RESUMO
Pancreatitis is a major cause of morbidity and mortality secondary to endoscopic retrograde pancreatography (ERP). One factor that may cause post-ERP pancreatitis is the type of contrast media utilized during the procedure. The purpose of this prospective, double-blind, randomized study was to evaluate the effects of three contrast agents of differing osmolality and ionicity on changes between pre- and post-ERP chemical changes in serum amylase and lipase and development of clinical symptoms of acute pancreatitis. Our study of 53 patients showed that those who received Omnipaque a non-ionic, relatively iso-osmolar contrast agent, had a significantly lower serum amylase (p = 0.0038) and serum lipase (p = 0.0002) in post-ERP serological markers, compared with patients who received the ionic agents, Hypaque meglumine 60% or Hexabrix. In addition, the development of clinical symptoms of pancreatitis was less in patients who received Omnipaque than in those who received Hexabrix or Hypaque (1 vs. 3 vs. 4). No significant difference was found between patients who received ionic agents. No patient who received Omnipaque needed hospitalization, whereas one (6%) patient who received Hexabrix was hospitalized compared to three (20%) hospitalized patients who received Hypaque. When the initial cost and cost of hospitalization were compared, the non-ionic contrast medium was also found to be more cost-effective for the patient. In summary, the risk of post-ERP acute pancreatitis was significantly lower for patients who received the non-ionic contrast agent than for those who received the ionic agents.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Diatrizoato de Meglumina , Iohexol , Ácido Ioxáglico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Pancreatite/etiologiaRESUMO
To optimally traverse the fascial and tendinous aponeuroses during percutaneous drainage of abdominal structures, a more rigid dilator is required than commonly used vascular dilators. Such a dilator is available and is useful and safe.
Assuntos
Drenagem/instrumentação , Abscesso/terapia , Ductos Biliares , Dilatação/instrumentação , Fáscia , Humanos , Rim , Punções/instrumentaçãoRESUMO
Two cases of peripelvic hemorrhage simulating tumors (Antopol-Goldman lesion) are reported. In the 2 cases, nephrectomies were performed. With more knowledge of this lesion, and of its rapid disappearance, a waiting period and repeated intravenous pyelogram might prevent some unnecessary surgery.
Assuntos
Hematoma/diagnóstico por imagem , Hematúria/etiologia , Nefropatias/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Idoso , Angiografia , Diagnóstico Diferencial , Feminino , Hematoma/complicações , Humanos , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , UrografiaRESUMO
Internal malignant fistulae of the gastrointestinal tract involving two or more loops of different segments of the bowel are rare. The colon is frequently one of the participating loops. Observations on four such cases indicate that the fistulous tract connecting the two bowel loops is usually linear, somewhat wide, and does not produce significant approximation of the bowel loops involved. These radiographic features help to differentiate such fistulae from the benign type.
