Comparative analysis of colorectal carcinoma staging using operative, histopathology and computed tomography findings.

BACKGROUND: The staging of colorectal carcinoma using 3 modalities viz operative, histopathology and CT scan has been subject of interest in accurately defining the extent of disease. This retrospective as well as prospective study was carried out at CMC, Ludhiana, Punjab from November 2011 to May 2014. AIM: The objective of this study was to assess the usefulness and accuracy of CT scan findings to state the extent and spread of colorectal malignancy and to correlate these findings with histopathological diagnosis. METHOD: A total of 31 biopsy proven patients showing variable bowel wall thickening involving the colon /rectum on CECT (Contrast Enhanced Computed Tomography) were included in the study. The tumours were staged based on the CT scan findings and were compared with the operative and histopathological findings. OBSERVATIONS: Rectum was the most common site of involvement followed by the recto-sigmoid involvement. Metastasis was observed in 5 cases out of the 31 malignant cases. Five of the 7 cases were correctly staged as T1 & T2 lesions on CT having a sensitivity of 83.3%, specificity of 92%, and positive predictive value of 71.4% and a negative predictive value of 95.8% in the diagnosis of T1 and T2 lesions. 15 of the 16 cases were correctly staged as T3 lesions. CT had a sensitivity of 88.2%, specificity of 93.8%, and positive predictive value of 93.8% and a negative predictive value of 86.7% in the diagnosis of T3 lesions. All the 8 cases were correctly staged as T4 lesions. CT had a sensitivity of 100%, specificity of 100%, and positive predictive value of 100% and a negative predictive value of 100% in the diagnosis of T4 lesions. CONCLUSION: We conclude that CT scan is an excellent modality in diagnosing malignant lesions of the colon and rectum.

Bilateral single-session retrograde intra-renal surgery: A safe option for renal stones up to 1.5 cm.

INTRODUCTION: Assessment of treatment outcomes in patients undergoing bilateral single-session retrograde intra-renal surgery (RIRS) for bilateral renal stones up to 1.5 cm. MATERIALS AND METHODS: Retrospective analysis of 74 patients was done with bilateral renal calculi, who underwent bilateral single-session RIRS at our stone referral hospital from December 2011 to May 2014. The selection criteria for this intervention were patient's preference, failure of other treatments and stone up to 1.5 cm. Patients with creatinine more than 2, pyonephrosis sepsis, bilateral impacted pelviureteric junction calculi were excluded from study. All patients were evaluated with serum biochemistry, urinalysis, urine culture, plain radiography of kidney-ureter-bladder, intravenous urography, renal ultrasonography (USG) and/or computed tomography (CT). Follow-up evaluation included serum biochemistry and postoperative plain film and renal USG. The success rate was defined as patients who were stone-free or only had a residual fragment of less than 4 mm. CT was conducted only in patients with residual stones, which were present in seven patients. RESULTS: A total of 74 patients (50 male, 24 female) with a mean age 39.2 ± 15.2 were included in the present study. The mean stone size was 11.7 ± 2.4 mm. The stone-free rates were 86.84% and 97.29% after the first and second procedures, respectively. In eight patients (10.8%), minor complications were observed, whereas no major complications were noted in the studied group. There was no significant difference in pre- and post-operative serum creatinine levels. CONCLUSION: In patients with bilateral renal stones up to 1.5 cm bilateral single-session RIRS with flexible ureteroscope can be safely performed with low complication rate.

Placental thickness: its correlation with ultrasonographic gestational age in normal and intrauterine growth-retarded pregnancies in the late second and third trimester.

OBJECTIVE: The aim was to study the correlation of placental thickness, measured at the level of the umbilical cord insertion, with the ultrasonographic gestational age in normal and IUGR pregnancies in the late second and third trimester. MATERIALS AND METHODS: A total of 498 patients were observed for correlation of the placental thickness with ultrasonographic gestational age and their outcomes by dividing them into Group A (outcome fetal weight < 2,500 g, n = 122) and Group B (fetal weight > 2,500 g, n = 376). The mean placental thickness was calculated at the umbilical cord insertion in both groups along with ultrasonographic fetal age and estimated fetal weight. The mean values of placental thickness along with respective standard deviation were calculated from the 24th to 39th week of gestational age. RESULTS: A positive correlation was observed between placental thickness and ultrasonographic gestational age in both groups (p value of 0.01), with Pearson's correlation coefficient ("r") values of 0.325 in Group A and 0.135 in Group B. Regression analysis yielded linear equations of relationship with placental thickness and gestational age in both groups. The placental thickness was also found to be lower in Group A between 26 and 27 weeks and 30 and 31 weeks, having mean values of 2.48 ± 0.063 cm (p value of 0.042) and 2.76 ± 0.552 (p value of 0.05) in Group A as compared to 3.04 ± 0.25 and 3.13 ± 0.183 cm in Group B. CONCLUSIONS: Placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in assessment of gestational age in singleton pregnancies because of its linear correlation.

A comparative study of conventional MRI with diffusion weighted imaging in the evaluation of acute cerebral ischaemia.

To compare the diagnostic sensitivity of diffusion weighted images with that of conventional magnetic resonance imaging (MRI) techniques in patients presenting within 24 hours of onset of symptoms of acute cerebral ischaemia, a one year prospective study was conducted in the department of radiodiagnosis of Christian Medical College and Hospital, Ludhiana. Patients with signs and symptoms of cerebral ischaemia, presenting within 24 hours of onset were included in the study. MR imaging was performed with 1.5 Tesla system (Signa; GE Medical systems) with echoplanar capability. A total of 40 patients were studied, with majority (80%) in the 40-80 years age group; 52% of patients presented to the hospital after 12 hours of symptom onset. Eight patients presented within three hours of symptoms. In this group of 8 patients conventional MR was positive in only 5 patients (62.5%) while diffusion weighted imaging was positive in all 8 patients. The time of presentation is a crucial factor in determining the therapeutic options for a patient with stroke. Diffusion weighted imaging is more sensitive than conventional MRI in detecting cerebral ischaemic changes in patients presenting less than 24 hours from the onset of symptoms.