Age-related complications following endovascular treatment of unruptured intracranial aneurysms.

BACKGROUND AND PURPOSE: The factors that led us to do the research for this paper was a desire to see if elderly patients did as well as non-elderly patients during endovascular intracranial aneurysm treatment. By doing this research, we could better stratify the most appropriate treatment for each patient with an aneurysm. The purpose of this study was to determine whether the incidence of procedural complications was greater in the elderly, defined as patients older than 65 years of age, compared with nonelderly patients undergoing elective endovascular treatment for intracranial aneurysms. MATERIALS AND METHODS: A retrospective review was performed in patients undergoing elective endovascular treatment of intracranial aneurysms between 2000 and 2010 at 1 institution. "Minor complications" were defined as those resulting in minimal or no loss of function that resolved before dismissal; "major complications" were complications that resulted in loss of function or complications that required a subsequent invasive therapy. Major complications were further stratified into those with and without neurologic disability, defined as an mRS score of >3. T tests and χ(2) analyses were used to compare groups. RESULTS: Three hundred fifty-five patients underwent 394 endovascular procedures treating 75 aneurysm recurrences and 319 untreated aneurysms. One hundred eight (30%) were elderly. There was no significant difference in the rate of complications in the elderly compared with the nonelderly (33% versus 26%, respectively; P = .18). Major complications were significantly more prevalent in the elderly than in the nonelderly (17% versus 7.4%, respectively, P = .004). Major complications with neurologic disability were also significantly more prevalent in the elderly compared with the nonelderly (8.2% versus 1.8%, respectively, P = .004). CONCLUSIONS: Major functional complications were markedly more common in the elderly compared with the nonelderly.

Puberty menorrhagia requiring inpatient admission.

INTRODUCTION: Puberty menorrhagia is a significant health problem in adolescent age group and severe cases may require admission and blood transfusion. Aim of this study was to evaluate the causes, associated complications and management of puberty menorrhagia. METHODS: Hospital records of all patients of puberty menorrhagia requiring admission were analyzed for etiology, duration since menarche, duration of bleeding, investigation profile and management. RESULTS: There were 18 patients of puberty menorrhagia requiring hospital admission. Etiology was anovulatory bleeding in 11 patients, bleeding disorders in five which included idiopathic thrombocytopenia purpura in three and one each with Von-Willebrand disease and leukemia. Two patients had hypothyroidism as the cause. Fourteen patients presented with severe anaemia and required blood transfusion. All except one responded to oral hormonal therapy. CONCLUSIONS: Puberty menorrhagia can be associated with severe complications and requiring blood transfusion. Although most common cause is anovulation but bleeding disorder, other medical condition and other organic causes must be ruled out in any patient of Puberty menorrhagia.

A Cretaceous hoofed mammal from India.

The sedimentary record documenting the northward drift of India (Late Cretaceous to late Early Eocene) has recently provided important clues to the evolution, radiation, and dispersal of mammals. Here, we report a definitive Late Cretaceous (Maastrichtian) archaic ungulate (Kharmerungulatum vanvaleni genus et species nova) from the Deccan volcano-sedimentary sequences exposed near Kisalpuri village in Central India. This find has important implications for the origin and diversification of early ungulates and raises three possible paleobiogeographic scenarios: (i) Archaic ungulates may have been cosmopolitan in distribution. (ii) Kharmerungulatum might be an immigrant from Western Asia. (iii) Archaic ungulates may have originated in India.

Maternal mortality in eclampsia: 489 cases.

In all, 489 women with eclampsia were reviewed, 20 (4%) of whom died, constituting 16% of all maternal mortality. Of all births in the hospital, 33% had stillbirths.

Evaluation of the efficacy of mifepristone/misoprostol and methotrexate/misoprostol for medical abortion.

BACKGROUND: Unsafe abortion is a major cause of mortality among women in India accounting for 12% of all maternal deaths. In developing countries, annually, up to 200,000 women die of complications after illegal abortion. Medical abortion is potentially a simple and a safe method for use in developing countries. We conducted a prospective controlled trial to compare the efficacy of low-lose mifepristone and methotrexate for medical abortion. OBJECTIVE: To find out the efficacy of low-dose mifepristone and methotrexate for inducing abortion. METHOD: In this prospective clinical study, 100 women opted for a medical method of abortion. Out of these, 50 patients were given 50 mg/m2 of methotrexate intramuscularly followed by 800 micro gm of intravaginal misoprostol, and 50 patients were given 200 mg of mifepristone orally followed by 800 micro gm of intravaginal misoprostol. MAIN OUTCOME MEASURES: Complete abortion was the principal outcome measure. Secondary outcome measures were side effects and acceptability data. RESULTS: The rate of expulsion by first week after initiation of treatment was 58% in methotrexate and 98% in mifepristone group (P <0.001). CONCLUSION: Low-dose mifepristone and intravaginal misoprostol is safe, effective, and well tolerated as compared to methotrexate and misoprostol.

Cesarean section in a wedged head.

Cesarean section many a times, has to be done late in labour when the head is deeply wedged in the pelvis. The techniques described in standard text books, usually result in extension of the incision either laterally into the broad ligament or vertically upwards into the upper segment or downwards posterior to the bladder from the centre of the incision line. In this study we have reviewed the Patwardhan's technique for the extraction of baby and fetomaternal outcome was compared with cases where this technique was not used. There was no extension of the incision either laterally into broad ligament or upwards or downwards. Haemorrhage due to extension of incision requiring blood transfusion occurred in 24% of patients in group II as compared to nil in group I.

Severe hemodynamic impairment and border zone--region infarction.

PURPOSE: To investigate the relationship between the patterns of cerebral infarction that have been associated with hemodynamic impairment and the presence of severe chronic hemodynamic compromise (increased oxygen extraction fraction) in a large prospectively enrolled group of patients with carotid artery occlusion. MATERIALS AND METHODS: At enrollment in a prospective study of cerebral hemodynamics, 110 patients with carotid occlusion underwent (a) positron emission tomography for the measurement of cerebral oxygen extraction fraction and (b) computed tomographic (CT) or magnetic resonance (MR) examinations of the brain. Infarcts were categorized retrospectively by vascular territory, location, and pattern. The association of these findings with hemodynamic impairment (increased oxygen extraction fraction) was investigated. RESULTS: No border zone-region infarctions were found in 35 asymptomatic patients. In 75 symptomatic patients, cortical border zone-region infarction was found in seven of 36 patients with increased oxygen extraction fraction, and in two of 39 with normal oxygen extraction fraction (P =.08, difference not significant). The pattern of multiple white matter lesions arranged parallel to the lateral ventricle was observed only in symptomatic patients with increased oxygen extraction fraction (eight of 36 patients; P =.002; sensitivity, 22%; specificity, 100%). This finding was more frequent with MR imaging (seven of 14 patients) than with CT (one of 22 patients). CONCLUSION: Multiple white matter infarctions, arranged parallel to the lateral ventricle, are associated with severe hemodynamic impairment. This pattern of infarction is likely due to a hemodynamic mechanism.

Epileptic seizures in supratentorial gliomas.

Two hundred patients with supratentorial glioma; astrocytoma (pilocytic, fibrillary, gemistocytic) 82, mixed glioma (oligoastrocytoma) 46, oligodendroglioma 8, malignant (anaplastic) astrocytoma 33 and glioblastoma multiforme 31, surgically treated for the tumours and followed up for one to sixteen years, were retrospectively analysed for the incidence of pre and postoperative epileptic seizures. 122 patients (61%) had seizures preoperatively. 62 (50.8%) of them had at least one or more seizures during follow up. Seizures were persistent in 22 patients. Doubtful, or one or two minor seizures occurred in 19 cases. Six patients in this group had seizure only at the time of CT confirmed recurrence, after a seizure free interval of one to nine years. Amongst 78 patients who did not have seizures preoperatively, 24 (30.6%) developed seizures during the postoperative follow up period. Recurrent attacks were reported only by 5 patients while 15 patients had seizure(s) only at the time of recurrence of tumour. Two patients had a few seizures in the early postoperative period and none thereafter, while doubtful seizures were reported by two patients.

The solitary intraspinal vertebral osteochondroma. An unusual cause of compressive myelopathy: features and literature review.

STUDY DESIGN: Reports of four patients with compressive myelopathy from solitary intraspinal vertebral osteochondromas. OBJECTIVES: To evaluate the clinical presentation and radiographic findings of patients with intraspinal osteochondroma with compressive myelopathy and to review the relevant English-language medical literature. SUMMARY OF BACKGROUND DATA: Involvement of the spine by solitary osteochondromas is rare. The addition of the current four cases to those already reported makes a total of 41 published cases of solitary vertebral osteochondromas with spinal cord compression. METHODS: Clinical histories, computed tomographic studies, magnetic resonance imaging studies, routine radiographs, and/or myelographic studies of the lesions were reviewed. A review of the English-language medical literature also was done. RESULTS: Patients gradually improved or symptoms stopped progressing after surgical removal of the lesions. Although magnetic resonance imaging is the preferred method for localizing the lesion, computed tomography can be more specific, because of its sensitivity, when the diagnosis is in doubt. CONCLUSIONS: Osteochondromas represent a hyperplastic-dysplastic disturbance of bone from progressive endochondral ossification. The tumors slowly enlarge, creating insidious but progressive symptoms. Magnetic resonance imaging, computed tomography, and postmyelogram computed tomography are useful in evaluating the size and extent of spinal osteochondromas as a cause of spinal cord compression.

Foreign body in vagina--an uncommon cause of vaginitis in children.

An intravaginal foreign body of long duration can pose diagnostic dilemma in children. We present a case of eight and a half years old girl who was suffering from blood stained vaginal discharge for 3 years for which she was treated by few gynaecologists. A vaginal examination performed under general anaesthesia revealed a foreign body (lead pencil). In cases of pediatric vaginitis one should always look for foreign body in vagina.

Prophylactic amnioinfusion during labor complicated by meconium.

A prospective study to see the safety and efficacy of transcervical amnioinfusion in labour complicated by meconium-stained amniotic fluid (MSAF) was carried out in a teaching hospital with limited resources. Fifty patients in labour with meconium-stained amniotic fluid and fulfilling the inclusion criteria (vertex presentation, gestational age of 36 weeks or more, no medical or obstetrical complications and normal fetal heart rate at time of inclusion) were taken for the study, 25 patients received amnioinfusion. The control group received only supportive therapy. Labour outcome was compared in the 2 groups. The incidence of Caesarean section was seen to be decreased but neonatal parameters showed no significant difference in the amnioinfusion group.

Coital tear: a rare cause of secondary peritonitis.

A rare cause of secondary peritonitis due to coital tear is presented. The correct diagnosis can be made by a detailed history and gynaecological examination. Prompt surgical management is mandatory to prevent grave prognosis.

Different effects of omeprazole and Sch 28080 on canine cerebrospinal fluid production.

We investigated the effects of omeprazole and Sch 28080, a more specific and a more potent inhibitor of K+,H+-ATPase than omeprazole, in canine cerebrospinal fluid (CSF) production. CSF production was measured by ventriculocisternal perfusion (VCP) technique in three groups (n = 10 in each group) of anesthetized, paralyzed and mechanically ventilated dogs. Group I served as control, Sch 28080 (10(-4) mol/l of synthetic CSF) was added to VCP in group II, and omeprazole (10(-5) mol/l of synthetic CSF) was added to VCP in group III, after baseline control CSF production had been determined at 15, 30, 45, and 60 min. Comparing the three groups, the mean baseline values for CSF production did not differ significantly. However, the percent decreases in CSF production in the omeprazole treated group were 26 +/- 17 and 24 +/- 13 at 210 and 225 min, which were significantly more than the respective values in the control group. Percent decrease in CSF production in Sch 28080 was not significantly different from that in the control group. We conclude that in the canine model, physiological doses of omeprazole decrease CSF production by about 26%. However, the effect is independent of the K+,H+-ATPase activity, since Sch 28080 which is more potent than omeprazole did not significantly affect CSF production.

Recurrence of supratentorial gliomas.

Two hundred patients treated for supratentorial gliomas and for whom a follow up of one to sixteen years was available have been reviewed retrospectively for recurrence of tumor. All patients were initially treated with radical surgical tumour removal followed by radiotherapy. The series consisted of 82 cases of astrocytomas, 46 cases of mixed gliomas (oligoastrocytomas), 8 of oligodendrogliomas, 33 cases of malignant astrocytomas and 31 glioblastomas. However, period of recurrence could not be correlated to histological grade or presence or absence of residual tumour in a postoperative CT scan. Illustrated cases have been described. Problems of diagnosis and therapy have been discussed.

Leiomyoma of the vagina.

Approximately 250 cases of leiomyoma of the vagina have been reported. A case of a 46-year-old female with leiomyoma of the anterior vaginal wall, not associated with uterine leiomyomas is presented. The practical approach to such a vaginal mass entails immediate careful excision.