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World Journal of Gastroenterology Feb 2015To determine the efficacy and safety benefits of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) to treat symptomatic... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To determine the efficacy and safety benefits of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) to treat symptomatic cholelithiasis.
METHODS
Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January 2012 and January 2014 for management of symptomatic cholelithiasis were recruited for this prospective randomized trial. Study enrollment was offered to patients with clinical presentation of biliary colic symptoms, radiological findings suggestive of gallstones, and normal serum biochemistry results. Study participants were randomized to receive either routine LC treatment or LC+IOC treatment. The routine LC procedure was carried out using the standard four-port technique; the LC+IOC procedure was carried out with the addition of meglumine diatrizoate (1:1 dilution with normal saline) injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors. Operative data and postoperative outcomes, including operative time, retained common bile duct (CBD) stones, CBD injury, other complications and length of hospital stay, were recorded for comparative analysis. Inter-group differences were statistically assessed by the χ2 test (categorical variables) and Fisher's exact test (binary variables), with the threshold for statistical significance set at P<0.05.
RESULTS
A total of 371 patients were enrolled in the trial (late-adolescent to adult, age range: 16-70 years), with 185 assigned to the routine LC group and 186 to the LC+IOC group. The two treatment groups were similar in age, sex, body mass index, duration of symptomology, number and size of gallstones, and clinical symptoms. The two treatment groups also showed no significant differences in the rates of successful LC (98.38% vs 97.85%), CBD stone retainment (0.54% vs 0.00%), CBD injury (0.54% vs 0.53%) and other complications (2.16% vs 2.15%), as well as in duration of hospital stay (5.10±1.41 d vs 4.99±1.53 d). However, the LC+IOC treatment group showed significantly longer mean operative time (routine LC group: 43.00±4.15 min vs 52.86±4.47 min, P<0.01). There were no cases of fatal complications in either group. At the one-year follow-up assessment, one patient in the routine LC group reported experiencing diarrhea for three months after the LC and one patient in the LC+IOC group reported on-going intermittent epigastric discomfort, but radiological examination provided no abnormal findings.
CONCLUSION
IOC addition to the routine LC treatment of symptomatic cholelithiasis does not improve rates of CBD stone retainment or bile duct injury but lengthens operative time.
Topics: Adolescent; Adult; Aged; Chi-Square Distribution; China; Cholangiography; Cholecystectomy, Laparoscopic; Cholelithiasis; Female; Humans; Intraoperative Care; Length of Stay; Male; Middle Aged; Operative Time; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 25717250
DOI: 10.3748/wjg.v21.i7.2147 -
Connective Tissue Research Apr 2015To observe the age-related changes of sulfated glycosaminoglycan (sGAG) content of hip joint cartilage of elderly people based on Equilibrium Partitioning of an Ionic...
OBJECTIVES
To observe the age-related changes of sulfated glycosaminoglycan (sGAG) content of hip joint cartilage of elderly people based on Equilibrium Partitioning of an Ionic Contrast Agent (EPIC) micro-CT.
METHODS
Seventy human hip cartilage-bone samples were collected from hip-fracture patients (ages 51-96) and divided into five groups (10 years in an age group). They were first immersed in 20% concentration of the contrast agent Meglumine Diatrizoate (MD) for 6 h at 37 °C, and then scanned by micro-CT. Following scanning, samples were stained for sGAG with toluidine blue. The X-ray attenuation and sGAG optical density were calculated by image processing. The correlation between X-ray attenuation and sGAG optical density was then analyzed.
RESULTS
The X-ray mean attenuation of the cartilage increased by 18.81% from the 50-80 age groups (p < 0.01), but decreased by 7.15% in the 90 age group compared to the 80 age group. The X-ray mean attenuation of the superficial layer and middle layer increased by 31.60 % and 44.68% from the 50-80 age groups, respectively (p < 0.01), but reduced by 4.67% and 6.05% separately in the 90 age group. However, the deep layer showed no significant change with aging. The sGAG optical density showed a linear correlation (r = -0.91, p < 0.01) with the X-ray attenuation.
CONCLUSION
The sGAG content of hip joint cartilage varied with aging in elderly people. The changes in superficial layer and middle layer were more evident than deep layer.
Topics: Age Factors; Aged; Aged, 80 and over; Cartilage, Articular; Contrast Media; Glycosaminoglycans; Hip Joint; Humans; Middle Aged; Osteoarthritis, Hip; X-Ray Microtomography
PubMed: 25602512
DOI: 10.3109/03008207.2015.1009052 -
The Korean Journal of Parasitology Dec 2014Infection cases of diphyllobothriid tapeworms are not much in the below teen-age group. We report a case of Diphyllobothrium nihonkaiense infection in a 13-year-old boy....
Infection cases of diphyllobothriid tapeworms are not much in the below teen-age group. We report a case of Diphyllobothrium nihonkaiense infection in a 13-year-old boy. He presented with severe fatigue, occasional abdominal pain at night time. He also had several episodes of tapeworm segment discharge in his stools. By his past history, he had frequently eaten raw fish including salmon and trout with his families. Numerous eggs of diphyllobothriid tapeworm were detected in the fecal examination. We introduced amidotrizoic acid as a cathartic agent through nasogastroduodenal tube and let nearly whole length (4.75 m) of D. nihonkaiense be excreted through his anus. After a single dose of praziquantel, the child's stool showed no further eggs, and his symptoms disappeared. The evacuated worm was identified as D. nihonkaiense by mitochondrial cox1 gene analysis. Here we report a successful extracorporeal worm extraction from an infection case of D. nihonkaiense by the injection of amidotrizoic acid.
Topics: Adolescent; Animals; Antiparasitic Agents; Cyclooxygenase 1; Diatrizoate Meglumine; Diphyllobothriasis; Diphyllobothrium; Feces; Humans; Male; Praziquantel; Sequence Analysis, DNA
PubMed: 25548421
DOI: 10.3347/kjp.2014.52.6.677 -
International Surgery 2014Parastomal hernia is the most common late stomal complication. Its appearance is usually asymptomatic. We report a parastomal hernia containing stomach. A 69-year-old...
Parastomal hernia is the most common late stomal complication. Its appearance is usually asymptomatic. We report a parastomal hernia containing stomach. A 69-year-old patient with end colostomy arrived at the emergency room presenting with abdominal pain associated with vomiting and functioning stoma. She had a distended and painful abdomen without signs of peritoneal irritation and pericolostomic eventration in the left iliac fossa. X-ray visualized gastric fornix dilatation without dilated intestine bowels, and computed tomography showed parastomal incarcerated gastric herniation. Gastrografin (Bayer Australia Limited, New South Wales, Australia) was administered, showing no passage to duodenum. She underwent surgery, with stomal transposition and placement of onlay polypropylene mesh around the new stoma. Parastomal hernias are a frequent late complication of colostomy. Only four gastric parastomal hernia cases are reported in the literature. Three of these four cases required surgery. The placement of prosthetic mesh in the moment of stoma elaboration should be considered as a potential preventive measure.
Topics: Aged; Colostomy; Contrast Media; Diatrizoate Meglumine; Female; Hernia, Ventral; Humans; Postoperative Complications; Stomach; Surgical Mesh
PubMed: 25058773
DOI: 10.9738/INTSURG-D-13-00100 -
Nihon Hoshasen Gijutsu Gakkai Zasshi Jul 2014We propose a new preparation method for the computed tomography colonography (CTC). This method consists of giving a small volume (400 ml) of cleansing solution on the... (Comparative Study)
Comparative Study
We propose a new preparation method for the computed tomography colonography (CTC). This method consists of giving a small volume (400 ml) of cleansing solution on the day before the examination and the same volume of solution on the day of the examination [low volume split-dose (LVSD) method]. Using this method, we compared the volume of residual fluid in the colon, the CT value of the residual fluid, and the quality of stool tagging with those for patients undergoing the conventional bowel preparation method. Polyp detectability of the CTC using this method and the acceptability of the preparation were also investigated. The volume of residual fluid in the colon with this method was smaller than that with the conventional method. The CT value of the residual fluid with this method was higher than that with the conventional method. Visual assessment of the quality of stool tagging with this method gave similar results to those obtained using the conventional method. The sensitivities were 95% for 5-10 mm polyps and 100% for polyps larger than 10 mm. The PPVs were 91% for 5-10 mm polyps and 100% for polyps larger than 10 mm. These results appear to be as good as in previous reports. In the questionnaires, about 80% of the answers were favorable regarding the volume and the taste of laxative. We conclude that LVSD bowel preparation method for CTC maintains polyp detectability and is better tolerated.
Topics: Aged; Colonography, Computed Tomographic; Diatrizoate Meglumine; Female; Humans; Intestinal Polyps; Laxatives; Male
PubMed: 25055948
DOI: 10.6009/jjrt.2014_jsrt_70.7.676 -
Iranian Red Crescent Medical Journal May 2014Myelograghy is a process of instilling contrast medium to the subarachnoid space for evaluating the spinal column by radiography. There are various contrast solutions...
INTRODUCTION
Myelograghy is a process of instilling contrast medium to the subarachnoid space for evaluating the spinal column by radiography. There are various contrast solutions for different radiographic studies but not all of them are suitable for spinal column evaluation.
CASE PRESENTATION
Our patient was a 60-year-old man who developed severe pain, tonic clonic convulsions and cardiopulmonary arrest after intrathecal injection of 14 mL of meglumine diatrizoate during an elective myelography procedure. Many of these cases would die or suffer from permanent sequelae if appropriate treatment is not received.
CONCLUSIONS
Our subject recovered completely without any sequelae after receiving appropriate treatment in a multidisciplinary intensive care unit.
PubMed: 25031869
DOI: 10.5812/ircmj.9661 -
Pediatrics and Neonatology Aug 2014
Topics: Contrast Media; Diatrizoate Meglumine; Enema; Humans; Infant; Infant, Newborn; Intestinal Diseases; Radiography; Renal Elimination
PubMed: 24861535
DOI: 10.1016/j.pedneo.2014.04.004 -
European Radiology Apr 2014To assess the frequency of oral contrast coating of flat polyps, which may promote detection, and influencing factors within a screening CT colonography (CTC) population. (Observational Study)
Observational Study
OBJECTIVES
To assess the frequency of oral contrast coating of flat polyps, which may promote detection, and influencing factors within a screening CT colonography (CTC) population.
METHODS
This was a retrospective, observational study performed at one institution. From 7,426 individuals, 123 patients with 160 flat polyps were extracted. Flat polyps were defined as plaque-like, raised at most 3 mm in height and reviewed for contrast coating. Factors including demographic variables such as age and sex, and polyp variables such as polyp size, location and histology were analysed for effect on coating.
RESULTS
Of 160 flat polyps (mean size 9.4 mm ± 3.6), 78.8 % demonstrated coating. Mean coat thickness was 1.5 mm ± 0.6; 23.8 % (n = 30) demonstrated a thin film of contrast. Large size (≥10 mm) and proximal colonic location (relative to splenic flexure) were predictive variables by univariate logistic regression [OR (odds ratio) 3.4 (CI 1.3-8.9; p = 0.011), 2.0 (CI 1.2-3.5; p = 0.011), respectively]. Adenomas (OR 0.37, CI 0.14-1.02; p = 0.054) and mucosal polyps or venous blebs (OR 0.07, CI 0.02-0.25; p < 0.001) were less likely to coat than serrated/hyperplastic lesions. Age and sex were not predictive for coating (p = 0.417, p = 0.499, respectively).
CONCLUSIONS
Surface contrast coating is common for flat polyps at CTC, promoted by large size, proximal location and serrated/hyperplastic histology. Given the difficulty in detection, recognition may aid in flat polyp identification.
KEY POINTS
• Oral contrast coats the surface of most flat colorectal polyps at CT colonography. • Large size, proximal colonic location and serrated/hyperplastic histology increase polyp coating. • Contrast coating increases diagnostic confidence for flat polyps. • Contrast coating may help in flat polyp detection at CTC.
Topics: Adenoma; Administration, Oral; Aged; Barium Sulfate; Colonic Neoplasms; Colonic Polyps; Colonography, Computed Tomographic; Contrast Media; Diatrizoate Meglumine; Female; Humans; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity
PubMed: 24482303
DOI: 10.1007/s00330-014-3095-z -
Radiology Apr 2014To compare the features of bone metastases at computed tomography (CT) to tracer uptake at fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and...
Bone metastases in castration-resistant prostate cancer: associations between morphologic CT patterns, glycolytic activity, and androgen receptor expression on PET and overall survival.
PURPOSE
To compare the features of bone metastases at computed tomography (CT) to tracer uptake at fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and fluorine 18 16β-fluoro-5-dihydrotestosterone (FDHT) PET and to determine associations between these imaging features and overall survival in men with castration-resistant prostate cancer.
MATERIALS AND METHODS
This is a retrospective study of 38 patients with castration-resistant prostate cancer. Two readers independently evaluated CT, FDG PET, and FDHT PET features of bone metastases. Associations between imaging findings and overall survival were determined by using univariate Cox proportional hazards regression.
RESULTS
In 38 patients, reader 1 detected 881 lesions and reader 2 detected 867 lesions. Attenuation coefficients at CT correlated inversely with FDG (reader 1: r = -0.3007; P < .001; reader 2: r = -0.3147; P < .001) and FDHT (reader 1: r = -0.2680; P = .001; reader 2: r = -0.3656; P < .001) uptake. The number of lesions on CT scans was significantly associated with overall survival (reader 1: hazard ratio [HR], 1.025; P = .05; reader 2: HR, 1.021; P = .04). The numbers of lesions on FDG and FDHT PET scans were significantly associated with overall survival for reader 1 (HR, 1.051-1.109; P < .001) and reader 2 (HR, 1.026-1.082; P ≤ .009). Patients with higher FDHT uptake (lesion with the highest maximum standardized uptake value) had significantly shorter overall survival (reader 1: HR, 1.078; P = .02; reader 2: HR, 1.092; P = .02). FDG uptake intensity was not associated with overall survival (reader 1, P = .65; reader 2, P = .38).
CONCLUSION
In patients with castration-resistant prostate cancer, numbers of bone lesions on CT, FDG PET, and FDHT PET scans and the intensity of FDHT uptake are significantly associated with overall survival.
Topics: Aged; Aged, 80 and over; Bone Neoplasms; Cross-Sectional Studies; Diatrizoate; Diatrizoate Meglumine; Dihydrotestosterone; Fluorodeoxyglucose F18; Glycolysis; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Receptors, Androgen; Retrospective Studies; Survival Rate; Tomography, X-Ray Computed
PubMed: 24475817
DOI: 10.1148/radiol.13130625 -
Abdominal Imaging Apr 2014Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging...
PURPOSE
Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH).
METHODS
A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT.
RESULTS
The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84).
CONCLUSIONS
A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.
Topics: Case-Control Studies; Contrast Media; Diatrizoate; Diatrizoate Meglumine; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Iohexol; Liver Cirrhosis; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 24366107
DOI: 10.1007/s00261-013-0057-x