ABSTRACT
Ring enhancing lesions are a common neurological problem seen in either gender and in all age groups. Objectives: To determine the clinical presentations and etiological factors in patients with ring enhancing lesion on CT scan brain. Design: Case series study. Period: One year. Setting: Department of medicine, Liaquat University Hospital, Hyderabad. Patients and methods: Subjects of either sex =12 years of age, presented with seizures, fever, focal neurological signs and deficit, headache, weight loss and vomiting and had single or multiple ring enhancing lesions on computed tomography [contrast CT brain film] were enrolled and entered in the study. CT scan brain was advised to evaluate any identified lesion and then certain specific biochemical tests were also advised to detect the particular existence etiological factor. The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results: During one year study period, total 50 subjects were detected as ring enhancing lesion on CT scan. The mean age +/-SD of the over all population was 28.87+/-4.84 whereas the mean age +/-SD of male and female population was 27.76+/-6.53 and 30.76+/-5.83 respectively. Ring enhancing lesions were right sided in 30 patients [60%], on the left side in 15 [30%] and bilateral lesions were identified in 6 subjects [10%] on brain imaging. Majority of the ring enhancing lesions were single 45 [90%] and the parietal lobe was observed as the commonest site. The headache, seizures, fever, pyramidal signs and papilledema was identified the common clinical features whereas the common etiological factors responsible for ring enhancing impression on brain CT scan were tuberculoma 17[34%], brain tumor 12[24%], metastasis 05[10%] and brain abscess 04[08%]. Conclusions: The male population was predominant while the seizure was observed as common clinical feature whereas the tuberculoma, brain tumour and metastasis are the common etiological factors responsible for ring enhancing lesion on brain imaging.
ABSTRACT
To determine the frequency of hepatocellular carcinoma in different Child-Pugh classes based on Alfa fetoprotein level. Case series study. Six months. Medical Unit-I of Liaquat University Hospital, Hyderabad Sindh Pakistan. A total of 100 patients admitted [inpatients] in Medical Unit I with the diagnosis of cirrhosis were enrolled in the study. Patients with cirrhosis of liver [more than six month duration] of either gender were included. If patients had metastatic lesion of the liver, liver abscess, or acute liver failure then they were excluded. Child-Pugh score was calculated which included ascites, encephalopathy, prothrombin time, albumin and serum bilirubin. The levels of alpha-fetoprotein were measured and HCC was diagnosed. The primary outcome variable was presence of HCC in cirrhotic patients. The proportion of males [53%] was higher as compared to females [47%]. The mean age of the study patients was 40.47 years with a standard deviation of 11.5. At the beginning patients were categorized according to Child Pugh Classes [A= up to 6, B=7-9 and C=10-11], age groups [15-30 years, 31-50 years and 51- 70 years respectively]. The mean Child Pugh score was 6.83 with +/- 1.8 S.D. The majority of the cases of HCC [75.61%] occurred in the Child Class A, whereas 21.95% occurred in Child Class B and finally only one case of HCC [2.44%] was present in Child Class C. This study comprehensively demonstrated that hepatocellular carcinoma [HCC] is far more common in compensated cirrhosis [Child Pugh Class A] vs. decompensated cirrhosis [Child Pugh Class B and C]