Intramedullary enterogenous cyst.
A case of intramedullary enterogenous cyst in the thoracic region is reported. Computed tomography findings are highlighted with a brief review of the literature.
Biomedical subjects
Publications and source records attributed to N Khandelwal.
A case of intramedullary enterogenous cyst in the thoracic region is reported. Computed tomography findings are highlighted with a brief review of the literature.
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An 11-year-old boy presented with pain in the back, urinary retention, paraplegia and loss of sensations below L1. Investigations revealed an intramedullary lesion. An intramedullary spinal cord abscess was found at surgery. The pus was evacuated and abscess was excised. Minimal recovery was seen following surgery. Early intervention and a high index of suspicion is required in such cases.
Three young children who presented with acute backache and rapidly progressive neurological deterioration were investigated and found to have spontaneous spinal extradural hematoma (SSEDH). They were operated on soon after the diagnosis had been confirmed. The present report highlights the fact that in children progressive weakness of nontraumatic origin should be investigated thoroughly and as early as possible. Patients with SSEDH should be operated on immediately, as this is a curable condition. The pertinent literature has been reviewed.
A case of spinal epidural extramedullary haematopoiesis in thalassemia is reported. Role of computed tomography in this rare manifestation is emphasized with brief review of literature.
Cranial chordomas are extremely rare in childhood with only 25 cases having been reported in the first decade of life. A 6-year-old female child with cranial chordoma is reported. Literature on the subject is reviewed, with special reference to the management, histopathological features and prognosis in childhood chordomas as compared to the adult variety.
A 12.5% corn oil-emulsion (COE) was tested as an oral contrast agent for abdominal computed tomography (CT) examinations in 100 patients. The results were compared with those obtained from another group of patients who received a conventional, high-density, oral contrast agent (2-3% iodinated solution). There was no statistically significant difference in the subjects' tolerance to the two agents (P greater than 0.05). There was, however, a significant improvement in image quality with COE (P less than 0.05). Gastrointestinal tract discrimination, and mucosal and mural visualisation was of higher quality with fat density oral contrast medium than with the high-density contrast agent. These data suggest that COE should be considered for routine use as an alternative to conventional high density oral contrast agents in upper abdominal CT.
Air in epidural haematoma is an uncommon finding. It is usually seen if epidural haematoma is associated with fracture involving one of the air sinuses, but can be seen at times in the absence of any demonstrable fracture on the CT scan. Seven such cases are described in the present communication and the significance of this finding discussed.
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Twenty-five patients of obstructive jaundice due to choledocholithiasis, were prospectively evaluated by ultrasonography and cholangiography. Ultrasound could demonstrate choledocholithiasis in 10 patients (40%). Choledocholithiasis in non-dilated ducts could be demonstrated only in one patient. All cases were diagnosed by cholangiography. Ultrasound, though an accepted modality of choice for diagnosing cholelithiasis, has a limited role in the diagnosis of choledocholithiasis. Ultrasonography (USG) is the screening modality of choice to distinguish obstructive from non-obstructive jaundice. It is highly accurate in the diagnosis of cholelithiasis but its role in detection of choledocholithiasis is less clear. Choledocholithiasis complicates 10% of all cases of cholecystitis and occurs in 2-4% of postcholecystectomy patients. The present study deals with the diagnostic value of USG in cases of choledocholithiasis subjected to USG prior to cholangiography and surgery.
Infectious complications of endoscopic injection sclerotherapy (EIS) are rare. We report here a case in which pyogenic meningitis and multiple cerebral abscesses developed after a session of EIS. The patient was successfully treated with a combination of parenteral antibiotics and repeated bedside pus aspirations. Prophylactic antibiotics may be considered in such situations for subsequent sessions of EIS.
Forty one cases of subdural empyema treated between 1977 and 1988 at the Postgraduate Institute of Medical Education and Research. Chandigarh, have been analysed. The patients ranged from 9 days to 80 years of age. There were 22 children, including 11 infants. Fever, altered sensorium and seizures were the most common symptoms present for 1 day to 6 months. Otogenic infection was the commonest aetiological factor followed by postoperative and posttraumatic causes. Thirty seven patients had supratentorial empyemas, including 4 with parafalcine collections, three had infratentorial empyemas, and in one there was extension of the empyema from the supratentorial to the infratentorial compartment. Therapeutic modalities used included percutaneous needle aspirations in infants and burr hole evacuation and craniotomies in adults. A wide spectrum of organisms was detected. Mortality in this series was 24%, which was mainly attributable to the deteriorated neurological status prior to treatment. A detailed review of the literature has been given, highlighting various controversies in the management of SDE. Important prognostic factors and a treatment plan are suggested.
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Renal papillary necrosis in 4 diabetic patients is described. Two of them had underlying diabetic nephropathy. Urinary tract infection was present in all of them. Three patients had passed fleshy material in the urine while in one the diagnosis was established by excretory urography. Two patients required haemodialysis for acute renal failure caused by sloughed papillae. The condition should be suspected in diabetic subjects who develop recurrent episodes of urinary tract infection, renal colic, haematuria or obstructive uropathy.
Leprous mononeuropathy may present without demonstrable maculoanesthetical patches. A case is described in whom wasting of the right hand was initially attributed to C8 T1 entrapment radiculopathy caused by cervical perineurial cysts. On the basis of the benign nature of the perineurial cysts and questionable right ulnar nerve thickening, the patient was given a trial of anti-leprosy drugs. A follow-up clinico-electrophysiological evaluation favored the diagnosis of leprotic ulnar mononeuropathy.
One hundred and twenty-five consecutive patients with obstructive jaundice were prospectively studied by ultrasonography to determine the level and cause of obstruction. These were diagnosed precisely in 80 (72%) and 52 patients (41.6%) respectively. The results were compared with cholangiography. The final diagnosis was established at surgery (97 cases) and fine needle aspiration cytology (28 cases). While US is an excellent screening modality in distinguishing obstructive and non-obstructive jaundice, cholangiography is still the gold standard for determining the precise anatomic level and cause of obstruction.