Thymic carcinoma developing in a pre-existing thymic cyst has rarely been reported in literature. The diagnosis of this entity in the past has always been established after surgery. We are reporting a case of thymic carcinoma that developed in a pre-existing multilocular thymic cyst in an elderly male. The diagnosis was based on imaging findings and confirmed on fine needle aspiration cytology (FNAC).

The pulmonary venous abnormalities are very rare and are difficult to diagnose. We present a case of middle age male who presented with cough and chest pain. Chest radiograph showed abnormal tortuous vessel in right lung. Computed tomographic angiography of chest demonstrated meandering anomalous right superior pulmonary vein.

Background & objectives:

Hyperthyroidism is associated with increased food intake, energy expenditure and altered body composition. This study was aimed to evaluate the role of adipocytokines in weight homeostasis in patients with hyperthyroidism.

Methods:

Patients (n=27, 11men) with hyperthyroidism (20 Graves’ disease, 7 toxic multinodular goiter) with mean age of 31.3±4.2 yr and 28 healthy age and body mass index (BMI) matched controls were studied. They underwent assessment of lean body mass (LBM) and total body fat (TBF) by dual energy X-ray absorptiometer (DXA) and blood sample was taken in the fasting state for measurement of leptin, adiponectin, ghrelin, insulin, glucose and lipids. Patients were re-evaluated after 3 months of treatment as by that time all of them achieved euthyroid state with carbimazole therapy.

Results:

The LBM was higher (P<0.001) in healthy controls as compared to hyperthyroid patients even after adjustment for body weight (BW), whereas total body fat was comparable between the two groups. Serum leptin levels were higher in patients with hyperthyroidism than controls (22.3±3.7 and 4.1±0.34 ng/ml, P<0.001), whereas adiponectin levels were comparable. Plasma acylated ghrelin was higher in patients than in controls (209.8±13.3 vs 106.2±8.2 pg/ml, P<0.05). Achievement of euthyroidism was associated with significant weight gain (P<0.001) and significant increase in lean body mass (P<0.001). The total body fat also increased but insignificantly from 18.4±1.8 to 19.9±1.8 kg. There was significant decrease (P<0.05) in serum leptin and acylated ghrelin but adiponectin levels remained unaltered after treatment. Serum leptin positively correlated with TBF and this correlation persisted even after adjustment for BW, BMI, gender and age (r=0.62, P=0.001). However, serum leptin and acylated ghrelin did not correlate with the presence or absence of hyperphagia.

Interpretation & conclusion:

Patients with hyperthyroidism predominantly had decreased lean body mass which increased after achievement of euthyroidism with carbimazole. The hyperphagia and the alterations in weight homeostasis associated with hyperthyroidism were independent of circulating leptin and ghrelin levels.

Objective:

To compare the helical and axial modes of indirect computed tomographic (CT) venography (CTV) for accuracy for diagnosing deep venous thrombosis (DVT) of the lower extremities as well as for their radiation burden in patients proven to have pulmonary thromboembolism (PTE) on CT pulmonary angiography (CTPA).

Subjects and Methods:

Of patients evaluated with CTPA for suspected acute PE, 20 of patients who were found to have PTE underwent both indirect CTV of the lower extremities and color Doppler examination. For indirect CTV, patients were randomly assigned to helical and axial modes. The CTV and Doppler findings were interpreted by two experienced radiologists who were blinded to the results of each other.

Results:

Out of total of 260 venous segments analyzed (130 venous segments each by helical or axial CTV), thrombi were seen in 43 venous segments (15 and 28 each by helical or axial CTV respectively). On comparison with Doppler, helical CTV had 82.35% sensitivity and 99.11% specificity, whereas axial CTV had 96.6% sensitivity and 100% specificity. The mean radiation dose was significantly higher for helical (1153.57 mgy.cm) as compared to axial mode CTV (806.28 mgy.cm) with P value of <0.0001.

Conclusion:

Axial CTV results in decreased radiation dose without significant change in the accuracy, as compared to helical CTV in the evaluation of DVT.

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

Background & objectives:

Hyperprolactinaemia affects testicular functions by influencing hypothalamo-pituitary-testicular (HPT) axis at various levels. Available literature on the level of defect, time course of improvement of gonadal functions and its relation with decline in prolactin levels is scanty. We carried out this study to evaluate the HPT axis in patients with macroprolactinomas, before and six months after cabergoline therapy.

Methods:

Fifteen men with macroprolactinomas underwent gonadotropin and testosterone response to their respective stimuli before and after six months of cabergoline therapy.

Results:

Serum prolactin levels decreased after six months of therapy. Pretreatment, mean lutenizing and follicle stimulating hormones (LH and FSH) levels were 2.0 ± 0.4 and 1.4 ± 0.2 IU/l, respectively. However, LH and FSH responses to GnRH were preserved in majority of the patients and LH peaked to 12.1 ± 2.3 IU/l (P<0.01), while FSH to 2.9 ± 0.4 IU/l suggesting the influence of hyperprolactinaemia at the level of hypothalamus with preserved gonadotrope reserve. After cabergoline therapy, there was an increase in basal as well as stimulated LH and FSH levels, though these were not statistically significant when compared to respective pretherapy levels. Basal testosterone (T) levels significantly improved after therapy, but peak T response to hCG was similar at both pre- and post treatment. A significant correlation was observed between peak LH and peak T at baseline (r=0.53, P<0.01) and it further strengthened after therapy (r=0.70, P<0.01). After cabergoline therapy, there was significant improvement in seminal volume, sperm count and motility and sperm count correlated with peak FSH response (r=0.53, P<0.05).

Interpretation & conclusions:

Hyperprolactinaemia affects testicular functions probably by influencing at the level of hypothalamus resulting in subnormal basal secretion of gonadotropins required for optimal testicular functions.

Ophthalmic vein thrombosis is an extremely rare entity. We present a case of middle-aged female who presented with proptosis. Contrast-enhanced computed tomography and magnetic resonance imaging showed cavernous sinus meningioma with ipsilateral superior and inferior vein thrombosis. A brief review of the vascular involvement of the meningioma and ophthalmic vein thrombosis is presented along with the case.

Aim:

The aim was to identify the position of sigmoid colon in children and discuss its clinical significance.

Materials and Methods:

Ninety-one contrast enema studies were retrospectively evaluated and the position of sigmoid colon categorized as below: Left lower quadrant, right lower quadrant, midline, and indeterminate.

Results:

The position of sigmoid colon in the right lower quadrant, left lower quadrant, midline, and indeterminate was 32 (35.16%), 33 (36.26%), 12 (13.19%), and 14 (15.38%), respectively. There was no statistically significant difference in mean age (P = 0.87) or gender prevalence (P = 0.49) for different positions of the sigmoid colon.

Conclusion:

The sigmoid colon occupies the right lower quadrant in a large number of children. Awareness of this finding is of crucial importance in correct interpretation of abdominal radiographs in the emergency room.

Aim:

We undertook this study involving 200 peri- and postmenopausal women to determine the prevalence of osteoporosis, and in turn increase the awareness, education, prevention, and treatment of osteoporosis.

Setting and Design:

Postgraduate Institute of Medical Education and Research, UT Chandigarh, India, and a clinical study.

Materials and Methods:

A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designated for the study. Height and weight was measured, weight-bearing exercise was assessed, and sunlight exposure per day for each woman was recorded. Food intake was estimated by using the 24-hour dietary recall method, and calcium and vitamin D consumption pattern was assessed. Bone mineral density (BMD) at postero-anterior lumbar spine and dual femurs was assessed by densitometer. Women were classified according to the WHO criteria.

Statistical Analysis Used:

Student's t-test, multiple logistic regression analysis.

Results:

The prevalence of low BMD was found in more than half of this population (53%). The mean age in group I (normal BMD) was found to be 50.56 ± 5.74 years as compared to 52.50 ± 5.94 in group II with low BMD (P=0.02). The two groups were similar with respect to parity, education, socioeconomic status, family history of osteoporosis, hormone replacement therapy, and thyroid disorders. 46.8% of the women in group I and 33% of the women in group II had low physical activity and there was no statistically significant difference in sunlight exposure between the groups. Parity or the number of children and type of menopause was not seen to have much association with low BMD in our study. Lack of exercise and low calcium diet were significantly associated with low BMD. Multiple logistic regression analysis showed that age, exercise, menopause, and low calcium diet acted as significant predictors of low bone density.

Conclusion:

The findings from the study suggest the need for large community-based studies so that high-risk population can be picked up and early interventions and other life style changes can be instituted if there is delay in implementing national or international health strategies to tackle this increasing global health problem. Strategies to identify and manage low BMD in the primary care setting need to be established and implemented.

Background & objectives

Fibrous dysplasia (FD) is a rare metabolic bone disease and information available from India is limited to only anecdotal case reports. We describe the clinical profile and therapeutic outcome of 25 patients with FD observed over a period of 14 yr in a tertiary care centre from north India.

Methods

In this retrospective study patients (n = 25) with diagnosis of fibrous dysplasia based on either classical radiological features and/or histological evidence on bone biopsy, were analyzed. Associated endocrinopathies if any, were evaluated. The diagnosis of McCune Albright syndrome (MAS) was considered when fibrous dysplasia was accompanied by either café-au-lait macules and/or endocrinopathies. The clinical presentation, biochemical parameters and imaging were analysed. Seven patients received bisphosphonate therapy. The final outcome and side effects were noted.

Results

Age of the patients ranged from 7 to 48 yr (mean ± SD, 24.2 ± 11.4 yr) with a lag time between onset of symptoms and presentation ranging from 1 to 20 yr (mean ± SD, 6.6 ± 6.2 yr). The mean duration of follow up was 3.5 ± 2.1 yr. Eighteen (72%) patients had polyostotic disease while the remaining had monostotic FD. Eight patients had endocrinopathies: five had acromegaly, one each had gonadotropin independent precocious puberty (GIPP), hyperthyroidism and hypophosphatemic rickets. One child with GIPP later developed hyperthyroidism. McCune Albright syndrome was observed in 10 (40%) patients. A majority of the patients underwent various minor or major surgical procedures and seven patients received bisphosphonates for recurrent pathological fractures. Bone pain was reduced in all bisphosphonate treated patients with a decrease in subsequent fractures.

Interpretation & conclusions

This series of FD patients from north India shows the varying presentations of this rare disease. Medical treatment with bisphosphonates appears to be potentially rewarding.

Diaschisis is the inhibition of function produced by focal disturbances in a portion of the brain at a distance from original site of injury. Many studies using brain SPECT (single-photon emission computed tomography) have demonstrated crossed cerebellar diaschisis (CCD) in patients with cerebral cortical infarct. We report a case of cerebrovascular accident involving the left middle cerebral artery territory. PET/CT performed one month after stroke showed hypometabolism in the left cerebral hemisphere with hypometabolism of the contralateral cerebellum. The finding of diminished glucose metabolism in the contralateral cerebellum represents CCD.

Uterine artery pseudoaneurysm is a rare cause of secondary postpartum hemorrhage but is potentially life-threatening and can occur after caesarean section (c-section) or a hysterectomy. A 28-year-old woman who developed secondary postpartum hemorrhage after c-section was diagnosed to have pseudoaneurysm from the left uterine artery on ultrasound (US) and computed tomography (CT) scan. She was treated with coiling of the pseudoaneurysm with stainless steel coil via selective catheterization of the uterine artery. The procedure was uneventful and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and effective method for treating postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Therefore, it should be considered as a treatment option before resorting to surgery, in appropriately selected cases.

Diffusion: weighted MRI (DWI) is a novel technique that analyzes the diffusion of water molecules in vivo. DWI has been used extensively in the central nervous system. Its use in body imaging is on the rise. In the prostate, it has been used in the evaluation of prostatic carcinoma. We present DWI findings in two patients of prostatic abscess.

Transient splenial lesions (TSL) of the corpus callosum are uncommon radiologic findings that are seen in a number of clinical conditions with varied etiologies. They were first described a decade earlier in patients with epilepsy and hence were thought to be seizure or seizure therapy related. Subsequently, more cases were described by different observers in diseases with different etiologies, and the list is still increasing. Awareness of these lesions is necessary as they are an uncommon finding and have to be differentiated from other infective/noninfective causes. MRI is the imaging modality of choice as these lesions are not seen on routine noncontrast CT scan. The authors here describe two cases which showed TSL, with complete/partial resolution on follow-up scans. The authors also present a review of the literature.

Background:

Acute onset fever with altered mentation is a common problem encountered by the physician practicing in tropical countries. Central nervous system (CNS) infections are the most common cause resulting in fever with altered mentation in children.

Aim:

In this study, we have tried to analyze the cause of encephalopathy following short febrile illness in adults presenting to a tertiary care center in Northwestern part of India.

Setting and Design:

A prospective observational study carried out in a tertiary care center in the Northwestern India over a period of 1 year.

Material and Methods

A total of 127 patients with fever of less than 2 weeks duration along with alteration in mentation were studied prospectively over a period of 12 months. The demographic variables were recorded in detail. In addition to routine investigations, cerebrospinal fluid analysis, noncontrast- and contrast-enhanced computed tomography, along with magnetic resonance imaging were performed in all the subjects.

Statistical Analysis

The results were analyzed using SPSS statistical software. The values were expressed as mean with standard deviation for contiguous variable as percentage for the others.

Results and Conclusion

Out of these, 70% had primary CNS infection as the etiology. A total of 33% patients had meningitis, 29.9% had evidence of meningoencephalitis, and 12.7% were diagnosed as sepsis-associated encephalopathy. These were followed by cerebral malaria, leptospirosis, and brain abscess as the cause of febrile encephalopathy in adults. Among the noninfectious causes, acute disseminated encephalomyelitis, cortical venous thrombosis, and neuroleptic malignant syndrome were documented in 2.36% each. In 11% of the patients, the final diagnosis could not be made in spite of the extensive investigations. Our study demonstrates that acute febrile encephalopathy in adults is a heterogeneous syndrome with primary CNS infections being the commonest etiology.

We report here a case of a large emphysematous bulla with a fluid level that was managed successfully by percutaneous catheter drainage in a 50 year-old man with chronic obstructive airway disease.

Cervical cancer can be presented as an unusual and aggressive manner in human immunodeficiency virus (HIV)-positive women. There are case reports of psoas abscess which mimick metastasis from cervical carcinoma in HIV-positive patients. However, such cases are very rare in HIV-negative women with only few case reports available in the literature. We report one case of psoas abscess mimicking metastasis in a HIV-negative woman, which was initially diagnosed as spinal tuberculosis.

Stroke is a heterogeneous syndrome caused by multiple mechanisms, all of which result in disruption of normal cerebral blood flow and thereby cause cerebral dysfunction. Its early diagnosis is important as its treatment is dependent on the time elapsed since ictus. Delay in diagnosis and treatment translates into increase neuronal loss and thereby increased morbidity. CT scan, and in particular perfusion CT, has helped greatly in the early diagnosis of stroke. This article is an endeavor to explain the pathophysiology of cerebral ischemia and the role of CT perfusion in detecting it.