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Background: Intussusception being the leading cause of acute abdomen in childhood, its timely and accurate diagnosis assumes utmost significance in reducing the morbidity and mortality. Childhood intussusceptions are still managed surgically in our region; however, non-operative reduction has now become the gold standard of treatment worldwide. In this study, authors desired to evaluate the suitability and effectiveness of hydrostatic reduction of intussusception under ultrasound (USG)-guidance and to scrutinize the factors affecting the successful outcome.Methods: Ours was a prospective study carried out at a tertiary care centre in central Kashmir. All except those with clinical features of bowel gangrene, intestinal prolapse and peritonitis underwent ultrasound-guided hydrostatic reduction (USGHR). A maximum of three attempts were allowed.Results: Mean age of the patients was 11.2±8.8 months with age range of 3-50 months. 69.1% (n=38) of the patients presented within 24 h of being symptomatic while 30.9% had delayed presentation (>24 h). The success rate of USGHR was 81.8% (n=45). Late presentation, age and gender of the patients had no influence on successful outcome of the procedure, p >0.005. The duration of hospital stay between those who had successful hydrostatic reduction and those who afterwards underwent operative reduction or resection achieved statistical significance, p=0.0015. Authors attained a 66.2 % (45/68) reduction in operative management using USGHR as the main modality of treatment.Conclusions: USGHR is a simple, safe and effective non-operative method of treating intussusceptions in children in a limited resource setting.
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Background: In view of the fact that Brightness (B)-mode ultrasound findings in patients with renal parenchymal disease are profoundly non-specific, this study was carried out to determine the efficiency of color Doppler sonography for assessing renal function. In this series, the relationship between the resistive index (RI) of renal interlobar artery and serum creatinine level was analyzed for any relevant association of this color Doppler index with the serum creatinine level.Methods: In this prospective cross-sectional study, 40 patients with renal parenchymal disease having serum creatinine level >1.4 mg/dL were chosen midst routine revisits. The control group comprised of 40 normal subjects with serum creatinine levels <1.4 mg/dL. After assessing the kidneys of these subjects with gray-scale ultrasound for presence of any stones, hydronephrosis, and/or space occupying lesions instead of, they were subsequently interrogated with color Doppler sonography and RI calculated.Results: The mean serum creatinine levels±SD in the case and control groups were 6.7±0.7 mg/dL and 1.0±0.4 mg/dL, respectively. The mean±SD resistive index (RI) was 79.0%±1.8% in the diseased group and 60.3%±0.7% in the healthy subjects (p<0.001). The correlation between the RI and the serum creatinine level was statistically significant (p<0.001).Conclusions: Resistive index (RI) measurement by color doppler ultrasonography is a reasonable prognosticator of functional outcome in patients with renal parenchymal disease.
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Introduction: Vertebral artery dissection (VAD) is animportant cause of posterior circulation stroke in youngpatients and presents with a host of clinically varied symptomsdepending upon the type and site of dissection. Currentresearch aimed to study the spectrum of magnetic resonanceimaging findings in vertebral artery dissection.Material and methods: This was an observational studywhere a cohort of 193 patients of posterior circulation strokewere evaluated with magnetic resonance imaging and amongthem 17 patients having vertebral artery dissection wereselected and magnetic resonance imaging findings werestudied using spin echo, diffusion weighted imaging and 3Dtime of flight MR angiography sequences.Results: Of the total 17 patients imaged with age range of23-59 years (mean age 38 years), 11 were males and 6 werefemales. V3 was the commonest site of dissection (n=10)followed by V4 (n=4) and V2 (n=3). The most commonpattern of dissection was steno-occlusive (n=15), whereas2 patients had aneurysmal type of dissection. T1W imagesrevealed intra-arterial thrombus in all the 17 patients. T2Wrevealed absent flow in vertebral artery in 5 patients. 3D TOFMRA revealed narrowed lumen in 10 patients and completeocclusion in 5 patients. One patient revealed intimal flap on3D TOF MRA.Conclusion: MRI is an excellent non-invasive modality forevaluation of posterior circulation stroke. MRI in conjunctionwith MR angiography helps clinch the diagnosis of VAD andthus helps in planning management and subsequent follow upof these patients.
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Introduction: Encephalitis is defined as inflammation of thebrain parenchyma. Study was done to determine the role ofDWI/ADC in the early diagnosis of acute viral encephalitis.Material and methods: 26 patients with clinical andlaboratory (CSF, blood culture) evidence of encephalitis wereprospectively evaluated with MRI, DWI/ADC and SWI withpatients divided into three groups on the basis of durationbetween the onset of clinical symptoms and timing of MRIbrain.Results: Of the total 26 patients imaged with age range of 3-70years (mean age 45 years), 20 were males and 6 were femaleswith a male to female ratio of 3.3:1. Group 1 comprised 8patients, group 2 and group 3 comprised 9 patients each. Pvalues were significant (p<0.05) between mean ADC valuesand their respective groups. We also found statisticallysignificant difference between group 2 and group 3 (p=0.041)with no statistically significant difference between groups 1and 2; and groups 1 and 3.Conclusion: MRI plays vital role in patients of acuteencephalitis in not only excluding intracranial space occupyinglesions but also in early diagnosis and specific treatment, thusreducing disease related morbidity and mortality. DWI/ADCis now an essential sequence in the colossal armamentariumof MRI sequences which not only helps in early diagnosis ofacute viral encephalitis but also has prognostic implications.