Keywords : ultrasound


A Comparison of Bupivacaine Instillation and Ultrasound Guided Field Block for Post-Operative Pain Relief in Inguinal Hernia Repair

Ali Moayed Jwad; Iyad Abbas Salman

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 3, Pages 248-251

ABSTRACT:
BACKGROUND:
Postoperative pain is a common problem after inguinal hernia repair. Postoperative pain may delay the return to normal activity and delay hospital discharge. Various techniques have been employed to provide postoperative analgesia, by the use of regional anesthetic technique, local anesthesia or traditional analgesic technique: opiates, non-steroidal anti-inflammatory drugs (NSAIDs) or combinations.
OBJECTIVE:
To compare the postoperative pain relief provided by simple bupivacaine wound instillation and ultrasound guided inguinal hernia field block.
PATIENT AND METHOD:
A single blind, prospective, randomized controlled clinical trial for 72 male patients who were undergoing elective unilateral inguinal hernia repair. In 37 of them 10 ml of 0.5% plain bupivacaine was instilled (irrigated) into the wound by the surgeon for 1 minute. In another 35 patients, ultrasound guided field block performed using 20 ml of 0.25% plain bupivacaine at the end of surgery. Vital signs, numerical pain score and analgesia requirement were recorded at recovery (zero hour), 1st, 2nd, 4th& 8th hours postoperatively.
RESULT:
By applying null hypothesis, using the t-student test of two independent samples, pain score and request for analgesia show significant difference only at the first two hours with p-value <0.05, otherwise there was no significant differences in the following hours. For vital signs there was no significant difference for both groups
CONCLUSION:
Bupivacaine instillation is as effective as ultrasound guided field block for inguinal hernia repair pain. We recommend this technique in places where ultrasound machine is not available especially in many developing countries.

Subdural Hematoma and Effusion in Children

Haider Faris Alwash; Ahmed Aman Al-Khalili

Iraqi Postgraduate Medical Journal, 2017, Volume 16, Issue 2, Pages 117-121

ABSTRACT:
BACKGROUND:
Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. A subdural effusion is a collection of cerebrospinal fluid
OBJECTIVE:
To gate an opinion about the types of surgical procedures which had been done for the collected cases into 2 centers in Baghdad
METHODS:
This is a prospective study conducted at 2 Neurosurgical Hospitals in Baghdad, between September 2012 to December 2013, on 21 children and infants of subdural collection of fluid excluding abscess ages ranging from 40 days to 13 years . Clinical data was collected including symptoms and signs, in addition to assessment of radiological picture and subdural tab and diagnostic burr hole proved the diagnosis .treatment ranged from conservative to surgical interference included burr hole ,subdural peritoneal shunt and craniotomy. condition of the patients during discharge from the hospital was evaluated
RESULTS:
In this study , the higher percentage of patient were under the age of one year. no great difference in the sex of patients , disturbance of consciousness was the more type of presentation , unilateral subdural collections were more than bilateral collections. only 12 patients had surgical interference , of these 12 the majority had subdural peritoneal shunt , which seemed to be the most convenient procedure in chronic cases but in acute cases burr holes were the most convenient procedure. craniotomy was also used in treating chronic cases.
CONCLUSION :
Most of the patient were under one year old , brain ct scan was the diagnostic procedure , brain ultrasound was also useful in diagnosis of subdural collection. the most convenient surgical treatment in acute cases was the burr holes and in chronic cases was the subdural -peritoneal shunt , and to arrange for surgical interference when decided as early as possible to gate better outcome

Ultrasound Guided Percutaneous Drainage of Intra-Abdominal Abscesses and Fluid Collections

Nawar Abdul Munim; Ali Zamil Mushettet; Talib A.Majid; Balsam Salim Atto

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 3, Pages 367-373

ABSTRACT:
BACKGROUND :
Percutaneous image-guided drainage is the first-line treatment for infected or symptomatic fluid collections in the abdomen and pelvis, in the absence of indications for immediate surgery and considered potentially a life saving therapeutic surgical procedure in high risk patients .
OBJECTIVE:
To evaluate the efficacy of US-guided percutaneous drainage in treating intra-abdominal abscesses and fluid collections
PATIENTS & METHOD :
Patients with intra-abdominal collections underwent percutaneous drainage under ultrasound (US) guide were studied prospectively in the Gastro-enterology and hepatology hospital in baghdad from April 2008-Sept 2009. The procedure done under local anesthesia & aseptic technique, needle access obtained before placing the catheter .Peritoneal Dialyses catheter was used in our study.
RESULTS :
There were 43 patients (29 females and 14 males ), Age ranging 8-67 years. The collections diagnosed basically on US in 33 patients ( 76.7% ) & US and CT-scanning needed in 10 (23.3%). These collections were post-operative in 36 patients (83.7%) and primary (spontaneous) in 7 (16.3%)The post-operative cases were as follow:18 patients (50 % ) operated on for gall bladder diseases, 6 (16.7 %) for abdominal trauma ,4 ( 11% ) for acute abdomen , 4 ( 11% )for Hydatid cyst, 2 (5.6 %) colonic surgery and one patient (2.8 %) operated on for acute appendicitis and one (2.8%) after ERCP. Twenty three (53.5 %) of the collections were single & 20 (46.5%) were multiple. The single collections were located as: Right Hypochondrial(Right subphrenic,Subhepatic and Hepatic) in 15 patients (65.2 %), Epigastric in 4(17.4 %),2 of them were pancreatic, Pelvic in 3 (13 % ) , and paracolic in one patient ( 4.4 % ). Six patients(14 %) have hepatic collections, 4 of which were following Hydatid Cyst Surgery, the remainder were Pyogenic hepatic abscesses. Material drained was Bile in 24 patients ( 56 %),Pus in 17(39.5 %) & blood and urine in one patient (2.25 %) for both, Fourteen patients (32.6%) underwent more than single drainage procedure, nine of them (64.3 % ) twice , three (21.4 %) three times& two (14.3% )more than 3 re-interventions.
The operations has been avoided in 26 patients (60.5 %) but was not avoidable in 17 ( 39.5% ), because of the ultimate need of the condition for operation in 15 patients (88 % )and failure of drainage in 2 patients ( 4.7 %)
CONCLUSION:
US guided drainage is an efficacious therapy for intra-abdominal collections and have become the treatment of choice for a wide variety of collections. It helps to obviate or delay a major surgery.

Ultrasonographically Observed Grade III Placenta at 36 Weeks’ Gestation: Maternal and Fetal Outcomes

Lilyan W. Sersam

Iraqi Postgraduate Medical Journal, 2011, Volume 10, Issue 1, Pages 67-72

ABSTRACT:
BACKGROUND:
Current ultrasound assessment of placental calcification relies on Grannum grading. The ultrasonographic appearance of grade III placental maturation, if it occurs before 37 weeks, may signify placental dysfunction and is found to be associated with development of pre-eclampsia and low birth weight.
OBJECTIVE:
To look at the prevalence of a grade III placenta at 36 weeks’ gestation in a low-risk obstetric population, and to explore the association between premature aging observed ultrasonographically and pregnancy outcome.
METHODS:
Scans were performed at 36 weeks’ gestation in 591 low-risk pregnant women to determine placental maturity. The prevalence of grade III placenta at 36 weeks’ gestation was determined. Follow-up was performed for the group of women demonstrating a grade III placenta in comparison to those not demonstrating a grade III placenta for determining pregnancy outcome.
RESULTS:
The prevalence of grade III placenta at 36 weeks’ gestation was 3.9%. A grade III placenta at 36 weeks’ gestation was significantly associated with young maternal age P = 0.01. The Grannum grade III of the placenta at 36 weeks’ gestation was statistically associated with increased risk for development of proteinuric pregnancy-induced hypertention (PIH) later in pregnancy (RR 4.94; 95% CI 1.15-21.26), P = 0.021. Women demonstrating a grade III placenta at 36 weeks’ gestation had a significant high risk of induction of labour for suspected fetal compromise (RR 4.7; 95% CI 1.76-12.59), P = 0.001. The risk for delivering a baby with a weight <10th centile at birth was significantly higher in women with grade III placentas in comparison to those with grades 0-II (RR 3.19; 95% CI 1.23-8.27), P = 0.017.
CONCLUSION:
In a low-risk obstetric population, ultrasound detection of Grannum grade III placenta at 36 weeks’ gestation helps to identify at risk pregnancy. It appears to predict subsequent development of proteinuric PIH and may help in identifying the growth-restricted baby

Evaluation of Triple Assessment Modalities in the Management of Palpable Breast Lumps

Khalid Nimat Saleem

Iraqi Postgraduate Medical Journal, 2010, Volume 9, Issue 1, Pages 48-56

BACKGROUND:
Breast masses are common clinical presentation in breast clinics, their managements require an efficient and accurate evaluation, using the least invasive, most accurate methods that cause minimal patients discomfort and limit any unnecessary procedure.
OBJECTIVE:
This study is designed to evaluate the diagnostic accuracy of triple assessment (a combination of clinical examination, imaging studies and tissue sampling) in the preoperative assessment and optimal management of palpable breast masses.
PATIENTS AND METHODS:
This clinical prospective study which was conducted in mosul breast center, department of surgery, al-jamhoory teaching hospital, mosul medical city, from november 2007 to november 2008 included 60 female patients with palpable breast masses, their age ranging between (20-76) years, were assessed prospectively using triple assessment modalities and the results of each modality were classified as benign, suspicious or malignant and compared with the confirmatory histopathological examination of the tissue specimens obtained from all patients under study via an appropriate surgical procedure. the data was collected, classified and analyzed.
RESULTS:
The results triple test (TT) was concordant (elements had either all benign or all malignant) in 31 cases (52٪) with diagnostic accuracy reaching (100٪). Again the TT achieved (100٪) diagnostic accuracy when all elements were either malignant or suspicious which appeared in 12 of 29 nonconcordant cases (20٪ of all cases). FNAC was the most reliable element of TT in cases where the elements of TT weren't concordant (NPV 94.5٪, sensitivity 92٪ and accuracy 96.7٪).
CONCLUSION:
The TT has proved to be accurate, reliable diagnostic approach for evaluation of breast masses, achieved (100٪) accuracy rate when all elements were concordant or when all elements were either suspicious or malignant, with the end result was neither missed cancer nor false positive malignant diagnosis, as the error or limitation of one modality was compensated by the other elements.
Any positive result of fnac should be taken seriously with negative results not exclude malignancy while the negative or positive results of imaging studies and examination not necessarily reflect the actual pathology should be supported by tissue diagnosis.
Patients in whom the TT elements were all benign can be safely observed, while patients in whom all the elements were malignant or suspicious, the diagnosis was certain enough to proceed with definite treatment without delay.

Evaluation of Focused Abdominal Sonography for Trauma (FAST) in Baghdad Teaching Hospital

Raed J .Wiwit; Saad Abdulla Ibrahim Sarsam; Salah M.Tajer

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 4, Pages 393-397

ABSTRACT:
BACKGROUND:
Focused Abdominal Sonography for Trauma (FAST) is widely applied in the initial management of trauma patients, Being non invasive, repeatable and without risk of irradiation, make it attractive tool in evaluation of trauma patients.
OBJECTIVE:
Evaluation FAST sensitivity and specificity in detection of hemoperitoneum in abdominal trauma victims .
METHODS:
Prospective study conducted in the emergency department of Baghdad teaching hospital for one year period .The FAST done by a general surgeon or emergency physician during the secondary survey of blunt and penetrating abdominal trauma victims with equivocal clinical findings.
RESULTS:
Ninety three (93) patients included in the study, with over all sensitivity of FAST was 80.9 % and specificity 95.8 %. In blunt abdominal trauma the sensitivity was 92.3 % and specificity was 96 % while in penetrating abdominal trauma the sensitivity was only 62.5 % and specificity 95.2 %.
CONCLUSION:
FAST is highly sensitive and specific in detection of hemoperitoneum after blunt abdominal trauma ,but its lower sensitivity in penetrating abdominal injury require modification in the protocols like repetition of the scan or application of extra views. Its high specificity make it suitable as "rule in" test in both blunt and penetrating abdominal injury.

Ultrasonographic Findings in Developmental Dysplasia of the Hip in Infants

Haider Qasim Hamood

Iraqi Postgraduate Medical Journal, 2009, Volume 8, Issue 2, Pages 124-132

ABSTRACT:
BACKGROUND:
Ultrasound (U/S) is valuable modality for evaluating the hip in infants because it enables direct imaging of the cartilaginous portion of the hip that cannot be seen on plain radiographs. Furthermore, U/S examination enables dynamic study of the hip with stress maneuvering. U/S is the preferred imaging modality which used to study the hip disorders like developmental dysplasia of hip ( DDH ), because it is sensitive indicator of malposition, instability and lack of acetabular development. U/S accomplishes all of these without exposing the infant to ionizing radiation, not expensive, non-invasive and available.
OBJECTIVE:
The aim of our study is to determine the effectiveness and sensitivity of ultrasound examination of neonates to confirm the early clinical diagnosis of developmental dysplasia of hip ( DDH ) especially in the high risk groups of neonates and young infants.
METHODS:
We conducted a retrospective review of ultrasonographic imaging in 60 neonates and young infants ( 36 females and 24 males ; age range, 1-9 months, median age , 4 months). U/S examination of the hip joint were evaluated for, percent bony coverage (PBC), which indicates the percentage of the femoral head that covered by the bony acetabulum, normally, 50% or over of the femoral head should be covered by bony acetabulum. And evaluated for Graf angles, alpha angle which defines the bony acetabulum and normally it is more than 60 degree and beta angle which indicates the cartilaginous development and it is normally less than 55 degree. Also evaluate the femoral head flattening which usually associated with delayed ossification , shortening and anteverting of the femoral neck .
RESULT:
DDH is more common in the female patients ( F:M = 3:1 ). Instability and dislocation is usually unilateral, this is seen in 30 patients (50%), (unilateral :bilateral = 3:1). Left hip is more commonly affected, this is seen in 24 patients(40%),( L:R = 4:1 ). Children born by caesarian section are more likely to have associated instability or dislocation of the hip, 10 patients(25%). First born baby are more affected, 4 patients(10%) and usually these children are more likely to have been breech presentation during their gestation, 14 patients (35%). Family history of DDH is seen in 6 patients(15%).
CONCLUSION:
The U/S is the preferred modality for evaluating the hip in infants who are younger than 6 months. U/S of infant's hip can be used in the diagnosis of DDH and also in monitoring of treatment or follow-up the improvement in the acetabular maturity and morphology, as well as the location of femoral head can be documented to assist in the guidance of therapy plan.

Maxillary Sinus Ultrasound Versus Plain Radiography and Diagnostic Antral Washout in the Diagnosis of Maxillary Sinus Diseases.

Abd Alameer K. Alaskaree

Iraqi Postgraduate Medical Journal, 2008, Volume 7, Issue 4, Pages 311-317

ABSTRACT:
BACKGROUND:
Maxillary sinus ultrasound has been found useful in diagnosis of maxillary sinus diseases.
OBJECTIVE:
Is to compare the usefulness of diagnostic ultrasound, radiography of the maxillary sinuses with the results of he diagnostic wash out in detection of the maxillary sinus diseases.
PATIENTS AND METHODS:
Fifty-five patients (109 maxillary sinuses) with suspected sinus diseases on clinical evaluation examined by ultrasonography, plain radiography and followed by diagnostic antral washout. RESULTS:
The positive returns were 48.6% (53/109). The sensitivity of the ultrasonography and plain radiography were (92.5%), (90.5%) respectively. The specificity of the ultrasonography and the plain radiography were (55%, 41%) respectively. The accuracy of the ultrasonography was (73.4) while of the radiography was (65%).
CONCLUSION:
Sinus ultrasonography is harmless (no radiation), less expensive and can be used safely in childhood and pregnancy, and gives comparable results with plain radiography and antral washout in diagnosis of sinus diseases.