Purpose. Incidental durotomy is a relatively common complication for patients undergoing posterior spinal surgery. Delineating anatomical variants in the posterior lumbar spinal canal is crucial in reducing future rates of incidental durotomy. Materials and Methods. The ligamentous attachments between the dura mater and ligamentum flavum in the lumbar region of 17 soft-fixed cadavers were investigated. The lumbar vertebral columns were removed, and cross-sectional dissection was performed at levels L1-S1. Anterior retraction of the dorsal dura mater identified attachments between the dorsal surface of the dura mater and the ligamentum flavum. Histological staining of the ligamentous attachments was carried out with hematoxylin and eosin (H&E) and elastic van Gieson (EVG). Results. Posterior epidural ligaments were present in 9 (52.9%) cadavers. Nine (9) separate ligaments were identified in these cadavers, with 3 (33.3%) at L3/L4, 5 (55.5%) at L4/L5, and 1 (11.1%) at L5/S1. Histology confirmed the presence of poorly differentiated collagen-based connective tissue, distinct from the normal anatomy. Conclusions. This study confirms the presence of multiple dorsomedial posterior epidural ligaments at the main sites for posterior spinal surgery (L3-S1). An intraoperative awareness of the variability of such connections may be an important step in reducing static rates of incidental durotomy.

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BACKGROUND: Perforator incompetence is an important part of assessment of chronic venous insufficiency (CVI), but the criteria for perforator incompetence and the relationship with clinical severity is not well established. AIM: To study whether measurement of diameter of perforator correlates with clinical severity of venous insufficiency. MATERIALS AND METHODS: One hundred and forty five consecutive patients (168 limbs) with varicose veins were evaluated with Doppler study of lower limb veins. Clinical severity and diameter of perforators were assessed. RESULTS: 23% of patients with clinically mild disease had perforator diameter of 3mm or more, whereas, 62% of moderate and severe disease patients had incompetent perforator. Average diameter of perforator in CVI class 1 & 2 patients was 1.44mm whereas, in class 3 & 4 patients, it was 3.31mm and 3.58mm in class 5 & 6 patients. CONCLUSION: Diameter of perforator compare favourably with clinical severity of chronic venous insufficiency. This study may help to evolve patient management guidelines in perforator incompetence treatment.

BACKGROUND Magnetic resonance imaging is known to demonstrate the perianal anatomy accurately. MR Fistulography with saline as contrast agent has been described to facilitate the detection of fistula tracks. We wanted to study the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of magnetic resonance fistulography using saline as a contrast agent using surgical findings as a reference standard. METHODS Fifty-nine clinically diagnosed cases of perianal fistulae who were sent for preoperative MR imaging of the perianal fistulae were included in the study. MR imaging after instillation of saline was obtained in these patients through a cannula inserted into the external opening. T2 and STIR images in axial and coronal planes were studied. Diagnostic indices were calculated using surgical findings as reference standard. RESULTS MR imaging with saline instillation demonstrated a sensitivity of 97.92 % in the detection of primary tracks. The sensitivity in determination of internal opening, secondary tracks, abscesses and horseshoe tracks were 98.04 %, 95.24 %, 100 % and 100 % respectively. MRI had 100 % specificity in detection of primary tracks, internal opening, secondary tracks, abscesses and horseshoe tracks before and after instillation of saline. The sensitivity was found to be more in participants who did not have active perianal discharge at the time of MR examination. CONCLUSIONS MRI with instillation of saline into the fistulous track is highly accurate for the presurgical evaluation of perianal fistula with respect to accurate depiction of primary track, secondary track, abscess and horseshoe extensions. It can serve as a cheaper alternative to MR examination using I.V. Gadolinium based contrast agents or MR Fistulography using Gadolinium agents. KEYWORDS Magnetic Resonance Imaging (MRI), Perianal Fistula, Saline, Pre-Operative Assessment, Fistulography, Horseshoe, Internal Opening, Secondary Tracks

Obturator externus tear is an extremely uncommon injury. The correct diagnosis is delayed due to nonspecific clinical features and normal x-rays. Isolated obturator externus tear is not reported in literature to the best of our knowledge. We present a case of isolated obturator externus tear diagnosed with MRI.

Thyroid ultrasound is the major diagnostic modality for evaluating thyroid nodules. The ultrasound features such as marked micro calcifications, hypoechogenicity and irregular margins were found as potential predictor for the presence of thyroid malignancies. Thus to assess the utility of USG in evaluating thyroid nodules is important. Current research objectives were to study the usefulness of ultrasound in differentiating benign and malignant thyroid nodules, to describe the thyroid nodules using ultrasound classification system and to compare the diagnostic indices for individual ultrasound features of different thyroid nodules. Material and methods: A prospective study was conducted among 173 patients attending the Radiology department of Sree Gokulam Medical College hospital from November 2011 to June 2013. Each thyroid nodule was assessed using GE voluson 7-30 Equipment scanner with a 5-13 GHz linear probe ultrasound. The diagnostic indices of ultrasonography with FNAC/biopsy as gold standard were studied. Data was analysed using statistical software SPSS. Results: On thyroid ultrasound examination, out of the 173 patients selected for the study, 16 of them had malignancy or suspicious for malignancy. Sensitivity of ultrasound to identify malignant thyroid nodule is 57% and specificity is 100% and the diagnostic accuracy is 93%. Sensitivity of ultrasound to identify benign thyroid nodule is 95% and specificity is 96% and the diagnostic accuracy is 95%. Conclusion: Ultrasound is good diagnostic tool for evaluating the benign from malignant thyroid nodule and unnecessary biopsies/surgeries could be prevented by proper ultrasound evaluation of thyroid Nodules.

INTRODUCTION:Even though radiofrequency ablation (RFA) is accepted as the first choice in treatment of varicose veins due to great sapheno femoral insuffiency, this treatment modality has not gained popularity in India. We present our experience with a large case series, involving more than a thousand RFAs. METHODS: Symtomatic varicose vein patients presenting to surgery OPD, who met the Doppler ultrasonography (USG) criteria for suitability for RFA, were offered RFA instead of open surgery. Radiofrequency ablation of varicose vein was done using the radiofrequency generator and segmental ablation catheter, under USG guidance. RESULTS:Patients who underwent RFA were followed up by check Doppler at 21 days and at 90 days. Out of a total of 1288 RFAs, technical success at 90 days was 99%. Factors affecting technical success were highlighted. Complications were minor and negligible. Modification of the technique to prevent some of the complications were carried out. CONCLUSION: This study, one of the largest series ever, has demonstrated that RFA is a safe and effective treatment and an alternate for surgery.