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Background: Hydrocephalus is a heterogeneous disease marked by abnormal dilatation of the cerebral ventricles secondary to varying etiologies. This study was aimed to determine the incidence, risk factors, severity, and outcome of hydrocephalic fetuses presenting to a tertiary healthcare hospital located in northern India.Methods: In this prospective observational study, pregnant women visiting the obstetrics outpatient department of our hospital from 01 July 2017 to 31 June 2018 were screened for hydrocephalic fetuses via ultrasonography along with a detailed history, and a comprehensive battery of diagnostic investigations. They were followed up for a minimum period of two months after delivery/termination of pregnancy.Results: A total of 3627 pregnant women were screened, of which 10 had hydrocephalic fetuses in the observed time period. The incidence of hydrocephalus was determined to be 2.75 per 1000 live births. Low socio-economic status was identified as a major risk factor. 50% of the hydrocephalic fetuses were severely afflicted and were discontinued. The remaining 50% were successfully delivered and were managed via a ventriculo-peritoneal shunt or are under close observation in the postnatal period without any adverse outcome.Conclusions: The burden of hydrocephalus is considerably high in India, as compared to western countries. In rural settings, low socioeconomic status and lack of folic acid supplementation have a major influence in the etiopathogenesis of hydrocephalus. Management of hydrocephalus requires a multidisciplinary approach and is tailored according to the severity of the presentation. Severe cases of hydrocephalus and cases with associated anomalies have a poor prognosis.
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AIM: To study the clinical, radiological and operative findings in childhood acquired cholesteatoma. Methods: Totally 50 patients of age less than 18 years with active squamosal chronic otitis media (COM) underwent thorough clinical examination and pre-operative high resolution computed tomography (HRCT) of temporal bone followed by surgery. Their clinical examination findings, HRCT temporal findings and operative findings were noted and correlated. Results: According to the present study, commonest age group was 11-15 years, average duration of complaints was 7.9 years, commonest complaint was ear discharge, commonest examination finding was central perforation in tympanic membrane (TM), most patients had moderate conductive hearing loss, on HRCT temporal bone most common finding was soft tissue attenuation in middle ear cavity, per-operatively cholesteatoma was found in middle ear cleft in all the cases. Conclusion: Cholesteatoma is more aggressive especially in children where it has a short course of duration, high incidence of ossicular involvement and is more often associated with complications. High resolution computerized tomographic scan of temporal bone was highly accurate in diagnosing cholesteatoma, assessing the extent of the disease, identifying bony erosion and ossicular chain destruction and detecting destruction of lateral wall of mastoid, dural plate erosion and sinus plate erosion.
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Aim: To study maternal outcome in terms of morbidity andmortality following intrauterine packing in postpartum atonichemorrhage (PPH).Methods: The study was conducted over a period of 24months in our institution over post-partum patients withintractable PPH before resorting to invasive surgicalmanagement after vaginal delivery & caesarean section.Results: 92% success rate was observed among the patientswith uterovaginal packing.Conclusion: Timely management of patients with intractablepostpartum hemorrhage which is unresponsive to conventionalmedical treatment can be safely managed by uterine packingwith minimal maternal mortality and morbidity. Maternal deathrates and hysterectomies could be minimized using thisconservative method.
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Background: Palpable abnormalities in the breast are a major cause of concern in females from their adolescence topostmenopausal state. Majority of the palpable lesions are benign but malignant lesions are always dreadful. Imaging provides a wide spectrum of noninvasive choices for evaluating these lesions ranging from x-ray mammography to magnetic resonance mammography. Ultrasonography of breast (sonomammography) is most suitable in majority of cases and is not only noninvasive but also radiation-free. Introduction: Due to wide availability, sonomammography is the most popular imaging tool for noninvasive evaluation of palpable breast lesions. Sonoelastography, a recent advancement in the field of ultrasound imaging has added a new dimension to sonomammography allowing differentiation of benign and malignant lesions based on their stiffness. Malignant lesions are usually harder than benign lesions. Methods: Fifty female patients with palpable breast lesions were evaluated with x-ray mammography and sonomammography with sonoelastography in tandem on the same day. The results obtained were compared with final histological diagnosis in terms of benign & malignant lesions followed by statistical evaluation and conclusions. Results &Conclusions:Observations when analysed revealed higher sensitivity, specificity, positive & negative predictive values and accuracy of sonomammography than x-ray mammography. The figures further improved when sonoelastography was added to sonomammography. Based on these results, we conclude that sonoelastography should be added in the sonomammography protocol of evaluating any breast lesion not only to prevent invasive procedure but also to provide image guidance when such invasive features are indicated.
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Background: Cerebrovascular accidents (CVA) are a major cause of mortality and morbidity in middle and elderly age-groups. It can be ischemic or hemorrhagic and thrombotic or embolic. Digital subtraction angiography (DSA) is a gold standard investigation for evaluating patients with CVA. Due to invasive nature of DSA, computed tomography angiography (CTA) has long been used as a primary noninvasive imaging tool to evaluated patients with CVA. Angiography can also be performed with magnetic resonance imaging, both with & without contrast.Introduction: CTA serves as a primary noninvasive imaging tool in evaluation of patients with CVA as nearly half of these patients do not have treatable underlying cause. Due to increasing awareness regarding the radiation exposure, contrast-induced nephrotoxicity and iodine-sensitivity, magnetic resonance angiography (MRA) is gaining more and more attention. Noncontrast MRA (NC-MRA) can be performed utilizing 3D-time of flight sequence which provides results comparable to that of CTA. Hence, we performed a study to evaluate comparable role of NC-MRA and CTA. Methods: Fifty patients with cerebrovascular accidents wereevaluated with CTA & NC-MRA in tandem on the same day. The results obtained were statistically evaluated and conclusions were drawn. Results & Conclusions: Detection of aneurysm in intracranial and stenoses in intracranial as well as extracranial vessels can be detected with good accuracy by NC-MRA. The results of NC-MRA was comparable to that obtained by CTA except in very small aneurysm (<3mm) and early stenosis (20-30%) which rarely affect immediate patient management. Hence, NC-MRA can be a good substitute to CTA especially in patients where iodinated contrast is relatively or absolutely contraindicated and in combination with routine protocol for stroke imaging.
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Background: Dental implant placement has become a very common procedure in the modern era. Pre operative assessment is of immense value to ensure the long term stability of dental implants. Aim: The aim of our study was to compare the efficacy of Dental CT with radiography in planning implant surgery and pre-operative evaluation prior to implant placement. Methods: We conducted a hospital based prospective study in which patients for dental implant placement were evaluated with Dental CT and Radiography. Results: The radiographs overestimated the height of the alveolar ridge in majority of the pre implant cases as compared to Dental CT. For bucco-lingual analysis Dental CT provided an overwhelming advantage over Dental Radiography and clinical examination. The angle of alveolar ridge could not be assessed on radiographs whereas could be accurately estimated on Dental CT. Bone density of the implant site could be quantitatively determined on Dental CT whereas could not be determined on Radiographs. Conclusions: We concluded that Dental CT yields significantly better information than radiographs regarding pre-operative assessment of dental implants.