Evaluation of hepatocellular carcinoma by contrast enhanced ultrasound : a novel technique.

Characterization of focal liver lesions remains a diagnostic challenge for the radiologists, more so when there is associated underlying chronic liver disease (CLD). Imaging plays a vital role and there has been a constant endeavor to improve the diagnostic accuracy of liver lesions. The introduction of mutiphasic CT and MRI has revolutionized the diagnostic ability of liver lesions. With the advent of ultrasound contrast agents (UCAs), it is possible to evaluate liver lesions using the non-invasive imaging technique of “contrast-enhanced ultrasonography” (CEUS).1-3 CEUS can overcome the limitations of grey scale and color doppler sonography4,5 and has been used for characterisation of focal liver lesions.2. It can depict arterialisation of hypervascular hepatocellular carcinoma (HCC)6,7 and can also help in assessment of the post-therapeutic response.8,9 We present two such cases of HCC evaluated by a recently available second generation ultrasound contrast agent, SonoVue (Bracco, UK).

Thoraco-abdominal mature teratoma in a left diaphragmatic hernia.

This case describes a contiguous mediastinal and retroperitoneal mature teratoma in a congenital diaphragmatic defect, a combination that is hitherto unreported in literature. It substantiates embryological chronology of events during the cephalad migration of the primordial germ cells through the developing diaphragm, prior to its closure.

Pyle metaphyseal dysplasia.

Pyle type metaphyseal dysplasia is a rare autosomal recessive disease that primarily affects metaphyses. We report a 12 year old boy with Pyles disease. He had mild facial dysmorphism, genu valgum and wasting of legs. Skeletal radiology revealed the characteristic Erlenmeyer flask sign at distal femoral and proximal tibial metaphyses along with platyspondyly.

Imaging features in Hirayama disease.

Purpose: To evaluate the MR findings in clinically suspected cases of Hirayama disease. Materials and Methods: The pre and post contrast neutral and flexion position cervical MR images of eight patients of clinically suspected Hirayama disease were evaluated for the following findings: localized lower cervical cord atrophy, asymmetric cord flattening, abnormal cervical curvature, loss of attachment between the posterior dural sac and subjacent lamina, anterior shifting of the posterior wall of the cervical dural canal and enhancing epidural component with flow voids. The distribution of the above features in our patient population was noted and correlated with their clinical presentation and electromyography findings. Observations: Although lower cervical cord atrophy was noted in all eight cases of suspected Hirayama disease, the rest of the findings were variably distributed with asymmetric cord flattening, abnormal cervical curvature, anterior shifting of the posterior wall of the cervical dural canal and enhancing epidural component seen in six out of eight (75%) cases. An additional finding of thoracic extension of the enhancing epidural component was also noted in five out of eight cases. Conclusion: Dynamic post contrast MRI evaluation of cervicothoracic spine is an accurate method for the diagnosis of Hirayama disease.

Percutaneous laser disc decompression: clinical experience at SCTIMST and long term follow up.

BACKGROUND: Low backache (LBA) is now increasing in younger population due to misdirected spinal kinetics secondary to improper posture, heavy load lifting and motorbike driving. Hence minimally invasive procedures are increasingly sought after. Among these, PLDD is currently popular and in use. We present our long term follow-up in the use of Nd:YAG laser for PLDD. AIM: To evaluate the efficacy of PLDD in treatment of contained herniation of lumbar discs & long term follow up results. MATERIALS AND METHODS: Forty patients with contained lumbar disc herniation on MRI and who did not respond to 6 weeks conservative treatment were subjected to PLDD. L4-5 disc was treated in 31, L5-S1 in 12 and L1-2 and L3-4 in one each. Nd:YAG laser at 1064 nm was used for the procedure. Total laser energy of 1500-2000 Joules was delivered at the disc space depending upon the size. RESULTS: There was immediate pain relief in 32/40 (80%). According to MacNab criteria good to fair response was seen in 37/40 (92%) and 3 patients (7.5%) responded poorly to this treatment. On follow up which ranged from 1 to 7 years, 34/40 (85%) had pain relief with no need for further treatment. COMPLICATIONS: Significant pain at local puncture site was experienced by 8 (20%), pain during lasing was experienced by one. One patient developed muscular spasm. CONCLUSION: Percutaneous laser disc decompression is a safe, relatively noninvasive and effective treatment modality for contained, nonsequestered, herniated lumbar disc disease in carefully selected patients.

Development of pharmacophoric model of condensed pyridine and pyrimidine analogs as hydroxymethyl glutaryl coenzyme A reductase inhibitors.

Quantitative structure-activity relationship (QSAR) has been established on a series of thirty-eight compounds of four different sets of condensed pyridine and pyrimidine analogs, for their hydroxymethyl glutaryl coenzyme (HMG-CoA) reductase inhibitor activity, in order to understand the essential structural requirement for binding with receptor, in terms of common biophoric and secondary sites employing APEX-3D software. Among several 3D pharmacophoric models with different sizes and arrangements, one model was selected based on r2 = 0.8, chance<0.001, match equivalent to 0.38 and all the 38 compounds were considered. The results suggest that hydrophobicity, hydrogen acceptor and optimum steric refractivity play a dominant role in the inhibition of HMG-CoA reductase. The information obtained from the present study can be used to design and predict more potent molecules as HMG-CoA reductase inhibitors, prior to their synthesis.

Invasive colonic mucormycosis in early induction therapy of childhood acute lymphoblastic leukemia.

Fungal infections occur in patients who are severely immunocompromised with profound and prolonged neutropenia. We report a patient of acute lymphoblastic leukemia who developed nonspecific abdominal symptoms within two days after the onset of neutropenia in the early induction phase of chemotherapy, which was later found to be due to intestinal mucormycosis and resulted in a fatal outcome.

Neurofibromatosis type I: spinal neoplasia without symptoms.

Neurofibromatosis1 (NF-1) or von Recklinghausen disease is the most common of the neurocutaneous syndromes. It is characterized by presence of hamartomas in multiple organs. Inheritance is autosomal dominant but spontaneous mutations are seen in half the cases. The authors are reporting a classical case of this syndrome with spinal neoplasia which was interestingly asymptomatic. Authorities seem to agree that because the risk of developing intradural disease is significant in patients with NF-1, a routine MRI of the entire spine should be obtained.

Long-acting GnRH analogue triptorelin therapy in central isosexual precocious puberty.

OBJECTIVE: To evaluate the efficacy of long acting GnRH analogue in improving the auxological outcome of patients with central isosexual precocious puberty (CIPP) and to determine the factors influencing the response. METHODS: Thirty-five patients (30 girls, 5 boys) with CIPP were treated with a long acting GnRH analogue, triptorelin. Final height outcomes and factors affecting treatment were analyzed. RESULTS: Treatment was started at the chronological age (CA) of 6.5 1.8 years in girls and 4.4 1.5 years in boys and continued for a period of 3.7 1.8 years in girls and 6 1.8 years in boys. Follow-up period after discontinuation of treatment was 2.2 0.5 years in girls and 2.6 0.3 years in boys. Treatment led to regression of precocious puberty and reversal of secondary sexual characteristics. There was decline in growth rate reflected by a fall in heightSD of 0.8 0.8 in girls and 2.3 0.9 in boys (p = 0.014), an even greater retardation in bone age (BA) advancement with a decrease in BA-CA of 1.7 1 years in girls and 2.7 1 years in boys and a fall in heightSDBA of 1.5 1.1 in girls and 2.1 1.6 in boys. Final height (149.8 6.9 cm in girls and 161.9 3.9 cm in boys) exceeded projected height at the onset of treatment (143.4 8.3 cm in girls and 154.3 2.7 cm in boys) by 6.4 2.4 cm in girls and 7.6 1.5 cm in boys ( p < 0.001 in both the groups). Factors influencing height gain included age at start of therapy (r = 0.715), BA-CA at the time of initiation of treatment (r = 0.734), heightSDBA at the onset of treatment ( r = 0.566) and the duration of treatment (r = 0.711). Girls treated at an age of less than 6 years (n = 9) had a greater height gain (8.7 1.6 cm versus 5.3 1.9 cm, p < 0.001) and achieved similar final height (148.7 8 cm versus 150.2 6.6 cm) in those treated after this age (n = 21). No side effects of GnRH therapy were observed in the study. CONCLUSION: Long acting GnRH therapy is effective in improving the auxological outcome of patients with CIPP. Maximum benefit is observed in girls with greater bone age advancement treated at a younger age and for a longer duration of treatment. These girls had lower bone age advance at discontinuation of treatment.

Gonadal involvement in leprosy - study of gynaecomastia, testicular and epidedymal involvement and therapeutic efficacy of indegenous drugs

Sessenta pacientes masculinos de hanseniase (idade media = 27,2+ ou - 5,04 anos), selecionados aleatoriamente, foram estudados quanto ao envolvimento gonadal e a eficacia terapeutica de duas drogas nativas. Destes pacientes 34 eram casados, com dura‡ao media da doen‡a de 4,17 + ou - 3,27 anos. Somente os pacientes com hanseniase virchowiana e dimorfa desenvolveram altera‡oes testiculares e de epididimos. Dor e/ou sensibilidade testicular (virchowianos = 62,5 por cento dimorfos = 30,0 por cento) foi a sintomatologia mais comum. Fun‡ao sexual alterada foi observada em 34 (56,6 por cento) casos, enquanto 11 pacientes apresentaram padrao sexual de distribui‡ao pilosa alterado e ginecomastia. O espermograna revelou azoospermia em 19 (35 por cento) dos casos e oligospermia em 16 (26,6 por cento) pacientes. Os achados histopatologicos das biopsia testicular revelaram evidencia de lesoes especificas nao relacionadas ao tamanho do testiculo, aos achados do semen e as manifesta‡oes clinicas. As altera‡oes histopatologicas mostraram grande variabilidade, nao tendo sido possivel classifica-las em vasculares, intersticiais ou obstrutivas: acredita-se que as altera‡oes encontradas sejam devidas ao estado alterado das gonadas na hanseniase. A eficacia das prepara‡oes terapeuticas nativas Speman e Tentex forte (Himalava) foi avaliada de um ponto de vista objetivo em 34 pacientes. Melhora subjetiva foi observada em 82,3 por cento dos casos, enquanto objetivamente o espermograma melhorou em 87,5 por cento dos casos com oligospermia. As drogas nao apresentaram efeitos colaterais e foram bem toleradas.