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Nasser Mohammed, Amey R. Savardekar, Devi Prasad Patra, Vinayak Narayan and Anil Nanda

during Operation Iraqi Freedom. 1 In this evolutionary arms race, there is an urgent need to review, evaluate, and find new ways to tackle this difficult problem. The intrathecal or intraventricular (IT) administration of antibiotics has been tried as a last resort in many cases of severe neuro-infections not responding to traditional intravenous (IV) regimens. 10 This analysis is an attempt to review the role of intrathecal or intraventricular antibiotic therapy and its effect on the mortality rate. Methods The aim of the study was to review the benefit of combined

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Lixin Huang, Maheshkumar P. Mehta, Anil Nanda and John H. Zhang

. 51 Hyperbaric oxygen therapy has been advocated to improve neurological recovery following brain injury 36, 45 and cerebral ischemia 3, 33, 46, 47, 50 because it may improve oxygen delivery in tissue. The concept of using HBO for SCI parallels the application of this therapy in patients who have suffered brain injuries. Although SCI-related HBO treatment has been previously investigated, its effectiveness remains controversial. To date, investigators of the major experimental studies have used single-treatment HBO, whereas most clinical studies have used serial

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Nasser Mohammed, Devi Patra and Anil Nanda

H igh-intensity focused ultrasound is a novel and emerging technique that uses ultrasound waves as carriers of energy. It was used as early as the 1950s for the treatment of Parkinson disease. After the advent of levodopa therapy, its application was forgotten. 12 Focused ultrasound came back to modern relevance with its use in prostate cancer in 1994. 26 The ultrasound waves traverse intervening tissues and generate heat at the point of focus. The use of the phased-array transducer technique allows for ultrasound beam steering and focusing without attenuation

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Subhas K. Konar, Shyamal C. Bir, Tanmoy K. Maiti and Anil Nanda

Alone Versus Surgery With Adjuvant Therapy Seventeen percent of the children underwent surgery only. Forty-nine percent received both RT and CT after surgery, 28.3% received only RT after surgery, and 6% received only CT after surgery. Gross-total resection with RT had a better outcome than STR with radiation (p = 0.04, log-rank test; Fig. 6 ). Patients who received adjuvant therapy had a better median survival than those who had surgery alone, as shown in the Kaplan-Meier analysis (p = 0.01, log-rank test; Fig. 7 ). In both univariate and multivariate analyses

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David E. Connor Jr., Prashant Chittiboina, Gloria Caldito and Anil Nanda

the range of 33%–47%. 3 , 11 , 20 , 21 The leading factor contributing to these poor outcomes is delay in—or missed—initial diagnosis, reported to occur in 11%–75% of cases. 5 , 7 The condition is often misdiagnosed in patients presenting with mild symptoms, especially those lacking any immediate neurological deficit, such as urinary tract infection, pneumonia, or degenerative spine issues, and patients may be treated with oral or parenteral antibiotics as a result of the misdiagnosis. Medical therapy is often based upon broad-spectrum coverage initially, with

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Jose A. Menendez, David L Lilien, Anil Nanda and Richard S. Polin

Intracranial mass lesions comprise approximately half of all acquired immune deficiency syndrome (AIDS)–related neurological complications. Although toxoplasmosis and lymphoma are the most common causes of these lesions, diagnosis and treatment can be delayed because computerized tomography and magnetic resonance imaging studies cannot accurately differentiate between them.

The authors retrospectively studied nine patients with AIDS in whom, after a 6-hour fast, [18F]-fluorodeoxyglucose (FDG)–positron emission tomography (PET) scanning demonstrated intracranial mass lesions. The FDG uptake within each lesion was classified as either increased or not increased. In six patients there was no increase in FDG uptake, which suggested a diagnosis of toxoplasmosis, and lymphoma was suggested in two patients in whom increased FDG uptake was demonstrated. In a patient with two lesions, one lesion was shown to have increased FDG uptake whereas the other was shown to have no increased FDG uptake. All patients in whom a diagnosis of toxoplasmosis was made were started on antimicrobial therapy. Two patients died of other AIDS-related complications before repeated neuroimaging could be performed to assess treatment response, one patient refused to undergo further treatment or follow up, and two patients responded well to treatment. One patient with toxoplasmosis did not respond to the drugs. Analysis of a biopsy sample of the lesion confirmed the diagnosis; however, the patient died shortly thereafter. The two patients with FDG-PET–diagnosed lymphoma began corticosteroid therapy and improved considerably. In the patient in whom PET demonstrated two different FDG uptakes, a biopsy sample was obtained that confirmed the diagnosis of lymphoma; this patient was started on corticosteroid therapy and improved. A safe and reliable diagnostic tool, FDG-PET scanning can be used to differentiate causes of human immunodeficiency virus-related intracranial mass lesions. When available, this diagnostic study should be conducted before initiating empirical treatment or obtaining a stereotactically guided brain biopsy sample.

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Amitabha Chanda, Donald R. Smith and Anil Nanda

Sharp WV, Stark M, Donovan DL: Modern autotransfusion. Experience with a washed red cell processing technique. Am J Surg 142: 522–525, 1981 29. Stehling LC , Doherty DC , Faust RJ , et al : Task force on blood component therapy: practice guidelines for blood component therapy. A report by the American Society of Anesthesiologists. Anesthesiology 84 : 732 – 747 , 1996 Stehling LC, Doherty DC, Faust RJ, et al: Task force on blood component therapy: practice guidelines for blood component therapy. A report by the

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Anil Nanda, Sudheer Ambekar, Vijayakumar Javalkar and Mayur Sharma

= subtotal resection. At last follow-up, 28 patients (93.3%) had a GOS score of 5. There were no deaths in our series. Transient electrolyte disturbances were observed in 3 patients, all with DSMs. One patient with TSM developed a superficial operative site infection that responded well to antibiotic therapy. Recurrence of tumor was observed in 2 patients with TSM and none with DSM. Both patients underwent Gamma Knife surgery to the recurrent tumor with good control at last follow-up. Figures 2 and 3 show some preoperative, intraoperative, and postoperative images of

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Anthony Sin, Donald Smith and Anil Nanda

repeated to assess his response to medical therapy. A sagittal T1-weighted MR image with contrast enhancement showed severe discitis at the L1–2 disc space and epidural extension, which is associated with kyphotic deformity ( Fig. 1A ). More than 50% of his spinal canal was compromised ( Fig. 1B ). He could exert full strength in dorsiflexion and plantar extension for only a short period of time because of severe pain generated through movement; surgical decompression and fusion with instrumentation via an anterior thoracolumbar approach was offered in the hope of

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David E. Connor Jr., Menarvia Nixon, Anil Nanda and Bharat Guthikonda

T , Pannek H , : Vagus nerve stimulation: outcome and predictors of seizure freedom in long-term follow-up . Seizure 19 : 264 – 268 , 2010 16 Hammond EJ , Uthman BM , Reid SA , Wilder BJ : Electrophysiological studies of cervical vagus nerve stimulation in humans: I. EEG effects . Epilepsia 33 : 1013 – 1020 , 1992 17 Handforth A , DeGiorgio CM , Schachter SC , Uthman BM , Naritoku DK , Tecoma ES , : Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial . Neurology 51 : 48