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Chinniah PK, Gopal B, Moses V, Keshava SN. Cervical Vertebral Bone Biopsy: Challenges and Tricks. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- PK Chinniah
- Department of Radiology, Christian Medical College Hospital, Vellore, India
| | - B Gopal
- Katpadi Scan Centre, Katpadi, India
| | - V Moses
- Department of Radiology, Christian Medical College Hospital, Vellore, India
| | - SN Keshava
- Department of Radiology, Christian Medical College Hospital, Vellore, India
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Punnen GE, Gibikote S, Deodhar P, Keshava SN. Decommissioned Computed Tomography Gantry Modified into Play Equipment to Promote Child-friendly Imaging. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- GE Punnen
- Department of Radiodiagnosis, Division of Clinical Radiology, Christian Medical College, Vellore, India
| | - S Gibikote
- Department of Radiodiagnosis, Division of Clinical Radiology, Christian Medical College, Vellore, India
| | - P Deodhar
- Office for the Promotion of Research & Writing, Principal’s Office, Carman Block, Christian Medical College, Vellore, India
| | - SN Keshava
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, India
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Gurijala PR, Punnen GE, Mani T, Keshava SN. Location of the Internal Mammary Arteries in Relation to the Lateral Border of the Sternum: A Key to Avoid Injury during Computed Tomography-Guided Biopsy of Anterior Mediastinal Masses. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2217277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- PR Gurijala
- Department of Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, India
| | - GE Punnen
- Department of Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, India
| | - T Mani
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - SN Keshava
- Department of Interventional Radiology, Division of Clinical Radiology, Christian Medical College, Vellore, India
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Abstract
Budd-Chiari syndrome (BCS) is an uncommon condition, caused by obstruction to hepatic venous outflow. It is largely underdiagnosed, and a high index of suspicion is required for any patient with unexplained portal hypertension. The understanding of its etiology and pathology is improving with advances in diagnostic techniques. Recent studies reported an identifiable etiology in > 80% of cases. Myeloproliferative neoplasm (MPN) is the most common etiology, and genetic studies help in diagnosing latent MPN. Better cross-sectional imaging helps delineate the site of obstruction accurately. The majority of BCS patients are now treated by endovascular intervention and anticoagulation which have improved survival in this disease. Angioplasty of hepatic veins/inferior vena cava remains under-utilized at present. While surgical porto-systemic shunts are no longer done for BCS, liver transplantation is reserved for select indications. Some of the unresolved issues in the current management of BCS are also discussed in this review.
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Affiliation(s)
- A Sharma
- Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, India
| | - S N Keshava
- Department of Interventional Radiology, Christian Medical College, Vellore, India
| | - A Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - E Elias
- Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, India.,Liver Unit, University Hospitals Birmingham, Birmingham, UK
| | - C E Eapen
- Hepatology Department, Christian Medical College, Vellore, Tamil Nadu, India.
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Padmanabhan A, Keshava SN, Ahmed M, Moorthy RK. Transient Blindness after Endovascular Parent Artery Occlusion to Treat Giant Aneurysm of Internal Carotid Artery: a Case Report. Hong Kong Journal of Radiology 2021. [DOI: 10.12809/hkjr2117191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- A Padmanabhan
- Department of Interventional Radiology, Christian Medical College, Vellore, India
| | - SN Keshava
- Department of Interventional Radiology, Christian Medical College, Vellore, India
| | - M Ahmed
- Department of Interventional Radiology, Christian Medical College, Vellore, India
| | - RK Moorthy
- Department of Neurological Sciences, Christian Medical College, Vellore, India
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Kandagaddala M, Sundaramoorthy M, Keshava SN, Gibikote S, Mahata KM, Kavitha ML, Poonnoose P, Srivastava A. A new and simplified comprehensive ultrasound protocol of haemophilic joints: the Universal Simplified Ultrasound (US-US) protocol. Clin Radiol 2019; 74:897.e9-897.e16. [PMID: 31474302 DOI: 10.1016/j.crad.2019.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/24/2019] [Indexed: 11/17/2022]
Abstract
AIM To present a new protocol to optimise ultrasound (US) assessment of haemophilic arthropathy. MATERIALS AND METHODS Ultrasound of haemophilic arthropathy joints was performed using three different ultrasound protocols, namely, the Toronto-Vellore Comprehensive Ultrasound (TVC-US) protocol, the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US), and the newly developed Universal Simplified Ultrasound (US-US) protocol. Synovial hypertrophy, haemosiderin deposition, effusion, erosion, and cartilage loss were evaluated in 20 joints. The reliability and diagnostic efficiency of these protocols was compared using magnetic resonance imaging (MRI). RESULTS The correlation between the TVC-US and US-US protocols for synovial hypertrophy was excellent: kappa significance (KS) was 1, but was substantial (KS=0.65) with the HEAD-US protocol. For effusion, both the TVC-US and the HEAD-US protocols had substantial correlation with the US-US protocol (KS=0.7 and 0.6 respectively). The correlation for erosion and cartilage loss was excellent between the TVC-US and the US-US with MRI (KS=1), but poor (KS=0) with the HEAD-US protocol. The US-US protocol also had good interobserver agreement (KS=1). CONCLUSION The accuracy of the US-US protocol is comparable to the TVC-US protocol and MRI and is superior to the HEAD-US protocol in the assessment of haemophilic arthropathy.
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Affiliation(s)
| | | | - S N Keshava
- Radiology, Christian Medical College, Vellore, India.
| | - S Gibikote
- Radiology, Christian Medical College, Vellore, India
| | - K M Mahata
- Radiology, Christian Medical College, Vellore, India
| | - M L Kavitha
- Haematology, Christian Medical College, Vellore, India
| | - P Poonnoose
- Orthopaedics, Christian Medical College, Vellore, India
| | - A Srivastava
- Haematology, Christian Medical College, Vellore, India
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Poonnoose PM, Hilliard P, Doria AS, Keshava SN, Gibikote S, Kavitha ML, Feldman BM, Blanchette V, Srivastava A. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia 2016; 22:925-933. [PMID: 27385495 DOI: 10.1111/hae.13023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study was undertaken to determine the correlation between the radiological changes in haemophilic arthropathy [X-ray, Ultrasound (US) and MRI] and clinical assessment as determined by the Hemophilia Joint Health Score (HJHS); and to document the US and MRI changes in joints that appear normal on plain X-ray and clinical evaluation. MATERIALS AND METHODS Of 55 study joints (22 knees and 33 ankles) in 51 patients with haemophilia/von Willebrand disease, with a median age of 15 years (range: 5-17) were assessed using X-rays (Pettersson score) and clinical examination (HJHS) at two centres (Toronto, Canada; Vellore, India). MRI and ultrasonographic scoring was done through a consensus assessment by imagers at both centres using the IPSG MRI and US scores. RESULTS The HJHS had a good correlation with the Pettersson score (rs = 0.66). Though the HJHS had moderate correlation with the osteochondral component of the MRI and US scores (rs 0.51, 0.45 respectively), its correlation with the soft tissue component was poor (rs 0.19; 0.26 respectively). Of the 18 joints with a Pettersson score of zero, 88.9% had changes that were detected clinically by the HJHS. Osteochondral abnormalities were identified in 38.9% of these joints by the MRI, while US images of the same joints were deemed abnormal in 83.3% by the current criteria. US identified haemosiderin and other soft tissue changes in all of the joints, while the same changes were noted in 94.4% of these joints on MRI. There were four joints with a HJHS of zero, all of which had soft tissue changes on MRI (score 1-7) and US (score 2-7). Osteochondral changes were detected in three of these joints by US and in 2 by MRI. There were four joints with an MRI score of 0-1 that had significant US scores (3-5) and HJHS scores (0-6). CONCLUSION US and MRI are able to identify pathological changes in joints with normal X-ray imaging and clinical examination. However, further studies are required to be able to differentiate early abnormalities from normal. Clinical (HJHS) and radiological assessment (US/MRI) provide complimentary information and should be considered conjointly in the assessment of early joint arthropathy.
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Affiliation(s)
- P M Poonnoose
- Department of Orthopaedics, Christian Medical College, Vellore, India
| | - P Hilliard
- Department of Rehabilitation, The Hospital for Sick Children, Toronto, ON, Canada
| | - A S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - S N Keshava
- Department of Radiology Christian Medical College, Vellore, India
| | - S Gibikote
- Department of Radiology Christian Medical College, Vellore, India
| | - M L Kavitha
- Department of Haematology, Christian Medical College, Vellore, India
| | - B M Feldman
- Division of Rheumatology, Departments of Paediatrics, The Hospital for Sick Children, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - V Blanchette
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - A Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
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Garge S, Keshava SN, Moses V, Ahmed M, Jain S, Joseph P. Hepatic Subcapsular Haemorrhage: Watering-can Appearance. Hong Kong J Radiol 2016. [DOI: 10.12809/hkjr1615370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Jasper A, Harshe G, Keshava SN, Kulkarni G, Stephen E, Agarwal S. Evaluation of normal abdominal aortic diameters in the Indian population using computed tomography. J Postgrad Med 2015; 60:57-60. [PMID: 24625941 DOI: 10.4103/0022-3859.128813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this study was to establish normal diameters for the suprarenal and infrarenal abdominal aorta measured at T12 and L3 vertebral levels in the Indian population and to study the variation in aortic diameters with age, sex, height, weight, body mass index (BMI), and body surface area (BSA). MATERIALS AND METHODS One hundred and forty-two patients who underwent helical contrast-enhanced computed tomography (CT) scans of the abdomen for non-cardiovascular reasons were recruited.. The mean internal diameters of the suprarenal and infrarenal abdominal aorta (maximum anteroposterior and transverse diameter) were measured at T12 and L3 vertebral levels and tabulated according to various age groups for both men and women. Pearson correlation coefficient was used to evaluate the correlation between aortic diameters, height, weight, BSA, and BMI. RESULTS The mean diameters of the suprarenal and infrarenal abdominal aorta measured at T12 and L3 vertebral levels, in men were 19.0 ± 2.3 and 13.8 ± 1.9 mm and in women 17.1 ± 2.3 and 12.0 ± 1.6 mm, respectively. The aortic diameter progressively increased in caliber with increasing age of the patients and was smaller in women than men. A significant positive correlation was found in men between the suprarenal and infrarenal aortic diameters and weight, BSA, and BMI. In women, this correlation was significant in the infrarenal aorta but not in the suprarenal aorta. CONCLUSION We obtained a set of normal values for the abdominal aorta in the Indian population. The aortic diameters correlated with age, gender, and body size of the patients as seen with previously published data in the Western population. A brief comparison of data between Indian and Western population showed that the values obtained were less than published elsewhere and hence, this should be considered while formulating intervention protocols.
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Affiliation(s)
- A Jasper
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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Keshava SN, Gibikote SV, Mohanta A, Poonnoose P, Rayner T, Hilliard P, Lakshmi KM, Moineddin R, Ignas D, Srivastava A, Blanchette V, Doria AS. Ultrasound and magnetic resonance imaging of healthy paediatric ankles and knees: a baseline for comparison with haemophilic joints. Haemophilia 2015; 21:e210-e222. [DOI: 10.1111/hae.12614] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S. N. Keshava
- Department of Radiology; Christian, Medical College; Vellore Tamil Nadu India
| | - S. V. Gibikote
- Department of Radiology; Christian, Medical College; Vellore Tamil Nadu India
| | - A. Mohanta
- Department of Radiology; The Hospital for Sick Children; Toronto Ontario Canada
| | - P. Poonnoose
- Department of Orthopedic Surgery; Christian Medical College; Vellore Tamil Nadu India
| | - T. Rayner
- Department of Radiology; The Hospital for Sick Children; Toronto Ontario Canada
| | - P. Hilliard
- Department of Rehabilitation Services; The Hospital for Sick Children; Toronto Ontario Canada
| | - K. M. Lakshmi
- Department of Haematology; Christian Medical College; Vellore Tamil Nadu India
| | - R. Moineddin
- Department of Family and Community Medicine; University of Toronto; Toronto Ontario Canada
| | - D. Ignas
- Department of Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto Ontario Canada
| | - A. Srivastava
- Department of Haematology; Christian Medical College; Vellore Tamil Nadu India
| | - V. Blanchette
- Department of Hematology/Oncology; The Hospital for Sick Children; Toronto Ontario Canada
| | - A. S. Doria
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto Ontario Canada
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Jasper A, Keshava SN. Aortic coarctation associated with an absent segment of the proximal right subclavian artery. J Postgrad Med 2014; 60:397-9. [PMID: 25370550 DOI: 10.4103/0022-3859.143970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Coarctation of the aorta is a congenital anomaly of the thoracic aorta with many known associations. We describe the case of a young man referred for management of subarachnoid hemorrhage, in whom subsequent work-up revealed the previously undescribed combination of severe postductal aortic coarctation and an absent segment of the proximal right subclavian artery.
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Affiliation(s)
- A Jasper
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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Moses V, Keshava SN, Mammen S, Ahmed M, Eapen CE, Ramakrishna B. Trans-caval trans-jugular liver biopsy--a technical modification of trans-jugular liver biopsy. Br J Radiol 2014; 87:20140327. [PMID: 25248931 DOI: 10.1259/bjr.20140327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To (a) describe the technical modification of trans-caval TJLB and (b) review our series of nine cases. METHODS We performed a retrospective review of all trans-caval TJLBs performed; we assessed indications for the procedure, technical success, complications, adequacy of specimen and histological positivity. RESULTS The technical success rate of the procedure was 9/9 (100%); the minor complication rate was 1/9 (11%), adequate specimen was obtained in all cases and a histological diagnosis was achieved in 8/9 (89%) cases. CONCLUSION This preliminary report suggests that trans-caval modification of TJLB is a relatively safe procedure that may be useful in cases where conventional TJLB is infeasible. ADVANCES IN KNOWLEDGE (a) We describe the technique of trans-caval TJLBs and report our findings in the largest series of published cases. (b) Trans-caval TJLB is relatively safe and can be used to increase the success rates of conventional TJLB.
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Affiliation(s)
- V Moses
- 1 Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
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Keshava SN, Prabhu SM, Irodi A. What to Do and What Not to Do in Radiology Viva Voce. Hong Kong J Radiol 2014. [DOI: 10.12809/hkjr1413217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lundin B, Manco-Johnson ML, Ignas DM, Moineddin R, Blanchette VS, Dunn AL, Gibikote SV, Keshava SN, Ljung R, Manco-Johnson MJ, Miller SF, Rivard GE, Doria AS. An MRI scale for assessment of haemophilic arthropathy from the International Prophylaxis Study Group. Haemophilia 2012; 18:962-70. [DOI: 10.1111/j.1365-2516.2012.02883.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2012] [Indexed: 11/29/2022]
Affiliation(s)
- B. Lundin
- Department of Clinical Sciences Lund, Division of Diagnostic Radiology and Center for Medical Imaging and Physiology; Lund University, Skåne University Hospital; Lund; Sweden
| | - M. L. Manco-Johnson
- Department of Radiology and Hemophilia & Thrombosis Center; University of Colorado; Denver; CO; USA
| | - D. M. Ignas
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto; Ontario; Canada
| | - R. Moineddin
- University of Toronto; Public Health, Family and Community Medicine; Toronto; Ontario; Canada
| | - V. S. Blanchette
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children and Department of Pediatrics; University of Toronto; Toronto; Ontario; Canada
| | - A. L. Dunn
- Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta; Emory University School of Medicine; Atlanta; GA; USA
| | - S. V. Gibikote
- Department of Radiology; Christian Medical College; Vellore; Tamil Nadu; India
| | - S. N. Keshava
- Department of Radiology; Christian Medical College; Vellore; Tamil Nadu; India
| | - R. Ljung
- Department of Paediatrics; Lund University; Skåne University Hospital; Malmö-Lund; Sweden
| | - M. J. Manco-Johnson
- Department of Pediatrics and the Hemophilia & Thrombosis Center; University of Colorado; Denver; CO; USA
| | - S. F. Miller
- St. Jude Children's Research Hospital; Memphis; TN; USA
| | - G. E. Rivard
- CHU Sainte Justine; University of Montreal; Montreal; Quebec; Canada
| | - A. S. Doria
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto; Ontario; Canada
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Amitha Vikrama KS, Keshava SN, Surendrababu NRS, Moses V, Joseph P, Vyas F, Sitaram V. Jejunal access loop cholangiogram and intervention using image guided access. J Med Imaging Radiat Oncol 2010; 54:5-8. [PMID: 20377708 DOI: 10.1111/j.1754-9485.2010.02130.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Jejunal access loop is fashioned in patients who undergo Roux en Y hepaticojejunostomy and biliary intervention is anticipated on follow up. Post-operative study of the biliary tree through the access loop is usually done under fluoroscopic guidance. We present a series of 20 access loop cholangiograms performed in our institution between August 2004 and November 2008. We aimed to evaluate the safety and efficacy of the procedure and to highlight the role of CT guidance in procuring access. Access loop was accessed using CT (n = 13), ultrasound (n = 3) or fluoroscopic guidance (n = 4). Fluoroscopy was used for performing cholangiograms and interventions. Twelve studies had balloon plasty of the stricture at anastomotic site or high up in the hepatic ducts. Seven studies showed normal cholangiogram. Plasty was unsuccessful in one study. Technical success in accessing the jejunal access loop was 100%; in cannulation of anastomotic site and balloon plasty it was 95%. One case required two attempts. Procedure-related complications were not seen. All patients who underwent balloon plasty of the stricture were doing well for variable lengths of time. Access loop cholangiogram and interventions are safe and effective. CT guidance in locating/procuring the access loop is a good technique.
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Surendrababu NRS, Keshava SN, Eapen CE, Zachariah UG. Transjugular intrahepatic portocaval shunt placed through the strut of an inferior vena cava stent in a patient with Budd-Chiari syndrome: a technical modification. Br J Radiol 2010; 83:e22-4. [PMID: 20139245 DOI: 10.1259/bjr/60833972] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Transjugular intrahepatic portocaval shunt (TIPS) is performed in patients with symptomatic Budd-Chiari syndrome (BCS) who do not have repairable hepatic veins. We report the case of a patient who had an inferior vena cava (IVC) stent placed previously as part of the management for BCS, and who subsequently required TIPS. The TIPS tract was created through the strut of the previously placed IVC stent; the TIPS stent was placed after dilatation of the liver parenchyma as well as the strut of the IVC stent. This novel technique of "strutplasty" of a previously placed stent as part of TIPS has not been reported in the literature.
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Affiliation(s)
- N R S Surendrababu
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
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Affiliation(s)
- A K Koshy
- Christian Medical College, Vellore, Tamil Nadu, India
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Sureka J, Sarawagi R, Eapen A, Keshava SN, Vedantam R. Skull base hydatid cyst with intracranial extension presenting as vocal cord palsy: a case report. Br J Radiol 2010; 83:e67-9. [PMID: 20197432 DOI: 10.1259/bjr/21853098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hydatid disease of the skull base is extremely rare, and intracranial extension of hydatid cysts through the skull base is even rarer. We report an interesting case of a 42-year-old man who presented with features of right vocal cord palsy. The diagnosis of hydatid cyst was made based on his history and on pre-operative MRI and was confirmed by surgery and histopathological examination.
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Affiliation(s)
- J Sureka
- Christian Medical College, Vellore, Tamilnadu, India.
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Moses V, Keshava SN, Wann VC, Joseph P, Sitaram V. Cystic artery pseudoaneurysm after laparoscopic cholecystectomy presenting as haemobilia: a case report. Trop Gastroenterol 2008; 29:107-109. [PMID: 18972774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cystic artery pseudoaneurysm which developed following a cholecystectomy and resulting in upper gastrointestinal bleeding is a rare entity, with only three cases described in the literature. We report the case of a 26-year old man who presented with upper gastrointestinal bleeding approximately three months after laparoscopic cholecystectomy. Emergency abdominal angiogram revealed a cystic artery stump pseudoaneurysm, with no evidence of active contrast extravasation. The pseudoaneurysm was coil embolised and the patient had no further bleeding episodes. In this situation an angiogram and embolisation rather than surgery is the preferred mode of management both in terms of diagnosis and treatment. The presence of a dilated cystic artery stump on angiogram following cholecystectomy is an "ominous sign", even in the absence of active extravasation of contrast.
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Affiliation(s)
- V Moses
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India.
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Poonnoose PM, Thomas R, Keshava SN, Cherian RS, Padankatti S, Pazani D, Kavitha ML, Devadarasini M, Bhattacharji S, Viswabandya A, John JA, Macaden AS, Mathews V, Srivastava A. Psychometric analysis of the Functional Independence Score in Haemophilia (FISH). Haemophilia 2007; 13:620-6. [PMID: 17880453 DOI: 10.1111/j.1365-2516.2007.01508.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Joint morbidity in haemophilia has traditionally been measured using clinical and radiological scores. There have been no reliable, validated tools for the assessment of functional independence in persons with haemophilia till recently. The Functional Independence Score in Haemophilia (FISH) has been developed as a performance based assessment tool to address this need. The FISH is designed to measure the patient's independence in performing activities of daily living (grooming and eating, bathing and dressing), transfers (chair and floor), and mobility (walking, step climbing and running). On assessment of its psychometric properties in 63 patients with haemophilia (mean age 14 years), FISH was found to have good internal consistency (Cronbach's alpha of 0.85). It had moderate correlation with the World Federation of Hemophilia clinical score (r = -0.61), and a correlation with the Pettersson score of -0.38. It had good correlation with other self-rated functional scores, such as the Stanford Health Assessment Questionnaire (r = -0.75); the Western Ontario and McMaster Universities Osteoarthritis Index (r = -0.66) and the Haemophilia Activities List (HAL) (r = -0.66). It had good reliability with a pooled intra class correlation of 0.98. On assessing responsiveness following treatment of flexion deformities of the knee in 12 patients, the FISH showed significant changes in the score with a standardized responsiveness mean of -1.93. In conclusion, the FISH was found to be a reliable and valid tool with good internal consistency and responsiveness to therapy, for the assessment of functional independence in persons with haemophilia.
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Affiliation(s)
- P M Poonnoose
- Department of Orthopaedics, Christian Medical College, Vellore 632004, India.
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Abstract
The right internal jugular vein (IJV) is a common vessel to obtain venous access. It is important to have a clear understanding of the anatomy of the IJV and its relationship to the common carotid arteries (CCA) to avoid inadvertent arterial puncture. This study aims to objectively evaluate the variations in the anatomy of IJV and its relation to the CCA. A total of 176 right and left IJV were retrospectively evaluated using CT imaging with the CentraRad Diagnostic Viewer Version 4.09.0190 (CDN Telemedicine Solutions, Wollongong, Australia). The data were recorded and analysed. The right IJV (80.5%) was more often larger than the left IJV. With reference to the CCA, 85.2% of the IJV were found in the lateral position, 12.5% anteriorly, 1.1% medially and 1.1% posteriorly. Seven IJV were found to be hypoplastic, and in one case this was seen bilaterally in both the right and left IJV. The maximum depth of IJV from the skin was 27.9 mm. More than half (69.5%) of the IJV were less than 1 mm from the carotids. Computed tomography is an excellent method to delineate the anatomy of IJV. Variations in the anatomy of the IJV and their correlation to the CCA are common.
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Affiliation(s)
- C L Lim
- Department of Radiology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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