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Biomedical subjects

J G Bova

Publications and source records attributed to J G Bova.

At least 19 recordsLinked to original sources
PubMed2002

MR cholangiopancreatography in patients with primary sclerosing cholangitis: interobserver variability and comparison with endoscopic retrograde cholangiopancreatography.

OBJECTIVE: The purpose of our study was to determine the degree of interobserver variability and correlation between MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) for the presence of bile duct strictures in patients with primary sclerosing cholangitis. MATERIALS AND METHODS: For this retrospective study involving 26 patients with primary sclerosing cholangitis, 31 MR cholangiopancreatograms were compared with 30 endoscopic retrograde cholangiopancreatograms. The MR cholangiopancreatograms were independently interpreted by two abdominal radiologists in a blinded, randomized manner for overall image quality, extent of ductal visualization, and the presence and location of bile duct strictures. Unweighted multirater kappa coefficient values were estimated for each comparison. RESULTS: Visualization of more than 50% of the expected ductal length was possible in the extrahepatic, central intrahepatic, and peripheral intrahepatic bile ducts in 99%, 88%, and 69% of the MR cholangiopancreatograms and 100%, 86%, and 52% of the endoscopic retrograde cholangiopancreatograms, respectively. Strictures were detected in the extrahepatic, central, and peripheral ducts in 53%, 68%, and 87% of the MR cholangiopancreatograms and 73%, 67%, and 63% of the endoscopic retrograde cholangiopancreatograms, respectively. The interobserver agreement for stricture detection was 61% for MR cholangiopancreatography and 76% for ERCP. MR cholangiopancreatographic findings were consistent with ERCP findings for the presence of strictures in 69% of the cases. CONCLUSION: In patients with primary sclerosing cholangitis, MR cholangiopancreatography better shows the bile ducts and can depict more strictures, especially of the peripheral intrahepatic ducts, than ERCP. MR cholangiopancreatography can be used to noninvasively diagnose and follow up patients with primary sclerosing cholangitis.

Adult↗
PubMed2000

Safety and efficacy of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. multicenter phase III clinical trials (safety).

The short-term safety of mangafodipir trisodium (MnDPDP) injection was studied in 546 adults with known or suspected focal liver lesions. An initial contrast-enhanced computed tomography examination was followed by unenhanced magnetic resonance imaging (MRI), injection of MnDPDP (5 micromol/kg), and enhanced MRI. Adverse events were reported for 23% of the patients; most were mild to moderate in intensity, did not require treatment, and were not drug related. The most commonly reported adverse events were nausea (7%) and headache (4%). The incidence of serious adverse events was low (nine events in six patients) and not drug related. Injection-associated discomfort was reported for 69% of the patients, and the most commonly reported discomforts included heat (49%) and flushing (33%). Changes in laboratory values and vital signs were generally transient, were not clinically significant, and did not require treatment. There were no clinically significant short-term risks from exposure to MnDPDP.

Abdominal Pain↗
PubMed1999

Comparison of no medication, placebo, and hyoscyamine for reducing pain during a barium enema.

OBJECTIVE: We carried out a prospective, randomized study to evaluate the usefulness of premedication with an oral anticholinergic for relief of pain during and after a barium enema of the colon. SUBJECTS AND METHODS: Patients were randomized into three groups: no medication, placebo, and sublingual 1-hyoscyamine sulfate. The placebo or hyoscyamine tablet was placed under the tongue 15-30 min before the examination. After the procedure the patients were interviewed. An analog scale (0-10) was used to score the level of pain that the patients experienced during the examination. Forty-eight hours after the examination, the patients returned by mail a survey that used the same scale and asked about delayed pain. RESULTS: Data from 110 patients were studied. Sixty-nine patients were women, and 41 were men. They ranged from 24 to 82 years old (mean, 55 years). For the no-medication group (n = 36), the mean pain score was 4.1; for the placebo group (n = 34), 3.8; and for the hyoscyamine group (n = 40), 4.2. No statistically significant difference in pain scores was found between any groups (p = .72). Six patients from each group reported minor side effects. The mean scores from the returned surveys (n = 79) were 3.8 for the no-medication group (n = 26) and placebo group (n = 22) and 3.1 for the hyoscyamine group (n = 31). No statistically significant difference was found between any of these groups (p = .48) or between delayed pain responses and initial pain responses (p = .27). CONCLUSION: Although safe, hyoscyamine seems to provide no benefit over no drug or a placebo when used as a pain premedication for patients undergoing a barium enema.

Atropine↗
PubMed1998

Utilization review of simultaneously ordered multiple radiologic tests for the same symptom.

The purpose of this study was to analyze the utilization of multiple radiologic procedures ordered simultaneously for the same clinical problem. The method was a retrospective study of patients referred to an urban community hospital who had multiple radiologic tests ordered simultaneously before the referring physician reviewed any of the results. Utilization Findings Codes, beta versions II and III, of the American College of Radiology were applied. In- and outpatient charts were reviewed for initial indication, subsequent diagnosis, and treatment. Ninety-three patients had 214 radiologic examinations (2.3 per patient). Of the 214 total, 129 (60%) were retrospectively coded as inappropriate (beta II version). For 98 reports, the initial interpreting radiologist's coded 16% as inappropriate versus 55% when retrospectively coded by the authors (P < 0.0001). After applying the beta III version, 18% were coded as positive (and related to symptoms), 79% negative, and 3% equivocal. There were 161 (74%) examinations ordered by primary care physicians and 53 tests ordered by specialists. Using the beta III version, the negative rate for primary care physicians was 81 and 75% for specialists (P = 0.447). It was concluded that ordering multiple radiologic tests simultaneously on the same patient resulted in a high number of inappropriate procedures and negative results.

Adult↗
PubMed1993

Magnetic resonance angiography in the preoperative evaluation of abdominal aortic aneurysms.

Magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) are noninvasive techniques of visualizing blood vessels without the use of intravenous contrast or ionizing radiation. This prospective study assessed preoperative MRA and MRI in the evaluation of 28 patients with abdominal aortic aneurysm (AAA). MRI and MRA accurately predicted the extent of cephalad AAA, the patency of the superior mesenteric artery, and the course of the left renal vein, but were less accurate in defining the extent of caudal AAA, flow of the inferior mesenteric artery, and multiple renal arteries. This study suggests that MRI and MRA are alternatives to the combination of angiography and computed tomographic scan in the preoperative evaluation of patients with suspected AAA and no evidence of mesenteric or renal ischemia. When combined with preoperative segmental Doppler arterial studies, an accurate surgical plan may be formulated. Further refinements in image acquisition and postprocessing software analysis will advance the use of MRI and MRA for complete evaluation prior to elective AAA repair.

Aged↗
PubMed1993

Idiopathic eosinophilic esophagitis.

A retrospective review was performed of 13 patients with the diagnosis of idiopathic eosinophilic esophagitis (IEE) occurring alone or in conjunction with idiopathic eosinophilic gastroenteritis (IEG) to identify clinical, radiographic, endoscopic, manometric, and therapeutic similarities. All patients presented with esophageal symptoms, predominantly dysphagia. An allergic disorder was present in 10 (77%) patients, and peripheral eosinophilia was present in 12 (92%) patients. Clinical investigation disclosed esophageal strictures in 10 patients, motility disorders in three, ulcerations in two, a cervical web in one, and a mucosal ring in one as the cause of esophageal symptoms. A proximal esophageal stricture was the single most common esophageal abnormality demonstrated. IEE should be included in the differential diagnosis of dysphagia and should be suggested in a patient with an allergic disorder, peripheral eosinophilia, and concurrent abdominal symptoms, especially in conjunction with IEG. Prompt diagnosis is extremely important since treatment with steroids produces rapid clinical remission in most patients.

Adolescent↗
PubMed1993

Positive bowel contrast agent for MR imaging of the abdomen: phase II and III clinical trials.

PURPOSE: To evaluate the efficacy and safety of two dose levels of an orally administered ferric ammonium citrate-based contrast agent for bowel enhancement on T1-weighted spin-echo magnetic resonance (MR) images in 222 patients with known or suspected abnormality of the upper abdomen. MATERIALS AND METHODS: Adverse reactions were graded for intensity, frequency, duration, and relationship to the contrast agent. Twelve unblinded readers compared enhanced with unenhanced images; all MR images were evaluated by two independent offsite radiologists in a blinded review. RESULTS: No statistically significant changes in mean vital signs or laboratory values were seen. Forty-eight of 220 patients (22%) reported minor side effects. The readers found increased intraluminal signal intensity and improved contrast enhancement of the gastrointestinal tract and distention and improved signal homogeneity in 101-107 cases (89%-98%) after ingestion; the blinded reviewers' findings were similar. CONCLUSION: The contrast agent provided new or additional radiologic information in 142 patients (64%), specific additional information in a detected abnormality in 46 of 142 patients (32%), and information that changed diagnosis, management, or surgical approach in 22 of 142 patients (15%).

Abdomen↗
PubMed1993

Antispasmodic drugs to reduce discomfort and colonic spasm during barium enemas: comparison of oral hyoscyamine, i.v. glucagon, and no drug.

OBJECTIVE: Parenterally administered glucagon is currently the agent of choice for reducing abdominal discomfort and colonic spasm during a barium enema. Because glucagon is expensive and frequently causes nausea, we evaluated the use of oral hyoscyamine sulfate as an alternate agent and compared it with IV glucagon and no medication. SUBJECTS AND METHODS: A total of 349 adult patients undergoing barium enema examinations were randomly assigned in a prospective fashion to one of four groups: (1) no medication (87 patients); (2) 1 mg of IV glucagon (88 patients); (3) 0.125 mg of oral hyoscyamine sulfate (87 patients); and (4) 0.25 mg of oral hyoscyamine sulfate (87 patients). The degree of distension of the colon on radiographs obtained after fluoroscopy, the amount of abdominal distress after the procedure, and the number of side effects (nausea, palpitations, blurred vision, dry mouth) were analyzed. To evaluate the amount of abdominal discomfort more completely, we asked the last 248 patients to estimate the level of severity of the discomfort (none, mild, moderate, or severe). RESULTS: We found no difference in the degree of distension of the colon in the four groups (p = .63). Most patients (79%) had some degree of abdominal discomfort. Fewer patients in the group who received no medication (10%) had no or mild pain compared with those given glucagon (15%, p < .05), 0.125 mg of hyoscyamine (14%, p < .05), or 0.25 mg of hyoscyamine (12%, p = .15). Less nausea occurred in the group that received 0.125 mg of hyoscyamine than in the other groups (p < .03). No patients in any of the groups had allergic or severe side effects. CONCLUSION: When compared with IV glucagon, oral hyoscyamine had fewer side effects, but the degree of colonic distension or abdominal distress was not significantly different. In addition, hyoscyamine is considerably less expensive than glucagon and can be given orally. Patients who received medications had less discomfort than those who did not. However, the degree of distension was not different.

Abdominal Pain↗
PubMed1992

In vivo analysis of gallstone composition by computed tomography.

In vivo computed tomography (CT) of the gallbladder was performed in 39 patients with known cholelithiasis and subsequently correlated with the chemical composition of the retrieved gallstones. Six CT patterns were identified: pattern 1, negative defect within the bile; pattern 2, nonvisualization of calculi; pattern 3, faint homogeneous central calcification; pattern 4A, thin rim of calcification; pattern 4B, thick rim of calcification; pattern 5, dense homogeneous central calcification. These CT patterns correlated well with cholesterol (p = 0.05) and calcium bilirubinate (p = 0.01) contents and CT attenuation values (p less than 0.001). The most common pattern was CT pattern 2 (56.5%). The authors conclude that there is good correlation of the CT pattern with gallstone composition. This simple approach can be used to help identify patients for therapy with chemical dissolution and/or lithotripsy.

Adult↗
PubMed1992

Computed tomography of primary transitional cell carcinoma of upper urinary tracts.

Preoperative computed tomography (CT) was utilized to evaluate 20 patients with primary transitional cell carcinoma of the upper urinary tracts. Of the 20 patients, 18 (90%) had CT visualization of the tumor as either a discrete mass or local ureteral and/or renal pelvic wall thickening; 2 (10%) had false-negative examinations. Seven of the 20 patients (35%) had CT evidence of tumor extension demonstrated by frank tumor invasion beyond the urothelium or by perirenal pelvic and/or periureteral fat streaks. Of the 4 patients with fat streaks, 2 (50%) had superficial tumors (T(A)T2), 1 had a T1 (25%) tumor, and 1 had a T3 (25%) tumor. All 3 patients with CT findings of direct extension of tumor through the wall of the ureter or renal pelvis had T3 tumors. Among the 13 with localized noninvasive tumor on CT, 5 (38%) had superficial tumors (TA, TIS, T1), 5 (38%) had T2 tumors, and 3 (21%) had T3 tumors. Of the 5 patients with enlarged regional lymph nodes (greater than or equal to 1.5 cm) on CT, 2 had tumor confirmed histologically, 2 had subsequent negative CT-guided biopsies, and 1 had a negative lymphadenectomy. Distant metastasis was discovered in 1 patient. The data suggest that when CT demonstrates direct tumor extension through the renal pelvic or ureteral wall, it is a sensitive indicator of high-stage disease. However, in the absence of this finding, CT is of limited value in staging patients with primary transitional cell carcinoma of the pyeloureteral system.

Carcinoma, Transitional Cell↗
PubMed1991

Magnetic resonance imaging detection of early experimental periostitis. Comparison of magnetic resonance imaging, computed tomography, and plain radiography with histopathologic correlation.

This study characterizes the appearance of periosteal reaction by magnetic resonance imaging (MRI), and evaluates the efficacy of MRI versus computed tomography (CT), and plain film radiography (PF) in detecting early, experimentally induced periostitis. Acute Staphylococcus aureus osteomyelitis was induced in 30 legs of 20 New Zealand white rabbits. The rabbits were then imaged with MR, contrast-unenhanced CT, and PF 4 days after infection. Histologically, periosteal elevation was present in 27 cases. Periosteal ossification was seen in 23 cases, and cellular reaction without ossification in 4 cases. Periosteal reaction was demonstrated by PF in 21 (78%) and by CT in 20 (74%) cases. Evidence of periostitis was seen by MR in all 27% (100%) cases. MR resulted in two false-positive diagnoses. Multiple concentric, alternating high and low signal arcs demonstrated by MR in 19 (70%) cases represented periosteal ossification surrounded by fibrous or granulation tissue. These findings demonstrate the ability of MR to detect periostitis despite the absence of periosteal ossification. MR was more sensitive than CT (P less than .05) or PF (P less than .05) in the detection of experimentally induced periostitis.

Acute Disease↗