Sonographic morphological features of ovarian tumours.

Fourty five patients with ovarian tumours were studied for their sonographic morphological characteristics and were followed up with histopathological report for correlation between most important sonographic features of benign and malignant ovarian tumours. Among different features, thin wall, smooth inner wall structure and anechogenicity or low echogenicity of the lesions were more important features of benign tumours. Complex mass without demonstrable wall, indistinct inner wall structure and highly echogenic lesion with solid component were predictors of malignancy.

Differentiation between benign and malignant ovarian tumours by ultrasonography.

A prospective non-randomized study was carried out during 2002-2003 in the Departments of Radiology & Imaging and Obstetrics & Gynaecology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu. Fourty five patients with ovarian masses underwent ultrasonographic examination. These masses were given certain scores according to the different morphological features and were classified as benign and malignant. The sonographic findings were correlated with the histopathological reports. Of 45 patients, 31 had benign and 14 had malignant ovarian tumours. Ultrasonographic differentiation of benign and malignant ovarian tumours showed good results with a sensitivity of 85.7%, specificity of 83.8%, and positive and negative predictive values of 70.5% and 92.8%, respectively. The result of the study was statistically significant (p = 0.00004). Among different features, thin (less than 3 mm) wall, smooth inner wall structure and anechogenicity or low echogenicity of the lesions were more reliable predictors of benignity. Highly echogenic lesions with solid component(s), without demonstrable and measurable wall and indistinct inner wall structure suggested malignancy. The ultrasonographic characterization by scoring system was useful in distinguishing benign from malignant masses.

Valley sign in Becker muscular dystrophy and outliers of Duchenne and Becker muscular dystrophy.

Valley sign has been described in patients with Duchenne muscular dystrophy (DMD). As there are genetic and clinical similarities between DMD and Becker muscular dystrophy (BMD), this clinical sign is evaluated in this study in BMD and DMD/BMD outliers. To evaluate the sign, 28 patients with Becker muscular dystrophy (BMD), 8 DMD/BMD outliers and 44 age-matched male controls with other neuromuscular diseases were studied. The sign was examined after asking patients to abduct their arms to about 90 cent with hands directed upwards; the muscle bulk over the back of the shoulders was observed. The sign was considered positive if the infraspinatus and deltoid muscles were enlarged and between these two muscles, the muscles forming the posterior axillary fold were wasted as if there were a valley between the two mounts. Twenty-five BMD patients and 7 DMD/BMD outliers had positive valley sign. However, it was less remarkable in comparison to DMD. It was absent in all the 44 controls. It was concluded that the presence of valley sign may help in differentiating BMD from other progressive neuromuscular disorders of that age group.

Neurocysticercosis in clinically suspected and MRI proven cases: evidence of sub-optimal antibody response.

Neurocysticercosis (NCC) has a worldwide distribution mainly in the developing countries like India. The study was done to find the seroprevalence of anti-cysticercus antibodies in clinically suspected and MRI proven cases and to corroborate the serological findings with radiological findings (MRI). A hospital based study among 204 suspected patients during January, 1996 to August, 2001 showed that 77 (32.2%, M:F = 2.2:1) had serological evidence of NCC. Of the total 189 sera, tested at 1:100 dilution 68 (35.9%) and of the total 50 CSF, tested at 1:5 dilution 9 (18%) were positive for anti-cysticercus IgG antibodies. In 35 cases where both were tested 13 sera (37.1%), 9 CSF (25.7%) and in 7 (20%) both sera and CSF were positive. In CSF from 62 patients with tubercular meningitis (disease control) 2 (3.2%) samples whereas in sera of 60 normal blood donors (normal control) 7 (11.7%) samples had anti-cysticercus IgG antibodies. In 33 MRI-positive cases, anti-cysticercus antibodies were seen in 15 (45.4%) patients. Antibodies were seen in 6 of 14 (42.8%) cases with single cortical cyst, 4 of 11 (36.3%) with 2-3 cysts and in 5 of 8 (62.5%) with multiple cysts. Alternatively, 18 of 33 (54.5%) MRI positive cases lacked anti-cysticercus antibodies. Six MRI negative cases were found to be seropositive and were treated successfully. Hence, immune response was sub-optimal even in MRI positive cases and conversely, few MRI negative cases were seropositive. Since positive response with MRI or serology depends on the stage of the disease, therefore both tests should be done together to confirm or to rule out NCC.