Is Abdominal Fat Distribution Measured by Axial CT Imaging an Indicator of Complications and Mortality in Acute Pancreatitis?

BACKGROUND

Obesity is an important risk-stratifying co-morbidity for many pathological conditions. Controversy exists about its influence in outcomes after acute pancreatitis (AP). This study assessed abdominal fat distribution (subcutaneous, retroperitoneal and intra-abdominal) measured using computer tomography (CT) images and related it to outcomes in patients with AP.

METHODS

The case notes of patients admitted with AP were identified from computerised records from 2008 to the 2013. Image analysis software was used to assess the individual abdominal fat distributions from CT images.

RESULTS

A total of 79 patients were included. There was no relationship between fat distribution and either severity of, or mortality from, AP. Fat distribution was not found to be an independent risk factor on multivariate analysis. There was, however, a positive correlation between retroperitoneal and intra-abdominal fat with APACHE II scores, Ranson and Glasgow score and Multiple Organ Dysfunction score (MODS) on various days following admission (r = 0.421, p = 0.0008; r = 0.469, p < 0.0001; r = 0.398, p = 0.007; r = 0.336, p = 0.011, respectively). On multiple logistical regression analysis, the only variables associated with mortality were Balthazar Severity Index, MODS and EWS with a p value of <0.0001, 0.0019 and 0.0481, respectively.

CONCLUSIONS

Obese patients have worse predicted outcomes as measured by the EWS, MODS and Ranson scores. Abdominal fat distribution, however, was not shown to be directly related to AP severity or mortality. The addition of fat parameters may be of use in prognostic CT severity index models, but from this data, it does not appear to be an independent risk factor of adverse outcome.

Dielectric Relaxation of NiFe2O4/Gd2O3 Core-Shell Nanoparticles

Gd2O3 encapsulated NiFe2O4 core-shell nano-particles (CSNPs) have been synthesized by chemical route. The phase formation of the materials is confirmed by X-ray diffraction analysis. The average particle size is found to be 60 nm by transmission electron microscope. The band gap of NiFe2O4/Gd2O3 CSNPs is obtained by UV-visible absorption spectroscopy. The observed band gap of 4.38 eV lies in between the individual band gap of Gd2O3 and NiFe2O4. The frequency-dependent dielectric relaxation of the material is investigated in the temperature range from 303 K to 543 K. The temperature dependent relaxation times are found to obey Arrhenius law having activation energy of 0.3 eV. The Nyquist plots of impedance data are analyzed by the RC equivalent circuit having a constant phase element. The dielectric relaxation is modelled by Havriliak-Negami technique in the electric modulus formalism. The frequency dependent conductivity spectra follow the double power law.

Mandibular aneurysmal bone cyst associated with cemento-ossifying fibroma - a case report

Aneurysmal bone cyst is an uncommon bone lesion which rarely occurs in craniofacial region. Among all the cystic lesions occurring in the jaws, aneurysmal bone cyst is infrequent and it more commonly occurs in the mandible. Most of the cases occur in the first two decades of life, with no gender predilection. Here, we are presenting a case of an aneurysmal bone cyst which occurred in the mandible of a twelve year old female patient.

In vitro Evaluation of Antibacterial Efficacy of Pineapple Extract (Bromelain) on Periodontal Pathogens

BACKGROUND

Periodontitis is an inflammatory disease resulting in the destruction of periodontal tissues. Various treatment modalities have been tried in the form of mechanical therapy and surgical therapy. Antimicrobial agents have been used as a monotherapy and as an adjunct with mechanical debridement. Various plant extracts have been used as antibacterial agents. Pineapple extract (bromelian) is one such agent. Hence this study was conducted to assess the antibacterial efficacy of bromelain on both aerobic and anaerobic periodontal microorganisms. The aim was to assess the antibacterial efficacy of bromelain on both aerobic and anaerobic periodontal microorganisms.

MATERIALS AND METHODS

Minimum inhibitory concentration (MIC) of bromelain was tested on isolated strains of Streptococcus mutans, Enterococcus fecalis Aggregatibacter actinomycetemcomitans (Aa), and Porphyromonas gingivalis (Pg) using serial dilution broth method.

RESULTS

S. mutans showed sensitivity at the lowest concentration of 2 mg/ml as compared to E fecalis (31.25 mg/ml) while Pgingivalis showed sensitivity at the lowest concentration of 4.15 mg/ml as compared to Aa (16.6 mg/ml).

CONCLUSION

Bromelain exerts an antibacterial effect against potent periodontal pathogens; hence, it may be used as an antibacterial agent. However, further trial has to be conducted to validate this result.

Traumatic rupture of arachnoid cyst with subdural hygroma

Intracranial arachnoid cysts developing in relation to the cerebral hemispheres and middle cranial fossa are usually incidental or asymptomatic. However, most of the clinically active cysts present with seizures because of chronic compression. Presentation as raised intracranial pressure due to cyst rupture into the subdural space is a rare clinical entity. We herein present a case of an asymptomatic arachnoid cyst with rupture into the subdural space bilaterally and presenting as raised intracranial pressure.

Infections and infestations of the gastrointestinal tract. Part 1: bacterial, viral and fungal infections

The purpose of this article is to review the imaging findings of various infections affecting the gastrointestinal tract. Barium examinations, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography all play an important role in the diagnostic workup of gastrointestinal tract infections. Knowledge of differential diagnosis, sites of involvement, and typical imaging features of different infections can help in accurate diagnosis and guide treatment.

Infections and infestations of the gastrointestinal tract. Part 2: parasitic and other infections

The purpose of this article is to provide a comprehensive review of the imaging findings of various parasitic infestations and other miscellaneous infections affecting the gastrointestinal tract. Barium examinations play an important role in the diagnostic workup of parasitic intestinal infections. Knowledge of differential diagnosis, sites of involvement, and imaging features of different infections and infestations can help in accurate diagnosis and guide treatment.

Pancreaticogastric fistula secondary to intraductal papillary mucinous neoplasia: a case report and review of the literature

Intraductal papillary mucinous neoplasms (IPMNs) are benign cystic lesions of the pancreas with recognised premalignant potential. An occasional feature of IPMNs is fistula formation to surrounding organs. This report describes a case of a pancreaticogastric fistula from a main duct IPMN that produced the complete resolution of the patient's symptoms.

Microbiological spectrum of brain abscess at a tertiary care hospital in South India: 24-year data and review

Intracranial abscesses are life-threatening infections that pose a diagnostic challenge not only to the neurosurgeon but also to the microbiologists. Detailed studies documenting the spectrum of infecting agents involved in brain abscesses are limited from India. Materials and Methods. This is a retrospective analysis of 352 samples from 1987 to 2010 analyzed at a tertiary care hospital in South India from 1987 to 2010, to document the changing trends with time. Results. The age of the patients ranged from 2 to 80 years, a larger number of males being affected. Otogenic infections were the most common cause while cryptogenic abscesses were 20%. Gram stain and culture positivity were 78% each. Gram-positive and negative facultative aerobes and obligate anaerobes were also on the rise. Unusual organisms, like Burkholderia pseudomallei, Salmonella typhi, Nocardia species, Cladosporium bantiana, Fonsecaea pedrosoi, Entamoeba histolytica, and Acanthamoeba were also isolated and/or detected from the brain abscesses aspirate or resected tissue. Summary. New and emerging pathogens associated with brain abscess, especially in immunosuppressed individuals, have renewed the necessity of an early detection, and it will be of great value in appropriate management of patients with brain abscess.

A fuller understanding of pancreatic neuroendocrine tumours combined with aggressive management improves outcome

BACKGROUND

Neuroendocrine tumours of the pancreas (PNETs) represent 1-2% of all pancreatic tumours. The terms 'islet cell tumours' and 'carcinoids' of the pancreas should be avoided. The aim of this review is to offer an overview of the history and diagnosis of PNETs followed by a discussion of the available treatment options.

METHODS

A search on PubMed using the keywords 'neuroendocrine', 'pancreas' and 'carcinoid' was performed to identify relevant literature over the last 30 years.

RESULTS

The introduction of a revised classification of neuroendocrine tumours by the World Health Organisation (WHO) in 2000 significantly changed our understanding of and approach to the management of these tumours. Advances in laboratory and radiological techniques have also led to an increased detection of PNETs. Surgery remains the only treatment that offers a chance of cure with increasing number of non-surgical options serving as beneficial adjuncts. The better understanding of the behaviours of PNETs together with improvements in tumour localisation has resulted in a more aggressive management strategy with a concomitant improvement in symptom palliation and a prolongation of survival.

CONCLUSION

Due to their complex nature and the wide range of therapeutic options, the involvement of specialists from all necessary disciplines in a multidisciplinary team setting is vital to provide optimal treatment of this disease.

Renal oncocytoma: CT features cannot reliably distinguish oncocytoma from other renal neoplasms

AIM

To retrospectively review the computed tomography (CT) imaging features of a series of histologically confirmed renal oncocytomas and to determine whether imaging features are predictive of this subtype of benign renal epithelial tumour.

MATERIALS AND METHODS

From May 2001 to October 2007, 21 patients with 28 renal masses, confirmed as renal oncocytoma on histological examination of the resection specimen, were identified from the pathology database at our institution. The preoperative imaging findings were retrospectively analysed to determine characteristic features, if any, to predict this rare subtype of benign renal tumour.

RESULTS

There were 11 female and 10 male patients and the age at presentation ranged from 40-80 years (mean age 65.9 years). The size of the masses ranged from 1.2-12 cm in diameter (mean diameter 4.9 cm). All masses showed contrast enhancement. In 18 (64.3%) lesions the enhancement of the tumour was isodense to renal cortex. Ten (35.7%) lesions were hypodense to renal cortex. In three (10.7%) lesions, a well-defined stellate central scar was seen at CT and confirmed pathologically. In two (7.1%) lesions, a central scar was identified pathologically, but not seen on CT. The size of the central scars ranged from 10-29 mm diameter on CT. Twenty-two (78.6%) lesions did not demonstrate a scar on CT or pathologically. None of the patients had regional lymphadenopathy or distant metastasis.

CONCLUSION

Renal oncocytoma is typically described as being hypervascular and homogeneous, with a characteristic central stellate scar on CT. The present study demonstrates that these imaging features are found in only a small proportion of these tumours. Therefore, imaging characteristics alone are unreliable when differentiating between oncocytoma and renal cell carcinoma, and histopathological diagnosis remains the reference standard.

Role of MRI in Crohn's disease

The traditional imaging of Crohn's disease has relied on barium and computed tomography (CT) examinations. In recent years magnetic resonance imaging (MRI) has emerged as an imaging method that can be used in the diagnosis and assessment of Crohn's disease. The advantages of MRI include lack of ionizing radiation and its superior tissue contrast resolution. The clinical progression of Crohn's disease can be variable, and MRI can be used to assess inflammatory status, disease progression, and complications of Crohn's disease. MRI of the small bowel is an evolving technique and it has the potential to become the preferred technique for imaging of small bowel Crohn's disease in the future.