Institutional experience of tuberculosis of craniovertebral junction

Background: Craniovertebral junction tuberculosis (CVJ-TB) is a rare entity occurring in only 0.3 to 1% of tuberculous spondylitis. It causes severe instability and neurological deficits. Present study includes 16 cases of CVJ tuberculosis with neck pain and progressive quadriparesis. Radiological evaluation showed wide spread disease around clivus, C1, C2, C3 with extensive bony destruction, cord compression, basilar invagination and atlantoaxial dislocation.Methods: The study included all the cases admitted with cv junction tuberculosis in neurosurgery ward in King George hospital, Visakhapatnam during a period of three years from 2014 to 2016. Four cases were managed conservatively and four cases were treated by only posterior occipitocervical fusion. We performed two stage operation in single sitting i.e. transoral decompression and posterior occipitocervical fusion in 12 cases. The pathological findings confirmed tuberculosis.Results: Postoperatively all the patients had decreased neck pain and two third of the patients (10 of 16 patients) had improvement in motor power.Conclusions: In the available literature, the treatment options offered for cvj-tb have ranged from a purely conservative approach to radical surgery without well-defined guidelines. In this study, we followed a radical approach as the patients included in our study presented with extensive TB cv junction. So, we recommend radical surgery for extensive TB of cv junction

Institutional experience of surgical management of intramedullary spinal cord tumours

Background: Intramedullary spinal cord tumors are rare entity accounting for only 5-6% of all central nervous system tumors. Much literature is not available regarding these tumors owing to their rarity. Present study includes 24 cases of intramedullary spinal cord tumors with pain and progressive weakness. Radiological evaluation showed various intramedullary lesions like ependymoma, astrocytoma, epidermoid etc. spreading over various levels of spinal cord like cervicomedullary, cervicodorsal and dorsal cords.Methods: The study included all the cases admitted with intramedullary spinal cord tumors in neurosurgery ward in King George hospital, Visakhapatnam, Andhra Pradesh, India during a period of three years from 2014 to 2016. Clinical profile of the patients was analyzed for the clinical presentation, age and sex distribution, histopathological study, pre-and postoperative neurological status, complications and functional outcome. All the patients are followed for a period of 6months to 3years.Results: Of the 24 cases, most common age group was second (7 patients) and third (7 patients) decades which is upto 29.16% each.  Males (16 patients) are more affected than females in 66.66%. Ependymoma is the most common tumor seen in 41.66% (10 patients) followed by astrocytoma in 33.33% (8 patients). The surgical technique, extent of resection, pre and postoperative neurological status and functional outcome are discussed.Conclusions: Intramedullary tumours occur commonly among males in the 2nd to 4th decades. Among the intramedullary tumours ependymoma from the commonest lesion subtypes. Most common location is cervical cord segment. Ependymomas have a good plane of cleavage and are thus amenable to radical excision. Patients with good Mc Cormicks grade in pre-operative stage are more amenable for total or near total excision. Prognostic factors affecting outcome are the preoperative neurological status, the plane of cleavage, the extent of resection, the nature and subtype of the lesion. With the improvement in microsurgical techniques and novel adjunctive like MRI, CUSA and intraoperative neurophysiological monitoring, surgery for intramedullary lesions can be carried out with acceptable morbidity and mortality.

Comparative study of duraplasty and non duraplasty in Chiari 1 malformation with syringomyleia our institute experience

Background: The prevalence of chiari malformation, defined as tonsillar herniations of 3 to 5 mm or greater, is estimated to be in the range of one per 1000 to one per 5000 individuals. The objective was to study the clinical presentation and outcome of ACM syrinx after foramen magnum decompression, c1 posterior arch removal duraplasty and without duraplasty.Methods: The study included 75 cases admitted with ACM with syrinx in neurosurgery ward in King George hospital, Visakhapatnam, Andhra Pradesh, India, during a period of five years.Results: Clinical improvement correlated strongly with enlargement of the subarachnoid cisterns and also correlated with reduction in size of the syrinx cavities. Postoperatively all the patients had decreased neck pain and two third of the patients had improvement in nystagmus, headache and dissociative anaesthesia in few cases.Conclusions: In the available literature, the treatment options offered for ACM syrinx are foramen magnum decompression and c1posterior arch removal, release of compression bands, which were followed in our institute also. We have compared pre-and post of MRI. Clinical improvement has been observed in 2 thirds of patient after a period of 2 year period follow up

Classical open lumbar laminectomy and discectomy for disc herniations among manual labourers in India

Background: Lumbar disc herniations are most common at L4/5 and L5/S1 levels and this is most prevalent condition among manual laborers. The aim of the study to analyze the clinical presentation, age and sex distribution, immediate postoperative complications and long-term complications/recurrence of symptoms and to formulate recommendations to avoid complications and recurrence of symptoms.Methods: This is a retrospective study which includes 250 patients operated for lumbar disc herniations at L4/5 and L5/S1 levels. A detailed history of presenting complaints, clinical examination and corresponding findings on imaging are correlated. In all these patients, there was severe symptomatology with failed conservative management which necessitated classical open lumbar laminectomy and discectomy. These patients were followed for a period of 5 to 10 years.Results: Assessment of outcome was done using the modified Macnab criteria. The overall success rate was 96% in our series. Post operatively, 9.2% of them experienced localized low back pain which is mild to moderate and being treated with NSAIDS and exercises. 2.4% developed residual disc herniation or hypertrophic fibrotic scar at the operated site which needed surgical intervention. 2% developed spondylolysis and spondylolesthesis at the level of previous surgery, and 4.4% developed adjacent disc herniations.Conclusions: The overall success rate was 96% in our series. In addition to removal of herniated disc other compressing elements like hypertrophied Ligamentumflavum, facet arthropathy and narrowed spinal canal diameter are also addressed with open procedure. To prevent later complications, these patients are supposed to avoid strenuous work, lifting weights, torsion and jerky movements, faulty posture at work and rest, gait training, crouching, sitting on the floor and haunches

Antihyperlipidemic activity of Chloroxylon swietenia in triton WR1339 induced hyperlipidemia

Background: Medicinal herbs are beneficial and effective either in the management and prevention of several metabolic disorders, associated with hyperlipidemia, hypertension and insulin resistance which increases the cardio-metabolic risk and demands for the life time therapy. Current allopathic medicines are expensive and reported with several adverse effects and hence, finding of a suitable herbal medicine for hyperlipidemic disorders is very important.Methods: Thirty albino rats weighing 200-230g were randomly divided into 5 groups were rendered hyperlipidemia with a single dose of triton WR 1339. Normal control, positive control, standard, aqueous and ethanolic extract groups were treated with tween-80, tween-80, atorvastatin, aqueous and ethanolic extracts of Chloroxylon swietenia respectively for seven days. At the end of the study, blood was collected for estimation of the lipid profile.Results: Both the aqueous and ethanolic extract groups significantly reduced the TG and VLDL levels.Conclusions: The extracts exhibited remarkable activity on one or either parameter of the lipid profile. It could be due to the presence of alkaloids, steroids, flavonoids, coumarins and phenols in the extracts

Quercetin-3-O-rhamnoside from Euphorbia hirta protects against snake Venom induced toxicity

Background The plant Euphorbia hirta is widely used against snake envenomations in rural areas and it was proved to be effective in animal models. Therefore, the scientific validation of its phytoconstituents for their antiophidian activity is aimed in the present study. Methods E. hirta extract was subjected to bioactivity guided fractionation and the fractions that inhibited different enzyme activities of Naja naja venom in vitro was structurally characterized using UV, FT-IR, LC–MS and NMR spectroscopy. Edema, hemorrhage and lethality inhibition activity of the compound were studied in mice model. In addition, molecular docking and molecular dynamic simulations were also performed in silico. Results The bioactive fraction was identified as Quercetin-3-O-α-rhamnoside (QR, 448.38 Da). In vitro experiments indicated that protease, phospholipase-A2, hemolytic activity and hemorrhage inducing activity of the venom were inhibited completely at a ratio of 1:20 (venom: QR) w/w. At the same concentration, the edema ratio was drastically reduced from 187 to 107. Significant inhibition (93) of hyaluronidase activity was also observed at a slightly higher concentration of QR (1:50). Further, in in vivo analysis, QR significantly prolonged the survival time of mice injected with snake venom. Conclusion For the first time Quercetin-3-O-α-rhamnoside, isolated from E. hirta, has been shown to exhibit anti-snake venom activity against Naja naja venom induced toxicity. General significance Exploring such multifunctional lead molecules with anti-venom activity would help in developing complementary medicine for snakebite treatments especially in rural areas where anti-snake venom is not readily available

Antihyperlipidemic activity of Chloroxylon swietenia in triton WR1339 induced hyperlipidemia

Background: Medicinal herbs are beneficial and effective either in the management and prevention of several metabolic disorders, associated with hyperlipidemia, hypertension and insulin resistance which increases the cardio-metabolic risk and demands for the life time therapy. Current allopathic medicines are expensive and reported with several adverse effects and hence, finding of a suitable herbal medicine for hyperlipidemic disorders is very important.Methods: Thirty albino rats weighing 200-230g were randomly divided into 5 groups were rendered hyperlipidemia with a single dose of triton WR 1339. Normal control, positive control, standard, aqueous and ethanolic extract groups were treated with tween-80, tween-80, atorvastatin, aqueous and ethanolic extracts of Chloroxylon swietenia respectively for seven days. At the end of the study, blood was collected for estimation of the lipid profile.Results: Both the aqueous and ethanolic extract groups significantly reduced the TG and VLDL levels.Conclusions: The extracts exhibited remarkable activity on one or either parameter of the lipid profile. It could be due to the presence of alkaloids, steroids, flavonoids, coumarins and phenols in the extracts