Ramesh Ananthakrishnan

Incidentally detected unilateral pulmonary artery agenesis with pulmonary hypoplasia in a 67 year old woman

Unilateral pulmonary artery agenesis is commonly seen associated with other congenital cardiovascular defects, when it is detected early in life, but isolated absence of the pulmonary artery is a rare entity, usually detected in adulthood. The latter patients are usually asymptomatic or might present with varied non-specific manifestations such as respiratory tract infections and hemoptysis. This report describes the imaging findings of a 67 year old female with absence of the right pulmonary artery. The embryology and clinical manifestations of the condition are reviewed.

Extrapontine myelinolysis: rare manifestation of a well-known disorder

A young alcoholic male patient was referred from another hospital with a history of loose stools and vomitings. There was documentation of hyponatraemia (Na-111 mEq/L) which was treated with intravenous normal saline. Next day, sodium was documented to be 134 mEq/L. On the third day, the patient had worsening of sensorium and was referred to our department for further management. On presentation, the patient was comatose and had sluggishly reactive pupillary reflexes. His MRI (figure 1) showed symmetrical hyperintensity in bilateral caudate and putamen …

Biodistribution properties of cleistanthin A and cleistanthin B using magnetic resonance imaging in a normal and tumoric animal model

Aim: To determine the biodistribution properties of cleistanthin A and cleistanthin B in rodents using magnetic resonance imaging (MRI). Materials and Methods: Cleistanthins A and B, constituents of Cleistanthus collinus Roxb., were labelled with gadolinium (Gd3+) directly and injected into normal and tumoric nude mice. The tissue signal intensity was measured using MRI to perform a noninvasive kinetic assay. Wistar rats were used for determination of the grayscale intensity to observe the distribution patterns of of cleistanthins A and B. Results: Cleistanthin A is kinetically more attractive to the gastrointestinal tract than is cleistanthin B, which gets accumulated in muscular tissues of mice in greater concentrations compared with cleistanthin A. Cleistanthin B but not cleistanthin A showed tumoric affinity and exhibited a tumor kinetic attraction in tumoric mice. In rats, cleistanthin A showed greater grayscale intensities in the brain, liver, and skeletal muscles in immediate post contrast MRI images, whereas the gadolinium tagged cleistanthin B showed higher grayscale intensities in the cardiac muscle and skeletal muscles in delayed post contrast MRI images. Conclusions: Cleistanthin A is more pharmacokinetically attractive to the gastrointestinal tract than cleistanthin B.

Nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and its association with cardiovascular disease

INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver disease that ranges from hepatic steatosis to non-alcoholic steatohepatitis. Obesity and diabetes mellitus are the prime risk factors for NAFLD. The aim of this study was to find out the prevalence of NAFLD among patients with type 2 diabetes mellitus and to detect the association of NAFLD with cardiovascular disease in them. STUDY DESIGN Prospective observational study. MATERIAL AND METHODS The study was conducted on 300 patients with type 2 diabetes mellitus attending the outpatient department of a tertiary care teaching hospital. All patients underwent hepatic ultrasonography to look for hepatic steatosis. Among the 300 patients, 124 were divided into NAFLD and non-NAFLD groups based on the ultrasound findings. These patients were subjected to electrocardiogram, 2D echocardiogram, carotid intima media thickness (CIMT) measurement and ankle brachial pressure index measurement along with measurement of markers of oxidative stress. RESULTS Hepatic steatosis was present in 61% of diabetic patients in this study. Cardiovascular disease was not found to be significantly associated in diabetic patients with NAFLD. However, cardiovascular risk factors like CIMT, high sensitivity c-reactive protein (hs-CRP) and malondialdehyde (MDA) were elevated in these patients. hs-CRP and MDA levels were found to be significantly associated with the severity of NAFLD. CONCLUSION There is a high prevalence of NAFLD in type 2 diabetic patients. No correlation was detected between the presence of NAFLD and cardiovascular disease in them; although there was an association between cardiovascular risk factors and NAFLD.

A Rare Cause of Recurrent Stroke in a Visually Impaired 10-year-old Girl

To the Editor: A 10-y-old visually impaired girl presented with weakness of left upper and lower limb for past 7 d. There was no fever, seizures or altered sensorium. Past history, birth and family history were unremarkable. Admission Glasgow Coma Scale (GCS) was 15/ 15. She had scaphocephaly, prominent jaw (Fig. 1a), widened wrists, ankles and genu valgum. Pupillary reflex were sluggish bilaterally. Motor examination showed spasticity, with power of grade 3/5 and exaggerated reflexes on left upper and lower limb with bilateral positive Babinski’s sign. Roentgenogram of skull and long bones showed thickening of skull bones at the base (Fig. 1b) and Erlenmeyer flask deformity (Fig. 1c) respectively. Initial CT head for stroke was unremarkable except for skull base thickening. She was managed conservatively with low dose aspirin and occupational therapy. Three months later, she presented with sudden onset weakness of right upper and lower limb with dystonic movements predominantly involving the right side of the body. In view of recurrent stroke, Protein C, Protein S, Antithrombin III, Factor V Leiden mutation and Plasma Homocysteine levels were done which were all normal. Magnetic Resonance Imaging (MRI) of the brain showed acute white matter infarcts in bilateral peri ventricular white matter with mild narrowing of the bilateral petrous and cavernous s e gm e n t s o f i n t e r n a l c a r o t i d a r t e r i e s o n angiography (Fig. 1d, e and f). Based on the typical rad io log ica l f ind ings , a d iagnos i s o f Cran io Metaphyseal Dysplasia (CMD) was made in the child. She was managed with warfarin, occupational therapy, calcitriol supplementation and low calcium diet. CMD is a rare inherited disorder characterized by bony overgrowth of the facial and skull bones and metaphyseal widening of the tubular bones [1]. Skeletal abnormalities include frontonasal bossing, hypertelorism, prognathic mandible and defective dentition, obliteration of paranasal sinuses and mastoid, genu valgum, bowing of humerus, radii, and ulna. Blindness, deafness and facial nerve paresis due to compression of cranial nerves are usual. Compression of blood vessels at the skull base and foramen magnum can result in avascular infarcts. In severe forms, death may result from medullary compression at foramen magnum [1, 2]. Medical management of hyperostosis with calcitriol, bisphosphonates, low calcium intake and somatostatin have been tried in the past without * Venkatesh Chandrasekaran cvenkatesh@hotmail.com

Panophthalmitis masquerading as retinoblastoma—an eye opener

We report a clinicopathological correlation of a 12-year-old female child who manifested as retinoblastoma clinically and radiologically but turned out to have acute panopthalmitis on histopathological examination. The authors feel that there is significant clinical implication in sharing the knowledge of this clinicopathological correlation. A 12-year-old female child born out of a consanguineous marriage reported to us with bilateral blindness. She was evaluated clinically. Ultrasound B mode and computerized tomogram (CT) examination were done. Based on all the inputs, right eye enucleation was performed, and the same was subjected to a histopathology examination. The patient had proptosis of the right eye with (LE) calcification of the lens. CT scan revealed irregular thickening of the right globe with heterogeneous uveoscleral enhancement. The vitreous showed irregular hyperdense thickening with multiple calcifications. There was mild thickening of the retrobulbar optic nerve and tendinous insertions of extraocular muscles. The right eye was enucleated, and its histopathology examination revealed panophthalmitis with intraocular ossification. The right globe revealed no evidence of malignancy. Painful blind eye is a major therapeutic dilemma for an ophthalmologist. Radiological findings of irregular thickening of sclera, vitreous with calcifications, and optic nerve thickening are highly suggestive of retinoblastoma. In our patient, we wanted to share the differential diagnosis of acute panopthalmitis which masqueraded as retinoblastoma.

Opportunistic Fonsecaea pedrosoi brain abscess in a patient with non-cirrhotic portal fibrosis-induced hypersplenism- a novel association

Abstract Non-cirrhotic portal fibrosis, a common cause of splenomegaly in tropical countries, can lead to hypersplenism and pancytopenia. Hypersplenism in this setting has not been associated with opportunistic infections. We describe a patient with hypersplenism secondary to non-cirrhotic portal fibrosis who developed a Fonsecaea pedrosoi brain abscess and succumbed to the illness despite aggressive management.

Delayed presentation of intraperitoneal bladder rupture following domestic violence in pregnancy

Trauma during pregnancy can present a unique challenge because of care for the mother and the fetus. About 6–7% of all pregnant patients are exposed to some sort of trauma, especially during the third trimester, with 0.3–0.4% requiring hospitalization. Although mostly accidental, injuries are sometimes caused by intentional violence. There is no published report on bladder rupture following trauma in pregnancy. We report a case of bladder injury following abdominal trauma in a pregnant woman.

Turner's syndrome presenting as metabolic bone disease.

Turners syndrome is a genetic disorder with a complete or partial absence of one X chromosome with characteristic phenotypic features. The prevalence of renal anomalies in turner syndrome is 30–40%. However, the renal function is usually normal. We report a case of Turners syndrome presenting with chronic kidney disease and renal osteodystrophy.