Purpose To assess the influence of various patient-, lesion-, and procedure-related variables on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Material and methods In a total of 208 patients, 215 lung/mediastinal lesions (seven patients were biopsied twice) were sampled under CT guidance using coaxial biopsy set via percutaneous transthoracic approach. Incidence of post procedure pneumothorax was seen and the influence of various patient-, lesion-, and procedure-related variables on the frequency of pneumothorax with special emphasis on procedural factors like dwell time and needle-pleural angle was analysed. Results Pneumothorax occurred in 25.12% (54/215) of patients. Increased incidence of pneumothorax had a statistically significant correlation with age of the patient ( p = 0.0020), size ( p = 0.0044) and depth ( p = 0.0001) of the lesion, and needle-pleural angle ( p = 0.0200). Gender of the patient ( p = 0.7761), emphysema ( p = 0.2724), site of the lesion ( p = 0.9320), needle gauge ( p = 0.7250), patient position ( p = 0.9839), and dwell time ( p = 0.9330) had no significant impact on the pneumothorax rate. Conclusions This study demonstrated a significant effect of the age of the patient, size and depth of the lesion, and needle-pleural angle on the incidence of post-procedural pneumothorax. Emphysema as such had no effect on pneumothorax rate, but once pneumothorax occurred, emphysematous patients were more likely to be symptomatic, necessitating chest tube placement. Gender of the patient, site of the lesion, patient position during the procedure, and dwell time had no statistically significant relation with the frequency of post-procedural pneumothorax. Surprisingly, needle gauge had no significant effect on pneumothorax frequency, but due to the small sample size, non-randomisation, and bias in needle size selection as per lesion size, further studies are required to fully elucidate the causal relationship between needle size and post-procedural pneumothorax rate. The needle should be as perpendicular as possible to the pleura (needle-pleural angle close to 90°), to minimise the possibility of pneumothorax after percutaneous transthoracic needle biopsy.

Background:Sheehan's syndrome manifests as hypopituitarism following a child birth usually preceded by postpartum hemorrhage. The symptoms range from vague feelings of ill health to symptoms of a full blown panhypopituitarism. A large series of such patients is not described in the literature.Materials and Methods:We present the details of ten women with partial Sheehan's syndrome. They presented with post-partum hemorrhage and lactation failure.Results:After delivery, seven out of ten patients had regular menstrual cycles indicating preservation of gonadotroph function. Lactotroph, thyrotroph, and somatotroph failure were present in all and corticotrophs preservation was documented in four out of ten patients. The hypophysial magnetic resonance imaging (MRI) confirmed empty sella in all.Conclusion:lactotroph, somatotroph and thyrotroph failure are common in patients with Sheehan's syndrome. In addition to known preservation of gonadotroph axis, corticotroph axis may be preserved in some of these patients arguing against the universal treatment of these patients with glucocorticoids.

We present a case of a 12-year-old boy who developed upper gastrointestinal bleeding in the form of hematemesis and melena 1 month after blunt trauma to liver. Computed tomography (CT) angiography with multidetector-row CT demonstrated pseudoaneurysm of right hepatic artery related to old liver laceration to be the cause of the bleeding. Pseudoaneurysm was resected using the roadmap provided by CT angiography findings.

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Earlier data on the relationship of 25 hydroxyvitamins (25OHD) levels with various components of polycystic ovary syndrome (PCOS) has been conflicting. We studied 122 normal body mass index (BMI) women with PCOS (cases) and 46 age and BMI-matched healthy women (controls) and assessed the impact of serum 25OHD levels on clinical, biochemical and insulin sensitivity parameters in these lean Indian women with PCOS. The mean age and BMI of the cases and controls were comparable. Mean serum 25OHD levels respectively were 10.1 ± 9.9 and 7.9 ± 6.8 ng/ml with 87.7% and 91.1% vitamin D (VD) deficient. No significant correlation was noted between 25OHD levels and clinical, biochemical and insulin sensitivity parameters except with the total testosterone levels (p = 0.007). Also, no significant difference in these parameters was observed once the PCOS women were stratified into various subgroups based on the serum 25OHD levels. We conclude that VD deficiency being common in normal BMI Indian women with or without PCOS does not seem to alter the metabolic phenotype in these women.

AIm:To describe imaging findings of cerebral hydatid cysts on computed tomography of brain. mAterIAl and methOds: We retrospectively reviewed CT scans of brain in 5 patients with pathologically confirmed hydatid cysts in cerebral hemispheres. The patients were scanned either on a spiral (single slice) CT or on multidetector-row CT before and after intravenous injection of iodinated contrast material. results: All the patients were children aged 8 to 13 years with 3 boys and 2 girls. Features of raised intracranial tension were present in all the cases at presentation. CT findings of a large intracerebral cystic lesion with significant mass effect and without any calcification or enhancement were common in all 5 cases. Perilesional edema was present in 1 case. Cerebral hydatid was seen as either a homogenous fluid attenuation unilocular cyst (3 cases) or a unilocular cyst with few peripheral daughter cysts (1 case) or cyst filled by multiple daughter cysts inside (1 case). All the cases were operated and cyst was removed completely after craniotomy. COnClusIOn: Accurate preoperative diagnosis of cerebral hydatid by CT followed by surgery with care to avoid cyst rupture can result in favorable outcome. KeywOrds: Cerebral hydatid cyst, CT, Echinococcosis ÖZ AmAÇ: Beyin bilgisayarlı tomografisinde serebral kist hidatiklerin görüntüleme bulgularının tanımlanması. yÖntem ve GereÇ: Serebral hemisferlerde hidatik kistleri olduğu patolojik olarak onaylanmış 5 hastanın BT görüntüleri retrospektif olarak incelendi. Hastalar iyotlu kontrast madde verilmesinden önce ve sonra ya bir spiral BT (single slice) ya da multidetector-row BT ile tarandı. BulGulAr: Hastalar 8 ile 13 yaş arası 3 erkek ve 2 kız çocuğu idi. Bütün vakalarda başvuru esnasında kafaiçi basınç artış bulguları vardı. 5 vakanın hepsinde belirgin kitle etkisi yapan ve kalsifikasyon veya kontrast tutulumu göstermeyen büyük bir intraserebral kistik lezyona ait BT bulguları görüldü. 1 vakada perilezyonel ödem görüldü. Serebral kist hidatik ya homojen sıvı dolu tek lobüllü kist (3 vaka), ya birkaç tane çevresel yavru kisti olan tek lobüllü bir kist (1 vaka), ya da içinde birçok yavru kist olan bir kist (1 vaka) şeklinde görüldü. Bütün vakalar ameliyat edildi ve kist kranyotomiyle tamamen çıkartıldı. sOnuÇ: Serebral kist hidatiklerin ameliyat öncesi BT ile doğru teşhisi ve kist patlamasını engellemek için dikkatli cerrahi uygulanması iyi sonuçlar alınmasını sağlayacaktır.

Aim:To evaluate the role of USG in the preoperative localization of parathyroid adenomas in patients with symptomatic hyperparathyroidism and to compare its usefulness with that of scintigraphy scan and postoperative findings.Material and methods:Twenty-five patients with symptomatic primary hyperparathyroidism were subjected to USG of the neck and nuclear scintigraphy, followed by surgery. The results were independently analyzed and compared with per-operative findings.Results:The 25 patients had a total of 28 abnormal glands: 22 solitary adenomas, and 6 multiple adenomas (two each in three patients). USG detected 20 out of 22 solitary adenomas and three out of six multiple adenomas. USG missed five abnormal glands, two of which were in the neck and three in the mediastinum. Scintigraphy was positive in 26 abnormal glands, out of which 22 were single and four were multiple. Two abnormal glands were missed: one in the neck and one in the mediastinum.Conclusion:As limited neck dissection for primary hyperparathyroidism becomes increasingly popular, USG has been found to be a sensitive, specific, and easily available noninvasive investigation for parathyroid localization. It can be easily offered to patients as a method for preoperative localization prior to limited parathyroid surgery outside tertiary care settings.

Cardiac abnormalities in patients with Sheehan syndrome are uncommon. A case of Sheehan syndrome with dilated cardiomyopathy is presented in whom hormone replacement with levothyroxine and prednisolone resulted in complete recovery of cardiomyopathy. A 25-year-old woman presented with lactation failure, secondary amenorrhea, features of hypothyroidism and a hypocortisol state following severe postpartum hemorrhage after her last child birth. She also had smear positive pulmonary tuberculosis. After starting antitubercular treatment, she developed shock, suggestive of hypocortisol crisis. Hormonal investigations revealed evidence of panhypopitutarism and magnetic resonance imaging revealed partial empty sella. Meanwhile echocardiography revealed evidence of dilated cardiomyopathy (DCM). The patient was given replacement therapy in the form of glucocorticoids and levothyroxine in addition to antitubercular treatment. She improved and on follow-up over a period of 7 months, the DCM completely reversed. To our knowledge this is the first report of reversible DCM in a patient with Sheehan syndrome.