Ultrasound guided percutaneous fine-needle biopsy of the liver: efficacy of color doppler sonography

BACKGROUND/AIMS: Fine-needle biopsy (FNB) is one of the diagnostic methods for the diagnosis of focal lesions in the liver. The method is relatively fast, inexpensive and safe. Complications after FNB are observed in only a few cases. Color Doppler sonography (CDS) is one way of minimizing the number of FNB complications. The aim of the present study is to evaluate CDS in the monitoring of FNB in the diagnosis of focal lesions in the liver. METHODOLOGY: The patient group consisted of 73 patients: 28 male and 45 female with a mean age of 53.5 years. Initially, all patients were examined using traditional B-mode gray-scale sonography. After visualization of focal lesions in the liver their echostructure and position were analyzed. Color Doppler sonography was the introduced for the visualization of vascularization of the liver. FNB was performed under the guidance of CDS. The cytological specimens obtained were microscopically evaluated. RESULTS: Of the 73 patients, 18 cases were diagnosed with liver abscess, 19 with cysts of the liver, and 36 with malignant tumors. Amongst the patients with malignancy tumors, the tumors were unifocal in 15 cases, and multifocal in 221. Histopathologically, there were primary hepatocellular carcinomas in 22 patients and metastatic tumors in 14 patients. During the first 48 hours after FNB no complications such as subcapsular hematoma or intraperitoneal bleeding were observed. CONCLUSIONS: Introducing CDS for ultrasound guided percutaneous FNB of the liver avoids such complications as bleeding, especially in patients with a high risk of hemorrhage.     

Extended field-of-view sonography in musculoskeletal disorders

The endogenous dipeptide, alpha-N-acetylaspartylglutamate behaves as a partial agonist of N-methyl-D-aspartate receptors, but can also activate metabotropic glutamate receptors, with a high degree of selectivity for the metabotropic glutamate receptor 3 subtype. Knowing that agonists of group-II metabotropic glutamate receptors (i.e. of mGlu2 and -3 receptors) are neuroprotective, we have examined the neuroprotective activity of alpha-N-acetylaspartylglutamate in mixed cultures of mouse cortical cells exposed to a toxic pulse with N-methyl-D-aspartate. Alpha-N-acetylaspartylglutamate co-applied with N-methyl-D-aspartate was neuroprotective, but its action was insensitive to the selective group-II metabotropic glutamate receptor antagonist, ethylglutamate. Protection was instead antagonized by ethylglutamate when alpha-N-acetylaspartylglutamate was applied to the cultures immediately after the N-methyl-D-aspartate pulse, a condition in which there was no direct competition between alpha-N-acetylaspartylglutamate and N-methyl-D-aspartate at the level of N-methyl-D-aspartate receptors. alpha-N-acetylaspartylglutamate was highly neuroprotective when transiently applied to pure cultures of cortical astrocytes and the conditioned medium, collected 20 h later, was transferred to sister mixed cultures challenged with N-methyl-D-aspartate. This particular form of neuroprotection was attenuated or abolished when astrocytes where exposed to alpha-N-acetylaspartylglutamate in the presence of the group-II metabotropic glutamate receptor antagonists ethylglutamate or (2S, 1'S,2'S,3'R)-2-(2'-carboxy-3'-phenylcyclopropyl)glycine, but not in the presence of the N-methyl-D-aspartate receptor antagonist, D-2-amino-5-phosphonopentanoate. These results indicate that alpha-N-acetylaspartylglutamate induces neuroprotective effects in culture, which are mediated, at least in part, by the activation of glial metabotropic glutamate receptor 3 receptors.     

Three-dimensional sonography in diagnosing trisomy 18

The minimally invasive reversed Z sternotomy is a surgical approach for aortic valve operations that provides an excellent view of the aortic root and allows access to the right atrium. It confers the advantages of preservation of the sternocostal articulations and both internal thoracic arteries with no need to enter either pleural cavity. It facilitates aortic and atrial cannulation for cardiopulmonary bypass and allows access for a superior pulmonary vein cardiac vent.     

Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography

OBJECTIVE: The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children. SUBJECTS AND METHODS: This prospective study involved 307 pediatric subjects (169 girls and 138 boys) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were 5 days to 16 years old. All measured organs were sonographically normal. At least two dimensions were obtained for each liver, spleen, and kidney. Relationships of the dimensions of these organs with sex, age, body weight, height, and body surface area were investigated. Suggested limits of normal dimensions were defined. RESULTS: Dimensions of the measured organs were not statistically different in boys and girls. Longitudinal dimensions of all three organs showed the best correlation with age, body weight, height, and body surface area. Height showed the strongest correlation of all. This correlation was a polynomial correlation. CONCLUSION: Determination of pathologic changes in size of the liver, spleen, and kidney necessitates knowing the normal range of dimensions for these organs in healthy neonates, infants, and children. Presented data are applicable in daily routine sonography. Body height should be considered the best criteria to correlate with longitudinal dimensions of these organs.     

Endo-anal sonography in diagnosis of fecal incontinence

Endoanal ultrasound is a new imaging technique in the diagnostic work-up of patients suffering from anal incontinence. A standardised examination as well as hardware specific reference values for the sphincter muscles are of paramount importance to allow correct interpretation of the continence organ. At the University Hospital of Würzburg from 1.2.1993 to 31.7.1994 90 patients (50 male, 40 female; age: 16-81 y.) with normal continence underwent endosonographic assessment of their sphincter complex. We measured the internal anal sphincter (IAS), puborectalis muscle as well as the three separate parts of the external anal muscle (EAS). Apart from establishing reference values we found a significant increase in thickness of both EAS and IAS with increasing age. However, no correlation was seen between muscle thickness, sex, height or weight. We also examined 29 patients with a history of incontinence. 13 (45%) had a morphological sphincter defect, most of which were due to obstetric trauma or previous proctological operations. 10 (35%) patients suffered from so called idiopathic incontinence. Anal ultrasound in these patients revealed muscle hypotrophy of the structurally intact sphincters.     

Office sonography and office hysteroscopy

Researchers involved in assessing technology and healthcare, including gynecologic care, have identified differences among the terms efficacy, effectiveness and efficiency. In order to assess the efficiency of procedures such as office sonography and hysteroscopy, it is first necessary to compare them with the alternatives in terms of patient-focused outcomes. Office sonography has been used to diagnose early pregnancy disorders such as ectopic gestations and evaluate other adnexal pathology, with mixed results. The use of office hysteroscopy to assess abnormal bleeding may replace procedures that are associated with greater risk and expense. More information regarding outcomes is needed for both procedures before they can be recommended as efficient alternatives for the diagnosis or treatment of gynecologic conditions.     

Intraoperative spinal sonography in the cervical anterior approach

Intraoperative spinal sonography was used during cervical anterior approach procedures for cervical discectomy and osteophytectomy to demonstrate spinal pulsation, the protruded disc or osteophyte, the anterior subarachnoid space, and the spinal cord. Spinal pulsation was recognized in some cases before removal of the disc but the anterior subarachnoid space and spinal cord could not be observed. However, the latter were more clearly observed during removal of the disc and could be seen after total removal of the disc and osteophyte. This method allows confirmation of decompression and pulsation of the spinal cord without cutting and removal of the posterior longitudinal ligament.     

Use of intravenous contrast material in transcranial sonography

RATIONALE AND OBJECTIVES: The appearance of the intracranial vasculature was compared on power and color Doppler ultrasound (US) scans obtained with and without a microbubble contrast agent. MATERIALS AND METHODS: Nine patients (three men, six women) aged 42-70 years (mean age, 53 years) participated in the study. Seven patients underwent both color Doppler US and power Doppler US before and after intravenous administration of contrast agent, and two underwent only color Doppler US. All patients had previously undergone cerebral angiography. RESULTS: Before contrast material was administered, power Doppler US was more sensitive than color Doppler US in the detection of intracranial vessels (P < .05); neither technique depicted the entire circle of Willis in eight of nine patients. Postcontrast power Doppler US depicted more vascular segments than postcontrast color Doppler US (P < .01) or precontrast power Doppler US (P < .01). Use of intravenous contrast material enabled the entire circle of Willis to be evaluated from a single temporal bone acoustic window with both power Doppler US and color Doppler US in all patients. Contrast-enhanced power Doppler US depicted vessels not shown by enhanced color Doppler US. CONCLUSION: Contrast-enhanced power Doppler US depicted more vessels, better demonstrated specific vascular segments, and provided better vascular definition of the intracranial vasculature than contrast-enhanced color Doppler US or unenhanced power Doppler US.     

Utilizing sonography to follow fetal growth

The tropical marine sponge Dysidea herbacea (Keller) contains the filamentous unicellular cyanobacterium Oscillatoria spongeliae (Schulze) Hauck as an endosymbiont, plus numerous bacteria, both intracellular and extracellular. Archaeocytes and choanocytes are the major sponge cell types present. Density gradient centrifugation of glutaraldehyde-fixed cells with Percoll as the support medium has been used to separate the cyanobacterial symbiont from the sponge cells on the basis of their differing densities. The protocol also has the advantage of separating broken from intact cells of O. spongeliae. The lighter cell preparations contain archaeocytes and choanocytes together with damaged cyanobacterial cells, whereas heavier cell preparations contain intact cyanobacterial cells, with less than 1% contamination by sponge cells. Gas chromatography/mass spectrometry analysis has revealed that the terpene spirodysin is concentrated in preparations containing archaeocytes and choanocytes, whereas nuclear magnetic resonance analysis of the symbiont cell preparations has shown that they usually contain the chlorinated diketopiperazines, dihydrodysamide C and didechlorodihydrodysamide C, which are the characteristic metabolites of the sponge/symbiont association. However, one symbiont preparation, partitioned by a second Percoll gradient, has been found to be devoid of chlorinated diketopiperazines. The capability to synthesize secondary metabolites may depend on the physiological state of the symbiont; alternatively, there may be two closely related cyanobacterial strains within the sponge tissue.     

An algorithm of diagnostic-therapeutic invasive sonography

The present study describes an algorithm of diagnostic-therapeutic invasive sonography that was used in 276 patients. 276 manipulations using ultrasound guidance were performed on 371 objects. These include therapeutic punctures (evacuations and drug applications), percutaneous nephrostomies and dilatational minilaparatomy with drainage system. We achieved complete therapeutic success in 77.5%, partial therapeutic success in 14.1% and failures only in 8.4%. These satisfactory results indicate that the developed algorithm makes possible the individual approach to the patient, allows correct choice of technique, method, and strategy; it helps to achieve the therapeutic target as well to include a diagnostic element at a certain stage of the therapeutic process.     

Contrast enhanced sonography of visceral perfusion defects in dogs

The role of adrenergic mechanism in the cardioprotective effect of ischemic preconditioning against ischemia-reperfusion induced injury in in vivo dog heart and isolated rat heart was investigated. Anesthetized dogs were subjected to LAD coronary artery ligation for 60 min followed by reperfusion for 4 h. Preconditioning protocol was 5 min of ischemia followed by reperfusion for 10 min. Rat hearts were subjected to global ischemia for 30 min followed by reperfusion for 30 min. Preconditioning protocol was 5 min global ischemia followed by reperfusion for 5 min repeated four times. Infarct size, electrocardiographic changes and release of LDH were estimated to assess the extent of cardiac injury. Preconditioning reduced the infarct size, ST segment elevation and prevented the loss of R wave. Prazosin attenuated the cardioprotective effect of preconditioning in dog. Preconditioning conferred protection against ischemia-reperfusion induced cardiac injury and reperfusion-induced arrhythmias in isolated rat heart. Reserpine pretreatment attenuated this protective effect of preconditioning on reperfusion-induced arrhythmias. These observations suggest the involvement of adrenergic mechanism in the cardioprotective and antiarrhythmic effect of ischemic preconditioning in dog and rat species respectively.     

Contrast-enhanced transcranial color-coded duplex sonography in ischemic cerebrovascular disease

BACKGROUND AND PURPOSE: Echo contrast agents have been shown to provide conclusive examinations in most patients with insufficient ultrasound penetration through the temporal bone. We investigated the diagnostic value of contrast-enhanced (CE) transcranial color-coded duplex sonography (TCCD) in patients with ischemic cerebrovascular disease and insufficient temporal windows and evaluated TCCD criteria that predict whether CE-TCCD studies may become conclusive. METHODS: Thirty-three patients presenting with ischemic strokes (n = 21) and transient ischemic attacks (n = 12) were investigated. Extracranial color duplex imaging showed normal findings in 24 patients, eight > or = 70% stenoses and one occlusion of the carotid arteries in 8 patients, and severe occlusive disease of both vertebral arteries in 1 patient. Seven carotid stenoses and vertebral artery obstructions were confirmed by angiography. The galactose/palmitic acid-based echo contrast agent was injected intravenously as bolus of 200, 300, or 400 mg/mL in a dosage of 10, 5, and 5 mL, respectively. RESULTS: Thirty-two of the 33 patients were completely examined because 1 patient who felt pain at the injection site declined further investigations. Twenty-one (66%) of 32 CE studies were conclusive and showed cross-flow through three anterior and two posterior communicating arteries, but no stenoses and occlusions. Precontrast identification of any cerebral artery provided an overall accuracy of 97% in predicting a conclusive CE investigation. Precontrast TCCD identified no arterial Doppler signals in patients with inconclusive CE studies. CONCLUSIONS: CE-TCCD provided conclusive examinations in two thirds of patients with ischemic cerebrovascular disease and ultrasound-refractory temporal windows. Precontrast detection of any cerebral artery reliably predicted a conclusive CE investigation.