RESUMEN
BACKGROUND/PURPOSE: We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO). METHODS: Medical records were reviewed retrospectively for all children admitted with ASBO between November 2010 and June 2017. Those admitted between November 2010 and October 2013 received nasogastric decompression with decision for surgery determined by surgeon judgment (preprotocol). Patients admitted after October 2013 (postprotocol) received water-soluble contrast early after admission, were monitored with serial examinations and radiographs, and underwent surgery if contrast was not visualized in the cecum by 24â¯h. Group outcomes were compared. RESULTS: Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (pâ¯=â¯0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2â¯days (preprotocol) vs 3.6â¯days (postprotocol) pâ¯=â¯0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42. CONCLUSIONS: Administration of water-soluble contrast after hospitalization for pediatric ASBO may play a dual diagnostic and therapeutic role in management with decreases in surgical intervention, LOS, and cost. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Medios de Contraste/uso terapéutico , Diatrizoato de Meglumina/uso terapéutico , Obstrucción Intestinal/terapia , Adherencias Tisulares/terapia , Adolescente , Niño , Preescolar , Medios de Contraste/economía , Diatrizoato de Meglumina/economía , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización , Humanos , Lactante , Obstrucción Intestinal/diagnóstico por imagen , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/efectos de los fármacos , Intestino Delgado/patología , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Adherencias Tisulares/complicaciones , Adherencias Tisulares/diagnóstico por imagen , Adulto JovenRESUMEN
PURPOSE: Many patients dislike oral contrast media due to their bad taste. The aim of the present study was to identify a solution that tastes better while providing the same opacification in order to offer oncological patients an alternative to the routinely used bad tasting oral contrast media. MATERIALS AND METHODS: In a single blinded, prospective clinical study, the orally administered intravenous contrast media iohexol (Omnipaque), iopromide (Ultravist), and iotrolan (Isovist) as well as the oral contrast media sodium amidotrizoate (Gastrografin) and ioxithalamate (Telebrix) were each compared to the oral contrast medium lysine amidotrizoate as the reference standard at a constant dilution. The density values of all contrast media with the same dilutions were first measured in a phantom study. The patient study included 160 patients who had undergone a prior abdominal CT scan with lysine amidotrizoate within 6 months. The patients rated their subjective taste impression on a scale of 0 (very bad) to 10 (excellent). In addition, adverse events and opacification were recorded and prices were compared. RESULTS: The phantom study revealed identical density values. Patients assigned much higher taste impression scores of 8 and 7 to iohexol and iotrolan, respectively, as compared to a score of 3 for the conventional lysine amidotrizoate (p< 0.05). Iopromide and sodium amidotrizoate did not differ significantly from lysine amidotrizoate. The opacification of all contrast media and experienced adverse events did not differ significantly. Iotrolan (ca. 120 euro/100 ml), Iohexol and Iopromide (ca. 70 euro/100 ml) are more expensive than the conventional oral contrast media (ca. 10 - 20 euro/100 ml). CONCLUSION: Orally administered solutions of non-ionic contrast media improve patient comfort due to the better taste and provide the same opacification in comparison to conventional oral contrast media. At present, their use should be limited to individual cases due to the higher costs.
Asunto(s)
Medios de Contraste/administración & dosificación , Medios de Contraste/economía , Yohexol/administración & dosificación , Yohexol/economía , Radiografía Abdominal , Gusto , Tomografía Computarizada por Rayos X , Ácidos Triyodobenzoicos/administración & dosificación , Ácidos Triyodobenzoicos/economía , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Interpretación Estadística de Datos , Diatrizoato de Meglumina/administración & dosificación , Diatrizoato de Meglumina/economía , Femenino , Humanos , Inyecciones Intravenosas , Intestino Delgado/diagnóstico por imagen , Yohexol/análogos & derivados , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Fantasmas de Imagen , Estudios Prospectivos , Estándares de ReferenciaRESUMEN
A diversity of X-ray contrast diagnostic techniques used in urology provides a way of using different groups of X-ray contrast materials (XCMs) in accordance of the set tasks. Many years' experience in handling water-soluble triiodinated XCMs while examining the kidneys and urinary tract provides evidence for their diagnostic effectiveness and safety. The new Triombrast (OAO "Farmac", Kiev) synthesized on the basis of the Spanish substance (Justesa Imagen SA) has successfully undergone clinical trials and meets the high requirements made by the specialized urological facilities is economically profitable. The paper has been prepared, by using the reports on the results of preclinical studies of the agent and the experience of its use in the clinic of the Research Institute of Urology and City Clinical Hospital No. 47, Moscow.
Asunto(s)
Medios de Contraste/administración & dosificación , Diatrizoato de Meglumina , Urografía/economía , Enfermedades Urológicas/diagnóstico por imagen , Administración Intravesical , Medios de Contraste/economía , Análisis Costo-Beneficio , Diatrizoato de Meglumina/economía , Humanos , Reproducibilidad de los Resultados , Urografía/métodos , Enfermedades Urológicas/economíaRESUMEN
A new oral formulation of iopamidol, "Gastromiro", was evaluated as a bowel contrast agent during abdominal computed tomography (CT). Comparison was made with the well established agents sodium/meglumine diatrizoate ("Urografin 370") and dilute barium sulphate ("E-Z CAT") in a randomized, blind study of 150 consecutive patients undergoing abdominal and/or pelvic CT. Parameters assessed included quality of bowel opacification, artefact generation, contrast-medium palatibility, side effects and cost. No significant difference was found between the three contrast media in stomach- or small-bowel opacification. E-Z CAT was superior at opacifying the caecum/ascending colon. No compelling reason to choose a particular agent was found in the other assessed parameters, but cost is a significant factor.