Showing papers by "Edwin A. Deitch published in 1981"

Acute acalculous cholecystitis: Ultrasonic diagnosis

Abstract: Ultrasonography is an effective and accurate diagnostic test for acalculous cholecystitis. Until recently, however, little attention was focused on the gallbladder wall as an indicator of disease. By accurately visualizing and measuring the gallbladder wall, ultrasonography can be used to screen patients in whom acute acalculous cholecystitis is suspected. If the gallbladder wall measures 3.5 mm or greater, in the absence of ascites, a diagnosis of acalculous cholecystitis can be made safely with a specificity greater than 98 percent. Four of our five patients with acute acalculous cholecystitis had ultrasonically measured gallbladder walls 3.5 mm or greater in width. We have found ultrasonography useful in any clinical situation, even in the face of ileus, jaundice or pancreatitis. In addition, with the use of the portable real-time ultrasound machine, postoperative, traumatized and other critically ill patients can be examined at the bedside.

Utility and accuracy of ultrasonically measured gallbladder wall as a diagnostic criteria in biliary tract disease

Abstract: Biliary tract sonography has achieved wide acceptance as a screening test for chronic calculous disease. However, the clinical usefullness of biliary sonography is limited by the inability of this test to identify patients with acalculous cholecystitis or to separate patients with calculous cholecystitis from those with asymptomatic calculi. A prospective blinded study of 106 patients undergoing cholecystectomy was performed to determine if, cholecystosonography could visualize the gallbladder wall accurately and to evaluate gallbladder wall thickening as a predictor of disease. Of these patients, 88 had a sonographically visible gallbladder wall and in 95% of the patients the ultrasonic and direct surgical measurements of the gallbladder wall agreed within 1 mm. To determine the sonographic size range of gallbladder wall thickness in the normal population, the width of the gallbladder wall in the fasting state was measured in 100 patients without biliary tract disease. One percent of the normal population had thickened gallbladder walls, in contrast to 96% of the patients with acute calculous or acalculous cholecystitis. Gallbladder wall thickness appears to be an accurate noninvasive technique for diagnosing patients with acute calculous and acalculous cholecystitis in the absence of other entities which thicken the gallbladder wall such as ascites and hypoproteinemic states.

The reliability and clinical limitations of sonographic scanning of the biliary ducts.

Abstract: Sonographic scanning of the biliary ducts has been successfully used as a screening test to distinguish between patients with surgical and medical jaundice, with an accuracy of 90%. However, there is no consensus in the literature on what numerically defines a dilated biliary duct. To clarify this problem a prospective study of 102 consecutive patients was initiated to determine the sonographic size range of bile ducts in patients with and without extrahepatic ductal obstruction. The ultrasonic measurements were compared with direct measurements of the common bile duct, at surgery. The extrahepatic ductal system was visualized sonographically in 62% of the patients, while the intrahepatic ducts were found in 81% of the population. Direct measurements at operation agreed with the ultrasonic measurements in 84% of the patients. Analysis of the size range of the biliary ducts in patients with and without extrahepatic obstruction, by chi square analysis and the Student's t-test, allowed the following guidelines to be established. Extrahepatic bile duct obstruction was present if the extrahepatic bile ducts was 1 cm or wider (p less than 0.001) or if the intrahepatic bile duct was in excess of 0.5 cm (p less than 0.001). Similarly if the extrahepatic bile duct measured less than 0.8 cm sonographically, and the intrahepatic bile duct was 0.4 cm or less than bile duct, obstruction was not present (p less than 0.001).

The value of ultrasound in the diagnosis of nonpalpable femoral hernias.

Abstract: • Nonpalpable femoral hernias were diagnosed in four patients by the ultrasonic visualization of a space-occupying mass medial to the femoral vein. All four patients had surgical verification of their ultrasonic diagnoses. Therefore, we suggest the liberal use of sonography in the femoral region to aid in the early diagnosis of nonpalpable and clinically questionable femoral hernias. In patients with incarcerated femoral hernias, early sonographic diagnosis prior to strangulation may decrease the high mortality associated with this complication. ( Arch Surg 116:185-187, 1981)