To evaluate the role of MRI in infants with suspected hypoxic ischemic encephalopathy and prognosticating neurological outcome at end of one year

Background: Hypoxic ischemic encephalopathy (HIE) is one the common causes of neonatal fatality due to perinatal asphyxia. The long-term outcomes of HIE are impaired mental and motor development, hearing loss, recurrent seizures and cerebral palsy. MRI is increasingly becoming the gold standard in diagnosis of HIE as it involves no radiation and can be performed during a neonates physiological sleep. To evaluate the role of MRI in infants with suspected hypoxic ischemic encephalopathy in prognosticating neurological outcomes at end of one year.Methods: A total of 50 patients were included in the study who underwent MRI of brain. A clinical follow up was done at the end of one year.Results: The sensitivity of MRI in prognosticating clinical outcome was 72% and specificity was 71% while PPV and NPV was 86% and 50% respectively.Conclusions: MRI is a useful modality to assess early changes in HIE and it can prognosticate clinical outcome

Ultrasound evaluation of carpal tunnel syndrome in patients with bifid median nerve

Background: Patients with high division of the median nerve proximal to carpal tunnel, or bifid median nerve, may present with carpal tunnel syndrome (CTS). Ultrasound (US) measurements indicative of CTS in this subset of patients differ from those in patients with non-bifid median nerve.   The objectives were to evaluate the parameter ∆CSA [difference between the maximum cross-sectional area of bifid median nerve within carpal tunnel (CSAc) and outside tunnel (CSAp)] in the diagnosis of CTS, to compare sensitivity and specificity of ∆CSA with nerve conduction velocity studies (NCS), and to compare the cross-sectional area (CSAc, CSAp & ∆CSA) of bifid median nerve in CTS patients with that in asymptomatic controls.Methods: 20 wrists with bifid median nerves and symptoms suggestive of CTS were included in the study group. Nerve conduction velocity studies (NCS) were performed in all cases. 4 wrists of asymptomatic age-matched subjects had bifid median nerves and normal NCS and were included in the control group. High resolution ultrasonography was performed for all wrists and findings documented. Statistical Analysis: Receiver Operating Characteristics curves were used to obtain the level of significance (p-value) and assessment of correlation between ∆CSA and NCS findings.Results: There was significant correlation between ∆CSA and NCS. A cut-off value of 2.3mm2 gave the best calculated sensitivity (76.9 %) and specificity (100%).Conclusions: CSA criteria for diagnosing CTS in patients with bifid median nerves are different from those in patients with non-bifid median nerve. ∆CSA is a sensitive and specific parameter for confirming the diagnosis of CTS in patients with bifid median nerve with sensitivity approaching that of NCS

H1N1 influenza: Does chest radiograph have a role in predicting prognosis?

Aims and Objectives: To assess pattern and distribution of chest ray findings in proven case of H1N1 & To evaluate sequential radiographs to assess progression/ resolution of disease. Material and Methods: Patients presenting to a tertiary care hospital in coastal Karnataka, India, from May 2009 to Feb 2011, who tested positive for H1N1 virus with real time PCR test and underwent chest X ray were included in the study. The pattern and distribution of findings and extent of involvement was studied in the initial chest radiograph. Sequential radiographs were studied for progression of disease. Results: The age of patients ranged from 1 to 65 years with 11 (31.5%) patients in pediatric age group, two patients above 60 years and rest were middle age adults (62.8%). Out of 39 patients, four patients had a normal chest radiograph. In the remaining 35 patients, commonest finding was consolidation (77.1%) followed by ground glass opacity (68.6%). Thirty patients had involvement of both lungs at presentation out of which 17 improved, 12 patients expired and one was discharged on request. Conclusion: Patients with bilateral multizonal involvement at presentation deteriorated faster and had an adverse outcome whereas patients with single zone or unilateral involvement had a better outcome. Consolidation and ground glass opacities, especially if bilateral and multizonal predicted adverse outcome. Chest radiograph can play an important role in assessing pattern and distribution of findings and may help in predicting prognosis

Case Report-Inguinoscrotal ureteral hernia diagnosed on micturating cystourethrography

The presence of a ureter within an inguinal hernia is an extremely rare entity, usually discovered incidentally during herniorrhaphy and may pose a surgical risk. Early preoperative diagnosis is crucial to guide proper surgical approach and to preserve renal function

CT features, mimics and atypical presentations of gastrointestinal stromal tumor (GIST)

The term stromal tumor was coined in 1983 by Clark and Mazur for smooth muscle neoplasm of the gastrointestinal tract (GIT). Gastrointestinal stromal tumors (GIST) are nonepithelial tumors arising from the interstitial cells of Cajal, which express KIT protein-CD117 on immunohistochemistry. GIST can arise anywhere in the GIT, including the mesentery, omentum, and retroperitoneum