Radiopacity and physical properties evaluation of infiltrants with Barium and Ytterbium addition

Abstract Radiopaque properties in the infiltrant should be interesting for clinicians to feel more confident to indicate this treatment. Thus, the aim of this study was to evaluate the effect of the incorporation of barium and ytterbium particles on the physical properties of resin infiltrants. Groups were divided according to the addition of ytterbium oxide (Y) alone (30 or 40%) or Y with barium (YB) (15/15% or 20/20% respectively) in the Icon commercial infiltrant and in the experimental infiltrant base. Digital radiography (n=5), Microradiography (n=5), Microtomography (n=3), degree of conversion (n=5), water sorption (n=16), solubility (n=16), contact angle (n=16), flexural strength (n=16), elastic modulus (n=16) and Energy dispersive X-ray Spectroscopy (n=10) were performed. Analyses were performed using the R program, with a significance level of 5%, and microradiography and Microtomography analyses were evaluated qualitatively. In groups with 30 or 40% of ytterbium, radiopacity was higher or equal to enamel. Microradiography and Microtomography appear to have more radiopacity in groups with 40% (Y). Among the groups with no particle addition, those of the experimental infiltrant presented a higher degree of conversion than those of Icon®. In most groups, there was solubility below the ISO-recommended levels. The addition of particles resulted in higher viscosity. Groups with Icon had higher flexural strength and elastic modulus than groups with experimental infiltrant. The addition of 40% (Y) improved polymerization, had low solubility, and had greater radiopacity than enamel, however negatively affected the viscosity increasing then. Experimental groups with the base showed a higher water sorption than Icon groups.

Resumo O objetivo desse estudo foi avaliar o efeito da incorporação de partículas de Bário e Itérbio nas propriedades físicas de infiltrantes resinosos. Os grupos foram divididos de acordo com a adição de Itérbio puro (30 ou 40%) ou Itérbio com Bário (15/15% ou 20/20% respectivamente) no infiltrante comercial Icon e no Infiltrante experimental base. Foram realizados os testes de: radiografia digital (n=5), microradiografia Transversa (n=5), microtomografia (n=3), grau de conversão (n=5), sorção (n=16), solubilidade (n=16), ângulo de contato (n=16), resistência flexural (n=16), modulo de elasticidade (n=16) e Espectroscopia por energia dispersiva (n=10). As análises foram realizadas utilizando o programa R, com nível de significância de 5%, e os testes de microradiografia e microtomografia foram analisados qualitativamente. Nos grupos com 30 ou 40% de Itérbio, a radiopacidade foi maior ou igual ao esmalte dentário. Na microradiografia e microtomografia parece ter maior radiopacidade nos grupos com 40% de itérbio. Dentre os grupos sem adição de partículas, os do infiltrante experimental apresentaram maior grau de conversão do que os do Icon e o grupo controle experimental e com 40% de itérbio apresentaram os melhores resultados. Na maioria dos grupos, a solubilidade foi abaixo dos níveis recomendados pela ISO. A adição de particulas resultou em maior viscosidade. Os grupos com Icon apresentaram maior resistência flexural e modulo de elasticidade do que os grupos com infiltrante experimental e a quantidade de partícula aumentou a resistência e o módulo de elasticidade. A adição de 40% de itérbio melhorou a polimerização, apresentou baixa solubilidade e maior radiopacidade do que o esmalte, porém afetou negativamente a viscosidade, aumentando-a.

Protective effect of barium chloride pretreatment on lung in mice with acute respiratory distress syndrome / 中华危重病急救医学

Objective:To explore whether barium chloride (BaCl 2) preconditioning has the protective effect on lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) model in mice and the possible mechanism. Methods:Sixty 8-12 week old healthy C57BL/6 male mice were randomly divided into control group, ARDS model group and BaCl 2 pretreatment group, with 20 mice in each group. The BaCl 2 pretreatment group was continuously injected with BaCl 2 (4 mg/kg through the tail vein) for 3 days before ARDS model establishment. ARDS model was established by intratracheally injecting (3 mg/kg) LPS. The control group was intratracheally given the same volume of 0.9% normal saline. On 24th hour after ARDS model establishment, some mice were sacrificed for obtaining fresh lung tissue. And the right lower lobe of the lung was separated for observing the pathological changes of lung tissue while the left lung tissue was used to measure the wet/dry weight ratio (W/D) of the lung. Some mice were sacrificed for observing pulmonary microvascular permeability at 2nd hours after injecting Evans blue (EB) through tail vein. The left mice were killed for alveolar lavage to measure the levels of tumor necrosis factor-α (TNF-α) via enzyme linked immunosorbent assay (ELISA). Results:Comparing with the control group, ARDS model group showed typical ARDS pathological changes, which included the increased W/D ratio (4.951±0.161 vs. 3.449±0.299, P < 0.01) and the content of EB in the lung tissue (μg/g: 0.130±0.027 vs. 0.085±0.011, P < 0.01), the damaged alveolar wall structure, lung congestion and exudates in the alveoli, as well as amounts of inflammatory cells. The pathological score of lung injury (10.33±1.15 vs. 1.67±0.58) and the level of TNF-α in BALF (ng/L: 900.85±247.80 vs. 68.21±5.79) were significantly increased in the ARDS model group (both P < 0.01). Comparing with the ARDS model group, the lung W/D ratio (4.620±0.125 vs. 4.951±0.161) and the EB content in the lung tissue (μg/g: 0.108±0.011 vs. 0.130±0.027) of BaCl 2 pretreatment group were significantly reduced (both P < 0.01). And the damaged pulmonary structural BaCl 2 pretreatment group were significantly alleviated. In addition, the pulmonary pathological score (5.00±1.00 vs. 10.33±1.15) and the level of TNF-α in BALF (ng/L: 169.16±73.33 vs. 900.85±247.80) were significantly decreased (both P < 0.01). Conclusion:Barium chloride pretreatment can improve the lung histopathological changes of ARDS model mice induced by LPS by reducing the permeability of pulmonary capillaries and local inflammatory reaction.Barium chloride has the protective effect against LPS attack in mice model of ARDS.

Serum concentration of thyroxine and triiodothyronine in newborn calves from cows supplemented with barium selenate / Concentración sérica de tiroxina y triiodotironina en terneros recién nacidos de madres suplementadas con selenato de bario / Concentração de tiroxina e triiodotironina sérica em bezerros recém-nascidos de mães suplementadas com selenato de bário

Abstract Background: Barium selenate is an inorganic source of selenium (Se) used in prolonged-release preparations to treat selenium deficiency in bovines. Objective: To evaluate serum concentrations of triiodothyronine (T3) and thyroxine (T4) hormones in newborn calves from mothers supplemented with barium selenate during prepartum. Methods: Six black Frisian pregnant cows were supplemented with barium selenate subcutaneously during the last two months of gestation, until calving. Six cows were used as controls. All cows were subjected to a low Se diet, consisting of hay from natural pasture and commercial concentrate lacking Se. The Se balance was measured through the activity of erythrocyte glutathione peroxidase (GPx). Serum concentration of T3 and T4 in calves was determined by electrochemiluminescence. Results: Se supplementation during prepartum increased GPx activity in cows from day 45 post-supplementation (p<0.05). Calves from supplemented mothers showed higher average serum Se concentration than calves from non-supplemented mothers. The average concentration of T3 in the calves from supplemented mothers was lower in the first hour of life (p<0.05) compared with calves from mothers of the non-supplemented group. A decrease (p<0.05) in T4 serum concentrations was observed in both groups at seven days of age. Conclusions: Administration of barium selenate to cows during prepartum generates a reduction in serum concentration of T3 in the first hour of life of calves.

Resumen Antecedentes: El selenato de bario es una fuente inorgánica de selenio (Se) utilizada en preparaciones de liberación prolongada para corregir el estado de carencia de Se en bovinos. Objetivo: Evaluar las concentraciones séricas de triyodotironina (T3) y tiroxina (T4) en terneros recién nacidos de madres suplementadas durante el preparto con selenato de bario. Métodos: Seis vacas frisón negro con 7 meses de gestación fueron suplementadas vía subcutánea con selenato de bario dos meses previos a la fecha de parto. Otras seis vacas permanecieron como controles. Todas las vacas se mantuvieron con una dieta cuyo aporte de Se fue inferior a los requerimientos y consistió en heno de pradera natural y concentrado comercial sin Se. El balance de Se se midió usando la actividad eritrocitaria de glutatión peroxidasa (GPx) y las concentraciones de T3 y T4 en terneros mediante electroquimioluminiscencia. Resultados: La suplementación con Se aumentó la actividad de GPx en vacas desde el día 45 post suplementación (p<0,05). Los terneros de madres suplementadas mostraron una concentración sérica promedio de Se mayor que los terneros de madres no suplementadas. La concentración promedio de T3 de terneros de madres suplementadas fue menor en la primera hora de vida (p<0,05) que en terneros de madres no suplementadas. A los 7 días de edad hubo una disminución (p<0,05) en las concentraciones séricas de T4 en ambos grupos. Conclusión: La administración de selenato de bario en vacas preparto genera una disminución en la concentración sérica de T3 en la primera hora de vida del ternero.

Resumo Antecedentes: O selenato de bário é uma fonte inorgânica de selênio (Se) usada em preparações de liberação prolongada para corrigir o status de deficiência de Se em bovinos. Objetivo: Avaliar as concentrações séricas de triiodotironina (T3) e tiroxina (T4) em bezerros recém-nascidos de mães suplementadas durante o pré-parto com selenato de bário. Métodos: Seis vacas friesianas negras aos 7 meses de gestação foram suplementadas com selenato de bário por via subcutânea dois meses antes do parto. Seis outras vacas permaneceram como controle. Todas as vacas foram mantidas em uma dieta cuja contribuição de Se foi inferior aos requeridos e consistiram em feno natural da pradaria e concentrado comercial sem Se. O balanço de Se foi medido usando a atividade eritrocitária das concentrações de glutationa peroxidase (GPx) e T3 e T4 em bezerros por eletroquimiluminescência. Resultados: A suplementação com atividade de GPx aumentou em vacas a partir do dia 45 após a suplementação (p<0,05). Os bezerros de mães suplementadas apresentaram uma concentração sérica média de Se maior que os bezerros de mães não suplementadas. A concentração média de T3 dos bezerros das mães suplementadas foi menor na primeira hora de vida (p<0,05) do que nos bezerros das mães não suplementadas. Aos 7 dias de idade houve uma diminuição (p<0,05) nas concentrações séricas de T4 nos dois grupos. Conclusão: A administração de selenato de bário em vacas de parto gera uma diminuição na concentração sérica de T3 na primeira hora de vida do bezerro.

Hernia hiatal tipo IV: presentación de caso / Hiatal hernia type IV: case presentation

RESUMEN Fundamento: la hernia hiatal es la anormalidad más frecuente del tracto digestivo superior, se clasifica en cuatro tipos, estas hernias pueden ser por deslizamiento y paraesofágicas, estas últimas de presentación mucho menos frecuente en la práctica clínica como es el caso que se presentó tipo IV; la mayoría son asintomáticas son descubiertas incidentalmente en radiografías de tórax o en tomografía computarizada multicorte y cuando son sintomáticas muchas veces están asociadas a complicación. Objetivo: presentar un paciente con hernia hiatal tipo IV diagnosticada por tomografía computarizada multicorte. Presentación del caso: paciente masculino, de 58 años de edad, con antecedentes de hipertensión arterial, que refiere presentar una hernia diafragmática diagnosticada hace 15 años, que presenta dolor abdominal a tipo cólico de moderada intensidad acompañado de distensión abdominal eructos, vómitos y disnea. Al examen físico, abdomen globuloso que sigue los movimientos respiratorios, doloroso a la palpación superficial y profunda. En el tórax se auscultan ruidos hidroaéreos en el lado derecho. La tomografía computarizada multicorte demuestra la herniación de estómago, colon transverso y epiplón en hemitórax derecho a través del hiato esofágico. Conclusiones: las hernias hiatales son las anomalías más frecuentes del tracto digestivo superior pero las gigantes tipo IV con herniación de otras estructuras abdominales, como colon, omento, intestino delgado, hígado y páncreas son una forma infrecuente de presentación de las mismas. La tomografía computarizada multicorte y el estudio baritado de esófago-estómago-duodeno, resultan fundamentales para el diagnóstico y caracterización de estas lesiones.

ABSTRACT Background: the hiatal hernia is the most frequent abnormality of the upper digestive tract, which are classified into four types, these hernias can be by sliding and paraesophageal, the latter being much less frequent presentation in clinical practice as is the case presented type IV; most of them are asymptomatic and are discovered incidentally on chest x-rays or multi-slice CT and when they are symptomatic they are often associated with complications. Objective: to describe a patient with hiatal hernia type IV diagnosed by multi-slice CT. Case report: a 58-year-old male patient with a history of arterial hypertension, who reported having a diaphragmatic hernia diagnosed 15 years ago, who presents with abdominal pain with a moderate intensity of colic accompanied by abdominal distension, belching, vomiting, and dyspnea. At physical examination, globular abdomen that follows the respiratory movements, painful to superficial and deep palpation. Hydro-aerial noises are heard in the right side of the thorax. Multi-slice CT shows herniation of the stomach, transverse colon and omentum in the right chest cavity through the esophageal hiatus. Conclusions: hiatal hernias are the most frequent anomalies of the upper digestive tract but type IV giants with herniation of other abdominal structures, such as colon, omentum, small intestine, liver and pancreas are an infrequent form of presentation of them. Multi-slice CT and barium study of the esophagus, stomach and duodenum are fundamental for the diagnosis and characterization of these lesions.

Multidisciplinary approach to assess the toxicities of arsenic and barium in drinking water

Well water could be a stable source of drinking water. Recently, the use of well water as drinking water has been encouraged in developing countries. However, many kinds of disorders caused by toxic elements in well drinking water have been reported. It is our urgent task to resolve the global issue of element-originating diseases. In this review article, our multidisciplinary approaches focusing on oncogenic toxicities and disturbances of sensory organs (skin and ear) induced by arsenic and barium are introduced. First, our environmental monitoring in developing countries in Asia showed elevated concentrations of arsenic and barium in well drinking water. Then our experimental studies in mice and our epidemiological studies in humans showed arsenic-mediated increased risks of hyperpigmented skin and hearing loss with partial elucidation of their mechanisms. Our experimental studies using cultured cells with focus on the expression and activity levels of intracellular signal transduction molecules such as c-SRC, c-RET, and oncogenic RET showed risks for malignant transformation and/or progression arose from arsenic and barium. Finally, our original hydrotalcite-like compound was proposed as a novel remediation system to effectively remove arsenic and barium from well drinking water. Hopefully, comprehensive studies consisting of (1) environmental monitoring, (2) health risk assessments, and (3) remediation will be expanded in the field of environmental health to prevent various disorders caused by environmental factors including toxic elements in drinking water.

Fístula bronquioesofágica asociada a reflujo gastroesofágico / Bronchial-esophageal fistula associated with gastroesophageal reflux

Se presenta un caso clínico demostrativo de fistula broncoesofágica asociado a reflujo gastroesofágico en un varón de 76 años con diagnóstico de reflujo gastroesofágico y hernia hiatal, que acude por episodios de tos de 1 año de evolución sin respuesta a tratamientos. Demostraremos la utilidad del estudio esofagográfico como elemento diagnóstico. Se revisa brevemente los aspectos clínicos, diagnósticos, terapéuticos y probable secuencia de desarrollo de esta complicación.

We present a clinical case of bronchoesophageal fistula associated with gastroesophageal reflux in a 76-year old man with a diagnosis of gastroesophageal reflux and hernia. He comes for episodes of cough of 1 year of evolution without response to treatments. We will demonstrate the usefulness of the esophagographic study as a diagnostic element. The clinical, diagnostic, therapeutic aspects and the probably sequence of development of this complication are briefly reviewed.

A new defecographic parameter for assessing rectal emptying / Um novo parâmetro defecográfico para avaliar o esvaziamento retal

ABSTRACT Purpose: To validate a new defecographic parameter to assess rectal empyting correlating the percentage of weight reduction of barium paste and the variation in the percentage of area reduction of rectum compared before and after defecation during cinedefecography. Method: Thirty-two consecutive female patients with dyschezia who had clinical indication for cinedefecography were selected. Their median age was 58 years old (18-78 years, mean = 55 years). During cinedefecography, we calculated the cross-sectional sagittal area of the rectum before and after defecation and, thus, the percentage of area reduction of the rectum. The percentage of weight reduction of barium paste was calculated after weighing the contrast injected into the rectum and the amount of contrast evacuated, in grams, using a scale. Finally, both percentages were compared and checked for a correlation between them. Pearson's correlation (r) and Student's t test were used for statistical analysis. Results: A correlation between evacuated barium paste and cross-sectional sagittal area of the rectum at the end of defecation was demonstrated (r = 0.668 and p < 0.0001). Conclusion: It is possible to estimate how much barium paste is evacuated based on the variations in cross-sectional sagittal area of the rectum before and after defecation, in cinedefecography.

RESUMO Objetivo: Validar um novo parâmetro defecográfico para avaliar o esvaziamento retal correlacionando o percentual de redução de peso da pasta baritada e a variação da porcentagem da redução da área do reto antes e depois da evacuação durante o exame de cinedefecografia. Métodos: Foram selecionadas 32 pacientes consecutivas do sexo feminino, portadoras de disquezia, com indicação clínica de investigação por cinedefecografia. A mediana de idade da amostra foi 58 anos (18-78 anos, média de 55 anos). Durante o exame de cinedefecografia, calcularam-se as áreas retais pela secção sagital antes e após a defecação e, assim, o percentual de redução da área retal. O percentual de redução do peso do contraste baritado foi calculado após medidas de peso do contraste injetado no reto e da quantidade de contraste evacuado, em gramas, utilizando uma balança. Por fim, os percentuais foram comparados e verificou-se se havia correlação entre eles. Para análise estatística, foram utilizados correlação de Pearson (r)eT este t de Student. Resultados: Foi observada correlação entre o contraste baritado evacuado e a área retal pela secção sagital ao final da evacuação (r = 0.668; p < 0.0001). Conclusões: É possível estimar o percentual de contraste baritado evacuado através da análise da variação da área retal pela secção sagital antes e após a evacuação, utilizando a cinedefecografia.

Comparative imaging studies of congenital pyriform sinus fistula using barium esophagography and CT / 实用放射学杂志

Objective To evaluate the value of barium esophagography and CT in the diagnosis of congenital pyriform sinus fistula (CPSF).Methods The preoperative radiographic data of 5 9 CPSF patients were analyzed retrospectively,which were confirmed by operation.5 5 patients underwent barium esophagography,and 5 7 patients underwent pre-and post-contrast CT scans.The images of barium esophagography and CT were analyzed and the positive diagnostic rates (PDR)between the two imaging modalities and among the different CT features were compared.Results Among the 5 9 patients,left fistula was found in 5 5 cases,right fistula was found in 2 cases and bilateral fistula in 2 cases.For the patients examined with barium esophagography,53 sinus tracts or fistulas from the pyriform in 52 patients(including 2 patients with bilateral fistula)were depicted.The other 3 patients had negative results.The overall PDR of barium esophagography was 93.0%(53/57).CT findings of CPSF included the narrowness of pyriform fossa,sinus tract or fistula in the neck,bubble sign medial to the superior pole of thyroid,low density in thyroid,thyroid morphologic change,and so on.For the 5 7 patients (including 2 patients with bilateral fistula)examined with CT.The PDR of narrowness of pyriform fossa was 44.1%(26/59),the PDR of sinus tract or fistula was 1 3.6%(8/5 9),the PDR of bubble sign medial to the superior pole of thyroid was 55.9%(33/5 9),the PDR of low density in thyroid was 1 6.9%(1 0/5 9),the PDR of thyroid morphologic change(defect sign of superior pole of thyroid)was 9 1.5%(54/5 9 ).And the total PDR of thyroid density or morphologic change was 94.9%(56/59).Conclusion Barium esophagography can be the main modality to diagnose CPSF because of its high PDR.Although the PDR of CT for direct sign(sinus tract or fistula)is not high,its PDR for indirect sign (thyroid density or morphologic change)is very high.So CT has great value for patients suspected of CPSF.

Standard Recipes for the Preparation of Thickened Barium Liquids Used in the Diagnosis of Dysphagia

Barium sulfate is commonly used to prepare contrast media for videofluorograpy. The flow characteristics of thickened liquids formulated for oropharyngeal imaging are known to be greatly affected by the addition of barium. In this study, thickened barium liquids were prepared by mixing a commercial xanthan gum (XG)-based thickener (Visco-up®) at different concentrations (0.1%–3.0%) with barium powder (Baritop HD®), and differences in the viscosity between thickened non-barium and thickened barium liquids were investigated. In addition, the thickness levels of thickened barium liquids, which are based on the National Dysphagia Diet (NDD) and International Dysphagia Diet Standardization Initiative (IDDSI) guidelines, were classified by measuring the viscosity (NDD) and gravity flow through a syringe (IDDSI) with 0.1%–3.0% thickener concentrations. The apparent viscosity (η(a),₅₀) values of thickened barium liquids were much higher than those of thickened non-barium liquids, indicating that the addition of barium to the XG-based thickener resulted in further thickening. Standard recipes for preparing thickened barium liquids with desirable thickness levels were also established, showing the different thickener concentrations corresponding to the different NDD and IDDSI levels.

Determination method of barium sulfate in the air of workplace / 中华劳动卫生职业病杂志

Objective@#To establish the method for determination of barium sulfate in the air of workplace. @*Methods@#The barium sulfate was collected by dichloride ethylene filter membrane and then processed by alkali fusion method. Inductively coupled plasma optical emission spectrometry (ICP-OES) was used for the detection of barium sulfate. @*Results@#The sampling efficiency was 100%, the linearity of ICP-OES was good at the range of 0.1~100.0 μg/mL, the recovery was ranged from 93.0%~97.8%, the RSD of intra- and inter-batch precision were 3.7%~7.6% and 4.7%~8.8%, respectively. @*Conclusion@#The sampling method and determination method meet the requirements of analysis and apply to the collection and determination of barium sulfate in the air of workplace.

Radiological study of megacolon in trypanosoma cruzi infected rats / Estudo radiológico de megacólon em ratos infectados por trypanosoma cruzi

ABSTRACT Background: Researches on Chagas disease still use several animals and rats, due to size and susceptibility were preferred by many authors. Aim: To develop an experimental model of megacolon in rats inoculated with the strain Y of Trypanosoma cruzi. Methods: Thirty male Wistar rats were distributed in three groups inoculated with different inoculants: Group A: 600000, Group B: 1000000 and Group C: 1500000 blood trypomastigotes of T. cruzi. Animals were sedated intramuscularly at zero inoculation time (T0) and 60 days after inoculation (T60), to perform the barium enema in order to evaluate the dilatation of the different segments of colon in a comparative study of the measurements obtained, using a digital caliper. Evidence of infection was performed by blood smear collected from the animal's tail 18 days after inoculation with observation of blood forms. Results: Comparing the intestinal diameter of the inoculated animals with 60,0000 trypomastigotes in the T0 of infection with T60 days after the inoculation, significant dilatation was observed between the proximal, medial and distal segments (p<0.01), indicating the establishment of the megacolon model. In addition, comparing intestinal diameter between the different segments, with in the T0 of infection and the T60 after inoculation, significant alterations were observed (p<0.05). Conclusion: The proposed model was possible for in vivo studies of alterations due to infection by T. cruzi and functional alterations of the colon. In addition, the changes manifested in the colon are not directly proportional to the size of the inoculum, but to the time of infection that the animals were submitted, since the animals inoculated with 60,0000 blood forms were the ones which presented the most significant alterations.

RESUMO Racional: Pesquisas para doença de Chagas ainda utilizam diversos animais e o rato por seu tamanho e sua suscetibilidade foi o preferido por muitos pesquisadores. Objetivo: Desenvolver um modelo experimental de megacólon em ratos inoculados com a cepa Y de Trypanosoma cruzi. Métodos: Utilizou-se 30 ratos, machos, distribuídos em três grupos inoculados com diferentes inóculos: Grupo A: 600000, Grupo B: 1000000 e Grupo C: 1500000 tripomastigotas sanguíneos da cepa Y de T. cruzi. Os animais foram sedados via intramuscular no tempo zero de inoculação (T0) e aos 60 dias após a inoculação (T60) para realização de enema opaco para avaliação da dilatação dos diferentes segmentos do cólon em estudo comparativo das medidas obtidas, com o auxílio de um paquímetro digital. A comprovação da infecção foi realizada com esfregaço de sangue coletado a partir da cauda do animal 18 dias após a inoculação com observação das formas sanguíneas. Resultados: Ao comparar o diâmetro intestinal dos animais inoculados com 60.0000 formas tripomastigotas no T0 de infecção com T60 dias após a inoculação, observou-se dilatação significativa entre os segmentos proximal, medial e distal (p<0,01), indicando o estabelecimento do modelo de megacólon. Além disso, ao comparar o diâmetro intestinal entre os diferentes segmentos, dentro do T0 de infecção e do T60 após a inoculação, observou-se alterações significantes (p<0,05). Conclusões: O modelo proposto mostrou-se factível para estudos in vivo das alterações decorrentes da infecção pelo T. cruzi e alterações funcionais do cólon. Além disso, as alterações manifestadas no cólon não são diretamente proporcionais ao tamanho do inóculo, mas sim ao tempo de infecção que os animais foram submetidos, visto que os inoculados com 600000 formas sanguíneas foram as que mais apresentaram alterações significantes.

Study on the Correlation between Barium Radiography and Pulmonary Infection rate in the Evaluation of Swallowing Function

OBJECTIVES: To compare the results respectively obtained from the utilization of 60% barium sulfate suspension and Iohexol as contrast agents for videofluoroscopic swallowing studies and the relationship between the clinical application of the two kinds of contrast agents and the incidence of pneumonia. METHODS: Sixty cases of stroke patients with dysphagia were selected in rehabilitation department of our hospital, and the gender, age, position of the disease, and stroke nature between groups had no significant difference. Among which, 30 patients who were administered 350 mgI/ml Iohexol, and the other 30 patients with 60% barium sulfate suspension as contrast agent. We performed videofluoroscopic swallowing studies with barium 60% versus Iohexol within 1 week after admission and 2 weeks after admission. RESULTS: After 2 weeks in hospital, the aspiration pneumonia incidence of two groups was statistically significant (p<0.05), the pneumonia incidence of Iohexol group was lower than barium sulfate group which might have a impossble relevance with barium aspiration. CONCLUSIONS: During the videofluoroscopic swallowing study of dysphagia after stroke, barium sulfate can enhance the pneumonia incidence, and Iohexol can be widely applied in videofluoroscopic swallowing study.

Barium sulphate aspiration pneumonia in a cat with megaesophagus and dextroposition of the aortic arch: case report / Pneumonia aspirativa por sulfato de barrio em gato com megaesôfago e destroposição de arco da aorta: relato de caso

A six-month-old female cat suffered aspiration of an abundant amount of barium sulfate during a radiographic procedure for the diagnosis of megaesophagus. Latero-lateral contrast radiography revealed severe dilation of the thoracic esophagus cranial to the base of the heart. Persistence of the right aortic arch was suspected and later confirmed during corrective surgery. Accumulation of barium sulfate, used as a contrast agent, was clearly observed in the lumen of the bronchi, bronchioles, and alveoli in the radiographic image. Days after the surgery, the animal developed severe respiratory distress, which resulted in death. Cytology results and histology analysis using polarized light demonstrated that the lumen of bronchi, bronchioles, and alveoli exhibited evident histiocytic infiltration with cytoplasm filled by abundant amorphous refractive granular material consistent with barium sulfate. In this report, we describe the anatomical, cytological, histopathological (using polarized light), and x-ray findings of a case of barium sulfate aspiration pneumonia in a cat resulting from the use of this contrast medium for the diagnosis of megaesophagus secondary to persistent right aortic arch.(AU)

Uma gata de seis meses aspirou grande quantidade de sulfato de bário durante procedimento radiográfico para diagnóstico de megaesôfago. Contraste radiográfico látero-lateral revelou dilatação de esôfago torácico até a base do coração. Persistência do arco aórtico direito foi confirmada durante cirurgia corretiva. Acúmulo de sulfato de bário, utilizado como agente de contraste, foi observado no lúmen de brônquios, bronquíolos e alvéolos à imagem radiográfica. Dias após a cirurgia o animal desenvolveu insuficiência respiratória grave e evoluiu para óbito. Resultado de citologia e histologia utilizado luz polarizada demonstrou que lúmen de brônquios, bronquíolos e alvéolos mostraram infiltração histológica com citoplasma cheio de material refratário granular amorfo compatível com sulfato de bário. Nesse relatório, descrevemos achados anatômicos, citológicos, histopatológicos e radiográficos de um caso de pneumonia aspirativa em gata resultante do uso desse meio de contraste para diagnóstico de megaesôfago secundário a persistência do arco aórtico direito.(AU)

Transfer Dysphagia Due to Focal Dystonia

OBJECTIVE: The inability to propel a bolus of food successfully from the posterior part of the oral cavity to the oropharynx is defined as transfer dysphagia. The present case series describes the varied presentation of transfer dysphagia due to focal dystonia and highlights the importance of early detection by following up on strong suspicions. METHODS: We describe seven cases of transfer dysphagia due to focal dystonia. Transfer dysphagia as a form of focal dystonia may appear as the sole presenting complaint or may present with other forms of focal dystonia. RESULTS: Four out of seven patients had pure transfer dysphagia and had previously been treated for functional dysphagia. A high index of suspicion, barium swallow including videofluoroscopy, associated dystonia in other parts of the body and response to drug therapy with trihexyphenidyl/tetrabenazine helped to confirm the diagnosis. CONCLUSION: Awareness of these clinical presentations among neurologists and non-neurologists can facilitate an early diagnosis and prevent unnecessary investigations.

Is Barium Enema Reliable for the Diagnosis of Total Colonic Aganglionosis?

PURPOSE: Barium enema is one of the diagnostic modalities for Hirschsprung'sdisease. The present study aimed to investigate the diagnostic accuracy of barium enema for Hirschsprung's disease, especially total colonic aganglionosis (TCA). METHODS: We retrospectively reviewed the medical records of all the patients who were diagnosed as having TCA and underwent a barium enema in Asan Medical Center Children's Hospital between January 1998 and December 2016. All the tests were performed and reviewed by pediatric radiologists. RESULTS: Among the total 19 patients with TCA who underwent barium enema, 9 patients (47.4%) had accurate radiographic results. Eight of the 13 neonate patients (61.5%) showed typical TCA radiological findings. However, only one of the 6 patients aged >4 weeks (16.7%) had accurate radiological diagnosis. CONCLUSION: Barium enema showed low accuracy for TCA, and its diagnostic performance was better in neonatal period than in those aged >4 weeks.

Peri-Treatment Evaluation of Swallowing in Head and Neck Cancer Patients

Head and neck cancer patients are prone to dysphagia and aspiration, which are usually neglected due to treatment of the cancer itself. However, dysphagia and aspiration could cause malnutrition, dehydration, pneumonia, and moreover, have negative impact on the quality of life, morbidity, and mortality. Due to its multifactorial etiology, thorough clinical and instrumental evaluation are necessary. In managing head and neck cancer patients, it has become very important to identify the possibility of dysphagia and aspiration, and to start management as early as possible.

Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings

OBJECTIVES: To compare the videofluoroscopic findings of patients with suspected oropharyngeal dysphagia with the results of a clinical screening protocol. METHODS: A retrospective observational cohort study was conducted on all consecutive patients with suspected oropharyngeal dysphagia between March 2015 and February 2016 who were assigned to receive a videofluoroscopic assessment of swallowing. All patients were first submitted to videofluoroscopy and then to the clinical assessment of swallowing. The clinical assessment was performed within the first 24 hours after videofluoroscopy. The videofluoroscopy results were analyzed regarding penetration/aspiration using an 8-point multidimensional perceptual scale. The accuracy of the clinical protocol was analyzed using the sensitivity, specificity, likelihood ratios and predictive values. RESULTS: The selected sample consisted of 50 patients. The clinical protocol presented a sensitivity of 50% and specificity of 95%, with an accuracy of 88%. "Cough" and "wet-hoarse" vocal quality after/during swallowing were clinical indicators that appeared to correctly identify the presence of penetration/aspiration risk. CONCLUSION: The clinical protocol used in the present study is a simple, rapid and reliable clinical assessment. Despite the absence of a completely satisfactory result, especially in terms of the sensitivity and positive predictive values, we suggest that lower rates of pneumonia can be achieved using a formal dysphagia screening method.

Value of modified Killian′s method in diagnosis of congenital pyriform sinus fistula / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the feasibility and significance of modified Killian(MK) method in the clinical diagnosis of congenital pyriform sinus fistula(CPSF) by electronic laryngoscopy.@*Methods@#The following examinations were performed for 30 suspected cases of CPSF, including the traditional electronic laryngoscopy, MK examination(modified Killian position+ head rotation+ the Valsalva maneuver), barium swallow X-ray(BSX) and CT , and a prospective comparison among them were done. Patients were divided into two groups according to their age: young age group(≤14 years old) and older age group (>14 years old). The results of MK examination from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests.@*Results@#Sinuses in 20 of 30 patients were depicted from pyriform sinus in BSX, and the PDR was 66.7%(20/30). The PRD of CT was 83.3%(25/30). The presence of air bubbles around the upper lobe of the thyroid gland or at the inferomedial edge of cricothyroid joints, morphological changes of thyroid grand as well as pseudo-fistula formation on lower neck were detected clearly on CT. Comparing to the traditional electronic laryngoscopy, the effect of exposing piriform fossa fistula by MK examination is significant(χ2=17.05, P<0.05), with the PDR of 13.3%(4/30) and 76.7%(23/30) respectively. Nevertheless, comparing to BSX and CT, there were no statistically significant differences in the effect to diagnose CPSF (χ2=0.31, χ2=0.10 respectively, P>0.05). The PDR of MK in older group is significantly higher than younger group(χ2=6.68, P<0.05).@*Conclusions@#MK examination can clearly reveal the hypopharyngeal anatomical structure and detect the sinus of CPSF .It could be a safe, feasible, convenient and economical method as an application in preoperative diagnosis and follow-up examination of clinical suspected CPSF.

Clinical features and imaging diagnosis of colonic stenosis in infants / 天津医药

Objective To explore clinical features and imaging diagnosis of colonic stenosis in infants. Methods Seven patients with congenital and acquired colonic stenosis proved by surgery were included in this study. The clinical features, erect abdominal plain radiograph and barium enema were analyzed. Results Of the 7 patients, 4 were congenital colonic stenosis with progressive abdominal distention and vomiting. The erect abdominal plain radiograph showed that intestinal inflation in 3 patients, low-set mechanical intestinal obstruction in 1 patient. In the remaining 3 patients who underwent ileostomy after neonatal necrotizing enterocolitis (NEC). Barium enema showed colonic stenosis in 5 patients and 2 were missed diagnosed who underwent contrast examination in the small intestine, and which showed stenosis in ascending colon near the ileocecus. Seven patients were all proved by surgery. The stenosis sites were located in sigmoid colon in 2 cases, in descending colon in 2 cases, in ascending colon in 2 cases and in transverse colon in 1 case. In 4 cases of congenital colonic stenosis, 2 cases underwent surgical staging, 1 case was followed up for half a year, showing normal defecation and well development, the other 1 case was lost visit after hospital discharge. The other 2 cases received end-to-end ileum and colon anastomosis, the abdominal distension was relieved in outpatient review, showing well-developed. Three cases with NEC and secondary colonic stenosis underwent staged surgery. Two patients were followed up in outpatient 2 weeks after operation. They were followed up for half a year, showing normal defecation and well-developed. The other 1 case was lost visit after hospital discharge. Conclusion Clinical features of colonic stenosis are very different and depend on the stenosis degree. NEC is the main cause of acquired colonic stenosis and it can be diagnosed by barium enema.

Diagnostic accuracy of barium enema findings in hirschsprung's disease / Acurácia do diagnóstico de achados do enema opaco na doença de hirschsprung

ABSTRACT Background: Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis. Aim: To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of Hirschsprung in patients underwent barium enema. Methods: This cross sectional study was carried out in Imam Khomeini Hospital for one year starting from 2012, April. Sixty patients were enrolled. Inclusion criteria were: neonates with failure to pass meconium, abdominal distention, and refractory constipation who failed to respond with medical treatment. Transitional zone, delay in barium evacuation after 24 h, rectosigmoid index (maximum with of the rectum divided by maximum with of the sigmoid; abnormal if <1), and irregularity of mucosa (jejunization) were evaluated in barium enema. Biopsy was obtained at three locations apart above dentate line. PPV, NPV, specificity , and sensitivity was calculated for each finding. Results: Mean age of the cases with Hirschsprung's disease and without was 17.90±18.29 months and 17.8±18.34 months respectively (p=0.983). It was confirmed in 30 (M=20, F=10) of cases. Failure to pass meconium was found in 21(70%) cases. Sensitivity, specificity, PPV, and NPV were 90%, 80%, 81.8% and 88.8% respectively for transitional zone in barium enema. Sensitivity, specificity, PPV, and NPV were 76.7%, 83.3%, 78.1% and 82.1% respectively for rectosigmoid index .Sensitivity, specificity, PPV, and NPV were 46.7%, 100%, 100% and 65.2% respectively for irregular contraction detected in barium enema. Sensitivity, specificity, PPV, and NPV were 23.3%, 100%, 100% and 56.6% respectively for mucosal irregularity in barium enema. Conclusion: The most sensitive finding was transitional zone. The most specific findings were irregular contraction, mucosal irregularity, and followed by cobblestone appearance.

RESUMO Racional: A doença de Hirschsprung é a causa mais comum de obstrução intestinal pediátrica. Enema baritado é usado para a avaliação dos pacientes com o diagnóstico . Objetivo: Avaliar a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de achados radiológicos para diagnóstico de Hirschsprung em pacientes submetidos ao enema opaco. Métodos: Este estudo transversal foi realizado em Imam Khomeini Hospital por um ano a partir de abril de 2012. Sessenta pacientes foram incluídos. Os critérios de inclusão foram: recém-nascidos com insuficiência de passagem de mecônio, distensão abdominal, e constipação refratária sem resposta ao tratamento médico. Foram avaliadas no enema zona de transição, atraso na evacuação de bário após 24 h, índice retossigmoide (máximo do diâmetro do reto dividido pelo máximo do sigmóide; anormal se <1), e as irregularidades da mucosa (jejunização). Biópsia foi obtida em três localizações acima da linha dentada. VPP, VPN, especificidade e sensibilidade foram calculados para cada achado. Resultados: A idade média dos casos com a doença de Hirschsprung e sem foi 17,90±18,29 meses e 17,8±18,34 meses, respectivamente (p=0,983). Confirmou-se em 30 (M=20, F=10) dos casos. Falha no mecônio foi encontrada em 21 (70%) casos. Sensibilidade, especificidade, VPP e VPN foram de 90%, 80%, 81,8% e 88,8%, respectivamente, para a zona de transição no enema. Sensibilidade, especificidade, VPP e VPN foram 76,7%, 83,3%, 78,1% e 82,1%, respectivamente para o índice de retossigmoide. Sensitividade, especificidade, VPP e VPN foram 46,7%, 100%, 100% e 65,2%, respectivamente, para contração irregular detectada no enema baritado. Sensibilidade, especificidade, VPP e VPN foram de 23,3%, 100%, 100% e 56,6%, respectivamente, para a irregularidade da mucosa. Conclusão: O achado mais sensível foi zona de transição. Os achados mais específicos foram contração irregular, irregularidade da mucosa, e seguido por aparecimento de mucosa em forma de paralelepípedos.