Algorithms of x-ray and ultrasonic diagnoses in urology]

Roentgenourologic methods and ultrasonic scanning (USS) should be combined in the radiologic diagnosis of urologic diseases. USS should be the first stage of examinations of urologic patients, and its results should be taken into account when planning and carrying out excretory urography. USS can be repeated before more sophisticated roentgenourologic examinations in order to single out the "zones of interest"; special programmes are possible for the purpose-pharmacoechography, dopplerography, etc. Development of tentative algorithms of x-ray and ultrasonic diagnosis of the major urologic diseases will help optimize the diagnostic process.     

X-ray and ultrasonic diagnosis of noninflammatory benign diseases of the gallbladder]

The author analyzes the results of x-ray (cholecystography) and ultrasonic examinations carried out in patients with noninflammatory benign diseases of the gallbladder (71 with cholesterosis and 28 with adenomyomatosis). X-ray and ultrasonic symptoms of these conditions are presented and the diagnostic potentialities of both methods in the detection of such diseases assessed. The author considers ultrasonic scanning the method of choice for the diagnosis of any forms of gallbladder cholesterosis, whereas an x-ray examination appears to be informative only in a polypous form of the disease. X-ray contrast examination is preferable for the recognition of gallbladder adenomyomatosis, for it presents a clear-cut pattern characteristic of each form of this condition, whereas ultrasonic symptoms of such involvement are nonspecific.     

Potentialities of x-ray diagnosis in improving the diagnosis of oncologic diseases in outpatient clinics]

The authors analyze the possibilities of improving the prehospital diagnosis of the most prevalent oncologic diseases (tumors of the lungs, stomach, large intestine, mammary gland) that may be effectively detected by modified methods of x-ray and x-ray fluorographic examinations. The x-ray diagnostic service of health centers is regarded as a most important component in the system of prehospital diagnosis. A program of reorganization of this service is suggested, that will help reorient its activities to purposeful screening examinations that will altogether improve the detection of a number of oncologic diseases.     

Radiologic methods in the diagnosis of diseases of the spleen]

Ultrasonic and computer-aided tomographic examinations of 2457 patients with suspected diseases of the abdominal cavity organs have revealed splenic involvement in 48. The sensitivity of ultrasonic technique for the detection of splenic diseases has made up 70.8%, that of computer-aided tomography--95.8%. Invasive interventions monitored by these two methods were carried out in 26 patients; in 10 of these transcutaneous puncture drainage was carried out for cysts (2), hematoma (1), and abscesses of the spleen (7). In one patient with multiple abscesses of the spleen the drainage was found insufficient for complete cure and he had to be subjected to splenectomy, in the rest cases surgery did not have to be resorted to. Therefore, ultrasonic and computer-aided tomographic examinations of the spleen, used together with various invasive interventions, result not only in correct diagnosis and differential diagnosis of this organ's disease, but permit various therapeutic measures and help achieve cure without laparotomy.     

X-ray-ultrasonic parallels in tumors of the stomach and intestines]

Combined clinical, radio and ultrasound investigation of 46 patients was carried out. It was shown that routine transabdominal UTS could be employed in diagnosis of gastric and intestinal tumors but mainly at more advanced stages (T3, T4). Potentialities of the method were shown to depend, to a great extent, on a tumor site, growth, type, sizes, and spreading, as well as on the resolving power of an US diagnostic apparatus. The use of a high resolution apparatus made it possible to detect tumor invasion, but topography of a tumor was difficult to define. The x-ray or endoscopic method can be used as an adjuvant method of specified diagnosis of gastric and intestinal tumors.     

Agreement Between Clinical and Radiological Diagnosis

Agreement between radiological and clinical diagnosis and the incidence of unexpected findings has been used as an indicator of the diagnostic contribution of radiology. The overall incidence of agreement was 33% — 533 out of 1,604 x-ray examinations. The wide variation in agreement in different radiological examinations is clearly related to the pathological nature of disease and the limitations of radiological techniques. If diagnostic radiology is to be effective its application rather than interpretation in the clinical situation must be emphasized in training programmes.     

Ultrasonography in the study of hepatocellular carcinoma in woodchucks chronically infected with WHV

The woodchuck hepatitis virus (WHV)/woodchuck system is studied as animal model of human hepatocellular carcinoma (HCC) induced by chronic hepatitis B virus infection. The aim of the present study was the evaluation of ultrasound (US) liver examination in woodchuck as a routine method to detect HCC nodules and to follow their growth. Sixteen woodchucks were included in the study. US liver examination was carried out in all animals using a 5 MHz convex scanner. Macroscopic and microscopic examinations were performed to evaluate the US findings. The lower limit of nodule detection by US examination was a diameter of 5 mm. Macroscopic and microscopic examinations confirmed US findings in 14 of 16 animals (86.6%). No false negative results were obtained. Increase of nodule size was faster in the early phase of tumour growth. Small nodules (16 +/- 5 mm) appeared as hypoechoic lesions with well-defined margins and homogeneous structure. Large nodules (42 +/- 19 mm) appeared as hyperechoic lesions with irregular margins, heterogeneous or of mixed pattern; microscopical examination showed different degrees of necrosis, inflammation and fibrosis inside these latter neoplasms. The hepatitis reaction was conspicuously more severe around HCC nodules. No fibrosis and/or cirrhosis were found in normal liver parenchyma surrounding tumour nodules. On the whole, US appears to be helpful in the diagnosis of woodchuck HCC even at an early stage. Serial US evaluation can be used to study the growth rate of tumour nodules during natural history or experimental HCC treatments in woodchuck.     

Determination of uric acid and p-aminohippuric acid in human saliva and urine using capillary electrophoresis with electrochemical detection: potential application in fast diagnosis of renal disease

The monitoring of uric acid (UA) and p-aminohippuric acid (PAH) levels in biological samples is routinely carried out in clinical laboratories as an indication of renal disease. With the aim of investigation of the correlation between the trace amounts of UA and PAH in human saliva or urine and renal diseases, we carried out the determination of UA and PAH in human saliva and urine by using capillary electrophoresis with electrochemical detection (CE-ED) in this work. Under the optimum conditions, UA, PAH and three coexisting analytes could be well separated within 21 min at the separation voltage of 14 kV in 80 mmol/L borax running buffer (pH 9.2). Good linear relationship was established between peak current and concentration of analytes over two orders of magnitude with detection limits (S/N = 3) ranged from 5.01 x 10(-7) to 2.00 x 10(-6) mol/L for all analytes. The result shows that this proposed method could be successfully applied for the study on the correlation between the levels of UA and PAH in human saliva and urine and renal diseases, and provide an alternative and convenient method for the fast diagnosis of renal disease.     

A comparison of diagnosis of pregnancy in the goat via transrectal ultrasound scanning, progesterone, and pregnancy-associated glycoprotein assays

Real-time ultrasound scanning (US) via the transrectal route, progesterone (P4) assay, and pregnancy-associated glycoprotein (PAG) detection can be used to diagnose pregnancy at around 3 weeks after breeding. Although several studies have been carried out to evaluate each of these different methods individually, it is difficult to establish adequate comparisons due to differences, such as the breed of goat, age, and farming conditions, among others. The aim of the present paper is to compare the accuracy of diagnosis of pregnancy using transrectal US, P4 assay and PAG detection at the same time and on the same animals. Canary dairy goats (n=143) were synchronized with an 11-day fluorogestone acetate (FGA) intravaginal sponge followed by PGF2alpha and eCG 2 days before the FGA withdrawal. Blood samples were collected on Days 20, 22, 24, and 26 after mating to determine P4 and PAG concentrations. Transrectal US examinations were performed at the same time. There were 79 pregnant goats and another 64 non-pregnant. The US via the transrectal method and the determination of PAG concentrations provide very accurate pregnancy diagnosis at 24-26 days after breeding; on the contrary, P4 assay on plasma samples performed on Day 22 after breeding was accurate, in this case, in detecting pregnant animals but did not always detect the non-pregnant does.     

PULMONARY SEGMENTAL RESECTION OF SOLITARY LESIONS OF DOUBTFUL CHARACTER

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness.Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

Pulmonary segmental resection for solitary lesions of doubtful character

Pulmonary cancer can be diagnosed earlier if patients with pulmonary symptoms of chronic type are given x-ray examination early, if patients over 40 years of age have a yearly roentgen examination of the chest regardless of their state of health, and if those with acute pulmonary illness are examined by x-ray within one month of the onset of illness. Observation of a known intrapulmonary lesion of unknown character should never last for more than one month. If it persists after that period, complete investigation, including thoracotomy, should be carried out if necessary to establish an exact diagnosis. A localized intrapulmonary lesion can be removed by segmental resection so that all healthy functioning lung is conserved if the disease is benign. If, after pathological examination, the lesion is shown to be cancerous, more radical resection can be carried out.     

Retroperitoneal Free Air

In the examination of 500 “well” executives, the number of unknown diseases found averaged 5.4 per person. Almost half of these executives had newly detected disease that was potentially significant to their health.Treatment was necessary in more than 47.7 per cent of them.One out of five of the total significant unknown defects found was either a peptic ulcer or gallstones; one out of five was a rectal adenoma; and one out of five was either hypertension or cardiac disease.One-third of the executives were overweight. Diabetes was found in every 20th person; and malignant disease was detected in one of every 41 people.For an examination to be “adequate” for the detection of unknown disease, the general physical examination must be complete and thorough. A proctoscopic is necessary, and certain basic laboratory screening procedures should be completed in each individual.Complete and routine x-ray studies of the gallbladder and gastrointestinal tract should be done, since they are the most important single diagnostic procedure, in detecting early, major, unsuspected, and often asymptomatic diseases.Routine consultations with specialists are a valuable asset in disease detection.Repeated periodic examinations help in detection of new unknown disease that was not present or not noted in earlier examinations.     

ENDOSCOPY IN HERNIA AT THE ESOPHAGEAL HIATUS

Endoscopy is useful for confirming diagnosis of hiatal hernia as made by x-ray examination, for establishing the diagnosis when x-ray examinations do not disclose the herniation, and for observation of resultant abnormalities in the affected area. The authors'' experience with gastroscopy and esophagoscopy in hiatal hernia is reported and the techniques and usual findings in these procedures are summarized.     

皮肤镜在皮肤真菌性疾病中的应用进展

皮肤镜的应用十分广泛,可用于皮肤恶性黑色素瘤、皮肤良性肿瘤等疾病的临床随访和术前诊断。皮肤真菌性疾病的诊断主要依靠真菌镜检及培养等检查,费时、操作要求高且阳性率低。而皮肤镜操作简单,耗时短,与真菌学检查互补,可作为辅助诊断皮肤真菌性疾病的有效工具,提高诊断准确性。本文就皮肤镜在皮肤真菌性疾病诊断中的应用进展作一综述。     

Visualization of the biliary tract; preoperative and post-operative radiologic investigation

Modern operative treatment of diseases of the bile passages requires the use of x-ray visualization of the biliary tract before, after and during operation. Nearly every surgeon uses x-ray study of the biliary tract before operation and it is widespread practice to carry out such study after operations in which a tube has been placed in the bile passages. However, there is a remarkable aversion to operative cholangiography.The usual reasons for avoiding operative cholangiography are unfamiliarity, inertia, concern over complications of the technique, and the feeling that it is unnecessary or wasteful of surgeon's time and patient's money. Yet the results of operative cholangiograms compare favorably with those obtained with the more customary x-ray studies of the bile ducts carried out after operation, at a time when the information gained is much less valuable in avoiding additional operations and in contributing to a smooth and rapid convalescence.     

Echotomography and excretory urography in the diagnosis of renal parenchymal "bridges"]

Sonographically detectable parenchymal 'bridges' in the median segment of the kidney may look atypical. The most incident parenchymal 'bridges' are asymmetric irregular ovoid incomplete connections, not reaching the parenchyma at the site of renal hilus; such 'bridges' may be compared to a 'humpbacked' overturned kidney. Besides that, double and Y-shaped connections were detected, occurring in different variants of fused kidneys. Clinical significance of atypical 'bridges' of the parenchyma consists in simulation by them of echomixed processes, of renal tumors first of all. Excretory urography should be the second stage of the diagnosis after initial ultrasonic examination of the kidneys; after it repeated pointed ultrasonography should be carried out, that will help rule out the diagnosis of a renal tumor.     

DIAGNOSIS OF ABDOMINAL LESIONS—The Use of Intravenous Aortography,Nephrotomography and Retrograde Aortography

New and safe methods of investigating the kidney by x-ray visualization of its circulation are now available. This can be done either by injecting large amounts of contrast material through a vein and then taking multiple x-ray exposures of the kidneys, or by injecting the contrast material backward into the aorta to the level of the renal arteries.Another method of x-ray examination now available is taking body section films of the kidneys when the contrast medium is in the kidney substance. This makes the kidney outline extremely sharp and allows more precise diagnosis.     

VISUALIZATION OF THE BILIARY TRACT—Preoperative,Operative and Postoperative Radiologic Investigation

Modern operative treatment of diseases of the bile passages requires the use of x-ray visualization of the biliary tract before, after and during operation. Nearly every surgeon uses x-ray study of the biliary tract before operation and it is widespread practice to carry out such study after operations in which a tube has been placed in the bile passages. However, there is a remarkable aversion to operative cholangiography.The usual reasons for avoiding operative cholangiography are unfamiliarity, inertia, concern over complications of the technique, and the feeling that it is unnecessary or wasteful of surgeon''s time and patient''s money. Yet the results of operative cholangiograms compare favorably with those obtained with the more customary x-ray studies of the bile ducts carried out after operation, at a time when the information gained is much less valuable in avoiding additional operations and in contributing to a smooth and rapid convalescence.     

Imaging diagnosis of schistosomiasis japonica--the use in Japan and application for field study in the present endemic area

For detecting lesions-related schistosomiasis japonica, X-rays, scintillation scanning, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) and endoscopic examinations with biopsies have been used in Japan. Liver fibrosis and calcified changes are detected by US and CT. Most of the lesions that are detected by endoscopic examinations are due to deposited ova of Schistosoma japonicum. Portal hypertension is detected by US, CT and gastroscopic examination. Because schistosome infection decreased rapidly in Japan, most of the studies on imaging diagnosis were performed on chronic lesions or sequelae of schistosomiasis. Most of the techniques were used on admitted patients in well-equipped hospitals. US was introduced in the 1970s as a safe, rapid, non-invasive and inexpensive technique and has been used for diagnosis in hospitals and screening in the fields. As a typical US image of the liver, septal formation by high echogenic bands like mosaic was described, and this network pattern was reported in the other endemic countries; China and Philippines. As an appropriate technique, US has been broadly used in developing countries. Not only for diagnosis in a hospital, but also for monitoring changes of morbidity, US is used in the community level. Network pattern related to the severity of S. japonicum infection, has not been described in S. mansoni or S. haematobium infection. Appearance of network pattern depends on pathological changes such as periportal fibrosis, postnecrotic fibrosis and calcified ova. For advanced studies on morbidity of schistosomiasis japonica, further research on pathological basis of network pattern and standardization of US diagnosis are necessary.     

Cytologic diagnosis of vaginal metastasis from renal cell carcinoma. A case report

BACKGROUND: Metastasis of renal cell carcinoma to the vagina is rare, although it may be the first evidence of the existence of the primary tumor. CASE: A metastatic deposit of renal cell carcinoma in the vagina was diagnosed by cytology as clear cell adenocarcinoma, which was confirmed by biopsy. Radiographic and ultrasound examinations confirmed the renal site of origin, which was corroborated by immunohistochemistry of the biopsy specimen. CONCLUSION: When a cytologic diagnosis of vaginal clear cell adenocarcinoma is made, metastasis of renal cell carcinoma should be considered in the differential diagnosis.