Multi detector computed tomography imaging in penetrating injuries

Background: Penetrating injuries forms an important component of surgical emergencies. Penetrating trauma typically involves the violation of the body by a gunshot wound (GSW) or stab wound. Emergency laparotomy is the accepted management in patients with a penetrating injury who are not hemodynamically stable. However, selective non-operative management has been shown to decrease the rate of unnecessary surgery. Plain radiographs and FAST are useful for initial assessment of these patients. Multi detector CT is an indispensable tool in the evaluation of patients who are stable and are candidates for conservative treatment.Methods: A cross sectional observational study was carried out on 40 patients admitted with penetrating injury to the trauma centre of PGIMER and Dr RML hospital. Of the 40 patients, 14 were taken for emergency laparotomy. In 26 cases, MDCT was done to evaluate for solid organ, hollow organ and vascular injuries.Results: The mean age of patients was 38 years, with male to female ratio of 5:1. Stab injury was the commonest type of injury, followed by gunshot wounds. Liver was the commonest solid organ involved, followed by kidneys and spleen. Other organs involved were diaphragm, small bowel and colon.Conclusions: Penetrating injuries can be life-threatening, making prompt diagnosis essential. Recognizing key abnormalities on MDCT ensures patients are triaged appropriately. Multi-detector CT is thus widely used to evaluate penetrating injuries in stable patients

Surface-Chemical Studies on Graphite Suspensions using Inorganic Disperants

Electrokinetic and dispersion characteristics of graphite suspensions were studied in the absence and presence of varying concentrations of different inorganic dispersants, namely sodium silicate, sodium hexametaphosphate and sodium tripolyphosphate. The isoelectric point of graphite was found to be located at pH 2.3. From the zeta potential data obtained as a function of pH in the presence of varying concentrations of the dispersants, it was observed that the phosphate based inorganic dispersants were more efficient in enhancing the electronegative character of zeta potential. Thus, better stability of the graphite suspension could be obtained using the phosphate based dispersants. The results of the dispersion tests corrobo-rated the zeta potential data. The electron microscopic studies indicated that the graphite particles obtained from the supernatant were finer than those in the settled portion

Role of hippocampal volumetry in drug resistant epilepsy

Background: Hippocampus is a brain structure located deep in the temporal lobe. The structure is crucial for learning and memory and is a natural inhibitor of seizure activity in brain. In drug resistant epilepsy (DRE), there is shrinkage of the hippocampus leading to poor seizure control.Methods: Patients meeting the diagnostic criteria for drug resistant epilepsy between the age group of 10-60 years were enrolled in the study. Epileptic non drug resistant controls and normal healthy individuals were taken from same cohort. Selected patients underwent MRI Brain and their hippocampal volumes were estimated manually. Coronal oblique sections, perpendicular to the long axis of hippocampus were taken and hippocampal volume (HV) were calculated using region of interest approach with manual delineation . Results: There was increment in detecting hippocampal atrophy from 30% to 46.6% in DRE patients when manual hippocampal atrophy was used in addition to visual assessment. The mean right and left hippocampal volumes in drug resistant epilepsy cases were found to be 2.17+0.57 cc and 1.52+0.54 cc respectively. Left HV was found to be statistically significantly smaller than right side (p value < 0.05). DRE patients had smaller mean bilateral HV than healthy controls, the difference being 33%. The left HV loss was almost double the right HV loss among DRE cases. The hippocampal volumes were reduced in DRE patients compared to epileptic non-resistant patients; however the difference was found to be less than that of normal healthy controls.Conclusion: Manual hippocampal volumetry detected more patients with hippocampal atrophy in our study compared to visual assessment. Manual hippocampal volumetry should be routinely done in patients with Drug resistant epilepsy

Magnetic resonance imaging of temporomandibular joint in juvenile idiopathic arthritis

Background: Juvenile Idiopathic Arthritis (JIA) is the most common autoimmune inflammatory synovial arthritis causing wide range of disability in children. The involvement of temporo-mandibular joint (TMJ) in JIA varies ranging from 17% to 87%. Unlike other synovial joints, the TM joint is particularly vulnerable to inflammatory damage as the mandibular growth plate is superficial. JIA is a clinical diagnosis and is characterized by synovial hyperplasia and inflammation leading to joint effusion. TMJ involvement is clinically difficult to assess and often goes untreated. Children with TMJ arthritis have mastication dysfunction and pain. Delayed detection and treatment leads to abnormalities like micrognathia, jaw deformity, facial dysmorphism and chewing problems. MRI is the most sensitive modality to diagnose synovitis and involvement of TMJ in children of JIA.Methods: A cross-sectional observational study was undertaken in 30 children diagnosed as JIA as per ILAE criteria. They were evaluated clinically followed by contrast enhanced MRI for evidence of TMJ arthritis.Results: Of the 60 joints evaluated, clinical involvement was found in 18 joints (10 patients). 12(66.7%) out of them had MRI changes. 3(7.1%) joints out of 42 asymptomatic joints had MRI changes. 13 joints had synovial hypertrophy, 8 joints showed bone erosions. Bone marrow edema was seen in 2 joints, with no evidence of cartilage involvement in any joint. The sensitivity, specificity, PPV and NPV of clinical examination to diagnose TMJ arthritis as compared to MRI was 80.0%, 86.7%, 66.7% and 92.7% respectively.Conclusions: With paucity of clinical signs and symptoms, early involvement of TMJ arthritis in children of JIA can be detected by MRI to prevent long term disability in patients

Role of imaging in neonatal Chikungunya encephalitis acquired by vertical transmission

Background: Chikungunya is a viral infection which usually manifests as fever, rash, and arthralgia. Neurological complications are rare but are increasingly been seen in children and adults in endemic countries like India. Vertical transmission is seen in neonates with mothers who have been infected with the virus in the antenatal period. Objective: The objective of the study was to identify the essential role of imaging in the workup of these neonates, especially magnetic resonance imaging (MRI). Methods: A retrospective descriptive analysis of 10 neonates presenting with hypoactivity, maculopapular rash, and fever progressing to generalized seizures, and apnea suggestive of encephalitis was done. Chikungunya was confirmed by serum IgM CHICK enzyme-linked immune sorbent assay. Imaging evaluation included neurosonogram, computed tomography, and MRI with diffusion-weighted sequence with follow-up imaging at 1–3 months. Results: All the neonates had encephalopathy (100%) with or without seizures and perioral rashes. Cerebrospinal fluid showed mononuclear pleocytosis, raised protein or hypoglycorrhachia in 75% cases. Bacterial markers including cultures were negative. MRI showed features of viral encephalitis involving frontoparietal subcortical and deep white matter and corpus callosum with restricted diffusion. Neurocognitive outcomes in these neonates revealed neurodevelopmental delays for which follow-up MRI imaging was important, revealing reversal in diffusion changes, cystic encephalomalacia, and diffuse cerebral atrophy. Conclusion: In countries like India, experiencing annual outbreaks of Chikungunya infections radiologists must be familiar with the neuroimaging features and its possible sequelae

Poland syndrome: Atypical presentation and review of literature

Poland syndrome is a rare congenital disorder with absent or hypoplastic pectoralis major and hand anomalies. Dextroposition,female predisposition, and the left-sided anomalies in Poland syndrome are rarely reported in literature. We report a female babywho was born with chest wall defects, left hand anomalies, dextroposed heart, and hypoplastic ribs. She was diagnosed as Polandsyndrome and managed conservatively

Importance of Conventional Radiography in Diagnosis and Management of Giant Cell Tumour at an unusual location

Giant cell tumour (GCT) or osteoclastoma of the bone is mostly benign but locally aggressive primary tumour of unknownorigin occurring at epiphysis. It is a tumour of long bones and rarely seen in bones of hand and foot. The cases are reported intarsal and carpal bone but involvement of metatarsal bone is very rare. We present a case of twenty years old female patientwith GCT of second metatarsal of left foot. The patient underwent aggressive curettage and filling with bone chips and is onregular follow up

Aggressive vertebral hemangioma in early adolescent age group: Atypical presentation with computed tomography and magnetic resonance imaging appearance

Vertebral hemangiomas (VH) are vertebral vascular malformations, which may remain asymptomatic until adulthood. Sometimes,young individuals present with unexplained backache, which poses the diagnostic dilemma. We present a case of 15-year-old femalewho presented with prolonged unexplained intermittent upper back pain in the dorsal region. She was diagnosed as a case of aggressiveVH after ruling out other infective and malignant pathologies and treated with decompressive therapy. The present case highlights therole of imaging studies such as computed tomography and magnetic resonance imaging in such conditions