recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Role of MDCT in Blunt Trauma Abdomen

The challenge in the imaging of abdominal trauma is to accurately identify injuries that require early exploration and at the same time avoid unnecessary operative intervention in cases that can be managed conservatively. To ascertain degree of trauma, a rapid, cost effective, safe and reproducible investigation used is ultrasonography. However limited information by USG limits its role in trauma. The advent of Multi Detector Computed Tomography (MDCT) is a major advancement in evaluation of patients of abdominal trauma by offering decreased scanning time, increased resolution owing to thinner collimation and reduced partial volume and motion artefacts. The aim of the present study was to assess role of Multi detector computed tomography (M.D.C.T) in evaluation of patients of blunt abdominal trauma and to assess the utility of multi planar reformations (MPR), maximum intensity projections (MIP) and 3-D reconstruction in patients of blunt trauma abdomen. At the outset of the study, a detailed history was taken, general physical examination and relevant local examination findings were recorded. Relevant laboratory examination findings were recorded. The most common mode of injury was road traffic accident (RTA) accounting for approximately 69.5% (32/46) of cases Pattern of the injuries showed that the liver was the most commonly injured organ accounting for 34.78% (16/46) of injuries The management plan of the patients prior and after MDCT examination which was guided by demographic profile like age, clinical status of the patients; time elapsed since injury and initial sonographic findings if done was studied. The use of multi detector CT in initial triage of clinically stable patients with blunt abdominal trauma results in reduction in number of unnecessary laparotomies by 91% and helps guiding initial management in emergency department in virtually every patient with high success rate of around 95%. The MDCT grade of solid organ injury does not correlate with management plan in patients with blunt abdominal trauma. The high resolution MPR, MIP, 3-D volume rendered images not only helped in displaying complex injuries but also increased diagnostic capabilities, accuracy and shortened the reporting time. The high Shadab Maqsood, Tasaduq Ahmad Khan, Shaafiya Ashraf. Role of M.D.C.T in Blunt Trauma Abdomen. IAIM, 2018; 5(3): 77-87. Page 78 resolution MIP and 3-D volume rendered images gave quick and prompt diagnosis of associated vascular and bony injury.

Role of high resolution computed tomography in evaluation of temporal bone diseases

Background: The imaging modalities for evaluation of temporal bone are plain radiographs, multidirectional tomography, angiography, CT and MRI Plain X-ray is an inexpensive method to study temporal bone, but results in an inaccurate diagnosis Multidirectional tomography provides excellent bony details; however, soft tissues can’t be delineated Also, there is increased radiation to the eye lens Angiography is the gold standard for evaluation of vascular lesions but is invasive with the risk of complications The aim of the present study was to evaluate Role of High Resolution Computed Tomography in Temporal Bone Diseases and correlate HRCT image based findings with the operative and pathological findings to determine the accuracy of HRCT findings wherever possible Materials and methods: This prospective study was done in Department of Radiodiagnosis & Imaging of Govt Medical College Srinagar, J&K in collaboration with the Department of Otorhinolaryngology, in patients suspected of having temporal bone disease All the patients who were, suspected of unsafe chronic serous otitis media (CSOM), evaluation of congenitally deaf child, having known or suspected deformities of inner, middle or external ear, tinnitus or vertigo, tumors of temporal bone and temporal bone fracture were included in the study While exclusion criteria included, Patients of age <1 or >70 years Results: Various findings associated with temporal bone trauma on HRCT showed 10 cases of Hemotympanum, 6 with facial nerve involvement, 2 with Labyrinthine involvement and Intracranial involvement was seen in 6 cases In the current study 9 patients had symptomatic congenital anomalies involving various structures of the ear and temporal bone

Role of Magnetic Resonance Imaging in Evaluation of Epilepsy

Introduction: Seizures have been classified in several ways, according to their etiology, ie, idiopathic (primary) or symptomatic (secondary); their site of origin; their clinical form (generalized or focal); their frequency (isolated, cyclic, or repetitive, or the closely spaced sequence of status epilepticus); or their electrophysiologic correlates Epileptic seizures are brief episodes of abnormal excessive or synchronous neuronal brain activity, characterized by typical ictal neurophysiological patterns and postictal and/or interictal abnormalities Computed tomography introduced in 1973, with its widespread availability at emergent care facilities, rapid scan time, high sensitivity in detecting major abnormalities is widely used for screening patients with newonset seizures The present study is to evaluate the magnetic resonance imaging characteristics of epileptogenic substrates to identify the epileptogenic substrates based on imaging features, to assess the distribution of epileptogenic substrates, the diagnostic yield of magnetic resonance imaging and evaluate the role of magnetic resonance imaging in the pre-operative evaluation of patients with intractable epilepsy Material and methods: The present study was a prospective observational study, conducted in the Department of Radiodiagnosis and Imaging, GMC Srinagar J&K, MRI centre, Sheerin Bagh Imaging was done with Magnetom Skyra, 3 Tesla Magnetic Resonance Imaging equipment from Siemens All patients with magnetic resonance imaging reference for seizures at SMHS and Associated Hospitals between April 2017 to April 2018, irrespective of age and sex were included in the study This was a type of purposive sampling Results: Majority of the patients were in the first two decades, the percentage of patients in the first decade being 29% and those in the second decade being 27% Mesial temporal sclerosis was the most Shadab Maqsood, Peerzada Ziaulhaq, Iqubal Hussain Dar, Shaafiya Ashraf Role of Magnetic Resonance Imaging in Evaluation of Epilepsy IAIM, 2018; 5(12): 102-110 Page 103 common abnormality identified in 29% of the study group MRI was normal in 60 patients while abnormalities were identified in 90 patients of the study group Among patients with partial seizures, 68 patients had lesions detected in magnetic resonance imaging The diagnostic yield in the partial seizure group was 68% Conclusion: Magnetic resonance imaging should be considered in the initial evaluation of patients presenting with seizures, particularly with intractable partial seizures because of its high sensitivity for epileptogenic substrates, superior soft tissue contrast, multiplanar capability, lack of beam hardening artifact and lack of ionizing radiation

Role of Ultrasound in Thyroid Pathologies

Disorders of thyroid gland may result from developmental failures, abnormalities of hormone production and structural changes which may or may not be accompanied by changes in function. The normal thyroid gland consists of two lobes and a bridging isthmus. Thyroid size, shape and volume vary with age and sex. Ultrasound is the initial and the commonest modality to study the thyroid gland. The thyroid gland is slightly more echo-dense than the adjacent structures because of its high iodine content. It has a homogenous ground glass appearance that makes detection of focal cystic or hypoechoic thyroid lesions relatively easy. The aim of the present study was to assess the nature of pathologies of thyroid gland, differentiate between focal and diffuse pathology and perform a Sonographic interpretation with subsequent confirmation by FNAC. The present prospective observational study was carried out in the Department of Radio-Diagnosis, Government Medical College and Associated Hospitals Srinagar. A convenience sampling of all patients referred to the Department of Radio-Diagnosis from OPD, in-patient wards or Emergency wing for thyroid ultrasound scan were included in study. Detailed history was elicited; Study was done on Logic S8 Ultrasound using 12 MHz linear array transducer. Before the ultrasound guided FNAC, the neck was hyperextended and skin was cleaned with povidine – iodine (Betadine) solution. The male: female ratio was 1:2.3. Maximum number of patients, 42(84%) came with clinically thyroid enlargement followed by pain in 7 cases (14%), 6(12%) cases presented with pressure effects like dysphagia, dyspnoea and hoarseness of voice. 3(6%) cases presented with signs of hyperthyroidism like tremors, sweating and loss of weight. Lesser involvement was seen in Left Lobe (8%). Total number of cases with swellings (84%) was more than cases (16%) with no swellings. In the study, majority of lesions had hypoechoic echotexture (34%) followed by isoechoic (28%) and heterogenous (24%). In this study among malignant cases papillary carcinoma was most common lesion in 83.34% of cases followed by anaplastic carcinoma in 1(16.66%) case.