Using contrast-enhanced MR cholangiography with IV mangafodipir trisodium (Teslascan) to evaluate bile duct leaks after cholecystectomy: a prospective study of 11 patients.

OBJECTIVE: The purpose of our study was to determine whether contrast-enhanced MR cholangiography using IV mangafodipir trisodium can accurately detect the presence and location of bile duct leaks in patients who have undergone cholecystectomy. SUBJECTS AND METHODS: Our study group included 11 patients with suspected bile duct leaks after cholecystectomy. Axial single-shot fast spin-echo and gradient-echo images were acquired in all patients before and 1-2 hr after IV administration of mangafodipir trisodium. The contrast-enhanced MR cholangiograms were evaluated for image quality, degree of ductal or small bowel opacification, and the presence and location of bile duct leaks, strictures, and stones. MR cholangiograms were correlated with conventional contrast-enhanced cholangiograms obtained in all patients, including endoscopic retrograde cholangiography (n = 10) and percutaneous transhepatic cholangiography (n = 1). RESULTS: Excretion of mangafodipir trisodium was noted in the intrahepatic and extrahepatic bile ducts in all patients from 1 to 2 hr after IV administration. Bile ducts and fluid collections that contained excreted mangafodipir trisodium showed increased signal intensity on gradient-echo sequences and decreased signal intensity on single-shot fast spin-echo sequences. Conventional contrast-enhanced cholangiography showed the presence of bile duct leaks in six patients and the absence of bile duct leaks in five patients, with false-negative findings in one patient and false-positive findings in one patient for bile duct leak (sensitivity, 86%; specificity, 83%). CONCLUSION: Contrast-enhanced MR cholangiography with IV mangafodipir trisodium can successfully detect the presence and location of bile duct leaks in patients suspected of having such leaks after undergoing cholecystectomy. More research is necessary before acceptance of this examination as routine in the workup of these patients.

The graveyard shift: experience with a night float system.

The aim of this study is to describe the effects of a new night float system on the circadian rhythm and clinical judgment of our residents. In addition, the study looks at the residents' opinions of how to optimize the night float system in the future. All 20 of the radiology residents at our institution completed a questionnaire about the night float system after completing their night float coverage. The results of the questionnaire were then compiled and tabulated. It took our residents an average of 2.0 days to become acclimated to the night float and an average of 2.3 days to return to a normal daily routine after completing the night float. No residents perceived impairment in their clinical judgment while on the night float. However, 9 of the 20 residents (45%) stated that their clinical judgment was improved on the night float compared to that of a 24-hour call. Eighteen of 20 residents (90%) preferred the night float system to a 24-hour call system. On average, our residents believe that the optimal number of hours for a night float shift is 10.5 hours and the optimal numbers of days to do the night float consecutively is 6.8 days. In conclusion, a night float system can be a preferable means of evening coverage as it has a minimal effect on the circadian rhythm by allowing residents to become acclimated to working the night shift over the course of several days. The night float system also demonstrates no appreciable adverse effects on clinical judgment and may allow better clinical judgment than a 24-hour call system.

Recurrent gallstone ileus: a case report.

Gallstone ileus is a rare complication of recurrent gallstone cholecystitis and usually occurs in elderly female patients. Recurrent gallstone ileus occurs in 5% of patients with a previous episode of gallstone ileus and is associated with a mortality of 20%. We present a 52-year-old female with recurrent gallstone ileus 1 year after her initial episode.

Ureterolithiasis: classical and atypical findings on unenhanced helical computed tomography.

Evaluation of patients with acute flank pain using helical computed tomography (CT) is a well-accepted, rapid, and safe procedure in the emergency setting. Various primary and secondary signs are described in the literature for evaluation of these patients. Our purpose is to demonstrate both the classical findings associated with ureteral calculi on unenhanced helical CT and atypical findings and potential pitfalls. We also provide readers with a systematic approach to interpreting unenhanced helical CT scans performed for acute flank pain.