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Arquivos Brasileiros de Cirurgia... 2023Adhesive small bowel obstruction is one of the most common causes of surgical emergencies, representing about 15% of hospital admissions. Defining the need and timing of...
BACKGROUND
Adhesive small bowel obstruction is one of the most common causes of surgical emergencies, representing about 15% of hospital admissions. Defining the need and timing of surgical intervention still remains a challenge.
AIMS
To report the experience of using meglumine-based water-soluble contrast in a tertiary hospital in southern Brazil, comparing with the world literature.
METHODS
Patients suspected of having adhesive small bowel obstruction, according to their clinical conditions, underwent an established protocol, consisting of the administration of water-soluble contrast, followed by plain abdominal radiograph within 12 hours and by a new clinical evaluation. The protocol was initiated after starting conservative management, including fasting and placement of a nasogastric tube, as well as intravenous fluid reposition.
RESULTS
A total of 126 patients were submitted to the protocol. The water-soluble contrast test sensitivity and specificity after the first radiograph were 94.6 and 91.0%, respectively; after the second radiograph, these values were 92.3 and 100%. The general test values for sensitivity and specificity were 91.9 and 100%, respectively.
CONCLUSIONS
The measure parameters evaluated in this study were similar to those found in the literature, contributing to endorse the importance of this test in the evaluation of patients with adhesive small bowel obstruction. The particular relevance of this study was the similar results that were found using a different type of meglumine-based contrast, which is available in Brazil.
Topics: Humans; Diatrizoate Meglumine; Tissue Adhesions; Contrast Media; Intestinal Obstruction; Meglumine; Water
PubMed: 38088723
DOI: 10.1590/0102-672020230059e1777 -
Langenbeck's Archives of Surgery Dec 2017Small bowel obstruction (SBO) from adhesive disease presents great burden for the healthcare system. Some groups have reported water soluble contrast agents (WSCA)...
BACKGROUND
Small bowel obstruction (SBO) from adhesive disease presents great burden for the healthcare system. Some groups have reported water soluble contrast agents (WSCA) protocols, but published studies are underpowered. This study introduces a WSCA protocol to improve outcomes and streamline patient care.
STUDY DESIGN
The study ran July 1, 2013-June 30, 2015, at Kaiser Permanente San Diego; protocol started July 1, 2014. Data was collected prospectively, on an intention to treat basis. We excluded patients whose SBO were not due to adhesive disease. Protocol included nasogastric tube, intravenous resuscitation, liquid docusate, and gastrografin study if symptoms persisted at 24 h. Colon contrast determined resolution vs operative consideration. Primary outcomes were operative rates and hospital length of stay (LOS).
RESULTS
Seven hundred fifteen were patients admitted with SBO; after exclusions there were 261 pre-protocol and 243 protocol patients. One hundred sixty patients resolved within 24 h; 96% of remaining patients stayed on protocol (n = 154). After WSCA protocol began, 15.6% required an operation, compared to 19.8% of pre-protocol patients (NS). The WSCA protocol significantly decreased the time to surgery (2.8 vs 4.88 days, p = 0.03), and the LOS of operated patients (9.51 vs 15.78 days, p = 0.02).
CONCLUSIONS
A standardized SBO protocol using WSCA significantly decreased time to operation and hospital LOS. This approach improves utilization of resources and may improve outcomes. More work should be done to investigate the positive effects of WSCA protocol for patients with SBO.
Topics: Aged; Aged, 80 and over; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Intestine, Small; Length of Stay; Male; Middle Aged; Patient Selection; Radiography; Time-to-Treatment; Tissue Adhesions
PubMed: 28770343
DOI: 10.1007/s00423-017-1605-6 -
Heliyon May 2024This study aims to investigate the use of sodium iodide (NaI), dimethyl sulfoxide (DMSO), ethyl alcohol, and ethyl acetate as cone-beam CT (CBCT) contrast agents for...
OBJECTIVES
This study aims to investigate the use of sodium iodide (NaI), dimethyl sulfoxide (DMSO), ethyl alcohol, and ethyl acetate as cone-beam CT (CBCT) contrast agents for diagnosing cracked teeth. The optimal delay time for detecting the number of crack lines beyond the dentino-enamel junction (Nd), the number of cracks extending from the occlusal surface to the pulp cavity (Np), and the depth of the crack lines was explored.
METHODS
14 human extracted cracked teeth were collected, 12 were used for enhanced scanning, and 2 were used for exploring the characteristic of crack lines. The teeth were scanned in 3 CBCT enhanced scanning (ES) modes: ES1 using meglumine diatrizoate (MD); ES2 using NaI and DMSO, ES3 using NaI, DMSO, ethyl alcohol and ethyl acetate. Three delay times (15mins, 30mins, and 60mins) were set for scanning. Nd, Np, and depth of crack lines were evaluated.
RESULTS
There were totally 24 crack lines on 12 cracked teeth. Nd was 10 in ES1 at 60mins, 24 in ES2 at 60mins and 24 in ES3 at 15mins. Np was 1 in ES1 at 60mins, 10 in ES2 at 60mins and 21 in ES3 at 60mins, and there were significantly different among them ( < 0.01). The average depth presented on ES3 was significantly deeper than ES1 and ES2 ( < 0.01).
CONCLUSION
NaI, DMSO, ethyl alcohol and ethyl acetate show potential as contrast agents for enhanced CBCT scanning in diagnosis of cracked teeth and their depth . A delay time of 15 min is necessary to confirm the existence of crack lines, while a longer delay time is required to ascertain if these crack lines extend to the pulp cavity.
PubMed: 38774323
DOI: 10.1016/j.heliyon.2024.e31036 -
Current Vascular Pharmacology 2017Contrast-induced acute kidney injury (CI-AKI) is a serious complication of the administration of iodinated contrast media (CM) for diagnostic and interventional...
BACKGROUND AND OBJECTIVE
Contrast-induced acute kidney injury (CI-AKI) is a serious complication of the administration of iodinated contrast media (CM) for diagnostic and interventional cardiovascular procedures and is associated with substantial morbidity and mortality. While the preventative measures can mitigate the risk of CI-AKI, there remains a need for novel and effective therapeutic approaches. The pathogenesis of CI-AKI is complex and not completely understood. CM-induced renal tubular cell apoptosis caused by the activation of endoplasmic reticulum (ER) stress is involved in CIAKI. We previously demonstrated that valsartan alleviated CM-induced human renal tubular cell apoptosis by inhibiting ER stress in vitro. However, the nephroprotective effect of valsartan on CI-AKI in vivo has not been investigated. Therefore, the aim of this study was to explore the protective effect of valsartan in a rat model of CI-AKI by measuring the amelioration of renal damage and the changes in ER stressrelated biomarkers.
METHOD AND RESULTS
Our results showed that the radiocontrast agent meglumine diatrizoate caused significant renal insufficiency, renin-angiotensin system (RAS) activation, and renal tubular apoptosis by triggering ER stress through activation of glucose-regulated protein 78 (GRP78), activating transcription factor 4 (ATF4), caspase 12, CCAAT/enhancer-binding protein-homologous protein (CHOP) and c-Jun N-terminal protein kinase (JNK) (P<0.05; n=6 in each group). Pre-treatment with valsartan significantly alleviated renal dysfunction, pathological injury, and apoptosis along with the inhibition of ER stressrelated biomarkers (P<0.05; n=8 in each group).
CONCLUSION
Valsartan could protect against meglumine diatrizoate-induced kidney injury in rats by inhibiting the ER stress-induced apoptosis, making it a promising strategy for preventing CI-AKI.
Topics: Activating Transcription Factor 4; Acute Kidney Injury; Animals; Apoptosis; Caspase 12; Contrast Media; Cytoprotection; Diatrizoate Meglumine; Disease Models, Animal; Endoplasmic Reticulum Chaperone BiP; Endoplasmic Reticulum Stress; Heat-Shock Proteins; JNK Mitogen-Activated Protein Kinases; Kidney; Male; Rats, Wistar; Renin-Angiotensin System; Signal Transduction; Time Factors; Transcription Factor CHOP; Valsartan
PubMed: 27781957
DOI: 10.2174/1570161114666161025100656 -
The Journal of International Medical... Jun 2021The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman...
The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman with chylous leakage following modified radical mastectomy. We describe the patient's diagnostic and treatment process in detail. The patient was diagnosed with grade II (left) breast invasive ductal carcinoma. Post-operatively, the patient's chest wall and axilla were pressurized, and negative pressure drainage was initiated. On the fifth post-operative day, the drainage from the chest wall and axilla increased significantly, and the patient developed chylous leakage on the eighth postoperative day. We injected meglumine diatrizoate (100 mL) and elemene (10 mL) into the patient's axilla, and the chylous leakage gradually resolved 18 days post-operatively. In this report, we focus on managing a case of chylous leakage after modified radical mastectomy for breast cancer. Meglumine diatrizoate combined with elemene is a possible treatment for the management of this rare complication.
Topics: Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Mastectomy; Mastectomy, Modified Radical; Middle Aged
PubMed: 34130539
DOI: 10.1177/03000605211021375 -
Asian Cardiovascular & Thoracic Annals May 2017
Topics: Adult; Conservative Treatment; Contrast Media; Diatrizoate Meglumine; Female; Humans; Iatrogenic Disease; Stents; Time Factors; Tomography, X-Ray Computed; Tracheoesophageal Fistula; Treatment Outcome
PubMed: 26936836
DOI: 10.1177/0218492316634488 -
The American Surgeon Apr 2022The advent of the Gastrograffin® small bowel follow through (G-SBFT) has resulted in a decreased rate of operative intervention of small bowel obstructions (SBO);...
INTRODUCTION
The advent of the Gastrograffin® small bowel follow through (G-SBFT) has resulted in a decreased rate of operative intervention of small bowel obstructions (SBO); however, there is no data to suggest when G-SBFT should be performed.
METHODS
We retrospectively reviewed 548 patients, admitted to 1 of 9 hospitals with a diagnosis of SBO. Patients were divided into two categories with regards to timing of G-SBFT: before (early) or after (late) 48 hours from admission. Primary outcomes were length of stay (LOS) and total cost. Secondary outcomes were operative interventions and mortality.
RESULTS
Of the reviewed patients, 71% had the G-SBFT ordered early. Comparing early versus late, there were no differences in patient characteristics with regards to age, sex, or BMI. There was a significant difference between LOS (4 vs 8 days, < 0.05) and total cost ($17,056.19 vs $33,292.00, < 0.05). There was no difference in mortality (1.3% vs 2.6%, = 0.239) or 30-day readmission rates (15.6% vs 15.9%, = 0.509). Patients in the early group underwent fewer operations (20.7% vs 31.9%, = 0.05).
DISCUSSION
Patients that had a G-SBFT ordered early had a decreased LOS, total cost, and operative intervention. This suggests there is a benefit to ordering G-SBFT earlier in the hospital stay to reduce the overall disease burden, and that it is safe to do so with regards to mortality and readmissions. We therefore recommend ordering a G-SBFT within 48 hours to reduce LOS, cost, and need for an operation.
Topics: Diatrizoate; Diatrizoate Meglumine; Humans; Intestinal Obstruction; Intestine, Small; Length of Stay; Retrospective Studies
PubMed: 34732062
DOI: 10.1177/00031348211050823 -
Internal Medicine Journal Dec 2018
Topics: Aged, 80 and over; Conservative Treatment; Contrast Media; Diatrizoate Meglumine; Endometriosis; Female; Humans; Hysterectomy; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Multimorbidity; Ovariectomy; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30517994
DOI: 10.1111/imj.14125 -
The American Surgeon Dec 2023The use of Gastrografin (GG) in the management of adhesive small bowel obstruction (SBO) has been shown to decrease the length of stay and operative intervention.
BACKGROUND
The use of Gastrografin (GG) in the management of adhesive small bowel obstruction (SBO) has been shown to decrease the length of stay and operative intervention.
METHODS
This retrospective cohort study examined patients with an SBO diagnosis prior to implementation (PRE, January 2017-January 2019) and following implementation (POST, January 2019-May 2021) of a GG challenge order set made available across 9 hospitals within a health care system. Primary outcomes were utilization of the order set across facilities and over time. Secondary outcomes included time to surgery for operative patients, rate of surgery, nonoperative length of stay, and 30-day readmission. Standard descriptive, univariate, and multivariable regression analyses were performed.
RESULTS
PRE cohort had 1746 patients and POST had 1889. The utilization of GG increased from 14% to 49.5% following implementation. Significant variability existed within the hospital system with utilization at each individual hospital from 11.5% to 60%. There was an increase in surgical intervention (13.9% vs 16.4%, .04) and decrease in nonoperative LOS (65.6 vs 59.9 hours, < .001) following implementation. For POST patients, multivariable linear regression showed significant reduction in nonoperative length of stay (-23.1 hours, .001) but no significant difference in time to surgery (-19.6 hours, .08).
DISCUSSION
The availability of a standardized order set for SBO can result in increased Gastrografin administration across hospital settings. The implementation of a Gastrografin order set was associated with decreased length of stay in nonoperative patients.
Topics: Humans; Diatrizoate Meglumine; Contrast Media; Cohort Studies; Retrospective Studies; Length of Stay; Treatment Outcome; Intestinal Obstruction; Tissue Adhesions
PubMed: 37191904
DOI: 10.1177/00031348231175135 -
PloS One 2017Post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) are rapidly becoming effective and practical methods in forensic medicine. In this article, the...
Post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) are rapidly becoming effective and practical methods in forensic medicine. In this article, the authors introduce a whole-body PMCTA approach involving left ventricle cardiac puncture. This procedure was performed in 9 males and 3 females. PMCT was performed first. Then a biopsy core needle was used for a percutaneous puncture into the left ventricle through the intercostal area under CT guidance. 1000 mL of contrast media (diatrizoate meglumine and normal saline [0.9%] at 1:2 ratio) was injected at a rate of 50 mL/8 s, followed by CT scan. Visualization of systemic arteries was achieved in 11 cases, while only partial visualization was achieved in 1 case, which may have been related to incomplete thawing of the cadaver. PMCTA results revealed no vascular diseases and abnormalities in 10 victims. Among the 10 victims, 4 post-scan autopsies were performed and found no vascular abnormalities, consistent with the PMCTA results. Autopsy of the other 6 victims were refused by the relatives. PMCTA revealed signs of internal carotid artery aneurysm inside the sphenoid sinus in one victim, which was confirmed by autopsy. PMCTA results of another victim showed signs of stenosis and blockage of the distal part of the right vertebral artery and basilar artery. Thromboembolism of those arteries was found during autopsy. Compared with other existing PMCTA methods for examination of vascular injuries and diseases, this technique involves simple procedures, is less time consuming, has lower associated costs, does not require specialized equipment, provides adequate imaging quality, and is suitable for centres not equipped with cardiopulmonary bypass machines or other specialized equipment.
Topics: Adult; Aged; Computed Tomography Angiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Postmortem Changes
PubMed: 28827844
DOI: 10.1371/journal.pone.0183408