International Journal of Medical Research & Review (IJMRR)
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Clinico-radiological profile and outcome of patients undergoing intercostal tube drainage in a tertiary care hospital in West Bengal, India
Get PDFIntroduction: Evacuation of empyema which was first performed centuries ago, marked the beginning of thoracic drainage. The subsequent acquisition of a greater knowledge of the anatomy, physiology, and pathology of the pleural space directed the design of thoracic catheters and drainage systems and the development of the methods by which they are used. Thoracic drainage systems are designed to remove air and liquids from the pleural space or mediastinum, which collect there as a result of injury, disease, or surgical procedures.
Method: A total of 100 patients who underwent intercostal tube drainage due to various etiologies are followed up for 3 months in the study
Results: In this study it was observed that pneumothorax (67%) as the most common indication for chest drain insertion followed by hydro-pneumothorax. During this period 100 patients of different pathologies related to chest underwent chest intubations. Amongst them 88(88%) were male and 12(12%) were female. Subcutaneous emphysema was found to be the most common complication followed by ICD tube blockage. Among the study population 95% patients were successfully treated & unsuccessful outcome was only 5%.
Conclusion: Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general. Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains
Reducing planning target volume margins decreases dose to parotid glands in head and neck cancers - a dosimetric analysis
Get PDFIntroduction: Radiotherapy in head and neck cancers is treated for several weeks and daily setup and reproducibility is a challenge. This daily variability causes setup errors which accounts planning target volume margins. Reduced PTV margins have to be taken to decrease the dose to the parotid glands, without compromising on loco regional control rates. The present study is done to identify setup errors and see the feasibility to decrease the PTV margins by creating dummy radiotherapy plans in order to decrease dose to parotid glands.
Material and Methods: 420 portal images were evaluated for setup errors in three dimensions (Antero Posterior, Left to Right and Superior to Inferior) which were performed in ten patients of oropharyngeal squamous cell carcinoma. All patients were treated in supine position using immobilization cast. After target volume delineation a PTV margin of 7mm was given. Dosimetric parameters of PTV and organs at risk were assessed. PTV margins were calculated according to three methods proposed by Stroom, Van Herk and ICRU 62. Dummy radiotherapy plans were generated using new PTV margins and compared with 7mm PTV margins. The data was analyzed using 3-way ANNOVA test for statistical significance.
Results: The optimum PTV margins were 4mm in LR and SI direction and 7mm in AP direction. The PTV parameters (V95, D95, Dmax, Dmean, HI and CI) had no significant difference among different radiotherapy plans with different PTV margins. There was a significant decrease in the dose to right parotid (39.12 Gy to 32.88Gy; p-0.04), left parotid (37.90 to 31.21Gy; p-0.03) and parotid combined (38.65 to 31.45 Gy; p-0.01) when 7mm PTV margins were reduced to 4mm PTV margins. The results of dummy radiotherapy plans using asymmetric PTV margins (LR-4mm, SI-4mm and AP-7mm) and symmetrical PTV margins (4mm in all directions) are compared with PTV margins (7mm in all directions), in terms of PTV and OAR dosimetric parameters.
Conclusion: The decreased PTV margins of 4mm decreases the dose to the parotid significantly. The implementation of radiotherapy plans needs to be supplemented by daily IGRT
Treatment non-compliance and government aided health schemes : a boon or a curse
Get PDFPurpose: In this study we tried to analyze the prevalence of non-adherence to radiation treatment, the factors behind the unplanned breaks and the evaluation of strategies to overcome such breaks.
Materials and Methods: Between January 2017 to October 2017, 486 patients were registered for radical radiotherapy of which 91 patients with unplanned treatment break were identified. We analyzed the social, economic, educational, and therapeutic barriers that led to treatment interruptions.
Results: 91 patients of 486 patients registered for radical radiotherapy with unplanned treatment break were identified. The age of such patients ranged from 30 to 85 years with a median age of 52.5 years. 61 were males and 30 were females. 39 patients were from urban areas and 52 belonged to rural area. Of these 91 patients 85 patients were receiving cashless treatment based on BPL cards and 6 were cash paying patients. 52 Patients had Head and neck, 23 had gynecological, 7 with breast and 4 patients had esophageal cancers. Majority of patients in our study had treatment breaks during the mid to end phase of a radical radiotherapy schedule with the onset of Grade II or III acute reactions.
Conclusion: As majority of patients were supported by government schemes without any binding factor, some compelling factors like blocking the BPL cards to avail other benefits, or to impose some kind of penalties to avoid wastage of government efforts and resources
Solid pseudopapillary neoplasms-experience from a tertiary care centre
Get PDFIntroduction: Solid pseudopapillary neoplasms (SPN/FRANTZ TUMOUR) of the pancreas are rare neoplasms of low grade malignant potential which were first described in 1959 by Frantz. These account for 0.13–2.7% of pancreatic neoplasms and approximately 13% of surgically resected cystic lesions of the pancreas. We present our experience with these rare tumors.
Methods: Total 406 patients with pancreatic tumours were admitted in our department during the 10year period (Between 2007 and 2017) were reviewed, only 18 were diagnosed as having SPN(4.4%). Clinico-pathological details, intervention done and follow up of all the cases were studied and reported here.
Results: 17 patients were woman and1was Man with median age of 23 years (range 11 to 54 years). The tumor size ranged from 3.8 to17cm (average 6.4 cm).12 patients presented with pain in the abdomen, 4 presented with a painless mass, 1 was detected incidentally and1presented with Malena. In 7 patients the tumor was in the pancreatic head, in 3 it was in the neck, and in the remaining 8 it is in the body and tail. CECT was done in all cases. 8 patients under went Distal pancreatectomy with splenectomy, 1 underwent a PPPD, 6 patients required classical Whipple operation. 3 underwent central pancreatectomy. Immuno histochemistry showed positivity for beta catenin, vimentin, PR receptor and chromogranin negativity. All 18 patients were free of disease in a median follow- up period of 32 months (range 6 – 84) months.
Conclusion: SPNs are rare neoplasms, typically affecting young women without notable symptoms, with a low malignant potential but excellent prognosis. Radical surgical resection with clear margins is the treatment of choice
Distribution of serum creatinine, calcium and protein levels in multiple myeloma patients - a hospital based study at Gauhati Medical College and Hospital, Guwahati, Assam
Get PDFIntroduction: Multiple Myeloma (MM) is a clonal plasma cell neoplasm characterized by the proliferation of plasma cells, monoclonal protein, Osteolytic bone lesions, renal disease and immunodeficiency. It accounts for 15% of lymphatohematopoietic cancers (LHC) and 2% of all cancers in the US.
Objectives: To see distribution of serum creatinine, calcium and protein level among MM cases.
Methods: A hospital based cross-sectional descriptive study was conducted in the OPD of the clinical Haematology Department of Gauhati Medical College & Hospital, Guwahati, Assam during November, 2010 to October, 2013 with a study population of 100 in number of newly diagnosed MM) cases.
Results: Serum creatinine - 54 (54%) patients had < 1.2 mg/dl, 26 (26%) patients had1.3-1.9 mg/dland20 (20%) patients had > 2 gm/dl.Serum calcium -> 11 mg/dlin 36 (36%);< 8 mg/dl in(8%) ;8 -11 mg/dl in 56 (56%) patients. Serum total protein – higher level in 52 (52%) patients. Serum albumin -< 3.5 gm/dlin 26 (26%) patients, > 3.5 gm/dlin4 (4%) patients , Normal value in70 (70%) patients. Serum globulin - < 3.5 gm/dl in 28 (28%) patients,> 3.5 gm/dl in72 (72%) patients.
Conclusion: The most frequently detected SC was < 1.2 mg/ dl (84% patients),serum calcium 8-11 mg/dl (56% patients); serum total protein, albumin and globulin level were> 6.3-8.2gm/dl (52%), > 3-5 gm/dl (70%) and > 3.5 gm/dl (72 % patients) respectively
Clinico-Microbiological profile in dacryocystitis: a prospective observational study
Get PDFIntroduction: Dacryocystit is is the inflammatory condition of the lacrimal sac which occur in acute and chronic form. Chronic dacryocystitis is commonly encountered, accounting for 87.1% of Epiphorawhich causes social embarrassment due to chronic watering from the eye. Understanding the antibiogram for micro organism causing inflammation of lacrimal sac can be useful in choosing the best antimicrobial. Hence the present study was done to evaluate the clinical profile and antibiogram of acute and chronic dacryocystitis.
Method: A prospective observational study was done in patients with acute or chronic dacryocystitis attending ophthalmology OPD. Those fulfilling the eligibility criteria were enrolled in the study. Samples were collected from all the cases and were sent to microbiology lab for gram staining, culture and sensitivity.
Result: 100 patients of dacryocystitis were enrolled, chronic dacryocystitis was found common than the acute dacryocystitis, along with a female (middle age group) preponderance. The main presenting symptom was watering (89%) followed by discharge (47%), swelling (34%), pain (23%) and tenderness (23%). Gram positive organisms (72.86%) were most commonly isolated. Among the Gram-positive organisms, Staph. aureus (37.14%) while Pseudomonas among Gram negative were the common isolate. Vancomycin and tobramycin are highly active against all Gram positive, tobramycin, gentamycin, fluoroquinolones and cephalosporins are found to be very active against Gram negative bacteria.
Conclusion: The most common bacterial isolate in dacryocystitis, prevailing in this geographical area is Staphylococcus (Gram positive) followed by Pseudomonas, Pneumococcus and Staph epidermidis. Combination of Vancomycin and 3rd generation cephalosporin can be used as empirical therapy when the culture reports are awaited
Safety and efficacy of Transurethral Bipolar Enucleation of prostate (TUBE) in BPH
Get PDFObjectives: To evaluate the safety and efficacy of transurethral bipolar enucleation of the prostate due to benign prostatic hyperplasia.
Methods: This is a prospective study and 37 patients undergoing Transurethral bipolar enucleation of the prostate (TUBE) for BPH will be taken for the study. Preoperative factors evaluated included International Prostate Symptom Score (IPSS), postvoid residual volume (PVR), estimated blood loss, operative time, pathologic weight, and complications. Postoperative evaluation was performed at 1month, 6 months and 12months.
Results: Preoperative, 1 month, 6 months, and 12 months mean postvoid residual volumes were 235 mL, 33.6 mL, 20 mL and 20 mL; mean IPSS were 31.6, 2.97, 2.97 and 2.97; mean Q max was 5.8ml/sec, 20.23ml/sec,25.5ml/sec, and 25.5ml/sec; preoperative and post operative mean quality of life scores were 5.4 and 2.2; mean operative time was 87.5 minutes. Hemoglobin drop was 0.6g/dl, and pathologic weight was 45.45 g. 10 patients underwent partial enucleation. Early stress incontinence occurred in 9 patients (24.3%).Urinary tract infection occurred in 1 patient, and Superficial mucosal bladder injury in 1 patient.
Conclusions: International Prostate Symptom Score, quality of life, Qmax, and postvoid residual volume (PVR) showed statistically significant improvements from baseline. TUBE is a safe, effective, and reproducible procedure for BPH
A study to assess the distribution of cystic and solid hepatic lesionson contrast enhanced helical computed tomography
Get PDFIntroduction: Focal liver lesions are defined as solid or liquid-containing masses foreign to the normal anatomy of the liver that may be told apart from the latter organ using imaging techniques.
Material and Methods: This prospective study was done in the Department of Radiodiagnosis and imaging at Bhopal Medical Centre, Bhopal, Madhya Pradesh, India. A total of 100 patients who were referred to our department with strong clinical suspicion of focal liver lesion and those diagnosed by ultrasonography underwent multiphasic contrast enhanced CT evaluation of abdomen using Single slice Spiral CT scanner from March 2010 to May 2012.
Results: The majority of lesions appeared as solid lesions on CT comprising 63% of lesions. The remaining were cystic lesions comprising 37% of cases. Among the cystic lesions, the most common CT diagnosis was Simple Cyst Seen in 49% of cases. The other diagnosis was liver abscess in 30% and hydatid cyst in 21%. Among the solid lesions, the most common CT diagnosis was that of metastases seen in 49% of cases. The next common lesions seen were HCC seen in 22.5% of cases and hemangioma seen in 19.5% of cases.
Discussion: Simple cysts are diagnosed by the presence of a well defined intra hepatic mass of fluid attenuation, no perceptible wall or internal septations and no enhancement. Among solid lesions, haemangiomas were diagnosed by the presence of a hypodense lesion with peripheral nodular enhancement of arterial attenuation with centripetal fill in.
Conclusion: Most of the lesions evaluated were solid compared to cystic. Among cystic lesions, simple cyst was the most common abnormality seen in around half the cases followed by liver abscess and hydatid cyst. Among the solid lesions, the most common abnormality detected was metastases seen in around half the cases followed by HCC and hemangioma
Clinicoradiological and demographic pattern in diffuse parenchymal lung diseases: An observational study
Get PDFIntroduction: Diffuse parenchymal disease is a group of lung disease affecting alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissue. It includes many diseases like IPF, Sarcoidosis, BOOP, COP, LAM etc. it is still under diagnosed entirety. Many patients die due to lack of awareness and investigating modalities.
Aims and objective: This study is to see Demographic pattern of DPLD, its clinical pattern and radiological findings in different type of ILDs.
Study Type: It is a Prospective Observational Study done over a period of 1 year.
Material & Method: Patients studied over20 years of age and having respiratory symptoms. We excluded patients of other diseases like COPD, Tuberculosis etc. Total 75 patients were diagnosed as a case of DPLD by clinical findings, and investigations like X ray chest, HRCT thorax, Bronchoscopy.
Results: Most common ILD (Interstitial lung Disease) is IPF 40.0% followed by Sarcoidosis etc. Most common clinical symptom was breathlessness (100.00%) in IPF, Fever & Chest Pain are common in Granulomatous type.
Conclusion: DPLD (Diffuse Paranchymal lung Disease) is a chronic lung disease characterized by progressive decline in lung function. IPF is most common in DPLD and leads to fast deterioration of lung function. HRCT (High Resolution computed tomography) is very important to assess type of disease. Spirometry, Broncoscopy are important for diagnosis of ILD and lung function
Contrast-enhanced ultrasound for the evaluation of hepatic artery occlusion after liver transplantation
Get PDFIntroduction:Vascular complications after liver transplantation remain a major threat to the survival of recipients.HAT is a major cause of graft loss and patient mortality, with an incidence between 3% to 8% in transplant recipients.Early detection of HAT is critical because urgent revascularization is required to avoid severe graft loss. Although ultrasound is the preferred first-line imaging modality in patients with suspected HAT, the accuracy and positive predictive value of HAT on Doppler US are reported to be low. Moreover, Doppler examination of the hepatic vasculature is time consuming and requires a high level of operator skill. Conventional angiography remains the gold standard for diagnosis. Recently, contrast-enhanced ultrasound (CEUS) has begun providing real-time angiographic-like images of vessels at bed side and allowing the accurate diagnosis of arterial diseases such as hepatic artery thrombosis. The purpose of this study was to evaluate the efficacy of CEUS in detecting HAT after liver transplantation:
Materials and Methods: This is a retrospective data of the medical records of patients undergoing Liver transplantation in the Osmania General Hospital, Hyderabad between 2016 to 2018. Status of hepatic vascular assessment following liver transplantation done by conventional Doppler Ultra sonography and Contrast Enhanced Ultrasonography tests were obtained from registries of medical records.
Results:23 cases of post Liver transplantation aged between 4years and 58 years, with a median age of 30 years were included in the analysis. There were 20 males and 3 females. 14 patients underwent DDLT, 7 patients underwent LDLT, 1underwent split Liver transplantation and another 1 patient underwent Auto liver transplantation. Doppler US was inconclusive regarding patency of the hepatic artery (HA) circulation in 5 (21.7 %) of 23 transplantations. CEUS was performed in these 5 patients and detected HA thrombosis (HAT) in 2 cases and patent HA in 3 transplants. These 5 Transplants were confirmed by CT Angiography /conventional Angiography. In the subset of transplantations examined with CEUS, the sensitivity, specificity and accuracy of CEUS were 100%. CEUS was done at bedside without any Radiation and Nephro toxicity. In approximately 21.7% of cases, conventional Doppler US did not provide sufficient visualization of the HA after liver transplantation. In these cases, correct diagnosis was achieved by supplementary CEUS.
Conclusion:CEUS may be a new approach for early diagnosis of postoperative vascular complications after Liver Transplantation, and it can be performed at the bedside. It is safe will not cause any nephron toxicity and Radiation. CEUS is a fast, non-ionizing imaging modality for the initial exclusion of vascular complications after liver transplantation. CEUS shows a high specificity and PPV in the detection of vascular complications. In unclear cases CT still is considered as the gold standar