Objective: To identify the usefulness of Doppler indices in the third trimester for intra-uterine growthrestricted pregnancies. Materials and Methods: It was an observational casecontrol study of singletons with intra-uterine growth restriction (fetal weight <10th percentile). Intra-uterine growth restricted fetuses (cases) and normal (controls) were examined for the umbilical artery. Time intervals between progressive Doppler abnormalities and configurations of worsening were related to umbilical artery Doppler status and gestational age. This study was conducted from August 2015 to January 2016 at Gilani Ultrasound Center Lahore Pakistan. A total of 60 pregnant females were studied with normal and abnormal umbilical artery Doppler ultrasound. Results: Doppler indices measurements of umbilical artery in intra-uterine growth restriction fetuses in the third trimester showed higher values as compared to normal fetuses. 30 females had normal umbilical artery Doppler indices and waveforms and 30 females showed (either thinning, absent or reversed Diastolic flow Doppler waveform) with higher indices. Conclusion: Fetal umbilical artery Doppler ultrasound is an effective tool in the detection of early intra-uterine growth restriction fetuses.

Typhoid fever is a potentially multi systemic and fatal illness, and this serious systemic infection caused by salmonella enterica serotype typhi and paratyphi which are both gram-negative bacteria Objectives: To determine the sonographic common abdominal findings among patients suffering from typhoid fever. Methods: This research was conducted at Al Qaim Ultrasound Centre and Islamia Hospital Chiniot in nine months duration. Honda Electronics (HS 2000, HS 2200, and Toshiba just vision) machines were used. Frequency range of 3.5-5.00 MHz was used. All the patients were enrolled voluntarily after explaining the procedure to the patient thoroughly. Statistical Package of Social Sciences (SPSS) version 21 was used to evaluate the data Results: In this study 176 patients were included, which clinically diagnosed suffering from typhoid fever and laboratory findings also showing positive results. All male and female patients of all age groups, who were clinically suspected of having typhoid fever, either acute or chronic. All male and female healthy individuals and noncooperative patients. Out of 176 patients, 91 were female and 85 males. Laboratory findings, 47(26.7%),56(31.8%),21(11.9%),52(29.5%) patients having (TyphidotIgG), (TyphidotIgM), (TyphidotIgG, IgM), (Widal) positive results respectively. Common abdominal findings on ultrasonography were 62(35.2%) patients with having hepatomegaly, and 88(50%) patients with splenomegaly. Mesenteric lymph adenitis showed only in 21(11.9%) patients. Results showed 27(15.3%) patients with bowel wall thickening, and 13(7.4%) patients with having acalculous-cholecystitis. Conclusions: Ultrasonography is a useful and helpful tool in diagnosing the typhoid fever, especially when serological tests are time consuming or showing negative results or cultures. Ultrasonography is also a quick, economical and non-invasive procedure.

Ectopia cordis is a rare congenital condition. It is defined as the abnormal position of the heart outside the thoracic cavity, associated with defects in the parietal pericardium, diaphragm, sternum, and, in most cases, cardiac malformations. Ectopia cordis was first proposed by Abott in 1998, although cases of patients with similar defects have been reported in the past. Ectopia cordis is produced by segmental defects in the mesodermal development in the third week of intrauterine life, and/or amniotic band syndrome that causes simultaneous cerebral and thoracoabdominal malformations. The existence of ectopia cordis with severe congenital heart disease may be confirmed in the prenatal period by vaginal echocardiography at 10-12 weeks of gestation or by abdominal echocardiography at 20-22 weeks. For such defects surgical correction is the only hope of survival, although the overall success rate is very poor. In recent years, surgery has been attempted in one or two phases with variable results that depend mainly on the type of associated heart disease. A 37 years old woman with gestational age of 29.5 weeks was referred for third trimester ultrasound to detect fetal anomaly. The fetal heart was seen outside lower the chest wall which was later confirmed by elective cesarean section. The heart was not covered with a membrane (pericardium). The rest of the anterior abdominal wall was intact. The abdomen was distended due to ascites.

Shoulder impingement is the painful entrapment of the soft tissues in the shoulder outlet. Currently, dynamic sonography of the shoulder is the modality of choice for the evaluation of shoulder impingement syndrome. However, the current sonographic criteria for the evaluation of shoulder impingement is more subjective (operator dependent). And it is rather difficult for a novice observer to diagnose it. The measurable distance between acromion and greater tuberosity is during shoulder abduction is considered for shoulder impingement syndrome. Objective: To estimate the accuracy of the acromion to greater tuberosity distance in shoulder abduction as a sonographic diagnostic parameter for the shoulder impingement syndrome. Methods: Seven hundred and seventy-two shoulders were observed in this study. All the shoulders were evaluated with Toshiba Xario Prime ultrasound Unit with linear transducer 7-14MHz. Acromion to greater tuberosity distance was measured during the abducted arm. All the shoulders with measurable distance during abduction were declared as positive for impingement while unmeasurable distance due to disappearance of the greater tuberosity underneath the acromion was normal. Results: At 95% confidence interval, the sensitivity, and specificity with lower and upper limits, of the acromion to greater tuberosity distance during abduction for the diagnosis of shoulder impingement syndrome were 0.9731% (95.25 to 98.49%) and 100% (98.49 to 100%) respectively. While the positive-predictive and negative-predictive value were 100% (98.22% to 100%) and 97.12% (94.96% to 98.37%) respectively. However, the overall Accuracy at 95% confidence interval was 98.45% (97.30% to 99.20%). There was a high-grade interobserver (novice and expert) agreement in the diagnosis of shoulder impingement through this criteria with a Kappa value of 0.96. Conclusion: Sonographically measurable acromion to greater tuberosity distance in abduction is a more accurate, reliable, and objective technique for the diagnosis of shoulder impingement syndrome.