ULTRASOUND
THE SURGEON`S NEW
 BEST COMPANION



       FELIPE CATAN MD FACS
       ADJUNCT PROFESSOR
       UNIVERSITY OF ...
HISTORY
• ULTRASOUND IN TRAUMA

• INTRAOPERATIVE US

• DETECTION AND MANAGEMENT
  OF POST OPERATIVE
  COMPLICATIONS
COMMON US APPLICATIONS
 MANAGED BY SURGEONS
•   TRAUMA
•   ACUTE NON TRAUMA PATIENT
•   INTRAOPERATIVE
•   VASCULAR
•   US...
OUR EXPERIENCE
• EMERGENCY ULTRASOUND
  ARRIVED IN SEPTEMBER 1998
• 10 WEEKS OF FORMAL TRAINING IN
  A RADIOLOGY SERVICE
•...
OUR EXPERIENCE
• US IN THE ACUTE NON TRAUMATIC
  PATIENTS SINCE 1999

• PERCUTANEOUS DRAINAGE SINCE
  1999

• INTRAOPERATI...
ULTRASOUND IN TRAUMA
       PATIENTS
• 357 PATIENTS
• ALTERED MENTAL STATUS
• BLUNT AND STAB ABDOMINAL
  WOUNDS
• CLINICAL...
ULTRASOUND IN TRAUMA
      PATIENTS
• EVIDENT SURGICAL INDICATION
 EXCLUDED THE PATIENT
• MEAN AGE 35,1±8,3 YEARS
• 60.9% ...
ULTRASOUND IN TRAUMA
              PATIENTS
  • TABLA FINDINGS IN TRAUMA PATIENTS
        US

Findings                    ...
FOLLOW UP

• 242 NEGATIVE PATIENTS
 – 64% BLUNT TRAUMA
 – 36% PENETRATING INJURY
• 5 PATIENTS REQUIERED SURGERY
  BECAUSE ...
US IN UPPER RIGTH
    ABDOMINAL QUADRANT
•   1307 PATIENTS
•   CHOLELITHIASIS 54.4%
•   ACUTE ACUTE CHOLECISTITIS 26.5%
• ...
US IN UPPER RIGTH
 ABDOMINAL QUADRANT
• IN ACUTE CHOLECISTITIS
 –   SENSITIVITY   92.1%
 –   SPECIFICITY   97.8%
 –   PPV ...
ULTRASOUND GUIDED


 RADIOFRQUENCY
US GUIDED
    RADIOFREQUENCY
       ABLATION
• 27 PATIENTS
• 30 PROCEDURES
• PRIMARY LIVER TUMOR OR
  METASTASIS
• UNRESEC...
US GUIDED RADIOFREQUENCY ABLATION
             ETIOLOGY


•   10 HEPATOCARCINOMA
•   12 COLON CANCER METASTASIS
•   3 GAST...
US GUIDED
        RADIOFREQUENCY
•   1 PUNCTION IN TUMOR < 3cm
•   2 TO 5 IN BIGGER TUMORS
•   MEAN AGE 62 YEARS ( 34 A 88...
PERCUTANEOUS TREATMENT OF
 INTRA ABDOMINAL COLLECTIONS
• PROSPECTIVE TRIAL
• ACUTE PANCREATITIS EXCLUDED
• US TO DEFINE WI...
US GUIDED PERCUTANEOUS
TREATMENT OF INTRA ABDOMINAL
         COLLECTIONS
•   101 PATIENTS
•   30% IN SEPTIC SHOCK
•   2 NO...
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
Us The Surgeon New Best Companion
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Us The Surgeon New Best Companion

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Us The Surgeon New Best Companion

  1. 1. ULTRASOUND THE SURGEON`S NEW BEST COMPANION FELIPE CATAN MD FACS ADJUNCT PROFESSOR UNIVERSITY OF CHILE
  2. 2. HISTORY • ULTRASOUND IN TRAUMA • INTRAOPERATIVE US • DETECTION AND MANAGEMENT OF POST OPERATIVE COMPLICATIONS
  3. 3. COMMON US APPLICATIONS MANAGED BY SURGEONS • TRAUMA • ACUTE NON TRAUMA PATIENT • INTRAOPERATIVE • VASCULAR • US GUIDED PROCEDURES • BREAST • SOFT TISSUE
  4. 4. OUR EXPERIENCE • EMERGENCY ULTRASOUND ARRIVED IN SEPTEMBER 1998 • 10 WEEKS OF FORMAL TRAINING IN A RADIOLOGY SERVICE • TEACH TO A SMALL NUMBER OF EMERGENCY SURGEONS
  5. 5. OUR EXPERIENCE • US IN THE ACUTE NON TRAUMATIC PATIENTS SINCE 1999 • PERCUTANEOUS DRAINAGE SINCE 1999 • INTRAOPERATIVE US SINCE 1999 • RADIOFREQUENCY SINCE 2001
  6. 6. ULTRASOUND IN TRAUMA PATIENTS • 357 PATIENTS • ALTERED MENTAL STATUS • BLUNT AND STAB ABDOMINAL WOUNDS • CLINICAL FOLLOW UP
  7. 7. ULTRASOUND IN TRAUMA PATIENTS • EVIDENT SURGICAL INDICATION EXCLUDED THE PATIENT • MEAN AGE 35,1±8,3 YEARS • 60.9% MALE • BLUNT TRAUMA 211(59.1) • STAB WOUND 146 (40.9)
  8. 8. ULTRASOUND IN TRAUMA PATIENTS • TABLA FINDINGS IN TRAUMA PATIENTS US Findings Number of Patients Percentage Free Peritoneal Fluid 66 18,5 Free Pleural Fluid 9 2,5 Pericardic Fluid 6 1,7 Solid Viscus Lesion or Haematoma 33 9,2 Fetal Death 1 0,3 Normal US 242 67,8 Total 357 100
  9. 9. FOLLOW UP • 242 NEGATIVE PATIENTS – 64% BLUNT TRAUMA – 36% PENETRATING INJURY • 5 PATIENTS REQUIERED SURGERY BECAUSE OF BOWEL PERFORATION • 1 OPERATED HEMOPERITONEUM
  10. 10. US IN UPPER RIGTH ABDOMINAL QUADRANT • 1307 PATIENTS • CHOLELITHIASIS 54.4% • ACUTE ACUTE CHOLECISTITIS 26.5% • NORMAL US 30.5 % • BILIARY TREE DILATATION 14.5% • OTHER FINDINGS 19.5%
  11. 11. US IN UPPER RIGTH ABDOMINAL QUADRANT • IN ACUTE CHOLECISTITIS – SENSITIVITY 92.1% – SPECIFICITY 97.8% – PPV 98.9% – PNV 89.7%
  12. 12. ULTRASOUND GUIDED RADIOFRQUENCY
  13. 13. US GUIDED RADIOFREQUENCY ABLATION • 27 PATIENTS • 30 PROCEDURES • PRIMARY LIVER TUMOR OR METASTASIS • UNRESECTABLE OR HIGH RISK • DIAGNOSIS CONFIRMED BIOPSY OR ELEVATED α-FP
  14. 14. US GUIDED RADIOFREQUENCY ABLATION ETIOLOGY • 10 HEPATOCARCINOMA • 12 COLON CANCER METASTASIS • 3 GASTRIC CANCER METASTASIS • 1 COLANGIOCARCINOMA • 1 ENDOCRINE TUMOR METASTASIS
  15. 15. US GUIDED RADIOFREQUENCY • 1 PUNCTION IN TUMOR < 3cm • 2 TO 5 IN BIGGER TUMORS • MEAN AGE 62 YEARS ( 34 A 88) • MEAN ENERGY 9275 Watt/sec
  16. 16. PERCUTANEOUS TREATMENT OF INTRA ABDOMINAL COLLECTIONS • PROSPECTIVE TRIAL • ACUTE PANCREATITIS EXCLUDED • US TO DEFINE WINDOW • US GUIDED PUNCTION • PERCUTANEOUS DRAINAGE 12 F • ANTIBIOTICS • CONTROL US • MINUMUM FOLLOW UP 1 MONTH AFTER DISCHARGE
  17. 17. US GUIDED PERCUTANEOUS TREATMENT OF INTRA ABDOMINAL COLLECTIONS • 101 PATIENTS • 30% IN SEPTIC SHOCK • 2 NO WINDOW • 3 ATEMPTED BUT UNSUCCESFULL • 5 REQUIRED A SECOND DRAINAGE • 3 DIED • 93 SUCCESSFUL DRAINAGE

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