A rare case of spontaneous heterotopic pregnancy with intrauterine gestational trophoblastic neoplasia and tubal ectopic pregnancy at a remote secondary care hospital.

A simultaneous presence of intrauterine and extrauterine gestation is called as heterotopic pregnancy (HP). The incidence of spontaneous HP is 1: 30000, which is very rare. In this case report, we are reporting a rare case of spontaneous HP in a 40-year-old lady with intrauterine gestational trophoblastic neoplasia (GTN) and ruptured tubal ectopic pregnancy in a remotely located secondary care hospital. The lesson learnt from our case report is that detection of intrauterine gestation does not rule out the possibility of the presence of ectopic pregnancy. Also, HP can occur without any obvious risk factors like in our case. It should be always kept in mind that HP can occur in any woman of reproductive age group. In the end, our patient was fortunate that she presented to us in a stable haemodynamic condition in spite of having ruptured tubal ectopic with spontaneous stoppage of bleeding from the ruptured tube. Hence, to achieve a great chance of favourable obstetric outcome, all treating doctors including family physicians should have a high index of suspicion to have accuracy in early diagnosis and treatment of a various variety of HP as these can occur with or without predisposing risk factors.

Appraisal of radiation dose with 64-slice computed tomography perfusion in lung cancer patients with special reference to SSDE: An initial experience in a tertiary care hospital.

CONTEXT: Computed tomography perfusion (CTP) is an important functional tool for lung cancer. It is expected to deliver high radiation dose, making its accurate estimation important. Size-specific dose estimate (SSDE) is a new dose metric, which includes the scanner output as well as the patient size. AIMS: To determine radiation dose [CT dose index (CTDIvol), dose length product (DLP), effective dose (ED), and SSDE] for CTP in lung cancer and the correlation of CTDIvol, DLP, and SSDE with effective diameter and SSDE with weight, body mass index (BMI), and the scan length. SETTINGS AND DESIGN: Cross-sectional study in the Department of Radio-diagnosis from October 2015 to March 2016. PATIENTS AND METHODS: Due ethical approval and informed consent was taken. Thirty consecutive adult patients of lung cancer undergoing CTP study were included; various radiation dose parameters were determined and presented as mean ± SD. STATISTICAL ANALYSIS USED: Paired Student's t-test and Pearson correlation using Statistical Package for the Social Sciences, Version 16. RESULTS: Mean radiation dose was CTDIvol = 270.138 ± 1.627 mGy, DLP = 681 ± 53.496 mGy.cm, ED = 12.501 ± 0.923 mSv, SSDE = 388.90 ± 81.27 mGy. The CTDIvol and DLP had significant positive correlation (r = 0.556, P = 0.000 and r = 0.522, P = 0.003, respectively) with effective diameter. SSDE had strong negative correlation (r = -0.997, P = 0.000) with effective diameter, significant negative correlation with the BMI (r = -0.889; P = 0.000) and weight (r = -0.910, P = 0.000) of patients. Scan length was not significantly correlated in SSDE (r = -0.012, P = 0.951). CONCLUSIONS: Smaller sized patients had greater SSDE.

Studies on the time course of apparent diffusion coefficient and signal intensities on T2- and diffusion-weighted MR Imaging in acute cerebral ischemic stroke.

The time course of changes in apparent diffusion coefficient (ADC) and signal intensity on diffusion-weighted magnetic resonance imaging (DW MR) imaging in acute ischemic stroke is a very dynamic event. There is an initial reduction in ADCs with no change on T2-W imaging but signal intensity increase on T2-weighted takes place about 6-12 hours after onset of stroke. As necrosis begins to set in, there is a gradual reversal of ADC change, and around 3-10 days post-onset, ADC pseudonormalizes. Twenty-four patients of acute stroke underwent diffusion MR imaging in addition to conventional T1W, T2W, and Fluid Attenuated Inversion Recovery (FLAIR) sequence performed within 12 hours, at 30 days, and at 90 days. The mean signal intensity at b = 0 s/mm2 and at b = 1000 s/mm2 were significantly higher than control values for all time periods. The ratio of signal intensity at b = 0 (rSI b=0) significantly increased from 1.63 +/- 0.20 in the acute stage to 2.19 +/- 0.24 in the chronic stage (P < 0.001). The ratio of signal intensity on DWI (r SIDWI) decreased from 2.54 +/- 0.46 to 1.54 +/- 0.22. The mean ADC in the lesion was found to be 41% lower than the mean ADC in the contralateral hemisphere .Linear regression analysis between rADC and log hours showed that pseudonormalization occurred at 6.61 days (P < 0.001). We conclude that the above information could be useful in the management of very early stroke.