Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy

BACKGROUND: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. METHODS: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5-7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. RESULTS: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. CONCLUSION: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

Liraglutide in diabetes mellitus: more facts and findings

Liraglutide exert favorable effects on most of the diabetes associated cardiovascular [CV] risk factors and this study was designed to further explore the benefits of liraglutide by observing its effect on plasma sialic acid [PSA] in diabetic rats. A total of 30 streptozotocin induced [50mg/Kg; i. p] diabetic rats were randomized into vehicle treated [1 ml/Kg s.c, twice daily] group I, liraglutide treated groups II and III [30 micro g/Kg and 150 micro g/Kg, twice daily respectively] and studied for 6 weeks. Liraglutide treated groups showed significant reductions in fructosamine levels [p

Biochemical characterization of the aeromonas species isolated from food and environment

Very few studies have been carried out to comprehensively characterize Aeromonas isolates. This study reports biochemical and enzymatic characterization of 60 isolates belonging to seven Aeromonas species. Seven types of API [Analytab Production Incorporation, France] strips [API 20 E, API 20 NE, Rapid ID 32 E, API 50 CH, ID 32 GN, ID 32 C, Rapid ID 32 A] were used for the biochemical characterization of the isolates. These strips provided an extensive biochemical profile of the isolates. AI 20 E gave reliable results. The H [2] S tubule of this strip was added with gelatin-cysteine-thiosulfate medium and got excellent results for H [2] S production from cysteine. Esculin formulation in ID 32 C was proved most reliable as no false positive or as many false positive and false negative results were given by it. All other strips provided test profile and some of the characteristics in them appeared as significant in differentiation of the various species