[Ultrasound investigation and mini-invasive ultrasound-assisted technologies in diagnosis and treatment of extra-organ separate fluid formations in abdominal cavity]. / Ul'trazvukovoe issledovanie i maloinvazivnye tekhnologii pod kontrolem UZI v diagnostike i lechenii vneorgannykh otgranichennykh skoplenii zhidkosti v briushnoi polosti.

The authors discuss the use of ultrasound-assisted percutaneous puncture and drainage for diagnosis and treatment of extraorganic separate fluid formations in abdominal cavity (abscess, limited non-infected fluid formation, hematoma with clotted blood), determination of their sizes and obtaining material for laboratory study. 307 patients with various extraorganic separate fluid in formations in abdominal cavity were examined. Ultrasonic symptoms of abscess were described in 54 patients, of limited non-infected fluid formation--in 234, of hematoma with clotted blood in 19 patients. 146 patients were cured conservatively, 75 patients underwent US-assisted puncture, 76--US-assisted drainage. Mean time of drainage was 14 days (ranged from 10 to 20). There were neither complications nor lethal outcomes. Ultrasound examination and US-assisted mini-invasive surgery permit to detect precisely the nature of fluid formation, to perform timely and low-traumatic treatment.

Leiomiomatosis peritoneal diseminada. A propósito de un caso y revisión bibliográfica / Leiomyomatosis peritonealis disseminata. Case report and review of the literature

Se presenta un caso clínico de leiomiomatosis peritoneal diseminada, en una paciente de 40 años, con antecedentes de miomas uterinos y múltiples tumoraciones intraabdominales detectadas mediante ecografía y TC. El tratamiento se realizó mediante cirugía hormonosupresora de estrógenos y progesterona y exéresis de las tumoraciones. Revisamos en la bibliografía la frecuencia, la técnicas diagnósticas y el diagnóstico diferencial, así como las posibilidades terapéuticas de esta rara enfermedad (AU)

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Ultrasound detection of free intraperitoneal fluid associated with hepatic and splenic injuries.

BACKGROUND: The objective of this study was to compare the sensitivity and specificity of 5 abdominal views for detecting free intraperitoneal fluid in trauma patients later diagnosed with hepatic or splenic injuries. METHODS: This retrospective study conducted over a 17-month period enrolled patients with trauma. A Focused Abdominal Sonogram for Trauma (FAST) examination was done using 5 abdominal views. Exploratory laparotomy or computed tomography (CT) confirmed the presence of intraperitoneal fluid and associated injuries. The sensitivity and specificity were determined. RESULTS: Of the 245 study patients, 29 had injuries to the liver or spleen or both. The 5-view FAST examination's sensitivity for detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 77%, 90%, and 100%, respectively. The sensitivity of the single Morison's pouch view in detecting free intraperitoneal fluid associated with hepatic, splenic, or combined injuries was 38%, 20%, and 67%, respectively. CONCLUSION: For identifying free intraperitoneal fluid associated with hepatic or splenic injuries, no single view of the FAST examination could match the sensitivity provided by the 5-view technique.

Delayed hemoperitoneum following large-volume paracentesis in a patient with cirrhosis and ascites.

The diagnosis of early or late hemoperitoneum after large-volume paracentesis can be reached easily by a repeat tap, but gastrointestinal bleeding and other common causes of hypotension in cirrhotics must be ruled out first. When the hemoperitoneum is confirmed, imaging studies are often inconclusive and laparotomy should be considered when hemodynamic instability persists despite adequate fluid resuscitation. However, in instances of delayed hemoperitoneum, it must be anticipated that operation may not identify the bleeding site and result in further decompensation of the liver. OLT may well be the best therapeutic option in this rare, high-risk situation.

Peliosis hepatis in a dog infected with Bartonella henselae.

A 6-year-old spayed female Golden Retriever was examined because of generalized weakness and abdominal distention. Abdominal ultrasonography revealed a large quantity of peritoneal fluid. In addition, the liver appeared larger than normal and contained multiple, small, nodular masses and cyst-like structures. Abdominal exploratory surgery was performed, and 5 L of serosanguineous peritoneal fluid was removed. Gross lesions were not found in the stomach, kidneys, intestines, adrenal glands, or urinary bladder. There were diffuse cystic nodules in all liver lobes. The dog did not recover from anesthesia. A diagnosis of peliosis hepatis was made on the basis of gross and histologic appearance of the liver. A polymerase chain reaction assay revealed Bartonella henselae DNA in liver specimens. To our knowledge, this is the first report of molecular evidence of B henselae infection in a dog with peliosis hepatis.

[Conservation of the left pancreas in rupture of the pancreatic isthmus. Apropos of 3 cases]. / Conservation du pancréas gauche dans les ruptures de l'isthme pancréatique. A propos de trois cas.

AIM OF THE STUDY: To report three cases of neck pancreatic disruption caused by blunt abdominal trauma and to emphasize the advantages of conservative surgery with internal drainage. PATIENTS AND RESULTS: In two cases, one with hemoperitoneum, and the other with intraperitoneal fluid collection with 1,323 U/mL of amylase, laparotomy showed a complete disruption of the neck of the pancreas. The pancreatic head side was sutured whereas the left side was anastomosed to a Roux-en-Y jejunal loop. The clinical results were good at 8 and 6 months after surgery, respectively. For the third patient, a pancreatic trauma (which was suspected on a CT. Scan), was not confirmed at laparotomy. In the postoperative course, the amount of fluid drainage was important and the endoscopic retrograde pancreatography (ERCP) showed a disruption of the neck of the pancreas. An endoprosthesis was placed into the duct of Wirsung. Three months later, the patient complained of pain, and a migration of the prosthesis was detected by X-ray examination. It was not possible to place another endoprosthesis because of a stenosis of the duct. A resection of the neck of the pancreas was performed, the cephalic side was sutured and the left side anastomosed to the posterior gastric wall. Eight months after surgery, the clinical result was good and glycemia was normal. CONCLUSION: In blunt abdominal trauma, if a pancreas injury is suspected upon clinical presentation an ERCP, or moreover a magnetic resonance imaging, is indicated. When there is no disruption of the Wirsung duct, a simple peritoneal drainage should suffice. In cases with partial disruption, an endoprosthesis may give good results. In patients with a complete disruption, as in the three cases reported, a suture of the head side of the pancreas, and an internal drainage of the left side with a Roux-en-Y jejunal loop (or more easily with the stomach), are indicated.

[Pancreatic and extrapancreatic fluid collections following acute and chronic pancreatitis]. / Colectii lichidiene pancreatice si extrapancreatice succedând pancreatitei acute si cronice.

Intra- or extrapancreatic liquid collections are common complications for acute and chronic pancreatitis, with variable morphologic features and possible evolution toward complications. A total of 31 liquid collections (pseudocysts, ascites and/ or enzymatic pleurisy) in 22 patients are presented. The study assems the etiology, the diagnostic methods and the treatment of the liquid collections. The preferred surgical treatment is either cysto-digestive anastomosis or distal pancreatic resections. Also some new therapeutic modalities are analyzed percutaneous or endoscopic drainage.

Syndrome of inappropriate antidiuretic hormone secretion in papillary serous surface carcinoma of the peritoneum.

A case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a patient with suboptimally cytoreduced stage III papillary serous surface carcinoma of the peritoneum is described. After the primary surgery, the patient refused further therapy. Within a month bilateral pleural effusions and abdominal ascites compelled the patient to accept treatment with carboplatin and cyclophosphamide. Ten days following the chemotherapy, she was admitted in a disoriented state with serum sodium of 117-mEq/L. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed. Numerous disease processes have been associated with the development of SIADH; however, there have been few reports in gynecologic malignancies. Possible etiology and clinical management of this patient are briefly discussed.

[Rectal endosonography for detection of free fluid in the abdomen]. / Die rectale Endosonographie zum Nachweis freier Flüssigkeit im Abdomen.

In a study of 60 patients suspicious of free fluid we found a very high sensitivity of 95% and specificity of 100% with endorectal sonography. In 6 patients free fluid could be shown preoperatively by endorectal ultrasound, whereas transabdominal sonography proved to be negative. We conclude that endorectal sonography should be performed in all cases with a clinical suspicion of free fluid when transabdominal sonography is negative. Rectal endosonography is an easy and less stressful examination which clarifies conditions in the pelvis which are not clearly discernible from the transabdominal sonography.

[The efficacy of different antimicrobial preparations in treating patients with disseminated peritonitis]. / Izuchenie éffektivnosti razlichnykh antimikrobnykh preparatov pri lechenii bol'nykh s rasprostranennym peritonitom.

The results of our investigations revealed that in 68% of cases the treatment of patients with diffuse peritonitis with ampiox, gentamicin and metronidazole led to arresting the infectious process and to a considerable decrease in microbial contamination of the abdominal cavity. The use of cephalosporins and metronidazole proved to be effective in 85% of cases. In this treatment a considerable decrease in the amount of aerobic and anaerobic bacteria in peritoneal exudate was registered. In the process of treatment with cyprophloxacin positive clinical and microbiological dynamics were observed in all patients.

[Mechanism of ascites formation and its management in liver cirrhosis].

The "underfilling" and "overflow" theories have been proposed as the pathogenesis of ascites formation in patients with liver cirrhosis. The "peripheral arterial vasodilation hypothesis" has been also proposed recently. Essential treatment of ascites are; restriction of physical activity, sodium restriction, supplement of albumin, and diuretic therapy. Alternative therapy for refractory ascites include peritoneal-venous shunt, ascites ultrafiltration and reinfusion and body oppression therapy. Assessment of liver function, renal function and the systemic hemodynamic state as well as characterization of ascitic fluid are also needed to evaluate the effectiveness of the therapy.

Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy.

Percutaneous gastrostomy (PG) with gastropexy was performed for relief of malignant small bowel obstruction in 12 patients with extensive ascites. Abdominal paracentesis was performed before PG in nine patients and after PG in one patient. Gastrostomy catheters were inserted without complication in all patients. Clinical follow up revealed that pericatheter leakage of ascitic fluid and skin excoriation occurred only in the three patients who did not have paracentesis performed before PG. No dislodgement of gastrostomy catheters occurred but mild peritonitis was noted in one patient. Our experience suggests that although in the past extensive ascites was a relative contraindication for PG, these patients can now be successfully treated with a combination of ultrasound-guided paracentesis to reduce pericatheter leakage of ascitic fluid, and gastropexy to prevent catheter dislodgement.

Modern management of ovarian hyperstimulation syndrome.

The number of women receiving ovulation induction has markedly increased with the advent of medically assisted reproduction. Consequently, ovarian hyperstimulation syndrome (OHSS) has become a frequent clinical problem. It is a potentially life-threatening situation. In its severe forms it is complicated by haemoconcentration, hypovolaemia, hypotension, acute renal insufficiency and thromboembolism. The pathophysiology of OHSS is poorly understood. The occurrence of OHSS correlates well with the level of oestradiol, the number of follicles, and administration of human chorionic gonadotrophin (HCG). The risk is increased in polycystic ovarian disease. The aim of this paper is to review critically the published literature on prediction, prevention and modern management of OHSS. Complete prevention of OHSS is not possible although several methods are used to predict and reduce its occurrence. Endocrine profile and ultrasonic follicular monitoring are the mainstays of prediction. The presence of a large number of small and intermediate size follicles at sonography is a risk factor. Withholding HCG, continuation of gonadotrophin-releasing hormone analogues and cryopreservation of embryos are optional courses of action for prevention. Mild OHSS is usually self-limiting and requires no active therapy. Moderate and severe cases are treated by correction of fluid and electrolyte imbalance, and by prevention of thromboembolism. The use of surgery is limited to cases of torsion or rupture of ovarian cysts, or the presence of concomitant ectopic pregnancy. Aspiration of the ascitic fluid, preferably by the transvaginal route, is recommended in cases with severe ascites.

Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities.

To determine whether untreated mild coagulopathy in patients with no evidence of clinical bleeding is associated with an increased risk of hemorrhage after paracentesis or thoracentesis, retrospective examination was conducted of 608 consecutive procedures for which prothrombin time (PT), partial thromboplastin time (PTT), platelet (Plt) counts, and preprocedure and postprocedure hemoglobin concentrations were available. There was no increased bleeding in patients with mild to moderate coagulopathy (defined as PT or PTT up to twice the midpoint normal range or pit count of 50 to 99 x 10(3) per microL [50-99 x 10(9)/L]). However, patients with markedly elevated serum creatinine levels (6.0 to 14.0 mg/dL [530-1240 mumol/L]) had a significantly greater average hemoglobin loss (-0.82 +/- 1.3 g/dL [-8 +/- 13 g/L], n = 11) than patients with normal serum creatinine levels (-0.12 +/- 0.88 g/dL [-1 +/- 9 g/L], n = 450) (p = 0.011). Overall, the frequency of bleeding complications requiring red cell transfusions was very low: 0.2 percent of events. The most common diagnosis for patients who had paracentesis was alcoholic liver disease (72%); for those having thoracentesis, it was infection (37%). It can be concluded that, for these patients, prophylactic plasma or platelet transfusions are not necessary. Patients with markedly elevated serum creatinine deserve close postprocedure observation.

[Surgical treatment of portal hypertension]. / Le traitement chirurgical de l'hypertension portale.

The surgical treatment, by means of shunts or disconnections, of ruptured oesophageal varices in portal hypertension is always indicated but not always on the forefront. However, it remains the first-line treatment in segmental portal hypertension and in Budd-Chiari syndrome. It is on a par with the non-surgical treatments in case of prehepatic block but ranks second in case of pre- and intrasinusoid blocks. In all the hepatic diseases with threatening hepatocellular deficiency, liver transplantation is the most spectacular of current and future achievements.