Water-soluble Contrast Medium Research Articles

Lymphangiography Using Water-Soluble Contrast Media and Cone-Beam CT-Guided Sclerotherapy to Treat Infrainguinal Lymphatic Leak.

Lymphangiography Using Water-Soluble Contrast Media and Cone-Beam CT-Guided Sclerotherapy to Treat Infrainguinal Lymphatic Leak.

Prognostic value of CT findings for conservative treatment failure in adhesive small bowel obstruction.

This study aimed to identify the radiological CT findings that are significantly correlated with the outcome of conservative management with oral water-soluble contrast medium in patients presenting with Adhesive Small Bowel Obstruction (ASBO) to the Emergency Room. In this retrospective single-center study, we considered all consecutive patients admitted to the ER from February 2019 to February 2023 for ASBO with an available contrast-enhanced CT scan performed at diagnosis and treated with conservative management. The investigated CT findings were type and location of transition zone, ASBO degree, fat notch sign, beak sign, small bowel feces sign, presence of peritoneal free fluidand pneumatosis intestinalis. Radiological parameters were analyzed using univariable and multivariable logistic regression to test the significant association between the CT parameters and the target. Among the 106 included patients (median age 74.5years), conservative treatment was effective in 59 (55.7%) and failed in 47 (44.3%), needing delayed surgery. In the failure group, there was a higher prevalence of patients who had previous ASBO episodes (p = 0.03), a greater proportion of females (p = 0.04) and a longer hospital stay (p < 0.001). At multivariable analysis, two CT findings were significantly correlated with failure of conservative treatment: fat notch sign (OR = 2.95; p = 0.04) and beak sign (OR = 3.42; p = 0.04). Two radiological signs correlate with failure of non-operative management in ASBO, suggesting their importance in surgical decision-making. Patients presenting with these signs are at higher risk of unsuccessful conservative treatment and may require undelayed surgical intervention.

O-023 Does flushing with oil-based contrast during hysterosalpingography (HSG) increase the live birth rate as compared to water-based contrast: a prospective cohort study

Abstract Study question What is the effectiveness of oil-based contrast during HSG compared to water-based contrast? Summary answer HSG with oil-based contrast increased the live birth rate as compared to water-based contrast. What is known already Tubal flushing has long been thought to increase live birth rate in infertile couples. A large randomised clinical trial (RCT) in The Netherlands confirmed the long-term hypothesis that HSG with oil-based contrast (Lipiodolâ) increased the live birth rate as compared to HSG with water-based contrast. We assessed whether this treatment effect was also achieved with oil-based contrast in Chinese women. Study design, size, duration We performed a prospective cohort study between May 4, 2020 and March 30, 2022. A total of 1187 women were included in the analysis.These women were categorized into two groups based on the contrast they used: the Oil-Soluble Contrast Media (OSCM) group, which employed poppy seed oil, consisting of 569 cases, and the Water-Soluble Contrast Media (WSCM) group, which used iodixanol, comprising 618 cases. Participants/materials, setting, methods This study was conducted at Shanghai Jiao Tong University International Peace Maternity and Child Health Hospital .The primary outcome was ongoing pregnancy rate within 6 months after the examination.Secondary outcomes included clinical pregnancies, miscarriage, ectopic pregnancy and thyroid Stimulating Hormone. Main results and the role of chance The ongoing pregnancy rate of the oil group is significantly higher than that of the water group (24.1% versus 17.2%, rate ratio [RR], 1.53; 95% confidence interval [CI], 1.14 to 2.06; P = 0.004). Women in the oil group also achieved higher clinical pregnancy rate (32.2% versus 22.2%, RR, 1.67; 95% CI, 1.27 to 2.18, P &amp;lt; 0.001), higher live birth rate (23.9% versus 16.8%, RR, 1.56; 95% CI, 1.16 to 2.09, P = 0.003), and bore higher risk of miscarriage (8.0% versus 5.0%, RR, 1.67; 95% CI, 1.02 to 2.72, P = 0.04) than water group. Limitations, reasons for caution The sample size along with the data was obtained from a cohort study in a single center. Wider implications of the findings Tubal flushing with oil-based contrast medium is an effective treatment to improve the pregnancy outcomes of infertile women that should be part of every infertility work-up. Trial registration number not applicable

Success rate and predictors of failure of enema reduction of intussusception in children with a water-soluble contrast medium at a height of 120 cm or less.

This study investigates the reduction rate and failure predictors of hydrostatic enema reduction for intussusception. The procedure typically begins with a water-soluble contrast medium at 90 cm above the patient, subsequently elevated to 120 cm. Our focus is on the reduction rate during initial attempts when the contrast medium is positioned at or below 120 cm from the patient. Hydrostatic enema reductions for intussusception, performed between March 2010 and May 2022 at Tokyo Metropolitan Children's Medical Center, were investigated retrospectively. The initial attempts involved one or more trials. The clinical characteristics, treatment modalities, and outcomes were analyzed. Logistic regression was used to identify the predictors of failure when the reduction was performed with the water-soluble contrast medium at a height of 120 cm or less. Reduction was achieved successfully with the water-soluble contrast medium at a height at or below 120 cm in 77.5% of 351 patients. When reductions performed at heights greater than 120 cm were included, 333 (94.9%) were successful during the initial attempts and were unaccompanied by complications. Predictors of failure of reductions performed at or below 120 cm were age less than 12 months and the presence of trapped fluid. The present study found a successful reduction rate of 77.5% during the initial attempts, suggesting that a height greater than 120 cm may yield an even greater success rate. Children aged below 12 months and those with trapped fluid may have a greater failure risk during the initial attempts.

Successful management of malignant colovesical fistula using covered colonic self-expanding metallic stent: a case report

BackgroundA colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of successful fistula closure and avoidance of colostomy after placement of a covered colonic self-expanding metallic stent (SEMS) as a palliative treatment for a malignant CVF.Case presentationA 75-year-old man undergoing infusional 5-fluorouracil and irinotecan chemotherapy plus bevacizumab for recurrent peritoneal dissemination of rectal cancer was admitted to our hospital because of fecaluria with a high-grade fever. Blood tests showed a moderate inflammatory reaction (white blood cell count, 9200/mm3; C-reactive protein, 11.03 mg/dL; procalcitonin, 1.33 ng/mL). Urinary sediment examination showed severe bacteriuria. Abdominal contrast-enhanced computed tomography showed intravesical gas, thickening of the posterior wall of the bladder, and irregular thickening of the sigmoid colon wall contiguous with the posterior bladder wall. Magnetic resonance imaging (MRI) clearly showed a fistula between the bladder and sigmoid colon. Colonoscopy revealed a circumferential malignant stricture 15 cm from the anal verge, and a fistula to the bladder was identified by water-soluble contrast medium. We diagnosed a complicated urinary tract infection (UTI) associated with a CVF due to peritoneal dissemination and started empirical treatment with sulbactam/ampicillin. Given the absence of active inflammatory findings around the fistula on MRI and the patient’s physical frailty, we decided to place a covered SEMS to close the fistula. Under fluoroscopic and endoscopic guidance, a covered colonic SEMS of 80-mm length and 20-mm diameter was successfully deployed, and the fistula was sealed immediately after placement. Urine culture on day 3 after stenting was negative for bacteria, and a contrast study on day 5 showed no fistula. The patient was discharged home on day 6 with no complications. The UTI did not recur for 4 months after discharge.ConclusionsA covered colonic SEMS was useful for sealing a malignant CVF in a patient unfit for surgery, and MRI was valuable to determine the status of the fistula. A covered colonic SEMS could be an alternative to surgical treatment for CVFs in patients who require palliative care.

Modified whole-body postmortem computed tomography angiography using neck approach

BackgroundThe use of radiologic imaging methods in postmortem practice has been advent since the discovery of X-rays. However, with advancement in technology and the emergence of multi-detector computed tomography (MDCT), computed tomography angiography (CTA) and magnetic resonance imaging (MRI) in clinical radiology, several centers around the world have begun using these methods as an adjunct to conventional autopsy. The aim of this study is to introduce a modified protocol for whole-body postmortem computed tomography angiography (PMCTA) based on body weight and neck approach as an alternative to the different PMCTA approaches currently available as most previous studies concentrated on the use of femoral approach for whole-body PMCTA with neck approach for selective or targeted PMCTA.MethodsThis was a prospective, double-blinded, cross-sectional study performed on 60 subjects with a mean age of 45.6 years and weight ranging between 43 and 112 kg utilizing ionized water-soluble contrast medium mixed with polyethylene glycol (polyethylene glycol 200).ResultsPMCTA using neck dissection showed promising results with good image quality and diagnostic capabilities assisting the forensic pathologists in determining the final cause of death with a strong correlation between both radiologists and pathologists in 86.7% of cases.ConclusionsThis study showed that the modified infusion protocol based on body weight using the neck approach provided a good depiction of the vascular system down to the level of the small supplying vessels similar to the other different approaches for PMCTA.

Recanalization of Proximal Fallopian Tube Obstruction in the Treatment of Infertility.

Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization (FTR) can result in up to 100% technical success rate with pregnancy rates of 12.8 to 51%. More pregnancies occur when oil-soluble contrast media are used versus water-soluble contrast media. Complications of FTR are rare and include tubal perforation, ectopic pregnancy, and pelvic infection. Reocclusion of fallopian tubes may occur in 20 to 50% of patients; however, FTR may be repeated in these cases. Overall, FTR is underutilized in the treatment of infertility secondary to proximal FTO and it can obviate costly and time-consuming assistive reproductive techniques such as in vitro fertilization in some patients, as well as decreasing physical and emotional stress.

Easily missed pediatric handlebar injury.

A 12-year-old girl, who fell from her bicycle, presented to the emergency department with severe epigastric pain and vomiting. Physical examination revealed torso contusion with a circular handlebar bruise over the upper anterior abdomen (Fig. 1a). Focused assessment with sonography for trauma (FAST) revealed no obvious fluid accumulation. Laboratory tests indicated elevated serum amylase (252 U/L) and lipase (>400 U/L) levels. Therefore, intravenous contrast-enhanced computed tomography (CT) with oral water-soluble contrast medium was performed to assess for any internal traumatic injury.

Overview of findings on radiographic examination of sialography in patients with sialolithiasis: case serial

Background: Sialolithiasis is the most common salivary gland disease. Salivary gland disease usually occurs in middle age, with an incidence of 12 in 1000 in the adult population. The peak incidence is between the ages of 30 and 50. Sialolithiasis generally occurs in the submandibular gland. Sialoliths can be single or multiple. Diagnosis of sialolithiasis can be based on clinical examination or simple supporting examination in the form of sialography. Case Report: There were 3 patients with the main complaint of pain in the lower jaw area with similar symptoms, such as swelling and discomfort every time they chewed food. In all three patients, conventional plain radiographs were examined, namely Skull AP photos, followed by conventional radiological examinations using water-soluble contrast media known as sialography. Conclusion: Correct diagnosis and determine the appropriate treatment for the patient. Plain AP skull radiographs can be used as an early indication of the presence or absence of sialolith images, although they may not be visible if they are relatively small. Furthermore, sialography examination can become the gold standard in determining the location and size of sialoliths. In these three cases, an opacity or filling defect, accompanied by a dilatation of the proximal duct and even narrowing of the distal lumen of the duct, indicates either partial or total obstruction. An ultrasound examination was performed to confirm the diagnosis. In all three cases, it was found that there was indeed a hyperechoic surrounded by clear anechoic (saliva), thus suggesting a sialolithiasis.

PROSEDUR PEMERIKSAAN LOPOGRAFI DENGAN KLINIS SUSPECT COLON CARCINOMA

ABSTRACT&#x0D; Background :The lopographic examination according to Lampignano and Kendrick (2018) uses barium sulfate contrast media which is inserted through the stoma, using plain photos, AP/PA, Lateral, Oblique, post evacuation. Installation of Radiology Hospital Prof. Dr. Margono Soekarjo Purwokerto using a non-ionic water soluble contrast media mixed with NaCl, inserted into the proximal stoma and anus with plain photos, AP, Lateral. The purpose of the study was to determine the lopographic examination procedure, the reasons for using water soluble contrast media, to find out anatomical information from the AP and Lateral.&#x0D; Methods :This research used qualitative approach with a case study. Data collection were used observation, interviews, documentation. Research respondents were patients, radiographers, radiologist, and dispatching doctors. Data analysis with interactive analysis model.&#x0D; Result : Showed that the lopographic examination was aimed at evaluating the colon after colostomy and chemotherapy. Patients undergo special preparation. The water soluble contrast medium was mixed with NaCl in a ratio of 1: 4 because it was safer than barium sulfate. The reason for insertion of contrast media through the proximal stoma and anus is the absence of a stoma to the distal colon. Anatomical information from the plain photo is the distribution of air in the colon, the AP projection looks contrast to fill the ascending colon, transverse colon, descending colon and superpositioned sigmoid colon. Laterally, the sigmoid colon and rectum are seen. Diagnostic information was not found in colonic carcinoma residif cells.

For women with subfertility, how does tubal flushing with oil-soluble contrast media (OSCM) compare with water-soluble contrast media (WSCM)?

For women with subfertility, how does tubal flushing with oil-soluble contrast media (OSCM) compare with water-soluble contrast media (WSCM)?

Hysterosalpingography as treatment and diagnostic tool in the management of infertility in NigeriaHysterosalpingography as treatment and diagnostic tool in the management of infertility in Nigeria

Hysterosalpingography (HSG) is a diagnostic modality still commonly used to evaluate tubal occlusion in infertility management. We evaluated the treatment benefit in achieving tubal patency and spontaneous pregnancy in women with bilateral tubal occlusion in our resource poor setting using water soluble contrast medium. Objective: To assess the proportion of women that achieved tubal patency and spontaneous pregnancy following a repeat HSG in the evaluation of infertility and the associated factors. Materials and Method: This is a retrospective study of 37 out of 180 women who achieved tubal patency and pregnancy after repeat HSG in the course of infertility evaluation over a period of 18 months. Result: Out of 180 patients with bilateral tubal occlusion that had the repeat HSG, 37 achieved tubal patency (20.5%) and from which 24 became pregnant. This gave a pregnancy rate of 13.3%. The mean age of the participants was 35.76 ± 4.72 years. The age group of 36-40 years had the highest frequency while most of them were nulliparous and had left tubal occlusion at the distal portion. Conclusion: Tubal patency and spontaneous pregnancy were achieved following repeat HSG in women with bilateral tubal occlusion undergoing infertility evaluation. HSG has both diagnostic and treatment uses in infertility management and it is cost effective.

Clinical and growth outcomes after meconium-related ileus improved with Gastrografin enema in very low birth weight infants.

Meconium-related ileus in very low birth weight infants can lead to increased morbidity or mortality and prolonged hospitalization without prompt diagnosis and treatment. This study primarily aimed to identify the incidence of and factors associated with meconium-related ileus and secondarily sought to investigate clinical and growth outcomes after water-soluble contrast media (Gastrografin) enema. We retrospectively reviewed medical records of very low birth weight infants born between February 2009 and March 2019 in the neonatal intensive care unit of a single medical center. Perinatal factors, clinical outcomes, and growth outcomes were compared between the group with meconium-related ileus that received Gastrografin enema and the control group. Twenty-four (6.9%) patients were diagnosed with meconium-related ileus among 347 very low birth weight infants. All achieved successful evacuation of meconium with an average of 2.8 (range: 1-8) Gastrografin enema attempts without procedure-related complications. Initiation of Gastrografin enema was performed at mean 7.0 days (range: 2-16) after birth. Incidences of moderate to severe bronchopulmonary dysplasia were higher and the duration of mechanical ventilation and need for oxygen were longer in the meconium-related ileus group (P = 0.039, 0.046, 0.048, respectively). Meconium-related ileus infants took more time to start enteral feeding and the nothing per oral time was longer (P = 0.001 and 0.018, respectively). However, time to achieve full enteral feeding and Z-scores for weight and height at 37 weeks and at 6 months corrected age did not differ between the two groups. Gastrografin enema in very low birth weight infants with meconium-related ileus was an effective and safe medical management. Following Gastrografin enema, very low birth weight infants with meconium-related ileus achieved similar subsequent feeding progress and similar growth levels as the control groups without meconium-related ileus.

Usefulness of ethiodized oil and gelatin sponge particles for delaying the washout of indocyanine green from the liver in swine

PurposeTo assess the effect of ethiodized oil (EO) and gelatin sponge particles (GS) on delaying the washout of indocyanine green (ICG) from the liver in swine.MethodsFifteen swine were divided into 3 groups: injection of a mixture of ICG and water-soluble contrast medium (CM) followed by embolization with GS (group A), injection of a mixture of ICG and EO (group B) and injection of a mixture of ICG and EO followed by embolization with GS (group C). The liver surface was observed using an infrared camera system during and at 1, 2, 3, and 6 h after the procedure to measure ICG contrast. Livers were removed at 6 h for histopathological examination.ResultsThe contrast ratio between injected and non-injected regions at 6 h was 1.45 ± 0.44 in group A, 1.89 ± 0.37 in group B, and 3.62 ± 0.76 in group C. The contrast ratio in group C was significantly greater than that in groups A and B (P = 0.032 and 0.033, respectively).ConclusionsEO and GS delayed the washout of ICG from the liver in swine and may extend intraoperative navigation in clinical use.Condensed abstractIndocyanine green (ICG) mixed with ethiodized oil (EO) was injected into the left hepatic artery in swine, and the artery was embolized with gelatin sponge particles (GS). We confirmed that ICG remained in the liver parenchyma up to 6 h after the procedure. EO and GS delayed the washout of ICG from the liver in swine.

Does Laparoscopic Adhesiolysis Decrease the Risk of Recurrence in Small Bowel Obstruction and Who Benefits the Most from Laparoscopic Approach? A literature review.

Adhesions are usual sequelae of almost all abdominal surgery and their incidence increases with multiple explorations. One of the most common reasons for emergency general surgery is Small bowel obstruction due to adhesions (ASBO). The patients usually have classic signs and symptoms of intestinal occlusion and many will be treated by non-operative measures and ingestion of a water-soluble contrast medium. Some patients may not respond to conservative measures and will need surgical exploration and around 46% will end up in further episodes of intestinal obstruction. Laparoscopy has been utilized in these cases recently in contrast to the earlier belief that rendered it relatively contraindicated in the past. Laparoscopy has been advantageous in causing less pain, early mobilisation, and fast return of the bowel function, along with the low incidence of further adhesion formation, thus fewer recurrence rates of small bowel obstruction. We carried out a non-systemic search of the available literature (Pub Med, Google Scholar) to determine whether laparoscopic adhesiolysis decreases the risk of recurrence in patients with small bowel obstruction or not and to see which patients are suitable for laparoscopic adhesiolysis. We concluded that each patient should be individualised as this approach allows many patients with possible benefits from minimally invasive surgery. However, randomised control trials are needed to properly delineate the benefits of laparoscopic adhesiolysis over the conventional open procedures in the form of long-term outcomes and recurrence rates.

Intranodal CT Lymphangiography with Water-soluble Iodinated Contrast Medium for Imaging of the Central Lymphatic System.

Background Dynamic contrast-enhanced MR lymphangiography (DCMRL) is the reference standard used to diagnose various thoracic lymphatic disorders, such as traumatic chylothorax and plastic bronchitis. However, accessibility and logistical challenges have prevented the wide dissemination of this technology. Purpose To evaluate the feasibility of intranodal CT lymphangiography (ICTL) in the diagnosis and planning of subsequent intervention in patients with thoracic lymphatic disorders. Materials and Methods In this retrospective review, five women suspected of having lymphatic abnormalities (ranging from traumatic chylothorax to plastic bronchitis) and with contraindications to MRI underwent ICTL from September 2019 to May 2020. Needles (25 gauge) were placed in the bilateral inguinal lymph nodes with US guidance, and water-soluble iodinated contrast material was injected. CT fluoroscopy was used to monitor the opacification of the cisterna chyli to determine the timing of CT. After ICTL, the thoracic duct was catheterized, and lymphangiography was performed through the thoracic duct catheter. The ICTL and subsequent lymphangiographic findings were then visually compared by using three-dimensional reconstructions. Results Intranodal injection of water-soluble contrast medium was successful in all patients evaluated (five women; mean age, 68 years ± 11 [standard deviation]; range, 53-83 years). The central lymphatics were opacified in four of the five women, demonstrating abnormal pulmonary lymphatic flow from the thoracic duct into the lung parenchyma. In one of the five women, thoracic duct injection showed successful ligation of the thoracic duct. The time elapsed from injection of contrast medium to visualization of the thoracic duct ranged from 2 to 27 minutes. ICTL and lymphangiographic findings matched well. Conclusion Intranodal CT lymphangiography sufficiently depicted central lymphatic anatomy in patients with lymphatic abnormalities, thereby demonstrating its use as a feasible alternative to more technically challenging methods, such as dynamic contrast-enhanced MR lymphangiography. © RSNA, 2021.

Evaluating Fallopian Tube Patency: What the Radiologist Needs to Know.

Impaired tubal patency accounts for up to 35% of cases of subfertility and infertility. Hysterosalpingography (HSG) or hysterosalpingo-contrast sonography (HyCoSy) represents a first-line test in evaluating fallopian tube patency. Despite the association of HSG with ionizing radiation, HSG is a reference standard in assessing fallopian tube patency and tubal conditions such as tubal occlusion, salpingitis isthmica nodosa, and hydrosalpinx. HSG is widely available and utilizes either a water-soluble contrast medium (WSCM) or an oil-soluble contrast medium (OSCM). Compared with WSCM, HSG with OSCM results in a higher incidence of non-in vitro fertilization pregnancies and, therefore, may be preferred in women younger than 38 years with unexplained subfertility. HSG may also be helpful in assessment after sterilization or before fallopian tube recanalization. US-based tubal tests are free of ionizing radiation and include HyCoSy, with either air-saline or microbubble US contrast material, and hysterosalpingo-foam sonography (HyFoSy), a tubal patency test that utilizes a gel foam. A comprehensive US infertility evaluation of the pelvis and fallopian tubes can be achieved in one setting by adding coronal three-dimensional imaging of the uterus, saline infusion sonohysterography, and HyCoSy or HyFoSy to routine pelvic US. MR HSG and virtual CT HSG also depict tubal patency and uterine and adnexal pathologic conditions and may be considered in select patients. While laparoscopic chromopertubation remains the standard for tubal patency evaluation, its disadvantages are its invasiveness and cost. Knowledge of the different fallopian tube tests and radiologic appearance of normal and abnormal fallopian tubes results in fewer pitfalls, accurate interpretation, and optimal patient care. Online supplemental material is available for this article. ©RSNA, 2021.

P–320 Endometrial flushing to improve fertility outcomes: a systematic review and meta-analysis

Abstract Study question Does flushing the endometrial cavity improve fertility outcomes in couples with infertility and what are the preferred flushing mediums? Summary answer Flushing the endometrial cavity appears to improve live birth rate, implantation rate and clinical pregnancy rate. There was no difference in miscarriage or complication rate. What is known already Live birth rate was improved in cleavage-stage transfer when the uterus was flushed with human chorionic gonadotropin (hCG) at a dose &amp;gt;500 IU in a Cochrane review (Craciunas L et al 2018). Chemical and clinical pregnancy rates and implantation rate may be improved by endometrial flushing with platelet-rich plasma (PRP) in a meta-analysis by Maleki-Hajiagha A et al 2020. Flushing the cavity with oil-based contrast at hysterosalpingography (HSG) improved pregnancy rates when compared with water-based contrast in a systematic review by Fang F et al 2018. Study design, size, duration Our study was a systematic review and meta-analysis. We searched MEDLINE (1946 to December 2020), Embase (1980 to December 2020), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1961 to 9 December 2020) PsychINFO (1806 to December 2020). We screened the titles of search results to identify studies for inclusion and then screened abstracts and full texts to ensure trials met search criteria. Participants/materials, setting, methods We included in this review all randomised controlled trials (RCTs), quasi-experimental or cohort studies evaluating intrauterine instillation or flushing with any medium, irrespective of timing of intervention and irrespective of language or country of origin. We performed the meta-analyses using a random-effects model and performed subgroup and sensitivity analysis. Two authors independently extracted the data. We calculated the risk ratio or odds ratio with 95% confidence intervals based on intention-to-treat or available data analysis. Main results and the role of chance We included 36 RCTs and 12 non-randomised trials including 12230 participants. The sample size varied from 15 to 1186. We included 11 comparisons. Primary outcomes were healthy baby rate and live birth rate. Healthy baby rate was not reported in any of the trials. Live birth rate favoured oil soluble contrast medium (at HSG) when compared to water based contrast medium (OR 0.64, 95% CI 0.52 to 0.78, 2 RCTs and 1 cohort study, 2050 participants, I2 = 86%) or no intervention (OR 3.53, 95% CI 1.64 to 7.60, 2 RCTs, 192 participants, I2 = 0%). With regards to our secondary outcomes: CSF instillation, HCG instillation, PRP instillation and oil-soluble contrast medium at HSG (over water-soluble contrast medium) were favoured for implantation rate and clinical pregnancy rate. There was no statistically significant difference in miscarriage or complication rate for any of the comparisons. All trials were at an overall high risk of bias when assessed on the following areas: sequence generation, allocation concealment, blinding of participants, personnel, and outcome assessors, incomplete outcome data, selective outcome reporting, and other sources of bias. Limitations, reasons for caution Only 36 studies included were RCTs. Twelve of the RCTs had post randomisation drop outs. There was a lack of detail on the instillation medium for several of the included studies. There was no placebo used in many of the control groups. All meta-analyses had high levels of heterogeneity. Wider implications of the findings: Our findings are in keeping with the literature suggesting a possible improvement in live birth rate following flushing the endometrium with oil soluble contrast medium when compared with a control group. Mechanistic studies are now required to understand how oil-based medium improves fertility. Trial registration number NA

Cost-effectiveness modelling of three different hysterosalpingography diagnostic strategies in addition to standard fertility management for couples with unexplained infertility in the United Kingdom

Previous studies have demonstrated hysterosalpingography (HSG) in general, and specifically with an oil-soluble contrast medium, directly increases pregnancy rates. Decision modelling was performed to compare fertility management using three HSG diagnostic strategies: (i) water-soluble contrast medium (WSCM)-HSG; (ii) Lipiodol® Ultra Fluid (LUF)-HSG; and (iii) No HSG, for women aged ≤39 years with unexplained infertility. Four reimbursement scenarios were modelled to reflect the various funding arrangements across the regions of the United Kingdom. Compared with WSCM-HSG, the live birth rates after 24 months increased by 3.4% with LUF-HSG and decreased by 2.7% with no HSG. From a patient perspective, fertility management with LUF-HSG is the most cost-effective strategy with cost-savings ranging from £299 to £857 per patient depending on the funding arrangement for IVF. From an NHS perspective, fertility management with LUF-HSG is cost-effective when 2 or more IVF cycles are NHS-funded. If none of the IVF cycles are NHS-funded, fertility management with LUF-HSG can be considered cost-effective if society is willing to pay £8,353 for an additional live birth. The findings from this analysis suggest that fertility management with WSCM-HSG is cost-effective compared to no HSG and LUF-HSG is the most cost-effective with increased live birth rates after 24 months.

Ultrasound-guided hydrostatic enema reduction of intussusception and confirmation with single abdominal radiograph in children.

To detect false-positive reduction results after ultrasound (US)-guided hydrostatic intussusception reduction, we have incorporated water-soluble contrast material to the enema fluid and confirmed the reduction with a single abdominal radiograph. We present the results of the combined imaging method for the reduction of intussusception in children. The records of the patients who were treated for intussusception were analyzed retrospectively. Patients were divided into two groups: a US-guided reduction group and a US-guided reduction plus radiographic control group. The patient characteristics, symptoms, treatment methods, outcomes, and complications and follow-up were analyzed. A total of 164 intussusception episodes were treated in 153 patients. Hydrostatic reduction of intussusception was performed in 59 patients in the US-guided group and in 94 patients in the US-guided plus radiographic control group. Recurrence rate in the US-guided group was 15.7%, vs 3.5% in the US-guided plus radiography group (P = .029). In the US-guided plus radiographic control group, 5 (5.3%) false positive reductions under US guidance were determined by abdominal radiography. In order to decrease false positive reduction rate and early recurrence, US-guided intussusception reduction can be performed with saline plus water-soluble contrast material and confirmation of reduction obtained with a single direct abdominal radiograph.