Risk analysis and seroprevalence of bovine ephemeral fever virus in Punjab, Pakistan.

Bovine ephemeral fever (BEF) is a vector-borne viral disease caused by the RNA virus which belongs to the genus Ephemerovirus and the family Rhabdoviridae. To evaluate the effect of the risk factors like the breed of cattle and buffaloes, age, sex, lactation, housing and region on the bovine ephemeral fever virus (BEFV) prevalence, ELISA and virus neutralisation (VN) tests (n = 600) were performed for the BEFV prevalence. The seroprevalence in cattle was 45.6% and 42% by ELISA and VN, respectively (P = 0.001). The breed-wise seropositive ratio was (55-64%) in cattle and (22.5-18.3%) in buffaloes by VN and ELISA. The sex-wise prevalence was (40-49.4%) in females and (35.8-46%) in males by VN and ELISA in cattle and a similar prevalence was reported in buffaloes. The age-wise prevalence in bovines by ELISA was 5.33, 22.66 and 17.66% in the age group < 1 year, 1-3 years and > 3 years, respectively. The disease prevalence was higher in the age group of 1-3 years. The prevalence was higher during the 3rd lactation in bovines. The region-wise prevalence was higher in the 07 districts while lower (18-21%) in Rawalpindi District by VN and ELISA, respectively (P = 0.001). Commercial dairy farms of cattle showed a higher disease prevalence (52% and 44%) than non-commercial farms (38% and 36%) by ELISA and VN, respectively (P = 0.227). Exotic cows showed higher disease prevalence (76.67% and 70%) by ELISA and VN. The mortality in bovines was 5% (7.7% and 2.3%) in the cattle and buffaloes. The case fatality of BEFV in bovines was 12.25%. There was a significant effect of the risk factors like the breed, age, sex, lactation, housing and region on the BEFV prevalence. This is the first comprehensive study of BEFV in Pakistan.

Prevalence of antibiotic resistance pattern in shigella isolates procured from pediatric patients at Faisalabad - Pakistan.

Shigella infection (shigellosis) is an intestinal disease caused by a shigella isolates belongs to a family Enterobacteriacea. Watery diarrhea, abdominal pain and tenesmus are the prominent symptoms of shigella infection. The present study was designed to determine period prevalence and antimicrobial susceptibility of Shigella species recovered from stool specimens obtained from diarrheal paediatric patients under 5 years of age. This cross-sectional study was carried out for a period of six months (Jan to June, 2016). All Shigella isolates were identified based on colony morphology, microscopic characteristics, and biochemical characteristics. After applying Kirby Baur disc diffusion method only 22 (18.96%) stool specimens were found positive for Shigella isolates among the 116 stool specimens. The isolates were also found susceptible to Levofloxacin (72.72%), Azithromycin (59.09%), and Cefotaxime (40.90%). However, the said isolates were resistant to Lincomycin (100%) and Penicillin-G (100%), followed by Amoxicillin (95.45%) and Oxacillin (95.45%). The chi-square test was used to check the close association among antimicrobial agents used and as highly significant (p-value < 2.2e-16). Based on antimicrobial susceptibility findings, Levofloxacin, Azithromycin and Cefotoxime were found effective for the control of shigellosis.

Pattern of clinical drug resistance and occurrence of Gram negative bacterial neonatal sepsis at a tertiary care hospital.

Sepsis is a leading cause of neonatal deaths across the world. Gram-negative rods such as Klebsiella and E. coli are major cause of sepsis in neonates. With a mortality rate of 1-4 deaths per thousand live births, sepsis is the second most important cause of neonatal deaths in the developing countries. The present study was designed to determine the occurrence of Gram-negative bacteria in neonatal sepsis and to find antibiotic susceptibility of isolated microbes. Blood samples of 100 neonates (1-89 days old) were sub cultured on MacConkey's and Blood agar for isolation of Gram-negative bacteria. A total of four bacterial species were isolated including Klebsiella (35.71%), E. coli (28.57%), Acinetobacter (21.42%) and Proteus (14.28%). Gram-negative bacteria were isolated more commonly from EOS (early onset sepsis) as compared to LOS (late onset sepsis). Klebsiella isolates from neonates showed sensitivity to imipenem (70%) followed by ceftazidime (40%) and cefotaxime (40%) and high resistance was shown by sulfamethoxazole (80%) and amikacin (70%). E. coli associated with neonatal sepsis were sensitive to imipenem (63%) while highly resistant to cefotaxime (75%) and ciprofloxacin (62%). For Acinetobacter high sensitivity was found for ceftazidime (50%) and resistance was shown to ciprofloxacin and sulfamethoxazole (100%). Proteus showed high sensitivity to amikacin (75%) and high resistance to imipenem and ciprofloxacin (75%). In conclusion, Gram-negative associated neonatal sepsis was found in the studied subjects and drug resistance was observed to clinically used antibiotics.

Phylogeny of hospital acquired MRSA, and its comparative phenotypic clinico-epidemiology with vancomycin resistant S. aureus (VRSA).

Staphylococcus aureus is emerging as complicated pathogen because of its wide-ranging origin, multiple variants, and compromised antibiotic susceptibilities. Current study was planned to find lineage of hospital acquired methicillin resistant Staphylococcus aureus (HA-MRSA), and its comparative phenotypic clinico-epidemiology with vancomycin resistant S. aureus (VRSA). A total of (n = 200) samples were aseptically collected from wound, nose, and cerebrospinal fluid of patients from metropolitan and rural background hospitals along with on spot filling in of questionnaire. Phylogenetic analysis of HA-MRSA was identified by targeting mecA gene in S. aureus. At optimal tree branch length of 1.91 and evolutionary distance 0.1, high level sequence similarity (97%-99%) was observed with different strains of S. aureus isolated from both human and animal. Non-descriptive statistics at 5% probability found 61% S. aureus, while 43.44% of them were HA-MRSA, 92.62% VRSA, and 42.62% were both MRSA and VRSA. Among assumed risk factors, use of antibiotics, venous catheterization, chronic disease, pre-hospital visits, and ICU admitted patients showed significant association (p<0.05) with pathogen. HA-MRSA was 37.50%, 80%, and 37.50% sensitive to chloramphenicol, gentamicin, and oxacillin, respectively. While <50% of VRSA were sensitive against oxacillin, enoxacin, and chloramphenicol. A significant difference (p<0.05) of percentage responses of MRSA and VRSA at resistant, intermediate, and sensitive cadre against all antibiotics except chloramphenicol was obvious in this study. The Current study concluded higher prevalence of MRSA & VRSA, significant association of risk factors, limiting antibiotic susceptibility profile, and genetic transfer at animal-human interface which suggests further studies cum preventive strategies to be planned.

Complications Associated with Medical Tourism for Facial Rejuvenation: A Systematic Review.

BACKGROUND: Medical tourism for cosmetic surgery has become increasingly popular in recent years. The existing literature has identified poor outcomes associated with general cosmetic tourism; however, the complications associated with cosmetic tourism for facial rejuvenation remain poorly understood. The aims of this study are to delineate the risk profile associated with medical tourism for facial rejuvenation. METHODS: A systematic review of PubMed, MEDLINE, and Embase was performed through January 2019 using the PRISMA guidelines. Search terms included combinations of keywords including medical tourism and plastic surgery and other related nomenclature. Articles published in English relevant to medical tourism for facial rejuvenation and its associated complications were examined. RESULTS: We identified six retrospective studies including 31 patients who had obtained facial rejuvenation procedures abroad and experienced treatment-associated complications. Twenty-five of 26 listed patients (96%) were female (age range 33-62 years). Departure nations included the USA, Switzerland, England, Ireland, Australia, and Thailand. Destination nations included the Dominican Republic, Cyprus, the USA, Colombia, Thailand, India, and China. Procedures included blepharoplasty, facelift, rhinoplasty, chin lift, and injections with botulinum toxin and dermal fillers. Complications included abscess, poor cosmesis, facial nerve palsy, and death. CONCLUSIONS: We present the first study to systematically review the complications associated with medical tourism for facial rejuvenation. No definitive conclusions can be made given the paucity of relevant data, its clinical and statistical heterogeneity, and small sample size. Additional research is warranted to help inform patients who seek facial rejuvenation procedures abroad and to better understand the health system implications associated with cosmetic tourism for facial rejuvenation. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The effects of granulocyte colony-stimulating factor on MR images of bone marrow.

Granulocyte colony-stimulating factor (G-CSF) analogs such as filgrastim/pegfilgrastim are increasingly used to enhance neutrophilic recovery after chemotherapy. It is widely known that, physiologically, pegfilgrastim stimulates marrow mitotic activity and induces marrow reconversion from fatty to cellular. However, there is limited literature discussing the effects of pegfilgrastim on musculoskeletal magnetic resonance imaging, with the consensus that marrow reconversion secondary to pegfilgrastim therapy is easily confounded with a malignant process, especially in patients with a history of cancer. We attempt to discuss the expected changes and MRI findings after pegfilgrastim therapy through a summary of current literature. Additionally, we provide images from our own practice to support the previously established findings. G-CSF-stimulated reconversion can appear as patchy expansions of baseline hematopoietic marrow, but can also appear to be diffusely homogeneous, adding to its ambiguity. We conclude that using a baseline MRI, clinical information, and assessing sequential MRI changes in conjunction with pegfilgrastim therapy may aid the differentiation between benign and pathological change. We expand our discussion to include the effects of novel technologies, such as whole-body MRI, chemical shift imaging, and contrast agents in helping the distinction.

Single Versus Simultaneous Double Free Flaps for Head and Neck Reconstruction: Comparison of Flap Outcomes and Donor-Site Morbidity.

INTRODUCTION: Ablative procedures of the head and neck often result in substantial defects that require large-volume tissue transfer for restoration of form and function. Multiple simultaneous free flaps may be required for complex defects, but these procedures are often avoided because of the perception of an increase in associated surgical complications and morbidity. We present our experience with the use of simultaneous multiple free flaps as compared with single free flaps (SFFs) for head and neck reconstruction. METHODS: Thirty-seven patients with a history of head and neck malignancy underwent SFF reconstruction, and 21 patients underwent double free flap (DFF) reconstruction. Statistical analysis was conducted comparing demographics, comorbidities, etiology of disease, and surgical outcomes between the 2 patient groups. RESULTS: Operative time and length of hospital stay were both significantly longer in the DFF group versus the SFF group. Despite significantly higher rates of preoperative radiation, osteoradionecrosis, and operation for secondary malignancy in DFF group, no significant differences in flap survival, partial flap loss, recipient site complications, or donor site complications were found. Overall flap-related reoperation rates were low, as were total flap losses. There were 10 complications (24%) that required reoperation in the DFF group, and 1 total flap loss (2.4%), on per-flap basis. There were 10 complications (27%) that required reoperation in the SFF group and 3 total flap losses (8.1%). Per-flap incidence of donor site morbidity in the DFF group was significantly lower than that in the SFF group (23.8% vs 56.8%, respectively, P = 0.011). CONCLUSIONS: The use of multiple free flaps for reconstruction of major head and neck tissue defects is sometimes necessary to achieve adequate reconstructive results. These procedures have no significant associated increase in overall flap-related complications. Our findings suggest that donor site morbidity can be minimized in double-flap reconstructions by thoughtful flap selection.

Change in Liver Imaging Reporting and Data System Characterization of Focal Liver Lesions Using Gadoxetate Disodium Magnetic Resonance Imaging Compared With Contrast-Enhanced Computed Tomography.

PURPOSE: The aim of this study was to determine whether gadoxetate-enhanced magnetic resonance imaging (MRI) improves lesion characterization in patients at risk for hepatocellular carcinoma compared with computed tomography (CT). MATERIALS AND METHODS: Forty-nine patients with indeterminate lesions found at contrast-enhanced CT were prospectively enrolled and imaged using gadoxetate-enhanced hepatobiliary phase (HBP) MRI within 30 days of their initial CT. Three readers graded each lesion at CT and MRI using the Liver Imaging Reporting and Data System (LI-RADS) v2014 major criteria and HBP characterization as an ancillary feature. Patients were followed for an average of 1.8 years to document growth or stability of each lesion. RESULTS: The Liver Imaging Reporting and Data System categorization changed for 71% (52/73) of lesions based on HBP MRI compared with CT, with 30% (22/73) of lesions upgraded and 41% (30/73) of lesions downgraded. There was almost perfect agreement between readers for arterial phase hyperintensity and HBP hypointensity, with lower interreader agreement for washout and capsule appearance. On the basis of composite clinical follow-up, lesions that were subsequently classified as hepatocellular carcinoma were assigned a higher LI-RADS category on HBP MRI when compared with CT. CONCLUSIONS: For patients with indeterminate lesions seen on contrast-enhanced CT, HBP MRI using gadoxetate improves lesion characterization when using LI-RADS v2014 criteria.

Management of Complications of Acute Otomastoiditis in Solid Organ Transplant Patients.

BACKGROUND: There are over 183,000 patients living with a functioning solid organ transplant in the United States, and almost no data exist discussing complications of acute otomastoiditis in this vulnerable population. Early recognition and treatment of acute otomastoiditis is essential in patients whose immune system is not normal, as progression can lead to sepsis, meningitis, brain abscess, Bezold's abscess, sigmoid sinus thrombosis, or other potentially fatal sequelae. METHODS: Case report with extensive literature review. RESULTS: A 63 year-old man presented 3 years after cadaveric renal transplant with otorrhea and altered mental status. His acute otitis media progressed to meningitis with sigmoid sinus thrombosis and sepsis, and management included IV and otic antibiotics, tympanostomy tube placement, and cortical mastoidectomy. The patient made a full recovery without residual neurologic deficit. CONCLUSION: Extrapolating data from patients immunosuppressed for other reasons, patients immunosuppressed after solid organ transplant should receive prompt recognition and aggressive treatment of acute otomastoiditis to prevent or address potentially devastating intracranial or systemic complications.

Comparison of Secondary and Primary Thyroid Cancers: Patient Characteristics and Postoperative Outcomes: A Cross-Sectional Analysis of Patients with Primary and Secondary Thyroid Cancers.

BACKGROUND: Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary thyroid cancer. We aim to examine the difference between primary and secondary thyroid cancer in terms of patient characteristics and perioperative outcomes at the national level. METHODS: A cross-sectional study utilizing the Nationwide Inpatient Sample database for 2003-2010 was merged with County Health Rankings Data. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify adult patients with thyroid cancer. RESULTS: A total of 21,581 discharge records were included. Overall, 16,625 (77.0 %) patients had primary cancer, while the rest (23.0 %) had secondary cancer. Younger (<45 years) and older (>65 years) patients, males, and those of White or Hispanic background were more likely to have secondary cancers (p < 0.05 each). The prevalence of secondary cancer was higher in communities of low health risk (24.0 % vs. 21.1 %; p < 0.024). Secondary cancer was more likely to be managed by total thyroidectomy (odds ratio [OR] 2.40, 95 % CI 2.12-2.73) and to require additional radical neck dissection (OR 12.51, 95 % CI 10.98-14.25). Patients with secondary thyroid cancers were at higher risk of postoperative complications (p < 0.01 each). The cost of secondary cancer management was significantly higher than primary cancer (US$12,449.00 ± 302.07 vs. US$7848.12 ± 149.05; p < 0.001). However, compared with intermediate-volume surgeons, the complication risk was lower for high-volume (OR 0.47, 95 % CI 0.24-0.92; p = 0.026). CONCLUSIONS: Secondary thyroid cancer is associated with a higher risk of perioperative complications and higher cost and distinct demographic profile. Patients managed by higher-volume surgeons were less likely to experience disadvantageous outcomes.

The utility of molecular markers in pre-operative assessment of thyroid nodules.

The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspiration (FNA) biopsy. This has been widely accepted and offers the most cost-effective approach for evaluation of thyroid nodules. However, its diagnostic accuracy can pose a challenging scenario to surgeons. These diagnostic difficulties may subject patients to unnecessary thyroidectomies for benign thyroid nodules. Thus, additional molecular tests are needed to improve the sensitivity and specificity of FNA. The role of molecular markers is being proposed to predict the type and risk of malignancy to abate the need for diagnostic thyroidectomies. This review discusses their utility and validity in pre-operative diagnosis of thyroid nodules and how these markers can enhance the accuracy of FNA cytology.

Low yield of chemical shift MRI for characterization of adrenal lesions with high attenuation density on unenhanced CT.

PURPOSE: To investigate the threshold unenhanced CT density of adrenal nodules at which further evaluation with chemical shift MRI is unlikely to be definitive and therefore not helpful in further characterizing some indeterminate adrenal lesions. METHODS: Retrospective evaluation of 44 adrenal lesions imaged with unenhanced CT and chemical shift MRI and followed for at least 1 year. Qualitative and quantitative assessment of signal loss on chemical shift MRI was performed. Adenomas were diagnosed if the lesion measured equal or less than 10 HU on unenhanced CT; on MRI a SI index greater than 16.5% or adrenal:spleen chemical shift ratio less than 0.71 was considered diagnostic of adenoma. RESULTS: 31.8% (14/44), 47.7% (21/44), and 20.5% (9/44) of the adrenal lesions had an unenhanced CT attenuation density ≤10, 10-30, and >30 HU. Adrenal lesions with an unenhanced CT density 10-30 and >30 HU had a 76.2% (16/21) and a 33.3% (3/9) chance of being categorized as an adenoma using MRI SI index, respectively. CONCLUSIONS: Adrenal lesions with unenhanced attenuation CT density >30 HU had a 66.6% of remaining indeterminate even after evaluation with chemical shift MRI. ADVANCES IN KNOWLEDGE: Chemical shift MRI is reasonable for evaluating adrenal lesions with an unenhanced CT attenuation density less than 30 HU. The likelihood of chemical shift MRI detecting signal loss in lesions CT density greater than 30 HU, however, is low.

Value of Intraoperative Sonography in Pancreatic Surgery.

The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease. Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care--the surgeon's scalpel--can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures.

Modified Approach for Robotic Retroauricular Thyroidectomy: Preclinical Simulation and a Surgical Case.

BACKGROUND: Recently, a single remote access retroauricular robotic technique has been described for thyroid lobectomy. We aimed to explore the feasibility and safety of modifying this novel approach using preclinical cadaver model followed by performing the same operation in a real patient. METHODS: The modified retroauricular approach was performed by creating a working space between the 2 heads of the sternocleidomastoid muscle, instead of that anterior to muscle. This was performed to create a wider working space. Two operations were initially performed in human cadavers. Subsequently, robotic-assisted thyroid lobectomy was performed using this novel modified retroauricular approach. RESULTS: Robotic-assisted hemithyroidectomy was performed successfully in 2 cadavers and subsequently in one patient using modified approach. The patient was discharged on the same day of surgery and had no complications. CONCLUSIONS: The modified retroauricular approach with creation of a working space between the 2 heads of sternocleidomastoid muscle is safe and feasible, and offers a wider working space for robotic thyroid surgery.

Neuroendocrine tumors: beyond the abdomen.

Several classification systems for neuroendocrine tumors (NETs) exist, which use variable terminology and criteria for grading and staging. This variability in terminology can cause confusion and difficulty in recognizing which tumors are, in fact, members of this heterogeneous group of malignancies. The largest group of NETs, the gastroenteropancreatic NETs, has been well described and characterized; however, there are less-recognized extra-abdominal NETs that can arise from nearly any organ in the body. In this article, the clinical features and imaging appearances of the extra-abdominal NETs will be reviewed, compared, and contrasted. This diverse group consists of paragangliomas, Merkel cell carcinomas, esthesioneuroblastomas, NETs of the lung, and medullary thyroid carcinomas. Recognition of these tumors as part of the larger group of NETs is important for understanding how best to approach imaging for their diagnosis, staging, and potential treatment. Familiarity with the computed tomographic and magnetic resonance imaging appearances and the role of radionuclide imaging of these heterogeneous groups aids in the correct diagnosis and in treatment planning.

Esophageal varices on computed tomography and subsequent variceal hemorrhage.

PURPOSE: Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH). METHODS: A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT. RESULTS: The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84). CONCLUSIONS: A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.

Activation of neutrophils by the two-component leukotoxin LukE/D from Staphylococcus aureus: proteomic analysis of the secretions.

Staphylococcus aureus is responsible for severe bacterial infections in hospitals and healthcare facilities. It produces single and bicomponent toxins (leukotoxins and hemolysins) that hinder innate immune function. Leukotoxin subunits bind to leukocyte cell membrane thus inducing transmembrane pores and subsequently, cell lysis. Leukotoxin LukE/D is a member of the bicomponent toxin family, but to date, no study concerning its involvement in host-pathogen interactions has been reported. In the present study, we performed the proteomic analysis of the secretions recovered after activation of human neutrophils by leukotoxin LukE/D. The neutrophil secretions were purified by RP-HPLC and different fractions were analyzed by Edman sequencing, LC-MS/MS, immunoblotted for chromogranin-derived peptides and further analyzed for antimicrobial properties. Proteomic analysis revealed that neutrophil secretions constitute a large number of proteins related with immune boosting mechanisms, proteolytic degradation, inflammatory process and antioxidant reactions.

Contrast-enhanced CT quantification of the hepatic fractional extracellular space: correlation with diffuse liver disease severity.

OBJECTIVE: The purpose of this study was to determine whether contrast-enhanced CT quantification of the hepatic fractional extracellular space (ECS) correlates with the severity of diffuse liver disease. MATERIALS AND METHODS: The cases of 70 patients without (46 men, 24 women; mean age, 59.1 years) and 36 patients with (23 men, 13 women; mean age, 63.1 years) cirrhosis who had undergone unenhanced and 10-minute delayed phase contrast-enhanced CT were retrospectively identified. By consensus one experienced radiologist and one trainee measured the CT attenuation of the liver and aorta to estimate the fractional ECS, defined as the ratio of the difference between the attenuation of the liver on 10-minute and unenhanced images to the difference between the attenuation of the aorta on 10-minute and unenhanced images multiplied by 1 minus the hematocrit. Findings were correlated with each patient's Model of End-Stage Liver Disease (MELD) score. RESULTS: The mean MELD score was higher in patients with than in those without cirrhosis (14.3 ± 7.3 versus 7.20 ± 2.4, p < 0.0001). The mean fractional ECS was significantly greater in patients with cirrhosis than in those without cirrhosis (41.0% ± 9.0% versus 23.8% ± 6.3%, p < 0.0001). The fractional ECS correlated with the MELD score (r = 0.572, p < 0.0001) and was predictive of cirrhosis with an area under the receiver operating characteristic curve of 0.953 (p < 0.0001). The sensitivity and specificity of an expanded fractional ECS greater than 30% for the prediction of cirrhosis were 92% and 83%. Multivariate linear regression revealed that the fractional ECS is complementary to the MELD score as a predictor of cirrhosis (p < 0.0001). CONCLUSION: Noninvasive contrast-enhanced CT quantification of the fractional ECS correlates with the MELD score, an indicator of the severity of liver disease, and merits further study.

Multidetector CT of the postoperative colon: review of normal appearances and common complications.

If not properly recognized, the normal postoperative appearance of the pelvis following colorectal surgery can be misinterpreted as disease, including infection or recurrent tumor. However, multidetector computed tomography (CT) with the supplemental use of multiplanar reformation clearly demonstrates the expected postoperative anatomic changes in this setting. The high-resolution images achievable with multidetector CT enable the radiologist to play an important role in the postoperative assessment of patients following colon surgery. Whenever possible, the radiologist should be aware of the specific indication for the study, the type of surgery that was performed (ranging from segmental bowel excision to more extensive radical resection), and what anastomoses were created. This knowledge, as well as familiarity with the normal multidetector CT appearances of various postoperative complications, is critical for prompt diagnosis and appropriate management of these complications and for better differentiation of complications from normal findings.

Gadolinium accumulation and fibrosis in the liver after administration of gadoxetate disodium in a rat model of active hepatic fibrosis.

PURPOSE: To evaluate the effect of gadoxetate disodium on fibrosis in a rat model of active hepatic fibrosis. MATERIALS AND METHODS: The local committee for animal research approved this study. Hepatic fibrosis was induced during 12 weeks of intraperitoneal injection of carbon tetrachloride (CCl(4)). Gadoxetate disodium was administered at 10 mmol/kg for 5 consecutive days starting after the final dose of CCl(4) (clinical dose of gadoxetate disodium is 0.25 mmol/kg). Three groups of Sprague-Dawley rats were studied. Group 1 consisted of six rats treated only with gadoxetate disodium, group 2 consisted of nine rats treated only with CCl(4), and group 3 consisted of nine rats treated with both gadoxetate disodium and CCl(4). Seven days after the final injection of gadoxetate disodium, the rats were sacrificed, and histologic findings and gadolinium deposition in the liver were examined. Fibrosis stage and gadolinium deposition were compared by using the Mann-Whitney test and Student t test. RESULTS: Fibrosis grading in groups 2 and 3 did not differ significantly (mean Batts-Ludwig fibrosis stage in group 2 was 2.67 and in group 3 was 2.78, P = .70; mean Ishak fibrosis stage in group 2 was 3.89 and in group 3 was 4.11, P = .71). Gadolinium deposition in the liver was slightly increased in group 3 in comparison to group 1 (3.2 ppm versus 4.0 ppm, P = .01), although this reversed when corrected as a percentage of total injected dose (0.022% versus 0.017%, P = .003). CONCLUSION: The high-dose administration of gadoxetate disodium in the setting of active hepatic fibrosis was not associated with increased fibrosis, suggesting that gadoxetate disodium does not incite a nephrogenic systemic fibrosis-like fibrotic change in the setting of active hepatic inflammation.