Effect of Iodinated Contrast Media on Serum Electrolyte Concentrations in Patients Undergoing Routine Contrast Computed Tomography Scan Procedure

Background and Objectives:

Being hypertonic solutions, iodinated contrast media such as iohexol can cause a shift of fluids and electrolytes between different compartments of the body, but there is an ongoing discrepancy in data and current studies as to the effect of iodinated contrast media on serum electrolytes. Hence, this hospital-based prospective clinical observational study was carried out with objectives of evaluating the changes in serum electrolyte concentrations with intravenous iodinated contrast media administration in adult population and to correlate the changes in electrolyte concentrations, if any, with the demographic profile of the patients.

Materials and Methods:

We analyzed 103 numbers of adult patient samples over a period of 2 months by collecting blood both before administration of contrast and after 24 h of the contrast-enhanced computed tomography scan procedure. Serum concentrations of sodium, potassium, chloride, and ionized calcium were measured using Eschweiler Combiline analyzer based on ion-selective electrode principle.

Results:

The mean age of the study population in our study was 40.11 ± 20.51 years. We found that changes in serum sodium and chloride concentration after administration of contrast media are significant (sodium: 136.29 ± 3.53 vs. 132.49 ± 6.36 mmol/L and chloride: 100.03 ± 0.70 vs. 97.53 ± 0.70 mmol/L). Sodium concentration shows more decrease in females compared to males after administration of iodine contrast. The most probable reason for this decrease in serum electrolytes was secondary changes to hemodilution due to high osmolality of the contrast.

Conclusions:

Attending physicians must be alert for such possibilities of changes in electrolytes after contrast administration and be prepared to treat any adversity if one occurs.

Multifocal Balo's Concentric Sclerosis in Children: Report of a Case and Review of Literature

Balo's concentric sclerosis (BCS) is a rare demyelinating lesion considered to be a variant of multiple sclerosis (MS). On magnetic resonance imaging (MRI) Balo's concentric sclerosis shows the typical concentric pattern. We report a case of 10 year old child with BCS who presented as post infectious acute disseminated encephalomyelitis (ADEM). He is asymptomatic and had no relapse after 6 years of follow-up.

Endovascular biopsy in Takayasu arteritis

Takayasu arteritis is a chronic inflammatory arteriopathy of the large vessels, mainly the aortic arch and its branches. The disease progression varies, ranging from a rapid progression to quiescence reached within 2 years. The activity of the disease is evaluated by biochemical markers, but at times, there is a discrepancy between the clinical picture and biochemical markers. Histopathology helps in assessing the disease activity, but it is not included in the antemortem diagnosis because of the invasiveness of the procedure and the availability of noninvasive vascular imaging. However, it may be performed simultaneously with angioplasty. Here we present a case of endovascular aortic biopsy conducted to detect active inflammation in the aortic wall.

Association of venous varix and developmental venous anomaly: report of a case and review of literature

Cerebral developmental venous anomalies (DVAs) are the most frequently encountered cerebral vascular malformation. Most are asymptomatic and incidentally detected. Here we present a case of DVA associated with venous varix presented with chronic headache. A 50-year-old woman presented with right hemicranial headache since 6 months. There was no neurological deficit. MRI showed a well-defined oval T2 hyperintense, T1 isointense extra-axial lesion in the right parietal region showing intense homogeneous enhancement. Prominent vascular flow void was extending from the lesion up to the deep parietal white matter. Subtle thin linear areas of blooming noted in the parietal white matter converging towards the vascular flow void. The venous sac is in communication with the cortical vein draining to the superior sagittal sinus. These MRI findings favoured a diagnosis of DVA in the right parietal lobe with prominent draining vein forming a cortical venous varix. The patient was managed conservatively with symptomatic treatment for headache.

Language matters. Addressing the use of language in the care of people with diabetes: position statement of the English Advisory Group

The language used by healthcare professionals can have a profound impact on how people living with diabetes, and those who care for them, experience their condition and feel about living with it day-to-day. At its best, good use of language, both verbal and written, can lower anxiety, build confidence, educate and help to improve self-care. Conversely, poor communication can be stigmatizing, hurtful and undermining of self-care and can have a detrimental effect on clinical outcomes. The language used in the care of those with diabetes has the power to reinforce negative stereotypes, but it also has the power to promote positive ones. The use of language is controversial and has many perspectives. The development of this position statement aimed to take account of these as well as the current evidence base. A working group, representing people with diabetes and key organizations with an interest in the care of people with diabetes, was established to review the use of language. The work of this group has culminated in this position statement for England. It follows the contribution of Australia and the USA to this important international debate. The group has set out practical examples of language that will encourage positive interactions with those living with diabetes and subsequently promote positive outcomes. These examples are based on a review of the evidence and are supported by a simple set of principles.

Outcomes in Patient Undergoing Maxillectomy for Squamous Cancer Invading Maxilla in a Rural Tertiary Care Institute in Socioeconomic Poor Group of Patients

Background: Oral cancer accounts for more than 250,000 new cases of cancer in India. Oral cancer combining all sites of cancer in oral cavity is the single commonest cancer in males in India. Oral cancer involving upper alveolus and primary maxillary sinus tumors are a surgical challenge due to the complex surgery and rehabilitation. Aim: Optimal treatment strategy for treatment of squamous cancer invading maxillary sinus. Methods: This is a retrospective study of clinicopathological features, treatment, rehabilitation and outcome of all patients who underwent surgical treatment of tumor invading maxillary sinus over a period of 30 months in a rural cancer hospital. Results: Out of a total of 47 patients, 26 (55.3%) were males and 21 (44.7%) were females. Median age was 56 year with youngest patient of 23 year and oldest 88 year old. Primary maxillary sinus cancers were 19.1%, palatal tumors were 10.6% and 70.3% were buccal mucosa and upper alveolus cancers. Early cancers were 51% and locally advanced were 49%. Total maxillectomy was performed in 59.6%, partial maxillectomy in 34.1% and extended maxillectomy in 6.3% of the patients. Histology was squamous carcinoma in all patients and 85.1% were grade 2. Peripheral neural invasion was present in 14.9%, lympho-vascular emboli in 23.4%, and surgical margins were positive in 10% of the patients. Eighty percent patients underwent reconstruction by free microvascular flap. Fifty-one percent patients received postoperative chemoradiotherapy while 25.5% received only radiotherapy and 19.1% received no adjuvant treatment. At a mean follow-up of 11 months 74.5% patients are alive. Good speech was achieved in 70% and intelligible speech in 17% of the patients, while 12.8% were not able to speak. Solid food swallowing was achieved in 36.2%, semisolid in 27.6%, liquid in 19.1% of the patients and 12.8% remained on nasogastric tube feeds. Conclusion: Surgical resection with reconstruction by microvascular flap and postsurgical chemoradiotherapy in locally advanced cancers is key for improved survival and successful rehabilitation in cancer invading maxilla.

Dynamics of virus-specific T cell immunity in pediatric liver transplant recipients

Immunosuppression following solid organ transplantation (SOT) has a deleterious effect on cellular immunity leading to frequent and prolonged viral infections. To better understand the relationship between posttransplant immunosuppression and circulating virus-specific T cells, we prospectively monitored the frequency and function of T cells directed to a range of latent (CMV, EBV, HHV6, BK) and lytic (AdV) viruses in 16 children undergoing liver transplantation for up to 1 year posttransplant. Following transplant, there was an immediate decline in circulating virus-specific T cells, which recovered posttransplant, coincident with the introduction and subsequent routine tapering of immunosuppression. Furthermore, 12 of 14 infections/reactivations that occurred posttransplant were successfully controlled with immunosuppression reduction (and/or antiviral use) and in all cases we detected a temporal increase in the circulating frequency of virus-specific T cells directed against the infecting virus, which was absent in 2 cases where infections remained uncontrolled by the end of follow-up. Our study illustrates the dynamic changes in virus-specific T cells that occur in children following liver transplantation, driven both by active viral replication and modulation of immunosuppression.

Role of MR spectroscopy in diagnosis of intracranial neuroenteric cyst

INTRODUCTION

Neuroenteric cysts are rare benign endodermal lesions of the central nervous system that result from incomplete resorption of neuroenteric canal and mostly found in cervical and upper thoracic spinal canal. Intracranial neuroenteric cysts are extra axial and commonly located anteriorly in the posterior cranial fossa. MRI demonstrates variable intensity within the lesion on T1, T2W, and DWI sequences.

METHODS

Three cases of posterior fossa non-enhancing cystic lesions of variable signal intensity underwent MRI with MR spectroscopy, where MR spectroscopy demonstrated dominant peak at 2 ppm, mimicking normal Nacetyl aspartate (NAA).

CONCLUSION

MR spectroscopy in addition to conventional MRI may help in differentiating intracranial neuroenteric cyst from its close differentials.

Weber syndrome secondary to brain stem tuberculoma

This case report describes a rare presentation of presumed brain stem tuberculoma in a 28-year-old male who presented with acute onset of third cranial nerve palsy with contralateral hemiparesis (Weber syndrome) and upgaze palsy. Isolated midbrain tuberculoma is rare, presenting with varied clinical manifestations and radiological findings posing as a diagnostic dilemma. Weber syndrome is commonly caused by midbrain infarct secondary to occlusion of branches of the posterior cerebral artery and rarely from a tuberculoma. The patient is a case of disseminated tuberculosis with granuloma in midbrain causing pressure effect, thereby presenting with features consistent with Weber syndrome and upgaze palsy. The patient had good recovery with antitubercular treatment and systemic steroids.

A Vasculitis-Associated Neuromuscular and Vascular Hamartoma Presenting as a Fatal Form of Abdominal Cocoon

Neuromuscular and vascular hamartoma (NMVH), also known as neuromesenchymal hamartoma, is a rare hamartomatous condition of the intestine. It usually presents with submucosal humps protruding in the intestinal lumen causing obstructive features. The other clinical manifestations are hematochezia or melena and protein-losing enteropathy. The etiopathogenesis of these lesions is not well known, although an association with small bowel Cröhn's disease and diaphragm disease had been postulated, the latter related to chronic nonsteroidal anti-inflammatory drug intake. Only 24 cases of NMVH are reported in the English literature and all of them could be adequately cured by resection of the affected part of the bowel. Moreover, none of these cases presented with abdominal cocoon or showed any evidence of vasculitis. We describe a peculiar case of NMVH in a 45-year-old male who presented with abdominal cocoon with symptomatic recurrence and fatal outcome within a month of surgery. Histopathology revealed classical histomorphology of NMVH with evidence of vasculitis. This appears to be the first case of a fatal form of NMVH, presenting with abdominal cocoon and associated with vasculitis.