Sonography of the small bowel after oral administration of fluid: an assessment of the diagnostic value of the technique.

PURPOSE: This study was performed to assess the feasibility and possible advantages of bowel sonography after fluid filling of intestinal loops compared with conventional sonography. MATERIALS AND METHODS: Forty-five consecutive patients with known or suspected coeliac disease (35 females, ten males; age range 11-65 years) prospectively underwent sonography before and after ingestion of 750 ml of an aqueous solution of polyethylene glycol. Results before and after fluid distension were compared to assess whether luminal filling improved small-bowel visualisation. RESULTS: Luminal filling improved visualisation of intestinal features (luminal diameter, mucosal folds, parietal layers) in 77.6% of cases (marked, moderate or mild improvement in 2, 16 and 17 patients; 4.4%, 35.5% and 37.7%), respectively, and showed no change or worsening in 20% and 2.2% nine and one patient), respectively. Baseline examination showed abnormal features in 13/25 celiac patients (dilated fluid-filled loops, increased peristalsis, transient intussusception, mesenteric lymph nodes, intraperitoneal fluid). Reexamination after luminal filling showed additional abnormalities in six of the previous 13 and in three further coeliac patients. There were no false positive signs due to fluid administration. CONCLUSIONS: Luminal filling can improve visualisation of bowel walls and fold pattern and may be helpful in selected cases.

The staff of the department of diagnostic imaging: radical changes and training.

When a complex reality as the Department of Diagnostic Imaging and its staff is aimed at the provision of a service, it may be extremely difficult to identify all present correlations and in turn, correlate them with the final goal. The relationship between human and technical resources, between organization and environment are of the utmost importance in planning the structure design. It should be kept in mind that "the person" is the pivot of any innovation for change. Participation by all members, a more flexible, structure, is required. In education and teaching, the global network we are heading for, could become the determining factor in a continuing training process and multispecialized research, facilitating the circulation of information in an interactive, formative dialogue.

Management of radiologic archive in a diagnostic imaging department.

One of the major and demanding problems in the management of a modern department of Radiology is undoubtedly the organization of a radiologic archive. Its management has been increasingly difficult in last years both for the increase in procedures and the number of radiologic exams. At the Radiology department of UCSC, since some years, this problem has been tackled. Major objectives have been identified in focusing on responsibilities, global management and planning of radiologic film retrieval and archiving integrated with health care activities (scheduling of admissions and exam appointments, reporting, discharge). Based on these assumptions, the archive has been divided into 3 sections, each dynamically integrated with the others. The 3 archives should be integrated with RIS and supported by information technology. RIS is considered the starting point of the process. In fact the system ensures communication to the archiving workstation and to the radiology room of patient admission and consequent execution of the exam which involves image production. This user-friendly procedure enables consistent information between RIS and archiving system and correct association of images to the patient medical report, for subsequent consultation.

Information management of a department of diagnostic imaging.

It is well-known that while RIS allows the management of all input and output data of a Radiology service, PACS plays a major role in the management of all radiologic images. However, the two systems should be closely integrated: scheduling of a radiologic exam requires direct automated integration with the system of image management for retrieval of previous exams and storage of the exam just completed. A modern information system of integration of data and radiologic images should be based on an automated work flow management in al its components, being at the same time flexible and compatible with the ward organization to support and computerize each stage of the working process. Similarly, standard protocols (DICOM 3.0, HL7) defined for interfacing with the Diagnostic Imaging (D.I.) department and the other components of modules of a modern HIS, should be used. They ensure the system to be expandable and accessible to ensure share and integration of information with HIS, emergency service or wards. Correct RIS/PACS integration allows a marked improvement in the efficiency of a modern D.I. department with a positive impact on the daily activity, prompt availability of previous data and images with sophisticated handling of diagnostic images to enhance the reporting quality. The increased diffusion of internet and intranet technology predicts future developments still to be discovered.

[Role of ultrasonography of the knee in the follow-up of juvenile rheumatoid arthritis]. / Ruolo dell'ecografia del ginocchio nel follow-up dell'artrite reumatoide giovanile.

Juvenile rheumatoid arthritis is a chronic disease, with the synovium as the target tissue. We made 594 US examinations of the knee in 240 children (mean age: 9 years) with juvenile rheumatoid arthritis. All patients underwent at least one US exam and 156 patients underwent many US examinations during 3 years' follow-up. In our series mean synovial thickness was 6 mm (range: 2.5-11 mm) while in normal subjects mean synovial thickness is 2.7 mm (range: 1-4.5 mm). The mean thickness of the suprapatellar bursa was 9 mm (range: 4-18 mm) versus 2.8 mm (range: 1-5 mm) in normal subjects. The mean length of the suprapatellar bursa was 27 mm (range: 13-44 mm) versus 14.3 mm (range: 8-23.5 mm) in normal children. Cartilage thickness was 3.3 mm (range: 1.2-5.8 mm) at the intercondylar notch, and 3 mm (range: 0.8-5.3 mm) at the femoral condyles. Cartilage thickness is 3.5 mm (range: 2-6 mm) at the intercondylar notch, and 3.2 mm (range: 1.8-5.4 mm) at the femoral condyles in normal subjects. The articular cartilage outline was blurred in 36% of patients with active knee involvement. A Baker cyst was found in 24 patients (10%). The mean volume was 3 ml (range: 1-40 ml). No tendinous alterations were observed. Changes in synovial membrane (synovial thickness), the presence of fluid in the suprapatellar bursa, and blurring of the articular cartilage outline showed statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. On the contrary, articular cartilage thickening or thinning showed no statistically significant differences between juvenile rheumatoid arthritis patients with active knee involvement and subjects in clinical remission. In conclusion, US is a simple, rapid, inexpensive and accurate method for the staging and follow-up of joint inflammation in patients with juvenile rheumatoid arthritis of the knee.

[Diagnosis of gastroesophageal reflux in childhood. Comparison of ultrasonography and barium swallow]. / Diagnosi di reflusso gastro-esofageo nell'età pediatrica. Confronto tra ecografia e pasto baritato.

Gastroesophageal reflux (GER) is a very common event in the pediatric patient. An accurate and atraumatic imaging technique must be used to differentiate normal from abnormal conditions. Sonography (US) appears to answer this purpose, as recently shown in the international literature. One hundred and seventy-eight patients with suspected GER were enrolled in this study; their age ranged 10 days to 15 years. They were examined with both US and barium swallow, in a double-blind trial. The patients were divided into three groups, according to GER severity, i.e., absent or physiologic GER, moderate GER and severe GER. We considered not only the number of reflux episodes, as related to patients' age, but also reflux volume, esophagus clearing time and possibly coexisting hiatal hernia or esophagitis. US and barium swallow results were in agreement in 93% of the cases. In the other cases US demonstrated more severe GER than barium meal. No statistically significant differences were observed in the various age groups. Since US is a relatively cost-effective, noninvasive and physiologic method which is widely available and uses no ionizing radiations, it can be recommended as the screening test of choice in symptomatic children and in the follow-up.

[Ultrasonography in hypertrophic stenosis of the pylorus: clinico-therapeutic implications in borderline cases]. / L'ecografia nella stenosi ipertrofica del piloro: implicazioni clinico-terapeutiche nei reperti dubbi.

Previous publications attempted to define normal and abnormal ranges in the measurement of pyloric length (L), breadth (D), muscle thickness (S), volume (V) and muscle index (MI). We examined with US 286 patients with suspected hypertrophic pyloric stenosis and investigated all the above diagnostic criteria. Normal and abnormal ranges were in agreement in all five measurements, though less apparent for pyloric volume and muscle index. The patients with borderline values were 46 (16%) for pyloric muscle thickness, 98 (34%) for breadth, 52 (18%) for length, but only 22 (7.7%) for pyloric volume and muscle index. Borderline patients received medical therapy with the antispasmodic drug metaclopramide hydrochloride and they were examined with US after 15 days. Only 8 of 22 borderline patients (36%) developed a typical hypertrophic pyloric stenosis. In the others, pyloric volume was reduced and the symptoms subsided. Pyloric parameters cannot be always measured accurately, but pyloric volume and muscle index measures better distinguish normal from abnormal findings. The formula for pyloric volume calculation is simpler than that for pyloric muscle index calculation and easier to memorize, also because no correction for body weight is necessary.

[Intestinal preparation for colon enema with fleet sodium phosphate: comparative study with the conventional method]. / Preparazione intestinale per clisma del colon mediante fosfo-soda fleet: studio comparativo con il sistema tradizionale.

PURPOSE: To evaluate the possible optimization of a well-tolerated and versatile method of intestinal preparation able to adequately free the lumen and consequently improve diagnostic results with a lower risk of prolonged hospital stay for incorrectly prepared patients. MATERIAL AND METHODS: We examined 40 patients, namely 20 men (mean age 70 years, range 52-87) and 20 women (mean age 68 years, range 49-81) referred to the Institute of Radiology of the Università Cattolica del Sacro Cuore, Gastrointestinal tract Unit, to undergo double contrast colonic enema. The patients were divided into two groups by one-to-one randomization: group 1 was prepared with the conventional method and group 2 with the new protocol for intestinal preparation. On the two days before the examination a low-residue diet was administered; the day before the examination a phial of Fosfo-soda fleet was administered in two times (at 8 am and 4.30 pm), which was diluted with half a glass of water. Bread, pasta and vegetables were strictly forbidden at lunch and soup or milk at supper; the patients were fasted on the examination day. Two evaluations were performed: one to assess tolerance to the preparation and the other, a radiographic study, to assess the grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting. RESULTS: Of the 20 patients given X-prep, 3 had to discontinue it and 4 exhibited severe side-effects, but completed the treatment; tolerance was satisfactory in the remaining 13 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 9, 17 and 16 patients respectively. None of the patients given Fosfo-soda fleet had to discontinue it and tolerance was satisfactory in 19 patients. The grade of intestinal preparation, the presence of secretions/bubbles, and the degree of painting were considered satisfactory in 15, 18 and 18 patients respectively. The statistical analysis of all data was performed with Wilcoxon test. DISCUSSION: Intestinal preparation with Fosfo-soda fleet appeared to be definitely better than the conventional method relative to tolerance (p = .02, a statistically significant difference), while providing similarly satisfactory data relative to the other parameters. CONCLUSIONS: Our results, coupled with the versatility of Fosfo-soda fleet (possible application in colonoscopy) and its ease of use recommend this preparation not only for inpatients but also for outpatients in whom self-administration is feasible.