Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trial.

BACKGROUND: Hyperosmotic water-soluble contrast materials have been fo und to be helpful diagnostic tools in postoperative small-bowel obstruction (POSBO); however, their therapeutic value remains controversial. PATIENTS AND METHODS: A prospective, randomized clinical study was conducted to examine the use of meglumine ioxitalamate as a supplement to the standard conservative treatment of POSBO. Patients with POSBO (n = 50) suitable for a conservative approach were randomized to receive standard conservative treatment with (n = 25) or without (n = 25) the addition of 100 mL of meglumine ioxitalamate via the nasogastric tube (patients with diffuse carcinomatosis and early POSBO were excluded). Both groups were compared for resolution of obstruction, need for surgical relief of obstruction, and complications. RESULTS: Seven (14%) patients required surgery: 3 in the contrast material group and 4 in the control group (P = not significant [NA]. Resolution of symptoms was achieved in nonsurgical patients within an average of 25.7 hours in the contrast material group and 28.7 hours in the control group (P = NS). There was no mortality in this study. In 2 (4%) patients (1 in each group), strangulated bowel was found during surgery, but only the 1 (2%) patient in the contrast material group required bowel resection. No difference was found in the length of hospital stay or rate of complications. There were no complications that could be attributed to the use of the contrast material itself. CONCLUSIONS: Although water-soluble contrast material is a safe and useful diagnostic tool, it offers no advantage as a supplement to the usual conservative treatment of POSBO.

Irresectable hepatoma treated by intrahepatic iodized oil doxorubicin hydrochloride: initial results.

In this study we describe the investigation and treatment of 14 patients with primary hepatocellular carcinoma. Patients were treated with intra-arterial infusion of iodized oil and doxorubicin hydrochloride. Five of these patients were alive after 1 year. Twelve patients showed a fall in alpha-fetoprotein, and in seven of these patients, the fall in alpha-fetoprotein was greater than 50%.

Arterial embolization of adrenal tumors: results in nine cases.

Adrenal arterial embolization was performed in nine patients, four with inoperable adrenal cortical carcinoma and five with metastatic adrenal tumors. Embolic agents used were polyvinyl alcohol foam (Ivalon) in seven patients, stainless steel coils in four, ethanol in three, and surgical gelatin (Gelfoam) in two. In eight patients, embolization was performed for palliation, either to decrease tumor bulk (all patients), suppress tumor hormonal function (three patients), or relieve pain (four patients). One patient had an embolization to facilitate subsequent adrenalectomy. In four patients in whom it was possible to assess the effect of embolization on tumor bulk by follow-up CT, a striking reduction in size has occurred in one, the lesions remained stable in size for 12 months in two, and the tumor continued to increase in size in the fourth. A striking reduction in the production of the cortisol for 12 months was seen in two of three patients with Cushing syndrome. This reduction was considered due at least in part to embolization. Adrenal embolization resulted in effective palliation of pain in three of four patients and may have contributed to palliation in the fourth. Apart from a hypertensive episode in one patient, the cause of which was unclear, no serious side effects occurred. Adrenal arterial embolization may play an effective role without serious side effects in palliation of pain and reduction of hormone production in inoperable adrenal lesions.

Contrast-enhanced computed tomography of the normal and abnormal gallbladder.

One hundred and fourteen upper abdominal computed tomography examinations performed before and after intravenous contrast were reviewed. In 48 patients who had no evidence of biliary or pancreatic disease, the mean gallbladder wall attenuation before contrast was 25 +/- 13 HU and after contrast 42 +/- 18 HU, with a wall thickness of 1.9 +/- 0.43 mm. In 14 patients with chronic pancreatitis these values were 24 +/- 10.5 HU, 44 +/- 25 HU and 2.0 +/- 0.54 mm, respectively. In a further group of 15 patients with chronic biliary disease, the values were 34 +/- 15 HU, 53 +/- 18 HU and 2.3 +/- 0.9 mm. The degree of wall enhancement was statistically significant in each group. There was no statistical difference in the attenuation characteristics or wall enhancement between normal patients and those with chronic pancreatitis. Patients with chronic biliary disease had a thicker gallbladder wall with higher attenuation before contrast but a similar degree of enhancement.

Angiographic ablation of parathyroid adenomas.

Six mediastinal parathyroid adenomas were stained by infusing contrast agent through a catheter wedged in the feeding artery. Adenomas in the first three cases were stained unintentionally with small volumes of dilute contrast media and hypercalcemia recurred within 3 to 6 months. In the next three patients, adenomas were deliberately stained with larger doses of concentrated contrast media and these patients have remained normocalcemic from 2 to 18 months following staining. The permanency of parathyroid ablation following deliberate staining with contrast media has not been established.