CT imaging and staging of carcinoma oesophagus

Background: Over the past decades, computerized tomography (CT) technology has led to an early detection of cancers and thereby decreasing mortality rate. The objective was to demonstrate usefulness of Toshiba Activion 16 slice multi detector computerized tomography (MDCT) scan in staging of oesophageal cancer.Methods: The study was carried out in the Department of Radio diagnosis, Bapuji Hospital and Chigateri Government Hospital attached to Jagadguru Jayadeva Murugarajendra Medical College, Davangere, Karnataka, India over a period of 24 months. After taking a properly informed written consent, complete history and thorough clinical examination was done and these patients were subjected to CT scan.Results: The total numbers of patients studied in present study were 25. Out of which 10 were males and 15 were females. There were 6 patients upto the age of 54 years and 8 patients equal to or greater than 65 years of age, there were 11 patients between 55-64 years of age. Dysphagia was the most common symptom in patients and was present in all the 25 patients of present study. Other common symptoms were weight loss followed by pain in throat. Two different types of wall thickenings of the involved portion have been reported. The most common asymmetrical wall thickening was observed in maximum number of patients 18 (72%) and circumferential wall thickening was observed only in 7 number (28%) of patients out of 25 total patients showing heterogeneous/homogeneous enhancement. Lower third (40%) and middle third (40%) of the esophagus was the most common site of involvement with regards to location of oesophageal cancer followed by upper third (20%) of the esophagus. Homogeneous wall attenuation was observed in most of the cases accounting for (64%). The other type of wall attenuation noted were heterogeneous (36%).Conclusions: By performing endoscopy uncertainty lies in discrimination of muscular layer from serosal layer in most parts of esophagus. However, by employing MDCT technique separation of 2 layers of esophagus can be better judged.  Therefore, MDCT has been found to be the most valuable and preferential technique for planning operational strategy

Radiographic imaging of metabolic bone disorders and their relative management

Background: Bone is a strong dynamic organ of the endoskeleton playing a vital role in structural integrity envisaging to keep proper shape and maintenance of the body, mineral reservoirs, blood production, coagulation and immunity. Metabolic bone diseases are a heterogeneous group of disorders that interrupt the normal homeostasis of bone formation and resorption. Bone regulates as well as acts as a host for hematopoiesis by providing niche for proliferation and differentiation of hematopoietic cell. Bone is a dynamic tissue but metabolically active as it is being constantly formed (modelling) and reformed (remodelling). Metabolic bone diseases comprise of a broad spectrum of inherited and acquired disorders characterized by abnormalities in calcium metabolism and bone cell physiology- that lead to an altered serum calcium concentration and skeletal failure.Methods: After taking a properly informed written consent and complete history, thorough clinical examination was done and these patients were subjected to radiographic imaging and biochemical analysis.Results: Serum alkaline phosphatase is a good marker in rickets and osteomalacia, ICTP in osteoporosis, pyridinoline, deoxypyridinoline in primary hyperparathyroidism, serum PICP in renal osteodystrophy.Conclusions: In cases of rickets and osteomalacia either decreased or normal values of serum calcium and serum phosphorus were obtained. But the cases pertaining to renal failure with rickets values of serum phosphorous were found to be raised. However, in all cases of rickets and osteomalacia values of serum alkaline phosphatase were also found to be raised

Radiographic imaging of metabolic bone disorders in consonance with biochemical parameters

Background: Bone is a strong dynamic organ of the endoskeleton playing a vital role in structural integrity envisaging keeping proper shape and maintenance of the body, mineral reservoirs, blood production, coagulation and immunity. Metabolic bone diseases are a heterogeneous group of disorders that interrupt the normal homeostasis of bone formation and resorption. Bone regulates as well as acts as a host for hematopoiesis by providing niche for proliferation and differentiation of hematopoietic cell. Bone is a dynamic tissue but metabolically active as it is being constantly formed (modelling) and reformed (remodelling). Metabolic bone diseases comprise of a broad spectrum of inherited and acquired disorders characterized by abnormalities in calcium metabolism and bone cell physiology- that lead to an altered serum calcium concentration and skeletal failure.Methods: After taking a properly informed written consent and complete history, thorough clinical examination was done and these patients were subjected to radiographic imaging and biochemical analysis.Results: With regards to fracture relating to different skeletal structures frequency was more in vertebra (38%), the maximum to be reported in 38 cases followed by hip fractures (17%) in 17 cases. Pelvis fractures were reported as (11%) in 11 cases and tibia fractures were reported to be only (7%) in meagre population of 7 cases, while remaining skeletal organs had (27%) fractures with subject to realisation in other 27 cases.Conclusions: In all the osteoporotic cases irrespective to age of patients, values of serum calcium, serum alkaline phosphatase, serum phosphorus, serum potassium, serum sodium, serum calcidiol were within normal limits

Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy

Background. Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited

Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research

BACKGROUND: Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting. METHODS: The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here. RESULTS: Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data highlighted some of the key issues concerning access to end of life care. These were: the identification of patients approaching end of life; and their awareness of end of life care; language barriers and informal carers' roles in mediating communication; and contrasting cultures in end of life kidney care. CONCLUSIONS: Reflection on the process of recruitment in this action research study provided insight into the complex scenario of end of life in kidney care. Some of the emerging issues such as the difficulty identifying patients are likely to be common across all patient groups, whilst others concerning language barriers and third party communication are more specific to ethnic minorities. A focus on South Asian ethnicity contributes to better understanding of patient perspectives and generic concepts as well as access to end of life kidney care for this group of patients in the UK. Action research was a useful methodology for achieving this and for informing future research to include informal carers and other ethnic groups.Peer reviewedFinal Published versio