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Havre RF, Leh SM, Gilja OH, Ødegaard S, Waage JER, Baatrup G, Nesje LB. Differentiation of Metastatic and Non-Metastatic Mesenteric Lymph Nodes by Strain Elastography in Surgical Specimens. Ultraschall Med 2016; 37:366-372. [PMID: 27070128 DOI: 10.1055/s-0041-107975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To investigate if strain elastography could differentiate between metastatic and non-metastatic mesenteric lymph nodes ex-vivo. MATERIALS AND METHODS 90 mesenteric lymph nodes were examined shortly after resection from 25 patients including 17 patients with colorectal cancer and 8 patients with Crohn's disease. Ultrasound-based strain elastography was performed with a linear probe. Tissue hardness in lymph nodes was assessed using visual scales and measuring the strain ratio. B-mode characteristics were also recorded. Pathological diagnosis with grading of fibrosis served as the reference standard. RESULTS 20 lymph nodes were metastatic and 70 lymph nodes were non-metastatic. The strain ratios of metastatic and non-metastatic lymph nodes were significantly different (1.83 vs. 1.42, p = 0.021). The VAS scale (0 - 100) for tissue hardness gave higher mean values for metastatic than non-metastatic nodes, but the difference was not significant (65.5 vs. 55.0, p = 0.055). There was no difference between lymph nodes in Crohn's and non-metastatic cancer specimens. The metastatic lymph nodes were significantly more fibrotic than the non-metastatic lymph nodes by the ordinal fibrosis score (0 - 3). In an ROC analysis, quantitative strain imaging was not superior to the measurement of the short-axis diameter of lymph nodes in differentiating metastatic from non-metastatic mesenteric lymph nodes ex-vivo. CONCLUSION Strain elastography is correlated to fibrosis in lymph nodes and a significant difference was observed on a group level using the strain ratio. Due to measurement overlap, individual mesenteric lymph nodes could not be identified accurately as metastatic or not in this ex-vivo model by strain imaging alone.
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Affiliation(s)
- R F Havre
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - S M Leh
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - O H Gilja
- Department of Medicine, Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
| | - S Ødegaard
- Department of Medicine, Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
| | - J E R Waage
- Department of Clinical Medicine, University of Bergen, Norway
| | - G Baatrup
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L B Nesje
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
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Abstract
Ultrasonography (US) is a safe and available real-time, high-resolution imaging method, which during the last decades has been increasingly integrated as a clinical tool in gastroenterology. New US applications have emerged with enforced data software and new technical solutions, including strain evaluation, three-dimensional imaging and use of ultrasound contrast agents. Specific gastroenterologic applications have been developed by combining US with other diagnostic or therapeutic methods, such as endoscopy, manometry, puncture needles, diathermy and stents. US provides detailed structural information about visceral organs without hazard to the patients and can play an important clinical role by reducing the need for invasive procedures. This paper presents different aspects of US in gastroenterology, with a special emphasis on the contribution from Nordic scientists in developing clinical applications.
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Affiliation(s)
- Svein Ødegaard
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen , Bergen , Norway
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Waage JER, Leh S, Røsler C, Pfeffer F, Bach SP, Havre RF, Haldorsen IS, Ødegaard S, Baatrup G. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Dis 2015; 17:124-31. [PMID: 25407010 PMCID: PMC4312907 DOI: 10.1111/codi.12845] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/17/2014] [Indexed: 12/17/2022]
Abstract
AIM Strain elastography is a method for recording tissue hardness. Strain in different areas may be compared using strain ratio (SR). The aims of this study were to validate a previously proposed SR cut-off value of 1.25 for differentiating adenocarcinomas from adenomas and to compare the performance of endorectal ultrasonography (ERUS), strain elastography and MRI in the same patients. METHOD A prospective evaluation of 120 consecutive patients with rectal neoplasia, using a predetermined elastography strain ratio cut-off value, was performed to differentiate adenomas from adenocarcinomas. ERUS and MRI were performed according to standard routine at Haukeland University Hospital, defining T0 as adenomas and T1-T4 as adenocarcinomas. Subsequent histopathology was used as the reference standard. RESULTS Histopathological evaluation revealed 21 adenomas and 99 adenocarcinomas. Sensitivity, specificity and accuracy (with 95% CI) were as follows: ERUS: 0.96 (0.90-0.99), 0.62 (0.40-0.80) and 0.90 (0.83-0.94); elastography SR: 0.96 (0.90-0.99), 0.86 (0.66-0.96) and 0.94 (0.88-0.97); and MRI: 0.99 (0.94-1.00), 0.07 (0.00-0.31) and 0.87 (0.80-0.93). CONCLUSION This study confirms that the elastography SR assessment accurately differentiates sessile adenomas from adenocarcinomas. SR assessment has a superior ability to differentiate adenomas and adenocarcinomas when compared with ERUS and MRI. MRI examination seems unable to recognize adenomas and should be interpreted with care when early-stage rectal neoplasia is suspected.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S Leh
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Pathology, Haukeland University HospitalBergen, Norway
| | - C Røsler
- Department of Radiology, Haukeland University HospitalBergen, Norway
| | - F Pfeffer
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S P Bach
- Academic Department of Surgery, Queen Elizabeth HospitalEdgbaston, Birmingham, UK
| | - R F Havre
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - I S Haldorsen
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Radiology, Haukeland University HospitalBergen, Norway
| | - S Ødegaard
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - G Baatrup
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Surgery A, Odense University HospitalSvendborg, Denmark,Institute for Regional Health Science, University of Southern DenmarkOdense, Denmark
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Ødegaard S, Ohm OJ, Langeland N, Gilhus NE, Nesje LB, Svarstad E. MINNEORD. Tidsskriftet 2015. [DOI: 10.4045/tidsskr.15.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Waage JER, Bach SP, Pfeffer F, Leh S, Havre RF, Ødegaard S, Baatrup G. Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer. Colorectal Dis 2015; 17:50-6. [PMID: 25176033 DOI: 10.1111/codi.12764] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/27/2014] [Indexed: 12/22/2022]
Abstract
AIM Strain elastography is a novel approach to rectal tumour evaluation. The primary aim of this study was to correlate elastography to pT stages of rectal tumours and to assess the ability of the method to differentiate rectal adenomas (pT0) from early rectal cancer (pT1-2). Secondary aims were to compare elastography with endorectal ultrasonography (ERUS) and to propose a combined strain elastography and ERUS staging algorithm. METHOD In all, 120 consecutive patients with a suspected rectal tumour were examined in this staging study. Patients receiving surgery without neoadjuvant radiotherapy were included (n = 59). All patients were examined with ERUS and elastography. Treatment decisions were made by multidisciplinary team (MDT) assessment, without considering the strain elastography examination. RESULTS Histopathology identified 21 adenomas, 13 pT1, 9 pT2, 15 pT3 and one pT4. Mean elastography strain ratios were predictive of T stage (P = 0.01). Differentiation of adenomas from early rectal cancer (pT1-2) had sensitivity, specificity and accuracy of 0.82, 0.86 and 0.84 for elastography and 0.82, 0.62 and 0.72 for ERUS. A combined staging algorithm was developed to identify tumours eligible for local resection. Based on MDT evaluation 32% of tumours later identified as pT0 or pT1 were treated with total mesorectal excision, even though a local excision might have sufficed. Combined ERUS and elastography evaluation would have significantly reduced this number to 9% (P = 0.008). CONCLUSION Elastography may improve the staging of adenomas and early rectal cancer compared with ERUS alone. Combined ERUS and elastography assessment is likely to further improve the selection of patients for local resection.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Abstract
OBJECTIVES. The aim of this study was to evaluate the diagnostic potential of strain assessment in solid focal pancreatic lesions using real-time elastography in combination with endoscopic ultrasonography (EUS). MATERIAL AND METHODS. Forty-eight solid focal pancreatic lesions in 39 patients were included prospectively over a 3-year period and studied by EUS with real-time elastography (EUS-RTE). Lesions previously described as cystic by CT were not included. Distribution patterns of tissue strain were assessed using strain ratio (SR) measurements, continuous visual analog scale (VAS), and a visual categorical score (VCS), based on color coding of relative strain. Final diagnosis was based on histopathology, fine-needle aspiration cytology, and/or follow-up for ≥6 months. RESULTS. The 48 lesions included 11 adenocarcinomas, 7 malignant neuroendocrine tumors (NETs), 11 benign or indeterminate NETs, 8 focal pancreatic lesions, 2 microcystic adenomas, and 9 other benign lesions. Malignant lesions had significantly higher median SR (7.05 vs. 1.56) and VAS scores (93.0 vs. 63.5) than benign lesions. A receiver operation characteristic curve analysis showed sensitivity of 67% and specificity of 71%, when using SR = 4.4 as a cut-off for malignancy. The highest SR values were found in two benign microcystic adenomas. CONCLUSIONS. EUS-RTE with SR measurements and VAS evaluation demonstrated a significant strain difference between benign and malignant lesions. However, the variation within the entities was substantial and some benign lesions presented with low strain. Benign lesions were generally characterized by a strain similar to reference tissue, whereas malignant lesions were harder. The recorded strain pattern in individual lesions must be interpreted with caution.
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Affiliation(s)
- Roald Flesland Havre
- Department of Medicine, Haukeland University Hospital , Jonas Lies vei, Bergen , Norway
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Havre RF, Leh S, Gilja OH, Ødegaard S, Waage JE, Baatrup G, Nesje LB. Strain assessment in surgically resected inflammatory and neoplastic bowel lesions. Ultraschall Med 2014; 35:149-158. [PMID: 23154869 DOI: 10.1055/s-0032-1325535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To investigate whether ultrasound-based strain imaging can discriminate between colorectal adenocarcinomas and stenotic Crohn's lesions in newly resected surgical specimens. MATERIALS AND METHODS Resected surgical specimens from 27 patients electively operated for colorectal tumors or stenotic lesions from Crohn's disease were prospectively examined with ultrasonography using a Hitachi HV 900 US scanner with real-time elastography (RTE). Three different methods were applied to assess tissue strain: A four-level categorical visual classification, a continuous visual analog scale (VAS, 0 - 100) and a strain ratio (SR) measurement between the lesion and surrounding reference tissue. The imaged sections were marked and subsequently examined by a pathologist. Results from RTE were evaluated according to diagnosis, degree of fibrosis, inflammatory parameters, tumor stage and grade. RESULTS 16 sections from Crohn's lesions, 18 sections from adenocarcinomas and 4 sections from adenomas were examined. Both adenocarcinomas and Crohn's lesions were found to be harder than the surrounding tissue, but they could not be discriminated from each other by any of the strain imaging evaluation methods. All adenocarcinomas had significantly higher strain ratios than adenomas. The categorical classification differentiated poorly between Crohn's lesions, adenocarcinomas and adenomas. Categorical evaluation and VAS score showed fair interobserver agreement. SR measurements provided semi-quantitative strain data and added improved information about elasticity properties, despite substantial intra-observer variation. CONCLUSION Sonoelastography with SR measurements and visual evaluation of strain differences could not differentiate stenotic Crohn's lesions from adenocarcinomas in resected bowel specimens. A small number of adenomas were found to be significantly softer than adenocarcinomas using the same evaluation methods. The tumor stage or grade did not have a significant impact on the elastography results.
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Affiliation(s)
- R F Havre
- Institute of Medicine, University of Bergen
| | - S Leh
- The Gade Institute, University of Bergen
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Institute of Medicine, Bergen
| | - S Ødegaard
- Institute of Medicine, University of Bergen
| | - J E Waage
- Department of Surgery, Haukeland University Hospital, Bergen
| | - G Baatrup
- Institute of Surgery, University of Bergen
| | - L B Nesje
- Institute of Medicine, University of Bergen
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Nylund K, Jirik R, Mezl M, Leh S, Hausken T, Pfeffer F, Ødegaard S, Taxt T, Gilja OH. Quantitative contrast-enhanced ultrasound comparison between inflammatory and fibrotic lesions in patients with Crohn's disease. Ultrasound Med Biol 2013; 39:1197-1206. [PMID: 23643057 DOI: 10.1016/j.ultrasmedbio.2013.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 01/25/2013] [Accepted: 01/27/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to determine whether there are differences in absolute blood flow between patients with Crohn's disease with inflammation or fibrosis using contrast-enhanced ultrasound. Eighteen patients with fibrotic disease and 19 patients with inflammation were examined. Video sequences of contrast data were analyzed using a pharmacokinetic model to extract the arterial input and tissue residue functions with a custom software, enabling calculation of the absolute values for mean transit time, blood volume and flow. Feasibility of the examination was 89%. The fibrosis group had lower blood volume (0.9 vs. 3.4 mL per 100 mL tissue; p = 0.001) and flow (22.6 vs. 45.3 mL/min per 100 mL tissue; p = 0.003) compared with the inflammation group. There was no significant difference in mean transit time (3.9 vs. 5.5 s). In conclusion, absolute perfusion measurement in the gastrointestinal wall using contrast-enhanced ultrasound is feasible. There seems to be reduced blood volume and blood flow in patients with fibrotic disease.
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Affiliation(s)
- Kim Nylund
- Institute of Medicine, University of Bergen, Bergen, Norway.
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Havre RF, Waage JR, Gilja OH, Ødegaard S, Nesje LB. Real-Time Elastography: Strain Ratio Measurements Are Influenced by the Position of the Reference Area. Ultraschall Med 2012; 33:559-568. [PMID: 21667433 DOI: 10.1055/s-0031-1273247] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Real-time elastography (RTE) is an ultrasound-based method for the visualization of relative strain distribution in soft tissues. Strain ratio is a semi-quantitative measurement of strain differences between two user-defined areas in an elastogram. The aim of this study was to evaluate the impact of the size and location of a reference area when measuring the strain ratio of focal lesions in a tissue-mimicking phantom and in normal liver tissue. We also investigated whether the strain ratio was affected by changing the scanner parameter: elasticity dynamic range (E-dyn). MATERIALS AND METHODS Two investigators individually collected data by scanning 4 spherical inclusions with different elasticity in a phantom in which the elastic modulus was known in both the lesions and the background. Subsequently, a liver scan was performed in-vivo using the same scanning protocol. Five different setups with changes in reference area position or size were tested. All eight levels of the scanner setting Edyn were recorded for each setup and the strain ratio was measured in 3 different representative elastograms for each recording situation. RESULTS The four inclusions had significantly different mean strain ratio levels (p < 0.01) when compared to the surrounding material. Changing the position of the reference area to a deeper position influenced the strain ratio measurements significantly for all phantom lesions and in the liver. Changing the size of the reference area, while keeping the center depth unchanged, did not influence the mean strain ratio levels significantly. The strain ratio was independent of the E-dyn parameter setting. The intraand interobserver reliability was high when measuring the strain ratio with a free-hand technique. CONCLUSION Strain ratio provides reproducible measurements of inclusions representing different elastic contrasts using a free-hand technique in vitro. Changes in the distance of the reference areas to the ultrasound probe, representing the stress source, seem to have a significant impact on strain ratio measurements.
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Affiliation(s)
- R F Havre
- Institute of Medicine, University of Bergen
| | - J R Waage
- Department of Surgery, Haukeland University Hospital
- Institute of Surgery, University of Bergen
| | - O H Gilja
- Institute of Medicine, University of Bergen
- Department Of Medicine, Haukeland University Hospital, National Center for Ultrasound in Gastroenterology
| | - S Ødegaard
- Institute of Medicine, University of Bergen
- Department Of Medicine, Haukeland University Hospital, National Center for Ultrasound in Gastroenterology
| | - L B Nesje
- Institute of Medicine, University of Bergen
- Department Of Medicine, Haukeland University Hospital, National Center for Ultrasound in Gastroenterology
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Nylund K, Hausken T, Ødegaard S, Eide GE, Gilja OH. Gastrointestinal wall thickness measured with transabdominal ultrasonography and its relationship to demographic factors in healthy subjects. Ultraschall Med 2012; 33:E225-E232. [PMID: 22504939 DOI: 10.1055/s-0031-1299329] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To describe the gastrointestinal (GI) wall thickness and the thickness of individual wall layers in healthy subjects using ultrasound and to determine whether demographic factors, the ultrasound transducer frequency, or a fasting state influences these measurements. MATERIALS AND METHODS After overnight fasting, the GI wall thickness and wall layers were measured in several regions with transabdominal, high-frequency ultrasound. 122 healthy subjects aged 23 - 79 were included. All measurements were performed with both 8 and 12-MHz transducers except for the rectum measurement (4 MHz). 23 patients were given a 300 Kcal test meal and re-examined after 30 minutes. RESULTS Wall thickness measurements of the GI tract with transabdominal ultrasonography are dependent on transducer frequency (p < 0.001), weight (p < 0.001) and age (p < 0.018). The thickness of individual wall layers in the ileum and the sigmoid colon was found to be dependent on both age (p = 0.007) and weight (p < 0.001). The mean wall thickness from the jejunum to the sigmoid colon ranged from 0.9 to 1.2 mm with standard deviations (SD) of 0.3 mm or less. The mean (SD) was 2.9 (0.8) mm in the gastric antrum, 1.6 (0.3) mm in the duodenum, and 2.1 (0.5) mm in the rectum. The gastric antrum was thinner and the ileum and sigmoid colon were thicker after the test meal (p < 0.05). CONCLUSION GI wall thickness depends on weight and age. Provided adequate measurement, an abnormal GI wall should be suspected if the thickness exceeds 2 mm except for in the gastric antrum, duodenum and rectum. Reference values for wall thickness can be used regardless of fasting state or probe frequency except for in the gastric antrum.
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Affiliation(s)
- K Nylund
- Institute of Medicine, University of Bergen
- Department of Medicine, Haukeland University Hospital
| | - T Hausken
- Institute of Medicine, University of Bergen
- Department of Medicine, Haukeland University Hospital
| | - S Ødegaard
- Institute of Medicine, University of Bergen
- Department of Medicine, Haukeland University Hospital
| | - G E Eide
- Department of Public Health and Primary Healthcare, University of Bergen
- Centre for Clinical Research, Haukeland University Hospital
| | - O H Gilja
- Institute of Medicine, University of Bergen
- Department of Medicine, Haukeland University Hospital
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Ødegaard S, Nesje LB, Lærum OD, Kimmey MB. High-frequency ultrasonographic imaging of the gastrointestinal wall. Expert Rev Med Devices 2012; 9:263-273. [DOI: 10.1586/erd.12.6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Brunner S, Eilevstjønn J, Ødegaard S, Kramer-Johansen J, Myklebust H. Why is compression depth less consistent on humans than on manikins? Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hoff DAL, Gregersen H, Ødegaard S, Hjertaker BT, Hatlebakk JG. Sensation evoked by esophageal distension in functional chest pain patients depends on mechanical stress rather than on ischemia. Neurogastroenterol Motil 2010; 22:1170-6, e309-11. [PMID: 20618835 DOI: 10.1111/j.1365-2982.2010.01555.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional chest pain is commonly reproduced by bag distension in the esophageal body. It is unknown whether such pain is primarily associated with mechanical stress and strain (force-deformation) or with changes in mucosal perfusion. METHODS Fourteen patients (6M, 8F, average age 55.9 years) underwent ramp bag distension before and after injection of 20 mg butylscopolamine bromide (BS) using a novel bag catheter incorporating endosonography and laser Doppler perfusion monitoring. Healthy subjects served as controls. Mucosal perfusion was evaluated and stress and strain were computed and related to the sensation. KEY RESULTS The symptom score increased with bag volume (P < 0.001). Volume as a function of pressure was higher in patients than in controls (P < 0.001), both before and during BS. The stress-strain relationship was exponential and indicated a stiffer esophageal wall in patients especially before BS (P < 0.01). The stress-strain curves indicate increased muscle tone in the functional chest pain patients. The perfusion decreased with increasing symptom score from visual analog scale 1-7 during BS. The decrease was on average 18.9% in patients and 19.7% in controls (P = ns). Multiple regression analysis from distensions during BS showed that the discomfort/pain sensations depended on stress and strain (P < 0.001) and with stress as the largest contributor. Perfusion did not contribute. CONCLUSIONS & INFERENCES Pain evoked by bag distension in patients with functional chest pain is stress-dependent rather than dependent on mucosal perfusion. Furthermore, the esophagus of the patients was characterized by more pronounced muscle tone during the distensions.
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Affiliation(s)
- D A L Hoff
- Institute of Medicine, University of Bergen, Bergen, Norway.
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Ødegaard S. Nøytral sakkyndig? Tidsskriftet 2010; 130:722. [DOI: 10.4045/tidsskr.10.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Nylund K, Leh S, Immervoll H, Matre K, Skarstein A, Hausken T, Gilja OH, Birger Nesje L, Ødegaard S. Crohn's disease: Comparison of in vitro ultrasonographic images and histology. Scand J Gastroenterol 2008; 43:719-26. [PMID: 18569990 DOI: 10.1080/00365520801898855] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine some typical histological findings in Crohn's disease using high-frequency ultrasound and to define the echo properties of these findings. MATERIAL AND METHODS Bowel resection specimens from 14 patients operated on for Crohn's disease were examined with a 10 MHz linear array ultrasound transducer in a saline reservoir. Needles were placed in the specimen corresponding to the ultrasound plane. After formalin fixation, histological sections were taken according to these markings. Fifty-eight ultrasonographic images with 123 regions of interest were compared with corresponding histology. RESULTS A thickened muscularis mucosae (>0.3 mm) was found in 48 of 69 regions of interest on histology. Submucosa with slight to moderate fibrosis was imaged as an echo-rich layer with sporadic, echo-poor elements (36/56), while severe fibrosis was seen as an echo-rich layer with diffuse, echo-poor elements (40/55). Muscularis propria with slight to moderate fibrosis was seen as an echo-poor layer with sporadic, echo-rich elements (49/66) while severe fibrosis was seen as an echo-poor layer with diffuse, echo-rich elements (17/22). Crohn's rosary was seen as echo-poor extensions of the 4th echo layer (31/50). CONCLUSIONS Typical histological findings in Crohn's disease such as a thickened muscularis mucosae and Crohn's rosary can be imaged with high-frequency ultrasound in vitro. Fibrosis in the submucosa and muscularis propria is associated with decreasing and increasing echogenicity, respectively.
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Affiliation(s)
- Kim Nylund
- National Centre for Ultrasound in Gastroenterology, Department of Medicine.
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Ødegaard S, Olasveengen T, Wik L, Kramer-Johansen J. Quality of CPR during transport of patients after out-of-hospital cardiac arrest. Resuscitation 2008. [DOI: 10.1016/j.resuscitation.2008.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bratland SZ, Ødegaard S. [Ultrasonography--something for general practice?]. Tidsskr Nor Laegeforen 2007; 127:1923. [PMID: 17700730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
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Gregersen H, Hausken T, Yang J, Ødegaard S, Gilja OH. Mechanosensory properties in the human gastric antrum evaluated using B-mode ultrasonography during volume-controlled antral distension. Am J Physiol Gastrointest Liver Physiol 2006; 290:G876-82. [PMID: 16293656 DOI: 10.1152/ajpgi.00131.2005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aims of this study were to evaluate gastric antral mechanical behavior and distension-induced sensorimotor responses in the human gastric antrum using transabdominal ultrasound scanning. Ten healthy volunteers underwent volume-controlled ramp inflation of a bag located in the antrum with volumes up to 125 ml. The active and passive circumferential tensions and stresses were calculated from measurements of pressure, diameter, and wall thickness before and during the administration of the anticholinergic drug butylscopolamine. The bag distensions elicited contractions in the antrum and sensory responses below the pain threshold. Butylscopolamine abolished the contractions and significantly reduced the sensory response. The length-tension diagram known from in vitro studies of smooth muscle strips could be reproduced as tension-volume diagrams in the human gastric antrum. The number of induced contractions and the contraction pressure amplitude (afterload) showed a parabolic behavior as function of the distension volume (preload), with maximum approximately at 70 ml. At the sensation threshold, the luminal circumference showed the lowest variation coefficient (13-25%), whereas the variation coefficient was more than 100% for the pressure, tensions, and stresses. We conclude that the muscle length-tension diagram and typical preload-afterload curves ad modem the Frank-Starling cardiac law can be obtained in the human gastric antrum. The sensory responses were most closely associated with the luminal circumference, indicating that the sensation during antral distension depends on deformation rather than on tension.
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Affiliation(s)
- H Gregersen
- Center for Visceral Biomechanics and Pain, Aalborg Hospital, Hobrovej 42A, DK-9100 Aalborg, Denmark.
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Ahmed AB, Gilja OH, Gregersen H, Ødegaard S, Matre K. In vitro strain measurement in the porcine antrum using ultrasound doppler strain rate imaging. Ultrasound Med Biol 2006; 32:513-22. [PMID: 16616598 DOI: 10.1016/j.ultrasmedbio.2005.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 12/19/2005] [Accepted: 12/29/2005] [Indexed: 05/08/2023]
Abstract
Strain rate imaging (SRI) enables study of deformation in soft tissues. The aim of this study was to evaluate the accuracy of SRI in measuring strain in the porcine antral wall in vitro. An experimental set-up enabled controlled distension of a porcine stomach in a saline reservoir. Radial strain obtained by SRI was compared with radial strain calculated from B-mode ultrasonography. Circumferential strain obtained by SRI was compared with circumferential strain calculated from sonomicrometry. The agreement between radial strain values measured by SRI and B-mode, along and across several ultrasound (US) beams, using US frequency 6.7 MHz and strain length (SL) = 1.9 mm was = -1.0 +/- 12.1% and 0.5 +/- 13.4%, respectively (mean difference +/- 2SD%) and it was better than with SL 1.2 mm. Compared with sonomicrometry, SRI-determined circumferential strain using 6.7 MHz and SL = 1.9 mm was less accurate, whether averaging along or across several US beams (-9.2 +/- 46.7% and 13.8 +/- 51.2%, respectively). In conclusion, SRI gave accurate measurement of radial strain of the antral wall, but seemed to be less accurate for measurement of circumferential strain for this in vitro set-up.
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Abstract
Improved technology and new clinical methods have expanded the possibilities of using ultrasound in the daily routine of gastroenterology. Gastrointestinal ultrasonography can, in principle, be applied in two different ways in patient management. It can be used as one imaging modality among others, for which the clinicians refer the patient to a radiologist, but it can also be used as a clinical tool, similar to the stethoscope, expanding on the clinical findings and paving the way for efficient work-up of patients. Furthermore, ultrasonography has scientific applications; for example, strain rate imaging and three-dimensional ultrasound are advanced methods that allow highly specified and detailed examination of the tissue or organ of interest.
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Affiliation(s)
- Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.
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Matre K, Ahmed AB, Gregersen H, Heimdal A, Hausken T, Ødegaard S, Gilja OH. In vitro evaluation of ultrasound Doppler strain rate imaging: modification for measurement in a slowly moving tissue phantom. Ultrasound Med Biol 2003; 29:1725-1734. [PMID: 14698340 DOI: 10.1016/j.ultrasmedbio.2003.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Doppler strain rate imaging (SRI) was evaluated in vitro using a silicone strip phantom mimicking slowly moving tissue. A test apparatus was developed that enabled controlled strain experiments with variable strain and strain rate to be performed. SRI strain was measured at eight different calculated strains (range 5.7 to 63.4 %) at three different pump speeds with tissue velocity 0.1, 0.5 and 1.0 mm/s. The effect of varying tissue velocity and strain sample size on the measured SRI strain was elaborated. SRI strains agreed well with calculated values for strain when SRI strain was measured as the average over the whole strip cross-section and the strain sample size was 1.9 mm (mean difference = 2.78%, limits of agreement +/- 9.97% for tissue velocity 1.0 mm/s, n = 8). The variance was substantial if single central samples were used, especially for strain sample size of 0.8 mm (mean difference = -7.47%, limits of agreement +/- 20.90 for tissue velocity 0.5 mm/s, n = 24). Increasing the strain sample size to 1.9 mm removed some of the underestimation (giving mean difference of -4.46%, n = 24). We found low intra- and interobserver variation. This study indicates that, for the SRI method to give accurate estimates of strain, strain sample size should be in the region of 2 mm. Averaging over several ultrasound (US) beams increased the accuracy further.
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Affiliation(s)
- Knut Matre
- Institute of Medicine, University of Bergen and National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
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Gilja OH, Hausken T, Ødegaard S, Wendelbo Ø, Thierley M. [Mobile ultrasonography in a medical department]. Tidsskr Nor Laegeforen 2003; 123:2713-4. [PMID: 14600742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND We examined the usefulness and image quality of a mobile miniaturised ultrasound scanner in a medical ward. MATERIAL AND METHODS The instrument (SonoSite 180), weighing 2.4 kg, is a hand-carried system powered by batteries. In 25 days we recruited consecutively 36 patients aged 23-92. Four different operators evaluated the use of the scanner. We examined one group of patients with relatively simple diagnostic challenges (e.g. gallbladder stone) and one group of patients demanding more advanced visualisation (e.g. peptic ulcer, colitis). RESULTS The scanner was easy to carry around and scanning was initiated in 10 seconds. We found satisfactory image quality on 81% of the examinations, despite the fact that in 28% of cases, bowel air and abdominal fat impaired acoustic penetration. Average scanning time was 7 +/- 3 minutes. In 83% of cases, mobile scanning adequately solved the clinical problem. Diagnostic work-up or treatment was changed because of scanning in 39% of the patients. In 64% of cases, standard-procedure referral to the department of radiology was avoided. In 81% of the examinations the operator was very satisfied with the scanner, also in cases that required advanced visualisation. INTERPRETATION This mobile scanner was simple to use and gave quick results in a medical ward. The operators were very satisfied: mobile scanning changed diagnostic work-up or treatment in 4 out of 10 cases. Mobile ultrasound scanning enables early diagnosis and seems to promote an efficient flow of patients in a hospital unit.
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Affiliation(s)
- Odd Helge Gilja
- Nasjonalt Senter for Gastroenterologisk, Ultrasonografi, Haukeland Universitetssykehus, Bergen.
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Gilja OH, Heimdal A, Hausken T, Gregersen H, Matre K, Berstad A, Ødegaard S. Strain during gastric contractions can be measured using Doppler ultrasonography. Ultrasound Med Biol 2002; 28:1457-1465. [PMID: 12498941 DOI: 10.1016/s0301-5629(02)00614-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study was undertaken to explore if strain of the muscle layers within the gastric wall could be measured by transabdominal strain rate imaging (SRI), a novel Doppler ultrasound (US) method. A total of 9 healthy fasting subjects (8 women, 1 man; ages 22 to 55 years) were studied and both grey-scale and Doppler US data were acquired with a 5- to 8-MHz linear transducer in cineloops of 97 to 256 frames. Rapid stepwise inflation (5 to 60 mL) of an intragastric bag was carried out and bag pressure and SRI were measured simultaneously. SRI enabled detailed studies of layers within the gastric wall in all subjects. Great variations in strain distribution of the muscle layers were found. Radial strain was much higher in the circular than in the longitudinal muscle layer. Strains derived from SRI correlated well with strains obtained with B-mode measurements (r = 0.98, p < 0.05). During balloon distension, we found an inverse correlation between pressure and radial strain (r = -0.87, p < 0.05). Intraobserver correlation of strain estimation was r = 0.98 (p < 0.05) and intraobserver agreement was 0.2% +/- 18.6% (mean difference +/- 2SD, % strain). Interobserver correlation was r = 0.84 (p < 0.05) and interobserver agreement was 6.9% +/- 56.8%. SRI enables detailed mapping of radial strain distribution of the gastric wall and correlates well with B-mode measurements and pressure increments.
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Affiliation(s)
- Odd Helge Gilja
- Institute of Medicine, Haukeland Hospital, University of Bergen, Bergen, Norway.
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Gregersen H, Gilja OH, Hausken T, Heimdal A, Gao C, Matre K, Ødegaard S, Berstad A. Mechanical properties in the human gastric antrum using B-mode ultrasonography and antral distension. Am J Physiol Gastrointest Liver Physiol 2002; 283:G368-75. [PMID: 12121884 DOI: 10.1152/ajpgi.00144.2001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aims of this study were to investigate gastric antral geometry and stress-strain properties by using transabdominal ultrasound scanning during volume-controlled distensions in the human gastric antrum. Seven healthy volunteers underwent stepwise inflation of a bag located in the antrum with volumes up to 60 ml. The stretch ratio and Cauchy stress and strain were calculated from measurements of pressure, diameter, and wall thickness. A second distension series was conducted in three volunteers during administration of the anticholinergic drug butylscopolamine. Analysis of stretch ratios demonstrated positive strain in the circumferential direction, negative strain in the radial direction, and no strain in the longitudinal direction. The stress-strain relation was exponential and did not differ without or with the administration of butylscopolamine. The wall stress was decomposed into its active and passive components. The well-known length-tension diagram from in vitro studies of smooth muscle strips was reproduced. The maximum active tension appeared at a volume of 50 ml, corresponding to a stretch ratio of 1.5. We conclude that the method provides measures of antral biomechanical wall properties and can be used to reproduce the muscle length-tension diagram in humans.
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Affiliation(s)
- H Gregersen
- Department of Gastrointestinal Surgery, Aalborg Hospital, DK-9100, Denmark.
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Arslan G, Ødegaard S, Elsayed S, Florvaag E, Berstad A. Food allergy and intolerance: response to intestinal provocation monitored by endosonography. Eur J Ultrasound 2002; 15:29-36. [PMID: 12044850 DOI: 10.1016/s0929-8266(02)00004-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Objective assessment of adverse reactions to food is a long-felt want. We report our preliminary experience with a new endosonographic allergen provocation test. METHODS Twenty patients were examined, seven patients having food allergy and 13 having food intolerance. The duodenal mucosa was challenged with allergen extracts via a nasoduodenal tube. The responses were recorded using a miniprobe for endosonography through the tube. Thereafter, intestinal lavage was performed by giving 2 l PEG solution containing micro Ci (51)CrEDTA. The gut lavage fluid and urine for 5 h were collected. RESULTS Increased mucosal thickness in response to provocation was recorded in 11 patients, but not more often or pronounced in the allergic than in the intolerance group. Interestingly, increased mucosal thickness associated with a new echogenic layer was seen in two patients and a sustained duodenal contraction, lasting 15-20 min associated with pain, in another two. Intestinal permeability and inflammatory mediators were not significantly different in the two groups. CONCLUSION In patients with self-reported adverse reactions to food abnormal responses to duodenal provocation may be recognised by endosonography. However, neither endosonography nor intestinal permeability or faecal calprotectin responses were able to distinguish between food allergy and intolerance. Sustained duodenal contractions in response to food might be a cause of abdominal pain.
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Affiliation(s)
- Gülen Arslan
- gulen.Medical Department, Division of Gastroenterology, Institute of Medicine, Haukeland University Hospital, University of Bergen, N-5021, Bergen, Norway.
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Nesje LB, Laerum OD, Svanes K, Ødegaard S. Subepithelial masses of the gastrointestinal tract evaluated by endoscopic ultrasonography. Eur J Ultrasound 2002; 15:45-54. [PMID: 12044852 DOI: 10.1016/s0929-8266(01)00166-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To diagnose and characterize subepithelial lesions of the gastrointestinal (GI) tract using endoscopic ultrasonography (EUS) and search for markers of malignancy in stromal cell tumors. METHODS Fifty-four patients with suspected subepithelial lesions at endoscopy were examined using miniature ultrasound probes, integrated ultrasound endoscopes, or both. Surgical treatment was considered if a solid lesion had a maximum diameter of at least 3 cm, mixed echogenicity, or an ill-defined or irregular border. RESULTS EUS disclosed 37 solid lesions and ten fluid-filled structures. In seven patients, including two with protrusion from a normal spleen, no pathology could be demonstrated. Thirteen patients were operated and 41 were observed clinically with (n = 9) or without EUS (n = 32) for a median follow-up period of 36 months. Twenty-three patients had an intramural stromal cell tumor. None of these were malignant, but increased mitotic activity was found in two medium-sized resected tumors with mixed echogenicity and bleeding lesions of the endoluminal surface. CONCLUSION EUS can detect and characterize subepithelial masses in the GI tract. Pathologic lesions of the overlying mucosa may indicate malignant development in stromal cell tumors, but valid markers of malignant potential are still lacking.
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Affiliation(s)
- Lars B Nesje
- Institute of Medicine, Haukeland University Hospital, University of Bergen, N-5021, Bergen, Norway.
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Hausken T, Li XN, Goldman B, Leotta D, Ødegaard S, Martin RW. Quantification of gastric emptying and duodenogastric reflux stroke volumes using three-dimensional guided digital color Doppler imaging. Eur J Ultrasound 2001; 13:205-13. [PMID: 11516632 DOI: 10.1016/s0929-8266(01)00134-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To develop a non-invasive method for evaluating gastric emptying and duodenogastric reflux stroke volumes using three-dimensional (3D) guided digital color Doppler imaging. METHODS The technique involved color Doppler digital images of transpyloric flow in which the 3D position and orientation of the images were known by using a magnetic location system. RESULTS In vitro, the system was found to slightly underestimate the reference flow (by average 8.8%). In vivo (five volunteers), stroke volume of gastric emptying episodes lasted on average only 0.69 s with a volume on average of 4.3 ml (range 1.1-7.4 ml), and duodenogastric reflux episodes on average 1.4 s with a volume of 8.3 ml (range 1.3-14.1 ml). CONCLUSION With the appropriate instrument settings, orientation determined color Doppler can be used for stroke volume quantification of gastric emptying and duodenogastric reflux episodes.
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Affiliation(s)
- T Hausken
- Med. Dept., Haukeland University Hospital, Bergen, Norway.
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Ødegaard S, Kimmey M, Cheung A, Nesje L, Morild I, Silverstein F, Martin R. High frequency endosonography of gastrointestinal arteries: Potential and limitations defined in vitro. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/0929-8266(95)00119-c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bjerknes R, Laerum OD, Ødegaard S. Impaired bacterial degradation by monocytes and macrophages from a patient with treated Whipple's disease. Gastroenterology 1985; 89:1139-46. [PMID: 2412931 DOI: 10.1016/0016-5085(85)90221-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A patient with Whipple's disease is described, and multiparameter flow cytometric examinations of several of the patient's phagocyte functions 3 and 9 mo after the start of oxytetracycline therapy are reported. Almost no intracellular degradation of Escherichia coli or Streptococcus pyogenes proteins and DNA occurred after ingestion by the patient's monocytes and macrophages. In addition, only minor digestion of phagocytized zymosan particles was detected. The mononuclear intracellular degradation was equally impaired 3 and 9 mo after the start of therapy. The monocyte and macrophage phagocytosis and intracellular killing, and all granulocyte phagocyte functions tested, were normal. The impaired mononuclear degradation of ingested material that was measured is consistent with the accumulation of periodic acid-Schiff-positive bacterial degradation products seen in macrophages of affected tissues in vivo, and suggests a key role of macrophage dysfunction in the pathogenesis of Whipple's disease.
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