CT coronary angiography as an alternative imaging method to ascertain cardiac output and its correlation with echocardiography.

AIM: To assess the feasibility and accuracy of cardiac output (CO) obtained using a test bolus in patients scanned with single-source prospective-gated cardiac computed tomography (CT), and comparing it with CO obtained from unenhanced two-dimensional (2D) echocardiography using biplane Simpson's method. MATERIALS AND METHODS: In the present study, 100 patients with a mean age of 55 ± 12 years who underwent coronary CT angiography with prospective electrocardiogram (ECG)-gated CT in which the scan delay was evaluated using a test bolus. The time-attenuation curves obtained from the test bolus were used to calculate the CO of the patients. The CO obtained was then compared with that obtained after follow-up 2D echocardiography using biplane modified Simpson method. RESULTS: Linear regression was calculated between the CO and contrast enhancement: CO = -0.16(HUmax) + 7.65. The study showed good correlation between the two methods with r=0.77, p<0.001. On Bland-Altman analysis, no significant difference was noted between the two methods. CONCLUSION: This less researched method for CO estimation appears feasible; however, the clinical usefulness of this parameter is uncertain in absence of further clinical and reference standard validation.

A study of contralateral occult inguinal hernia in adult male patients undergoing total extraperitoneal herniorraphy.

BACKGROUND: The incidence of contralateral occult hernia (COH) varies from 4.2% to 57.5%. Total extraperitoneal (TEP) gives us opportunity to visualize contralateral groin for occult hernia and its simultaneous repair. Ultrasonography (USG) helps to diagnose occult hernia preoperatively with detection rate of 96.6% with specificity 84.4%. OBJECTIVE: The aims of this study were to identify the incidence of contralateral occult inguinal hernia in clinically diagnosed unilateral inguinal hernia patients using USG as diagnostic modality and to compare the clinical outcomes of unilateral TEP vs. bilateral TEP with respect to pain, duration of hospital stay, time for return to normal work, and postoperative complications. SETTING AND DESIGN: This was a prospective observational, single-center study. MATERIALS AND METHODS: A total of 30 male patients were included in the study who was having clinically diagnosed unilateral hernia. All patients were assessed by USG for contralateral occult inguinal hernia. RESULTS: Incidence of COH was 10%, two (6.7%) had indirect defect, and 1 (3.3%) had direct defect. Two (6.7%) patients underwent bilateral TEP and 28 (93.3%) underwent unilateral TEP. No significant difference was observed in terms of mean duration of hospital stay, duration of surgery, and visual analog scale score for pain in both unilateral and bilateral TEP. The mean for resuming daily work in unilateral TEP was 4.86 ± 0.833 days and in bilateral TEP the mean was 7.50 ± 0.70 days and this showed statistically significant difference (P < 0.001). CONCLUSION: Patients with COH should be counselled for synchronous repair as there is no significant difference in clinical outcomes of unilateral and bilateral TEP. On the basis of this pilot study, it can be concluded that preoperative USG is mandatory for diagnosis and simultaneous management of preexisting contralateral hernia.

Colour Doppler evaluation of uterine and ovarian blood flow in patients of polycystic ovarian disease and post-treatment changes.

AIM: To assess the morphology and colour Doppler parameters in patients with polycystic ovarian syndrome (PCOS) and also to assess the changes in Doppler parameters in follow-up patients, who underwent treatment. MATERIALS AND METHODS: The study was conducted on 50 women of reproductive age who had clinical and biochemical findings suggestive of PCOS. Clinico-hormonal parameters were recorded. Ultrasound and colour Doppler flow measurements of bilateral ovaries were performed in the early proliferative phase of the menstrual cycle. After assessment of the bilateral ovaries, colour Doppler ultrasound was used to evaluate the main uterine artery at the cervico-uterine junction. Follow-up imaging after 3 months was undertaken in patients who underwent treatment (metformin) and changes in the imaging and hormonal parameters were correlated. RESULTS: The mean value of luteinising hormone (LH) and the ratio of LH: follicle-stimulating hormone (FSH) was significantly higher in PCOS patients. Ultrasound parameters were significantly higher in PCOS patients. Ovarian stromal vessels in PCOS patients had a significantly higher peak systolic velocity (PSV), low resistance index (RI), and pulsatility index (PI). The PSV of uterine arteries were significantly decreased and the RI and PI were significantly increased. On follow-up patients revealed changes in hormonal parameters. CONCLUSION: PCOS is a heterogeneous disorder and is a convergence of multisystem endocrine derangements. Ultrasound is good diagnostic tool for PCOS and the use of Doppler aids in the evaluation of haemodynamic changes in small vessels of utero-ovarian circulation and in response assessment.

Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: a hospital-based retrospective observational study and our experience.

PURPOSE: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. SUBJECTS AND METHODS: After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. RESULTS: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. CONCLUSION: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder.

Implications for healthcare knowledge management systems: a case study.

The notion of incorporating knowledge management (KM) in the healthcare sector has recently witnessed a lot of interest, both from healthcare practitioners and scholars. Because KM for healthcare has just started to appear on the radar of healthcare stakeholders, there exists very limited research (particularly empirical data) to guide healthcare stakeholders, both from an academic and organizational perspective. This paper attempts to contribute to the adoption of KM in the clinical and healthcare sectors by collecting and analyzing data on technological, organizational and managerial perspectives on KM in these sectors. This paper provides an analysis of a case study which looks at current practices towards healthcare information management.

Towards a web-based knowledge management system for cardiovascular disease.

The objective of this paper is to examine the efficacy of the Knowledge Management (KM) paradigm for a web-based patient administration system (PAS) for cardiovascular disease (CVD). We discuss the role of contemporary information and communication technologies (ICTs) for the management of electrocardiographic information and how this can act as a foundation for a KM-based system.

Towards total knowledge management for healthcare: clinical and organizational considerations.

Knowledge Management (KM) has made a significant impact on the global healthcare sector. However, it is important to address the link between knowledge, information and engineering. Knowledge Engineering (KE) is often only a small part of a KM-based project, yet some KM practitioners favour wholly KE-biased Knowledge Management projects, disregarding a more necessary holistic stance. This paper analyses some current achievements in the KM field and provides a benchmark from which academics and practitioners can attempt to attain "Total Knowledge Management for Healthcare" (TKMh).

The knowledge management landscape: implications for clinical knowledge management and practice.

The objective of this paper is to determine the future for Knowledge Management (KM) applications that focus on healthcare processes. This is achieved by tracing the evolution of KM by examining how different sectors have formulated industry-specific KM applications, then discussing the key constraints that these sectors have faced whilst formulating industry specific KM applications. It then details how these constraints can impede the coming of age of KM applications for healthcare. The results of several case studies on the future of healthcare KM applications are presented. This paper thus attempts to contribute to the adoption of KM in healthcare by looking at how practitioners can overcome stumbling blocks in KM healthcare applications.