Glomus vagale presenting as a supraclavicular mass: Magnetic resonance imaging findings

Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant but rarely hormonally active. A rare case is reported of glomus vagale presenting as a supraclavicular mass.     

Conjoint bicondylar Hoffa fracture in an adult

Conjoint bicondylar Hoffa fracture is an extremely rare injury. Only one case has been reported previously in the pediatric age group. We describe this injury in a 17-year-old male who presented following a fall with direct impact on his semiflexed right knee. Plain radiographs were inadequate to define the exact pattern of injury. Computed tomographic (CT) scans demonstrated the coronal fracture involving both the femoral condyles which were joined by a bridge of intact bone. The patient was treated with open reduction and internal fixation using swashbuckler (modified anterior) approach. Union occurred within 3 months and at final followup (at 18 months) the patient had a good clinical outcome. The possible mechanism of injury is discussed.     

Cardiac MRI in Congenital Heart Disease – Our Experience

A significant recent advance that has occurred world over in the continuously evolving field of Magnetic Resonance Imaging (MRI) practice is the introduction of Cardiac applications. Cardiac MRI has moved to the centre stage of clinical management strategy by non-invasively imaging the structure as well as function of the heart. It has a wide range of specific applications such as delineation of morphological anatomy, quantification of flow and pressure across cardiac valve dysfunction, evaluation of myocardial function, assessment of infarcts, mapping coronary arteries and so on. Evaluation of congenital heart disease (CHD) is an important application of Cardiac MRI since the morphological details of chambers, septum, defects and anomalous connections are depicted accurately. Besides, flow information across valves, chambers, outflow tracts and shunts are also provided. This article describes our experience in the use of cardiac MRI in congenital heart disease.Key Words: Cardiac MRI, Congenital heart disease, Cyanotic and Acyanotic heart disease     

Routine placement of a ventricular reservoir at endoscopic third ventriculostomy

OBJECTIVE: Endoscopic third ventriculostomy (ETV) failure may be abrupt in onset, causing a potentially life-threatening increase in intracranial pressure. ETV failure may also have a more insidious onset, and in these cases, diagnosis on clinical and radiological grounds can be difficult. This study evaluates the usefulness of routine ventricular reservoir placement at the time of ETV for subsequent emergency ventricular access or the diagnosis of ETV failure. METHODS: A retrospective review of 84 consecutive patients undergoing ETV with routine insertion of a ventricular reservoir during a 4-year period (1996-2000) was undertaken. The mean follow-up period was 14.8 months. End points for ETV failure were shunt insertion or revision of ETV. The diagnostic and therapeutic use of the reservoir was quantified. RESULTS: The reservoir was used in 32% of patients (n = 27). The reservoir allowed life-saving emergency ventricular access in two cases of acute recurrent hydrocephalus. In patients with symptoms but equivocal radiological evidence of recurrent hydrocephalus, the reservoir allowed for assessment of intracranial pressure (n = 19) and/or a therapeutic trial of cerebrospinal fluid aspiration (n = 5). Seven of these patients subsequently required revision ETV or shunt insertion. In the 14 patients who had normal intracranial pressure, conservative management was successful. The reservoir also facilitated intrathecal drug administration for postoperative ventriculitis (n = 2). No patients requested reservoir removal. CONCLUSION: Routine insertion of a ventricular reservoir allows life-saving emergency therapeutic cerebrospinal fluid aspiration to be performed for sudden neurological deterioration caused by ventriculostomy failure. It also assists in the diagnosis of ETV failure and allows intrathecal drug administration.     

Endoscopic methods of hydrocephalus treatment

This article discusses the use of the endoscope in treatment of hydrocephalus without shunting. The selection of candidates for third ventriculostomy and choroid plexus coagulation are described together with the overall published rates of success with each technique. A summary of the nature and frequency of complications of third ventriculostomy are given after reviewing published data on over a thousand patients who have had the operation to date. The role of other endoscopic techniques, such as septal fenestration and decompression of obstructing cysts, also are discussed.     

Primary calvarial cryptococcal osteomyelitis in a patient with idiopathic lymphopenia

Summary  An example of primary calvarial cryptococcal osteomyelitis in a patient with idiopathic lymphopenia is presented. The patient was a suboptimally immunocompetent host with an isolated skull involvement without any systemic infection. The Magnetic Resonance Imaging radiographic findings of the head are reviewed. The patient underwent surgical debridement of the lesion as well as receiving a course of oral antifungal medication. We discuss cryptococcal osteomyelitis and review the reports of cryptococcal disease and Idiopathic Lymphopenia. Correspondence: Amit Amit, Department of Neurosurgery, Frenchay Hospital, Bristol.     

Lack of awareness of Hepatitis B screening and vaccination in high-risk groups

Background/aim Hepatitis B virus (HBV) vaccination rates are insufficient in high-risk patients worldwide. This study aimed to investigate the screening, immunization, and vaccination rates in three high-risk groups for HBV infection: allogeneic hematopoietic stem cell transplantation (AHSCT), renal transplantation (RT), and chronic hepatitis C (CHC) groups. Materials and methods The serological data of consecutive patients between 2014 and 2019 were reviewed using the hospital database. Results The HBV screening rates were 100.0%, 90.4%, and 82.4% in the AHSCT, CHC, and RT groups, respectively (p = 0.003). The immunization rates against HBV through either previous exposure or vaccination were 79.5%, 71.7%, and 46.5% in the AHSCT, RT, and CHC groups, respectively (p < 0.001). The HBV vaccination rate was significantly low in the CHC group (71.5%, 69.0%, 34.6% in the AHSCT, RT, and CHC groups, respectively, p < 0.001). If patients lost their immunity due to immunosuppressive therapy were accounted, the vaccination rates increased to 95.2% in the AHSCT group and 72.9% in the RT group. The rate of annual screening for HBV status was 97.9% in the AHSCT group, but it was only 23.9% in the RT group. Conclusion HBV screening and vaccination rates were significantly lower in the RT and CHC groups than in the AHSCT group.