Adrenal morphology and cortical function in patients with extrapulmonary tuberculosis: response to antituberculosis treatment

ABSTRACT Objective: Enlargement of the adrenal glands and variable adrenocortical function have been reported in patients with pulmonary tuberculosis and, in a few studies, in patients with extrapulmonary tuberculosis (EPTB). However, none of the studies have evaluated the course of the adrenal morphology in these patients. Subjects and methods: Prospective study including 37 patients with EPTB and 37 healthy age- and sex-matched controls. The adrenal function was evaluated by measurement of cortisol levels at baseline and after stimulation with ACTH (Acton Prolongatum) before and 6 months after antituberculosis treatment. The size of both adrenal glands was evaluated using 64-slice computed tomography (CT) scanning before and 6 months after treatment. The findings were compared with those in a group of healthy matched controls. Results: Clinical and biochemical parameters were comparable between groups. The mean baseline serum cortisol level was significantly lower in the EPTB group (397.1 ± 184.9 nmol/L) compared with the control group (696.3 ± 101.8 nmol/L). Compared with controls, patients with EPTB had significantly lower mean cortisol levels at baseline and 1 hour after ACTH, both before (397 ± 184.9 nmol/L and 750.7 ± 176.8 nmol/L, respectively) and after (529.7 ± 100.4 nmol/L and 1017.2 ± 119.7 nmol/L, respectively) antituberculosis treatment. Both the length and thickness of the right and left adrenal glands were greater in patients with EPTB than in controls but became comparable to those in controls after treatment completion. Conclusions: Patients with EPTB have an enlarged adrenal size and low baseline and stimulated serum cortisol levels. After treatment completion, cortisol levels increased significantly, and the adrenal size normalized in these patients.

Comparison between peak systolic velocity of the inferior thyroid artery and technetium-99m pertechnetate thyroid uptake in differentiating Graves' disease from thyroiditis

ABSTRACT Objectives The differentiation between the various etiologies of thyrotoxicosis, including those with hyperthyroidism (especially Graves' disease [GD], the most common cause of hyperthyroidism) and without hyperthyroidism (like thyroiditis), is an important step in planning specific therapy. Technetium-99m (99mTc) pertechnetate thyroid scanning is the gold standard in differentiating GD from thyroiditis. However, this technique has limited availability, is contraindicated in pregnancy and lactation, and is not helpful in cases with history of recent exposure to excess iodine. The aim of this study was to identify the diagnostic value of the peak systolic velocity of the inferior thyroid artery (PSV-ITA) assessed by color-flow Doppler ultrasound (CFDU) and compare the sensitivity and specificity of this method versus 99mTc pertechnetate thyroid uptake. Subjects and methods We prospectively analyzed 65 patients (46 with GD and 19 with thyroiditis). All patients were evaluated with clinical history and physical examination and underwent 99mTc pertechnetate scanning and measurement of TRAb levels and PSV-ITA values by CFDU. The diagnosis was based on findings from signs and symptoms, physical examination, and 99mTc pertechnetate uptake. Results Patients with GD had significantly higher mean PSV-ITA values than those with thyroiditis. At a mean PSV-ITA cutoff value of 30 cm/sec, PSV-ITA discriminated GD from thyroiditis with a sensitivity of 91% and specificity of 89%. Conclusion Measurement of PSV-ITA by CFDU is a good diagnostic approach to discriminate between GD and thyroiditis, with sensitivity and specificity values comparable to those of 99mTc pertechnetate thyroid uptake.

High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults

Background: Ultrasonography (USG) is a cheap, easily available and painless modality for the diagnosis of carpal tunnel syndrome. However, the main sonographic criteria of cross sectional area (CSA) and flattening ratio (FR) of median nerve show a wide normal variation which warrants establishment of normal range of variability in the dimensions of median nerve in different populations. Objective: The main aim of this study was to calculate the mean cross sectional area (CSA) and flattening ratio (FR) of median nerve at wrist in asymptomatic adults. Materials and methods: This prospective observational study included asymptomatic adults visiting our tertiary care hospital for unrelated heath conditions with no symptoms to suggest carpal tunnel syndrome. Ultrasound examination of both wrists was carried out by high frequency linear array transducer with frequency of 10MHz with the arm in supine neutral position on LOGIQ P5 (GE Healthcare, Chicago, Illinois, USA) ultrasound machine. The cross-sectional area (CSA) and flattening ratio (FR) of the median nerve was measured at the level of carpal tunnel inlet and mean values with standard deviation were calculated. Results: Three hundred seventy six (376) wrists of 188 subjects were examined. 36 wrists were excluded owing to presence of anatomic variations of the median nerve in them. 340 wrists of 170 patients were included in the study. Mean cross sectional area of median nerve was 9.2 mm2 (±1.2). Arshed Hussain Parry, Abdul Haseeb Wani, Naseer Ahmad Choh, Tariq Ahmad Gojwari. High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults. IAIM, 2019; 6(4): 144-149. Page 145 Mean value of flattening ratio was 2.4 (±0.6). Mean CSA (9.26 ±1.2 mm2 ) and FR (2.41 ±0.6) of males was not significantly different from mean CSA (9.16 ±1.2 mm2 ) and FR (2.4±0.55) of females. However, mean CSA of right wrist (9.4 ±1.2 mm2 ) was significantly different from mean CSA of left wrist (9.10 ±1.1 mm2 ). Conclusion: We found a higher mean cross sectional area (CSA) of 9.2 mm2 of median nerve in our population. There was a significant difference in the cross sectional area of median nerve between right and left wrists. However, we did not find statistically significant difference in the CSA and FR between the males and females. Establishment of normative data for the dimensions of median nerve is essential for different populations given the wide range of variations in the dimensions of median nerve

Isolated psoas schwannoma: A rare retroperitoneal tumor

Retroperitoneal neurogenic tumors are very rare. Isolated or primary psoas schwannoma is one of the rarest tumors of retroperitoneum. The images of such a case are presented in this report.

Clinical, sonological and radiographic predictors of abdominal injuries after blunt abdominal trauma

There are several situations that complicate the diagnosis of abdominal injuries. Physical examination may be unreliable due to the presence of multiple trauma or changes in the levels of consciousness. This prospective observational study was done consecutive adult blunt abdominal trauma patients. Parameters from pre hospital information, physical examination, laboratory investigations, FAST, and CR were recorded for all patients. Predictors for the presence of ≥1 injuries on abdominal CT were determined. 175 patients were included, with mean ages of 32.94± 14.21 years. 145 had injuries on abdominal CT. Patients with abdominal injuries had significantly lower mean systolic BP on admission (98.79±12.8 v/s 114±7.38), lower mean GCS (11.70±2.02 vs 13.10±1.74), significantly lower levels of hematocrit (29.18±8.31 v/s 34.33±6.46 %); significant difference in presence of abdominal bruises [pvalue ≤ 0.0001,or 6.669 CI (2.42-18.47)]; abdominal tenderness [p value ≤ 0.0001, or 63.708 CI (20.171-201.218)] and guarding /rigidity[ p value ≤ 0.0001, or 5.662 CI (2.054- 15.608) ], significantly higher frequency of abnormal chest CR [p value 0.019, or: 7.886 CI (1.033- 60.202)] ; significantly higher frequency of abnormal pelvic CR [p value : 0.011; or : 8.545 ( CI: Peerzada Ziaulhaq, Mohammad Imran Wagay, Sheikh Riaz Rasool, Rouf A Wani, Naseer A Choh, Saba Banday. Clinical, sonological and radiographic predictors of abdominal injuries after blunt abdominal trauma. IAIM, 2018; 5(4): 144-152. Page 145 1.121-65.115)]; significantly higher frequency of FAST score of > 3 [ p value : ≤ 0.0001 , or 0.034 (0.005-0.256)] as compared to the group of patients with no organ injuries on CT. we observed that the predictors for injuries on CT are: Hemodynamic instability, Altered level of consciousness (GCS≤13), Decreased haematocrit levels, Abnormal physical examination of the abdomen (particularly abdominal tenderness), Fracture of the ribs ,Fracture of the pelvis and FAST score of >3.

MRI findings in Joubert syndrome.

Joubert syndrome is a very rare autosomal recessive disorder with only 200 cases reported worldwide.Here we report 4 cases of this rare disorder with MRI findings.

Right internal carotid artery agenesis.

Congenital absence of one or both carotid arteries is a rare anomaly. It is usually discovered incidentally by computed tomography, or magnetic resonance imaging of head and neck taken for some other reason. Most of the patients are asymptomatic, although there is a close association of intracranial aneurysms and subarachinoid hemorrhage in many patients. Here we report a case of right internal carotid agenesis in a young female associated with recent onset amnestic syndrome.

Wandering spleen presenting as recurrent abdominal pain in a young female.

A young female child presented to our OPD for evaluation of recurrent abdominal pain. During the process of investigation USG abdomen and subsequently CECT abdomen revealed pelvic location of spleen. Splenopexy was performed and patient discharged. Patient is asymptomatic and on regular follow up.