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Labrad : Vol 40, Issue 1 - April 2014, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Provocative Testing for Growth Hormone Disorders
• Serum Procalcitonin for Early Sepsis Diagnosis
• Monoclonal Gammopathy of Undetermined Significance (MGUS)
• Understanding Six Sigma Methodology
• Blood Collection for Culture
• Molecular Analysis of Alpha Thalassaemia by Multiple Ligation Probe Assay
• Prognostification of Acute Myeloid Leukemia with FLT 3 Mutation
• Interferon Gamma Release Assay (IGRA) for Detection of Mycobacterium Tuberculosis Infection in the Host
• Meeting Report: The 37th Annual Conference of the Pakistan Association of Pathologists

Correlations Of Skin Fold Thickness And Validation Of Prediction Equations Using Dexa As The Gold Standard For Estimation Of Body Fat Composition In Pakistani Children., Zainab Hussain, Tazeen H. Jafar, Maseeh Uz Zaman, Riffat Parveen Hussain

Department of Radiology

OBJECTIVE:

To determine the correlation between dual energy X-ray absorptiometry (DEXA) and skin fold thickness (SKF) equations for estimation of body fat (BF) composition in secondary school children and validation of prediction equations by Slaughter, Goran and Dezenberg.

DESIGN:

Cross sectional analytical study.

SETTING:

Joint Commission for International Accredited (JCIA) tertiary care hospital of Karachi, Pakistan from January 2010 to May 2010.

PARTICIPANTS:

The study was approved by the Hospital's ethical review committee. Written and verbal consents were obtained from principals of two schools and parents of 99 children (mean age of 14±1.89 years; min-max 9-19 years; 54 men and …

5-Fu Induced Acute Toxic Leukoencephalopathy: Early Recognition And Reversibility On Dwi-Mri, Shayan Sirat Maheen Anwar,, Fatima Mubarak, Zafar Sajjad, Muhammad Azeemuddin

Department of Radiology

Acute toxic leukoencephalopathy (ATL) is a rare adverse effect of 5-Fluorouracil (5-FU) chemotherapeutic agent. It is imperative for the radiologist to confidently identify the white matter changes caused by this agent in case of toxicity. This will help in early detection and appropriate management of patient, as the condition is reversible both clinically and on imaging. We report a case of a 29 years old gentleman, known case of carcinoma of esophagus who suffered from acute toxic leukoencephalopathy secondary to leukotoxic therapeutic agent 5-FU, and illustrate the reversible imaging findings of this condition on withdrawal of the inciting agent.

Gossypiboma Diagnosed Fifteen Years After A Cesarean Section: A Case Report, Abdul Rehman, Noor Ul-Ain Baloch, Muhammad Awais

Department of Biological & Biomedical Sciences

Gossypiboma, a retained surgical sponge, is a rare complication following any surgical procedure and is primarily a result of human error. Such patients often have vague clinical presentations and the diagnosis often comes as a surprise. We present the case of a 40-year-old woman who had a long-standing history of lower abdominal discomfort. She was diagnosed with a gossypiboma fifteen years after a cesarean section. All general physicians, surgeons and radiologists must be aware of this rare but clinically significant entity.

18fdg Synthesis And Supply: A Journey From Existing Centralized To Future Decentralized Models, Maseeh Uz Zaman, Nosheen Fatima, Zafar Sajjad, Unaiza Zaman, Rabia Tahseen, Areeba Zaman

Department of Radiology

Positron emission tomography (PET) as the functional component of current hybrid imaging (like PET/ CT or PET/MRI) seems to dominate the horizon of medical imaging in coming decades. 18Flourodeoxyglucose (18FDG) is the most commonly used probe in oncology and also in cardiology and neurology around the globe. However, the major capital cost and exorbitant running expenditure of low to medium energy cyclotrons (about 20 MeV) and radiochemistry units are the seminal reasons of low number of cyclotrons but mushroom growth pattern of PET scanners. This fact and longer half-life of 18F (110 minutes) have paved the path of a centralized …

Mdct Of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images In Localizing Point Of Transition?, Wasim Memon, Yasir Jamil Khattak, Tariq Alam, Luca Maria Sconfienza, Muhammad Awais, Shayan Sirat Maheen Anwar

Department of Radiology

The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar's test was used to detect any statistical difference in POT …

Assessment Of Apparent Diffusion Coefficient Values As Predictor Of Aggressiveness In Peripheral Zone Prostate Cancer: Comparison With Gleason Score, Shayan Sirat Maheen Anwar, Zahid Anwar Khan, Rana Shoaib Hamid, Fahd Haroon, Raza Sayani, Madiha Beg, Yasir Jamil Khattak

Department of Radiology

Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants …

Knowledge, Attitudes And Practices Of Parents Regarding Antibiotic Use In Children, Saad Siddiqui, Mubeen Sultan Cheema, Romana Ayub, Noreen Shah, Ameer Hamza, Sheraz Hussain, Muhammad Hamza Khan, Syed Musa Raza

Department of Radiology

Background: Emerging resistance to antimicrobial chemotherapy is becoming a challenge for medicine in recent times. Un-prescribed use of antibiotics is a major contributor to development of this problem. In Pakistan access to antibiotics remains unchecked and hence results in it are over use. The aim of this study was to assess knowledge of parents regarding use of antibiotics, its associated problems, their source of information and their expectations from Paediatricians for prescription of anti-biotics.Methods: This is a questionnaire based cross sectional study conducted in Hayatabad town, District Peshawar. Parents who were consenting, had children aged between 0-16 years, and were …

The Utility Of A Tablet Computer Device In Comparison To A Standard High Resolution Monitor For Reporting Ct Kub Images, Kenneth Kiriinya Ibeere

Master of Medicine in Imaging and Diagnostic Radiology

Background: The latest technological developments in the field of digital medical imaging have facilitated the transfer of the power and utility of the personal computer to mobile computing devices. One of these that have been used in diagnostic imaging is a tablet computer. Mobile tele-radiology using a tablet computer device is an apt extension of imaging services, for after-office-hours consultation. It is crucial to determine the diagnostic accuracy of these portable computer devices in order to determine safety for use in diagnostic image interpretation without compromising patient care. Objective: To find out the diagnostic accuracy of urolithiasis (urinary tract calculi) …

Prediction Of Breast Tumor Size By Ultrasound: A Comparison With Pathology, David Toyis Wanyonyi

Master of Medicine in Imaging and Diagnostic Radiology

Background: Tumor size is one of the most important prognostic factors in breast cancer and its accurate assessment is critical in planning appropriate treatment. Although histology is often regarded as the definitive way of establishing tumor size, radiological techniques, particularly ultrasonography, are usually relied upon to give an estimate of the tumor size for prognostication and treatment planning. Correlations between mammography, ultrasonography, magnetic resonance imaging (MRI) and pathology size have been performed in different populations with varying results however no prospective study has been done to establish the agreement between sonographic tumor size and histopathological tumor size in our population. …

Prevalence Of Significant Liver Fibrosis In Patients With Hiv Monoinfection Compared To Those With Hiv-Hepatitis B Coinfection As Assessed By Shear Wave Elastography, Samuel Nguku

Master of Medicine in Imaging and Diagnostic Radiology

Background: Liver disease is an emerging management problem in human immunodeficiency virus (HIV) infected patients. The incidence of chronic Hepatitis B infection, which accelerates the progression of chronic liver disease and development of liver fibrosis, is ten times higher in patients with HIV than the general population. Staging of liver fibrosis provides essential information in management of these patients. Objective: To determine the prevalence of significant liver fibrosis in patients with HIV mono-infection versus those with HIV-HBV co-infection as assessed with shear wave elastography (SWE). Methods: This was a cross-sectional study whereby HIV infected patients attending the HIV clinic at …

Accuracy Of Magnetic Resonance Imaging In Pretreatment Lymph Node Assessment For Gynecological Malignancies, Saira Naz Sufian, Imrana Masroor, Waseem Mirza, Zainab Hussain, Saima Hafeez, Zafar Sajjad

Department of Radiology

Objective: To determine the accuracy of magnetic resonance imaging (MRI) in detection of metastasis in pelvic and para-aortic lymph nodes from different gynecological malignancies.MATERIALS AND Methods: This retrospective cross sectional analytic study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital Karachi Pakistan from January 2011 to December 2012. A sample of 48 women, age range between 20-79 years, fulfilling inclusion criteria were included. All patients had histopathologically proven gynecological malignancies in the cervix, endometrium or ovary and presented for a pretreatment MRI to our radiology department.Results: MRI was 100% sensitive and had a 100% positive predictive …

Endovascular Embolisation Of Visceral Artery Pseudoaneurysms, Yasir Jamil Khattak, Tariq Alam, Rana Hamid Shoaib, Raza Sayani, Tanveer-Ul Haq, Muhammad Awais

Department of Radiology

Objective. To evaluate the technical success, safety, and outcome of endovascular embolization procedure in management of visceral artery pseudoaneurysms. Materials and Methods. 46 patients were treated for 53 visceral pseudoaneurysms at our institution. Preliminary diagnostic workup in all cases was performed by contrast enhanced abdominal CT scan and/or duplex ultrasound. In all patients, embolization was performed as per the standard departmental protocol. For data collection, medical records and radiology reports of all patients were retrospectively reviewed. Technical success, safety, and outcome of the procedure were analyzed. Results. Out of 46 patients, 13 were females and 33 were males. Mean patient …

Diagnostic Accuracy Of Ultrasonography In Differentiating Benign And Malignant Thyroid Nodules Using Fine Needle Aspiration Cytology As The Reference Standard, Tariq Alam, Yasir Jamil Khattak, Madiha Beg, Abdul Raouf, Muhammad Azeemuddin, Asif Alam Khan

Department of Radiology

Background: In Pakistan thyroid cancer is responsible for 1.2% cases of all malignant tumors. Ultrasonography (US) is helpful in detecting cancerous thyroid nodules on basis of different features like echogenicity, margins, microcalcifications, size, shape and abnormal neck lymph nodes. We therefore aimed to calculate diagnostic accuracy of ultrasound in detection of carcinoma in thyroid nodules taking fine needle aspiration cytology as the reference standard.MATERIALS AND Methods: A cross-sectional analytical study was designed to prospectively collect data from December 2010 till December 2012 from the Department of Radiology in Aga Khan University Hospital, Karachi, Pakistan. A total of 100 patients of …

Pancreatic Lymphangioma, Shaista Afzal, Imrana Masroor, Gulnaz Shafqat

Department of Radiology

Lymphangioma develops as a consequence of lymphatic malformation and blockage of lymphatic flow. Pancreatic lymphangioma is a rare benign tumour which can grow reasonably large prior to manifestation of symptoms. On imaging, it appears as a complex multiseptated cystic mass. However, this appearance is not diagnostic and overlaps with cystic pancreatic neoplasm. We present a case of pancreatic lymphangioma incidentally discovered in an elderly lady who was managed conservatively since surgery could not be performed as the patient was high risk for surgery. Imaging findings along with follow-up of the case and review of literature is presented.

Wandering Meckel's Diverticulum On 99m Technetium-Pertechnetate Scintigraphy: A Diagnostic Dilemma?, Maseeh Uz Zaman, Nosheen Fatima, Unaiza Zaman, Zafar Sajjad

Department of Radiology

Meckel's diverticulum (MD) is the most common gastrointestinal anomaly with heterotopic mucosa in 60% of cases. 99m technetium-pertechnetate scintigraphy is a sensitive tool for detection of MD containing heterotopic gastric mucosa. It is usually located in the right lower quadrant or umbilical region and less frequently in other quadrants. A mobile or wandering MD is a rare clinical presentation and may pose a diagnostic dilemma. However, presence of temporal correlation with gastric activity and compactness of focus during wandering period could make this riddle easy.

Outcome Of Radiologically Placed Tunneled Haemodialysis Catheters, Raza Sayani, Muhammad Anwar, Tanveer-Ul-Haq, Nauman Al-Qamari, Muhammad Asif Bilal

Department of Radiology

Objective: To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure.STUDY Design: Case series.PLACE AND DURATION OF STUDY: Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011.METHODOLOGY: All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, …

Labrad : Vol 39, Issue 2 - December 2013, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Diagnosis of Inborn Errors of Metabolism in Pakistan
• Inherited Metabolic Disorders-Presenting as Metabolic Emergencies
• Role of Biochemical Genetics Laboratary in Evaluation of IEM
• Amino Acid Chromatography for the Diagnosis of Inborn Error of Metabolism
• Polymorphism in Methylenetetrahydrofolate Reductase (MTHFR) Gene
• Diagnosis of Tyrosinemia Type I
• Congential Hypothyroidism
• Congential Adrenal Hyperplasia, An Insight of Laboratory
• Inaugration Ceremony of Section of biochemical Genetics Laboratory

Hirayama Disease, A Rare Cause Of Posture Related Cord Compression: A Case Report From Radiological Perspective, Shumaila Arooj, Fatima Mubarak, Muhammad Azeemuddin, Zafar Sajjad, Wasey Jilani

Department of Radiology

Hirayama Disease is a disease of young adults lying in the age group between twenty to thirty years. It is an extremely uncommon disorder. Its other synonyms are juvenile muscular atrophy of the distal upper extremity (JMADUE) or monomelic amyotrophy (MMA). A previously healthy 25-year-old man presented with gradually increasing weakness in both hands for the past few years. There was neither history of trauma nor family history of neuromuscular disease. MRI was advised. Routine cervical sagittal MR images (Non-flexion or extension) revealed cord flattening and atrophy at C5 to C7 levels.There was evidence of syrinx. Flexion MRI was performed …

An Unsuspected Bleeding Meckel's Diverticulum In An Adult Detected On Mesenteric Angiography, Muhammad Ali, Raza Sayani, Muhammad Azeemuddin, Tanveer-Ul-Haq, Rizwan Khan

Department of Radiology

Meckel's diverticulum is usually asymptomatic and found in almost 2% of the population. Haemorrhage from a Meckel's diverticulum is common in children but rare in adults. Here we report a case of 20 years old male with recurrent gastrointestinal bleeding. Meckel's diverticulum was diagnosed due to abnormal vascularity on mesenteric angiography and embolization was performed. Diagnosis was correlated with other radiological imaging and later elective resection was performed. This case is reported to emphasize the potential role of mesenteric angiography in the detection and management of bleeding Meckel's diverticulum and correlation with other radiological imaging.

Indigenously Developed Close Delivery System For Oral Iodine-131 Therapy: Nominal Cost But Phenomenal Protection., Imran A Shah

Department of Radiology

Abstract

BACKGROUND:

Administration of radiopharmaceuticals through intravenous and oral routes is the major source of radiation exposure to nuclear medicine (NM) technologists. Adopting new strategies to minimize radiation exposure is an important step toward safe practice in nuclear pharmacy.

MATERIALS AND METHODS:

We have indigenously developed a relatively close delivery system for oral administration of radioiodine-131 ((131)I) to minimize radiation exposure to the technologists.

RESULTS:

The efficacy of this indigenously developed close system was assessed upon 23 patients who were given (131)I therapies for benign (13 patients) and malignant thyroid disorders (10 patients). There was 64 ± 6% (P < 0.05) reduction in exposure rate using indigenously developed delivery system.

CONCLUSION: …

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Learning From Errors In Radiology To Improve Patient Safety, Shaista Afzal Saeed, Imrana Masroor, Gulnaz Shafqat

Department of Radiology

Objective: To determine the views and practices of trainees and consultant radiologists about error reporting.STUDY Design: Cross-sectional survey.PLACE AND DURATION OF STUDY: Radiology trainees and consultant radiologists in four tertiary care hospitals in Karachi approached in the second quarter of 2011.METHODOLOGY: Participants were enquired as to their grade, sub-specialty interest, whether they kept a record/log of their errors (defined as a mistake that has management implications for the patient), number of errors they made in the last 12 months and the predominant type of error. They were also asked about the details of their department error meetings. All duly completed …

Labrad : Vol 39, Issue 1 - September 2013, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Immunophenotyping by Flowcytometry
• Chronic Lymphocytic Leukaemia: Diagnosis and Prognostic Factors
• Tumour Markers
• Role of Chemical Pathology in Screening and Diagnosis of Multiple Myeloma
• 1p/19q Deletion: Favourable Prognostic Marker for Oligodendroglioma
• EGFR Mutation Screening Test for Lung Cancer Patients
• Clinical Utility of BCR-ABL1 Kinase Domain Mutational Analysis
• Molecular Cytogenetic Testing for Acute Myeloid Leukaemia
• Diffuse Large B-Cell Lymphoma (DLBCL) Subgroups have Different Phenotype

Honouring Social Accountability: A Moral Responsibility Of The Medical Profession, Riffat Parveen Hussain, Nighat Ali Shah

Department of Radiology

No abstract provided.

Utility Of Limited Protocol Magnetic Resonance Imaging Lumbar Spine For Nerve Root Compression In A Developing Country, Is It Accurate And Cost Effective?, Kiran Hilal, Zafar Sajjad, Raza Sayani, Dawar Khan

Department of Radiology

STUDY Design: Cross sectional study.PURPOSE: To determine the accuracy of the screening magnetic resonance study of the lumbar spine in the diagnosis of nerve root compression in cases of low back pain as compared to the routine magnetic resonance imaging (MRI) study of the lumbar spine.OVERVIEW OF LITERATURE: No local study has been conducted for this purpose. In an international study, the reported sensitivity and specificity of screening MRI lumbar spine protocol in the detection of nerve root compression are 54% and 100% respectively.Methods: Patients of both genders older than 20 years of age with low back pain of any …

Ultrasound Based Evaluation Of Hepatic Steatosis And Fibrosis In Hepatitis C Non-Responders, Saba Sohail, Sina Aziz, Talat Mirza

Department of Radiology

Objective: To determine the accuracy of ultrasound in the diagnosis and grading of steatosis and fibrosis in Hepatitis C (HCV) patients not responding to ribavarin-interferon therapy.
Study design: A cross-sectional, analytical study.
Place and duration of study: Radiology Department, Civil Hospital, Karachi, from March 2008 to August 2010.
Methodology: Patients with positive HCV RNA despite 24 weeks ribavarin-interferon therapy (non-responders) were subjected to ultrasound and biopsy prior to institution of pegylated interferon therapy for detection and grading of steatosis and fibrosis. Using histopathology as the gold standard, sensitivity, specificity, negative and positive predictive values for ultrasound were determined.
Results: The …

Evaluation Of Chronic Liver Disease: Does Ultrasound Scoring Criteria Help?, Shaista Afzal Saeed, Imrana Masroor

Department of Radiology

Abstract

Noninvasive approaches for assessment of liver histology include routine laboratory tests and radiological evaluation. The purpose of our study was to determine the utility of a simplified scoring system based on routinely evaluated ultrasound features for the evaluation of chronic liver disease and correlate it with the histological findings. For this cross-sectional analytical study the data was collected prospectively by nonprobability purposive sampling technique. The ultrasound variables/parameters and their assigned scoring system that was a modified version adopted from published literature were evaluated. Sensitivity, specificity, positive and negative predictive values of the liver morphological score and combined score of …

Hepatic Artery Pseudoaneurysm Mimicking Mirizzi Syndrome, Zahid Anwar, Raza Sayani, Darakshan Kanwal, Mohammed Ali, Mohammed Anwar Saeed

Department of Radiology

Acute cholecystitis leading to development of a pseudoaneurysm of the hepatic artery is a very rare complication; however, a pseudoaneurysm resulting in gallbladder neck compression with dilatation of intrahepatic duct giving a Mirizzi syndrome like presentation is virtually unreported to the best of our knowledge. We report a case of a 60 years male patient who presented in emergency department with right hypochondrial pain and mild jaundice. Initial diagnosis of hepatic artery pseudoaneurysm causing compression of neck of gallbladder and common bile duct was made on ultrasound examination. This was resulting in gross distention of gallbladder and mild dilatation of …

Abdominal Tuberculosis With Massive Jejunal Haemorrhage, Abdul Rehman Alvi, Tanveer Ui Haq, Amyn Pardhan

Department of Surgery Docs

ABSTRACT Jejunum is a rare site of involvement in intestinal tuberculosis (TB) and massive lower gastrointestinal haemorrhage is an even rare reported condition. The authors report a 15-year-old female student, who presented with fever, anaemia, hypoalbunemia and developed massive lower gastrointestinal haemorrhage during hospital stay. The diagnosis of abdominal TB was established on tissue biopsy; tissue culture was positive for Mycobacterium TB. Optimal outcome was achieved with aggressive resuscitation, repeated mesenteric angio-embolization and anti-tuberculosis chemotherapy

Single Centre Study Of Using Bendamustine In The Treatment Of B-Cell Malignancies, Asif Husain Osmani, Nehal Masood

Department of Radiation Oncology

Objective: To evaluate the experience of bendamustine in the treatment of B-cell malignancies at a tertiary care centre.Methods: The retrospective descriptive analysis included data of all adult patients with B-cell malignancies treated with bendamustine from 2009 to 2011 at the Aga Khan University Hospital, Karachi. Data was analysed using SPSS 17.0. Frequencies and percentages were computed for baseline characteristics, responses and toxicities.Results: Of the 19 patients 15 (79%) were males and 4 (21%) were females.The mean age was 59.53+/-12.14 (with a range of 46-86). Eight (42%) had follicular lymphoma, 6 (32%) had mantle cell lymphoma, 2 (11%) had diffuse large …