The incidence of subarachnoid haemorrhage (SAH) is stable, at around six cases per 100 000 patient years. Any apparent decrease is attributable to a higher rate of CT scanning, by which other haemorrhagic conditions are excluded. Most patients are <60 years of age. Risk factors are the same as for stroke in general; genetic factors operate in only a minority. Case fatality is approximately 50% overall (including pre-hospital deaths) and one-third of survivors remain dependent. Sudden, explosive headache is a cardinal but non-specific feature in the diagnosis of SAH: in general practice, the cause is innocuous in nine out of 10 patients in whom this is the only symptom. CT scanning is mandatory in all, to be followed by (delayed) lumbar puncture if CT is negative. The cause of SAH is a ruptured aneurysm in 85% of cases, non-aneurysmal perimesencephalic haemorrhage (with excellent prognosis) in 10%, and a variety of rare conditions in 5%. Catheter angiography for detecting aneurysms is gradually being replaced by CT angiography. A poor clinical condition on admission may be caused by a remediable complication of the initial bleed or a recurrent haemorrhage in the form of intracranial haematoma, acute hydrocephalus or global brain ischaemia. Occlusion of the aneurysm effectively prevents rebleeding, but there is a dearth of controlled trials assessing the relative benefits of early operation (within 3 days) versus late operation (day 10-12), or that of endovascular treatment versus any operation. Antifibrinolytic drugs reduce the risk of rebleeding, but do not improve overall outcome. Measures of proven value in decreasing the risk of delayed cerebral ischaemia are a liberal supply of fluids, avoidance of antihypertensive drugs and administration of nimodipine. Once ischaemia has occurred, treatment regimens such as a combination of induced hypertension and hypervolaemia, or transluminal angioplasty, are plausible, but of unproven benefit.

/pdf/subarachnoid-haemorrhage-diagnosis-causes-and-management-2bxfcfscjw.pdf

Subarachnoid haemorrhage: diagnosis, causes and management

A report of two cases

Imatinib, a potent inhibitor of the oncogenic tyrosine kinase BCR-ABL, has shown remarkable clinical activity in patients with chronic myelogenous leukaemia (CML). However, this drug does not completely eradicate BCR-ABL-expressing cells from the body, and resistance to imatinib emerges. Although BCR-ABL remains an attractive therapeutic target, it is important to identify other components involved in CML pathogenesis to overcome this resistance. What have clinical trials of imatinib and studies using mouse models for BCR-ABL leukaemogenesis taught us about the functions of BCR-ABL beyond its kinase activity, and how these functions contribute to CML pathogenesis?

http://nsmn1.uh.edu/frankino/assets/docs/lifesciseries/asmussen/ren.pdf

Mechanisms of BCR-ABL in the pathogenesis of chronic myelogenous leukaemia.

Pathogenesis and natural history of osteonecrosis.

Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.

Infections Caused by Scedosporium spp.

The authors report the cases of three brothers with pituitary adenomas who had classical findings of acromegaly and gigantism. Two had irreducibly elevated growth hormone (GH) values and underwent transsphenoidal microsurgical extirpation of their tumors. The third acromegalic brother had a normal GH value and evidence of panhypopituitarism; he had a small intrasellar tumor and a partially empty sella. The pattern of inheritance was probably autosomal recessive. A review of literature indicated that familial incidence of isolated acromegaly with pituitary adenomas is rare.

Familial acromegaly with pituitary adenoma Report of three affected siblings

A rare case of bilateral intracavernous internal carotid artery aneurysms is presented. The clinical and laboratory data strongly suggested the mycotic nature of the aneurysms. Internal carotid artery ligation was performed because of clinical evidence of progressive enlargement of the right-sided aneurysm. The left-sided aneurysm was managed medically. It remained asymptomatic and, 14 months later, a control angiogram showed no significant change in its size and configuration.

Bilateral Mycotic Aneurysms of the Intracavernous Carotid Artery

Traumatic rotary posterior dislocation of the atlas on the axis without fracture. Report of a case and review of literature

A case of paraganglioma of the filum terminale is presented where normal sympathetic ganglion cells were seen in conjunction with tumour cells in a well-encapsulated tumour, suggesting a possible origin from heterotopic sympathetic ganglion.

Paraganglioma of the filum terminale internum. Report of a case and review of the literature.

Study Design. Four cases in which, during standard laminectomies, knife blades brokes deep into the disc space are reported. Summary of Background Data. These broken knife blades could not be removed at the time of initial operations. Results. Follow-up studies indicated further anterior migration of retained fragments in two cases after ambulation. Conclusions. Because of the potential hazards of late intraabdominal visceral or vascular injuries, removal of sharp retained fragments at another session is recommended

Abbass Amirjamshidi

Papers

Familial acromegaly with pituitary adenoma Report of three affected siblings

Bilateral Mycotic Aneurysms of the Intracavernous Carotid Artery

Traumatic rotary posterior dislocation of the atlas on the axis without fracture. Report of a case and review of literature

Paraganglioma of the filum terminale internum. Report of a case and review of the literature.

Retained broken knife blades within the disc space.