Gallstones in elderly patients: impact of laparoscopic cholecystectomy.

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.

Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: immediate and medium-term results.

Background: Obstruction of the main pancreatic duct with upstream hypertension and dilation is a cause of pain in patients with chronic pancreatitis. Pancreatic ductal drainage can be achieved endoscopically by intraductal stone removal after endoscopic pancreatic sphincterotomy and/or by insertion of a pancreatic stent. Extracorporeal shock wave lithotripsy may be needed whenever stones cannot be removed by endoscopic procedures.

Gall stone pulverisation strategy in patients treated with extracorporeal lithotripsy and follow up results of maintenance treatment with ursodeoxycholic acid.

Between November 1988 and July 1992 70 patients with radiolucent gall stones were treated with extracorporeal lithotripsy (ESL) and ursodeoxycholic acid (UDCA; mean (SD) dose 11.2 (1.9) mg/kg/day).

Lower gastrointestinal endoultrasound.

Following a brief history of transrectal ultrasonography, the author explains the fundamentals that led to his research on rectal echographic layers and then describes his theory as applied to the anatomical interpretation of these layers. Personal cases of preoperative staging with transrectal echography provide a basis for the critical evaluation of this method and its proposed role in clinical application.

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).

Morphological appearance of low-level echoes in the gallbladder. Interpretation with microscopic biliary analysis and clinical correlation.

A total of 743 patients affected by various gastrointestinal disorders were examined by ultrasound. The presence in the gallbladder bile of low-level echoes (LLE) was observed in 56 (7.5%).

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.

Transrectal ultrasonography: three years' experience.

Since 1983 we have used radial and linear ultrasound probes in the laboratory and clinical examination of the rectum. Normal endosonographic appearances have been characterised by examining polyethylene membranes and resection specimens. Twenty normal subjects and 11 patients with rectal cancer have been examined, and of these 9 were correctly staged.

Transrectal ultrasonography: interpretation of normal intestinal wall structure for the preoperative staging of rectal cancer.

An in vitro ultrasonographic study was carried out to four polyethylene membranes of different thicknesses and on four normal surgical specimens from the rectal wall, to assess its various layers and their anatomical structure. Three different techniques were used, and an electronic equipment measured the thickness of the membranes and of the surgical specimens. Polyethylene membranes less than 1000 microns thick gave linear echoes; the 1000-microns-thick membrane gave a three-layer image--two hyperechogenic layers separated by a hypoechogenic one.

[Ultrasonically-guided percutaneous puncture of Wirsung's duct].

A technique of ultrasonically guided percutaneous puncture of Wirsung's duct for pancreatic juice collection and radiological opacification is described. The equipment used is a linear array real-time transducer with a groove into which a metallic support provided with a guiding needle is attached. Once the depth at which the duct lies has been determined, a Chiba's needle is passed through the guiding needle and pushed up to the corresponding length.

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.

[Spontaneous splenorenal and splenocaval shunts studied by echotomography].

Spontaneous spleno-renal and spleno-caval shunts may be anatomically and functionally important in portal hypertension syndromes, as demonstrated by the distinct opacification of the inferior vena cava observed after portal venography with iodine contrast media. Part of the course of these porto-caval anastomotic vessels can be visualized by ultrasonography opposite the left adrenal gland and in the space between the spleen and the left kidney. The images obtained are characteristic enough for the diagnosis of spleno-renal shunt to be suspected before it is confirmed by portal venography, as was the case in the four patients with hepatic cirrhosis reported by the authors.

[Ultrasonographic appearances in three cases of pancreas divisum (author's transl)].

Pancreas divisum is an embryological malformation resulting from imperfect fusion of the dorsal and ventral parts of the gland. In this not infrequently observed anomaly, the excretory systems of the two parts remain independent, secretion being through the principal papilla for the ventral, and the accessory papilla for the dorsal pancreas. The pathogenic role of this malformation is now well established.