Round ligament varices: sonographic appearance in pregnancy.

Round ligament varices (RLV) are an important clinical entity as they may cause hernia-like symptoms in the absence of a true hernia. When this condition is diagnosed correctly, unnecessary intervention may be prevented. We aimed to determine the significance and anatomy of RLV in pregnancy and to review and describe their clinical and sonographic appearance. We followed prospectively five patients who presented during pregnancy with clinical symptoms suspicious of an inguinal hernia. All patients were diagnosed with RLV on ultrasound examination. All patients were managed conservatively and in all five cases, RLV resolved spontaneously postpartum. The diagnosis of RLV should be considered in pregnant women presenting with a groin mass. Sonography is diagnostic and can save unnecessary surgical exploration and associated morbidity.

The use of MRI to demonstrate small bowel obstruction during pregnancy.

Patients who present during pregnancy with acute abdominal symptoms often present a significant diagnostic challenge. Although ultrasound is often the first mode of abdominal imaging, in complex cases further imaging is often necessary. MRI of the small bowel has been made possible with the development of rapid scanning techniques. This has increased the attractiveness of a modality whose benefits include multiplanar imaging, excellent soft tissue contrast and the avoidance of ionizing radiation. With these capabilities MRI has been shown to be a useful adjunct when imaging the small bowel in pregnancy. Although MRI has been employed to investigate small bowel obstruction in the obstetric setting, to date there have been no reports of MR identifying small bowel obstruction secondary to extrinsic compression from a gravid uterus. During pregnancy, small bowel obstruction is most commonly attributed to adhesions. However, there are also antenatal occurrences of small bowel obstruction secondary to uterine compression. We present the MRI findings of an unusual case of small bowel obstruction occurring secondary to compression from a 32-week gravid uterus, in a patient with an end ileostomy. Furthermore, while clinical history and examination are fundamental to diagnosis of intestinal obstruction, the following case highlights the value of MRI in pregnancy as a confirmatory test.

Polyethylene glycol solution as an oral contrast agent for MRI of the small bowel in a patient population.

AIM: To assess the efficacy of polyethylene glycol solution as an oral contrast agent in a patient population. MATERIAL AND METHODS: Patients were fasted from 12.00 am. Administration of the oral contrast medium commenced 15 min before imaging and comprised one sachet of Norgine (Klean-prep, Middlesex, UK) reconstituted in 1 l water of which the patient took between 500-750 ml. Norgine is a balanced mixture of polyethylene glycol and electrolytes, which when added to water produces a clear colourless, iso-osmotic solution. RESULTS: In total 38 candidates were identified retrospectively covering a 2-year period. Visualization of the jejunum, ileal loops and ileocaecal region was excellent or sufficient in 87, 95 and 89%, respectively. The time taken to obtain complete visualization of the small bowel, from the jejunum to the ileocecal region varied from 15-240 min with an average time of 65 min and 73.7% of patients necessitating delayed imaging. CONCLUSIONS: Polyethylene glycol was demonstrated to be an excellent oral contrast medium in distending the small bowel. However, small bowel transit times were significantly delayed and problematic necessitating repeated imaging within the patient population. As result of theses findings longer examination time should be expected within a patient population and this should be borne in mind when scheduling patients.

Therapeutic drug monitoring reduces toxic drug reactions: a meta-analysis.

Therapeutic drug monitoring (TDM) is commonly employed to optimize the dosing of certain drugs, including digoxin, aminoglycosides, theophylline, and phenytoin. Studies were reviewed in order to (a) evaluate the effect of TDM on the occurrence of toxic drug reactions (TDRs) and (b) identify factors that may modify or invalidate the relationship. In 14 studies, monitored patients suffered fewer toxic drug reactions than nonmonitored patients (odds ratio = 0.35, 95% confidence interval, 0.13 to 0.89). The average effect size was larger in studies that utilized a control group for comparisons rather than a before-and-after study design. TDM appeared to be most beneficial for patients taking theophylline or digoxin. Issues that must be addressed in future TDM service evaluations include (a) study design, (b) adverse patient selection, (c) insufficient sample size, (d) incomplete or inconsistent description of the TDM service, and (e) incomplete, inconsistent, or absent description of criteria for reporting TDRs.

Meta-analysis of research on the effect of clinical pharmacokinetics services on therapeutic drug monitoring.

A meta-analysis of 27 published and unpublished studies of the impact of clinical pharmacokinetics services on patients' serum drug concentrations, the appropriate collection of blood samples, and the appropriate use of assay results was conducted. An individual study's effect size (ES) was determined by subtracting probits or by calculating the Bayesian estimate of pi derived from the percentages observed in the experimental and control groups. Weights based on an individual study's sample size were used to estimate the overall ES. Patients monitored by clinical pharmacokinetics services were significantly more likely to have serum drug concentrations within an acceptable therapeutic range than were patients who were not monitored. When each of the monitoring parameters was investigated individually, monitored patients were more likely to have therapeutic peak (ES = 0.51, 95% confidence interval = -0.34 to 1.36) and trough (ES = 1.15, 95% CI = -0.37 to 2.68) serum drug concentrations, to be within therapeutic range (ES = 0.91, 95% CI = 0.19 to 1.63), and to have fewer toxic peak (ES = 0.06, 95% CI = -0.53 to 0.65) and trough (ES = 0.96, 95% CI = 0.12 to 1.82) serum drug concentrations. Clinical pharmacokinetics services were also more likely to have collected blood samples appropriately (ES = 0.87, 95% CI = -0.25 to 2.00) and to have used assay results appropriately (ES = 1.21, 95% CI = -0.46 to 2.88). Clinical pharmacokinetics services appeared to have a significant influence on the proportion of patients with desirable serum drug concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of therapeutic drug monitoring services on the number of serum drug assays ordered for patients: a meta-analysis.

In order to quantify the impact of therapeutic drug monitoring (TDM) services on the average number of serum drug assays (SDAs) ordered for patients, a meta-analysis was conducted on the data collected from 16 published and unpublished studies. Overall, TDM has no effect on the number of SDAs ordered per patient. However, there were a number of moderator variables that influenced the results. In studies utilizing control groups for comparison, TDM service-monitored patients were ordered fewer SDAs than nonmonitored patients. When data from the same institution were collected before and after implementation of a TDM service, there was an increase in the number of SDAs per patient. Aminoglycoside patients monitored by a TDM service were ordered more SDAs and nonaminoglycoside monitored patients were ordered fewer SDAs than nonmonitored patients. When the pharmacy department determined when the SDAs were to be collected and adjusted the dose, monitored patients were ordered fewer SDAs than nonmonitored patients. However, when the pharmacy department did not have control of these parameters, the TDM patients were ordered more SDAs than nonmonitored patients. Methodologic limitations of the studies and their possible effects on the results are discussed.