ABSTRACT
Background and Aim: There is limited data on imaging features of extra hepatic portal venous obstruction (EHPVO) induced portal biliopathy. We describe a decade long experience of imaging spectrum of EHPVO induced portal biliopathy using MR/CT in a referral centre for liver diseases. Methods: Retrospective data of patients with primary EHPVO on contrast magnetic resonance imaging MRI/ computed tomography (CT) (n=120) and portal biliopathy (PB) on subsequent magnetic resonance cholangiopancreatography (MRCP) (n=80/120) between June 2009 - 2019 was collected. Categorisation of portal biliopathy was as per the Sarin classification and the corresponding, relevant imaging parameters were studied and analysed. Results: Sarin Type 1 biliopathy was present in 16.3 %, Type 2 in 13.8%, Type 3a in 8.8% and Type 3b in 61.3%patients. The median total serum bilirubin was 1.6 (0.9-3.4) mg/dl with a mean CBD diameter of 6.7 ± 2.9 mm. Bilobar and unilobar IHBRD were observed in 87.5% and 6.3% patients respectively. The mean CBD angle was 138.9 ± 18.8º. CBD showed smooth wall contours (10%), extrinsic indentations (83.8%) and smooth strictures (6.3%). The median CBD stricture length was 26 mm (1.25- 45 mm). Pre-stenotic dilatation was observed in 66.3% with stricture length >16 mm (sensitivity 81.1 % specificity 78%) predisposing to it. Statistically significant associations were tabulated according to the classification of PB. Conclusion: This study provides the decade long experience of imaging findings in EHPVO induced portal biliopathy according to its classification and its clinical implications.
ABSTRACT
Background & objectives: Chronic obstructive pulmonary disease (COPD) is characterized by slowly progressive airflow limitaion, chronic lung inflammation and associated systemic manifestations. The objective of this preliminary study was to investigate the levels of high sensitivity C reactive protein (hs CRP) and tumour necrosis factor-α (TNF-α) as markers of systemic inflammation and assessment of systemic vascular reactivity that may play an important role in development of cardiovascular disease in COPD patients. Methods: Systemic vascular reactivity was assessed non-invasively by measuring peripheral pulse waveform changes during reactive hyperemia (RH) in 16 COPD patients and 14 controls by photoplethysmography technique (PPG). Parameters measured were pulse wave amplitude (PWA), slope and pulse transit time (PTT). Tumour necrosis factor-α (TNF-α) and hs CRP were measured as markers of inflammation. Results: PWA during the 1st, 2nd and 3rd minutes post release of occlusion were significantly higher than the baseline means in controls, whereas in the patient group there was no significant change in the PWA during any of the observed time periods following release of occlusion, in comparison to the baseline means. Similar results were observed in slope values for patients and controls. Maximum percentage change in PWA during RH with reference to baseline was significantly lower in patients as compared to controls (26.78±20.19 vs 57.20±19.80%, P<0.001). Maximum percentage change in slope during RH with reference to baseline was significantly lower in patients as compared to controls (19.77±10.73 vs 39.25±13.49%, P<0.001). A vascular tone response as represented by PTT was also impaired in the 3rd minute of RH as compared to baseline mean values in COPD patients only. Interpretation & conclusions: Our findings showed raised hs CRP levels and impaired systemic vascular reactivity in COPD patients. Whether these may increase the risk of cardiovascular disease in COPD patients need to be confirmed in future studies with large sample size and appropriate study design.
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Purpose: To determine the socioeconomic impact of long‑term glaucoma therapy. Materials and Methods: One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side‑effects was administered. Results: The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/‑ (range: Rs. 500/‑ to Rs. 50,000/‑) with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti‑glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001). The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001). Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6–96 h/month). About 2.7% experienced systemic side‑effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment. Conclusions: Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.
ABSTRACT
OBJECTIVE: To derive norms for the size of uterus, uterine shape (fundal-cervical ratio) and ovarian volume in girls in various Tanners stages of puberty. METHODS: Pelvic ultrasound was performed in ninety-two healthy girls in the age group of 8-15 years. These included twenty girls each in Tanner stages 1-4 and twelve in stage 5. All the subjects enrolled in the study had a weight and height within 5th-95th percentile of NCHS standards and their bone ages corresponded to the chronological age. Uterine height, fundal-cervical ratio (FCR) and ovarian volume were measured in all the subjects. The data was stratified according to various pubertal stages as well as for different ages. Statistical analysis was carried out to derive the percentiles for the three parameters in different pubertal stages and to study the correlation between these parameters and age, weight and height of the subjects. RESULTS: A statistically significant increase in uterine height, FCR and ovarian volume was observed with progressive pubertal stages. Maximum increase in uterine height was observed during the transition from stage 2 to stage 3. All girls beyond the age of 10 years or beyond Tanner stage 2 had a FCR>1. The ovarian volume, after showing an initial increase, tended to plateau and there was no significant increase from stage 4-stage 5. A significant correlation was found between the three parameters and the subject's age, weight and height, the maximum correlation was with age (correlation coefficients being 0.748, 0.648, 0.568 for uterine height, FCR and ovarian volume respectively). Centiles for these parameters were obtained for different pubertal stages. CONCLUSION: This work has provided some guidelines for normative data for various pubertal stages as well as for ages between 8-15 years. These may be used as a reference in evaluation of patients with suspected disorders of puberty.