Junichi Ishine

Evaluation of virtual CT sonography for enhanced detection of small hepatic nodules: a prospective pilot study.

OBJECTIVE Virtual CT sonography is a system for synchronizing multiplanar reconstructed CT scans with corresponding conventional ultrasound images in real time. The aim of this study was to prospectively evaluate the feasibility of virtual CT sonography for detection of nodules difficult to detect with conventional sonography alone. SUBJECTS AND METHODS Fifty-nine patients with 140 nodules were included in the study. All patients underwent CT angiography then conventional sonography and finally virtual CT sonography. The number, location, and echogenicity of nodules and parenchyma were assessed. RESULTS Among 140 nodules detected with CT angiography, 71 were detected with conventional sonography and another 46 were detected with virtual CT sonography, increasing the overall sensitivity from 50.7% to 83.57%. The average diameter of nodules detected only with virtual CT sonography (9.7 +/- 3.3 mm) was significantly smaller than that of nodules detected with conventional sonography (16.6 +/- 6.2 mm). The results of multivariate analysis suggested that nodule size (p < 0.001), echo pattern (p = 0.004), and location (p = 0.028) are associated with the difference in detection. Interestingly, 87% of the nodules 10 mm in diameter or smaller were already dysplastic or malignant. CONCLUSION Nodules 10 mm in diameter or smaller have significant malignant potential and therefore are clinically important. Even though we do not consider virtual CT sonography a screening tool, we conclude it superior to conventional sonography for detection of small hepatic nodules, allowing bedside percutaneous ultrasound-guided biopsy and treatment that would not be possible with conventional sonography alone.

Ferucarbotran expands area treated by radiofrequency ablation in rabbit livers

Background and Aim:  Several studies have examined the factors involved with expansion of the coagulation volume following radiofrequency ablation (RFA). Ferucarbotran contains superparamagnetic iron oxide that generates heat in a radiofrequency electric field and may have an effect on the area affected by RFA. We attempted to determine whether ferucarbotran administration expands radiofrequency‐ablated volume using a rabbit model.

W1002 Usefulness of Real Time Virtual Sonography for Detection of Small Hepatic Nodules: A Prospective Study

Purpose:Ultrasonography(US) has excellent spatial resolution, uses neither X-rays nor magnetic fields, is a portable machine that can be conveniently used at the bedside, and displays lesions in real time. The latter feature is convenient for curative percutaneous procedures such as radiofrequency ablation and percutaneous ethanol injection. However, US is not sensitive for the detection of small nodules in patients with advanced liver disease, and the ability to detect nodules varies depending on the experience and technical skill of the examiner. Real time virtual sonography(RVS) is the first system capable of demonstrating virtual multiplanar reconstructed images corresponding to ultrasonographic images in real time. The purpose of this study was to prospectively evaluate the diagnostic efficacy of RVS for detection of liver malignancy often overlooked by conventional US. Materials and Methods:Sixty-six patients with a presumptive diagnosis of hepatocellular carcinoma were assessed between January 2005 and December 2006 at Shimane University Hospital. All of the patients underwent CT angiography, either during arterial portography or hepatic arteriography. Patients with diffuse invasive hepatoma, 6 or more nodules, and nodules for which US-guided percutaneous therapy (>3 cm lesions) was not indicated were excluded. A final total of 59 patients with 140 nodules were included. After CT angiography, conventional US and RVS were performed. The number of nodules detected by these two methods as well as their characteristics (nodule diameter, location and echo pattern of the nodule, and the echo pattern of the liver parenchyma) were compared to determine which method was more sensitive and which characteristics had a stronger influence on sensitivity. Results:From a total of 140 nodules detected by CT angiography, 71 (50.7%) were detected by both conventional US and RVS, and 46 (32.9%) were detected by RVS but not by conventional US. Twenty-three nodules (16.4%) were not detected by either conventional US or RVS. Univariate analysis demonstrated that nodule size, location, and echo pattern of the nodule and the liver parenchyma, influenced the difference in detection ability between the two methods. Multivariate analysis suggested that the most important factor affecting the difference in detection ability was nodule size. Conclusion:The RVS system is useful for detection of non-hyperechoic nodules with 10 mm or smaller diameter located in the periphery of the liver.

Partial obstruction of the colon caused by postoperative adhesions after cholecystectomy as a rare form of postcholecystectomy syndrome

nously) and mesalamine (3.2 g/day per os). During the following days his general situation improved markedly. Computed tomography of the abdomen and transdermal ultrasonography confirmed the involvement of many bowel loops corresponding to the involved terminal ileum and cecum. On the next days his general situation improved markedly and he was discharged from the hospital after 20 days in good condition. One month later, except for the palpation of a hard mass in the right ileal fossa, no other abnormality on physical examination or laboratory investigation could be identified. The patient continued to be on ornidazole 500 mgb.i.d. per os. He was advised to continue the drug at the reduced dose of 500 mg/day for a few months. The patient was seen again on September 1999 for an episode of abdominal pain accompanied by four to six watery bowel movements per day due to Salmonella infection. It was a great surprise for us to realize that the patient continued receiving ornidazole 500 mg/day (some times 1000 mg/day) continuously, all these years. He received the drug without medical knowledge or advice because he thought that he must receive it indefinitely as a maintenance treatment. Diarrhea was settled promptly as was not related to Crohn’s disease itself. Liver and renal function tests were normal. No abnormality on the peripheral blood picture was noticed. The patient was advised to stop the drug immediately. Nitroimidazoles (metronidazole, ornidazole, and tinidazole) are well known drugs for their efficacy against anaerobes, giardia lamblia, and protozoal infections ( Trichomonas vaginalisand amoebic). They are well absorved from the gastrointestinal tract, including the rectum (7, 8). Therapeutically effective concentrations have been demonstrated in the central nervous system, bile, and peritoneal fluid. The elimination half-live of ornidazole has been estimated to be 14–15 h (8). Ornidazole has been used on patients with Crohn’s disease with an acceptable rate of efficacy either for acute exacerbations (1, 2) or as a maintenance treatment (3). The most common side effects include symptoms of the gastrointestinal system such as nausea, metallic taste, and vomiting. Other minor side effects such as dizziness, headache, urticaria, and ataxia have also been reported. However, there is always a fear of development of peripheral neuropathy in patients receiving this drug for a period longer than 3 or 6 months (9). It is well accepted that peripheral neuropathy is timeand dose-related. In one study (10), metronidazole at a dose of 800 mg daily for several months produced no clinical or laboratory signs of peripheral neuropathy. To the best of our knowledge ornidazole has never been administered for a.12 months (1, 3). Our patient received the drug continuously for a period.10 yr. Fortunately, he did not develop liver or renal disturbances or significant hematological abnormality. We suggest that the relatively low dose of ornidazole (500 mg/day) could explain the absence of toxicity. We conclude that ornidazole may not produce either peripheral neuropathy or dysfunction of vital organs in some patients, even if it is administered for 10 yr at a dose of 500 mg/day.