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INTRODUCTION: Portable ultrasound is a modality of medical ultrasonography that utilizes small and light devices, and is an established diagnostic method used in clinical settings such as Cardiology, Vascular Surgery, Radiology, Endocrinology, Pediatric and Obstetric & Gynecology. PRESENTATION OF CASES: We present a case report of 86-years old patient who underwent surgical rib fixation for multiple rib fractures followed by falling from standing height and our management experience. DISCUSSION: The use of portable ultrasound device in operation theatre demonstrates several advantages.We believe that Portable color doppler ultrasound system would be necessary in the management of rib fracture. CONCLUSION: This study demonstrates that the portable ultrasound system is a valuable method of imaging in the assessment of rib fractures, and which can save time, economically affordable for many patients, and allow surgeons to make a minor incision in order to avoid complications such as infection, particularly in this group of vulnerable patients.
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OBJECTIVE: To investigate the characteristics of lymph node metastases in advanced gastric cancer and its clinical significance. METHODS: From April 2002 to July 2003, we studied 91 patients with advanced gastric cancer who underwent radical gastrectomy and lymphadenectomy from which specimens were obtained during surgery. Then, collection of dissected lymph node, histopathological and immunohistological studies were performed to detect the lymph node metastasis rates and calculation. In addition, to analyze the relationship between lymph node metastasis rates and tumor diameters, TNM classification, Borrmann analysis, tumor localization and the extent of lymph node resection. RESULTS: Among 91 patients with advanced gastric cancer, lymph node metastases were found in 63 patients (69.2%) with a total collection of 3149 lymph nodes and an average of 34.6 lymph nodes collected per patient. Lymph node metastasis rate was lower in tumor < 3 cm than that in tumor >3 cm. About TNM classification, lymph node metastases in advanced gastric cancer among patients in stage IIIa and stage IV was 100%, with the lymph node metastasis rates varying from 30.3% to 58.4%, which were significantly higher than that among patients in stage I and II (P<0.001). About Borrmann classification, lymph nodes metastasis in advanced gastric cancer among patients in Borrmann type III (79.6%) was higher than other Borrmann types, while in Borrmann type IV with the highest lymph node metastasis rate of 35.3% (P<0.05). Patients undergone lymph node dissection D(3) had higher lymph node metastases among patients and higher lymph node metastasis rate (88.2%, 38.0%) than patients in the D(1) and D(2) (P<0.05). Among 91 patients, 17 patients was found with micrometastasis (18.7%) from which 183 lymph nodes was collected, but no statistically significant difference between tumor location and micrometastasis was found (P>0.05). For tumor localization, lymph node metastases in proximal gastric cancer were more shown in station 1, 2, 3, 5, 7, 8, 9, 12, 13 and 16, with the highest metastasis rate in station 8 (68.1%). Lymph node metastases in middle gastric cancer were more shown in station 1, 3, 7, 12, 13 and 16, with the highest metastasis rate in station 3 (47.6%). Lymph node metastases in distal gastric cancer were more shown in station 1, 2, 3, 5, 6, 12, 13, and 16, with the highest metastasis rate in station 16 (83.3%). CONCLUSION: Metastasis among patients and lymph node metastasis rates are significantly correlated with the severity of gastric malignancy and they may be valuable guideline to evaluate the extension of lymph nodes dissection in gastric cancer.
