Operative Ultrasonography Research Articles

Efficacy of Operative Ultrasonography Plus Neuronavigation for Brain Glioma Surgery: 2 – Year Single Center Experience in a Developing Country

Background: preoperative MRI data has been the gold standard for the diagnosis and therapy of malignant gliomas for decades, and operative ultrasonography for the management of patients with neurological pathologies that require surgical treatment has been also used for many years as it provides additional image guidance for surgical procedure to neuronavigation techniques. The main objective of this study is to find out if the use of operative ultrasonography in glioma surgery could give greater benefit in the total resection of brain gliomas and how improvement influences the degree of neoplastic resection on the survival of patients. Methods: prospective case-control study that was performed at the ISSEMyM Licenciado Arturo Montiel Rojas Medical Center, of patients with a histopathological diagnosis of cerebral glioma treated by the neurosurgery service in the period between January 2018 and December 2020. Results: Thirty - two patients were included, with 13 patients (40.6%) with grade IV astrocytoma. Operative USG + NNV was used in 17 patients and a subtotal or total resection was achieved in 75% of the patients, with a significantly lower postoperative volumetry in patients operated on by NNV + USG (5.6mm3 + 2.5), compared to NNV alone (8mm3 + 2.8) However, these results did not affect tumor-free time, which was comparable between both groups. Conclusions: Surgical treatment of brain gliomas with USG + NNV has a good degree of tumor resection compared to those treated with NNV only, but the main factor affecting survival is the hystophatological grade of the tumor.

A Comparative Study between Operative Ultrasonography and Perioperative Cholangiography in Screening of The Common Bile Duct for Stones During Laparoscopic Cholecystectomy

A Comparative Study between Operative Ultrasonography and Perioperative Cholangiography in Screening of The Common Bile Duct for Stones During Laparoscopic Cholecystectomy

AN OBSERVATIONAL STUDY ON PREDICTION OF DIFFICULTIES DURING LAPROSCOPIC CHOLECYSTECTOMY IN CASES OF CHOLELITHIASIS BY PREOPERATIVE ULTRASONOGRAPHY

BACKGROUND: Laparoscopic cholecystectomy has become the treatment of choice for cholelithiasis. Some reliable factors are needed to predict difficulties during laparoscopic cholecystectomy. So, our aim was to study various preoperative ultrasonographic parameters which may predict difficulties in performing laparoscopic cholecystectomy. METHOD: One twenty five patients of cholelithiasis admitted for elective laparoscopic cholecystectomy were studied. Preoperative ultrasonographic parameters such as gall bladder(GB) wall thickness, transverse diameter of GB, pericholecystic fluid collection, gall stone mobility, number of stones & size of largest stone, common bile duct(CBD) diameter and emphysematous cholecystitis were given a score of 0 or 1 based on findings being negative or positive respectively. Total score was correlated with the difficulties faced during laparoscopic cholecystectomy. RESULT: Out of 125 cases, 42(33.6%) cases were found to be difficult during laparoscopic cholecystectomy and 6 cases (4.8%) required conversion to open cholecystectomy. GB wall thickness (p value= 0.00001), transverse diameter of GB (p value= 0.001), pericholecystic fluid collection (p value= 0.00001), dilated CBD (p value=0.007), size of stone (p value= 0.007) found to be statistically significant in predicting difficulties during laparoscopic cholecystectomy. Higher the preoperative USG score, higher were the chances of difficult laparoscopic cholecystectomy and conversion to open cholecystectomy. CONCLUSION: Pre operative ultrasonography in the form of a formulated score is a good predictor of difficulties during laparoscopic cholecystectomy.

Incidence and location of deep vein thrombosis of lower extremity following surgery of tibial plateau fracture

<div class="Section1"><p><strong>Background:</strong><strong> </strong>Tibial plateau fractures are commonly seen fractures of lower limb. They are challenging to manage since they are mostly associated with soft tissue injuries. Deep vein thrombosis (DVT) is a significant cause of morbidity and pulmonary embolism can even cause mortality in all hospitalized patients, especially after trauma and lower extremity fracture, which further carries risk of significant morbidity and mortality. We aim to evaluate the epidemiological characteristics of postoperative DVT in tibial plateau fractures.</p><p><strong>Method: </strong>A prospective observational randomized study was performed. A total of 79 patient were included in this study who had proximal tibia fractures. Pre-op ultrasonography was done and post operative ultrasonography was done following proximal tibia plating surgery on day 2. Successive evaluation with USG was done at week 2, week 3 and week 4 for DVT. If DVT is diagnosed it will be managed medically.</p><p><strong>Result: </strong>A total of 79 patients were included in the study, 28 were females and 51 males. 4 out of 79 patients were diagnosed with DVT following surgery of tibial plateau fracture. Predominantly DVT was seen in male patient of elderly age group who had high energy trauma operated by open reduction with duration of surgery of more than 1 hour. 3 out of 4 patients had distal DVT and 1 had proximal DVT.</p><p><strong>Conclusions</strong>: Six risk factors were found to be strongly associated with DVT i.e., old age, male gender, high energy trauma, increased preoperative interval, open reduction and prolonged duration of surgery. These epidemiologic data will be helpful in individual assessment, risk categorisation and development of targeted prevention programs.</p></div>

A study of Diagnosis and surgical management of pancreatic insulinoma

Introduction: Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. They pose a challenge for pre-operative localization. Many invasive and non-invasive methods exist for localization of an insulinoma. Intra-operative ultrasonography (IOUS) with palpation can be done for tumors not localized by conventional imaging modalities. Pancreas Preserving surgery is the treatment of choice. This article gives an overview on localization and surgical strategies for treatment of insulinoma. Materials and Methods: This is a retrospective data of the patients undergoing surgical treatment of insulinoma in the Osmania General Hospital, Hyderabad between 2007 to 2017. Demographic data, symptoms and diagnostic tests and type of resections were analyzed from medical records. All patients had a complete intraoperative exploration of the pancreas done by digital palpation and intra operative ultrasonography. Results: 10 cases (6 males and 4 females) of insulinoma aged between 22 and 55 years, with a median age of 30 years were included in the analysis. The size of the insulinoma ranged between 1.2 to 3 cm with average size of 2.14cm. 8 patients presented with Neuro glycopenicsymptoms however sympatho adrenergic symptoms were present in all cases. Different modalities were employed for pre-operative localization of these patients out of which 5 cases were localized with CT, 2 cases with MRI, 1 case with EUS, 2 of them could not be localized preoperatively were localized by IOUS. Tumor was in Head 2 cases, in the neck1 case and in the body/ Tail in 7 cases. 2 patients underwent Enucleation, 5 underwent distal pancreatectomy and splenectomy, 2 under went distal pancreatectomy and 1 underwent central pancreatectomy. 4 had pancreatic leak. All are symptom free and no episode of hypoglycemia at the time of discharge. Conclusion: Insulinomas are the most common neuroendocrine tumors of the pancreas. Surgical resection is the treatment of choice for insulinomas. From a surgical stand point, localization of the tumor is of critical importance. Intraoperative Ultrasonography with palpation gives good help in localizing the lesion.

RETROPERITONEAL LAPAROSCOPIC DISMEMBERED PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION (UPJO)

Objective: To share our experience of retroperitoneal laparoscopic dismembered pyeloplasty as the treatment of Ureteropelvic Junction Obstruction (UPJO) in Department of Urology, Hasan Sadikin Hospital Bandung. Material & Methods: Boy 8 years old came for a chance to relieve mass at both flank region especially at left flank region. From the ultrasonography there were bilateral hydronephrosis. We decided to urethrocystoscopy, bilateral ureteral catether insertion, bilateral retrograd pyelography guided with c-arm and left retroperitoneal laparoscopic dismembered pyeloplasty. Results: Operative time was 240 minutes and blood loss was about 200cc. Double J Stent was used for ureteral stenting. Parenteral ketorolac was given as needed to control the pain. The Visual Analogue Scale (VAS) post operative day 1 until 4 were6, 4,, 2, 2 respectively. Urethral catheter was removed at post operative day 2 and drain was removed at post operative day 3. Operating wound was good. Patient was hospitalization until post operative day 4. Left nephrostomy was removed at postoperative day 7 after there was no leakage, confirmed with left antegrad pyelography. From post operative ultrasonography we found that hydronephrosis at left kidney became almost normal. Conclusion: In our opinion that the retroperitoneal laparoscopic dismembered pyeloplasty is an alternative treatment for UPJO. This procedure depends on experience and pristine surgical tehnique from the surgeon

Effect of Intraoperative Ultrasonography on Change of Surgical Decision for Patients with Hepatocellular Carcinoma

Background: Hepato cellular carcinoma (HCC) is one of the most common cancers worldwide. Intra operative ultrasonography (IOUS) is considered an indispensable operative procedure for intra operative decision-making and guidance of surgical procedures. IOUS had changed hepatic surgery dramatically because it was the only modality that was capable of delineating and examining the interior of the liver during surgery especially after incorporation of color Doppler imaging and laparoscopic ultrasound into IOUS in1990s. IOUS can accurately define the hepatic segmental boundaries as well as the tumor boundaries. The use of IOUS started in Japan and from there it spread worldwide allowing for the development of different therapies to treat patients with HCC. Our aim was to determine if IOUS can changes surgical decision in hepatic resection for HCC. Methods: We retrospectively analyzed 48 consecutive liver resections performed at multiple centers over 3 years. Preoperative surgical decision was based on ultrasonography, computed tomography and/or dynamic magnetic resonance imaging (DMRI). The size, location and number of lesions were determined by IOUS and compared with preoperative imaging. Reviewing the operative report helped determine if new IOUS findings led to changes in surgical strategy. Pathology reports were analyzed for margins. Results: This study was conducted on 48 HCC consecutive patients 27 males and 21 females with age range from 49 to 67 years. Hepatic resection was decided as the treatment of choice for all patients. During operation direct inspection and palpation of the liver followed by IOUS were done. The operative decision was changed in 17 patients (35.4%), this was due to finding new additional tumors in 13 cases, and 4 cases showed change in tumour size on background of cirrhosis. Conclusion: We found that IOUS findings directly changed the operative surgical decision in 35.4 % of cases. Surgery was more accurately performed with IOUS. Despite the improvement of preoperative imaging modalities, IOUS can correctly define the hepatic segments as well as the extent of a tumor so it help for best operative decision in hepatic resections.

Tendon Resection and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair

Category: Other. Introduction/Purpose: An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon, itself, as well as the thin surrounding soft tissue. For management of an infected Achilles tendon following tendon repair, we first focused on complete debridement with tenectomy and then promoted scar healing of the Achilles tendon using functional management. Methods: We retrospectively reviewed all of the medical records of 15 patients with post-operative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, twenty two to 97 months). Tenectomy with radical debridement was performed, and the ankle was placed in a short leg splint for two weeks. The splint was then replaced with an ankle brace for the next four weeks. Partial weight-bearing walking was allowed immediately, and full weight-bearing walking was allowed two weeks postoperatively. We assessed the physical parameters such as range of motion, the calf circumference, capability of single heel raising, satisfactions and the Arner Lindholm scale were recorded. Laboratory test, post- operative ultrasonography and isokinetic plantar flexion power was also checked. Results: At the final follow-up, any sign of infection had disappeared without recurrence in all of the patients. Achilles tendon continuity recovered in all by scar healing. Compared to the contralateral side, there was no difference in the range of motion in eight patients. According to the Arner Lindholm scale, nine of fifteen cases were excellent and the other six cases were good. Their ability regarding single-heel rising on involved leg was achieved in ten patients. Eleven of 15 patients could return to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity within the tendon sheath was observed on the ultrasonographic examination or MRI. Conclusion: Tenectomy of infected Achilles tendon and radical debridement with vigorous rehabilitation is simple and successful management way for the postoperative infection following Achilles tendon repair.

P17.27 * HIGH GRADE GLIOMAS IN ELDERLY PATIENTS: RESULTS OF SURGERY AND INFLUENCE ON KARNOFSKY'S PERFORMANCE STATUS

The management of high grade gliomas (HGG) is complex and multidisciplinar. It has been demonstrated that the extent of resection, achieving gross total volume removal (GTR) has a relevant impact on progression free survival (PFS) and on overall survival (OS). Many strategies have been proven to be effective in achieving GTR such as neuronavigation, fluorescence and intra operative ultra sonography. It is remarkable to say that in multicentric trials, often elderly patients were excluded. Recently the interest in results of surgery in elderly patients has grown, and some studies proved the feasibility and advantages of a surgical resection of HGG in elderly patients. We retrospectively analyzed 73 elderly patients (age at diagnosis at least 70 years old) that were affected by HGG in non eloquent areas, therefore amenable to radical surgical excision, that underwent surgical resection in Our division from January 2008 to December 2012. KPS prior to surgery, post surgery and a month after was assessed. OBJECTIVE: Assess the role of surgery on variation of KPS in elderly patients. Materials and methods: we retrospectively analyzed 73 patients, 42 males (57%), 32 ( 43%) females, age range 70-84, mean age 73.87 years old, that underwent surgical excision of newly diagnosed HGG in Our division from January 2008 to December 2012. KPS assessment was performed prior to surgery, and a month after surgery, before adjuvant therapies administration. RESULTS: From data analysis, mean KPS pre-op was 82.5 (overall); mean KPS post operatory (1 month) was 84.5 (overall). 35/73 (47.9%) patients experienced no change in KPS. 24/73 (32%) improved their KPS score, 14/72 (19%) worsened their KPS score. Of the 14 patients which had a worsening in KPS, one month after surgery (before adjuvant treatment), 8 patients recovered, improving their KPS score, which was similar to pre operatory evaluation. The 35 patients that had stability of KPS after surgery, at 1 month after, did not worse; the same was found for patients that took benefit from surgery. CONCLUSIONS: We observed that surgical intervention in this cohort of elderly patients, lead to a stability or improvement of KPS in 59/72 patients (81,9%). The worsening in KPS was observed in 14/72 patients (19.4%), of which 8/14 recovered after rehabilitative program. Thus, we suggest that surgery for HGG in elderly patients with good KPS should be taken into consideration as a viable option.

Video-Assisted Thyroidectomy for Papillary Thyroid Carcinoma

Background. The results of video-assisted thyroidectomy (VAT) were evaluated in a large series of patients with papillary thyroid carcinoma (PTC), especially in terms of completeness of the surgical resection and short-to-medium term recurrence. Methods. The medical records of all patients who underwent video-assisted thyroidectomy for PTC between June 1998 and May 2009 were reviewed. Results. Three hundred fifty-nine patients were included. One hundred twenty-six patients underwent concomitant central neck node removal. Final histology showed 285 pT1, 26 pT2, and 48 pT3 PTC. Lymph node metastases were found in 27 cases. Follow-up was completed in 315 patients. Mean postoperative serum thyroglobulin level off levothyroxine was 5.4 ng/mL. Post operative ultrasonography showed no residual thyroid tissue in all the patients. Mean post-operative 131I uptake was 1.7%. One patient developed lateral neck recurrence. No other recurrence was observed.

Methods for induced abortion.

We describe present methods for induced abortion used in the United States. The most common procedure is first-trimester vacuum curettage. Analgesia is usually provided with a paracervical block and is not completely effective. Pretreatment with nonsteroidal analgesics and conscious sedation augment analgesia but only to a modest extent. Cervical dilation is accomplished with conventional tapered dilators, hygroscopic dilators, or misoprostol. Manual vacuum curettage is as safe and effective as the electric uterine aspirator for procedures through 10 weeks of gestation. Common complications and their management are presented. Early abortion with mifepristone/misoprostol combinations is replacing some surgical abortions. Two mifepristone/misoprostol regimens are used. The rare serious complications of medical abortion are described. Twelve percent of abortions are performed in the second trimester, the majority of these by dilation and evacuation (D&E) after laminaria dilation of the cervix. Uterine evacuation is accomplished with heavy ovum forceps augmented by 14-16 mm vacuum cannula systems. Cervical injection of dilute vasopressin reduces blood loss. Operative ultrasonography is reported to reduce perforation risk of D&E. Dilation and evacuation procedures have evolved to include intact D&E and combination methods for more advanced gestations. Vaginal misoprostol is as effective as dinoprostone for second-trimester labor-induction abortion and appears to be replacing older methods. Mifepristone/misoprostol combinations appear more effective than misoprostol alone. Uterine rupture has been reported in women with uterine scars with misoprostol abortion in the second trimester. Fetal intracardiac injection to reduce multiple pregnancies or selectively abort an anomalous twin is accepted therapy. Outcomes for the remaining pregnancy have improved with experience.

Operative ultrasonography for upper genital tract pathology.

A procedure using transvaginal sonohysterography (SHG) to perform operative intrauterine biopsies and resections is described. Seven women, six with intrauterine pathology noted on diagnostic SHG and one with a thickened endometrium noted on transvaginal ultrasonography, underwent attempted operative SHG. The indications were peri- and postmenopausal bleeding (n = 4) and infertility requiring assisted reproduction (n = 3). Access to the uterine cavity was accomplished with a 9-F cervical access catheter (CAC) with a 3-ml balloon (BEI Medical Systems, ZSI Gynecology Products Division, Chatsworth, CA), which was placed in the cervical canal or lower uterine segment. Depending on the position of the noted uterine pathology, a 6-F uterine ostial access catheter (UOAC) (BEI Medical Systems, ZSI Gynecology Products Division) was placed through the CAC. The uterine cavity was distended with 5-10 ml of 1% Lidocaine and a 3-F loop grasper or finger-like biopsy grasper was then passed through the UOAC or a 5-F operative instrument directly within the CAC with attempted resection under ultrasound guidance. Biopsied samples were sent to pathology for definitive diagnosis. Office hysteroscopy was then performed to confirm adequate resection. Three of six patients had adequate resection or biopsy of intrauterine pathology, while the seventh patient successfully had a directed biopsy of the fundal cavity under ultrasound guidance. In one case, the visualized lesion could not be grasped. In the other two cases, each patient had severe cervical stenosis and declined in-office cervical dilation precluding the procedure. Each procedure was well tolerated, with an average time from start to finish of about 25 min (range, 18-43 min) without complications. Operative SHG makes it possible to resect and biopsy intrauterine pathology often missed on Pipelle sampling. If found to be as effective as hysteroscopy, operative SHG would provide a cost-effective alternative. Further study is ongoing to perfect the existing instruments to allow removal of larger lesions both safe and possible.

The Management of Hepatic Hydatid Cyst Cavity By Overlapping

The obliteration of the cyst cavity after evacuation is a controversial procedure in hepatic hydatid disease. There is no ideal surgical technique which can be used in all hydatid cyst cavities. Since 1989 we have been using a new technique, which we call overlapping, in the treatment of suitable cases of hepatic hydatid cyst cavities. The technique depends on the obliteration of the cavity without drainage. After evacuating the hydatid material from the cavity, instillation of the cystic cavity is performed with scolecidal agent (silver nitrate solution, 0.5%). The cavity is opened along its long axis. The pericyst is prepared, and the upper edge is sutured to the bottom of the cavity with absorbable stitch (modified external collapse). Before doing this, if there is no possibility of operative ultrasonography, the cavity is punctured with a fine needle to evaluate any dangerous areas. Then the other edge of the pericyst is laid down beside the collapsed one and sutured to the former with the same technique. The term “overlapping” stems from this second procedure. During the operation, we decide which pericyst will collapse and which one will overlap. Before overlapping, openings between the cavity and biliary tree should be found and if there are any, they should be secured. In cases of large and multiple openings, T-tube choledochostomy is necessary. We applied overlapping to 31 of 43 hepatic hydatid cysts (ranging from 5 to 17 cm in diameter, with a mean of 12 cm) in 19 patients. Twenty-four of 31 cysts had partial pericystectomy before overlapping. Three cystic cavities were connected to the biliary tree. Because of a large connection, T-tube choledochostomy was added in one case. We have not seen any complications, either infection or biliary fistula. The results of the obliteration of cavities were excellent in 15 cysts. There were no residual cavities

Anatomical hepatectomy for resection or transplantation

Anatomical resection has become the basis for the treatment of hepatic tumors recognizing the portal-based intrahepatic architecture of the liver. In transplantation, these principles have been applied to the creation of partial liver grafts used to treat pediatric recipients with grafts from adult donors. In this study we reviewed the results of application of these techniques in 60 patients undergoing major hepatectomy and in 47 liver transplants in children. Records of patients undergoing resection and children undergoing transplantation were reviewed. A descriptive study was performed characterizing the methods and results achieved using anatomic hepatectomy. Outcomes analyzed included surgical morbidity and survival. Sixty consecutive patients underwent major hepatectomy without operative mortality (60 days). Complications occurred in 26% of patients, requiring reoperation in 2 cases (3%); median hospital stay was 8.5 days. Of 47 liver transplants in children, 57% utilized partial grafts, and living donors were used in 15 cases. Actual patient survival is 91% 1-36 months after surgery. No patient deaths were due to technical graft failure. Major hepatic surgery can be accomplished with low mortality applying portal-based anatomy. Surgical precision is made possible by vascular isolation for hepatectomy and operative ultrasonography. These principles are essential for successful use of partial liver grafts in children.

Operative ultrasonography during hepatobiliary and pancreatic surgery.

On the basis of our experience with operative ultrasonography during hepatobiliary and pancreatic surgery, its indications, benefits, and disadvantages are summarized. High-resolution operative ultrasound scanning of the liver, biliary tract, and pancreas was performed during 357, 735, and 242 operations, respectively. The benefits of operative ultrasonography were categorized as acquisition of diagnostic information otherwise not available, replacement for or complement to operative radiography, and guidance of surgical procedures. Operative ultrasonography provided beneficial information during 73 of 82 hepatic operations (89.0%), 57 of 69 noncalculous biliary operations (82.6%), and 177 of 242 pancreatic operations (73.1%). Operative ultrasonography was significantly superior (sensitivity 93.3%) to other screening tests for diagnosing liver metastasis from colorectal carcinoma evaluated in 189 patients, and it detected previously unrecognized metastatic tumors in 18 patients (9.5%). For screening common bile duct calculi during 666 operations, operative ultrasonography and operative cholangiography were comparable in all indices of accuracy except for a higher predictability of a positive test of operative ultrasonography (94.8% versus 71.7%). For diagnosing portal vein invasion of pancreatic carcinoma, operative ultrasonography provided better overall accuracy than preoperative studies (89.7% versus 64.1%). On the basis of operative ultrasound findings, previously planned surgical procedures were altered in 32 of 82 hepatic operations (39.0%) and 24 of 145 pancreatic operations for chronic pancreatitis (16.6%). Operative ultrasound guidance of various surgical procedures was performed during 88 hepatic and 84 pancreatic operations, including 40 ultrasound-guided hepatectomies and 42 pancreatotomies. Operative ultrasonography has a number of advantages, such as safety and speed in performance, wide application, high diagnostic accuracy, and ability of guiding procedures. Its disadvantages are the limitation of the fields of view in certain applications, the need for special equipment, and a slow learning curve.

Hepatic resection guided by needles inserted under ultrasonographic guidance.

Operative ultrasonography for orienting the direction of transection of the liver is often useful in obtaining an adequate disease-free surgical margin. We have devised a new technique for hepatectomy guided by needles inserted under ultrasonographic guidance. One hundred two hepatectomies were performed between January 1987 and September 1991, and the hepatectomy with this technique was begun in January 1989. In 10 of 29 limited hepatectomies performed in the first phase of the period in which this technique was not available, disease-free surgical margin of less than 1 cm was left because of inadequately directed division. Disease-free surgical margin of more than 1 cm was left in 18 of 23 limited hepatectomies in the second phase of the period in which this technique was available. In the other five operations where disease-free surgical margin of less than 1 cm was left, carcinomas were located too close to the major hepatic vessels. The average blood loss during the limited hepatectomies was reduced by this technique. Two-year and 3-year survival of patients undergoing hepatectomy for hepatocellular carcinoma were more favorable in the second phase than in the first phase. Although the difference between the two groups was not significant, this technique is useful in performing adequate transection of the liver.

The value of operative ultrasonography in diagnosing tumor extension of carcinoma of the stomach : Kodama 1, Machi J, Tanaka M, Yoshida C, Sigel B (J.M.: Department of Surgery, The Medical College of Pennsylbania, 3300 Henry Avenue, Philadelphia, PA 19129) Surg Gynecol Obstet 1992;174:479–484

Operative ultrasonography was performed during operations to improve the accuracy of diagnosing the extent of the spread of carcinoma of the stomach in the following areas: tumor invasion in the gastric wall (31 patients), para-aortic lymph node metastasis (30 patients) and hepatic metastasis (30 patients). The over-all diagnostic accuracy rates of operative ultrasonography were 81 per cent for determining the depth of tumor invasion, 80 per cent for carcinoma of the mucosa, 70 per cent for carcinoma of the submucosa, 83 per cent for carcinoma of the proper muscle, 80 per cent for carcinoma of the subserosa and 100 per cent for carcinoma of the extraserosa. The over-all accuracy of operative ultrasonography in diagnosing para-aortic lymph node metastasis was 93 per cent. In comparison with the results of preoperative studies, the accuracy (sensitivity) of operative ultrasonography was significantly superior in diagnosing metastasis to the lymph nodes. In three of 30 operations, preoperatively unrecognized and nonpalpable (occult) hepatic metastases were identified by operative ultrasonography. Operative ultrasonography provides more accurate information regarding the spread of carcinoma of the stomach, and thus may be helpful in deciding upon the type of surgical procedure or in avoiding unnecessary tissue dissection.

Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears

In this study we assessed the clinical usefulness of ultrasonography as a modality in the diagnosis of rota tor cuff tears. One hundred twenty patients with pre operative ultrasonography were analyzed by diagnostic arthroscopy to evaluate rotator cuff integrity. Two groups, 61 patients with a positive ultrasonogram and 59 patients with a negative ultrasonogram, were ana lyzed. The 61 patients with a positive ultrasonogram preoperatively were found to have 42 full-thickness tears and 19 partial-thickness tears. Diagnostic arthros copy confirmed a sensitivity of 95% for the full-thick ness tears and 41 % for the partial-thickness tears. In the 59 patients with negative ultrasonography, the specificity for full-thickness tears was 93% and in the 19 partial-thickness tears it was 91 %. Our conclusion is that ultrasonography is an effective modality for the assessment of full-thickness tears, but not partial-thick ness tears.

Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears

In this study we assessed the clinical usefulness of ultrasonography as a modality in the diagnosis of rotator cuff tears. One hundred twenty patients with preoperative ultrasonography were analyzed by diagnostic arthroscopy to evaluate rotator cuff integrity. Two groups, 61 patients with a positive ultrasonogram and 59 patients with a negative ultrasonogram, were analyzed. The 61 patients with a positive ultrasonogram preoperatively were found to have 42 full-thickness tears and 19 partial-thickness tears. Diagnostic arthroscopy confirmed a sensitivity of 95% for the full-thickness tears and 41% for the partial-thickness tears. In the 59 patients with negative ultrasonography, the specificity for full-thickness tears was 93% and in the 19 partial-thickness tears it was 91%. Our conclusion is that ultrasonography is an effective modality for the assessment of full-thickness tears, but not partial-thickness tears.

Operative ultrasound guidance for various surgical procedures

Although percutaneous ultrasound-guided technique is currently a common practice, the use of ultrasound for the purpose of guidance during surgery has not been widely practiced. Over a period of 10 years, we performed operative ultrasonography in 2,314 operations. In 321 of these operations, operative ultrasound guidance was performed for direct assistance of various surgical procedures, particularly during operations on the brain and spinal cord, liver, pancreas, and kidney. Procedures guided by operative ultrasound were classified into the following categories: intraoperative needle placement for fluid aspiration ( n = 38), agent injection ( n = 14), catheter introduction ( n = 27), biopsy ( n = 57), surgical tissue dissection for incision ( n = 48), resection ( n = 82) of organs, and extraction ( n = 55) of stones or foreign bodies. Operative ultrasound guidance facilitates various surgical procedures and is considered a useful modality for reducing operative complications, shortening operating time, performing otherwise impossible procedures, and, at times, developing new surgical operations.