Context: High-frequency ultrasound (US) of painful rheumatoid joints allows an increasingly refined analysis of the extent of joint involvement and disease activity. Aims: The aim of this study was ...to establish the role of the US in the evaluation of painful hand joints in patients with rheumatoid arthritis (RA) and its comparison with Conventional Radiography (CR) changes. Settings and Design: Cross-sectional study. Subjects and Methods: Patients diagnosed with RA were assessed by a thorough clinical examination and relevant laboratory investigations. After X-ray imaging, grayscale, and power Doppler US examination of the wrist, metacarpophalangeal, and proximal interphalangeal joints of both hands were performed using a high-frequency linear transducer. Statistical Analysis Used: SPSS version 20.0 (a statistical package for the social sciences) was used to collect, tabulate, and analyze all data. The results were presented as mean standard deviation or percentage. Differences in categorical data were compared using the Chi-square test and Fisher's exact test. A P < 0.05 was considered statistically significant. Results: Thirty-two of the 51 individuals studied had radiographic abnormalities, whereas 44 had abnormal findings in the US. The US can detect erosions in 37 patients, including all 15 of those who had radiographically visible erosions. A statistically significant difference was noted between the findings of radiography compared with US findings (P < 0.001). Conclusions: US is more sensitive than CR for the detection of erosion and can complement the CR in the evaluation of these patients.
Abstract Background There is increasing recognition of association of nonalcoholic fatty liver disease (NAFLD) with cardiovascular disease (CVD). Metabolic syndrome is common in both NAFLD and ...cardiovascular diseases. Our study is designed to investigate the association of NAFLD with cardiovascular disease. Methods It's a cross-sectional study which included 104 patients of coronary artery disease and hypertensive heart disease. Those patients having secondary causes of steatosis were excluded. Complete cardiovascular evaluation which included assessment of metabolic syndrome, routine biochemistries, viral markers, Ultrasonography (USG) abdomen, hs-CRP and TNF-α levels were obtained for all patients. Results Of all patients with cardiovascular disease, 19.2% (20/104) had essential hypertension with hypertensive heart disease the remaining 80.8% (84/104) patients had ischemic heart disease (IHD). On USG 69.2% (72/104) had NAFLD, these 50% (36/72) had grade 1 NAFLD and the rest grade 2 NAFLD. The hs-CRP levels and TNF-α were significantly higher in patients with NAFLD ( p -value <0.001) and within patients with NAFLD the levels were higher in patients with grade 2 NAFLD. Also, binary logistic regression showed that high body-mass index (BMI), raised serum triglyceride levels, increased waist circumference and hypertension were significantly associated with the presence of NAFLD. Conclusion Our data indicates that NALD is highly prevalent in patients of cardiovascular disease (69.2%) and is significantly associated with metabolic syndrome and its individual components. The levels of hs-CRP and TNF-α were significantly higher in patients with NAFLD and showed an increasing trend with the severity of fatty liver.
Laparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis. Still some patients required conversion to open cholecystectomy (OC). Our aim was to develop a standardized ...Ultrasound based scoring system for preoperative prediction of difficult LC.
Ultrasound findings of 300 patients who underwent LC were reviewed retrospectively. Four parameters (time taken, biliary leakage, duct or arterial injury, and conversion) were analyzed to classify LC as easy or difficult. The following ultrasound findings were analyzed: GB wall thickness, pericholecystic collection, distended GB, impacted stones, multiple stones, CBD diameter and liver size. Out of seven parameters, four were statistically significant in our study. A score of 2 was assigned for the presence of each significant finding and a score of 1 was assigned for the remaining parameters to a total score of 11. A cut-off value of 5 was taken to predict easy and difficult LC.
66 out of 83 cases of difficult LC and 199 out of 217 cases of easy LC were correctly predicted on the basis of scoring system. A score of >5 had sensitivity 80.7% and specificity 91.7% for correctly identifying difficult LC. Prediction came true in 78.8% difficult and 92.6% easy cases. US findings of GB wall thickness, distended GB, impacted stones and dilated CBD were found statistically significant.
This indigenous scoring system is effective in predicting conversion risk of LC to OC. Patients having high risk may be informed and scheduled appropriately and decision to convert to OC in case of anticipated difficulty may be taken earlier.
Giant cell reparative granuloma (GCRG) is a rare lesion that is a reactive process, not a true neoplasm. It was originally coined by Jaffe to describe lesions, which he believed were a response to ...intraosseous hemorrhage from jaw trauma. Regardless, GCRG is much more distinct from giant cell tumor (GCT) of bone, both histologically and clinically. We report a patient who presented with multiple facial swelling involving the facial skeleton that showed a multiloculated cystic appearance on CT involving the maxilla and mandible. The patient refused surgery, but after 6 months of follow up there was no progression.
Macrodystrophia lipomatosa is a rare cause of gigantism of limb which can be confused with other common causes like congenital lymphedema. It presents usually with loss of function and cosmetic ...problems. Four cases are described with emphasis on clinical presentation, differential diagnoses, imaging and treatment options.
Four patients of macrodystrophia lipomatosa were thoroughly examined and subjected to investigations.
Besides diligent clinical examination, imaging and histopathology are crucial in clinching the diagnosis.
Diaphragmatic injury following blunt thoracoabdominal trauma is rare and usually associated with key radiological features like dependent viscera sign, collar sign, diaphragmatic thickening and ...defects. It may also be associated with secondary signs like intrathoracic herniation of abdominal viscera. Diaphragmatic crura, which are attached to the upper lumbar vertebra represent prominently thickened folds along the posterior diaphragm, are usually inconspicuous on routine CT scans. We present a case of a young patient whom sustained a motor vehicle accident and developed difficulty in breathing. CT scan of the patient revealed bilateral crural hematomas, with splenic and renal lacerations and no other sign of diaphragmatic injury. The patient was operated upon and blunt diaphragmatic rupture was confirmed at surgery.
To determine the value of color Doppler ultrasonography (CDUS) as a routine investigational method for diagnosis of scrotal pathologies.
This prospective observational study (case series) was carried ...out over a period of 16 months on 122 patients in the age range of 13 to 70 years old, who presented with scrotal swellings. After adequate history taking and examination, CDUS was performed. The diagnosis of the surgeon and that of radiologist were compared with final outcome, which was based on course and outcome of the disease, fine needle aspiration cytology results, and operative findings.
The final diagnoses were epididymitis or epididymo-orchitis (46), hydrocele (26), varicocele (16), testicular malignancy (16), orchitis (6), testicular torsion (4), spermatic cord injury (2), hematocele (2), and pyocele (2). Color Doppler ultrasonography accurately diagnosed all cases of epididymitis or epididymo-orchitis, spermatic cord injury, testicular torsion, varicocele, and hydrocele (sensitivity 100% and specificity 100%). Of 16 subjects diagnosed as testicular malignancy on CDUS, only 14 were subsequently found to have malignancy. Two cases of orchitis were wrongly diagnosed as malignancy. Similarly, of 6 patients diagnosed as orchitis, 1 was found to have seminoma (sensitivity 87.5% and specificity 66.7%). Overall sensitivity of CDUS in diagnosing scrotal diseases was 98% while specificity was 66.7%.
Color Doppler ultrasonography is an excellent, a safe, and reliable method for evaluating patients with scrotal diseases. It aids in diagnosis of testicular tumors and reduces the number of unnecessary exploratory operations. It is especially important in conditions like testicular torsion where immediate diagnosis is required.
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