ABSTRACT
The irritable bowel syndrome is a functional chronic disorder with a likely multifactorial genesis widely diffused through Western population. The aim of this study was to evaluate the effectiveness of a biological supplement (FloRelax, Sanofi Winthrop) in this syndrome. This randomized multicentric study included 380 patients. The group treated with biological supplement for 6 weeks showed a reduction of the intensity, frequency and duration of the symptoms greater and/or quicker than the group randomized for the only diet.
ABSTRACT
BACKGROUND: Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resection or percutaneous ethanol injection (PEI). In this study, certain clinical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients with single HCC < 5 cm treated by PEI. METHODS: After PEI treatment of HCC, the patients were followed for a mean period of 33 +/- 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child-Pugh score, hepatitis B virus surface antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha-fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the posttreatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated. RESULTS: The cumulative 4-year intrahepatic recurrence rate of HCC was 62%. The log rank test indicated that, among pretreatment parameters, time from cirrhosis diagnosis > 6 years (P = 0.05) and AFP level before PEI of > 25 ng/mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P < 0.002). With regard to posttreatment parameters, an AFP level 1 month after PEI of > 13 ng/mL was shown to be significantly related to tumor recurrence by the log rank test (P < 0.0001). CONCLUSIONS: Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow-up program.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular/therapy , Ethanol/therapeutic use , Liver Cirrhosis/complications , Liver Neoplasms/therapy , Neoplasm Recurrence, Local/epidemiology , Neoplasms, Second Primary/epidemiology , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/blood , Carcinoma, Hepatocellular/blood , Carcinoma, Hepatocellular/pathology , Female , Follow-Up Studies , Humans , Italy/epidemiology , Liver Neoplasms/blood , Liver Neoplasms/pathology , Male , Middle Aged , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/pathology , Neoplasms, Second Primary/blood , Neoplasms, Second Primary/pathology , Proportional Hazards Models , Risk FactorsABSTRACT
We studied, by means of Doppler ultrasonography, the blood flow in the superior mesenteric artery in 12 untreated patients with celiac disease (nontropical sprue) and in 15 healthy controls; peak systolic velocity, end diastolic velocity, mean velocity, flow volume, and resistive index were measured in the fasting state and at regular intervals after ingestion of 0.5 liter of water containing 50 g of saccharose. Under fasting conditions, celiac patients showed peak systolic velocity, end diastolic velocity, mean velocity, and flow volume values significantly higher than those of normal subjects, whereas resistive index was significantly lower. After saccharose ingestion these parameters showed greater variations in normal subjects than in celiac patients. Fasting end diastolic velocity turned out to be the best parameter to distinguish celiac patients from healthy subjects. Doppler ultrasonography of the superior mesenteric artery could discriminate between normal subjects and celiac patients with overt disease. However, these data need further confirmation given the limited sample that we studied; moreover, the capability of this technique in distinguishing nontropical sprue from other gastrointestinal diseases that cause increasing splanchnic flow remains to be ascertained.
Subject(s)
Celiac Disease/diagnostic imaging , Fasting , Mesenteric Artery, Superior/physiology , Ultrasonography, Doppler , Adult , Female , Humans , Intestines/drug effects , Male , Middle Aged , Regional Blood Flow , Sucrose/pharmacologyABSTRACT
Large spontaneous intrahepatic portosystemic venous shunts are occasionally found and their diagnosis by Doppler sonography is rarely reported. The authors describe a case of spontaneous intrahepatic porto-systemic venous shunt in liver cirrhosis diagnosed by color Doppler and characterized by an unusual pulsed Doppler spectrum: a continuous flat portal-like pattern of flow in the portal branch, and in both the shunt and the hepatic vein.
Subject(s)
Fistula/diagnostic imaging , Hepatic Veins/abnormalities , Liver Cirrhosis/complications , Liver/blood supply , Portal Vein/abnormalities , Aged , Biopsy , Diagnosis, Differential , Fistula/complications , Hepatic Veins/diagnostic imaging , Humans , Liver Cirrhosis/diagnosis , Male , Portal Vein/diagnostic imaging , Portography , Tomography, X-Ray Computed , Ultrasonography, Doppler, Color , Ultrasonography, Doppler, DuplexABSTRACT
The acute systemic haemodynamic effects of cigarette smoking are well known, but there are no studies dealing with the possible smoke-related acute changes of splanchnic circulation in man. In the present study we evaluated the acute effects of cigarette smoking on portal blood flow (PBF) in normal subjects by the use of Doppler ultrasound. Twenty-three normal volunteers were asked to smoke two cigarettes with a known total nicotine content (1.1 mg each) in a supine position. Each cigarette was smoked during a 5 min period and a 5 min interval between the two cigarettes was allowed. Both mean PBF velocity and volume were evaluated at time 0 (basal values) and 8, 15, 30, 45 and 60 min after the first inhalation of the first cigarette. The basal mean PBF velocity (22 cm/s; 95% CI 20.9-24.2) was significantly decreased at 8 min (19 cm/s; 95% CI 17.9-20.8; P < 0.0007) and 15 min (20 cm/s; 95% CI 17.8-21.3; P < 0.005). Similarly, the PBF volumes at 8 min (710 mL/min; 95% CI 660-876; P < 0.002) and 15 min (750 mL/min; 95% CI 650-862; P < 0.005) were significantly lower than those measured at time 0 (850 mL/min; 95% CI 766-987). Both mean PBF velocity and volume measured at successive times did not differ significantly from basal values. The present study shows that cigarette smoking causes acute and transient reduction of PBF velocity and volume in normal subjects.
Subject(s)
Portal System/diagnostic imaging , Smoking/adverse effects , Adult , Blood Flow Velocity , Female , Humans , Male , Reference Values , Ultrasonography, DopplerABSTRACT
This study was conducted to identify the sonographic findings that might be used to diagnose sliding gastric hiatal hernia. We first performed a retrospective evaluation of 12 patients known to have sliding hiatal hernia and 18 normal controls. In the controls the esophagogastric junction could be visualized clearly in all cases and the alimentary tract section at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The esophagogastric junction was not visualized in any of the hernia patients, whose alimentary tract diameters ranged from 16.0 to 21.0 mm. These two markers (nonvisualization of the junction and diameter greater than 16 mm) were then evaluated for their ability to predict the occurrence of sliding hiatus hernia in a prospective study of 38 patients subsequently diagnosed by means of barium contrast examinations and endoscopy. In this group, each sign had a positive predictive value of 100%. The negative predictive value of the alimentary tract diameter was 90%; that of nonvisualization of the esophagogastric junction was 94.7%. Inclusion of ultrasonography in the initial work-up of patients with symptoms of gastroesophageal reflux may reduce the need for more invasive diagnostic procedures.
Subject(s)
Esophagogastric Junction/diagnostic imaging , Hernia, Hiatal/diagnostic imaging , Adult , Aged , Aged, 80 and over , Barium Sulfate , Endoscopy, Gastrointestinal , False Negative Reactions , Female , Gastroesophageal Reflux/diagnostic imaging , Humans , Intestine, Small/diagnostic imaging , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Retrospective Studies , UltrasonographyABSTRACT
Defective gallbladder emptying has been proposed as a possible accessory pathogenetic factor to explain the increased prevalence of gallstones in liver cirrhosis. In this study we have evaluated the fasting volume and the meal-stimulated emptying of the gallbladder, the plasma levels of estradiol and progesterone, and the basal and postprandial secretion of cholecystokinin in Child A cirrhotic patients compared to normal subjects. Basal (42.2 +/- 27 vs 22.8 +/- 8.4 ml) (P < 0.002) and residual (8.4 +/- 8.7 vs 4.6 +/- 3.8 ml) (P < 0.05) gallbladder volumes were higher in cirrhotics but neither the integrated gallbladder response to meal nor the maximal percentage of emptying was significantly different. Circulating estradiol and progesterone was slightly increased in only 1/13 and 5/13 cirrhotics, respectively. In eight cirrhotics and seven normals taken from the overall populations, the secretion of cholecystokinin was also measured. The fasting plasma level of cholecystokinin was higher in the cirrhotics (6.71 +/- 5.08 vs 2.02 +/- 0.46 pmol/liter) (P < 0.01). The meal-stimulated integrated plasma cholecystokinin response also was greater in cirrhotics (438.5 +/- 615 pmol/liter/270 min) than in normals (153 +/- 170.4 pmol/liter/270 min), but this difference was not significant because of the small study population. In spite of a normal kinetics of postprandial emptying, cirrhotic patients show increased fasting gallbladder volume and increased plasma levels of basal and postprandial cholecystokinin. Circulating estradiol and progesterone do not seem to be responsible for the large gallbladder volume found in liver cirrhosis.
Subject(s)
Cholecystokinin/metabolism , Estradiol/blood , Gallbladder Emptying , Liver Cirrhosis/physiopathology , Progesterone/blood , Adult , Aged , Cholecystokinin/blood , Eating/physiology , Fasting/blood , Fasting/physiology , Female , Humans , Liver Cirrhosis/blood , Logistic Models , Male , Middle Aged , Radioimmunoassay , Statistics, NonparametricABSTRACT
Nodular regenerative hyperplasia of the liver is characterized by multiple and usually small nodules of hyperplastic hepatocytes surrounded by compressed atrophic liver cells. Given the small size of nodules and the preserved framework, the imaging techniques often show a normal liver and blind percutaneous biopsy is misinterpreted. The Authors report two cases of nodular regenerative hyperplasia diagnosed by ultrasound and percutaneous echoguided biopsy.
Subject(s)
Biopsy, Needle , Liver Diseases/diagnostic imaging , Female , Humans , Hyperplasia , Liver/pathology , Liver Diseases/pathology , Male , Middle Aged , Ultrasonography, InterventionalABSTRACT
This study was conducted to identify the sonographic findings that might be used to diagnose sliding gastric hiatal hernia. We first performed a retrospective evaluation of 12 patients known to have sliding hiatal hernia and 18 normal controls. In the controls the esophagogastric junction could be visualized clearly in all cases and the alimentary tract cross section at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The esophagogastric junction was not visualized in any of the hernia patients, whose alimentary tract diameters measurements ranged from 16.0 to 21.0 mm. These two markers (non visualization of the function and diameter greater than 16 mm) were then evaluated for their ability to predict the occurrence of sliding hiatas hernia in a prospective study of 38 patients subsequently diagnosed by means of barium studies and endoscopy. In this group, each sign had a positive predictive value of 100%. The negative predictive value of the alimentary tract diameter was 90%; that of non-visualization of the esophagogastric junction was 94.7%. Inclusion of ultrasonography in the initial work-up of patients with symptoms of gastroesophageal reflux may reduce the need for more invasive diagnostic procedures.
Subject(s)
Esophagogastric Junction/diagnostic imaging , Hernia, Hiatal/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Retrospective Studies , UltrasonographyABSTRACT
OBJECTIVES: The aims of this study were to evaluate the typing accuracy of smear cytology and microhistology and of their association in the diagnosis of hepatocellular carcinoma arising in liver cirrhosis, and to analyze the usefulness of smear cytology in the diagnosis of well-differentiated neoplasms. METHODS: One hundred sixty patients with hepatocellular carcinoma underwent an ultrasound-guided fine-needle biopsy, providing material for cytological and histological study. In 73 patients, a double biopsy with noncutting and cutting needles was performed (double-needle group), whereas in the remaining 87, a single biopsy with cutting needle was carried out (single-needle group). RESULTS: In the whole population examined, smear cytology, microhistology, and their association, provided the diagnosis of hepatocellular carcinoma in 128 (80%), 98 (61%), and 144 (90%) cases, respectively. The double-needle and the single-needle groups did not differ significantly as to typing accuracy. Smear cytology correctly diagnosed 54 of 64 neoplasms classified histologically as well-differentiated. CONCLUSIONS: Our results show that both smear cytology and microhistology should be applied immediately, when diagnosing hepatocellular carcinoma arising in liver cirrhosis, and that smear cytology is effective in the diagnosis of well-differentiated neoplasms.
Subject(s)
Biopsy, Needle , Carcinoma, Hepatocellular/diagnosis , Liver Neoplasms/diagnosis , Ultrasonography, Interventional , Aged , Aged, 80 and over , Biopsy, Needle/methods , Carcinoma, Hepatocellular/complications , Cytodiagnosis , Female , Histological Techniques , Humans , Liver Cirrhosis/complications , Liver Neoplasms/complications , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
A case of Osler-Weber-Rendu disease or hereditary haemorrhagic telangiectasia with hepatic involvement diagnosed by Doppler ultrasound is described showing an increased blood flow within the dilated common hepatic artery and multiple aneurysms of the intraparenchymal branches of the proper hepatic artery. Doppler ultrasound provides findings suggestive of hepatic involvement in this rare disease and allows invasive imaging studies to be avoided.
Subject(s)
Liver Diseases/diagnostic imaging , Telangiectasia, Hereditary Hemorrhagic/diagnostic imaging , Aged , Female , Humans , Liver/blood supply , Liver/diagnostic imaging , UltrasonographyABSTRACT
The authors describe a case of subcutaneous neoplastic seeding in the abdominal wall in a 67-year-old man with posthepatitic liver cirrhosis complicated by a single nodule of well-differentiated hepatocellular carcinoma. He was treated with percutaneous ethanol injection (PEI) performed under ultrasound guidance. The neoplastic seeding developed along the needle track used to carry out fine-needle biopsy and PEI and was diagnosed 6 months after the beginning of treatment.
Subject(s)
Carcinoma, Hepatocellular/therapy , Ethanol/administration & dosage , Injections, Intralesional/adverse effects , Liver Neoplasms/therapy , Neoplasm Seeding , Neoplasms, Second Primary/etiology , Skin Neoplasms/etiology , Abdominal Muscles/diagnostic imaging , Aged , Carcinoma, Hepatocellular/diagnostic imaging , Humans , Liver Neoplasms/diagnostic imaging , Male , Neoplasms, Second Primary/diagnostic imaging , Radiography , Skin Neoplasms/diagnostic imagingABSTRACT
Gastric emptying time was measured by ultrasonography in 18 NIDDM patients with and without autonomic neuropathy, evaluated by cardiovascular autonomic tests and in 10 controls before and after a physiologic test meal. Six neuropathic subjects showed gastrointestinal symptoms such as fullness and early satiety. Blood glucose, gastrin and pancreatic polypeptide were evaluated before and up to 200 min after the test meal. The gastric emptying rate was similar in controls (275 +/- 45 min) and in diabetic patients without (260 +/- 49 min) and with autonomic neuropathy (257 +/- 48 min) (p = ns), while diabetic symptomatics showed a significant reduction of gastric emptying rate (420 +/- 19.7 min) (p less than 0.001). Basal serum glucose concentration was similar in all diabetic patients (132 +/- 18 mg/dl, 166 +/- 52 mg/dl, 161 +/- 61 mg/dl, p = ns). A basal value of serum gastrin was similar in all groups while the test meal produced a rise with a peak at 40' significantly higher only in symptomatics (195 +/- 58 pg/ml vs control 107 +/- 88 pg/ml, diabetics without and with autonomic neuropathy: 98 +/- 12 pg/ml and 88 +/- 22 pg/ml respectively; p less than 0.01). Basal and stimulated PP values were similar in all groups. In conclusion ultrasonography is a simple, reliable method to evaluate gastric emptying rate without any interference in the mechanism of digestion and absorption of nutrients. The presence of non specific symptoms, such as nausea and gastric fullness, may indicate an early gastric involvement as supported by sonographic evidence of impaired emptying.
Subject(s)
Diabetes Mellitus, Type 2/physiopathology , Diabetic Neuropathies/physiopathology , Gastric Emptying , Gastrins/metabolism , Pancreatic Polypeptide/metabolism , Adult , Analysis of Variance , Blood Glucose/metabolism , Blood Pressure , Eating , Gastrins/blood , Heart Rate , Humans , Kinetics , Middle Aged , Pancreatic Polypeptide/blood , Reference Values , Time FactorsABSTRACT
In the period 1985-1988, 62 focal liver lesions in 58 cirrhotic patients were studied by ultrasonography; 12 of these focal lesions were documented to be regenerating lesions by echo-guided fine-needle biopsy. During an average follow-up period of 10.2 months (range 3-22 months), hepatocellular carcinoma was subsequently found in 10 of the cases of regenerating nodules, whereas the initial diagnosis of regenerating nodule was confirmed in the remaining two cases. Based upon this finding, it is suggested that every focal mass visualized by ultrasonography in a cirrhotic liver should either be considered to be a neoplastic lesion or at least a preneoplastic lesion if the possibility of either a metastatic or benign lesion (eg, hemangiomas, focal fatty liver change areas) can be excluded. Therefore either fine-needle aspiration or biopsy of all ultrasonographically revealed mass lesions within a cirrhotic liver is advised, such that early appropriate treatment for hepatocellular carcinoma can be instituted.
Subject(s)
Carcinoma, Hepatocellular/diagnosis , Liver Cirrhosis/diagnosis , Liver Neoplasms/diagnosis , Liver/pathology , Precancerous Conditions/diagnosis , Ultrasonography , Aged , Biopsy, Needle , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/pathology , Female , Humans , Liver Cirrhosis/pathology , Liver Neoplasms/epidemiology , Liver Neoplasms/pathology , Longitudinal Studies , Male , Middle Aged , Precancerous Conditions/epidemiology , Precancerous Conditions/pathology , Prognosis , alpha-Fetoproteins/analysisABSTRACT
The following parameters were retrospectively evaluated in 64 patients with suspected pancreatic neoplasm: (1) time required to obtain cytohistologic diagnosis, (2) days in hospital, (3) number and type of surgical operations, and (4) total hospital costs. Echo-guided fine needle biopsy (FNB) was performed on 34 patients (FNB group) and in a further 30 patients diagnostic workup did not include percutaneous biopsy (laparotomy group). Both diagnostic and hospital stay were shorter (8 and 7 days, respectively) in the FNB group than in the laparotomy group. In the FNB group, surgery was avoided in 18 patients, while in the laparotomy group 18 explorations proved diagnostic alone. Finally, FNB was shown to reduce hospital costs by 23%.
Subject(s)
Biopsy, Needle , Pancreatic Neoplasms/diagnosis , Biopsy, Needle/economics , Biopsy, Needle/methods , Humans , Laparotomy/economics , Length of Stay , Middle Aged , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/surgery , Retrospective Studies , UltrasonographyABSTRACT
The usefulness of real-time ultrasonography as a guidance method in performing percutaneous renal biopsy is evaluated on the basis of a series of 114 patients with diffuse nephropathies. Sufficient renal tissue for light microscopy was obtained in 102 patients (89.5%) and enough for electron microscopy in 93 patients (81.6%) and for fluorescence microscopy in 91 patients (79.8%). A final histological diagnosis was possible in 106 patients (93%). The high diagnostic rate, the reduction in the contraindications to the procedure, the lack of major postbiopsy complications, and the cost effectiveness probably make realtime ultrasound scanning the method of choice when performing renal biopsy in patients with diffuse nephropathies.
Subject(s)
Biopsy, Needle/methods , Kidney Diseases/pathology , Kidney/pathology , Ultrasonography , Adult , Female , Humans , Male , Microscopy, ElectronABSTRACT
Gastric wall thickness (body-antrum) was blind measured prospectively by real-time ultrasound in 58 patients (30 with gastric cancer and 28 healthy) who had previously undergone endoscopy. Gastric wall thickness on the average measured 15.933 +/- 4.471 mm in the neoplastic patients and 5.107 +/- 1.100 mm in the normal subjects. Seven millimeters was the highest value found in the normal subjects (4 cases) and the minimum value found in the neoplastic patients (1 case). Knowing the normal gastric wall thickness value on a standard ultrasound examination of the upper abdomen is useful, as ultrasound is often performed as a screening or first-step procedure, in order to address the patients with higher values toward more specific techniques.
Subject(s)
Stomach Neoplasms/pathology , Stomach/anatomy & histology , Ultrasonography , Humans , Prospective Studies , Reference Values , Stomach/pathologyABSTRACT
The usefulness of ultrasound and echo-guided fine-needle biopsy (FNB) in the diagnosis of focal fatty liver change (FFLC) is stressed, on the basis of a retrospective series of 21 patients (8 of whom with a past history of primary cancer), followed-up for a mean period of 13.7 months. FFLC presented with various echographic patterns, shapes, dimensions and localizations. In 17 patients the diagnosis of FFLC was made by FNB, yielding cytologic and/or histological samples with steatotic, but also normal, hepatocytes. In another 4 patients the diagnosis was made by echographic follow-up. In all patients, clinical, hematological and echographic follow-up excluded the onset of neoplastic disease, confirming the high specificity of FNB in diagnosing FFLC. The possibility of changing appearance over time, and the inconstant correlation of FFLC with known causes of hepatic steatosis are discussed, as well as the hypothesis that the focal defect seen with ultrasound, could be an area of normal hepatic tissue in a fatty liver. The authors affirm the necessity to perform FNB on each doubtful lesion, but certainly when the patient has a history of malignancy.
Subject(s)
Fatty Liver/diagnosis , Liver/pathology , Ultrasonography , Adult , Aged , Biopsy, Needle/methods , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Lipid peroxidation of microsomal membranes isolated from rat liver, and Morris hepatomas 9618A (slow-growing) and 3924A (fast-growing) was induced by superoxide radicals generated by the action of xanthine oxidase on xanthine. The peroxidation, measured as malondialdehyde and lipid hydroperoxide formation, was optimized with regard to iron concentration and chelation of iron by ADP. In such conditions hepatoma microsomes catalyze lower rates of lipid peroxidation than the normal counterpart. However, while microsomes from hepatoma 3924A show a marked decrease in both the malondialdehyde and hydroperoxide production rates, microsomes from hepatoma 9618A differ moderately from the control, mainly in the long-term production of hydroperoxides. It is also reported here that the 9618A microsomes partially lack cytochrome P-450 (about 40% deficiency), but they have a fatty acid composition similar to that of control. No differences were found in the content of vitamin E between normal and hepatoma 3924A microsomes. Moreover, induction of vitamin E deficiency in hepatoma 3924A microsomes does not influence the rate of either malondialdehyde or lipid hydroperoxide production. On the basis of these results and previous data on the lipid composition of hepatoma 3924A microsomes it is proposed that the high resistance to superoxide-dependent lipid peroxidation of hepatoma 3924A microsomes is related to the low substrate availability rather than the content of membrane antioxidants; and a limitation only in the propagation phase characterizes the hepatoma 9618A microsomal lipid peroxidation and would be due to the partial deficiency of the endogenous propagating agent, cytochrome P-450.