B-cell lymphoma of the brainstem with central neurogenic hyperventilation

Non-Hodgkin\u27s lymphoma of the brainstem is a rare entity. Central Neurogenic Hyperventilation (CNH), an associated manifestation of this disease, is an even rarer event. We report a case of an immunocompetent individual who presented to us with tachypnea and facial nerve palsy. Neuroimaging showed a Cerebellopontine angle tumour which on histopathology showed feature consistent with a Non-Hodgkin\u27s B-Cell Lymphoma. The patient went on to develop severe respiratory alkalosis with findings consistent with CNH. Chemotherapy with Methotrexate was started and high dose Dexamethasone was added to the regimen a month later. Radiologically, the tumour size decreased by 50% but the patient\u27s clinical condition deteriorated. He eventually expired due to cardiopulmonary arrest. Some common clinical presentations of this disease and various diagnostic modalities and treatment options available to such patients are discussed

The antimicrobial activity of oil-in-water microemulsions is predicted by their position within the microemulsion stability zone

It has been shown previously that thermodynamically stable oil-in-water microemulsions have significant antimicrobial activity against planktonic cells and biofilm cells over short periods of exposure. It was the aim of this study to identify whether the position of the microemulsion within the microemulsion stability zone of the pseudo-ternary phase structure predicts the efficiency of the antimicrobial action of the microemulsion. Microemulsions were formulated at different points within the microemulsion stability zone. Experiments were performed to observe the kinetics of killing of these microemulsions against selected test microorganisms (Pseudomonas aeruginosa ATCC 9027, Candida albicans ATCC 10231, Staphylococcus aureus ATCC 6538 and Aspergillus niger ATCC 16404). The results indicated that the antimicrobial activity of the microemulsion is dependant upon its position within the zone of stability and is greater nearer the centre of that zone. The results indicate that significant antimicrobial activity can be observed at all points within the zone of microemulsion stability, but that maximal activity is to be found at the centre of that area

Prospective case control evaluation of epidural midazolam for improving pain and ambulation after microdiscectomy

Objective: To evaluate midazolam as an epidural analgesic in patients undergoing single-level microdiscectomy.Methods: This prospective case control study was carried out at the Aga Khan University Hospital, Karachi, from January 20 to September 20, 2007, on patients undergoing microdiscectomy. Cases (group A) received midazolam with saline, while controls (group B) received saline only, placed intra-operatively over involved nerve root. Post-operatively, patients were monitored for various variables. Data was analysed using SPSS 13.0 and groups were compared using student\u27s t-test for continuous variables and chi square for categorical variables. P-value \u3c0.05 was considered significant.Results: Patients in group A ambulated earlier (p = 0.005) and although they did not show significantly better post-operative pain control, but post-operative nausea and vomiting (PONV) score was better at six hours (p = 0.020). There was no difference in other variables such as requirement of analgesics, anti-emetics, hospital stay and complications.Conclusion: Midazolam may improve post-operative nausea and vomiting score, and may lead to earlier ambulation, without affecting patient\u27s vitals, consciousness, lower extremity power or sensations, and is not associated with adverse effects

Neurosurgeons and electrocautery

Abstract are not provided by the author/publishe

Role of surgery in cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity