Safety profile and protocol prevention of adverse reactions to uroangiographic contrast media in diagnostic imaging.

The purpose of the study is to examine the incidence of adverse reactions caused by non-ionic contrast media in selected patients after desensitization treatment and to evaluate the safety profile of organ iodine contrast media (i.c.m.) in a multistep prevention protocol. In a population of 2000 patients that had received a CT scan, 100 patients with moderate/high risk for adverse reactions against iodinated contrast agents followed a premedication protocol and all adverse reactions are reported and classified as mild, moderate or severe. 1.7 percent of the pre-treated patients reported a mild, immediate type reaction to iodine contrast; of these five patients with allergy 0.71 percent had received iomeprol, 0.35 percent received ioversol and 0.71 percent received iopromide. The incidence of adverse reactions was reported to be higher (4 out of 5 patients) among those that referred a history of hypersensitivity against iodinated i.c.m. Although intravenous contrast materials have greatly improved, especially in terms of their safety profile, they should not be administered if there isn't a clear or justified indication. In conclusion, even if we know that the majority of these reactions are idiosyncratic and unpredictable we propose, with the aim of improving our knowledge on this subject, a multicenter study, based on skin allergy tests (prick test, patch test, intradermal reaction) in selected patients that have had previous experiences of hypersensitivity against parenteral organ iodine contrast media.

Three-dimensional anal endosonography in depicting anal-canal anatomy.

PURPOSE: This report describes the advantages of 3D anal endosonography in depicting the normal anatomy of the anal canal in relation to sex and age. MATERIALS AND METHODS: A retrospective study was performed of 85 patients, 33 men and 52 women, previously examined with 3D anal ultrasound (US) for clinically suspected anorectal disease but found to be negative. The examinations were performed with a Bruel and Kjaer US system with a 2050 transducer, scanning from the anorectal junction to the subcutaneous portion of the external anal sphincter (EAS). The 3D reconstructions provided an estimation of sphincter length in the anterior and posterior planes, and axial 2D images enabled calculation of the thickness of the internal anal sphincter (IAS) and EAS in the anterior, posterior and lateral transverse planes. RESULTS: Distribution of the sphincter complex is asymmetric in both sexes: the EAS and IAS are significantly shorter in females, especially in the anterior longitudinal plane (p=0.005 and p<0.001, respectively). EAS and IAS thickness increases with age, especially the lateral IAS (R(2)=0.37, p<0.001) and the posterior EAS (R(2)=0.29, p=0.01). CONCLUSIONS: A good knowledge of anal-canal anatomy is essential to detect sphincter abnormalities when assessing pelvic floor dysfunction.

The role of nasoenteric intubation in the MR study of patients with Crohn's disease: our experience and literature review.

PURPOSE: The aim of this study was to compare magnetic resonance (MR) enteroclysis with MR enterography to verify whether nasoenteric intubation in patients affected by Crohn's disease can provide supplementary information to that afforded by MR study of the small bowel. MATERIALS AND METHODS: In a 12-month period, 40 patients (28 women and 12 men, mean age 35 years) affected by Crohn's disease underwent MR imaging. Distension of the small-bowel loops was obtained by administering polyethylene glycol: 15 patients were given the mixture by mouth (MR enterography), whereas the remaining 25 received it via nasoenteric intubation (MR enteroclysis). Our study protocol included morphological sequences taken before and after intravenous injection of contrast medium and real-time functional sequences. Accuracy criteria for the execution of the examinations were designed according to 11 bands. RESULTS: Complete distension of the small-bowel loops was obtained in the 25 patients who underwent MR enteroclysis, with the additional advantage of a suitable assessment of those segments involved in the pathological process. This was not the case for the 15 patients who underwent MR enterography, because both the jejunum and the small-bowel loops appeared partially collapsed. CONCLUSIONS: MR enteroclysis is the most effective technique for studying the small bowel in Crohn's disease, as it not only provides a suitable morphological assessment but also supplies functional information.