Role of CT and ultrasonography in acute blunt trauma of the abdomen

From March 1985 to April 1989, one hundred thirty-one patients were examined using computed tomography (CT) and/or ultrasonography (US) in the evaluation of acute blunt trauma of the abdomen (CT and US in 36 patients, CT in 25 US in 70). Twenty-three out of the 131 cases (17.6%) showed positive findings of abdominal trauma on CT and/or US. Sixteen of the 23 patients with positive findings underwent therapeutic laparotomy, while all of the other 108 patients with negative findings were successfully managed conservatively. This fact suggests that one of the roles of CT and/or US is to pick up patients with negative findings who do not have any laparotomy. Free fluid collection was demonstrated in all of the 23 patients with positive findings in: all 22 on CT (100%), and 13 of 14 on US (92.9%). In all of the 23 patients but one with an injured mesenterium, injured organ was demonstrated by CT and/or US in: 21 of 22 by CT (95.5%), and 11 of 14 by US (78.6%). In one of the 11 patients, not an immediate US but a follow-up on the next day revealed an injured organ. In 6 out of the 12 patients who underwent both plain and contrast enhancement (CE), CT, CE-CT demonstrated the injured organ more clearly than plain CT. US with sector probe was also useful for demonstrating the injured lesion.(ABSTRACT TRUNCATED AT 250 WORDS)     

局限性脂肪肝的超声表现

不均质脂肪肝有多种表现,通常认为脂肪肝中的局限性低回声区是正常肝组织,但因其常呈"肝脏实性病变",有时难与肝癌等肝脏病变区别.本文通过对本院2001年1月～2002年8月B超检查中检出的298例脂肪肝中12例局限性低回声脂肪肝患者声像图分析,旨在对其声像图表现及鉴别诊断做进一步探讨.     

Computed tomography of the abdomen and pelvis in non-Hodgkin lymphoma

The experience of one institution using abdominal computed tomography (CT) for staging and restaging of non-Hodgkin lymphoma (NHL) patients is reported. In 49% of abnormal examinations no significant difference in quantity of involved nodes between diffuse and nodular lymphomas appeared. High paraaortic, iliac, and mesenteric nodal sites were most commonly involved. At restaging examination, usually less extent of disease was found. Abdominal involvement could not be predicted from the presence of peripheral adenopathy. Computed tomography changed the staged during initial workup significantly in 14%. During restaging, CT detected unsuspected active disease in 43% and changed the clinical impression from limited to extensive involvement in 16%. Computed tomography proved to be useful in the management of NHL patients and is recommended as the primary imaging procedure in the abdomen in this disease.     

超声与多层螺旋CT在急腹症诊断中的临床价值分析

目的 探讨急诊超声在急腹症中的应用价值.方法 选择2011年1月～2012年12月间我院急诊科诊治的急腹症患者100例,进行超声检查及螺旋CT检查.结果 超声定性准确92例,定位准确90例,准确率分别为92％和90％,多层螺旋CT定性准确94例,定位准确96例,准确率分别为94％和96％,两者间差异不具有显著性(P＞0.05).结论 在急腹症的诊断中,多普勒超声对其定位及定性诊断均具有很高的准确性.     

Role of endovesical echography in the assessment of bladder neoplasms]

The correct assessment of T (depth of infiltration of bladder wall by cancer) is relevant to plan therapy. In fact, besides staging the local lesion, this can predict pelvic and lumboaortic lymphnode involvement (N parameter) statistically. At the INRCA Hospital in Florence, from January 1987 to December 1989, transurethral US was performed on 66 patients affected with bladder carcinomas, in order to assess the value of this diagnostic method; in all patients pathologic staging on surgical specimens from TUR (63 cases) and cystectomy (3 cases) was performed. Follow-up lasted 24 months at least. When comparing US staging (according to Holm classification) to postoperative histopathologic findings, our results showed that US tends to overstage the lesions, while no understaged tumors were seen in our series. Diagnostic accuracy was 70%. It must be pointed out that TRUS demonstrated hidden submucosal tumors in two patients previously treated with intravesical chemotherapy. Retrospectively, we were able to detect causes of error in cancer staging in some cases--i.e., large carcinomas, calcifications on tumors, radiotherapy scars, bladder wall inflammation due to intravesical BCG therapy. Moreover, some lesions which appeared to have been overstaged with TRUS and which had been treated according to histopathologic findings from TUR exhibited recurrence or disease progression. This was probably due to incomplete TUR and to the presence of residual tumor in the bladder wall.     

经阴道联合腹部超声检查在妇科急腹症诊断中的应用价值

我院于2007年11月～2009年11月采用经阴道联合腹部超声诊断妇科急腹症．探讨经阴道联合腹部超声检查在妇科急腹症诊断中的应用价值，现将结果报道如下。     

超声在梗阻性无精子症病因诊断中的价值

目的评价高频超声（HFUS）和经直肠超声（TRUS）在梗阻性无精子症病因诊断中的价值。方法 189例梗阻性无精子症患者,经过一系列临床与实验室检查包括体检、精液分析、精浆生化、血清性激素检测后,均进行了阴囊HFUS和TRUS检查。结果 189例梗阻性无精子症患者病变类型多样,梗阻水平分近段梗阻和远段梗阻,梗阻因素有先天发育异常,与胚胎发育相关的残留囊肿、射精管梗阻及附属性腺的炎性病变。结论 HFUS和TRUS检查是临床诊断梗阻性无精子症的安全可靠的首选检查手段。     

Relaparotomy in penetrating gunshot wounds of the abdomen]

The article studies the results of treatment of patients with abdominal wounds inflicted by modern small arms, who had laparotomy performed. Because of various postoperative complications these patients have undergone a relaparotomy. The most frequent complications were: peritonitis and acute occlusive ileus. Indications for relaparotomy at an early stage of diagnosis were the following: symptoms of intoxication, Blumberg's symptom, muscle tension in the front side of the abdomen. The article makes an analysis of medical errors that led to relaparotomy.     

经胸、经腹超声诊断主动脉夹层临床应用分析

目的 探讨超声检查诊断主动脉夹层临床应用价值及体会.方法 选择2010年4月～2012年4月间我院就诊的16例患主动脉夹层的患者,行超声诊断分析对主动脉夹层的诊断情况及对各种征象的显示情况.结果 按照Debakey分型,其中Ⅰ型7例,Ⅱ型4例,Ⅲ型5例.其中,5例明确其破口,3例合并假腔血栓,2例无名动脉及右颈总动脉血栓.其他合并表现心包少量积液3例,主动脉瓣反流1例,主动脉增宽2例.结论 超声检查准确性高,并以无创成为诊断主动脉夹层的主要检查方法,对于识别困难的胸痛患者来说,超声可以提供主动脉夹层的早期诊断及鉴别诊断.     

术中超声对肾切开取石治疗多发性肾结石的价值

目的：降低多发性肾结石术后残余结石的发生率。方法：回顾性分析28例应用术中超声指导肾切开取石治疗多发性肾结石的临床资料。结果：本组28例中27例取净全部结石，1例发生结石残留。术后未发生出血、尿瘘等并发症。结论：术中超声对减少术后结石残留保护肾功能具有重要临床价值。     

Role of computerized tomography in the densitometric assessment of lithiasis of the gallbladder]

Radiolucent gallstones frequently contain significant calcium deposits. Their detection is important to select the patients to submit to medical gallstone dissolution. Since CT facilitates the identification of calcifications undetected at conventional radiologic procedures, 60 patients were studied with CT. All of them had US confirmation of cholelithiasis and in the whole of cases an X-ray examination of the right upper abdominal quadrant was performed (for the identification of radiopaque stones), together with oral cholecystography (to evaluate gallbladder function). CT attenuation values of the stones were measured and the patients subsequently divided into 2 groups; the threshold value was 50 HU: below it, the stones were considered hypo- or isodense (group I); above it, they were considered hyperdense (group II). Later on, 28 patients (14 from group I and 14 from group II) were selected for chemical dissolution with ursodeoxycholic acid over a 1-year period. US examinations were performed at 6 and 12 months. Seventy per cent of the patients in group I responded to treatment (50% with complete stone dissolution and 20% with partial dissolution), whereas no patient in group II had complete dissolution and only 30% had partial response.     

Role of color Doppler ultrasonography with contrast media in the monitoring of hepatocarcinoma after intralesional treatment]

INTRODUCTION: We investigated the accuracy of contrast-enhanced color Doppler US in the assessment of the effectiveness of intralesional treatment of hepatocarcinomas. MATERIAL AND METHODS: Eight cirrhotic patients (HCV+), Child-Pugh class B, with a single hepatocarcinoma (< 4 cm O) and ineligible for surgical resection for various reasons (age > 70 years, reduced partial hepatic reserve, esophageal varices at risk, postoperative recurrence, no consent to the operation) were submitted to radiohyperthermia (6 patients) and percutaneous alcoholization (2 patients). The diagnosis was made with alpha-fetoprotein titration. CT, B-mode and color Doppler US with the administration of Levovist (Schering AG, Berlin, Germany). Thirty and 60 days after the treatment, both the alpha-fetoprotein titration and contrast-enhanced color Doppler US were repeated. RESULTS: Baseline color Doppler was carried out before intralesional treatment in the 8 patients and was followed by Levovist color Doppler which showed some intralesional signals, afferent vessels and rich vascularization in all the lesions. At the first follow-up (30 days), no intralesional vascular signals or afferent vessels were detected in any patient, while rich peripheral vascularization persisted in all cases, even after radiofrequency and alcoholization treatments. At 60 days' follow-up, the color Doppler pattern of all cases was the same as at 30 days. CONCLUSIONS: The absence of any intralesional vascular signals in all the treated patients and the possible demonstration of complete tumor necrosis seem to confirm the important role of contrast-enhanced color Doppler US in monitoring focal hepatic lesions after intralesional treatment.     

Response assessment in lymphoma

The lymphomas are a heterogeneous group of malignant diseases. They are divided into two broad groups: Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Patients suffering from HD and NHL can be cured by appropriate chemotherapy and/or radiotherapy. Accurate staging and response assessment is essential to guide management decisions. The International Workshop Group (IWG) criteria, published in 1999, have become the widely accepted standard for response assessment in NHL. Although the IWG criteria have proved extremely useful in the standardization of treatment response, they do have a number of limitations. As a consequence of this, together with advances in functional imaging, revised criteria have been published recently. The aim of this review is to describe the evidence supporting the available imaging techniques, the limitations of each technique, and how these should be applied in clinical practice. We briefly review the corresponding response criteria for central nervous system (CNS) lymphomas, and take a look at novel imaging techniques that may play a role in the future.     

Blood reinfusion in penetrating gunshot wounds of the abdomen]

On the basis of literature and their own experience in performing the reinfusion of bacteria-contaminated blood in 20 patients with gunshot penetrating abdominal injuries the authors make a conclusion that in critical cases there are no alternative to application of reinfusion. The article gives clinical examples and contains data concerning the character of lesions. Indications and counter-indications for reinfusion are enclosed.