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Objectives Free intraperitoneal fluid is a secondary sign of abdominal disorders. The detection of small volumes of fluid has been documented as a normal finding in women of childbearing age and also in pediatric sonography. However, the finding of free fluid in asymptomatic men has not been similarly documented by sonography. We postulate that with high-frequency linear probes, small volumes of fluid may be detected in asymptomatic men without underlying abdominal disorders. Methods Ten healthy male volunteers underwent targeted abdominal sonographic examinations after an overnight fast and in an immediate postprandial state. The findings were documented, and representative images were saved for analysis. Results We found small slivers or geometric collections of fluid between bowel loops in 4 of the 10 volunteers. No obvious correlation between the detection of fluid and the nutritional or hydration status of the patient was identified. Conclusions The findings suggest that small volumes of pelvic free fluid in healthy men can be normal and do not necessarily indicate underlying disorders. The role of free fluid identification as an indicator of major intra-abdominal disorders must be viewed with caution and with careful clinical correlation.

The use of ethnornedical information has immensely contributed to health care, and scientific studies have shown that the evaluation of traditionally used medicines may provide leads towards effective drug discovery. Since antiquity, Alstonia scholaris connmonly known as devil's tree has been used for the treatment of many human ailments. Literature suggests that Alstonia scholaris is useful in treating malaria, abdominal disorders, dyspepsia, leprosy, skin diseases, tumors, chronic and foul ulcers, asthma, bronchitis, helminthiasis, agalactia, and debility. Preclinical studies have shown that it possesses anti-microbial, anti-diarrhoeal, anti-plasmodial, anti-oxidant, anti-inflammatory hepatoprotective, nootrophic, anti-stress, anti-fertility, immunomodulatory, analgesic, anti-ulcer, wound healing, anti-cancer, chemopreventive, radiation protection, radiation sensitization, and chemosensitization activities. The diverse pharmacological observations are supposed to be due to the presence of alkaloids, flavonoids and phenolic acids. The bark and leaf extract when administered orally did not induce lethality or adverse affects at the limit doses of 2 000 mg/kg body weight. However when administered intraperitoneally at high concentrations, the extract showed systemic and developmental toxicities. This review addresses the experimentally authenticated facts and also suggests the need for research on chemical and pharmacological properties of Alstonia scholaris.

Chilaiditi's syndrome should be considered in the differential diagnosis of abdominal and chest pain. Although interposition of the right colon is a relatively common radiologic finding, there is a distinct paucity of information in the medical literature. Chilaiditi's syndrome is usually asymptomatic, but when symptoms occur, conservative treatment is usually effective. Recognition is important because this syndrome can be mistaken for more serious abnormalities, which may lead to unnecessary surgical intervention.

We report a case of adnexal torsion in a singleton pregnancy at 27 weeks of gestation. Adnexal torsion during pregnancy is a rare condition, and it is quite exceptional during the third trimester. The symptoms are non-specific and can be confused with other acute abdominal disorders. In our case, ultrasound allowed an accurate preoperative diagnosis.

The radiologic workup of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this complex situation have undergone considerable changes over the past two decades. The diagnosis and treatment of small bowel obstruction, a common clinical condition often associated with signs and symptoms similar to those seen in other acute abdominal disorders, continue to evolve. This article examines the changes related to the use of imaging in the diagnosis and management of patients with this potentially dangerous problem and revisits pertinent controversies.

Titelblatt Gutachter Widmung Inhaltsverzeichnis Einleitung Literatur Anatomie, Pathologie und Röntgentechnik Literatur Röntgenologische Pathologie Material und Methoden Ergebnisse, Patientenzahlen Ergebnisse, Magen Ergebnisse, Magen, gashaltig Ergebnisse, Magen, weitere Befunde Ergebnisse, Dünndarm Ergebnisse, Dickdarm, Zäkum Ergebnisse, Dickdarm, Kolon, allgemeine Darmbefunde Ergebnisse, Leber, Pankreas Ergebnisse, Milz Ergebnisse, Harntrakt Ergebnisse, Geschlechtsorgane weiblich Ergebnisse, Trächtigkeit 1 Ergebnisse, Trächtigkeit 2 Ergebnisse, Geschlechtsorgane männlich und andere Befunde Ergebnisse, Befundsummary Diskussion Summary Bibliographie Danksagung Lebenslauf Selbstständigkeitserklärung, In den Jahren 1994 bis 1999 wurden in der Klinik und Poliklinik für kleine Haustiere der Freien Universität Berlin 368 Meerschweinchen, davon 233 (63,3 %) weibliche und 132 (35,9%) männliche Tiere, abdominal geröntgt. Die Vorbereitungen des Patienten zur röntgenologischen Untersuchung sowie die Lagerungstechniken werden diskutiert. Anhand der erstellten Aufnahmen wird in dieser Arbeit, unter Berücksichtigung der klinischen Symptomatik, die Anwendbarkeit der Röntgenuntersuchung bei abdominalen Erkrankungen des Meerschweinchens in der Nativaufnahme untersucht. Physiologische und pathologische Darstellungen der Abdominalorgane werden beschrieben. Zu den physiologisch röntgenologisch abgrenzbaren Abdominalorganen des Meerschweinchens gehören die Leber, der Magen, der Blinddarm, die Nieren und die Harnblase. Bei geringgradigem Gasgehalt können auch der Dünndarm und einzelne Kolonabschnitte differenziert werden. Bei Tieren unter einem halben Jahr ist eine Differenzierung der Abdominalorgane bis auf die Leber nicht möglich. Größere Gasansammlungen im Magen-Darm-Trakt korrelieren beim Meerschweinchen häufig mit Erkrankungen desselben, des Urogenitalapparates und mit Allgemeinerkrankungen. Als Ausdruck massiver Gasbildung kommen oft Magen- und Blinddarmtympanien, auch in Kombination, vor. Die Magentympanie trat in dieser Studie häufiger auf als die Zäkumtympanie. Während die Magentympanie bei weiblichen Tieren häufiger zu sehen war, trat die Zäkumtympanie häufiger bei männlichen Meerschweinchen in einem Alter von drei bis vier Jahren auf. Grunderkrankungen, die häufig zu Inappetenz bzw. Anorexie geführt haben, waren die auslösenden Ursachen, vor allem Erkrankungen der Maulhöhle und Enteropathien. Magenbefunde wie Überladung, Bezoarbildung und Verkalkung der Magenwand werden in dieser Arbeit beschrieben. Leberveränderungen können als Organvergrößerungen bei Steatosis, Kongestion sowie bei Leberabszessen beobachtet werden. Röntgenologische Anzeichen einer Hepatomegalie sind die Lokalisation des Kaudalrandes des Lobus quadratus über L1 hinaus, Werte der kraniokaudalen Ausdehnung von mehr als vier Zentimeter und die Dislokation der kranialen Magenwand unter T11 bis T13. Aufgrund einer neoplastischen Entartung konnte die Bauchspeicheldrüse in einem Fall wegen diffuser Verkalkungsherde röntgenologisch dargestellt werden. Die Darstellung der Milz wird beispielhaft als Splenomegalie bei Infektionen des Gastrointestinaltraktes und bei Neoplasien beschrieben. Die physiologische Nierenlänge entspricht nach den vorliegenden Untersuchungen der 2,1 bis 2,9 - fachen Länge des ersten Lendenwirbelkörpers. Neben tympanischen Zuständen und raumfordernden Prozessen in der Bauchhöhle des Meerschweinchens hat die Röntgenologie bei der Diagnostik der Urolithiasis große Bedeutung. Sie kann röntgenologisch in den Nieren, den Harnleitern, der Harnblase und in der Harnröhre bei männlichen und bei weiblichen Tieren als Grieß- und Konkrementbildung nachgewiesen werden. Die Urolithiasis ist bei weiblichen Meerschweinchen mit 63% häufiger als bei männlichen. Ab einem Lebensalter von einem dreiviertel Jahr waren in dieser Studie alle Altersklassen betroffen. Weibliche Meerschweinchen neigen deutlich mehr zur Konkrementbildung in der Harnröhre bzw. an Orificium urethrae als männliche. Bei Anzeichen eines dolenten Abdomens sowie von Erkrankungen der Harnwege sollte die Radiologie aufgrund des häufigen Vorkommens der Urolithiasis beim Meerschweinchens wesentlicher Bestandteil der Diagnostik sein. Veränderungen am Uterus wie Pyometra, Nachgeburtsverhaltung, tumoröse Entartung und fruchtbedingte Geburtsstörungen konnten in dieser Studie nachgewiesen werden. Desweiteren lassen sich zystische Veränderungen an den Eierstöcken ab einer Größe von 1,5 cm röntgenologisch darstellen. Das Alter der betroffenen Tiere lag in dieser Studie mit einer Häufung der drei- bis fünfjährigen Tiere zwischen einem und sieben Jahren. Nebenbefunde am Skelettsystem werden in dieser Arbeit zusätzlich noch herausgearbeitet und dokumentiert., This study evaluated radiographs taken at the Clinic for Small Animals at the Free University of Berlin between 1994 & 1999\. Abdominal radiographs of 368 guinea pigs, 233 (63.3%) female and 132 (35.9%) male are included. Subject preparation and positioning techniques are discussed. In view of the clinical signs, the application and diagnostic value of plain radiographs in guinea pigs with abdominal diseases are examined. Another primary goal of this study is to describe the normal radiographical anatomy, including the exact positioning of the abdominal organs, in guinea pigs. Within the gastrointestinal tract of guinea pigs older than six months, under normal physiologic conditions, it is possible to distinguish the stomach, liver, cecum, descending colon, kidneys and bladder. Large amounts of gas inside the gastrointestinal tract are seen in guinea pigs with gastrointestinal, urogenital or general disorders. The occurrence of tympania of the stomach, cecum or both combined could be seen very often, of which tympania of the stomach predominates. Whereas tympania of the stomach could be seen mostly in females, cecal tympania predominated in males. These gastrointestinal disorders were rarely caused by improper feeding, but instead were secondary to diseases of the oral cavity that lead to anorexia. Overloading, bezoars and calcification of the stomach are also described. The radiographic portrait of the liver, pancreas and spleen in guinea pigs are described. Disorders of the liver can be seen as an enlargement with steatosis, congestion and abscesses. Radiological signs of liver enlargement include extension of its caudal margin beyond the first lumbar vertebra, a distance between cranial and caudal border greater than 4 cm and dislocation of the cranial stomach border above thoracic vertebra 11 to 13 on the ventral dorsal view. Specific detection of the normal pancreas is limited, but diffuse calcification of the pancreas secondary to malignant tumors enhances its visibility. Splenomegaly was correlated with serious infections of the gastrointestinal tract and tumours. The normal length of the kidneys varied between 2.1 and 2.9 times the length of the first lumbar vertebral body. Besides tympania and space occupying processes in the abdominal cavity, radiography is very important for the diagnosis of urolithiasis. These can be seen as early as nine months of age, and are one of the most common diseases in guinea pigs. Urinary gravel and calculi could be found in each part of the urinary tract. Urolithiasis is more frequent in females. A painful abdomen and urinary disorders should always prompt a radiographic examination in this species. This study found and describes abdominal radiographs as valuable in examination of disorders of the female guinea pigs genital tract and pregnancy. Abnormal findings of the skeleton are considered and included in the description.

Small bowel obstruction is a common clinical condition, often presenting with signs and symptoms similar to those seen in other acute abdominal disorders. The diagnosis and treatment of this dynamic process continues to evolve. The imaging approach in the work-up of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this disease have undergone considerable changes over the past two decades. This article examines the changes related to the use of imaging technology in the diagnosis and management of patients with small bowel obstruction. The meaning of frequently used but poorly defined terms in describing intestinal obstruction is clarified and illustrated.

Although ultrasonography is the method of choice for evaluating the fetus, magnetic resonance imaging (MRI) complements ultrasonography in the accurate diagnosis of fetal abnormalities. The advantages of MRI include excellent tissue contrast, a large field of view, and relative operator independence. To date, most studies on fetal MRI have focused on the fetal central nervous system and thoracic disorders. However, our experience suggests that MRI can be helpful even in evaluating fetal abdominal disorders. This pictorial essay illustrates the various MRI appearances of fetal abdominal abnormalities and discusses the indications and advantages of fetal MRI.

Portal vein aneurysm is a rare clinical entity with only 42 published cases in the English literature. We present a 30-yr old woman who was incidentally diagnosed with an extrahepatic portal vein aneurysm during the investigation for dyspepsia. Expectant management with regular follow-up and surveillance imaging was adopted. This pathology is increasingly encountered with the frequent use of radiological imaging modalities in the work-up of abdominal disorders. Etiology, clinical significance and management strategies for extrahepatic portal vein aneurysms are discussed.

The plant Pavetta crassipes K. Schum (syn.P.barteri) is a shrub or small tree widespread in the tropical savannah. In Nigeria, the leaves of this plant are used medicinally in the management of respiratory infections and abdominal disorders. The leaves are also used in Tanzania in the treatment of gonorrhoea, while in Central Africa, the acid infusion of the leaves are taken as cough remedy. We report the macroscopy, microscopy and some pharmacognostic standards such as moisture content, ash and extractive values for the leaves of P.crassipes, which could be used to prepare a monograph for proper identification of the plant. Key Words: Pavetta crassipes, macroscopy, chemomiscroscopy, pharmacognostic standards [Nig. J. Nat. Prod. And Med. Vol.6 2002: 30-32]

Of the nonorganic abdominal disorders the celiac/solar plexus syndrome represents a frequently seen entity characterized by the typical association of epigastric pain and "lambda-type" tenderness. It is a special type of abdominal neurosis in which the pain arises in the periaortic nervous plexuses. Its clinical importance is in the differential diagnosis, since it is often misinterpreted as a painful condition of abdominal or retroperitoneal origin.

Abdominal distention is a common clinical sign in guinea pigs and may have many causes. Abdominal ultrasonography may be a useful diagnostic tool in differentiation of abdominal disorders in guinea pigs. Ovariohysterectomy is indicated for granulosa cell tumors and cystic rete ovarii in guinea pigs.

Spontaneous rectus sheath hematoma is an uncommon condition which usually presents as acute abdomen, mimicking other abdominal disorders. Management must be initially conservative, but surgery is indicated in progressive hematomas. We present a case report of rectus sheath hematoma conservatively managed.

Over the past several years, laparoscopic techniques have been applied to the surgical management of almost all abdominal disorders, including both benign and malignant intestinal diseases. Although laparoscopic cholecystectomy has clearly gained acceptance as a major advance in abdominal surgery, having readily apparent benefits over conventional surgery (1), the role of laparoscopic techniques in managing intestinal disorders remains unclear.

To assess the accuracy of emergency department (ED) provisional diagnosis (ProDx) as compared with the hospital discharge diagnosis (HDDx) and the impact on hospital morbidity and mortality among nonelderly and elderly persons presenting with acute nontraumatic abdominal complaints, a retrospective review was conducted of 1,863 nonelderly (younger than 65 years) and 428 elderly (65 years or older) adults admitted to a university hospital from its ED. The sensitivity/ specificity of the ProDx was 82%/86% for patients younger than 65 versus 68%/76% for those 65 or older. When the ProDx and HDDx did not agree, the overall disease-related morbidity was 16% for patients younger than 65 versus 45% for those 65 or older (P < .02). There were no differences in mortality based on agreement of the ProDx and HDDx. Prospective studies to determine the factors that are most useful in the ED diagnosis of acute nontraumatic abdominal disorders in the elderly are needed to improve the accuracy of diagnosis and reduce the incidence of morbidity in this high-risk group.

The medical management of postoperative abdominal disorders remains a diagnostic and therapeutic challenge for the equine clinician. Recent advances in the development of techniques and medications to offset or attenuate ischemia-reperfusion injury, endotoxemia, and ileus are encouraging and potentially will decrease the incidence of additional complications.

Laparoscopy is becoming the preferred approach for managing several abdominal disorders. The main limitations of laparoscopic surgery and diagnostic laparoscopy are the loss of the surgeon's tactile feedback and the inability to undertake a complete internal evaluation of solid parenchyma. Probes for laparoscopic sonography have been introduced to compensate for the limitations of laparoscopic surgery and to increase the diagnostic efficacy of laparoscopy [1]. In this article we describe our experience with laparoscopic sonography and illustrate the normal anatomic findings and some applications in biliary surgery and other abdominal laparoscopic procedures.

It has been over 10 years since the publication of the last issue of the Radiologic Clinics of North America devoted entirely to imaging acute abdominal disorders. Significant advances in technology, new applications, changed protocols, and considerable accumulated experience have prompted an update of this important clinical subject. The purpose of this new issue is twofold. First, acute abdominal conditions that can be diagnosed and evaluated rapidly by relatively noninvasive imaging examinations are reviewed. I have tried to avoid overlaps and duplications while maintaining the relevance of the topic by focusing on pertinent, potentially lifethreatening abdominal conditions. Second, this issue provides an abbreviated but comprehensive presentation of new applications of imaging modalities—such as multidetector (multislice) CT, sonography, and MR imaging—that were previously not available or were not commonly used in the evaluation of patients with acute abdominal complaints. After perusing through this issue, readers will no doubt notice that radiologists, based on their experience and established beliefs, tend to address similar clinical challenges by different means using various imaging modalities or distinctly idiosyncratic technical protocols. Theoretically, the selection of a given

Despite several years of clinical experience with magnetic resonance (MR) imaging, only few relevant clinical applications for liver and upper abdominal disorders have appeared. The main factor limiting wide use of MR of the liver is image artifacts due to biological motion. Therefore optimal pulse sequences using different modalities of motion reduction must be employed (Paling et al. 1988).

• We audited our recent experience with diagnostic laparoscopy performed over a 30-month period on 131 consecutive patients. Laparoscopy was 100% accurate in the diagnosis or exclusion of intra-abdominal malignant neoplasms, and future care decisions were affected by this information. Laparoscopy in the evaluation of chronic abdominal pain yielded positive findings in 47% of cases. The majority of referrals (73%) for the investigation of chronic abdominal pain came from the medical services, whereas the majority of referrals (72%) for the investigation of cancer originated from surgeons. Laparoscopy in the setting of acute abdominal pain yielded useful information that affected patient outcomes in 71% of cases. There were no serious complications in this series. Laparoscopy is a safe and useful diagnostic tool, especially for the diagnosis, staging, or exclusion of cancer. ( Arch Surg . 1992;127:379-383)

A retrospective audit carried out in the Department of Clinical Biochemistry, covering a period of 42 months, showed 19 benign conditions, that gave rise to elevated serum CA-125 concentrations. These included six patients with non-malignant gynaecological disease, six patients with abdominal disorders, and seven patients with lung disease. These observations confirm that false-positive elevations can occur and that care must be taken before attributing an elevated serum CA-125 as an indicator of ovarian malignancy.

This manuscript demonstrates that gray-scale ultrasonography can be useful for the diagnosis of many canine abdominal disorders. It is safe, noninvasive, and requires minimal patient preparation. Size, shape, and location of abdominal organs can be determined readily. The unique physical properties of ultrasound allow detection and characterization of mass lesions and parenchymal pathology associated with abdominal organs. Ultrasonography can complement existing imaging modalities by adding information not obtainable by other methods. The effective use of ultrasound requires knowledge of its advantages, limitations, and how it complements other diagnostic procedures. The medical histories of four dogs were reported in order to illustrate proper application of ultrasound to clinical problems. Basic findings concerning ultrasound utilization for investigation of the liver, kidney, and caudal abdomen were discussed.

78 patients suffering from various functional abdominal complaints have been treated in a 2 × 2 double-blind design: (a) psychotherapy with Ro 5-3350 (TH/Ro); (b) psychotherapy with placebo (TH/P); (c) Ro 5-3350 without psychotherapy (NTH/Ro); (d) placebo without psychotherapy (NTH/P). Results show that a considerable amount of improvement cannot be ascribed to the two critical factors or the interaction of both, but are due to unspecific influences in the course of treatment. Some of the results concerning the combination of TH and the psychotropic drug pose interesting questions for further research and bare implications for double-blind trials of psychotropic drugs. The results suggest that possibly properties of any psychotropic drug have to be related to a doctor-patient relationship within which the personal problems of the patient are dealt with. In order to evaluate such properties, special methodological precautions have to be taken. These will be briefly discussed.

Recognition of the association of congenital hemihypertrophy and benign and malignant abdominal disorders has increased. We present our experience with these conditions and offer an hypothesis relating them.

The patient-doctor relationship is based on the principles of interaction, collecting data and integration of both interaction and data into an overall diagnosis/therapy. Patients with functional abdominal disorders are seen as representatives of today's general patients and a study of their management in present medical practice is reported, as revealed through literature. The literature reveals an almost complete neglect of interactional and integrational principles. This holds true even for psychosomatically oriented literature, which offers some crude clinical guidelines at best. Thus the primary physician gets little support from psychosomatic medicine in understanding the full meaning of the doctor-patient relationship. The clinical implications of the relationship are demonstrated through a short case history and implications for future training are described which are based on the primary physician's actual working experiences.

In the paralysed and sedated patient, acute abdominal diseases are difficult to diagnose. Clinical signs such as tenderness, rebound, guarding and rigidity are often misleading or absent and in the fully monitored, critically ill patient, the abdominal X-ray, ultrasound and CT scan may be associated with a high incidence of artifact abnormality.The acute abdominal disorders commonly found in the critically ill patient are listed, the diagnostic approach using standard clinical and investigational methods is considered, and the problems commonly encountered by the clinician are highlighted.

Despite its rarity, it is advisable for the general surgeon and other members of the profession to recognize carcinoma of the small intestine as a definite entity, and to keep it in mind in differential diagnosis of abdominal disorders. Signs and symptoms are discussed which, when present, should enable one to make a diagnosis of carcinoma of the small intestine with a reasonable degree of assurance. The accepted methods of treatment of these lesions are mentioned. A case of carcinoma of the terminal ileum is reported.

THE mortality in acute intestinal obstruction continues to be prohibitively high. Recent reports from large municipal hospitals where cases of bowel obstruction are frequently seen indicate that from 35 to 60 per cent of patients operated upon for acute bowel obstruction die (Miller). Despite the fact that marked improvement is manifest in the results of practically all other acute abdominal catastrophes, the mortality of obstruction to-day is almost that of forty years ago. This is due in large measure to late diagnosis, for any number of statistical studies indicate that when cases come to operation early the results compare fairly satisfactorily with the issue attending the surgery of other acute abdominal disorders. Finney reports a mortality of 36 per cent in 217 cases, but within the first 12 hours the mortality was 5 per cent and for the 12-to-24-hour period, 11 per cent. Whereas the mortality in the entire group of 128 cases of acute intestinal obstruction reported by Tuttle was 41.3 per cent, in ...

Operative surgery has contributed in a great measure toward the solution of many diagnostic problems. The role which surgical exploration has played in the clarification of the pathologic basis of symptoms referable to the abdomen requires no elaboration. There is, however, one phase of abdominal involvement which has been the subject of considerable speculation and discussion—I refer to the matter of pericolitis, or pericolic membrane, more familiarly designated as Jackson's membrane, as an etiologic factor in abdominal complaints. Jabez N. Jackson, in a paper presented before the Western Surgical Association in 1908, definitely described a membranous veil in connection with the cecum, ascending colon, and hepatic flexure which he felt was of great significance in the causation of abdominal disorders. I can do no better than quote, with his permission, some portions of his original article in which he incorporates a report by Frank Hall, pathologist to the Kansas City General Hospital, describing the con...

Neonatal intussusception in premature infants is uncommon and may mimic other abdominal disorders. We present a case of intussusception in a very low birthweight neonate. Presenting signs initially suggested necrotizing enterocolitis and meconium disease, and the diagnosis was confirmed at laparotomy.

SUMMARY Indirect arterial blood pressure was determined on 33 horses prior to surgical intervention for the diagnosis and/or correction of acute abdominal disorders and a relationship between low systolic blood pressure and non-survival was established. It is suggested that blood pressure determination should be used to augment other methods of clinical and laboratory examination in cases of equine colic. RESUME On mesure la pression arterielle de 33 chevaux avant l'intervention chirurgicale pour le diagnostic et pour le raitement de desordres abdominaux aigus chez le cheval. Une relation entre une basse pression systolique et le taux de mortalit On pense que la mesure de la pression sanguine peut etre utilisee comme methode complementaire de la clinique et du laboratoire, dans les cas de coliques chez le cheval. ZUSAMMENFASSUNG Die indirekte arterielle Blutdruckmessung wurde an 33 Pferden vorgenommen, bevor sie fur die Diagnose und/oder die Korrektur akuter abdominaler Storungen operiert werden mussten. Eine Beziehung zwischen tiefem systolischem Druck und Nicht-Ueberleben konnte etabliert werden. Es wird vorgeschlagen, die Blutdruckmessung vorzunehmen und andere klinische und labortechnische Untersuchungsmethoden damit zu erganzen.

The authors review the imaging techniques currently used to study some of the more common emergency medical and surgical problems that are encountered in children and that are not covered elsewhere in this volume.

As a technique that excels in the demonstration of soft tissues it seems obvious that ultrasound should be used in the study of abnormalities of muscle and subcutaneous tissue. However, the field has been surprisingly slow to develop. This probably results mainly from lack of familiarity with the technique in those departments dealing with these disorders. Until recently, many have regarded ultrasound as the province of those who deal with obstetric and abdominal disorders. However, as appreciation of its potential has spread, there has been a rapid growth in its use in the musculoskeletal system (Harke et al., 1988; Wilson, 1988) including the study of soft tissue lesions. Diagnostic ultrasound has a variable capacity for solving problems. The technique is highly operator dependent and a diagnosis cannot be made from hard copies. It is therefore particularly important for clinical teams to critically and regularly review the diagnostic value of each application. There are several groups of disorders where ultrasound has the potential to make a positive contribution to clinical management and these are set out below.

In 1790 the British physician John Hunter first introduced gastric intubation as an artificial means of feeding a paralyzed patient (1). During the last century William Beaumont’s classic studies of gastric juice led to further utilization of such tubes in the analysis of digestive functions of the stomach (2). More recently, however, technical refinements have made gastrointestinal intubation a routine procedure in medical and surgical management of many abdominal disorders. The principal application of this technique is in intestinal decompression in patients with obstructive symptoms or paralytic ileus (3,4). Flexible tubes are also placed into the gastrointestinal tract for various other diagnostic or therapeutic purposes, including alimentation with liquefied food (5–7), hypotonic duodenography, enteroclysis, gastrointestinal secretory tests, and mucosal biopsy (8–13).

For the classification of acute abdominal disorders in children, it is convenient to limit the neonatal period to the first 15 days of life for the following reasons: 1. The atretic forms of congenital intestinal obstruction are seen only in the first days of life, because they are incompatible with life beyond that period. 2. Several “acquired” forms of obstruction are extremely rare in the first 2 weeks after birth, such as pyloric stenosis and intussusception.

Evaluation of nuclear magnetic resonance (NMR) imaging of the abdomen was done in 41 patients with focal and diffuse disorders of the liver and retroperitoneal and vascular abnormalities. Spin-echo technique was used in each situation with varying time to echo (TE) and repetition rates (TR). No single pulsing technique was optimal in all situations. Three false-negative NMR studies of 22 patients with focal lesions of the liver were attributed to incomplete coverage of the involved area or inappropriate pulsing technique. When appropriate technique was achieved, NMR was equal to computed tomography (CT) in detecting abdominal disorders, except in fatty infiltration of the liver. NMR was superior to CT in imaging vascular anatomy because of the inherent increased contrast produced by the absence of signal from flowing blood and the flexibility of imaging planes.

Investigations by the author (see Alfidi et al., 1975) and by Philips and Stephens (1975) have shown the capability of computed tomography (CT) in the diagnosis of a variety of abdominal disorders. In the liver, primary and metastatic neoplasms, abscesses, cysts, and certain stages of cirrhosis are demonstrable. This chapter includes a comparison of CT scanning of the liver with nuclear medicine scans and a discussion of the use of contrast agents as well as CT as an adjunct in transhepatic cholangiography, biopsy, and drainage procedures.

Arteriography has become an important and necessary procedure for the investigation of intracranial, intrathoracic, and abdominal disorders in today’s modern medicine. The first experiments in arteriography concerned the differential diagnosis of bone neoplasms. The work of Dos Santos et al. (1932), Caldas (1934), and Farinas (1937) provided the major impetus in the development of modern selective arteriography.

The assessment and management of abdominal disease in persons with spinal cord injuries is extremely complex. Alterations in the normal conduction of impulses to the brain can result in symptoms that may be quite unlike those which are commonly associated with abdominal pathology. A number of features, however, have been identified which can assist the practitioner in the interpretation of the clinical evaluation. This article discusses those findings and the most commonly occurring abdominal disorders in which they are seen. Two case studies are presented which exemplify the symptomatology described and which reinforce the need for early accurate diagnosis and management of abdominal disease in spinal cord injured persons.

Ultrasound was used to diagnose and demonstrate an anterior abdominal wall abscess of unknown cause in a diabetic woman. This condition may mimic major abdominal disorders and, in our patient, appeared as acute cholecystitis. The use of ultrasound is simple, quick, painless, and without known adverse side effects. The diagnosis may be more easily and accurately established than by routine roentgenography.