Value of Combination of Standard Axial and Thin-Section Coronal Diffusion-weighted Imaging in Diagnosis of Acute Brainstem Infarction

AIM: To determine the value of the combination of thin-section 3 mm ‎coronal and standard ‎axial DWI and their impact in facilitating the diagnosis of ‎‎acute brainstem infarction. METHODS: A cross-sectional study conducted from the 1st of April 2017 to the end of February 2018 on 100 consecutive patients (66% were male, and 34% were female) with isolated acute ischemic infarction in the ‎brainstem. The abnormal MRI findings concerning the ischemic lesions were interpreted on standard axial 5 mm and thin-section coronal 3mm DWI. RESULTS: The mean age of the studied group was 69.2 ± 4.3 for male and 72.3 ± 2.5 years. The standard axial DWI can diagnose 20%, 6.7% and 6.7% of the infarctions in midbrain, pons and medulla oblongata respectively, while both axial and thin coronal sections together can diagnose 80% of midbrain infarctions, 93.3% of pons infarctions and 93.3% of medulla oblongata infarctions. Furthermore, the thin section coronal 3 mm section can diagnose very smaller ischemic lesion volume in comparison to the standard axial 5mm section (3.4 ± 0.45 / cm3 versus 4.6 ± 0.23 / cm3, P < 0.001) CONCLUSION: The addition of thin-section coronal DWI can facilitate the detection of brainstem ischemic lesions. We suggest its inclusion in the stroke MRI protocol

Brain MRI Findings of Complicated Meningitis in Children: A Cross Sectional Study from Central Iraq

Background Meningitis is a common neurological emergency and a leading cause of death and neurological disability worldwide. MRI is extremely useful for detecting and monitoring the complications of meningitis. The purpose of this study was to describe the brain MRI findings in children with complicated meningitis. Materials and Methods  This cross-sectional study was conducted in Radiology Department at the Central Pediatric Teaching Hospital, Baghdad, Iraq between the period of October 2015 and August 2017. A total of 40 children who were known cases of meningitis that not respond to the conventional treatment and examined with MRI were included in this study. MRI protocols were achieved with Variable Echo Multiplanar sequences and all the images were interpreted by two qualified radiologists for any intracranial findings. Results The mean age of patients was 3.3±3.2 years; 35% of them were infant age group. Females were more than males with a female to male ratio as 1.2:1. About half of children were diagnosed by MRI with necrosis, 30% of them with hydrocephalus, 15% of them with abscess and 7.5% of them with subdural effusion. The hydrocephalus was found among children with lower mean age and abscess was found among children with higher mean age children. Conclusion The main MRI findings of children with complicated meningitis were necrosis, hydrocephalus, abscess and subdural effusion

The Prevalence of a Clinically Silent Nephrolithiasis in Baghdad Population: An Initial Ultrasound Screening Study From Iraq

Asymptomatic or clinically silent kidney stones are possibly serious because, in their expected passage, they may cause infection, obstruction and renal impairment. The purpose of this study was to determine the prevalence of silent kidney stones in a sample of Baghdad population and consider how this value could affect the justification for a screening system. To our best knowledge, this is the first study of its kind conducted in Iraq. We investigated 714 consecutive patients who sustained an abdominal ultrasound at our hospital with further kidney screening. All these patients did not have clinical signs and symptoms of nephrolithiasis. Age, sex, the indication for ultrasound, the size, side, and the number of the discovered stones were recorded. We observed silent kidney stones in 3.4% of patients. Males were stone carriers mostly. Stones were detected more in the left kidney than the right. Distinctly, multiple stones and stones of a large size were minimally seen. We conclude that the prevalence of clinically silent nephrolithiasis of 3.4% does not support a global screening. Yet, this screening may be justified in a limited pattern for those male subjects higher than 50 years, having a positive family history of renal stones, and their socioeconomic status is granted

Value of Combination of Standard Axial and Thin-Section Coronal Diffusion-weighted Imaging in Diagnosis of Acute Brainstem Infarction

AIM: To determine the value of the combination of thin-section 3 mm ‎coronal and standard ‎axial DWI and their impact in facilitating the diagnosis of ‎‎acute brainstem infarction. METHODS: A cross-sectional study conducted from the 1st of April 2017 to the end of February 2018 on 100 consecutive patients (66% were male, and 34% were female) with isolated acute ischemic infarction in the ‎brainstem. The abnormal MRI findings concerning the ischemic lesions were interpreted on standard axial 5 mm and thin-section coronal 3mm DWI. RESULTS: The mean age of the studied group was 69.2 ± 4.3 for male and 72.3 ± 2.5 years. The standard axial DWI can diagnose 20%, 6.7% and 6.7% of the infarctions in midbrain, pons and medulla oblongata respectively, while both axial and thin coronal sections together can diagnose 80% of midbrain infarctions, 93.3% of pons infarctions and 93.3% of medulla oblongata infarctions. Furthermore, the thin section coronal 3 mm section can diagnose very smaller ischemic lesion volume in comparison to the standard axial 5mm section (3.4 ± 0.45 / cm3 versus 4.6 ± 0.23 / cm3, P < 0.001) CONCLUSION: The addition of thin-section coronal DWI can facilitate the detection of brainstem ischemic lesions. We suggest its inclusion in the stroke MRI protocol

Comparative Study of Single Dose Per-operative Metronidazole versus Multiple Doses Postoperative Metronidazole in Acute Non-Complicated Appendicitis: A View on Postoperative Complications

Background: It has now been proved by researches that per-operative single dose prophylactic antibiotics more crucial in preventing postoperative wound infection in elective cases and clean-contaminated cases like acutely inflamed non-perforated appendicitis. Aim and Objectives: This study investigated the effect of a single dose of metronidazole infusion per-operatively in the treatment of patients undergoing appendicectomy regarding postoperative infective complications. Material and Methods: A total number of 111 patients of non-complicated (suppurative and catarrhal) appendicitis enrolled in this prospective study between October 2015 and October 2017. Patients were allocated to two groups in a randomized way. Fifty-one patients in Group A were given a single dose of metronidazole per-operatively. Sixty patients in Group B were given multiple doses of metronidazole postoperatively. Postoperative fever, wound infection, seroma, and intrabdominal collections were compared between both groups. Statistical analysis was performed using Student's t-test and Chi-square test. Results: The patients of both groups were similar in baseline characteristics. No significant difference was found in the rate of postoperative fever and wound infection in both groups. In Group A there were five patients (9%) developed postoperative fever, four of them (7.8%) because of wound infection. In Group B there were six patients (10%) developed postoperative fever, four of them (6.7%) because of wound infection. None of the patients developed seroma or intraabdominal abscesses. Conclusion: Single per-operative dose of metronidazole is quite effective in reducing the incidence of postoperative feve

Ultrasound-guided percutaneous treatment of liver hydatid cysts using 3% hydrogen peroxide as a scolicidal agent

BackgroundHydatid disease of the liver is endemic in cattle areas of the world. A variety of treatment options is available. The common treatment options are medical therapy, surgery and puncture-aspiration-injection-reaspiration (PAIR) therapy. AimsTo evaluate the clinical outcomes and effectiveness of PAIR therapy in the treatment of liver hydatid disease using 3 per cent hydrogen peroxide (HP) as a scolicidal agent.Methods Between October 2012 and October 2015, seventy hydatid cysts in 52 patients were treated by PAIR procedure using three per cent HP as a scolicidal agent. Pre-procedural clinical, radiological and laboratory characteristics and post-procedural morbidity, mortality and length of hospital stay were recorded.Results We performed PAIR of 70 hydatid cysts in 52 patients with a success rate of 95 per cent without any mortality. The mean length of hospital stay was three days (ranges 1–8). In our series, minor complications occurred in six patients and major complications in five patients. The follow-up period ranged from 12–18 months, with a mean of 15.3 months. Three patients developed recurrence.ConclusionPAIR therapy is a minimally invasive procedure for Gharbi type I-III hepatic hydatid cysts. It is a relatively safe procedure with a significant reduction in the duration of hospital stay. We believed that HP by itself plays a role in influencing the results and the outcomes of PAIR