Factors Associated with Severe Carotid Artery Stenosis in a Population with One of the Highest Incidences of Ischemic Stroke in Europe - Single National Center Analysis

Introduction: Despite significant advances in its prevention and acute-phase treatment, stroke is still one of the leading causes of disability and death worldwide. Ischemic stroke accounts for 80 to 87% of all strokes, with 15-30% of cases being caused by extracranial carotid artery (CA) stenosis. Methods: This is an observational, cross-sectional, single-center, prospective, registry-based study. The current research presents the preliminary results after analyzing the demographic features, biological data, and cardio- and cerebro-vascular risk factors of the first 74 patients included in the first "Romanian registry for cervical and cerebral arterial stenosis." Results: In our group of patients, the severity of carotid artery stenosis was related to fibrinogen, total cholesterol, and triglyceride blood levels. Moreover, patients who underwent carotid artery stenosis were more prone to having peri-procedural complications if they had a low blood platelet count. Concerning the associated pathologies of patients with severe carotid atheromatosis, the risk of having lower cognitive abilities was higher in subjects with atrial fibrillation, regardless of the severity of carotid artery stenosis. Conclusions: The presented study brings essential information about a population more prone to cerebral ischemic events than that of most other countries. All data obtained until this moment and which will further result from analyzing the clinical, demographic, and biological features of patients included in this registry should be used for implementing populational strategies for preventing further strokes.

Decompressive Craniectomy: the Right Call at the Right Moment

Introduction:Massive intracerebral hemorrhages and large internal carotid artery infarcts may cause early death due to severe cerebral edema with elevated intracranial pressure, despite maximal medical therapy. Decompressive craniectomy may be of benefit to these patients in terms of survival and even functional outcome. The aim of our paper is to present two cases that illustrate the use of decompressive craniectomy both in ischemic and hemorrhagic stroke, followed by a discussion on the indication and right timing of the intervention, but also on the outcome of these patients. Materials and methods: We present the cases of a 38-year-old man with a right lenticular and capsular hemorrhage who underwent decompressive craniectomy in the first 24 hours from onset of symptoms and a 64-year-old patient with an ischemic stroke in the territory of the left carotid artery with a decompressive craniectomy performed at more than 72 hours from the beginning. For each of the two cases, we analyzed the following parameters: neurologic status, Glasgow Coma Scale, aspect of the cerebral computed tomography before and after surgery, in-hospital complications and modified Rankin Scale at discharge. Outcomes: While the intervention was life-saving in both cases, the procedure had different functional outcomes. Conclusion: Decompressive craniectomy may be a life-saving procedure for patients with both hemorrhagic or ischemic strokes complicated with massive edema and increased intracranial pressure. When performed in the first 48 hours, especially in patients with ischemic stroke aged less than 60, it may also improve the functional outcome compared to conservative treatment.

P1545 Predictors of survival in patients with pulmonary hypertension receiving specific vasodilator therapy

In patients with pulmonary hypertension (PH) right ventricular (RV) function is a well-recognized determinant of clinical outcome, including cardiac death. Data regarding the prognostic value of comorbidities in patients with PH are scarce. Purpose. To identify predictors of cardiac death and all-cause mortality on mid-term follow-up in PH patients receiving specific vasodilator therapy. Methods. Sixty-eight patients (40 ± 16 years, 51 women) with PH (12 with idiopathic pulmonary arterial hypertension-PAH, 32 with congenital heart disease, 10 ith connective tissue disease, 7 with chronic thromboembolic PH and 7 with other forms of PAH) treated with pulmonary vasodilators were studied. Clinical parameters (NYHA class, 6-minutes walking distance, 6MWD), biological (hemoglobin, B-type natriuretic peptide-BNP), and echocardiographic parameters of RV function (TAPSE, tissue-Doppler imaging-derived free-RV wall S- and e’-wave, RV fractional area change (FAC), Tei index, I/H, RV isovolumic acceleration-IVA) and cardiac index were assessed. RV global longitudinal strain (RV-GLS) was measured from the apical 4-chamber view as the average of 3 (free-wall) and 6 (free-wall and interventricular septum) segments by 2D speckle-tracking echocardiography. Parameters of pulmonary artery stiffness (PAS) were assessed: pulsatility, capacitance, elastic modulus, dynamic compliance. Two endpoints were defined: cardiac death and all-cause mortality. Results. PH patients were followed-up for 35 months (4-81). Comorbidities were identified in 15 patients (non-cardiac surgery, anemia, chronic kidney disease, neoplasia, respiratory infections). During follow-up, 20 patients died, 14 deaths being cardiac deaths. At univariable analysis, the following parameters correlated with all-cause mortality: age (51 ± 14 in deceased patients vs 36 ± 15 years in surviving patients, p < 0.001), 6MWD (262 ± 171 vs 369 ± 155 m, p = 0.015), FAC (30 ± 9 vs 38 ± 8%, p < 0.001), 6 segments RV-GLS (-12.3 ± 5.1 vs -15.1 ± 4.5%, p = 0.025), S-RV (9.9 ± 2.2 vs 11.4 ±2.3 cm/s, p = 0.016), TAPSE (16.3 ± 3.3 vs 18.6 ± 3.5 mm, p = 0.014), right atrial (RA) area (30.6 ± 13.1 vs 21.2 ± 8.8 cm2, p = 0.001) hemoglobin (12.9 ± 2.6 vs 15.2 ± 3.0 g/dl, p = 0.004) and BNP levels (lnBNP, 5.8 ± 1.3 vs 4.1 ± 1.4, p < 0.001), presence of comorbidities (10 vs 5, p = 0.001). At multivariable analysis, only comorbidities (p = 0.05) and FAC (p = 0.07) seemed to independently predict all-cause mortality. Predictors of cardiac death at univariate analysis were age, RV function parameters, RA area, PA capacitance (1.02 ± 0.56 vs 1.48 ± 0.80 ml/mmHg, p = 0.05) and cardiac index (2.48 ± 0.64 vs 3.31 ± 1.34 l/min/m2, p = 0.03) but only age (p = 0.03) and cardiac index (0.06) emerged as independent predictors of cardiac death. Conclusions: In PH patients, RV function and comorbidities predict all-cause mortality, while age and cardiac index are independent determinants of cardiac death. Identifying and properly treating associated pathologies could impact survival in this setting.

Unruptured Giant Intracerebral Aneurysms: Serious Trouble Requiring Serious Treatment - Case Report and Literature Review

Giant intracranial aneurysms (ICGA) represent 3 to 5% of all intracranial aneurysms in adults. They are defined as arterial dilatations, with more than 25 mm in diameter. Despite important advances in the research of endovascular techniques of treating giant intracranial aneurysms, the management of these vascular malformations still poses great difficulties for neurologists and interventional radiologists. In particular, these challenges arise from the difficult and modified cerebral anatomy of patients with ICGA. Choosing the best treatment for patients with ICGA involves not only finding the perfect balance between the potential risks and benefits of endovascular treatment, but also taking into consideration the patient's biological condition and associated diseases. The aim of this paper is to describe the decisional algorithm of treating patients with giant intracranial aneurysms and factors which could influence the choice of endovascular technique. We report a clinical case of a 63-year-old female with cardio-vascular risk factors (atrial fibrillation, high blood pressure), diagnosed with a symptomatic giant aneurysm of the right internal carotid artery and multiple cerebral micro-bleeds. Given the very large size of the aneurysm, its characteristics as well as patient's associated comorbidities, it was decided to exclude the ICA aneurysm from circulation by occluding the parent vessel (right internal carotid artery) by using endovascular techniques. Also, a review of the literature on the currently available endovascular methods for treating patients with giant intracranial aneurysms was performed in order to see the indications and possible long-term complications of each method. In selected cases, the risks of serious complications associated with occluding a large cervical-cerebral vessel (as the internal carotid artery) are far exceeded by the risk for rupture of giant aneurysms, which is fatal in many cases. Nevertheless, it is of utmost importance to mention that, although the use of endovascular methods leads to a significant increase in life expectancy, a severe decline in quality of life might be experienced by these patients.

Impact of controlled attenuation parameter on detecting fibrosis using liver stiffness measurement

BACKGROUND

Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis.

AIM

To determine how to use CAP in interpreting liver stiffness measurements.

METHODS

This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP.

RESULTS

Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis.

CONCLUSIONS

Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.

EFSUMB Statement on Medical Student Education in Ultrasound [long version]

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we report EFSUMB policy statements on medical student education in ultrasound that in a short version is already published in Ultraschall in der Medizin 1.

EFSUMB statement on medical student education in ultrasound [short version]

The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) recommends that ultrasound should be used systematically as an easy accessible and instructive educational tool in the curriculum of modern medical schools. Medical students should acquire theoretical knowledge of the modality and hands-on training should be implemented and adhere to evidence-based principles. In this paper we summarise EFSUMB policy statements on medical student education in ultrasound.

Point Shear Wave Elastography by Acoustic Radiation Force Impulse Quantification in Comparison to Transient Elastography for the Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C: A Prospective International Multicenter Study

PURPOSE

The aim of the present prospective European multicenter study was to demonstrate the non-inferiority of point shear wave elastography (pSWE) compared to transient elastography (TE) for the assessment of liver fibrosis in patients with chronic hepatitis C.

MATERIALS AND METHODS

241 patients with chronic hepatitis C were prospectively enrolled at 7 European study sites and received pSWE, TE and blood tests. Liver biopsy was performed with histological staging by a central pathologist. In addition, for inclusion of cirrhotic patients, a maximum of 10 % of patients with overt liver cirrhosis confirmed by imaging methods were allowed by protocol (n = 24).

RESULTS

Owing to slower than expected recruitment due to a reduction of liver biopsies, the study was closed after 4 years before the target enrollment of 433 patients with 235 patients in the 'intention to diagnose' analysis and 182 patients in the 'per protocol' analysis. Therefore, the non-inferiority margin was enhanced to 0.075 but non-inferiority of pSWE could not be proven. However, Paired comparison of the diagnostic accuracy of pSWE and TE revealed no significant difference between the two methods in the 'intention to diagnose' and 'per protocol' analysis (0.81 vs. 0.85 for F ≥ 2, p = 0.15; 0.88 vs. 0.92 for F ≥ 3, p = 0.11; 0.89 vs. 0.94 for F = 4, p = 0.19). Measurement failure was significantly higher for TE than for pSWE (p = 0.030).

CONCLUSION

Non-inferiority of pSWE compared to TE could not be shown. However, the diagnostic accuracy of pSWE and TE was comparable for the noninvasive staging of liver fibrosis in patients with chronic hepatitis C.

Chronic pancreatitis with hemosuccus pancreaticus. The diagnostic contribution of computed tomography and contrast enhanced ultrasonography--case report

Hemosuccus pancreaticus is defined as upper gastrointestinal hemorrhage from the ampulla of Vater via the pancreatic duct. It is a rare disease, with non-specific presentation, challenging to diagnose and difficult to treat, with high mortality rates in untreated patients with massive bleeding. Given the intermittent nature of the bleeding, delays in diagnosis frequently occur. Timely diagnosis and treatment seem to result in markedly reduced mortality, therefore we emphasize the diagnostic contribution of imaging techniques by presenting the case of a patient with chronic pancreatitis in whom computed tomography established the diagnosis of blood in the Wirsung duct and contrast-enhanced ultrasound brought its added value by excluding the active bleeding.

Contrast-enhanced ultrasound (CEUS) for the evaluation of focal liver lesions - a prospective multicenter study of its usefulness in clinical practice

PURPOSE

To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs) and for diagnosing different FLL types.

MATERIAL AND METHODS

CEUS performed in 14 Romanian centers was prospectively collected between February 2011 and June 2012. The inclusion criteria were: age > 18 years; patients diagnosed with 1 - 3 de novo FLLs on B-mode ultrasound; reference method (computed tomography (CT), magnetic resonance imaging (MRI) or biopsy) available; patient's informed consent. FLL lesions were characterized during CEUS according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. For statistical analysis, indeterminate FLLs at CEUS were rated as false classifications.

RESULTS

A total number of 536 cases were included in the final analysis, 344 malignant lesions (64.2 %) and 192 benign lesions (35.8 %). The reference method was: CT/MRI - 379 cases (70.7 %), pathological exam - 150 cases (27.9 %) and aspiration of liver abscesses - 7 cases (1.4 %). CEUS was conclusive in 89.3 % and inconclusive in 10.7 % of cases. To differentiate between malignant and benign FLLs, CEUS had 85.7 % sensitivity, 85.9 % specificity, 91.6 % positive predictive value, 77.1 % negative predictive value and 85.8 % accuracy. The CEUS accuracy for differentiation between malignant and benign liver lesions was similar in tumors with diameter ≤ 2 cm and those with diameter > 2 cm.

CONCLUSION

CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).

The combined role of intravenous contrast enhanced ultrasound (CEUS) and computed tomography (CT) in liver abscess diagnosis

BACKGROUND AND AIMS

Through this study, we intend to review the main aspects regarding the contrast enhanced ultrasound evaluation of liver abscesses, pursuing a comparative analysis between the medical literature and our own experience.

MATERIAL AND METHODS

From June 2008 until December 2010 we have evaluated in our department a consecutive series of 11 patients with liver abscesses (7 males, 63.63%) all between the ages of 45 and 74. All the patients displayed a clinical and biological picture leading to an inflammatory process. The imaging diagnosis was made after confronting the results of the contrast enhanced ultrasound with those of the computed tomography.

RESULTS

In 10 out of 11 patients that were part of the study, we have assessed 14 liver abscesses. A single patient showed spread lesions inside both liver lobes, and they were assessed as hepatic micro abscesses. Three of the patients showed multiple right lobe lesions, 7 patients showed single lesions and one patient showed disseminated lesions within both lobes. We examined six mature lesions, 4 lesions with incomplete necrosis and 4 immature lesions, with no necrosis. The particular aspect of mycotic microabscesses is mentioned at the conventional ultrasound and at the CEUS as well.

CONCLUSION

Various types of hepatic abscesses have different imaging findings, and typical CT and CEUS findings can suggest the diagnosis.

Quantitative contrast-enhanced harmonic endoscopic ultrasonography for the discrimination of solid pancreatic masses

PURPOSE

Contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) for the assessment of microcirculation and the delineation of pancreatic tumors in order to characterize and stage them has only recently become available for commercial use, and few reports have been published. The purpose of the study was the qualitative and quantitative digital image analysis of pancreatic adenocarcinomas using conventional endoscopic ultrasonography (EUS) and CEH-EUS and the evaluation of whether contrast medium injection modified adenocarcinoma staging and patient management.

MATERIALS AND METHODS

In each of 30 prospectively examined patients with suspected pancreatic solid lesions, CEH-EUS was performed using the same quantity of the contrast agent SonoVue and a low mechanical index (0.3 - 0.4), followed by EUS-FNA. The histology, based on EUS-FNA or surgery and 9 months of follow-up, was: pancreatic adenocarcinoma (n = 15), pseudotumoral chronic pancreatitis (n = 12), neuroendocrine tumor (n = 1), common bile duct tumor (n = 1), lymph node metastases of gastric cancer (n = 1). The quantitative analysis was based on histograms obtained from each CEH-EUS video recording.

RESULTS

CEH-EUS showed a hypoenhanced pattern in 14 cases of adenocarcinoma and in 10 cases of chronic pancreatitis. The index of the contrast uptake ratio was significantly lower in adenocarcinoma than in mass-forming chronic pancreatitis. A cut-off uptake ratio index value of 0.17 for diagnosing adenocarcinoma corresponded to an AUC (CI 95%) of 0.86 (0.67 - 1.00) with a sensitivity of 80%, a specificity of 91.7%, a positive predictive value of 92.8%, and a negative predictive value of 78%. The size of the pancreatic mass was assessed significantly more effectively by CEH-EUS but adenocarcinoma staging was not modified.

CONCLUSION

The majority of cases of both pancreatic adenocarcinoma and chronic pancreatitis were hypoenhanced and visual discrimination was not possible. This is the first study about CEH-EUS for the quantitative assessment of uptake after contrast injection which has shown that it can aid differentiation between benign and malignant masses but cannot replace EUS-FNA. Neither tumor stage nor therapeutic management have changed after contrast medium injection during CEH-EUS.

Liver biopsy versus noninvasive methods--fibroscan and fibrotest in the diagnosis of non-alcoholic fatty liver disease: a review of the literature

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in general population so it is impossible to perform liver biopsy in such a large number of patients to identify those with advanced fibrosis or non-alcoholic steatohepatitis. Liver biopsy has a potential sampling error, it is invasive and prone to complications, so it is no longer considered as mandatory as first line screening tools for chronic liver disease. The development of non-invasive biomarkers, FibroTest-ActiTest in 2001 and more recently FibroMax, as well as transient elastography (TE) has changed the management of chronic liver disease. The aim of this review is to summarize the advantages and limits of the available non-invasive biomarkers of liver fibrosis, in comparison with liver biopsy in NAFLD patients.

[Echographic differential diagnosis in oculo-orbital tumors]

Within the period October 1987-September 1990, the authors submit 130 patients to clinical examination and ultrasonography the latter performed by adapting commercially available ultrasonograph type Bruel and Kjaer 3405 and Shimasonic. Among the investigated individuals, 25 exhibited oculo-orbital tumours of various types. The cases are assessed considering the following for establishing the diagnosis: clinical examination, ultrasonography, fluorescein angiography, radiotracer and morphopathological examinations. Besides the use an adapted device, the authors propose a simple and fast morphopathological method: the fixation in formaldehyde solution as long as 48 hours.

Ultrasonographic study of gall-bladder emptying in obese patients

In order to assess gall-bladder (GB) motility in obese patients, we measured by ultrasound the GB fasting volume (FV) in 45 women (23 obese, 22 controls) and 43 men (21 obese, 22 controls). The FV was larger in obese women (45.9 +/- 21.6 cm3) than in controls (26.6 +/- 10.7 cm3) (P less than 0.001), and also in obese men (39.2 +/- 20.2 vs. 23.8 +/- 9.9 cm3) (P less than 0.01). In obese women, GB FV correlated with relative body weight. No correlation was found between GB volume and age in obese subjects. In controls, but not in obese subjects, the GB ejection fraction was significantly greater in men (65.3 +/- 19.9%) than in women (51.3 +/- 9.0%) (P less than 0.02). Gall-bladder contraction was not decreased in obese subjects vs. controls, suggesting that GB hypocontractility is not a lithogenic risk factor in obesity. The observation that GB emptying does not correlate with body weight represents another argument that obesity does not impair GB contraction.

Incidence of gallstones in liver cirrhosis

We conducted a longitudinal follow-up of 72 patients with liver cirrhosis (LC) in order to assess gallstone (GS) incidence. The period of survey was 24.5 +/- 12.2 months. Patients were divided into two groups: group I--26 patients with ascites at the start or appearing during follow-up, and Group II--46 patients with compensated LC (no ascites) throughout the survey. During follow-up, 12 of 72 (16.6%) patients developed GS. The global cumulative incidence of GS was 5.5 cases/100 people/year. Age and sex had no influence on the incidence of GS in LC; neither had etiology or cirrhosis. On the contrary, the study revealed a significant increase in the incidence of GS in decompensated cirrhosis. In group I patients, GS appeared more frequently (34.6%) than in group II patients (6.5%) (chi 2 9.479; p less than 0.002). The cumulative incidence of GS was five times higher in decompensated versus compensated LC.

The role of transvaginal sonography as compared with endorectal sonography in the evaluation of rectal cancer: preliminary study

We carried out a preliminary study on the efficacy of endovaginal sonography (EVS) in the evaluation of rectal cancer. The study included 12 women with endoscopically documented rectal cancer, 10 of which were treated surgically. We found that EVS evidenced metastasized lymph nodes (7/9) and infiltration of the rectovaginal space more clearly; moreover, this technique can also be performed in cases of stenosing cancer. Endorectal sonography (ERS) evidenced infiltration of the rectal wall but was less accurate both in detecting metastasized lymph nodes (6/9) and for exploration of the rectovaginal space. We concluded that the two methods complement one another and improve ultrasonographic staging of rectal cancer.

Non-specific tumoral markers in hepatocellular carcinoma

The number of biological tumoral markers used in the diagnosis and therapy monitoring of hepatocellular carcinoma has increased, but their separate use is limited as none of them is specific, being only tumour-associated (proteins). But when in abnormal amounts and used in combination, they are of great help in the diagnosis and therapy monitoring. A combination of alpha-fetoprotein (AFP) and alpha 1-antitrypsin (AAT) data raises the diagnostic accuracy in hepatocellular carcinoma from 43% obtained with AFP alone, to 90.5% and if the combination includes the carcinoembryonic antigen (CEA) data too the accuracy increases to 100%, still without strict specificity for hepatocellular carcinoma.

Ultrastructural aspects of human liver tumours collected by thin needle aspiration biopsy

Fourteen liver tumor samples, obtained by echographically-guided thin needle aspiration biopsy were electron microscopically studied, pointing out the ultrastructural aspects that allowed the diagnosis of primary and secondary liver neoplasia, and those providing indications for malignancy degrees. Criteria of electronoptic differential diagnosis between dysplastic and malignant lesions are presented. The paper suggests that electron microscopy may be helpful in establishing the forms of liver carcinoma, difficult to be determined only by cytologic examination, and for the early diagnosis mandatory to increase the resectability rate of malignant hepatoma.

The impact of advances in radiologic biliary imaging on the diagnosis of obstructive jaundice. Comparative analysis of two groups of patients hospitalized at a 5-year interval

The study evaluates the impact of advances in biliary imaging techniques on the accuracy and rapidity of diagnosis in patients with obstructive jaundice. Two series of patients hospitalized at an interval of 5 years in the same clinic were prospectively analyzed. In both series, the results of ultrasonography (US) and percutaneous transhepatic cholangiography (PTC) were compared with the intraoperative findings. The performances of US in the assessment of ductal dilatation and choledocholithiasis significantly improved during this period. The fine-needle biopsies taken from the solid masses in liver or pancreatic parenchyma under US guidance in the second series of patients contributed to the greater proportion of correct preoperative diagnoses in this group. The number of PTC investigations increased in the second group (p less than 0.001) given the clinicians' confidence in the safety and easy performance of this method. Using both methods, the etiology of biliary obstruction was correctly diagnosed preoperatively in 85.2 per cent of the second series of patients, significantly more frequently than in the first series of patients (62.7 per cent) (p less than 0.05). The mean period in hospital necessary for the diagnosis decreased during the period analyzed from 15.4 +/- 10.8 days to 10.2 +/- 7.8 days (p less than 0.05), a fact with direct impact on the course of disease, and also on the hospital costs.

Prevalence of gallstones in liver cirrhosis: a sonographic survey

A sonographic prospective study of the prevalence of gallstones was performed in 140 patients with liver cirrhosis and in 140 controls. Gallstones were found more often in cirrhotic patients (29.2%) than in controls (13.6%) (p less than 0.01). Their prevalence increased with age. The ratio of women to men in cirrhotics was the same as in the general population, with a higher prevalence in women. The prevalence of gallstones increased in decompensated liver disease. There was a significantly higher prevalence of both hypersplenism and hemolysis in cirrhosis. No difference was found in gallstone prevalence in relation to cirrhosis etiology. This prospective study confirms, by means of sonography, the high prevalence of cholelithiasis in liver cirrhosis, and extends the previous data about the lithogenic risk factors in this disease.

Morphological M-mode and real-time echocardiographic changes in liver cirrhosis

The morphological echocardiographic parameters were studied in a heterogeneous group of 60 cirrhotics without cardiovascular or pulmonary disease. Enlarged left ventricle (20% of cases) associated with enlarged atrium (15% of cases), enlarged right ventricle (23.3% of cases), left ventricular hypertrophy (10% of cases) and signs of pulmonary hypertension (6.7% of cases) were the most common changes encountered. These were assumed to be due to the hemodynamic changes described in cirrhosis and were related to the decompensation of the liver function and not to the etiology of liver disease, hepatitic activity without decompensation, or age.

Ultrasonically guided fine needle aspiration biopsy for the diagnosis of abdominal tumors

The authors report on the value of ultrasonically guided fine needle (0.6 mm = 23 gauge) biopsy in the morphological diagnosis of abdominal tumors. The method is characterized by a high specificity, resulting from the direct evidencing of the tumoral cells. The accuracy of the method bears on the ultrasonographist's experience, who must puncture the tumor in its peripheral, un-necrotized, zones. The method is rapid and only slightly invasive, involving low risk for the patients. Our results correlate well with the existing literature.