A Study of Pituitary Macroadenoma Transnasal Endoscopic Excision

BACKGROUND: Pituitary macroadenomas are enclosed, invasive or expanding tumours of size > 10mm. The role of imaging techniques has implication in surgery based on the tumour size, extent and consistency that determines the ease of resection, cure and occurence of complication. The transnasal trans-sphenoidal endoscopic approach has recently been applied procedure that is minimally invasive to ressect pituitary tumours with minimum morbidity and mortality. AIM OF THE STUDY: 1. To Study about the Pituitary Macroadenoma-Transnasal Endoscopic Excision. OBJECTIVES: 1. To study the modes of presentation of pituitary macroadenoma. 2. To evaluate radiological study of the tumour by computed tomography (CT) /magnetic resonance imaging ( MRI) and its implications in surgical techniques. 3. To review the surgical techniques in complete excision of the macroadenoma. 4. To study the per operative and post operative complications and its management. METHODS AND MATERIALS: The study was conducted in Rajiv Gandhi Government General Hospital and Madras Medical College in the Upgraded Institute of Oto-Rhino-Laryngology, Chennai from June 2015 to September 2016. The study was a retrospective and prospective study. The study population comprised of patients who were diagnosed to have pituitary macroadenoma. Cases of pituitary macroadenoma attending neurology opd, surgical endocrinology opd and cases referred from these opd’s to Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital were studied. The sample size for this study was 28. CT scan / MRI was done. Instituitional Ethical clearance and informed consent was obtained. RESULTS: Majority of the pituitary macroadenomas were seen in the age group 41-50 year (32.14%) and among females (53.6%). Among the 28 cases, nonsecretory tumours were 17 (60.7%) and secretory were 11(39.3%).The predominant symptoms were headache (71.4%) and visual defects (42.8%). Majority of tumour extension was to the suprasellar region (50%). On MRI based images, consistency of 10 tumours were semisolid of which on peroperative findings 6 (60%) were soft and 4 (40%) were firm. 92.3% of the tumours having solid consistency on MRI images were firm and the remaining 7.6% were found to be soft on per operative finding. Suprasellar extension on MRI was s similar in 12 (85.7%) cases peroperatively. Suprasellar and parasellar extension on MRI were similar only in 5 (71.4%) cases. CSF leak was the only peroperative complication found in 6 cases (21.4%). The most common post operative complication was diabetes insipidus (42.8%). Peroperative CSF leak repair was done for 6 cases and for 1 case post operative CSF leak repair done and lumbar drain was kept. Post operative diabetes insipidus was treated with intranasal desmopressin in 3 cases. CVA was managed conservatively in 2 cases. CONCLUSION: The transsphenoidal endoscopic surgical approach is adequate for total removal of pituitary macroadenoma with cystic and soft consistency. In solid tumours with extensive suprasellar extension and parasellar encasement of carotids, the trans sphenoidal endoscopic approach may not be adequate for complete resection. The incidence of per operative complications like csf leak, haemorrhage and post operative diabetes insipidus is very less if meticulous dissection technique is carried out with tissue respect and minimal injury

Traversing the Inner Courtyard to the Public Sphere: Exploring Lalithambika Antharjanam’s Short Stories as Narratives of Protest in Early Twentieth Century Kerala

This essay analyzes women writing about their experience in the changing socio-cultural and political context of the early twentieth century and especially in the face of the global, national, and regional transformations that Kerala underwent. The essay argues that the short stories of Lalithambika Antharjanam subverted the popular representation of antharjanams in the early 20th century as impassive, oppressed, and vulnerable subjects and provided alternative ways to conceptualize an antharjanam as a feminist trailblazer with a strong voice of protest. Her writing exposes her first-hand experiences of gender discrimination practiced in families as related to her caste and family lineage. Thus, her literary expression is one of the first ventures in feminist writing that Malayalam literature witnessed. This article draws on the scholarship of Uma Chakravarti, Nur Yalman, and Michel Foucault, employing their theories on gender, sociology, psychoanalysis, and cultural and anthropological frameworks to explore women’s roles in their respective social groups. Furthermore, the works of Joan Watt and J. Devika are applied in this interpretation of works by women writers in twentieth-century Kerala

Neural Network Precept Diagnosis on Petrochemical Pipelines for Quality Maintenance

Pipeline tubes are part of vital mechanical systems largely used in petrochemical industries. They serve to transport natural gases or liquids. They are cylindrical tubes and are submitted to the risks of corrosion due to high PH concentrations of the transported liquids in addition to fatigue cracks. Due to the nature of their function, they are subject to the alternation of pressure-depression along the time, initiating therefore in the tubes body  micro-cracks that can propagate abruptly to lead to failure by fatigue.On to the diagnostic study for the issue the development of this prognostic process employing neural network for such systems bounds to the scope of quality maintenance. Keywords: Percept, Simulated results, Fluid Mechanic

Neural Network Precept Diagnosis on Petrochemical Pipelines for Quality Maintenance

Pipeline tubes are part of vital mechanical systems largely used in petrochemical industries. They serve to transport natural gases or liquids. They are cylindrical tubes and are submitted to the risks of corrosion due to high PH concentrations of the transported liquids in addition to fatigue cracks. Due to the nature of their function, they are subject to the alternation of pressure-depression along the time, initiating therefore in the tubes' body micro-cracks that can propagate abruptly to lead to failure by fatigue. On to the diagnostic study for the issue the development of this prognostic process employing neural network for such systems bounds to the scope of quality maintenance. Keywords: Percept, Simulated results, Fluid Mechanic

Suspending droplets beyond the Rayleigh limit: The interplay of acoustic and gravity forces

In this work, we experimentally investigate the suspension behavior of droplets subjected to standing acoustic waves. We focus on the droplet sizes beyond the Rayleigh limit, i.e., when the droplet size is comparable to the wavelength of the acoustic wave. We show that an acoustic field can disrupt the uniform motion of aqueous droplets in oil and cause them to either suspend or settle, depending on the interplay between acoustic and gravity forces. Remarkably, in contrast to droplets within the Rayleigh limit, the critical acoustic power or minimum pressure amplitude required to suspend droplets beyond the Rayleigh limit is dependent on droplet size. As the droplet size increases, the critical acosutic power increases significantly. Building upon this understanding, a novel sorting method is proposed based on critical acoustic power

Steganography Based on Random Pixel Selection For Efficient Data Hiding

ABSTRACT In this paper we present a novel steganographic approach to increase the security of the data hidden in a cover RGB image. Here we have used LSB insertion method that hides the bits of a secret message into the least significant bit in the red plane of the pixels within a cover image. The pixels are selected by using a random number generator. It is commonly seen that the changes in the LSB of the colour cannot be detected due to noise that is presents in the digital images by the human visual system. The central idea of the proposed method is to increase security, so the data is embedded only into the red plane of the image. We have also explained the method that extracts the hidden message at the receiving end using a key. The main objective of the paper is to combine both the preferences and the resistance to the visual and statistical attacks for a large amount of the data to be hidden in a cover image

Aalap: AI Assistant for Legal & Paralegal Functions in India

Using proprietary Large Language Models on legal tasks poses challenges due to data privacy issues, domain data heterogeneity, domain knowledge sophistication, and domain objectives uniqueness. We created Aalalp, a fine-tuned Mistral 7B model on instructions data related to specific Indian legal tasks. The performance of Aalap is better than gpt-3.5-turbo in 31\% of our test data and obtains an equivalent score in 34\% of the test data as evaluated by GPT4. Training Aalap mainly focuses on teaching legal reasoning rather than legal recall. Aalap is definitely helpful for the day-to-day activities of lawyers, judges, or anyone working in legal systems

Unidentified bright objects of spleen on arterial phase CT: mimicker of splenic vascular injury in blunt abdominal trauma

PURPOSEWe have described unidentified bright objects of spleen (UBOS), a hitherto undescribed entity, as hyperdense areas on arterial phase (AP) computed tomography (CT) seen in relation to splenic lacerations and are isodense to the normal parenchyma on portal venous phase with no correlate on digital subtraction angiography (DSA). UBOS mimic splenic vascular injuries like active contrast extravasation and pseudoaneurysm and need to be differentiated from them as it would have implications on patient management. We undertook this study to identify CT features of UBOS that can differentiate them from splenic vascular injuries and to calculate their diagnostic accuracy.METHODSThis retrospective study was approved by the institutional ethical committee and the need for informed consent was waived. Patients with splenic injury who had undergone dual-phase CT and DSA were included. All the lesions that were hyperdense on AP were evaluated for their outline, their relation to the adjacent/parallel margins of a laceration (margin sign), string of beads appearance, and the presence of adjacent normal parenchyma (adjacent parenchyma sign). The Hounsfield unit (HU) of the lesion and the aorta on the AP were also noted. The diagnostic accuracy of various signs for distinguishing UBOS from splenic vascular injuries was calculated using DSA as the reference standard.RESULTSOf 48 patients, 5 were excluded due to suboptimal quality of the examination or a time difference of more than 6 hours between the CT and DSA. A total of 54 hyperdense lesions were detected on AP in 43 patients. These were classified as vascular injuries (pseudoaneurysm, n=11; active contrast extravasation, n=11) and UBOS (n=32) based on DSA. The margin sign, string of beads appearance, and ill-defined outline had high specificity (95%, 86%, and 82%, respectively) but low sensitivity (50%, 65%, and 63%, respectively). The adjacent parenchyma sign had a moderate sensitivity and specificity of 84% and 77%, respectively. ROC analysis showed that a difference of 50 HU between the aorta and the lesion had a high sensitivity and specificity of 88.9% and 90.6%, respectively, with an area under the curve of 0.90.CONCLUSIONAn attenuation difference of over 50 HU between the aorta and the lesion and the presence of normal adjacent parenchyma had the highest diagnostic accuracy, while an ill-defined outline, string of beads appearance, and margin sign had high specificity but low sensitivity for differentiating UBOS from splenic vascular injuries