Cholelithiasis in the morbidly obese: diagnosis by US and oral cholecystography

Forty-two morbidly obese patients underwent cholecystectomy at the time of gastroplasty, primarily for prophylactic reasons. Preoperatively, 37 patients underwent ultrasonography (US) of the gallbladder and oral cholecystography, four US only, and one oral cholecystography only. There was one indeterminate US study (2.4%) and one indeterminate oral cholecystogram (2.7%). At US study, gallstones were detected in six of the eight patients with gallstones (sensitivity = 75%), and the gallbladders of all 32 patients without gallstones were categorized as normal (specificity = 100%). The gallstones not identified measured 1-2 mm in diameter. Oral cholecystographic study enabled detection of gallstones in three of the seven patients with gallstones (sensitivity = 43%) and categorized as normal all 30 gallbladders without gallstones (specificity = 100%). The gallstones not seen were small and included those not detected by US. The results suggest that US is equal or superior to oral cholecystography for detection of cholelithiasis in obese patients.     

The value of the fatty meal in oral cholecystography.

In order to assess the value of the after fatty meal films, 232 oral cholecystograms were reviewed. Gallbladder opacification, duct visualisation, separation of gallbladder from overlying bowel gas shadows, and the demonstration of abnormalities were assessed from the pre-fatty meal films, and then again in conjunction with those taken after fat, when contraction was also assessed. Of the 200 examinations given the fatty meal, 132 were adjudged normal, 63 had gallstones, four had adenomyomatosis (one with stones), and two cholesterolosis. The post-fatty meal films, were found to be essential for the diagnosis of adenomyomatosis and cholesterolosis, and considered to be occasionally helpful in diagnosing small stones. They were of little value in assessing the biliary ducts, or separating the gallbladder from overlying bowel gas, and of no value in the diagnosis of functional biliary tract disorders.     

Real-time high-resolution echotomography and oral cholecystography in the study of hyperplastic cholecystosis

A series of 305 patients underwent both cholecystosonography and oral cholecystography. Ultrasounds showed a higher diagnostic accuracy in the diffuse and localized cholesteroloses. Oral cholecystography is still reliable in the diagnosis of adenomyomatosis, especially of the fundus. As present diagnostic and therapeutical indications are nonhomogeneous, early sonographic visualization and follow-up of small cholesterol polyps are valuable for understanding the development of the disease and its clinical and prognostic significance.     

Multidetector CT of the small bowel: evaluation after oral hyperhydration with isotonic solution

PURPOSE: The aim of our study was to assess the diagnostic capabilities of multidetector CT in the evaluation of the small bowel in different pathological conditions, with the use of oral hyperhydration with isotonic solution. MATERIALS AND METHODS: The study retrospectively evaluated 106 patients who underwent multidetector CT of the small bowel. Four groups were considered on the basis of the clinical findings: group A (48 cases), with suspected or certain chronic inflammatory disease of the small bowel; group B (16 cases), with suspected neoplastic lesion of the small bowel; group C (17 cases), patients affected by malabsorption; group D (25 cases), others: 13 cases with non-specific abdominal pain, 4 cases with occult bleeding, 8 cases affected by fever of unknown origin. Thirteen patients had previously undergone surgical intestinal resection. In all cases the CT examination was performed after the oral administration of 2000 mL polyethylene glycol electrolyte balanced solution; before the scan, N-butyl scopolamine or glucagon were administered intravenously to obtain rapid inhibition of bowel peristalsis. All multidetector CT scans were acquired at baseline and 50 seconds after the I.V. administration of 110-130 ml high-concentration non-ionic iodinated contrast medium. The images were subsequently processed on a dedicated workstation (Advantage Windows 4.0, GE Medical Systems) to obtain multiplanar reconstruction (MPR). We considered the following CT findings: fold distribution, wall thickening and stratification and contrast enhancement, extraparietal involvement and abnormalities of the abdominal organs. The CT diagnoses were compared with the clinical and laboratory findings (86 cases) and with the results of barium follow-through (55 cases), ileo-colonoscopy (45 cases) or surgery (28 cases). RESULTS: CT examination allowed the correct diagnosis in 86/106 cases (89%); 20 patients were not included in the study because of a poor (11 cases) or absent (9 cases) small bowel loop distension. The final diagnoses in the 86 patients were: Crohn's disease of the small bowel (38 cases), Crohn's disease of the duodenum (1 case), granulomatous colitis (3 cases), malabsorption (8 cases), neoplastic lesion (4 cases), post-radiation conglomeration of ileal loops (1 case), intestinal lymphangiectasia (1 case), ulceration of the last ileal loop (1 case). In 29 cases no abnormalities of the small bowel were found. Spiral CT yielded 52 true positive cases, 5 false negative cases, 2 false positive cases, and 27 true negative RESULTS: The sensitivity of the technique was 91%, specificity 93% and diagnostic accuracy 92%. CONCLUSIONS: Multidetector CT of the small bowel performed after oral hyperhydration with isosmotic solution, proved to be an accurate and thorough technique. It can be considered a safe and effective alternative to conventional radiographic studies and to small bowel spiral CT enema in patients that refuse the nasojejunal balloon catheter or the administration of methylcellulose.     

单一应用磷酸钠盐口服溶液在大肠癌术前肠道准备中的临床观察

目的探讨单一应用磷酸钠盐口服溶液在大肠癌术前肠道准备中的清洁效果、不良反应和耐受性。方法将212例需做术前肠道准备的大肠癌患者随机分为四组:A组53例,口服磷酸钠盐口服溶液;B组55例,口服磷酸钠盐口服溶液联合磷酸钠盐灌肠液肛入;C组51例口服聚乙二醇电解质溶液;D组53例,口服硫酸镁溶液。观察4种不同肠道准备方法的肠道清洁有效率、不良反应率和耐受性。结果A组患者的肠道清洁有效率显著优于C组(P=0.031),而与B组、D组相比均无统计学差异(P>0.05)。A组患者在腹胀及恶心发生率方面显著低于D组(P=0.037,0.008),而在腹痛、腹胀、恶心、呕吐方面A组与B组、C组相比均无统计学差异(P>0.05)。A组患者的耐受性显著优于D组(P=0.001),而与B组、C组比较均无统计学差异(P=0.570,0.379)。结论 单一应用磷酸钠盐口服溶液用于大肠癌术前肠道准备的肠道清洁有效率高,且不良反应少,患者耐受性好。     

有血清和无血清培养基中BFU-E的比较研究

目的 :比较有血清和无血清培养基中BFU -E生长情况。方法 :分离脐血中单个核细胞 (MNC) ,接种于有血清和无血清甲基纤维素半固体培养基中生长 14～ 18d ,观察BFU -E ,并染色鉴定。结果 :有血清中约在培养 14～ 16d集落数达高峰 ,BFU-E为 ( 70 .3± 5 0 .5 ) /10 5MNC ,大部分BFU -E的细胞为 3 0 0～ 5 0 0个 ,小部分集落细胞超过 10 0 0个 ;无血清培养 16～ 18d集落数达高峰 ,BFU -E为 ( 3 6.5± 18.2 ) /10 5MNC ,集落形态与有血清基本相似 ,但集落体积普遍较小 ,细胞数约为 2 0 0～ 3 0 0左右。结论 :无血清培养基中生长时BFU -E数目及BFU -E平均细胞数均较有血清培养中少 ,血清中含有促进BFU -E生长与分化的因子     

Multidetector helical CT in the evaluation of acute small bowel obstruction: comparison of non-enhanced (no oral, rectal or IV contrast) and IV enhanced CT

Purpose

To compare accuracy of non-enhanced CT (NECT) (no oral or IV contrast) and enhanced CT (ECT) (IV enhanced only) to diagnose small bowel obstruction and evaluate reviewer's experience impact.

Materials and methods

Ninety-nine adult patients underwent 105 NECT and ECT (6 patients had 2 examinations) on a four-detector CT. An abdominal radiologist, an abdominal imaging fellow, a second-year radiology resident retrospectively reviewed NECTs and ECTs separately and independently blinded to outcome. Discrepancy of diameter of proximal and distal small bowel ± a transition was considered indication of mechanical bowel obstruction. Reference standard was surgery in 26 and chart review in 79.

Results

Mechanical obstruction was present in 56% (59/105). The average sensitivity, specificity, negative and positive predictive and accuracy values for NECT were 88.1% (CI: 80-96%), 77% (CI: 65-89%), 83.0% (CI: 72-95%), 83% (CI: 74-92%), and 83% (CI: 76-90%) with no significant difference between three reviewers. The corresponding numbers for ECT were 87.6% (CI: 79-96%), 75% (CI: 63-88%), 82.6.0% (CI: 71-94%), 82.1% (CI: 73-92%), and 82% (CI: 75-90%) (p > 0.5). Area under curve (AUC) of ROC curves of three reviewers did not show significant statistical difference (p > 0.5).

Conclusions

NECT and ECT have comparable accuracy to diagnose mechanical small bowel obstruction and can be interpreted by reviewers with different levels of expertise.     

Crohn disease of the small bowel: spiral CT evaluation after oral hyperhydration with isotonic solution

PURPOSE: Our aim was to evaluate the accuracy of spiral CT study of small-bowel Crohn disease with use of oral hyperhydration with isoosmotic solution. METHOD: We prospectively analyzed 33 consecutive patients and 10 control subjects with spiral CT after oral administration of 2,000 ml of polyethylene glycol electrolyte-balanced solution. The CT diagnoses were compared with the results of conventional radiologic oral barium examination (33 cases), ileum colonoscopy (8 cases), and surgery (4 cases). RESULTS: The final diagnoses were Crohn disease (14 cases), no small-bowel disease (16 cases), cancer of ileocecal valve (1 case), carcinosis of mesenteric root (1 case), and intestinal lymphangiectasia (1 case). In the control group, no abnormalities of the small bowel were found. The sensitivity of spiral CT was 85.7%, specificity 100%, positive predictive value 100%, negative predictive value 90%, and diagnostic accuracy 93.9%. CONCLUSION: Our method allowed adequate distension of the small bowel for spiral CT studies, thus resulting in a safe and effective alternative to small-bowel spiral CT enema, which can be used in patients that refuse the nasojejunal balloon catheter.     

A sensitive human thyroglobulin RIA to define clearly the presence or absence of functioning thyroid tissue

This paper describes a practical procedure to establish a sensitive radioimmunoassay for the measurement of human thyroglobulin (HTg) in serum. The assay enables a clear distinction to be made between levels of HTg indicating the presence or absence of functioning thyroid tissue. It compares the use of HTg serum levels with the conventional I-131 scintigram as a marker for recurrent thyroid cancer. In addition, a simple and sensitive radioimmunologic assay is described for the determination of serum antithyroglobulin autoantibodies, the presence of which may give falsely elevated HTg levels.