A review of common anatomical variants of paranasal sinuses and nasal cavity and its frequency of occurrence as evidenced on multi-detector computed tomography

This study was carried out to know the frequency of occurrence of common anatomic variants in computed tomography of paranasal sinuses and nasal cavity. Non contrast Computed tomography (CT) of paranasal sinuses of 100 patients referred to Department Of Radiology, Saveetha Medical College were retrospectively studied. The Multi-detector computed tomography (MDCT) scans were evaluated for various anatomical variants of paranasal sinuses and nasal cavity. The frequency of occurrence was calculated in percentage.We found out that deviated nasal septum (DNS) was the most common variant in this study, seen in 86% of cases, followed by Agger nasi cells which was seen in 56% and the third most common was supra-orbital ethmoidal cells seen in 42% of the study population. All the cases included in the study, had minimum of one variant. Most of the study population showed multiple anatomical variations of paranasal sinus and nasal cavity. In conclusion, multidetector Computed tomography plays an important role is the assessment of various anatomical variants of the paranasal sinuses and nasal cavity. Pre-operative MDCT of Paranasal sinuses, gives the surgeons most if not all of the anatomical information they need to tailor surgeries. Considering the relatively high frequency of occurrence of these variants, it is essential for the radiologists to have a precise knowledge of imaging features of normal anatomy and anatomical variants of Paranasal sinuses.

Reliability in detection and differentiation between calcification and hemorrhage by 3 d GRE/ SWI technique compared to CT

This study was conducted to evaluate the sensitivity of Magnetic Resonance (MR) Susceptibility- Weighted Imaging (SWI) and also to compare the sensitivity of Magnetic Resonance (MR) susceptibility-Weighted Imaging (SWI) and Computed Tomography (CT), such that SWI can replace the use of CT as a standard protocol in the detection and differentiation between calcification and hemorrhage. A series of 70 patients included in this study with clinical suspicion or known history of intracranial hemorrhage/ calcifications for follow up, were scanned using both Philips Multiva 1.5T (MRI/SWI) and Philips Ingenuity 128 slice (CT). Results showed that SWI had 100% relative sensitivity, as it was able to detect both hemorrhage and calcifications in all the cases identified in CT. In addition, SWI detected hemorrhage in 2 additional cases that were nonspecific in CT. Furthermore, SWI detected signal from micro bleeds, which was missed on CT in three cases, and also detected calcification in two cases, which were not positively identified in CT. In conclusion, Susceptibility- Weighted Imaging (SWI) is highly sensitive for the detection and differentiation of hemorrhage and calcifications using Phase reconstructed images compared to conventional MRI methods and Computed Tomography

A retrospective observational study of clinical profile, diagnosis, management and outcome of abdominal tuberculosis in 30 patients

Background: Abdominal tuberculosis is found worldwide although prevalence rates are still highest in the developing countries. The sites of involvement of abdominal tuberculosis are peritoneum, lymph nodes, intestine and solid viscera. The objectives of this study were to describe the clinical profile of patients with abdominal tuberculosis, to review the use of diagnostic modalities, both non-invasive and invasive and to study the outcome of management of abdominal tuberculosis.Methods: This is an observational retrospective study of 30 patients with diagnosis of abdominal tuberculosis treated at university linked teaching hospital of South Gujarat from August 2015 to November 2017.Results: In our study, disease was found almost equally prevalent in both rural and urban areas affecting mostly lower socio-economical class. The mean age was 34 years (range from 13 to 62); male and female ratio was 2.33:1; the mean hospital stay was 09 days (range from 5 to 48 days). Abdominal pain was present in almost all cases, having chronic pain in 21 patients and acute in 9 patients. There were 05 (16.7%) patients found to be HIV positive in this study. There was mortality of 02 patients post operatively due to sepsis in those patients operated in emergency with peritonitis.Conclusions: Abdominal tuberculosis is prevalent in lower socioeconomic class patients and affects younger male patients more commonly. Most commonly intestinal and mesenteric disease presented with chronic abdominal pain and constitutional symptoms of tuberculosis.

Clinico-Haematological Profile of Haemophilia in Patients Attending Gandhi Medical College and Associated Hamidia Hospital, Bhopal..

BACKGROUND Haemophilia A and haemophilia B are the commonest form of haemophilia encountered and they result from a defect in Factor VIII and Factor IX gene respectively. This hinders the process of haemostasis and predisposing haemophiliacs to spontaneous or post traumatic bleeding. We wanted to study the clinico-haematological profile of patients with haemophilia.METHODSThis observational study was conducted in Gandhi Medical College and Associated Hamidia Hospital, Bhopal, during the period of March 2017 to June 2018. After clinical evaluation, patients were subjected to a battery of coagulation tests (Bleeding Time, Prothrombin Time, Activated Partial Thromboplastin Time, Correction Studies and whenever possible, Specific Coagulation Factor Assay). The results were analysed.RESULTSDuring the study period, 100 patients of haemophilia were studied. Majority of patients were of haemophilia A (89%). Most common age group was 6 - 15 years (49%) and mean age was 19.02±12.58 years. Most common age of onset was <1 year (62%). Positive family history was present in 57% of cases. 52% patients had severe haemophilia. Most common presentation was haemarthrosis & knee joint was the most common joint involved. APTT was prolonged in all cases.CONCLUSIONSHaemophiliacs are distributed worldwide and have heterogeneous presentation depending upon disease severity. Knowledge of the spectrum of presentation of haemophilia in the population helps in early diagnosis and management planning. Promotion of regular availability of factor concentrate, establishing comprehensive care center and positive public awareness along with good haematology laboratory will help in achieving outcome comparable to that of developed countries.

Management Of Autism Spectrum Disorder With Abhayaghrita And Pancha Bhautika Tailanasya- A Case Report

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition with its onset before the age of three years. It is characterized by abnormalities in communication, impaired social function, repetitive behaviours and restricted interests. There is no effective treatment currently available for ASD and there is a growing need of an alternative treatment modality. A three year six month old male patient, diagnosed with ASD was brought to the OPD for Ayurvedic treatment of ASD. There is no mention of ASD in Ayurveda classics and hence, considered an Anukta Vyadhi. ASD involves vitiation of all the three Doshas mainly Vata Dosha in the lead. The management was primarily based on the associated Doshas and Ayurvedic formulations i.e. Abhaya Ghrita orally for three months and Marsha Nasya with Panchabhautika Taila for forty five days were used. Changes in the clinical features were assessed using Aberrant Behaviour Checklist (ABC) and changes in the severity of disease after treatment was done using Clinical Global Impression scale (CGI). The patient showed significant improvement in the core features of ASD after the treatment duration.

Cystic fibrosis in a retro-positive child.

We present a rare association of cystic fi brosis and retro positivity in a grossly malnutrited child. The child had pulmonary, pancreatic and colonic manifestations with superadded herpes simplex virus interstitial pneumonia and lymphocytic meningitis.

A Regression Model to Predict Diameter of Mitral Valve Prosthesis Preoperatively: An Aid to Clinical Decision Making.

Aim: Accurate estimation of the prosthetic valve size pre-operatively can aid to the efficiency and effectiveness to mitral valve surgery. Traditionally Two dimensional Echocardiography is being used for this purpose but cannot be claimed as optimum tool. This study computes and analyses several linear regression equations in order to obtain a best fit model for predicting mitral prosthesis size well before operation. Materials and Methods: This hospital based longitudinal study was conducted in a tertiary care Cardio Thoracic Vascular Department from August 2011 to August 2012. A total of 67 participants suffering from Rheumatic Heart Disease (with severe mitral valve disease) were recruited. Short and long axis of the mitral annulus were measured through 2-dimensional transthoracic echocardiography. Further three regression models were plots using short axis, long axis and area of the annulus as independent variables and diameter of prosthetic valve as dependent variable. Results: Among the three predictors namely the anterio-posterior axis (short axis), commissurecommissural axis (long axis) and area of mitral valve annulus; the regression equation with short axis predicted the diameter of prosthesis more accurately. The optimum regression model for short axis is calculated as -Diameter of prosthetic valve= -0.165 + 0.769X short axis of Ellipse. The coefficient of determination for this equation (R2) is 0.905. This equation offers the explanation for maximum observations in the model (F=609.48). Conclusion: The size of optimum prosthetic valve may be determined preoperatively as a function of anterio-posterior axis (short axis) of annulus through non invasive 2-D Echocardiography. However this finding is amenable for further multi-centric validation.

Cardiac risk factors in descendants of parents with history of coronary artery disease (CAD) : An evaluation focusing on small dense low density lipoprotein cholesterol (sdLDLc) and high density lipoprotein cholesterol (HDLc).

The risk of coronary artery disease (CAD) in descendants with positive family history of CAD was evaluated in either one of or both the parents among 71 selected families. Subjects were grouped as parents and descendants without and with CAD and descendants spouses without CAD or family history of CAD. All subjects were examined for anthropometric characteristics, fasting blood sugar, serum lipids, lipoprotein sub-fractions, insulin, insulin resistance and pancreatic beta cell function. The results were subjected to statistical analysis by using the analysis of variance (ANOVA). Metabolic syndrome (MetS) was prevalent in the 83% descendants with CAD and 54.6% parents with CAD. The traditional risk factors were observed in both parents and descendants with CAD. Metabolic risk factors, including hypertriglyceridemia, low HDLc levels and hyperglycaemia had a higher frequency in the descendants with CAD. ANOVA showed significant ‘F’ ratio for the anthropometric characteristics, hypertension, serum lipids, small dense (sd) LDLc levels, HDL2c levels and HDL3c levels in the descendants parents with CAD and CAD + diabetes mellitus (DM), as compared to those without CAD. The descendants without CAD, but with a positive family history had central adiposity, hypertension and had lower HDL levels and elevated sdLDLc levels. Multiple analyses of variance showed that sdLDLc and waist circumference were the most potent risk factors for prevalence of CAD. Thus, we conclude that a positive family history of CAD along with central adiposity and elevation of sdLDLc levels appear to be important factors in the assessment of CAD risk in humans.

Primary gastric adenosquamous carcinoma in an Indian male.

Adenosquamous carcinoma (ASC) of the stomach is a very rare tumor comprising less than 0.5% of all stomach malignancies. Here, we report a case of a 37-year-old male, who presented with upper gastrointestinal bleeding in the form of hematemesis and malena. A subtotal gastrectomy was done in view of massive uncontrolled bleed. Histology showed evidence of ASC of the body and antrum with metastasis to the liver, perigastric lymph nodes and peritoneal and pleural cavity.

Prevalence, severity, and risk factors of symptomatic gastroesophageal reflux disease among employees of a large hospital in Northern India.

Background and aims Gastroesophageal reflux disease (GERD) is considered to be a common and chronic gastrointestinal disorder. The prevalence of GERD is believed to be less in Asia than in Western countries. Population-based data on GERD are lacking from India. The present study aimed at determining the prevalence of GERD symptoms in an adult Indian community and the potential risk factors associated with GERD. Methods The study population consisted of all the employees of All India Institute of Medical Sciences, New Delhi. An interview-based observational study was done on the basis of an earlier validated questionnaire. The subjects were asked about the frequency and severity of heartburn and/or regurgitation experienced by them in the previous year. These symptoms were then scored from 0 to 18. Subjects with a score of at least 4 were considered to have symptomatic GERD. Association of GERD with factors like age, sex, BMI, Kuppuswamy social class index, smoking, alcohol, NSAID use, and comorbid illness was analyzed. Results A total of 4079 employees were interviewed in person on a 29-item questionnaire from June 2003 to January 2005. Of the 4039 eligible subjects, 653 (16.2%) had GERD; 3.6% had heartburn on daily basis and 5.9% on a weekly basis. The corresponding prevalences for regurgitation were 3.3% and 5.0%, respectively. One hundred and eight of 4039 (2.7%) had severe GERD symptoms. Higher BMI (OR=1.90, 95% CI: 1.4–2.6 for BMI ≥25), current smoking (OR=1.48, 95% CI: 1.19–1.83), asthma (OR=3.13, CI: 2.06–4.76) and hypertension (OR=1.71, 95% CI: 1.16–2.50) were associated with the presence of GERD symptoms. Conclusions Prevalence of GERD in an urban adult population from northern India is 16.2% which is similar to other industrialized countries. Higher body mass index, current smoking, and presence of asthma or hypertension predisposes to GERD in our population.

Hepatic venous pressure gradient measurement: time to learn!

Portal hypertension is a clinical syndrome defined by a pathological increase in portal pressure. The development of cirrhosis of the liver is characterized by clinical manifestations related to portal hypertension like esophageal varices, ascites, bleeding, and encephalopathy. Direct measurement of portal pressure is invasive, inconvenient, and clinically impractical. Currently, the most commonly used parameter is the Hepatic Venous Pressure Gradient (HVPG), i.e., the difference between the wedged (WHVP) and the free hepatic venous pressures. HVPG represents the gradient between pressures in the portal vein and the intra-abdominal portion of inferior vena cava. When blood flow in a hepatic vein is stopped by a wedged catheter, the proximal static column of blood transmits the pressure from the preceding communicated vascular territory (hepatic sinusoids) to the catheter. Thus, WHVP reflects hepatic sinusoidal pressure and not the portal pressure itself. In the normal liver, due to pressure equilibration through interconnected sinusoids, wedged pressure is slightly lower than portal pressure, though this difference is clinically insignificant. In liver cirrhosis, the static column created by balloon inflation cannot be decompressed at the sinusoidal level due to disruption of the normal intersinusoidal communications; therefore, WHVP gives an accurate estimation of portal pressure in cirrhosis. The normal HVPG value is between 1 to 5 mmHg. Pressure higher than this defines the presence of portal hypertension, regardless of clinical evidence. HVPG >or= 10 mmHg (termed clinically significant portal hypertension) is predictive of the development of complications of cirrhosis, including death. HVPG above 12 mmHg is the threshold pressure for variceal rupture. The main advantages of HVPG are its simplicity, reproducibility, and safety. This review summarizes the technique of the HVPG measurement.

Techniques in the treatment of craniovertebral instability.

The techniques of craniovertebral region stabilization introduced and used by the senior author over the last 20 years are summarized. The lateral masses of atlas and axis are strong and largely cancellous in nature and can be used for direct implantation of screws. Opening up of the joint and placement of bone graft within the joint stabilizes the region and provides a large area for bone fusion. Distraction of the facets provides an opportunity to treat a range of congenital craniovertebral anomalies. The technique of exposure of the lateral mass of the atlas and axis and the atlantoaxial joint is technically relatively complex and needs precise understanding of anatomy of the vertebral artery and training with cadavers.

Craniovertebral realignment for basilar invagination and atlantoaxial dislocation secondary to rheumatoid arthritis.

OBJECTIVE: We present our experience of treating nine consecutive cases of rheumatoid arthritis involving the craniovertebral junction by atlantoaxial joint manipulation and attempts towards restoration of craniovertebral region alignments. MATERIAL AND RESULTS: Between November 2001 and March 2004, nine cases of rheumatoid arthritis involving the craniovertebral junction were treated in our department of neurosurgery. Six patients had basilar invagination and 'fixed' atlantoaxial dislocation and three patients had a retroodontoid process pannus and mobile and incompletely reducible atlantoaxial dislocation. The patients ranged from 24 to 74 years in age. Six patients were males and three were females. Neck pain and spastic quadriparesis were the most prominent symptoms. Surgery involved attempts to reduce the atlantoaxial dislocation and basilar invagination by manual distraction of the facets of the atlas and axis. Reduction of the atlantoaxial dislocation and of basilar invagination and stabilization of the region was achieved by placement of bone graft and metal spacers within the joint and direct inter-articular plate and screw method of atlantoaxial fixation. Following surgery all the patients showed symptomatic improvement and restoration of craniovertebral alignments. Follow-up ranged from four to 48 months (average 28 months). CONCLUSION: Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments in selected cases of rheumatoid arthritis involving the craniovertebral junction leads to remarkable and sustained clinical recovery.