We conclude that albendazole is safe and effective adjuvant therapy in the treatment of hydatid liver disease.

Background/Aim:Hydatidosis has a worldwide distribution and the liver is the most common organ involved. Hydatid cysts of the liver can be managed either by nonoperative or operative methods. Nonoperative methods include chemotherapy and percutaneous treatment. The study aimed at understanding the effect of albendazole therapy on the viability of protoscoleces and recurrence rate of hydatid disease of the liver.Patients and Methods:The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India, over a period of 2 years from January 2002 to December 2003, with further follow-up of 5 years. The study included 72 cases in the age group of 17-66 years, comprising 39 males and 33 females. The patients were randomized into two groups of 36 patients each. In group A, patients were directly subjected to surgery, while in group B, patients were administered albendazole for 12 weeks preoperatively, followed by a further postoperative course for 12 weeks.Results:Of patients who received albendazole therapy, no patient had viable cysts at the time of surgery, as compared to 94.45% of the patients who did not receive any preoperative albendazole (P<0.01). In patients who did not receive any albendazole therapy, recurrence rate was 16.66%, while no recurrence was seen in patients who received albendazole therapy (P≤0.05).Conclusion:We conclude that albendazole is an effective adjuvant therapy in the treatment of hydatid liver disease.

Epidural hematomas which are located at the vertex are rarely seen and form a small percentage of total epidural hematomas. Tearing in the superior sagittal sinus is the usual cause of an epidural hematoma located in the vertex. The clinical features of this entity are non-specific; hence, localization of the lesion is difficult. We report an adult who was hit by a motorcycle and was initially discharged from the hospital as a case of concussional head injury. He returned back with raised intracranial pressure symptoms, so a CT scan was done but was misinterpreted, and he reported one week later with bilateral abducent nerve palsy. Magnetic resonance imaging confirmed vertex EDH for which he was operated.These hematomas are seen rarely and can be interpreted as an artifact. Its recognition is important because it has an excellent prognosis. We concluded that all head injury patients should get high axial cuts on the CT scan, and any degree of suspicion should prompt a neurosurgeon to investigate further with coronal CT scan or MRI. KeywOrds: Extradural hematoma, Vertex, Abducent nerve palsy ÖZVertekse yerleşmiş epidural hematomlar nadir görülürler ve tüm epidural hematomlar içinde küçük bir yüzde olarak bulunur. Bu hematomlara süperior sagital sinüsteki bir yırtık yol açar. Bu hematomların spesifik klinik bulguları olmadığından kafa içindeki yerini belirlemek çoğunlukla mümkün olmaz. Yaya halde iken motorsiklet tarafından çarpılan hastaya serebral kontüzyon tanısı konulmuş ve taburcu edildi, hasta tekrar hastaneye kafa içi basınç artışı bulguları ile getirildi ancak çekilen beyin bilgisayarlı tomografisinde patoloji yok denilerek hasta tekrar taburcu edildi. Hasta bir hafta sonra bu kez iki taraflı abdusent paralizisi ile hastaneye müracat etti ve yapılan kranial manyetik rezonans görüntülemesinde vertekste epidural hematom saptanan hasta ameliyat edildi. Vertekse yerleşmiş epidural hematomlar bilgisayarlı tomografide artefakt olarak değerlendirilerek kolayaca atlanabilir; bunun yanı sıra bu patoloji oldukça nadir görülür ve tanındığı zaman gerekli tedavi ile hastaların prognozu mükemmele yakındır. Kafa travması ile gelen hastaların özellikle vertikal bölgesi bilgisayarlı tomografi ile iyi taranmalı, şüphe durumunda koronal kesitler alınmalı, yine şüphe varsa hastalara kranial manyetik rezonans görüntülemesi yapılmalıdır.

Management of 3794 gunshot wounds of head at disaster scale, who presented to our emergency room in groups continuously over a period of 20 years, by the Department of Neurosurgery at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Kashmir, India, from September 1988 to November 2008, revealed an overall mortality of 87.69% (3327 out of 3794). Patients were triaged in emergency CT-room. Most of the victims were males. Most of the deaths 79.14% (2633 out of 3327) occurred within 30 minutes of the patient's arrival to the hospital and only 694 patients lived beyond one hour of arrival. Out Of total (3327) deaths, 2844 patients had admission GCS score of 3 and all of these died. No deaths occurred in the group of patients with GCS score 9-15. Poor and delayed mode of transportation accounted for 89.2% (2133 out of 2391) deaths. Elderly patients above 41 years of age in both sexes had poor outcome. 45 Children (below 18 years) were injured with a mortality of 42.2% (19 out of 45), attributing 0.57% (19 out of 3327) to total deaths. Surgical mortality was 30.9% (181 out of 585) and un-operative patients had 42.2% (46 out of 109) mortality. About 65.87% (276 out of 419) patients with admission-GCS score 4 to 8 were surgically salvageable. Predictors of poor outcome were low admission GCS score, fixed and dilated pupils, poor and delayed mode of transportation, hemodynamic instability, abnormal breathing at admission, coagulopathy and disseminated intravascular coagulation (DIC), CT visualisation of subarachnoid hemorrhage (SAH), ventricular hemorrhage, midline shift, bihemispheric and multilobar injuries and scalp wounds at occipital, temporal and frontal areas. However retained missile and bone fragments were less harmful than retained wooden (pulped mulberry stem) and cardboard wads and pneumocephalus in causing infections, cortical atrophy and seizures in the long run.

Background:Neural tube defects (NTDs) are the most common congenital malformations affecting the brain and spinal cord and have a multifactorial etiology. Genetic and environmental factors have been found to cause these defects, both individually and in combination.Methods:A 2-year hospital-based prospective study was carried out from November 2013 to October 2015 to determine the incidence, types, demographics, risk factors, and other associated anamolies relevant to NTDs in Kashmir Valley. A detailed history of the mother was taken along with detailed clinical examination of neonate including measurement of head circumference and checking the status of fontanella, whether lax/full/bulging/or tense, type of NTD. Investigations that were done included were X-ray skull: Anterior-posterior (AP) and lateral, X-ray spine: AP and lateral, ultrasonography abdomen, magnetic resonance imaging: Spine and brain.Results:The total number of babies with NTD's was 125 with an overall incidence of 0.503. Kupwara district was having the highest incidence (1.047) and Srinagar district the lowest incidence of NTD's (0.197). Majority of NTD's (116 cases, 92.8%) were found in the rural areas. Among the different types of NTD's, spina bifida had an incidence of 0.342 (85 cases, 68%) and anencephaly had an incidence of 0.113 (28 cases, 22.4%). There was a slight preponderance of females over males with NTD's. There were 70 females (56%) and 55 males (44%), respectively, with a male: female ratio of 0.8:1Conclusions:The incidence rates of NTDs is very high for Kashmir Valley. Geographical distribution of NTDs at this place confirms a relationship between the socioeconomic status, educational status, maternal too young or advanced age, and environmental factors for the development of a NTD. The results of this study point to the importance establishing a health policy to prevent NTD in Kashmir Valley.