Thyroid nodules are very common and often deceptive in their appearance. Deciding whether the nodule requires biopsy, fine needle aspiration or just follow up will be difficult without using standard guidelines. The American College of Radiology-Thyroid Imaging Reporting and Data Systems was published in 2017. It is entirely based on ultrasound imaging and allows a risk-based classification of thyroid nodules. In addition of estimating the risk of the lesion being malignant, it also determines the further course of action, like biopsy, fine needle aspiration or follow up.
Background Zinner syndrome is a rare Wolffian duct anomaly presenting as a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. The condition is due to a developmental anomaly leading to malformation of the mesonephric duct. Magnetic resonance imaging is considered to be the gold standard for the diagnosis of Zinner syndrome. Due to the limited number of cases reported in the literature, the associations of Zinner syndrome are not well established. Case presentation In this case report, we are presenting a case of a 38-year-old male with dysuria, intermittent pain in the scrotum and lower abdomen and painful ejaculation for the past six months. Imaging findings led to the diagnosis of Zinner syndrome, with unilateral testicular agenesis and an aberrant course of the left common iliac artery. Conclusions Apart from the known associations of Zinner syndrome, testicular agenesis in a patient with Zinner syndrome has not been reported in the literature and is an important addition to the limited literature available.
Background: Due to high prevalence of Diabetes Mellitus in India, Diabetic nephropathy is on the rise. Diabetic Nephropathy is the leading cause of End stage renal disease and the major factor responsible for renal transplantation. Grey scale ultrasound can detect morphologic renal parenchymal changes late in the disease but the functional haemodynamic changes can be detected early on, by the means of doppler indices such as Resistive Index (RI) and Pulsatility Index (PI). Hence, application of renal doppler can aid in the diagnosis of early nephropathic changes to allow early medical intervention, therefore improving disease prognosis. Methods: Renal doppler ultrasonography was performed in 64 diabetic individuals, in the main renal artery and at the interlobar arteries of both kidneys in the upper pole, interpolar region, and lower pole. RI and PI were obtained for each artery and averaged. The correlation between the Mean RI and Mean PI, each with HbA1c and serum creatinine was checked for every patient using relevant statistical tests. Results: Mean RI and PI in study participants were above the normal range. RI and PI both showed a statistically significant positive correlation with serum creatinine, HbA1c as well as the age of the patient and duration of diabetes mellitus (p<0.001). Conclusions: Evaluation of renal doppler indices while correlating them with laboratory parameters can help slow disease progression. The patient can be provided with medical intervention at the early stage on detection of altered renal indices, hence reducing morbidity and mortality and significantly improving disease prognosis and outcome.
Androgen insensitivity syndrome is a rare disorder of sex development that results from genetic mutations affecting the androgen receptor. Recently, we encountered a case of a 13-year-old individual who had been raised as female and sought medical attention for primary amenorrhea, which led to the discovery of partial androgen insensitivity syndrome. Early detection and gonad removal are necessary to mitigate the risk of cancer. Additional management steps such as corrective surgery and psychological support can also be valuable.
Background: An estimated 70 million people worldwide are thought to be affected by some severity of infertility. Ultrasound, MRI, and invasive procedures like venography and vasography are the usual investigations taken for the evaluation of infertility. Ultrasound is the preferred initial modality due to its availability and non-invasive nature. In our study, we evaluated the usefulness of advanced ultrasound techniques like Doppler and Elastography and compared the results with biochemical parameters of semen analysis. Methods: A comparative cross-sectional study was conducted over a period of one year, on men between the ages of 22 and 45, with normal or abnormal sperm analysis reports, who presented with inability to conceive. The testicular parenchyma resistive index, shear value and shear ratio were recorded. The mean values of the data and their standard deviations were assessed and compared by Student’s t-test. The correlation of semen parameters with RI and shear wave indices was tested by One way ANOVA test, with a p value<0.05 considered statistically significant. Results: Our study found that strain value and strain ratio were significantly elevated in the non-fertile group compared to the fertile group. The resistive index of the intraparenchymal arteries did not show any difference between infertile and fertile men. Conclusions: Hence, we concluded that strain value and strain ratio are important investigative tools in the evaluation of male infertility. However, since our study was conducted on a small sample, larger large-scale studies are useful in establishing a concrete conclusion.
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