DTI correlates of cognition in conventional MRI of normal-appearing brain in patients with clinical features of subacute combined degeneration and biochemically proven vitamin B(12) deficiency

BACKGROUND AND PURPOSE

Vitamin B12 deficiency may cause neural injury that results in cognitive deficits. The main purpose of our study was to evaluate morphometric and microstructural changes in the brain and relate them to cognition in subacute combined degeneration of the spinal cord and patients with biochemically deficient vitamin B12.

MATERIALS AND METHODS

Fifty-one patients were recruited and underwent nerve-conduction velocity tests and routine hematologic examinations. Serum vitamin B12 and homocystine levels were also measured. All patients and 46 age- and sex-matched controls underwent cervical spine and brain MR imaging along with cognition tests. MR imaging included conventional scans and DTI. Voxel-based morphometry was performed for determining the WM and GM volumes, based on T1-weighted images. DTI measures that included fractional anisotropy, ADC, radial diffusivity, and axial diffusivity were determined by using tract-based statistics.

RESULTS

None of the patients showed any abnormality on conventional MR imaging. No significant changes in GM and WM volumes were observed in patients compared with controls. Significant reductions in the fractional anisotropy and an increase in ADC and radial diffusivity values were observed in multiple brain regions in patients compared with controls. These changes were confirmed on the region-of-interest analysis. Neuropsychological scores were significantly different in patients compared with controls and showed significant correlation with fractional anisotropy and radial diffusivity in a few brain regions.

CONCLUSIONS

Microstructural changes are seen in WM regions on DTI in patients with vitamin B12 deficiency and correlate with cognition scores. DTI can be used for objective assessment of microstructural changes in the brain in vitamin B12 deficiency.

Early down regulation of the glial Kir4.1 and GLT-1 expression in pericontusional cortex of the old male mice subjected to traumatic brain injury

Astroglia play multiple roles in brain function by providing matrix to neurons, secreting neurotrophic factors, maintaining K(+) and glutamate homeostasis and thereby controlling synaptic plasticity which undergoes alterations during aging. K(+) and glutamate homeostasis is maintained by astrocytes membrane bound inwardly rectifying K(+) channel (Kir4.1) and glutamate transporter-1 (GLT-1 or EAAT-2) proteins, respectively in the synapse and their expression may be altered due to traumatic brain injury (TBI). Also, it is not well understood whether this change is age dependent. To find out this, TBI was experimentally induced in adult and old male AKR strain mice using CHI technique, and expression of the Kir4.1 and GLT-1 in the pericontusional cortex at various time intervals was studied by Western blotting and semi quantitative RT-PCR techniques. Here, we report that expression of both Kir4.1 and GLT-1 genes at transcript and protein levels is significantly down regulated in the pericontusional ipsi-lateral cortex of old TBI mice as compared to that in the adult TBI mice as function of time after injury. Further, expression of both the genes starts decreasing early in old mice i.e., from the first hour after TBI as compared to that starts from fourth hour in adult TBI mice. Thus TBI affects expression of Kir4.1 and GLT-1 genes in age- and time dependent manner and it may lead to accumulations of more K(+) and glutamate early in the synapse of old mice as compared to adult. This may be implicated in the TBI induced early and severe neuronal depolarization and excito-neurotoxicity in old age.

CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 2: discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens

SUMMARY

While the previous review of CNS-IRIS in the HIV-infected patient on highly active antiretroviral therapy (Part 1) dealt with an overview of the biology, pathology, and neurologic presentation of this condition and a discussion of the atypical imaging findings in PML-IRIS and cryptococcal meningitis-IRIS due to the robust inflammatory response, the current review (Part 2) discusses the imaging findings in other commonly encountered organisms seen in association with CNS-IRIS, namely, VZV, CMV, HIV, Candida organisms, Mycobacterium tuberculosis, and Toxoplasma gondii. Also described is the imaging appearance of CNS-IRIS when not associated with a particular organism. Recognition of these imaging findings will give credence to the diagnosis of CNS-IRIS and will allow the clinician to institute changes in medical management, if necessary, so that immune reconstitution and improved patient outcome can occur with time.

Regular or covert sex defines two lineages and worldwide superclones within the leaf-curl plum aphid (Brachycaudus helichrysi, Kaltenbach)

Asexual reproduction occurs widely in plants and animals, particularly in insects. Aphid species usually reproduce by cyclic parthenogenesis, but many species include obligate asexual lineages. We recently showed that the leaf-curl plum aphid, Brachycaudus helichrysi, actually encompasses two lineages, B. helichrysi H1 and H2. Ecological data suggest that these lineages have different life cycles. We conducted a large population genetics study, based on 14 microsatellite loci, to infer their respective life cycles and investigate their population structure and geographical distribution. Brachycaudus helichrysi H1 displayed the genetic signature of cyclical parthenogenesis, using plum trees as primary hosts for sexual reproduction, as classically described for B. helichrysi. This global survey showed that the Central Asian population of H1 was clearly differentiated from American-European populations. By contrast, B. helichrysi H2 displayed the typical signature of obligate asexual reproduction. H2 encompassed at least eight highly successful genotypes or superclones. This lack of ability to undergo sexual reproduction was confirmed for one of the superclones by sex induction experiments. We found only one B. helichrysi H2 population that underwent sexual reproduction, which was collected from peach trees, in Northern India. Our results confirm that H1 and H2 have different life cycles. Brachycaudus helichrysi H1 is clearly heteroecious using plum trees as primary hosts, while B. helichrysi H2 encompasses several anholocyclic lineages, and some heteroecious populations that until now have only been found associated with peach trees as primary hosts. We discuss implications of these findings for the pest status of B. helichrysi lineages.

Preoperative diagnosis of squamous cell carcinoma of the gallbladder by ultrasound-guided aspiration cytology: clinical and cytological findings of nine cases

INTRODUCTION

Squamous cell carcinoma is a rare tumour of the gallbladder and accounts for about 1% of all the malignant neoplasms of the gallbladder. The clinical presentation of patients with squamous cell carcinoma of the gallbladder is not specific, and in majority, it mimics that of acute cholecystitis. As a result, preoperative diagnosis is not made, and patients undergo operative procedures. Squamous cell carcinoma of the gallbladder is detected at an advanced stage with infiltration into adjacent structures, with infiltration of the liver being the commonest. Ultrasound-guided fine-needle aspiration cytology is considered an important minimally invasive investigation in the preoperative diagnosis of adenocarcinoma of the gallbladder. However, sparse literature is available regarding preoperative fine-needle aspiration diagnosis of squamous cell carcinoma of the gallbladder.

METHODS

On retrospective analysis of ultrasound-guided fine-needle aspiration cytology of gallbladder lesions, nine cases of pure squamous cell carcinoma were identified. Clinical and cytopathological features were analysed for these cases and compared with those of adenocarcinoma of the gallbladder.

RESULTS

Patients presented with non-specific abdominal symptoms, and on radiological assessment, eight out of nine cases had evidence of local infiltration. Four of these cases had pathologically documented evidence of liver infiltration. Cytology showed presence of atypical squamous cells with keratinized cytoplasm, tadpole cells and giant cells along with necrosis. Eight of the nine cases were inoperable, and only a single patient underwent hepatopancreaticoduodenectomy along with cholecystectomy. Three patients received cisplatin and gemcitabine-based chemotherapy.

CONCLUSION

Ultrasound-guided fine-needle aspiration is a useful minimally invasive investigation in the preoperative diagnosis of squamous cell carcinoma of the gallbladder and can be helpful in deciding the management and prognostication of the patient.

Bile duct injuries during open and laparoscopic cholecystectomy: management and outcome

BACKGROUND

The widespread application of laparoscopic cholecystectomy has led to a rise in the numbers of major bile duct injuries (BDI). Perioperative management of these injuries is complex and challenging. There are few published reports locally regarding the perioperative management of BDI. Purpose of this review was to analyze our experience in diagnosis, management and prevention of BDI.

METHODS

This study was conducted in department of surgery at B. P. Koirala Institute of Health Sciences. From January 2001 to September 2010, a observational study of all patients with a BDI following cholecystectomy was maintained. Patients' charts were retrospectively reviewed to analyze incidence, type of injury, presentation, and perioperative management of BDI.

RESULTS

A total of 92 patients had BDI which occurred during cholecystectomy, were analysed retrospectively. There were 60/92 (65.5%) patients with BDI resulting from the wrong identification of the anatomy of the Calot's triangle during cholecystectomy. Abdominal ultrasonography was diagnostic for BDI in 71/90 (78.8%). Magnetic resonance cholangiography could reveal the site of injury, the length of injured bile duct and variation of bile duct tree with a diagnostic rate 22/23 (95.6%). The most common injury was Strasberg's E2 in 65/92 (70.7%). A transection or stricture of the bile duct was repaired by hepaticojejunostomy (83 cases in this series). Seventy-five (81.5%) patients were followed up. The mean follow-up time was 2.6 years (range 0.16-6). Good results were achieved in 62/75 (82.6%) of the patients.

CONCLUSIONS

The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.

T1-weighted dynamic contrast-enhanced MR evaluation of different stages of neurocysticercosis and its relationship with serum MMP-9 expression

BACKGROUND AND PURPOSE

Epileptogenesis in NCC is associated with perilesional inflammation and disruption in BBB. We quantified BBB in different stages of NCC by using DCE-MR imaging to look for the differences in perfusion indices and to correlate these indices with serum MMP-9 expression.

MATERIALS AND METHODS

DCE-MR imaging along with conventional MR imaging was performed in 57 single cysticercous brain lesions to quantify the kep, K(trans), and ve around the lesions, which were in different stages of evolution. There were 6 lesions in the vesicular stage and 17 lesions each in the colloidal, granular-nodular, and calcified stages. Serum MMP-9 was quantified from all patients, whereas perfusion indices were quantified from all stages except for the vesicular stage.

RESULTS

We observed significant differences among the 3 stages of NCC in serum MMP-9 expression as well as DCE-derived kep values. In addition, kep showed a strongly significant positive correlation with MMP-9 expression when modeled with the individual stage of the disease as well as with all stages when pooled together. Other DCE-derived hemodynamic and pharmacokinetic parameters showed inconsistent differences with each stage of the disease. The correlation of DCE-derived parameters with serum MMP-9 expression and edema volume also showed inconsistency with the stage of the disease.

CONCLUSIONS

We conclude that kep correlates best with serum MMP-9 expression among the pharmacokinetic indices and most closely represents the degree of BBB breakdown, which is highest in the colloidal stage and lowest in the calcified stage. kep may be used as a noninvasive image biomarker of BBB breakdown in different stages of NCC.

Colonic inflammatory myofibroblastic tumours: an institutional review

AIM

The aim of the study was to present the largest series of colonic inflammatory myofibroblastic tumour (C-IMFT) in the literature so far and to provide a review of this condition.

METHOD

A retrospective review was carried out of a consecutive series of patients diagnosed with a C-IMFT at a community-based hospital with a specialized gastrointestinal unit between 2002 and 2011. The main outcome measures were success rate and postoperative complications. Using a set of terms we searched the PubMed database for papers published on C-IMFT. We reviewed the data from these studies and case reports.

RESULTS

There were seven patients with a histopathologically proven C-IMFT. The patients' mean age was 39 ± 11.3 years. Four presented with clinical features of intestinal obstruction of varying severity and three with symptoms of anaemia. Complete surgical resection with end-to-end anastomosis was performed. The gross morphology included polypoidal myxoid tumours that served as a lead point for intussusception in two cases, a whorled mass in two and a circumferential infiltrative tumour in three. Microscopically, all tumours had typical features of IMFT with a variable expression of anaplastic lymphoma kinase (ALK-1) and tumour-free resection margins. All patients were well without local recurrence or metastasis at a mean follow-up of 46.8 ± 11.9 months.

CONCLUSION

Surgical resection is effective for this rare tumour which mostly behaves in a benign manner. Our review supports the need for patients to be followed up for long periods because of the possibility of metastasis or late recurrence.

Persistence of insecticides in ready-mix formulations and their efficacy against Lipaphis erysimi (Kalt) in cauliflower

Persistence of cypermethrin, deltamethrin, profenofos, and triazophos in cauliflower curd was studied, following application of two premix formulations viz: Roket 44EC (profenofos 40 % + cypermethrin 4 %) and Anaconda Plus 36EC (triazophos 35 % + deltamethrin 1 %) at recommended (1.0 L ha(-1)) and double doses (2.0 L ha(-1)). In the case of Roket 44EC, residues of cypermethrin dissipated with the half-life values of 1.5-2.1 days, whereas residues of profenofos dissipated with the half-life of 2.9-3.3 days on cauliflower curd. In the case of Anaconda, residues of triazophos and deltamethrin dissipated from curd with the half-life values of 2.6-3.0 and 2.2-2.6 days, respectively. Both the combination mix significantly reduced the aphid population up to 14 days after spray and increased the yield by 155-160 % over control. Anaconda (2.0 L ha(-1)) treated plots yielded the highest number of marketable curds. Based on risk assessment analysis, safe waiting period of 3 and 5 days has been suggested for Roket 44EC and Anaconda Plus 36EC, respectively, in cauliflower at recommended dose of application.

Fractional flow reserve: intracoronary versus intravenous adenosine induced maximal coronary hyperemia

BACKGROUND

Fractional Flow Reserve (FFR), a measure of coronary stenosis severity is based on the achievement of maximal hyperemia of coronary microcirculation. The most widely used pharmacological agent is adenosine which is administered either by intra coronary or intra venous routes. IV route is time consuming, has more side effects and expensive. This study is undertaken to compare the two routes of administration.

METHODS

FFR was assessed in 50 patients with 56 intermediate focal lesions using both IV and intracoronary (IC) adenosine. FFR was calculated as the ratio of the distal coronary pressure to the aortic pressure at maximal hyperemia.

RESULTS

A total of 25 left anterior descending, 8 right, 21 circumflex, and 2 left main coronary arteries were evaluated. The mean percent stenosis was 63.91 ± 13.13 SD and, the mean FFR was 0.831 ± 0.0738 SD for IV and 0.832 ± 0.0707 SD for IC adenosine. There was a strong and linear correlation between 2 sets of observations with IV dose and IC adenosine dose (R = 0.964, y = 0.065 + 0.923x; p < 0.001) (y = IV dose, x = IC dose). The agreement between the two sets of measurements was also high, with a mean difference of: 0.001 ± 0.0197. The changes in heart rate and blood pressure were significantly higher in IV adenosine group. Different incremental doses were well tolerated, with fewer systemic adverse events with IC adenosine. Transient AV blocks were observed with both IV and IC adenosine.

CONCLUSIONS

This study suggests that IC adenosine is equivalent to IV infusion for the determination of FFR. The administration of IC adenosine is easy to use, cost effective, safe and associated with fewer systemic events.

Multiple virulence factors regulated by quorum sensing may help in establishment and colonisation of urinary tract by Pseudomonas aeruginosa during experimental urinary tract infection

PURPOSE

Damage caused by an organism during infection is attributed to production of virulence factors. Different virulence factors produced by the organism contribute to its pathogenicity, individually. During infectious conditions, role of virulence factors produced by the pathogen is different, depending upon the site of involvement. Pseudomonas aeruginosa is an opportunistic nosocomial pathogen known to cause infections of the respiratory tract, burn wound, urinary tract and eye. Importance of virulence factors produced by P. Aeruginosa during infections such as keratitis, burn wound and respiratory tract is known. The present study was designed to understand the importance of different virulence factors of P. aeruginosa in urinary tract infection in vivo.

MATERIALS AND METHODS

An ascending urinary tract infection model was established in mice using standard parent strain PAO1 and its isogenic mutant, JP2. Mice were sacrificed at different time intervals and renal tissue homogenates were used for estimation of renal bacterial load and virulence factors.

RESULTS

Both parent and mutant strains were able to reach the renal tissue. PAO 1 PAO1 was isolated from renal tissue till day 5 post-infection. However, the mutant strain was unable to colonise the renal tissue. Failure of mutant strain to colonise was attributed to its inability to produce protease, elastase and rhamnolipid.

CONCLUSION

This study suggests that protease, elastase and rhamnolipid contribute to pathogenesis and survival of P. aeruginosa during urinary tract infection.

Medico-social and behaviour problems amongst primary school children in rural area of Kathmandu, Nepal

The objective of the study was medico- social and behaviour problems among primary school children of age (6-10 years) in rural area of Eastern part of Kathmandu Valley. Observational descriptive study was conducted in Govt. and Private Boarding Schools of rural Kathmandu Valley. Total 503 school children in primary school (6-10 years), Schools of rural area of Eastern part of Kathmandu, 4 were randomly chosen by systematic random technique. All students aged 6-10 years were included in the study. Complete data of each child was collected in a pre-designed, pre-tested questionnaire proforma. Out of 503 children, 230 (45.7%) boys and 273 (54.3%) were girls. Four hundred and thirteen (82.1%) children were found to be suffering from one or more morbid conditions. Hygienic condition was poor as in apparent look. Ninty nine (19.7%) respondents had lice and urticarial rashes in 47(9.3%), behaviour problems in 117 (23.3%), eye related diseases in 94 (18.7%), ear diseases in 413 (82.1%) and dental carries in 130 (25.8%) as observed in the study. Diseases that are seen among the school children are mostly preventable and the health of the child can be improved by promotion of hygienic practices through proper health education by the teachers and parents.

Study of immunisation status of rural children (12-23 months age) of district Jaipur, Rajasthan and factors influencing it: a hospital based study

To outline the immunisation status of rural children and factors influencing it, a cross-sectional study was undertaken in the paediatric OPD of a medical college hospital among children (n = 300) in the age group of 12-23 months belonging to rural areas of the district Jaipur, Rajasthan. Parents of 300 children were interviewed using a preformed schedule. Children were labelled as 'completely immunised', 'partially immunised' or 'non-immunised' according to working definitions. Various socioeconomic, demographic, cultural, logistic and behavioural factors found to influence the immunisation status were outlined. Chi-square test and logistic regression analysis was done for statistical analysis. There were 100 children (33.3%) who were 'completely' immunised, 144 (48%) were 'partially' immunised and the remaining 56 (18.7%) were 'non-immunised'. The immunisation status was significantly influenced by the visit of the health worker at home, social class, religion, place of delivery, distance from the vaccination centre to child's residence, caste and education. Sex of the child, birth order and type of the family had no impact. The most common reasons for partial immunisation (n = 144) were: Parents' 'forgetfulness' of the schedule, adverse effects observed and not recalled by the health worker. The most common reasons for non-immunisation (n = 56) were lack of knowledge regarding vaccines and schedule, fear of 'injection' and busy in profession. The various factors found to influence the immunisation status of rural children need to be addressed in order to achieve millennium development goal of reducing under-five child mortality.

Filaria associated clinical manifestations in children in an endemic area and morbidity control by immunomonitoring and optimal DEC therapy: Sevagram experience

Lymphatic filariasis is a major public health problem in India with 412 million people living in bancroftian endemic areas and is a major cause of clinical morbidity. Twenty million people are reported to suffer from chronic disease manifestations such as lymphoedema, hydrocele or elephantiasis. At least twice the number have been shown to suffer from acute and occult filarial infections in an endemic area without diagnosis. Due to non-availability of suitable diagnostic test for confirming filaria aetiology other than parasitological examination, no significant study on filariasis in children has been reported earlier. Studies in our laboratory for more than a decade showed usefulness of microfilarial excretory-secretory antigen in confirming filarial aetiology in acute and occult infections in adults as well as in children. This study reports acute and atypical manifestations such as lymphadenopathy, asthmatic bronchitis, pulmonary eosinophilia, mono-arthritis, recurrent URI, pneumonia, nutritional anemia, pain in abdomen etc. in children living in filaria endemic area having no microfilaraemia but showing filaria aetiology by immunomonitoring for the presence of antibody or antigen and responding to optimal DEC therapy.

Structural and optical properties of nanostructure CdZnO films

CdZnO thin films with different ratio of CdO and ZnO (3:1, 1:1, and 1:3) were grown on glass substrate using sol-gel spin coating method. The morphology of the CdZnO films depends on the amount of ZnO and CdO in the films. The optical band gap of the CdZnO films depends on the compositions of CdO and ZnO. Films having higher amount of CdO shows the presence of grains along with the fiber nature of ZnO, whereas the film with lower percentage of CdO shows fiber nature of the film very similar to pure ZnO film. The optical bandgap of CdZnO (3:1), CdZnO (1:1), and CdZnO (1:3) films was calculated to be 2.80, 2.49, and 2.52 eV, respectively. Other optical properties such as refractive index, extinction coefficient, and dielectric constants were calculated using the optical data. The volume and surface energy loss functions were also calculated and observed to increase with increase in the photon energy.

CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome

SUMMARY

While uncommon, CNS-IRIS developing after the initiation of HAART in the setting of HIV-related severe immunosuppression is characterized by an intense inflammatory reaction to dead or latent organisms or to self-antigens due to a heightened but dysregulated immune response. While this reaction can range from mild to fulminating, encompassing a very wide clinical spectrum, it is important to recognize because changes in medical management may be necessary to prevent neurologic decline and even death. Once contained, however, this inflammatory response can be associated with improved patient outcome as immune function is restored. Among the infectious organisms that are most commonly associated with CNS-IRIS are the JC virus and Cryptococcus organisms, which will be the subject of this review. CD8 cell infiltration in the leptomeninges, perivascular spaces, blood vessels, and even parenchyma seems to be the pathologic hallmark of CNS-IRIS. While recognition of CNS-IRIS may be difficult, the onset of new or progressive clinical symptoms, despite medical therapy and despite improved laboratory data, and the appearance on neuroimaging studies of contrast enhancement, interstitial edema, mass effect, and restricted diffusion in infections not typically characterized by these findings in the untreated HIV-infected patient should raise the strong suspicion for CNS-IRIS. While CNS-IRIS is a diagnosis of exclusion, the neuroradiologist can play a critical role in alerting the clinician to the possibility of this syndrome.

Quantitative determination of higher harmonic content in the soft x-ray spectra of toroidal grating monochromator using a reflection multilayer

Use of a grating monochromator causes a problem of higher harmonic contaminations in a synchrotron beamline operating in the soft x ray/vacuum ultraviolet region. Generally gratings are used to experimentally determine the higher harmonic contaminations. In this method, the relative contribution of contaminant wavelengths is measured with respect to the first harmonic wavelength (desired wavelength). The quantitative fit of grating spectra is rather complex, and therefore qualitative analysis is carried out. Analysis of multilayer reflectivity data has become rather simple with recent advances in the theoretical modeling. Therefore we propose to use a multilayer mirror and analyze its reflectivity data for quantitative determination of harmonic contamination in a soft x ray beamline. In the present study we used a Mo/Si multilayer of d=97  Å to quantify the spectral purity of 600  lines/mm toroidal grating at the reflectivity beamline of Indus-1 450 MeV synchrotron source. The measured reflectivity spectra at each wavelength is analyzed and the actual contribution of higher harmonics in the incident beam is obtained. Details of methodology and results are discussed.

Understanding epileptogenesis in calcified neurocysticercosis with perfusion MRI

OBJECTIVES

Calcified cysticercus larva with perilesional abnormality is thought to be responsible for seizures in patients with neurocysticercosis (NCC). However, it is not well understood why some calcified cysts are associated with seizures even without perilesional abnormality.

METHODS

The study group consists of 30 subjects from an ongoing survey for disease burden estimation of a swine farming community who had a single calcified lesion without any perilesional abnormality with or without presentation of seizures. Each group consisted of 15 patients with calcified cysts and was labeled as asymptomatic and symptomatic. We performed dynamic contrast-enhanced (DCE) MRI on all these subjects and determined serum matrix metalloproteinase-9 (MMP-9) levels and MMP-9 gene polymorphisms.

RESULTS

DCE-MRI-derived rate transfer constant (k(ep)) and serum MMP-9 levels showed significant differences between symptomatic and asymptomatic subjects. We observed an increase in the MMP-9 levels, k(ep), and the volume transfer coefficient (k(trans)) in these lesions. We also observed a significant increase in MMP-9 (R279Q) gene polymorphism in symptomatic subjects compared with asymptomatic and control subjects.

CONCLUSIONS

Perilesional inflammation, which varies from symptomatic to asymptomatic subjects, can be quantified using DCE-MRI in calcified cysticercosis and may help distinguish these 2 groups with similar imaging findings. The observed increase in k(ep) with serum MMP-9 levels suggests that the former may serve as a biomarker of MMP-9 levels in these subjects. The significant MMP-9 (R279Q) gene polymorphism in symptomatic subjects might explain the differences in the observed DCE-MRI indices between symptomatic and asymptomatic subjects.

Apparent diffusion coefficient with higher b-value correlates better with viable cell count quantified from the cavity of brain abscess

BACKGROUND AND PURPOSE

DWI by using higher b-values provides tissue diffusivity with less T2 shinethrough effect. VCD in the abscess cavity correlates with ADC values. The purpose of this study was to investigate which b-value-derived ADC correlates better with VCD.

MATERIALS AND METHODS

Thirty patients with brain abscess underwent conventional MR imaging and DWI with b = 1000, 2000, and 3000 s/mm(2) on a 3T MR imaging scanner. ADC values were quantified by placing regions of interest inside the abscess cavity in all sections where the lesion was apparent on coregistered ADC maps derived from different b-values. VCD was measured on pus aspirated.

RESULTS

An increase in b-value was associated with a decrease in ADC values in normal parenchyma as well as in the abscess cavity. The most significant negative correlation of VCD was observed with b = 3000 s/mm(2) (r = -0.98, P = .01).

CONCLUSIONS

VCD in the abscess cavity can be best assessed at b = 3000 s/mm(2) secondary to the reduction in the T2 shinethrough effect. DWI with b = 3000 s/mm(2) is of promising value in the assessment of the therapeutic response of brain abscess.

A case of pure red cell aplasia and immune thrombocytopenia complicating systemic lupus erythematosus: response to rituximab and cyclophosphamide

Pure red cell aplasia (PRCA) is a recognized but rare complication of systemic lupus erythematosus (SLE) and is characterized by the near absence of red blood cell precursors in the bone marrow but with normal megakaryocyte and granulocytes. We report a novel case of acquired PRCA occurring simultaneously with immune thrombocytopenia in the context of active SLE. Both syndromes were refractory to conventional treatment but responded to rituximab and cyclophosphamide.

Lipoma arborescens

Lipoma arborescens is a very uncommon condition of the synovial joints and bursae. Although the etiology is unknown, lipoma arborescens is characterized by hyperplasia of mature fat tissue in the subsynovial layer. The knee joint, especially the suprapatellar pouch, is the most frequent site of involvement. Cases are occasionally reported in the shoulder, elbow, hip and wrist. To the best of authors' knowledge no case of lipoma arborescens has been reported in children in Indian subcontinent with multiple joint involvement and uveitis.