Gd-EOB-DTP-enhanced MRC in the preoperative percutaneous management of intra and extrahepatic biliary leakages: Does it matter?

Postoperative bile leakage is a common complication of abdominal surgical procedures and a precise localization of is important to choose the best management. Many techniques are available to correctly identify bile leaks, including ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI), being the latter the best to clearly depict "active" bile leakages. This paper presents the state of the art algorithm in the detection of biliary leakages in order to plan a percutaneous biliary drainage focusing on widely available and safe contrast agent, the Gb-EOB-DPA. We consider its pharmacokinetic properties and impact in biliary imaging explain current debates to optimize image quality. We report common sites of leakage after surgery with special considerations in cirrhotic liver to show what interventional radiologists should look to easily detect bile leaks

Seasonal and monthly variation in occurrence of hypertensive urgency.

The analysis included all consecutive cases of hypertensive urgency admitted to the Emergency Department (ED) of the Hospital of Varese between December 2010 and 2011. Patients with hypertensive emergency (SBP ≥180 or DBP ≥110 mmHg), associated with target organ damage/dysfunction [4], were not included in the analysis, to avoid possible confounding factors. The BP was measured at admission to the ED, at least three times within 1 h, in a sitting position, by trained nurses. For the purpose of the study the mean of the last two values was used. For data analysis, the day of hypertensive urgency onset was categorized both into twelve 1-month intervals and four 3-month intervals (spring: 21st March–20th June, summer: 21st June–22nd September, fall: 23rd September–20th December, winter: 21st December–20th March). The monthly distribution of hypertensive urgency onset during the year was tested for uniformity in the overall population and in the various subsets by the χ 2 test for goodness of fit. Chronobiological analysis was performed by applying partial Fourier series to the monthly data using the Chronolab software. Details of the analysis are available upon request. Significance levels were set at P < 0.05. During the considered period, 360 subjects (mean age 67.1 ± 14.3 years, 243 women) were included. Baseline characteristics are summarized in Table 1. The peak number of hypertensive urgency episodes occurred in December (n = 45 or 12.5 %) and the nadir in May (n = 15 or 4 %), the difference being statistically significant (χ 2 = 23.5, P = 0.015). Similar results were obtained for the subgroups by gender (243 women, χ 2 = 25, P < 0.01; 117 men, χ 2 = 31, P < 0.001). Inferential chronobiological analysis identified a significant annual pattern in hypertensive urgency, with a peak in December for total sample (P = 0.006) (Fig. 1). Hypertensive urgency was most frequent in winter (n = 106 or 29.4 %) and least in spring (n = 66 or 18.3 %), the difference being statistically significant (χ 2 = 12.3, P = 0.007). Similar results, although not statistically significant for men, were obtained for subgroups by gender (men P = 0.14 and women P = 0.012. Our results are the first to show the existence of a monthly and seasonal variation in the occurrence of hypertensive urgency in primary care, and the validity of these findings is strengthened by the uniform nature of the results of subgroup analyses