Us guidance for thoracic biopsy: a valuable alternative to CT

The purpose of this study was to determine the role, accuracy and selection criteria of ultrasonographic [US] guidance for biopsy of thoracic lesions. Material and From January 2003 to January 2004 forty US and CT guided biopsies for thoracic lesions were performed in 40 consecutive patients. US guidance was used for lesions abutting the chest wall. CT guidance was used for all masses surrounded by aerated lung. Location of masses, their diameters, modality of guidance, procedure time and occurred complications were all recorded. US guidance was used in 20 [50%] cases; lesions were parenchymal [n=11], pleural, [n=4] chest wall [n=3] and mediastinal [n = 2]. The mean diameter of these lesions was 3 cm and the procedure time was 20-minutes. One case of pneumothorax occurred but it resolved spontaneously and did not require placement of a chest tube. CT guidance was used in 20 [50%] of cases; lesions were parenchymal [n=15], pleural [n= 1], mediastinal and hilar [n = 4]. The mean diameter was 2cm and the mean procedure time was 45 minutes related complications were pneumothorax [n = 5] and pulmonary haemorrhage [n = 1]. US guidance is an effective and safe alternative to CT guidance for biopsy of lesions abutting the chest wall. Real-time US visualization allows accurate needle placement, shorter procedure time, less complications and it can be performed for uncooperative patients or for patients at the ICU that can not be transported to CT unit

Predictive value of leucocyte count, c-reactive protein, ultrasonography and laparoscopy in the diagnosis of acute appendicitis in children

In a prospective study, the mean preoperative leucocyte count, C- reactive protein [CRP] value, ultrasonographic outer appendiceal diameter and diagnostic laparoscopy [when needed] in 120 children suspected of having acute appendicitis were studied. The patients were divided into three groups. Diagnostic laparoscopy allowed the correction of the preoperative suspected diagnosis of acute appendicitis in seven patients in group I, thus preventing an unnecessary appendectomy. The study also revealed a significant increase in the leucocytic count and appendiceal diameter in groups II and III compared with group I. Moreover, there was a significant increase in CRP in group III compared with groups I and II

Doppler sonography in early detection of hepatic metastases after colorectal carcinoma.

It is known that the presence of even small hepatic metastases may lead to subtle changes in liver blood flow and it is possible that by monitoring these hemodynamic changes, an earlier detection of liver metastases may be feasible. As only half of the curatively resected patients develop liver metastases, many patients are over- treated and better methods to predict an individual patients risk for developing liver metastases are urgently needed. To treat occult metastases at an early stage, adjuvant chemotherapy has been given after curative resection of primary tumors, which is recommended now for some cases of colorectal carcinoma. The fact that duplex perfusion index for controls and patients with overt liver metastases is clearly separated suggested that Doppler ultrasonographic measurement can identify patients with overt hepatic metastases. This study showed a marked correlation between tumor staging and elevated Doppler perfusion index in colorectal carcinoma patients without liver metastases. This group of patients should be followed up to elaborate the results