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Introduction. Ion channels are subjects of intense research, due to their easy access and potential for being drug targets. Kv1.5 is a voltage gated potassium channel, earlier thought to be cardiac specific. Recent studies have revealed that K++ channels play an important role in apoptosis, glial cell proliferation and biology of various cancers. No study has so far been performed to assess their expression in astrocytomas and correlate its impact on the clinical behaviour of gliomas. Methods. Sixty samples of astrocytoma which included 9 diffuse astrocytoma (DA) grade II, 11 anaplastic astrocytoma (AA) grade III and 40 glioblastoma (GBM), along with normal brain tissue (cerebral cortex; n == 5) were analysed for their Kv1.5 protein expression. Immunohistochemical expression of Kv1.5 in various grades was assessed semi quantitatively. The patients with GBM ( n == 40) were treated with uniform protocol and their survival was documented. Results. The mean expression of Kv1.5 in DA, AA and GBM was 22.2 ± 9.71%, 11.81 ± 12.3% and 10.37 ± 11.05%, respectively, the difference being statistically significant ( p == 0.004). The mean expression in low grade astrocytoma (WHO II) was significantly higher than higher grades (22.2% and 10.7%; p == 0.005). On analysing the influence of Kv1.5 expression on survival of GBM patients, we noted that increasing Kv1.5 labelling index (LI) correlated with a favourable prognosis, albeit not being significant ( p == 0.310; HR == 0.901). Conclusions. Kv1.5 expression occurs more in DA, when compared to high grade astrocytoma. GBM patients with higher Kv1.5 expression had better survival, though not reaching statistical significance. [ABSTRACT FROM AUTHOR]

Presurgical evaluation of children with mesial temporal sclerosis has shown severe neurocognitive impairments. There is debate about lateralized material-specific deficits in memory in children with mesial temporal sclerosis. The authors examined lateralization of brain dysfunction and age appropriate development of cognitive functions in 17 children (7-15 years) with mesial temporal sclerosis who had histories of uncontrolled epilepsy. The National Institute of Mental Health and Neurosciences (NIMHANS) neuropsychological battery for children was employed and each participant's performance was compared with the norms. Results showed that the battery was sensitive to deficits in learning and memory associated with mesial temporal sclerosis. However, a lack of clearly lateralized material-specific memory deficits in children with left/right mesial temporal sclerosis was also observed. Performance on tests that assess learning, attention, working memory, and visuospatial functions was found to be below the age appropriate level. Children with mesial temporal sclerosis showed widely distributed neuropsychological deficits. [ABSTRACT FROM AUTHOR]

Aim: Intracranial subdural empyemas (SDEs), the majority of which are supratentorial in location, are common neurosurgical emergencies in developing countries, especially in the pediatric age group. They result in significant morbidity and mortality despite improvements in neuroimaging, surgical techniques and antibiotic therapy. In the present study, we retrospectively analyze our experience with operated cases of intracranial supratentorial SDEs in the pediatric age group. Patients and Methods: 65 pediatric patients (age ≤18 years) with supratentorial SDEs were treated in our institute between January 1988 and May 2006, and the case records analyzed with respect to clinical, radiological, bacteriological and surgical complications and outcome data. Results: There was a slight male preponderance (55%), with mean age being 9.54 ± 6.43 years (range 3 months to 18 years). Otogenic source was the most common identifiable etiology, followed by postmeningitic and rhinogenic sources. The initial surgical intervention, burr holes (44 patients; 67.7%) and craniotomy (21 patients; 32.3%), varied with individual cases and surgeon preference. Initial craniotomy was associated with lesser repeat procedures, and slightly better clinical outcome. The majority (83.3%) of patients with significant residual requiring repeat surgery were found to have undergone burr hole evacuation initially. The mortality rate in the present series was 10.8%. Follow-up was available for 41 patients (70.7%) with an average follow-up of 10.4 months. 88% of patients showed good outcomes (Glasgow Outcome Scores of 4 or 5) at the latest follow-up. Conclusion: Pediatric supratentorial SDEs, although rapidly fatal if not identified promptly, can be effectively managed with early surgical drainage (preferably craniotomy), eradication of the source, and sensitive broad-spectrum antibiotics (i.v.) with good outcomes. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aim: Meningiomas are very rare in children comprising only 0.44.1% of pediatric age tumors and only 1.5–1.8% of all intracranial neoplasms. We analyzed the clinical, pathological and management profile of these rare tumors and elucidated their differences from meningiomas in adults. Methods: From 1990 to 2005, 33 patients belonging to the pediatric age group with intracranial meningiomas were treated in NIMHANS. Results: There were 19 male and 14 female children. The duration of symptoms ranged from 1 to 60 months. The study had a mean follow-up of 23.4 months. The commonest presenting symptoms were headache (90.9%) and visual disturbances (51.5%). Three patients had associated neurofibromatosis. Calcification was noticed in 22% of the tumors. Intraventricular meningiomas were the commonest (24.2%). Gross total or near total resection was possible in 22 out of 33 patients. Nine patients had reversible postoperative motor deficits. Fibrous meningioma was the commonest histological subtype (24.2%). Five patients had atypical or anaplastic subtypes. Adjuvant radiotherapy was administered in 4 patients. Six patients had recurrences and underwent surgery. Ten patients required either staged procedures or multiple surgeries for the recurrence/residual tumors. Conclusion: Pediatric meningiomas are rare tumors and differ from those in adults by their male predominance, atypical locations, higher rates of malignant subtypes, recurrence and association with neurofibromatosis. Surgical management is challenging because of atypical location. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Colloid cysts of the 3rd ventricle are relatively rare intracranial tumours, more so in children. They are benign tumours with excellent prognosis if diagnosed and treated early. Methods: A retrospective analysis of 18 cases of colloid cysts in children below 18 years, operated in our institution between September 1998 and November 2003 (5 years) was made. Clinical presentation, radiological findings, surgical approaches and outcome were analysed. Results: Age ranged from 7 to 18 years. The male-to-female ratio was 12:6. Headache and vomiting were the most common symptoms. Papilloedema was the most common clinical sign. Pre-operative CT showed a hyperdense non-enhancing lesion in the majority. Twelve patients underwent a transcallosal, 2 a transcortical and 4 an endoscopic approach. Ventriculoperitoneal shunts were done in 5 patients. Postoperatively 2 patients developed epidural haemorrhage which required evacuation. One patient was re-explored for symptomatic residue. A mean follow-up of 10.2 months was available in 9 patients; the majority were asymptomatic. Conclusion: Colloid cysts though rare are increasingly detected in children. Their early recognition and treatment give excellent results. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Pediatric glioblastoma multiforme (GBM) tumors, which have been established as ‘de novo’ neoplasms, are known to differ from their adult counterparts in terms of biology, genetics and ultimately survival of patients. In order to evaluate the utility of markers of tumor biology for refining prognostic assessment, we retrospectively analyzed 54 pediatric GBMs (age range 9 months to 15 years) occurring at different anatomical sites in the brain, operated at our institute between 1995 and 2001. The expression of p53, epidermal growth factor receptor (EGFR), bcl-2 and retinoblastoma proteins (pRb) was analyzed by immunohistochemistry and the results were compared with the clinical profile, MIB-1 labeling index (LI) and patient survival. p53 immunoreactivity was noted in 53.7% of cases, predominantly in thalamic (75%) and cerebral lobar (62.2%), followed by brainstem tumors (30%). It was absent in cerebellar tumors. p53-positive tumors had a higher MIB-1 LI, compared to p53-negative tumors (p = 0.003). EGFR and bcl-2 overex pression was observed in 25.9% and 33.3% of cases, respectively, and loss of pRb expression was evident in only 7.4% of cases, indicating that loss of this gene function is not significantly involved in pediatric GBMs. p53 and bcl-2 expression were maximally noted in patients with poorer outcome. Our results indicate that p53 expression status is noted in a significant number of pediatric supratentorial neoplasms. p53 with bcl-2 overexpression is more often associated with ominous prognosis. Further molecular characterization would provide newer insights into the biology of these neoplasms and form a basis for future therapeutic decision making. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The sign of a negabinary number is not explicit. This paper presents a method to detect the sign as well as the zero magnitude of a negabinary number using cellular arrays. The basic cell is designed to implement the recursive relation of the logical equation defining the sign. The cellular arrays are constructed using basic cells both in the serial and parallel modes. [ABSTRACT FROM AUTHOR]

Discusses the prevention of atrial fibrillation (AF), and presents information on drug and non-drug therapies. Consequences of AF; Recommendation of aspirin by the American Heart Association; Relation between aging and the risk of AF; Clinical risk factors for stroke in patients with AF; Identification of drugs used in the treatment of AF; In-depth look at nondrug strategies for managing AF. INSET: An approach to antithrombotic therapy in patients with AF.

Conversion between binary and negabinary numbers using negabinary and binary adders is described. [ABSTRACT FROM AUTHOR]

A new cellular array structure to detect the sign and zero magnitude ofa negabinary number is presented in this paper. A single recursive relation is defined and implemented with simpler basic cells. [ABSTRACT FROM AUTHOR]

A brain abscess which is caused by Streptococcus pneumoniae is a rare entity. Here, we have described a gentle man who presented with the signs and symptoms of a mass lesion which was localized to the temporal lobe. The clinical examination and computerized tomography revealed the diagnosis of a temporal abscess. The loculated mass was tapped and it was sent for histopathology, which confirmed the presence of an organizing abscess. A laboratory investigation of the pus revealed Streptococcus pneumoniae. The treatment included total excision and the administration of prolonged antibiotics, which led to a good outcome in the patient.

A brain abscess which is caused by Streptococcus pneumoniae is a rare entity. Here, we have described a gentle man who presented with the signs and symptoms of a mass lesion which was localized to the temporal lobe. The clinical examination and computerized tomography revealed the diagnosis of a temporal abscess. The loculated mass was tapped and it was sent for histopathology, which confirmed the presence of an organizing abscess. A laboratory investigation of the pus revealed Streptococcus pneumoniae. The treatment included total excision and the administration of prolonged antibiotics, which led to a good outcome in the patient. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The role of VP shunt in grade IV tubercular meningitis with hydrocephalus(TBM with HC) is controversial, with majority opining against the use of the same. To summarize our institutional experience in this regard, we have looked retrospectively into pediatric patients with grade IV TBM with HC, who have been treated with ventriculoperitoneal shunt(VPS), and assessed their outcome. MATERIALS AND METHODS: Case reports of 57 consecutive pediatric(2 points in their GCS, 40% of the patients remained status quo or improved by <2 points, and the rest deteriorated. Five patients expired following surgery. Follow-up was available in 13 (25%) patients. The median follow-up was 8 months, and the median GCS at follow up was 14. Age and duration of symptoms did not correlate with outcome. Presence of basal exudates on CT scan had a higher incidence of the patient developing an infarct. A lower GCS at presentation (<6) and a longer duration of altered sensorium prior to intervention (>72 hours) were indicators of a poorer outcome (GCS<8 at discharge) (P=0.07 & 0.02, respectively). There were no significant differences in outcome between patients who underwent EVD placement prior to VP shunt, and those who did not. CONCLUSION: Shunt is an effective option in Grade IV tubercular TBM with HC. Prior placement of EVD may not necessary for majority of these patients. GCS at presentation and duration of altered sensorium prior to intervention sue related to outcome. [ABSTRACT FROM AUTHOR]

AIMS : To study the microneurosurgical anatomy involved in the surgical treatment of suprasellar Craniopharyngioma. MATERIALS AND METHODS: 2 cadavers were specially prepared, dissected and photographed to study the microsurgical anatomy of the approach to the suprasellar region. The preoperative CT and MRI scans and intraoperative pictures/video (where available), of craniopharyngioma patients treated at NIMHANS over the last two years were also analyzed. RESULTS: Most tumors in our series were larger than 5 cms and distorted the floor of the third ventricle. Majority of the tumors had a large cystic component. Drainage of the cyst, provided adequate space through which the tumor could be internally decompressed and capsule dissected and removed. Excision of tumors with adherence to vessel walls and the hypothalamus increased morbidity. Injury to small perforator vessels was also associated with significant morbidity. CONCLUSIONS: We were able to photograph and describe the anatomy related to the surgical treatment of suprasellar tumors, as commonly applied to craniopharyngioma in pediatric neurosurgery. It is important to realise that it is sometimes prudent to leave behind tumor which is adherent to the hypothalamus and vessels in order to minimise patient morbidity and mortality. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pituitary adenomas occur rarely during childhood. It constitutes less than 3% of supratentorial tumors in children. Most pituitary tumors in children are functional. In children, non functional pituitary tumors account for only 3 to 6%. Children do not often complain of visual symptoms, hence presenting symptoms of these tumors are generally related to endocrine dysfunction, such as growth delay and primary amenorrhea. Prolactinomas are the most frequent pituitary tumors in children. MATERIALS AND METHODS: This was a retrospective study. Data was obtained from case records and patient, correspondence- Between 2001 and 2007, 12 cases of pituitary adenoma were treated at our Institute. RESULTS: There were 7 females and 5 males. All patients were between 14 and 18 years of age. All 7 female patients had secondary amenorrhea. 6 patients had visual impairment. 5 patients had prolactin, 2 growth hormone, 2 adrenocortitrophic hormone (ACTH) and 1 thyroid stimulating hormone (TSH) secreting pituitary adenomas. Craniopharyngioma was considered the pre operative diagnosis in 4 and thalamic glioma in 1 patient. 5 patients underwent craniotomy, 6 patients underwent sub labial transsphenoidal surgery and 1 patient had craniotomy following a transsphenoidal approach. Of patients who underwent transcranial surgery 2 had deterioration of vision, 1 developed a third nerve palsy and 2 developed diabetes insipidus. 3 patients who underwent transsphenoidal surgery had diabetes insipid us following surgery. There was no mortality amongst these patients. Of the 6-patients who had residual tumors following surgery, three prolactin secreting tumor patients were started on Bromocriptine and 3 were referred for post operative radiotherapy. CONCLUSION: The majority of the pituitary tumors in children are functioning adenomas. This differential diagnosis should be considered in children with sellar/ suprasellar tumors and hormonal assays should be performed. Sublabial transsphenoidal approach is a safe and effective surgical modality for these tumors and should be the procedure of choice. [ABSTRACT FROM AUTHOR]

Closed continuous lumbar subarachnoid drainage is an accepted strategy in the management of cerebrospinal fluid (CSF) leaks. Post lumbar drain haematoma as a complication has been reported in various planes including intraventricular, subdural, subarachnoid, intraparenchymal and spinal extradural locations, most often in patients receiving anticoagulants. Supratentorial extradural haematoma secondary to intracranial hypotension due to spinal CSF drainage are extremely rare and have been reported in a few cases. We present a rare case of near fatal fronto-temporo-parietal extradural haematoma following a lumbar CSF drain and review the literature. We report a 50 year old lady who developed CSF rhinorrhea following trans-sphenoidal decompression of non-functioning pituitary macroadenoma. A lumbar CSF drainage was placed to manage the CSF leak. She became unconscious within 24 hours of placement of lumbar drain and an urgent CT scan demonstrated a large supratentorial extradural hematoma which required an emergency evacuation. A review of the five previously reported similar cases was performed in the light of the present case and salient features highlighted. The present report emphasizes the fact that a simple procedure like lumbar CSF drainage can have rare life threatening complications and needs immediate recognition and management. [ABSTRACT FROM AUTHOR]

Introduction: We present a retrospective study of distal anterior cerebral artery (DACA) aneurysms operated at our institute.Material and Methods: From 1988 to 2013, a total of 132 DACA aneurysms were managed surgically. The retrospective data of these patients was collected and analysed.Results: They comprised 6.2% of all 2137 aneurysms operated during the same period. The mean age at presentation was 48.3 years (range: 24-77 years) and the male: female ratio was 1:2. The notable symptom in 114 (86.4%) patients was headache, in 94 (71.2%) was loss of consciousness, in 25 (18.9%) was seizures, and in 17 (12.9%) was limb weakness. There were 99 (75%) patients in World Federation of Neurosurgical Societies (WFNS) grade <3 at admission. On plain computed tomography (CT) scan, intracerebral hemorrhage was seen in 49 (37.1%) and intraventricular hemorrhage in 23 (17.4%) patients. The most common site of aneurysm was the pericallosal (A3 segment) artery noted in 65 (49.2%) patients. Multiple aneurysms were observed in 16 (12.1%) cases. The mean timing of surgery from the first ictus was 17.8 days. The delay was due to a late referral, poor general condition, recurrent bleeding, and worse WFNS grade at presentation. Aneurysms were operated through the following approaches: parasaggital craniotomy in 61 (46.2%), bifrontal craniotomy in 64 (48.5%), and frontotemporal craniotomy in 7 (5.3%). Aneurysms could be successfully clipped in 93.2% of the cases. Postoperative mortality was 8 (6%). The follow-up data was available for 83 (62.9%) patients. The mean duration of follow-up was 15.1 months (1-70 months), with more than 41 (31%) patients having a follow-up of more than 6 months. A favorable outcome (good recovery or moderate disability) was seen in 71 (85.5%) cases.Conclusions: A meticulous attention to the surgical technique provides gratifying results in DACA aneurysms even in patients who present initially in a compromised clinical status. [ABSTRACT FROM AUTHOR]

Purpose We studied the MRI findings in 16 patients with Rasmussen's encephalitis (RE), further analysed serial MRI changes in 11 of them and correlated it with clinical features. Methodology The diagnosis of RE was based on the European consensus statement (Brain, 128, 2005, 454). Details related to demographical, clinical, MRI observations were analysed. Results Forty MRIs of brain of 16 patients were reviewed. Eleven patients had undergone serial brain MRIs ranging from two to five occasions. All the patients had unihemispheric focal cortical atrophy, predominantly in the perisylvian region ( n = 13). Other features were white matter signal changes ( n = 14), and ipsilateral caudate ( n = 6) and putamen ( n = 4) atrophy. Signal alterations in putamen and caudate were noted in four each. In all the 11 patients with serial MRI, there was progression of cerebral atrophy and a trend towards increase in MRI staging. The MRI signal changes remained same in five patients, resolved in three patients, differential change in two patients and increased in one patient. Diffusion-weighted imaging showed facilitated diffusion ( n = 5), and MR spectroscopy showed reduced N-acetyl-aspartate and elevated lactate ( n = 2). Conclusions Pattern recognition of MRI findings and the changes in serial MRI might serve as a surrogate marker of disease viz. unihemispheric progressive focal cortical atrophy and signal changes predominantly in the perisylvian distribution and caudate followed by putamen involvement. This might assist in understanding and monitoring of the disease progression. [ABSTRACT FROM AUTHOR]

Background: Epidemiology of primary central nervous system lymphoma (PCNSL) world-wide shows an increase in incidence linked to human immunodeficiency virus (HIV) pandemic. Materials and Methods: This retrospective review of case records analyzed the trends of hospital-based incidence of PCNSL over two decades (1991-2010), relation to immune status and effect of steroids on yield of stereotactic biopsy (STB). Results: A total of 76 cases of PCNSL were diagnosed over a period of two decades. Incidence of lymphomas amongst all biopsied lesions showed a gradual increase from 0.18% at the beginning of study period to 0.41% at the end of study period. Only 8.6% (3 of 35 tested) of the PCNSL patients were positive for HIV. The mean age of patients with HIV infection (31.3 ± 3.5 years) was significantly lower compared with those without HIV infection (44.7 ± 10.9 years) (P = 0.033). Diagnosis was obtained by open biopsy in 32 patients (42.1%) and STB in 44 patients (57.9%). Open biopsy yielded a histological confirmation of PCNSL in all cases. Among those who underwent STB, the incidence of negative biopsy with short duration of steroids (≤1 week) was 33.3% and increased to 57.1% with increasing duration of steroid treatment (>1 week). Conclusions: This study documented an increase in hospital based incidence of PCNSL in our institute, independent of HIV association. Steroid intake administration for more than a week prior to biopsy adversely affected the yield of STB in PCNSL. [ABSTRACT FROM AUTHOR]

ims: The aims of this study were to analyze the clinical features, radiologic findings, bacteriologic spectrum, and management protocols and outcomes in posterior fossa subdural empyemas in children. Materials and methods: This study is a retrospective analysis of all children (age, <18 years) treated over a ten-year period (1994-2004) at NIMHANS, India. Clinical, bacteriologic, radiologic, and follow-up data were analyzed. Results: Twenty-seven children with posterior fossa empyemas were treated during this period, making this the largest series to date dealing with this rare entity. Posterior fossa empyemas are seen more commonly in the summer months and in males. Of the patients, 74.1% were in altered sensorium. The clinical features included the triad of fever, headache, and vomiting, which is a nonspecific picture. Cerebellar signs were elicited only in 40%. The most common source was untreated middle ear infection. Pus usually accumulates over the cerebellar convexity and is associated with hydrocephalus in 74% of patients. Cultures of the empyema pus were positive in 74% of cases, and 18.5% had polymicrobial infections. Only 21% of the patients needed a permanent CSF diversion procedure. Craniectomy is the treatment of choice in these cases. Conclusions: The clinical features are nonspecific. Early surgery can salvage most patients and obviate the need for permanent CSF diversion procedures. Surgery (evacuation of empyema and mastoidectomy), antibiotics, and management of hydrocephalus are the mainstays of treatment. [ABSTRACT FROM AUTHOR]

Idiopathic spinal cord herniation (SCH) is a rare condition, occurring in thoracic spinal cord through an anterior dural defect. We report a case of posterior thoracic SCH into extradural arachnoid cyst in a patient with multiple sclerosis. A 28 year old lady presented with recurrent bilateral visual loss, which improved with steroids. Two weeks after the onset of illness, she developed rapidly evolving spastic paraplegia. MRI of brain was suggestive of demyelination, while MRI spine revealed an extradural arachnoid cyst at D6-9 vertebral level, posterior to dural tube, with herniation of spinal cord into it. Following laminectomy and excision of arachnoid cyst, reduction of SCH and duraplasty, she improved in lower limb function. She later had another episode of demyelination with visual loss and quadriplegia, which improved partially with steroids. This is the fi rst report of posterior spinal cord herniation in a patient with relapsing remitting multiple sclerosis. [ABSTRACT FROM AUTHOR]

Intracranial subdural tubercular empyema is an extremely rare entity. To our knowledge, only one such case has been previously reported in the pediatric population (Cayli et al. J Neurosurg 94(6):988–991, ). We report a case of intracranial tubercular subdural empyema in a child, with both convexity and interhemispheric fissure involvement. A 12-year-old boy with history of exposure to an active case of pulmonary tuberculosis (his father) presented to our institution with features of raised intracranial pressure and fever for 1 month and altered sensorium for 2 days. Computerized tomography (contrast enhanced) revealed a left fronto-parietal and interhemispheric subdural space abscess. A left fronto-parietal craniotomy was performed and the subdural empyema was evacuated, and adjacent calvarium was normal. Ziehl–Neelsen staining revealed acid-fast bacilli and the subsequent polymerase chain reaction test was positive. Histopathological examination showed granulation tissue including scattered multinucleated giant cells and caseation. Mycobacterium tuberculosis bacilli were the sole organisms cultured after 6 weeks. Anti-tuberculous treatment was given in appropriate doses for 18 months at the end of which the patient was doing well with no deficits. Intracranial tubercular subdural empyema in the pediatric age group is an extremely rare but curable entity. [ABSTRACT FROM AUTHOR]

AIMS: To assess the prognostic influence of EGFR amplification/overexpression, p53 immunoreactivity and their age-dependent prognostic effects in a large prospective cohort of uniformly treated adult patients with newly diagnosed glioblastoma. METHODS: Tumours from a uniformly treated prospective cohort of adult patients with newly diagnosed glioblastoma (n=140) were examined for EGFR amplification by fluorescence in situ hybridisation and EGFR/p53 expression by immunohistochemistry. Statistical methods were employed to assess the degree of association between EGFR amplification/overexpression and p53 immunopositivity. Survival analyses were performed by employing Cox proportional hazard models to assess the independent prognostic value of EGFR/p53 alterations and test the propensity for risk with age by assessing their interaction with patient age. RESULTS: A strong positive correlation between EGFR amplification and EGFR overexpression (ρ=0.5157; p<0.0001; CI 0.3783 to 0.6309) and a negative association of EGFR amplification (ρ=–0.3417; p<0.0001; CI –0.4842 to –0.1816) and EGFR overexpression (ρ=–0.3095; p<0.001; CI –0.4561 to –0.1465) with p53 immunopositivity was observed. Only patient age (HR: 1.029; p=0.004; CI 1.009 to 1.049) was associated with shorter survival by univariate Cox regression analysis. Multivariable Cox proportional hazards models revealed a statistically significant interaction between EGFR overexpression and age to be associated with shorter survival (HR: 1.001; p<0.0001; CI 1.000 to 1.002), thus predicting a higher hazard with increasing age. No age interaction of EGFR amplification status (HR: 1.001; p=0.642; CI 0.995 to 1.008) and p53 immunopositivity (HR: 1.000; p=0.841; CI 0.999 to 1.001) was noted in this cohort. CONCLUSIONS: The prognostic value of EGFR overexpression is age-dependent, and there is a propensity for a higher hazard with increasing patient age. Identifying such groups of patients with more aggressive disease becomes mandatory, since they would benefit from intense therapeutic protocols targeting EGFR. [ABSTRACT FROM AUTHOR]

Neurological manifestations in Paget’s disease are rare. Hydrocephalus is infrequent, its etiology in Paget’s disease being multi-factorial. Surgical and anesthetic procedures may be challenging, requiring special precautions. We describe one such case and discuss these peculiarities. An elderly lady, diagnosed to have Paget’s disease presented with features of recent onset dementia, gait disturbances with urinary incontinence. Hydrocephalus secondary to posterior fossa crowding was present. A ventriculo-peritoneal shunt was inserted. Endotracheal intubation proved to be difficult. Modification of the surgical technique was required to ensure a safe procedure. She improved immediately following CSF diversion. Timely CSF diversion yields good results. Certain precautions during anesthesia and surgery can ensure a safe and uneventful peri-operative period. [ABSTRACT FROM AUTHOR]