Improvement in the pattern of advice of investigations following rationalization campaign

To assess the magnitude of change in advising pattern of laboratory and radiological investigations during and after campaign emphasizing rational use of these tests. Comparative cross sectional study. Combined Military Hospital Peshawar, Twenty seven months. The laboratory investigation analysis were Blood Glucose, Thyroid Function Tests, Liver Function Tests [LFT], Renal Function Tests [RFT] and Cardiac Markers and radiological tests were X-Rays Chest, Skull, Wrist and Plain Abdomen, Obstetric Ultra Sound [USG] and CT Scan. The awareness was done by Lectures, handouts, feedback advice on test reports and personal communications to the Medical Officers, Nursing Officers and Paramedical Staff. The data was analyzed through Quarterly Returns, records of laboratory and radiology retrieved from Hospital Information System and departmental registers. In some laboratory investigations there was a significant improvement in the advisory pattern e.g. blood glucose fasting instead of random, ALT instead of whole LFT, electrolytes not included in every RFT and abolishing of AST and LDH from cardiac marker profile and TSH only as screening test. In Radiology there was improvement in the rationality of X-Ray chest, X-Ray skull, X-Rays wrist and obstetric USG. CT scan data could not be compared because CT Scan equipment became out of order during the study. There was also reduction in expenses incurred on irrational investigations. A dynamic ongoing process of awareness and realization campaign for medical professionals is required in any public sector medical institute for cultivating a culture of rational use of investigations

Evaluation of color doppler imaging in the diagnosis of deep vein thrombosis

To evaluate the accuracy of Color Doppler Imaging in diagnosing deep vein thrombosis [DVT] of the lower extremities taking Venography as gold standard. Cross validation study. The study was conducted in the radiology department Combined Military Hospital Peshawar from January 2007 to August 2008. Seventy four patients suspected of having deep venous thrombosis of the lower extremities were examined by Color Doppler Imaging [CDI]. But sixty nine patients underwent successful venography of the affected lower limbs and 5 patients were excluded from the study. Using venography as the reference standard fro diagnosing DVT, the sensitivity and specificity of CDI was 965 and 94.4%, respectively. Positive predictive value was found to be 98% and negative predictive value was 89.5% .Overall accuracy of the CDI was 95.6%. With meticulous technique, Color Doppler Imaging is highly accurate in diagnosing deep vein thrombosis of symptomatic lower limbs, avoiding contrast venography in most of the cases

Bilateral multifocal renal cell carcinoma

Bilateral synchronous renal cell Carcinomas occur in approximately 1-3% of all patients with RCC. Ultrasound and contrast-enhanced CT scan are the most useful tests for diagnosing and staging. US has an advantage over CT in determination of nature of the lesion [solid/cystic]. CT is more sensitive in evaluation of lesion size and detection of calcification and necrosis. CT also has an advantage over US in evaluation of perinephric extension, adjacent organ infiltration and regional lymphadenopathy. Both US and CT are equally sensitive in detection of IVC thrombus