To evaluate the role of sonography as an adjunct to mammography in women with dense breasts.

OBJECTIVE: To assess the role of sonography as an adjunct to mammography in women with dense breast tissue by determining yield and validity of sonography using histopathology/follow-up mammography as gold standard. METHODS: It was a descriptive analytical study conducted at the Radiology Department of Aga Khan University Hospital, from September 2005 to April 2007. A total of 76, mammographically dense breasts were evaluated with ultrasound. Of these 32 had palpable lumps on mammography, and were excluded from the study. A total of 44 patients had either symptoms of vague nodularity, nipple discharge, mastalgia or had no symptoms and the mammograms showed dense breast parenchyma without any focal abnormality. All these patients underwent whole breast ultrasound. The findings on ultrasound and subsequent histopathology and follow-up mammography were used to calculate the sensitivity, specificity, positive and negative predictive value of whole breast ultrasound as an adjunct to mammography. RESULTS: The age range of patients was 35 to 56 years, mean age was 42 +/- 7.33 years. Of the 44 patients included, 37 had normal ultrasound examinations and had the same findings on one year follow-up mammograms and ultrasound examinations. The remaining, seven patients were categorized as BI RADS category 4 due to presence of suspicious findings on ultrasound examination. They underwent ultrasound guided biopsy of the detected lesions. Out of seven solid lesions biopsied six were benign and one was reported malignant on histopathological examination. The sensitivity, specificity, positive and negative predictive values were 100%, 85%, 14% and 86% respectively. CONCLUSION: Breast ultrasound can be a useful adjunct to mammography in women with dense breast by detecting small cancers not identified on mammography or clinical breast examination. Larger studies will be required to suggest that ultrasound could be used as an adjunct.

Percutaneous radiologic gastrostomy: results and complications.

BACKGROUND: Percutaneous endoscopic gastrostomy is usually difficult in patients with malignant involvement of oral cavity, pharynx and esophagus. Flouroscopic guided insertion of Gastrostomy catheter with Gastropexy have gained acceptance because it is easy and less time consuming as well as less invasive as compare to surgical procedure. This study was done to evaluate the safety and efficacy of percutaneous placement of gastrostomy with gastropexy using imaging guidance in patients with oropharyngeal and esophageal cancers. METHODS: Over five years, 105 patients were referred to our department for percutaneous radiologic gastrostomy. In five patients the procedure was not performed because of overlying viscera and high position of stomach. We performed 100 gastrostomies with gastropexy procedures using seldinger technique. RESULTS: Success rate for percutaneous radiologic gastrostomy was 100%. No major complication had occurred. There were 11 minor complications occurred including 4 stomal infection, 3 catheter obstruction, one peritonism and three were extensive pneumoperitoneum. Stomal infection and catheter obstruction were not related to procedure. So, our true minor complications were only 4 (4%) which is comparable to literature. CONCLUSION: Percutaneous radiologic gastrostomy is an effective and safe procedure for enteric access of nutrition in patients with oral, pharyngeal and esophageal cancer where percutaneous endoscopic gastrostomy is difficult.

Role of computed tomography in acute pancreatitis and its complications among age groups.

OBJECTIVE: To determine value of CT scan in diagnosis of acute pancreatitis, its complications and to correlate with severity among different age groups. METHODS: The study was carried out from August 2001 to August 2002 at the Radiology Department, Aga Khan University Hospital. A total of 40 patients (33 male and 7 female) with age range from 16-71 years were divided in three groups. Group I was less than 40 years (12 patients), Group II was between 40-60 years (17 patients), and Group III was more than 60 years (11 patients). CT scans were assessed for pancreatic necrosis and its complications. CT Severity Index (CTSI) was calculated according to Balthazar's method. RESULTS: In 17 patients with mild pancreatitis, 5 had necrosis involving one-third of pancreas. In 13 patients with severe pancreatitis, 8 had necrosis involving more than half of the pancreas and 5 had necrosis involving half of the pancreas. No significant correlation was demonstrated between moderate pancreatitis and degree of necrosis. Thirty patients had complications, 8 had mild CTSI, 9 had moderate CTSI and 13 patients had severe CTSI. CONCLUSION: The study demonstrated a relationship between CTSI and severity of pancreatic damage and incidence of complications.