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Between January 1990 and January 2005, incidental hypoechoic, vascular tumours of the spleen were identified in 13 patients using B-mode and colour Doppler ultrasound (CDS). All lesions found were well demarcated, intrasplenically located, and ranged in size between 1 cm and 4 cm. The increased vascular pattern on CDS was confirmed in 9 of the 13 cases by contrast enhanced ultrasound (CES), while two patients showed reduced vascularity on CES. In 10 patients, lesions were confirmed by contrast enhanced CT. Histological examination was performed in three patients with the diagnosis of capillary haemangioma (n = 2) and hamartoma (n = 1). In the remaining cases, ultrasound follow-up was performed (range 4 months to 13 years) and demonstrated no evidence of tumour growth in all but one patient. During a 4 year follow-up, one lesion increased in size from 1.0 cm to 1.5 cm and in the same patient an additional 0.5 cm sized hypoechoic increased vascular lesion was also found. In the spleen a hypoechoic lesion with an increased vascular pattern incidentally found by ultrasound most likely indicates a benign tumour with capillary haemangioma/hamartoma as the most likely diagnosis. However, it should be emphasised that in all cases a careful ultrasound follow-up is warranted.

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Spectral curve-analysis of arterial flow signals (FS) in patients with pulmonary lesions is able to discriminate FS of bronchial arteries (BA) from FS of pulmonary arteries (PA). In patients with chest wall lesions a different FS from that of the BA/PA can be obtained. The aim of the study was to evaluate and characterize arterial supply of chest wall lesions using quantitative colour Doppler ultrasound (CDS). Between September 2002 and June 2003, 29 consecutive patients with chest wall lesions were examined by CDS. 16 lesions were located strictly to the chest wall (group I). 13 lesions had a chest wall lesion with pulmonary extension (group II). The following parameters were prospectively determined: (1) qualitative CDS (absence or evidence of vascularity); (2) quantitative CDS of intercostal or non-intercostal located arterial FS (resistive index (RI) and pulsatility index (PI)); (3) number of different arterial FS in one lesion using CDS-mapping. In a control group of 17 healthy volunteers quantitative measurement of RI and PI of the intercostal artery (ICA) was performed. 4 of 29 patients (14%) had no FS by CDS mapping. Quantitative CDS parameters of the control group were mean RI of ICA 0.88 (+/-0.056); mean PI of ICA 2.88 (+/-0.643); of group I mean RI of ICA 0.79 (+/-0.127) mean PI of ICA 1.93 (+/-0.641), and of group II mean RI of ICA 0.79 (+/-0.144), mean PI of ICA 2.1 (+/-1.015), mean RI of non-ICA 0.68 (+/-0.675) mean PI of non-ICA 2.5 (+/-2.506). Median RI as well as PI-value obtained within the chest wall (ICA) do not differ between group I, group II, and the control group. Within group II impedance measurements discriminates intercostal from non-intercostal arterial supply. In 29 patients 37 different arterial FS were obtained. None of the 16 patients in group I and 8 of the 13 patients in group II had 2 or more different FS. Lesions strictly located to the chest wall had an arterial supply characteristic for ICA by quantitative CDS. Chest wall lesions with pulmonary extension demonstrate a complex arterial supply by quantitative CDS.

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Splenic infarction frequently occurs in patients with myeloproliferative diseases, endocarditis, and sickle cell anemia. Various sonographic patterns of splenic infarction do exist. but little is known about tumor associated splenic infarction in cancer patients. Between January 1992 and December 2002, 66 patients were diagnosed with splenic infarction by color Doppler sonography (CDS). Ten patients had an underlying solid cancer. Clinical and sonographic data of cancer patients were evaluated retrospectively with regard to age, sex, frequency of thrombotic episodes, splenic size, echomorphology and vascularity of splenic lesions, and follow-up examination. The median age was 53 years (range, 16-73 years). Nine of 10 patients had abdominal metastases, four had evidence of a hypercoagulable state, five had a small spleen (< 7 x 3 cm), and seven had acute complete infarction of the spleen without hilar and parenchymal vessels on CDS. Survival of six patients with acute complete infarction ranged from 1 to 30 days. In cancer patients with splenic infarction, an acute complete infarction is the most common pattern. It is caused predominantly by a hypercoagulable state and is associated with an extremely short survival.

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Spontaneous rupture of the spleen is an extremely rare complication usually of infectious diseases or disorders of the haematopoietic system and has been described mostly in case reports. The incidence, symptoms, causes, therapy, and prognosis are poorly defined. From July 1985 to January 2000 41 patients with spontaneous splenic rupture were diagnosed by abdominal ultrasound and confirmed by splenectomy (n=12), CT (n=15), and ultrasound follow up (n=26). An ultrasound grading system was retrospectively established based on the degree of splenic injury (grade 0-2=low grade injury, grade 3=high grade injury) and correlated with surgical procedures. 30 day mortality rate was studied in relation to underlying disorders, ultrasound grades and treatment decisions. 21 patients had underlying malignant disorders (group I) and 20 patients had benign diseases (group II). Between group I and II we observed a highly significant difference in 30 day mortality rates (n=7; 38.1% vs n=1; 5%, p<0.01), but no significant difference in high grade injury rate (n=3; 14.3% vs n=2; 10.0%; p=ns) and surgical treatment rate (n=5; 23.8% vs n=7; 35.0%; p=ns). Depending on ultrasound grades the surgical procedures were 0% for grade 0, 16.7% for grade 1, 30.4% for grade 2, and 60% for grade 3. There were no significant differences between patients, who died within the first 30 days (n=9) and those who survived more than 30 days (n=32) regarding high grade splenic injury rate (n=0; 0% vs n=5; 15.6%; p=ns), and surgical treatment rate (n=2; 22.2% vs n=10; 31.2%; p=ns). Spontaneous rupture of the spleen is an extremely rare event. It is associated with a high mortality rate within 30 days in patients with malignant disease. Sonomorphologic grading is helpful for treatment decisions. 30 day mortality rate is correlated with neither ultrasound grades, nor surgical treatment rates.

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Abdominal sonography is now the most frequently used screening method for the detection of abdominal lymph node enlargement. For proper classification, size, localisation and infiltration pattern must be known. The definitive determination whether lymph nodes are benign or malignant cannot be made by the size of the lesion alone. The localisation (parietal/visceral) of enlarged lymph nodes has been shown to be of significance in the staging of abdominal carcinomas. Different infiltration patterns (diffuse small nodular, focal small nodular, focal large nodular, bulky formations) show the broad spectrum of abdominal lymphomas detected by ultrasound. Knowledge of these different infiltration patterns together with clinical information often helps to discriminate between lymph node enlargement caused by inflammation, metastasis, or malignant lymphoma. The definitive diagnosis is made via laparotomy, ultrasound guided biopsy or sonographic follow-up studies.

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Sonographic findings in 19 patients with proved adrenal pheochromocytomas observed over a 10 year period were evaluated retrospectively. Adrenal tumors were analyzed by number, size, echogenicity, internal echogenicity, and biologic behavior. There were 16 benign and 3 malignant pheochromocytomas, all of which were well marginated or encapsulated and ranged from 1.4 to 11 cm in greatest diameter (mean, 4.8 +/- 2.2 cm). A broad spectrum of sonographic appearances has been noted, including purely solid tumors (68%), complex masses (16%), and cystic lesions (16%). Compared with renal parenchyma as a reference tissue, 10 (77%) of 13 solid pheochromocytomas were isoechoic or hypoechoic, whereas three (23%) were hyperechoic. Six (46%) of the solid tumors were homogeneously echogenic, and seven (54%) were heterogeneous. Ultrasonic discrimination between benign and malignant pheochromocytoma on the basis of acoustic features alone has proved impossible. Abdominal sonography, however, provided evidence of malignancy in all three patients with malignant tumors by disclosing regional or distant metastases. In conclusion, rather than showing a specific uniform ultrasonographic appearance, pheochromocytoma is associated with a broad spectrum of possible sonographic presentations.

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This report summarizes the results of ultrasound-guided percutaneous drainage procedures in eight patients with solitary (n = 6) and multiple (n = 2) splenic abscesses. Seven patients underwent a total of 15 closed-needle aspirations with local installation of antibiotic solution. In one case, catheter drainage was performed. All patients received parenteral broad-spectrum antibiotic therapy. Seven (88%) of the eight patients with splenic abscesses recovered completely following percutaneous drainage procedures and none of these required splenectomy later. In one patient with multiple splenic abscesses, repetitive needle aspiration was ineffective, necessitating splenectomy. The only complication associated with nonsurgical percutaneous interventions was a pleural empyema that resolved with chest tube drainage (complication rate, 13%). These results and those reported in the literature indicate that pyogenic splenic abscesses can be treated effectively by (repetitive) closed aspiration technique or catheter drainage with a relatively low rate of complications. From our experience, splenectomy should only be performed in splenic abscesses that are not accessible percutaneously and in those cases with percutaneous drainage failure.

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Preclinical experiments with cisplatin and carboplatin showed radiosensitizing capability for these drugs against non-small cell lung cancer (NSCLC) cell lines and phase II clinical investigations were undertaken in patients with stage IIIA/B NSCLC. In the first trial, cisplatin 20 mg/m2 was infused on the first day of every treatment week, followed in about 1 hour by radiotherapy. Radiotherapy was given in single daily 2-Gy doses 5 days a week for 3 weeks, and, after a 2-week interval, for an additional 2 weeks. There were 5 complete responses (CRs) and 15 partial responses (PRs), while 6 patients had no change and 4 progressive disease, for a 67% overall response. Median survival was 14 months; the 2-year survival rate was 20%. To investigate the maximum tolerated dose of carboplatin, escalating doses were given on day 1 of each treatment week; simultaneous radiotherapy was administered as in the cisplatin study. Drug doses began at 100 mg/m2 and were increased by increments of 10 or 20 mg/m2 to a maximum of 200 mg/m2, with 5 patients treated at each dose level. Dose escalation was to stop when 3 of 5 patients developed intolerable World Health Organization (WHO) grade 3 myelosuppression. No grade 3 or 4 leukopenia occurred at carboplatin doses less than or equal to 140 mg/m2. Grade 3 leukopenia was seen in only 1 patient from the groups receiving 150, 160, or 180 mg/m2. Of the 35 patients evaluable thus far, 1 achieved CR and 18 PR, while 10 had no change and 6 progressive disease despite treatment, for a 54% overall response rate. Response rate in patients with stage IIIB disease was 48%.(ABSTRACT TRUNCATED AT 250 WORDS)

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Ultrasound-guided fine-needle aspiration biopsies were performed in 37 patients (23 women, 14 men; mean age 58 [47-81] years) out of 310 patients in whom an adrenal tumour had been diagnosed by ultrasound between 1985 and 1991. In 21 the tumour diameter was 2-4 cm, in 16 over 4 cm. In 36 patients (97%) the material was suitable for histological analysis. There were 15 metastases, 4 primary adrenal carcinomas and 17 adenomas. 20 of 27 with an underlying malignant tumour had a malignant adrenal tumour (one of the aspiration biopsies in these cases was false-negative), while in 7 the space-occupying lesion was found to be benign. There were no false-positive findings. Ultrasound-guided fine-needle biopsy thus proved to be a reliable and informative method in the diagnosis of adrenal tumours. It should be undertaken under appropriate indication to ascertain the benign or malignant nature of a suspected adrenal lesion.

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42 patients with solitary (n = 34) and multiple (n = 8) abscesses of the liver (n = 36) and the spleen (n = 6) were treated with ultrasound guided percutaneous interventions. 38 patients (90%) underwent a total of 97 closed abscess aspirations using needles of 0.9 and 1.3 mm in diameter. In 4 cases (10%) percutaneous catheter drainage was performed. Intravenous antibiotics were used in all cases. Those patients with closed abscess aspiration additionally received local injection of aminoglycosides into the cavity. 40 out of the 42 patients could be treated successfully by percutaneous methods for a cure rate of 95.2%. Percutaneous drainage failure occurred in 2.4%. One patient with multiple liver abscesses and catheter drainage died from myocardial infarction (hospital mortality 2.4%). Complications of ultrasound-guided interventions included two minor bleedings, requiring no therapy, and one pleural empyema (complication rate 7.1%). There were no treatment related lethal complications. These results indicate that abscesses of the liver and the spleen up to 10 cm in diameter can be effectively treated by closed (repetitive) needle aspiration and antibiotic therapy with a relatively low rate of complications. About half of our patients with abscesses of more than 10 cm received percutaneous catheter drainage. On the basis of our experience surgical drainage of liver abscesses and splenectomy in splenic abscesses should be restricted to those cases with percutaneous drainage failure.

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In this study the sonographic findings of 30 patients with hepatic lymphoma have been reviewed. Lesions have been confirmed by autopsy (n = 1), laparatomy (n = 1), sonographically guided biopsy (n = 15), and during long-term follow-up (n = 13). Ten patients had Hodgkin's disease (HD) and 20 non-Hodgkin lymphomas (NHL). Focal lesions, less than 3 cm in diameter, were seen in 20 patients. The remaining ten cases presented large-nodule transformation of the parenchymal texture. All lesions were predominantly hypoechoic with a halo sign in two cases. No diffuse involvement of the liver was observed, and no correlation between histological lymphoma subtyping and patterns of hepatic infiltration was found.

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Within a multicentre observation study on non-Hodgkin lymphomas (NHL) diagnosed according to the Kiel classification advanced stages III and IV of centrocytic (CC) lymphoma exhibited the worst prognosis among lymphomas of low-grade malignancy with a 5-year survival probability of less than 10 per cent. Treatment had been solely expectative and palliative with treatment results showing a prognostic superiority of patients achieving partial and complete remissions over non-responders. Therefore, a randomized multicentre study was initiated to compare the remission-inducing potential of the COP regimen (Bagley et al., 1972) with that of the more intensive adriamycin-containing CHOP regimen (McKelvey et al., 1976). From 91 newly diagnosed CC lymphomas 63 fulfilled randomization criteria with 37 patients assigned to the COP regimen and 26 patients to the CHOP regimen. Between the COP- and CHOP-treated patients no significant differences could be demonstrated with respect to initial clinical parameters, rate of complete (41 per cent versus 58 per cent) or partial remissions (43 per cent versus 31 per cent), median overall survival probability (32 versus 37 months), relapse-free survival (10 versus 7 months) and rates of relapse (73 per cent versus 67 per cent) and death (57 per cent versus 50 per cent). It can be concluded that CC lymphoma is a typical lymphoma of low-grade malignancy with its inability to reach stable remissions while the demonstration of identical survival probabilities for patients with complete and partial remissions constitutes a unique feature of this lymphoma entity. These observations prove advanced CC lymphoma to represent an incurable neoplastic disease under conventional therapeutic approaches.

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A total of 63 patients with cystic pancreatic lesions (60 pseudocysts, 3 true cysts) underwent percutaneous therapeutic procedures with ultrasound guidance. Repeated needle aspirations were performed in 50 patients, 13 underwent transabdominal catheter drainage. Complete resolution of the cystic lesion was obtained in 37 (59%) patients overall, while 41% required further therapy. Thirty seven (62%) of the 60 pancreatic pseudocysts were successfully drained by percutaneous procedures, in 23 (38%) fluid collections recurred. Complications of the drainage procedures occurred in two patients (3.2%). Considering these results, ultrasound guided needle aspiration and catheter drainage of pancreatic pseudocysts have proved to be of value for both nonsurgical temporary and definitive treatment.

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Report on twelve patients suffering from malignant primary disease associated with pleural effusion and diaphragmatic metastasis, basically diagnosed via sonography. In no case tumour formation could be detected by x-ray film. Cytohistological evidence of diaphragmal metastasis can be found by sonographically detected pleural tumours malignant effusion must be assumed, despite negative exudate cytology. In such cases diagnostic thoracoscopy is not necessary.

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We report on a 47-year-old male patient with IgA-kappa plasmacytoma, who 12 months subsequent to diagnosis developed marked ascites. On light and electron microscopy morphologically identical plasma cells with bizarre intracytoplasmatic material were found in the bone marrow, pleural exudate, and ascites fluid. This kind of extramedullary spread is extremely rare and usually resists therapy. The mean survival rate for the 9 patients with malignant plasmacellular ascites whose cases have been documented so far was 2 months. After progression under VCMP regimens our patient has been successfully treated over a period of more than 4 years with i.v. VP16 monotherapy with additional intermittent local administration of methotrexate and systemic poly-chemotherapy according to the VAD scheme.

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A 44-year-old patient with polycystic kidney disease received a renal transplant in December 1984. Nine months after immunosuppressive therapy with cyclosporin A and prednisolone the patient developed Hodgkin's disease of the mediastinum.

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