Background/Aims: The diagnostic potential of magnetic resonance cholangiopancreaticography (MRCP) has improved as a result of evolving technique. MRCP has the advantage of negligible morbidity and mortality in contrast to endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate MRCP as a replacement for diagnostic ERCP for the suspicion of common bile duct (CBD) stones. Methods: From 1998 to 2001, MRCP was performed in 202 patients with a suspicion of CBD stones based on medical history (MH), cholestatic liver function tests (CL), both MH and CL or other reasons. ERCP was performed in all patients where MRCP indicated the presence of CBD stones and in those patients with a persistent strong clinical suspicion for CBD stones despite a negative MRCP. Results: In 25 patients, MRCP suggested CBD stones which were proven with ERCP in 24 patients. Despite a negative MRCP, 27 patients had a subsequent ERCP. None of these patients appeared to have CBD stones. In this group, MRCP resulted in 100% sensitivity and 96% specificity in detecting CBD stones. Follow-up of all patients revealed 5 more patients with persistent clinical suspicion or cholestatic liver function values. Assuming CBD stones in these patients, MRCP had a sensitivity of 83 % and a specificity of 99% for this diagnosis. Conclusion: In the case of CBD stone suspicion, MRCP should be the diagnostic procedure of choice.
Fifty patients with suspected renal artery stenosis (RAS) were studied with renal scintigraphy before and after administration of captopril. Twenty-three patients had RAS (greater than or equal to 75% RAS or greater than or equal to 50% RAS with poststenotic dilatation) and 27 had normal renal arteries at angiography. Angiotensin-converting enzyme inhibitors were discontinued 24 hours prior to renal scintigraphy; all other medications were continued. Each patient was evaluated with a simplified captopril renal scintigraphic protocol: renal imaging after administration of 12 mCi (444 MBq) of technetium-99m diethylenetriaminepentaacetic acid (DTPA), a 3-hour wait, oral administration of 50 mg of captopril, a 1-hour wait, and another scintigram obtained after administration of 12 mCi (444 MBq) of Tc-99m DTPA. Times of peak renal activity (Tmax) were determined from renal time-activity curves, and glomerular filtration rates (GFRs) were calculated with the Gates technique. A Tmax greater than or equal to 11 minutes after injection or a GFR ratio (larger GFR/smaller GFR) greater than 1.5 enabled detection of RAS with 91% sensitivity, 93% specificity, and 92% accuracy. Renal scintigraphy without captopril had only 43%-68% sensitivity in detecting RAS, depending on the criteria used.
Changes in intraovarian arterial blood flow were monitored by means of colour-coded and pulsed Doppler ultrasonography in Beagle bitches during the normal oestrous cycle (n = 11) and pregnancy (n = 3), and at PGF(2alpha)-induced luteolysis (n = 4). The ultrasonographic findings were related to the reproductive stage of the bitch, as determined by vaginoscopical and cytological criteria, and by the concentrations of oestradiol, LH and progesterone in peripheral blood plasma. Colour-coded Doppler ultrasonography was used to visualize and estimate intraovarian vascularization, and pulsed Doppler ultrasonography was used to measure the arterial blood flow. The systolic and diastolic peak velocities, the end-diastolic velocity, and the pulsatility index and resistance index were calculated for quantitative analysis of the Doppler waveforms. Intraovarian perfusion increased gradually during pro-oestrus. A marked enhancement of intraovarian colouring and blood flow velocities, and a decline in the indices for pulsatility and resistance were observed in the preovulatory period. Maximum perfusion was observed at ovulation and during the early luteal phase. Significant differences (P < 0.05) were detected for the values of all calculated Doppler parameters 2 days before and 2 days after ovulation. Intraovarian blood flow decreased gradually in accordance with luteal regression. Treatment with PGF(2alpha) caused a distinct decline in luteal activity and a concomitant reduction in intraovarian perfusion. The values of blood flow parameters found during the luteal phase of pregnant bitches were comparable to those of the normocyclic bitches. Doppler ultrasonography of the intraovarian arteries in bitches provides complementary information about cyclic changes of ovarian function.
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