We present two cases of congenital intrahepatic portosystemic shunts in which the right portal vein directly communicated with the inferior venacava (IVC) in one patient and with the hepatic vein in the other. Multiple hepatic nodules consistent with focal nodular hyperplasia (FNH) were seen in the first patient. The second patient presented with recurrent history of hepatic encephalopathy. Percutaneous transhepatic embolization was performed using coils and Amplatz device following which she completely recovered.

Objective: The consistency of pituitary macroadenomas can be a confounding factor during transnasal transsphenoidal decompression, often necessitating incomplete removal and need for a transcranial approach for complete tumor excision. Very few studies have evaluated preoperative tumor consistency in relation to imaging findings. Our objective was to determine whether conventional magnetic resonance images and diffusionweighted (DW) imaging with apparent diffusion coefficient (ADC) maps are predictive of the consistency of pituitary macroadenomas.Methods: A retrospective study of 31 patients who had undergone surgery for pituitary macroadenoma in our hospital. Preoperative magnetic resonance images were reviewed and regions of interest were drawn on the macroadenoma and normal white matter on DW images independently by 2 neuroradiologists. Consistency of macroadenomas was determined from the surgical records and was classified into soft, intermediate, or hard. Mean ADC values, signal intensity ratio of tumor to white matter within regions of interest on conventional and DW images, and degree of enhancement were compared with tumor consistency using analysis of variance.Results: The mean ADC values in the soft group was 0.754 Â 10 À 3 mm 2 /s, in the intermediate group was 0.963 Â10 À 3 mm 2 /s, and in the hard group was 1.312 Â 10 À 3 mm/s. Statistical analysis revealed a significant correlation between consistency and ADC values (P < 0.004). There was no significant association between tumor consistency and signal intensity or degree of contrast enhancement. Conclusions:The findings in this study suggest that DW images with ADC maps are useful for preoperative prediction of consistency of pituitary macroadenomas. E ndoscopic transsphenoidal technique has been widely accepted as the modality of choice for removing pituitary tumors. 1-4 This technique is minimally invasive and incidence of postoperative complications is less compared with the traditional microscopic decompression. 5 But this procedure has got its own limitations in certain conditions like sphenoid sinusitis and ectatic midline carotid arteries, where transcranial approach is preferred. 6 Another important factor that determines the outcome and the method of approach is the tumor consistency. 7,8 Approximately 5% to 14% of pituitary macroadenomas are firm and fibrous, thus not compliant to suction/curettage, which makes total excision of the tumor difficult. This would necessitate a second transcranial approach for complete tumor removal. Information about the consistency of tumor before surgery helps the surgeon plan accordingly, thus avoiding an unnecessary second procedure and also helps to bring down the cost and complications.The conventional magnetic resonance imaging (MRI) findings, previously described in literature, indicating the consistency of tumor included T2-weighted hypointensity and homogenous enhancement as a marker of fibrous lesions. 9,10 This finding is controversial and not always consistent with surgical findings. 11,12 Diffus...

The authors relate the observation of an inveterated bilateral posterior dislocation, occurring during a generalized epileptic attack and mimicking a painful stiff shoulder. The clinical signs (i.e. aetiologic circumstances causing a forced internal rotation, limitation or absence of external rotation) and radiological data, especially the necessity of a profile X-ray, which lead to the diagnostic are reiterated. The interest of computerized tomography in the pre-operative assessment is underscored.

Introduction:The objective of our study was to review the results of percutaneous angioplasty (PTA)/stenting in the treatment of patients who presented with symptoms and angiographic findings of chronic mesenteric ischemia (CMI).Materials and Methods:We performed a retrospective analysis of 13 consecutive patients from a single institution who underwent PTA/stenting for the treatment of symptoms suggestive of CMI.Results:All 13 patients in our study were men, and most common presenting symptoms were weight loss and postprandial pain. Atherosclerosis was the most common cause. PTA and stenting was performed in 9 patients and PTA alone was done in 4 patients. Primary technical success rate was 92% with complete resolution of symptoms within 2 weeks in all patients. No statistical difference was noted in primary clinical success rate based on the number of vessels treated or the method of treatment. However, in patients whom SMA was treated had longer duration of symptom-free survival as compared to other vessels.Conclusion:PTA and stenting are very effective therapeutic options for patients presenting with CMI symptoms. It should be considered as the first-line of management in such patients.

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BACKGROUND Gastric carcinoma represents the most common gastric neoplasm accounting for 95% of all gastric tumours and represents a group of aggressive malignancy. Although highly aggressive, the early gastric cancer shows a better prognosis with a 5-year survival rate of more than 90%. There is a wide variation of the prognosis varying from less than 3% to 90% in early gastric cancers. Early diagnosis and accurate staging are therefore very crucial for the choice of an accurate therapeutic approach and also for the good survival rate. This study aims at evaluating the validity of MDCT in staging gastric cancer. MATERIALS AND METHODS Between May 2014 and September 2016, 35 patients (27 males, 8 females), with mean age of 63 years were evaluated. CT was performed using 16 slice and 64 slice CT and Tumour staging and nodal staging was done according to TNM staging put forward by AJCC 7 th edition. All the stages were compared with the gold standard histopathological staging. Site and extent of the lesion and surgery done were also assessed. RESULTS The comparison of tumour and nodal staging to histopathological staging was statistically done by McNemar test, and all the stages of the malignancy showed statistical agreement between the two. The sensitivity, specificity, accuracy and p value of all the T stages and N stages were the statistical parameters assessed. The sensitivity of early gastric cancer (T1 and T2) was comparatively lower than advanced cases (T3 and T4). The sensitivity of staging T1 lesion was 55% whereas it was 93% in staging T3 lesions. The sensitivity of nodal staging was about 70% in all the stages. CONCLUSION CT as a modality in staging gastric cancer helps staging the advanced gastric cancer more accurately than early gastric cancer. Along with the tumour and nodal staging it can also give the details of distant organ metastasis. It can be used in conjunction with other endoscopic methods for accurate preoperative staging.

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