El camino de la ecografía / The course of ultrasonography

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[Renal hemodynamics and blood pressure. Intrarenal Doppler evaluation]. / Hemodinamia renal y presión arterial. Evaluación Doppler intrarrenal.

UNLABELLED: This new technique has been used to evaluate renal hemodynamic pattern because although it is impossible to measure the arterial diameter, the doppler signal is easier to obtain than in the renal artery. In order to define normal patterns we studied 67 untreated patients, with no evidence of acute or chronic disease, using intrarenal doppler ultrasound technique. The mean (SD) systolic, diastolic and mean renal doppler deviation were 2.144 +/- 0.54, 0.688 +/- 0.23 and 0.604 +/- 0.28 kHz respectively. The mean peak doppler frequency was 1.136 +/- 0.34 kHz, and Stuart, Pourcelot and Gosling indexes were 3.6 +/- 0.8, 0.67 +/- 0.06 and 1.31 +/- 0.39 respectively. The mean ejection time was 0.28 +/- 0.03 s. A multiple regression analysis was performed and a marked negative correlation was found between all the velocities and age. Arterial blood pressure was the second determinant of velocity. To examine the influence of blood pressure in renal hemodynamics, we compared normal (diastolic blood pressure below 90 mm Hg) and hypertensive patients (13 patients in each group) matching them for age, sex, weight and height. RESULTS: In addition to blood pressure differences (caused by design) we found that systolic arterial doppler deviation was higher in normotensive than in hypertensive patients (2.152 +/- 0.48 vs 1.730 +/- 0.44 kHz. p < 0.05). As arterial area probably decreases with age, it is possible that low velocity of flow might be caused by an effective plasmatic renal flow fall. Contrary to expected, hypertensive patients blood flow velocity was lower than in normal which suggests that intrarenal arteriolar resistance was increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodinamia renal y presión arterial. Evaluación Doppler intrarrenal. / [Renal hemodynamics and blood pressure. Intrarenal Doppler evaluation]

This new technique has been used to evaluate renal hemodynamic pattern because although it is impossible to measure the arterial diameter, the doppler signal is easier to obtain than in the renal artery. In order to define normal patterns we studied 67 untreated patients, with no evidence of acute or chronic disease, using intrarenal doppler ultrasound technique. The mean (SD) systolic, diastolic and mean renal doppler deviation were 2.144 +/- 0.54, 0.688 +/- 0.23 and 0.604 +/- 0.28 kHz respectively. The mean peak doppler frequency was 1.136 +/- 0.34 kHz, and Stuart, Pourcelot and Gosling indexes were 3.6 +/- 0.8, 0.67 +/- 0.06 and 1.31 +/- 0.39 respectively. The mean ejection time was 0.28 +/- 0.03 s. A multiple regression analysis was performed and a marked negative correlation was found between all the velocities and age. Arterial blood pressure was the second determinant of velocity. To examine the influence of blood pressure in renal hemodynamics, we compared normal (diastolic blood pressure below 90 mm Hg) and hypertensive patients (13 patients in each group) matching them for age, sex, weight and height. RESULTS: In addition to blood pressure differences (caused by design) we found that systolic arterial doppler deviation was higher in normotensive than in hypertensive patients (2.152 +/- 0.48 vs 1.730 +/- 0.44 kHz. p < 0.05). As arterial area probably decreases with age, it is possible that low velocity of flow might be caused by an effective plasmatic renal flow fall. Contrary to expected, hypertensive patients blood flow velocity was lower than in normal which suggests that intrarenal arteriolar resistance was increased.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamic comparison of two nifedipine formulations in patients with essential hypertension.

The hemodynamic and humoral effects and trough-to-peak 24-hour blood pressure responses of 2 nifedipine formulations, capsules and continuous-release once-daily formulation tablets, were evaluated in 10 patients with mild to moderate essential hypertension. Both formulations reduced mean arterial pressure similarly from 120 +/- 3 (baseline) to 107 +/- 2 (p less than 0.005) and 105 +/- 2 mm Hg (p less than 0.005) and total peripheral resistance index from 65 +/- 9 (baseline) to 47 +/- 4 (p less than 0.05) and 45 +/- 3 U/m2 (p less than 0.05), respectively. Renal, splanchnic and total forearm (including skin and skeletal muscle) blood flows were maintained or even increased slightly associated with reductions in regional vascular resistances. Decreases in renal, total forearm and skeletal muscle resistances were significant (p less than 0.05) with the capsules, but the decrease was only significant in renal resistance with the long-acting tablets. Intravascular volume did not expand with reduction in arterial pressure. This antihypertensive effect was not related to baseline plasma renin activity levels or age. Nifedipine tablets provided a better control of mean arterial pressure (66%) than did capsules (44%).

Hepatic venography in the surgical assessment of hepatic tumours.

Hepatic venography was performed on 80 patients with hepatic tumours for the pre-operative assessment of resectability. Sixty-six patients subsequently underwent laparotomy, 27 undergoing hepatic resection. Forty-two patients had metastases from colo-rectal primaries, 19 hepatocellular carcinoma and 19 a variety of other tumours. The type and frequency of the abnormalities shown on venography were noted for each tumour category and for their hepatic segmental distribution. The results of venography were compared with those of arteriography, computed tomography and ultrasound and with the findings at laparotomy. Displacement was the commonest abnormality seen while encasement or obstruction occurred less frequently and tumour invasion was rare. The sensitivity of venography in correctly identifying the segmental distribution of tumour deposits was 41%. Sensitivity was poorest with tumours in the left lobe (31%) and bilobar tumours (0%). Venography was most sensitive in detecting tumour involvement of the major segmental hepatic veins and inferior vena cava (100%). Peripheral colo-rectal metastases frequently produced no venographic abnormality. Hepatic venography provides no additional information to arteriography, computed tomography or ultrasound in patients with peripheral or bilobar tumour deposits. Some additional information may be obtained with central tumours and venography is the most accurate means of detecting tumour involvement of the major segmental hepatic veins.

Biliary lithotripsy with a mechanical lithotripter.

A simple device for easy and safe mechanical disintegration of hard and large (1-2.5 cm in diameter) biliary calculi, the mechanical lithotripter, has been designed for use with a Dormia or similar type of basket. This device is capable of generating a steady increase in tension in the basket wires, which in turn breaks up the calculus. It may be introduced through a T-tube tract or by a percutaneous transhepatic approach. The lithotripter has been successfully tested in vitro with ten mixed gallstones obtained soon after cholecystectomy and has been successfully employed in six patients with biliary calculi, three with T tubes and three without. In the latter three patients, a percutaneous transhepatic biliary procedure was performed to enable introduction of the lithotripter. There were no complications.

Serendipitous adrenal masses: prevalence, significance, and management.

Over a 2 year period, 63 of 1,459 patients examined by computerized tomography were found to have adrenal masses. In 19 patients (1.3 percent of patients examined and 30 percent of patients with adrenal masses), they were unexpected and did not give rise to symptoms or signs. Three patients were explored. Two of the patients had adrenocortical adenomas and a third, a ganglioneuroma. Adrenal function tests were performed in 14 patients and showed evidence of Cushing's syndrome in 1 patients and revealed no abnormalities in 13. The lesions in 10 of 11 nonsurgical patients followed by computerized tomography for 11 to 36 months showed no change. One lesion became significantly smaller. In a review of 988 autopsy reports, grossly visible adrenal masses were present in 73 patients (7.3 percent), including 19 adrenocortical adenomas (1.9 percent) and 50 metastases (5 percent). We conclude that serendipitous adrenal masses are usually small, nonfunctioning, and benign, the most common lesion being adrenocortical adenoma. A protocol has been suggested for management to identify the minority of patients with functioning or malignant lesions and to avoid unnecessary surgery in the others who have benign disease.

Cystic lesions of the adrenals: diagnosis and management.

Until recently, adrenal cysts were diagnosed at surgery or autopsy. Current imaging methods allow accurate preoperative diagnosis in symptomatic patients and may obviate surgery in the asymptomatic. Eighteen cystic lesions of the adrenal glands are described. Computed tomography was the most useful diagnostic test. Many cysts had typical appearances of a thin-walled, fluid-filled lesion with or without thin septa and mural calcification. Atypical features included central densities, which may be characteristic of intracystic hemorrhage, and wall thickening which should initiate a search for endocrinopathy and tumor.

Cytologic diagnosis of hepatocellular carcinoma by fine-needle aspiration biopsy.

From 1976 to June 1982, 237 patients with clinical suspicion of hepatic malignant disease underwent guided percutaneous fine-needle aspiration biopsy of the liver. Of these, 12 were diagnosed cytologically as "hepatocellular carcinoma" and this diagnosis was confirmed in the follow-up of all cases. On the basis of the cytomorphologic features observed in the aspirates, the tumor was subclassified into three types; well differentiated, pleomorphic large cell; and poorly differentiated. The various cytologic appearances of different types of hepatocellular carcinoma are presented and illustrated. Cytomorphologically, these three types of hepatocellular carcinoma were distinctly different and their cytomorphologic features were also sufficiently distinctive from those of secondary hepatic cancer to be diagnostic. Guided percutaneous fine-needle aspiration biopsy of the liver appears to be a definitive minimally invasive means of establishing the diagnosis of hepatocellular carcinoma, and promises to be a valuable diagnostic procedure for potentially resectable localized hepatocellular carcinoma.

Guided percutaneous fine-needle aspiration biopsy of the liver.

Forty patients with suspected malignant disease of the liver underwent percutaneous fine-needle aspiration biopsy with radioisotope scintigraphic and fluoroscopic guidance. The needle was aimed at focal defects identified on the liver scan and several passes were made. When the scan was diffusely abnormal, the liver was widely sampled with multiple passes. Thirty patients were eventually considered to have malignant disease and aspiration biopsy was positive in 28 (93%) of these patients, including 25 of 26 with liver metastases (96%). There were two false-positive results and one minor complication. In 24 patients, conventional wide-bore needle biopsy was also performed. In this group, 16 patients had a final diagnosis of hepatic malignancy. Aspiration biopsies were positive in 14 of these (87%) and conventional needle biopsies were positive in four (25%). Guided percutaneous fine-needle aspiration biopsy is recommended for pathologic diagnosis of hepatic malignancy because of its simplicity, high yield, and reasonable safety.

Pitfalls to avoid: psoas hypertrophy mimicking retroperitoneal fibrosis.

Mild obstructive uropathy and medial deviation of the ureters were observed in an athletic young black male, raising the possibility of retroperitoneal fibrosis. These findings were shown by computed tomography and ultrasonography to be due to psoas muscle hypertrophy.

Computed tomography in congenital anomalies of the aortic arch and great vessels.

Computed tomography can help in the evaluation of congenitally anomalous aortic arches and subclavian arteries. The authors discuss the role of computed tomography in the evaluation of such anomalies in seven patients.

The role of computed tomography in assessment of tumoral pathology of the adrenal glands.

The findings at computed tomography (CT) of the adrenal glands in 58 patients are presented. Most patients (50) were referred for suspected adrenal dysfunction. In three, adrenal masses were suspected from other radiological studies. Three patients had palpable abdominal masses, and incidental adrenal metastases were found in two. Pathological findings included pheochromocytomas (nine patients), adrenocortical adenomas (six), adrenocortical carcinomas (three), metastases (two), and one example each of myelolipoma, hemorrhagic renal cyst, and probable granuloma. Of 24 adrenal masses, 23 were clearly apparent in the scans and one was suspected. The smallest tumor diagnosed was 0.5 cm in diameter. There was on false positive diagnosis of a small tumor and no known false negatives. Because of their consistent location and unusual shape and because they are usually surrounded by retroperitoneal fat, the adrenal glands are ideal organs for study by CT, a highly accurate method for detecting and excluding mass lesions that may render arteriography and venography unnecessary. Surgery was performed in five patients with tumors following localization by CT only. Limitations and potential diagnostic pitfalls in interpretation are discussed.