Sonological Findings Research Articles

CLINICOPATHOLOGICAL EVALUATION OF ABNORMAL UTERINE BLEEDING IN PERIMENOPAUSAL WOMEN

Objective: Abnormal uterine bleeding (AUB) is defined as any bleeding from the uterus that is deviated from normal in terms of regularity, duration, frequency, and amount of blood loss. It interferes with the woman’s physical, emotional, social, and material quality of life. The prevalence of AUB ranges between 11% and 13% rising to 24% in perimenopausal women. The aim of this study is to analyze the demographic profile and risk factors of AUB in perimenopausal women, to classify the causes of AUB based on PALM-COEIN classification, and to correlate the clinical and sonological findings with post-operative histopathology findings. Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynecology at GIMSR hospital, Visakhapatnam, for 1 year from September 2022 to September 2023. A total of 151 perimenopausal women with complaints of AUB in the age group of 41–50 years who underwent hysterectomy were included in the study. Results: The most common clinical presentation was heavy menstrual bleeding (HMB) seen in 96 cases (63.5%). Clinically, the PALM component accounted for 61% of cases and the COEIN component accounted for 39% of cases. Ultrasonographically, the PALM component was detected in 76.8% of cases. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detection of PALM lesions. Conclusion: Leiomyoma was the most common cause clinically, sonologically, and pathologically. Correlation was good for leiomyoma. USG has good specificity for diagnosis of AUB-A and AUB-P but low sensitivity.

A Clinicopathological Study of Hepatocellular Carcinoma: A Cross Sectional Study

The purpose of the present study was to find out the clinicopathological characteristics of Hepatocellular Carcinoma (HCC) patients. All the clinically suspected patients were recruited as per inclusion and exclusion criteria. The relevant socio-demographic characteristics, clinical findings as well as the physical examination were performed after talking written consent from all the study subjects. The ultrasonography was performed to all the patients. After that, the patients were sent to the department of pathology for histopathological examination. The descriptive cross-sectional study was carried out in the Department of Oncology of National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh from July 2014 to June 2015 for a period of 12 months. Total sample size was 52 in this study and age distribution of HCC was found from 25 years to 97 years to with the mean age 50.57 ± 12.09 years. Males were predominant (78.0%), male and female ratio was 3.72:1. The common presenting features of HCC were abdominal pain and swelling, fever and jaundice; viral marker was positive in 86.5% of patients (HBsAg-67.3%, Anti HCV-19.2%) with normal tumor marker alpha-fetoprotein (AFP) in 69% of the patients. Okuda staging shows 82.7% patients within stage I and Stage II and performance status, 38.5% patients were unable to carry out normal activity. Sonological findings revealed 69.2% patients had ≤2 cm tumor size, 88.4% had ascites lastly splenomegaly was present among 86.5% respondents.

A Comparative Study of Fetal MRI and Antenatal Ultrasound in Prenatal Diagnosis with Histopathological Correlation

AbstractThe aim of this study was to assess the role of magnetic resonance imaging (MRI) in the diagnosis of fetal anomalies and its correlation with antenatal Ultrasound (US) and histopathology. The study was conducted in the Department of Radiodiagnosis, Basaveshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Kalaburagi. It was conducted over 6 months and included pregnant women with suspected fetal anomalies on US. MR images were read independently by two radiologists and findings were confirmed with histopathology and post natal follow up. 15 patients underwent MRI for different indications all of who were referred after US. In 8/15 cases (53.34%), the US findings and MRI findings were concordant. MRI imaging provided additional information in 7/15 cases (46.66%). With advances in MRI technology and cumulative experience, MRI can be used as a valuable complementary tool to ultrasound in detecting and better evaluating fetal anomalies. The major role of fetal MRI is confirmation of abnormal sonological findings, evaluation of sonological occult fetal CNS pathologies and reassurance in equivocal US findings.

Sonological Evaluation of Ectopic Pregnancy-an Analysis of 50 Cases

Introduction: Ectopic pregnancy is the implantation of a fertilized egg in a location outside of the uterine cavity, including the fallopian tubes, cervix, ovary, cornual region of the uterus, and the abdominal cavity. Objective: To evaluate the sonological findings of ectopic pregnancy. Materials and Methods: A descriptive study was carried out at ultrasound unit in Lab-Aid diagnostic, Comfort Medical Services and Green View Diagnostic Complex in Sylhet city between January 2012 to January 2014. We included all cases with confirmed diagnosis of ectopic pregnancy, all antenatal mothers who are present in antenatal unit in a selected Hospital and excluded mothers with other associated medical condition. Results: Common clinical pattern were shock, marked pallor ness, abdominal pain, amenorrhea and irregular vaginal bleeding 52%, 66%,62%,54% and 38% respectively. Risk factor of ectopic pregnant in this study, 40% had history of infertility, 06% had Non tuberculous PID, 70% had no risk factor, 04% had tuberculous PID, 14% had previous abdominal pelvic surgery, 18% had previous ectopic and 10% had endometriosis. Conclusion: Common clinical pattern were shock, marked pallor ness, abdominal pain, amenorrhea and irregular vaginal bleeding. History of infertility, Non tuberculous PID, no risk factor, tuberculous PID, previous abdominal pelvic surgery, previous ectopic and endometriosis were risk factor of ectopic pregnant in this study. Medicine Today 2022 Vol.34(1): 75-78

A prospective study of preoperative neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and sonological findings in predicting severe cholecystitis

Background: The aims and objectives of the study was to assess the utility of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and ultrasound findings to predict severe cholecystitis and to identify an NLR, PLR cut off value that discriminates between simple and severe cholecystitis.Methods: A prospective observational time bound study was conducted with sample size of 100 patients from December 2019 to January 2021. Severe cholecystitis was defined as cholecystitis complicated by secondary changes like haemorrhage, gangrene, emphysema, abscess, perforation, carcinoma. NLR, PLR values were calculated from absolute neutrophil count and absolute lymphocyte count. All patients underwent ultrasound abdomen by the same radiologist and findings were grouped into three categories, luminal, mural and pericholecystic changes. Intraoperative findings, Histopathological examinations were also taken into account. Data was analysed using Statistical package for social sciences (SPSS) Software Version 22. Receiver operating characteristic curve analysis was employed to identify optimal NLR, PLR cut off values and to predict combined accuracy of NLR, PLR and Ultrasound findings to predict severe cholecystitis.Results: In our study, 23% patients had severe cholecystitis. The mean age of patients was 46 years. 65% were females. Presence of calculi and presence of multiple calculi was higher in patients with severe cholecystitis (p value 0.25) calculated using Chi square test. Ultrasound findings of luminal, mural and pericholecystic changes were also found to be higher in severe cholecystitis (p<0.001). Mann whitney test showed mean NLR, PLR higher in severe cholecystitis. A Cut off NLR of 3.75 had a sensitivity of 100%, specificity of 77.92%. Length of hospital stay in patients with severe cholecystitis was longer.Conclusions: NLR of 3.75 is a cut off value to predict severe cholecystitis and prolonged length of hospital stay. Combined Predictive Accuracy of NLR, PLR, Ultrasound findings was 91%. Ultrasonography is a reliable, specific diagnostic tool.

Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR) and Sonological Findings in Predicting Severe Cholecystitis

Aims and Objectives: To assess the utility of Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR) & Ultrasound findings to predict Severe Cholecystitis. To identify an NLR, PLR cut off value to discriminate between simple and severe cholecystitis. METHODS: A prospective observational time bound study conducted with sample size of 100 patients from December 2019 to January 2021. Severe cholecystitis was defined as cholecystitis complicated by secondary changes like haemorrhage, gangrene, emphysema, abscess, perforation, carcinoma. NLR, PLR values were calculated from absolute neutrophil count and absolute lymphocyte count. All patients underwent Ultrasound abdomen by the same Radiologist, findings were grouped into three categories, Luminal, Mural and Pericholecystic changes. Intraoperative findings, Histopathological examinations were also taken into account. Data was analysed using SPSS Software Version 22. Receiver Operating Characteristic Curve analysis was employed to identify optimal NLR, PLR Cut off values and to predict Combined accuracy of NLR, PLR and Ultrasound findings to predict severe cholecystitis. Results: In our study, 23% patients had severe cholecystitis. Mean age was 46 years. 65% were females. Presence of calculi and presence of multiple calculi was higher in patients with severe cholecystitis (p value 0.25) calculated using Chi square test. Ultrasound findings of Luminal, Mural and Pericholecystic changes were also higher in severe cholecystitis (p value <0.001). Mann whitney test showed mean NLR, PLR higher in severe cholecystitis. A Cut off NLR of 3.75 had a sensitivity of 100%, specificity of 77.92%. Length of hospital stay in patients with severe cholecystitis was longer. CONCLUSION: NLR of 3.75 is a cut off value to predict severe cholecystitis and prolonged length of hospital stay. Combined Predictive Accuracy of NLR, PLR, Ultrasound findings was 91%. Ultrasonography is a reliable, specific diagnostic tool.

Role of Concurrent use of Thoracic Section Ultrasonography with 2D Echocardiography among Patients with Commonly Diagnosed Respiratory Illnesses- A Cross-sectional Study

Introduction: Respiratory diseases may affect the functioning of the heart, lung and heart work synchronously. Clinical assessment and work-up of patients with pulmonary problems may need an extension to cardiac disease. Thoracic Ultrasonography (TUS) is a diagnostic modality being used to assess respiratory conditions as it carries the inherent advantages of ultrasonography such as being reliable, inexpensive, safe, reproducible, and having no radiation hazard. Aim: To assess the usefulness of performing Thoracic Ultrasound (TUS) and 2D echocardiography in the same sitting, so as to confirm the respiratory diagnosis and to early identify various cardiac dysfunctions in patients with respiratory illnesses. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department of Respiratory Medicine at Netaji Subhash Chandra Bose Medical College (tertiary care hospital), Jabalpur, Madhya Pradesh, India, from January 2019 to March 2020. Patients hospitalised with clinico-radiological diagnosis of pleural effusion, pneumonia, pulmonary fibrosis of interstitial lung disease, pulmonary oedema and Chronic Obstructive Pulmonary Disease (COPD) were subjected to TUS and echocardiography. Sonological findings and cardiac abnormalities were recorded. Data was analysed by applying descriptive statistics, t-test, and Chi-square test. Results: A total of 133 patients were enrolled with diagnosis of pleural effusion (n=46), pneumonia (n=22), pulmonary fibrosis (n=18), pulmonary oedema (n=14), and COPD (n=33). Out of total 46 patients,36 patients with pleural effusion had cardiac findings. The presence of pleural effusion showed a significant association with cor-pulmonale (p-value=0.012), dilated Right Ventricle (RV) (p-value=0.012), septal deviation (p-value=0.012), Pulmonary Hypertension (PH) (p-value=0.0002), Left Ventricular (LV) dysfunction (p-value=0.02) and Left Ventricular Ejection Fractions (LVEF) (p-value=0.006). The focal B-lines were seen in patients with pneumonia. Patients with Pulmonary fibrosis had scattered B-Lines, and patients with pulmonary oedema had bilateral diffuse B-lines. Among patients with pulmonary fibrosis, 11 (61.1%) had cor-pulmonale and dilated RV, whereas 10 (55.5%) had septal deviation. Patients with scattered B-lines more commonly had PH. A statistically significant association was found between lung ultrasound detected B-lines and cor-pulmonale, dilated RV, septal deviation, RV hypertrophy, Pulmonary Artery Systolic Pressure (PASP), and LVEF (p-value <0.005). In patients with COPD, cor-pulmonale was detected in 21 (68.8%), LV dysfunction in 5 (14.7%), mild PH in 14 (41.2%), moderate PH in 7 (20.6%), and severe PH in 5 (14.7%) using echocardiography. Conclusion: This study reveals the importance of performing a combination of TUS with 2D echocardiography and suggests its usefulness in early diagnosis of cardiac dysfunctions in patients with various respiratory illnesses.

Role of Ultrasonography and Inflammatory Markers in Predicting Complicated Appendicitis.

Aim:The aim is to compare the diagnostic accuracy of laboratory investigations and ultrasonography (USG) in distinguishing complicated appendicitis (C-AA) from uncomplicated appendicitis (UC-AA).Materials and Methods:Forty-six children who underwent appendicectomy at our center between November 2018 and July 2020 were included. Based on intraoperative findings, they were divided into two groups – complicated (perforated, gangrenous, or associated with fecal peritonitis; n = 18) and UC-AA (n = 28). USG findings and inflammatory markers were compared in both groups at admission.Results:At admission, the mean values for total leukocyte count (TLC) (16090.56 vs. 11739.29 per mm3), high sensitivity C-reactive protein (hsCRP) (35.8 vs. 31.62 mg/L), and procalcitonin (PCT) (3.83 vs. 1.41 ng/mL) were significantly higher in C-AA. Visualization of a blind tubular aperistaltic structure was the only sonographic sign showing statistical significance – significantly lower in C-AA (50% vs. 90%). Independent predictors of C-AA were – duration of symptoms >48 h (odds ratio [OR] 6.3), free fluid/loculated collection in right iliac fossa (OR 3.75), TLC >11000/mm3 (OR 3.6), hsCRP >35 mg/L (OR 6.0), PCT >0.6 ng/mL (OR 4.02), and nonvisualization of appendix on USG (OR 8.33). Biochemical factors were sensitive (89%) and specific (55%) in differentiating C-AA from UC-AA but the addition of sonological parameters significantly improved the specificity of predicting complicated AA to 61% (P = 0.0036).Conclusion:Combining laboratory data with sonological findings significantly improves the predictive value for differentiating C-AA from UC-AA and can help decide operative approach and prognosticating.

Pre-operative assessment of difficult laparoscopic cholecystectomy: a scoring method

Background: Laparoscopic cholecystectomy (LC) has become the gold standard procedure for management of symptomatic gallstone disease. At times, it is difficult and takes longer time or has to be converted to an open procedure. The study was undertaken to determine the factors which predict difficult LC. The aim of the study was to evaluate a pre-operative scoring method to predict difficult LC.Methods: This was a prospective study conducted in the department of general surgery, MVJ Medical College, Bangalore from December 2020 to August 2021. There were 100 cases operated by experienced surgeons. Scoring method which included parameters from history, clinical and sonological findings with maximum score up to 15. Score up to 5 predicted easy, 6-10 difficult and 11-15 is very difficult.Results: Pre-operative scoring system correlated with 85.7% for easy, 83.3% in difficult cases and 100% in very difficult cases. The factors like previous history of hospitalization (p=0.004), clinically palpable gallbladder (GB) (p=0.009), impacted GB stone (p=0.001), pericholecystic collection (p=0.04), and abdominal scar due to previous abdominal surgery (p=0.009) were found statistically significant in predicting difficult LC.Conclusions: Pre-operative prediction of risk factors to assess the operative difficulty is an important point for planning the surgery and the high-risk patients may be informed accordingly.

Comparison of High Resolution Ultrasonography with Clinical Examination in the Assessment of Peripheral Nerve Involvement in Leprosy.

Context:Assessment of peripheral nerves in leprosy by clinical methods is subject to considerable inter-observer variability. High resolution ultrasonography (HRUS) can assess peripheral nerves more objectively.Aims:To compare the findings of peripheral nerve involvement in newly diagnosed cases of leprosy by clinical and sonological methods.Settings and Design:Cross sectional study in a tertiary care teaching hospital.Subjects and Methods:Four pairs of peripheral nerves of 40 newly diagnosed patients with leprosy were examined clinically and by HRUS.Statistical Analysis Used:Agreement between clinical examination and HRUS using kappa statistic; sensitivity; specificity; and predictive values.Results:Of the 320 nerves examined, 71 (22.18%) were abnormal clinically and 63 (19.7%) sonologically. Sonological abnormalities were increased cross sectional area (n = 63; 100%), hypoechogenicity with loss of fascicular architecture (n = 46; 73%) and increased vascularity (n = 35; 55.6%). There was moderate agreement (Cohen's Ḳ = 0.59) between clinical and sonological findings. HRUS findings were abnormal in 18 (7.2%) nerves that were clinically normal. HRUS was normal in 26 (36.6%) nerves which were clinically abnormal. Sensitivity of HRUS compared to clinical examination was 63%; specificity 92.7%; positive predictive value 71.4%; and negative predictive value 89.9%. Increased cross sectional area agreed with clinical findings the most.Conclusions:HRUS has low sensitivity (63%) and high specificity (92.7%) to identify abnormal peripheral nerves in leprosy, compared to clinical examination. It could detect abnormality of some (n = 18, 7.2%) clinically normal nerves, but showed normal findings of some nerves (n = 26, 36.6%), which were considered clinically abnormal.

Predictors of Difficulty in Laproscopic Cholecystectomy -a Retrospective Study from a Tertiary Care Centre of Northern India

Introduction: Laparoscopic cholecystectomy (LC) has become the gold standard treatment for the management of symptomatic gall stone disease but a small yet significant number of LC procedures turn out to be difficult during the procedure. Knowledge of factors that can help in predicting the difficulty can help in better preoperative planning. Aim: To develop and validate a scoring method to predict difficult and very difficult LC preoperatively. Materials and Methods: This was a retrospective study conducted on medical records of 122 patients with gall stone disease. A quantitative tool based on age, gender, hospitalization history, the clinical and sonographic profile was designed to capture relevant information from these 122 patients postoperatively and was analysed. There was a total score of 21 from history, clinical, sonological findings. A score up to 7 was predicted as easy, 8–14 as difficult and > 14 as very difficult. The proposed scoring was compared against the laparoscopic difficulty criteria suggested by Randhawa and Pujahari. Data were analyzed using SPSS 21.0 version. Chi-square test and Independent samples ‘t’-test were used to compare the data. Results : History of hospitalization (p 27.5 kg/m2 (p = 0.017), abdominal scar (p=0.001), palpable gall bladder(p < 0.001), thickened wall of the gall bladder(p = 0.010), Pericholecystic collection (p=0.005) and raised ALP (p = 0.002) were found to be significantly contributing in predicting the outcome of surgery. Conclusion: The proposed scoring system was effective and can be helpful in diagnosing preoperatively into easy, difficult and very difficult cases

Preoperative prediction and good planning for technically difficult laparoscopic cholecystectomy: a scoring method

BackgroundLaparoscopic cholecystectomy (LC) has become the standard procedure of choice for management of symptomatic gallstone disease recently. Sometimes, it is difficult and takes longer time or it may be converted to an open procedure.AimThis study was undertaken to determine the preoperative factors and their predictive value for the difficulty of LC. The study used some important factors preoperatively that have a significant effect in the literature that can predict difficult LC via a scoring method in Menoufia University hospitals.Patients and methodsThe present retrospective study was conducted by an experienced laparoscopic surgeon in the period of 1 year from October 2018 to October 2019 in the Department of General Surgery at Menoufia University hospitals. The study included 132 patients who underwent LC. A total score up to 15 score from history, clinical, and sonological findings was retrospectively analyzed to evaluate preoperative predictors included in our study. Score up to 5 predicted easy, 6–10 difficult, and more than 10 very difficult LC. All the data was recorded in a tabulated form and analyzed using SPSS software, version 2018.ResultsThe factors included in the score of this study were divided as history factors, such as age, sex, BMI, previous abdominal surgery, and previous hospitalization for biliary causes; clinical factors, such as acute calcular cholecystitis, hydrops (mucocele) or empyema of gallbladder (GB), and acute pancreatitis; and sonological factors such as GB wall thickness, stone impacted at the neck of GB, common bile duct diameter, and pericholecystic fluid collection, and all were grouped to form a scoring method in Menoufia University hospitals that can strongly help the surgeon expect the difficulty of the procedure to be prepared preoperatively with the suitable plan for safety of both the surgeon and the patient.ConclusionThe scoring system depending on preoperative factors included in this study was so reliable and useful that it could successfully predict difficult cases.

Evaluation of Adnexal Masses-Correlation of Clinical, Sonological and Histological Findings in Adnexal Masses

Adnexal mass is a common clinical finding in gynaecological practice. The study aims to find out the diagnostic value of clinical examination, ultrasonography and Ca-125 and its correlation, using Risk of Malignancy Index with histopathological diagnosis in adnexal masses. Clinical records were retrieved of women who had surgical management for adnexal mass in the last 2 years duration. Based on the data, Risk of Malignancy Index values were calculated. It was then compared with histopathological diagnosis. Out of 66 patients, 56 patients had benign tumor and 10 patients had malignancy. The Risk of Malignancy Index values of each patient was calculated which ranged from 8 to 2205 with mean value of 425.52 (SD±41.8). Risk of Malignancy Index sensitivity was 70%, specificity was 96.42%, positive predictive value was 77.78%, and negative predictive value was 95.83%. Risk of Malignancy Index is a reliable diagnostic tool in differentiating benign from malignant adnexal masses.

CLINICAL PROFILE OF INTUSSUSCEPTION IN CHILDREN ADMITTED TO A TERTIARY CARE CENTRE IN KERALA

Background and objectives: Intussusception is the commonest cause of bowel obstruction and is one of the common abdominal emergencies in children younger than 2 years of age.The objective of the study was to assess the clinical profile of intussusception in children and the management and the outcome and to assess whether the characteristics mentioned in clinical profile are predictive of subsequent management and outcome of the disease.&#x0D; Methods: A hospital based descriptive study conducted in a tertiary care centre in Kerala, using purposive sampling technique. 120 children admitted with diagnosis of intussusception fulfilling inclusion criteria and whose parents consented for study were included in the study population, during the study period from November 2018 to June 2020. Detailed history, clinical examination including per rectal examination and USG was done to make diagnosis of intussusception in suspected cases. Follow up is done at 72 hours,1 week after the admission and 1month later. To assess the clinical profile and outcome of patients, frequency and percentage is used. To obtain the association of clinical profile with outcome chi square test is applied.&#x0D; Results: Outcome of the problem was correlated with age, sex, symptoms, risk factors sonological findings treatment protocol and duration of hospital stay. Out of the 120 children in study population, majority were males(65.8%) with male to female ratio 1.9:1 and majority was in the age group 7- 12 months, which is similar to many other similar studies. Maximum number of cases were in the month of February(14.2%) and November(15%). Majority of the patients(57.5%) presented to healthcare facility within 24 hours of onset of first symptom.Irritability was the most common clinical symptom(62.5%) followed by vomiting(58.3%) and abdominal pain(49.2%). Ileocolic intussusception (96.7%) was the commonest type. Majority of the cases could be managed with hydrostatic saline reduction(73.3%) and significantly lesser number of patient went for surgical intervention(7.5%) and spontaneous resolution(19.2%).&#x0D; Conclusions: Incidence of intussusception is more common among males and more in the 7-12 month age group. Majority of the cases presented to health care facility within 24 hours of onset of symptom and could be managed with hydrostatic reduction technique and had a shorter duration of hospital stay compared to surgical reduction technique. Even recurrent cases could be managed with hydrostatic saline reduction.&#x0D; Keywords: Intussusception; Intestinal obstruction; Hydrostatic reduction; Spontaneous resolution

Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature

BackgroundThe presence of intra-abdominal calcification in the pediatric population can be due to a wide range of conditions. Calcification in the abdomen can be seen in normal or abnormal anatomical structures. In some patients, abnormal calcification points towards the pathology; whereas in others, calcification itself is the pathology. After a thorough history and clinical examination, point-of-care ultrasound (POCUS) would complement the assessment of acute abdominal pain, based on the list of differentials generated as per the abdominal region. The main objective of this article is to review commonly encountered causes of intra-abdominal calcifications in the pediatric population and help in clinical decision-making in a Pediatric Emergency Department.Case presentationWe describe a series of pediatric patients who presented to the Pediatric Emergency Department with acute abdominal pain, in whom point-of-care ultrasound helped expedite the diagnosis by identifying varying types of calcification and associated sonological findings. For children who present to the Pediatric Emergency Department with significant abdominal pain, a rapid distinction between emergencies and non-emergencies is vital to decrease morbidity and mortality.ConclusionsIn a child presenting to the Pediatric Emergency Department with abdominal pain, POCUS and the findings of calcifications can narrow or expand the differential diagnosis when integrated with history and physical exam, to a specific anatomic structure. Integrating these findings with additional sonological findings of an underlying pathology might raise sufficient concerns in the emergency physicians to warrant further investigations for the patient in the form of a formal radiological ultrasound and assist in the patient's early disposition. The use of POCUS might also help to categorize the type of calcification to one of the four main categories of intra-abdominal calcifications, namely concretions, conduit wall calcification, cyst wall calcification, and solid mass-type calcification. POCUS used thoughtfully can give a diagnosis and expand differential diagnosis, reduce cognitive bias, and reduce physician mental load. By integrating the use of POCUS with the history and clinical findings, it will be possible to expedite the management in children who present to the Pediatric Emergency Department with acute abdominal pain.

Acute viral hepatitis in children: a prospective hospital based study

Background: Viral hepatitis is a major public health issue throughout the world affecting millions of children despite the availability of vaccines, prophylactic measures and improved sanitation. The objective of the study was to analyze the etiology, clinical features, laboratory parameters and sonological findings of Acute Viral Hepatitis in pediatric population.Methods: A total of 88 children admitted in paediatric department and gastroenterology unit of medicine department with confirmed acute viral hepatitis from June 2016 to July 2018 at tertiary health care teaching hospital of north India were included. The patients were divided in 3 age groups; 1-5, 6-10 and 11-18 years. Clinical features, laboratory parameters, ultrasound findings were compared in three age groups.Results: Out of 88 cases 48 were boys and 40 girls. In the present study hepatitis A was the most common (85.2%) etiology. Jaundice (90.9%) is the most common symptoms followed by dark colored urine (86.3%), loss of appetite (83.3%) and fever (68.2%) reported in this study. Icterus (90%) is the most common sign reported followed by hepatomegaly (86%). Out of 88 cases 4 cases died. Out of 4 deaths, 2 cases of hepatitis A and 2 cases positive for Hepatitis B. The cause of death was hepatic encephalopathy in both the cases.Conclusions: Majority of cases in children were hepatitis A cases. Most of the cases were aged above 5 years with slight male predominance. Those cases with elevated liver enzymes (SGOT &gt;5000) and those with PT INR &gt;3.5 at admission has higher mortality.

Evaluation the efficacy of scoring method for pre-operative prediction of difficult laparoscopic cholecystectomy

Laparoscopic Cholecystectomy the procedure of choice for symptomatic Cholelithiasis. Preoperative prediction of a difficult cholecystectomy and the risk of conversion is of great help both to the patient who can plan his work and the surgeon who can also schedule his time and team accordingly. Randhawa developed a scoring method on the basis of History, Clinical Examination and Sonological findings to predict difficult Laparoscopic Cholecystectomy preoperatively. We are conducting this study to evaluate the efficacy of Randhawa scoring method in pre-operative prediction of difficult laparoscopic cholecystectomy and to identify the predictors of difficult laparoscopic cholecystectomy which will help the surgeon to provide better surgical care to the patient.

Role of ultrasound in the diagnosis of acute appendicitis: A prospective study

Background and Aim: Although the clinical presentation of acute appendicitis is typical in 70% of the cases, about 30%of the patients have an uncertain pre-operative diagnosis. Consequently the rate of unnecessary laparotomy is as high as 20-25%. The aim of the study was, to evaluate the role of ultrasound in the diagnosis of acute appendicitis in clinically equivocal cases. Materials and Methods: 100 patients clinically suspected to be acute appendicitis were referred for ultrasound examination. Presence of appendicoliths, loculated collections, complex masses in the right iliac fossa were also considered in the diagnosis of acute appendicitis. The sonological findings were correlated with surgical findings. In patients, who had negative graded compression US examination, abdomen and pelvis were assessed with curvilinear transducer of 3.5-7.0MHz Results: Of the 100 patients who formed the study population, 76 patients had acute appendicitis. Ultrasound was sensitive in detecting acute appendicitis in 66 patients. 10 patients were falsely diagnosed as acute appendicitis on ultrasound. One patient was false positively diagnosed as having acute appendicitis. US could detect normal appendix in 8 cases. Ultrasound provided alternate diagnosis in 6 patients, thus influencing the management. The overall accuracy of ultrasound in the diagnosis of acute appendicitis was 86.36%. The sensitivity, specificity, predictive value of a positive test and predictive value of a negative test were 86.64%, 83.33%, 97.05% and 50% respectively. Conclusion: Ultrasound being non-invasive, non-traumatic, readily available modality is a result-oriented examination in clinically equivocal cases of acute appendicitis.

Complications of Two Port Laparoscopic Cholecystectomy-Studyof 50 Cases

Background: For the management of Gallstone disease, laparoscopic cholecystectomy has been the the gold standard and is preferred over open cholecystectomy. As patients’ demand has increased for improved postoperative quality of life and cosmesis, surgeons have continued to decrease the number of ports for laparoscopic cholecystectomy. To meet these expectations we adopted two-port techniques at Comilla, Bangladesh. For the last three years we have selected 50 patients where two-port laparoscopic cholecystectomy was trialled. The procedure were successfully performed in 47(94%) &amp; conversion were required in 3(6%) with some accepted complications like epigastric port infection &amp; herniation, post cholecystectomy syndrome, reactionary haemorrhage, bile leakage &amp; biloma, significant epigastric port pain postoperatively &amp; stricture of CBD. The present two port technique not only overcoming specimen extraction difficulties but also contributes to good cosmesis.&#x0D; Objectives: To see the outcome of two port laparoscopic cholecystectomy.&#x0D; Methods: Consecutive 50 patients were admitted in surgery ward of Central medical college, Comilla with gallstone disease over a 3 years period. Diagnosis is confirmed by ultrasound with the assessment of operative feasibility. Data collection sheet was maintained by Microsoft Excel. Data were analyzed manually.&#x0D; Results: In this study 50 patients were included. Among them 34 (68%) were females and 16 (32%) were males (ratio = 2.1:1). Mean age was 35.7 years (range 20–55years).All patient were undergone two port laparoscopic cholecystectomy &amp; successfully accomplished in 47 (94%),conversion were required in 3 (6%) patients. Most common (62%) sonological findings were cholelithiasis with normal size &amp; shape of gall bladder. Mean operative time was 50 minutes. Among the per operative difficulties bleeding were 14%, perforation of gall bladder 10%, spillage of gallstones 6%, epigastric forceps manipulation difficulties 4%,conversion to open cholecystectomy 6%. Most of the patients(80%) admitted in hospital for 2-3 days. 4 (8%) patient had epigastric port infection &amp; 1 (2%) patient developed this site herniation, 3 (6%) patient had post cholecystectomy syndrome,1 (2%) patient had reactionary haemorrhage, 1 (2%) bile leakage &amp; biloma,4(8%) patient had significant epigastric port pain postoperatively, 1 (2%) patient developed delayed stricture of CBD. In all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no problem so far in 3 years follow up. Most patients (90%) returned to work within 2 weeks.&#x0D; Conclusion: Two-port laparoscopic cholecystectomy is a safe procedure &amp; cosmetically rewarding.&#x0D; TAJ 2018; 31(1): 29-37

Demographic and Clinical Profile in Patients with Liver Cirrhosis in a Tertiary Care Hospital in Central Nepal

Liver cirrhosis is an important health problem worldwide and is a common disease in Nepal. The profile of cirrhosis may vary due to different factors. This study was undertaken to see the demographic and clinical profiles of patients with cirrhosis of liver attending a tertiary care hospital in Central Nepal. Six hundred patients with clinical features, laboratory and sonological findings suggestive of chronic liver dysfunction and endoscopic evidence of portal hypertension were included in the study. Their demographic and clinical profile, endoscopic findings, outcomes during hospitalization were studied. Ethical approval was taken from Institutional Review Committee of College of Medical Sciences. SPSS 20 was used for statistical analysis. The mean age of subjects was 54±11.84 years with 435 males (72.5%) and 165 (27.5%) females. Majority of 203 (33.8%) patients were from Mongol ethnicity followed by 127 (21.2%) Khas. Two hundred and twenty (36.6%) were farmers followed by 169 (28.2%) retired personnel. A total of 338 (56.4 %) patients were from rural areas. The commonest aetiology of cirrhosis was chronic alcohol consumption and seen in 552 (92%) patients. Abdominal distension was commonest presenting sign and observed in 561 (93.5%) patients. Ascites seen in 555 (92.5%) patients was the commonest complication followed by UGI bleed in 326 (54.3%) patients. Gastro-oesophageal varices observed in 345 (57.5%) patients, was the most common endoscopic finding followed by portal gastropathy, peptic ulcer and erosive mucosal diseases. In patient mortality was noted in 92 (15.3 %) patients. This study highlights the burden of cirrhosis, usually caused by chronic alcohol consumption in Central Nepal. Majority of subjects were male, middle aged, farmers, from rural areas and predominantly observed in some ethnicity like Mongols. Cirrhotic patients usually Keywords: cirrhosis of liver; complications; endoscopy.