| 1. |
- Latifi, Ali, et al.
(författare)
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Does enteral contrast increase the accuracy of appendicitis diagnosis?
- 2011
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Ingår i: Radiologic Technology. - 0033-8397 .- 1943-5657. ; 82:4, s. 294-299
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several approaches traditionally have helped opacify the bowel when computed tomography (CT) is used to diagnose appendicitis. With the development of multidetector row CT (MDCT), the need for enteral contrast agents is less obvious. Purpose The objective of this study was to evaluate retrospectively the accuracy of MDCT demonstration of appendicitis using enteral contrast agents. METHODS: We reviewed radiologic reports of all 246 adult patients with suspected appendicitis who underwent 16-slice MDCT during 2005-2006 at our department. The use of enteral contrast agents and the route of administration were documented by one investigator. A radiologist evaluated whether the responses in the reports were consistent with diagnosis of appendicitis. The accuracy of the radiologic reports was assessed using the results of surgery, histopathology and 3 to 21 months of follow-up. RESULTS: Of patients studied, 14.6% received no enteral contrast agent, 8.5% received both oral contrast and rectal contrast (enema), 46.7% received oral contrast and 30.1% received rectal contrast enemas. The accuracies for the CT diagnosis of appendicitis with different combinations of agents ranged from 95% to 100%, with no significant difference among groups. CONCLUSION: Our study shows that the accuracy for diagnosis of appendicitis by abdominal 16-slice MDCT is high regardless of enteral contrast use. Therefore, further use of enteral contrast agents for CT diagnosis of appendicitis in adults cannot be recommended.
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| 2. |
- Latifi, Ali, et al.
(författare)
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The accuracy of focused abdominal CT in patients presenting to the emergency department
- 2009
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Ingår i: Emergency Radiology. - : Springer Science and Business Media LLC. - 1070-3004 .- 1438-1435. ; 16:3, s. 209-215
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Tidskriftsartikel (refereegranskat)abstract
- Focused computed tomography(CT) examination (FCT) is CT limited to a specific abdominal area in an attempt to reduce radiation exposure. We wanted to evaluate FCT on the basis of information from the request form and thus reduce radiation dose to the patient without missing relevant findings. We retrospectively analyzed 189 consecutive acute abdominal CT, dividing the findings as localized in the upper or lower abdomen. Another researcher blindly determined where the CT should be focused to, based only on information provided in the request form. The sensitivity and specificity of FCT in patients with symptoms from only upper abdomen was 100%. Sensitivity, specificity, and accuracy of FCT in patients with symptom from only lower abdomen were 79%, 100%, and 92%, respectively. Our study suggests that among patients with symptoms from the lower abdomen, not examining the upper abdomen would lead to missing relevant findings.
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| 3. |
- Torkzad, Michael R, et al.
(författare)
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Manifestations of small bowel disease in pediatric Crohn's disease on magnetic resonance enterography
- 2012
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Ingår i: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1078-0998 .- 1536-4844. ; 18:3, s. 520-528
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We report the manifestations of Crohn's disease (CD) observed on magnetic resonance enterography (MRE) in a pediatric population at the time of CD diagnosis. METHODS: MRE of 95 consecutive pediatric patients with inflammatory bowel disease (IBD) examined in 2006-2009 were retrospectively analyzed, with documentation of findings based on type and location of the small bowel (SB) disease. RESULTS: In all, 51 were boys and 44 girls. 54 had CD, 31 non-CD IBD, and 10 no IBD. The most common site of SB involvement in CD was the terminal ileum seen in 29 (53.7%) patients, followed by ileum in 10 (18.5%) and jejunum in 9 (16.7%) patients. Solitary jejunal inflammation (3.7%), SB stenoses (1.9%), fistula formation (0.95%), and abscess (0.95%) were much less common. Perienteric lymphadenopathy was seen in 30 (55.6%) patients and fatty proliferation in 9 (16.7%). The most common manifestation of SB inflammation was increased contrast enhancement of bowel wall (93.5%), thickening of the bowel wall (90.3%), and derangement of bowel shape with saccular formations (25.8%). CONCLUSIONS: MRE in the pediatric population often demonstrates increased contrast uptake, bowel wall thickening, and perienteral lymphadenopathy in CD. More chronic small bowel changes seen commonly in adults and solitary jejunal involvements are less commonly seen.
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| 4. |
- Ullberg, Ulla, et al.
(författare)
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Hyrtl's anastomosis is normally developed in placentas from small for gestational age infants.
- 2003
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 82:8, s. 716-721
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Tidskriftsartikel (refereegranskat)abstract
- Background. The aim of this study was to investigate the occurrence and appearance of the anastomosis between the two umbilical arteries in placentas from infants small for gestational age (SGA). Methods. The arterial systems of 64 placentas from singleton pregnancies resulting in SGA infants were visualized by angiography. The method allowed study of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each artery. The results were compared with findings in a previous study of appropriate for gestational age (AGA) infants. One-way analysis of variance (anova) and chi2-analyses were used for statistics. Results. In 56 placentas the anastomosis was represented by a true vessel, in two by a fenestration, and in another two cases by fusion of the umbilical arteries. The anastomosis was absent in one case and another three cases had a single umbilical artery (SUA). When the diameter of the anastomosis was thinner than that of the umbilical arteries, their supply areas were significantly (p <= 0.001) more symmetrical than in cases with a wider anastomosis. The anatomy of the anastomosis and the relationship between its width and the symmetry between the supply areas of each umbilical artery did not differ in placentas from SGA and AGA infants, despite various types of cord insertion and placentation. Conclusion. Static measurements of Hyrtl's anastomosis do not indicate a contributing part for intrauterine growth retardation.
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| 5. |
- Ullberg, Ulla, et al.
(författare)
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Hyrtl's anastomosis, the only connection between the two umbilical arteries. A study in full term placentas from AGA infants with normal umbilical artery blood flow
- 2001
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 80:1, s. 41280-41280
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of this study was to describe the Variable anatomy in the anastomosis between the umbilical arteries for better understanding of the physical characteristics of the umbilical Row velocity waveform (FVW). Methods. The arterial system of 67 placentas from pregnancies with normal umbilical FVW and resulting in a full-term AGA infant was visualized by angiography. The method allowed study of the anatomy of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each umbilical artery. Results. In 60 cases there was one anastomosis between the umbilical arteries, in one case then were two, in four the anastomosis was absent, and another two cases had a single umbilical artery. The anastomosis was represented by a vessel, a fenestration or coalescence of the umbilical arteries. In case the anastomosis diameter was of at least that of the umbilical arteries, they supplied in mean 26% and 74% (+/-8.2%) of the placental area respectively. When the anastomosis diameter was smaller than that of the umbilical arteries their supply areas were in mean 41% and 59% (+/-6.0%) respectively. In placentas lacking anastomosis the two umbilical arteries supplied 45% and 55% (+/-2.6%) respectively, indicating a higher degree of symmetry. Conclusions. By using angiography we were able to demonstrate the variable anatomy of the anastomosis of Hyrtl. We found the occurrence and width of the anastomosis was correlated to the symmetry in size between the supply areas of each umbilical artery.
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| 6. |
- Ullberg, Ulla
(författare)
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The human placenta : an angiographic study
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The arterial vessels from the umbilical cord spreading over the chorion and its cotyledonary branches constitute the main body of the placental vascular tree. In the present study it was visualized by angiography and related to placental developmental factors. The results were correlated with intrauterine growth and umbilical artery blood flow velocity waveforms (FVW). The association between FVW and placental morphology was investigated by angiography in 30 pregnancies at risk for intrauterine growth retardation (IUGR). Placentas from fetuses with an end-diastolic zero flow were small and thick with an extrachorial configuration, marginal cord insertion, magistral or mixed allantochorial vessel pattern and few cotyledons. The incidence and the extension of gross lesions were only slightly increased. The results show that placental developmental factors are associated with fetal growth and abnormal FVW. To further evaluate the arterial pattern, fractal geometry was accomplished and showed to be an applicable model. In 22 placentas from uncomplicated pregnancies with normal FVW, the scaling properties were as good as for constructed perfect fractals. The fractal dimension was in mean 1.864. The results suggest that there is an underlying regular mechanism behind the placental vasculogenesis. Sixteen placentas from SGA fetuses with pathologic FVW showed a significantly decreased fractal dimension (mean 1.755), indicating a lower grade of complexity. The anatomy of the frequent connection between the two umbilical arteries, Hyrtl s anastomosis, was investigated in 67 placentas from full term infants appropriate for gestational age (AGA) and in 64 placentas from infants small for gestational age (SGA). The anastomosis was constituted by a separate vessel in 112 placentas (85 %), a fenestration in 6 (5%) and a fusion in 3 (2%). In 10 the anastomosis was absent, in five of these due to a single umbilical artery. The anastomosis was wide in placentas in which the relative area supplied by each umbilical artery was asymmetric and thinner with a higher degree of symmetry. Placentas lacking anastomosis were highly symmetric. The occurrence and anatomy of Hyrtl s anastomosis seemed to depend on the demand on shunting between the umbilical arteries, and did not differ between placentas from AGA and SGA infants. The results show that the placental arterial pattern reveals abnormalities in early placental expansion and development and is linked with impaired fetal growth and pathologic FVW. The structure of Hyrtl s anastomosis is related to the size of the umbilical arteries supply areas proving its role as a shunting mechanism.
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