Preoperative diagnosis of perforated duodenal diverticulum with ultrasonography.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
K Ido
Publications and source records attributed to K Ido.
Sonographic diagnosis of small intestinal anisakiasis.
PURPOSE: We studied the utility of sonography in the early diagnosis of anisakiasis of the small intestine. METHODS: The imaging findings and clinical data of 12 patients with proven small intestinal anisakiasis were retrospectively reviewed. RESULTS: Dominant sonographic findings were ascites, small bowel dilatation, and focal edema of Kerckring's folds. CONCLUSIONS: Patients who have acute abdomen after recent ingestion of seafood and in whom ascites, small bowel dilatation, and focal edema of Kerckring's folds are seen by sonography should be suspected of having small intestinal anisakiasis and should be treated conservatively without laparotomy.
Abdomen, Acute↗
Microwave coagulation therapy on hepatomas: CT and MR appearance after therapy.
Laparoscopic microwave coagulation (LMC) for hepatocellular carcinomas (HCCs) was performed on 26 HCCs in 17 patients. Contrast-enhanced CT (CECT) and MR images (T1-weighted imaging [T1WI], T2WI, gadolinium-diethylenetriamine pentaacetic acid [Gd-DTPA] T1WI) were obtained to determine changes over time. The irradiated center exhibited low to moderate intensity with surrounded high intensity (HI) on T2WI and Gd-DTPA T1WI. On T1WI, lesions showed four patterns of intensity: uniform HI (30.8%), arcuate HI (26.9%), mainly low with spot HI (30.8%), and isointensity to hypointensity (11.5%). Follow-up imaging at more than 170 days revealed isointensity to hypointensity on T1WI (96.2%) and reduced HI on T2-weighted imaging (T2WI) and Gd-DTPA T1WI. All lesions became less conspicuous and were reduced in volume. HCC shows time-related changes in signals and size after LMC. Identifying the irradiated lesion is necessary to estimate the adequacy of treatment by comparison with the pretherapeutic image.
Adult↗
Expanding role of emergency embolization in the management of severe blunt hepatic trauma.
Emergency embolization using Gelfoam particles alone, or in combination with stainless steel coils or epinephrine, was attempted in 4 patients with severe blunt hepatic trauma complicated by hypovolemic shock to control exsanguinating hemorrhage. Angiography prior to embolization revealed extravasation in all cases. None of the patients rebled or required further intervention. Postembolization course was uneventful in each case. Embolization could become the treatment of choice for more unstable and complicated patients than previously considered.
Adult↗
Safe percutaneous canalization of the biliary tree using a sheath in patients with malignant biliary stenosis.
BACKGROUND: Percutaneous canalization of the bile duct is essential for radiologic interventions of the biliary tract. This study discusses technical considerations for safe approaches for canalization of the bile duct when using a sheath. METHODS: During early and late periods, percutaneous canalization was performed in 104 patients and 79 patients with malignant biliary stenosis, respectively. The late period differed from the early period in that the bile duct was canalized with a previously placed sheath to prevent catheter dislodgement during the procedure. RESULTS: During the early and late periods, catheter dislodgement during canalization occurred in three of 104 patients (3%) and none of 79 patients (0%), respectively. The success rate of canalization without cholangioscopy in the late period (99%) was better than that in the early period (89%; p < 0.05). CONCLUSION: Placement of a sheath into the biliary tree increases the safety and success of canalization in patients with malignant stenosis.
Adult↗
Catheter dislodgement of percutaneous transhepatic biliary drainage: identification of role of puncture sites and catheter sheath.
BACKGROUND: To identify the appropriate puncture points in the bile duct to avoid catheter dislodgement. METHODS: Percutaneous transhepatic biliary drainage catheters (n = 300) were placed in 242 patients. The frequency of dislodgement (complete dislodgement or bending of the catheter) was prospectively investigated. The puncture site of the bile duct was classified on the ultrasonographic findings as follows: Main-B3, main branch of the lateral inferior segment; peripheral-B3, peripheral branch of the lateral inferior segment; B2, lateral superior segment; left hepatic duct, proximal portion of the left hepatic duct; B8, anterior superior segment; B5, anterior inferior segment; B5 + 8, main bile duct of the anterior segment; B6, bile duct of posterior inferior segment; and right hepatic duct, proximal portion of the right hepatic duct. RESULTS: When a catheter without an outer sheath was used, catheter dislodgement in peripheral-B3 (2/11, 18%) was more common than in main-B3 (0/32, 0%; p < 0.05). In B5, catheter dislodgement (6/12, 50%) was more frequent than in B8 (3/20, 15%; p < 0.05) and in B6 (0/14, 0%; p < 0.005). When a catheter with an outer sheath was used, catheter dislodgement (2/207, 1%) was rare. CONCLUSION: Drainage from B5 and peripheral-B3 is associated with a high risk of dislodgement of the catheter. A catheter with an outer sheath was useful to prevent catheter dislodgement.
Adult↗
Hyperechoic lines as a sonographic confirmatory sign during percutaneous transhepatic biliary drainage.
BACKGROUND: In ultrasonically guided percutaneous transhepatic biliary drainage, we often can recognize hyperechoic lines at the tip of the needle when the duct is penetrated successfully. We evaluated the frequency of this phenomenon and analyzed whether it was a useful sign for confirming successful bile duct puncture. METHODS: In 65 patients with biliary tract diseases, 84 catheters were placed in the course of 108 attempts at puncture. Results of puncture and the presence of hyperechoic lines were investigated prospectively. RESULTS: When the ultrasonographic findings showed hyperechoic lines, successful puncture was significantly more frequent than when the findings did not show hyperechoic lines (53/55, 96%, vs. 31/59, 53%; p < 0.0001). When we judged the hyperechoic lines as the sign of successful puncture, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 63%, 93%, 96%, 48%, and 71%, respectively. CONCLUSION: Hyperechoic lines are a useful confirmatory sign of successful puncture. However, absence of these lines was not invariably associated with unsuccessful puncture.
Aged↗
Intraductal ultrasonography for evaluating the patency of biliary metallic stents: correlation with cholangioscopic findings.
BACKGROUND: This is the first study to correlate intraductal ultrasonography (IDUS) with cholangioscopy in evaluating the patency of biliary metallic stents. METHODS: The findings of IDUS (probe 2.0 mm in diameter and 20-MHz frequency) through a percutaneous transhepatic (n = 24) or transpapillary (n = 2) approach were retrospectively reviewed without other information. Criteria for IDUS are as follows: type 1, the inside of the stent is free; type 2, the inner edge is smooth; type 3, the inner edge is irregular; type 4, the inside of the stent is totally occupied; type 5, the solid echo is connected to the outside mass; type 2+D, a hypoechoic line is seen between the bile duct wall and the inside solid component and the inner edge of the bile duct wall is smooth; type 3+D, an irregular hypoechoic line is seen between the bile duct wall and the inside solid component. RESULTS: In the control group (n = 11), IDUS showed type 1 (n = 9) or type 2 (n = 2). In the occluded group (n = 15), when IDUS showed type 3 or 5, the patients (n = 5) required additional stents (n = 3), microwave coagulation of the tumor (n = 1), or transient external drainage (n = 1). When IDUS showed type 4 (n = 5), after washing, the findings changed to type 2+D (n = 4). When IDUS after washing showed a smooth inner edge (type 2+D), the patients were treated without additional stents more frequently than the other groups (eight of nine vs. two of six), a significant distinction (p < 0.05). CONCLUSION: IDUS is useful in assessing the patency of metallic stents. When the inside of the stent is totally occupied, however, examination after washing is necessary.
Aged↗
Utility and limitations of intraductal ultrasonography in distinguishing longitudinal cancer extension along the bile duct from inflammatory wall thickening.
BACKGROUND: We wanted to distinguish wall thickening caused by cancer extension from that caused by inflammation after placing a biliary catheter on intraductal ultrasonography (IDUS). METHODS: We studied 51 patients with biliary tract malignancies who had undergone placement of biliary drainage catheters before IDUS. IDUS was performed from a transhepatic (n = 34) or transpapillary (n = 17) route with a thin-caliber ultrasonic probe (2.0 mm in diameter, 20-MHz frequency). At the hepatic side of the tumor, the thickness, asymmetry, outer margin, inner margin, and internal echoes of the bile duct wall were reviewed prospectively and correlated with the histologic findings of the surgically resected specimens in all cases. RESULTS: When IDUS showed wall thickening in a semicircular fashion, notched outer margin, rigid inner margin, papillary inner margin, and heterogeneous internal echoes, each finding had a positive predictive value for diagnosing cancer extension (100%, 100%, 83%, 100%, and 90%, respectively). When these factors were used as the diagnostic criteria of cancer extension, IDUS accurately demonstrated suitable surgical margins in 76% of all patients and 71% of patients with bile duct carcinoma. CONCLUSION: Wall thickening in a semicircular fashion, notched outer margin, rigid or papillary inner margin, and heterogeneous internal echoes are specific for cancer extension. However, surgical margins can be inaccurately assessed in some patients.
Aged↗
Prediction of the histologic type of bile duct cancer by using intraductal ultrasonography.
BACKGROUND: Patients with papillary adenocarcinoma survive longer than do patients with other histologic types of bile duct tumors. We evaluated the usefulness of intraductal ultrasonography (IDUS) for predicting the histology. METHODS: Preoperative tumor assessment was performed by using IDUS through a percutaneous tract or the transpapillary route in 37 patients with extrahepatic bile duct cancer. In 30 of 37 patients, imaging results were compared prospectively with histologic findings in resected specimens. Probes 2.0 mm in diameter and 20 MHz in frequency were mainly used. When IDUS showed a "narrow-based polypoid pattern" or a "papillary surface pattern," the patients were judged as having papillary adenocarcinoma. RESULTS: The accuracy, sensitivity, and specificity of IDUS in predicting papillary adenocarcinoma were 90%, 89%, and 90%, respectively. When intraductal ultrasonography showed a papillary surface pattern or a narrow-based polypoid pattern, lymph node metastases and perineural invasion were rarely seen when compared with other patients with bile duct cancer (p < 0.05). CONCLUSION: IDUS is useful for assessing the histologic type of bile duct cancer.
Adenocarcinoma, Papillary↗
Evaluation of a prototype long-lasting insecticide-treated mosquito net under field conditions in rural Burkina Faso.
Insecticide measurements and standard World Health Organization bioassays on random samples of new unwashed, traditionally washed and up to 18 months field-used 'long-lasting' deltamethrin treated mosquito nets demonstrated a rapid reduction of efficacy under field conditions. The technology of 'long-lasting' insecticide-treatment needs much improvement.
Animals↗
Severe central fracture-dislocation of the hip migrated deep into the pelvis complicating ileal rupture and ipsilateral comminuted femoral fracture: CT characteristics.
A case of severe central fracture-dislocation of the hip migrated deep into the pelvis complicating ileal rupture and ipsilateral comminuted fracture of the proximal femur was described. Plain CT images of the pelvis were distinctive and quite useful for evaluating the severity of the injury. Osteomyelitis of the proximal femur occurred soon after resection of the femoral head and suturing of the peritoneum though laparotomy. Complete closure of the peritoneal laceration and rapid totally diverting colostomy would be recommendable in order to avoid infectious complications in such a severe central fracture-dislocation of the hip.
Abdominal Pain↗
CT and ultrasound findings of surgically retained sponges and towels.
The CT and ultrasound features of retained sponges (gossypibomas) are described in six patients. They are well-circumscribed cystic masses without surrounding edema. The retained sponges or towels were correctly identified in only three cases. In the other three cases retained sponges were organized and lost their original configuration. Gas was seen in one case and calcification in two cases. Gossypibomas should be included in the differential diagnosis in all patients with a well-circumscribed cystic mass in the abdomen and with a history of previous laparotomy.
Foreign Bodies↗
Laparoscopic cholecystectomy in the elderly: analysis of pre-operative risk factors and postoperative complications.
A retrospective study was conducted of two groups of patients over (group 1, n = 57) and under (group 2, n = 655) the age of 70 years who underwent laparoscopic cholecystectomy (LC). The pre-operative physical status and systemic complications, operation time, postoperative complications, postoperative hospital stay and other clinical features of the two groups were compared. The incidence of pre-operative complications in group 1 was significantly higher than that in group 2 (P < 0.05). Postoperatively no severe complication was found in any patient. Group 1 showed significantly prolonged operation time and postoperative hospital stay compared with group 2 (P < 0.05). The difference between the groups in the intra-operative treatment time and postoperative treatment is attributed to the greater prevalence of common bile duct stone in group 1 as there was little difference between the groups in the postoperative recovery after exclusion of these patients. No pulmonary complications, which are associated with LC, were observed; the postprocedure pain was slight and the period of bedrest was short. If complications associated with pneumoperitoneum can be prevented, this surgery is an excellent measure to improve the quality of life of even elderly patients with cholecystolithiasis.
Aged↗