A new method for study of the rectum using transvaginal ultrasound with water enema.

BACKGROUND: To propose a new method for the ultrasound study of the rectum. METHODS: Twenty-one healthy female patients, 58-72 years old, were examined. To achieve optimal filling and distention of the rectum, the examination was performed with the patient in the right lateral decubitus position. After placing the probe into the vagina, 1000-1500 mL of water warmed to 35 degrees C was introduced into the rectum through a cannula. After the rectum was completely full, the cannula was extracted. Images were obtained before and after rectum distention on the transverse plane by using a 5.0-MHz convex radial endocavitary probe. RESULTS: Using water eliminated air and fecal artifacts, so rectal wall layers were reliably demonstrated, with the rectal ampulla well distended. In addition, the rectum in whole circumferential extension and the perirectum fat were clearly visualized. CONCLUSION: This new method is useful for study of the rectum.

[Transvaginal echography in the study of the rectum. A new method with rectal distension with water]. / L'ecografia transvaginale nello studio del retto. Nuova metodica mediante distensione dell'ampolla rettale con acqua.

Transrectal sonography (TRUS) accurately assesses the depth of invasion in the staging of rectal carcinomas. However, the method is limited in the evaluation of upper rectal and highly stenotic rectal cancers. These conditions can be demonstrated in female patients by transvaginal sonography (TVUS) with a 5-MHz convex probe. Conventional TVUS becomes even more accurate when the rectum is distended with water. Twenty-one asymptomatic female patients were examined in a prospective study to assess the value of conventional versus water-distended TVUS. Water improves rectal depiction because it eliminates air and fecal artifacts. In our series, the rectum was demonstrated from anum to rectosigmoid junction in all cases. The whole rectal outline could also be demonstrated. Besides rectal lumen evaluation, the method allowed rectal wall layers and perirectal fat to be detailed. Subsequently, 14 female patients were examined--8 during the preoperative staging and 6 during the follow-up. In preoperative patients, the extent of stenosing rectal cancer and perirectal fat infiltration were assessed; in postoperative patients rectal recurrences were excluded. In conclusion, TVUS with rectal distension by means of water is a new diagnostic procedure which can markedly improve the US imaging of highly stenosing rectal cancers.

Rectal carcinoma: preoperative staging and detection of postoperative local recurrence with transrectal and transvaginal ultrasound.

Transrectal ultrasound (TRUS) was performed preoperatively in 35 patients with rectal carcinoma and the results were compared to histologic findings. In the same group, postoperative studies were performed in 22 patients; in women, transvaginal ultrasound (TVUS) was added to the transrectal study. According to Duke's classification modified by Astler-Coller, in relation to the "T" parameter, TRUS correctly staged 33 of 35 neoplasms (accuracy, 94.3%); one was overstaged and one was understaged. In detection of lymph node involvement, accuracy was 74% (sensitivity 69%, specificity 73.9%). Recurrent local tumors, histologically confirmed, developed in two of 22 postoperative patients who had undergone curative anterior resection. This study demonstrates that TRUS is an accurate method in preoperative staging of rectal carcinoma. In the prospective study, the role of follow-up TRUS and TVUS in detection of local recurrences is evaluated.

[Echography in the study of the neonatal hip: the diagnostic-therapeutic implications of type-IIa (borderline) findings]. / L'ecografia nello studio dell'anca neonatale: implicazioni diagnostico-terapeutiche dei reperti di tipo IIa (borderline).

Sonography (US) is a useful method in the early diagnosis of congenital hip dislocation; X-ray examination exhibits limitations due to high false-positive and false-negative rates. The advantages of US include: non-invasiveness, direct visualization of muscle and cartilage, dynamic demonstration of anatomical structures, and possible diagnosis in neonatal age. Therefore, US can be used as a screening or targeted diagnostic technique in selected newborns with clinical suspicion and/or risk factors. In this paper the authors report their experience in 1271 patients (721 females, 550 males), aged 1 day to 7 months, who were examined with US for the diagnosis of congenital hip dislocation. The newborns were divided into two groups at first examination: a) the screening group included 524 consecutive newborns (F = 266, M = 258) from S. Chiara Regional Hospital in Trento, and b) a selected group of 747 newborns (F = 455, M = 292) with clinical suspicion and/or risk factors, who had been selected in the Trento area. According to Graf's classification, the results of US in 2542 neonatal hips, were: 2346 (92.3%) normal hips, 171 (6.1%) type IIa hips, and 24 (1.6%) pathological hips. In the selected group (1494 hips) we observed: 1351 (90.4%) normal, 119 (8%) type IIa, and 24 (1.6%) pathological hips (IIb, IIc, D, III). In the screening group (1048 hips) we detected: 995 (95%) normal hips (Ia/Ib), 52 (4.9%) type IIa, and 1 (0.1%) pathological hips (D). Our experience suggests that US is a useful method in selected newborns with clinical suspicion of congenital hip dislocation and/or risk factors. US limitations consists in the dispersion of type IIa hips. Moreover, the need emerged for complete cooperation between pediatrician, radiologist, and orthopedist to optimize the cost/benefit ratio.