Risks of contrast media applied via the gastrointestinal route

Prevalence of digestive disorders associated with imported Chagas disease (PADChI study): an observational study

BACKGROUND

Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10-20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care.

METHODS

An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated.

RESULTS

After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25-62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25-45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram.

CONCLUSIONS

The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered.

Delayed hypersensitivity reaction after oral intake of non-ionic iodinated contrast medium

Following intravenous contrast medium (CM) injection, a small proportion of patients acquires hypersensitivity reactions that occur either immediately or non-immediately (delayed). Although it is now claer that even oral applied CMs are able to cause adverse reactions, many radiologists as well as physicians of other disciplines, still believe that CM-application via the gastrointestinal route does not induce hypersensitivity reactions. Since this kind of misinterpretation may harm the patient, education on this topic is still necessary. Therefore, we describe a case who acquired a delayed hypersensitivity reaction following the oral intake of a non-ionic iodinated CM.

Three-dimensional design of a geometric model for an ocular prosthesis in ex vivo anophthalmic socket models

PURPOSE

Fitting a customized ocular prosthesis for anophthalmic patients entails an artisanal labour-exhausting process and is standardly based on impression moulding of the socket, which may be anatomically inaccurate. The objective of the study was to design an impression-free socket mould with three-dimensional (3D) technology.

METHODS

The ex vivo anophthalmic socket models included one silicone, one fresh pig cadaver head and three fresh-frozen human cadaver heads. After intra-socket application with iodine substance, five observers obtained eighteen low-dose cone beam computed tomography (CBCT) scans and one observer one high-dose CBCT scan of each model. The observers designed non-impression 3D moulds of the socket with 3D software. For the human cadaver sockets 3D geometric models of the ocular prosthesis were rendered from the 3D mould of the socket and the mirrored cornea of the contralateral eye.

RESULTS

The posterior surface of the 3D mould was highly accurate, with a mean absolute deviation of 0.28 mm, 0.53 mm, 0.37 mm and mean upper deviation of 0.53 mm, 0.86 mm, 1.17 mm, respectively, for the phantom, pig and human model. The intra- and interobserver repeatability and reproducibility of the 3D moulds and designs was good (<0.35 mm). The largest variation in the 3D geometric model was found at the junction of the 3D mould and mirrored cornea.

CONCLUSION

3D design of an impression-free geometric model for an ocular prosthesis with low-dose CBCT is highly accurate in ex vivo anophthalmic socket models. This novel method is a critical step towards the manufacturing of 3D printed ocular prostheses and requires validation in anophthalmic patients.