Prevalence of chronic (latent) pancreatitis in hospitalized chronic consumers of alcohol.

A pancreatic echographic investigation was carried out in 120 chronic consumers of alcohol, hospitalized for digestive diseases (hepatic, gastrointestinal) or extradigestive diseases (rheumatic, cardiovascular). Seventy cases (66%) presented pancreatic echographic--structural changes of various degrees. In 50 patients (41.5%) these changes were well definite. The intensity of echographic changes was correlated with the degree of alcoholic impregnation, 50% of the cases presenting also alcoholic hepatic disease. Emphasis is laid on the clinical latency of pancreatic disease. Echographic screening proved to be a valuable method for the detection of latent pancreatic fibrosis in heavy alcohol consumers.

Decision analysis in the clinical and imaging diagnosis of acute cholecystitis.

The importance of clinical, laboratory and imaging data in the diagnosis of acute cholecystitis (AC) was studied in 825 patients with right upper quadrant pain hospitalized in the Surgical Clinic of the Fundeni Hospital--Bucharest, between January 1, 1986 and June 30, 1988. A number of 21 parameters were analysed in each case. Of these 825 patients, 259 were considered after surgery as AC. These 259 cases were divided, after the microscopical examination of the surgically-obtained specimens, into two groups: 1) pathologically confirmed AC (137 cases) and 2) pathologically non-confirmed AC (122 cases). The importance of every parameter in establishing a histologically confirmed diagnosis of AC was determined by the diagnostic probability calculated according to Bayes'theorem. The hierarchy of the value of parameters in the diagnosis of AC was based on their capacity to distinguish between the cases histologically confirmed and those detected on surgery, but without microscopically demonstrated changes of AC. The same decision criterion was used in building the decision trees in the exploration of the cases of presumed AC. In the 825 cases with right upper quadrant pain, the main and most frequent cause was chronic calculous cholecystitis (31.8%), followed by AC pathologically confirmed (16.6%), AC non-confirmed (14.7%) and chronic acalculous cholecystitis (12.4%). The most useful parameters in distinguishing between pathologically confirmed AC and pathologically non-confirmed AC were: 1) sudden onset of pain; 2) mild resistance to abdominal palpation; 3) frank peritoneal irritation; 4) stone impacted in the gallbladder neck (ultrasonography); 5) fever; 6) palpable gallbladder; 7) lithiasis (ultrasonography); 8) gallbladder wall with double outline (ultrasonography). Ultrasonography supplied a diagnostic probability of 85% for the correct diagnosis of AC in cases without a clinical picture suggestive for AC. The decision tree analysis supported the same conclusion: only ultrasonography gives a good distinction between pathologically confirmed AC and pathologically non-confirmed AC.

[The cholestasis syndrome. A critical evaluation of an exploratory strategy]. / Sindromul de colestaza. Evaluarea critica a strategiei de explorare.

The authors studied 160 cases of biliary stasis: 120 having intrahepatic cause (101 hepatic cirrhoses and 19 primitive biliary cirrhoses) and 40 extrahepatic cause (17 choledochal lithiases and 23 cancers of the pancreas head) and check up the diagnosis value of two investigation algorithms: echography, the first investigation, followed by hepatic biopsy puncture, if the intrahepatic biliary ducts are not dilated, or transhepatic cutaneous cholangiography if the intrahepatic biliary ducts are dilated in comparison with intravenous cholangiography in the first investigation. Echography has an increased diagnosis yield (96% sensitivity, 99% specificity), is cheap, noninvasive and is the first imaging exploration used in biliary stasis syndrome.

[Is an esophageal transit scintigram necessary in patients with gastroesophageal reflux?]. / Este necesara scintigrama de tranzit esofagian la pacientii cu boala de reflux gastroesofagian (BRGE)?

Efficient esophageal clearance has an important defence role in the pathogenesis of the gastroesophageal reflux disease (GERD). Many GERD patients have esophageal disturbances associated with or secondary to reflux, producing delayed clearance. This delay exposes the esophageal mucosa to the reflux acid content. To determine esophageal transit we scanned the esophageal transit of a 15 ml bolus containing colloidal 300/cCi 99m Tc. The esophageal transit was calculated in seconds according to formula E.T. = T 1/2 x 5. The study included 74 GERD patients. The following investigations were carried out in all the cases: esophageal X-ray, GER scintigram, endoscopy, esophageal biopsy, Bernstein test and esophageal transit scintigram. Endoscopy revealed lesions of the esophagus (of 1st, 2nd and 3rd degree) in 39 patients, Barrett syndrome in 8 cases and normal in 27. Esophageal transit scanning was normal in 18 cases (24%), and prolonged in 56 cases (76%). Only 7 (39%) of the 18 patients with a normal transit presented lesions of the mucosa, the latter being more frequent in patients with a prolonged transit, i.e. 40 of 56 patients (71.5%). The mean value of the transit in different degrees of esophagitis (I, II, III) and Barrett syndrome were: 12.73 +/- 5.36; 13.30 +/- 7.90; 10.35 +/- 5.78; 17.25 +/- 11.17. In conclusion esophageal transit scanning is a useful test in GERD patients as it has a prognostic value. A prolonged esophageal transit is frequently associated with lesions, the more severe the slower is the transit. Moreover the test may indicate certain drugs acting upon the esophageal motor disturbances.

The value of computed tomography in the diagnosis of the prehepatic portal hypertension.

The dynamic computed tomography (CT) is used by the authors in a complex system of investigations. It is preceded by a diagnosis stage which determines the "normal" character of the liver and it is followed by the angiographic exploration for the cases with surgical indication. 36 patients with CT diagnosis of prehepatic portal hypertension were studied; from these patients, 24 had an angiographic confirmation and 16 of them were operated. The most valuable CT signs which have been found by the authors were: the study of the portal vein at the hilum level and in the distal parapancreatic region, the hypoplasia of the left hepatic lobe and the absence of the ascites. The other signs were considered less important, only the localization of the porto-systemic shunts being to a certain degree important for surgery. It is underlined the early age of the patients (69% are under 30 years old). The diagnosis concordance was in the studied group 100% for the positive diagnosis of the syndrome, but only 79% for the localization of the obstruction. CT is the most innocuous diagnostic procedure which obtains a maximum of data on the portal system morphology.

The causal diagnosis of obstructive jaundice. A Bayesian approach.

To compare the contribution of clinical, laboratory and imaging data for the diagnostic accuracy in establishing the cause of obstructive jaundice, the records of 333 patients operated on for a presumed obstruction of the biliary ducts were analysed. The final diagnoses, after surgery, were divided into six groups: stones of the gallbladder and biliary tract, pancreatic cancer, biliary tract neoplasms, ampullary carcinoma, postoperative stenosis of the bile ducts, intrahepatic cholestasis (biliary cirrhosis, chronic cholangitis) and other causes of jaundice (liver tumours, cysts, extended cancer of the upper abdomen). Twenty-three parameters (9 clinical symptoms and signs, 10 biochemical alterations and 4 imaging methods) were examined. Not every case had all the investigations performed but the number of each group of data was large enough to allow a statistically significant conclusion. The contribution of each of the 23 parameters in increasing the probability of correct diagnosis was determined using a computer program based on Bayes' theorem. This analysis showed that for patients which presented suggestive clinical signs and symptoms for stones of the gallbladder and biliary tract and for pancreatic cancer, the diagnosis can be predicted with a probability of 90% only on the basis of clinical findings. The probability of a correct preoperative diagnosis was increased to 99% by imaging methods. On the contrary, for patients with a less clear diagnostic probability (with ampullary carcinoma, intrahepatic cholestasis and other causes) only ultrasonography and computed tomography could increase the probability of correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic value of echotomography in alcoholic liver disease.

In 32 patients with alcoholic liver disease a comparison was made between the classical liver morphologic changes (laparoscopic and histologic) and the echotomographic aspects, to demonstrate the diagnostic value of the latter. Though the echographic changes were nonspecific, they supply some indications on the anatomoclinical form of disease. The only element of echotomography with certain value is the differentiation between cirrhosis and the other forms: steatosis and alcoholic hepatitis. To this, some possibilities of detecting incipient fibrosis and concomitant involvement of the pancreas can also be added.