[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.

[Renal Doppler ultrasonography and its relationship with the renal function in patients with liver cirrhosis]. / Ecografía Doppler renal y su relación con la función renal en pacientes con cirrosis hepática.

BACKGROUND: To relate the renal hemodynamic changes, as assessed by Doppler ultrasonography,with the development of ascites, renal function, and endogenous vasoactive systems in patients with liver cirrhosis. PATIENTS AND METHODS: 60 cirrhotic patients were studied prospectively, 31 of these compensated and 29 with ascites. The renal resistive index, renal function and plasmatic levels of renin, aldosterone, noradrenaline and ADH activity were determined. RESULTS: The renal resistive index was significantly higher in the cirrhotic patients with ascites (0.68) than in the compensated cirrhotics (0.63) and was significantly correlated with the serum levels of creatinine,urinary excretion of sodium, plasmatic renin activity and plasmatic concentration of aldosterone. CONCLUSIONS: The renal resistive index, study by means of Doppler ultrasonography, shows progressively increased levels with the evolution of the disease, with the deterioration of the renal function and with the activation of the endogenous vasoactive systems.

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.

Doppler ultrasonography in the assessment of renal hemodynamics in patients with chronic liver disease.

AIM: To assess renal hemodynamics by Doppler analysis of resistive index (RI) in small intrarenal arteries in patients with chronic liver diseases at different stages, and to analyze renal RI in patients with cirrhosis as a function of the absence or presence of ascites and the response to diuretic therapy. METHODS: Prospective cross-sectional study of 24 patients with chronic hepatitis, 39 with compensated cirrhosis, and 34 with ascites. The last group was divided into two subgroups: 1) responders to sodium restriction and a low dose of diuretics, and 2) patients with refractory ascites or those requiring high-dose therapy. RESULTS: Renal RI was increased in patients with cirrhosis and ascites (0.68 +/- 0.06) in comparison with patients with compensated cirrhosis (0.63 +/- 0.03, p < 0.01). Renal RI in the latter group was higher than in patients without cirrhosis (0.61 +/- 0.04, p < 0.05). Renal RI in patients with ascites was lower in subgroup 1 than in subgroup 2 (0.65 +/- 0.05 vs 0.72 +/- 0.06, p < 0.01). CONCLUSIONS: Renal RI increases as liver disease progresses. Patients with cirrhosis and ascites and increased RI require high-dose treatment or do not respond. Further studies are needed to demonstrate the predictive value of renal RI in assessing the effectiveness of diuretic therapy.