Evaluation of Gallbladder Diseases

Gallbladder diseases are very common entities with diverse features of presentation at clinical, radiological and pathological settings with variable morbidities and mortalities. It implies an altered hepatobiliary function. A majority of gallbladder diseases involve gallstones, which form about 95% of all gallbladder diseases. The noncalculus disease forms only about 4–5% of the cases. Inflammations of gallbladder, either acute or chronic, are commonly seen in association with calculus gallbladder. Benign neoplasms are very rare compared to malignant neoplasms that are more common but uncommon compared to inflammatory conditions. Gallbladder diseases are very common and it is appropriate to emphasise that knowledge of these diseases is imperative. In the present study of 50 patients an attempt was made to correlate the clinical, radiological and pathological features of gallbladder diseases and to ascertain the sensitivity of ultrasound in the evaluation of gallbladder diseases. The radiological diagnosis in gallbladder diseases had favourable results against the clinical diagnosis and has also been shown to be impressive against the pathological diagnosis. In our study the radiological diagnosis of gallbladder diseases is shown with reference to most of the disease conditions.

Ultrasound Evaluation of Thyroid Lesions

This study was done at Santhiram general hospital. 57 patients with thyroid swelling were examined with ultrasound and followed up with FNAC. Findings were analyzed which showed that 14 were cystic, 27 solid and 16 were mixed lesions; 93% of cystic lesions were benign (Table 2). Among solid lesions 83% were benign rest malignant. Among mixed lesions 87.75% benign and only 12.25% were malignant (Table 3). Ninty two per cent of goiter showed calicification papillary; carcinoma case showed calicification. Hypoechoic hallow showed 88% benign lesions and 12% of malignant lesions; hence US has a definete role in charecterising thyroid lesions. It is being cheap and readily available. The characterisation of perilesion halo is whether irregular or smooth which helps in differentiating benign and malignant nature of lesion. It helps in FNAC for exact localisation.

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.