Ultrasound guided hydrostatic enema reduction of ileocolic intussusception: a safe and effective technique.

BACKGROUND: Currently, the primary management of ileocolic intussusception in children is usually by non-operative image-guided enema reduction. In most centres around the world especially in Australasia the predominant technique is the pneumatic reduction under fluoroscopic guidance. At our institution, we have been performing ultrasound-guided hydrostatic reduction since 2012.This is an audit to determine the efficacy and safety of ultrasound-guided hydrostatic reduction for intussusception. METHODS: Following ethics approval, a retrospective review of all patients presenting to our institution with intussusception and subsequently undergoing hydrostatic reduction over a period of 9 years (2012 to-2020) was performed. The parameters studied included (i) successful reduction, (ii) recurrence, (iii) need for surgery and (iv) lead point at surgery. RESULTS: The mean age at presentation was 12 months. One hundred and eight children were diagnosed to have ileocolic intussusception. One hundred and six underwent ultrasound-guided hydrostatic reduction with successful reduction in 96 (90.5%) patients. Reduction was unsuccessful in 10 patients (9.5%). Of these eight were noted to have a pathological lead point (four-Meckel's diverticulum and four-Lymphoma) at the time of the surgery. The intussusception recurred in six patients (6.25%) within 24 h. No reduction related perforation occurred during the study period. CONCLUSION: Ultrasound-guided hydrostatic reduction is a safe and effective technique for managing intussusception as it allows continuous monitoring of the reduction of the intussusception without exposing the children to ionizing radiation.

Ultrasound imaging as the first line of investigation to diagnose intestinal malrotation in children: Safety and efficacy.

BACKGROUND: Upper gastrointestinal contrast study is considered the gold standard investigation to diagnose intestinal malrotation and midgut volvulus which is potentially devastating condition. Ultrasound imaging is an alternative but has been considered unreliable due to significant false negative results. At our institution we have been using ultrasound imaging as the first line investigation to diagnose malrotation since 2008 with a preliminary study of 139 patients published in 2014. This is an ongoing audit of a further much larger cohort of patients to determine the efficacy and safety of ultrasound imaging in the diagnosis of intestinal malrotation. MATERIALS AND METHODS: Following ethics approval, a retrospective analysis of a prospectively collected patient database undergoing ultrasound scans to exclude malrotation at our centre was performed from 2012 to 2019. RESULTS: 539 patients underwent ultrasound to assess for malrotation. The mean age of presentation was 365 days (median 30 days, mode 1 day). Malrotation was diagnosed in 17 with 5 having volvulus, with findings confirmed at surgery. 12 had equivocal findings and subsequent contrast studies ruled out malrotation. The remaining 510 patients with no evidence of malrotation were managed conservatively. CONCLUSION: We have shown ultrasound to be a safe and effective tool to assess intestinal malrotation without exposure to ionizing radiation. LEVEL OF EVIDENCE: Level IV.

Incidental Malignancies Identified During Staging for Prostate Cancer With 68Ga Prostate-specific Membrane Antigen HBED-CC Positron Emission Tomography Imaging.

The rapid uptake of 68Ga prostate-specific membrane antigen HBED-CC positron emission tomography (PSMA PET) imaging for prostate cancer staging has led to concerns regarding its specificity, with uptake in both malignant and nonmalignant tissues. We describe 3 separate malignancies identified on PSMA PET imaging. The misnomer "prostate-specific membrane antigen" is demonstrated by this case and highlights the importance of continued investigation of the potential role of PSMA PET in other malignancies.

The recovery of illicit drugs from oral fluid sampling devices.

Testing for drugs in oral fluid is a convenient procedure for determining recent drug use. A number of issues are still to be resolved and this paper investigates the effects of storage systems on drug stability and recovery using three different collection devices supplied by Cozart, Immunalysis and Microgenics (third party). Drugs were analysed using a range of immunoassay systems followed by MS confirmation and quantitation. The reproducibility of the weight of specimen collected was excellent (CV<10%) for the three collection devices tested. Of the three systems studied, only the Cozart product gave acceptable recovery of THC from drug-spiked oral fluid. A combination of Cozart, Immunalysis and Diagnostix immunoassays with the Cozart collection system gave the most sensitive and discriminating screening assays for the drugs studied, namely THC, benzodiazepines, methamphetamine and morphine. Storage at either 5 degrees C or room temperature had no significant effect on drug recoveries.