Chloral hydrate sedation in radiology: retrospective audit of reduced dose.

BACKGROUND: Chloral hydrate (CH) is safe and effective for sedation of suitable children. OBJECTIVE: The purpose of this study was to assess whether adequate sedation is achieved with reduced CH doses. MATERIALS AND METHODS: We retrospectively recorded outpatient CH sedations over 1 year. We defined standard doses of CH as 50 mg/kg (infants) and 75 mg/kg (children >1 year). A reduced dose was defined as at least 20% lower than the standard dose. RESULTS: In total, 653 children received CH sedation (age, 1 month-3 years 10 months), 42% were given a reduced initial dose. Augmentation dose was required in 10.9% of all children, and in a higher proportion of children >1 year (15.7%) compared to infants (5.7%; P < 0.001). Sedation was successful in 96.7%, and more frequently successful in infants (98.3%) than children >1 year (95.3%; P = 0.03). A reduced initial dose had no negative effect on outcome (P = 0.19) or time to sedation. No significant complications were seen. CONCLUSION: We advocate sedation with reduced CH doses (40 mg/kg for infants; 60 mg/kg for children >1 year of age) for outpatient imaging procedures when the child is judged to be quiet or sleepy on arrival.

Perianal dermatofibrosarcoma protuberans: a case report.

A 67-year-old man presented with a perianal lump that had increased in size. On examination he had a 3-cm irregular, mobile, elevated, red, polypoid lump at the edge of the anus at the 8-o'clock position. Biopsy results unexpectedly revealed a spindle cell lesion extending deep into the subcutaneous tissue with occasional mitoses. The lesion was positive for CD34 and negative for epithelial markers, consistent with dermatofibrosarcoma protuberans (DFSP). Magnetic resonance imaging of the pelvis showed the mass extending deep into the ischiorectal space with no involvement of the external or internal anal sphincter. He underwent excision of the lesion with circumferential margins of 1 cm and formation of a skin rotation flap to achieve primary closure. Histology confirmed DFSP. Both the deep and lateral resection margins were involved. He proceeded to have a wider excision of margins, which was free of any remaining tumor. Dermatofibrosarcoma protuberans is a rare lesion. It most commonly occurs on the trunk; the perianal presentation in this case is unique. Surgical excision and preservation of functionality with cosmesis was an issue in this case, as DFSP is a locally aggressive tumor with a high recurrence rate.

Magnetic resonance enteroclysis compared with conventional enteroclysis and computed tomography enteroclysis: a critically appraised topic.

Recent advances in CT and MR technology, particularly the advent of multidetector CT (MDCT), the advent of rapidly changing gradients in industry standard MRI scanners, enabling ultrafast sequences, have led to an expansion in the role of cross sectional imaging in the investigation of small bowel disorders. We conducted an evidence-based review of MR enteroclysis (MRE) and how it performs in comparison to CT enteroclysis (CTE) and the gold standard of conventional enteroclysis (CE) for diagnosis of small bowel Crohn's disease and small bowel neoplasia. We used the standard 5 step evidence-based medicine method of ask, search, appraise, apply and evaluate. We found 3 relevant level 1B studies, and one level 3B study. No studies evaluating MRE in small bowel neoplasia were found. MRE does not perform as well as CE in evaluation of fine mucosal detail, but the additional extraluminal detail, and absence of ionising radiation enhances its overall performance. It was not possible to establish the relative diagnostic performances of MRE and CTE from existing literature. CTE does involve patient irradiation. For patients in whom jejunal intubation and enteroclysis is considered to evaluate the small bowel, MRE should be considered the first-line investigation, local resources and expertise permitting.

Open-MRI measures of cam intrusion for hips in an anterior impingement position relate to acetabular contact force.

Open MRI in functional positions has potential to directly and non-invasively assess cam femoroacetabular impingement (FAI). Our objective was to investigate whether open MRI can depict intrusion of the cam deformity into the intra-articular joint space, and whether intrusion is associated with elevated acetabular contact force. Cadaver hips (9 cam; 3 controls) were positioned in an anterior impingement posture and imaged using open MRI with multi-planar reformatting. The ß-angle (describing clearance between the femoral neck and acetabulum) was measured around the entire circumference of the femoral neck. We defined a binary "MRI cam-intrusion sign" (positive if ß < 0°). We then instrumented each hip with a piezoresistive sensor and conducted six repeated positioning trials, measuring acetabular contact force (F). We defined a binary "contact-force sign" (positive if F > 20N). Cam hips were more likely than controls to have both a positive MRI cam-intrusion sign (p = 0.0182, Fisher's exact test) and positive contact-force sign (p = 0.0083), which represents direct experimental evidence for cam intrusion. There was also a relationship between the MRI cam-intrusion sign and contact-force sign (p = 0.033), representing a link between imaging and mechanics. Our findings indicate that open MRI has significant potential for in vivo investigation of the cam FAI mechanism.