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Objective: The aim: This study aims to investigate some of the immunological parameters related to Helicobacter pylori patients, including: interleukin (IL-17), cluster of differentiation 4 (CD4), macrophage inhibitory migration factor (MIF), nuclear factor kappa B (NF-kB)., Patients and Methods: Materials and methods: The immunological parameters were investigated by using ELISA technology, and compared with the healthy individuals (control)., Results: Results: The level of IL-17A in the serum showed a significant increase (p < 0.05) in the HPP group compared to the control group. The CD4 serum concentration in infected with H. pylori patients was high level (4.23 ± 0.41 ng/ml) with significant increase (p < 0.05) than to healthy individuals (control) (1.93 ± 0.22 ng/ml). Also, there was significant elevation (p < 0.05) in in the level of serum MIF levels in H. pylori patients (75.23 ± 1.88 ng/ml) as compared to the control (65.11 ± 2.25 ng/ml). Serum NF-kB concentration in patients infected with H. pylori was at a high level (8.15 ± 0.58 ng/ml) with a significant elevated (p < 0.05) as compared to control (3.91 ± 0.47 ng/ml). On the other hand, the results proved that there is significant elevation (p < 0.05) in blood NF-kB level in smokers infected with H. pylori (9.43 ± 0.95ng/ml), compared with non-smokers infected with Helicobacter pylori (4.96 ± 1.46 ng/ml)., Conclusion: Conclusions: Both humoral and cellular immune response plays an important role in patients with Helicobacter pylori. The nuclear factor kappa B is considered a risk factor in smoking patients, infected with Helicobacter Pylori can be considered as an early diagnosis of stomach cancer.

Objective: The aim: The aim of this research is to evaluate some immunological biomarkers in cases of Rheumatoid arthritis and to verify their correlation with activity of disease among the population of Thi-Qar province., Patients and Methods: Matherials and methods: This study included 45 cases of rheumatoid arthritis and 45 healthy subjects. All cases underwent complete history taking, thor¬ough clinical examination, and laboratory tests including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Anti-citrulline antibody (Anti-CCP) and rheumatoid factor (RF). IL-17and TNF-α blood level was measured by Enzyme Linked Immunosorbent Assay (ELISA) method. DAS-28 (Disease activity score 28) was evaluated., Results: Results: Serum levels TNF-α was higher in Rheumatoid arthritis patients (424.3±19.46 pg/ml) than in healthy individuals (112.7±4.73 pg/ml), and IL-17 blood levels were higher in Rheumatoid arthritis patients (233.5±241.4 pg/ml) than the healthy individuals group (47.24±49.7 pg/ml). There was significant association found among IL-17, DAS-28, CRP and hemoglobin levels., Conclusion: Conclusions: In conclusion, IL-17 blood levels were significantly increased in peoples with rheumatoid arthritis than in healthy individuals. Its significant relationship with DAS-28 suggested that the level of IL-17 in serum could be important immunological biomarker for activity of disease in disease of Rheumatoid arthritis.

Type 1 diabetes mellitus (T1D) is a chronic autoimmune illness defined as insulin insufficiency resulting from the autoimmune breakdown of pancreatic beta cells producing insulin in the islets of Langerhans. Biomarkers are markers of physiological or pathological processes that are normal or abnormal, playing a crucial function in clinical evaluation, prognosis, and therapy response monitoring. This study aimed to investigate some biomarkers associated with T1D and examine the association between glutamic acid carboxylase (GADA) antibody and islet antigen-2 autoantibody (IA-2A) for β-cell stress and death in patients with T1D. The current study included 60 patients with T1D, 32 (53.33%) males and 28 (46.67%) females between 9 to 18 years old, and 30 healthy individuals as control. Glutamic acid carboxylase, islet antigen-2 autoantibody and connecting peptide levels in the blood were evaluated. Positive results for IA-2A and GADA were shown in 89.04% and 38% of T1D patients, respectively. The normal level frequency and C-peptide titer mean were significantly lower between T1D and healthy control. However, no statistically significant changes were observed in the C-peptide level among GADA positive and negative patients. Finally, the C-peptide concentrations were significantly lower for positive IA-2A compared to negative IA-2A persons. The combination of IA-2A, GADA, and C-peptide could indicate stronger diagnostic measures at a low cost for patients with T1D., Competing Interests: The authors declare no conflict of interest., (©2022 JOURNAL of MEDICINE and LIFE.)

Forty-one US jurisdictions (37 states) have legalized comprehensive medical cannabis programs since 1996. The number of qualifying conditions per jurisdiction varies from 5 to 29. Five (12%) of 42 qualifying conditions have conclusive or substantial evidence of efficacy and are listed in more than half of all jurisdictions. Half (50%) of qualifying conditions have no or insufficient scientific evidence of benefit from medical cannabis; 9% of qualifying conditions have limited evidence of harm from medical cannabis. The mean number of qualifying conditions per jurisdiction and the proportion of conditions with and without evidence of benefit have not changed since 1996., Competing Interests: Disclosure Dr G.M. Burnett has no disclosures. Dr D.A. Gorelick receives royalties from Wolters Kluwer for writing medical articles about cannabis and honoraria from Springer Nature and Colorado State University—Pueblo for serving as Editor-in-Chief of the Journal of Cannabis Research. Dr K.P. Hill is a consultant to Greenwich Biosciences and is an author with Wolters Kluwer., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Although many of the tenets of harm reduction have been around for centuries and more traditional harm reduction services such as syringe services programs have been in existence for decades, there has been a recent increase in interest and acceptance of harm reduction as an essential component of a public health approach to substance use. This article provides an overview of harm reduction and its application to alcohol, tobacco, and drug use. It discusses the importance of integrating harm reduction principles and services with traditional psychiatric, medical, and addiction treatment programs., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Recurrent miscarriage (RM) is defined as the loss of pregnancy three or more consecutive times in the first and second trimester, which in some cases occurs due to immune abnormalities. This study aimed to assess some immunological parameters in women with recurrent miscarriages, including the level of antiphospholipid antibody (APA), anticardiolipin (ACA), antinuclear antibody (ANA), complement C3 and C4, and interleukine-3 (IL-3). We included 100 patients together with 100 healthy women as a control. ELIZA was used to measure some types of autoantibodies. APA and ACA significantly increased (P≤0.05) in patients compared to control. In addition, 29% of the patients were positive for antinuclear antibodies (ANA), while the control subjects had negative results for these autoantibodies. Regarding the complement, the serum levels of C3 and C4 were significantly elevated in the serum level of patients when compared to the control group, but in treated patients (heparin and low-dose aspirin), the levels of the complement (C3 and C4) showed a significant decrease in patients compared to total controls. Cytokine level (IL-3) significantly decreased in untreated patients 302.78 pg/ml compared to treated patients (741.57 pg/ml). Antiphospholipid antibodies are more prevalent among women with recurrent miscarriages and are also believed to be the result of abnormal autoimmune activation., (© 2022 JOURNAL of MEDICINE and LIFE.)

Background: Relative risk is insufficient to guide treatment decision-making for unruptured intracranial aneurysms. Our objective was to introduce a novel risk assessment methodology called the Rupture Criticality Index (RCI), which allows for concurrent evaluation of groups of risk factors (RFs)., Methods: From a retrospective database of saccular aneurysms, we identify 915 patients and delineate 50 potential RFs for aneurysms in 11 unique locations. RF combinations for multivariable analysis were defined by aneurysm size, location, and a third variable from the study design. Data analysis was performed by applying frequency distribution methods to define the RCI of each RF combination., Results: RF combinations at greatest risk were small (4.8-8.2 mm) or medium (8.3-14.5 mm) anterior communicating aneurysms (ACoA) in male individuals (RCI 9.87-10), small ACoA in those ≤37 years or 38-55 years (RCI 8.67-8.99), medium basilar tip aneurysms (BTAs) in male individuals (RCI 10), and large (14.6-22.5 mm) BTA in Caucasians or those aged 38-55 years (RCI 9.25, 9.35, respectively)., Conclusions: We introduce the concept of RCI and compare how RF combinations are associated with aneurysmal rupture. This novel approach to aneurysmal rupture identifies high-risk clinical presentations and can be used to guide clinical decision-making in patients with non-traditional risks., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Automatic text summarization (ATS) enables users to retrieve meaningful evidence from big data of biomedical repositories to make complex clinical decisions. Deep neural and recurrent networks outperform traditional machine-learning techniques in areas of natural language processing and computer vision; however, they are yet to be explored in the ATS domain, particularly for medical text summarization., Objective: Traditional approaches in ATS for biomedical text suffer from fundamental issues such as an inability to capture clinical context, quality of evidence, and purpose-driven selection of passages for the summary. We aimed to circumvent these limitations through achieving precise, succinct, and coherent information extraction from credible published biomedical resources, and to construct a simplified summary containing the most informative content that can offer a review particular to clinical needs., Methods: In our proposed approach, we introduce a novel framework, termed Biomed-Summarizer, that provides quality-aware Patient/Problem, Intervention, Comparison, and Outcome (PICO)-based intelligent and context-enabled summarization of biomedical text. Biomed-Summarizer integrates the prognosis quality recognition model with a clinical context-aware model to locate text sequences in the body of a biomedical article for use in the final summary. First, we developed a deep neural network binary classifier for quality recognition to acquire scientifically sound studies and filter out others. Second, we developed a bidirectional long-short term memory recurrent neural network as a clinical context-aware classifier, which was trained on semantically enriched features generated using a word-embedding tokenizer for identification of meaningful sentences representing PICO text sequences. Third, we calculated the similarity between query and PICO text sequences using Jaccard similarity with semantic enrichments, where the semantic enrichments are obtained using medical ontologies. Last, we generated a representative summary from the high-scoring PICO sequences aggregated by study type, publication credibility, and freshness score., Results: Evaluation of the prognosis quality recognition model using a large dataset of biomedical literature related to intracranial aneurysm showed an accuracy of 95.41% (2562/2686) in terms of recognizing quality articles. The clinical context-aware multiclass classifier outperformed the traditional machine-learning algorithms, including support vector machine, gradient boosted tree, linear regression, K-nearest neighbor, and naïve Bayes, by achieving 93% (16127/17341) accuracy for classifying five categories: aim, population, intervention, results, and outcome. The semantic similarity algorithm achieved a significant Pearson correlation coefficient of 0.61 (0-1 scale) on a well-known BIOSSES dataset (with 100 pair sentences) after semantic enrichment, representing an improvement of 8.9% over baseline Jaccard similarity. Finally, we found a highly positive correlation among the evaluations performed by three domain experts concerning different metrics, suggesting that the automated summarization is satisfactory., Conclusions: By employing the proposed method Biomed-Summarizer, high accuracy in ATS was achieved, enabling seamless curation of research evidence from the biomedical literature to use for clinical decision-making., (©Muhammad Afzal, Fakhare Alam, Khalid Mahmood Malik, Ghaus M Malik. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.10.2020.)

OBJECT Treatment of brain arteriovenous malformations (bAVMs) in the elderly remains a challenge for cerebrovascular surgeons. In this study the authors reviewed the patient characteristics, treatments, angiographic results, and clinical outcomes in 28 patients over 65 years of age who were treated at Henry Ford Hospital between 1990 and 2014. METHODS The bAVM database at the authors' institution was queried for records of elderly patients with bAVMs, and data regarding patient demographics, presenting symptoms, bAVM angioarchitecture, treatment modalities, angiographic results, clinical outcomes, and treatment complications were tabulated and analyzed. RESULTS There were 9 male (32%) and 19 female (68%) patients, with an average age ( ± SD) of 73.0 ± 6.95 years. The most common symptoms on presentation were hemorrhage (36%) and headaches (18%). The bAVMs were equally distributed between the supra- and infratentorial compartments. The most common Spetzler-Martin grade was II, observed in 57% of the patients. Eleven patients (39.3%) underwent resection, 4 patients (14.3%) received standalone radiation therapy, and 13 patients (46%) did not receive treatment or were managed expectantly. Four patients (14.3%) were lost to follow-up. Complete bAVM obliteration was achieved in 87% of the treated patients. None of the patients who received any form of treatment died; the overall mortality rate was 3.6%. CONCLUSIONS Surgical management of bAVMs in the elderly can result in complete obliteration and acceptable clinical outcomes.

Background: Arteriovenous malformations (AVMs) of the corpus callosum (CC) are rare entities. We performed a systematic review of the available literature to better define the natural history, patient characteristics, and treatment options for these lesions., Methods: A MEDLINE, Google Scholar, and The Cochrane Library search were performed for studies published through June 2015. Data from all eligible studies were used to examine epidemiology, natural history, clinical features, treatment strategies, and outcomes of patients with CC-AVMs. A systematic review and pooled analysis of the literature were performed., Results: Our search yielded 37 reports and 230 patients. Mean age at presentation was 26.8 years (±13.12 years). AVMs were most commonly located in the splenium (43%), followed by the body (31%), and then the genu (23%) of the CC. A Spetzler-Martin grade of III was the most common (37%). One hundred eighty-seven (81.3%) patients presented with hemorrhage, 91 (40%) underwent microsurgical excision, and 87 (38%) underwent endovascular embolization. Radiosurgery was performed on 57 (25%) patients. Complete obliteration of the AVM was achieved in 102 (48.1%) patients and approximately twice as often when microsurgery was performed alone or in combination with other treatment modalities (94% vs. 49%; P < 0.001). Mean modified Rankin Scale (mRS) at presentation was 1.54 and mean mRS at last follow-up was 1.31. This difference was not statistically significant (P = 0.35)., Conclusion: We present an analysis of the pooled data in the form of a systematic review focusing on management of CC-AVMs. This review aims to provide a valuable tool to aid in decision making when dealing with this particular subtype of AVM.

Objective: Treatment of giant intracranial arteriovenous malformations (gAVMs) is a formidable challenge for neurosurgeons and carries significant morbidity and mortality rates for patients compared with smaller AVMs. In this study, we reviewed the treatments, angiographic results, and clinical outcomes in 64 patients with gAVMs who were treated at Henry Ford Hospital between 1980 and 2012., Methods: The arteriovenous malformation (AVM) database at our institution was queried for patients with gAVMs (≥ 6 cm) and data regarding patient demographics, presentation, AVM angioarchitecture, and treatments were collected. Functional outcomes as well as complications were analyzed., Results: Of the 64 patients, 33 (51.6%) were female and 31 (48.4%) were male, with an average age of 45.7 years (SD ± 15.5). The most common symptoms on presentation were headaches (50%), seizures (50%), and hemorrhage (41%). The mean AVM size was 6.65 cm (range, 6-9 cm). Only 6 AVMs (9.4%) were located in the posterior fossa. The most common Spetzler-Martin grade was V, seen in 64% of patients. Of the 64 patients, 42 (66%) underwent surgical excision, 10 (15.5%) declined any treatment, 8 (12.5%) were deemed inoperable and followed conservatively, 2 (3%) had stand-alone embolization, 1 (1.5%) had embolization before stereotactic radiosurgery, and 1 (1.5%) received stereotactic radiosurgery only. Complete obliteration was achieved in 90% of the surgical patients. Mortality rate was 19% in the surgical cohort compared with 22% in the observation cohort (P = 0.770)., Conclusions: Treatment of gAVMs carries significant morbidity and mortality; however, good outcomes are attainable with a multimodal treatment approach in carefully selected patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: A versatile neurosurgical approach, the retrosigmoid craniectomy (RS) has traditionally been associated with high rates of post-operative cerebrospinal fluid (CSF) leak, headaches, and aesthetic defects. We introduce a simple surgical strategy for bony cranial reconstruction designed to minimize peri-operative complications and improve cosmetic outcomes., Methods: In accordance with the Institutional Review Board, the senior author's (G.M.M.) records were queried between 2006 and 2014. We identified 50 consecutive patients who underwent demineralized bone matrix (DBM)-augmented cranioplasty after RS for MVD (DBM group) and 92 consecutive patients in whom standard cranial reconstruction was undertaken using autologous bone chips only after RS for MVD (non-DBM group). Demographic and clinical information regarding the laterality of each operation, intra-dural drilling for petrous hyperostosis, method of dural closure, length of hospitalization, presence of post-operative headaches, and procedure-related complications were collected and analyzed., Results: The DBM and non-DBM cohorts were well matched for age, laterality of procedure, surgical indications, primary versus revision surgery, intra-dural drilling of petrous hyperostosis, and dural closure techniques. Trigeminal neuralgia was the most common surgical indication (98.6%) in each cohort. Post-operatively, 15% of patients in non-DBM group experienced chronic headaches at the last follow-up compared to only 8% of the patients in the DBM group (p=0.21). The non-DBM patients also suffered more incisional pain in comparison to the DBM patients (7.6% vs. 0%, p=0.045)., Conclusion: DBM-augmented reconstruction of posterior fossa defects resulted in low rates of post-operative headaches, better cosmetic outcomes, and represents a simple and effective cranioplasty option for skull base surgeons., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Aneurysms of the posterior cerebral artery (PCA) are a distinct pathological entity and are surgically challenging. Fusiform aneurysms involving the PCA are quite rare and scarcely reported in the literature. In this video, we demonstrate the utility of the subtemporal approach to surgically reconstruct an unruptured, fusiform aneurysm of the left PCA, located at the junction of P3 and P4 segments. Curved clips were used to reconstruct the aneurysm such that flow was maintained in the parent vessel as well as distal branches. Postoperatively, the patient remained neurologically intact. The video can be found here: http://youtu.be/l7yzUPsaMc4.

Object: Sylvian arteriovenous malformations (sAVMs) are challenging lesions of the central nervous system. The natural history of these unique lesions as well as clinical outcomes following treatment of sAVMs has been limited to case series owing to the rarity of these lesions. The authors present their experience with sAVMs and review the literature., Methods: In accordance with the Henry Ford Institutional Review Board, medical records of patients with sAVMs treated from 2000 to 2012 were reviewed. Clinical data were retrospectively collected to calculate pre- and posttreatment modified Rankin Scale scores for all patients., Results: The authors identified 15 patients with sAVMs who received treatment. Of these, 12 were female and 3 were male, and the average age at presentation was 39.6 ± 12.94 years (± SD). Two patients (13.3%) had Spetzler-Martin Grade I lesions, 6 patients (40%) had Grade II lesions, 5 patients (33.3%) had Grade III lesions, and another 2 (13.3%) harbored Grade IV arteriovenous malformations (AVMs). According to the Sugita classification, 6 patients (40%) had medial lesions, 6 (40%) had lateral lesions, 2 (13.3%) had deep lesions, and 1 patient (6.67%) had a pure sAVM. Eight patients (53.3%) underwent stereotactic radiosurgery while 7 patients (46.7%) had microsurgical resection; 1 patient underwent surgical extirpation after incomplete response following radiosurgery. After treatment, 9 patients were unchanged from pretreatment (60%), 3 patients worsened, and 2 patients had improved functional outcome (20% and 13.3%, respectively). The authors' literature search yielded 348 patients with sAVMs, most of them harboring Spetzler-Martin Grade II and III lesions. Approximately 98% of the patients underwent resection with excellent outcomes., Conclusions: While the ideal choice of therapeutic modality for cerebral AVMs remains controversial in light of the recent publication of the ARUBA (A Randomized trial of Unruptured Brain AVMs) trial, a multidisciplinary treatment approach for the management of sAVMs can lead to acceptable neurological outcome.

This Statement of Ethics in Neurosurgery was developed by the Committee for Ethics and Medico-Legal Affairs of the World Federation of Neurosurgical Societies to help neurosurgeons resolve problems in the treatment of individual patients and meet obligations to the larger society. This document is intended as a framework rather than a set of rules. It cannot cover every situation and should be used with flexibility. However, it is our intent that the fundamental principles enunciated here should serve as a guide in the day-to-day practice of neurosurgery., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Groundwater samples were collected from different locations of Surat city, Gujarat (India). These samples from 32 locations of Surat city were analysed for their physico-chemical characteristics involving pH, colour, odour, hardness, chloride, alkalinity, COD, sulfate, TDS, SS, iron, Cu, boron, chromium, temperature and Langelier Saturation Index. On comparing the results against drinking water quality standards laid by Indian Council of Medical Research (ICMR) and World Health Organization (WHO), it is found that most of the water samples are non-potable. Most of the samples indicated Total Alkalinity, Hardness, Chloride and TDS values much higher than the permissible level stipulated by ICMR and WHO. Even at some places Langelier Saturation Index values found higher too. The high values of these parameters may have health implications and therefore these need attention.

Objective: To investigate the association of passive smoking with respiratory symptoms and clinical correlates in married women in a rural area of Pakistan., Method: A Cross-sectional study was carried out on married women of Nurpur Shahan (rural Islamabad) by means of an Interviewer administered questionnaire. Systematic sampling of households was done. A total of 296 women were surveyed. The study period extended from January to July 2009. All data was entered and analyzed using SPSS v 10.0., Results: The two major respiratory symptoms that were found to be associated with passive smoking were sinusitis [adjusted O.R(95% CI) 2.2 (1.3 - 3.5), p = 0.001] and cough [adjusted O.R (95% CI) 2.4 (1.2 - 4.8), p = 0.017]. Wood used as fuel for cooking purposes also contributed to one of the symptoms such as headache (p = 0.007). The pulse rate (79 +/- 11 beats/min) of the passive smoking women was statistically significantly higher than the pulse rate (76 +/- 9 beats/min) of the non-passive smoking women (p = 0.012)., Conclusion: Passive smoking was found to be associated with respiratory symptoms among married women in this study. Higher pulse rate was associated with passive smoking.

Background: A limited framework of incident reporting exists in most of the health care system in Pakistan. This poses a risk to the patient population and therefore there is a need to find the causes behind the lack of such a system in healthcare settings in Pakistan., Aims: To determine the attitudes and perceived barriers towards incident reporting among tertiary care health professionals in Pakistan, Materials and Methods: The study was done in Shifa International Hospitals and consisted of a questionnaire given to 217 randomly selected doctors and nurses. Mean ± SD of continuous variables and frequency (percentage %) of categorical variables are presented. Chi square statistical analysis was used to test the significance of association among doctors and nurses with various outcome variables (motivators to report, perceived barriers, preferred person to report and patient's outcome that influence reporting behaviors). P value of <0.05 was considered significant. Student doctors and student nurses were not included in the study., Results: Unlike consultant, registrars, medical officers and nurses (more than 95% are willing to report), only 20% of house officers will report the incident happened through them. Sixty nine percent of doctors and 67% of nurses perceive 'administration sanction' as a common barrier to incident reporting. Sixty percent of doctors and 80% of nurses would prefer reporting to the head of the department., Conclusions: By giving immunity from administrative sanction, providing prompt feedback and assurance that the incident reporting will be used to make changes in the system, there is considerable willingness of doctors and nurses to take time out of their busy schedules to submit reports.

In order to evaluate the effects of peritoneal dialysis as a modality of renal replacement therapy for adults with acute renal failure (ARF) of varied etiologies, we studied 43 ARF patients who underwent peritoneal dialysis at our hospital from April 2004 to November 2005. The age of the patients ranged from 18 to 75 years with a mean of 35 years. There was no significant difference in the incidence of ARF between males and females. Acute tubular necrosis secondary to acute gastroenteritis was the cause of ARF in 32 (80%) patients; four (10%) patients expired secondary to ARF. There was an average fall of around 60% in the S. creatinine at the end of PD. We did not notice any significant complications related to the procedure. We conclude that peritoneal dialysis is still a good option for the treatment of patients with ATN.

Dural arteriovenous malformations (AVMs) are interesting lesions, which can present as diagnostic and therapeutic challenges. Such AVMs were initially described as located solely in the dural venous sinuses, but during the last decade researchers have discovered them in other locations such as the tentorium and foramen magnum. It is understandable that they can develop in other locations because numerous arteriovenous shunts normally occur all over the dura. Early reports emphasize that they are congenital; however, some investigators have proposed that they are acquired lesions arising after sinus thrombosis and trauma. They also have variable clinical features. From 1975 to 2000 we treated 400 AVMs, of which 46 were dural. Of these 46 dural AVMs, 18 could be classified as skull base AVMs. We restricted the designation of skull base AVMs to those AVMs located in the tentorium or adjacent to bones of the skull base. Two of these AVMs actually had their vascular nidus located in the bone. The common dural sinus AVMs were excluded from this category. The presenting clinical features of these skull base AVMs ranged from headache and pulsatile tinnitus to intracranial hemorrhage. They were treated by a combination of endovascular and microsurgical treatment. The majority of patients had a good clinical outcome. Skull base dural AVMs are an interesting clinical entity. Their clinical course, treatment and final outcome are variable depending on their location. They should be managed by a multidisciplinary approach.

Object: Vasospasm remains a significant source of neurological morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH), despite advances in current medical, surgical, and endovascular therapies. Magnesium sulfate therapy has been demonstrated to be both safe and effective in preventing neurological complications in obstetrical patients with eclampsia. Evidence obtained using experimental models of brain injury, cerebral ischemia, and SAH indicate that Mg may also have a role as a neuroprotective agent. The authors hypothesize that MgSO4 therapy is safe, feasible, and has a beneficial effect on vasospasm and, ultimately, on neurological outcome following aneurysmal SAH., Methods: A prospective randomized single-blind clinical trial of high-dose MgSO4 therapy following aneurysmal SAH (Hunt and Hess Grades II-IV) was performed in 40 patients, who were enrolled within 72 hours following SAH and given intravenous MgSO4 or control solution for 10 days. Serum Mg++ levels were maintained in the 4 to 5.5 mg/dl range throughout the treatment period. Clinical management principles were the same between groups (including early use of surgery or endovascular treatment, followed by aggressive vasospasm prophylaxis and treatment). Daily transcranial Doppler (TCD) ultrasonographic recordings were obtained, and clinical outcomes were measured using the Glasgow Outcome Scale (GOS). The patients' GOS scores and the TCD recordings were analyzed using the independent t-test. Forty patients were enrolled in the study: 20 (15 female and five male patients) received treatment and 20 (11 female and nine male patients) comprised a control group. The mean ages of the patients in these groups were 46 and 51, respectively, and the mean clinical Hunt and Hess grades were 2.6 +/- 0.68 in the MgSO4 treatment group and 2.3 +/- 0.73 in the control group (mean +/- standard deviation [SD], p = 0.87). Fisher grades were similar in both groups. Mean middle cerebral artery velocities were 93 +/- 27 cm/second in MgSO4-treated patients and 102 +/- 34 cm/second in the control group (mean +/- SD, p = 0.41). Symptomatic vasospasm, confirmed by angiography, occurred in six of 20 patients receiving MgSO4 and in five of 16 patients receiving placebo. Mean GOS scores were 3.8 +/- 1.6 and 3.6 +/- 1.5 (mean +/- SD, p = 0.74) in the treatment and control groups, respectively. Significant adverse effects from treatment with MgSO4 did not occur., Conclusions: Administration of high-dose MgSO4 following aneurysmal SAH is safe, and steady Mg++ levels in the range of 4 to 5.5 mg/dl are easily maintained. This treatment does not interfere with neurological assessment, administration of anesthesia during surgery, or other aspects of clinical care. We observed a trend in which a higher percentage of patients obtained GOS scores of 4 or 5 in the group treated with MgSO4, but the trend did not reach a statistically significant level. A larger study is needed to evaluate this trend further.

The Henry Ford Hospital (HFH) was founded in 1915 as a philanthropic gift from Henry Ford, the automobile magnate and inventor of the Model T. The hospital and its organizational structure represented a nonsectarian facility that would provide care for all members of society. The system was patterned after the newest and most modern medical centers at the time in Europe, Canada, and the United States, including the German Krankenhauser, the Johns Hopkins Hospital, the Mayo Clinic, and the Peter Bent Brigham Hospital in Boston. The HFH grew into the Henry Ford Health System in the 1970s to 1990s, with the acquisition of other hospitals, the development of a multiple-region-based clinic system through southeastern Michigan, and the development of comprehensive, vertically integrated health care systems. The Division of Neurosurgery at HFH was established by Albert Crawford in 1926. The tradition of training residents in neurosurgery began in 1946, and the residency training program was accredited by the American Board of Neurosurgery in 1954. In 1970, the Division of Neurosurgery of the Department of Surgery was combined with the Division of Neurology to create the joint Department of Neurology and Neurosurgery. A separate Department of Neurosurgery was established in 1981. Four individuals have served as chairmen of the Department of Neurosurgery at HFH, i.e., Albert Crawford (1926-1952), Robert Knighton (1952-1978), James Ausman (1978-1991), and Mark Rosenblum (1992 to the present). During the 1980s and 1990s, HFH evolved into the vertically integrated, regionally distributed Henry Ford Health System. Under the current direction of Dr. Rosenblum, the Department of Neurosurgery at HFH has grown to include 11 full-time neurosurgeons, 2 neuro-oncologists, and 3 investigators with Ph.D. degrees and has recently expanded into three additional hospitals in southeastern Michigan, paralleling the growth of the system. The faculty annually treats more than 2,000 cases in all neurosurgical subspecialties, ranging from neuro-oncological surgery, cranial base surgery, radiosurgery, cerebrovascular surgery, epilepsy surgery, treatment of movement disorders, pain and spasticity surgery, pediatric neurosurgery, and neurotrauma treatment to complex instrumentation of the spine. This article chronicles the history of the Henry Ford Health System and the Department of Neurosurgery, its research endeavors, and its residency training program.

Objective: In 90% of normal subjects, the left hemisphere is dominant for language function. We investigated whether congenital lesions of the left perisylvian regions altered cortical language representation in right-handed individuals., Methods: Using functional magnetic resonance imaging, we studied language hemispheric dominance in five right-handed adult patients with congenitally acquired arteriovenous malformations (AVMs) originating from left hemispheric cortical language regions. The AVMs had not caused neurological symptoms during early development, but patients presented as adults with migraine, seizure, or minor hemorrhage. Results obtained from the AVM patients were contrasted to those from right-handed brain-injured stroke patients recovering from aphasia and to those from right-handed normal subjects., Results: During silent picture naming and verb generation tasks, cortical language networks lateralized primarily to the right hemisphere in the AVM group, compared with the left hemisphere in the normal group. This right hemisphere-shifted language network in the AVM group exceeded the shifts toward right hemispheric dominance found in the stroke group., Conclusion: Patients with AVMs affecting the left perisylvian regions recruited the right hemisphere into language processing networks during early development, presumably in response to congenitally aberrant circulation. This early right hemisphere recruitment in the AVM patients exceeded the similar process in the brains of stroke patients whose left cortical language networks were damaged in adulthood. Our data provide evidence of effective plasticity in the developing human brain compared with the mature brain response to injury. Knowledge of cortical language representation should assist presurgical planning in patients with developmental anomalies affecting apparently language-dominant brain regions.

The present study is a comprehensive retrospective analysis of 1341 gastric neoplasms out of 10 733 individuals subjected to upper gastrointestinal endoscopy at the main teaching cum referral hospital in the Kashmir Valley. Of these 78% were males and 22% females, majority being in the age group of 41-60 years with 60% of the patients being smokers. On endoscopy, the commonest site of cancer was the body of stomach 40.7%, followed by the antrum 35.5% and the cardiac region 23.8%. Endoscopic features revealed nodular masses 39%, polypoid masses 21%, malignant ulcers 11%, infiltrative masses 12%, rounded tumor masses 9%, linitus plastica 5% and early gastric carcinoma 3%. Histology revealed adenocarcinoma 91%, (including mucoid carcinoma 9%, and schirrous carcinoma 7%), leiomyosarcoma 7%, and reticulum cell sarcoma 2%. No significant association between Helicobacter pylori infection and gastric cancer was observed in a short study out of these patients. The peculiar geography and some special dietary habits with a possible familial predisposition may have a bearing on the high risk of gastric cancer in the valley.

Objective: The spontaneous occlusion of a cerebral arteriovenous malformation (AVM) occurs rarely. Occlusion of a parent artery feeding the AVM is even more rare, and its incidence is unknown. We undertook this study to determine the incidence of occlusion of a major artery feeding an AVM and to recommend a management strategy for such an AVM., Methods: We identified AVMs associated with an occluded artery by performing a retrospective angiographic analysis of 500 patients with AVMs who presented to Henry Ford Hospital from 1976 to 1998., Results: A review of the angiograms revealed that 7 (1.4%) of 500 patients with an AVM had occlusion of one or more major arteries feeding the nidus. In four patients, an internal carotid artery and its bifurcation were occluded; in two patients, the M1 segment of the middle cerebral artery was occluded, and in one patient, a vertebral artery was occluded. Pial collaterals and/or a moyamoya pattern of anastomoses developed in all patients, with the exception of one who had vertebral artery occlusion. Five patients underwent definitive treatment: one received radiosurgery, and four underwent surgical excision. One of the surgically treated patients died of complications from excessive blood loss and coagulopathy, but the other three had no postoperative complications., Conclusion: The occlusion of a major artery feeding an AVM occurs rarely (1.4%). These AVMs are moderate to large in size (>3 cm). To prevent collateral flow-related complications of cortical "steal" and hemorrhage, as well as the usual risk of hemorrhage from the AVM itself, surgical management should be considered for these AVMs.

Objective: The factors associated with spontaneous angiographic obliteration of cerebral arteriovenous malformations (AVMs) are not well understood. We present a review of the literature and a report of our experience with six cases (four with no previous treatment intervention and two postoperative residual malformations) that were identified as having occurred during a 20-year period and describe the clinical and lesion features associated with this rare phenomenon. We present the first detailed histological study of a spontaneously thrombosed AVM specimen, including immunohistochemical analysis of angiogenesis factor expression., Methods: A combined experience in the management of approximately 700 AVMs during 20 years identified six cases of spontaneous angiographic obliteration of cerebral AVMs. A literature review revealed another 24 cases with angiographic documentation of the initial AVMs and follow-up data showing nonfilling of the lesions. Histological analysis of a recently excised lesion included immunostaining with monoclonal antibodies to the antigens of Factor VIII, Tie, vascular endothelial growth factor, and its receptors, Flt-1 and Flk., Results: A single draining vein was a feature in each of our 6 cases and in 12 of 14 (86%) cases from the literature. Hemorrhage as the presenting symptom was identified in 5 of our 6 (83%) cases and in 17 of 24 (71%) of the literature cases. The size of the AVM was less than 6 cm in each of our 6 cases and in 22 of 24 (92%) of the literature cases. A histological examination of a thrombosed AVM surgical specimen revealed persistent patent vascular channels within the lesion. Immunohistochemical analysis with angiogenesis and endothelia-specific factors showed expression of these factors within the lumen of the thrombosed nidus vessels., Conclusion: We propose that the occlusion of a single draining vein may lead to total venous outflow obstruction and lesion thrombosis. Hemorrhagic presentation and small nidus may also predispose to this phenomenon. Immunohistochemical analysis of a thrombosed AVM revealed possible ongoing angiogenic changes within the AVM vessels 1 month after angiographically documented thrombosis. It is possible that neovascularization within a thrombosed AVM may lead to lesion recanalization; however, this phenomenon seems to be clinically exceedingly rare.

Objective This study aimed to find out prevalence of Helicobacter pylori (H. pylori) in peptic ulcer disease (PUD) which is highly endemic disease in Kashmir.Method This study consisted of 50 PUD patients and 30 asymptomatic volunteers. Peptic ulcer was diagnosed by endoscopic examination and H. pylori was detected by histology (using Giemsa stain), one minute endoscopy room test (OMERT) and modified Gram's staining. Positive results from OMERT plus histology were considered as the "gold standard" for the presence of H. pylori.Results Out of 50 patients, 46 had duodenal ulcer (DU), 2 had benign gastric ulcer (GU) and 2 had both DU and GU. The sensitivity and specificity of OMERT were 94% and 96.70%, histology 97.90% and 96.90% and Gram's staining 91.30% and 85.30%, respectively, as compared to our gold standards. H. pylori was present in 76.09% of DU, 50% of GU, whereas patients with duodenitis, channel ulcers, chronic active DU and those with multiple ulcers were 100% H. pylori positive. H. pylori was present in 10 (33.33%) of healthy volunteers.Conclusion A significant association between H. pylori infection and PUD was found in this study. However, there seem to be other causative factors as well which contribute for this highly endemic disease.

Aims and objectives The present study was undertaken to compare the diagnostic yield of three available test procedures for detecting Helicobacter pylori (H. pylori) infection in endoscopic biopsies.Methods H. pylori infection was sought in 150 patients referred for upper gastrointestinal (GI) endoscopy. Multiple (about six) biopsy specimens were taken from pyloric antrum in each patient. Two biopsy specimens were subjected to one minute endoscopy room test - OMERT (a modified form of urease test), two were sent for histopathological analysis, where multiple sections were subjected to Giemsa staining and two were sent for microbiological evaluation after Gram's staining of heat fixed biopsy material.Results H. pylori positivity using histology, microbiology and OMERT was observed to be 33%, 30% and 27% respectively. However, overall 40% patients were infected when the results from three test procedures were combined, as H. pylori positivity was repeated more than once by these procedures separately. Histology was found to be superior to other two tests in our study, especially when multiple sections were examined, for the distribution of the organism was patchy. Amongst the infected, H. pylori was seen in only 30% of all 3-8 sections cut from a biopsy, whereas in 70% it was noted in a single section only.Conclusion The study revealed that histology has the highest detection rate and can be chosen as the "gold standard" amongst the three low cost test procedures available at present in our setup.

Background: Peripheral lymphadenopathy can be caused by benign and malignant diseases. In this logistic regression model, we attempted to identify the clinical findings predicting high probability of nodal malignancy., Materials and Methods: Two hundred and twenty cases diagnosed by peripheral lymph node biopsy were studied. Of these, 164 had benign lymph node pathology, while the other 56 were malignant. The patientsâ medical charts were reviewed and a logistic regression model used to identify physical signs and simple investigations that will predict nodal malignancy., Results: Hard lymph node consistency, negative Mantoux test and positive abdominal ultrasound (showing hepatosplenomegaly with or without lymphadenopathy) were found to correlate with a higher probability of nodal malignancy., Conclusion: A logistic regression model is proposed to calculate the probability of lymph node malignancy at different ages and both sexes in relation to lymph node consistency, Mantoux test and abdominal ultrasound results.

In a retrospective case-control study of 58 cases of human brucellosis, adjusted mean serum calcium levels were found to be significantly higher in patients with brucellosis compared with controls: mean (95% confidence interval) = 2.39 (2.35-2.42) mmol/L versus 2.30 (2.26-2.34) mmol/L (P = 0.0012). The possible mechanisms underlying the cause of hypercalcemia in human brucellosis are discussed.

Seventy-three cases of acute brucellosis were studied in relation to fever duration and hospital stay following different drug combinations, including gentamicin plus cotrimoxazole, rifampicin plus doxycycline, rifampicin plus cotrimoxazole, rifampicin plus tetracycline, streptomycin plus doxycycline, doxycycline plus cotrimoxazole, tetracycline plus cotrimoxazole, and tetracycline plus streptomycin. No statistical significant difference was found between these combinations regarding early clinical response in human brucellosis.

Three hundred and thirty-four cases of confirmed malaria seen in the Asir Central Hospital, Abha, in southwestern Saudi Arabia, were studied retrospectively. Two hundred and eighty-two of these (84.4%) were Saudis and the majority (72.2%) were living in the lowlands of Tihama. Transmission was found to occur throughout the year, with peaks following the rainy season and in the summer. In Saudis, falciparum malaria is more common than vivax (97.2% vs. 2.8%), while vivax malaria is more commonly seen in expatriates (46.2%). Poor response of falciparum malaria to chloroquine was more prevalent in expatriates than in Saudis (46.4% vs. 23%). Most of the expatriates gave a history of recent travel to countries known to be endemic with resistant malaria. The possibility of the emergence of chloroquine-resistant malaria in the southwestern region of Saudi Arabia was discussed.

Aim: To study the association of Helicobacter pylori infection with chronic antral gastritis in peptic ulcer disease patients and healthy population of Kashmir., Methods: 50 peptic ulcer patients (duodenal ulcer = 46, gastric ulcer = 2 and combined duodenal and gastric ulcer = 2) and 30 asymptomatic healthy volunteers were included in this study. Peptic ulcer was diagnosed on endoscopic examination. 4-6 punch biopsies were taken from gastric antrum in all the individuals and in case of gastric ulcer an additional biopsy was taken from the edge of the ulcer to exclude its malignant nature. Helicobacter pylori (H. pylori) organism was diagnosed using three different test methods, viz. Histology (using Giemsa Stain), Microbiology (Gram Stain) and Biochemistry (using one minute Endoscopy Room Test). Histological diagnosis of H. pylori was taken as the "gold standard" for the presence of H. pylori organism. Histological diagnosis of gastritis was made using Hematoxylin and Eosin Stain and the gastritis was classified as active chronic gastritis and superficial chronic gastritis., Results: Out of 30 peptic ulcer disease patients with associated antral gastritis, 27 (90%) were positive for H. pylori on histological examination (13 superficial chronic gastritis and 14 active chronic gastritis) whereas out of 8 healthy volunteers with histological evidence of chronic antral gastritis, H. pylori was observed in 7 individuals (87.50%) (4 active chronic gastritis and 3 superficial chronic gastritis)., Conclusion: A highly significant association between H. pylori infection with chronic antral gastritis both in peptic ulcer disease patients and healthy volunteers of Kashmir was found in this study. Association between H. pylori infection and chronic gastritis was 90% in peptic ulcer group and 87.50% in healthy population (P<0.005).

Bilateral superior ophthalmic vein (SOV) enlargement has rarely been shown to occur in patients with septic and aseptic cavernous sinus thrombosis, Graves' disease due to obstruction of the SOV by enlarged extraocular muscles, or carotid-cavernous fistulas caused by retrograde flow. The authors describe 11 patients with bilateral SOV enlargement associated with cerebral swelling as detected by computerized tomography scanning. The bilaterally enlarged SOVs returned to a normal size following resolution of cerebral swelling and elevated intracranial pressure. To the authors' knowledge, this is the first report of bilateral SOV enlargement associated with diffuse cerebral swelling that subsequently resolved after treatment of the cerebral edema. The authors believe that the bilateral SOV enlargement was caused by mechanical cavernous sinus venous stagnation due to cerebral swelling, a syndrome that occurs more commonly than currently appreciated.

One hundred four Saudi patients with brucellosis who were admitted to Abha General Hospital in the Asir region of southern Saudi Arabia were studied. All the patients had Brucella melitensis infection; 61.5% were females while 38.5% were males. Their mean age was 32 years. Most of the patients (61.5%) lived in the lowland (Tihama) and the majority were shepherds (84.6%). The most common presenting symptoms were fever (100%), sweating (96.2%), headache (76.9%), joint pains (76.9%), and backache (73.1%). Physical findings included fever (96.2%), hepatomegaly (46.2%), splenomegaly (42.3%), tenderness over the spine (30.8%), arthritis (26.9%), and lymphadenopathy (19.2%). Mild anemia, leukopenia, and relative lymphocytosis were common. A history of raw milk ingestion was an important factor in disease transmission (84.6%), followed by close animal contact (73%) and raw liver consumption (63.3%). The study shows the effectiveness of several drug combinations in the treatment of brucellosis and the low relapse rate if the treatment is prolonged for not less than six weeks.