Chilaiditi's sign possibly associated with malposition of chest tube placement.

Although diaphragmatic paralysis is a rare recognized complication of chest tube malposition, Chilaiditi's sign occurring as a result of this complication has never been reported in literature to the best of our knowledge. We describe one such case, which had an interesting clinical sequence of events and radiographic findings and suggest that the medial end of the chest tube should be positioned at least 2 cm from the mediastinum on the frontal chest radiograph to avoid these complications.

Update in liver imaging.

Over the last decade, liver imaging has experienced a revolution providing a bewildering array of options for detection and characterisation of liver lesions. Cross-sectional imaging modalities like computed tomography and magnetic resonance imaging have improved in speed and resolution, thereby facilitating multiphasic scanning of the liver. The advent of the use of contrast agents for ultrasonography and magnetic resonance imaging has further paved the way for definitive diagnosis in an attempt to obviate the need for invasive diagnosis. This article captures advances made in ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography and brings the specialist up to date with the latest in liver imaging.

High resolution CT (HRCT) in miliary tuberculosis (MTB) of the lung: Correlation with pulmonary function tests & gas exchange parameters in north Indian patients.

BACKGROUND & OBJECTIVE: High resolution computed tomography (HRCT) scans are known to be helpful in early diagnosis and management of patients with miliary tuberculosis (MTB). We made an attempt in this study to identify patterns of pulmonary MTB on HRCT and to correlate the HRCT disease extent with pulmonary function tests (PFT) and gas exchange analysis (GEA). METHODS: A total of 16 non-HIV patients with MTB underwent HRCT of the chest, PFT and GEA. All the investigations in these patients were completed within 20 days of presentation. Evidence of TB was diagnosed by biopsy from lymph nodes (3/16), organ biopsy [skin, liver, bone marrow and lung (transbronchial) (6/16)]. In one patient fundoscopy revealed choroid tubercles. In 6 patients, diagnosis was confirmed by clinical/radiological improvement following anti-tuberculosis therapy. Radiological patterns of involvement on HRCT of the lungs were studied and disease extent was estimated in each case by consensus between two radiologists using specially devised visual scoring system. Disease extent was correlated with PFT and GEA. Spearman rank correlation was used for statistical analysis. RESULTS: Findings on HRCT in MTB included miliary nodularity (16/16), alveolar lesions such as ground glass attenuation and/or consolidation (5/16), lymphadenopathy (8/16), peribronchovascular interstitial thickening (1/16), emphysema (1/16), pleural pathology (2/16), and pericardial effusion (2/16). A significant correlation was noted between disease extent score and forced vital capacity (FVC) (r = -0.76; P=0.003), forced expiratory volume in one second (FEV(1))(r = -0.74; P = 0.005), total lung capacity (TLC) (r = -0.66; P = 0.037), oxygen saturation in arterial blood (SaO(2)) (r = -0.69, P = 0.01), diffusion capacity of the lung (DLco) (r = -0.8; P = 0.02). INTERPRETATION & CONCLUSION: Our findings showed that HRCT reliably diagnosed MTB, and thus could help in predicting derangement of pulmonary function tests and GEA in these patients.

Clinical profile, diagnosis and management of patients presenting with symptomatic pulmonary embolism.

OBJECTIVE: To study the clinical profile and diagnostic methods in patients with symptomatic pulmonary embolism (PE). METHODS: Prospective assessment of clinical features, radiology and outcome of patients presenting with symptomatic PE over an 18-month period. RESULTS: During study period, 24 patients with a mean age of 39 +/- 12.1 years were diagnosed to have symptomatic pulmonary embolism. Dyspnoea (91.7%) and cough (58.3%) were the predominant complaints. Spiral computed tomographic pulmonary angiography (CTPA) was performed in 21 (87.5%) patients and perfusion scans in 14 (58.4%) patients. Echocardiography performed in all patients revealed evidence of pulmonary artery hypertension and right ventricular dyskinesia in 20 (83.3%) and 15 (62.5%) patients, respectively. Thrombolysis with streptokinase was performed in 14 (58.3%) patients. All patients received low molecular weight heparin followed by warfarin. Of the 24 patients, 20 (83.3%) were discharged and are under regular follow-up; four patients died. CONCLUSIONS: Pulmonary embolism is a common problem and can be easily diagnosed provided it is clinically suspected. Early diagnosis and aggressive management is the key to successful outcome.

Aortic aneurysm and dissection: evaluation with spiral CT angiography.

The study was undertaken for aortic evaluation and to see its usefulness for assessing aortic aneurysm, aortic dissection and pseudoaneurysm by spiral CT angiography (CTA). A total of 28 patients with aortic aneurysm (n=19), aortic dissection (n=5) and aortic pseudoaneurysm (n=4) were included. CTA findings were compared with ultrasonography in 14, digital subtraction angiography (DSA) in 14, MRI in 9; and surgical findings in 12 patients. CTA was an excellent imaging modality for comprehensive evaluation of aortic aneurysm, dissection and pseudoaneurysm combining the advantage of conventional contrast enhanced CT axial images and those of angiography in the form of 3D reformatted images.

Mucoepidermoid carcinoma of the bronchus: is conservative surgery always justified?

A case of mucoepidermoid carcinoma of the bronchus in a 7-year-old boy is reported. The patient underwent right pneumonectomy. Histologically, the tumor was a low-grade muco-epidermoid carcinoma arising from the bronchus with lymph node metastasis in the drainage area. Presence of lymph node metastasis in this low-grade tumor suggests the possibility of early progression of disease in what has until now been considered a very slow growing tumor. Aggressive surgery may be necessary in these situations.

Radiofrequency ablation: a new therapeutic modality for the management of hepatocellular cancer.

We report two patients of hepatocellular cancer who recently underwent radiofrequency ablation at our center. Both underwent successful ablation of the tumour requiring 1-2 sessions of upto 15 minutes. There were no post procedure complications. One of the patients had developed another lesion after 10 months of follow up and underwent another session of RFA, while the second patient is doing well after one year of the procedure.

Protein energey malnutrition and skeletal muscle wasting in childhood acute lymphoblastic lukemia.

OBJECTIVE: To determine the nutritional status and the extent of skeletal muscle wasting in children with acute lymphoblastic leukemia (ALL) at the time of diagnosis and after induction chemotherapy. DESIGN: Prospective observational study. SETTING: Tertiary care teaching hospital. METHODS: 25 new cases of ALL underwent somatometric measurements and ultrasonographic evaluation of skeletal muscle and subcutaneous fat at initial presentation and after completion of induction therapy. RESULTS: Malnutrition (weight for age < 80percnt) was evident in 13 cases (52percnt), but cumulative incidence of malnutrition (weight for age < 80percnt, weight for height < 90percnt, height for age < 95percnt, skin fold thickness < 5th centile, midarm muscle circumference < 5th centile) was 88percnt. Nine children lost weight during induction (range: 0.2 to 5.8 kg; means +/- SD: 1.9 plusmn 1.8 kg). All these cases had a complicated course during induction chemotherapy. Fourteen children (56percnt) had skeletal muscle wasting during induction chemotherapy. All those children who had lost weight also had skeletal muscle wasting. Subcutaneous fat, in contrast increased in 24 cases (96percnt). CONCLUSION: Malnutrition exists in a significant proportion of children with ALL. If induction chemotherapy is complicated, children lose significant weight and have significant muscle wasting. Increase in subcutaneous fat occurs in almost all children, which is probably a consequence of therapy with oral steroids

Comparison of sealing efficacy of materials placed in lateral root perforations--an in vitro study.

An endodontic perforation interferes with the principal goal of sealing the root canal system. An in vitro study was conducted on comparative efficacy of three materials-Dispersalloy, Cavit and Prisma VLC Dycal when placed in lateral root perforations in cervical third areas. Root canals were prepared and irrigated thoroughly. Perforations were made with No. 2 round bur and sealed with Dispersalloy, Cavit and Prisma VLC Dycal. Dispersalloy Group I showed best sealing ability. Prisma VLC Dycal Group I too was comparable to Dispersalloy Group I in its sealing ability, followed by Cavit Group II, Prisma VLC Dycal Group II, Dispersalloy Group II in that order. Cavit Group I was least effective in sealing perforations.

A comparative study of effects of mouth breathing and normal breathing on gingival health in children.

The present study was conducted to assess the effects of mouth breathing, lip seal and upper lip coverage on gingival health of children. 240 school children aged 10-14 years were selected irrespective of sex race and socioeconomic status. They were divided into two major groups i.e. mouth breathers and normal breathers. These groups were further subdivided into six sub-groups or categories on the basis of lip seal and upper incisor coverage. Gingival index was found to be higher in the mouth breathers than in the normal breathers in the subjects with incompetent lip seal. Increased lip separation and decreased upper lip coverage were all associated with higher levels of Plaque index and Gingival index. No statistical difference existed between mouth breathers and normal breathers with respect to Plaque index.

Clinical evaluation of supplementing tongue brushing to most advocated regime of tooth brushing.

Tongue, because of its surface texture contributes significantly in plaque formation and accumulation, has remained a neglected part in the oral cavity. The study conducted on twenty students aged 18 to 23 years, was undertaken to clinically evaluate the role of supplementing tongue brushing to most advocated regime of tooth brushing. In both the phases of the study, plaque scoring was done daily and oral debris was collected on the eighth day. It was observed that tongue brushing when supplemented to the most advocated regime of tooth brushing that is, immediately after breakfast in the morning and immediately after dinner at night significantly reduced the initial rate of plaque formation and total plaque accumulation.

Evaluation of antimicrobial efficacy of various root canal filling materials for primary teeth.

Four materials viz. zinc oxide-eugenol, iodoform paste, Kri paste, Maisto's paste and Vitapex (Calcium hydroxide + iodoform) were tested for their antibacterial effect against the aerobic and anerobic bacteria, viz. Staphylococcus aureus, Streptococcus viridans, Streptococcus faecalis, Bacteroides melaninogenicus and mixed bacterial culture; obtained from infected non-vital deciduous anterior teeth. The antimicrobial sensitivity was checked on BHI-agar plates using well method. The results showed that all the 4 materials were distinctly different from each other in their antimicrobial activity. Maisto's paste was invariably the superior most in its antibacterial efficacy (in comparison to all the 5 micro-organism strains). Iodoformized zincoxide eugenol appeared to be the second best followed by Kri paste. Vitapex showed the least antibacterial activity.

Combined percutaneous-endoscopic approach for biliary endoprosthesis placement.

A nonoperative method of palliation was used in four patients with malignant obstructive jaundice in whom biliary endoprosthesis could not be placed endoscopically. A guide wire was manipulated through the lesion by a percutaneous transhepatic route and retrieved from the duodenum through an endoscope. A 10 Fr stent was then passed through the endoscope over the guide wire across the stricture. The procedure was successful in all four patients, with no complication.

Bifid pancreas: a case report.

Bifid pancreas is a rare anatomical anomaly in which the main pancreatic duct is bifurcated along its length. Although the pancreatographic appearance has been described in the literature, there is no mention of the computerised tomographic appearance of this condition. We report a case of bifid pancreas with the ERCP and CT appearances, who also had alcohol induced changes of chronic pancreatitis.

Fluoroscopic transbronchial fine needle aspiration for diagnosis of peripheral pulmonary nodules.

Transbronchial fine needle aspiration (TBNA) was performed under fluoroscopic guidance in 21 patients with either solitary (15 patients) or multiple (6 patients) peripherally located nodules. Good aspirate could be obtained in 16 patients (76.1%). Ten were confirmed to be malignant and 2 turned out to be tubercular. Nonspecific benign inflammatory aspirate was obtained in the other four. There were no significant complications. TBNA is thus an effective, safe and quick method for diagnosis of solitary/multiple pulmonary nodules.