The role of interventional radiology in the management of intra- and extra-peritoneal leakage in patients who have undergone continent urinary diversion.

PURPOSE: To assess how radiologic intervention altered the hospital course of patients undergoing continent urinary diversion. METHODS: Thirty-seven consecutive patients with bladder cancer invading the muscular layer were treated with total cystectomy and construction of a continent urinary reservoir. Eleven of 37 patients suffered early and late anastomotic leakage; six had prolonged extraperitoneal leakage at the urethroenteric anastomosis, three had prolonged intraperitoneal pouch leaks, and two had delayed ureteroenteric leaks. Seven of these patients required radiologic intervention. RESULTS: Intervention in the form of drainage catheter manipulation (n = 4), percutaneous nephrostomy (n = 4), or ureteral stent placement (n = 2) resulted in cessation of leakage without surgical intervention in all seven patients. Intraperitoneal pouch leaks were more difficult to control than extraperitoneal leakage and required longer drainage intervals. CONCLUSION: Interventional radiologic procedures played a key role in the management of continent urinary diversion complications, obviating the need for repeat surgical intervention in all instances.

Lack of interaction between magnetic resonance imaging and the copper-T380A IUD.

To determine if the CuT380A (ParaGard) IUD is affected by magnetic resonance imaging (MRI), in vitro studies utilizing a CuT380A IUD (ParaGard), a copper-bearing IUD, and a Signa 1.5T HR system were used to evaluate whether the dynamic magnetic forces generated by the MRI resulted in movement, torque, or heat when the IUD was exposed to the magnetic field generated by the MRI. There was no deflection, turning motion (torque), or temperature change when the IUD was exposed to a magnetic field. There appears to be no reason to exclude women with IUDs of the type examined from an MRI system or its environs.

Selective blockade of cholecystokinin type B receptors with L-365,260 does not impair gallbladder contraction in normal humans.

OBJECTIVES: To evaluate the effect of selective blockade of type B cholecystokinin receptors on gall bladder contraction in normal humans and to compare methods for quantitative analysis of gall bladder contraction. METHODS: L-365,260, a novel, nonpeptide cholecystokinin antagonist shown to be selective for type B cholecystokinin receptors, was administered every 6 h over a 5-7 day period. Plasma levels of L-365,260 were determined by high pressure liquid chromatography. Gallbladder contraction after a standardized fatty meal was measured by ultrasonography, and results were calculated by ellipsoid or sum of cylinders methods. RESULTS: L-365,260 levels were comparable to levels in earlier studies demonstrating inhibition of pentagastrin-stimulated acid secretion in normal subjects and blockade of anxiogenic effects of cholecystokinin injections in patients with panic disorder. Regardless of the method used for estimating gallbladder size, none of the L-365,260 doses studied inhibited gallbladder contraction. Gallbladder size was most consistently estimated by the ellipsoid method using measurements normalized to individual values for minimum and maximum gallbladder dimensions. CONCLUSIONS: Multiple oral doses of L-365,260 do not alter ultrasonographically assessed gallbladder contraction at doses shown to be clinically effective in earlier studies. Despite being more difficult to implement, the sum of cylinders method for estimating gall bladder size offers no advantage over the ellipsoid method.