sTUDt OF r00 cAsls:

sTUDt OF r00 cAsls:

I 

I 

I 

TN rr 

//1O 

52' 

rkB) 

& 

bIAijNlElI( 1:VAl,lA1'ILtl \tt nt,tpt:t, J.tuf!t:11Apt;i 

stx,bA^ptt Jl [Fpirw]u,'ar uJ&r aB _ 

2

IITERTAI AND IIE"TdODS 

100 ctrsrs shoeing sign6 and symDrons or 

heD.lobilraly

ueiah! Io55 and uasaing, gyheconrstlr, easv bru15&- 

btliLy, abdoDinal distehsion in.leasina patlo!, p.o- 

. hlselt sbdoolnll ve1ns, Bse1lilg of fee!, libido, anv 

It/o uhbilical sepsts, jaundice atter cbol€cysiecldyt 

bleedi.s t;ndency, p11e6, rerstrual bistoty' exposure 

to dog6, a@ber of lregnancies, t.eatnelt history .nd 

ary abdoninar su.aery 1r tbe p.st. 

Atler nol-ing dovn rhe points ol hlslorr' 

Eeneral physic.l eruin.liotr rE doDe. pulse, 8.P., 

Itcsprrurory rare, JvP, Tehperaturc, Prtlor, Jau.drce, 

ly'nrhrdrnoprrhr, oedd'!, koi lony(Iif, , r I ubbing, *hi rt 

opaque nail6, brirlle nalIs, eeighr, .ut!ltion.r status, 

xanthoma, xanthelcsa, plgoentatlo!, live. palm, spider 

angtma, gyneaconrstio, body b.1. e.d f.tor beparicls 

SYSTETIC SYTAXINATION: 

rxeinatior ot Gastlolnte6tipal Systep: 

Orodentar exuiDation, tbddilal &11 veilsr 

h€rnlal orifices, velou6 bM uas Doted. lpper .Dd 

lo*er border of live! ea€ touDd. lts coleistency, 

aurface, oargin .nd terd€!!e6€ u.. not€(t. Splsnlc 

enlalgene.t and presence of rBcite6 *.3 Dot€d. Prlpable 

gall bludder or d.56c5 1n tbe rtght hypochondliu o. 

eptga€tltu w€!€ noted. It leceaaary leclal 4.

:Ns rnatron qJs donc 

Nrrr({rr Srsron Er.minat ion: 

hvrl or colscious.css, Mtrcsi!, hlllu.ira- 

!ioDs, p.rsouali!y chlDg! !.d LoDdon jelks eore nored. 

Ex@lnrtior of respi.atory rtrd c.rdlovascul.r 

Aller hlsto.y aod exMinatio! irv€etigatlorE 

oere done. aoutlDe tnvostlgatioDs lDcludtlg totar and 

differential count, ltbt ,lsnr u.iDe lor blle salts, 

bll! pignenis an.t urobillnogen, sl,ool fo! ov!, cyst, 

occult bloo.t atrd celluta. exudote, rere pertor@d in 

Folloytng inveatlgailona $€re don. fhen r6qutred 

accordirg to clitricrl judg€@rt:- 

l. Liver luncrlon t€sta. 

2. One srsge protlrroobln tire. 

3. Atood gloup. 

4. lsciiie fluid exein.rio!. 

5, Pleural or Pcrica.dirl fluld exMinrrion. 

6. Bariuo Sv&rlov. 

7. Ba!i@ lollo* rblougb- 

9. Ploctoscopy , colonoEcopr; Big[oidoscopy. 

r0. Spteboportogrlphy. 

11. or.1 Choleeysrograpby. 

12. Intrav€Bous chol.Daioglalhy. 

13. Ee!.t1t16 B-a!t1g€n

l!,. G.atro-duod.ral e.dorcoDy. 

t5, EECP. 

16. P6lcur.o.our T?e!3 b.9rtlc cholagiogr.pby. 

r?. T-Tube CboL.rg loSrrDhy . 

Ra

PROFot|lt 

IVALUATION OP UEPATOBILTINT DTAON)ERII BY 8CIIITIGRAPdY I 

SOTOGAIPET ATD !IqPAY 

t. ----------------------- 

2. ---------------------- 

3. ---------------------- 

P.si Elstot9! 

lnv.sr i g.l lone. 

1LC---------- 

Drc---------- 

Bb,t--------- 

&al|--------- 

:J: 

U!i.e---------- 

. 

Stool 

-------- 

!.t'1.--------- 

Oral Chol.cYatolilrDhy: 

Iltnv€Dls Ctolrlatqr{|lyt

0lt!.aou.d Ea..|I!.i10!t 

Aoy oib€r hvo.tl|ltlon: 

Op6l.tto! Ioiea! 

. 

BloDsy B€Dorr: 

Blt.ct ol l!€.tr!t: 

lo! t.l,t.!|,. .bwl.t .lar. .!rr ar!90(!, 

ot beD.tlc d1..... to4l or tllttu..'

h( Iirst tn!!strgrtio! aller rourino invectiglrrons. 

ulrfrsolnd lxMinlilon $!s pcrfomod rfler ir rnd 

durrtrg suougrlpUt llru lcsulrs ol lcdionuclidc slu

lor more vie{s Anger G.ma Ceera Xodel 

Gltl-04A-2 Nas used vitb i.i6.s1ty ot 400 aDd photo! 

en€rgy or 140 kev. Rlgbt 1a1e!.1, Iett lEtelall 

anterior, posiello!, ri8ltt st€rlo! obllque and .lgbt 

posrerior vie*s sere taLeD. x-!.y tilDs oI size 

14,,x17", llrxl4',, a"xt0', vere uaeat. 

Tc99o- sulfu! colloid sls !6ed for tiver scann_ 

rns and jr {a6 lsbelled im€diately befo.e use. lhe 

usuxr d!'\( u:t{t rns 1-3m ci ^nd 

l5 ninur{:s wc.c rfrlu)rr'( 

ro tcr(om' rhc lesr. Ttle pltienl eas positioned supin{: 

undcr a Iarge lield scinrillrtion c,rer! equippcd vlrtt 

ttre highest sensitivity parsllgl hole cdlliMror. 3D 

Cr do.e ol Tc"""'- SC {aB injeci€d &E a bolus thlough 

an a.tecubit.l veln and statlc to.8es eele obtalned 

300,000 counts !e! exposure. lbe pslte.ta ver€ u.dre_ 

ssed atrd mt.lllc obJ€cLs rsv.d. care ra6 iaie! tor 

retained one@6 .od otber coltlrst !edl! !a tbev 61gbt 

cause la1€€ posltlve focal def€ct6 lnltoEic.l lsrd 

narks rele dr&vn on the pape! lot b€t1-e! lppr€c1rtlon 

Cbol.a.lltlg!.pby s.s p.rto@d uatrg 2-5 Dcl 

ot rcggo-ErDl. Tbe l.belllng r.3 doD€ l0 o1!!tes 

rJolore u6e. once the @iertil r.6 .drlnlstered inlrrvcnously 

thc bl@d cteallncc *.. oxtrercry rapld rtth

h.l1 of nnrcrirl bcing cle!.ed ftom tbe bl.od in 2-5 

mrrurcs. 1lr. r.rnsit limc lh.ough tbe liver slr sbort 

vi.h ! rapid visurlizatiotr of intra hepitic ducls !n

exadlnrrion. sector sc&aning plobe of 32 eleneltB and 

ol 2.4 llllz lrequerc, uaa used *hcn e.ouAh sp.ce Ior 

rhe exsib.tiotr *a6 trot available due to bandages o. 

,ound6 erc. The 6lngle probe of 2.15 ulz {a6 used 

*henever exmitratlon ot tbe be.!t sra reeded to co4plete 

the patient'6 cliDic.l da!a. 

Folloring rdJusrrclcs rore dolc bcrorc uso: 

SETTINC OI EACII SI{ITCII AND XNOB 

I nn"" 

! "*t"o 

Itonltor Blightne36 ooth !oni1o.s ccnlral 

Contres! 

scare tsctor tor E 

ECG SYNC 

posir ion 

Bolb rerltols ccn!.81 

position 

OJI 

?o da 

0dB 

50 dB 

olt ( out.B) 

B-fode Dy! lange 3 a0 dB 

l.bo Enhance oft 

corrrot x.rkcr olt 

panel ECC Sync luto Oll 

gglr 

orr 

B-lod€ Eosition Botb X .sd v C€ntrsl 

Po6ltlo!

(orr( sDond,{ ro l($ rlelrLh in hsrn 

bodJ. Scanning width wa$ ?3.9@.Dd Lbe diagnoslic 

Nunber ol scannlng lin€6 to! B-mde dlsplay 

v.s 104 lines/t!@e. 

Fo. phorographrlg Porarold cuers aD-o2A eas 

used. lr hed a sbilt oech4.is for double photographins. 

Tbe shutter sped *.6 (B) .nd the aporture nB 

on 16. lilh psck nuber 567 sas used rbicb Deeded no 

T.ansducer output a.d receiver galn seriinga 

D€ie optimized fo! each pallent .nd tFe iDternar g!.t 

scale lssigMeDt *a6 adjuBted Eo tbat it dlsplayed 

10*e! to redlu tewet reflections over mst shldes ot 

grry. Curclul 

glveo !o tcchnlcll llcrofa 

,or proper ex&tnrtion ot liv€r. as ,nproper ucbln( 

selrlng colld eirher cause subile lesions 1o disappeu 

enrlrely or 3!tifactually creare a diftuse Pattern of 

i+l 

t:- 

Ixcept lor so!€ DatleDts rbo 

emerSelcy basls, lrepar.tloa tor an electlve exetattlon 

llvolverl t tast lor .t lea6t 8 bours p!1or to ib€ 

exsolnltion. selial 6can. of the riabt upp6r quadrrnt 

Gle c.!!ied out 1! tbe auplle l.tersl d6cubltu6 .!d

erect lrosilions, Posterio! scds or sc.ns in lbe p.ore 

position vere also done when indlcated. The surfsoe 

ot the upper p!!t sas s@.r€d wiib Ecbo oel. In 

patienrs {here air bubl,l$ in rhe duodena produced 

disrol €hadowing, it vas avolded bt askiag the patle.t 

to drj.nk rarer *hich dispt.ced al! a!.1 converted the 

stomlch trom an lcousti. Inpedent to an a.ousttc vlndof. 

Ihe suprne ,!!ren! 

!o rbc rerl or L! rl!! 

bil1, du(lr oxmin!rion. Extrninrrron oI 

comon bil. dDc! *as also done in RAo 45' and R-aO 90' 

Sagittal scans wele p€rfolned fir6t. Tbe6e 

{e.e done ehile tbe pati€ot r.s boldirg tbe breatb i! 

full insprration in .. ittoupt to dtive the llver do*n 

s5 tar belos the lib c.ge .6 po6a1ble. l! 9atietris 

rirb s@ll livers ilrerco6tal aDDro@b ]!s irsed lo! 

Eonography, The eriire llv€! {.a €x@ined Ji@ tbe 

diaphragnatic surf.ce ro tbe irfellor bot

necessaly in sore pltients vbere there v.6 a auboptiD4l 

srudy during the initial 6cannlng due ro poor preparation 

ol tbe p.ttert. 

Gall bladder vlsurllzation v.s.ccepted as 

satlsfactort vhen rbe ceDtf.r tluld sp.ce .!d the bo!odr.y 

r1s vere botb delined. Lolg Bxis and sholt .xrs 

vtels ot tbe galr bt.dder eele acbteved b, probe !otirion 

and entlle volu@ of tbe g.1l bladde! vle{ed in 

each plojectron. Tbe probe e.s plr in ihe subco8tar 

tocrtlo! and observatton *aE coatlnued durlng deep 

insplrstory etlo$. A posltlv€ Iurphy'|s 61gn {.a recorded 

when plin vas olicitcd by thc plcssure of lrahsduccr. 

lo rlrosc crsos ylrc.c lhc glll bllddcr could nor Uu 

identltied or it e$ narkeatly coorracted a .ep€et exa- 

Din.Iio! r.s done fbeD 6to!€rere ideDtilied they eele 

viewed ln dlfferetrt proj€cttons and po6lttons tor 

conflaalion. tbe grrl bl.dtle! 1t@., ridtrr .!d leugth, 

uall tttrckness rnd the du.t diaeler vcs neEsured {tth 

A ge.ela1 6urvey ol the uppe! abdonen sa6 

perlored j.! alt patiebta. P.lticulr.ttertlo! e.6 

dilected to prncreas, sp16e!, spl€n1c aeln, ktdners 

old .bdoolntl va6cul.! stlucturea, pl€ulrl aDd 

perttoleal apaces.

As llve! bropsy is An invd6ive procedure rt 

*as only pertor@d shon neoded alier acintlgtapbv and 

sonog..pby. lenght.i's one second liver blopsv nserlle vas used 

in Dost case6 but tn a lef csE€s Trucut ud sulecqt 

@diti€d lelghiDitB Deedles rere tl6o u6ed. ESR, TLC, 

DLC, urine and liver functions teats *ere petfo!-€d 

in each case. One stage prothloobln tioe, benaloctit 

and blood plrielet count rere alone sithin 3 d.vs of 

biopsy ln p.rienta eilh stabl,e beDailc diser6e atrc 

one dat befo.e biopEy 1n psilentE rith qnst.ble ltver 

diee$e. I c.!elu1 bistory oi bl€edilg 

inrake of drugs was obtal.ed. If a prtlent had been 

.lktng sny aspirln rtthln 5 days ot tbe plan.ed blopsv, 

i( {as ettbe! posrpon€d or a bleeding tioe q5 deterhined 

before bioDsy. lnl. vlt. x vas alvea 2-3 davs 

prlor to biopsy ir pail.nts qitb auapected clottilg 

abno@ltty. lbe prothr@bin ti@ rls rot @te tha. 

3 seconds plololged iD atry crse. ln eacb patlent tbe 

platelet coun! erceeded 30,000,|m". Blood slouping a.d 

closs @tching rss don6 ald 1-2 plDts ot blood re.e 

svrilablo for tr$61!61o! sbould lt b€ n€c€B.alv rltet 

btopst. Aselt€s {6 coDtroll€d s6 f3r ae po661bl€. I 

dld Dot !€rlolo aly b1o!5y 1o p.tlelts tbele bi1l.ry 

tr.ct obatluction s&a docaoDted !t otb.! 1!ve3t18.t1on6.

Betore th€ piocedure rritt€n coDse.t of tbe 

plti€li v.s take!. Tb6 plocedure {as oxplaired to tbe 

patient stresslng the Deed to botd tlte b.ertb at tb€ 

6Dd ot explratloo lor eev€..l s€co!d6, Illd 6ed.tton 

rN s.bieved by DiazepN l0 ng orrlly 45-60 ninllcs 

before tbe plocedu.e. Tb€ blopsy ra. done eitber on 

bed or o! th€ blopsy table. Tbe p.tiont sas lvlng 

sDpine d the €dge ol tbe bed rith ttre head re6thg or 

a pilld and tbe abducied rlght am. 

Blopsy Bite {as chos€, by pelcussron transtho.Bclcrlly 

or by p.lprtton subcost.ltt. ?tn or stb 

ilielcostst 6!rce, 1n tbe Did atltlary liDe jusi cepb_ 

alsd to the costsl n.rglD *s6 selected, or a partlcul.r 

site r.s selected uDde! ndlorucllde eealDing add 

sonography guidrnse. stllct septic conditiotrs vere 

u3ed. Tbe 6lr. rs6 iltlltrrtod *1tb slt ;t 2! xvtoctlo. 

A 2@ 1ne16io! rs ud€ tbrougb tbe ath sd the !€€dl6 

ea6 lntrodlced. If no tlaau€ wa6 obt.1n€d or tbe t15su€ 

rds not sult1cl6lt for oDiblo! or ti6su. Jr@ era 

sitea va6 to be trk€Dr sddltiotal !.sae6 *e!e @de. 

After biopay tne patlenta r€Ettn€.! on tbe tsble to! 

20-30 liDute6 dd tbe! sbttteat to tbelr beda' B.P.' 

pul6e cbslts s6!. !aj,!tai!6d 1/2 bourty lor tbe t1!6t 

trc h@r6, oDe boult lor !€xt a bouia ud tbed z 

i 

I

202 

bourly tor 12 bou!6. lbe p.tlilti 

v€re t!.t!uci.d to 

Ue .lom lo! 24 houra .arl to .voltl b.rry llltha ot 

rthl.tle t t!?ltt tot 4a iootr. PrlD r! t!€rted tlt! 

rt41. a.tas.lc. olrl ot i!!t.ntc!Lr. 

ltt.r biopay,tle .D.olD! r|l !,t r€te.d l! 

1Ol. r@rd.by.lc url s6!t to tt irlot.iolt tor 

blatoD.tboloalc.l .trrl,lrtloo, lb. blood r.tdtrt.d i! 

tbe .yrlnF r.E !.Dt tor.cultur..!d lor oalla..nt

cAs! ntsr9Rlxs o! 

rOO PATIENTS

:g!=: 

a 63 s 

fi?€Pi?""36'5" 

soF.l:-";:"s'j 

' = S*:: i =- -": 

! " lj':

_ 

--_b aF

: 

J

I 

8 

i Ic563FgHs'g 

X i.FE5B 

6

f,;;;;6 a;; 

gE:cr9id68 B I 

rrl?i.lBi;Eig 

;x 3:'93"58 

t' :?c ! iq 

t 

Er$9gg 

11 '*g 

6 

:-; 

E 

2.-

I 

o;: 

-_i:i 

;

!:t 

: 

':: 

d99EE;-gF;E1:

.;F9"" 

l 

-.

iit 

E:5"S

66 

'8 E'8 

g?E8e

5B:;o'*tse. 

:'9;19,:

!! B 95331:5;9 

P :9.e.;:3ii 

sg;r49 9".& 

o ht ooo?!P 

=q--39;.5'; 

!,i! 

;::3;

."9 55 

os-5, :5, 

: g:"s.3 

3 

/( 

5

.--|'_ 

;a;i! 

E:.1Bg9eEF 

3

.:l- 

':l 

''l 

388.9 

dgEBB5EgEiT 

= &€'5::'r; 

36',5' 30E rEl 

"

:: 

E 

; 

a 

':9 ;?:'5 

:, ":3 i "

BEE 

:;'-6ts96'63. 

s

.9 

s gi3'..6

-r9 T 

lEE i 

zq 1 

E ! --

I 

i 

;i6i' 

9 E 9E B T 

at ! 

f,

'i 

9 

3 

FJ 

;

*--=i-aR-' 

a 'F rd 

5- 

t 

!l 

5

-6!8SB9t 

9;i;t9E9

I I B:; 

.-3i;@ :EgE3!dE" 

!.-

; 9E r ; eB g 

d,.o r ' 

a r,'

'9.iEg 

sBB9t9 

5S.$g

;F;i:,3Bfiii 

i , ,3 3.9 3'-r, G r- 

e e* .' ;t 3;; 

i 

;89:-P 3 e:3 

Fi i:i;s;; ia: 

3g€" c*g-; : 

9F

69 

ii;citi 

589I E'; 

$lals?[ 

e 

-s€ 39 tr 

E;I r3.e: 

;e,tN-: 

:9-:ri 

6 o 3i 

i:i 9538 

;*;, g^' 

; I o! 

E€3qs' 

!-E;:;5 

a:i;I'g 

!:03E8 

'i:! 

+ 

e' 

; F; ;B;'9 

;EiBi:i 

ixf;egFi 

eESggEr 

:;":3gg 

3.:3"1" " 

E;3Sr: 

t,;:.: 

;ts'i:-r 

;i;ss5gff 

s; s::::- 

Ii:,"',{E

;:E E;,*q 

!-

'3CAP gEe

H:98.9.

l9oo!1 

;

a @ t,i ii€ 6 

:-

: i'! 

:': e:9'' bd 

L'

€ F:.ii F 

- 3 gt t-l'-: 3 EgEi';FEE5' 

9-tH*,;3"e

-44 

.::| 

El 

3l 

-""1 

-*l 

:l 

'il 

I al 

r; 

I ;l 

I rl 

t'-'1 

I El 

I :l 

I f,l 

t"l 

t---l 

I rl 

r: 

I 5l 

I Cl 

I il 

lil 

I 'l

oF53.o'' 

t 

tn

: P e 6 E I = 

3 : 3 .E : 8 

-: 

-ci a ! . t 

?:3 . i i ' ;lB

9; n "

';e;-

6ibr66d*ii'i 

i a6' 

'1i5. 

2.-

v 

;

I 

-::; "iE.F;- 

P; E E 

tii.ii)

5:;;5 

o 

. iB'ql -- 

4 

,.:: 

!99

$l 

: 

:.

t 

r-q 

;d*; 

t 

399;.3:3811fr:F 

=;::.;*-!3le:! 

5-:

t 

I 

; 

gg'i! - e + 

189 - !

FFP 

'P=E6tE3

':.i; 

! CEEHEFS:P 

! 9 9if 9:E *' 

It.Sosn 

f ;R'E lts

6dii-5 

68""83

ee 9 

oiF 

'I

.39e198931 

'-e*.'i5;5E 

3B;re:i9E 

r3 |

ja:l 

:1 

6dE i-;id 

__-ii;i 

5;9R;gg 

i;Et

539E 

l 

I

' 1;3;',-S; e 

5': 

'tBgg;.,3

E:5.9 Sig 6g ? 

5e3F'.q"Bg 

9?ii{rlirr 

:

?l 

i

; a;;

91" 3 

:"9:-?gs;6 5: E 

rii[:ii] E'? i; 

:9;B "."' '* " 

. J:8:?E:- ; : 

rE;c; *tiii 

9FP"3*

o= 

i 6- ;' 

!''.

t:':j

9- ; 

3;P

!;in 

o o il 

----o,F---T- 

- 

g:-F:i 

!s85ts8; 

' 86 e6E3 

g&gg!:;.lBi;l;; 

9idEeiliE:[esE 

:t *:*- ?'-g 39=*1 

,3::E : i- i 

r" io-o*ro 

I

;,,:

E 

.. 

3 3!: eq E i.'. e 

? 

5Ei. E ic; ! 

.E 995" ' '."" 

9EE 5:F; ' 

oo9 _E f 

;:" n

clsE NO. 90 

luRrnn's srrDRor! 

A boy of 3 years preaeat€at ln eoergeD.y eith 

LDc coop l!iuls olt 

2. Prlpltatlob - 6 daYs 

Tbe mrbei rold thit be ta hrvlng at0lllr .ttack6 for 

.rte lGt 6l years. fheie 16 no lolly hlatory ot 6ucb 

on exainat-io! it- ia tou.d tbat hia iltelllgence 

tevel ts belor rrelaae. le la brv!.3 couae t.c1.r 

festures, tbic! lips, lalge tolgrer arddle abaDed !ose, 

side no.rrils, open @uth .!d Dot6y ble.thtlg. Bilatelal 

conear croldila i6 pre.€rt. tber€ 1€ do4o luDbar 

kyphGi6 abd 8ibbu6 fo!4tlo!. 

EXAX]NATION OT C.V.S. 

Pulse 90/n1n. legula!, coll.p€rng ln cltaracte! 

B.P, l5O/20 | o€d6mE l€et + 

Ap€x b€at ts in tb€ 6tb Iltelco€trl space in 

the oid rxilllry liDe. An election ayatollc nurn! i5 

preserit at the eritc alea (lt) rld 3! €ally dlctolic 

dut@! is beard .t tb€ 12 u€r. 

TADOIIIIAI, ETIIIXAITOI{ 

rbd@n_19 pr9tubglrnt. Ihblllc.I b€u1r 15

pleserr. Liver enlarged 6I belo* lhe cosial mlgin, 

spleen enla.sed 2F. No ascit6.. 

RESPIRATORY SYSTEI 

Bltftelal couse crepirarloE tr tbe 4iddle abd 

Io*er puta ot lulgE. 

INVESTIGA'IONS 

DIACNOSIS 

1!C, DL,- NAD 

ollne to! toluiditre blu€ ta6t 1a poeitrv€ 

X-r.y chest - C.rdtftgcly ,ith bilaterat 

pul@.ary conaeatto.. 

x-r!y sxull - L$ge slull rtrh iacial bda 

deforott ies. 

,(-!rt sptDe - cibb$ l. graaelt .t the D?-a 

vert€b!4e, Kyphoacolloala eith hooktng 

ot veftebe pres€ni. 

Echocardiograpby A.d B€ctor sctEnitg. 

lalt veBtricul.r eDlr4.o.!t lEsent . 

Schtig!.phy - BeDatoslleloo€galy titb decr€rsed 

hepetic uptate. 

Uttlso.ograpby - E8l.t3€d live! ud splee!. 

lsFrtlc ve1.s v€rt dl1.t€d. 

Corae€ttvo berfi talloF du€ to .oriic

33; 

cASCrX{rA O! St\)lACn 

r\ mrrri.d fcnalc of 34 vears Drcaen.ed ih 

our-p!rlents dep4rrneit *ith the c@prsiots of: 

1. Iarr.ctable bacL-acbe - 20 days 

1. Yelloele66 of eyes - l0 alaya 

She givea H/o dy8pep6l., uorexis and b€rlt 

burD for 3 ionths. She has tso chlldle!. Tbere 8re no 

ElBtrual codDlrlnts. 

o/E - she ia. pare, 6oct.ted, ill l@tlng ladt. 

Pallo! 

Jaundlce + 

C.I.T. EXAXINATIOTI 

Lrver eDlaraed bard, lrleaular Mratls, lodultr 

3urlace 8d !oo-teDde!. 

C.v.S. ExuiDatio! - Pulae oo/oin. !€gu1d. 

Botb healt sounds homal. Grlde II Ey6totic numu! rt 

:..i 

i;:i::: 

Respllrtory Syatd - NID . 

ExtrtNtrrorl 0! SPME 

a soJt 6{€11iog 16 p!€6€nr .t tbe back et tbe 

I6ee1 o! Ll ald L,g.

IIIVES1lCATIONS 

TL,c , Dl,c - NID , IsR- 80@. f,b.aot 

Stool - Clay coloured, ro ove, rc cv6i 

!!i!e - D.rk colour. Bile s.lts, Blle pigEetrts +' 

!!obilinog€tr trlce6. 

selud bililubt! - 4.2 otl 

SGPT - Tsur 

s.lltaliDe PbosDbrte 320uI. 

S.Albudln .. 4.8snl 

lontrol 15 sec 

A:C r.tio 2: r, PtI( -prtlent 13 sec 

x-rry cbesr - IAD 

X-rsy 6pi!e - Lt and !4 velt€br t.e .l€n6e. 

Live! sca! - Elluaed livet eitb mltlple 

local delecte. 

ULAMSOI'ND IXAIII!{ATION 

lnluged liver rtib rulilDl,e ilr d€tt!.at 6p1ex 

ossses i! botb robes ol live!. II.iBr dil.tatloD oI 

bllialy passrges. Gatt blddei nomal. 9ancreas nomat. 

Bolh ov.rlea .!d uterua ro@1. 

llrgr--uigpEr - 

r1!6t att4pt 

latty !€t.@lpboals ritb no evidence ot @l1g_ 

'i

crRnBosrs ot Ltvta 

a 45 ,er!6 aa€d D.! preaeDted i! eelg€rcy 

witb th€ corptsl.ts otl 

lte@t€@ala - 1 d.y 

Iel€la - 1 day 

Re c@plails ol plosr6s6lve.bd@j,!.! dl6tonsion 

lor tbe 1.at I @nth6. Tbere ia easy t.1'tgq.bllity 

for the sme dulation. ge gtvos H/o jaundlce 7 years 

leo. 

O/E - A pale looking @n vell olle[ted in 

tlne and 6pac.. 

Sltder A!81o@ + 

Pal@r erytb@ + 

Nalls l!€ sbite ed o!qu€. 

G.I.T. ESAIIXA1ION 

Prorub.lut abddF! qlrh di€t€ldsd abdollrl 

veins. lbe llov ot blood ls rr@ b€loe uDs.!ds. shttt- 

1!g du11!e66 +r lluld tb!111 +. Ltve! Dot Drlplbl.. 

splcen enrlr8od ?!. 

C.V.S.r C.N.S. ..d cxeinar,lon of 

respl!.toty 6yatd .. .. lltD

NvEsltcAl loNs 

TI', 

DL,C . NID 

Urlne - 1r&es of blle salts and blle pignehrs, 

Stool for occult blood +. 

Selun bilirubin 2.3nsi . 

SCP4 - 130 ut. 

s. Alkali& Phosphrrcs - 250 ul. 

S.Albunin - 2.1go1 

S.Cloburin - 4.2, A:G la.ion - r:2 

!ivcr scln - small slzed livcr,dimitrishcd hcp!rj 

uDtakei€Dleen cnla.ged sbo*ita 

'spill over: Acrlvilt see! in bones. 

!M-!94t _ Nl'o 

BARIUII IEAL E)(AIIIN IION 

Ocsopltagcrl va!ic€s ure preccnr. 

GssLroscuDy 

O6sopbageal varices .!e p.eaent. 

t{o g.€iric ulce! detected. 

IJLTAASOUI'ID !]XIXII{ATION 

Soall live! eith j,lclea€ed ecboaenlcltt. Uppe! 

surtrce is irregulu. Dolt.l 6d Epleoic velns ate 

dllated, sooe cotlctelal ch.!!el6 ilFo seen. Gall 

bladder rel! .pDelrllg tblcl. Asctt.6 preao.t. !.testlnal 

coll. tloatlnE tE tb6 llee lluid. Spl€€n is

Dilaied splenic rnd porral veins with well 

developed collate.al vessels. 

Liver bloosv - Post hepatltlc erlrhosrs. 

DIAGNOSIS 

Cifbosis of liver sith bleeding oesophageal

!r)0 

PYOCElltc LtvER aascEss 

A 53 vsd6 mle pttient c,G to u6 witb tbe 

r. BtAb grde t€ve! .. - 2 daYs 

2. P.In rlght bvpocboodris - 2 dsvs 

3. Alolexra .. .. - 2 days 

ie is ! ktrodn dlrbetic iot 12 vears ritb rd 

trreaular lntsle ol dlugs and inlectioDs' ae i5 havlne 

ptles to! fou! yeus r!.1 t big celbuncle o! his b'cl 

fo! rbe Lrst l0 davF. 

A toxlc l@klng @! eitb profuse sve'thg' 

O/E - 

Pulse - 102/oio. !egul$. 

TeoP. - 104"1 

Respl!.tory .!te - 22loi!. 

c.1. T. EXAIIINATION 

Livet pslpsble 5!, Velv teDde!'sDlee! lot 

palDsble. No ascite6. 

Re6!tr!to!v ststetr - NAD 

c.N.s. _ Btlaielslrv rbaeDt dkle ierks' 

SiIT ETAIINATIOT 

A bta calbuBcle Pleseot st the b*k' 

Ot thrles@Dv - D!.betlc !€thoE tbt p!6'€ti '

leduced. lvo s.l.t liero euaccsses prcscnr, I|)c!e rs 

atso €m!11 aubdlrpbraloa11c collectlo. or puc. tio 

@. 

Irlv€r Scu - Norul lieer iDlp. 

ULTATSOIJIO IXAIIINATION 

I€dluD to blgb lcvel 

Plevlou8ly eeho f!€e cavlty. 

eh@a P!€sert 1! the 

Tbe 3lz€ tr.s !ed!c€.t, 

DIAGIOSIS 

Pyoge!ic ltver ab.cess. 

-.t -

ACII-TE CBOI,ECASTITIS 

A l@ale ot 42 yeals pleaented ln stergency 

rtth acu!6 pai! t! lisbt hypochondriu 2 days. 

l6ve! - 2 d&ta 

V@lting - 2 dlts 

Sbe give8 H/o vrgue .bdotlar dlac@fort' llrtulence, 

dyspepsia ard indiae6rlon ro! 3 rcnths. 

o/E - Tdp. 103'F 

Dehydlatlon + 

6. t.1. EXtrrNATrOtl 

l1ve! not Ditp3ble. Terderneas 1! ligbt 

lypocboldr1u !!€6eEt. 

cNs, aespllatoly asd c.v.S, - NID 

INVESTIGAIIOIiS 

tlc - !,r,2oo r DIrc-P.?81 

L.201 

L. It 

B. lt 

lrtDe exutratto! - NID 

St@1 exullatio. - l|ID 

S.!@ btltrubln - 1.6 ral 

x-r.y pt.lD ddoG! - llD 

ot.l cbol.cystoglarby - G.ll bl.dde! oot 

vtaual izod.

a c.1 

ITIDA scsn - Gall lrladde! tror viaullized. !r!c 

flov ro rhc gul. 

ULTRASOUIID ErIIINATION 

Dilated 8rl1 blsdde! sitb a single atone louod 

ne!. rbe grtl blsdder !ec*. so@ lo* revel €cboes 

plese.t 1! tbe 1u!€t of the gsll bladde!. cbalEing 

the posltlon oith pstientrs posltio!. Liver size lnd 

sr4cture i6 !or!.1. 

OPERATIVE FIITDII'ICS 

Cola€st6d ed o.d€@tous 3.ll bl.dd.r. A 

silsle big stone toud tncDeented i! th. g.u brstde! 

neck. c.rt bladdei is llll€d vith oucopuluI€nt oat€rlrl' 

POST OPEtATIVE BiOPSY 

G411 bl.dder vsll sho*tna scute lnll@tory 

cburr.. Soe cbrcoic rall@tott cells rrto s6'D' 

DIAGIIOSIS 

acute chol4y6tltla titb cbolelttblrais.

:0i 

CARCII{OIIA Of GALL ALADDEN 

A ?0 y€E!6 old lgrile cE@ rlth a Dase in rlgbt 

lrypo choDdriu fo! 2 lonths. sbe alves [/o progresslee 

weigbt loss for thc lrsr 4 DonLhs lnd lnorcxia tot the 

G. !.T. EXAIINATION 

Liver eDlsrged 3r, hard, non-teod€r, irregulsr 

nalgin and oodul.r .urface. 

CIs! cvs lod Re6plt.rory Eysteo - NlD 

INVESTIGAT!ONS 

fLC, DIC - NAD. Ilb. 621 ' 

EsR - 55m. 

Stool Eaataatton - NAD 

urltre rot lroblliroge! - T.rces 

Ser@ blttllbin - 6.8 ngl 

SGP! - 80 u1 

s.alkrlile Phospbat$€ - 300 ul. 

Ll!e. sc.! - Ellsrged Llv€r 1@g€ *ltb dultlple 

local delect6. 

fiIDA scsn - Gall bladd.r nol uiauol!zed. 

ULTAASOUND EIAIINATION 

Llver e!I.!aed. lultiple cooptex lourded @66e5 

tould I! lller aubatdc€. Dil.trtloo ot bl118y Praaag6a 

' 

l

.(mn bllc ducr nor dilarcd. Plncrcs rotul. Gnll 

bll.ldcr lilhd *iLlt ! cdlpler @!!' nol- clrloging rls 

Bbap€ or Doaitlo! vlth tbe cltoae oI pailgntra 

positio!. Vert ltttle lue. is 1d6.t1fied, bbedd€d 

in the msa ls e a@11 echo denEe $€a vlth .countlc 

OPAMTIVS IIIIDITGA 

A tueEtha grorth ol g.ll btadder 1i111!g 

slDst vbol,e ot lt. Tuo 3.Il srones tound. Livet 

eoltrsed, arrJrcG j,!regulrr utl nodular. 

!9!l_9!9:!!il9_!!9P!r - Paplllir6toud colsne. 

ee11 ad.locatciooor' 

Dt^GNO6rS 

ot ;alr bladdcr stth econd.rlcs

:9i 

ltYt l'l ll, Dls8ls! ot Llvln 

A young nan ot 28 ye.!s c@ to ue eitb B! 

ioc.€r5in8 plinlese nass ln opigasiriu to! 6 rcnths. 

No orhe! cooplainl6, 

O/E - A younA rell built @n. Tbere 1s no 

jrurdice or p&llor. 

c.l.T. Itxatl{alloN 

A big b.66 is p.lp.bte 1! litht bypochondltu 

ssd epig.atric regton. The rass tG no!-terd€r rnd noves 

t IIVESIIGATIOI'IS 

CNs, cvs and Res91ra:ory 

sysred exeiortlo. - Nl,D 

ioutile l.bolarory tesrs - NAD 

L.!.T. - NID 

Llve! 6ca! - a bta tocal deiect 3@. io tb. 

red1.l lst ot tLe rlSbt 1ob. 

aDd 1! tbe l€tt tobe. 

llDA Scu - tlAD 

IJLT'NASOUND IXAIINATIOII 

lerr detlned, rht. ualled nultiple ecbofrec 

sp.ce6 fould 1! tb€ rlgbr lob€ ot liver. Ihe conte.ts

i,r9c 

cctx,glar | ( I ty is no|el. 

OPEBIIIVA TIiDIIGA 

ttr1ilDl€ cy!t3 3r€ loudd iD tbe D.dlsl Flt 

ot rlllt rob€ ot uv.r r!.r.Duirstrlu. tt ct.t3 rt€ 

tbi! rellod rltb cL.l! co!t.!ia. 

!9!!-9r94!!r!-!!9Er - svdrtid cv.ta' 

Dlaolt(x|ls 

Ird.ttd

IOBCEIiAIN GALL BLADDER 

I 43 y€&rs n.le proaented ln tbe out-P.llent 

deparr@lt rttb the coDpl.l.t6 ot prl! tlabt 

Otl rn

Non-tulctlohlhg gslt bladder. 

CJ.pl-Sg8& - Slugsl€b €oFtllng ol asll bladder. 

Grll bl.dde! dilated 

ULTRASOIJND IXAITNA1 IOII 

Live! slze rnd stlucture notul. Antetior 

s.1l ot arll bl.dder aDDealtog double rnd thlck. Tb€ 

eltile vrll t6 c$tlog . tblck acoustic abrdorilg. 

OPE-RATIVE FIiDI GS 

Dirared gsll bladder rith betvily c.lcilied 

r!116. The g.1l bl.dder !. tltl rl,t! atoo.a. 

Post opelrthe biops! - le.vy deDoattlo! ol 

crl.1u t! tbe gall 

bladd€t *11 1. 

DtACliosls 

purc(trrn gulJ lrluddrr wlrh chululltlrl!s15.

ARTAIXED STONI 

I {3 yeus ord f@re *g3 oper.ted Jo! ch&lic 

PRE-OPERA1 IVE ULTMSOIJND REPO.T 

Nomct slze gall bladde! vith a blg gatl sLonc, 

a €nall etone syspecle.l rn Lhe cysrlc .luct. Biria.v 

p$6tges not dirrted. 

oPEMTIVE lnaDmGS 

Colg€sted gd1 bladder *.r1. A siogle srone 

lornd. No .ystic duct stole. B1le ducta not dilaied. 

Atre! qholeetstect.my the tattent deleroped 

j&undlc€ alte! 4 d.ys. 

T.lube cbolapsio$.phe. 

A.rone tr tbe co!b! bite duct su6pected. 

BIDI ac.p - l{o Jroq oi brle ln tbe aut. 

ULTR4SOIJND EIAIIII{ATTOX 

r!t!. hepatic billalt p.aa.8€a d1lrie.l. CBD 

d1@t€r la 13 @. AD ecbo

post ctfDtorcIr sYNDtorE 

I 2? y€a$ lrle pre€elt.d In e@tg€!cy. 

Dyspne._ I *€e& 

Dal! ligbt byDocholdriub - 1 ses 

lhe p.tient b.d a reprtr oEelation !o! ASO 

O/l - Pulae is 90/nin. 1ow volune, legular, 

JVE I 

oedd. + 

c, v. s. lxAxtNATloN 

Apex bect lot parpable. Arsa oJ carqrrc 

dulhes ilcrers€d. A6err tuds ir @fft6(t. 

REsPIMTONT SYSTEI E|{IX INAIIOII 

Bigbt 6id.d Dloursl ettuslon. 

G.!.T. ETIXIdATIOT 

' Ascltes !!6r.!t. Ltv€! .!ta!8€rt, t€!d6!. 

ap1e.D lot !alE.bl.. 

' c.x.s. - I|rD

303 

I NVISTI OATIONS 

Routile in!€stigations - NtD 

l-!!y Che6t - Crldlo@3sly ritb rigbr srded 

ple!!.1 ettuio!. 

E.C.G - Lou volt.ge cooplexe€ with I 

$ave invereloD ln all the leads. 

Gchocardio.laohv - I-@d. lecordilg 6bos echo 

I rce sprcc l,cryoco rhe 

nyoc!.dlun and cptcar

crfllolt I c cuoLEcYstrTrs 

A 49 yerr6 otd rale cooDt.l!6 ot rccurlent 

rlgbr 8bd@inal pain - I year. 

rarry heal inrolerance - I yesr. 

Tbele iB norhilg sia.itlc$t i! !o€ pEr 

Ge!e!31 phtaicar an.t syst€oic 

I NVEI/IICATI ONS 

Boutl.e ibrestigatiols - NtD 

- 1,2usl 

orar cholecvsroeraDbv - 

Sb.lt poolly lulctio!1ng grlt bl.dderr 

ftlled rltb oultiDte 6ro.e6- 

Erp4 sc.n - oltl bt.dde! vtsualize.r sbortag 

slo, eDptytDg. 

ii ?.:. 

i-lt 

UITRASOUND IXAUINATION 

s@11, rhlct r.lted a.lt bladde! tilt€d 

tltn lultirle schodelse D.se6 rlth .@Etic 

OPEIATIVE FINDINCS 

sE.r! 81..d g.u bleatd€r. Ilick salt..

Iulltple stones are preselr. 

posr Operarrve bropsj - The galt oladder va/t 

sbo*ing cbronic infla-

306 

Nolort vslues fo! !h€ libo!.rory 

rrv€.rla.tlona us€rt to! t!. .rudr3 

tot.l seru Drorei!. 

LD{ 

scor 

SCPT 

cpr 

- 0.3 - l.O rrt 

- t.6 - 5.2 gll 

- 2-/r - 3.7 gntt 

- 6,2 _ s.z ..Inl 

- 230 - 460 ut 

- t- J5 ul 

- 2- 30 ul 

- 15- l0ul 

tl&.1loe pbosDb.r... - gs _ 2r9 ul 

s3!u .lyla€e lDro - l3O ut.

NISULTS 

OBSIBVATIONS

RESULTS AI{D OBSERVATIONS 

ACE AND SIX D I SIRI BUT I OX 

!.ae. I 

I 

I 

r00.00 

40" 

10 

26 

6 

60.00 

34.61 

I7 

40.00 

55.3a 

80" 

14 

3o 

9 

61.22 

6tt.28 

t9 

5 

38.?7 

lo0 54 46.00 

Irlo!tty ot the csE€s b€torged to 

The youlaest prltelt vs6 

the oldelt Dsttelt res a

TS! PAfIENTS PRISEI{TED 19 IJS 

rlTlt ttE lottotrNc stapTors 

1. P.in lisbt bypo- 

3. M.ss .ight hypo- 

4, |rass cpjslstrluur 

5. P!i. epigas!riun 

6. Nause., lo@ithg 

43 

32 

2t .!3.33 

r7 53.13 

r 25.00 

5 t1.42 

5 38.1t6 

22 

3 

2 

8 

51.16 

?5.00 

6r.54 

3. ProareEstve wej.ent 

loss- 

10. Indigeatlo! .hd 

rrl55 bypocboadrtu 

+ !ls8 epu.strl@ 

10 

t2 

L2 

? 

I 

7 ?0.00 

? 18,33 

5 { 1,6? 

5 ?1.42 

3 

30.00 

41.67 

s8.33 

2a,57 

100.00 

74. 

ra. 

lclvirogs tn rrghl 

-2(}-It6c6ll!!€Ou. 

14 

5 

5 

t0 

6 

3 

3 

5 

11.43 

80.00 

40.00 

71.?6 

60.00 

75.00 

66.6? 

62.50 

I 

2 

2 

4 

2 

6 

24.51 

20.00 

60.00 

22.22 

40.00 

25.00 

44.44 

3!.3t 

10 

li.5o 

:-_!E.9gqo9o .y"p!o* se!e, D3l! ll3ulhyp9rb9aix1 

and laundi.e

lrffi'3fr++9$.3#fiHl+F 

Dull coltinuous patE ritb 

Acute coltcky p.r! r.d1*Iog 

Recur.eni colicty p.iD rltb 

Beeullelt colicky p.i. 

Acute coli.ky prtn rlth 

Dull priD ,ltb J.u.d1ce, 

10 

I 

la.6 

44.43 

4.55 

23.25 

2.32 

2-32 

The preseltatto! ol pitlents wrth garl 

ot tbe ti@, u scut€ DalD 1n rtgbt 

hypocboDd!1u. Soe p.tielt6 crb€ ,tt! chrcDlc 

history ol recltelt rttscts ot psln vbrte 1! s@e 

patielt . stlelt grtl stoaes, ,e!a detectsd *he! 

tbe ultrEoud 6ru1o.t1oE r& ps!to@.t ror .oG

310 

32 PATIErf-Is PRESINTED IITII JAUXDICE. TlE fIN& 

DIACNOgIS IN THEEE CASES TAS AS FOLTO'S. 

ii ll:i'i,ili!!i'."-lr *'.ii 

:l .!ccs.:l l: :l 

I'c.r.n-:i Fc- ii I,o.c.na€. 

i: Bre:l t38€. 

32 

r00 

2 

2 

6.25 

6.25 

2 

t00 

50 

50 

3.12 

100 

3.3? 

66.6 

33.3 

t 

I 

3.r2 

3.12 

100 

lo0 

3,!2 

!00 

!.12 

100 

3.12 

15.62 

I 

100 

3 60 

2 

a0 

5.25 

50 

50 

I 

3 

3 

!.r2 

0.3? 

9.3? 

t 

66.6 

I 

I 

2 

to0 

33.1 

55.6 

I 

I 

3,12 

- 3.12 

100 

100 

31 100.00 tl 5t.13 a6.8?

3ir 

tlulllEtt of cnsls tN flrlc tor,rdrNc 

'iItlFlTCmi6mrTmE-IFEIED-aini;. 

il 

love6tigations 

1. Urt!.86lograpby + Llv€r Sc.D + 

EIDA Sca! + Ltve! btopsy. 5 5 

2. sotrogr.phy + liver Scan 

+ SIDA sc.n 23 2X 

3. Sonognpby + Liver Sca! 

+ Llre! blop6y. 12 12 

4. . SoDogr.pht + Ltvsr scao 33 33 

5. Sonography + IIDA Sc.! 27 27 

100 100 

Llver soro3r.pby vcs p€rfo@d 1. atl the 

prticnis i.c., 100 tatlenrs- trDA s.!n n6 done in 55 

patierts rnd liver sc&!'rr€ pe!to!@d in 73 pArie!1s, 

Liver btopsy *cs peffo&ed orly lD !? patients; i1 

ls .n 1walv3 p!@edure alal re p6ltore(t lt o.tt 

*here tbe reaults ot othe! tro tle€atlgattona n€eded 

tultb€! €v.lulttoa. l. .o@ prttanta t!6 r€aulta 

ol !o!-i!va5lve l!!e6t1Art1ons reve.led tbat liver 

blopat 1s co!tr.1!d1.rt6d e.9., ly.l.ttd cy8t. 

L

3l:l 

W 

l. 

7a 

59 

L2 

3. 

92 

I 

9l 

7. 

9. 

!Dt!r !.r,atic .to!€ 

P!9i9t! 

L2 

5 

1 

a, 

l3 

92 

8 

I

H 

6 

a2 

- - --fe

314 

W 

Slze ot grtt bladdet 

79 

7 

lncrea6€d thick!ess 

83 

3 

I 

qsttc duct StoDe 

Coomn bile duct 6tone 

Cucl.@ o, astl bl.dder 

Carcllo@ ol bile duct 

Putul.ot cbolecystltts 

Sinsle g!l I s1o..) 

l|uliiple gall stoles 

lt 

3 

5 

I 

1 

3 

I 

1 

2 

ii+ 

l:i! 

l 

J 

't-

a 

PI 

;l 

3l 

9t 

!i 

: 

E 

E 

; 

F 14

ADDIfIOI{AL PATITOII)G I CAI- FINDII{GS DITEC-TED 

BY IJL-TRASOUN' 

s. ii :llolalii :lNo. ol 

No,il :iNo.otii :lcases 

:i iic.ses:l 

1. 

a) Acule pucteatitls 

b) Cbrolic Dahcleatitis 

c) P6eudo palcreatlc cyst 

d) Csrct!@r head ol 

e) Pancreatrc cyst 

.) Rer.l lltbiasis 

1 

3 

3 

3. 26 

5. 

a. 

c) Poly cystic disease 

d) Ilydrohepbrosts 

e) Size L.rse 

S@ll 

b) spleoic vei. dilrted 

.) !1€u!d e!lu61ou 

t) Peltc.rdld ettuslon 

b) rltlrl at6nosia 

c) Aorttc l!c@rEt.!co 

d) Int.rlor -l6!e ..!! - 

. dilrt€d 

2 

3 

2 

10 

t3 

t 

I 

I 

1 

L 

I 

I 

I

3!7 

r|slE-lI 

ESULTS O! LIVIB SCITAICTUPIY 

tot.l !o. ol pEil.!t. - ?! 

iirb. or:: FlD.li!i'6 i: Io. ot 

1. 

b.ll 

12 

.32 

2. 

73 

I 

t 

13 

l,.1cbt 

i. 

8 

a. 

2l 

Shal. 

IultlDlo 

t3 

br.rard 

54 

ta 

6. SDIeotc uptd. 

?l 

e0 

1l

FOCAL DEFECTS III LIVER SCAI{ 

:i ReDor[ ot Llver ScaD :: Fi!!l Dr.glosis 

1 lultiple local defects lultiple bydatid cysts 

5 local delect i. light Pyogenic live! abscess 

11 uultiple focal deJecls xetasiasea j.n live! lrod 

c$cr!(M of aalt bl.dder 

,0 xultiple foc.l del€cts secoarlailes trob c.!c1!ooa 

ot bleEt 

24 Multiple iocal detecrs Dllated blliary pessases 

25 alg focal defect in A@ebtc tlve! .b*ess 

2? Iocal defect in lelt lydatid cysi 

29 tocll defect in right lepatocellular ctrrcinona 

32 ||ulttple focal defe.ts Hep.to.ellular calcinom 

35 Xuttille rocal delecrs s€co.d.ries i! 1lver tr@ 

Ce-Pencteas 

41 Big locdl detecr iD uydatld d1se.6e 

llght lobe l.: 

44 .. 

Blg foc.l def€ct iD 81s!t lydloleDbro6ts, rentl 

righl lobr litbisslg ..;i: 

, 

45 s@ll toc.l delect ln aepatj,c be@lgrott 

s4 focal detecr in right 

Post btoFy bepatic 

63 Big Jocal det6ct i! secolil$1€a tlotr calclnoia 

69 Ll,!ea! del€cta Dtlitod blli.ry p....a€6 

?5 hltiDle tocal detects S€coDd$lea llo cecllo@ 

aa11 b]&dder 

?3 lulttlle tocd del.cts aecold.llea lrd .DclnoM 

8a Focrr del.ct 1! Ielt 

Pa€udoDscE.tlc cy.t

31' 

-2- 

E€Porr ot lle€r && 

0! IurtlDl€ t@.1 d.!cc!3 

03 Big locat de!6ct 1D 

05 lultj,DLe l@.1 dot.cta 

96 Btg loc.l delact 1! 

S.co!.ts-1.a lro cFclD{ 

E og.!1c l1ver rbceag 

S.co!d.r16 lro o.lcloo 

IulrlPle btd.tlrt ctata

TADLE - XItl 

RESULTS OI EIDA SCIN 

Total uober ol P.rre.ts 55 

s. ii 

n..i: 

:iro- il 

54 

26 

2 

48.14 

46.29 

3.?0 

I 

1.85 

29 

27 

I 

93.10 

3.44 

3.44 

3. 5l 

43 

5 

t 

33.33 

9.25 

1.85 

4. 

54 

44 

7 

2 

31.43 

12.96 

3.?0 

1,85 

55 

5{ 

1 

98.18 

l. at

3:t 

TABIJ-X1Y 

SEIOT AIIIRIJBII{ LIVELS AND 

REPO}T OF IIIDA SCAN 

li riIDA scan Repor! 

:i llDat 

2, !l.6 

4. 10 12 .8 

18.0 

G.tl. nol visu4lizcd. Ac.clrclecvsrilis *irb 

Cholelilhlasi6 

G.8. Dot visqali2ed 

sfre! ccK'dll.ted 

G.B. aot !isualized 

Cbronic cbolecYstltis sit 

.holedocholiihtasls 

Ac.cholecy6tltis rttb 

Choredoohori lbi,sis 

CEr.iuo@ besd of lancleas 

7- 

8. 19 

12.6 

0.9 

G.B. lot visq.l1.ed 

C&!.tDo4 tdl bl.daler 

Cb.CborecYatltis chore_ 

9. 21 

t0. 22 

11. 2g 

L2. 24 

13. 28 

0.3 G.B. oo! visurl,ized 

O.a G.B. vi6u.llzed 

1.2 0.B. not viguallzed 

6.2 llcoiclu6iv€ lesult 

0,8 C.B. not visu.lized 

Acrte cbolecYstitrs. 

Chlorlc cholecystl!i5 

Acute chol€cyatiils 

Posr cbolecysiectooy 

strlct!!€ ol C.B.D. 

chlollc chol€cYst1t13

ll2 

ii 3 ii 

14. 32 2.t C.B. vlsualized No.bal G.B. cirrhosls oi 

livet 

15. 33 1.2 G.B. trot viEudlzed Ac.Cbol€cystrtis 

Cbolellthiasis. 

16. 35 16.2 Dihted G.B. Carclrd. head ol P.!cre.6 

Dll&ted bite duct€ vith s€.o!da!i€6 1a llve!. 

1?. 36 0.3 G.B. vi.u.tlz€d Ch. Cbolecv6tlt16 with 

cbolelttbia6is' 

13. 3? 1,1 G.B. not v16u.11zed Cholelitbi.sls.nd bltlaly 

aludge. 

19. 39 1.9 G.B. visualized Colgesieit llver' silslt 

grlI 6tone 

20. 40 1.2 G.B. not visualtzed putllent cholecvstltla 

cholelithlasis. 

21. 43 t.2 G.B. visuallzed Ci*ho6i6 of livet' sllent 

aalt stole' 

22, 45 0.9 G.B. rot llsu.1lzed Ac.Cbol.cvstltis aod 

cholelitbia€16. 

29. 46 2.1 G.S. vlsualtz€d Cilrbosls ot tl{er, 

cbole1itbl.6l5 

24. 47 r.2 G.B. visutlited CalciDoie g.tl bladder 

chol€11!hia€1s 

25. 4s !5.6 G.B. lot etsuallted Bllluv .trosi! 

26. 49 15.2 Dtl.16d blll.rt choluglocatciloo' 

Das..ge. v€rt ltttle Cb.chol€cvstttis 

tlorto Int€stioes cholelttbiagls- "d 

2?. 53 l3.O G.B.lot visuallzed cholecvatitl6' cholelltblrais 

.!d choledebo- 

ItthtEla.

323 

28, 

29. 

5? 0.3 G.B.not visullized 

0.3 G.a. not vtsualized 

Pu.llent cholecysrttts an 

f,uco.ele of C.B., Cystic 

31. 62 

1.2 G. B. vlsualizcd 

5.3 Sluagiah flor 1'o 

Chlonic cbolecysLiris 

32 

c4 

, ,2. C.B, not vtsualized 

34. 66 

35, 68 

1.2 G.B. visualized 

aftei tstty @al 

0.9 G.B. !tsuslized 

1.0 G.B. vis!!1iz€d 

dilated bil ilry 

Chronic cholecysrirls, 

Cholelitbiasis *1th 

choledo-choli rhtsBis. 

36 69 5.2 G.B, not visuatt.ed Chol€1itbia616 elth 

31. 72 

33. 73 

0.8 G.g. llauatlzed 

1.9 G.B. vlsualtzed 

cboledo

a2 

1.0 

Ptrrygl& c.p detorhiry 

$ith cbolellrbtasis 

47. 

85 

a6 

1.0 

t.0 

G.B. lot visuellzed 

Nolnel gall bladder 

Ac.Cbolecystiris. 

CholellrhisEls 

Aclte hredolrh.gic pabcrearltls 

Pith cbol€ti- 

38 

1.1 

G.A. not visu.Itzed 

Chro.ic cbolecystrtls 

vltb cystic duct 6tone 

Ci.lhos1s of live..,itb 

50. 

9l 

Norei C.B., Uer.sr.s€s 

5r 

2.a 

xor4l G.B., cir.lrosis 

84 

53, 95 

1.8 

l0,6 

G. B. not vrsuatlzed 

C.B, rot visuslized 

Ac.Cholecyatltls. 

cbolelithiasts. 

54, 97 

0.8 

3l"g:;* ..o*'"" 

Polcelrrn C.8, . vr!h 

55. r00 

t.2 

Chlollc cbotecysrttls 

rlth cbolellthtrst.

:Ii 

TASL! - It 

RESULTS O! LIVER AIOISY 

lor41 N@ber of prtie.rs 

operatlve tlvpr blopsy 

-20 

-l? 

-3 

,? parlenrs ot percur..eous trver bropsy DAq 

rnc 'orrorrns 

numbcr or ar tcEpls I ;!sscs 

s, 

P.tienrs in ebob olty one rrtdDt 

.no one p.as w.s done- 

Prlielts tD rb@ o.€ rtreDDt wtth 

pa8ses rere done 

3. Parie.rs ir Rboo h.e 

rtteDpts wirh one plss 

P.tietrts tD eh@ @re tbe ole 

arremprs vltb @re than one 

76.47 

11.76 

s.88 

5.88 

AIOPSY RIPORT 

r. Cirrho6is 

z. 

ot tiver 

xuroat rlvqr 

J. 

rr!!uq. 

r.rry @t.dorpho6ls. 

.. Icrasrnsea 2 

5. 

ra tiver- 

Hj.rlocytlc 

o. ly6!bo@ 

3 

rDronlc scttve heprtllls 

I 

'. lleetrc 2 

3. 

ltve! 

aepatocelluls! calctnofu 

I 

2 

35.0 

10. (J 

10.0 

15.0 

5.0 

10.0 

5.0 

10,0

3 ild 

co PllcaTrot{s o} LlyEt Bro!,sl 

Pelcuraneous Itve. biopst urs 

17 patlenrs. all rhe palients hrd sone 

rhe procedure. xo se.lous cdpticatlotr 

l. P.ln .t rbe slre ot eDrry 

2. EDigostric dlscontorr 

94.L7 

23.52 

4. I.traperlto.€sl bteed 

5. Btliary pe!itoniris 

(r. N.! dt. fra.r ukl 

10. lntra beprtic h@aroDa 

11. pelerratio! ot abd@tDal viscerE 

5 

I 

3 

1 

29.41 

5.S8 

!7 .64 

5.38 

5 pstielts hd @re tbu ole coDDlailts. The pai! 

rnd dlacoolort dls&ppesled elth aD.lsesic€ eltbln r_2 

d.t6, rbll. tbe pt6ur.l hb dl..pD.ued ,ttht! 1_S d.ys. 

Ia oDe pltle.t the lub pelsl.ted Jo! s dsys. 3 pstteDts 

vo&ited lusr aJt6! the p!ocE(tu!e. One patterr vonlted 

tblic. 1! tbe tllst etgbt bo{rs rtte! btopsy.

. 

9: 

!-& 

it ii 

"._tt::!:-!:-!-^r 

:E 

1 t a: 

=ri 

aa :a 

I 

:5 

:;: i::: __ a z 

t- 

z ae 

ai 

i e 

It 

:EiEE!:E 

9q e 

2 

; l! , 

::!iEr,l€li!,ii=i

i4 

ci 

3 

i 

t 

e'; ,"8 

xz 

:: 

te 

E 

i 

6 

: 

I 

E 

5t 

l;i:is:iii

E 

! 

t 

t 

It 

!: 

E 

?.4 

i 

:n 

t 

z 

I 

I t. E&rE t a 

I 

! 

g;eEig€g 

EEe

DlscussroN

Llver is an unpaired organ. Ir i6 very varllbte 

in size and sbrpe. Ir ba8 gor nuelous t@crions. fbe 

o.jolity oI tbe diaers€s j,nvolve tbe ttve! dilt$€ly so 

lnd d&.ge !o . partlcul.r p.!t does Dot ploduce loy 

.pecillc loas of tuncrron. tbe iDvesrla.tion pl.n of 

hepBtic d1ae.se6 lacks a aiople lnd aate lest ro 

demnalr.te sttuctural ard funcltoBrl slsrus sr one 

rlm. Cli.icrl ftndinga and biocbdtc.t !6sts of liver 

tulctlon @y be i!€*tct due to eoo@s tulctton.l 

reaerve ot livet. Tbe orjorlty oi ibs.€ brocleDlc.r 

ie6t5 do not bscoc rbnoforl ulril rb€ dis.lse 15 

advrnced. lu)tlple 8!.ce occuDrlns t.alor€ betng c@pr_ 

t.ible rith ltttle o! no dcrrngeGnt ot ltvcr function 

IBglng rechnlquc€ for lbc ev.lustto. of rjvcr 

.nd bllj,$y staid bavs drurtcrlly !!p!oved tbe 

dlEgnostlc c.prbilirte6. Ihey plovide intoharrot 

*b1cb previously could b6 oblstD6d olty by tnv.stve 

Ulrlasooog!.pby hra grhed luch loEolt..c€ rs 

It j,s non-lnvaatve. It 1a uot !r1!lul. Ib€!€ ts !o 

.D€ct.r Dr€tuatto! ot ib€ p.tt.!i. tt 16 lot ttD.

coa6uoing. Tbele ale !o physleal b.zrrds t6 tbe 

palien. or ro Lhc exeine.. Ii. provides nbuodlnt diagnoatic 

irfomtio. and pareet€ra. Jldgi.g aDd !eading 

tbe pattern is siople so tbrt rtre leport ca! be 

glven pronptly, rt can be u6ed for naly sott orgtu. 

except air containing viscelr. sev€ral organs can be 

oramlned in one sitting. It can vtsu.lize both dyn@ic 

rmagins field is vidc lod loeg.spbic 

directioD ol scanning ls not r€Etrlcr€d, so the.e is 

flee selectivtty of sc.nnina dlrectio! ud tield. 

scln c.n be perfo@d in any Dl.ne rbu6 pemittiDF I 

conside.able leDatb oI lny v€a5el ald it€ cotrD€ction 

vrtlt ttte @in vessets to be 6e€n, selirl stldies c.! 

safelt be perto$ed to follo* the courEe ot aD illless 

and the results oi treati€Dt. thele is no baz.rd !o 

prea.a.t Dotner o! tetus. Tb€re are oo cobtEildicattolg. 

llaDy p.tients can be exeiBed dsIly. lbe €quipoerr is 

not vely expelslve and ealntelrnc€ la e!6y ard of los 

cost. Tbe lnstdlatio! ed bardll.S o! t!6 iDEt'l@D! 

15 e3ay ald it6 lortrble tyDe cu b€ Dved to tbe 

5i*1 

t- 

Ihe i@ge6 produc€d 1! dlitele.t liver di.ea6es 

rle very helpful iD the ditfereorisr dtrglosis{IEbDa!. 

r066t R.sdussea €t 31.119?3). Th6 .bllriy of ultra6olld

to orltdlD lrrgcs rn roDsrLudrnllr curunlt lnd obriqle 

pranea i5 frequellly helpJut ln ctaritylng anaroni. 

.elatio.sbiDs. [orever, surgicrt dressings, drains, 

ale aigrif icalr lDpedi@lrs. ultrrsou.d 

has Cot its .xtrere deDe.deDcc on operetor skill ..d 

eapprtise (Broqh, lS75i Donald, t976). Tbe ioges.re 

often confustng 10 physicians untrained i! this rechnlque. 

Tbere is lacl of standsldlz.tlo! itr eqllpnenr 

ard {ide varlstlon in exlertlse. Iulerous sectionB oust 

be oade io €xdtne the river .deq!.tety. nece.t rDproveoe.ts 

ln.e.l ti@ lechnology b.ve tacililaied tbe 

a.qustrion of technicrlly oprtnal acars overcdrag 

some of tbe6e limitrtion. Ior€ ovsr, ss lrs disgiostlc 

nore evidenr and rhe nunber of traioed 

rn.l physicius incrcrscs rhis rrclor 

sllould beco@ less of a plobleo. 

Tlre other ilpolralt !o! llla€lve iecbDique t6 

.adionuclide ioaglng. lepatl. sclntlarspby has severat 

teaiures vhlch dak€ it useful sE s scleelilg ,rocedur.. 

It ce be pellorred r! al@at att p.tleDrs. It glves 

u overele{ ot tb€ ertile llve!, l! La aelsttlv€ a.d 

easilt reproduclble, vhile uliraaoirnd i6 . t@grapblc 

tecbnique rBd lta use6.scr.€!t!8 plo.€iture b$ got 

llherelt llDlt&t1o!6(Surriva. 6t rl., l0?8). Live.

330 

s€lnn1ng rs a 6rople, safe iDveetigaiio! {tticl! providea 

itrlorMtion About size, posltioD aDd 6t.uctur.l &bd to 

fulctioial lblotuIlrie6 ol liver (Sdde!6 

abd Srndergr1977; Brye ei al.,1977). Despiie it6 

presert linttrtton of resolutto! ..(t th€ lel.tire lon 

speclflclty ol 1ts lositive iindltrgs tr has contrlbrt€d 

gre.tly to rhc diagnosis .nd undor€rlndlng of heprtic 

disordcrs ir ! !!ricrt oI clirlcul siru!riodlrurdin! 

lnd tliIr, 196?; l.rec@! et !t.,19G8i Jolrnson, cr rr., 

1963i John6o!, 19691 lcAfe€ er.1.t1965; torlis er al., 

1965i parkea.d SieGeb, 196?: Scht@! et aI,,1964). 

the ridioiucride scarnj,Dg 16 a technique ebtch 

his heretofore beeD the oaln stsy oJ lnve6tigE11on ot 

llver dlsolder. sucb a lorg exp€!16nce lo *self ls 

ole ot the atroogeat poiDt i! Ila tavou!. The study 

provrdes Lbe resulls srth vbicb cliorcra! by virlue 

ot th€ir lonS exlElieuce.re tullla!. The e$e ed 

lrpidity of pelto@nce, lelatlee lor co6t, aDd lov 

ilcidence of l&lee.€gative leaulrB coDtilue to nalre 

rhe Dodallty ot chor.e lor rbe t.lttal screenina 

procedure ( Green , 1979). 

Tbo percent.so or plriclta yho clrnoL bc c:elned 

becruse ot rDltldces, dratF, roteatiD.l 9.6, 

obesity, mtron o. dlessiDe ta htgh ritb urt.$ourd

all 

and vt{ualr} ze.o 10. radronucltde rsotope(c.os@n 

and Tbomas, l9a0). The dilAnostic ultrsound c.nno. 

panetlate bone o! ai! lilred lungE. Tbus tbe po6tero 

superior aspect ot the live! conEti,tuies a solog!.pblc 

rbliDd spotr iD p.tielts ebo c.noot iBspire deetly o. 

*ho have a, sbDo@llt erevated llgbt b€oidiaphr.gb. 

No si4ilar blind apor exista lo! sciliiglapby. 

The sclntlgrcphy is based on pbagocAtic activity 

of the live!. Thereiore, vben the live! function ls 

lnp.ired it rppeBrs as cold area. fblle tb€ ultlr6ound 

ieaging process ls based largoly on ditterence tt 

collagen content betseen rlsauss. Slnce ihe collage. 

content betveen tissues is often greatly alteled ln 

patbologic condirio!6, it i6 prlrleularly eetl auiled 

!o study tbe palercbyDal lesioDa(v16c@i a.d raylo!, 

t9?9 ). 

The 6p.tia1 resolutioD ol !.dioauclide BcuDilg 

is poor especlrll,y for deep hepatic lesiols. Snall 

lesiols of 2 co o! le6loDs ot 4 co deep iu riglt lobe 

ot liver ca! esily be ltssed by 6clntlgrapby, .€ i! 

our ca6e tlo. 79. ybile hiah reaohtion of sooos!.pby 

vas abte to dlsptay tbe tlssue colslstercy dtfl€lelce 

lld.! 

alrtorlc stdd poilt beprttc 6cl!tl3!.pby

s a dual organ 

t.e., hagtla river .nd 

spleen at one t1ne. l9herers ultraaound is a dulttorg& 

ermi.ation. li plovldes lot of cliDlcal inforolt1on 

ir one exdinario!. Refer€bce to t.ble No.x the rddltionalpathotogtc 

ttoditrgs plovided by ultlasound b€Iped 

a grear in .ercbtng the firal d1.8Bo6is. 

0trlaeound is supe.ior Ior clarificalion 01 

edge defecls dus io lesions in ttte periphery or adls.ent 

ro thr lrv.r(Gros6@h:mdlh('nrs, 1930). Included in lhjs 

c$ego.y are suspicious gall bl.dder fossa, rerar 

rrpressions, rib inp.essiola, sup bepatic lluid 

collection,porta bepatis delects, left lobe v.rt.nts, 

falclforn llgments, grooves, r€trohepatic Dode6 or 

pancrearic iopre€stoDs. l! th6 pleaenr €tud! in crse 

No.8 sd 85 sclDtigr.phy could lor detect tbe edge 

les:o. snd iD csse t{o. 44, hydroneplrosis produced r 

tocal deteer on liler scan srd the6e cases uere clarlfied 

by uttraaoun.!. so tb€ diae.ae atrtes and anatoDic 

variants tbat produce equivocal llndhgs on laotope 

studies can be easily ald rell.bly ilterpleted bt 

urrrasotnd(covtnaton, 1970r F c(un et !1.|1969i 

Jobnso! aDd s*48€y, 196?i Joh..ton ild Jo.ea, 1960i 

Iccelland, 1975t Sha.ser, et al.,l9?5i l4yton, et al., 

1973: LoDonuco, cl aI.,1975i Gorrote, ct al.,l976i 

':: 

--:: 

.i:

Grossmrn, e1 r1.,1977). Iind the lesio. on tiv,r srr 

and identily i. {i.b ulirsound. Thus tbe g.erter 

sensirtvity .nd le6s speciticlty ol liver scan i,6 

complenented by less sersitlvtty .nd nore speclllclty 

of ultrasound (EtI and tilli&6, 1981). 

Ultr.sound bs got untqu€ property of dj.fterenrrrlio! 

be een r cystic .od i aolid oE6 (Talort 

et al.i19??: {eave!, I9?3), sblle the appea!3Dc6 ot . 

cy8t, rlenalgron. abacess, henaton. or Detasta6es 1s 

slrltar o. scintlgrrpby{Reler ro ttbre No. xlI). 

cbeetber.Dy c& occsrolally dr@ric.lly 

alt€. tbe arpealaDce o{ liver ctastases otr ull.raound, 

aDd surgery .3D ladically cbaoge tbe alat@y ot the 

righl uppor quldr!tr!. So ir is inportul lhal u ro[plhislory 

sDould rcc@plny clch Drlicnt 

rDd the probld sbourd be explrl.ed to rie s@ogr.pber. 

lf the patient blB aD equivocrl acln the study ou6r 

be availatlre 10 enau.e ad€quate tomgrapbic secllon6 

tbrough ihe .rer ot co.ce!n. 

!ltbo!A! lucb atteltio! be bee! directed 

receatly tdMda detllIlg tbe relatlye utllitv ot 

solography E.d €cldtl8ralby ol ltrer yet tult ev.lurtlo. 

is srill rerrted(Blya!r 6r r1.,rgtti cfr€ii€, 

et 11.,19?6: Cl€€a, €t al.,rl??r croa€oa!, et 51.,t9??i 

i'

3li l 

xock and p1!{els, l9?6: Levt-os' et sl''19?2i Soitb' 

et al.,tg?Oi Tsvror, et ar.,1o??i latlor lnd cfleote!' 

!975i zr1:2t et dl ,l911t. 

Tbe tblrd investlgstlo! th tbe pr€geat studv 

ts the pelcultneous liver biopsy. Tbe coDtrlbullon tb'i 

hls been @de to tbe Dder. colc6Di oJ liver diseMeg 

by riler biopsy t6 iqe86e. ob€ mt lot foiget the 

value of intelllgont clinic.l .ppr.isal End the proper 

interDretitton ot acculltelv pelto!red labotatoly te6!s' 

None the less llver biopsv constltutes a kev slone i! 

the diagnosis rnd prosress of river disese- No labor'- 

tory t€st even vbe!.epe.ted seri.llt cd correctlv 

reflect the true histologic 6tate of the liver at ' 

given r.i@ o! tbe chalges taktta plcce in due courle 

ot tire. heque.tlv tbe otrlv @.06 oI dele'dtniog lhi€ 

ls tbe oicioscoplc er@iD.tlon ot tb€ tctual liv€r 

rissue (volrllsr .!d Jone, 19a?i Psrets' 1959i Sberrocl' 

194si Scbitl, 1951; Krec&!e!' 1954i lolle ald Arplrn, 

t952i Bo{d€r, 1!53i za@hek snd rroB!' 1953i Conn' 

19?2i P.!l.er, et al.,1952) - 

It ls Dot . tEt ibti bloDst 16 !o lolg€r 

cotrIincd 10 sPccirlized ccolfcs bul, l!!s bccrm rn 

4lDost routln6 pfocodu.e 1n dt|,g!o€16 ot livcr dr6e'aes 

to! td-pltt€nts snd even to! out-Dsi1elts (K'aus!,19?a;

Pc!!!ur1, e1 aI.,197d)- 

Ore ol the drarbuLs ot liver biopsy is irs 

s4Dlibg larrrblliL!. Tbe rrssue oblajnyd is !er! 

shall and it nny aol be lepreE€ntalive of shot€ tive!. 

Itr farty live!, alcoholic hepstltls, non 6pecttlc 

l'(p.tr.rs, fulornant heparitrs, leuketrrc intilrrare 

f,r(l venous congrstion otrc biopsy is cxougb. ln crrrhosib, 

clrronic acrive hepu!11is an.t tn de1€crjon ol tocal 

losions Like oetaslatic csrcinoDa, and granulobi one 

Dlopsy my nor be vcry belptut. 

p.'rcutnneous live. biopsy is .n inporr.lr 

dragnoslrc tool !lrh a lol mltaliry (fisn.r lnd 

nrloon, 1953), Houcver, rhe mrbtdlly is bigh and Dany 

coEpLicaiions are descrlbed (Aro*n .trd ralsh, 1952; 

Tcrry, 1952; Zucbcct aad Kt.u€etrsrock, l9j3i co.., i 

. 

l9?4r ||cclo6key, r9?3i Cos, l9O?i cartrson, 1969i Btari, 'i' 

1969; R51ne6, et !t.,19?4i lrevlnsoD,l9?2i Derers,1968; 

Altiyeh, 19?6; Preger! r96Zi Okudn, 1974: B.1tei, et 

aI.,1969i slrav.r et al.rt9?5i Dosil,19?5i tengltill, 

r9?0i Ball, €t.t.,19?s; Lindne!, et ar.,to6?; Jobnson, 

et ar,,l963i !tranutri, 196ri Kelley, et al.,19?1i 

Aulliv!., 19?ar Pu.ow, 10?7i X€rt!6r, t96O). 

It la .!.pected tb.t rh. true @rr.llty rnd 

@rbidity raie tolloeitrg p€lcutaneow btopsy t. Dot

336 

known, but ls higber lttan tbe figule6 produced. the 

rnportanee ol experienee is obvlous. On 1r largely 

depends success of the procedule (tenabini,19?0). 

conplicattons also depeld on the @thod u*d fo. it. 

Ir rbe procedure is perlumcd correcrly seriuus 

cdpllcrtlons vill be r.re. Tlre cdplicatioD. c6 be 

nrnrn:zed by strrcr sdnererce ro. prolocot rhar generally 

includes bo.pitatizalion 10. 24 hou.s and strlcl 

supervision du!1ng lbis perlod. 

Ltver biopsy is an liport.nt disglostic tool 

*ith cerrain codqlndicarions a.d 6hori c@iogs. fe 

nusl be av!.e of its viccs and tske full sdvanilge oI 

its viltues. ln each instance se Dq6t re18b our optj,on6 

and bat&nce the possible risk6 against potenttat galns. 

The dit{erenLjal drEg.o6is ot. p.rren! {rrh 

Jaubdice rs . drlflcul! crr.icsl plobtd. Durrrs rrvestigatlo! 

ol a l.u.di@d prrielr .! lolort.Dt et€p ia 

to detemln€ vbethe! tbe ictelus ts ol bepatocettul.r 

or @cltanleal orLgtD. lf obstlrctlve, tbe obstructlon 

is i.trabepatlc or extla hepatlc. Clllrcal aDd biocbenl.il 

d.t. genelElly allor ore to .nar€! aucb questtobs. llowrnlurulliun 

is necdcd oLlrcr rcrr iqlea 

are used. CoDveatio!.I coDtra6t @d1,. exeinatiols, tn 

sucb sltuailoEa .re either coltlaln.tlcateat, iDtol.labte

or thconclusrve. The other avritabte pro.edules 11ke 

THC, ERCp lDd argiogrsphy ale invrstve procedures .ssocrlLed 

vrtn certlin @fblatity and &orrllity risl€. so 

recbniques sbould be Dretelled. 

UlrrasouDd is rbe a.ltral i@sins t€ch.lque 

-r. the exelrarrob of a J.undrced parrentrTcytor, e( 

a1,,r9?9; Taylor and Carpgnrer, t9?4r Taylor and 

ftos.ntietdi 1971; Tlylor.nd tlcor.udy,197S; Tsytor, 0! 

rl,,l9?9i Cilby ahd Taylor, 1975; Tayro., er sl.,l9?Oi 

Viscomi and Taylor, l9?4). Il con.iderably re.tuces 

lhr long 1i51" of invesliglrioos and sbdlllns Lbe pcrroo 

o, investigaaioos balore I definir.e diag.osis is nrde. 

Tbe cllnlcal i.tolnattoD gsined fron ultra sousd usualty 

rcnrasenls rhe basi6 for rbe selection 6f subsequeot 

drugnoatrc tesrs ( xcPhee and shapi.o, 1932). 

In drrierenllat diagDosis ot; parren! ujrb 

jauodice Tc---- Sc produce6 lfge !u!be. or equivoc.t 

resul.s, silce the cold ir€Es nay be due to dilfied 

coopoDelts oJ tbe bili.ry tlee calsed by extr. bep.llc 

ob6!ructlo! or to ltver @t..taseB causlng tntrs 

hepatl. obetruction. Tbe plobteD iE c@pourded It 

tho pEtl€nt i. krovtr io brv6 the prlDary twour. 

ull!..ound ca. establlsb rhe c.ua6, slle snd rrtqF 

oa obstructioo ln patieot,s ultb 6u!s1ctl jaudlcs 

ij:,1

333 

(lioellgsbers, et !r. ,1979). rt csn sssess th€ level 

of obst.uctioB (sDlnelli, et .1.,1982), ortr$oulrt is 

ve.t aenFtire in det€crto! of btt€ duct dit.t.rio! 

(Behan ald (Me, l9?8i cotdbersr r0?6i rsi&ott snd 

Dllconls, 19??i 1n€ et &1., 19??i telinl ed s.bet, 

l9??i Nl€@ ud tl!t2er, l9??; perlEurter &d coldbelg, 

l0?6i Surrle, 197ai *eill, €. rI., l9?5; teitr, cr st., 

loTs). 

It c&n treasure tbe blle duct

Ul thsound .xminltioh with proper pat jent 

prct,drrion, cln usuarry disDlry lhc ahotc tcngrb of 

the coI@! bile duct(Perloutrer, 19?6). tt can preclsety 

delinecte tbe anltohicat site ol obslruction and leEs 

lrequcntly rhe plthologic c4use of ir (Taylor and 

BoseDtlerd, 19?7), It otten plovjdes lnromslron loour 

the statE of paDclers vhich is Euarlt @r a. esiry 

app.oacbable orga! by other llvestiglrtols. t!o! .adloopaque 

srones can b6 viBualized succe66J{11y. I could 

vlsualize CBD atonss iD case nuber 53, 62 .o.l 69. 

go*eve!, in cr€e tlo. lo, the sto.e ua6 oissed oD ul!.s_ 

sound and in cr6€ nuber 6! !ub.r ot 5to!e5 tound !r 

op€rarlon wrs not the s.m sa tbar on uttlesound 

Boweve!, qlir4ound diagnosis of choledo- 

.holithiasls i6 not rlvrys eEy(L.irF .Bd Jrffley,r983), 

and it p1ay6 a llnlted role ln tbe excllslon of tbese 

sLoncs (c!ono!,1933). Th16 sspecr b€co@6 ot a pa.tlcutar 

prAcLical ielortance i. rhe posl cholccysLecl@y 

prtiert (G!oss, 1983). SurAiclr ctips or posr opert_ 

ilve 6car€ at tbe site ot galt bt.dder c!! proouce 

pseudo calculous ertect, tbus lloduclna conruslDg 

lesurt8 (&.ptopout@, 1980). Ior€ 

bire ducr stole6 .re ott€D rlihour icolsr1e 6brdori.g.

'Ih. dtllrcu)1]. i! d.i0nsr.ar Ing.cousllc shldorins 

Dr\ be relarcd to thf s@tr slze of nost .olmn ducl 

s1oae6 ud ro degradarion of 

rting air *ilbin tbe gastric 

(Behqn !.d l(Aze, rtTB). 

tr'e sound beM by overantru 

and duoden@ 

The dilaration persiats eve! rfier sqrgic.t 

retlef of obstrucrion. Thls the efflc.cy 

nust be judged by o fatl i! the seru trittrubln level 

lnd not by cbanges t. rbe c.tibef of ihe bill{ry 

vessels (T.y1or and tosenJietrr, 19?z). rt is also 

e&phaBired here thar &rgic.ll, corlected jlundice is 

nor" ro b€ equared wlth btle ducr dtlatslion. lntelol_ 

rt.-nt obstluctirg calcuti srd occasrotrrlly strl.tu.e 

.r Lne err!. bepattc dlct nay be preseht whe. the ducr 

.!1lber is nornar. I( rhe.llnlcal .ou!6e and tabora_ 

rory invcarlglrions slgaest the Doscibittly ot a. 

iltelnittent o! low glade ob6rructio! shlle ulrlasoqnd 

deronstrarcs s nomll ealiber duct mlc rtrvesrrgarrols 

.':..: 

DAy be Decessrry ro provide lore precise ansl.oDlcrl 

sego€lt.l obatrucrlo. oJ slDtte of 4uttiple 

poltlors ot th6 biliary tre. lE a llequent seqrel 

ol pri@ry o! Deia6r.tlc .@ur .irvolvina rbe t1ver. 

Eeclqse thi6 a.oup ot patl€lts 1s otten .nict6rus, th6y

irc plll suitcd Lo h.plrobrltlfy 

scinrigrlPhv(zcnrnl 

Cbolescin.igrapby co otten identif, Dariiat 

bepatic or cdmon bile duc! obstructloo rnd evetr detet_ 

trine the level ot obs.ructio! (Ru, et a1.'1931; Ialoro 

et ar., 19??i Nielson, et al,,1978i Krlngelsith, et 

a].,1931). There oay be i.tenae opaclllcation ot tlte 

lrver ls6ocl.ted with a bon-l&sged brliary tree iD 

partetrrs slth obstructed cods. ltepatic ducts({eissDnn, 

et ar.,1981). Adever, itr iaubdrced psliebts rbe! 

c(!@n blle duct obstruction iE a posslbilitv cbole6_ 

cintlgraplt, i6 leas us€ful .6 both gall bladder .Dd 

tb€ blle duct6 nay bot fill re.qltlng ln an equivoc.l 

Tho cbole6centigrllbie ll.dtngs aro judge.l bv 

(!) quality of tbe eairy bepatlc uptske, (b) qualitv 

of ihe late p.renchymtous dtscbrlge ( c) degtee ot 

trace! concentntios i! tbe bile ducts .nd tbe borel 

'r# 

:.?' 

ID c@plete @cba!rc.1 obstluctioD, well p!eselved 

b€lstlc lptake vitb tittle o' no bepatic d1B_ 

charge sld !o !1su31iz.tio! o! bll€ duct6 o! boeer 

I! tbe c.s€ ol hc(DDl6!. @cbslc.l obatructlo!

3t2 

:re i6 good hepstic qplste, delaved hepalic discba'ge 

I bofcl visualiz lun rith sllsis of rhc rrrccf rn 

p hilo ducts. vhilc 1n hcDar'occllula 

decrco$ad hcpatic uDtuLe, dclavcd hcDrllc drsclr!'gs 

d bovel visuslizatlon vith no stosls ol the Ir'ce! 

Io*ever, thele is to ilverse relatioasnip beten 

rhe seruo bilL bln level tnd tellabilltv of the 

a! in deiectiog an obstluctive iaundice (Pauve16' et 

.,1980). The duratio. ol l.lDdice does not irflreDce 

G tinrl l6sue ot tbe scM. Trle overall rcc6.cv 

)c!ease6 rhen tlte btlilubin level is l0ogl ud r-be 

)cid€nce of true posirive scsn dtops slgnitrc$rlv 

rib billrubin tevel sboee 20 Eal (neler to tabre 

st.sts ol the ilacer iD tbe bile duct co.s_ 

itlre6 s typic.I slgn ol obAtructlve iaurdice. Bul 

hun rlrr blliury treo lnU Lh! g!l lro [ol !isu!li,od' 

be only criterionth4r halps to ditterenilate beise€r 

echlnlcll obdi.u€tIotr rnd sevele bcDltocellolrr 

allu!€ ls tbe deglee ol heDattc uD!.te. Ab@e 2oogl 

I bj,Ilrubln, the hep&tlc uptsle 16 uauallt poor o! 

on sxisteot i! majorlty ot patielts. 

Tls ilrruenc€ ol tb€ desreo ot JNEdice on

tbe reliabrlity of scan is not 6u4rising, stnce bilrruljrn 

comperitlvety irblbirs the a!ionic crearaoce 

p4th ray ot Tc - IDt de.ivatives ol the lrver. A6 long 

as the bitirqbi! d6s lot exceed l0 og! er€o I .egatlve 

scan ls rellable. BeyoEd tbie tb€ Dt6dlcrrve value 

dlops srd the .es!lt6 .re oite! listerdllg. 

The partiat ob6rructton n.y have a vulery o, 

preeerbtionsdepe.dtng on the durstton o, obsrluctlo! 

and extelt of bepatlc dyEru.ction(Ro6elth.l, et.1.! 

1973i Re, et at.,los1i latoro, €t rl.,l9??t xielson, 

et rr.,1973; Klinsen€oithr ei ar.,19stt reiss@nE, €t 

aI.,1930). Tbere @y be pr@Dr or delryed hepitic 

d isrfrd|d !t te 

obsr ru.rton,! cur off a! Lhc t.vct ot obsLru.!roD or 

deleyed excretioD into tbe duo

3ll 

Rapid gall bladder eDptyilg sld vi6uslizstlon of rbe 

duo{renu siih ccti of si.caltde exclud€s signlftcs.t 

obsrtuctto! (Tlylo!, et at., 1982). 

CbolescintlFraphy can 4lso be u6ed to dlsanose 

bilidrr ntresla snd lts dlfferentjarioo f.on neonatat 

heprritls, llth a blgh degree ot spe.tflcity and sen_ 

sirlvait, {cerbold, er 41.,1983). csse No. 48, a chitrl 

of l7 reeks, r&a disgDosed s6 a c.se ot Bill.ry allesta 

and Chole scinirgrrpby herpe.r us in rbe diaglosis. The 

supe.ro! resolutio! s.d the adv.oragc ot Lransaxlar 

p.ojectlo! prace6 uttllso!tr(i rbsad of rrcroruclrde 

imaglng in the dlagnosts ot obstructtve Jrusorce. I{oe_ 

ever, ltdionucllate stud, i6 selt suited for delemtn_ 

1ng pat€ncy arier surgely. the dtlrted bltisry p.s6.ge6 

vrsu.llsed by utr.soud alre! surg€ry Dy indic.te 

ettbe! peralstelr uDlel!6yed ob.tmetioD or lestcu&l 

dilrtatlon despire p.teBcy. fbe Dle.etrce o, Euglcst 

crips, acars ed ge6 i. rbe bili..y tree o!!e the 

issue mlc conpl tcal cd. Rrdionu(tidc 

tr4te blliary-ebterlc bt_pasE and t.he errecrtve drllrase 

of bile f.@ vsltous bael toops .nd noos ups 

cnalacteri€ttc of iDcressiag cooller( billsry proceoules. 

1!6 lote ot liv€! btopEy i! obstlucttve 

i.uldlce 1a 1i!!ted. fberetole, I d1d Dot Derfon uy

iti 

percutlleous llver bropsy *here presence of obsiruction 

$rs demonsrrared by olhcr oeans. Thr biopsy speciocn 

tbougn est$lLsbidg tbe plesenc€ of obstructioD, .slely 

czuse. Cerrrin hislologi. chlnges in rne 

leedle biopsy speci@. irvaltably indicale lDe ple€eDce 

of extrr beparrc obsttuclive Jdudice bu. are oDserved 

i! only a sratr ploportloo ot ca6e6 (noboro .!d Kr.r!p, 

r94l; lovtrt .!d Dsvi6, 195{). there is no sr.gre hls_ 

Loloaic feaiure but coDblnailon ot these .!e of consl_ 

derable tdpolrance i, dltf€.enrlsl dllgrosls (call 

ud Dobrosorski, 1964). Ljvcr biopsy D.y bc nccdcd to 

dilferenlla!. btli y clptlIa.y srssis fron axr.a 

neDaric obslruclion lrodueed bt celtain drugs. I. 

l8undLce hisrologic diagnosrs 1s oore ditt_ 

lcurt rhen tbe jsundlce Is ot shorr dlrrtion. !f the 

needle biopsy sboEevtd6rce ot btli&ry obsrlucrro! 

ea.ly 6urs1c.t inielv6.tloD csD be rtooe, thus svoldila 

tbe risLs of opelatrna o! lattents sltb long sra.dlnS 

bilialt obEtruction. I. &dditlo! i, the surseo.s are 

::_l 

provtded ritb cl€a! evtd€nc€ ot large biie olcr ob6_ 

tructto! tbls eDcolr.ges tb€n to e.t€ rD rnreDse soalch 

fo! D€ehlrlcet btlla.y ob6tluclro!(Bjolleboe, .t rl., 

llag), tieedle bloDsy srso exctu.tes I diEglo61s o, 

cbolestatlc pbs. ot vi!.I h.pltttlr, 1r eblcb surSery

t en &ppr€clable oorreliry oialvlrle 

and sume. sil*, 1963), 

ln high grade extla hepatlc obstructlon it 

ro,1. lrv(,f I'iot'sv in r,ili(,nrs rrrr rr 

enlarged palp.ble gall bladder. It may produce bile 

ehboliso. In 1ow slr

3l? 

Ulrrlsourd is not ycr al !he s!.ge of rourirety 

providing tissue diffcrentiarion oteire and Eusbandl 

l9?9i yagg, er al,,19?t). torcver,.efineoelrs i! gray 

scate equipnent ard the resuttrnr abltiry ro obtai! 

textural lnfon4tloo trd the liver tlssue has tDploved 

its diagnosric cap.biltty fo! @lignanL otseases, ootb 

Jocrl ald dlffuse. tt d€tects hepati. 

sersrtivlry ot about 90t (sut11vs., et ar,, 19?8). It 

also m|.es po6sible the lelisble €xctusio! of a rrver 

specitlcity of 961 (sulltvln, et sl., t9?s). 

fiotrcv.r, bcnia! 

b. ditferenrralcd rr@ 

The solosrsDbic app;arance ot 

sr4llar to rbat seen 1u be.ign lumurs and infl@a1oly 

nasses. $ben . Declotic @taBtasls becooes cyslrc, lt 

al@st in!!ri.b1y 6hors a solid c@poBeit ud deb.is 

(Taylor ard Aiabod, 1983). this oakes rhe disgnosis 

mre dilftcutt. periflulo-Octytbrodide !!y help i! rhe 

delection ot tuBours by ultrssound (natt!€y, ei ar,,tcs2) 

Eeparo@s bNe gor vafi.ble rppealec€ oD urt!.- 

60u!d (Dubbi!, et e1., 1981). lb€,| 4!e delectec ,rth 

a 6€r€atlvitt ot 891 (Brod€rick, et rl,, 1r8o). 

For d€tectron ot bepatic @testases rcgq_& 

ac.rnilg give6 valtable re€ults. Io o.e 5€!re5 by Dsvles,

et al.(1974) the ove.all .ccor.cy reported 15 951 blr 

have sbovn less accurlcy ofLen vilb osny 

false po6ittve results (Conn aDd llxigron, 1963i Jhingra, 

er ar., r97li XaAns and poe€r1, t9?3). For de.ec!ion 

oI hepatic Errstases singrc tce9lSc sca. rs ot lioiled 

sensltlvlty 4!d ls aon specltic, xulriple sert.l llve. 

the speciftcity of tbe te6r sooe$brt, 

(cede.Dark, et at., r9??) ahd cbange6 in a radronucrlde 

period of tlme csn be correl.ted with tbe 

p.tienls conditloD(ltsc@i, e! rl., 1981). 

Sulr @iastatic loatule6 @y not oe ceiect.ble 

by sc.trtrlng. Tberejore, I Dom.t s.il d@s noi excrude 

th€ presehce of dise€e. lov€verr a Doroar sean 1s a 

srrorg evldence r8rlnst E rhour belng dete.ted by 

s.otb€r i!.gi.8 @d!rrty(B!yo!, er sr., 19??), 

Tbe p.tchy scd s@etiEi obidned rlth uultlple 

neta6trtic deDo€its ale siltta! 10 those see! rn drlruse 

rrver dts€sse. fhe 6pace occupytng )esions may oe 

n!6hed by the hererogenous ladionucli.le peLle.r see! 

rn parlenrs rbo alao have h.lratoc€]]!la, dysrunctjon 

(ch.fotz, et .r., r9?9). Ib cs66 ot bigb tteu. 

susprcro! lo! €rulle rhe! ltve! frnction tests ale 

abtro4el o! the rlve! itsett i5 ellrlged iD . p.tieat 

flltb . *noh plioaly ueoplaso elseobele . !o!o.r

.dlonuclide sludy sbould be tollo*ed bt urlrasou.d. 

Tlrc incltsion 01 qulnriLarive liver 1lo! sruqres 

enhance rhe s€hsiltvity of liver iDlging 

ot nel'tstases (s.lper, et sr., r98r). So llversctntirn_ 

groaraDhy (stadatink e! al., l9?5i *rxnEn, eL al.l 

1974) lnd eaMlnatlo! !1tb 6.t1iun clrrate (Be14nger, 

ei !1., 1975t Blrsggi, et.t., 19?6), hsve been sdvoc._ 

!€d as retho&-of further ev.loaLlng toctl dcfecls. 

T\cy loo lre non sl)ecitic blr scrlc !s un rn.1rrlry 

nclhs or .cducing rbe long lisr of diagnosrjc possibilities 

(ut., er !1., r98o). 

[epalooas appasr as cotd aress on Tcggn_sc 

scrnrrg.rphy. The specilici!y crn b. lncrlased Dy 

Ho*ever, uprore or cau, rill occur in 

upto 501 of tive! derlsi.sos rnd virrustry rn all 

iDll@rtolt lestons. Tbe cohbi.stloo of Tc99 -Sc 

ald galli@ ts ho.e selsitire tbaa ultrsouDd.roDe for 

delectlon of hepstdA. Neverrhetess tbe o:lgnosr6 

crn.ot be nade

local cold alea seeo oD tbe 1t!er sean na! be due to 

a regeoerating nodute, 3n area of dense ftb.osis o! 

hepatoma. tlptake of c.llluh6? in tbe defo€t rs nlahry 

hoDnt@a. A rcgcnr:r!ling .odurc sotds 

fppcrrs ss a roc!l d.rrccr on urrr!s(,und !s sen(rrlly 

ttlet look the 

of rhe llver llssue. oltrasound 

ts of no vrtue i. dirlerenrrarrng hcongi@., 

tocal nodulu hyperpl.cia and Ilver cetl adebon*(llein€r 

&rd paruleka!, r9?9). Althoush mst often tbese ..e 

echogenlc but oay be hypo€cholc espectally when tbele 

brs been hlemrrb.ge in thc lesion. such s parteot 

should have a liver-spleen sc.n done io exetude focal 

nvdutar hyperplasra as 50! ot rhes. r.ke up Tcggh-Sc 

Tbe coobinattoa ot a bas6 o! uttrssound wirb . aohal 

uptahe oi Tc-sc acan appeals ro b€ diaSDo6ric ot toe&l 

todultr byperplrsta. Tbe lascul.r larore of sucb tesioos 

cbn bc.l€fibed by btood poot srudre6, usrng Aul98, 

'rr_.'- or lD"'(Iunot, .nd Juhnson, t9/4i LuLin,r9?2). 

But tbeie are pit farla, includtng Jalsc n€garive 

resultE, tbat car lesd to c@pl1cltions 1t blopsy i5 

atterDted (T.ylor, er .1., t93t). 

The Eccu!.cy o! needle blopsy 1n patie.ts suspecled 

ot b.vlna @1asts6es oD cltlical snd biocheEic.l 

srouDda i3 ?5: by Iarat et 11,(195{) ald pdets (1959). 

Tlmu! detectlot is ?t! rn. selles by satdi, ei tr., 

---+t'

3it 

(194d) ard ?01, by Oikasa ald Schiff ( r956). Uerasiages 

@J be Dissed ar laFlor@t as in 15; 01 patienrs 

{ith letasta36 the appeara.ce ol llver at t.parot@y 

is no!@l(ozarda aod llckren, r962). A blind liver 

b1op6t ts generally pertofoed th.ougb the rlghr lobe 

ol l1!er to! deteciion ol 

Eor€!€!, ebe! 

rbele is olly ni.Bioal oet.starlc d16ee5e or shen tr!6 

tmour ts tlllted to ihe teft lobe this procedure rs 

lrequently unproductlve. The biop€y speciren may be 

too small fo! 

Th€ c@blortion ol pe.cut&leous liver biopsy 

wilh rccur.te locstis.rloD of lesion by sclnttgrapnt 

rnd sonogrlphy ldproves the diagnosll€ vllue (talson 

and Torr.lce 19?0i Trylor .nd Ricbod, 1983). 

The di.el)osis of nerast&tlc diseaae ls 46I 

qtrb ole biopsy i! tbe series by Abdi er 81.(19?9) lnd 

4lI i. tbe Berie6 by Glosed er rl,(19?2). lorever, 

1t 1s 541 {1!h tso blopsiea (Abdr, et al.,I9?9r GloBaDa!, 

et at., 1972). The detecrion is lncreased by tbe crtologlcat 

ex&llrtio! ot tbe fluid Drtelial accooprbyllg 

tbe ttver blolBy Bleclmn rnd by taklna . thlrd biop.y. 

Occasiolally blopsy allords a cluc to tbe p!to.!y 51te 

F.tty lalilt!.t10! 

geo6rally 3lf€ct€ ibe 

.t 

-r '!1 

l,

dillusell, l)ovevcrr focar farry !nfllrfAtto! Day occur 

(scotr, €r 3r., 1s81; Braver, e! a1.,1980). In thls 

seitiDg the Epprecirtion ol a focal .bnot@litt $itbiD 

a liler ltlecled try a diftuse paretrchyoal proceas ory 

b!'dirliculr. It nny no1 be posstlr)e 1o dclect it by 

any dhe diaSnostic tectlnique shorr of liv€r biopsy. 

Tbere i$ !o Eaopltag variability tound itr cases ol 

la1ly inliltration 3!d one biopsy ia elough to represent 

the disease 6tate (soloway, er !1.,19?1). Itowever, 

guided Deedle biopsy orlers a betier rechnique lor 

diffe.enttatinS focal ferry tltlltiarlon fr@ beDeto4 

atcohollc livei di6ease In.ludes l.tty intilrr.tion, 

&lcholic belatiiis &nd cillhosis. Therr diile!- 

eiriaiio! t3 hportant as tatty intllrraiion is vllolly 

reverslble ehlle cir.hosis tE rot. Alcoholic bepattl js 

oay valy fr@ r oild antcrerlc i1lne55 to fulrln.nt 

hepatic f.ilure(Gatebos, t9?2). TcgL-sc gu. i@gcs 

ol livrr (olrospond ro rhc..v.rity.f thc dis( as.' 

(cesleln, er !1.,1s76). chang.s in the sizc of llver 

and splee!, 1n the uptake pstrern rnd shitt of aciillty 

to slreeo .!d boae o.rror c.h b€ docuoe.ted *ltb a 

creat 6e!6lr1v1ty ard rbe coufse ol the disease cen 

be follo*.d by sequelri.l arudi$. h trrty 1!J11t!.tio. 

i.i, 

#l r' fr 

Tll ' i'; r'); 

': 

''-?-a: 

T: 

I rl.

It 

354 

dls€ase. [oreve!, . bloDat !...lle t€.d. ro b€ detl.cted 

by delae tlbrcalB, & t1!d1!s ort olly lat sd 

ne.ro515 4l be hlal..dlog. Tb..e 15 v.ri.btlity in 

tno prtlcr! of sclrrltrs tr ctrrhoBt6 (lrld6teln .nd 

szanto, r056i solo*ry, 6t ar.,r9?r). so lbe ,DuDt ot 

t.t &d rlbr@16 iouod l.e Dot equl i! ditteleot 

btopay ap€cl!€la lroo tb6 srF strbl6ct .od .re lor 

repreaeltatlve ot tbe 11ver a a rbola (abdi, et al.r 

19?0). Tbe ltee! btoDay Erde rt D.i1to!6oacoDy coltlror 

th€ diag!o616 ot clrrboala iD o.1y a8,8l(Vtdo.nd 

tlldbt.t, 1969). lhe dlrgioalic ylcld cr! b€ lnc!€aed 

b, aequeorlrl btoDstea. tbe dlrgnoala ot cltfbo5l6 16 

10Ol rttb !b!€e a€qleDtt.l btoD.l€a, trot.v.t, tDerc 1. 

!o aupllog v$l.btllry 1n rlcobollc h€pat1t16- 

tb€ dlqro€u ol tb. ryr. o! ebrc.lc rctlve 

h.Drtltls rld 1t. ..verlty cu be J!6a.d rltb l1i6r 

blop.t. Bd.v6!, oD€ .1!31€ llve! blopay cd oo o@41o. 

b€ ntslsrdlng ard the rccu!.cy ca! b€ llcr€agir io 

l00l *ith thr.\. acquonrlrl btoDBacs. 

13 Tc-8c €tldy Drovtdea tunctlo..l lototDtlon 

rbolt retleulo-€.dotheurl c€tl. t! r Y.tt.ty ot b.Dttlc 

.li*a€a, rdgttr3 lts chEolc .crlvo leprtltla !o 

early ctlrhoala. It ta v.!y ..o.!ttv€ 1! d€toctl!3 

dtttuls h.Drto@uulu dl.6s9P^(G€lLr' lei...l..llra \ - r --.

355 

teral cbannel6, s.ll 

A pat€nt ublllc.l 

19? 3 ). 

;li 

I 

1930 ). 

,l 

Tho anctllrrv thdlnas on ultrasouDd llke 

splenonegaly' .lllslod 6plsnlo and portal v6insr colla_ 

slsorl Iivef atrd the p'e6enc€ oi 

asclt€s help ln th6 atisgno€ls of cir.hoais of 11ve!' 

v6tn c.n bo dotect€d Eoooe'ephtcallv 

in paiionts tlih port.l hvp€rt ons ror ( Sa'ldekn t ' 

1932 ) 

' 

Tbe stst€ of esttdbepsllc.nd lnlt4heP.ilc po'trr ayaieo 

.an be as66.6€d bv sttr.Bound. tt odv be partlcuti!I, 

helpiul t. tb6 o@.g€ocv dl.gtrosi6 ol gast'otDtesri!.I 

hre@rrb.36, both l. d6tlnr.g portal hvpa'_ 

tension a5 ! ca[s€ srd lD dtstt.$rlslirng irtr! hep'tic 

frd axtra heDAilc potlnl bvpertcnsto. (lebbr et 'l'' 

19??i lc.tt1, r9?O). Iorcovo. porl! lteoltrs can !lso 

be localisod by ultrssound prtor to Psrcut'Deous 

transhepstte portoSltphy (Burcb&rrh 3nd &aeDusse" 

sonogrcphy is exttomlv useful in the diagnoEta 

.nd msnagement ot h€Poitc enosblc &b6cose (Ralls' et 

br., 1932), Uttrs sound det6cta aituctu'al cbange 

rhile tsotope Ecsrnlng €bo{. tho tunctlon4l chaog€' It 

is 9!ob.bl6 th.t rn laotop€ ac.b d€t€crs an 'D'c€as 

befo.e it ts d€tociod bv ultra 6oo.d (Ds*burv' et rl'r 

!o.eov€r, lt !s th€ @athod ot ehoico lo' !o11ot

356 

up. as lurctlon chengss nor6 tsprdrv th.n norphologvt 

ur!.!sound elll .ot surprss tho lnioMutio. obtaltr€d 

I.oo tbe rrdto isotopc scan fot ovrluatl.g the r€ault6 

(ull ntrtl llllirn, l08l). 'l.lrls ft(:l ta 

clea.ly demn6ira.ted In c.s€ tD. 93 ol tho D.ea6ot 

study, see.litra of ltvor *1th oultlple rlnute pvog6nlc 

absc€sses oay not b6 d€tected by Tc_sc €cdn or ultr'_ 

sound

tfr':t,. 

35? 

enieric ao.st@srs (24.., €t 61"1002) 

Both tb€se iDralna tecluiques pl.v llDit..l rc16 

ln the dotsction oi h€pctle glatrulooa. The dotectton 

oa hepattc gr.rllqs la adrcoldogls 16 83I elth oa6 

llv6r biopBy (laglo6rr €t al., 1051). lbll6 ln th€ 

6iudy oJ Kl.tEkln and Y66o6" (1950) th6 h€pattc aranuldr 

in r p.ttesi qltb ssrcoid@l. rG .l€@Dstr!t6d o! 

lnlttol tlver btop.y but lot Ir . BscoDd llv€r biopay 

usu.lly lr@ tl$ afrnul.fu detoci€d ot tiv6t 

blopsy tr daflnt!e o!lologlo basls (:qnnor bd €sLdrtsh€d 

froh the sp€ctren slon6. In . lov in6taocos the cauE.- 

ttvo agenL nly be d@.atrated by etltn or cultur€. 

The dotecilon ol a tub€.cql* pr@css oey aerve to 

tntttate p€rtlnetrt cllntcsl teata that l€ad to ctarl- 

Ult!.souod c.s detect sub.trspblrg!.tlc abscsss 

sccu..tely. Ho*eve!, llv€r acan m.y otas lt. Tbe 

cmblD€d llv€r-l[oa sc.n proe1.l66. better dlaglo€ta 

rc ln c.so No. la. 

Esrly chol€cyslecl-ooy ls smellmoc !€clJ|mnded 

lo. pattents *tth ac[t€ cholecystltls (Ll.den .nd 

sunzel,l9?0), Rapid, 16ll.ble.nd aafe d1.gno61a la 

DAndatory {h€n acute cbol6cystlilE le suapacied. O.l1

353 

chorocy6tosrapby 1s a hlshlv cccutato lnveatlg'tlon 

tor !h€ dl.gnos1s ot gsll bledd€r diaeaa6' It 1a nor€ 

reltrble, st.ndatdlred .nd tochoicallv €aav. Itorevar' 

rrlse norMt exMinsrlons do occuf. Th€ proso.c€ ot 

jrundrce, nlusaa, vmiling Elv prccludd oral cholecve- 

!oar4phy. GsrrIn6ic c4uso6 ot non{p.clllcrl'Ion tnclude 

inlerference ivlrh lhe trunster ot co'rltrsl nodlum 

to Lhe snrll intosilro 6uch s5 i[teailnal ob€lructlotrr 

v6lttn*; Dllabsolptlon, tlv€r dise.ae ind chorocystolojunostdy. 

tltlioslc csuses includc obatructiotr ot 

tb€ cysllc duct .od cltroolc cholecvaittla lnl'rv€noua 

chol.nglogr&phy, .od inatr€to! ttugrapbv ol tb€ aatl 

bl4.ldor have prov6d to b€ lnteltable(ltar.lngton €t rl.l 

to8oi sh€ma! et sl., I080). rn prcgnonl prtlont6 a.d 

the pstlent6 allorSlc Io conila6t nedia, th6B6 tocbrrquos 

9e oot s!1isbl6 (c.6pe. et il.r 19?3). Tb€r€lore 

gray scsle ultrGonogr.phy of galr bradd€r.nd Te-IDA 

srrtrnirs f,rd l,o.d ltrg ftrrc lnd 'mrd 

po|lqlnr (litrpplr&o 

!nd S!nd(!fs' 1930i llcDdlcr, r9?9i ldiasnantr cl !r.' 

19?ai Par€ et al., 19?3i {e1ssm.nn ot ar,' r0791 

crode 1979; Leopold 6! .1.,19?6i B.!truo €t al., l9?61 

llsrlrw et rl., 19??i C..rollr 1973). th€3o no, t€cholquenou 

ptay &! topqttsAt tols !s alterntttvaa o! 

suppleoeots to p!6vlously €siablished radloloSlc.l

3s9 

In tho as€esedent o! acute clplocvstltta tha 

ostn slrerglh ot aonogr.Pby ia tcg sbllltv to 1o196 

gsll brodder psthorogy da.€ctlv. l@alns o, rho s.lr 

blidder rsll thlctq€€s or sonoluc6ncv Ia bolplur 

(r&!cb.r et rl., l9?8i l.trrtl€r, rg?e). G.a t. th€ a.rr 

bladd€. rsll, stz€ ot aiir bl.d.l€r, p€.lcbor6cvattc 

.bscoss $d 3.ll bhdde! !€od3!n€.€ .ro .rl h€lDlur 

tor tbe dtsgno€ls. The s!r€, poaltto. .od n@ber ol 

sroncs cutr rlso Do Judgod. xo*ovcr, ttndi.S ol slonc6 

ts noL sDecttlc rof rculc cbolccrarll,la. lhla rg lrao 

poesiblo Lhrl asll sroma ca. h€ roled colnoldenrlv r. 

s Dsllenl rtlh a non-g.ll bl.dder c!!ae of ocule rlght 

upper qusdr.nt !.!n. TbIs can lead to i.!ae Dosltlv€ 

drssnosls oi .cut6 cbol€cyerttis by uttftsou.d. Hoe6v6r, - 

beplttc leslons'P€.Ih€Prtlc spacoar re.ar .nd pAncr€rlic 

leslons c.n slso b6 dolect€d by tt. Thue tt praya 

in inpoltrnl rol€ !b galt lrladde! dta€aao Md lL 13 

the Inltlal study ln p.t!€nt rltb tiaht upp€r qu6.!.ant 

poln, Jaundlco or . !!lp!bl€ .lght upnrir qurdr.nf o..a 

(llublltz €t st.,ls?2r t.bllskv 6t .1.' l9?5r l€oPold 

end skorolf, r9?3; tuDplooan lnd sondorE, !9?8; c.ad€ 

et 61., lo?8t lrno. snd Rot€nqulat !9?61 La{son' 10??t 

/tnd.rson rnd llrrnod, lC??i Ctu*.1 rl.,l0?{i: ztnl ot

i{!.1I 

360 

al., l9t?; La*6o!, l9??). Sonograpby of gall bl.dde! 

hrs got !ol!ltvely lo* prodicrivo vutuo ol trogalivd 

sirll bladdi,r soDosr.n. thlc rs oritrly duc ro dtlllculrles 

ln dere.rtnF cnatl aion€s of dltferontt.ilna 

sall stonea tr@.bille.t aludgo. 

Ntth.!.lescltrtlgldphy ono c.n ovaluat€ tho 

Duretrcy oI Lhe cyatlc duct vith ! voly htgh scnsltivlty 

lnd apeclficlty. Th€ u6e ol nucle.r inaglng io 6etrbrish 

tbe pre€otrco or absenc€ ol cystic ducl pstetrcy 

ls on rise and ,irr plobauly con€tlrute sn €ver lEct6r- 

€iog perc€ntaa€ ol tho crs€ lo&d ln truclaar n€dlcln€ 

departne.ts (vistov €i al,, 197?; flato* .nd cro€a, 

l0?9i ||on.i, l9??i'tlator e! al., ltToi taopord €t 

qr., 19?6i v16toe €t rl.! l97a; Psulela €t !l.,lg?ar 

no6onthal et dl., 1973). 

Ancill.ry findlnga My be noted. lo p.ri6ntF 

tlth aev6.e grll blrddar lnfla@al,Io!, tbe t.ll bladdet 

wrll woul.l bo iodgod rluring Ltro llo* porlror ol 

choloscintigrapllyi r-b1d llnding coupled vit-h .ontnaglng 

of gall bladder Epresent6 aev€le i[fl.matlon 

of ihe gatl bladde. ( A.rb ot .1., 1932). s@€tl@a 

lL uly glve clue lo non-chol.cysllc crusos ol .lgbt 

upp6r quadront paln (l|els6nson et .1., 1030). The ooet 

fr.qqent findlng of rhts l-ype ls tocrl rrcac ol

361 

decre.sed bepstic uptake c.ua€d bv h€D.ilc abscasa 

o. wldening o! th€ dudd€tral av,€6p i! pBncr6at1tls. 

Tb6 lnDactto. of tho slotr€ 1n lcute chol€cystis 

ey be teopor..y .nd r.y D. reuovod €lo.taoooualt 

*hlle lbe Bcut. Intl.matory procoas orco lolttrtedl 

cotrtlnu€B to plogr€ss shlch nsy g1!6 l&lae nagativo 

resulis otr chole sct.tlsrspby(Bcbevarfld ard Gl6.€o!, 

1O3o). ctrol€ sclntlSlsphy la l6aa t€chnlcrllv dep.!_ 

denr in oxcludlDg th6 di&gnoal€ ot acule chol€cyatltls 

(Irovn er at., re?g). 

rlrlh !!srs uro oxc€ll€nl snd ctlosld be ua€d 

trhld! ever 1s @st sftective 1n s paltloula! clhtc.l 

setl,tag. l'hl€ cholco degolde upon s6v6r!l t.cto.a 

Qqarlty o! oqqiDoonl- svallcbl€ lor 

!€rlor0rng th. 

Capsbil lty ol ioclrnoloSlsta. 

n€lstrvo €xp€rtenoo ol physrclan€ EUDErvt6!.a 

tbs studles 6nd vllllog!€aa ot 

abe €urslcat cotraultsta to receDt 

9ostrlvo exMt16lrotr, 

fc-IDA dludlea do not dllectlv lnage aton€a, 

*lrtch lra Lhe Drjo. cou6o of {cure cholocrstitia. Tlr15 

problen ts vlewed os a s€rlou. deficl€ncy by o.ny 

Eusoons vlp pr€J€r lhe posltlvo soto8rsphtc d€tronatrer

:t0 2 

of gall stono6 !o tl!€ nogetive crite!:ion 6f nonfilli.g 

oI tho gsll bl.ddor 10 confilDlnS Llre dlAaooala' 

ll rlrc rcf.'rrlnS surAoon fc.ls it ncc'asArv ro domnsirrt(: 

gnll slon.s €onocttrnhic.llv befo'6 ennrsencv 

sur8e.y, tllen lt ok€s lirtre sense to use chole 

scinLlgrlplly as !h. lrlDulv s!rcsuing [odrliLv' tlovcv'f, 

cyslic duct sLotres sro sdellea dilJicult Lo detect 

on ultresound (Latns anq JPIr.ev' t933). 

Sonography and sclntlg!.phv {betr comblnod 

tosethor give rOOt ressrts ltr th€ detecitotr ot Bcute 

chol€.y€tItls (susrez et al., le80). 

t"99t- Ioe i. llso usetul in tho dlignoslE ot 

lcslculous chol€eystttls (l|eisso... €t ar.' 1939)' Ib€ 

or4l cholecystography ts aup€rlo! to ult"sodnd 1n 

ac.lculous chol6cystti16 sd choleaterolosis My be 

niasod by both pro€edurae. 

rn lIc dtAsnosls or catcttrm! or glll baa'ldor 

rndi('*rnphy nlttrrJ doos nor .Fl{bltslr lh. d'{gi'}s's' 

0lLfa souod t)luys a vo.v imporuanL role tn such a 

condillotr (!ch, l9?9i Crqde ot at.r lll?9; Olkon €t 

ul., l9?ai lolll et dl,, ro?9i Dllla P.ld! er ar.' 

l,ercutnneoue uli.asound glided puncturo oi 

tho glll bladd€r cao be do.e lor dlagnostlc and

t0l 

t!€rrpautlc tndlc.tlont (PhlllID. €t al.' loat). 

Chorad*b.t cytt ..d ;toll'. dl.€rs ts 

.|l.t!osd by botb ultt.lould .!.1 cbols6ctutrarlDlv 

(au..ell, €t .1., l0?!r a.aa €t .1., ll?it xorlr! .t 

ar., l0?r). oltrrroon.l dlapl.r. tho rp.to.rc.l 

Btrrctus.. tbtl6 ro99'- tol rtor" tle tuctlolrl 

re!.ct (Dlpl€tro .!d lryror, lt80). 

8o lt is coocluded tb.t 

.ccur.cy 1oc!.3aor rh.n Dotb .r.

AOITAAY

fhls cllrtc5l study sls undcrtrken to fln'l 

ou! an lnvesrlsation pl.n for p'iienls sllovlns slgos 

and synptds of hoDa-toblli&rv dvsfutrction- ls Lltts 

6cp€ct ha6 no! beon Etudled ln det&Il bv anv 16s€!rch 

*ork6f 10 ihls countrt so far' thie Btudv r's undort'ksn 

ro €valuate the ne{ dlsgtrostlc proc€dure€ rn our oe! 

clrcunstrnces and llnltalloos. 

the studv ts bcsed on the an&rtsl6 oi clinlorl 

lhd laboratory da[r and result€ of aooogt'ptv' scrntraraphy 

lnd tiver btopsv pe.tll;ira to 100 patlents vho 

€lg!6 snd svnDtoos o! liv€r &trd gall 

proBenled {lth 

bladder dis6.ses. Detatls of the6€ ih.qo lnvestlgations 

vlrh revrev ot lltorrlur€ ate de6crlbed' 

Par! I ls divtded inl,o diffetoni cnaplo's' 

Bfief descrlption ol rel€vant .natonv, eobryorosv a!'l 

.ongenrtal a nilr€s ot llve! .trd g.ll bl'dder rs glv€D 

tn .ne tl.s! ch.Dter. Cbspter II hrs been d€toied to 

lhe blstorical becl-glound, plltrctples 4od phvalcE ol 

ult.isoundr oD€r.tlon ot ultnaolDd ar€t€!' rndtr@'_ 

tstlon atrd btologlc et!6cts ot ulirisound' Pr€p$attor 

ol th€ pati6nt and coaduct- oI Lhe exloinrlion for 

ultrsgound 16 descrtbed. ln Cheptd! ltl aonogtspnrc

365 

ao.imy oa llve! Is givon. Sooogr'phlc ch Actettstlca 

in !.rloos .c{ts .!d chronic, toc'l and dlfluse' coneanlLrl 

and lcqutr€d, b€nrgb snd neoplrsttc llv6' 

disordors .ro d€scribod tod s revtov of lti€laturo ts 

giv6n. 

chrDro. IV slortc ri!h Lhe sonog'ephrc lnaLdv 

ol gsll blsdder. conduci ol tbe €xminrtton rnd €onogfaphrc 

sPpslrslce of 3Brr blrdder ln dlll€rant 

dlse.sss 13 deacrtbed' 

chtpter v-Dl6totlc.l b.ctglound o! llve! bropay 

is briefly @ntlonod. lrdlc.tlonc, oontta-lndlc'tlo'4, 

rod codplicstiols of river Diopsv !!o describod' 

D6sc.lpLlon of dlfferdtrt neodlos and dtlieront natllode 

u6ed lo. p€rcutsd.ous ltve. blopsv l€ gtv6o' pr€c'u_ 

tion6 aod pr€paratlor ol lho patloni botor€ tbo 9roce_ 

dure rf6 slveo. A descriptionot rbo proc€dur€ aDd 

prtlent's .fte. csre i. givs! l! tho erd. 

chaDl,ef-vI llt6tory ol b€pnto-bill!ry 6.rnt1- 

glspby ls glv€n. ln€1lurencatlon a.d varloqs ladloph_ 

aro.oeullcsl sa€nta lced lor thic pqrpoge are .oa- 

.flbL,d. l\'el)nrnl lon ot lh.r n ll.nr rtrd d.lnlls obout 

thc pro.edure !!6 grvetr. lppoBrlnco of D6rml llvof 

with no.Ml valistrtE !!d alttlrcts t6 deEcrlbed' 

Scln!rsrrDhic appcs.tnco of llvct ln dilrcrcnr draorsoa

chuplot Vll: ahrc chlpl-or is for choloscirtlarsphy. 

DlftoreDt radlophsrnaceutlc'ls us€d lor 1t' 

p.ep.raiio. ol ib6 p.iletri !.d procod!'Q tB dssctlbed' 

Th€ sppearance ot nolhll gsll blodder a'd tn dille!€'t 

dl6€.Ees r3 glv€o. 

Prrt II - Cb.pt€. vlII co.slsts ol 'tudt 

ot 

100 cas6s. Dtscussion ..d cooclu'lo!6 tre tncluded 

ln th16 psrt, Iaterlsl snd nethodB used ttr tbe pr€aont 

study uo d€scrlbed. a descttptlon lot e'ch llveatlgratlon 

Is glven s€ptt.telv. D€t.116 ol nlstorv t'kln3 

!trd critri(itrl oxlnlno(lon rr. gtv'xr' Comploilj {:linlcol 

lnd llbonl-ory d!!! oL loo Dr!lcn!s is glvln' llosulL! 

ol scinllglsPly, sonognpbv r..l Ilver bioPsv lo 100 

pdilents a!6 glven ltr a tsbulet€d tord to ahoe nov 

tlrese dlsgnostic lechniques c@pre@ot 6r aubetitut6 

esch otber iD drlleEnt ctinacsl setthga op€fatro! 

no!€s and po6t oparativs biopsv leDoft-a ir6 includod 

tor conDl.te an.lysl. of the c.s€. In tbd 6nd resulta 

lnd ubservdl roos ol tlre 5lndv lro grvcn_ 

cbopt€! Ix, oonsldeltng the reEulla ol the 

present study ald tho rosults ol €tudl6€ corduct€'t 

lr otb€I p.rts ol ih€ rotld, a dtscu6ston 1a slve!' 

so sn evstu.tion o! .ol.tive .od absolqlo 'ensiilvltv

36? 

lod sDcctli€lly flgues ls dond to 

t€cbnlque should b6 ptofsrred !n 

silu4!ion. ln rhe aod conclusrons

coNcLUSloNs

,rl,.i!r 

363 

col{c LUSro!! 

tl 

,i 

llcr)drobll lo.v 6vsroft 

rrny disrrrlr fondil [[s, ri 

'l.h.ae l)ul-lotrla ua{a! 

t3 frcqqenll v lnvolved ln 

Ilr! r t,rin'nrrlv "r rralnllnrllv' 

ly prosont viLh a vrrrcrY 

ot stgtrs and stopt@. 

Th€ p.!!e!ts bolong to rll g'oups' rr! 

'8p 

50cl.l cl.sses.od both s€x6s tr€ 'lf€cta'l' 

Esrrv di.aoosls is lor prop6r d'r_ 

'ec€tssry 

ae@nc .nd to reduco botlr rrbidltv rod @rt&lttv 'at6a' 

cl1.lc.l d.te .nd routl!€ l'borltorv inveatlSations 

otien isal to ovalurle l'he p'LionL c@ptctely' 

fbe @16 €ophlsttc't€d lovestlgstloE ahould 

be q6ed rlth turt lod€retlnruna ol t!6lr lndlcrtto'a' 

cont!!-tndlcttons! .dvsntsge€' dlstdlant4ss' c@pr1_ 

clttons dnd PIt a.llt. 

non-I!toslve lechntquec should b€ protette6' 

thc lDvostlaa!1o' plrn 6hould lto sllrtod 'lth 

le5c esDencivc 5nd leld !I@ conaulrina Loctrtrrquo' 

'lhough [he r[dlsLlon dxpocrro rs accct'ruDr€ 

as s sm4ll rl6t uhetr comp'!6d to tlt6 bon€flra ot 

lnrorrndrlon obltlnod ncvor!holoss' the 6msller th€ 

oxPosur€ tbo bettor tt 1s' 

sonsttlvl!y and €Doclllcllv of orcl! teclnrqq6

j #.ii i,. . 

. 

300 

nusl be ktro*n for erch can[.e lnd opcrslor' 

Ultrqsolnd €srdinallo. sboold boi be r€quoateq 

It the expertise !s ln6ulflcaeot' vltlabro or rnretllblc, 

or .hd tnslru@nt t. not statrdltdt'od' 

lhen tbe r€qu€st aot 60@ tlv€stlslLto' r' 

mAde, the clinical Frobl€n should be oxplatrod ard 

lhe rosulis of otbof t€chntques €hould be 3v8tl'b16 

!r ltro t-irrc of dxadln!!lon. 

The copl€@rt.rv o! substitulion 'ole 

ot €Fch 

lov€stigctton shootd bc tn4o to 'vord 

duDrlq'rlon ol 

fosulls, rastlge ot tts ood @nev aod utrnccosaarv 

dlscdtort to t-he paironls. 

Considerlna th6s6 fets 6 copallBon ot convootlooal 

.a.lios.aphlc Procsdu!os, sonogreDhv' a'1nt1- 

gruphy rnd livor biopcy ia givon

' , i;ld: 

370 

corPARtsol oF 

DtTfBBENT DIACIOS!!! 

ISUEq 

I 

dltlioull dtfftcut L 

Possible Dttfloul 

Dttllcult Dltllcult 

Iod€rrte tr.D6ods 

tb€ o€tl 

[!ah 

cunrr!lndic!1. ions 

Inny 

loder.to

iliijiii1,,,, 

3?l 

Data coll€ctod lrom lhe sludv ot 100 plttenta 

rrJorrty oi tbea6 Datlenta preseoted urth 

Jaundlca or D.lo tlght hvpochondlluo ard tho 

atnsl dlrgnoBts was quite ditlarent h 

Ultrssound essnlnctlon codtd be perlolDs.l 

ln a1l th6 r0o Datlelt6 &s 

coni r.t bdtcst 1o. . 

3. 

Llvor sc.nnatrg e.a dore 1! ?3 pstleota 

lnd llDA scan.lng lo 55 patteot6. It ls 

bottof 1l th€so trv€stigttloDs .ro .volderl 

in Dreao4ncy, 

For llvcr blopay eo htvc ro tlkc d.tlg,or 

sftea b.I.trctn8 lta €xpect€d advlntsges 

snd potsqtlal haz.!ds. Io eacb case tt 

ws6 don€ .ft6! aooographv and aelnttSraphy. 

Llvor s.ennlng ta ch6 b6st scleening 

lnv€silgatlon sa under its guldanc€ ultr._ 

sound could bs don€ oaslrr.nd in lega tloe' 

Ultr.€ou.d .ft€r llv6r 6ca! va6 don€ tor 

(l) To collect addlLtonil l!- 

torelro! .bou! l,hs .alure of Lhe .b.orqltty.e6n 

on th€ actltlgru (2) To 

evslu.t€ turtbar tbo p.!ients rilh stfooa 

susplclon ot h€p.ttc l€sloos and r€gatlv€ 

or equivocll radlonucllda scan. 

In Jrutrdlco'.| pr!lonrc ulrruaound €xantna-

{ 

312 

tton {.B th6 llrgt lnvsstlgatlon to be 

10. 

'fho rtndttrg! oa llvor d.!n bEd lo lto eva_ 

l(rl,.d by ullr{H,trlrd. ThcHr' trl'n(! urrc 

nor tsullicleoi for doftrlte dlotlndsis. 

ul!r.sdur.l €x.Dltr.tioo plovlded ebuldaot 

lnfor@!Ioo .boul livet psro.chv.at bil6 

ductsr porL.l .od h6paLr( vatns. rn clse 

of g.lr brodde! it ptovlded lnlorMtlo! 

.bou! the etz€, €lie, contetrte and r&ll 

The .nclllary tlndttrg6 provlded bv urtr.- 

sou.d r.duc6d tbe lo.g llat ol drtlo.6t_ 

tlst dltgnoal. cotrald6r.blv .D.l in @!v 

lnst.Dc€s tatet ult!sso{!d €xutnatton 

{e stoDDod rEvoaltArtln8 l,hs cqse fuftbe'. 

Betols llver btop6v ih€ c6a6 had to be 

rnv€stta6t6d'tully *htcb t@t Mnv d.vs 

and 1l th€ bropsy uor6 to be r€p6.ted tlt€ 

rxv,jsrlstrl'un.trel rtlnxt.al. sur'lr n lrrn* 

pcrtod vird vory dl4lro€ding Jor rlto patlent 

xnd Lof lho nll-otrdrnlts trnd q4s laso.:ldrod 

*lth .rl the hazards ol l&to dl4gnos1s. 

12. No melo! compllcstlolB ol liv€r blop€v 

r€ro o6t in the atudy. 

consldering th6s€ itots I hav€ trled to cbalk 

out a llov cha.t vh{ch vlll hsrp in the eork up of 

putient€ vllh hcpnto-bllld!v dvslunctlon '

t, 

fi 

i{$},iil' 

1.. 

I 

;, 

3?l 

.rl 

! 

i 

grn^TEOv tol ISPAIOAILIAIY DlgoaDaBa 

Alt€t cogloto bt.tolv .!d cllnlc'l €x'_ 

.lnrtton rcutln€ l.borrtotv t€sts .bould be p6llorftd' 

!!v.r tunottoo t..ti sbould b. dolo rD€! D€c6a'att' 

tho lurtbor trv€lits.atong .t. do!. ';@rdln3 

to tbe 

provlslon.l dt.g.ml.t 

il 

: 

d! 

c 

D- 

It lhcrs ls otnly ltvof prcbl€o. 

rl brlnl, 8.lt lrl.drrot Plthologv !a auaF6't€d' 

tt iho trvolve.t of both a.ll bt.dd3! .nd 

Itve! la eu6P6ct6d. 

U!d.ctd€d! 

c) obatluctlvo J.u.dlce 

b) IEs rlSht hY!@bo[drtuo 

rttbout lru.dlc.. 

c) Po.t cbolocy.l.atoY 

.l

,:+-Tlr,1, 

37!l 

croup A 

LtvEq DrsB 

^sas 

t,.P.T. 

lhri !h€ dl6o.dor l. 

{;;---;,. 

I 

I 

I 

r"'1r.. 

"oJ.r.",o.'."0" 

chlo;lc 

*-t *"" ."-u" J- 

u.gl'-ro.tron ur.""""u{o 

Bxd1.at10. 

I 

Llvor blop.t 

Itfisound Ex@Itretlon 

Il rnaotlrrrnote 

I 

l.r.s8od 

Loc@yt. 3c.n 

t'Llvsr-runs 8c0r 

Lt,lvsr-\id.oy 

c$lhI.r sc.n 

aos! 

r,rvoJr,r.pev

3?5 

GALI. A'IDDAR DISEASA 

AcuLo- ClrolucYat It Ia 

".rJ 

r-.., .oo*. 

cbore{crntrs!opby 

u,,.J_.u 

c[ronlc cbotecysrlLis 

I 

I 

o'rer 

I 

ul !r.aou.d 

I 

irthJut ccx 

6x.!l!.tlor 

I 

cf,or€sc!ntlsrrDht 

rrih' c!{ 

I 

I 

c.oup c 

LTVAR IND G .B. DISEAAB 

L.1.T. 

I 

Ut 

",,",f", ', ,.'"rt 

I

t78 

obstr[ctlvo J.un.llc€ 

Pos! chol6cY.ie.tonY P!l1enL 

I 

4igt 

I 

t" 

I 

el 

t 

I 

l"o 

(lD sll tb..6 gfougs It tb€".ta pragoalcv or 

retr.l t.llur€ &trogr.Phv ls tn€ ltrsi 

i.vostlaatlon to b6 do|!6). 

In th€ €nd It !B conclud€d th't the lapl'l 

technologldsl .dv.oc€rents! Itcf€aetia sxp'r16nc€ bv 

l!.ger nlnb€r ot lnv€sct8.to!. lnd carolullv planb€d 

prospectlv. studles wtll h€u It f€-€valuaLlon ol tb6 

.clatlv€ utll lly snd dr.gnosrlc accPrecv dr thode 

I

BloLtocnlPllY

'rtri:li 

374 

BIBLTOG&PfiY 

I r. ABDr' r., rrll l' Jrc'r rEzEYr E'(19?e)r 

s@pllna v"!abtlity on p€rcutaoeoue tlver 

bloPeY' Alch Int6tn xed' 130' 680' 

2. ABDULLI, V., carp08Ll' s.' DsfllullsT' c'J ' 

TALBGRT' 

D.,LUCAS, ll., I IIULLARf,BY' X.(19?l): 

Eilect ol drrglosrlc ult!'souod on Mtetnal 

cnd iot.l chro@els6 

L&oc€o | 2' 329 -831 ' 

3. A CltAViL, A., TAUX!! f.N., & GAIBILL' 8.8'(1065): 

litrYo Ciin Proc', 40' 205' 

,!. llrNao-LEJ, F., REVE&' v.9., t PESSACNO, D J'(19s9): 

coiaenrtal choredoctrel cyat' 

tntorbattotrrl sbstlact€ ot sqrae'v' r08' l-30' 

5. ANDERSON, J.C., IL{RNAD, 0.K.(19??): 

Gr.v sc.le ult..sonog!.Dhy ot th6 a'lr bl'ddor: 

an ovsluatlon ol .ccuracv and report of 

sdditto!.I ultraeouBd a18sa' 

AJll l2g:9?5-0??. 

6. aNsARI, A.N., ATKIltg, u.L., LI|IBRECIIT' A.rl.r et a1'(rt?4) 

tl23_toao.v"nin. green, as " 

agont tor 

dvndlc studles ot tho hoprtoblll'rv 6vatd' 

Itr Dvnstc studtcs *lth radtoi6otopea tn 

tlutr re I ou. 

Vol.!. Xnoxvllret Tennesso€ IIEA Julv' 111-123

3?9 

1, AR|{ON, S,, ROSENQUTSl, C.J. ( 19?6) 

Gray scal€ ctrolecyatoaoboarrphy: .. 

6valurilon ot accu.rcy. 

AJA !2?:8? l-381. 

AIXTNS, lr.L., HAUSBB, f., RtCfifitD (1968): 

Itsducrlon ot roaDlr.lory artltect€ 

sclntillAtlon sc.o.hs. 

l! J Roontgotr. roa:68r-635, 

A1'l IYEIlt F.P., XC S{EEIiAY, J,r FOFTNaR, J.G.( r076): 

llarmtril lq conpllcrrlng .o6dl6 llv6! 

ardlology. lta:55e-56o. 

l0 

ll 

lrzr|ltr, F., xARANoota, J.P., BRttN, P.J.(r9??)t 

Ultrsound evaluatlon ol tho notr-vl6ua- 

Itred gill blldrter. 

Gaat.ol.ro€i A&dlol, r:193-200 

BACCEXIt)SS, A.8., SOrarAy, n.D., SUI|E&SIILL, I.B.J. 

EIVBSACI; L.R., I SHOa FISLD, L.J.(tS?2): 

Chronlc acllv€ llv€r dtsaae€, Tbe !.n86 

ot hlstologtc toslo.s,tb€lr reslonao to 

tr€.t@nt .Dd ev.lu.tlo!, 

lllmo Patbolosy, 3r !83-!98. 

llAGl.DY(, C.LJr., Rm!, J.4., Tltollas, L.4., ot rr.(19?: 

Llv€r bloDsy tD UodSxln's dls€lso. Cllolcorrola!ions 

1n 13? patlonts. 

r:opathologlr, 

Ann. Int6rn.

,illil,ii r 

330 

oIRD, r.I., EOGocll, A.r a FETIICE, J.B.(r050)! 

Liv€r btopsY ln s.rcoidosls, 

C.oad. |led Asa. 6a!55X. 

BAKERI T'L' ' 

DALTYTPLE, G.V.(1078)I 

Dlologlcdl eta6ota o! dlagtostic ult!.- 

soqn! . A rsv16ry. 

Badloloay. 126:197_433. 

BALL. 1.J., rUTCIil{lCX, r.C., mNEEt O.X. ot.l.(19t5): 

Uemb!lla tollorrns percqt&eous llv€r 

D!opay. 

Gsd!16.lsrotogY. 5ar 129?-r299. 

AsDlrrclo! ro! Iemvsl or biopsv ort6r1.l 

lroo Lhd llvdr 

Arch Inl, Iod,62r2?6. 

17. 

ta, 

BARnY, $., SSERIOCT(, S.(197r)! 

x6.suremnl, oi live! iron conc€trtr.tior 

in roedlts biolsY apecitretrs. 

L.ocat. l, 100-r03 ' 

BARTIUII R.J., COOI, ,C., idvt8r s.&.(1s??): 

Uttrssotrrc 4n.l lsdlographic cholecyatog.aphv 

N Eng J l€rl. 206: 534-541. 

lrAATttut' n.J. Jr., CBOIr tl.C',ioofa' S.B.(ll?a)l 

crrorr! dlsoaso : A! ultrlsonic dl.gooa!.. 

at J Rodtol. 50:343-369.

l8r 

20. BAITAIIIA' p'S', Lc@ l (' t"J" BRo{ll' c'U'(1960): 

lleedl€ btopsv o! rhc rive! i! oalistrrnt 

hepattc 'llaorae' 

am J Gsstro6nt€foI 34:39?-401' 

. 21. BAU!, S.' sILVB&' 1"', vouculD8s; D'C:(1966): 

' 

J An I6d aBs 6?5' 

.l9?' 

' 

ll " 

22. BUEANT l|.' KAZAr' l (19?a): 

sonogrsphy ol the c@@n blre duct Value 

' ot tbo rlght obllque vler' 

'nterlor 

lD J io€ntaenol' 130:?0r-?09 ' 

2!. BILIrIGEE' r'A r BAACtlAtp', J l'' llElrzsc tAxr B'R'(19?5): 

c'rrr@ uPtes€ ltr bdnlgn tu@ut ot the 

lrr, 

rivor' cddo llcPorl' 

J l{ucl lod 16:4?0_4?1' 

gENJAr,rN, r.s.' t RlE' c ll" BLUTGART' L g'(19??)! 

"tv€! btopsy in drltrcurt laundlce' 

Bt l|ed J' 2: 5?3' 

25. BERNAiDINO, I.E.I I GREE 

' B'(T'?9): 

tllirsso'ogtrpbtc 6vtlu'tlo! ol che@th'!'- 

Deutlc f'sDons€ t! b€prtlc @t'ats€a' 

Radlolog,' 133 r'13?_'4r ' 

26, BEnSTT E, R.L. (1960)! 

J sct€tv studl€s rtth ultrdsootc DopPlo! f€clrllc 

a cllnlcal tolros up ot Dttl€nt6 and ttsBu' 

obst€t GYnscoI. 34t lo7'1og 

I

34, 

Br|,l,llrc, !.11., @xro , ll.J. ' 

lMt{, D.B" I acllrfl' 

L. (1053)! 

,tlro vrtuo or uoo'llo l'iolNv itr llto cltorrcrr 

os!tB!loo ol llvor llplda 1' mn' 

J Cll. lrvoal.3lr214. 

2A. DJOR EDOE, 1., lvEuta ' 

P.' (EIDIIC' R (1949): 

rb6 rlpbrt.rc6 ot llvet blo|,sv tn drtt€ronttar 

dt.anosts esDsct'lrv lD co!!'ctlo! 

ritb olor.tro.. 

rcta I€d gca[. !35!303_30? ' 

29. 

30. 

0l,Ani, c. ( 1969) ! 

Iophr.ctdv loll4lDg llvor broDav' 

lD J Dtg Dts. 14, 

'15-147 

' 

@LIC8, E.n., Tvaor, I 

'8. ( t9?l) ! 

P.!.. !o.!trv€ rtv€t tDat du€ to 

locrrls€.| b6P.trc 1d3t.f . 

R.dlolosY. l0O: !10_!ao. 

31. @rD8it, L., r *RI|VITZ, a.(1951)l 

xoodlo bto9dv ol tlp llvorr ! dlrgnoa!lo 

.Id lo rbo lrerl*lr ol crbcer ' 

c.ncet. 6: l0lo. 

!ov!, p,, DcolrvatR, t'n., I SPAalNgllll' l'(1t63)! 

l.tr.h6p.tIc ll!hl.€Ia' 

G.qtr@otorology, at: l!!-25t ' 

33. 

( 1935 ): 

rphryard csp' rn cborocvatolr'Dbv' 

Itoenr Ac.ol 33r 58t_eor.

383 

BnaDxAN, J.r., CoAKLEY, r.T.r COULD' R ('(19?4): 

ttlmn lvrDboovto chrmosones an't qltrasorlc 

csvrtatlon ( lett€!). 

Br J. Rsdlol. 4t!158-161' 

35. BMUNSTBIN, B. ( 1956) t 

ri€€dre bt6Psv ol tho tlv€r io c1!rho51't 

dr4tro€ttc €!tlct€lcv rs d€tolotned bv 

posiooltd qrtpltlB' 

a r l Arcb. Prth. 6s:!?' 1056' 

3ri. 

B&A|EA. r.X., ausTlNr 6.8.t t8lrll' x.L' (ls3o): 

aoc.l t.ttv ch..g6 oa tb€ llv€" s bitl!€rto 

goorly r€cognizod €ol1lv. 

O.st.oelt€.oloay. 7 a | 241 -152' 

3? 

33 

39. 

40. 

Bnocf,, !,D., PEACOCX' 1.J., OaABD, C.B" 6t '1'(19?3)' 

ult!.sound.!d cbro@a@6 Bb6rtst l00s ' 

!.d J lus. 21 533-598' 

BRODERIC(, r.ll. I GOSTNKT 

achog!.Ehlc and 

n6paroo!. 

BsdloloaY. 135: 

a., xaNUCx, L.r €t.r.(1930): 

fsdlobucltd€ dstectlon ot 

lar-151. 

BROtiN, c,Y., & aALABT 0.C.(1012)t 

F.tsr blle €obolIstr follovlna rlv€r blopev' 

lDo ht 16.1. 33: ll20' 

BROTN, D,l.(r0?2): 

c@btn€d llver - lung rrdio'6otope sca' tE 

lho .lr.anosta ot lubdlrphrsspltrc lbscosa' 

seolo tlucl l€d. 2, ItO-150;

384 

r tof, n.H. (l0?5): 

D15g.ost1. ultrsound ..d llv€r diseaa6' 

seDln no€.taenol. l0 ! 223_228' 

42, 

a3 

BRYAN, p.J,, DIN!, f.t.r cRoSsxaN' 2.D., ot ar'(19??)! : 

corrol.ttor ol cqnput€d t@arepbv arev I 

scat€ qlttssoaoa!.pbv' !.dlqnucllde 1o'81n9 

ot th€ ltv€r tn d6tecttng sFace oc'upvlla 

procea€sa. 

Bsdtoloay, lltl: 38?_391. 

BUCKIOi, f,.E., r arxBR, n.v. (tr?2): 

Al lDvostlgrtlo! rltb Do.slbr€ cD!o€@ 

d.!.31.4 o!!6ct ot ultr.erD't d h|Ar bt@d 

Br J R.dlol' 45! 340-342. 

BURAGGI, G.L., LAURINI' R.' NADAAT 

' 

A.' €t.I.(1976)I 

Doublo t!.c€r scl.ttar.pnv ertb ;d6?-ort!'t€ 

and T.99m-sc ln tho dl&gnosis ot heptl'lc 

J Nucl lod. l?! 369_3?3. 

t5 

lluncl^lrlur l.! t ll^srusslr, s.N.(ltJ?4). 

lo.allsttiotr ol th€ porta b€p.tis bv ultr'- 

solic sc..nlna pilo. to pelcutsneous ti'!6- 

hep.ttc portog.rpbt. 

Br J R.dlologv, {?t 5e8_502. 

BURDTNE, J.A., l8tLL, C.a. ( r96? ): 

n.dloroSY' 00, 113r.

385 

47. 

CaLKIIS, 5., CIUBNr A. S. ( 1960 ): 

DlaaDosls ot aoY1otdo61a. 

Bull Rb6s Dla. 10!215_213 

48 ctiol,r, J. r @ncos, v. (1964)! 

La dtlrt.tion co!3€lttslo des vors6 blllet€a 

lntrsh€pdtlque6. 

tlevldw I€dIco.ttllugto *alsdes l'old. 30' l-2' 

49. 

50. 

cAiolt, J., souPAUi,T, n., {OS8Al(OtSl(r, J.' PLOCI(ER 

L. & PRADOISf,A, l.(19t8)l 

In dll.t.tlo! tDlvkystlqse corgonit.l€ da 

voi€s QrIl.r6a lntr.b6prt ique6. 

Essrl de cl.s.ltrcrtlo.. seol! .s lloapli.ll 

Parls, lar a86-495. 

cAROt,r, J. ( r963): 

Dise46os ol lnLlrhoPll,lc liile duotc. 

lsraer Jorilnrl of lodtcar Science6, atll-95' 

caRol-r , J,(1973)l 

Di6€.s€d ot th€ tntr.hep.tic t,rltary tt6€. 

c1t.tc tD cstlo.nto.ologtr ,: l'rr_161' 

52 

caRR, D., DUrlCAll, JiG,, MtLrloX, i. I srlrll' c.G'(1e76). 

Llve! volt@o dglomloslion bv ulLNsound. 

e iolstblo acudY. 

Br J AAdlol. 45. I?a-774. 

caaaol-I,,8..t.(19?8)t 

BiIIary cy.t.d€n6a rnd cv6tedenocarclood.: 

Gi.ay sc.ro urtr.souid spp€.tanc€. 

J clld Ultrrsound, 6: 295_302.

lir 1,. 

0'iri 

I 

i 

ri 

lt0 

-tl 

4 

I 

ti 

i1 

j 

Ll 

J 

,t 

rl 

.ii 

i? 

ft 

li 

fil 

,(' 

tf 

li 

1'l 

1i 

t{ 

fil 

ffi 

fl 

54. CAIIOII, D,A. ( lefl)r 

G.u at@€.. l! 

!.dlogl.Dllc rod 

a! J lto.!!t€ool. 

cAB&UtLr r ll,,8oaa!Dl, I' 

L1v€! ic;!. ra 

JaIA.2lltll0l. 

CA8TEIJ,, D.O., JqXSOl' B.E!( re00)! 

r.er Alal .t l€d, l?l' ll3. 

vltlo coaDrrts@ ot PbYslc.ri.f 

|rltri.ollc ch.rsct.ri*ro!.i;fi 

tttr zal-415. 

, BONCTIA' ni ?t sl'(lotttt 

th. Budd-chlall ayldro!€. 

corni|rnr, o..r., sasu.rr, s's.; B|tsrl' €t rr.(te??)i 

Tto vrl!. ot llv.r ro.o lD tlF lolrd ut 

stu.ly ot trtlo.t tttb r.l..ocrrctlq ol 

tho cold s.d roctur. 

surg Gylocot 06r. la,a! 715_t4. 

58. cEAFalz, l{. 

' t !Il&i, t.l.(r9?9)! :., ,.il 

Port.l ed h.Drtlc v.l..t Afcutrav ot n'l.lrfrf 

eobo.. to! dl.tllasl.bioa lFLr'b€P'tlo 

00. 

v.a.el.. 

Ldlololt. ttor ?25-?28. 

, ':,-;: 

cuarn){lrBt, 1.f,.(rt?t) 

c.utlo! !! l.t.rDEtrtlo! ot ltv€' 8ol! lr' -l 

Dr.i.!o. of bt!.tGPnro.. 

J utol, llat aEt ( t ti.t ao the orUtot) ' l ;. 

cnruDiuar, r.r. (lrio)t 

i:t 

I 

:.), 

1l 

htsd.D.tto l.alo. .ru.!ra lr1& Do.itle.,ilgd 

v!r31.t. L.t lontb. lolr !, 9-165.

38? 

oiSarSilltll, J'T. ( toaa) t 

choto

388 

coEL, ll.,IIALPARN' 8.' ll,Az8Arl, N" €t al' 

Intr.h€prtlc l*ton ptea€otltrt is 

rncle4sod lldiocol lold uP!rk' on 

J t{ricl red. tlt t2l-222' 

(10?2)t 

63. COTAS, &,D. ( l9?5): ' 

Ab€6nce ot uut'tloD lo!ldtng ultr'soDtc 

tr€..@!t ot B'crllus '!bt1Ut 

c€1la aDd ira- 

DstotDlna d'sosvltboolcl€t' rcl'l' 

Or J A.dlologt' 4't 100-3!r' 

6$. CONN, tt. }jDlmRrAt. (lo?a)l 

ItrLr!lroP4! Ic hcdl@ 

Gs6t r@DtarologY ' 6?: 

!fter llver bioDsv, 

3?5-38r. 

?0, coNri. [. EDlTOntl|,. ( lt?5): 

l,lv€. bloPst !n €xt!' b6p'tlc blll$v obatnc_ 

troo .nd tr oth€! | cooir'tndlcttod! dlsrd€ra' 

Gsst ro€nt€lolo3Y ' 03:8r?_821' 

71. coNN, ll.o. 

?2, coNN, ll.o. 

(r9?2)t 

aationrl us6 ot liv€t blopFv t! tbe dlagDosta 

o! h6Patlo cenc€r. 

Grstto.!te!ologY. 6a! 142-146' 

, SPENCER,8.P:(19?2): 

Obs€lrv6! €rrot tt liv.r €o'tr€' 

C.rt !oe. torologY ' 62r 1045' 

r.J. I JlNBa, J.o. ( t9?3 ): 

!'t)Irull.l Chntrtrol't slgn oI bllllrv

. 38t 

74. 

?5. 

76, 

1? 

.nlafacn.nl In nlld lo d|dornlo ob6lrrctreo 

Jundrcd. 

Ad J Roetti€nor 130! 2?e-280' 

' 

@ B|D, r.i., t EoNlBD, J.r tArDlY' r'(!960): 

t tt l.tetrl decubttus e'oglsDlv ot 961l 

stoo6. h'tb€ conir'ctod gtl! blrdd6r' 

l! J lloootgblol . !34: lal-!"' 

c@PEnaBBG, P.L., BUirlEllS, u.J. (1080): 

ne.l ttE ul t !.€oDoar.Pbv ' Dr'aldtlc 

t€chllqu€ ot cbolc' to c'lculoua "rr 

bl.dd€r qF€..6 ' 

EEgl J Ld' 30lt r2t?-r2t0 ' 

cooPBA8ERG, P.L. ( lt?3): 

lt18b r6solu!1on 16.l itF uttlr'ouad I' 

ibo evalu.tton of tbo noful roil obatruot€d 

bItl.rY ir.ci. 

ftudlologY. l2e I 477 '4ao. 

coot,a{ nlc, 1,.1 ., l,ID, lol{G' P., COlllll{, l'r" 

iRrlar{B' 

,t. J. ( 1030) r 

Accor.cv ot c@! h€Prttc duo! al'€ ln thE 

6v.lustlon ot €xt!.h€p.ttp blttrrv obat'qctloo' 

R.drology. r35, lal_r44. 

?3. covrilcmrir E.l. | ( r9to) 

Pli lall€ tn 

Ah J Ro€nta€. 

. lO0t 745-?48. 

ts. 

covrlcTonr E. B. ( 1073) I 

loser t! ttv€r 9botoac.n..

d,$ffii 

'.l.t, 

390 

ao J C..tro.!t.!o1. 5t: 

262-r66, 

30. COtrE, n.L., liic(rallr a.' adlDERS' 

Amebrc llv.!.bEa€* !D 

{iib laundtc€. L€tl€r6 

s Al! x€d J. 55! 402. 

s.J., 1EIBLANCIIE, ,t. ( 10?9 

PstieDts p&a€ntIE3 

to the edltor. 

cox, t.r'. (196?); 

Uctrulobill! lollo{ltrg lcrcuL!!'"'rs icritllc 

btopsY o! tbe llv€r. 

A.ch surA. 05r 198_10l ' 

a2. CRADE, r., TAilI)R, f,.J.r.r sogaNFlBt',D' A'T"et 'l'(19?8)t 

surglc.l .nd PrtboloAlc corr€rtttoo ol 

cbolecvsi@ooograPbv sld cbolecvstog'rpDv' 

Ao J RoeDt€3eml. !3lr '2t-229' 

33. CRADE, ll., tluoR, r.J.l" f,oaE FIALD' l'T" uLR6lCD' 

s., sIwoNE, J., SOI{BR' !.c., vIs'ollt' c'ri'(19?9): 

Th€ v.!l€d ultrusgltc ot!"eate! ot gtll 

blddet tu@ur. 

JAIA 2O' Vol.141t 2195_2196' 

J,J., IUELLSRT P.f,., sllaoxB' J.F.' et ar'(1983)t 

prosp€ctlvo dl.gno.ls ot cDoledocholtthr'la' 

&edloiory, 140t tl67_469' 

r.f,., ftvEAall, 4.8., ASl0, J.r.(t9??): 

lrve!. A c.se demnslrat€d bv --sr and 

rc99n- sc ecrnntng. 

J Nlcl l6d, 12! 754_?55.

d.[E;:;. 

a1 

tst 

plr,m, i., srzz@xt, r. r DlPtalllllorro, r'(t9?8) 

Abdolln.!.ootr.st tomSnDli t! tb' avrlu'- 

tro! ot a.ll b!.tt.ter .nd bttt$v trect ( rlt! 

€oph6.Is ulon Jrurdtc.d p'tlsDta)' 

Brttlsh Jou!!.I ot n dloloav' 5rl 

'84_{93' 

DIILA PALrAr.L.r atrtafm' c.r DoaalrocBll'l 

' R's" 

BAZZOCCIT, l.( rr80) | 

croy sc.te ultrresolr'Dby l! th6 ov'lu'tlo! 

ol c$ctno.. ot tb€ A'll bl'dd€r' 

at J ardloloaY. 5:t! 002-00?' 

38. [., lElN, l.J. l glnllaa' t.a,(!9?'). 

Br6.tlo3 up E.!du.l atl! eto!'a vltb '! 

ultrrsoltc dtlu. 

L.nc6t, rlt rrt-r79. 

A.ll. .lo C.r srlltoli' l"t.(lodn)' 

f.trl !€.ctlo.a to Lt3oocr1.'. 

AdaosLhcsl!. l0! 2t?. 

DDL/!|D, F.lt. t lactltsi, ll.ll.(1168)! 

R€s€!€trtto. ot th. llv'r 'tt6t 

boD't€ctov' 

J [ucl reolch6.03 58t-i891 

9l 

DElSoiYr {.C, (1900)3 

Vtsu.rt..ttoo ot no.6! blrt'lv duct' rttb 

ultr.ao6d. 

Br J Rrrtlot. 53: ??t_780. 

02. 

DE Boivr L.c. I cll.ax, 

Ib. .ccuraov 

B.B. ( l0t0) t 

ot urir|.oqld 10 tb. d.t.otlo!

. .,.,611 

3S2 

03 DE{BURY, l

I 

i-J-l 

393 

DO|N, R.lt., larol,D, J., C,oLDIN, a.' l^rlar J'll'r 

BETNEAS,0.(19?S). 

CoDplrrson ol .courrcv o! Tc"r-Pvr'doxvlldctiii 

gluLtrtrtuto scnnnins' elLh or!l chorocvatographv 

.dd ultt. eooog!.pby ln di'gbosis ol 

lcuL0 chol6cyal rI ra' 

Lancet. 2: lOga-1007' 

rOO. DUBBIN, P.4., O'nlORDAIi' D., IELIA' 

UltrasouBd in h€9rtotr. - 

B! J R.dlol. 5ar 30?-31I. 

t.I.( 198r) r 

o.b a!€clllc dtagnoala 

lot. DUNCAII, J.G, ( 19?5): 

th€ di4glostic v.lq6 ot ult"souod in h€patooegalv 

&.d up!€r abdoDlnat D'aa6t' 

Joulnar ol iovil cotr€so o! sula€ods ' 

( Edlnbulah ) , 

1o! lo?-11.1. 

lo2. ECHEvlnntt, R.a. ,Gra@,J.L.(lrao): 

legatlv6 a.ll bladd€r acltttgru ln 

cbol€cYstttla. 

xed. ,l r 841-34s. 

l03. EDDLESIbN, A.L.l.F., nl{B, r.o.' PAGIllaos' l.P'' 

osBon , s.ll., llLLlars, R.(lr?l): 

s€75_ 6el€.oo.tblontle t! tbe scirtiscs! 

.ll.gtosis ot p!tdaly bopatoc.llular c'rcln@'' 

cuL 12. 245. 

1O4. ED{ARDS, C.Q.! CASSO!!, X., BMY' P.' I CUART l8rCgr' 

Uet€dtt.av h€@chrdrtosl6. Di'a'oars io siblt'34

:&H$ 

304 

aod chlldr... 

N Eog J r6d' 28?: 7_13' 

ro!. EtKra , 8.A., CdEnoi' J.1", @IIAX' 

A tosl- 'or 

Prt€ncY ot ihe 

l9?5)!. 

Au tnt6r; x€d. 8rl 318_922' 

l06. BLL, P.J., ftLLrats, 8.8.(ro8r)! 

The ltvsr' tplt'n 

"d Dtdcr€rsr tcl'ar 

I€dlclns: .n l'troductorv t€st' 103_lr{' 

Brsck*oll scl€nttilc Irubllcttloos' l.n'lo!' 

ro?. EI{GEL, 

J.r., DEltt!r 8.1.. ltrf,xara' f'(reeo': 

carl bl.dd€! t.ll cblcl!€ss sonqr'Pbrc 

sccuricv and t6l.iioD to dlae'6€' 

AJB. 13at 9o?-908. 

I 

tl 

l 

rii 

ro3, EvANs, C.8., cunTtN' ! 6 , tccAeTlYr Il'C ' 

XTARIAN' 

J,X. ( l9?2) I 

Ltvar 6c&rtrg tn P'tl6Dta *ltb 6uap€ci'o 

.bddl!.I tudur' 

Jour!.I ol lDltcs l€'lrc'r Assoclrtloo' 

230: r6t5-r6t?. 

los, EYLERT v.R., SC{UI|AN,8.l" DusAULT', L'A" lINSOll 

R.E. ( 1965): 

R.dlo1ogY' 341 409' 

I lo. lrLLl, R.A., ALLElll 

a., llY, L.r. ( 1930) 

IINTOI{, J.J., BEEIIHOFI, 

,l

''$ifrJ#, 

395 

I I 

.chocs wtihtn l'l litrrY sludge' 

J Clin Ulir'sound 3: 193_200' 

tt,. IjrNrrrtttc t.J., I Bl&l{goLz, J c'(19?9): 

uttrasoutrd 6valustlo! ol tho ga!1 bl''td€' 

v'l l ' 

Badioloav" l!3: 6t3-698' 

112, !rNC(H,8.S., BA(AR' S.J.' & BYIIN' r'r'P'(1953): 

'rhe vrtue ol tlv€r blopsv ln Lhs dlsgnoaig ol 

rubercutosts snd 6"coido6i5' 

!.d J lns. 21360' 

,, tt". Flsll8tr, c.J., ! f&oon' l'f (re53)l 

i 

*6odle blop€v ot tr'e ll"er; coop'rraoo ot 

ln1till cllnlcil 

'nd blstologlc dlitlosis' 

{lth s !ot6 on Post blopsy nort'ltty itr 

patients *lth n6tBststlc tr6oplrad' 

Ao J ne.l. 25r 36,' 

I r4. r_l,Atlilc, R.J.(194?): 

cvst ot th€ co!@o bile 'lucl 

rtr I cada 

ot pregE.ncv ol ergbt @Dibs csuslns pvlotic 

ob6t!uetlon. 

Souih atricsn ||€dlc&l Joqroil' 2lt 71a-742' 

r15. FL|EGEL, c.P., DErd{JaE' r.K'r HotllaN, l"o ' 

et !l'(19?4): 

t"99t- tetu cvcltno .s r kltln'v '!

396 

116. Fol{sEca, c., nosBNTllALlr L., GITEBIIBERG' D" et 'r' 

Drlterentt.l dt'gnos16 ol l'undlc6 bv Tc 

IDA hepatobll Idty to&grrg' 

Clrn aiucl red' 4: 135-143' 

I17. 

(19ze)! 

FOs-rB8, tt.J., DAfBO&yr K.c., cRttFlT{, A.H.' latcur' 

R.(r930). 

The.ccu..cv ol ultt'souod lD th6 detectloo 

ol fattv lntiltr'tioD ol the llv€r' 

Br1!tsh Journ.l ot R'dtotogv SS! 440-442' 

lla 

120 

l2l 

fout,t(, r.!., t8azlaR, S.fi., CAr r J'C', t BATBOI'OXB', 

L.C. ( 1959 ). 

A tecinic lor ltvor btoDsv apPrtcrble to 

uncoope!.tlve laychotlc patt6!t6' 

Proc Xavo ctinlc 3'l|3' 

toulKr tt,T.(19?0): 

cora€olt.l d1!o!Brio's ol ihe 1'tra b€patrc 

blltary tree tn tbe 'dult' 

Crst.oent€.ology ' 5a! 253_'56' 

FRBE|IAN, L.lt., BLAUrox 

' r.D.(€de) (19?l)' 

R.dloouclld€ studl6s ot the gtstrotrtestlbrt 

5v6t4 1. LIv€r. Io soDloar lr uctoa! I6dtc1no' 

Grube .!d Stlsttoo' N€' tort' Vol'2' No'l' 

r"RaDrAl{, L.r., DERTON, l.! {ATZ' r" I rE}tc', c's'(1964)' 

J. Nucl l6d. 9: 3l? ' 

!'REEITAN, I.. tl. , IANDELI,, c.H.(19?2): 

uyoDic vr6cqlr. scitrrrgrlplrv 

scoitr Nucl Isd. 2: 133-134'

;*ril. 

30? 

I24. FBBBIINI 

L.x., ullic, c.ll., JoHNsoN. P'x rot- !I (1969): 

t.lse poslttv6 llv€r scsns csuB€d bv diaoea6 

process€s ln odJsc€oi olsans and atructur€s' 

ar J Rldiol.'l2r 65r_655. 

L.ta., s0cl lN, !.a., fErssrad, l.s'(1981): 

Aole ot cb'orecvslorl.sLtc rseota tn Tc - 

tDA Choleacl!llglapby. 

Sedin ucl I6d. ll: 136_193' 

p.c., vrxoNT, 1.n., BA&tlEl'f, D.c.(10?0)! 

coveinoqs h6o.n3l@ of tb€ ltv6r: Ultrraono_ 

alaphy, Ara€rtogrEDhv sld c@Put€'l Tb@gr'pbv' 

Rsdlologt. 132 ! la3-143. 

tRalTUS, 

J.E., !rlll(-BENNET',T, D.X., T{naLL' J.ll ' 

et 

Dlliescy o{ h€p4lobtlta.v In'Etng tn 'cut€ 

sbd@ibrt patn! conclse cdmunlca!lon' 

J Nucl |.ed. 2lr 019_92!r. 

J.E. I GUulTr r n x.(1930): 

R.pld evtlustlon ot &cut€ tbdootnsr p'rn bv 

hepatobltlaly 6c&nn1ng. 

JAriA.244! 1585-r58?. 

l2a. FRIEDELL, ll.L., rsclliTYru' t.J't RAJALIT A r'(195?)' 

a Fthod lor tb6 vrsuallzstlo' ot tia cortlgulatiod 

.nd .tructure ol tb' llver' p'rt A' 

Prallni.arv Cltnlcal inve6ttgalrons 

Ade. J no€ttgon 17t 455-410'

398 

129. aRoELICll, J.I., AIIEO A, J.!.' Lc[ustc[' |('A'l 

tlNzELBaRC, G.G. I Araausgr ll.1.(1932): 

Bt4ioDuclld€ h.3ln8 .od rltt'sosld ttr llv'r/ 

sPreeo l..u!r! A Dtoap6cttve coop'rr€o!' 

Rrdrologv. la5: an,-461. 

::to. c^r.ll|l]os, J.1,(r9t2t. 

Natursl blstoay of alcohollc helltltla 

{lsioroglcel oh..goa 

Cast roen tero loAY . 63: 1026-1035' 

lll' 

l3r. GAI,L, 8.4., r DoAaoGoaS{I, O.(le6a)t 

D€pttic alt6!.tlo.s 1! obst'uctlvo J'uod1c6' 

l! J crl. P.th. al: 125. 

132. OAILISON, D.T., SKTNNER, D'(1950): 

Alr€ portto.rtts coopllc&tttrg n6€dls blo9av 

of llv€r, 

ll EbAl J ll€d. 2{Sr 4?-50 

133. Gtt,PBRlN-LAr4rrRB, {., XrRgCll, V'r., I I,BVI' a'(19t5)t 

F.!sent.t!o! ol Purlltad @llt' 

DNA @lo_ 

cures bv qrtr.cound belov h|@o thorap€utlc 

dose6. 

ll@angenetll. l: 6l_65. 

rJ4, CAt,t,!n| -l,BxA rTnD, I{. 

, lnd l,Evl, s.(19?3): 

19?. 

r3s. GrRRdtT, Y.r., xossoP!, c., uRBll, R.a. €t 41.(rgt')t 

Gtsv €c.16 ultr..otrtc t[v€sttg'tlo' ol l@'l

399 

dofects on Tcgoe-Sc rtver 6c6nnts8. 

nsdiorogt.. lre. 124-423- 

l30. 6ENAm, s.X.r lloFFEn, P.B.(19?2): 

Fatse poslttva llvor sca! dus to lung 

J Nucr Ia.t, 13, 8rr5. 

J.P., KLII{GENarllll, {.c., f,uNl 

DlognoslB of blllatv atresi! 

bep.tobllr.r, lDaBrnl. 

nudiology, 146.,!or-504. 

, c.c. €r.r.(1933)r 

eith rsdlonucl tdo , 

l3a. GasllEll, G-8,, 

r.c.{ 19?6): 

DI srt! 8.r,r 90ru, &.x., Jof,Ngoli 

' 

Md speclllclty or Tc999_ 8. 

dlttuse bepatocolrulu dt.€r.€. 

I t5-119. 

I39, CHADII!, lI. , 6lss-(oFTs^x , A (1961): 

EvsluADlotr ot tho rsdiosctive 'o56_be'asl 

tast lo. the ditt€reltr&l di'gooals ol obstrrctlv€ 

l.uldrc€ In r.r.cv. 

N Eogt J led. 205; 351_353. 

r4o. Gtlal, 8,P., T Ytan, (.J.1.(19?5): 

ult..6ound @nltollng ol h€pttlc !€taatasea 

durlng chem!hof.pv. 

Br xed .1. rt 3?1_3?3. 

14l. crlDAY, D.L., ALDa&AON, E.O.(r0?4) 

scinr igrtrPhlr evrltr!r ron of llvor.nd sploor

a00 

S€ot! Nucl I6d. a: 3s?_3?0' 

clLlJlN, T., a GILtTAN' J.(1945): 

a @diftdd ltver sslIr'tton biopav 'Pp'!atu6 

ald tecbnlqpe' riib sEecisr retaisnc€ to Ita 

cliricsl iDpltc'tro! 6 s6s€ssod bv 5OO 

8oI. 10:53. 

I4J. GI LI'ORE 

' 

!.T., BRADLBt, R.D" TdorPsoN' R'P lt (19t?)t 

f..nslugll.r llv€r bioDsY' 

B. Ied J.2:100. 

144. CLEES, J.P., TAYIDR, (.J.1.' GAzsr' J'c ' 

€t '!'(!97t)t 

Accur&cy o! A!.v 6c.le ultlssooog'Blhv ot 

llv€! an

a0l 

148. COIDSTBIN, F., fRUITT a.' IARCULTAS, r.(19?4): 

cbolecvs!olt.ttr cholgcvsiog[phv tr in€ 

dilfelenitrl dt.goos{s ot ac!lc[lous a'tl 

bl.dder .l!.e..o . 

Ae J Dtg Dls. l9t 835-349' 

140. GOLDSTEIN, L.r., SAllptS' v.l.r KARDBLI',T B ll" tEINEi' 

ll.lt911l. 

crev scsle ultrssonogr.phv aBd tbln De€

,1i.,3,.11': 

'102 

!iliarv sc.nting ogcnt-. 

J llucl led. l4:A2O-323. 

t55 

150. 

157. 

r5 8. 

cqra, n.8.. ! zuroErA, o.D.(19?0): 

Dilatalion ot lhe lnt!.be!'ttc blliBrv ducca 

io a p&tiott etth a chol€docb'l cvst' 

Arerlcsn J'ournal ot surgelt' 119: ?26' 

ccrmscltAL(, A. ( 196? ) r 

J. Ao ||ed A€s. 202; 3,r. 

c,oulD, !., @!LrcA, c., corPBEC{T, R'P'(19?2)' 

scitrtlpbotoanlbv lo coosestlve heeti t'!tur6' 

Jou.osl ol tb. &.t!c!o L'dlcql Assocl'tton' 

219. 1131. 

G8AflAl, ll.!., c9oPEsBE&G, P !.' COI$N' r'I" 

U.J.(1040)! 

Tbe slz€ ot the noro&l co|@! 

followlng chol€cYalect@Y: a! 

au8 a Nl' 

ItadiologY. l35r !3?-130. 

159. 

CREEN, 8., BNEE, N.L. 

Gray sc.l€ 

beoP1.5!sl 

RadlologY. 

, cor,DsTElN, n.r. i srAnlEYr c.(10?7): 

urt!;souDd ovtrustion ol b€P.tlc 

P.ti6!ns .!.1 co.rel.t1on 

124r 30S-203' 

GREEN. B, ( r9?9): 

ult..sonoSltpltv as En adjunct to lsdionuoltd€ 

6ca!s tD tbo €v.l$!to! ol b€p'tlc M"6'' 

APPIi€d SadlologY' 9A-105'

i'ffil u,,: 

403 

l6t. Gnoss, Il.B.! traRTEnr L.E., @Ra, R.r.' et ar-(re83)! 

ultrasonlc ov.l!.!!o. of c@n blls 'luci 

stooes: Pro.pocttvs cdp.rtaoo rltb 6ndoacoplc 

tet.osfad€ chol.natoD&ocre.tosf'pnv' 

Rldloto3v. 146: a?r_4?4. 

!62. 

caossxAN, 8,, GOLDaTEIN, ll.J.r (oas, L.c., €t.I.(19?r)t 

Cytologlccl 6x.rhstloo ae a! &dJuct to rlvor 

blop6y t! thd dl.ano8la of h6p.trc retaat.€'4, 

Gast to€ltsro 1o3Y 

' 82r 56-60. , 

ld3. GlossrAN, 2.D., TlIOrls, D'P.(!l3O): 

Position ol lucle!! legllg itr tbe ag€ oi 

tr$e!66loo. c@puisd t@graptrv and !ltrasouod. 

In. [ucl€t! Iodlctre. 

Annlat. !.es!||n' l.I.' f€ls6@D!. Ibeetr Pr€8ar 

NeY lork. 

104. 

165. 

106 

GnossIAN, 2.D., llaTol, g.lt., BAYAN, p.J., €t .1.(1r??)l 

&sdtonucltd€ lb.glnl, conputod iomS.lpnv' 

tod gr€sy sctl€ ultr.sonograpbv of th€ 1lv6!. 

A e@pr.atlv€ atudt. 

J Nucl ll€d, lai 32?-394. 

u6ocHouEL, rl., r GAualB&, r.(lt?6): 

IiistopstholoStc stuilv ot the live. tn th6 

eslly ehol€.i.llc pbss€ olcclT delict€ncy' 

Journol ol P6dlatrlca. a9, 2ll-215. 

IIAI,PEANI S" COELI X', ASITBURN, I'I ALAZRA(I' N.' 

Ll11,llNB&BG, R., liuRlll',lZ, 4., ciaGN! J.(19?4): 

Corrdlrllon ol llro llvor .nd spreon srzo'

404 

r{i?. IlAlill,lpl{, 

t.J.( r9?6) ! 

Intornal ledicl.e. !!a r lrs-lra. 

Itu!!|n A!.t@Y, ,n.l 6dltio! 

168. ITTNDLER, 

a.J. ( 19?9): - 

oltrasound o! arll bl'dd€' rr11 thlct€nllA 

s..t its !€lstlon to cbolecvatltla' 

Ad J Roentg€not. l3l! 581-585' 

t.P., soBB!f,, N.J.r fERntccrI J'T'(1080): 

rbe aiacooera o! citrlrosls bv r€'lotrrl cb'nasa 

ln bepttlc norpholoav: 

' r"lrolo8tc'r rnd 

psLhoroarcsl .nulYaia' 

i.dtorosY. 135: .2t3-'83' 

r?o. llalil(aNvI,2., SZOLLTR, J. ! VIGVAAI' Z (10?3)' 

A so!.ch lor sn otfoc! o( ulttasound lrooo 

.Dd ir c@bltr'ttoo rllh x_roys o' cDr.es@s 

in vlvo' 

B. J nsdlol' 5r: '8nr9' 

P.V., IATAROP, K.A., alcHlRD' D'(1064): 

rcggn-as . lidtocoltoid' 

J iucr led. 5t 382. 

8.. rraERC, r.r cooPan, l.(19t5)t 

To9gt-8rDt, a ne* tsdtopbar"coutlcrl loi 

l€patoblltsry lotgtng' 

J Nucl I€d. 16t533.

405 

l?3. IIaBVTLLET D.Di I SUrrBlaxIt',L' I'd'J' ( rg'9) ! 

Surs€lY tn 'c!to 

bep'tttr6' 

JAIA. r34:25?_261' 

t74 

ItafFrELD, " ' '---' Ir.ll.(t0?5): 

;"i" of rtvor *rnntng tn tho drtgnosi€ ot 

l!rn!l l. mrosrrsox' 

r€dicir cllnlcs ot llottb 59r 2t1-216' 

'm!ler' 

r75. HAYDEN, P.I{.' RUDD' T.G.' CHRISTIE' D'L'(T'?6): 

Ros€ beng;r 'odlu 

lrJr slu'lto' ln lnrttrta 

elih su6p€ct€d bu!'ry tlrct dla€ase' 

Ctln [ucl led' lt l?l_185' 

l?6. dECt(, L.!., GOttscEALK, l'(19?l)l 

th€ app€a!'nc6 ol ltrt"h€Drtlc biliarv dllrtatton 

o' tb€ llvef scan' 

R.dlologY' 90! 135-r10' 

l??. IIELBTC, l.D.(r9?3): 

!oc.l istrogeolc Incle'sad r'dlocollqtd uPt'16 

on llver Fcan 

J Nucl $ed' l4t 354_355' 

l?a. uuLl.ral{, t,.t.' D!FaUS' O l , DOI{'LD' l'' cL rl'(19t0)' 

slteiv ol 'tl6g'o6tl' 

ull-t'sou'd ln obsteirlc€' 

Llncot. I:tll3-ll'4' 

17 9. 

urLL, c.a. ( 1968 ): 

Tbe Dossiblilt, ot hs'srd tD oadtctl a'd 

tndustri.r .ptllc'i10! ot !ltrdourd' 

B! J Rsdrol. alr t6l-560'

'Jl;l1,. .,f't r,. . 

406 

r80. IrLL, c.8., JOSUT, G.P.,IEVAL!' S's'(r0?2)3 

a leslcb to! c!!cr66oN d.sg6 lollo{ilg 

€xpogur€ ol chln€s€ hMst6f csll' to hlel! 

1nt€rsltY Pul.6d ultrasound' 

gr J Radiol 45r 333-334. 

l3l. BJOaTSJO, c. u. ( r t'a3 t: 

Tbo tlt€io.l topoaEphv ol tb€ ltv6! studr€d 

bv lontgeo sad lDloction t€chnlque' 

Noldisk xsdtc!... 33: ?4s-?48" 

l8l. ItoBBY, J.A.B. ( r9?0) 

Btlobed altl bllddor. 

xr J surg. 5?, a?o. 

lll3. uorBlt, ll., oo&ts,8., PfBl!FDR, G.(r968)l 

sDldroport060j nl, igraphy ro dofl)na['!0c 

poriosv6te!lc ahunt6, 

J lrucl led. 9! 62a-529' 

r 84. xollllAlrER! !.1.(r9!t?). 

{eodle bioPEY ot the llver' 

.tA A. l3{: 666. 

j 

rl 

I 

135. EOT,DGR, L.8., I SAAnCa&, E.L.(rr?5)l 

Tb€ use oa lucl€.r rdlclle ln €v'luatiog 

Itver d1ae.a€. 

S€oins!6 ttr &o€tt36lologv lor 215_9'2' 

136. IIOL,DERT L,8., STRM, J., PADTKAL, T.N.' et 'r'(r9?5)t 

Lrver size d€rerotn.tro! ln p€'llatrlcs d6tng 

;i

i 

107 

sooogr.pbic .nd sclDtlatrlbic t€ehn1qu66' 

RsdrorogY. r1?: 341-351' 

1l 

137, lroLllQulaf, D.L.r BUADIlll' J.A.(1l?3)t 

Csvdl-porral clt!'tt'g ss ' 

caqao o! ioo'l 

i.c&r€6 t!' rrruocollotd upt'te tn Dorul 

llvorc. 

J Nucl led. 1a! 348-351' 

r 38. DOLT,8.t., racNEB, i.(r9?8): 

ri I t rasolosr&phv 

' cltol€llthtaEis 'nd 5rck16. 

cou dta€.so. 

JIIA. 2!0: e' 829' 

l 

' 

r89. doNc, R., scIiuBERT, t.K.(t960). 

Ienghlot !i,6.Ue blopsv ol tb€ llv€r' 

A! J DIs Cbrld. 100, 4,. 

100. soitalla, r., coLDslEtN, O., rAXrA!|, A.' AEINOLDA, 

T. ( l9?5 ): 

Th€ .b.ornl hepatlc sc.o ot chrontc uver ' 

dlse.€er it6 lelatlotrshlp to b€p6i1c hs@'rynMtcs 

srd collold 

c.si reotorologY . ? 1:110. 

l!t. 

ltotuxPA, a.f,. Jr,, AC{IrI, 1., ltlLfxAN' a.L.(19?l): 

Bu.ld-chlali syn.lrooe ttr w6o tallns oral 

co.tr.c69tlv€a. 

AD J led. 50, l3?-1i10. 

192. tuaLrrz, u.F., xlrtN, p.c., SELL' L.A. (19?2): 

' 

cholecv6tosoiogr.phv: s applo.ch to tlr€

l08 

Ldloloai. arll bbdrtEt. 

l0st 645-ellt. 

19r. Elm, P{., Csrltl4lD' 4., Illl&lu' D'(1980)i 

r*t."-l"ntio !Dtl5. ot rc9h- !6ti't't rtt ' 

r.ahsl{.nd tlsnltlo|lo€ 16 chlo.tc llv'!' 

19a. raBlrcll I 

rsuJr | f,. 

lgi. tSmsl 

c.rtt@t€torolY. t6tta' 

t.r.al,ltt!, t., o€gtroil, r.r Alllrl' J.' 

, I gllrrzu, 1.( le?3): 

UI l,rsNnd o.d c{,ruYorlc cllt -'rxata. 

trJ. !, rlr. 

a,D., scitfl, B.l. I l,EE, J.C.l.(tgt?)l 

Cytoch.otorl !.t!oo. !o! coDDct. ArohIY€' 

ot P.ttolqat .rd hDot.lott lotuot!3. 

t01, 103-!01, 

r06. tal{oPtr r.8,, DtA@Ilr8, J.X.(!o?t): 

Ult .ouxlt a.or {rFo.ch to th. J'undlotd 

93tt€nt. 

JaI|. l3atal!-t23' 

19?, TVTBSEN, t., I lotr6,r, {.(!9lt)l 

o!.rplratlo! blot€v ol tbe liverr 'ltb 

!41rts oa lts .lt.a!o.ilc .lanltlaarcoa' 

Lr. L.d aouc. 10rt r. 

ro8. Jlta8, o., ldD, 8.J., af,l act, g.(let4)! 

o16? rcuotal t! tbo drr|ioo.lF ot llv.r 

(i!r l6' 4o.l-4 | 0.

,l0D 

rrt. JciNEnr 8.a., cLARf,!, r.8., llorâD, "'"'tt?11'.] ro. 

Livor snd grlr broddcr tNgrng 

dlbvdrotbtoctlc etro rno t"09t- Ptrldo:vlt'l6no 

glualrdnlc- s srldv 'n 

rhe vorng Pls' 

!r J tudiol. {9'352 ' 

200, 

J[txcRl{.4.G., rulol@lDllYlY, A.l(., AJrlrlI, s'r' 6t rl'(le7?: 

!6p.alc .dsnus ..d t@'l 'odu!" 

ht9elplrorr 

of tbe rlv€t rn voula ,@! o' or'l corta'coDtlvoa: 

ca. r.Dofr.' 

J llucl I€d. ll. 263-166. 

201. 

JO{rSOll, P.r., cio68l/|r, 4.r., t aTrus, {.L.(1968): 

202. 

t{tRA, !.o., GLASCOf, J.L.( 1963): 

Grr!roonl.50r l3l ' 

!0?. JollllsoN, n.!., cAatgL!, 1..o. l,lJ(lgll, l'l' 

Lavo. scrn.t.s !o' do!6crlotr o' 

clrcul.!lon ltr rrvot dr'ort6 ' 

Joufnll ot tb. a@!tc.n lddlc'r 

2011 524. 

203. JOI|{SOI. n.c., DElono, J.l. (llt3)! 

Th6 hepttlc hot sPot' 

roltc.n Jot!.rl ot Dlaestlv€ Dl'€'€'a' tl' 

r|o' i ( glEpl€Gnt):00t. 

204 

JONES, 4., SHaRrrcx, s. (le3?)r 

Bdctsro.l! 1! rss@Irtlo. elth ll694ioo'llulr! 

.nd h.D.tobilrarv dr.€.eo' 

Poslglad I€d J {suppl.) 43r ',_rr'

4t0 

206. JONSSOiI, 

P.8., lliD8isgoll, a.( 19?0 ): 

scuto Bcrtculoug ctrolect6tttla. 

r00?-rr0!. 

20?. JOSEPI! l.B,A,' DEIBURI, K.C', IoGUIRF' P'c'(19?0)3 

ultr!.outrd rn tbo delecllon oa chrorrc 

Itv6! .ll€a.se ( the " bllaht llve'")' 

lrr J llll(|iol . 5i: 134-3. 

K. (!063): 

Prolongtd sovorc olrs!rucllvc Jlundicc r' 

llodgkinra dlaolao. 

G.stroeot.rologt.'l'Il le9. 

209. JOYNEt, J.1. ( l9?2): 

llvot acro ( r.dlocotlol

4ll 

l(lr'r'l,lttlr{, r.0., slnDBns, !.c. (!o?n): 

ult..sound tr th€ !trveatltatiotr ol Sall 

bl.rl.ler dlasaa€. 

JAI . 239r rl28-1423. 

2 t4. 

|6RDEL, 4,, [Olr, U,!,, n^grU8SE , S.ll" roRlBnaarr 

T. (le?t)r 

Ultrrsotrlc dstorrln.lron ol ltver lnd apleotr 

volue. s..nd!..vton Joum.l ot cllotc.l .nd 

[^bo!.toty Ileo.tl3.t1oo. 2?, 113_128. 

215. l(As^l, I.,laTAitBa. r., of,r, a. (10?5)r 

lbllo uP sl,ldt€s ot lons !€E su.vrior. 

aft€r gortdnteto.t@y iot I no!_co!&ct.bl.' 

bil!.!y.trearr. 

Joqn.t ot P€dl.irtc AorC€tt, lO, r?!_tt,. 

ri]|snrr^Glr '1., lilt u/|r 'f.r aua, l|. (10?a): 

DynMlc .tudle. o. tho pottrl h.Ddv.urca 

by sc!.rlDbotosDroooDorloanphv! tb€ vlaurll_' 

z.lloo of !o!t.l v€oous sy.t€. u6r^s tcge'. 

C.6ar@.teroloaY. 0? : a0a-6?t. 

2t1 . 

2t3. 

(ELIY, r.J. ( r9tl ): 

Cea. ot c.rollra d1...46. 

orlttsh Lsdlcrl Jou!o.I. a, l0?. 

(8nR, D,rr.s., laaBllsoN, c.v,, suBn c(, s. I llll(El, 

n.r. ( 196l ): 

Co.s6trlt.l ho!.trc lib&at€. 

Qu.rr€rty ladlcln€. 10, 91.

412 

,t9 

221 

222. 

225 

XERR, D, ,S., tARlICl, C.X. I [lrr-rBScf,rs, J. (re62)t 

A loeiod r€s€oblllg Edutl.rv s!,o!l€ kldn.v 

lb Datl€ots rtih coDgsltttl bep.trc tlb&a13' 

cli!Ic.I Radlology. 13, 85-91. 

xIloKtAR, lr.T.r oLrvBn, R, (lsr5)! 

an inv€sti&etlon oi chtomelre dmtso l. 

viclafuba root tlpa .tt6r €xpoaure to t 5 

lZ ultr.sortc r.dlatlo.. 

tnt J Rsdl.r. Blo. l8! 3?3-383. 

xlmr c. ( t9?5) r 

PriDsry llver c.ocer (lnsloe.apby ald actntlSrrDtrv 

auEt..lt.n R.dloloSy. 19, 129-ts9. 

KIx, D.(., lcSllEENEY, S,D., vB||, J. (19?5): 

T\rmu!6 ol llv€r .s d€mnstrated bt scar rnd 

rEpcrotoDy. 

surg6ly, Cyna€cology abd obatotrtcs. 

141,400-alo/ 

t(rNG, D.L., LELE, P.O. (10?a): 

BtoroAlc €lt€.ts ol dt.gnostlc ultr..ou.d. 

ao Ktng Dl! Dlrgnoatlc urtrrsound. 

St Luis, C.V. Ioshy Co. 

224. l(IRcllllDRr x.! ttA8tr !. (lob. rg??): 

Radioouclido.a.sa6dent ot I! vootr shutt 

patency. 

Ann surg. l{5, 

225 

(LATA(rN, c., & IEANBR; n. (1950): 

cepatlc @nlt€at.tlona ot aarcoldoalg and

413 

other gr.luloqtous disosa6.: . aiqdv b.a6d 

on bistolo8tcrl oxuir.aiod o! tiesue obtrln6.l 

by needle btopay o! tho lle6!. 

Yale J Blol l6d. 23r 20? 

220. XLacxNER, I.S. J!. {105a): 

Needle biopsy ol rhc liveri rn rppraisal ot 

1!3 di.ADoattc Indtc.tto!6 ald lllltatlola. 

Antr Inl lod. 40: l1?r. 

22?. t(LINGENSIIrsr v,C,, tBrrtBlRC, A.n,, g9I'ZBR, V.l. 

t(UNt, c.c., trLLtArsoN, r,8., GE[lloLDr J,P.(1983): 

fort in Dro8roga : Clldlcr! oval{alion ol 

tc99t r.tettrylbro - rDll .nd Tcggo-Di 

l.opropyl -IDl lor hep.tobtlliry Itraglng. 

Rldioloay, l4€3 l3l-144. 

228. lillOI, F,I., nUDAVSXy, A.Z. (1e68). 

l.l5o posttlv€ ltvsr 5c..4 to P.ti€nts vlth 

al9ohoric ltv€r draedae. 

Antr.ls ol Int€rtrrl xeCtcln6. 69:183. 

!29. (llAUER, ||.C. ( 1973 ): 

Pofcutaneous biopay ol tb€ ltv6r i5 a Deceduto 

:i tol olt Datlenta. 

Oaat rosn taroloay . ?4! l0l-!02. 

230, KOCK, C,t., PAUITELS, E.I(, (19?0)! 

avaluatio! ot ult.asonlc and ac{Bttgr.phy 

6tldres ol tho ltvo.. 

irdlol clln ( a..€l). 45! 242-291.

4L4 

t31. KOENICSBERC, U., ArtNER, S.N., IIALZER, A.(19?S)r 

be trccuracy ol €o4ography l! the dt!,€rontlal 

dlisno6ts oi olrslru.ttv( Jau.dtc€: A coipdlaotr 

etth .holantl ography . 

tldtology. 133: 157-165. 

232. K AIUP! N. B. (t949): 

taplratioo blopay ol tb€ llver rith apoctal 

f€t6rerce ro tlr6 @tbod ot lvdrae!-iohoh. 

Act. Iedlca ScrndI.avlcd {Suppl.). 234, 109-209. 

li 

233. XlilSrNArUnlUY, T., ttBlS, |l., ltDot, J.S., e!.1,(1rt2)r 

Tc--- perlclllul.e. A n.r r.dlophrMc6qr,lc.l 

lor clrol€sc!ntiinphy. 

J Iucl xed. 13 !44?. 

234. t(U!^, J., SEIDtOVt, V. (lO?2): 

lvalu.r-to! of Dortel circqllllo. 

acl.tlllatlon ca@r!. 

J Nucl Xed. 13r 549-692. 

by r,ho 

2:i5. XUltNr It./I. (19?l): 

Idc.€lasd .l&al lo€ pDcph.lEe lev€l 

conLrultrdicrlion for btt.d livcr biopsy. 

Yed rltn. 66: r063. 

' 

lr' 

236. r,tING, F.C.r GOODTNO, c.A., BROTN, T., LaOmLD, c.B.(19?9): 

AcyDlc.l Peerdocy€ts ot th. p!.cr€As. Ar 

ultra so.ogr.Phtc €valuatlor. 

JcV, 7 t 21-ss.

al5 

231 , 

LAING. I.C., JA'PREY' R.B. (1983): 

Chol€docborltbiasl€ ..d cv.iic dlci obst!!c_ 

tlon: Dittlcult urtrGono3raDblc dt's'oata'. 

ABdlologY. 146! {?5_4?9' 

233. !AING, 1.C., LONDoN, L.ll.' Fll,l,v' n.A. (rO??): 

ulirssololr.9hrc Id€DiItlcr;1on or dil'ts'l 

trtrr hep.ttc rrll€ ducts rod tb€lr ditter6!- r, 

tl.tioD trd Dorisl v€loua aif!ctu!6s' Pr€a€at6d 

st th6 22nd Annu.l motila ol th€ rlutl. 

D.lla6, tesas, (oct. 30-Nov.a). 

23g. LA|{CE, p., BEVAN, P.G., llOULfr J-G., PAT'IOX' A'(rg?t)t 

l,tvdr baopsy ln t Difllcull Jaundicor' 

af l|ed J, 2:236, 

,1, 

ir !.j 

1i 

ii 

lr 

;i{ 

I 

241) 

241, 

242. 

243. 

LATDAY, ll.J,,'sETttAN, ll., firnsd, c., CIRISTENSEN' 

4.D., collRlD, r.R. ( r93O) ! 

ll.P.ttc tod fhotrclc .egbl.ala. 

AJR. 135: aa9-.15a. 

LAXGIAN, J. (19?5): 

Iodtc.t €Ebryologv. 3rd odltlo!. Illll.o€ 

t fllkils. 

LAST, R.J. ( r9?6): 

Anstomy: 8€g1on.l add ApplI€d. chulcl!ill 

L1v1naatoo.. 

r,luirLt, s, I LUNDQOIAI (19?r). 

Ll,pt.l cmposllron ot hualn llvor biopsv 

.poctrens. 

Acr! l|dd sc!trd. l$9, 05.

' ,,$.,lii 

4lg 

rr r. r,lvl,tlslrN, lt.s. (19o0): 

: cYsl s of I ho conmn br l€ ducl ' 

j 

' 

Amtlcan Journsl ol ||edlcal scten'€s' 

t3?, s63-5?0. 

245. l,AllsoN. T L. (19??)r 

crlv scsl6 chol €cvE ! osonoglsphv I dl'Atoattc 

rlt€!la a.d rccu.rcY, 

|ladloloay. l22r 24?_251' 

246. LEo, J.K.T. I rElsoNr c.L. (r9?9)! 

lhusqsl so.osr.lbrc .pp€ar'oco of a coulvoi_ 

a16r g.ll bl.

4t7 

251, LEIlllN' J.S. ( r960) I 

ullrasound i! the dls8rosis ot hepatobtllf,lv 

nadiol clln North An 43 605-693' 

| 252. LDoPoLD, c &., soKoloFr, J' (19?3): 

Urtr'son1d sssnning tn tbs dt'3!os1a ol 

bl1ilIY dlsesae ' 

surg ctl! Nolth Ato' 5l! 1043-1052' 

2s3. lSltoNA, P.1., GO' R.T.' coRNEl.!' s'tr' (19?4): 

l,lmiLatlonF ol !ngiog!cprrv !rlrl acrntlig 

ln disgnoels ol llve' Baseg' 

Rtdioloay' llz ' 

139-r45' 

254. LESESI{E, tl R.' ItoLTr r" onslNcEl', B (19?'): 

Is hepatlc absc€E3 s contr&Iodlc'tio' to 

P€rcutaneous llvor bIoPEY? 

Gastoen!etorogY 70 r29? ' 

255, l lalsNu, ll.tt., {oltuAli, J ll ' 

llLl'l"l'' l"lt ' 

ul rl'(r9??): 

Llver bloDsy tn he@Phtll'' 

a ann lnieln ldd 36' ?03' 

256. LEVIN, J.' GEDDES' E'f'' 8EY', I'C'(19t4): 

nudlonucli'ls scrlolna ot llv€! 1n prutrv 

h€pstic 'atrc€r' 

Anslygts ol 202 caa66' 

J ltucl lod 15: 2t6-30e' 

It'?. r,l{V rNli, ll.A. (r962): 

lrnylold disclgc of Lho tiver' 

am J [{ed. 33: 349-35t'

ll8 

259. 

l,$vlNsoN, J,D r OLS!!, (j ' 

.fllltlli\N 

r J'l r cL rl'(r0?2): 

lle@b1lt. deco.dsrv to Dercutan€oua llvef 

bloPsY. 

Arch InL€rn u€d. r30: 396-'100 

!EVI, S., CUSlVt, 9.' ! CAL!EnI!-LArAIT88' tl (1974)t' 

ln vtvo €ttect ol ultresouod at hu'n th€rrpc{ttc 

do€cs oo @ffoe cell ch'@ap@s ol 

gotdeo rr.o8tet. 

fuDdng€!€tiN. l5r 133-r'r ' 

LBY!OI{, 8., tlaLPERN, S.' 

Correlatto! ot 

tlacab atldi€a 

J Nucl Ld. 14: 

[!om!D' c., €t sl. ( 10?s ): 

llllasoutrd sld collold Ecl!_ 

ot tDa trol@l .!d dls€.sed llv€'' 

2?-31. 

' 

LICltTltAN, a.s. ( l05l ): 

rltsossos oi tho llve!r asll bls4rl€r and b!t' 

ducts. 

P. 1243 (xloPLon I t'odon)' 

25r. IIXDE!, U. (1967): 

Gre[zcn atd 

biopsi6 Dtt 

boi 40,o00 

Deutscb Ied 

Cetthr€o der Pcrkulanen Iebe'- 

d6r leogbtnl-nad€lr Erlahrung€n 

voch6nscb!. 92: 1t5l-r?5?. 

203. LtPrD , r.J.r DE{AnDO' C.L.' STLVARTd' S" 

GLA',fSTET , D (1972)I 

Evslu.tlo. of ibe live! lod sgleen In godgkllls 

dr€easar Th6 v.tue ol heDrtlc aclntlsrtpnv' 

ao€rtcan Jourtr.l or t€dic1n6' 52' 356-361'

ff€lfrr: 

4t9 

, 264, r.rSBoNA, n.,86XLER, U.J" I|OVALES_OIAZ' J.A.(1r80)t 

. Pitfsll. to 6vold mislosdtng .p96srAnc' ot 

j 

blllafy dil.t.tlon. 

' J Csn As6oc R.dlor. 3t' 5?-68, 

265. lolUDlCE, T.D.O., 8UDaC, I., a BALIIiT, J.(10??). 

sepllceir; as. c@Drlcrtloo ol p6tcut..eous 

livdr blopsY. 

Grs!toonLerologY' ?2: 049-951. 

260. loxAs, ts.' DIBOS' t.8., tACxER, tt.N.J.. (19?2): 

lncress6d ap€clflcitv ot li\4or 'canning 

wlth 

Lhc use ol G!67- cll..t6. 

I ldgl J led. 2a0! 1323_1329' 

26?. loroliAct, 1., KLrdB, P,r ltaLPEnN' A.' LEOPOI',D' C'(19?5): 

rlucl€lf rdtclo€ .!d corlol.tlo! l! dl'Snosra 

of dt.€.s€s ol llve! and btlltlv tr'ct' Inl 

Sesin.ra ttr Nuclear Xedlclne. 

Grur .od Str.ttolr Ner York' 5!30?' 

263, losoual(v, lI.A., & VAL(ER, B E. (1033): 

Liv€r biopsv snd splstopo.togr.Ehv i! p'ttertd 

*tth thr@bocytoDen1.. 

Glstro€nl6rologY. 54! 2al. 

. 2$9. l,uBtN,0,, l,ElllUS, Z. (1162): 

lood pool scrnntng in lnvesLrgrltds hoprtlc 

rtuss tosio!6. 

; Seolns!€ Io N!ct€8 ledlclne' 2' 138-13X'

420 

270. LUCAftl,t , L. (1947): 

Aulls punctulo dsr l€aato s 6coPo diaaroEttco 

itr l4vo!1 d6r congr€aa1 dl @diclna intoraal 

p.32?' tde' r895 (quoted bv gollbtue!'|104?)' 

2?1. LUDBE@X, J;,GLAVdrINEX' A.g.' loNAl ' 

P'I (197?): 

ob6erve! orrot ln repottlnS od llver 6csn6 

lot sp.co-occu9Y169 r06lone' 

G&'tooot€lologY' 62r l0l3' 

272. LUNXIUIST, r. ( l9?o): 

I 

Llver bro!6y elth r roedle ol 0'?m outor 

drrGtor. 

: aci! Iod scsnd. laa! '?l_471' 

l 

' 

273. LUNDVÎt, o., & EI{8RBAC|(! r'' (1969)l 

fl€Patlc troulsE€nc€ ln porphvll' c|lt6!€' teldr 

tudisd !. lln€ needl€ aapif'tlon bropty a@rta' 

J Clin PathologY' 22' 7oA'1o9' 

2?4. LUNTAT S., DABIIAAAMTIIYT s.' gaxxar' s'' DENDSBT 

ln evaluatlon ot Tcggr-sc lrvor scrrttscris 

rnd tholr usetuloeaa l' etaEtatrc voll rp: 

s !€vlo* ol l4r4 etudl€8. 

J ucl l6dich€. 16, 52_65. 

I 

2?5. LYON' t.F.' I STIPaON' C.r'(19?4)! 

Atr tnvosttgitlon iDto th€ posslbl€ geoattc 

h.r.rda of ultr.Foutral. 

Br J 86dlol. 41t 712'122.

a2L 

ractrmsB! l.J.c., DAVE1, D.A. (1970). 

Chronosona aDortnllols !n.lu'od l'y an 

ullrrsontc felal Pul66 d€tector. 

Br led J. 'l: 92_93. 

rAcrNmsH, I.J.C., DAVOt,. D.A. (lO?2): 

Itelntlon6l6ip bcireen lnt€trsitv ol ul!r'souo'l 

lnd in

422 

J Nucl r€d. 14r 484-1130. 

, 2A4, {AllflUCEl, P.r., TRANCIII ! F., I DIOGUAROI' r.(19t6): 

I 

corroctton oi ab[orq&I co'gulatlon tn ohrollc ' 

' 

llver dts6.€€ bv coobln6d us€ ol lr6'b ito'e! 

Dlad. .ril p.othroobln cdplei colcontr't€€' 

' t-anc€i. ri. 542. 

235. rAnSUAl,, G., CnOLLA, D.r BAEiT, A.L.' FBVE&I' J. r 

|(BRREXTANS, B. ( l9?3 ) ! 

o&rl btarlder usll thlckenlngr . ndv slgn 

of glll bl.ddor dls€.8. vrsulllzed by 8r'v 

scale cbolocvato€o.oar.Pnv. 

J clln Ult;asound. 6, \11-r15. 

2s6. lt^trs ^l,, 

c.J.r., cAsAHR, r., UABnr' ir.l.' .t tr1.(lot9): 

c.rr bl.d.lo. *.11 aonoluc6ncv 1[ acut€ 

cbol€cYatltta. 

B.diorogv, 133! 429-rr3S. 

' 

2a7. lATolo, N.x., STADALNII(' A.c.' |OL[IAI' E r.Jt'(1077)l 

fiepaiobrl irrv scsnnr.g urng lc98o-pvrtao"vlid€n6 

glut@.t6. 

An J Sura. 1g3r 116-120. 

2SS. IAI'TREY, R.Ff, SCIIIEBLB, !.r., coErNK, B.a.' et.l.(1932): 

Perttuoroctvtbronlde ! s l1ver/spleen-spoclllo 

and Tu@ur - ln.glng ultr.sound 

nrdlnloav. 14 5: 750-tOl' 'onstraa' 

'uxr\:rl{1.

12s 

,N0, ncAl$ll, J.C., AUSE, R.C., *ACIAA' $.1{.Jt.(1005): 

DraFnos!tc vrllo ol sctnttllail6n scnnnins 

o! tbe ltver. rorld qP o! l0o0 aludles. 

Ar.h rni€rn x€d. 116: 95-110. 

290, 

291. 

xccARtlY, C.a.' tELl,S, P.N.T.' ROSA, F.G'I.' nalD' 

E. a, (r969)l 

Tho uso ot ultr.euld.t! tb€ dt.gooala ol 

cy4tic reslonE o! th€ ltvef.tr.t upp6r &bd@r 

.nd in tho det€ctio. ol ascltFs' 

cur. 10,004. 

lccaLLA D' R,R, ( 1075 ): 

focal porte hop.tts sclntigc.n dot6ct.! llrt 

Is tb€Ir slgolltcanc€? 

J llucl Led. 161 1007. 

|lccIIJ,r D.U.' drtr D.J.' TlYLOftr Y.F.(10?4)l 

Ltver biopsv: coplrlaotr ol tl:b 

Intl€trla ond tn-P.ttont.. 

Gstiodt€tology. 6?:ala. 

rn out- 

293. 

lcCLoA|(rY' n.V., GOLD, I., fESEnr E.(19?3): 

DqclcteDl. aftor livor blopsy. 

Alcb lnt6rn red. 132:213-215. 

294. f,ecnEADY, v.R. ( r072): 

Sctntigr.Phtc Etir.llod ol spl.a 

11v6! dl.€aae. 

s€!l! llcl r€d. 2. l0a_12?. 

lcSliERRY' C.K., SI'UBENBORD| 

lhe sls.!ttcanc6 

fl,T., r GLarr, r. ( lr6s) 

ot rrr i! tba bill$v

424 

ayateo .nd lrv6r. 

Surgory 

' Cynrocolog, lod obstetrlc6. 128, 49-01. 

TEIRE, ll,tl., taRRAllr, P. ( lr?a): 

Pfspustto! o! the Dollent lor 'bdooinal 

ult!.sou!d €cr.E1.g. 

Br J n.drbl. 51r 33?-388' 

10?. rDrtt, Il.B, ( lt?9) t 

Grcv sc4lo ultrdsound sctrtrntng ot rh'r trr'oonon ' 

tn: Raconc ldvonccs tn RrdtoloBv tnd lodtcal 

rnrghg' Eilitorsr Lodge at" Stetne!' R'a' 

Chuehlll lovltasto!€' 241-255' 

293 

XEIRE, H.B. [ IUABAND, J' (19?O)I 

Do@osir.tton ot l@sl live! dlse'ae bv ulf'- 

sound cnd coorpuied to@s!'phv' Ir' Ditgnoatl' 

urtlasound in C.6troIntestlnal dlaeas€' 

lld. (Jt T6vlor. Cburcblll Llvingatotre! 

Edl.bu.gb' 35-38' 

xELLrllxofF, s'x. ( 10t9) i 

So@ @.nlDgs ot th6 llver' 

crstloent€.otoav'?6t635' 

300. TELSON, C.L., nr6'rBRr F., EVEI{g' A_G'(19?6)! 

nlreurouBcondltlols ot th€ grll bladdet' 

Sdtrin noonLsunol ' ll! 2li!-Ia:r' 

lllrNcnl l, c. ( r05a ). 

one 6econd live. btopav of the llver' 

cos!.osnl,s.ologY 33r tlo'

425 

[!]NCUlNt, G. ( 19?0 ). 

On.r-srrcond biotsv ot Ih. llvtr.. Problcm ol 

i!s olinlcol aPPltc!tlon. 

angl J u. 2a3:542. 

303. tIDDLA1ON, ll.r, 111,. GarlltN, J.f .Jr.,CAllIloNDO, 

J.C., lDAllS, ll.t. ( r9?? ): 

slgnlftcunce oI cbroges ir blood !'eBaur€ 

and puls€ rate att€r lercul$eou6 rlvor 

blopay. 

at J D1t Dia. ,2:94e. 

304. ||OLAJI(O|, a., JASTNS(I, r.{. (10?3)r 

Incfoa66d aocsr upt.k6 ot ladiocollold bv 

tl!€ Ilver. 

.r r{rc I red. l4rt?5. 

JO5, $lLLEn,8.t., TIiOI]|S, ft.8. (19?r): 

Portal v€1n lnvtsior 'lemonstrated 

bv ultraaound' 

J CIln ult.s6ould' 7i5?_59. 

IILLTARD SADLAR, G.II'I I{ORfBI,L' P'J. 

L1v6r blopSvr l€thods, dtrgoogtlc varu€ alo 

lnt6lpr€tttion. chaEtor 18. 4l?-43A In llv6r 

lnd bi11uv d1€.sset P.tho-pbvaloroev, 

dirgio6ls, @n.3e@nt. Edttoaar frtght' 

Albsrtl, t.t...' Illlr.rd_S.dl6r: l'B' 

sa!trdors coopanv Ltd. 

30? 

uINDELL, H.J., 8I{G, A.B. (r919): 

G!ll bladdc. *!ll lltlckentng: ulira6ortc llndlnaa 

ncdrorogy. 133. 699-?01.

,;i-i.t.?l: 

42$ 

3OA. lrrCHEL!, S.4., GROSS, S.H" SPtrz, Ir.B.(!082): 

Th€ hypoacholc csud.t€ lober sn ultrAsonlc 

Ps€udol€ato!. 

Rlallology. laat 56,_5t2' 

I sos. xoI,l-ar {,E.r KAPIaNr L. (1952): 

Needle bi.)psv ot th€ llver' g6o€rct conalde'rtlor 

. calit red. ?0: 10-ls. 

3lo. roRRrs, J.s., caLlo, G.4., SCllEUEi' P.J.' et ar'(19?5): 

Parcut.ueous ltver biopBy in p'tleni6 rllth 

lorge brle duc! ob6truct ion ' 

i 6lsi.oenie.ology,63: ?50-?54. 

'i 

' 

i 

srr. MoItcAN, c.L , TRoucHT, t a.' oDDsoN, T'l fllotlPsoN' 

r.x. ( r9?9): 

Type lI choledocb'r cvstr ultr'aoDognphrc 

!pp.ar.nca. 

A.dlotogy' l3l: lg0 ' 

." 312. llORRIa, J.G., llcRAc! J.r PIRKINS, K'r'r AB18R' t'(1055): 

l' 

Liv6r 8c.nr1n8 1! obatluctlve Jsundlc€ u€lna 

.o1told.1 !.dlo8old. 

J coll,&.diol Aust. 9r 63_??' 

' 

,' 

'; 

ili 

.i: 

:i1'. 

!!i 

f. 

313. IOVITT,4.n., & DAVTS, A.E. (1954)l 

irr tnl!oI!l-td b! I ldrv ousr'ucL Ion I cxDorlotco 

1th tr€gdle biopaY ol tho rlver' 

,ttrnalB or Int€lntl !€dlcl!e. 40, 952-952' 

314. xuJAl[D. 2.. GLENN, F.. Eva s' J.l. (10?l): 

comuntcrttna clvoroou' €ct&41' ot th€

42? 

int..hep.ttc btle ducL6. 

ao J Ro€uteorol. ll3(t): 21_36. 

315. {lNOfF, L.R., & JOIrrSOrl, P .r. (19?4)r 

'tllc uso of dultiple rurlionuctidc inaglrg Lo 

dlf f o!cnl-iuLo tlro looal i.lrlhoprllc loslona. 

ao J Roon'tg€nol. l2lt 129-734. 

3r6. NAFTALUS, J., LEEW, C.r. (1963): 

!o J Dlg- DIa. A, 233. 

317, NATIiAN, .I1., Ntl{lAN, A., llAc }AilAND, J.! ltuSRAY' 

D. J. ( 1900 ): 

cholecrstokinln cho I ecvatograpbv ' 

n&dioloaY. 93t t-3. 

3I a, SLSON, R.S. (1954): 

'lle dovolop@nL ond runction oI s llvcr blopay 

proarsn: tralnlog of goraornel, descrl9tion 

of a @dili€d vio silve!@o needle and crlntc'l 

value ol 500 b1opai6E. 

a; J r6d sc1. 22?! 152. 

319. NIDI,SON, S,P.I IIIAPIINSINI J" I,INDENBE&G' J.' NIILSON' 

x. L. (t9?8): 

Iteparo-blliary sclnilSlophv and hepllog!.pbv 

{rrh T.99!- d1€rhv1 acon!anllrdo-im1rodl.- 

4otic It obarluctlv€ lrqndlc€. 

J qcl led. l't 152-457. 

320. IEI|AN, U.L., MtNfZER, R,A. (107?) 

Accur.cy o! bllt$v rtuc! ult..sound: 'oop'rtsd'

424 

*1ib cbolroglogr.luv. 

Ao J Eo€ntsanol. r20! 9t9_'82' 

:t:ll. Noltl, 1.f., Icc/rllTllY' r.r slrIItZr N' (lO?4): 

('hole(:vsl-oktn I n clnl(ivslosrflPhv in trctrlculoun 

garl bla.lder dieease' 

Arcb Sug. lO8! 5O?-51l ' 

I 

', 

i 

': 

322. OKUDA, K., KqIDDA, l(., lcaMsEl' r. ' 

et al'(19?4)t 

Intr. b€pstlc ut€'rov6'ous 'istula '€autitlg 

rr@ no6dle broFY' 

a ca6o r€port Aota fi€pstog'at to6nte !o 1 

' 

Zr,tzZ-tZs. 

323. O(UDA, t(,, uosltAi t., NAXJINA, Y.' €t 'l 

(19?8)t 

Froqueocv ol trtrt heprtlc 'rtortovonoua 

tlsiula .a I s€quela !o percut'r€oqs no€dlo 

puocture ot th6 11v6r. 

G.stroentcrology. 74 t l2O4-14O7' 

324 or,(EN, 4.t,, BLEDSoE, n.,.NEr |laRx, ll,l11'(19?2): 

. The ultr.gouDd dlagEoala of ptr@'v carc!!o4 

ll 

: 

i 

ot Lhc gull blr.rdcr. 

lttdioloSy. l29t 431_442. 

32s. OLI(EN, S.t" ALaDAOE, R. I Nafranl(r r'llt' (19?8)r 

Tltc ultl4Eont. dtagnosls of p'tfitrv clrclnda 

ot ths 3.11 br'dd€'' 

nrdlology. 129 

' 4al_4a' ' 

326. ozAltDA, A., PTCXASNi J. (1062). 

J Nucl r|€d. 3' 149.

429 

327 

-18 

B8E1TNAR, 4., DANICAES, J.A. €t .1.(19t1)! 

Etsscotic osteos.rcor! ol 

1Iver. 

reEort, AsdlologY. r00r ll3_114 ' 

324. 

329. 

33t. 

PAIIE, P., 8IIAF'!B' !'A., BOSETITTAL, L' 

xon visu.lizstto! ol tbo a.u 

Tc996 DIDA clol€.ciltlgr.pby 

ol €holocYatltl.. 

C.. Ied Ass@ J. lla: 3a4-333' 

(!973)r 

PABETS, A.D. (r059)t 

Oet€etton ol inirsboi.trc @tsstlEes bv bltnd 

nlcdro lrver rrlopst. 

,'lD J uod. sct. ,3?:335. 

p l|iDR, J.C., Srror, r., zltBrolur, l',6r !r'(lt5?): 

Noedl€ llve! btopsv tn b6nign snd naligtra'! 

dlde.so. cmpdlsoa ol tbe r€nghtol '!d 

vln 

Stlv€ro.. i6chntc6. 

Ao J D18 DiE. t: 63?-698' 

PARKER! J.J., & glBraE ' 

J.{. (1967)t 

R.dtology. 33' 142. 

332. PARULAKAf,, s,G. ( le?5): 

l,lganents .nd l!€su!.€ ot th€ ltvelr 

Rsdiology..130: 4o9_alr. 

333. PISQUTER, 

J., mRaa, T. ( l9?4): 

Focrr hyDartl:ttlon ol radtocollord

.t i.:l-. 

430 

liver ( rettert. 

J Nucl I.d. r5: ?25. 

334. pISSALAqUA, 4.t., OSTER, Z.d.' clAl{DIlA' 

Live. Pl€ursl cavttY sc'n fo! 

sub-di.Phragmdllc abaceas' 

clitr Nu.l'Ied. 3r 209-211' 

R,, er.l.(19?a): 

33s 

P/IUTDL, S., PIR8T, L., SCIIOUTENS' 4., 

aEC(ARs, C. ( l98O ). 

Tcs9'-DloLhyl lD^ inlgtng: 

Io lsun.llced P!rrenla. 

J lucr |.€d. 21: r022_1028. 

VANDEB COTEN, G.' 

qlrntcrl evrluation 

336. PEpPERT Il.f., XENIIE' J. (Oct' r9?5): 

use o! stctbocone l! rbdmln'! 6crtot@t"pDv' 

Pres€nt€rt.t tbe trentl€tb toou'l conlo'elce 

oJ Lb€ Aneltcrn lostlLut€ of Ultlasoqnd tn 

xedt.lne. 

33? PURRAULT. J., xcCIlL, D.O. 

' qtl, B'J',TAYLO&, r'! (r9?8)! 

Livcr btopsv. rooplics!tons ln 1000 1n-D'tients 

and out-p!tie.ts. 

(i!srro0ol,c!olorly, ?4: 

333. pET8RS.8.S. ( 1963 ): 

t.actute of lenghtni neodre io liver bloPev. 

JA|IA.206:1515-15?6. 

p&TDRSSON, H. ( l9?a): 

Clrcinons of the gtrll bt'dd€r' A revj'€w ol 

153 cdcoa. 

Actn Rsdlologios Dirgnosrs' 15, 225-236'

431 

340. PIILLTPS, G., BANK, S., I(UXABI-SUEAIYA, S.I 

tiui'lz, L.r. (1942). 

Pefcutaleoua ullfr6outrd Suided punctule 

or tho gaII blldder. 

E!.llology. l45r ?69-??2. 

341 

prEllDn, J.r., I CnIc|llOI, A.U. (1073): 

P.tmcry c5rclrd. ol th€ a.ll bladd€r. 

su!g6ry, cynecologt I obat€tltce. l{?, 919-942. 

34!. nrz?,anr:t,t,o, D.J., fo|-sl(vl /1., BECXDn, l|.[,, ol r1.(19t4)r 

Lo Lcsiltrg 0h() olfoct of 

!taaue grortb and dlllete.ttatlon. 

226-232, 

343. POtXt, J.R., SrIT[, C.t. (10?6)r 

The rsdlo iodlrrted ros b6ogal tect tn iho 

diugnoela ot congeoit.l blllary 

Clltr Nucl led. l: l?9-185. 

344 POPPIR, lr., ScllaFFNER, !. (r95?): 

l,ive. structure and tuoclton. Flrat aditlon. 

lrccrrw-fill1 Booh co. N€v York, P.182. 

345. pnANm, r.. C,ou)SIE[N, ll.r,, BE&lillDINo, 1.8., GREEN, 

B. (r0?0): 

UlLro6ontc psoudole€ions oa th€ livet. 

n diology. 130r aO3-ilo?. 

Pntrcln, L. ( 1967 ) r 

ln,prl- lc a.ra.lov.nous tiat!l& afler Dcr

ll!2 

cutloeoua llv€r blogay. 

tro J Ro6ntgenol, l0l! 6r9_6P0. 

i 34?. PRBSTIN, !.8. (re?8): 

I 

percltsn€oue liv€r btoE€v add chronlc llv€! 

. 

d1se.se 1! he@thlttac 

hncet. 11,5r3. 

' 

343. PUROT,4., GROSDAAG, S.J., IAPNICI' S.1r0??): 

Ieosbr!t leedl. !..ctur€ tltdr rttdpt€d 

rlver blopay. 

cast ro.!torologY . ? 3 ! r404_1405 ' 

349. naoiravEltDRr, B.N. I FIENER, x.o., suadA|ultu, 

' 4.R. €t .1. 11081)t 

tu!o cttotccvslrlis: 3otrogrlphIc prlhorogrc 

r!!rYa ls' 

AJll. 13?:32?-332 

i 

li 

i 

'" 

i: 

350. RAlitDs, D.tr., vîlaaaflrl, R.L', Jolllsol{, L.F.(10?'}! 

lntrshopattc hsnstocl . conpllc'tlon of 

D€rcut.Deous l1vo. trlo9av' 

G!6!foe.t eroloav ' C?:244-2e9 

351. RAXE, r.o.r r0BMv-LYoN, I.L" allsBLL' l.D.' 

' Itl,LlAr, R ( 1060) | 

1r 

trprov6d ltvsr btopsY .€sdlo' 

,l Lancet. 2: 1283. 

352. RArlS, P.f., ml|,8T,r I, P.r., QUr N, |r.F.' ltALL, J.(1932): 

, RsdloloSy. l45t 123-126 ' 

fr;:

t 

433 

il 

35:J, llltl,ls, P.1., fiALLs, J., LAEI!,4.2., qOlril{, I.F., 

ronnlst u.t,., BosfEII, t, (le8l); 

P.ospectlv6 6v.luttlon ol tbe €otogrrDllc 

Nrpby 61g0 l! a!.pect€

434 

359. R^STUSSEII, S.N., so!I, 8.x., ExrlrrB aElr' J.D., 6t rl.(tg?l) 

' 

ultlaEouod tD tbe dlrgoosla of llv€! dl'€'a€' 

J Cllo Utttc.ou.d. t, 220-226. 

360. RASf,USSEN, S.N. (10?2)t 

Ltver votom dst6rmlB.tlon bv ultla6oitc 

scannl!3. 

Br J Rrdlol. a5, 4?r-485. 

361. IlErD, r,d. ( 1976 ): 

vtsu.llzstlo! ot tb. btl€ ducts uallg ioaua.€d 

ultra60u!d. 

Rsdlology. ltat rii-158. 

362, RENNER, T., |BNT, J.,ICLEIII, J.' PLATTNER, G.(1982)1 

ultlssould d€@!.tt.tlo! ol a loD-calctll.d 

gall 6tor€ ln the d1€ts1 lleu caqsllg .Dallboqsl 

ob.tluctlo! ' 

Radtorosy. 144! 884. 

363, RIyNOLDS, T,S, ( 19?l): 

A@eb1c tbac€€€ oi tbe lrv€.. 

Gstoeat6rotoSy. 60 ! 952-r5t. 

354. ROBA&TSOr{, n.D. ( lt?O): 

Non-crlculoqs .cut€ .tlolecv6titla lolloxlDl 

aurg€lyr tr.@. ald lllneaa. 

A! sulg. 36. 610-a 14. 

365, ROUOLI|, r., TRAHJP, N.8., I MRaEN, P..(1942): 

A6pi!.ttotrs blopate d€! l€be!. {lt €1d6!

4t5 

ubersicht ubo. dte afgebnlsse b€t 29? 

Biopst€n, ar3€btr. lno led. Ktodelh. 61tCl5. 

366. noLlrr F.D., DELAIID, l.[. (r968): 

ftl6 det€rtrln.llo. ot llver dess lld 

radioouclld€ lo.gea. 

Radiorosy; 91, 1!01-r194. 

:lri7, ttoNll, r,.x. {1077): 

xepatobiltsry r!d1oph.loac€utic.la: d€ttnlng 

![ci! role *lll !c 4 gllling c.Dcriaoco. 

J Nucl r..d. l8 | t33. 

163. IiOSC , J., LAKTN, P.C,, ANltllovrC, n., et ir.(r9?3): 

Tr.nsJugqrsr .pp!o.ch to livea biopsv 

lnd tra!6hcpatlc cholanglograpnv. 

N EDg J l6d. 2a0t 227-23r. 

;100. tosEN!.rELD, A.1., sIuolti, N.J., (APPLEIAN, N.B. 6t al.(19?? 

crcy scale ultraEonography 1o nedullary 

cyailc dlaslae ot tbe ktdtrey ind cog€nit.l 

hepatic flbr@r€ *ith tubula! ectaslA: 

Ne, ob6€!v.tlon.. 

aD J noontS€lol. 129: 20?-303. 

3?0. trosENfsal,L, L., slI.PSaR, D.A., Lrs@l{A, R.r et.l,(r9?8): 

Lrrasnosrs ot hsp.lobrlrsry drde.6* uy Tc99'- 

HrDrr clloloactnttarrphy. 

Rddioloay. 123: 46?-4?4. 

r,,, us||!li, ti, s, (r9so): 

A€6esseol ot coiirlned rlonl.r and laloril

436 

vro*a 1n llv€r €crnntna. 

J csord aaa R.dlol. 3?r 151-!54. 

3?2. ROSS, tt.D.! rrNBY, n., I EVaNSl, J.A.(t9s5)r 

l.t.sourrl dlveltlorloata ol ihe gell 

Re.liology.. 8ar 300. 

37 3. R('fl., d.lt., sotDNEa, t. (!0?3)l 

Tb€ €tt€ct ot ultrraouEd on buD.o ch.(Ds@a 

liuDDae.otlk, 20r lol-112. 

lwtulAal, I.I. (l9ll5)t 

clstr@ot€loloay, ddllsd bv Socb!6, vol'5, 

p.600( I.L.. gaun

437 

RUSaSLL, J.G,, fAYLOR, V., molaNcB! B' (19?6). 

Ult.rsonlc .ltlgnoala oi choled@hal cv6t 

r! !r€gn@cy, 

Br J Radtol. 40t 121-426. 

IIYIRSON, r.t. (1974)! 

PercutsnEous !o6d1s !ivor blopay {ril 

scinllgraphlc .ontrol. 

Radlology. 1r0t226. 

3al. 

342. 

saBATINr, D.D.r BE SCtl, X.! I BlRRNEft, n.J.(1983): 

cytocheolstly .trd €loctro! olcroacopv. 

Joufnal ot c6ll Brorogv' r?t 19-58. 

saDDEr( tr s., {urculraoN, D.E" C@PttrBEBG, P.L.(1931): 

Tbe sonogrsphtc.lly p.tont uobilic.l v6ln 

1n portal hyporc€nsron. 

RrdloloSy. l45r aal-443. 

sA!DI, S.A., CALLr E.A.! tlulpE, c,V., ! scxIF!" L.(1043)3 

Nc€dro btopsy ol tho llvcr. II Axpa.tonc96 

ril-h Dllig.onl trcoDllso' glsr rocnrcrorogv' 

1r,93. 

344 

3 35. 

SA!U6!S, L.D., CROSSFEU), J.L., xrRTIll, ll.(Nov. l9?0): 

Livet scsns lflot p.iBrv tle.tmnt or tu@u!3 

in chil.lren. 

surgery, Cr!€cology I obst€tatca. 953_064. 

SAI{DERS, 8.C., ZEtrHOUrI, !.(10?8) l 

Thc stsntlltincc ot ultrosonlc gall broddor 

wcr.r thtck3nl48.

438 

j 

' 

i 

Pres€nte.l .t th€ AFtrc.n ltrBtltuls of 

UlLrusoutr.l in f,udicioo, sar Dlcso, CA, ool-.xl-23, 

3s6. sAtpaR, R. r rAJsar{, t.A., TAtlcax, Y.A., NlxoN, D.ll'(1931): 

Etrhanc€d dot.ctio. ot ei.atattc llv€r 

drsess€ by c.ncer ol ih6 llver qirh Gs6? cltr.le 

Ab J Ro €nlgonol. ll9r 02-103. 

3s7- saT^va, la.a., vlN gEtnDEI, T.A.r gllDUDYr P.l'., et al.(I9751 

I (hd!lnl rrlcrlovqrous riil!ttr lollowitrs 

.r liver bloDsy. 

:.: Gnsl r(mntarolosy. 09. n02-495. 

:i 

,. rss. seutn, n., FA RLAIIoER, t., FBIDRICII, R.(19?3): 

:t c*p.lrson ol th6 tccu.act ol llver 6c4.s 

and Pe.rtoneos.opy itr benlgn and @ligr4nt 

prl@ry snd @t.atrtlc tuloufa ol tbe liv6r. 

Sc.ndlnavl.n Journol of C.attoenterolosv. 

8 t 239. 

339. scaDDn{Gr J.G., a sliEtrLoc[, s.(1943)l 

Liver blopay 1n a.rcoldoat6, Thoraa. 3:?9. 

' 

390. sclAF!'Nlllt, !.I sl'lBNl,lulj, l,,llall(Ar'l.r I PoPPlll 

II. ( 1962 ): 

fieDatocellula. cbanB6€ 1n titl6on's d1sea.6. 

lllBtochentc4t .nd 6loctron mlcroscoplc studles. 

Arrricln Jourlll oL lllhuloay. .ll: lr5-323. 

:r91, SelrLrll.rL,$, rl., collNK, lJ,lJ,, & LSolroLD, u'lt.(19??): 

crey acql€ ochoaropltic prlLerns or hopatrc 

I 

Ad J Roenigc.ol, l2or oa3-03?.

'$*tli'ill 

430 

sclrlrrF, r,. ( 1051) l 

'Ihc cllrlc.l v.luo of nsodto bropsv oa 

rh€ llver. 

A!. lnt rod. 3a: &la. 

scHrfF, L.r GALL, A.l. (1972): 

needl€ btoDey ol th€ llvor. l.

39S. sEv$OU8. C., NAALE, C, I EETERS, T.J' (19??): 

l,vsosomrl chsngoa l. llv€r ll6au€ trm 

pstlsnts rlth th€ Dubtn_JohaoE-sprtnz avn

44r 

S ERTOCK, S. (1902): 

Ieedto blo9aY ot !ho llvor: ! rovicr. 

J clltr Palhol . l5: ,lsl -304. 

srlLltl,oC(, s. (l)68)l 

Dlseusls o.l lho rtvor und bill!.v svslcn' 

3rd cd. ' 

p.550.(Bllckvelr' O,tord)' 

407. SUERLOCX, S. ( r 981): 

cvst6 and cong€nltsl .biorollitios In' Diaerae6 

ol the ltvot rnd bttr.rt sYgteo' 

sixth edltton' dr.clv€rr Sciotrtllic Publtc'troda' 

4OS. sulll, f.J., cll6x, t,B. (l!?5): 

An lodlnlted ros€botrg.l atudv lor gelr 

itrdenrocion tn the r.dlocolloid ltver 

chlne66 t€dlc.l J' 22t 76-a2: 

409. sHlH, I.J,, NOLAN, N,C. 

!'atse_PoalLlte llv€r Bcsn due to splle 

detornltY: LeIl€re to 

J ljucl. l€d. vor. l1' 

4IO. SHERIIANI M', RALLSI P'I" QUINN' X'' BALLS' J" 

xrats, J.ll. ( 1930 ). 

lntlavonous chotstraloglspbv and eologlapbv 

in !cute cholccyc!tLIs Dfospcclivo ovlluotlon' 

AJR. 135:3ll-313. 

4lt. sltl|(Al^, T.! UZA|A, T., YorSllrtARA, N.' A(ATSUf,r' 

T. r YAvazaKI, a. ( 10?4): 

srrrtrlrg dilltod or lustrlrlu !'Llscn lr

+-1t:i!. i 

142 

plraLI itr soerior. 

rntrn.s. Joxrnrl .l llsDdriftxrl!l rddlclno. 

:l lr:. Stlulun, 1.J., Lf,OmLD, C.lt.r sClllEOLB, F'f'(1981)' 

Ii 

somsrophy.of rhe Lhlcketred garl bt.dd€r r.rl: 

i 

r non-specltlc flndlng. 

AJn. t36: 33?-330 

'i 

I' ers, sltx aKrtrom (Ja!. 1083)l 

Inl rr ope.ltlve ultrasonosrJin'L and ultraonically 

gulded hep.t€ctoy. 

t!. Tosblb. I€dlc.l ievisv. Vor.7, 2e-30' 

.l 414. SllIAAZt, P.fi.r RAYUDU, C.V., lOf,DlIAr, 8.V,(l0tl): 

Extt.osseous oslqogonlc 6a!c@& o, 6dall 

bowel ddnon.t.*Led by lla 6canrlng. 

J Nucl l6d. !4: 295-296. 

I 

415. sILVdtiBBUG, X., AOSEI{llllLL! L., FREETAI{, L.!.(19?3): 

tlosa l,cna.l exrrotrotr sru.lies as !n ald ln 

l,he dillercoti!1, dilgnosis ol oocn.lrl J&u.dico. 

sm llucl Isd. 3: a9-a0. 

4r6. SXETANA, [.F. ( r9s! ): 

The histologlc dl.gno6is of vllal h6p&tlttE 

by noedle blop.y. 

Gastroent6roloSy. 26:512. 

4l?. SNAPPER l. (1951): 

Discussion o! iappiport E.l: Liv€r btop.t aev. 

castroentorot. l8: 049-650.

{43 

4la. solo{Ay, n.D., BAGGINlOSS, A. ., SCUOEIfIaLD, L.J., 

suurGRsl(lLl,, 9.tr.J. : (t9?l) ! 

obs€rver error sad alnpllra va.labllltv toat€'l 

tn gvtlustloE ol h69stlt1. snd crrrhoEls by 

llvor bloP.Y. 

A4 J Dlg D16. 16r l082-1046. 

419 

SoIIERIELT, S.C. ! ( !a5l ): 

!.ligltnt !6prtots dtb loprro.tloD et.st_ 

06ta lollortrg l ltcr Punct{.e. 

Notd rbd Tl.lakr. ,16: la92_1494. 

sortBR, c., FILLY, R.4., LAIXCT r.C,(197?): 

Ude. ot slFtblcono .s i p.trent pleplratlo! 

lo. .bdooro.l aolog.rDby. 

lsdiorogy. r25r 2!0-r2r. 

421. Sl)tttrllrc r r.a., BauuDlz, r.(ls??r! 

vuluo !..1 €raoly ol perculn.eous llv€f btopsv 

rn ob8tructlve laundrc6. 

ln€tlcsn Journ.l o! c.at ro€. terologv . 

6?r 444-,I48. 

422, SPENC!&, R.p.(1S67)l 

Quanttt.tlv€ r.dlotaotopo sppro.cb€E 

h6pstlc .126 .nd lunctlot. 

Ao J Dla€.tiv€ Dta6.a6.! Nov sorles. 

l2:515-521 

423, 

sPE|{cEa, R.P, ( l97a ): 

lhd lonuc I ld.' 

Cltoic€ In CaalootrtstologY. t: 4?5

aplDGUL, n.U., xINC, D'L., GREAI' f,.n (19?3)! 

l,lirasonoat.phv oa prto.lv cv€ta ol the llve!' 

aD J llocoigeDot. l3l: 235-2la' 

.125. SpINEILI. G.D., XLB1tlcllus, D.ll., IE cBR' J.J" 

cfiitlsftlNN, D.J.L., rAfmR, D.P.' {IRTEB' P.C'(rt32): 

ObstNctlve JAundt.e .nd abdotrlnal tortlc 

.n€ufv6n! sn ul!rA€onogrcphlc aiudy' 

RldioloAY. l{4: 435-436' 

aptrxr f.1., uoaFMUEll, P.1., lau(aR' 

R. A. ( tgat ): 

Ul.topaiholoAy of the ltver 

t.f. r 6&EEx, 

J Lab Clln U€d. 34140/ 

,12?. sr'lllr, 1.v., luxTl^ , ll c.l 

Livcr iuging ln 

venous ta!.onboa1s 

lreregtobinurir. 

ItudiologY. 117 ! 34 

t-3.t4. 

t13 

STADAI,NIK, R.C., DoNARDO, S J., DoNARDO' 

critic.l ev.lultlor of hep.tlc 

grapby lor n6oplaattc tu@u.a 

J Nucl ||ed, lltt 595-001. 

STAIiFARr X,I{,, CnOSS, J.B., IOULK, ll.T.,6t a1.(1961)r 

AnylotdoEl.. Diagnosls lttb ||dedle blop€v ot 

ihe I iv€r It elghteen PnLtcirr' 

G.6rro6ntorologv.'tl: 92-96.

445 

430 

STEVBNSON, C.!., I SUER|@D' r.lt'(19'.10): 

Th€ roentgetr dlagnoslE of 'hol€cvBtocoltc 

tratulr' 

RsdlologY 35t 616-521' 

431. STEVINAO , CiA.( 1044): 

EmPbysen4;ou6 cltolecy€tttls' 

lturican Journar of AoonleonorogY 

4 33. 

4X4 

5l:59-60. 

It-, sfansr,t(, R.J.(!r?a) 

tePAtic 6cttrttgtaDhY ln c.roll'. diaerB€. 

liddlology. r2? 731' 

stY,,i.ll., sul r,IvAN' l'., { CNfin' 

' 

soAREZ, C.A,, BLOCI(, F.' aEnsTltlE' l''' riERll'llll' c" 

&oDttN, c., ZEPPA, R. ( 1980) ! 

Th€ fole ot trIDA/PrPlDA 6c'nnltrg tn di'g'oattc 

cv6tic duct obatrucllotr' 

Ann Surg. 191: 391-30€' 

SUBRAIIANYAT, i.B.' EALIIIAZAR' E' J' I f, ADANBAI I.R., 

naG|tAvEliDRA, B.ri., ltoRll, S.C', IEFLEU!' R C . ( 1933 ): 

Sonog.aphv ol po'Losvel'eoic vctrous 

ln Porirt !YPcrlensrdn ' 

RsdlologY. 146: r51_166 ' 

4 35. SUBRAIINYAITI B'R', BALTIAZAR' E'J 

ttoRtlr S.C., llrl,ro!|, s., ltllD'cll' 

Ul l-r.€ound an4lYei6 ol 

n.dlology. 146: rI3?_40! 

.I RAGIIAVENDRA' 8.N., 

D.P. (r933):

4.16 

.136. SUI(OV, ll.J., sllPl,!, rr.l.' s/Infl' D'1" r^lll ' 

J'o ' 

{lrITcolrB, n.T. (r9?0): 

Cholccvstosonogtuphv - 1hc Juncttoml told' 

RldiologY. 133: 435-436' 

437 suLllv^ll, D.c., TlYlnR, t(.J.f . 

' 

'rhs us€ oi ultresound 

dlsgDostlc utllllY ot 

c0r"rsclA|,K, A. ( rt?3 ): 

rbe €quivocal llver 

Rrdtoloay. 123: 72?-?33. 

N., flLLlArs, R. ( r9?6) | 

osti@tlon ol llver arze: a 

t€ctroiques .nd a! r!.1v61' 

l0a2-1043. 

4!.J. gljr,l,lv^t{, s., fATCOt{' lt.c. (197{)l 

i(:ul'e !rrnsient DvPoL'rnsion trs cdnDlicrllon 

o! pelcutaneoud llvo! biopav' 

L!trcel. 300 ( Irrch 9)' 

suzuKl, T., IloNJO, l.' lllrAtcno, K'' et al' (19?1)t 

Posittv€ scl.llgrlphv ot ca'cc' ol the llve' 

rlih Ga6? citrste' 

ftD J Bo€.rgerol llS' 92-103' 

szraBlcK, R.E., CAfto, J .A., IINI(Ba NE!t, D.' 

vEvr'UaA, v. (1930)i 

H6pstoblllalv acannlng ln tbo dtsgnoslg ol 

acu!e cholecvatl lis. 

Arcb Sug. rl5r 540-544.

;-e 

447 

442, 

lAtLOR, A. Jf, |(lPPDR, M.S.r tlITZl'Uf,' l(., GR8!NSpAN' 

c,. &lN. r. (1942): 

abnolnal Tc99'-PIPIDA scans mlst4ksn tot 

codmr duct obatiuctron. 

RrdtoloSv. 144 | 373-3?5. 

.t.1ir. .r.APLrn, G.V. (19?l)l 

Acvte* pdpe. : Dvnatrlc sludlc6 oI rlvo' lu'ctton 

rlib r.dlolsoiopes' In' Dv'ulc atudl6a 

ri!h rsdlolsolopcs In ls'ltelno' 

P.oceedlng6i pp. 3?3-392' eott6rdu: l!t€r_ 

trat{o!&l atoDlc EnofSy Agencv' 

lAyt,oR, t(.J,r., CARFEN R, D.A. (19?4)l 

Grey sctle ul!!.soooSrapby ib tbe inveati_ 

gatlon ot obsiructtvo laundlce ( Lett€! to 

the edltor), 

Lanc€t.586. (S6pt. t)' 

445. 

(. J.f . I clRPEmat, D.a., rcc0BADl' V.R. ( l9?') : 

ultrssound and ecrntlgr&phv 1n the dilr€rantttl 

dlssnosls ol obstlqctrvo J.undrce' 

J Clib Uttra.ound' 2t 105_ll6' 

clliics In dingrosl l. ullrrsound: ditrgndsrrc 

urlflsound in gtrsrrolnLerl tnul drscusc 

N.N York: Ch{f.lrlll I lvlnasldno. t0o' 

447 , 

K.J.lt., lllLL, c, R. (19?5)l 

sclotrirg Lcchni{ruor ttr grov_scrl€ ulttrEonoareph) 

B. J Radlor. 43: 9t2-920.

443 

aaa. TTYLOR, r.J.l. (lgta)t 

curi.6!t status ol toxloltt lnv€st18't1on" 

J clro Ultr.su.d. 2t l'9-r5'' 

449 TAYiOR, {.J.1., ! LccRBADY, V.n. (19?6): 

r cllnlorl evrtuttlon oi gr6t aa'l€ 

Br, J lrsdtol. 49: 244-352. 

x.J.t,, POND, J.B. (10?2)! 

t .tudy ot Lh€ p.orl{clloo ot h&rtth'alo 

:li 

l";;.;: ;;i;;;';".; ;;i;.i ..; "'$i 

pol.€d utt!.sou.d o! lo* r€B.b€rt! lr6qu'! 

ct6s tn th€ contoxl- ot s.lott lof cll'lorl 

Bf J nadlol. a5. 3a3-153 

451. t'altoltr x.J'f., ROSINFIaID' a.'1., D€OilaEF' C'a' 

ar.tdv rDd p.t'boroav ot th6 bill8v tr'€ 

d€nooEt!'t€d bY ultlaaould' 

a52. TAvloR, l(.J'f,., BoaENFIEID' A.T. (rs?tt: 

Gr€Y gc.l6 ultrssonoSrapbY ln tbe 

dr.snoal€ ol lroD'lico' 

Arch sug. 112:820-825 

453. TAYtOf,, f'J'r" toeBxrralD' !'T' (r9?'): 

N8l€.t rdlctle v6!5u! ultr'sound' 

J llucr ra.t. r8: !133' 

45,a, TAYIOAT f-J'l' 

Gf.y 

I gultlvlri, D., ROSEllFrEtD, A.r., €t rI:a 

6c.1. llir.€ouod Ed l.qtoP. .c.lnlDtr t 

I 

i;i

F.:i 

ti l:; 

',i , r ! 

ate 

C4r-!!rry 

t.ahrlqu.t tor t-11!a tn 

i158. tlvlLLt 

. GAt@ll t 

lr .t io€lt3eool. r": 3t?_rar' 

455. taflp8, l(.J.t" aIclIAIl' l.s. (1013)l 

D1....€. ot tn. !rv.!i a"itllta 

Vol . a!!tl' Lo.r. 

at6. rlYl(xt r.r'1. (lcta)! 

oltrr.olto P.tt.!!. ot trmlit ol tb€ 

J cltn Ult$.oot!.!. ar la-to. r 

a5?, TarrlD, 

SIrllO. 

459. lAAtISltY, 

t.D., alDalgf,r P,I., llxlllfl' r.1.' 

t.!. (leta) r 

D!.post. o! b.9.t1c h-.allo.. u.l!a 

r.rUo.ucltde .!.1 rt arr.an.l !@l|||lqu'a' 

.I Nuol Ld, 4tt t6l_t64. 

e.e.'. iro,8.J., asaE, L.,.rma, l.a.' 

r., s@tt cr, 8. (1e?5)t 

It Bu.ld. chr.ll s'ldrct cors.l.itor !ttl!'t 

h.irtlc rohtla!.pnv .!

450 

a6l. 

462. 

tBtet, a,B. ( l05a): 

x.croacoPlc .11&gno6ia ln r1v6r blopsY. 1 

. Jouro.l ot tb€ loefl..o ledlo&I A.@i.t!oo 

l5a:990. 

rBnIEtBG, J.1., f,alT.tic, J.p,( le?5) ! 

acute sorlcrlou. chol.ovatltrs 

ot otb€r llln..a I. cblldb@d. 

alch St!., l l0l 5'I3-547. 

,16t. toxxrll. a.x., DELlllD, f.!. (Jorc, rg?a): 

Dlhyd.othtoctlc icidr a no{ polvgoatr c.lL 

ioatna .3€ni. 

J ducl l€4. ls: 530. 

464 

,t9PP, J.!., LIIDEAIT l.C.t., r MPdt,,l.o.(19{8): 

Io6r[e btoFy ot thc llvor. 

Int I6d. 8lr 392. 

^rcb. 

c.J,, I td)aR, D,a. (1041): 

Th6 dlll6!6!tl.l .l1ran@ia ol iFrtrl! 

dts€rses ot tb€ llve! by pirlob bloPat. 

Ar J Crl! E.tb. rr: 516. 

40s. TR!POLr, 

{66 

TRtCEi, 

tRoralr, 

D.R., ttLLttiD-gaDLaR, C.1., CIA'XOSSXI, 

1,, I tircua, &. (lr?0)r 

Alphs-r-!ntlLrypsln doliciencv and I lvct 

dls€.s tn ldirlts. 

Qu.Ilerry Journ.l of IedtcIn.. 45r 5I-72 

dAsEDA, Y. (lgao): 

concotrrrrrlon rtrd clcarricu 

,i"l! 

Iii 

w

t5l 

lsorolclne bY e b.Petd.i 

5! 196-199. 

468. UgZtA&, J.r" srrxsd' L.A' (19?5)! 

Foc.l lo

414. 

115. 

452 

vrscorl, G.N" CI.)XZII,ERI R" TAlton' l'J'f' 

Ilstoprthologlcal corrolatlo! ot 

.pD€aBnces qt ltv€r Ftaat'a€€' 

J Crio d..t!o6tte!or' 3r 395_400' 

(t93r)r 

vrscorlrr c.!1., TAtlo!, x.J.r. (r9?'): 

lnatonv oi tbe 1lv€r bt groy sarl6 ulttasooogr.pby' 

J cllD Gsstroerterol l: 351_3ct' 

1,t 

476 vor.pu, J.4., Jollllglbll, G.s. (107o): 

rfioc' hoP'tic br$trndrh& ! 

cotrceltr.tlrg tlve! *" 

J gurg Oncor' 't 

213'311' 

477 

4ta 

vo!{rLEn, 1., i JoNBS, c.l. (!94?): 

Tho dr.aoostic 'nd 

lh€lspoutlc v'lue 

bloD6ios tith p'rticul&r t€t€"nce to 

blopav ' 

Ite* Etrgl J led' 23t:551' 

voNlllALDR, ll., lla ' (10'!6). 

xlln frsch. ?5:533 ' 

a?9. vot{ |AES, L.r Llao8n' c s (19??): 

!..1v poftv€nllbr sclero6ls in slcohotlc l'tty 

lrvorr .n lndsi ot ptoarosslve rlv€r lrJury' 

Gd6!'oentetoloAY' ?l: 6rt6_65o' 

|AAC, n.C., GRAI{LAI(r R.' LER An' R l ' 

LaB', p'P K" 

HUX',r'ER, L.P., SCIIENKT E. (10?2): 

Tlseue ch.lsclorr6slton bv ullraaonrc

diIltr(rion. 

lrlrriiotr..l itr lft{li'ln' 

:llt' lnlS' 

;tl . TAL,Ds"flllN, s.s., srAlt1o, p.ll. (l9so): 

Accurlcv or sadl,ling l'v nccdlc hioplv in 

drllus! llver Jl5'u3'r' 

Aruh l'rrhol. 50::l2d-323' 

4a2. YAOINERT G.P., ul-8vtlcll, ll'' CILL' A'a', €t al'(r95!): 

lliopsy ol needle spoclmna ot tlver t1ssu6! 

vt. Cdp6rtson of iinditrgg on bloDsv 'od 

at 

autopsv. 

Ao J Ctttr Paihol.?l: 33a_341' 

433. tAL(, L. ( 196l ): 

noantgenologtc d€t'rntnlllon ot ttto liver volud'' 

Acr! ltldiologio!. 55: 4$-50' 

434, r]\l,{, r,. ( 106?): 

Rotirrscnolosi' dorcroinrlloo of llrt: livcr vol@' 

A.l d Ilndtoldljlctr Dirgtosls' tt 360_371' 

4a5. {A!,LACE, S,, UrOELl,tN, ll., N8l.soN, n's (r0?2)! 

]tngtogrlplttc chdnges due lo ne€dle blopst 

of lhe rivcr. 

tt.dlology. | 05: t3-l8' 

436. XAltfIcx & fIlJ,lars (10?3): 

oruv's lns!@y 35'lr edi[10!' Longnco ' 

4sl. *41Sol{, A., 1oRtraNcl, ll.ll. { l'J?0): 

I.iter scorntng rn surgicrl Pracllce' 

lrtr J Sur8. Vol 5?' No'6' pll' 405_404 '

{54 

4aa. taTrs, P.L" llltTs, A.J.r a fLEtlilc' J'B'E'(19?2): 

lrl!r.sound .nd thr(ms()ft duNgc' 

ar J lIldlol. n5! 335-339. 

430. UEAVIIR, R'X.J!., COLDSI'IItN, ll.x., oRllDti' a" et a1'(lt?8): 

crev sc.le ultr.so'ogr'phtc ev'lu'tiotr oi 

hePAtic cistrc dr&ase' 

An J tioeotgeno' 130: 349-452' 

tro. l{l:ltl, L..1 . , lllrltcER, 1,.4, sll&Rl,oc(t s (10??): 

Grev serl. ultrtrsonosrrplrv oI porl!r vcrn' 

Llnccr . 2: 675-6??. 

4ul. f},llis, 1,.t.,.!t rl. (19??r! 

Unususl echoglaphtc appelruoc' ot a lcour_ 

voister carl !l4dder'. 

J Ctin. UlInsouid. vol S' l)p 341-342' 

n92. fEtl,L, 4., alsENsc|tEnr 1., z!l"ll{ER' f ' 

nouraR' P" 

BrIlR, E. f, SAUCEEI, Y. (1979): 

Aspecte ultraGo.ote dcs cMcors de l' vsalcll' 

blllare. 

Antrals de Rldiologle' 22: l?-ll' 

493. lErLL, F., ErSBllcUER,4., ZaLTXEA' F. (r0?8): 

ullrlsontc s!{dv ol the nofnrl 'trd 

dllato'l 

billr.v l-rec. llB " shor sln' 51ltn' 

lludi0losY. 127 t !3r r2a' 

i 

40,1. rDlNsl[tll, l].J., i lElNs'|'llIl{r D.P. (l!r?o): 

Btltsrv Lroct rn rhe no!_jqundlc€d psrients'

Anerlc!n Ins!tr!lo ot !llfdaound in vodlctne' 

oklthorn clll. v()l l, l).lii. 

495, \vEtSlltloD, F.G., SCIIlln, 1,., cal,l,, 11.4., CLEVILAND' 

I.P., & llEltxlN, J.ll, (r050). 

Neddlo blopsy ol llrc lIvdr. lll cxDofiences 

l! rho dlatercnl lal dlngnosis of lllndice. 

casrrocrrorolodY. l4 t 5li. 

406. 'EISSIANI{, 

II.S.I BADIA, J'' SUGARIAN, L.A.I XLUGERI L'' 

ROStXDLA',T',T, 4., lltEBrlt{, 1.. r. ( r931): 

speclluo of fcggrtr- lD/t cholescintig.apltic 

prttcrn itr acutc cholccyst rr1s. 

Rldtology. t33. r0? -l ?5. 

ri?. rlBsslANx, lr.s., Bunxofltzr D,, lox, r.s., e. rl'(1033)! 

r1(: rulr ol l.$!tI'- rl,,t .lNt,rsl irr isrupl'y i! 

rculo ! cdl.ulour cholecysr i Lis. 

llldlology. l40r l7 ? - 130. 

408. lvr{ss ANN, ll.s,, lllANti, lt.s. , DllltsfllIr{, I,.ll., IrRItEllaN, 

L.n. (r979)l 

ll!|id nnd &r(arrrl( ditrADocis ot aQrLc chorecvs!Ms 

vi !lr'l!9utrr-lDA r-'holes.r D.rgrrptv. 

AJR. t32:523-523. 

400. TJIjELAN, 1,J.r Clt,I.DSPtll|, J.',I. (1005): 

'r.orrnrnt or 

AnD surg. l G2: r:lo-!li?. 

5OO. IllITE, T.J., |ILLACE, ll.ll., GNASal,4., ct al.(195r)t 

lrdprr i. trbnor rrir lca

456 

loilure, Ndldlr 

crrculut I un. J: 501-5u7. 

5ot. lrllicllut,, x.1.. ( 1064 ): 

Pi,rcuLaDcous trrDsh.!l)rl i. rlx,lrnrioBr!phv' 

l\.rr chirurgirr s.rudinavit:r sul)llrr :nru'n' 

3:10: I-9$: 

s02, fI$ortl, ti.L. (19?1): 

'fckntkuu vtd per.trra! rr'trltep!lrsk porLa_ 

punLlion (Pll). 

Nordisk lcdtc lnr! $0:9rl' 

503. tINlflON, r.1. , l(AltDLl l z, J.,lElss, li.lt.' liltlsllNArunTul, 

c.f. ( r9?2): 

Vsriation 1n lhc uDDca.rnco of thc lalet'l 

rivcr sc!. trllx Prr r(!nr llosrLron' 

RldioloAY, l0!, dG5-06e 

51r4. ftNsroN, n.a.r sliaPlno, l. ( li?4) 

Psetrdorumurs in i.urc h.P!r I Lra ' 

J Nucl I€d. l5: 1030-loto. 

50a. rvlsluH, lr.lt., & GnossMlN! r.D. (197r): 

Itxdiutr!.li.l,: irrrr.lirrr, r!rrpurl{ lr!trr\!rnphv and 

gf()v sc!lc (llrnsonogrnpDir of lho Llvcr' 

chrD!cr 1n. c()rf('rrr iols io Ditrgnocllc tiuging' 

odited by Dr. ll.u.c Sodee' Appl6ton- 

Cantury-Crofl.s. 

506. vlsl'()v, lr.lr., sulJ&?\lliN I /\l{ t (i., G/\Nctlt, c.s.'.t rl.(r9?a): 

Uxpcrin(nrrl rtrd rlrrr.ul rrruld rr new fc'---

'157 

!lbsl led hoprrouiI i$y xgcnrs. 

tddiology. 123: ?93-?9n. 

B.lt., sualia!trN I Au, 

At €valustlon of 

c., vaN ttltl'ut, R. L. 

T"9o'n- labul Ied xcp!tobilialy 

J Nuct ltud. l8: 455-461 

a.*., suBBAllaN I lllt, 

A! ovullrtlon ol 

c., vAlt HEDiTUIT R.L, 

1"i9r'r- l{1,,, I tu,l truprrubilta!y 

J Nucl ||ed. l3: 

ltrfltx, .r.T., sFItNCEn, tt.p. ( t9?5): 

Cl Inicrt .orr.trr idn oI troprt 

!J Nucl Xed. l6: Zt_?2. 

tyoo,l.DNr V.0. , c86DN, lt., 

Ut I rtrsonogrnDhy 

Iladiology. t2!: 

455. 

r cot,l)sT!Ill, I.!. ( l9?8 ): 

tri,|nrl ic n{sses. 

5ti. YACINt R.,_l{ncINTynIr! tv. J., cllfi t!?,t]t, J,u. ( r!62) : 

tivr,. si2e by rhe n{rttple cut 

orf_sctDrtt trr jon sr:untring lcctrrrqu.. 

^h J no€nrsondl. a8: 239_:tg5. 

Yllll, €.t,.,.pottl,||tl,6.p., !!4Dlt, l.c. (r97s): 

r:rkri.l)cd.. tDuarxs jn evrl{rrjtrg rrdp!!!c 

focnt d(!tr)ct. 

J lu.:t ||ed.

Ut irisdnosrdphy ..d.onDutod rtugrarrhy 

cafcrno@ ol the 

Sadlology. t33: t6?-l?3. 

zalclrtcx, N., [ \LAUSf,NS1.OC(, 

Needle biops, ot rhe 

needle btopsy. 

New Eigl J tied. 249r 

1iver. ll, The list 

r062. 

zAlrcriEcri, N,, ll SrDniN, R.L. (r953)l 

Needle biopsy ol ile live! 

criricAl cnd thvesatgative 

|{e* lng1 J f,ed. 24r:1020. 

16. LA.|Z, L, 

GOIJIDIlI, J., TIANLNY, 

a complrtsoa ot arey 

raoronuctlde i&4at!g 

rocut lr!D!t1c l.sioDs 

J Clin Ut rilsound. i: 

0.(r9?7)r 

acrle ultrsouDd sld 

io! the detectloo ot 

r7, ..L AN. R.I(., cotD, J.A,, cj,uctt. L.- 

BUNRELL, {,,.HO.F;N, ;.;..,;;;;,:' 

CAEIDE, V'J'. 

fc,Jh_ I DA sclDrrcrrphy rl D segDeDtal lillarY 

obstruclion. 

J Nucl rbd. 22r 4s6_45g. 

tr. ,t*", n.R,,l LE]E CAnoL, srr8l., 8.s., er .r. (1982).1 

ur.rssologr.phy 

lld beparobltt.ry sctntlgraphy 

;1.ff::r:;,:"il1;irv-ea,eric aaee,o@ses.'

ZlliiR\i\i\, :.J. (r9?0): 

rn rifus.tiseases df the 1iver. 

London: gutterrortbs,

sTUDt OF r00 cAsls:

Create successful ePaper yourself

Delete template?

Save as template?