Ultrasound-guided percutaneous galactography.

We present a new percutaneous ultrasound-guided galactography technique that may be used in patients in whom the conventional technique fails and breast ultrasonography show dilated ducts.

Carpet-layer's knee. An ultrasonographic study.

In order to reveal abnormalities in the soft tissue of the anterior part of the knee, caused by protracted mechanical stress, we performed ultrasound studies of both knees of 95 male workers in the carpet-laying and parquet floor trade (group 1). Seventy-three painters (group 2) served as controls. In group 1, an anechoic fluid collection was detected in 10 knees, localized in the superficial infrapatellar bursa and in one patient in the prepatellar bursa, whereas there were no cases of fluid accumulation in the controls. A hypoechoic, oval subcutaneous thickening in the anterior wall of the superficial infrapatellar bursa was detected in 35 (18.4%) and 4 (2.7%) knees, respectively. Prepatellar subcutaneous thickening was detected in 45 knees (23.7%) in group 1, but in only 2 knees (1.4%) in group 2. Two knees in group 1 had thickened and inhomogeneous patellar tendons, while one in group 2 had a thickened and 2 both thickened and hypoechoic patellar tendons. We conclude that ultrasonography is a useful method for the detection of bursitis and soft tissue changes in carpet-layers. Detection of a fluid collection in a bursa does not necessarily denote bursitis of clinical importance, but does signify irritation due to work stress. Patellar tendon pathology is rare among carpet-layers and is probably unrelated to the occupation.

Parathyroid adenomas: pre-operative localization with ultrasound combined with fine-needle biopsy.

Sixteen patients with biochemically proven primary hyperparathyroidism (PHPT) underwent ultrasonography (US), fine-needle aspiration (FNA) for cytologic sampling (n = 9), or intact parathormone assay (n = 3) before operation (n = 15) in order to determine the accuracy of the methods. Pre-operative US was found sensitive (100 per cent), but two thyroid lesions were initially diagnosed as parathyroid tumours by US (i.e. false positives). Parathyroid cells were detected in six cytologic specimens, one sample was insufficient and another inconclusive, while one was diagnosed as thyroid tissue. Parathormone assay revealed a high hormone content in all three patients who underwent the procedure. We conclude that US is sufficiently sensitive to detect enlarged parathyroid tumours. Specificity can be improved by US-guided FNA for cytology or parathormone assay prior to neck exploration.

Percutaneous ultrasound-guided biopsy. Fine needle biopsy, cutting needle biopsy, or both?

The results of 155 US-guided cutting needle biopsies, mainly of abdominal and transthoracic lesions, were reviewed to assess the diagnostic accuracy of the method. A fine needle biopsy (FNB) was additionally performed in 99 of the patients. Sufficient material for histologic and cytologic analysis was obtained in 88% (137/155) and 98% (97/99), and a correct benign or malignant diagnosis was made in 87% and 88%, respectively. Among the 99 combined biopsies the corresponding figures were 100% and 97%, respectively. The proportions of inconclusive and false-negative results among histologic samples were 0% and 4% (2/57), in FNBs 7% (7/99) and 5% (3/56), and in combined examinations 3% (3/99) and 0%. One major complication, Streptococcus faecalis sepsis, occurred. The combined use of FNB and histologic biopsy increases the proportion of correct diagnoses about 10% without increasing the complications.

Diagnostic accuracy of ultrasound-guided fine-needle pancreatic biopsy.

We reviewed the results of 187 consecutive ultrasound-guided fine-needle biopsies of the pancreas in 171 patients to assess the diagnostic accuracy of the method. The final diagnosis obtained at operation, autopsy or follow-up were: adenocarcinoma (n = 83), metastatic cancer (n = 11), cystadenocarcinoma (n = 2), lymphoma (n = 2), malignant gastrinoma (n = 1), pseudocyst (n = 25), cyst (n = 13), chronic pancreatitis (n = 9), normal pancreas (n = 10), abscess (n = 7), benign islet-cell tumour (n = 5), cystadenoma (n = 3). Sufficient cytologic material was obtained in 95.3% of biopsies and the overall accuracy in distinguishing benign from malignant disease was 85.4%. False negative results were obtained in 12 patients (13.1%). Inconclusive results (CIII) were found in aspirates from one cyst and two islet cell tumours. There were no false-positive results. The only complication was a post-biopsy haematoma around the head of pancreas, which resolved spontaneously. Ultrasound-guided pancreatic fine-needle biopsy is a safe method and allows of a high degree of diagnostic accuracy. It has a high specificity. Its sensitivity in the detection of malignancy improves if biopsies are repeated in doubtful cases. It further permits tumours to be graded and allows complications of pancreatitis to be diagnosed.

Radiological findings in primary liver malignancies.

The imaging findings in 134 patients with primary liver malignancy were evaluated retrospectively to determine the sensitivity and appearances of the tumour by each method. One hundred and thirty-one patients were examined by ultrasound, 77 via computed tomography, 62 via arteriography, 30 were subjected to isotope examination, and fine-needle biopsies were performed in 93 patients. 53 patients were operated on and 23 autopsied. In 59 cases a solitary tumour was found, in 69 cases multiple tumours and in 6 diffuse tumours. US gave a correct solitary/multiple/diffuse classification in 85%, CT in 88%, arteriography in 71% and scintigraphy in 71% of positive imaging results. The largest mean diameter of the tumour was 9.5 cm, range 2-25 cm. US showed a lesion that was interpreted as a tumour in 94, CT in 91, arteriography in 89 and scintigraphy in 80%, a focal lesion with false interpretation was detected in 1, 3, 5 and 0%, respectively, shares of false negative results were 5, 6, 6 and 20%. In the group of tumours of diameter less than 8 cm, US missed 5%, CT 15%, arteriography 9% and scintigraphy 22%. In tumours 8 cm or larger US missed 4%, CT 0%, arteriography 5% and scintigraphy 18%.

Osteoarthritis of the hip. Radiologic findings and etiology.

The purpose of the work was to investigate: Whether osteoarthritis of the hip can be divided into radiologic classes by examining the tendency of osteoarthritis of the hips to increase the growth and calcific content of the bone on the one hand and the associated loss of calcium and cartilage and the deformation and destruction of bone on the other. The prevalence of osteoarthritis of the hip in the internal medicinal and surgical outpatients of the University Central Hospital of Oulu, who were radiographed. Whether osteoarthritis of the hip or its different radiologic manifestations correlate with the patient's age, sex, occupation and strenuousity of work, rickets, cancerous diseases, diabetes, rheumatoid arthritis, family history, parity, smoking, obesity, physical activity, corticosteroid and anti-epileptic medication, and previous injuries to the lower extremities causing immobilization. Whether the radiologic findings of osteoarthritis of the hip are associated with typical symptoms. Whether there are correlations between the effects of medication and physiotherapy and the radiologic forms of osteoarthritis of the hip. The study population consisted of two series, of which the first included 401 patients: 167 males and 234 females. The second, or major part comprised 518 patients, of whom 249 were male and 269 female. For all these patients we had radiograms available which permitted reliable assessment of the hip condition. The second series, i.e. the latter group of 518 patients, also filled in a questionnaire which dealt with the etiology and symptoms of the osteoarthritis of the hip as well as the therapies they had received. Whenever possible, the changes of the pelvis and the lumbar spine were also assessed on the basis of the radiograms. On the basis of the radiologic findings, osteoarthritis of the hip was divided into two qualitative classes, hypertrophic and destructive, and a mixed type, and into three grades of severity. Hypertrophic osteoarthritis of the hips accounted for 51% of the cases, destructive for 20% and mixed type for 29%. The percentages for the different severities were 47% for the mild, 16% for the moderately severe and 37% for the severe. A total of 26% of the cases were right-sided, 22% left-sided and 52% bilateral. The mild, bilateral cases of osteoarthritis were mostly hypertrophic, whereas destructive osteoarthritis was clearly more common in the unilateral cases. Hypertrophic osteoarthritis was also more frequent in younger age-groups and destructive in older age-groups. The osteoarthritis of the older patients was more severe.(ABSTRACT TRUNCATED AT 400 WORDS)