Clinics in diagnostic imaging (166)

A 68-year-old woman with poorly controlled diabetes mellitus presented to the emergency department with choreoathetoid movements affecting the upper and lower left limbs. Computed tomography of the brain did not show any intracranial abnormalities. However, subsequent magnetic resonance (MR) imaging of the brain revealed an increased T1 signal in the right basal ganglia, raising the suspicion of nonketotic hyperglycaemic chorea-hemiballismus. Management consisted of adjusting her insulin dose to achieve good glycaemic control. The patient subsequently recovered and was discharged after eight days. There are many causes of basal ganglia T1 hyperintensity, including hyperglycaemia in patients with poorly controlled diabetes mellitus. This case emphasises the importance of MR imaging in the early diagnosis of hyperglycaemia as a cause of chorea-hemiballismus, to enable early treatment and a better clinical outcome.     

Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture.

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain’s disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.     

Clinics in diagnostic imaging (165)

Oesophageal rupture is a life-threatening complication of balloon tamponade for bleeding oesophageal varices. We herein describe the clinical course and imaging findings in a 33-year-old Indian man who had a Sengstaken-Blakemore (SB) tube inserted for uncontrolled haematemesis, which was unfortunately complicated by malposition of the gastric balloon with resultant oesophageal rupture. The inflated SB tube gastric balloon was visualised within the right hemithorax on chest radiography after the SB tube insertion. Further evaluation of the thorax on computed tomography confirmed the diagnosis of oesophageal rupture associated with right-sided haemopneumothorax. It is crucial for both the referring clinician and reporting radiologist to recognise early the imaging features of an incorrectly positioned SB tube gastric balloon, so as to ensure prompt intervention and a reduction in patient morbidity and mortality.     

Clinics in diagnostic imaging (158). Duodenal ectopic pancreas

A 46-year-old man presented with right loin tenderness following a road traffic accident. Computed tomography and magnetic resonance imaging showed a well-defined, smooth, enhancing oval lesion in the wall of the first part of the duodenum. The lesion was seen separately from the normal pancreas. It showed attenuation, intensity and enhancement similar to that of normal pancreas. Based on the imaging appearance, a diagnosis of ectopic pancreas was made. The patient underwent oesophagogastroduodenoscopy, endoscopic ultrasonography and fine-needle aspiration cytology of the lesion, which confirmed ectopic pancreatic tissue. Since the patient was asymptomatic, surgical resection was deferred. The embryologic origin, various locations, imaging appearance and clinical significance of ectopic pancreas are discussed.     

Clinics in diagnostic imaging (153). Severe hypoxic ischaemic brain injury.

A 58-year-old Indian woman presented with asystole after an episode of haemetemesis, with a patient downtime of 20 mins. After initial resuscitation efforts, computed tomography of the brain, obtained to evaluate neurological injury, demonstrated evidence of severe hypoxic ischaemic brain injury. The imaging features of hypoxic ischaemic brain injury and the potential pitfalls with regard to image interpretation are herein discussed.     

Clinics in diagnostic imaging (157). Acinar cell carcinoma (ACC) of the pancreatic tail.

A 50-year-old Chinese man presented to the clinic with left hypochondrial pain, more than 10 kg of weight loss over a 3-month period, and a firm, large, ill-defined mass in the left upper quadrant. Contrast-enhanced computed tomography of the abdomen and pelvis revealed a well-circumscribed exophytic pancreatic mass with features suggestive of acinar cell carcinoma (ACC). The patient underwent chemotherapy and radiotherapy, with no evidence of local recurrence detected at one-year follow-up. He remains under close surveillance by his oncologist. Treatment for ACC includes surgical resection with adjuvant radiotherapy. Better overall survival is seen in patients with surgically resectable ACC as compared to those with the more common ductal cell carcinoma.     

Clinics in diagnostic imaging (159). Jejunal intussusception due to Peutz-Jeghers syndrome.

A 21-year-old woman presented with acute onset of upper abdominal pain. A diagnosis of Peutz-Jeghers syndrome (PJS) was made based on the clinical picture of perioral pigmentation with imaging findings of transient jejunojejunal intussusceptions and small bowel polyps, and confirmed by characteristic histopathological appearances of Peutz-Jeghers polyps. PJS is a rare hereditary condition characterised by unique hamartomatous polyps, perioral mucocutaneous pigmentations, and increased susceptibility to gastrointestinal and extraintestinal neoplasms. Patients usually present with recurrent abdominal pain due to intussusception caused by polyps. Other modes of presentations include rectal bleeding and melaena. We describe the imaging findings of PJS and provide a brief review of bowel polyposis syndromes. The latter are relatively rare disorders characterised by multiple polyps in the large or small intestine, with associated risk of malignancies and other extraintestinal manifestations. Awareness of the manifestations and early diagnosis of these syndromes is crucial to prevent further complications.     

Clinics in diagnostic imaging (152). Right lower lobe segmental pulmonary embolus.

A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton’s hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dual-energy computed tomography innovations.     

Clinics in diagnostic imaging (160). Levocardia with abdominal situs inversus

Levocardia (left-sided cardiac apex) with abdominal situs inversus is extremely rare. This is also known as isolated levocardia and is almost always associated with severe forms of congenital heart defects with poor prognosis. We report isolated levocardia in a 13-year-old symptomatic male patient. The purpose of this paper is to outline the imaging features of isolated levocardia and to highlight the role of cardiovascular magnetic resonance imaging (CMR) in the diagnosis and management of such cases. Other forms of cardiac malposition, including dextrocardia, mesocardia and criss-cross heart, with chest radiograph and CMR correlation, are also discussed.     

Clinics in diagnostic imaging (155). Incidental PDA with secondary pulmonary arterial hypertension.

We report the case of a 70-year-old man with an asymptomatic large patent ductus arteriosus (PDA) incidentally detected on triple-rule-out computed tomography (CT). CT clearly demonstrated a vascular structure connecting the descending thoracic aorta to the roof of the proximal left pulmonary artery, consistent with a PDA. Secondary pulmonary arterial hypertension was also evident on CT. The patient was eventually diagnosed with acute coronary syndrome and was successfully treated with coronary artery bypass graft surgery and concomitant patch closure of the PDA. This article aims to outline the imaging features of PDA and highlight the information provided by CT, which is crucial to treatment planning. The pathophysiology, clinical manifestations and closure options of PDA are also briefly discussed.     

Clinics in diagnostic imaging (161). Cervical OPLL with cord compression

A 53-year-old man presented with acute cervical myelopathy following a fall. Cervical radiography and computed tomography showed ossification of the posterior longitudinal ligament (OPLL) from C2 to C6 level, with severe cervical canal stenosis and cord compression. Magnetic resonance imaging further showed increased T2-weighted signal in the spinal cord at the level of greatest central spinal canal stenosis. OPLL is a significant cause of myelopathy in Asian populations and is found in up to 25% of patients presenting with cervical compression myelopathy. The clinical presentation, radiological evaluation and management of OPLL are discussed.     

Clinics in diagnostic imaging (151). Acromioclavicular joint geyser sign with chronic full-thickness supraspinatus tendon (SST) tear.

An 82-year-old man presented with neck pain, right upper limb radiculopathy and right shoulder pain. Physical examination revealed a soft lump over the right shoulder joint, as well as reduced range of shoulder movements. On magnetic resonance imaging, the soft lump was shown to be a cystic mass over the acromioclavicular joint and was related to a full-thickness supraspinatus tendon tear. This is the classic geyser sign. The pathophysiology and clinical features of the geyser sign, and its imaging features with various imaging modalities, are discussed.     

DWI诊断CO中毒迟发性脑病的应用价值

目的 研究弥散加权成像(DWI)诊断CO中毒迟发性脑病的应用价值。方法 对31例CO中毒迟发性脑病患者均行MR DWI检查,MRI检查在CO中毒后15～90d内完成,DWI使用单次激发平面回波序列,TR=2900ms,TE=84ms,b值为0和1000s/mm2。通过常规MRI、DWI及ADC图评价脑室周围脑白质区信号改变,测量病变区ADC值并与正常信号区进行对比。结果 所有患者DWI序列均显示在双侧脑室周围脑白质区及半卵圆中心弥漫高信号影,显示范围与T2WI及Flair序列所显示范围相似,ADC图显示为轻度低信号或等信号,其平均ADC值均较T2WI及Flair序列显示正常的区域明显减低(P<0.05)。结论 脑白质区ADC值减低的程度和持续时间与患者临床进展过程有关,通过对ADC值的观察能对CO中毒迟发性脑病患者的临床进展过程及预后进行推测。     

高压氧综合疗法抢救急性一氧化碳中毒32例的分析

对32例一氧化碳中毒用高压氧综合疗法抢救治疗全部恢复健康,9例未昏迷者.治疗一次后症状消失.14例昏迷者治疗3～5次后清醒,9例深昏迷病人,治疗11～13次昏迷症状消失,疗效可靠安全.     

Repellent properties of Cardiospermum halicacabum Linn. (Family: Sapindaceae) plant leaf extracts against three important vector mosquitoes

Objective

To determine repellent activity of hexane, ethyl acetate, benzene, chloroform and methanol extract of Cardiospermum halicacabum (C. halicacabum) against Culex quinquefasciatus (Cx. quinquefasciatus), Aedes aegypti (Ae. aegypti) and Anopheles stephensi (An. stephensi).

Methods

Evaluation was carried out in a net cage (45 cm×30 cm×25 cm) containing 100 blood starved female mosquitoes of three mosquito species and were assayed in the laboratory condition by using the protocol of WHO 2005; The plant leaf crude extracts of C. halicacabum was applied at 1.0, 2.5, and 5.0 mg/cm² separately in the exposed area of the fore arm. Only ethanol served as control.

Results

In this observation, the plant crude extracts gave protection against mosquito bites without any allergic reaction to the test person, and also, the repellent activity was dependent on the strength of the plant extracts. The tested plant crude extracts had exerted promising repellent against all the three mosquitoes.

Conclusions

From the results it can be concluded the crude extract of C. halicacabum was potential for controlling Cx. quinquefasciatus, Ae. aegypti and An. stephensi mosquitoes.     

Unusual optic disc infarction in a case of arteritic anterior ischaemic optic neuropathy (AAION)

Herein, we report another case of arteritic anterior ischaemic optic neuropathy from Singapore, in which the initial optic disc swelling was extreme and the sequential disease resolved because the patient was already on maximum treatment. As the management of this biopsy-proven giant cell arteritis case was complicated by the presence of a number of other medical conditions, including end-stage renal failure, monitoring of the response to treatment proved problematic.     

In vitro control of Staphylococcus aureus (NCTC 6571) and Escherichia coli (ATCC 25922) by Ricinus communis L.

Objective

To evaluate antibacterial activity of hot and cold ethanol and methanol leaf extracts of Ricinus communis L (R. communis) against Staphylococcus aureus (S. aureus) (NCTC 6571) and Escherichia coli (E. coli) (ATCC 25922).

Methods

Leaf powder of R. communis L. was extracted with hot (in Soxhlet) and cold ethanol and methanol, separately. The antibacterial activity of the extracts was determined by agar well diffusion and macro broth dilution methods. The extracts were also subjected to phytochemical analysis.

Results

All the four test extracts showed inhibition on both S. aureus and E. coli. Hot and cold ethanol extracts revealed significantly (P<0.05) higher inhibition on S. aureus than methanol extracts, and the hot ethanol extract had the lowest minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values (5 mg/mL and 10 mg/mL, respectively). E. coli was highly inhibited by hot extracts of both ethanol and methanol with the MIC and MBC of 40 mg/mL and 80 mg/mL, respectively. Phytochemical analysis revealed the presence of saponins, cardiac glycosides, tannins, flavonoids and terpenoids in all test extracts.

Conclusions

This study demonstrates that the hot and cold methanol and ethanol extracts are potential sources for control of S. aureus and E. coli. Especially, the hot and cold extracts of ethanol are more inhibitive against S. aureus even at lower concentration. Further study is needed to identify the specific bioactive compounds, their mode of action and their nontoxic nature in vivo condition.     

Acaricidal activity of different extracts from Syzygium cumini L. Skeels (Pomposia) against Tetranychus urticae Koch

Objective

To investigate the acaricidal activity of different extracts from Syzygium cumini (S. cumini) (Pomposia) againsst Tetranychus urticae Koch (T. urticae) and the biochemical changes in antioxidants enzymes.

Methods

Six extracts of S. cumini (Pomposia) at concentrations of 75, 150 and 300µg/mL were used to control T. urticae (Koch).

Results

The ethanol extract showed the most efficient acaricidal activity agent against T. urticae (98.5%) followed by hexane extract (94.0%), ether and ethyl acetate extract (90.0%). The LC₅₀ values of the promising extract were 85.0, 101.0, 102.0 and 98.0µg/mL, respectively. The activities of enzymes including ascorbate peroxidase (APX), peroxidase (POD), superoxide dismutase (SOD) and catalase (CAT) in susceptible mites were increased. The activities of all antioxidant enzymes reach the maximum value in mites at LC₅₀ with ethanol and ethyl acetate extracts, respectively.

Conclusions

The extract of S. cumini has acaricidal acivity against T. urticae, and the ethanol extract is the most efficient.     

The first case report of Leishmania (leishmania) chagasi in Panthera leo in Brazil

We reported here the first known case of natural infection of a lion (Panthera leo-Linnaeus, 1758) with Leishmania (Leishmania) chagasi (L. chagasi) in Brazil. The specimen was created by a circus handler in the state of Mato Grosso and was donated to the zoological park of the Federal University of Mato Grosso. Infection by L. chagasi was detected using a PCR-RFLP test. It was known that the domestic felids can act as reservoir of infection of L. chagasi in endemic areas, making it important that studies demonstrate their participation in the epidemiological chain. We demonstrate in this work that wild animals can have an important role in the epidemiological chain and must be considered in order to plan methods of control of this zoonosis.     

Occurrence of Clinostomum complanatum in Aphanius dispar (Actinoptrygii: Cyprinodontidae) collected from Mehran River,Hormuzgan Province,South of Iran

Objective

To investigate the possibility of Aphanius dispar (A.dispar) acting as intermediate host for Clinostomum complanatum (C. complanatum), from Mehran River, Hormuzgan Province of Iran.

Methods

During a biological study of A. dispar in Mehran River, Hormuzgan Province, South of Iran, a total of 97 fish specimens were collected in 24 January 2006.

Results

4 specimens (4.12%) including 1 male and 3 female were found infected with C. complanatum metacercaria. These metacercaria were coiled in the epiderm on the body surface of infected fishes. The infection is known as yellow spot disease. The parasite abundance, intensity and prevalence were 0.05%, 1.25% and 4.12%, respectively. The infection was higher in females than males.

Conclusions

To the best of our knowledge, this is the first report on occurrence of C. complanatum metacercaria in A. dispar in Iran.