Mesenteric ischemia: a radiologic perspective.

Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia.

A Study of Adaptive Gambling Behavior of Casino Employees in Macau.

Two hypotheses have been advanced to explain gambling prevalence and addiction among various populations-the exposure hypothesis and the adaptation hypothesis. This study tests these hypotheses in the context of casino employees in Macau. In the etiology of gambling, casino employees have been considered a unique segment of the population. Employees working in casinos are probably more exposed to gambling stimuli than any other group. The findings suggest that indicators of heavy involvement in casino gambling among casino employees were no higher than among other residents of Macau. In terms of gambling frequency, casino employees actually gambled less often than the general adult population in Macau. These results are in contrast to results from studies of gaming venue employees in Australia and Canada. The differing findings are probably attributable to particularities of Macau discussed in the article.

A rare cause of median neuropathy at the carpal tunnel: Thrombosis of the persistent median artery.

Carpal tunnel syndrome is a common peripheral nerve entrapment neuropathy caused due to compression of the median nerve at the level of the wrist joint. Bifid median nerve associated with a persistent median artery is a rare entity and in itself asymptomatic anatomical variant. However, distension of the persistent median artery due to a thrombus can be symptomatic due to compression on the median nerve and can compromise the blood flow to the palm. We report a case of persistent median artery thrombosis in a young female patient who presented with symptoms of carpal tunnel syndrome diagnosed on the ultrasonography and confirmed on the MRI with subsequent improvement post anticoagulation therapy.

Primary hepatic neuroendocrine tumor: A rare entity.

Liver is the most common site for neuroendocrine metastasis. However, primary neuroendocrine tumor is a rare focal hepatic lesion with a better prognosis than hepatocellular carcinoma and other malignant hepatic lesions. We present a case of primary hepatic neuroendocrine tumor in a 38-year-old female patient with a radiological diagnosis of atypical focal hepatic lesion, and a confirmed diagnosis on histopathology. Few radiology features like predominant cystic component with absence of focal lesion at any other site, aids the imaging diagnosis of primary hepatic neuroendocrine tumor.

Added value of strain elastography in the characterisation of breast lesions: A prospective study.

BACKGROUND: Elastography is a new promising ultrasonographic technique which is used to differentiate benign and malignant breast lesions based on the stiffness of the lesion. PURPOSE: To determine the role of strain elastography in characterisation of breast lesions and to compare the diagnostic performances of strain elastography and conventional ultrasound (US). METHODS: In total, 113 breast lesions in 100 women were prospectively evaluated by US and strain elastography followed by the histopathological examination. Elastography score based on the Tsukuba colour scale and strain ratio were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for each modality and the diagnostic performances were compared. The best cut-off point was calculated for each of the elastography parameters using the receiver operator curve analysis. RESULTS: Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). The area under the curve for elastography score showed significant difference with that of US: 0.98 versus 0.90 (Difference = 0.08, p =0.02). The elastography parameters were more specific as compared to US (ES-95 and SR-93% vs. 63%, p < 0.05) with a high negative predictive value. The combined use of elastography and US gave better results with 95% sensitivity, 94% specificity, 94% accuracy and negative predictive value reaching 97%. CONCLUSION: Strain elastography is a useful adjunct to conventional ultrasonography. The combined use of strain elastography and ultrasound improves the characterisation of breast lesions and helps in down-staging of assigned BI-RADS category, thereby avoiding unnecessary biopsies. ES is the most useful elastography parameter to differentiate between benign and malignant breast lesions.

Fibrosing mediastinitis mimicking as chronic pulmonary thromboembolism.

Fibrosing mediastinitis is an uncommon, benign, progressive disorder caused by proliferation of fibrous tissue within mediastinum resulting in encasement of vital mediastinal broncho-vascular structures. Due to its rarity and variable clinical presentation, it is often misdiagnosed. We are presenting a case of fibrosing mediastinitis in an Ethiopian origin young male presenting with pulmonary hypertension due to simultaneous occlusion of pulmonary vein and arteries, clinically misdiagnosed as chronic pulmonary thromboembolism.

Can strain elastography be used in reclassification of indeterminate breast lesions in BIRADS lexicon?: A prospective study.

PURPOSE: To evaluate the role of strain elastography (SE) in reclassification of indeterminate breast lesions placed under BIRADS 3 and 4 categories by conventional ultrasound (US) parameters so as to recourse biopsy only for suspicious stiffer lesions. METHODS: 113 breast lesions in 100 women assigned as BIRADS category 3 and 4 on US parameters were prospectively evaluated by SE followed by histo-pathological examination. Strain ratio (SR) and Elastography Score (ES) were determined for each lesion. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality and diagnostic performance were compared. The best cut-off point was calculated for each of the elastography parameter using the receiver operator curve analysis (ROC). RESULTS: Out of the 113 lesions, 40 were malignant (35.4%) and 73 were benign (64.6%). A statistically significant difference was observed in the AUC for ES and conventional US: 0.98 vs 0.90 (Difference = 0.08, P = 0.02). Elastography parameters were more specific as compared to US (ES-94.5 & SR-93.2% vs 63%, P < 0.05) with high NPV. SE performed better in BIRADS 4 category lesions. On the basis of elastography parameters, 85% of BIRADS 4 category lesions were correctly predicted as benign with overall sensitivity, specificity and diagnostic accuracy of elastography being 97%, 84.6% and 91.9%. Among BIRADS 3 category lesions, 97% were correctly predicted as benign and 50% lesions were correctly predicted as malignant with a sensitivity of 50%, specificity of 97.8% and diagnostic accuracy of 94%. CONCLUSION: Strain elastography is a useful adjunct to conventional ultrasonography for the assessment of indeterminate breast lesions and may help in avoiding unnecessary follow ups and biopsies. Elastography score is a better parameter as compared to strain ratio.

"Look Before You Leap": Urachal Mass in Adults.

Diseases of the urachal remnant can present at any age. Urachal adenocarcinoma is the most frequent cause of urachal mass in adults, albeit infected urachal cyst constitutes a significant number. Lack of typical clinical and imaging findings combined with absence of definitive guidelines makes evaluation of urachal mass in adults very challenging. We present a case of a 58-year-old man presenting with an urachal mass with overlapping clinical and imaging findings mimicking urachal malignancy which later turned out to be an infected urachal cyst.

Problem gambling among international and domestic university students in Australia: who is at risk?

Young people are a high risk group for gambling problems and university (college) students fall into that category. Given the high accessibility of gambling in Australia and its association with entertainment, students from overseas countries, particularly those where gambling is restricted or illegal, may be particularly vulnerable. This study examines problem gambling and its correlates among international and domestic university students using a sample of 836 domestic students (286 males; 546 females); and 764 international students (369 males; 396 females) at three Australian universities. Our findings indicate that although most students gamble infrequently, around 5 % of students are problem gamblers, a proportion higher than that in the general adult population. Popular gambling choices include games known to be associated with risk (cards, horse races, sports betting, casino games, and gaming machines) as well as lotto/scratch tickets. Males are more likely to be problem gamblers than females, and almost 10 % of male international students could be classified as problem gamblers. Hierarchical regression analysis showed that male gender, international student status, financial stress, negative affect and frequency of gambling on sports, horses/dogs, table games, casino gaming machines, internet casino games and bingo all significantly predicted problem gambling. Results from this study could inform gambling-education programs in universities as they indicate which groups are more vulnerable and specify which games pose more risk of problem gambling.