Case report: tuberculosis of the parotid gland--diagnosis by CT

A case of parenchymal and intraparotid lymph node tuberculosis is reported in a young Asian male. The diagnosis was suggested pre-operatively by the contrast enhanced CT (CECT) appearance. There were no systemic symptoms of tuberculosis and this is a characteristic feature of the 100 cases reported in the literature. The presence of thick walled rim enhancing lesions with a central lucency on CECT should suggest the diagnosis. Filling defects with or without thin walls are non-specific findings and are seen in tumours and other inflammatory processes. In an appropriate clinical setting, thick walled round rim enhancing lesions with a central lucency are characteristic of tuberculosis.

Pseudocyst of the auricle: a new method of treatment

Pseudocyst of the auricle is a condition where spontaneous serous fluid collection is seen on the lateral surface of the pinna. The aetiology of this condition is not known. Several methods of treatment have been advocated in the past. We report 10 cases of unilateral pseudocyst who were treated with aspiration and pressure dressing by a plaster of Paris cast over the pinna for two weeks.

Burning sensation in the throat--should it be named caloripharyngeus?

A burning sensation in the throat is often complained of by patients, but this symptom has been neglected in the literature. To emphasize its importance, should we give the name 'caloripharyngeus' to the symptom of burning in the throat? A preliminary study of 30 patients with the sensation of burning in the throat is presented in this study. Of the patients studied 73.33 per cent had hyperacidity detected for the first time. Reflux was presented in only one patient; four patients showed oesophagitis in the lower one-third of the oesophagus; 90 per cent of the patients responded to antacids. We suggest that one of the causes of burning in the throat is a referred sensation due to hyperacidity.

Detection of inflammatory bowel disease in pediatric patients with technetium-99m-HMPAO-labeled leukocytes

Technetium-99m-HMPAO-labeled leukocyte imaging is now an accepted technique in the assessment of adult patients with inflammatory bowel disease (IBD), but its role in pediatric patients has not been studied.

METHODS

We evaluated the efficacy of 99mTc-HMPAO-labeled leukocyte imaging in 21 children. We studied 16 children with active IBD (4 ulcerative colitis, 10 Crohn's disease, 1 indeterminate colitis, 1 C-difficile) and 5 controls.

RESULTS

The sensitivity and specificity for active bowel inflammation were excellent. The intensity of uptake noted in most patients rendered image interpretation easy and straightforward. The inclusion of a tail on detector (TOD) view and anterior standing view of the abdomen is important. All patients with ulcerative colitis showed rectosigmoid disease and no small bowel activity, whereas, all patients with Crohn's disease showed discontinuous uptake and often small bowel activity. It was therefore possible to differentiate ulcerative colitis from Crohn's disease on the basis of location and distribution.

CONCLUSION

The 99mTc-HMPAO-labeled leukocyte scan is an excellent technique for the detection, localization and characterization of IBD in children.

Effect of tamoxifen, estradiol 17 beta on coenzymes NAD, NADPH and the metabolism of estradiol and estrone in rabbit uterus in vivo

Biotransformation of estradiol (E2) and estrone (E1) and the concentrations of NAD, NADPH and 17 beta-estradiol dehydrogenase (E2DH) were measured in the uterus of rabbits treated with tamoxifen (Tam) in two doses; 100 micrograms/day, (Tam 100) and 500 micrograms/day, (Tam 500), E2 (10 micrograms/day) and combination of E2 + Tam 500 for 4 days. The concentration of NAD in Tam 500 treated group was significantly higher than E2, low dose Tam and E2 + Tam 500 treated groups (P < 0.01). The concentration of NAD in E2+ Tam 500 uteri was also significantly higher than E2 treated uteri. The concentration of NADPH was not significantly different from each other amongst the various treatment groups. The studies have shown that E2DH in E2 treated uteri was less than control and Tam 500 treated groups. A significant rise in the enzyme estradiol oxidoreductase (E2OR) activity (P < 0.02) was observed in E2 + Tam 500 treated uteri over control and other treated groups whereas high dose Tam decreased the E2OR activity significantly over the E2 treated group. The rate of conversion of E1 to E2 in Tam 500 treated group was significantly less than the other treatment groups except E2 + Tam 500 treated group (P < 0.04). This study showed that E2 decreases the uterine biosynthesis of NAD and E2DH and the biotransformation of E2 to E1, while high dose Tam increases uterine NAD, E2DH activity and E2 to E1 conversion.

Short term treatment of tamoxifen and estradiol on estradiol and progesterone receptors in rabbit uterus

Effects of tamoxifen (Tam) on cytosolic estradiol (E2) receptors (ERc), progesterone (P4) receptors (PRc), nuclear estradiol (ERn) and progesterone receptors (PRn) were studied in adult normal rabbit uterine tissue. The ratio of cytosol: nuclear estradiol receptors (ER) was greater in rabbits treated with Tam than E2 or control uterine tissues. Rabbit uterine progesterone receptors (PR) in E2 treated animal were greater than Tam-treated animals. Tam caused nuclear accumulation of estradiol receptor, and simultaneous administration of E2 + Tam 500, estradiol could not revert Tam mediated accumulation of ER. The results suggest that Tam has an essentially antagonist action in the rabbit uterine tissue.

Distribution of corticotropin-releasing factor immunoreactive neurons in the brain of the tigerfrog, Rana tigrina

The distribution of immunoreactive (ir) neurons containing corticotropin-releasing factor (CRF) is described in the brain of the tigerfrog, Rana tigrina. The olfactory bulb, medial pallium, nucleus of the diagonal band of Broca and medial area of the amygdala of the telencephalon showed ir-CRF perikarya. The anterior and ventromedial thalamic nuclei, and the magnocellular nucleus preopticus (NPO) revealed several ir cells; a few NPO neurons were cerebrospinal fluid contacting in nature. The nucleus hypothalamicus ventromedialis contained a few cells, but the nucleus infundibularis ventralis of the infundibulum revealed several diffusely distributed perikarya. Individual ir-CRF perikarya were visualized in the optic tectum and interpeduncular nucleus. Extensive fiber terminals were present in the median eminence, but no fibers were discerned either in the neural lobe or in the pituitary gland.

Paraquat tolerance in a photomixotrophic culture of Chenopodium rubrum

A paraquat tolerant line of Chenopodium rubrum has been compared with paraquat susceptible cultures, in terms of growth, chlorophyll content, photosystem I partial reactions, and the activities of some enzymes involved in detoxification of harmful oxygen radicals. Results indicate that paraquat tolerance is manifested through increased activity of superoxide dismutase, peroxidase and catalase, in the tolerant line, only in the presence of paraquat. The behaviour of the paraquat tolerant. and susceptible cultures in the absence of paraquat is quite similar.

Peripheral and renal vein renin activity in patients with renovascular hypertension due to nonspecific aortoarteritis

The diagnostic utility of peripheral and renal vein renin estimations in relation to angiographic findings was evaluated in 13 patients with renovascular hypertension and non-specific aortoarteritis (NSAA, Gr I), in comparison with 10 patients with renal artery stenosis due to other causes (Gr II). Plasma renin activity (PRA) was measured by radioimmunoassay. Blood samples were collected after angiography from the femoral vein and renal vein on the affected side followed by sampling from the less affected or unaffected side. Renal vein renin ratio (RVRR) was calculated from renal vein renin values. The effect of captopril (25 mg oral) on blood pressure, PRA, and RVRR was examined in 8 patients from each group. Normotensive volunteers (8) with moderately low salt intake were also included in the study for comparison of twenty-four-hour urinary sodium output, peripheral PRA, and response to captopril. The mean peripheral PRA was high in both groups as compared with normotensive controls; however, the values were lower in patients with NSAA. The rise in PRA in response to captopril was insignificant in Gr I (p greater than 0.05) and RVRR greater than 1.5 was observed in 5 of 13 patients in contrast to 9 of 10 in Gr II (p less than 0.05). A paradoxical ratio, ie, (high renal vein renin levels on the less stenotic side) was noticed in 3 patients of Gr I, whereas none of the patients of GR II showed such a ratio. An improvement in RVRR after captopril was observed in 50% of patients of Gr I as compared with a marked response in all patients of Gr II.(ABSTRACT TRUNCATED AT 250 WORDS)

Thallium-201 single-photon emission computed tomography imaging in a pediatric brain tumor. A case report

Thallium brain single-photon emission computed tomography (SPECT) may be useful for differentiation of tumor recurrence from scar tissue and radiation necrosis and to predict low or high grade brain tumors. We report a case of an 11-year-old boy with recurrent oligodendroglioma who showed increased focal uptake of thallium-201 at the site of recurrence after surgery and radiotherapy on a SPECT imaging of the brain. This indicates viable tumor mass as opposed to radiation necrosis.

Transfer RNA genes in mycobacteria: organization and molecular cloning

DNAs from nine mycobacterial species were cleaved with different restriction endonucleases and hybridized with cDNA probes synthesized to total transfer RNAs (tRNAs) from Mycobacterium smegmatis and M. tuberculosis. The hybridization data indicate that tRNA genes are conserved but their gross genomic organization has diverged in six of the nine species examined. Species of the MTB complex appeared to have identical tRNA gene organization. Hybridization with cDNAs synthesized to 23S plus 16S rRNAs from Escherichia coli indicate that the tRNA genes map near the rRNA genes. Recombinant plasmids, pSB1, pSB2, pSB4 and pSB8 encoding tRNA(s) and rRNA(s) were isolated from a gene bank of M. tuberculosis H37Rv. Using pSB2 as probe, a SalI RFLP was observed that distinguishes the virulent and avirulent strains of M. tuberculosis H37Rv and H37Ra, respectively.

tRNA genes in mycobacteria: organization and molecular cloning

DNAs from nine mycobacteria cleaved with restriction endonucleases were hybridized with cDNA probes synthesized to tRNAs from Mycobacterium tuberculosis and Mycobacterium smegmatis. The tRNA genes are conserved, but their gross genomic organization has diverged in six of the nine species examined. Organisms of the M. tuberculosis H37Ra and H37Rv-M. bovis BCG complex appeared to have identical tRNA gene organization and were indistinguishable from each other. M. tuberculosis and M. smegmatis tRNA-derived cDNA probes hybridized differentially to tRNA-coding DNA segments in five of the species examined, suggesting the existence of qualitatively different tRNA pools in these slow- and fast-growing species. Mycobacterial DNAs hybridized with cDNA synthesized to 23S plus 16S rRNAs from Escherichia coli, and the data suggested that the tRNA genes map close to the rRNA genes. A gene bank of M. tuberculosis H37Rv DNA was constructed, and a recombinant plasmid, pSB2, coding for tRNA(s) and rRNA(s) was partially characterized. Plasmid pSB2 recognized a SalI restriction fragment length polymorphism (RFLP) in M. tuberculosis H37Rv and H37Ra; however, the RFLP is not linked to the tRNA-coding region. To the best of our knowledge, this is the first report of an RFLP which distinguishes the pathogenic strain M. tuberculosis H37Rv from its avirulent derivative H37Ra.

Bony ankylosis of the temporomandibular joint: a computed tomography study

Bony ankylosis of the temporomandibular joint is a disabling disease that almost invariably manifests itself in the first two decades of life. CT of the temporomandibular joints was performed in 50 patients--axial CT in 2 and coronal CT in 48--of whom 43 (86%) had received trauma to the joints. New bone of variable form and thickness was observed in 64 joints (the involvement was bilateral in 14 patients). These joints were classified into one of two categories: type I, medially angulated condyle with deformed articular fossa and a mild-to-moderate amount of new bone formation; and type II, no recognizable condyle or fossa but instead a large mass of new bone. Type I was etiology-specific and seen only when trauma was the antecedent, whereas type II was a sequelae of either insult. A pseudofracture in the new bone was seen in 49 (77%) joints. Six joints showed subtle deformities but no new bone. Since coronal CT fully characterizes the lesion at acceptable radiation exposure levels, it appears to be valuable in the preoperative workup of these patients.

Lymphnode infarction and lymphoma

Lymphnode infarction is seen in two sets of situations viz. spontaneous banal infarction of non-neoplastic nodes, and in association with lymphoma. It needs to be differentiated from other causes of lymphnode as a phenomenon occurring synchronous with and occasionally preceding diagnosis of lymphoma is significant.

Unusual manifestation of extramedullary haematopoiesis in thalassaemia major (report of 2 cases)

2 cases of thalassaemia reported with skeletal changes of severe haemolytic anaemia with the striking feature of extra-medullary haematopoiesis in relation to anterior ends of the rib. This is a rare finding in thalassaemia and is a manifestation of long-standing disease found in thalassaemia intermedia.

Bladder hemangioma: ultrasonographic demonstration

We report a child with bladder hemangioma, which is a very rare benign vascular tumor. Postvoid excretory urography and ultrasound of the bladder demonstrated the lesions. The merits and demerits of various imaging modalities and the possible role of computed tomography (CT) and magnetic resonance imaging (MRI) are also discussed.

Spontaneous intraventricular haemorrhage

Twenty-one patients with spontaneous intraventricular haemorrhage (IVH) were reviewed with particular reference to the clinical outcome. Based on clinical and computed tomography (CT) findings, as well as possible mechanisms governing the formation of IVH, we were able to identify two separate groups: patients with haemorrhage into ventricles without clinical or CT evidence of a lesion in adjacent brain parenchyma and patients with IVH occurring as a result of erosion of the ventricular wall by either a juxtaventricular small haematoma shown by CT and/or IVH with focal neurological deficit. Out of 12 patients in the first group, 8 survived and resumed their previous activities; in the second group (i.e. patients with clinical and/or CT evidence of adjacent intraparenchymal bleeding only three patients survived, two with considerable handicap. The overall prognosis, however, was significantly better in patients with IVH of unknown cause. Altered sensorium as an initial presentation was associated with a grave prognosis, irrespective of the cause of IVH. The outcome was not affected by the age of patient or the amount of blood within the ventricles. Our data suggest a favourable outcome in a relatively large percentage of patients with spontaneous IVH, if there is no clinical or CT evidence of concomitant parenchymal bleeding. Hence we question the notion that there is a grave prognosis in all kinds of IVH.

Neurocysticercosis in childhood

Manifestations of cysticercosis in 11 children (mean age 9.5 years) are presented. Features of raised intracranial pressure dominated the clinical picture (10 cases), followed by seizures (7 cases). Subretinal cysts occurred in three children. Focal signs were infrequent and often not attributable to anatomical lesions. Electro-encephalograms were invariably abnormal, but did not help to localize lesions. Plain roentgenograms of the skull showed sutural diastasis in the majority. Computerized tomography revealed white matter oedema with throttled ventricles in 6 patients and single localized lesions in 3 others. None had hydrocephalus. Histopathology and indirect haemagglutination test aided diagnosis in 6 cases. Two children recovered completely, one after surgical excision of a parietal lobe cyst and the other following praziquantel therapy. Half of the remaining patients improved spontaneously.

Embryonic zeta-globin chains in adults: a marker for alpha-thalassemia-1 haplotype due to a greater than 17.5-kb deletion

Hemolysates from adults with the alpha-thalassemia-1 haplotype due to the greater than 17.5-kb deletion of both alpha-globin genes from the same chromosome were found to contain embryonic zeta (zeta)-globin chains (alpha-globin-like chains), as determined by a specific and sensitive radioimmunoassay and an electrophoretic technique. zeta-Globin chains were not present in hemolysates from adults with deletion of a single alpha-globin gene from one or both chromosomes. These results indicate that zeta-globin chains, which can be assayed by immunologic techniques, can serve as markers for the alpha-thalassemia-1 haplotype due to the greater than 17.5-kb deletion. The ability to detect zeta-globin chains may be useful in populations in which the gene frequency of the greater than 17.5-kb deletion is high, for screening couples at risk of having offspring with homozygous alpha-thalassemia.

Anal agenesis with recto-bulbar fistula

Four cases of anal agenesis with rectobulbar fistula, a rare type of anorectal anomaly, are described along with the preferred mode of radiological investigation to demonstrate the fistula.

Radiological evaluation of mucocoele of the paranasal sinuses

Ten cases of mucocoele of the para-nasal sinuses are reported. Plain X-ray findings were suggestive of the diagnosis in all cases. CT revealed a well defined homogeneous mass, isodense with brain, with expansion of the para-nasal sinuses and extension of the mass into the orbit or parasellar area in eight cases. Surgical confirmation was obtained in all cases.

Effect of medical treatment on intracranial tuberculoma--a CT study

Computerized tomography (CT) provides a non-invasive method for making a reasonably confident diagnosis of intracranial tuberculosis and an opportunity to study the response to treatment. Using this facility a series of 50 patients with intracranial tuberculomas, whose vision or life was not threatened by severe intracranial hypertension, were treated with antituberculosis chemotherapy. Most of the small and medium sized lesions resolved completely. Central liquefaction was observed in one case while only three failed to respond to treatment, there was one death. Three illustrative cases have been reported in detail.

Allergic bronchopulmonary aspergillosis in Indian children with bronchial asthma

Out of 243 children with bronchial asthma, 107 children (44%) were found to have perennial asthma. These children were studied to determine the incidence of allergic bronchopulmonary aspergillosis (ABPA) in Indian children. Clinical and radiologic evaluations, skin testing, and precipitin studies with Aspergillus fumigatus antigen, and total IgE level estimations were done. Fifteen percent of children had four or more of the criteria, and were considered to have ABPA.

Ankylosing spondylitis in North India: a clinical and immunogenetic study

Fifty-one North Indian patients with ankylosing spondylitis (AS) are described with mean age of onset 21.2 years and male to female ratio of 16:1. AS began with peripheral arthritis in 47%, low back pain in 41%, acute anterior uveitis in 10%, and heel pain in 2% of the patients. 76% of 51 patients had one of the extra-axial features of AS: peripheral arthritis (61%), heel pain (24%), anterior uveitis (22%), urethritis (12%), kidney disease (10%), mucosal ulcerations (6%), aortic incompetence (4%), and apical pulmonary fibrosis (4%). A majority (71%) of the patients with peripheral arthritis had mono- or oligoarthritis affecting mainly the lower limb joints. Two patients had coexistent rheumatoid arthritis also. HLA-B27 antigen was detected in 48 (94%) of 51 patients compared with 7 (6%) of 118 controls (relative risk 254; Fisher's exact p = 3.49(-29]. On comparing patients with juvenile onset AS and patients with adult onset disease we found peripheral arthritis to be more frequent at the beginning and during the course of disease in the former.

Evaluation of quantitative sacroiliac scintigraphy for the early detection of sacroiliitis

Quantitative sacroiliac scintigraphy (QSS) was evaluated for the detection of sacroiliac (SI) joint disease before the appearance of radiographic/changes. QSS with fractional quantitation was done in 13 age- and sex-matched controls and 28 patients with different grades of radiographic sacroiliitis. The SI index of each joint was considered separately. The mean SI index values in patients with grade I radiographic sacroiliitis (1.54) and HLA-B27 positive patients with low back pain (1.50) were significantly (P less than 0.01) higher than the mean SI index of controls (1.22); but more than 50% of their SI index values were within the 97.5% confidence limits of the control range. The mean SI index values of patients with grade II (1.38) and grade III (1.34) radiographic sacroiliitis did not differ significantly from the mean SI index of controls (P greater than 0.05). Thus a large overlap between the normal and abnormal ranges of sacroiliac ratios limits the utility of quantitative sacroiliac scintigraphy for the early diagnosis of sacroiliac joint disease.

Hydrocephalus caused by tuberculous meningitis: clinical picture, CT findings and results of shunt surgery

This study is an analysis of 70 children, five months to eleven years of age, with hydrocephalus secondary to tuberculous meningitis. They presented as an acute illness, mostly in early childhood, with disturbance of consciousness, convulsions, rigidity and, sometimes, neurological deficit. CT scans showed ventricular dilatation, periventricular translucency and exudates in basal cisterns. Shunt surgery performed early produced gratifying results without dissemination of tuberculosis. Residual ventricular dilatation following shunt surgery was inversely related to intellectual status. Even with advanced degrees of tuberculous meningitis, thirteen of the twenty-eight children tested for intellectual status were found to be educable or having near normal intelligence. Fatal intraventricular haemorrhages were seen in six cases as a late complication.

HLA B27 related 'unclassifiable' seronegative spondyloarthropathies

Twenty-five patients (22 males and 3 females) are described who had 'unclassifiable' seronegative peripheral arthritis affecting mainly the large joints of the lower limbs with other typical features of spondyloarthropathies such as heel pain, low back pain, and mucosal ulcers. But their disorders could not be diagnosed as any specific spondyloarthropathy such as ankylosing spondylitis, Reiter's disease, etc. The mean age of onset of disease was 21.4 years and 60% of them had mono- or oligoarthritis; 60% had arthritis of only lower limb joints. Knee, ankle, and hip joints were most commonly involved, often asymmetrically (mean degree of asymmetry = 0.28). Minimal radiographic sacroiliitis was present in 4 patients, though 13 had low back pain. HLA B27 antigen was detected in 21 (84%) of these patients and only 5.9% of 118 controls (relative risk 83). In addition to these 25 patients there were 4 others whose only symptom was severe bilateral heel pain: 3 of them were positive for HLA B27.

Evaluation of peripartum strokes by computed tomography

Eleven women with peripartum strokes were evaluated by cranial computed tomography (CT). The interval between childbirth and the onset of symptoms varied from 1 day to 22 days. Computed tomography scans were done within 7 days of the onset of symptoms in six cases and in the remaining five cases on the 8th, 12th, 12th, 12th and 20th day, respectively. All CT scans were abnormal, 10 showing evidence of arterial infarction by low-attenuation lesions and only one of sino-venous occlusion shown by a high-attenuating haematoma.