Can Diffusion Weighted Imaging Aid in Differentiating Benign from Malignant Sinonasal Masses?: A Useful Adjunct.

BACKGROUND: To evaluate the role of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values at 3 Tesla in characterizing sinonasal masses. MATERIAL/METHODS: After ethical clearance, 79 treatment naive patients with head and neck masses underwent magnetic resonance imaging (MRI), including DWI at 3 Tesla using the following b values - 0, 500 and 1000 s/mm2. Thirty-one patients were found to have sinonasal tumours and were subsequently analysed. Image analysis consisted of a morphological evaluation of conventional MR images, qualitative evaluation of DW trace images and quantitative assessment of mean ADC values. Receiver operating characteristic (ROC) curve was drawn to determine a cut-off ADC value for the differentiation between benign and malignant masses. RESULTS: Sinonasal masses showed an overlapping growth pattern on conventional imaging, irrespective of their biological nature. The mean ADC value of benign lesions was 1.948±0.459×10-3 mm2/s, while that of malignant lesions was 1.046±0.711×10-3 mm2/s, and the difference was statistically significant (p=0.004). When a cut-off ADC value of 1.791×10-3 mm2/s was used, sensitivity of 80% and specificity of 83.3% were obtained for characterization of malignant lesions, which was statistically significant. Juvenile nasopharyngeal angiofibroma (JNA) showed distinctly high ADC values, while meningioma was the only benign lesion with restricted diffusion. Atypical entities with unexpected diffusion characteristics included: adenocarcinoma, adenoid cystic carcinoma, meningioma, chondrosarcoma and fibromyxoid sarcoma. CONCLUSIONS: DWI in conjunction with conventional imaging can potentially enhance the diagnostic accuracy in characterizing sinonasal masses as benign or malignant. Some specific entities such as JNA and meningioma showed distinctive diffusion characteristics.

Ingestion of safety razor blade and delayed hanging in a complex suicide.

Ingestion of a foreign body is mostly accidental in children and intentional in prisoners to achieve hospitalization; however, use of this method of suicide is rare. We report a case where the victim first ingested a safety razor blade, but failed to die and then hanged himself, but failed again and finally succumbed to the complications on the sixth day. He had also attempted suicide by inflicting multiple incised wounds on his neck four days before the safety blade ingestion, but none were fatal.

Neonatal and infantile spinal sonography: A useful investigation often underutilized.

Sonography is an ideal, effective, noninvasive tool for evaluation of the spinal cord in neonatal and early infantile age groups owing to lack of ossification of the posterior elements of spine. Understanding normal anatomical appearances is a prerequisite for the interpretation of various pathologies of the spinal canal and its contents. This review elucidates normal appearances of the spinal cord in this age group, in both axial and sagittal planes. Usefulness of Doppler sonography is briefly discussed, and special emphasis is placed on normal anatomical variants that may mimic spinal abnormalities. Sonographic appearances of common intraspinal pathologies, both congenital and acquired, are exhaustively described. Key points regarding sonographic diagnosis of important spinal anomalies are emphasized and explained in detail. To conclude, spinal ultrasound is a reliable and widely available screening tool, albeit the usefulness of which is often underestimated.

Nail injury to the brain obfuscated by a fall from height - homicide or suicide? a case report.

Penetrating head injuries caused by unconventional objects such as a nail generate speculation and doubt regarding the manner of infliction. We report a case of a 24-year-old woman alleged to have committed suicide by a fall from height. Autopsy revealed an unprecedented penetrating intracranial injury caused by a nail over the right temporal region, confounding the manner of death. The underlying intersecting pattern of fractures determined the chronological sequence of events. In this paper, we discuss the manner, incidence and pathology of nail injuries to the brain.

Intracranial penetrating injury by screw driver: a case report and review of literature.

Penetrating injury to the head, with the exception of missile injuries is rare owing to thick calvarium. Orbital and temporal areas are comparatively vulnerable to penetrating injuries, due to their relative thinness. A case is presented in which a man killed his wife by forcefully thrusting a screw driver into her cranial cavity. The deceased presented to the hospital with the screw driver embedded in her head. She was declared as 'brought dead on arrival' at the emergency of the hospital. Pre-autopsy plain radiography and Computed Tomography (CT) of the head were done to assess the extent of brain damage. The peculiarity of this case lies in the fact that screw driver as a stabbing weapon in the head is very rarely used. In such cases, there is a need to perform radiography and CT with the weapon in-situ for better interpretation on injuries. In this paper role of radiography and CT in intra cranial penetration is discussed with review of literature.

Sudden death in advanced abdominal pregnancy: a case report and discussion of the related medicolegal issues.

We report sudden unexpected death in a 35-year-old woman with pregnancy of seven months duration. There was an allegation by the parents of the woman that she was subjected to an assault prior to death. Autopsy examination showed an abdominal pregnancy with a dead fetus, ruptured gestational sac, massive haemorrhage and secondary placental attachment. During her antenatal check-ups, she had persistently complained of abdominal pain and loose stools, but the diagnosis of abdominal pregnancy was missed clinically and on ultrasound scan. In this paper we discuss the diagnostic difficulties and medicolegal issues in such cases.

A practical total synthesis of (+)-spirolaxine methyl ether.

An efficient and practical total synthesis of (+)-spirolaxine methyl ether is described. The phthalide-aldehyde 3 has been prepared via the Diels-Alder reaction between 1,4-unconjugated diene 5 and a long-chain acetylenic dienophile 6. The carbon framework of spiroketal sulfone 4 has been constructed from monobenzyl protected 1,5-pentanediol and the stereochemistry in both the phthalide portion and the spiroketal portion has been established by the Sharpless asymmetric epoxidation.

A simple solution for reducing artefacts due to conductive and dielectric effects in clinical magnetic resonance imaging at 3T.

The quality of imaging obtained at high magnetic field strengths can be degraded by various artefacts due to conductive and dielectric effects, which leads to loss of signal. Various methods have been described and used to improve the quality of the image affected by such artefacts. In this article, we describe the construction and use of a simple solution that can be used to diminish artefacts due to conductive and dielectric effects in clinical imaging at 3T field strength and thereby improve the diagnostic quality of the images obtained.

Chronic haematoma or soft-tissue neoplasm? A diagnostic dilemma.

Chronic soft-tissue haematomas are infrequently reported in the literature. We present a case of a slowly expanding post-traumatic chronic soft-tissue haematoma located anterior to the knee and leg, occurring in a region previously unreported. Both clinically and radiologically, it was impossible to distinguish the haematoma from an aggressive soft-tissue neoplasm. We review the literature and discuss the diagnostic problems related to this uncommon presentation.

Role of fine needle aspiration cytology in the diagnosis of breast lumps and its histopathological correlation.

Lumps in breast may be due to benign or malignant lesions. Fine Needle Aspiration Cytology is a quick, simple and inexpensive procedure in diagnosis of these lesions. This helps the clinician in planning the correct surgical or medical treatment. Two hundred and twenty two fine needle aspirations were done on breast lesions. There were 205 satisfactory smears out of which 144 were benign lesions, 61 malignant lesions. Seventeen were unsatisfactory smears. Histopathology correlation was done in 126 benign lesions, 44 malignant lesions and 12 unsatisfactory smears. The cytological correlation for benign and malignant lesions was 91.09% and 91.6%, respectively. There were false negatives which were due to extensive necrosis or due to scanty aspirate. There were no false positives in this study.