Diagnostic value of ultrasonography in evaluation of blunt abdominal trauma

To evaluate the diagnostic value of ultrasound in detecting intraabdominal injuries in patients with blunt abdominal trauma. The study was conducted in the department of radiology, Combined Military Hospital Lahore, from 13[th] September 2006 to 29[th] September 2007. A total of 70 patients with blunt abdominal trauma were included. They all underwent Ultrasonography [US] followed by Computed Tomographic [CT] scan of abdomen. Sensitivity, specificity, positive and negative predictive values and accuracy of US in detecting intraabdominal injury were calculated keeping CT findings as gold standard. The cases in which laparotomy was performed; the surgical findings were taken as the standard. US examinations were positive in 34 patients. Of these, US showed free fluid in 18 [52.9%], and abdominal organ injury in 12 [35.3%] and only abdominal organ injury in 4 [11.8%]. True-positive findings were seen in 28 [82.35%] of these on CT and/or laparotomy. There were two false negative cases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US in detecting intraabdominal injury were 93.3%, 85.0%, 82.3%, 94.4% and 88.5%, respectively. Ultrasonography has high diagnostic performance in the screening of patients 2 with blunt abdominal trauma

Urological complications of intrauterine contraceptive device

To elucidate the urological complications of Intrauterine contraceptive device [IUCD]. This study was conducted in Fauji Foundation Hospital Rawalpindi to elucidate. The urological complications of IUCD presenting to Urology department from January 2002 to December 2006. During this period 12 ladies having IUCDs presented with lower urinary tract symptoms [LUTS]. After thorough work up, 6 patients were managed surgically and the remaining 6 were managed conservatively. In all cases the IUCDs were inserted by paramedics. Out of six cases managed surgically, 3 patients had developed complete intravesical migration of device with stone formation. While in two other patients there was partial migration of the IUCD and stone formation over the migrated component of the device. One patient had simultaneously two IUCDs, one in uterus and another in bladder. We successfully performed cystolitholapaxy and retrieved four IUCDs in these patients endoscopically. A large vesical stone and the entombed IUCD in one of our patients were also removed endoscopically. The patient who presented with two IUCDs also got the vesical IUCD removed endoscopically. In remaining six cases, the IUCDs were in proper location and the cause of LUTS in these patients was urinary tract infection. These patients were successfully managed conservatively. Insertion of IUCD necessitates regular follow-up to confirm its correct position. Migration of an IUCD warrants prompt removal, even in asymptomatic patients. Cases presenting with UTI with undisplaced IUCD should be managed with appropriate antimicrobial therapy

Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease

Supraclavicular and mediastinal amyloid lymphadenopathy with concomitant multiple myeloma presenting as a lump in the neck

We report a case that presented with a hard lump in the neck [right supraclavicular region], pain in the right shoulder and anemia. On radiological investigation, well-defined calcified soft tissue masses were detected in the right supraclavicular and right superior mediastinal regions. Multiple osteolytic lesions typical of multiple myeloma were incidentally discovered in the ribs, clavicles, scapulae, humeri and skull. Diagnosis of multiple myeloma with associated nodal amyloid deposits in the right mediastinal and supraclavicular regions was made. Histopathology with Congo red staining confirmed amyloidosis. Serum electrophoresis showed a spike in the gamma globulin region and substantiated the early radiological diagnosis of multiple myeloma. The patient was referred to a tertiary care facility for further management. The detection of coexistent multiple myeloma lesions paved the way for a confident diagnosis regarding the calcified soft tissue masses despite the extremely rare nature of the case