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A prospective study was carried out to compare the value of ultrasound examination with conventional management in patients presenting with emergency surgical problems. During an 4 years period the authors followed 301 patients referred to the Ist Institute of Surgery of the University of Rome "La Sapienza". After immediate clinical evaluation one or more US examinations were performed in each patient following a standard protocol of study. Abdominal emergencies were the most frequent conditions, found in 75% of the cases and the acute abdomen due to trauma in 17.6% of the cases. The overall sensibility, specificity and accuracy of clinical examinations and US examinations were respectively of 88%, 33%, 70% and 95%, 94%, 95%. In 38 patients (12.7%), a diagnosis was made up by sonographic examination which had not been clinically expected (group A). The principal condition in this group was gynaecological pathology, found in 17 patients. In 161 patients (53.3%) sonography confirmed the first diagnosis clinically suspected (group B) and in 23 cases the second or third differential diagnosis (group D). Sonography made no contribution to the diagnosis in 77 cases (25,5%) and only in 2 cases was considered misleading. The result of this study demonstrate the usefulness of emergency ultrasonography in gynecological, gall bladder, pancreatic and vascular diseases. Moreover sonography must be considered the principal diagnostic tool in patients with trauma. In order to recognize gynecological diseases which can simulate appendicitis US examination must be considered necessary in young female patients. When appendicitis is suspected US is useful in children and in older patients too.

The Authors report their experience about fifty patients affected with renovascular hypertension, treated by percutaneous transluminal angioplasty (PTA) for stenosis of main renal artery and now studied by Duplex-Scan and Color-doppler. Results, compared with arterial pressure measurements, renography and laboratory renal function evaluation, showed a sensibility of 84%, specificity of 90% and an accuracy of 87.5%. Advantages and limits of Duplex-scan in patients treated by PTA are briefly discussed.

From February 1986 to March 1988 113 abdominal US exams were performed in emergency situation to evaluate the accuracy of this methodology: 13 were blunt traumas, 18 postoperative complications. A real-time scanner with a linear probe of 5 MHz was employed. The results were confirmed by surgical and/or clinical and instrumental evaluation. In 81% of the examinations, ultrasonography allowed a diagnosis to be made. Gallbladder and biliary pathologies were the most common findings. The results (sensibility 96%, specificity 88%, accuracy 95%) confirm the reliability of ultrasonography in abdominal emergencies, as shown in literature.

Real-time B-mode ultrasonography was used to study in vivo the behavior of bifurcated aortic grafts (Dacron knitted) implanted over a period of 1 to 88 months previously in 67 patients, 28 of whom (42 per cent) were hypertensive. Most grafts showed an increase in size, when compared with the original one, which appeared to be closely related to arterial pressure (P less than 0.05). This increase was not dependent on the time elapsed from implant.

Intrarectal ultrasonography is a new imaging method used in the preoperative staging of rectal cancer. Twenty five patients with proven rectal cancer were submitted to preoperative intrarectal ultrasonography; 24 were resected. Real time scanner with a linear probe of 5 MHz was employed. Five sonographic structures corresponding to the five histological layers were evidenced. Ultrasound T staging was compared to pathology, using UICC classification. In all but two cases pathology corresponded to ultrasound T staging (accuracy 92%). Perirectal nodal involvement was also investigated. It is concluded that intrarectal ultrasonography will play a definite role in the preoperative staging as well as in programming treatment of rectal carcinoma.