Minoru Sukigara

Transesophageal real-time two-dimensional Doppler echography—a new method for the evaluation of azygos venous flow

gallstones. Br Moo J 1975;4:371-4. 12. Safrany L. Endoscopic sphincterotomy and gallstone removal. Gastroenterology 1977;72:338-43. 13. Sigel JH. Endoscopic papillotomy in the treatment of biliary disease. Dig Dis Sci 1981;26:1057-62. 14. Stephen ES. Therapeutic endoscopy. New York: Igaku-Shoin, 1984:198-240. 15. Allen NJ, Bordoy TJ, Buglisoi TF, May GR. Rapid dissolution of gallstones by methyl tert-butyl ether. Preliminary report. N Engl J Moo 1985;312:217-20. 16. Thistle JE, Carlson GL, Hofmann AF. Monooctanoin, a dissolution agent for retained cholesterol bile duct stones: physical properties and clinical application. Gastroenterology 1981;78:1016-22. 17. Sauerbruch T, Delius M, Paumgart G. Fragmentation of gallstones by extracorporeal shock wave. N Engl J Med 1986;314:818-22. 18. Ell CH, Wondracek F, Frank F, et al. Laser-induced shockwave lithotripsy of gallstones. Endoscopy 1986;18:95-6. 19. Lux G, Ell CH, Hochberger J, Dewling L. The first successful endoscopic retrograde laser lithotripsy of common bile duct stones in man using a pulsed neodymium-YAG laser. Endoscopy 1986;18:144-5. 20. Hwang MH, Mo LR, Yang JC, Lin C. Percutaneous transhepatic cholangioscopic ultrasonic lithotripsy (PTCS·USL) in the treatment of retained or recurrent intrahepatic stones. Gastrointest Endosc 1987;33:303-6. 21. Hwang MH, Mo LR, Chen GD, Yang JC, Lin C, Yueh SK. Percutaneous transhepatic cholecystic ultrasonic lithotripsy. Gastrointest Endosc 1987;33:301-3. 22. Hwang MH, Ker CG. Ultrasonic guided percutaneous transhepatic bile drainage for septic intrahepatic stones. Arch Surg (in press). 23. Harrison J, Morris DL, Haynes J. Electrohydraulic lithotripsy of gallstones-in vitro and animal studies. Gut 1987;28:267-71.

Colour flow mapping of oesophagogastric varices and vessels in and around the liver with trans-oesophageal real-time two-dimensional doppler ultrasound

Conventional transcutaneous ultrasound examinations are often compromised by intervening intestinal or pulmonary gas and have limited resolution. Ultrasonic probes of frequencies greater than 5 MHz, which enhance resolution, cannot be used successfully on the skin surface, because they do not penetrate enough to to visualise intra-abdominal organs in most adults. To overcome these problems, we have used transoesophageal real-time two-dimensional Doppler echography. The ultrasonic probe, with a 5 MHz, curved array, was integrated into the end of a steerable insertion tube. Fifteen patients with oesophagogastric varices were examined. Oesophagogastric varices were visualised in colour in 10 patients. The direction of blood flow was determined in six patients. The flow velocity was measured quantitatively in five patients by the pulsed Doppler technique. The vessels in and around the liver were also visualised even when they could not be seen with transcutaneous ultrasonography. This technique is useful for the evaluation of both oesophagogastric varices and other abdominal vessels.

Bleeding varices located in the second portion of the duodenum

A 41-year-old woman with cirrhosis of the liver was admitted to our hospital because of a severe melena. Blood pool scanning with labelled red blood cells showed a high concentration in the right upper quadrant of the abdomen. Endoscopy of the second portion of the duodenum revealed fresh blood on the first examination and varices with overlying erosion were evident in the second study. Co-existent esophageal varices were present but were apparently not associated with the bleeding. Because of the continuous hypotension even with blood replacement, ligation and sclerotherapy were performed. To evaluate the efficacy of the procedures, intraoperative two-dimensional Doppler echography was used and the transducer was applied directly to the viscera. Blood flow was visualized in the serosal and submucosal varices. After ligation and sclerosing of the veins, the blood flow velocity signals disappeared. This woman died of multiple organ failure on the ninth postoperative day.

Doppler echography for hemodynamic studies of the azygos vein

SummaryUsing a convex array transducer, the advantages and shortcomings of transesophageal real-time two-dimensional Doppler echography (TE2DD) were assessed in a study of the vessels around the esophagus and the stomach in 67 adult patients with (n=56) or without (n=11) liver cirrhosis. In most cases, all but the upper- and lowermost margins of the azygos vein could be visualized. The more caudally the portion located, the smaller its diameter and flow velocity became. The average number of intercostal veins visualized by TE2DD was 4 per person. The observable esophagogastric varices seemed to be limited to deeply located ones around the esophagogastric junction. In five patients who had undergone distal splenorenal shunt, splenic venous flow, or shunt flow could be seen from the stomach over a length of about 5 cm. The azygos venous flow in cirrhotic patients was significantly greater than that of patients without cirrhosis. TE2DD appears to be very useful for evaluating flow in the cephalad collateral veins and other vessels around the esophagus and the stomach.

Percutaneous transhepatic biliary drainage guided by color Doppler echography

Percutaneous transhepatic biliary drainage (PTBD) guided by color Doppler echography was performed on nine patients. By color Doppler echography, the segmental and subsegmental branches of both the portal vein and the hepatic artery could be identified and discriminated from the bile ducts because of their color flow mapping. We could select the safe pathway of needle advance, which did not injure the vessels. Thus, complication of bleeding did not occur in any of the patients. Color Doppler echography seems a very useful and safe method for the guidance of PTBD.

Die farbigkodierte Blutflußdarstellung abdomineller Gefäße in Echtzeit mit dem zweidimensionalen Dopplerverfahren

Die ersten Versuche, mit Hilfe des Ultraschalldopplerverfahrens den Blutflus nichtinvasiv nachzuweisen, bezogen sich uberwiegend auf die Untersuchung der A. carotis. So konnte Hokanson [2] 1971 erstmals mit dem gepulsten Dopplerverfahren den Blutflus in der A. carotis nachweisen. Im Jahre 1972 folgten die Untersuchungen von Reid und Spencer [6] an der A. carotis mit dem Dauerschalldopp-lerverfahren (CW-Doppler). Curry und White [1] konnten erstmals den Blutflus der A. carotis mit dem CW-Doppler farbig, jedoch nicht in Echtzeit abbilden.

Visualization of Distal Splenorenal Shunt by Isotopic Splenovenography

Radioisotopic angiography of the splenic vein was performed in six patients following a distal splenorenal shunt (Warren procedure). Under echographic guidance, the spleen was punctured with a 22-gauge needle, and Tc-99m pertechnetate was injected into the splenic pulp. In five patients whose esophageal varices had remained atrophic, the splenic vein, the left renal vein, the inferior vena cava, and the heart were clearly visualized within 8 seconds. In one patient, in whom recurrence of esophageal varices had been recognized, the splenic vein was not imaged. The injected material coursed mainly upwards through collaterals.

Effects of intraaortic balloon pumping on portal venous flow : assessment with color doppler echography

The effects of intraaortic balloon pumping (IABP) on portal venous flow were assessed using color Doppler echography. A total of 23 heart failure patients treated with IABP were assessed. Balloon inflation was timed to occur with every other cardiac contraction. The maximum, minimum, and mean flow velocity (Vmax, Vmin and Vmean, respectively) in the right portal vein were measured with the IABP ON and OFF, and the values compared. The Vmin with IABP ON and OFF was the same (11 ±5 cm/sec), whereas the difference between Vmax and Vmean was small for each patient. The velocities measured with IABP ON were larger than or equal to those with IABP OFF in all cases, however, except one. Thus, Vmax (22±8 cm/sec) and Vmean (17±6 cm/sec) with IABP ON were significantly larger (p 0.01) than those with IABP OFF (20±7 cm/sec and 16±6 cm/sec, respectively). The flow pattern of the portal vein was characteristically pulsatile either with IABP ON or OFF in most cases.