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Frontiers in Surgery 2023Enterocutaneous fistula is one of the most challenging problems facing surgeons. In severe cases, a large amount of fluid loss can lead to problems such as water and...
BACKGROUND
Enterocutaneous fistula is one of the most challenging problems facing surgeons. In severe cases, a large amount of fluid loss can lead to problems such as water and electrolyte acid-base imbalance, malnutrition, infection, and organ dysfunction. Here we reported a case of platelet-rich plasma combined with lyophilizing thrombin powder for the treatment of complicated enterocutaneous fistula.
CASE PRESENTATION
A 48-year-old male, more than 2 years after the operation of abdominal trauma, the leakage of the fistula in the right upper abdominal wall was accompanied by fever for 3 days. The Contrast Fistulography and upper abdomen CT accurately depicted the entry of the meglumine diatrizoate into the small intestine through the small fistula. The patient had a large abdominal wall defect and severe intestinal adhesions. Reoperation may lead to more serious ECF. Therefore, we decided to seal the fistulas with PRP combined with lyophilizing thrombin powder.
CONCLUSIONS
The findings in this case report suggest that the combination of PRP and lyophilized thrombin powder holds promise as a viable approach for managing ECF in patients with chronic abdominal wall fistulas, as it appears to facilitate fistula closure, reduce healing time, and improve patient outcomes.
PubMed: 37928064
DOI: 10.3389/fsurg.2023.1252045 -
European Journal of Radiology Nov 2011To evaluate the influence of CAD for the evaluation of CT colonography (CTC) datasets by inexperienced readers during the attendance of a dedicated hands-on training...
PURPOSE
To evaluate the influence of CAD for the evaluation of CT colonography (CTC) datasets by inexperienced readers during the attendance of a dedicated hands-on training course.
METHOD AND MATERIALS
Twenty-seven radiologists inexperienced in CTC (11 with no CTC training at all, 16 having previously reviewed no more than 10 CTC cases overall) attended a hands-on training course based on direct teaching on fifteen workstations (four Advantage Windows 4.4 with Colon VCAR software, GE; six CADCOLON, Im3D; five ColonScreen (Toshiba/Voxar) with ColonCAD™ API, Medicsight). During the course, readers were instructed to analyze 26 CTC cases including 38 colonic lesions obtained through low-dose MDCT acquisitions, consisting of 12 polyps sized less than 6 mm, 9 polyps sized between 6 and 10 mm, 12 polyps sized between 11 mm and 30 mm, and 5 colonic masses sized>3 cm. CTC images were reviewed by each reader both in 2D and 3D mode, respectively by direct evaluation of native axial images and MPR reconstructions, and virtual endoscopy or dissected views. Each reader had 15 min time for assessing each dataset without CAD, after which results were compared with those provided by CAD software. Global rater sensitivity for each lesion size before and after CAD usage was compared by means of two-tailed Student's t test, while sensitivity of each single reader before and after CAD usage was assessed with the McNemar test.
RESULTS
For lesions sized<6 mm, global rater sensitivity was 0.1852±0.1656 (mean±SD) before CAD-assisted reading and 0.2345±0.1761 after CAD (p=0.0018). For lesions sized 6-9 mm, sensitivity was 0.2870±0.1016 before CAD-assisted reading and 0.3117±0.1099 after CAD (p=0.0027). For lesions sized 10-30 mm, sensitivity was 0.5308±0.2120 before CAD-assisted reading and 0.5637±0.2133 after CAD (p=0.0086), while for lesions sized>30 mm, sensitivity before CAD-assisted reading was 0.3556±0.3105 and did not change after CAD usage (p=1). Sensitivity of each single rater did not significantly differ before and after CAD for any lesion size category (McNemar test, p>0.05). Specificity was not significantly different before and after CAD for any lesion size (>96% for all size categories).
CONCLUSION
CAD usage led to increased overall sensitivity of inexperienced readers for all polyps sizes, except for lesions>30 mm, but sensitivity of individual raters was not significantly higher compared with CAD-unassisted reading.
Topics: Colonic Polyps; Colonography, Computed Tomographic; Contrast Media; Diagnosis, Computer-Assisted; Diatrizoate Meglumine; Humans; Radiographic Image Interpretation, Computer-Assisted; Radiology; Retrospective Studies; Sensitivity and Specificity; Software
PubMed: 20832219
DOI: 10.1016/j.ejrad.2010.07.014 -
The British Journal of Radiology Aug 2012To determine the role of abdominal CT in assessment of severity and prognosis of patients with acute gastrointestinal (GI) graft-vs-host disease (GVHD).
OBJECTIVE
To determine the role of abdominal CT in assessment of severity and prognosis of patients with acute gastrointestinal (GI) graft-vs-host disease (GVHD).
METHODS
During 2000-2004, 41 patients with a clinical diagnosis of acute GI-GVHD were evaluated. CTs were examined for intestinal and extra-intestinal abnormalities, and correlated with clinical staging and outcome.
RESULTS
20 patients had GVHD clinical Stage I-II and 21 had Stage III-IV. 39 (95%) had abnormal CT appearances. The most consistent finding was bowel wall thickening: small (n=14, 34%) or large (n=5, 12%) bowel, or both (n=20, 49%). Other manifestations included bowel dilatation (n=7, 17%), mucosal enhancement (n=6, 15%) and gastric wall thickening (n=9, 38%). Extra-intestinal findings included mesenteric stranding (n=25, 61%), ascites (n=17, 41%), biliary abnormalities (n=12, 29%) and urinary excretion of orally administered gastrografin (n=12, 44%). Diffuse small-bowel thickening and any involvement of the large bowel were associated with severe clinical presentation. Diffuse small-bowel disease correlated with poor prognosis. 8 of 21 patients responded to therapy, compared with 15 of 20 patients with other patterns (p=0.02), and the cumulative incidence of GVHD-related death was 62% and 24%, respectively (p=0.01). Overall survival was not significantly different between patients with diffuse small-bowel disease and patients with other patterns (p=0.31). Colonic disease correlated with severity of GVHD (p=0.04), but not with response to therapy or prognosis (p=0.45).
CONCLUSION
GVHD often presented with abdominal CT abnormalities. Diffuse small-bowel disease was associated with poor therapeutic response. CT may play a role in supporting clinical diagnosis of GI GVHD and determining prognosis.
Topics: Abdominal Pain; Acute Disease; Adult; Contrast Media; Diarrhea; Diatrizoate Meglumine; Female; Gastrointestinal Diseases; Graft vs Host Disease; Hematologic Neoplasms; Humans; Immunosuppressive Agents; Kaplan-Meier Estimate; Male; Middle Aged; Nausea; Prognosis; Retrospective Studies; Stem Cell Transplantation; Tomography, Spiral Computed; Transplantation, Homologous
PubMed: 22128129
DOI: 10.1259/bjr/60038597 -
Journal of the American College of... Dec 1987Ventricular fibrillation during coronary angiography with Renografin-76 (meglumine sodium diatrizoate) has been attributed to the calcium-binding additives sodium... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Ventricular fibrillation during coronary angiography with Renografin-76 (meglumine sodium diatrizoate) has been attributed to the calcium-binding additives sodium citrate and sodium ethylenediaminetetraacetic acid (EDTA), which may produce repolarization changes manifested as prolongation of the QT interval. Angiovist-370 is a newer form of meglumine sodium diatrizoate that contains calcium EDTA as its additive and thus has a decreased calcium-binding effect. Eight hundred sixteen patients were prospectively randomized to receive either Renografin-76 or Angiovist-370. Ventricular fibrillation occurred in 10 of 410 patients receiving Renografin-76 and in 0 of 406 patients given Angiovist-370 (p less than 0.0005). Clinical data were analyzed without knowledge of other data in the 10 patients treated with Renografin-76 who had ventricular fibrillation (Group I), 103 randomly selected patients who also received Renografin-76 but had no ventricular fibrillation (Group II) and 108 randomly selected patients given Angiovist-370 (Group III). Of several variables examined, only the QT interval differentiated patients receiving Renografin-76 and Angiovist-370. The mean corrected QT interval (QTc interval) before coronary angiography was slightly but not significantly (p = 0.7) higher in Group I than in Groups II and III. Ten seconds after the first left coronary artery injection it was more prolonged in Groups I and II (0.552 and 0.561 second, respectively) than in Group III (0.448 second) (p less than 0.00005). Similarly, 10 seconds after the first right coronary artery injection it was significantly longer in Groups I and II (0.545 and 0.544 second) than in Group III (0.477 second) (p less than 0.00005).(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Calcium; Citrates; Citric Acid; Coronary Angiography; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Edetic Acid; Electrocardiography; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Ventricular Fibrillation
PubMed: 3119687
DOI: 10.1016/s0735-1097(87)80126-2 -
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 -
World Journal of Gastroenterology May 2005Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has been reported recently, but late feeding is common.... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
AIM
Postoperative gastrointestinal-tract motility is normally delayed. Early feeding after colorectal surgery has been reported recently, but late feeding is common. Gastrografin not only enhances bowel peristalsis, but also decreases bowel-wall edema. Whether contrast medium allows early oral feeding and reduces the duration of hospitalization requires clarification.
METHODS
Fifty patients underwent elective colorectal surgery in a regional medical center. Patients were prospectively randomized into a Gastrografin group or control group (n = 25 each). Patients in the Gastrografin group began their feeding schedule with 100 mL of 5% dextrose water with 100 mL of Gastrografin on postoperative d 3 and were advanced to a full liquid diet when the contrast reached the colon in 4 h. Patients in the control group began their feeding schedule with 200 mL of 5% dextrose water on postoperative d 3 and were advanced to a full liquid diet after the passage of flatus and stool. Nasogastric tubes were inserted for persistent postoperative vomiting. Fullness, nausea, vomiting, complications, time of anesthesia, time of operation, time of mobilization, time of oral feeding, and duration of hospital stay were recorded and analyzed with Student's t-test.
RESULTS
In the Gastrografin group, one patient had aspiration pneumonia and one patient had anastomotic leakage resulting in sepsis and eventual death. This mortality was excluded from the subsequent statistical analysis. In the control group, two patients had wound infections. There was no significant difference between the two groups at the time of anesthesia, time of operation, or time of mobilization. There were significant differences between the two groups in the time of oral feeding (3.3+/-0.3 d in the Gastrografin group vs 4.8+/-0.4 d in the control group; P = odds ratio--, 95%CI [-0.5 to +0.7 d]) and in the length of hospital stay (7.6+/-1.1 d in the Gastrografin group vs 10.2+/-1.3 d in the control group; P = odds ratio--, 95% CI [-1.2 to +1.4 d]).
CONCLUSION
Gastrografin not only allowed early oral feeding but also reduced the duration of hospitalization after elective colorectal surgery.
Topics: Aged; Aged, 80 and over; Colorectal Surgery; Contrast Media; Diatrizoate Meglumine; Eating; Humans; Length of Stay; Middle Aged; Postoperative Period; Solubility; Time Factors; Water
PubMed: 15884127
DOI: 10.3748/wjg.v11.i18.2802 -
Journal of the American College of... Aug 1991The influence of contrast media on thrombus formation during percutaneous transluminal coronary angioplasty was assessed in 124 consecutive patients undergoing coronary... (Comparative Study)
Comparative Study
The influence of contrast media on thrombus formation during percutaneous transluminal coronary angioplasty was assessed in 124 consecutive patients undergoing coronary angioplasty and receiving either ionic (n = 57) (Group I) or nonionic (n = 67) (Group II) contrast medium. The presence of thrombus was assessed by qualitative analysis of angiograms in identical pre- and postangioplasty projections by four observers who had no knowledge of other data. Quantitation of stenosis severity before and after angioplasty and qualitative analysis of lesion eccentricity and complexity and of the presence of dissection were also performed. Although the baseline clinical characteristics of the two groups (including presenting syndromes and procedural and angiographic variables) did not differ, more patients in Group II than Group I developed new thrombus during coronary angioplasty (18% vs. 4%, p less than 0.02). In particular, patients with a presenting syndrome of recent myocardial infarction or rest angina, or both, and patients with an eccentric coronary plaque were more likely to develop new thrombus if they received nonionic than if they received ionic contrast medium (p less than 0.05). Patients with new thrombus formation and patients with thrombus present both before and after angioplasty had a high incidence of acute procedural complications (36% and 23%, respectively). Patients in Groups I and II had a similar incidence of ischemic events during follow-up.
Topics: Angioplasty, Balloon, Coronary; Contrast Media; Coronary Angiography; Coronary Disease; Coronary Thrombosis; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Female; Humans; Incidence; Iopamidol; Male; Middle Aged; Multivariate Analysis; Osmolar Concentration; Retrospective Studies
PubMed: 1856412
DOI: 10.1016/0735-1097(91)90598-4 -
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 -
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 -
Dysphagia Sep 2013
Topics: Contrast Media; Deglutition; Deglutition Disorders; Diatrizoate Meglumine; Fluoroscopy; Humans
PubMed: 23812237
DOI: 10.1007/s00455-013-9476-7