MATERIALS AND METHODS: We retrospectively reviewed ultrasound and CT images for 146 patients with clinical suspicion of cholecystitis from January 2013 until December 2018. Ultrasound criteria reviewed included calculus, wall thickening, pericholecystic fluid, gallbladder distension and presence of echogenic material within the gallbladder. For CT, criteria reviewed were wall thickening, gallbladder distension, mucosal enhancement, pericholecystic fluid and hyperdense bile with an attenuation value of more than 20 HU. Association of these findings was made with intraoperative and pathological findings of 85 patients with proven gallbladder empyema.
RESULTS: Sonographic signs that were statistically significantly associated with gallbladder empyema (p < 0.05) were thickened gallbladder wall (mean 5.4 versus 3.0 mm), distended gallbladder (mean 8.5 versus 6.4cm), pericholecystic fluid and echogenic material within the gallbladder. No significant association between gallstones and gallbladder empyema. Scores of two and more out of four significant sonographic findings were found to have an association with higher chances of developing gallbladder empyema (p < 0.05, odds ratio: 10). None of the CT features was found to be significant with gallbladder empyema (p > 0.05).
CONCLUSION: A combination of few ultrasound features has a high significant association with gallbladder empyema. Thus, in the proper clinical setting, these findings should alarm the sonographic operator on the possibility of gallbladder empyema.
METHODS: This was a real-world study of a fixed-dose combination of netupitant and palonosetron (NEPA) to inhibit CINV in adult patients receiving moderately (MEC) or highly emetogenic chemotherapy (HEC) for solid/hematological malignancies at eight Malaysian centers. Each HEC/MEC cycle received one dose of NEPA + dexamethasone for CINV prevention. Complete response (no emesis, no rescue medication) (CR), no more than mild nausea (severity score ≤ 2.5), and complete control (CR) (no more than mild nausea) during the acute (0-24 h), delayed (25-120 h), and overall (0-120 h) phases post-chemotherapy were measured. Treatment-related adverse events (AEs) were recorded.
RESULTS: During March 2016-April 2018 (NMRR-17-3286-38282), NEPA + dexamethasone was administered to 54 patients (77.8% solid, 22.2% hematological malignancies). Note that 59.3% received HEC, while 40.7% received MEC regimen. During the overall phase of the first cycle, the majority had CR (77.8%), no more than mild nausea (74.1%), and complete control (61.1%). Seventeen patients received two consecutive cycles at any point of chemotherapy cycles. During the overall phases across two consecutive cycles, all patients achieved CR, and the majority reported no more than mild nausea and complete control. No grades 3-4 AEs were reported.
CONCLUSIONS: NEPA had sustained efficacy and tolerability at first administration and across two cycles of MEC/HEC for CINV prevention.