Effect of adjusted positioning on gastric distention and fluid distribution during CT gastrography

OBJECTIVE: We hypothesized that performing CT gastrography with the patient in the left posterior oblique (LPO) position would provide better distention and less residual fluid for the lower part of the stomach than CT gastrography with the patient in the standard supine position. CONCLUSION: The LPO position for CT guaranteed the distensibility of and minimal residual fluid in the lower part of the stomach, thus resulting in excellent 3D CT gastrographic images.     

Bone changes from prostaglandin therapy

Prostaglandin E therapy in infants causes periosteal elevation. Although the changes usually take 30–40 days to become visible, we have seen them as early as nine days. In 15 infants who had prostaglandin E therapy for over six days, three developed periosteal elevation. Three other cases are described in greater detail, with long-term follow-up in two in which the bone remodeled to normal. Gallium scan in one showed increased uptake in areas involved. The periosteal cloaking may mimic Caffey disease but the pattern of involvement is different, since the mandible, which is commonly affected in Caffey disease, is rarely involved in prostaglandin E therapy.     

An analysis of the physiological FDG uptake in the stomach with the water gastric distention method

PURPOSE: Physiological FDG uptake in the stomach is a common phenomenon, especially noted at the cardia. Water intake just before scanning will result in gastric distention and thinning of the gastric wall, which in turn may lead to a reduction in the physiological uptake in the gastric wall. In the current study, we investigated whether gastric distention by water intake just before PET imaging reduces physiological FDG uptake in the stomach. METHODS: The patient population comprised 60 patients who underwent whole-body FDG-PET imaging for cancer screening following gastroscopy performed within the preceding week. All patients took 400 ml of water for hydration and were administered 185 MBq of FDG intravenously. The patients were randomly divided into two groups: a group with additional water intake (AW group; n = 30) and a group without additional water intake (NW group; n = 30). In the AW group, an additional 400 ml of water was given just before PET imaging. For quantitative analysis, the stomach was classified into three areas [upper (U), middle (M) and lower (L)], and the degree of FDG uptake in each area was evaluated using standardised uptake values (SUVs). RESULTS: In the NW group, the mean SUVs in the U, M and L areas were 2.41 +/- 0.75, 2.28 +/- 0.73 and 1.61 +/- 0.89, respectively, while in the AW group they were 1.82 +/- 0.66, 1.73 +/- 0.56 and 1.48 +/- 0.49, respectively, and 2.21 +/- 0.38 in the oesophago-gastric junction. The mean SUVs in the U and M areas in the AW group were significantly lower than those in the NW group (p < 0.05). CONCLUSION: Additional water intake just before PET imaging is an effective method for suppressing physiological FDG uptake in the stomach.     

Arterial occlusions in neonates: use of fibrinolytic therapy

For neonates with ischemia of an extremity or extensive thrombosis of the aorta after umbilical artery catheterization, prompt recognition and management decisions are necessary. The cases of eight infants with symptomatic thrombosis who were treated with fibrinolytic agents were retrospectively reviewed to study means of diagnosis and response to therapy. Peripheral thrombosis was seen in two otherwise healthy infants; fibrinolytic therapy produced complete lysis in one and partial lysis in the other. The six infants with central thrombosis presented with low Apgar scores and multiple clinical problems; umbilical catheters were already in place. To assess the clot, real-time sonography was performed in all six patients, and umbilical arteriograms were obtained in five. Fibrinolytic therapy produced complete lysis of clot in five of the six infants. The one death occurred in a premature infant in whom a large intracranial hemorrhage developed 6 hours after institution of therapy.     

Periosteal hyperostosis resulting from prostaglandin therapy

Lamellated cortical hyperostosis about the long bones of a premature infant is usually an indication of trauma, congenital infection or Caffey disease. Prostaglandin preparations are now being used for extended periods of time to keep the ductus arteriosus open. As a result of the long-term use of this drug, bilaterally symmetric marked diaphyseal periosteal new bone can be induced.     

Cortical hyperostoses after long-term prostaglandin E2 therapy

Cortical hyperostoses are found to be side effects after therapy in early infancy with prostaglandin E1 and E2. Correlation seems to exist between dosage and duration of therapy. Radiologically the lesions cannot be differentiated from Caffey's disease. Pathogenetic relationship of the two diseases is discussed; 62 cases of newborn children with ductal related vitium cordis, who were treated for a short time or for longer with prostaglandin E2 are demonstrated.     

The role of gastric distention in differentiating recurrent tumor from physiologic uptake in the remnant stomach on 18F-FDG PET.

Physiologic (18)F-FDG uptake in the stomach can often cause false-positive results and lowers the usefulness of (18)F-FDG PET in evaluating the remnant stomach. We assessed the role of gastric distension to see whether it is beneficial for the differentiation of recurrent tumors from physiologic (18)F-FDG uptake in the remnant stomach. METHODS: Thirty patients (22 men and 8 women; age range, 27-80 y; mean age, 58.3 y) with a history of subtotal gastrectomy for gastric cancer underwent (18)F-FDG PET for various clinical indications. After whole-body imaging, the patients were asked to drink water, and then spot imaging of the stomach was performed. (18)F-FDG uptake in the remnant stomach was considered positive for malignancy if it was persistently increased, whether focal or diffuse, after water ingestion. We used 2 standardized uptake value (SUV) criteria to differentiate benign from malignant uptake. First, a lesion was considered benign if its SUV was less than 2 on whole-body imaging. Second, for a lesion with an SUV of 2 or above, it was classified as benign if SUV decreased by more than 10% after water ingestion. RESULTS: Visual analysis of whole-body images produced 9 true-negative, 4 false-positive, 16 true-positive, and 1 false-negative results. Use of additional spot images produced 12 true-negative, 1 false-positive, 15 true-positive, and 2 false-negative results. When an SUV cutoff of 2 was applied for malignancy before water ingestion, all 17 patients with local recurrence were correctly identified, but 11 of the 13 patients without local recurrence were falsely considered to have a recurrent tumor in the remnant stomach. To reduce the false-positive results, we used the second SUV criterion after water ingestion. Use of that criterion produced 4 false-negative results although it correctly identified the 11 false-positive results as true negative. CONCLUSION: Gastric distension by having patients drink a glass of water seems to be a simple, cost-effective way of improving the diagnostic accuracy of (18)F-FDG PET in patients with suspected recurrence in the remnant stomach. Visual analysis with special attention to the configuration of (18)F-FDG activity after water ingestion seems to be more useful than the change in SUV in evaluating the remnant stomach.     

A prospective randomized controlled study of erythromycin on gastric and small intestinal distention: Implications for MR enterography

Objectives

To assess if erythromycin increases gastric emptying and hence improves small intestinal distention during MR enterography.

Methods

Gastric, small intestinal, and large intestinal volumes were assessed with MR after neutral oral contrast (1350 ml in 45 min) and balanced randomization to erythromycin (200 mg i.v., age 31 ± 3y, 13 females), or placebo (37 ± 3y, 13 females) in 40 healthy asymptomatic volunteers. Fat-suppressed T2-weighted MR images of the abdomen were acquired on a 1.5 T magnet at standard delay times for enterography. Gastric, small, and large intestinal volumes were measured by specialized software. In addition, two radiologists manually measured diameters and percentage distention of jejunal and ileal loops. Treatment effects were evaluated by an ITT analysis based on ANCOVA models.

Results

All subjects tolerated erythromycin. MRI scans of the stomach and intestine were obtained at 62 ± 2 (mean ± SEM) and 74 ± 2 min respectively after starting oral contrast. Gastric volumes were lower (P < 0.0001) after erythromycin (260 ± 49 ml) than placebo (688 ± 63 ml) but jejunal, ileal, and colonic volumes were not significantly different. However, maximum (76–100%) jejunal distention was more frequently observed (P = 0.03) after erythromycin (8/20 subjects [40%]) than placebo (2/20 subjects [10%]). The diameter of a representative ileal loop was greater (P = 0.001) after erythromycin (18.8 ± 4.3 mm) than placebo (17.3 ± 2.8 mm) infusion.

Conclusions

After ingestion of oral contrast, erythromycin accelerated gastric emptying but effects on small intestinal dimensions were variable. In balance, erythromycin did not substantially enhance small intestinal distention during enterography using current standard delay times.     

MR and CT appearance of iliopsoas bursal distention secondary to diseased hips

Occasionally hip joint disease may extend into surrounding structures, including the retroperitoneum, via the iliopsoas bursa. The enlargement of this bursa may present as an inguinal or pelvic mass that may affect other surrounding structures and can result in a multitude of clinical presentations. The two cases presented herein of iliopsoas bursa distention secondary to hip disease demonstrate the excellent specificity of CT and magnetic resonance in differentiating this clinical entity from other causes of groin masses.     

新生儿高频声导抗测试分析

目的分析通过瞬态耳声发射（TEOAE）筛查的正常新生儿1000Hz声导抗图的特点。方法先对新生儿进行听力筛查,对双耳通过TEOAE筛查的新生儿选入743例,然后采用GSITymp Star VersionⅡ中耳分析仪测试声导抗图,对其进行分型,分析峰声导纳值对应的外耳道压力（Tpp）、峰补偿静态声导纳值（Ypc）等指标的正常范围。结果将纳入的1486耳的声导抗图按Vanhuyse分型方法分类,其中1Y1B1G型845耳（占56.90%）、1Y3B1G型158耳（占10.64%）、0Y0B0G型307耳（占20.67%）、其它176耳（占11.86%）。其中声导纳图中单峰型有1104耳,计算单峰型声导纳图各指标的95%医学参考值范围,其中Tpp为-57.00～180.00daPa、峰声导纳值（Yp）为0.97～2.89mmHo、Ypc为-0.02～1.19mmHo、外耳道容积（Vec）为0.30～0.80ml、鼓室导抗图宽度（TW）为45.00～190.00daPa。结论通过TEOAE听力筛查的新生儿1000Hz声导纳图以单峰型为主,相应的Tpp、Yp、Ypc、Vec、TW的95%医学参考值范围可作为新生儿中耳功能评估时的参考依据。     

进展期胃癌介入治疗疗效分析

目的研究进展期胃癌的介入治疗及疗效。方法对212例进展期胃癌进行介入治疗。对贲门癌经胃左动脉和左膈下动脉或脾动脉进行化疗灌注和胃左动脉栓塞;对胃体小弯侧癌经胃左、右动脉或肝总动脉,对胃大弯侧癌经胃十二指肠动脉、胃网膜右动脉或脾动脉化疗灌注;对胃窦癌经胃十二指肠动脉或对胃网膜右动脉中段栓塞后进行化疗药物灌注。对胃癌复发和残胃癌经腹腔干和肠系膜上动脉化疗灌注。结果对未手术的193例胃癌的疗效为贲门癌CR PR53.1%,胃体癌CR PR44.4%,胃窦癌CR PR10.0%,胃癌复发和残胃癌CR PR0。贲门癌与胃体癌有效率相比(P>0.25),两者差异无统计学意义。贲门癌与胃窦癌相比及胃体癌与胃窦癌相比,差异有统计学意义(P值均<0.05)。介入治疗后手术切除者术后1、2年生存率分别为81%、56%。结论胃癌在胃组织的发病部位不同,其疗效也不同,贲门癌和胃体癌的疗效较好,胃窦癌及胃癌复发和残胃癌疗效较差。