Biomedical subjects
Publications and source records attributed to R B Gujral.
An unusual case of completely thrombosed giant aneurysm of the left posterior cerebral artery, showing much more loss of signal on T2-weighted images compared with T2*-weighted images in the periphery of the thrombus is presented. Possible mechanism of this preferential signal loss on T2-weighted images is discussed.
PURPOSE: The role of expandable metallic Z stents (non-mesh) in the treatment of recurrent posterior and bulbar urethral strictures was evaluated. PATIENTS AND METHODS: Seven men with recurrent posterior/bulbar urethral strictures underwent balloon angioplasty followed by insertion of two stents in tandem. Retrograde urethrography, micturating cystourethrography, and urodynamic evaluation of these patients was done initially. RESULTS: Successful dilation and placement of stents was possible in all cases. In one patient slight proximal migration of the stent occurred; terminal dysuria in this patient necessitated stent extraction. In two other patients near total occlusion of the stent by an exuberant fibrous reaction occurred and this open urethroplasty in the other. Immediate postprocedure urethrography and urodynamic evaluation showed significant improvement. Five patients continue to show a satisfactory clinical urodynamic response. The follow-up period in this patient group ranged from 5 months to 1 year. CONCLUSION: Short-term response (5 months to 1 year) in patients with posterior/bulbar urethral strictures treated with Z stents appears promising. However, the efficacy of the procedure on a long-term basis requires further follow-up and evaluation.
BACKGROUND/AIMS: Preoperative staging of carcinoma of the gallbladder is important in choosing the most appropriate treatment modality. Ultrasonography is commonly used for the diagnosis of carcinoma of the gallbladder, but its role in staging of the disease has not been adequately evaluated. The aim of this study was to prospectively evaluate the role of ultrasonography performed by a single operator in the staging of carcinoma of the gallbladder. METHODOLOGY: Twenty-six patients with carcinoma of the gallbladder were evaluated in this study. Ultrasonographic staging was done by a single senior radiologist and compared with surgical staging using the AJCC TNM staging system. A retrospective evaluation was done of 122 operated patients with carcinoma of the gallbladder, and the findings were compared to the results of the prospective study. RESULTS: In the prospective study, the overall accuracy of ultrasonogaphy in correctly staging the disease was 38% (10/26). Only 1 patient was overstaged, while the majority of patients were understaged (15) due to missed distant metastasis (10) and missed advanced local infiltration (5). The sensitivity in detecting liver infiltration was 50%; lymph node metastasis, 50%; and liver metastasis, 8%. In the retrospective study, the similar detection rates were 27%, 25% and 10%, respectively. CONCLUSION: Real time ultrasonography has been found to have inherent limitations in staging carcinoma of the gallbladder. Its accuracy, though improved in a prospective study, is inadequate in staging the disease accurately. More accurate imaging modalities are therefore required to accurately stage the disease preoperatively, so as to avoid unnecessary laparotomies.