Search

Operative ultrasonography was performed during operations to improve the accuracy of diagnosing the extent of the spread of carcinoma of the stomach in the following areas: tumor invasion in the gastric wall (31 patients), para-aortic lymph node metastasis (30 patients) and hepatic metastasis (30 patients). The over-all diagnostic accuracy rates of operative ultrasonography were 81 per cent for determining the depth of tumor invasion, 80 per cent for carcinoma of the mucosa, 70 per cent for carcinoma of the submucosa, 83 per cent for carcinoma of the proper muscle, 80 per cent for carcinoma of the subserosa and 100 per cent for carcinoma of the extraserosa. The over-all accuracy of operative ultrasonography in diagnosing para-aortic lymph node metastasis was 93 per cent. In comparison with the results of preoperative studies, the accuracy (sensitivity) of operative ultrasonography was significantly superior in diagnosing metastasis to the lymph nodes. In three of 30 operations, preoperatively unrecognized and nonpalpable (occult) hepatic metastases were identified by operative ultrasonography. Operative ultrasonography provides more accurate information regarding the spread of carcinoma of the stomach, and thus may be helpful in deciding upon the type of surgical procedure or in avoiding unnecessary tissue dissection.

Operative ultrasound using real-time high resolution B-mode ultrasound scanning is a practical and useful diagnostic aid. At operations upon the biliary tract, pancreas and blood vessels, ultrasound had a favorable impact upon surgical management. When similar operative roentgenographic studies were available, operative ultrasound compared favorably with both operative cholangiography and arteriography. Problems with the lack of familiarity of the surgeon with the performance and interpretation of imaging ultrasound and lack of specifically dedicated ultrasound instruments need to be resolved to increase and improve the use of this potentially helpful aid to surgical diagnosis during operation.

Operative roentgenographic cholangiography entails problems during pregnancy because of the hazard of radiation to the fetus and mother. In 450 biliary tract operations in which real-time B-mode operative ultrasonography was performed, five were for diseases of the biliary tract during pregnancy. Operative ultrasound correctly revealed non-palpable stones in the gallbladder in one patient and in the common bile duct in three patients. Furthermore, operative ultrasound provided anatomic information, such as dilation or stenosis of the common bile duct. Of seven possible occasions in which roentgenography would customarily be expected to be performed, operative cholangiography was used only once. Thus, ultrasound significantly reduced the number of operative roentgenographic studies. Operative ultrasonography was not associated with any complications and significant time delays. It is concluded that operative ultrasonography can replace operative roentgenographic cholangiography as a screening procedure for gallbladder and common duct calculi at biliary tract operations during pregnancy.

A new experimental model was developed for dynamic in vitro evaluation of clamp effects in normal and atherosclerotic human arteries. Five normal and 25 atherosclerotic arteries obtained at autopsy were perfused by a pulsatile blood pump. Five vascular clamps--DeBakey, Satinsky, Fogarty, bulldog and Potts--were applied separately to 150 arterial segments, 30 each. The arterial segments were examined by single exposure arteriography and real time ultrasonography. The arteries were opened longitudinally and examined for traumatic lesions and atherosclerotic plaques. Except for a single intimal tear, there were no lesions produced by the clamps applied to normal arteries. In atherosclerotic arteries, the number of traumatic lesions, intimal tears and flaps, was comparable for all five clamps except the bulldog clamp which caused no intimal flaps. Intimal tears and flaps were observed in 14 and 26 per cent of all atherosclerotic vessels, respectively. The occurrence of clamp trauma in atherosclerotic arteries was independent of the age, sex and direct clamp application to plaques. Sensitivity of intimal tears by arteriography and ultrasonography was comparable low. Intimal flap sensitivity and accuracy of ultrasonography were greater than that of arteriography, p less than 0.01. It is concluded that the occurrence of important trauma by vascular clamps in atherosclerotic arteries is high and occurs whether or not discrete plaques are clamped. Clamp trauma is minimal in normal arteries. Imaging ultrasonography is superior to arteriography in detecting intimal flaps and can demonstrate the majority of intimal flaps produced by vascular clamps.