Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers

Introduction:

This study planned to compare immediate cardiovascular effects of different yoga asanas in healthy young volunteers.

Materials and Methods:

Heart rate (HR), systolic pressure (SP), and diastolic pressure (DP), blood pressure (BP), were recorded using the non invasive blood pressure (NIBP) apparatus in 22 healthy young subjects, before and after the performance of Dhanurasana (DA), Vakrasana (VA) (both sides), Janusirasasana (JSA) (both sides), Matsyasana and Shavasana for 30 s. HR and BP were further recorded during supine recovery at 2, 4, 6, 8, and 10 min. A repeated measure of ANOVA was used for statistical analysis.

Results:

There were significant changes in HR and BP both immediately after the Asanas as well as during the recovery period. Overall comparisons of ∆% changes immediately after the performance of the Asanas revealed significant differences with regard to HR that increased significantly after DA. In the recovery phase, there were significant intergroup differences from 2 min onward in both SP and DP. The decrease of SP after VA (right side) (VA-R) was significantly greater than Shavasana (4^th, 6^th, and 8^th min) and JSA (left side) (JSA-L) at 6^th and 8^th min. DP decreased significantly after performing JSA-L compared to VA-R at the 6^th and 8^th min.

Discussion:

The cardiovascular changes immediately after the Asanas and during the recovery phase reveal inherent differences between the selected postures. The rise of HR in DA may be attributed to increased sympathetic response due to the relative difficulty of the posture as well as abdominal compression occurring in it. The effect of supine relaxation is more pronounced after the performance of the Asanas as compared to mere relaxation in Shavasana. This may be attributed to a normalization and resultant homeostatic effect occurring due to a greater, healthier de-activation of the autonomic nervous system occurring towing to the presence of prior activation. There were also subtle differences between the right sided and left sided performance of VA and JSA that may be occurring due to the different internal structures being either compressed or relaxed on either side.

Conclusion:

Our study provides initial evidence of differential cardiovascular effects of Asanas and subtle differences between right and left sided performance. Further, cardiovascular recovery is greater after the performance of the Asanas as compared to shavasan; thus, implying a better response when effort precedes relaxation.

Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time

BACKGROUND

Recent studies have reported the differential physiological and psychological effects of yogic uninostril breathing (UNB) and alternate nostril breathing (ANB) techniques. This study aims to determine differential effects of these techniques on reaction time (RT), heart rate (HR), and blood pressure (BP).

MATERIALS AND METHODS

Twenty yoga-trained subjects came to the lab on six different days and RT, HR, and BP were recorded randomly before and after nine rounds of right UNB (surya nadi [SN]), left UNB (chandra nadi [CN]), right initiated ANB (surya bhedana [SB]), left initiated ANB (chandra bhedana [CB]), nadi shuddhi (NS), and normal breathing (NB).

RESULTS

Overall comparison of ∆ % changes showed statistically significant differences between groups for all parameters. There was an overall reduction in HR- and BP-based parameters following CB, CN, and NS with concurrent increases following SB and SN. The differential effects of right nostril initiated (SB and SN) and left nostril initiated (CB, CN, and NS) UNB and ANB techniques were clearly evidenced. Changes following NB were insignificant in all respects. The overall comparison of ∆ % changes for RT showed statistically significant differences between groups that were significantly lowered following both SB and SN.

DISCUSSION AND CONCLUSION

Our study provides evidence of sympathomimetic effects of right nostril initiated pranayamas with sympatholytic/parasympathomimetic effect following left nostril initiated pranayamas. We suggest that the main effect of UNB and ANB techniques is determined by the nostril used for inspiration rather than that used for expiration. We conclude that right and left yogic UNB and ANB techniques have differential physiological effects that are in tune with the traditional swara yoga concept that air flow through right nostril (SN and pingala swara) is activatory in nature, whereas the flow through left nostril (CN and ida swara) is relaxatory.

Safety, tolerability and clinical efficacy of ultra-rush sublingual immunotherapy among patients suffering from allergic rhinitis

BACKGROUND

Conventional immunotherapy for allergy with 3-5 years of treatment period has poor compliance. Ultra-rush sublingual immunotherapy with a shorter period of treatment can have better compliance. There are very few studies on ultra-rush sublingual immunotherapy all over the world.

OBJECTIVES

(1) To determine allergen sensitivity among allergic rhinitis patients. (2) To assess safety, tolerability and clinical efficacy of ultra-rush sublingual immunotherapy.

METHODS

The present study was conducted in Allergy clinic, KIMS Hospital & Research Centre, Bangalore, India from January 2010 to June 2011. After obtaining Institutional Ethics Committee approval, 40 allergic rhinitis patients (according to ARIA guidelines) in the 18-60 years age group who were positive for aeroallergens in skin prick test were recruited for ultra-rush sublingual immunotherapy (20min initial phase and 4-month maintenance phase) and followed for 8 months with symptom and treatment diary.

RESULTS

Out of 40 patients, the majority, 36 (90.00%) patients were sensitive to house dust mites. Six patients had seven immediate adverse reactions and seven patients had eight delayed adverse reactions. All subsided without medication or with symptomatic oral medications. All patients tolerated ultra-rush SLIT and there was significant decrease in both symptom-score and treatment received in these patients.

CONCLUSION

Ultra-rush SLIT regimen has excellent safety, tolerability and clinical efficacy among allergic rhinitis patients.

Magnetic resonance imaging of diabetic muscle infarction: report of two cases

Diabetic muscle infarction (DMI) occurs as a rare complication of long standing or severe diabetes mellitus. The condition usually occurs spontaneously and patients usually present with acute pain and swelling of affected muscles which persists for weeks, and resolves spontaneously without intervention. Magnetic resonance (MR) imaging is the modality of choice in patients with suspected DMI based on appropriate clinical setting and plays a major role in the diagnosis, assessing the extent of involvement and differentiating DMI from other conditions. The DMI affected muscles are bulky and appear heterogeneous with hyperintense signals on T2-weighted and STIR sequences, hypo or isointense on T1-weighted images with loss of normal fatty intramuscular septae. Subcutaneous and perifascial edema can be present. On postgadolinium scans, there is diffuse heterogeneous enhancement with non-enhancing foci, which may represent areas of necrosis. Biopsy can be avoided as MR findings are highly sensitive and specific. Treatment is usually conservative. Surgical intervention is required only in patients who do not respond to conservative management. The common differential diagnosis includes cellulitis, abscess, necrotizing fasciitis and polymyositis. We present two cases below to highlight the clinical, MR imaging findings and differential diagnosis of DMI.

Ptosis correction: a challenge following complex orbital injuries

Ptosis occurs when the muscles that raise the upper eyelid (levator and Muller's muscle) get damaged. There are lot of ptosis correction surgery reported in the journals of oculoplastic surgery and opthalmic surgery. Most of these surgeries are cosmetic correction. Rarely ptosis can be seen as a complication following orbitozygomatic complex injuries. Cause of traumatic ptosis most often is levator detachment from the superior tarsal plate. Lacerations of the lid may sever the levator tendon leading to scarring and secondary mechanical ptosis. Challenge in surgical management lies in identification of Levator aponeurosis, posterior to orbital septum and preaponeuratic fat. Once the levator muscle is freed from scar tissue it should be reapproximated to tarsal plate.

Immediate effects of Suryanamaskar on reaction time and heart rate in female volunteers

Suryanamaskar (SN), a yogic technique is composed of dynamic muscular movements synchronised with deep rhythmic breathing. As it may have influence on CNS, this study planned to investigate immediate effects of SN on reaction time (RT) and heart rate (HR). 21 female volunteers attending yoga classes were recruited for study group and 19 female volunteers not participating in yoga were recruited as external-controls. HR, auditory reaction time (ART) and visual reaction time (VRT) were recorded before and after three rounds of SN in study group as well as 5 minutes of quiet sitting in both groups. Performance of SN produced immediate decrease in both VRT and ART (P < 0.001). This was significant when compared to self-control period (P < 0.001) and compared to external-control group, it decreased significantly in ART (p = 0.02). This was pronounced when delta% was compared between groups (P < 0.001). HR increased significantly following SN compared with both self-control (p = 0.025) and external-control group (p = 0.032). Faster reactivity may be due to intermediate level of arousal by conscious synchronisation of dynamic movements with breathing. Rise in HR is attributed to sympathetic arousal and muscular exertion. We suggest that SN may be used as an effective training means to improve neuro-muscular abilities.

Cystic Lymphangioma of the Breast: Magnetic Resonance Imaging Features

BACKGROUND: The aim of this study was to report magnetic resonance imaging (MRI) features of cystic lymphangiomas of the breast. METHODS: MRI of the breast was performed using a phased-array double breast coil with a 1.5-T MR scanner. Routine T1 and T2 and post-contrast sequential imaging was performed. RESULTS: The MRI characteristics of cystic lymphangioma in the breast are described. CONCLUSION: MR imaging provides for multiplanar evaluation and diagnosis of cystic lymphangioma of the breast, which is a rare occurrence.

Frontoethmoidal encephalocele with subependymal nodular heterotopia: an unusual association. A case report

Frontonasal encephaloceles involve herniation of meninges and brain tissue through defects in the floor of the anterior cranial fossa affecting the frontal, ethmoid and nasal bones. Subependymal nodular heterotopias are malformations of cortical development resulting from abnormal neuronal migration. This report describes the coexistence and association of these two entities which is extremely rare. We describe an unusual case of a six-year-old girl with a frontonasal encephalocele in whom further imaging disclosed subependymal nodular heterotopias. Clinically she presented with swelling over the glabella since birth but otherwise was asymptomatic. CT and MRI showed herniation of brain tissue with the overlying dura and CSF through a defect in the frontal, ethmoid and nasal bones. In addition, MRI revealed heterotopic nodules in the subependymal regions of the lateral ventricles that were isointense with grey matter on all sequences. The patient underwent one stage surgery for correction of the encephalocele.

Ovarian carcinoma metastasis to the breast and imaging features with histopathologic correlation: a case report and review of the literature

Metastasis to the breast from primary ovarian carcinoma is rare. We describe a case in which the patient developed breast metastasis 3 years after initial treatment of a primary ovarian cancer.

A rare case of solitary fibrous tumour of the sigmoid mesocolon: imaging features and review of literature

Solitary fibrous tumours are rare spindle cell tumours that generally arise from the pleura but on rare occasions arise in other locations such as the head and neck region, stomach and retroperitoneum. Very few reports exist on the imaging findings of these tumours in extra pleural sites such as the mesentery. We report the computed tomography (CT) imaging findings of a rare case of solitary fibrous tumour in a 68-year-old man who presented with a slowly enlarging painless pelvic mass. CT scan showed a well-defined, multilobulated, highly vascular pelvic mass with dense calcifications and central hypoatteunating areas arising from the mesentery.

Neuroimaging patterns of central nervous system metastases in neuroblastoma: report of 2 recent cases and literature review

The authors describe imaging patterns of intracranial metastases in 2 children with grade 4 neuroblastoma. Central nervous system metastases from neuroblastoma are extremely rare and may involve the cerebral parenchyma, leptomeninges, or dura. Cerebral parenchymal metastases can be cystic with mural nodules or solid with hemorrhagic elements. The first patient in our study had multiple cystic parenchymal metastases with calcific mural nodules, while the second patient developed solid hemorrhagic parenchymal metastatic lesions along with extensive leptomeningeal and dural deposits. Central nervous system involvement in both patients occurred within a time span ranging from 12 to 14 months from the time of initial diagnosis.

Magnetic Resonance Imaging of a Benign Phyllodes Tumor of the Breast

SUMMARY: BACKGROUND: The aim of this study was to evaluate a phyllodes tumor of the breast with magnetic resonance imaging (MRI) and magnetic resonance spectroscopy. METHODS: MRI of the breasts was performed using a phased array double breast coil with spectroscopic capability on a 1.5T MR scanner. Post-contrast sequential imaging was done, and the subtracted images were evaluated. Timesignal intensity curves were obtained. MR spectroscopy using BREASE software was also performed. RESULTS: MRI combined with MR spectroscopy was used in the diagnosis and characterization of a phyllodes tumor of the breast. CONCLUSION: MRI and MR spectroscopy may offer an in vivo imaging technique for the characterization of phyllodes tumors of the breast.

Multivoxel (1)H MR Spectroscopic Approach to the Diagnosis of Intraventricular Central Neurocytoma. A Case Report

We describe the proton ((1)H) magnetic resonance spectroscopic (MRS) imaging of central neurocytoma (CNC), a rare benign intraventricular neuronal tumor. Multivoxel MR Spectroscopy is a feasible and reproducible non-invasive tool for the specific diagnosis of CNC and to distinguish CNC from other intraventricular tumor types. The detection of glycine and alanine peaks, high choline and lactate and low NAA levels are characteristic of CNC.

Influence of alpha lipoic acid on antioxidant status in D-galactosamine-induced hepatic injury

D-Galactosamine (GalN)-induced liver injury is associated with reactive oxygen species and oxidative stress. In the present study, we evaluated the effect of alpha lipoic acid (ALA) supplementation on acute GalN-induced oxidative liver injury. Hepatotoxicity induced by single intraperitoneal injection of GalN (500 mg/kg body wt) was evident from increase in lipid peroxidation and serum marker enzymes (asparate transaminase, alanine transaminase, alkaline phosphatase, and lactate dehydrogenase). The decreased activities of enzymic antioxidants (superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase) as well as glutathione levels were the salient features observed in GalN-induced hepatotoxicity. Pretreatment with ALA (50 mg/kg body weight for 7 days) significantly precluded these changes and prevents the hepatic injury. Hence, this study clearly exemplified that ALA might be a suitable candidate against GalN-induced cellular abnormalities.

Chemotherapy-Induced Posterior Reversible Encephalopathy Syndrome in Childhood Chronic Myeloid Leukemia

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological phenomenon seen in a wide spectrum of clinical conditions and is characterized clinically by headache, altered mental status, visual loss and seizures and reversible neuroimaging findings. This study evaluated MR imaging in PRES in a clinical oncology setting. MR findings may be helpful in disclosing the underlying pathophysiological mechanisms of the syndrome. The MR imaging protocol consisted of T2–weighted, fluid attenuation inversion recovery (FLAIR), diffusion weighting imaging (DWI) and apparent diffusion coefficient (ADC) sequences. Contrast enhanced computed tomography (CT) of the brain revealed bilateral symmetric subcortical hypodense lesions in the parieto-occipital regions. T2–weighted and FLAIR sequences showed bilateral, symmetrical focal cortical and subcortical hyperintensities involving the parietal and occipital lobes. These areas appeared hyperintense on DWI while the ADC (Apparent Diffusion Coefficient) maps demonstrated higher apparent diffusion coefficients in areas of FLAIR abnormalities thus confirming vasogenic edema. Follow-up scan five days later showed improvement or resolution of the abnormalities. Transient DWI hyperintensities seen in cortical watershed areas corresponding to the hyperintense foci in FLAIR imaging are suggestive of foci of vasogenic edema secondary to vasospasm in highly ischemia-sensitive cerebral tissue.

Imaging of desmoplastic infantile ganglioglioma: a spectroscopic viewpoint

PURPOSE

Desmoplastic infantile gangliogliomas (DIG) are rare benign intracranial neoplasms of early childhood with involvement of superficial cerebral cortex and leptomeninges. The purpose of the study was to determine the alterations in metabolite ratios occurring in the neoplasm and combine with magnetic resonance (MR) imaging features to narrow down the diagnosis.

METHODS

MR imaging sequences include T1- and T2-weighted sequences, fluid-attenuated inversion recovery sequences, and post-gadolinium-contrast T1-weighted imaging. Single-voxel short TE (1)H MR spectroscopy was used to study the changes in metabolite ratios in the tumor.

RESULTS

Comparison of metabolite ratios between normal brain tissue and tumor-affected region showed lower N-acetyl aspartate to creatine (Cr; 1.58 vs.1.28), higher choline to Cr (0.82 vs.2.03), and no significant change in myo-inositol to Cr (0.42 vs.0.39).

CONCLUSION

MR spectroscopy and imaging provide valuable information in the diagnosis of DIG.

CT imaging of malignant metastatic hemangiopericytoma of the parotid gland with histopathological correlation

We report an extremely rare case of malignant hemangiopericytoma (HPC) of the parotid gland and its metastatic spread to lung, liver, and skeletal muscle. Computed tomography (CT) imaging, histopathological and immunohistochemical methods were employed to study the features of malignant HPC and its metastases. CT imaging was helpful to determine the exact location, involvement of adjacent structures and vascularity, as well as evaluating pulmonary, hepatic, peritoneal, and muscular metastases. Immunohistochemical and histopatholgical features of the primary tumor as well as the metastases were consistent with the diagnosis of malignant HPC.

MR and CT Evaluation of Dysembryoplastic Neuroepithelial Tumor

A 33-year-old man presented with a long history of intractable partial seizures with the first episode at the age of 18 years. The seizure frequency had increased in the recent past. CT imaging revealed a low attenuation lesion in the left frontal cortex with calvarial scalloping. MR imaging revealed a heterogeneous signal intensity lesion with involvement of the cortex and the sub-cortical white matter. In dysembryoplastic neuroepithelial tumor the neoplastic elements adjacent to the cortex might cause disorganization of cortical layers in the developmental stage leading to cortical dysplasia. Architectural dysplasia is characterized by cortical thickening and ectopic neurons in the white matter. MR imaging features reflect the characteristics of cortical dysplasia and ectopic neurons in the sub-cortical white matter.

Longitudinal CT and MR appearances of hemimegalencephaly in a patient with tuberous sclerosis

CASE REPORT

A 3-day-old baby was referred to our institution with seizures since birth and a presumptive diagnosis of cerebral tumor detected by prenatal ultrasound. Computed tomography (CT) and Magnetic Resonance (MR) imaging performed immediately after birth revealed the presence of an enhancing mass in the left cerebral hemisphere.

DISCUSSION

The possibility of a congenital malignant brain tumor was considered. Although surgery was advised, the parents opted for conservative medical management. The infant was under treatment for seizures with antiepileptic drugs. At 7-month follow-up, there was a noticeable increase in the seizure activity with signs of developmental delay and increased head circumference. Repeat CT and MR imaging showed features of hemimegalencephaly with a calcified mass involving the left hemisphere. The patient was diagnosed to have tuberous sclerosis. This case report illustrates how an enhancing mass (possibly a tuber) over a period of time diminishes in size and becomes calcified in a patient with tuberous sclerosis and associated hemimegalencephaly.

Pachymeningeal metastasis from squamous cell carcinoma of the uterine cervix with involvement of the optic nerve: case report and review of the literature

This report describes the case of a 50-year-old woman with carcinomatous meningitis from squamous cell carcinoma of the uterine cervix. Ultrasound showed an irregular hypoechoic mass in the cervix. Contrast enhanced computed tomography imaging revealed intense linear enhancement along the falx cerebri suggestive of pachymeningeal metastasis with involvement of the optic nerve. To our knowledge this is the first reported case of imaging features of isolated metastatic dural involvement from cervical carcinoma. Moreover, this is the first case of its kind in which dural involvement was diagnosed at presentation in a locally confined tumour.