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Sonourethrography is a dynamic 3-dimensional study that can be repeated with minimal radiation exposure, provides higher efficiency than RGU in the detection of anterior urethral stricture disease and would greatly aid in diagnosis and choice of therapies and we have found it to be a notable improvement over the conventional radiographic urethrography in examination of male anterior urethra. SUG can evaluate anterior urethra more accurately than the conventional RGU. RGU fails to measure the exact length of the stricture urethra irrespective of the site due to anatomical and technical limitations. Periurethral changes, urethral lumen, plaques and spongiofibrosis are better visualised on sonourethrography. Based on the current study, it is strongly recommended that always the evaluation of the male urethra shall include both the conventional RGU and retrograde SUG to achieve accurate results and thus helping in further management. SUG results did change the final management mode in 32.14% of the cases, and the techniques and graft preparation were decided after SUG in almost 100% of the cases that required urethroplasty, which is very significant (p

Extensive en plaque intradural extramedullary tuberculomas can occur as a paradoxical response to chemotherapy for intracranial tuberculomas. We report a case of 31-year-old male who presented with backache and progressive weakness and urgency of micturition. Magnetic resonance imaging dorsolumbar spine which showed an ill-defined T1 hypointense and T2 heterointense lesion noted posterior to the thoracic spinal cord, extending from C7 to D5 vertebral levels suggestive of en plaque meningioma. The patient underwent D1-D5 laminectomy, with subtotal debulking of the tumor. The histopathological examination of lesion was suggestive of granulomatous inflammation with multinucleated and Langhan type giant cells confirming the diagnosis of tuberculoma.

Multilocular cystic renal cell carcinomas (RCC’s), Unilocular cystic RCC’s and RCC’s with extensive cystic necrosis and unilocular cysts with mural tumor nodules forms a wide category of RCC’s. Cystic RCC’s represent upto 3-14% of all RCC’s.[1] Here we present a case of 68 year old female who is a known case of DM, hypothyroidism, bronchial asthma presenting with complains of pain abdomen since 1 year. She has been a case of renal TB and on ATT 30 years ago. Further the patient was evaluatedand foundto have a small partly exophytic cortical cyst measuring 13x12mm noted in the inter polar region posteriorly along with multiple well defined hyper dense non enhancing cortical and exohytic cysts notes in upper / lower and inter polar regions, largest measuring 1.8x1.7cms in upper pole suggestive of hemorrhagic cysts. A diagnosis of left renal complex cyst was made. Alaporoscopic left partial cystectectomy was done and sent for histopathological examination. Microscopy revealed Cystic clear cell fgv Renal cell carcinoma, Furhman Grade 1(Low grade) within a 0.1cm thickening which was further confirmed with IHC expressing strongly for CK7,PAX8 and CAIXand confirmed the diagnosis as Clear cell Papillary Renal cell carcinoma. Patient is being followed up and no recurrence / metastasis has been reported. This provides us an opportunity to consider an unusual finding of Clear Cell Papillary RCC in a complex renal cyst and to look into the cystic lesion with more importance helping us in avoiding missing a carcinoma as found in the present case.

Leiomyosarcoma (LMS) of vascular origin is uncommon. This leiomyosarcoma is seen occurring from the tunica media of major blood vessels. Leiomyosarcoma of venous origin is five times more common those of arterial origin. Most cases are presented in woman with a median age of 50 years [1]. We are presenting a case where histopathology was instrumental in making the diagnosis of LMS in the thrombus and confirmed by IHC. A 46-year old female presented with bilateral swelling of lower limbs and distention of abdomen. Her CT, MRI, and color Doppler were suggestive of IVC, hepatic, and renal vein thrombosis. Histopathology of thrombus revealed leiomyosarcoma and was confirmed by IHC. Conservative treatment was given and asked for a regular follow-up. This case report gives us an opportunity to think of a differential diagnosis in a patient presenting with IVC thrombus

Background & objectives: In patients with rheumatoid arthritis (RA), disease severity assessment is done using Disease Activity Score in 28 joints with ESR (DAS28). Computing DAS28 is time-consuming, requires laboratory testing and an online calculator. There is a need to validate rapid methods of disease severity assessment for routine daily use. This study was conducted to compare DAS28, Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire Disability Index (HAQ-DI) and Routine Assessment of Patient Index Data with 3 measures (RAPID3) to assess the disease activity in patients with RA. Methods: We prospectively studied the utility of CDAI, HAQ-DI and RAPID3 scoring in 100 consecutive newly diagnosed, disease modifying antirheumatic drugs (DMARDs) naïve adult patients with RA seen during January 2013 and June 2014 at a tertiary care teaching hospital in south India. Results: The mean age of the patients was 42.1±11.6 yr, there were 82 females. The median [interquartile range (IQR)] symptom duration was 6 (range 4-12) months. The median (IQR) DAS28, CDAI, HAQ-DI and RAPID3 scores at presentation were 7 (6-7), 36 (28-43), 2 (1-2) and 17 (13-19), respectively. A significant positive correlation was observed between DAS28 and CDAI (r=0.568; P

Ageing is an inevitable process that affects all organs and kidneys are no way an exception. There is an urgent need to understand ageing as a holistic process. The changes occurring in ageing kidneys resemble to those occurring in chronic kidney disease. However, many differences exist between them. Old age is a risk factor for acute kidney injury and increased risk of urinary tract infections and asymptomatic bacteriruria, Serum creatinine is a suboptimal indicator of renal function in the elderly because loss of muscle mass in elderly decreases creatinine production. Serum cystatinc measurement, with reference values adjusted for age represents a promising marker to measure renal function in the elderly. The default management strategy for renal failure in elderly is more of conservative in developing countries when compared to developed countries where there is changing trend from conservative to initiation of renal replacement therapy. The decision when to initiate renal replacement therapy is more challenging. Haemodialysis or peritoneal dialysis each has its own advantages and disadvantages.

Encephaloceles are rare embryological mesenchymal developmental anomalies resulting from inappropriate ossification in skull through with herniation of intracranial contents of the sac. Encephaloceles are classified based on location of the osseous defect and contents of sac. Convexity encephalocele with osseous defect in occipital bone is called occipital encephalocele. Giant occipital encephaloceles can be sometimes larger than the size of baby skull itself and they pose a great surgical challenge. Occipital encephaloceles (OE) are further classified as high OE when defect is only in occipital bone above the foramen magnum, low OE when involving occipital bone and foramen magnum and occipito-cervical when there involvement of occipital bone, foramen magnum and posterior upper neural arches. Chiari III malformation can be associated with high or low occipital encephaloceles. Pre-operatively, it is essential to know the size of the sac, contents of the sac, relation to the adjacent structures, presence or absence of venous sinuses/vascular structures and osseous defect size. Sometimes it becomes imperative to perform both CT and MRI for the necessary information. Volume rendered CT images can depict the relation of osseous defect to foramen magnum and provide information about upper neural arches which is necessary in classifying these lesions.

There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body. Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc.

Thymic cysts are usually diagnosed accidentally during radiological evaluation of the chest for unrelated conditions. Symptoms appear late when the mass compresses on adjoining tissues. We report an unusual case of asymptomatic mediastinal thymic cyst which was seen in the neck whenever the patient was asked to perform Valsalva maneuver. This case is being reported for the unusual clinical presentation of a rare disease. The role of imaging in the diagnosis and common differential diagnoses are also discussed.

Osmotic demyelination syndrome primarily occurs due to an imbalance of serum electrolytes and caused by rapid correction of hyponatremia. Isolated extrapontine myelinolysis is extremely rare, etiopathogenesis of which may be related to osmotic stress resulting from electrolyte disequilibrium. Extrapontine sites involved in osmotic demyelination syndrome show abundant oligodendrocytes, which are highly susceptible to osmotic stresses. Myelin vacuolization followed by intramyelinic splitting and disruption of myelin sheaths occur due to rapid osmolar fluctuations. Symmetrical hyperintensities showing restriction, which resolve in subsequent magnetic resonance scans can help in clinching the diagnosis of this condition in a given clinical setting.