Double trouble - dual outflow tract obstruction in congenital heart disease: a case report.

BACKGROUND: Double chambered right ventricle is a rare congenital heart disease that is characterised by the presence of an anomalous muscle bundle that divides the right ventricle into a low pressure superior (distal) chamber and a high pressure inferior (proximal) chamber. It is found in association with a ventricular septal defect in 90% cases with other associations being tetralogy of Fallot, transposition of great vessels, atrial septal defect and Ebstein's anomaly. On the other hand, subaortic membrane is a form of discrete subaortic stenosis that is characterised by a membranous diaphragm in the subvalvular location of the left ventricular outflow tract. Both of these entities are responsible for causing subvalvular outflow tract obstruction. The occurrence of double chambered right ventricle in association with subaortic membrane is an extremely rare entity with only a few case reports available in the literature. CASE REPORT: A 13-year-old male child with history of chest pain and palpitations presented to the outpatient department of a tertiary care center. Transthoracic echocardiography revealed a subaortic membrane producing a pressure gradient across the left ventricular outflow tract with dilatation of the right atrium and right ventricle which could not be fully evaluated on echocardiography. Cardiac computed tomography was then performed which additionally revealed an anomalous muscle bundle coursing across the right ventricle from the septum to the subinfundibular region creating a double chambered right ventricle. The patient was then taken up for reconstruction of right ventricular outflow tract and resection of subaortic membrane. CONCLUSION: Right and left outflow tract obstructions are rare congenital lesions which when seen in combination, become even more infrequent. Echocardiography is a robust tool that detects turbulent flow to identify such lesions. However, poor acoustic window may sometimes result in missing these lesions and computed tomography in such situations can play an important role in detection as well as complete preoperative imaging evaluation.

Doppler hemodynamic liver index and hepatic elastic modulus: Advanced ultrasonographic techniques for non-invasive prediction of esophageal varices in cirrhosis.

PURPOSE: Currently esophagoscopy is the gold standard for assessment of esophageal varices in cirrhosis. Predicting the presence of esophageal varices, varices needing treatment (VNT) and variceal grade by advanced ultrasonographic techniques using a combination of Doppler hemodynamic liver index (HDLI) (quantifying portal hypertension) and hepatic elastic modulus (quantifying hepatic fibrosis) would be a cost-effective and non-invasive alternative to routine endoscopy. METHODS: Our cross-sectional study consisted of cirrhotic patients diagnosed using clinical features and laboratory parameters. Portal venous Doppler and liver sonoelastography were performed in selected subjects for obtaining measurements of HDLI (portal vein diameter/mean velocity) and hepatic elastic modulus respectively. Within 3 days of ultrasound, the subjects underwent upper GI endoscopy for assessment of presence, VNT and grade (F1, F2, F3) of varices. Subjects were divided into two groups (without and with varices) and data analyzed using XLSTAT. RESULTS: A total of 60 subjects (26 without and 34 with varices) were evaluated. Mean Doppler HDLI of subjects with varices was significantly higher (0.72 vs. 0.59, p < 0.0001) with progressive increase in values with variceal grade, being highest in grade-F3 (mean 0.77). Likewise, mean hepatic elastic modulus was also higher in subjects with varices (28.9 vs. 12.6 kPa, p < 0.0001) and showed progressive increase with grade (51.1 kPa for F3). For predicting presence of varices, maximum accuracy of elastic modulus was at cut-off of 14.5 kPa (sensitivity, specificity 83% and 84.6%) and Doppler HDLI was at 0.66 (66% and 92.3%). Good inter-rater agreement was present (κ 0.66). CONCLUSION: Combination of Doppler HDLI and hepatic elastic modulus is an excellent non-invasive method for predicting the presence, VNT, and variceal grade and may obviate need for routine endoscopic screening in cirrhosis.

Cerebroplacental ratio and aortic isthmus Doppler in early fetal growth restriction.

PURPOSE: To assess the utility of cerebroplacental ratio (CPR) and fetal aortic isthmus (AoI) Doppler in the prediction of perinatal outcome in early fetal growth restriction (FGR). METHODS: A prospective observational cohort study of 70 early FGR cases was conducted through serial Doppler examinations and findings of the last examination were correlated with perinatal outcome. Doppler blood flow measurements of AoI included end diastolic velocity (EDV), peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI), and isthmic flow index (IFI). RESULTS: Significant association of CPR and all Doppler indices of AoI with the overall adverse perinatal outcome was seen. The sensitivity of CPR was moderate (63.64%) but higher than most AoI indices. Most AoI Doppler indices (PI, RI, IFI) had higher specificities (100%). AoI PSV and EDV had higher sensitivities than CPR for the prediction of overall adverse perinatal outcome, with AoI PSV having the highest sensitivity (100%). CONCLUSION: CPR shows significant association and moderate sensitivity for prediction of overall adverse perinatal outcome in early FGR; hence recommended in all cases of early FGR. AoI Doppler also appears to have a role in assessment and decision making in FGR in view of high sensitivity and high specificity of AoI indices in the prediction of perinatal outcome. However, larger studies are required to confirm its utility in the management of early FGR.

Role of ultrasonography (USG) and color Doppler in the evaluation of thyroid nodules and its association with USG-guided FNAC - A cross-sectional study.

Introduction: Thyroid diseases affect approximately 42 million people in India. The majority (15%-40%) of these cases remain asymptomatic and benign and warrant special investigations such as ultrasonography (USG) and fine-needle aspiration cytology (FNAC) for diagnosis. Early diagnosis and management of thyroid disorders determine the disease course in many patients. Objective: To determine the role of USG and color Doppler in the evaluation of thyroid nodules and its association with USG-guided FNAC. Methods: We did a cross-sectional analytical study over 2 years, where we recruited 108 patients with thyroid swelling attending the OPD. We used a semi-structured data collection proforma that captured information on sociodemographic details, clinical symptoms, physical examination, and all ne cessary laboratory investigations. All patients underwent USG, color Doppler, and FNAC as a part of the investigation of thyroid nodules. The diagnostic value of ultrasound and Doppler parameters was assessed in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for detection of malignancy in comparison to FNAC. Results: Approximately 155 nodules were identified from the selected 108 cases, and the prevalence of malignancy among the selected thyroid nodule patients was found to be 9.1%. We observed that malignant tumors were likely to be solitary with lobulated margins, >2 cm in size with <50% peripheral halo, with markedly hypoechoic, predominantly solid, with nodal involvement and extrathyroidal extension, microcalcifications, and central vascularity. We also observed that tumors that had USG characteristics of being taller than wide (91%), poorly defined margins (92%), marked hypoechoic (95%), and microcalcifications (96%) had the highest diagnostic accuracy in detecting malignancy when compared to FNAC. Conclusion: Thus, through our study findings, we conclude that USG and color Doppler can serve as vital tools for the evaluation of thyroid nodules with high sensitivity and specificity.

pH-sensitive semi-interpenetrating network of microcrystalline cellulose and methacrylic acid hydrogel for the oral delivery of insulin.

Insulin is commonly administered to diabetic patients subcutaneously and has shown poor patient compliance. Due to this, research has been carried out extensively to find molecules that could deliver insulin orally. In this context, a new type of pH-responsive hydrogel, composed of microcrystalline cellulose and methacrylic acid-based hydrogels, has been developed and studied for the oral delivery of insulin. These hydrogels were prepared by free radical polymerization using potassium persulphate as initiator and N, N'-methylenebisacrylamide as a cross-linker. These pH-sensitive hydrogels showed swelling in distilled water as high as 5800 %. The hydrogels were investigated for swelling in saline and glucose solutions, and pH sensitivity was confirmed by swelling in solutions of different pH. The morphological shape was established by SEM, and the structure was analyzed by FTIR. Thermal degradation was investigated by TGA. In vitro release studies have confirmed pH sensitivity, showing lower insulin release at pH 1.2 than at pH 6.8. The encapsulation efficiency was determined to be 56.00 ± 0.04 %. It was further validated by in-vivo investigations for which insulin was loaded into hydrogels and administered orally to healthy and diabetic Wistar rats at 40 IU/kg, showing maximum hypoglycemic effect at 6 h, which was sustained for 24 h. In the stomach's acidic environment, the gels remained unaffected due to the formation of intermolecular polymer complexes. Insulin remained in the gel and was protected from proteolytic degradation. Thus, pH-responsive methacrylic acid-based hydrogels are promising for biomedical applications, especially oral drug delivery.

Nonbifurcating carotid artery-embryological scrutiny, intriguing associations, and review of literature.

Nonbifurcating carotid is quite a rare anatomical variant of carotid anatomy. The embryology of carotid development is more intricate and convoluted than is presently known. This case report finds an unusual case of a nonbifurcating carotid artery whose embryological basis cannot be explained by popular prevalent theories. It also stresses about an abundance of case reports from East Asia on this topic, to the best of the authors' knowledge. The formation of atherosclerotic plaque requires more than abnormal fluid hemodynamic, which has been briefly pointed out.

Placental elastography in second trimester preeclampsia prediction: A prospective study.

Objective: The aim of the study was to evaluate the diagnostic potential of placental shear wave elastography in predicting preeclampsia at 16 to 20 weeks of gestation. Materials and methods: A total of 230 pregnant women between 16 and 20 weeks of gestation were observed for the study. These women underwent shear wave elastography ElastPQ (Philips Healthcare, Bothell, Washington, USA) of the placenta. The mean value of placental shear modulus was obtained for each participant. These participants were followed up for the development of preeclampsia and were divided into two groups; group A included those who developed preeclampsia and group B included those who remained normotensive until delivery. The elasticity values of the two groups were compared, and the ROC curve was drawn to obtain the best cut-off value that would predict the onset of preeclampsia. Results: Placental shear modulus varied from 1.03 kPa to 7.4 kPa at 16 to 20 weeks of gestation with an average of 2.74 ± 0.87 kPa. There was a statistically significant difference in the mean value of elasticity between two groups, being 4.61 kPa in group A and 2.51 kPa in group B. Maximum diagnostic accuracy was obtained at 2.9667 kPa with area under the curve 0.970, sensitivity 92%, specificity 91.71%, positive predictive value 57.5% and negative predictive value 98.9%. Conclusion: Stiffness of placenta, quantitatively measured by SWE at 16 to 20 weeks of gestation, is higher in the women who develop preeclampsia and hence may be used for predicting preeclampsia.

Magnetic Resonance Imaging of Malformations of Cortical Development-A Comprehensive Review.

Malformations of cortical development (MCDs) are structural anomalies that disrupt the normal process of cortical development. These include microcephaly with simplified gyral pattern/microlissencephaly, hemimegalencephaly, focal cortical dysplasia, lissencephaly, heterotopia, polymicrogyria, and schizencephaly. They can present with intractable epilepsy, developmental delay, neurologic deficits, or cognitive impairment. Though the definitive diagnosis of MCD depends on histopathology, the pathologic tissue is rarely available; hence diagnosis begins with neuroimaging. This article shall briefly review the embryology, followed by specific magnetic resonance imaging features of MCD in an attempt to simplify the process of diagnosing these disorders with clinical and genetic correlation. A table has been included to highlight the embryologic, clinical, and genetic findings associated with various MCDs.

Polyaspartic acid, 2-acrylamido-2-Methyl propane sulfonic acid and sodium alginate based biocompatible stimuli responsive polymer gel for controlled release of GHK-Cu peptide for wound healing.

Stimuli responsive polymer based on Polyaspartic acid, 2-Acrylamido-2-methylpropane sulfonic acid and sodium alginate (NaAlg) were synthesized using two cross-linkers Ethylene glycol dimethacrylate (EGDMA) and TMPTA (Trimethylolpropane triacrylate). The polymers were standardized and optimized to obtain a polymer with maximum swelling in distilled water, saline, glucose and solutions of varying pH. The synthesized polymer swelled well in distilled water, glucose solution and acidic- alkaline medium. The biocompatibility of the polymer was evaluated for blood compatibility and protein adsorption. The polymer with maximum swelling property was used for peptide release studies. The polymer was further used to study the peptide encapsulation and release efficiency of the polymeric material which was confirmed by FTIR, Scanning Emission Microscope and EDX. The encapsulation efficiency of the polymer for encapsulating (glycyl-l-histidyl-l-lysine-copper) GHK-Cu was observed to be 55.26% and peptide release of 51.84% was observed for Ethylene glycol dimethacrylate based polymer after 24 h whereas for Trimethylolpropane triacrylate based polymer the encapsulation efficiency was observed to be 49.6% and release was 39.01%. The EGDMA based polymer was further examined under in vivo studies in order to evaluate the efficiency of the synthesized polymer. The in vivo studies include wound closure, histopathological analysis, biochemical and toxicity assay. The material has shown promising results for both in vivo and in vitro studies.

Role of MRI in diagnosing the primary site of origin in indeterminate cases of uterocervical carcinomas: a systematic review and meta-analysis.

OBJECTIVE: To perform a literature review assessing role of MRI in predicting origin of indeterminate uterocervical carcinomas with emphasis on sequences and imaging parameters. METHODS: Electronic literature search of PubMed was performed from its inception until May 2020 and PICO model used for study selection; population was female patients with known/clinical suspicion of uterocervical cancer, intervention was MRI, comparison was by histopathology and outcome was differentiation between primary endometrial and cervical cancers. RESULTS: Eight out of nine reviewed articles reinforced role of MRI in uterocervical primary determination. T2 and Dynamic contrast were the most popular sequences determining tumor location, morphology, enhancement, and invasion patterns. Role of DWI and MR spectroscopy has been evaluated by even fewer studies with significant differences found in both apparent diffusion coefficient values and metabolite spectra. The four studies eligible for meta-analysis showed a pooled sensitivity of 88.4% (95% confidence interval 70.6 to 96.1%) and a pooled specificity of 39.5% (95% confidence interval 4.2 to 90.6%). CONCLUSIONS: MRI plays a pivotal role in uterocervical primary determination with both conventional and newer sequences assessing important morphometric and functional parameters. Socioeconomic impact of both primaries, different management guidelines and paucity of existing studies warrants further research. Prospective multicenter trials will help bridge this gap. Meanwhile, individual patient database meta-analysis can help corroborate existing data. ADVANCES IN KNOWLEDGE: MRI with its classical and functional sequences helps in differentiation of the uterine 'cancer gray zone' which is imperative as both primary endometrial and cervical tumors have different management protocols.

Fibroblast Growth Factor-23 in Pre-Dialysis Chronic Kidney Disease Patients and its Correlation with Carotid Artery Calcification.

Introduction: Fibroblast growth factor 23 (FGF-23) is a phosphate metabolism regulator in patients with chronic kidney disease (CKD). The present study is aimed to examine the FGF-23 level in pre-dialysis patients with CKD and its correlation with carotid artery calcification (CAAC). Methods: This cross-sectional study included patients with CKD and controls. The patients were compared with controls having similar distribution of age and sex to determine serum FGF-23 level in Indian healthy adult population. Detailed medical history, physical examination, and investigations were done for each patient. Atherosclerotic risk factors, cardiovascular comorbidities, and drug history were recorded. Carotid calcification was observed using carotid ultrasound. Results: In total, 62 patients with a mean age of 50.0 years were enrolled. Majority of the patients had hypertension (66.1%), followed by diabetes (27.4%) and dyslipidemia (3.2%). Mean serum corrected calcium levels were significantly higher in patients with CAAC compared to the patients without CAAC (9.21 ± 1.34 vs. 8.53 ± 0.93 mg/dL; P = 0.014). The FGF-23 levels were significantly higher in patients with CAAC compared to those without CAAC (396.0 vs. 254.0 pg/mL; P = 0.008). CAAC was found to be present in both early and late stages of CKD. Multivariate analysis showed that log FGF-23 and serum corrected calcium remained as independent determinants of CAAC. The prevalence of CAAC increased with the ascending quartiles of FGF23. Conclusion: In conclusion, FGF-23 was found to be independently associated with CAAC in CKD.

Imaging of primary testicular lymphoma with unusual intraabdominal spread along the spermatic cord and gonadal vein.

Primary testicular lymphoma (PTL) is a rare Testicular neoplasm found in elderly patients. Imaging features in PTL presenting with contiguous involvement of spermatic cord and extension along gonadal vein have been rarely detailed before. We describe a case of a 50-year-old male who presented with complaints of scrotal swelling and abdominal discomfort. Imaging, which included Ultrasonography and contrast-enhanced computed tomography of chest-abdomen, showed features of aggressive-looking bilateral testicular mass lesions with the distinctive feature of contiguous spread along the spermatic cord and gonadal vein till retroperitoneum and disseminated chest and abdominal metastases. The distinctive feature of contiguous extension along the spermatic cord and gonadal vein can help suggest a diagnosis of PTL on imaging.

Role of intrarenal resistive index and ElastPQ® renal shear modulus in early diagnosis and follow-up of diabetic nephropathy: A prospective study.

Introduction: We aimed to establish baseline normal values of ElastPQ® (Philips Healthcare, Bothell, Washington, USA) renal shear modulus, evaluate changes in intrarenal resistive index and renal shear modulus in various stages of diabetic nephropathy, their diagnostic potential and role in follow-up. Methods: Our prospective observational study was performed over two years. In total, 130 adult cases with diabetic nephropathy and 130 normal adult controls were selected. Diabetic nephropathy was confirmed by persistent albuminuria on 24-hour urinary albumin testing at three month intervals and staged by albuminuria quantification. Measurement of intrarenal resistive index and renal shear modulus in all subjects was performed and their variation with stage of nephropathy was statistically analyzed using Pearson's correlation. Receiver operating characteristic curves were plotted and their individual and combined diagnostic potentials were assessed. Statistical significance was tested using t tests and analysis of variance. Interrater agreement was tested using Cohen's kappa coefficient. Results: Mean intrarenal resistive index was significantly higher for cases (mean 0.72 ± 0.05) than controls (mean 0.62 ± 0.04) and showed significant age variation (p < 0.05). Normal values of ElastPQ® renal shear modulus ranged from 3.87 to 4.72 kPa and was significantly higher for cases (mean 8.59 ± 1.77 kPa) than controls (mean 4.32 ± 0.45 kPa) and showed significant differences between each stage of nephropathy, being highest in stage 2. Maximum diagnostic accuracy was at 0.65 (sensitivity 90%, specificity 76.2%, area under curve 0.916) for intrarenal resistive index and at 5.31 kPa (sensitivity 90.8%, specificity 84.6%, area under curve 0.923) for renal shear modulus. Combination of the two further improved diagnostic performance (highest accuracy of 89%, sensitivity 81.7%, specificity 96.3%). Conclusions: Normal range of ElastPQ® renal shear modulus values could be established. Intrarenal resistive index and renal shear modulus can be used as imaging parameters for early diagnosis and follow-up of diabetic nephropathy.

Intracranial Fetus In Fetu-a Pediatric Rarity.

BACKGROUND: Intracranial fetus in fetu is an extremely rare entity in which a discrete vertebrate fetiform mass is found inside a diamniotic, monochorionic twin. It is a benign mass and can manifest with symptoms owing to mass effect. To establish the diagnosis, a vertebra must be present within the mass. CASE DESCRIPTION: A 5-year-old child presented at a multispecialty hospital with gradual weakness of both lower limbs. Magnetic resonance imaging of the brain revealed a midline intraventricular mass with lobulated margins having both cystic and fatty components with areas of blooming within. A provisional diagnosis of teratoma/primitive neuroectodermal tumor was made. The patient subsequently presented to our hospital with drowsiness and vomiting for 1 day. Noncontrast computed tomography revealed a mass of heterogeneous density occupying the third ventricle. The mass contained a few well-formed long bones representative of the appendicular skeleton and a vertebra-like bone representative of the axial skeleton, fulfilling the Willis criteria. A biopsy sample was taken from the mass; no malignant cells were seen on histopathologic examination. Based on noncontrast computed tomography findings of well-formed long bones and a vertebra and no significant increase in the size of the mass over 2 years, an intracranial fetus in fetu was diagnosed. CONCLUSIONS: Whenever bony structures are identified in an intracranial mass in a pediatric patient, we should always look for bones of the axial skeleton, as this finding will point toward a diagnosis of intracranial fetus in fetu and will help in differentiating it from teratoma, which can have malignant transformation.

Cervical Lipomyelocele with Congenital Inclusion Cyst.

BACKGROUND: Spinal dysraphism refers to a group of congenital malformations affecting the spine and the spinal cord. Although there are several varieties, all have one thing in common, i.e., faulty closure of midline structures at embryogenesis. Rarely, these anomalies are associated with spinal inclusion cysts. Lipomyelocele (LMC) is a type of spinal dysraphism wherein the neural elements along with fat herniate through a posterior defect in the spine. A vast majority of these anomalies are seen in the lumbosacral region, and their occurrence in the cervical region is extremely rare. CASE DESCRIPTION: A 45-year-old female patient presented with swelling over the nape of her neck since birth, with recent-onset paresthesia and unsteady gait. On local examination, a soft fluctuant swelling with blackish discoloration of skin was noted at the nape of the neck. Radiographs revealed congenital C4-C5 block vertebra with defect in posterior elements from C4 to C6. Magnetic resonance imaging revealed a cervical LMC with extramedullary intradural congenital inclusion cyst. Other notable findings were dorsal dermal sinus in cervical region, low lying tethered cord, and aberrant right subclavian artery. In our literature review, we could find only 1 case report of a cervical LMC and no cases reported of cervical LMC with congenital inclusion cyst. CONCLUSIONS: Herein, we report a case of a cervical LMC with a spinal inclusion cyst.

In Vitro and in Vivo Studies of pH-Sensitive GHK-Cu-Incorporated Polyaspartic and Polyacrylic Acid Superabsorbent Polymer.

The main aim of this study was to evaluate the in vitro and in vivo efficiency of the polyaspartic acid- and acrylic acid-based superabsorbent polymer. The synthesized polymer was first investigated to check the blood compatibility by protein adsorption and blood clotting tests. Further, the GHK-Cu peptide was incorporated within the polymer and release studies were performed to evaluate the drug-delivery efficiency of the superabsorbent polymer. The polymer with best peptide release results were further used for in vivo analysis for wound healing. The healing efficiency of polymer with and without peptide was analyzed using wound closure, biochemical assay, histopathological, and toxicity studies.

Mri morphometry of lumbar discs and vertebral bodies in correlation with serum vitamin d level / Morfometria de rm de discos lombares e corpos vertebrais em correlação com o nível sérico de vitamina d / Morfometría de rm de discos lumbares y cuerpos vertebrales en correlación con el nivel sérico de vitamina d

ABSTRACT: Introduction: The knowledge of the intervertebral disc morphology and its relation with the vertebrae is vital for managing degenerative spine disease. It is imperative to study the role of preventable and treatable causes, such as Vitamin D deficiency, so that standard guidelines can be framed for apt management. Objective: To evaluate the correlation between serum vitamin D levels and MRI morphometry of lumbar intervertebral discs. Methods: A total of 100 subjects (20-40 years) underwent an MRI of the lumbosacral spine. Intervertebral disc and vertebral body heights were measured, and disc degenerative changes were noted. Serum vitamin D levels were correlated with disc changes using the Pearson/Spearman rank correlation coefficient. A p-value of <0.05 was considered significant. Results: Vitamin D deficiency showed a high prevalence in patients with disc degenerative diseases, even in young adults and females with more severe vitamin D deficiency than males (p-value < 0.001). However, a significant relationship between vitamin D levels and disc or vertebral body heights could not be established. Conclusion: Vitamin D deficiency is more prevalent in patients with disc degenerative changes; however, its effect on disc and vertebral body heights needs to be extrapolated further in larger studies. Level of Evidence I; Cross-Sectional, Observational Study.

RESUMO: Introdução: O conhecimento da morfologia do disco intervertebral e sua relação com as vértebras é vital para o manejo da doença degenerativa da coluna. É imperativo estudar o papel das causas evitáveis e tratáveis, como a deficiência de vitamina D, para que possam ser elaboradas diretrizes padrão para um manejo adequado. Objetivo: Avaliar a morfometria da ressonância magnética dos discos intervertebrais lombares em correlação com os níveis séricos de vitamina D. Métodos: Um total de 100 indivíduos (20-40 anos) foram submetidos a ressonância magnética da coluna lombossacra. As alturas do disco intervertebral e do corpo vertebral foram medidas e alterações degenerativas do disco foram anotadas. Os níveis séricos de vitamina D foram correlacionados com alterações discais usando o coeficiente de correlação de Pearson/Spearman. Um valor de p <0,05 foi considerado significativo. Resultados: A deficiência de vitamina D apresentou alta prevalência em pacientes com doenças degenerativas do disco, mesmo em adultos jovens e mulheres que apresentavam deficiência de vitamina D mais grave que os homens (valor p < 0,001). No entanto, não foi possível estabelecer uma relação significativa entre os níveis de vitamina D e a altura do disco ou do corpo vertebral. Conclusão: A deficiência de vitamina D é mais prevalente em pacientes com alterações degenerativas do disco, no entanto, seu efeito na altura do disco e do corpo vertebral precisa ser extrapolado em estudos maiores. Nível de Evidência I; Estudio Observacional Transversal.

RESUMEN: Introducción: El conocimiento de la morfología del disco intervertebral y su relación con las vértebras es vital para el tratamiento de las enfermedades degenerativas de la columna vertebral. Es imprescindible estudiar el papel de las causas prevenibles y tratables, como la deficiencia de vitamina D, para poder elaborar directrices estándar para un tratamiento adecuado. Objetivo: Evaluar la morfometría por resonancia magnética de los discos intervertebrales lumbares en correlación con los niveles séricos de vitamina D. Métodos: Un total de 100 individuos (20-40 años) se sometieron a una resonancia magnética de la columna lumbosacra. Se midieron las alturas del disco intervertebral y del cuerpo vertebral y se observaron cambios degenerativos en el disco. Los niveles séricos de vitamina D se correlacionaron con los cambios discales mediante el coeficiente de correlación Pearson/Spearman. Se consideró significativo un valor p <0,05. Resultados: La deficiencia de vitamina D mostró una elevada prevalencia en pacientes con enfermedad degenerativa discal, incluso en adultos jóvenes y mujeres que presentaban una deficiencia de vitamina D más grave que los hombres (valor p < 0,001). Sin embargo, no fue posible establecer una relación significativa entre los niveles de vitamina D y la altura del disco o del cuerpo vertebral. Conclusión: La deficiencia de vitamina D es más prevalente en pacientes con cambios degenerativos del disco; sin embargo, su efecto sobre la altura del disco y del cuerpo vertebral debe extrapolarse en estudios mayores. Nivel de Evidencia I; Estudio Observacional Transversal.

Contained rupture of a thoracoabdominal aortic aneurysm presenting as a back mass.

Chronic contained rupture of aortic aneurysm is a rare but important subset of ruptured aneurysms, which has a presentation that is distinctly different from that of acute rupture. These aneurysms are usually small. Patients are hemodynamically stable, usually presenting with a long history of back or loin pain, with symptoms attributable to compressive or erosive effects. The resultant pseudoaneurysmal sac may cause extensive vertebral erosion, but rib erosion has rarely been described previously. Even more unusual is the presentation of the pseudoaneurysmal sac as a large back mass. We present an unusual case of contained rupture of a thoracoabdominal aortic aneurysm, which presented as a back mass, and demonstrate the radiographic and computed tomography findings. Radiographs of the chest show large posterior mediastinal mass eroding the rib. Computed tomography scans demonstrate fusiform dilatation of the thoracoabdominal aorta with positive aortic drape sign, which is highly suggestive of a contained leak. The importance of early identification of this condition lies in the imminent danger of exsanguination, if undetected.

Imaging appearances of atypical hydatid cysts.

Hydatid disease continues to be a significant health problem in many parts of the world. It can occur in any part of the body, but liver is the commonest site of involvement. The disease may remain asymptomatic for years. Symptoms occur due to compression of local structures or complications like rupture and infection. The diagnosis is clear when typical radiological appearance is observed at the common sites of involvement. Complications give rise to atypical appearances. These coupled with unusual localizations pose diagnostic difficulty. The aim of this pictorial essay is to demonstrate the atypical manifestations of hydatid cysts - atypical either due to complications or the unusual site.