ABSTRACT
BACKGROUND: Anastomotic leakage is a severe complication after esophagectomy. The objective was to investigate the diagnostic and predictive value of routine contrast swallow study and endoscopy for the detection of anastomotic dehiscence in patients after esophagectomy. METHODS: All patients who underwent contrast swallow and/or endoscopy within 7 days after oesophagectomy for cancer between January 2005 and December 2009 were selected from an institutional database. RESULTS: Some 173 patients underwent endoscopy, and 184 patients underwent a contrast swallow study. The sensitivity of endoscopy for anastomotic leakage requiring intervention is 56 %, specificity 41 %, positive predictive value (PPV) 8 %, and negative predictive value (NPV) 95 %. The sensitivity of contrast swallow study for detecting leakage requiring intervention in patients without signs of leakage was 20 %, specificity 20 %, PPV 3 %, and NPV 97 %. CONCLUSIONS: In patients without clinical suspicion of leakage, there is no benefit to perform routine examinations.
Subject(s)
Anastomotic Leak/diagnosis , Endoscopy, Gastrointestinal , Esophageal Neoplasms/surgery , Esophagectomy/adverse effects , Esophagus/surgery , Stomach/surgery , Surgical Wound Dehiscence/diagnosis , Aged , Anastomosis, Surgical/adverse effects , Anastomotic Leak/diagnostic imaging , Anastomotic Leak/etiology , Contrast Media , Diagnostic Tests, Routine , Female , Humans , Male , Middle Aged , Neck/surgery , Plastic Surgery Procedures/adverse effects , Retrospective Studies , Surgical Wound Dehiscence/diagnostic imaging , Surgical Wound Dehiscence/etiology , Triiodobenzoic AcidsABSTRACT
The influence of the incorporation of cholesterol and water on the particle size, bilayer thickness, melting behavior, and relative sucrose ester composition of reversed vesicles was studied. Reversed vesicles (RVs) were prepared of sucrose ester in silicon oil by sonication. The RVs were characterized by polarized light microscopy, laser diffraction, high-performance liquid chromatography, small angle X-ray scattering (SAXS), and differential scanning calorimetry. The particle size distributions of the studied dispersions were bimodal with peaks at 5 and 0.4 microm. There was no significant difference in the sucrose ester composition of these two size categories of RVs. The incorporation of cholesterol and water had no effect on the size distribution of the RVs. The SAXS results showed that the RVs prepared without cholesterol and water consisted of bilayers with fully interdigitated alkyl chains. The incorporation of high concentrations of cholesterol caused a phase separation within the bilayers. The incorporation of water also resulted in a phase separation within the bilayers but at a lower cholesterol concentration. The presence of two different size classes of RVs in one RVs dispersion and the phase separation within the bilayers of certain compositions can have consequences for the application of RVs.
Subject(s)
Cholesterol/chemistry , Esters/chemistry , Lipid Bilayers/chemistry , Sucrose/chemistry , Water/chemistry , Drug Delivery Systems/methods , Particle SizeABSTRACT
The formation of reversed sucrose ester vesicles in silicon oil and mixtures of silicon oil and isopropyl palmitate was studied. The vesicles were characterized by polarized light microscopy, freeze-fracture electron microscopy, and differential scanning calorimetry. Furthermore the ability to encapsulate p-aminobenzoic acid and cholesterol in such vesicles was studied. The vesicles were multilamellar and had sizes up to several micrometers. The vesicles agglomerated but did not show fusion for at least 2 years when stored at room temperature in glass vials. The encapsulation efficiency of both p-aminobenzoic acid and cholesterol strongly depended on the oil phase in which the vesicles were prepared. Reversed sucrose ester vesicles in silicon oil encapsulated nearly 100% of the amount of p-aminobenzoic acid or cholesterol present in the dispersion. These compounds were encapsulated in different compartments of the vesicles. Reversed sucrose ester vesicles offer new perspectives regarding the development of novel pharmaceutical dosage forms.
Subject(s)
Drug Compounding , Oils/chemistry , 4-Aminobenzoic Acid/chemistry , Calorimetry, Differential Scanning , Cholesterol/chemistry , Freeze Fracturing , Lipid Bilayers , Models, Chemical , Solubility , Sucrose/chemistry , Sunscreening Agents/chemistryABSTRACT
To obtain a topical dermatological product with a high degree of occlusivity combined with attractive cosmetic properties, a water-in-oil (w/o) cream containing small particles of solid paraffin was developed. Dynamic light scattering, freeze-fracture electron microscopy, polarization microscopy, and differential scanning calorimetry were used to characterize the cream. The preparation method essentially consisted of two steps. First, an aqueous dispersion of solid paraffin particles, with a mean diameter of 200 nm, was prepared with an oil-in-water (o/w) emulsifier. The aqueous dispersion proved to be extremely stable, and the particles had a spherical shape. Second, the aqueous dispersion was incorporated into the water phase of the cream during its production. After production of the cream, 68% of the paraffin was present as particles in the dispersed water phase. The size and shape of these particles did not change by the mechanical treatment during the production of the cream. At least 28% of the paraffin was present in the continuous oily phase, either as solid particles or in the form of a gel structure. At most, 4% of the paraffin was dissolved in this oily phase. The excess o/w emulsifier present in the aqueous phase of the w/o cream did not cause physical instability.
