Diagnostic Value of Serum Amylase Levels Indicating Computed Tomography-Defined Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Prospective Multicenter Observational Study.

Objective:Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis involves persistent serum amylase levels of 3 times or more the standard upper limit. However, these criteria were mostly based on retrospective studies and not necessarily supported by diagnostic imaging. Our prospective study aimed to investigate cutoff serum amylase levels suggesting post-ERCP pancreatitis using computed tomography as the criterion standard.Methods:We prospectively followed 2078 cases. Computed tomography was performed in patients whose serum amylase levels exceeded the institutional upper limit 12 to 24 hours after ERCP. Two expert radiologists blindly assessed the images and judged the presence or absence of pancreatitis. Correlations between serum amylase levels with pancreatitis were investigated using receiver operating characteristic analysis.Results:Amylase levels increased in 416 (23.2%) of 1789 cases included, and 350 cases were analyzed using computed tomography. Post-endoscopic retrograde cholangiopancreatography pancreatitis was diagnosed in 12.0% (214/1789). The cutoff amylase levels for judging pancreatitis after 12 to 24 hours was 2.75 times higher than the institutional upper limit, with an area under the curve of 0.77.Conclusions:The appropriate cutoff serum amylase level for judging post-ERCP pancreatitis at 12 to 24 hours after ERCP was 2.75 times higher than the institutional upper limit. These results may clarify the definition of post-ERCP pancreatitis

The effect of one-dose package on medication adherence for the elderly care in Japan.

Deterioration of the medication adherence for elderly could result in wasteful medical expenditure in a long-term span as well as aggravating the patient's medical condition. Objective: This study surveyed the effect of onedose package medication made up by a pharmacist on the patient's behavior towards medication, what is expected to be one of the measures to improve the medication adherence for elderly. Methods: With support activity of the Pharmacist Association in Ueda-city in Nagano Prefecture, Japan, the survey form of one-dose package was sent to 86 pharmacy directors located in Ueda-city. Results: The most frequent reasons of one dose packaging was �Patient�s request� though, �Large number of doses�, �Prevent the improper drug use� and �Improved medication adherence� which is considered that the pharmacists are willing to utilize one dose package for patient�s care in order to improve the medication adherence were chosen as well. The influences of one dose package for patient�s medication adherence were very positive, and most answers indicated that medication adherence was improved. Conclusion: It is noticed that the pharmacists were willing to dispense one dose packaging by own decision, not physician�s order, in order to improve the medication adherence, prevent improper drug use and optimize the medication therapy. It is also noticed that there are great improvement of patient�s compliance by one dose package, and patients felt advantage to reduce the improper drug use as well.RESUMEN El deterioro de la adherencia a la medicación en ancianos podría producir desperdicio del gasto médico a largo plazo así como agravar el estado de salud de los pacientes. Objetivo: Este estudio investigó los efectos de los paquetes de dosis unitarias hechos por farmacéuticos sobre la actuación de los pacientes sobre la medicación, lo que se espera que sea una de las medidas que mejoren la adherencia a la medicación en los ancianos. Métodos: Con el apoyo de la Asociación de Farmacéuticos de Ueda en la Prefectura de Nagano (Japón), se envió por fax a 86 directores de farmacia el cuestionario y las respuestas se recogieron por fax en junio de 2007. Resultados: La razón más frecuente de la realización de los envases de dosis unitaria fue �la demanda del paciente�, aunque también eligieron como respuesta �Gran numero de dosis�, �prevenir el uso inadecuado� y �Mejora de la adherencia a la medicación�, lo que da idea de que los farmacéuticos están dispuestos a utilizar los envases de dosis unitaria para que mejore la adherencia a la medicación de sus pacientes. Las influencias del envase de dosis unitaria sobre la adherencia a la medicación fueron muy positivas, y la mayoría indicó que mejoró la adherencia a la medicación. Conclusión: Se puede evr que los farmacéuticos estaban dispuestos a dispensar envases de dosis unitarias por su propia decisión, sin orden del médico, para mejorar la adherencia a la medicación, prevenir uso inapropiado de medicamentos, y optimizar el tratamiento farmacológico. También se ve que existe una gran mejoría en el cumplimiento del paicente con los envases de dosis unitaria, y los pacientes también sienten que reducen su uso inadecuado de medicamentos

A Case of Bilateral Decidualized Endometriomas during Pregnancy: Radiologic-pathologic Correlation

Clinical differentiation between decidualized endometrioma and malignant transformation still poses difficulties as both are intracystic vascularized excrescences of an endometrial cyst and exhibit similar characteristics on color-flow Doppler sonography. This is a characteristic sonographic finding associated with ovarian cancer, but MRI can provide further information about mural excrescences that can aid in their differential diagnosis; for example, the signal of decidualized endometriomas is isointense with the placenta within the uterus on all sequences and the apparent diffusion coefficient is higher than that of malignant mural nodules. Thus, MRI should be an aid in deciding whether to intervene during pregnancy. However, considering that it is not yet possible to clearly differentiate decidualized endometriomas from ovarian cancer, surgery or watchful observation may still be needed to exclude the possibility of malignancy

A Case of Bilateral Decidualized Endometriomas during Pregnancy: Radiologic-pathologic Correlation

Clinical differentiation between decidualized endometrioma and malignant transformation still poses difficulties as both are intracystic vascularized excrescences of an endometrial cyst and exhibit similar characteristics on color-flow Doppler sonography. This is a characteristic sonographic finding associated with ovarian cancer, but MRI can provide further information about mural excrescences that can aid in their differential diagnosis; for example, the signal of decidualized endometriomas is isointense with the placenta within the uterus on all sequences and the apparent diffusion coefficient is higher than that of malignant mural nodules. Thus, MRI should be an aid in deciding whether to intervene during pregnancy. However, considering that it is not yet possible to clearly differentiate decidualized endometriomas from ovarian cancer, surgery or watchful observation may still be needed to exclude the possibility of malignancy

Comparison among single-, bi-, and tri-phasic excretory phase for complete and adequate opacification of the upper urinary tracts.

<p>Comparison among single-, bi-, and tri-phasic excretory phase for complete and adequate opacification of the upper urinary tracts.</p

Homogeneity of the urinary bladder.

<p>Homogeneity of the urinary bladder.</p

Comparison among single-phasic excretory phase for complete and adequate opacification of the upper urinary tracts and the urinary bladder.

<p>Comparison among single-phasic excretory phase for complete and adequate opacification of the upper urinary tracts and the urinary bladder.</p

Opacification scores of the urinary systems.

<p>Opacification scores of the urinary systems.</p