Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs

Sonographic findings in 497 patients with suspected acute cholecystitis were analyzed prospectively. Combined use of primary and secondary sonographic signs led to excellent positive and negative predictive values. Positive predictive values for stones combined with either a positive sonographic Murphy sign (92.2%) or with gallbladder wall thickening (95.2%) were excellent for acute cholecystitis. Positive predictive value of these signs for patients requiring cholecystectomy was even higher (99.0%). Negative predictive values for combined use of primary and secondary signs to exclude acute cholecystitis were also excellent (95.0% for no stones and negative sonographic Murphy sign). Real-time sonography alone, using both primary and secondary signs, can be definitive in nearly 80% of patients with suspected acute cholecystitis. These patients require no further imaging evaluation. Sonography should be the screening test of choice in acute cholecystitis because it is cost effective, prospectively highly accurate, quick, and better at characterizing and detecting other abdominal lesions than cholescintigraphy. A proposed algorithm is described.     

Amebic liver abscess: MR imaging

Hepatic magnetic resonance (MR) imaging was performed in 12 patients with 13 amebic liver abscesses. While no specific image or intensity pattern was noted, most lesions were round or oval with smooth, well-defined margins; had decreased signal intensity compared with that of liver parenchyma on T1-weighted images and increased signal intensity on T2-weighted images; and had prominent, often multiple rims of variable signal intensity. Signal homogeneity within the abscess was present more often on T1- than on T2-weighted images. Diaphragmatic disruption was seen in two cases on coronal MR images. An amebic empyema was differentiable from sympathetic pleural effusions by its hyperintensity on both T1- and T2-weighted images. In patients who also underwent computed tomography (CT) or ultrasonography (US), no lesion was missed with any modality, and except for shape, no consistent features were found among images obtained with the different modalities. The data suggest that CT, US, and MR imaging are comparably effective in the detection of amebic abscess.     

Corrected cholesterol,a novel marker for predicting semen post-thaw quality: a pilot study

Semen cryopreservation is the recommended method for protecting the fertility of men before they undergo iatrogenic treatments. However, post-thaw sperm quality is highly variable between and within individuals. Thus, prediction of post-thaw quality has not been achieved with great certainty. Men (n?=?101) attending our andrology clinic each produced a single ejaculate for semen analysis and semen cryopreservation. Post-thaw semen quality was examined for associations with traditional and novel semen and seminal plasma parameters. This current research demonstrates that the cholesterol concentration of human sperm is associated with ejaculate tolerance to cryopreservation. Corrected cholesterol, calculated as the difference between the cholesterol of semen and the cholesterol of cell free seminal plasma, is predictive of post-thaw motility. This may have potential as a method to guide the number of ejaculates stored for individual patients before iatrogenic treatment and/or for the appropriate selection of ART with frozen/thawed semen.     

Characterizing abdominal pain in IBS: guidance for study inclusion criteria,outcome measurement and clinical practice

Aliment Pharmacol Ther 2010; 32: 1192–1202

Summary

Background Although irritable bowel syndrome (IBS) is a multisymptom disorder, abdominal pain drives illness severity more than other symptoms. Despite consensus that IBS trials should measure pain to define study entry and determine efficacy, the optimal method of measuring pain remains uncertain. Aim To determine whether combining information from multiple pain dimensions may capture the IBS illness experience more effectively than the approach of measuring ‘pain predominance’ or pain intensity alone. Methods Irritable bowel syndrome patients rated dimensions of pain, including intensity, frequency, constancy, predominance, predictability, duration, speed of onset and relationship to bowel movements. We evaluated the impact of each dimension on illness severity using multivariable regression techniques. Results Among the pain dimensions, intensity, frequency, constancy and predictability were strongly and independently associated with illness severity; the other dimensions had weaker associations. The clinical definition of ‘pain predominance’, in which patients define pain as their most bothersome symptom, was insufficient to categorize patients by illness severity. Conclusions Irritable bowel disease pain is multifaceted; some pain dimensions drive illness more than others. IBS trials should measure various pain dimensions, including intensity, constancy, frequency and predictability; this may improve upon the customary use of measuring pain as a unidimensional symptom in IBS.     

感觉神经元的轴突分叉及其在躯体内脏相关中的作用(英文)

80年代以来已在脊髓背角鉴定出10种以上新的感觉投射神经元。所有这些神经元均以其分支的轴突或侧支轴突为特征。这些神经元的分支轴突分别向两个以上的不同核团，包括体感核和内脏感觉核投射。其中有些神经元从其所投射的中枢靶核接受躯体与内脏的传入输入，同时通过分叉初级传入从外周接受躯体与内脏的传入输入。有些外周感觉输入可首先在脊神经节神经元上会聚并被加工处理。这些发现看来是对感觉神经元单投射与单支配的传统观念的挑战并参与躯体内脏相关和有关的临床障碍。     

Digital subtraction angiography of the extremities using table translation

Digital subtraction angiography (DSA) of the extremities has been performed with both intravenous and intraarterial injections of contrast material. Intravenous studies are usually site specific and are limited by contrast material load; a complete intraarterial study with multiple injections of contrast material may be time consuming. A feasibility study to evaluate a DSA technique that would allow table translation and imaging of two contiguous regions following a single injection of contrast material--bolus-chase DSA--was performed. Forty-five examinations were performed, 13 intravenously and 32 intraarterially. Twelve intravenous and 16 intraarterial DSA examinations were totally satisfactory. Inadequate studies were predominantly caused by slow arterial clearance of contrast material in the distal calf and by operator error. Compared with conventional DSA, anatomic studies of lower-extremity vessels could be obtained faster and with lower contrast material loads using bolus-chase DSA.     

Cholelithiasis: evaluation with CT

Computed tomography (CT) is often the first imaging modality used in the diagnosis of patients with suspected abdominal disease. While it is known that early generation CT scanners often detect gallstones, the detection rate of newer equipment is not widely known. Abdominal CT scans of 226 patients who had undergone ultrasonographic (US) studies of the gallbladder were reviewed in a blinded study to determine the accuracy of state-of-the-art CT scanning equipment in the detection of cholelithiasis. Of 110 patients with US or surgical evidence of cholelithiasis, gallstones were demonstrated on CT images of 87 (79.1% sensitivity). Overall accuracy was 89.8%, while specificity was 100%. On CT images stones could appear densely (48.3%) or slightly (11.5%) calcified, as an area with a rim of increased density (21.8%), as an area of soft-tissue density (14.9%), or as an area of low density (3.4%). Stone size, stone density, section incrementation, and the pericholecystic anatomy affected the detection rate. Understanding the spectrum of findings and the other factors involved can optimize success of diagnosis of cholelithiasis on the basis of CT examinations.