Management and Complications of Arnold Chiari Hydrocephalus at Tertiary Health Care Center

Objective: to investigate the role of CT and MRI in diagnosis of Arnold chiari malformation of hydrocephalus and its treatment with VP shunt along with complications. Study Design: Prospective study Place and duration: Department of Neurosurgery, DG Khan Medical College from May 4, 2018 to May 4, 2019. Methodology: Fifty patients of congenital hydrocephalus who were not treated previously were selected. Detailed history about disease and clinical examination of patients was performed. Follow ups were done at neurosurgery OPD. SPSS software for data analysis was used and mean ± SD, frequency and percentages were calculated for variables. P value ≤0.05 was considered as significant. Results: Treatment in case of congenital hydrocephalus as VP shunt, intra-aneurysmal coiling, excision of meningomyelocele with VP shunt and suboccipital craniectomy + upper cervical laminectomy (scucl) were observed as 10%, 6%, 8% and 8% respectively.  Twelve percent of patients were not treated. Conclusion: CT and MRI are the main diagnostic tools for diagnosis of Arnold chiari malformation and VP shunt is the treatment of choice. Among complications of VP shunt infection of shunt and shunt block are the main complications

Correlation between Ultrasonographic Grading of Fatty Liver and Lipid Profile

Fatty liver disease can easily cause  detrimental  changes when it slolwly  progressess towards the aggressive stages of  liver fibrosis leading to cirrhosis, and it can also cause collateral damages in the form of   cardiovascular diseases and atherosclerotic disease. The main  purpose of this study is to analyze the correlation between the grading of fatty liver disease provided by the ultrasound with lipid profile work of the affected patient.  A comparative analytical study  was conducted on 138 patients affected with fatty liver disease,the patients were chosen by  convenient sampling technique. Study was conducted at Radiology Department of General Hospital Lahore and Sheikh Zayed Hospital Rahimyar khan during July 2019 to October 2019. Total 138 patients data were analyzed. Out of 138 males were 65 (47.1%) males and females were 73 (52.9%) w.The study indicated  that the total number of patients having grade 1 fatty liver was 84 (60.9%), patients having grade 2 fatty liver was 52 (37.7%) and patients having grade 3 fatty liver was 2 (1.4%). Out of 138 patients there were total  67 (48.6%)cases of patients with fatty liver disease and  out of 138 patients, 71 (51.4%) were considered normal .Female patients were allegedly found to be more effected with fatty liver than males and majority of patients fell into the category of grade1 fatty liver. Since the majority of the patient fell into the category of grade 1 of fatty liver disese and there lipid profile test also indicated towards normal values so the risk of developing any cardiovascular disease among the patients was mininal

Sonographic Association of Cholelithiasis with Obstructive Jaundice in Adult Patients

Background: Cholelithiasis is the commonest cause of obstructive jaundice and for the investigation of cholelithiasis and obstructive jaundice ultrasound is a gold standard modality. Obstructive jaundice is generally due to biliary obstruction, which is a blockage of the common bile duct or any duct that carries bile from the liver to the gallbladder and then enters into the small intestine. Objective: To determine sonographic association of cholelithiasis with obstructive jaundice in adult patients. Methodology: A cross sectional study was conducted among 138 individuals. All were young adults within the age range of 18-35 years. Data was collected from Civil Hospital Gujranwala city, by using simple random sampling technique. The examination was done with Toshiba Xario 3.5-5MHz curvilinear transducer. Gallbladder scan was started with the patient in the supine position from both subcostal and intercostal approaches. It was analyzed through SPSS version 24.0 and presented through frequency and percentages. Results: Total 138 individuals were included in this study. Out of 138 subjects, 69 individuals with cholelithiasis out of 69, 24 individuals with obstructive jaundice. And other 69 individuals without cholelithiasis in which 26 subjects presented with jaundice. It was found that females (51.4%) were more commonly affected than males (48.6%).Conclusion: It was concluded that cholelithiasis is one of the main causes of obstructive jaundice and ultrasound can easily diagnose the cases of cholelithiasis. It was found that females were more commonly affected than males. Keywords: cholelithiasis, obstructive jaundice, jaundice, ultrasound. DOI: 10.7176/JHMN/72-04 Publication date:March 31st 202

Evaluation of Cervical Disc Degeneration in Patients with Neck Pain on Magnetic Resonance Imaging

Background: Cervical disc degeneration is the most common pathology that in most of the cases  clinically present as Objective: To evaluate the cervical region abnormalities in patients with neck pain on magnetic resonance imaging. Methodology: In this descriptive study 180 adult patients were included. All patients had been collected from DHQ hospital Gilgit and Ghurki Trust teaching hospital. After informed consent, data were collected through 1.5 tesla GE (closed bore) and 0.35 tesla Hitachi (open bore) MRI machines. Results:  Findings show that among 180 adult patients, 136 presented with disc degeneration among which 81 were males and 55 were females. Among 81 males, 63 had disc degeneration at multiple levels while 18 had single disc degeneration. In females 35 patients showed multiple disc degeneration while 20 involved a single disc. Conclusion: It is concluded that disc degeneration is prevalent in males than females. Disc degeneration at multiple levels is higher than single disc degeneration in both genders. Keywords: Disc degeneration, magnetic resonance imaging. DOI: 10.7176/JHMN/99-03 Publication date: April 30th 2022

Differentiation of Small Hepatic Hemangioma from Small Hepatocellular Carcinoma with Tri-Phasic Helical Computed Tomography Method

Background: Hepatocellular carcinoma (HCC) ranks second amongst all causes of cancer deaths globally. It is on a rise in Pakistan and might represent the most common cancer in adult males. Among women, HCC is the 7th most common cancer and 6th most common cancer related death. In Pakistan prevalence of HCC varies from 3.7%-16% of malignant tumors and most common cause of HCC is viral hepatitis B, C and D related cirrhosis. Pakistan contributes significantly to global burden of hepatitis C, which is a known risk factor for HCC, and has one of the highest prevalence rates (>3%) in the world. Objective: To find out the difference of small hemangioma from small hepatic cellular carcinoma by using tri- phasic helical Computed Tomography method. Methodology: In this descriptive study, among 81 patients of suspected hepatocellular carcinoma and hepatocellular hemangioma were selected with age and gender discrimination by convenient sampling, at Department of Radiology, UOL Teaching hospital Lahore Pakistan. 128 slice Computed Tomography Toshiba Aquilion machine was used. Results: Out of 81 patients collected with the suspicion of hepatic hemangioma and hepatocellular carcinoma , 41 were females and 40 were males who visited radiology department. It shows 50.6% were females and males were 49.4%. Out of 81 patients, 25 patients came with HHS and 31 were with HCC. 25.9% develop carcinoma on left side, 32.1% on right side, 6.2% on R/L side and remaining 35.8% were Nill. Out of 81 patients 8 develop carcinoma on anterior, 5 on both, 3 on caudate, 5 on lateral,13 on both 4 on middle, 7 on posterior, 6 on segment eight, 1 on segment 4, 1 on segment 7, 1 on segment 2 and remaining 36 sites were nill. 27.5% males develop HCC and 48.8% females develop HCC. Out of 81 patients 36.6% female patients develop HHS and 25.0% male patients develop HHS. Conclusion: In this study we conclude that females develop a large number of HCC and HHS than males. Hepatocellular carcinoma shows enhancement in early arterial and early washout phase while post-contrast images showing capsule-appearance which is relatively specific for HCC. On the other hand, HHS shows uniform enhancement in arterial phase and iso- or hyper-attenuating to liver parenchyma on delayed phase. Keywords: Hepatocellular carcinoma, Hepatocellular hemangioma, Computed tomography DOI: 10.7176/JHMN/73-07 Publication date: April 30th 202

Frequency of Hepatocellular Carcinoma in Patients Infected with Hepatitis C Virus visiting a Tertiary Care Hospital in Lahore for Computed Tomographic Evaluation

Background: Hepatitis C virus has been identified as one of the leading causes of chronic liver disease and its complications world-wide. Subsequent development of hepatocellular carcinoma in these patients is a major complication of this infection having serious implications on morbidity and mortality rates. The objective of this study was to find out the frequency of Hepatocellular carcinoma in patients suffering from Hepatitis C visiting Radiology department of a tertiary care hospital for multi-detector computed tomography evaluation.Methods: This cross-sectional analytical study was conducted at Shalamar Hospital Lahore. A total of 195 patients, suffering from Hepatitis C, visiting Shalamar Hospital, Lahore for evaluation by CT during 6 months study interval were included in this study. Abdominal CT was performed using Triphasic contrast enhancement protocol. All images were interpreted by a senior Radiologist. Frequency of Hepatocellular carcinoma was calculated. Statistical analysis was made using MEDCALC.Results: Out of 195, 63(32.3%) patients were seen to have hepatocellular carcinoma. This disease was more common in male, 45(34.6%) as compared to female patients 18 (27.7%). The presence of HCC showed statistically significant association with alcoholism, obesity, diabetes mellitus and cirrhosis.Conclusion: The study concluded that a substantial number of HCV positive patients develop HCC, which is more common in men as compared to women. The presence of HCC is strongly associated with alcoholism, obesity, diabetes mellitus and cirrhosis.Keywords: Hepatocellular carcinoma (HCC); Hepatitis C (HCV); Multi-detector Computed Tomography (MDCT)

SONOGRAPHIC FINDINGS IN FEMALES OF REPRODUCTIVE AGE WITH ACUTE PELVIC PAIN

Background: Acute pelvic pain can result from the gynecological, urological systems and/or gastrointestinal. Ultrasound can be used as an initial imaging modality in the evaluation of acute pelvic pain. To determine sonographic findings in females of reproductive age coming with acute pelvic pain. Objective: To determine Sonographic findings in females of reproductive age with acute pelvic pain. Methodology: Toshiba Xario ultrasound machine with a standard gray scale and Doppler ultrasound convex probe of 3.5 MHz – 7.5 MHz or trans-vaginal probe of 5 MHz - 7.5MHz is used. Both transvaginal and trans-abdominal probes were used in this study. The study was conducted at Ultrasound University Clinic, Township, Lahore. Data of 163 patients was collected through convenient sampling. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: A total of 163 patients were examined in the study. The age incidence of the cases in this study varied between 15 years to 45 years. The mean age of the patients in the study was 29.8712 years. The uterine fibroid is most commonly involved in acute pelvic pain and is seen in 30.1% cases followed by simple ovarian cyst in 20.2% cases, hemorrhagic cyst in 14.1% cases. 8.6% cases with pelvic pain have no abnormal sonographic findings. Adenomyosis, PID and endometrial polyp in 4.3% each. Endometrial hyperplasia in 3.1%. Follicular cyst, simple adnexal cyst and complex adnexal cyst in 1.8% each, followed by ovarian endometrioma in 0.6% cases and dermoid cyst in 0.6%. In obstetric patients of acute pelvic pain; RPOCs are most common, constituting 1.8% of total acute pelvic pain, molar pregnancy in 1.2%, ectopic pregnancy in 0.6% patients, subchorionic bleed in 0.6% cases. Conclusion: Ultrasound is a very good modality for acute pelvic pain, as it can easily diagnose and characterize the causes of pelvic pain. The wide availability, radiation free and cost effectiveness makes it a first line investigation in acute pelvic pain. In the present study, the most common cause of pelvic pain is uterine fibroid. Key words: Ultrasound (US), Pelvic inflammatory disease (PID), acute pelvic pain, retained products of contraceptives (RPOCs), pouch of Douglas (POD). DOI: 10.7176/JHMN/71-14 Publication date: February 29th 202

Sonographic Incidence and Characteristics of Thyroid Nodules in Various Age Groups and Gender

Background: Thyroid nodules (TNs) are among the common diseases of the endocrine system, with 3%–7% prevalence by palpation. The prevalence by high-resolution ultrasonography among randomly selected individuals is 19%–67%, with annual increasing trends worldwide. 5% to 15% of TNs is thyroid cancer, which has become the fastest growing cancer.1 Ultrasonography has become an indispensable tool in the evaluation of thyroid nodular disease, and most patients will have had a thyroid ultrasound prior to initial surgical evaluation.9 Objective: To characterize thyroid nodules in various age groups and gender.  Methodology: In this descriptive study, among 179 patients of thyroid nodule were selected with age and gender discrimination by convenient sampling, at Department of Radiology, Lahore General hospital and Inmol Cancer hospital Lahore. Mindray Z5 and Toshiba xario 100 with linear probe of 7.5-11MHz ultrasound machine was used. Results: Out of 179 collected, 105 were females and 74 were males who visited radiology department due to thyroid nodule. It shows 58.7% females and 41.3% males patients diagnosed. Out of 179 patients 106 patients 59.2% came with irregular margins thyroid nodules and remaining 73 patients 40.8% had thyroid nodules with regular margins. 127 patients 70.9% had hyperechoic thyroid nodules and 52 patients 29.1% had hypoechoic thyroid nodules. Out of 97 patients 54.2% developed (Multi Nodular Goiter) MNG, 66 patients 36.9% developed right thyroid nodules and 16 patients 8.9% developed left thyroid nodules. Females developed 56.2% MNG, 33.3% right thyroid nodule and 10.5% left thyroid nodule while males developed 51.4% MNG, 41.9% right thyroid nodule and 6.8% left thyroid nodule. Out of 179 patients 109 (60.9%) patients shows no perfusion of blood while remaining 70 (30.1%) shows some perfusion of blood on USG. Minimum age was 5 years and maximum were 90 years while their mean was 43. Age group between 41 to 50 years most likely develop thyroid nodules.  Conclusion: In this study we conclude that females most likely develop thyroid nodules than males.  Both males and females mostly develop multi nodular goiter and least develop left thyroid nodule. Patients in 4th decade most likely develop thyroid nodules. Key words: Thyroid nodules, Ultrasonography DOI: 10.7176/JHMN/80-15 Publication date:September 30th 202

Frequency and Anatomical Distribution of Pulmonary Embolism on CT Pulmonary Angiography

Background: Pulmonary embolism, with its growing prevalence, has become a potentially life-threatening medical condition with crucial symptoms. However, prognosis is good if timely diagnosis is made and to the level of segmental and sub segmental arteries as well. Standard computed tomography pulmonary angiography (CTPA) is thus used to diagnose acute pulmonary embolism. Objective: The primary objective of the current study was to determine and investigate the anatomical distribution frequency of pulmonary emboli, where segmental, sub segmental, and lobar arteries on CT pulmonary angiography are included. Methodology: In a descriptive cross-sectional study, single-centered studies and CTPA scans of 98 patients were included. Data was obtained from Shalimar Hospital and University of Lahore – Teaching Hospital, Lahore, Pakistan. Sample size included patients of all age groups with suspected pulmonary embolism, with no differentiation of male or female samples. Results: According to statistics and analysis, the current study results indicated the presence of pulmonary embolism in 36 patients and its absence in 62 patients. Results indicated that amongst the 98 patients scanned, the highest frequency of pulmonary emboli was found in the pulmonary trunk and lobar artery in 8 patients (8.2%). Furthermore, CTPA of the participants detected pulmonary emboli in segmental and sub-segmental arteries of 5 patients (5.1%), with another 2 patients showing pulmonary emboli in only the sub-segmental artery (2.0%). Another 2-2 patients showed pulmonary emboli in lobar and segmental artery and lobar, segmental and sub-segmental artery respectively (2.0%, 2.0%). Conclusion: The largest number of pulmonary emboli were found in the pulmonary trunk, followed by emboli of segmental and lobar arteries in patients. It is concluded that CTPA evaluates pulmonary embolism with great precision and anatomical distribution localized main trunk, and pulmonary artery emboli along with lobar, segmental and sub-segmental artery emboli. Keywords: Computed Tomography Pulmonary Angiography (CTPA), pulmonary emboli, segmental artery, sub segmental artery, lobar arteries DOI: 10.7176/JHMN/100-02 Publication date:May 31st 202