Akash Handique

Case report and brief review of literature on sonographic detection of accidentally implanted wooden foreign body causing persistent sinus

Despite advances in imaging techniques, the detection of vegetative foreign bodies in soft tissues remains a difficult and sometimes even a challenging task. Clinical evaluation of such patient may present several months or even years after the initial injury and clinician may fail to elicit an antecedent skin puncture. X-ray examination will miss radiolucent foreign bodies. A 15-year-old boy presented with a draining non-healing sinus at the lateral aspect of his right thigh for 9 months. Musculoskeletal ultrasonography was ordered after ruling out chronic osteomyelitis to detect possible lesions around the thigh. High-frequency linear ultrasonic probe readily detected an elongated foreign body within the vastus lateralis muscle. A long piece of wood was confirmed at surgery. Non-healing sinus with normal finding in radiograph following old trauma should raise the suspicion of implanted radiolucent foreign body/bodies. The role of diagnostic ultrasound as a valuable screening tool for the detection of foreign body is briefly reviewed.

Symmetrical Chorioretinal Colobomata with Craniovertebral Junction Anomalies in CHARGE Syndrome - A Case Report with Review of Literature

CHARGE syndrome is a common cause of congenital anomalies. Its rate of incidence is about 1:10,000. It is phenotypically heterogeneous, usually a sporadic or autosomal dominant disorder resulting from a mutation in the CHD7 (chromodomain helicase DNA-binding protein) gene. Since the time it was first described by Hall,[1] the knowledge of the clinical characteristics of CHARGE syndrome has increased over the years. Recently, basiocciput hypoplasia and basilar invagination in patients with CHARGE syndrome have been reported. We report here a case of CHARGE syndrome where there is involvement of symmetrical chorioretinal colobomata with craniovertebral junction anomalies. The patient had symmetrical chorioretinal colobomata, external and inner ear anomalies, sensorineural deafness, characteristic facial appearance, retarded growth and development, history of patent ductus arteriosus, and craniovertebral junction anomalies. Craniovertebral junction anomalies may be an under-diagnosed phenotypic expression of CHARGE syndrome. The diagnostic criteria of CHARGE syndrome may require further revision to include the addition of craniovertebral junction anomalies.

Sonographic images of hepato-pancreatico-biliary and intestinal ascariasis: A pictorial review

Despite advancement in the diagnosis and treatment of intestinal helminthiasis, ascariasis remains the most common cause of helminthic infections in the developing countries. Ultrasound offers a rapid, safe, and noninvasive approach to the diagnosis of intestinal ascariasis. Ultrasound is also the modality of choice for diagnosis of hepatobiliary ascariasis, which is relatively rare and is due to migration of intestinal worms through the papilla of Vater. We present an imaging spectrum of hepato-pancreatico-biliary and intestinal ascariasis.Main messages• Ascariasis refer to infestation by the round worm ascaris lumbricoides.• Ascaris eggs are excreted in faeces and are infective to humans.• Eggs hatch to larva, travel to the lungs and mature to adult worms.• Intestinal obstruction can be caused by multiple ascariasis forming bag of worms.

Endovascular Treatment in Spinal Perimedullary Arteriovenous Fistula

This study includes 20 patients with 21 spinal perimedullary fistulae. There were nine Type IVa (42.8%) lesions, ten Type IVb (47.6%) and two Type IVc (9.5%) lesions. The dominant arterial supply was from the anterior spinal artery (47.6%), posterior spinal artery (19%) and directly from the radiculomedullary artery (28.5%). Sixteen lesions in 15 patients were treated by endovascular route using n-butyl-2-cyanoacrylate. Endovascular treatment was not feasible in five patients. Of the ten patients with microfistulae, catheterization failed/was not attempted in 40%, complete obliteration of the lesion was seen in 60% but clinical improvement was seen in 40% of patients. Catheterization was feasible in all ten patients with macrofistulae (nine type IVb and two type IVc lesions). Complete obliteration of the lesions was seen in 60% and residue in 30%. Clinical improvement was seen in 80% and clinical deterioration in 10%. In conclusion, endovascular glue embolization is safe and efficacious in type IVb and IVc spinal perimedullary fistulae and should be considered the first option of treatment. It is also feasible in many of the type IVa lesions.

Locally Advanced Askin’s Tumour in a Child—a Rare Case Report and Review of the Literature

Askin’s tumor is a primitive neuroectodermal tumor (PNET) developing from the soft tissues of the chest wall and mainly occur in children and adolescents. The management approach is complex and requires a multidisciplinary team. We report a case of locally advanced Askin’s tumour in a child because of its rarity and also to highlight the importance of keeping the possibility of PNET tumours in mind while dealing with cases of chest wall tumour in children.

2D/3D Liver Segmentation from CT Datasets

Imaging modalities are noninvasive, fast, and accurate in the diagnosis of different anatomical disorders. As such, there is a pertinent requirement for segmentation of the organs to give proper visual information on the morphological and pathological changes. The aim of the proposed work is to implement the automatic liver segmentation from the CT images, using active contour segmentation technique. The localization and detection of liver tumor will be easier for radiologist with the extraction of the liver from other adjoining organs. In this paper, we are discussing the different techniques employed for liver segmentation and our present ongoing study is based on 2D and 3D liver segmentation with its future implementation.

Automatic segmentation of human ribcage from 3D medical dataset for diagnosis

Segmentation of human ribcage or bony thorax is essential for computer-aided biopsy or during any surgical procedures that requires removal of tumor from any region of the thoracic cavity. In this study, we have proposed an algorithm that will automatically segment the ribcage from CT dataset available from hospital and online resources. The images are pre-processed and a threshold is applied to the set of images containing the ribcage area. The images are further validated with various validation techniques and projected on a 3D platform, for a better understanding of the results obtained. The output will allow the treating physicians to find the shortest distance to insert needle from the outer surface of the body to the region of interest. It will also help in setting landmarks before proceeding for any major surgery.

Bronchoesophageal Fistula Repair with Intercostal Muscle Flap Followed by Occlusion of Residual Diverticula with N-butyl Cyanoacrylate (NBCA) Glue: A Case Report

The incidence of bronchoesophageal fistula in presence of benign pathology of tracheal tree or oesophagus is rare. It is encountered in thoracic diseases like tuberculosis, syphilis or histoplasmosis due to erosion by infected lymph node or abscess to adjoining structures. The source of primary pathology has to be eliminated followed by appropriate steps of fistula tract closure is essential for optimal result. We report a 25-year-old patient with left sided bronchoesophageal fistula. He had a past history of pulmonary tuberculosis. A left lower lobectomy followed by repair of oesophageal fistula opening was performed by primary closure and reinforcement with an intercostal muscle flap based on posterior intercostal artery. Postoperative oesophagogram showed short diverticula, which was occluded with n-butyl cyanoacrylate (NBCA) glue under radiological guidance. Feeding was started one week after application of glue without further complication. Reports on intercostals muscle flap repair and intervention of residual oesophageal diverticula with n-butyl cyanoacrylate (NBCA) glue under radiological guidance are scanty.

Association of thyroid disorders in females with primary infertility attending a tertiary-care hospital in northeast India -

Background: A close interconnection is present between hypothyroidism and hyperprolactinemia. Failure to ovulate regularly in women of the reproductive age group may occur owing to hypothyroidism. Objective: To look for thyroid disorders among the primary infertile group of female patients and to see the association of serum prolactin level and thyroid-stimulating hormone (TSH) level, if any. Materials and Methods: In this study, we investigated 53 diagnosed female subjects of primary infertility who were sent to the Department of Biochemistry for hormonal investigation. Fifty-three fertile age-matched females were enrolled for the study as control subjects. Serum prolactin and the TSH levels were measured by using chemiluminiscence method (Access 2, Beckman Coulter). Result: Significantly higher prolactin and TSH levels were found among cases when compared with control subjects. A positive association was found between TSH and prolactin levels among the primary infertile female subjects. Conclusion: This study showed significantly higher prolactin and TSH levels among the primary infertile female patients. Therefore, for proper management of infertile cases, it may be necessary to look for thyroid dysfunction and treat it accordingly.

Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique

Purpose: To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. Materials and Methods: We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. Results: We achieved technical success in all the three patients with immediate relief of dyspnea. Conclusion: Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort.