Detecting Intestinal Malrotation on Hepatobiliary Scintigraphy: Making a Case for a Better Standardized Reporting Template.

Intestinal malrotation displays classic pattern of the small bowel activity on hepatobiliary scintigraphy that could lead to the diagnosis, but only if an interpreting physician looks for it. Presented are 2 cases, one demonstrates diagnostic findings during the first 60-minute phase, whereas the other reveals the diagnosis only on the later sincalide stimulation phase. The currently recommended structured reporting for hepatobiliary scintigraphy does not include examination of bowel activity pattern, which could result in a missed diagnosis. Including interrogation of the small bowel pattern into the structured reporting checklist would ensure consistent detection of this rare but most consequential diagnosis.

Prospective, randomized trial of the safety and efficacy of a limited donor exposure transfusion program for premature neonates.

We investigated the safety and efficacy of using a single unit of packed red blood cells until its expiration date (35 days) to meet the transfusion needs of infants weighting < 1.5 kg. Unit concentration of potassium and infants' hematocrit value, K+ level, pH, and base excess were measured before and after transfusion. Compared with control infants, study infants had similar transfusion needs, but received blood from significantly fewer donors. The age of the blood received by study infants was significantly older and had a higher plasma K+ level. However, the change in infants' serum K+ levels before and after a transfusion was not significantly different in the two groups, and no adverse effects from transfusion of older blood were observed. We conclude that a protocol that allows use of an assigned unit of packed red blood cells preserved with citrate-phosphate-dextrose-adenine anticoagulant until its expiration date is safe, minimizes donor exposures, and meets the transfusion needs of low birth weight neonates.