Glanzmann's thrombasthenia: role of angioembolization and factor VII in recurrent bleeding from ulcerated duodenum

Introduction: Glanzmann's thrombasthenia [GT] is a rare, genetically inherited, functional disorder of platelets. The pathology is deficient or dysfunctional platelet glycoprotein IIb/IIIa [GP IIb/IIIa] complex resulting in bleeding diathesis

Case Report: Here in, we report the effectivity of angioembolization with factor VII in a patient with Glanzmann's thrombasthenia [GT], who presented with recurrent bleeding from duodenal ulcer

Conclusion: Angioembolization with added infusion of factor VII, can be considered an equally effective alternate to platelet transfusion in patients of GT, who present with recurrent bleeding

Outcome of radiologically placed tunneled haemodialysis catheters

To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure. Case series. Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011. All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter [Permacath] placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed. Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% [5 catheters]. Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 [72.4%] predominantly had uneventful course during the study period. Twelve patients developed infection [17.3%]; two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters [10.1%] failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was accidentally damaged in the ward and had to be removed. Radiological guided tunneled haemodialysis catheter placements are a safe and reasonable means of providing temporary vascular access for haemodialysis patients.

Hepatic artery pseudoaneurysm mimicking Mirizzi syndrome

Acute cholecystitis leading to development of a pseudoaneurysm of the hepatic artery is a very rare complication; however, a pseudoaneurysm resulting in gallbladder neck compression with dilatation of intrahepatic duct giving a Mirizzi syndrome like presentation is virtually unreported to the best of our knowledge. We report a case of a 60 years male patient who presented in emergency department with right hypochondrial pain and mild jaundice. Initial diagnosis of hepatic artery pseudoaneurysm causing compression of neck of gallbladder and common bile duct was made on ultrasound examination. This was resulting in gross distention of gallbladder and mild dilatation of intrahepatic ducts. Findings were confirmed on CT scan. Later successful selective transcatheter arterial embolization of the aneurysm and percutaneous cholecystostomy were performed

unsuspected bleeding Meckel's diverticulum in an adult detected on mesenteric angiography

Meckel's diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from Meckels diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel's diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel's diverticulum and correlation with other radiological imaging

Utility of Limited Protocol Magnetic Resonance Imaging Lumbar Spine for Nerve Root Compression in a Developing Country, Is It Accurate and Cost Effective?

STUDY DESIGN: Cross sectional study. PURPOSE: To determine the accuracy of the screening magnetic resonance study of the lumbar spine in the diagnosis of nerve root compression in cases of low back pain as compared to the routine magnetic resonance imaging (MRI) study of the lumbar spine. OVERVIEW OF LITERATURE: No local study has been conducted for this purpose. In an international study, the reported sensitivity and specificity of screening MRI lumbar spine protocol in the detection of nerve root compression are 54% and 100% respectively. METHODS: Patients of both genders older than 20 years of age with low back pain of any duration or any severity who were referred to the radiology department of Aga Khan University Hospital for MRI of their lumbar spine were evaluated. Two sets of MRI imaging were recruited for each patient: one labeled as 'screening' and the other labeled as 'routine'. The findings of screening MRI were compared with the findings of the routine MRI study. RESULTS: A total of 109 patients fulfilling the inclusion criteria were included in this study. The diagnostic accuracy, specificity and sensitivity of the screening protocol in our study was 100%, 100% and 100%, respectively in comparison with the routine MRI lumbar spine study for the detection of nerve root compression. CONCLUSIONS: Our data proved that the MRI screening study is a highly accurate tool, and its findings are comparable to the routine study for the detection of nerve root compression especially in cases of lumbar spondylosis.

Needle stick injury in a radiology department: a decade analysis

To determine the frequency of needle stick injury in health care workers of radiology department. Study type, settings and duration: Cross sectional, observational study conducted at the Radiology department of Aga Khan University hospital from January 2000 to May 2010. Subject and Methods: All self-reported needle stick injuries data of Health care workers of radiology department was recorded. The personnel involved [Radiologist, resident, radiographer, nurses etc], area of working and the causes of injury were identified including the procedural or post procedural details. Patient's status of hepatitis or blood borne infection was also noted. Data was recorded and analyzed in Excel worksheet. A total of 55 health workers reported needle stick injuries at all sections of radiology departments with maximum number needle stick injuries at general radiography, fluoroscopy and IVP section. Radiographers and radiology residents received the maximum number of injuries. Major cause of injury was cannulation however, many injuries occurred during disposing or handling of bin. In majority of cases the patients were not infected with any known blood borne infections. Doctors and nurses get needle-stick injuries while carrying out clinical procedures, while, ancillary staff get infected post procedure during disposal of garbage. Policy message: Good occupational health and safety practices must be promoted to all staff. Safer disposal of needles is an important area where practice and procedure needs to be carefully reviewed. It is necessary to undertake a risk assessment, to offer counseling and Post Exposure Prophylaxis and treatment where necessary