[Ultrasound-guided biopsy of the pancreas: a multicenter study]. / Punción pancreática ecodirigida: estudio multicéntrico.

OBJECTIVE: Members of "Asociación de Ecografía Digestiva" decided to carry out a multicenter retrospective study on fine-needle aspiration biopsy for pancreatic space-occupying lesions under ultrasonographic guidance and via the percutaneous route in order to assess this technique s performance versus endoscopic ultrasound-guided biopsy. SUBJECTS: 10 hospitals for a total of 222 patients with suspiciously malignant, 8-120-mm pancreatic lesions were included in the study. RESULTS: The analysis of results shows a sensitivity of 89%, a specificity of 98%, a positive predictive value of 99%, and a negative predictive value of 74%, for an overall diagnostic accuracy of 91%. No major complications occurred. CONCLUSION: Percutaneous fine-needle aspiration for pancreatic lesions is highly cost-effective and has few and mild complications.

Ultrasonography in patients with chronic liver disease: its usefulness in the diagnosis of cirrhosis.

OBJECTIVE: To prospectively assess the usefulness of ultrasonography in predicting the presence of cirrhosis in patients with asymptomatic chronic liver disease in unknown stage. EXPERIMENTAL DESIGN: Eighteen doppler and ultrasonographic features were prospectively assessed immediately before performing laparoscopy and/or liver biopsy. Usefulness of predictive variables selected by multiple regression analysis and included in a scoring scale was determined by ROC curves. PATIENTS: One hundred and thirteen consecutive patients with neither clinical nor biochemical signs of advanced liver disease submitted for study. RESULTS: Liver enlargement, liver surface nodularity, liver parenchyma distortion, flattening of flow wave in hepatic veins, portal and splenic veins dilatation, decreased variability in splenic vein caliber with breathing. Collateral vessels, and splenomegaly were associated to cirrhosis. Multivariate analysis showed the joint assessment of hepatic echostructure, portal vein caliber and spleen area to be the best approach to ultrasonographic staging, with sensitivity of 80%, specificity of 92% and accuracy of 89% in the diagnosis of cirrhosis. CONCLUSIONS: Ultrasonography enabled the presence or absence of cirrhosis to be correctly determined even in patients with asymptomatic disease. Combined assessment of hepatic echostructure, portal vein diameter and spleen size provides the highest accuracy.

Risk factors for hepatocellular carcinoma in patients with liver cirrhosis.

OBJECTIVE: Although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence the risk for HCC in patients with cirrhosis. This study was designed to identify differences in cirrhosis-related risk factors for developing HCC in relation to epidemiological characteristics, stage of the disease and etiology. METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprotein (AFP) concentration was measured. RESULTS: The average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of follow-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infection (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) and AFP levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients, only age (risk increased by 15% per year), and hepatitis C virus infection (relative risk: 5.4) were risk factors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex (relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4.9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% were infected with hepatitis C virus. Alcoholism, Child-Pugh stage and duration of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: The risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infection was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered AFP level.

Prognostic usefulness of ultrasonographic signs of portal hypertension in patients with child-pugh stage A liver cirrhosis.

OBJECTIVE: The aim of this study was to identify factors related with mortality in patients with cirrhosis in the absence of habitual biochemical markers of liver dysfunction. METHODS: Seventy-five cirrhotic patients in Child-Pugh stage A, without hepatocellular carcinoma, were followed until death or the end of the study period. We analyzed the association between cumulative survival and 15 variables determined at the moment of inclusion: age, sex, time from diagnosis of cirrhosis, alcohol abuse, history of variceal bleeding, hepatitis B and C virus infection, Child-Pugh score, plasma albumin and bilirubin levels, prothrombin activity, and four sonographic parameters (size of liver, portal vein diameter, size of spleen, and presence of collateral circulation). RESULTS: Mean follow-up was 38.7+/-10 months. Eighteen patients died. Four-year cumulative survival was 77.4+/-5%. Only five variables had a significant influence on survival according to log-rank test: sex, previous variceal bleeding, hepatitis B virus infection, portal vein diameter, and size of the spleen. Multivariate Cox's model showed male sex (relative risk 4.6; 95% confidence interval 1.2-16.8) and diameter of the portal vein > 13 mm, splenomegaly > 145 mm, or both together (relative risk 6.0; 95% confidence interval 1.3-27.2) as independent predictors of the risk of death. CONCLUSIONS: Child-Pugh stage A cirrhotic patients have substantial variability in mid-term survival. Ultrasonography is a useful aid in establishing their prognosis. Men with dilation of the portal vein, splenomegaly, or both, form a group with a significantly higher risk of death.

[Usefulness of ultrasonography in the early diagnosis of hepatocarcinoma in patients with liver cirrhosis]. / Utilidad de la ecografía en el diagnóstico precoz del hepatocarcinoma en pacientes con cirrosis hepática.

OBJECTIVE: To assess the efficacy of a screening program of ultrasonography (U.S.) every six months in the early diagnosis of HCC in liver cirrhosis patients. PATIENTS AND METHODS: We review retrospectively the 99 HCC detected by U.S. in our service from January 1991 to July 1994. We compared patients in the ultrasonography screening program (Group I) with patients who did not (Group II) and, also with, patients with a previous diagnosis of cirrhosis (Group IIa) and patients with simultaneous HCC diagnosis of and cirrhosis (Group IIb). Liver function, the tumor size and extension, and the chance of treatment at the time of diagnosis were analyzed in each group. RESULTS: Twenty (58%) HCC out of 34 from group I single nodules < 5 cm in diameter vs seven (11%) out of 65 from group II (p < 0.001) were detected and this difference persisted between group I and groups IIa and IIb (p = 0.002 and p < 0.001). Most patients with grade C Child-Pugh's score (24 from 27) in each group showed a > 5 cm or multinodular HCC. Ten patients from group I were treated vs 4 from group II (p = 0.001). CONCLUSIONS: Ultrasonography screening program is useful in the early diagnosis of HCC in liver cirrhosis patients and increases the chances of treatment.

[Ultrasonography-guided percutaneous drainage of hepatic abscess. Results and complications]. / Drenaje percutáneo guiado por ecografía de los abscesos hepáticos. Resultados y complicaciones.

Interventional echography has been proposed as an effective method for the drainage of pyogenic hepatic abscesses. We present the technique and the results with this therapeutic alternative in 23 patients suffering from this serious disease. The procedure was effective in 19 patients (82.6%), being palliative in 3 cases (a carcinoma of the gallbladder, a biliary-bowel fistula and a gastric perforation). The drainage failed in 4 patients (17.4%) (in an infected hematoma were and in 3 cases due to technical problems). There were 4 complications, one of them severe (pleural empyema). We consider that percutaneous drainage guided by echography should by a first choice in the treatment of hepatic abscesses. To achieve good results and to avoid complications it is necessary to have good knowledge of the technique.

[Gastric lipoma diagnosed using transcutaneous echography with a fluid-filled stomach]. / Lipoma gástrico diagnosticado mediante ecografía transcutáneá con llenado líquido del estómago.

A patient with a lipoma of the stomach was diagnosed preoperatively by transcutaneous ultrasound and replenishment of the stomach with fluid, obtaining in this way specific ultrasound diagnostic criteria. This technique might be considered as complementary to endoscopy in the diagnosis of submucous tumours and as an alternative to other expensive examinations such as endoscopic echography.