Frequency of abnormal hepatic venous waveforms in cirrhotic patients

Objective: To determine the frequency of abnormal hepatic venous waveforms in patients suffering from hepatic cirrhosis

Study Design: Cross sectional

Place and of Study Duration: Shafique Medical Centre Quetta and Radiology Department Combined Military Hospital, Quetta from December 15[th] 2009 to July 15[th] 2010

Material and Methods: The instrument used in this study was Toshiba Eccocee SSA-340A and ALOKA SSD- 5000 doppler ultrasound machines with linear and convex probes. Hepatic venous Doppler was performed with convex 3-5 MHz probe. Hepatic venous Doppler examination was performed by two radiologists [operators] on all the 135 patients with positive HCV, HBV, chronically raised amino transferase level and clinical and radiological features of cirrhosis, who independently and blindly recorded their findings. Nonprobability, purposive sampling was done. After Doppler ultrasonographic examination liver biopsy and histopathology of all the patients was performed. Data from each patient was collected on designed form for age, gender, types of hepatic vein waveforms and grades/severity of liver cirrhosis on histopathology

Results: 135 patients with maximum 50 years and minimum 41 years of age have mean age of 46.79 +/- 2.37. Out of 135 patients in 103 [76.3%] Type 1 [Triphasic] flow was observed in 3%, Type II [Biphasic without reduced oscillation] flow was observed in 29.6%, type III [Biphasic with reduced oscillation] flow was observed in 34.1% and type IV [Monophasic] flow noted in 33.33%. There was significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology [r=0.887, p< 0.001]

Conclusion: Hepatic venous Doppler is noninvasive tool which can be employed to assess the types of abnormal hepatic venous waveforms in patients with hepatic cirrhosis. There is significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology

Airway management in a patient with severe Ankylosing Spondylitis causing Bamboo Spine: use of Aintree Intubation Catheter

Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter [AIC] with intubating fiberoptic bronchoscope

Ileo-colic intussusception; is hydrostatic reduction worth considering till late?

To evaluate the success rate of hydrostatic reduction of intussusception and incidence of complications in late presenting cases. Prospective study. Study was carried out in Armed Forces Institute of Radiology and Imaging Rawalpindi and different Combine Military Hospitals during last 5 years. All the children up to 2 years age with diagnosis of ileo-colic intussusception and 3 days or less history of onset of symptoms were included in the study. Patients with signs of perforation, suspicion of lead point or long intussusceptum protruding through rectum were excluded. After plain film evaluation, thin barium was instilled through Foleys catheter under fluoroscopic guidance. Rule of 3 was followed and reduction was considered successful when contrast refluxed into terminal ileal segment. Follow up plain x-ray and ultrasound was done after 48 hours to rule out recurrence. Hydrostatic reduction was successful in 18 out of 21 patients collected during last five years. Reduction was incomplete in one case while perforation was observed in 2 cases. These complications were observed in the largest group [52%] of patients reporting on 3rd day of onset of symptoms. A significant number [38%] of patients reached the hospital within 48 hours. Only 2 [10%] patients presented in first 24 hrs but uneventful reduction was possible in later two groups. Careful hydrostatic reduction in cases of ileo-colic intussusception reporting within 72 hrs will reduce hospital stay and patient morbidity in most of the cases

Posterior reversible encephalopathy syndrome [PRES]

Posterior reversible encephalopathy syndrome [PRES] is a clinicoradiologic entity. Neurotoxicity with characteristic watershed CT/MR imaging features characterize this condition. This case report describes PRES syndrome in a 35-year-old patient admitted with eclampsia. On the first postpartum day; she developed severe headache, generalized tonic-clonic seizures and visual symptoms including transient visual loss. MRI scan of the brain showed symmetric areas of hyperintense signal on T2-weighted images in the occipital lobes bilaterally. Patient improved symptomatically. Repeat MRI of the brain 4 months after initial admission showed resolution of the previous abnormalities

Bronchial atresia with partial anomalous pulmonary venous return

Bronchial atresia and anomalous superior pulmonary venous return into the left brachiocephalic vein are unusual anomalies. We present a young asymptomatic man in whom these two distinct anomalies were co-existingly found on routine medical examination. Patient was diagnosed as a case of congenital bronchial atresia with partial anomalous pulmonary venous return based on the evidence of special features on X-ray chest film, characteristic contrast enhanced 16-slice CT chest findings, lack of symptoms and no change on fallow-up X-ray chest films

Role of ultrasound in rotator cuff tears

The study was designed to evaluate the efficacy of ultrasound in rotator cuff tears and to compare it with MRI. Descriptive study. The study was conducted in the radiology department of Combined Military Hospital Rawalpindi from July 2005 to January 2006. Total number of patients was thirty. All of these were above thirty years of age and were referred by clinicians, with shoulder pain for diagnostic workup. Post operative patients were excluded. Ultrasound and Magnetic Resonance Imaging [MRI] were performed on each patient. Same operator performed ultrasound in all patients. Ultrasound [US] and Magnetic Resonance Imaging [MRI] detected equal number of full thickness tears while two partial thickness tears were missed on US. Hypoechoic defect was the most important primary sign while cortical irregularity and fluid in subacromial and subdeltroid busra were the most important secondary signs on US. US was equally effective to MRI in detection of rotator cuff tears. It should be the primary investigation because of its availability, cost effective and real time evaluation provided significant expertise is developed, as it is highly operator dependent

Mucocele of the appendix: an unusual cause of disturbed bowel habits

There are many causes of disturbed bowel habits. In this rare case of mucocele of appendix, patient presented with disturbed bowel habits of increased frequency, urgency and semisolid stool. Ultrasound of abdomen revealed fusiform cyst just below umbilicus. Differential diagnoses included mesenteric cyst, duplication cyst and mucocele of appendix. Coronal and saggital reformats of CT abdomen confirmed its origin from ceacum. Its tip was in contact with sigmoid colon. Surgical resection was carried out and histopathology revealed mucinous cyst adenoma

Effectiveness of an oral hygiene program for patients undergoing fixed orthodontic treatment

The aim of the present study was to assess the effectiveness of an oral hygiene program for patients undergoing fixed orthodontic treatment. Main sample consisted of one hundred patients with an age range of 12-25 years, having a full complement of permanent dentition, reporting to the orthodontic department of the de, Montmorency College of Dentistry, Lahore. Community Periodontal Index was used to assess the periodontal status of these patients. From these 100 patients, 20 patients having good oral hygiene and in need of fixed orthodontic treatment were divided into experimental and control groups, and their periodontal status was assessed before and during fixed orthodontic treatment. Modified Bass toothbrushing technique and the relation between the fixed orthodontic appliances, plaque accumulation and gingival inflammation were explained to the experimental group. Data was analyzed by using SPSS [Version 8.0] in personal computer. Results showed although no significant differences were noted in the periodontal status of experimental and control groups, but as a group, control group patients showed more statistically significant deterioration of periodontal health as compared to the experimental group

Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease