Search

Purpose Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain’s tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery. Method 62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic. Results The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p Conclusion We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.

We propose an automated method for the segmentation of lumen intima layer of the common carotid artery in longitudinal mode ultrasound images. The method is hybrid, in the sense that a coarse segmentation is first achieved by optimizing a locally defined contrast function of an active oblong considering its five degrees-of-freedom, and subsequently the fine segmentation and delineation of the carotid artery are achieved by post-processing the portion of the ultrasound image spanned by the annulus region of the optimally fitted active oblong. The post-processing includes median filtering and Canny edge detection to retain the lumen intima representative points followed by a smooth curve fitting technique to delineate the lumen intima boundary. The algorithm has been validated on 84 longitudinal mode carotid artery ultrasound images provided by the Signal Processing laboratory, Brno university. The proposed technique results in an average accuracy and Dice similarity index of 98.9% and 95.2%, respectively.

Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain's tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery.62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic.The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p 0.05) and was comparable to each other. Two patients in Set A came back with recurrence at eight and 10 months and two reported occasional pain on heavy work. Three patients had tenderness and two had numbness in Set B at the scar site.We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.

We ascertained two unrelated consanguineous families with two affected children each having microcephaly, refractory seizures, intellectual disability, and spastic quadriparesis. Magnetic resonance imaging showed atrophy of cerebrum, cerebellum and spinal cord, prominent cisterna magna, symmetric T2 hypo-intensities in the bilateral basal ganglia and thinning of corpus callosum. Whole-exome sequencing of three affected individuals revealed c.105C>A [p.(Tyr35Ter)] variant in AIMP2. The variant lies in a common homozygous region of 940 kb on chromosome 7 and is likely to have been inherited from a common ancestor. The phenotype noted in our subjects' shares marked similarity with that of hypomyelinating leukodystrophy-3 caused by mutations in closely related gene AIMP1. We hereby report the first human disease associated with deleterious mutations in AIMP2.

We propose a fully automated algorithm for the segmentation of common carotid artery in longitudinal mode ultrasound images using active oblongs. The problem of segmentation and subsequent delineation of lumen-intima layer is solved as an optimization of a locally defined contrast function with respect to five degrees-of-freedom that characterize the active oblong. The detection of the common carotid artery and subsequent initialization of the active oblong inside the common carotid artery region has been done using a combination of binary thresholding, Hough transform, and pixel-offset operations. The algorithm has been validated on the Brno university signal processing lab B-mode ultrasound image database, which contains 84 longitudinal mode ultrasound images of the common carotid artery. The segmentation results are validated against the ground truth provided by two practising radiologists using Jaccard and Dice similarity measures. We have achieved a detection and segmentation accuracy of 95.2% and 97.5%, respectively.

We propose an elliptical active disc technique for the segmentation of common carotid artery lumen intima layer from transverse mode ultrasound images. The segmentation and subsequent outlining problem is posed as one of optimization of a local energy function with respect to the five degrees-of-freedom that characterize the elliptical active disc. Gradient descent technique is used to find the minimum of the energy function with respect to the five parameters that describe the disc. In addition, we use Green's theorem to optimize the computation of the partial derivatives. For automatic initialization of the active disc, we use the normalized crosscorrelation technique. We report results of experimental validation on SPLab, Brno university database, which contains 971 transverse mode ultrasound images of the carotid artery. We achieve accurate carotid artery lumen intima detection in 97.63 of cases. In addition, for lumen intima layer segmentation we achieve an average Dice index of 94.83. © 2018 IEEE.

BACKGROUND: Diabetes mellitus is a metabolic disorder with involvement of the neurovascular and muscular system. Peripheral neuropathy (PN) is thought to be the principal cause of foot complications in type 2 diabetes mellitus (T2DM). However, foot evaluation using ultrasonography early in the course of diabetes has not gained due importance. The aim of the present study was to evaluate the thickness of intrinsic foot muscles, plantar skin, plantar fascia, and plantar fat pad in T2DM subjects with and without PN using musculoskeletal ultrasonography. METHODS: This study was conducted in 30 T2DM subjects with and without PN and 30 age-matched non-diabetes mellitus (NDM) subjects. After detailed clinical evaluation, high-frequency musculoskeletal ultrasonography was used to measure the thickness of the intrinsic foot muscles and plantar tissue thickness under the metatarsals. Data were analyzed using independent t-tests to compare T2DM groups with NDM subjects, and one-way ANOVA followed by Tukey's honestly significant difference test for between- and within-group analyses. RESULTS: There was a significant reduction in the thickness of the intrinsic foot muscles and plantar tissue in T2DM compared with NDM subjects (P

The purpose of this study is to present the variations of the pancreatic duct system and hepatopancreatic ampulla so that an awareness of these variations may help in surgical planning and prevention of ductal injury. Forty human pancreatic specimens were used to study the duct pattern of the pancreas and the formation and mode of termination of the pancreatic ducts. Also, the patency of the main pancreatic ducts, length of the hepatopancreatic ampulla, and length of the main pancreatic duct were measured. The main pancreatic duct was patent in 37 out of 40 specimens, 2 specimens showed the embryonic type of the duct system, and one had the duct obliterated at its duodenal end. The mode of termination of the main pancreatic and common pancreatic ducts was divided into four types. Seventy-five percent specimens belonged to type I, followed by type II in 22.5 % and type III in 2.5 % of specimens. The length of the main pancreatic duct ranged from 11 to 21.2 cm, the average being 17.3 cm, and the length of the hepatopancreatic ampulla varied from 1 to 10 mm (1 to 2 mm—5 %, 3 to 8 mm—55 %, and more than 8 mm in 15 % of specimens), and it was absent in 25 %. Awareness of these anomalies may help in surgical planning and prevention of undue ductal injury.

Background Imaging modalities in medicine gives complementary information. Inadequacy in clinical information made single imaging modality insufficient. There is a need for computer-based system that permits rapid acquisition of digital medical images and performs multi-modality registration, segmentation and three-dimensional planning of minimally invasive neurosurgical procedures. In this regard proposed article presents multimodal brain image registration and fusion for better neurosurgical planning. Methods In proposed work brain data is acquired from Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) modalities. CT and MRI images are pre-processed and given for image registration. BSpline deformable registration and multiresolution image registration is performed on the CT and MRI sequence. CT is fixed image and MRI is moving image for registration. Later end result is fusion of CT and registered MRI sequences. Results BSpline deformable registration is performed on the slices gave promising results but on the sequences noise have been introduced in the resultant image because of multimodal and multiresolution input images. Then multiresolution registration technique is performed on the CT and MRI sequence of the brain which gave promising results. Conclusion The end resultant fused images are validated by the radiologists and mutual information measure is used to validate registration results. It is found that CT and MRI sequence with more number of slices gave promising results. Few cases with deformation during misregistrations recorded with low mutual information of about 0.3 and which is not acceptable and few recorded with 0.6 and above mutual information during registration gives promising results.

Preloading coupled with vertical drains is a successful ground improvement technique for soft clay deposits. Though surcharge in the form of sand pile is conventionally used, vacuum consolidation is also an option. This paper presents a case study on ground improvement using vacuum consolidation technique carried out near the shoreline in the city of Kakinada, Andhra Pradesh. Detailed methodology, method of installation of PVD, settlements observed during the consolidation process and results from light cone penetration test performed to quantify the ground improvement and the insights gained from the study are described.

A 14-year-old girl presented to emergency triage with acute retention of urine. There was history of cyclic pelvic pain for the past 6 months, for which she had been prescribed non-steroidal anti-inflammatory drugs by a private practitioner. There was no history of ureteric colic or burning during micturition. Gynaecological history indicated menarche at 12 years followed by regular menses. There was no history of abnormal vaginal bleeding. Ultrasound of the abdomen revealed findings suggestive of bicornuate uterus with haematocolpos. Subsequently, MRI was requisitioned, revealing two widely divergent, symmetrical uterine corpii, partially fused at the cervix without any communication between their endometrial cavities (figure 1A). There was a thick hypointense left hemivaginal septum with a large ipsilateral haematocolpos appearing hyperintense on T1-weighted and hypointense on T2-weighted images, findings consistent with intracellular methaemoglobin stage of bleed. A similar intensity dilated tortuous tubular structure was seen extending from left uterine cornu up to the left ovary, findings consistent with haematosalpinx. The right uterine cervix was seen normally opening into the patent right hemivagina (figure 1B, C). In addition, left renal agenesis with compensatory hypertrophy of the …

Context and Objective: Accessory pancreatic duct (APD) designed to reduce the pressure of major pancreatic duct by forming a secondary drainage channel. Few studies have mentioned the variant types of accessory ducts and their mode of formation, some of these have a clear clinical significance. Present study is aimed to evaluate the possible variations in the APD and its terminations. Materials and Methods: Forty formalin fixed adult human pancreas with duodenum in situ specimens were studied by injecting 1% aqueous eosin, followed by piece meal dissection of the head of the pancreas from posterior surface. Formation, tributaries, relations, and the termination of the accessory pancreatic duct were noted and photographed. Results: Accessory ducts revealed 50% belonged to long type, 22.5% were of short and ansa pancreatica type each, and embryonic type of duct pattern was seen in 5% specimens. 75% of long type ducts showed positive patency with eosin dye, followed by ansa type (44.4%), and least patency was found in short type (22.2%). With regard to the patency of the accessory pancreatic ducts towards their termination, we found 52.5% of the accessory ducts and 5% of the embryonic type pancreatic ducts were patent and in 42.5% of the specimen the ducts were obliterated. In 85% of specimens the minor duodenal papillae was anterosuperior to the major papilla and superior to the major papillae in 10% of the cases, and in 5% minor papillae was absent. The average distance between the two papillae was 2.35 cm. Conclusion: The knowledge of the complex anatomical relations of the gland with its duct, duodenum and bile ducts are essential for the surgeons and sinologists to plan and perform both the diagnostic as well as therapeutic procedures effectively.

Food and Feeding Relationships of some Commercial Fishes of the Tungabhadra Reservoir

Breast Thermography is an emerging medical imaging tool, used for early detection of breast cancer. The growing tumor in the breast will cause the occurrence of some asymmetric heat patterns in the left and right breast. Asymmetry analysis of left and right breast is used for detecting the breast cancer from the breast thermogram images. This paper presents a method for segmenting the left and right breast from breast thermogram images using Projection Profile Approach. Horizontal Projection Profile (HPP) method is used for locating the lower and upper borders of the breast by detecting the inframammary fold and axilla curves of the breast respectively. Vertical Projection Profile (VPP) method is used for locating the left and right borders of the breast thermogram image, which detects the parabolic shape of the breast. The results of segmentation are satisfactory. Generalization of this method can be done for various types of breast thermogram images by standardizing the height, background and removal of the noise present in the image.

Upper gastrointestinal bleeding (UGIB) includes hemorrhage originating from the esophagus to the ligament of Treitz. It is a gastrointestinal emergency that can result in significant morbidity, mortality, along with laborious utilization of health-care resources. With the advent of definite management protocols, the recent trends have revealed that patients rarely die from exsanguination, with decompensation of the underlying disorders, rather, proving to be causative of the same. Rapid assessment, resuscitation, and early endoscopic investigation serve as the foundation of early management. Common sinister underlying aetiology include Oesophageal Varices, Peptic Ulcer Disease, NSAID Induced Acute Gastritis or Malignancy. Arising from a conglomeration of aetiologies, an infrequent one, is a silently sinister pseudoaneurym rupturing into the stomach, stemming from a visceral artery. Since the first description by Beaussier in 1770, the condition has been detected with increasing frequency, primarily as a consequence of the increasing use of accurate imaging methods. Coeliac artery aneurysms (CAAs) occur in approximately 0.2% of the overall population and constitute approximately 4% of all visceral artery aneurysms (VAAs). Their risk of rupture is estimated at 10% to 15% and is associated with high mortality. Associated risk factors include atherosclerosis, hypertension, systemic inflammation, trauma, collagen vascular disease, infection, fibromuscular dysplasia, and cirrhosis

Diabetes mellitus is a metabolic disorder with involvement of the neurovascular and muscular system. Peripheral neuropathy (PN) is thought to be the principal cause of foot complications in type 2 diabetes mellitus (T2DM). However, foot evaluation using ultrasonography early in the course of diabetes has not gained due importance. The aim of the present study was to evaluate the thickness of intrinsic foot muscles, plantar skin, plantar fascia, and plantar fat pad in T2DM subjects with and without PN using musculoskeletal ultrasonography.This study was conducted in 30 T2DM subjects with and without PN and 30 age-matched non-diabetes mellitus (NDM) subjects. After detailed clinical evaluation, high-frequency musculoskeletal ultrasonography was used to measure the thickness of the intrinsic foot muscles and plantar tissue thickness under the metatarsals. Data were analyzed using independent t-tests to compare T2DM groups with NDM subjects, and one-way ANOVA followed by Tukey's honestly significant difference test for between- and within-group analyses.There was a significant reduction in the thickness of the intrinsic foot muscles and plantar tissue in T2DM compared with NDM subjects (P 0.05). However, there were differences in intrinsic foot muscle and plantar tissue thickness between T2DM subjects with and without PN.There was a substantial decrease in intrinsic foot muscle and plantar tissue thickness in T2DM compared with NDM subjects, indicating that structural changes appear in the foot before PN develops. The techniques used in this study cannot exclude the possibility that neuropathic changes that are clinically undetectable may develop in parallel with changes in plantar tissues.

Coronary arteriovenous fistulae are a rare but potentially curable cause of ischaemic heart disease and should be considered as a differential diagnosis especially in patients lacking classical risk factors for coronary artery disease. We discuss one such case of cardiac ischaemia resulting from a coronary arteriovenous fistula. While there are sporadic case reports of similar patients in medical literature, our patient is the first reported case of ST-elevation myocardial infarction secondary to the fistulous connection.

Aim of this study was to determine the distance between Henle's spine (HS) on the temporal bone to the clinically important bony landmarks on the dry skulls that will act as a guide in various surgical procedures on skull base. Distances from the head of malleus (HOM) to surgically relevant landmarks were also studied on CT images.Thirty-nine adult preserved dry skulls were studied bilaterally. The parapetrosal triangle bounded by spinopterygoidal, bispinal and the midsagittal lines was identified. The location of the HS and its distance from the various important anatomical structures were measured. In addition, five CT images, where distances from the HOM to various anatomical landmarks were measured.The mean and range of distances from the HS to various important anatomical landmarks on the spinopterygoidal line, bispinal line and in the parapetrosal triangle were tabulated. The mean and range of CT-based measurements of distances from HOM to other anatomical landmarks were also noted.The knowledge of unvarying relationship of the HS and the HOM to the various structures of the skull would assume significance while planning surgeries around the temporal bone by guiding the direction and degree of bone removal. Statistical differences between the two genders showed significant difference only in the distance between the HS to the medial margin of the external orifice of carotid canal. Therefore, these landmarks can also be applied as references for various surgeries of middle cranial fossa, as well as transpetrosal and transmastoid approaches.

A 51-year-old woman presented to our department with multiple episodes of massive haemoptysis. She had a history of pulmonary tuberculosis. High-resolution CT scan showed a completely destroyed right lung with fibrocavitatory changes (figure 1). CT pulmonary and bronchial angiography was performed, which showed non-enhancement of the right pulmonary artery in the pulmonary angiographic phase, leading to suspicion of a pulmonary arterial embolus (figure 2). The bronchial angiographic phase showed brilliant enhancement of the right pulmonary artery and its branches through reversed filling via multiple systemic collaterals arising …

We conducted this study to demonstrate the value of non-invasive three-dimensional CT angiography (3D CTA) in the detection of a cerebral aneurysm.A helical CT acquisition was obtained using non-ionic contrast media in 50 patients with 1 mm per second table speed, 1 mm collimation, and pitch 1:1. Axial source images were transferred into a workstation console (Advantage windows GE) and CTA was obtained using MIP (Maximum Intensity Projection) reconstruction. Fourteen patients underwent conventional digital subtraction angiography (DSA) after 3D CTA prior to surgery.A total of 39 aneurysms were detected in 50 patients. All patients with an aneurysm were operated and the presence of aneurysms was confirmed. 3D CTA detected 38 of these 39 aneurysms. In 37 aneurysms, the origin of the aneurysm and aneurysm neck was adequately visualized. 3D CTA was found to be 100% specific and 97.2% sensitive in picking up cerebral aneurysms. 3D CTA was 97% specific in demonstrating the exact origin and showing the neck of the aneurysm.CT angiography is a simple, quick, and non-invasive technique and can replace DSA in most patients with acute subarachnoid hemorrhage aneurysm for the detection and characterization of aneurysms of the circle of Willis. The relation of the aneurysm with bony landmarks was clearly depicted.

Human rabies leads to a mortality of 55 000 deaths/year worldwide, out of which mortality in India is 20 000, hence is regarded as an endemic in the subcontinent. Even though rabies is definitively confirmed by the isolation of virus from biological samples or detection of the rabies antigen or antibodies, MRI of the brain may also be used as one of the modalities of investigation for the early detection of rabies. It is worthwhile to note that the imaging features of rabies encephalitis on diffusion-weighted imaging have not been described.1 ,2 The postmortem diagnosis of rabies is more sensitive and specific as …

A 22-year-old man, diagnosed 7 weeks before with pulmonary tuberculosis and started on antitubercular therapy, presented with non-exertional retrosternal chest pain since the past week. He was diagnosed on the strength of thoracic radiograms and CT imaging to have a mediastinal abscess, which was percutaneously drained. He was continued on the same regimen of drugs. Analysis of the fluid obtained was suggestive of tuberculous aetiology. Steroids were not required.