[Show abstract][Hide abstract] ABSTRACT: Tuberculosis is an immense health problem in the developing world and it remains a healthcare challenge in the developed world. It can affect virtually any organ system in the body. Diagnosis of tuberculosis is often difficult. Many patients with tuberculosis present with nonspecific symptoms, negative purified protein derivative skin test and negative culture of specimens. Cross-sectional imaging with ultrasound (US), multidetector computed tomography (CT), and magnetic resonance imaging (MRI) plays an important role in the diagnosis of tuberculosis. Tuberculosis demonstrates a variety of radiologic features depending on the organ involved and can mimic a number of other disease entities. Cross-sectional imaging alone is insufficient in reaching a conclusive diagnosis. Tuberculosis is a great mimicker as its radiologic manifestations can simulate numerous other diseases across the body systems. However, recognition and understanding of the common and uncommon radiologic manifestations of tuberculosis should alert considering tuberculosis in the high-risk population and correct clinical setting to enable appropriate treatment.
Seminars in Ultrasound CT and MRI 06/2014; 35(3). DOI:10.1053/j.sult.2014.02.002 · 1.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aim:
We examinted the attitude, knowledge and perceived barriers to evidence-based practice of radiology (EBPR) among residents in radiology.
Study design and setting:
We used the McColl questionnaire (1) and the BARRIERS scale (2) to assess the issues among radiology trainees attending an annual refresher course. Ninety six residents from 32 medical colleges from Southern India attended the course.
Eighty (83.3%) residents, 55 male and 25 female of age range 24-34 years, consented and returned the questionnaire. The majority of the participants had a positive attitude towards EBPR. However, 45% were unaware of sources for evidence based literature although many had access to Medline (45%) and the internet (80%). The majority (70%) were aware of the common technical terms (e.g. odds ratio, absolute and relative risk) but other complex details (e.g. meta-analysis, clinical effectiveness, confidence interval, publication bias and number needed to treat) were poorly understood. Though majority of residents (59%) were currently following guidelines and protocols laid by colleagues within their departments, 70% of residents were interested in learning the skills of EBPR and were willing to appraise primary literature or systematic reviews by themselves. Insufficient time on the job to implement new ideas (70.1%); relevant literature is not being complied in one place (68.9%); not being able to understand statistical methods (68.5%) were considered to be the major barriers to EBPR. Training in critical appraisal significantly influence usage of bibliographic databases (p<0.0001). Attitude of collegues (p=0.006) influenced attitude of the trainees towards EBPR. Those with higher knowledge scores (p=0.02) and a greater awareness of sources for seeking evidence based literature (p=0.05) held stronger beliefs that EBPR significantly improved patient care.
The large knowledge gap related to EBPR suggests the need to incorporate structured training into the core-curriculum of training programmes in radiology.
European journal of radiology 02/2013; 82(5). DOI:10.1016/j.ejrad.2013.01.026 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Carotid body tumors are considered rare. However, there has been an increase in the number of these tumors managed at our center in recent years. Delayed presentation with large tumors is common. We studied the clinical profile, interventions, and outcomes of these tumors and assessed the factors influencing operative neurological morbidity and recurrence.
This retrospective study was conducted at the Christian Medical College in Vellore, a tertiary care center in south India. We analyzed the inpatient and outpatient records of patients diagnosed to have carotid body tumors undergoing excision from January 1, 2005 to December 31, 2011. Patients diagnosed to have vagal paragangliomas were excluded.
Thirty-four of 48 tumors were excised from 32 patients (11 female, 21 male). Average age at presentation was 38.2 years, and three patients had familial bilateral tumors. All patients presented with a painless neck mass. There were 27 Shamblin group III, six Shamblin group II, and one Shamblin group I tumor. Eleven Shamblin group II/III tumors were associated with transient cranial nerve palsy or paresis (32.3%). Two Shamblin group III tumors were associated with perioperative stroke (5.8%). Preoperative embolization was done in 17 tumors, 12 of which were associated with neurological complications (two stroke, nine nerve palsy, one hemianopia). One patient underwent thrombolysis for a middle cerebral artery thrombus and recovered completely on follow-up, and another with a capsuloganglionic infarct managed conservatively had minimal persistent disability. Three patients had persistent nerve palsy (8.8%). Although complications were more common in patients with higher Shamblin group tumors, the difference was not statistically significant.
The overall rate of neurological complications is higher with tumors of higher Shamblin groups. Preoperative embolization was not effective in reducing neurological complications. The rates of postoperative stroke and permanent cranial nerve palsy after resection of large tumors are acceptable.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2013; 57(2 Suppl):64S-8S. DOI:10.1016/j.jvs.2012.06.114 · 3.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the long-term outcomes of bronchial artery embolization in patients with massive hemoptysis due to pulmonary tuberculosis and post-tuberculosis sequelae and to study the factors influencing success.
In this study, 58 patients underwent 64 bronchial artery embolizations for massive hemoptysis due to tuberculosis or its sequelae between 1998 and 2008. Their images and procedure details were reviewed. Medical records and direct contact were used to obtain information on outcome. The cumulative hemoptysis control rate per follow-up interval was calculated.
The data showed that 25 patients presented with acute massive hemoptysis and 33 presented with chronic recurrent hemoptysis. The median quantity of blood was 400 mL (range, 70-2000 mL). The median follow-up period was 432 days (range, 11-1789 days). Twenty-seven patients had recurrence after a median period of 110 days after the procedure (range, 1-959 days). The hemoptysis control rate was 93% at 2 weeks, 86% at one month, 79.5% at 3 months, 63% at 6 months, 51% at one year and 39% at 2 years. Six patients underwent repeat procedures. Chest pain was the most common procedure-related complication (n=20, 34.5%); there was no spinal cord complication or mortality. There were seven deaths, five of which were related to hemoptysis. Nine patients were lost to follow-up. Lung cavities (P = 0.08), nonbronchial systemic artery collaterals (P = 0.081) and systemicto- pulmonary venous shunts (P = 0.053) were more common in those who experienced recurrence.
Bronchial artery embolization is a relatively safe procedure that is lifesaving in patients who are not suitable for surgery. However, the associated long-term outcome is less satisfactory.
[Show abstract][Hide abstract] ABSTRACT: Henoch The aim of the study was to evaluate the efficacy of preoperative embolization in the management of carotid body tumours.
Of the 15 patients admitted to the Department of Vascular Surgery (General Surgery Unit II), Christian Medical College, Vellore,
from January 1st 2002 to December 31st 2006 for management of carotid body tumours, 4 patients underwent preoperative embolization and were grouped together. Of
the remaining 9 patients who underwent surgical excision, there were 5 with comparable tumour size and these were grouped
together into the control group. Surgical outcome of both the groups were compared in terms of operating time, intraoperative
blood loss, nerve injury, postoperative morbidity and mortality. There was statistically significant reduction in blood loss
and duration of surgery in patients who underwent preoperative embolization. In conclusion, the preoperative embolization
is effective in the management of Shamblin type III carotid body tumours.
Central European Journal of Medicine 09/2009; 4(3):337-339. DOI:10.2478/s11536-009-0023-8 · 0.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with intrahepatic portal hypertension and negative etiological work-up for liver disease are often labeled as having cryptogenic cirrhosis. The aim of this study was to evaluate causes of liver disease in patients with unexplained intrahepatic portal hypertension.
We retrospectively analyzed cause of liver disease in all patients with cryptogenic intrahepatic portal hypertension who underwent liver biopsies between June 2005 to June 2007 in our center.
Five hundred and seventeen patients underwent liver biopsies of whom 227 had portal hypertension. Of these, the cause of liver disease could not be detected prior to liver biopsy in 62 patients. Causes of liver disease identified after liver biopsy in these 62 patients were: idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH) (30 patients, 48%), cirrhosis (14), fatty liver disease (7) and other causes (11). Initial presentations in idiopathic NCIPH patients were splenomegaly and anemia (18 patients), variceal bleed (9) and ascites (3). Median age (range) of patients at first presentation was 32 (15-57) years, and 19 were male. Majority (90%) were in Child's class A. Hepatic vein pressure gradient was <5 mmHg in 2 of 7 NCIPH patients tested.
We identified 30 patients with idiopathic NCIPH at our center over the 2 year study period. The clinical presentation and investigations of NCIPH closely mimic cryptogenic cirrhosis. Idiopathic NCIPH should be considered as a differential diagnosis of cryptogenic cirrhosis in India.
Indian Journal of Gastroenterology 05/2009; 28(3):83-7. DOI:10.1007/s12664-009-0030-3
[Show abstract][Hide abstract] ABSTRACT: A patient presented to the urology outpatient department with complaints of recurrent episodes of painless hematuria. A contrast-enhanced computed tomography scan of the abdomen revealed vesical varices that had developed secondary to obstruction of the inferior vena cava. Additional investigation revealed idiopathic retroperitoneal fibrosis. Steroid therapy was started and tapered during a 6-week period. No recurrence of the hematuria was noted on follow-up. We have described a unique presentation of hematuria due to vesical varices in a patient with idiopathic retroperitoneal fibrosis.
[Show abstract][Hide abstract] ABSTRACT: Hepatic artery aneursyms are rare and are often caused by trauma and following surgical and radiological procedures. We report the imaging findings and management of a case of hepatic artery pseudo aneurysm (HAPA) secondary to extending aortic dissection, presenting with hemobilia and obstructive jaundice HAPA carries high mortality, when it ruptures into the bile duct presenting as hemobilia. When this happens due to dissection of aorta, management becomes challenging. In our patient, HAPA was successfully managed by trans-catheter embolisation of both proximal and distal arteries.
EJVES Extra 12/2007; 14(6):59-61. DOI:10.1016/j.ejvsextra.2007.09.003
[Show abstract][Hide abstract] ABSTRACT: Objective: This study aims at comparing high frequency ultr1asound (US) in the diagnosis of enthesopathy in patients with seronegative spondyloarthropathy (SSA) as compared to controls, to ascertain whether US adds objectivity to the diagnosis of enthesopathy. Methods: Consecutive patients who were diagnosed as having SSA were studied by high frequency US for the presence of changes of enthesopathy, namely thickening, abnormal echogenicity, irregularity, nodules, fluid collection, calcification, bony changes, rupture and bursa. Results: There were 73 cases and 34 controls in the study. Each individual change studied had high specificity and positive predictive value (PPV) in individual subtypes of SSA and the group as a whole. Among the changes echogenicity, irregularity and nodules showed statistically significant values (0.03, 0.015, 0.01) with specificity of 94.1%, 94.1% and 94.1%; PPV of 88.9%, 90.5%and 90.5% and likelihood ratio of 3.73, 4.42 and 4.66. All changes were found diagnostically important except bursa, which was common in cases and controls. Conclusions: US examination of entheses offers morphological information, which is unobtainable by clinical and plain X-ray examination, in the detection of enthesopathy in patients with SSA.
Indian Journal of Rheumatology 09/2007; 2(3):95-99. DOI:10.1016/S0973-3698(10)60092-1
[Show abstract][Hide abstract] ABSTRACT: There is increasing evidence that Budd Chiari syndrome occurs when acquired predisposing factor(s) affect a susceptible individual with one or more underlying thrombophilic conditions. Geographical variations in disease pattern of Budd Chiari syndrome exist, which may reflect differing predisposing factors. We review a change in disease profile of Budd Chiari syndrome in India over the past three decades. While earlier studies from India reported isolated inferior vena cava (IVC) obstruction as the commonest disease type, this is a minority in more recent reports where a combination of IVC and hepatic vein obstruction is the commonest type. Longer duration of illness has been shown to be associated with IVC obstruction and the recent change in disease profile in India may reflect earlier diagnosis of Budd Chiari syndrome. Poverty, malnutrition, recurrent bacterial infections and filariasis have been previously suggested as predisposing factors for IVC obstruction. Improvement in hygiene and sanitation may partly explain the recent change in disease profile of Budd Chiari syndrome in India.
Indian Journal of Gastroenterology 03/2007; 26(2):77-81.
[Show abstract][Hide abstract] ABSTRACT: Vascular conditions presenting with Pancoast syndrome are rare. A case of vertebral artery pseudoaneurysm presenting with Pancoast syndrome is reported. The aneurysm was successfully treated by proximal coil embolization.
European Journal of Vascular and Endovascular Surgery 01/2006; 30(6):621-3. DOI:10.1016/j.ejvs.2005.06.020 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Morbidity in haemophilia has been described predominantly in terms of musculoskeletal dysfunction and assessed by the clinical and radiological joint scores. These scores document changes in a particular joint, but do not reflect the impact of these changes on the individual in terms of his overall musculoskeletal function. Several self-assessment instruments have been used to measure musculoskeletal function but none have been specifically validated for use in haemophilia. In order to objectively assess musculoskeletal function of patients with haemophilia, we developed Functional Independence Score in Hemophilia (FISH), a performance-based instrument. FISH measures the patient's independence in performing seven activities under three categories: self-care (grooming and eating, bathing and dressing), transfers (chair and floor) and mobility (walking and step climbing). Each function is graded from 1 to 4 depending on the amount of assistance needed in performing the function. We evaluated 35 patients who were over 10 years old and had had at least three major bleeds per year. All subjects were scored for clinical (World Federation of Hemophilia, WFH score) and radiological changes (Pettersson's score). Functional independence of the patient was assessed using the Stanford Health Assessment Questionnaire (HAQ) and the FISH. Correlation of the FISH score was modest with both the WFH clinical score (r = -0.68) and the radiological score (r = -0.44). While there was good correlation between FISH and HAQ (r = -0.90), FISH had better internal consistency than HAQ (Cronbach's alpha 0.83 vs. 0.66). FISH appears to be a promising disease-specific instrument for assessing overall musculoskeletal function in haemophilia. It requires evaluation in different patient populations.
[Show abstract][Hide abstract] ABSTRACT: Aneurysms of collateral arteries are unusual. A case of transverse cervical artery aneurysm as the sole presentation of vascular thoracic outlet syndrome is presented and the relevant literature reviewed.
European Journal of Vascular and Endovascular Surgery 07/2005; 29(6):611-2. DOI:10.1016/j.ejvs.2005.02.015 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Computed Tomography (CT) scan of nose and paranasal sinuses play a key role in preoperative evaluation of patients undergoing endoscopic sinus surgeries (ESS) for chronic rhinosinusitis. The asymmetry of ethmoid fovea olfactory fossa, anatomical variations of lateral lamella and course of anterior ethmoid artery are critical in ESS as it may predispose to dangerous consequences like hemorrhage. CSF leak and intracranial complications. A prospective study was done on 75 patients of clinically and diagnostically proven chronic rhinosimusits. The coronal CT scan was evaluated with special attention to anatomical variations of anterior skull base including ethmoid fovea, olfactory fossa, lateral lamella and course of anterior ethmoid artery. The endoscopic surgeon's awareness of these variations and its role in preventing complications are highlighted.
Indian Journal of Otolaryngology and Head & Neck Surgery 01/2005; 57(1):5-8. DOI:10.1007/BF02907616 · 0.05 Impact Factor