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Uncertainties on the intensive care unit (ICU) regarding the eligibility of a patient to be a potential deceased organ donor may prevent their referral and enrolment in the pathway for organ donation. Healthcare staff may exclude potential donors for medical reasons, which are no longer applicable. Hence, Swisstransplant implemented a digital donor evaluation tool (DET) in 2021, which allows the local hospital's organ donation coordinator to send a direct request to medical advisors (MA) of the organ procurement organization before excluding potential donors. All 156 requests entered in 2022 were analyzed. 117 patients (75.0%) were primarily accepted by the MA as potential donors. Of those 60 patients (51.3%) became actual organ donors. Main reasons for using the DET were questions regarding malignancies (n = 33, 21.2%), infectious diseases (n = 35, 22.4%) and age/co-morbidities (n = 34, 21.8%). The average age of the actual "DET donor" compared to the regularly enrolled, actual "Non-DET donor" was 65.3 ± 15.8 vs. 56.8 ± 17.5 years, respectively ( p = 0.008). On average 1.9 ± 1.1 organs compared to 3.2 ± 1.3 organs were retrieved from DET vs. Non-DET donors. In summary, this new digital donor evaluation tool supports reporting and facilitates eligibility decisions in uncertain, complex donor cases, potentially increasing the number of organ donations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Imbimbo, Nauwerk, Cammarota, Beyeler, Krügel, Elmer, Mueller and Immer.)

Purpose: The aim of this work is to investigate the role of power Doppler sonography as an additional predictor of surgical recurrence in Crohn's disease., Methods: A sample of 33 patients, with ileal or ileocolonic Crohn's disease, that had underwent intestinal resection, were retrospectively enrolled. All patients had bowel ultrasonography 7-16 months after resection. Power Doppler sonography of the preanastomotic ileum was evaluated as a possible prognostication tool to assess the risk of long-term need for reoperation., Results: The absolute incidence of surgical recurrence in those who had a positive power Doppler was 42 %, while that of those who had a negative power Doppler was 28.6 %. Combining the power Doppler with bowel wall thickness, the surgical recurrence risk grew from 41.2 % of those with a positive power Doppler and thickness >3 mm to 55.6 % of those with a positive power Doppler and thickness >6 mm., Conclusions: Power Doppler look to be another useful prediction tool for the personalization of patient's care. It could be useful to perform power Doppler in all patients with a wall thickness >5 mm: for those who have a positive power Doppler it may be indicated as a more aggressive prophylactic therapy.

Background: In Crohn's disease natural history, about 80% of the patients require surgery, which is not curative: unfortunately, the disease recurs in many patients., Objective: To investigate the role of intestinal ultrasound to predict the risk of post-operative surgical recurrence in Crohn's disease., Material and Methods: A total of 196 patients, with ileal or ileocolonic Crohn's disease, undergoing intestinal resection, were retrospectively enrolled. All patients underwent bowel ultrasonography 6-15 months after resection. Wall thickness at the anastomosis level was measured, and thickening >3 mm was evaluated as risk factor of long-term need for reoperation., Results: Patients who have a bowel wall thickness >3 mm have an risk ratio (RR) of surgical recurrence = 2.1 [95% confidence interval (CI) = 1.12-3.74] higher than those with a thickness of ≤3 mm. The absolute incidence of new surgical intervention is 13% in patients with thickness of 3 mm, 28% in patients with thickness >3 mm, 29,1% with thickness >4 mm, 34% with thickness >5 mm, and 40% with thickness >6 mm., Conclusions: Bowel wall thickness >3 mm at ultrasound may be a non-invasive predictor of early surgical recurrence after ileo-colonic resection.

We used ultrasonography to evaluate the nature and the extent of subcutaneous damage provoked by Mycobacterium ulcerans (M. ulcerans) and to investigate the possible involvement of the tributary lymph nodes during the various stages of progression of Buruli ulcer. Nineteen patients affected by M. ulcerans infection in Benin, West Africa, were studied. Ultrasonography was performed on all subjects, except one, at the site of nonulcerated lesions and/or at perilesional site. The tributary lymph nodes were also studied in six patients. Ultrasound (US) evaluation was carried out using a 10 MHz linear probe and all lesions were compared with the homologous unaffected controlateral site. The ultrasonography showed relevant alterations at the dermo-hypodermic level, in agreement with histological specimens. In the active forms of the disease, these alterations are characterized by significant oedematous imbibition of the adipose tissue and necrosis (adiponecrosis) that leads to varying irregularities in the echogenicity of the hypodermis, which is generally thicker. In agreement with the clinical examination, the lymph nodes in six patients evaluated, despite their possible histological involvement with necrotic phenomena described in literature in M. ulcerans infection, did not display significant alterations visible by ultrasonography. The US scanning we have performed is the first use of this technique for M. ulcerans infection. We have shown that it can reveal the subcutaneous depth and the peripheral extent of the pathological process and it is particularly useful for monitoring the efficacy of or resistance to antibiotic treatment, especially in extensive ulcero-oedomatose forms. Such monitoring offers also a useful guide to the surgeon allowing the reduction or postponement of the removal of the large cutaneous areas that were carried out until recently.

Objective: To prospectively evaluate the vascularization of the thickened terminal ileum in Crohn's disease patients using contrast enhanced ultrasound (CEUS) and to compare the clinical activity measured by the Crohn's disease activity index (CDAI) with the CEUS findings., Patients and Methods: Forty-eight of 104 consecutive patients (17 females and 31 males, aged 42.4+/-13.8 years) with a thickened terminal ileum at sonography were recruited for the study. CEUS examinations were performed using a real-time low mechanical index harmonic ultrasound technique after intravenous injection of a second generation contrast agent. We used two parameters to assess the vascularization of the bowel wall: a semi-quantitative method, the pattern of enhancement (which is the description of the arrangement of the enhanced layer in the bowel wall) and a quantitative method, the E/W ratio (which is the ratio between the major thickness of the enhanced layer, E, and the thickness of the entire wall section, W). In order to assess the accuracy of the CEUS findings in discriminating between active and inactive patients according to CDAI values (>150 and < or =150, respectively), the patterns of enhancement (four patterns) were dichotomized in two groups and an E/W ratio cutoff value was calculated to differentiate between poor and abundant bowel wall enhancement., Results: The CEUS findings, namely the pattern of enhancement and the E/W ratio (best cutoff value ranging between 0.43 and 0.47), had a sensitivity of 81.0% and 81.0%, respectively, a specificity of 63.0% and 55.6%, respectively, a positive predictive value of 63.0% and 58.6%, respectively, and a negative predictive value of 81.0% and 78.9%, respectively, in distinguishing patients with active and inactive disease., Conclusions: CEUS assessment of diseased bowel wall vascularization may be a sensitive tool for the detection of inflammatory activity.

Background: The aim of the study was to evaluate the diagnostic role of Kruis score and intestinal ultrasound in young patients with abdominal pain and bowel dysfunction., Methods: Prospective, double blind, case-control study in 297 consecutive patients with Crohn's disease and irritable bowel syndrome (from 1993 to 1995)., Inclusion Criteria: abdominal pain, bowel dysfunction without clear symptoms or signs of organic disease. The final diagnosis is obtained with usual diagnostic criteria and confirmed by at least 2 years of follow-up. Intestinal ultrasound is considered diagnostic of Crohn's disease if bowel wall thickness is = or > 7 mm; the Kruis score is diagnostic for irritable bowel syndrome if = or > 44., Results: To diagnose Crohn's disease, intestinal ultrasound and Kruis score respectively showed sensitivity of 84 and 97%, specificity of 98 and 50%, positive predictive value of 91 and 33%, negative predictive value of 96 and 98%, efficacy of 95 and 60%. Both exams suggest the same diagnosis in 55% of patients with a correct diagnosis of 97%., Conclusions: The intestinal ultrasound and the Kruis score can be a good diagnostic association in young patients with abdominal pain and bowel dysfunction but without clear symptoms or signs of organic disease. If their diagnostic conclusions are the same (55%), they have a low probability of diagnostic error (3%). If they show a different diagnostic hypothesis, other markers of disease, for example ASCA, can be used.

Purpose: To devise and implement a programme of measurements to assess the entrance surface dose for a standard-sized patient and to check the compliance with diagnostic reference levels., Material and Methods: Dose evaluation was performed on 40 radiographic instruments. The exposure parameters were collected for the main radiographic procedures (chest, skull, spine, pelvis, abdomen) each performed with instrument on a standard-sized patient. The output of each X-ray tube at 70, 80, 90, 100, 110 and 120 kV was measured with a solid state detector during quality controls. Beam quality and geometric characteristics of the equipment were also determined. The entrance surface dose for a standard patient was assessed for each procedure carried out with the 40 instruments, thus obtaining a total of 155 radiographic techniques. Finally, the method was validated by comparing the values obtained with the solid state and an ionization chamber for X-ray beam detector., Results: The comparison between the solid state detector and the ionisation chamber demonstrated a good agreement. Results show that reference diagnostic levels are respected in most examinations (147/155) even if exposure values do not always comply with those indicated by European guidelines. The measurement programme seems to be applicable in hospital practice where the large number of radiographics instruments and procedures requires the acquisition and processing of a large number of data., Conclusions: The evaluation of patient dose during quality control is feasible and allows a first check of compliance with reference levels in order to identify which procedures can be optimised by means of more specific measurements and assessments.

Purpose: To evaluate the role of intestinal ultrasound (US) in differentiating organic from functional bowel disease., Material and Methods: We examined with abdominal and intestinal US 313 consecutive outpatients presenting abdominal pain and bowel dysfunction, lasting more than 3 months, with no symptoms or signs of alarm and with no previous diagnosis of organic disease. Our population consisted of 191 women and 122 men, with average age at diagnosis of 36.5 years; 236 of these patients had irritable bowel syndrome, 61 Crohn's disease, and 16 ulcerative colitis. Intestinal wall thickness exceeding 7 mm was considered diagnostic for inflammatory bowel diseases. We compared US findings with the diagnosis made with the conventional diagnostic workup of radiological and endoscopic examinations., Results: Sensitivity of intestinal US for diagnosis of inflammatory bowel diseases was 74% and specificity 98% (respectively 84% and 98% for the diagnosis of Crohn's disease and 38% and 98% for ulcerative colitis), and positive and negative predictive values were both 92%; efficacy was also 92%. The likelihood ratio was 35 if US was positive for inflammatory bowel diseases and 0.26 if bowel wall thickness was less than 7 mm. Diagnostic efficacy was 95% for Crohn's disease and 94% for ulcerative colitis., Discussion: Intestinal US proved to be a valuable tool in diagnosing Crohn's disease. As the first step examination US can show the disease site and suggest further instrumental tests., Conclusions: In our experience intestinal US is an important diagnostic examination for the approach to young patients without symptoms or signs suggestive of organic diseases and can help avoid invasive instrumental examinations.

Objective: The diagnosis of most skin diseases, both focal and diffuse, has long relied mainly on physical examination findings. The recent introduction of technologically advanced ultrasound equipment using 20 MHz probes has permitted the specific application of ultrasound to dermatology. Accordingly, we investigated whether the findings at very high frequencies can represent a valid adjunct to clinical assessment in many skin conditions, including neoplasms, inflammatory states and diseases of unknown origin., Materials and Methods: Skin lesions are studied using high frequency probes, which very clearly detail the three layers (epidermis, dermis and subcutaneous tissues) forming the normal skin. The choice of the probes frequency should depend mainly on the lesion diameters and site. Electronic 7.5-13 MHz linear probes depict flat and regular surfaces effectively and provide a wider field of surface vision and, therefore, a wider view than sectorial probes. Water bath sectorial mechanical probes with 10-20 MHz frequency have very superficial focusing and are excellent to study irregular surfaces., Results: High frequency ultrasound can be usefully correlated with clinical tests to study focal skin lesions. The diagnosis of most benign skin cancers is usually made on clinical bases. Ultrasound examinations are performed preoperatively in questionable cases. Malignant neoplasms appear at ultrasound as hypoechoic focal lesions, generally with no specific features in relation to the histologic type; nevertheless, preoperative ultrasound may play an important role in that it measures the thickness of cutaneous melanoma, which is a very important prognostic factor. In particular, 20 MHz probes permit to assess the depth of melanoma invasion. The sonographic evaluation of melanoma thickness is usually in agreement with histologic findings. 'Satellite' neoplastic lesions growing near the main tumor can also be revealed. Color and power Doppler studies may be combined with gray-scale imaging: the identification of abnormal intra- or peritumoral low-resistance pulsatile flow signals suggests the malignant nature of the cutaneous lesion. High frequency ultrasound can also be used to study diffuse cutaneous conditions. Among them, ultrasound can provide a valid morphologic representation of psoriatic skin lesions and it is also a noninvasive and accurate method for evaluating the therapeutic efficacy of antipsoriatic drugs. In scleroderma, sonographic findings vary depending on disease activity and the patterns vary; therefore, 20 MHz probes may also prove useful over the other instrumental tools to monitor the disease course and treatment efficacy in focal scleroderma. Other potential applications include allergic dermatitis, nodular erythema, dermatomyosis, sarcoidosis, lymphedema of the limbs and allergologic conditions. Ultrasound can also be used in monitoring the response to or complications of topic drugs administration, and in the follow-up of focal burns., Conclusion: High frequency ultrasound can provide a reliable morphologic representation of skin lesions but it is also an accurate noninvasive tool for monitoring the therapeutic efficacy of drugs administration in focal or diffuse diseases. The application of high frequency studies to dermatology is very challenging. Indeed, the very high frequency probes up to 20 MHz currently available are particularly useful for reliable studies. Contrast-enhanced color and power doppler are very promising techniques. Advancements in technology will improve the correlation of clinical with high frequency ultrasound findings in the assessment of several skin diseases.

The authors describe a case of 21-year-old man suffering from tuberous sclerosis, more than once operated for subependymal astrocytomas, presenting multiple bilateral renal angiomyolipomas of 1.5 cm as greatest diameter. Last abdominal ultrasonographic exam, done a few years after the former, revealed an angiomyolipoma measuring 10 cm in diameter at the upper pole of the right kidney. This angiomyolipoma projected into a large haematoma of 15 cm in diameter, absolutely asymptomatic. After CT control bone lesions were removed. This case shows the progressive increase in number and size of renal angiomyolipomas, with subsequent haemorrhagic complications, suggesting as opportune periodic ultrasonographic controls.

A rare case of idiopathic chyluria is presented. The pathological and radiological aspects of this disease are discussed and the diagnostic importance of lymphography stressed.

Personal experience of echotomography in 7 cases of hepatic echinococcosic cysts in the first quarter of 1982 in presented. The echotomographic problems of differential diagnosis (especially with congenital cysts) are described for each case, and the information required by the surgeon to facilitate exeresis is emphasised.

Trans-rectal ultrasound with a 5 MHz probe was used to examine 16 patients who had perianal fistulas and 5 of them underwent one or more surgical explorations. In 11 cases, all surgically checked, sonography was able to demonstrate a pararectal abscess and accurately image the site, size, extension and--in some cases--the fistula itself. It can be advised that, using high frequency probes (7 or 10 MHz), transrectal ultrasound could provide even more exact diagnostic information in anorectal pathology.