Portal Hypertension with Visceral Leishmaniasis.

We conducted this study to observe evidence of portal hypertension in children with visceral leishmaniasis (VL). Eighty-eight consecutive cases (50 male) of VL were subjected to ultrasonography. Those with evidence of portal hypertension also underwent upper gastrointestinal endoscopy and liver biopsy. Eight patients had portal hypertension as evidenced by dilated caliber of portal and splenic veins. Two patients had periportal, splenic and peripancreatic collaterals and one patient had cavernous transformation of portal vein. Out of eight patients, four patients had esophageal and gastric varices. Liver biopsy was done in four patients and revealed hepatic sinusoidal dilations without any evidence of fibrosis. Portal hypertension may be an independent manifestation of VL and remain undiagnosed unless a physician maintains a high index of suspicion.

The Significance of Abdominal Ultrasonography as the Initial Diagnostic Method in Blunt Renal Trauma / 대한비뇨기과학회지

PURPOSE: To evaluated the effectiveness of abdominal ultrasonography as the initial diagnostic method in blunt renal trauma. MATERIALS AND METHODS: This study was undertaken to compare computerized tomography with abdominal ultrasonography in radiographic staging of blunt renal trauma(Renal Injury scale grade I-V by Moor) except vascular injury. During 3-years period(May 1994 to March 1997), emergency computerized tomography was performed in 66 patients with blunt renal trauma, simultaneously 34 patients among 66 patient were scanned by abdominal ultrasonography. RESULTS: Gross hematuria were present 48% of renal trauma cases. The degree of hematuria showed not correlation with the severity of renal injury(p-value=0.213, by Chi-square test). In diagnostic agreement of abdominal ultrasonography compared to computerized tomography, the diagnostic agreement of minor renal injury(x=0.544, by k2 statistics) was higher than that of major renal injury(r=0.375, by k2 statistics). The overall diagnostic agreement of abdominal ultrasonography in detecting adjacent organ injury was 0.321 (k value). CONCLUSIONS: In ultrasonography imaging, we concluded that minor blunt rectal trauma is not necessary other radiologic evaluation, but major blunt renal trauma should be evaluated by computerized tomography for proper diagnosis of combined injury and diagnostic staging of renal trauma. Renal trauma associated Intraabdominal injury should undergo with ultrasonography-guided paracentesis. Based under result of our study, we suggest the use of abdominal ultrasonography as the initial diagnostic method in blunt renal trauma compatible for prompt diagnosis and treatment.