High resolution ultrasound of ophthalmic patients in a tertiary hospital.

The study was done to find out pathologic processes in ophthalmic patients in different age group to understand the use, role and limitations of ultrasonography in the diagnosis of ocular pathology in this locality. A prospective study was done on total 143 patients from September 2004 to January 2006 who attended Centre for Nuclear Medicine & Ultrasound, Mymensingh for ultrasound evaluation of eye. Total 100 (69.93%, n=100) cases were male and 43 (30.06%, n=43) cases were female. The age ranges were 2 months to 80 years. A variety of ocular pathology was diagnosed with the help of high resolution ultrasound (HRUS) with unique ultrasound appearance. Bulk of the referral patients had history of ocular trauma (38.46 %, n= 38) and most commonly detected pathology in these group are vitreous hemorrhage (34.44%, n=34) and cataract formation (28.28%, n=28). Almost all of the patients did not have conclusive diagnosis clinically and by conventional means available before ultrasonography were performed. High resolution sonography may be used as a valuable tool for evaluation of ophthalmic pathology as a well suited, noninvasive method, and only practical imaging modality for assessing those cases particularly when light conducting media are opaque.

Prenatal diagnosis of achondroplasia.

A 25 years old lady came to Centre for Nuclear Medicine and Ultrasound, Mymensingh for ultrasonographic evaluation of gestational condition. Transabdominal ultrasonogram showed mal development of skeletal system with abnormally shortened limbs. This seems to be a case of achnodroplasia, which was proved subsequently true after termination of pregnancy.

Placenta previa and it's relation with maternal age, gravidity and cesarean section.

The placenta provides the essential connection between the mother and the developing fetus. Placental position were routinely mentioned in an ultrasound report starting from early second trimester to the end of third trimester when asked for pregnancy evaluation. The aim of this study was to see the prevalence of lower segment placenta (placenta previa) and its relations with previous cesarean section delivery, parity and maternal age. The study conducted in Centre for Nuclear Medicine and Ultrasound (CNMU) Mymensingh in a period from January 2001 to December 2002. About 2536 pregnant women (those included in this study) underwent ultrasound examination during pregnancy at third trimester. The prevalence of lower segment placenta was 1.34%. The highest prevalence of placenta previa (2.58%) was seen in 3rd and higher gravida group. Also the highest prevalence were seen 30 yr. and above age group in compare to below 30 yr. age group. No increased prevalence of placenta previa were seen in previous cesarean section (C / S) delivery group (0.65%) in compare to normal delivery group (1.97%). From our study it was seen that development of lower segment placenta has relation with increased number of gravidity and maternal age but no increased prevalence were seen in subjects with previously done cesarean section

Prevalence of antithyroid microsomal antibody in thyroid patients of endemic goitre area.

The region of greater Mymensingh known for iodine endemicity, recently came under iodine supplementation as a result of mandatory universal iodination of salt program. Autoimmune thyroid diseases (AITD) are among the most common human autoimmune disorders & presence of autoantibodies to the microsomal antigen (AntiMCAb) is a hallmark of disease activity. Both iodine deficiency & iodine supplementation precipitate increase rate of autoimmunity to the thyroid gland. Study was undertaken to determine prevalence of AntiMCAb positive cases among patients with various thyroid diseases. High resolution ultrasound (HRUS), serum thyroid hormone assays & scintiscan were used to classify the thyroid patients into 8 categories. 221 patients were studied during the stipulated period of 3 months. Male patients were 60 & female patients were 161. Age ranged from 11 to 65 years with median age 29.4 years. AntiMCAb test were done with radioimmunoassay (RIA). 126 patients had antimicrosomal antibody (57.01%). All form of hypothyroid (atrophic, goitrous, Hashimoto's) have very high rate of AntiMCAb positive cases. Highest 89.28% were seen in patients showing feature of Hashimoto's thyroiditis or generalized feature of AITD in HRUS with hypothyroidism, followed had 61.29% positive cases, However, antithyroid antibody was found in all form of thyroid disorders. Nodular goiter had 21.73% antiMCAb positive cases. AntiMCAb found positive at the rate of 33.33% in euthyroid patients with HRUS feature of AITD & diffuse euthyroid goiter, 40% in subclinical hypothyroid, 40% in subclinical hyperthyroid. Female rated higher in range of antimicrosomal antibody positivism. 59% of all thyroid patients among female subjects were AntMCAb positive, where as 51.67% male thyroid patients were positive. Highest number of positive cases found in the 30-35 age group. No definite pattern, however, was observed among age distribution. 20 age matched sample from patients unsuspected of thyroid disease shows 10% AntiMCAb positive compared to 73.33% of the same among same age group of thyroid patients. Frank Hashimoto's thyroiditis with positive antiMCAb and hypothyroidism were all detected by HRUS.

Hydrops fetalis: report of 3 cases.

Ultrasound is a well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. Reported cases are hydrops fetalis diagnosed during ultrasonic evaluation of fetal condition in the Center for Nuclear Medicine and ultrasound (CNMU), Mymensingh. Only fetal ascites was detected in one case of 26 +/- 2 wks of gestation, fetal ascites with hydramnios and thick placenta was seen in another case of 28 +/- 2 wks of gestation. In third case, there was fetal ascites, scalp edema, hydrothorax and myelomeningocele with oligohydramnios at 20 +/- 2 wks of gestation; sonographic diagnosis was hydrops fetalis with myelomeningocele. Follow up was advised in first two cases and third case was terminated electively. To decrease the mortality rate and to improve the outcome of hydrops fetalis cases appropriate prenatal investigations and therapy is needed. Recent advances in prenatal ultrasound have made possible the early detection of hydrops fetalis which is helpful for proper management in time.

Incidence of bony secondary at presentation of breast carcinoma in our region.

Study is conducted to evaluate the incidence of bony secondary and to evaluate the need for routine bone scintigraphy at the time of presentation of breast carcinoma in this region. Of the total 130 patients evaluated by bone scan, sixty (n = 60, 46.15%) had secondary lesion in bone. Among the 54 preoperative patients, all with positive FNAC, twenty (n = 20, 37.03%) had bony metastases. Of the 76 post-operative patients, forty (n = 40, 52.63%) had secondary bone lesions. Single lesion was seen in only five (n = 5, 8.53%) cases. Rest fifty five (n = 55, 91.67%) had multiple bony secondaries. Most of the postoperative cases (n = 40, 52.63%) were invasive/infiltrative duct cell carcinoma. The very high incidence of bony secondary appears to be due to delayed presentation associated with poor socioeconomic condition, ignorance and also shyness. Bony metastases at the time of presentation suggests poor prognosis. As it can affect therapeutic management of these patients, routine bone scintigraphy at the time of presentation of breast carcinoma patients to a tertiary label hospital is proposed, against conflicting conclusion by papers in the developed countries.

Abdominal wall defect: a case report and review.

Ultrasound is well recognized imaging modality for prenatal diagnosis of fetal congenital anomalies. However, precise diagnosis of fetal anomaly with gray scale ultrasound may not be possible at times. Color Doppler ultrasound compliments gray scale ultrasound in accurately diagnosing fetal anomaly. We report a case of an omphalocele with short lower limbs, diagnosed during 3rd trimester on the basis of color Doppler ultrasound. Gray scale ultrasound failed to diagnose the condition initially. Color Doppler sonography helped in accurate diagnosis. Findings were confirmed after termination of pregnancy.