Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis.

OBJECTIVE: To determine the accuracy of FACT (focused appendiceal computed tomography) in evaluation of acute appendicitis. METHODS: The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT. Axial scans were obtained in a single breath hold from L2 vertebral level to the pubic symphysis with 5-mm collimation and a pitch of 1.5. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix (>6 mm diameter) and periappendiceal inflammation. Final diagnoses were established with the results of surgical or clinical follow-up. RESULTS: There were 21 true-positive diagnoses, 38 true-negative diagnoses, no false-positive diagnoses, and 2 false-negative diagnoses, which yielded a sensitivity of 91% and a specificity of 100%. CONCLUSION: Non-enhanced FACT is a highly accurate problem solving technique in clinically equivocal cases of acute appendicitis.

Role of magnetic resonance imaging in lumbar spondylosis.

OBJECTIVE: To assess the frequency of various MRI findings in patients with lumbar spondylosis and determine their association with symptoms of patients. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Radiology Department,The Aga Khan University Hospital, Karachi, from January to December, 2002. PATIENTS AND METHODS: The study included 120 patients who presented with low back and leg pain. Segmental classification system was used to classify the pain distribution. All patients underwent lumbar MRI using 1.5 T-scanner. MRI scans was evaluated for magnitude and location of nerve compression, disc extrusion and the nature of nerve and thecal sac deformation in the central canal, lateral recess and intervertebral foramen at each spinal level. Statistical analysis was performed using computer program SPSS (Version; 10). Chi-square test was also used to determine significance of association between degree of compression, duration of symptoms, site of pain and presence of weakness and numbness. Independent samples test (Levenes test) and Chi-square test were used to determine the significance of associations between age, gender, chronicity of symptoms and MRI findings. A p-value of <0.05 was considered to indicate statistically significant association. RESULTS: The study included 120 patients, the age range was 22 to 88 years (mean 47 years). Twenty-three patients had acute pain of less than 2 months, 40 patients had recurrence of previous symptoms within past 2 months and 57 patients had chronic pain. Disc herniation was most frequent finding seen in 107 patients (89%). Eighty-eight patients (73%) had MRI evidence showing some degree of nerve or thecal sac compression. Severe nerve compression was present in 48 patients (40%). Disc extrusion was present in 22 patients (18%). There was no significant association between segmental distribution of symptoms and presence of anatomic impairment. However, severe nerve compression and disc extrusion were significantly associated with pain distal to the knees. CONCLUSION: The presence of disc extrusion or ipsilateral severe nerve compression at one or multiple side is strongly associated with distal leg pain. There should be a correlation between patient symptoms and signs of sciatica and imaging demonstration of nerve root compression before invasive therapy is undertaken.

Transcatheter embolization of acute non-variceal gastrointestinal hemorrhage.

OBJECTIVE: To determine the efficacy and safety of transcatheter embolization of nonvariceal gastrointestinal hemorrhage. DESIGN: Descriptive analytical study. PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, Pakistan, from October 1999 to August 2004. SUBJECTS AND METHODS: The study included 27 patients who underwent angiography for suspected gastrointestinal hemorrhage. The presumptive diagnosis was based on the findings of endoscopy in 08 patients, scintigraphy in 05 patients and on clinical findings only in 14 patients. Nine patients had gastroduodenal hemorrhage, 04 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Five patients had comorbidities. One patient had uremia, 2 had hepatitis C, 1 had cirrhosis and 1 had coagulopathy. Technical success, clinical success, complications and patient survival were assessed. RESULTS: Nine patients had upper gastrointestinal hemorrhage, 4 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Etiology of bleeding was known in 15 patients and unknown in 12 patients. Clinical success was achieved in 23 (85.18%) of 27 patients. Two patients had early rebleeding. One of these was managed surgically and recovered. The other had severe coagulopathy and was unfit for surgery. Two patients had bowel infarction, one of these was managed surgically and recovered and the other died of complication of procedure. One patient had small splenic infarcts and was managed conservatively. Overall 85.18% success was achieved for the embolization procedure. Two of 27 patients died. One patient died because of recurrence of bleeding and other died because of infarction of right hemi-colon which occurred as complication of embolization. CONCLUSION: Transcatheter embolization is effective and safe in patients with nonvariceal gastrointestinal hemorrhage.