Abdominal Ultrasound Research Articles

Diagnostic Use of Ultrasonography for Acute Appendicitis: A Single Centre Experiences

Background: Acute appendicitis is a common and urgent surgical condition characterized by inflammation of the appendix. Rapid and accurate diagnosis is critical to prevent complications such as perforation. Ultrasonography has emerged as a valuable diagnostic tool due to its non-invasive nature, accessibility, and effectiveness in visualizing appendiceal inflammation. Aim of the study: This study aims to evaluate the effectiveness of ultrasonography in the diagnosis of appendicitis. Methods: This prospective observational study was conducted at 250 Beded general hospital Tangail, Bangladesh from 1/1/23 to 31/12/23. Ninety-five patients aged 15 to 60 years with acute appendicitis and right lower quadrant pain were included after obtaining informed consent. The hospital's review committee granted ethical approval. Data collection involved comprehensive clinical, radiological, and surgical evaluations using a standardized protocol. High-resolution abdominal ultrasonography was performed with the graded compression technique by experienced radiologists. Diagnostic accuracy was assessed through sensitivity, specificity, PPV, and NPV calculations. Data were analyzed using SPSS version 26.0, with significance at p<0.05. Result: The study included 95 participants, with a mean age of 28.57 years. Most were aged 15-20 (46.32%), and 58.95% were male. Pain was universally reported, with anorexia (85.26%), fever and nausea (65.26%), and vomiting (52.63%) being common. Peri-umbilical pain shifting to the right iliac fossa (RIF) was noted in 49.47%. Pain lasted 18-24 hours in 35.79% of cases. Pulse rate was ≤100/min in 75.79% of patients, with 61.05% having body temperatures between 98.6-100°F. Localized tenderness was present in 70.53% of patients. High-resolution ultrasonograms diagnosed acute appendicitis in 60% of cases with a sensitivity of 85.5% and specificity of 83.3%. Conclusion: High-resolution ultrasonography (HRUS) is an effective diagnostic tool for acute ...

Validation of a tele-robotic ultrasound system for abdomen and thyroid gland explorations: a comparison with standard ultrasound

BackgroundTele-robotic ultrasound (US) is a novel technique that might help overcome the current shortage of radiologists and poor access to radiologists and/or sonographers in remote or rural areas. Despite the promising results of this technology in the past two decades, there is still insufficient data about its advantages and limits, as well as the implementation in routine clinical practice and the learning curve for the user. The purpose of this prospective cohort-based study is to evaluate the performance of a 5G-based tele-robotic US system for abdominal and thyroid gland assessment in a cohort of healthy volunteers and outpatients, as well as assessing the learning curve and patient satisfaction.Results64 participants (23 male, 41 female) were consecutively included during the recruitment period, for a total of 51 abdominal and 37 thyroid gland US studies. The mean age was 45.23 ± 18.90 years old, and the body mass index of the abdominal cohort was 22.97 ± 2.95 kg/m2. The learning curve estimated a minimum of 20 patients for abdominal tele-robotic US training, being almost non-existent in the thyroid gland cohort. All the variables showed no-statistical differences between standard US and tele-robotic US in the abdominal post-trained cohort except the visualization of the left kidney short axis and its interpolar length. Thyroid gland variables showed no statistical differences. The mean time of exploration for the tele-robotic US for abdomen and thyroid gland examinations were 18.33 ± 6.26 min and 4.64 ± 0.97 min respectively. Most participants (> 70%) felt comfortable and safe while being examined by the tele-robotic US.ConclusionTele-robotic US achieves equal performance in comparison with the standard US when evaluating abdominal structures in this cohort of patients, as well as a relatively fast learning curve and good patient satisfaction. The performance when assessing the thyroid gland is almost identical to the standard US, which makes it a strong first candidate for a future clinical implementation.

Abdominal Ultrasonography in Healthy Female Standard Donkeys

Abdominal Ultrasonography in Healthy Female Standard Donkeys

Case report: Rituximab combined with plasma exchange treatment for systemic lupus erythematosus complicated with thrombotic microangiopathy and non-cirrhotic portal hypertension

IntroductionSystemic lupus erythematosus (SLE) complicated by thrombotic microangiopathy (TMA) and non-cirrhotic portal hypertension (NCPH) is rare. We present a case of a female patient with SLE who developed TMA and NCPH and responded positively to rituximab and plasma exchange treatment.Case descriptionA 53-year-old woman was admitted with 6 h of confusion. Upon admission, she was diagnosed with SLE complicated by lupus encephalopathy, blood system impairment, cardiomyopathy, and nephritis. Initial treatment with high-dose methylprednisolone, immunoglobulin shock therapy, and tacrolimus (1 mg, twice daily) improved her symptoms and laboratory indicators. However, after a pulmonary infection and infection with the 2019 novel coronavirus, the patient’s condition deteriorated further. She experienced confusion and a delayed response. Hemoglobin levels and platelet counts decreased, lactate dehydrogenase and creatinine levels increased, and the percentage of peripheral schistocytes was approximately 6.5%. Abdominal ultrasonography revealed a substantial amount of ascites, diffuse liver lesions, splenomegaly, and splenic varices. Enhanced computed tomography revealed diffuse liver disease along the portal veins, intrahepatic lymphatic dilatation, esophageal and gastric varices, a splenorenal vein shunt, and splenomegaly. The patient was negative for hepatitis virus, autoimmune liver disease antibodies, ceruloplasmin, and tumor markers. Therefore, SLE complicated by TMA and NCPH was considered. She was treated with high-dose methylprednisolone (500 mg) for 3 days and immunoglobulin (0.4 g/kg/day) for 5 days, followed by rituximab (500 mg) for suppressive immunotherapy combined with plasma exchange (seven times), low-molecular-weight heparin (5,000 U every 12 h) for anticoagulation, and a diuretic. The patient’s symptoms and laboratory indicators improved.ConclusionThis case suggests that a combination of rituximab, plasma exchange, anticoagulation, and diuretics may be an effective treatment for patients with SLE complicated by TMA and NCPH.

Frequency of polycystic ovarian morphology and other ultrasonographic findings in Iranian female athletes.

Polycystic ovary morphology and ovarian cysts are frequent and usually asymptomatic in young female individuals. The present study is the first to examine ovarian sonographic findings in asymptomatic female athletes from Iran. This study aimed to evaluate the frequency of such sonographic findings in healthy female athletes on a screening basis. In this cross-sectional observational study, 455 females from 16 provinces of Iran were evaluated by trans-abdominal sonography during their routine pre-participation medical evaluation. The mean age of participants was 21.8 years (SD 5.3). The mean age at the beginning of exercise was 14.20 years (SD = 4.25). Menarche occurred at 11-20 years with a mean of 13.5 years (SD 1.5). Judokas had the lowest (12.1 years), and football players had the highest menarche age (14.6 years; as compared to 12.8 years in the Iranian female population). In 87.5 % of participants, the sonographic findings were within normal limits. 4.8 % of all examinations revealed polycystic ovary morphology (PCOM), 5.7 % of participants had a simple cyst(s), and 20.8 % of cysts had diameters >49 mm. In those athletes who began regular performance-oriented training before menarche, PCOM was found in only 2.4 %. There was a significant positive linear association between BMI groups and PCOM (p = 0.003), but not for simple cysts. Frequency of PCOM (p < 0.001) as well as ovarian cysts (p = 0.012) were significantly different among studied sport types. There was a significant positive correlation between delayed menarche status and PCOM (p = 0.017). However, no such relationship was found for simple cysts. Maintaining a healthy body mass index and beginning regular exercise before menarche may have a preventative effect for polycystic ovary morphology in female athletes.

Maximum Diameter of Ileocecal Lymph Nodes Measured Using Abdominal Ultrasonography Allows for the Discrimination of Yersinia pseudotuberculosis Infection from Kawasaki Disease.

This study aimed to determine whether the maximum diameter of ileocecal lymph nodes measured using abdominal ultrasonography is useful for differentiating Yersinia pseudotuberculosis infection from Kawasaki disease in the acute phase. The optimal maximum diameter cutoff of the ileocecal lymph nodes was also explored to optimize differentiation between these 2 diseases. We included pediatric patients <15 years old who met the diagnostic criteria for Kawasaki disease. Stool culture testing, loop-mediated isothermal amplification of stool specimens, and serological diagnosis were performed to confirm the presence or absence of Y. pseudotuberculosis infection. Of the 122 patients included in the analysis, 17 were confirmed to have Y. pseudotuberculosis infection and 105 were not. The age (in months), white blood cell count, C-reactive protein level, prediction score (risk score) for nonresponse to intravenous immunoglobulin, and number of intravenous immunoglobulin doses did not differ significantly between the Y. pseudotuberculosis -positive and -negative groups. The maximum diameter of ileocecal lymph nodes was 6.0 (5.5-9.5) mm in the Y. pseudotuberculosis -positive group and 3.0 (2.5-3.8) mm in the Y. pseudotuberculosis -negative group (numbers presented as median, interquartile range), with a significantly larger diameter in the Y. pseudotuberculosis -positive group ( P < 0.01, Mann-Whitney U test), suggesting potency of ultrasonography. In patients meeting the diagnostic criteria for Kawasaki disease, the possibility of Y. pseudotuberculosis infection is significantly higher if the maximum ileocecal lymph node diameter ≥5.1 mm. Its sensitivity and specificity being 100%, and 89.5%, respectively.

Diagnostic Accuracy of Transabdominal Ultrasound in the Diagnosis of Ectopic Pregnancy Taking Transvaginal Ultrasound as the Gold Standard

Background: The diagnostic accuracy of transabdominal ultrasound in the diagnosis of ectopic pregnancy has rarely been studied in our population. Hence, the study has been planned. Objective: This study aimed to determine the accuracy of transabdominal ultrasound in the diagnosis of ectopic pregnancy, transvaginal ultrasound was used as the gold standard. Materials and Methods: This cross-sectional study was carried out at the Department of Radiology, Northwest General &amp; Research Centre, Peshawar, from 12th June 2022 until 12th December 2022. Patients aged 15--45 years presenting with signs and symptoms of ectopic pregnancy were enrolled. Transabdominal ultrasound was performed, and the diagnostic accuracy was compared with that of transvaginal ultrasound to determine the diagnostic accuracy. The data were analysed via SPSS version 25. Results: A total of 143 patients were enrolled. The mean age of the patients was 30.01±5.518 years. The majority of the patients were aged less than 30 years (n = 84, 58.7%). The sensitivity, specificity, PPV, NPV and accuracy of transabdominal ultrasound were 93.9%, 100.0%, 100.0%, 57.8% and 94.4%, respectively. Conclusion: The clinical spectrum of ectopic pregnancy is very wide. Transabdominal ultrasound is a useful noninvasive diagnostic tool for the diagnosis of ectopic pregnancy.

The Relationship of Fatty Liver with Body Composition Indices in Individuals with Metabolic Disorders - A Cross-Sectional Study

Objective: In this study, it was aimed to screen fatty liver in individuals with metabolic disorders, and to investigate the use of some anthropometric calculations and body composition indices in demonstrating fatty liver disease. Methods: The cross-sectional study included 224 participants with metabolic diseases. Anthropometric measurements of the participants were measured. Waist/Height ratio, Rohrer Index, Broca-Katsura Index, Relative Fat Mass (RFM), Body Roundness Index (BRI), A Body Shape Index (ABSI) were calculated. The presence of qualitative steatosis was evaluated abdominal ultrasonography. As a result of all analyzes, p &lt;0.05 was accepted as significant. Results: The mean age of the 224 participants included in the study was 55.1±10.6 (min=23, max=83) years. 84 (37.5%) of the participants were female and 140 (62.5%) were male. Steatosis was detected on ultrasonography in 142 (63.4%) of the participants. Waist/Height ratio, Rohrer index, Broca-Katsura index, RFM, BRI, BMI and waist circumference were found to be significantly higher in participants with steatosis (p&lt;0.05). According to the ROC analysis, BRI cut-off value of 4.6 were found to be significant in detecting steatosis. Conclusions: As a result of our study, we found that various body composition indices, especially BRI, were associated with fatty liver. Especially in female, it was seen that screening of fatty liver with cut-off values of body composition indices, and confirmation by ultrasonography, if necessary, may enable early diagnosis. In male, it was seen that body composition indices and fatty liver could not be determined directly, only BMI and waist circumference were indicative. doi: https://doi.org/10.12669/pjms.41.1.9261 How to cite this: Hacıagaoglu N, Oner C, Cetin H, Simsek EE. The Relationship of Fatty Liver with Body Composition Indices in Individuals with Metabolic Disorders - A Cross-Sectional Study. Pak J Med Sci. 2025;41(1):214-218. doi: https://doi.org/10.12669/pjms.41.1.9261 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment.

Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated MRIs are being investigated. Multiphasic CT or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease immune checkpoint inhibitor (ICI)-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.

Efficiency of Skeletal Muscle Mass/Weight Measurement for Distinguishing Metabolic Dysfunction-Associated Steatotic Liver Disease: A Prospective Analysis Using InBody Bioimpedance Devices.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is diagnosed when hepatic steatosis is proven by imaging and one of the five cardiometabolic criteria is present. The relationship between MASLD and body composition components has recently received increased research attention. However, the five cardiometabolic criteria do not include components of body composition. This study aimed to identify significant body composition factors associated with MASLD in patients undergoing health checkups. This study included a cohort of 6599 examinees who participated in a health check-up conducted between 2022 and 2023, and their data were prospectively analyzed. The inclusion criteria were undergoing abdominal ultrasonography, alcohol consumption <30 g/day for males or <20 g/day for females, and one of the five cardiometabolic criteria. Finally, 3864 examinees were enrolled. In total, 1133 (51.8%) males and 454 (27.1%) females had MASLD. Sarcopenia was present in only 0.62% of males and 0.66% of females with MASLD. The MASLD group had significantly lower skeletal muscle mass/weight (SMM/WT) values than the non-MASLD group. Multivariate analysis revealed that SMM/WT was independently associated with MASLD. SMM/WT was significantly associated with MASLD. Therefore, muscle mass assessment using SMM/WT may be a potential marker for diagnosing MASLD.

Casual detection of an abdominal aortic aneurysm thanks to a trainee-made ultrasound with two subsequent "domino" diagnoses: case report and insights on the role of ultrasound courses.

Early detection of abdominal aortic aneurysm (AAA) is crucial as untreated lesions can be life-threatening. We describe the case of a fortuitous ultrasound (US) detection of AAA by a trainee which allowed two subsequent "domino" diagnoses. A 69 y.o. male underwent US to evaluate prostate and bladder. He was a heavy smoker affected by hypertension and dyslipidemia. An endocrinology resident and ultrasound trainee started the exam accidentally from the epigastrium and found a fusiform aneurysmal lesion. Subsequent computed tomography (CT) scan confirmed the diagnosis of AAA and incidentally revealed a colon adenocarcinoma and a diffuse non-Hodgkin lymphoma. This case report underlines the importance of extending the abdominal US examination to the aorta in patients over 60years of age (especially in those people with multiple risk factors for AAA) and emphasizes the critical role of organizing hands-on-patient US courses with a multidisciplinary approach to optimize the training of future sonographers.

FREQUENCY OF UTERINE CURETTAGE AS A RISK FACTOR AMONG PATIENTS WITH PLACENTA PREVIA PRESENTING AT TERTIARY CARE HOSPITAL

Placenta previa is the placenta lying entirely or in part in the lower uterine segment. Its incidence is about 0.28–2%. In local studies, a frequency of 0.51–3.5% has been reported. Advancing maternal age, multiparity, previous cesarean sections, miscarriages, uterine curettage cocaine use, smoking, and previous history of placenta previa have all been attributed as risk factors for placenta previa. Objective: To determine the frequency of uterine curettage leading to placenta previa among women presenting to tertiary care hospitals. Methods: This Descriptive cross-sectional study was conducted at the Department of Gynaecology and Obstetrics, Lady Reading Hospital Peshawar from 2/10/2020 to 2/4/2021. In this study, a total of 136 patients were observed. History was taken from the patient (bleeding, pain in abdomen to exclude other causes). Placenta previa was defined as placenta covering or reaching within 2 cm of internal or detected by the last trans-abdominal ultrasonography before delivery. Results: Our study shows that among 136 women mean age was 34 years with SD ± 8.91. 30(22%) patients were primi para while 106(78%) patients were multi para. 27(20%) patients were primi gravida while 109(80%) patients were multi gravida. More than 29(21%) patients had uterine curettage while 107(79%) patients didn’t have uterine curettage. Conclusion: Our study concludes that the frequency of uterine curettage in patients presented with Placenta previa was 21% in our setup.

Cutaneous plasmacytosis in a dog (Caninus familiaris)

AbstractCutaneous plasmacytosis is rarely reported in veterinary medicine, but far more described in human medicine. Extramedullary plasmacytomas are plasma cell tumours without bone marrow involvement. This study aimed to report a case of a 7‐year‐old, mixed‐breed dog with a presumptive diagnosis of cutaneous plasmacytosis. At clinical examination, the dog presented 15 cutaneous nodules disseminated through the body. Cytopathological analysis revealed plasmacytoma in 13 out of 15 nodules. Thoracic radiography revealed radiopaque structures suggestive of pulmonary nodules, and abdominal ultrasonography indicated suspicion of a hepatic neoplastic process. The animal died during the diagnostic screening period, with a survival of 16 days from the initial consultation. Thus, further confirmatory tests such as histopathology and immunohistochemistry were not performed, and the pulmonary and hepatic lesions were not assessed. This report demonstrates the importance of cytopathology in the presumptive diagnosis of cutaneous plasmacytosis in a dog, considering the absence of other complementary examinations.

Unusual Manifestation of Retained Product of Conception in the Cervix: A Case Study

Retained products of conception (RPOC) occur when fragments of the placenta or decidual tissue remain in the uterus, often leading to postpartum hemorrhage. Early and accurate diagnosis, aided by ultrasonography, is essential for appropriate management and prevention of complications. We report a case of a 22-year-old woman admitted to our tertiary medical department with irregular vaginal bleeding and abdominal pain. She had no significant past medical history. Abdominal ultrasonography revealed a normal-sized uterus with homogeneous myometrial echogenicity. However, a heterogeneous echogenic mass, exhibiting considerable vascularity and feeding vessels from the endometrial cavity, was observed in the cervix. Additionally, the patient’s beta human chorionic gonadotropin (Beta-HCG) concentration was positive, with a titer of 201 μ/l, despite her claim of being a virgin. Subsequently, the patient underwent hysteroscopy, during which an infected and malodorous lesion was removed from the uterus, confirming the diagnosis of RPOC. In follow-up assessments, she experienced no complications. To the best of our knowledge, no cases of RPOC located in the cervix have been reported previously, as RPOC is typically expected to be found in the endometrial cavity. This study aims to share our experience in considering the differential diagnosis of RPOC as cervical lesions and highlights the importance of ultrasonography in early pregnancy management

A quality assessment tool for focused abdominal sonography for trauma examinations using artificial intelligence.

Current tools to review focused abdominal sonography for trauma (FAST) images for quality have poorly defined grading criteria or are developed to grade the skills of the sonographer and not the examination. The purpose of this study is to establish a grading system with substantial agreement among coders, thereby enabling the development of an automated assessment tool for FAST examinations using artificial intelligence (AI). Five coders labeled a set of FAST clips. Each coder was responsible for a different subset of clips (10% of the clips were labeled in triplicate to evaluate intercoder reliability). The clips were labeled with a quality score from 1 (lowest quality) to 5 (highest quality). Clips of 3 or greater were considered passing. An AI training model was developed to score the quality of the FAST examination. The clips were split into a training set, a validation set, and a test set. The predicted scores were rounded to the nearest quality level to distinguish passing from failing clips. A total of 1,514 qualified clips (1,399 passing and 115 failing clips) were evaluated in the final data set. This final data set had a 94% agreement between pairs of coders on the pass/fail prediction, and the set had a Krippendorff α of 66%. The decision threshold can be tuned to achieve the desired tradeoff between precision and sensitivity. Without using the AI model, a reviewer would, on average, examine roughly 25 clips for every 1 failing clip identified. In contrast, using our model with a decision threshold of 0.015, a reviewer would examine roughly five clips for every one failing clip - a fivefold reduction in clips reviewed while still correctly identifying 85% of passing clips. Integration of AI holds significant promise in improving the accurate evaluation of FAST images while simultaneously alleviating the workload burden on expert physicians. Diagnostic Test/Criteria; Level II.

Investigating the Reproducibility of Abdominal and Vaginal Uterine Artery Doppler Ultrasound in the First and Second Trimesters

Investigating the Reproducibility of Abdominal and Vaginal Uterine Artery Doppler Ultrasound in the First and Second Trimesters

Is Antenatal Ultrasound Isolated Fetal Liver Calcifications a Sign of Concern?

Is Antenatal Ultrasound Isolated Fetal Liver Calcifications a Sign of Concern?

Biliary sphincterotomy resets pancreaticobiliary pain refractory to intrasphincteric Botox injections in functional biliary pain.

The management of Type III sphincter of Oddi dysfunction or functional biliary pain (FBP) is challenging. A strategy of intermittent intrasphincteric botulinum toxin (Botox) injections into the sphincter of Oddi can alleviate pancreaticobiliary pain. In patients who lose response to intermittent Botox injections, endoscopic biliary sphincterotomy (ES) could potentially reset pain facilitating ongoing management of symptoms. A retrospective review of case notes over a seven-year period (2014-2021) was performed. All patients underwent blood tests, gastroscopy, trans-abdominal ultrasonography, cross-sectional imaging withmagnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) and endoscopic ultrasound (EUS)to rule out alternative causes for their symptoms of pancreaticobiliary pain. A diagnosis of FBP was made in patients with typical post-cholecystectomy pain and normal liver function tests and bile duct size on imaging. Patients with symptomatic FBP underwent intermittent endoscopic Botox injections to the sphincter of Oddi. Patients who lost response to Botox injections underwent ES and were followed up in an outpatient setting to assess response. One hundred and thirty (128 female, 2 male) patients with FBP underwent a mean of four (2-8) Botox injections over the study period. Of 130 (90%) patients, 117 reported a significant improvement in pain on post procedure review with 81% of patients managing to discontinue opioid medication post procedure. Fifty-one out of 130 (39%) lost response to Botox injections after a median of six (range 5-11) sessions (median eightmonths between sessions [range 6-18months]) and continued to have ongoing pancreaticobiliary pain and subsequently underwent biliary ES. Forty-one out of 50 (82%) reported a clinical improvement in their symptoms of pancreaticobiliary pain following ES, with response persisting at follow-up for up to mean of eight (5-15) months and no further hospital attendances due to severe pancreaticobiliary pain. ES can reset pancreaticobiliary pain in FBP once Botox injection therapy to the sphincter of Oddi becomes ineffective and may provide ongoing relief of symptoms.

Combinatorial Effects of Terpene, Chenodeoxycholic Acid, and Ursodeoxycholic Acid on Common Bile Duct Stone Recurrence and Gallbladder Stone Dissolution.

Background: Ursodeoxycholic acid (UDCA), chenodeoxycholic acid (CDCA) plus UDCA (C&U), and terpene are widely administered to prevent common bile duct (CBD) stone recurrence and dissolve gallbladder (GB) stones. We evaluated and compared the combined effects of these agents on CBD stone recurrence and GB stone resolution. Methods: This study included patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at six referral centers, retrospectively. A total of 940 patients who underwent cholecystectomy before or after CBD stone removal by ERCP were evaluated to assess CBD stone recurrence (the CBD recurrence cohort), and 98 patients with GB stones were assessed by abdominal or endoscopic ultrasonography before and 6 months after ERCP to evaluate GB stone resolution (GB cohort). Patients were divided into no-medication, single-agent treatment (UDCA, C&U, or terpene), or dual-agent treatment (terpene plus UDCA or C&U) groups for the analysis. Results: In the CBD recurrence cohort, baseline characteristics were similar in the three groups. CBD stone recurrence rates were 41.5%, 12.7%, and 9.8% in the no-medication, single-agent, and dual-agent groups, respectively (p < 0.001), and the recurrence rate was significantly lower for those administered C&U plus terpene (5.2% vs. 13.2%, p = 0.002). In the GB cohort, baseline characteristics were also similar in the groups. GB stone resolution rates of >30% were observed in 5.3%, 14.3%, and 34.8% of patients in the no-medication, single-agent, and dual-agent groups, respectively (p = 0.028). Conclusions: C&U plus terpene was significantly more effective for preventing CBD stone recurrence and achieving GB stone resolution than no medication or single agents.

Percutaneous Ultrasound Guided Celiac Plexus Approach: Results in a Pig Cadaveric Model.

Celiac plexus (CP) block (CPB) and neurolysis (CPN) are interventional techniques employed in human analgesia to control visceral pain originating from the upper abdomen. Visceral pain is common in animals and its treatment is challenging. A percutaneous ultrasound (US)-guided approach to the CP has been reported in people but not in veterinary species. The objective of this study is to describe a US-guided percutaneous approach to the CP in a porcine cadaveric model. Cadavers were positioned in right lateral recumbency. The vertebral body of the last thoracic vertebra (T15) was identified (in transverse view) with a left cranial abdominal US scan. Under US guidance, an 18 G Tuohy needle was inserted parallel and ventral to the transverse process of T15. The transducer was gently slid and tilted to have an in-plane view while introducing the needle through the epaxial muscle layer. Once the T15 body was contacted, the needle was advanced towards the ventral surface of the vertebra, and if loss of resistance was present, 2 mL of dye (China Ink) was injected. A laparotomy was performed, and the dyed tissue dissected for histological preparation from 14 cadavers. In all samples submitted for histological study, tissue belonging to the CP was found. The percutaneous ultrasound-guided approach to the CP was effective in localizing the CP in all subjects. Future studies are warranted to identify the clinical utility of this technique in veterinary species.