An ultrasonographic monitoring of skin condition in patients receiving radiotherapy for head and neck cancers

Radiodermatitis is one of the commonest side effects of radiotherapy. They are usually assessed by semi‐quantitative clinical scores, which are not validated and may be subject to inter‐observer variability. A few previous studies suggested that high‐frequency ultrasonography (HF‐USG) is useful in the assessment of the acute phase of radiation dermatitis in breast cancer patients. (a) To monitor skin changes by HF‐USG during the course of radiotherapy due to head and neck cancers, and (b) to determine whether there is any connection between skin sonograms and the skin scoring criteria. This prospective, observational study includes patients diagnosed with head and neck cancers, treated with radiotherapy or concomitant chemoradiation. The final analysis includes six patients. In every patient, the HF‐USG as well as dermatological assessment (target lesion score—TLS and CACE v. 4.0) were performed 4×: before, in the middle, day after, and 3 months after radiotherapy. There were significant differences between non‐irradiated skin thickness and thickness of skin with clinically obvious radiodermatitis (TLS grade 1‐4; P < .0001), as well as between irradiated, unchanged skin thickness (TLS grade 0) and thickness of skin with clinically obvious radiodermatitis (TLS grade 1‐4; P = .0002). There was no significant difference between non‐irradiated and irradiated, unchanged skin thickness (TLS grade 0; P = .9318). In four patients, we demonstrated subepidermal low echogenic band (SLEB). HF‐USG can be useful tool to noninvasive and objective assessment of skin changes during radiotherapy.     

急性阑尾炎的B超诊断分析

目的:对97例经手术后病理结果证实的与术前超声检查所得结果对比分析。方法:应用超声诊断仪检查全腹,重点右下腹,分析了急性单纯性阑尾炎、化脓性坏疽穿孔性阑尾炎及阑尾周围脓肿的典型声像改变及其超声所伴发的间接征象。结果:97例中,均行手术治疗后结果为单纯性阑尾炎的26例,化脓坏疽穿孔性阑尾炎45例,阑尾周围脓肿20例,有1例误诊,5例漏诊。结论:阑尾周围脓肿及急性穿孔化脓性化疽性阑尾炎因有典型的声像图改变,故超声诊断的符合率较高;而部分急性单纯性阑尾炎因为声像图改变不典型,则容易造成误诊和漏诊。所以,在今后的工作中既要注重超声诊断的直接征象,也要重视间接征象及临床病史等,以提高正确的诊断率。     

MRI evaluation of fatty liver in day to day practice: Quantitative and qualitative methods

Intracellular fat accumulation is a common feature of liver disease. Steatosis is the histological hallmark of non-alcoholic fatty liver disease (NAFLD) but also may occur with alcohol abuse, viral hepatitis, HIV and genetic lipodystrophies, and chemotherapy. This condition is common in the Western population and is typically associated with obesity and the metabolic syndrome. Early diagnosis and early treatment of NAFLD are important to prevent the development of end-stage liver disease and cancer. In addition, liver fat is a risk factor for postoperative complications after liver resection and transplantation. MRI has become a primary modality to assess hepatic steatosis, both qualitatively and quantitatively. In this article we discuss various MRI methods for evaluation of hepatic steatosis.     

An unusual complication of CSOM — Lateral sinus thrombosis with lung abscess: A clinicoradiological study

Aims To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the radiological findings. Material and methods An 11-year-old male child with a history of pyrexia of unknown origin, right-sided torticollis, cough with expectoration and right ear discharge was referred to us from department of paediatric medicine. Chest examination revealed dull areas on percussion and areas with bronchial breath sounds on auscultation bilaterally. Otological examination revealed right attic retraction pocket filled with cholesteatoma, post-auricular tenderness and Greisinger’s sign along with foul smelling muco-purulent discharge. Results Routine blood investigations revealed normocytic normochromic anaemia, polymorpho-nuclear leucocytosis and raised ESR. Audiological investigations showed a right-sided mixed hearing loss. Digital radiography of chest showed multiple thin walled cavities involving all of the lung zones bilaterally. USG (Ultrasonography) of neck showed thrombosis of right internal jugular vein. CT scanning of head, neck and thorax showed soft tissue collection within the right mastoid with erosion of posterior wall & presence of gas bubble in the right sigmoid sinus and thrombosis of right internal jugular vein and multiple abscess cavities occupying both lung parenchyma. The patient was initially managed with conservative antibiotic therapy for lung abscess followed by radical mastoidectomy and thromboembolectomy from the lateral sinus. Conclusion Otogenic lung abscess though rare in this present postantibiotic era, it can occur in underprivileged and poor population like our country.     

Aortic and coronary calcifications in Takayasu arteritis

Objectives

Atherosclerosis is well recognized in Takayasu arteritis (TAK) and the associated plaques tend to be more common in areas of arteritis. We now report arterial wall calcification in a large group of TAK patients and controls. We hypothesized that the degree of coronary artery calcification would point to a systemic effect of inflammation while that in the thoracic aorta more of local inflammation.

Methods

A total of 47 patients with TAK, 43 patients with SLE and 70 healthy controls (HC) were studied. The presence of coronary artery and thoracic aorta calcifications (ToAC) was investigated by multi-detector computed tomography (MDCT). Atherosclerotic plaques in the carotid arteries were screened using B mode ultrasound.

Results

The frequency of coronary artery calcification was significantly increased among patients with SLE as compared to the healthy controls while the increase in TAK did not reach statistical significance. There were more TAK patients with ToAC among the TAK as compared to the SLE patients [21/47 (45%) vs 10/43 (23%), P = 0.033]. In addition, a circumferential type of calcification, vs a punctuate or linear type, was the more common type in 67% of patients with TAK whereas only the linear or punctuate type was seen in SLE patients and HC. SLE and TAK patients were found to have increased risk for carotid artery plaques. Among TAK patients, coronary artery calcification, ToAC and carotid artery plaques tend to be at sites of primary vasculitic involvement.

Conclusions

There is increased atherosclerosis in TAK and SLE. Vessel wall inflammation seems to be also important in the atherosclerosis associated with TAK.     

Thromboembolic complications in children with cancer

Thrombosis is a significant problem in patients with cancer. The impact of thromboembolism in association with childhood cancer is not clearly defined. Similarly the information of prevention and management of thromboembolic events in children receiving cancer-therapy is limited. This review aims to examine current knowledge regarding the epidemiology, pathophysiology and management of thrombosis in association with cancer in children.     

Retrocaval ureter with vesicoureteric reflux,a very rare entity

Introduction

A circumcaval ureter is a rare congenital anomaly in which the ureter passes behind inferior vena cava. VUR is rarely found in association with retrocaval ureter. Diagnosis and management are difficult. To our knowledge, we report a second case of retrocaval ureter with ipsilateral VUR.