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.

Obstrucción intestinal por bariolito / Bowel obstruction due to an impacted bariolith: a case report

Se define como bariolito a la concreción de sulfato de bario en intestino luego de la realización de algún estudio radiológico contrastado con dicho material. Se trata de una patología poco frecuente en pediatría, que puede ser sospechada tras la realización de una radiografía de abdomen de pie, junto al antecedente del estudio contrastado. Presentamos el caso clínico de una paciente de 2 meses para enfatizar la necesidad de una buena anamnesis que rescate el antecedente de la realización del estudio con contraste y el oportuno diagnóstico y tratamiento, para disminuir la posibilidad de complicaciones.

"Barolith" is an infrecuent complication of bowel contrast studies that occurs after barium oral administration. There are not many cases published in the literature regarding bariolith in pediatrics. It can be suspected after realization of an abdomen X Ray in a patient with a previous oral contrast study. We report a case of bariolith in a 2-month-old baby. We emphasize the need of a proper anamnesis in order to explore the history of contrasted examination, and the opportune diagnosis and treatment to prevent complications.

Development of two oral contrast materials for CT evaluation of the esophagus.

BACKGROUND: Computed tomography (CT) is a widely available modality in evaluating benign and malignant diseases of the esophagus. To date, there is no substantial consensus on the optimal and widely available method for opacifying the esophageal lumen exists for CT OBJECTIVE: The present study was performedf or complete and continuous opacification of the esophagus using two developed oral contrast materials and a commercial barium paste formulated for CT MATERIAL AND METHOD: One hundred and seven adult patients were sent for spiral routine CT scan of the chest (Light speed plus; General Electric Medical System, Milwaukee, Wis., USA) to evaluate variety of clinical conditions at Ramathibodi Hospital. They were divided into three groups. Two developed oral contrast materials, 1.5%(wt/vol) carboxy-methyl cellulose sodium paste containing 2%(wt/vol) barium sulfate and 5.5%(wt/vol) potato starch containing 2%(wt/vol) barium sulfate, and a commercial barium paste were randomly administered Data collection and analysis of the CT findings were performed double blindly. Results: The patients undergoing CT scan of the chest were performed with one of the oral contrast material. No streak artifact was present in any of the CT slices. Of the grade 1, contrast present without luminal distension and grade 2, contrast present with luminal distension, 1.5% CMC containing 2% barium sulfate was opacified in 36.48% and 17.45/o, respectively. Opacification with 5.5% starch containing 2% barium sulfate was of 36.41% and 19.71% while that of 3% commercial barium paste was of 36.68% and 27.54%, respectively. Acceptable taste was also achieved However, mild to moderate difficulty in swallowing occurred in 35% with no medication or intervention needed CONCLUSION: All oral contrast materials tested were less continuous and did not opacified the esophageal lumen as much when compared with the prior studies. However, acceptable taste, only mild to moderate difficulty in swallowing during the procedure, and significantly cheaper cost enable them to be used in selected cases in CT scan of the neck, chest, and upper abdomen for clarification of the problem areas.

A Case of Idiopathic Colitis Developed after Barium Enema / 대한소화기학회지

It has been reported that colitis may be associated with intrarectally administered drugs or chemicals. Colonotoxicity may results from conventional medical therapy, herbal or other illicit drugs, contrast materials, and detergents. Clues that a colitis may be due to an intrarectally administered agent include perianal excoriation, segmental distal colitis due to a concentration gradient from enema administration, and recent diagnostic or therapeutic administration of high risk solutions such as hypertonic contrast agents or detergent enemas. Barium is a highly viscous contrast agent that is insoluble in water. Barium enemas are usually very safe. Also, no case report of barium-induced chemical colitis has been reported yet. We report a case of chemical colitis with colonic stricture occurring after the barium enema for diagnostic purpose.

Barium peritonitis--following barium enema of the proximal colon through a colostomy

Perforation with extravasation of barium is a rare complication of contrast enema examination of the large bowel with a high associated mortality rate. The experience of performing a re-laparotomy in a patient previously exposed to barium peritonitis is even less common. We describe an elderly male patient with a Hartmann's procedure performed a year previously, presenting with peritonitis following barium enema evaluation of the proximal colon via an end descending colon stoma. Emergency laparotomy, segmental bowel resection and liberal peritoneal toilet resulted in a satisfactory outcome. The patient had a subsequent successful reversal of his Hartmann's procedure nine months later despite the presence of dense barium induced adhesions. This potentially preventable iatrogenic complication is discussed in this report, which is supplemented by a brief review of the English literature.

Peritonite por bário / Barium peritonitis

We report a case of a 49 years-old man who underwent a barium meal examination for an epigastric pain. A perforated gastric ulcer with barium extravasation into peritoneal cavity was seen on X-rays. During an emergency laparotomy, a perforated pyloric ulcer was noted, along with barium contamination in the peritoneal cavity. The ulcer was closed with an omental patch and an extensive peritoneal lavage with saline was performed. During the postoperative period, the patient developed signs of peritonitis and underwent a new laparotomy was at the 9th day showing a subfrenic abscess with a large barium contamination. The patient presented septic shock and multiple organ failure, dying on the 21th day

Colonic chemobezoar--intestinal obstruction due to barium inspissation.

A 72-year-old man presented with constipation of 45 days' duration, with history suggestive of recurrent episodes of subacute intestinal obstruction relieved by passage of fluid and flatus; he had noticed an abdominal lump 30 days prior. Examination revealed a lump corresponding to the contours of the entire large intestine. X-ray showed barium outlining the colon. Enquiry revealed that he had undergone a barium enema study 10 days prior to appearance of the lump. The diagnosis of barium inspissation was confirmed at laparotomy; total colectomy with ileo-rectal anastomosis was done.

Colorectal perforation by barium enema

A perfuraçäo coloretal por enema baritado é muito séria e mais freqüente que a mencionada na literatura. Nesse estudo, oito perfuraçöes foram revistas; ocorreram no cólon ascendente (uma), descendente (uma), sigmóide (quatro, e no reto (duas). A afecçäo de base dos pacientes era: enterocolite necrosante do recém-nascido (uma), estenose de colostomia (uma), fecaloma (duas), câncer (duas), trauma (uma) e dor abdominal pós-radioterapia (uma). Na maioria dos enfermos o tratamento consistiu em ressecçäo do segmento perfurado e colostomia; colostomia; a taxa de mortalidade foi de 62,5%. A causa dessa alta mortalidade é a lesäo produzida pela presença de bário e de fezes na cavidade peritoneal e no espaço retro-peritoneal. Säo considerados os mecanismos causadores desse acidente e medidas profiláticas. O número significativo de casos nos quais a responsabilidade médica é envolvida, deveria forçar cirurgöes e radiologistas a sempre tomarem precauçöes para prevenir este sério acidente

Perforación colorrectal por enema baritada / Colorrectal perforation barium-enema

La perforación colorrectal por enema baritada es muy grave y más común de lo que se refiere en la literatura. Se estudian 8 perforaciones que se produjeron 1 en el colon derecho, 1 en el colon descendente, 4 en el sigmoides y 2 en el recto. La patología de base por la que se solicitó el examen fue enterocilitis necrotizante del recién nacido, estenosis colostómica, fecaloma en 2, cáncer en 2, traumatismo rectal y dolor abdominal en 1 paciente irradiada. El tratamiento, que en la mayoría de los casos consitió en la resección del sector comprometido y colostomía, tuvo una mortalidad del 62,5%. Se estudian las causas de esta elevada mortalidad y en particular el efecto nocivo del bario y materias fecales derramados en la cavidad peritoneal y en el espacio retroperitoneal, los mecanismos de producción del accidente y los medios par aprevenirlos. La alta proporción de casos en los que hay que reconocer responsabilidad médica, obliga a cirujanos y radiólogos a extremar precauciones e incita a divulgar los accidentes observados y destacar la extrema gravedad de los mismos

Efectos tóxicos de las sales de bario / Barium salts toxic effects

Se describe 14 pacientes intoxicados por ingesta inadvertida de sales solubles de Bario (sulfito y sulfuro). Fueron 11 varones y 3 mujeres, con un promedio de edad de 37 años. La sintomatología predominante estuvo dada por molestias gastrointestinales (diarrea, náusea, vómito y dolor abdominal) y neuromusculares (mareo, debilidad, parestesia y dificultad respiratoria); que iniciaron a las pocas horas de la ingesta. Hubo una correlación estrecha entre la sintomatología neuromuscular y la deplesión de potasio sérico (valor promedio: 2.72 mEq/L); tanbién se observó deplesión de magnesio sérico en 5 pacientes (valor promedio: 1.16 mEq/L), relacionándose a la existencia de paresia muscular. El estudio electromiográfico en 2 pacientes encontró alteración miopática definida. El tratamiento estuvo dirigido al disturbio electrolítico de potasio y magnesio. Un paciente falleció en paro cardio-respiratorio y el resto se recuperó ad-integrum en 24 a 36 Hrs