Venous aneurysm of neck is a rare anomaly, usually presenting as a painless mass which increases in size on valsalva maneuver. A child with multiple aneurysms of the right common facial and external jugular veins diagnosed on Doppler ultrasonography and magnetic resonance venography is reported.
A 3-day-old male neonate presented with features of anorectal malformation and duplication of the external genitalia. He was subsequently diagnosed with complete duplication of the colon, rectum, bladder, and urethra associated with spinal lipoma. We report this case of caudal duplication syndrome, considering its rarity and the diverse combination of gastrointestinal, genitourinary, spinal, and limb anomalies.
Type II Diabetes Mellitus is one of the most common non-communicable diseases with innumerable & potentially life threatening complications. In 2017, approximately 462 million individuals were affected by type 2 diabetes corresponding to 6.28% of the world's population (4.4% of those aged 15-49 years, 15% of those aged 50-69, and 22% of those aged 70+), or a prevalence rate of 6059 cases per 100,000. Over 1 million deaths per year can be attributed to diabetes alone, making it the ninth leading cause of mortality. The burden of diabetes mellitus is rising globally, and at a much faster rate in developed regions, such as Western Europe. The gender distribution is equal, and the incidence peaks at around 55 years of age. Global prevalence of type 2 diabetes is projected to increase to 7079 individuals per 100,000 by 2030, reecting a continued rise across all regions of the world.[¹] . Two of the common complications due to acute hyperglycaemia are Diabetic Ketocidosis & Non ketotic hyperosmolar coma which are considered a spectrum of the same complication due to low circulating levels of insulin leading to impaired glucose metabolism by insulin dependant tissues with rising levels of anti-insulin hormones like glucagon, cortisol & catecholamines due to intracellular starvation resulting in hypergylcemia & fatty acid breakdown & ketonemia. Amongst the numerous complications of Type II Diabetes Mellitus, here we present a rare complication of acute hyperglycaemia and its radiological picture in the central nervous system. A 56 year old female patient with a history of Type II Diabetes Mellitus with Hypertension under long term medication came for a private consultation with a complaint of Right sided involuntary, random, irregular, inging and ailing, rapid, non-patterned movements for past 7 days. The patient was advised for an urgent MRI of Brain which demonstrated high T1 signal & low T2/FLAIR intensity with no diffusion restriction of DWI & ADC map in left sided putamen & head of caudate nucleus. We illustrated a rare classical nding of acute hyperglycemic effect on brain in a case of long standing Type II Diabetes Mellitus despite being on medications
Introduction: Ultrasound guided percutaneous ethanol injection (PEI) of benign thyroid nodule is an easy and effective procedure particularly in cystic and predominantly cystic nodule. Aims: To evaluate efficacy and safety of PEI in managing purely cystic and mixed cystic and solid thyroid nodules. Materials and Methods: Patients of either sex presented with solitary purely cystic benign thyroid nodule, solitary benign mixed with predominantly cystic (>50% of total volume) thyroid nodule, solitary benign mixed with predominantly solid (>50% of total volume) thyroid nodule, solitary solid thyroid nodule were included in this study. Patients who had a nodule BETHESDA 3 and above, pregnancy, patients with critical or terminal illness, patients with other malignancies, multinodular lesions of thyroid, patients with raised T3, T4 and/ or suppressed TSH level were excluded from the study. One hundred sixty patients presenting with thyroid nodule were initially evaluated with thyroid function test and USG. Only those patients with euthyroid solitary thyroid nodules are subjected for fine needle aspiration (FNA). Nodules under BETHESDA 2 are considered for US guided percutaneous ethanol injection (PEI). One hundred twenty-three patients were excluded because of various reasons. Finally ethanol ablation was done in 37 patients. Benign, purely cystic and mixed thyroid nodules were aspirated under ultrasonography guidance. Sterile absolute alcohol (99.99%) (50% of volume aspirated/ maximum 10 ml) was injected and reviewed after 2, 5and 7 months. In case of solid nodule alcohol (50% of nodule volume) was injected. A reduction in volume is calculated at each follow up visit. An adequate response is considered as ≥50 percent reduction in size from baseline after 7 months. If the reduction is <50%, then a second session of absolute ethanol injection is given. Again, patients were similarly followed up after 2, 5 and 7 months. Results: Thirty seven patients underwent PEI. Thirty three patients were considered for final analysis (4 lost to follow up). Response rate of PEI for purely cystic nodule was 100.0% and the overall response rate for mixed nodule was 53.57%. None of the solid nodule responded to PEI even after second session. Among the responder in the mixed nodules, 93.33% responded after first session of PEI. Minor complications like headache occurred in 54.1% patients in the first session. Transient pain at injection site were complained by 86.5% and 37.8% patients in the first and second session respectively. Nausea and vomiting were complained by 18.9% and 16.2% patients in the first and second session respectively. Conclusions: PEI is an effective and safe for purely cystic and mixed thyroid nodules. It is a relatively safe and less invasive procedure from management of benign solitary cystic and mixed thyroid nodules.
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