Fetal biometry in the population of Southern Punjab, Pakistan

Background: Ultrasound estimation of fetal parameters is one of the most important examinations. Hadlock and other foreign fetal biometry curves are used in Pakistan as there are no national normative data derived from local population

Objectives: To construct local reference charts and equations for fetal biometric measurements and amniotic fluid index [AFI] using a large sample of fetuses examined at 14 - 40 weeks in the population of southern Punjab

Study design, settings and duration: The prospective, cross sectional study conducted at the Multan Institute of Nuclear Medicine and Radiotherapy [MINAR] over a one year period from December 2010 to November 2011

Subjects and Methods: A total of 566 randomly selected pregnant females, who fulfilled the inclusion criteria were included in the study after informed consent. Each woman was scanned once only, between 14 and 40 weeks of gestation, and her fetal measurements were also recorded simultaneously. Regression models were used to estimate the mean and standard deviation at each week of gestation. Fetal biometric parameters of local population were compared with those of Hadlock and Singaporean Asian population. Results were statistically analyzed and also presented graphically across the different gestational ages to allow visual comparison

Results: Biometric measurements were obtained for 566 fetuses. There was no significant difference between fetal parameters of local population and those of Hadlock. When compared with those of the Singaporean Asian population, femur length and head circumference were larger while biparietal diameter was smaller in our population

Conclusion: We have constructed local reference centiles for fetal measurements and equations for dating of pregnancy for Southern Punjab. The biometric measurements are slightly different from Singaporean Asian population, but there was no statistically significant difference between these measurements and those by Hadlock

Radiation dose-rate reduction pattern in well-differentiated thyroid cancer treated with I[-131]

To determine the patterns of dose rate reduction in single and multiple radioiodine [I[-131]] therapies in cases of well differentiated thyroid cancer patients. Analytical series. Department of Nuclear Medicine and Radiation Physics, Multan Institute of Nuclear Medicine and Radiotherapy [MINAR], Multan, Pakistan, from December 2006 to December 2013. Ninety three patients [167 therapies] with well differentiated thyroid cancer treated with different doses of I[-131] as an in-patient were inducted. Fifty four patients were given only single I[-131] therapy dose ranging from 70 mCi [2590 MBq] to 150 mCi [5550 MBq]. Thirty nine patients were treated with multiple I[-131] radioisotope therapy doses ranging from 80 mCi [2960 MBq] to 250 mCi [9250 MBq]. T-test was applied on the sample data showed statistically significant difference between the two groups with p-value [p < 0.01] less than 0.05 taken as significant. There were 68 females and 25 males with an age range of 15 to 80 years. Mean age of the patients were 36 years. Among the 93 cases of first time Radio Active Iodine [RAI] therapy, 59 cases [63%] were discharged after 48 hours. Among 39 patients who received RAI therapy second time or more, most were discharged earlier after achieving acceptable discharge dose rate i.e 25 microSv/hour; 2 out of 39 [5%] were discharged after 48 hours. In 58% patients, given single I[-131] therapy dose, majority of these were discharged after 48 hours without any major complications. For well differentiated thyroid cancer patients, rapid dose rate reduction is seen in patients receiving second or subsequent radioiodine [RAI] therapy, as compared to first time receiving RAI therapy

Ultrasound scan; coupling gel as a potential source of infection

To assess the infective potential of ultrasound gel and probes when used in a routine manner on ambulatory patients with intact skin. At our institute, ultrasound probes are wiped with a non-sterile absorbent paper towel after each patient. The probes become dry and clean in social terms but we were unsure if they also became bacteriologically decontaminated after wiping clean. We also wished to ascertain the intrinsic infective potential of ultrasound gel. Bacteriological samples were taken from probe surface [after wiping it clean as per out protocol]; gel dispensing bottles; and the gel jars that contain the gel in bulk. A total of 61 samples were cultured, out of these 13 were jar samples that were acquired daily on 13 days, 10 from gel bottles and 38 from probe surface [27 before beginning ultrasound, 11 after ending the day's work]. Probe surface samples were collected on sterile cotton wipes dipped in sterile nutrient both; bottle and jar samples were collected by sterile nickel loops and cultured on commercially available nutrient ager. Colonies were counted at 24 and 48 hours. The results show bacterial contamination in all [10/10] gel bottle samples, 7% pre-scan probe surface wipes [2/27] and 27.3% [3/11] on post scan wipes. Gel Jar samples were sterile on the first 3 days and then progressively showed greater colony counts. This showed that the gel is initially sterile but is apparently contaminated from air and it serves as growth medium for bacteria. We conclude that the highest contamination is observed in gel bottle samples [100%]. The lowest contamination was observed from wipes probe sample. This was probably due to repeated cleaning of probes by the operators. Gel jar samples have the second highest contamination but the initial samples showed no growth. The ultrasound gels probably contain no or little antibacterial agent and the gel serves as a growth medium for bacteria

Comparison of di-isopropyl iminodiacetic acid with methyl isobutyl isonitrile in the work-up of infants with prolonged jaundice

The study group comprised of 16 jaundiced children [mean age 3.16 months] with bilirubin levels of more than 8mg/dl. The clinical differential diagnosis included biliary atresia versus neonatal hepatitis. Informed consent was taken from all the parents. Parents were advised to omit the morning feed. All children were pretreated with phenobarbitone [5mg/ kg/day for 5 days] and imaged twice on two different days: first with Tc-99m-DISIDA and dose of 37MBq was injected intravenously. Liver images were obtained at 1, 2, 3 and 24 hours following injection. Then injection of Tc-99m-MIBI with a dose of 37MBq was injected intravenously. Anterior abdominal images with 350k counts were obtained at 10, 20, 30 and 40 minutes post injection and where appropriate delayed additional views were taken to optimize radionuclide intestinal transit. Two nuclear medicine physicians visually analyzed the scintigrams. On the basis of biliary-enteric kinetics the patients were subdivided into sub-groups: Group 1: Included 12 patients with no bowel activity with DISIDA scan but demonstrable bowel activity with MIBI liver scan with the appearance of central or peripheral abdominal activity. Group 2: Consisted of 4 patients with no bowel activity with both DISIDA and MIBI liver scans. Of the 4 patients 2 had biliary atresia confirmed at laparotomy whilst 2 children were lost to follow-up since the children had traveled from remote parts of the country

Normal shapes of liver: analysis of normal nuclear scans in Multan

Five hundred 'Normal' liver scans were analysed to find out the incidence of various shapes of normal liver. There were differences between our series and the series reported in the literature. The differences may be due to selection criteria or geographical variation

Radionuclide evaluation of the superior vena cava and upper thoracic veins in mediastinal syndrome

Radionuclide studies of the superior vena cava are non-invasive and simple to perform. These studies give information about the patency of the superior vena cava, innominate and the obstruction can be determined. Since this technique is non-invasive or minimally invasive, it can be repeated as often as required. The anatomic and physiologic basis of this investigation and methodology of the procedure is given. Two cases are described in detail. The only other investigation giving comparable clinical information is contrast venography which is uncomfortable and carries a definite risk of allergic reaction

Demonstration of a renoperitoneal fistula by radionuclide renal scanning: a case report

Radionuclide renal studies are minimally invasive, easy to perform and give information about both renal structure and function. These studies may be safely used to detect urinary extravasations from the upper urinary tract. A case of renoperitoneal fistula imaged by nuclear medicine technique is described. [JPMA 36: 118, 1986] The diagnosis of urinary extravasation using nuclear medicine procedures after trauma and renal transplants is well documented1-4 but radionuclide scanning for urinary extravasation in conditions other than these has rarely been reported 5-6. Surgically related extravasations are common but they are usually small and retroperi-toneal. We describe here an iatrogenic renoperitoneal fistula which presented with tense ascites

Liver scintiscan in Budd Chiari syndrome

Budd Chiari Syndrome is a rare disease and can be difficult to diagnose. Most of the investigations to diagnose this disease are invasive. Liver scintiscanning is not only non-invasive, it also shows a typical pattern in this condition. Good correlation exists between Liver scanning and other procedures. A case of Budd Chiari Syndrome with typical clinical and scan findings is described