Three-dimensional computed tomography analysis of the atlanto-dental interval in a healthy Karachi population: a single-center retrospective cross-sectional study.

Background: The atlantoaxial joint has a complex anatomical configuration and has a wide range of mobility. Traumatic, inflammatory, and neoplastic joint pathologies frequently affect this joint. The aim of this retrospective cross-sectional study was to evaluate the atlanto-dental intervals (ADI) in patients who underwent computed tomography (CT) scans of the neck and cervical spine in at a Tertiary Care Hospital in Karachi, Pakistan. Methods: This was a retrospective cross-sectional study conducted at a tertiary care hospital in Karachi between 1 January 2021 and 31 December 2021, following approval from the hospital ethical review committee. Patients above the age of 15 who underwent CT scans were included, while individuals with a history of cervical trauma, infection, rheumatoid arthritis, or congenital anomalies, as well as those younger than 15 years old, were excluded. CT scans were performed using a multidetector scanner utilizing a standardized protocol. Sagittal and coronal images were reconstructed. ADI measurements, including anterior ADI (AADI), posterior ADI (PADI), and lateral ADI (LADI) on both sides, were determined using appropriate bone window settings. A radiologist with a minimum of 3 years of experience analyzed the CT scans. Results: The mean age of the patients was 49.3±17.7 years (age range: 16-85 years). The mean AADI was 1.4±0.4 mm, with a range of 0.0-2.1 mm. The mean PADI was 19.1±1.9 mm, with a range of 13.8-24.6 mm. The mean left LADI measurement was 3.3±1.2 mm with a range of 1.2-10.0 mm, and the mean right LADI measurement was 3.2±1.1 mm with a range of 1.2-6.3 mm. Conclusion: Our study examined the ADI in patients who underwent CT scans of the neck and cervical spine in Karachi. The findings provide valuable insights into the relationship between ADI measurements, age, and sex. These results contribute to our understanding of the anatomical variations in this region, which may aid in the diagnosis and management of cervical spine disorders.

A Rare Case of Single Gallbladder and Multiple Pancreatic Metastases of Renal Cell Carcinoma.

Renal cell carcinoma (RCC) is the most common tumor to metastasize to uncommon sites. Synchronous metastases in the gall bladder and pancreas are rare entities. In this report, we present the case of a 43-year-old male with a complaint of hematuria presenting with a left renal mass. Contrast-enhanced CT revealed an arterially enhancing mass in the left kidney, a synchronous tiny polyp in the gall bladder, and multiple focal lesions in the pancreas. The patient underwent surgery and the tumor was histopathologically labeled as a clear cell RCC with metastases to the pancreas and gall bladder. Post-surgery, the patient has been followed up.

Non-Hodgkin's Vaginal Lymphoma: A Rare Presentation.

Vaginal non-Hodgkin's lymphoma (NHL) is a rare entity. We report a case of a 38-year-old lady who presented with complaints of lower abdominal pain for three to four months and vaginal bleeding for one month. Her examination under general anesthesia revealed a hard vaginal mass which was biopsied and immunohistochemistry was performed. Diagnosis of diffuse B­cell NHL (DLBCL) was made. Imaging plays an important role to reach the diagnosis. Chemotherapy is the treatment of choice.

Diaphragmatic Hernia Presenting as Acute Gastric Outlet Obstruction: A Rare Complication of Left Lower Lobectomy.

Diaphragmatic hernia is defined as the prolapse of abdominal contents into the thoracic cavity through a defect in the diaphragm that is either congenital or acquired. Acquired hernias are common in adults and frequently occur as the result of trauma, either iatrogenic or non-iatrogenic. Iatrogenic diaphragmatic hernia is a rare complication of patient-related treatment maneuvers/procedures. The rate of late presentations of an iatrogenic diaphragmatic hernia is disparate, ranging from 5 to 62%. Iatrogenic diaphragmatic hernia after pulmonary resection is extremely rare with only two case reports published worldwide so far. In this report, we discuss the case of a young male presenting several years after undergoing left lower lobectomy with signs and symptoms of acute gastric outlet obstruction.

Metastatic Choriocarcinoma of the Breast: A Rare Entity.

Breast neoplasms are becoming more common in the last few years. Among these masses, metastasis to the breast is rare. Extra-gestational choriocarcinoma is extremely rare among breast neoplasms. We intend to present a case of a 30-year-old female with complaints of breast and axillary lumps. She had a history of a previously treated uterine trophoblastic tumor. Subsequently, she underwent a trucut biopsy of the breast mass and the axillary node, revealing metastatic choriocarcinoma.

Frequency of ABO Blood Group in Pregnant Women and Its Correlation With Pregnancy-Related Complications.

Introduction The ABO blood group type has been considered an independent risk factor in the occurrence of pregnancy-related complications leading to significant morbidity and mortality in pregnant mothers and neonates. This study aims to determine the maternal ABO blood group and its correlation with pregnancy-related complications. Methods We analysed data of 497 pregnant female patients aged between 25 and 40 years who presented with a gestational age of > 14 weeks from June 1, 2020, to November 30, 2020. Patients' age, parity, gestational age at the first visit, body mass index (BMI) at the first visit, ABO blood group, gestational age at delivery, mode of delivery, birth weight of neonate, and pregnancy-related complications including preeclampsia, gestational diabetes mellitus (GDM), preterm delivery, low birth weight (LBW), and small for gestational age (SGA) infants were evaluated. Results The mean age of 497 patients was 27.6 (27.62 ± 3.35) years. Mean BMI was 22.7 (22.7 ± 3.1 kg/m2), parity was 1.85 (1.85 ± 2.3), gestational age at first visit was 23.19 (23.19 ± 3.4) weeks and gestational age at delivery was 37.0 (37.0 ± 2.6) weeks. There were 205 (41.25%) spontaneous vaginal delivery and 292 (58.75%) cesarean sections. The average birth weight of the neonate was 2684.31 ± 622.4 g. Preeclampsia was observed in 107 (21.53%), GDM in 17 (3.42%), and preterm delivery in 154 (30.99%) women. Considering the neonatal outcome, 124 (24.95%) babies had LBW and 49 (9.86%) were SGA. The rate of preeclampsia and GDM was not statistically significant among different blood groups while the rate of preterm delivery, LBW, and SGA was significant among women with different blood groups. Conclusion We conclude that the ABO blood group is associated with maternal and neonatal pregnancy-related complications when considering the risk of preterm delivery, LBW, and SGA but not with GDM and preeclampsia. This finding will help clinicians to identify the patients at risk of developing pregnancy-related complications and hence, to take timely and appropriate measures.

Vasitis Nodosa: A Rare Diagnosis for Inguinal Swelling.

Vasitis nodosa involves benign, reactive spindle-shaped nodular thickening of the ductal epithelium of vas deferens. We report the case of a 21-year-old male with a history of bilateral undescended testes and left orchidopexy. The patient presented with the complaint of a non-tender left inguinal swelling. The definitive diagnosis of vasitis nodosa was made based on clinical evaluation and imaging findings. We suggest that this rare entity should be considered as a differential diagnosis of inguinal swelling during the assessment of the male urogenital system.

Right Scapular Swelling Revealed to Be a Spontaneous Lateral Chest Wall Hematoma: An Intriguing Case Report.

Chest wall hematoma commonly occurs as a result of blunt thoracic trauma. We report an intriguing case of spontaneous lateral chest wall hematoma that presented with right scapular swelling and tenderness on palpation having hemodynamic instability without any prior history of recent trauma or surgery. Chest x-ray and ultrasound were carried out at the time of admission to evaluate the swelling, followed by contrast-enhanced CT (CECT) of the chest to identify and localize the bleeder. Transcatheter arterial embolization (TAE) of the intercostal artery was performed to treat the condition successfully. CECT is found to be vitally important in localizing bleeders. Other possible options include exploratory thoracotomy, video-assisted thoracic surgery (VATS) exploration, and angiography.

Role of Multidetector Computed Tomography with Multiplanar and Curved Multiplanar Reformations in the Detection of Cause of Intestinal Obstruction: A Tertiary Care Experience.

Objective To determine the role of multidetector computed tomography (MDCT) with multiplanar (MPR) and curved multiplanar reformations (CMPR) in the detection of the cause of intestinal obstruction. Materials and methods A retrospective analysis of 200 patients with a clinical suspicion of intestinal obstruction referred to the department of radiology, Dr. Ziauddin University Hospital, Clifton campus, from September 2016 to October 2019, was done. All patients who underwent an MDCT scan with oral and intravenous (I/V) contrast were included in the study. Patients with deranged serum creatinine and an allergic reaction to contrast were excluded from the study. MPR and CMPR images were acquired in each patient in addition to routine axial images. The causes of intestinal obstruction as determined by a computed tomography (CT) scan were confirmed on surgery and colonoscopy. The CT scans were analyzed by an independent radiologist with five years of experience blinded to the surgical and colonoscopy findings in detecting the cause of bowel obstruction using the axial, MPR, and CMPR images. Data analysis was done on IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY). Results Out of 200 patients with a clinical suspicion of intestinal obstruction, 120 patients with intestinal obstruction was confirmed on CT scan. Fifty-eight patients were males (48.33%) and 62 patients were females (51.66%) with a male-to-female ratio of 1:1.06. The mean age of the patients was 54.7 years (age range from 06 years to 85 years). Abdominal distension was the most common presentation seen in 37 patients (30.83%) followed by vomiting in 25 patients (20.83%). Small bowel obstruction was seen in 96 patients (80.00%) with the ileum being the most common site of obstruction seen in 76 patients (63.33%). Among the patients with the ileum being the site of obstruction, distal ileal obstruction was seen in the majority of patients (30 patients, with a frequency of 25.00%). Twenty-three patients (19.16%) had a large bowel obstruction, with sigmoid colon involvement seen as the most common site in 10 patients (8.33%). Adhesions were the leading extrinsic cause of bowel obstruction seen in 32 patients (26.6%). Intraluminal causes of obstruction were seen in 36 patients (30.0%) with carcinoma being the commonest cause (12 patients with a frequency of 10.0%). A foreign body is the primary cause of intraluminal obstruction (three patients, with a frequency of 2.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 86.2%, 92.7%, 90.1%, and 96.4%, respectively. Conclusion MDCT has high sensitivity and specificity to diagnose and determine the cause of bowel obstruction. It not only determines the site of obstruction but also the cause of obstruction, including intrinsic, extrinsic, and intraluminal causes.

Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone (The Metabolic Resuscitation Protocol) on Early Weaning from Vasopressors in Patients with Septic Shock. A Descriptive Case Series Study.

OBJECTIVES:  The aim of this study was to assess the efficacy of intravenous vitamin C, hydrocortisone, and thiamine in early weaning (within 48 hours) from vasopressor support in patients with septic shock. We also aimed to assess mortality and intensive care unit (ICU) stay. STUDY DESIGN:  We conducted a descriptive case series study of 50 patients with septic shock who were admitted in the ICU of the Combined Military Hospital Rawalpindi in Pakistan from August 2017 until April 2018. MATERIALS AND METHODS:  The study included men and women (16 to 80 years of age) who were admitted to the ICU with septic shock. Data were analysed using the IBM Statistical Package for Social Sciences (SPSS), version 18.0 (IBM Corp., Armonk, NY, USA). Inferential analysis was done with the help of simple and multivariate binary logistic regression that generated unadjusted and adjusted odds ratios (OR), respectively. RESULTS:  Of the 50 patients, 56% (N = 28) were male with a mean age of the respondents being 46.7 ± 18.4. Eighty-four percent were successfully weaned off vasopressors within 48 hours. Median days in the ICU were reported as 8.3 (interquartile range (IQR) = 5). Primary bacteremia (34%) was the most reported cause of ICU admission. The most common vasopressor was norepinephrine and its mean dose was 21.6 ± 10.7 microgram/min. The ICU mortality was observed at 52% (N = 26). Unadjusted OR showed a dose of norepinephrine, Sequential Organ Failure Assessment (SOFA) score, plasma procalcitonin, and plasma lactate to be significant predictors (p-value < 0.05), while the adjusted odds ratio (AOR) showed only a dose of norepinephrine to be a statistically significant predictor (AOR = 0.804, 95% CI = 0.674 - 0.960; p-value = 0.016). CONCLUSION:  The administration of intravenous vitamin C, hydrocortisone, and thiamine to patients with septic shock was successful in early weaning from vasopressors. There was also a reduction in procalcitonin and lactate levels, as well as the SOFA score. Further trials are needed to determine whether the metabolic resuscitation protocol can become part of the treatment for septic shock.

Role of Interventional Radiology in the Management of Peripheral Vascular Malformations: A Tertiary Care Center Experience.

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our approach. Materials and methods A retrospective review of all patients with PVMs treated in our interventional radiology department from 2011 to 2017 was carried out. Medical records, imaging, and follow-up notes were reviewed to evaluate the response to treatment and post-procedure complications. Results Thirty-four sessions were performed in 15 patients (eight male, seven female) with PVMs. Low-flow lesions were identified in 10, intermediate flow in one, and high flow in four patients. Sodium tetradecyl sulfate (STS) was used as the sclerotherapeutic agent in 10 (66.67%), glue with lipoidal in three (20.0%), and bleomycin in one patient (6.67%). Coils with PVA and a covered stent were used in one and a combination of coil, PVA, and gel foam was used in one patient. A marked response was seen in 11 and a partial response in four patients. One patient developed foot gangrene. Stent thrombosis was noted in one patient with no clinical consequences. Recurrence was seen in two patients, who were lost to follow up. Conclusion PVMs are complex lesions. Sclerotherapy with or without embolization is a safe and effective treatment modality, with clinical response approaching 100%.