Friday, December 31, 2004


Gods of Earth and Sea.

And the old lady cries.
And the lonely children suffer.
Their mother's now alone.
Their fathers wont come home.

And the old lady cries.
And the old lady cries.

The gods were hungry.
And the gods weren't happy.
They had offered their jewellery
They had paid and prayed only.

But the stones know no mercy.
Their hunger must be appeased.
While the guilty run free.
The innocent are punished.

But the little girl asks.
Why were we punished?
What did we do wrong?
We would have followed

Had we been told

And the old lady cries.
Her son will not return.
Her faith will not rise
The stones, she will burn.

And the anger wont subside.
Like the waves killed her love.
Her revenge will come.
Her children she must save.
But her anger wont subside


USG image showing ascariasis or a round worm in a bowel loop!!!

Tuesday, December 28, 2004

Disaster strikes South-east Asia

USGS: Warnings Could Have Saved Thousands in Asia
A warning center such as those used around the Pacific could have saved most of the thousands of people who died in Asia's earthquake and tsunamis, a U.S. Geological Survey official said on Sunday.
None of the countries most severely affected -- including India, Thailand, Indonesia and Sri Lanka -- had a tsunami warning mechanism or tidal gauges to alert people to the wall of water that followed a massive earthquake, said Waverly Person of the USGS National Earthquake Information Center.
"Most of those people could have been saved if they had had a tsunami warning system in place or tide gauges," he said.
"And I think this will be a lesson to them," he said, referring to the governments of the devastated countries.
Person also said that because large tsunamis, or seismic sea waves, are extremely rare in the Indian Ocean, people were never taught to flee inland after they felt the tremors of an earthquake.
Tsunami warning systems and tide gauges exist around the Pacific Ocean, for the Pacific Rim as well as South America. The United States has such warning centers in Hawaii and Alaska operated by the U.S. Geological Survey. But none of these monitors the Indian Ocean region.
The 8.9-magnitude underwater quake -- one of the most powerful in history -- off the Indonesian island of Sumatra devastated southern Asia and triggered waves of up to 30 feet high.
U.S. seismologists said it was unlikely the Indian Ocean region would be hit any time soon by a similarly devastating tsunami because it takes an enormously strong earthquake to generate one.
"That's really what has created all of these problems -- is that the earthquake is just so massive," said Dan Blakeman, a USGS earthquake analyst.
But Person said governments should instruct people living along the coast to move after a quake. Since a tsunami is generated at the source of an underwater earthquake, there is usually time -- from 20 minutes to two hours -- to get people away as it builds in the ocean


Monday, December 27, 2004

Antenatal USG at 18 weeks showing bilateral enlarged echogenic kidney with oligohydramnios!! suggestive of autosomal recessive polycystic kidneys!!!

Thursday, December 23, 2004

Ultrasound abdomen transverse section showing cystic dilatation of distal common bile duct suggestive of choledochal cyst!!!

Tuesday, December 21, 2004

Medical news

Report from RSNA: CTA nails down role of gold standard for pulmonary embolism
Whether it scans in four slices or 16, CT is the method of choice for detecting pulmonary emboli, researchers said at the RSNA meeting. Even four-slice technology boasts a negative predictive value greater than 99%, better than ventilation/perfusion (V/Q) studies or conventional pulmonary angiography.
Differences among four-, eight-, and 16-slice scanners appear marginal so far, but few data are available to solidify any claims of superiority for 16, except in speed. Researchers at Stanford University clocked lung scan times at 26.6 seconds for four-slice, 9.25 seconds for eight-slice, and 5.45 seconds for 16.
Dr. Alessandro Napoli and colleagues at Stanford reviewed CT studies for 1240 consecutive patients referred for suspected pulmonary emboli. Overall, 20% of cases were deemed positive, with 41% of emboli found in the segmental arteries, 27% in lobal regions, 17% in subsegmental arteries, and 15% on the main branches.
While there was no statistically significant difference in detection rates among the three generations of scanners, readers said that eight- and 16-slice studies yielded more and clearer diagnostic data. The 16-slice scanner may eventually prove better at finding subsegmental emboli, but only a small number of cases were included in the study.
If a CT study is negative, it is safe to forgo further examination. Researchers at the University of South Carolina conducted a metastudy of 14 published papers with 3283 patients who had undergone CTA to evaluate suspected pulmonary emboli, had negative findings, and had stopped anticoagulation therapy based on those findings. Fourteen developed fatal pulmonary embolism, 23 demonstrated nonfatal embolism, and 52 showed evidence of deep venous thrombosis during follow-up.
The studies produced 95% to 100% negative predictive value (NPV), with an average of 99.1%. NPV for mortality was 99.4%. Whether the CTAs were performed on single-slice or multislice CT made no significant difference. By comparison, conventional pulmonary angiography has an NPV of 98.4%, and V/Q studies average 88%.

from diagnostic imaging news

Sunday, December 19, 2004

Plain radiographs (often called "plain Xrays" - but you can't see the X-rays, only the images created by them) can be obtained using a variety of imaging methods, and they all require exposing the patient to X-Ray radiation. The image or picture is basically a shadow of the parts of the patient that absorb or block the X-Rays. The image can be collected on photosensitive film, on a digital imaging plate, or on a flouroscope. The image is a "photographic negative" of the object - the "shadows" are white regions (where the X-rays were blocked by the object). Plain radiographs ("plain films") are usually taken by a trained Registered Radiologic Technologist. The resulting films are then interpreted by the Radiologist to make a diagnosis.

this is a poem from the last century when x-rays were just discovered!!!!

Thursday, December 16, 2004

Journal Watch

Effects of repeated prenatal ultrasound examinations on childhood outcome up to 8 years of age: follow-up of a randomised controlled trial.

Newnham JP, Doherty DA, Kendall GE, Zubrick SR, Landau LL, Stanley FJ

BACKGROUND: Despite the widespread use of prenatal ultrasound studies, there are no published data from randomised controlled trials describing childhood outcomes that might be influenced by repeated ultrasound exposures. We previously undertook a randomised controlled trial to assess the effects of multiple studies on pregnancy and childhood outcomes and reported that those pregnancies allocated to receive multiple examinations had an unexplained and significant increase in the proportion of growth restricted newborns. Our aim was to investigate the possible effects of multiple prenatal ultrasound scans on growth and development in childhood. Here, we provide follow-up data of the childrens' development. METHODS: Physical and developmental assessments were done on children whose pregnant mothers had been allocated at random to a protocol of five studies of ultrasound imaging and umbilical artery Doppler flow velocity waveform between 18 and 38 weeks' gestation (intensive group n=1490) or a single imaging study at 18 weeks' gestation (regular group n=1477). We used generalised logistic and linear regression models to assess the group differences in developmental and growth outcomes over time. Primary data analysis was done by intention-to-treat. FINDINGS: Examinations were done at 1, 2, 3, 5, and 8 years of age on children born without congenital abnormalities and from singleton pregnancies (intensive group n=1362, regular group n=1352). The follow-up rate at 1 year was 85% (2310/2714) and at 8 years was 75% (2042/2714). By 1 year of age and thereafter, physical sizes were similar in the two groups. There were no significant differences indicating deleterious effects of multiple ultrasound studies at any age as measured by standard tests of childhood speech, language, behaviour, and neurological development. INTERPRETATION: Exposure to multiple prenatal ultrasound examinations from 18 weeks' gestation onwards might be associated with a small effect on fetal growth but is followed in childhood by growth and measures of developmental outcome similar to those in children who had received a single prenatal scan.

Lancet. 2004 Dec 4;364(9450):2038-44

Tuesday, December 14, 2004

spot the diagnosis here??
cant see anything abnormal, take a closer look notice the nasogastric tube coiled in the neck!!
correct-this is esophageal atresia with tracheo-esophageal fistula (note the gas in the stomach)

Saturday, December 11, 2004

Carcinoma esophagus- a barium swallow showing irregular narrowing with "shouldered edges" suggestive of a malignant stricture!!

Wednesday, December 08, 2004


Docs bitten by the blog bug

NEW DELHI: From talking about dogs who can sniff out bladder cancer to solved AIIMS question papers, from cheap accommodation near Safdarjung Hospital to three exclusive 'from the bedside' opinions on the cause of Yasser Arafat's death — the medical community is warming up to the idea of sharing it all over blogs on the Net.For the uninitiated, blogs are short for web logs which are Internet journals or diaries. They differ from regular websites in being much more interactive, with the writers behind them updating the blogs frequently and inviting instant feedback. The idea seems to have gained ground amongst the members of the medical community in the past few months. Says Dr Sumer Kumar Sethi, a senior resident at the Lady Hardinge Medical College, who runs a blog on radiology, "I have had 2,000 visitors on my blog in the past three months. Starting with a lone visitor or two in September, I get as many as 30-40 visitors daily now." Sethi adds that one of the reasons behind the concept acquiring popularity is the fact that it is very difficult to get any work published in the medical community. "Authorities review your findings then check the evidence, and the process may take more than a year at times. Blogs are the easy way out," he says. For medical students like Manisha, "They are like small newspapers wherein you can share everything from what you felt when an infant passed away on Diwali morning to stuff on how to get that offending mole on your cheek removed." Interns aspiring for a post-graduate seat in their chosen specialisation also find blogs a good platform to share notes. "If someone from outside Delhi wants to take up MD here, all he has to do is to post a query on a blog and soon enough, doctors from here post their suggestions on where to stay, which specialisation is good at which hospital and what questions to expect," says Dr Ankit Verma, who works at a private hospital. Net-savvy patients, meanwhile, are the latest to join the blog bandwagon. "There are so many survival stories on the blogs about cancer patients, people who are living with AIDS and it's really inspiring," says Vidhi Chauhan (name changed), a teacher. "I suffer from polycystic ovarian syndrome, due to which I have a constant weight-gain problem. Awareness about the disease is low and there is no permanent cure. Getting onto blogs, learning from people's experiences on use of acupuncture and supplements really helped me out," she adds.

Monday, December 06, 2004

Friday, December 03, 2004


Comparison of MRI and CT for Detection of Acute Intracerebral Hemorrhage

Context Noncontrast computed tomography (CT) is the standard brain imaging study for the initial evaluation of patients with acute stroke symptoms. Multimodal magnetic resonance imaging (MRI) has been proposed as an alternative to CT in the emergency stroke setting. However, the accuracy of MRI relative to CT for the detection of hyperacute intracerebral hemorrhage has not been demonstrated.

Objective To compare the accuracy of MRI and CT for detection of acute intracerebral hemorrhage in patients presenting with acute focal stroke symptoms.
Design, Setting, and Patients A prospective, multicenter study was performed at 2 stroke centers (UCLA Medical Center and Suburban Hospital, Bethesda, Md), between October 2000 and February 2003. Patients presenting with focal stroke symptoms within 6 hours of onset underwent brain MRI followed by noncontrast CT.

Main Outcome Measures Acute intracerebral hemorrhage and any intracerebral hemorrhage diagnosed on gradient recalled echo (GRE) MRI and CT scans by a consensus of 4 blinded readers.

Results The study was stopped early, after 200 patients were enrolled, when it became apparent at the time of an unplanned interim analysis that MRI was detecting cases of hemorrhagic transformation not detected by CT. For the diagnosis of any hemorrhage, MRI was positive in 71 patients with CT positive in 29 (P<.001). For the diagnosis of acute hemorrhage, MRI and CT were equivalent (96% concordance). Acute hemorrhage was diagnosed in 25 patients on both MRI and CT. In 4 other patients, acute hemorrhage was present on MRI but not on the corresponding CT—each of these 4 cases was interpreted as hemorrhagic transformation of an ischemic infarct. In 3 patients, regions interpreted as acute hemorrhage on CT were interpreted as chronic hemorrhage on MRI. In 1 patient, subarachnoid hemorrhage was diagnosed on CT but not on MRI. In 49 patients, chronic hemorrhage, most often microbleeds, was visualized on MRI but not on CT.

Conclusion MRI may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute focal stroke symptoms and is more accurate than CT for the detection of chronic intracerebral hemorrhage.

JAMA. 2004;292:1823-1830.

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