Endoscopic tattooing to mark distal margin for low anterior rectal and select sigmoid resections.

Obtaining a reliable distal margin during anterior colorectal resection can be difficult. In this study, endoscopic transmural tattoos were placed to mark the distal transection point in patients with distal colorectal neoplasms who undergo bowel resection. In the operating room, before surgery, sigmoidoscopy is performed with a 2-channel scope using CO2 insufflation. Through channel 1, a biopsy forceps, marked 5 cm from its end, is inserted to the tumor's distal edge; in channel 2, a sclerotherapy catheter is placed. The scope is then withdrawn and forceps inserted at the same rate until the mark is seen, next, via the needle catheter, 4 tattoos are placed at that level circumferentially. After rectal mobilization, visible external tattoos guide stapler placement. If no tattoo is seen, sigmoidoscopy is done and the tattoos used to guide stapler placement. In all 27 patients, the tattoos guided stapler placement; tattoos were seen via the abdomen in 26 and the stapler placed as per tattoos in 25. In 2 patients, repeat endoscopy was done and tattoos used to guide or confirm stapler placement. The margin was ≤1 cm from target in 74% while in 22% the margin was 2 to 3.5 cm off target (mean deviation from target margin = 0.33 cm). In conclusion, this method facilitates stapler placement and provides more reliable margins.

Removal of oral debris and bacteria during supervised tooth brushing.

OBJECTIVE: To investigate foam generation during brushing, and the oral debris and bacteria removal efficacy of an experimental gel-to-foam dentifrice compared to a commercially-available dentifrice after brushing. METHODS: Thirty-four subjects participated in this blinded, crossover study. After a wash-out period prior to each session of product use, subjects reported to the site having abstained from oral hygiene, eating and drinking from 22:00 h on the evening prior to treatment visits. The subjects brushed with a weighed dose of assigned paste and were asked to expectorate their toothpaste slurry into a collection vessel at 30 and 60 seconds during supervised brushing. The expectorated foam was measured immediately, after which subjects rinsed with 10 ml of sterile water and expectorated into the same vessel. Samples were placed on ice and immediately transported to the laboratory for analysis. Bacteria (total anaerobes and VSC-producing bacteria) were enumerated using appropriate selective media. To calculate the amount of debris, a measured portion of the sample was deposited onto a pre-weighed dish and weighed. Dishes were dried thoroughly and weighed again after cooling. RESULTS: Use of the gel-to-foam dentifrice resulted in 105% greater foam volume compared with use of the control dentifrice (p < 0.0001). Further, the gel-to-foam dentifrice removed 15.77% more debris than the control dentifrice (p-value = 0.0342). There was greater removal of total anaerobes and VSC-producing bacteria by the gel-to-foam dentifrice versus the control dentifrice (p-value < 0.0001). CONCLUSION: Single use of a gel-to-foam dentifrice generated a greater volume of foam and removed a greater amount of oral debris and bacteria during brushing than a standard dentifrice.