Abstract: Contrast enhanced ultrasonography (CEUS) has improved both the detection and characterization of focal liver lesions. It is now possible to evaluate in real time the perfusion of focal liver lesions in the arterial, portal and late contrast phases, and thus to characterize focal liver lesions with high diagnostic accuracy. As a result, CEUS has taken a central diagnostic role in the evaluation of focal liver lesions that are indeterminate upon computed tomography (CT) and magnetic resonance imaging. The combined use of second generation contrast agents and low mechanical index techniques is essential for the detection of liver metastases, and it now allows the examination of the entire liver in both the portal and late phases. Several studies have shown that using CEUS instead of conventional ultrasonography without contrast agents significantly improves sensitivity in detection of liver metastases. Furthermore, the detection rate with CEUS seems to be similar to that of CT. This review describes the clinical role of CEUS in detecting liver metastases, including details about examination techniques, features of metastases observed with CEUS, and clinical results and guidelines.
Abstract: PURPOSE: To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and 4-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC). MATERIALS AND METHODS: Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly and the combination of US, CEUS, biphasic MDCT, IOUS, follow up and biopsy was the gold standard. RESULTS: Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS and MDCT and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (p=0.02). In a patient-by-patient analysis MDCT had a non-significantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, p=0.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (p=0.02). CONCLUSION: Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a non-significant better sensitivity (p=0.06) in detecting liver metastases in patients with CRC.
Abstract: The risk of severe bleeding after liver biopsy is estimated to be 1:12,000 in patients with near normal coagulation (INR < 1,5 and platelet count > 60 billion /l). Beyond these limits, the risk is higher, but still uncertain. The Danish guidelines require INR > 1.5, platelet count < 40 billion /l and normal APTT. In some instances the risk of not knowing the histology is so high that a biopsy is considered even with a more disturbed coagulation. Vitamin K, freshly frozen plasma and recombinant activated factor VII may reduce the risk of bleeding in specific situations, but no firm recommendations can be given.
Abstract: OBJECTIVE: To compare sensitivity and specificity of contrast enhanced ultrasonography (CEUS) with conventional ultrasonography (US) in detection of liver metastases in patients with colorectal adenocarcinoma (CRC) in a patient-by-patient analysis. MATERIALS AND METHODS: A prospective study of 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. In order to detect possible liver metastases all patients underwent liver US, followed by CEUS by another investigator. Multislice CT scanning (MDCT), and intraoperative ultrasonography (IOUS) were then performed. Fine-needle biopsy was performed on all suspicious lesions. Each examination was interpreted blindly and the combination of biphasic MDCT, IOUS, follow up and biopsy was the gold standard. RESULTS: Standard of reference found liver metastases in 54 patients (14.8%). Contrast enhanced ultrasonography improved the sensitivity significantly in detection of liver metastases from 0.69 by US to 0.80 (p=0.031). In 24 patients, CEUS found a higher number of metastases than US (p<0.001). The specificity (0.98) and the positive predictive value (0.86) was the same. CONCLUSION: Contrast enhanced ultrasonography improves sensitivity in detection of liver metastases in patients with CRC and in nearly half of the cases CEUS found a higher number of metastases than US.
Abstract: BACKGROUND AND AIMS: The surgical gold standard in primary hyperparathyroidism was until recently exploration of all four parathyroid glands. Today more patients undergo minimal invasive procedures demanding more accurate preoperative localization studies. The aim of the study was to determine the positive predictive value (PPV) of parathyroid scintigraphy (PS) and to some extent ultrasonography (US), defined as the probability of finding one single adenoma on the affected side at surgery when the scans had shown one single focus. MATERIAL AND METHODS: Eighty-eight surgically treated patients (76 women and 12 men, 8 with multiglandular disease) were included. The PS consisted of 99mTc-sestamibi scan with dual-phase technique, both planar and SPECT imaging, followed by 99mTc-pertechnetate scan. A positive scan was defined as a single focus accumulating sestamibi. Focal lesions on US were defined as hypoechoic nodules. RESULTS: PS was positive in 80 patients. Seventy-nine had only one focus, of which 64 were correctly localized adenomas (PPV 81%). Forty-seven of 77 US examinations were positive. In 44 there was only one focus of which 38 were correctly localized (PPV 86%). PPV was 97% when both examinations were positive. CONCLUSIONS: Both PS and US have acceptably high PPVs defined as the ability to predict whether or not one single focus represents a parathyroid adenoma. Concordant positive results were accompanied by a PPV close to 100%.
Abstract: The accuracy of sonography in the diagnosis of acute rupture of the anterior cruciate ligament (ACL) was tested. Sixty-two patients with a recent traumatic haemarthrosis were examined. A haematoma at the origin of the ACL in the femoral intercondylar notch was interpreted as evidence of ligament injury. The standard of reference was arthroscopy or clinical follow-up. The sonographic findings were confirmed in 59 of 62 cases. The sensitivity was 88%, the specificity 98%, and the positive and negative predictive values 93 and 96%.
Abstract: OBJECTIVE: To describe women's barriers to cervical screening by asking about their experience with and knowledge of smear tests and by examining the women's contact and relationship with their GP. SETTING: Questionnaires sent to women in Aarhus County, Denmark. METHODS: A case control study in a cohort. The cohort, 133,500 women, represents women aged 23-60 years who were invited to the organized cervical screening program between 1.10.90 and 1.4.94. A case group, non-attenders (n=694), who had not had a smear within the previous 42 months, and a control group, attenders (n=1131), who had at least one smear test within the previous 42 months, were compared with each other. Predictor variables in the two groups were analyzed by univariate and multivariate (logistic regression) analysis. RESULTS: Non-attenders more often had insufficient contact with the GP (having a bad relationship, feeling of not receiving sufficient information) and associated a gynecological examination with more psychological unpleasantness. Most non-attenders (65.5%) and attenders (88.5%) intended to attend next time they were invited for cervical screening, and resistance to mass screening on principle did not seem to have great influence on the number of non-attenders. Both non-attenders and attenders had poor knowledge of the smear test. No significant difference was found concerning the characteristics of the general practice used by non-attenders and attenders. CONCLUSIONS: The main barriers to regular cervical screening are insufficient contact with the GP and psychological unpleasantness associated with the gynecological examination. Resistance to cervical screening on principle does not seem to have a great influence on attendance.
Abstract: OBJECTIVE: To find out the duration of postoperative pneumoperitoneum and the factors that are responsible for its persistence. DESIGN: Prospective open (non-random) study. SETTING: County hospital, Denmark. SUBJECTS: 32 patients over 18 years of age undergoing abdominal operations during a 6 month period. INTERVENTIONS: Abdominal radiographs with the patient in the left lateral position were taken at fixed time intervals until no free air could be seen. MAIN OUTCOME MEASURES: The amount of free air and the time postoperatively by which it had disappeared. RESULTS: In 20 [corrected] patients the air had disappeared within 48 hours and only one patient (3%) had free air for more than five days postoperatively. High body mass index and a small initial amount of free air were associated with the shortest period of postoperative pneumoperitoneum. CONCLUSION: Postoperative pneumoperitoneum disappeared within two days in most patients. Heavier patients and patients with small volumes of free air initially had the shortest duration of pneumoperitoneum. There were large variations among patients in the volumes of free air.
Abstract: The aim of the study was to present social and other characteristics of non-attenders in an organized cervical screening programme. It was conducted a case-control study in a cohort. The cohort consists of women in the age group 23-60 years who were invited to the organized cervical screening programme in Aarhus county, Denmark, between 1.10.1990 and 1.4.1994, totalling 133,500 women. The case group included 694 "non-attenders" and the control group 1131 women who had had at least one smear performed during the previous 42 months. The results showed that non-attenders, compared to attenders, had less frequent contact to their general practitioner. The non-attender group did not have an over-representation of markers for special risk of cervical cancer.
Abstract: OBJECTIVE: Several studies have compared attenders and non-attenders in organised cervical screening programmes but few have analysed subgroups of attenders and non-attenders. This study presents social and other characteristics of such subgroups. SETTING: Aarhus County, Denmark. METHODS: A case-control study in a cohort of 133,500 women, aged 23-60, included in the programme from 1 October 1990 to 1 April 1994. The participation rate was 75%, and those taking part comprised women with opportunistic screening or who had had a smear owing to symptoms in the previous three years ("active" attenders), and women who were invited for screening because they had not been otherwise tested ("passive" attenders). "Passive" (n = 708) and "active" attenders (n = 692) were compared. Women who had never had a smear test ("never" attenders, n = 287) were then compared with "ever" attenders (n = 1215)-that is, women who had not had a smear test during the previous 42 months, but had had at least one previous test. Data were collected by mailed questionnaires. RESULTS: The response rate was 81% and 53% for attenders and non-attenders, respectively. After correction for age, there was no difference between the "active" and "passive" attenders for cancer risk factors (smoking, age of first intercourse, number of sexual partners, and social group), or in the degree of responsibility for close relatives, but "active" attenders seemed to have more frequent contact with their general practitioner. "Never" attenders had less frequent contact with their general practitioner than "ever" attenders. They were more often living alone and nullipara, but had no overrepresentation of cancer risk factors. CONCLUSIONS: Increased effect cannot be obtained by focusing on the described groups, but by increasing the participation rate. "Never" attenders do not belong to a special risk group.
Abstract: BACKGROUND: The presence of sphincter of Oddi (SO) slow waves has been noted in earlier studies on the effect of cholecystokinin (CCK) on the SO, but a more thorough description of changes in SO slow-wave and pressure activity induced by CCK is needed. METHODS: The SO and duodenum in anaesthetized rabbits were prepared with perfused catheters and bipolar electrodes. Increasing, successive doses of CCK (1/32 to 1/1 Ivy Dog Units (IDU)/kg) were administered intravenously every 15th min. The digitized recordings were scored on a computer in control and stimulatory CCK sequences. RESULTS: CCK had a significantly stimulatory effect on SO and duodenum when estimated as area below pressure peaks (p < 0.001), but quantitatively, this effect did not differ in the two organs (p = 0.59). CCK significantly decreased SO slow-wave frequency (p < 0.05), whereas a similar trend in duodenal slow-wave frequency failed to reach statistical significance. Most pressure peaks recorded from the SO were associated with only one slow wave ('simple peak'), but the incidence of broad, irregular peaks belonging to more than one slow wave ('complex peaks') was significantly higher in CCK sequences (p < 0.02). Spectral analysis of SO pressure and slow-wave activity confirmed the dominating one-to-one relation between SO slow-wave and pressure peaks up to 1/4 IDU/kg, but also showed the disturbance caused by the increasing number of complex peaks generated by doses of at least 1/2 IDU/kg. CONCLUSIONS: CCK increases SO and duodenal activity equally. Up to a CCK dose of 1/4 IDU/kg the SO slow-wave regulatory mechanism is undisturbed, but higher doses lead to a fall in slow-wave frequency and qualitative changes in the relation between SO pressure and slow-wave activity.
