Comparison between Greulich-Pyle and Girdany-Golden methods for estimating skeletal age of children in Pakistan

To compare Greulich-Pyle [GP] and Girdany-Golden [GG] methods for estimation of Skeletal Age [SA] in children referred to a tertiary care hospital in Karachi, Pakistan. Cross-sectional study. Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan, from July 2010 to June 2012. Children up to the age of 18 years, who had undergone X-ray for the evaluation of trauma were included. Each X-ray was interpreted using both methods by two consultant paediatric radiologists having at least 10 years experience, who were blinded to the actual Chronologic Age [CA] of children. A total of 283 children were included. No significant difference was noted in mean SA estimated by GP method and mean CA for female children [p=0.695]. However, a significant difference was noted between mean CA and mean SA by GG method for females [p=0.011]. For males, there was a significant difference between mean CA and mean SA estimated by both GP and GG methods. A stronger correlation was found between CA and SA estimated by GP method [r=0.943 for girls, r=0.915 for boys] as compared to GG method [r=0.909 for girls, r=0.865 for boys] respectively. Bland- Altman analysis also revealed that the two methods cannot be used interchangeably. Excellent correlation was seen between the two readers for both GP and GG methods. There was no additional benefit of using GP and GG methods simultaneously over using GP method alone. Moreover, although GP was reliable in estimating SA in girls, it was unable to accurately assess SA in boys. Therefore, it would be ideal to develop indigenous standards of bone age estimation based on a representative sample of healthy native children

Chest radiograph in the pediatric inpatient: a chart review

To determine the usefulness of the chest radiograph in reaching a clinical diagnosis in the pediatric inpatient population at a tertiary care centre in Karachi, Pakistan. This was a retrospective chart review of pediatric inpatients [1 month -14 years] at Aga Khan Hospital, Karachi between April and June 2009. Radiographs ordered to assist diagnosis of disease, or as 'routine', were selected samples [n=326]. For each radiograph, the clinical indication, the radiological diagnosis and the final clinical diagnosis were recorded and analyzed for frequencies and by cross-tabulation for concurrence. The largest proportion of the clinical indications was the routine chest x-ray, at 39.3%. The most common diagnosis in radiology reports was 'no chest pathology' [39.9%]. The second most common was 'pulmonary infection'. Almost 46.3% of the patients who had chest x-rays had no chest pathology in the clinical diagnosis. The greatest concurrence was found between the clinical indication 'fever and cough' with a radiological and clinical diagnosis of pulmonary infection [62.3% and 49.1% respectively]. A significant proportion of the radiographs ordered for pediatric inpatients were normal and not associated with chest pathology on clinical diagnosis. Strong clinical suspicion of pulmonary infection, denoted by fever and cough, had the highest likelihood of giving the same radiological and clinical diagnosis

Imiglucerase treatment in gaucher's disease

Gaucher's disease is an inherited lysosomal storage disorder with a deficiency of the enzyme glucocerbrosidase that manifests with clinical features of anemia, hepato-splenomegaly, skeletal destruction and organ dysfunction due to the accumulation of glucocerbrosides. There are several types of Gaucher's disease with varying prognosis and clinical progression of disease. We describe two cases followed at the Aga Khan University, Karachi, Pakistan, with different forms of the disorder. The enzyme Imiglucerase [Cerezyme, Genzyme] has been used to treat Type 1 Gaucher disease while the neuronopathic type has been resistant to therapy. We used Imiglucerase 60 micro g/kg every 2 weeks in one patient with Type 1 Gaucher disease and followed hepatic, splenic volumes and blood counts. Treatment with Imiglucerase resulted in a decrease in splenic size, reduced requirements for transfusions and an improvement in cardiopulmonary symptoms

Giant multiple intra-abdominal hydatid cysts

Hydatid disease is endemic in the cattle grazing areas. It is a parasitic infection caused by the Echinoccocus Granulosus. Dogs are the definitive host and humans get infected either by contact with the definitive host or by consuming hydatid ova contaminated vegetables. A 42 yr old lady presented with shortness of breath on exertion, orthopnea and progressively increasing abdominal distention. She had past history of hydatid disease and had progressively increasing abdominal distention three laparatomies and a right thoracotomy, in the past five years. On physical examination, she had a distended, non-tender abdomen. Her routine laboratory investigations were normal. Echinococcus antibody titres were 1:64 [Normal 1:32]. Computed Tomography [CT] scan revealed multiple, well defined cysts throughout the abdomen. Laparotmy and right thoracotomy was planned. Patient refused to undergo any further surgical procedure. She was discharged from the clinic with a prescription of Albendazole 400 mg twice a day for an indefinite period. Symptomatic or large cysts should be surgically treated. In cases suspected of having peritoneal spillage, antihelminthic drugs should be administered. In addition, small asymptomatic cysts, some daughter cysts, and peritoneal secondary cysts and splenic cysts may also be effectively treated with Albendazole

Primary Splenic Hydatid Cyst: a case report with characteristic imaging appearance

A middle-aged lady presented with pain, tenderness and swelling in the left hypochondrium since one month. She had a history of contact with dogs and grazing animals. Sonography and computed tomography showed the pathognomonic signs of hydatid disease. The patient refused surgical treatment. She was discharged on Albendazole therapy and did not return for a follow up

Multiple parameters in the diagnosis of Ectopic pregnancy

To determine the role of emergency ultrasound examination in the diagnosis and management of ectopic pregnancy. A descriptive study done at the Radiology Department, Aga Khan University Hospital, Karachi from January 1999 to December 2000 using observational facts by non-probability convenient sampling method. Seventy one patients who presented with acute symptoms in early pregnancy, were subjected to emergency pelvic ultrasound. Both transabdominal and transvaginal ultrasound were done in 52 patients while in 19 patients only transabdominal ultrasound was performed. Serum Beta hCG levels, of all patients were greater than 1500 iu/ml. Ultrasound correctly identified ectopic pregnancy in 71 patients. Ultrasound diagnosis included live embryo in six patients, adnexal mass with pelvic fluid in 54 patients, extrauterine gestational sac in 4 patients and pelvic fluid without adnexal mass in 7 patients. There was no indeterminate ultrasound scan, resulting in 100% specificity and sensitivity. The use of multiple parameters in the diagnosis of ectopic pregnancy resulted in 100% sensitivity and specificity