Thursday, September 30, 2004
click on the link below--
Wednesday, September 29, 2004
Discussion: The mass prevents the central part of the lobe from losing volume. Because the peripheral lobe collapses and the central portion doesn't, it appears convex centrally and concave peripherally. The shape therefore resembles an S or reverse S, and is called the Golden S sign after Golden's description of cases of lobar collapse caused by carcinoma of the lung.
CHECK THE LINK BELOW----
A Forty-year old man presented with complaint of mild pain right hypochondrium and frequent micturition for last ten months. On clinical examination there was mild hepatomegaly, spleen was not palpable. Chest and cardiovascular examination was normal. Laboratory results showed haemoglobin level of 13.2gm% and a total leucocyte count of 8900/mm3 with 5% eosinophilia. Blood urea levels, creatinine levels, and the results of liver function tests were normal. Examination of urine and faeces revealed no pathological findings.
Ultrasound examination of the abdomen was carried out. Liver showed a well-defined, multiseptae cystic lesion in the right lobe of liver anteriorly showing multiple daughter cysts classic appearance of a hydatid cyst. There was no evidence of calcification. Ultrasonography also revealed another well defined heteroechoic cystic lesion with evidence of internal septations in the pelvis posterior to the bladder displacing the bladder forwards. There was no evidence of calcification. No other cyst was noted. Chest X-Ray was normal. Indirect Hemagglutination test for E.granulosis was positive. A diagnosis of coexistent hepatic and pelvic hydatid was made.
Hydatid disease (Echinococcus granulosus) is endemic in India as well as other parts of the world, including Middle East, Africa, New Zealand, Australia, Turkey and Southern Europe. The clinical presentation of the hydatid disease depends on the size and the site of the lesion and accessibility of the organ involved for clinical examination. Eosinophilia can be present as expected for parasitic infestations. As in this case, the diagnosis of hydatid can be made with US and confirmed by a CT scan. The MRI is also helpful in cardiac and intracranial hydatidosis. Different serological tests can be carried out for the diagnosis, including enzyme-linked immunosorbent assay (ELISA) and indirect haemagglutination (IHA) test. 
Localisation of cysts is mostly hepatic or pulmonary but peritoneal, splenic, pancreatic, thyroid, muscular and bone lesions are also reported. Juxta vesical location, preponderantly retrovesical, is rare. The position follows a tear of a cyst in the superior abdominal area, usually hepatic or splenic, and the parasite settles in the pelvic region of the peritoneal cavity, where a new cyst forms. Such a rupture can occur spontaneously or result from trauma at the operation. Very often the pelvic cyst coexists with a hepatic one, detected before or on the same occasion, so that these cysts are secondary in most cases. 
Pelvic localization may be considered primary if no other site is found to be affected. Such cysts are mostly retrovesical and are even more rare. 
Most frequent presenting symptoms in retrovesical hydatid cyst are frequency, urgency, burning micturition and urinary retention. Although clinical symptoms and signs are not specific of retrovesical hydatid cyst, hydatiduria, which is characterized by the presence in urine of gelatinous material and membranes reminiscent of grape skins in texture, is pathognomonic of a hydatid cyst ruptured in the urinary tract. 
Ultrasonography is the key diagnostic tool in the cases of hydatid cyst. Sonographic appearance can be either a simple cyst containing no internal architecture except sand, cysts with detached endocyst secondary to rupture, cysts with daughter cysts and matrix and densely calcified masses. CT is useful when the diagnosis is in doubt or to determine the relation with other adjacent organs. 
Retrovesical hydatid cyst is uncommon even in endemic areas. It results from peritoneal seedling of a intraperitoneal cyst or from haematogenous dissemination. The present case highlights the role of Ultrasound in diagnosis of retrovesical hydatid cyst, a rare location for hydatid cyst.
Abu-Eshy SA. Some rare presentations of hydatid cyst (Echinococcus granulosus). J R Coll Surg Edinb. 1998; 43(5): 347-52.
Neagu V, Ioanid PC. Juxtavesical hydatid cysts. Eur Urol. 1978; 4(2): 111-4.
Basaranoglu M, Sonsuz A, Perek A, Perek S, Akin P. Primary pelvic hydatid cyst. J Clin Gastroenterol. 1998; 26(2): 157-8.
Horchani A, Nouira Y, Chtourou M, Kacem M, Ben Safta Z. Retrovesical hydatid disease: a clinical study of 27 cases. Eur Urol. 200; 40(6): 655-60.
AJR Am J Roentgenol. 2004 Oct;183(4):1093-6
OBJECTIVE: The purpose of our study was to objectively examine the temporal utilization patterns of CT pulmonary angiography in emergency department and hospitalized patients in an academic tertiary care center. SUBJECTS AND METHODS: Patients who underwent CT examination for suspected pulmonary embolism either through our emergency department or as inpatients during a recent 9-month interval were identified. The absolute number of studies and incidence of positive results and ancillary findings were compared with similar data published from our institution during the corresponding 9-month interval in 1997-1998.
RESULTS: The overall number of patients imaged for pulmonary embolism was significantly greater in the 2002-2003 period than in the 1997-1998 period (homogeneity of rates = 88.45, p < 0.0001). The absolute number of scans obtained was significantly greater in both the emergency department (chi(2) = 167.03, p < 0.0001) and inpatient (chi(2) = 210.62, p < 0.0001) groups in the more recent population. Significantly fewer ancillary findings were reported in both the emergency department (chi(2) = 5.93, p = 0.019) and inpatient (chi(2) = 6.03, p = 0.015) groups in the more recent population. The incidence of CT-detected pulmonary embolism was significantly less in both the emergency department (chi(2) = 34.26, p < 0.0001) and inpatient (chi(2) = 8.52, p < 0.01) groups in the more recent population. This decrease in the incidence of scans with positive findings for pulmonary embolism over time was significantly greater in the emergency department group than the inpatient group (homogeneity of odds = 0.003, p < 0.007).
CONCLUSION: The evolution of CT pulmonary angiography utilization has led to a significant increase in the number of patients being imaged for pulmonary embolism with a coincident significant decrease in the rates of CT-detected pulmonary embolism and ancillary findings both in emergency department and hospitalized patients.
Monday, September 27, 2004
second edition of review of radiology, by dr sumer k sethi, peepee publishers.. is out it is an edition which is updated with a radioloogical quiz and has recieved great reviews world over and is already recieving great feed back
check it out!!!
Saturday, September 25, 2004
Ultrasound is an ugly word in India because of the immediate connection it provokes with female foeticide. And sadly so, because there’s a lot more to ultrasound than pre-natal sex determination. Apart from being more affordable and accessible than other imaging techniques, ultrasound is extremely useful in the diagnosis of pregnancy abnormalities and diseases of the gall bladder and pancreas.
The Indian Radiological and Imaging Association (IRIA), which is campaigning to remove the stigma and restrict the practice of ultrasound only to doctors who have studied ultrasound as part of their postgraduate syllabus, will take up the issue of ultrasound practice once again with the Central Supervisory Board.
The Central Supervisory Board, constituted under the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act (PNDT Act), is scheduled to meet on September 23 for the first time since the new government was formed. The meeting will be chaired by the Union Minister for Health and Family Welfare, Dr Anbumani Ramdass.
The board is responsible for reviewing the implementation of the act, and also for recommending any changes, if required, by the government.
The IRIA will be represented on the board by Dr C.S. Pant, past president of the association. Speaking to AuntMinnieIndia.com, Pant was emphatic that only doctors who have studied US in their postgraduate syllabus should be permitted to perform ultrasonography, which means only those with a two- or three-year postgraduate specialisation in gynaecology or radiology.
"On one hand, the government wants to prevent misuse of ultrasound. On the other hand, it is practically allowing everybody to do it," he said. The IRIA's stand is that restricting the practice of ultrasound to those who are either radiologists or gynaecologists will also reduce the misuse of the modality for sex determination.
For instance, the IRIA, as an association of radiologists, can take action against members who are misusing US. But with more than just radiologists performing US, the association has no control over the misuse of US.
"We are not claiming to curb it. But what we are saying is that we can control it," said Pant, admitting that merely restricting US practice to radiologists or gynaecologists will not eliminate the problem of female foeticide.
Backbone of radiology
But the larger reason why the IRIA is pushing for US to be restricted to those with a postgraduate specialisation is because it believes that US is not a skill that can be learnt in six months or one year.
"If that's the case, then why have ultrasound as a postgraduate course in medicine?" Pant asked. It is the most widely taught subject in radiology in India and makes up close to 70% of the content of a radiology course in US, he said.
He likens the status of US today to the x-ray machine of yesteryear because of its availability. Unlike the more expensive CT and MRI units, ultrasound machines are affordable for nearly every medical university, making ultrasound a very widely taught modality.
"We are (contending) in the Supreme Court that only a radiologist who takes two years or three years to get trained, and then undergoes specialised training in US is qualified to perform US," said Col M.N. Sree Ram, central council member of the IRIA representing the armed forces. The matter is yet to come up for hearing.
Currently, anyone with a basic degree in medicine (MBBS) and even those with a degree from the Indian System of Medicine (including homeopathy, ayurveda, and unani) can practice US.
Harassment under PNDT Act
The IRIA has received complaints that its members are being harassed when they approach the district and state health authorities to register their facilities. Under the PNDT Act, hospitals, clinics, laboratories, and nursing homes that provide genetic counselling, conduct pre-natal diagnostic tests, and analyse test samples need to obtain a certificate of registration.
The act also states, "All records, charts, forms, reports, consent letters, and all other documents are required to be maintained under this Act, and the rules shall be preserved for a period of two years or for such period as may be prescribed."
According to Pant, there is scope for considerable ambiguity in the interpretation of the act, leading to harassment of radiologists. "There is no clear stipulation on the records that need to be maintained. There are no clear guidelines," he told AuntMinnieIndia.com. Harassment is one of the issues that the IRIA will take up at the upcoming Central Supervisory Board meeting.
Strangely, Pant also points out that the board does not have any radiologists among its members although US is performed by radiologists. He himself is a special invitee and not part of the board as envisaged under the PNDT Act. The board consists of geneticists, gynaecologists, paediatricians, social scientists, and representatives of women’s welfare organisations, among others
Wednesday, September 22, 2004
click on the link below for full information--
THE THYMIC SAIL SIGN..
THYMUS IS A NORMAL ANTERIOR MEDIASTINAL SAIL SHAPED STRUCTURE
Monday, September 20, 2004
Bilateral rib notching (Dock's sign) corresponding to the collateral circulation of the internal mammary arteries (ribs 3-8).
Normal heart size (relevant as clinical features may suggest hypertension)
Diagnosis: Coarctation of the Aorta
CLICK HERE FOR THE IMAGE-
Although it was archeologists who discovered the mummified remains of Harwa, an artisan who lived during the XXII or XXIII dynasty, it took multislice CT to put a face on the 3000-year-old Egyptian. An article in the September issue of the American Journal of Roentgenology describes Italian researchers' efforts to reconstruct the mummy's face with the aid of MSCT.CT data have been used in the past to virtually unwrap mummies and reconstruct 3D faces, but this is the first time MSCT was used for this purpose . It allowed for the accurate acquisition of thin overlapping slices, providing much finer detail than has been acquired in the past.“The only other way to have gotten the information we got from MSCT would have been to unwrap, destroy, and otherwise alter the conservation of the bandages and the mummy,” said lead author Dr. Federico Cesarani, of the Struttura Operative Complessa di Radiodiagnostica in Asti, Italy.The facial reconstruction was done in several steps. The researchers first acquired data from the mummy head using the following parameters:· helical scanning· 0.8-sec rotation time· 1.25-mm slice thickness· 7.5-mm/sec table speed· 0.7-mm reconstruction interval, large field-of-view· 120 kVp and 140mAsThey then put the data through postprocessing and used software to automatically reconstruct the head. Further processing allowed the investigators to virtually unwrap the bandages from the head, separating them from superficial dried tissues remaining on the mummy’s skull.Next, they generated a resin model of the head using a system that produces a physical model based on the computer-assisted design file of the object.Anthropologists and forensic artists added the finishing touches to the final model, based on information from the residual soft tissues as seen on the MSCT data. Details garnered from the data were so accurate the artists were able to reconstruct a mole on the left side of Harwa’s face.
Amazing things that can be done with CT these days never thought we radiologists wud be able to help solve Egypt's mysteries..
Sunday, September 19, 2004
answer extradural haemorrhage..
always remember EDH is biconcex and Subdural Hge is concavo-convex.
very important PG entrance question
Most common type of short limbed dwarfism; caused by defect in enchondral bone formation => shortening of tubular bones with normal shaft caliber hereditary: auto-dominant, > 90% sporadic x-ray features: short extremities and ribs v. trunk length "ball-in-socket" epiphyses pelvis: squared iliac wings and narrow sacrosciatic notch ("champagne glass") hands: fingers widely opposed and equal length ("trident hands") skull: enlarged vault and mandible, small f. magnum spine: narrow AP diameter with concave posterior surface and spinal canal only 1/2 normal depth decreased lumbar interpediculate distance hypoplastic ("bullet nose") T-L vertebrae
a very important spot for undergraduates, post graduates and also asked in a lot of entrance exams......
all radiology residents are supposed to know ICRP recommendations and are always asked bout the latest so this is official site of ICRP for accurate information...
Saturday, September 18, 2004
Diffusion Imaging is an excellent review by Mathias Hoehn, from Max-Planck-Institute for Neurological Research, Cologne, Germany. Available at http://www.ujf-grenoble.fr/ismrm/Diffusion/diffusion_outline.htm this important topic is dealt under several sections including Historical Outline, Theory, Artefacts and Corrections, Free and Restricted diffusion, basics of Anisotropy, Incorporation of Diffusion Weighting into Imaging Sequences and Applications to Biomedical Research
Diffusion MRI at http://www.irc.chmcc.org/Research_Areas/brain/diffusion.htm is a brief treatise focusing on principles of Diffusion MRI and Diffusion Tensor MRI. In addition the site focuses on projects such as Age Differences in the Normal Pediatric Population and Differences in White Matter Architecture between Musicians and Non-Musicians.
For the evaluation of blunt abdominal trauma which of the following imaging modalities is ideal:
a) Ultrasonography b) Computed tomography
c) Nuclear scintigraphy d) Magnetic resonance imaging
Angiographically, the typical beaded or “Pite of plates” appearance involving the internal carotid artery is observed in:
a) Takayu’s disease b) Non-specific aorto-arteritis
c) Fibromuscular dysplasia d) Rendu-Osler-Weber disease
The right lobe of the liver consists which of the following segments:
a) V, VI, VII and VIII b) IV, V, VI, VII and VIII
c) I, V, VI, VII and VIII d) I, IV, V, VI, VII and VIII
The investigation of choice for imaging of urinary tract tuberculosis is:
a) Plain x-ray b) Intravenous urography
c) Ultrasound d) Computed tomography
Which of the following usually produces osteoblastic secondaries:
a) CA lung b) CA breast c) CA UB d) CA Prostate
After contrast media injection in the radiology department, a pt develops severe hypotension, bronchospasm and cyanosis. Which one of the following drugs should be used for treatment:
a) Atropine b) Aminophylline
c) Dopamine d) Adrenaline
Friday, September 17, 2004
Dear Drs Sumer and Siddarth Sethi
Please Accept my heartiest Greetings for Authoring excellent book Aiims May 2004The Information is very comprehensive and very high yielding. The extensive information on Lasers, Hombox gene and leukemia was excellent. Congratulations and hope to see your book on upcoming Aiims exam
A PG ASPIRANT
All the 200 Questions of AIIMS May 2004 solved with references and detailed explanations. The answers are referenced from Standard textbooks and the basics as well as the high yield points of the particular topic are given in detail.
Detailed Discussion of HOX Genes
a sample section of the book
Kluver-Bucy Syndrome Bilateral destruction of the amygdaloid body and inferior temporal cortex results in emotive behavioral changes known as Kluver-Bucy syndrome. The amygdala is a brain area located in the subcortical region of the temporal lobe. Human occurence of Kluver-Bucy syndrome typically results from surgical lesions, meningoencephalitis, or the rare disorder, Pick's Disease. Symptoms of Kluver-Bucy Syndrome 1. Emotional Blunting: The subject suffering from Kluver-Bucy displays a flat affect and may not respond appropriately to stimuli. Following bilateral amygdala lesions, previously fierce monkeys will approach fear-inducing stimuli with no display of anger or fear. 2. Hyperphagia: Patients with Kluver-Bucy often suffer from extreme weight gain without a strictly monitored diet. This is likely for the purpose of oral stimulation or exploration and not indicative of a satiety disorder. There is a strong tendency for those with Kluver-Bucy to compulsively place inedible objects in their mouths. 3. Inappropriate Sexual Behavior: Human subjects with Kluver-Bucy may fail to publicly observe social sexual morays and there may be an increase in their sexual activity. Monkeys with bilateral amygdala lesions demonstrate atypical sex behaviors, mounting inanimate objects and members of the same sex. 4. Visual Agnosia: Subjects with Kluver-Bucy suffer from "psychic blindness," i. e. an inability to visually recognize objects. Oral compulsions may provide an alternate means of object identification.
Thursday, September 16, 2004
A reevaluation of the National Institute of Neurological Disorders and Stroke data confirms the benefit of intravenous tissue plasminogen activator for the acute management of ischemic stroke.
Pearls for Practice
T-PA treatment within NINDS protocol guidelines within three hours of acute ischemic stroke presentation is associated with a favorable outcome at three months (OR, 2.1) compared with placebo.
Less favorable outcome for t-PA is associated with older age, increasing stoke severity, history of diabetes, and preexisting disability.
Wednesday, September 15, 2004
these links give some intersting features particularly the book review which is unique to this site and offers a lot of information on various pg entrance books
these links give some intersting features particularly the book review which is unique to this site and offers a lot of information on various pg entrance books
Although it was intended for Post-graduate students preparing for medical admission tests of All India and the different states, I find this book also useful to other post-graduate students from other parts of the world especially in the developing world like Africa…The book is well written and comprehensive ….Its size is a further advantage because of the short time made available in the curriculum of Medical students…Finally the book provides a clear, concise and in-depth knowledge of the various radiological procedures, highlighting various imaging techniques that are now the vogue in Medical diagnosis.
Prof. P.S. Igbigbi
Dean of Medicine
College of Medicine
University of Malawi
One of the main advantages of this little book is that is packed with information, which has been presented in points, so that it can be easily remembered by both undergraduate medical students and doctors on their way to specialization….this is a valuable quick reference and concise pocket book on Radiology, not only for students but for specialists too
Dr. Dimitrios I Zafeiriou Assistant Professor in Child Neurology and Developmental Pediatrics Aristotle University of Thessaloniki, Greece
The author should be congratulated for assembling basic information on Radiotherapy. Most doctors especially in the developing world have no practical experience of the subject in any form.The concept of this book and its arrangement are brilliant.
Prof Ndubuisi Eke, FRCSEd, FWACS
University of Port Harcourt, Port Harcourt, NIGERIA.
A sincere and successful effort at providing the maximum amount of essential and up-to-date information to undergraduates about the subject of Radiodiagnosis and radiotherapy in the most comprehensive manner. A point based systematic approach, simple illustrations and tables permit a complete review of the subject in a manageable time. A glossy, colourful coverpage takes away the monotony from the black and white world of X-rays! An indispensable book for medical students.
Professor (Radiodiagnosis), Lady Hardinge Medical College
Opinions of a few PG aspirants
Good things come in small packages. Review of Radiology is a book that lives up to this adage and more... This book has the unique quality of being all inclusive, yet in a manner that allows efficient utilization of time…Within a few hours, it gives you a feeling of one subject under your belt…Kudos to the author for aiding overburdened students to scale one hurdle with relative ease…
Hats off to book on radiology- very comprehensive authentic and manageable in small time. The Information is very comprehensive and very high yielding…
The success of the author lies in the fact that he has been able to give SO MUCH OF THE "NEEDED" POINTS in so few pages. ..Most of the points that are given in the book have been already asked and more importantly almost all questions that have been previously asked can be solved with this little book…This book is bound to be one of the classics of PG Preparatory … “This book can be read at the cost and time of two movies” and to answer 100 % in State PG and about 90 % (87.5 % to me more accurate) in All India (where you are expected to answer 66 % correctly to get into the top 100 ranks) from such a small book is commendable and the author needs to be appreciated
Quantification of internal carotid artery stenosis with duplex US: comparative analysis of different flow velocity criteria.Sabeti S, Schillinger M, Mlekusch W, Willfort A, Haumer M, Nachtmann T, Mullner M, Lang W, Ahmadi R, Minar E.Dept of Angiology, Vienna General Hosp, Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria.PURPOSE: To compare 13 previously published sets of duplex ultrasonographic (US) criteria with the US criteria used at the authors' institution in terms of agreement with carotid artery angiographic results. MATERIALS AND METHODS: The authors studied 1,006 carotid arteries in 503 patients at duplex US and angiography. The degree of stenosis was determined by using duplex flow US velocities and applying 13 previously published sets of criteria and the criteria used at the authors' institution. Two independent observers evaluated the angiograms according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. kappa statistics, sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs), and generalized linear mixed regression models were used to assess agreement between duplex US and angiographic findings. RESULTS: Stenoses of 0%-29%, 30%-49%, 50%-69%, 70%-99%, and 100% could be differentiated with 73% overall agreement between duplex US and angiographic findings according to flow velocity criteria (kappa = 0.57; 95% confidence interval [CI]: 0.54, 0.60); however, with duplex US, the angiographic degree of stenosis tended to be overestimated. In the differentiation of stenoses of less than 70%, only 45% agreement (kappa = 0.26; 95% CI: 0.23, 0.29) was observed, whereas in the differentiation of high-grade (> or =70%) stenoses, 96% agreement was observed (kappa = 0.85; 95% CI: 0.83, 0.87). The PPV and NPV for the identification of 70%-99% angiographic stenosis were 69% and 98%, respectively, with use of the most sensitive duplex US criteria. CONCLUSION: Duplex US is an excellent examination to screen for high-grade carotid artery stenosis; however, it tends to lead to an overestimation of the degree of stenosis. Exclusion of 70%-99% angiographic stenosis can be achieved with a sensitivity of up to 98%.
Tuesday, September 14, 2004
links to my email are available in my profile
best of luc buddies!!!
Assistant Professor in Child Neurology and Developmental Pediatrics
Aristotle University of Thessaloniki
"Review of Radiology" by Sumer K. Sethi, Peepee publishers, New Delhi, India, 145 pages, is a small pocket book aimed mainly at the overburdened undergraduate medical student.
The book is divided in 3 main chapters, namely General Radiology, Systemic Radiology and Radiotherapy (total of 66 pages), which are followed by a last Chapter on Commonly Asked Questions and Answers, covering more than half of the total book pages (79 pages).
One of the main advantages of this little book is that is packed with information, which has been presented in points, so that it can be easily remembered by both undergraduate medical students and doctors on their way to specialization. In some instances one finds himself trying to remember to include all possible differential diagnoses of a specific X-ray sign (i.e. wormian bones on scull X-ray) before reading further; in this way this fine booklet serves as a differential diagnostic compendium too.
There are some minor points which need to be carefully thought in the next revised edition, especially the amount of pages devoted to some Chapters: i.e. the Chapter on Radiotherapy is probably too long for the public the book was designed to appeal to (much is discussed on theoretic background of Radiotherapy, something that is carefully omitted in other Chapters), while in the other hand the information given on Pediatric Radiotherapy is probably too little. There are some classification problems too: for example trisomy 18 and Downs syndrome are listed among metabolic and hematological disorders. However, the information given is correct and what one could have entitled as “classic” knowledge.
The multiple choice questions at the end of the book beautifully summarize the main points of the previous chapters and help to test one's knowledge on radiology and radiotherapy.
In conclusion, this is a valuable quick reference and concise pocket book on Radiology, not only for students but for specialists too
Monday, September 13, 2004
SK SETHI, U HEMAL, RS SOLANKI, A BHAGRA
Ind J Radiol Imag 2004 14:1:65-66
Key Words: Chorioangioma, Placenta
Chorioangioma constitutes the commonest benign growth of placenta. It consists of a benign angioma arising from chorionic tissue. Chorioangioma is often associated with unfavourable effects on the mother as well as on the fetus. With the advent of gray scale and color flow ultrasonography in prenatal diagnosis these tumours can be easily detected antenatally. We present a case of Choriangioma with associated polyhydramnios and PIH, detected antenatally on gray scale and color flow imaging.
A healthy 22year old primigravida presented at 28 weeks of gestation by dates with history suggestive of PIH and severe edema. On admission the physical examination revealed blood pressure of 150/100, respiration rate of 18/min with mild pallor. The patient had evidence of pitting edema of her lower extremities. Her Hb was 8.6gm% and her VDRL was negative. Urine examination revealed evidence of albuminuria.
Ultrasonography revealed a single fetus. Lie was transverse. The biparietel diameter was 74mm and femur length being 51mm both corresponding to a 28 weeks Gestation. Abdominal circumference (240mm) and head circumference (268mm) both corresponded to a 28 weeks period of gestation. There was no craniospinal anomaly. Fetal stomach, kidneys and bladder were normal and the umbilical cord was trivascular. Fetal cardiac four chamber view was normal and there was no pleural effusion or ascites. Polyhydramnios was present. The placenta was on the right lateral wall, was not low lying and was grade II. A well-defined oval echogenic mass measuring 7.5 x 6 cm having echogenicity different from the rest of placenta with focal area of peripheral hypoechogenicity was noted in the central part of the placenta close to the insertion of the umbilical cord causing a lobulated bulge on its fetal side. On color Doppler imaging a central feeding vessel was seen which showed a branching pattern and on pulsed Doppler it showed a pulsatile flow at a rate similar to that of umbilical artery. Patient was admitted and was advised absolute bed rest. The patient delivered vaginally at 34 weeks of gestation. The female infant weighed 1200 gm and had apgar scores of 7 and 7 at one and five minutes respectively. The placenta contained a lobular gray and tan coloured mass measuring 8 x 6 cm. histology showed marked proliferation of small capillaries with intervening loose, fibrous stroma compatible with chorioangioma.
Placental chorioangioma is the most common benign tumour of the placenta, occurring in approximately 1% of all pregnancies or in 0.5-1% of all placentas examined at term. It consists of a benign angioma arising from chorionic tissue. Three histological patterns of chorioangiomas have been described: angiomatous, cellular and degenerate. The angiomatous is the most common, with numerous small areas of endothelial tissue, capillaries and blood vessels surrounded by placental stroma. The cellular pattern has abundant endothelial cells within a loose stroma. The degenerate pattern has calcification, necrosis or hyalinization. These lesions are sometimes classified as placental hamartomas rather than true neoplasia. 
Most chorioangiomas are of no clinical importance. Those measuring more than 5 cms in diameter may be associated with complications that can affect the mother, the fetus or the neonate. 
Of the various reported clinical complications, the correlation of chorioangioma with hydramnios and premature delivery is significant, latter being a sequela of the hydramnios. The association with hydramnios is significantly correlated with the presence of large tumours. Fetal congestive heart failure may develop because of the increased blood flow through the low resistance vascular channels in the chorioangioma acting as an arteriovenous shunt. Other associated complications
being hydrops, anemia, and growth retardation. 
Antenatal ultrasound has made diagnosis and follow up possible before delivery. Usual gray scale findings include intraplacental subchorionic location, well-defined circumscription, complex echogenicity different from rest of the placenta, single or multiple tumours and protusion into the amniotic cavity near the insertion of the umbilical cord. 
Chorioangiomas show vascular channels in the tumour, which show pulsatile flow in the vascular spaces of the tumour, at the same pulsation rate as the umbilical cord. Color Doppler imaging is important not only for differentiating chorioangioma from other placental lesions but also for confirming that vascular channels in the tumour are continuous with the fetal circulation, thus ruling out other diagnosis such as degenerated myoma, placental teratoma, and incomplete hydatidiform mole. [5,6]
Due to the apparently high fetal death rate associated with large chorioangiomas, early diagnosis is necessary so that fetal surveillance can be instituted. In the present case characterstic gray scale and Doppler findings confirmed the diagnosis of chorioangioma. Doppler studies were particularly useful in confirming the presence of vascular channels with a pulse rate equal to the fetal heart rate.
Grundy HO, Byers L, Walton S, Burblaw J, Dannar C. Antepartum Ultrasonographic evaluation and management of Placental chorioangioma. The J Reproductive Medicine 1986;31(6): 520-522.
Naik RD, Lobo FD, Kamath AS. Chorioangioma of Placenta: report of three cases. Indian J Pathol Microbiol 1993; 36(3): 285-288.
Wallenburg HCS. Chorioangioma of the placenta-review. Obstetrical and Gynecological Survey. 1971; 26: 411-425.
Dao AH, Rogers W, Wong SW. Chorioangioma of the placenta: Report of 2 Cases with Ultrasound Study in 1. Obstet Gynecol 1981; 57(6S): 46-49.
Zalel Y, Gamzu R, Weiss Y, Schiff E, Shalmon B, Dolizky M. Role of Color Doppler Imaging in Diagnosing and managing pregnancies complicated by Placental chorioangioma. J Clin Ultrasound 2002; 30: 264-269.
Kung FT, Chen WJ, Hsu PH, Wu JF, Chang SY. Large chorioangioma: antenatal color flow Doppler ultrasonographic imaging and its correlation with post-partum pathology. Acta Obstet Gynecol Scand 1997;76: 277-279.
a) Metrizamide b) Iopamidol c) Iohexol d) Iothalamate
Retrograde Pyelography is most useful investigation in :
a) Non visualization of kidney in IVP b) In all cases of hydronephrosisc) Horse shoe kidney d) Ectopic kidney
For posterior urethral valve, investigation of choice is :a) RGU b) MCU c) CT scan d) Ultrasound
To differentiate between gall stone and renal stone which of the following is true about Xray :
a) Triradiate sign is seen in renal stone & not in gall stones
b) Renal stone is placed more laterally than gall stones
c) In lateral view of Xray , renal stone overlies the vertebra while gall stones are anterior to vertebra
d) Renal stone is in relation to L2 - L4 while gall stone is at L1
Sunday, September 12, 2004
example of a question
A young patient presents with history of dysphasia nerve to liquids than solids. The first investigation you will do is
a) Barium swallow b) Esophagoscopy
c) Ultrasound of the chest d) CT scan of the chest
MRCP VERSUS ERCP
- MR cholangiopancreatography is noninvasive and safe, because it does not require anesthesia or injection of intraductal or intravenous contrast agent. On current MR imaging systems high-quality images can be obtained consistently.
- MRCP is useful in patients after incomplete or unsuccessful ERCP In some patients, such as those who have undergone surgery with biliary enteric anastomosis or Billroth II, it may not be possible to perform ERCP, so MRCP is the modality of choice to evaluate these postsurgical patients.
- Unlike ERCP, MRCP produces images of the ducts in their natural state, because it does not involve distention of the ducts by injected contrast medium. ERCP cannot evaluate extraductal structures directly, whereas MRCP can be combined with conventional MR imaging for the evaluation of extraductal disease, such as tumors.
- ERCP has advantages over MRCP, which include direct therapeutic interventional procedures that may be performed concurrent with diagnostic imaging.
- ERCP is generally a safe procedure, but still associated with nonnegligible morbidity and mortality rates. Also, technical failures occur in up to 10% of cases because of unsuccessful cannulation of the common bile duct (CBD) or pancreatic duc. In some institutions MRCP is gradually replacing ERCP as a primary diagnostic imaging modality to evaluate the biliary system and pancreatic duct.
A 25 years old man presents with cough , fever, expectoration and breathlessness of 2 months duration . CECT of chest shows bilateral upper lobe fibrotic lesions and mediastinal lymph nodes show enlarged necrotic nodes with peripheral rim enhancement. diagnosis is
a. Sarcoidosis b. Tuberculosis c. Lymphoma d. Silicosis
A 30 years old hiv positive patient presents with fever dyspnea, non-productive cough. pt is cyanosed. his chest x-ray reveals bilateral symmetrical interstitial infiltrates. diagnosis is
a. tuberculosis b. Pneumocystis c.toxoplasmosis d. cryptococcosis
The radiological signs of PTE are all except:
a. Melting sign b. Hampton’s hump c. Cut off sign
d. Westermark’s sign e. None
The roentgen ® is defined as a unit of radiation exposure that will liberate a change of 2.58 x 10-4 Coulombs per kilogram of air.
The rad is the unit of absorbed dose. One rad is equal to the radiation necessary to deposit energy of 100 ergs in 1 gram of irradiated material.
Gray (Gy) is the SI unit for absorbed dose
1 Gy = 100 rads
1 rad = 1 c. Gy (Centigray)
The rem is a unit of absorbed dose equivalent. The rem is a unit used only in radiation protection.
The rem is a measure of the biological effectiveness of radiation.
SI unit of absorbed dose equivalent is Sievert.
1 Sievert (Sv) = 100 rems
Rem = Rads x Quality factor
B/ c the quality factor for Xray is 1 , therefore diagnostic energy levels.
1R = 1 rad = 1 rem
a) Phalanges b) Skull c) Pelvis d) Sternum
2) ‘Honey comb appearance’ lung is seen in which of the following neurocutaneous syndrome?
a) Von Reckling heusen’s disease b) Sturge weber syndrome
c) Tuberous sclerosis d) Von ippel lindau disease
3) In chest x-ray PA view, hilum is formed by following except:
a) Upper lobe vein b) Lower lobe vein
c) Proximal bronchii d) Pulmonary artery
4) ‘Candle wax’ appearance is seen in:
a) Osteogenesis imperfecta b) Melorheostosis
c) Diaphyseal dysplasia d) Exostosis
5) Flask shaped femora seen in all except:
a) Osteomalacia b) Osteopetrosis
c) Gaucher’s disease d) Thalasemia
6) Most radioresistant blood cell is:
a) Lymphocyte b) Neutrophil c) Platelets d) All are equal
7) Compound used in PET is:
a) Tc99 MDP b) I-131 seen c) 18 Flurodeoxy glucose d) All can be used
8) PET is a:
a) Anatomical scanning b) Functional scanning c) Both d) None
9) Half life of Tc99 is:
a) 6 hrs b) 8 hrs c) 10 hrs d) 12 hrs
10) “Continuous diaphragm” is seen in:
a) Pneumothorax b) Pleural effusion
c) Pneumo pericardium d) Pneumo mediastinum
11) CT Scan is useful in lesions of:
a) Optic N b) Trigeminal N c) Trochlear N d) Hypoglossal N
12) The commonest tumour with of metastasis to the small bones of hand is carcinoma of:
a) Breast b) Lungs c) Stomach d) Testis
13) The contrast agent used in contrast enhanced CT is:
a) Iodine b) DTPA c) Xenon d) Air
14) Radiological investigation in a female of reproductive age should be restricted to:
a) First 10 days of cycle b) Last 10 days
c) 10-20th days d) Period of menstruation
v Due to Vit. C deficiency
v Characterised by generalised hemorrhagic tendency.
v Most common in infants between 5 - 10 months
v When associated with Rickets : Barton's Disease
v Endochondral ossification ceases.
Clinical Features :
v Restless, Fibrile child
v Affected limb is swollen, tender, painful with muscular spasm (Pseudo Paralysis)
v Bluish spongy gums especially upper central incisor
v Skin ecchymosis, hematuria, hematemesis
v Epiphyseal fracture separation : At lower femur, upper tibia, upper humerus
Costochondral separation (Scorbotic rosary)
X - Rays :
v Groud glass appearance
v Subperiosteal haemorrhage - ossification
A. White line of frankel : dense line between Epiphysis and Metaphysis
B. Scurvy Line : Dense line between Metaphysis
C. Wimberger's Line : Dense line within epiphysis
D. Pelkan Spur : A bone spur from lateral border of metaphysis
Saturday, September 11, 2004
Key words: Conjoined Twins
One of the most interesting congenital malformations is a conjoined twin. Conjoined twins are a rare occurrence in obstetric practice. More commonly known as Siamese twins, this phenomenon is shrouded in mystery and considered a curiosity by general public. Current technology is providing a basis for earlier diagnosis and a better prognosis. Frequently, the twins are born dead, but there are few cases in which the twins survive. We present a case of Dicephalus Dipus Conjoined Twins; a rare type of conjoined twins.CASE REPORT
A 29 year old women, gravida3, para 2 Last childbirth - FTNVD male baby. She had regular menstrual periods before getting pregnant. Her grandmother had a history of twins. She was an unbooked case with no antenatal Ultrasound report. She presented to our hospital at term in the second stage of labour and underwent a vaginal delivery. Twins were delivered as breech. Twins had single male external genitalia, weighing 3 kg together. Placenta was single. On clinical examination it was noted that the twins were conjoined from level of xiphisternum downwards. The twins had two heads, two pairs of upper limbs, a shared pelvis and a single pair of lower limbs (dicephalus, tetrabrachius, dipus twins). Twins had single male external genitalia. Two separate heartbeats were auscultated with heart rate of around 146/min, respiratory rate being 45 for right twin and 52 for the left twin. No murmur was evident clinically. An infantogram was done to further assess the twins; findings of clinical examination were confirmed. Twins had a two heads, two thoraces, two pair of upper limbs and a shared abdomen, pelvis and a single pair of lower limbs. X-ray revealed the twins had two separate thoraces, two hearts and two vertebral columns. Echocardiography revealed that both the hearts were morphologically grossly normal, with no evidence of any gross cardiac anomaly. Ultrasonography of the abdomen revealed a shared liver, a single spleen on the left side and a single pair of kidneys. There was no evidence of any hydronephrosis. Twins were referred to a higher center for surgical management.
Four days after fertilization the trophoblast (chorion) differentiates. If the split occurs before this time the monozygotic twins will implant as separate blastocysts each with their own chorion and amnion. Eight days after fertilization the amnion differentiates. If the split occurs between the 4th and 8th days, then the twins will share the same chorion but have separate amnions. If a split occurs after the 8th day and before the 13th day, then twins will share the same chorion and amnion. This is a very rare condition and accounts for 1-2% of monozygotic twins. The embryonic disk starts to differentiate on the 13th day. If the split occurs after day 13, then the twins will share body parts in addition to sharing their chorion and amnion. 
The classification of conjoined twins is based on the site of union. The suffix-pagus is used meaning fastened. Thoracopagus - shared thorax. 90% have a shared heart. Omphalopagus - shared abdomen. Thoraco-omphalopagus - one of the most common types. Ileopagus - connected at the iliac bone. When the twins are extensively connected then the duplicated part is named. For example, dicephalus refers to two heads with one body. 
An attempt to standardise and classify conjoined twins according to the external forms of conjunction has been proposed by Leacham (Table 1) 
Table1. Classification of conjoined twins
Thoracopagus Cephalo-thoracopagus Dicephalus Craniopagus Omphalopagus Rachipagus Thoraco-omphalopagus
Joined at chestJoined at head and chestSingle trunk and two headsJoined at headJoined at abdomenDorsal union of head and trunkJoined at chest and abdomen
Regardless of the site of union, variations occur with regard to the internal organs. Certain organs may be common to both twins or these may be separate. In the thoracophagus, the heart is often conjoined with associated cardiac anomalies, and in omphalopagus the liver is often conjoined. Prognosis, obstetric management, and treatment planning are determined by degree of fusion and extent of joining of fetal organs. Cesarean section is recommended in most third-trimester deliveries because of the high incidence of dystocia and resultant fetal damage. 
Antenatal diagnosis by ultrasound is possible in modern day obstetrics. Ultrasonographic identification of any of the following classical signs may suggest the diagnosis: both fetal heads in the same plane, unusual backward flexion of the cervical spine, no change in the relative position after maternal movement and manual manipulations and inability to separate fetal bodies after careful observation. 
Dicephalus Dipus Conjoined Twins form a rare variant of conjoined twins. Such variants are usually stillborn or die immediately after birth, but some including the Scottish brothers of James III have lived for a number of years. As most of the studies concentrate on the obstetrical problems, the anatomical description of the dicephalus twins is often incomplete. A conjoint twin is frequently the mirror image of its partner and this is particularly true in dicephalus twins. The right set of lungs may be a mirror image of the normal and the right aorta usually has a right aortic arch. The liver is always single and there is usually one spleen and that is on left. The right stomach may be atrophic but is usually present, and the intestines almost always join either just distal to the duodenum or at the level of Meckel's diverticulum. Diaphragmatic hernia are also frequent. The right sided twin of the dicephalus dipus twin will usually have complex cardiovascular anomalies not amenable to surgical correction. This should be taken into account if the surgical separation of this variant of conjoined twins is planned. 
Separation of conjoined twins is complicated procedure. The importance of multidiscipline team with rehearsal of all aspects (surgical, anesthetic and nursing) of the operative procedure cannot be overemphasized. Although the outcome is influenced by careful planning and organization from all participants, the prognosis is often predetermined by the underlying anatomy which may preclude successful separation. 
Although, conjoined twins are rare, occurring in approximately 1 per 50,000 to 1 per 100,000; it should be suspected in all monochorionic, monoamniotic twin pregnancies, and careful sonographic assessment should be performed to identify the presence of shared fetal organs. 
Siamese twins or double monsters have always been a subject of curiousty and mystery for the general public. The present case highlights morphological features of an antenataly undiagnosed Dicephalus Dipus Conjoined Twins, a rare form of conjoined twins. Indirectly emphasizing the importance of careful antenatal sonographic assessment in all monochorionic, monoamniotic twin pregnancies to rule out conjoined twins. Early prenatal diagnosis and precise characterization of conjoined twins are essential for optimal obstetric, interventional and postnatal management as well as to reduce psychological trauma to the parents.REFERENCES
Finberg HJ. Ultrasound Evaluation In Multiple Gestation. In Callen's Ultrasonography in Obstetrics and Gynecology:Harcourt Publishers 3rd edition,1994;Chapter 8:121-124.
Gerlis LM, Seo JW, Ho SY, Chi JG. Morphology of the cardiovascular system in conjoined twins: spatial and sequential segmental arrangements in 36 cases. Teratology. 1993; 47:91- 108.
Tandon R, Sterns LP, Edwards JE. Thoracopagus Twins. Arch Pathol 1974; 98: 248-251.
Kalchbrenner M, Weiner S, Templeton J, Losure TA. Prenatal Ultrasound Diagnosis of Thoracophagus Conjoined Twins. J Clin Ultrasound 1987; 15: 59-63.
Golladay ES, Williams GD, Seibert JJ,Dungan WT, Shenefelt R. Dicephalus Dipus Conjoined Twins: A surgical separation and review of previously reported cases. Journal Of Pediatric Surgery 1982; 17(3): 259-264.
Miller D, Colobani P, Buck JR, Dudgeon DL, Haller JA. New techniques in the diagnosis and operative management of Siamese twins. . Journal Of Pediatric Surgery 1983; 18(4): 373- 376.
Levi CS, Lyons EA, Martel MJ, Dashefsky SM, Holt SC. Sonography in the diagnosis and management of Multifetal Pregnancy. In Rumack's Diagnostic Ultrasound: St. Louis, Mosby- Year Book Inc,1997;Chapter 35: 1062-1065.
full article on www.ijri.org
1.Sardarji is not sleeping with his wife these days because somebody hadtold him that it is wrong to sleep with married women.
2.A sardarji was working as editor in a daily newspaper. Once he wastraveling to Bombay to deliver a speech about railway departmentimprovements. His coach was the last coach in the train. The train wasmoving very fast and so sardarji’s coach was jerking heavily. This madehim not to prepare for the speech. Annoyed by the event, next day in themeeting, his first point towards improvement of railway department was“There should not be last coach in any train.”
3.A Sardarji goes to a hotel and eats heartily. After eating he goes towash his hands but starts washing the basin instead. The manager comesrunning and asks him, “Prahji, aap kya kar rahe ho?” To this the manreplies,”Oye, tumne hi to idhar board lagaya hai, “Wash Basin”.
4.Two sardarjis were sitting outside a clinic. One of them was crying likeanything. So the other asked, “Why are you crying?” The first onereplied, “I came here for blood test” Second one asked, “So? Are youafraid?” First one replied, “No, not that. During the blood test theycut my finger” Hearing this the second one started crying. The first onewas astonished and asked other, “Why are you crying?” The other replied,“I have come for my urine test.”
5.Our sardarji was filling up an application form for a job. He promptlyfilled the columns titled NAME, AGE, ADDRESS etc. Then the column SEX.He was not sure as to what to be filled there. After much thought hewrote THRICE A WEEK. On seeing this in his application form, he was toldthat it was wrong and what they wanted it to be filled was either MALEor FEMALE. Again our sardar thought for a long time before coming upwith the answer: PREFERABLY FEMALES.
6.Santa Singh applied for an engineering position at an MNC office inAmritsar. Reddy from Chennai applied for the same job and bothapplicants having the same qualifications were asked to take a test bythe Department manager. Upon completion of the test, the results showedthat both men only missed one of the questions. The manager went toSanta and said, “Thank you for your interest, but we’ve decided to givethe job to Reddy”. Santa: “And why would you be doing that? We both got9 questions correct. This being Punjab I should get the job!” Manager:“We have made our decision not on the correct answers, but on the onequestion that you got wrong.” Santa: “And just how would one incorrectanswer be better than the other?” Manager: “Simple, for the questionthat both of you got wrong, Reddy put down ‘I don’t know’ as the answer.And you wrote ‘Neither do I’!”
7.Sardarji praising his son who is a Civil engineer, who just laid a roadnear his house. “Wow! This is terrific! Look at the job he has done! Thedistance from my house to the railway station is the same as the railwaystation to my house!!!!!!!!”
8.A sardarji once took an answering machine home in Punjab anddisconnected it within a couple of days because he was gettingcomplaints from his relatives like “Saala phone utha ke bolta hai kighar pe nahin hai”
9.One train which was going peacefully on the rail-tracks suddenlydeviated from the tracks and went to the fields nearby and then cameback on the tracks.The passengers were horrified.On the next Railway station, the driver was caught He was found to be aSardar. When he was questioned. He explained that there was a manstanding on the track and he was not moving from there even after lotsof honks etc.Then authorities questioned :Sardarji are you mad! just to save life of one person you put life of somany passengers under danger. You should have run over that person.Sardar said : Exactly,that is what I also decided, but this idiotstarted running towards the field when the train came very close!
10.Santa Singh and Banta Singh were discussing how they would like to die.Santa said, “When I die, I want to go peacefully like my Grandfatherdid,in his sleep. I dont want to die screaming like some of hisfriends,who also died at the same time.”Banta asked, “How did his friends die screaming while your grandfatherdied sleeping peacefully?”Santa Singh replied, “His friends were the passengers in the car he wasdriving.”
11.Hamare apne zail ji….Zail Singh was preparing for his MBA exams.He could understand everything except for the LOGIC part.One day when he was reading Rajiv came home.RAJIV: Zail singhji, How is your MBA preparation?Zail Singh: Every thing is fine, but I could not understand Logic.RAJIV: Logic is very easy.Zailsingh: Can you give me an example,so that I can understand.RAJIV: OK,Do you have fish pot in your house?Zail : YES.RAJIV: Logically, there will be water in it.Zail : YES.RAJIV: Logically, there will be fish in it.Zail : YES.RAJIV: Logically, someone will be feeding the fish.Zail: YES.RAJIV: I take a guess that your wife will be feeding the fish.Zail : YES.RAJIV: so, Logically, you are married.Zail: YES.RAJIV : SO, logically you are not homo sexual.Zailsingh was very glad that he understood logic. Next day he sees ButaSingh who was also preparing for MBA.Zail: How is your MBA preparation?BUTA : Everything is fine except for the logic.Zail : oh, logic is easy Rajiv explained me yesterday.BUTA : Please give me an example ...Zail : Do you have a fish pot in your house?BUTA : NO, I dont.Zail : Then your are homo sexual!
HOPE U HAVE A HEARTY LAUGH!!!!!!!
Lady Hardinge Medical College
REVIEW OF RADIOLOGY
Sumer K Sethi
Pee Pee Publishers
Good things come in small packages. Review of Radiology is a book that lives up to this adage and more. Written in a student-friendly & comprehensive manner, it is intended for PG aspirants who have to cover a myriad of subjects in as short a time as a few months. Radiology (Radiodiagnosis and Radiotherapy ) forms a significant & easily-scored part of it, nonetheless one for no standard yet time-friendly book is available on the shelf. That is until now. This book has the unique quality of being all inclusive, yet in a manner that allows efficient utilization of time. It fits in the pocket of your coat and I have had the luxury of enjoying it between lunch breaks and travel times without once feeling burdened by it. The text is divided into apropos sections, including an extensive list of frequently asked MCQs from recent examinations at the end. Within a few hours, it gives you a feeling of one subject under your belt. It isn’t just packed with facts that overwork the rote memory, there are ad rem explanations & mnemonics that make retention easier. This book should soon become a favorite with exam-going students. Kudos to the author for aiding overburdened students to scale one hurdle with relative ease.
(Dr. Pakhee Aggarwal)
A pg aspirant
BOOK REVIEW – REVIEW OF RADIOLOGY
The Book Review of Radiology written by Sumer Kumar Sethi is a synopsis of what Post-graduate medical students require in Radiology. Although it was intended for Post-graduate students preparing for medical admission tests of All India and the different states, I find this book also useful to other post-graduate students from other parts of the world especially in the developing world like Africa.
The book is structured into four main sections which deals with all aspects of Radiology and Radiotheraphy. It is presented in an outline format for easy understanding and multiple choice questions and answers are also provided to assess students understanding and aid memory.
The book is well written and comprehensive and will greatly assist all interested in the very important subject of Radiology and Radiotherapy.
Its size is a further advantage because of the short time made available in the curriculum of Medical students.
Finally the book provides a clear, concise and in-depth knowledge of the various radiological procedures, highlighting various imaging techniques that are now the vogue in Medical diagnosis.
Prof. P.S. Igbigbi
Dean of Medicine
College of Medicine
University of Malawi
Private Bag 360, Blantyre
Friday, September 10, 2004
Given that the U.S. sets great store by the quality of their training and practice standards, it is only appropriate that the expectation of that standard of care be met.
By N. Shivapriya AuntMinnieIndia.com staff writer, August 20, 2004
Ind J Radiol Imag 2004 14:1:95-96
Schizencephaly is one of the migrational disorders of brain, which include lissencephaly, pachygyria, heterotopia, and polymicrogyria.it is characterized by a gray matter lined cleft that extends from the ependymal surface of the brain through the white matter to the pia.
Two types are recognized: type I, or closed lip schizencephaly, in which the cleft walls are in apposition, and type II, or open lip schizencephaly, in which the walls are separated. In either instance the cleft is lined by heterotopic gray matter. The clefts can be unilateral or bilateral, symmetric or asymmetric.
Bilateral clefts have a worse prognosis for development, with seizures present in the majority. Patients may present with hemiparesis (more likely in unilateral forms) or tetraparesis (more likely in bilateral forms). Mental retardation and seizures are other common presentations, being more severe in bilateral clefts.
CT scans of closed lip schizencephaly may show only a slight outpouching, or "nipple" at the ependymal surface of the cleft. The full thickness cleft or the pial-ependymal seam may be difficult to detect on CT scans. Open lip schizencephaly has a larger, more apparent gray matter lined CSF cleft. The majority of patients have bilateral clefts, most of them roughly symmetrical in location and more likely open (type II) than closed (type I) the presence of heterotopic gray matter is considered pathognomic for schizencephaly, distinguishing it from an acquired condition. 
Barth PG. Schizencephaly and Nonlissencephalic Cortical dysplasias. AJNR 1992;13: 104-106.
Osborn AG. Disorders of Diverticulation and Cleavage, Sulcation and Cellular Migration. In Osborn AG's Diagnostic Neuroradiology : St. Louis, Mosby-Year Book Inc,1997;Chapter 3: 52-56.
Denis D, Chateil JF, Brun M et al. Schizencephaly: clinical and imaging features in 30 infantile cases. Brain & Development 2000;22: 475-483.
Sener RN, Bilgin G, Mermis A. CT of Schizencephaly. Am J Roentgenol 1992 Aug;159(2): 436
Review of Radiology
Sumer K Sethi
Peepee Publishers and Distributors
Type of book
AIIMS and All India PG Entrance, State PGs and all PGs
Can be used for
AIIMS and All India PG Entrance, State PGs and all PGs
The concept of the book
Most of the Questions can be attended
Concept Based instead of the Facts Based Approach of other similar books
The Review MCQs
Areas for improvement
Language and Grammar - The text appears to have been written in another language and translated "verbatim" into English
Type setting - It is hard to find whether the Heading in Sub heading or Main Heading
Radiology accounts for about 2 to 3 percent questions in any Post Graduate Medical Entrance Exams. This amount to 6 to 9 questions in All India Exam and 4 to 6 questions in AIIMS and so on
The uniqueness of these Questions is that they are often straightforward and consume very little time as the question is hardly a lengthy one and the choices are usually crisp
The students for long were having no book for these questions. We were able to read Psychiatry from Ahuja, Anesthesia from Pharmacology books and Dermatology from Harrison / Davidson, but Radiology had always eluded us during the preparation period until the advent of Books like SARP, PARAS and Sure Sucess in PG by Ram gopal. Though these books touched the hitherto unexplored areas of the medical knowledge, the very fact that those book catered to all the four subjects made them in adequate for Radiology.
Gone are the days when you were asked about the Water Lily Sign or Flower vase appearence. Now a days questions are more specific and are more often than not from the Radiology text books as well. When a Doctor is not able to allocate even a week for Radiology in his Time table for preparation, he obviously cannot read the "Big Books" like Sutton etc.
“Review of Radiology” by Sumer K Sethi and published by Peepee brothers is a book that could well fill in the lacuna that exists in this area. The book written by a Senior Resident in Radiology in LHMC, who was once the topper in AIPG 2000, AIIMS 2000 and PGI 2000 and earlier was in the top 5 in CBSE PMT and DPMT Exams offers interesting reading
The success of the author lies in the fact that he has been able to give SO MUCH OF THE "NEEDED" POINTS in so few pages. This is possible because the author had once been a candidate in the Entrance Exam race itself
Most of the points that are given in the book have been already asked and more importantly almost all questions that have been previously asked can be solved with this little book. To check this the team decided to check this book with 2 question papers, All India PG 2004 (AIPG 2004 conducted on 11th January 2004) representing AIIMS Pattern and the memory recollected Tamil Nadu PG 2004 (TNPG 2004 / TN PG 2004 / Tamil Nadu PG 2004 conducted on February 29th 2004) Question Paper representing the State Model of Questions
Exam in 2004
Page number in “Review of Radiology”
Codman's Triangle is seen in
Answer given in Page 32
MIBG used in
Answer given in Page 44
Snow driven appearance
Answer given in Page 14
Investigation for Tumour in Superior Sulcus in Lung
Answer given in Page 64
inside / near radio therapy within tumor -
Answer given in Page 10
Inferior notching of ribs is not seen in 1. SLE, 2. SVC Obstruction 3. Coarctation 4. Pulmonary AV Malformation
Answer given in Page 75
In scurvy all the following radiological signs are seen except:
1. Pelican spur. 2. Soap bubble appearance.
3. Zone of demarcation near epiphysis. 4. FrenkeI's line.
2. Soap bubble appearance.
Answer given in Page 37
On radiography widened duodenal 'C. loop with irregular mucosal pattern on upper gastrointestinal barium series is most likely due to:
1. Chronic pancreatitis. 2. Carcinoma head of pancreas.
3. Duodenal ulcer. 4. Duodenal ileus.
2. Carcinoma head of pancreas.
Answer given in Page 53
A young man with pulmonary tuberculosis presents with massive recurrent hemoptysis. For angiographic treatment, which vascular structure should be evaluated first:
1. Pulmonary artery. 2. Bronchial artery
3. Pulmonary vein. 4. Superior vena cava.
2. Bronchial artery
Answer given in Page 21
In which of the following a 'Coeur en Sabot' shape of the heart is seen.
1. Tricuspid atresia. 2. Ventricular septal defect.
3. Transposition of great arteries. 4. Tetralogy of Fallot.
4. Tetralogy of Fallot.
Answer given in Page 33
A 55-year old man who has been on bed rest for the past 10 days, complains of breathlessness and chest pain. The chest x-ray is normal. The next step in investigation should be:
1. Lung Ventilation -perfusion scan. 2. Pulmonary arteriography.
3. Pulmonary venous wedge angiography. 4. Echocardiography.
1. Lung Ventilation -perfusion scan.
Answer given in Page 13
Which of the following is the most penetration beam'?
1. Electron beam. 2. 8 MV photons.
3. 18 MV photons. 4. Proton beam.
3. 18 MV photons.
Topic given in Page 70
The radiation tolerance of whole liver is : .
1. 15 Gy. 2. 30 Gy.
3. 40 Gy. 4. 45 Gy
3. 40 Gy.
Not given Given in Harrison but The question has been added in the end
In which malignancy postoperative radiotherapy is minimally used?
1. Head and neck. 2. Stomach.
3. Colon. 4. Soft tissue sarcomas.
Answer given in Page 73
Answers for ALL THE QUESTIONS in Tamil Nadu PG and 6 out of 8 Questions is AIPG 2004 are given explicitly can be found in this small book. You can answer one more question from the points given
The next litmus test was to know whether one can answer the “mirage questions”. Mirage Questions are those few questions asked in a PG Entrance Exam that are not found in the usual text books and the aspirants will be searching one book after another after the Exam is over and the answer will elude them. One reviewer wanted to know about H shaped Vertebrae. We could see that it is seen in Sickle cell Anemia Another reviewer wanted to know whether the answer for Bracket Calcification can be found in the book. He had once faced the question in JIPMER 2002 and could not find the answer in "ordinary" books and when he saw Lipoma of Corpus Callosum in this book, he was much impressed. Rummaging around the pages we found that Golden S Sign seen in Right Upper Lobe Collapse (the recent exams ask the specific lobe)
Well Done Dr.Sumer K Sethi !!! This book is bound to be one of the classics of PG Preparatory books if the author changes the style of the text which now appears truncated and chewed upon to be more flowing and vibrant and the Publishers could concentrate a little on the Typesetting
As one of the reviewers remarked “This book can be read at the cost and time of two movies” and to answer 100 % in State PG and about 90 % (87.5 % to me more accurate) in All India (where you are expected to answer 66 % correctly to get into the top 100 ranks) from such a small book is commendable and the author needs to be appreciated
24th April 2004
Team Target PG
All Medical Book Stores
011 55195868, 98111 56083
second edition and more reviews coming soon!!!!!!!!!!!!!!!
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