BackgroundDiaphragmatic rupture due to blunt or penetrating injury may be a missed diagnosis in an acute setting and can present with a delayed complication with significantly increased morbidity and mortality.ObjectivesThe objective of this study is to better understand why diaphragmatic tears with delayed presentation and diagnosis are so often missed and why traumatic diaphragmatic tears are difficult to diagnose in emergency settings and how they present with grievous complications.Patients and MethodsEleven patients with diaphragmatic hernias with delayed presentation and delayed diagnosis were operated within the last five years. All patients presented with different complications like gut gangrene or respiratory distress.ResultsOut of eleven patients who were operated on for diaphragmatic hernia, three patients (27%) died. Three patients required colonic resection, one patient needed gastrectomy and one patient underwent esophagogastrectomy.ConclusionsA small diaphragmatic tear due to blunt trauma to the abdomen is difficult to diagnosis in acute settings due to ragged margins and possibly no herniated contents and usually present with a delayed complication. Therefore a careful examination of the entire traumatized area is the best approach in treating delayed presentation of traumatic diaphragmatic hernia prior to development of grievous complications.

Aims: This prospective study was designed to determine whether ultrasound (US)-guided percutaneous fi ne needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is effi cacious in diagnosis, is helpful in treatment choice, to evaluate whether various other investigations can be avoided, especially invasive ones, its time (shortening hospitalization) and cost-effectiveness. Materials and Methods: A total 159 US-guided PFNAB (67) and US-guided automated PNCB (92) of abdominal lesions were performed percutaneously in 150 patients; the youngest patient was a 3-month-old female and eldest was a 75-year-old female. The patient selection was irrespective of age, sex, or location of the abdominal lesion. These patients presented with abdominal mass/lesions, suspected malignancy, jaundice, and in some cases, however, biopsy was performed to determine the nature of indeterminate lesion (malignant / benign versus abscesses). They were 47 hepatobiliary, 6 pancreas, 24 gastrointestinal tract (GIT), 20 kidneys and urinary bladder, 20 prostate, 3 lymph nodes, 4 adrenals, 8 retroperitoneal, 13 ovaries, and 9 other types of lesions. We used free-hand technique (without biopsy attachment) in 129 cases, and transrectal and transvaginal with biopsy attachment was used in 30 cases. Results: In 91.99% of cases, US-guided PFNAB/US-guided PNCB contributed signifi cantly to diagnosis in which USguided PFNAB/US-guided PNCB was the diagnostic test in 23.33% cases. It confi rmed a highly suspected diagnosis in 64% patients, and indicated a specifi c diagnosis that was not suspected in the remaining 36%. In 57.33% cases, the results of US-guided PFNAB/US-guided PNCB, did not alter treatment choice but increased physician confi dence in the choice. US-guided PFNAB/US-guided PNCB was responsible in avoiding 107 planned investigations, including 8 laparotomies, with no signifi cant complications and decreasing length of stay and resulting in 20% cost savings. Conclusions: Thus, the US-guided PFNAB/US-guided PNCB contributed signifi cantly in diagnosis, and in most of the cases it did not change treatment choice but increased clinicians confi dence in the choice. We can avoid the number of investigations, decrease morbidity and mortality, shorten hospitalization and cost by using these methods.Key-words: Biopsy, cost-effectiveness, effect on diagnosis, effect on treatment, percutaneous fi ne needle aspiration biopsy, percutaneous needle core biopsy, ultrasound RésuméObjectifs: Cette étude prospective a été conçue afi n de déterminer si l'échographie (US)-guidé percutanée fi ne aiguille biopsie d'aspiration (PFNAB) / biopsie guidée par U.S. percutanée aiguille (PNCB) des lésions abdominales est effi cacious en diagnostic, est utile dans le choix de traitement, d'évaluer si les divers autres enquêtes peuvent être évités, surtout envahissantes, son temps (raccourcissement hospitalisation) et la rentabilité.

This study suggests that the estimation of adenosine deaminase activity in pleural fluid is a rapid diagnostic tool for differentiation of tubercular and non tubercular-effusions. The sensitivity and specificity of adenosine deaminase for tubercular effusions in this study was 90% and 50% respectively.

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Background:The aim of this study was to see the efficacy of endorectal coil MRI and MR spectroscopic imaging in patients with elevated serum PSA and negative transrectal ultrasonography (TRUS)-guided biopsy.Materials and Methods:This study was conducted on 87 patients presented with: • Elevated prostatic specific antigen levels >5 ng/ml • Symptoms and signs of prostatic carcinoma • Patients with negative TRUS-guided biopsy • Suspicious lesion on TRU. All the patients were subjected to TRUS and followed by TRUS-guided biopsy of the lesion identified on endorectal coil MRI and MR-Spectroscopy. TRUS-guided biopsy of prostate was done with a Siemens Sonoline Adana Scanner. The scanning was performed by mechanical probe 5-7.5 MHz.Results:Out of 87 patients, 43 (49.4%) had hypointense lesion, 11 (12.6%) had hyperintense lesion. Out of 87 patients, MR-spectroscopy showed peak choline-creatine in 74 patients. Normal citrate peak was seen in 13 patients. Patients who had choline-creatine peak, among them 28 (37.8%) had peak in left peripheral zone, 23 (31.1%) had peak in the right peripheral zone, 2 (2.7%) had peak in the central zone, 17 had (23%) peak bilaterally. Four patients (5.4%) had peaks in right and central zones. The difference was statistically significant (P < 0.001).Conclusion:Prostatic biopsy directed with endorectal coil MRI and MR-spectroscopic imaging findings in patients with elevated serum PSA and prior negative biopsy, improves the early diagnosis of prostatic carcinoma and accurate localization of prostate cancer within the gland.