Contrast medium extravasation injury: guidelines for prevention and management.

Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. The management of this complication is contentious; therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and issue guidelines. A comprehensive literature search was carried out. The resulting report was discussed at the 8th European Symposium on Urogenital Radiology in Genoa, Italy. Automated power injection may result in extravasation of large volumes and may or can lead to severe tissue damage. Infants, young children and unconscious and debilitated patients are particularly at risk of extravasation during contrast media injection. Fortunately, most extravasations result in minimal swelling or erythema, with no long-term sequelae; however, severe skin necrosis and ulceration may occur. Large volumes of high osmolar contrast media are known to induce significant tissue damage. Compartment syndrome may be seen associated with extravasation of large volumes. Conservative management is often adequate, but in serious cases the advice of a plastic surgeon is recommended. Based on the review simple guidelines for prophylaxis and management of contrast medium extravasation injuries are proposed.

Long-term effects of a very low calorie diet (Nutrilett) in obesity treatment. A prospective, randomized, comparison between VLCD and a hypocaloric diet+behavior modification and their combination.

OBJECTIVES: To compare weight loss on a balanced hypocaloric diet to that of a Very Low Calorie Diet (VLCD) after two months of treatment and to further compare 26 months of weight maintenance and safety with or without VLCD assistance in obese patients. DESIGN: Prospective, randomized, controlled intervention trial, initially with two and later with three parallel groups. SETTING: Swedish University out-patient obesity clinic. SUBJECTS: Eighty-one obese patients of both gender with a BMI > or = 30 kg/m2 from the waiting list participated in a structured weight reduction + weight maintenance programme. INTERVENTION: Twenty-seven patients (group A) were randomized to a balanced diet of 6720 kJ/d (1600 kcal/d) during the whole treatment period. The other patients (n = 54) were randomized to VLCD (Nutrilett) 1764 kJ/d (420 kcal/d) diet during the first two months. The VLCD treated patients were rerandomized after the initial treatment to the well balanced hypocaloric diet (6720 kJ/d) with (group C) or without (group B) 1 MJ of VLCD to be taken during the evening. MAIN OUTCOME MEASURES: During the first two-month period, the mean body weight loss in the VLCD group was 18.9 +/- 7.1 kg compared to 7.2 +/- 4.8 kg in the diet treated group, with a similar relative fat loss assessed by bioimpedance of 68% and 76% respectively. The maintained weight loss in all groups after 28 months of treatment was 10.9 +/- 10.2 kg in the 52% who completed the programme. Weight losses and drop-out rates were similar in all three groups. CONCLUSIONS: Twenty-four months weight maintenance and drop out rates are independent of whether the initial treatment commences with VLCD or a hypocaloric diet. One MJ nutrition powder taken freely does not affect 24 months weight maintenance on a hypocaloric (6.7 MJ/d) diet.

VLCD versus LCD in long-term treatment of obesity.

OBJECTIVE: To compare the long-term effects of three different programs including initial 6 weeks (V)LCD diets 420 kcal/d, 530 kcal/d, 880 kcal/d) on sustained weight loss, attrition and obesity associated conventional cardiovascular risk factors. DESIGN: Prospective, randomized clinical 52 weeks trial. Two weeks of a booster (V)LCD period after week 26. SETTING: University outpatient obesity clinic. SUBJECTS: Ninety-three middle-aged obese patients (30 men), initial mean BMI 38.7 kg/m2, age 20-65 y, from the waiting list. MAIN OUTCOME MEASURES: Weight loss pattern, attrition, reported side effects, blood pressure, blood glucose and serum lipid levels. Repeated frequent measurements up to week 26, intermittently up to final measurements at week 52. RESULTS: One year attrition (30-45%), sustained weight loss (8-15% of initial body weight) and changes in obesity associated risk parameters were similar in all three group. Fewer adverse events were reported in the LCD group. CONCLUSION: The results compare favorably with most previous reports of similar design. VLCD (420 kcal or 530 kcal/ d and LCD 880 kcal/d) were equally effective in long term treatment of obesity. The tendency to less side effects with LCD suggests that such preparations deserve further attention.

Effects of weight loss on single meal eating behaviour in obese subjects.

In 22 obese patients the eating pattern during a single meal as evaluated by the universal eating monitor VIKTOR was assessed after one year of treatment, initially with VLCD (Nutrilett) followed by combined long term diet, exercise and behavioural modification, underscoring the importance of appropriate meal habits. A mean weight loss from 117 to 101 kg was achieved. Before treatment a decelerated eating curve was found; after treatment this curve changed significantly towards a flatter and more linear shape.

Fish-oil concentrate: effects on variables related to cardiovascular disease.

Sixty-four male, healthy volunteers aged 35-45 y were randomly assigned to receive (as 1-g capsules) either 14 g fish-oil concentrate/d (55% n-3 fatty acids) or 14 g olive oil/d for 6 wk. Plasma fibrinogen was reduced by 13% and serum triglycerides by 22% after fish-oil supplementation ended. Three weeks after supplementation ended both variables were back to baseline values. An appreciable increase in the ratio of eicosapentaenoic acid to arachidonic acid (EPA:AA) in plasma eicosapentaenoic acid to arachidonic acid (EPA:AA) in plasma and red blood cell phospholipids occurred during the fish-oil intake. High-density-lipoprotein (HDL) cholesterol and HDL2 activity tended to be lowered by fish-oil supplementation. Systolic and diastolic blood pressures, serum cholesterol, gamma-glutamyltransferase, blood glucose, and monocyte low-density-lipoprotein receptor activity did not differ significantly between the two groups. The reduction in plasma fibrinogen concentration seems of special interest because this variable in several recent studies emerges as a separate cardiovascular risk factor with a high predictive value.