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.

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