Cervical Intramedullary Ganglioma

A 48 year male presented to the ER with severe headaches which were episodic in nature and which had been present for several weeks. Patient had a history of traumatic head injury (TBI) several years prior. Otherwise, he was in good health with no significant past medical or surgical history. On physical exam, patient was oriented x 3 with an intact cranial nerve exam. He had significant upper and lower extremity spasticity with mild hand intrinsic weakness. His motor exam was otherwise unremarkable. His gait was very spastic. He had sustained lower extremity clonus, upgoing toes, and increased tone in the upper and lower extremities. His sensation was intact to light touch, pinprick, proprioception and temperature

Lymphocytic Hypophysitis

A 59 year-old female presented with visual problems in 2006, and was initially diagnosed with a pituitary macroadenoma on MRI (Figure 1). Preoperatively, the pituitary lesion decreased in size after the patient was started on steroids, raising the possibility of lymphoma and inflammatory conditions. Ultimately, endoscopic trans-nasal biopsy of the pituitary lesion revealed lymphocytic hypophysitis. She was treated with steroids for two years and developed several side effects from chronic steroid use, including Cushingoid features, diabetes, cataracts, weight-gain and osteopenia. As a result, she was subsequently treated with methotrexate and gradual weaning of the steroids

Early Results of a Geriatric Hip Fracture Program in India for Femoral Neck Fracture

Geriatric hip fractures are a challenging clinical problem throughout the world. Hip fracture services have been shown to shorten time to surgery, decrease the cost of admissions, and improve the outcomes. We instituted a geriatric hip fracture program for comanagement of these injuries by orthopedic and internal medicine teams at our hospital in India. From January 2010 till December 2011, 119 patients with a femoral neck fracture were treated with cemented modular hemiarthroplasty under this program using a cost-effective Indian implant. The cohort included 63 males and 56 females with a mean age of 70.7 years (range 55-98 years). Hypertension (n = 42) and diabetes mellitus (n = 29) were the most common comorbidities. The follow-up period ranged from 12 to 37 months with an average of 24 months. The surgery was performed within 24 hours of admission in 60.5% (n = 72) patients. The use of antiplatelet drugs was the most common reason for delay of surgery. The mean length of hospital stay was 10.4 days (range 3-24 days) with 77% (n = 92) of patients discharged within 1 week of admission. On follow-up, good to excellent Harris hip scores were seen in 88% of patients with 76% of patients returning to the preinjury ambulatory status. The mortality rate was 6% at 6 months follow-up and 10.9% at 2 years. Our study shows that a hip fracture program can be instituted in India. The program helped us in achieving the goal of early surgery, mobilization, and discharge from hospital with decreased mortality

Indian Farmers’ Perceptions and Willingness to Supply Surplus Biomass to an Envisioned Biomass-Based Power Plant

The main objectives of this socio-technical study are to investigate the Indian farmers’ biomass production capacities and their perceptions and willingness to supply their surplus biomass to fuel an envisioned biomass-based power plant in three selected Indian states: Maharashtra, Madhya Pradesh and Tamil Nadu. For doing so, 471 farmers (about one-third from each state) have been interviewed in the field with info-sheet filled in by the field investigators. The farmers from all of the states appeared very much willing to sell their surplus biomass directly to a power plant. The farmers seem to depreciate the involvement of a middleman in the biomass procurement process. The farmers, however, appeared to highly appreciate a community-based association to regulate the biomass prices, with varying perceptions regarding government intervention. The majority of the farmers perceived the establishment of a biomass-based power plant in their region with positive economic outcomes. The farmers identified several barriers to supply biomass to a power plant where transportation logistics appeared to be the main barrier. The study recommends considering biomass collection, storage and transportation logistics as a fundamental segment of any envisioned investment in a biomass-based power plant. Biomass processing, such as pelletization or briquetting is recommended for efficient transportation of biomass at longer distances to reduce the transportation costs. The study further encourages the establishment of a farmers’ association aimed at collecting and selling biomass in agriculture areas predominant for small land holdings