Is MDCT an accurate tool to differentiate between benign and malignant etiology in diffuse peritoneal disease?

PURPOSE: There is often considerable overlap of imaging findings in benign and malignant peritoneal diseases. We evaluated patients with diffuse peritoneal disease, to assess the diagnostic value of MDCT in predicting benign or malignant etiology in patients with unknown etiology, by analyzing the various patterns of involvement, particularly tuberculosis (TB) vs malignancy. METHODS: One hundred and thirty-six patients with diffuse peritoneal disease who had abdominal CT and subsequently underwent omental biopsies were included in the study. Peritoneal, mesenteric and omental involvement by disease was evaluated on CT using specific parameters. The presence of lymphadenopathy, ascites, scalloping of organs, involvement of liver and spleen, were also compared between benign and malignant conditions using histopathology as the gold standard. RESULTS: In 136 patients, 72 benign and 64 malignant pathologies were classified as per histopathology. Higher age (p < 0.001), increasing omental thickness (mean 25.2 mm, p = 0.004), omental caking (p < 0.001), > 10 mm mesenteric/peritoneal nodules (p < 0.03), visceral scalloping (p = 0.001), free ascites (p = 0.003), serosal involvement (p = 0.004) and bilateral pleural effusion (p = 0.02) were associated with malignant etiology. Mesenteric thickening/stranding (p = 0.02), mesenteric adenopathy (p < 0.001), necrotic nodes (p = 0.02), splenomegaly (p = < 0.001) and higher attenuation (> 20HU) of ascitic fluid (p < 0.001) were associated with benign etiology. The presence of mesenteric thickening or stranding (p = 0.01), splenomegaly (p = 0.02), higher ascitic fluid attenuation > 20HU (p = < 0.01), mesenteric adenopathy (p < 0.01), necrotic nodes (p = 0.03) favored tuberculosis. CT had diagnostic accuracy (79.3, 86.7%), sensitivity (79.2, 74.6%) and specificity (79.4, 97%) for observers 1 and 2, respectively (Kappa 0.713). CONCLUSION: Contrast-enhanced MDCT has good sensitivity, specificity and accuracy in differentiating benign and malignant etiologies of diffuse peritoneal disease. Multiple common parameters can be used to differentiate between tuberculous peritonitis and peritoneal carcinomatosis.

Osseous Hydatidosis of Femur in a Patient with Fracture Non-union: An Uncommon Entity.

Hydatid disease caused by the larval form of the parasitic tapeworm, Echinococcus granulosus, commonly affects the liver and lungs. Bone involvement by Hydatid is extremely uncommon and is reported in 1-3% of cases. It is often a dormant disease, presenting at a late stage with non-specific clinical and radiological findings. Usually they occur as an isolated entity without liver/lung involvement and a clinical suspicion of this disease is not possible. We report a rare case of Hydatid cyst of femur in a 25-year-old female, with unresolving non-union of fracture for five years. The occurrence of this disease in atypical locations and lack of a specific radiological sign makes the diagnosis challenging and it is important for the orthopaedicians and pathologists to be aware of this entity for a precise diagnosis.

Influence of music on operation theatre staff.

BACKGROUND AND OBJECTIVE: The purpose of the study was to evaluate the perception of influence of music among surgeons, anesthesiologist and nurses in our hospital as well as to critically evaluate whether music can be used as an aid in improving the work efficiency of medical personnel in the operation theatre (OT). MATERIALS AND METHODS: A prospective, questionnaire-based cross-sectional study was conducted. A total of 100 randomly selected subjects were interviewed, which included 44 surgeons, 25 anesthesiologists and 31 nurses. Statistical package for social sciences (SPSS) Windows Version 16 software was used for statistical evaluation. RESULTS: Most of the OT medical personnel were found to be aware of the beneficial effects of music, with 87% consenting to the playing of music in the OT. It was also found that most participants agreed to have heard music on a regular basis in the OT, while 17% had heard it whenever they have been to the OT. CONCLUSIONS: Majority of the respondent's preferred playing music in the OT which helped them relax. It improved the cognitive function of the listeners and created a sense of well being among the people and elevated mood in them. Music helped in reducing the autonomic reactivity of theatre personnel in stressful surgeries allowing them to approach their surgeries in a more thoughtful and relaxed manner. Qualitative, objective and comprehensive effect of specific music types varied with different individuals. Music can aid in improving the work efficiency of medical personnel in the OT. The study has reinforced the beneficial effects of playing music in the OT outweighing its deleterious outcomes.