High resolution ultrasonography in isolated soft tissue and intramuscular cysticercosis

Background: Cysticercosis is a common parasitic public health issue especially in developing countries. Though the extraneural tissues are usually involved synchronously or metachronously with the brain, isolated infestation of soft tissue and muscle in the absence of neural involvement is more common than previously thought. High resolution ultrasonography has evolved now as an investigation of choice with proven sonological patterns of soft tissue cysticercosis which can entirely negate the need for invasive interventions.The aim of the study is to: a) evaluate the diagnostic utility of HRUSG in isolated soft tissue- intramuscular    cysticercosis; and b) evaluate and emphasized the role of the non-surgical conservative medical management in these cases.Methods: Prospective evaluation of total 15 cases of extraneural cysticercosis over a period of 2 years at DMIMS Sawangi. HRUSG analysis of 15 cases was done to evaluate and classify the various classic sonomorphological features of isolated cysticercosis involving soft tissue and muscles. FNAC was done in 3 cases. 12 out of 15 patients were followed up closely over serial ultrasound after initiation of medical therapy at 15 days, 1 month and at 3 months interval. Tablet Albendazole with or without steroid cover was given to each of 12 patients and treatment response was recorded.Results: Out of 15 cases, 7 were male and 8 were female patients. Nine individuals were vegetarian and six were non vegetarian. Mean age was 28 years. All cases were diagnosed on HRUSG. Intramuscular lesion was identified in 11 cases and 4 cases had subcutaneous involvement with anterior abdominal wall in muscular plane as the commonest site in three patients. FNAC was done in 3 cases confirming the cysticercosis and was treated surgically. 12 patients were treated with medical therapy and showed complete resolution at 3 month ultrasound follow up.Conclusions: With the advent of high resolution ultrasonography and increased clinical awareness of the isolated soft tissue-intramuscular cysticercosis especially in endemic zone, a more conservative non-invasive approach can be applied both in diagnosis and treatment of these isolated cases of cysticercosis

Androgen insensitivity syndrome: discussion based on three cases

Androgen insensitivity syndrome is an X-linked recessive condition due to a complete or partial insensitivity to androgen, resulting in a failure of normal masculinisation of the external genitalia in chromosomally male individuals. This failure of virilisation can be either complete or partial depending on the amount of residual androgen receptor function. It is classified into three categories depending upon the degree of genital masculinisation into complete, partial and mild insensitivity with phenotype variation from normal female at one end to normal male on other end.Here we described two cases of partial and one case of complete androgen insensitivity syndrome. The presenting feature in partial androgen insensitivity patients was amenorrhea in 16 year female and ambiguous genitalia in 7 months baby. The complete androgen insensitivity case presented with inguinal hernia only at 6 years of age. All the three cases were classified according to Quigley scale with Karyotyping confirming 46 XY genotype. After full evaluation two patients had undergone gonadectomy while in third case parents opted to take definitive decision in future. The role of psychological support and counselling is also emphasized with timing of disease disclosure to patient left over to the parents for appropriate age

Fetal transcerebellar diameter and transcerebellar diameter – abdominal circumference ratio as a menstrual age independent parameter for gestational age estimation with grading of cerebellar

Background: It is important for achieving an uneventful gestation to have a sensitive, specific and age independent obstetric biometric parameter which stays constant throughout the gestation. Transcerebellar diameters (TCD), TCD/ abdominal circumference (AC) ratio are reliable, constant predictors to assess the gestational age and to evaluate fetal growth. Along with TCD, the morphology of the cerebellum also changes gradually with the advancing gestation. The aim of the study was to evaluate TCD and TCD/AC ratio in singleton uncomplicated pregnancy in assessing fetal gestational age and growth and to evaluate the morphological changes in the appearance of the cerebellum with advancing gestation and categorizing it into three grades system.Methods: Prospective cross sectional study carried out in 100 singletons uncomplicated pregnancy between 12-40 weeks of gestation attending antenatal ultrasound clinics of DMIMS Sawangi, Wardha. Morphology of cerebellum was studied and categorized on USG with measurement of TCD, AC, and TCD/AC ratio.Results: There was a significant linear correlation of TCD; AC with GA.TCD/AC ratio for normal fetal growth with gestational age from 12-40weeks was found to be constant with a mean of 13.75.Cerebellar grading was 27% in grade I, 40% in grade II and 33% in grade III. The median GA and TCD was 18 weeks and 17mm for grade I, 27 weeks and 27mm for grade II and 34 weeks and 42mm for grade III.Conclusions: Significant linear relation of TCD with GA indicating the reliability of this biometry in estimating gestational age and assessing fetal growth. TCD/AC ratio remains fairly constant throughout the gestation and is a sensitive gestational age independent parameter and a good predictor for fetal growth monitoring. Ultrasonography of posterior fossa demonstrated gradual morphological changes in the cerebellum

High resolution ultrasonography in isolated soft tissue and intramuscular cysticercosis

Background: Cysticercosis is a common parasitic public health issue especially in developing countries. Though the extraneural tissues are usually involved synchronously or metachronously with the brain, isolated infestation of soft tissue and muscle in the absence of neural involvement is more common than previously thought. High resolution ultrasonography has evolved now as an investigation of choice with proven sonological patterns of soft tissue cysticercosis which can entirely negate the need for invasive interventions.The aim of the study is to: a) evaluate the diagnostic utility of HRUSG in isolated soft tissue- intramuscular    cysticercosis; and b) evaluate and emphasized the role of the non-surgical conservative medical management in these cases.Methods: Prospective evaluation of total 15 cases of extraneural cysticercosis over a period of 2 years at DMIMS Sawangi. HRUSG analysis of 15 cases was done to evaluate and classify the various classic sonomorphological features of isolated cysticercosis involving soft tissue and muscles. FNAC was done in 3 cases. 12 out of 15 patients were followed up closely over serial ultrasound after initiation of medical therapy at 15 days, 1 month and at 3 months interval. Tablet Albendazole with or without steroid cover was given to each of 12 patients and treatment response was recorded.Results: Out of 15 cases, 7 were male and 8 were female patients. Nine individuals were vegetarian and six were non vegetarian. Mean age was 28 years. All cases were diagnosed on HRUSG. Intramuscular lesion was identified in 11 cases and 4 cases had subcutaneous involvement with anterior abdominal wall in muscular plane as the commonest site in three patients. FNAC was done in 3 cases confirming the cysticercosis and was treated surgically. 12 patients were treated with medical therapy and showed complete resolution at 3 month ultrasound follow up.Conclusions: With the advent of high resolution ultrasonography and increased clinical awareness of the isolated soft tissue-intramuscular cysticercosis especially in endemic zone, a more conservative non-invasive approach can be applied both in diagnosis and treatment of these isolated cases of cysticercosis