Comparison of Sonography and Scintigraphy in the Evaluation of Gallbladder Functional Studies With Cholecystokinin
pain; Acoustics; ultrasonography; Radiology; disease; Nuclear Medicine & Medical Imaging; sonography; contraction; gallstones; cholecystokinin; cholescintigraphy; chronic acalculous cholecystitis; ejection fraction; gallbladder ejection fraction; infusion; scintigraphy
Objective. Both sonography and scintigraphy have been used to evaluate gallbladder function with the use of sincalide (cholecystokinin [CCK]). However, the reported ejection fractions (EFs) for the two modalities are not the same. The techniques measure slightly different parameters. This study directly compared both techniques performed simultaneously on the same participants. Methods. Twenty healthy volunteers were evaluated with sonography and scintigraphy to estimate the gallbladder EF simultaneously. The gallbladder EF was calculated at 5-minute intervals for 1 hour. Results. The mean El's +/- SD were 66.3% +/- 20% and 49% +/- 29% for sonography and scintigraphy, respectively. The mean times to the peak EF were 38 12 and 33 9 minutes for sonography and scintigraphy. An average time of 34 minutes was noted after radiopharmaceutical injection before CCK administration for the scintigraphic studies. The earliest time to the peak EF for sonography was 15 minutes, and the latest time to the peak EF was 60 minutes (mode, 40 minutes); for scintigraphy, the earliest and latest times were 15 and 50 minutes (mode, 30 minutes), respectively. One participant could not be evaluated secondary to nonfilling of the gallbladder on scintigraphy. There was wider variability of the gallbladder EF with scintigraphy than sonography. Conclusions. Scintigraphy estimated a lower EF than sonography, had wider EF variability than sonography, and required additional time (>30 minutes more) to complete the study. Scintigraphy could not be performed in 5% of the participants because of nonfilling of the gallbladder The use of sonography to estimate the gallbladder EF is less time-consuming and less costly. With these techniques, the range of normal gallbladder El's should be adjusted for the technique used.
Barr R G; Kido T; Grajo J R
Journal of Ultrasound in Medicine
2009
2009-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.7863/jum.2009.28.9.1143" target="_blank" rel="noreferrer noopener">10.7863/jum.2009.28.9.1143</a>
Comparison Of Dopamine To Dobutamine And Norepinephrine For Oxygen Delivery And Uptake In Septic Shock
agents; cardiac-output; catecholamines; consumption; dobutamine; dopamine; General & Internal Medicine; hemodynamics; infusion; inotropic; intra-pulmonary shunt; lactic-acidosis; norepinephrine; oxygen consumption; septic shock; severe sepsis; skeletal-muscle; therapy; transport
Objectives: To test whether dopamine infusion improves oxygen delivery (D over dot O-2) and oxygen uptake (V over dot O-2) in hyperdynamic septic shock patients stabilized by adequate volume and dobutamine alone, or by the combination of dobutamine and norepinephrine. Design: Prospective clinical trial of two patient groups. Group 1 (n = 15) was stabilized with dobutamine, and group 2 (n = 10) was stabilized with dobutamine and norepinephrine. Setting: Intensive care unit in a university hospital. Patients: Twenty-five postoperative, hyperdynamic septic shock patients. Interventions: The stabilizing catecholamine infusion was replaced in a stepwise manner by dopamine to achieve a similar mean arterial pressure (dopamine doses: group 1, mean 22 +/- 15 mu g/kg/min [range 6 to 52]; and group 2, mean 57 +/- 41 mu g/kg/min [range 15 to 130]). Measurements and Main Results: A complete hemodynamic profile was performed with oxygen transport-related variables at baseline, after replacement by dopamine and after resetting to the original catecholamine infusion. The change to dopamine resulted in increases in cardiac index (group 1: 20% [p < .01]; group 2: 33% [p < .01]), and D over dot O-2 (group 1: 19% [p < .01]; group 2: 27% [p < .01]). However, V over dot O-2, whether directly measured from the respiratory gases or calculated by the cardiovascular Fick principle, did not change in both groups with dopamine, while the oxygen extraction ratio decreased significantly in both groups with dopamine. Heart rate, pulmonary artery occlusion pressure, and pulmonary shunt fraction all increased with dopamine, Pao(2) decreased, but oxygen saturation remained stable in both groups with dopamine. Conclusions: Short-term dopamine infusion in hyperdynamic septic shock patients, de. spite producing higher global D over dot O-2, was not superior to dobutamine or the combination of dobutamine and norepinephrine infusion.
Hannemann L; Reinhart K; Grenzer O; Meierhellmann A; Bredle D L
Critical Care Medicine
1995
1995-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00003246-199512000-00004" target="_blank" rel="noreferrer noopener">10.1097/00003246-199512000-00004</a>
Prostacyclin In Septic Shock
critically; delivery; failure; General & Internal Medicine; ill patients; increases oxygen-consumption; infusion; lactate; norepinephrine therapy; Respiratory System; respiratory-distress syndrome; sepsis; tissue oxygenation
Objective: Investigation of the hypothesis that the infusion of 10 ng/kg/min prostacyclin (epoprostenol) (PGI(2)) improves O-2 uptake in patients with hyperdynamic septic shock. Design: Prospective, single cohort design. Setting: ICU, university hospital. Patients: Fifteen postoperative patients with septic shock. Interventions: Infusion of 10 ng/kg/min of PGI(2) for 60 min. Measurements: Complete hemodynamic profile with O-2 transport-related variables (simultaneous measurements of Vo(2) from the respiratory gases and by cardiovascular Fick) and blood lactate levels before start of the PGI(2)-infusion and 60 min thereafter. Main results: Oxygen delivery increased significantly (14 percent) from its already high value, 750+/-238 to 852+/-214 ml/min/m(2). The O-2 extraction ratio remained unchanged. When Vo(2) was measured from the respiratory gases, it was unchanged. When Vo(2) was measured by cardiovascular Fick, it increased slightly (p<0.05). Conclusions: We conclude that in this O-2 challenge test with PGI(2) in patients with septic shock, an increase in O-2 delivery was not matched by an increase in Vo(2). We believe that the adequate conventional support of these patients may have prevented the PGI(2) from revealing a ''covert'' O-2 debt. The PGI(2) test did not predict mortality by O-2 supply dependency. The small increase in Vo(2) as calculated indirectly suggests a degree of mathematical coupling of O-2 delivery and uptake.
Hannemann L; Reinhart K; Meierhellmann A; Bredle D L
Chest
1994
1994-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1378/chest.105.5.1504" target="_blank" rel="noreferrer noopener">10.1378/chest.105.5.1504</a>
Dopexamine Hydrochloride In Septic Shock
consumption; dobutamine; dopexamine hydrochloride; endotoxic dogs; General & Internal Medicine; heart failure; infusion; inotropic support; lactate; muscle; O-2 transport; O-2 uptake; optimal values; oxygen delivery; Respiratory System; respiratory-distress syndrome; sepsis; septic shock; tissue oxygenation; volume support
Objective: To test whether dopexamine hydrochloride, by its beta(2)-adrenoceptor and dopaminergic 1 (DA(1)) and dopaminergic 2 (DA(2)) agonistic properties, can improve oxygen consumption (V over dot O-2) in hyperdynamic patients with septic shock. Design: Prospective, single-cohort study. Setting: ICU, university hospital. Patients: Twenty-nine postoperative, hemodynamically stabilized, hyperdynamic patients with septic shock. Interventions: Short-term application (30 min) of dopexamine hydrochloride at a dose of 2 mu g/kg/min. Measurements: Complete hemodynamic profile with O-2 transport-related variables at baseline, 30 min after starting the dopexamine infusion, and 30 min after stopping the infusion. Main results: The dopexamine infusion resulted in significant increases in cardiac index (17%) (p<0.001) and O-2 delivery (DO2) (16%) (p<0.001), V over dot O-2 increased slightly but significantly about 4% (p<0.01) by respiratory gas exchange measurements and 9% (p<0.01) by cardiovascular Fick calculations. The O-2 extraction ratio decreased about 8% (0.001). Conclusions: The addition of dopexamine hydrochloride at a dose of 2 mu g/kg/min resulted in significant increases of DO2 and to a lesser extent V over dot O-2. Much of the global DO2 increase was not utilized, because O-2 extraction ratio decreased. Direct calorigenic effects of dopexamine and an increase in myocardial V over dot O-2 likely account for a large portion of the increase in global V over dot O-2. Whether any of the V over dot O-2 increase reflects improvement in regions of jeopardized tissue oxygenation remains to be clarified before the definite value of this lug in septic shock can be established.
Hannemann L; Reinhart K; Meierhellmann A; Wallenfang G; Bredle D L
Chest
1996
1996-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1378/chest.109.3.756" target="_blank" rel="noreferrer noopener">10.1378/chest.109.3.756</a>