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Papers by raju sharma

Tropical Gastroenterology, 2014

or ascites. Perfusion parameters were calculated for the pancreatic head lesion (Figure 2) of whi... more or ascites. Perfusion parameters were calculated for the pancreatic head lesion (Figure 2) of which blood flow (BF), blood volume (BV) and peak enhancement intensity (PEI) were reduced compared to the normal body and tail of Volume perfusion computed tomography as an aid to diagnosis of pancreatic tuberculosis

Tropical gastroenterology : official journal of the Digestive Diseases Foundation

Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a v... more Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a vital role in the diagnosis of this disease. Rupture of the cyst can give rise to a wide spectrum of complications. We describe a case of hepatic hydatid cyst with rupture into the biliary tree, right pleural cavity and dissemination into the peritoneal cavity, with associated splenic hydatid cysts. MRI may be a useful non-invasive diagnostic tool in such disseminated cases to define the complete extent of the disease.

Tropical gastroenterology : official journal of the Digestive Diseases Foundation

Case 1 Left sided pneumoperitoneum masquerading as gastric bubble A 19-year-old female presented ... more Case 1 Left sided pneumoperitoneum masquerading as gastric bubble A 19-year-old female presented with history of recurrent colicky pain abdomen, non bilious vomiting, anorexia, and weight loss. She had earlier been investigated in a private institution and was diagnosed as Celiac disease, on the basis of positive IgA anti tissue transglutaminase levels and duodenal biopsy demonstrating altered C:V ratio and increased intraepithelial lymphocytes. There was no clinical response on gluten free diet although her repeat biopsy had shown reversal of changes. At our institution she underwent CT Enteroclysis which demonstrated grossly dilated stomach (reaching the left iliac fossa), first and second part of duodenum, with a stricture in the third part of duodenum. Her Mantoux test was 18 x 18 mm, and on basis of above findings she was started on antitubercular drugs. She underwent balloon dilatation of the stricture, following which she had pain abdomen with distension and had guarding and rigidity, on examination. She was passing faeces and flatus. Radiograph abdomen done after the procedure demonstrated air lucency under left dome of the diaphragm. No air was seen under the right dome of diaphragm. This was interpreted as gastric bubble by resident on call (Figure 1). CT done after 4 hours, because of high clinical suspicion, revealed pneumoperitoneum in the left subphrenic space (Figure 2). The patient was taken for emergency laparotomy which revealed perforation in proximal jejunum and pus in the peritoneal cavity.

Acta radiologica (Stockholm, Sweden : 1987), Jan 23, 2014

Blunt pancreatic trauma is an uncommon injury with high morbidity and mortality. Retrospective an... more Blunt pancreatic trauma is an uncommon injury with high morbidity and mortality. Retrospective analyses of computed tomography (CT) performance report CT to have variable sensitivity in diagnosing pancreatic injury. Both a prospective analysis of multidetector CT (MDCT) performance and diagnostic utility of magnetic resonance imaging (MRI) in acute blunt pancreatic injury remain unexplored. To prospectively evaluate the utility of MDCT with MRI correlation in patients with blunt pancreatic trauma using intraoperative findings as the gold standard for analysis. The contrast-enhanced CT (CECT) scans of patients admitted with blunt abdominal trauma were prospectively evaluated for CT signs of pancreatic injury. Patients detected to have pancreatic injury on CT were assigned a CT grade of injury according to American Association for Surgery of Trauma classification. MRI was performed in patients not undergoing immediate laparotomy and MRI grade independent of CT grade was assigned. Surg...

The Indian Journal of Pediatrics, 2004

Magnetic Resonance Imaging is a non-invasive multiplanar imaging modality which does not use ioni... more Magnetic Resonance Imaging is a non-invasive multiplanar imaging modality which does not use ionizing radiation. In recent years major technical advances in this field have led to shorter imaging times and better resolution. This has widened the scope of this modality in pediatric imaging. MRI is already an established technique for the brain and spine and is increasingly being used for musculoskeletal, abdominal and pelvic imaging. In this article the authors provide an update on this exciting modality with stress on applications relevant to pediatric surgeons.

RadioGraphics, 2008

A broad spectrum of congenital anomalies and pathologic conditions can affect the inferior vena c... more A broad spectrum of congenital anomalies and pathologic conditions can affect the inferior vena cava (IVC). Most congenital anomalies are asymptomatic; consequently, an awareness of their existence and imaging appearances is necessary to avoid misinterpretation. Imaging also plays a central role in the diagnosis of Budd-Chiari syndrome secondary to membranous obstruction of the intrahepatic IVC. Primary malignancy of the IVC is far less common than intracaval extension of malignant tumors arising in adjacent organs, and imaging can accurately help determine the presence and extent of tumor thrombus, information that is crucial for surgical planning. However, the radiologist should be aware that artifactual filling defects at computed tomography and magnetic resonance imaging can mimic true thrombus in the IVC and must be able to differentiate true from pseudo filling defects. Other imaging findings such as flat IVC and early enhancement of the IVC are useful in limiting the differential diagnosis. Familiarity with the imaging features of the various congenital and pathologic entities that can affect the IVC is paramount for early diagnosis and management. ©

Pediatric Radiology, 2010

Background Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gla... more Background Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gland disease of childhood, after mumps. Diagnosis of JRP is usually based on clinical history of recurrent unilateral or bilateral parotid swelling and demonstration of sialectasis. Conventional sialography, digital sialography, US, MRI and sialoendoscopy have been used as investigative tools for the diagnosis of JRP. MR sialography is increasingly recognized as a useful supplement to sialography in salivary duct disorders. Objective To describe the MRI and MR sialographic findings in children with JRP. Materials and methods MR Sialography was performed using T2-weighted three-dimensional constructive interference in steady-state (CISS) and half fourier acquisition single-shot turbo spin-echo (HASTE) sequences in 62 children with inflammatory salivary gland disease. Out of these 62 children, 6 had JRP. Axial T1-and T2-W images were also performed. Results The main parotid duct was normal in all six children with JRP. High signal intensity focal lesions suggestive of sialectasis were seen involving both parotid glands in all six children. CISS sequence demonstrated the intraglandular ducts and sialectasis better than HASTE images. Conclusion MRI and MR sialography can non-invasively delineate the parenchymal and ductal system abnormalities of the parotid glands in children with JRP. Although MR and MR sialography cannot substitute US, they can accurately depict findings such as sialectasis and signal intensity changes in the parotid gland depending upon the phase of the disease (acute vs. chronic inflammation). The radiologist should be familiar with MR findings of JRP.

Pediatric Radiology, 2010

Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension ... more Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension and the only permanent treatment is shunt surgery. The inferior mesenteric vein (IMV) is a portal venous channel that can be used for the shunt when the splenic vein/superior mesenteric vein is thrombosed or when a lienorenal shunt is not possible. To compare MDCT venography (MDCTV) and contrast-enhanced MR venography (CEMRV) for visualisation of the IMV in children with EHPVO. This was a prospective study of 26 children (4-12 years, median 10 years) who underwent MDCTV and CEMRV. The IMV visualisation was graded using 4- and 2-point scales and the difference in visualisation was assessed by calculating the exact significance probability (P). The IMV was visualised in all children on MDCTV and 25/26 children on CEMRV (96%). The images were diagnostic in 23/26 children (88%) on MDCTV and in 18/26 (69%) children on CEMRV (P=0.063). MDCTV and CEMRV are comparable for IMV visualisation with a tendency toward MDCTV being superior.

Pediatric Radiology, 2006

We present the rare case of a 14-year-old female pseudohermaphrodite due to congenital adrenal hy... more We present the rare case of a 14-year-old female pseudohermaphrodite due to congenital adrenal hyperplasia (CAH). MRI revealed the presence of a hypoplastic uterus, ovaries, clitoromegaly, and prostate gland with its typical zonal anatomy. Transrectal sonography also confirmed the presence of a prostate gland.

Pediatric Radiology, 2009

A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such ... more A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such as Doppler sonography, helical CT, and MRI, identification of a specific etiology is often possible. Knowledge of clinical information, normal anatomy, and imaging characteristics of salivary gland pathology are essential for appropriate radiologic evaluation. This review illustrates the various congenital, neoplastic, and inflammatory entities that can occur within the parotid, submandibular, and sublingual spaces.

Journal of Pediatric Surgery, 2010

Mediastinal neurenteric cysts are the least common types of the bronchopulmonary foregut malforma... more Mediastinal neurenteric cysts are the least common types of the bronchopulmonary foregut malformations, and their antenatal diagnosis is rare. We report a case of mediastinal neurenteric cyst diagnosed on antenatal ultrasonography at 28 weeks' gestation. A small intraspinal component and vertebral segmentation anomalies were also noted. The diagnosis was confirmed on postnatal magnetic resonance imaging and at the time of operation.

Journal of Medical Imaging and Radiation Oncology, 2013

Pulmonary tuberculosis is a ubiquitous infection and a re-emerging medical and socioeconomic prob... more Pulmonary tuberculosis is a ubiquitous infection and a re-emerging medical and socioeconomic problem resulting in increasing mortality and morbidity, especially in Asian countries. We aim to review the spectrum of imaging findings in airway involvement in tuberculosis through characteristic radiological images and to assess the role of computed tomography and image-guided interventions in the diagnosis and management of pulmonary tuberculosis.

Journal of Medical Imaging and Radiation Oncology, 2010

Jaw lesions in paediatric and adolescent population are uncommon and can arise in odontogenic or ... more Jaw lesions in paediatric and adolescent population are uncommon and can arise in odontogenic or non-odontogenic tissues. With the advent of multidetector computed tomography (MDCT), algorithm for imaging jaw lesions has changed dramatically. This pictorial essay describes the imaging appearance of commonly encountered jaw lesions in children and adolescents with emphasis on MDCT findings.

Indian Journal of Radiology and Imaging, 2013

Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemivagin... more Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, is an uncommon combined Mullerian and mesonephric duct anomaly, and its presentation in adulthood is even rarer. We report here a 22-year-old female presenting with primary infertility where magnetic resonance imaging (MRI) suggested the diagnosis of HWWS with endometriosis. In a patient of infertility with endometriosis and unilateral renal agenesis, diagnosis of HWWS should be suspected and MRI is the investigation of choice for such anomalies.

Indian Journal of Ophthalmology, 2006

A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectio... more A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectional imaging plays an important role in the diagnosis and management of these patients. We reviewed our imaging record and collected representative cases of pediatric orbital pathology. The purpose of this pictorial essay is to illustrate the imaging features of various orbital lesions encountered in children.

Indian Journal of Gastroenterology, 2010

Head & Neck, 2011

Background. Although 2 studies totaling 11 cases have indicated some benefit of anti-androgen tre... more Background. Although 2 studies totaling 11 cases have indicated some benefit of anti-androgen treatment with flutamide on juvenile nasopharyngeal angiofibroma (JNA), it is not part of contemporary practice. Methods. Our approach was through a prospective, singlearm, before-and-after study, in which 20 patients with advanced JNA (Radkowski stage IIB-IIIB) were administered flutamide (per oral: 10 mg kg À1 day À1 Â 6 weeks) prior to surgical excision. Pretherapy and posttherapy tumor volume measurements were established by MRI. Periodic assessments were recorded of liver, kidney functions, testosterone levels, and secondary sexual characteristics. Results. Prepubertal and postpubertal cases responded differently (p < .05). Prepubertal cases had inconsistent and minimal responses; 13/15 postpubertal cases demonstrated measurable volume reduction (mean, 16.5%; maximum, 40%). Two cases with optic nerve compression had visual improvement. Volume reduction correlated with serum testosterone level (r ¼ .53; p < .05). No significant toxicity was noted, with the exception of transient breast tenderness. Conclusions. Prepubertal and postpubertal patients differ in their response to flutamide. In postpubertal patients, 6 weeks preoperative use is safe and leads to partial tumor regression. Tumor regression from adjacent vital structures may facilitate surgical excision and limit morbidity. V

Haemophilia, 2001

ABSTRACT A case of pseudotumour of the paranasal sinuses occurring in a patient with haemophilia ... more ABSTRACT A case of pseudotumour of the paranasal sinuses occurring in a patient with haemophilia A is reported. There was a favourable response to combined treatment with radiation therapy and factor VIII replacement.

Gastrointestinal Endoscopy, 2008

Figure 2. Linear endoscopic US showing a conglomerate of thin-walled cysts (cyst-by-cyst appearan... more Figure 2. Linear endoscopic US showing a conglomerate of thin-walled cysts (cyst-by-cyst appearance). No solid component was seen inside the cyst. Figure 3. Destained pancreatic FNA smear showing acid-fast bacilli in a necrotic background (ZN stain, orig. mag. Â1000).

Tropical Gastroenterology, 2014

or ascites. Perfusion parameters were calculated for the pancreatic head lesion (Figure 2) of whi... more or ascites. Perfusion parameters were calculated for the pancreatic head lesion (Figure 2) of which blood flow (BF), blood volume (BV) and peak enhancement intensity (PEI) were reduced compared to the normal body and tail of Volume perfusion computed tomography as an aid to diagnosis of pancreatic tuberculosis

Tropical gastroenterology : official journal of the Digestive Diseases Foundation

Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a v... more Hydatid disease is a parasitic infection that most commonly involves the liver. Imaging plays a vital role in the diagnosis of this disease. Rupture of the cyst can give rise to a wide spectrum of complications. We describe a case of hepatic hydatid cyst with rupture into the biliary tree, right pleural cavity and dissemination into the peritoneal cavity, with associated splenic hydatid cysts. MRI may be a useful non-invasive diagnostic tool in such disseminated cases to define the complete extent of the disease.

Tropical gastroenterology : official journal of the Digestive Diseases Foundation

Case 1 Left sided pneumoperitoneum masquerading as gastric bubble A 19-year-old female presented ... more Case 1 Left sided pneumoperitoneum masquerading as gastric bubble A 19-year-old female presented with history of recurrent colicky pain abdomen, non bilious vomiting, anorexia, and weight loss. She had earlier been investigated in a private institution and was diagnosed as Celiac disease, on the basis of positive IgA anti tissue transglutaminase levels and duodenal biopsy demonstrating altered C:V ratio and increased intraepithelial lymphocytes. There was no clinical response on gluten free diet although her repeat biopsy had shown reversal of changes. At our institution she underwent CT Enteroclysis which demonstrated grossly dilated stomach (reaching the left iliac fossa), first and second part of duodenum, with a stricture in the third part of duodenum. Her Mantoux test was 18 x 18 mm, and on basis of above findings she was started on antitubercular drugs. She underwent balloon dilatation of the stricture, following which she had pain abdomen with distension and had guarding and rigidity, on examination. She was passing faeces and flatus. Radiograph abdomen done after the procedure demonstrated air lucency under left dome of the diaphragm. No air was seen under the right dome of diaphragm. This was interpreted as gastric bubble by resident on call (Figure 1). CT done after 4 hours, because of high clinical suspicion, revealed pneumoperitoneum in the left subphrenic space (Figure 2). The patient was taken for emergency laparotomy which revealed perforation in proximal jejunum and pus in the peritoneal cavity.

Acta radiologica (Stockholm, Sweden : 1987), Jan 23, 2014

Blunt pancreatic trauma is an uncommon injury with high morbidity and mortality. Retrospective an... more Blunt pancreatic trauma is an uncommon injury with high morbidity and mortality. Retrospective analyses of computed tomography (CT) performance report CT to have variable sensitivity in diagnosing pancreatic injury. Both a prospective analysis of multidetector CT (MDCT) performance and diagnostic utility of magnetic resonance imaging (MRI) in acute blunt pancreatic injury remain unexplored. To prospectively evaluate the utility of MDCT with MRI correlation in patients with blunt pancreatic trauma using intraoperative findings as the gold standard for analysis. The contrast-enhanced CT (CECT) scans of patients admitted with blunt abdominal trauma were prospectively evaluated for CT signs of pancreatic injury. Patients detected to have pancreatic injury on CT were assigned a CT grade of injury according to American Association for Surgery of Trauma classification. MRI was performed in patients not undergoing immediate laparotomy and MRI grade independent of CT grade was assigned. Surg...

The Indian Journal of Pediatrics, 2004

Magnetic Resonance Imaging is a non-invasive multiplanar imaging modality which does not use ioni... more Magnetic Resonance Imaging is a non-invasive multiplanar imaging modality which does not use ionizing radiation. In recent years major technical advances in this field have led to shorter imaging times and better resolution. This has widened the scope of this modality in pediatric imaging. MRI is already an established technique for the brain and spine and is increasingly being used for musculoskeletal, abdominal and pelvic imaging. In this article the authors provide an update on this exciting modality with stress on applications relevant to pediatric surgeons.

RadioGraphics, 2008

A broad spectrum of congenital anomalies and pathologic conditions can affect the inferior vena c... more A broad spectrum of congenital anomalies and pathologic conditions can affect the inferior vena cava (IVC). Most congenital anomalies are asymptomatic; consequently, an awareness of their existence and imaging appearances is necessary to avoid misinterpretation. Imaging also plays a central role in the diagnosis of Budd-Chiari syndrome secondary to membranous obstruction of the intrahepatic IVC. Primary malignancy of the IVC is far less common than intracaval extension of malignant tumors arising in adjacent organs, and imaging can accurately help determine the presence and extent of tumor thrombus, information that is crucial for surgical planning. However, the radiologist should be aware that artifactual filling defects at computed tomography and magnetic resonance imaging can mimic true thrombus in the IVC and must be able to differentiate true from pseudo filling defects. Other imaging findings such as flat IVC and early enhancement of the IVC are useful in limiting the differential diagnosis. Familiarity with the imaging features of the various congenital and pathologic entities that can affect the IVC is paramount for early diagnosis and management. ©

Pediatric Radiology, 2010

Background Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gla... more Background Juvenile recurrent parotitis (JRP) is the second most common inflammatory salivary gland disease of childhood, after mumps. Diagnosis of JRP is usually based on clinical history of recurrent unilateral or bilateral parotid swelling and demonstration of sialectasis. Conventional sialography, digital sialography, US, MRI and sialoendoscopy have been used as investigative tools for the diagnosis of JRP. MR sialography is increasingly recognized as a useful supplement to sialography in salivary duct disorders. Objective To describe the MRI and MR sialographic findings in children with JRP. Materials and methods MR Sialography was performed using T2-weighted three-dimensional constructive interference in steady-state (CISS) and half fourier acquisition single-shot turbo spin-echo (HASTE) sequences in 62 children with inflammatory salivary gland disease. Out of these 62 children, 6 had JRP. Axial T1-and T2-W images were also performed. Results The main parotid duct was normal in all six children with JRP. High signal intensity focal lesions suggestive of sialectasis were seen involving both parotid glands in all six children. CISS sequence demonstrated the intraglandular ducts and sialectasis better than HASTE images. Conclusion MRI and MR sialography can non-invasively delineate the parenchymal and ductal system abnormalities of the parotid glands in children with JRP. Although MR and MR sialography cannot substitute US, they can accurately depict findings such as sialectasis and signal intensity changes in the parotid gland depending upon the phase of the disease (acute vs. chronic inflammation). The radiologist should be familiar with MR findings of JRP.

Pediatric Radiology, 2010

Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension ... more Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension and the only permanent treatment is shunt surgery. The inferior mesenteric vein (IMV) is a portal venous channel that can be used for the shunt when the splenic vein/superior mesenteric vein is thrombosed or when a lienorenal shunt is not possible. To compare MDCT venography (MDCTV) and contrast-enhanced MR venography (CEMRV) for visualisation of the IMV in children with EHPVO. This was a prospective study of 26 children (4-12 years, median 10 years) who underwent MDCTV and CEMRV. The IMV visualisation was graded using 4- and 2-point scales and the difference in visualisation was assessed by calculating the exact significance probability (P). The IMV was visualised in all children on MDCTV and 25/26 children on CEMRV (96%). The images were diagnostic in 23/26 children (88%) on MDCTV and in 18/26 (69%) children on CEMRV (P=0.063). MDCTV and CEMRV are comparable for IMV visualisation with a tendency toward MDCTV being superior.

Pediatric Radiology, 2006

We present the rare case of a 14-year-old female pseudohermaphrodite due to congenital adrenal hy... more We present the rare case of a 14-year-old female pseudohermaphrodite due to congenital adrenal hyperplasia (CAH). MRI revealed the presence of a hypoplastic uterus, ovaries, clitoromegaly, and prostate gland with its typical zonal anatomy. Transrectal sonography also confirmed the presence of a prostate gland.

Pediatric Radiology, 2009

A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such ... more A variety of lesions occur in the pediatric salivary glands. With modern imaging techniques such as Doppler sonography, helical CT, and MRI, identification of a specific etiology is often possible. Knowledge of clinical information, normal anatomy, and imaging characteristics of salivary gland pathology are essential for appropriate radiologic evaluation. This review illustrates the various congenital, neoplastic, and inflammatory entities that can occur within the parotid, submandibular, and sublingual spaces.

Journal of Pediatric Surgery, 2010

Mediastinal neurenteric cysts are the least common types of the bronchopulmonary foregut malforma... more Mediastinal neurenteric cysts are the least common types of the bronchopulmonary foregut malformations, and their antenatal diagnosis is rare. We report a case of mediastinal neurenteric cyst diagnosed on antenatal ultrasonography at 28 weeks' gestation. A small intraspinal component and vertebral segmentation anomalies were also noted. The diagnosis was confirmed on postnatal magnetic resonance imaging and at the time of operation.

Journal of Medical Imaging and Radiation Oncology, 2013

Pulmonary tuberculosis is a ubiquitous infection and a re-emerging medical and socioeconomic prob... more Pulmonary tuberculosis is a ubiquitous infection and a re-emerging medical and socioeconomic problem resulting in increasing mortality and morbidity, especially in Asian countries. We aim to review the spectrum of imaging findings in airway involvement in tuberculosis through characteristic radiological images and to assess the role of computed tomography and image-guided interventions in the diagnosis and management of pulmonary tuberculosis.

Journal of Medical Imaging and Radiation Oncology, 2010

Jaw lesions in paediatric and adolescent population are uncommon and can arise in odontogenic or ... more Jaw lesions in paediatric and adolescent population are uncommon and can arise in odontogenic or non-odontogenic tissues. With the advent of multidetector computed tomography (MDCT), algorithm for imaging jaw lesions has changed dramatically. This pictorial essay describes the imaging appearance of commonly encountered jaw lesions in children and adolescents with emphasis on MDCT findings.

Indian Journal of Radiology and Imaging, 2013

Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemivagin... more Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, is an uncommon combined Mullerian and mesonephric duct anomaly, and its presentation in adulthood is even rarer. We report here a 22-year-old female presenting with primary infertility where magnetic resonance imaging (MRI) suggested the diagnosis of HWWS with endometriosis. In a patient of infertility with endometriosis and unilateral renal agenesis, diagnosis of HWWS should be suspected and MRI is the investigation of choice for such anomalies.

Indian Journal of Ophthalmology, 2006

A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectio... more A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectional imaging plays an important role in the diagnosis and management of these patients. We reviewed our imaging record and collected representative cases of pediatric orbital pathology. The purpose of this pictorial essay is to illustrate the imaging features of various orbital lesions encountered in children.

Indian Journal of Gastroenterology, 2010

Head & Neck, 2011

Background. Although 2 studies totaling 11 cases have indicated some benefit of anti-androgen tre... more Background. Although 2 studies totaling 11 cases have indicated some benefit of anti-androgen treatment with flutamide on juvenile nasopharyngeal angiofibroma (JNA), it is not part of contemporary practice. Methods. Our approach was through a prospective, singlearm, before-and-after study, in which 20 patients with advanced JNA (Radkowski stage IIB-IIIB) were administered flutamide (per oral: 10 mg kg À1 day À1 Â 6 weeks) prior to surgical excision. Pretherapy and posttherapy tumor volume measurements were established by MRI. Periodic assessments were recorded of liver, kidney functions, testosterone levels, and secondary sexual characteristics. Results. Prepubertal and postpubertal cases responded differently (p < .05). Prepubertal cases had inconsistent and minimal responses; 13/15 postpubertal cases demonstrated measurable volume reduction (mean, 16.5%; maximum, 40%). Two cases with optic nerve compression had visual improvement. Volume reduction correlated with serum testosterone level (r ¼ .53; p < .05). No significant toxicity was noted, with the exception of transient breast tenderness. Conclusions. Prepubertal and postpubertal patients differ in their response to flutamide. In postpubertal patients, 6 weeks preoperative use is safe and leads to partial tumor regression. Tumor regression from adjacent vital structures may facilitate surgical excision and limit morbidity. V

Haemophilia, 2001

ABSTRACT A case of pseudotumour of the paranasal sinuses occurring in a patient with haemophilia ... more ABSTRACT A case of pseudotumour of the paranasal sinuses occurring in a patient with haemophilia A is reported. There was a favourable response to combined treatment with radiation therapy and factor VIII replacement.

Gastrointestinal Endoscopy, 2008

Figure 2. Linear endoscopic US showing a conglomerate of thin-walled cysts (cyst-by-cyst appearan... more Figure 2. Linear endoscopic US showing a conglomerate of thin-walled cysts (cyst-by-cyst appearance). No solid component was seen inside the cyst. Figure 3. Destained pancreatic FNA smear showing acid-fast bacilli in a necrotic background (ZN stain, orig. mag. Â1000).