Pocket-size ultrasound device in cholelithiasis: diagnostic accuracy and efficacy of short-term training.

Pocket-size ultrasound devices (PSUD) are now widely available becoming a useful tool for diagnostic and therapeutic purposes. We aim to investigate the accuracy of PSUD in diagnosing cholelithiasis as compared to traditional ultrasonography. Moreover, we tested the reliability of PSUD when performed by inexperienced internal medicine residents after a short-term training. We consecutively enrolled inpatients and outpatients referred to undergo abdominal ultrasonography for signs or symptoms of gallbladder diseases in two different hospitals. Every patient underwent two independent examinations with PSUD by both expert (EXPPSUD) and nonexpert operators (N-EXPPSUD), and a conventional examination with traditional abdominal ultrasound (AUS). Every naive operator underwent a short-term training with a 2-h theoretical lesson, and a practical training focused on gallbladder under expert operator supervision. Overall, 146 patients were consecutively enrolled. Considering conventional AUS as the reference standard, sensitivity and specificity of EXPPSUD were, respectively, 93.75 and 100%. Sensitivity and specificity of N-EXPPSUD were, respectively, 75 and 91.25%. Nevertheless, when considering outpatients, PSUD has a high diagnostic accuracy even when performed by N-EXPPSUD with sensitivity of 93% and specificity of 88%. PSUD is a reliable tool for the diagnosis of cholelithiasis when used by expert operators potentially reducing the need for further diagnostic tests. It can even be successfully used by non-expert operators in outpatients setting after a short focussed training.

The effect of gluten on intestinal fermentation, gastric and gallbladder emptying in healthy volunteers.

BACKGROUND: The relationship between gluten ingestion and gastrointestinal tract function is a matter of debate. AIM: We analysed the effect of gluten on gastric and gallbladder emptying and intestinal fermentation in healthy volunteers. METHODS: Ultrasound measurement of gastric and gallbladder emptying after both gluten-containing and gluten-free meals was performed in 18 volunteers (8 women, age 25.0±2.5 years; BMI 22±1.9). Breath hydrogen excretion after a gluten-containing meal, a gluten-free meal and a gluten-free meal with added gluten powder was measured in 16 volunteers (10 women, age 25.2±2.7 years; BMI 22±1.8). The severity of symptoms was monitored. RESULTS: Gluten presence in the meals was not recognised. Gastric emptying time was 81.6±13.8min after gluten-containing and 73.9±21.6min after gluten-free meals (p=0.11). Percentage ejection fraction after gluten-containing meals was 60±9% and 60.6±6% after gluten-free meals (p=0.68). Peak and cumulative hydrogen excretion were significantly higher after gluten-containing than after gluten-free meals (peak: 12.5±7.3 vs 6.5±5.1 parts-per-million, p<0.01; and cumulative: 2319±1720 vs 989±680 parts-per-million/minute, respectively; p<0.01). Adding gluten powder to the gluten-free meal did not modify fermentation. Symptoms were mild and not different after the meals. CONCLUSIONS: In healthy volunteers, gluten may induce gastrointestinal alterations. Further studies are needed to clarify which patients could benefit from dietary modification.

Ultrasonographic findings in Crohn's disease.

In recent years transabdominal bowel sonography has become a first-line modality both in the diagnosis and in the follow-up of inflammatory bowel diseases, especially Crohn's disease, reaching values of sensitivity ranging from 84 to 93 %. In particular, its role is very useful in the early diagnosis of complications such as stenosis, phlegmons, abscesses and fistulae. According to the available literature the ability of US to provide information about disease activity is still under debate and further studies are necessary. In this regard, of fundamental importance is the use of additional techniques such as color- and power-Doppler and contrast-enhanced ultrasound. The purpose of this paper is to report the main sonographic intestinal and extraintestinal findings detectable in Crohn's disease.

Is it worth investigating splenic function in patients with celiac disease?

Celiac disease, an immune-mediated enteropathy induced in genetically susceptible individuals by the ingestion of gluten, is the most frequent disorder associated with splenic hypofunction or atrophy. Defective splenic function affects more than one-third of adult patients with celiac disease, and it may predispose to a higher risk of infections by encapsulated bacteria and thromboembolic and autoimmune complications, particularly when celiac patients have concomitant pre-malignant and malignant complications (refractory celiac disease, ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma). However, the clinical management of patients with celiac disease does not take into account the evaluation of splenic function, and in patients with high degree of hyposplenism or splenic atrophy the prophylactic immunization with specific vaccines against the polysaccharide antigens of encapsulated bacteria is not currently recommended. We critically re-evaluate clinical and diagnostic aspects of spleen dysfunction in celiac disease, and highlight new perspectives in the prophylactic management of infections in this condition.

Lymphomatous superficial lymph nodes: limitations of physical examination for accurate staging and response assessment.

BACKGROUND AND OBJECTIVES: Superficial lymph nodes in lymphoma management are usually evaluated by physical examination. However the accuracy of this assessment has not been thoroughly tested and so it remains debated whether physical examination can meet the international requirements for clinical evaluation and response assessment. DESIGN AND METHODS: Palpatory size estimates of lymph nodes in 97 lymphoma patients were separately compared with ultrasonographic (US) measurements in cervical, supraclavicular, axillary and inguinal regions. Comparisons were made between the products of lymph node cross-sectional diameters, whose changes are critical to assess response. Statistical analysis was carried out by simple linear regression, in which the palpatory estimate was entered as the mean of the measurements separately taken by two different clinicians and the dependent variable was the US measurement. RESULTS: Physical examination tended to underestimate the lymph node size in all regions but appeared to be closely related to US measurements. However, while R2 was very high for cervical and inguinal lymph nodes (0.902 and 0.802, respectively), it was disappointingly low for lymph nodes in supraclavicular and axillary regions (0.529 and 0.368, respectively). INTERPRETATION AND CONCLUSIONS: This indicates that, with the current response criteria, pre- and post-treatment evaluation of cervical and inguinal lymph nodes makes substantial errors in 20-30% of cases when left to physical examination alone. Errors are even more numerous in supraclavicular and axillary regions. Thus, physical evaluation of superficial lymph nodes should be integrated by US or other imaging techniques for accurate fulfilment of the current standardized guidelines for response assessment.