No abstract

Complete PT does not modify TIPS' long-term outcome. Rather than a contraindication, PT should be considered as an indication for TIPS in cirrhotic patients with accessible intrahepatic portal vein. Further randomized studies should be planned in cirrhotic patients with recent PT to better qualify TIPS and anticoagulation indications, respectively.

Measurement TechniquesNon-invasive quantification of diaphragm kinetics using m-mode sonography Purpose: The standard conditions of spirometry (i.e., wearing a noseclip and breathing through a mouthpiece and a pneumotachograph) are likely to alter the ventilatory pattern. We used "time-motion" mode (M-mode) sonography to assess the changes in diaphragm kinetics induced by spirometry during quiet breathing.Methods: An M-mode sonographic study of the right diaphragm was performed before and during standard spirometry in eight pa~ents without respiratory disease (age 34 to 68 yr).Results: During spirometry, the diaphragm inspiratory amplitude (DIA) increased from 1.34 + 0.18 cm to 1.80 + 0, 18 cm (P = 0,007), whereas the diaphragmatic inspiratory time (T, diaph) increased from 1.27 -+_ 0.15 to 1.53 + 0.23 sec, (P = 0.015), without change in diaphragmatic total time interval (-I-tot diaph). Therefore, the diaphragm duty cycle (T, diaph /Ttot diaph) increased from 38% +--I% to 44% _ 496 (P = 0.023). The diaphragm inspiratory (DIV) and expiratory (DEV) motion velocity increased (P = 0.007).Conclusion: M-mode sonography enabled us to demonstrate that the wearing of a nose clip and breathing through a mouthpiece and a pneumotachograph induce measurable changes in diaphragm kinetics.Object-if : Les conditions de la spirom&ne standard (c.-,~-d. le port du pince-nez et la respiration ~ travers un embout buccal et un pneumotacographe) sont susceptibles d'altErer la morphologie de la ventilation. Nous avons utilisE le mode ~temps-amplitude,, (mode M) de la sonographie pour 6valuer les changements de la cinEtique diaphragmatique provoquEs par la spiromEtne pendant la respiration de repos.R~sultats : Pendant la spiromEtrie, I'amplitude inspiratoire diaphragmataque augmentait de 1,34 + 0, 18 ~ 1,80 +-0, 18 cm (P = 0,007), alors que le temps diaphragmatique inspiratoire (T, diaph) augmentmt de 1,27 _+ 0, I 5 ,~ 1,53 z 0,23 sec (P = 0,015), sans changement du temps diaphragmatique total (Trot diaph). Par consequent, le temps de I'activitE diaphragmatique (T, diaph/Ttot diaph) augmentait de 38 +_ I 96 ,~ 44 + 496 (P=0,023). La v41ocit4 de I'amplitude inspiratolre et expiratoire augmentait (P = 0,007).Conclusion : La sonographie en mode M nous a permis de dEmontrer que le port du pince-nez et la respiration h travers un embout buccal et un pneumotacographe provoquent des changements tangibles de la cin4tique diaphragmatique.From the

Robotic telesonography can be used for reliable diagnosis without moving the patient. No false diagnoses were made in this study. A bandwidth of 250 Kbps via integrated services digital network or satellite is required for reliable diagnosis. Such a system can provide diagnostic information that is currently unavailable in isolated or inaccessible areas and on rescue vehicles.