Jacob Chandy: pioneering neurosurgeon of India.

Jacob Chandy, who passed away in 2007 at the age of 97, was born into a deeply religious Christian family in Kerala, South India. After obtaining his medical education at the Madras Medical College, Madras, he serendipitously came to work with Dr Paul Harrison, a renowned medical missionary, in the Gulf state of Bahrain. Harrison urged Chandy to pursue training in the fledgling specialty of neurosurgery in North America. Chandy received his neurosurgical training at the Montreal Neurological Institute with Wilder Penfield and in Chicago with Theodore Rasmussen. At Harrison's urging, Chandy decided to return to India after completing his training to work at the Christian Medical College in Vellore. Thus, it was in 1949 that Chandy established the first neurosurgery department in south Asia in Vellore. He initiated the first neurosurgical training program in India at the Christian Medical College in 1957, with a distinct North American neurosurgical tradition. He went on to train nearly 20 neurosurgeons, many of whom set up new departments of neurosurgery in their home states. Chandy also had several other remarkable achievements to his credit. Despite the pressures of clinical practice, he insisted on fostering both basic and clinical neurosciences within his department, an arrangement that persists to this day in the Department of Neurological Sciences at the Christian Medical College, Vellore. As the Principal (Dean) of the Christian Medical College, Chandy displayed his skills as a medical educator and administrator. In this role, he was instrumental in starting specialty training programs in several other medical and surgical disciplines. His greatest legacies survive in the form of the department that he founded and his trainees and their students who have helped to establish neurosurgery all over the country.

Non-traumatic cerebrospinal fluid rhinorrhea: the "normal pressure leaks".

Non-traumatic cerebrospinal fluid (CSF) rhinorrhea is an uncommon condition. 15 patients with non-traumatic CSF rhinorrhea having "normal pressure leaks" are presented. Metrizamide CT cisternography failed to reveal the site of the fistula in 3 patients. 11 of the 15 patients underwent surgery for closure of the fistulous communication. In 8 of them the fistula was in the anterior fossa, in one it was in the sellar floor and in two the fistula site was not seen either radiologically or at surgery. In all except the one patient with sellar floor defect an intracranial approach was used. 12 patients have been followed up for 6 months to 9 years and 10 (83%) have been cured of their rhinorrhea. The intracranial approach is preferred to an extracranial approach in the repair of anterior fossa fistulae. Conservative treatment may be effective in selected patients.

Immune response to Bacteroides ureolyticus in a patient with brain abscess.

A high titer (1:256) of agglutinating antibodies against Bacteroides ureolyticus was demonstrated in a 35-year-old woman with brain abscess, using a microagglutination test. Tests done with B. ureolyticus and heterologous sera as well as with heterologous strains and the patient's serum were negative. Circulating antibody to B. ureolyticus has not been reported previously.

The effect of right temporal lobe lesions on matching of smells.

Thirty patients with bitemporal lobe epilepsy, 14 patients with right temporal lobe epilepsy, 14 patients with left temporal lobe epilepsy, 14 patients who had right temporal lobectomy, 10 patients who had left temporal lobectomy and 12 patients who had lobectomy involving frontal or fronto-parietal regions were tested for their ability to match smells. A simple matching technique was used. It was found that patients with right temporal lobe lesions had difficulty in matching smells. There was no significant difference between the right temporal lobe epilepsy group and the right temporal lobectomy group. The implications of these findings are discussed.

Brain abscess and other protean manifestations of actinomycosis.

Reports on human actinomycosis documented by culture have been infrequent, particularly from India. The present paper reports 12 cases of actinomycosis confirmed by culture. These include two unusual cases of actinomycosis of the brain with no granules in the pus, two pulmonary cases, one renal, one abdominal, and six cervico-facial. The lethal outcome with organ involvement, and the chronicity in some cases, warrant early etiologic confirmation and prompt treatment.

Phenylketonuria in Indian children.

Three untreated phenylketonuric Indian children aged respectively 3 1/2 years, 1 1/2 years and 1 year showed rapid neurological deterioration. Plasma, cerebrospinal fluid and urine phenylalanine concentrations were significantly raised and the phenylalanine-tyrosine ratio was high. Analysis of a biopsy of the right frontal lobe of the brain in one case showed the myeline lipids--cerebroside and sulphatide--to be decreased. The total cerebroside in white matter was low. Light microscopy showed marked pallor of the white matter of the brain and extensive spongy degeneration. Ultrastructurally these spongy vesicles are located between the lamellae of the myelin sheath.

Landry-Guillain-Barré-Strohl syndrome. A study of 302 cases.

Three hundred and two cases of Landry-Guillain-Barré-Strohl syndrome (LGBSS) are studied and relevant literature is reviewed. The existing diagnostic criteria appear not in keeping with the histopathological and immunological findings of this condition, hence some modifications have been suggested. The role of steroids in the treatment of this disorder is critically examined, and no benefit is found to be gained from their use.