ITPA polymorphisms do not predict additional risk beyond TPMT and NUDT15 for thiopurine-induced cytopenia in inflammatory bowel disease

INTRODUCTION AND AIM

Thiopurine-related leukopenia is associated with polymorphisms in the thiopurine methyltransferase (TPMT) and nucleoside diphosphate-linked moiety X type motif 15 (NUDT15) genes. However, those polymorphisms explain only a fraction of thiopurine-related leukopenia. Our aim was to study the role of an inosine triphosphate pyrophosphatase (ITPA) polymorphism in patients with inflammatory bowel disease (IBD) and thiopurine-related leukopenia that was unexplained by the TPMT and NUDT15 polymorphisms.

MATERIAL AND METHODS

We enrolled consecutive IBD patients on thiopurines (azathioprine or 6-mercaptopurine) from January 2019-March 2020, at a tertiary care center in North India. The presence of the ITPA (C.94C > A) polymorphism was evaluated in all patients, along with its association with thiopurine-related leukopenia.

RESULTS

Of the 33 patients (from a total of 119 patients) that developed leukopenia, 8 had the TPMT (n = 1) or NUDT15 (n = 7) polymorphism. Of the remaining 111 patients, their mean age was 36.36 ± 13.54 years and 57 (51.3%) were males. Twenty-five (21.01%) had unexplained leukopenia. The ITPA polymorphism was detected in 4 (16%) patients in the unexplained leukopenia group and 24 (27.9%) patients in the non-leukopenia group (p = 0.228). The odds ratio for predicting leukopenia with the ITPA polymorphism was 0.4921 (95% CI 0.1520-1.5830, p = 0.234).

CONCLUSION

The ITPA (C.94C > A) polymorphism was frequently detected in the study population but was not predictive for leukopenia in patients with IBD on thiopurine therapy.

Amino Acid Tracer PET MRI in Glioma Management: What a Neuroradiologist Needs to Know

PET with amino acid tracers provides additional insight beyond MR imaging into the biology of gliomas that can be used for initial diagnosis, delineation of tumor margins, planning of surgical and radiation therapy, assessment of residual tumor, and evaluation of posttreatment response. Hybrid PET MR imaging allows the simultaneous acquisition of various PET and MR imaging parameters in a single investigation with reduced scanning time and improved anatomic localization. This review aimed to provide neuroradiologists with a concise overview of the various amino acid tracers and a practical understanding of the clinical applications of amino acid PET MR imaging in glioma management. Future perspectives in newer advances, novel radiotracers, radiomics, and cost-effectiveness are also outlined.

Differential 18F-NaF uptake in various compartments in knee osteoarthritis: an observational study using PET/MRI

AIM

To investigate if the pattern of fluorine-18-labelled sodium fluoride (¹⁸F-NaF) uptake on integrated positron-emission tomography (PET)/magnetic resonance imaging (MRI) of bone marrow lesions (BML) and osteophytes differs between different knee compartments.

MATERIALS AND METHODS

Sixteen patients with no prior history of knee injury with or without pain were recruited for the study. The images of both knees were acquired on simultaneous PET/MRI. The acquisition was done after 45 minutes of intravenous injection of ¹⁸F-NaF 185-370 MBq (5-10 mCi) for 40 minutes. Each knee was divided into eight compartments patella, trochlea, medial central femur, lateral central femur, medial posterior femur, lateral posterior femur, medial tibia, lateral tibia, and cruciate ligament insertion specifically for BML. BML and osteophytes were scored using MRI Osteoarthritis Knee Score (MOAKS) criteria and their corresponding maximum standardised uptake values (SUVmax) recorded.

RESULTS

BML and osteophytes both showed statistically significant differences among knee compartments, i.e., p-value <0.000 and < 0.043 respectively. SUVmax for BML and osteophytes was greatest in the medial tibia.

CONCLUSION

¹⁸F-NaF PET/MRI showed that BML and osteophytes had differential uptake values due to bone remodelling amongst the various knee compartments and this may help to design disease-modifying osteoarthritis drugs in the future.

Comparison of efficacy of diode laser in patients of facial hirsutism with normal dehydroepiandrosterone sulfate and dihydrotestosterone versus deranged dehydroepiandrosterone sulfate and dihydrotestosterone level - A Longitudinal study

INTRODUCTION

Hirsutism is defined as an excessive terminal hair growth in female over male pattern distribution areas. Traditional methods of hair removal have been replaced by lasers.

OBJECTIVE

To observe the effect of diode laser in hirsutism patient with normal and deranged dehydroepiandrosterone sulfate (DHEAS) and dihydrotestosterone (DHT) level.

MATERIALS & METHODS

50 patients of facial hirsutism with skin type IV and V were enrolled. 18 patients with deranged dehydroepiandrosterone sulfate and dihydrotestosterone level were allocated in group A whereas 16 patients with normal level were allocated in group B. Three sittings of diode laser was done in all subjects with varying session within a period of 6 months.

RESULT

At first follow-up visit, the percentage of hair reduction was fair in 62.5% of patients in group B and 16.7% of patients in group A, whereas at second follow-up visit, it was good in 56.3% of patients in group B and 11.1% of patients in group A. Increase in vellus hair and reduction in percentage of terminal hair were more significant in group B. Hair free interval and satisfaction level was significantly higher in group B.

CONCLUSION

Diode laser is effective mode of treatment in hirsutism patient irrespective of hormone level. But, the effect is observed to be more efficacious in patients with normal DHEAS & DHT level.

A randomized prospective study of low-dose isotretinoin alone and combination with salicylic acid and mandelic peel against acne tarda

BACKGROUND

Acne tarda (AT) is typically known as adult acne and most preferably affected 25-45 age groups. Used isotretinoid mono-therapy is not effective and also produces side effects from long treatment.

AIM

The present study assesses the effectiveness of combined treatment of oral isotretinoid with topical chemical peeling (20% salicylic and 10% mandelic acid known as SM peeling) by a comparative double-blind randomized single-center interventional open-label study.

MATERIALS AND METHODS

A total fifty-eight participants AT outpatients (25-45 age-groups) attending for diagnosis in two groups and effectiveness of proposed combined treatments were determined at baseline and follow-up within 4weeks interval. Briefly group A (n=28) received 0.5 mg/kg of oral isotretinoin once daily for sixteen weeks and group B (n=30) received the same oral dose, addition with SM peeling every four weeks interval for sixteen weeks. After four weeks, treatment efficacy was assessed based on Michelson's acne severity index (MASI) and visual analog scale (VAS), further validated using statistical tools.

RESULTS

Based on MASI and VAS scores, combined treatment was significantly effective than the monotherapy. The pre- and post-treatment analyses of response to scarring, inflammatory components at baseline and at the end of treatment were also statistically significant with p>0.008.

CONCLUSION

The above investigation revealed that the combination of oral isotretinoin with SM peeling was highly effective and could be used as newer therapy against AT without any serious side effects.

Consensus and development of document for management of stabilized acute decompensated heart failure with reduced ejection fraction in India

Aim

Ensuring adherence to guideline-directed medical therapy (GDMT) is an effective strategy to reduce mortality and readmission rates for heart failure (HF). Use of a checklist is one of the best tools to ensure GDMT. The aim was to develop a consensus document with a robust checklist for stabilized acute decompensated HF patients with reduced ejection fraction. While there are multiple checklists available, an India-specific checklist that is easy to fill and validated by regional and national subject matter experts (SMEs) is required.

Methodology

A total of 25 Cardiology SMEs who consented to participate from India discussed data from literature, current evidence, international guidelines and practical experiences in two national and four regional meetings.

Results

Recommendations included HF management, treatment optimization, and patient education. The checklist should be filled at four time points- (a) transition from intensive care unit to ward, (b) at discharge, (c) 1st follow-up and (d) subsequent follow-up. The checklist is the responsibility of the consultant or the treating physician which can be delegated to a junior resident or a trained HF nurse.

Conclusion

This checklist will ensure GDMT, simplify transition of care and can be used by all doctors across India. Institutions, associations, and societies should recommend this checklist for adaptability in public and private hospital. Hospital administrations should roll out policy for adoption of checklist by ensuring patient files have the checklist at the time of discharge and encourage practice of filling it diligently during follow-up visits.

Multiparametric Evaluation in Differentiating Glioma Recurrence from Treatment-Induced Necrosis Using Simultaneous 18F-FDG-PET/MRI: A Single-Institution Retrospective Study

BACKGROUND AND PURPOSE

Differentiating glioma recurrence from treatment-induced necrosis can be a challenge on conventional imaging. This study aimed to assess the diagnostic performance of each functional MR imaging and PET parameter derived by using simultaneous FDG-PET/MR imaging individually and in combination in the evaluation of suspected glioma recurrence.

MATERIALS AND METHODS

Thirty-five treated glioma patients with 41 enhancing lesions (World Health Organization grade II = 9, III = 13, IV = 19) on MR imaging after an operation followed by radiation therapy and/or chemotherapy formed part of this study. Using PET/MR imaging, we calculated the normalized mean relative CBV, mean ADC, Cho/Cr, and maximum and mean target-to-background ratios. Statistical analysis was performed to determine the diagnostic performance of each parameter by receiver operating characteristic analysis individually and in combination with multivariate receiver operating characteristic analysis for the detection of glioma recurrence. Histopathology or clinicoradiologic follow-up was considered the criterion standard.

RESULTS

Of 35 patients, 25 (30 lesions) were classified as having a recurrence and 10 (11 lesions) patients as having treatment-induced necrosis. Parameters like rCBV_mean (mean relative CBV), ADC_mean, Cho/Cr, and maximum and mean target-to-background ratios were statistically significant in the detection of recurrent lesions with an accuracy of 77.5%, 78.0%, 90.9%, 87.8%, and 87.8%, respectively. On multivariate receiver operating characteristic analysis, the combination of all 3 MR imaging parameters resulted in an area under the curve of 0.913 ± 0.053. Furthermore, an area under the curve of 0.935 ± 0.046 was obtained when MR imaging parameters (ADC_mean and Cho/Cr) were combined with the PET parameter (mean target-to-background ratio), demonstrating an increase in diagnostic accuracy.

CONCLUSIONS

Simultaneous PET/MR imaging with FDG offers correlative and synergistic multiparametric assessment of glioma recurrence with increased accuracy and clinical utility.

Primary extragastrointestinal stromal tumors: a clinicopathological and immunohistochemical study - a tertiary care center experience

BACKGROUND

Extra gastrointestinal stromal tumors (EGIST) are uncommon compared to their gastrointestinal counterparts. EGISTs involve omentum, mesentery, retroperitoneum, pancreas, and pelvis.

MATERIALS AND METHODS

Ten EGISTs were analyzed in this study from January 1995 to November 2011. They were analyzed with respect to clinical features, imageological, histopathological, and immunohistochemical findings. The immunohistochemical stains used were Smooth muscle actin (SMA), Desmin, S-100 protein, CD34 and CD-117.

RESULTS

There was slight female preponderance with wide age range. Four of the tumors were in retroperitoneum, three in mesentery, and two in omentum and one in pelvis. Histopathologically majority were spindle cell tumors. Immunohistochemically CD117 was consistently positive followed by CD34. Smooth muscle actin was positive in eight cases, S-100 protein and desmin were positive in two cases each.

CONCLUSION

EGISTs are rare and should be considered in the differential diagnosis of the mesenchymal tumors and immunohistochemistry helps to confirm the diagnosis. Further study with better follow-up is desired to characterize these uncommon tumors.

Palliative weekly chemotherapy along with cetuximab in recurrent and metastatic head and neck cancers: a retrospective analysis

BACKGROUND

This study was undertaken to report the results of weekly combination chemotherapy with cetuximab in recurrent/metastatic head and neck squamous cell carcinoma (R/M SCCHN).

MATERIALS AND METHODS

Retrospective analysis of 35 R/M SCCHN patients who received cetuximab with weekly paclitaxel and platin (cisplatin/carboplatin) from SCCHN August 2006 to October 2008 at our Institute was performed.

RESULTS

Thirty-five patients (33 [94.3%] males and 2 [5.7%] females) received the planned weekly chemotherapy protocol. Median age of these patients was 52 years. Of the SCCHN 32 evaluable patients, 25 patients showed symptomatic improvement and 7 showed no improvement. Radiological responses using RECIST criteria reported CR in 1 patient (3.1%), PR in 17 patients (53.1%), and SD in 6 patients (18.8%). The remaining six patients demonstrated disease progression while two could not be assessed. Median overall survival (OS) was 8.016 months (95% CI; 6.572--9.461) and median PFS was 5.782 months (95% CI; 4.521--7.044). The major chemotherapy-related grades 2 and 3 toxicity recorded was cetuximab-induced rash reported in 24 patients. No treatment-related death within 30 days was observed.

CONCLUSION

Cetuximab with weekly combination chemotherapy (Paclitaxel + Platinum compound) has shown promise, demonstrating comparable response and outcomes with acceptable toxicity in R/M SCCHN patients.

Gemcitabine and cisplatin-based combination chemotherapy in advanced hepatocellular carcinoma: An Indian experience

BACKGROUND

Gemcitabine, an anti-metabolite, has some activity in hepatocellular carcinoma (HCC) in terms of responses and median survival.

AIMS

To analyze our experience with the use of gemcitabine in combination with cisplatin in HCC with respect to response, toxicity and survival.

MATERIALS AND METHODS

We studied the records of patients of HCC treated from January 2000 to December 2005 with gemcitabine and cisplatin, and found 24 of them to be evaluable for response, toxicity and survival.

RESULTS

Of 24 patients receiving three or more cycles of chemotherapy, six (25%) had a partial response and an additional 12 (50%) had stable disease. The median overall survival (OS) was 7.5 months (95% confidence interval, 4.5-10.5 months) and 1-year survival was 18%. Grade 3 and 4 anemia, thrombocytopenia and neutropenia were observed in, respectively, 17, 17 and 33% patients. The most frequent non-hematologic toxicities were nausea and vomiting and peripheral neuropathy.

CONCLUSION

We report a partial response rate of 25% with stable disease in an additional 50% to three or more cycles of chemotherapy with gemcitabine and cisplatin, with a median OS of 7.5 months (95% confidence interval, 4.5-10.5) and acceptable toxicity profile from our single-center retrospective study of 24 patients of HCC. We trust that, in HCC, gemcitabine is a good drug to be the foundation to build the chemotherapeutic or targeted agents' combinations on.

Swyer Syndrome : A Case Report with Literature Review

Gonadoblastomas are known to develop in dysgenetic gonads, especially so, if Y chromosome material is present. A 20-years- old girl who noticed breast development since the age of 12 years presented with primary amenorhoea, distension of lower abdomen and intermittent pain for two months. She had breakthrough bleeding with six months of estrogen replacement. Tanner breast stage was fi ve and pubic hair stage was also fi ve. Examination revealed a mass in the lower abdomen extending into hypogastrium, umbilical and lumbar regions. Her gonadotropin levels were grossly elevated. Karyotyping showed 46XY. CT scan of abdomen showed a 17X11 cm mass in the pelvis without visible gonads. Surgical excision of the mass along with bilateral salpingophorectomy was performed. Histopathology revealed the mass to be a dysgerminoma, while the right gonad lodged gonadoblastoma. She was diagnosed as a rare case of Swyer syndrome. Keywords: Dysgerminoma, gonadoblastoma, Swyer syndrome, XY gonadal dysgenesis.

Swyer syndrome: a case report with literature review

Gonadoblastomas are known to develop in dysgenetic gonads, especially so, if Y chromosome material is present. A 20-years-old girl who noticed breast development since the age of 12 years presented with primary amenorhoea, distension of lower abdomen and intermittent pain for two months. She had breakthrough bleeding with six months of estrogen replacement. Tanner breast stage was five and pubic hair stage was also five. Examination revealed a mass in the lower abdomen extending into hypogastrium, umbilical and lumbar regions. Her gonadotropin levels were grossly elevated. Karyotyping showed 46XY. CT scan of abdomen showed a 17X11 cm mass in the pelvis without visible gonads. Surgical excision of the mass along with bilateral salpingophorectomy was performed. Histopathology revealed the mass to be a dysgerminoma, while the right gonad lodged gonadoblastoma. She was diagnosed as a rare case of Swyer syndrome.

Melanotic neuroectodermal tumor of infancy: discussion of a case and a review of the imaging findings

Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon melanin-containing mesenchymal tumor of neural crest origin. What make this tumor unique and interesting is its characteristic predilection for anterior maxilla (premaxilla) and the presence of pigment melanin which gives the tumor distinct clinicopathological, immunohistochemical, ultrastructural and imaging features. Although first described almost a century ago, to the authors’ knowledge, only a few hundred cases of MNTI have been reported worldwide in the English medical literature. The pool of documented radiological findings is even more sparse as not more than a dozen cases could be abstracted from an Internet search of the radiology literature. We document a case of MNTI and describe the imaging findings with intent to contribute to its small but accruing radiological data.

Prometheus' spirit: quality survival in advanced hepatocellular carcinoma after gemcitabine and cisplatin-based chemotherapy

In advanced virus-induced hepatocellular carcinoma (HCC) associated with cirrhosis, the average survival is four months. We report a 56-year-old man with a large-volume advanced HCC, in whom gemcitabine and cisplatin-based chemotherapy resulted in near-complete regression, and quality survival of 24 months.

Isolated intraorbital metastasis in breast carcinoma

We report a case of metastases to the eye, in a 30 year old lady with carcinoma breast leading to isolated metastatic involvement of the lateral rectus muscle with no evidence of metastases at any other site in the body after a follow up of one year after completion of chemotherapy.

Usefulness of dynamic maneuvers in MR evaluation of oral malignancies

Objectives: The purpose of this study was to evaluate the usefulness of dynamic maneuvers like "distended cheek" and "tongue deviation" in MR evaluation of oral malignancies. Methods: Ninety nine patients of oral malignancies who reported to this institute for treatment were enrolled in this study. All the patients evaluated with conventional MR imaging and supplemented by additional MR imaging with dynamic maneuvers using T1Weighted and STIR sequences with reduced scan time. Distended cheek imaging was performed in 73 cases of carcinoma cheek, gingiva & RMA (retromolar area) and tongue deviation in 24 cases of carcinoma tongue & floor of mouth. Two cases of carcinoma of lower gingiva performed both maneuvers. In selected cases MR imaging with dynamic maneuvers was also performed following contrast administration. Results: Lesions appearing inseparable from two mucosal surfaces (buccal mucosa and gingiva) on routine MR images were well separated in the distended cheek images in all cases except for two cases who could not perform the maneuvers. Distended cheek images demonstrated involvement of buccogingival sulci in 30 patients of carcinoma of cheek, involvement of cheek in 8 cases of carcinoma gingiva & involvement of gingiva in 6 cases of carcinoma cheek which were not appreciated on routine MR images. Similarly MR imaging with tongue deviation helped in better delineation of tongue lesions in 12 cases and showed involvement of glossogingival sulcus in 5 cases that were not appreciable on routine MR imaging. Conclusion: MR imaging with dynamic maneuvers provide additional information of clinical significance regarding origin and extent of disease in oral malignancies & should supplement the conventional MR imaging in selected cases.

Parametrial invasion in carcinoma of cervix: role of MRI measured tumour volume

The aim of the study was to determine the correlation between MRI measured tumour volume and parametrial invasion on histology in the evaluation of carcinoma of the cervix showing full thickness stromal invasion (FTSI). Original MR images of 159 surgical cases of carcinoma of the cervix retrieved from the MR image bank of the department were analysed retrospectively. Tumour volume from the maximum tumour diameters in each case was computed using the standard formula for an ellipse and correlated with parametrial invasion on histology. Of 105 cases showing FTSI on axial T(2) weighted MRI, tumour volume between the two groups of cases, with parametrial invasion (n=27) and without parametrial invasion (n=78), shows a statistically significant difference (p=0.006). Best accuracy of 60.95%, sensitivity 59.26% and specificity 61.54% was found for tumour volume of 36.39 cm(3). The study concludes that MRI measured tumour volume is associated with low accuracy in the evaluation of parametrial invasion in carcinoma of cervix showing FTSI in axial T(2) weighted MR images and may not help as an additional diagnostic criterion to predict parametrial invasion pre-operatively.

Isolated hypoglossal nerve palsy due to skull base metastasis from breast cancer

We describe a 44-year-old woman who presented with an isolated unilateral hypoglossal nerve paralysis caused by a skull base metastasis from breast cancer. The patient had a modified radical mastectomy followed by local radiotherapy and adjuvant chemotherapy. Fourteen months later she presented with difficulty in speaking. Physical examination revealed an isolated left hypoglossal nerve paralysis. The MRI scan showed a mass lesion involving the left occipital condyle extending into hypoglossal canal.

Correlation of clinical course with magnetic resonance imaging in tuberculous myelopathy

Sixty cases of spinal tuberculosis with neurological deficit treated with 'middle path regimen' were analysed and therapeutic response was correlated with the magnetic resonance imaging (MRI) observations. Tuberculous lesions were found to be more extensive than seen on plain X-ray in 60% of the cases. MRI showed the involvement of one or both pedicles in nearly 90% of the cases, in addition to the vertebral body lesion as seen in the X-rays. The patients showing predominantly extradural collection of fluid with relatively preserved cord size, and MRI evidence of myelitis/oedema, improved neurologically with treatment. The myelomalacia of cord was found to be a poor prognostic sign for neural recovery. The magnitude of thinning of cord did not always correlate with severity of neural deficit, however, thinning of cord in association with myelomalacia carried a bad prognosis. The complete neural recovery is not expected in patients with syrinx formation proximal or distal to the diseased spine, either with antitubercular drugs or after mechanical decompression. MRI changes in dura-subarachnoid complex suggesting arachnoiditis generally correlated with poor neural recovery. MRI provided a reliable guide to the level and extent of surgical decompression, and prognostication of the outcome of therapeutic measures.

Cervical mass lesion presenting as reflex sympathetic dystrophy of the hand

A case with multiple small joint swelling and skin dystrophic changes in the right hand was initially treated as seronegative non-specific arthritis. Later, a triple phase bone scan indicated reflex sympathetic dystrophy (RSD) and the primary lesion was shown on MRI scan to be a cervical cord mass with associated sub-acute haematoma. The case underscores the need to consider RSD in the differential diagnosis of such conditions and the importance of a detailed neurological examination in RSD with no local causative factor.

MR evaluation of the mediastinal lymph nodes

Clinico-radiological profile of 25 patients with mediastinal lymphadenopathy due to tuberculosis, Hodgkin's lymphoma and metastases is presented. The main objective was to study the signal intensity pattern of the mediastinal lymph nodes both in plain and contrast enhanced magnetic resonance imaging (MRI), and find out its potential value in the diagnosis. Fifteen patients of tuberculous mediastinal lymphadenopathy, 5 patients of Hodgkin's lymphoma and 5 patients of metastatic lymphadenopathy were studied by 1.5 T Siemens, Magnetom. Both intensity and enhancement pattern were evaluated. Tuberculous lymph nodes appeared isointense in both T1WI and T2WI. On contrast administration multiple hypointense foci were seen in 14 out of 15 patients. The metastatic lymph nodes revealed solitary or multiple hyperintense central foci in T2WI, whereas the lymphomatous lymph nodes revealed heterogenous intensity. Though the lymphomatous nodes revealed mild to moderate type of enhancement, the metastatic nodes revealed dense enhancement of the multiple foci which were seen in noncontrast images. Hence, the MR characteristics of the mediastinal nodes may be useful index in evaluating the aetiology of the mediastinal lymphadenopathy.

Improving cancer radiotherapy with 2-deoxy-D-glucose: phase I/II clinical trials on human cerebral gliomas

PURPOSE

Evaluation of tolerance, toxicity, and feasibility of combining large fraction (5 Gy) radiotherapy with 2-deoxy-D-glucose (2DG), an inhibitor of glucose transport and glycolysis, which has been shown to differentially inhibit repair of radiation damage in cancer cells.

METHODS AND MATERIALS

Twenty patients with supratentorial glioma (Grade 3/4), following surgery were treated with four weekly fractions of oral 2DG (200 mg/kg body weight) followed by whole brain irradiation (5 Gy). Two weeks later, supplement focal radiation to the tumor (14 Gy/7 fractions) was given. Routine clinical evaluation, x-ray computerized tomography (CT), and magnetic resonance (MR) imaging were carried out to study the acute and late radiation effects.

RESULTS

All the 20 patients completed the treatment without any interruption. The vital parameters were within normal limits during the treatment. None reported headache during the treatment. Mild to moderate nausea and vomiting were observed during the days of combined therapy (2DG + RT) in 10 patients. No significant deterioration of the neurological status was observed during the treatment period. Seven patients were alive at 63, 43, 36, 28, 27, 19, and 18 months of follow-up. In these patients, the clinical and MR imaging studies did not reveal any late radiation effects.

CONCLUSIONS

Feasibility of administering the treatment (2DG + 5 Gy) is demonstrated by the excellent tolerance observed in all 20 patients. Further, the clinical and MR studies also show the absence of any brain parenchymal damage.

Safety of ciprofloxacin therapy in children: magnetic resonance images, body fluid levels of fluoride and linear growth

We evaluated the safety of ciprofloxacin administered in a dose of 15-25 mg/kg for 9-16 days, in a case series of 58 children who were between 8 months and 13 years of age. No arthropathy was observed during therapy and follow-up. Blinded evaluation of 22 pairs of nuclear magnetic resonance scans obtained before and between day 10 and 15 of therapy did not reveal any cartilage damage. After the first dose of ciprofloxacin (10 mg/kg), serum fluoride levels increased at 12 h in 15 of 19 (79%) patients; 24-h urinary fluoride excretion was higher on day 7 compared with basal values in 16 of 18 (88.9%) patients. Height z scores of 53 patients at a mean of 22.5 months of follow-up were not significantly different from basal scores (p = 0.12). In conclusion, ciprofloxacin may be recommended for use in children for short duration when effective alternative antibacterials are unavailable. However, there is a need for further studies to evaluate the tissue accumulation of fluoride and its potential to cause toxic effects.

MnPcS4: a new MRI contrast enhancing agent for tumor localisation in mice

Manganese-tetrasulfonated phthalocyanine (MnPcS4) has been evaluated as a potential contrast agent in Magnetic resonance imaging (MRI) for tumor localisation in mice. MnPcS4 showed favourable molar relaxivity, much better than Gd-DTPA and comparable to tetrasulfonated manganese complex of porphyrin (TPPS4). Tumors showed selective retention of the metal complex (dye) with the peak value reached at 24 hours following intravenous administration. Dye concentration in tumors remained consistently higher than either kidney or muscle tissue both at 1 and 24 hours and a 10-fold increase in tumor-to-muscle ratio over the control was seen at 24 hr. Normal liver tissue, however, showed higher concentration than tumor at all times during the study. A linear correlation was found between longitudinal relaxation rate (1/T1) and the corresponding concentration of MnPcS4 in various tissues. MR imaging done in animals using 1.5 T superconducting clinical imager showed a mean percent increase in signal intensity of 131.8% (SD +/- 32.86) in the tumor and a 70% increase in tumor-to-muscle ratio over the pretreatment value, at 24 hr. The results suggest that MnPcS4 is a potential tumor-selective contrast agent in MRI.

Magnetic resonance imaging (MRI) in evaluation of left atrial masses: an in vitro and in vivo study

Thirty patients, 15 each of suspected of left atrial myxoma and clot were studied in a prospective study to assess the role of magnetic resonance imaging (MRI) in evaluation of left atrial masses. Upon clinical and echocardiographic suspicion of a left atrial mass, patients were subjected to ECG-gated MRI (in vivo study) and subsequently all of them underwent surgery for the removal of mass and/or mitral valve replacement/repair. Within 6 hours of its removal the mass was subjected to in vitro MRI study and subsequently to histopathological examination. During the study T1, T2 gated images were obtained and tissue characterization was done. A magnetic dye Gd-DTPA was used for contrast enhancement. Cine-display of the images was obtained to demonstrate dynamic movement of the mass across the mitral valve. MRI was found to be highly useful in delineating the exact anatomical details of left atrial masses. Results of MRI diagnosis with illustrations are discussed.

Enterogenous cyst in the thoracic spinal canal in association with a syringomeningomyelocele

A thoracic intradural extramedullary enterogenous cyst in association with a syringomeningomyelocele in a 5-year-old boy is presented. The pathogenesis of this rare association is discussed and the pertinent literature reviewed.

Hypothalamo-pituitary axis by magnetic resonance imaging in isolated growth hormone deficiency patients born by normal delivery

Magnetic resonance imaging was performed using a 1.5 Tesla magnet in 22 children (14 boys and 8 girls) between 5-20 yr of age with isolated GH deficiency (IGHD), born by normal vaginal delivery without any birth asphyxia or trauma. A total of 22 children (10 boys and 12 girls) without short stature and endocrine disease were evaluated as controls. The IGHD group had a height velocity less than 4 cm/yr and delayed bone age. The peak GH levels were less than 10 micrograms/L (mean, 2.4 micrograms/L). The height of the pituitary gland ranged from 3-7.5 mm in controls. An intact stalk was observed in 21 children with IGHD, with nonvisualization in 1. An apparently thin stalk was seen in 6. The posterior lobe identified by the hyperintensity signal, had a mean diameter of 1.84 mm and was located in a normal position in 21 children. An ectopic posterior pituitary hyperintensity was present in 1 patient. The anterior pituitary was hypoplastic in 17 children, with partial empty sella in 13. A total of 5 children had associated brain anomalies, such as Arnold Chiari malformation, craniovertebral malformation with basilar impression, degenerative plaques around posterior horn of lateral ventricle and parietal area, and infarcts in caudate nucleus and putamen. These findings suggest that IGHD was not related to transection or compression of the stalk.

Magnetic resonance imaging in occult spinal dysraphism

A prospective study was carried out in 100 cases of suspected occult spinal dysraphic anomalies with Magnetic Resonance Imaging in order to determine its diagnostic efficacy as the initial imaging modality. MR imaging provided accurate preoperative information in 91 out of 92 cases (98.9%). Some of the unusual and interesting findings in the series were: presence of intrinsic cord abnormality in 19 out of 21 cases (90.4%) with a normal plain radiograph, 4 cases of diastematomyelia with a dermoid in the dorsal and lumbar region associated with syringohydromyelia, intradural fibrous/glial bands, syringohydromyelia/myelomalacia of the conus with tethered cord syndrome having a normally placed conus, and myelocystocele. It is concluded that MRI is an excellent primary diagnostic tool, together with a plain radiograph, for complete preoperative evaluation of mid-line spinal anomalies.

MR observations on the effects of praziquantel in neurocysticercosis

Eight patients with neurocysticercosis treated with praziquantel (PZQ) were studied with serial MR imaging to demonstrate the early effects of the drug in brain lesions. Increase in cyst size and appearance of pericystic edema were observed as early as 24 hr, followed by gradual degeneration of the scolex and cyst contents. Cysts showed varied degree of response to the drug and in their rate of disappearance. MRI was found to be a sensitive technique to objectively document early changes in the parasite and patterns of response to the cysticidal drug in brain cysticercosis.

Magnetic resonance imaging in childhood epilepsy

One hundred and seventy children of chronic seizures with strong clinical suspicion of an underlying intracranial lesion as its cause were studied by Magnetic Resonance Imaging (MRI). Maximum number of patients were between 6-12 years, males outnumbering females. Structural abnormalities were seen in 158 of the 170 patients. The study revealed tuberculoma as the commonest lesion in this series (n = 64) followed by cysticercosis (n = 27). Three patients were seen to have glioma. An interesting finding was disappearing lesion in 6 children. MRI proved to be an excellent modality in demonstrating and characterising the intracranial lesion.