Transabdominal Ultrasound: A Potentially Accurate And Useful Tool For Detection Of Choledocholithiasis.

BACKGROUND: Choledocholithiasis denotes to the presence of gallstones within the common bile duct. In patients with Gall stones, the precise incidence and prevalence of choledocholithiasis are not known, but it has been estimated that 5-20 percent of patients have choledocholithiasis at the time of cholecystectomy, with the incidence increasing with age. The transabdominal ultrasound examination (US) is the most commonly used modality for symptoms attributable to gallstone disease. US can provide important evidence for presence of stones in CBD. METHODS: This was a descriptive cross-sectional validation study which was conducted at PAEC General Hospital, Islamabad from February to July 2015. Patients with suspected choledocholithiasis attending radiology department for ultrasound abdomen were included in the study. Findings for dilatation of common bile duct, intrahepatic biliary channel dilatation and direct visualization of calculus in CBD were noted. Ultrasound findings were compared with subsequent ERCP which was considered gold standard. RESULTS: Diagnostic accuracy of trans abdominal ultrasound in detection of choledocholithiasis came out to be 76.9% with sensitivity of 76.2% and specificity of 81.3%. CONCLUSIONS: Ultrasound can be used as an initial and baseline tool for detection of CBD calculi as it is non-invasive, easily available, radiation free and cost effective.

ULTRASOUND--A USEFUL COMPLEMENTARY TOOL TO MAMMOGRAPHY IN ASSESSMENT OF SYMPTOMATIC BREAST DISEASES.

BACKGROUND: Breast cancer is the most common female malignancy worldwide. Pakistan has the highest incidence rate of breast cancer than any other Asian population. The purpose of the study was to evaluate the worth of sono-mammography in diagnosis of symptomatic breast diseases by comparing it with mammogram. METHODS: In this cross-sectional validation study, 45 subjects with mean age of 45 +/- 12.07 were included. Majority of the patients presented with complaint of breast lump. After complete history and clinical examination, all the patients had high resolution ultrasound of bilateral breasts and axilla followed by bilateral mammography. Histopathology was taken as gold standard in this study. The exclusion criteria were pregnancy and patients having direct clinical signs of breast malignancy. RESULTS: Based on histopathology, out of 45 patients with breast symptoms, 12 patients had benign lesions, whereas 32 patients were diagnosed as the cases of breast cancers. Finally one patient did not have biopsy proven final diagnosis. Sensitivity and specificity of ultrasound were calculated to be 100% and 67% as compared to sensitivity and specificity of 90.6% and 91.7% for that of mammography. CONCLUSIONS: Ultrasound is a useful complementary tool to mammography in assessment of symptomatic breast diseases since it helps in characterization and localization of breast lesions seen on mammogram and it is not limited by dense breasts. Also it should be the considered as initial imaging technique for assessment of palpable breast lumps.

Testicular choriocarcinoma: diagnosed on cervical lymph node biopsy.

Choriocarcinoma is a very rare germinal testicular tumour and in literature its incidence has been reported to be 0.3% of all germinal testicular tumours. An important tumour marker is serum beta-hCG which not only helps in establishing diagnosis but also in assessing response to chemotherapy. In this study we present a case of testicular choriocarcinoma, who presented with abdominal pain, cough, generalized weakness and left sided cervical mass. Incisional biopsy of cervical mass was performed. Histopathology revealed metastatic choriocarcinoma. Serum beta-hCG levels were 1227 ng/mL. Patient received intravenous cycles of PEB (cisPlatin, Etoposide, Bleomycin) chemotherapy but he had progressive disease both radiologically and on tumour marker monitoring. He was planned for salvage chemotherapy but was lost to follow up there after. It is concluded that in males, choriocarcinoma carries a very dismal prognosis and a very poor response to chemotherapy and radiotherapy; surgery has no role in the management.

Validation of tuning fork test in stress fractures and its comparison with radionuclide bone scan.

BACKGROUND: Stress fractures are quite common both in athletes and military recruits. The purpose of the study was to evaluate the efficacy of tuning fork in stress fractures by comparing it with three phase bone scan. METHODS: The current study examined 55 subjects whose age ranged 18-28 years. X-rays of all the subjects were unremarkable. After history and clinical examination tuning fork test (TFT) was performed on each case by placing 128 Hertz vibrating tuning fork on the site of pain (underlying bony surface) of tibia or fibula. Each case was scanned using triple phase bone scintigraphy. RESULTS: Fifty-five patients had a total of 67 stress fractures, out of which 53 were picked up by TFT. Sensitivity of TFT was found to be 79% and specificity of 63%. Positive and negative predictive values were 88% and 46% respectively. CONCLUSION: Tuning fork test is a simple and easy approach of diagnosing stress fractures which can be performed even by athletics and military trainers. Management should be initiated in patients who have history of stress related below-knee pain and positive tuning fork test without waiting for bone scintigraphy. For complicated cases the bone scan is the gold standard for diagnosis.

Bone stress injuries in the Army cadets of Pakistan Military Academy.

BACKGROUND: Bone stress injuries are common among army cadets during training period and these injuries give rise to morbidity and loss of training hours. Some cadets with stress fractures re-join their duties while some are kept out of services resulting in attrition and economic loss. A retrospective analysis of bone stress injuries of one hundred and twenty cadets between June 2006 and Dec 2007 was conducted from the case documents available at Institute of Nuclear Medicine, Oncology & Radiotherapy (INOR) Abbottabad. RESULTS: The occurrence of stress fractures among cadets at Pakistan Military Academy, presenting with exercise induced pain was 68.3% amongst these cadets. Seventy fours percent of the fractures were labelled grade-I. High grade fractures were confined to tibia. Tibia was the commonest site of stress fractures in both sexes, accounting for about 73% of all stress fractures. Fifty percent of these patients were labelled as having shin splints and 3% as thigh splints. CONCLUSIONS: Most of the stress injuries were confined to the tibia. The referral was considered early as most of the stress injuries were of low grade.