Ultrasound and infections on the Tibetan Plateau().

introductionThe authors report on an ultrasound (US) outreach program for the nomadic people living in Yushu, a remote area of Qinghai, Tibet, People's Republic of China (PRC) about 4800 m above sea level. The program was carried out in cooperation with ROKPA INTERNATIONAL, a non-profit organization (NGO) that aims at helping the poorest peoples living in remote regions of the world. MATERIALS AND

methodsA hand-held US scanner (Sonosite 180 Plus, Sonosite Inc., Bothell, WA, USA) equipped with a 3.5-5 MHz convex probe was used at a local clinic for 21 days in 2007 and for 32 days in 2009.

resultsA total of 1128 US examinations were performed (578 in 2007 and 550 in 2009). The main diagnoses were: Echinococcal cysts (66 cases; 6.23%) - Biliary tract and intrahepatic gallstones (10% of patients examined) - Ascariasis - Acute and chronic hepatitis, liver cirrhosis, abdominal masses - Abdominal tuberculosis - Miscellaneous (trophoblastic tumor, megacalicosis, splenomegaly in acute leukemia). After the first experience in 2007, collaboration with the local hospital was established for the treatment of patients affected by active echinococcal cysts using albendazole and puncture, aspiration and injection of scolicidal agent and re-aspiration (PAIR) and subsequent follow-up. DISCUSSION AND

conclusionsUS scanning was well accepted by the local population and allowed diagnosis, classification and choice of treatment of the echinococcal cysts according to recent criteria based on a stage-specific approach. Percutaneous treatment was also introduced, but more training of local healthcare providers is needed to secure continuation of this practice. Further experience may help improve the standard of health care services offered to the nomadic populations in this remote area.