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Irish Medical Journal Mar 2019Introduction Meconium Ileus (MI) is the presenting feature of CF in approximately 10-15% of cases. This report outlines the clinical presentation, imaging and management...
Introduction Meconium Ileus (MI) is the presenting feature of CF in approximately 10-15% of cases. This report outlines the clinical presentation, imaging and management of two neonates with MI and subsequent diagnosis of Cystic Fibrosis (CF). Methods A retrospective chart review was performed to evaluate the clinical course of two neonates with MI. Results Case 1 and 2 presented clinically with signs of abdominal obstruction. Subsequent laparotomies confirmed MI. MI is strongly associated with CF and CF is the most common genetically inherited disease in Ireland. Genetic testing was positive for a homozygous ∆ F508 mutation in both case 1 and 2, securing a diagnosis of MI secondary to CF. Conclusion Our cases highlight that all infants born in Ireland with MI should be considered as CF positive until proven otherwise.
Topics: Cystic Fibrosis; Diatrizoate Meglumine; Female; Homozygote; Humans; Ileostomy; Infant, Newborn; Intubation, Gastrointestinal; Ireland; Laparotomy; Male; Meconium Ileus; Mutation; Retrospective Studies
PubMed: 30932447
DOI: No ID Found -
Journal of Medical Imaging and... Apr 2019There is no consensus as to the most optimal bowel preparation regime for Computed Tomographic Colonography (CTC). Concerns regarding laxative bowel preparation (LBP)... (Observational Study)
Observational Study Randomized Controlled Trial
INTRODUCTION
There is no consensus as to the most optimal bowel preparation regime for Computed Tomographic Colonography (CTC). Concerns regarding laxative bowel preparation (LBP) include tolerability, adverse effects and complexity of regimen. Two hospitals in Auckland changed CTC bowel preparation from standard LBP to Gastrografin (GG) in 2015. The aim of this study is to retrospectively assess objective and subjective quality measures of these different bowel preparations.
METHODS
Two study groups were selected retrospectively from patients who underwent CTC at two hospitals in September-October 2013 (LBP) and September- October 2015 (GG). Each study group comprised 60 patients (30 consecutive patients from each hospital). Patients were randomized and anonymized to reduce bias in analysis. Study patients were assessed independently by three experienced Radiologists using a simple grading system derived from the literature.
RESULTS
There was significantly less faecal residue (P = 0.006) and better faecal tagging (P = 0.001) in the right colon in the GG group. There was significantly higher fluid residue in the GG group than the LBP group (P = 0.0001), particularly in the right colon, with better fluid tagging in the GG group(P ≤ 0.0001). Higher Hounsfield Units of residual fluid were observed in the GG group (P ≤ 0.0001). There was no statistically significant difference in the subjective quality scores (P = 0.219), between the two preparations.
CONCLUSIONS
This study has demonstrated better faecal cleansing and faecal tagging in the GG group. Higher fluid residue in the GG group was offset by better fluid tagging.
Topics: Adult; Aged; Aged, 80 and over; Barium Sulfate; Cathartics; Colonography, Computed Tomographic; Contrast Media; Diatrizoate Meglumine; Feces; Female; Humans; Laxatives; Male; Middle Aged; New Zealand; Retrospective Studies
PubMed: 30785667
DOI: 10.1111/1754-9485.12860 -
Cardiovascular and Interventional... Jun 2019To investigate the novel zein-based non-adhesive precipitating liquid embolic HEI.
PURPOSE
To investigate the novel zein-based non-adhesive precipitating liquid embolic HEI.
MATERIALS AND METHODS
Zein-based liquid embolics are an own class of embolization material. In this study, HEI, a novel zein-based liquid embolic, was investigated. Visibility was assessed in vitro in CT and MRI phantoms, embolization characteristics were assessed in vivo in the kidneys of 12 pigs. Components of HEI were zein as occlusion material, ethanol as solvent, and iodized oil as radiopaque material. HEI was used in pure (HEI-PURE) and manually modified (HEI-MOD) form and compared with 6% ethylene vinyl alcohol copolymer (EVOH). Different radiological methods (CT, MRI, DSA, cone-beam CT, and micro-CT) and histopathologic analyses were applied to compare visibility and vascular occlusion patterns.
RESULTS
In CT phantoms, all embolics were definitely visible as hyperdense materials. In MRI phantoms, signal-to-noise ratio was highest for HEI-PURE, followed by HEI-MOD and EVOH. In all kidneys, embolization procedures were technically successful and without complications. In DSA, all embolics were definitely visible during and after embolization. Only EVOH caused substantial artifacts in cone-beam CT and CT. In micro-CT and histopathology, HEI-PURE showed a homogeneous occlusion from segmental arteries to glomerular capillaries. HEI-MOD demonstrated the deepest vascular penetration (up to the level of peritubular capillaries), but with an inhomogeneous distribution. For EVOH, there was inhomogeneous vascular occlusion from segmental arteries to glomerular capillaries.
CONCLUSION
HEI is a promising novel zein-based liquid embolic. Further preclinical and clinical studies with higher case numbers and long-term follow-up are needed to further assess the value of this embolic material.
Topics: Angiography, Digital Subtraction; Animals; Artifacts; Chemoembolization, Therapeutic; Diatrizoate Meglumine; Ethanol; Iodized Oil; Kidney; Magnetic Resonance Imaging; Models, Animal; Phantoms, Imaging; Propylene Glycol; Radiography; Swine; Tomography, X-Ray Computed; X-Rays; Zein
PubMed: 30761410
DOI: 10.1007/s00270-019-02179-9 -
American Journal of Surgery Jun 2019One of the most common reasons for admission to a surgical service is for a partial small bowel obstruction. There is considerable variation in management. Several...
BACKGROUND
One of the most common reasons for admission to a surgical service is for a partial small bowel obstruction. There is considerable variation in management. Several studies suggest that the use of diatrizoate (Gastrografin), a hyperosmolar contrast agent, can be helpful as a diagnostic agent as well as possibly therapeutic, reducing the need for operative intervention. There is a paucity of data on the use of Gastrografin in the community setting. We hypothesized that this standardized algorithm of Gastrografin administration would decrease the need for surgery and shorten a patient's length of stay, even outside the confines of a regulated clinical trial.
METHODS
We performed a retrospective review of all patients admitted to two major hospitals in our network with the diagnosis of partial small bowel obstruction. Patients were excluded if they were admitted within thirty days of bowel surgery or if they were <18 years of age. The primary variable for analysis was the subsets of patients who were placed on our protocol versus no protocol at the other hospital. The primary outcome was hospital length of stay. Secondary outcomes included rate of surgery during the same admission and readmission within 30 days of discharge. All analyses were performed using Fisher's Exact test of Mann-Whitney U Test, as appropriate.
RESULTS
A total of 1302 patients with partial small bowel obstruction were identified (103 on-protocol and 1199 off-protocol at our sister hospital). On-protocol patients had a shorter duration of hospitalization (mean, 4.9 days vs. 6.0 days, p < 0.001), lower rates of surgery (2% vs. 16%, p < 0.001), and similar rates of readmission for the same diagnosis (8% and 5%, p = 0.26), compared to off-protocol patients at our sister institution.
CONCLUSION
A protocol utilizing Gastrografin for the management of partial small bowel obstruction decreases the need for surgery and shortens a patient's length of stay in a diverse community setting.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Clinical Protocols; Contrast Media; Diatrizoate Meglumine; Female; Gastrointestinal Agents; Humans; Intestinal Obstruction; Intestine, Small; Length of Stay; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 30621907
DOI: 10.1016/j.amjsurg.2018.12.063 -
The Journal of Surgical Research Jan 2019Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon...
BACKGROUND
Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen.
METHODS
A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals.
RESULTS
Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P < 0.05; 0.478 [0.240-0.952], P < 0.036).
CONCLUSIONS
A significant proportion of patients at 48 h (29%) "failed" the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations.
LEVEL OF EVIDENCE
Level II.
Topics: Aged; Aged, 80 and over; Conservative Treatment; Contrast Media; Datasets as Topic; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Length of Stay; Male; Middle Aged; Multicenter Studies as Topic; Retrospective Studies; Time Factors; Tissue Adhesions; Treatment Outcome
PubMed: 30502278
DOI: 10.1016/j.jss.2018.08.019 -
Internal Medicine Journal Dec 2018
Topics: Aged, 80 and over; Conservative Treatment; Contrast Media; Diatrizoate Meglumine; Endometriosis; Female; Humans; Hysterectomy; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Multimorbidity; Ovariectomy; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30517994
DOI: 10.1111/imj.14125 -
Emergency Radiology Apr 2019Performance of a modified abdominopelvic CT protocol reconstructed using full iterative reconstruction (IR) was assessed for imaging patients presenting with acute...
OBJECTIVES
Performance of a modified abdominopelvic CT protocol reconstructed using full iterative reconstruction (IR) was assessed for imaging patients presenting with acute abdominal symptoms.
MATERIALS AND METHODS
Fifty-seven patients (17 male, 40 female; mean age of 56.5 ± 8 years) were prospectively studied. Low-dose (LD) and conventional-dose (CD) CTs were contemporaneously acquired between November 2015 and March 2016. The LD and CD protocols imparted radiation exposures approximating 10-20% and 80-90% those of routine abdominopelvic CT, respectively. The LD images were reconstructed with model-based iterative reconstruction (MBIR), and CD images with hybrid IR (40% adaptive statistical iterative reconstruction (ASIR)). Image quality was assessed quantitatively and qualitatively. Independent clinical interpretations were performed with a 6-week delay between reviews.
RESULTS
A 74.7% mean radiation dose reduction was achieved: LD effective dose (ED) 2.38 ± 1.78 mSv (size-specific dose estimate (SSDE) 3.77 ± 1.97 mGy); CD ED 7.04 ± 4.89 mSv (SSDE 10.74 ± 5.5 mGy). LD-MBIR images had significantly lower objective and subjective image noise compared with CD-ASIR (p < 0.0001). Noise reduction for LD-MBIR studies was greater for patients with BMI < 25 kg/m than those with BMI ≥ 25 kg/m (5.36 ± 3.2 Hounsfield units (HU) vs. 4.05 ± 3.1 HU, p < 0.0001). CD-ASIR studies had significantly better contrast resolution, and diagnostic acceptability (p < 0.0001 for all). LD-MBIR studies had significantly lower streak artifact (p < 0.0001). There was no difference in sensitivity for primary findings between the low-dose and conventional protocols with the exception of one case of enteritis.
CONCLUSIONS
Low-dose abdominopelvic CT performed with MBIR is a feasible radiation dose reduction strategy for imaging patients presenting with acute abdominal pain.
Topics: Abdomen, Acute; Contrast Media; Diatrizoate Meglumine; Female; Humans; Iohexol; Male; Middle Aged; Prospective Studies; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 30448900
DOI: 10.1007/s10140-018-1658-z -
Revista Espanola de Anestesiologia Y... Feb 2019Practice guidelines for preoperative fasting have not clearly established the fasting time needed after oral administration of water-soluble contrast media. The aim of...
BACKGROUND AND OBJECTIVES
Practice guidelines for preoperative fasting have not clearly established the fasting time needed after oral administration of water-soluble contrast media. The aim of this study was to determine the time required for the gastric emptying during the water-soluble contrast media in patients with acute abdominal pain.
METHODS
This prospective longitudinal study included sixty-eight patients older than 18 years of age with acute abdominal pain, who required a water-soluble contrast media enhanced abdominal computed tomography study. Plain radiographs were obtained hourly until complete the gastric emptying. Patients with probable bowel obstruction were not included in the study.
RESULTS
A total of 31 (45,6%), 54 (79,4%), and 64 (94,1%) patients achieved a complete gastric clearance of barium in 1, 2 and 3 hours, respectively. All patients achieved complete emptying of water-soluble contrast media within 6 hours. Gastric emptying time was not associated with gender (P=0,44), body mass index (P=.35), fasting time prior to water-soluble contrast media intake (P=0,12), administration of opioids in the emergency room (P=0,7), and the presence of comorbidities (P=0,36).
CONCLUSION
Ninety-four percent of the patients with acute abdominal pain achieved complete gastric emptying within 3hours after the administration of water-soluble contrast media. All of them achieved complete gastric emptying within 6hours. The results suggested 6hours after oral intake of the contrast media is enough to complete transit of water-soluble contrast media through the stomach and avoid unnecessary risks.
Topics: Abdomen, Acute; Adult; Barium Sulfate; Contrast Media; Diatrizoate; Diatrizoate Meglumine; Fasting; Female; Gastric Emptying; Humans; Longitudinal Studies; Male; Practice Guidelines as Topic; Prospective Studies; Sex Factors; Solubility; Time Factors; Tomography, X-Ray Computed
PubMed: 30424890
DOI: 10.1016/j.redar.2018.08.005 -
Journal of Pediatric Surgery Jan 2019We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO). (Comparative Study)
Comparative Study
BACKGROUND/PURPOSE
We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO).
METHODS
Medical records were reviewed retrospectively for all children admitted with ASBO between November 2010 and June 2017. Those admitted between November 2010 and October 2013 received nasogastric decompression with decision for surgery determined by surgeon judgment (preprotocol). Patients admitted after October 2013 (postprotocol) received water-soluble contrast early after admission, were monitored with serial examinations and radiographs, and underwent surgery if contrast was not visualized in the cecum by 24 h. Group outcomes were compared.
RESULTS
Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (p = 0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2 days (preprotocol) vs 3.6 days (postprotocol) p = 0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42.
CONCLUSIONS
Administration of water-soluble contrast after hospitalization for pediatric ASBO may play a dual diagnostic and therapeutic role in management with decreases in surgical intervention, LOS, and cost.
TYPE OF STUDY
Retrospective comparative study.
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Child; Child, Preschool; Contrast Media; Diatrizoate Meglumine; Female; Health Care Costs; Hospitalization; Humans; Infant; Intestinal Obstruction; Intestine, Small; Length of Stay; Male; Retrospective Studies; Tissue Adhesions; Young Adult
PubMed: 30414689
DOI: 10.1016/j.jpedsurg.2018.10.002 -
JAMA Surgery Feb 2019This study examines the effectiveness and cost of gastrografin upper gastrointestinal imaging test performed on patients after a laparoscopic sleeve gastrectomy.
This study examines the effectiveness and cost of gastrografin upper gastrointestinal imaging test performed on patients after a laparoscopic sleeve gastrectomy.
Topics: Adult; Aged; Anastomotic Leak; Bariatric Surgery; Contrast Media; Diatrizoate Meglumine; Female; Gastrectomy; Humans; Laparoscopy; Male; Middle Aged; Postoperative Care; Prospective Studies
PubMed: 30383124
DOI: 10.1001/jamasurg.2018.3197