Primary neuroendocrine mediastinal tumor presenting with carcinoid syndrome and left supraclavicular lymphadenopathy: clinico-radiological and pathological features.

Primary mediastinal neuro-endocrine tumor is very rare. The primary modality to evaluate the lesion is computed tomography, to know disease extent, involvement of various structures, vascular invasion and metastasis. Histo-pathological and immuno-histochemical confirmation is mandatory. We report a rare case of primary neuroendocrine mediastinal tumor/atypical carcinoid in a young male who presented with carcinoid syndrome and left supraclavicular lymphadenopathy. Complete diagnostic work up was done followed by histo-pathological and immuno-histochemical confirmation. Later on patient underwent radical surgery followed by chemotherapy. The patient is currently on follow up. Neuroendocrine carcinoma of the thymus generally follows an aggressive clinical course.The biologic behavior is directly related to grade and degree of differentiation. This case report of primary low grade neuroendocrine tumor/atypical carcinoid adds to the biological behavior of this tumor and sheds light on the radiological and pathological features of neuroendocrine carcinomas.

Magnetic resonance imaging evaluation of temporomandibular joint and associated soft tissue changes following acute condylar injury.

PURPOSE: This study evaluated the role of magnetic resonance imaging (MRI) in cases of acute condylar injury and assessed soft tissue damage such as disc displacement, capsular tear, and hemarthrosis within the temporomandibular joint (TMJ). PATIENTS AND METHODS: This prospective study was conducted in 15 patients who presented with unilateral or bilateral condylar fracture or contusion with a unilateral or bilateral diagnosis of TMJ sprain/strain. Patients with trauma of less than 7 days previously with a unilateral or bilateral condylar fracture or contusion with a diagnosis of TMJ sprain/strain were included in the present study. The clinical diagnosis of TMJ sprain was made and further classified and graded according to the severity and type of injury. On confirmation of the diagnosis of condylar injury, patients underwent evaluation by MRI. All patients were treated by closed reduction of the condylar fracture and intermaxillary fixation for 14 to 21 days. RESULTS: Of the 15 patients, 5 were children and 10 were adults. Of all 17 TMJ cases (2 bilateral, 13 unilateral), 2 condylar fractures were of the high variety and 13 were of the low variety. MRI diagnosis of disc displacement was established in 8 of 17 TMJ cases. There was a significant association between degrees of condylar injury and the MRI diagnosis of displaced disc and hemarthrosis. However, an MRI finding of capsular tear was not significantly associated with the degree of condylar injury. CONCLUSIONS: Soft tissue changes of the TMJ can be predicted accurately by MRI and are in direct proportion to the severity of the condylar injury of the mandible. Among the soft tissue changes, disc displacement and hemarthrosis seem to affect the outcome of functional treatment.

Computed tomographic features of congenital left ventricular diverticulum.

Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized out-pouching from the cardiac chamber. They are most often found in the left ventricle (LV) but have been reported to occur in all chambers of the heart. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture may be the initial presentation. Diagnosis can be established by echocardiography (EKG), computed tomographic (CT) angiography, and magnetic resonance imaging (MRI). We report a case of congenital left ventricular diverticulum in an adult with no valvular abnormality as an incidental finding in an uncommon location.

Role of kidney in hypertension.

Renin angiotensin system in the genesis of hypertension was established long after Goldblatt's belief that the minute capillaries of the kidney regulate blood pressure and he also suggested kidney released a pressure substance which lead to rise of blood pressure. Guyton provided experimental and analytical data supporting the role of renal pressure natriuresis in the regulation of normal circulation and its function resulting in the pathogenesis of hypertension. Hady and Overbeck proposed that the blood pressure of volume expanded hypertension was raised by a circulating inhibitor of the Na+/K+ ATPase pump. Brenner et al proposed that hypertension may arise from a congenital reduction in the number of nephrons or in the filtration surface area per glomerulus, thereby limiting ability to excrete sodium, raising blood pressure. Renin angiotensin system can be interrupted at four sites by adrenergic blocker, renin inhibitor, angiotensin converting enzyme inhibitor and angiotensin receptor blocker. Non-modulation in the face of relatively high dietary sodium could explain the pathogenesis of sodium sensitive hypertension and provide a more targeted, rational therapy for its correction.