A prospective study evaluating emotional disturbance in subjects undergoing defecating proctography.

AIM: To investigate the prevalence of psychiatric illness in association with functional gastrointestinal disorders using defecating proctography (DP) and validated questionnaires. METHODS: We prospectively evaluated 45 subjects referred for DP using hospital anxiety and depression scale (HADS), state trait anxiety inventory (STAI), patient health questionnaire 15-item somatic symptom severity scale (PHQ-15), validated questionnaires for sexual or physical abuse; post-traumatic stress disorder questionnaire (PTSD) and ROME-III questionnaires for gastrointestinal complaints. DP results were considered negative if levator ani function was normal, rectoceles (if any) were < 4 cm and there was no evidence of intussusception, rectal prolapse, or other anatomic abnormality demonstrated. Subjects were subsequently divided into those with structural defects seen on DP (DP positive group) and those with a normal defecography study (DP negative group). RESULTS: Forty five subjects were included in the study of which 20 subjects were classified as DP negative (44.4%). There was a striking prevalence of a history of sexual abuse in DP negative group compared to the DP positive group (n = 9, 5 respectively; P = 0.036). Further, subjects in the DP negative group scored significantly higher on the HADS anxiety (6.60 ± 1.00 vs 4.72 ± 0.40, P = 0.04) and depression scales (5.72 ± 1.00 vs 3.25 ± 0.46, P = 0.01). This correlated well with significantly higher scores on the STAI state anxiety scale (42.75 ± 3.16 vs 35.6 ± 2.00, P = 0.027), PHQ-15 questionnaire (13.15 ± 0.82 vs 10.76 ± 0.97, P = 0.038) and prevalence of PTSD (20% vs 4%, P = 0.045) among DP negative subjects. There was no difference between the groups in terms of STAI trait anxiety. CONCLUSION: The findings of this prospective study demonstrate a significantly high degree of psychiatric ailments in patients with negative findings on DP who should be appropriately screened for a history of sexual abuse and symptoms of psychosocial distress.

Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) without replacement requires precise knowledge of the anatomic dimensions and physical characteristics of the peripheral vasculature and aortic valve annulus at the insertion of the aortic valve leaflet and root at the level of the sinus of Valsalva. Multislice computed tomography (CT) allows detailed and precise assessment of the anatomic variables. Noncardiovascular structures are also amenable to assessment by CT. Of the 394 patients screened for TAVI, 259 (65.7%) had non-contrast CT to evaluate chest anatomy and contrast CT to evaluate ilio-femoral anatomy. Significant noncardiac findings were defined as those requiring immediate evaluation or intervention or additional clinical or radiologic follow-up. Noncardiovascular findings known before CT were not included. Of the 259 patients, 105 (40.5%) were men. The mean age was 82.3 +/- 8.1 years. New, significant noncardiovascular findings were found in 89 (34.3%) and malignancy in 11 (4.2%) patients. Insignificant noncardiovascular findings were identified in 222 patients (85.7%). Signs of fluid retention were noted on CT in 105 patients (40.5%), with pleural effusion in 100 (38.6%), ascites in 17 (6.5%), and pericardial effusion in 14 (5.4%). Important peripheral vascular disease was found in 98 patients (37.8%), resulting in exclusion of 49 (19.1%) from TAVI using the transfemoral approach. An aortic aneurysm was found in 10 patients (3.8%) and a "porcelain" aorta (heavily calcified ascending aorta) in 19 (7.3%). In conclusion, malignancy and other noncardiovascular abnormalities are often found in patients who undergo CT for evaluation for TAVI. Populations must be meticulously examined to ensure that important findings are not missed.

Ultra-low-dose intra-arterial contrast injection for iliofemoral computed tomographic angiography.

OBJECTIVES: This study sought to evaluate the feasibility of using ultra-low-dose intra-arterial contrast injection for iliofemoral computed tomographic (CT) angiography to follow diagnostic cardiac catheterization. BACKGROUND: Cardiovascular interventions such as percutaneous aortic valve replacement require transfemoral delivery of large-bore intra-arterial catheters; therefore, pre-procedural assessment of aortoiliofemoral anatomy is important. CT angiography is ideal for this purpose but requires a large volume of intravenous contrast. METHODS: Consecutive patients requiring evaluation of aortoiliofemoral anatomy underwent conventional anteroposterior projection iliac angiography during cardiac catheterization. A pigtail catheter was left in situ in the infrarenal abdominal aorta, and patients were transferred to the CT suite. Subsequently, 10 to 15 ml of contrast diluted with normal saline was injected intra-arterially via the pigtail catheter while a spiral CT of the abdomen and pelvis was acquired. Conventional angiographic and CT images were analyzed independently to assess suitability for large-bore (7-mm-diameter)intra-arterial catheter access. RESULTS: Excellent CT image quality was achieved in 34 of 37 patients (92%). The mean contrast dose for CT was 12 +/- 2 ml. In 9 patients (24%), CT changed the assessment of femoral access feasibility. Furthermore, in another 7 patients (19%), unfavorable anatomy as shown by CT directed the avoidance of a particular side. Overall, CT findings altered the interventional approach in 16 patients (43%). There was no significant deterioration detected in renal function after coronary and CT angiography (estimated glomerular filtration rate 54.8 +/- 3.8 ml/min before 53.3 +/- 3.9 ml/min after, p = 0.55). CONCLUSIONS: High-quality aortoiliofemoral CT angiography can be obtained with a technical success rate of >90% using 10 to 15 ml of contrast injected via a catheter in the abdominal aorta, and offers an alternative to conventional X-ray or CT angiography with high-volume intravenous contrast injection.