Staging papillary carcinoma of the thyroid: magnetic resonance imaging vs ultrasound of the neck

AIM: To evaluate the role of magnetic resonance imaging (MRI) for staging local disease and lymph node metastases in papillary carcinoma of the thyroid by comparing MRI with ultrasound (US) of the neck. MATERIALS AND METHODS: Fourteen patients with papillary carcinoma underwent MRI and US. The images were prospectively reviewed for (1) identification of the primary lesion; (2) presence of multifocal thyroid disease; (3) extracapsular extension; (4) invasion into the trachea, oesophagus and major vessels; and (5) presence of lymph node metastases. Correlation was made with the surgical findings. RESULTS: The site of the primary lesion was correctly identified by US in 14 of 14 (100%) and by MRI in 13 of 14 (93%) of patients. Multifocal thyroid tumour was correctly identified by US in two of two patients (100%) and by MRI in zero of two (0%). Extracapsular extension (n = 9), oesophageal invasion (n = 1) and tracheal invasion (n = 2) were identified by MRI in seven, zero, and one, and by US in six, zero and zero patients, respectively. Invasion of the major vessels was not seen. Metastatic cervical nodes were present in 19 nodal groups in 10 patients involving the internal jugular chain (n = 10), posterior triangle (n = 4) supraclavicular fossa (n = 1) and central group (n = 4). Both MRI and US failed to identify metastatic nodes in the central group but correctly identified 14 of the 15 nodal groups outside the central group. CONCLUSION: Ultrasound should be used as the first line of investigation for detecting the primary lesion, multifocal disease and cervical lymphadenopathy. In cases where the primary tumour is not surrounded by normal thyroid tissue MR imaging should be added to assess extracapsular spread, especially into the trachea.     

A study of psychiatrically normal children in a hospital based child guidance clinic

A total of 1330 children who attended a hospital-based child guidance clinic in last three years were studied retrospectively. 7.37% of these were found to have no psychiatric disorder. Epilepsy and scholastic backwardness without any psychiatric disorder, together constituted 70.41% of this group. Children referred to a child guidance clinic require proper assessment to detect psychiatrically normal children who would otherwise receive unnecessary label of psychiatric disorder and treatment.     

Hypoparathyroidism simulating brain tumor—an unusual presentation

A 13 yr old boy presented with generalised tonic-clonic convulsions and papilledema simulating an intracranial space occupying lesion. CT scan showed bilateral basal ganglia calcification. Biochemical investigations established the diagnosis of hypoparathyroidism. On treatment with oral calcium and vitamin D the patients became seizure free and papilledema regressed. The possibility of hypoparathyroidism should be considered when basal ganglia calcification is seen and CT scan.     

Prevalence of multiple drug resistance amongst strains of Esch.coli isolated from cases of diarrhea

A total of 348 Esch.coli strains isolated from cases of diarrhoea in infants and children during 1979 and received at the National Salmonella and Escherichia Centre, Central Research Institute, Kasauli were serotyped and tested for the prevalence of multiple drug resistance. These strains belonged to 43 different serotypes, the most common being 060, 01, 011, 017 and 020. About one third (113) of the strains could not be typed. It was found that 248 strains (80.5%) were resistant to 3 or more drugs. The resistance pattern of various serotvpes and their epidemiohgical significance with particular reference to diarrhea in children isdiscussedln this report.     

HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

Background  

The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN), namely of angiotensin converting enzyme inhibitors (ACE) and antiretroviral therapy, has not been reported for a national sample of dialysis patients.     

Antibiotic associated diarrhoea: a controlled study comparing plain antibiotic with those containing protected lactobacilli

Antibiotic associated diarrhoea is known to occur with broad spectrum antibiotics. Lactobacillus has been used for prophylaxis and therapy of this condition. In a double blind controlled study, the antibiotic containing ampicillin (250 mg) and cloxacillin (250 mg) with or without protected lactobacilli was evaluated in 740 patients undergoing cataract surgery. The incidence of diarrhoea in patients receiving plain antibiotic was 13.3% compared to 0.0% in patients receiving antibiotic with protected lactobacilli (p<0.001). The study demonstrates that antibiotic formulations containing protected lactobacilli maintain prophylactic effect of lactobacilli.     

Second branchial cleft cysts: variability of sonographic appearances in adult cases

BACKGROUND AND PURPOSE: Previous reports have suggested that second branchial cleft cysts (BCCs) appear on sonograms as well-defined, cystic masses with thin walls and posterior enhancement. Previous CT and MR imaging findings, however, have indicated heterogeneity of these masses, and, in our experience, sonography also shows a similar variable appearance. In this communication, we report the cases of 17 patients with second BCCs and document the variability of sonographic patterns. METHODS: The sonograms of 17 adults with second BCCs were reviewed. Only patients with surgical or cytologic evidence of BCCs were included in this study. The features evaluated were the location, internal echogenicity, posterior enhancement, and presence of septa and fistulous tract. RESULTS: Four patterns of second BCCs were identified: anechoic (41%), homogeneously hypoechoic with internal debris (23.5%), pseudosolid (12%), and heterogeneous (23.5%). The majority (70%) showed posterior enhancement. All were situated in their classical location, posterior to the submandibular gland, superficial to the carotid artery and internal jugular vein, and closely related to the medial and anterior margin of the sternomastoid muscle. Fourteen (82%) of the 17 BCCs had imperceptible walls, and all were well defined. For none of the patients was a fistulous tract revealed by sonography; the presence of internal septations was revealed for three patients. CONCLUSION: As previously suggested by CT and MR imaging findings, sonography reinforces that second BCCs in adults are not simple cysts but have a complex sonographic pattern ranging from a typical anechoic to a pseudosolid appearance.