RESUMEN
The Authors report their experience in primitive bladder diverticula treatment during the last six years. They identify criteria for a general classification of this clinical entity and limited to primitive forms they divide in 4 groups. This classification is related to clinical and topographycal criteria, aiming to delineate a new diagnostic and therapeutic pathway.
Asunto(s)
Divertículo/cirugía , Enfermedades de la Vejiga Urinaria/cirugía , Niño , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
This study was aimed at investigating the time-course and recovery from eccentric (EC) exercise induced muscle damage by means of surface electromyography (sEMG), ultrasonography (US), and blood enzymes. Five subjects (EC Group) performed two bouts of 35 EC maximum contractions with the biceps brachii of their non dominant arm, five subjects were tested without performing EC (Control Group: CNT). The maximal isometric force (MVC) was measured. Force and sEMG signals were recorded during 80% MVC isometric contractions. In EC and CNT subjects US assessment on non-dominant biceps brachii was performed; creatin kinase (CK) and lactic dehydrogenasis (LDH) plasma levels were also assessed. Force, sEMG and CK-LDH measurements were performed before EC and after it periodically for 4 weeks. The sEMG was analysed in time and frequency domains; a non-linear analysis (Lyapunov 1st exponent, L1) of sEMG was also performed. After EC, the MVC was reduced by 40% on average with respect to the pre-EC values. A significant decrease in the initial frequency content, and in the MDF and L1 decay (13-42% less than the pre-EC values, respectively) was also observed. The sEMG amplitude (Root Mean Square, RMS) was unchanged after EC. The US revealed an increase in muscle belly thickness and in local muscle blood flow after EC. A complete recovery of all the considered parameters was achieved in two weeks. In conclusion sEMG analysis was confirmed as an early indicator of muscle damage. Muscle recovery from damage is followed by both sEMG and US and this may have useful clinical implications. Non linear analysis (L1) was revealed to be sensitive to early sEMG modifications induced by EC as well as able to follow the post EC changes in the sEMG.
Asunto(s)
Electromiografía , Ejercicio Físico , Músculo Esquelético/fisiopatología , Adulto , Brazo , Velocidad del Flujo Sanguíneo , Pruebas Enzimáticas Clínicas , Creatina Quinasa/sangre , Edema/diagnóstico por imagen , Edema/etiología , Femenino , Humanos , Contracción Isométrica , L-Lactato Deshidrogenasa/sangre , Masculino , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/lesiones , Flujo Pulsátil , Procesamiento de Señales Asistido por Computador , Ultrasonografía DopplerRESUMEN
The Authors, on the basis of their observation of two cases of giant posterolateral congenital extratrigonal diverticula of the bladder (D.G.P.P.L.E.), identify it as a nosological entity apart in the widest category of bladder's diverticula, which implies a peculiar diagnostic and therapeutic attitude.
Asunto(s)
Divertículo/diagnóstico por imagen , Vejiga Urinaria/anomalías , Niño , Divertículo/congénito , Humanos , Masculino , Ultrasonografía , Vejiga Urinaria/diagnóstico por imagen , UrografíaRESUMEN
The Authors present 4 cases of femoral hernia treated in their pediatric surgery department during the last 11 years. Childhood femoral hernia is rare and often missed clinically because of difficulty in eliciting their clinical signs. During an operation for inguinal hernia it is essential to think of femoral hernia when a non obliterated processus vaginalis is not found.
Asunto(s)
Hernia Femoral/diagnóstico , Hernia Inguinal/cirugía , Niño , Preescolar , Femenino , Hernia Femoral/cirugía , Humanos , Lactante , Periodo Intraoperatorio , MasculinoRESUMEN
We studied, by means of Doppler ultrasonography, the blood flow in the superior mesenteric artery in 12 untreated patients with celiac disease (nontropical sprue) and in 15 healthy controls; peak systolic velocity, end diastolic velocity, mean velocity, flow volume, and resistive index were measured in the fasting state and at regular intervals after ingestion of 0.5 liter of water containing 50 g of saccharose. Under fasting conditions, celiac patients showed peak systolic velocity, end diastolic velocity, mean velocity, and flow volume values significantly higher than those of normal subjects, whereas resistive index was significantly lower. After saccharose ingestion these parameters showed greater variations in normal subjects than in celiac patients. Fasting end diastolic velocity turned out to be the best parameter to distinguish celiac patients from healthy subjects. Doppler ultrasonography of the superior mesenteric artery could discriminate between normal subjects and celiac patients with overt disease. However, these data need further confirmation given the limited sample that we studied; moreover, the capability of this technique in distinguishing nontropical sprue from other gastrointestinal diseases that cause increasing splanchnic flow remains to be ascertained.
Asunto(s)
Enfermedad Celíaca/diagnóstico por imagen , Ayuno , Arteria Mesentérica Superior/fisiología , Ultrasonografía Doppler , Adulto , Femenino , Humanos , Intestinos/efectos de los fármacos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional , Sacarosa/farmacologíaRESUMEN
The acute systemic haemodynamic effects of cigarette smoking are well known, but there are no studies dealing with the possible smoke-related acute changes of splanchnic circulation in man. In the present study we evaluated the acute effects of cigarette smoking on portal blood flow (PBF) in normal subjects by the use of Doppler ultrasound. Twenty-three normal volunteers were asked to smoke two cigarettes with a known total nicotine content (1.1 mg each) in a supine position. Each cigarette was smoked during a 5 min period and a 5 min interval between the two cigarettes was allowed. Both mean PBF velocity and volume were evaluated at time 0 (basal values) and 8, 15, 30, 45 and 60 min after the first inhalation of the first cigarette. The basal mean PBF velocity (22 cm/s; 95% CI 20.9-24.2) was significantly decreased at 8 min (19 cm/s; 95% CI 17.9-20.8; P < 0.0007) and 15 min (20 cm/s; 95% CI 17.8-21.3; P < 0.005). Similarly, the PBF volumes at 8 min (710 mL/min; 95% CI 660-876; P < 0.002) and 15 min (750 mL/min; 95% CI 650-862; P < 0.005) were significantly lower than those measured at time 0 (850 mL/min; 95% CI 766-987). Both mean PBF velocity and volume measured at successive times did not differ significantly from basal values. The present study shows that cigarette smoking causes acute and transient reduction of PBF velocity and volume in normal subjects.
Asunto(s)
Sistema Porta/diagnóstico por imagen , Fumar/efectos adversos , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Masculino , Valores de Referencia , Ultrasonografía DopplerRESUMEN
During a 4-year period portal vein thrombosis was diagnosed in 20 Child class A patients with cirrhosis by means of ultrasound and ultrasound-Doppler study. Seventeen of them showed single or multiple focal liver lesions diagnosed as hepatocellular carcinoma by ultrasound-guided fine-needle biopsy and the remaining three a coarse liver echo-pattern without focal lesions. One patient was found to have developed portal vein thrombosis after the fifth ethanol injection of a single hepatocellular carcinoma lesion 17 mm in diameter. Ultrasound-guided fine-needle biopsy of the thrombus was performed on all the patients: portal vein thrombosis was neoplastic in 13 cases and non-neoplastic in seven cases (five patients with a single lesion; one with two lesions; one with coarse liver echo-pattern). Among the five patients with a single lesion, one had already been treated by percutaneous ethanol injection therapy. There were no complications related to the biopsy procedures. The diagnosis of non-neoplastic thrombosis allowed five new patients to be recruited for percutaneous ethanol injection treatment and allowed it to continue in the patient with portal vein thrombosis occurring after the fifth ethanol injection. The routine use of ultrasound-guided fine-needle biopsy of portal vein thrombosis yields an accurate diagnosis of the nature of the thrombus and can improve the selection for percutaneous ethanol injection treatment of patients with cirrhosis with hepatocellular carcinoma lesions.
Asunto(s)
Carcinoma Hepatocelular/complicaciones , Neoplasias Hepáticas/complicaciones , Vena Porta/diagnóstico por imagen , Vena Porta/patología , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Anciano , Biopsia con Aguja/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trombosis/terapia , UltrasonografíaRESUMEN
This study was conducted to identify the sonographic findings that might be used to diagnose sliding gastric hiatal hernia. We first performed a retrospective evaluation of 12 patients known to have sliding hiatal hernia and 18 normal controls. In the controls the esophagogastric junction could be visualized clearly in all cases and the alimentary tract section at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The esophagogastric junction was not visualized in any of the hernia patients, whose alimentary tract diameters ranged from 16.0 to 21.0 mm. These two markers (nonvisualization of the junction and diameter greater than 16 mm) were then evaluated for their ability to predict the occurrence of sliding hiatus hernia in a prospective study of 38 patients subsequently diagnosed by means of barium contrast examinations and endoscopy. In this group, each sign had a positive predictive value of 100%. The negative predictive value of the alimentary tract diameter was 90%; that of nonvisualization of the esophagogastric junction was 94.7%. Inclusion of ultrasonography in the initial work-up of patients with symptoms of gastroesophageal reflux may reduce the need for more invasive diagnostic procedures.
Asunto(s)
Unión Esofagogástrica/diagnóstico por imagen , Hernia Hiatal/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Sulfato de Bario , Endoscopía Gastrointestinal , Reacciones Falso Negativas , Femenino , Reflujo Gastroesofágico/diagnóstico por imagen , Humanos , Intestino Delgado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estudios Retrospectivos , UltrasonografíaRESUMEN
Defective gallbladder emptying has been proposed as a possible accessory pathogenetic factor to explain the increased prevalence of gallstones in liver cirrhosis. In this study we have evaluated the fasting volume and the meal-stimulated emptying of the gallbladder, the plasma levels of estradiol and progesterone, and the basal and postprandial secretion of cholecystokinin in Child A cirrhotic patients compared to normal subjects. Basal (42.2 +/- 27 vs 22.8 +/- 8.4 ml) (P < 0.002) and residual (8.4 +/- 8.7 vs 4.6 +/- 3.8 ml) (P < 0.05) gallbladder volumes were higher in cirrhotics but neither the integrated gallbladder response to meal nor the maximal percentage of emptying was significantly different. Circulating estradiol and progesterone was slightly increased in only 1/13 and 5/13 cirrhotics, respectively. In eight cirrhotics and seven normals taken from the overall populations, the secretion of cholecystokinin was also measured. The fasting plasma level of cholecystokinin was higher in the cirrhotics (6.71 +/- 5.08 vs 2.02 +/- 0.46 pmol/liter) (P < 0.01). The meal-stimulated integrated plasma cholecystokinin response also was greater in cirrhotics (438.5 +/- 615 pmol/liter/270 min) than in normals (153 +/- 170.4 pmol/liter/270 min), but this difference was not significant because of the small study population. In spite of a normal kinetics of postprandial emptying, cirrhotic patients show increased fasting gallbladder volume and increased plasma levels of basal and postprandial cholecystokinin. Circulating estradiol and progesterone do not seem to be responsible for the large gallbladder volume found in liver cirrhosis.
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Colecistoquinina/metabolismo , Estradiol/sangre , Vaciamiento Vesicular , Cirrosis Hepática/fisiopatología , Progesterona/sangre , Adulto , Anciano , Colecistoquinina/sangre , Ingestión de Alimentos/fisiología , Ayuno/sangre , Ayuno/fisiología , Femenino , Humanos , Cirrosis Hepática/sangre , Modelos Logísticos , Masculino , Persona de Mediana Edad , Radioinmunoensayo , Estadísticas no ParamétricasRESUMEN
This study was conducted to identify the sonographic findings that might be used to diagnose sliding gastric hiatal hernia. We first performed a retrospective evaluation of 12 patients known to have sliding hiatal hernia and 18 normal controls. In the controls the esophagogastric junction could be visualized clearly in all cases and the alimentary tract cross section at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The esophagogastric junction was not visualized in any of the hernia patients, whose alimentary tract diameters measurements ranged from 16.0 to 21.0 mm. These two markers (non visualization of the function and diameter greater than 16 mm) were then evaluated for their ability to predict the occurrence of sliding hiatas hernia in a prospective study of 38 patients subsequently diagnosed by means of barium studies and endoscopy. In this group, each sign had a positive predictive value of 100%. The negative predictive value of the alimentary tract diameter was 90%; that of non-visualization of the esophagogastric junction was 94.7%. Inclusion of ultrasonography in the initial work-up of patients with symptoms of gastroesophageal reflux may reduce the need for more invasive diagnostic procedures.
Asunto(s)
Unión Esofagogástrica/diagnóstico por imagen , Hernia Hiatal/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Estudios Retrospectivos , UltrasonografíaRESUMEN
OBJECTIVES: The aims of this study were to evaluate the typing accuracy of smear cytology and microhistology and of their association in the diagnosis of hepatocellular carcinoma arising in liver cirrhosis, and to analyze the usefulness of smear cytology in the diagnosis of well-differentiated neoplasms. METHODS: One hundred sixty patients with hepatocellular carcinoma underwent an ultrasound-guided fine-needle biopsy, providing material for cytological and histological study. In 73 patients, a double biopsy with noncutting and cutting needles was performed (double-needle group), whereas in the remaining 87, a single biopsy with cutting needle was carried out (single-needle group). RESULTS: In the whole population examined, smear cytology, microhistology, and their association, provided the diagnosis of hepatocellular carcinoma in 128 (80%), 98 (61%), and 144 (90%) cases, respectively. The double-needle and the single-needle groups did not differ significantly as to typing accuracy. Smear cytology correctly diagnosed 54 of 64 neoplasms classified histologically as well-differentiated. CONCLUSIONS: Our results show that both smear cytology and microhistology should be applied immediately, when diagnosing hepatocellular carcinoma arising in liver cirrhosis, and that smear cytology is effective in the diagnosis of well-differentiated neoplasms.
Asunto(s)
Biopsia con Aguja , Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Ultrasonografía Intervencional , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/métodos , Carcinoma Hepatocelular/complicaciones , Citodiagnóstico , Femenino , Técnicas Histológicas , Humanos , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/complicaciones , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
A case of Osler-Weber-Rendu disease or hereditary haemorrhagic telangiectasia with hepatic involvement diagnosed by Doppler ultrasound is described showing an increased blood flow within the dilated common hepatic artery and multiple aneurysms of the intraparenchymal branches of the proper hepatic artery. Doppler ultrasound provides findings suggestive of hepatic involvement in this rare disease and allows invasive imaging studies to be avoided.
Asunto(s)
Hepatopatías/diagnóstico por imagen , Telangiectasia Hemorrágica Hereditaria/diagnóstico por imagen , Anciano , Femenino , Humanos , Hígado/irrigación sanguínea , Hígado/diagnóstico por imagen , UltrasonografíaRESUMEN
The authors describe a case of subcutaneous neoplastic seeding in the abdominal wall in a 67-year-old man with posthepatitic liver cirrhosis complicated by a single nodule of well-differentiated hepatocellular carcinoma. He was treated with percutaneous ethanol injection (PEI) performed under ultrasound guidance. The neoplastic seeding developed along the needle track used to carry out fine-needle biopsy and PEI and was diagnosed 6 months after the beginning of treatment.
Asunto(s)
Carcinoma Hepatocelular/terapia , Etanol/administración & dosificación , Inyecciones Intralesiones/efectos adversos , Neoplasias Hepáticas/terapia , Siembra Neoplásica , Neoplasias Primarias Secundarias/etiología , Neoplasias Cutáneas/etiología , Músculos Abdominales/diagnóstico por imagen , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Neoplasias Primarias Secundarias/diagnóstico por imagen , Radiografía , Neoplasias Cutáneas/diagnóstico por imagenRESUMEN
Being more evident that primary achalasia is not confined to the esophagus and that it may involve other organs in the digestive tract, gallbladder emptying was ultrasonographically evaluated in 10 patients affected with primary achalasia and in 10 controls. An intravenous cerulein infusion was used to induce gallbladder contraction. Eight out of 10 achalasic patients had a lower gallbladder emptying, and 6 out of 10 had a markedly delayed gallbladder emptying compared with the controls. Achalasic patients, taken as a whole, showed a significantly lower and delayed mean gallbladder emptying when compared with the controls. Such a finding confirms the possible extra-esophageal extension of primary achalasia. In this study, the hypothesis of impaired cholinergic gallbladder innervation in primary achalasia is discussed.
Asunto(s)
Acalasia del Esófago/fisiopatología , Vaciamiento Vesicular/fisiología , Ceruletida , Acalasia del Esófago/diagnóstico por imagen , Femenino , Vesícula Biliar/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , UltrasonografíaRESUMEN
In the period 1985-1988, 62 focal liver lesions in 58 cirrhotic patients were studied by ultrasonography; 12 of these focal lesions were documented to be regenerating lesions by echo-guided fine-needle biopsy. During an average follow-up period of 10.2 months (range 3-22 months), hepatocellular carcinoma was subsequently found in 10 of the cases of regenerating nodules, whereas the initial diagnosis of regenerating nodule was confirmed in the remaining two cases. Based upon this finding, it is suggested that every focal mass visualized by ultrasonography in a cirrhotic liver should either be considered to be a neoplastic lesion or at least a preneoplastic lesion if the possibility of either a metastatic or benign lesion (eg, hemangiomas, focal fatty liver change areas) can be excluded. Therefore either fine-needle aspiration or biopsy of all ultrasonographically revealed mass lesions within a cirrhotic liver is advised, such that early appropriate treatment for hepatocellular carcinoma can be instituted.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico , Cirrosis Hepática/diagnóstico , Neoplasias Hepáticas/diagnóstico , Hígado/patología , Lesiones Precancerosas/diagnóstico , Ultrasonografía , Anciano , Biopsia con Aguja , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/patología , Femenino , Humanos , Cirrosis Hepática/patología , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/patología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/patología , Pronóstico , alfa-Fetoproteínas/análisisRESUMEN
The following parameters were retrospectively evaluated in 64 patients with suspected pancreatic neoplasm: (1) time required to obtain cytohistologic diagnosis, (2) days in hospital, (3) number and type of surgical operations, and (4) total hospital costs. Echo-guided fine needle biopsy (FNB) was performed on 34 patients (FNB group) and in a further 30 patients diagnostic workup did not include percutaneous biopsy (laparotomy group). Both diagnostic and hospital stay were shorter (8 and 7 days, respectively) in the FNB group than in the laparotomy group. In the FNB group, surgery was avoided in 18 patients, while in the laparotomy group 18 explorations proved diagnostic alone. Finally, FNB was shown to reduce hospital costs by 23%.
Asunto(s)
Biopsia con Aguja , Neoplasias Pancreáticas/diagnóstico , Biopsia con Aguja/economía , Biopsia con Aguja/métodos , Humanos , Laparotomía/economía , Tiempo de Internación , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Estudios Retrospectivos , UltrasonografíaRESUMEN
The usefulness of real-time ultrasonography as a guidance method in performing percutaneous renal biopsy is evaluated on the basis of a series of 114 patients with diffuse nephropathies. Sufficient renal tissue for light microscopy was obtained in 102 patients (89.5%) and enough for electron microscopy in 93 patients (81.6%) and for fluorescence microscopy in 91 patients (79.8%). A final histological diagnosis was possible in 106 patients (93%). The high diagnostic rate, the reduction in the contraindications to the procedure, the lack of major postbiopsy complications, and the cost effectiveness probably make realtime ultrasound scanning the method of choice when performing renal biopsy in patients with diffuse nephropathies.
Asunto(s)
Biopsia con Aguja/métodos , Enfermedades Renales/patología , Riñón/patología , Ultrasonografía , Adulto , Femenino , Humanos , Masculino , Microscopía ElectrónicaRESUMEN
Gastric wall thickness (body-antrum) was blind measured prospectively by real-time ultrasound in 58 patients (30 with gastric cancer and 28 healthy) who had previously undergone endoscopy. Gastric wall thickness on the average measured 15.933 +/- 4.471 mm in the neoplastic patients and 5.107 +/- 1.100 mm in the normal subjects. Seven millimeters was the highest value found in the normal subjects (4 cases) and the minimum value found in the neoplastic patients (1 case). Knowing the normal gastric wall thickness value on a standard ultrasound examination of the upper abdomen is useful, as ultrasound is often performed as a screening or first-step procedure, in order to address the patients with higher values toward more specific techniques.
Asunto(s)
Neoplasias Gástricas/patología , Estómago/anatomía & histología , Ultrasonografía , Humanos , Estudios Prospectivos , Valores de Referencia , Estómago/patologíaRESUMEN
We have stimulated seventeen children (4-12 years old) with bilateral non palpable testes with LH-RH and HCG. The differential diagnosis between anorchia (5 patients) and bilateral cryptorchidism (12 patients) was possible with evaluation of FSH and Testosterone plasma levels before and after hormonic stimulation.