Role of Multi-Detector CT (MDCT) in Evaluation of Bowel Diseases.

INTRODUCTION: Multi-Detector Computed Tomography (MDCT) has revealed excellent results in various systems of the body. Its role in abdominal imaging for solid viscera has been proved beyond doubt. It is an emerging non invasive tool for evaluation of bowel diseases. AIM: To see the efficacy of MDCT in evaluation of various bowel diseases. MATERIALS AND METHODS: The study was carried out in the Department of Radiodiagnosis and Imaging, Batra Hospital and Medical Research Centre, Delhi, India. A total of 60 patients were enrolled in this study from March 2008 to June 2010 over a period of 24 months. All patients suspected to have inflammatory, obstructive, ischaemic and neoplastic diseases of small or large bowel disease were included in the study. The patients with past history of chronic renal failure, allergic reaction to contrast were excluded from the study. Comparison was made between CT findings with the operative findings, endoscopy, angiography or histopathology correlation whichever was relevant with case. All this data was compiled and statistically analysed. RESULTS: Out of 60 patients 12 patients were diagnosed having appendicitis using axial, Multiplaner Reconstruction (MPR) and curved MPR images. The findings of appendicitis were confirmed on surgery and subsequent histopathology correlation. Inflammatory bowel diseases comprised of 28 cases out of which seven persons were diagnosed with intestinal Koch's disease. Four patients had idiopathic inflammatory bowel diseases. Rest of the 17 patients were reported to have findings of non-specific colitis and they responded well with antibiotic treatment. CONCLUSION: The sensitivity and specificity of MDCT in case of bowel obstruction clearly demonstrates not only the site of obstruction, but also reveal the cause of obstruction which includes intraluminal, intramural and extrinsic factors. CT scan categorizes the lesion to inflammatory or neoplastic to a greater accuracy. MDCT can also demonstrate the complications associated with obstruction like strangulation and perforation. CT is now considered a good tool in the evaluation of patients with suspected bowel obstruction, particularly in indeterminate clinical and conventional radiographic findings.

Cotard's syndrome and delayed diagnosis in Kashmir, India.

Cotard's syndrome is a rare syndrome, characterized by the presence of nihilistic delusions. The syndrome is typically related to depression and is mostly found in middle-aged or older people. A few cases have been reported in young people with 90% of these being females. We present a case of a young pregnant woman suffering from Cotard's syndrome. This is the first report of this syndrome in a pregnant woman. The case was diagnosed late, due to lack of awareness of psychiatric problems in primary care physicians resulting in undue suffering, loss of precious time and resources for the patient. Besides highlighting the rare combination of pregnancy and Cotard's syndrome this report delineates the difficulties faced by patients with such symptoms in a low resource setting.

Topical diclofenac versus dexamethasone after strabismus surgery: a double-blind randomized clinical trial of anti-inflammatory effect and ocular hypertensive response.

BACKGROUND: Compared to steroids non-steroidal anti-inflammatory drugs offer comparable anti-inflammatory action without ocular side-effects. AIM: To compare the anti-inflammatory effect and effect on IOP (Goldmann) of topical diclofenac 0.1% with dexamethasone 0.1% after strabismus surgery. DESIGN: Prospective, randomized, double-blind, single-center, clinical trial. MATERIALS AND METHODS: Forty-three cases of constant horizontal strabismus, qualifying for standard uniocular recession-resection surgery on two horizontal rectus muscles were randomized to either the dexamethasone or diclofenac group. They were excluded if they had previous ocular surgery, recently used anti-inflammatory drugs and had a neurological, systemic or an ocular inflammatory condition. In addition all received ciprofloxacin 0.3% four times daily. Assessment was done on the first postoperative day and at two and four weeks. The inflammatory characteristics graded from nil (0) to severe (3) were: discomfort, chemosis, injection, discharge and drop-intolerance. Their sum provided the total inflammatory score (TIS). RESULTS: Dexamethasone group (n=21) was comparable in age, gender, preoperative IOP, strabismus, anesthesia administered and baseline IOP, to diclofenac (n=22). There were no significant differences in the inflammatory characteristics and TIS. The dexamethasone group had IOP significantly higher at two weeks (95% CI 0.17 to 3.25) and four weeks (95% CI 1.09 to 4.24) compared to diclofenac group and the net change of IOP at four weeks (95% CI 0.60 to 3.14). Compared to the baseline IOP. CONCLUSION: Topical diclofenac is comparable to dexamethasone in providing anti-inflammatory and analgesic effect with the advantage of significantly lesser IOP rise and should be preferred after strabismus surgery.