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PurposeTo analyze the appropriateness of primary response for anaphylaxis due to iodinated contrast media (ICM) or gadolinium-based contrast agents (GBCA).Materials and methodsThis retrospective study included all patients in whom intravenous contrast agents (five types of ICMs and four types of GBCAs) were administered at our hospital between April 2016 and September 2021. For the patients who developed anaphylaxis, we obtained data on the time records of contrast injection, anaphylaxis onset, and intramuscular adrenaline (epinephrine) administration.ResultsOf the 76,555 ICM and 30,731 GBCA administrations, anaphylaxis occurred in 49 cases (0.05%), and in 48 cases (98.0%) the onset was within 30 min after administration with widely distributed times (median, 7.5 min; interquartile range, 4.5–10.8 min; max, 26 min). Intramuscular adrenaline administration was performed in 43 cases (87.8%), and this was done within five minutes after the onset in 37 cases (75.5%). Only in 24 cases (49.0%), there were time records of both the onset and adrenaline administration (if performed).ConclusionAnaphylaxis occurred within 30 min after contrast injection in the majority of the cases, but times were widely distributed. Only in 75.5% of cases, appropriate primary treatment was performed, and the importance of keeping exact time records in patients’ charts should be re-emphasized.

To evaluate the reliability of ultrasound hepatorenal index (US-HRI) and magnetic resonance imaging proton density fat fraction (MRI-PDFF) techniques in the diagnosis of hepatic steatosis, with magnetic resonance spectroscopy proton density fat fraction (MRS-PDFF) as the reference standard. Fifty-two adult volunteers (30 men, 22 women; age, 31.5 ± 6.5 years) who had no history of kidney disease or viral/alcoholic hepatitis were recruited to undergo abdominal US, MRI, and MRS examinations. US-HRI was calculated from the average of three pairs of regions of interest (ROIs) measurements placed in the liver parenchyma and right renal cortex. On MRI, the six-point Dixon technique was employed for calculating proton density fat fraction (MRI-PDFF). An MRS sequence with a typical voxel size of 27 ml was chosen to estimate MRS-PDFF as the gold standard. The data were evaluated using Pearson's correlation coefficient and receiver operating characteristic (ROC) curves. The Pearson correlation coefficients of US-HRI and MRI-PDFF with MRS-PDFF were 0.38 (p = 0.005) and 0.95 (p<0.001), respectively. If MRS-PDFF [greater than or equal to]5.56% was defined as the gold standard of fatty liver disease, the areas under the curve (AUCs), cut-off values, sensitivities and specificities of US-HRI and MRI-PDFF were 0.74, 1.54, 50%, 91.7% and 0.99, 2.75%, 100%, 88.9%, respectively. The intraclass correlation coefficients (ICCs) of US-HRI and MRI-PDFF were 0.70 and 0.85. MRI-PDFF was more reliable than US-HRI in diagnosing hepatic steatosis.

To formulate the relationship between the dextrin hydrate concentration and T1 relaxation rate and create a magnetic resonance imaging (MRI) phantom with an arbitrary T1 value. Dextrin solution with nine different concentrations was prepared by dissolving 0–20 g (2.5 g increments) of dextrin in 25 g of purified water. The T1 values of the phantoms were measured using a 1.5 T MR scanner, and the relationship between the R1 value and dextrin concentration was regressed using linear and quadratic equations. Phantoms with concentrations adjusted to T1 values of 500, 1000, and 1500 ms were created from each regression equation, and the errors between the measured T1 and target values were evaluated. In addition, the temporal changes in the T1 and T2 values of the phantoms were also evaluated. The T1 and T2 values ranged from 367.4 ± 14.1 to 2577.6 ± 76.5 ms and 20.0 ± 0.9 to 1805.3 ± 8.3 ms, respectively. The linear and quadratic regression equations were y = 2.9631 x + 0.2043 and y = 1.8295 x 2 + 1.4995 x + 0.37 , with coefficients of determination of 0.9763 and 0.9954, respectively. The maximum errors were 12.3% and 2.1% for the linear and quadratic equations, respectively. The T1 value was maintained at a fluctuation rate of approximately 10% during the first 4 weeks. The T2 value decreased by approximately 20% after 4 weeks. MRI phantoms with arbitrary T1 values in the range of 500–1500 ms with an error within 2.1% can be created using dextrin, which can be used as human tissue-equivalent MRI phantoms for T1 of the grey or white matter of the brain, liver, pancreas, spleen, and prostate.

Aim Surgical site infection (SSI) is one of the most common postoperative complications in gastrointestinal surgery. To clarify the superiority of 1.5% olanexidine, we conducted a randomized prospective clinical trial that enrolled patients undergoing gastrointestinal surgery with operative wound classes II–IV. Methods To evaluate the efficacy of 1.5% olanexidine in preventing SSIs relative to 10% povidone‐iodine, we enrolled 298 patients in each group. The primary outcome was a 30‐day SSI, and the secondary outcomes were incidences of superficial and deep incisional SSI and organ/space SSI. In addition, subgroup analyses were performed. Results The primary outcome of the overall 30‐day SSI occurred in 38 cases (12.8%) in the 1.5% olanexidine group and in 53 cases (18.0%) in the 10% povidone‐iodine group (adjusted risk ratio: 0.716, 95% confidence interval: 0.495–1.057, p = 0.083). Organ/space SSI occurred in 18 cases (6.1%) in the 1.5% olanexidine group and in 31 cases (10.5%) in the 10% povidone‐iodine group, with a significant difference (adjusted risk ratio: 0.587, 95% confidence interval: 0.336–0.992, p = 0.049). Subgroup analyses revealed that SSI incidences were comparable in scheduled surgery (relative risk: 0.809, 95% confidence interval: 0.522–1.254) and operative wound class II (relative risk: 0.756, 95% confidence interval: 0.494–1.449) in 1.5% olanexidine group. Conclusion Our study revealed that 1.5% olanexidine reduced the 30‐day overall SSI; however, the result was not significant. Organ/space SSI significantly decreased in the 1.5% olanexidine group. Our results indicate that 1.5% olanexidine has the potential to prevent SSI on behalf of povidone‐iodine. This study demonstrated 1.5% olanexidine reduced the overall SSI incidence relative to 10% povidone‐iodine (p = 0.083), and significantly reduced organ/space SSI (p = 0.049). Subgroup analyses revealed that emergency surgery and operative wound class did not increase SSI incidence.

Objectives To evaluate the effect of abolishing instructions to fast prior to contrast-enhanced CT on acute adverse reactions (AARs). Methods In our institution, we instructed patients to fast one meal before contrast-enhanced CT examinations. However, we abolished these instructions at the end of March 2019, and solid food intake was not restricted before contrast-enhanced CT after this date. The differences in the incidence of AARs before (December 2015–November 2018, n = 43,927) and after (April 2019–March 2020, n = 14,676) abolishing instructions to fast were compared. We allowed 4 months (December 2018–March 2019) for this policy change to fully permeate the CT referrals. The medical records of patients who vomited were retrospectively reviewed by one of the authors for notations of aspiration or aspiration pneumonia attributable to vomiting. Results The overall incidence of AARs before (1.60%, n = 705) and after abolition (1.40%, n = 205) did not change significantly. As the chemotoxic reactions, the incidence of nausea decreased significantly (0.31 to 0.18%, p = 0.006). The incidence of vomiting did not change (0.12 to 0.16%), and there were no cases of aspiration pneumonia attributable to vomiting during the study period. The incidence of severe hypersensitivity/allergy-like reactions did not change (0.06 to 0.05%). Conclusions Abolishing instructions to fast decreased the incidence of nausea, but did not affect the incidence of vomiting. No cases of aspiration pneumonia attributable to vomiting were found. Our study confirmed that fasting is not required prior to contrast-enhanced CT.

Objective To compare the effects of two low-osmolar contrast media (LOCM), iohexol and iomeprol, on renal function in patients undergoing percutaneous coronary intervention (PCI), as measured by estimated glomerular filtration rate (eGFR). Methods This retrospective study included 180 patients who underwent PCI between January 2021 and December 2022. After propensity score matching based on age, sex, diabetes mellitus, pre-PCI eGFR, contrast media volume, and left ventricular ejection fraction, 88 patients who received either iohexol or iomeprol (44 each) were analyzed. Changes in eGFR at 24 hours and more than 72 hours post-PCI were evaluated. Results There were no differences between the two groups in age [median 71.5 (range 33-86) vs. 73 (range 50-83) years], gender [35 (79.5%) vs. 37 (84.1%) male], pre-PCI eGFR [64.9 (6.8-112.2) vs. 61.3 (8.5-105.2) ml/min/1.73m²], or amount of LOCM used [108 (42-217) vs. 109 (52-222) ml] between the iohexol and iomeprol groups, respectively. No significant differences in absolute or relative changes in eGFR were observed between the two groups at either time point. At 24 hours, the mean relative change in eGFR was 1.6% (-2.5 to 5.8) in the iohexol group and 1.1% (-2.8 to 4.9) in the iomeprol group. At more than 72 hours, relative changes were -2.1% (-5.9 to 1.7) and -0.3% (-4.4 to 3.8), respectively. No cases of post-contrast acute kidney injury were observed.  Conclusion Changes in renal function after PCI did not differ significantly between iohexol and iomeprol, despite differences in osmolality and viscosity.

To evaluate the effectiveness of diaphragm matching (DM) for carbon-ion radiotherapy (CIRT) of pancreatic cancer patients and develop a simple method to estimate tumour position. Treatment planning CTs from 27 pancreatic cancer patients treated with CIRT in our facility were used in this study, and 32 other CT image datasets taken on different days were used for measuring tumour and diaphragm displacements. A correction method (SI-correction) was developed using the coefficient x of the regression line formula for the displacements between the diaphragm and tumour in the superior-inferior direction. The tumour positioning errors of bone matching (BM), DM, and SI-correction were measured. Mean (±standard deviation) absolute errors of BM, DM, and SI-correction were 5.10±3.31, 7.48±4.04, and 4.13±2.51 mm, respectively. DM showed significant differences compared to the other correction methods. DM was subject to larger errors than BM. Our correction method improved positional errors.

Background A standard procedure for the treatment of incarcerated umbilical hernia among severely obese patients has yet to be established. We used the hybrid intraperitoneal onlay mesh repair (IPOM) plus method, which combines open and laparoscopic surgery to treat incarcerated umbilical hernia in a severely obese patient. Case presentation A 46-year-old man presented in our department with a chief complaint of a painful mass in the umbilical region. Incarcerated umbilical hernia was diagnosed on the basis of abdominal computed tomography, and the decision was made to perform emergency surgery. The patient was severely obese (body mass index, 53.8 kg/m 2 ), and the incarcerated portion of the hernia was therefore first addressed by open surgery. As bowel resection was unnecessary, the risk of infection was considered low, and after direct closure of the hernia orifice, IPOM was performed laparoscopically using the hybrid IPOM plus method. Conclusion Among severely obese patients, first trocar insertion is difficult and the wound site tends to come under strain, meaning that simple closure of the hernia orifice results in a high recurrence rate. The hybrid IPOM plus method used in this case combines open surgery and laparoscopy and appears useful for treating uninfected incarcerated umbilical hernia in severely obese patients safely and with an anticipated low rate of postoperative recurrence.

Purpose To investigate the incidence and risk factors of contrast induced nephropathy (CIN) after contrast enhanced (CE) computed tomography (CT) in patients with renal dysfunction. Materials and methods Two hundred sixteen inpatients with estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m 2 underwent CE CT using iodine doses of 420 or 480 mg I/kg. Data of all enrolled patients was collected for baseline serum creatinine level (SCr), post-CE CT SCr within 3 days after CE CT, and conditions considered risk factors for CIN [renal dysfunction, contrast media dose, advanced age, diabetes mellitus, no intravenous hydration, cardiac dysfunction (left ventricular ejection fraction <60%) and intensive-care unit (ICU) admission]. CIN was defined as an increase in SCr level of more than 0.5 mg/dl or more than 25% from baseline within 3 days post-CE CT without any other identifiable cause of acute kidney injury. Results The incidence of CIN was 11/216 (5.1%) and was associated with cardiac dysfunction [odds ratio (OR) 6.540; 95% confidence interval (CI) 1.090–39.300; p  = 0.040] and ICU admission (OR 11.500; 95% CI 2.050–64.100; p  = 0.005). Conclusion Our results suggested that cardiac dysfunction and ICU admission may be risk factors for CIN in patients with preexisting renal dysfunction.

Introduction: Reduced port laparoscopic Well's procedure (RPLWP) is a novel technique used to overcome the limitations of single-incision laparoscopic surgery. The aim of this study was to compare outcomes between RPLWP and conventional laparoscopic Well's procedure (CLWP) and to investigate the learning curve of RPLWP. Patients and Methods: From January 2006 to March 2017, a retrospective review of a prospectively maintained laparoscopic surgery database was performed to identify patients had undergone CLWP and RPLWP. From these patients, each of 10 cases were manually matched for age, sex, body mass index. From January 2006 to March 2015, CLWP was used for all procedures whereas, from April 2015, RPLWP was routinely performed as a standard procedure for rectal prolapse. Results: No significant differences were observed between the two groups in terms of operating time, blood loss, intraoperative complications, and conversion to CLWP or open rectopexy. Based on the postoperative outcomes, the hospital stay was significantly shorter in the RPLWP group. The estimated learning curve for RPLWP was fitted and defined as y = 278.47e-0.064x with R2= 0.838; therefore, a significant decrease in operative time was observed by using the more advanced surgical procedure. Conclusions: RPLWP is an effective, safe, minimally invasive procedural alternative to CLWP with no disadvantage for patients when a skilled surgeon performs it.