Malignant hyperthermia and neuroleptic malignant syndrome in a patient during treatment for acute asthma

PURPOSE: The safety and diagnostic efficacy of iodixanol (Visipaque) 270 mg I/ml was compared to that of iopamidol (Iopamiron) 300 mg I/ml in knee arthrography. MATERIAL AND METHODS: This trial was a bi-center double-blind trial including 128 patients (iodixanol/iopamidol 64/64 patients). Efficacy was evaluated by blinded grading of the diagnostic quality of the p.a. images taken 0, 12 and 25 min after contrast administration by the examining radiologist and later at a consensus evaluation by two experienced skeletal radiologists. Adverse events were recorded. RESULTS: No patient experienced any adverse event. The proportion of better images at both 12 and 25 min after injection was higher in the iodixanol group compared to the iopamidol group both by the examining radiologist and at the consensus evaluation. CONCLUSION: In the knee joint iodixanol is a safe contrast medium. The contrast effect of iodixanol lasted longer than that of iopamidol, which can be important when performing arthrography, especially CT arthrography, where the time between puncture and examination can be prolonged.     

Rate of neuronal fallout in a transsynaptic cerebellar model

PURPOSE: A retrospective study was undertaken of the late adverse reactions following the injection of contrast media. The purpose was to determine whether there was a difference between non-ionic monomeric (iohexol) and non-ionic dimeric (iodixanol) contrast media in the reactions produced. MATERIAL AND METHODS: A total of 3,408 patients were sent a written questionnaire in which they were asked to confirm or deny any subjective discomfort or adverse event during a period of one hour to one week after a previous radiological examination with contrast medium. Patients who had undergone angiography (i.v. or i.a. injection) and CT (i.v. injection) were included. Objective signs of an allergy-like reaction were listed and the patients were asked to subjectively quantify any consequent discomfort. RESULTS: The compliance rate was 84%. Of the 3075 injections finally included in the study, 133 (4.3%) had resulted in contrast-medium-related adverse reactions of which 72 (2.3%) were immediate and 61 (2%) were late. Iohexol induced late reactions in 14/851 (1.7%) cases, and iodixanol in 24/1218 (2.0%) cases following i.v. injection and in 23/1006 (2.3%) cases following i.a. injection. The differences were not significant. There were no differences between the two contrast media in the subjective rating of discomfort except that the patients who had received iodixanol also had the highest individual-intensity score. No patient had been hospitalized owing to an adverse reaction and all reactions had been regarded as mild or moderate. CONCLUSION: The number of late adverse reactions was low. There was no difference in the frequency of the late adverse reactions following i.v. injection between iodixanol and iohexol. There was also no difference in the reactions between the i.a. and i.v. injections of iodixanol.     

Anesthesia for a child with complex I respiratory chain enzyme deficiency

Computed tomography (CT) excretory urography was performed in five adult female dogs after intravenous injection of a bolus of four different doses of water-soluble iodinated contrast medium (100, 200, 400, and 800 mgI/kg). CT images centered over the urinary bladder were performed before injection and 1, 3, 5, 7, 9, 11, 15, 20, 25, 30, 40, 50, and 60 minutes after injection. Opacification of both ureters was evaluated by measuring maximum CT number of individual ureters at each time. Time opacification curves were generated for each dose. Best opacification of the ureters was obtained with 400 and 800 mgI/kg, with a constant peak at 3 minutes and durable opacification for 1 hour. Insufficient opacification was obtained with lower dose of 100 and 200 mgI/kg.     

Motile properties of vimentin intermediate filament networks in living cells

PURPOSE: To evaluate the clinical utility and morphologic accuracy of gadolinium-enhanced excretory magnetic resonance (MR) urography after low-dose diuretic injection and to correlate the results with those of conventional urography. MATERIALS AND METHODS: In 71 patients with urologic symptoms, excretory MR urography was performed after intravenous injection of 5-10 mg furosemide and, 30-60 seconds later, 0.1 mmol of gadopentetate dimeglumine per kilogram of body weight. The MR urograms were interpreted by three radiologists, who were blinded to the clinical outcome, and subsequently compared with conventional urograms. RESULTS: Injection of furosemide before contrast material led to rapid, uniform gadolinium distribution inside a sufficiently distended collecting system such that there was no excessive concentration of gadolinium in the urine. In patients with normal or moderately reduced excretory function, this effect allowed complete visualization of the urinary tract within 5-20 minutes of contrast material injection while minimizing gadolinium-related endoluminal T2* effects. The clinical course helped verify almost all MR urographic results. The MR urographic technique was significantly superior to conventional urography in the assessment of the ureters and bladder (P < .0001). Delineation of small caliceal abnormalities is still problematic. The best depiction of the pelvicaliceal system was obtained with fat-suppressed MR imaging, although it was still slightly inferior to conventional urography (P < .05). CONCLUSION: Gadolinium-enhanced excretory MR urography performed after low-dose diuretic injection is a promising and accurate alternative to conventional excretory urography for imaging the morphology of the urinary tract.     

Molecular cloning and functional expression of a recombinant 72.5 kDa fragment of the 110 kDa regulatory subunit of smooth muscle protein phosphatase 1M

RATIONALE AND OBJECTIVES: We compared adverse reactions and image quality for hysterosalpingography (HSG) performed with ionic (diatrizoate meglumine combined with iodipamide meglumine [DM + IM]) and nonionic (iohexol) contrast media. METHODS: We performed a study of 95 patients who had HSG and were randomly selected to receive DM + IM or iohexol. Patients reported episodes of abdominal pain and other adverse reactions immediately and 24 hr after the procedure and categorized severity of symptoms on a subjective scale. Two radiologists evaluated image quality for diagnosis. RESULTS: Prevalence of abdominal pain and other reactions both immediately and 24 hr after HSG was lower in patients who received iohexol than in patients who received DM + IM. Moderate or severe abdominal pain was significantly lower in the iohexol group than in the DM + IM group (p < .05). Visualization of the uterine cavity and ampullary rugae was judged excellent with both contrast media (87% with iohexol and 92% with DM + IM). CONCLUSION: Iohexol and DM + IM are excellent contrast media for use during HSG; iohexol 300 may cause fewer episodes of more severe and prolonged abdominal pain.     

Allotype-associated differences in concentrations of human IgA2

A prospective clinical trial comparing adverse postmyelographic effects and myelographic quality of metrizamide and iohexol was conducted. Using a predetermined, randomized assignment, 24 horses exhibiting neurologic signs were administered either metrizamide (180 mgl/ml) or iohexol (180 mgl/ml) via cerebellomedullary puncture. Each horse was evaluated postmyelographically for adverse effects. Myelographic quality was assessed by a numerical scoring method. Adverse effects were observed more frequently with metrizamide (21) compared with iohexol (6) myelography (p < 0.05). Seizures, intensification of preexisting neurologic signs and prolonged anesthetic recovery were the most common complications after myelography. There was no difference in myelographic quality (p > 0.05). We conclude that iohexol is safer than metrizamide for equine myelography and that quality myelograms can be obtained with either contrast medium.     

Must the patient fast before intravascular injection of a non-ionic contrast medium? Results of a controlled study

PURPOSE: Prospective evaluation of food and fluid restriction before the intravascular injection of a non-ionic contrast medium. MATERIAL AND METHODS: 1000 patients (657 men, 343 women; average age 59 +/- 1/4 5 years) undergoing intravascular contrast injections (CT, phlebography, angiography, urography) were randomly allocated to two groups. Group A had no fluid or solids for at least four hours before the injection (499 cases); group B were allowed unlimited food and fluid (501 cases). Both groups were comparable in all other respects and all were given the non-ionic contrast medium iopamidol (300 mg l/ml). RESULTS: The incidence of acute complications was 3.5%. There was, however, no statistically significant difference between the two groups (p = 0.29). Late adverse reactions were seen in 3.9% patients. There was again no difference between the two groups (p = 0.33). No serious or life threatening complications occurred. CONCLUSION: Restriction of food and fluid before intravascular injection of contrast medium does not reduce the number of adverse side effects. For reasons of patient comfort and compliance, and to achieve adequate hydration, the patient should not fast before injection of contrast.     

Aneurysm of sinus of Valsalva dissecting into interventricular septum

PURPOSE: We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute flank pain and suspected ureteral obstruction. MATERIALS AND METHODS: During a 25-month interval 417 patients with acute flank pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome. RESULTS: Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone extraction in 7, additional imaging (excretory urography) was performed in only 1. Additional imaging studies generated by CT were done in 3 cases in which the dictated reports were indeterminate for ureteral stones, including negative excretory urography in 2 and retrograde urography in 1. In 1 patient in whom CT misdiagnosed a ureteral stone unnecessary retrograde urography revealed the calcification to be a gonadal vein phlebolith. Seven patients with false-negative examinations reported spontaneous stone passage with no complications. CONCLUSIONS: Unenhanced helical CT accurately determines the presence or absence of ureterolithiasis in patients with acute flank pain. CT precisely identifies stone size and location. When ureterolithiasis is absent, other causes of acute flank pain can be identified. In most cases additional imaging is not required.     

Clearance of iohexol, chromium-51-ethylenediaminetetraacetic acid, and creatinine for determining the glomerular filtration rate in pigs with normal renal function: comparison of different clearance techniques

RATIONALE AND OBJECTIVES: We wanted to improve determination of the glomerular filtration rate (GFR) with plasma clearance techniques because the alternative-renal clearance techniques-may involve inaccurate urine sampling or risk of urinary tract infection when bladder catheterization becomes necessary. Therefore, we compared the renal and plasma clearances of iohexol and chromium-51-ethylenediaminetetraacetic acid (51Cr-EDTA), as well as endogenous creatinine clearance, in 19 normal pigs using different techniques. METHODS: After an intravenous bolus injection of the GFR markers, 16 plasma samples were used to plot the marker concentrations versus time for 4.5 hr. Urine was collected during nine 30-min periods. Plasma clearance was calculated by dividing the dose of marker with the area under the plasma concentration curve (AUC) from the time of injection to infinity using one-compartment (ClAUC-slope) and three-compartment (ClAUC-3comp) models. The renal clearance was calculated by dividing the amount of marker excreted in the urine in a period with the AUC in the same period. This AUC was determined by integrating the total area in the period (Clren adv)--our reference method representing the "true" GFR--or by using the arithmetic mean of the plasma concentrations of the marker at the beginning and end of the urine collection period (Clren simple). Creatinine clearance was determined according to Clren simple. RESULTS: Renal clearances of iohexol and 51Cr-EDTA were significantly higher than creatinine clearance (P = .0002). There was no significant difference between the renal clearances of iohexol and 51Cr-EDTA or between their plasma clearances. The two mathematical methods of calculating the renal clearance of iohexol were highly correlated (rs = .99), as were the two methods of calculating its plasma clearance (rs = .95). Because of the extrarenal clearance of the markers, the plasma clearance methods for iohexol and 51Cr-EDTA always overestimated the true GFR. ClAUC-3comp was the method closest to the true GFR. For iohexol, the median overestimation of the GFR was higher with ClAUC-slope when early plasma samples (30-120 min) after injection of the marker were used (5.5 ml.min-1.10 kg-1) than when late samples (180-270 min) were used (4.0 ml.min-1.10 kg-1). After subtracting the median extrarenal clearances of iohexol and 51Cr-EDTA (previously determined in nephrectomized pigs) from their plasma clearances (ClAUC-3comp), the median overestimation of the true GFR was reduced from 2.0 to 1.1 ml.min-1.10 kg-1 with iohexol and from 2.1 to 1.3 ml.min-1.10 kg-1 with 51Cr-EDTA. CONCLUSION: GFR determination with plasma clearance techniques can be improved in three- and one-compartment models by taking late plasma samples and by subtracting the extrarenal plasma clearance of the species. One-compartment models can be improved by determining a correction formula in the species for the early parts of the decay curve of the plasma concentration of the marker.     

Aqueous two-phase partitioning sample preparation prior to liquid chromatography of hydrophilic drugs in blood

The technique of aqueous two-phase partitioning is investigated as a sample preparation procedure prior to LC determination of drugs in blood. In the extraction 500 microl of whole blood is added to 2.00 g of PEG 300 and 18.0 g of phosphate buffer. The phases are mixed by stirring and allowed to separate before the clear lower salt phase is drained out using a specially designed glass adapter. After filtration 20 microl is injected into the LC system. When validated for the X-ray contrast medium iohexol R.S.D. was 2.0% and 1.2% at 10 microg/ml and 100 microg/ml of iohexol in blood, respectively.     

LPS and PMA induced PKC-alpha and PKC-epsilon activation and translocation in murine peritoneal macrophages

PURPOSE: Aim of this study has been to evaluate natural killer (NK) activity in patients with colorectal tumors before and after curative surgery. METHODS: Forty colorectal cancer patients without distant metastases were stratified according to American Joint Committee on Cancer/International Union Against Cancer staging system into three categories: Stage I (n = 12), Stage II (n = 15), and Stage III (n = 13). All of them underwent curative resection, and there were no major postoperative complications. Venous blood samples were obtained preoperatively, at surgical wound closure, and on the 1st, 7th, and 21st postoperative days. Mononuclear cells were isolated over Ficoll-Hypaque (Lymphoprep, Nycomed Pharma AS, Oslo, Norway) gradients, and NK activity was assayed by evaluation of cytotoxic response against K562 cells. Normal NK activity was achieved from 15 healthy donors. Percentage relative increments in relation to preoperative levels were calculated for every postoperative sample, and t-test was used for statistical evaluation. RESULTS: Before surgery, Stages II and III patients had lower levels of NK activity than healthy people (P < 0.05 and P < 0.001, respectively). NK activity always fell after surgery (Stage I: -18.48 +/- 11.42; Stage II: -16.93 +/- 13.57; Stage III: -35.29 +/- 12.03, at day 1 postsurgery) and appeared to rise slightly by the 21st postoperative day in Stage I patients (+4.87 +/- 12.41). Stage II, and especially Stage III, patients did show a significant recovery by the 21st postoperative day (+23.63 +/- 9.36 and +43.19 +/- 13.34, respectively). At this time, NK activity in these two groups was not significantly lower than in normal subjects (P > 0.05). CONCLUSION: NK activity is depressed in colorectal cancer patients in relation to progression of illness, even at locoregional stages. Curative resection of tumors at Stages II and III has promoted a recovery of NK activity in patients with uneventful postoperative courses.     

Laparoscopic nephropexy: 3-year experience

PURPOSE: Operative treatment of nephroptosis is rarely performed and is indicated only in select patients. Postoperatively approach related symptoms and morbidity often limit therapeutic success. We evaluated the technique and outcome of laparoscopic nephropexy in patients with symptomatic nephroptosis. For comparison the records of patients who underwent open nephropexy were reviewed. MATERIALS AND METHODS: Since 1993, 22 women and 1 man 16 to 56 years old (mean age 29) underwent laparoscopic nephropexy at our hospital. Preoperatively excretory urography and radioisotope renography were performed with the patient supine and erect, and careful pain evaluation was also done. For laparoscopic nephropexy the transperitoneal approach was used in all patients. The kidney was completely mobilized by dissection of the perirenal fat. The upper pole and convexity of the kidney were fixed to the muscle using single nonabsorbable sutures and an extracorporeal technique for tying. Between 1984 and 1994, 12 patients underwent open nephropexy at our hospital. The results of this group were reviewed and compared with those treated by laparoscopy. RESULTS: Mean operative time in the laparoscopy and control groups was 61 (range 40 to 85) and 49 minutes (range 28 to 70), respectively. In patients who underwent laparoscopic nephropexy mean analgesic use was 15 mg. morphine equivalent intravenously and 550 mg. ibuprofen orally. Postoperatively 3 minor complications (13%) were noted. Hospital stay was 3.7 days (range 2 to 9) and patients returned to work after 19 days (range 4 to 30). Six weeks after nephropexy excretory urography showed a correctly positioned kidney. At a mean 13-month followup pain intensity had improved in 21 patients (91%). According to these parameters laparoscopic nephropexy was superior to the open approach except for operative time. CONCLUSIONS: Laparoscopic nephropexy is safe and effective in the select group of patients in whom nephropexy is indicated.     

New set of serum reaction tests for syphilis and its clinical significance (author''s transl)

The water soluble radiopaque medium, metrizamide (Amipaque) was introduced into the lumbar subarachnoid space in chloralose anesthetized cats at a standard volume of 0.35 cc/kg in concentrations of 300 mgI/cc to 500 mgI/cc during EMG recording. These animals did not differ from controls which received cerebrospinal fluid under otherwise identical conditions; both groups usually showed some mild and occasional muscle fasciculations or mild spasms. Treatment with metrizamide appeared to be a less deleterious procedure than that using hyperosmotic sucrose (1.32 M) as judged from EMG records. In contrast, equivalent amounts of neglumine iothalamate produced frank convulsions in 7 of 15 cases and a range of hyperirritability in the remaining 8.     

Liver perfusion studied with ultrafast CT

OBJECTIVE: Our goal was to quantify absolute hepatic arterial and portal venous perfusion noninvasively in patients with and without liver disease using ultrafast CT. MATERIALS AND METHODS: A single slice through the porta hepatis was repeatedly scanned after bolus injection of 25 ml of iohexol 300 mg I/ml, followed by a 25 ml saline "chaser" intravenously at 10 ml/s. Thirty-nine controls, 7 cirrhotic patients, and 5 patients with known metastases on the slice plane were studied; hepatic arterial perfusion was determined in 41 patients and portal venous perfusion in 24. Time-attenuation curves from regions of interest drawn over the liver, spleen, aorta, and portal vein were analysed. Hepatic arterial perfusion was calculated by dividing the peak gradient of the liver time-attenuation curve prior to the time of peak splenic attenuation by the peak aortic CT number increase. Splenic perfusion was calculated by dividing the peak gradient of the splenic time-attenuation curve by the peak aortic CT number increase. Portal perfusion was derived by scaling the splenic time-attenuation curve by the ratio of hepatic arterial/splenic perfusion. This scaled curve was subtracted from the liver time-attenuation curve to give a portal curve. The peak up-slope of this curve was divided by the peak rise in splenic or portal vein density. RESULTS: Hepatic arterial perfusion averaged 0.19 ml/min/ml (n = 31) in controls and was raised in cirrhosis to 0.25 ml/min/ml (n = 6) and metastases 0.43 ml/min/ml (n = 4). Portal venous perfusion was 0.93 ml/min/ml (n = 19) in controls and 0.43 ml/min/ml (n = 4) in cirrhosis. Reproducibility has been confirmed. CONCLUSION: Dynamic ultrafast CT shows potential in quantifying arterial and portal hepatic perfusion. The technique may be adaptable to dynamic bolus MRI.     

Recognition of synthetic oligopeptides from nonstructural proteins NS1 and NS3 of dengue-4 virus by sera from dengue virus-infected children

OBJECTIVE: To investigate the correlation between soluble forms of the intercellular adhesion molecule (sICAM-1) and vascular cell adhesion molecule (sVCAM-1) and the severity of pre-eclampsia or its possible consequences for fetal growth. DESIGN: Prospective observational study. SETTING: Institute of Medical Genetics, University of Oslo, Department of Medical Genetics and Haematological Research Laboratory, Ullev?l University Hospital; and the Department of Obstetrics and Gynaecology, The National Hospital, Oslo, Norway. PARTICIPANTS: Seventy-six women with normotensive pregnancies and 157 women with pre-eclampsia divided into three subgroups: mild, severe and pre-eclampsia with fetal growth retardation. METHODS: ELISA-measurements of plasma sICAM-1 and sVCAM-1 were performed in a group of healthy pregnant normotensive women and three groups of women with varying degrees of pre-eclampsia. RESULTS: sICAM-1 concentrations were higher in the pre-eclampsia group compared with the control group, but this difference was not statistically significant. Plasma concentrations of sVCAM-1 were significantly greater (P < 0.0001) in all pre-eclampsia subgroups (835.34, 855.25 and 964.05 ng/mL) compared with the control group (667.62 ng/mL). Within the pre-eclampsia group, plasma concentration of sVCAM-1 was significantly higher in the subgroup exhibiting fetal growth retardation (P = 0.03) compared with mild pre-eclampsia. CONCLUSION: The observed increases in plasma concentrations of sVCAM-1 suggest that measurements of this adhesion molecule may be useful in monitoring pregnancies with respect to the development of pre-eclampsia or fetal growth retardation.     

Effects of iodinated contrast media on pulmonary airway resistance in anesthetized guinea pigs

RATIONALE AND OBJECTIVES: Bronchospasm is occasionally observed following iodinated X-ray contrast medium administration. We performed an in vivo study in guinea pigs to investigate the effects of a number of iodinated contrast media on pulmonary airway resistance and the mechanisms underlying the potential bronchoconstrictor effect. METHODS: The contrast media studied were the pharmaceutical formulations of iomeprol (400 mg I/ml), iopamidol (370 mg I/ml), and iohexol (350 mg I/ml), which are nonionic, triiodinated contrast media; diatrizoate (370 mg I/ml), an ionic, triiodinated contrast medium; iotrolan (300 mg I/ml), a nonionic, hexaiodinated contrast medium; and iocarmate (280 mg I/ml) and ioxaglate (320 mg I/ml), which are both hexaiodinated and ionic contrast media. Each contrast medium was administered intravenously at 2 g I/kg. Changes in pulmonary airway resistance were evaluated by measuring intratracheal pressure at the moment of maximum insufflation, or maximal insufflation pressure (MIP), in anesthetized guinea pigs submitted to forced ventilation. RESULTS: All contrast media except ioxaglate caused mean increases of MIP of no more than 20%. By contrast, ioxaglate caused a marked bronchoconstrictor effect, increasing MIP by 242% +/- 46%. Of the drugs tested for antagonistic action on this increase in MIP, salbutamol inhibited almost completely the increase in MIP for the first 40 min posttreatment. Similarly, lysine acetylsalicylate and indomethacin consistently reduced MIP after contrast media administration to levels only 30% and 14% above those of baseline precontrast media, respectively. Promethazine had only a minor inhibitory effect, and the response to prednisolone varied. CONCLUSION: There was no apparent relationship between the size of the increase in airway resistance and the charge or molecular weight of the contrast agent molecule or the pharmaceutical formulation. The increase induced by ioxaglate must be attributed to inherent molecular toxicity mediated through a direct action on the production of bradykinin and/or the prostanoid products of the cyclooxygenase pathway, rather than through a direct action on the release of histamine.     

Adverse events and cost savings three years after implementation of guidelines for outpatient contrast-agent use

The ability of guidelines limiting the use of low-osmolality contrast media (LOCM) to save money without jeopardizing patient care was studies. In February 1993 an academic medical center implemented guidelines to reduce the use of LOCM for outpatient computed tomography and excretory urography; the guidelines limited LOCM to patients at high risk of adverse reactions to contrast agents. Data on contrast media received and frequency of adverse events were compiled from billing sheets and incident reports for March 1993 through February 1996. The number of patients receiving LOCM over the three years was 1325, and the number receiving high-osmolality contrast media (HOCM) was 4435. Of the HOCM recipients, 165 (3.7%) had adverse reactions; 0.4% of these reactions were major, 3.1% were minor, and 0.2% were extravasations. Among LOCM-treated patients, 35 (2.7%) had adverse reactions; 0.5% were major, 1.7% were minor, and 0.5% were extravasations. The only significant difference in adverse effects between the groups was in the frequency of minor reactions. The costs of HOCM and LOCM over the three years were $54,660 and $152,523, respectively. Had 90% of the 5760 patients received LOCM, the total cost of contrast agents would have been $603,723; thus, the estimated drug cost saving was $396,540, or $132,180 annually. With costs of treating adverse events factored in, the net annual cost saving was $132,093. Guidelines limiting the use of LOCM to high-risk patients saved an academic medical center an estimated $132,093 annually in drug costs for specific outpatient imaging procedures, without adversely affecting patient care.     

Incontinence due to an infrasphincteric ectopic ureter: why the delay in diagnosis and what the radiologist can do about it

PURPOSE: To determine (1) the reasons for the frequently long delay in the diagnosis of an infrasphincteric ectopic ureter in girls, and (2) what role the radiologist can play in decreasing the delay. MATERIALS AND METHODS: Twelve girls were referred to our hospital from June 1994 until April 1997 for evaluation of constant urinary dribbling and/or vaginal discharge. Available imaging studies, radiology reports, and clinic notes were reviewed. RESULTS: Mean age at the time of diagnosis was 6 years 7 months (range 2 years 10 months to 11 years 11 months). Mean delay until diagnosis after presentation was 2 years 5 months. Excluding the one girl whose ectopic ureter was diagnosed while she was still in diapers, mean age at the time of the first parental "complaint" was 4 years 9 months. The significance of the classic history of constant urinary dribbling was not recognized by physicians in 7 girls for 4 months to 7 years 10 months after presentation. Physical exam was not meticulously performed, as the ectopic orifice was visible in 8 of 12 girls. Imaging studies were ineffectively utilized: no imaging was done (for 2 years in 2 girls), inappropriate studies were done (ultrasound and voiding cystourethrography) and were misleading, studies were called normal when they were not (ultrasound and excretory urography), or perinatal imaging led to the incorrect assumption of a congenitally absent kidney in one girl and a multicystic dysplastic kidney in another. Excretory urography (EU) was diagnostic in all 10 girls with a duplex kidney, and computed tomography (CT) was supportive in 2 with a dysplastic kidney. CT was an adjunct in 3 girls; a Tc-99m-dimercaptosuccinic acid (DMSA) scan was needed in 2. CONCLUSION: The classic history of constant urinary dribbling in a successfully toilet-trained girl should immediately lead to an imaging search for the portion of kidney (or entire kidney) drained by an infrasphincteric ectopic ureter. EU should usually be the first imaging performed and is often the only imaging study needed.     

Quantitative assessment of platelet function and clot structure in patients with severe coronary artery disease

RATIONALE AND OBJECTIVES: Although systemic absorption of enterically administered iohexol and its excretion in urine has been previously documented in rats with ischemic bowel, a practical and sensitive method of detecting urinary iohexol has not been available. We proposed to detect the presence of iohexol in the urine of rats with normal and ischemic bowel by use of a computed tomography (CT) number increase in the bladder with the use of CT. METHODS: Anesthetized rats (250 g) underwent either sham laparotomy (n = 6), ligation of two vascular arcades to the proximal jejunum (n = 5), ligation of six vascular arcades to the proximal jejunum (n = 6), or ligation of the superior mesenteric artery (n = 6). Rats were hydrated with saline (3.2 ml/hr intravenously). Each received a 3-ml enteric bolus of isotonic iohexol. Serial CT scans and plain film radiographs of the bladder were performed at 2, 4, and 6 hr to detect systemic absorption of contrast from the gut. Urine iohexol concentrations were measured by capillary electrophoresis. CT number and iohexol concentration were compared with evidence from plain film radiographs of bladder opacification. Intestinal ischemia was graded histologically. RESULTS: Histologic evidence of ischemia was present in all six-arcade and five of six superior mesenteric artery (SMA)-ligated animals. No animals in the control or two-arcade group showed evidence of bowel ischemia. Statistically significant increases (P < 0.05) in bladder density were demonstrated in the six-arcade and SMA-ligated groups. No statistical difference was noted between the two-arcade ligation and control groups. CONCLUSIONS: Experimental intestinal ischemia was reliably detected by bladder opacification after administration of enteric contrast. CT detection of systemic absorption of enteric iohexol was more sensitive than plain film radiographs and may be useful in the diagnosis of intestinal ischemia, although it may not be specific for ischemia.