Percutaneous fine-needle pancreatic pseudocyst puncture guided by three-dimensional sonography.

BACKGROUND/AIMS: At present a pancreatic pseudocyst puncture guided by ultrasonography is a treatment of choice in the majority of hospitals. A classical two-dimensional sonography is usually implemented in these cases. However, its shortcomings, mainly in differential diagnosis, are acknowledged by most physicians. The real time monitoring of a fine-needle pseudocyst procedure by two-dimensional ultrasonography is of questionable reliability. In our study we evaluated the usefulness of three-dimensional sonography in the percutaneous fine-needle pancreatic pseudocyst puncture. METHODOLOGY: We examined fifty-two patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional ultrasonography findings. Then the decision to qualify certain patients for the percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of two- and three-dimensional scan results. The next step in our investigation was to implement color Doppler in order to visualize all blood vessels at the planned biopsy site. Three-dimensional sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection. RESULTS: Pancreatic pseudocysts were diagnosed in all of the 52 cases. Three-dimensional sonography was more precise in visualizing the shape and size than two-dimensional ultrasound scans. CONCLUSIONS: Three-dimensional presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical two-dimensional ultrasound scans. The use of subtraction in three-dimensional scans of blood vessels increases the safety in performing biopsies. It makes the aspiration of cytologic materials much safer to perform. In our study we have shown that three-dimensional sonography collects extremely useful information about the status of the pseudocyst structure and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis ought to help us change the inclusion criteria for guided biopsies.

[Clinical, morphological and biochemical prognostic factors in acute pancreatitis]. / Kliniczne, morfologiczne i biochemiczne czynniki prognostyczne w ostrym zapaleniu trzustki.

Acute pancreatitis is a potentially lethal disease and mortality depends on severity. The clinical spectrum of acute pancreatitis depends greatly on whether or not pancreatic necrosis is present and to what extend. The effectiveness of any treatment is related to the ability to early predict severity, but there is still no ideal predictive system or biochemical marker. An early enthusiasm over several biochemical markers has diminished because of the costs and impracticability of routine use. Undoubtedly, inflammatory mediators do appear capable of offering greater accuracy, speed and flexibility than older systems but they still require more improvement. Nowadays, prediction of acute pancreatitis severity is based on compilation of methods--clinical assessment, use of multifactor score system, measurement of biochemical markers and computed tomography.

Three-dimensional sonography in the diagnosis of hepatic hemangiomas.

The purpose of the study was to compare power 3-D with conventional 2-D sonography with color and power Doppler in assessment of tumor vascularity in small hepatic hemangiomas. The study group comprised 12 patients (7 males and 5 females) aged 28-60, (mean 44) with diagnosed hemangiomas. In all the patients 2-D and 3-D sonography was performed and their results were compared. Both color and power Doppler 2-D sonography failed to detect blood flow in the tumors. Blood flow signals were detected in 3-D power Doppler sonography. 3-D power Doppler is superior to 2-D color and power Doppler imaging in the detection of blood flow signal in hemangiomas.

Surgical management of chronic pancreatitis.

During the past 21 years 222 patients with chronic pancreatitis have undergone surgery at the Department of General Surgery, Medical School Bialystok. In 117 cases (52.7%) resection was performed and 48 patients (21.6%) had anastomotic procedures and the rest of patients underwent bile duct anastomotic surgery or were re-operated on because of surgical complications. Based on the own clinical experience and the latest data from the world literature diagnostic criteria and indications for surgical treatment of chronic pancreatitis are shown below. Good results obtained in 192 cases (86%) strongly support our opinion that resection procedures in chronic pancreatitis are the most effective management however patients should be operated on in specialized centers with good diagnostic bases because a correct diagnosis is essential while choosing the appropriate line of treatment.