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

Dual application of duckweed and azolla plants for wastewater treatment and renewable fuels and petrochemicals production

Shortages in fresh water supplies today affects more than 1 billion people worldwide. Phytoremediation strategies, based on the abilities of aquatic plants to recycle nutrients offer an attractive solution for the bioremediation of water pollution and represents one of the most globally researched issues. The subsequent application of the biomass from the remediation for the production of fuels and petrochemicals offers an ecologically friendly and cost-effective solution for water pollution problems and production of value-added products. Results: In this paper, the feasibility of the dual application of duckweed and azolla aquatic plants for wastewater treatment and production of renewable fuels and petrochemicals is explored. The differences in absorption rates of the key wastewater nutrients, ammonium and phosphorus by these aquatic macrophytes were used as the basis for optimization of the composition of wastewater effluents. Analysis of pyrolysis products showed that azolla and algae produce a similar range of bio-oils that contain a large spectrum of petrochemicals including straight-chain C10-C21 alkanes, which can be directly used as diesel fuel supplement, or a glycerin-free component of biodiesel. Pyrolysis of duckweed produces a different range of bio-oil components that can potentially be used for the production of "green" gasoline and diesel fuel using existing techniques, such as catalytic hydrodeoxygenation. Conclusions: Differences in absorption rates of the key wastewater nutrients, ammonium and phosphorus by different aquatic macrophytes can be used for optimization of composition of wastewater effluents. The generated data suggest that the composition of the petrochemicals can be modified in a targeted fashion, not only by using different species, but also by changing the source plants' metabolic profile, by exposing them to different abiotic or biotic stresses

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

Application of nanoindentation to establish influence of heat on soils

In the scenario of rapid industrialization and infrastructural development, many situations are encountered where in soil like bentonite is subjected to elevated temperatures (about 200 degrees C). This may lead to alteration in the mechanical and engineering characteristics (such as hardness and residual modulus) of the soil. In this context, these characteristics can be quantified by measuring deformation of individual soil grains exposed to different elevated temperatures, by employing nanoindentation. With this in view, an attempt was made to explore the potential of this technique, normally used for material characterization by material scientists to study heat induced alteration in mechanical and engineering characteristics of the metals, to study the behavior of soils when they get exposed to elevated temperatures. As such, soils of entirely different characteristics were exposed up to 200 degrees C (in steps of 50 degrees C), nanoindentation studies were conducted on the residues and the results are reported in this technical note. It has been observed that there is a significant change in the hardness, residual modulus and resistance to indentation of the soils due to their exposure to elevated temperatures. It has also been demonstrated that the effect of elevated temperature is more pronounced on fine-grained soils as compared to coarse-grained soils. (C) 2013 Elsevier B.V. All rights reserved