Primary lumbar hernia: a rarely encountered ventral hernia

Ventral hernia is a fascial defect located on the abdominal wall. Primary ventral hernias are named as umbilical, epigastric, spigelian and lumbar hernias. A lumbar hernia is a parietal wall defect that may occur anywhere in the lumbar region between the 12th rib and the iliac crest. A 47-year-old female, came with complaints of mass in left lower abdomen since 2 months. On clinical examination a defect of 8 × 8 cm was felt in the left lumbar region with positive cough impulse. CECT abdomen and pelvis was done to confirm lumbar hernia. Patient underwent mesh repair for the same. Lumbar and flank hernias are uncommon and are a challenge to treat for any general surgeon. Surgery is considered gold standard either an open mesh repair or laparoscopically.

Starry sky appearance of tuberculoma

CNS tuberculosis accounts for only 10% of all cases of tuberculosis, carries a high mortality and morbidity. Tuberculoma of the brain is an important clinical entity. The main challenge in the management of brain tuberculoma is its diagnosis. Hereby, referring case of a 12 years old male child who presented with clinical picture of tuberculosis but radiologically NCC, hence posing a diagnostic dilemma as clinically it was in the favor of tuberculosis whereas radiologically inclination was towards neurocysticercosis. Based on clinical manifestations it was suggestive of meningitis, CSF picture was suggestive of hypoglycorrhachia. CT chest showed miliary pattern and neuroimaging showing multiple ring enhancing lesions. High index of clinical suspicion is required to make a diagnosis and evaluation with reports.

Huge keratocystic odontogenic tumour in medically compromised patient–a management dilemma

Keratocystic odontogenic tumour (KCOT) is a cystic lesion of the jaws with tumourbehaviour. Its high prevalence rate makes it one of the commonest cystic lesions especially involving the lower jaw. The characteristic histologic features and aggressive nature corresponds to the high recurrence rate associated with KCOT. Lesion expands mostly in an anteroposterior direction and can cause extensive bone destruction before the appearance of any clinical symptoms. The characteristic radiological picture is that of a multilocular cystic lesion with the common differential diagnosis being dentigerous cyst and ameloblastoma. Here we are presenting a case of KCOT of the left lower jaw of size 10.9×7.86×8.54 cm. It is a huge multilocular cystic lesion extending from the right canine region to the left side involving the body, ramus, coronoid and condyle. Various management options are there ranging from enucleation and chemical cauterization to resection and reconstruction depending upon the size of the lesion. In this case we were not able to perform the ideal treatment option for the case because of the multiple drug allergy the patient was having, including most of the general anesthetic agents. Also the patient was not willing for any extensive procedure under general anesthesia. So we had to follow a compromised treatment plan aiming to reducethe size of the lesion, to improve the aesthetics and frequent follow up

A study on MRI of internal derangements of knee

Background: The various imaging modalities used to evaluate pathological conditions of the knee include conventional fluoroscopy, arthrography, radiography, sonography, computed tomography, nuclear medicine, and magnetic resonance imaging. However, magnetic resonance imaging (MRI) has been recognized as an efficient, non-invasive test for identifying meniscal tears and other knee diseases. The Aim of the study: To evaluate the internal derangements of ligaments of the knee in an acute traumatic knee setting and to identify their patterns in MRI. Materials and methods: A cross-sectional study of fifty cases where MRI was used as the diagnostic modality evaluating the internal derangement of the knee. The study period was May 2017 to November 2018. The study included patients with traumatic knee injuries. The studies were carried out with a 1.5 Tesla Philips MRI machine. Results: Majority of the participants having IDK had anterior cruciate ligament tear followed by medial menisci tear and lateral menisci tear while posterior cruciate ligament tear and lateral collateral ligament tear are not so much common. Conclusion: MRI is a beneficial and non-invasive modality which possesses higher diagnostic accuracy and better sensitivity. It might be advantageous in the clinical conditions where the arthroscopy may not useful for the inferior surface and peripheral meniscus tears. The results of this present study support that MRI can be very helpful in diagnosing the cruciate and meniscal ligament injuries. It can accurately detect, localize and distinguish various internal derangements of the knee joint with excellent soft tissue delineation and help in arriving at an accurate anatomical diagnosis thereby helping further management of the patients.

Effect of Patient Characteristics on Vessel Enhancement at Lower Extremity CT Angiography

OBJECTIVE: To evaluate the effect of patient characteristics on popliteal aortic contrast enhancement at lower extremity CT angiography (LE-CTA) scanning. MATERIALS AND METHODS: Prior informed consent to participate was obtained from all 158 patients. All were examined using a routine protocol; the scanning parameters were tube voltage 100 kVp, tube current 100 mA to 770 mA (noise index 12), 0.5-second rotation, 1.25-mm detector row width, 0.516 beam pitch, and 41.2-mm table movement, and the contrast material was 85.0 mL. Cardiac output (CO) was measured with a portable electrical velocimeter within 5 minutes of starting the CT scan. To evaluate the effects of age, sex, body size, CO, and scan delay on the CT number of popliteal artery, the researchers used multivariate regression analysis. RESULTS: A significant positive correlation was seen between the CT number of the popliteal artery and the patient age (r = 0.39, p < 0.01). A significant inverse correlation was observed between the CT number of the popliteal artery and the height (r = −0.48), total body weight (r = −0.52), body mass index (r = −0.33), body surface area (BSA) (r = −0.56), lean body weight (r = −0.56), and CO (r = −0.35) (p < 0.001 for all). There was no significant correlation between the enhancement and the scan delay (r = 0.06, p = 0.47). The BSA, CO, and age had significant effects on the CT number (standardized regression: BSA −0.42, CO −0.22, age 0.15; p < 0.05, respectively). CONCLUSION: The BSA, CO, and age are significantly correlated with the CT number of the popliteal artery on LE-CTA.

Renal cell carcinoma – A spectrum of radiological findings

Background: Renal cell carcinomas (RCC) are primary malignant adenocarcinomas derived from the renal tubular epithelium and are the most common malignant renal tumor. They usually occur in 50- 70-year-old patients. Aim: Radiological evaluation of patients of renal cell carcinoma by modalities like USG, CT-Scan and MRI. Materials and methods: All the patients were cases of renal cell carcinoma that had come to Department of Radiology in Dhiraj Hospital. They were evaluated by different modalities like USG, CT-Scan and MRI after taking consent when and where needed. Results: Renal cell carcinoma followed age and sex trends which means 72% patients were males and 28% patients were females and most of the patients were above 50 years of age. Conclusion: CECT is the modality of choice for evaluation of renal cell carcinoma patients as it gives the information not only about the localization but also the distant spread of tumor. MRI can be used as an alternative and also to know about the renal vein and IVC invasion by the tumor. USG as is a cheap and easily available method can be used to screen the patients with a palpable flank mass and those with hematuria.

Adenocarcinoma of gastro-esophageal junction - Case report.

Adenocarcinoma of the gastro-esophageal junction (GEJ) remains a significant clinical problem that is increasing in incidence and is associated with a poor prognosis. The majority of patients present with advanced disease and less than 50% undergo curative treatment. To diagnose GE junction mass with conventional procedure like Barium swallow where endoscopy cannot be performed, CECT is done to access the potential spread of disease.

Jejunal intussusception in an adult due to small intestine lipomatosis: a case report and review of literature.

Intussusception is rare in adults. Benign neoplasm are common causes for intussusception in adults, lipoma is the commonest. Lipomas are usually solitary but 5% are multiple. Lipomatosis of small bowel is rare condition and presenting, as intestinal obstruction is even rarer. A 55 year old male patient presented with pain abdomen, distention and constipation. CECT revealed intussusception due to multiple lipomas of jejunum causing jejunojejunal intussusception. On exploratory laparotomy bowel was gangrenous and hence a resection and anastomosis was done. On 12 months fallow up patient was normal. First described by Helmstrom in 1906. Fat deposition in intestine are classified as isolated lipoma, multiple lipomas, nodular lipomatosis and diffuse fatty infiltration of wall without projecting into lumen. Usually present as malena or intussusception, volvulus. Radiologically identified by “pseudo kidney sign” and “target sign”. Reduction should not be attempted in the signs of ischemia or malignancy. Lipomatosis should kept in mind as one of the cause for intussusception in adults and CECT is the best modality to ascertain the nature of lesion in most of the cases.

Clinico-Radiological Manifestations of Invasive and Non-Invasive Fungal Infections in Sinuses and Respiratory Tract.

Introduction : Fungal sinusitis was once considered a rare disorder but is now reported with increasing frequency throughout the world. Fungal chest infection is relatively considered common. The classification of fungal sinusitis has evolved in the past two decades, and this entity is now thought to comprise five subtypes. Acute invasive fungal sinusitis, chronic invasive fungal sinusitis and chronic granulomatous invasive fungal sinusitis made the invasive group, whereas non-invasive fungal infection is composed of allergic fungal sinusitis and fungus ball (fungal mycetoma). Objective : The five subtypes of sinusitis described above are distinct entities with different clinical and radiologic features. The treatment strategies for the subtypes are also different, as are their prognosis. We aim to clearly delineate the radiologic features of culturally proven fungal cases so as to direct the clinician towards expeditious diagnosis and necessary treatment. Methodology : 40 culturally positive patients with the spectrums of different manifestations were studied and recorded. They were followed up for one month. Conclusion : An understanding of the different types of fungal sinusitis and knowledge of their particular radiologic features allowed the radiologist to play a crucial role in alerting the clinician to use appropriate diagnostic techniques for confirmation. Prompt diagnosis and initiation of appropriate therapy avoided a protracted or fatal outcome.

Bio-preservation of ground beef meat by Enterococcus faecalis CECT7121

Meat and particularly ground beef is frequently associated with Food Poisoning episodes and breeches in Food Safety. The main goal of this research was to evaluate the bactericide effect of the probiotic Enterococcus faecalis CECT7121, against different pathogens as: Escherichia coli O157:H7, Staphylococcus aureus, Clostridium perfringens and Listeria monocytogenes, inoculated in ground beef meat. Three studies were performed to evaluate the inhibition of E. faecalis CECT7121 on ground beef meat samples inoculated with pathogens: Study I: Samples (100 g meat) were inoculated with pathogens (10³ CFU/g)) and E. faecalis CECT7121 (10(4) CFU/g) simultaneously. Study II: Samples were inoculated with E. faecalis CECT7121 24 h before the pathogens. Study III: E. faecalis CECT7121were inoculated 24 h after pathogens. The viable counts were performed at 0, 24, 48 and 72 h post-inoculation. The simultaneous inoculation of E. faecalis CECT7121 with E. coli O157:H7 strains resulted in the absence of viable counts of bacteria at 72 h post-treatment. However, when the probiotic was added 24 h before and 24 h after the pathogen E. coli O157:H7, viable cells were not detected at 24 h and 48 h post-treatment, respectively. Consistently, neither S. aureus nor Cl. perfringens viable bacteria were detected at 48 h in whole assays when inoculated with E. faecalis CECT7121. The same trend than described before was obtained after applying the 3 models assayed for L. monocytogenes. The current assays demonstrated the bactericide activity of E. faecalis CECT7121 strain on bacterial pathogens in ground beef meat.

Pulmonary Spergilloma : An Interesting Case.

In many cases, the diagnosis of pulmonary aspergilloma become difficult on the basis of radiological sign by chest X-ray or computed tomography (CT) scan as it can produce wide variety of radiographic changes. Often there is a diagnostic dilemma between lung malignancy and pulmonary aspergilloma. The diagnosis also can be established by sputum examination and culture. In our case, we report a 40-year old male presented with cough and hemoptysis. He was subsequently diagnosed as a case of pulmonary aspergilloma on the basis of evidence of radiological findings mainly.

In vitro and in vivo effects of Enterococcus faecalis CECT7121 on Toxocara canis

The aim of the present paper was to evaluate the larvicidal effect of Enterococcus faecalis CECT7121 (Ef7121) on the Toxocara canis cycle both in vitro and in vivo. For the in vitro experiments, T. canis larvae were incubated with the supernatants of Ef7121 (EI) and mutant Ef7121 (EIm), in a pre-culture of Ef7121 (EII) and in a fresh culture with Ef7121 (EIII) and the Ef7121 mutant strain (EIIIm). The viability of the larvae was calculated after a 48 h incubation. A significant reduction of the viability of T. canis larvae was observed in EI, EII and EIII. A decrease of this inhibitory effect was observed in EIm and EIIIm (p = 0.008). In the in vivo experiments, mice were orally inoculated with three doses of Ef7121. To study the probiotic persistence in the intestine, the animals were sacrificed every four days and their intestines were dissected. The initial average bacterial levels were 9.7 x 10(4) for Ef7121 (colony forming units/g). At the end of the assay the levels were 1.46 x 10(4). No bacterial translocation was detected in mesenteric lymphatic nodules and spleen. Ef7121 interference with the biological cycle was evaluated in mice challenged with T. canis. The interference was significant when the mice were challenged with probiotic and T. canis simultaneously (p = 0.001), but it was not significant when the challenge was performed 15 days after administration of the bacterial inoculum (p = 0.06). In conclusion, Ef7121 possessed in vitro and in vivo larvicidal activity.

Papillary Cystic and Solid Tumour of Pancreas.

A 15-year old female presented with a progressively increasingly right hypochondrial mass since 3 months. CECT abdomen showed a large well-defined, heterogeneous lesion with specks of calcification and areas of cystic degeneration in the region of head of pancreas. Successful enucleation of the tumour from the head of pancreas was achieved. Histopathology confirmed solid cystic papillary epithelial cystadenoma of pancreas.Papillary cystic and solid tumours of pancreas are a rare, low-grade malignant tumour, typically found in young women. The etiology and cell of origin of this tumour are still not clear. It is important to differentiate this tumour from other pancreatic tumours, as this tumour is amenable to cure after complete surgical resection.