Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom.

PURPOSE: To retrospectively determine the incidence of potentially serious adverse events associated with computed tomographic (CT) colonography performed in patients with symptoms of colorectal cancer. MATERIALS AND METHODS: Ethical approval and informed consent were waived, since the study was deemed a clinical audit and patients would not be approached. With a national survey in the United Kingdom, all departments offering CT colonography in everyday practice were identified. The lead gastrointestinal radiologist from all responding departments was interviewed, and the frequency of potentially serious adverse events associated with CT colonography performed in patients with symptoms of colorectal cancer, the total number of examinations performed, and technical factors possibly related to perforation were determined. Where a potentially serious adverse event was encountered, it was explored in detail. Responses were collated, and raw frequencies were determined. Fisher exact test was used to determine differences in event rates between groups. RESULTS: At 50 centers, 17 067 CT colonographic examinations (mean number per center, 359; range, 10-3000) were performed. No deaths were reported. Thirteen patients (one [0.08%] of 1313) had had a potentially serious adverse event related to the procedure. There were nine perforations: Four (44%) were asymptomatic and five (56%) were symptomatic, and perforation had an attributable cause, with a symptomatic perforation rate of 0.03% (one in 3413 patients). One patient required laparotomy. An inflated rectal balloon was used to perform 9378 examinations. There was no significant difference between the proportion of perforations associated with rectal balloon inflation (n = 6) and the proportion of those that were not (n = 2) (P = .3). CONCLUSION: Potentially serious adverse events related to CT colonography occurred in 0.08% of symptomatic patients.

An epidemiological study of renal pathology in tuberous sclerosis complex.

OBJECTIVES: To report the frequency of renal symptoms and complications of patients with tuberous sclerosis complex (TSC), to describe the ultrasonographic appearance of the kidneys in a population-based sample, and to investigate the relationship between a history of renal haemorrhage and renal lesions identified by ultrasonography. PATIENTS AND METHODS: As part of an epidemiological study, 179 patients with TSC were identified as living in the Wessex Region in the South of England. Patients were interviewed and examined in their homes, to elicit the presence of renal symptoms or a history of renal complications. Renal ultrasonography was used in consenting patients in their homes. RESULTS: There was a history of renal complications in 16 (9%) patients; 149 consented to interview and examination, and 19 gave a history of renal symptoms in the previous year; 124 had renal ultrasonography; 86 (69%) had renal angiomyolipomas and 37 (30%) had renal cysts. Large lesions (>3 cm in diameter) were strongly associated with a history of symptomatic bleeding, although significant haemorrhage occurred in a 6-year-old child with small angiomyolipomas. CONCLUSIONS: The formation of angiomyolipoma in TSC is common. Polycystic kidney disease, renal carcinoma and renal failure, although rare, occur in TSC. Most patients with angiomyolipomas have neither complications nor symptoms. There was no appreciable difference between the sexes in the risk of developing these lesions. Although less commonly seen in the very young, there is no identifiable relationship after adolescence between age and the risk of having a renal angiomyolipoma. Bleeding tends to occur from large lesions (>3 cm) but most such patients have remained asymptomatic to date.