The value of sonography for estimation of liver volume by using a simple geometric formula ascertained in cadaveric livers

Accurate assessment of liver size and its volume are important. However, as the clinical methods do not produce reliable results especially when the liver is shrunken, and the previous attempts to accurately assess liver volume by radio-isotopes, CT scans and computer assisted ultrasonography have not gained popularity due to high cost and complex techniques, the need to devise a simpler technique for estimation of liver volume continues. In doing so, we estimated volume of 10 cadaveric livers by water displacement technique to serve as the reference value. Thereafter, assuming the shape of liver like a right-angled pyramid, we calculated its volume by a simple geometric formula of '1/2 abc'. However, a reduction of 15% was made from this to compensate for depression on the inferior surface of liver. This method was subsequently implemented to assess liver volume of 14 healthy individuals and 20 patients of fulminant hepatic failure (FHF) by using ultrasonography. Our findings revealed smaller liver volume in Indians as compared to the reported Western figures, and a significantly smaller liver volume in females as compared to males. The liver volume of 6 FHF patients who died was significantly smaller (696.5 +/- 143.5 cm3) as compared to that of the 14 FHF patients who survived (1083 +/- 365.3 cm3). Moreover, mortality rate was 100 per cent in 3 patients of FHF who showed markedly shrunken globular liver with a liver volume of less than 500 cm3. Thus, a markedly reduced liver size in FHF patients suggests a poor prognosis. However, since the number of FHF patients in the present series is small, it is our contention that a larger series is mandatory to confirm the findings of the present study.

Ultrasound-guided fine needle aspiration cytology of malignant gallbladder masses

OBJECTIVE

To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses.

STUDY DESIGN

We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases.

RESULTS

After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease.

CONCLUSION

US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.

Cholecystosonographic evaluation of the prevalence of gallbladder diseases. A university hospital experience

Ninety-five healthy volunteers and 515 patients with problems other than those of the biliary tract were examined using real-time, gray-scale, B-mode ultrasonography. Eighty-two patients (13.44%) were found to have asymptomatic gallbladder disease: 68 (11.14%) had cholelithiasis, 5 (0.81%) had acalculus cholecystitis, and 2 (0.32%) had polyps. Three cases of carcinoma of the gallbladder were also detected, suggesting that ultrasound examination of the high-risk population in an endemic area should not be confined to the disease concerned but that the gallbladder of such patients should also be screened to pick up asymptomatic gallbladder disease. Hence ultrasound can be used as a screening modality for the early detection of carcinoma of the gallbladder.

The effects of unilateral stellate ganglion blockade on human cardiac function during rest and exercise

INTRODUCTION

Left-sided stellate ganglion predominance has been proposed as a mechanism responsible for lethal ventricular arrhythmias, due to heterogenous ventricular repolarization. To determine the cardiovascular effects of such asymmetric sympathetic ganglion innervation in man, studies were performed in 15 patients undergoing unilateral stellate ganglion blockade for the management of chronic arm pain.

METHODS AND RESULTS

Standard 12-lead ECGs, systemic blood pressure, body surface potential mapping, and radionuclide angiography were performed during rest and graded exercise before and after blockade. Successful unilateral blockade was accomplished in 13 of the patients, 11 of whom had right-sided blockade and two left-sided blockade. No significant changes due to blockade of stellate ganglia, including QT intervals, were detected during rest or graded exercise in standard ECGs. No cardiac rhythm disturbances occurred in these states. Body surface potential maps and arterial blood pressure were similar during resting supine and upright positions, as well as immediately after exercise before and after blockade. Unilateral ganglionic blockade did not modify resting or exercise cardiac ejection fractions.

CONCLUSION

Unilateral stellate blockade in man does not induce untoward cardiovascular effects during rest or exercise.