040063   SURANA K, SAGRULE D, LANJEWAR S (Surgery Dep, Indira Gandhi Medical Coll and Hospital, Nagpur) : Primary closure with suction drain of acute breast abscess after incision, drainage, and curettage. Indian J Surg 2020, 82(2), 129-33.

Breast abscess is a common challenge for the surgeon as well as the patient. There are various methods for the treatment of breast abscess. We have done a prospective study on the primary closure of breast abscess with a suction drain in situ after incision, drainage, and curettage. A total of 38 cases were enrolled in the study over a period of 34 months. We found the third decade as the most common age group. Lactation was the most common predisposing factor. Staphylococcus aureus was the most common organism in pus. Mean hospital stay was only 4.18 days. The mean healing time was 12.03 days (range 3–16 days). A comparative analysis of other similar studies was done. We concluded that for a large breast abscess, primary suturing after incision and drainage with curettage is a better procedure and should be used wherever possible as it reduces patient morbidity and discomfort.

22 ref

040062   LIU Z, ZHANG Y, WANG X, ZHANG D, DIAO D, CHANDRAMOHAN K, BOOTH C M (Surgical Oncology Dep, Regional Cancer Centre, Thiruvananthapuram- 695011, Kerala) : Recommendations for surgery during the novel coronavirus (covid-19) epidemic. Indian J Surg 2020, 82(2), 124-8.

The whole world is going through an unprecedented period during the pandemic of COVID-19. This pandemic has affected all aspects of daily life with far-reaching implications, especially in most aspects of healthcare. Practice of surgery across the globe is in a standstill as of now. When we restart surgical practices across world, we have to bring new protocols and practices in place to combat the transmission. This article discusses the major changes in surgical practice, which need to be brought in. This article is based on scientific information about transmission of virus and experiences of some of the authors from China, a country which successfully dealt with and contained the virus outbreak.

23 ref

040060   MAIMAITIAILI A, LIU Z, WU D, FAN Z (Breast Surgery Dep, First Hospital of Jilin Univ, Changchun- 130021, China) : Sentinel lymph node biopsy in breast cancer: Current status and recent progress. Indian J Surg 2020, 82(1), 84-9.

Sentinel lymph node biopsy (SLNB) is a standard procedure used to evaluate the status of axillary lymph nodes (ALNs) that are clinically tumor-free in patients with early-stage breast cancer. Recent research on SLNB has led to continual improvements in the scope of application, accuracy in information provided, and relevance of the results for subsequent treatment. This review is based on selective searches of the Springer Publishing Company and PubMed databases for articles about progress and developments of SLNB in patients with breast cancer. The main purposes are to summarize the current status and established indications for SLNB, identify specific topics that are still under debate, and suggest specific areas where further studies are most needed.

44 ref

040059   GUNER B, GUNAYDIN B (Urology Dep, Edremit Korfez Hospital, Balikesir, Turkey) : Using polidocanol in treatment of simple renal cyst. Indian J Surg 2020, 82(1), 81-3.

The aim of this study was to assess the efficacy of polidocanol in patients with simple renal cysts who were not eligible for surgery due to comorbidities. Twenty-nine patients with Bosniak type 1 or 2 were assessed retrospectively. All of the cysts were exophytic. All of the patients were injected a maximum 20 mL 3 % polidocanol as a sclerosing agent following cyst aspiration. Vanishing of symptoms and decrease in size to 10 % of the initial size were accepted as complete remission, decrease in size to 10–50 % of the initial size was accepted as partial remission, and a return to the initial size of the cyst in a short time or decrease in size > 50 % of the initial size was accepted as failure. The results of an average of 14 months’ follow-up are reported. Complete remission was seen in 18 (62 %) patients, partial remission was seen in 5 (17.2 %) patients, and failure was observed in 6 (20.68 %) patients during an average of 14 months’ follow-up. Percutaneous sclerotherapy using polidocanol can be used safely and with low complication rates in the elderly population with comorbidities.

2 tables, 17 ref

040058   ULUSAN A, BENLI M Y, EKICI M A, SANLI M, ISIK A F (Thoracic Surgery Dep, Gaziantep Univ, Gaziantep, Turkey) : Omentum transposition as a solution for bronchopleural fistula and empyema. Indian J Surg 2020, 82(1), 74-80.

Bronchopleural fistula (BPF) is still a detrimental problem for thoracic surgeons that cause undesirable results in patients. The aim of this study is to evaluate the results of omentum transposition into the thoracic cavity which is used to treat the patients with BPF and empyema Between April 2008 and May 2018, 29 patients with postoperative BPF, two patients with empyema and one patient with tracheal rupture were treated by omentum transposition into the thoracic cavity to reinforce the bronchial stump and to obliterate the pleural space. Each procedure was performed using both thoracotomy and laparotomy, and the omentum was mobilized to the thoracic cavity by a transabdominal approach. The data of the patients’ were analyzed retrospectively. Total length of hospital stay was statistically higher in females (59 days) compared with males (38 days) (p = 0.04) and statistically lower in patients with lung cancer (34 days) compared with patients with benign diseases (57 days) (p = 0.016). There was a positive correlation between the age of patients, chest tube removal time, and the duration of hospital stay after omentopexy (r = 0.53, p = 0.002, r = 0.53, p = 0.01, respectively). The success rate was found to be 72 % (n = 23) in the patients who underwent primary repair with omentopexy. Only 5 patients were discharged with a Heimlich valve. There was no complication associated with the omentum transposition except minimal temporary dyspeptic symptoms. Omentum transposition seems to be an invasive intervention for these patients. However, this research’s results reveal that BPF and empyema can be treated safely by omentum transposition.

2 illus, 1 table, 30 ref

040057   HUANG H, CHEN H, XU L, LI G, LI W (Interventional Radiology Dep, Fudan Univ Shanghai Cancer Center, Shanghai- 200 032, China) : Computed tomography-Guided hookwire localization for ground-Glass opacity dominant pulmonary nodules before video-Assisted thoracoscopic surgery: analysis of 472 lesions. Indian J Surg 2020, 82(1), 67-73.

Recent advances in imaging technique and the deterioration of environment have promoted increased detection of ground-glass opacities (GGOs). The aims of the present study were to evaluate the clinical efficiency and safety of CT-guided hookwire localization of GGO-dominant pulmonary nodules before video-assisted thoracoscopic surgery (VATS) and to summarize the key points for differential diagnosis of GGOs. From April 2008 to December 2015, 472 solitary GGO-dominant (GGO component > 50 %) pulmonary nodules localized by hookwire were retrospectively analyzed. They ranged from 2.9 to 29.8 mm and were successfully localized with mean duration of 8.1 ± 3.6 min. Postoperative complications were mild and included asymptomatic needle track hemorrhage (28.8 %), minimal pneumothorax (8.9 %), and haemoptysis (0.4 %). All patients accepted VATS resection but one patient (0.2 %) was converted to thoracotomy because of strong pleural adhesion. Histological results revealed 102 benign nodules and 370 primary pulmonary adenocarcinomas. The malignant rate of lesions with 50–90 % GGO component common in T_1bN₀M₀ and T_1cN₀M₀ was higher than that of over 90 % occurred more in T_1aN₀M₀ (83.5 % and 87.0 % vs. 52.3 %, P < 0.001). Besides, there were significant statistical differences between malignant and benign GGOs in terms of age, nodular size, percentage of GGO component, margin, spiculation, lobulation, and vascular convergence (P < 0.05). CT-guided hookwire location for GGO-dominant pulmonary nodules before VATS showed to have a great clinical value for diagnosis and treatment without serious complications. If a GGO-dominant nodule with larger size, 50–90 % GGO component, irregular margin, spiculation, lobulation, and vascular convergence was detected in an elder patient, it might have a higher malignant tendency.

2 illus, 4 tables, 27 ref

040056   AKBULUT S, DIRICAN A (Surgery Dep, Inonu Univ, Malatya- 44280, Turkey) : Pilonidal disease of the intermammary cleft: Report of two cases and literature review. Indian J Surg 2020, 82(1), 62-6.

Although pilonidal disease (PD) characterized by chronic inflammation of the skin and subcutaneous tissue most commonly seen in the intergluteal cleft, it rarely affects the umbilicus, axilla, nose, neck, interphalangeal and toe webs, and breast and intermammary cleft. Herein, we aimed to present two patients with intermammary cleft PD and to provide a literature review on this subject. The first case was a 16-year-old woman who presented to our clinic with discharge from the intermammary cleft that had first started 6 months earlier. Her physical examination revealed two sinus orifices consistent with PD. Several days after drainage and antibiotherapy, the patient was operated and all involved tissue was excised. The second case was an 18-year-old woman referred to our hospital after having undergone several drainage procedures for a pilonidal sinus detected in the intermammary cleft at an outside center. After completing preoperative tests, the patient was taken into operation and all tissues until the anterior aspect of the sternum were excised. The defects of both patients were primarily closed and no recurrent PD developed in any of them. Hidradenitis suppurativa and breast abscesses should be considered in the differential diagnoses of PD localized to the intermammary cleft or breast tissue. Drainage and antibiotherapy are the most appropriate approaches among cases presenting with abscess formation. As cosmetic issues are more of a concern with intermammary cleft PD, excision and primary closure technique may be prioritized instead of flap techniques in chronic PD.

4 illus, 1 table, 22 ref

040055   RIJU J, GEORGE N A (Head and Neck Surgical Oncology Dep, Regional Cancer Centre, Kerala- 695 011) : Factors influencing locoregional recurrence and disease-free survival in buccal mucosal squamous cell carcinoma. Indian J Surg 2020, 82(1), 57-61.

Oral cancers are the most common malignancy affecting Indian population with buccal mucosa being the frequent subsite. This study is to evaluate the histopathological factors influencing locoregional recurrence (LRR) and disease-free survival (DFS) in buccal mucosal squamous cell carcinoma (BSCC). One hundred and twenty patients treated surgically for BSCC with a curative intend between January 2014 and December 2015 were retrospectively analyzed. Histopathological factors like tumor stage, grade of differentiation, tumor front, skin involvement, bone involvement, depth of invasion, perineural invasion, lymphovascular emboli, primary resection margin in frozen section, nodal stage, extracapsular extension, and lymph node ratio were analyzed and compared for LRR and DFS. With a median follow-up of 41 months, LRR occurred in 34 patients (28.3 %) and a 2-year DFS was 75.8 %. Multivariate analysis identified that the factors that independently influenced the LRR were pathological nodal stage (p < 0.0001) and primary resection margin in frozen section (p < 0.0001). A single neck node involvement increases risk by 6.8 times for LRR compared to no nodal involvement (95 % CI 2.897–15.888, p < 0.0001). Frozen section studies on primary tumor excision margin showed that close margin had 2.3 times chance of LRR (95 % CI 1.020–5.035, p < .045) and involved margin showed 20.9 times risk of LRR compared to clear margin (95% CI 6.529–67.021, p < 0.0001). Primary resection margin on frozen section and pathological nodal status are the most important factors influencing LRR and DFS. This study highlights importance of aggressive treatment and close follow-up even with a single node involvement and when frozen section margin clearance is less than 5 mm.

2 illus, 3 tables, 15 ref

040054   CAYIR D, KULAH B, BOZKURT M, YILMAZER D (Nuclear Medicine Dep, Health Sciences Univ, Ankara, Turkey) : Factors influencing the presence of remnant thyroid tissue after thyroidectomy for differentiated thyroid carcinoma. Indian J Surg 2020, 82(1), 50-6.

Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. The study was performed to evaluate the factors that are likely to be responsible for the presence of remnant thyroid tissue. The data of 183 patients who underwent total thyroidectomy for DTC were retrospectively reviewed. The remnant thyroid tissue was determined by technetium-99 m pertechnetate (Tc-99 m) scintigraphy. The association of all possible factors (age, gender, size, multifocality, type, and characteristics of the tumor), extension of thyroidectomy, postoperative serum thyroglobulin (Tg), Tg antibody, and thyroid stimulating hormone levels with the presence of remnant tissue was evaluated. Remnant thyroid tissue was more common in patients with intermediate or high-risk features compared to low-risk group (p < 0.001) and in patients who underwent total thyroidectomy compared to patients with total thyroidectomy and central lymph node dissection (p = 0.009). Age, gender, and size, multifocality, type, and characteristics of the tumor were not found to be associated with the presence of remnant tissue. The extent of surgery is the single independent factor for the presence of remnant thyroid tissue after thyroidectomy (p < 0.001). The patients with intermediate and high-risk and extensive surgery were more likely to have remnant thyroid tissue after thyroidectomy for DTC.

1 illus, 3 tables, 30 ref

040053   HONG-QING XI, ZHANG K, LI J, GAO Y, LIANG W, CUI J, WEI B, CHEN L (General Surgery Dep, Chinese People’s Liberation Army General Hospital, Beijing- 100 853, China) : Comparison of perioperative and survival outcomes of laparoscopic versus open gastrectomy after preoperative chemotherapy: A propensity score-matched analysis. Indian J Surg 2020, 82(1), 42-9.

Comparisons of laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) in the setting of neoadjuvant chemotherapy (NACT) are lacking. A prospectively maintained database of patients with gastric cancer who underwent LAG or OG following NACT from June 2013 to March 2016 was retrospectively reviewed. Perioperative and survival outcomes were compared between the LAG and OG groups. In total, 174 patients were identified from the database. After PSM analysis, 45 patients who underwent OG were one-to-one matched to 45 patients who underwent LAG in the setting of NACT. These two groups had similar outcomes in terms of intra- and postoperative complications and 3-year overall survival. However, the LAG group had a longer operation time (P = 0.031) and lower estimated blood loss (P = 0.001). Moreover, compared with patients in the OG group, those in the LAG group had fewer days until first ambulation (P = 0.028), first flatus (P = 0.015), first liquid diet (P = 0.035), and first soft diet (P = 0.024) and a shorter postoperative hospital stay (P = 0.041). Additionally, despite an equivalent total number of retrieved lymph nodes between the two groups, the OG group had marginally more lymph nodes dissected from the splenic hilum (P = 0.032) and splenic artery area (P = 0.020). The present study indicates that LAG performed by well-qualified surgeons for treatment of locally advanced gastric cancer after preoperative chemotherapy is as acceptable as OG in terms of oncological outcomes.

1 illus, 4 tables, 24 ref

040052   VIVEKANANDA M, RAMACHANDRA L, DINESH B V (General Surgery Dep, Kasturba Medical Coll, Manipal) : Laparoscopic versus open rectopexy for full-thickness rectal prolapse: A comparative study. Indian J Surg 2020, 82(1), 38-41.

Abdominal rectopexy for patients with rectal prolapse is well suited for laparoscopic approach as no resection or anastomosis is necessary. The objective of this study was to compare efficacy and safety of laparoscopic and open abdominal Wells rectopexy in patients with full-thickness rectal prolapse. Between January 2010 and December 2015, 70 patients underwent abdominal rectopexy for full-thickness rectal prolapse. Among those 70 patients, 40 patients underwent open rectopexy and the remaining 30 patients underwent laparoscopic rectopexy based on preference of the patient. Both these groups were compared for operative time, intraoperative blood loss, post-operative pain, duration of post-operative stay, post-operative complications/morbidities, and recurrence. Mean operative time was longer in laparoscopic group compared to open group (204.83 min vs. 159 min; p < 0.001), mean intraoperative blood loss was less in laparoscopic group (43.18 ml vs. 121.13 ml; p < 0.001), post-operative pain was milder in laparoscopic group at 12 h, 24 h, and 48 h. Mean hospital stay post-operatively is shorter in the laparoscopic group (4.53 vs. 8.15 days; p < 0.001), complications/morbidity were lesser in the laparoscopic group (p < 0.05). Recurrence was observed in two patients in open rectopexy group and one patient in the laparoscopic group, p value is .733 which is statistically not significant. This study demonstrated significant differences in favor of laparoscopic rectopexy. To conclude the laparoscopic approach may be considered as a better approach for rectopexy in patients with full-thickness rectal prolapse.

3 tables, 13 ref

040051   JAIN N, RASTOGI A, RAMANI S (Radiology Dep, Tata Memorial Hospital, Navi, Mumbai) : When to worry and when not to: A pictorial review. Indian J Surg 2020, 82(1), 32-7.

Nipple discharge is the third most common complaint in patients with symptoms pertaining to breast diseases, accounting for 7 % of overall breast symptoms. Nipple discharge may be spontaneous or induced, unilateral or bilateral, and of varied colors depending on the etiology. Also, it may be physiological or pathological. Both benign and malignant processes can lead to nipple discharge, with benign pathology accounting for more than half of the cases. The gold standard of management is surgical duct excision. In conjunction with good clinical history and laboratory work-up, imaging, i.e., mammography and sonography, can conclusively differentiate between benign and malignant etiology, and thus guide further course of management. MRI has been gaining a wider role in its evaluation; however, it is limited by cost and lack of availability. The purpose of this article is to comprehensively elucidate the various causes of nipple discharge and their imaging features on mammography and sonography, as a guide to further management.

5 illus, 28 ref

040050   LIU X, FENG F, QIN J, XING Z, DUAN J, WANG W, LIU J (Hepatobiliary Surgery Dep, Second Hospital of Hebei Medical Univ, Shijiazhuang- 050 000, China) : Laparoscopic pancreaticoduodenectomy with major vein resection: Single institutional experience. Indian J Surg 2020, 82(1), 25-31.

Pancreatic cancer is a common tumor of the digestive system with high malignancy, and the incidence is increasing annually. Approximately 40% of pancreatic cancer patients have a locally advanced disease at the first diagnosis. The safety and feasibility of laparoscopic pancreaticoduodenectomy (LPD) has been established in recent years. Pancreatic cancer with major vein involvement, once considered an absolute contraindication of surgical treatment, is now also a potential candidate for LPD. This study aims to describe the detailed surgical procedures (standard procedure and retrocolonic approach in LPD) and provide the short-term outcomes of patients receiving this challenging operation. From August 2016 to November 2017, among 137 patients undergoing LPD at our center, 8 patients received LPD with major vein resection and reconstruction. The patients’ general data, intraoperative parameters, postoperative morbidity, pathological outcomes, and specific information related to SMV/PV resection and reconstruction were extracted and analyzed. The median age of all patients was 53 (range 49–67) years. The median body mass index (kg/m²) and American Society of Anesthesiologists score were 22.7 (range 18.9–30.2) and 2 (range 2–3), respectively. One patient received tangential resection and primary suture reconstruction, 5 patients underwent segmental resection and end-to-end anastomoses, and 2 patients had a segmental resection and prosthetic vein interposition graft. The median duration of operation and total SMV/PV clamping time were 570 (range 440–640) min and 45 (range 30–60) min, respectively. The median intraoperative estimated blood loss was 630 (range 100–1500) ml. Postoperative pathological outcomes revealed pancreatic ductal adenocarcinoma in 7 patients and chronic pancreatitis in 1 patient. Negative margin was obtained in 6 of 7 patients suffering from pancreatic cancer. One positive margin was found due to local cancer infiltration at the retroperitoneal margin. Median lymph node harvest was 13 (range 6–20), and lymph node metastasis was confirmed in 3 patients. No severe complications after LPD were detected. No 30-day or in-hospital mortality occurred. To date, all patients involved in this study were alive without evidence of tumor recurrence except one patient undergoing R1 resection. LPD with major vein resection and reconstruction is safe and feasible in high-volume tertiary centers. Substantial experience in laparoscopic operations and advanced skills of intracorporal vascular suture in open surgeries should be obtained before attempting LPD with major vein resection. A standard LPD procedure and retrocolonic approach should be adopted appropriately according to the results of preoperative imaging studies.

3 illus, 2 tables, 7 ref

040049   RIJU J, GEORGE N A, MONY R P, KRISHNA J, RAJAN R (Surgical Oncology Dep, Regional Cancer Centre, Kerala- 695 011) : A prospective study to find the significance of delphian nodal metastasis in papillary carcinoma thyroid. Indian J Surg 2020, 82(1), 19-24.

Delphian node (DLN) involvement is well known for its poor prognosis in laryngeal malignancies. With less than 10 studies available with respect to DLN and carcinoma thyroid, this prospective study to analyze the significance of DLN in management of thyroid carcinoma was planned. Study included 151 patients with histopathologically proven papillary carcinoma thyroid. Histopathological factors analyzed included size of the tumor, isthmus involvement, tumor capsule involvement, extrathyroidal extension, multifocality, lymphovascular invasion, thyroiditis, and pyramidal lobe association. DLN was harvested in 80 patients (53 %). Seventeen patients (21.25 %) had DLN metastasis. Male gender, capsular involvement, and extrathyroidal extension were independently associated with metastatic in DLN. DLN metastasis had accuracy of 83.8 % to predict central compartment neck nodal involvement, risk of which is increased by 24.7 times compared to DLN with no nodal metastasis. Similarly, DLN metastasis is associated with an accuracy of 81.3 % to predict lateral compartment neck nodal involvement risk of which is increased by 9.8 times compared to DLN with no nodal metastasis, both of which showed a significant p value of 0.0001. DLN involvement is a predictor of nodal metastasis which mandates an aggressive treatment and a close follow-up. When DLN is involved with total thyroidectomy with central compartment neck dissection has to be performed and lateral neck dissection is preferred on the side of disease when DLN is involved with capsular invasion, extrathyroidal extension and in case of male gender, after radiological correlation.

1 illus, 4 tables, 16 ref

040048   ZINGARETTI N, GUARNERI G F, BIASIO F D, CORDARO E R, ALMESBERGER D, PARODI P C (Medical Science Dep, Udine Univ, Udine- 33100, Italy) : A simple and fast technique to perform submuscular breast augmentation. Indian J Surg 2020, 82(1), 14-8.

The benefits of placing breast implants below the muscle very often outweigh placing them above the muscle. This dissection plane is less vascularized than the retroglandular one, and favoring this option may reduce hematoma incidence. Furthermore, the correct submuscular dissection is not easy to perform (mostly for beginners); thus, the pocket is not carried out quickly. To solve these problems, we present an alternative submuscular surgical technique, which uses hydrodissection to delimitate the submuscular pocket dissection. We analyzed the results of 11 patients with breast cancer who underwent mastectomy and breast implant reconstruction and eight patients who underwent breast implant augmentation from March 2016 to September 2017. First, the submuscular plane is accessed via an inframammary incision, then creates a small cavity at the lateral border of major pectoralis muscle, above the distal insertion of minor pectoralis muscle. After that, a 60-mL syringe (catheter tip) is inserted and a tumescence solution is infiltrated (epinephrine and saline solution). With hydrodissection, the soft tissue is separated using the gentle force of the water-jet (atraumatic dissection); the epinephrine allows vasoconstriction and an easier preventive hemostasis is established. Minimum follow-up after surgery was 1 year, with an average of 14.8 months. Among the treated patients, the percentage of complications was extremely low and time of surgery was very fast. This technical note explains a very simple, economical, and less time-consuming method to perform the submuscular pocket. It may be applied to all procedures within the field of the breast augmentation, including reconstructive and esthetic surgery.

1 illus, 1 table, 7 ref

040047   AWAD A T, ALHUSSINI M A, BALBAA M A (Surgery Dep, Menoufia Univ, Menoufia, Egypt) : Quilting of mastectomy flaps; A simple way to avoid postmastectomy seroma. Indian J Surg 2020, 82(1), 9-13.

Mastectomy is still one of the fundamental options for treatment of breast cancer. Postmastectomy seroma formation is a common complication that can lead to significant morbidity. A lot of studies focused on mechanical obliteration of the postmastectomy dead space assuming it is the primary factor for seroma development. The aim of this study was to evaluate the efficacy of quilting technique in reducing the incidence of postmastectomy seroma. The study included 800 patients who were randomized into two equal groups; A and B, where quilting has been performed to “group B.” The patients were followed up to measure daily drain output with monitoring of seroma formation in the next 14 days after drain removal. “Group B” showed significant reduction in the mean of fluid drained (246.08 ± 78.94 mL) (P < 0.001) compared with “group A” (664.75 ± 69.43 mL) together with significant reduction in incidence of seroma formation with incidence of 21.75 % and 3.5 % (P < 0.001) for groups A and B, respectively. Quilting is an effective technique in reducing the incidence of postmastectomy seroma formation.

1 illus, 2 tables, 27 ref

040044   KUMAR P, MEHTA N, KANTALE R A, CHATLI M K, HUNDAL J S, WADHWA M (Livestock Products Technology Dep, Guru Angad Dev Veterinary and Animal Sciences Univ, Ludhiana-141 004, Punjab, Email: vetpavan@gmail.com) : Effect of fibre combination on quality characteristics of chevon patties. Indian J Small Rumin 2020, 26(1), 97-103.

A study was undertaken to assess the effect of various fibre combination on the quality characteristics of chevon patties. Based on preliminary trials, five combinations of inulin and pineapple peel powder (PAP) were used to prepare chevon patties viz., control (without inulin and PAP), T1 (1.0 % inulin powder), T2 (1.0 % inulin and 1.5 % PAP), T3 (1.0 % inulin and 3.0 % PAP) and T4 (1.0 % inulin and 4.5 % PAP). The developed patties were assessed for various physicochemical, proximate, instrumental colour, texture profile and sensory analysis. The incorporation of fibre combinations resulted in significant (P<0.05) increase in emulsion stability and ash contents and decrease in protein and fat contents. Crude fibre content of treatments was significantly (P<0.05) higher than the control, and it increased with increasing levels of PAP in the formulation. Fibre incorporation resulted in better retention of dimensional characteristics. Moisture and hardness values of PAP incorporated patties were lower than T1 and control. The overall acceptability of T3 (7.16) was comparable to T2 and the control and was recorded significantly (P<0.05) higher than T4. Thus, good quality chevon patties can be prepared by incorporating fibre combination of 1.0 % inulin powder and 3.0 % PAP (T3).

3 tables, 23 ref

040043   PATHAK V, RAJPUT R (Veterinary Anatomy Dep, Chaudhary Sarwan Kumar Himachal Pradesh Krishi Vishvavidyalaya, Palampur- 176 062, Himachal Pradesh, Email: pathakv26@yahoo.com) : Gross anatomical studies on larynx of gaddi sheep. Indian J Small Rumin 2020, 26(1), 92-6.

The aim of the study was to investigate the anatomical structure of larynx of Gaddi sheep. The larynx formed the connection between the nasopharynx and tracheobronchial tree. In Gaddi sheep, there was no apparent sexual difference in the size of larynx. The larynx of Gaddi sheep was an elongated structure made up of unpaired epiglottis, thyroid and cricoid. The thyroid cartilage was largest cartilage of larynx that formed the lateral and ventral portion of cartilaginous skeleton of larynx. The maximum length from the anterior cornu to the posterior cornu was 4.45±0.34 cm. The maximum breadth of thyroid cartilage was 2.89±10 mm. The signet ringshaped cricoid cartilage was the caudal most cartilage of the larynx. The transverse and vertical diameters of the cricoid cartilage were 2.44±0.5 and 2.82±0.10 cm, respectively. The arytenoid cartilages were paired cartilages of the larynx and had three surfaces (dorsal, medial and lateral) and three borders (ventral, medial and lateral) which met each other by three processes (muscular, vocal and articular) with apex and base. The apex of arytenoid cartilages did not show well-defined corniculate process in Gaddi sheep. The epiglottis cartilage was the rostral cartilage which projected out at laryngeal opening. The obovate leaf-like epiglottic cartilage was curved ventrally with rounded apex. The length and width of epiglottic cartilage were 3.03±0.03 and 2.48±0.27cm, respectively. 

9 ref

040042   SHARMA D, SHARMA K, AGNIHOTRI R K, POONAM, RAMESHWAR ( Veterinary Parasitology Dep, Dr G.C. Negi Coll of Veterinary and Animal Sciences, Palampur- 176 062, Himachal Pradesh, Email: devinasharma23@yahoo.co.in) : In vitro evaluation for acaricidal efficacy of and melia azedarach Eupatorium adenophorum against rhipicephalus (boophilus) microplus ticks of goats. Indian J Small Rumin 2020, 26(1), 86-91.

In vitro acaricidal activity of biopesticides prepared from and Melia azedarach Eupatorium adenophorum was evaluated against adult engorged females of ( ) Rhipicephalus Boophilus microplus of goats at concentrations of 5, 10 and 20 % using adult immersion test and larval packet test. A dose-dependent larval mortality response (82, 42 to 90, 46 %) was recorded in all the concentrations of . Significant (P<0.05) inhibition of oviposition (IO) in adult females M. azedarach at concentration of 20 % suggested negative effect of on the reproductive physiology M. azedarach of ticks. significantly (P<0.05) affected the oviposition and mortality rates of the E. adenophorum tick larvae in a dose-dependent manner with highest mortality at 20 % concentration. The results indicated potential use of biopesticides formulated from in M. azedarach E. adenophorum and developing sustainable strategy for integrated tick management and a step towards organic chevon production.

2 illus, 1 table, 26 ref

040040   GUPTA C, MURUGAN M, GANESAN A, RAMPRABHU R, KUMAR S S (Veterinary Coll and Research Institute, Tiruneveli- 627 358, Tamil Nadu, Email: chhavigk@gmail.com) : A retrospective study on dystocia and its management in goats. Indian J Small Rumin 2020, 26(1), 75-8.

A retrospective study was conducted on causes and management of dystocia in 116 goats presented to the Veterinary Clinical Complex, Veterinary College and Research Institute, Tirunelveli during June to December, 2018. The incidence of dystocia was significantly (P<0.05) higher in Kanni Adu (41.38 %) followed by Kodi Adu (33.62 %) and Salem Black (25.00 %) breed. The monthly incidence varied significantly (P<0.01) from 5.17 % (August) to 30.17 % (September). The principal causes of dystocia in goats were foetal malpresentation (31.03 %) and twinning (20.68 %). Maternal causes were narrow pelvis (10.34 %), ring womb and uterine inertia (6.89 % each) and uterine torsion (1.72 %). Methods employed to relieve dystocia were mutation and manual traction (53.44 %) followed by partial foetotomy (21.55 %), medicinal management (13.80%) and caesarean section (11.21%). The success rate of different methods was >75.00 % with maximum of 100 % by caesarean section. It was inferred that dystocia was a major reproductive problem in goats and the timely management of the condition must be instituted to save the pregnant goats and reduce the kid losses.

2 tables, 16 ref

040039   PATEL G A, SUTHAR B N, NAKHASHI H C, CHAUDHARI C F, SUTARIA T V, CHAUDHARI R K (Gynaecology and Obstetrics Dep, Sardarkrushinagar Dantiwada Agricultural Univ, Sardarkrushinagar-385 535, Gujarat, Email: ravjivgo@gmail.com) : Haemato-biochemical profile in goats with dystocia and retained foetal membranes. Indian J Small Rumin 2020, 26(1), 71-4.

A study was conducted to evaluate the haemato-biochemical and hormonal changes in dystocia (n=11) and retained placenta-affected (n=7) Mehsana goats. The mean concentration of haemoglobin, packed cell volume and total leucocyte count did not differ significantly (P>0.05) in both dystocia and retained placenta affected goats. The mean total erythrocyte count was significantly (P<0.05) reduced in dystocia affected goats. The plasma level of aspartate amino transferase and alkaline phosphatase significantly (P<0.05) increased after the obstetrical manoeuvres while that of creatine kinase was apparently higher. Triiodothyronine, thyroxine, sodium and potassium levels decreased while cortisol increased immediately after the obstetrical management. It was concluded that the findings of the alterations in haemato-biochemical attributes in dystocia and retained placenta-affected goats may be useful in the management of obstetrical conditions. 

3 tables, 11 ref

040036   KUMAR V, PUROHIT S, PATHAK R K, SINGH A, SRIVASTAVA M K , PANDEY V, PANDEY R P ( Veterinary Surgery and Radiology Dep, U.P. Pt. Deen Dayal Upadhyay Pashu Chikitsa Vigyan Vishwavidyalaya Eva, Mathura- 281 001, Uttar Pradesh, Email: spurohit2000@gmail.com) : Electrocardiographic studies using bipolar base apex lead-i in apparently healthy goats. Indian J Small Rumin 2020, 26(1), 57-61.

A study was conducted to evaluate the cardiothoracic parameters in 12 apparently healthy goats. They were divided into two groups (Gr-I: 3-6 months- old and 11.83±0.70 kg body weight; Gr-II: 6-12 months- old and 25.67±1.73 kg body weight). Electrocardiogram (ECG) was recorded using bipolar base apex lead using limb lead-I in standing position in calm goats without any sedation. Significant (P<0.05) negative correlation was found in the value of heart rate with body weight and age of the goats. Amplitude of P wave showed positive correlation with both age and body weight, R and T wave with body weight and R wave showed significant (P<0.05) positive correlation with age while other parameters of amplitude were negatively correlated with both age and body weight. Significant (P<0.05) positive correlations with both age and body weight were observed in duration in QRS complex and R-R interval. The baseline data of cardiothoracic parameters and their correlation with age and body weight appears to be helpful in diagnosing various cardiothoracic abnormalities in goats. 

2 tables, 11 ref

040035   SINGH R, SINGH A, SINGH V, BEIGH S A (Veterinary Medicine Dep, Sher-e-Kashmir Univ of Agricultural Sciences and Technology of Jammu, Jammu-181 102, Jammu and Kashmir, Email: rajivrajiv101@gmail.com) : Oxidative status in rambouillet x gaddi of himalayan region during peripartum period. Indian J Small Rumin 2020, 26(1), 53-6.

To assess the oxidative stress in sheep of Himalayan region during the peripartum period, a study was conducted on 24 Rambouillet x Gaddi sheep. Based on parity, ewes were equally divided into two groups as Gr 1 (primiparous) and Gr 2 (pluriparous). Blood samples were collected at - 4 and -1 week (before lambing) followed by 1, 4 and 8 weeks (post lambing) for the estimation of oxidative agents like malondialdehyde (MDA), superoxide-dismutase (SOD), catalase, glutathione-peroxidase (GPx) and glutathione-s-transferase (GST) along with trace minerals (copper and zinc). Along the time, MDA revealed a steady increase up to 1 week post lambing when levels were significantly (P<0.05) higher compared to 8 weeks post lambing. SOD activity in Gr 1 and 2 showed significant (P<0.05) variation at -4 week and -4 and 1 weeks, respectively as compared to 8 weeks post lambing. Catalase activity was significantly (P<0.05) lower at 4 week among Gr 1 and -4, -1, 1 and 4 week among Gr 2 animals. The GPx activity significantly (P<0.05) decreased at -1 week among Gr 1 animals compared to 8 weeks. GST activity in Gr 1 showed significant (P<0.05) decrease at 1 week post lambing; however, no significant difference was observed among Gr 2 animals compared to 8 weeks post lambing. Plasma levels of copper and zinc failed to show any definite pattern. The study concluded that Rambouillet x Gaddi sheep experience decreased antioxidant and trace mineral levels with increased oxidant levels during the peripartum period.

1 table, 16 ref

040025   SWARUP M S, GUPTA S, SINGH S, PRAKASH A, MEHNDIRATTA A, GARG A (Radiology Dep, Maulana Azad Medical Coll and Lok Nayak Hospital, New Delhi- 110 002, Email: me.drswati@gmail.com) : Phakomatoses: A pictorial review. Indian J Radiol Imaging 2020, 30(1), 195-205.

Phakomatoses or Neurocutaneous syndromes are a heterogeneous group of disorders and have variable inheritance pattern. Currently, more than 30 entities are included in this group. These disorders primarily affect the central nervous system; however, skin, viscera, and other connective tissues can also be involved with variable clinical presentation. We will describe and illustrate the various radiological findings of the common entities through the iconography of the cases presented to our department.

26 illus, 15 ref

040024   SAHU A, VIKAS H, SHARMA N (Hospital Administration Dep, AIIMS, New Delhi- 110 029, Email: vickygaddi@gmail.com) : Life cycle costing of MRI machine at a tertiary care teaching hospital. Indian J Radiol Imaging 2020, 30(1), 190-4.

Life cycle costing (LCC) is an excellent decision‑making tool that can assist a hospital administrator in seeking more cost‑effective decisions to select the best course of action. LCC can be defined as “an economic assessment of competing design alternatives, considering all significant costs of ownership over the economic life of each alternative, expressed in equivalent rupees. To determine the LCC of magnetic resonance imaging (MRI) machine at a tertiary care teaching hospital.  A descriptive, observational study in MRI scan center of a tertiary care teaching hospital. LCC analysis (LCCA) was performed to ensure total cost visibility for the entire life span of the MRI scan equipment, which was assumed to be 10 years.  Data were analyzed using MS Excel. The total cost per MRI scan was calculated to be Rs. 2944. It was estimated that the MRI scan center would reach the break‑even point by the end of the third year.

7 tables, 6 ref

040023   DHAGAT P K, JAIN M, FAROOQ A (Radiodiagnosis Dep, Base Hospital Delhi Cantt and Army Coll of Medical Sciences, Delhi Cantt, New Delhi, Email: peeyushdhagat@gmail.com) : MRI evaluation of soft tissue vascular malformations. Indian J Radiol Imaging 2020, 30(1), 184-9.

Soft tissue vascular malformations are not uncommonly encountered in clinical practice and are often mistaken for other pathologies. Vascular anomalies are divided into vascular tumors and malformations. Vascular malformations progressively increase in size with increasing age and are classified into low‑flow (venous, lymphatic, veno‑lymphatic, capillary and capillary venous) and high‑flow malformations (arteriovenous malformations (AVM) and arteriovenous fistula (AVF)) depending on the presence or absence of arterial flow. Aim of this study is to evaluate the Magnetic resonance imaging (MRI) features of the soft tissue vascular malformations and to classify the lesions depending on flow pattern. A total of 52 patients of soft tissue vascular malformations were included in this study over a period of 3 years. All patients underwent detailed clinical examination and dynamic post contrast MRI evaluation. Doppler and ultrasound were done as an adjunct. There were 31 females and 21 male patients with age ranging from 9 to 34 years. In total 33 venous, 11 lymphatic, 8 veno‑lymphatic malformations were seen. No case of high‑flow malformation was seen. Majority of the lesions involved the head and neck region and the extremities. Fat saturated T2WI, STIR, and 3D dynamic post contrast sequences were found to be the most useful MRI sequences. MRI is the modality of choice for evaluating the soft tissue vascular malformations. It depicts the extent of the lesion, classifies the lesions into low or high flow and helps in treatment planning.

8 illus, 1 table, 18 ref

040022   MEHRA R, LANGER V, MANRAL S (Surgery Dep, Armed Forces Medical Coll, Pune- 411040, Maharashtra) : A prospective study on return of protective tactile sensations in split-thickness skin grafts. Indian J Surg 2020, 82(3), 350-4.

In the long evolution of world surgery, split-thickness skin grafting has distinguished itself as an age-old clinical tool utilised for soft tissue coverage. However, the scanty endorsement of return of protective tactile sensations in these split-thickness skin grafts seems mired between therapeutic subservience and clinical necessity. The objective of this study was to evaluate recovery of tactile protective sensations in split-thickness skin grafts. A total of 100 patients were recruited for the study. Prospective analysis of demographics, pre- and post-operative variables was done to evaluate the return of tactile sensations by two-point discrimination and cotton touch. Males represented 69 % of the patients with a mean age of 49.04 (± 16.34) years. Early recovery of two-point discrimination at the periphery of the split-thickness skin graft was observed in 1 week in 23.9 % and cotton touch in 61.4 % of patients. Over a follow-up period of 1 year, 60 % patients had recovery of two-point discrimination and 92.8 % for cotton touch. The return of sensation at the centre of the graft was delayed and at 1-year follow-up, 67 % developed tactile sensations. The rate of change of two-point discrimination with respect to time was significant (F = 5.74, P = 0.018). Delayed recovery of sensations was observed in patients who developed graft bed oedema or had a scarred graft bed. The encouraging early return of tactile sensation furnishes the split-thickness skin graft with a protective capability against shear, often offered as a reason for graft loss in contemporary wisdom. The findings of a delayed return in a scarred and oedematous graft bed can be expressed as clinical underpinnings and these observations should expand the myriad uses a split thickness skin graft can be put to in soft tissue coverage.

2 illus, 2 tables, 22 ref

040021   FOYE P M, JASON W T K, ZHENG K Y, LEONG K K (Physical Medicine and Rehabilitation Dep, Rutgers New Jersey Medical School, New Jersey, United States, Email: Doctor.Foye@gmail.com) : Low incidence of vascular uptake during ganglion impar sympathetic nerve blocks for coccydynia. Indian J Radiol Imaging 2020, 30(1), 181-3.

Focal sympathetic nerve blocks of the ganglion impar are often effective treatments for coccydynia (coccyx pain) and other pelvic pain syndromes. These injections are generally performed under contrast‑enhanced fluoroscopic guidance. Vascular uptake may potentially occur during the injection and vascular uptake rates have been reported for other spinal injections, but never for ganglion impar blocks. The purpose of the study was to determine vascular uptake rates during fluoroscopy‑guided ganglion impar blocks. An academic/University‑based Coccyx Pain Center. A total of 78 consecutive trans‑coccygeal ganglion impar blocks were analyzed for vascular uptake of contrast as determined by intermittent fluoroscopy. Direct calculation of incidence.  Only one patient (1.3 %) demonstrated a vascular uptake pattern, which was readily recognized and corrected by slightly adjusting the position of the needle tip and thereby subsequently obtaining the desired contrast pattern at the ganglion impar. Vascular uptake incidence is low during ganglion impar blocks. This information can be one of the multiple factors considered when a physician is deciding whether or not to use contrast in an individual patient.

1 illus, 9 ref

040020   DESHPANDE A A, CHANDRASHEKHARA S H, SHARMA A (Cardiovascular Radiology & Endovascular Interventions Dep, All India Institute of Medical Sciences (AIIMS), New Delhi- 110 029, Email: drarungautam@gmail.com) : Horizontal sandwiched interventricular septum: Complex cardiac anatomy deciphered with DSCT. Indian J Radiol Imaging 2020, 30(1), 177-80.

The superior‑inferior ventricle is a rare anomaly with the unknown incidence owing to less number of reported cases. However, one of the studies has reported this incidence to be <0.1 % of all congenital heart diseases. This has a characteristic imaging appearance with horizontal interventricular septum. Most of the previous reports of superior‑inferior ventricles have been described on echo, catheter angiography and only a few with cross‑sectional imaging. We report two cases of superior‑inferior ventricles associated with complex congenital cardiac defects on dual‑source CT.

6 illus, 5 ref

040019   KALE S V, SHAH A (Radiology Dep, Seth G.S. Medical Coll and K.E.M Hospital, Somerset BS23 4TG, UK, Email: drshahalam.rad@gmail.com) : Determining the normal effective diameter of thoracic aorta in pediatric population of India. Indian J Radiol Imaging 2020, 30(1), 170-6.

It is imperative to establish normative ranges of aortic diameter to diagnose various aortic pathologies. There have been very few studies establishing the normal aortic diameter on cross‑sectional imaging, and none pertaining to the Indian pediatric population. The objective of this study was, therefore, to establish the normal effective diameter of thoracic aorta at multiple levels using computed tomographic data, calculate z‑scores, and plot reference curves. The effective thoracic aorta diameters (average of anteroposterior and lateral diameters) were measured at predefined levels (aortic root, ascending aorta at the level of right pulmonary artery, aortic arch, proximal descending aorta, and aorta at the level of diaphragmatic hiatus) on double‑oblique reconstructed computed tomography (CT) images perpendicular to the direction of the vessel. Multiple functional forms relating the effective diameter to subjects’ age were evaluated with least square regression methods, and further R² was used to ascertain the best model. Age‑based formulas to derive normal aorta diameters and mean squared errors (MSEs) were established. Two hundred and seven contrast‑enhanced CT (CECT) thorax studies of children without known cardiovascular disease were studied. The polynomial regression model relating the effective diameter that included linear, quadratic, and cubic age terms as independent variables were found to the best statistical model. The z scores were calculated, and normative curves were plotted. We have established normative effective diameters of the thoracic aorta at multiple levels in Indian children of different age groups. Measurements outside of the normal ranges are indicators of ectasia, aneurysm, hypoplasia, or stenosis.

6 illus, 5 tables, 10 ref

040018   NEYAZ Z, HASHIM Z, KUMAR S, NATH A, KHAN A, MOHINDRO N (Pulmonary Medicine Dep, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow- 226014, Uttar Pradesh, Email: ziasgpgi@gmail.com) : Correlation of asthma severity, IgE level, and spirometry results with HRCT findings in allergic bronchopulmonary aspergillosis. Indian J Radiol Imaging 2020, 30(1), 163-9.

Few studies have been done for correlating asthma severity, IgE level, and spirometry results with high‑resolution computed tomographic (HRCT) findings in allergic bronchopulmonary aspergillosis (ABPA).  This prospective observational study was conducted to correlate asthma severity, IgE level, and spirometry results with HRCT findings in ABPA. Settings and Design: Prospective observational. Fifty consecutive adult patients with asthma and positive specific IgE (>0.35 kUA/L) to Aspergillus fumigatus were recruited from October 2015 to July 2017. Asthma severity, IgE levels, and spirometry results were correlated with HRCT score, bronchiectasis score, air trapping segments, and low‑attenuation lung volume on inspiratory CT and expiratory CT.  One way ANOVA, Spearman’s correlation coefficients. Asthma severity showed a significant positive correlation with HRCT score and bronchiectasis score. MEF pre and postbronchodilator values showed a significant negative correlation with HRCT score, bronchiectasis score, and percentage expiratory volumes ‑851 to ‑950 HU voxels. FEV1 prebronchodilator value showed a significant negative correlation with percentage expiratory volume ‑851 to ‑950 HU voxels and percentage expiratory volume ‑851 to ‑1024 HU voxels. Specific IgE antibody level showed a significant positive correlation with bronchiectasis score. Asthma severity, specific IgE level, and MEF values showed a good correlation with HRCT findings. The restrictive pattern is common on spirometry in patients of ABPA. In addition to central bronchiectasis, peripheral bronchial and small airway involvement was an important finding in ABPA. Expiratory HRCT may reveal air trapping in patients having no abnormality on inspiratory CT.

5 illus, 5 tables, 22 ref

040017   HIWALE S, FIRTION C (Philips Innovation Campus, Bengaluru- 560 045, Karnataka, Email: sujit_hiwale@outlook.com) : Analysis of factors influencing accuracy of ultrasound-based fetal weight estimation. Indian J Radiol Imaging 2020, 30(1), 156-62.

The primary objective of this study was to examine the impact of maternal age, parity, gestational age, fetal gender, gestational diabetes mellitus, and pregnancy‑induced hypertension on the accuracy of ultrasonography‑based fetal weight estimation. The secondary objective was to find the impact of a formula selection on the accuracy of fetal weight estimation.  The inclusion criteria were a live‑birth singleton pregnancy and the last ultrasound scan to delivery interval ≤7 days. Fetal weight was estimated using the Hadlock‑4 formula. To study the concurrent impact of all the factors on the accuracy, cases were divided into two subcategories based on percentage error, with ±10 % as a threshold. The accuracy of Hadlock‑4 formula was compared with the two Indian population‑based formulas, Hiwale‑1 and Hiwale‑2. In total, 184 cases were included in the study. It was observed that the systematic error in weight estimation was significantly less in the male fetuses (8.45 ± 9.34 %) in comparison to the female fetuses (11.71 ± 10.34 %). The combined impact of all the factors on the accuracy was found to be nonsignificant by the multivariate analysis. The Hiwale‑1 (‑0.59 ± 8.75 %) and Hiwale‑2 (‑0.65 ± 8.7 %) formulas had statistically significant less errors compared to the Hadlock‑4 formula (11.67 ± 7.95 %). All the studied clinical factors were found to have a limited impact on the overall accuracy of fetal weight estimation. However, the formula selection was found to have a significant impact on the accuracy, with the native population‑based formulas being significantly more accurate.

2 illus, 6 tables, 28 ref

040016   AGGARWAL N, SHARMA G L (Anatomy Dep, All India Institute of Medical Sciences, Punjab, Email: navita22a@gmail.com) : Fetal ultrasound parameters: Reference values for a local perspective. Indian J Radiol Imaging 2020, 30(1), 149-55.

Fetal biometry, with the help of ultrasonography (USG) provides the most reliable and important information about fetal growth and well‑being. Frequently used parameters for fetal measurements by this method are the biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). These fetal dimensions depend upon the racial demographic characteristics, nutrition, genetics and many more environmental factors of a particular population. The purpose of the present investigation was to define and analyze these fetal biometric parameters in our local population and to compare them with the given norms. This cross‑sectional study with convenience sampling was conducted on a total of 425 fetuses with a period of gestation between 18 to 38 weeks. Descriptive statistics was used to calculate the mean with standard deviation and 95 % confidence interval (CI) for each fetal parameter in each gestational week. Mean of BPD and FL in our population are similar to the mean values given by Hadlock throughout the pregnancy, except near the end of the third trimester where our population shows a slightly lower range of mean values. HC and AC fall below the lower range of Hadlock as early as 24 weeks of pregnancy. Fetal biometric parameters in the studied population are at the lower range of established nomograms by Hadlock on white fetuses, more so with the progression of pregnancy.

2 illus, 6 tables, 25 ref

040015   BHAGAT A C, KUMAR J, GARG A, PRAKASH A, MEHER R, ARYA S (Radiodiagnosis Dep, Maulana Azad Medical Coll, New Delhi- 110 002, Email: drjyotikumar@gmail.com) : Imaging in congenital inner ear malformations-An algorithmic approach. Indian J Radiol Imaging 2020, 30(1), 139-48.

Malformations of the inner ear are an important cause of congenital deaf‑mutism. Arrest in embryologic development of inner ear during various stages gives rise to the variety of malformations encountered. Current treatment options include hearing aids, cochlear implants, and auditory brainstem implants (ABI). With the advent of cochlear implant surgery and ABI, decent functional outcomes can be obtained provided such cases are diagnosed correctly and timely. To that end, high‑resolution computed tomography (HRCT) has a fundamental role in the assessment of these conditions, ably supplemented by magnetic resonance imaging (MRI). The purpose of this pictorial essay is to illustrate the imaging features of inner ear anomalies in children with congenital deaf‑mutism as per the latest terminology and classification and provide an algorithmic approach for their diagnosis.

20 illus, 16 ref

040014   REDDY R (Radiology Dep, Holy Family Hospital, Thodupuzha- 685 605, Kerala, Email: ravikanthreddy06@gmail.com) : MR evaluation of tongue carcinoma in the assessment of depth of invasion with histopathological correlation: A single center experience. Indian J Radiol Imaging 2020, 30(1), 126-38.

Magnetic resonance imaging (MRI) has become the cornerstone for pretreatment evaluation of carcinoma tongue and provides accurate information regarding the extent of the lesion and depth of invasion that helps the clinician to optimize treatment strategy. Aim of the study is to correlate MRI and histopathological findings, to evaluate the role of MRI in loco‑regional tumor node metastasis (TNM) staging, and to assess the depth of invasion of tongue carcinoma. This study was undertaken on 30 patients with clinical diagnosis of tongue carcinoma referred for MR imaging at a tertiary care hospital over the 2‑year period between July 2017 and June 2019. MRI was performed with GE 1.5 Tesla scanner, neurovascular (NV) array coil. Clinical and MRI staging of tongue carcinoma was done preoperatively and correlated. Post‑surgery, histopathological TNM staging was done and correlated with clinical and MRI TNM staging.The cutoff value of histopathological (HP) depth that could determine the existence of nodal metastasis was 5 mm.  In 30 patients diagnosed with tongue carcinoma, the incidence was higher in males (92 %). Moderate agreement (k = 0.512) was noted for T staging between clinical and MRI staging assessments. Fair agreement (k = 0.218) was noted for N stage between clinical and MRI staging assessments. There was good agreement (k = 0.871) for M stage between the clinical and MRI staging assessments. Good agreement (k = 0.822 and k = 0.767, respectively) was noted for both T staging and Nstaging between MRI and histopathology staging assessments. The agreement for the T stage was poor (k = 0.012) between the clinical and histopathology staging assessments. Agreement for the N stage was also poor (k = 0.091) between the clinical and histopathology staging assessments. Mean depth of invasion by histology and MRI was 14.22 mm and 16.12 mm, respectively. Moderate agreement (k = 0.541) was noted between clinical and pathological tumor depth and good agreement (k = 0.844) was noted between radiological and pathological tumor depth. As for the T1WGd MRI depth with a cutoff value of 5 mm, the nodal metastasis rate in the group with values >5 mm was 52 %, and for those <5 mm was 24 %, both of which were significantly different (P = 0.040). Pearson’s correlation coefficient of HP depth and T1WGd MRI depth was 0.851 (P < 0.001) suggesting that HP depth shows a strong correlation with T1WGd MRI depth.  MRI is the imaging modality of choice for evaluation of tongue carcinoma as MRI helps in accurate staging of the tumor using TNM classification which is crucial for optimizing treatment options. The current study shows a high correlation between MRI and histopathological findings regarding thickness of tumor and depth of invasion. MRI and histopathology assessments of tumor spread were equivalent to within 0.5 mm DOI. Estimation of invasion depth using MRI as a preoperative study in oral tongue carcinoma is essential in planning surgical treatment strategies such as the extent of elective neck dissection. Invasion depth, which greatly affects occult node metastases, must be included in the TNM staging of oral tongue carcinoma.

20 illus, 13 tables, 36 ref

040013   GEETHAPRIYA S, GOVINDARAJ J, RAGHAVAN B, RAMAKRISHNAN B, ARAFATH R, VISHWANATHAN S, KRISHNA M (Radiology Dep, Apollo Cancer Institutes, Chennai-35, Tamil Nadu, Email: geethadspriya@gmail.com) : Cranial nerve schwannoma- A pictorial essay. Indian J Radiol Imaging 2020, 30(1), 116-25.

Schwannomas are peripheral nerve sheath tumours arising from cranial, spinal or peripheral nerves. Most of the schwannomas are benign with the rare possibility of malignant transformation. Cranial nerve schwannomas can be seen along the course of any cranial nerve in the intracranial region or head and neck location. Although a majority are solitary sporadic lesions, multiple schwannomas can be seen in syndromes like neurofibromatosis type 2 and rarely in type 1. Since intracranial schwannomas are slow‑growing, clinical presentation varies between no symptoms to cranial nerve palsy. Most of the times, the symptoms are due to mass effect over the adjacent structures, foraminal widening, compression of other cranial nerves, denervation injury or hydrocephalus. Familiarity with the course of the cranial nerves, imaging appearances and clinical presentation of schwannomas helps in accurate diagnosis and possible differential diagnosis, especially in uncommon clinical and radiological appearances. In this pictorial review, we illustrate relevant anatomy of cranial nerves, imaging features of schwannomas of most of the cranial nerves, clinical presentation and differential diagnosis.

19 illus, 23 ref

040012   CHACKO A, VEDAJALLAM S, ANDRONIKOU S, SIMPSON E, THAI N J (Bristol Univ, United Kingdom, Email: anithchacko@gmail.com) : Accuracy of radiologists, nonradiologists, and laypeople for identifying children with cerebral cortical atrophy from "Mercator map" curved reconstructions of MRIs of the brain. Indian J Radiol Imaging 2020, 30(1), 111-5.

Using text reports to communicate bilateral, symmetric, and zonal cortical brain atrophy in children with term hypoxic ischemic injury (HII) to parents and legal professionals contesting compensation rights can be difficult. Using standard cross‑sectional images for explaining bilateral, regional brain imaging to laypeople is also challenging. A single flattened image of the brain surface, much like a map of the earth is derived from a globe, can be generated from curved reconstruction of magnetic resonance imaging (MRI) scans, i.e., a Mercator map. Laypeople’s ability to identify abnormal “Mercator brain maps,” without prior training, requires evaluation before use in nonmedical settings. To determine the sensitivity and specificity of laypeople in detecting abnormal pediatric Mercator flat‑earth maps of the brain, without prior training. 10 Mercator brain maps were provided to 111 participants individually. The maps comprised 5 HII, 1 cortical dysplasia, and 4 normal cases. Participants were required to identify the abnormal scans. Sensitivity and specificity overall and for participants’ subgroups were calculated. Overall sensitivity and specificity were 67 % and 80 %, respectively. General radiologists (n = 12) had sensitivity and specificity of 91.2 % and 94.6 %, respectively. Laypeople (n = 54) had a sensitivity of 67 % and specificity of 80 %. The high specificity and sensitivity of radiologists validated the technique for distinguishing abnormal scans, regarding cortical pathology. High specificity of laypeople for identifying abnormal brains using Mercator maps indicates that this is a viable communication tool for demonstrating cortical MRI abnormalities of HII in children to laypersons.

3 illus, 9 ref

040011   THAKER S, BOTCHU R, GUPTA H (Musculoskeletal Radiology Dep, The Royal Orthopedic Hospital, UK, Email: drbrajesh@yahoo.com) : Insights into obtaining FRCR and beyond: Obstacles, opportunities and post-relocation dilemma ? An Indian perspective. Indian J Radiol Imaging 2020, 30(1), 70-6.

Indian radiology trainees and radiologists are interested to have FRCR (Fellow of the Royal College of Radiologists) qualification for various reasons including academic career progression, subspecialty interest and other socioeconomic factors. The path for acquiring FRCR qualification is adventurous yet onerous and exhausting. Perseverance, meticulous planning and clarity in the vision are essential prerequisites for an Indian graduate aiming to complete FRCR qualification, and one may require to invest an average of 1.5–2 years even if there is no reattempt in this tripartite examination. Indian doctors including radiologists are considered amongst the finest across global medical fraternities. However, the Indian medical education is skewed and variably distributed over the subcontinent due to organisational inability to provide single radiology curriculum‑based education to all radiology training programmes. Parallel educational boards and a variety of institutions such as government, trust‑funded and private organisations provide radiology training to further complicate the grand picture of radiology education in India. Conversely, UK radiology education is uniform nationally and rigorously enforced by deaneries based upon state‑provided guidelines. UK training opportunities are essentially academically rewarding experience but they require herculean efforts to gain access to one. One should constantly focus on building a resume at par with that of a UK trainee by obtaining experience required to fulfil checklist for such opportunities. Alongwith addressing local (UK) competition thoughtfully, hard work, diligence, and high standards of work ethics are absolute musts to build a great resume, to obtain training opportunity and, in turn, to satisfy the ultimate goal of carrier advancement. 

1 table, 6 ref

040010   SHAFIEE M, RASHIDFAR R, ABDOLMOHAMMADI J, BORZOUEISILEH S, SALEHI Z, DASHTIAN K (Radiation Sciences Dep, Yasuj Univ of Medical Sciences, Iran, Email: z.salehi@yums.ac.ir) : A study to assess the knowledge and practice of medical professionals on radiation protection in interventional radiology. Indian J Radiol Imaging 2020, 30(1), 64-9.

Ionizing radiation has been extensively used in medical procedures throughout the world. Such interventional radiological procedures could result in occupational exposure that needs urgent control. Therefore, MPs (medical professionals) should receive education and appropriate training on occupational radiation protection. In this context, the present study is aimed to investigate the MPs’ knowledge and practice regarding radiation protection principles during interventional radiological procedures. A descriptive questionnaire‑based study was carried out among 215 MPs involved in interventional fluoroscopy procedures. The practice of 31 MPs was studied using a checklist based on ALARA principles and ICRP guidelines. Results: A total of 43.3 % and 45.1 % answered correctly for knowledge and practice. However, the difference between radiation protection knowledge and practice between the physicians and nurses was statistically significant. The knowledge and practice survey of MPs demonstrated that nurses rarely adhered to radiation‑protection measures. The present study reflects the lack of knowledge and practice concerning radiation protection concepts among the nurses. This deficiency needs to be resolved by periodic practical radiation protection courses in the curriculum of medicine.

1 illus, 3 tables, 35 ref

040009   YADAV H, KHANDURI S, YADAV P, PANDEY S, YADAV V K, KHAN S (Radiodiagnosis Dep, Era’s Lucknow Medical Coll, Lucknow- 226 003, Uttar Pradesh, Email: drsachinrad@gmail.com) : Diagnostic accuracy of dual energy CT in the assessment of traumatic bone marrow edema of lower limb and its correlation with MRI. Indian J Radiol Imaging 2020, 30(1), 59-63.

Bone marrow edema is assumed to be caused as a result of trabecular microfractures that are detected by MRI. As MRI is not widely available in countries like India, this study aims to encourage the use of DECT in detection of bone edema as evidence with comparable efficiency to MRI. To assess the diagnostic accuracy of dual‑energy CT in detecting bone marrow edema in patients of trauma of lower limb and correlate it with MRI. It is a cross‑sectional study. The study included 40 patients of age 15–70 years irrespective of sex. All the patients of lower extremity trauma underwent DECT and MRI evaluation after clinical evaluation. All the images were postprocessed on a work station and were further evaluated by a radiologist. Mean attenuation at fractured site observed by Dual energy CT was found to be significantly higher as compared to that at adjacent site (170.75 ± 33.99 vs. 19.73 ± 22.50 HU). The sensitivity and specificity of dual energy CT as compared to MRI in detecting bone marrow edema were 94.1 % and 91.3 %, respectively. Of the 40 cases enrolled in the study, agreement of MRI and Dual energy CT was observed in 37 (92.5 %). Dual energy CT can be an effective alternative to MRI in the detection of bone marrow edema in patients of lower limb trauma. Dual energy CT can also be used in patients in whom MRI is contraindicated.

3 illus, 6 tables, 17 ref

040008   RATNAPARKHI C R, BAYASKAR M V, DHOK A P, BHENDE V (Radiodiagnosis and Imaging Dep, LMH, Nagpur- 440 025, Maharashtra, Email: madhura29.mb@gmail.com) : Utility of doppler ultrasound in early-onset neonatal sepsis. Indian J Radiol Imaging 2020, 30(1), 52-8.

Neonatal sepsis is an important cause of morbidity and mortality among newborns. As there is paucity of literature regarding early alteration of the cerebral blood flow (CBF) in neonatal sepsis our study aims to evaluate the changes in the CBF velocities and Doppler indices in neonates with early‑onset neonatal sepsis (EONS) and to evaluate the predictive accuracy of cerebral blood flow velocities (CBFV) by using ultrasound Doppler as a diagnostic marker of EONS. This cross‑sectional analytical study was conducted over a period of 2 years with 123 neonates enrolled in the study. The neonates were divided into two groups: Group I (with 54 neonates) ‑ neonates with EONS and group II (with 69 neonates) ‑ age‑matched neonates without any signs of sepsis. Ultrasound Doppler examination was performed and the cerebral hemodynamics assessed in neonates during the first seventy two hours of life. Doppler indices and CBFV were measured in the internal carotid artery (ICA), middle cerebral artery (MCA), and vertebral artery (VA) of either side. Data were analyzed using the statistical program SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated at different selected cutoff values for CBFV parameters. Lower resistance and higher peak systolic velocity and end diastolic velocity have been documented in neonates with EONS.Our study shows that the cerebral hemodynamics in neonates with EONS is altered which can be assessed bedside by noninvasive ultrasound Doppler examination.

8 illus, 3 tables, 31 ref

040007   HUSSAIN I Z, ZAKI F M, MUKARI S A, PAUZI S H, LOH C, ALIAS H (Radiology Dep, Kebangsaan Malaysia Medical Center Univ, Malaysia, Email: faizahbangi@yahoo.co.uk) : Correlation between MRI characteristics of medulloblastoma with histopathological subtypes and 2-year survival. Indian J Radiol Imaging 2020, 30(1), 46-51.

The objective of this study is to describe the imaging features of medulloblastoma (MB) and correlate the MR characteristics with the different histological subtype of MB with 2‑year survival. This is a retrospective descriptive study. A total of 29 patients diagnosed with MB from January 2005 to December 2015 were included in this study. The MRI brain and spine studies of these patients were retrieved and reviewed by a pediatric radiologist and a neuroradiologist independently, both blinded from the histological type of the MB. The HPE slides were also retrieved and reviewed by a pathologist. 80 % of desmoplastic MB showed the presence of intracranial leptomeningeal seeding and 57.1% of anaplastic MB showed the presence of necrosis. The presence of intracranial leptomeningeal seeding (P = 0.002) and necrosis (P = 0.019) was predictive of the histological subtypes. There is a significant correlation between the enhancement pattern and the 2‑year outcome (P = 0.03) with 6 out of 8 patients whose tumors showed minimal enhancement having disease progression within 2 years. A significant correlation was also seen between the presence of necrosis with a poorer outcome (P = 0.03) and between the HPE subtype and 2‑year outcome (P = 0.03) with anaplastic MB having the poorest prognosis. MR imaging features of intracranial leptomeningeal seeding and the presence of necrosis were correlated with a specific histologic subtype of MB. The enhancement pattern as well as necrosis correlated with 2‑year poorer outcome of the disease.

3 illus, 3 tables, 12 ref

040006   GROVER S B, ANTIL N, KATYAN A, RAJANI H, GROVER H, MITTAL P, PRASAD S (Radiology and Imaging Dep, Vardhman Mahavir Medical Coll and Safdarjung Hospital, New Delhi- 110 019, Email: shabnamgrover@yahoo.com) : Niche role of MRI in the evaluation of female infertility. Indian J Radiol Imaging 2020, 30(1), 32-45.

Infertility is a major social and clinical problem affecting 13–15 % of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero‑ salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono‑hysterography (syn: hystero‑sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in diagnosing entities comprising the garden variety, however, extensive pelvic inflammatory disease, complex tubo-ovarian pathologies, deep‑seated endometriosis deposits with its related complications, Mulllerian duct anomalies, uterine synechiae and adenomyosis, often remain unresolved by both transabdominal and transvaginal US. Thus, MRI comes to the rescue and has a niche role in resolving complex adnexal masses, endometriosis, and Mullerian duct anomalies with greater ease. This is a review, based on the authors’ experience at tertiary care teaching hospitals and aims to provide an imaging approach towards the abnormalities which are not definitively diagnosed by ultrasound alone.

16 illus, 29 ref

040005   SHARMA L K, BINDAL J, SHRIVASTAVA V A, SHARMA M, CHOORAKUTTIL R M, NIRMALAN P K (Woman and Child Development Dep, Raj Sonography and X-Ray Clinic, Madhya Pradesh, Email: drlksharma_guna@yahoo.co.in) : Discordant dating of pregnancy by LMP and ultrasound and its implications in perinatal statistics. Indian J Radiol Imaging 2020, 30(1), 27-31.

High perinatal mortality in India may be caused by inaccurate dating of pregnancy resulting from suboptimal uptake of antenatal care and ultrasound services during pregnancy. To determine the discrepancy in the last menstrual period (LMP) assigned expected date of delivery (EDD) and ultrasound assigned EDD in pregnant women in a rural district of central India. Data from an ongoing cross‑sectional screening program providing fetal radiology imaging in Guna district of Madhya Pradesh from 2012–2019 was analyzed for recall of LMP and discordance between LMP and ultrasound assigned EDD. The discrepancy was present when EDD assigned by ultrasound differed by 3 or more days at gestational ages less than 8+6 weeks, 5–7 days at gestational ages 8+6 weeks till 14 weeks, and 7–10 days at gestational ages 14–20 weeks. The program screened 14,701 pregnant women of which 4,683 (31.86 %, 95 % CI: 31.11, 32.61) could not recall LMP. EDD assigned by LMP and ultrasound matched in 7,035 (70.22 %, 95 % CI: 69.32, 71.12) of the remaining 10,018 pregnant women. EDD was overestimated by LMP for 26.06 % (95 % CI: 25.21, 26.93) women; these foetuses were at risk of being misclassified as a term fetus. In 2018, the project had no maternal deaths, infant mortality rate of 24.7, low birth weight rate of 9.69 %, and 100 % antenatal coverage. Accurate dating of pregnancy and systematic follow‑up integrating radiology imaging and obstetrics care for appropriate risk‑based management of pregnant women can significantly improve perinatal statistics of India.

3 tables, 31 ref

040004   DHAMIJA E, MEENA P, RAMALINGAM V, SAHOO R, RASTOGI S, THULKAR S (Radiodiagnosis Dep, All India Institute of Medical Sciences, New Delhi, Email: drektadhamija.aiims@gmail.com) : Chemotherapy-induced pulmonary complications in cancer: Significance of clinicoradiological correlation. Indian J Radiol Imaging 2020, 30(1), 20-6.

Chemotherapy while revolutionizing cancer management by improving survival and quality of life; is also associated with several adverse effects. Lung is the most common organ affected in chemotherapy‑related complications, due to either drug toxicity or more commonly due to infections caused by immunosuppression and less commonly due to immune‑mediated injury. Radiology, when used in combination with clinical and lab data, can help reach the specific diagnosis or narrow down the differentials. The common radiological patterns of drug toxicity include pulmonary interstitial and airway infiltrates, diffuse alveolar damage, nonspecific interstitial pneumonia, eosinophilic pneumonia, cryptogenic organizing pneumonia, pulmonary hemorrhage, edema and hypertension. Cancer patients are immunosuppressed due to the underlying malignancy itself or due to therapy and are prone to a gamut of opportunistic infections including viral, bacterial, fungal and mycobacterial pathogens. Immune reconstitution inflammatory syndrome (IRIS), a well‑known complication in HIV, is now being increasingly recognized in non‑HIV patients with immunosuppression. Engraftment syndrome is specifically seen following hematopoietic stem cell transplant during neutrophil recovery phase. Pulmonary involvement is frequent, causing a radiological picture of noncardiogenic pulmonary edema. Thus, radiology in combination with clinical background and lab parameters helps in detecting and differentiating various causes of pulmonary complications. This approach can help alter potentially toxic treatment and initiate early treatment depending on the diagnosis.

7 illus, 2 tables, 38 ref

040003   RUPA R, THUSHARA R, SWATHIGHA S, ATHIRA R, MEENA N, CHERIAN M P (Radiology Services Dep, Kovai Medical Center and Hospital, Coimbatore- 641 014, Tamil Nadu, Email: dr.mathewcherian@gmail.com) : Diffusion weighted imaging in breast cancer? Can it be a noninvasive predictor of nuclear grade?. Indian J Radiol Imaging 2020, 30(1), 13-9.

DWI and ADC values are noninvasive MRI techniques, which provide quantitative information about tumor heterogeneity. To determine the minimum and mean ADC values in breast carcinoma and to correlate ADC values with various prognostic factors. Prospective observational study.  Fifty‑five patients with biopsy‑proven breast carcinoma were included in this study. MRI with DWI was performed with Siemens 3T Skyra scanner. ADC values were measured by placing regions of interest (ROIs) within the targeted lesions on ADC maps manually. The histopathological and immunohistochemical analysis of surgical specimen was done to determine the prognostic factors. Students T test and ANOVA were used to study the difference in ADC between two groups. Pearson correlation coefficient was used to quantify the correlation between ADC values and prognostic factors. Lower grade (grade I) breast carcinoma had a significantly high ADC value as compared to higher grade carcinoma (grade II and III). For differentiating Grade I tumors from grade II and III, a minimum ADC cut‑off value was 0.79 × 10‑3 mm2/sec (83 % sensitivity and 84 % specificity) and a mean ADC cut‑off value was 0.82 × 10‑3 mm2/sec (83 % sensitivity and 71 % specificity) was derived. There was no significant correlation between ADC and other prognostic factors. ADC values can be used to differentiate lower grade breast carcinoma (grade I) from higher grades (grade II and III). Minimum ADC values are more accurate in predicting the grade of the breast tumor than mean ADC value.

7 illus, 1 table, 31 ref

040002   GUPTA N, MAHAJAN S, SUMANKUMAR A, SAKLANI A, ENGINEER R, BAHETI A D (Radio Diagnosis Dep, Tata Memorial Hospital, Maharashtra, Email: akshaybaheti@gmail.com) : Impact of a standardized reporting format on the quality of MRI reports for rectal cancer staging. Indian J Radiol Imaging 2020, 30(1), 7-12.

Besides providing a surgical roadmap, rectal MRI plays a major role in treatment planning. We recently started using a structured template for reporting rectal cancer via MRI. We study the impact of using this template at our hospital in terms of number of essential imaging parameters described in the reports as compared to the pre‑template free‑text reports. A structured rectal MRI reporting template was created in consensus with members of the colorectal tumour board and was introduced in the department, which included 14 essential parameters to be mentioned in the reports. We conducted a retrospective analysis of rectal MRI reports of 100 cases with histologically proven rectal cancer, comprising 50 consecutive free‑text reports before the template was introduced and 50 consecutive structured reports after its introduction, checking for the presence or absence of inclusion of the 14 parameters. An anonymous online feedback survey was conducted as well after the introduction of the template for the members of the colorectal tumour board. Overall, the total number of parameters reported increased from a median value of 10 (range 6‑13) to 14 (range 12‑14). The common unreported parameters prior to template introduction included T staging, presence or absence of restricted diffusion, anterior peritoneal reflection (APR) involvement, and presence or absence of extramural vascular invasion; these were reported in 16 %, 22 %, 30 % and 50 % respectively. These improved to 98‑100 % reporting after template introduction. Maximum improvement was in T staging (16 % to 98 %) (P < 0.0001), restricted diffusion on DWI (from 22 % to 100%) (P < 0.0001) and APR involvement (from 30 % to 100 %) (P < 0.0001). The most common unreported parameter after template introduction was the “tumoral T2 signal intensity” (unreported in 4 % cases). The results of the survey were as follows: 100 % felt a decreased need to talk to the radiologist to clarify the report, 81.8 % felt an improvement in the quality of reporting as compared to free style reports, and 91 % felt that the new template is easier to interpret. The introduction of a structured template for rectal cancer significantly improved the quality of rectal MRI reports, along with the satisfaction of referring providers.

8 illus, 1 table, 12 ref

040000   SINGH B, SINGH K P, KUMAR R, SINGH S V, HUSAIN S (Veterinary Gynaecology and Obstetrics Dep, Acharya Narendra Dev Univ of Agriculture & Technology, Kumarganj- 224 229, Uttar Pradesh, Email: drbsvet@gmail.com) : Postpartum uterine prolapse in a goat and its successful management. Indian J Vet Sci Biotechnol 2020, 16(1), 73-4.

Postpartum uterine prolapse occurs in all animal species. It is most common in cows and ewe, less common in the doe and rare in the mare. It is an eversion of the uterus, which turns inside out as it passes through the vagina. Prolapse of uterus generally occurs immediately after or a few hours of parturition when the cervix is open, and the uterus lacks tone (Hanie, 2006). The prolapse is visible as a large mass protruding from the vulva, often hanging down below the animal’s hock. The etiology of uterine prolapse is not yet fully known. Hormonal imbalance, hypocalcemia, mineral imbalances, injuries or stretching of birth passage, excessive traction at assisted parturition, dystocia or forceful removal of fetal membranes may contribute to the occurrence of prolapse (Hanie, 2006; Jackson, 2004). Animals with uterine prolapse should be treated promptly; otherwise, it may lead to edema, ischemia, laceration, internal hemorrhage (Noakes et al., 2001), prostration, and shock making prognosis poor to hopeless. The success of treatment depends on the type of case, the degree of damage, and contamination. The present case highlights the successful management of postpartum uterine prolapse in a goat.

1 illus, 8 ref

039999   BORAKHATARIYA D N, RAVAL R J, VALA K B, CHAVDA B P, PRAJAPATI S G (Junagadh Agricultural Univ, Junagadh, Email: devasee94@gmail.com) : Congenital hydrocephalic monster in an indigenous Gir calf. Indian J Vet Sci Biotechnol 2020, 16(1), 69-70.

There are several types of fetal dropsy (fetal ascites, fetal anasarca, fetal hydrocephalus), which have obstetrical importance preventing normal easy delivery of calf. Hydrocephalus is one of the fetal causes of dystocia. It is characterized by an accumulation of fluid which may be in the ventricular system or between the brain and the subarachnoid space. The swelling or enlargement of cranium occurs as a result of an imbalance between formation and drainage of cerebrospinal fluid (Arthur et al., 2001). This congenital dropsical condition is associated with an autosomal recessive gene, whereas some cases are due to BVD-MD or bluetongue virus infection in bovine (Roberts, 1986). Though this dropsical condition is rare in Gir cattle, it is reported in many other species (Dhami et al., 2007; Kumar et al., 2010; Parmar et al., 2018). The present case report depicts an unusual instance of hydrocephalic monster in an indigenous Gir calf, causing dystocia, which was successfully managed by per vaginum

1 illus, 6 ref

039998   ASHOO, VERMA H C, SINGH R K, KUMAR R, RAMAKANT, DIWAKAR R P (Veterinary and Animal Husbandry Extension Education Dep, ANDUAT, UP-224229, Email: drhukumchandraverma@gmail.com) : Incidence of reproductive disorders in cattle and buffalo under field conditions in eastern plain zone of Uttar pradesh. Indian J Vet Sci Biotechnol 2020, 16(1), 66-8.

This study was conducted in the Barabanki district of Uttar Pradesh on reproductive disorders in cattle and buffaloes under field conditions. The information was generated from 120 farmers, 20 farmers from each of six selected villages, who had at least one milking dairy animal at the time of the investigation. The information was generated regarding reproductive disorders of indigenous cattle, crossbred cattle, and buffalo due to improper feeding, breeding, and healthcare management practices and was analyzed to explore the incidence rate of reproductive disorders faced by dairy farmers in three categories of animals. The overall incidence rate of reproductive disorders among indigenous cattle, crossbred cattle, and buffalo in the area surveyed revealed maximum incidence in buffalo (76.05 %) and minimum in indigenous cattle (48.77 %), the crossbreds being intermediate (72.62 %). Late maturity was the major problem in indigenous cattle and anoestrus in buffalo. The incidence of repeat breeding was the highest in crossbred cattle. Dystocia, prolapse and stillbirth were more in buffaloes, while abortion, RFM, and uterine infections were more in crossbred cattle. Reproductive disorders like dystocia, prolapse, abortion and stillbirth were mostly treated by veterinarians; however, remaining reproductive disorders like anoestrus, repeat breeding, uterine infection etc. were treated by dairy farmers and quacks through their own experiences by using different type of indigenous technical knowledge. There is a need to create awareness about scientific animal husbandry practices among dairy farmers of the region studied.

1 table, 14 ref