[Ultrasonic study of biliary tract dilatations].
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Biomedical subjects
Publications and source records attributed to F Weill.
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Analysis of the ultrasound patterns obtained in 63 pancreatic tumours and 147 cases of chronic pancreatis shows a considerable difference in the two conditions. The echostructure is mainly dense and reflexogenic in chronic pancreatitis and trans-sonic in carcinomata.
Through real time ultrasonography, it is possible to display the splenic vein, the superior mesenteric vein, the vena porta, and the intrahepatic portal and systemic veins. In jaundice, it is of the utmost importance to carefully identify the vena porta before making a diagnosis of common bile duct enlargement. It is also necessary, when confronted with a pattern of apparently enlarged intrahepatic ducts, to conduct a thorough study of possible confluences of the ducts with the vena porta or vena cava to be certain that the ducts are not part of the portal or systemic venous network. Without such differentiation, portal enlargement caused by portal hypertension, systemic venous enlargement caused by cardiac insufficiency, or even nonpathological wide veins may lead to an erroneous diagnosis of obstructive jaundice.
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For a long time, echotomography of the pancreas was limited to the identification of pseudocysts. Little by little, those using ultrasound learnt how to construct images of the pancreatic gland itself, and faced with the changes in size and shape of the latter to recognize lesional processes. Analysis of the pancreatic echostructure represents an important step in the progress of the diagnosis of lesions. Echotomography, the results of which must be compared with those of roentgenological methods of exploration, as well as the clinical and laboratory data, enables the attainment of very fiable diagnoses of chronic pancreatitis with or without pseudo-cysts, of acute pancreatitis or of rare cystic tumors. The precision of the results however depends fundamentally on technical data: it is necessary to combine with the classical apparatus, with manual displacement of the wave, a tomo-echoscopic apparatus, with real time; above all, it is necessary to use the degraded intensity scale. This scale is innate in real time apparatuses. At present it takes the form of a complementary module, on the classical apparatuses. Without these technical conditions, real time and degraded intensity scale, it seems impossible to attack the problem of ultrasonic diagnosis of pancreatic conditions, except by exposing oneself to disappointments which would unmeritedly cast discredit on the method. Six years of experience, several thousands of pancreatic examinations, three hundred pancreatic lesions which were anatomically checked has however convinced us of the importance of echotomography in this field.
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Used in 100 patients, in whom the gall bladder was badly opacified, and apparently contained no stones, xeroradiography led to the appearance of images of radiolucent calculi on 8 occasions. Furthermore, it enabled a differential diagnosis between lacunae due to lithiasis and gaseous pseudo-lacunae. The weak system transfer density however prevented it being considered other than as a complementary method. Undoubtedly, however it announces the wider possibilities for electronic radiography, of which the images are comparable with a greatly reduced irradiation.
Amongst 77 patients studied by phlebography for obstruction of the inferior vena cava, 5 (6%) showed evidence of a portal collateral network: 3 via the mesenteric vein, 2 via the epiploic veins. In four cases the portal flow represented the principal collateral flow. Our cases, together with those described in the literature, show that portal collateral flow occurs in at least 5% of cases of caval obstruction. They should, therefore, have been reported more frequently since it would appear that our five cases bring the total published to date to only 13.
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