Perforated pyloroduodenal peptic ulcer and sonography.

OBJECTIVE: The purpose of this article is to illustrate the spectrum of sonographic findings in perforated pyloroduodenal peptic ulcer and discuss the potential role of sonography in the diagnosis. CONCLUSION: Although sonography is not the first-line investigation of choice in suspected perforated peptic ulcer, understanding of the characteristic appearances seen during general abdominal sonography may aid the reader in the diagnosis of this important and sometimes overlooked cause of nonspecific abdominal pain. This may shorten time to the diagnosis and ultimate surgical management.

Changes in interleukin-1ß and 6 after hepatic microwave tissue ablation compared with radiofrequency, cryotherapy and surgical resections.

BACKGROUND: Cytokine changes after microwave tissue ablation (MTA) were compared with hepatic resection, cryotherapy (CRYO), and radiofrequency ablation (RFA). Cytokine production was measured at various ablation volumes for each modality and correlated with the transitional inflammatory zone produced by the ablation techniques. METHODS: Live rats underwent MTA, surgical resection, CRYO or RFA of 15%, 33%, or 66% of the total hepatic volume. Serum samples were collected preoperatively and at 1, 3, 6, 24, and 48 hours after surgery and analyzed for pro-inflammatory cytokines interleukin (IL)-1ß and IL-6. RESULTS: Significantly higher levels of both cytokines were present after CRYO and RFA compared with MTA, hepatic resection, or controls (P < .001). All animals survived except those undergoing RFA or CRYO of 66% of the hepatic volume, which died within 6 hours. Transitional zones produced after RFA were larger than those after CRYO or MTA, but no correlation was present with the amount of cytokines. CONCLUSIONS: Large-volume MTA is associated with a significant decreased cytokine response and is well tolerated compared with RFA and CRYO.

Large volume hepatic microwave ablation elicits fewer pulmonary changes than radiofrequency or cryotherapy.

BACKGROUND: Lung changes after microwave tissue ablation (MTA) of different volumes of liver were compared with hepatic resection, cryotherapy (CRYO) and radiofrequency ablation (RFA). METHODS: Live rats underwent MTA, surgical resection, CRYO or RFA of 15%, 33% and 66% of total hepatic volume and lung samples were collected at the time of death. Lung impairment was assessed directly by examining the tissue specimens for the degree of interstitial pneumonia and by comparing the alveolar thickness in the different groups. RESULTS: All RFA and CRYO rats undergoing 66% of ablations died, but the MTA group had no fatalities. Following 66% RFA or CRYO ablations, the animals had a significantly increased thickness of the alveolar septa compared to 15% or 33% ablations and to 66% ablations in the MTA group. CONCLUSIONS: Large volume MTA is associated with a significant reduction in consequent lung damage and is well tolerated compared to RFA and CRYO.

Renal effects of microwave ablation compared with radiofrequency, cryotherapy and surgical resection at different volumes of the liver treated.

BACKGROUND: Renal changes after microwave tissue ablation (MTA) were compared with those following hepatic resection, cryotherapy (CRYO), and radiofrequency ablation (RFA). Structural damage producing renal impairment has been assessed directly by examining tissue specimens and by serum analysis for two sensitive biomarkers, retinol binding protein (RBP) and the heat shock protein 70 (HSP-70) for each modality at different ablation volumes. METHODS: Live rats underwent MTA, surgical resection, CRYO or RFA of 15, 33 or 66% of total hepatic volume. Urine and tissue samples were collected at the time of death. Percentage of tubules with casts and glomerular damage, tissue expression of HSP-70 and urine RBP were evaluated and compared. Behaviour of the animals was also assessed by means of five different parameters and combined to produce a response score. RESULTS: All RFA and CRYO rats undergoing 66% died and these animals had >60% of damaged tubuli and 8% of altered glomeruli. No animals treated by MTA or surgical resection died. Cut-off values (those predicting fatal treatments) could be identified for levels of HSP-70 and RBP. CONCLUSIONS: Large volume MTA is associated with a significant reduced renal damage and is well tolerated compared with RFA and CRYO.

Ileocolocolic intussusception secondary to a submucosal lipoma: an unusual cause of intermittent abdominal pain in a 62-year-old woman.

We present a case of subacute nonobstructing ileocolocolic intussusception secondary to a submucosal lipoma and a mobile cecum diagnosed sonographically in a 62-year-old woman. The patient was seen following a 2-month history of nonspecific intermittent pain in the right and middle abdomen and weight loss. Sonography revealed ongoing intussusception involving distal ascending and transverse colon. Analysis of the distal intussusception end demonstrated a 3.0 x 2.5 cm echogenic polypoid lesion consistent with a lipoma serving as a lead point. The sonographic diagnosis was confirmed at surgery.