Ultrasound guided hydrostatic reduction of intussusception: suitability and effectiveness with factors affecting its successful outcome

Background: Intussusception being the leading cause of acute abdomen in childhood, its timely and accurate diagnosis assumes utmost significance in reducing the morbidity and mortality. Childhood intussusceptions are still managed surgically in our region; however, non-operative reduction has now become the gold standard of treatment worldwide. In this study, authors desired to evaluate the suitability and effectiveness of hydrostatic reduction of intussusception under ultrasound (USG)-guidance and to scrutinize the factors affecting the successful outcome.Methods: Ours was a prospective study carried out at a tertiary care centre in central Kashmir. All except those with clinical features of bowel gangrene, intestinal prolapse and peritonitis underwent ultrasound-guided hydrostatic reduction (USGHR). A maximum of three attempts were allowed.Results: Mean age of the patients was 11.2±8.8 months with age range of 3-50 months. 69.1% (n=38) of the patients presented within 24 h of being symptomatic while 30.9% had delayed presentation (>24 h). The success rate of USGHR was 81.8% (n=45). Late presentation, age and gender of the patients had no influence on successful outcome of the procedure, p >0.005. The duration of hospital stay between those who had successful hydrostatic reduction and those who afterwards underwent operative reduction or resection achieved statistical significance, p=0.0015. Authors attained a 66.2 % (45/68) reduction in operative management using USGHR as the main modality of treatment.Conclusions: USGHR is a simple, safe and effective non-operative method of treating intussusceptions in children in a limited resource setting.

Role of duplex ultrasonography in patients with renal parenchymal disease: renal resistive index vs serum creatinine level

Background: In view of the fact that Brightness (B)-mode ultrasound findings in patients with renal parenchymal disease are profoundly non-specific, this study was carried out to determine the efficiency of color Doppler sonography for assessing renal function. In this series, the relationship between the resistive index (RI) of renal interlobar artery and serum creatinine level was analyzed for any relevant association of this color Doppler index with the serum creatinine level.Methods: In this prospective cross-sectional study, 40 patients with renal parenchymal disease having serum creatinine level >1.4 mg/dL were chosen midst routine revisits. The control group comprised of 40 normal subjects with serum creatinine levels <1.4 mg/dL. After assessing the kidneys of these subjects with gray-scale ultrasound for presence of any stones, hydronephrosis, and/or space occupying lesions instead of, they were subsequently interrogated with color Doppler sonography and RI calculated.Results: The mean serum creatinine levels±SD in the case and control groups were 6.7±0.7 mg/dL and 1.0±0.4 mg/dL, respectively. The mean±SD resistive index (RI) was 79.0%±1.8% in the diseased group and 60.3%±0.7% in the healthy subjects (p<0.001). The correlation between the RI and the serum creatinine level was statistically significant (p<0.001).Conclusions: Resistive index (RI) measurement by color doppler ultrasonography is a reasonable prognosticator of functional outcome in patients with renal parenchymal disease.

Main pulmonary artery diameter assessment in a large sample of Indian population: a MDCT based study

Background:The gold standard for pulmonary artery pressure measurement is right heart catheterization but its invasive nature precludes its routine use. Main pulmonary arterial trunk calibreincrease is a strong indicator of underlying pulmonary arterial hypertension. MDCT can accurately measure the diameter of main pulmonary artery. The objective of the study was to establish the normative values of main pulmonary artery caliber using contrast enhanced CT and try to ascertain any significant difference in main pulmonary artery calibers between two genders and correlation of age and main pulmonary artery diameter. Methods:Contrast enhanced CT images of 462 subjects were analysed on a PACS workstation monitor and widest diameter perpendicular to long axis of the main pulmonary artery as seen on reformatted axial image was measured with electronic caliper tool at the level of the main pulmonary artery bifurcation.Results:The mean main pulmonary artery diameter in females was 22.54±2.19 mm and 23.34±3.06 mm in males. The mean pulmonary artery diameter in males was larger than females with statistically significant difference seen (p<0.05). The correlation coefficient between age of whole sample and their mean main pulmonary artery was found to be 0.1006 with no statistically significant difference.Conclusions:There is a statistically significant difference in the mean main pulmonary artery calibre between males and femaleswith no strong correlation between the age and mean main pulmonary artery calibre. Further studies are warranted to find the complex interaction between main pulmonary artery diameter and sex, age and body mass index

Determination of subcarinal angle of trachea using computed tomography

Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.

Anatomical variations of intra-sphenoid sinus septations in a sample of Kashmiri population: a non-contrast computed tomography study

Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.

Spectrum of Magnetic Resonance Imaging Findings in Vertebral Artery Dissection

Introduction: Vertebral artery dissection (VAD) is animportant cause of posterior circulation stroke in youngpatients and presents with a host of clinically varied symptomsdepending upon the type and site of dissection. Currentresearch aimed to study the spectrum of magnetic resonanceimaging findings in vertebral artery dissection.Material and methods: This was an observational studywhere a cohort of 193 patients of posterior circulation strokewere evaluated with magnetic resonance imaging and amongthem 17 patients having vertebral artery dissection wereselected and magnetic resonance imaging findings werestudied using spin echo, diffusion weighted imaging and 3Dtime of flight MR angiography sequences.Results: Of the total 17 patients imaged with age range of23-59 years (mean age 38 years), 11 were males and 6 werefemales. V3 was the commonest site of dissection (n=10)followed by V4 (n=4) and V2 (n=3). The most commonpattern of dissection was steno-occlusive (n=15), whereas2 patients had aneurysmal type of dissection. T1W imagesrevealed intra-arterial thrombus in all the 17 patients. T2Wrevealed absent flow in vertebral artery in 5 patients. 3D TOFMRA revealed narrowed lumen in 10 patients and completeocclusion in 5 patients. One patient revealed intimal flap on3D TOF MRA.Conclusion: MRI is an excellent non-invasive modality forevaluation of posterior circulation stroke. MRI in conjunctionwith MR angiography helps clinch the diagnosis of VAD andthus helps in planning management and subsequent follow upof these patients.

Anatomical Variations of Paranasal Sinuses – A MDCT Based Study

Background: Pneumatisation of various bones around the nasal cavity results in the formation of paranasal sinuses. Varying degrees of pneumatisation result in multiple variations of paranasal sinuses some of which are important from clinical, pathological and surgical perspective. Objective: Determining the prevalence of various sinonasal anatomical variations on multi-detector computed tomography. Materials and methods: 852 patients with various symptoms of active rhinosinusitis were subjected to non-contrast enhanced CT examinations of the paranasal sinuses and nasal cavity. Multi-planar reconstructions were done in axial, coronal and sagittal plane and the reconstructed CT images were evaluated for the presence of anatomic variants of the sinonasal cavities and the prevalence of each variant was calculated. Results: Deviated nasal septum (DNS) was the most common anatomic variant of the paranasal sinuses and nasal cavity seen in 724 patients (85%), if minimal septal deviation (<1 mm) was also taken into account. The second most common variant was prominent ethmoid bulla which was present in 392 of 852 patients (46%). Dehiscent lamina papyracea (0.9%) and pneumatised crista galli (11.7%) were the least commonly seen sinonasal anatomic variants. Conclusion: Sinonasal anatomic variants are a rule rather than an exception, being present in a majority of population. These variations should be diagnosed and documented on CT examinations of paranasal sinuses to avoid any unforeseen complication during functional endoscopic sinus surgery and other skull base surgeries.

A CT scan anatomical study correlating between the retroversion of the humeral head and the orientation of the inter-tubercular sulcus

The shoulder socket is called the glenoid fossa This socket is shallow and is part of the scapula (shoulder blade) The surface of the humeral head and the inside of the fossa are covered with articular cartilage The glenohumeral joint consists of an articulation between the scapula and humerus Retroversion angle of humeral head (or retrotorsion angle, RA) is an important parameter in total shoulder arthroplasty and is one of these important reference factors which can influence the outcomes of total shoulder arthroplasty This study was undertaken to evaluate the correlation between retroversion angle of humeral head and position of intertubercular sulcus The present study is a prospective one which was conducted in the Department of Radiodiagnosis and Imaging at Government Medical College and Hospital, Srinagar The 60 dry adult humeri were analyzed by multiplanar computed tomography (CT) CT data were transferred to a workstation (Silicon Grafics; Sunnyvale, CA) for multiplanar CT-reformation The mean retroversion angle of the humeral head in relation of the transe-picondylar axis was 123 degree The mean ITS orientation was 407 degree The Pearson correlation coefficient between the retroversion of the humeral head and the ITS orientation was -037 There was an inverse correlation between the retroversion of the humeral head and the ITS orientation This variation is due to several factors, including the definition of humeral head retroversion, different methods of measurement, ranges of normal values, and accuracy of anatomic landmarks to guide determination of anatomic retroversion Humeral head retroversion is generally defined with respect to the plane of the humeral head articular surface proximally; distally, however, Yassar Shiekh, Aamir Javed Khan, Mohammad Iqbal Bhat A CT scan anatomical study correlating between the retroversion of the humeral head and the orientation of the inter-tubercular sulcus IAIM, 2018; 5(12): 96-101 Page 97 the reference axis has been debated, including the transepicondylar axis, trochlear tangent axis and forearm axis The study concludes that there is a reverse correlation between the retroversion of the humeral head and the orientation of the intertubercular sulcus