Magnetic Resonance (MR) Patterns of Brain Metastasis in Lung Cancer Patients: Correlation of Imaging Findings with Symptom

IntroductionAsymptomatic brain metastasis in lung cancer patients, if detected early have been reported to show survival benefit with treatment. These asymptomatic metastasis have been found to be smaller and less in number than those with symptoms. We however observed that many lung cancer patients bear a significant metastatic load in the brain irrespective of the stage or neurologic symptoms at the time of initial presentation.Material and MethodsA retrospective study was conducted on 175 patients of proven non-small cell lung cancer to assess the patterns of brain metastasis in the two groups of patients, with and without neurologic symptoms. All patients had undergone screening magnetic resonance imaging for brain metastasis as an initial staging protocol. The patients with brain metastasis were divided into two groups: asymptomatic (group I) and symptomatic (group II). The lesions were studied with regards to the number, size, site, nature (solid with and without necrosis), and presence of perilesional edema and intralesional hemorrhage in both the groups in various stages of disease.ResultsBrain metastasis was seen in 62 (31.3%) patients of whom 46.7% were neurologically asymptomatic. Patients (90.3%) with brain metastasis were in stage IV at the time of presentation. No statistically significant correlation was found between the two groups regarding the number of lesions (p = 0.554), size of lesion (p = 0.282), site of lesion (p = 0.344), nature of lesion (p = 0.280), presence of perilesional edema (p = 0.404), and presence or absence of intralesional hemorrhage (p = 0.09). In our study, brain metastases were present only in stages III and IV disease with no statistically significant difference in the lesion patterns.ConclusionThe study reveals almost equal number of patients with brain metastasis in the symptomatic and asymptomatic groups with no significant difference in lesion patterns. We therefore conclude that although imaging surveillance of the brain for metastasis will detect asymptomatic metastasis early for early institution of appropriate therapy the prognosis in these patients would not solely depend on the presence or absence of symptoms and the pattern of lesion may have an influence on the patients’ response to therapy and survival benefit specially for those asymptomatic patients with equally large metastatic load

Female genital tuberculosis: Revisited.

Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases

A case of broad ligament leiomyoma presenting as an ovarian mass

The broad ligament is the commonest extra uterine site for the occurrence of leiomyoma but with a very low incidence rate. It poses both clinical and radiological challenge in differentiating from an ovarian tumour. A 25-year-old unmarried female presented with history of lower abdominal pain associated with rapidly increasing abdominal distension for last 3 months. General physical examination was unremarkable. Examination of the abdomen revealed a firm, non-tender mass, with limited mobility arising from the pelvis corresponding to a uterine size of 32 weeks. Ultrasonography of abdomen revealed a 20×17×11cm right adnexal multi-loculated cyst. Contrast enhanced computer tomography scan of abdomen and pelvis showed a 12×17×17 cm well defined cystic lesion arising from the pelvis and ascending in to the abdominal cavity. The lesion also showed internal septa and peripheral rim enhancement. Right ovary was not seen separately. Tumor markers including CA-125 (22.4 IU/ ml), CEA (1.83/ml), CA-19.9 (22U/ml), Beta HCG (1.20IU/ ml), LDH (1.17IU/ml), and alpha feto-protein (0.8 ng/ml) were within normal limit. Laparotomy revealed a cystic mass arising from the right broad ligament. Histopathological examination revealed a broad ligament leiomyoma with extensive cystic degeneration. Broad ligament leiomyoma is uncommon tumour of pelvis and its differentiation from ovarian masses may be challenging for the clinicians.

Can endometrial volume assessment predict the endometrial receptivity on the day of hCG trigger in patients of fresh IVF cycles: a prospective observational study

Background: Objective of present study was to evaluate the role of three dimensional (3D) endometrial volume measurement on the day of hCG trigger in predicting the endometrial receptivity. The present study is a prospective observational study conducted at assisted reproductive centre of a tertiary care hospital.Methods: Endometrial volume was evaluated by three-dimensional ultrasound in 90 patients undergoing first cycle of IVF on hCG trigger day and was correlated with endometrial receptivity.Results: Out of 90 patients studied 12 patients achieved pregnancy. A significant difference was found in mean endometrial volume on hCG trigger day among pregnant (5.33±2.14 cm3) women compared to non-pregnant women (4.17±1.72cm3). Using Receiver operating characteristics (ROC) analysis the cutoff value for endometrial volume on hCG trigger day was 3.50 cm3 corresponding to sensitivity 75% and specificity 37.2%. Conclusions: The endometrial volume on hCG trigger day was significantly higher in pregnant women as compared to non-pregnant

Metastatic Signet-Ring Cell Gastric Carcinoma Masquerading as Breast Primary

Metastasis to the breast from an extra-mammary primary is a rare phenomenon; metastasis from gastric carcinoma to the breast is extremely so. We report a case who initially presented as mucin-secreting and signet-ring cell tumor of the ovary, and after an interval of 8 months with breast and chest wall metastatic nodules. The covert gastric primary eluded the oncologists at both presentations

Severe hydrops in the infant of a Rhesus D-positive mother due to anti-c antibodies diagnosed antenatally: a case report

<p>Abstract</p> <p>Introduction</p> <p>Rhesus haemolytic disease of the newborn is a prototype of maternal isoimmunisation and fetal haemolytic disease. There are other rare blood group antigens capable of causing alloimmunisation and haemolytic disease such as c, C, E, Kell and Duffy. In India, after the confirmation of a newborn's blood group, antibodies are screened only if the mother is Rehsus D-negative negative and the father is Rhesus D-positive. Hydrops in Rhesus positive women are investigated along the lines of non-immune hydrops.</p> <p>Case presentation</p> <p>We report the case of a patient from India where irregular antibodies were requested for an O-positive 26-year-old mother in order to investigate fetal hydrops. Anti-c antibody was revealed and the fetus was treated successfully with compatible O negative and c negative intrauterine blood transfusions. The baby was treated postnatally with double volume exchange transfusion with the same compatible blood, and was discharged 30 days after birth.</p> <p>Conclusion</p> <p>We highlight the importance of conducting irregular antibody screening for women with significant obstetric history and fetal hydrops. This could assist in diagnosing and successfully treating the fetus with appropriate antigen negative cross-matched compatible blood. We note, however, that anti-c immunoglobulin is not yet readily available.</p

Sharma’s Python Sign: A New Tubal Sign in Female Genital Tuberculosis

Female genital tuberculosis (FGTB) is an important cause of infertility in developing countries. Various type of TB salpingitis can be endosalpingitis, exosalpingitis, interstitial TB salpingitis, and salpingitis isthmica nodosa. The fallopian tubes are thickened enlarged and tortuous. Unilateral or bilateral hydrosalpinx or pyosalpinx may be formed. A new sign python sign is presented in which fallopian tube looks like a blue python on dye testing in FGTB

JB Sharma's white cotton ball sign: A new laparoscopic sign in abdominopelvic tuberculosis

Background: Abdominopelvic tuberculosis (TB) is a variant of extrapulmonary TB causing significant morbidity, including infertility. Materials and Methods: Results of 87 cases of diagnostic laparoscopy in cases of abdominopelvic TB diagnosed on composite reference standard (CRS) for demonstration of new laparoscopic white cotton ball sign are presented. Results: Mean age, parity and duration of infertility were 27.2 years, 0.21 and 3.1 years, respectively. Oligomenorrhoea and hypomenorrhea were seen in 35 (40.22%) and 32 (36.78%) cases, while infertility was seen in all 87 (100%) cases while abdominal mass was seen in 27 (31.03%) cases and pelvic mass in 37 (42.58%) cases. Positive acid fast bacilli on microscopy and culture of endometrial biopsy was seen in 3.34% and 6.89% cases while epithelioid granuloma was seen in 12.64% cases on endometrial biopsy and in 13.79% cases on peritoneal biopsy. Positive polymerase chain reaction was seen in all cases while definitive abdominal pelvic TB was seen in 35 (40.1%) cases and probable findings in 42 (48.27%) cases. A new laparoscopic white cotton ball sign (resembling a large white cotton ball) was observed in 5 (5.74%) cases and biopsy from 3 showed it to be epithelioid granulomas positive. Conclusion: Demonstration of a new white cotton ball sign on laparoscopy seems to be a useful finding in abdominal pelvic TB

Female genital tuberculosis: Revisited

Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases

Survey of knowledge, attitudes and practices of urogynecological problems amongst gynecologists of Delhi

non