Adrenal masses in children may occur as a result of neoplasm, hemorrhage, infection, or cysts. Ultrasound is the initial imaging modality of choice in suspected adrenal pathology in children. Computed tomography, magnetic resonance imaging, and functional imaging are usually required for confirmation and further characterization of adrenal lesions. This review article highlights the imaging features of common adrenal masses that may involve the adrenal gland in pediatric population.

Aims and Objectives: Proton pump inhibitors (PPIs) are the most commonly used drugs in healthcare systems. Their inappropriate use has been reported in several studies. This study was undertaken to assess the prescribing practices, appropriateness of use, and cost incurred on PPI in a tertiary care, public, teaching hospital in India. Methods: A total of 500 inpatients’ records and 600 outpatients’ prescriptions were analyzed. Extent of prescribing, dosing information given, and cost incurred on the use of PPI in both inpatients and outpatients was assessed. The appropriateness of PPI prescribed was analyzed only among inpatients. Results: PPIs were prescribed to 62.2% inpatients and 27% outpatients. Extent of use of PPI was maximum in medicine department in both inpatients (78.5%) and outpatients (44.5%). Complete dosing information was seen in 9.9% (inpatients) and 30.2% (outpatients) prescriptions. In all the prescriptions of outpatients, tablets/capsules were prescribed whereas in inpatients, 79.74% PPI were prescribed as injections. All PPIs were prescribed by branded generic names except three prescriptions in inpatients of the medicine department. Most common PPI prescribed was pantoprazole by the name of PANTOP in both inpatients and outpatients. The use of PPI was appropriate in 7.4% cases, inappropriate in 91% of the cases, and probable in 1.6% cases. Total cost incurred on the prescriptions of inpatients and outpatients was Rs. 10,04,102. Of this cost, Rs. 1,20,085 (11.95%) was spent on PPI. Cost incurred on PPIs in inpatients was Rs. 1,12,621 (11.65%) and in outpatients was Rs. 7463.67 (19.93%). Maximum cost was incurred on pantoprazole in both inpatients and outpatients. Conclusions: PPIs are being prescribed inappropriately to many patients resulting in a waste of economic resources. Lack of regular audits and feedback to prescribers could be the contributing factors. Educational interventions in rational prescription of PPIs are required to encourage their proper utilization for patients.

Introduction: Patients of rheumatoid arthritis (RA) are prone to osteoporosis and overt fractures. Subclinical vertebral fractures (SVFs) precede overt vertebral fractures. We studied prevalence and risk factors of SVFs among women with RA. Aim: To determine the prevalence of SVFs in women with RA and to study the various risk factors associated with presence of SVFs. Settings and design: Adult patients of RA attending the rheumatology clinic of medicine department at a tertiary teaching hospital in Delhi. One hundred eleven adult women with RA were included. Clinical assessment included anthropometry, Body Mass Index (BMI), duration of RA, disease activity using Clinical Disease Activity Index (CDAI), disease disability using Health Assessment Questionnaire (HAQ), and details of glucocorticoid (GC) use. Thoracic and lumbar vertebrae were graded for presence of VFs using the semi-quantitative method of Genant by two radiologists. Statistical analysis used: Simple descriptive statistics were used to describe prevalence of SVFs. Risk factors for SVFs were tested for significance using the Studentʼs t-test for quantitative variables and chi-square test for qualitative variables. Kappa statistics were calculated for assessment performed by the two radiologists. Two-sided alpha was set at <0.05. Results: Forty Nine percent women had SVFs; 40% had 1–3 SVFs, and 9% had >3 SVFs. Women with any SVF were significantly older as compared to women with no SVF. Fifty five percent of women using GCs had any SVF, while 44%, not using GC, had any SVF (P = ns). GC use, duration of RA, CDAI score, HAQ score, BMI, presence of RF, and anti-CCP were not different between women with and without SVFs. Kappa for inter-reader variability among the two radiologists was 0.98. Conclusions: This study provides evidence of very high prevalence of SVFs among women with RA. Traditional risk factors do not fully account for this enhanced risk.

Introduction: Neural preservation is particularly imperative in the surgical management of acoustic neuromas. Intraoperative neuromonitoring is essential in structural and functional preservation of these cranial nerves during the operations. Intraoperative stimulus threshold and response amplitude measurements from trigeminal and facial nerves can predict the functional outcome postoperatively. Materials and Methods: A prospective study was conducted on 30 patients over a period of one year from March 2011 to April 2012 in the Govind Ballabh Pant Hospital, New Delhi, India. Results: There were 27 (90%) cases of vestibular schwannomas, one of meningioma (3.33%), and two of epidermoids (total cases n = 30). Among these, 11 (36.66%) were male and 19 (63.33%) were female patients, and 37% of patients in our study were in the age group of 20 to 30 years. Among the vestibular schwannomas, 16 were right sided and 11 were left sided. Hearing loss was the main presenting symptom (56%) followed by tinnitus (27%), facial pain (10%), and gait instability (7%) in our study. Conclusion: Intraoperative neurophysiological monitoring showed strong support in the value of identification of facial and trigeminal nerves, prevention of injury, and value of prognosis. Stimulus thresholds, response amplitude, and proximal-to-distal amplitude ratio can assist the surgeon during tumor dissection.

Background: Paraneoplastic syndrome is a clinical syndrome with systemic effects, triggered by altered immune response to a neoplasm. Paraneoplastic syndrome was described mostly in association with epithelial malignancies, while in a soft tissue sarcoma it is unusual and hyperleucocytosis as a paraneoplastic phenomenon is very rare. Case presentation: We report a middle aged male patient with bilateral retroperitoneal masses with histomorphology of myxoid liposarcoma with dedifferentiation. Hyper-leucocytosis in the peripheral blood and pronounced myeloid hyperplasia in marrow was found with no obvious focus of infection. There was gradual reduction in white cell count in the postoperative period and reached normal values on Day 8. Hence a diagnosis of dedifferentiated liposarcoma of the retroperitoneum with hyperleucocytosis as a paraneoplastic manifestation was made. Conclusion: Paraneoplastic manifestation could probably be due to production of G-CSF by tumor cells as the leucocytosis disappeared after tumor resection. Further, leucocytosis is not reported in association with well differentiated liposarcoma, and if happens to be so, it might be a clue to search for the dedifferentiated component.

Parapharyngeal space is an infrequent site for foreign bodies to lodge. Presence of neurovascular structures in this space mandates immediate and meticulous removal of the foreign body to prevent any complications. In this case report, we present a rare case of metallic foreign body (sewing needle) in the parapharyngeal space that was removed using external approach without any complications after appropriate imaging (contrast-enhanced computed tomography). Only one case has been reported so far in the literature and ours is the second one.

Mycetoma, a chronic granulomatous disease more common in tropical countries such as India, has been conventionally diagnosed by invasive and time-consuming modalities like biopsy and microbiological culture. This case series aims to stress on the benefits of leveraging magnetic resonance imaging and ultrasonography in the early diagnosis of mycetoma, avoiding the invasive techniques and preventing debilitating complications that may develop from delay in diagnosis.