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Canadian Journal of Surgery. Journal... Sep 2017Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain...
BACKGROUND
Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs.
METHODS
We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments.
RESULTS
Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000.
CONCLUSION
The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead.
Topics: Adult; Contrast Media; Diatrizoate Meglumine; Endoscopy, Gastrointestinal; Female; Fluoroscopy; Gastrectomy; Humans; Male; Middle Aged; Obesity, Morbid; Postoperative Complications; Retrospective Studies; Sensitivity and Specificity; Surgical Stapling; Time Factors
PubMed: 28742012
DOI: 10.1503/cjs.015216 -
World Journal of Gastroenterology Jun 2017A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively...
A 48-year-old woman was admitted with 15-mo history of abdominal pain, diarrhea and hematochezia, and 5-mo history of defecation difficulty. She had been successively admitted to nine hospitals, with an initial diagnosis of inflammatory bowel disease with stenotic sigmoid colon. Findings from computed tomography virtual colonoscopy, radiography with meglumine diatrizoate, endoscopic balloon dilatation, metallic stent implantation and later overall colonoscopy, coupled with the newfound knowledge of compound Qingdai pill-taking, led to a subsequent diagnosis of ischemic or toxic bowel disease with sigmoid colon stenosis. The patient was successfully treated by laparoscopic sigmoid colectomy, and postoperative pathological examination revealed ischemic or toxic injury of the sigmoid colon, providing a final diagnosis of drug-induced sigmoid colon stenosis. This case highlights that adequate awareness of drug-induced colon stenosis has a decisive role in avoiding misdiagnosis and mistreatment. The diagnostic and therapeutic experiences learnt from this case suggest that endoscopic balloon expansion and colonic metallic stent implantation as bridge treatments were demonstrated as crucial for the differential diagnosis of benign colonic stenosis. Skillful surgical technique and appropriate perioperative management helped to ensure the safety of our patient in subsequent surgery after long-term use of glucocorticoids.
Topics: Abdominal Pain; Anti-Bacterial Agents; Biopsy; Colectomy; Colon, Sigmoid; Colonography, Computed Tomographic; Colonoscopy; Constipation; Constriction, Pathologic; Contrast Media; Diagnosis, Differential; Diarrhea; Diatrizoate Meglumine; Dilatation; Drugs, Chinese Herbal; Female; Fluid Therapy; Gastrointestinal Hemorrhage; Humans; Inflammatory Bowel Diseases; Intestinal Obstruction; Laparoscopy; Levofloxacin; Middle Aged; Pityriasis Rosea; Self Expandable Metallic Stents
PubMed: 28638234
DOI: 10.3748/wjg.v23.i21.3934 -
The Korean Journal of Gastroenterology... Jan 2017A Morgagni hernia was first described in 1761 by Giovanni Morgagni. In adults, it is accompanied by gastrointestinal- or respiratory-type symptoms. Herein, we report an...
A Morgagni hernia was first described in 1761 by Giovanni Morgagni. In adults, it is accompanied by gastrointestinal- or respiratory-type symptoms. Herein, we report an 84-year-old woman presented to our hospital with nausea and vomiting. After hospitalization, an X-ray revealed a right diaphragmatic hernia. Based on the results of abdominal computed tomography, duodenoscopy, and upper gastrointestinography (gastrografin), we concluded that her symptoms were caused by Morgagni hernia. Our patient underwent laparoscopic surgery, and shortly thereafter, her symptoms resolved.
Topics: Aged, 80 and over; Diatrizoate Meglumine; Duodenoscopy; Dyspepsia; Female; Hernias, Diaphragmatic, Congenital; Humans; Laparoscopy; Nausea; Tomography, X-Ray Computed; Vomiting
PubMed: 28135794
DOI: 10.4166/kjg.2017.69.1.68 -
The Medical Journal of Malaysia Dec 2016Positive oral contrast is no longer deemed necessary for abdominopelvic computed tomography (CT) scans. Studies have shown water to be an equally effective oral contrast...
INTRODUCTION
Positive oral contrast is no longer deemed necessary for abdominopelvic computed tomography (CT) scans. Studies have shown water to be an equally effective oral contrast agent. However, to our knowledge no study has compared effectiveness between gastrografin and water in the same patient, which will provide a more objective evaluation of the two oral contrast agents. We aim to make a head-to-head comparison of water as neutral oral contrast (OC) against gastrografin as positive OC for abdominopelvic CT scans in the same patient.
METHODS
A retrospective review of 206 abdominopelvic CT scans of 103 patients was performed. The scans were reviewed in consensus by two blinded radiologists. The ability to visualise each abdominopelvic organ, contrastassociated artefacts and small bowel wall delineation, was qualitatively scored on a 5-point scale. Each patient had two sets of scores, one with water and another with gastrografin as OC. Paired scores from the two OCs were evaluated by Wilcoxon signed rank test to determine any significant difference in performance between the two OCs for visualisation of abdominopelvic anatomy on CT.
RESULTS
There was significantly better delineation of duodenal wall (p<0.001) and overall visualisation of the duodenum (p=0.011) using water as OC compared to gastrografin. No statistically significant differences were demonstrated between water and gastrografin for visualisation of the rest of the abdominopelvic organs, walldelineation of the rest small bowel and contrast-associated artefacts.
CONCLUSIONS
Water can be used in place of gastrografin as oral contrast in abdominopelvic CT without compromising visualization of abdominopelvic organs.
Topics: Abdomen; Administration, Oral; Contrast Media; Diatrizoate Meglumine; Humans; Pelvis; Retrospective Studies; Tomography, X-Ray Computed; Water
PubMed: 28087955
DOI: No ID Found -
BMC Oral Health Jan 2017Micro-CT (μCT) studies that combine simulated canals with meglucamine diatrizoate to evaluate the shaping ability of nickel-titanium (NiTi) rotary instruments are...
BACKGROUND
Micro-CT (μCT) studies that combine simulated canals with meglucamine diatrizoate to evaluate the shaping ability of nickel-titanium (NiTi) rotary instruments are lacking in the literature. The purpose of this study was to evaluate the shaping ability of three new different nickel-titanium rotary instruments in simulated root canals using μCT.
METHODS
Thirty simulated root canals with a curvature of 60° were randomly allocated into the following 3 groups (n = 10): Group 1, ProTaper Universal (PTU) rotary system; Group 2, Reciproc single-file system; and Group 3, K3XF rotary system. Pre- and post-instrumented images of simulated canals were scanned with μCT via a radiopaque contrast technique to build a 3-dimensional (3D) model. Canal transportation, volumetric change and centring ability were evaluated in each group. Instrument failure and preparation time were also recorded. The Kruskal-Wallis test was used for statistical analysis and the significance level was set at p = 0.05.
RESULTS
Reciproc produced greater volume change in the apical part of the canals compared with PTU and K3XF (p < 0.05). K3XF exhibited less transportation and better centring ability at the 2- and 3-mm levels from the apical foramen compared with PTU and Reciproc (p < 0.05). There were no significant differences in the centring ratio and transportation between PTU and Reciproc. Preparation time was significantly shorter in the Reciproc group (p < 0.05).
CONCLUSIONS
Under the conditions of our study, all of the canals were 3D reconstructed successfully via the radiopaque contrast technique. Reciproc showed enhanced apical volume changes and K3XF exhibited better centring ability when compared with other groups.
Topics: Contrast Media; Dental Instruments; Diatrizoate Meglumine; Equipment Design; Imaging, Three-Dimensional; In Vitro Techniques; Nickel; Root Canal Preparation; Titanium; X-Ray Microtomography
PubMed: 28068971
DOI: 10.1186/s12903-016-0326-5 -
Journal of Visualized Surgery 2016A 59-year-old female presented with upper esophageal squamous cell carcinoma had swallowing disorders. We performed the total mesoesophageal excision (TME) and...
A 59-year-old female presented with upper esophageal squamous cell carcinoma had swallowing disorders. We performed the total mesoesophageal excision (TME) and systematic en bloc mediastinal lymph node dissection via VATS. The surgery process was successful and the postoperative course was uneventful. A squamous cell carcinoma of stage T1aN0M0 was identified on pathological examination, and the postoperative examination of esophageal swallow diatrizoate meglumine and computed tomography (CT) scan confirmed no anastomosis fistula and no signs of recurrence.
PubMed: 29399489
DOI: 10.21037/jovs.2016.05.03 -
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 -
International Journal of Surgery... Aug 2015The prompt recognition of complications is essential in reducing morbidity following anti-reflux surgery. Consequently, many centres employ a policy of routine... (Comparative Study)
Comparative Study
BACKGROUND
The prompt recognition of complications is essential in reducing morbidity following anti-reflux surgery. Consequently, many centres employ a policy of routine post-operative contrast studies. The study aimed to examine whether routine contrast studies more effectively recognised early post-operative complications following anti-reflux surgery compared with selective use.
METHODS
This was a retrospective analysis of 240 adults who had undergone primary anti-reflux surgery. Selective use of water-soluble contrast swallows was employed for 115 patients (Group 1) while 125 patients (Group 2) had routine studies.
RESULTS
10 (0.9%) patients from Group 1 underwent contrast studies, four (40%) of which were abnormal. Routine studies in Group 2 identified thirty-two abnormalities (27%) however the inter-group difference was not significant (p = 0.32). Only one case from group 2 required immediate re-intervention. This was not statistically significant (p = 0.78). Multivariate analysis found no significant association between selective or routine imaging and re-intervention rates. One patient from group 2 presented three days following discharge with wrap migration requiring reoperation despite a normal post-operative study.
CONCLUSION
Routine use of contrast imaging following anti-reflux and hiatus hernia surgery is not necessary. It does not identify a significantly greater number of post-operative complications in comparison to selective use. Additionally, routine use of contrast studies does not ensure the diagnosis of all complications in the post-operative period.
Topics: Adult; Aged; Contrast Media; Diatrizoate Meglumine; Female; Fundoplication; Gastroesophageal Reflux; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Radiography; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 26118598
DOI: 10.1016/j.ijsu.2015.06.052 -
American Journal of Physiology.... Aug 2015Vitamin D deficiency (VDD) is widespread in the general population. Iodinated (IC) or gadolinium-based contrast media (Gd) may decrease renal function in high-risk...
Vitamin D deficiency (VDD) is widespread in the general population. Iodinated (IC) or gadolinium-based contrast media (Gd) may decrease renal function in high-risk patients. This study tested the hypothesis that VDD is a predisposing factor for IC- or Gd-induced nephrotoxicity. To this end, male Wistar rats were fed standard (SD) or vitamin D-free diet for 30 days. IC (diatrizoate), Gd (gadoterate meglumine), or 0.9% saline was then administered intravenously and six groups were obtained as the following: SD plus 0.9% saline (Sham-SD), SD plus IC (SD+IC), SD plus Gd (SD+Gd), vitamin D-free diet for 30 days plus 0.9% saline (Sham-VDD30), vitamin D-free diet for 30 days plus IC (VDD30+IC), and vitamin D-free diet for 30 days plus Gd (VDD30+Gd). Renal hemodynamics, redox status, histological, and immunoblot analysis were evaluated 48 h after contrast media (CM) or vehicle infusion. VDD rats showed lower levels of total serum 25-hydroxyvitamin D [25(OH)D], similar plasma calcium and phosphorus concentration, and higher renal renin and angiotensinogen protein expression compared with rats fed SD. IC or Gd infusion did not affect inulin clearance-based estimated glomerular filtration rate (GFR) in rats fed SD but significantly decreased GFR in rats fed vitamin D-free diet. Both CM increased renal angiotensinogen, and the interaction between VDD and CM triggered lower renal endothelial nitric oxide synthase abundance and higher renal thiobarbituric acid reactive substances-to-glutathione ratio (an index of oxidative stress) on VDD30+IC and VDD30+Gd groups. Conversely, worsening of renal function was not accompanied by abnormalities on kidney structure. Additionally, rats on a VDD for 60 days displayed a greater fall in GFR after CM administration. Collectively, our findings suggest that VDD is a potential risk factor for IC- or Gd-induced nephrotoxicity most likely due to imbalance in intrarenal vasoactive substances and oxidative stress.
Topics: Animals; Contrast Media; Diabetic Nephropathies; Disease Models, Animal; Gadolinium; Kidney; Kidney Diseases; Male; Oxidative Stress; Rats, Wistar; Risk Factors; Vitamin D; Vitamin D Deficiency
PubMed: 26041113
DOI: 10.1152/ajpregu.00526.2014 -
BMC Research Notes Apr 2015Pneumopyopericardium is a rare disease with poor prognosis. The usual presentation is with fever, shortness of breath and haemodynamic compromise. The Electrocardiogram...
BACKGROUND
Pneumopyopericardium is a rare disease with poor prognosis. The usual presentation is with fever, shortness of breath and haemodynamic compromise. The Electrocardiogram changes associated with this disease entity would be similar to pericarditis such as concave shaped ST elevations in all leads with PR sagging. Pneumopyopericardium mimicking an acute ST Elevation Myocardial Infarction, with regional Electrocardiogram changes has hitherto not been described in world literature.
CASE PRESENTATION
We describe the case of a 48 year old native Sri Lankan man, presenting with chest pain and Electrocardiogram changes compatible with an Acute ST Elevation Myocardial Infarction, subsequently found to have Pneumopyopericardium secondary to an oesophageal tear. Retrospective history revealed repetitive vomiting due to heavy alcohol consumption, prior to presentation. It unfortunately led to a fatal outcome.
CONCLUSION
Pneumopyopericardium may mimic an acute ST elevation myocardial infarction with associated regional Electrocardiogram changes. A high degree of suspicion should be maintained and an adequate history should always be obtained prior to any intervention in all ST Elevation Myocardial Infarction patients.
Topics: Diagnosis, Differential; Diatrizoate Meglumine; Electrocardiography; Esophagus; Fatal Outcome; Humans; Male; Middle Aged; Myocardial Infarction; Pneumopericardium; Radiography, Thoracic; Rupture; Tomography, X-Ray Computed; Ultrasonography
PubMed: 25924710
DOI: 10.1186/s13104-015-1143-7