scholarly journals DOES TRANS RECTAL ULTRASOUND (TRUS) HELPS IN DIFFERENTIAL DIAGNOSIS OF PROSTATE LESIONS? A STUDY AT TERTIARY CARE CENTER.

2021 ◽  
pp. 16-22
Author(s):  
Dhagash Patel ◽  
Brijesh Modh ◽  
Kalpesh Bhabhor
Keyword(s):  
Predictive Value ◽  
Prostatic Carcinoma ◽  
Tertiary Care ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Statistical Characteristics ◽  
Care Hospital ◽  
Radionuclide Scintigraphy ◽  
Prostatic Abscess ◽  
Rectal Examination

BACKGROUND: There are successions of investigations used in evaluation of prostatic pathology. Currently digital rectal examination & serum PSA levels are used for screening of prostatic cancer. Many conventional imaging techniques like plain radiography, computed tomography, radionuclide scintigraphy and transabdominal sonography were proved to be ineffective in detection of many prostatic conditions specially cancer at an early stage. Transrectal ultrasound (TRUS) has traditionally been considered as the pivotal imaging test for the prostate, providing clinically important information regarding benign and malignant conditions. OBJECTIVES: to evaluate the TRUS and colour Doppler ndings in various benign and malignant prostatic lesions with respect to its site, echo pattern, capsular status, local invasion, vascularity and to correlate with other investigations, like digital rectal examination and serum PSA etc. and also to study the accuracy of TRUS in differentiating benign from malignant lesions. METHODOLOGY: A prospective observational study carried out over a period of 1.5 years at a tertiary care hospital. All male patient referred to department of radio diagnosis with prostate related complains referred from surgery department. Study includes clinical symptoms, family and personal history, laboratory examination like PSA, radiological examination, digital rectal examination. . Various statistical characteristics of the test such as sensitivity, specicity, positive predictive value, negative predictive value were calculated whenever applicable. Out of total 64 patients' recruited OBSERVATIONS: commonest age group was 61 – 70 years (39.1%). Commonest prostatic pathology encountered was BPH (56.2%) followed by prostatic carcinoma (31.3%), prostatitis (4.7%), prostatic abscess & calculus (3.1%) prostatic cyst (1.6%). 75% patients of prostatic carcinoma and 13.9% of Benign Prostate Hypertrophy show PSA value greater than 10ng/ml. Echotexture pattern found on TRUS, in prostatic carcinoma patients was hypoechoic echotexture in 70% patients followed by mixed echotexture in 20% patients. Examination in Color Doppler found, 80 % patients of prostatic carcinoma show increased vascularity and 25 % of benign lesion also shows increased vascularity including all three cases of prostatitis and one out of two case of prostatic abscess. Any single test alone is not helpful in arriving at a diagnosis, but all the thr CONCLUSION: ee tests i.e. PSA level, digital rectal examination, and transrectal ultrasound, together give very conrmatory result, specically to differentiate benign from malignant condition of prostate. . Considering that the initial screening of patients will help in reducing the number of negative biopsies (unnecessary), without impairing the cancer detection capacity.

scholarly journals Impact of Positive Vancomycin-Resistant Enterococcus (VRE) Screen Result on Appropriateness of Definitive Antibiotic Therapy

2020 ◽  
Vol 41 (S1) ◽  
pp. s263-s263
Author(s):  
Jenna Reynolds ◽  
Lynn Chan ◽  
Raelene Trudeau ◽  
Maria Teresa Seville
Keyword(s):  
Antibiotic Therapy ◽  
Predictive Value ◽  
Hematologic Malignancy ◽  
Tertiary Care ◽  
Alternative Therapy ◽  
Care Hospital ◽  
Positive Screen ◽  
Screen Result ◽  
Definitive Therapy ◽  
Vancomycin Resistant

Background: Vancomycin-resistant Enterococcus (VRE) screening has been utilized to identify colonized patients to prevent transmission. However, little is known about the utility of screening to guide antibiotic therapy. We assessed the appropriateness of definitive therapy in patients with a VRE screen and evaluate the predictive value of screening for the development of a VRE infection. Methods: In this retrospective study, we evaluated VRE screening of patients aged 18 years admitted between June 1, 2015, and May 31, 2018, to a 280-bed, academic, tertiary-care hospital. Rectal swabs were tested using Cepheid Xpert. Screening was performed routinely on admission for hematologic malignancy and liver transplantation patients. Only the first screen result was included for patients who had multiple VRE screens. The patient was classified as having a VRE infection if any Enterococcus isolates were vancomycin resistant. The primary outcome was appropriateness of antibiotic therapy in patients who had a VRE screen. Appropriateness of VRE-directed therapy was defined as therapy with linezolid or daptomycin for patients who had a positive VRE culture and an identifiable source of infection, or who had no clinical improvement on alternative therapy, or who had a documented β-lactam allergy. If appropriateness was unclear, 2 infectious diseases specialists determined appropriateness. Results: In total, 1,374 patients who had a rectal VRE screen met inclusion criteria. Of these, 1,053 (88%) had a negative screen. We detected no difference in the appropriateness of VRE-directed therapy between patients with a positive screen and those with a negative screen (59.3% vs 61.0%; P = .8657). The VRE screen had a sensitivity of 60% (95% CI, 43%–74%), specificity of 90% (95% CI, 88%–92%), positive predictive value of 18% (95% CI, 12%–25%), and negative predictive value of 98% (95% CI, 97%–99%) for VRE infection. Conclusions: Although VRE screening may have utility to detect colonization in high-risk patients, a positive VRE screen is of limited value in determining the need for VRE-directed therapy. Patients with a negative VRE screen have a low likelihood of developing a VRE infection, and a negative screen could be used to identify patients who may not require empiric coverage for VRE. Further research is needed to determine optimal utilization of VRE screening for prediction and treatment of VRE infections.Funding: NoneDisclosures: None

Ultrasound Employed to Detect Breast Lumps among Symptomatic Patients in Tertiary Care Hospital

2020 ◽  
Vol 10 (4) ◽  
pp. 296-300
Author(s):  
Ameet Jesrani ◽  
Pari Gul ◽  
Nida Khan ◽  
Seema Nayab ◽  
Fahmida Naheed
Keyword(s):  
Predictive Value ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Ultra Sound ◽  
Categorical Variables ◽  
Breast Lesions ◽  
Care Hospital ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Breast Lumps

Objective: To assess different pathological breast lesions in ultra sound in a subgroup of population. Study design and setting: It was a cross sectional study conducted at Bolan Medical Complex Hospital Quetta, Pakistan from June 2018 to January 2019. Methodology: Total 103 patients with breast swelling, pain and discharge were targeted. Gray scale and Doppler Ultrasound of breast followed by FNAC/biopsy of breast lesion was performed. Data presented as mean ± standard deviation for continuous variables and frequency with percentages for categorical variables. Results: Out of 48 clinically palpable lumps US detected all of 48 lumps and additionally 12 clinically non palpable masses were detected on US examination. Thus, overall sensitivity of ultrasound in detecting breast lumps was 100%. Fibroadenoma of the breast was diagnosed accurately in 80.3% of women. Ultrasound reliably differentiated cystic from solid breast masses (100%). The sensitivity of ultrasound for detecting breast carcinoma was 63.4% with a positive predictive value of 87.5%, a negative predictive value of 99.5% and accuracy of 58.33%. US findings most suggestive of benign lesions were oval or round shape in 88.3%, well defined margin in 84%, absent lobulation in 86.04% and wider than taller ratio in 90.69% of the cases.US findings of most predictive for malignancy were of irregular shape in 81.8%, ill-defined margin in 90.9% and length to height ratio in 63.6% of cases. Conclusion: Ultrasound is simple, cheap, safe and relatively accessible imaging modality for evaluation of breast pathologies. Due to its high sensitivity in diagnosing benign breast lesions particularly cystic lesions and fibroadenoma unnecessary interventions can be avoided

Diagnostic accuracy of Multiparametric MRI in detection of prostate cancer compared with histopathology obtained by MRI directed TRUS guided cognitive fusion biopsy are T2WI, DWI and DCE enough for Indian scenario

2021 ◽  
Vol 20 (1) ◽  
pp. 10-12
Author(s):  
Mallinath Biradar ◽  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Prostatic Cancer ◽  
Tertiary Care ◽  
Multiparametric Mri ◽  
Care Hospital ◽  
Cognitive Fusion ◽  
Fusion Biopsy ◽  
Indian Scenario

Background: The incidence of prostatic carcinoma is increasing worldwide. With its high resolution, ability to provide excellent tissue characterization and multiplanar imaging capabilities, multi-parametric magnetic resonance imaging (mpMRI) plays a crucial role in detection, local staging and follow-up of carcinoma prostate. It also helps guide targeted biopsies in initial biopsy negative patient. Objectives: Study diagnostic accuracy of mp-MRI and primarily that of the three MR sequences T2, DWI and DCE in detection of prostatic cancer by correlating them with histopathology and thus whether it is feasible for a short MRI of 3 sequences to be used on a large scale in Indian scenario. Materials and Methods: A prospective study was done at a tertiary care hospital between April 2017 to November 2018 in which 50 patients who presented with suspicion of prostate cancer were referred to radiology department for evaluation using MRI. MRIexamination was done using 3T Siemens Magnetom Verio. Followed by this MRI directed TRUS guided cognitive fusion biopsy was done from the prostate. Samples were sent for histopathology. Results: Out of 50 cases studied, 24 cases (48%) were found to be malignant and 26 cases (52 %) were benign on histopathology. In our study, combined T2 + DWI + DCE gave sensitivity of 95.83 %, specificity of 57.69%, positive predictive value of 68.21 % and negative predictive value of 93.75%. Conclusion: Multiparametric MRI using T2, DWI and DCE has a high diagnostic accuracy for evaluation of prostatic cancer.

Assessing the Severity of Acute Pancreatitis with CT Severity Index and Other Conventional Methods in a Tertiary Care Hospital in Tamil Nadu, India – A Comparative Cross-Sectional Study

2021 ◽  
Vol 8 (41) ◽  
pp. 3541-3546
Author(s):  
Jayaprakash Subramani ◽  
Rajesh Prabhu ◽  
Jagadeesapandian Palpandi
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Predictive Value ◽  
Tamil Nadu ◽  
Objective Assessment ◽  
Tertiary Care ◽  
Severity Index ◽  
Apache Ii ◽  
Care Hospital ◽  
Male Predominance

BACKGROUND Acute pancreatitis is not uncommon in surgical practice with variable clinical presentation. Because of its potential notable catastrophic complications, it is mandatory to assess the severity at the earliest. In recent times, the decision making in the management is quite difficult due to its complications and outcome. So, an objective assessment of severity based on clinical and laboratory scoring verses computed tomography (CT) severity is still debate, hence the need for study. The purpose of this study was to compare the efficiency of CT severity index verses APACHE II and Ranson criteria in predicting the severity of acute pancreatitis. METHODS A total number of 36 consecutive cases of acute pancreatitis who were admitted between January 2013 and December 2014 in Apollo Specialty Hospitals – Madurai were included in the study. Written informed consent was obtained from all study participants. RESULTS In our study, out of 36 patients, 30 (83.33 %) were males and 6 (16.66 %) were females. The sex distribution shows a clear male predominance. Most of the patients in the present study belonged to the middle age group. Alcohol was the most common cause accounting for 41.7 % of the cases followed by the billiary pathology. CT severity index was the superior tool for prediction of the prognosis and early complications. CONCLUSIONS When using contrast enhanced computed tomography, it was found that there was a significant correlation between the development of organ failure and severity of pancreatitis. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of Ranson and acute physiology and chronic health evaluation – II (APACHE II) at 48 hours of admission with acute pancreatitis does not correlate in determining the severity of acute pancreatitis. KEYWORDS Acute Pancreatitis, Severity Markers, CT Severity Index

scholarly journals Diagnostic and therapeutic utility of transrectal ultrasound in urological office prostatic abscess management: A short report from a single urologic center

2014 ◽  
Vol 86 (4) ◽  
pp. 344 ◽  
Author(s):  
Andrea Fabiani ◽  
Alessandra Filosa ◽  
Valentina Maurelli ◽  
Fabrizio Fioretti ◽  
Lucilla Servi ◽  
...  
Keyword(s):  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Positive Culture ◽  
Needle Aspiration ◽  
Short Report ◽  
Prostatic Abscess ◽  
Fire Needle ◽  
Diagnostic Work

Objectives: Prostatic abscess (PA) is an infrequent condition in the modern antibiotic era. The everyday use of transrectal ultrasound (TRUS) during diagnostic work-up and the widespread recurrence to prostatic biopsies may lead to an increase of PA diagnosis. In this short report we analyze the patients characteristics and the management of seven recent cases of PA diagnosed in our institution. Materials and Methods: The records of 7 patients admitted to our Center for LUTS associated to septic fever or acute urinary retention, was prospectively collected. Suspect of PA was done on digital rectal examination (DRE) and confirmed by TRUS performed after urinary system ultrasound (UUS) evaluation. Patients were admitted to hospital only in case of septic signs. A sovrapubic (SPC) or urethral catheter (UC) was placed depending on symptoms. A TRUS-guided aspiration of PA was performed with patient in lithotomic position, using a 18 gauge two-part needle, side/end fire needle access. Patient was discharged with antibiotic therapy and followed up until complete resolution of the PA and symptoms. Results: Mean age was 62 years (range 24-82). Two patients were diabetics and one was affected by the immunodeficiency acquired syndrome (HIV). In one case, PA was detected after a persistent fever post TRUS guided prostate biopsy. Average prostate volume was 69 ml (range 19-118 ml). DRE was able to diagnose PA only in 2 cases (29%), UUS evaluation in 1 case (14%). All cases were confirmed by TRUS as hypo-anechoic areas with or without internal echoes in all patients. Mean PA dimension was 3.64 cm (range 1.5-8). SPC was placed in 3 cases (43%), UC in 3 patients (43%). Only 1 patient refused catheterization. Side fire needle aspiration was performed in all cases and in combination with end fire access in case of particular location of abscess cavities. Second look was needed in 2 cases (29%). Antibiotics were administered in all cases. The aspirated pus showed a positive culture for Escherichia coli (43%), Klebsiella pneumoniae (29%), Pseudomonas aeruginosa (14%) and Enterococcus faecalis (14%). PA resolution time mean was 9 days (range 3-24). Conclusions: TRUS evaluation in case of persistent LUTS associated with fever or acute urinary retention is determinant in the diagnosis of PA. Office or institutional management with TRUS needle aspiration is a good option in these cases.

scholarly journals Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions

2020 ◽  
Vol 9 (2) ◽  
pp. 95-102
Author(s):  
Abdul Rasheed Qureshi ◽  
Muhammad Irfan ◽  
Zeeshan Ashraf
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Tertiary Care ◽  
Positive Likelihood Ratio ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Pleural Effusions ◽  
Malignant Pleural Effusions ◽  
Malignant Group

Background: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions. Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value < 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated. Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively. Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures.

scholarly journals Histology results of systematic prostate biopsies by in-bore magnetic resonance imaging vs. transrectal ultrasound

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Alon Lazarovich ◽  
Gil Raviv ◽  
Yael Laitman ◽  
Orith Portnoy ◽  
Orit Raz ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Digital Rectal Examination ◽  
Resonance Imaging ◽  
Rectal Examination ◽  
Number Of Patients ◽  
Clinically Significant

Introduction: We aimed to compare systematic biopsies (SBs) of in-bore magnetic resonance-guided prostate biopsy (MRGpB) with those performed under transrectal ultrasound (TRUS) guidance in the clinical setting. Methods: Data on all 161 consecutive patients undergoing prostate biopsy in our institution between November 2017 and July 2019 were retrospectively collected. The patients were referred to biopsy due to elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination and/or at least one Prostate Imaging Reporting and Data System (PI-RADS) lesion score of ≥3 on multiparametric magnetic resonance imaging (mpMRI). We included patients with PSA levels ≤20 ng/ml and those with 8–12 core biopsies. Histology results of SBs performed by in-bore MRGpB were compared to TRUS SBs. Chi-squared, Fischer’s exact, and multivariate Pearson regression tests were used for statistical analysis (SPSS, IBM Corporation). Results: In total, 128 patients were eligible for analysis. Their median age was 68 years (interquartile range [IQR] 61.5–72), mean prostate size 55±29 cc, and mean PSA and PSA density levels 7.6±3.5 ng/ml and 0.18±0.13 ng/ml/cc, respectively. Thirty-five patients (27.3%) had suspicious digital rectal examination findings. Both biopsy groups were similar for these parameters. Thirty-eight (62.3%) MRGpB patients had a previous biopsy vs. 5 (7.1%) TRUS-SB patients (p<0.0001). The number of patients diagnosed with clinically significant and non-significant disease was similar for both groups. High-risk disease was more prevalent in the TRUS-SB group (22.4% vs. 4.9%, p<0.01). Conclusions: Our data suggest that in-bore MRGpB is no better than TRUS for guiding SBs for the detection of clinically significant prostate cancer.

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