RESUMO
To evaluate frequency of fetal anomalies in polyhydramniotic patients through antenatal ultrasound in Radiology Department of Pakistan Institute of Medical Sciences [PIMS]. Cross Sectional Observational study. This study was conducted at the Mother and Child Health [MCII] Centre, Pakistan Institute of Medical Sciences [PIMS], Islamabad from January to December, 2003. All women coming for antenatal ultrasound scan during the period January December 2003 were included in this study. The ultrasound scans were done by the Radiology resident and confirmed by a single consultant radiologist. The data obtained was entered on a proforma. A total of 42[0.79%, n5260] women were found to have polyhydramnios, out of which 11[26%] had associated fetal anomalies. Among all [11] anomalies detected, there were 5 cases [45.45%] of anencephaly, 3 cases [27.27%] ofhydrocephalus, one of which had associated nieningocele, and 01[9%] case each ofomphalocele, spinal anomaly and skeletal dysplasia. 3 [27.27%] women had concurrent disease. Expart antenatal ultrasound is recommended to assess the presence of polyhydramnios and any associated fetal anomalies. Amniocentesis, glucose tolerance test or HbA1c levels are advisable when the suspicion of associated fetal anomalies is high
RESUMO
Intravenous urography is the second most common tool after sonography for investigating urological pathology. To compare the effect of various factors like age, gender, symptoms and their duration on the yield of intravenous urography used for investigating uropathology. Retrospective case review study was done at department of Radiology, Pakistan Institute of Medical Sciences, Islamabad, from July - August 2009. Over a period of 2 months, case records of all patients referred to the radiology department for intravenous urography were retrospectively analysed for their indications for referral and the findings of the urogram and variations in the pelvi-calyceal system. Demographic and clinical data for each patient was collected on prescribed proforma. All patients were prepared with low fat diet for 2 days to reduce bowel gases after which a preliminary post micturation control x-ray film was taken which included kidney and urinary bladder. Intravenous water soluble contrast was administered to all patients at a dose of 50 ml of 350-370 strength after which a series of cross kidney films were taken at 0, 5, 15 minutes with full bladder and post micturation films. These timings were modified in some patients with particular circumstances for optimal visualization, and to reduce the radiation dose. Ultrasonography of the kidneys and urinary bladder was also performed in some patients when required and to verify results. Out of 127 patients studied, 93[74%] demonstrated pathology, while 33[26%] did not show any pathology and were thus labeled as normal. Most patients [42] were in the age group 32-39 years and the overall male to female ratio was 2:1 and it remained the same in all 4 age groups from 20-29 to 50-59 years. Calculus disease [stone] was the most common uropathology seen in 82[64.5%] patients. The shorter was the duration of presenting complaints the lesser were the chances of picking pathology on urogram as seen in 43% patients who had few week's complaints and showed a normal urogram. Those having complaints of over a month's duration showed 26% as normal cases and this figure dropped to 20% when presenting complaints were chronic i.e of few year's duration. Use of intravenous urography should not be generalized to all cases. In younger patients with shorter duration of symptoms, ultrasonography should be performed as the first investigation. This non invasive technique will rule out many normal cases. Duration of symptoms should also be taken into account as patients with long standing symptoms are more likely to demonstrate pathology on intravenous urography. Initial intravenous urography facility should be available in all diagnostic centers of tertiary care hospitals