超声检测胸膜滑动征判定胸膜腔粘连

目的 评价胸部超声检测胸膜滑动征对胸腔镜手术前判定胸膜腔粘连的临床价值.方法 63例病人于胸腔镜术前经胸部超声检查术侧胸腔9个位点胸膜滑动征,并与术中同样位点胸膜粘连情况做对照.结果 共检测567个位点胸膜滑动征,超声下判定106个位点存在胸膜粘连,术中证实粘连位点72个;超声下判定无粘连位点461个,术中证实无粘连位点495个,其灵敏度、特异度、阴性预测值、阳性预测值及准确度分别为80.56%、90.03%、96.96%、54.72%及89.07%;受试者工作特征(Receiver Operating Characteristic,ROC)曲线分析显示,8个点以上胸膜滑动征阳性可以作为判定胸膜无粘连的重要标准.结论 经胸部超声检测胸膜滑动征有助于胸腔镜手术前判定是否存在胸膜粘连及确定粘连部位.     

Fleece bound sealing prevents pleural adhesions

This study assessed the value of haemostatic fleece (HF) in prevention of pleural adhesions in an experimental animal model. Forty rats were randomly assigned to four equal groups and underwent bilateral thoracotomy. In Group 1 standardized defects of 5 mm were generated in the visceral and the opposite parietal pleura without further coverage. In Group 2 a 5-mm piece of HF (TachoSil) was applied onto the intact pleura. In Group 3 a standardized pleural defect was completely covered by HF. The same kind of defect was only partially covered by HF in group 4 animals. Autopsy at 6 weeks (n=5, each group) revealed the fleece widely unchanged and covered by a smooth serous membrane. After 12 weeks (n=5, each group) the fleece had been completely resorbed. Histological studies revealed the area of the defect covered by regular mesothelium. In all animals pleural adhesions were detected only in the area without fleece coverage. In this experimental model HF prevented the development of pleural adhesions. This property may have clinical impact in patients with some probability of re-thoracotomy enabling to reduce the risk of pleural adhesions significantly.     

Preoperative volumetry of the prostate by transabdominal ultrasonography

The transabdominal ultrasonography using a sector scanner, was useful to estimate the morphology of the prostate and to easily measure its width, depth and height, and the inferential volume of the prostate could be calculated preoperatively by the ellipsoid method. In the cases of good transurethral resection of prostate, the correlation (p less than 0.001) between the estimated and actual volumes, Y = 0.806X - 0.924 (r = 0.958), and that between the estimated volumes and the actual weights, Y = 0.973X - 2.175 (r = 0.981), were significant.     

Preoperative evaluation of localized prostatic carcinoma by transrectal ultrasonography

We evaluated 31 patients with clinically localized prostatic carcinoma by transrectal ultrasonography before radical prostatectomy. Results of ultrasonography were reviewed without previous knowledge of the extent of the disease and were compared to the pathological staging obtained by step section of the prostate. Preoperative transrectal ultrasonography was sensitive in detecting capsular and seminal vesicle involvement (89 and 100 per cent, respectively). However, the specificity of the method was low for capsular involvement (50 per cent), probably owing to the inability of this method to detect microscopic disease. This method is a valuable tool in the preoperative evaluation of patients with clinically localized prostatic carcinoma.     

Preoperative ultrasonography of the undescended testis

In a prospective study during 1981-1983 42 boys aged 3-12 (mean 6.5) years were operated on for a palpable undescended testis. Twelve boys 3-8 (mean 4) years old were operated on for an unpalpable testis and 2 boys for an ectopic testis. The day before operation an ultrasound examination was performed. Reoperations were made on 11 patients and a bilateral operation on 2. In total, 69 ultrasound examinations were made. Comparison of the position at operation and ultrasound showed accordance in 47 of the 55 cases with only a slight variation of the position in 8 cases. Of the 12 non-palpated testes the ultrasonography showed 4 testicles, 3 non-testis-like formations and no finding in 5 cases. Exploration of these 5 latter cases showed an aplasia testis in 4 and a small intraabdominal testis in 1 boy. Preoperative ultrasonography can be recommended in case of an unpalpable testis in a boy not previously operated on in the inguinal area. Ultrasonography is particularly valuable before reaching a decision on hormonal therapy.     

Imaging of pleural and chest wall tumors

MPM is a difficult disease to characterize radiographically because of its diffuse nature and propensity to infiltrate between tissue planes. Although significant information is obtained by CT, MRI, and PET, correlation with intraoperative findings is inconsistent. Overall, CT and MRI are similar in predicting surgical resectability of pleural and chest wall malignancies. MRI has a slight advantage in select situations such as Pancoast tumors; however, CT is less expensive and is sufficient in the majority of cases. Because radiologic imaging cannot differentiate benign from malignant lesions with 100% accuracy, surgical biopsy remains the gold standard for diagnosis. Newer imaging modalities such as PET scan and combined PET/CT might provide greater information and warrant further study in the preoperative evaluation of pleural and chest wall tumors.     

Preoperative diagnosis of splenic cysts in children by gray scale ultrasonography.

Ultrasonography is a useful noninvasive modality for the diagnosis of splenic cysts in children. Characteristic features plus the typical clinical and radiographic presentation should obviate the need for further more invasive and costly techniques which add little to diagnostic accuracy. Additional advantages offered by ultrasound a minimal patient discomfort, no ionizing radiation, and immediate reassurance to parents that the mass is a cyst. We report two cases of epidermoid splenic cysts preoperatively diagnosed by ultrasonography. The typical sonographic characteristics are presented and the sonographic differential diagnosis is discussed.     

Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound

Viscera slide is the normal, longitudinal movement of the intraabdominal viscera caused by respiratory excursions of the diaphragm. By detecting areas of restricted viscera slide, ultrasonic imaging was used to identify anterior abdominal wall adhesions prior to laparotomy or laparoscopy. Transcutaneous ultrasound examination was performed on 110 patients. A prediction of adhesions was made for each patient and then compared to the findings during subsequent laparotomy or laparoscopy. Only patients with previous abdominal surgery or history of peritonitis demonstrated adhesions. Sensitivity and specificity of viscera slide ultrasound in predicting adhesions were 90% and 92%. Nine out of 10 false results involved misinterpretation of ultrasound images of the lower one-third of the abdomen. Ultrasonic imaging of viscera slide is highly accurate in detecting abdominal wall adhesions. This technique is most useful in guiding the insertion of trocar in laparoscopic surgery, and as a noninvasive method in studying the formation of adhesions.     

Air transport and the fate of pneumothorax in pleural adhesions.

Air travel is contraindicated in patients with a pneumothorax but was necessary because of the exigencies of war in three patients. Three patients with high velocity missile injuries to the chest and pleural adhesions are reported. All had to be evacuated by air, without an intercostal drain or oxygen supplement, from the war stricken area of Northern Somalia (Horn of Africa) to Mogadishu. Two patients with a partial pneumothorax flew on military transport aeroplanes at an altitude of 3000 m in a non-pressurised cabin and recovered rapidly after a few days in hospital. One patient, transported on a small Cessna aeroplane, died after developing bilateral tension pneumothoraces.