Browsing by Author "R.C. Shukla"

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A 20-year-old woman with a painful swollen left thumb.
(2006) S.K. Tiwary; M.K. Singh; R.C. Shukla; M. Pandey; V.K. Shukla
[No abstract available]
A comparative study of intratumoral chemotherapy in advanced childhood common solid tumors
(Medknow Publications and Media Pvt. Ltd, 2007) Rajeev Rahi; K. Vijyendra; S.P. Sharma; N.C. Aryya; R.C. Shukla; S. Pradhan; T.B. Singh; A.N. Gangopadhyay
Background: Advanced and inoperable solid tumors in children are great killer despite aggressive multimodality treatment. Intravenous chemotherapy, due to high dose of drug given systemically, at times leads to abandonment of therapy due to systemic toxicities. To overcome this problem lots of studies are going on to explore alternative modes of giving anticancer drugs so as to decrease the systemic toxicities of the drugs and increase their therapeutic index at the same time. Aim: The study was conducted to know the results of anterior intratumoral chemotherapy and its comparison to anterior intravenous chemotherapy. Materials and Methods: Forty patients of advanced inoperable solid tumors in children (Wilms′ tumor and neuroblastoma) between 2000-2004 were randomly allocated to two groups. Group A (20 patients) was given intratumoral chemotherapy while Group B (20 patients) was given intravenous chemotherapy. Both the groups were compared in terms of reduction in size and volume, resectability of tumor, histopathological changes and side-effects of chemotherapeutic drugs. The Institute′s ethics committee approved this study. Results: Males were predominant in both type of cases (Wilms′ tumor and neuroblastoma) in both the groups (Group A and Group B). Mean age in the study was 3.27 years. All cases in Group A had Stage III disease except three cases which had Stage IV disease (one case of Wilms′ tumor and two cases of neuroblastoma) while in Group B only two cases had Stage IV disease (one case of Wilms′ tumor and one case of neuroblastoma). Intratumoral chemotherapy was found to be superior over intravenous chemotherapy in terms of reduction of size and volume (63% in Group A vs. 22% in Group B). The resectability was 70% in the intratumoral group in comparison to 40% in the intravenous group. The overall good histopathological response was 71% in Group A as opposed to 0% in Group B. Moreover, the incidence and severity of side-effects of chemotherapy and morbidity was less in intratumoral chemotherapy. Mortality was also low in Group A (5%) in comparison to Group B (20%). Conclusion: In this study intratumoral chemotherapy was found to be superior over intravenous chemotherapy in terms of better and early tumor regression, minimal side-effects, better tumor resectability and well response on histopathological criteria. This study is still going on at our center where different drug combinations, different drug doses, their toxicities, their mechanisms of action, their serum levels and long-term results of intratumoral mode of chemotherapy are to be evaluated thoroughly in future.
Bifurcated extrahepatic biliary tract
(1998) A. Kumar; V.K. Dixit; R.C. Shukla
[No abstract available]
Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: A hospital-based retrospective observational study and our experience
(2012) A.N.D. Dwivedi; M. Pandey; R.C. Shukla; V.K. Shukla; S. Gaharwar; B.N. Maurya
Purpose: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. Subjects and Methods: After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. Results: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. Conclusion: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder. Dwivedi AND 1 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Pandey M 2 Department of Surgery, Institute of Medical Sciences, BHU, Varanasi Shukla R 3 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Shukla V 4 Department of Surgery, Institute of Medical Sciences, BHU, Varanasi Gaharwar S 5 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Maurya B 6 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi Shukla VK, Khandelwal C, Roy SK, Vaidya MP. Primary carcinoma of gall bladder: A review of a 16-year period at the university hospital. J Surg Oncol 1985;28:32-5. National Cancer registry Programme: Consolidated report of the population based cancer registries 1990-1996, Incidence and distribution of cancer, New Delhi: Indian Council of Medical Research, ICMR; 2001. p. 52-3. Kapoor VK, Mc Michael AJ. Gall Bladder Cancer: An ′Indian" disease. Natl Med J India 2003;16:209-13. Maram ES, Ludwig J, Kurland LT, Brian DD. Carcinoma of the gallbladder and extrahepatic biliary ducts in Rochester, Minnesota, 1935-1971. Am J Epidemiol 1979;109:152-75. Nervi F, Duarte I, Gomez G, Rodreguez G, Delpino G, Ferrerio O, et al. Frequency of the gallbladder cancer in Chile. Int J Cancer 1988;41:657. Soira M, Aro K, Pamilo M, Palvansalo M, Suramo I, Taavitsainen M. ultrasonography in carcinoma of gall bladder. Acta Radiol 1987;28:711-4. Palma LD, Rizzatto G, Pozzi-Mercerri RS, Bazzoccbi M. Gray scale ultrasonography in the evaluation of the carcinoma of the gall bladder. Br J Radiol 1980;53:662-7. Itai Y, Araki T, Yoshikawa K, Fureri S, Yashiro N, Tasaka A. Computed tomography of gall bladder carcinoma. Radiology 1980;137:713-8. Zatonski WA, La Vecchia C, Przewozniak K, maisonneuve P, Lowenfels AB, Boyle P. Risk factors for gall bladder cancer: A polish case control study. Int J Cancer 1992;51:707-11. Strom BL, Soloway RD, Rioz-Palenz JL, Rodriguez-Martinez HA, West SL, Kinman JL, et al. Risk factors for gallbladder cancer. Cancer 1995;76:1747-56. Zatonski WA, Lowenfels AB, Boyle P, Maisonneuve P, Bruno De Mesquita HB, Ghadirian P, et al. Epidemiologic aspects of gall bladder cancer. A case control study of the search programme of the International agency for Research on Cancer. J Natl Cancer Inst 1997;89:1132-8. Kats K, Akai S, Tominaga S, Kato I. A case control study of biliary tract cancer in Nigata Prefecture, Japan. Jpn J Cancer Res 1989;80:932-8. Waterhouse J, Muir C, Correa P, Powell J, editors. Cancer incidence in five continents, Vol 3, IARC Publication No. 15. Lyon: IARC; 1976. Zeman RK, Burrell Ml, editors. Gallbladder and Bile Duct Imaging: A clinical radiologic approach. New York: Churchill Livingstone; 1987. p. 292-307. Chaurasia P, Thakur MK, Shukla HS. What causes cancer gallbladder?: A review. HPB Surg 1999;11:217-24. Furlan A, Ferris JV, Hosseinzadeh K, Borhani AA. Gallbladder carcinoma update: Multimodality imaging evaluation, staging and treatment options. AJR Am J Roentgenol 2008;191:1440-7. Nakayama F. Recent progress in the diagnosis and gtreatment of carcinoma of gall bladder: Introduction. World J Surg 1991;15:313-4. Piehler JM, crichlow RW. Primary carcinoma of gall bladder. A collective review. Surg Gynecol Obstet 1978;147:929-42. Pandey M, Gautam A, Shukla VK. ABO and Rh blood groups in patients with cholelithiasis and carcinoma of the gall bladder. Br Med J 1995;310:1639. Shukla VK, Shukla PK, Pandey M, Rao BR, Roy SK. Lipid peroxidation products in bile from patients with carcinoma of the gall bladder. A preliminary study. J Surg Oncol 1994;54:258-62. Pandey M, Shukla PK, Gautam A, Rao BR, Roy SK, Shukla VK. Increased peroxidation of polyunsaturated fatty acids: A possible link in the peroxidant pathogenesis of carcinoma of the gallbladder with cholelithiasis. Proc. UICC XVI International Cancer Congress, Monduzzi Editore, Roma, Italy 1994; 3: 2055-8.. Shukla VK, Tiwari SC, Roy SK. Biliary bile acids in cholelithiasis and carcinoma of the gall bladder. Eur J Cancer Prev 1993;2:155-60. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81. Silk YN, Dougras HO Jr, Nava HR, Driscoll DL, Tartarian G. Carcinoma of the gall bladder. The Rosewerr Park experience. Ann Surg 1989;210:751-7. Pandey M, Pathak AK, Gautam A, Aryya NC, Shukla VK. Digestive diseases and sciences. Dig Dis Sci 2001;46:1145-51. Yoshimitsu K, Honda H, Shinozaki K, Aibe H, Kuroiwa T, Irie H, et al. Helical CT of the local spread of carcinoma of the gall bladder: Evaluation of the gall bladder: Evaluation according to the TNM system in patients who underwent surgical resection. AJR Am J Roentgenol 2002;179:423-8. Grand D, Horton MK, Fishman EK. CT of the gall bladder: Spectrum of disease. AJR Am J Roentgenol 2004;183:163-70. Rckert JC, Rckert RI, Gellert K, Hecker K, Mller JM. Surgery for carcinoma of the gallbladder. Hepatogastroenterology 1996;43:527. Fong Y, Wagman L, Gonen M, Crawford J, Reed W, Swanson R, et al. Evidence-based gallbladder cancer staging: Changing cancer staging by analysis of data from the National Cancer Database. Ann Surg 2006;243:767. Kiran RP, Pokala N, Dudrick SJ. Incidence pattern and survival for gallbladder cancer over three decades-an analysis of 10301 patients. Ann Surg Oncol 2007;14:827. Kapoor VK, Pradeep R, Haribhakti SP, Sikora SS, Kaushik SP. Early carcinoma a of gall bladder: An elusive disease. J Surg Oncol 1996;62:284-7.
Chemical Shift Artifact on Steady-State MRI Sequences for Detection of Vesical Wall Invasion in Placenta Percreta
(Federation of Obstetric and Gynecologycal Societies of India, 2016) Ishan Kumar; Ashish Verma; Shivi Jain; Madhu Jain; R.C. Shukla; Arvind Srivastava
Background: Antenatal diagnosis of the invasiveness of a placenta percreta helps in planning the surgical approach, reducing blood loss and morbidity. Doppler sonography is the mainstay diagnostic modality with a sensitivity of 80–95 %. With the advent of high magnetic field MRI techniques, there has been recent interest in evaluation of placenta by MRI. On an extensive PUBMED search, we could not find any citations describing imaging, ultrasound, or MRI features to evaluate vesical wall invasion by placenta percreta. Purpose: We attempt to evaluate transmyometrial vesical wall invasion by placenta percreta using chemical shift artifact as a marker of intact bladder-myometrial interface on steady-state MRI sequences. Materials and Methods: This is a prospective observational study, conducted at a university hospital. We have compiled clinico-radiological criteria for diagnosis of invasive placentae based on the existing body of evidences, in four patients. We further go on to analyze a specific proposed sign on a newly introduced MR imaging sequence i.e., loss of chemical shift artifact (India ink line) on steady-state GRE sequence (TrueFISP), to diagnose transmyometrial vesical invasion in placenta percreta. Results: Though the sample size is small, the sensitivity, specificity, positive, and negative predictive value of the proposed sign for the purpose was 100 %. Conclusions(s): Loss of chemical shift artifact (India ink line) on steady-state GRE sequences at the vesico-myometrial junction in case of invasive placentae confirms vesical wall invasion, a prospective diagnoses of which can help in planning the surgical protocol and preventing potentially fatal blood loss. © 2015, Federation of Obstetric & Gynecological Societies of India.
Colour Doppler evaluation of uterine and ovarian blood flow in patients of polycystic ovarian disease and post-treatment changes
(W.B. Saunders Ltd, 2020) A.N.D. Dwivedi; V. Ganesh; R.C. Shukla; M. Jain; I. Kumar
AIM: To assess the morphology and colour Doppler parameters in patients with polycystic ovarian syndrome (PCOS) and also to assess the changes in Doppler parameters in follow-up patients, who underwent treatment. MATERIALS AND METHODS: The study was conducted on 50 women of reproductive age who had clinical and biochemical findings suggestive of PCOS. Clinico-hormonal parameters were recorded. Ultrasound and colour Doppler flow measurements of bilateral ovaries were performed in the early proliferative phase of the menstrual cycle. After assessment of the bilateral ovaries, colour Doppler ultrasound was used to evaluate the main uterine artery at the cervico-uterine junction. Follow-up imaging after 3 months was undertaken in patients who underwent treatment (metformin) and changes in the imaging and hormonal parameters were correlated. RESULTS: The mean value of luteinising hormone (LH) and the ratio of LH: follicle-stimulating hormone (FSH) was significantly higher in PCOS patients. Ultrasound parameters were significantly higher in PCOS patients. Ovarian stromal vessels in PCOS patients had a significantly higher peak systolic velocity (PSV), low resistance index (RI), and pulsatility index (PI). The PSV of uterine arteries were significantly decreased and the RI and PI were significantly increased. On follow-up patients revealed changes in hormonal parameters. CONCLUSION: PCOS is a heterogeneous disorder and is a convergence of multisystem endocrine derangements. Ultrasound is good diagnostic tool for PCOS and the use of Doppler aids in the evaluation of haemodynamic changes in small vessels of utero-ovarian circulation and in response assessment. © 2020 The Royal College of Radiologists
Correlation of Clinical, Hormonal, Biochemical and Ultrasound Parameters Between Adult and Adolescent Polycystic Ovarian Syndrome: Adult and Adolescent PCOS
(Springer, 2022) Shivi Jain; Madhu Jain; R.C. Shukla
Purpose: To correlate the clinical, hormonal, biochemical and ultrasound parameters in adolescent patients with polycystic ovarian syndrome (PCOS) and to compare them with adult patients. Methods: This was a prospective, correlational study. 50 adult (20–35 years) and 50 adolescent patients (15–19 years) who had features of PCOS (Rotterdam Criteria, 2003) were selected. The control group comprised of 50 women of same age in each group with normal parameters. Pelvic ultrasound was done in early follicular phase (3–5th day of menstrual cycle). Assessment of hormonal and biochemical parameters (LH/FSH ratio, free testosterone level, lipid profile and fasting glucose/insulin ratio) and grey-scale ultrasound was done. Results: No significant difference was observed in menstrual pattern in adults and adolescents with PCOS. The mean values of serum LH/FSH ratio and free testosterone were significantly higher in both adult and adolescent PCOS patients as compared to their controls (p < 0.001). The mean value of serum insulin was significantly higher (p < 0.001) with positive correlation (adult: r = 0.655, p < 0.01; adolescent: r = 0.451, p < 0.01) of serum insulin with free testosterone. Hyperandrogenemia without hyperinsulinemia was found in 56% adolescent and 60% adult PCOS patients. 82% adolescent and 88% adult PCOS patients showed multiple follicles (> 5) on ultrasound. The ovarian morphology had positive correlation with serum LH and free testosterone. The mean ovarian volume was significantly higher in adult (10.48 ± 4.38 vs. 4.17 ± 0.91) and adolescent (11.08 ± 5.82 vs. 4.23 ± 0.89) PCOS patients, when compared with controls, respectively. Conclusion: No statistically significant difference was noted in PCOS between adults and adolescents. © 2021, Federation of Obstetric & Gynecological Societies of India.
Doppler cerebroplacental ratio for the prediction of adverse perinatal outcome
(John Wiley and Sons Ltd, 2004) M. Jain; T. Farooq; R.C. Shukla
[No abstract available]
Esthesioneuroblastoma: a case report.
(2010) R.C. Shukla; P.K. Singh; S. Senthil; R. Pathak
Esthesioneuroblastoma (olfactory neuroblastoma) is an uncommon neuroectodermal tumor. Its biological activity ranges from indolent growth to local recurrence and rapid widespread metastasis. Treatment options consist of surgical resection followed by radiation therapy for primary lesions and the addition of chemotherapy for advanced, recurrent, or metastatic lesions. Patients often present with nasal obstruction, rhinorrhea, recurrent epistaxis, hyposmia, or anosmia. We report a case of esthesioneuroblastoma involving bilateral nasal cavity leading to bilateral nasal obstruction, epistaxis and proptosis of the right eye associated with decreased visual acquity on that eye and loss of smell. A diffuse nontender, 6x6 cms swelling with illdefined margins was seen over the nasal bridge, extending superiorly to glabella and laterally to right maxillary region. X-ray PNS showed soft tissue mass in the nasal cavity with destruction of nasal septum, intense periosteal reaction with destruction of right maxillary wall and extension to right orbit. CT scan of paranasal sinuses showed 8.5 x 4.9 x 7.8 cms irregularly marginated heterogeneous iso- to hyper dense soft tissue mass lesion with extensive adjacent bony destruction and spiculated periosteal reaction involving bilateral nasal cavity and anterior cranial fossa. Biopsy from right nasal mass showed neuroblastoma. The patient received radiotherapy and chemotherapy. The modified Kadish staging system, lymph node status, treatment modality, and age are useful predictors of survival in patients who present with esthesioneuroblastoma. Excellent outcomes for esthesioneuroblastoma are achievable. Long-term follow-up is necessary because of the extended interval for recurrent disease; unlike most sinonasal malignancies, surgical salvage is possible.
Evaluation of Sassone Sonographic scoring system in various adnexal masses
(2001) Anuradha Khanna; Shweta Garg; R.C. Shukla; Mohan Kumar
Background: For diagnosis of ovarian masses, Sassone has described his scoring system. Aim: To evaluate the efficacy of Sassone Sonographic scoring system for adnexal masses. Material & Methods: Two hundred and fifty cases of adnexal masses underwent transabdominal and transvaginal sonography and detailed study was carried out for size, site, surface, inner wall, echogenicity of tumor and Sassone scoring was applied to look for its sensitivity and specificity. Results: The sensitivity, specificity, positive predictive value and negative predictive value to differentiate benign from malignant masses as per the Sassone sonographic score were 100%, 95.3%, 99.04% and 100% respectively. Conclusions: Sassone sonographic scoring system is a reliable scoring system to differentiate between benign and malignant tumor.
Intracerebral hemorrhage following scorpion bite
(1990) M. Rai; R.C. Shukla; D.N. Varma; H.S. Bajpai; S.K. Gupta
[No abstract available]
Multi imaging approach with low field MRA in diabetic foot ulcer: Hospital based study
(2011) Amit Nandan Dhar Dwivedi; K.K. Tripathi; R.C. Shukla
The aim of study was to assess the usefulness of non-invasive imaging in patient of diabetic foot ulcer with low field MRA and determine the severity and extent of lower extremity arterial disease in diabetic patients with poor socio economic status. The present study is based on 38 patients who were referred to Department of Radiology with complaint of non-healing ulcer of lower limb of more than 6 weeks duration. The patients were subjected to plain radiographs, Duplex scanning with color flow imaging and MR angiography (non contrast enhanced). The modalities were used to detect vascular calcifications, osteomyelitis, bone resorption, deformities, thickening of arteries, plaques, spectral waveforms, collaterals. MRA was used to assess subjective calibre of vessels and presence of stenosis. The patients were categorised according to age and a note of ulcer duration made. Grade of ulcer was determined (wagner's criteria) and note was made of severity of stenosis (cossman). Radiographs assessed bony destruction and vascular calcification. Doppler assessed degree of stenosis and vascularity. MRI gave a road map of vascular integrity. Integration of the tests provided a satisfactory diagnostic protocol to decide future prognosis and assessment of advancement of disease process. The data was subjected to calculation of mean, standard deviation and Pearson's chi square test. p value>0.05 was considered to be stastically significant. Majority of patients were males (80%) and highest incidence was noted in fourth-fifth decade (43.33%). 47.37% presented with grade III ulcer. Duplex scanning with color flow imaging was more accurate and sensitive in picking up calcified arteries, focal plaques, stenosed arteries and abnormal arterial waveforms. These patients had co-existent lower extremity arterial disease with moderate to severe stenosis (i.e. on comparision with peak systolic velocity (PSV), p<0.05. Ulcer grade had stastically significant correlation with severity of stenosis, (p<0.05). However MRA did not corroborate the same findings. It proved to be only 60% sensitive when compared to Duplex scanning (100%). Plain radiographs and color Doppler evaluation plays an indispensable role in imaging and evaluating patients with chronic non-healing ulcer of diabetic foot. MRA gives crucial information regarding parameters like vascularity, degree of stenosis, and extent of disease. Not all patients in our set up afford CTA or CEMRA followed by DSA or cost of stenting. When the diagnostic workup in our cases suggested poor prognosis or non salvageable vascular compromise the patient was counseled against further investigation and advised surgery. By using this approach many financially constrained patients are benefitted from unnecessary and costly diagnostic workup. © Research Society for Study of Diabetes in India 2011.
Pancreatic metastases of renal cell carcinoma--case report.
(2008) R.C. Shukla; R. Pathak; S. Senthil
Metastasis to the pancreas from renal cell carcinoma is distinctly uncommon. A solitary renal cell carcinoma (RCC) metastasis to the head of pancreas is rarely encountered. We present a 55 years old male who was admitted in our hospital with the complaint of abdominal pain on and off but more continuous since 15 days. He did not have any urinary symptoms. The laboratory tests were within the normal limits. Ultrasound of abdomen revealed an encapsulate mass in the kidney plus a mass in the head of pancreas, but no other distant metastases. On histopathological examination, sections of the renal mass showed features of a highly vascularized, clear cell neoplasm, with solid, nested, and alveolar architecture, consistent with RCC, clear cell type. Fine needle aspiration from the mass in the head of the pancreas confirmed the diagnosis of metastatic renal cell carcinoma, clear cell type. In the absence of widespread disease, pancreatic resection can provide long term survival in metastatic RCC, although few cases have been reported with lengthy follow up. The prognosis is better than for pancreatic adenocarcinoma.
Power Doppler sonography - A supplement to hysteroscopy in abnormal uterine bleeding: Redefining diagnostic strategies
(Wolters Kluwer Medknow Publications, 2022) Shuchita Batra; Anuradha Khanna; R.C. Shukla
Background: Abnormal Uterine Bleeding (AUB) is a very frequent cause of gynecological visits in women of all age groups. Ultrasound pelvis with or without endometrial sampling have been conventionally used to make diagnosis. Power Doppler is a comparatively recent modality which can be used to screen patients who will need endometrial biopsy/ curretage. We hereby conducted a study to compare the diagnostic accuracy of power Doppler sonography and hysteroscopy with histopathology associated with abnormal uterine bleeding. We also calculated the incidence of uterine pathology in AUB by power Doppler ultrasound and hysteroscopy and compared it with histopathology. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology, Institute of Medical Sciences, Banaras Hindu University. After excluding 42 women, a total of 100 women fulfilling the inclusion criteria contributed to our study. Selected women underwent power Doppler ultrasound and hysteroscopy with guided biopsy. Results were compared with histopathology as per the gold standard. Evaluation of sensitivity, specificity, positive and negative predictive values were performed for each modality. All statistical analyses were performed using the SPSS 11.0 statistical package. P value ≤0.05 was considered statistically significant for all tests used. Results: Sensitivity and specificity of power Doppler are 75% and 100% for carcinoma endometrium, 72.72% and 98.9% for endometrial hyperplasia, and 81.81% and 100% for endometrial polyp, respectively. Conclusion: Power Doppler sonography can be used to screen outpatients who do not need an endometrial biopsy for abnormal uterine bleeding. This will avoid unnecessary hysteroscopy in definitive benign cases, and watchful hysteroscopy in suspected premalignant and malignant cases. Irregular branching vessels and color splashes were found to be the best parameters for diagnosing endometrial carcinoma. Power Doppler should be done along with transvaginal sonography in all cases of abnormal uterine bleeding. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
Role of preoperative versus post-operative HCG therapy in bilateral nonpalpable undescended testis
(Medknow Publications and Media Pvt. Ltd, 2005) A.N. Gangopadhyay; Shilpa Sharma; V. Bhushan; R.C. Shukla
To evaluate the role of human chronic gonadotropin (HCG) and compare the results when it is given preoperatively and postoperatively in bilateral nonpalpable undescended testes (BNUDT) to facilitate the surgical outcome. Sixty-six cases of BNUDT, from January 1997 to January 2004, were divided equally into two groups on a random basis: Group A - control group received HCG doses which were completed 7-10 days preoperatively and Group B - test group received postoperative HCG doses started 7-10 days after surgery. The HCG was given as per WHO recommendation. The results were assessed clinically, by color Doppler ultrasound and HCG stimulated testosterone assay. Standard orchidopexy was done in all cases. Both groups were comparable in terms of age, testicular size, and vascularity as assessed by the Doppler ultrasonographic study. The mean basal serum testosterone and the HCG stimulation were also comparable in both the groups. At the sixth week follow up, the difference in the serum testosterone level was statistically significant, Group A 60.50 ± 7.19 ng/dl vs Group B 81.17 ± 5.88 ng/dl. The testicular vascularity at the sixth week follow up was more in Group B (74% normal vs 55% normal). Sixteen (24%) testis were retracted in Group A, while none were in Group B. Postoperative HCG therapy has been proved to be more effective than conventional preoperative therapy for better surgical outcome in BNUDT.
Role of sonourethrography in anterior urethral stricture
(1999) S.S. Samaiyar; R.C. Shukla; U.S. Dwivedi; P.B. Singh
Conventional urethrography although the most commonly used technique for diagnosis and characterization of anterior urethral stricture has limitations in accurate characterization with associated complications. We compared retrograde urethrogram and/or micturating cystourethrogram (RGU and/or MCU) and sonourethrography in evaluation of anterior urethral stricture. Diagnostic accuracy of RGU was 85.71% compared to 96.44% of sonourethrography. This difference between RGU and sonourethrography was mainly in penobulbar (70% and 90% respectively) and bulbar region (93.75% and 100% respectively). RGU/MCU underestimated the length by 37%, which was statistically significant. Sonourethrography detected periurethral spongiofibrosis. All these characteristics are important for proper selection of treatment modalities. Sonourethrography was used for follow-up in 19 patients and correctly diagnosed the recurrence in short follow-up of up to 6 months (mean follow-up = 4.6 months).
Saline perfusion sonography and transvaginal sonography in abnormal uterine bleeding
(2001) Anuradha Khanna; Meenal Gupta; R.C. Shukla
Transvaginal sonography (TVS) and saline infusion sonograpoy (SIS) or sono hysterography are the simple ultrasound procedure that may be used to evaluate the endometrium. 70 patients were studied by TVS and SIS and the results were compared with standard hysteroscopy and biopsy. TVS could diagnose atrophic, normal, malignancy in endometrium but at times could not delineate between hyperplasia and polyp. TVS had advantage of being non-invasive, cost-effective and bleeding episodes did not interfere with the test. The saline infusion sonography, an extension of TVS had a sensitivity and specificity of 94.2% and 97.3% respectively in cases of abnormal uterine bleeding. SIS is an accepted procedure of choice but it was not possible to do if there was heavy bleeding prior to procedure.
Sonocholangiometry: A simple method to detect residual stones after CBD surgery [1]
(W.B. Saunders Ltd, 2003) V.K. Shukla; V.S. Chauhan; R.C. Shukla; O.P. Sharma
[No abstract available]
Sonographic morphology of carcinoma of the gallbladder: A review of 173 cases
(Georg Thieme Verlag, 1997) A. Gautam; B.P. Sood; M. Pandey; V.K. Dixit; R.C. Shukla; A.K. Agrawal; V.K. Shukla
Objective: To evaluate the ultrasonographic features of carcinoma gallbladder in an endemic area. Materials and Methods: A retrospective study from January 1994 to December 1995 of 173 consecutive patients of carcinoma gallbladder presenting in a teaching university hospital, was conducted. US was performed in all patients. Results: The presentation of carcinoma gallbladder was either as a mass (150 patients) or as wall thickening (23 patients). The mass was intraluminal in 93 patients (body - 46, fundus 41, total replacement - six) and infiltrative in 57 patients (neck 32, fundus 23, total 2). Associated gallbladder calculi were present in 112 (65%) patients with ascites in seven. According to the TNM classification there were no patients in stage I, 14 in stage II, 111 in stage III and 48 in stage IV. Conclusions: Early detection of carcinoma of the gallbladder by US is difficult even in an endemic area. Polyps, as a sign of precancer or early cancer were rare in our series. Even in advanced disease US tends to understage the disease when compared to the findings at exploratory laparotomy.
Study of Pattern of Origin of Central Branches of Middle Cerebral Artery by Using 64-Slice Computed Tomography Angiography
(Wolters Kluwer Medknow Publications, 2020) Mahendra Kumar Pant; Jayanti Pant; S.K. Pandey; R.C. Shukla
Background and Aims: Middle cerebral artery (MCA), a branch of the internal carotid artery, is the most commonly affected vessel in cerebrovascular diseases. Various studies have reported for variations in the origin pattern of MCA. The detection of these variations is of clinical relevance for the clinicians for planning their line of treatment. The present study was performed to identify the variations using 64-slice computed tomography (CT) angiography. Materials and Methods: The present study was performed in 45 participants (32 males and 13 females). MCA was identified and observed for a different pattern of origin of the central (perforating) branches using 64-slice CT angiography. Results: The observations revealed that the M1 segment of MCA showed single, dual, or multiple origins of central branches. Single central branch of MCA originated in 8.88% of cases, double branches were observed in 11.11% of cases, whereas the multiple branches were found in 66.67% of cases and mix pattern was observed in 13.3% of cases. These central branches coursed through the anterior perforating substance to reach the basal area of the subcortical zone. Conclusions: The present study revealed the variations in origin of the central branches of MCA using 64-slice CT angiography and the knowledge of radiological identification of these variations can be of use for radiologists and neurosurgeons dealing with cerebrovascular diseases. © 2020 National Journal of Clinical Anatomy.