ABSTRACT
OBJECTIVE: This article reviews optimal treatment of allergic reactions to iodinated contrast material in pregnant patients. Initial evaluation and treatment of a pregnant patient is similar to that for a nonpregnant patient. However, additional steps, including assessment for uterine cramping, using left uterine displacement to improve venous return, and maintaining blood pressure to ensure placental perfusion, may be required. CONCLUSION: Adequate preparation and a team approach will provide optimal care for a pregnant patient who has an allergic reaction to a contrast agent.
Subject(s)
Contrast Media/adverse effects , Drug Hypersensitivity/therapy , Iodine Compounds/adverse effects , Drug Hypersensitivity/diagnosis , Female , Humans , Pregnancy , Risk Factors , Tomography, X-Ray ComputedABSTRACT
Pancreatic metastases are rare but are thought to be most commonly from renal cell carcinoma (RCC). These metastases can present many years after the initial tumor is resected, and accordingly, these patients require prolonged imaging follow-up. Although the computed tomographic findings of these metastases have been extensively reviewed in the literature, little has been written about the magnetic resonance imaging appearance of these metastases. Pancreatic metastases from RCC are typically T1 hypointense and T2 hyperintense. After intravenous administration of gadolinium, they are typically hypervascular and less commonly hypovascular. Chemical shift and diffusion-weighted imaging can aid in the diagnosis of these metastases.
Subject(s)
Carcinoma, Renal Cell/secondary , Kidney Neoplasms/pathology , Magnetic Resonance Imaging/methods , Pancreatic Neoplasms/secondary , HumansABSTRACT
BACKGROUND: US critical access hospitals play an integral role in rural healthcare. Accreditation may be helpful in assuring that these hospitals provide high-quality care. OBJECTIVE: To determine whether quality measures used in the US Centers for Medicare and Medicaid Services Hospital Compare database differed for critical access hospitals based on Joint Commission on Accreditation of Healthcare Organizations accreditation status. RESEARCH DESIGN: Cross-sectional with t-test statistics computed on weighted data to ascertain statistically significant differences (P < or = 0.01). MAIN OUTCOME MEASURE: Differences between accredited and non-accredited rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure, pneumonia and surgical infection. SUBJECTS: US critical access hospitals. RESULTS: The differences between accredited and non-accredited rural critical access hospitals for 4 out of 16 hospital quality indicators were statistically significant (P < or = 0.01) and favored accredited hospitals. Also, accredited hospitals were more likely to rank in the top half of hospitals for 6 of the 16 quality measures. CONCLUSIONS: The results indicate that in the setting of critical access hospitals, external accreditation appears to result in modestly better performance.
