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PubMed1991

Cepstral analysis of ultrasound in chronic liver disease--a preliminary study in the non-invasive evaluation of structural change.

To evaluate the morphological changes in chronic liver disease non-invasively we used the frequency-domain analysis of ultrasound. We assumed that liver tissue is a collection of semi-regularly arrayed small scatterers of ultrasound. We applied cepstral analysis to ultrasonic waveforms and evaluated the periodicity of scalloping of the power spectrum, caused by an interference effect among liver scatterers of a given spacing. In a phantom experiment, we could correctly measure the space among scatterers of a phantom consisting of a regularly spaced distribution of nylon filaments. In an experiment involving a freshly excised porcine liver, the distribution of the space among scatterers (SAS) determined on cepstral analysis reflected the size distribution of the hepatic lobules. In a human study, two statistical parameters, mode and kurtosis, were determined from the distribution of the SAS for each patient. In a previous study, we collected ultrasonic data during peritoneoscopy with a 10 MHz transducer directly contacting the liver and showed that we could evaluate morphological changes in chronic liver disease using cepstral analysis. In the present study, we obtained data in two ways: with a 3.5 MHz transducer through the abdominal wall and with a 10 MHz transducer directly contacting the liver during peritoneoscopy. The mode and kurtosis of the SAS obtained with the 3.5 MHz transducer were both well correlated with the mode and kurtosis of the SAS obtained with the 10 MHz transducer. These results suggest that we can evaluate morphological changes in chronic liver disease non-invasively.

Animals↗

PubMed1974

[Contribution of clinical, biohumoral, morphological and instrumental parameters to the diagnosis of some chronic liver diseases].

A comparative study concerning the diagnostic importance of clinical, humoral, morphological and instrumental parameters had been carried out on 105 patients affected by chronic liver disease (51 cases with liver cirrhosis, 15 with metastatic tumors, 10 with liver steatosis and 29 with chronic hepatitis). The final diagnosis of the patients used for the comparison was formulated considering the greatest numbers of data. The results of this study can be drawn as follows: --clinical and laboratory data show satisfactory diagnostic value principally in patients suffering from liver cirrhosis (90 per ceny) and metastatic tumors (93 per cent); --peritoneoscopy appears to be generally the most useful procedure with the most significance value above all in cirrhotic patients; --morphological examination in biopsy specimen results of the greatest importance in patients affected by chronic hepatitis and hepatosteatosis while rather high has been the percentage of false negatives in secondary tumors of the liver (40 per cent) and cirrhosis (68 per cent); --scintiphotoscanning is generally less useful as a diagnostic tool than peritoneoscopy a part of the cases of metastatic tumors. In such a condition the diagnostic power of both the procedures results to be identical; --it may be concluded that an integrating diagnostic information generally results to be the most precise and maximally capable of reducing the number of false negatives. In individual cases, of course, the less important procedure shows to have the maximum of diagnostic capacity.

Biopsy, Needle↗

PubMed1984

[Is Monroe's point the site of choice for the establishment of pneumoperitoneum in laparoscopy?].

On the occasion of a case of death during performance of pneumoperitoneum before peritoneoscopy the presence of adhesions in the left lower quadrant of the abdomen in 850 peritoneoscopied patients was investigated. In 91,55% of the evaluated results the left lower quadrant of the abdomen was free from adhesions. Thus, the Monroe-point is even further on the place of choice in order to make the pneumoperitoneum. The Verres-needles are preferable to all other types of needles.

Embolism, Air↗

PubMed1981

[Differential diagnostic possibilities of the liver and bile duct cysts (author's transl)].

The authors examined the diagnostical possibilities of the liver and bile duct cysts with different origin. On the base of the literature and own experiences surveyed the specific signs and the diagnostic value of peritoneoscopy, liver biopsy, scintigraphy, angiography, gray-scale ultrasonography, ERCP and PTC in the hepato-biliary cysts. GSU is the most suitable method to demonstrate the cystous character, but the connection with the biliary tract can be verified by ERCP. Peritoneoscopy is the best procedure in the diagnosis of the polycystic liver; the congenital liver fibrosis can be recognized by biopsy, only. The hepato-biliary cysts can be separated preoperative with the parallel adoption of these methods, in the majority of cases.

Bile Duct Diseases↗

PubMed1982

Tuberculous peritonitis in children.

Twelve patients with tuberculous peritonitis were studied. The provisional diagnosis was based on clinical, laboratory and radiological investigations. Later on peritoneoscopy with biopsy established the diagnosis. The presenting symptoms varied and not one symptom or sign was of definite diagnostic significance. Ten of the twelve patients gave a history of exposure to tuberculosis. Ascites was present in three patients, while liver enlargement was observed in seven patients. At the original clinical examination none was diagnosed as tuberculous peritonitis. The results of 5 TU tuberculin test were 10 mm or more in six patients. The chest roentgenogram was abnormal in seven patients, while multiple calcified mesenteric lymph nodes were demonstrated in three patients on the abdominal roentgenogram. Proven sites of tuberculosis besides the tuberculous peritonitis were discovered in seven patients, including pulmonary tuberculosis and tuberculous cervical adenitis. The ascitic fluid studies did not allow a conclusive diagnosis; only one of three ascitic fluid yielded acid-fast bacilli. Peritoneoscopy performed at the same time with peritoneal biopsy seems to be the best approach to establish a definite diagnosis. This disease may easily be overlooked and misdiagnosed, and without specific treatment may give rise to serious complications.

Child↗

PubMed1978

[Peritoneoscopic diagnosis of M. Whipple--making an indirect diagnosis (author's transl)].

A case report is given of a patient with a malabsorption syndrome. Primary diagnostic procedures including x-ray examinations and endoscopy yielded no results. Alterations of the abdominal lymph vessel system were found during peritoneoscopy giving rise to the hypothetical diagnosis of Whipple's disease. This diagnosis was confirmed by intestinal biopsy yielding macrophages with PAS-positive inclusion bodies. It is pointed out, that peritoneoscopy is a good means to evaluate the abdominal lymph vessel system.

Doxycycline↗

PubMed1977

[Lateral transparietal cholangiography. Okuda's technic. Remarks apropos of 111 examinations].

The diagnosis of proctated jaundice is done in 50% of all cases by clinical examination; in 30% of all cases by peritoneoscopy; in the other 20% instrumental opacification of the biliary tract is required (before the laparotomy) in order to determine the site and the nature of the cholestasis. Among these instrumental devices, a transhepatic cholangiography with the Okuda needle allows biliary tract opacification in 98% of all cases if the obstacle is extra-hepatic and in 69% of all cases if the obstacle is intra-hepatic. This technique is easy to perform, without danger, and readily available to any physician. It should be performed after the peritoneoscopy and before the retrograde cholangiography.

Bile Ducts, Intrahepatic↗

PubMed1976

Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey.

Esophagogastroduodenoscopy (211,410 examinations) had a complication rate of 1.3/1,000 cases. Duodenoscopy with cannulation was performed 3,884 times and had a complication rate of 21.6/1,000 examinations. Diagnostic coloscopy (25,298 examinations) had a complication rate of 3.4/1,000. Polypectomies during coloscopy (6,124 cases) had a complication rate of 23.3/1,000 cases. Esophageal dilations (13,139 cases) had a complication rate of 4.25 with mercury bougies, and in 9,431 cases metal olives produced a complication rate of 6.1/1,000 treatments. Dilation for achalasia in 1,224 patients produced a complication rate of 18.4/1,000 procedures. Peritoneoscopy (4,404 examinations) produced a complication rate of 5.4/1,000 patients. The value of these diagnostic and therapeutic procedures is now well established but must be weighed against a potential risk of complications.

Endoscopes↗

PubMed1976

Future prospects of radiotherapy in gynecologic oncology.

Major areas of progress in radiotherapy over the past decade have included important refinements in equipment and treatment techniques, as well as improved and expanded training programs for radiation oncologists. In 1975, approximately 14% of all new cancers were gynecologic, representing almost 68,000 new cases. Although end results in treatment of early cervix and corpus uteri lesions are quite good, results in treatment of early cervix and corpus uteri lesions are quite good, results in treatment of the later stage lesions, as well as ovarian and vulvo-vaginal tumors, are discouraging. Progress in the future will center around five primary areas: 1) greater understanding and utilization of radiation sensitizing agents such as hyperbaric oxygen, metronidazol, and other electroaffinic agents, purine and pyrimadine analogs, and antibiotics such as Actinomycin D and Adriamycin; 2) introduction into clinical use of high LET particle beams, such as fast neutrons, pi mesons, low atomic number nuclei, and heavy accelerated nuclei; 3) combined modality therapy utilizing radiation and chemotherapy or radiation and immunotherapy for management of subclinical disease; 4) radiobiologic and clinical advances in the utilization of radiation and hyperthermia; and 5) improved understanding of the pathophysiology and natural history of the gynecologic malignancies with increasing use of staging laparotomies, lymphangiography and peritoneoscopy.

Female↗

PubMed1977

Advances in the staging and treatment of ovarian cancer.

The age adjusted death rate for ovarian cancer has remained unchanged for the past 20 years. Recent data obtained by staging ovarian cancer patients with lymphangiography and peritoneoscopy demonstrated that many patients with apparently localized disease actually have occult dissemination within the abdomen. These new staging techniques plus the determination of the histologic grade of anaplasia may permit a more precise determination of a patient's prognosis and therefore better design of therapeutic stategy. Radiotherapeutic techniques are being adapted to attempt to treat some areas of occult disease. Numerous single chemotherapeutic agents are capable of producing objective tumor responses. Preliminary data suggest that combination chemotherapy can increase the objective response rate above that seen with single agents. Longer follow-up is necessary to determine whether combination chemotherapy can prolong survival.

Alkylating Agents↗

PubMed1977

Bone-marrow examination in the staging of small-cell anaplastic carcinoma of the lung with special reference to subtyping. An evaluation of 203 consecutive patients.

Histologic examination of bone-marrow from the posterior iliac crest was routinely done as a pretreatment staging procedure in 203 consecutive patients with small-cell anaplastic carcinoma of the lung. Subtyping of the patients according to the WHO classification included 27.8% with "fusiform" cell type (WHO II,1), 28.3% with "polygonal" cell type (WHO II,2), 42.8% with "lymphocyte-like" cell type (WHO II,3), and 1.1% with mixed types (WHO II,4). Bone-marrow involvement was found in 17.2%. No significant difference was observed among the histological subtypes with regard to bone-marrow involvement. A comparison of bone-marrow biopsy and aspiration in patients investigated with both procedures showed that aspiration alone was diagnostic in nine of 24 (38%) positive patients as compared with two of 24 (8%) with biopsy alone, while in the remaining 13 patients (54%) both procedures were positive. Of the 35 patients with positive bone-marrow examination, 77% had no other evidence of distant metastatic disease if liver metastases identified by peritoneoscopy and liver biopsy are excluded as a staging procedure. With the exception of thrombocytopenia which was observed in six patients, with bone-marrow metastases, hematological findings were of little value in detecting bone-marrow involvement.

Adult↗

PubMed1978

Sequential nonsurgical and surgical staging of non-Hodgkin's lymphoma.

The results of clinical and surgical staging in a series of 170 patients with non-Hodgkin's lymphoma are reviewed. Advanced disease (Stage IV) was established without laparotomy in 95 patients (56%), primarily through bone marrow biopsy, closed liver biopsy, and peritoneoscopy. Laparotomy revealed a high incidence of liver involvement and involvement of lymph nodes outside of conventional abdominal irradiation portals only in patients with nodular types of pathology and in patients with positive lymphangiograms. The limitations and indications for staging laparotomy are discussed in the context of these findings.

Biopsy↗

PubMed1984

Hepatocellular carcinoma. Diagnostic and prognostic features in North American patients.

Diagnostic and prognostic characteristics of 121 North American patients with hepatocellular carcinoma seen in one metropolitan area over a 6-year period were assessed using multivariate analysis. Presenting symptoms commonly included abdominal pain (53%) or mass (34%), anorexia (31%), and ascites (20%); however, the ability to make an early diagnosis was complicated by a variety of unusual symptoms accounting for 25% of presentations. While cirrhosis (63%) and hepatitis B surface antigen (HBsAg) positivity (52%) were common associated findings, the majority of patients (67%) had no prior diagnosis of liver disease. Despite the vascular nature of these malignancies, percutaneous biopsy procedures performed in 66 patients provided diagnostic material in over 85% of cases with little morbidity. Histologic diagnosis was made by blind percutaneous biopsy (41 done, 83% positive), peritoneoscopy with directed percutaneous biopsy (25 done, 88% positive), laparotomy (42 done, 98% positive), or autopsy (19). Percutaneous hepatic biopsy procedures were associated with no mortality and rare bleeding (three cases). Overall median survival was only 18 weeks; multivariate analysis indicated increased bilirubin or presence of pulmonary metastases adversely influenced outcome. Unexpectedly, patients younger than 45 years of age had a significantly (P less than 0.01) greater survival (median, 40 versus 9 weeks) than did older patients with this disease. We conclude: (1) hepatocellular carcinoma can be rapidly and safely diagnosed using percutaneous biopsy procedures; (2) North American patients with hepatocellular carcinoma younger than 45 years of age have a more favorable prognosis.

Actuarial Analysis↗

PubMedDate not supplied

Staging and treatment with cyclophosphamide, vincristine and prednisone (CVP) in advanced cutaneous T-cell lymphomas.

Twenty-three consecutive patients with cutaneous T-cell lymphomas were submitted to staging procedures including lymphangiography, bone marrow biopsy and aspiration, peripheral blood morphological examination, peritoneoscopy with liver and spleen biopsy, and in selected patients lymph node biopsies. Extracutaneous disease (lymph nodes, bone marrow, liver and spleen) was detected in 12 patients. Bone marrow was involved in 25 per cent of the patients at presentation (all patients had lymph node involvement) and in two of nine patients with advanced disease during the follow-up. Peripheral blood was involved in 65 per cent of the patients at presentation (ten patients with advanced disease) and in six of nine patients with advanced disease during the follow-up. In 16 patients with advanced disease (T3-T4 and/or extracutaneous disease), CVP was given with a 50 per cent objective response rate and four complete remissions of 47+, 12+, 19 and 19 months duration. Median survival of patients with advanced disease was 4 years.

Adult↗

PubMed1987

Primary liver cancer in a referral hospital in Hawaii.

This is a retrospective review of 43 patients who had primary liver cancer diagnosed during 1974-1983. Patients' ages ranged from 27 to 84 years (median 52.5). Nine of 39 patients with hepatoma were females, while two of the four patients with cholangiocarcinoma were women. Hepatitis surface antigen was positive in 90% tested, and 62% had cirrhosis. Also, 60-65% were heavy users of alcohol and cigarettes. Alpha-fetoprotein was elevated in one of four white patients, and in six of eight patients of other races (75%). Tissue diagnosis was obtained by peritoneoscopy in 16, by percutaneous biopsy in 7, by laparotomy in 9, and at autopsy in 11. Only one of 11 patients who were explored has his lesion resected. About half of the cases diagnosed antemortem died 1 month or less after diagnosis. The median survival of hepatoma patients who had no specific treatment or systemic chemotherapy was 2 months. Two patients who received chemotherapy in conjunction with occlusion of the hepatic artery lived 16 to 19 months.

Adult↗

PubMed1996

A phase I study of paclitaxel and cyclophosphamide in recurrent adenocarcinoma of the ovary.

We have conducted a disease specific phase I study of paclitaxel and cyclophosphamide in recurrent adenocarcinoma of the ovary. This was done to take advantage of the cellular and molecular synergism between paclitaxel and DNA-damaging agents, with the hope of avoiding paclitaxel-cisplatin toxicities. Paclitaxel was given as a 24-hr CIVI, after which cyclophosphamide was given as a 60-min infusion. Cycles of therapy were repeated every 3 weeks; and granulocyte colony-simulating factor (G-CSF) was given in a "flexible" dosing fashion. Starting doses were 170 mg/m2 paclitaxel and 750 mg/m2 cyclophosphamide. Dose-limiting toxicity (DLT) was seen at the doses of 250 mg/m2 paclitaxel and 1250 mg/m2 cyclophosphamide. DLT was cumulative thrombocytopenia. There were six nonhematologic grade 3 or 4 toxicities experienced in the study. Eleven of 20 evaluable patients (55%) have achieved an objective response (4 CCR;7 PR). Three of four CCRs were confirmed by negative findings at peritoneoscopy. The median number of prior therapies was 2 (range 1-4) and 17 individuals had platinum-refractory disease. We conclude that paclitaxel followed by cyclophosphamide is an active combination in recurrent ovarian cancer and that further study is needed to determine if this combination is truly better than paclitaxel alone.

Adenocarcinoma↗

PubMed1981

Prospective study with HEXA-CAF combination in ovarian carcinoma.

The value of combination chemotherapy with HEXA-CAF was analyzed in 31 patients with histologically documented epithelial ovarian cancer in advanced stages (minimal or gross disease). No patient had been previously treated with chemotherapy. Peritoneoscopy with diaphragmatic inspection, peritoneal cytology, lymphography, and chest X-ray were routinely used in staging and restaging the patients. Complete (CR) plus partial (PR) responses were obtained in 13/31 fully restaged patients (41.9%). CR was recorded in seven patients (22.5%) and PR in six patients (19.3%). Remission duration was significantly longer in patients who achieved CR (20 months) than in those who attained PR (9.5 months) (P Less Than 0.01). In all treated patients the median duration of survival was 16.5 months. Survival was significantly longer in patients with CR than in patients who did not achieve CR (P Less Than 0.05). Nevertheless, considering the rate of CR in patients with gross disease (20.6%), HEXA-CAF combination seems a useful but not yet a hopeful treatment for patients with advanced ovarian carcinoma.

Altretamine↗

PubMed1987

Hepatic epithelioid hemangioendothelioma in a young female.

Epithelioid hemangioendothelioma in a young female is reported. Her symptoms were right upper quadrant pain and low-grade fever. Laboratory examinations showed an increased number of white blood cells and an elevated erythrocyte sedimentation rate. Plasma factor VIII:C was increased. The hepatic lesions were demonstrated as low-density areas by CT scan, and multiple nodules with central depression on the surface of the liver were identified by peritoneoscopy. The biopsy specimens showed spindle-shaped tumor cells set in the fibrous and myxohyalinous tissue. The tumor cells were positive for factor VIII-related antigen and Weibel-Palade bodies. The patient received transcatheter arterial embolization therapy using Gelfoam and mitomycin C following which the plasma level of factor VIII was normalized and regression of the tumors was observed.

Adolescent↗