Ultrasound Study of Atherosclerotic Changes in Carotid Vessels and Role of Certain Factors which Increase the Incidence of Atherosclerosis

Atherosclerosis is supposed to be causing number of deaths due to coronary artery stenosis and major inability in the shape of hemipleagias involving carotid arteries, which is called stroke or vascular accident. In this study, evaluation of the factors causing increased incidence of carotid artery atherosclerosis is done. Ultrasound has unique capability to visualise vessel wall in vivo. This important arterial pathophysiolgy detected with B-mode sonography is arthrosclerosis and plaque formation. Atherosclerotic plaque is represented sonographically by echogenic material that thickens the intimal reflection and encroaches onto the arterial lumen and produces flow void. The study was carried out with 375 patients who were attending the medical, surgical and diabetic departments of Santhiram Medical College, Nandyal for attributable neurological signs. All the cases were examined with SIEMENS SONOLINE G-50 ultrasound machine using the 7.5–10 MHz linear array transducer. All examinations are done with the Doppler angle of 60 degree and sample volume of 1–5 mm[2,5]. All four vessels, i.e., common carotid, internal carotid, external carotid and vertebral arteries of both sides are evaluated both longitudinally and transversely. Following parameters are observed on both real time and frozen images. Intima-media thickness, patent lumen diameter, residual lumen diameter, dimensions of the plaque, peak systolic velocity, systolic velocity ratio (carotid index), diastolic velocity ratio and percentage of diameter stenosis.

MRI Evaluation of Disc Lesions Causing Lumbar Canal Stenosis and Backache

Degenerative disease of the lumbar spine refers to a syndrome in which an intervertebral disc with adjacent spine structures is compromised, this can be due to aging process associated with pathology. Thirty five percent of asymptomatic individuals may have degenerative spine findings, including: disc degeneration, modic changes, disc bulges, facet joint arthropathy and spinal stenosis. Plain radiography provides only limited diagnostic information. It cannot show the structural morphology of the intervertebral disc. Magnetic resonance imaging (MRI) is helpful in detecting changes like disc displacement (bulge, protrusion, extrusion, sequestration), OPLL, zygapophyseal joint hypertrophy, buckling or hypertrophy of ligaments. Also MRI is helpful in differentiating central canal stenosis from lateral canal stenosis. Study population included all patients above 20 years of age with LBP with/without radiculopathy who were referred for lumbar spine MRI at Radiology Department, SRMCH from August 2011 to September 2013. All consented patients with LBP with/without radiculopathy referred for lumbar MRI were consecutively included in the study. A total of 280 individuals had lumbar MRI scan from August 2011 to September 2013, but only 250 whom fulfilled the study criterion were studied.

Ultrasonographic and Computed Tomography Evaluation of Hydatid Disease

Echinococcosis has always been an endemic disease. It remains today a common surgical condition in many parts of the Kurnool district, carrying a significant morbidity and mortality. The development of real-time ultrasound and computed tomography (CT) with greater imaging versatility and diagnostic accuracy has resulted in a change. To know the precise location of the cysts, number, multiple organ involvement, complications like infection, cyst rupture, mass effect, etc., by ultrasound and CT. To measure the size and depth of the cysts in an organ thereby indicating their operability or otherwise monitor the response to medical treatment. A study of 30 patients with palpable abdominal masses, pulmonary cysts, renal cysts, etc. was undertaken. Data was collected based on clinical features, plain radiographic, ultrasonographic and computed tomographic findings. Thirty cases were studied and analyzed according to their anatomical distribution, age, sex distribution, multiplicity of lesions, multi organ involvement and sonographic appearance. With the aim of ultrasonographic and CT evaluation of hydatid disease, 30 cases studied and analysed. Eighteen cases were in males and twelve were in females. Hepatic hydatids comprised the largest group with 26 cases out of 30 cases with next largest pulmonary hydatid cysts. Multiplicity of cysts was noted in eight cases and multiple organ involvement was seen in seven cases. The preponderance of hepatic hydatid cysts is more in 3rd to 5th decades and in 2nd to 6th decades in cases of lung cysts. Right lobe of liver is more involved than the left one.

The Role of Umbilical Artery Doppler in Predicting the Fetal Out Come in Cases of Pregnancy Induced Hypertension

Purpose To determine and compare the diagnostic performance of Doppler sonography of fetal umbilical artery (UA) for prediction of adverse perinatal outcome in suspected intrauterine growth retardation (IUGR) and pre eclampsia. Materials and Methods 100 women with singleton pregnancy between 26 to 30 weeks of gestation were studied in this prospective study over a period of one and half years with color Doppler. UA flow velocity form was studied. In UA systolic/diastolic (S/D) ratio, pulsatility index (PI) and Resistance index (RI) were studied. In UA absent diastolic flow or reversed diastolic flow is noted. Results Out of 50 clinically suspected pregnancy induced hypertension (PIH) cases, 31 (62%) cases show abnormal PI, 40 (80%) cases show abnormal RI values and 45 (90%) cases show abnormal S/D Ratio's. Sensitivity and specificity of the S/D ratio in predicting PIH are 90% and 88% respectively followed by positive and Negative predictive value (PPV & NPV) of 88% and 89% whereas sensitivity, Specificity, PPV and NPV of RI & PI are lower than S/D ratio. This shows that S/D ratio has more Sensitivity, Specificity and Predictive values. Sensitivity of PI value in predicting fetal outcome is 75%. 22% (11 out of 50 cases) cases show absent/reversal of end diastolic velocities, of these four are reversal of end diastolic velocity (RDEV). All four cases of REDV died before 32 weeks of gestation. Absent diastolic flow is seen in 7 cases, 4 cases died and three cases admitted in NICU with severe respiratory distress. Our study shows absent or reversal of end diastolic velocity is more sensitive in predicting adverse fetal outcome. There was no case of eclampsia or maternal death. Conclusion UA flow velocity waveforms abnormality is more predictive for preeclampsia and IUGR. Hence Doppler is a promising tools in prediction of PIH and IUGR

Non-traumatic Acute Abdomen Evaluation

The term “acute abdomen” defines a clinical syndrome characterized by the sudden onset of severe abdominal pain requiring emergency medical or surgical treatment. A prompt and accurate diagnosis is essential to minimize morbidity and mortality. The differential diagnosis includes an enormous spectrum of disorders ranging from benign self-limiting diseases to conditions that require emergency surgery. The clinical diagnosis of acute abdomen can be challenging because physical examination clinical presentation and laboratory examination are often non specific and non diagnostic. It is often difficult based on history and physical examination alone to separate these patients from those who require immediate surgery. The increased availability and use of computed tomography (CT) and Ultrasonography (US) have dramatically changed the clinical examination and treatment of patients who present with acute abdominal pain. These noninvasive imaging techniques have effectively replaced exploratory as the primarymeans of examiningpatientswho present with what was formerly known asa surgical abdomen.