Biomedical subjects
Publications and source records attributed to Raju Sharma.
Lymphangiomas are benign tumors of unknown etiology often seen in children, involving the neck (75%), and axillary (20%) region, but rarely the kidney [Zapzalka et al. (2002) Lymphangioma of the renal capsule. J Urol 168:220.]. We report a case of unilateral renal lymphangiectasia, where the diagnosis was made on imaging.
We present the rare case of a 14-year-old female pseudohermaphrodite due to congenital adrenal hyperplasia (CAH). MRI revealed the presence of a hypoplastic uterus, ovaries, clitoromegaly, and prostate gland with its typical zonal anatomy. Transrectal sonography also confirmed the presence of a prostate gland.
Cherubism is a paediatric disease affecting the jaws. It is a close radiological mimic of giant cell lesions of the mandible. The radiographic features of this condition are well known; however, the MR imaging features have not been well described. We describe the radiographic, CT and MR imaging features of cherubism in a 5-year-old girl. We highlight the MR appearances of cherubic lesions and the ability of MRI to not only accurately depict the anatomical extent of the lesions, but also to reveal signal intensity changes in those areas that are apparently normal on radiographs and CT images.
PURPOSE: To measure radiation doses for computed tomography (CT) of the head, chest, and abdomen and compare them with the diagnostic reference levels, as part of the International Atomic Energy Agency Research coordination project. MATERIALS AND METHODS: The local ethics committees of all participating institutions approved the study protocol. Written informed consent was obtained from all patients. All scanners were helical single-section or multi-detector row CT systems. Six hundred thirty-three patients undergoing head (n = 97), chest (n = 243), or abdominal (n = 293) CT were included. Collected data included patient height, weight, sex, and age; tube voltage and tube current-time product settings; pitch; section thickness; number of sections; weighted or volumetric CT dose index; and dose-length product (DLP). The effective dose was also estimated and served as collective dose estimation data. RESULTS: Mean volumetric CT dose index and DLP values were below the European diagnostic reference levels: 39 mGy and 544 mGy . cm, respectively, at head CT; 9.3 mGy and 348 mGy . cm, respectively, at chest CT; and 10.4 mGy and 549 mGy . cm, respectively, at abdominal CT. Estimated effective doses were 1.2, 5.9, and 8.2 mSv, respectively. CONCLUSION: Comparison of CT results with diagnostic reference levels revealed the need for revisions, partly because the newer scanners have improved technology that facilitates lower patient doses.
Hydrometrocolpos is cystic dilatation of the vagina and uterus due to congenital vaginal obstruction. It may be secretory or urinary in character and manifests in the neonatal period with abdominal distension. Urinary hydrometrocolpos occurs in patients with urogenital sinus or cloacal anomaly. A rare case of antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus is presented.
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A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectional imaging plays an important role in the diagnosis and management of these patients. We reviewed our imaging record and collected representative cases of pediatric orbital pathology. The purpose of this pictorial essay is to illustrate the imaging features of various orbital lesions encountered in children.
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BACKGROUND: The tumor marker Cancer Antigen 125 (CA 125), though not ovarian cancer specific, is widely used for the evaluation of suspected and under-treated ovarian cancer. Many studies show that serum CA 125 level demonstrates ovarian tumor burden and its response, but they lack quantitative correlation between the two. Instead, they rely on clinical or radiological assessment of gross tumor burden. This study examines ovarian tumor volumes and corresponding serum CA 125 values before and during chemotherapy. MATERIALS/METHODS: [corrected] Ovarian tumor volume was measured by CT scans at pre-chemotherapy and after each cycle of chemotherapy in 15 patients. Blood serum CA 125 was determined on the days of CT scans using a one-step immunoenzymatic assay. RESULTS: There was no statistically significant correlation (r = 0.18, p > 0.05) between ovarian tumor volumes and CA 125 among patients at pre-chemotherapy or any subsequent time. In individual patients, the reduction or increase in tumor volume correlated with the corresponding CA 125 values during chemotherapy in 85% (12 out of 14) of patients. Mean CA 125 halving time was 44.1 days, which correlated with tumor halving time (r = 0.63, p < 0.05). CONCLUSIONS: Values of CA 125 cannot be used for comparison of ovarian tumor mass among patients. However, serial estimation of CA 125 in individuals is fairly reliable in terms of the course of the tumor. CT scan is a more informative response indicator, but it is costly and hence may be supplemented by the easy and economical CA 125 estimation.
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We report a 10 year-old girl with panhypopituitarism and coexistent ocular and neurocysticercosis. Intrasellar cystic lesions whether neoplastic or non-neoplastic in origin are often difficult to distinguish because their symptoms, signs, and radiological characteristics are similar. The diagnosis of intrasellar cysticercosis was initially considered because of high endemicity, positive serology for cysticercus and radiological evidence of cysticercosis in the eye and parietal lobe. However, since there was no improvement with cysticidal therapy and no radiological resolution of the sellar lesion, surgery was performed, which revealed a Rathke's cleft cyst.
Magnetic Resonance Imaging is a non-invasive multiplanar imaging modality which does not use ionizing radiation. In recent years major technical advances in this field have led to shorter imaging times and better resolution. This has widened the scope of this modality in pediatric imaging. MRI is already an established technique for the brain and spine and is increasingly being used for musculoskeletal, abdominal and pelvic imaging. In this article the authors provide an update on this exciting modality with stress on applications relevant to pediatric surgeons.
A rare case of spondylo-megaepiphyseal-metaphyseal dysplasia is reported in a 10-year-old boy. The features were metaphyseal dysplasia, markedly defective ossification of vertebral body centres and enlarged epiphyses. Although it shares some features with spondylo-metaphyseal dysplasia, oto-spondylo-megaepiphyseal dysplasia and cleidocranial dysplasia, the presence of several unusual radiological findings sets it apart.
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BACKGROUND: Response prediction in patients undergoing chemotherapy for ovarian cancer is an important issue, since the cure rate is only about 15-20%. We attempted to develop a semi-empirical model to predict response in individual cases after the first cycle of chemotherapy. MATERIAL/METHODS: This prospective study included 51 cases of advanced ovarian cancer. A method was standardized to estimate ovarian tumor volume accurately from CT scan films. This permits the inclusion of patients who have undergone CT scan elsewhere. Patients underwent 4-6 cycles of chemotherapy and tumor volume was estimated after each cycle. This yielded a tumor regression curve for each patient. RESULTS: Percent reduction in tumor volume after the first chemo-cycle was a significant prognostic factor in multivariate analysis. Depending upon the rate of regression patients could be classified into Fast Regressing FR (n=29) and Moderately Regressing MR (n=16), whereas 6 patients showed Progressive Disease (PD) despite ongoing chemotherapy. The median survivals for the FR, MR and PD groups were 29.3, 18.9 and 8.5 months respectively. We found that 'percent reduction in volume after first chemo-cycle' could categorize a patient as FR/MR/PD correctly in 94.1% of cases. This parameter could also detect 5 out of 6 inherently resistant PD cases, who would otherwise undergo further chemotherapy, since early detection of resistance by clinical monitoring is quite difficult. CONCLUSIONS: An individual patient at risk for shorter survival and with inherent drug resistance can be identified after the first cycle of chemotherapy.
Internal hernia is difficult to diagnose clinically because the symptoms are often non-specific. Although this entity is an uncommon cause of small-bowel obstruction, prompt diagnosis is essential for a favorable outcome. We report the barium, CT and MRI features of a rare case of non-obstructing combined transmesocolic and left paraduodenal hernia.
We report a case of mixed sclerosing bone dysplasia in a 26-year-old man. This is a very rare disorder characterized by a variable combination of melorheostosis, osteopoikilosis and osteopathia striata. The disease may be generalized or may show unilateral involvement.
Meckel's diverticulum represents a patent omphalomesenteric duct at its junction with the ileum. Although it is a common anomaly, it is often a surgical surprise as the preoperative diagnosis is seldom established. We present an unusual case where the constellation of imaging findings was so typical that we could suggest this diagnosis prospectively and it was subsequently confirmed surgically.