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American Journal of Surgery Dec 2019Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and... (Clinical Trial)
Clinical Trial
Differentiation between SBO that will resolve with supportive measures and those requiring surgery remains challenging. WSC administration may be diagnostic and therapeutic. The purpose of this study was to evaluate use of a SBO protocol using WSC challenge. A protocol was implemented at five tertiary care centers. Demographics, prior surgical history, time to operation, complications, and LOS were analyzed. 283 patients were admitted with SBO; 13% underwent immediate laparotomy; these patients had a median LOS of 7.5 days. The remaining 245 were candidates for WSC challenge. Of those, 80% received contrast. 139 (71%) had contrast passage to the colon. LOS in these patients was 4 days. Sixty-five patients (29%) failed contrast passage within 24 h and underwent surgery. LOS was 9 days. 8% of patients in whom contrast passage was observed at 24 h nevertheless subsequently underwent surgery. 4% of patients who failed WSC challenge did not proceed to surgery. Our multicenter trial revealed that implementation of a WSC protocol may facilitate early recognition of partial from complete obstruction.
Topics: Adult; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 31623878
DOI: 10.1016/j.amjsurg.2019.09.031 -
Lancet (London, England) Oct 2019
Topics: Animals; Anthelmintics; Diatrizoate Meglumine; Diphyllobothriasis; Diphyllobothrium; Female; Humans; Intestinal Diseases, Parasitic; Praziquantel; Ultrasonography; Young Adult
PubMed: 31591983
DOI: 10.1016/S0140-6736(19)32132-4 -
BMC Gastroenterology Aug 2019Intramural esophageal bronchogenic cyst is very rare. Surgical removal of the cysts is advised even the patients are asymptomatic, since the cyst can lead to...
BACKGROUND
Intramural esophageal bronchogenic cyst is very rare. Surgical removal of the cysts is advised even the patients are asymptomatic, since the cyst can lead to complications, and there is a risk of malignant transformation. Thoracotomy or thoracoscopy is the most commonly used approach for complete excision of the cysts. To our knowledge, this is the first report to excise intramural esophageal bronchogenic cyst completely by endoscopic submucosal tunnel dissection (ESTD).
CASE PRESENTATION
A 40-year-old male was referred to our hospital due to the detection of a submucosal tumor at the distal esophagus. The tumor was found during gastroendoscopy in a general health check-up. The patient had no symptoms. A benign esophageal tumor was confirmed by endoscopic ultrasonography (EUS) and computed tomography (CT). On the basis of these results, ESTD was performed. During the procedure, a cystic mass was observed between the mucosa and the muscular layers of the esophagus, and a hybrid knife was used for dissection. Histopathological examination showed the cyst wall was lined by pseudostratified ciliated columnar epithelium, consistent with a bronchogenic cyst. The esophagography using meglumine diatrizoate showed no leakage on the seventh day after ESTD. The patient remained asymptomatic and had a regular diet during the follow-up period.
DISCUSSION AND CONCLUSIONS
We successfully utilized ESTD for complete removal of esophageal bronchogenic cysts originating from the muscularis propria. The approach appeared safe, providing a minimally invasive treatment option for patients.
Topics: Adult; Bronchogenic Cyst; Endoscopic Mucosal Resection; Esophageal Cyst; Esophagoscopy; Humans; Male; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31462259
DOI: 10.1186/s12876-019-1072-3 -
PloS One 2019The aim of this study was to describe the specific gross and radiographic anatomy of the digestive tract of inland bearded dragons (Pogona vitticeps). Eleven bearded...
Specific anatomy and radiographic illustration of the digestive tract and transit time of two orally administered contrast media in Inland bearded dragons (Pogona vitticeps).
The aim of this study was to describe the specific gross and radiographic anatomy of the digestive tract of inland bearded dragons (Pogona vitticeps). Eleven bearded dragon cadavers of both sexes (6 females, 5 males) were dissected to examine, measure, and document the specific gross anatomy of the alimentary canal. Measurements collected from the cadavers included snout-vent length, total length of the alimentary canal, and the lengths of the individual sections of the gastrointestinal tract, including the esophagus, stomach, small intestine, ampulla coli, isthmus coli, rectum, and the distance from the coprodeum to the vent opening. Twenty-two healthy adult bearded dragons (13 females, 9 males) maintained under standardized husbandry conditions underwent a physical examination, blood collection, and whole-body dorsoventral and lateral survey radiographs; these animals were used to provide the radiographic images of the complete digestive tract. For the subsequent contrast passage studies, two different contrast media, barium sulfate (BaSO4, Barilux suspension) and an iodinated ionic radiocontrast agent (Sodium meglumine amidotrizoate [SMAT], Gastrografin), were used. Water-diluted Barilux suspension (dose 9 ml/kg) was administered orally to 5 bearded dragons, while Gastrografin (dose 5ml/kg) was administered orally to 21 bearded dragons. Four animals were used for both contrast media studies, but received a break of four weeks in between. Dorsoventral and laterolateral radiographs were collected at 0 (baseline), 15, 30, and 45 minutes and 1, 2, 3, 4, 5, 6, 8, 10, 12, 24, 30, and 36 hours after each contrast medium was administered. Both contrast media were found to illustrate the alimentary tracts in the adult bearded dragons. Transit time was substantially faster with SMAT, and SMAT illustrated the entire gastrointestinal tract within 36 hours; BaSO4 did not fully illustrate the gastrointestinal tract in 36 hours. These results might serve as a guideline for the interpretation of subsequent contrast studies in this lizard species.
Topics: Animals; Australia; Barium Sulfate; Contrast Media; Diatrizoate Meglumine; Female; Gastrointestinal Tract; Gastrointestinal Transit; Germany; Guidelines as Topic; Lizards; Male
PubMed: 31437183
DOI: 10.1371/journal.pone.0221050 -
Zhen Ci Yan Jiu = Acupuncture Research Jul 2019To observe the effect of acupuncture and moxibustion on renal Fas and Fas ligand (FasL) expression in contrast-induced nephropathy (CIN) diabetic rats, so as to explore...
OBJECTIVE
To observe the effect of acupuncture and moxibustion on renal Fas and Fas ligand (FasL) expression in contrast-induced nephropathy (CIN) diabetic rats, so as to explore its protective mechanisms.
METHODS
A total of 40 diabetic male SD rats were randomly divided into control, model, acupuncture, moxibustion and combined treatment (acupuncture combined with moxibustion) groups (=8 rats in each group). The diabetic model was established by i.p. injection of Streptozotocin (60 mg/kg), followed by regular raising for 9 weeks. Then, the manual acupuncture, moxibustion or acupuncture plus moxibustion at "Sanyinjiao"(SP6) "Shenshu"(BL23) and "Pishu"(BL20) was given to the diabetic rats, once daily for 7 days. On the 8th day, these diabetic rats received i.p. injection of compound Meglumine Diatrizoate Injection (10 mL/kg) for establishing CIN model. Then, the venous blood specimens were collected for detecting contents of serum urine nitrogen (BUN, with urease method) and creatinine (Scr, with picric acid method). The kindey tissues were exteriorized for detecting nitricoxide synthase (NOS, with oxidation-reduction method), malondialdehyde (MDA, with thiobarbituric acid method), superoxide dismutase (SOD, with xanthine oxidase technique) and total antioxidant capacity (T-AOC, with colorimetric technique). The expression levels of Fas and FasL in the kidney tissues were detected by quantitative real-time PCR and Western blot separately. The histopathological and ultrastructural changes of the kidney were observed under microscope (after H.E. staining) and transmission electron microscope, respectively.
RESULTS
Following modeling and compared with the control group, the BUN, Scr and renal MDA contents, and Fas and FasL mRNA and protein expression levels were significantly increased (<0.01, <0.05), and renal NOS, SOD and T-AOC levels considerably decreased in the model group (<0.05). After the interventions and compared with the model group, serum BUN and Scr contents and renal Fas mRNA and protein expression levels in both acupuncture group and combined treatment group, BUN in the moxibustion group, and renal MDA content and FasL mRNA and protein expression levels in the 3 treatment groups were obviously down-regulated (<0.05,<0.01), while renal NOS in the 3 treatment groups, and SOD and T-AOC levels in the combined treatment group were considerably up-regulated (<0.01,<0.05). The effects of the combined treatment were significantly superior to those of simple acupuncure and simple moxibustion in down-regulating serum BUN contents, and Fas and FasL mRNA and protein expression levels, and in up-regulating renal NOS, SOD and T-AOC activity (<0.05). No significant differences were found between the acupuncture and moxibustion groups in down-regulating serum BUN, Scr and renal MDA contents, and Fas and FasL mRNA and protein levels, as well as in up-regulating NOS content (>0.05). H.E. staining showed lobular changes of glomeruli, many local necrosis and vascular degeneration in the model group, and transmission electron microscope displayed thickened basement membrane of the glomerular blood loop, many vacuoles in the cytoplasm of renal tubular epithelial cells, severely swollen mitochondria with disordered, broken or disappeared cristae, and some apoptotic cells in the model group, which were relatively milder in the combined treatment group.
CONCLUSION
Joint application of acupuncture and moxibustion can reduce the oxidative stress and renal injury in CIN diabetic rats, which may be associated with its function in down-regulating the expression of renal Fas and FasL genes and proteins. Acupuncture and moxibustion has a synergistic effect.
Topics: Acupuncture Therapy; Animals; Diabetes Mellitus, Experimental; Fas Ligand Protein; Kidney; Male; Moxibustion; RNA, Messenger; Rats; Rats, Sprague-Dawley
PubMed: 31368275
DOI: 10.13702/j.1000-0607.180345 -
Chemico-biological Interactions Aug 2019Diabetes mellitus is an independent risk factor for renal impairment in patients exposed to contrast media. It doubles the risk and decreases survival rate of contrast...
Contrast media (meglumine diatrizoate) aggravates renal inflammation, oxidative DNA damage and apoptosis in diabetic rats which is restored by sulforaphane through Nrf2/HO-1 reactivation.
Diabetes mellitus is an independent risk factor for renal impairment in patients exposed to contrast media. It doubles the risk and decreases survival rate of contrast induced nephropathy (CIN). Sulforaphane has antioxidant properties via Nrf2 activation. The interaction of diabetes and/or sulforaphane with contrast media on Nrf2 regulation is not yet understood. Herein, diabetes was induced by a single intra-peritoneal injection of streptozotocin. Animals were then divided into five groups; control non-diabetic group; diabetic group; diabetic/sulforaphane group; diabetic/CIN group; diabetic/CIN/sulforaphane group. Animals were assessed 24 h after CIN induction. Sulforaphane improved the impaired nephrotoxicity parameters, histopathological features, and oxidative stress markers induced by contrast media (meglumine diatrizoate) in diabetic rats. Immunofluorescence detection revealed increased Nrf2 expression in kidney sections after sulforaphane pretreatment. Moreover, gene expression of Nrf2 and HO-1 were up-regulated, while IL-6 and caspase3 were down-regulated in kidney tissues of animals pretreated with sulforaphane. In NRK-52E cells, sulforaphane pretreatment significantly ameliorated the cytotoxicity of meglumine diatrizoate. However, silencing Nrf2 using small interfering RNA (siRNA) abolished the cytoprotective effects of sulforaphane. Collectively, the results of this study suggest that Nrf2/HO-1 pathway has a protective role against CIN and support the clinical implication of Nrf2 activators, such as sulforaphane, in CIN particularly in diabetic patients.
Topics: Animals; Antioxidants; Apoptosis; Cell Line; Contrast Media; DNA Damage; Diabetes Mellitus, Experimental; Diatrizoate Meglumine; Gene Expression Regulation; Heme Oxygenase-1; Isothiocyanates; Kidney; Male; NF-E2-Related Factor 2; Nephritis; RNA Interference; RNA, Small Interfering; Rats; Rats, Wistar; Signal Transduction; Sulfoxides
PubMed: 31173751
DOI: 10.1016/j.cbi.2019.06.002 -
Journal of Cystic Fibrosis : Official... Nov 2019
Topics: Adult; Constipation; Contrast Media; Cystic Fibrosis; Diatrizoate Meglumine; Duration of Therapy; Exocrine Pancreatic Insufficiency; Female; Gastrointestinal Motility; Humans; Hyperthyroidism; Intestinal Obstruction; Lung Transplantation; Male; Postoperative Complications; Radionuclide Imaging; Thyroid Function Tests; Withholding Treatment
PubMed: 31129069
DOI: 10.1016/j.jcf.2019.05.011 -
Abdominal Radiology (New York) Apr 2020Routine low dose non-contrast CT of the abdomen and pelvis has been suggested prior to same day completion CT colonography (CTC) to assess for occult perforation at...
PURPOSE
Routine low dose non-contrast CT of the abdomen and pelvis has been suggested prior to same day completion CT colonography (CTC) to assess for occult perforation at preceding incomplete colonoscopy, before further gaseous insufflation at CTC. The aim of our study is to examine the incidence of clinically significant perforation at low dose CT. We also examine the benefits of low dose pre-scan in assessing adequacy of bowel preparation and identifying any other relevant contraindications to CT colonography.
MATERIALS AND METHODS
We conducted a retrospective review of all low dose non-contrast CTs performed following failed colonoscopies over a 4-year period (n = 392). We also assessed the adequacy of bowel preparation on a scale of 1-5, in order of increasingly adequate preparation. Incidentally noted bowel pathology and contraindications to CT colonography were also recorded.
RESULTS
No perforation was identified either prospectively or in the course of our retrospective review. However, 15 patients (3.8%) were found to have potential contraindications to CT colonography, including: acute diverticulitis, acute colitis, and poor bowel preparation. Overall, the bowel preparation was felt to be adequate (≥ 3) in 86% percent of patients. Two patients (0.5%) identified prospectively had their CT colonography postponed due to poor bowel preparation.
Topics: Adult; Aged; Colon; Colonography, Computed Tomographic; Colonoscopy; Contrast Media; Diatrizoate Meglumine; Female; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors
PubMed: 31123769
DOI: 10.1007/s00261-019-02062-8 -
Resolution of adhesive small bowel obstruction with a protocol based on Gastrografin administration.Journal of Medicine and Life 2019The use of Gastrografin may have a therapeutic effect on resolving adhesive small bowel obstruction. Adhesive Small Bowel obstruction (ASBO) accounts for the majority of...
The use of Gastrografin may have a therapeutic effect on resolving adhesive small bowel obstruction. Adhesive Small Bowel obstruction (ASBO) accounts for the majority of patients with small bowel obstruction. Most patients are managed conservatively; frequent admissions create a considerable burden. We sought to examine the adherence to the Bologna guidelines for the management of ASBO in a high volume tertiary center and whether or not Gastrografin had a therapeutic effect. A comparison was made between an initial retrospective audit looking at ASBO and a prospective re-audit after applying standards derived from the Bologna guidelines. During re-audit it was found that more patients underwent conservative management and fewer patients had surgery as first line management. In the re-audit, those who had to undergo surgery within/after a period of 72h of conservative management were also fewer. Whether they were managed surgically primarily or after a period of conservative management, the average length of stay was also shorter. In comparison to the preliminary audit, there appeared to be no change in the way that medical history and physical examination was documented during the re-audit. However, there was a marked difference in the use of appropriate blood tests and CT scans. Changes were made successfully following the initial audit results and have been implemented, thus closing the audit loop. This study shows that the use of Gastrografin has decreased the need for surgical intervention in a group of patients with small bowel obstruction.
Topics: Diatrizoate Meglumine; Humans; Intestinal Obstruction; Prospective Studies; Reference Standards; Retrospective Studies; Tissue Adhesions
PubMed: 31123519
DOI: 10.25122/jml-2018-0082 -
Journal of Indian Association of... 2019Meconium ileus (MI) is defined as an intestinal obstruction caused by the impaction of inspissated meconium in the terminal ileum. In this study, we have evaluated the...
BACKGROUND
Meconium ileus (MI) is defined as an intestinal obstruction caused by the impaction of inspissated meconium in the terminal ileum. In this study, we have evaluated the nonoperative management of patients of simple MI without fluoroscopic support -an important requisite of the Noblett's criteria. Besides this, surgical management in cases of failed conservative management and complicated MI was also assessed.
MATERIALS AND METHODS
This was a retrospective observational study. Various clinical and radiological parameters were evaluated. Conservative management included the use of water-soluble contrast diatrizoate meglumine and diatrizoate sodium. In case of nonpassage of meconium in 24 h from first intervention, exploratory laparotomy with ileostomy was performed. All complicated MI underwent exploratory laparotomy with creation of stoma as and when needed.
RESULTS
The duration of this study was 6½ years. Twenty-five neonates of MI were admitted. Of these, 22 had simple MI and remaining three had complicated MI. Eighteen neonates responded to the conservative management. In four neonates, who did not respond, exploratory laparotomy was performed. All three neonates having complicated MI underwent exploratory laparotomy. One patient expired in follow-up.
CONCLUSION
MI is an important neonatal emergency, which needed immediate attention of a pediatric surgeon. Proper evaluation of the patient, careful application of principals of conservative management, and timely surgical intervention may fetch satisfactory results.
PubMed: 31105398
DOI: 10.4103/jiaps.JIAPS_41_18