Modified computed tomography peritoneography: clinical utility in continuous ambulatory peritoneal dialysis patients.

The purpose of the present paper is to review the indications, results, clinical correlation and implications for management of a modified CT peritoneography (CTP) technique in the evaluation of continuous ambulatory peritoneal dialysis (CAPD) patients. Forty CTP in 33 patients were reviewed by two observers blinded to clinical history or outcome. The CTP technique included 100 mL non-ionic intraperitoneal contrast, 1 h of ambulation and prone positioning during the CT. No precontrast or delayed examinations were performed. A CAPD-related complication was diagnosed in 33 of 40 (82%) CTP. Twenty-nine CTP were performed for evaluation of suspected dialysate leaks. In this group there were 18 leaks, a total of seven umbilical hernias (five as isolated findings) and five normal studies. Nine of 18 (50%) leaks resolved with conservative management and six of nine patients (67%) of the remainder continued CAPD after appropriate surgery. Seven patients were evaluated for scrotal swelling (one bilateral), and there were five communicating hydroceles (all with inguinal fat herniation and all surgically confirmed) and three non-communicating hydroceles (none of which progressed). Umbilical hernias were present in nine of 33 patients (27%). No false positive or false negative studies were identified. The CTP technique described provides accurate diagnostic information in the management of common CAPD-related complications, particularly dialysate leak, genital swelling, abdominal wall hernias and peritoneal adhesions. Computed tomography peritoneography directs appropriate conservative or surgical management.

The Simon nitinol inferior vena cava filter: preliminary experience in the UK.

The Simon nitinol filter is one of a new range of inferior vena cava filters designed for percutaneous placement. It employs a thermal memory alloy allowing it to be introduced in a straight form via a 9F sheath when cool but transforming instantly into its predetermined filter shape at body temperature. It was placed rapidly and successfully in six patients via a femoral approach and one patient via an antecubital vein. The only complication was an asymptomatic IVC obstruction in one patient.

Diaphragmatic muscular bundles (slips): ultrasound evaluation of incidence and appearance.

Diaphragmatic muscular bundles (slips) connect the central tendon of the diaphragm to the inner aspect of the lower thoracic cage. They cause hepatic invaginations which may be visualized at ultrasound (US) or computed tomography. Two hundred patients underwent prospective US of the diaphragm and liver to determine the incidence and characteristics of slips. The incidence was 15%, rising to 30% in those aged 80 years and over. Slips average 1.2 cm in depth (range 0.1-3.6 cm) and their occurrence has no racial or sexual bias. Multiple slips were seen in 4% of patients, all females. Slips are echogenic and have a variety of appearances, typically nodular on transverse section and strand-like longitudinally. Knowledge of these structures will avoid confusion with liver and peridiaphragmatic pathology.

Barium meals in the elderly--a quality reassurance.

The consecutive double contrast barium meal examinations of 100 elderly patients (aged over 65 years) and a group of 33 younger adult patients were analysed by two observers for technical quality and pathological abnormalities. Technical quality declined with patient age, especially in those over 75 years, but was sufficient to enable diagnosis of abnormalities in 60% of the elderly group. It is concluded that, in the majority of elderly patients, the technical quality of double contrast barium meal examinations is sufficiently high to offer considerable diagnostic utility.