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

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.

Super-Selective Mesenteric Embolization Provides Effective Control of Lower GI Bleeding

Introduction. We aimed to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolization (SMAE) in managing lower GI bleeding (LGIB). Method. A retrospective case series of patients with LGIB treated with SMAE in our health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multidetector CT angiography (CE-MDCT), were referred for DSA +/− SMAE. Data collected included patient characteristics, screening modality, bleeding territory, embolization technique, technical and clinical success, short-term to medium-term complications, 30-day mortality, and progression to surgery related to procedural failure or complications. Results. There were fifty-five hospital admissions with acute unstable lower gastrointestinal bleeding which were demonstrable on CE-MDCT or RS over a 31-month period. Eighteen patients proceed to embolization, with immediate success in all. Eight patients (44%) had clinical rebleeding after intervention, warranting repeated imaging. Only one case (5.6%) demonstrated radiological rebleeding and was reembolized. Complication rate was excellent: no bowel ischaemia, ischaemic stricture, progression to surgery, or 30-day mortality. Conclusion. SMAE is a viable, safe, and effective first-line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted practice at our institution to manage localised LGIB with embolization.

Radionuclide study in gastroparesis: Is it still relevant?

The incidence of gastroparesis in Malaysia is not well documented. Gastroparesis may present with various combinations of debilitating sign and symptoms that decrease quality of life and increases morbidity. It is diagnosed based on clinical symptoms and exclusion of the obstruction. There should be a high index of suspicion in patients who present with symptoms to avoid missing the diagnosis. There are various approaches to study the gastric motility. Here’s a case of a young adult woman with type 1 diabetes mellitus suffering severe gastrointestinal symptoms. In this case, radionuclide scintigraphy is used as one of the investigation to confirm the diagnosis of gastroparesis. Radionuclide scintigraphy remains a hallmark in the diagnosis of gastroparesis after excluding mechanical obstruction.