoperitoneal (VP) shunt surgery for hydrocephalus have been known to occur. The more common complications include peritoneal pseudocyst, obstruction of the lower end, and shunt infection. Perforations of the intra-abdominal hollow viscera leading to spontaneous extrusions of the peritoneal catheter via the natural orifices have also been reported. A rarer phenomenon still is the migration of the lower end of the VP shunt through the anterior abdominal wall, leading to the formation of a spontaneous umbilical fistula at a site unrelated to the surgical site. Eight cases have been described in the literature so far with various causes elucidated. We report this condition in a child 4.5 years after his shunt surgery and postulate different mechanisms for both early and late presentations of this condition.

Choroid plexus papilloma of posterior third ventricle: A case report and review of literature.

Choroid plexus papillomas (CPPs) are rare intracranial neoplasms, especially in the third ventricle. The most common site of presentation of these lesions is in the fourth ventricle in adults and lateral ventricles in children. We report a male child with a posterior third ventricular CPP who presented with the symptoms of increased intracranial pressure. Magnetic resonance imaging revealed hydrocephalus related to a mass in the posterior third ventricle, occluding the aqueduct of Sylvius. After endoscopic third ventriculostomy, tumor was approached through the infratentorial-supracerebellar approach and completely excised. Pathological examination revealed a typical CPP. This entity should be considered an extremely rare cause of a lesion in the posterior third ventricle.

Thalamic syndrome as the heralding manifestation of atlantoaxial dislocation.

In India, Atlantoaxial dislocation (AAD) is the commonest skeletal craniovertebral junction (CVJ) anomaly, followed by occipitalisation of atlas and basilar invagination. The usual presentation is progressive neurological deficit (76-95% cases) involving the high cervical cord, lower brainstem and cranial nerves. The association between vertebro-basilar insufficiency and skeletal CVJ anomalies is well recognised and angiographic abnormalities of the vertebrobasilar arteries and their branches have been reported; however, initial presentation of CVJ anomaly as thalamic syndrome due to posterior circulation stroke is extremely rare. Here, we report one such rare case of thalamic syndrome as the initial presentation of CVJ anomaly with AAD.

Apparent diffusion coefficient with higher b-value correlates better with viable cell count quantified from the cavity of brain abscess.

BACKGROUND AND PURPOSE: DWI by using higher b-values provides tissue diffusivity with less T2 shinethrough effect. VCD in the abscess cavity correlates with ADC values. The purpose of this study was to investigate which b-value-derived ADC correlates better with VCD. MATERIALS AND METHODS: Thirty patients with brain abscess underwent conventional MR imaging and DWI with b = 1000, 2000, and 3000 s/mm(2) on a 3T MR imaging scanner. ADC values were quantified by placing regions of interest inside the abscess cavity in all sections where the lesion was apparent on coregistered ADC maps derived from different b-values. VCD was measured on pus aspirated. RESULTS: An increase in b-value was associated with a decrease in ADC values in normal parenchyma as well as in the abscess cavity. The most significant negative correlation of VCD was observed with b = 3000 s/mm(2) (r = -0.98, P = .01). CONCLUSIONS: VCD in the abscess cavity can be best assessed at b = 3000 s/mm(2) secondary to the reduction in the T2 shinethrough effect. DWI with b = 3000 s/mm(2) is of promising value in the assessment of the therapeutic response of brain abscess.

Eosinophilic granuloma: Presenting as a draining fistula.

A case report of an orbital eosinophilic granuloma presenting as a fistula in a 15-year-old boy is presented. The patient had a history of a painful right upper eyelid swelling which required drainage and was considered as an abscess. An increase in swelling occurred and a small fistula appeared in the area subsequently. Computed tomography scan revealed a large soft tissue lesion in right superolateral orbit having intracranial extradural extension with destruction of bony orbital margin. Fine needle aspiration biopsy of the lesion revealed eosinophilic granuloma. A complete excision of the lesion was performed by a brow incision and histopathological examination of the excised specimen confirmed diagnosis. Although upper eyelid area eosinophilic granuloma is known to occur, its presentation as a fistula is not known.

Scalp meningioma.

Primary extracranial meningiomas occur very rarely. We present a rare case of extracranial meningioma of the transitional variant which was excised satisfactorily. There was no suggestion of any connection to the intracranial compartment or cranial nerves. The underlying galea was uninvolved, suggesting the true extracranial nature of this tumour. This rare diagnosis should nonetheless be kept in the differential diagnosis of scalp tumors.

Awake craniotomy versus surgery under general anesthesia for resection of intrinsic lesions of eloquent cortex--a prospective randomised study.

OBJECTIVES: Complete removal of a brain tumor without inflicting neurological deficits is a desirable end result in neurosurgical practice. Currently no prospective randomized surgical series in the literature exists comparing tumor resection under general versus local anesthesia awake surgery may achieve more aggressive tumor resection and minimize postoperative neurological morbidity. PATIENT AND METHODS: We thence conducted a prospective randomized comparative study of results of surgery under awake versus surgery under general anesthesia for intrinsic eloquent area lesions. Fifty-three patients with intrinsic brain tumors in eloquent areas were prospectively randomized (26 patients in awake group and 27 for surgery under general anesthesia). At 3 months follow up, 23% patients in awake group had permanent deficits compared to 14.8% in GA group. RESULTS: More than 90% tumor excision was observed in 57% patients in awake group versus 73.7% in GA group. CONCLUSIONS: The mean operative time, blood loss was found to be was found to be less in GA group patients than in awake group. Better tumor cytoreduction, neurological improvement was seen in GA group (motor improvement in 35.7%, speech improvement in 62.5%) than in awake group patients (motor improvement in 18.7%, speech improvement in 14.3%).

Dumbbell-shaped paraganglioma of the cervical spine in a child.

Paragangliomas are tumors arising from extra-adrenal paraganglia and account for 0.3% of all neoplasms. The carotid body and temporal bone are the most frequent sites of paraganglioma, though it has been reported to occur in almost every part of the body. Spinal paragangliomas are uncommon and mainly take the form of intradural compression of the cauda equina or thoracic cord. Extradural paragangliomas are still rare; only few cases involving the dorsolumbar spine have been reported. We are reporting an interesting case of a dumbbell-shaped primary extradural paraganglioma of the cervical spine in an 8-year-old boy that presented with progressively increasing spastic quadriparesis.

Recurrence in craniopharyngiomas: analysis of clinical and histological features.

The aim of this study was to investigate the recurrence patterns and significance of various clinical and histological features as predictors of recurrence in craniopharyngiomas. A series of 234 craniopharyngiomas (156 males, 78 females; age range 1.6-65 years) was reviewed. The mean follow-up period was 18.53 months (range 1-120 months). Peri-operative mortality was 7.4% and tumor recurrence was observed in 26 patients (20.3%). Of the patients with recurrence, one had total tumor excision (recurrence-free survival (RFS) 14 months), four had near-total excision (mean RFS 18.2 months) and 21 had subtotal tumor excision (RFS for symptomatic recurrence 7.1 months). Histologically, an adamantinous pattern was seen in 81.4% of cases and a papillary pattern was seen in 18.6%. Brain tissue was included in 67 cases and brain invasion was noted in 44 (all were of adamantinous histology). No correlation was noted between histopathological subtyping or brain invasion and recurrence. The significant clinical factors predictive of recurrence included the extent of resection, tumor size greater than 4 cm and cystic tumors.

Recurrence in pediatric craniopharyngiomas: analysis of clinical and histological features.

OBJECTIVE: The purpose of this study was to investigate the recurrence pattern and significance of various clinical and histological features as predictors of recurrence in pediatric craniopharyngiomas. METHODS: A series of 116 pediatric craniopharyngiomas (68 boys and 48 girls; age range, 1.6-18 years) was reviewed. Mean follow-up period was 18.53 months. Tumors recurred in 15 patients within 96 months [mean recurrence-free survival (RFS), 12.67 months]. Of the recurrence cases, 2 had complete (mean RFS, 16 months) and 13 had subtotal tumor excision (mean RFS, 9.03 months). Histologically, an adamantinous pattern was seen in 95% of cases, whereas a papillary pattern was noted in 5%. Brain tissue was included in 41 cases. In 32 of 41 cases, brain invasion was noted, and all were of adamantinous histology. No correlation was noted of histopathological subtyping or brain invasion with recurrence. CONCLUSIONS: The significant clinical factors associated with recurrence included extent of resection, tumor size >4 cm, and cystic tumors.

Pediatric pituitary adenoma: a series of 42 patients.

Pituitary adenomas are uncommon in childhood. This report describes the presentation, endocrinological profile, management and outcome of 42 children with pituitary adenomas. The majority of the tumors were functioning adenomas (40/42, 95.2%). Only two patients (4.8%) had non-functioning tumors. Amongst the functioning tumors, there were 20 patients (47.6%) with prolactinomas, 11 patients (26.2%) with Cushing's disease and nine patients (21.4%) with growth hormone (GH)-secreting adenomas. The most common presenting features were endocrinopathy and visual disturbances. The majority of tumors were macroadenomas, with only eight patients (all with Cushing's disease) having a microadenoma. Transsphenoidal tumor decompression was performed in most cases (71.4%). Complications following transcranial surgery were more frequent when compared to transsphenoidal surgery. There was one death following surgery. Response to radiotherapy was satisfactory. Overall, 67.6% of patients achieved endocrinological remission. Of these, 89% of the children with GH-secreting tumors and 100% of the children with Cushing's disease achieved remission. We conclude that the transsphenoidal approach is effective and safe in surgery for pituitary adenomas in children and is the procedure of choice if there is no contraindication. The combination of surgery and radiotherapy, as well as medical therapy with bromocriptine, achieves good results in the management of these uncommon tumors.

Scalp malignant peripheral nerve sheath tumor (MPNST) with bony involvement and new bone formation: case report.

Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, usually arising from somatic soft tissues or peripheral nerves. Primary MPNST of the scalp is extremely rare, with only a single case reported so far. Here, we describe an unusual case of scalp MPNST in a 50-year-old male. The tumor was associated with bony projection, intracranial extension and underlying bone destruction. The tumor was treated with complete surgical excision followed by adjuvant radiotherapy. Histologically, the tumor showed malignant spindle cells with focal S-100 positivity on immunohistochemistry and a diagnosis of MPNST was made. This case is being reported for its rarity and presence of associated bony projection, which to the best of our knowledge, has not been described before in soft tissue sarcomas.