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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