Podcasts about Gadolinium

It's Prostate Week in Podcastistan: what happens when an MRI scan for prostatitis includes the injection of rare earth metals—should you, or shouldn't you? Gadolinium crosses the blood-brain barrier if the barrier is not fully intact—does that affect your decision? Then: a letter from an MD-PhD student at Harvard prompts musings on the federal funding of science, what science is for, how complicit universities and many scientists have been for years, and what to do. Also: uterine transplants for “trans women.”*****Our sponsors:Timeline: Accelerate the clearing of damaged mitochondria to improve strength and endurance: Go to http://www.timeline.com/darkhorse and use code darkhorse for 10% off your first order.Caraway: Non-toxic & beautiful cookware. Save $150 on a cookware set over buying individual pieces, and get 10% off your order at http://Carawayhome.com/DarkHorse10.ARMRA Colostrum is an ancient bioactive whole food that can strengthen your immune system. Go to http://www.tryarmra.com/DARKHORSE to get 15% off your first order.*****Join us on Locals! Get access to our Discord server, exclusive live streams, live chats for all streams, and early access to many podcasts: https://darkhorse.locals.comHeather's newsletter, Natural Selections (subscribe to get free weekly essays in your inbox): https://naturalselections.substack.comOur book, A Hunter-Gatherer's Guide to the 21st Century, is available everywhere books are sold, including from Amazon: https://amzn.to/3AGANGg (commission earned)Check out our store! Epic tabby, digital book burning, saddle up the dire wolves, and more: https://darkhorsestore.org*****Mentioned in this episode:Gadolinium Contrast Dye: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-gadolinium-based-contrast-agents-gbcas-are-retained-bodyLetter from Harvard: https://naturalselections.substack.com/p/letter-from-harvard/commentsHigher Education Research & Development Survey: https://ncses.nsf.gov/surveys/higher-education-research-development/2023#dataJones et al 2018. Uterine transplantation in transgender women. Bjog 126(2): 152-156: https://pmc.ncbi.nlm.nih.gov/articles/PMC6492192/pdf/BJO-126-152.pdfSupport the show

Gadolinium contrast agents used in MRIs can cause severe toxicity in 1 out of 10,000 people, leaving patients with debilitating symptoms often misdiagnosed as other conditions. Dr. Richard Semelka, a world-renowned expert in MRI safety and gadolinium toxicity, exposes the alarming reality behind gadolinium deposition disease (GDD). This condition has left countless patients struggling with brain fog, burning skin pain, stabbing bone pain, muscle spasms, and chronic fatigue—often without answers from their doctors. In today's episode, Dr. Semelka explains how gadolinium toxicity happens, the warning signs to watch for, and the treatment protocols that work. He shares why traditional medicine is so slow to recognize this condition, the shocking prevalence of misdiagnoses, and how you can protect yourself from unnecessary gadolinium exposure.  Plus, learn how chelation therapy with DTPA can help remove this toxic metal and why certain supplements and lifestyle changes can support your body's recovery.   "There are people with gadolinium toxicity who have been admitted to mental health facilities as inpatients. ~ Dr. Richard Semelka   In This Episode: - Dr. Semelka's background and experience with GDD - How gadolinium enters the body and MRI concerns - Alternatives to gadolinium contrast scans - Key symptoms of gadolinium deposition disease - Who's most vulnerable to gadolinium toxicity - Treatment options and chelation therapy - Why chelation requires multiple sessions - Managing side effects of chelation - Anti-inflammatory supplements that help - Commonly misdiagnosed conditions - Patient stories and success with treatment For more information, visit https://www.myersdetox.com    Ready to detox heavy metals? Take the quiz: http://www.heavymetalsquiz.com    Resources Mentioned: Purity Woods Age-Defying Dream Cream: Get 27% off with code WENDY at: https://puritywoods.com/wendy  Puori PW1 Whey Protein: Get 20% off with code WENDY at: https://puori.com/wendy    About Dr. Richard Semelka: Dr. Richard Semelka is a world-renowned expert in MRI safety and medical imaging. As the leading authority on gadolinium toxicity, he ranks in the top 0.05% of scholars worldwide in his field (ranked #10 in MRI and #14 in medical imaging by Scholar GPS). Dr. Semelka treats patients with gadolinium toxicity from around the world and has pioneered effective chelation protocols. His work at gadtrack.org has helped thousands understand and address gadolinium deposition disease. Learn more at https://gadttrac.org or contact Dr. Semelka at https://www.richardsemelka.com/   Disclaimer The Myers Detox Podcast was created and hosted by Dr. Wendy Myers. This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast, including Wendy Myers and the producers, disclaims responsibility for any possible adverse effects from using the information contained herein. The opinions of guests are their own, and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guests' qualifications or credibility. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.

Full article: Use of Photon-Counting Detector CT to Visualize Liver-Specific Gadolinium-Based Contrast Agents: A Phantom Study Aishwariya Vegunta, MD, discusses the AJR article by Rau et al. exploring the potential of photon-counting detector CT, combined with low-keV virtual monoenergetic reconstructions, to visualized a hepatocyte-specific gadolinium-based contrast agent.

Voyageur Pharmaceuticals CEO Brent Willis joined Steve Darling from Proactive to announce the company has received a $600,000 grant from Alberta Innovates, a provincial Crown corporation and Alberta's largest research and innovation organization. The grant, awarded through the AICE-Market Access Program, is aimed at supporting the commercialization and market access of emerging health technologies in Alberta. Willis shared that the funds will be used for a pivotal study assessing the efficacy of Voyageur's Frances Creek barium sulfate compared to competing products. The study will focus on evaluating the performance of natural barite from Frances Creek against synthetic barium precipitate and oral iodine products. Currently, synthetic barium and diluted iodine contrast media dominate the fluoroscopy and Computed Tomography examination markets. Voyageur aims to highlight the superior imaging quality of its natural barium sulfate, attributed to its wider particle distribution. This research is expected to enhance the financial viability of the Frances Creek project and strengthen marketing strategies to drive sales growth. Willis also noted that Voyageur is in the testing and refinement phase for its five Health Canada licensed barium contrast products. The company is making steady progress toward its market launch, with a go-to-market plan that includes third-party barium sulfate imports and contract manufacturing partnerships. #proactiveinvestors #voyageurpharmaceuticalsltd #tsxv #vm #vyyrf #ctscan #xray #BrentWillis, #RainCage, #Nanoscience, #MRI, #CTScan, #MedicalBreakthrough, #Fullerenes, #Vanadium, #Gadolinium, #Bismuth, #Iodine, #Radiology, #MedicalInnovation, #DrugDevelopment, #Healthcare, #ScientificBreakthrough

Nurses Out Loud with Jodi O'Malley MSN, RN – Gadolinium, a heavy metal used in MRI contrast, can pose hidden risks like neurological and autoimmune issues. Exploring chelation therapy, immune support, and holistic care can help affected patients. Nurses must advocate for comprehensive health solutions while balancing faith, purpose, and compassion to transform care and address the broader impacts of chronic illness.

Nurses Out Loud with Jodi O'Malley MSN, RN – Gadolinium, a heavy metal used in MRI contrast, can pose hidden risks like neurological and autoimmune issues. Exploring chelation therapy, immune support, and holistic care can help affected patients. Nurses must advocate for comprehensive health solutions while balancing faith, purpose, and compassion to transform care and address the broader impacts of chronic illness.

Voyageur Pharmaceuticals CEO Brent Willis joined Steve Darling from Proactive to share details from a recently released Letter from the CEO, highlighting the company's significant achievements in 2024 and its ambitious plans for 2025. Willis reflected on 2024 as a transformative year for Voyageur, with the company entering into a Letter of Intent with a large multinational pharmaceutical company. This collaboration aims to improve production efficiencies and expand Voyageur's presence in the contrast media market. Both parties are actively working toward a definitive agreement, expected in early 2025. Voyageur introduced five new Health Canada-licensed barium contrast products aimed at raising the bar for medical imaging standards and enhancing diagnostic precision for healthcare professionals. This accomplishment followed 18 months of dedicated research and development. The company secured a $2.7 million sales distribution contract for its SmoothX 2% Barium Contrast product, solidifying its market presence in Latin America. Regulatory approvals are in progress, with sales slated to commence in the second half of 2025. Additionally, Voyageur is engaging with global distributors to broaden its reach. Voyageur is entering 2025 with a clear roadmap for advancing its product pipeline and market position, which includes extensive testing of its barium contrast formulations in human subjects is set to begin, with a focus on ensuring safety and efficacy in clinical settings. Voyageur aims to secure FDA approvals for its barium contrast products, demonstrating compliance with rigorous U.S. regulatory standards. A major initiative for 2025 involves advancing its iodine contrast drug development in the U.S. The goal is to produce the lowest-cost iodine contrast drugs in the market. Preliminary bench-scale testing has already commenced, and the company is laying the groundwork for full-scale production. With North America currently relying 100% on imported radiology drugs, Voyageur is focused on addressing critical mineral supply constraints. The company is working to establish the first secure, vertically integrated supply chain for radiology drugs in North America, aiming to fill critical gaps in the industry. As Willis explained, these efforts underscore Voyageur's commitment to innovation and its vision to redefine the radiology drug industry by providing secure, cost-effective, and high-quality solutions for healthcare professionals. With its robust pipeline and strategic partnerships, Voyageur is well-positioned for sustained growth and success in 2025 and beyond. #proactiveinvestors #voyageurpharmaceuticalsltd #tsxv #vm #vyyrf #ctscan #xray #BrentWillis, #RainCage, #Nanoscience, #MRI, #CTScan, #MedicalBreakthrough, #Fullerenes, #Vanadium, #Gadolinium, #Bismuth, #Iodine, #Radiology, #MedicalInnovation, #DrugDevelopment, #Healthcare, #ScientificBreakthrough,

Voyageur Pharmaceuticals CEO Brent Willis joined Steve Darling from Proactive to announce the commencement of human testing for the company's latest suite of barium contrast products, designed to optimize radiographic examinations of the gastrointestinal tract. The product lineup, including SmoothX, SmoothHD, SmoothLD, VisionHD, and VisionLD, is tailored to provide enhanced clarity, detail, and versatility for both adult and pediatric imaging applications. Willis emphasized the importance of this milestone, as it represents a critical step toward the company's goal of entering the Canadian market in 2025. The human testing process is being conducted in two phase with Phase 1 in Q1 2025 and will focus on assessing product performance based on key indicators such as imaging quality, diagnostic yield, contrast administration success rates, detection sensitivity, and patient safety. The company says some additional metrics will include patient satisfaction, procedure completion rates, adverse event rates, and compliance rates will also be closely monitored. These advanced formulations are designed to meet diverse clinical needs, ensuring high performance while maintaining safety and ease of use for patients. Voyageur aims to set a new standard in barium contrast agents, offering both precision and reliability in diagnostic imaging. This testing phase is an essential step in achieving regulatory approval and market readiness. #proactiveinvestors #voyageurpharmaceuticalsltd #tsxv #vm #vyyrf #ctscan #xray #BrentWillis, #RainCage, #Nanoscience, #MRI, #CTScan, #MedicalBreakthrough, #Fullerenes, #Vanadium, #Gadolinium, #Bismuth, #Iodine, #Radiology, #MedicalInnovation, #DrugDevelopment, #Healthcare, #ScientificBreakthrough,

Voyageur Pharmaceuticals CEO Brent Willis joined Steve Darling from Proactive to announce a significant milestone for the company: entering into a Letter of Intent (LOI) with a major multinational pharmaceutical company. This strategic collaboration is aimed at enhancing production efficiencies and expanding Voyageur's project portfolio within the contrast media industry. Willis explained that the proposed partnership is expected to accelerate Voyageur's development of vertically integrated production for its suite of contrast media products. The collaboration would also enable the company to expedite its entry into new segments of the contrast media market, positioning Voyageur for faster progress across its operations. The LOI serves as a precursor to a formal definitive agreement anticipated in the New Year. The agreement will define the full scope of the partnership, including the deal structure, project expectations, and timelines for achieving key milestones. Willis emphasized the importance of this collaboration, noting its potential to diversify Voyageur's product mix and drive forward the company's vision for growth in the pharmaceutical sector. This partnership marks a pivotal step in Voyageur's journey toward becoming a leading player in the contrast media industry. #proactiveinvestors #voyageurpharmaceuticalsltd #tsxv #vm #vyyrf #ctscan #xray #BrentWillis, #RainCage, #Nanoscience, #MRI, #CTScan, #MedicalBreakthrough, #Fullerenes, #Vanadium, #Gadolinium, #Bismuth, #Iodine, #Radiology, #MedicalInnovation, #DrugDevelopment, #Healthcare, #ScientificBreakthrough, #VoyageurPharmaceuticals #MedicalImaging #BrentWillis #FDAApproval #ContrastMedia #HealthCanada #PharmaceuticalInnovation #2025Milestones #DiagnosticsMarket #ProactiveInvestors

Pr. Douraied BEN SALEM est neuroradiologue au CHU de Brest, professeur des universités et chercheur au LATIM. Depuis 2012, il combine pratique clinique, recherche et responsabilité éditoriale, notamment en tant qu'éditeur en chef du « journal of neuroradiology ». Pionnier dans le domaine du recyclage du gadolinium à travers le projet MeGadoRe, il œuvre pour une radiologie plus verte et responsable. Venez en découvrir plus en écoutant cet épisode de Trajectoire(s) aux rayons X.

In a conversation with CancerNetwork®, Nader Sanai, MD discussed the current state of the glioblastoma field, highlighting ongoing research efforts to help improve outcomes among patients with this disease.  Sanai is the director of the Ivy Brain Tumor Center and J.N Harber Professor of Neurological Surgery, Francis and Dionne Najafi chair for Neurosurgical Oncology, and chief of neurological oncology at Barrow Neurological Institute. Specifically, Sanai described plans to assess treatment with niraparib (Zejula) compared with temozolomide (Temodar) in a population of patients with newly diagnosed MGMT unmethylated glioblastoma as part of the phase 3 Gliofocus study (NCT06388733).1 He contextualized the rationale for conducting this study by focusing on findings from a proof-of-concept hybrid study (NCT05076513) and detailing how they supported additional investigation into the utility of niraparib.  According to findings from this proof-of-concept study presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, the median overall survival (OS) was 20.3 months among patients who received niraparib in combination with radiotherapy.2 Additionally, data showed that niraparib reached drug concentrations in Gadolinium-nonenhancing newly diagnosed glioblastoma tissue exceeding those of any other evaluated PARP inhibitors; investigators identified no new safety signals after combining niraparib with radiotherapy in this population. With the Gliofocus trial, Sanai and co-investigators aim to provide a clinically meaningful quality of life benefit with niraparib-based therapy beyond a marginally valuable statistical advantage. By evaluating treatment with niraparib, investigators look to improve historical survival rates reported with standard-of-care options among patients with unmethylated disease. “What we're looking to do with this trial is set a benchmark that's clinically relevant for patients and providers. The [OS] target for the study is 18 months, which is to effectively convert [a] 12-month natural history to a natural history closer to the methylated glioblastoma population,” Sanai said. “We think that is a meaningful transformation of a difficult patient population, a significant chunk of survival time that would be beneficial to patients, providers, and caregivers. Importantly, [it may also mean] an advantage for quality of life, which is of paramount importance for this patient population.” References 1.        A study comparing niraparib with temozolomide in adult participants with newly-diagnosed, MGMT unmethylated glioblastoma. ClinicalTrials.gov. Updated June 24, 2024. Accessed September 16, 2024. https://tinyurl.com/y25er8p9 2.        Sanai N, Umemura Y, Margaryan T, et al. Niraparib efficacy in patients with newly-diagnosed glioblastoma: Clinical readout of a phase 0/2 "trigger" trial. J Clin Oncol. 2024;42(suppl 16):2002. doi:10.1200/JCO.2024.42.16_suppl.2002

Voyageur Pharmaceuticals CEO Brent Willis joined Steve Darling from Proactive to announce the successful completion of formulation work for the company's latest product line, which includes five Health Canada-licensed products. These advanced formulations are set to raise industry standards, offering enhanced value to healthcare providers and stakeholders. Willis also revealed the launch of two new product brands, Vision and Smooth barium contrast agents, aimed at improving versatility and performance in medical diagnostics. Classified as new drugs, these innovative products are poised to benefit from faster approval processes, significantly reducing costs and timelines compared to traditional New Drug Application (NDA) submissions. This move marks a shift away from generics, positioning Voyageur Pharmaceuticals as a more competitive force in the market. Voyageur has already completed several pilot test batches for its product suite and is now advancing to patient testing. The company is entering the final phase of clinical trials, where these products will be used in X-ray and Computed Tomography procedures, signaling significant progress toward full market deployment. Additionally, the company has appointed Dr. Iryna Saranchova as its new Chief Science Officer, pending regulatory approval. Dr. Saranchova is a recognized expert in clinical research and immunology, with a distinguished career that includes roles as Honorary Professor/Lecturer at the University of British Columbia's Faculty of Medicine and Research Fellow at the Michael Smith Laboratories and Vancouver Prostate Center. Her expertise in biomarker discovery, clinical research, and immunotherapy development will be a key asset as Voyageur accelerates its scientific initiatives. #proactiveinvestors #voyageurpharmaceuticalsltd #tsxv #vm #vyyrf #ctscan #xray #BrentWillis, #RainCage, #Nanoscience, #MRI, #CTScan, #MedicalBreakthrough, #Fullerenes, #Vanadium, #Gadolinium, #Bismuth, #Iodine, #Radiology, #MedicalInnovation, #DrugDevelopment, #Healthcare, #ScientificBreakthrough, #Nanotechnology, #MedicalResearch, #Pharmaceuticals #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

Join Ben and Rahul for their discussion with Jake and Tor, breaking down the recent 495 million Dollar verdict in a product liability case against Abbott Laboratories for pre-term infant formula that increases the risks for developing necrotizing enterocolitis. Hear how Jake and Tor navigated this difficult case and won this epic battle. About Jacob Plattenbergerhttps://www.torhoermanlaw.com/team/jake-plattenberger/Jacob Plattenberger has taken hundreds of depositions, argued in countless hearings, and tried over 35 cases to a jury.His experience in and out of the courtroom has made him a passionate advocate for those injured due to the negligence of others.Jake started his career trying cases at one of the busiest civil courthouses in the country – the Richard J. Daley Center in downtown Chicago.He started out doing insurance defense because he knew that afforded him the best opportunity to get courtroom experience.“When I was working on the defense side, I always knew that I was going to be a plaintiff's lawyer. I knew that being able and willing to try a case to a jury was a skill that I needed to have if I was going to be able to offer my clients the best legal representation. Insurance companies and corporate defendants need to believe you when you say you will take them to trial – they need to fear that.”This type of real trial experience is exceedingly rare in complex civil litigation and having seen it from the defense side gives Jake an added advantage.At TorHoerman Law, Jake manages our Chicago office where he leads trial teams in nationwide, complex litigations such as:Representing dozens of workers across the United States who were exposed to Diacetyl at work and now suffer lung diseaseeg. The Juul/E-cigarette LitigationThe Incretin Mimetics Products Liability Litigation, currently pending in the Southern District of California, where he was named to the Plaintiff's Steering CommitteeVarious Transvaginal Mesh multidistrict litigations that are currently pendingJake also maintains a personal injury practice in Chicago, representing people and their families who have been victims of catastrophic auto and truck accidents, products liability, maritime accidents, premises liability, and medical negligence.Jake believes that to successfully represent his clients, it is absolutely necessary to get personally involved.Jake's quote below perfectly reflects that belief! Notable Cases & ResultsIncretin Mimetics – Products Liability Litigation, MDL Case No. 13MD2452 AJB (MDD). Appointed to the Plaintiff's Steering Committee by Judge Battaglia in the MDL. The case is pending.JUUL E-Cigarettes – Products Liability Litigation, JCCP No. 5052. Appointed to the Plaintiff's Steering Committee by Judge Anne Jones in the JCCP. The case is pending.Diacetyl – Leads the Diacetyl litigation for TorHoerman Law. Previous settlements and verdicts have exceeded $5,000,000.00 to date. Litigation is currently ongoing.Actos Related Cases, MDL Case No. 11 L 10011, Et. Al. – Actively participated in managing the case for TorHoerman Law which resulted in a $2.4 billion settlement.Gadolinium-based Contrast Agents Litigation Case No. 279 and Products Liability Litigation MDL No. 1909 – Managed the cases for TorHoerman Law which resulted in a large, confidential settlement.Bus Accident – Handled a bus accident injury case in which an individual was thrown from a seat. Resulted in a $850,000.00 settlement.Auto Accident – Handled an auto accident injury case that resulted in a $650,000.00 settlement.Slip and Fall – Handled a slip and fall accident that occurred on a sightseeing boat in Chicago. Resulted in a $490,000.00 settlement. Personal LifeJake was born and raised in Chicago.He now lives in the Chicago suburbs, where his two young sons keep him busy.When he isn't working, Jake is a lifelong Bears and Cubs fan and loves participating in the (mostly) healthy rivalry between the Cubs and Cardinals fans at TorHoerman Law.   About Tor Hoermanhttps://www.torhoermanlaw.com/team/tor-hoerman/Tor Hoerman is a nationally recognized attorney who has served in the field for more than 25 years.He is most well-known as the founder of the personal injury law firm TorHoerman Law, LLC (THL). Early Life & EducationTor was born the youngest of four boys on July 16, 1969, in Bethesda, Maryland to Kirk and Greta Hoerman.With his father serving as a Captain in the Navy, Tor often moved towns during his childhood, eventually landing in the Chicago metropolitan area.In Chicago, Tor lived in the Great Lakes Naval Base and Lake Bluff before his family settled in Lake Forest, which is where he attended high school.Despite repeatedly switching homes, Tor made the most of his situation.In high school, he played football, basketball, and baseball, and he earned varsity letters in each of these sports.In addition to varsity recognition, he was recognized as an All-county athlete and awarded the Booster Club Athlete of the Year his senior year.Outside of sports, Tor coached little league baseball, served as a summer camp counselor, and worked as a summertime janitor at his former high school after graduating.Tor attended Depauw University and majored in Political Science.He played NCAA baseball and football at Depauw, and he was the captain of the baseball team.After graduating from Depauw in 1991, Tor enrolled in the Chicago-Kent College of Law.During law school, Tor bartended at a local bar and clerked for Kravolec, Jambois & Schwartz, LLC. Legal CareerAfter graduating from law school in 1995, Tor took on a job doing insurance defense at Bolero, Cart & Stone, LLC, where he worked reluctantly for a year and a half.One day at work, Tor received a phone call from Steve Jambois, his former employer throughout law school, asking if he wanted a job on the plaintiff's side of insurance law.Tor immediately accepted the job, kickstarting decades to come of fighting corporations on behalf of harmed individuals.Tor's Transition to Medical Malpractice LitigationTor returned to Kravolec, Jambois & Schwartz to fight on behalf of medical malpractice victims, which mostly consisted of high-intensity trial work in the Chicago courthouse.After seven years at the Jambois firm, Hoeman was recruited by the Simmons law firm, based in an Illinois suburb of St. Louis, to start and lead a branch of the practice that focused on pharmaceutical litigation.Leading the Pharmaceutical Practice at Simmons Law FirmTor became a partner of what is now Simmons, Hanly, and Conroy and led the pharmaceutical practice for seven years.One of Tor most notable achievements while leading the practice was his work against Purdue Pharma and its reckless distribution of OxyContin.Tor was the first to file a case alleging Purdue Pharma's wrongdoing in distributing OxyContin and failing to adequately warn healthcare providers and the public of the risks of addiction.Achieving Justice Against Purdue PharmaHe led the litigation process and got Purdue Pharma to agree to a large settlement, which was distributed to thousands of accidental addicts.Tor took a step further to achieve justice in this case, assisting the Department of Justice in obtaining guilty pleas by Purdue Pharma representatives who had a direct role in contributing to the opioid epidemic. Founding TorHoerman LawHaving garnered success leading the pharmaceutical branch at the Simmons firm, Tor amicably decided to split from Simmons in 2009 and start his own pharmaceutical and personal injury practice called TorHoerman Law, LLC (THL).After negotiating the terms of the split, Tor struck a deal that allowed him to bring his entire staff from Simmons to his new practice, which summed up to more than 25 lawyers and staff members.Expansion and Success of THLTor opened offices in Edwardsville, IL; Clayton, MO; and Chicago, IL to kickstart operations; all three offices remain open today.In the time since opening THL, Tor and his team have litigated many pharmaceutical malpractice and personal injury cases.Notable Successes at THLTor's most notable successes while operating THL are perhaps co-leading the litigations against Boehringer Ingelheim's Pradaxa and Takeda's Actos.Through intense research and vetting, Tor was able to find substantial evidence indicating Actos causes bladder cancer and Pradaxa causes internal bleeding.He then presented the evidence to the companies, which decided to settle the cases.Tor played a significant role in negotiating these settlements, which ended up being $650 million for Pradaxa and $2.4 billion for Actos.Tor has also had major success in several other product liability lawsuits, such as Zelnorm, Gadolinium-based Contrast Agents, and Incretin Mimetics.We've outlined these cases, a few other notable cases, and their correlating results in the section below.Recognition & AwardsHis successes with these cases and beyond earned him the distinction as a Top 25 Notable Alumni from the Chicago-Kent School of Law, which was awarded to him and 24 other lawyers out of the tens of thousands who have graduated from the school since its founding in 1888.Tor is also recognized as a Top 100 National Trial Lawyer by the National Trial Lawyers Organization. Notable Cases & ResultsPradaxa (Dabigatran Etexilate) – Products Liability Litigation, MDL 2385 – Appointed by Judge Herndon as national lead counsel in the MDL. After protracted litigation successfully negotiated a $650 million settlement.Actos Related Cases, MDL Case No. 11 L 10011, Et. Al. – Appointed by Judge Dooling as lead counsel in Cook County consolidated docket (over 4400 cases). After protracted litigation, he was one of four lead negotiators (along with Pete Flowers, Mark Lanier, and Andy Birchfield) on a $2.4 billion settlement.Incretin Mimetics Products Liability Litigation, MDL Case No. 13MD2452 AJB (MDD) – Appointed as lead counsel by Judge Battaglia in the MDL. The case is pending.OxyContin – Represented thousands of “accidental addicts”. After protracted litigation, he negotiated a large settlement and assisted the DOJ in obtaining guilty pleas by corporate representatives.Zelnorm Litigation., Case No. 280 – Appointed lead counsel in NJ state court consolidation, took the major depositions and negotiated a confidential settlement.Gadolinium-based Contrast Agents Litigation Case No. 279 and Products Liability Litigation MDL No. 1909 – Appointed by Judge Polster as both the state and federal liaison and lead counsel in the Cook County consolidated docket. He negotiated large, confidential, individual settlements. Involvement in the Legal CommunityIn addition to his litigation work, Tor is on the Board of Managers of the Illinois Trial Lawyer Association and an Executive Board Member of the Mass Torts Trial Lawyer Association.He also attends national legal conferences on a yearly basis. Personal LifePersonally, Tor is the proud father of Casey, Kirsten and Quinn, and husband of Jessica.He tries to stay active, including still playing baseball.

AKI Tips and Tricks from Joel Topf MD, Kashlak's Chief of Nephrology Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak's Chief of Nephrology! We've put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium. Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode's release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written (including CME questions) and Produced by: Cyrus Askin, MD Infographic by: Cyrus Askin, MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Joel Topf, MD Time Stamps 00:00 Sponsors - VCU Health CE and Pediatrics On Call podcast by APP 00:30 Intro, disclaimer, guest bio 03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame); 08:45 Sponsor - Pediatrics On Call podcast by APP 09:15 Definition of acute kidney injury (AKI) and fundamentals 11:00 Cardiorenal syndrome 12:24 Schema for AKI 17:30 Establish an etiology, determine urine output and address electrolyte abnormalities 21:22 AKI in the otherwise-healthy patient; 32:20 Rhabdomyolysis
38:21 Vancomycin 41:43 Acute interstitial nephritis (AIN) 44:52 Contrast induced nephropathy (CIN) 50:37 Gadolinium in AKI and/or CKD 52:53 Timing of dialysis 
 56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors; 62:01 Is Ultrasound necessary in AKI
 64:58 Dr. Topf's take home points and Plug for Seminars in Nephrology 68:45 Outro and Sponsor - VCU Health CE Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Panacea Financial If you're ready to join the thousands of doctors who have declared independence from traditional banks, visit panaceafinancial.com today. Sponsor: Locumstory Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts.

Bill Faulkner and Dr Manny Kanal discuss gadolinium-based contrast agents Click Here to  Claim your Credit This MR iCast episode is supported by Bracco Diagnostics Inc. through an unrestricted educational grant.

Why You Should Listen:  In this episode, you will learn above the role of gadolinium in chronic conditions and about the entity of Gadolinium Deposition Disease. About My Guest: My guest for this episode is Dr. Richard Semelka.  Richard Semelka, MD has been in practice as a radiologist for 28 years and is a world authority in body MRI, safety in radiology, and gadolinium toxicity.  He is a leading published expert in radiology for body MRI and gadolinium toxicity and has made presentations at major meetings all over the world.  Dr. Semelka has written over 370 peer-reviewed papers and 16 text-books.  He is the first doctor to publish on the entity of Gadolinium Deposition Disease. Key Takeaways: What is gadolinium? What are the symptoms of Gadolinium Deposition Disease? Are certain populations at higher risk for GDD than others? Should gadolinium be treated before the immune priming event? How is gadolinium tested for? What is the primary route of gadolinium excretion? Are the symptoms toxigenic or immunogenic? Does gadolinium cross the blood brain barrier? Does gadolinium have an effect on the mast cells? How does gadolinium impact the mitochondria? Is there a correlation between methylation and response to gadolinium? Is supporting drainage pathways important? What are GAD removal and re-equilibration flares? How is gadolinium chelated from the body? Can glutathione be helpful in addressing gadolinium toxicity? Is there a role for sauna therapy? Connect With My Guest:  http://RichardSemelka.com Interview Date: July 10, 2024 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode203. Additional Information: To learn more, visit https://BetterHealthGuy.com. Disclaimer:  The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority. 

Voyageur Pharmaceuticals CEO Brent Willis joined Steve Darling from Proactive to announce that the company and Rain Cage Carbon are advancing their collaboration following the first commercial creation of a V@C60 endohedral fullerene or Vanadium atom inside a C60 molecule. Rain Cage is now embarking on the next phase of radiology drug development using their cutting-edge technology. Willis told Proactive that Rain Cage will begin working to create on a commercial scale, the encapsulation of gadolinium, bismuth, and iodine within endohedral fullerenes. This pioneering work, set to begin later this month, aims to develop a process to create Gd@C60, Bi@C60, and I@C60 endohedral fullerenes, targeting the development of highly advanced radiology contrast agents for Magnetic Resonance Imaging (MRI) and CT scans. These novel compounds, known for their rarity and complex synthesis, hold the promise of transforming medical imaging by significantly enhancing the precision and clarity of radiological scans. Endohedral fullerenes are a class of fullerenes that enclose an additional atom, ion, or cluster within their inner sphere, exhibiting superior physical and electronic characteristics compared to regular fullerenes. In the context of radiology drugs, endohedral metallofullerenes offer distinct advantages through exceptional stability and bioavailability, an amplified signal that leads to better image clarity and resolution, targeted delivery, and reduced toxicity. These properties have garnered interest in applications such as MRI contrast agents #proactiveinvestors #voyageurpharmaceuticalsltd #tsxv #vm #vyyrf #ctscan #xray #BrentWillis, #RainCage, #Nanoscience, #MRI, #CTScan, #MedicalBreakthrough, #Fullerenes, #Vanadium, #Gadolinium, #Bismuth, #Iodine, #Radiology, #MedicalInnovation, #DrugDevelopment, #Healthcare, #ScientificBreakthrough, #Nanotechnology, #MedicalResearch, #Pharmaceuticals #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

Immunic Inc (NASDAQ:IMUX) CEO Dr Daniel Vitt joined Proactive's Stephen Gunnion with news of the publication of extended data from the Phase 2 EMPhASIS trial of vidofludimus calcium in relapsing-remitting multiple sclerosis (RRMS) in the peer-reviewed journal, Neurology® Neuroimmunology & Neuroinflammation, an official journal of the American Academy of Neurology. Vitt noted that the EMPhASIS trial demonstrated a notable reduction in gadolinium-enhancing lesions by 78% and 74% in two high-dose groups compared with the placebo. These results also correlate with improvements in serum neurofilament light chain levels, consistent with recent interim phase 2 clinical data from the ongoing CALLIPER trial in progressive MS, indicating ongoing progress in the field. Vitt highlighted the study's contribution to understanding the neuroprotective and anti-inflammatory effects of the treatment under investigation. The drug's potential impact on the treatment landscape of MS, particularly its role in addressing disease progression independent of relapse activity, was emphasized. Immunic is also conducting the CALLIPER trial in progressive MS, with key results expected by April 2025. Additionally, the phase 3 ENSURE trials are actively enrolling, with projected readouts in 2026. Dr Vitt expressed optimism about the drug's unique profile, combining safety and effectiveness in potentially altering the management of all forms of MS. #ImmunicInc, #DrDanielVitt, #EMPHASISTrial, #MultipleSclerosis, #MSResearch, #Neurology, #ClinicalTrials, #Phase2, #Phase3, #DrugDevelopment, #MedicalInnovation, #Neuroprotection, #AntiInflammatory, #Healthcare, #MedicalJournal, #AmericanAcademyOfNeurology, #Gadolinium, #SerumNeurofilament, #ProgressiveMS, #NeurodegenerativeDiseases #ProactiveInvestors #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

Gadolinium is a toxic rare earth metal commonly used as a contrast agent in medical scans. Doctors love it because it makes bones and muscles glow in the dark. However, autopsy reports have proved that the body retains gadolinium for years!     Many patients experience severe symptoms after gadolinium injections without knowing the root cause. Unfortunately, no FDA-approved cure or antidote is currently available. Today's guest is among the people living with the effects of gadolinium poisoning.      Debbie Heist Lambert, founder of Living with Gadolinium, has spent thousands of hours researching this condition that caused her near-death experience and dementia. She shares valuable insights on the symptoms of gadolinium retention, such as brain fog, neuropathy, bone pain, autoimmune diseases, and skin conditions.      Debbie advocates for patients to exercise their right to informed consent before a gadolinium injection. Affected patients need proper detoxification and chelation to relieve the symptoms, and they need community support.     Tune in to learn about the types of medical scans that use gadolinium and your options as a patient.        “If you've been injected with gadolinium, you're retaining some. Whether or not you have a lot of symptoms and a lot of problems, that's to be determined.” -  Debbie Heist Lambert   Today's Episode Explores: - What is gadolinium? - What are the symptoms of gadolinium toxicity? - Advocacy and support for gadolinium toxicity patients - Types of medical scans that use and don't use gadolinium  - Why patients develop severe gadolinium-related issues  - A patient's options when getting a medical scan - Challenges in the diagnosis of gadolinium poisoning - Detoxification and treatment options for gadolinium toxicity  For more information, visit www.myersdetox.com/gadolinium     After listening to this episode, you might be wondering about heavy metals. You can take my quiz here for more info: heavymetalsquiz.com    About Debbie Heist Lambert: Debbie Heist Lambert, founder of Living with Gadolinium, advocates for all medically injured patients. Debbie holds a BA from George Fox University. She graduated with a Certificate as a Functional Nutrition Counselor in 2022. Debbie is enthusiastic about ensuring informed consent, truth, and transparency become the gold standard for healthcare. After her experience following multiple injections of Gadolinium contrast dye, Debbie found passion and purpose in learning and applying new knowledge to help herself heal and provide support and help to others.    Join Debbie's Facebook Gadolinium advocacy group at https://www.facebook.com/groups/1431383276922546 and follow her Facebook page https://www.facebook.com/livingwithgadadmin.    Disclaimer The Myers Detox Podcast was created and hosted by Dr. Wendy Myers. This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast, including Wendy Myers and the producers, disclaims responsibility for any possible adverse effects from using the information contained herein. The opinions of guests are their own, and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guests' qualifications or credibility. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.  

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: October 25, 2018 Every time you order an MRI with contrast, you should think to yourself, "Why do I need contrast?" Then, "If I need contrast, what are the risks?" This week's show is all about the risks of routine neuroimaging. Produced by James E Siegler. Music by Little Glass Men, Loyalty Freak Music, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES McDonald RJ, McDonald JS, Kallmes DF, et al. Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology 2015;275(3):772-82. PMID 25742194Pullicino R, Radon M, Biswas S, Bhojak M, Das K. A review of the current evidence on gadolinium deposition in the brain. Clin Neuroradiol 2018;28(2):159-69. PMID 29523896Rogosnitzky M, Branch S. Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms. Biometals 2016;29(3):365-76. PMID 27053146 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Gadolinium-Associated Nephrogenic Systemic Fibrosis⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠from the Renal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

Welcome to Resiliency Radio with Dr. Jill, where we bring you the latest insights from leading experts in the field of health and wellness. In this episode, we have the honor of hosting Dr. Richard Semelka, a renowned expert on Gadolinium Toxicity. Gadolinium, a heavy metal commonly used in contrast agents for medical imaging, has been a topic of concern in recent years due to its potential health risks. During our conversation, Dr. Semelka will shed light on Gadolinium Deposition Disease (GDD) and its implications for patients who have undergone contrast-enhanced MRI scans. Key Points A small percentage of people experienced symptoms of Gadolinium Deposition Disease (GDD) or gadolinium deposition in the brain after MRI with contrast Recognize the most common symptoms of Gadolinium Deposition Disease (GDD) Optimize treatment with chelation to excrete gadolinim and other heavy metals and restore health after GDD

Happy 2024! I am ready for another year of writing about the intersections of weight science, weight stigma, and healthcare and I'm glad you are here reading! This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I received the following question from reader Lisa:I notice that when you write about things that can hurt larger people's health you usually mention weight cycling, weight stigma, and healthcare inequalities. I've read your posts for the first two – is there a post that describes the third one?Thanks for asking Lisa, I've been meaning to write this and you've given me the perfect gentle push! For the record the piece for the harm of weight cycling is here and the one on the harm of weight stigma is here.The idea of healthcare inequalities is difficult to quantify because it's such a vast category. In terms of a definition, the one I'm going to use here is any way in which higher-weight people's healthcare experiences differ from those of thin people to the detriment of higher-weight people.It's always important to remember that when we discuss these inequalities we are clear that they don't impact everyone equally, as people's weight becomes higher their experience of inequality typically increases as well and, utilizing Kimberlé Crenshaw's framework of intersectionality, those who have multiple marginalized identities will also face greater inequality in their individual marginalizations and at the intersections of them.Finally, I want to point out that thin people can face healthcare disparities as well based on things like marginalized identities and socioeconomic status. The comparisons I'm drawing here are about the typical experience of thin people and are not meant to indicate that thin people never face issues in accessing healthcare, just that as a group thin people are not systematically marginalized within the healthcare system because of their size.I also want to be clear that this is not an exhaustive list and I welcome you to add other examples in the comment section. I'm going to divide these up into groups to help give this conversation some structure.Practitioner BiasThis includes a lot of different things. Before I get into it, I want to point out that providers aren't necessarily bad actors who just hate fat people (though, sadly, some absolutely are.) Many are simply a product of a healthcare system (including healthcare education) that is deeply rooted in weight stigma. Regardless of how they got to this place, these practitioners are responsible for the harm that they do.Some practitioners are operating out of implicit bias, which is to say that the bias is subconscious. Others are operating from explicit bias, they are fully aware of their negative beliefs and stereotypes about higher-weight people and they are working with higher-weight patients based on those beliefs and feelings. This can lead to a lot of negative impacts. Some examples:There is the classic (and far too prevalent) example of a practitioner who offers ethical, evidence-based treatments to thin patients for health issues, but sends higher-weight patients with the same symptoms/diagnoses/complaints away with a diet.There's the “Occam's razor” mistake. Occam's Razor states “plurality should not be posited without necessity.”  Said another way, when choosing between theories, the simplest one is usually correct. This gets applied to the care of higher-weight patients when providers don't address individual health issues/symptoms/diagnoses/complaints for fat patients because they assume weight loss will solve them all (and/or they want to see what weight loss solves before attempting the ethical, evidence-based treatments that thin people would typically get for the same issues/symptoms/diagnoses/complaints.)Some practitioners assume that fat patients are lying if what they are telling the provider doesn't match up with the provider's stereotypes of people their size. These practitioners base decisions and recommendations on their stereotypes rather than what the patient is telling them.There are practitioners who, consciously or subconsciously, are reluctant to touch fat patients or manipulate their bodies which can impact everything from examinations to post-operative care.There are practitioners who think it's worth risking fat people's lives and quality of life in attempts to make them thin. Some of these practitioners take this further by deciding that they know better than fat people and so try to manipulate/trick/bully fat people into weight loss interventions (including dangerous drugs and surgeries) by almost any means necessary including intentionally failing to give a thorough informed consent conversation – blowing patients off with phrases like “all drugs have side effects” or “it's nothing to worry about” rather than being honest about the risks and/or making threats about the patient's health and life expectancy that are not supported by evidence. These inequalities can lead to many harms. First of all, we know from a century of data that weight loss almost never works and typically results in weight cycling which is independently linked to a number of harms. It can also delay care – when a thin person gets an intervention at their first appointment but a fat person with the same symptoms/diagnosis gets sent away with a recommendation to lose weight the higher-weight patient's actual care is delayed.The “Occam's Razor” mistake creates similar problems. It must be remembered that Occam (actually, it seems, Ockham but that's a whole other thing) was a philosopher, not a physician. Deciding to treat something as complex as the human body by going for the simplest strategy is problematic on its face, even before we add the ways that weight stigma impacts providers' beliefs around and treatment of higher-weight patients.And there is another layer of harm here. As we'll see over and over, the harm from healthcare inequalities is intensified when the results of the harm are blamed on fat bodies. For example, higher-weight patients follow practitioners' advice to attempt weight loss. They lose weight short term and gain it back long term (which is exactly what all the research we have says will happen.) Their doctors tell them to try again, they weight cycle again. This happens repeatedly across their entire lives. Eventually these patient are diagnosed with cardiovascular disease (CVD). The fact that CVD is strongly linked to weight cycling is completely ignored and research (often created by/for the weight loss industry) blames “ob*sity” for the CVD and uses these higher rates of CVD to lobby for greater insurance coverage of weight loss treatments and the cycle of harm continues unabated.Structural InequalitiesThis occurs when the things that higher-weight patients need in order to access healthcare don't accommodate them. This can be because the things don't exist or because the healthcare facility that the patient is visiting doesn't have them.Again, there are too many examples here to name. One very common example is chairs. Having sturdy armless chairs in the waiting room, treatment rooms, and anywhere a patient may need to sit is the absolute least a facility can do and it's deeply disturbing how many facilities don't even get this right.Then there are the absolute basics of care – when the practice doesn't have (or can't find) properly sized/accommodating blood pressure cuffs, proper length vaccine needles, gowns, scales (for medically necessary weigh-ins like those to dose medications or check for edema from a heart condition). These are all things that thin patients can typically expect to be available.Durable medical equipment is another area where structural inequalities can compromise care – crutches, braces, walkers, wheelchairs, prosthetics.  Even when these things are available, they are often exponentially more expensive even when they don't have to be custom made.Then there are more specialized tools like operating tables and surgical instruments. Often the only place these instruments can be reliably found is in centers that focus on weight loss surgeries, meaning that higher-weight patients are excluded from the kind of surgical care that is routine for thinner patients.Next is imaging -   MRI and CT scanners that have high-weight rated tables and large enough bore sizes, ultrasounds that can appropriately view through adipose tissue, x-ray tables and spaces that are accommodating and more. Harm is added here when energy from those in the healthcare system is wasted on complaining that higher-weight people exist or justifying the lack of care, rather than focusing on solutions and working from the basis that healthcare should fit bodies, bodies shouldn't have to be changed to fit healthcare.As an example of this, let's look at the ways that a single MRI appointment can create healthcare inequalities. A patient is referred for an MRI of their knee with contrast. First, the patient goes to the facility to which their doctor referred them but is turned away because the MRI is too small. They call the referring doctor, who isn't aware of any other option and tells them to call around. After hours of research they find an MRI with a 550 pound weight limit and a bore size that will accommodate them, but unlike the first facility this one has a backlog so they'll have to wait three more weeks. When they arrive for their appointment the MRI tech is using a Gadolinium-based contrast agent (GBCA). The dosage table the tech has stops at 300 pounds and the patient says that they weigh more than that. So the tech decides to use a GBCA calculator, using the formula of the recommended dose (mmol/kg) multiplied by weight (kg) and divided by concentration (mmol/mL). Except the scale in the MRI facility has a limit of 400 pounds which is less than this patient weighs. The tech explains the risk of incorrect dosage and tells the patient that they can either cancel the MRI or give the tech their best guess of their weight. The patient offers their best guess. The patient is given a gown to change into, but it's way too small. The patient is told that they don't have gowns that are any bigger. The patient offers to wear their own clothes, explaining that they have worn 100% cotton clothes for exactly this reason. They are told that it's against policy and that the tech will have to ask their boss. The boss is off today so the patient can be rescheduled in 3 weeks and the tech says he will “try to remember” to ask his boss about the patient wearing their own clothes but suggests that the patient keep calling to try to verify and also that the patient find a scale that works for them so that they can give the tech an accurate weight. The patient comes back in three weeks with an accurate weight and having confirmed that they can wear their own clothes. They lay down on the MRI table and the tech tries to put the knee in the dedicated knee coil that allows the MRI to view the knee structure. It is too small for the patient's leg. The patient is told that there is no way to get an MRI of their knee.This is just one scan for one patient, and this is based on a true story. The failure of the healthcare system to accommodate higher-weight patients has the potential for a massive amount of harm, most of which goes uncaptured or, worse, is blamed on “ob*sity.”Research BiasThis also happens in multiple ways. It can include higher-weight people being left out of research. For example, it is well known that clearance rates of some anesthesia drugs can vary based on the amount of adipose-tissue a patient has, but higher-weight patients have traditionally been excluded from the trials for anesthesia medications so there isn't good data on this.Here harm is also increased when naming the inequality is seen as sufficient remedy. I recently spoke at the combined conference for the Washington State Society of Anesthesiologists and British Columbia Anesthesiologists' Society (which was an absolute delight! I gave a keynote and then had the honor of being on a panel with Dr. Lisa Erlanger and Dr. Sandi Pitfield.) In preparation for this, I read hundreds of pages of anesthesia research. What I repeatedly found were decades of studies that started by saying that higher-weight patients' exclusion from drug trials created serious knowledge gaps, but then just moved on. Admitting that there is a problem is the first step, it must be followed by taking steps to solve the problem. The solution is not to cobble together what exists and keep creating guidelines based on shoddy research.Part of this issue is researcher bias, limitations of time and money, and perceptions that it's not worth studying fat people or that it's reasonable for fat people to be excluded from research (often under the guise that it's acceptable to make fat patients become thin before they can access ethical, evidence-based medicine.)Another issue is the massive amount of money that is earmarked only to study the prevention and/or eradication of fatness instead of researching how to actually support the health of fat people.It Seems Like A Lot…This happens when we actually do know what fat patients need, for example, in terms of dosage. But they are still under-medicated because the amount that higher-weight people need “seems like a lot” to those who are dosing the drugs and who are used to the dosage for thinner patients.When someone's education is focused on thin patients (including viewing thin patients as “normal” and higher-weight patients as “different/abnormal/extra” and the treatment protocols for thin patients are the focus, then those practitioners can balk at what higher-weight patients actually need.Risk predicated on sizeThis happens when patients who are higher-weight are given treatments that are more dangerous based on their size alone. In an example I wrote about more in depth here, thin patients with type 2 diabetes are not referred to weight loss surgeries that create a permanent disease state in their digestive systems, carry extensive risk, and have very little long-term term data. Patients with so-called “class 1 ob*sity” have the surgery offered if they can't reach their glycemic management goals. Those with so-called “class 2 ob*sity” have the surgery “recommended” if they can't reach their glycemic management goals. Patients with so-called “class 3 ob*sity” have the surgery “recommended” regardless of their glycemic management. Even if someone believes that these surgeries meet the requirements of ethical, evidence-based medicine, the reality is that they are risky and suggesting that someone with well-controlled type 2 diabetes have a dangerous surgery simply because of their size is another dangerous healthcare inequality.BMI-Based Denials of CareI've written about these, and options to fight them, quite a bit (this is a good place to start). This occurs when a fat patient is denied healthcare (often a surgical procedure) unless or until they change their height-weight ratio. These denials are often “justified” using rationale that comes from blaming fat bodies for the negative outcomes of weight stigma, weight cycling, and other healthcare inequalities (for example, as I wrote about above, higher rates of post-op complications) and they amount to holding healthcare hostage for a weight loss ransom (and a ransom that most people will not be able to pay.) While all of the denied procedures are important, in some cases (like some organ transplants,) the procedures that are denied are truly life or death.Saving Money Through Healthcare InequalitiesA common attempted “justification” for the healthcare inequalities that fat people face is the idea that fat people shouldn't get the resources they need if they happen to need more resources than the average thin person. When added to a general focus on profit (especially in the US healthcare system) this leads to staff-to-patient ratios that make it impossible to correctly care for fat patients (for example, having adequate staff to safely turn patients to prevent bed sores or help them ambulate to improve post-surgery outcomes.) It can also mean not having the supplies that these patients need in order to have the best outcomes. Some examples are InterDry to prevent/treat skin fold infections or Hoyer lifts so that they can use a commode and avoid bedpans and chuck changes (both of which are made more difficult and dangerous for the patient and more likely to create negative outcomes when staff-to-patient ratios don't allow for adequate care, even if the practitioners aren't coming from a place of weight bias.)All of this, in turn, can create practitioner bias when they blame higher-weight patients rather than the healthcare system that is leaving both patients and practitioners without what they need.   When healthcare facilities are allowed to decide that they don't want to spend the money to give higher-weight people the care they need, or they are not adequately funded to do so, then higher-weight patients suffer. Here again the negative impacts of this are often simply blamed on “ob*sity.” For example, research on post-operative complication rates will often suggest that “ob*sity” causes higher complication rates without exploring the ways that these size-based healthcare inequalities may actually be at the root of any elevated rate of complications.This is not an exhaustive list of healthcare inequalities that higher-weight people face (please feel free to add other examples in the comments.) I'll also say that this is made much worse because these harms are not adequately measured or remedied and the harms from them get attributed to “ob*sity” rather than the inequalities that higher-weight people face.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Overlæge på Hvidovre Hospital Einer Kragh står i lidt af et dilemma. Han har modtaget et enormt generøst tilbud fra rejsekongen Simon Spies som tak for god behandling. Hvad mangler Hvidovre Hospital, og hvad kan bedst komme patienterne til gavn? Da først Einer Kragh modtager donationen, er Simon Spies gået bort. Men ikke desto mindre har en af hans sidste akt ændret markant, hvordan det danske syghusvæsen så ud for 40 år siden.Periodisk – en RAKKERPAK Original af Rakkerpak Productions.Historierne du hører bygger på journalistisk research og fakta. De kan indeholde fiktive elementer som for eksempel dialog.Hvis du kan lide min fortælling, så husk at gå ind og abonnér, give en anmeldelse og fortæl dine venner om Periodisk.Podcasten er blevet til med støtte fra Novo Nordisk Fonden. Hvis du vil vide mere kan du besøge vores website periodisk.dkAfsnittet er skrevet og tilrettelagt af Mads G. LadekarlTor Arnbjørn og Dorte Palle er producereMartin Birket-Smith står for lyddesign og mixSimon Bennebjerg er vært

Step into the powerful realm of MRI imaging, providing us with an unparalleled view of multiple sclerosis. Discover how acute inflammation becomes vivid with contrast, and how various MRI sequences unveil the past battles fought within your brain and spinal cord. We'll explore advances in techniques, revealing brain shrinkage, gray matter disease and myelin repair. Understand the impact of MS on brain processing efficiency during rest and specific tasks through functional MRI imaging. Crucial questions regarding where and how often to get MRI scans are addressed. Latest guidance on avoiding contrast for routine MRI monitoring in MS shared. Barry Singer MD, Director of The MS Center for Innovations in Care, interviews: Christina Azevedo MD, Assistant Professor of Clinical Neurology at the University of Southern California Robert Zivandinov MD, PhD, Director of the Buffalo Neuroimaging Analysis Center & Professor of Neurology at Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, State University of New York.

Nurses Out Loud with Kimberly Overton, BSN, RN – Gadolinium toxicity is a concerning issue that needs to be given our utmost attention. Gadolinium is a contrast agent commonly used in medical imaging procedures, despite the fact that it has been found to have potentially harmful effects on the human body. The use of gadolinium-based contrast agents in MRI scans has revolutionized the field of diagnostic medicine. However...

Nurses Out Loud with Kimberly Overton, BSN, RN – Gadolinium toxicity is a concerning issue that needs to be given our utmost attention. Gadolinium is a contrast agent commonly used in medical imaging procedures, despite the fact that it has been found to have potentially harmful effects on the human body. The use of gadolinium-based contrast agents in MRI scans has revolutionized the field of diagnostic medicine. However...

Mikroplastik, Glyphosat, Schwermetalle, Pestizide: Wir alle sind vergiftet, leider eher mehr als weniger. Andreas Breitfeld mit dem inneren Putzprogramm von Aktivkohle bis Glutathion, von NAC bis NAD, von Chlorella bis Zeolith, von Apherese bis Sauna. Der Sponsor dieser Folge ist Blinkist. Hol dir den Blinkist Premium Account mit 25% Ermäßigung auf https://www.blinkist.com/biohacking Probleme mit Gadolinium? Eine hyperbare Sauerstoffkammer (zum Beispiel die in Andreas Breitfelds Biohacking-Lab in München) könnte helfen. Die Entgiftung generell unterstützen können: • Aktivkohle (problemlos überall im Internet oder in der Apotheke) • Medizinische Kohle (aus grünen Kaffeebohnen), z.B. hier: https://www.hevert.com/market-de/de/arzneimittel/arzneimittel_von_a-z/produkt/kohle-hevert• Zeolith, z.B. hier: https://www.biosa-vitalkonzepte.de/ZeolithMED-Detox-Pulver-gepruefte-Medizinqualitaet-400g• Quicksilver Scientific Push & Catch gibt es hier: https://www.functionalself.co.uk/quicksilver-scientific-liver-saucer.html• Chlorella, aktuell (Stand Oktober 2022) sauber sollte diese sein: https://www.amazon.de/dp/B01NGTJYHV/ Ansonsten gilt https://www.heidelberger-chlorella.de als gute Adresse für all die genannten Entgiftungstinkturen, wie eben Chlorella, aber auch Bentonit, Koriander etc. Andreas Breitfeld setzt sie selbst in der Arbeit mit seinen – meist fortgeschrittenen – Klientinnen und Klienten aber nicht ein. • Ob man NR also Nicotinamide, NMN oder NAD+ verwendet, hängt von Budget und Level der Energielosigkeit ab. NR ist relativ günstig, braucht aber länger bis es zu wirken beginnt: https://www.sunday.de/vitamin-b3-niacin-nicotinamid-500mg-kapseln-hochdosiert.html; NMN ist ein paar Protonen reicher, geht schneller, kostet aber schon mehr: https://www.moleqlar.de/produkt/uthever-nmn/ (mit Code a.breitfeld aber 10% weniger); NAD+ als Infusion gibt's z.B. bei https://www.burn-out-muenchen.de/standorte/index.html Liposomales Glutathion gibt es bei Mitocare: https://mitocare.de/products/lipo-glutathion-booster • Um Glutathion selbst basteln zu können, braucht der Körper 3 Aminosäuren, welche es alle unter anderem bei https://edubily.de gibt. 1.) Cystein, z.B. https://edubily.de/products/n-acetyl-l-cystein2.) Glutamin, https://edubily.de/products/glutamin-pulver3.) Glycin, https://edubily.de/products/glycin-pulver EinläufeEin vernünftiges Gerät für den Einstieg ist zum Beispiel dieses: https://www.amazon.de/Magent-Edelstahl-Darmeinlauf-Irrigator-Darmreinigung-Verstopfung/dp/B08TQJMWMP Bernd Stösslein ist Experte in der Sache. Hier Bernds Anleitung für den Kaffee-Einlauf: https://www.bernd-stoesslein.de/tag/kaffee-einlauf/Sein YouTube-Kanal: https://www.youtube.com/c/BerndStoesslein Infos zu Chelattherapie und EDTA-Therapie hier: https://www.chelattherapeuten.com/chelattherapie/ Apherese? Das Thema ist ein Dschungel, in dem sehr gerne sehr viel versprochen und nicht ganz so viel gehalten wird. Bei ernsthaftem Interesse gerne den Andreas direkt kontaktieren, er hat sich mit dem Thema intensiv beschäftigt. Andreas Breitfelds Website: https://breitfeld-biohacking.com Das ausführliche Porträt über Andreas Breitfeld in The Red Bulletin (Autor, übrigens: Stefan Wagner): https://www.redbull.com/at-de/theredbulletin/biohacking-andreas-breitfeld Das Biohacking-Special, das Andreas Breitfeld und Stefan Wagner gemeinsam für The Red Bulletin Innovator produziert haben: https://issuu.com/redbulletin.com/docs/0221_trbi_at_lowres Stefan Wagners Biohacking-Kolumne im „carpe diem“: https://www.carpediem.life/wagner

KSQD 10-19-2022: Another Gene of the Week -- the detoxification gene COMT; New nutrition formula that supports the microbiome greatly improves malnutrition treatment; How to judge PSA levels and the risks for prostate cancer; Risks of gadolinium in contrast imaging and other heavy metal risks; The role of iodine in reducing breast cancer; Hormone disruptors in water-proof makeup products; Cleaning kitchen surfaces, especially spice bottles, is important to remove bacteria; Propyzamide weed killer interferes with anti-inflammatory regulation in the gut

Daniel Kahneman, a Nobel Prize-winning psychologist and renowned quantitative analyst, talks about how he applies the principles of behavioural science to analyze news and markets.

Dr. Lauren Kim interviews Dr. Yoon Hae Ahn and Dr. Hye-Ryun Kang to discuss "Allergic-like hypersensitivity reactions to Gadolinium-based contrast agents: An 8-year cohort study of 154 539 patients" Allergic-like Hypersensitivity Reactions to Gadolinium-based Contrast Agents: An 8-year Cohort Study of 154 539 Patients. Ahn and Kang et al. Radiology 2022; 303:329–336. 

Terence Kooyker, founder and CEO of the commodity hedge fund Valent Asset Management, rejoins the Essential Podcast to talk about the market and uses for the elements of the energy transition. In this episode, we return to the lanthanides to cover gadolinium, lucky element #64 on the Periodic Table.

This episode represents the final part of a series of conversations regarding the safety of gadolinium based contrast agents. Here we discuss who is most at risk for retaining gadolinium and how we can effectively get it out of the body using chelation therapy. I am joined by:Dr Richard Semelka - Dr Richard Semelka is a leading expert in Radiology for body MRI and gadolinium toxicity.He has written over 370 peer-reviewed papers and 16 text-books. and is the first doctor to publish on the entity of gadolinium deposition disease.Dr semelka offers clinical medical consultations for individuals experiencing gadolinium toxicity and in this discussion we will be observing practically how this is treated in the clinic.Kate Skardon - A patient advocate, continuing chelation therapy to remove gadolinium from the body following devastating consequences. Her story can be found here:   https://www.youtube.com/watch?v=4aozx...https://www.youtube.com/watch?v=1RvHA...Debbie Lambert- A patient advocate who seeks to raise awareness about Gadolinium Deposition Disease through various mediums, including the links below:https://m.facebook.com/pg/livingwithg...https://twitter.com/lambertdebbShow notes:HOPO Therapeutics- oral chelationhttp://www.hopotx.com/science/SAGE- Symptoms Associated with Gadolinium Exposurehttps://pubs.rsna.org/doi/abs/10.1148/radiol.2021211349

Gadolinium ist ein Kontrastmittel das bei der Anwendung eines MRT häufig eingesetzt wird. Obwohl häufig behauptet wird, dass Gadolinium binnen kürzester Zeit aus dem Körper ausgeschieden wird, kommt es in einigen Fällen zu einer chronischen Belastung. Die Folgen können chronische Müdigkeit, Schwindel, Sehstörungen, Herzrhythmusstörungen usw. sein. Dabei ist Gadolinium als Kontrastmittel oftmals gar nicht notwendig. Selbst das MRT muss nicht immer das Mittel der Wahl sein, sondern kann oftmals durch eine sanftere Therapie ersetzt werden. Du erfährst in diesem Interview, wie man sich auf eine Gadolinium-Belastung testen kann und wie es wieder ausgeleitet werden kann.   >>Hier geht's zu den Shownotes hier klicken hier klicken

Dr. Wagner is a clinical nephrologist. He is the Director of the Kidney Institute of New Mexico as well as being the acting Associate Chief of Research and Renal Section Chief for the VA in Albuquerque. This is the second time Dr. Wagner has been on the podcast with his research team. In this episode we re-examine the mechanisms behind gadolinium retention and receive updates on new discoveries.To fund Dr. Wagner's work you can donate to the Kidney Institute of New Mexico athttps://www.unmfund.org/fund/unm-kidney-institute-of-new-mexico/Links:Reveal Pharmaceuticals, Gadolinium-free MRI contrast agents products.http://www.revealpharma.comThe FDA adverse event reporting systemhttps://open.fda.gov/data/faers/Gadolinium-Based Contrast Agent Use, Their Safety, and Practice Evolutionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378745/

Gadolinium ist ein Kontrastmittel das bei der Anwendung eines MRT häufig eingesetzt wird. Obwohl häufig behauptet wird, dass Gadolinium binnen kürzester Zeit aus dem Körper ausgeschieden wird, kommt es in einigen Fällen zu einer chronischen Belastung. Die Folgen können chronische Müdigkeit, Schwindel, Sehstörungen, Herzrhythmusstörungen usw. sein. Dabei ist Gadolinium als Kontrastmittel oftmals gar nicht notwendig. Selbst das MRT muss nicht immer das Mittel der Wahl sein, sondern kann oftmals durch eine sanftere Therapie ersetzt werden. Du erfährst in diesem Interview, wie man sich auf eine Gadolinium-Belastung testen kann und wie es wieder ausgeleitet werden kann.   >>Hier geht's zu den Shownotes Hol dir jetzt die pure Energie! hier klicken hier klicken

Gadolinium ist ein Kontrastmittel das bei der Anwendung eines MRT häufig eingesetzt wird. Obwohl häufig behauptet wird, dass Gadolinium binnen kürzester Zeit aus dem Körper ausgeschieden wird, kommt es in einigen Fällen zu einer chronischen Belastung. Die Folgen können chronische Müdigkeit, Schwindel, Sehstörungen, Herzrhythmusstörungen usw. sein. Dabei ist Gadolinium als Kontrastmittel oftmals gar nicht notwendig. Selbst das MRT muss nicht immer das Mittel der Wahl sein, sondern kann oftmals durch eine sanftere Therapie ersetzt werden. Du erfährst in diesem Interview, wie man sich auf eine Gadolinium-Belastung testen kann und wie es wieder ausgeleitet werden kann.   >>Hier geht's zu den Shownotes Jetzt zuschlagen hier klicken hier klicken

Welcome to HerniaTalk LIVE, a Q&A hosted by Dr. Shirin Towfigh, hernia and laparoscopic surgery specialist who practices at the Beverly Hills Hernia Center. This is the only Q&A of its kind, aimed at educating and empowering patients about all things related to hernias and hernia-related complications. For a personal consultation with Dr. Towfigh: +1-310-358-5020, info@beverlyhillsherniacenter.com.This week, the topic of discussion was: Radiology Imaging MRI CT scan Ultrasound Hernias Mesh IV Contrast Gadolinium  Oral Contrast Adhesions PET scanIf you find this content informative, please LIKE, SHARE, and SUBSCRIBE to the HerniaTalk Live channel and visit us on www.HerniaTalk.com.Follow Dr. Towfigh on the following platforms:Youtube | Facebook | Instagram | Twitter

Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.21.25924  Intracranial deposition of gadolinium after contrast-enhanced MRI is an emerging area of concern with much still to be learned. Kalen Riley, MD, MBA discusses a new article that proposes a dose-reduction strategy that takes advantage of relatively higher T1 relaxivity of one macrocyclic agent compared to another while still striving to maintain an adequate imaging examination.

Dr. Yavuz Nuri Ertaş lisans eğitimini Başkent Üniversitesi Biyomedikal Mühendisliği bölümünde tamamlaması akabinde Bilkent Üniversitesi'nde bulunan Ulusal Nanoteknoloji Araştırma Merkezinde, Malzeme Bilimi ve Nanoteknoloji programında yüksek lisansa başlamıştır. Burada mikro-nano fabrikasyon ve sensörler konularında araştırmalar yaptıktan sonra dünyanın en saygın okullarından Kaliforniya Üniversitesi'nde (UCLA) doktora eğitimine başlayan Ertaş, manyetik nanoparçacıkların üretimi ve MR kontrast ajanı olarak uygulamaları üzerine odaklanmıştır. Bu çalışmalar sırasında dünyada bir ilk olan Gadolinium nanoparçacıklarının yüksek saflıkta üretilebileceği bir nanofabrikasyon tekniği geliştirmiştir ve bu parçacıkların MR görüntülemede yüksek performans sergilediğini deneysel olarak göstermiştir. Doktora sonrası araştırmalarına yine UCLA'de devam edip üç boyutlu biyobaskı alanında yayınladığı son makalesi alanının en iyi dergilerinden Advanced Healthcare Materials’da kapak olarak yayınlanmıştır. TÜBİTAK 2232 Uluslararası Lider Araştırmacılar Programı kapsamında yurda kesin dönüş yapan Dr. Ertaş çalışmalarına Erciyes Üniversitesi Nanoteknoloji Araştırma Merkezi (ERNAM) ve Erciyes Üniversitesi Biyomedikal Mühendisliğinde devam etmektedir. #biyoprinting​ #3D​ Hazırlayanlar: Sunucu ► Melis Zenginler Konuk İletişim ► Yavuz Aydın Yayın Teknik/Reji ► Buse Kuloğlu Sosyal Medya/ İletişim ► Sosyal Medya Ekibi ––––––––––––––––––––––––––––– ► Gelecek Bilimde kanalımızda, bilimin her alanından özgün canlı yayınlar bulabilirsiniz. Fizikten biyolojiye, yapay zekadan psikolojiye, müzik analizinden astronomiye, satrançtan teknoloji haberlerine kadar birçok içeriği her gün kaçırmamak için kanalımıza abone olun! ► https://youtube.com/gelecekbilimde?su...​ ► Bize destek olmak için: https://www.youtube.com/gelecekbilimd...​ ► Yayınlarımızı izlemek için: YouTube Kanalı ► https://youtube.com/gelecekbilimde​ Twitch Kanalı ► https://twitch.tv/gelecekbilimde​ Podcast ► https://podcast.gelecekbilimde.net​ ► Bizi takip edin! Twitter ► https://twitter.com/gelecekbilimde​ Instagram ► https://instagram.com/gelecekbilimde​ ► Diğer Bağlantılarımız: Gönüllü Olmak İçin ► https://birlikte.gelecekbilimde.net​ Kaynaklar ► https://bit.ly/gb-kaynak​ İngilizce Kelimeler ► https://quizlet.com/Gelecek_Bilimde​ Discord ► https://discord.gelecekbilimde.net​ Kitaplık ► https://goodreads.com/gelecekbilimde​ Gelecek Bilimde canlı yayınlarında konuklarımızın sözlerinden sadece kendileri sorumludur. Gelecek Bilimde ve gönüllüleri hiçbir şekilde sorumlu tutulamaz.

In this episode we continue our discussion of Gadolinium-based contrast agents (GBCA) from our introduction in Ep 27. Building on previous discussions of MRI safety (Ep9 & 11) and Contrast and Adverse Reactions from Ep 5 & 6, this episode will review specific considerations of gadolinium use in pregnancy and breast feeding. We also explore the non-acute adverse reactions of NSF and GDD. This is part two of the two-part series on the basics of GBCA. Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology. Guest: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Resources: • Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update. J. Ramalho, R.C. Semelka, M. Ramalho, R.H. Nunes, M. AlObaidy, and M. Castillo.AJNR Am J Neuroradiol 37:1192–98. dx.doi.org/10.3174/ajnr.A4615 • Gadolinium Deposition Disease: A New Risk Management Threat. H. Benjamin Harvey, Vrushab Gowda, Glen Cheng. J Am Coll Radiol 2020;17:546-550. doi.org/10.1016/j.jacr.2019.11.009. creativecommons.org/licenses/by-nc-nd/4.0/ • ABR Noninterpretative Skills Guide 2020. www.theabr.org/wpcontent/uploads/2020/02/NIS-Study-Guide-2020.pdf

In this episode we discuss Gadolinium-based contrast agents (GBCA) or media (GBCM). Building on previous discussions of MRI safety (Ep9 & 11) and Contrast and Adverse Reactions from Ep 5 & 6, this episode will introduce MRI contrast agents (GBCA or GBCM), their make-up, categories and general safety profiles. m including some of the inherent safety issues that arise from them; the concept of safety zones and its importance; examples of unique safety issues in MRI, and the screening process. Summary of some common GBCA and their trade names includes: Gadoteridol (ProHance) - Macrocyclic - Nonionic Gadobutrol (Gadavist) - Macrocyclic - Nonionic Gadoterate (Dotarem) - Macrocyclic - Ionic Gadodiamide (Omniscan) - Linear - Nonionic Gadoversetamide (Optimark) - Linear - Nonionic Gadobenate (MultiHance) - Linear - Ionic Gadopentetate dimeglumine (Magnevist) - Linear - Ionic This is part one of a two-part series on the basics of GBCA. Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology. Guest: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Resources: • Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Matthew S. Davenport, Mark A. Perazella, Jerry Yee, Jonathan R. Dillman, Derek Fine, Robert J. McDonald, Roger A. Rodby, Carolyn L. Wang, Jeffrey C. Weinreb. Radiology 2020; 294:660–668; https://doi.org/10.1148/radiol.2019192094 • ABR Noninterpretative Skills Guide 2020. www.theabr.org/wp content/uploads/2020/02/NIS-Study-Guide-2020.pdf

This episode discusses the different types of injuries that can occur. With the events surrounding the 6-year-old boy that died in New York while undergoing an MRI. This lead to the development and implementation of required MRI safety policies moving forward. Matt discusses the wide range of injuries that can occur ranging from minor radio-frequency burns to fatal results. Discussed as well as the concern for different implants in modern medicine. Matt discusses which implants are safe, which implants are not safe, and which implants are only safe when specific parameters are followed. And how to classify each. MRI safety can also include allergic reactions to Gadolinium. Gadolinium is a contrast agent used in MRI. Typically it’s injected intravenously but can also be given in the oral form. Reactions vary from minor headaches, hives, dyspnea, and can rarely be anaphylactic resulting in a fatality. For a great online educational resource. Check out riteadvantage.com

Commentary by Dr. Kalyanam Shivkumar

Commentary by Dr. Kalyanam Shivkumar

CardioNerd Amit Goyal is joined by Dr. Erika Hutt (Cleveland Clinic general cardiology fellow), Dr. Aldo Schenone (Brigham and Women’s advanced cardiovascular imaging fellow), and Dr. Wael Jaber (Cleveland Clinic cardiovascular imaging staff and co-founder of Cardiac Imaging Agora) to discuss nuclear and complimentary multimodality cardiovascular imaging for the evaluation of myocardial viability. Show notes were created by Dr. Hussain Khalid (University of Florida general cardiology fellow and CardioNerds Academy fellow in House Thomas). To learn more about multimodality cardiovascular imaging, check out Cardiac Imaging Agora!  Collect free to CME/MOC credit just for listening to the episode!  CardioNerds Multimodality Cardiovascular Imaging PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Show Notes & Take Home Pearls In response to ischemia the myocardium can dynamically change along a spectrum from myocardial stunning to myocardial hibernation to myocardial necrosis. The goals of viability testing are to identify patients who may benefit from revascularization as hibernating or stunned myocardium are potentially reversible causes of LV dysfunction. There are numerous imaging modalities available for the evaluation of myocardial viability. The broad range of ways in which myocardial viability is assessed speaks to the complexity of the disease spectrum and the difficulty in creating a unifying definition of viability to assess in clinical trials.   Five Take Home Pearls 1. In response to an acute episode of ischemia with subsequent reperfusion, the myocardium can be exposed to a large flux of oxygen free radicals or calcium overload that affects the cellular membrane and contractile apparatus. This phenotypically results in decreased contractility of the affected region of myocardium that can persist for weeks, labeled myocardial stunning  2. Repeated episodes of myocardial stunning or chronic low myocardial blood flow can lead to cellular changes such as resorption of the contractile apparatus in order to decrease oxygen demand and allow the myocardial cells to survive. Phenotypically, this might appear as regions of hypokinesis or akinesis at rest with a fixed perfusion defect on myocardial perfusion imaging. This is typically considered hibernating myocardium.   3. The goal of myocardial viability testing is to be able to differentiate between stunned, hibernating and necrosed myocardium. In patients with known epicardial coronary disease, this differentiation allows us to identify who may benefit from revascularization with improved LV systolic function and overall survival.   4. There are several imaging modalities that can be used in the assessment of myocardial viability. The most sensitive modalities are FDG-PET and CMR. The addition of Dobutamine or first pass perfusion with Gadolinium additionally increases the specificity of CMR. These modalities are more expensive and not as widely available.   5. The dynamic nature of the myocardial hibernation and the lack of a unifying definition/phenotypic expression of myocardial hibernation and viability have made it difficult for clinical trials to show that re-establishing myocardial blood flow to hibernating myocardium is beneficial. As Dr. Jaber stated in the episode in his spin on the classic opening phrase from Leo Tolstoy’s masterpiece, Anna Karenina, “All normal hearts are normal in the same way, and all abnormal hearts are abnormal in different ways.”  6. The PARR-2 trial was one of the few randomized, controlled trials of patients with LV systolic dysfunction and coronary artery disease who were randomized to either FDG-PET guided management or standard care with respect to whether to pursue revascularization. Overall,

Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.20.24536  Tyler Richards, MD discusses an AJR article that found no significant increase in the intrinsic T1 signal in the globus pallidus and dentate nucleus after more than 10 administrations of gadobutrol in pediatric patients compared to matched-age gadolinium naïve control and discussion of similar imaging based and autopsy studies.

"A Primer for Pain Physicians on Gadolinium-Based Contrast Agents: Caution Is Advised," by Zachary Pellis, BA, Lewis Katz School of Medicine, Philadelphia, Pennsylvania; Leonard DeRiggi, MD, Brighton Radiology Associates, Sewickley, Pennsylvania; Kim Shaftner, MD, JD, Fellow of the American College of Legal Medicine, Knott & Boyle, PLLC, Raleigh, North Carolina; David A. Provenzano, MD, Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania. From ASRA News, November 2020. See original article at www.asra.com/asra-news for figures and references. This material is copyrighted.

Let's gear up for the new year by making a decision to make positive changes next year. Be sure and write them down and focus on them often. Medical tests and procedures are often times necessary. However, it is still imperative to do your own research and consider the risks. MRI contrast-one type known as Gadolinium-can have serious side effects. Proceed with caution and wisdom.

Andrew Scarborough has a masters in nutritional therapy and a degree in human medical science. He's currently doing a postgraduate certification in clinical bioninformatics. He was diagnosed in 2013 with an incurable malignant brain tumour after having a brain haemorrhage on a train. We talk about: 8 years with a highly malignant brain tumour The public discussion of cancer therapies Interpreting cancer therapy studies Spontaneous remission Chemical & viral cancer triggers Genetic & environmental protection from cancer Andrew's e-book on the concerns around Gadolinium based contrast agents used in MRI scans Awareness of the problem within the industry New BHB coming soon from KetoSwiss Benefits of taking ketones Andrew can be found at: Twitter - https://twitter.com/ascarbs His podcast - https://podcasts.apple.com/us/podcast/the-human-guinea-pig-project/id1488201848 Ally can be found at: Twitter - https://twitter.com/paleocanteen Twitter - https://twitter.com/paleoally Instagram - https://www.instagram.com/paleocanteen YouTube - https://www.youtube.com/c/AllyHouston

In this episode of the Zone 3 podcast Dr. Emanuel Kanal, MD, FACR, FISMRM, AANG joins us to discuss the subject of Gadolinium administration for the purpose of diagnostic imaging.

Recently, researchers were able to build an electret the size of a single molecule. They were able to demonstrate that this minuscule device could store information, or, in other words, that they could make a memory out of it. We interviewed Mark Reed, a member of the team that made this incredible breakthrough, about what an electret is in the first place, how they got one to work on such a small scale, and what this all means for future technologies. Concerning the thumbnail: The image depicts ball made out of 60 carbon atoms, known as a buckyball, with an Gadolinium atom inside of it. These two ingredients, as explained by Professor Reed, were the basic constituents of the single molecule electret. About us: Socratic Media is a science communication company run by students. It's co-founders, Vishnu Veeravalli and Sunjum Sanghari, are both science lovers and are on a mission to share their passion with the world.

Have you had an MRI? Was it an MRI ‘with contrast’? That’s when the MRI technician injects you with a chemical called gadolinium so they can read the MRI easier. They probably told you to drink a lot of water to flush it out of your system, and that it would be gone from your body in 24 hours. What they probably didn’t tell you is that some people’s bodies don’t flush out the gadolinium and it makes them chronically sick and disabled.  And they probably didn’t tell you that the Food and Drug Administration requires that an MRI with gadolinium comes with a black box warning. Or that Europe and Japan have banned the use of gadolinium. And they probably didn’t tell you that even if you do report side effects, you’ll be gaslighted by doctors who will tell you it’s impossible to have gadolinium toxicity and that you’re imagining your symptoms.  In this episode of Medical Error Interviews, I chat with Casey Steidle, a creative and athletic woman living in California. Casey tells us about her body’s immediate reaction to the gadolinium injection, the response of the health care workers and her doctor, and then the tragedy of her doctor sending Casey for another MRI with contrast and how that severely damaged her body. Casey also shares how she had to take control of her own health destiny when the medical system turned its back on her, and about the treatments she pursued that have helped her regain a lot, but not all, of her health and quality of life.   Mri toxicity illnesses - FB -- https://www.facebook.com/groups/Gadolinium The Lighthouse Project:  https://gadoliniumtoxicity.com/ Casey’s website www.caseysteidle.com  Instagram @caseysteidle Be a podcast patron Support Medical Error Interviews on Patreon by becoming a Patron for $2 / month for audio versions.  Premium Patrons get access to video versions of podcasts for $5 / month.   Be my Guest I am always looking for guests to share their medical error experiences so we help bring awareness and make patients safer. If you are a survivor, a victim’s surviving family member, a health care worker, advocate, researcher or policy maker and you would like to share your experiences, please send me an email with a brief description:  RemediesPodcast@gmail.com  Need a Counsellor? Like me, many of my clients at Remedies Counseling have experienced the often devastating effects of medical error. If you need a counsellor for your experience with medical error, or living with a chronic illness(es), I offer online video counseling appointments. **For my health and life balance, I limit my number of counseling clients.**  Email me to learn more or book an appointment:  RemediesOnlineCounseling@gmail.com Scott Simpson:  Counsellor + Patient Advocate + (former) Triathlete I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard. Train hard. Rest hard. I have been living with HIV since 1998. I was the first person living with HIV to compete at the triathlon world championships. Thanks to research and access to medications, HIV is not a problem in my life. I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life. Counseling / Research I first became aware of the ubiquitousness of medical error during a decade of community based research working with the HIV Prevention Lab at Ryerson University, where I co-authored two research papers on a counseling intervention for people living with HIV, here and here.  Patient participants would often report varying degrees of medical neglect, error and harms as part of their counseling sessions. Patient Advocacy I am co-founder of the ME patient advocacy non-profit Millions Missing Canada, and on the Executive Committee of the Interdisciplinary Canadian Collaborative Myalgic Encephalomyelitis Research Network. I am also a patient advisor for Health Quality Ontario’s Patient and Family Advisory Council, and member of Patients for Patient Safety Canada. Medical Error Interviews podcast and vidcast emerged to give voice to victims, witnesses and participants in this hidden epidemic so we can create change toward a safer health care system.   My golden retriever Gladys is a constant source of love and joy. I hope to be well enough again one day to race triathlons again. Or even shovel the snow off the sidewalk.  

Podcast Contents 00:00-9:55- Introduction by David A. Bluemke, MD, PhD, Editor of Radiology.   09:45- 17:27– Radiogenomic Analysis of Breast Cancer by Linking MRI Phenotypes with Tumor Gene Expression. Bismeijer et al. Radiology 2020; 296:277–287. [Full Text]   17:28- 26:23– Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction. Leng and Ge et al. Radiology 2020; 296:299–309. . [Full Text]    26:24- 32:39 - Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis. Walker et al. Radiology 2020; 296:312–321. [Full Text]    32:40- 38:47– Distal Femoral Cortical Irregularity at Knee MRI: Increased Prevalence in Youth Competitive Alpine Skiers. Stern et al. Radiology 2020; 296:411–419. [Full Text]   38:04-38:47– Conclusion by David A. Bluemke, MD, PhD, Editor of Radiology

On the flip side of a grueling dance with death, Ginger Casper is on a mission to hold space for and provide help to folx struggling with chronic illness. She is a loving mother, a lawyer, a business-owner and a visionary. "How are you, Ginger?" "I am SO good," she'll say. She has a fresh perspective on life and what it means to be healthy, alive and happy. Since healing from Gadolinium poisoning, Ginger has launched two businesses with co-founder Chelsea Banks: Workflow Offices and Commons and Unburden. We dive into what these businesses are about, how she got here, and how she is able to help others heal. Notes:In case it wasn't clear, we believe COVID-19 is real, masks are helping, and keeping our immune systems healthy is important. As always, please post comments from a space of love and curiosity, never of reactivity or judgement. If it doesn't resonate with you, don't worry about it.Resources:Guest: Ginger CasperWorkflow Site: www.workflowokc.comWorkflow socials: @workflowokcUnburden Site: unburden.spaceUnburden socials: unburden.spacefollow us on instagram: @reddustrisingKarli's personal instagram: @astoldbykarliKarli's website: www.karliblalock.comHeart Centered Activism:Here is my site for heart-centered activism: https://www.karliblalock.com/activismGratitude:To Paige Bell @paigebelldesigns for the cover art and title treatmentTo Bryan and Ricky of Slow Cats for the musicSupport the show (https://venmo.com/KarliBee)Support the show (https://venmo.com/KarliBee)

Contributor: Michael Hunt, MD Educational Pearls: Contrast agents are commonly used for X-rays and CT’s to better characterize disease, but contrast doesn’t work with MRI. That’s where the element Gadolinium comes into play. Gadolinium, element 64, is ferromagnetic (attracted to iron) below 68 degrees and above that temperature it’s paramagnetic which makes it useful in MRI (Magnetic Resonance Imaging). Gadolinium is toxic alone, but when paired with chelators it can be used in humans and allows for better characterization of tumors or abnormal tissue on MRI. It helps identify this abnormal tissue because when MRI causes polarization of our body’s cells, the gadolinium, which has the maximum number of unpaired electrons in its orbital shells, alters the rate of decay in abnormal tissue highlighting abnormalities on imaging. Gadolinium can also be used in the treatment of cancers because it collects in the cells of abnormal tissue, allowing for more targeted therapies. In people exposed to gadolinium, the anaphylaxis rate is low, below 1/1000, and in rare cases there are reports of kidney injury and nephrogenic systemic fibrosis which is why it’s not recommended in renal failure patients. References 1)Ibrahim MA, Hazhirkarzar B, Dublin AB. Magnetic Resonance Imaging (MRI) Gadolinium. [Updated 2020 Mar 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482487/ 2)Pasquini L, Napolitano A, Visconti E, et al. Gadolinium-Based Contrast Agent-Related Toxicities [published correction appears in CNS Drugs. 2018 May 15;:]. CNS Drugs. 2018;32(3):229-240. doi:10.1007/s40263-018-0500-1   Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD

Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak’s Chief of Nephrology! We’ve put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium.   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written (including CME questions) and Produced by: Cyrus Askin, MD Infographic by: Cyrus Askin, MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Joel Topf, MD   Sponsors Pediatrics On Call podcast by the American Academy of Pediatrics If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here.   VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Sponsors - VCU Health CE and Pediatrics On Call podcast by APP 00:30 Intro, disclaimer, guest bio 03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame); 08:45 Sponsor - Pediatrics On Call podcast by APP 09:15 Definition of acute kidney injury (AKI) and fundamentals 11:00 Cardiorenal syndrome 12:24 Schema for AKI 17:30 Establish an etiology, determine urine output and address electrolyte abnormalities 21:22 AKI in the otherwise-healthy patient; 32:20 Rhabdomyolysis
38:21 Vancomycin 41:43 Acute interstitial nephritis (AIN) 44:52 Contrast induced nephropathy (CIN) 50:37 Gadolinium in AKI and/or CKD 52:53 Timing of dialysis 
 56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors; 62:01 Is Ultrasound necessary in AKI
 64:58 Dr. Topf’s take home points and Plug for Seminars in Nephrology 68:45 Outro and Sponsor - VCU Health CE   Links* Dr. Topf: Nephrology & Social Media - May 2020, Vol 50, Issue 3, p 247-328 of Seminars in Nephrology Dr. Topf: Zoe Keating - cellist & composer Dr. Topf: Mrs. America a miniseries which dramatizes the women’s movement and fight for and against the Equal Rights Amendment in the 1970s Dr. Williams: Last of Us 2   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will develop a rational approach to the diagnosis and management of the patient with acute kidney injury (AKI).   Learning objectives After listening to this episode listeners will…   … be facile with the definition of AKI … have a framework for approaching AKI including an understanding of what features in a patient’s history may shed light on the diagnosis … appreciate prerenal azotemia and the relationship with ATN … develop an approach to rhabdomyolysis and AKI … be able to discuss the various types of AKI likely to be seen in the critically ill patient ... recognize the paradigm shift related to the safety when using iodinated contrast and gadolinium with regards to renal function … know common medications implicated in AKI … appreciate common AKI-related issues in the outpatient setting and have a head-start on how best to deal with them   Disclosures Dr. Topf has received honoraria from AstraZeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures.    Citation Topf J, Askin CA, Williams PN,  Watto MF. “#226 Kidney Boy on Acute Kidney Injury: Myths & Musings”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Original Air Date: July 20th, 2020.

Like Luke Skywalker, today's tale takes a farmboy to greatness.

When I first connected with Debbie Lambert about her experience with gadolinium toxicity, I had to google ‘gadolinium’. When I read that gadolinium is the substance they inject you when you get an ‘MRI with contrast’ and that it can cause toxicity, I immediately started to search my memory.  I can recall at least one occasion of getting an MRI with contrast -- I remember the warm sensation it caused in my body, and the technicians telling me to drink lots of water to flush the chemical out of my body. After interviewing Debbie about her experiences living with the disabling chronic symptoms, and learning the facts about gadolinium toxicity, like the black box warning the FDA now requires, and the admission by the manufacturer that gadolinium accumulates in the body, I’m shocked that I’d never heard about this widespread problem.  I guess that’s a testament to the medical industries ability to hide, ignore and deny medical errors. As Debbie recounts, she was experiencing severe pain and it was determined it was emanating from her pancreas. Debbit was sent for a routine MRI with contrast to be able to get a better image of her troubled pancreas. The MRI technician did not ask for Debbie’s consent to be injected with gadolinium or inform Debbie about any potential harms from the invasive procedure. Debbie was hooked up to an IV and the gadolinium started to flow into her veins.  It was during Debbie’s 3rd MRI with contrast when things went horribly wrong and Debbie felt like she was being fried from the inside out. Debbie told the MRI technician immediately, but Debbie’s symptoms were dismissed and she was told to drink lots of water. But water wasn’t going to cure the damage done to Debbie’s organs. Water wasn’t going to stop the pain. Water wasn’t going to stop her from being disabled. Debbie does share what has helped - but not cured - her battle with gadolinium toxicity, and she shares about the community of survivors advocating and creating awareness about this problem so that others can make informed decisions about having the procedure. If you’ve had an MRI with contrast, or are concerned about the potential harm from gadolinium toxicity, you’ll want to hear what Debbie has learned about the medical system, the legal system, and your body’s systems when they are exposed to this rare earth metal. Connect with Debbie Lambert on twitter: @DebbieLambert On Facebook - Living With Gadolinium: https://m.facebook.com/livingwithgadadmin/… Info about MRIs and Gadolinium Toxicity: ttp://Mridye.com  Amazon e-book by Dr. Catriona Walsh: Contrasts: More Than Meets The MRI Be a podcast patron Support Medical Error Interviews on Patreon by becoming a Patron for $2 / month for audio versions.  Premium Patrons get access to video versions of podcasts for $5 / month.   Be my Guest I am always looking for guests to share their medical error experiences so we help bring awareness and make patients safer. If you are a survivor, a victim’s surviving family member, a health care worker, advocate, researcher or policy maker and you would like to share your experiences, please send me an email with a brief description:  RemediesPodcast@gmail.com  Need a Counsellor? Like me, many of my clients at Remedies Counseling have experienced the often devastating effects of medical error. If you need a counsellor for your experience with medical error, or living with a chronic illness(es), I offer online video counseling appointments. **For my health and life balance, I limit my number of counseling clients.**  Email me to learn more or book an appointment:  RemediesOnlineCounseling@gmail.com Scott Simpson:  Counsellor + Patient Advocate + (former) Triathlete I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard. Train hard. Rest hard. I have been living with HIV since 1998. I was the first person living with HIV to compete at the triathlon world championships. Thanks to research and access to medications, HIV is not a problem in my life. I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life. Counseling / Research I first became aware of the ubiquitousness of medical error during a decade of community based research working with the HIV Prevention Lab at Ryerson University, where I co-authored two research papers on a counseling intervention for people living with HIV, here and here.  Patient participants would often report varying degrees of medical neglect, error and harms as part of their counseling sessions. Patient Advocacy I am co-founder of the ME patient advocacy non-profit Millions Missing Canada, and on the Executive Committee of the Interdisciplinary Canadian Collaborative Myalgic Encephalomyelitis Research Network. I am also a patient advisor for Health Quality Ontario’s Patient and Family Advisory Council, and member of Patients for Patient Safety Canada. Medical Error Interviews podcast and vidcast emerged to give voice to victims, witnesses and participants in this hidden epidemic so we can create change toward a safer health care system. My golden retriever Gladys is a constant source of love and joy. I hope to be well enough again one day to race triathlons again. Or even shovel the snow off the sidewalk.

Kool-Aid to Kelsey Grammer, Key West to South Korea, the Dolomites to Fluid Impervious Floor Coverings.Immerse yourself in another round of enriching trivia training.Ready yourself for when the pubs open up again for your weekly Trivia Night.Level up your Trivia skills the easy way with Pub Quiz Prep.Pub Quiz Prep - Putting the 'edge' in your general knowledge.Invest in success with Pub Quiz Prep.The education you want, the education you deserve.https://www.pubquizprep.com/https://www.youtube.com/c/PubQuizPrephttps://www.instagram.com/pubquizprep/?hl=enhttps://twitter.com/PubQuizPrephttps://www.tumblr.com/blog/pub-quiz-prephttps://podcasts.google.com/?feed=aHR0cHM6Ly9yc3Mud2hvb3Noa2FhLmNvbS9yc3MvcG9kY2FzdC9pZC81MDkz

Dr Catriona Walsh helps people suffering from toxicity caused by MRI contrasts. Using diet, lifestyle and supplements, she helps them recover their health. Dr. Walsh is a graduate of Cambridge University, England, and Queen's University, Belfast. She practiced pediatric medicine for a decade and a half. While working as a consultant pediatrician, she developed a fascination with nutrition and lifestyle, and how they can improve the health of people suffering from chronic illness. Her experiences with chronic ill health led to a diagnosis of hypermobility Ehlers Danlos Syndrome (hEDS). EDS is an inherited connective tissue disorder. During investigations for hEDS, Dr Walsh had a contrast MRI. She still suffers the toxic side effects. Following her experiences with MRI contrast toxicity, Dr Walsh authored the book: Contrasts: More than meets the MRI – Demystifying the Devastating Damage Due to Gadolinium Contrasts and Some Natural Steps You Can Take to Reverse Those Dreadful Effects Using Diet and Lifestyle She now works as a Nutrition and Lifestyle Coach with people from all over the world. Mollie Brewer is an advocate against Gadolinium contrast agents. After she had a contrast MRI to diagnose a brain tumor, her health went downhill fast. She had multiple scans and became bed bound. She recently found a chelator that has helped her tremendously called NBMI. She is now working to restart her life before Gadolinium took it away. She runs the website mridye.com. Her website is a great source of information for anyone looking to learn more. Notes: Dr. Walsh’s Website: https://thefoodphoenix.co.uk Dr. Walsh’s Facebook Group: http://facebook.com/thefoodphoenix/ Buy Dr. Walsh’s Book: https://thefoodphoenix.co.uk/book/ or https://www.amazon.com/Contrasts-More-than-meets-MRI-ebook/dp/B084GVCRVX Mollie’s Website: www.mridye.com Mollie’s Twitter: https://twitter.com/HrsQuiet Paper Mollie Mentioned: https://pubs.rsna.org/doi/abs/10.1148/radiol.2019190461 First Steps after a contrast MRI: https://www.mridye.com/steps.html Gadolinium Toxicity Website: https://gadoliniumtoxicity.com/ Gadolinium Debate: https://www.itnonline.com/article/debate-over-gadolinium-mri-contrast-toxicity NBMI Chelation Info: https://www.lewrockwell.com/2019/11/mark-sircus/dr-boyd-haleys-super-glutathione-molecule/ Homepage: www.quaxpodcast.com Music by Jenny Jahlee from Live at KBOO

Ein bestimmtes Kontrastmittel, das bei Magnetresonanztomografien eingesetzt wirdund das Schwermetall Gadolinium enthält, soll gesundheitsschädlich sein. Stimmt das?

Bislang gibt es keinen wissenschaftlichen Nachweis dafür, dass Gadolinium-haltige Kontrastmittel die Gesundheit schädigen. Trotzdem klagen immer wieder Patienten über Nebenwirkungen. Von Peter Jaeggi.

Just the dudes gathered to talk about the JAMA Internal Medicine Meta Analysis on Gadolinium in CKD stage 4 and 5.Risk of Nephrogenic Systemic Fibrosis in Patients With Stage 4 or 5 Chronic Kidney Disease Receiving a Group II Gadolinium-Based Contrast AgentA Systematic Review and Meta-analysis.Summary on NephJCCast:Joel TopfSwapnil HiremathMatt SparksShow Notes:Swap has a disclosure!He was an author on the Canadian Association of Radiology guidelines on use of Gad in CKD.Grobner’s original paper reporting the association between gadolinium and NSF.Matt’s article on alternatives to gadolinium in MRI:Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging—a comprehensive overviewUsing Ferumoxytol as an MRI contrast agent.Saurabh Jha’s editorial (@RogueRad) for NephMadness when Gadolinium in CKD 4 was a team in 2018.PEXIVAS was an abstract in 2018 and was not published until 2020.A Cultural History of Rock-Paper-ScissorsMichelle’s recent case of NSF in a child (in case you thought this disease was gone)Removing Gad with dialysis.Matt’s tubular secretion: Biorender.comJohn Mandrola Expert or not an expert?JACC Case Reports on the Kardashian IndexRobert Cardiff’s editorial on the Kardashian Index in JACC Case Reports.Bryan Vartabedian blog post on Robert Cardiff’s editorialAnd NephMadness is coming! Friday March 13, 2020!

In this Live Friday CME Series recap, Dr. Todd Holcomb, an Internist and hospitalist with Lakeview Clinic and Ridgeview Medical Center, presents an interesting Internal Medicine case that is sure to scratch some heads, and remind us of the need to go back to the beginning, if it's not making sense after several attempts. Dr. Holcomb is accompanied by cardiologist Dr. Joshua Buckler, with Minneapolis Heart Institute, Dr. Jonathan Larson, family physician at Lakeview Clinic, Dr. Carl Dean, nephrologist with Kidney Specialists of Minnesota, and Dr. David Gross, radiologist with Consulting Radiologists.  So put on your thinking caps, listen closely and ask yourself what you would do as Dr. Holcomb guides us through this interesting case. Enjoy the podcast! OBJECTIVES:    Upon completion of this podcast, participants should be able to: Identify secondary causes of hypertension. Identify when further testing is warranted. Discuss newer treatments available for cholesterol related conditions. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org.   CLICK ON THE FOLLOWING LINK FOR YOUR CME CREDIT: CME Evaluation: "2019 Internal Medicine Case Conference" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: PART 1: Alright, let's break down the first portion of this case discussion. This is a 60 yo male with chest pain for over a year. Intermittent aching and burning in right anterior chest, worse with activity and lately has worsened overall with a stressful job and strong family hx of heart disease. General exam ins unremarkable. ECG normal. HDL is 60 and LDL slightly up at 137. PFTs and CXR are normal.  Stress echo is normal.  Cardiology referral results in a low Ca++ score but some plaque in the LAD. Dr. Buckler, the cardiologist, feels this is ischemic heart disease until proven otherwise. Therefore, a coronary angiogram is necessary. Imaging has its limitations, as do stress tests. When the history still doesn't point in another explicable direction, we must follow the logic and most likely etiology, which is till coronary artery disease and ACS. One of the problems with stress tests in general, is there are limitations inherent. It's hard to miss the big stuff, but the more minor findings can be missed. With a high pretest probability, he could have perhaps gone straight to angio. In this case, though, he was started on a statin and aspirin. Per Dr. Buckler, Imdur could also have been given. Two year later, he comes in with headaches in the same area of the head since his wife recently passed away. He takes Advil for this. BP has been elevated at home. Dr. Jonathan Larson, family physician, questions the type of headache, it's location and possible etiologies. Is the Advil causing rebound headaches or contributing to the headaches? The elevated home blood pressures also need further investigation. His kidney function is temporarily normal. NSAIDs are d/c'd and Lisinopril is started. A month later, the headaches have improved. BP improved, but not tremendously. In addition, his chest pain has gone away. A new antihypertensive, a combo HCTZ/Lisinopril regimen is started. Although Amlodipine would have been a reasonable choice. A year later, he returns with the same chest pain on exertion. Normal ECG. Normal renal function too. He now goes back to a CT angiogram showing multi-vessel disease. Per Dr. Buckler, one of the reasons he has worsened on a statin is that we may have limited understanding of his pathology, or potentially the CTA was not accurate the first time. Virtual FFT now can show the flow and how significant the lesion is, which is an advancement in this technology. Unfortunately, despite aggressive lipid therapy, sometimes people progress. A few days after the CTA, his Creatinine goes up a bit and GFR goes to 43. This is also after years of Lisinopril. Dr. Carl Dean comments on this alteration in renal function. He feels this is not entirely unexpected, but the data doesn't really reflect CIN (contrast induced nephropathy). Yet intuitively and experientially, we sometimes see this. The amount of contrast used is significantly more on a CTA than on an invasive angio. At this point, the ACE inhibitor is held and Amlodipine is started. Renal function now has improved. The angiogram demonstrates significant 3 vessel disease, with good downstream targets. The SYNTAX surgical risk score directs the cardiologist toward CABG instead of PCI. Post angio, he develops some lower extremity edema, and he is discontinues on Amlodipine, resumed on the HCTZ, Lisinopril. The creatinine is now 2.4. Did he receive enough fluids for the angiogram? Or was the few hundred cc's he obtained during the angio okay? Again, hindsight is 20/20, but the data doesn't support a causality for AKI due to CIN, nor is there a true preventable measure, including n-acetylcysteine or bicarbonate. Perhaps, in this case, CIN as a possibility in the past as discussed, that many would not argue with overhydrating. Ultimately it was felt the ACE and contrast contributed to his creatinine elevation. The ACE combo is now stopped and he is started on Hydralazine and Metoprolol. Creatinine improves, and he goes into CABG surgery. He is discharged and he continues on aspirin and Plavix for 3 months, and Carvedilol and Hydralazine. Atorvastatin is increased to 80 mg daily, a more aggressive dose. EF is normal on echo.  Do statins affect kidney function positively or negatively? According to Dr. Dean, there is no trial that supports either. His BP starts to increase, and Lisinopril is once again added, along with an increase of creatinine, and the ACE is again d/c'd. HCTZ was added. Then spironolactone for ongoing HTN. He's still running high though. Labetalol is replacing carvedilol now. And the pressure is still running high. What is happening here? What to do next? Do we try Lisinopril again? It is attempted, and he once again fails the creatinine test. It goes up again. PART 2: What we do now for this patient? It seems he can only improve on Lisinopril for blood pressure, but his creatinine continues to go up. According to Dr. Dean, in this patient, Lisinopril may not be a great option going forward, not only due to creatinine increase, but it will not help him in terms of mortality outcome. renal artery stenosis is a concern in this case. Dr. Tara McMichael interjects the question, could a loop diuretic have been tried? With a creatinine of 2.3, a loop diuretic could have been an option, since volume and sodium retention could be contributing to the hypertension. Isosorbide with hydralazine is also an option if more meds were to be added. Per Dr. Buckler, however, a four drug regimen that is poorly controlling blood pressure doesn't necessarily indicate adding a fifth drug. We need to know if there is a secondary cause of HTN. Sometimes, even in the setting of renal artery stenosis, patients still require significant anti-HTN drug regimens. Also, per Dr. Dean, the pretest probability in this type of patient for renal artery disease is high. And will an intervention be desirable if it is found? The ASTRAL trial demonstrated no improvement in outcomes. The CORAL trial was also done and considered to be a negative trial. One of the trial criticisms though was that it didn't include patients with severe enough disease. According to Dr. Dean, refractory hypertension should cause screening for this and an intervention should be done if it is seen.  Our patient has a renal u/s that shows bilateral RAS. Dr. David Gross, radiologist discussed the results of the MRA. The aorta, SMA and celiac trunk show atherosclerosis. The renal arteries are paired bilaterally. They have moderate to high grade narrowing of the arteries. Dr. Buckler asks the question of the safety of gadolinium in renal disease. In the setting of low GFR, in other words, less than 30, the risk for nephrogenic systemic fibrosis exists, although very rare. This is usually fatal, though. Basically, he has 4 out of 4 arteries occluded. Dr. Dean feels referral to a center of excellence for this unique issue is best for the patient. He undergoes transaortic endarterectomy, as his creatinine is rapidly going up. A significant plaque is resected from the aorta which was extending into the renal arteries. Post-procedure, he is placed on metoprolol, requiring nothing further. Rosuvastatin, Zetia and baby aspirin is started. Basically, unclogging the pipes resulted in a cure. And a while later, he's no longer on any antihypertensives. Blood pressures are great now. LDL now 57 on the new cholesterol meds. Zetia has limited data, but the PcsK9 inhibitor and his LDL is now 1. Dr. Buckler states there is a lot of unknowns about the LDL levels and whether there is a point of diminishing returns, but the science is not there yet. In this case, Dr. Buckler feels that stopping the Zetia and continuing the pcksk9 inhibitor makes sense. PART 3: Renovascular HTN is more commonly found in the setting of acute, severe, refractory, very high blood pressure. Work-up is needed when there is a strong possibility of secondary cause, and in the absence of another secondary cause, like pheochromocytoma or hyperaldosteronism. Also in an acute rise in BP, a young age, elevated Cr after starting an ace inhibitor, etc. Renal asymmetry on imaging and flash pulmonary edema are other clues. If Cr and BP are stable in the setting of stenosis, no intervention is indicated. Testing can potentially worsen function, as can the interventions performed to treat the disease. Who benefits most? People with short term hx of HTN, people who fail optimal medical therapy, not tolerating medical therapy and progressive renal failure. Ultrasound and CTA or MRA are the options for work-up. US is cheaper, but time consuming and operator dependent, with modest sensitivity/specificity. CTA is accurate for atherosclerosis. Highly sensitive and better if GFR below 30. MRA is highly sens/spec. Gadolinium complications can ensue in low GFR situations. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9) will lower LDL up to 60%. 50% decease in stroke and MI risk. The PCSK9 enzyme binds to liver LDL receptors and thereby increases plasma LDL levels. so inhibiting this enzyme leads to a lower LDL level. These inhibitors also can decrease triglycerides, increase HDL somewhat and decrease the volume of atheroma. Low adverse effects are noted with the med as well. Regarding renovascular HTN, Dr. Dean also reminds us that someone who is significantly older with chronic renal ischemia in the setting of this disease, may not have improvement in renal function even after intervention. Therefore, some of these patients who suddenly reperfuse a chronically ischemic kidney may actually worsen. Renal artery stenosis is also not an absolute contraindication for ACE. Such as in low EF heart failure. If the creatinine markedly rises, it can be discontinued again. Fibromuscular dysplasia patients, unlike atherosclerosis patients, should all receive an intervention. This is more commonly found in younger patients. Dr. Buckler addresses the ease of use and cost of the PCSK9 inhibitors. It turns out the cost is high at this point, up to $14k/year. But coverage has shown promise in FH and refractory high LDL. As it was alluded to by Dr. Holcomb, the patient really doesn't exercise and has a very stressful job, as it turns out. His dies wasn't discussed. Was he managing his risk factors very well? What does that mean nowadays? We have potent medications and skillful intervention options for reacting to this sort of pathology nowadays, but where are we at with prevention? Hopefully a conversation for another day.

Dr. Rupp is back! Today we talk about whether it's safe to give group 2 gadolinium based contrast agents to patients with CKD stage 4 and 5 and whether metoprolol can be used to prevent COPD exacerbations. We also shine some more sunlight on the sunshine vitamin's inability to change any meaningful outcomes, and discuss some interesting data from the Intern Health Study. Risk of Nephrogenic Systemic Fibrosis in Patients with Stage 4 or 5 CKD Receiving Group II Gadolinium Based Contrast AgentMetoprolol for the Prevent of Acute Exacerbations of COPDEarly High-Dose Vitamin D3 for Critically Ill, Vitamin D-Deficient PatientsPolitical events and mood among young physiciansMusic from https://filmmusic.io"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Dr. Wagner is a clinical nephrologist. He is the Director of the Kidney Institute of New Mexico as well as being the acting Associate Chief of Research and Renal Section Chief for the VA in Albuquerque. In this episode we discuss recent evidence urging caution over the use of gadolinium based contrast agents.To fund Dr. Wagner's work you can donate to the Kidney Institute of New Mexico athttps://www.unmfund.org/fund/unm-kidn...Links:Reveal Pharmaceuticals, Gadolinium-free MRI contrast agents products.http://www.revealpharma.comPeter Caravan PhD. Director, Institute for Innovation in Imaging Massachusetts and Associate Professor of Radiology at Harvard Medical School.Twitter- @PeterCaravanThe FDA adverse event reporting systemhttps://open.fda.gov/data/faers/Gadolinium-based contrast agents: why nephrologists need to be concernedhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416778/

This is one of the few places you will be able to find important information on risks of MRI dye (containing the toxic chemical gadolinium). Since I began reporting on this topic on Full Measure, many of these dyes have been banned in Europe and Japan. However, the FDA in the U.S. decided to keep them on the market and, instead, issued new warnings. However, the new warnings are very difficult to find. Investigative producer David Bernknopf joins me for this podcast. Share with your friends and family who might be interested in MRI dye safety. Read the text of the Full Measure story and watch the video investigation here. --- Send in a voice message: https://podcasters.spotify.com/pod/show/sharylattkissonpodcast/message

Most Americans don't know it but after we began reporting on MRI dye risks, many of the common MRI dyes containing gadolinium were banned in Europe and Japan. The US chose to leave them on the market and instead issue a warning. Problem is, the warning is nearly impossible for ordinary folks to find. Here is the information. Joining the Full Measure After Hours podcast is investigative producer David Bernknopf. Read the Full Measure story in text form and watch the video investigation here. Subscribe to "Full Measure After Hours" and also check out "The Sharyl Attkisson Podcast" for more original reporting. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/sharylattkisson/support

This is one of the few places you will be able to find important information on risks of MRI dye (containing the toxic chemical gadolinium). Since I began reporting on this topic on Full Measure, many of these dyes have been banned in Europe and Japan. However, the FDA in the U.S. decided to keep them on the market and, instead, issued new warnings. However, the new warnings are very difficult to find. Investigative producer David Bernknopf joins me for this podcast. Share with your friends and family who might be interested in MRI dye safety. Read the text of the Full Measure story and watch the video investigation here. --- Send in a voice message: https://anchor.fm/fullmeasurepodcast/message Support this podcast: https://anchor.fm/fullmeasurepodcast/support

David A. Bluemke, MD, PhD, Editor of Radiology discusses five research articles from the October 2019 issue of Radiology. ARTICLES DISCUSSED – Summary of Error Disclosure and Apology in Radiology: The Case for Further Dialogue. Radiology 2019; 293:30–35.;Summary of Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function Detected at Quantitative MRI. Radiology 2019; 293:97–106.;Summary of First-Trimester Exposure to Gadolinium-based Contrast Agents: A Utilization Study of 4.6 Million U.S. Pregnancies. Radiology 2019; 293:193–200.;Summary of Digital Mammography versus Breast Tomosynthesis: Impact of Breast Density on Diagnostic Performance in Population-based Screening. Radiology 2019; 293:60–68.;Summary of A Deep Learning Model to Triage Screening Mammograms: A Simulation Study. Radiology 2019; 293:38–46.

From India to Maryland to Michigan to Auburn—Allan David is on a quest. The John W. Brown Associate Professor is setting biomedical benchmarks with his smarts on smart materials and nanomaterials and all that amazing stuff. Gadolinium toxicity, you have met your match...

There’s a litigation tsunami on the horizon. If you order any MR imaging studies, you will want to hear more. Including how to mitigate the risk. Gadolinium is a contrast agent. Each year, about 30 million MR scans are performed. 1/3rd use contrast. The newly described diagnosis is called Gadolinium Deposition Disease. It was described only recently in clinical journals. Even today, the diagnosis is controversial. But, the lawsuits have started. First up, lawsuits against manufacturers/distributors of gadolinium contrast agents. Chuck Norris (and his wife) are some of the plaintiffs. These are being propelled in MultiDistrict Litigation (MDL) by a small number of attorneys. For those attorneys left out, they are starting to target healthcare systems, radiologists, and doctors who ordered such studies. On this episode of the Medical Liability Minute, Dr. Segal interviews Dr. Benjamin Harvey, Director of Quality Improvement, Department of Radiology, Massachusetts General Hospital, Harvard Medical School. Learn about Gadolinium Deposition Disease. Is it real? Is it just litigation theatre? If you order even one MR with contrast, learn how to mitigate the legal risk of being caught in the snare. 

Gadolinium has interesting magnetic properties and is used as a contrast agent in MRI scans, according to AUT's Prof Allan Blackman in ep 29 of Elemental.

Gadolinium has interesting magnetic properties and is used as a contrast agent in MRI scans, according to AUT's Prof Allan Blackman in ep 29 of Elemental.

Gadolinium has interesting magnetic properties and is used as a contrast agent in MRI scans, according to AUT's Prof Allan Blackman in ep 29 of Elemental.

David A. Bluemke, MD, PhD, Editor of Radiology discusses five research articles from the February 2019 issue of Radiology. ARTICLES DISCUSSED – Summary of Radiomic versus Convolutional Neural Networks Analysis for Classification of Contrast-enhancing Lesions at Multiparametric Breast MRI. Radiology 2019; 290:290-297. Summary of Detection of Breast Cancer with Mammography: Effect of an Artificial Intelligence Support System. Radiology 2019; 290:305-314. Summary of Validity of RECIST Version 1.1 for Response Assessment in Metastatic Cancer: A Prospective, Multireader Study. Radiology 2019; 290:349-356. Summary of Long-term Excretion of Gadolinium-based Contrast Agents: Linear versus Macrocyclic Agents in an Experimental Rat Model. Radiology 2019;290:340-348. Summary of Detection of Colorectal Hepatic Metastases Is Superior at Standard Radiation Dose CT versus Reduced Dose CT. Radiology 2019;290:400-409.

  Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re talking about a topic… Nachi: … woah wait, slow down for a minute, before we begin this month’s episode – we should take a quick pause to wish all of our listeners a happy new year! Thanks for your regular listenership and feedback. Jeff: And we’re actually hitting the two year mark since we started this podcast. At 25 episodes now, this is sort of our silver anniversary. Nachi: We have covered a ton of topics in emergency medicine so far, and we are looking forward to reviewing a lot more evidence based medicine with you all going forward. Jeff: With that, let’s get into the first episode of 2019 – the topic this month is first trimester pregnancy emergencies: recognition and management. Nachi: This month’s issue was authored by Dr. Ryan Pedigo, you may remember him from the June 2017 episode on dental emergencies, though he is perhaps better known as the director of undergraduate medical education at Harbor-UCLA Medical center. In addition, this issue was peer reviewed by Dr. Jennifer Beck-Esmay, assistant residency director at Mount Sinai St. Luke’s, and Dr. Taku Taira, the associate director of undergraduate medical education and associate clerkship director at LA County and USC department of Emergency Medicine. Jeff: For this review, Dr. Pedigo had to review a large body of literature, including thousands of articles, guidelines from the American college of obstetricians and gynecologists or ACOG, evidence based Practice bulletins, ACOG committee opinions, guidelines from the American college of radiology, the infectious diseases society of America, clinical policies from the American college of emergency physicians, and finally a series of reviews in the Cochrane database. Nachi: There is a wealth of literature on this topic and Dr. Pedigo comments that the relevant literature is overall “very good.” This may be the first article in many months for which there is an overall very good quality of literature. Jeff: It’s great to know that there is good literature on this topic. It’s incredibly important as we are not dealing with a single life here, as we usually do... we are quite literally dealing with potentially two lives as the fetus moves towards viability. With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: Oh, and speaking of being worth your time…. Don’t forget that if you’re listening to this episode, you can claim your CME credit. Remember, the indicates an answer to one of the CME questions so make sure to keep the issue handy. Jeff: Let’s get started with some background. First trimester emergencies are not terribly uncommon in pregnancy. One study reported 85% experience nausea and vomiting. Luckily only 3% of these progressed to hyperemesis gravidarum. In addition, somewhere between 7-27% experience vaginal bleeding or miscarriage. Only 2% of these will be afflicted with an ectopic pregnancy. Overall, the maternal death rate is about 17 per 100,000 with huge racial-ethnic disparities. Nachi: And vaginal bleeding in pregnancy occurs in nearly 25% of patients. Weeks 4-8 represent the peak time for this. The heavier the bleeding, the higher the risk of miscarriage. Jeff: Miscarriage rates vary widely based on age, with an overall rate of 7-27%. This rises to nearly 40% risk in those over 40. And nearly half of miscarriages are due to fetal chromosomal abnormalities. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes. Jeff: So key points here, since I think the wording and information you choose to share with often scared and worried women is important – nearly 25% of women experience bleeding in their first trimester. Not all of these will go on to miscarriages, though the risk does increase with maternal age. And of those that miscarry, nearly 50% were due to fetal chromosomal abnormalities. Nachi: So can we prevent a miscarriage, once the patient is bleeding…? Jeff: Short answer, no, longer answer, we’ll get to treatment in a few minutes. For now, let’s continue outlining the various first trimester emergencies. Next up, ectopic pregnancy… Nachi: An ectopic pregnancy is implantation of a fertilized ovum outside of the endometrial cavity. This occurs in up to 2% of pregnancies. About 98% occur in the fallopian tube. Risk factors for an ectopic pregnancy include salpingitis, history of STDs, history of PID, a prior ectopic, and smoking. Jeff: Interestingly, with respect to smoking, there is a dose-relationship between smoking and ectopic pregnancies. Simple advice here: don’t smoke if you are pregnant or trying to get pregnant. Nachi: Pretty sound advice. In addition, though an IUD is not a risk factor for an ectopic pregnancy, if you do become pregnant while you have in IUD in place, over half of these may end up being ectopic. Jeff: It’s also worth mentioning a more obscure related disease pathology here – the heterotopic pregnancy -- one in which there is an IUP and an ectopic pregnancy simultaneously. Nachi: Nausea and vomiting, though not as scary as miscarriages or an ectopic pregnancy, represent a fairly common pathophysiologic response in the first trimester -- with the vast majority of women experiencing nausea and vomiting. And as we mentioned earlier, only 3% of these progress to hyperemesis gravidarum. Jeff: And while nausea and vomiting clearly sucks, they seem to actually be protective of pregnancy loss, with a hazard ratio of 0.2. Nachi: Although this may be protective of pregnancy loss, nausea and vomiting can really decrease the quality of life in pregnancy -- with one study showing that about 25% of women with severe nausea and vomiting had actually considered pregnancy termination. 75% of those women also stated they would not want to get pregnant again because of these symptoms. Jeff: So certainly a big issue.. Two other common first trimester emergency are asymptomatic bacteriuria and UTIs. In pregnant patients, due to anatomical and physiologic changes in the GU tract – such as hydroureteronephrosis that occurs by the 7th week and urinary stasis due to bladder displacement – asymptomatic bacteriuria is a risk factor for developing pyelonephritis. Nachi: And pregnant women are, of course, still susceptible to the normal ailments of young adult women like acute appendicitis, which is the most common surgical problem in pregnancy. Jeff: Interestingly, based on epidemiologic data, pregnant women are less likely to have appendicitis than age-matched non-pregnant woman. I’d like to think that there is a good pathophysiologic explanation there, but I don’t have a clue as to why that might be. Nachi: Additionally, the RLQ is the the most common location of pain from appendicitis in pregnancies of all gestational ages. Peritonitis is actually slightly more common in pregnant patients, with an odds ratio of 1.3. Jeff: Alright, so I think we can put that intro behind us and move on to the differential. Nachi: When considering the differential for abdominal pain or vaginal bleeding in the first trimester, you have to think broadly. Among gynecologic causes, you should consider miscarriage, septic abortion, ectopic pregnancy, corpus luteum cyst, ovarian torsion, vaginal or cervical lacerations, and PID. For non-gynecologic causes, you should also consider appendicitis, cholecystitis, hepatitis, and pyelonephritis. Jeff: In the middle of that laundry list you mentioned there is one pathology which I think merits special attention - ovarian torsion. Don’t forget that patients undergoing ovarian stimulation as part of assisted reproductive technology are at a particularly increased risk due to the larger size of the ovaries. Nachi: Great point. Up next we have prehospital care... Jeff: Always a great section. First, prehospital providers should attempt to elicit an ob history. Including the number of weeks’ gestation, LMP, whether an IUP has already been confirmed, prior hx of ectopic, and amount of vaginal bleeding. In addition, providers should consider an early destination consult both to select the correct destination and to begin the process of mobilizing resources early in those patients who really need them, such as those with hemodynamic instability. Nachi: As with most pathologies, the more time you give the receiving facility to prepare, the better the care will be, especially the early care, which is critical. Jeff: Now that the patient has arrived in the ED we can begin our H&P. Nachi: When eliciting the patient’s obstetrical history, it’s common to use the G’s and Ps. This can be further annotated using the 4-digit TPAL method, that’s term-preterm-abortus-living. Jeff: With respect to vaginal bleeding, make sure to ask about the number of pads and how this relates to the woman’s normal number of pads. In addition, make sure to ask about vaginal discharge or even about the passage of tissue. Nachi: You will also need to elicit whether or not the patient has a history of a prior ectopic pregnancies as this is a major risk for future ectopics. And ask about previous sexually transmitted infections also. Jeff: And, of course, make sure to elicit a history of assisted reproductive technology, as this increases the risk of a heterotopic pregnancy. Nachi: Let’s move on to the physical. While you are certainly going to perform your standard focused physical exam, just as you would for any non-pregnant woman - what does the evidence say about the pelvic exam? I know this is a HOTLY debated topic among EM Docs. Jeff: Oh it certainly is. Dr. Pedigo takes a safe, but fair approach, noting, “A pelvic exam should always be performed if the emergency clinician suspects that it would change management, such as identifying the source of bleeding, or identifying an STD or PID.” However, it is noteworthy that the only real study he cites on this topic, an RCT of pelvic vs no pelvic in those with a confirmed IUP and first trimester bleeding, found no difference between the two groups. Obviously, the pelvic group reported more discomfort. Nachi: You did leave out one important fact about the study enrollment - they only enrolled about 200 of 700 intended patients. Jeff: Oh true, so a possibly underpowered study, but it’s all we’ve got on the topic. I think I’m still going to do pelvic exams, but it’s something to think about. Nachi: Moving on, all unstable patients with vaginal bleeding and no IUP should be assumed to have an ectopic until proven otherwise. Ruptured ectopics can manifest with a number of physical exam findings including abdominal tenderness, with peritoneal signs, or even with bradycardia due to vagal stimulation in the peritoneum. Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. Nachi: And that’s a perfect segue into our next section - diagnostic studies. Jeff: Up first is the urine pregnancy test. A UPT should be obtained in all women of reproductive age with abdominal pain or vaginal bleeding, and likely other complaints too, though we’re not focusing on them now. Nachi: The UPT is a great test, with nearly 100% sensitivity, even in the setting of very dilute urine. False positives are certainly plausible, with likely culprits being recent pregnancy loss, exogenous HCG, or malignancy. Jeff: And not only is the sensitivity great, but it’s usually positive just 6-8 days after fertilization. Nachi: While the UPT is fairly straight forward, let’s talk about the next few tests in the context of specific disease entities, as I think that may make things a bit simpler -- starting with bHCG in the context of miscarriage and ectopic pregnancy. Jeff: Great starting point since there is certainly a lot of debate about the discriminatory zone. So to get us all on the same page, the discriminatory zone is the b-HCG at which an IUP is expected to be seen on ultrasound. Generally 1500 is used as the cutoff. This corresponds nicely to a 2013 retrospective study demonstrating a bHCG threshold for the fetal pole to be just below 1400. Nachi: However, to actually catch 99% of gestational sacs, yolk sacs, and fetal poles, one would need cutoffs of around 3500, 18000, and 48,000 respectively -- much higher. Jeff: For this reason, if you want to use a discriminatory zone, ACOG recommends a conservatively high 3,500, as a cutoff. Nachi: I think that’s an understated point in this article, the classic teaching of a 1500 discriminatory zone cutoff is likely too low. Jeff: Right, which is why I think many ED physicians practice under the mantra that it’s an ectopic until proven otherwise. Nachi: Certainly a safe approach. Jeff: Along those lines, lack of an IUP with a bHCG above whatever discriminatory zone you are using does not diagnose an ectopic, it merely suggests a non-viable pregnancy of undetermined location. Nachi: And if you don’t identify an IUP, serial bHCGs can be really helpful. As a rule of thumb -- in cases of a viable IUP -- b-HCG typically doubles within 48 hours and at a minimum should rise 53%. Jeff: In perhaps one of the most concerning things I’ve read in awhile, one study showed that ⅓ of patients with an ectopic had a bCHG rise of 53% in 48h and 20% of patients with ectopics had a rate of decline typical to that of a miscarriage. Nachi: Definitely concerning, but this is all the more reason you need to employ our favorite imaging modality… the ultrasound. Jeff: All patients with a positive pregnancy test and vaginal bleeding should receive an ultrasound performed by either an emergency physician or by radiology. Combined with a pelvic exam, this can give you almost all the data necessary to make the diagnosis, even if you don’t find an IUP. Nachi: And yes, there is good data to support ED ultrasound for this indication, both transabdominal and transvaginal, assuming the emergency physician is credentialed to do so. A 2010 Meta-Analysis found a NPV of 99.96% when an er doc identified an IUP on bedside ultrasound. So keep doing your bedside scans with confidence. Jeff: Before we move on to other diagnostic tests, let’s discuss table 2 on page 7 to refresh on key findings of each of the different types of miscarriage. For a threatened abortion, the os would be closed with an IUP seen on ultrasound. For a completed abortion, you would expect a closed OS with no IUP on ultrasound with a previously documented IUP. Patients may or may not note the passage of products of conception. Nachi: A missed abortion presents with a closed os and a nonviable fetus on ultrasound. Findings such as a crown-rump length of 7 mm or greater without cardiac motion is one of several criteria to support this diagnosis. Jeff: An inevitable abortion presents with an open OS and an IUP on ultrasound. Along similar lines, an incomplete abortion presents with an open OS and partially expelled products on ultrasound. Nachi: And lastly, we have the septic abortion, which is sort of in a category of its own. A septic abortion presents with either an open or closed OS with essentially any finding on ultrasound in the setting of an intrauterine infection and a fever. Jeff: I’ve only seen this two times, and both women were incredibly sick upon presentation. Such a sad situation. Nachi: For sure. Before we move on to other tests, one quick note on the topic of heterotopic pregnancies: because the risk in the general population is so incredibly low, the finding of an IUP essentially rules out an ectopic pregnancy assuming the patient hasn’t been using assisted reproductive technology. In those that are using assisted reproductive technology, the risk rises to 1 in 100, so finding an IUP, in this case, doesn’t necessarily rule out a heterotopic pregnancy. Jeff: Let’s move on to diagnostic studies for patients with nausea and vomiting. Typically, no studies are indicated beyond whatever you would order to rule out other serious pathology. Checking electrolytes and repleting them should be considered in those with severe symptoms. Nachi: For those with symptoms suggestive of a UTI, a urinalysis and culture should be sent. Even if the urinalysis is negative, the culture may still have growth. Treat asymptomatic bacteriuria and allow the culture growth to guide changes in antibiotic selection. Jeff: It’s worth noting, however, that a 2016 systematic review found no reliable evidence supporting routine screening for asymptomatic bacteriuria, so send a urinalysis and culture only if there is suspicion for a UTI. Nachi: For those with concern for appendicitis, while ultrasound is a viable imaging modality, MRI is gaining favor. Both are specific tests, however one study found US to visualize the appendix only 7% of the time in pregnant patients. Jeff: Even more convincingly, one 2016 meta analysis found MRI to have a sensitivity and specificity of 94 and 97% respectively suggesting that a noncontrast MRI should be the first line imaging modality for potential appendicitis. Nachi: You kind of snuck it in there, but this is specifically a non-contrast MRI. Whereas a review of over a million pregnancies found no associated fetal risk with routine non-contrast MRI, gadolinium-enhanced MRI has been associated with increased rates of stillbirth, neonatal death, and rheumatologic and inflammatory skin conditions. Jeff: CT is also worth mentioning since MRI and even ultrasound may not be available to all of our listeners. If you do find yourself in such a predicament, or you have an inconclusive US without MRI available, a CT scan may be warranted as the delay in diagnosis and subsequent peritonitis has been found to increase the risk of preterm birth 4-fold. Nachi: Right, and a single dose of ionizing radiation actually does not exceed the threshold dose for fetal harm. Jeff: Let’s talk about the Rh status and prevention of alloimmunization. While there are no well-designed studies demonstrating benefit to administering anti-D immune globulin to Rh negative patients, ACOG guidelines state “ whether to administer anti-D immune globulin to a patient with threatened pregnancy loss and a live embryo or fetus at or before 12 weeks of gestation is controversial, and no evidence-based recommendation can be made.” Nachi: Unfortunately, that’s not particularly helpful for us. But if you are going to treat an unsensitized Rh negative female with vaginal bleeding while pregnant with Rh-immune globulin, they should receive 50 mcg IM of Rh-immune globulin within 72 hours, or the 300 mcg dose if that is all that is available. It’s also reasonable to administer Rh(d)-immune globulin to any pregnant female with significant abdominal trauma. Jeff: Moving on to the treatment for miscarriages - sadly there isn’t much to offer here. For those with threatened abortions, the vast majority will go on to a normal pregnancy. Bedrest had been recommended in the past, but there is little data to support this practice. Nachi: For incomplete miscarriages, if visible, products should be removed and you should consider sending those products to pathology for analysis, especially if the patient has had recurrent miscarriages. Jeff: For those with a missed abortion or incomplete miscarriages, options include expectant management, medical management or surgical management, all in consultation with an obstetrician. It’s noteworthy that a 2012 Cochrane review failed to find clear superiority for one strategy over another. This result was for the most part re-confirmed in a 2017 cochrane review. The latter study did find, however, that surgical management in the stable patient resulted in lower rates of incomplete miscarriage, bleeding, and need for transfusion. Nachi: For expectant management, 50-80% will complete their miscarriage within 7-10 days. Jeff: For those choosing medical management, typically with 800 mcg of intravaginal misoprostol, one study found this to be 91% effective in 7 days. This approach is preferred in low-resource settings. Nachi: And lastly, remember that all of these options are only options for stable patients. Surgical management is mandatory for patients with significant hemorrhage or hemodynamic instability. Jeff: Since the best evidence we have doesn’t suggest a crystal clear answer, you should rely on the patient’s own preferences and a discussion with their obstetrician. For this reason and due to the inherent difficulty of losing a pregnancy, having good communication is paramount. Nachi: Expert consensus recommends 6 key aspects of appropriate communication in such a setting: 1 assess the meaning of the pregnancy loss, give the news in a culturally competent and supportive manner, inform the family that grief is to be expected and give them permission to grieve in their own way, learn to be comfortable sharing the products of conception should the woman wish to see them, 5. provide support for whatever path she chooses, 6. and provide resources for grief counselors and support groups. Jeff: All great advice. The next treatment to discuss is that for pregnancy of an unknown location and ectopic pregnancies. Nachi: All unstable patients or those with suspected or proven ectopic or heterotopic pregnancies should be immediately resuscitated and taken for surgical intervention. Jeff: For those that are stable, with normal vitals, and no ultrasound evidence of a ruptured ectopic, with no IUP on ultrasound, -- that is, those with a pregnancy of unknown location, they should be discharged with follow up in 48 hours for repeat betaHCG and ultrasound. Nachi: And while many patients only need a single additional beta check, some may need repeat 48 hour exams until a diagnosis is established. Jeff: For those that are stable with a confirmed tubal ectopic, you again have a variety of treatment options, none being clearly superior. Nachi: Treatment options here include IM methotrexate, or a salpingostomy or salpingectomy. Jeff: Do note, however, that a bHCG over 5000, cardiac activity on US, and inability to follow up are all relative contraindications to methotrexate treatment. Absolute contraindications to methotrexate include cytopenia, active pulmonary disease, active peptic ulcer disease, hepatic or renal dysfunction, and breastfeeding. Nachi: Such decisions, should, of course, be made in conjunction with the obstetrician. Jeff: Always good to make a plan with the ob. Moving on to the treatment of nausea and vomiting in pregnancy, ACOG recommends pyridoxine, 10-25 mg orally q8-q6 with or without doxylamine 12.5 mg PO BID or TID. This is a level A recommendation as first-line treatment! Nachi: In addition, ACOG also recommends nonpharmacologic options such as acupressure at the P6 point on the wrist with a wrist band. Ginger is another nonpharmacologic intervention that has been shown to be efficacious - 250 mg by mouth 4 times a day. Jeff: So building an algorithm, step one would be to consider ginger and pressure at the P6 point. Step two would be pyridoxine and doxylamine. If all of these measures fail, step three would be IV medication - with 10 mg IV of metoclopramide being the agent of choice. Nachi: By the way, ondansetron carries a very small risk of fetal cardiac abnormalities, so the other options are of course preferred. Jeff: In terms of fluid choice for the actively vomiting first trimester woman, both D5NS and NS are appropriate choices, with slightly decreased nausea in the group receiving D5NS in one randomized trial of pregnant patients admitted for vomiting to an overnight observation unit. Nachi: Up next for treatment we have asymptomatic bacteriuria. As we stated previously, asymptomatic bacteriuria should be treated. This is due to anatomical and physiologic changes which put these women at higher risk than non-pregnant women. Jeff: And this recommendation comes from the 2005 IDSA guidelines. In one trial, treatment of those with asymptomatic bacteriuria with nitrofurantoin reduced the incidence of developing pyelonephritis from 2.4% to 0.6%. Nachi: And this trial specifically examined the utility of nitrofurantoin. Per a 2010 and 2011 Cochrane review, there is not evidence to recommend one antibiotic over another, so let your local antibiograms guide your treatment. Jeff: In general, amoxicillin or cephalexin for a full 7 day course could also be perfectly appropriate. Nachi: A 2017 ACOG Committee Opinion analyzed nitrofurantoin and sulfonamide antibiotics for association with birth defects. Although safe in the second and third trimester, they recommend use in the first trimester -- only when no other suitable alternatives are available. Jeff: For those, who unfortunately do go on to develop pyelo, 1g IV ceftriaxone should be your drug of choice. Interestingly, groups have examined outpatient care with 2 days of daily IM ceftriaxone vs inpatient IV antibiotic therapy and they found that there may be a higher than acceptable risk in the outpatient setting as several required eventual admission and one developed septic shock in their relatively small trial. Nachi: And the last treatment to discuss is for pregnant patient with acute appendicitis. Despite a potential shift in the standard of care for non pregnant patients towards antibiotics-only as the initial treatment, due to the increased risk of serious complications for pregnant women with an acute appy, the best current evidence supports a surgical pathway. Jeff: Perfect, so that wraps up treatment. We have a few special considerations this month, the first of which revolves around ionizing radiation. Ideally, one should limit the amount of ionizing radiation exposure during pregnancy, however avoiding it all together may lead to missed or delayed diagnoses and subsequently worse outcomes. Nachi: It’s worth noting that the American College of Radiology actually lists several radiographs that are such low exposure that checking a urine pregnancy test isn’t even necessary. These include any imaging of the head and neck, extremity CT, and chest x-ray. Jeff: Of course, an abdomen and pelvis CT carries the greatest potential risk. However, if necessary, it’s certainly appropriate as long as there is a documented discussion of the risk and benefits with the patient. Nachi: And regarding iodinated contrast for CT -- it appears to present no known harm to the fetus, but this is based on limited data. ACOG recommends using contrast only if “absolutely required”. Jeff: Right and that’s for iodinated contrasts. Gadolinium should always be avoided. Let me repeat that Gadolinium should always be avoided Nachi: Let’s also briefly touch on a controversial topic -- that of using qualitative urine point of care tests with blood instead of urine. In short, some devices are fda-approved for serum, but not whole blood. Clinicians really just need to know the equipment and characteristics at their own site. It is worth noting that there have been studies on determining whether time can be saved by using point of care blood testing instead of urine for the patient who is unable to provide a prompt sample. Initial study conclusions are promising. But again, you need to know the characteristics of the test at your ER. Jeff: One more controversy in this issue is that of expectant management for ectopic pregnancy. A 2015 randomized trial found similar outcomes for IM methotrexate compared to placebo for tubal ectopics. Inclusion criteria included hemodynamic stability, initial b hcg < 2000, declining b hcg titers 48 hours prior to treatment, and visible tubal pregnancy on trans vaginal ultrasound. Another 2017 multicenter randomized trial found similar results. Nachi: But of course all of these decisions should be made in conjunction with your obstetrician colleagues. Jeff: Let’s move on to disposition. HDS patients who are well-appearing with a pregnancy of undetermined location should be discharged with a 48h beta hcg recheck and ultrasound. All hemodynamically unstable patients, should of course be admitted and likely taken directly to the OR. Nachi: Also, all pregnant patients with acute pyelonephritis require admission. Outpatient tx could be considered in consultation with ob. Jeff: Patient with hyperemesis gravidarum who do not improve despite treatment in the ED should also be admitted. Nachi: Before we close out the episode, let’s go over some key points and clinical pearls... J Overall, roughly 25% of pregnant women will experience vaginal bleeding and 7-27% of pregnant women will experience a miscarriage 2. Becoming pregnant with an IUD significantly raises the risk of ectopic pregnancy. 3. Ovarian stimulation as part of assisted reproductive technology places pregnant women at increased risk of ovarian torsion. 4. Due to anatomical and physiologic changes in the genitourinary tract, asymptomatic bacteriuria places pregnant women at higher risk for pyelonephritis. As such, treat asymptomatic bacteriuria according to local antibiograms. 5. A pelvic exam in the setting of first trimester bleeding is only warranted if you suspect it might change management. 6. Unstable patients with vaginal bleeding and no IUP should be assumed to have an ectopic pregnancy until proven otherwise. 7. If you are to use a discriminatory zone, ACOG recommends a beta-hCG cutoff of 3500. 8. The beta-hCG typically doubles within 48 hours during the first trimester. It should definitely rise by a minimum of 53%. 9. For patients using assisted reproductive technology, the risk of heterotopic pregnancy becomes much higher. Finding an IUP does not necessarily rule out a heterotopic pregnancy. N. Send a urine culture for patients complaining of UTI symptoms even if the urinalysis is negative. J. The most common surgical problem in pregnancy is appendicitis. N, If MRI is not available and ultrasound was inconclusive, CT may be warranted for assessing appendicitis. The risk of missing or delaying the diagnosis may outweigh the risk of radiation. J. ACOG recommends using iodinated contrast only if absolutely required. N. For stable patients with a pregnancy of unknown location, plan for discharge with follow up in 48 hours for a repeat beta-hCG and ultrasound. J For nausea and vomiting in pregnancy, try nonpharmacologic treatments like acupressure at the P6 point on the wrist or ginger supplementation. First line pharmacologic treatment is pyridoxine. Doxylamine can be added. Ondansetron may increase risk of fetal cardiac abnormalities N So that wraps up episode 24 - First Trimester Pregnancy Emergencies: Recognition and Management. J: Additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. N: And the address for this month’s credit is ebmedicine.net/E0119, so head over there to get your CME credit. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!  

Every time you order an MRI with contrast, you should think to yourself, "Why do I need contrast?" Then, "If I need contrast, what are the risks?" This week, a show all about the risks of routine neuroimaging. Produced by James E. Siegler. Music by Little Glass Men, Loyalty Freak Music, and Kevin McLeod. Sound effects by Mike Koenig, Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES McDonald RJ, McDonald JS, Kallmes DF, Jentoft ME, Murray DL, Thielen KR, Williamson EE and Eckel LJ. Intracranial Gadolinium Deposition after Contrast-enhanced MR Imaging. Radiology. 2015;275:772-82. Rogosnitzky M and Branch S. Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms. Biometals. 2016;29:365-76. Pullicino R, Radon M, Biswas S, Bhojak M and Das K. A Review of the Current Evidence on Gadolinium Deposition in the Brain. Clin Neuroradiol. 2018;28:159-169.

David A. Bluemke, MD, PhD, Editor of Radiology discusses three research articles from the September 2018 issue of Radiology. ARTICLES DISCUSSED Summary of Gadolinium Distribution in Cerebrospinal Fluid after Administration of a Gadolinium-based MR Contrast Agent in Humans. Radiology 2018; 288(3):703-709. Summary of Immediate Mild Reactions to CT with Iodinated Contrast Media: Strategy of Contrast Media Readministration without Corticosteroids. Radiology 2018; 288(3):710-716. Summary of Contrast-enhanced CT for Colonic Diverticular Bleeding before Colonoscopy: A Prospective Multicenter Study. Radiology 2018; 288(3):755-761.Summary of Classification of CT Pulmonary Opacities as Perifissural Nodules: Reader Variability. Radiology 2018; 288(3):867-875.

MRI offers some advantages over ultrasound as a diagnostic tool in pregnancy. In this session, we were review the ACOG committee opinion on MRI use in pregnancy with a focus on gadolinium contrast agent.

Dr. Paul Anderson Discusses: How to mitigate toxicity from MRI contrast, anesthesia and sedation Thoughts on the spectrum between full integrative and going all natural in deciding what’s best for you Dr. A’s three foundations of a successful approach to cancer without which all other therapies are not likely to work Dr. Anderson’s new book on integrative cancer treatment Outside the Box Cancer Therapies Video Interviews and Anticancer How-To’s Anticancer Inspiration  Dr. Paul S Anderson is the CEO of the Anderson Medical Group which includes Advanced Medical Therapies, a state of the art medical center providing fully compliant IV, Hyperbaric and Mild Hyperthermia therapies and a medical education company Consult Dr. Anderson. He brings over four decades of medical training and experience together to allow his clinical and educational presence to grow and serve patients and physicians in the best way possible. He is a well-known continuing education presenter and author in the allopathic, naturopathic, acupuncture and nursing CME arenas. His areas of specialty are in complex clinical medicine, intravenous and injection medicine, oncology and genomics. He is co-author of the Hay House book “Outside the Box Cancer Therapies” a guide for patients, families and physicians. Dr. Anderson is former Chief of IV (intravenous therapy) Services for Bastyr Oncology Research Center and a past Professor at Bastyr University where he continues to consult in research design and holds the rank of Full Professor. He is a graduate of the National University of Natural Medicine in Portland, Oregon and began instructing classes at naturopathic medical schools in the early 1990’s. He is extending his medical education mission through the Anderson Medical Group CE site ‘ConsultDrA.com’ a web based educational platform. And it is only fitting that doctor Anderson is our first second time full length interview here on Integrative Answers to cancer.   I say full length interview because we did have doctor Ed Group back on recently to finish his two part miniseries on water fasting answering all of your questions and if you haven’t caught that one definitely go back and check it out but as far as a full length solitary interview doctor Anderson is our first repeat guest which is awesome because he just so also happens to be the naturopathic oncologist that saw us through the most difficult time of Ryder’s recovery from cancer right at the start.   And back then four years ago now I was incredibly impressed at the way he was able to answer all of my questions on literally everything I had managed to scour off the internet before seeing him, and that was a lot.   After we moved states we lost touch for a little while and we had some rather disappointing experiences with other naturopathic doctors and then when I started to go to integrative cancer conferences to learn everything I could for Ryder and all of you as our online presence started to grow I came to see he was actually the one teaching all the other doctors at these conferences so they all had some pretty big shoes to fill with us as it turned out! Helpful information? Help us keep it coming with your pledge of $3/month! https://www.patreon.com/thesternmethod

David A. Bluemke, MD, PhD, Editor of Radiology discusses three research articles and five review articles from the April 2018 issue of Radiology. ARTICLES DISCUSSED Summary of Observed Deposition of Gadolinium in Bone Using a New Noninvasive in Vivo Biomedical Device: Results of a Small Pilot Feasibility Study. Radiology 2018;287(1):96-103 Summary of Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis. Radiology 2018;287(1):104-115. Summary of Glioma Grade Discrimination with MR Diffusion Kurtosis Imaging: A Meta-Analysis of Diagnostic Accuracy. Radiology 2018;287(1):119-127. Summary of The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study. Radiology 2018;287(1):156-166. Summary of Reduction in Thyroid Nodule Biopsies and Improved Accuracy with American College of Radiology Thyroid Imaging Reporting and Data System. Radiology 2018;287(1):185-193.

Commentary by Dr. Valentin Fuster

David A. Bluemke, MD, PhD, Editor of Radiology discusses three research articles from the January 2018 issue of Radiology.ARTICLES DISCUSSED: Influence of Risk Category and Screening Round on the Performance of an MR Imaging and Mammography Screening Program in Carriers of the BRCA Mutation and Other Women at Increased Risk. Radiology 2018;286:443-451. Coronary Artery Disease: Analysis of Diagnostic Performance of CT Perfusion and MR Perfusion Imaging in Comparison with Quantitative Coronary Angiography and SPECT—Multicenter Prospective Trial. Radiology 2018;286:461-470. Allergic Reactions to Gadolinium-based Contrast Agents: A Systematic Review and Meta-Analysis. Radiology 2018;286:471-482.

The FDA announced that it is requiring a new class warning and other safety measures for all gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (or MRI) concerning gadolinium remaining in patients’ bodies, including the brain, for months to years after receiving these drugs. Report side effects involving GBCAs to FDA’s MedWatch program at www.fda.gov/medwatch. A link to the full communication detailing specific information for health care professionals and a list of FDA approved GBCAs can be found at www.fda.gov/DrugSafety. Released 12/19/2017

Listen to an audio podcast of the December 19, 2017 FDA Drug Safety Communication "FDA warns that gadolinium-based contrast agents (GBCAs) are retained in the body; requires new class warnings". This is an update to the FDA Drug Safety Communication: FDA identifies no harmful effects to date with br

Sandie Gascon is a Certified Functional Diagnostic Nutrition Practitioner from Ontario, Canada. She works with men and women to help free them from various health issues, live their lives to their fullest and do the activities they love. She is our guest this week where we talk about overcoming chronic health conditions like migraines, acne & Lupus, and steps to healing. Here's what you'll hear: Min 01:50 Introduction to Sandie Gascon & her training Min 02:45 Sandie Gascon's health history Min 11:00 Dealing with Lupus & gadolinium Min 14:10 Sandie's resources to heal herself Min 19:05 Amino acid therapy & SSRI Min 24:20 Trial & error healing, and studying FDN Min 28:45 Laying the foundation of healing Min 35:00 Frustrations during healing Min 43:15 Oxilates & testing Min 47:00 Sandie's resources To learn more about Sandie Gascon, visit her website here and follow her on social media: Facebook Page Facebook Group Instagram  Resources: Sandie's Free Training Series Effects of Childhood Trauma on Women's Health With Nikki Gratrix  Heal Your Pain With Dr. Joe Tatta Women's Wellness YouTube Channel   Sign Up For Our Newsletter  If you have not yet joined our community, be sure to grab our hidden Hormone stressors quiz here, and come on board! Thanks for listening, Bridgit Danner, Founder of Women's Wellness Collaborative

Listen to an audio podcast of the May 22, 2017 FDA Drug Safety Communication. FDA announced that to date a review has not identified adverse health effects from gadolinium retained in the brain after the use of gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (MRI); review to

We talk to Dr Adhipatria Kartamihardja, Post Doctoral Fellow at Gunma University, Japan about his recent study published in BJR on the distribution and clearance of retained gadolinium in the brain.

Gadolinium podcast from Chemistry World - the magazine of the Royal Society of Chemistry.

Die Eignung des neuartigen intravaskulären Kontrastmittels MS-325 (Vasovist) zur Darstellung kurzzeitig ischämisch geschädigten Myokards mit der Magnetresonanztomographie (MRT) werden experimentell an der Ratte untersucht. Es sollte geprüft werden, ob bzw. inwieweit bei Verwendung von MS-325 kurze Ischämiezeiten im Bereich von 12 bis 30 Minuten (12, 18, 30 min) im Vergleich zum bisher in der klinischen Kardiologie genutzten extrazellulären gadoliniumhaltigen Kontrastmittel Magnevist(r) detektierbar sind, ab welcher Okklusionszeit ein Myokardinfarkt mit einem Kontrastmittel darstellbar ist und ob ein intravaskuläres Kontrastmittel wie MS-325 ischämisch geschädigtes jedoch nicht infarziertes Gewebe detektieren kann. Die Untersuchungen wurden an 40 weiblichen Ratten durchgeführt. Je drei Gruppen für MS 325 bzw. Gadolinium zu drei Ischämiezeiten: 12, 18 und 30 min. Es wurden T2- und T1-gewichtete Sequenzen innerhalb eines 120-Minuten Monitorings (nativ bzw. T2, 3, 15, 30, 45, 60, 90 und 120 min) erfasst und die MRT-Messungen histomorphometrisch (TTC-Gewebefärbung) überprüft. Dabei konnte bei insgesamt 16 Tieren ein Infarkt nachgewiesen werden. Dies betraf von den mit MS 325 behandelten Tieren 2 nach 18 min und 7 nach 30 min Ischämiedauer (n = 7 pro Versuchsgruppe). Von den Tieren, denen Magnevist(r) appliziert wurde, war nur die 30 min-Gruppe TTC-positiv. Die Untersuchungen ergaben, dass MS-325-Anreicherungen nach allen drei Okklusionszeiträumen zu erkennen waren. Es wurde sowohl infarziertes als auch nicht infarziertes, nur ischämisch geschädigtes Myokard dargestellt. Bei der 12-Minuten-Gruppe zeigten 3 Tiere eine erhöhte Signalintensität. In der Testgruppe MS 325; 30 min Okklusionszeit waren nur teilweise MRT-detektierbare Kontrastmittelanreicherungen nachweisbar. Nach 120 min des Monitorings konnten innerhalb dieser Gruppe bei 5 Tieren keine erhöhten T2-Signale im Ischämiegebiet erfasst werden. Hinsichtlich der Einschätzung der Infarktgröße (MRT versus TTC) zeigte sich bei der Bland-Altman-Analyse nach Kontrastmittelgabe für beide Kontrastmitteln zuerst eine Überschätzung der Infarktgröße. 60 bis 120 min nach Kontrastmittelgabe ist für MS 325 bereits eine leichte Unterschätzung der Infarktgröße festzustellen, für Gadolinium erst 120 min nach Kontrastmittelgabe. Die statistischen Auswertungen (4-Way-ANOVA, t-Tests) der Kontrastmittel-Spätan-reicherung (Kontrast Blut/Myokard, ischämisch geschädigtes Areal/Myokard, ischä-misch geschädigtes Areal/Blut) ergaben einen signifikanten Unterschied im Vergleich der beiden Kontrastmittel für den Kontrast Blut/Myokard. Die T1-gewichteten Sequenzen (4-Way-ANOVA, 3-Way-ANOVA, t-Tests) zeigten, dass Gewebekontraste auch bei kurzen Ischämiezeiten (12 bis 30 min) durch MS 325 im Vergleich zu Magnevist teilweise besser darstellbar waren. Dabei nahm die Kontrastdarstellung mit zunehmender Ischämiedauer zu.

In MRI (Magnetic Resonance Imaging) or MRA (Magnetic Resonance Angiography) scans, patients may be injected with a gadolinium-based contrast agent which can lead to a life-threatening skin disorder in kidney patients. Because kidney failure patients may be unable to filter the gadolinium out of their systems, a recently identified disorder called Nephrogenic Systemic Fibrosis / Nephrogenic Fibrosing Dermotherapy (NSF/NFD) may develop.

In MRI (Magnetic Resonance Imaging) or MRA (Magnetic Resonance Angiography) scans, patients may be injected with a gadolinium-based contrast agent which can lead to a life-threatening skin disorder in kidney patients. Because kidney failure patients may be unable to filter the gadolinium out of their systems, a recently identified disorder called Nephrogenic Systemic Fibrosis / Nephrogenic Fibrosing Dermotherapy (NSF/NFD) may develop.

The Show Notes:Minoishe Interroberg's To Make with the Good English- very unique- short minute- literally- blunt vs. brunt IntroBill Bruford with Genesis, filmed in concertLousy concert filmsRupert McClanahan's Indestructible Bastards - Alan UrwinThe correct pronunciation and version of MolybdenumOccasional Songs for the Periodic TableCadmium, Indium, Tin, Antimony, Tellurium, Iodine, Xenon, Caesium, Barium, Lanthanum, Cerium, Praseodymium, Neodymium, Promethium, Samarium, Europium, Gadolinium, Terbium, Dysprosium, Holmium, Erbium Religious Moron of the Week  - Ronald Marquez (sent in by Scott Ornat)Ask Georgefrom Danny Schade- music major?- music and woo-woo?- Phil Hendrie?PFA at MusikfestShow Close ...................................... Mentioned in the show: Philadelphia Funk Authority's website and YouTube videos, Musikfest. And as always: George's blog, website, flickr, and myspace page. Have a comment on the show, a topic for Minoishe Interroberg, or a question for Ask George? Drop George a line at geo@geologicrecords.net or through his blog. Have any comments?

Seltene Erde Elemente sind eine Gruppe ähnlicher Elemente, zu denen das Lanthan und die 14 im Periodensystem folgenden Elemente Cer, Praeseodym, Neodym, Promethium, Samarium, Europium, Gadolinium, Terbium, Dysprosium, Holmium, Erbium, Thulium, Ytterbium und Lutetium zugerechnet werden. Lanthancarbonat wird in der Humanmedizin in neuester Zeit als Phosphatbinder bei Dialysepatienten eingesetzt. Es handelt sich dabei um einen nicht aluminiumhaltigen Phosphatbinder, der ein ebenso großes Phosphatbindungspotenzial aufzuweisen scheint wie Aluminiumhydroxid. In der vorliegenden Arbeit wurde der phosphorsenkende Effekt von Lanthancarbonat im Vergleich mit Aluminiumhydroxid und einer Nierendiät bei Katzen untersucht. Die Untersuchung wurde als Fütterungsversuch über einen Zeitraum von zehn Monaten an zwölf Europäisch Kurzhaarkatzen durchgeführt, die randomisiert in zwei bzw. vier Gruppen aufgeteilt wurden. Während dieses Versuchszeitraumes wurde dem Futter in insgesamt sieben verschiedenen Fütterungsperioden entweder Lanthancarbonat (34 mg/kg KM/d) oder Aluminiumhydroxid (90 mg/kg KM/d) in einer oder mehrmaliger Dosierung als Phosphatbinder zugesetzt. Die Effekte dieser Phosphatbinder wurden dabei bei bedarfsgerechter Phosphorversorgung (Alleinfutter) bzw. bei phosphorreduzierter Fütterung (Nierendiätfutter) untersucht. Als Proben wurden am Ende jeder Fütterungsperiode Blut, 24h-Urin und Kot genommen. In diesen Proben wurde jeweils der Phosphorgehalt bestimmt. Anhand der jeweiligen Gesamturin- bzw. -kotmenge wurde zusätzlich die Phosphorexkretion pro kg Körpermasse und Tag ermittelt. Die Ergebnisse dieser Studie zeigen, dass sowohl Lanthancarbonat als auch Aluminiumhydroxid bei klinisch gesunden Katzen im gewählten Untersuchungszeitraum (14 Tage) und einer Dosierung von 34 bzw. 90 mg/kg Körpermasse/1 x tgl. kaum Effekte auf den Phosphorstoffwechsel erzielten. Die Verfütterung eines Nierendiätetikums konnte im gleichen Untersuchungszeitraum und im gleichen Versuchsaufbau die Phosphorkonzentrationen des Serums, des Urins und des Kotes senken und die renale und fäkale Gesamtexkretion an Phosphor vermindern. Um eine endgültige Bewertung der Wirkung von Lanthancarbonat im Vergleich mit Aluminiumhydroxid auf den Phosphorstoffwechsel der Katze vorzunehmen, müssten allerdings weitere Untersuchungen mit höheren Dosierungen, längeren Versuchszeiträumen und über den Tag verteilten Dosierungen durchgeführt werden.

Die Superparamagnetic Iron Oxides (SPIO)-verstärkte MRT der Leber wird als sinnvolle präoperative diagnostische Methode mit einer hohen Sensitivität und Spezifität für die Detektion von fokalen Leberläsionen angewendet. Mit der SPIO-verstärkten MRT ist aber prinzipiell auch eine Differenzierung zwischen benignen und malignen fokalen Leberläsionen möglich auf der Basis ihrer zellulären Zusammensetzung und Funktion (RES-Zellen in normalem Lebergewebe und in benignen Tumoren, keine RES-Zellen in malignen Tumoren). In früheren Studien wurden die Effekte von SPIO-Kontrastmitteln fast ausschließlich auf die Detektion von Läsionen sowie die Effekte in T2-gewichteten (w) Fast-Spin Echo (FSE) und T2*-w Gradienten Echo (GRE) Sequenzen beschränkt, da SPIO hauptsächlich die T2 / T2* - Zeiten verkürzen. Ferucarbotran ist ein relativ neu zugelassenes SPIO-Kontrastmittel, welches als intravenöser Bolus appliziert werden kann und sich durch eine geringe Nebenwirkungsrate vor allem im kardiovaskulären Bereich auszeichnet. Eine dynamische T1-w Perfusionsmessung nach der Bolusapplikation von Ferucarbotran könnte Informationen über die Vaskularisation solider Tumore in der Leber liefern. Die Möglichkeit der Charakterisierung von fokalen Leberläsionen mit Hilfe der dynamischen Ferucarbotran-verstärkten MRT wurde bereits in der Literatur angedeutet und typische Befunde konnten an einer begrenzten Anzahl von Fällen für einzelne fokale Leberläsionen gezeigt werden. Das erste Ziel dieser Arbeit war die Evaluierung der diagnostischen Effizienz des SPIO Kontrastmittel Ferucarbotran in T2-w FSE and T2*-w GRE Sequenzen zur Charakterisierung von fokalen Leberläsionen. Das zweite Ziel war es typische Anreicherungsmuster fokaler Leberläsionen in der dynamischen T1-w MRT mit 2D-GRE and 3D-GRE VIBE Sequenzen zu beschreiben. An einem 1.5 Tesla MRT-System wurden native und kontrastverstärkte T2-w FSE and T2*-w GRE Sequenzen 10 Minuten nach Bolusinjektion von 1.4 ml Ferucarbotran bei 68 Patienten durchgeführt. An einem 1.5 Tesla MRT-System wurden T1-w dynamische Bilder bei 23 Patienten mit einer 2D-GRE Sequenz und bei 37 Patienten mit einer 3D-GRE-VIBE Sequenz akquiriert. Die endgültige Diagnose der 68 Patienten, bei denen T2-w FSE/ T2*-w GRE Sequenzen durchgeführt wurden war Hepatozelluläres Karzinom (HCC, n=29), Lebermetastasen (n=15), Cholangiozelluläres Karzinom (CCC, n=2), Hämangiom (n=6), Leberzelladenom (n=5), Fokal Noduläre Hyperplasie (FNH, n=3) und Zysten (n=8). Die endgültige Diagnose der 60 Patienten, bei denen eine T1-w dynamische Ferucarbotran-verstärkte MRT durchgeführt wurde war HCC (n=25), Lebermetastasen (n=14), CCC (n=2), Hämangiom (n=6), Leberzelladenom (n=3), FNH (n=3) and Zysten (n=7). In den T2-w FSE und T2*-w GRE Bildern wurde das Signal-zu-Rausch-Verhältnis (SNR) und das Kontrast-zu-Rausch-Verhältnis basierend auf Signalintensitätsmessungen in den fokalen Läsionen und dem Leberparenchym durchgeführt. Der prozentuale Signalverlust (PSIL) der verschiedenen fokalen Läsionen von der nativen zur kontrastverstärkten T2-w FSE –Sequenz wurde errechnet. Eine qualitative Auswertung der Bildqualität sowie der Abgrenzbarkeit der Läsionen im Vergleich zwischen kontrastverstärkten T2-w FSE und kontrastverstärkten T2*-w GRE Bildern erfolgte. In den T1-w dynamischen Bildern wurden Signalintensitätsmessungen im Leberparenchym, den Lebergefäßen und in fokalen Leberläsionen vorgenommen um SNR und CNR zu errechnen. Das mittlere SNR von soliden benignen Läsionen zeigte einen Abfall in der T2-w FSE Sequenz von 34.1 vor auf 21.0 (p