Ultrasonographic examination of the liver circulation in patients with liver metastasis from colorectal cancer.

PURPOSE: Conventional imaging modalities are presently recommended for the detection of liver metastases. However, the presence of liver micrometastases is a major diagnostic problem. It has been known that micrometastases could be associated with changes in the liver blood flow. METHODS: We examined several parameters by color Doppler ultrasound to estimate hepatic artery flow in 30 patients without and 17 patients with liver metastases from colon cancer. RESULTS: Mean values of hepatic artery diameter (4.25 + or - 0.81 mm in patients with liver metastases were not statistically different from those in patients without metastases (3.98 + or - 0.81). Patients with liver metastasis had significantly higher (p=0.007) mean values of systolic speed (61.33 + or - 30.01 cm/s) in comparison to patients without metastasis (41.38 + or - 16 cm/s). CONCLUSION: Based on these results we suggest that color Doppler examination can be an additional quick noninvasive method in the detection of circulatory changes in the estimation of liver metastases.

[Comparison of clinical data, ultrasonography, mamography and histological findings obtained by ex tempore biopsy for breast cancer diagnosis].

Breast cancer is really one from tumor with highest mortality in this country as well as in the word. For early detection of the loco-regional breast cancer and disease confirmation, many diagnostic procedures were recommended with aims to help in decision for surgery treatment. This comparative study reported data by clinical analyses, ultra-sonography, mammography and histological findings obtained after ex tempore biopsy, in 59 women with breast cancer aged from 16 to 69. The highest incidence of cancer was obtained in women over 61 years of age, although high rate of breast cancer was found in aging between 21 to 50 years. The fibroadenoma were founded in 40.68%, while malignant carcinoma ductale in 13.55% of all cases. Correlation between applied analyses for fibroadenoma was found in 86.05% cases, while in malignant lesions this percentage was highest (93.33%). Apart of these methods applied for early diagnosis in general hospital and obtained statistical significance in diagnosis, new techniques based on molecular level (hormone receptor status) must be used.

[Traumatic rupture of the right hemidiaphragm].

The right hemidiaphragm rupture, caused by blunt force, occurs rarely and often is overlooked because of immediate management of life-threatening injuries. Our paper presents 31-year-old female patient, admitted as emergency case due to traffic accident injuries. Physical examination revealed diminished respiratory mobility of the right hemothorax, along with the impaired respiratory sound to the right infrascapular aspect, diffuse painful sensitivity of the abdomen and limited mobility of the lower extremities. X-ray examination of the chest verified the tight hemidiaphragm elevation without any signs of bone structure fractures and hydro-pneumothorax. Computerized tomography of the abdomen and small pelvis showed the rupture of the right diaphragmatic cupola with the prolaps of the right hepatic lobe, sacral fracture and fracture of both ischial rami. The surgery verified the rupture of the right hemidiaphragm in transversal direction of about 10 cm long, with partial prolaps of liver to the right hemithorax. Surgical intervention included the insertion of thoracic drain and liver mobilization by severing the falciform ligament. The operation was completed by interrupted sutures of the right hemidiaphragm and hematomas in the retroperitoneum were incised. Postoperative course was uneventful, and oral nutrition was initiated on day 4. The patient was discharged 18 days after the surgery. Preoperative diagnostics, attentive intraoperative examination and early surgical treatment significantly reduce morbidity and mortality of patients with traumatic diaphragmatic rupture.

[Doppler hemodynamic study in evaluation of liver metastases].

The color Doppler spectral analyses can be usefully in description of the liver circulation as one from non-invasive methods. Using color Doppler B mod ultrasound (Toshiba Core Vision) with duplex ultrasound we founded difference in liver circulation between patients with colon cancer and liver metastasis in comparison with those without metastases. We suggested this non invasive method for early detection of occult liver metastasis presence.

[Endometriosis in cesarean section surgical scar].

INTRODUCTION: Endometriosis is the presence of endometrial glands and stroma outside of uterine cavity. It may occur in the abdominal wall scar after the operation in which uterus was opened. In cesarean section scar it occurs in 0.4%. It is in 2/3 patients characterised with triad of: tumor, periodic pain associated with menses and history of cesarean section. The mechanism of endometriosis occuring in the cesarean scar is felt to be secondary to iatrogenic transplantation of endometrium or extrauterine decidual tissue into the incision during the cesarean section. CASE OUTLINE: Forty years old patient with tumor 4,5x4 cm that appeared in abdominal wall scar one year after second cesarean section, followed by periodic pain and macroscopic changes associated with menses. First diagnosis was granuloma in the surgical scar, but as she had periodic simptoms, diferential diagnosis was endometriosis. Hormonal therapy with contraceptiv drugs was ordered. As it was no improvement she was operated. The surgical excision of the tumor including fascia and muscle tissue was done. Sample revealed endometrium after histopathologic examination. Patient was complitely recoverd and without relepse of simptoms during followup to date. CONCLUSION: When there is a tumor in the cesarean section scar or scar after the operation in which uterus or ovarial tube was opened, followed with periodical pain and macroscopic changes associated with menses, endometriosis should be considered. Surgical excision of the tumor is sufficient and patohistological examination confirms diagnosis.

Specificity of splenic blood flow in liver cirrhosis.

UNLABELLED: The association between portal hypertension, splenomegaly and splenic hemodynamics has not been clearly defined until these days. Therefore, hemodynamics of splenic blood vessels and the role of spleen in portal hypertension were the aim of our study. METHODS: Study included 44 patients with liver cirrhosis and splenomegaly and 25 healthy controls. Using color Doppler duplex ultrasonography, morphological and hemodynamic parameters of portal hypertension were analysed: liver and spleen diameters, presence of ascites, morphology of portal and splenic vein; portal and splenic vein flow velocity, hepatic and splenic artery velocity, arterial resistive and pulsatile Doppler indices. RESULTS: In patients with liver cirrhosis, significant differences of venous flow in the liver and spleen were found, compared to the control group (p<0.05). Also, splenic vein flow was significantly faster than in the portal vein. On the contrary, in healthy controls, splenic vein flow was significantly slower than in the portal vein. Mean systolic splenic artery velocity in liver cirrhosis was considerably slower (51.07+/-11.91 cm/sec) than in the control group (58.50+/-13.31 cm/sec), while mean diastolic velocity in splenic artery (18.3+/-7.9 cm/sec) was approximate to the flow in the controls (19.76+/-5.58 cm/sec) (p>0.05). In patients with liver cirrhosis, mean systolic (51.07+/-11.91 cm/sec) and mean diastolic velocities (18.3+/-7.9 cm/sec) in the splenic artery were significantly faster than the mean systolic (42.58+/-14.54 cm/sec) and mean diastolic (12.07+/-5.59 cm/sec) velocities in hepatic artery (p<0.05). In patients with liver cirrhosis, mean resistive index (RI) of splenic artery was significantly lower (0.64+/-0.11) compared to mean RI of hepatic artery (0.72+/-0.08) (p<0.001). In healthy controls, mean RI of splenic artery was also significantly lower than mean RI of hepatic artery (p<0.001). In patients with liver cirrhosis, mean pulsatile index (PI) of splenic artery was significantly lower (1.24+/-0.47) than mean PI of hepatic artery (1.56+/-0.46) (p<0.01). In healthy controls, mean PI of spenic artery was significantly lower (1.17+/-0.36) than mean PI of hepatic artery (1.64+/-0.48) (p<0.001), as the result of high diastolic velocity in splenic artery. CONCLUSION: We consider that high diastolic velocity in splenic artery is a specific phenomenon and may be a kind of modulated response to hypokinetic venous flow in portal hypertension.

[Experience of the surgical service and surgeons at the 1st Surgical Clinical Center in Belgrade in the primary care of abdominal war injuries 1991-1992]. / Iskustvo hirurskih ekipa i hirurga I Hirurske klinike Klinickog centra u Beogradu u primarnom zbrinjavanju ratnih povreda abdomena 1991-1992]

During the recent (1991/92) war on the territory of the former Yugoslavia, 12 of our surgeons participated in the treating of war abdominal injuries, on 8 localities with the various characteristics of combat. Treating all injuries, with adequate evidence and documentation, the general experience of all participants of our team was that abdominal injuries range from 0-12% depending on the the intensity of combat, with the mean percentage of 5.43% while combined injuries approximate 50% with the most common injuries of extremities (24%). The number of laparotomies was 65. The most common cause of abdominal injuries were bullets (75%) except in the localities with heavy combat where the explosive and bullet woundings were equally observed. The blast injuries were recorded in 3%. The most common injured organs were large (29.5%), small intestine (23.46%) liver, stomach and spleen subsequently. The severity of injury and mortality depends mostly of the number of injured organs, and multiorgan lesions were systematically observed (1.89 of injured organs SD 0.96). The total hospital mortality was 6.15% (4 cases: 2 "in tabula" and 2 later) due to multiorgan injuries with severe shock and bleeding. To achieve better results, early transportation to a place where operation could be made is necessary, with the effective first aid and good organisation of the initial management and triage. The diagnosis must be fast and effective, decision quick and the operation must deal with all the injuries primary, by the most safe surgical procedure, with the exposition of external wound.