Determination of relationshiop between size and location of gastrointestinal lipoma on plaint CT scan with symptomatology and complications: a retrospective study at tertiary care hostpital

To determine the frequency, size and location of different types of gastrointestinal [GIT] lipomas plaint CT scan and diagnostic accuracy of CT scan in diagnosis of lipoma. Descriptive study. Radiology department, Civil Hospital and Dow University of Health Sceicnes, Karachi, from Jan 2010 to Jun 2012. This descriptive study was conducted in Radiology department of a tertiary care hospital in Karachi. All cases of CT scan which showed fat containing lesions in GIT were included in study. In all cases, CT scan abdomen was performed due to any other intraabdominal pathology. Diagnosis of lipoma was based on homogenous hypodensity of lesion with CT number[Hounsfield units] corresponding to fatty lesion. A total of 45 cases were selected for this study. Among these, 40 patients under-went follow up CT scan abdomen performed after 1-3 years and showed no change in size, shape and remained asymptomatic as far as lipomas were concerned. In 13 [28.9%] cases of small intestinal lipoma, four cases showed multiple lipomas. Nine cases had lipomas in ileum and 6 cases showed lipomas in jejunal loops. In 19 [42.2%] cases of large bowel lipomas, seven cases showed multiple lipomas. In 8 [17.8%] cases, lipoma was identified in stomach. In five [11.1%] cases, esophageal lipoma was diagnosed on CT scan. In three cases lipoma identified intramurally while submucosal in two cases. All cases showe smooth homogenously hypodense well define lesions with fat density range of -30 HU to -140 HU. All lesions were ovoi to spherical in shape. Size of lesions ranged 1-3.5 cm. No lipoma irrespective of its location, size and shape, was associated with ulcer, bleeding, obstruction, intussusceptions. All patients were asymptomatic and devoid of complications. Diagnosis of GIT lipoma can be reliably made on plain CT scan without going for endoscopic or surgical biopsy for histopathology. The size and location of lipoma were neither associated with symptoms of patients nor complications. Lipomas also remained stable in respect to size, shape, appearance and density on follow up study

Intracerebral hemorrhages as an atypical radiographic presentation of herpes simplex encephalitis on CT scan: an analysis of 23 patients

To find out the effect of the atypical presentation of herpes encephalitis in the form of intracerebral Hemorrhage on the morbidity and mortality of patients. It is basically retrospective study conducted at radiology department Dow University of Health Sciences Civil Hospital, Karachi from 2009 to 2011. Total numbers of patients presented with clinical diagnosis of encephalitis were109 and underwent CT scan plain and post contrast study. Physical diagnosis was based on fever, fits and altered level of consciousness. Laboratory diagnosis was based on pleocytosis with predominant lymphocytes, low glucose and high proteins and confirmation by polymerase chain reaction test [PCR] and empirical use of acyclovir. Total cases presented with clinical diagnosis of viral encephalitis and presented as hypo density with focal edema on CT scan were 109, out of which 23 cases presented with intracerebral hemorrhages. Hemorrhagic encephalitis was found in 21% of the cases. On plain CT scan brain, five cases showed isolated bilateral basal ganglia and thalamic hemorrhages. In seven cases bilateral temporofrontal region showed hemorrhages. Nine cases showed unilateral temporoparietal region [six cases were on right side and three cases were on left side] hemorrhages and in three cases unilateral right frontoparietal and basal ganglia hemorrhages were found on CT scan. In five cases leptomeningeal enhancement was associated with bilateral temporoparietal encephalitis. Hemorrhage size ranged from 2-5 cm. In nineteen cases, post contrast enhancement was seen in areas of encephalitis. In appropriate clinical setting of encephalitis with CT SCAN diagnosis of intracerebral unilateral or bilateral hemorrhages and post contrast enhancement with CSF positive criteria for viral infection, diagnosis of herpes encephalitis should be on top of differential diagnosis. An early use of acyclovir without waiting for further tests can save the life of patients and significantly reduce the mortality and morbidity of patients

Early computerized tomographic scan in mild pancreatitis may be deceiving: an experience of tertiary care hospital

To assess the justification of Computerized Tomographic [CT] scan for the diagnosis of acute pancreatitis at early stage and its impact on mortality and morbidity of patients. It was a retrospective study conducted at Radiology Department Dow University of Health Sciences from April 2009 to August 2011. Patients were diagnosed as acute pancreatitis both clinically and radiologically. Severity of acute pancreatitis was clinically assessed by Ranson's criteria and radiologically by Balthazar CT Grading and CT Severity Index. Fourteen of the total 131 included patients underwent early CT scan at 4-12 hour after start of symptoms of abdominal pain and vomiting and were normal radiologically[10.68% out of total 131 patients presented with acute pancreatitis. These patients revisited at 24-36 hours, with severe epigastric pain and on follow-up CT scan on re-admission, two patients showed intra and peripancreatic collections, swollen pancreas with peripancreatic fat necrosis without necrotizing pancreatitis [Balthazar Grade-E] and moderate pancreatitis according to CT Severity Index[four points]; Three patients had 30% pancreatic necrosis with Balthazar grade-E changes and according to CT Severity Index moderate pancreatitis[2+4=6]; Two patients had 30-50% necrosis and rated as Balthazar Grade-E and labeled as severe necrotizing pancreatitis according to CT Severity Index[4+4=8]; while Seven patients showed severe necrotizing pancreatitis with >50% of pancreatic necrosis according to CT Severity Index[6+4] along with Balthazar Grade-E pancreatitis[6+4=10]. Patients with severity index of 10 had 100% mortality. Early CT scan has very little role in diagnosing and determining severity of disease or in predicting prognosis of patients.

Discuss the effects of surgical ligation and percutaneous embolization of testicular varicocele on improvements in fertility parameters

Varicocele is term used to define as abnormal dilatation of testicular vein and or its collaterals with retrograde venous blood flow. It is treated by two techniques surgical ligation and percutaneous emblization. It is claimed in various international journal that varicocele is a leading cause of male infertility and shows significant improvement in fertility parameters and pregnancy rate after treatment of varicocele either by varicocelectomy or gondal vein embolization but we have disproved this claim in our study. A retrospective study with few prospective cases. It is retrospective study with few prospective cases. We have selected all those infertile male patients who under gone varicocele treatment. We obtained hormonal assay, seminal assay as pre-treatment baseline values as well as post-treatment values at 1,2,3 and 6 months intervals. Couples were also followed for pregnancy for up to 5 years. Total cases selected were pre-treatment and post-treatment. Results were analyzed and compared with those published in national and international journals. No significant improvement was observed in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males. Treatment of varicocele either by surgical ligation or percutaneous embolization did not showed any significant improvement in fertility parameters and pregnancy rate. This signifies that varicocele is not significant and leading cause of infertility in males