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Sinha R.,GI Unit | Rawat S.,Ruby Hall Clinic
Indian Journal of Radiology and Imaging | Year: 2013

Aim: To assess the impact of an extended oral preparation magnetic resonance (MR) enterography protocol on bowel distension, timing of imaging, and the quality of diagnostic images. Materials and Methods: An analysis of 52 patients who underwent divided oral preparation and 39 patients who underwent standard preparation for MR enterography examination was done. Distension was assessed by measuring the transverse diameters of the jejunum, ileum, and the ileocecal region. Diagnostic quality of the examination was assessed subjectively by two radiologists and graded as poor, diagnostic, and excellent (Grades 1-3). Correlation between bowel diameter and diagnostic quality was assessed using regression analysis. Results: The mean diameters of the jejunum, ileum, and colon in patients who underwent divided preparation were 1.90 ± 0.47, 2.14 ± 0.41, and 4.27 ± 0.96 cm, respectively, and the mean diameters in patients who underwent standard preparation were 1.46 ± 0.47, 2.02 ± 0.47, and 4.45 ± 0.90 cm, respectively. A total of 96.6% of patients on divided dose had diagnostic distension of the bowel (Grades 2 and 3). A total of 87.9% of the patients on standard dose had diagnostic distension of the bowel (Grades 2 and 3). A greater number of patients who underwent divided preparation had diagnostic quality examinations compared to those given standard preparation (96.6% vs. 87.9%). A greater number of patients who underwent divided preparation had Grade 3 quality examinations compared to those on standard preparation (75.5% vs. 68.5%). There was significant difference between diagnostic (Grades 2 and 3) and optimal grades (Grade 3) of the jejunal diameters in patients having divided or standard preparation (89.7% vs. 66.6%, P < 0.05; 40.8% vs. 25%, P < 0.05, respectively). Linear regression showed a positive correlation between increasing bowel diameter and diagnostic grade of the examination (ρ = 0.76). Conclusion: Using an extended oral preparation with divided dose resulted in the majority of patients being scanned in a single visit to the MRI suite. Dividing the oral contrast into aliquots can promote uniform distension of the entire small bowel and provide better bowel distension and improve the diagnostic quality.


Shinde R.S.,Ruby Hall Clinic | Carbone V.,Messina University | Shinde S.N.,Poona Hospital and Research Center | Oreto G.,Messina University
Annals of Noninvasive Electrocardiology | Year: 2011

The electrocardiogram of a patient with acute pulmonary embolism showed right bundle branch block (RBBB) on alternate beats; following thrombolysis, the pattern evolved to persistent RBBB and eventually to normal conduction. Analysis of serial tracings suggested that the mechanism of RBBB alternans was tachycardia-dependent bidirectional bundle branch block, caused by prolongation of both anterograde and retrograde refractory periods (RPs) of the right bundle branch (RBB). The sinus impulse found the RBB refractory, and was conducted over the left bundle branch only, depolarizing the left ventricle and then attempting to penetrate retrogradely the RBB; at that time, however, the RBB was still refractory. When a QRS complex had a RBBB configuration, therefore, the RBB was not depolarized; the ensuing sinus impulse found the RBB fully responsive as a consequence of the long period intervening between two successive depolarizations, and resulted in normal intraventricular conduction. With right ventricular afterload decrease, the recovery of RBB anterograde and retrograde excitability was asynchronous, since the retrograde RP became normal earlier than the anterograde one. In accordance with the relatively short retrograde RP, the RBB was retrogradely invaded by the transseptal impulse coming from the left ventricle; this "shifted to the right" the anterograde RP of the RBB. The RBB, thus, was still refractory to the next sinus impulse, and RBBB again occurred; the RBB, thus, was once more depolarized retrogradely, and this led to perpetuation of RBBB. Finally, intraventricular conduction became normal owing to full normalization of RBB anterograde and retrograde refractoriness. © 2011, Wiley Periodicals, Inc.


Sinha R.,Warwick Hospital | Rajesh A.,University of Leicester | Rawat S.,Ruby Hall Clinic | Rajiah P.,Cleveland Clinic | Ramachandran I.,Warwick Hospital
Clinical Radiology | Year: 2012

The purpose of this article is to review the imaging findings of various infections affecting the gastrointestinal tract. Barium examinations, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography all play an important role in the diagnostic workup of gastrointestinal tract infections. Knowledge of differential diagnosis, sites of involvement, and typical imaging features of different infections can help in accurate diagnosis and guide treatment. © 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.


Rathod S.B.,Ruby Hall Clinic | Kumbhar S.S.,Ruby Hall Clinic | Nanivadekar A.,Ruby Hall Clinic | Aman K.,TN Medical College
Acta Radiologica | Year: 2014

Background: Imaging is vital in diagnosis of complicated pyelonephritis and has been traditionally performed by computed tomography (CT). However, CT with contrast agents cannot be performed in patients with renal failure. Diffusion-weighted (DW) magnetic resonance imaging (MRI) has the potential to overcome this disadvantage. Purpose: To prospectively evaluate the accuracy of quantitative apparent diffusion coefficient (ADC) values to differentiate nephritis from renal abscesses in patients with pyelonephritis. Material and Methods: Forty-two patients with clinical and laboratory diagnosis of pyelonephritis underwent CTand DW MRI examinations. Diffusion images were obtained by using a non-breath-hold, single-shot echo-planar sequence with b values of 0, 600, and 1000 s/mm2. Circular regions of interest were places on areas of nephritis, normal renal parenchyma, and renal abscesses as localized by CT and DW MRI images to obtain the ADC values of each of these regions. The ADC values of these three different tissue types were statistically compared using the one-way analysis of variance test for statistical significance. A P value <0.05 was considered to be statistically significant. Results: For the diagnosis of pyelonephritis, DW MRI had a higher sensitivity of 95.3% as compared to that of noncontrast CT (66.7%) and contrast-enhanced CT (88.1%). Areas of nephritis had significantly lower ADC values (P<0.001) than the normal renal cortical parenchyma. Also, renal abscesses had significantly lower ADC values (P<0.001) than areas of nephritis. However, CT is more useful for the diagnosis of renal calculi and emphysematous pyelonephritis. Conclusion: ADC values derived from the diffusion sequence have significantly lower values in renal abscesses than in areas of nephritis. Copyright © The Foundation Acta Radiologica 2014.


Sinha R.,Warwick Hospital | Murphy P.,Warwick Hospital | Sanders S.,Warwick Hospital | Ramachandran I.,Warwick Hospital | And 3 more authors.
Clinical Radiology | Year: 2013

Aim To determine the accuracy of high-resolution magnetic resonance enterography (HR-MRE) against surgical and histopathology standards in Crohn's disease, and to determine quantitative MRE findings that can differentiate minor from advanced bowel inflammation. Materials and methods Forty-nine consecutive patients who underwent 51 surgical procedures underwent standard MRE and HR-MRE prior to surgery. MRE images were assessed for superficial ulcers, deep ulcers, abscesses, fistulae, and strictures. Quantitative MRE parameters, such as mural thickness, enhancement ratios (ER) of the abnormal bowel, mesentery (ME), and normal bowel (controls), were recorded. MRE findings were compared with surgical and histological results to obtain sensitivity, specificity, and accuracy. Grading of inflammation was compared with MRE parameters for correlation and discriminating power. Results The sensitivities and specificities of MRE and HR-MRE enterography in the detection of abnormal segments were 0.82 and 0.95 versus 0.86 and 0.95 respectively. HR-MRE was significantly more sensitive than MRE and HR-MRE in the detection of superficial and deep ulcers, fistulae, and abscesses (0.5 versus 0.69; 0.69 versus 0.94; 0.76 versus 0.95; 0.77 versus 1.0, respectively). Mural thickness, ER, and ME had positive correlation with higher grades of inflammation(r = 0.8, 0.66, 0.42, respectively). Regression analysis showed deep and superficial ulcers, ER > 1.85 and mural thickness >4.5 mm were independent predictors of advanced inflammation. Conclusion HR-MRE has significantly greater diagnostic accuracy as compared to MRE in the diagnosis of bowel ulceration, fistulae and abscesses. Bowel ulcers, mural enhancement ratio >1.85 are strong predictors of advanced inflammation. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.


Patent
Siemens AG and Ruby Hall Clinic | Date: 2011-05-11

A system includes determination (S401) of a plurality of radiation beams for a radiation treatment fraction, each of the plurality of beams associated with a respective intensity, beam aperture and beam energy, and at least two of the plurality of beams respectively associated with two different beam energies, and determination of a forward dose associated with the plurality of input beams. If it is determined (S405) that the forward dose does not conform to a dose prescription, a beam weight is determined for each of the plurality of input beams based on the forward dose and the dose prescription using Gaussian elimination, and a second forward dose associated with the plurality of input beams and their respective beam weights is determined.


Shah S.,Laparascopic and Bariatric Surgery | Shah P.,Laparascopic and Bariatric Surgery | Todkar J.,Laparascopic and Bariatric Surgery | Gagner M.,Florida International University | And 2 more authors.
Surgery for Obesity and Related Diseases | Year: 2010

Background: Published data on sleeve gastrectomy (SG) have indicated better remission of type 2 diabetes mellitus (T2DM) and improvement in satiety compared with other restrictive procedures. Mechanisms in addition to rapid, extensive weight loss are responsible for the restoration of the euglycemic state. To prospectively evaluate the role of laparoscopic SG on gastric emptying half-time and small bowel transit time (SBTT) and effect of these on weight loss, satiety, and improvement in T2DM. Methods: A total of 67 subjects were studied. Of these 67 subjects, 24 were lean controls (body mass index 22.2 ± 2.84 kg/m2), 20 were severely and morbidly obese patients with T2DM who had not undergone SG (body mass index 37.73 ± 5.35 kg/m2), and 23 were severely and morbidly obese patients with T2DM after SG (body mass index 40.71 ± 6.59 kg/m2). All 67 patients were evaluated for gastric emptying half-time and SBTT using scintigraphic imaging. Imaging was performed every 15 minutes up to the ileocecal region. The Three-Factor Eating Questionnaire was administered simultaneously. Fasting blood sugar, postprandial blood sugar, and glycated hemoglobin were assessed. Nonparametric analysis of variance and the Mann-Whitney U test were applied. Results: The mean SBTT was significantly lower (P <.05) in the post-SG group (199 ± 65.7 minutes) than in the non-SG group (281.5 ± 46.2 minutes) or control group (298.1 ± 9.2 minutes). The gastric emptying half-time values were also significantly shorter (P <.05) in the post-SG (52.8 ± 13.5 minutes) than in the non-SG (73.7 ± 29.0 minutes) and control (72.8 ± 29.6 minutes) groups. The glycated hemoglobin, fasting blood sugar, and postprandial sugar were all significantly lower after SG. The Three-Factor Eating Questionnaire findings revealed significantly earlier satiety (29.0 ± 7.2) for the post-SG patients (P <.05) compared with the non-SG (45.8 ± 9.0) and control (37.9 ± 6.2) subjects. Conclusion: A decreased gastric emptying half-time and SBTT after SG can possibly contribute to better glucose homeostasis in patients with T2DM. © 2010 American Society for Metabolic and Bariatric Surgery.


D'souza N.,All India Institute of Medical Sciences | Swami M.,Ruby Hall Clinic | Bhagwat S.,Ruby Hall Clinic
International Journal of Gynecology and Obstetrics | Year: 2011

Objective: To compare intravenous dexamethasone and ondansetron for the prophylaxis of postoperative nausea and vomiting (PONV), a main complaint that affects almost 40%-75% of patients undergoing laparoscopic gynecologic surgery. Methods: In a prospective study, 93 women were divided into 3 groups receiving 4 mg of dexamethasone, 8 mg of dexamethasone, or 4 mg of ondansetron. PONV score was used for assessment during the first 24 hours after surgery. Results: The incidence of PONV during the 24-hour postoperative period was highest in the ondansetron group (61%). In the first 3 hours, the incidence of PONV in the ondansetron group was also higher: 51.6% as compared with 22.6% and 36.6% in the dexamethasone 4 mg and 8 mg groups, respectively. The overall incidence of PONV was highest in the first 3 hours as compared with later time periods, and there was a linear trend in decreasing PONV among the groups (P = 0.017). In the dexamethasone 4 mg group, the request for a rescue antiemetic was significantly lower: 0% as compared with 6.7% and 16.1% in the dexamethasone 8 mg and ondansetron 4 mg groups, respectively. Conclusion: Dexamethasone was found to be an efficacious and cost-effective drug for the prophylaxis of PONV. © 2011 International Federation of Gynecology and Obstetrics.


Gadre K.S.,Ruby Hall Clinic | Waknis P.,Deenanath Mangeshkar Hospital
International Journal of Oral and Maxillofacial Surgery | Year: 2010

The surgical removal of impacted third molars is the most common procedure performed by maxillofacial surgeons. Only a few cases of ectopic third molars in the condyle have been reported. Most have been treated using an extra-oral or endoscopic approach. The management of this condition using an intra-oral approach (removal of this tooth and maintaining the anatomy of the condyle) is described in two case reports. © 2009 International Association of Oral and Maxillofacial Surgeons.


Narayanan V.K.,Ruby Hall Clinic
Journal of applied clinical medical physics / American College of Medical Physics | Year: 2012

In static intensity-modulated radiation therapy (IMRT), the fundamental factors that determine the quality of a plan are the number of beams and their angles. The objective of this study is to investigate the effect of beam angle optimization (BAO) on the beam number in IMRT. We used six head and neck cases to carry out the study. Basically the methodology uses a parameter called "Beam Intensity Profile Perturbation Score" (BIPPS) to determine the suitable beam angles in IMRT. We used two set of plans in which one set contains plans with equispaced beam configuration starting from beam numbers 3 to 18, and another set contains plans with optimal beam angles chosen using the in-house BAO algorithm. We used quadratic dose-based single criteria objective function as a measure of the quality of a plan. The objective function scores obtained for equispaced beam plans and optimal beam angle plans for six head and neck cases were plotted against the beam numbers in a single graphical plot for effective comparison. It is observed that the optimization of beam angles reduces the beam numbers required to produce clini-cally acceptable dose distribution in IMRT of head and neck tumors. Especially N0.1 (represents the beam number at which the objective function reaches a value of 0.1) is considerably reduced by beam angle optimization in almost all the cases included in the study. We believe that the experimental findings of this study will be helpful in understanding the interplay between beam angle optimization and beam number selection process in IMRT which, in turn, can be used to improve the performance of BAO algorithms and beam number selection process in IMRT.

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