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Friday, 24 October 2008

Buy homes abroad, save tax here

Posted on 05:44 by Unknown
Buy homes abroad, save tax here
Wednesday, 29 August , 2007, 08:01
Last Updated: Wednesday, 29 August , 2007, 08:49

 


For
long-term capital gains earned on sale of property, the tax rate is 20
per cent. If the value is above Rs 10 lakh, the tax rate climbs to
22.66 per cent. This applies both to residents as well as non-resident
Indians (NRIs).

Sec. 54 of the Income Tax Act offers a way out of paying such
tax. If the capital gain amount is invested in a residential house
within one year before to two years after the sale, then the capital
gains earned are fully exempted from tax. In case the investor intends
to construct a house, the time limit is extended to within three years
of the date of sale. Of course, if only a part of the capital gain is
used, the exemption would be proportional and the excess will be
chargeable to tax.

So far, so good. Now comes the interesting part, especially for NRIs.

Nowhere does Sec. 54 specify that the new house purchased should
be within India. This means, to save capital gains earned in India, the
NRI can even purchase a house in his or her own host country abroad and
yet claim exemption. Why just NRIs, now even resident Indians can
benefit from this rule. RBI allows an Indian resident up to $1,00,000
per annum to be invested abroad. Such investment could be even in
property.

So far, this was just a theoretical possibility based on a
plain reading of the law. However, in a recent judgment, the Income Tax
Tribunal in the case of Prema P Shah (Citation 282 ITR 211) has ruled
that the exemption offered by Sec. 54 can indeed be extended to a
property purchased in a foreign country.

The brief facts of the case were that the assessee claimed the
capital gains on sale of house property situated in India as exempt. To
support her claim, she filed a photocopy of a lease agreement for a
house in London. The assessing officer disallowed the claim noting that
Sec. 54 speaks of purchase of residential property or construction
thereof. In this case, Shah had purchased only tenancy rights and hence
exemption under Sec. 54 would not be available to her.

This argument was rejected by the Tribunal based on the facts
of the case. In the UK, property belongs to the Sovereign; citizens,
instead of being allowed to purchase, are granted long-term leases. In
the instant case, the lease was valid for 150 years -- in other words,
it was in perpetuity and for all practical purposes, the assessee was
the owner of the property.

It's not even necessary that the same amount of capital gains
be used to buy the property. The assessee can very well buy the
property even on mortgage (housing finance) -- as long as the
conditions specified in Sec. 54 are satisfied, the exemption is
available. This is because, even for properties bought using mortgage,
the borrower instantly becomes the owner of the property.

That he is paying his EMIs (mortgage) on the loan taken is an
agreement between the lender and the borrower inter se. It has no
bearing on the ownership of the property. In other words, as far as
Sec. 54 is concerned, an investment has indeed been made in property.
Whether it's through the mechanism of mortgage or otherwise is
immaterial.

This judgment will have far reaching impact, especially on NRI
investments and taxation. No one is born an NRI. Indian residents
become NRIs when they go abroad for employment or business. More often
than not, such persons own property in India, either the one they left
behind when they went abroad and became NRIs, or one that is inherited.

A number of such persons, who have set up a new life abroad
definitely don't need a new property just to save on tax. Now, such
persons can actually consider buying property abroad and claiming tax
benefits in India.

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NRI's - FAQs

Posted on 04:24 by Unknown


Definition of an NRI


An
Indian Citizen who stays abroad for employment/ carrying on business or
vacation outside India or stays abroad under circumstances indicating
an intention for an uncertain duration of stay abroad is a
non-resident. (Persons posted in U.N. organizations and officials
deputed abroad by Central/ State Government and Public Sector
Undertakings on temporary assignments are also treated as non-resident)
Non-resident foreign citizens of Indian Origin are treated on par with
non-resident Indian citizens.


For Investment in immovable properties:

A foreign citizen (other than a citizen of Pakistan, Bangladesh,
Afghanistan, Bhutan, Sri lanka or Nepal), is deemed to be of Indian
origin if,


  • (i) he held an Indian passport at any time, OR
  • (ii)
    he or his father or paternal grand-father was a citizen of India by
    virtue of the Constitution of India or the Citizenship Act, 1955 ( 57
    of 1955).

FAQs







































































































Do non-resident Indian citizens require permission of Reserve Bank to acquire residential/commercial properly in India?

Do
foreign citizens of Indian origin require permission of Reserve Bank to
purchase immovable property in India for their residential use?

In
what manner the purchase consideration for the residential immovable
property should be paid by foreign citizens of Indian origin under the
general permission?

What
are the formalities required to be completed by foreign citizens of
Indian origin for purchasing residential immovable property in India
under the general permission.

Can such property be sold without the permission of Reserve Bank?


Can sale proceeds of such property if and when sold be remitted out of India?

Are any conditions required to be fulfilled if repatriation of sale proceeds is desired?
What is the procedure for seeking such repatriation?

Can foreign citizens of Indian origin acquire or dispose of residential property by way of gift?

Can foreign citizens of Indian origin acquire commercial properties in India?

Can they dispose of such properties?

Can sale proceeds of such property be remitted out of India?

Can the properties (residential/commercial) be given on rent if not required for immediate use?


Can
NRIs obtain loans for acquisition of a house/flat for residential
purpose from financial institutions providing housing finance?

Can authorized dealer grant loans to NRIs for acquisition of a flat/house for residential purposes?

Can Indian companies grant loans to their NRI staff?

What are the options available for obtaining guarantors while applying for a HDFC/LIC loan

While purchasing real estate most developers demand a Power of Attorney in their favor, is there a way to avoid it?

   

ADDITIONAL DETAILS

Acquisition and Transfer of Immovable Property in India by a person resident outside India

These
FAQ's have been prepared in order to address various issues relating to
acquisition and transfer of immovable property in India by a person
resident outside India under the provisions of the Foreign Exchange
Management Act, 1999. These FAQs seek to cover the broad spectrum of
issues relating to acquisition and transfer of immovable property in
India by a non-resident Indian (NRI) or a foreign national of Indian
origin (PIO) or a foreign national of non-Indian origin as also by a
person resident in India who is not a citizen of India

1) Regulations/Directions issued by Reserve Bank of India

2) Acquisition of immovable property in India by way of purchase by a person resident outside India

3) Acquisition of immovable property in India by way of gift by a person resident outside India

4) Acquisition of immovable property in India by way of inheritance by a person resident outside India

5) Transfer of immovable property in India by way of sale by a person resident outside India


 


Q) Do non-resident Indian citizens require permission of Reserve Bank to acquire residential/commercial properly in India?
A)


No.


BACK ON TOP


Q)
Do foreign citizens of Indian origin require permission of Reserve Bank
to purchase immovable property in India for their residential use?


A) Yes. However, Reserve Bank has granted general permission to foreign
citizens of Indian origin, whether resident in India or abroad, to
purchase immovable property in India for their bona fide residential
purpose. They are, therefore, not required to obtain separate
permission of Reserve Bank.


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Q)
In what manner the purchase consideration for the residential immovable
property should be paid by foreign citizens of Indian origin under the
general permission?


A) The purchase consideration should be met either out of inward
remittances in foreign exchange through normal banking channels or out
of funds from NTE/FCNR accounts maintained with banks in India.


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Q)
What are the formalities required to be completed by foreign citizens
of Indian origin for purchasing residential immovable property in India
under the general permission.?


A) They are required to file a declaration in form IPI 7 with the
Central Office of Reserve Bank at Mumbai within a period of 90 days
from the date of purchase of immovable property or final payment of
purchase consideration along with a certified copy of the document
evidencing the transaction and bank certificate regarding the
consideration paid.


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Q)


Can such property be sold without the permission of Reserve Bank?


A) Yes. Reserve Bank has granted general permission for sale of such
property. However, where the property is purchased by another foreign
citizen of Indian origin, funds towards the purchase consideration
should either be remitted to India or paid out of balances in NRE/FCNR
accounts.


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Q)


Can sale proceeds of such property if and when sold be remitted out of India?


A) In respect of residential properties purchased on or after 26th
May,1993, Reserve Bank considers applications for repatriation of sale
proceeds up to the consideration amount remitted in foreign exchange
for the acquisition of the property for two such properties. The
balance amount of sale proceeds if any or sale proceeds in respect of
properties purchased prior to 26th May, 1993, will have to be credited
to the ordinary non-resident rupee account of the owner of the
property.


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Q)


Are any conditions required to be fulfilled if repatriation of sale proceeds is desired?


A) Applications for repatriation of sale proceeds are considered
provided the sale takes place after three years from the date of final
purchase deed or from the date of payment of final installment of
consideration amount, whichever is later.


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Q)


What is the procedure for seeking such repatriation?


A) Applications for necessary permission for remittance of sale
proceeds should be made in form IPI 8 to the Central Office of Reserve
Bank at Mumbai within 90 days of the sale of the property.


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Q) Can foreign citizens of Indian origin acquire or dispose of residential property by way of gift?

A) Yes. Reserve Bank has granted general permission to foreign citizens
of Indian origin to acquire or dispose of properties up to two houses
by way of gift from or to a relative who may be an Indian citizen or a
person of Indian origin whether resident in India or not,provided gift
tax has been paid.


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Q) Can foreign citizens of Indian origin acquire commercial properties in India?

A) Yes. Under the general permission granted by Reserve Bank properties
other than agricultural land/farm house/plantation property can be
acquired by foreign citizens of Indian origin provided the purchase
consideration is met either out of inward remittances in foreign
exchange through normal banking channels or out of funds from the
purchasers' NRE/FCNR accounts maintained with banks in India and a
declaration is submitted to the Central Office of Reserve Bank in form
IPI 7 within a period of 90 days from the date of purchase of the
property/final payment of purchase consideration.


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Q)


Can they dispose of such properties?


A) Yes.


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Q)


Can sale proceeds of such property be remitted out of India?


A) Yes. Repatriation of original investment in respect of properties
purchased by foreign citizens of Indian origin on or after 26th May
1993 will be allowed to be remitted up to the consideration amount
originally remitted from abroad provided the property is sold after a
period of three years from the date of the final purchase deed or from
the date of payment of final installment of consideration amount,
whichever is later. Applications for the purpose are required to be
made to the Central Office of Reserve Bank within 90 days of the sale
of property in form IPI 8.


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Q)


Can the properties (residential/commercial) be given on rent if not required for immediate use?


A) Yes. Reserve Bank has granted general permission for letting out of
any immovable property in India. The rental income or proceeds of any
investment of such income has to be credited to NRO account.


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Q)
Can NRIs obtain loans for acquisition of a house/flat for residential
purpose from financial institutions providing housing finance?


A) Reserve Bank has granted general permission to certain financial
institutions providing housing finance e.g. HDFC,LIC Housing Finance
Ltd.,etc. to grant housing loans to non-resident Indian nationals for
acquisition of houses/flats for self-occupation subject to certain
conditions.


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Q) Can authorized dealer grant loans to NRIs for acquisition of a flat/house for residential purposes?

A) Authorized dealers have been granted permission to grant loans up to
non-resident Indian nationals for acquisition of house/flat for
self-occupation on their return to India subject to certain conditions.
Repayment of the loan should be made within a period not exceeding 15
years out of inward remittance through banking channels or out of funds
held in the investments' NRE/FCNR accounts.


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Q)


Can Indian companies grant loans to their NRI staff?


A) Reserve Bank permits Indian firms/companies to grant housing loans
to their employees deputed abroad and holding Indian passport subject
to certain conditions.


Source: Reserve Bank of India


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Q)


What are the options available for obtaining guarantors while applying for a HDFC/LIC loan?


A) One will need a guarantor for a loan mainly for collateral security.
The guarantor will have to demonstrate appropriate net worth to cover
for the loan. Usually one can have a guarantor in any city where the
loan issuer has a branch. Talk to loan issuers they will work something
out for NRIs and foreign banks.


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Q) While purchasing real estate most developers demand a Power of Attorney in their favor, is there a way to avoid it?

A) One can choose not to grant the Power of Attorney (POA) to the
developers. However this will mandate the mailing of all documents to
your foreign residence and associated time delays. A good compromise is
to grant the POA to the builder only for specific necessary items.


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Regulations/Directions issued by Reserve Bank of India


Q:
Where can one find regulations/directions issued by Reserve Bank for
acquisition and transfer of immovable property in India by a person
resident outside India?


A:
Regulations regarding acquisition and transfer of immovable property in
India by a person resident outside India have been notified vide RBI
Notification No. FEMA 21/2000-RB dated May 3, 2000 as amended vide
Notification No. FEMA 64/2002-RB dated June 29, 2002 and Notification
No. FEMA 65/2002-RB dated June 29, 2002 and relevant directions issued
in the form of A.P. (DIR Series) Circulars. These are available on RBI
website:
www.fema.rbi.org.in


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Acquisition of immovable property in India by way of purchase by a person resident outside India


Q:
Under the extant foreign exchange regulations to whom is general
permission available for purchase immovable property in India?


A:
General Permission is available to purchase only a
residential/commercial property in India to a person resident outside
India who is a citizen of India (NRI) and who is a Person of Indian
Origin (PIO).


Q: Who is a Person of Indian Origin (PIO)?


A:
For the purpose of acquisition and transfer of immovable property in
India, a PIO means an individual (not being a citizen of Pakistan or
Bangladesh or Sri Lanka or Afghanistan or China or Iran or Nepal or
Bhutan), who (i) at any time, held Indian passport; or (ii) who or
either of whose father or grandfather was a citizen of India by virtue
of the Constitution of India or the Citizenship Act, 1955 (57 of 1955).


Q: Is NRI/PIO
who has purchased residential/commercial property under general
permission required to file any documents with Reserve Bank of India?


A:
NRI/PIO who has purchased residential/commercial property under general
permission is not required to file any documents with the Reserve Bank.


Q: Is there
any restriction on number of residential/commercial property that
NRI/PIO can purchase under the general permission available?


A:
There is no restriction on number of residential/commercial property
that NRI/PIO can purchase under the general permission available.


Q:
Can a name of a foreign national of non-Indian origin be added as a
second holder to a residential/commercial property purchased by
NRI/PIO?


A: No.


Q:
Can a foreign national of non-Indian origin resident outside India
acquire any immovable property in India by way of purchase?


A:
No. Under section 2 (ze) of the Foreign Exchange Management Act, 1999
‘transfer' includes among others, ‘purchase'. Therefore, a foreign
national of non-Indian origin resident outside India cannot acquire any
immovable property in India by way of purchase.


Q: Can a foreign national of non-Indian origin acquire residential property on a lease in India?


A:
Yes. A Foreign National of non-Indian origin including a citizen of
Pakistan or Bangladesh or Sri Lanka or Afghanistan or China or Iran or
Nepal or Bhutan may acquire only residential accommodation on lease,
not exceeding five years for which he/she does not require prior
permission of Reserve Bank of India.


Q:
Can a person resident outside India (i.e. a NRI or a PIO or a foreign
national of non-Indian origin) acquire agricultural land/plantation
property/farm house in India by way of purchase?


A:
No. A person resident outside India cannot acquire by way of purchase
agricultural land/plantation property/farm house in India.


BACK ON TOP


 

Acquisition of immovable property in India by way of gift by a person resident outside India


Q: Can NRI/PIO acquire residential/commercial property by way of gift under the general permission available?


A:
Yes. Under general permission available NRI/PIO may acquire
residential/commercial property by way of gift from a person resident
in India or a NRI or a PIO.


Q: Can a foreign national of non-Indian origin resident outside India acquire residential/commercial in India by way of gift?


A:
No. Under section 2 (ze) of the Foreign Exchange Management Act, 1999
‘transfer' includes among others, ‘gift'. Therefore, a foreign national
of non-Indian origin resident outside India cannot acquire
residential/commercial property in India by way of gift.


Q:
Can a person resident outside India (i.e. a NRI or a PIO or a foreign
national of non-Indian origin) acquire agricultural land/plantation
property/farm house in India by way of gift?


A: No. A person resident outside India cannot acquire agricultural land/plantation property/farm house in India by way of gift.


BACK ON TOP


 

Acquisition of immovable property in India by way of inheritance by a person resident outside India


Q:
Can a person resident outside India (i.e. NRI or PIO or foreign
national of non-Indian origin) hold any immovable property in India
acquired by way of inheritance from a person resident in India?


A:
Yes. A person resident outside India can hold immovable property
acquired by way of inheritance from a person resident in India as per
the provisions of Section 6(5) of the Foreign Exchange Management Act,
1999.


Q: Can
a person resident outside India (i.e. NRI or PIO or foreign national of
non-Indian origin) hold any immovable property in India acquired by way
of inheritance from a person resident outside India?


A:
With the specific approval of Reserve Bank a person resident outside
India may hold any immovable property in India acquired by way of
inheritance from a person resident outside India, provided the bequeath
or had acquired such property in accordance with the provisions of
foreign exchange law in force at the time of acquisition or under FEMA
regulations.


BACK ON TOP


 

Transfer of immovable property in India by way of sale by a person resident outside India


Q: Under general permission available to whom can NRI transfer by way of sale his residential/commercial property?


A: NRI can transfer by way of sale residential/commercial property in India to a person resident in India or to a NRI or a PIO.


Q: Under general permission available to whom can a PIO transfer his residential/commercial property by way of sale?


A: PIO can transfer by way of sale residential/commercial property in India only to a person resident in India.


Q: Can a PIO transfer by way of sale his residential/commercial property to a NRI or a PIO?


A:
No. He would need to seek Reserve Bank prior approval for transfer by
way of sale residential/commercial property in India to a NRI or a PIO.


Q: Can a
foreign national of non-Indian origin whether resident in India or
outside India transfer by way of sale residential/property in India
acquired with the specific permission of Reserve Bank to a person
resident in India or outside India?


A:
No. A foreign national of non-Indian origin whether resident in India
or outside India would need to seek prior approval of Reserve Bank for
transfer by way of sale residential/property in India acquired with the
specific permission of Reserve Bank to a person resident in India or
outside India.


Q:
Under general permission available to whom can NRI/PIO transfer by way
of sale his agricultural land/plantation property/farm house in India?


A:
Under the general permission available NRI/PIO may transfer by way of
sale his agricultural land/plantation property/farm house in India to a
person resident in India who is a citizen of India.


Q:
Can a foreign national of non-Indian origin resident outside India
transfer by way of sale agricultural land/plantation property/farm
house acquired by him in India?


A:
A foreign national of non-Indian origin resident outside India would
need to seek prior approval of Reserve Bank for transfer, by way of
sale, agricultural land/plantation property/farm house acquired in
India.

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Wednesday, 22 October 2008

RANZCR 2007 ASM MELBOURNE - MULTIMEDIA PRESENTATIONS

Posted on 06:56 by Unknown
Nephrogenic systemic fibrosis
Dr Maurice Molan
http://media.medeserv.com.au/RANZCR2007/MMR-5107/viewer_lrgvid.html

Virtual colonoscopy
Professor Bill Lees
http://media.medeserv.com.au/RANZCR2007/MMR-5113/viewer_lrgvid.html

Uterine artery embolisation
Dr Stuart Lyon
http://media.medeserv.com.au/RANZCR2007/MMR-5114/viewer_lrgvid.html

MRI rectal cancer
Dr Allan McKenzie
http://media.medeserv.com.au/RANZCR2007/MMR-5115/viewer_lrgvid.html

Primary gastrointestinal lymphomas
Professor Richard Mendelson
http://media.medeserv.com.au/RANZCR2007/MMR-5112/viewer_lrgvid.html

Renal Cancer Ablation
Dr David J. Breen
http://media.medeserv.com.au/RANZCR2007/MMR-5136/viewer_lrgvid.html
Vertebroplasty
Dr Stuart Lyon
http://media.medeserv.com.au/RANZCR2007/MMR-5134/viewer_lrgvid.html

CT Small Bowel Enteroclysis
Dr Frank Parrish
http://media.medeserv.com.au/RANZCR2007/MMR-5125/viewer_lrgvid.html

Magnetic resonance enteroclysis
Professor Richard Mendelson
http://media.medeserv.com.au/RANZCR2007/MMR-5123/viewer_lrgvid.html

Small bowel imaging from a gastroenterology perspective
Andrew Taylor
http://media.medeserv.com.au/RANZCR2007/MMR-5122/viewer_lrgvid.html

Computer aided Diagnosis: friend or foe'
Professor Bill Lees
http://media.medeserv.com.au/RANZCR2007/MMR-5130/viewer_lrgvid.html

Complications in laparoscopic
gastric banding
Dr David J. Breen
http://media.medeserv.com.au/RANZCR2007/MMR-5119/viewer_lrgvid.html

Hepatic resection surgery
Sean Mackay
http://media.medeserv.com.au/RANZCR2007/MMR-5118/viewer_lrgvid.html

Hepatic imaging and intervention for surgeons
Dr Anthony Schelleman
http://media.medeserv.com.au/RANZCR2007/MMR-5117/viewer_lrgvid.html

Ultrasound guided liver biopsy
Professor Rob Gibson
http://media.medeserv.com.au/RANZCR2007/MMR-5150/viewer_lrgvid.html

Pathology specimens - What the Radiologists should know
Professor Catriona McLean
http://media.medeserv.com.au/RANZCR2007/MMR-5148/viewer_lrgvid.html

Liver Imaging 2 & Radiology Scientific Proffered Papers (Specialty Gastrointestinal Genitourinary)
Dr James Anderson & Dr Samantha Ellis
http://media.medeserv.com.au/RANZCR2007/MMR-5147/viewer_lrgvid.html

Radiofrequency ablation of liver tumours
Professor Bill Lees
http://media.medeserv.com.au/RANZCR2007/MMR-5143/viewer_lrgvid.html

Biliary Intervention
Professor Andy Adam
http://media.medeserv.com.au/RANZCR2007/MMR-5141/viewer_lrgvid.html

Chemoembolisation
Dr Mark Goodwin
http://media.medeserv.com.au/RANZCR2007/MMR-5140/viewer_lrgvid.html

Management of acute emergencies for radiologists Resuscitation Workshop
N. Cunningham; T. Vawser; A. Pitman
http://media.medeserv.com.au/RANZCR2007/MMR-5139/viewer_lrgvid.html

Has Radiology got a sell-by date?
Professor Andy Adam
http://media.medeserv.com.au/RANZCR2007/MMR-5138/viewer_lrgvid.html

Quality Use of Diagnostic Imaging (QUDI) Program - Implications for Policy & Practice
L. Kenny; S. Goergen; A. Revell; G. O’Rourke; C. Mandel; and J. Grimm
http://media.medeserv.com.au/RANZCR2007/MMR-5137/viewer_lrgvid.html

Understanding Hepatic Perfusion Anomalies
Dr David J. Breen
http://media.medeserv.com.au/RANZCR2007/MMR-5156/viewer_lrgvid.html

Pancreatic cancer diagnosis, screening & new therapies
Professor Bill Lees
http://media.medeserv.com.au/RANZCR2007/MMR-5153/viewer_lrgvid.html

Problematic renal masses
Professor Peter Choyke
http://media.medeserv.com.au/RANZCR2007/MMR-5152/viewer_lrgvid.html

Imaging and erectile dysfuntion
Professor Bill Lees
http://media.medeserv.com.au/RANZCR2007/MMR-5151/viewer_lrgvid.html
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Tuesday, 21 October 2008

Palatal & Mandibular Torus, & Exostosis

Posted on 19:23 by Unknown
Palatal & Mandibular Torus, & Exostosis

While not technically soft tissue masses, the torus palatinus, torus mandibularis and bony exostosis (buccal exostosis) are all lesions which present as surface masses and are removed with minimal disturbance of deeper cancellous bones. As such, they are submitted to the pathologist as palatal or alveolar masses and might be confused with peripheral ossifying fibroma or other bone-producing soft tissue masses of the oral mucosa. For this reason, it is included in the present section.

The torus is considered to be a developmental anomaly, although it does not present until adult life and often will continue to grow slowly throughout life. It may be the outcome of mild, chronic periosteal ischemia secondary to mild nasal septum pressures (palatal torus) or the torquing action of the arch of the mandible (mandibular torus) or lateral pressures from the roots of the underlying teeth (buccal exostosis), but this is largely speculation. The most similar bony growth outside the jaws is the bunion of the lateral foot, and the earliest dental journal report of a torus palatinus was probably in an 1857 essay by Parmentier relating to tumors of the palate. The prevalence rate for tori is 27/1,000 adults (Table 1).

Clinical Features: These entities are all very site-specific. The palatal torus is found only in the midline of the hard palate (Figures 1 & 2). The mandibular torus is found only on the lingual surface of the mandible, near the bicuspid teeth (Figures 3 & 4). The buccal exostosis is found only on the facial surface of the alveolar bone, usually the maxillary alveolus.7 Bony surface proliferations found in another site are typically given the generic diagnosis of bony exostosis or osteoma, i.e. are considered to be trauma-induced inflammatory periosteal reactions or true neoplasms. Unless such a bony prominence is specifically located, is pedunculated or is associated with an osteoma-producing syndrome such as the Gardner syndrome, there may be no means by which to differentiate an exostosis from an osteoma, even under the microscope.

As previously stated, these lesions are not present until the late teen and early adult years, and many, if not most, continue to slowly enlarge over time. Fewer than 3% occur in children. Taken as a group, these lesions are found in at least 3% of adults and are more common in females than in males. The torus may be bosselated or multilobulated but the exostosis is typically a single, broad-based, smooth-surfaced mass, perhaps with a central sharp, pointed projection of bone producing tenderness immediately beneath the surface mucosa. Lesions may become 3-4 cm. in greatest diameter, but are usually less than 1.5 cm. at biopsy. A definite hereditary basis, usually autosomal dominant, has been established for some cases of tori and Asians, especially Koreans, have a much higher prevalence rate than do other racial groups.

Pathology: On cut surface the torus and exostosis show dense bone with a lamellar or laminated pattern (Figure 5). They are usually comprised of dense, mature, lamellar bone with scattered osteocytes and small marrow spaces filled with fatty marrow or a loose fibrovascular stroma. Some lesions have a thin rim of cortical bone overlying inactive cancellous bone with considerable fatty or hematopoietic marrow present. Minimal osteoblastic activity is usually seen, but occasional lesions will show abundant periosteal activity. Large areas of bone may show enlarged lacunae with missing or pyknotic osteocytes (Figure 6), indicative of ischemic damage to the bone. Ischemic changes such as marrow fibrosis and dilated veins may also be found in the marrow, with rare examples showing actual infarction of fatty marrow.

Treatment & Prognosis: Neither the torus nor the bony exostosis requires treatment unless it becomes so large that it interferes with function, interferes with denture placement, or suffers from recurring traumatic surface ulceration (usually from sharp foods, such as potato chips or fish bones). When treatment is elected, the lesions may be chiseled off of the cortex or removed via bone bur cutting through the base of the lesion.

Slowly enlarging, recurrent lesions occasionally are seen, but there is no malignant transformation potential. The patient should be evaluated for Gardner syndrome should he or she have multiple bony growths or lesions not in the classic torus or buccal exostosis locations. Intestinal polyposis and cutaneous cysts or fibromas are other common features of this autosomal dominant syndrome.
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New Horizons Lecture by Zerhouni

Posted on 13:23 by Unknown
http://www.rsna.org/generalsessions/zerhouni/index.html

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Monday, 6 October 2008

Posted on 22:49 by Unknown
Guyon's Canal Syndrome
Guyon's Canal is a small tunnel that lies within the wrist (between the Hamate and Pisiform bones of the hand, the roof of the canal is formed by the Volar carpal ligament), it is through this tunnel that the ulnar nerve and artery pass within a neurovascular bundle. The canal is one of the principal sites of ulnar nerve compression.
Guyon's Canal Syndrome is numbness and tingling in the ring and little fingers caused by irritation of the ulnar nerve as it passes through Guyon's Canal.
Causes
Guyon's Canal Syndrome arises when there is pressure on the ulnar nerve within the canal.
This pressure can be caused by:
A cyst within the canal.
Clotting of the ulnar artery.
Fracture of the hamate bone.
Arthritis of the wrist bones.
Symptoms
No matter what the cause of compression of the ulnar nerve, the symptoms are the usually the same.
They include:
Pins and needles in the ring and little fingers.
A burning pain of the wrist and hand.
Decreased sensation and clumsiness in the hand.
In extreme cases, compression of the ulnar nerve at Guyon's Canal can result in a phenomenon known as Claw Hand.
In all cases of compression of the ulnar nerve at Guyon's Canal, sensory supply to the skin of the back of the hand is spared.
This is because the branch of the nerve that supplies this area (the dorsal cutaneous nerve) leaves the main trunk of the ulnar nerve in the arm before it reaches Guyon's Canal.
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Anatomical variations of the cystic duct

Posted on 18:00 by Unknown
Anatomical variations of the cystic duct are usually of no clinical significance, occurring in 18%-23% of cases[4]. However, unrecognized variant anatomy can be a source of confusion on imaging studies. In addition, the cystic duct may be involved in a wide variety of both primary and secondary disease processes. The rate of injury varies in the medical literature from 0% to 1%[5]. The following are some of the cystic duct variations found: (1) the cystic and common hepatic duct are in parallel; (2) low confluence of the cystic duct[2]; (3) insertion of the cystic duct in the left and right hepatic ducts, and bifurcation of the left and right hepatic ducts[2]; (4) anterior, posterior spiral types of insertion of the cystic duct on the left side of the common hepatic duct; (5) parahepatic duct insertion into the cystic duct; (6) absent or short cystic duct (length <> 5 mm; (8) double cystic duct[6,7]; (9) right hepatic duct emptying into the cystic duct[8]; and (10) hepaticocystic duct[9], a very rare congenital abnormality in which the common hepatic duct enters the gallbladder. The left, right, and common hepatic ducts are all defective, with the cystic duct draining the entire biliary system into the duodenum.
Multiple modalities permit depiction of the normal anatomy, as well as disease processes of the cystic duct, including CT, PTC, ERCP, intraoperative cholangiography and MRCP. Although visualization of the dilated cystic duct is possible with US and CT, the normal-caliber cystic duct may be difficult to detect with these techniques[10]. In our first case, CT demonstrated minimal intrahepatic ductal dilatation, but failed to show low insertion of the cystic duct, as was revealed by surgery. In this case, the low insertion of the cystic duct was misdiagnosed as gallbladder and bile duct calculi. However, in the second case, ERCP showed a long cystic duct with a narrow and in-curved lumen. An anomalous cystic duct was diagnosed before surgery. Anatomical variation is readily identified at ERCP. In clinical practice, if the patient presents with intermittent non-colic right upper abdominal pain, and ultrasound, CT and endoscopy eliminate choledocholithiasis, tumor and peptic ulcer, then a narrow-winding cystic duct should be considered. ERCP is extremely helpful in diagnosis. Recent studies have demonstrated that MRCP may provide a non-invasive alternative to ERCP and PTC in diagnosis of anomalous cystic ducts[11]. Taourel and colleagues[12] evaluated the accuracy of MRCP in the diagnosis of anatomic variants of the biliary tree in 171 patients. MRCP demonstrated a cystic duct in 126 patients (74%), including low cystic duct insertion in 11 (9%) and a parallel course of the cystic and hepatic ducts in 31 patients (25%). These findings suggest that accurate preoperative assessment is very useful in providing a surgical treatment plan in addition to confirming diagnosis. During cholecystectomy, to avoid biliary tree injury, it is important to identify the common hepatic-cystic duct junction. Misidentification of the cystic duct can lead to postoperative complications. In particular, attention should pay to low medial insertion of the cystic duct because this anatomical variant may lead to misdiagnosis on imaging, and thus affect therapeutic intervention, as was seen in our first case.
A limited literature review of bile duct variation has shown that the aim of most surgeons is to identify whether there are bile duct stones. With respect to the accidental discovery of bile duct variation, it is not the nature of the variation itself but rather the existence of the bile duct variation that is the most important factor in the prevention of bile duct injury. Most injuries to the cystic duct usually occur when it runs parallel to the common bile duct and is encased in a common sheath, so that separation between the ducts is not readily apparent at surgery. T-tube placement in the cystic duct remnant is usually of no consequence; however, there may be a difficulty if retained common duct stones are present, and stone removal via the T-tube is attempted. In such cases, access to the bile duct is via a tract that enters the cystic duct, and manipulation and extraction must occur via the cystic duct across the valves of Heister. Stone extraction is more difficult or may be impossible via this route[13]. Suspicion should be raised if the cystic duct is of an unusually large calibre. Intraoperative cholangiography should be used in case of doubt and, in unusual circumstances, cholangiography can be performed via the gallbladder to aid in the identification of the cystic duct as well as the common bile duct.
In conclusion, the cystic duct may be involved in a variety of anatomical variations. Diagnostic accuracy relies on a clear understanding of the normal anatomy and anatomical variants of the cystic duct, and imaging features of calculous disease.

REFERENCES
1 Sendrath DNA. Anomalies of the bile ducts and blood vessels as the cause of accidents in biliary surgery. JAMA 1918;
71: 864-867
2 Lamah M, Karanjia ND, Dickson GH. Anatomical variations of the extrahepatic biliary tree: review of the world literature.
Clin Anat 2001; 14: 167-172 PubMed
3 Krahenbuhl L. Sclabas G, Wente MN, Schafer M, Schlumpf R, Buchler MW. Incidence, risk factors, and prevention of
biliary tract injuries during laparoscopic cholecystectomy in Switzerland. World J Surg 2001; 25: 1325-1330 PubMed
4 Shaw MJ, Dorsher PJ, Vennes JA. Cystic duct anatomy: an endoscopic perspective. Am J Gastroenterol 1993; 88: 2102-
2106 PubMed
5 Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A. Complications of
cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-
based study. Ann Surg 1999; 229: 449-457 PubMed
6 Fujikawa T, Takeda H, Matsusue S, Nakamura Y, Nishimura S. Anomalous duplicated cystic duct as a surgical hazard:
report of a case. Surg Today 1998; 28: 313-315 PubMed
7 Bernard P, Letessier E, Denimal F, LeNeel JC. Accessory cystic duct discovered by intraoperative cholangiography during
cholecystectomy. Ann Chir 2001; 126: 1020-1022 PubMed
8 Hashimoto M, Hashimoto M, Ishikawa T, Iizuka T, Matsuda M, Watanabe G. Right hepatic duct emptying into the cystic
duct: report of a case. Surg Endosc 2002; 16: 359 PubMed
9 Losanoff JE, Jones JW, Richman BW, Rangnekar NJ. Hepaticocystic duct: a rare anomaly of the extrahepatic biliary
system. Clin Anat 2002; 15: 314-315 PubMed
10 Zeman RK, Burrell MI. Gallbladder and bile duct imaging. New York: Churchill-Livingstone, 1987: 36-46
11 Turner MA, Cho SR, Messmer JM. Pitfalls in cholangiographic interpretation. Radiographics 1987; 7: 1067-1105
PubMed
12 Taourel P, Bret PM, Reinhold C, Barkun AN, Atri M. Anatomic variants of the biliary tree: diagnosis with MR
cholangiopancreatography. Radiology 1996; 199: 521-527 PubMed
13 Ghahremani GG. Postsurgical biliary tract complications. Gastroenterologist 1997; 5: 46-57 PubMed
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Sunday, 5 October 2008

General keyboard shortcuts

Posted on 03:44 by Unknown
• CTRL+C (Copy)
• CTRL+X (Cut)
• CTRL+V (Paste)
• CTRL+Z (Undo)
• DELETE (Delete)
• SHIFT+DELETE (Delete the selected item permanently without placing the item in the Recycle Bin)
• CTRL while dragging an item (Copy the selected item)
• CTRL+SHIFT while dragging an item (Create a shortcut to the selected item)
• F2 key (Rename the selected item)
• CTRL+RIGHT ARROW (Move the insertion point to the beginning of the next word)
• CTRL+LEFT ARROW (Move the insertion point to the beginning of the previous word)
• CTRL+DOWN ARROW (Move the insertion point to the beginning of the next paragraph)
• CTRL+UP ARROW (Move the insertion point to the beginning of the previous paragraph)
• CTRL+SHIFT with any of the arrow keys (Highlight a block of text)
• SHIFT with any of the arrow keys (Select more than one item in a window or on the desktop, or select text in a document)
• CTRL+A (Select all)
• F3 key (Search for a file or a folder)
• ALT+ENTER (View the properties for the selected item)
• ALT+F4 (Close the active item, or quit the active program)
• ALT+ENTER (Display the properties of the selected object)
• ALT+SPACEBAR (Open the shortcut menu for the active window)
• CTRL+F4 (Close the active document in programs that enable you to have multiple documents open simultaneously)
• ALT+TAB (Switch between the open items)
• ALT+ESC (Cycle through items in the order that they had been opened)
• F6 key (Cycle through the screen elements in a window or on the desktop)
• F4 key (Display the Address bar list in My Computer or Windows Explorer)
• SHIFT+F10 (Display the shortcut menu for the selected item)
• ALT+SPACEBAR (Display the System menu for the active window)
• CTRL+ESC (Display the Start menu)
• ALT+Underlined letter in a menu name (Display the corresponding menu)
• Underlined letter in a command name on an open menu (Perform the corresponding command)
• F10 key (Activate the menu bar in the active program)
• RIGHT ARROW (Open the next menu to the right, or open a submenu)
• LEFT ARROW (Open the next menu to the left, or close a submenu)
• F5 key (Update the active window)
• BACKSPACE (View the folder one level up in My Computer or Windows Explorer)
• ESC (Cancel the current task)
• SHIFT when you insert a CD-ROM into the CD-ROM drive (Prevent the CD-ROM from automatically playing)
• CTRL+SHIFT+ESC (Open Task Manager)

Dialog box keyboard shortcuts

If you press SHIFT+F8 in extended selection list boxes, you enable extended selection mode. In this mode, you can use an arrow key to move a cursor without changing the selection. You can press CTRL+SPACEBAR or SHIFT+SPACEBAR to adjust the selection. To cancel extended selection mode, press SHIFT+F8 again. Extended selection mode cancels itself when you move the focus to another control.
• CTRL+TAB (Move forward through the tabs)
• CTRL+SHIFT+TAB (Move backward through the tabs)
• TAB (Move forward through the options)
• SHIFT+TAB (Move backward through the options)
• ALT+Underlined letter (Perform the corresponding command or select the corresponding option)
• ENTER (Perform the command for the active option or button)
• SPACEBAR (Select or clear the check box if the active option is a check box)
• Arrow keys (Select a button if the active option is a group of option buttons)
• F1 key (Display Help)
• F4 key (Display the items in the active list)
• BACKSPACE (Open a folder one level up if a folder is selected in the Save As or Open dialog box)

Microsoft natural keyboard shortcuts

• Windows Logo (Display or hide the Start menu)
• Windows Logo+BREAK (Display the System Properties dialog box)
• Windows Logo+D (Display the desktop)
• Windows Logo+M (Minimize all of the windows)
• Windows Logo+SHIFT+M (Restore the minimized windows)
• Windows Logo+E (Open My Computer)
• Windows Logo+F (Search for a file or a folder)
• CTRL+Windows Logo+F (Search for computers)
• Windows Logo+F1 (Display Windows Help)
• Windows Logo+F1 (Display Windows Help)
• Windows Logo+ L (Lock the keyboard)
• Windows Logo+R (Open the Run dialog box)
• Windows Logo+U (Open Utility Manager) Roll Eyes


Accessibility keyboard shortcuts


• Right SHIFT for eight seconds (Switch FilterKeys either on or off)
• Left ALT+left SHIFT+PRINT SCREEN (Switch High Contrast either on or off)
• Left ALT+left SHIFT+NUM LOCK (Switch the MouseKeys either on or off)
• SHIFT five times (Switch the StickyKeys either on or off)
• NUM LOCK for five seconds (Switch the ToggleKeys either on or off)
• Windows Logo +U (Open Utility Manager)


Windows Explorer keyboard shortcuts

• END (Display the bottom of the active window)
• HOME (Display the top of the active window)
• NUM LOCK+Asterisk sign (*) (Display all of the subfolders that are under the selected folder)
• NUM LOCK+Plus sign (+) (Display the contents of the selected folder)
• NUM LOCK+Minus sign (-) (Collapse the selected folder)
• LEFT ARROW (Collapse the current selection if it is expanded, or select the parent folder)
• RIGHT ARROW (Display the current selection if it is collapsed, or select the first subfolder)


Shortcut keys for Character Map

After you double-click a character on the grid of characters, you can move through the grid by using the keyboard shortcuts:
• RIGHT ARROW (Move to the right or to the beginning of the next line)
• LEFT ARROW (Move to the left or to the end of the previous line)
• UP ARROW (Move up one row)
• DOWN ARROW (Move down one row)
• PAGE UP (Move up one screen at a time)
• PAGE DOWN (Move down one screen at a time)
• HOME (Move to the beginning of the line)
• END (Move to the end of the line)
• CTRL+HOME (Move to the first character)
• CTRL+END (Move to the last character)
• SPACEBAR (Switch between Enlarged and Normal mode when a character is selected)

Microsoft Management Console (MMC) main window keyboard shortcuts

• CTRL+O (Open a saved console)
• CTRL+N (Open a new console)
• CTRL+S (Save the open console)
• CTRL+M (Add or remove a console item)
• CTRL+W (Open a new window)
• F5 key (Update the content of all console windows)
• ALT+SPACEBAR (Display the MMC window menu)
• ALT+F4 (Close the console)
• ALT+A (Display the Action menu)
• ALT+V (Display the View menu)
• ALT+F (Display the File menu)
• ALT+O (Display the Favorites menu)

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• CTRL+N (Open a new console)
• CTRL+S (Save the open console)
• CTRL+M (Add or remove a console item)
• CTRL+W (Open a new window)
• F5 key (Update the content of all console windows)
• ALT+SPACEBAR (Display the MMC window menu)
• ALT+F4 (Close the console)
• ALT+A (Display the Action menu)
• ALT+V (Display the View menu)
• ALT+F (Display the File menu)
• ALT+O (Display the Favorites menu)


MMC console window keyboard shortcuts

• CTRL+P (Print the current page or active pane)
• ALT+Minus sign (-) (Display the window menu for the active console window)
• SHIFT+F10 (Display the Action shortcut menu for the selected item)
• F1 key (Open the Help topic, if any, for the selected item)
• F5 key (Update the content of all console windows)
• CTRL+F10 (Maximize the active console window)
• CTRL+F5 (Restore the active console window)
• ALT+ENTER (Display the Properties dialog box, if any, for the selected item)
• F2 key (Rename the selected item)
• CTRL+F4 (Close the active console window. When a console has only one console window, this shortcut closes the console)


Remote desktop connection navigation

• CTRL+ALT+END (Open the Microsoft Windows NT Security dialog box)
• ALT+PAGE UP (Switch between programs from left to right)
• ALT+PAGE DOWN (Switch between programs from right to left)
• ALT+INSERT (Cycle through the programs in most recently used order)
• ALT+HOME (Display the Start menu)
• CTRL+ALT+BREAK (Switch the client computer between a window and a full screen)
• ALT+DELETE (Display the Windows menu)
• CTRL+ALT+Minus sign (-) (Place a snapshot of the entire client window area on the Terminal server clipboard and provide the same functionality as pressing ALT+PRINT SCREEN on a local computer.)
• CTRL+ALT+Plus sign (+) (Place a snapshot of the active window in the client on the Terminal server clipboard and provide the same functionality as pressing PRINT SCREEN on a local computer.)
May 3 quote
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Microsoft Internet Explorer navigation

• CTRL+B (Open the Organize Favorites dialog box)
• CTRL+E (Open the Search bar)
• CTRL+F (Start the Find utility)
• CTRL+H (Open the History bar)
• CTRL+I (Open the Favorites bar)
• CTRL+L (Open the Open dialog box)
• CTRL+N (Start another instance of the browser with the same Web address)
• CTRL+O (Open the Open dialog box, the same as CTRL+L)
• CTRL+P (Open the Print dialog box)
• CTRL+R (Update the current Web page)
• CTRL+W (Close the current window)
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