The diagnosis of cirrhosis by high resolution ultrasound of the liver surface.

The objective was to assess the clinical usefulness of high resolution ultrasound (US) analysis of the liver surface for the diagnosis of cirrhosis. In a prospective study, US evaluation of the ventral contour of the liver was performed using a 7.5 MHz linear transducer in 100 patients with suspected liver disease. Only reproducible diffuse ventral liver surface irregularities were considered as an objective US sign of cirrhosis. All patients underwent liver biopsy and/or laparoscopy in order to obtain a definitive diagnosis. Disease prevalence for cirrhosis was 49%. In nine cases the visualized US irregularities were both unconvincing and hardly reproducible. Consequently, they were considered as non-diagnostic and excluded from further analysis. On 91 diagnostic studies, the sensitivity of US for cirrhosis was 91.1%, the specificity 93.5% and the accuracy 92.3%. Positive and negative predictive values were 93.2% and 91.5%, respectively. Provided non-diagnostic cases were considered as technically satisfactory studies and included as true-positive and false-positive cases, this would slightly increase the sensitivity but decrease specificity and accuracy to 91.8%, 84.3%, and 88.0%, respectively. High resolution US analysis of the ventral liver contour is a clinically reliable non-invasive test for the diagnosis of cirrhosis.

Peripheral nerve schwannoma preoperatively diagnosed by sonography: report of three cases and discussion.

The preoperative diagnosis of peripheral nerve schwannoma was correctly made by US in 3 patients referred to US because of upper extremity palpable mass. The patients complained of no pain and neurological symptoms, except in two cases where there was painful sensation radiating distally during lesion compression. In all cases, sonography demonstrated a sharply delineated hypoechoic homogenous mass with distal acoustic enhancement. The lesions were noted to be in a direct continuity with the cord-like echogenic structure consistent with a nerve. These features enabled a reliable diagnosis of peripheral nerve tumor, most likely schwannoma, to be made. Following a surgical excision, the diagnosis of schwannoma was confirmed by histopathology in all cases.

[Detection of diseases mimicking acute appendicitis using ultrasonography]. / Detekce chorob imitujících akutní apendicitidu pomocí ultrasonografie.

Using the method of graded compression the author examined by ultrasonography a total of 1318 patients with an equivocal clinical finding of acute appendicitis. In patients where finally appendicitis was not verified a wide spectrum of other diseases was detected including gastrointestinal (n = 406), biliary (n = 12), gynaecological (n = 72), urological (n = 12) and other (n = 7) pathological conditions using sonography. Sonography is a useful differential diagnostic modality which makes it possible to visualize diseases which clinically imitate appendicitis.

[Detection of acute appendicitis using ultrasonography]. / Detekce akutní apendicitidy pri ultrazvukovém vysetrení.

1318 patients with a clinically equivocal diagnosis of appendicitis were evaluated using graded compression sonography. Sonographic (US) examination could able be performed in 1199 patients. Appendicitis was diagnosed if the appendiceal maximal mural thickness was 3 mm or more, or the appendices presented with luminal dilatation due to a large appendicolith or non-expressible fluid. In patients with verified appendicitis (n = 176) sonographic findings on a visualized appendix were correlated with surgical and histopathological findings. In patients who did not have surgery the reference standard was the clinical consensus based follow-up. A pathological appendix was detected in 165 cases of 176 surgically verified ones. The sensitivity of US in detecting appendicitis was 93.7%, the specificity 95.5% and the accuracy 95.2%.

[Portal vein thrombosis after splenectomy]. / Trombóza portální vény po splenektomii.

Elective splenectomies in haematologic malignancies are associated with two serious risks: infection and thrombotic complications. The case of a patient operated on for chronic lymphatic leukaemia with subsequent postoperative portal vein thrombosis is described. The complication was detected using abdominal ultrasonography and was treated successfully with anticoagulants (Fraxiparin).

Sonographic detection of normal and abnormal appendix.

AIM: The aim of the study was to assess the value of sonography in detecting the normal appendix and in identifying abnormality. METHODS: The appendiceal wall thickness (normal: <3 mm) and ultraluminal contents (abnormal: large appendicolith, non-expressible fluid) were used as the primary criteria to determine the appendiceal status in 716 appendices. In patients who underwent appendicectomy (n = 166), surgical and histopathological findings were correlated with the ultrasound (US) findings; in patients who did not have surgery the reference standard was the clinical consensus based on follow-up. RESULTS: Thirty-four patients out of 179 with abnormal sonographic findings did not undergo appendicectomy and recovered spontaneously; in 22 of these, the US changes were confined to the appendiceal tip. A normal appendix was identified in 537 patients (45.9% of all patients without appendicitis), with histologic verification subsequently obtained in 21. In 76 normal appendices (14.2% out of all normal appendices), luminal dilatation due to non-expressible inspissated faeces resulted in appendiceal outer diameter >6 mm (range, 6.2-12 mm); a histopathologic proof of non-inflamed appendix was obtained in seven of these. CONCLUSIONS: A normal appendix can be visualized in a high percentage of cases and it may present with an outer diameter >6 mm (the widely-accepted upper limit of normal) due to the inspissated faecal material within the lumen. A significant percentage of early appendicitis can resolve spontaneously, especially when confined to the appendiceal tip.

Jejunal duplication cyst displaying peristalsis and a five-layered appearance of the wall: a preoperative ultrasound diagnosis.

A case of preoperatively diagnosed jejunal duplication cyst displaying the characteristic five-layered appearance of the gastrointestinal tract wall and peristaltic activity is reported. Both these rare features allowed a specific diagnosis of enteric duplication to be made.

Ultrasound in the differential diagnosis of appendicitis.

The purpose of this study was to determine the accuracy of sonography in detecting diseases other than appendicitis in the clinical setting of suspected appendicitis. Six hundred and nine patients were evaluated using graded compression ultrasound (US). A broad spectrum of diseases was suggested in the group of patients who eventually turned out not to have appendicitis (n = 426), including gastrointestinal (154), gynaecological (32), biliary (11), urological (8), and miscellaneous (5) abnormalities. However, out of these there were three cases of incorrect sonographic diagnoses with serious sequelae. Appendicitis coincidental with another disease capable in itself of explaining the patients' symptoms was confirmed in seven out of 10 patients where sonographically suggested; in six patients out of this group only the suggested alternative condition was held responsible for the symptoms while the inflamed appendix was overlooked. US is of considerable value in establishing alternative diagnoses in patients with equivocal signs of appendicitis. However, one should always consider the possibility of co-existing appendicitis in patients where US has revealed another condition which could be held in itself responsible for the patient's symptoms.

[Approach to the examination of patients with suspect portal hypertension using duplex ultrasonography. I. Quantitative evaluation of flow in the portal vein]. / Prístup k vysetrení pacientu se suspektní portální hypertenzí s vyuzitím duplexní ultrasonografie. I. Kvantitativní hodnocení toku v portální zíle.

The paper deals with the application of duplex real-time ultrasonography in the area of portal vein system. The attention is centered to the method of quantification of the flow. The author first analyzes the methodology and refers to some main technical factors influencing validity of the results obtained. The author then draws attention to basic ultrasonographic symptoms of portal hypertension. Having analyzed literature data he refers to limited importance of measuring the portal vein flow for the diagnosis of portal hypertension, draws attention to the contribution of respiratory changes in the area of portal vascular bed and the changes in blood flow velocity for this diagnosis. Finally, attention is paid to the possibility of suitable combination of these two signs by creating s. c. "congestive index" (18).

[Neurinoma of the ulnar nerve detected by ultrasonography: case report and discussion]. / Neurinom ulnárního nervu detekovaný ultrasonograficky: kasuistické sdelení a diskuse.

The author describes the observation of nervus ulnaris neurinoma in a 10-year boy, who manifested the tumour clinically as a palpation -sensitive resistance. It was represented in the ultrasonographic picture as a sharply demarcated ovoid lesion of strongly hypo-echogenic character, homogenous echo-structure, while distal enhancement was mildly expressed behind the tumour. Based on the analysis of literature data the author discusses in detail ultrasonographic picture of tumours of peripheral nerves.

[The ultrasonic picture of acute appendicitis]. / Ultrasonografický obraz akutní apendicitidy.

A total of 42 patients with clinically suspect acute appendicitis or equivocal clinical finding indicating this diagnosis were examined by means of high resolution ultrasonography. The sensitivity reached in a group of 14 patients with acute appendicitis confirmed by surgery was 92.8%. The finding was considered positive if the appendix was visualized and, at the same time, its wall was wider than 3 mm or if there was an anechogenic lumen. In this way the specificity for the diagnosis reached 100%, overall accuracy reaching 95.2%. In this study there were two non-diagnostic cases and one false-negative case. In one subject without clinical signs of acute appendicitis there was a picture of normal appendix. A detailed attention was also paid to eight patients (from the total of 26 who were indeed negative), where ultrasonography contributed to the detection of another organic origin of the patients' complaints. The results have shown that ultrasonography may significantly contribute in conditions, where the surgeon is reluctant whether to operate on or not. This method appears to be a contribution also for differential diagnosis in this area.

Urinary iodine and the state of the thyroid gland in Czech children.

In 1988 the authors examined by palpation a total of 978 13--14-year-old children (490 boys and 488 girls) from two areas with a different endemic incidence of goitre (Sedlcany area high endemic, Príbram area low endemic). By palpation in this group a non-palpable thyroid gland was found in 48.2% boys and 33.2% girls. Type 1A in 44.9% boys and 50.0% girls, type 1B in 6.5% boys and 14.8% girls and type 2 in 0.3% boys and 2.0% girls. From this basic group by random selection a representative group of 200 children was selected where the following were assessed: urinary iodine/g creatinine, T3, T4, TSH and the volume of the thyroid gland. Urinary iodine in children from the Sedlcany area: boys 74.98 +/- 52.57 micrograms I/g cr, girls 75.36 +/- 77.05 micrograms I/g cr, children from the Príbram area: boys 55.0 +/- 23.36, girls 58.0 +/- 30.24 micrograms I/g cr. The difference between urinary iodine in boys from the two areas is significant (P < 0.05). The prevalence of optimal urinary iodine (i.e. 101-150 micrograms I/g cr) was in the Sedlcany area 6--13%, in the Príbram area 2.5-8.0% (girls, boys). The difference between areas was not significant. Volume of the thyroid gland in the Sedlcany area: boys 7.20 +/- 2.26 ml, girls 8.0 +/- 2.66 ml, in the Príbram area: boys 7.18 +/- 3.01 ml, girls 7.79 +/- 2.63 ml. The prevalence of children with a volume of the thyroid gland above 10 ml in the Sedlcany area was 20% in boys and 21.6% in girls. In the Príbram area 18.4% in boys and 17.5% in girls. The difference between areas was not significant. T3 in the Sedlcany area in boys: 2.43 +/- 0.53, in girls 2.42 +/- 0.51 nmol/l, in the Príbram area in boys 2.61 +/- 0.50, in girls 2.53 +/- 0.62 nmol. The difference between areas is not significant. T4 in the Sedlcany area in boys: 132.3 +/- 26.39 nmol/l, in girls: 132.92 +/- 26.77 nmol/l, in the Príbram area in boys: 126.7 +/- 23.89 nmol/l, in girls 147.8 +/- 40.2 nmol/l. The difference is significant in girls (P < 0.05). TSH Sedlcany area in boys: 1.62 +/- 0.67 mU/l, in girls 2.07 +/- 0.72 mU/l in the Príbram area in boys: 1.77 +/- 0.95 mU/l, in girls 2.10 +/- 1.25 mU/l. The difference is not significant. The prevalence of elevated T3 levels (above 3.0 nmol/l) in the Sedlcany area was 7.4% in boys and 8.9% in girls, in the Príbram area 15.4% in boys and 14.0% in girls. The difference is not significant.(ABSTRACT TRUNCATED AT 400 WORDS)