ABSTRACT
Superior Mesenteric Artery Syndrome (SMAS) is a rare clinical entity presenting as acute or chronic upper gastrointestinal obstruction. It occurs due to compression of third part of duodenum between abdominal aorta and overlying superior mesenteric artery caused by a decrease in angle between the two vessels. Rapid loss of retroperitoneal fat, in conditions leading to severe weight loss is the main factor responsible for this disorder. Superior mesenteric artery syndrome in association with abdominal tuberculosis has not been reported earlier to the best of our knowledge. Therefore, an unknown cause (SMAS) of upper gastrointestinal obstruction in a patient of abdominal tuberculosis is being presented for the first time through this case report. An imaging diagnosis of SMAS was made on contrast enhanced CT abdomen which also confirmed the clinical suspicion of abdominal tuberculosis in the patient. The patient was managed conservatively and recovered without requiring any surgical intervention for the obstructive symptoms.
ABSTRACT
Background: Infertility is a common health problem requiring imaging to delineate the anatomical causes in women. Three dimensional multi-detector computed tomography hysterosalpingography [3D-MDCT-HSG] offers an easy workup for uterine, tubal and peritoneal factors
Methods: To present the spectrum of uterine, tubal and peritoneal factors on 3D-MDCT-HSG and determine its diagnostic accuracy for female factor infertility, a prospective study was conducted on 25 infertile women with non-diagnostic HSG from November 2012 to March 2014. Sixty four slice MDCT acquired the scan during pre-ovulatory phase by contrast instillation into uterine cavity. A blinded reviewer interpreted the 3D-MDCT-HSG and results were compared with final diagnosis made on hystero-laproscopy in 22 patients. Diagnostic accuracy of 3D-MDCT-HSG for various factors was expressed as sensitivity, specificity, positive and negative predictive value
Results: MDCT-HSG demonstrated definite findings in 96% of patients having non-diagnostic HSG. In this study, tubal, uterine and peritoneal abnormalities were present in 68.75%, 56% and 32% of cases, respectively. 48 tubes in 25 patients were evaluated of which 22 tubes were blocked constituting the commonest finding present in 15 [60%] patients. The sensitivity, specificity, positive predictive value and negative predictive value for uterine factors was 83.33%, 100%, 100% and 96.84%, respectively, for tubal factors 93.55%, 94.68%, 85.29% and 96.83%, respectively and for peritoneal factors 62.5%, 92%, 71.43% and 88.46%, respectively. Mean effective radiation dose was 1.76 +/- 0.18 mSv in MDCT-HSG
Conclusion: 3D-MDCT-HSG can detect various factors responsible for female infertility especially tubal and uterine; in cases where HSG fails to clearly delineate the pathology
ABSTRACT
<p><b>OBJECTIVE</b>To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior (AP) view and also assess if the addition of lateral view changes the classification and management plan.</p><p><b>METHODS</b>Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan. Then the same films were reshown in conjunction with their lateral view after 10 days. Results were compared with respect to the classification and management plan between two groups. Interobserver agreement was calculated using Fleiss' kappa.</p><p><b>RESULTS</b>There was only a fair interobserver agreement (kappa value 0.39) on Garden classification on AP view only which improved to moderate agreement (kappa value 0.52) after adding a lateral view. While there was only a slight improvement in the interobserver agreement on the management plan on AP view only (kappa value 0.50) and AP combined with lateral views (kappa value 0.52). Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases.</p><p><b>CONCLUSION</b>We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Femoral Neck Fractures , General Surgery , Observer VariationABSTRACT
A 24-year-old lady presented with left flank pain of 3 months duration. She had stigmata of tuberous sclerosis complex in the form of angiofibromas on face, ash-leaf macules on back and right upper limb and shagreen patches over back. Computed tomography scan of the abdomen showed 6.5 cm x 5.0 cm x 4.4 cm lobulated intensely enhancing exophytic mass lesion in mid pole of left kidney with significant para-aortic lymphadenopathy with no evidence of fat in the mass. She underwent radical left nephrectomy with a provisional diagnosis of renal cell carcinoma. Histopathological examination showed multicenteric angiomyolipoma involving kidney and para-aortic lymph nodes. This case report underscores the need for further research to differentiate fat-poor angiomyolipoma and lymphadenopathy from renal cell carcinoma
Subject(s)
Humans , Female , Lymphatic Diseases/diagnosis , Flank Pain , Tomography, X-Ray Computed , Kidney/pathology , Carcinoma, Renal Cell , Kidney Neoplasms , Nephrectomy , Magnetic Resonance ImagingABSTRACT
To compare efficacy and tolerability of phytotherapy [PT] vs. potassium citrate [KC] in patients with minimal nephrolithiasis. To compare and assess changes in value of certain serum [Ca[2]+, PO[4][3-], uric acid [UA]] and urinary [24-hr Ca [2+], PO[4][3-], UA, citrate, oxalate, and urine pH] parameters in patients being treated with PT or KC. After clearance by the local institutional ethics committee, 60 patients of nephrolithiasis who had consented for the study, were enrolled [as per entry criteria] and randomized into citrate therapy [group-I] or PT [group-II]. PT was administered as a nutritional supplement, using a lupeol-based extract [Tablet Calcury[TM], two tablets twice a day]. They were monitored for the changes in the serum and urinary biochemical, radiological, and clinical parameters [efficacy and tolerability] as per protocol. Group-I patients demonstrated favorable changes in certain biochemical parameters [decreased serum calcium, urinary UA/oxalate, increased urinary citrate and pH] along with significant symptomatic improvement [decrease in visual analogue pain score with increased stone clearance/reduction in stone size]. Four [13.3%] patients of group-I had mild upper gastrointestinal discomfort which was controlled with antacids. Group-II patients had favorable changes in biochemical parameters [decreased serum UA and increased urinary citrate] along with significant symptomatic improvement [reduction/clearance in the stone size], but without any noticeable side effects. Medical therapies with both KC and PT [with lupeol extract using Calcury[TM]] were effective in reducing the stone size and symptoms of nephrolithiasis. It appeared that KC was biochemically efficacious in producing some favorable biochemical changes with some side effects, whereas PT was probably clinically efficacious in hastening stone expulsion [<8 mm] without any observed adverse events. Although both the medical therapies were not effective in all aspects, we believe that PT using lupeol-based extract [Calcury[TM]] may be used as an alternative form of medical therapy in select patients with minimal nephrolithiasis. Long-term randomized placebo-controlled trials are needed to better define the precise role of lupeol-based PT vs. citrate therapy in minimal nephrolithiasis