Completely Extradural Spinal Arteriovenous Fistula (Abnormal Direct Connection between Arteries and Extradural Venous Plexus) with Totally Extradural Venous Drainage Causing Compressive Cervical Myelopathy.

Spinal extradural arteriovenous fistulas are rare vascular lesion which are defined as abnormal direct connection between an artery or arteries and the extradural venous plexus within the spinal canal and/or intravertebral foramen. These lesions with exclusive extradural venous drainage are even rarer. Because of the limited cases the natural history, demography and treatment understanding of these are limited. Endovascular treatment remains the mainstay of treatment for these lesions. This case and its management are thus presented for its rarity.

A rare case of absent left common carotid artery with bovine origin of the left external carotid artery.

A 22-year-old man had cerebral venous sinus thrombosis and his angiogram incidentally revealed an absent left common carotid artery with bovine origin of the left external carotid artery. There was also an associated low bifurcation of the right common carotid artery and basilar artery fenestration. The absence of a common carotid artery is a very rare angiographic finding, and an association with a bovine origin of the left external carotid artery has not been reported previously in the literature. Here we provide a description of the case along with a review of the literature and embryology.

A rare case of absent left common carotid artery with bovine origin of the left external carotid artery.

A 22-year-old man had cerebral venous sinus thrombosis and his angiogram incidentally revealed an absent left common carotid artery with bovine origin of the left external carotid artery. There was also an associated low bifurcation of the right common carotid artery and basilar artery fenestration. The absence of a common carotid artery is a very rare angiographic finding, and an association with a bovine origin of the left external carotid artery has not been reported previously in the literature. Here we provide a description of the case along with a review of the literature and embryology.

Purely endoscopic pterional extradural approach: A novel technique for repair of cerebrospinal fluid rhinorrhea.

STUDY DESIGN: Retrospective descriptive study of an innovative surgical technique. OBJECTIVE: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope. SUMMARY OF BACKGROUND DATA: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches. MATERIALS AND METHODS: Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6-18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit. RESULTS: Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed. CONCLUSION: This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches.

Generation of cytotoxic molecules and oxidative stress in haemolymph of pebrinised tasar silkworm Antheraea mylitta Drury.

The present study was carried out to investigate the effects of microsporidial infection on redox regulation mechanism and oxidative stress in tasar silkworm Antheraea mylitta. High level of superoxide radical (p < 0.05), nitric oxide (p < 0.001) and lipid peroxidation (p < 0.001) was observed in haemolymph of pebrinised larvae, which indicated the resultant generation of cytotoxic molecules and oxidative damage. Increased phenol oxidase (PO) activity in haemolymph of pebrinised larvae indicated the activation of immune defences during pathological conditions. In addition, higher level of glutathione-S-tranferase (GST) activity and reduced glutathione (GSH) level observed in pebrinised larvae indicated adaptive behaviour of tissue against toxic oxyradicals (p < 0.05). Conversely, low level of ascorbic acid (ASA) content suggested that the larvae might have used these compounds to counteract stress in tissues or low uptake under microspridial infection (p < 0.05). Present findings provide new insights into the cellular and biochemical bases of host-pathogen interactions in tasar silkworm A. mylitta.

Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique.

STUDY DESIGN: Retrospective descriptive study of an innovative surgical technique. OBJECTIVE: To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases. SUMMARY OF BACKGROUND DATA: C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications. MATERIALS AND METHODS: Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain. RESULTS: The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery-mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%). CONCLUSION: Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain.

Tuberculosis in end-stage renal disease patients on hemodialysis.

Recent studies have shown that there is an increase in the incidence of mycobacterium tuberculosis (MBT). This is more prevalent among immune compromised patients (those on dialysis) and recipients of organ transplants. Furthermore, extra-pulmonary presentation appears to be more common and difficult to diagnose. We aimed in this study to assess and evaluate the presentation of MBT in a retrospective study conducted among 256 hemodialysis (HD) patients where 18 of them were diagnosed and managed for tuberculosis over a 10-year period between 1990 and 2000. The mean age of the patients was 38 years (21-75 years). The mean interval between the onset of HD and the time of diagnosis was about 24 months (1-120 months). The diagnosis of tuberculosis was made either by isolation of acid-fast bacilli (AFB), the typical caseating granuloma on biopsy, or by recovery of tubercle bacilli from the culture of the biopsy material. Extra-pulmonary tuberculosis was more common (77.8%) than pulmonary tuberculosis (22.2%). The various extra-pulmonary tuberculosis sites noted were cervical lymphadenitis (16.7%), gastrointestinal (16.7%), genitourinary (11.1%), peritonitis (11.1%), pleural effusion (5.6%), pericardial effusion (5.6%), miliary tuberculosis (5.6%), and pyrexia of unknown origin (5.6%). None of the patients with extra-pulmonary tuberculosis had evidence of pulmonary tuberculosis. The atypical presentation with insidious onset was quite common. Anergy to tuberculin skin test was noticed in 56% of cases. All of our patients received modified antituberculosis treatment for 1 year with adequate response, and without undue side effects. We conclude that a high index of suspicion is required especially in the diagnosis of extra-pulmonary tuberculosis, and when there is a high percentage of anergy to tuberculin skin test. Tissue biopsy both for characteristic histology and demonstration of MTB, either by staining or culture, remains the main criteria for the diagnosis of extra-pulmonary tuberculosis.