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IMO 1419 Interventional abdominal ultrasonography in critically ill patients
INTERNAL MEDICINE
s31
IMO 1419
IMO 1605
Interventional Abdominal Ultrasonography in Critically ill Patients Berkowski Dario E., Reichman Pablo, Lipinszki Albert0 I, Berkowski Gregorio y Bumaschny Eduardo. Servicio de Cirugia General de1 Hospital Israelita de Buenos Aires. Argentina. Between April, 1994 and January 1997 we carried out 11 trans-hepatic percutaneous cholecystostomies (PC) and 10 percutaneous drainages (PD) of intraabdominal collections guided through ultrasonography, in 21 critically ill patients. Out of all PCs., 9 revealed alithiasic acute cholecystitis and 2 lithiasic ones. The method failed with one of the patients. Out of all PDs., most frequent ethiology in the the collections was postoperative: 5 right subfrenic abscesses, as well as 2 left ones and 1 from the splenic region; 2 from the hepatic parenchyma and one from the area of Douglas, revealing therapeutic and diagnostic 100% effectiveness. 3 complications. One death There were, occurred due to the patient's primary pathology. No mortality arose due to the method itself. According to our experience we agree with the bibliography on the fact that procedures guided though ultrasonography are eligible at present for the treatment of alithiasic acute cholecystitis and for intraabdominal collections of critically ill patients.
PORl L HYPERTENSIVE GASTROPATHY: POTENTIAL ROLE 3FLEVOVISTBENHANCEDCOLORDOPPLER M.J. Gebel*, M. Caselitz*, K. Sterath*, C. Schoe.fl*,P.N. Meier*, J.S. B&k*, S. Weber+, M.P. Manns*. *Dept. Gastroenterologyand Hepatology, Medizinische Hochschulemover, ‘Schering Inc., Berlin, FRG Portal hypertensivegastropathy (PHG) can caose.substantial chronic blood loss in patients with portal hypertension. There is evidence that small AV- shunts in the gastric mucosa form the morphological basis for PHG. Enhancement of the ultrasound color doppler signal (CD) by Levovist@enhancement should lead to the detection of the increased vascuIarblood flow of the gastric mucosaand support clinical diagnosis. METHOD: 15 patients (8 female, 7 male, age 36 - 76 years,average 59 years) .with portal hypertension ( 13 patients with liver cirrhosis: toxic 6, viral 5, PBC 1, cryptogenic 1; 2 patients with portal vein thrombosis without liver cirrhosis) and 8 patients without liver disease received 2,5 g Levovist@(Schering Inc., Berlin) as dosagesof 200,300 or 400 m&ml iv. within 5 set (written consent) during examination of the stomach wall by CD (Toshiba 270, 3,75 MHz). Enhancement of CD signals was graded (no, positive, strong positive) and compared to endoscopic findings (PHG grading according to McCormack, 1985, examiners unaware of CD findings). RESULTS: Signal enhancement started 20 set after start of injection, reached maximum after 25 set and lasted for 2.30 min. Compared to gastroscopy(GS) aI1 12 casesof PHG showed marked increase in CD mucosal signals (12 right pos., 1 false pas. (liver cirrhosis)., 0 false neg., IO right neg.). There was a moderate agreement of PHG grading: CD/GS neg lO/ll, pos. 6/9, strong pos. 7/3 (Sensitivity 100%. Specificity91%) CONCLUSION: L.evovist@enhanced CD seems to be a very sensitive non-invasive method for the detection of PHG. Results of this preliminary study suggest that PHG and simple congestion could be separatedby Levovist@enhanced CD.
IMO 1420
IMO 1606
INTRAOPERATIVE ULTRASOUND OF THE LIVER AND PANCREAS. &I&an B. Ku&& Beth Israel Deaconess Medical Center. Harvard Medical School, Boston, MA, USA.
ECHOSICNALENRANCEMENTOFTREPORTALVASCULAR SYSTEM WITH LEVOVIST@ (SA USOSA) - RESULTS OF A CONTROLLEDMULTKENTERSTUDY. M.J. Gebel*. M. Caselitz*. S Webe?. *Dept. Gastroenterolo8y and Hepatology,Medizinische Hochschule Haanover, ‘Schering Inc., Berlin, FRG on behalf of the Levovist@! portal hepatic studygroup.
Intraopemtive ultrasound of tbe liver and pancreas is a versatile and valuable adjunct to .&rgical inspection and palpation. The techniaue uenuits visualization of small (
The purpose of this studywas to determine if LevovistO (SH U 508A) improves the accuracyof Doppler sonography in fhe evaluation of blwd flow abnormalities in the portal vascular systemin patients with nondiagnostic Doppler scansdoring routine sonography and to confirm the safetyand tolerability of Levovist@. METHODS: In a multicenter (20 European centers). open label. controlled trial patients referred for Doppler sonography of the portal vascular systemwere randomized to active treatment group (group B) or control group (group A) in ratio of 4:l. Patients in group B who had diagnostically insticient Doppler signals receivedLevovistQ, followed by confirmatory CT scansand angiography if diagnostically advisable: corresponding patients in group A received additional imaging pro&are(s) (dynamic CT, angiography). ~ovist@ was administered as bolus injections as dosagesof 200, 300 or 400 m&l, in total 2.5g. RESULTS: A total of 558 patients were evaluable (85 group A, 473 group B). Preliminary results show that diagnostic confidence improved from 35.3% with unenhanced Doppler to 82.6% with Levovist@ enhanced Doppler. When compared with dynamic CT . LevovistQ enhanced Doppler had a sensitivity80.5% and specificity 89.7% in 200 patients who were assessablein both examinations. Regarding the main diagnostic question only 4.5% in echo enhanced,but 12.2% of vesselsin question were not assessablein dynamic CT. Levovist@ was well tolerated and no clinically significant adverseeffectswere related to its use were observed.Only 4 patients experienced minor treatment related adverseeffects CONCLUSION: Levovis@ significantly increased the diagnostic confidence of the Doppler sonography of the portal vascolatore. It allowed also the visualization of the portal vessels in more patients than CT. - previouslyconsidered the ,,gold standard“ diamostic orocedure.
s31
IMO 1419
IMO 1605
Interventional Abdominal Ultrasonography in Critically ill Patients Berkowski Dario E., Reichman Pablo, Lipinszki Albert0 I, Berkowski Gregorio y Bumaschny Eduardo. Servicio de Cirugia General de1 Hospital Israelita de Buenos Aires. Argentina. Between April, 1994 and January 1997 we carried out 11 trans-hepatic percutaneous cholecystostomies (PC) and 10 percutaneous drainages (PD) of intraabdominal collections guided through ultrasonography, in 21 critically ill patients. Out of all PCs., 9 revealed alithiasic acute cholecystitis and 2 lithiasic ones. The method failed with one of the patients. Out of all PDs., most frequent ethiology in the the collections was postoperative: 5 right subfrenic abscesses, as well as 2 left ones and 1 from the splenic region; 2 from the hepatic parenchyma and one from the area of Douglas, revealing therapeutic and diagnostic 100% effectiveness. 3 complications. One death There were, occurred due to the patient's primary pathology. No mortality arose due to the method itself. According to our experience we agree with the bibliography on the fact that procedures guided though ultrasonography are eligible at present for the treatment of alithiasic acute cholecystitis and for intraabdominal collections of critically ill patients.
PORl L HYPERTENSIVE GASTROPATHY: POTENTIAL ROLE 3FLEVOVISTBENHANCEDCOLORDOPPLER M.J. Gebel*, M. Caselitz*, K. Sterath*, C. Schoe.fl*,P.N. Meier*, J.S. B&k*, S. Weber+, M.P. Manns*. *Dept. Gastroenterologyand Hepatology, Medizinische Hochschulemover, ‘Schering Inc., Berlin, FRG Portal hypertensivegastropathy (PHG) can caose.substantial chronic blood loss in patients with portal hypertension. There is evidence that small AV- shunts in the gastric mucosa form the morphological basis for PHG. Enhancement of the ultrasound color doppler signal (CD) by Levovist@enhancement should lead to the detection of the increased vascuIarblood flow of the gastric mucosaand support clinical diagnosis. METHOD: 15 patients (8 female, 7 male, age 36 - 76 years,average 59 years) .with portal hypertension ( 13 patients with liver cirrhosis: toxic 6, viral 5, PBC 1, cryptogenic 1; 2 patients with portal vein thrombosis without liver cirrhosis) and 8 patients without liver disease received 2,5 g Levovist@(Schering Inc., Berlin) as dosagesof 200,300 or 400 m&ml iv. within 5 set (written consent) during examination of the stomach wall by CD (Toshiba 270, 3,75 MHz). Enhancement of CD signals was graded (no, positive, strong positive) and compared to endoscopic findings (PHG grading according to McCormack, 1985, examiners unaware of CD findings). RESULTS: Signal enhancement started 20 set after start of injection, reached maximum after 25 set and lasted for 2.30 min. Compared to gastroscopy(GS) aI1 12 casesof PHG showed marked increase in CD mucosal signals (12 right pos., 1 false pas. (liver cirrhosis)., 0 false neg., IO right neg.). There was a moderate agreement of PHG grading: CD/GS neg lO/ll, pos. 6/9, strong pos. 7/3 (Sensitivity 100%. Specificity91%) CONCLUSION: L.evovist@enhanced CD seems to be a very sensitive non-invasive method for the detection of PHG. Results of this preliminary study suggest that PHG and simple congestion could be separatedby Levovist@enhanced CD.
IMO 1420
IMO 1606
INTRAOPERATIVE ULTRASOUND OF THE LIVER AND PANCREAS. &I&an B. Ku&& Beth Israel Deaconess Medical Center. Harvard Medical School, Boston, MA, USA.
ECHOSICNALENRANCEMENTOFTREPORTALVASCULAR SYSTEM WITH LEVOVIST@ (SA USOSA) - RESULTS OF A CONTROLLEDMULTKENTERSTUDY. M.J. Gebel*. M. Caselitz*. S Webe?. *Dept. Gastroenterolo8y and Hepatology,Medizinische Hochschule Haanover, ‘Schering Inc., Berlin, FRG on behalf of the Levovist@! portal hepatic studygroup.
Intraopemtive ultrasound of tbe liver and pancreas is a versatile and valuable adjunct to .&rgical inspection and palpation. The techniaue uenuits visualization of small (
The purpose of this studywas to determine if LevovistO (SH U 508A) improves the accuracyof Doppler sonography in fhe evaluation of blwd flow abnormalities in the portal vascular systemin patients with nondiagnostic Doppler scansdoring routine sonography and to confirm the safetyand tolerability of Levovist@. METHODS: In a multicenter (20 European centers). open label. controlled trial patients referred for Doppler sonography of the portal vascular systemwere randomized to active treatment group (group B) or control group (group A) in ratio of 4:l. Patients in group B who had diagnostically insticient Doppler signals receivedLevovistQ, followed by confirmatory CT scansand angiography if diagnostically advisable: corresponding patients in group A received additional imaging pro&are(s) (dynamic CT, angiography). ~ovist@ was administered as bolus injections as dosagesof 200, 300 or 400 m&l, in total 2.5g. RESULTS: A total of 558 patients were evaluable (85 group A, 473 group B). Preliminary results show that diagnostic confidence improved from 35.3% with unenhanced Doppler to 82.6% with Levovist@ enhanced Doppler. When compared with dynamic CT . LevovistQ enhanced Doppler had a sensitivity80.5% and specificity 89.7% in 200 patients who were assessablein both examinations. Regarding the main diagnostic question only 4.5% in echo enhanced,but 12.2% of vesselsin question were not assessablein dynamic CT. Levovist@ was well tolerated and no clinically significant adverseeffectswere related to its use were observed.Only 4 patients experienced minor treatment related adverseeffects CONCLUSION: Levovis@ significantly increased the diagnostic confidence of the Doppler sonography of the portal vascolatore. It allowed also the visualization of the portal vessels in more patients than CT. - previouslyconsidered the ,,gold standard“ diamostic orocedure.