Influence of intravitreal bevacizumab therapy on the patterns of diabetic maculopathy on optical coherence tomography

To evaluate the effect of intravitreal Bevacizumab [Avastin[TM]] on optical coherence tomography [OCT] patterns of patients with different subtypes of diabetic macular edema [DME]. Ophthalmology Department, King Hamad University Hospital, Bahrain. A Retrospective Study. Seventy-one patients [142 eyes] with clinically significant diabetic macular edema who received intravitreal Bevacizumab therapy for six weeks were included in the study. Visual acuity and OCT patterns before and after receiving treatment were documented. Diabetic macular edema was subdivided into four groups: diffuse retinal thickening [DRT], cystoid macular edema [CME], pigment epithelial detachment [FED], and mixed features [both DRT and CME]. Macular thickness, macular volume, and visual acuity before and after treatment were compared. Changes in patients' macular thickness and macular volume were significantly different for all four subtypes of DME [p=0.002, p=0.001] after treatment with Bevacizumab. Compared to CME and FED, eyes with DRT showed the greatest change in macular thickness, macular volume, and visual acuity after receiving intravitreal Bevacizumab. The change in visual acuity six weeks after treatment was not statistically significant [P= 0.61]. Eyes affected with CME or FED were more likely to persist with chronic DME even after receiving treatment. Patients with DRT had major benefit from intravitreal Bevacizumab. The study advocates the sub-classification of DME on OCT scans in order to predict patients' visual prognosis after receiving intravitreal Bevacizumab

Frequency of incidental extra-cardiac findings in patients undergoing multi slice computed tomographic (msct) angiography for detection of coronary artery disease

The purpose of this study was to evaluate the frequency of incidental extra-cardiac findings on MSCTcoronary angiography. Patients undergoing MSCT angiography were included. Coronaries were interpreted with limited field of view [FOV] reconstructions. Reconstruction using larger FOV were used to examine and detect extra-cardiac incidental findings. All extra-cardiac structures were reviewed systematically. Patients were divided in two groups on basis of age, younger 50 years. Out of 307 patients included in the study,87 [28%] had extra-cardiac incidental findings. Patients in the older age group i.e., more than 50 years were significantly [p = 0.004] more likely to have incidental findings. Most common finding was pericardial fat pad. Most of the findings were not of clinical significance. Only 2 pulmonary nodules were detected. Extra-cardiac findings are commonly detected on MSCT cardiac scans especially in older patients with larger FOV reconstructions. Most of the findings are of minor clinical significance, only few are important. Routine screening of cardiac scans for extra-cardiac incidental findings is not mandatory

Role of radiology in pancreatic disorders

To find out mode of presentation and role of image modalities in pancreatic lesions in patients referred to radiology department. Prospective study. Radiology departments of CMH Muzaffarabad and CMH Sialkot from Jan 2003 to Jan 2006. This study was conducted at CMH Muzaffarabad in collaboration with Kashmir CT Scan installed at CMH Muzaffarabad and CMH Sialkot in collaboration with PVT-CT Scans. Radiology departments of CMH Muzaffarabad and CMH Sialkot are equipped with ultrasound and fluoroscopic facilities. We evaluated 50 patients of different pancreatic lesions referred to our radiology department. Pancreatic lesions were more common in men [70%] than women [30%]. Large group of patients [90%] belong to old age group. Out of 50 cases, 60% patients presented with jaundice, 20% with acute abdomen, 10% with mass abdomen and 10% with mixed symptoms. Ultrasonograph [USG] has been the main imaging modality in our study. All patients initially scanned with USG, patients diagnosed as mass pancreas on USG were advised CT scan, percutaneous transhepatic cholangiogram [PTC]/endoscopic retrograde cholangiopancreatogram [ERCP], and USG guided FNAC. In 15 [30%] cases ultrasound was inconclusive, in 10 patients pancreas was not clearly visualized and in 05 cases pancreas was normal looking. CT scan is more sensitive in picking up pancreatic lesions. CT scan was done in 24 [48%] patients. The results are shows in table. In our study 26 [52%] patients were of pancreatitis [Acute/chronic] and 20 [40%] of growth pancreas, 04 [8%] misc. cases [Divisum pancreas 02, annular pancreas 01, retropancreatic haemangioma 01]. It is concluded that pancreatic lesions present as acute abdomen, mass epigastrium and jaundice. In our set up USG is the main imaging modality to diagnose the pancreatic lesions. CT scan, PTC and ultrasound guided FNAC used as complementary tool

Per-cutaneous transhepatic cholangiography in obstructive jaundice by using lumbar puncture needle

To assess the effectiveness of per-cutaneous transhepatic cholangiography [PTC] with 22G lumbar puncture [LP] needle in obstructive Jaundice. The study was carried out at CMH Muzaffarabad and CMH Sialkot from January 2003 to March 2006. Twenty two patients were included in our study who underwent PTC for evaluation of obstructive Jaundice. PTC was done in these patients using ordinary LP needles [22 G] instead of Chiba needle under fluoroscopic guidance. Preliminary ultrasound scan and coagulation profile were done in all patients. Of 22 patients 12 were males, and 10 females, their mean age being 55+ 10 years. Intra hepatic and extra hepatic channels were opacified with 100% accuracy. Growth / masses and stones were commonest causes of obstructive jaundice. Out of growth and masses, cholangiocarcinomas [including Klatskin tumor] and carcinoma head of pancreas were more common. PTC related complications were nil. PTC can be successfully performed in cases of obstructive jaundice with ordinary LP needle [22 G]. This is cost effective, simple and less time consuming