Imaging and interventions in Budd-Chiari syndrome

Budd-Chiari syndrome(BCS) consists of a group of disorders with obstruction of hepatic venous outflow leading to increased hepatic sinusoidal pressure and portal hypertension.Clinically,two forms of disease(acute and chronic) are recognized.Mostly the patients present with ascites,hepatomegaly,and portal hypertension.In acute disease the liver is enlarged with thrombosed hepatic veins(HV) and ascites,whereas in the chronic form of the disease there may be membranous occlusion of HV and/or the inferior vena cava(IVC),or there may be short or long segment fibrotic constriction of HV or the suprahepatic IVC.Due to advances in radiological interventional techniques and hardware,there have been changes in the management protocol of BCS with surgery being offered to patients not suitable for radiological interventions or having acute liver failure requiring liver transplantation.The present article gives an insight into various imaging findings and interventional techniques employed in the management of BCS.     

A single incision surgical new anterior technique for forequarter amputation

Background  

Conventionally described standard techniques of forequarter amputation may not be suitable for patients presenting with neglected or maltreated very large tumors of the proximal humerus.     

Imaging in renal trauma

Renal injuries are classified,based on the American Association for the Surgery of Trauma classification,in to five grades of injury.Several imaging modalities have been available for assessing the grade of renal injury,each with their usefulness and limitations.Currently,plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury.Ultrasonography(USG) has a limited role in evaluating patients with suspected retroperitoneal injury;however,it plays an important role during follow up in patients with urinoma formation.USG helps to monitor the size of a urinoma and also for the drainage procedure.The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility.Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose,like placing a stent across the site of ureteric injury.Magnetic resonance imaging has no role in acute renal injuries.Multidetector computed tomography is the modality of choice in the evaluation of renal injuries.It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region.The combination of imaging findings along with clinical information is important in the management of the individual patient.This article will describe a spectrum of renal injuries encountered in a trauma setting.     

Posttraumatic subacute ascending myelopathy in a 24-year-old male patient

Posttraumatic subacute ascending myelopathy is a rare late complication of spinal trauma. We present a case of 24-year-old male patient of motor vehicle accident who initially presented with T12 vertebral fracture and associated cord compression and signal changes in lower dorsal cord causing paraplegia with bladder and bowel involvement. In the subsequent week, he developed complete paraplegia with cord signal abnormality on magnetic resonance imaging extending cephalad from the injury site to involve the cervicomedullary junction. The patient clinically and radiologically improved over 6 weeks on steroid treatment.     

PHOTO-STIMULATORY EFFECT OF LOW ENERGY HELIUM-NEON LASER IRRADIATION ON EXCISIONAL DIABETIC WOUND HEALING DYNAMICS IN WISTAR RATS

Background:

Generally, the significances of laser photo stimulation are now accepted, but the laser light facilitates wound healing and tissue repair remains poorly understood.

Aims:

We have examined the hypothesis that the laser photo stimulation can enhance the collagen production in diabetic wounds using the excision wound model in the Wistar rat model.

Methods:

The circular wounds were created on the dorsum of the back of the animals. The animals were divided into two groups. The study group (N = 24) wound was treated with 632.8 nm He-Ne laser at a dose of 3-9 J/cm² for 5 days a week until the wounds healed completely. The control group was sham irradiated.

Result:

A significant increase in the hydroxyproline content and reduction in the wound size were observed in the study group. The pro-healing actions seem to be due to increased collagen deposition as well as better alignment and maturation.

Conclusion:

The biochemical analysis and clinical observation suggested that 3-6 J/cm² laser photo stimulation facilitates the tissue repair process by accelerating collagen production in diabetic wound healing.     

Autistic Disorder Associated with an Iso-dicentric Y Chromosome

The relationship between a fragile site on the X chromosome and autism has been well documented. The authors report a three-year-old child with partial duplication of the short arm of chromosome Y, who had an autistic disorder. He was microcephalic, but otherwise had a normal phenotype. There was a history of preterm birth and maternal diabetes. This is the sixth case of sex chromosome Y aneuploidy associated with autism, but the first with an isodicentric Y. In well-substantiated cases of autism, clinicians should now consider abnormalities of the Y as well as the X chromosome.     

Permeability of cellulose polymers: water vapour transmission rates

The water vapour transmission rates (WVTR) through solvent cast polymer films prepared from cellulose acetate, cellulose acetate propionate, and cellulose acetate butyrate have been determined. They were influenced by the relative humidity, the substituent type and the extent of substitution. Increasing the relative humidity from 32 to 90% increased the WVTR 3 to 5 times depending on the polymer used. The WVTR increased in the order of butyrate less than propionate less than acetate. An increase in the extent of substitution with acetyl and/or butyryl groups resulted in an exponential decline in the WVTR.