Intravenous urogram as a first line investigation in comparison with ultrasound

The objective of was to evaluate the usefulness and efficacy of intravenous urogram in patients with urinary tract pathology detected on ultrasound and X-ray KUB. The duration of the study was from September 2007 to August 2009 and a total of 250 patients were included in this cross-sectional study by non probability purposive sampling technique. Ultrasound scans and intravenous urograms were conducted by/under direct supervision of consultant radiologist. Out of 254 patients, four were unable to complete the intravenous urogram due to reaction to the contrast medium; hence a total of 250 patients were included in the final study. There were 66 male and 184 female patients. Calculi [renal, ureteric and vesical] were seen in 139 patients, pefviureteric Junction obstruction in 9, double collecting system and/or ureter in 6, neurogenic bladder in 13, horseshoe/pancake kidney in 2, ectopic kidney in 1, ureterocele in 2, cystocele in 1 and bladder mass in 7 patients. In 14 patients, the tests conducted were inconclusive and further investigations were advised. 28 patients had no detectable urinary tract pathology on any of the diagnostic modality. Intravenous urogram should not be performed routinely as a first line investigation in every patient presenting with flank pain. However, in congenital anomalies, intravenous urograms are needed and should be performed after a preliminary ultrasound

Results of separate anastomoses of multiple renal arteries with recipient external iliac artery in renal transplant surgery

To evaluate the results of separate anastomoses of multiple arteries of the donor kidney with the external iliac artery of the recipient in renal transplant surgery. A descriptive study conducted at department of Urology and Renal Transplantation, Foundation University Medical College, Fauji Foundation Hospital, Rawalpindi and Hearts International Hospital, Rawalpindi from January 2005 to December 2007. Living voluntary kidney donors having multiple renal arteries as seen on preoperative screening. During regular renal transplant surgery, donors having multiple renal arteries as diagnosed on preoperative computerized tomographic renal angiography were selected for further study. Such kidneys from volunteer donors were harvested and no ex vivo bench surgery was performed to unit these multiple renal arteries. An arterial punch was used to make separate arteriotomies on the external iliac artery of the recipient and anastomoses of the multiple renal donor arteries were carried out separately with the external iliac artery in an end to side manner using 7/0 prolene suture. Of the fifty grafts harvested, 38 had two renal arteries arising from the aorta and reaching the renal hilum [Group I]. These were anastomosed separately to the external iliac artery. Nine grafts had triple renal arteries, two running to the hilum and one entering into the lower pole [Group II]. All these three arteries were anastomosed in an end to side manner with the external iliac artery. Three grafts had one main renal artery and a tiny upper polar cortical vessel incapable of anastomoses [Group III]. The small upper polar cortical artery was sacrificed and the main renal artery was anastomosed with the external iliac artery. One release of vascular clamps perfusion of the graft was observed. Diuresis of the graft was notices. Color Doppler study of the graft was carried out on third postoperative day. Serum creatinine of the recipient was determined on alternate days for one week, after a month and then regularly at three months interval for two years. Early and late vascular and urological complications were observed over a period of two years. A total of 50 kidneys with multiple renal arteries were harvested. On release of vascular clamps, reperfusion of all the allograft occurred within 5 to 75 seconds [mean: 30 seconds]. Diuresis from the graft started in 1/2 to 8 minutes [mean 3.5 minutes]. One of the recipients in Group I developed sudden decline of urine output 2 hours postoperatively and a color Doppler scan showed lack of perusion. On re-exploration a positional kink of the arteries was found which was corrected. Color doppler study on third postoperative day revealed normal perfusion of all the grafts. Serum creatinine of all the recipients steadily came down and reached normal values within a week. Serum creatinine levels remained within normal range over two years of follow-up. None of the patients developed postoperative hypertension or other vascular complications during the follow-up period. Three patients in Group I developed lymphocele requiring percutaneous aspiration. Two patients in Group II had wound infection. Performing separate anastomoses for multiple renal arteries of the donor with the external iliac artery of the recipients in renal transplant surgery is a safe, easy to perform and practical with minimal complications. The renal arterial anatomy of the donor kidney should be evaluated by the spiral computed tomographic angiography, prior to harvesting it in the host and this angiography should be available in all renal transplant surgery units

Doppler indices in fetoplacental and uteroplacental circulation at 22 weeks of gestation

Doppler has revolutionized the field of obstetrics since its introduction in late 1950's. Useful information is obtained during second half of pregnancy and pregnancies with high resistance can be determined. A total number of 100 patients were studied in Combined Military Hospital, Rawalpindi from 01 June 2002 to 25 January 2003. Normal pregnant women with 20 weeks of gestation, from all socioeconomic strata and singleton pregnancy were included in the study. Doppler examination was performed and the range of normal indices determined from all the four vessels. Descriptive statistical analysis of data was carried out. For umbilical artery mean PI was 1.48 [range = 0.92-1.91] RI was 0.78 [range = 0.64-0.84] S/D ratio was 4.68 [range = 3.84-5.6] For uterine artery mean PI was 1.18 [range = 0.69-1.86] RI was 0.54 [range = 0.44-0.66] and S/D ratio was 2.18 [range = 1.92-2.36] for fetal aorta mean PI was 1.94 [range = 1.54-2.42] RI was 0.80 [range = 0.68-0.88] S/D ratio was 6.22 [range = 3.18-6.94]. For MCH PI was 1.86 [range = 1.44-2.30] RI was 0.84 [range = 0.72-0.88] S/D ratio was 5.64 [range = 3.22-7.1]. The determined range of Doppler indices in our study varies as compared to international data. This variation equipment used difference in time of gestation and site of vessel under study

Mammographic and sonographic features in carcinoma breast

The most common malignant disease among the females is carcinoma breast. Its management requires team effort, in which modern imaging techniques play an important rote, in diagnosis and assessing the severity of disease. A total number of 71 patients were studied from 01 January 2000 to 30 August 2001 at CMH Rawalpindi. The age range was 19-65 years. Duration of disease ranged from 2-6 months. Sixty three patients were married and eight were unmarried. On mammogram, the lesion pick up rate was 88%, that is 62 out of 71 patients. Mostly the lesion appeared as dense irregular mass. False negative cases were seen in patient s with dense glandular breasts. On ultrasound, lesion pick up rate was 93%, that is 66 out of 71 patients. In most of cases lesion appeared as solid hypoechoeic or heterogeneous mass with irregular margins and posterior shadowing. It is concluded that when the mammography and sonography are used simultaneously the diagnostic yield is very high, that is, in 85% of cases, there is agreement of findings. It is also concluded that the mammographic and sonographic features of Ca breast are not 100% diagnostic and false negative cases do exist

Role of imaging in renal transplant complications - a hospital based study

Thirty five thousands patients receive renal transplants every year world wide. This study was conducted to determine and evaluate the diagnostic role and accuracy of Ultrasonography including Doppler analysis and Radionuclide Scanning in patients with renal transplant complications. It was an observational study. Cases were collected from AFIU, MH and Jinnah Memorial Hospital Rawalpindi. Ultrasound and Doppler analyses were done in the Radiology Department of CMH Rawalpindi. Renal isotope scans were performed at NMC Rawalpindi. A total number of 52 patients were studied. Male female ratio was 42 to 10 [80.8% to 19.2%]. The post-transplant duration was 02 days to 06 years. The most frequent complications were peri-transplant fluid collection [27%], followed by rejection of transplant [25%] and cyclosporine nephrotoxicity [11.54%]. Other complications which were also observed were Acute Tubular Necrosis [7.69%] and hydronephrosis [15.4%]. Ultrasound is excellent modality to evaluate location, volume and change in volume of Perinephric fluid collection. Radionuclide imaging detects altered or diminished renal function due to acute tubular necrosis, rejection of transplant and toxicity from medications. Radionuclide imaging is most useful modality for assessing renal function. Standard for evaluating vascular complications is angiography, however duplex Doppler ultrasound is an excellent non invasive method for screening. Other transplant complications like abnormalities of collecting system and renal parenchyma are well evaluated by both ultrasound and radionuclide imaging

Vein of galen aneurysm: antenatal diagnosis: a case report

Aneurysm of vein of Galen is a rare congenital malformation with reported incidence of less than 1% of cerebral vascular malformations. Most cases present in neonatal life with congestive cardiac failure. We report a case of aneurysm of vein of Galen diagnosed in intrauterine life at 36 weeks of gestation. The importance of third trimester Doppler ultrasound is highlighted

Vein of galen aneurysm: antenatal diagnosis: a case report

Aneurysm of vein of Galen is a rare congenital malformation with reported incidence of less than 1% of cerebral vascular malformations. Most cases present in neonatal life with congestive cardiac failure. We report a case of aneurysm of vein of Galen diagnosed in intrauterine life at 36 weeks of gestation. The importance of third trimester Doppler ultrasound is highlighted

Role of MRI in differentiating various causes of non-traumatic paraparesis and tetraparesis

To assess the frequency of various causes of non-traumatic paraparesis and tetraparesis in adults based only on the findings of magnetic resonance imaging [MRI]. Design: Non-interventional descriptive study carried out from May 2001 to October 2002 at Radiology Department, CMH, Rawalpindi. Patients and A total of 100 adult patients who presented with non-traumatic paraparesis or tetraparesis, were studied. MRI spine of all the patients and MRI brain of selected patients, was carried out. Based on MRI findings alone causes of non-traumatic paraparesis and tetraparesis were categorized. Paraparesis was more frequent than tetraparesis. Cord compression was found in 72% cases. Neoplastic compression, infective spondylitis and non-compressive myelopathies were the main causes of paraparesis while spondylotic myelopathy was the main cause of tetraparesis. Based upon MRI findings causes of non-traumatic paraparesis or tetraparesis can be subcategorized into spondylotic, infective or neoplastic cord compression and non-compressive myelopathies. Further subcategorization of neoplastic lesions according to their compartment of origin can also be done

Correlation between type of leprosy and specific and non-spcific bone lesions

This study is probably one of its kinds in Pakistan, in which radiological assessment was done in order to find out which type of leprosy has higher frequency of specific and non-specific bone lesions. Forty four patients of leprosy were selected after clinical and laboratory tests. They comprised lepromatous [LL], borderline lepromatous [BL], borderline tuberculoid [BT] and indeterminate [polyneurotic][IL] types of leprosy. The lepromatous [LL] and borderline tuberculoid [BT] showed maximum specific and nonspecific bone lesions in hands and feet. The radiologist has seldom any role in making initial diagnosis, but has got a vital part to play in assessing the disease activity and extent of bone involvement. In cases of lepromatous and borderline tuberculoid type of leprosy, it is advisable to have serial X-rays of hands and feet routinely to detect any bone lesions and associated complications to help the surgeons in planning reconstructive surgery and rehabilitation

Evaluation of prostatic diseases with transrectal ultrasonography

A study was conducted in radiology department CMH Rawalpindi to determine the role of transrectal ultrasonography in the evaluation of prostatic diseases. A total of 78 cases were examined with transrectal ultrasound probe and later followed for histopathological findings. Transrectal ultrasound was found correct in 51 cases of benign prostatic hyperplasia and 16 cases of prostatic carcinoma. Two cases of prostatitis with prostatic abscess were also noted. The sensitivity and positive predictive value for prostatic carcinoma in our study were 80% and 76.19% respectively. In 16 cases of prostatic carcinoma, the digital rectal examination was positive in only 08 cases and raised serum prostate specific antigen were noted in 13 cases. In view of this study, it is recommended that transrectal ultrasonography should be adopted for pre-operative assessment of benign prostatic hyperplasia, diagnosis / staging of prostatic carcinoma and in all clinically suspected cases of prostatic abscess

Comparative study of radiologic examinations and the upper gastrointestinal endoscopy in diagnosis and staging of gastric masses

A study was conducted in the Radiology Department, CMH Rawalpindi to evaluate the role of different radiological modalities and upper gastrointestinal endoscopy in the diagnosis of the gastric masses and staging of malignant tumors because early diagnosis plays an important role in the better management of the patients. The patients having suspicion of gastric masses underwent double contrast upper GI examination, ultrasound examination with LOGIC 500 ultrasound scanning system, CT scan and upper gastrointestinal endoscopy. A total number of 37 patients of different age groups were evaluated by these modalities. On basis of these investigations we found that in our setup there is no statistical difference between the sensitivity and specificity of barium meal examination and upper gastrointestinal endoscopy in the diagnosis of a mass of gastric origin

Role of ultrasonography in clinically suspected cases of acute appendicitis

This study was conducted at CMH Rawalpindi to evaluate the diagnostic rate of ultrasonography in clinically suspected cases of acute appendicitis. In our study which was conducted from 1998 to 2000, a total number of 100 patients with the clinical suspicion of acute appendicitis were included. There were 47 male patients and 53 female patients. Male to female ratio was 1:1.12. The age of the patients ranged from 8 to 70 years. The subject were studied with Aloka SSD-630 machine equipped with 7.5 MMz short focused high resolution probe. A final diagnosis of appendicitis and allied appendix disorders was made in 72 patients while 26 patients were true negative. Out of 72 patients suffering from diseases of appendix, 63 patients had acute appendicitis. Out of 63 patients suffering from appendicitis, 56 patients had positive ultrasound examination for appendicitis. Ultrasound has shown the sensitivity of 88.8% in diagnosis of appendicitis while it has shown a specificity of 83.9%. We, therefore, conclude that the use of ultrasound helps to make prompt decision in suspected cases of acute appendicitis especially in patients at extremes of age, females of child bearing age and pregnant women and also in establishing alternate diagnosis, so it should be recommended as a routine screening method in suspected cases