Stroke: a rare presentation of cardiac hydatidosis.

A 13-year-old boy presented with acute stroke leading to right-sided hemiparesis. A contrast CT scan of the brain showed a hemorrhagic infarct in the left basal ganglia region with surrounding edema. Echocardiography showed a hydatid cyst in the right atrial chamber extending into the left atrium. A single hepatic hydatid was also seen.

Comparative efficacy and tolerability of nimesulide and piroxicam in osteoarthritis with specific reference to chondroprotection: a double blind randomised study.

The aim of the study was to assess the efficacy, tolerability and chondroprotection afforded by nimesulide, a selective cyclooxygenase-2 inhibitor and piroxicam in a randomised, double blind, controlled clinical trial in 90 patients suffering from osteoarthritis of the knee joint. A significant improvement in the osteoarthritis severity index at 2 weeks (p < 0.01) and an improvement in physicians assessment of global arthritic condition at 4 weeks (p < 0.01) was seen with both the treatments. A significant decrease in articular index of joint tenderness (p < 0.05) at 8 weeks and in self assessment of handicap at 4 weeks (p < 0.05), in comparison to baseline, was observed only in patients receiving nimesulide. Rescue therapy was required by a greater percentage of patients being administered piroxicam. Functional capacity improved in 64% of the patients on nimesulide and 74.5% of the patients receiving piroxicam. Adverse effects were observed in 6 patients on nimesulide and 9 patients receiving piroxicam. No significant difference was found in any of the efficacy and tolerability parameters between the two treatment groups. Magnetic resonance imaging evaluation of the knee joint of 10 patients showed no significant change in the articular cartilage and associated joint structures after 6 months of therapy with both the treatments. The results show that nimesulide and piroxicam are comparable in efficacy and tolerability in patients suffering from osteoarthritis.

Comparative evaluation of fine needle aspiration cytology and biopsy of testis in diagnosis of male infertility.

Infertility has a fair degree of male factor contribution in its aetiology, hence needs complete evaluation of male partner especially the status of spermatogenesis. In the present study comparative evaluation of fine needle aspiration cytology (FNAC) and biopsy of testis showed 90% accuracy of FNAC in respect of histopathological diagnosis of spermatogenesis. FNAC is a safe, fairly accurate, outdoor investigation in infertile man and it is devoid of the complications of haematoma formation, suppression of spermatogenesis and antigenic stimulation as seen with testicular biopsy.

Evaluation of plasma serotonin concentration in acute appendicitis.

BACKGROUND: Due to lack of reliable biochemical/radiological markers, the diagnosis of acute appendicitis is based only on clinical features. METHODS: We estimated plasma serotonin levels in 48 patients with acute appendicitis (histologically proven), 27 patients with abdominal pain of other etiologies, and 20 healthy controls. RESULTS: The plasma serotonin levels were (mean +/- SD) 36.6 +/- 12.5 nmol/L, 12.5 +/- 3.6 nmol/L and 10.4 +/- 3.5 nmol/L in the three groups, respectively. The levels in patients with acute appendicitis were significantly higher (p < 0.001) than in the other groups, giving 93.8% sensitivity and 95.7% specificity to the test. CONCLUSION: Plasma serotonin level is a reliable marker of acute appendicitis, especially in the first 48 hours.

MRI (magnetic resonance imaging) spectrum of epilepsy.

In 361 patients with strong clinical suspicion of secondary epilepsy magnetic resonance imaging (MRI) was performed. Three hundred and forty-five patients revealed a positive study. Maximum number of patients (28.3%) were in the age group of 2 to 12 years without any significant sex predilection. More than 70% patients presented with generalised seizures. MRI revealed definite evidence of tuberculoma in 98, neurocysticercosis in 86, tumour in 60 and cerebrovascular accident in 23 patients. There were 78 patients in miscellaneous group which included patients with magnetic resonance (MR) diagnosis of generalised or focal atrophy, demyelinating disease, hydrocephalus with or without basal exudates, calcification and disappearing lesion. In 16 patients MR was found to be within normal limits.

Computed tomography evaluation of esophageal carcinoma.

Forty patients of histologically proven esophageal carcinoma were subjected to computed tomography (CT) with the objective to assess its reliability in preoperative evaluation of these patients. The findings were confirmed on surgery in twenty five of these patients, thought to be resectable. Bronchoscopy was performed to evaluate bronchial tree in cases of tumor of upper and middle third of esophagus. CT was found to be sensitive in predicting the location and size of tumor, in assessing invasion of tracheo-bronchial tree, spread to liver, celiac and left gastric nodes. However, it was not successful in picking up metastatic spread to local periesophageal nodes in five cases and celiac in one case. The study concluded CT should be carried out for preoperative evaluation of esophageal carcinoma to select operable cases and avoid unnecessary radicle surgery in advanced cases.

Undescended testis: evaluation by magnetic resonance imaging.

We describe our experience of prospective magnetic resonance imaging (MRI) study in patients of undescended testis, with a 1.5 T equipment using body coil. There were thirty two patients, aged 1.5 to 14 years with a mean age of nine years. Surgical follow up was obtained for thirty one patients. We were able to indicate the position of 26 testes in 22 patients and absence of five testes in three patients. MRI was falsely positive and negative for five and two testes, respectively. Testicular tissue at ectopic site was identified by presence of characteristic signal intensity pattern, mediastinum testis and its location along empty spermatic canal in cases of inguinal testis either singly or in combination. MRI was able to detect atrophic changes in four testes, confirmed on surgery. The study concludes that MR imaging is useful in the localization and tissue characterization of a non palpable testis. However, it is not sensitive enough for complete exclusion of the diagnosis of an undescended testis. Thus a surgical or laproscopic exploration may be needed further in selective cases for the management of patient.

Cranial sonography in preterm infants.

Fifty preterm newborn infants with gestational age of 28-36 weeks were subjected to real time cranial sonography to (a) evaluate the ventricular system and brain parenchyma, (b) determine the incidence of intracranial abnormalities, and (c) to establish the utility and advantages of routine cranial sonography in preterm infants. The lateral ventricular width varied from 6-12 mm (8.67 +/- 1.85 mm) while hemispheric width ranged between 3.68 to 3.95 cm with a mean of 3.84 +/- 0.25 cm. The lateral ventricular ratio ranged from 20.9 to 26.4% and it showed progressive decrease with increasing gestational age. Cavum septum pellucidum was found in 68% of the preterms. Incidental intracranial pathologies were detected in 12% of the preterms screened.

Pyogenic meningitis: sonographic evaluation.

Forty infants with proven pyogenic meningitis were evaluated by real time cranial sonography. A spectrum of sonographic abnormalities was observed which included echogenic sulci, focal or diffuse increase in parenchymal echoes, ventriculitis, ventriculomegaly with or without aqueductal block, subdural collection, parenchymal infarcts, abscess and subdural empyema. There were two infants with normal sonogram while encephalomalacia was seen in another two patients. An excellent correlation was observed between clinical profile, cerebrospinal fluid biochemistry and sonographic findings.

Magnetic resonance imaging in childhood epilepsy.

One hundred and seventy children of chronic seizures with strong clinical suspicion of an underlying intracranial lesion as its cause were studied by Magnetic Resonance Imaging (MRI). Maximum number of patients were between 6-12 years, males outnumbering females. Structural abnormalities were seen in 158 of the 170 patients. The study revealed tuberculoma as the commonest lesion in this series (n = 64) followed by cysticercosis (n = 27). Three patients were seen to have glioma. An interesting finding was disappearing lesion in 6 children. MRI proved to be an excellent modality in demonstrating and characterising the intracranial lesion.

Separate pancreatic and biliary ductal openings in alcoholic chronic pancreatitis.

Endoscopic retrograde cholangiopancreatograms of 49 patients with chronic pancreatitis (alcohol related 18; idiopathic 31) were assessed retrospectively. Thirteen (72%) of 18 patients with alcohol-related chronic pancreatitis had separate openings of the common bile duct and the main pancreatic duct into the duodenum. This was significantly more frequent (p less than 0.01) than in previously studied controls (37%). Although this finding was seen more frequently in patients with alcohol related chronic pancreatitis than in those with idiopathic chronic pancreatitis (14 of 31, 45%), the difference was not statistically significant. It is concluded that alcohol-related chronic pancreatitis, but not idiopathic chronic pancreatitis, is associated with the presence of separate openings of the common bile duct and main pancreatic duct into the duodenum.

Periventricular hemorrhage in term newborns originating from germinal matrix.

Six term newborns, presenting with seizures, in whom cranial sonogram showed isolated periventricular hemorrhage (SEH) are described. Age of onset of seizures ranged from day one of birth to day twenty-one. Seizures appeared spontaneously in previously healthy newborns in three cases. All but one survived, and three have near normal development. Isolation of hemorrhage to the periventricular area suggests germinal matrix to be the source of hemorrhage in these cases. These cases also emphasize the need to consider diagnosis of IVH in term-newborns presenting with seizures.