OBJECTIVE. The purpose of this study was to show the usefulness of MRI in the evaluation of pregnant women with acute abdominal or pelvic pain.SUBJECTS AND METHODS. All MRI studies of pregnant patients who were referred for examination because of acute abdominal or pelvic pain between June 2002 and May 2004 were included in this study (n = 29). The use of MRI was at the discretion of the clinician. Fetal sonography was performed in all patients before any other imaging. A complete abdominal sonographic examination was performed in six patients before MRI. In the remaining 23 patients, MRI was the choice for primary imaging. Multiplanar multisequence MR images of the abdomen and pelvis were obtained in each patient. Unenhanced images were reviewed by an experienced radiologist to determine whether a diagnosis could be made without the administration of gadolinium. In 22 of 29 studies, gadolinium was not administered. The prospective clinical MR interpretations were compared with follow-up medical, surgical...

/pdf/mri-of-acute-abdominal-and-pelvic-pain-in-pregnant-patients-36lxbkgnnn.pdf

MRI of Acute Abdominal and Pelvic Pain in Pregnant Patients

Biliary sludge in dogs is dismissed commonly as an incidental finding. On the other hand, gallbladder mucocele is reported increasingly in dogs and can lead to biliary obstruction or gallbladder rupture. Cholestasis is suspected to play a role in development of sludge and mucoceles, though there are no data in dogs to support this. We investigated gallbladder emptying, a key factor in biliary flow, in dogs with mobile sludge, immobile sludge, or gallbladder mucocele and in healthy controls. Gallbladder ejection fraction estimated by ultrasonography was used as the index of gallbladder emptying. The ejection fraction at 60 min after eating was significantly decreased in all three abnormal groups. Moreover, all dogs with sludge or a mucocele had gallbladder distension. These changes were the greatest in the mucocele group. Thus, biliary stasis occurs not only in dogs with gallbladder mucocele but also in dogs with biliary sludge. Cholestasis may play a role in the pathogenesis or progression of these diseases in dogs.

Decreased gallbladder emptying in dogs with biliary sludge or gallbladder mucocele.

Background and Aims: Cholestatic liver dysfunction and biliary sludge are common problems in critically ill patients. No specific strategies have been described to prevent cholestasis and biliary sludge in the intensive care unit (ICU). We examined liver dysfunction and biliary sludge prospectively in a large medical long-stay ICU population and hypothesized that tight glycemic control with intensive insulin therapy (IIT) reduces cholestasis and biliary sludge. Methods: This study was a preplanned subanalysis of 658 long-stay (at least a fifth day) ICU patients out of a large randomized controlled trial (n = 1200), studying the effects of IIT on the outcome of medical critical illness. Patients were allocated to either IIT (glycemia 80–110 mg/dl) or conventional insulin therapy (CIT) requiring insulin above a glycemia of 215 mg/dl. Different patterns of liver dysfunction were studied based on daily blood sample analysis, and biliary sludge was evaluated by ultrasonography. Results: On admission, cholestas...

/pdf/the-effect-of-strict-blood-glucose-control-on-biliary-sludge-2auzmg3qf4.pdf

The effect of strict blood glucose control on biliary sludge and cholestasis in critically ill patients.

AIM: To assess spectrum and etiology of gallstones and biliary sludge in the pediatric population of a North American tertiary care centre. METHODS: Retrospective review of abdominal ultraso- unds recorded at Saint Justine Hospital over a period of 24 mo (8/2003 to 8/2005) in patients 2 years of age idiopathic gallstone disease was found. These 48 patients represent 2.1% of the population who required ultrasound for abdominal pain. Complicated gallstone disease occurred in 28/48 with idiopathic disease, mainly adolescent girls. Patients with hemolytic disorders, cystic fibrosis, oncologic diseases or kidney transplantation and gallstones were asymptomatic and stones were detected during routine abdominal ultrasound. Twenty two patients < 2 years of age not consulting for abdominal pain had gallstone disease of diverse etiology. Biliary sludge was seen in 84 patients, 78.5% on total parenteral nutrition. In 4 patients, sludge progressed to gallstones. CONCLUSION: Idiopathic gallstone disease and its rate of complication are more frequent in our cohort than expected from previous studies. Adolescent girls with abdominal pain and idiopathic gallstones require special attention for complicated disease course.

High rate of complicated idiopathic gallstone disease in pediatric patients of a North American tertiary care center.

BACKGROUND: Adequate nutrition support for critically ill patients optimizes outcome, and enteral feeding is the preferred route of nutrition. Small intestinal glucose absorption is frequently impaired in critical illness. Despite lipid being a major constituent of liquid nutrient administered, there is little information about lipid absorption during critical illness. OBJECTIVES: To determine small intestinal lipid, as well as glucose, absorption in critical illness compared with health. MATERIALS AND METHODS: Twenty-nine mechanically ventilated critically ill patients and 16 healthy volunteers were studied. Liquid nutrient (60 mL, 1 kcal/mL), containing 200 µL (13)C-triolein and 3 g 3-O-methyl-glucose (3-OMG), was infused directly into the duodenum at a rate of 2 kcal/min. Exhaled (13)CO2 and serum 3-OMG concentrations were measured at timed intervals over 360 minutes. Lipid absorption was measured as the cumulative percentage dose (cPDR) of (13)CO2 recovered at 360 minutes. Glucose absorption was measured as the area under the 3-OMG concentration curve. Data are median (range) and analyzed using the Mann-Whitney U and Pearson correlation tests. RESULTS: Lipid absorption was markedly less in the critically ill (cPDR(13)CO2: patients, 22.6% [0%-100%] vs healthy participants, 40.7% [5.3%-84.7%]; P = .018). While glucose absorption was less at 60 minutes in the critically ill (3-OMG60: 13.2 [3.5-29.5] vs 21.1 [9.3-31.9] mmol/L·min; P = .003), this was not apparent at 360 minutes (3-OMG360: 92.7 [54.5-147.9] vs 107.9 [64.0-168.7] mmol/L·min; P = .126). There was no relationship between lipid and glucose absorption. CONCLUSION: Small intestinal absorption of lipid is diminished during critical illness.

Effect of Critical Illness on Triglyceride Absorption

Biliary sludge: the sluggish gallbladder.

Predicting the presence of choledocholithiasis in patients with symptomatic cholelitihasis

7 P Severe impairment of gallbladder motor functions in acromegalic patients during octreotide treatment

Like other western countries, Italy has a high inciŽ . dence of colorectal cancer CRC . Emilia Romagna is the region with the third highest number of cases of CRC, with a prevalence of 251 100 000 inhabitants. In particular, in the district of Ferrara, 648 new cases of CRC were diagnosed in 1994 1995 and 166 CRC-related deaths were recorded. The natural history of CRC suggests that screening programmes should be effective in preventing progression from adenoma to cancer. In fact, evidence from controlled trials suggests that removing adenomatous polyps reduces the incidence of CRC. Nevertheless, it is very difficult and expensive to perform a screening programme for the general population and most people are not currently screened for CRC. There is evidence from studies that people with close relatives with colorectal cancer have an increased risk of CRC and develop the disease at a younger age than people without a family history of CRC. Moreover, recent data have shown that there is a high prevalence of adenoma in first-degree relatives of patients affected by CRC. People with a first-degree relative who has developed CRC or adenomas at a relatively early age may prefer periodic complete evaluation of the colon, although there are no studies that have addressed the effectiveness of this approach directly. For these reasons we designed a screening endoscopy-based programme focused on this population. Here we report our preliminary results. The aim of this study was to evaluate the prevalence of adenomas in first-degree relatives of patients affected by CRC and to assess the usefulness and feasibility of a screening programme on this population using colonoscopy. In October 1999 we started a campaign stressing the usefulness of colonoscopy in first-degree relatives of CRC patients. We held meetings with general practitioners, surgeons and public conferences. Local newspaper articles, local ratio TV programmes and a booklet were published. A detailed website is also available. We try to reach as many people as possible in order to give the right information about the increased risk in these subjects. Moreover, all patients submitted to surgical intervention for CRC were asked to inform their first-degree relatives about the programme. All subjects aged between 45 and 75 and with one or more first-degree relative with CRC were invited to a preliminary interview, in order to collect personal and family history and to suggest colonoscopy as a screening option. When colonoscopy was refused, barium enema or faecal occult blood testing were suggested. At colonoscopy, we recorded the number of polyps and the size, histological type and degree of atypia of the most advanced adenoma in each patient. Between January and June 2000 we evaluŽ . ated 175 people age range 45 71 years , 57.1% of whom were male. One hundred and seventytwo participants were enrolled in the screening

Screening colonoscopy in asymptomatic increased-risk subjects.

The scintigraphy with radiolabelled WBC plays an important role in the diagnosis and management of the patients with inflammatory bowel disease (IBD) because of the limitations of both endoscopy and radiography. Barium radiography is important in the diagnosis of IBD and of strictures of bowel but can to fail in the diagnosis of disease activity or in the detection of such complications as abscesses1. Endoscopy has a very high sensitivity in the diagnosis of large bowel inflammation but sometimes it can miss the localizations in both the small bowel and the right colon because of an incomplete examination in active disease2, 3. The sensitivity of scintigraphy in the diagnosis of the disease and in the assessment of the disease activity in IBD is higher than radiography and like endoscopy plus biopsy, and it is an indispensable means in the diagnosis of abdominal sepsis4, 5, 6, 7. Moreover, is a simple, rapid and noninvasive procedure because it does not require enema or intubation for the evaluation of the patients3.

99mTc-Hmpao Radiolabelled Leucocytes in Inflammatory Bowel Disease: Spect Vs Planar Scintigraphy

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