Pancreatic lymphangioma

Lymphangioma develops as a consequence of lymphatic malformation and blockage of lymphatic flow. Pancreatic lymphangioma is a rare benign tumour which can grow reasonably large prior to manifestation of symptoms. On imaging, it appears as a complex multiseptated cystic mass. However, this appearance is not diagnostic and overlaps with cystic pancreatic neoplasm. We present a case of pancreatic lymphangioma incidentally discovered in an elderly lady who was managed conservatively since surgery could not be performed as the patient was high risk for surgery. Imaging findings along with follow-up of the case and review of literature is presented

Learning from errors in radiology to improve patient safety

To determine the views and practices of trainees and consultant radiologists about error reporting. Cross-sectional survey. Radiology trainees and consultant radiologists in four tertiary care hospitals in Karachi approached in the second quarter of 2011. Participants were enquired as to their grade, sub-specialty interest, whether they kept a recod/log of their errors [defined as a mistake that has management implications for the patient], number of errors they made in the last 12 months and the predominant type of error. They were also asked about the details of their department error meeting. All duty completed questionnaires were included in the study while the ones with incomplete information were excluded. A total of 100 radiologists participated in the survey. Of them 34 were consultants and 66 were trainees. They had a wide range of sub-specialty interest like CT, Ultrasound, etc. Out of the 100 responders, 49 kept a personal record/log of their errors. In response to the recall of approximate errors they made in the last 12 months. 73 [73%] of participants recorded a varied response with 1 - 5 errors mentioned by majority i.e. 47 [64.5%]. Most of the radiologists [97%] claimed receiving information about their errors through multiple sources like morbidity/mortality meetings, patients' follow-up, through colleagues and consultants. Perceptual error 66 [66%] were the predominant error type reported. Regular occurrence of error meetings and attending three or more error meetings in the last 12 months was reported by 35% participants. Majority among these described the atmosphere of these error meetings as informative and comfortable [n = 22, 62.8%]. It is of outmost importance to develop a culture of learning from mistakes by conducting error meetings and improving the process of recording and addressing errors to enhance patient safety

Migration of health workers: a challenge for health care system

The migration of health workers has resulted in a growing apprehension universally because of its impact on health system of the developing countries. Although the choice to migrate is basically a personal one, however, the overall social and economic circumstances have important impact on the decision to migrate. The "push and pull" factors for migration are disparity in working conditions, pay, lack of promotion opportunities, poor living conditions, desire to gain experience, professional development, family background and family wealth. A strategic approach by the government and other agencies is mandatory for regulating the flow of health workers between countries. A range of policies and interventions are needed to deal with the broader health system issue and problems of health workers that influence their recruitment, retention, deployment and progress

Diffusion weighted mr imaging [DWI] and ADC values in endometrial carcinoma

To determine the sensitivity of MR imaging utilizing diffusion weighted imaging [DWI] in detection of endometrial cancer and to compare the Apparent Diffusion Coefficient [ADC] values of malignant and normal endometrium. Cross-sectional analytical study. Radiology Department, Aga Khan University Hospital Karachi, from January 2007 to December 2009. Patients were defined as undergoing MRI for suspected endometrial malignancy, and the controls were female subjects who underwent MRI examination for indications other than endometrial malignancy. Studied variables included the signal characteristics of the endometrium and ADC values. The sensitivity of DWI for the detection of endometrial carcinoma was calculated using histopathology as the gold standard, and the ADC values of the endometrium in patients and controls were recorded. The mean ADC values were compared using two-sided t- test with significance at p < 0.05 at 95% confidence interval. Out of 52 patients, 10 had hyperintense, 40 had hypointense and 2 had isointense endometrium on T2 weighted imaging. On DWI, 42 patients had hyperintense and 10 patients had hypointense endometrium. In comparison, 40 controls had hypointense endometrium on DWI and 12 had hyperintense endometrium. The mean ADC value for abnormal endometrium was 0.730 +/- 0.215 x10-[3] mm[2]/sec and of normal endometrium was 1.265 +/- 0.305 x10[3] mm[2]/sec [p < 0.001]. The sensitivity for detection of endometrial carcinoma on DWI was 77.77%. False positive cases were found to be due to secretory and hyperplastic endometrium. False negative findings were found in a few cases of adenocarcinoma, endometroid carcinoma and clear cell sarcoma. In patients with suspected endometrial carcinoma, MRI examination utilizing DWI was a sensitive tool in detecting endometrial cancers with significantly lower ADC values for carcinoma in general. Physiological and histopathological variants may be responsible for a few false results