[Intestinal preparation with an osmotic solution for edema with double contrast media]

PURPOSE

To evaluate the most effective way of cleansing the colon lumen for double contrast colon enema with a single preparation at osmotic effect.

MATERIAL AND METHODS

We examined 80 patients (age range: 29-84 years) and divided them into two groups. Group 1: patients (no. 41) were prepared with the traditional method consisting of a residue-free diet in the three days before the examination followed by the administration of a sennoside-based laxative the morning of the day before and a dose of magnesium sulphate in the afternoon, after the Genoa School method. Group 2: patients (no. 39) were prepared with a Phospholax solution according to the following administration schedule: one dose in the evening two days before the examination and four doses the day before, that is two in the afternoon and two in the evening, followed by abundant hydratation. The examination was performed in a double blind fashion and graded as follows: excellent, good, sufficient, poor. The statistical analysis of all data was performed with Student's t-test and the chi-square test.

RESULTS

We obtained better results with the new protocol than with the traditional one, where some patients discontinued the preparation because of intolerance (nausea, abdominal pain and swelling). In addition, more fecal residues were found in the colon with the first preparation, which however provided better contrast agent coating than the new protocol. The second preparation provided better mucosal cleansing, with more cases graded as excellent-good, and there were no cases of poor coating or electrolyte disturbances.

DISCUSSION AND CONCLUSIONS

Intestinal preparation with Phospholax was better than the conventional method relative to compliance, intestinal cleansing and side-effects (in both the latter two cases, the difference is statistically significant, p < 0.01). In conclusion the new protocol is a possible alternative to the traditional method thanks to its ease of preparation and effective results.

[Subacute Budd-Chiari syndrome treated with rTPA. Considerations on a case]

The authors report on a case of hepatic vein thrombosis or Budd-Chiari syndrome (BCS) successfully treated with recombinant Tissue Plasminogen Activator (rTPA). They briefly outline the etiology and symptomatology of this disease as well as the various surgical procedures used for treatment. Medical therapy has been so far poorly effective in treatment BCS, but recently various reports seem to indicate that rTPA may have a role. The authors suggest that rTPA may be used as the only therapy in selected cases, or in treating patients that are not candidates for surgical intervention, or as a temporizing measure to improve symptoms in patients awaiting surgery.

[Echographic study of the shoulder. Clinico-echographic correlations]

US is indicated in the study of the impingement syndrome. A series of 152 shoulders was examined in a clinical-US study carried out following a standard protocol including a physical examination first and then a US examination. The study was aimed at investigating the agreement between clinical and US findings and at assessing the diagnostic reliability of US. 57% of the shoulders were positive to clinics (1 test at least) and were then divided in 4 groups. Positivity rate was high (85-87% for at least 3 or 4 tests). US findings included several different patterns. Our results demonstrate that a correct clinical-diagnostic protocol increases reliability, besides reducing the use of more complex and expensive imaging modalities--e.g., CT and MR.

[The nephrotoxicity of ionic and nonionic contrast media in urography. An evaluation with immunoenzyme technics and monoclonal antibodies]

The nephrotoxicity of ionic and nonionic contrast media (cm) was evaluated in 52 patients undergoing pyelography. The contrast media were i.v. injected in 30'. Urine samples were collected before, 2 and 48 hours after the injection. Urinary albumin (alb) and retinol binding protein (RBP) excretion was evaluated by immunoenzymatic methods; alb and RBP were considered as indicators of glomerular permeability and of tubular reabsorption, respectively. The urinary excretion of brush-border antigen of proximal tubule (BBA) was also measured, as an indicator of microtissue damage, by a sensitive double-antibody ELISA with monoclonal antibodies. The results demonstrate ionic cm to have greater functional effects than nonionic ones, as suggested by the increased urinary excretion of both alb and RBP. However, tubular damage seemed to be more severe with nonionic agents, as suggested by BBA excretion. Although toxic damage had little significance for the patients' health, long-term effects are not to be excluded.