Extra Burden on Urology Outdoor Due to Non Urology Flank Pain

Background: Flank pain is one of common urological emergency. It can be result of various causes. Most commonly results from one of three causes: urinary tract infection (UTI), kidney stones, and musculoskeletal problems like a muscle strain or pinched nerve. Objective: Determine frequency of none urological flank pain burden in urology outdoors. Methods: This was prospective descriptive case study conducted at department of urology and transplantation at Jinnah Postgraduate Medical Center Karachi from September 2020 to December 2020. All patients with flank pain, who visited in urology outdoor, were included in study. All patients had detailed history and physical examination. Urinalysis and ultrasound abdomen were done in all patients. CT KUB was also done in patients who had abnormal ultrasound finding of kidney ureter and bladder. Results: Total 100 patients were included in this study, 41 (41%) male while 59 (59%) patients were females. 45 patients had right sided pain, 34 had left sided while remaining 21 patients had bilateral flank pain and six patients had also lower urinary tract symptoms along with pain. 13 patients had positive renal punch on examination, 23 patients had positive straight leg rising sign and rest of the 64 patients’ examination was unremarkable. 55 patients had urology related pathology on ultrasound, in 9 patients had non urological pathology and rest 36 patients it was unremarkable. CT KUB was done in all 55 patients who had positive findings on ultrasound showing pathology in kidney and ureter in which 47 patients CT scan had confirmed the diagnosis while in 8 patients it was in remarkable. Conclusion: flank pain is not always secondary to renal origin. It has wide spectrum of alternative significant causes also. Keywords: Flank pain, none urological, CT KUB

Spectrum of Histopathological Lesions in Cholecystectomy Specimens at Pak Red Crescent Teaching Hospital

Objective: To study the spectrum of histopathological lesions found on surgically resected gallbladder to quantify the various abnormalities in gallbladder specimen. Methodology: A descriptive observational study was carried out from Nov 2017 to Oct 2021. All the patients undergoing emergency and elective cholecystectomy regardless of age and sex were included in the study. After cholecystectomy, gallbladder specimen along with history and ultrasound findings was sent for histopathology to our own institution. Department of histopathology has the standardized method to process the gallbladder specimens. Demographic data along with diagnosis, ultrasound finding and histopathology report were collected and analyzed with Excel 2019. Results: Total number of patients in this study was 395, out of which 93 patients were male and 302 patients were female. Average age of our patients was 43.05± 13 years. Acute calculus cholecystitis was found in 55 (13.92%) patients, 298 (75.44) patents had chronic calculus cholecystitis, empyema was found in 15 (3.80) patients, cholestrolosis was found in 5 (1.27%) patients, gallbladder polyp was found in 02 (0.51%) patients, gangrenous gall bladder was found in 01 (0.25%) patient and adenocarcinoma in situ was found in 01 (0.25%) patient. Conclusion: Our study shows that, chronic cholecystitis is the most common presentation followed by acute cholecystitis in surgically resected gallbladders. Females are predominantly suffering from the gallbladder diseases. The frequency of malignant lesion was very low. Keywords: Gallbladder-histopathology, Acute Cholecystitis, Chronic Cholecystitis, Gallstones.

Persistent Eustachian valve and transient arterial hypoxemia in a newborn: a clinical observation

The Eustachian valve (EV) is located in the orifice of inferior vena cava and belongs to structures of the normal heart. It plays an important role in the fetal blood flow by directing the flow of blood from inferior vena cava through an open foramen ovale to the left atrium, thereby ensuring the systemic flow in a fetus and bypassing the pulmonary circulation. After birth and upon closure of the foramen ovale, the valve ceases to function and tends to regress. Usually, a prominent EV is a clinically non-significant ultrasound finding. In isolated cases, however, it can cause significant hemodynamic abnormalities and subsequent rhythm disorders, delayed fetal development and transient hypoxemia in newborns. It can extremely rare be a cause of blood right-toleft shunting through the foramen ovale leading to desaturation. Clinically it can manifest by central cyanosis in newborns and infants. The differential diagnosis is made in neonatal intensive care units. We present a case of transient arterial hypoxemia in a newborn with prominent EV and inter-atrial shunt. A one-month old infant was transferred from the Department of Pediatric Cardiology with a history of transient hypoxemic spells related to right-to-left shunting via atrial septal defect caused by obstruction of the tricuspid valve by the prominent EV. The instrumental findings including contrast-enhanced tomography supported this hypothesis. The patient was stable for subsequent 10 days of the follow-up, which allowed for further conservative managements until the conventional time point for children with an atrial septal defect. Potential regress of the prominent EV, as well as natural growth of an infant and his/hers intracardiac structures, provide mostly favorable outcome without a surgical intervention. This was clearly illustrated in the clinical case.

Case Report: Neonatal Massive Pneumothorax Resulting in Compression Atelectasis Treated by Ultrasound-Guided Pleural Puncture Therapy: A Typical Case Based on Lung Ultrasound Finding

Atelectasis is a complication of different pulmonary diseases; however, neonatal compression atelectasis due to pneumothorax is rarely reported in the literature. Recently, we encountered a typical case of atelectasis. A preterm infant was admitted to the neonatal intensive care unit owing to severe respiratory distress. Lung ultrasound examination confirmed severe pneumothorax and large area of atelectasis. Lung re-expansion occurred when the air was drained from the pleural cavity.

The Association of Pericardial Fat and Peri-Aortic Fat With Severity of Nonalcoholic Fatty Liver Disease

Background: Visceral adipose tissue (VAT) is associated with central obesity, insulin resistance and metabolic syndrome. However, the association of body-site specific adiposity and non-alcoholic fatty liver disease (NAFLD) has not been well characterized. Methods: We studies 704 consecutive subjects who underwent annual health survey in Taiwan. All subjects have been divided into three groups including normal (341), mild (227) and moderate (136) NAFLD according to ultrasound finding. Pericardial (PCF) and thoracic peri-aortic adipose tissue (TAT) burden was assessed using a non-contrast 16-slice multi-detector computed tomography (MDCT) dataset with off-line measurement (Aquarius 3DWorkstation, TeraRecon, SanMateo, CA, USA). We explored the relationship between PCF/TAT, NAFLD and cardiometabolic risk profiles.Result: Patients with moderate and mild NAFLD have greater volume of PCF (100.7±26.3vs. 77.1±21.3 vs. 61.7±21.6ml, P < 0.001) and TAT (11.2±4.1 vs. 7.6±2.6 vs. 5.5±2.6ml, P < 0.001) when compared to the normal groups. Both PCF and TAT remained independently associated with NAFLD after counting for age, sex, triglyceride, cholesterol and other cardiometabolic risk factors. In addition, both PCF and TAT provided incremental prediction value for NAFLD diagnosis. (AUROC: 0.85 and 0.87, 95%, confidence interval: 0.82-0.89 and 0.84-0.90). Conclusion: Both visceral adipose tissues strongly correlated with the severity of NAFLD. Compared to PCF, TAT is more tightly associated with NAFLD diagnosis in a large Asian population.

Sensitivity and specificity of Point-of-Care ocular ultrasound for optic neuritis: a hypothesis generating study

Purpose: This retrospective study compares point-of-care ocular ultrasound to MRI in order to establish preliminary data for and identify challenges to a multicenter study into the utility of ocular ultrasound for diagnosing optic neuritis. Methods: Our ultrasound archive was queried to identify subjects suspected of having optic neuritis who underwent ocular ultrasound and MRI of the brain or orbit. Blinded ultrasounds were reviewed by ultrasound faculty. The presence of optic disc elevation, optic nerve, or sheath dilation, and overall impression were recorded and compared to MRI results. Sensitivity and specificity of each ultrasound finding and the overall impression, as well as agreement between the raters, were calculated. Results: Sensitivity and specificity of ultrasound for MRI confirmed optic neuritis was 100 % (95 % CI 54.1-100) and 58.3 % (95 % CI 27.7-84.8). Optic nerve sheath diameter had nearly perfect agreement (κ = 0.8828), however agreement on optic disc elevation (κ = 0.5641), nerve diameter (κ = 0.2174), and overall agreement (κ = 0.1818) were moderate, fair, and poor, respectively. Conclusions: This preliminary study estimates test characteristics of ocular ultrasound for the diagnosis of optic neuritis for the purposes of power analysis and to identify potential pitfalls in preparation for a larger prospective investigation.

832 Groin Hernia Should Remain A Clinical Diagnosis -- An Evidence-Based Study

Introduction British Hernia Society (BHS) 2013 guidelines1 suggest that groin hernia diagnostic investigation should not be done at the primary care level. Nevertheless, General Practitioners refer patients with a positive ultrasound finding of groin hernia to secondary care. As a result, patients have false hopes that their symptoms would resolve if the ultrasound finding is addressed. The study aims to find the positive predictive value (PPV) for groin ultrasound for hernia and should the primary care physicians request the scan before referral to secondary care. Method A retrospective audit of outcome of patients referred to a general surgical department for groin hernia treatment. The study looked at elective groin hernia referrals for the period between June and August 2019. Results 127 patients were electively treated for groin hernia in secondary care. 40% of the patients had ultrasounds before treatment. The GP requested 78% of the ultrasounds. A positive finding was the reason for the referral. Two patients (5%) in this group had negative operative findings. 24 herniograms over 57 months for patients referred with positive ultrasound and negative clinical findings showed only 2 had positive findings (8%). None of the negative patients returned to the same hospital for groin hernia treatment until date. Conclusions It is recommended that the diagnostic tests for groin hernia be requested by the operating surgeon as per the BHS guidelines. Patients should not be subjected to hernia operations based on ultrasound findings as the PPV for this investigation is very low for patients who have negative clinical findings.2

Ultrasound-Verified Peripheral Arthritis in Patients with HLA-B*35 Positive Spondyloarthritis

Background: We aimed to investigate possible association between the HLA-B*35 allele and peripheral arthritis, tenosynovitis and enthesitis. Methods: Ultrasound of peripheral joints and tendons was performed in 72 HLA-B*35 positive patients with preliminary diagnosis of undifferentiated axial form of spondyloarthitis and joint and tendon pain. Patients with other known types of axial and peripheral spondyloarthritis were excluded as well as patients with other known types of arthritis. Results: Pathological changes were found in the joints of 33 (46%) patients and on the tendons in 13 (18%) patients. The most common ultrasound findings were joint effusion and synovial proliferation with positive power Doppler signal grade 1. The most common ultrasound finding in patients with painful tendons was tenosynovitis. A higher disease activity and an increased incidence of elevated CRP (≥5 mg/L) were more often observed in the group with positive ultrasound findings. Conclusion: In this study, we showed that the HLA-B*35 allele could be a potential risk factor for developing peripheral arthritis, but not for tenosynovits and enthesitis in patients with the undifferentiated axial form of spondyloarthritis. This result may influence the follow up of these patients, especially since it gives us an opportunity to consider the use of different types of DMARDs in the treatment of these patients.