Mehraj Sheikh

CT features in abdominal tuberculosis: 20 years experience.

BackgroundAbdominal tuberculosis (TB) is endemic in the developing world and is reemerging in the West. Since computed tomography (CT) has the ability to demonstrate changes in the peritonium, mesentry, lymphnodes, bowel and solid organs and is being increasingly used for primary evaluation of abdominal conditions, it is important to be familiar with the CT features of the disease.MethodsCT findings were retrospectively analysed in 49 patients with proved abdominal TB. Patients with genitourinary TB and with AIDS/HIV were not included in the study.ResultsPeritoneal involvement was the most common feature (77.5%) with ascites (wet peritonitis) seen in more than half the cases (55.2%). The rest showed peritoneal, mesenteric or omental thickening or mass formation but no ascites (dry peritonitis). Other findings included lymphadenopathy (46.9% mainly of diffuse nature, bowel wall thickening (38%) and solid organ involvement (20.4%).ConclusionsCT reliably demonstrates the entire range of findings which need interpretation in the light of clinical and laboratory data.

Combined Ciprofloxacin and Amikacin Prophylaxis in the Prevention of Septicemia After Transrectal Ultrasound Guided Biopsy of the Prostate

PURPOSE A steady increase in the incidence of septicemia after prostate biopsy in our unit between 2001 and 2005 prompted us to review our prophylactic antibiotic regimen. We compared the incidence of septicemia in patients undergoing prostate biopsy between 2001 and 2005 when only oral ciprofloxacin was used prophylactically (group 1) to the incidence among patients undergoing biopsy between 2006 and 2010 when a single dose of intravenous amikacin was added to ciprofloxacin (group 2). MATERIALS AND METHODS In group 1 the 300 patients were given 500 mg oral ciprofloxacin twice daily 1 day before and for 2 days after the biopsy while in group 2 the 897 patients, in addition to the ciprofloxacin previously mentioned, received 500 mg intravenous amikacin 30 minutes before the biopsy. Patients admitted to the hospital with septicemia after prostate biopsy had urine and blood culture and sensitivity tests. The number of patients in whom septicemia developed in each group after prostate biopsy and the microorganisms isolated from the urine and blood of such patients were compared using the chi-square test. RESULTS Septicemia was seen in 24 of 300 (8%) and 15 of 897 (1.7%) patients in groups 1 and 2, respectively (p <0.001). In group 1 the rate of septicemia after prostate biopsy was 2.1% and 13% in 2001 and 2005, respectively (p <0.001). In group 2 the rate of septicemia was 1.5% in 2006 and 1.6% in 2010 (p <0.25). Escherichia coli resistant to quinolones was responsible for 33 of 39 (84.6%) septicemic cases. CONCLUSIONS The addition of amikacin to ciprofloxacin prophylaxis significantly reduces the incidence of septicemia after prostate biopsy.

Value of radiologically guided fine needle aspiration cytology (FNAC) in the diagnosis of spinal tuberculosis: a study of 29 cases

FNAC is a simple diagnostic tool for the initial evaluation of various deep seated pathological lesions. This study describes the applicability and practical aspects of the technique in establishing the diagnosis of spinal tuberculosis (TB) with the aid of radiographic guidance. The study was conducted in a major teaching hospital in Kuwait between the years 1985 and 1994. Twenty‐nine patients (M:F = 18:11 and age range 8–72 years) with clinically and/or radiologically suspected spinal TB were seen in the Department of Cytology, Mubarak Al Kabeer Hospital. The patients were re‐examined by either computed tomography (CT) scanning (n = 19) or fluoroscopy (n = 10) to localize the lesion for FNAC. FNAC smears were routinely stained with Papanicolaou and Diff Quik stains and one smear of each case was stained with Ziehl–Neelsen (Z‐N) stain for acid‐fast bacilli (AFB). Aspirated purulent material or syringe washings of dry aspirates were also submitted for microbiological cultures including AFB. Radiological and cytological findings were recorded in each case. Radiological findings included: bony rarefaction and destruction (93.1%), narrowed disc space (89.7%), soft tissue calcification (65.5%) and para‐vertebral abscess formation (51.7%). Cytological findings included: epithelioid cell granulomas (89.7%), granular necrotic background (82.8%) and lymphocytic infiltration (75.9%). Smears were positive for AFB in 51.7% of cases. A positive AFB culture was obtained in 82.8% of cases, including all cases with positive AFB on smear by Z‐N stain. Radiologically guided FNAC with AFB culture is a simple, reliable and practical approach to diagnosing spinal TB lesions. With a high diagnostic yield, it allows immediate initiation of specific treatment, helps to avoid invasive diagnostic procedures, and decreases hospitalization time.

Spinal tuberculosis: CT and MRI feature.

BACKGROUND Spinal tuberculosis (TB) is perhaps the most clinically important extrapulmonary form of the disease. Early recognition is therefore necessary to minimize residual spinal deformity and/or permanent neurological deficit. We defined the CT and MRI image morphology of spinal TB and correlated the imaging features of these two modalities. METHODS CT (29 patients) and MRI (11 patients) images were retrospectively analyzed in 30 patients with proved spinal TB. CT and MRI findings were compared in cases with both imaging tests (10 cases). The parameters assessed were the type and extent of bone and soft tissue involvement. RESULTS The majority of the 30 patients were males (n=18) in the 30–49 year age group (43%). The most common clinical presentation was backache (73.3%) followed by fever (63.3%) and malaise (36.6%). The lumbar spine was the commonest site of the disease (43.3%) followed by the thoracic region (36.6%). A fragmentary type of bone destruction was the most frequent CT feature of the disease (48.2%) followed by the lytic type (24.1%). Intervertebral disc destruction (72%) and paravertebral mass/abscess (65.5%) were other features. Of the 11 patients who had an MRI, contiguous vertebral disease with disc destruction was seen in 10 cases. In 4 patients, there was distant vertebral disease in addition to the disease at the symptomatic site. CONCLUSIONS MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites. CT is useful in assessing bone destruction, but is less accurate in defining the epidural extension of the disease and therefore its effect on neural structures. MR imaging clearly demonstrated the extent of soft tissue disease and its effect on the theca/cord and foramen in cases with doubtful CT findings.

Papillary Thyroid Carcinoma and Its Variants in Fine Needle Aspiration Smears

OBJECTIVE To study the fine needle aspiration (FNA) cytologic features of papillary thyroid carcinoma (PTC) with special reference to its tall cell variant (TCV), which is the most aggressive of the variants. STUDY DESIGN Fifty-four PTC cases were classified into variants, and the frequency of well-known morphologic criteria was determined. Four parameters were quantitatively analyzed based on a study of 200 consecutive neoplastic follicular cells: shape of cells, color of cytoplasm, intranuclear cytoplasmic inclusion (INCI) and nuclear grooves. RESULTS The PTC cases included 6 TCV (> or = 30% tall cells), 8 cases with a significant tall cell component (sig. TCC) having 10-29% tall cells, 17 usual variant (UV), 17 follicular variant (FV) and 6 miscellaneous variants. TCV differed significantly from UV and FV in having a higher tall cell count, higher count of cells with reddish cytoplasm and INCI, and higher frequency of cases with lymphocytic infiltration. PTC (with significant tall cell component [TCC]) differed significantly from TCV with regard to tall cell count and lymphocytic infiltration, from UV with respect to tall cell count and monolayered sheets, and from FV with respect to tall cells, INCI, grooved nuclei, acinar formation, fire-flare appearance and giant cells. CONCLUSION TCV was cytologically distinct from other variants. The biologic behavior of PTC cases with significant TCC, which morphologically seem to be a group intermediate between TCV on the one hand and UV and FV on the other, however, needs to be carefully monitored.

Radiologic Features of Granulomatous Mastitis

Abstract: Granulomatous mastitis (GM) is a recognized, but an uncommon cause of breast mass. Awareness of this condition is important, because it can clinically as well as radiologically mimic breast carcinoma. In this study, we present the imaging features of a series of 10 cases with proved diagnosis of granulomatous mastitis with emphasis on magnetic resonance (MR) findings. All those patients who were histologically proven to have GM of the breast were analyzed. Their files were reviewed and data recorded for demographic, clinical presentation and imaging appearances. The imaging features of the lesions by mammography, ultrasound, and magnetic resonance imaging were analyzed. Of the 305 patients who were surgically treated, 10 (3%) cases proved to have GM. All the patients were females with age ranging from 27 to 53 years (average 38 years and median age 36 years). Guided core biopsy was performed in all cases for confirmation of diagnosis followed by either excision biopsy (in five cases) or lumpectomy (in five cases). The final histopathologic results were chronic granulomatous inflammation consistent with tuberculosis in four cases and GM with acute inflammation, but unknown etiology in four cases and GM due to duct ectasia in two cases. GM, a rare breast condition, should be considered in the differential diagnosis of patients with a breast mass associated with inflammatory change. Routine breast imaging with US, MG, or MRI, the condition from malignant lesions and biopsy, still remains the only method of definite diagnosis.

Alteration of sonographic texture of the endometrium in post-menopausal bleeding a guide to further management

BACKGROUND The purpose of this study was to assess the utility of transvaginal ultrasonography in the evaluation of endometrial morphology in addition to the standard criterion of endometrial thickness for selecting patients for endometrial sampling. METHODS Two hundred and seven consecutive cases of postmenopausal bleeding were evaluated by transvaginal ultrasound. Endometrial thickness was measured as the maximum anteroposterior thickness of the endometrium including both the anterior and posterior layers, in the sagittal long axis view. The morphology of the endometrium was studied and categorized as homogeneous, focally increased echogenecity, diffusely increased echogenecity or diffusely inhomogeneous. Patients were followed up for clinical course and endometrial histopathology. RESULTS Textural inhomogeneity was observed in all the three cases of endometrial cancers with endometrial thickness of less than 6 mm, and, in ten out of 11 cases of a more than 6 mm thick endometrium. On the other hand the endometrial texture was homogeneous in all cases of endometrial atrophy/tissue inadequate for diagnosis, with thickness of less than 6 mm. CONCLUSION This study adds the dimension of abnormal echogenecity of the endometrium to the currently followed criterion of endometrial thickness with a view to enhance accuracy, both for a better prediction of atrophy and a higher prediction for endometrial cancer. Expectant management can be offered to patients with a homogeneous endometrium which is 6 mm thick or less. Aggressive evaluation for a malignancy must be made if there is a focal increased echogenecity or a diffuse increased echogenecity even in a thin endometrium.

High serum prostate‐specific antigen levels in the absence of prostate cancer in Middle‐Eastern men: the clinician's dilemma

To investigate the common causes of total serum prostate‐specific antigen (PSA) values of> 10 ng/mL in an Arab population, as in the USA and Europe the risk of prostate cancer is considered high in men with such PSA levels.

Age-specific reference levels of serum prostate-specific antigen and prostate volume in healthy Arab men

To determine age‐specific reference ranges for serum prostate‐specific antigen (PSA) concentration and prostate volumes in a population of healthy Arab men.

Accuracy of 64-Multidetector-Row Computed Tomography in the Diagnosis of Coronary Artery Disease

Objectives: The aim of this prospective study was to assess the accuracy of 64-multidetector-row computed tomography coronary angiography (CTA) in the diagnosis of coronary artery disease (CAD). Patients and Methods: Ninety-two patients suspected of having CAD underwent CTA using a 64-slice CT scanner before a scheduled, conventional coronary angiogram (CCA). Blinded assessment of CTA to detect CAD was performed. The accuracy of CTA in detecting significant stenoses (≥50%) was compared to CCA. Data analysis was performed on 73 patients because the scans were nondiagnostic in 5 patients and 14 refused to undergo coronary angiography. Results: The CTAs of 21 of these 73 patients were considered as normal; 19 were confirmed on CCA. For the remaining 52 diagnosed as abnormal, 51 were confirmed on CCA. For patient-based analysis, CTA had a sensitivity of 95%, a specificity of 96%, a positive predictive value of 98% and a negative predictive value of 90%. For the whole vessel, the sensitivity of CTA was 60–100%, for all vessels and the specificity was 82–100%. Pooled sensitivity was 92% and pooled specificity was 98%. For the segments, the sensitivity of CTA was 64% or above for all vessels except for the distal left anterior descending artery (40%), mid circumflex artery (50%) and posterior descending artery (60%); the pooled sensitivity was 79%. The specificity for the segments was 82–100% for all vessels and pooled specificity was 94%. Conclusion: The sensitivity and specificity for patient-based analysis and for the main coronary vessels were high whereas for the segments, the sensitivity was moderately good, but the specificity was high, confirming that a negative CTA is useful to rule out significant CAD. A coordinated classification system between radiologists and cardiologists is required to eliminate errors in segment classification.