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BMC Research Notes Apr 2020Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Some surgeons still perform routine post-sleeve gastrografin (RSG)...
OBJECTIVE
Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures. Some surgeons still perform routine post-sleeve gastrografin (RSG) study believing that it would detect post-LSG complications, especially leak. In this study, we aimed to evaluate the cost-effectiveness of RSG by considering the cost of the study, length of hospital stay and complications-related costs RSG could prevent.
RESULTS
A total of 98 eligible patients were included. Of them, 54 patients underwent RSG and 44 did not. Excluding the cost of LSG procedure, the average cost for those who underwent RSG and those who did not in Saudi Riyal (£) was 5193.15 (1054.77) and 4222.27 (857.58), respectively. The average length of stay (ALOS) was practically the same regardless of whether or not the patient underwent RSG. 90.8% (n = 89) of all patients stayed for 3 days. None of the patients developed postoperative bleeding, stenosis or leak. The mean weight, body mass index (BMI) and percentage weight loss (PWL) 6 months postoperatively were found to be 87.71 kg (SD = 17.51), 33.89 kg/m (SD = 7.29) and 26.41% (SD = 9.79), respectively. The PWL 6 months postoperatively was 23.99% (SD = 8.47) for females and 30.57 (SD = 10.6) for males (p = 0.01).
Topics: Adolescent; Adult; Aged; Bariatric Surgery; Contrast Media; Cost-Benefit Analysis; Cross-Sectional Studies; Diatrizoate Meglumine; Female; Gastrectomy; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Obesity, Morbid; Outcome and Process Assessment, Health Care; Postoperative Complications; Radiography; Young Adult
PubMed: 32299510
DOI: 10.1186/s13104-020-05060-y -
Scientific Reports Jun 2018Ehrlichia chaffeensis, a tick-transmitted rickettsial bacterium, is the causative agent of human monocytic ehrlichiosis. Biochemical characterization of this and other...
Ehrlichia chaffeensis, a tick-transmitted rickettsial bacterium, is the causative agent of human monocytic ehrlichiosis. Biochemical characterization of this and other related Rickettsiales remains a major challenge, as they require a host cell for their replication. We investigated the use of an axenic medium for E. chaffeensis growth, assessed by protein and DNA synthesis, in the absence of a host cell. E. chaffeensis organisms harvested from in vitro cultures grown in a vertebrate cell line were fractionated into infectious dense-core cells (DC) and the non-infectious replicating form, known as reticulate cells (RC) by renografin density gradient centrifugation and incubated in the axenic medium containing amino acids, nucleotides, and different energy sources. Bacterial protein and DNA synthesis were observed in RCs in response to glucose-6-phosphate, although adenosine triphosphate, alpha-ketoglutarate or sodium acetate supported protein synthesis. The biosynthetic activity could not be detected in DCs in the axenic medium. While the data demonstrate de novo protein and DNA synthesis under axenic conditions for E. chaffeensis RCs, additional modifications are required in order to establish conditions that support bacterial replication, and transition to DCs.
Topics: Axenic Culture; Carbon; Cell-Free System; DNA; Diatrizoate Meglumine; Ehrlichia chaffeensis; Hydrogen-Ion Concentration; Models, Biological; Protein Biosynthesis; RNA; RNA, Ribosomal, 16S
PubMed: 29915240
DOI: 10.1038/s41598-018-27574-z -
BMJ Case Reports Nov 2022We present a case of a small bowel obstruction secondary to a rare plastic bezoar. A man in their early 20s with autism and an intellectual disability presented with...
We present a case of a small bowel obstruction secondary to a rare plastic bezoar. A man in their early 20s with autism and an intellectual disability presented with symptoms of small bowel obstruction. CT revealed very subtle signs and, despite passage of gastrografin, ongoing clinical suspicion led to operative management which confirmed the diagnoses of plastic bezoar.
Topics: Male; Humans; Bezoars; Plastics; Intestinal Obstruction; Diatrizoate Meglumine; Affect
PubMed: 36446472
DOI: 10.1136/bcr-2022-251438 -
The Journal of Laryngology and Otology Apr 2020Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3-5 ml gastrografin to detect pharyngeal... (Comparative Study)
Comparative Study
OBJECTIVES
Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3-5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae.
METHODS
A retrospective case-control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3-5 ml) post-operative gastrografin videofluoroscopy.
RESULTS
In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively.
CONCLUSION
Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.
Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Cutaneous Fistula; Diatrizoate Meglumine; Female; Fluoroscopy; Humans; Laryngectomy; Male; Mass Screening; Middle Aged; Pharyngeal Diseases; Pharynx; Postoperative Complications; Retrospective Studies; Sensitivity and Specificity
PubMed: 32172698
DOI: 10.1017/S0022215120000596 -
PloS One 2023Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most serious complications of ERCP. Various procedures can reduce the...
BACKGROUND
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is one of the most serious complications of ERCP. Various procedures can reduce the incidence of PEP, such as wire-guided cannulation, prophylactic pancreatic stent placement, and pretreatment anal insertion of NSAIDs. Recently, iso-osmolar contrast media (IOCM) have been used for ERCP in several hospitals to reduce the risk of PEP in Japan. However, the effect of IOCM is uncertain because few reports have examined IOCM in relation to PEP.
AIM
This study aimed to investigate the relationship between contrast media used and the incidence of PEP.
METHODS
This retrospective study included all qualifying patients who had undergone ERCP at Hamamatsu University Hospital between January 2012 and January 2020. This study examined whether there was a difference in the onset of PEP between patients administered IOCM and high osmolar contrast medium (HOCM). Propensity score matching was used to analyze patient characteristics and ERCP procedures. Amidotrizoic acid was used as HOCM and iodixanol as IOCM.
RESULTS
ERCP was performed on 458 patients, and 830 procedures were conducted. After propensity score matching, 162 patients from the amidotrizoic acid group and 162 patients from the iodixanol group were selected. The incidence of PEP was 10.5% (17) in the amidotrizoic acid group and 9.3% (15) in the iodixanol group (P = 0.71). Changes in serum amylase levels post- and pre-ERCP were 240.6 ± 573.8 U/L and 142.7 ± 382.1 U/L in the amidotrizoic acid and iodixanol groups, respectively (P = 0.072).
CONCLUSION
Iodixanol had no prophylactic effect on PEP and clinical outcomes.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Contrast Media; Retrospective Studies; Diatrizoate Meglumine; Risk Factors
PubMed: 36608042
DOI: 10.1371/journal.pone.0280279 -
Cardiovascular and Interventional... Jun 2019To investigate the novel zein-based non-adhesive precipitating liquid embolic HEI.
PURPOSE
To investigate the novel zein-based non-adhesive precipitating liquid embolic HEI.
MATERIALS AND METHODS
Zein-based liquid embolics are an own class of embolization material. In this study, HEI, a novel zein-based liquid embolic, was investigated. Visibility was assessed in vitro in CT and MRI phantoms, embolization characteristics were assessed in vivo in the kidneys of 12 pigs. Components of HEI were zein as occlusion material, ethanol as solvent, and iodized oil as radiopaque material. HEI was used in pure (HEI-PURE) and manually modified (HEI-MOD) form and compared with 6% ethylene vinyl alcohol copolymer (EVOH). Different radiological methods (CT, MRI, DSA, cone-beam CT, and micro-CT) and histopathologic analyses were applied to compare visibility and vascular occlusion patterns.
RESULTS
In CT phantoms, all embolics were definitely visible as hyperdense materials. In MRI phantoms, signal-to-noise ratio was highest for HEI-PURE, followed by HEI-MOD and EVOH. In all kidneys, embolization procedures were technically successful and without complications. In DSA, all embolics were definitely visible during and after embolization. Only EVOH caused substantial artifacts in cone-beam CT and CT. In micro-CT and histopathology, HEI-PURE showed a homogeneous occlusion from segmental arteries to glomerular capillaries. HEI-MOD demonstrated the deepest vascular penetration (up to the level of peritubular capillaries), but with an inhomogeneous distribution. For EVOH, there was inhomogeneous vascular occlusion from segmental arteries to glomerular capillaries.
CONCLUSION
HEI is a promising novel zein-based liquid embolic. Further preclinical and clinical studies with higher case numbers and long-term follow-up are needed to further assess the value of this embolic material.
Topics: Angiography, Digital Subtraction; Animals; Artifacts; Chemoembolization, Therapeutic; Diatrizoate Meglumine; Ethanol; Iodized Oil; Kidney; Magnetic Resonance Imaging; Models, Animal; Phantoms, Imaging; Propylene Glycol; Radiography; Swine; Tomography, X-Ray Computed; X-Rays; Zein
PubMed: 30761410
DOI: 10.1007/s00270-019-02179-9 -
Surgery May 2017This study evaluated the association between oral gastrografin administration and the need for operative intervention in patients with presumed adhesive small bowel... (Randomized Controlled Trial)
Randomized Controlled Trial
Use of water-soluble contrast medium (gastrografin) does not decrease the need for operative intervention nor the duration of hospital stay in uncomplicated acute adhesive small bowel obstruction? A multicenter, randomized, clinical trial (Adhesive Small Bowel Obstruction Study) and systematic...
BACKGROUND
This study evaluated the association between oral gastrografin administration and the need for operative intervention in patients with presumed adhesive small bowel obstruction.
METHODS
Between October 2006 and August 2009, 242 patients with uncomplicated acute adhesive small bowel obstruction were included in a randomized, controlled trial (the Adhesive Small Bowel Obstruction Study, NCT00389116) and allocated to a gastrografin arm or a saline solution arm. The primary end point was the need for operative intervention within 48 hours of randomization. The secondary end points were the resection rate, the time interval between the initial computed tomography and operative intervention, the time interval between oral refeeding and discharge, risk factors for the failure of nonoperative management, in-hospital mortality, duration of stay, and recurrence or death after discharge. We performed a systematic review of the literature in order to evaluate the relationship between use of gastrografin as a diagnostic/therapeutic measure, the need for operative intervention, and the duration of stay.
RESULTS
In the gastrografin and saline solution arms, the rate of operative intervention was 24% and 20%, respectively, the bowel resection rate was 8% and 4%, the time interval between the initial computed tomography and operative intervention, and the time interval between oral refeeding and discharge were similar in the 2 arms. Only age was identified as a potential risk factor for the failure of nonoperative management. The in-hospital mortality was 2.5%, the duration of stay was 3.8 days for patients in the gastrografin arm and 3.5 days for those in the saline solution arm (P = .19), and the recurrence rate of adhesive small bowel obstruction was 7%. These results and those of 10 published studies suggest that gastrografin did not decrease either the rate of operative intervention (21% in the saline solution arm vs 26% in the gastrografin arm) or the number of days from the initial computed tomography to discharge (3.5 vs 3.5; P = NS for both).
CONCLUSION
The results of the present study and those of our systematic review suggest that gastrografin administration is of no benefit in patients with adhesive small bowel obstruction.
Topics: Aged; Female; Humans; Male; Middle Aged; Acute Disease; Contrast Media; Diatrizoate Meglumine; Intestinal Obstruction; Length of Stay; Tissue Adhesions; Treatment Outcome
PubMed: 28087066
DOI: 10.1016/j.surg.2016.11.026 -
The Journal of Surgical Research Jan 2024Small bowel obstruction (SBO) is one of the most common causes for hospital admission in Ethiopia. The use of water-soluble contrast agents (WSCAs) such as Gastrografin...
INTRODUCTION
Small bowel obstruction (SBO) is one of the most common causes for hospital admission in Ethiopia. The use of water-soluble contrast agents (WSCAs) such as Gastrografin to manage adhesive SBO can predict nonoperative resolution of SBO and reduce decision time to surgery and length of hospital stay. However, nothing is known about practice patterns and Gastrografin use in low-income settings. We sought to characterize current management practices, including use of WSCAs, as well as outcomes for patients with SBO in Addis Ababa, Ethiopia.
METHODS
We conducted a mixed-methods study consisting of a survey of surgeons throughout Ethiopia and a retrospective record review at five public, tertiary care-level teaching hospitals in Addis Ababa.
RESULTS
Of the 76 surgeons who completed the survey, 63% had heard of the use of WSCAs for SBO and only 11% used oral agents for its management. Chart review of 149 patients admitted with SBO showed the most common etiology was adhesion (39.6% of admissions), followed by small bowel volvulus (20.8%). Most patients (83.2%) underwent surgery during their admission. The most common diagnosis in patients who did not require surgery was also adhesion (68.0%), as well as for those who had surgery (33.9%), followed by small bowel volvulus (24.2%).
CONCLUSIONS
The etiology of SBO in Ethiopia may be changing, with postoperative adhesions becoming more common than other historically more prevalent causes. Although a Gastrografin protocol as a diagnostic and potentially therapeutic aid for SBO is feasible in this population and setting, challenges can be anticipated, and future studies of protocol implementation and effectiveness are needed to further inform its utility in Ethiopia and other low-income and middle-income countries.
Topics: Humans; Diatrizoate Meglumine; Intestinal Volvulus; Retrospective Studies; Feasibility Studies; Ethiopia; Intestinal Obstruction; Contrast Media; Tissue Adhesions
PubMed: 37802018
DOI: 10.1016/j.jss.2023.08.017 -
Environmental Science and Pollution... Jun 2022As persistent and ubiquitous contaminants in water, iodinated X-ray contrast media (ICM) pose a non-negligible risk to the environment and human health. In this study,...
As persistent and ubiquitous contaminants in water, iodinated X-ray contrast media (ICM) pose a non-negligible risk to the environment and human health. In this study, we investigated the adsorption behavior of two typical ICM compounds, iohexol (IOH) and amidotrizoic acid (DTZ), on magnetic activated carbon. Theoretical investigations, using density functional theory, identified the molecule structures and calculated the molecular diameters of IOH (1.68 nm) and DTZ (1.16 nm), which revealed that ICM could be adsorbed by mesopores and larger micropores. Therefore, magnetic activated carbon with a porous structure was prepared by the co-precipitation method to investigate the adsorption mechanism of IOH and DTZ. MAC--5 (magnetic activated carbon with a theoretical iron oxide content of 37%) showed the best adsorption ability for both IOH and DTZ, with maximum adsorption capacities of 86.05 and 43.00 mg g, respectively. Adsorption kinetics and isotherm models were applied to explore the mechanisms involved, and the effects of solution pH, initial concentration, temperature, ionic strength, and natural organic matter were also investigated. The pore filling effect, π-π stacking, hydrogen bonding, and electrostatic interaction, were found to be the main adsorption mechanisms. The co-adsorption data showed that competition may occur in ICM coexisting environments. Interestingly, the used MAC--5 could be successfully regenerated and its adsorption efficiency did not decrease significantly after five cycles, indicating that it is a promising adsorbent for ICM. The results from this study provide some new insights for the treatment of water containing ICM.
Topics: Adsorption; Charcoal; Contrast Media; Diatrizoate Meglumine; Humans; Hydrogen-Ion Concentration; Iohexol; Kinetics; Water; Water Pollutants, Chemical; X-Rays
PubMed: 35147873
DOI: 10.1007/s11356-022-19127-9 -
The Journal of Surgical Research May 2016The gastrografin (GG) challenge is a diagnostic and therapeutic tool used to treat patients with small bowel obstruction (SBO); however, long-term data on SBO recurrence...
BACKGROUND
The gastrografin (GG) challenge is a diagnostic and therapeutic tool used to treat patients with small bowel obstruction (SBO); however, long-term data on SBO recurrence after the GG challenge remain limited. We hypothesized that patients treated with GG would have the same long-term recurrence as those treated before the implementation of the GG challenge protocol.
METHODS
Patients ≥18 years who were treated for SBO between July 2009 and December 2012 were identified. We excluded patients with contraindications to the GG challenge (i.e., signs of strangulation), patients having SBO within 6-wk of previous abdominal or pelvic surgery and patients with malignant SBO. All patients had been followed a minimum of 1 y or until death. Kaplan-Meier method and Cox regression models were used to describe the time-dependent outcomes.
RESULTS
A total of 202 patients were identified of whom 114 (56%) received the challenge. Mean patients age was 66 y (range, 19-99 y) with 110 being female (54%). A total of 184 patients (91%) were followed minimum of 1 year or death (18 patients lost to follow-up). Median follow-up of living patients was 3 y (range, 1-5 y). During follow-up, 50 patients (25%) experienced SBO recurrences, and 24 (12%) had exploration for SBO recurrence. The 3-year cumulative rate of SBO recurrence in patients who received the GG was 30% (95% confidence interval [CI], 21%-42%) compared to 27% (95% CI, 18%-38%) for those who did not (P = 0.4). The 3-year cumulative rate of exploration for SBO recurrence in patients who received the GG was 15% (95% CI, 8%-26%) compared to 12 % (95% CI, 6%-22%) for those who did not (P = 0.6).
CONCLUSIONS
The GG challenge is a clinically useful tool in treating SBO patients with comparable long-term recurrence rates compared to traditional management of SBO.
Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Contrast Media; Diatrizoate Meglumine; Female; Follow-Up Studies; Humans; Intestinal Obstruction; Intestine, Small; Intubation, Gastrointestinal; Kaplan-Meier Estimate; Male; Middle Aged; Proportional Hazards Models; Radiography; Recurrence; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 27083946
DOI: 10.1016/j.jss.2015.11.017