Imaging and Intervention in Internal Carotid Artery Pseudoaneurysm Secondary to Retropharyngeal Abscess.

Vascular complications secondary to retropharyngeal abscess are rarely encountered in the post antibiotic era and include compression of internal carotid artery (ICA), infective arteritis and pseudoaneurysm formation. Post infectious ICA pseudoaneurysm formation is reported predominantly in the paediatric age group and rare in adults. We report a case of retropharyngeal abscess complicated by ICA pseudoaneurysm in an adult successfully managed by endovascular approach.

Unique Reciprocal Association Seen Between Latent Tuberculosis Infection and Diabetes Is Due to Immunoendocrine Modulation (DM-LTB-1).

Aim: The prevalence of latent tuberculosis infection (LTBI) among diabetes patients is poorly studied. In the present study, the prevalence of LTBI among pre-diabetes and diabetes patients was studied, along with immunoendocrine biomarkers (n = 804). Methods: LTBI was screened by Quantiferon TB gold in Normal glucose tolerance [(NGT); n = 170, [Pre-diabetes (PDM; n = 209), Newly diagnosed diabetes (NDM; n = 165) and Known diabetes (KDM; n = 260) subjects. CRP, TNF-α, IL-6, IL-1ß, IFN-ß, IL-12, IFN-γ, IL-2, insulin, leptin, and adiponectin levels in serum and IFN-γ levels in quantiferon supernatants were quantified by ELISA. The expression of T-bet was quantified using qRT-PCR. Serum TBARS and nitrite levels were quantified by colorimetry. Results: The LTBI prevalence was 32% in NGT, 23% in PDM, 24% in NDM, and 32% in KDM groups, with an adjusted OR of 0.61 (p < 0.05). Downregulation of CRP, TNF-α, and nitrites and upregulation of adiponectin could be responsible for LTBI mediated protection against insulin resistance (IR), while the high levels of IL-1ß, IL-12, and leptin could be responsible for IR mediated anti-TB immunity. The defective antigen-specific IFN-γ response, as seen in the KDM group, could be responsible for the low detection rate of LTBI and high probability of endogenous reactivation. Conclusion: There appears to be a biphasic relationship between diabetes-latent tuberculosis: At the early stages of diabetes it is reciprocal, while at a late stage it is synergistic, this important phenomenon obviously needs further research.

Auxin: An emerging regulator of tuber and storage root development.

Many tuber and storage root crops owing to their high nutritional values offer high potential to overcome food security issues. The lack of information regarding molecular mechanisms that govern belowground storage organ development (except a tuber crop, potato) has limited the application of biotechnological strategies for improving storage crop yield. Phytohormones like gibberellin and cytokinin are known to play a crucial role in governing potato tuber development. Another phytohormone, auxin has been shown to induce tuber initiation and growth, and its crosstalk with gibberellin and strigolactone in a belowground modified stem (stolon) contributes to the overall potato tuber yield. In this review, we describe the crucial role of auxin biology in development of potato tubers. Considering the emerging reports from commercially important storage root crops (sweet potato, cassava, carrot, sugar beet and radish), we propose the function of auxin and related gene regulatory network in storage root development. The pattern of auxin content of stolon during various stages of potato tuber formation appears to be consistent with its level in various developmental stages of storage roots. We have also put-forward the potential of three-way interaction between auxin, strigolactone and mycorrhizal fungi in tuber and storage root development. Overall, we propose that auxin gene regulatory network and its crosstalk with other phytohormones in stolons/roots could govern belowground tuber and storage root development.

Dual Aneurysm Formation in an Occupationally Predisposed Male: Atypical Hypothenar Hammer Syndrome.

Hypothenar hammer syndrome is typically described as a chronic repetitive injury to the ulnar artery at the level of hamulus of hamate and shows certain occupational predilection. Our case is an occupationally predisposed patient who had two aneurysm formations from the superficial palmar branch of ulnar artery and the digital branch, respectively, diagnosed and treated surgically. We call it an atypical hypothenar hammer syndrome as the arterial involvement was not typically at the level of hamate bone and only corresponded to the site of recurrent friction. This article also discusses the role of imaging and treatment options.

Radiological and cadaveric study of anatomical safe zone for transoral base of tongue surgery.

The aim of this study is to identify a surgical safe zone in base of tongue surgery. Fifteen Fresh frozen cadavers (30 head and neck regions) were included in the anatomical study. Twenty-two CT-angiogram (CTA) scans of neck were included in the radiological study. Surgical safe zone for base of tongue surgery was studied in cadavers and correlated the same in CTA. Depth of the lingual artery (LA) from the tongue surface and distance of origin of lingual artery from tip of greater cornu of hyoid bone was significantly different when comparing anatomical to radiological study (p < 0.005). On protruded position of tongue, lingual artery appeared more close to the tongue surface and was never encountered posterior to foramen caecum. Preoperative CTA evaluation would over-estimate the depth of LA putting the lingual artery at risk during resection. A surgical safe zone exists posterior to foramen caecum and towards the midline.

CT in the diagnosis of adnexal torsion: a retrospective study.

Ultrasonography (USG) is the first and best modality for diagnosis of the adnexal torsion. But frequently in clinical practice, computed tomography (CT) scan becomes the first acquired modality as adnexal torsion mimics other non-gynaecological conditions. This retrospective study evaluated the diagnostic performance of CT as a modality in adnexal torsion. Thirty cases of surgically proven adnexal torsion with preoperative CT scans were included. Changes in the ovary, fallopian tube, uterine axis and other features were documented and analysed. At least one positive CT sign was seen in all 30 adnexal torsion patients. Twisted pedicle was seen in 100% cases. Peripherally displaced follicles in 57.1%, associated mass in 93.3%, ovarian hyperdensity in 46.4%, hydrosalpinx in 46.7%, change in uterine axis in 43.4% and ascites in 73.3%. CT of the pelvis can diagnose ovarian torsion when the described signs are carefully looked for.Impact statementWhat is already known on this subject? Adnexal torsion is an surgical emergency where delayed diagnosis may reduce the ovarian salvageability rate. USG has been a trusted modality for imaging the adnexa and associated pathologies such as torsion. It is a general assumption that CT is not an apt modality for diagnosis of torsion.What the results of this study add? The results of this study emphasise that CT can be used to diagnose adnexal torsion when the signs described are carefully looked for. A normal appearing ovary on CT can rule out torsion as at least one sign will be positive in such cases.What the implications are of these findings for clinical practice and/or further research? As adnexal torsion clinically mimics non-gynaecological conditions such as ureteric colic, appendicitis, etc. where CT is the initial and only available modality, applying the results of our study can aid in diagnosis of adnexal torsion on CT itself, prompting immediate surgical referral and thereby reducing the delay by not acquiring or confirming by another modality such as USG.

Mind the gap: imaging spectrum of abdominal ventral hernia repair complications.

Ventral hernia repair with or without mesh placement is a commonly done procedure. Laparoscopic approach is more preferred than open in recent surgical practice. Complications occur as like any other abdominal surgeries and are dependent on multiple factors. Complications such as collections, adhesions, and related changes are non-specific. Specific complications related to hernia repair include recurrent hernia, mesh infection, mesh migration, and fistula formation. Post inguinal hernia repair chronic inguinal pain is gaining more attention with increasing use of image-guided nerve interventions for symptomatic management. Imaging plays a vital role in defining and delineating the type and extent of complications. Prior knowledge of the surgical indication and technique helps in better imaging interpretation of complications. This article describes the role of imaging in diagnosis of complications in general ventral hernia surgery setting.

Hydropic degeneration of leiomyoma in nongravid uterus: The "split fiber" sign on magnetic resonance imaging.

Extensive hydropic degeneration in uterine leiomyoma is a rare occurrence and is commonly reported in association with pregnancy. It is a close mimicker of malignancy due to rapid growth and atypical imaging appearances. Awareness of the imaging features helps in diagnosis, avoids unnecessary patient anxiety, and hence reassurance especially when encountered in pregnancy. We report two cases of extensive hydropic degeneration of leiomyoma in nonpregnant females with imaging and histopathology correlation. We also propose the "split fiber" sign as a useful magnetic resonance imaging feature for diagnosing this condition.

Sonographic features of invasive ductal breast carcinomas predictive of malignancy grade.

CONTEXT: Assessment of individual sonographic features provides vital clues about the biological behavior of breast masses and can assist in determining histological grade of malignancy and thereby prognosis. AIMS: Assessment of individual sonographic features of biopsy proven invasive ductal breast carcinomas as predictors of malignancy grade. SETTINGS AND DESIGN: A retrospective analysis of sonographic findings of 103 biopsy proven invasive ductal breast carcinomas. MATERIALS AND METHODS: Tumor characteristics on gray-scale ultrasound and color flow were assessed using American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) Atlas Fifth Edition. The sonographic findings of masses were individually correlated with their histopathologic grades. STATISTICAL ANALYSIS USED: Chi square test, ordinal regression, and Goodman and Kruskal tau test. RESULTS: Breast mass showing reversal/lack of diastolic flow has a high probability of belonging to histological high grade tumor (ß 1.566, P 0.0001). The masses with abrupt interface boundary are more likely grade 3 (ß 1.524, P 0.001) in comparison to masses with echogenic halos. The suspicious calcifications present in and outside the mass is a finding associated with histologically high grade tumors. The invasive ductal carcinomas (IDCs) with complex solid and cystic echotexture are more likely to be of high histological grade (ß 1.146, P 0.04) as compared to masses with hypoechoic echotexture. CONCLUSIONS: Certain ultrasound features are associated with tumor grade on histopathology. If the radiologist is cognizant of these sonographic features, ultrasound can be a potent modality for predicting histopathological grade of IDCs of the breast, especially in settings where advanced tests such as receptor and molecular analyses are limited.

Stress and Stressors among Medical Undergraduate Students: A Cross-sectional Study in a Private Medical College in Tamil Nadu.

BACKGROUND: Medical education is perceived as being stressful, and a high level of stress may have a negative effect on cognitive functioning and learning of students in a medical school. OBJECTIVES: To (a) assess the perceived stress among medical undergraduate students, (b) identify the sources of stress, and (c) find an association of perceived stress with sociodemographic characteristics and various stressors. MATERIALS AND METHODS: A cross-sectional study was conducted among medical undergraduate students in a private medical college in Tamil Nadu. A total of 750 medical students from 1st year to final year were invited to participate in the study. Self-administered questionnaire was used to collect data regarding sociodemographic profile, perceived stress using perceived stress scale-14 and academic, psychosocial and environmental stressors. Descriptive statistics was used to describe the sociodemographic characteristics, sources of stress and perceived stress. Logistic regression analyses were carried out to assess determinants of stress. RESULTS: The overall response rate was 93.33% (700 out of 750 students). The mean perceived stress score was 25.64 ± 5.44. Higher age-group, year of studying bachelor of medicine and bachelor of surgery, vastness of academic curriculum, fear of poor performance in examination, lack of recreation, loneliness, family problem, and accommodation away from home were important determinants of perceived stress. CONCLUSIONS: The perceived stress was higher among higher age group and final year medical students. Academic, psychosocial, and environmental stressors are associated with perceived stress. Reframing the academic curriculum and examination patterns, incorporating recreational and sports activities, and establishment of counseling cells in the institution is needed.

Case 248: Cystic Duodenal Dystrophy with Groove Pancreatitis.

History A 59-year-old man presented to the gastroenterology outpatient department with acute abdominal pain centered in the epigastrium. He had experienced similar episodes of abdominal pain in the past that had been treated with surgery. He reported multiple failed attempts at upper gastrointestinal endoscopy. Laboratory tests were performed at the time of admission and revealed a serum glutamic-oxaloacetic transaminase level of 9 U/L [0.15 µkat/L] (normal range, 5-40 U/L [0.08-0.67 µkat/L]), a serum glutamic-pyruvic transaminase level of 34 U/L [0.57 µkat/L] (normal range, 5-45 U/L [0.08-0.75 µkat/L]), a serum γ-glutamyltransferase level of 210 U/L (3.50 µkat/L) (normal range, 10-50 U/L [0.17-0.83 µkat/L]), a serum alkaline phosphatase level of 157 U/L (2.62 µkat/L) (normal range, 30-120 U/L [0.50-2.0 µkat/L]), a serum amylase level of 210 U/L (3.50 µkat/L) (normal range, 30-100 U/L [0.50-1.66 µkat/L]), a serum lipase level of 391 U/L (6.52 µkat/L) (normal range, 13-60 U/L [0.21-1.0 µkat/L]), an α-fetoprotein level of 3.81 ng/ mL (normal range, 0-9 ng/mL), a total protein level of 4.6 g/dL (normal range, 6.0-8.5 g/dL), and an albumin level of 2.6 g/dL (normal range, 3.5-5.2 g/dL). The rest of the laboratory data were unremarkable. The patient underwent erect abdominal radiography, contrast material-enhanced multidetector row computed tomography (CT) of the abdomen with 100 mL of iohexol (300 mg iodine per milliliter, Omnipaque; GE Healthcare, Shanghai, China) followed by combined positron emission tomography (PET) and CT (hereafter, PET/CT) with 6.9 mCi of fluorodeoxyglucose (FDG) and magnetic resonance (MR) imaging of the upper abdomen.

A rare case of adult ovarian hernia in MRKH syndrome.

Inguinal hernias containing ovary have a documented incidence of 3%. Most of the cases are associated with congenital anomalies of genital tract such as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. A 20-year-old female presented with primary amenorrhoea, normal secondary sexual characteristics and genetic karyotyping showing 46XX chromosome. On USG abdomen and pelvis examination complete absence of uterus, cervix and vagina was found. Both the ovaries were seen away from normal anatomical location in bilateral inguinal canal without significant complication. MRI study confirmed agenesis of uterus, cervix and vagina; bilateral inguinal hernia with ovaries as contents. Type 1 MRKH syndrome with bilateral ovarian hernias was diagnosed.

Bilateral nasolabial cysts - case report and review of literature.

Nasolabial cyst is a non-odontogenic, extraosseous, soft tissue cyst, commonly unilateral, located in the nasolabial fold. Bilateral nasolabial cysts are of rare occurrence. This case report describes the multimodality imaging appearance of bilateral nasolabial cysts with a review of literature.

Angioinvasive rhinocerebral mucormycosis with complete unilateral thrombosis of internal carotid artery-case report and review of literature.

Angioinvasive rhinocerebral mucormycosis is an acute fulminant infection caused by fungi of the order Mucorales that targets uncontrolled diabetics and other immunosupressed individuals. Early imaging features of angioinvasiveness include the presence of thrombosed vessels, especially in the orbital regions and the "black turbinate" sign representing devitalized paranasal sinus mucosa. Intracranial extension carries a grave prognosis, with death reported in 90% of cases. This case report highlights the early and key imaging features of angioinvasive rhinocerebral mucormycosis and a rare complication of complete internal carotid artery thrombosis.

Oesophageal perforation as a complication of ingested partial denture.

We report herein the case of a 53-year-old female who came to the emergency room with the chief complaints of severe dysphagia and chest pain following accidental swallowing of her denture. The patient had swelling of the face, neck and eyelids with difficulty in breathing. A skull radiograph was taken, which revealed a missing partial denture from the right lower jaw. Anteroposterior radiograph of the chest showed two metallic objects in the mid-thorax, adjacent to the descending aorta. CT scan of the neck and chest revealed two metallic objects (measuring approximately 17mm each) in the middle one-third of the oesophagus (right posterolateral aspect), causing perforation of the oesophagus and leading to pneumomediastinum, and left pneumothorax with subcutaneous emphysema of the neck and chest. An emergency thoracoscopic removal of the foreign body (partial denture) was performed with subsequent repair of the oesophageal tear in the same sitting. Post surgery, the patient was shifted to intensive care unit and she recovered well over a course of time. In summary, accidental ingestion of a partial denture can lead to grave complications such as oesophageal perforation, which should be managed on an emergency basis with thoracoscopic removal of the foreign body.

Multimodality imaging in adnexal torsion.

Adnexal torsions are one among the causes of acute pelvic pain in females. Commonly occurring adnexal torsions are ovarian either involving the normal ovary with functional cysts or an associated mass. Fallopian tube torsions, torsions involving paraovarian, fimbrial cysts and subserosal fibroids are rare. Here we discuss the multimodality imaging approach for the diagnosis of adnexal torsion, its limitations and mimics.

Trends in Average Living Children at the Time of Terminal Contraception: A Time Series Analysis Over 27 Years Using ARIMA (p, d, q) Nonseasonal Model.

BACKGROUND: India's National Family Welfare Programme is dominated by sterilization, particularly tubectomy. Sterilization, being a terminal method of contraception, decides the final number of children for that couple. Many studies have shown the declining trend in the average number of living children at the time of sterilization over a short period of time. So this study was planned to do time series analysis of the average children at the time of terminal contraception, to do forecasting till 2020 for the same and to compare the rates of change in various subgroups of the population. MATERIALS AND METHODS: Data was preprocessed in MS Access 2007 by creating and running SQL queries. After testing stationarity of every series with augmented Dickey-Fuller test, time series analysis and forecasting was done using best-fit Box-Jenkins ARIMA (p, d, q) nonseasonal model. To compare the rates of change of average children in various subgroups, at sterilization, analysis of covariance (ANCOVA) was applied. RESULTS: Forecasting showed that the replacement level of 2.1 total fertility rate (TFR) will be achieved in 2018 for couples opting for sterilization. The same will be achieved in 2020, 2016, 2018, and 2019 for rural area, urban area, Hindu couples, and Buddhist couples, respectively. It will not be achieved till 2020 in Muslim couples. CONCLUSION: Every stratum of population showed the declining trend. The decline for male children and in rural area was significantly faster than the decline for female children and in urban area, respectively. The decline was not significantly different in Hindu, Muslim, and Buddhist couples.