Ramesh P Babu, M.D.

Right leg pain
Singh, Anuradha; Engler, John; Babu, Ramesh
Case-based neurology New York : Demos Medical, c2012,
— id: 5939, year: 2012, vol: , page: 133, stat: Chapter,

Brain tumor location and psychiatric symptoms: is there any association? A meta-analysis of published case studies
Madhusoodanan, Subramoniam; Opler, Mark G A; Moise, Despina; Gordon, Jessica; Danan, Deepa M; Sinha, Abhishek; Babu, Ramesh P
2010 Oct;10(10):1529-1536, Expert review of neurotherapeutics
A meta-analytic study of reports of brain tumors and psychiatric symptoms for the past 50 years was conducted to examine potential associations between tumor location and psychiatric symptoms. Results demonstrated that there is a statistically significant association between anorexia symptoms and hypothalamic tumors. For the rest of the brain regions a statistically significant association could not be definitively determined. However, several of the regions demonstrated an increased likelihood of associated symptoms when compared with other regions. The methodological limitations of this analysis are discussed
— id: 114475, year: 2010, vol: 10, page: 1529, stat: Journal Article,

The effect of dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy
Bekker, Alex; Sturaitis, Mary; Bloom, Marc; Moric, Mario; Golfinos, John; Parker, Erik; Babu, Ramesh; Pitti, Abishabeck
2008 Oct;107(4):1340-1347, Anesthesia & analgesia
BACKGROUND: The perioperative course of patients undergoing intracranial surgery is frequently complicated by hypertensive episodes. Dexmedetomidine (DEX), an alpha-2 adrenoreceptor agonist, is gaining popularity in neuroanesthesia, because its sympatholytic and antinociceptive properties may improve hemodynamic stability at critical moments of surgery. We designed this study to assess the efficacy of DEX in controlling hypertensive responses in patients undergoing intracranial surgery. METHODS: Patients scheduled for elective craniotomy were randomly assigned to receive either sevoflurane-opioid or sevoflurane-opioid-DEX anesthesia. Bispectral index was used to maintain a similar level of hypnosis in both groups (40-50). Opioids, sevoflurane, and vasoactive medications were titrated in a routine manner, at the discretion of the blinded anesthesiologist managing the case, to maintain systolic blood pressure (SBP) targeted within 90-130 mm Hg and heart rate (HR) between 50 and 90 bpm. Hemodynamic variables were continuously recorded and stored on a computer for analysis. Efficacy of the anesthetic technique in controlling SBP or HR is inversely proportional to the area under the curve (AUC) outside the targeted range. Areas under the curves above and below targeted ranges for SBP-time (AUCsbp mm Hg*min/h) and HR-time (bpm*min/h) were compared. Coefficient of variation was used to assess hemodynamic stability. RESULTS: Seventy-two patients were recruited for the study. Computerized records of 56 patients only were analyzed because of technical problems with data collection in 14 cases. AUCsbp for above the targeted range was significantly lower for patients in the DEX group (P=0.044). The coefficient of variation for SBP or HR did not differ between groups. A significantly smaller proportion of patients in the DEX group required treatment with antihypertensive medications (12 of 28, 42% vs 24 of 28, 86%, P=0.0008). The DEX group required fewer opioids in the intraoperative period, but there were no differences in the use of sevoflurane. In the postanesthesia care unit, patients in the DEX group had fewer hypertensive episodes (1.25+/-1.55 vs 2.50+/-2.00, P=0.0114) and were discharged earlier (91+/-17 vs 130+/-27 min, P<0.0001). There were no differences in the requirement for postoperative opioids or antiemetics. CONCLUSIONS: By using indices, which assess a global hemodynamic stability of the anesthetic, we determined that intraoperative DEX infusion was effective for blunting the increases in SBP perioperatively. The use of DEX did not increase the incidence of hypotension or bradycardia, common side effects of the drug
— id: 87811, year: 2008, vol: 107, page: 1340, stat: Journal Article,

Up-cycling of PET (polyethylene terephthalate) to the biodegradable plastic PHA (polyhydroxyalkanoate)
Kenny, Shane T; Runic, Jasmina Nikodinovic; Kaminsky, Walter; Woods, Trevor; Babu, Ramesh P; Keely, Chris M; Blau, Werner; O'Connor, Kevin E
2008 Oct 15;42(20):7696-7701, Environmental science & technology
The conversion of the petrochemical polymer polyethylene terephthalate (PET) to a biodegradable plastic polyhydroxyal-kanoate (PHA) is described here. PET was pyrolised at 450 degrees C resulting in the production of a solid, liquid, and gaseous fraction. The liquid and gaseous fractions were burnt for energy recovery, whereas the solid fraction terephthalic acid (TA) was used as the feedstock for bacterial production of PHA. Strains previously reported to grow on TA were unable to accumulate PHA. We therefore isolated bacteria from soil exposed to PET granules at a PET bottle processing plant From the 32 strains isolated, three strains capable of accumulation of medium chain length PHA (mclPHA) from TA as a sole source of carbon and energy were selected for further study. These isolates were identified using 16S rDNA techniques as P. putida (GO16), P. putida (GO19), and P. frederiksbergensis (GO23). P. putida GO16 and GO19 accumulate PHA composed predominantly of a 3-hydroxydecanoic acid monomer while P. frederiksbergensis GO23 accumulates 3-hydroxydecanoic acid as the predominant monomer with increased amounts of 3-hydroxydodecanoic acid and 3-hydroxydodecenoic acid compared to the other two strains. PHA was detected in all three strains when nitrogen depleted below detectable levels in the growth medium. Strains GO16 and GO19 accumulate PHA at a maximal rate of approximately 8.4 mg PHA/l/h for 12 h before the rate of PHA accumulation decreased dramatically. Strain GO23 accumulates PHA at a lower maximal rate of 4.4 mg PHA/l/h but there was no slow down in the rate of PHA accumulation over time. Each of the PHA polymers is a thermoplastic with the onset of thermal degradation occurring around 308 degrees C with the complete degradation occurring by 370 degrees C. The molecular weight ranged from 74 to 123 kDa. X-ray diffraction indicated crystallinity of the order of 18-31%. Thermal analysis shows a low glass transition (-53 degrees C) with a broad melting endotherm between 0 and 45 degrees C
— id: 95064, year: 2008, vol: 42, page: 7696, stat: Journal Article,

Quantitative evaluation of transtemporal and facial translocation approaches to infratemporal fossa
Kuriakose, Moni A; Sorin, Alex; Sharan, Rajeev; Fishman, Andrew J; Babu, Ramesh; Delacure, Mark D
2008 Jan;18(1):17-27, Skull base
Objective: To compare the extent of exposure and surgical maneuverability provided by facial translocation and transtemporal approaches for access to the infratemporal fossa and anterolateral skull base. Materials and Methods: Surgical procedures were performed on five fresh frozen adult cadavers (ten sides) with no known pathology. Facial transfacial approaches with and without a mandibulotomy and transtemporal approaches were evaluated. Objective measures were (1) the distance from the surgical plane to designated anatomic landmarks and (2) the surgical angle of exposure. Results: Distances from the surgical plane to the anatomic reference points were comparable for most of the access procedures (3 to 6 cm). The extended midfacial translocation and bilateral facial translocation approaches did, however, provide a shorter operative distance (1 to 3 cm) for access to the infratemporal fossa and contralateral structures, respectively. The transtemporal approaches facilitate a better angle of exposure (74 to 84 degrees) to the petrotemporal region, while the transfacial approaches were superior for access to the infratemporal structures. Conclusions: Based on the results, we propose a clinical algorithm for selecting a surgical approach based on the position and extent of an infratemporal or petrotemporal lesion
— id: 96303, year: 2008, vol: 18, page: 17, stat: Journal Article,

The conversion of BTEX compounds by single and defined mixed cultures to medium-chain-length polyhydroxyalkanoate
Nikodinovic, Jasmina; Kenny, Shane T; Babu, Ramesh P; Woods, Trevor; Blau, Werner J; O'Connor, Kevin E
2008 Sep;80(4):665-673, Applied microbiology & biotechnology
Here, we report the use of petrochemical aromatic hydrocarbons as a feedstock for the biotechnological conversion into valuable biodegradable plastic polymers--polyhydroxyalkanoates (PHAs). We assessed the ability of the known Pseudomonas putida species that are able to utilize benzene, toluene, ethylbenzene, p-xylene (BTEX) compounds as a sole carbon and energy source for their ability to produce PHA from the single substrates. P. putida F1 is able to accumulate medium-chain-length (mcl) PHA when supplied with toluene, benzene, or ethylbenzene. P. putida mt-2 accumulates mcl-PHA when supplied with toluene or p-xylene. The highest level of PHA accumulated by cultures in shake flask was 26% cell dry weight for P. putida mt-2 supplied with p-xylene. A synthetic mixture of benzene, toluene, ethylbenzene, p-xylene, and styrene (BTEXS) which mimics the aromatic fraction of mixed plastic pyrolysis oil was supplied to a defined mixed culture of P. putida F1, mt-2, and CA-3 in the shake flasks and fermentation experiments. PHA was accumulated to 24% and to 36% of the cell dry weight of the shake flask and fermentation grown cultures respectively. In addition a three-fold higher cell density was achieved with the mixed culture grown in the bioreactor compared to shake flask experiments. A run in the 5-l fermentor resulted in the utilization of 59.6 g (67.5 ml) of the BTEXS mixture and the production of 6 g of mcl-PHA. The monomer composition of PHA accumulated by the mixed culture was the same as that accumulated by single strains supplied with single substrates with 3-hydroxydecanoic acid occurring as the predominant monomer. The purified polymer was partially crystalline with an average molecular weight of 86.9 kDa. It has a thermal degradation temperature of 350 degrees C and a glass transition temperature of -48.5 degrees C
— id: 95065, year: 2008, vol: 80, page: 665, stat: Journal Article,

Plexiform neurofibroma of the cauda equina: case report
Joseffer, Seth S; Babu, Ramesh P; Kleinman, George
2005 Feb;63(2):182-184, Surgical neurology
BACKGROUND: Plexiform neurofibromas are rarely found in the cauda equina. The most recent report of a plexiform neurofibroma of the cauda equina noted only 2 previously described cases. CASE DESCRIPTION: To these we add the current case, as well as 2 additional previously published cases. We report the case of a 44-year-old man with a sudden exacerbation of his long-standing lower-back and bilateral leg pain. An intradural lesion was seen on magnetic resonance imaging and he underwent surgery. Intraoperatively, there were swollen nerve roots and tumor insinuating itself between the roots. A biopsy was performed, and pathology findings were consistent with plexiform neurofibroma. CONCLUSIONS: Plexiform neurofibroma of the cauda equina is a rare tumor, with variable manifestations. These tumors are not amenable to complete resection. Surgical treatment consists of either partial resection or biopsy, possibly with dural grafting for decompression
— id: 49010, year: 2005, vol: 63, page: 182, stat: Journal Article,

Evaluation of preoperative administration of the cyclooxygenase-2 inhibitor rofecoxib for the treatment of postoperative pain after lumbar disc surgery
Bekker, Alex; Cooper, Paul R; Frempong-Boadu, Anthony; Babu, Ramesh; Errico, Thomas; Lebovits, Allen
2002 May;50(5):1053-1057, Neurosurgery
OBJECTIVE: A combination of analgesics with different mechanisms of action may improve postoperative pain control and reduce the incidence of side effects. This study was designed to assess the efficacy of preoperative administration of rofecoxib (Vioxx; Merck & Co., Inc., Somerset, NJ) in reducing pain and opioid requirements after single-level lumbar microdiscectomy. METHODS: A randomized, double-blind, placebo-controlled clinical trial was performed on 61 consenting patients who were considered American Society of Anesthesiologists Class I or II and who were scheduled for elective single-level lumbar microdiscectomy. Patients received either two doses of rofecoxib 50 mg or a placebo preoperatively. The outcome measures included morphine use in the postanesthesia care unit (PACU), discharge times, and side effect profile. Data were analyzed by use of independent sample t tests for continuous variables or chi(2) tests for categorical variables. A P value of <0.05 was considered significant. RESULTS: The two groups were comparable with respect to patient characteristics, intraoperative opioid and hypnotic consumption, and duration of surgery. Patients in the rofecoxib group required significantly less morphine postoperatively. Significantly more patients in the placebo group reported pain scores greater than 7 at admission to the PACU. Time to first request for analgesia was shorter in the placebo group, but the difference did not reach statistical significance. There were no significant differences between groups in the incidence of nausea, time to discharge from the PACU, or hospital stay. CONCLUSION: Preoperative rofecoxib is effective in reducing postoperative narcotic consumption in patients undergoing lumbar laminectomy. The use of rofecoxib does not shorten PACU length of stay or hospital discharge time. These outcome measures depend on multiple administrative factors
— id: 48718, year: 2002, vol: 50, page: 1053, stat: Journal Article,

Thoracic paraganglioma presenting with spinal cord compression and metastases
Houten, John K; Babu, Ramesh P; Miller, Douglas C
2002 Aug;15(4):319-323, Journal of spinal disorders & techniques
We report a case of a 41-year-old man with a primary thoracic spine paraganglioma presenting with spinal cord compression and distant metastasis. Paragangliomas arising within the spinal canal are rare and when they occur are usually found in the intradural, extramedullary compartment and in the lumbosacral region. Thoracic paragangliomas are very rare, with only five prior cases reported in the literature and with distant metastasis seen in only one of these. In this case, the tumor was entirely extradural and produced extensive sclerosis of the surrounding vertebrae. The clinical, radiographic, and pathologic features of this case are detailed and the relevant literature is reviewed
— id: 95066, year: 2002, vol: 15, page: 319, stat: Journal Article,

Isolated inflammatory pseudotumor of the occipital condyle - Report of two cases
Pallini, R; Liverana, L; Maria, LL; Cesare, C; Eduardo, F; Babu, R
2002 Sep;97(2):248-251, Journal of neurosurgery
Although the craniocervical junction is involved in a variety of conditions including trauma, neoplastic lesions, and inflammatory processes, isolated inflammatory conditions involving the occipital condyle exclusively are not known. The authors report this unusual condition in two cases. Unless the patient is of poor medical risk, excision of the lesion is the treatment of choice to decompress the neural structures
— id: 32441, year: 2002, vol: 97, page: 248, stat: Journal Article,

Erdheim-Chester disease of the central nervous system. Report of two cases
Babu, R P; Lansen, T A; Chadburn, A; Kasoff, S S
1997 May;86(5):888-892, Journal of neurosurgery
The authors report two cases of Erdheim-Chester disease (ECD), an illness of unknown pathogenesis. Generally, this disease process involves the metaphyseal and diaphyseal portions of the long bones, the lungs, and the retroperitoneum; however, other tissues may be involved including the central nervous system (CNS). To date only two cases of CNS-related ECD have been reported. The present report adds to the literature by documenting two more recent cases of ECD involving the CNS. The clinical presentations of these cases, their radiological findings with special reference to magnetic resonance imaging, pathological determination, and clinical management are briefly reviewed
— id: 133232, year: 1997, vol: 86, page: 888, stat: Journal Article,

Pott's puffy tumor: the forgotten entity. Case report
Babu RP; Todor R; Kasoff SS
1996 Jan;84(1):110-112, Journal of neurosurgery
Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with underlying frontal osteomyelitis. The introduction of antibiotic medications has diminished the incidence of complications of frontal sinusitis. As a result, Pott's puffy tumor has become a rarity. In this communication a case of Pott's puffy tumor secondary to antecedent frontal sinusitis in an otherwise healthy adult man is described
— id: 56803, year: 1996, vol: 84, page: 110, stat: Journal Article,

Resection of olfactory groove meningiomas: technical note revisited
Babu R; Barton A; Kasoff SS
1995 Dec;44(6):567-572, Surgical neurology
BACKGROUND: Although large olfactory groove meningiomas present in the midline, tumor volume is often unequally distributed to one side. Most surgeons favor a bifrontal craniotomy with retraction or partial resection of the frontal lobes to resect these tumors. However, frontal lobe retraction is not without complications. METHODS: We present a technical note regarding the resection of these large olfactory groove meningiomas. We describe the advantages of a unilateral frontal craniotomy complemented with orbital osteotomy. RESULTS: The orbital osteotomy has considerably reduced the need for frontal lobe retraction and avoids partial resection of the frontal lobe to uncap the tumor. Utilizing this approach we have been able to remove the tumor from one side, followed by an incision to the falx cerebri in order to remove the tumor from the other side. With this approach, we have gained excellent visualization of the tumor in its entirety. Moreover, this approach permits the surgeon to intercept the arteries emerging from the skull base during the initial stages of the procedure. CONCLUSIONS: Unilateral frontal craniotomy and orbital osteotomy has obviated the need to retract or resect the frontal lobe when resecting large olfactory groove meningiomas, which extend to either side of the falx. Because surgery is performed from one side, olfaction may also be preserved on the contralateral side
— id: 56802, year: 1995, vol: 44, page: 567, stat: Journal Article,

Cavernous angiomas of the internal auditory canal. A case report and review of literature
Babu R; Ransohoff J; Cohen N; Zagzag D
1994 ;129(1-2):100-104, Acta neurochirurgica
Cavernous angiomas of the internal auditory canal (IAC) are rare. They are angiographically occult; and because the clinical symptoms are similar both in intracanalicular cavernous angiomas and acoustic tumors it had been difficult to differentiate pre-operatively both of these pathologies until the advent of magnetic resonance imaging (MRI). Even nowadays the correct diagnosis may be missed if the patient is imaged only with gadolinium enhanced MRI without prior obtaining a non-contrast MRI. These diagnostic difficulties are illustrated by the report of a related case. The importance of thorough neuroradiological investigations stressed and MRI features, surgical management and relevant literature concerning the cavernous angiomas of the internal auditory canal are discussed
— id: 9355, year: 1994, vol: 129, page: 100, stat: Journal Article,

Late radiation necrosis of the brain: case report
Babu R; Huang PP; Epstein F; Budzilovich GN
1993 Jul;17(1):37-42, Journal of neuro-oncology
We report a case of radiation necrosis occurring 47 years after resection and radiotherapy for a juvenile pilocystic cerebellar astrocytoma, the longest yet reported. The patient presented with progressive lower cranial nerve dysfunction, and eventually died from cardiopulmonary arrest secondary to aspiration. The presentation, diagnosis, pathological features, and management of radiation necrosis are discussed
— id: 6312, year: 1993, vol: 17, page: 37, stat: Journal Article,

Post-traumatic syringomyelia: a general review
Jafar JJ; Babu R; Siegel B; Machi J
Thoracolumbar spine fractures New York : Raven Press, 1993,
— id: 3016, year: 1993, vol: , page: 421, stat: Chapter,

Schwannoma of the fourth ventricle presenting with hemifacial spasm. A report of two cases
Weiner HL; Zagzag D; Babu R; Weinreb HJ; Ransohoff J
1993 Jan;15(1):37-43, Journal of neuro-oncology
Two cases of cystic brainstem schwannomas protruding into the fourth ventricle are described. Both patients presented with hemifacial spasm. While there is only one previous case report of an intraventricular brainstem schwannoma, there has been no prior description in the literature of hemifacial spasm associated with such a tumor. The clinical, radiographic, surgical, and histopathological features of these tumors are elaborated. The relationship of hemifacial spasm to the various putative theories of origin proposed for intraparenchymal schwannomas is discussed
— id: 9357, year: 1993, vol: 15, page: 37, stat: Journal Article,

Intramedullary abscess associated with a spinal cord ependymoma: case report
Babu R; Jafar JJ; Huang PP; Budzilovich GN; Ransohoff J
1992 Jan;30(1):121-124, Neurosurgery
Intramedullary spinal cord abscesses are relatively uncommon. We report the first case of an intramedullary spinal cord abscess in a preexisting spinal cord ependymoma. The clinical features and pathogenesis are discussed. Salient features of the management of intramedullary spinal cord abscesses are outlined
— id: 13715, year: 1992, vol: 30, page: 121, stat: Journal Article,

ARACHNOID CYST OF THE CEREBELLOPONTINE ANGLE MANIFESTING AS CONTRALATERAL TRIGEMINAL NEURALGIA - CASE-REPORT
Babu, R; Murali, R
1991 Jun;28(6):886-887, Neurosurgery
A case of an arachnoid cyst in the cerebellopontine angle manifesting as contralateral trigeminal neuralgia is presented. Decompression and excision of the lesion resulted in total relief of symptoms. The possible causes of contralateral trigeminal neuralgia are briefly reviewed, and the surgical treatment of this entity is discussed
— id: 32213, year: 1991, vol: 28, page: 886, stat: Journal Article,