Advances in hepatobiliary ultrasonography

Okuda, Kunio

doi:10.1002/hep.1840010616

Cited by 49 publications

(9 citation statements)

References 84 publications

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“…For screening purposes, the hepatobiliary system may be examined within 10 min, and for more thorough study, perhaps in 20 min or so in the hands of experienced examiners. Using a specially designed transducer, aimed puncture is and ducts (58). This modality, still improving in instruas 3 mm may behiscerned.'…”

Section: Us In Early Detectionmentioning

confidence: 99%

Early recognition of hepatocellular carcinoma

1986

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Primary liver cancer (PLC) is a malignant disease which is difficult to detect in its early stages and has very poor prognosis. Although relatively uncommon among Caucasians it is one of the major malignancies in many countries throughout the world, particularly in sub-Saharan Africa and the Far East. It accounts for 65.5% of all malignant disease in men and 31% of malignant tumors in women among Shangaan blacks in South Africa (1). It is the third major cause of cancer death in males and the fourth among females in China (2); it ranked third and fifth in these groups, respectively, in Japan in 1983 (3). Of PLC, hepatocellular carcinoma (HCC) is the major histological type followed in frequency by cholangiocellular carcinoma-the ratio of HCC to cholangiocellular carcinoma varies from 5:l to nearly 401 (4). In other words, the major malignant killer in the high PLC incidence areas is HCC.A close association of HCC with cirrhosis, particularly the posthepatitic or macronodular variety, has long been known (5-7). This interrelationship, an enigma in the past, now seems explainable in part by the hepatocarcinogenic properties of hepatitis B virus infection (8, 9). However, some epidemiological data speak against the theory that this virus is the sole etiologic factor in HCC (10,ll). Besides food contamination by aflatoxins in the tropical and subtropical regions, chronic non-A, non-B hepatitis is one recent etiologic candidate in Japan where HCC incidence has more than doubled in the past 15 years despite a concomitant increase in hepatitis B virus seronegative cases (12). A recent study in Tokyo shows that 40% of patients with HCC now have a history of past blood transfusion (13). Because of frustrations due to late diagnosis and bad therapeutic results, Japanese gastroenterologists have pioneered clinical programs for the early detection of HCC. MASS SCREENING FOR ASYMPTOMATIC HCCIn the early 1970's, when serum a-fetoprotein (AFP) was still under investigation for its diagnostic significance in HCC, an attempt was made by Masseyeff and his group (14) in Senegal to screen normal people for the detection of early HCC. They used the AFP Ouchterlony test and screened 9,000 male workers three times a year for 2 years. AFP-positive HCC was found in three apparently healthy males. Unfortunately, in only 1 of the 3, the tumor was sufficiently small to permit surgical removal. In South Africa, the young blacks coming from Mozambique to work in gold mines near Johannesburg were the high risk group for developing HCC prior to the discontinuation of diplomatic relations between South Africa and Mozambique. Purves and his group (15) screened AFP in more than 5,000 such gold miners by radioimmunoassay (RIA) and more than 4,000 by immunodiffusion methods. This study was a complete failure and not a single asymptomatic black patient with cancer was found (15).After the founding of the People's Republic of China, the central government set out to determine the regional incidences of various cancers as a prime public health program....

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Section: Us In Early Detectionmentioning

confidence: 99%

Early recognition of hepatocellular carcinoma

1986

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“…It is important to diagnose common bile duct (CBD) stones because they are associated with various severe complications, such as cholangitis and pancreatitis, especially if left untreated [4] . Diagnosis of choledocholithiasis is based on clinical signs and symptoms, laboratory findings of cholestasis and imaging examinations [5] . Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP), it has been considered the gold standard for the diagnosis of and eventually the nonsurgical therapeutic approach for choledocholithiasis.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Clinical Predictors for Patients with Intermediate Risk of Choledocholithiasis

et al. 2016

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Background/Aims: For the suspected choledocholithiasis, the American Society for Gastrointestinal Endoscopy has proposed guidelines to assign risk based on clinical predictors. The study aimed to assess the usefulness of clinical predictors of choledocholithiasis set forth by the guidelines in patients with intermediate risk of choledocholithiasis. Methods: In 2014, 109 patients with intermediate risk of choledocholithiasis underwent endoscopic ultrasound. Their medical records were retrospectively reviewed. The gold standard for choledocholithiasis was endoscopic retrograde cholangiopancreatography or clinical follow-up. Results: Based on endoscopic ultrasound findings, choledocholithiasis was suspected in 18 patients, and it was removed in 17 patients. Choledocholithiasis was absent in the remaining 91 who did not show any signs from endoscopic ultrasound. Among the 2 strong (common bile duct (CBD) diameter >6 mm and bilirubin 1.8-4 mg/dl) and 3 moderate (abnormal liver biochemical test other than bilirubin, age >55 years and gallstone pancreatitis) clinical predictors, 28.8% of patients with one of the strong predictors had choledocholithiasis; however, only 3.5% of patients with any one of the moderate predictors had choledocholithiasis. As a result, only strong clinical predictors showed predictability: increased bilirubin level (OR 3.23; 90% CI 0.85-12.28) and dilated CBD diameter (OR 5.83; 90% CI 1.93-17.57). Conclusion: Only strong clinical predictors of choledocholithiasis showed predictability for patients with intermediate risk of choledocholithiasis.

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“…Strong echoes with acoustic shadows in a dilated biliary duct are a readily visible sign of stones. Even small gallstones generate sufficient reflective discrepancy to cast shadows when there is an adequate amount of fluid surrounding them [14]. The intraductal stones in the presence of obstructive jaundice and fluid-filled ducts produce more obvious shadows than in patients without jaundice.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonic diagnosis of primary intraductal cholelith and neoplasm

Hadidi

1983

Gastrointest Radiol

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This report presents 19 patients with obstructive jaundice with dilatation of the biliary tree. The obstruction was due to common hepatic duct stones in 14 and intraductal biliary neoplasm in 5. The diagnostic ultrasonographic features consisted of strong echoes with acoustic shadows in a dilated extrahepatic biliary duct for stone and echogenic protrusion into the dilated lumen casting no shadows for neoplasm. The correct diagnoses were made or suggested in 18 patients (94.7%).

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Advances in hepatobiliary ultrasonography

Cited by 49 publications

References 84 publications

Early recognition of hepatocellular carcinoma

Early recognition of hepatocellular carcinoma

The Efficacy of Clinical Predictors for Patients with Intermediate Risk of Choledocholithiasis

Ultrasonic diagnosis of primary intraductal cholelith and neoplasm

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