Sanjay Gandhi Post Graduate Institute of Medical Sciences
Lucknow, UP | India
Main Specialties: Vascular & Interventional Radiology
Additional Specialties: TACE/ RFA/UFE/VARICOCELE EMBOLIZATION
Primary Affiliation: Sanjay Gandhi Post Graduate Institute of Medical Sciences - Lucknow, UP , India
15PubMed Central Citations
Indian Journal of Otolaryngology and Head & Neck Surgery · March 2019 with 47 Reads
Main limitation of classical technique is limited access to cochlea in terms of cochlear rotations and related structures, thus causing difficulty in electrode insertion. Veria technique allows full access to cochlea after raising tympanomeatal flap. To our best knowledge this is first clinic-radiological study for Veria technique studying distance between tympanic segment of facial nerve and posterior wall of external auditory canal (EAC) demonstrating facial nerve safety. Prospective study was done on 50 patients having bilateral sensori-neural hearing loss. Patients underwent cochlear implant surgery irrespective of age and gender. Preoperative high-resolution computed tomography temporal bone and magnetic resonance imaging head was done, distance between tympanic segment of facial nerve and posterior wall of EAC and basal turn angle were measured. Intraoperative NRT followed by orbito-meatal X-ray was done in post operative period. 25 (50%) were male, 25 (50%) female. 35 patients (70%) showed that the distance between tympanic segment of facial nerve and posterior wall of EAC was more than 3 mm with mean 4.41 mm (± 0.63 SD). Distance calculated was greater in older age group than younger group. Patient having inner ear malformation, mean was 3.96 mm (± .44 SD). Whereas patients having acquired disease, mean distance was 4.30 mm (± .47 SD). On gender comparison of basal turn angle score, no significant difference was observed male (54.34° ± 4.48°) versus female (55.66° ± 4.15°) (p = 0.282). Mean of basal turn angle (BTA) in ≤ 5 years age group was 54.89° ± 3.65°, in 6–10 years age group was 55.21° ± 5.23° and in age group ≥ 11 years was 54.93° ± 4° with no significant difference in mean value between the groups (p = 0.282). High jugular bulb was seen in 4 patients (2 in right side, 2 in left side), hypoplastic jugular bulb was seen in 10 patients (9 in left, 1 in right), otosclerosis in 2 patients. Veria technique is safe for facial nerve, as preoperatively distance between tympanic segment of facial nerve and posterior canal wall can be identified. It is suitable method for rotated cochlea (identified preoperatively through BTA) and deformed cochlea as it offers a wide visibility and accessibility as compared to posterior tympanotomy approach. BTA and distance between posterior canal wall of EAC and tympanic segment of facial nerve should be done in all cases to see any cochlear rotation and feasibility of surgery.
Kumar S, Mishra P, Kumar S. Ureteral obstruction by an aberrant renal artery: A case report. Indian J Case Reports. 2018
ABSTRACTThe ureter is a muscular tubular structure that carries urine from the kidney to the urinary bladder. It is usually about 20–25 cm in length and 3–5 mm diameter. The upper half lies in the belly and the lower half in the pelvic area. A ureteral obstruction is a blockage of either unilateral or bilateral ureters that carry urine from the kidneys to the urinary bladder. Ureteral obstruction can be curable. However, if it is not treated, symptoms can quickly move from mild pain, fever, and infection to severe including loss of kidney function, sepsis, and death. Here, we report the case of an upper ureteral obstruction by an aberrant artery. The artery was originating from the right renal artery, supplying the right psoas muscle, and causing gross proximal hydroureteronephrosis in a 24-year-old male patient. ureter is a muscular tubular structure that carries urine from the kidney to the urinary bladder. It is usually about 20–25 cm in length and 3–5 mm diameter. The upper half lies in the belly and the lower half in the pelvic area. A ureteral obstruction is a blockage of either unilateral or bilateral ureters that carry urine from the kidneys to the urinary bladder. Ureteral obstruction can be curable. However, if it is not treated, symptoms can quickly move from mild pain, fever, and infection to severe including loss of kidney function, sepsis, and death. Here, we report the case of an upper ureteral obstruction by an aberrant artery. The artery was originating from the right renal artery, supplying the right psoas muscle, and causing gross proximal hydroureteronephrosis in a 24-year-old male patient. The patient was diagnosed using contrast-enhanced computed tomography through the abdomen examinatio
Int J Radiography Imaging Radiat Ther, 1(1): 18-24.
A Comparison of Radiation Exposure between CTA and DSA Examinations of Acute Gastrointestinal Bleed
Background: The number of CTA investigations is continuously increasing compared to the DSA investigations; there is little comparative dose information about the different imaging techniques. In the present study, we compared the patient radiation exposure resulting from diagnostic CTA and DSA examinations for acute gastrointestinal bleed. Materials and methods: This was hospital based prospective study. A total of 80 cases of GI bleed were included in whom both CT angiography and Digital substraction angiography was done. These patients were finally analyzed. Results: There was good overall agreement (64/80, 85%, 95% CI=75.6-91.2) with Sensitivity (64/66, 97%, 95% CI=88.5-99.5) and specificity (4/14, 28.5%, 95% CI=1-58) of CTA as compared to DSA. Kappa coefficient (0.33, 95% CI=0.05-0.61, p=0.001) showing a significant fair absolute agreement between two modalities (CTA and DSA). Effective Radiation doses (mSv) of the triple phase was significantly high in CTA as compared to DSA (19.71 ± 1.50 vs. 1.56 ± 0.56, p<0.001). Conclusion: Although CTA can be easily used as a diagnostic modality in cases of acute GI bleed and it has similar accuracy in localization as compared to DSA, easily available in hospital and requires less expertise than the DSA with no morbidity but effective radiation dose of CTA was approximately 12 times as compared with DSA which revealed that DSA is much better (quite low radiation) than CTA. Keywords: Computed tomography angiography; Digital subtraction angiography; Acute gastrointestinal bleed; Radiation doses; Kappa coefficient
Journal of Drug Delivery & Therapeutics
Pancake kidney, also called pelvic fused kidney, lump or cake kidney, is a rare type of congenital renal fusion anomaly. It is characterized by the presence of a lobulated pelvic renal mass which has a dual parenchymatous system without an intervening septum. Pancake kidney is prone to obstruction due to abnormal rotation of collecting system and calculus. We report a case of pancake kidney with right PUJ and left ureteric calculus causing hydronephrosis in a 9-years-old male child, evaluated by ultrasonography and MDCT, underwent image-guided (sonography and fluoroscopy) percutaneous nephrostomy for relieving the ureteric obstruction
J Indian Assoc Pediatr Surg 2018 Jul-Sep;23(3):148-152
Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, India.
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Journal of Indian Association of Pediatric Surgeons
Aim and Objectives: Despite the significant advancements in the management of anorectal malformations (ARMs), there are various surgical and functional complications reported. Complications are closely related with the surgical techniques adopted and the types of malformations. In this article, we present our experiences with ARM patients who required reoperation after unsuccessful previous surgeries or who had developed complications related to the previous surgical techniques. Materials and Methods: We retrospectively reviewed clinical and electronic records of all the patients with ARM who were operated for ARMs in our institute from June 2010 to May 2016. All ARM patients who needed reoperation were included in the study. These patients were previously operated outside our institute and referred to us with ongoing problems of constipation, stool impaction with overflow incontinence, perineal soiling, and difficult urination. Results: There were 31 patients (M: F = 2.1:1) of an ARM, reoperated for 38 indications during the above-mentioned period. Five patients had more than one problem. Presentation included neo anus stenosis (11), complete obliteration of neo anus (2), malpositioned neo anus (2), persistent/recurrent rectourethral fistula (3), iatrogenic rectovaginal fistula (4), rectal prolapse (5), large widened neo anus with soiling (2), and urethral stricture (2), which required revision interventions. Six patients had megarectum. All patients showed improvement in their symptoms after revision surgery, but 10 (41.7%) patients required further regular bowel management program (BMP) to avoid the soiling and constipation. Fourteen (58.3%) patients stayed clean without regular BMP. Conclusion: All these complications had clear explanations and are well described in the literature. Revision surgery in such patients had fair outcome, but some sort of BMP was required. Both posterior sagittal ano rectoplasty and anterior sagittal ano rectoplasty are excellent techniques for revision surgery with few simple modifications. K : Anorectal malformation, anterior sagittal ano rectoplasty, complication, posterior sagittal ano rectoplasty, revision surgery
International Journal of Medicine Science and Public health
Background: Colorectal cancer is the third most common cancer in men, and it is second most common in women worldwide. Magnetic resonance imaging (MRI) is free of ionizing radiation and imparts highest soft tissue contrast; therefore, it can provide the best assessment of evaluation of local spread. The available data show that only a few studies have been done describing the role of high-resolution MRI (HRMRI) in staging of rectal cancer in Indian population. Objectives: The present study attempts to find the correlation and level of agreement between HRMRI and Surgico- pathological findings in rectal carcinoma patients. Materials and Methods: This hospital-based prospective study was conducted on patients diagnosed with rectal cancer. MR study for pre-operative evaluation was done on 97 patients. 60 operated cases who gave the consent were included in the final study. Findings from MR study were compared with surgical and histopathological findings. Results: Result showed that mean tumor size was 7.43 ± 3.12, 6.88 ± 3.04, and 5.67 ± 2.50 by MRI, surgical, and histological methods (P < 0.001). Overall agreement between MRI and operative finding and histopathological finding was 0.95 and 0.75 respectively (P < 0.001), showing good absolute agreement between the methods. Conclusions: There was good agreement between the MR, surgical, and histopathological findings for local staging and pre-operative planning of rectal carcinoma. KEY WORDS: High-resolution Magnetic Resonance Imaging; Surgical and Histopathological findings; Rectal Carcinoma, Local Staging
Abstract Background and aim: Prognostic scoring systems (PSS) have not been validated in children with chronic Budd-Chiari syndrome (BCS). We aimed to analyse the long-term outcome of radiological intervention (RI) and validate the PSS in children. Methods: Chronic BCS children were analysed in four subgroups: SI: successful intervention (primary or secondary stent patency) b) PO: poor outcome (refractory stent block or requirement of liver transplantation), c) NU: naïve unintervened (awaiting RI) and d) DBI: died before intervention. PSS analysed included Pediatric end-stage liver disease (PELD), Rotterdam, BCS-Transjuglar intrahepatic Portosystemic shunt (BCS-TIPS) index, Zeitoun, Child-Pugh and Model for end-stage liver disease. Results: Of 113 BCS children, 48 children underwent 53 successful primary RI. Actuarial probability of vascular patency was 87% at 1 year and 82% at 5 year follow-up. 4 groups (SI: n=40, PO: n=7, NU: n=13, DBI: n=6) were analysed. Univariate analysis showed pre-intervention PELD score [PO: 11 (-1 to 23) vs. SI: 2 (-8 to 25), p=0.009] with a cut-off of 4 (AUC: 0.809, 86% sensitivity, 75% specificity) determined poor outcome following intervention. In unintervened group (NU vs. DBI), multivariate analysis demonstrated that Zeitoun score predicted death independently (OR 15.4, 95%CI: 1.17-203.56, p=0.04) with a cut-off of 4.3 (AUC: 0.923, 83% sensitivity and 77% specificity). Conclusions: Children with BCS have a favourable long-term outcome. Among those undergoing RI, pre-intervention PELD score determines the outcome. Survival is determined by Zeitoun score in those unintervened. This article is protected by copyright. All rights reserved.
Liver International 38(7) · January 2018
Int J Radiol Radiat Ther 2017, 4(4): 00103
International Journal of Radiology & Radiation Therapy
Abstract Image Guided placement of lines and ports by Interventional Radiologist has increased dramatically over last decade and has advantage of precise positioning of the catheter tip and have less chance of complications, like pneumothorax and arterial puncture. These lines and ports are used for infusion of antibiotics, chemotherapeutic drugs and administration of blood products, hyperalimentation, dialysis and aphaeresis. PICC are long intravenous lines inserted under ultrasound guidance in basilic vein or brachial vein. The advantage of inserting under image guidance is that PICC can be inserted through mid-arm vein and elbow joint is free for movement. Some IR is these days placing tunnelled PICC for securing these PICC and to decrease change of infection at exit site. The inner end of these PICC is generally at cavoatrial junction. Power PICC have recently been approved for use in India and these PICC can be used with pressure injector with flow rate up to 5ml/sec and pressure up to 300Psi. Non-tunnelled CVC are indicated for short term use and these CVC are generally inserted into jugular vein. Non-tunnelled CVC insertion is generally done as bed side procedure and that too in quick time. But, non-tunnelled CVC have high chance of infection and are dislodged easily. Tunnelled CVC are inserted under image guidance into large vein (jugular vein) and then this catheter travel through a subcutaneous tunnel before exiting the skin. These catheters have dacron cuff embedded on the shaft and it is believed that these dacron cuff incite a fibrotic reaction that ultimately secures the catheter in place and decrease spread of infection from skin exit site to the circulation. Tunnelled Hickman Catheters are generally dual lumen devices and generally used for aphaeresis. Tunnelled Hemodialysis catheters are generally 14.5Fr dual lumen devices with length varying from 19cm to 28cm and these catheters are capable of handling high flow rate (500 to 600ml/min). Ports are made of titanium and plastic and this part have two parts: a) a silicone or polyurethane catheter and this catheter are generally connected to a b) reservoir. These reservoirs are accessed by special non-coring Hubner needle through the skin and a silicon window. These Ports are available in single or double lumen configuration and entire port is buried in the subcutaneous tissue of the chest or arm or even the thigh or abdomen. Recently, Power Port has been approved for use in India and these Power Port are triangular in shape and can be used with Pressure Injector. The selection of most appropriate catheter in an individual case is made jointly by the referring physician, IR and the patient. The choice of which access device to choose is a collaborative process and this decision needs to be made judiciously. Care and maintenance of these catheters and ports is important, so that this access device can be used for long time. Keywords: Tunnelled; Hemodialysis; Chemotherapy
Journal of Clinical Interventional Radiology
The use of central venous catheters has become ubiquitous in the clinical practice. While a majority of them are easy to insert, many consider it a mundane interventional procedure. However, it is important to ensure that the right catheter is selected for the right patient. In addition, due diligence should be observed during site selection and catheter securement. This article briefly but concisely covers various aspects of venous catheter insertion ranging from catheter selection, patient preparation, choice of skin antisepsis to catheter tip position. This article, however, does not deal with the actual steps involved in the insertion of various catheters.
European Journal of Pediatric Surgery
J Gastroenterol Hepatol 2017
Abstract Background/Aims There are sporadic reports of occurrence of intussusception in celiac disease (CD) but no systematic study yet. We prospectively studied the prevalence and natural history of intussusception in newly diagnosed CD. Methods From January 2010 to October 2013, 150 children, diagnosed to have CD on the basis of positive serology and duodenal biopsy, were recruited in this study. Abdominal ultrasonography was done before starting gluten-free diet (GFD) and repeated in those who had intussusception, on day three and then weekly till the resolution of intussusception. Results The median age was 72 (range,16-204) months and 79 (53%) were boys. Diarrhea was the presenting symptom in 119 (79%) cases. A total of 45 intussusceptions were detected in 37 (25%) children. Out of 45 intussusceptions, 95% involved small bowel. All but one had asymptomatic intussusception. On GFD, intussusception resolved spontaneously within 7 days in 65%, within 14 days in 84 % and within 28 days in 92% of cases, and none required surgical or hydrostatic reduction. On univariate analysis, younger age, low weight z score, presentation with diarrhea, abdominal distension, rickets, lower serum albumin, more severe villous atrophy and refeeding syndrome were more common in children with intussusception. On multivariate analysis abdominal distension and hypoalbuminemia were found to be significantly associated with intussusception. Conclusions Intussusception is frequently (25%) seen in children with newly diagnosed CD, generally asymptomatic and resolves spontaneously on GFD. It is often associated with more severe disease. Children with CD and intussusception should not be subjected to surgical/radiological intervention.
Afr J Paediatr Surg. JulSep; 14(3): 43–48. .
➢ Background: To analyse our experience with acute presentations of abdominal tuberculosis (TB) in children for early diagnosis and management. Materials and Methods: From December 2010 to April 2016, available electronic and operation theatre (OT) records of 17 patients with confirmed diagnosis of abdominal TB were analysed retrospectively. Parameters reviewed were age, sex, presentations, diagnostic investigations, surgery/intervention performed, final outcome and followup. Results: Out of 17 patients, 6 (35.3%) were already operated elsewhere. The duration of symptoms ranged from 4 to 58 weeks. Abdominal pain was present in all cases whereas 11 (64.7%) had abdominal distension, 16 (94.1%) fever, 14 (82.3%) ascites, 9 (52.9%) vomiting, 14 (82.3%) weight loss, 6 (35.3%) anorexia and 4 (23.5%) night sweat. All patients needed surgical intervention for definitive diagnosis. Thirteen (76.5%) out of 17 patients managed by staged surgery and primary anastomosis/repair/adhesiolysis were done in 4 (23.5%) patients. The main post operative problems were wound infections (8; 47.1%), subacute bowel obstruction (6; 35.3%) and chest infections (12; 70.6%). Followup period ranged from 3 months to 5.5 years. Conclusion: Abdominal TB should always be considered in differential diagnosis in children presenting with abdominal pain/distension, fever and ascites or with abdominopelvic mass. Recurrent bowel obstruction or anastomotic disruptions also give clues of its diagnosis. A careful history of illness, high index of suspicion, ascitic fluid adenosine deaminase or polymerase chain reaction for Mycobacterium needed for early diagnosis. Prompt minimal surgical interventions, preferred diversion over primary anastomosis, algorithmic vigilant postoperative care and early antitubercular treatment required for success in acute crisis. Keywords: Abdominal tuberculosis, acute abdomen, antitubercular treatment, diagnosis, management
Journal of Surgical Techniques and Procedures
Abstract Colonic stenosis/atresias account only 5% to 15% of all atresias and mostly occur in ascending and transverse colon. Patients usually present in neonatal period with symptoms and signs of distal bowel obstruction. We present a 5-month-old male child with congenital stenosis of sigmoid colon having recurrent malena and abdominal distension, borborygmi, anemia and failure to thrive. Pediatric Gastroenterologist diagnosed the condition and tried to treat it by endoscopic balloon dilatation. The child was referred to us with colonic perforation. This case highlights the superior role of surgery over endoscopic dilatation in congenital colonic stenosis. Keywords: Congenital colonic stenosis; Malena; Anemia; Perforation
Pancreas 2017 01;46(1):110-115
From the Departments of *Pediatric Gastroenterology, and †Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Journal of Clinical Imaging Science
ABSTRACT Aims: The aim of this study was to evaluate the safety and clinical efficacy of percutaneous direct needle puncture and transcatheter N‑butyl cyanoacrylate (NBCA) injection techniques for the embolization of pseudoaneurysms and aneurysms of arteries supplying the hepato‑pancreato‑biliary (HPB) system and gastrointestinal (GI) tract. Subjects and Methods: A hospital‑based cross‑sectional retrospective study was conducted, where the study group comprised 11 patients with pseudoaneurysms/aneurysms of arteries supplying the HPB system and GI tract presenting to a tertiary care center from January 2015 to June 2016. Four patients (36.4%) underwent percutaneous direct needle puncture of pseudoaneurysms with NBCA injection, 3 patients (27.3%) underwent transcatheter embolization with NBCA as sole embolic agent, and in 4 patients (36.4%), transcatheter NBCA injection was done along with coil embolization. Results: This retrospective study comprised 11 patients (8 males and 3 females) with mean age of 35.8 years ± 1.6 (standard deviation [SD]). The mean volume of NBCA: ethiodized oil (lipiodol) mixture injected by percutaneous direct needle puncture was 0.62 ml ± 0.25 (SD) (range = 0.5–1 ml), and by transcatheter injection, it was 0.62 ml ± 0.37 (SD) (range = 0.3–1.4 ml). Embolization with NBCA was technically and clinically successful in all patients (100%) No recurrence of bleeding or recurrence of pseudoaneurysm/aneurysm was noted in our study. Conclusions: Percutaneous direct needle puncture of visceral artery pseudoaneurysms and NBCA glue injection and transcatheter NBCA injection for embolization of visceral artery pseudoaneurysms and aneurysms are cost‑effective techniques that can be used when coil embolization is not feasible or has failed. Key words: Gastrointestinal bleed, N‑butyl cyanoacrylate, pseudoaneurysms,
July 2016Volume 6, Supplement 1, Pages S94–S95,DOI: http://dx.doi.org/10.1016/j.jceh.2016.06.159
Clinical and Experimental Hepatology
Prognostic scoring systems (PSI) have not been validated to identify high risk children with chronic Budd-Chiari syndrome (BCS) who undergo radiological intervention (RI). Our aim was to identify which of known PSI predict the outcomes in various subgroups of chronic BCS.
Tropical gastroenterology: official journal of the Digestive Diseases Foundation 37(1):72-5
Tropical gastroenterology: official journal of the Digestive Diseases Foundation 37(1):72-5
West African Journal of Radiology ♦ Vol. 24, 2017 Issue 1,
Journal of Pediatric Gastroenterology & Nutrition. 61(4):451-455, October 2015.
Objective: Recent years have witnessed an increase in acute pancreatitis (AP) in children; however, the natural history of acute fluid collection (AFC) and pseudocyst is largely unknown. We evaluated the frequency, clinical characteristics, and natural history of pseudocysts in children with AP. Methods: Children with AP admitted at Sanjay Gandhi Postgraduate Institute of Medical Sciences from 2001 to 2011 were enrolled and studied until complete resolution. Subjects with inadequate follow-up, recurrent AP, and chronic pancreatitis were excluded. Results: Of the 58 children (43 boys, median age 14 [1–18] years) with AP, 34 (58.6%) and 22 (38%) developed AFC and pseudocyst, respectively. No difference in age (12 [4–18] vs 13 [1–16] years), etiology (idiopathic 64% vs 47% and traumatic 27.2% vs 22.2%), and systemic complications (pulmonary [18% vs 11%], renal [22.7% vs 11%], and shock [13.6% vs 10%]) was observed between children with and without pseudocyst. A total of 11 of the 22 subjects with pseudocyst underwent drainage, the commonest symptom requiring drainage being gastric outlet obstruction [n = 5] and infection [n = 2]. The 11 of the 22 children with AP and pseudocyst (size 6.4 [3–14.4] cm) showed spontaneous resolution (disappearance [n = 9] and significant reduction in size [n = 2]) during 110 (25–425) days. Symptomatic pseudocysts requiring drainage were more often secondary to traumatic AP (6/6 vs 2/14 [idiopathic], P = 0.0007) than asymptomatic pseudocysts resolving spontaneously. Overall, only 26.4% (9/34) children with AFC required drainage because of symptomatic pseudocyst. Conclusions: Among children with AP, 58.6% developed AFC and 38% developed pseudocysts. Only patients with symptomatic pseudocyst need drainage, and asymptomatic pseudocyst can be safely observed irrespective of size and duration of collection.
World Journal of Endocrine Surgery
Pathologically elevated vasoactive intestinal polypeptide (VIP) plasma levels cause secretory diarrhea with excessive loss of water and electrolyte and is characterized by the typical symp-toms of hypokalemia and metabolic acidosis. It rarely occurs in patients with non-pancreatic disease. Despite the clinical severity, diagnosis of a VIP-secreting tumor is often delayed. We herein present a 14-month-old boy having prolonged therapy-resistant secretory diarrhea, persistent hypokalemia with tissue diagnosis of ganglioneuroblastoma and raised plasma VIP-levels. (11) Ganglioneuroblastoma as Vasoactive Intestinal Polypeptide-secreting Tumor: Rare Case Report in a Child. Available from: https://www.researchgate.net/publication/282464499_Ganglioneuroblastoma_as_Vasoactive_Intestinal_Polypeptide-secreting_Tumor_Rare_Case_Report_in_a_Child [accessed Dec 08 2017].
Trop Gastroenterol 2014 Oct-Dec;35(4):256-8
Hirschsprung’s disease (HD) is a congenital aganglionosis of the submucosal and myenteric neural plexuses, principally affecting the rectosigmoid area or varying length of the colon starting from the rectum.1 Most cases manifest during the neonatal period but in rare instances, the disease is first diagnosed in adulthood.2 On the other hand Budd-Chiari syndrome (BCS) or hepatic venous outflow obstruction (HVOO) is often an acquired disorder resulting from obstruction to the hepatic venous outflow at the level of hepatic veins or inferior vena cava.3,4We present here a 15-year-old girl who had both HD and BCS.To the best of our knowledge such an association has never been reported in literature before. We postulate that repeated enterocolitis due to HD might have produced a hypercoagulable state leading to BCS in this child.
Europian Journal of Surgical oncology
In malignant renal masses, Wilms' tumor accounts for almost 85% cases while other rare renal tumors including stromal tumors constitute only 15% of all pediatric renal masses. These rare tumors are usually aggressive and have similar presentation and radiological features as Wilms' tumor and are very difficult to differentiate. Differentiation is important because each tumor has different chemotherapy protocol. Definite tissue diagnosis is essential for better outcome. Experience with clear cell sarcoma and primitive neuro-ectodermal tumor (PNET) of kidney presented here
Hepatol International DOI 10.1007/s12072-014-9575-z,
Archives of International Surgery / January-April 2014 / Vol 4 / Issue1
Wandering spleen is a rare clinical entity that accounts for only 0.1-0.2% of all splenectomies. Early diagnosis and intervention is necessary for the preservation of the spleen, especially in children. However, most of the times in acute settings a précised clinical diagnosis is difficult because of its similarity of presentation with other causes of acute abdomen resulting in delayed diagnosis. We present a 12-year-old boy with left-sided abdominal pain following fall from bed. His abdominal examination revealed an enlarged tender spleen. Abdominal ultrasound and computed tomography showed enlarged spleen with multiple areas of infarction and thrombosis of the splenic vein. At laparotomy a diagnosis of torsion of a wandering spleen with infarction was confirmed and splenectomy done. We present the management of the patient with wandering spleen that presented as acute abdomen with lower abdominal mass and briefly review the literature.Key words: Acute abdomen, splenic torsion, splenopexy, wandering spleen
Journal of Clinical Imaging Science
ABSTRACT Caudal regression syndrome (CRS) is a rare congenital abnormality in which a segment of the lumbo-sacral spine and spinal cord fails to develop. The severity of the morphologic derangement inversely correlates with residual spinal cord function. We present a case report of a 10-year-old girl with Group 2 CRS, to emphasize clinical and radiologic findings in this rare abnormality. Key words: Dysgenesis, dysraphic, imperforate, lipomyelocystocele
Journal of Vascular and Interventional Radiology
Purpose Analysis of technical success,complications,primary patency and need for reintervention in percutaneous management of BCS. Materials and Methods Study was undertaken from august 2009 to august 2012. Inclusion criterion was patients with features of primary and secondary BCS. Those excluded were ones unwilling for follow up or refusing to give informed consent. Out of total of 24 patients, 18 (75%) and 6 (25%) were males and females respectively with age range of 4-17 years. Diagnosis of BCS was based on doppler sonography showing obstruction of supra/retro hepatic IVC and/or hepatic veins. Technique for intervention and route of access was selected on the basis of extent and type of hepatic vein(HV)/IVC block. Post procedure, patients were maintained on oral anticoagulation with target INR of 2.5-3.5 with regular six monthly clinical, biochemical and doppler followup for upto 36 months. Results Interventional procedures performed included angioplasty (2 cases), stenting of right HV, middle HV and accessory HV in 6,15 and 1 case respectively. HV cannulation failed in 1 case. Complications encountered included minimal hemoperitoneum (2 cases), sub capsular hematoma and minimal hemothorax (1 case each). 30 days mortality was not encountered. Technical success of hepatic vein stenting was 95.8%. Outcome over 30 days follow up included normal stent flow in 22 cases, needing reintervention in 1 case while 1 case was lost to followup. Follow-up at 1 year included…
Indian Journal of Radiology and Imaging / February 2013 / Vol 23 / Issue 1
Barium studies are one of the best investigations for evaluating submucosal and extrinsic mass lesions. However, barium studies bring less money, are operator dependent and one of the more difficult investigations for radiologists to master. Economic factors have acted as powerful disincentives for performing gastrointestinal (GI) fluoroscopy in most radiology practices. In this pictorial essay, we discuss the role of conventional defecography in evaluating evacuatory disorders in the Indian population.
Kumar S, Kumar B, Sundarayan RN, Malal AM. Imaging clues for exophytic liver lesions. West Afr J Rad
West African Journal of Radiology, Year : 2013 | Volume : 20 | Issue : 1 | Page : 41-44
Preoperative diagnosis of the organ of origin in cases of exophytic lesions of liver is difficult and a challenge for the radiologist and clinicians. It needs careful examination and interpretation of radiological findings for correct diagnosis. We present our experience with exophytic liver lesions in four patients diagnosed with hepatocellular adenoma, hepatocellular carcinoma (HCC), cavernous hemangioma, and hydatid cyst, and highlighted these issues. Keywords: Adenoma; exophytic; hepatocellular carcinoma; liver
JK Science 14(3):146-148
Abstract Bezoar is an agglomeration of food or foreign material in intestinal tract. Contiguous extension of trichobezoar into the small bowel can lead to the Rapunzel syndrome. We present rare case of Rapunzel syndrome in 16 year old female who presented with recurrent vomiting
Journal of Cancer Research and Therapeutic
Haemorrhage is a rare complication of meningiomas that can occur spontaneously, after embolization, stereotactic radiation and perioperatively. Our first case was a 16 year old male, admitted with spastic quadriparesis, and retention of urine. Magnetic Resonance Imaging (MRI) revealed anteriorly placed cervical intradural extramedullary mass. Patient underwent emergency surgery following sudden worsening of neurological symptoms and intratumoral bleed was noted peroperatively. Tumor was labeled as angiomatous meningioma with hemorrhage. The second case was of a 45 year female who presented with history of sudden onset weakness in right upper and lower limb followed by unconsciousness. MRI revealed heterogeneous lesion in left parasagittal area with intratumoral bleed. Left frontal craniotomy with tumour decompression was performed. Tumour was labelled as meningothelial meningioma with haemorrhage. Meningiomas with hemorrhagic onset remain rare, and pathophysiology is still incompletely understood. Prevention and outcome of intratumoral haemorrhage highly depends on early diagnosis and adequate treatment. Keywords: Meningioma, intracranial, spinal, haemorrhage
Oman Journal of Ophthalmology (OJO, 0974-620X)
Tuberculosis is still endemic in developing countries such as India and tuberculomas account for up to 40% of space occupying intracranial masses.  Isolated brain stem tuberculomas are rare lesions and account for about 5% of all intracranial tuberculomas.  These intracranial lesions commonly present as oculomotor and other cranial nerve palsies, , unilateral saccadic paralysis, one and a half syndrome, other ocular signs, and neurological deficits. In this article, the authors describe two cases of isolated ocular motility abnormality due to brain stem tuberculoma.
Sharma P, Kumar S.
Eurorad .Abdominal Imaging -Clinical Case. , http://www.eurorad.org/case.php?id=9877
Eurorad 2012 Interventional Radiology
Eurorad Interventional Radiology,
Ind J Radiol Imaging; Volume 21 Issue 4 ,( 2011).
Indian Journal Radiol Imaging.
Abstract Empyema of the gallbladder develops when the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct. Treatment options include cholecystectomy or, in patients with comorbidities, drainage via percutaneous cholecystostomy, later followed by cholecystectomy. Here, we describe a 59-year-old man who presented with complaints of recurrent hiccups and was found to have cholangiocarcinoma causing obstruction to cystic duct drainage. The patient was managed successfully by percutaneous transhepatic cholecysto-duodenal self-expandable covered metal stent. Keywords: Cholecystectomy, empyema, intrahepatic biliary radical dilatation, stent
Korean J Radiol. 2010 May-Jun; 11(3): 346–354.
Korean Journal of Radiology
Abstract The increased use of laparoscopic nephrectomy and nephron-sparing surgery has prompted the need for a more detailed radiological evaluation of the renal vascular anatomy. Multidetector CT angiography is a fast and accurate modality for assessing the precise anatomy of the renal vessels. In this pictorial review, we present the multidetector CT angiography appearances of the normal renal vascular anatomy and a spectrum of various anomalies that require accurate vascular depiction before undergoing surgical treatment. Keywords: Multidetector CT, Computed tomography (CT), angiography, Volume rendering, Renal artery, Renal veins, Abnormalities
SK Mittal, Y Mangal, S Kumar, RR Yadav