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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
"Abdominal Ultrasound in Assessing"