Correlation between Femoral Intercondylar Notch Width and Anterior Cruciate and Posterior Cruciate Ligament Widths on MRI of Knee Joint.

Background Anatomic variations have been implicated as one of the intrinsic causes of injuries to the cruciate ligaments which can induce a functional deficiency to the knee. Narrow cruciate ligament widths as well as narrow femoral intercondylar notch widths can increase the risk of these ligaments rupturing. Objective To correlate the width of the femoral intercondylar notch (ICN) with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) widths on MRI of the knee joint. Method A total of 46 patients who met the inclusion criteria were evaluated. Intercondylar notch was identified on coronal T1W images while anterior cruciate ligament and posterior cruciate ligament were identified on proton density coronal images. All the widths were measured in the same plane at a mid-coronal level where anterior cruciate ligament and posterior cruciate ligament cross each other. Result Our result showed a significant correlation between the widths of intercondylar notch and anterior cruciate ligament (r = 0.68, p < 0.001) and between intercondylar notch width (INW) and posterior cruciate ligament width (r = 0.65, p < 0.001). Overall, the mean intercondylar notch width measured was 17.5 ±2.5 mm (range 11.8 to 21.8 mm), the mean anterior cruciate ligament width was 5.9 ±1.3 mm (range 3.3 to 8.6 mm), and the mean posterior cruciate ligament width was 8.9 ±1.5 mm (range 5.9 to 11.8 mm). A statistically significant difference was observed between males and females for mean widths of intercondylar notch (p < 0.001) and posterior cruciate ligament (p=0.01). However, no statistically significant difference was seen for anterior cruciate ligament width (p=0.07) between the two genders. Conclusion Measurement of the femoral intercondylar notch width can be used as an indicator of anterior cruciate ligament and posterior cruciate ligament widths which can further assist to identify the individuals who are more susceptible to cruciate ligament injuries.

Correlation between Sonoelastographic, Doppler and Histopathological Findings in Chronic Kidney Disease Patients in Tertiary Care Centre.

Background Ultrasound (USG) with Doppler examination of intrarenal vessels is the imaging modality of choice employed in patients with renal failure and is commonly performed early in the clinical course. The pulsatility index (PI) and the resistive index (RI) of downstream renal artery have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. Pathological process in any tissues alters their elastic properties which can be assessed non-invasively through newer technique like elastography. Objective To correlate the findings obtained by sonoelastographic, doppler and histopathological studies in chronic kidney disease patients. Method Study was done in 146 patients referred to Department of Radiodiagnosis and Imaging, TUTH for native renal biopsy. Renal sonographic morphology (length, echogenicity, cortical thickness), Sonoelastography (Young's modulus) and Doppler parameters (peak systolic velocity, resistive index) were assessed. The grading of estimated GFR (eGFR) was calculated based on chronic kidney disease (CKD) criteria. Result Among 146 patients, 63 (43.2%) were females and 83 (56.8%) were males. Maximum patients were in age group of 41-50 years (25.3%) followed by age group 51-60 years (24%). Mean age of patient was 42.06±14.70 for males and 39.57±12.54 females. Maximum mean Young's modulus was seen in eGFR stage G1 with 46.57±19.51 kPa followed by in stage G3a with 36.46±10.01 kPa and observed to be statistically non-significant (p=0.172). However, statistical significance difference was noted between the resistive index and elastographic measurement of Young's modulus (r=0.462, p=0.0001). Minimum mean cortical thickness was seen in eGFR stage G5 with 4.42±1.48 mm followed by stage G4 with 5.57±1.24 mm (p= 0.0001). Cortical thickness is decreasing as eGFR stage was increasing in our study (p=0.0001). Resistive index is increasing with decrease in renal size (r=-0.202, p=0.015). Conclusion Ultrasonography along with doppler study and elastography have limited role in diagnosing the pathology of chronic kidney disease, however, it has significant role in the disease progression.

Real Time Trans-Rectal Elastography of Prostate Correlation with Histopathology in a Suspected Case of Prostate Cancer.

Background Early detection of prostate cancer, the second most common cancer in men worldwide, is the key for its successful treatment. Commonly used clinical criteria and imaging tools for detection of prostate cancer are less sensitive. Objective This study was aimed to find role of real time transrectal elastography of prostate for detection of prostate cancer. Method Study was conducted in 66 patients with clinical suspicion of prostate cancer, who were sent for ultrasound guided prostate biopsy. Transrectal ultrasound with real time elastography was performed in all the patients prior to the biopsy and looked for hard areas within the prostate. Then six-core tru-cut biopsy were taken in six zones of prostate, including the hard areas detected in the elastography. The histopathology report were correlated with the elastography findings. Result Median prostate specific antigen of the patients was 11.5 ng/ml with interquartile range of 8 to 23.5 ng/ml. Digital rectal examination showed hard nodular findings in 35 patients. Transrectal ultrasound showed 81 hypoechoic lesions in 31 patients. Elastography showed 127 hard areas in 31 patients. Histopathology showed 90 positive biopsy cores in 23 patients. Cancer detection rate of elastography was 82.6%. At 95% confidence interval, patients with elastography detected hard lesions had 19.4 times more likelihood to have prostate cancer. Sensitivity of elastography was high as compared to digital rectal examination and transrectal ultrasound alone. Conclusion Transrectal elastography had high sensitivity over clinical tools and transrectal ultrasonography for detection of prostate cancer.

Computed Tomography in the Evaluation of Pathological Lesions of Paranasal Sinuses.

BACKGROUND: Computed tomography is now the modality of choice for imaging paranasal sinuses and along with Functional Endoscopic Sinus Surgery has empowered the modern rhinologist to treat patients more effectively. This study aims to evaluate anatomical variation in paranasal sinuses; compare computed tomography with histopathological and surgical findings and establish its diagnostic value. METHODS: A hospital based observational study including all patients referred from the department of Ear, Nose and Throat for computed tomography scan of paranasal sinus to the department of radiology and imaging of Trubhuvan University Teaching Hospital from August 2011 to July 2012. Both axial and coronal sections were evaluated and findings were correlated with surgical findings and histopathology. RESULTS: A total of 44 patients were included in the study. The most common clinical diagnosis was sinonasal polyposis and chronic rhinosinusitis. Most common anatomical variation was deviated nasal septum (68.2%) followed by choncha bullosa(27%). In most cases more than one sinus was involved. Maxillary sinus was involved in 90.9% followed by ethmoid sinus in 81.8%. Inflammatory pathology was seen in 35 (79.5%) patients with sinonasal polyposis pattern being the most common pattern of involvement. Findings of computed tomography were similar to surgical findings in 84.6% cases. The sensitivity and specificity of computed tomography was fairly good except for fungal rhinosinusitis. CONCLUSIONS: CT scan should be performed preoperatively in order to guide the surgeon for Functional Endoscopic Sinus Surgery or other surgical procedures.

Ultrasonographic evaluation of carotid intima-media thickness in hypertensive and normotensive individuals.

This was a case control study designed to evaluate carotid intima-medial thickness (IMT) by high-resolution ultrasound in hypertensive and normotensive individuals. High-resolution carotid ultrasound was done in 203 hypertensive patients (cases) and 101 normotensive individuals (control). Scanning of bilateral common carotid artery (CCA) was performed in anteroposterior projections. To obtain a better image sound wave was adjusted perpendicularly to the arterial surface of the posterior wall of the vessel, yielding two parallel echogenic lines which correspond to lumen-intima and media-adventitia interfaces. Intima-medial thickness was measured in the far wall 1-1.5 cm proximal to the bulb bilaterally. The age of the study population ranged from 35 to 65 years. Mean IMT was significantly high in hypertensive patients compared to the control group, p<0.001 (in cases, IMT in right side was 0.968 mm and that of left side was 0.969 mm and in control group IMT of right side was 0.551 mm and that of left side was 0.555 mm). A significant difference in IMT of bilateral common carotid arteries was found between the smoker and non-smoker hypertensive patients (p<0.02). IMT was found to increase progressively with age. In conclusion, the study revealed a strong correlation between IMT of common carotid artery and hypertension. Hence, IMT measurement of CCA by high-resolution ultrasound in hypertensive patients is a helpful tool to assess the atherosclerosis and to identify individual at risk of cardiovascular and cerebrovascular complications.

Isolation and molecular identification of extracellular polymeric substances (EPS) producing bacterial strains for sludge settling and dewatering.

One of the major problems in overall wastewater treatment process is sludge settling and dewatering. In general, sludge settling and dewatering is carried out using conventional physico-chemical methods that are known to be expensive, and these processes further increase the sludge volume and ultimate disposal costs. To overcome this problem, a suitable alternative could be the use of bioflocculants for sludge settling and dewatering. To achieve bioflocculation, extracellular polymeric substances (EPS) producing bacterial strains were isolated from the complex microbial community of wastewater sludge. Crude EPS produced in the form of bacterial broth was used to test kaolin flocculation activity. Three out of 10 bacterial strains (B2, B8 and B9) were pre-selected for sludge settling. Based on sludge settling and dewatering results, B8 possessed better flocculating property than other bacterial strains. These sludge microorganisms were identified based on their 16S rDNA sequences and bacterial strain B8 was identified as Serratia sps.

Long-term land application of biosolids-a case study.

Impact of long-term land application of biosolids on groundwater and soil quality of an application site, which had been operated for 8-15 years, was evaluated in this study. During and after the biosolids application, biosolids-amended soil, groundwater, and background soil samples were collected mainly for pathogen, nitrogen, phosphorus, and heavy metal analyses. Soil test data showed that there was no heavy metal accumulation in the biosolids-amended soil even after 10 years of biosolids application. Similar results were also observed from the groundwater samples in which the heavy metal concentrations in all groundwater samples were well below the maximum contamination levels of the drinking water standards. In addition, bacteriological levels of the soil and groundwater samples were close to the background level and below the permissible limits, respectively, thereby showing no pathogen contamination. However, nitrate-nitrogen contamination of the groundwater was occasionally observed probably due to an excess loading of the biosolids in the past. This problem can be alleviated by applying biosolids at agronomic rates so that no excess nitrogen is available for leaching down to the groundwater.

Accuracy of ultrasonography in evaluation of level and cause of biliary obstruction: a prospective study.

AIM: To find out the accuracy of ultrasound in evaluation of level and cause of biliary obstruction. MATERIALS AND METHODS: Forty-five patients (26 to 86 years of age) with suspected biliary obstruction underwent Ultrasonography followed by Direct Cholangiograms (Percutaneous Transhepatic Cholangiography / Endoscopic Retrograde Cholangiography). The levels of biliary obstructions were grouped as hilar, suprapancreatic and intrapancreatic. Similarly the causes were grouped as malignant and benign. Diagnosis was confirmed either at surgery or histopathologically (USG-guided FNAC or ERC-biopsy). RESULTS: Ultrasonography accurately identified the level of obstruction in 89 %( hilar), 91% (suprapancreatic) and 87% ( intrapancreatic) cases. Malignancy was found in 33 patients and remaining 12 had benign diseases. USG accurately identified malignant and benign causes in 91% and 84% cases respectively. Findings were found to be statistically significant (p-value =< 0.05 at 95%confidence interval). CONCLUSION: This study showed that USG has high accuracy in identifying the level and cause of biliary obstruction. Considering cost, availability and patient friendly nature, Ultrasound should be the first imaging modality of choice in evaluation of biliary obstruction.

Predictive value of ultrasonography in the diagnosis of palpable breast lump.

A lump is the first symptom in over 80 percent of all patients with cancer of the breast. Consequently, the finding of any lump in the breast is a highly significant sign and warrants a thorough investigation. The present study was undertaken to study the predictive value of ultrasonography in the diagnosis of palpable breast lumps. Fifty-two female patients with palpable breast lumps that were unilateral underwent ultrasonography of the breast. Thirty-six of these patients who had solitary, unilateral, solid lumps were followed up with FNAC/biopsy/mammography and the findings were compared. The mean age group was seen to be 41 years. The youngest patient was 17 years old and the oldest was 80 years. The validity of USG in the diagnosis of palpable breast lumps was calculated. A sensitivity value of 95%, specificity of 94.10%, positive and negative predictive values of 95.50% and 93.75% were noted and were comparable to other similar studies. The sensitivity, specificity, positive and negative predictive values were statistically significant (p=0.0000006) and were comparable to the values obtained by different studies conducted elsewhere. Among the multiple USG parameters, shape, margins, vascularity, surrounding tissue character, sound transmission through the lump were more significant in the diagnosis of benign vs. malignant lumps. Echogenicity and echotexture were of less significance.

Optimization of ambient air quality monitoring networks : (Part I).

A method has been developed to obtain a joint solution to the problem of optimum number and configuration of ambient air quality monitors, on the principles of spatial correlation analysis and the minimum spanning tree. The interest in this case is to represent the patterns of regional air quality, at a minimum of an overlap of information. This methodology is extended to account for the uncertainties in air quality simulations and also to incorporate the probabilities of occurrence. As an illustration to these methodologies, an example of Taipei City, Taiwan has been considered.

Optimization of ambient air quality monitoring networks : (Part II).

Minimum Spanning Tree (MST) algorithm developed by Modak and Lohani (1984a) has been extended to consider multiple objectives for the optimum siting of ambient air monitors. Two approaches have been proposed, namely one based on the utility function and another based on the principles of sequential interactive compromise. The sequential interactive approach is heuristic but perhaps best suited to consider several objectives at a time, and particularly when professional judgements are also involved. The utility function approach may be normally restricted to two objectives at a time, but could be extended to consider a number of pollutants in the optimum design. For the purpose of illustration, the case of Taipei City, Taiwan has been considered.

Optimization of ambient Air Quality Monitoring Networks : (Part III).

The methodologies presented in Parts I and II (refer Modak and Lohani, 1984a and b) are essentially for deciding the best number and configuration for a single pollutant monitor. In practical situations however, Air Quality Monitoring Networks (AQMN) are expected to measure more than one pollutant and therefore simultaneous consideration of different types of pollutants must be made.In this paper, two new approaches have been developed for the multipollutant AQMN design. The first method makes use of the index theory and the other makes use of the principles of Pareto optimality. As an illustration of these methodologies, an example from Taipei City, Taiwan is considered.