bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis and Characterizing of High Aspect Ratio Silver Nanowires by Polyol Process
Authors: Chen Tian Rui , Wang Hai Feng , Yang Hui , Guo Xing Zhong
Published: April 2018

Silver nanowires with controllable and high length-diameter ratio were prepared by using the reductibility of ethylene glycol under high temperature and selective adsorption of PVP. AgNO3, ethylene glycol, PVP and CuCl2was used as the silver source, the reductant, the capping agent and the ion additives, respectively. The effects of centrifugal rate, silver ions' concentration, AgNO3adding rate on the morphology of silver nanowires were investigated by SEM, XRD, TEM and other technologies. The results show that the optimal centrifugal rate is 2000n/s, the better silver ions’ concentration is 6.55 mg/mL, and the best rate of adding AgNO3is 6 ml/min. The silver nanowires with an average diameter of 74.9 nm, the average length of 45.5μm and its length-diameter ratio of 607.5 are obtained. The silver nanowires with good morphology and high length-diameter ratio are adjustable, which is suitable for the preparation of OLED transparent film electrode materials, and other conductive materials.
The Impact of Slugs on Pipe Response - Physical Testing and Numerical Correlation
Authors: Connaire Adrian , Payne Jason , Green Steve , Supak Kevin
Published: April 2018

Subsea systems that transport multiphase flow such as wellhead and manifold jumpers, tie-in spools, free-spanning pipelines and risers can all be subject to slug and turbulence loading and response, depending on the characteristics of the reservoir fluids, the pipe geometry and the flow conditions.

As part of the SLARP (slug loading and response in pipelines) joint industry project (JIP), a series of tests were undertaken to provide experimental measurements at field-realistic scale dimensions for an investigation into the interactions between slug flow and the dynamics of subsea pipeline jumpers. Advanced numerical methods were validated for simulating the effects of slug flow on subsea pipe structures. The test campaign, pipe configurations, sample test results and numerical correlation of slug flow characteristics with measured pipe dynamics are presented in this paper.

The test section consists of a U-bend constructed from 4-inch pipe. Liquid slugs were propelled through the piping by gas pressure and the structural response of the test section was measured as the slugs traversed a series of 90° pipe bends. As a basis for the test programme, slug lengths and velocities of up to 30m and 15m/s, respectively, were used. Frictional slides and wire rope slings were employed to provide differing restraint and damping conditions for the test section.

The experimental data during the test campaign were compared to numerical simulations that accounted for load contributors of slugs travelling through the test section. Strong correlations were observed between the slug speed and pipe deflections from the physical tests. The system response was shown to be sensitive to slug velocity, pipe system restraint, pipe system stiffness and the evolution with time of the slug characteristics. The numerical methods employed are shown to be suitable for use in the prediction of dynamic response of subsea pipelines to slug loading where flow conditions are well understood.

The novel aspect of this work relates to the successful development of a test piece which has features particular to subsea jumpers and the passing of high velocity slugs through the system combined with the simulation of the test conditions using finite element (FE) software that accounts for all key load contributors. These tests provide key insight to the interaction between slug flow conditions and the dynamics of pipe jumpers at field-realistic scale and in part formed a basis for industry guidelines developed as part of the JIP.
Platelet-Activating Factor–Induced Reduction in Contact Hypersensitivity Responses Is Mediated by Mast Cells via Cyclooxygenase-2–Dependent Mechanisms
Authors: Ocana Jesus A. , Romer Eric , Sahu Ravi , Pawelzik Sven-Christian , FitzGerald Garret A. , Kaplan Mark H. , Travers Jeffrey B.
Published: April 2018

Platelet-activating factor (PAF) stimulates numerous cell types via activation of the G protein–coupled PAF receptor (PAFR). PAFR activation not only induces acute proinflammatory responses, but it also induces delayed systemic immunosuppressive effects by modulating host immunity. Although enzymatic synthesis and degradation of PAF are tightly regulated, oxidative stressors, such as UVB, chemotherapy, and cigarette smoke, can generate PAF and PAF-like molecules in an unregulated fashion via the oxidation of membrane phospholipids. Recent studies have demonstrated the relevance of the mast cell (MC) PAFR in PAFR-induced systemic immunosuppression. The current study was designed to determine the exact mechanisms and mediators involved in MC PAFR-mediated systemic immunosuppression. By using a contact hypersensitivity model, the MC PAFR was not only found to be necessary, but also sufficient to mediate the immunosuppressive effects of systemic PAF. Furthermore, activation of the MC PAFR induces MC-derived histamine and PGE2 release. Importantly, PAFR-mediated systemic immunosuppression was defective in mice that lacked MCs, or in MC-deficient mice transplanted with histidine decarboxylase– or cyclooxygenase-2–deficient MCs. Lastly, it was found that PGs could modulate MC migration to draining lymph nodes. These results support the hypothesis that MC PAFR activation promotes the immunosuppressive effects of PAF in part through histamine- and PGE2-dependent mechanisms.
Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care?
Authors: Osterman Michael , Claiborne Tina , Liberi Victor
Published: April 2018

Context: 

Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care.

Objective: 

To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care).

Design: 

Cross-sectional study.

Setting: 

Public and private secondary schools in northwest Ohio and southeast Michigan.

Patients or Other Participants: 

Thirty schools (24 public, 6 private) volunteered.

Main Outcome Measure(s): 

Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care.

Results: 

Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED (F1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle.

Conclusion: 

Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.
The intersection of disability and food security: Perspectives of health and humanitarian aid workers
Authors: Quarmby Candice A. , Pillay Mershen
Published: April 2018

Background: Most people with disabilities the world over can be found in the Majority (or ‘economically developing’) World. This is also where most of the world’s hungry and malnourished are found. We argue that the intersectionality between disability and nutrition may best be understood through a food security framework, and we position all people living with disability, including those experiencing feeding and swallowing disabilities, as at risk for food insecurity, especially those living in humanitarian emergency contexts.Objectives: This study aimed to explore and describe the knowledge and experience of humanitarian aid workers (HAWs) and health care professionals (HCPs) in food assistance contexts with regard to the nutrition and food security of people living with disabilities.Method: In this exploratory, descriptive study, 16 participants with experience in sub-Saharan Africa and Southern Asia participated in an online survey. Three survey participants with extensive experience were also interviewed. Data analysis involved descriptive statistics and thematic content analysis.Results: Results revealed that participants had generally low levels of exposure to and experience with disability, including swallowing and feeding disorders.Conclusions: Reduced knowledge of HAWs and HCPs regarding disability and the lack of professionals such as speech–language therapists, who manage disability-specific issues such as feeding and swallowing disorders, may affect the food security of people living with disabilities in food assistance contexts.
Regional disaster risk management strategies for food security: Probing Southern African Development Community channels for influencing national policy
Authors: Tirivangasi Happy M.
Published: April 2018

Natural disasters and food insecurity are directly interconnected. Climate change related hazards such as floods, hurricanes, tsunamis, droughts and other risks can weaken food security and severely impact agricultural activities. Consequently, this has an impact on market access, trade, food supply, reduced income, increased food prices, decreased farm income and employment. Natural disasters create poverty, which in turn increases the prevalence of food insecurity and malnutrition. It is clear that disasters put food security at risk. The poorest people in the community are affected by food insecurity and disasters; hence, there is a need to be prepared as well as be in a position to manage disasters. Without serious efforts to address them, the risks of disasters will become an increasingly serious obstacle to sustainable development and the achievement of sustainable development goals, particularly goal number 2 ‘end hunger, achieve food security and improved nutrition and promote sustainable agriculture’. In recent years, countries in southern Africa have experienced an increase in the frequency, magnitude and impact of climate change–related hazards such as droughts, veld fire, depleting water resources and flood events. This research aims to reveal Southern African Development Community disaster risk management strategies for food security to see how they an influence and shape policy at the national level in southern Africa. Sustainable Livelihood approach was adopted as the main theoretical framework for the study. The qualitative Analysis is based largely on data from databases such as national reports, regional reports and empirical findings on the disaster management–sustainable development nexus.
Twenty years of community-based disaster risk reduction experience from a dryland village in Indonesia
Authors: Lassa Jonatan A. , Boli Yos , Nakmofa Yulius , Fanggidae Silvia , Ofong Alex , Leonis Herman
Published: April 2018

Academics and practitioners often argue indirectly that all the roads to community resilience should be paved with community-based disaster risk reduction (CBDRR) approach. Community-based approach to resilience building has been a discursive material that appeals many disaster management players including international donors, non-governmental organisations and high-level government officials as well as politicians. Some researchers argue that CBDRR is the foundation of disaster risk governance. Unfortunately, globally, there is lack of studies on long-term and real-world experience of CBDRR. This article addresses this research gap by providing insights of CBDRR activities from a village in eastern Indonesia based on long-term studies. The adoption of CBDRR approach in Indonesia took place in the late 1990s and the authors have been part of the early adopters of the framework. Using longitudinal participant observations, this research combined qualitative and quantitative data collected during 1998–2017. It shows the rise and fall of a community responding to disaster risks over time. The article further highlights stories of frustrations and celebrations that surround CBDRR activities implemented by one local community in a dryland village in eastern Indonesia.
Die politiek van die mens-hondverhouding in Op ’n dag, ’n hond van John Miles
Authors: Nel Adéle
Published: April 2018

The politics of the human-dog relationship in Op ’n dag, ’n hond by John Miles. This article investigates the way in which the human-dog relationship is presented in the novel Op ’n dag, ’n hond by John Miles. The premise of this article is that the novel can be read within the theoretical framework of Posthumanism, in which the embodied communalities of humans and animals (dogs) are emphasised. Despite the differences between the human and nonhuman animal, it is possible to constitute relationality, based on their shared physical mortality. The investigation will focus on the visual paradigm of the novel: the reciprocal view between dog and human, human and dog, which contradicts anthropocentricism and establishes an intersubjective relationship. The dog as guide embodies a moral agent that causes the teacher to look downward, into the underworld, as well as backward to the past. This, in turn, foregrounds the issues of loyalty and betrayal, and the balance between good and evil in a human life.
Comparison of phenytoin versus levetiracetam in early seizure prophylaxis after traumatic brain injury, at a tertiary care hospital in Karachi, Pakistan
Authors: Younus Syed , Basar Saqib , Gauri Sheraz , Khan Ateeq , Imran Muhammad , Abubakar Saadia , Sheikh Daniya , Shehbaz Naila , Ashraf Junaid
Published: April 2018

Aims: The aim of the study was to compare the efficacy of phenytoin and levetiracetam for seizure prophylaxis in patients with severe traumatic brain injury (TBI). Subjects and Methods: A randomized controlled trial was conducted over a period of 6 months, at a tertiary health care center in Karachi, Pakistan. Patients with TBI were divided into two groups. Patients in Group A were given phenytoin, whereas Group B patients received levetiracetam. The first dose of the drugs was given within 24 h of injury and continued for 7 days. Data were collected using a predesigned pro forma. All the patients who were in a state of persistent coma, had altered mental status, or had clinical signs of seizures underwent a 1-h electroencephalographic (EEG) recording to observe the seizures, the first EEG was done on the 1st day posttrauma and a second one was done on day 7 of drug use, both the EEGs were compared for changes. We also analyzed the patients according to their duration of antiepileptic drug therapy, length of hospital stay, and complications during therapy. Results: One hundred and forty (117 males and 23 females) patients who presented with TBI having a mean age of 29.48 ± 16.24 years were part of the study. The most prevalent cause of brain injury was road traffic accidents in 72.85% patients. There was no significant relationship between the antiepileptic drug used with the initial EEG (P = 0.313) and seizure activity (P = 0.502). However, a significant correlation of the antiepileptic drug used was found with EEG (P = 0.002) and seizure activity (P = 0.014) on follow-up. Patients who took levetiracetam had decreased the incidence of abnormal EEG and seizure activity on follow-up. There was not any correlation between GCS both initially (P = 0.845) and on follow-up (P = 0.104) with the antiepileptic drug used. Conclusion: The incidence of abnormal EEGs and seizure activity in patients with TBI is the same for both levetiracetam and phenytoin for the initial 7 days post-TBI; however, the incidence of seizures is lower for patients who used levetiracetam on the subsequent follow-up.
Congenital hydrocephalus, corpus callosum agenesis, and prosencephalic cyst with supernumerary nostril: A neurocristopathy
Authors: Gupta Rahul , Barolia Dinesh , Goyal Manisha
Published: April 2018

A 3-month-old-male infant presented with enlargement of head since birth. Clinical and radiological evaluation revealed congenital hydrocephalus, corpus callosum agenesis, prosencephalic cyst, and cranial vault deficiency with supernumerary nostril on the left side. Right ventriculoperitoneal shunt (Chhabra shunt) surgery was performed. The patient did well postoperatively. Parents of the patient have been counseled for repair of supernumerary nostril. Congenital hydrocephalus with corpus callosum agenesis is rare. Furthermore, supernumerary nostril is a very rare anomaly with <40 cases reported in the literature till date. To the best of our knowledge, congenital hydrocephalus, corpus callosum agenesis, prosencephalic cyst, and cranial vault deficiency associated with supernumerary nostril have not been reported till date. We herein briefly review the pertinent literature and describe the embryopathogenesis of this rare association. We propose that this association is a neurocristopathy.
Spinal cord-derived neural precursor cells as a preventive therapy for spinal cord injury
Authors: Hosseini Seyed , Sharafkhah Ali , Ziaee Seyyed
Published: April 2018

Background: Spinal cord injury (SCI) as one of the most important diseases of central nervous system (CNS) without any definite treatment is still growing in incidence. In addition to trauma, some surgeries such as cardiac and thoracic aorta surgery may result in SCI as a complication. In last years, a promising approach has shed light on this CNS injury thanks to stem cell technology. Stem cell therapy could be considered as a good candidate for transplantation and enhancing neural regeneration in SCI. In this study, we identified the effects of spinal cord-derived neural precursor cells (NPCs) transplantation on SCI in after and before injury injection. Materials and Methods: NPCs were isolated from the adult rat spinal cord and cultured in vitro using complete culture media. After neurosphere formation, the cells were differentiated to neurons, oligodendrocytes, and astrocyte. The cells were transplanted to the rat model of SCI in 1 day before and 1 day after injury. The animals were followed for 12 weeks to assess their neurological performance. In addition, histological study and inflammatory cytokines levels have been studied. Results: Our results indicate that NPCs infusion both pre- and post-SCI could decrease the level of inflammatory cytokines. In addition, the neurological performance and histologic studies showed recovery after this type of injury using NPCs, and it might be due to inflammation modulatory effects on neural stem cells. Conclusion: NPCs therapy for SCI in both two-time points (before and after SCI) could be beneficial and make a neurological recovery. In other words, NPCs therapy could be considered as a therapeutic and also preventive approach for SCI.
Spinal–epidural abscess presenting as an acute abdomen in a child: A case report and review of the literature
Authors: Fakhouri Fakhr , Ghazal Ahmad , Alnaeb Hasnaa , Hezan Rasha , Araj Joudi
Published: April 2018

Abdominal presentations in patients with spinal–epidural abscess (SEA) are not uncommon. However, it needs to be continually emphasized that the atypical presentations of these diseases could delay the timely diagnosis and consequently prompt management, which threatens spinal cord, leading to potential to paralysis or even death. We report a case of a young girl who presented with abdominal pain and fever. The diagnosis of SEA was unfortunately so delayed that the patient did not show any functional recovery postoperatively. This report aims to highlight the importance of high level of clinical suspicion to recognize an atypical presentation of the SEA. Moreover, the fully detailed history-taking and physical examination are of paramount importance. Spinal underlying pathologies should always be considered as a cause of abdominal pain, especially in children.
Unravelling hitherto unreported masses camouflaged as pituitary macro adenomas
Authors: Velho Vernon , Guha Amrita , Naik Harish , Bhople Laxmikant , Jain Nimesh
Published: April 2018

Background: Lesions of the pituitary gland and the juxtasellar region are quite frequently encountered in daily practise of a neurologist/neurosurgeon. While the differentials of sellar masses are quite large and form an extensive list and the management protocol varies in each case, the onus of properly categorizing and diagnosing the pituitary mass often falls on the reporting radiologist. We hereby present two such unusual masses in the sellar-suprasellar region which were masquerading as pituitary macro adenomas. Materials and Methods: Two cases of sellar-suprasellar masses which were preoperatively diagnosed as pituitary macro-adenomas on radiological imaging proved out to be pituitary natural killer cell lymphoma and lepromatous abscess. Results: The first one is a rare case of pituitary abscess seen in a lepromatous patient which is not yet reported in the literature. The second case is of primary pituitary natural killer cell lymphoma which is almost entirely unknown, with only two such cases being reported worldwide till date. Conclusion: It is important to realize that all enhancing pituitary lesions are not macro adenomas and it is necessary to have a high index of suspicion in such cases. The clinical implications of such an error and steps that can be taken to prevent misinterpretations of unusual sellar masses camouflaging as pituitary macro adenomas have been briefly outlined.
Posterior fossa arteriovenous malformation with multiple pedicle aneurysms and recruitment of meningeal supply
Authors: Nonaka Senshu , Oishi Hidenori , Tsutsumi Satoshi , Ishii Hisato
Published: April 2018

Cerebral aneurysms arising on the peripheral posterior inferior cerebellar artery (PICA) are rare. Here, we present a unique case of arteriovenous malformation (AVM) with pedicle aneurysms arising on the peripheral PICA and recruited by meningeal supply. A 67-year-old woman presented with subarachnoid hemorrhage. Cerebral angiography revealed two saccular aneurysms on the peripheral PICA, which formed an abnormal arteriovenous shunt adjacent to the transverse sinus. The shunt was also fed by the ipsilateral superior cerebellar and contralateral posterior meningeal arteries. The proximal aneurysm was larger and deep seated while the distal aneurysm was smaller and located superficially. The patient underwent coil embolization of the proximal aneurysm followed by microsurgical trap of the distal aneurysm and resection of the arteriovenous shunt lying superficially in the cerebellar hemisphere. The shunt was histologically verified as AVM. Staged approach with coil embolization and open microsurgery can be a treatment option for multiple PICA aneurysms associated with an AVM.
Is transposition of deep brain stimulation device a solution in patients with recurrent skin erosions?
Authors: Servello Domenico , Saleh Christian , Zekaj Edvin
Published: April 2018

Skin erosion and infection are common but serious problems in deep brain stimulation (DBS). They can lead to the removal of the entire DBS device and consequently stop the entire treatment. Of critical importance, therefore, is to find surgical solutions that allow to leave the complex DBS device in place when medical treatment fails in repeated skin complications, to allow continuing treatment in otherwise pharmacological refractory patients. We present a patient with repeated retro-auricular skin erosions, who failed to respond to surgical revisions and antibiotic treatment. However, instead of removing the DBS device as it would be general practice we succeeded with a right to left transposition of connecting cables to save the entire DBS system. There is lack of data on therapeutic surgical options in repeated skin complications. We propose the transposition of DBS device as possible solution for multiple skin erosions in DBS surgery.
An unusual cause of posterior reversible encephalopathy syndrome
Authors: Das Biplab , Goel Gaurav , Mahajan Anshu , Bansal Atma , Sapra Harsh , Jha Ajaya
Published: April 2018

Posterior reversible encephalopathy syndrome (PRES) is a clinical radiographic diagnosis of heterogeneous etiologies. The pathogenesis of PRES remains unclear, but may be related to impaired cerebral autoregulation and endothelial dysfunction. We present a case of intravascular nonionic contrast-induced PRES observed after cerebral angiography. The index patient was a follow-up case of large vertebrobasilar artery-dissecting aneurysm for which endovascular coiling was done 6 months back. She improved completely within a week. Contrast-induced PRES is a reversible benign condition, knowledge of which is crucial for appropriate management.
Chronic unilateral temporo-occipital headache attributed to unilateral C3 radiculopathy
Authors: Ko Hak-cheol , Son Byung-chul
Published: April 2018

Although C1–C3 upper cervical radiculopathy can cause a headache, most case reports are occipital neuralgia (ON), not headache. Here, we report a unique case of chronic temporo-occipital headache due to C3 radiculopathy. A 62-year-old male presented with a chronic left-sided temporo-occipital headache with duration of 4 years. The headache was aching and pressure like in nature. It had a typical radiating pattern on every occasion. It started in the posterior temporal area above the ear. It then extended to retroauricular area, then suboccipital area, and lateral neck. No hypesthesia, allodynia, or limitation in neck motion was noted. Myelographic computed tomography revealed a left-sided C2/C3 foraminal stenosis. Subsequent foraminotomy and decompression of the left C3 completely alleviated the chronic left-sided temporo-occipital headache. Unilateral C3 radiculopathy can cause chronic temporo-occipital headache besides ON. The present case might be a typical example of “headache attributed to upper cervical radiculopathy” (A11.2.4) rather than cervicogenic headache according to the International Classification of Headache Disorders, 3rd edition (beta version).
Ruptured posterior circulation aneurysms with bilateral internal carotid artery occlusion: Surgical nuance
Authors: Dange Nitin , Mahore Amit , Patil Ashwini , Kawale Juhi
Published: April 2018

Background: Craniotomy and surgical clipping is the standard modality of treatment in patients of cerebral aneurysms. However, the surgical clipping of aneurysm may pose serious difficulties in the case of a bilateral carotid artery occlusion. The endovascular treatment has shown promising results in this disease. Methods: A retrospective study of all patients of posterior circulation aneurysms in the background of carotid occlusive disease at our department was performed. The aim of this study was to describe the clinical, radiological characteristics, and the treatment of this rare entity. Results: Four patients were treated from January 2009 to October 2015. The mean age of our patients was 34 years with ages that ranged from 17 to 45 without any gender predominance. The mean period between onset of symptoms and diagnosis was 6 weeks. Angiographic localization of the disease was observed in all patients. All patients were treated by endovascular techniques. The postoperative course has been satisfactory with a complete neurological recovery in all patients. Conclusions: Rupture of posterior circulation aneurysms in the setting of bilateral internal carotid artery occlusion is extremely rare. Treatment is exclusively endovascular intervention. The functional outcome of ruptured posterior circulation aneurysms in setting of bilateral carotid occlusive disease is particularly favorable with good neurological recovery.
Diprosopus a rare craniofacial malformation
Authors: Bhuyan Mrinal , Haque Inamul
Published: April 2018

Diprosopus is an extremely rare form of craniofacial malformation seen in newborns where there is duplication of face which may be partial or complete. The baby usually has a single trunk and normal limbs. We report a case of diprosopus admitted in our institute and analyze the anomalies and clinical problems and outcome of the case.
Endoscopic approach to putaminal bleed
Authors: Suyama Daisuke , Kumar Brajesh , Watanabe Saiko , Tanaka Riki , Yamada Yasuhiro , Kawase Tsukasa , Kato Yoko
Published: April 2018

Objective: To highlight the basic points of brain endoscopic procedure for Putaminal Bleed to achieve repeatability and reproducibility in the results among the new brain endoscopic surgeons. Method: Sharing the experience of 10 years as an endoscopic surgeon to bring out the basic insight into the method, challenges, points which need special attention during the surgery and discussion of recent advancements in the endoscopic equipment for safe surgery. Conclusion: Procedure of endoscopic evacuation of brain hematoma is simple with learning curve. In the beginning new endoscopic surgeons should operate in the presence of experience surgeon. They should follow standard technique to achieve the good surgical outcome and uniformity in the result every time they perform the surgery.
Endoscopic approach to thalamic and intraventricular hemorrhage
Authors: Suyama Daisuke , Kumar Brajesh , Watanabe Saiko , Tanaka Riki , Yamada Yasuhiro , Kawase Tsukasa , Kato Yoko
Published: April 2018

Objective: To highlight the basic points of brain endoscopic procedure for Thalamic and Intraventricular Hemorrhage to achieve repeatability and reproducibility in the results among the new brain endoscopic surgeons. Method: Sharing the experience of 10 years as an endoscopic surgeon to bring out the basic insight into the method, challenges, points which need special attention during the surgery and discussion of recent advancements in the endoscopic equipment for safe surgery. Conclusion: Procedure of endoscopic evacuation of brain hematoma is simple with learning curve. In the beginning new endoscopic surgeons should operate in the presence of experience surgeon. They should follow standard technique to achieve the good surgical outcome and uniformity in the result every time they perform the surgery.
Outcome of posttraumatic delayed intracerebral tension pneumatocele: Prospective study of four cases: Single institutional experience
Authors: Kankane Vivek , Gupta Tarun
Published: April 2018

Aim: Delayed intracerebral tension pneumatocele (DITP) is an uncommon cause of raised intracranial pressure following trauma. However, it can cause herniation syndrome due to a sudden increase in intracranial pressure which requires emergent intervention. Pneumocephalus is a complication of head injury in 3.9%–9.7% of the cases. The accumulation of intracranial air can be acute (<72 h) or delayed (≥72 h). Method: When intracranial air causes intracranial hypertension and has a mass effect with neurological deterioration, it is called tension pneumocephalus. In our case series, we demonstrated four cases of DITP in adult patients from January 2012 to January 2017 in the Department of Neurosurgery at R. N. T. Medical College and M. B. Hospital, Udaipur, Rajasthan. Result: During this period, a total number of patients admitted of head injury are 1768 and hence, the incidence of DITP in our series is 0.226% which is very less as compared to previous literature. All patients are male; age ranging from 17 years to 55 years (mean age was 31.75 years). All patients have a history of head injury, and mode of injury had road traffic accidents. Glasgow Coma Score (GCS) at readmission were 12–13 (mean GCS 12.75). Duration of developed DITP 1 month to 2½ months (mean 1.375 months), all patients had gone to surgical intervention, and outcome assessed using Glasgow outcome score. All patients had a good outcome and average follow-up was 12.5 months. Conclusion: long term observation of patients with simple pneumocephalus following trauma is beneficial as there is an expected risk of developing delayed tension pneumocephalus which may manifest with raised intracranial pressure.
Airway management in case of diffuse idiopathic skeletal hyperostosis
Authors: Gosavi Kundan , Dey Paulomi , Swami Sachin
Published: April 2018

Diffuse idiopathic skeletal hyperostosis (DISH) is associated with abnormal ossification of spinal and extraspinal appendages. Incidence of DISH is high in old age with predilection for males. Cervical hyperostosis can make intubation difficult in multiple ways. Here, we report a case of DISH bridging the cervical spine from C2 to C7 vertebrae managed using awake fiberoptic technique and a small-sized endotracheal tube.
Moulded osteomyofascial pedicled split (MOPS) craniotomy flap in reconstruction of anterior cranial fossa defects: Pilot study of a novel technique
Authors: Gopal Vinu , Bhooshan Lekshmi , Michael Alfred , Issac Philip , Mathew Shaju , Abraham Tinu , Balakrishnan P
Published: April 2018

Introduction: Anterior cranial fossa (ACF) defects still remains a reconstructive challenge to neurosurgeons due to the difficult location, inaccessibility, and unfavorable vascular anatomy. Usual reconstructive methods reported complications such as recurrent cerebrospinal fluid leak due to bone resorption and tissue breakdown. This is mainly due to the avascularity of the bone graft and inability to provide bony structural support for the skull base. An ideal reconstructive modality should provide a rigid bony support to prevent brain herniation as well as ensure a water tight barrier between sinonasal tract and intracranial compartment. Methodology: Hence, we thought of a novel technique of taking the outer table of the primary craniotomy flap with its intact myofascial pedicle and moulded it with multiple osteotomies (moulded osteomyofascial pedicled split (MOPS) craniotomy flap) to fit into uneven ACF defects. Advantages of our flap include (1) It is a pedicled vascularized bone flap. (2) It is taken from primary craniotomy flap; hence, no separate craniotomy is required. (3) The inner table is intact and leaves no secondary calvarial bone defect on the donor site. (4) Osteoplastic flap is moulded to fit into the defect, thus providing good contour. Results: MOPS flap was used in five patients with ACF defects due to varied etiologies such as encephalocele defect, frontal mucocele, skull base meningioma, and complex naso ethmoid fracture. Age of the patients included in the study varied from 21 to 60 years. Male:female ratio was 4:1. ACF defects were reconstructed using MOPS flap in all cases. There were no postoperative complications and 1-month postoperative computerized tomography scan showed no evidence of bone resorption with acceptable cosmesis. Conclusion: MOPS craniotomy flap provides a novel, easily mastered, and cost-effective technique with minimal complication in reconstruction of complex ACF defects with acceptable esthetic and functional outcome.
Speech and language dysfunctions in patients with cerebrocortical disorders admitted in a neurosurgical unit
Authors: Bobba Ushasree , Munivenkatappa Ashok , Agrawal Amit
Published: April 2018

Introduction: Speech and language abnormality among brain injury patients are common, especially during the acute stage. The details of same from Andhra Pradesh (AP) state are limited. The present study provides details of speech and language abnormality among brain damage patients, from a tertiary care hospital AP. Materials and Methods: This study was conducted at tertiary care hospital, Nellore, AP. Patients with acute brain damage due to traumatic brain injury (TBI), cerebrovascular accident (CVA), and postoperative cases of brain tumors were selected for the study. Detail of speech and language disturbances was accessed using Western Aphasia Battery. All patients were right-handed and Telugu was their first language. Results: There were totally 38 patients, of them 28 had TBI, 8 patients were postoperative cases of brain tumor, and 2 cases were of CVA. The mean age was 45.6 years. A total of 22 patients were literate. TBI patients with left cerebral hemisphere damage manifested with anomic, conduction, transcortical sensory, global, and Wernicke's aphasia. Four patients of postoperative brain tumor manifested with anomic and transcortical sensory aphasia had left-sided brain damage and mild dysarthria had right-sided brain damage patient. CVA patients had anomic aphasia and subcortical aphasia having right and left cerebral hemisphere damage, respectively. Conclusions: This study reports that acute brain damage due to various causes manifest with speech and language abnormality, especially when the left cerebral hemisphere is involved.
Enterococcal meningitis/ventriculitis: A tertiary care experience
Authors: Khanum Iffat , Anwar Sana , Farooque Aisha
Published: April 2018

Context: Enterococcal meningitis is very rare among bacterial meningitis and has variable clinical outcomes. Aims: The purpose of the current study is to evaluate clinical features, therapeutic options with susceptibility profile, and outcomes of enterococcal meningitis in a tertiary care hospital. Settings and Design: We retrospectively reviewed medical records of all patients with enterococcal meningitis over the periods of 4 years. Subjects and Methods: The clinical and laboratory data of all patients with enterococcal meningitis were evaluated between 2013 and 2016. Results: Six cases of enterococcal meningitis were found (three infant and three adults). All patients developed meningitis after neurosurgical procedures, and majority of patients (four out of six) had central nervous system (CNS) devices in situ at the time of development of meningitis. The causative organism isolated from cerebrospinal fluid (CSF) culture of all patients was Enterococcus species only. All Enterococcus spp. were resistant to ampicillin, Amoxicillin-clavulanate, and oxytetracycline and two isolates were also resistant to vancomycin. Four patients with vancomycin-sensitive Enterococcus spp. were treated with vancomycin alone for mean periods of 18 days (14–21 days). One patient with vancomycin-resistant Enterococcus (VRE) meningitis was treated with linezolid alone, and another one requires combination with rifampicin to achieve microbiological clearance of CSF. CNS devices were removed in all patients. No mortality was reported in current case series. Conclusions: Enterococcal meningitis is very uncommon, mostly associated with neurosurgical intervention. Early treatment is associated with favorable outcomes. Removal of CNS devices is recommended to achieve a clinical cure.
Exploring a tumor spectrum in a patient with familial angiolipomatosis
Authors: Maheshwari Shradha , Arora Eham
Published: April 2018

Angiolipomas are uncommon spinal tumors which differ from their cutaneous counterparts in having larger caliber vascular stroma. Although slow growing, they can cause rapid spinal cord compression and sudden-onset sensorimotor symptoms due to vascular engorgement, hemorrhage, or thrombosis. The goal of surgery is spinal decompression, and favorable outcome is the rule. We report a patient with spinal angiolipoma, vertebral hemangioma along with subcutaneous lipomas and angiolipomas, exhibiting the entire histopathological spectrum of these related soft-tissue tumors. Analysis of his family tree revealed a hereditary predilection. Familial angiolipomatosis is an uncommon genetic condition which has not been reported to occur with spinal angiolipomas thus far.
Extensive paraspinal tuberculosis masquerading malignant tumor in an elderly male
Authors: Kumar Veldurti , Shanthi Vissa , Sandeep Yashwanth , Samudrala Veda , Agrawal Amit
Published: April 2018

Paraspinal tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis, and in rare cases, these lesions can mimic malignant lesions. We report a case of an elderly man where imaging showed extensive left paraspinal lesion which was mimicking malignant neoplasm. The patient underwent L3–L4 unilateral partial laminotomy, there was grayish, relatively avascular lesion in the left paraspinal region, involving the left psoas muscle and going into the neural foramina, and a subtotal resection of the lesion could be performed. However, after biopsy, it turned out to be tuberculoma, and the patient was on antitubercular therapy and doing well. The present case illustrates that extensive involvement of the paraspinal soft tissue and adjacent bony structures on imaging in tuberculosis can mimic malignant tumors. Conservative surgical excision will help in preserving the bony elements and in establishing the diagnosis.
Modified inside-outside occipito-cervical plate system: Preliminary results
Authors: Caglar Sukru , Turkoglu Erhan , Kertmen Hayri , Gurer Bora , Bozkurt Huseyin , Ozay Rafet , Hanalioglu Sahin , Colpan Efkan
Published: April 2018

Context: Internal rigid fixation provides immediate stability of the occipito-cervical (OC) junction for treatment of instability; however, in current practice, the optimal OC junction stabilization method is debatable. Aims: The aim of this study to test the safety and efficacy of a newly designed modified inside-outside occipito-cervical (MIOOC) plate system for the treatment of instability. Settings and Design: This was a feasibility study of MIOCC plate system. Subjects and Methods: Five male and four female patients with OC instability were treated using MIOOC plate system. Stabilization rate, safety, and efficacy were evaluated radiologically and clinically. Results: Mean age of the patients was 35 ± 11 (range: 22–58) years. Etiology of OC instability included trauma, neoplasm, congenital abnormalities, and iatrogenic. The fusion levels ranged from occiput-C3 to occiput-C6. Mean follow-up duration was 22 ± 10 (range: 6–46) months. There were neither complication nor was there any need for plate revision or screw pullout. Mortality occurred in one patient due to primary malignancy at 6 months; otherwise, no morbidity was observed. During the follow-up, no recurrent subluxation or newly developed instability at adjacent levels occurred. All patients showed a satisfactory union at the most recent follow-up examination. Conclusions: These preliminary results suggest that the MIOCC plate system is a useful and safe method for providing immediate internal stability of the OC junction. Using a multi-piece plate design in this plate system provided easy implantation and a better interface between plate and OC bones. Further, clinical studies and long-term results are needed to determine the reliability of the MIOOC plate system.
Adult thoracic intradural exophytic mature teratoma: Case report and literature review
Authors: Danison Aaron , Ramanathan Dinesh , Matin Mahan , Kim Kee , Panchal Ripul
Published: April 2018

Mature thoracic intraspinal teratomas are rare tumors in adults. In this case study, we present a case of intradural, extramedullary teratoma, which was surgically resected. A 50 year old man presented with progressive bilateral leg pain, severe myelopathy and weakness. Magnetic Resonance Imaging (MRI) revealed a cystic mass lesion in the T11-12 region region. Microsurgical resection of the tumor using CO2 laser with neuromonitoring was performed. Postoperatively, the patient had a remarkable clinical improvement. Mature spinal teratomas are rare, slow growing spinal tumors. Surgical resection provides excellent recovery, and recurrence rates are low.
Clinical characteristics of cerebellar infarction due to arterial dissection
Authors: Inamasu Joji , Nakae Shunsuke , Kato Yoko , Hirose Yuichi
Published: April 2018

Objectives and Background: Arterial dissection (AD) of the vertebral artery (VA) or its branches may cause ischemic stroke of the posterior circulation. However, clinical and radiological characteristics of patients with AD-related cerebellar infarction (CI) have rarely been reported. Methods: Forty-nine patients with CI admitted to our department from April 2008 to March 2015 were identified from our database. After dichotomization into the AD and non-AD group, their demographics and presenting symptoms were compared. Subsequently, a multivariate regression analysis was performed to identify variables that correlated with AD. Results: During the 7-year period, 14 and 35 patients were identified in the AD and non-AD group, respectively. The AD group was significantly younger than the non-AD group (55.0 ± 16.3 vs. 69.7 ± 10.7 years, P = 0.001) and was also more likely to experience acute pain at onset (86% vs. 17%, P < 0.001). Using a multivariate regression analysis, these two variables and the male sex were found to correlate with AD. AD was located in extracranial VA (n = 3); intracranial VA (n = 8); posterior inferior cerebellar artery (PICA) (n = 3); and superior cerebellar artery (n = 1). Identification of AD was delayed in one patient with an extracranial VA and one patient with a PICA dissection. Conclusions: AD was responsible for approximately 30% of CI in our cohort. Pain at onset may be a useful symptom to identify patients with AD-related CI. While intracranial VA was the most common location of AD, physicians should be aware of the possibility of extracranial VA or PICA dissection in patients with seemingly unremarkable radiological findings.
Early surgical outcome of endoscopic third ventriculostomy in the management of obstructive hydrocephalus: A randomized control trial
Authors: Rahman Mohammad , Salam Mohammad , Uddin Kalim , Rahman Mohammad , Islam Mohammad , Haque Mohammad , Hussain Ahmed , Yusuf Mohammad
Published: April 2018

Background: Management of obstructive hydrocephalus is an important issue for the reduction of mortality and morbidity. Objectives: The aim of the present study was to assess the early surgical outcome of endoscopic third ventriculostomy (ETV) in the management of obstructive hydrocephalus. Methodology: This randomized controlled trial was conducted at the Department of Neurosurgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from April 2009 to September 2010 for 1½ years. All patients presenting with obstructive hydrocephalus with the obstruction at or distal to the third ventricle and age 6 months and above were included in the study population. All the patients were divided into two groups named as Group A (experimental group) who were treated with ETV and Group B (control group) who were treated with ventriculoperitoneal shunt (VPS). The early surgical outcome was defined as outcomes within 1 month following surgical interventions. Pre- and post-operative outcomes of this study were measured. Results: A total number of sixty patients were recruited from which thirty patients were in Group A and the rest thirty patients were in Group B. The mean postoperative head circumference was 43.4 ± 7.1 cm and 47.8 ± 5.6 cm in VPS and ETV surgery, respectively (P ≤ 0.01). Postoperative vomiting was improved 24 (92.3%) in Group A and 23 (88.5%) in Group B (P < 0.05). Postoperative infection occurred in 1 (3.3%) case in Group A and 8 (26.7%) cases in Group B (P < 0.05). The success of the operation in Group A and Group B included 25 (83.3%) cases and 12 (40%) cases, respectively (P < 0.05). Conclusion: Early surgical outcome following ETV is better than VPS surgery in patients with obstructive hydrocephalus.