Objectives: This study was carried out to ascertain the aetiology of exudative pleural effusions when other diagnostic investigations such as pleural fluid and sputum examination for cytology and acid fast bacilli fail to yield a definitive diagnosis and to differentiate between tuberculosis and malignancy in cases suspicious of malignancy. Methods: Pleuroscopic biopsies were obtained in 219 cases by Chest Physicians in the endoscopy suite using flexi-rigid fiber-optic pleuroscopes. Histological sections were stained with H&E and microscopic examination performed. Ziehl-Nielsen stain for acid fast bacilli was performed in all suspected tuberculosis cases and immunohistochemistry for Thyroid transcription factor 1 and other markers were carried out for all cases suspicious of malignancy. Results: Adequate biopsy material for interpretation was obtained in 210 (95.9%) of 219 cases. Histopathology revealed 79 (37.6%) cases were tuberculosis, 64 (30.5%) were malignant (primary from lung and other sites), 62 (29.5%) were non-specific inflammation and 5 (2.4%) were empyema. A definitive diagnosis of tuberculosis, malignancy and empyema was obtained in 70.5% of cases. Tuberculosis was encountered in a younger age-group than malignancy. Mean age for tuberculosis patient was 49 years while for malignant patients was 63 years. The majority (79.6%) of malignances encountered were metastatic lung adenocarcinoma.

STUDY DESIGN: Prospective randomized study of antibiotic prophylaxis in elective spine surgery. PURPOSE: The aim of this study was to compare the rate of postoperative surgical site infection for a single dose of two different generations of cephalosporin with different dosage and timing of the antibiotics. OVERVIEW OF LITERATURE: Current recommendation for prophylaxis in elective spine surgery is up to 60 minutes prior to incision. No study has investigated between different generation of cephalosporin for prophylaxis in elective spine surgery with respect to choice, dosage and timing. METHODS: This study was a prospective randomized study of 90 patients, assessed for the occurrence of surgical site infection (defined by the Centers for Disease Control and Prevention criteria) and other infections for up to 6 months after surgery. Demographic, surgical and further data were collected on subsequent operations, including hardware removal. RESULTS: Mean age in our group was 47 years (range, 19-71 years). The male to female ratio was 49:41 and the average timing of administration of antibiotics was 77 minutes (range, 30-120 minutes). The average blood loss was 626 mL (range, 150-3,000 mL) with a mean duration of surgery for 3.2 hours (range, 1.5-6 hours). One case of superficial infection and one case of deep infection met the exclusion criteria. CONCLUSIONS: Our results support the use of a single preoperative dose of antibiotics in instrumented and non-instrumented elective spine surgery up to one hour prior to incision. There was no difference in terms of occurrence of surgical site infection with respect to dosage, choice and timing of antibiotics.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Centers for Disease Control and Prevention (U.S.) ; Female ; Humans ; Male ; Prospective Studies ; Spine

Central retinal artery occlusion and central retinal venous occlusion are rare entities of retinal vascular disorders that can cause sudden visual loss and combined occurrence results in devastating outcomes. The role of protein C deficiency is well established in venous thrombosis however the occurrence of concurrent arterial thrombosis is rare and the combination in association with carotid artery occlusion is an exceptionally rare occurrence. Here we report a case of protein C deficiency presenting as combined central retinal artery occlusion and central retinal venous occlusion with bilateral carotid artery disease

Wallenberg syndrome (lateral medullary syndrome) is a type of posterior circulation stroke resulting in brainstem infarction which is most often caused by occlusion of vertebral artery or posterior inferior cerebellar artery or both.1 Here we report a case of right lateral medullary syndrome secondary to vertebral artery occlusion with associated left cerebellar and cervical cord infarct resulting in quadriparesis.