ABSTRACT
In order to assess systemic absorption, serum diatrizoate levels were measured in 25 patients requiring endoscopic retrograde cholangiopancreatography (ERCP). Urinary diatrizoate was measured in the urine of seven of these. In five additional patients, diatrizoate was instilled into the duodenum during endoscopy. Blood was drawn before and after completion of the procedure in all patients and at intervals from 2 to 24 hr in nine. Eighteen-hour urine collections were obtained from seven patients. Increases in serum diatrizoate concentration were 7.10 micrograms/ml +/- 3.01 (mean +/- SE) in the duodenal-instillation patients, 230.68 +/- 53.24 micrograms/ml in 9 patients in whom only the pancreatic duct was visualized, 7.83 +/- 1.05 micrograms/ml in three patients in whom only the bile duct was visualized, and 77.67 +/- 28.22 micrograms/ml in 13 patients in whom both ducts were visualized. The mean total urinary excretion of diatrizoate was 3.05 +/- 0.98 g of diatrizoate. Endoscopists performing ERCP should be aware of the likelihood of systemic absorption and the possibility of reactions to iodinated contrast materials in sensitive patients.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Diatrizoate Meglumine/metabolism , Diatrizoate/analogs & derivatives , Absorption , Adult , Aged , Cholangiography , Diatrizoate Meglumine/analysis , Female , Humans , Male , Middle Aged , Pancreatic Ducts/diagnostic imagingABSTRACT
Tuberculosis of the distal colon occurring in the absence of ileocecal or pulmonary involvement is often mistaken for neoplasm or Crohn's disease. In spite of various studies, including colonoscopy and brushings with biopsy, the diagnosis might still be in doubt at the time of operation. The combined approach of surgery and chemotherapy appears to be the treatment of choice, especially in those patients who have bleeding and/or obstruction in whom the diagnosis cannot be made by other modalities.
Subject(s)
Colonic Diseases/diagnosis , Colonic Neoplasms/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , Adult , Diagnosis, Differential , Endoscopy , Humans , MaleABSTRACT
The association of abnormalities of the common bile duct with chronic inflammatory disease of the pancreas is described in this report in which the important diagnostic role of endoscopic retrograde cholangiopancreatography (ERCP) is emphasized in this disease entity. ERCP was utilized as a single diagnostic modality in 27 patients (15 females) in whom both the biliary tree and pancreatic ducts were demonstrated. Abnormalities of the pancreatic duct were noted in all patients while the associated changes of the common bile duct were noted in 12 (44%--7 females). The role of ERCP in confirming the diagnosis and its importance in planning specific therapy is emphasized.
Subject(s)
Cholangiography , Common Bile Duct/pathology , Endoscopy , Pancreatitis/complications , Adult , Aged , Chronic Disease , Dilatation, Pathologic , Female , Humans , Male , Middle Aged , Pancreatic Ducts/pathologyABSTRACT
Fifty patients (29 females) undergoing ERCP were studied prospectively for the occurrence of bacteremia associated with this endoscopic procedure. Each patient had blood samples drawn for aerobic and anaerobic cultures before endoscopy, after entering the duodenum, 5 and 15 minutes after cannulation of the papilla of Vater. Subcultures were made at 24 and 48 hours for a total of 1,200 cultures. No positive cultures were obtained in 48 patients. One patient developed a Staphylococcus epidermidis bacteremia during the procedure. The cleansing technic for the instruments consisted of alcohol and water only. Prophylactic antiobiotics were not administered. In contrast to other gastrointestinal procedures, our results suggest that bacteremia is an uncommon occurrence in ERCP despite the longer duration of the procedure and instrumentation of a sterile duct system.
