Liver cirrhosis and chronic calcifying pancreatitis are associated with different morphotypes.

The different morphotypes of patients have been determined by sonography of the upper abdomen and statistical calculation according to a previously published method. Patients have been classified into the following 3 groups: 'longilignes', 'normotypes' and 'brèvilignes' which fit with ancient anatomical descriptions. In 74 normal controls, there were 21.6% brévilignes and 44.5% longilignes, in alcoholic cirrhosis (n = 31) 77.4 and 6.4%, respectively, in postnecrotic viral cirrhosis (n = 28). 25.0 and 17.8% and in alcoholic chronic calcifying pancreatitis (n = 25) 12.0 and 76.0%. These differences which are significant between all groups show that the morphotype of the human body is different in cirrhotic and pancreatitis patients. As morphotypes preexist to cirrhosis and chronic pancreatitis, this is an argument for the assumed predisposition (possibly hereditary) to cirrhosis and chronic pancreatitis.

Hepatic morphotypes. Their statistical individualization using ultrasonography.

The shape, topography, and vascular disposition of the liver depend on a subject's morphotype. The definition and classification of morphotypes was previously based on cadaver observation. In this study, 74 healthy adults (42 women, 32 males) were assessed using ultrasonographic parameters (hepatic diameters, xiphoid angle, orientation of the inferior face of the liver). The results were analyzed by discriminant analysis to differentiate the morphotypes. The three groups known by anatomists as breviligne (endomorphic), longiligne (ectomorphic), and normotype were again demonstrated and individualized in a significant manner. However, with the exception of the normotype group, fundamental differences were observed between our results and those of the anatomists. Ultrasonographic assessment shows that in the breviligne, the liver occupies the right hypochondrium and extends only slightly to the left of the midline; in the longiligne it extends into the left hypochondrium.

Determination of a hepatic volumetric index by ultrasonic scanning.

A prospective study was carried out to calculate, by a fast and simple ultrasonic method, the size of the liver. Seventy-five normal subjects, 38 men and 37 women, average age 51 +/- 17 years (range 19-85) were studied. The three main diameters of the liver, breadth, thickness, and height, were obtained using a compound scan technique; each diameter was measured at its largest dimension. These measurements were multiplied together and the product arbitrarily divided by 27, which is the cube of the three diameters. This yielded the hepatic volumetric index (HVI), which was between 95 and 140 in 95% of normal subjects below 65 years of age and ranged from 80 to 135 in those above 65 years. These last data proved to be in accordance with the well-known involution of liver size in the elderly and with our retrospective study on 207 normal subjects. Then, using the criteria previously proposed by us, the population studied in the prospective study was divided into three groups of morphotypes: endomorphs, ectomorphs, and mesomorphs. The ectomorphs had an HVI slightly lower than that of the endomorphs. This HVI determination, based on standardized measurements and on a statistically controlled method, allows us to separate normal from pathological livers in 10 min and plays an important part in day-to-day clinical practice.

La ecotomografia en la hidatidosis hepática / Echotomography in hepatic hydatidosis

Creemos que la ultrasonografía constituye un excelente método de diagnóstico complementario para la hidatidosis hepática. Hemos examinado ecográficamente 11 pacientes con un síndrome de masa ocupante hepática. Hallamos hepatomegalia en 4 pacientes. En todos, encontramos formaciones líquidas (masas libres de ecos en su interior, con paredes bien definidas). La ultrasonografía nos brindó una exacta localización topográfica de los quistes

La ecotomografia en la hidatidosis hepática / Echotomography in hepatic hydatidosis

Creemos que la ultrasonografía constituye un excelente método de diagnóstico complementario para la hidatidosis hepática. Hemos examinado ecográficamente 11 pacientes con un síndrome de masa ocupante hepática. Hallamos hepatomegalia en 4 pacientes. En todos, encontramos formaciones líquidas (masas libres de ecos en su interior, con paredes bien definidas). La ultrasonografía nos brindó una exacta localización topográfica de los quistes (AU)

[Echotomography in hepatic hydatidosis]. / La ecotomografía en la hidatidosis hepática.

Ultrasonography, we found as a good diagnosis method for echinococcal hepatic cysts. We studied by U.S. 11 patient with a mass hepatic syndrome. Hepatomegaly was found in 4 patients. In all those cases, a liquid formation (echo-free mass with well walls defined) was seen. Ultrasonography (U.S.) give us an exactly localization topographically of the cysts.

La ecotomografía en la hidatidosis hepática. / [Echotomography in hepatic hydatidosis]

Ultrasonography, we found as a good diagnosis method for echinococcal hepatic cysts. We studied by U.S. 11 patient with a mass hepatic syndrome. Hepatomegaly was found in 4 patients. In all those cases, a liquid formation (echo-free mass with well walls defined) was seen. Ultrasonography (U.S.) give us an exactly localization topographically of the cysts.

[Spontaneous portacaval anastomoses by veins of the falciform ligament of the liver in cirrhosis. Their ultrasonic exploration]. / Anastomoses porto-caves spontanées par des veines du ligament suspenseur du foie dans la cirrhose. Leur exploration ultrasonique.

The aim of this work was to study the portacaval shunts described by Sappey in the falciform ligament of the liver in the cirrhotic patient. Twenty men and 8 women (mean age: 63 years) were studied by ultrasonography. Ascites was present in 20 patients. Venous anastomoses through the falciform ligament were visualized in 16 of the 28 patients. When present, they were usually multiple (1 to 4) with a diameter of about 10 mm. In 8 patients, a large communication with one of the main portal branches was seen. In the same patients, gastroesophageal shunts were always present but umbilical and splenorenal anastomoses were found only in 3 and in 4 patients respectively. This emphasizes the importance of such shunts which are in part intrahepatic. Ultrasonic exploration of these shunts should be routine in the evaluation of collateral circulation in cirrhosis.

[Value of echography in acute pancreatitis]. / Valeur de l'échographie dans les pancréatities aiguës.

We were evaluated the sensibility in acute pancreatitis with ultrasound method (US). Thus, we were studied 48 cases with clinical and biological table of acute pancreatitis. In all these cases, we had surgical confirmation. US exploration were made before and/or after surgical treatment. US was made once in 27 patients, twice in 14, and more times in 7. Accurate diagnosis we made in the 75% of the cases; 8.3% were false negatives; 16,6% were unexplored ultrasonically. The increase of the pancreatic volume, was the most tiically characteristic ultrasound finding. In agreement with others authors, we had 35.41% of the cases with cysts and abscess formation between the complicated acute pancreatitis, (20.84% were confirmed surgically). Hence, we conclude that US is an high sensitive and specific method to employ when clinical acute pancreatitis is pose.

Valeur de léchographie dans les pancréatities aiguÙs. / [Value of echography in acute pancreatitis]

We were evaluated the sensibility in acute pancreatitis with ultrasound method (US). Thus, we were studied 48 cases with clinical and biological table of acute pancreatitis. In all these cases, we had surgical confirmation. US exploration were made before and/or after surgical treatment. US was made once in 27 patients, twice in 14, and more times in 7. Accurate diagnosis we made in the 75

of the cases; 8.3

were false negatives; 16,6

were unexplored ultrasonically. The increase of the pancreatic volume, was the most tiically characteristic ultrasound finding. In agreement with others authors, we had 35.41

of the cases with cysts and abscess formation between the complicated acute pancreatitis, (20.84

were confirmed surgically). Hence, we conclude that US is an high sensitive and specific method to employ when clinical acute pancreatitis is pose.

[Recurrent acute pancreatitis, associated with pancreas divisum. Clinical study of 12 cases]. / Pancréatites aiguës à rechutes, associées au pancréas divisum. Etude clinique de 12 cas.

Sixty-three cases of pancreas divisum were diagnosed in a series of 2,800 endoscopic retrograde cholangiopancreatographies performed between 1976 and 1982. This anomaly was significantly associated with recurrent pancreatitis. Based on 12 cases in which the only possible causative factor of acute pancreatitis was pancreas divisum, the symptoms of this association are described. There were seven males and five females. Average age at the onset of symptoms was 35.3 +/- 12.4 years. Heavy to moderate consumption of alcohol was never found; protein and fat intakes were within normal ranges. All patients presented with acute recurrent pancreatitis, half of them having suffered three to five attacks. The duration of troubles ranged from 6 months to 14 years. In half of the cases the attacks did not last more than twelve hours and were of moderate intensity. Even in case of frequent attacks, no loss of weight was observed. These features are different from that of chronic calcifying pancreatitis. Ultrasonography showed the intrapancreatic course of the mesenteric vein and/or the appearance of two areas of different tonality in the pancreatic head in 58 p. 100 of cases. Endoscopic retrograde cholangiopancreatography was always able to make the diagnosis of pancreas divisum. After 7 endoscopic and 2 surgical sections of the minor papilla symptoms regressed completely in 4 cases and improved in 3 cases (follow-up 2 to 36 months).

[Value of echotomography in cancer of the pancreas]. / Valor de la ecotomografía en el cáncer de páncreas.

We studied by ultrasound (U.S.) a diagnostic method, 87 cases with probable pancreatic cancer; 29 were confirmed surgically. We found an accurate diagnosis in 93.1% of the cases with 6.89% of false negatives and 19.54% of false positives. Likewise, 2.29% of the patients could not be explored by U.S. because they had important meteorism. Among the false positive cases the most important differential diagnosis for us was Chronic Pancreatitis. We conclude that U.S. is a certainly, high sensitive, specific, non invasive and not expensive method. Hence, for us, U.S. is one of the first diagnostic method that must be used when pancreatic neoplasm is suspected.

[Hepatomegaly, hepatic amebiasis: diagnostic accuracy with echography]. / Hepatomegalia, amebiasis hepática: precisión diagnóstica con ecografía.

Ultrasonography explorations were made in 8 patients suspected with amoebic hepatic abscesses. We have used commercially available contact B-Scanning equipment. We found in all the 8 cases, a liquid area, round or oval, with well walls defined but irregular borders, with increased distal sonic enhancement. Random echoes appeared inside (detritus, pus). An hepatic volumetric index H.V.I. help us to know the volume of the liver and the abscesses, and give us the response to specific antiamoebic therapy.

Determination of a splenic volumetric index by ultrasonic scanning.

In a prospective study carried out to determine spleen size by a rapid and simple ultrasonic method, 45 normal subjects, 20 men and 25 women, average age 54 +/- 17 years (range 17-78) were studied. The three principal dimensions of the spleen, breadth, thickness, and height, were obtained with a compound scan technique; each dimension was measured at its largest point. The values obtained were multiplied by each other and the product arbitrarily divided by 27, which is the cube of the three values. This gave a splenic volumetric index (SVI), which, in 95 per cent of normal subjects, was between 8 and 34. There were no statistically significant differences related to age, sex, or morphotype when endomorphs, ectomorphs, and mesomorphs were examined. This SVI determination, based on standardized measurements, allows the distinction of normal from abnormal spleens in 10 minutes.

Valor de la ecotomografia en el cancer de pancreas. / Value of the echotomography in cancer of the pancreas

Hemos estudiado por ultrasonido, 87 casos con probable cancer pancreatico; 29 casos fueron confirmados quirurgicamente. Realizamos un diagnostico seguro en 93.1% de los casos habiendo observado 6.89% de falsos negativos y 19.54% de falsos positivos Ademas, 2,29% de los pacientes no pudieron ser explorados por ultrasonografia a causa de un importante meteorismo. Entre los casos falsos positivos, el mas importante diagnostico diferencial para nosotros fue pancreatitis cronica. Entendemos, en definitiva, que la ultrasonografia es un metodo de diagnostico no invasivo, certero especifico, altamente sensible y no costoso, Incluso para nosotros, la ultrasonografia es uno de los metodos de diagnostico de primer nivel a ser usados inicialmente cuando se sospecha una neoplasia pancreatica

Hepatomegalia, amebiasis hepatica: precision diagnostica con ecografia. / Hepatomegalia, hepatic amebiasis: diagostic accuracy with echography

Hemos explorado 8 pacientes sospechosos de amebiasis hepatica con ecotomografo en tiempo diferido con escala de grises practicando cortes en los tres planos del espacio, reconstruyendo el higado tridimensionalmente. Calculamos la volumetria hepatica y tomamos las dimensiones en los tres planos de los abcesos amebianos. Este metodo mostro una elevada precision diagnostica y permitio seguir la respuesta al tratamiento especifico con elevada eficacia, al mostrar disminucion del volumen hepatico y de los abcesos, hasta lograr su desaparicion total. Acotemos que si bien ultrasonograficamente no existe una patente patognomonica permiten arribar al diagnostico de certeza, permitiendo obtener mejores resultados comparados con otros metodos v.g. radionucleotidos, arteriografia hepatica, T.A.C