Ragini Singh

MRI in congenital duplication of urethra.

Congenital urethral duplication is a rare anomaly, with less than 200 cases described in the literature. The investigations that are usually performed are micturating cystourethrography (MCU) and retrograde urethrography (RGU), which can diagnose the presence of duplication but cannot diagnose the precise relationship of the duplicated urethra with other pelvic structures. MRI, because of the excellent tissue contrast that it provides and its multiplanar ability, can demonstrate with precision, the size, shape and position of the two urethras. We describe below a case where MRI was able to show this exquisitely.

Cerebral astroblastoma: A radiopathological diagnosis.

Astroblastoma is a rare glial neoplasm whose histogenesis has been clarified recently. It primarily occurs in children and young adults. We are reporting a case of 12-year-old girl child who presented with features of raised intracranial tension and generalized tonic-clonic seizures. Brain magnetic resonance imaging revealed a large well-circumscribed, cystic lesion without perifocal edema, and enhancing mural nodule in right parietal region. A radiological differential diagnosis of pilocytic astrocytoma and cerebral astroblastoma was made. A complete excision was done and histologically the lesion turned out to be an astroblastoma. We review the histology, immunohistochemistry, and imaging features of astroblastoma and survey the current literature, treatment strategies, and prognostic aspects for the management of this rare neoplasm.

Three-dimensional Quantitative Analysis of the Bone Density of Mandibular Condyle in Dentulous and Edentulous Jaws: An In Vivo Study

Studies have reported that masticatory function and occlusal force are low in edentulous patients, which brings about a change in the density, thickness, and alignment of bony trabeculae. However, studies that have quantitatively measured the differential cortical and medullary bone densities of the mandibular condyle in vivo remain rare. This study determined and compared the cortical and medullary bone density of the mandibular condyle in dentulous and edentulous jaws, using multidetector computed tomography (CT). Forty mandibular condyles with no clinical signs of temporomandibular disorders were investigated in 2 groups with 10 subjects (aged 50-80 yr) in each group (group I: dentulous subjects with maintained occlusion; group II: completely edentulous patients) with multidetector CT. The density of condylar cortical and medullary bone was determined by using bone density analysis algorithms available within the proprietary software. Data were analyzed statistically with the 1-way analysis of variance test (p<0.05). The mean cortical bone density of the right and left condyles of group I was 686.11±102.78 Hounsfield unit (HU) and 775.91±89.62 HU, respectively and that of group II was 531.33±289.73 HU and 648.53±294.39 HU, respectively. The mean medullary bone density of the right and left condyles was maximum in group I subjects (429.69±102.62 HU and 486.62±108.60 HU, respectively) than in group II subjects (214.89±104.37 HU and 205.36±90.91 HU, respectively) with a statistically significant decrease in the mean scores (p<0.001). Within the limitations of this study, it can be concluded that the cortical and medullary densities of the mandibular condyle are more in dentulous than the edentulous jaws.

Prevalence of Psychiatric Morbidity among Urban Elderlies: Lucknow Elderly Study

Background: Paucity of systematic studies in elderly mental health in an aging population is an urgent need, which is required to address services and planning issues for health. Aim: The present study aims to investigate the distribution of physical, neuropsychiatric, and cognitive disorders of a community sample of elderlies with certain socioeconomic data. Materials and Methods: A door-to-door household survey was conducted to identify houses with elderlies (≥55 years) in two urban localities of Lucknow. Mini mental state examination (MMSE), Survey Psychiatric Assessment Schedule (SPAS)/Mood Disorder Questionnaire (MDQ) and physical and neurological examination were used for screening all consenting elderlies. MMSE positive participants were assessed on Cambridge Mental Disorders of the Elderly Examination-Revised for diagnosis of cognitive disorders; SPAS/MDQ positives were assessed on Schedule for Clinical Assessment in Neuropsychiatry based clinical interview for diagnosis of neuropsychiatric disorders other than cognitive disorders (using ICD-10 criteria). Routine and indicated laboratory/radiological investigations on all and on MMSE/SPAS (organic section) positive/physically ill participants respectively were done to confirm organic and/or physical illness. Only percentages were calculated to find the distribution of morbidity. Results: The sample had proportionate age structure as that of the surveyed population and had balanced gender representation in each age deciles. Prevalence of neuropsychiatric disorders (with/without comorbidities) was 11.8% in the elderlies (60 years and above) highest being in the 60-69 years age group. Being women and of lower socioeconomic status was more commonly associated with a neuropsychiatric diagnosis. 7.6% of the elderlies had cognitive impairment. Overall findings suggest a prevalence rate of 17.34% of total psychiatric morbidity among elderlies. A significant number had comorbid physical illness diagnoses. Conclusion: More than half the elderlies had some diagnosable physical or mental ailment. The study familiarizes us to the significant amount of physical and psychiatric comorbidity in the particular age group. About one-fifth was found to suffer from psychiatric morbidity, which any health services for the elderly should be oriented towards.

MRI in isolated dextrogastria with eventration of the right hemidiaphragm with associated mesentero-axial volvulus

Isolated dextrogastria is the rarest of all visceral transpositions and usually coexists with eventration of the right hemidiaphragm. We herein report a unique case of isolated dextrogastria with eventration of the right hemidiaphragm along with mesentero-axial volvulus. Such a case has not been reported in young children. As the barium study was suboptimal, MRI helped by exquisitely depicting the anomaly without radiation risk to the child.

Magnetic resonance-retrograde pyelography: A novel technique for evaluation of chyluria

There are no standardized radiological investigations in a patient with chyluria. Retrograde pyelography (RGP) is usually done to demonstrate pyelo-lymphatic reflux before invasive therapy in the form of sclerotherapy and surgery. We describe magnetic resonance-RGP using gadolinium to demonstrate pyelo-lymphatic reflux in addition to the other intra-abdominal details provided by MRI. The advantages of this technique include avoidance of ionic contrast media and radiation exposure and possibility of better understanding of the disease pathophysiology.

Morphometry of the celiac trunk: a multidetector computed tomographic angiographic study

Aims: We carried out this study for evaluating the normal anatomy trunk and prevalence of anatomical variations of celiac trunk in the North Indian population. Materials and methods: Computerized tomographic images of 50 North Indian subjects, obtained from the Department of Radiodiagnosis, King Georges Medical University, were retrospectively analyzed. The anatomy of the celiac trunk was studied using dynamic scans. Results: A variation in the site of origin of celiac trunk was observed in about 55% cases. The length and dimensions of the trunk also displayed a wide range of variation. Conclusion: Anatomic variations of the celiac trunk as observed by us may become important in patients undergoing diagnostic angiography for gastrointestinal bleeding or prior to an operative procedure. Recognition of variations would enable clinicians to distinguish features which merit further investigations or treatment from those which do not.

Sonographic measurement of the spleen: splenic length in adults and its correlation with different parameters

Aim: The purpose of this study was to establish guidelines for normal splenic length at different ages by using a simple and reproducible sonographic method and to find out a relation between spleen length, age, height, weight, and surface area. Materials and methods: One hundred sixty subjects, from 21 years to 60 years old, had sonography because of abdominal and/or pelvic problems unrelated to the spleen. The splenic size was measured by obtaining a coronal view that included the hilum during deep inspiration to minimize masking by lung. The greatest longitudinal distance between the dome of the spleen and the tip (splenic length) was measured and correlated with age, height, and weight. Results: The results show that the splenic length decreased with increase in age in both males and females. The length of the spleen increased with increase in the body height, body weight, and body surface area in both males and females. In most of the subjects, the splenic length was found to be <11 cm. The splenic size in males was greater than that in females. Discussion: The findings of present study that the splenic length decreases with age are similar to the findings of Loftus and Metreweli. Konus et al in 1998 proposed that the splenic length correlated best with the body height. This is similar to the findings of the present study. The finding of present study that the splenic length has positive correlation with the body height, weight, and surface area is similar to the finding of Megremis et al. Conclusion: On the basis of the above study, it was concluded that the splenic length decreased with increase in age in both males and females. The length of the spleen has positive correlations with increase in the body height, body weight, and body surface area in both males and females. The splenic length was less in females than that in males with the corresponding age, body height, body weight, and body surface area. In most of the subjects, the splenic length was found to be <11 cm.

Atypical presentation of Lemierre syndrome: role of imaging.

A 51-year-old male patient presented with breathlessness for 10u2005days. Chest radiograph revealed bilateral moderate pleural effusion. Ultrasound-guided diagnostic pleural aspirate revealed sterile transudative fluid. CT thorax revealed bilateral moderate pleural effusion with partial collapse of both lower lobes and thrombus in right brachiocephalic vein. Two-dimensional-echo revealed circumferential pericardial effusion with mild pericardial thickening and moderate tricuspid regurgitation. Cardiolipin antibodies were within normal limits. d-Dimer assay and C reactive protein were markedly raised. During the period of investigations, the patient had developed mild swelling and pain in right upper limb for which colour Doppler ultrasonography of his right upper limb and neck regions were done. Thrombi in right internal jugular, subclavian and brachiocephalic veins were noted. CT angiography, CT abdomen and chest confirmed the above findings. However, extent of the thrombus and lung lesions was better delineated by CT angiography. We have highlighted the pathognomonic imaging findings of Lemierre syndrome.

Use of collagen in extraoral wounds

The basic fundamental elements that collagen bring into the wound activity are its hemostatic effect, its interaction with platelets and interaction with fibronection, increase in fluid exudates, increase in cellular components (macrophages) and support for fibroblastic proliferation into wound activity. In this way collagen plays a significant parts in almost every function of the body. Previously broad use of collagen was stifled because of cost, recent advances made it possible to develop cost effective collagen. In this study twenty patients of maxillofacial wounds were treated with the use of collagen. The results were satisfactory without any significant complication.