The Association Between Chronic Plaque Psoriasis and Nonalcoholic Fatty Liver Disease in Indian Patients: Results of a Pilot Study.

Background: Psoriasis is a chronic dermatosis with potential to cause systemic disease by triggering dysmetabolism, such as metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). We studied the relationship and associations between NAFLD and clinical features, including age, gender, disease duration, and severity of psoriasis in our patients. Methods: This cross-sectional study comprised 61 (m:f, 43:19) patients without pre-existing comorbidities and matched 24 (m:f, 16:8) healthy controls aged between 20 and 68 years. Disease severity was graded as mild, moderate, and severe by psoriasis area and severity index score and body surface area (BSA) involvement. The grades of fatty liver and liver fibrosis were assessed using liver ultrasonography (USG) and transitional vibration-controlled elastography (Fibroscan). Results: Overall, 67.2% of patients were aged >40 years, and the duration of disease was <5years in 60.7% of patients. Mild and moderate to severe psoriasis occurred in 78.7% and 21.3% of patients, respectively. BSA was >10% in 57.5% patients. The proportion of NAFLD was 27.9% and 32.8% by USG and Fibroscan compared with 20.8% in controls. Statistically, there was no significant difference or association between the prevalence of NAFLD among patients and controls, and gender, age (mean ± standard deviation, 47.5 ± 13.8 vs. 45.2 ± 15.7), duration, severity of psoriasis, and arthritis between psoriatic patients with and without NAFLD. Conclusion: This was a pilot study because of the numerosity of sample and highlights trends for possible link between psoriasis and NAFLD, but the results need cautious interpretation and clinical application. Whether NAFLD can be attributed to overall systemic inflammatory process of psoriasis or it occurs as an epiphenomenon of concurrent metabolic syndrome needs elucidation with well-designed studies. Cross-sectional study design, small number of patients, and controls remain major limitations. The study did not compare its findings with liver biopsy.

Spontaneous subcapsular renal haematoma in a diabetic patient with acute pyelonephritis.

Spontaneous renal subcapsular haematoma is not a common clinical condition. It is mainly caused by renal tumours, vascular diseases, trauma, anticoagulation, and urological interventions. Patients present with sudden onset abdominal pain mainly in the flank region, haematuria, and abdominal tenderness. We report a case of 42-year-old diabetic patient who presented with a history of fever and left flank pain with clinical signs of pyelonephritis, on whom abdominal ultrasound and computed tomography demonstrated a subcapsular renal haematoma which was confirmed by percutaneous aspiration. Management with antibiotics and percutaneous nephrostomy proved successful.

Pictorial Essay: Classic Signs in Pediatric Neuroradiology.

BACKGROUND: A number of metaphorical imaging signs have been described in the radiology literature. OBJECTIVE: These signs not only make the learning process easier but also increase diagnostic confidence. For this reason, these signs are quite popular among radiologists. CONCLUSION: In this article, we have demonstrated classic signs described in pediatric neuroradiology with appropriate examples and illustrations.

Quantitative assessment of airway and parenchymal components of chronic obstructive pulmonary disease using thin-section helical computed tomography.

PURPOSE: The purpose of this study was to diagnose and characterise chronic obstructive pulmonary disease (COPD) into its forms, patterns, and severity using MDCT. MATERIAL AND METHODS: In this prospective study, spirometric and MDCT evaluation was done in 52 consecutive patients diagnosed with COPD. In each patient six segmental bronchi were evaluated for CT morphometric indices of bronchial wall thickness (BWT) and wall area percentage (WAP). Quantitative evaluation of emphysema was done using inbuilt software, and volume of emphysematous lung was determined using percentage low attenuation area (LAA). COPD was categorised into the following: emphysema predominant; airway predominant; or mixed phenotypes, and severity grading was assigned as mild, moderate, or severe. RESULTS: Centrilobular was the predominant emphysema pattern occurring alone (36.5%) or in combination with paraseptal changes (34.6%). Among COPD phenotypes, emphysema predominant was the commonest (44.3%), followed by mixed (30.8%), and bronchitis predominant (25.0%). The mean BWT in the airway-predominant group was significantly higher (1.94 ± 0.28 mm) than in the emphysema-predominant subgroup (1.79 ± 0.23 mm) with a p value of 0.005. CONCLUSION: MDCT is an indispensable tool in quantitative and qualitative evaluation of COPD patients. Measurement of CT indices like BWT, WAP, and %LAA can reliably categorise COPD into phenotypes like emphysema predominant, airway predominant, or mixed, which serve as a guide for patient management.

Pediatric Clear Cell Renal Cell Carcinoma with Pelvicalyceal System Invasion and Contiguous Extension Upto Bladder: Novel and Bizarre Tumor Behaviour.

BACKGROUND: Paediatric renal cell carcinoma (RCC) is a rare neoplasm which differs significantly in its clinico-pathological behaviour from the adult variant. The clear cell variant constitutes a relatively small histological subset of this neoplasm. CASE REPORT: We present a very unusual, pathologically proven case of clear cell variety of pediatric RCC which showed invasion into the pelvicalyceal system with contiguous extension up to the urinary bladder. Such a novel manifestation of paediatric RCC has not been described previously in literature. A relevant review of literature is included. CONCLUSIONS: The aggressive biological behaviour of the paediatric RCC in our case and the consequent atypical imaging findings are distinctly unusual. These findings may represent a new aggressive variant of this rare neoplasm. The radiologist and clinician should be aware of these novel manifestations of paediatric clear cell RCC.

Rapunzel Syndrome: Rare 'Tale' of a Broken 'Tail'.

BACKGROUND: Rapunzel syndrome is a rare and unique form of trichobezoar, in which a cast of hairs is formed in the stomach with its 'tail' extending up to varying lengths into the small bowel. Almost all cases described in literature are of 'classic' and more common form of Rapunzel. Sometimes however, the tail of bezoar is broken into smaller fragments. There is not much literature available on this rarer subset of Rapunzel syndrome. CASE REPORT: In this report we present the ultrasound (USG) and CT findings of a case of Rapunzel syndrome in which the tail had broken into five separate fragments. The patient presented clinically with intestinal obstruction due to the impaction of the distal- most fragment in the ileum. CONCLUSIONS: Our case highlights the fact that although USG features may be suggestive, a careful evaluation of CT images is essential for a confidant preoperative diagnosis of Rapunzel syndrome. In cases of this syndrome with a broken tail, CT is essential for precise count and localization of the separated fragments to ensure their complete removal at the time of surgery. We also propose to name the fragments of the broken tail as 'bezoarlets'. This word aptly describes the tail fragments as it suggests their origin from the larger gastric bezoar and the suffix 'lets' conveys they are smaller in size.