Effect of iodixanol and ioxilan on QT interval and renal function in patients with systolic heart failure

Background

Contrast media (CM) exposure is associated with a substantial risk of arrhythmias and nephrotoxicity. These adverse effects may be exacerbated in high-risk conditions such as heart failure, although no studies have evaluated newer CM agents in this population. This study evaluated the electrophysiologic and renal effects of two newer CM agents, iodixanol and ioxilan, in heart failure patients undergoing angiography.

Methods

Eighty-seven consecutive systolic heart failure patients who received either iso-osmolar iodixanol (n = 44) or low-osmolar ioxilan (n = 43), stratified for concomitant amiodarone, were evaluated for QT interval and serum creatinine changes in comparison to baseline. QT values were corrected according to three formulae: Bazett's correction, Fridericia formula, and Framingham equation.

Results

Baseline patient characteristics were not significantly different in the iodixanol versus ioxilan groups, except for myocardial infarction and renal disease. No significant change in mean QTc was observed after exposure to either CM agent compared to baseline. These results were unaffected by amiodarone. A significant improvement in serum creatinine from baseline was observed in the iodixanol group compared to the ioxilan group (−0.121 ± 0.35 mg/dL vs. 0.033 ± 0.23 mg/dL, respectively; p = 0.045).

Conclusions

No significant change in QTc interval was observed in patients receiving either iodixanol or ioxilan during angiography. Iodixanol appeared to improve short-term renal function in patients with heart failure and should be further investigated.     

Laparoscopic-assisted versus open resection of right-sided colonic cancer—a prospective randomized controlled trial

Purposes  

This study aims to compare the perioperative outcomes and survival between laparoscopic-assisted right hemicolectomy (LARH) and open right hemicolectomy (ORH) for right-sided colon cancer.     

The risk of advanced histology in small-sized colonic polyps: are non-invasive colonic imaging modalities good enough?

Purpose

The study aims to evaluate the risk of advanced histology within small colonic polyps and assess whether this risk warrants different recommendation for surveillance and treatment of such polyps.

Methods

A retrospective study of all patients undergoing their first ever colonoscopy and polypectomy in a tertiary hospital for one of three indications: screening, positive family history, and positive occult blood in stool. The histological reports of all resected polyps were retrieved and stratified according to the various polyps’ sizes. Advanced neoplasia was defined as tubular adenoma ≥10?mm or any size polyp with advanced histology, i.e., villous or tubulovillous adenoma, high-grade dysplasia, intramucosal carcinoma, or invasive cancer.

Results

Seven hundred forty-one patients who had a total of 1,192 resected polyps were included. Of polyps ≤5?mm in size, 1.6% harbored invasive cancer or high-grade dysplasia, and additional 4.1% contained villous component. The rate of advanced histology for polyps sized 6–9?mm was over 15%. The rate of advanced histology in polyps ≤5?mm was not significantly different when employing sensitivity analysis accounting for possible under or overestimation of polyp sizes by 1 and 2?mm. However, 4.6% of polyps sized 6–9?mm were found to harbor an invasive or high-grade dysplasia component when taken into account a 2-mm overestimation.

Conclusions

A non-negligible fraction of small polyps harbor advanced histology. This finding suggests that expectant follow-up by non-invasive colonic imaging modalities for small polyps or not reporting them may put more than 5% of patients at risk of dysplasia progression.     

Role of endoscopy in patients with diverticular disease

Acute diverticulitis occurs in 10-25% of patients with diverticulosis. Colonoscopy is advised 6 weeks after an attack of acute diverticulitis in order to completely evaluate the colonic lumen and exclude a potential malignancy. We conducted several studies aimed to evaluate the feasibility and safety of early colonoscopy in patients with acute diverticulitis. Consecutive patients hospitalized for acute diverticulitis were included. In the first phase of the study, patients with adjacent peri-diverticular air/fluid on CT were excluded. In the second phase of the study, we included patients with peri-diverticular air/fluid on CT as well. During the first phase of the study, 39 patients underwent uneventful colonoscopy. During the second phase of the study, 40 patients underwent colonoscopy and 1 of 6 patients with peri-diverticular air had perforation of her sigmoid colon. Two patients had a more protracted course and were clearly those who benefited most from the early colonoscopy. Based on our study, we concluded that early colonoscopy in acute diverticulitis is feasible. It should be reserved either for all patients with no air adjacent to diverticuli on CT or just for those with a more protracted course. In the third phase, a prospective randomized study was conducted on patients with acute diverticulitis with no peri-diverticular air. Such patients were randomized into those who underwent early colonoscopy and those who underwent colonoscopy 6 weeks later. Eighty-three patients were included in both groups and in none has a significant lesion been identified (except polyps). It seems therefore that the current abdominal CT with its excellent resolution is enough to exclude colonic cancer. Colonoscopy should be reserved only for patients with a protracted unresolved course of acute diverticulitis.