Evaluation of gastric carcinomas with high resolution transabdominal sonography

Introduction: Assessment of the stomach is not commonly included in routine scanning protocol of upper abdominal ultrasound (USG). Aim: To evaluate the efficacy of high-resolution trans abdominal sonography in the evaluation of gastric carcinomas. Materials and Methods: 42 patients diagnosed gastric carcinoma were included in the study. The patients were taken for conventional abdominal sonography followed by high resolution trans abdominal sonography. An UGI endoscopy was done in all cases and biopsy taken from pathological / suspicious site. The accuracy of high resolution sonography of the fluid filled stomach was evaluated in the diagnosis of gastric carcinoma as compared to endoscopy. Results: Commonest age group in the study with gastric carcinoma was 61-70 years of 35.7% and females are more affected than males of 54.7%. Commonest symptoms with which patients of gastric carcinoma presented was weight loss (73.8%) and abdominal pain (69%). This represented the advance stage of the disease at which most of our patients present. The commonest site of gastric involvement in carcinoma was the antrum – 19 out of 42 cases (45.2%). In all 42 patients of gastric carcinoma (97.7%) wall layering is lost. Wall thickness was increased in all the cases (100%). Wall echotexture is hypoechoic in all the patients. There was luminal narrowing and reduced peristalsis seen in all the 42 (100%) cases. Heterogeneous intraluminal masses were seen in 38 out of 42 (90.5%) cases of gastric carcinoma. Serosal involvement was seen in 35 out of 42 (83.3%). Invasion of pancreas is most common site involvements of spread of gastric carcinoma is 42.8%. Conclusion: High resolution sonography is a supportive diagnostic modality and is a supplementary diagnostic procedure to endoscopy.

Study on the value of focused abdominal sonography for trauma used by emergency doctor in emergency department / 中华急诊医学杂志

Objective To study the value of focused abdominal sonography for trauma (FAST) used by emergency doctor in emergency department. Method It's a prospective,double-blinded and controlled study from June 2008 to October 2009. A total of 97 casualties with severe multiple trauma, 72 male and 25 female aged from 14 to 88 years old with average age of (41 ± 16) ,admitted to emergency department were enrolled, and the bedside focused abdominal sonography for trauma was performed by emergency doctor. It was diagnosed as positive if free fluid was detected in abdomen or pericardium. The severe injury scores (ISS) were from 14 to 38 with average score of (23.2±9.3). The criteria of inclusion were age over 14 years old, injury happened within 12 hours and casualties admitted directly into emergency room. The criteria of exclusion were death of patients within 2 days without CT scanning of abdomen and exploration of abdomen with laporotomy, and operations directly determined by using FAST without conventinal sonographic examination. The FAST was compared with CT and conventional sonography judged by the findings observed during operation. Results The examination with FAST was completed in (3.18±0.79) min, whereas that with conventional sonography was (16.63t4.62) min(t = 28.61,P ＜0.001). The FAST was positive in 11 cases and negative in 86 cases, whereas the conventional sonography was positive in 13 cases and negative in 84 cases ( P = 0.5). There were 4 false negative findings in FAST resulting in 73% sensitivity, 100% specificity, 95.3% negative predictive value, 4.6% false negative rate, 100% positive predictive value, 0% false positive rate and 95.9% accuracy. Conclusions The emergency doctors are able to operate the FAST well for casualties with multiple trauma in emergency department after proper training.

Changes in Sonographic Findings after Treatment of Patients with Clonorchiasis in a Heavy Endemic Area

We measured changes in sonographic findings of patients with clonorchiasis after a treatment in a highly endemic area. A total of 347 residents showed positive stool results for Clonorchis sinensis eggs in a village in northeastern China, and were treated with praziquantel. Of them, 132 patients underwent abdominal sonography both before and 1 year after treatment, and the changes in sonographic findings of 83 cured subjects were compared. Diffuse dilatation of intrahepatic bile ducts (DDIHD) was found in 82 patients (98.2%) before and 80 (96.4%) after treatment, which was improved in 3, aggravated in 1, and unchanged in 79 patients. Increased periductal echogenicity (IPDE) was observed in 42 patients (50.6%) before and 45 (54.2%) after treatment, which was improved in 5, aggravated in 8, and unchanged in 70 patients. Floating echogenic foci in the gallbladder (FEFGB) was detected in 32 patients (38.6%) before and 17 (20.5%) after treatment, which was improved in 20, aggravated in 5, and unchanged in 58 patients. Improvement of FEFGB only was statistically significantly (P = 0.004). The present results confirm that DDIHD and IPDE persist but FEFGB decreases significantly at 1 year after treatment. In a heavy endemic area, the sonographic finding of FEFGB may suggest active clonorchiasis 1 year after treatment.

Evaluation for Usefulness of Abdominal Sonography in Acute Appendicitis

PURPOSE: Acute appendicitis is one of the most common surgical diseases and the accuracy of diagnosis has been reported to be between 71% and 85%. In this study we tried to determine whether abdominal sonographic examination is critical to the decision to operate and whether its use is essential before surgery of patients with clinically diagnosed or suspected acute appendicitis. METHODS: A total of 552 patients with clinically diagnosed acute appendicitis from January 2000 to December 2001 were enrolled in this study. All patients underwent an abdominal graded compression sonography performed by a staff radiologist. RESULTS: A total of 535 patients (96.9%) with positive findings of appendicitis proceeded to surgery. 17 patients (3.1%) were found to have other diseases. Of the 535 patients undergoing operation, 531 (99.3%) were proved to have appendicitis by pathologic reports. The 17 patients with negative findings in sonography underwent operation or CT examination; 12 (70.6%) were proved to have appendicitis. Abdominal sonography for detecting acute appendicitis had a sensitivity of 97.8%, a specificity of 55.6%, an accuracy of 97.1%, a positive predictive value of 99.3%, and a negative predictive value of 29.4%. CONCLUSION: Abdominal sonography is therefore one of the most useful examinations in diagnosing acute appendicitis before surgery and our experience suggests that patients with clinically suspected acute appendicitis should routinely undergo abdominal sonographic examination.