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Pediatrics and Neonatology Aug 2014When abdominal distention occurs or bowel obstruction is suspected in the neonatal period, a water-soluble contrast enema is helpful for diagnostic and therapeutic...
BACKGROUND
When abdominal distention occurs or bowel obstruction is suspected in the neonatal period, a water-soluble contrast enema is helpful for diagnostic and therapeutic purposes. The water-soluble contrast medium is evacuated through the anus as well as excreted via the kidneys in some babies. This study was designed to evaluate the incidence of renal excretion after enemas using water-soluble contrast media and presume the causes.
METHODS
Contrast enemas using diluted water-soluble contrast media were performed in 23 patients under 2 months of age. After the enema, patients were followed with simple abdominal radiographs to assess the improvement in bowel distention, and we could also detect the presence of renal excretion of contrast media on the radiographs. Reviewing the medical records and imaging studies, including enemas and consecutive abdominal radiographs, we evaluated the incidence of renal excretion of water-soluble contrast media and counted the stay duration of contrast media in urinary tract, bladder, and colon.
RESULTS
Among 23 patients, 12 patients (52%) experienced the renal excretion of water-soluble contrast media. In these patients, stay-in-bladder durations of contrast media were 1-3 days and stay-in-colon durations of contrast media were 1-10 days, while stay-in-colon durations of contrast media were 1-3 days in the patients not showing renal excretion of contrast media. The Mann-Whitney test for stay-in-colon durations demonstrated the later evacuation of contrast media in the patients with renal excretion of contrast media (p = 0.07). The review of the medical records showed that 19 patients were finally diagnosed as intestinal diseases, including Hirschsprung's disease, meconium ileum, meconium plug syndrome, and small bowel atresia or stenosis. Fisher's exact test between the presence of urinary excretion and intestinal diseases indicated a statistically significant difference (p = 0.04).
CONCLUSION
The intestinal diseases causing bowel obstruction may increase the water-soluble contrast media's dwell time in the bowel and also increase urinary excretion.
Topics: Contrast Media; Diatrizoate Meglumine; Enema; Female; Hirschsprung Disease; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestine, Small; Male; Meconium; Radiography, Abdominal; Renal Elimination
PubMed: 24295782
DOI: 10.1016/j.pedneo.2013.07.012 -
Journal of Medical Case Reports Nov 2013Peptic ulcer disease is still the major cause of gastrointestinal perforation despite major improvements in both diagnostic and therapeutic strategies. While the...
INTRODUCTION
Peptic ulcer disease is still the major cause of gastrointestinal perforation despite major improvements in both diagnostic and therapeutic strategies. While the diagnosis of a perforated ulcer is straightforward in typical cases, its clinical onset may be subtle because of comorbidities and/or concurrent therapies.
CASE PRESENTATION
We report the case of a 53-year-old Caucasian man with a history of chronic myeloid leukemia on maintenance therapy (100mg/day) with imatinib who was found to have a subphrenic abscess resulting from a perforated duodenal ulcer that had been clinically overlooked. Our patient was febrile (38.5°C) with abdominal tenderness and hypoactive bowel sounds. On the abdominal plain X-ray films, a right subphrenic abscess could be seen. On contrast-enhanced multi-detector computed tomography, a huge air-fluid collection extending from the subphrenic to the subhepatic anterior space was observed. After oral administration of 500cm3 of 3 percent diluted diatrizoate meglumine, an extraluminal leakage of the water-soluble iodinated contrast media could then be appreciated as a result of a perforated duodenal ulcer. During surgery, the abscess was drained and extensive adhesiolysis had to be performed to expose the duodenal bulb where the ulcer was first identified by methylene blue administration and then sutured.
CONCLUSIONS
While subphrenic abscesses are well known complications of perforated gastric or duodenal ulcers, they have nowadays become rare thanks to advances in both diagnostic and therapeutic strategies for peptic ulcer disease. However, when peptic ulcer disease is not clinically suspected, the contribution of imaging may be substantial.
PubMed: 24215711
DOI: 10.1186/1752-1947-7-257 -
The Tokai Journal of Experimental and... Sep 2013Pancreatitis is the most common and serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Several studies have compared contrast media (CM) with... (Comparative Study)
Comparative Study
OBJECTIVE
Pancreatitis is the most common and serious complication of endoscopic retrograde cholangiopancreatography (ERCP). Several studies have compared contrast media (CM) with different osmolalities, but the results are conflicting. We conducted this study to clarify the difference between 2 CM used in ERCP.
METHODS
Five hundred and seventy-six patients were examined by using ERCP in our hospital during 2010. Out of these, 56 patients were enrolled in this study. We investigated the incidence of post ERCP pancreatitis (PEP) and hyperamylasemia. Serum amylase levels were compared in the 2 groups.
RESULTS
Twenty-seven patients were treated with iodixanol and 29 with diatrizoate meglumine Na. The rate of PEP in the diatrizoate meglumine Na group and iodixanol group was 0% (0/29) and 7.4% (2/27), respectively (P = 0.228). The rate of hyperamylasemia was 10.3% (3/29) and 14.8% (4/27), respectively (P = 0.70). There were no significant differences between two groups for amylase levels pre-procedure (P = 0.082), 3 h post procedure (P = 0.744), or next morning (P = 0.265).
CONCLUSIONS
There were no significant differences in the rates of PEP or hyperamylasemia between CMs in ERCP. We believe it is unnecessary to use the more expensive low osmolality CM in ERCP to prevent PEP.
Topics: Aged; Cholangiopancreatography, Endoscopic Retrograde; Contrast Media; Dimerization; Female; Humans; Hyperamylasemia; Ions; Male; Middle Aged; Osmolar Concentration; Pancreatitis
PubMed: 24030487
DOI: No ID Found -
Anais Da Academia Brasileira de Ciencias 2013Contrast media (CM) are frequently used in diagnostic radiology and in radiotherapy as a diagnostic tool and in treatment planning. Previous studies have demonstrated...
Contrast media (CM) are frequently used in diagnostic radiology and in radiotherapy as a diagnostic tool and in treatment planning. Previous studies have demonstrated that these compounds induce chromosomal aberrations. This study evaluates the mutagenic effects induced by the contrast medium Urografina® 292 (meglumine amidotrizoate and sodium-ionic dimmer) in bone marrow cells (BMC) of mice in vivo. Micronuclei assay was performed in BMC of CF-1 mice injected with CM 1.5 and 3.0 mL/kg intravenous doses and 1.0, 2.0, 3.0 mL/kg intraperitoneal doses. The animals were beheaded 24 h after treatment by cervical dislocation, and femur BMC from each animal were used in the micronucleus test. The group treated with the highest intravenous injection of Urografina® 292 (3.0 mL/kg) presented an increase in the frequency of micronucleated polychromatic erythrocytes (MNPCEs) in relation at the control group (P<0.05). The results obtained after intraperitoneal administration of CM showed that all doses (1.0 mL/kg, 2.0 mL/kg and 3.0 mL/kg) increased the frequency of MNPCEs, being significantly different from the negative control (P< 0.01). The present results suggest that iodinated contrast media Urografina® 292 may cause a significant increase of cytogenetic damage in bone marrow cells of mice.
Topics: Animals; Bone Marrow Cells; Chromosome Aberrations; Contrast Media; Diatrizoate Meglumine; Dose-Response Relationship, Drug; Male; Mice; Mice, Inbred Strains; Micronucleus Tests
PubMed: 23828339
DOI: 10.1590/S0001-37652013000200018 -
Dysphagia Sep 2013
Topics: Contrast Media; Deglutition; Deglutition Disorders; Diatrizoate Meglumine; Fluoroscopy; Humans
PubMed: 23812237
DOI: 10.1007/s00455-013-9476-7 -
The British Journal of Radiology May 2013To assess the palatability of iodinated oral contrast media commonly used in abdominopelvic CT and CT colonography (CTC). (Comparative Study)
Comparative Study
OBJECTIVE
To assess the palatability of iodinated oral contrast media commonly used in abdominopelvic CT and CT colonography (CTC).
METHODS
80 volunteers assessed the palatability of a 20-ml sample of a standard 30 mg ml(-1) dilution of Omnipaque® (iohexol; GE Healthcare, Cork, Ireland), Telebrix® (meglumine ioxithalamate; Guerbet, Aulnay-sous-Bois, France), Gastromiro® (iopamidol; Bracco, High Wycombe, UK) and Gastrografin® (sodium diatrizoate and meglumine diatrizoate; Bayer, Newbury, UK) in a computer-generated random order.
RESULTS
Gastrografin is rated significantly less palatable than the remaining media (p<0.005). Omnipaque and Telebrix are significantly more palatable than Gastromiro. No difference existed between Omnipaque and Telebrix. 39% of participants would refuse to consume the quantities of Gastrografin required for a CTC examination compared with Telebrix (7%) and Omnipaque (9%) (p<0.05).
CONCLUSION
Omnipaque and Telebrix are significantly more palatable than both Gastromiro and Gastrografin, with participants more willing to ingest them in larger quantities as well as being less expensive.
ADVANCES IN KNOWLEDGE
Omnipaque and Telebrix are significantly more palatable iodinated oral contrast media than both Gastromiro and Gastrografin, which has potential implications in compliance with both abdominopelvic CT and CTC.
Topics: Administration, Oral; Adolescent; Adult; Contrast Media; Diatrizoate; Diatrizoate Meglumine; Female; Humans; Iohexol; Iopamidol; Iothalamate Meglumine; Male; Patient Satisfaction; Taste; Triiodobenzoic Acids; Young Adult
PubMed: 23564884
DOI: 10.1259/bjr.20120636 -
Radiology Jul 2013To assess the variation in diagnostic performance among radiologists at screening computed tomographic (CT) colonography.
PURPOSE
To assess the variation in diagnostic performance among radiologists at screening computed tomographic (CT) colonography.
MATERIALS AND METHODS
In this HIPAA-compliant, institutional review board-approved study, 6866 asymptomatic adults underwent first-time CT colonographic screening at a single center between January 2005 and November 2011. Results of examinations were interpreted by one of eight board-certified abdominal radiologists (mean number of CT colonographic studies per reader, 858; range, 131-2202). Findings at CT colonography and subsequent colonoscopy were recorded, and key measures of diagnostic performance, including adenoma and advanced neoplasia detection rate, were compared among the radiologists.
RESULTS
The overall prevalence of histopathologically confirmed advanced neoplasia was 3.6% and did not differ significantly among radiologists (range, 2.4%-4.4%; P = .067; P = .395 when one outlier was excluded). Overall, 19.5% of polyps detected at CT colonography proved to be advanced neoplasia and did not differ significantly among radiologists (range, 14.4%-23.2%; P = .223). The overall per-polyp endoscopic confirmation rate was 93.5%, ranging from 80.0% to 97.6% among radiologists (P = .585). The overall percentage of nondiagnostic CT colonographic examinations was 0.7% and was consistent among radiologists (range, 0.3%-1.1%; P = .509).
CONCLUSION
Consistent performance for adenoma and advanced neoplasia detection, as well as other clinically relevant end points, were observed among radiologists at CT colonographic screening.
Topics: Chi-Square Distribution; Clinical Competence; Colonography, Computed Tomographic; Colonoscopy; Colorectal Neoplasms; Contrast Media; Diatrizoate Meglumine; Female; Humans; Male; Middle Aged; Observer Variation; Prevalence; Prospective Studies; Regression Analysis; Wisconsin
PubMed: 23449954
DOI: 10.1148/radiol.13121246 -
Dysphagia Jun 2013In the treatment of oropharyngeal dysphagia, the link between diagnosis and prescription of thickened liquids that are safe to swallow is not always straightforward.... (Comparative Study)
Comparative Study
In the treatment of oropharyngeal dysphagia, the link between diagnosis and prescription of thickened liquids that are safe to swallow is not always straightforward. Frequently, the capacity to objectively assess and quantify the rheological properties of diagnostic test fluids and to select "rheologically equivalent" dietary products is missing. Perhaps sometimes the importance of an objective comparison is not fully appreciated because two liquids seem reasonably similar in a subjective comparison (e.g., flow from a spoon). The present study deals with some of these issues. Shear viscosity measurements were used to characterize the flow behavior of videofluoroscopic contrast agents and of thickened fluids prepared with commercial thickening agents. Effects of time and composition of the different fluids were analyzed regarding shear-rate-dependent viscosity. Nearly all materials tested showed a pronounced dependence of viscosity with shear rate ("shear thinning"). Results confirm that it is feasible (but not always straightforward) to "match" the viscosities of diagnostic fluids and thickened beverages if certain precautions are taken. For example, the time required to reach final viscosity levels can be significant for some thickeners, particularly when used with liquids containing contrast agents. It is recommend to use only diagnostic materials and thickening agents for which reliable viscosity data are available.
Topics: Contrast Media; Deglutition; Deglutition Disorders; Diatrizoate Meglumine; Fluoroscopy; Humans; Video Recording; Viscosity
PubMed: 23407897
DOI: 10.1007/s00455-012-9441-x -
World Journal of Gastroenterology Jan 2013To evaluate the efficacy of reduced cathartic bowel preparation with 2 L polyethylene glycol (PEG)-4000 electrolyte solution and 10 mg bisacodyl enteric-coated tablets... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To evaluate the efficacy of reduced cathartic bowel preparation with 2 L polyethylene glycol (PEG)-4000 electrolyte solution and 10 mg bisacodyl enteric-coated tablets for computed tomographic colonography (CTC).
METHODS
Sixty subjects who gave informed consent were randomly assigned to study group A, study group B or the control group. On the day prior to CTC, subjects in study group A were given 20 mL 40% wt/vol barium sulfate suspension before 3 mealtimes, 60 mL 60% diatrizoate meglumine diluted in 250 mL water after supper, and 10 mg bisacodyl enteric-coated tablets 1 h before oral administration of 2 L PEG-4000 electrolyte solution. Subjects in study group B were treated identically to those in study group A, with the exception of bisacodyl which was given 1 h after oral PEG-4000. Subjects in the control group were managed using the same strategy as the subjects in study group A, but without administration of bisacodyl. Residual stool and fluid scores, the attenuation value of residual fluid, and discomfort during bowel preparation in the three groups were analyzed statistically.
RESULTS
The mean scores for residual stool and fluid in study group A were lower than those in study group B, but the differences were not statistically significant. Subjects in study group A showed greater stool and fluid cleansing ability than the subjects in study group B. The mean scores for residual stool and fluid in study groups A and B were lower than those in the control group, and were significantly different. There was no significant difference in the mean attenuation value of residual fluid between study group A, study group B and the control group. The total discomfort index during bowel preparation was 46, 45 and 45 in the three groups, respectively, with no significant difference.
CONCLUSION
Administration of 10 mg bisacodyl enteric-coated tablets prior to or after oral administration of 2 L PEG-4000 electrolyte solution enhances stool and fluid cleansing ability, and has no impact on the attenuation value of residual fluid or the discomfort index. The former is an excellent alternative for CTC colorectum cleansing.
Topics: Administration, Oral; Adult; Aged; Bisacodyl; Cathartics; China; Colonography, Computed Tomographic; Defecation; Female; Humans; Male; Middle Aged; Multidetector Computed Tomography; Pilot Projects; Polyethylene Glycols; Predictive Value of Tests; Prospective Studies; Tablets, Enteric-Coated; Therapeutic Irrigation; Treatment Outcome; Young Adult
PubMed: 23382637
DOI: 10.3748/wjg.v19.i4.561 -
Singapore Medical Journal Nov 2012We compared the effectiveness of different types of non-commercial neutral oral contrast agents for bowel distension and mural visualisation in computed tomographic (CT)... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
We compared the effectiveness of different types of non-commercial neutral oral contrast agents for bowel distension and mural visualisation in computed tomographic (CT) enterography.
METHODS
90 consecutive patients from a group of 108 were randomly assigned to receive water (n = 30), 3.8% milk (n = 30) or 0.1% gastrografin (n = 30) as oral contrast agent. The results were independently reviewed by two radiologists who were blinded to the contrast agents used. The degree of bowel distension was qualitatively scored on a four-point scale. The discrimination of bowel loops, mural visualisation and visualisation of mucosal folds were evaluated on a 'yes' or 'no' basis. Side effects of the various agents were also recorded.
RESULTS
3.8% milk was significantly superior to water for bowel distension (jejunum, ileum and terminal ileum), discrimination of bowel loops (jejunum and ileum), mural visualisation and visualisation of mucosal folds (ileum and terminal ileum). It was also significantly superior to 0.1% gastrografin for bowel distension, discrimination of bowel loops, mural visualisation and visualisation of mucosal folds (jejunum, ileum and terminal ileum). However, 10% of patients who received 3.8% milk reported immediate post-test diarrhoea. No side effects were documented for patients who received water and 0.1% gastrografin.
CONCLUSION
3.8% milk is an effective and superior neutral oral contrast agent for the assessment of the jejunum, ileum and terminal ileum in CT enterography. However, further studies are needed to explore other suitable oral contrast agents for CT enterography in lactose- or cow's milk-intolerant patients.
Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Animals; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestines; Male; Middle Aged; Milk; Multidetector Computed Tomography; Water
PubMed: 23192500
DOI: No ID Found