Assessment of endocrine abnormalities in severe traumatic brain injury: a prospective study.

OBJECTIVE: The frequency and pattern of endocrine abnormalities among patients with traumatic brain injury have been the subject matter of very few studies. This study was intended to assess the pattern of endocrine dysfunction following severe head injury. METHODS: Severe head injury patients admitted to the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, from January to December in 1 year formed the study group. Apart from clinical assessment, NCCT of the head was performed on all patients on admission. A complete anterior pituitary hormone analysis was performed within 24 h of injury and was repeated at 2 weeks, 3 months and 6 months amongst patients who survived. RESULTS: A total of 99 patients were included in the study. Forty of our patients succumbed in the hospital. Rest of the patients were followed up for 6 months. Elevations of cortisol followed by prolactin were the most common hormonal derangements at admission. Midline shift on CT scans was inversely related to cortisol elevation and directly related to GH elevation. Infarct on CT scans was inversely related to cortisol and LH elevation. A significant alteration was found in the decreasing trend of the mean T4 values and normalisation or a decreasing trend from initially elevated mean cortisol and GH levels during follow-up (p < 0.05). CONCLUSIONS: This study reveals that abnormalities in hormonal profiles appear to be relatively common in severe traumatic brain injury and fluctuate significantly over at least 6 months; there is a correlation with age and radiological findings. Performance of hormonal analysis evaluation should be considered in patients with severe brain injury so that appropriate hormonal replacement can be done to optimise the clinical outcome.

Esthesioneuroblastoma: The Princess Margaret Hospital experience.

BACKGROUND: Esthesioneuroblastoma is rare. The aim of the study was to review our experience and to evaluate the staging system and treatment that best correlates with the patient outcome. METHODS: Thirty-nine patients were identified between 1972 and 2006. RESULTS: At presentation 10% had cervical metastases. None had distant metastasis. Five were treated with surgery, 2 with chemotherapy, 1 with radiotherapy, and 30 with surgery and radiation. Local disease control was 82.6% at 5 years. Recurrence was seen in 33% with local and regional disease recurrence at 15% and 18%, respectively. The 5- and 10-year overall survival rates were 87.9% and 69.2%, respectively. Dulguerov classification correlated most closely to survival and recurrence. CONCLUSIONS: Dulguerov classification best correlates with the patient's outcome. A combined approach is the preferred treatment. It makes no difference whether radiotherapy is given pre or postsurgical resection. Recurrence can occur even 15 years after treatment. Therefore, long-term follow-up is essential.

Pituitary adenoma associated with intraventricular meningioma: case report.

Although rare, the association of intracranial meningiomas and pituitary adenomas has been reported. Intraventricular meningiomas are unusual, and meningiomas located in the fourth ventricle are even more so. We report a patient who harbored a prolactin-secreting pituitary adenoma and a fourth ventricle meningioma who was treated with surgical resection of the latter and medical treatment for the former. To our knowledge, this is the first report of such an unusual association.

Tuberculous appendicitis in India.

Tuberculous appendicitis (TBA) is a rare condition. The present study has been conducted to study its prevalence and presentation. This retrospective study was performed in the Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India, in 870 consecutive appendectomies performed between January 1991 and December 2000. Of 870 consecutive appendicular specimens, 10 cases of primary (1.1%) and 16 of secondary TBA (1.8%) were encountered. Results of all pre-operative investigations were non-specific and the diagnosis was made only after histopathology. The prevalence of TBA in this study was 2.9%. Although it is a rare condition, its possibility should be kept in mind by clinicians as well as pathologists. All surgically removed appendix specimens should be histopathologically examined, whether or not the specimens are macroscopically normal. Given antitubercular treatment in addition to appendectomy, patients recover without complications.