; Abdominal Ultrasound in Assessing
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Abdominal Ultrasound in Assessing


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									                                              EPITOMES-GENERAL SURGERY

when control of the skin rejection process has                     (for example, pancreatic carcinoma) can also be
been achieved will there be wide application of                    detected.
skin pedicle transplantation.                                         Because cystic structures (for example, pancre-
                                                                   atic pseudocysts, renal and ovarian cysts) may be
                         ERNEST N. KAPLAN, MD                      causally related to abdominal pain, the ability of
                          REFERENCES                               ultrasound to accurately diagnose and localize
  American Replantation Mission to China: Replantation surgery     these cysts is of obvious clinical benefit.
in China. Plast Reconstr Surg 52:476, Nov 1973                        The verification or exclusion of a suspected
  Harii K, Ohmori K, Ohmori S: Successful clinical transfer of
ten free flaps by microvascular anastomoses. Plast Reconstr Surg
53:259, Mar 1974
                                                                   intra-abdominal abscess is a common surgical
   Kaplan EN, B3uncke H, Murray D: Distant transfer of cutaneous   problem. Ultrasonography can help in resolving
island flaps in humans by microvascular anastomoses. Plast Re-     this problem by showing abscesses, especially
constr Surg 52:301-305, Sep 1973
                                                                   those of the para-appendiceal, pelvic, subphrenic
                                                                   and intrahepatic variety. When a technically ade-
                                                                   quate ultrasonogram fails to show an intra-ab-
Abdominal Ultrasound in Assessing                                  dominal abscess, such a condition may be excluded
the Surgical Abdomen                                               with a high degree of certainty.
                                                                       Last, ultrasound is highly accurate in the de-
BECAUSE IT CAN visually depict cross-sectional                      tection and measurement of abdominal aortic
and saggital anatomy and can delineate abnormal                     aneurysms.
structures and distinguish whether they are cystic                     Ultrasonography is a painless, non-invasive
or solid, the use of ultrasound offers unique                       technique, without known deleterious side effects.
promise in assessing the abdomen before surgical                    It represents a significant addition to the arma-
operation.                                                          mentarium that can be brought to bear upon the
    Diagnostic ultrasound uses repetitive pulses of                 diagnosis of the abdomen before surgery.
sound with frequencies far above the range of hu-                                           STEPHEN I. MARGLIN, MD
man hearing. At these frequencies the sound waves                                           RoY FILLY, MD
can be concentrated into a narrow, well-directed
column, capable of penetrating the soft tissues of                                            REFERENCES
the body. As these waves traverse the abdomen                        Holm HH, Kristensen JK, Rasmussen SN, et al: Indications for
                                                                   ultrascnic scanning in abdominal diagnostics. J Clin Ultrasound
they are partially reflected at tissue interfaces be-              2:5-15, Mar 1974
cause of relative differences in acoustical impe-                     Freimanis AK: Echographic exploration of abdominal struc-
                                                                   tures. Critical Rev Radiol Sci 1:207-236, May 1970
dance. Returning echoes are accumulated on a
 storage oscilloscope, and by this means an accu-
 rate two-dimensional anatomic section is built up.
 By varying the receiver sensitivity, cystic structures
 can be distinguished from those that are solid.                    Treatment of the Subclavian
    The applicability of diagnostic ultrasound in                   Steal Syndrome by Carotid-
 assessing the surgical abdomen is extensive. What                  Subclavian Bypass
 follows is a brief and by no means all-inclusive
 review.                                                            STENOSIS OR OCCLUSION of the proximal subcla-
     In evaluating patients with abdominal trauma,                  vian artery often results in retrograde flow through
 ultrasound can successfully delineate hematomas,                   the ipsilateral vertebral artery. While most patients
 whether they are perihepatic, perisplenic, peri-                   with this abnormality are asymptomatic, in some
 nephric or retroperitoneal. It can also detect the                 the subclavian steal syndrome develops; that is,
 presence of blood (or other fluids) within the                     symptoms of cerebrovascular insufficiency with or
 peritoneal cavity.                                                 without claudication in the affected arm. This syn-
     When conventional radiographic methods have                    drome has increasingly been treated by carotid-
 failed to show a cause of jaundice, ultrasonography                subclavian bypass grafting to avoid the risks of
 can demonstrate the size of the gallbladder, its                   thoractomy, particularly in poor risk patients.
 response to fatty meals and, inferentially, whether                However, experimental and clinical studies indi-
  or not there is obstruction. The technique also per-              cate that, in the presence of occlusive disease of
  mits, with reasonable accuracy, the visualization                 the carotid vessels, carotid-subclavian bypass may
  of gallstones. Obstructive causes other than stones               produce carotid steal with failure of the patient

      224       SEPTEMBER 1974 * 121               * 3

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