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Objective: The objective of our study was to investigate the accuracy of sonography in patients with symptoms suggestive of a hernia and normal or equivocal clinical examination findings., Subjects and Methods: Fifty-nine consecutive patients (47 men, 12 women; median age, 51 years; range, 19-82 years) were enrolled in a prospective study of sonography and herniography for investigation of inguinofemoral pain. All patients were referred with a history suggestive of hernia but with equivocal clinical features by three experienced surgeons. All patients underwent sonography and herniography examinations performed by experienced radiologists blinded to clinical details. The imaging variables recorded for each side were normal (including posterior inguinal wall bulging), hernia (indirect, direct, femoral, and abdominal wall), or nondiagnostic. The percentage of exact agreement, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for sonography and herniography and were compared with surgery when performed; then all sides for sonography were compared with herniography., Results: Surgery was performed in 18 patients (31%) on 21 sides and found hernia (n = 20) and patulous posterior inguinal wall (with no hernia) (n = 1). Compared with surgery, the results of sonography versus herniography, respectively, were exact agreement (91% vs 71%), sensitivity (95% vs 70%), specificity (100% vs 100%), PPV (100% vs 100%), and NPV (50% vs 14%). The sensitivity of sonography was significantly higher than that of herniography (McNemar test, p = 0.025). Both techniques had one false-negative in the same patient. Herniography had five additional false-negatives identified as hernias at sonography and surgery. Compared with herniography as the reference, the sonography findings were in exact agreement in 91% (107/118) of the cases; and sensitivity was 90% (19/21); specificity, 91% (88/97); PPV, 68% (19/28); and NPV, 98% (88/90)., Conclusion: Sonography is an accurate technique for the detection of inguinofemoral hernias in patients with clinically equivocal findings.

1 The antagonist actions of quipazine on 5-hydroxytryptamine (5-HT) receptors have been investigated in the rabbit isolated superior cervical ganglion and on the rat isolated spinal cord and stomach strip. 2 Changes in membrane potential induced by 5-HT or by the nicotinic agonist, 1,1-dimethyl-4-phenyl piperazinium (DMPP), were measured in the ganglion by the sucrose-gap technique. At ganglionic receptors, quipazine had little or no agonist activity, but greatly depressed depolarizations evoked by 5-HT but not depolarizations evoked by DMPP or trimethylammonium (TMA). Injections into the superfusion stream to the ganglion of 2 to 5 mumol quipazine in a small volume of Krebs solution prevented all subsequent responses to 5-HT. Superfusion of the ganglion with quipazine at a concentration of 1 microM produced complete blockade of responses to 5-HT in 3 of 6 ganglia and reduced responses by over 90% in 2 others; responses to DMPP were potentiated in amplitude and duration. Superfusion at a concentration of 0.1 microM depressed responses to 5-HT by 75% on average. The threshold concentration for the blocking action was around 0.01 microM, which depressed responses by 42% on average in 6 experiments (range 0 to 75%). 3 5-HT (1 microM or 100 microM) depressed the amplitude of the dorsal root potentials recorded from the isolated, hemisected cord of the neonate rat by 27 +/- 5% (mean +/- s.e. mean, n = 14) and by 45 +/- 6% (n = 14), respectively. In the presence of quipazine (0.01 microM), 5-HT (1 microM or 100 microM) depressed the amplitude by 6 +/- 2% (n = 15) and by 3 +/- 1% (n = 7), respectively. 4 Concentration-response curves of the contractions induced by 5-HT in the fundus of the rat stomach were obtained in the absence and presence of quipazine. Quipazine (1 microM) shifted the concentration-response curve to the right and depressed the maximum, suggesting a non-competitive mode of antagonism. pI50 values were calculated in order to assess the antagonist activity of quipazine at rat fundus 5-HT receptors; the mean pI50 was 6.91 +/- 0.2 (n = 6). 5 It is concluded that quipazine may be an effective antagonist at 5-HT receptors in various tissues.