Gastrografin as a gastrointestinal contrast agent in the Greek tortoise (Testudo hermanni)

Eighteen Greek tortoises (Testudo hermanni), divided into three groups, were kept at three different average ambient temperatures. Gastrografin was administered to all individuals by orogastric tube at a dosage of 1 ml/130 g body weight. The partial and total transit times were recorded by means of radiographs taken immediately postadministration and at 20, 40, 60, 90, 120, and 150 min and 3, 4, 6, 8, 12, 24, 48, 72, and 96 hr postadministration. Mean total transit times were 2.6 hr (range 1.5-4.0 hr) at 30.6 degrees C, 6.6 hr (range 3.0-8.0 hr) at 21.5 degrees C, and 17.3 hr (range 8.0-24.0 hr) at 15.2 degrees C. These transit times allow a radiologic diagnosis within a relatively short period, especially compared with contrast studies performed with barium sulfate. The visualization of the intestinal tract is good with Gastrografin; however, intestinal mucosal detail was not completely satisfactory.

The role of ultrasonography in the diagnosis of pyloric stenosis: a decision analysis

BACKGROUND/PURPOSE

The appropriate role for ultrasonography (US) as a replacement for the upper gastrointestinal series (UGI) in vomiting infants remains undefined. The authors have used decision analysis techniques to determine whether the use of ultrasonography as an initial screen in vomiting infants is cost effective when compared with the UGI as the only study.

METHODS

Two diagnostic strategies were compared: 1) UGI alone and 2) ultrasonography followed by an UGI series in 50% of cases when ultrasonography scan was negative for pyloric stenosis. The test sensitivity (US, 0.9; UGI, 1.0) and test specificity (US, 1.0; UGI, 1.0) and the incidence of pyloric stenosis among vomiting infants presenting to the community pediatrician (0.30) or after a negative examination by an experienced examiner (0.02 to 0.18) were obtained from a review of the literature. The relative charges for ultrasonography and UGI were obtained from a national survey from which the cost ratio of US to UGI was estimated to range from 0.67 to 1.81 with a median of 1.06.

RESULTS

Under these baseline assumptions, UGI only was the preferred strategy. The results of the decision analysis were sensitive to, or dependent on, assumptions made regarding the incidence of pyloric stenosis, the US to UGI cost ratio, the sensitivity of the US, and the proportion of patients that proceed to UGI when the US scan was negative for pyloric stenosis. When at least 50% of patients whose US scan was negative for pyloric stenosis proceeded to a UGI, UGI remained the preferred strategy for all cost ratios examined (0.6 to 1.7). Even when no patients proceeded to UGI, the cost ratio of US to UGI had to be less than 0.7 under the typical incidence (0.30) of pyloric stenosis among vomiting infants presenting to the community pediatrician for US to be cost effective. Finally, only UGI was indicated when an olive was not appreciated by an experienced examiner.

CONCLUSION

Under assumptions that fit most clinically relevant circumstances, the UGI as the initial study is the most cost-effective radiological diagnostic test in the evaluation of the vomiting infant.

Expansion and division of conjoined twins

Omphalopagus conjoined twins were born by cesarean section after their 24-year-old gravida 2, para 1 mother went into labor at 35 weeks' gestation. Initial studies included roentenograms, an upper gastrointestinal study, small bowel follow-through, and computerized tomography with intravenous contrast from neck through pelvis. Results of these studies showed that the twins had very little shared vasculature, but did share a pericardium and liver parenchyma. The infants were allowed to gain weight and grow. After 3 weeks, tissue expanders were placed subcutaneously and were rapidly expanded in 2 weeks. The infants were then separated. An Argon Beam Coagulator was used to aid the separation of the liver. The abdominal fascia was closed primarily on each infant, and the skin easily closed without tension. During the first 36 hours of the postoperative course, both infants required significant ventilatory support including inhaled nitric oxide. After this period, the ventilatory support decreased dramatically and rapidly. The infants were discharged 9 days after their surgical separation. Conjoined omphalopagus twins, the use of tissue expanders and the Argon Beam Coagulator, and the postoperative course are discussed.

BUN/creatinine ratios: aid to decision making about delayed imaging in Tc-99m red blood cell scans for gastrointestinal hemorrhage

In patients with gastrointestinal hemorrhage, delayed or late scans with Tc-99m labeled red blood cells are readily performed and have prognostic impact when early images are negative. Nevertheless, there have been no indicators for the likelihood of detecting bleeding on such images. In a review of all gastrointestinal bleeding scans over an 8-year period, 73 patients had delayed images (> 3 hours) following early negative exams. For these patients, determinations of serum blood urea nitrogen (BUN) and creatinine (Cr) were evaluated as the BUN/Cr ratio and were compared against delayed scan findings and confirmed diagnoses. Patients with significant renal failure were excluded from analysis. There were 34 late positive (46%) and 39 late negative (54%) studies. Mean BUN/Cr was 26.5 and 20.0 in patients with late positive and late negative scans, respectively (p < 0.05). Occurrence of late positive scans was 38% (19/50) for BUN/Cr < 25.0 vs. 65% (15/23) for BUN/Cr > 25.0 (p < 0.05). Patients with early negative images and a BUN/Cr ratio of 25 or greater have a greater likelihood of a positive delayed image. Late imaging should be encouraged in patients with elevated BUN/Cr and early negative scintigraphy.

[Does angiographic localization of bleeding affect the management and mortality in gastrointestinal hemorrhage of unknown origin?]

PURPOSE

To evaluate the effect of angiography on patient management and mortality in patients with GIB of unknown origin.

MATERIAL AND METHODS

88 angiographies were performed in 74 patients with GIB of unknown origin (18 upper gastrointestinal tract [GIT]), 35 lower GIT. 21 unknown localisation) and were evaluated retrospectively in regard to the influence on patient management and clinical outcome.

RESULTS

After unsuccessful endoscopic diagnosis, angiography shows a sensitivity of 60% in the acute phase of GIB. Once the GIB had stopped the sensitivity was 14%. Following angiographic localisation, patients were more commonly treated surgically (71% vs. 44.5%) and subsequently had a lower rate of persistent or recurring bleeding (15% vs. 37.5%) as well as a lower event related mortality (10.5% vs. 25%). Patients with angiographic localisation of the bleeding site had a better outcome than patients with unsuccessful bleeding localisation, with regard to both surgical (85% vs. 62.5%) and conservative (100% vs. 85%) treatment.

CONCLUSION

Angiographic localisation should be attempted in all cases of unknown GI-bleeding after endoscopic methods have been unsuccessful or ambiguous, because such a procedure has a positive effect on patient management and outcome. Moreover, angiography also offers therapeutic options.

Abdominal pain in a healthy young man

Images

Activated charcoal as a potential radioactive marker for gastrointestinal studies

The scintigraphic measurement of colonic transit is currently performed using 111In ion exchange resin pellets delivered to the colon in a capsule coated with a pH sensitive polymer, methacrylate, which dissolves in the distal ileum. However, in the USA, this requires an investigational drug permit. Our aim was to evaluate the in vitro binding characteristics of activated charcoal in milieus that mimicked gastric and small intestinal content. The in vitro incubation of activated charcoal was performed with Na99Tc(m)O4, 99Tc(m)-DTPA, 111InCl3, 111In-DTPA, 201TlCl and 67Ga-citrate in the pH range 2-4 and pH 7.2 at 37 degrees C. We estimated the association of radiopharmaceuticals with the activated charcoal over a 3 h in vitro incubation. With the exception of 67Ga-citrate, the association of activated charcoal with the other radiopharmaceuticals was approximately 100% throughout the 3 h incubation. In conclusion, activated charcoal appears to adsorb avidly with common radioisotopes, and appears promising as an alternative to resin ion exchange pellets used for the measurement of gastrointestinal transit by scintigraphy.

In vivo evaluation of the absorption and gastrointestinal transit of avitriptan in fed and fasted subjects using gamma scintigraphy

The study was conducted to assess the bioavailability of avitriptan after a standard high fat meal, in relation to gastrointestinal transit. Six healthy male subjects were enrolled in a four-period study with a partial replicate design where each was administered 150-mg avitriptan capsule (i) after an overnight fast, (ii) 5 min after a standard high-fat breakfast, and (iii) 4 hr after a standard high fat breakfast. The treatment administered in Period 3 was repeated in Period 4 to assess intrasubject variations in pharmacokinetics and gastrointestinal (GI) transit. Avitriptan capsules were specially formulated with nonradioactive samarium chloride hexahydrate which was neutron-activated to gamma-emitting samarium before dosing. Serial blood samples were collected for analysis of avitriptan up to 24-hr postdose, and serial scintigraphic images were obtained to assess the plasma concentration-time profile in relation to the GI transit of the avitriptan capsule contents. Bioavailability of avitriptan was reduced when administered in the fed condition but only the decrease in AUC(INF) was statistically significant. Tmax was significantly delayed between the fed conditions and the fasted condition. Qualitative appearance of plasma concentration-time profiles for avitriptan could be related to the manner in which the drug emptied from the stomach. It was also apparent that avitriptan exerted a secondary pharmacologic effect that temporarily suspended gastric emptying in the fasted treatment. Thus, when gastric emptying was interrupted and then resumed, the net result was a double peak in some of the individual plasma concentration profiles. Scintigraphic analysis also demonstrated that upon emptying from the stomach, avitriptan was rapidly absorbed from the upper small intestine. In the fed state, gastric emptying was slow and continuous resulting in extended absorption and a lower occurrence of double peaks. Qualitatively, the intrasubject variability in Cmax and AUC could be explained by the intrasubject variability in gastric emptying in both fasted and fed conditions.

Urinalysis of body packers in Japan

Urinalysis was performed on nine body packers/smugglers who were referred to the emergency room of a hospital near the New Tokyo International Airport between September 1994 and February 1996. This analysis had rarely been used on suspected body packers in Japan. Only one of the nine body packers was a female. Foreign bodies were detected in the gastrointestinal tracts of the body packers by plain x-ray photography or computerized tomography, and the suspected drugs were cocaine (five cases), heroin (two cases), opiate (one case), and marijuana (one case). The results of urinalysis and confessions of the smugglers corresponded well for the latter three drugs (four cases). In two of the suspicious cocaine cases, opiates were detected along with cocaine by urinalysis, and the metabolites were confirmed by gas chromatography-mass spectrometry. The urinary screening tests of another two suspicious cocaine cases were negative. Opiates (morphine and codeine), but no cocaine metabolites, were detected in the urine of the subject who confessed to smuggling in cocaine only. It may be inferred from these results that urinalysis on body packers is beneficial to both the patient (body packer) and the physician in preventing the disastrous outcome of drug intoxication. It can also be concluded that there is a need for the prompt establishment of a protocol that includes urinalysis upon admission to the hospital for the management of body packers in Japan.

[Computed tomography in the diagnosis of digestive tract tumors]

As many as 616 patients with malignant tumours of the alimentary canal were studied by CT tomography using different contrast mediums and methodical approaches toward identifying the site of the tumour. Based on the comparison of the results obtained from pathomorphologic findings and those from the surgical intervention, CT semiotics has been developed of tumours, criteria established to determine the depth of the tumour invasion and extra-wall spread of the tumour CT potentialities were verified in the diagnosis of metastatic involvement of regional lymph nodes and remote organs as was the role of the method in selection of a specific therapeutic alternative.

[Oral contrast media in CT: improvement by addition of guar?]

PURPOSE

To evaluate the additional effect of guar with iotrolan as an oral contrast medium.

METHOD

In a clinical double-blind randomised study a viscous iotrolan (11.2 mg iodine/ml)/guar (4 g/l)-suspension was compared with aqueous solutions of pure iotrolan (11.2 mg iodine/ml) and meglumine ioxithalamate (12 mg iodine/ml). The contrast media were evaluated according to filling, distribution, transit time, artifacts, radiodensity, patient acceptance and side effects.

RESULTS

The addition of guar delayed the transit time of the contrast media. Consequently a more homogeneous filling of the bowel with fewer artifacts was observed in comparison to the aqueous contrast media. The results of the pure iotrolan solution were comparable to meglumine ioxithalamate, except for a higher radiodensity in the distal small intestine. The colon showed a better filling with non-viscous contrast media in the given time frame. Pure iotrolan had the best patient acceptance. Two patients considered the iotrolan/guar-solution impossible to drink, the other 18 patients found taste and consistency just about acceptable.

CONCLUSION

In spite of the discussed advantages, due to a less subjective acceptance the guar/iotrolan solution is not suitable in routine-diagnosis, unless taste and consistency are greatly improved. Individual use is recommended in selected cases and long-term examinations.

[The ingestion of foreign bodies for the purpose of self-injury. The conservative treatment of 2 clinical cases]

Although not rare, the ingestion of foreign bodies becomes uncommon when it is done with intent to cause self-damage. When used for this purpose, foreign bodies usually take the form of liquid substances, such as caustic agents, detergents, poisons, etc. It is less rare in certain situations like psychiatric and prison settings. The author reports two cases of foreign bodies voluntarily swallowed by patients in prison.

Scintigraphic biodistribution and plasma kinetics of indium 111-labeled transferrin in dogs

OBJECTIVE

To determine plasma clearance kinetics and imaging biodistribution of indium 111-labeled transferrin (111In-TF) in dogs.

ANIMALS

7 adult dogs.

PROCEDURE

After 30 minutes' incubation of 18.5 MBq (0.5 mCi) of 111InCl3 with 1 ml of serum (n = 3) or 1 ml of plasma (n = 4) at 37 C, dogs were given autologous 111In-TF i.v., and serial blood samples and right lateral and dorsal scintigraphic images were obtained immediately and 1, 3, 5, 9, 22, and 48 hours later. Blood and plasma clearance kinetics were determined from a least-squares, nonlinear fit of the sample radioactivity data. Blood radioactivity was compared with plasma radioactivity to determine the extent of cellular labeling. Imaging biodistribution was characterized by subjective and objective assessment of blood pool, liver, gastrointestinal (abdomen) tract, kidney, and bone marrow activity.

RESULTS

111In-TF plasma clearance was best described by a biexponential fit, with early and late clearance half-times of 6 and 49 hours, respectively. The 111In was not redistributed between transferrin (plasma proteins) and blood cells. Imaging studies documented progressive liver and bone marrow uptake of the 111In-TF over 48 hours. Some radioactivity was evident in the colon of 1 dog on 48-hour images. Decay-corrected count rates (counts/pixel/mCi/kg/min) within the abdominal region of interest increased over the 48-hour imaging period and exceeded the blood pool (cardiac) activity at 20 hours after injection.

CONCLUSION

111In-TF has a biexponential plasma clearance in clinically normal dogs, with early and late clearance half-time of 6 and 49 hours, respectively. Scintigraphically, 111In-TF localizes to sites of iron storage (bone marrow and liver) over time. Some loss of 111In-TF via the gastrointestinal tract may be seen on late 48-hour images.

CLINICAL RELEVANCE

111In-TF appears to be a viable radiopharmaceutical for use in dogs, with specific application for identifying those with protein-losing enteropathy.

MR imaging of the gastrointestinal tract with i.v., gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT

OBJECTIVE

To determine an optimal MR imaging technique and pulse sequence for evaluating mural and serosal disease of the gastrointestinal tract, we administered 2% oral barium sulfate and obtained fat-suppressed gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled (FMPSPGR) MR images. We then compared these images with spin-echo T1-weighted and T2-weighted fast spin-echo MR images and with CT images.

SUBJECTS AND METHODS

Thirty-one patients with suspected diseases of the gastrointestinal tract were imaged with spin-echo T1-weighted, fast spin-echo T2-weighted, and fat-saturated gadolinium-enhanced FMPSPGR MR imaging. Before undergoing MR imaging, all patients received 1350 ml of 2% barium sulfate oral contrast media. For CT scans, patients received 120 ml of iodinated i.v. contrast material and 2% barium sulfate oral contrast material. CT and MR images were retrospectively and independently reviewed by two radiologists for ability to see normal bowel wall, for the presence of abnormal gastrointestinal tract mural thickening or enhancement, and for overall gastrointestinal tract visualization. Findings were correlated with surgical findings, endoscopy, and barium studies.

RESULTS

Ten patients had benign disease, 16 had malignant gastrointestinal tract disease, and five had no gastrointestinal tract abnormalities. In 94% of patients, the gadolinium- and barium-enhanced FMPSPGR MR images were superior to CT and spin-echo MR sequences for depicting the wall of the normal bowel (p < .001). For the two observers, the FMPSPGR MR images with i.v. and oral contrast material were seen as revealing 94% and 95% of bowel segments with malignant or inflammatory mural thickening or serosal tumor. In comparison, CT revealed 64% and 72% (p < .01 and p < .0001, respectively), fast spin-echo T2-weighted MR images revealed 21% and 28% (p < .0001), and T1-weighted MR images revealed 17% and 18% (p < .0001). The gadolinium- and barium-enhanced MR images were preferred for overall gastrointestinal tract visualization in 65% of patients compared with 1% for CT scans (p < .001). In 32% of patients, the enhanced MR images were equivalent to CT images.

CONCLUSION

MR evaluation of the gastrointestinal tract requires bowel distention with oral contrast material as well as motion reduction techniques, including glucagon and rapid gradient-echo pulses that allow breath-hold imaging. Fat-suppressed gadolinium-enhanced FMPSPGR MR imaging with diluted barium oral contrast media is effective for imaging benign and malignant mural and serosal abnormalities of the gastrointestinal tract.

Acute gastrointestinal bleeding

Diagnosis and intervention in pediatric GI bleeding is the shared responsibility of pediatric endoscopists, radiologists, and surgeons. Brisk hemorrhage, though alarming, is most often self-limited; few cases require urgent surgery before diagnostic evaluation is accomplished. The choice between endoscopic and radiographic evaluation varies with the differential diagnoses being considered and with local referral patterns. Many imaging options exist for assessing GI bleeding in children, but these options are generally narrowed by clinical history and age-appropriate differential possibilities.

Neonatal gastrointestinal emergencies

Intestinal obstruction is the most common and important gastrointestinal emergency in the newborn period. This article presents a general approach to neonatal obstruction and discusses the most common specific cases of obstruction. The importance of the plain abdominal radiograph is emphasized.

Zinc toxicity following massive coin ingestion

This is the first reported case of human fatality associated with zinc intoxication following a massive ingestion of coins. Four hundred and sixty-one coins were removed form the gastrointestinal tract of a schizophrenic patient during the course of hospitalization. Many of the post-1981 pennies, which consist primarily of zinc, showed severe corrosion due to their prolonged contact with acidic gastric juice. The patient presented with clinical manifestations consistent with the local corrosive as well as systemic effects of zinc intoxication and died 40 days after admission with multi-system organ failure. Tissue samples of the kidneys, pancreas, and liver obtained at autopsy revealed acute tubular necrosis, mild fibrosis, and acute massive necrosis, respectively, and contained high levels of zinc. The overall effects of zinc intoxication on the various organ systems, possible hematological derangement, and the impairment of copper absorption as well as the outcome with treatment are discussed.

[Follow-up of Crohn's disease: can hydro-MRI replace fractionated gastrointestinal passage examination?]

PURPOSE

To compare the value of hydro-MRI with follow-through examinations in the follow-up of Crohn's disease.

METHOD

22 patients known to be suffering from Crohn's disease were examined via 1.5 T-MR system; an oral contrast examination using 1000 ml of a 2.5% mannitol solution was performed in all patients. T2-weighted TSE sequences and T1-weighted SE sequences were performed before and after the intravenous injection of Gd-DTPA. To reduce movement artifacts caused by peristalsis of the gut, intravenous injection of 40 mg Buscopan was given. The findings of hydro-MRI were compared with the follow-through examinations.

RESULTS

In the upper gastrointestinal tract, the follow-through examination showed clear advantages compared with hydro-MRI for the demonstration of inflammatory changes in the gut; Hydro-MRI was, however, somewhat more reliable in the ileum and colon. It was also more sensitive than the follow-through for the demonstration of enteric fistulae (four as compared with two cases), and in demonstration extraluminal changes (free fluid in six against zero, and inflammatory adherent loops (four against zero)). Amongst the 22 patients, hydro-MRI was equal (in 10) or better (in 8) than the follow-through examination for demonstrating the intestinal manifestations of Crohn's disease, and follow-through was better in only four.

CONCLUSION

For follow-up of Crohn's disease, hydro-MRI is at least as good as follow-through examination, and is even preferable, because of the absence of radiation exposure of the usually young patients.

Nationwide survey of fluoroscopy: radiation dose and image quality

PURPOSE

To determine the average abdominal entrance air kerma, low-contrast sensitivity, and spatial resolution in upper gastrointestinal tract fluoroscopy in the United States.

MATERIALS AND METHODS

A random sample of fluoroscopic facilities was selected to be surveyed for the Nationwide Evaluation of X-ray Trends program. Measurements were performed by using a newly developed fluoroscopic phantom. The surveys were conducted by state radiation control personnel.

RESULTS

Average air kerma rates 1 cm above the tabletop, free in air, were 43 mGy/min (n = 340). The rate increased to 64 mGy/min when a 1.6-mm-thick copper filter, which simulated the use of barium contrast medium, was added to increase attenuation. The average entrance air kerma, free in air, for radiographs was 3.4 mGy, and an average of 12 radiographs were obtained per examination. Of 352 facilities surveyed, 306 (87%) were able to resolve wire mesh with 20 or more lines per inch. Of 339 facilities for which percentage contrast could be calculated, 192 (57%) had minimum percentage contrast values of 4% or more.

CONCLUSION

Spatial resolution for fluoroscopy is adequate for most of the facilities surveyed, but a substantial proportion of facilities could not visualize low-contrast test objects, which strongly suggests image quality problems.

Scintigraphic evaluation of four dogs with protein-losing enteropathy using 111indium-labeled transferrin

The purpose of this study was to determine the clinical utility of 111In-labeled transferrin (111In-TF) scintigraphy for evaluating dogs suspected of having protein-losing enteropathies. Four dogs were injected intravenously with autologous 111In-TF after 30 min incubation (at 37 degrees C) of 18.5 MBq (0.5 mCi) 111InCl3 with one ml of autologous plasma. Serial right lateral, left lateral and dorsal images were obtained 2, 4, and 24 hours post 111In-TF administration. Images were subjectively evaluated for the presence or absence of 111In-TF within the gastrointestinal tract. The results of total protein, albumin and globulin levels and results from gastrointestinal biopsies were recorded. In one dog, a follow-up scintigraphic study was done six months after initial evaluation and initiation of treatment for plasmocytic-lymphocytic enteritis. Gastrointestinal activity was noted by two hours in two dogs, while all four dogs had gastrointestinal activity on the 24 hour images. The mean (+/-std dev) plasma protein, albumin and globulin levels were 3.5 (+/-0.9), 1.7 (+/-1) and 1.8 (+/-0.3) respectively at the time of initial presentation. In the one dog that was evaluated after therapy, faint visualization of radioactivity within the colon was noted on the 24 hour image. Based on this study, 111In-TF appears to be a viable scintigraphic method for evaluating dogs with suspected protein-losing enteropathies. Potential limitations of this radiopharmaceutical include cost and prolonged isolation of the animal prior to release to the client due to the long physical half-life (T1/2 = 2.82 days).

Gastrointestinal involvement in Henoch-Schönlein syndrome: CT findings

OBJECTIVE

The purpose of this study was to describe the CT features of gastrointestinal involvement in seven patients with Henoch-Schönlein syndrome.

CONCLUSION

Although the incidence of Henoch-Schönlein syndrome is low, it should be considered when CT scans show multifocal areas of bowel-wall thickening, mesenteric edema, vascular engorgement, and nonspecific lymphadenopathy. It should be considered especially in young patients with acute gastrointestinal symptoms.

The antenatal diagnosis of fetal abnormalities: a 10 year audit of influencing factors

During the 10 years 1984-1993, a total of 438 fetuses and children with a congenital abnormality, identified antenatally or in the first year of life, were registered from the North Tees Health District with the Northern Region Congenital Abnormality Survey (NorCAS). This represented an abnormality rate of 2% of all births. In total, 252 structural abnormalities (57.5%) were detected by antenatal ultrasound examination. In spite of a targeted education programme, identification of cardiac lesions remained poor. The detection of structural abnormality by antenatal scan rose from 52% in 1984 to 85% in 1993, due mainly to improvements in image quality and resolution of ultrasound equipment. Also important was audit, based both on review of images and feedback from a comprehensive central register (NorCAS).

Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment

BACKGROUND & AIMS

Endosonography-guided fine-needle aspiration biopsy (EUS-FNA) permits cytological confirmation of EUS findings. A multicenter prospective evaluation of EUS-FNA for primary diagnosis, staging, and/or follow-up purposes was undertaken.

METHODS

EUS-FNA was performed in 457 patients with 554 lesions. Clinical (n = 218) or histopathologic (n = 256) confirmation was available in 192 lymph nodes, 145 extraluminal masses, 115 gastrointestinal wall lesions, and 22 cystic lesions.

RESULTS

EUS-FNA sensitivity, specificity, and accuracy was 92%, 93%, and 92% for lymph nodes, 88%, 95%, and 90% for extraluminal masses, and 61%, 79%, and 67% for gastrointestinal wall lesions, respectively. The sensitivity and accuracy for lymph nodes and extraluminal masses was superior to that for gastrointestinal wall lesions. When EUS-FNA was compared with EUS size criteria in lymph node evaluation, specificity (93% vs. 24%) and accuracy (92% vs. 69%) were superior, whereas sensitivity (92% vs. 86%) was similar. The accuracy of EUS-FNA in patients with previously failed biopsy procedures was 81% (73 of 90). Five nonfatal complications occurred for a rate of 0.5% (95% confidence interval, 0.1%-0.8%) in solid lesions vs. 14% (95% confidence interval, 6%-21%) in cystic lesions.

CONCLUSIONS

EUS-FNA accurately and safely evaluates solid peri-intestinal lesions and improves lymph node staging accuracy.

Anaphylactoid reactions with gastrointestinal contrast media

Significant anaphylactoid reactions to gastrointestinal contrast media are rare. Whether a patient who is atopic or has asthma is predisposed to these reactions is speculative. The rare patient who previously had a severe allergic reaction to such a product probably should not undergo a subsequent examination with a similar agent. The American College of Radiology classification of contrast media side effects can also be applied to the gastrointestinal contrast media.

Spiral CT: clinical applications in the gastrointestinal tract

Spiral CT provides the ability to acquire single breathhold volume acquisitions that allow for optimization of the infusion of iodinated contrast material and CT data acquisition. Although initial applications focused on the chest, liver, and vascular system, spiral CT has important implications for the tubular structures of the GI tract (esophagus, stomach, small bowel, and colon). Tumor detection and staging may be optimized by these better datasets which also provide multiplanar and 3D imaging capabilities. This article reviews many of these specific applications and emphasizes the potential value of spiral CT scanning.

Evaluation of solid-phase labels for gastric emptying studies in cats

Development of appropriate radiolabeled diets for solid-phase gastric emptying studies in experimental animals is important for testing the effects of disease, drugs, surgical procedures and stress. This study evaluates the in vitro and in vivo stability of various radiolabels in commercially available dry, extruded and canned cat foods.

METHODS

Dry, extruded cat food was labeled with 99mTc-pertechnetate, 99mTc-sulfur colloid or 99mTc-disofenin. Canned cat food was labeled with 99mTc-Dowex resin beads, 99mTc-pertechnetate, 99mTc-sulfur colloid or 99mTc-disofenin. A sample of each labeled diet and 99mTc-sulfur colloid-labeled egg was digested in water, gastric juice, intestinal juice or gastric juice followed by intestinal juice. The samples were centrifuged and the activity in the samples counted before and after removal of the supernatant. Based on in vitro results, three labeled diets were fed to 10-12 cats for in vivo testing.

RESULTS

99mTc-Dowex beads had the best labeling efficiency in vitro, but were not stable in vivo, resulting in unacceptable levels of circulating 99mTc. Technetium-99m-disofenin labeling resulted in in vitro percent solid-phase retention of 92.5% and 89.5% in water and gastric juice, respectively, for dry food and 86% and 94.9% in water and gastric juice, respectively, for canned food.

CONCLUSION

Technetium-99m-disofenin is a suitable label for solidphase gastric emptying studies using commercially available cat foods.

Double-contrast barium examination of the upper gastrointestinal tract with nonendoscopic biopsy: findings in 100 patients

PURPOSE

To evaluate the performance of double-contrast barium examination of the upper gastrointestinal tract augmented with nonendoscopic gastric mucosal biopsy.

MATERIALS AND METHODS

One hundred twenty-six patients (aged 9-81 years) underwent double-contrast barium examination of the upper gastrointestinal tract and nasogastric biopsy. Pathology reports were recovered for 100 patients. These patients' records were searched for procedural complications, sufficiency of biopsy tissue, diagnoses among various age groups, and radiographic findings.

RESULTS

Forty-nine (49%) of the 100 patients had biopsy-proved Helicobacter pylori infection with chronic active gastritis. Twenty-one patients (21%) with H pylori-negative biopsy specimens had chronic gastritis. One patient with eosinophilic gastritis and one with granulomatous gastritis were identified. Twenty-nine patients (29%) had negative biopsy results. Nineteen (30%) of the patients with negative barium studies had a positive biopsy specimen, and four (6%) of the patients with positive barium studies had negative biopsy specimens. Eight patients (8%) had a second diagnosis of intestinal metaplasia.

CONCLUSION

Use of double-contrast barium examination of the upper gastrointestinal tract combined with nonendoscopic biopsy is quick and safe and can provide reliable histologic information to the primary care physician.

[Diagnostic ultrasonography of perforating foreign bodies of the digestive tract]

Perforations of the gastrointestinal tract by ingested foreign bodies such as chicken or fish bones are rare and may occur at any site from the oesophagus to the rectum; the diagnosis is often very uneasy with conventional radiography. For many years, sonography has been more frequently requested as the first modality for the evaluation of abdominal pathology, and in many cases allowed a correct diagnosis to be reached without further assessment. We report six cases of complicated foreign bodies very successfully and specifically diagnosed by sonography in six different sites of the gastrointestinal tract. Four of these cases were preliminary correctly suspected by CT but the shape, length and the probable nature of the body were always better appreciated by multiaxial real time sonography. The correct sonographic diagnosis and follow-up allowed a conservative treatment in three cases, avoiding surgical exploration. We recommend the systematic sonographic investigation of foreign bodies in close relation with the gastrointestinal tract in all atypical inflammatory processes or to perform sonography as a complement to CT.

The workup for bariatric surgery does not require a routine upper gastrointestinal series

BACKGROUND

Morbid obesity is a serious disease that afflicts over five million Americans, threatening their health with such co-morbidities as diabetes, arthritis, pulmonary failure and stroke. Surgery is the only effective therapy, providing long-term control of weight, diabetes, pulmonary failure, and hypertension for as long as 14 years. Because the operation presents a major expense, this study examined whether X-ray examination of the gut could be omitted safely as a cost-saving measure.

METHODS

The records of 814 consecutive morbidly obese patients who underwent gastric bypass were reviewed to determine: (1) whether these individuals had undergone an upper gastro-intestinal (GI) series, and (2) if these studies influenced therapy or caused cancellation or postponement of surgery.

RESULTS

Of the 814 patients, 657 (80.7%) underwent a preoperative GI radiography. Of these examinations, 393 (59.8%) were normal, with the following abnormalities in the remaining 264: hiatal hernia, 164; esophageal reflux, 39; Schatzki's ring, 18; small bowel diverticula, four; renal stones, four; malrotation, three; gall stones, two; pyloric ulcer, one; possible pelvic mass, one; calcified leiomyoma, one; and dysphagial lusoria, one. None of these findings resulted in cancellation or a delay in surgery.

CONCLUSIONS

The upper GI series can be safely omitted from the routine preoperative evaluation of patients undergoing gastric bypass. At a cost of $741.00 per examination, this change represents significant potential savings. Similar evaluations of other routine preoperative tests may well provide a better basis for the evaluation of these complex patients.

Thoracoabdominal duplication cyst: US, CT and MR findings

A rare case of thoracoabdominal duplication is reported. Radiological workup including US, CT and MR provided the correct diagnosis. The US revealed the cystic nature of the lesions, whereas CT and MR showed their relationship with the diaphragm and each other. Coronal- and sagittal-plane MR images were helpful in demonstrating the extension of the lesions. The patient was discharged after an uneventful surgery and recovery. The histological evaluation revealed the cyst lined with single-layered columnar epithelium and the cyst wall contained submucosal mucous glands with underlying smooth muscle and also some mature chondroid elements with bronchogenic origin. Radiological findings and differential diagnosis are discussed.

Comparison of scintigraphy and lactulose breath hydrogen test for assessment of orocecal transit: lactulose accelerates small bowel transit

The lactulose breath test (LBT) and gastroenterocolonic scintigraphy (GECS) can both be used to measure orocecal transit time (OCTT). The aims of this study were (1) to measure OCTT by LBT and GECS and (2) to determine whether lactulose alters orocecal transit.

METHODS

Eight normal subjects underwent simultaneous breath hydrogen testing, GECS, and duodenal manometry while receiving either 10 g lactulose or placebo with a radiolabeled solid/liquid test meal during two studies. There was a good correlation between OCTT by LBT and GECS when performed simultaneously (r = 0.95; P < 0.001). OCTT by GECS with lactulose was significantly faster (P = 0.004) than by GECS without lactulose, despite no change in gastric emptying of liquids and slowing of gastric emptying of solids (P = 0.02). The postprandial duodenal motility index was greater with lactulose than with placebo (P = 0.031). This study demonstrates that LBT and GECS (without lactulose) are not equivalent measures of OCTT. The standard LBT accelerates OCTT and slows gastric emptying. Therefore, lactulose has a direct accelerating effect on small intestinal transit.

Oral administration of iopentol (Imagopaque 300 mg I/ml) compared with amidotrizoate (Peritrast 300 mg I/ml), both diluted to 2% (v/v), in imaging of the gastrointestinal tract in abdominal contrast enhanced CT. A clinical trial assessing patient tolerance, distribution of contrast medium and Hounsfield unit measurements

The aim of the trial was to evaluate and compare the safety and efficacy of iopentol (Imagopaque, Nycomed Imaging AS, Oslo, Norway) and amidotrizoate (Peritrast, Köhler Pharma, Alsbach, Germany), both 300 mg I/ml initially, but diluted to 2% (v/v) and administered orally. Sixty-four and 65 patients were included in the respective contrast medium groups. Portions of contrast medium, totally 1.51, were taken every 15 min during the hour before the examination. A standard radiological procedure for abdominal CT was followed. Nine percent of the patients in each group experienced adverse events which were possibly contrast medium related. Taste acceptance was comparable in the two groups. Except for the stomach, radiographic efficacy was satisfactory for all intestinal segments. The difference in density in the proximal small bowel (main parameter) achieved with the media was not significant (p = 0.33), nor was that as regards image homogeneity (contrast distribution). In conclusion, iopentol is well suited for oral contrast enhancement of the gastrointestinal tract in abdominal computed tomography.

Prognostic factors of prenatally diagnosed gastroschisis

OBJECTIVE

To evaluate the prognosis of prenatally diagnosed gastroschisis.

STUDY DESIGN

In a retrospective study, we analyzed the clinical and echographic data of gastroschisis. These data were correlated with fetal outcome including delivery, surgical procedure, follow-up in the neonatal intensive-case unit and in the gastropediatric unit.

RESULT

Twenty cases were analyzed. The overall survival rate was 85%. Classical criteria were analyzed (maximal bowel dilatation, thickening of bowel wall). Fetuses with both severe perivisceritis and meconium-stained amniotic fluid were born earlier than fetuses with mild perivisceritis and normal amniotic fluid (p < 0.01).

CONCLUSION

Our data suggest that an inflammatory response could follow bowel exposure to amniotic fluid. This response could lead to perivisceritis and premature birth. This hypothesis is currently under investigation.