Efficacy of ileus tube combined with meglumine diatrizoate in treating postoperative inflammatory bowel obstruction after surgery.

BACKGROUND: Early postoperative inflammatory small bowel obstruction (EPISBO) is easy to be complicated after colorectal cancer surgery. Both intestinal obstruction catheter and meglumine can treat EPISBO. AIM: To investigate the efficacy of an intestinal obstruction tube combined with meglumine diazo in treating EPISBO of colorectal cancer. METHODS: Data from 60 patients with colorectal cancer and intestinal obstruction admitted to the Proctology Department of our hospital from April 2018 to May 2022 were collected and analyzed and divided into three cohorts according to different treatment regimens. Cohort A (n = 20) received a transnasal intestinal obstruction catheter with panumglumine, and cohort B (n = 20) received a transnasal intestinal obstruction catheter with liquid paraffin. Cohort C (n = 20) received oral treatment with meglumine. The clinical efficacy, first exhaust/defecation time, length of hospital stay, gastrointestinal decompression time, relief time of abdominal pain, and relief time of abdominal distension were compared among the three cohorts. The levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), monocyte chemotactic protein-1 (MCP-1), serum albumin, and transferrin were compared among the three cohorts before and after treatment. The occurrence of adverse reactions in the three cohorts was compared. RESULTS: Compared with cohort C, the successful treatment rate of cohort A was significantly higher. There were statistically significant variations in the time of first exhaust/defecation, length of hospital stays, gastrointestinal decompression time, relief time of abdominal pain, and relief time of abdominal distention among the three cohorts. Compared with cohort C, cohort A's first exhaust/defecation time, hospitalization time, gastrointestinal decompression time, abdominal pain relief time, and abdominal distension relief time was reduced (P < 0.05). After treatment, serum CRP, TNF-α, IL-6, and MCP-1 expression levels increased, and serum albumin and serum transferrin levels increased in the three cohorts. The serum albumin level in cohort A was higher than in cohort C. Compared with cohort B and cohort C, the serum transferrin level in cohort A increased (P < 0.05). Compared with cohort C, the total incidence of adverse reactions in cohorts A and B was significantly higher (P < 0.05). The incidence of adverse reactions was similar between cohort A and cohort B. CONCLUSION: Using an ileus tube combined with meglumine diatrizoate can effectively treat postoperative inflammatory ileus obstructions after surgery colorectal cancer and improve prognosis, inflammatory response, and nutritional status.

The preventive effect of oral 76% Meglumine Diatrizoate for the postoperative ileus.

After emergency surgery for intestinal obstruction caused by colorectal cancer, postoperative ileus (POI) is more likely to occur in the early-stage oral intake. POI incited the occurrence of postoperative complications and prolongs hospital stay. Reducing the occurrence of POI will Enhance Recovery After Surgery (ERAS). AIM: The aim of this study is to observe and evaluate the preventive effect of postoperative oral administration of 76% Meglumine Diatrizoate in reducing the incidence of POI and promoting intestinal absorption during the recovery of intestinal peristalsis in patients after intestinal obstruction surgery. METHODS: From October 2018 to December 2021, 94 patients (47 vs 47) with intestinalobstruction were rolled. Patients with an ASA score of 4 or higher and gastrointestinal perforation with peritonitis were excluded. After 24 hours of surgery, the patients were divided into experimental group and control group disposed of with an opaque airtight envelope method, patient-side single blind. After intestinal peristalsis recovery (2.45 ± 0.62 d vs 2.60 ± 0.68 d, P > 0.05), the experimental group was given 76% Meglumine Diatrizoate 20 ml orally 9am and the control group was given 10% glucose 20 ml for three consecutive days. POI cases, the time taken to achieve full daily oral calorie and discharge days were counted. RESULTS: The time required to achieve full daily oral calorie (11.04 ± 2.70 d vs 14.09 ± 3.74 d, p < 0.05), POI cases (10/47 vs 20/47, p < 0.05) and discharge days (14.00 ± 4.89 d vs 16.77 ± 5.94 d, p < 0.05) are significantly different between the two groups. CONCLUSIONS: Oral 76% Meglumine Diatrizoate is safe and effective, which can reduce the occurrence of POI, promote the recovery of intestinal absorption and shorten the length of hospital stay effectively.

The effectiveness and biosafety of diatrizoate contrast media in complicated cholelithiasis.

Adverse reactions after intravascular administration of iodine-based contrast media are well-known. Nevertheless the same type of contrast media is also used for endoscopic retrograde cholangiopancreatography and systemic absorption of contrast media after mentioned procedure routinely occurs, not much is known about effects of widely used diatrizoates (Triombrast) on the hepato-pancreato-biliary system in case of cholelithiasis treatment. AIM: The aim of the present study was to determine the effectiveness and biosafety of diatrizoate contrast media in terms of complicated cholelithiasis healing using conventional and improved surgery treatment protocols based on set of biochemical markers. MATERIALS AND METHODS: The paper presents materials of clinical observation and biochemical analysis of 122 patients have been diagnosed with gallstone disease complicated by choledocholithiasis and cholangitis and biliary pancreatitis. Biochemical liver tests before and after surgery treatment using conventional and improved protocols were determined. RESULTS: Biochemical manifestations of hepatocellular injury included exceeded activity of γ-glutamyltranspeptidase and aminotrasferases as well as level of liver fatty acid-binding protein and bilirubin which were different between groups of patients with cholelithiasis who suffered from concomitant cholangitis and pancreatitis. Proposed management algorithm for patients with gallstone disease with concomitant cholangitis and pancreatitis links to get rid of endoscopic retrograde cholangiography with contrast agent from the conventional surgery treatment protocols because its most obvious downside. CONCLUSIONS: Patients with gallstone diseases revealed significant biochemical changes that should be successfully resolved after surgery treatment without endoscopic retrograde cholangio- pancreatography with contrast media because its hepatotoxic effect.

Enhanced reductive reactivity of zero-valent iron (ZVI) for pollutant removal by natural organic matters (NOMs) under aerobic conditions: Correlation between NOM properties and ZVI activity.

While ubiquitous natural organic matters (NOMs) are capable of enhancing zero-valent iron (ZVI) performance under aerobic conditions, there is limited understanding of how the properties of NOMs affect the reactivity of ZVI towards contaminants removal. Here, the corresponding activity of ZVI under aerobic conditions was investigated in the presence of humic acid (HA), fulvic acid (FA), bovine serum albumin (BSA). It was found that three models of NOMs were all effective in promoting diatrizoate (DTA) reduction via depassivating ZVI. Interestingly, fast adsorption of NOM onto ZVI surface initially caused inconspicuous impact or visible inhibition on hydrophilic DTA reduction depending on their hydrophobicity. However, subsequent exposure of more reactive sites with high hydrophilicity arising from the detachment of surfaced NOM-associated iron oxide finally contributed to the enhanced consumption of Fe0 with the ability: HA > FA ≈ BSA, and 1-2 times increase in DTA removal kinetic rate following the order: HA > FA > BSA. It further revealed that there were two key factors in determining DTA removal under aerobic conditions, including the ability of NOMs to boost Fe0 consumption as contributed by their aromaticity degree and amino groups, and the hydrophobicity of NOMs to initially affect the property of ZVI surfaces.

Diatrizoate (Gastrograffin®) Small Bowel Follow Through for Small Bowel Obstructions: Timing and Outcomes.

INTRODUCTION: The advent of the Gastrograffin® small bowel follow through (G-SBFT) has resulted in a decreased rate of operative intervention of small bowel obstructions (SBO); however, there is no data to suggest when G-SBFT should be performed. METHODS: We retrospectively reviewed 548 patients, admitted to 1 of 9 hospitals with a diagnosis of SBO. Patients were divided into two categories with regards to timing of G-SBFT: before (early) or after (late) 48 hours from admission. Primary outcomes were length of stay (LOS) and total cost. Secondary outcomes were operative interventions and mortality. RESULTS: Of the reviewed patients, 71% had the G-SBFT ordered early. Comparing early versus late, there were no differences in patient characteristics with regards to age, sex, or BMI. There was a significant difference between LOS (4 vs 8 days, P < 0.05) and total cost ($17,056.19 vs $33,292.00, P < 0.05). There was no difference in mortality (1.3% vs 2.6%, P = 0.239) or 30-day readmission rates (15.6% vs 15.9%, P = 0.509). Patients in the early group underwent fewer operations (20.7% vs 31.9%, P = 0.05). DISCUSSION: Patients that had a G-SBFT ordered early had a decreased LOS, total cost, and operative intervention. This suggests there is a benefit to ordering G-SBFT earlier in the hospital stay to reduce the overall disease burden, and that it is safe to do so with regards to mortality and readmissions. We therefore recommend ordering a G-SBFT within 48 hours to reduce LOS, cost, and need for an operation.

Thiourea Dioxide Coupled with Trace Cu(II): An Effective Process for the Reductive Degradation of Diatrizoate.

Diatrizoate, a refractory ionic iodinated X-ray contrast media (ICM) compound, cannot be efficiently degraded in a complex wastewater matrix even by advanced oxidation processes. We report in this research that a homogeneous process, thiourea dioxide (TDO) coupled with trace Cu(II) (several micromoles, ubiquitous in some wastewater), is effective for reductive deiodination and degradation of diatrizoate at neutral pH values. Specifically, the molar ratio of iodide released to TDO consumed reached 2 under ideal experimental conditions. TDO eventually decomposed into urea and sulfite/sulfate. Based on the results of diatrizoate degradation, TDO decomposition, and Cu(I) generation and consumption during the TDO-Cu(II) reaction, we confirmed that Cu(I) is responsible for diatrizoate degradation. However, free Cu(I) alone did not work. It was proposed that Cu(I) complexes are actual reactive species toward diatrizoate. Inorganic anions and effluent organic matter negatively influence diatrizoate degradation, but by increasing the TDO dosage, as well as extending the reaction time, its degradation efficiency can still be guaranteed for real hospital wastewater. This reduction reaction could be potentially useful for in situ deiodination and degradation of diatrizoate in hospital wastewater before discharge into municipal sewage networks.

Diagnosis and treatment of chylous leakage after modified radical mastectomy for breast cancer: a case report.

The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman with chylous leakage following modified radical mastectomy. We describe the patient's diagnostic and treatment process in detail. The patient was diagnosed with grade II (left) breast invasive ductal carcinoma. Post-operatively, the patient's chest wall and axilla were pressurized, and negative pressure drainage was initiated. On the fifth post-operative day, the drainage from the chest wall and axilla increased significantly, and the patient developed chylous leakage on the eighth postoperative day. We injected meglumine diatrizoate (100 mL) and elemene (10 mL) into the patient's axilla, and the chylous leakage gradually resolved 18 days post-operatively. In this report, we focus on managing a case of chylous leakage after modified radical mastectomy for breast cancer. Meglumine diatrizoate combined with elemene is a possible treatment for the management of this rare complication.

Unexpected degradation and deiodination of diatrizoate by the Cu(II)/S(IV) system under anaerobic conditions.

Transition metal catalyzed sulfite auto-oxidation is a promising technology used in water and wastewater treatment for the elimination of contaminants. In the literature, this process has been reported to be efficient only in the presence of oxygen. However, in this study, we unexpectedly found that the degradation of diatrizoate (DTZ) by a system based on the combination of copper ion and sulfite (Cu(II)/S(IV)) reached over 95% under anaerobic conditions, but was considerably retarded under aerobic conditions at pH 7. Furthermore, it was found that Cu(I), generated from the cleavage of the CuSO3 complex, was the main reactive species responsible for the degradation of DTZ by the Cu(II)/S(IV) system under anaerobic conditions. In fact, the absence of oxygen promoted the accumulation of Cu(I). The concomitant release of the iodide ion with the degradation of DTZ indicated that the anaerobic degradation of DTZ by the Cu(II)/S(IV) system mainly proceeded through the deiodination pathway, which was also confirmed by the detection of deiodinated products. The anaerobic degradation of DTZ was favored at higher initial concentrations of Cu(II) or sulfite in this system. Since the CuSO3 complex, the precursor of Cu(I), was formed mainly at pH 7, the highest anaerobic degradation of DTZ was achieved at pH 7. An increase in reaction temperature considerably enhanced the degradation of DTZ by the Cu(II)/S(IV) system with an apparent activation energy of 119.4 kJ/mol. The presence of chloride, bicarbonate and humic acid slightly influenced the anaerobic degradation of DTZ. The experiments with real water samples also demonstrated the effectiveness of the degradation of DTZ by the Cu(II)/S(IV) system under anaerobic conditions.

Darbepoetin alfa reduces cell death due to radiocontrast media in human renal proximal tubular cells.

The hypersialylated erythropoiesis stimulating agent (ESA) darbepoetin alfa was developed for the treatment of anemia, and has also been reported to have other nonerythropoietic effects. This study outlines one such effect against the toxicity of the radiocontrast medium (RCM) sodium diatrizoate (NaD) in human renal proximal tubular (HK-2) cells in vitro. Using a standard cell viability assay, we observed that pre-incubation of HK-2 cells with darbepoetin (at concentrations of 0.25and 1.0 µg/mL) for 2.5 h prior to addition of NaD (75 mg I/mL, for 2 h) reduced the decrease in cell viability due to the RCM, assayed 22 h after removal of the NaD, whilst maintaining the cells incubated with darbepoetin. Western blot analysis showed that darbepoetin reduced the phosphorylation of c-Jun N-terminal kinases (JNK)1/2 over a period of 1 h incubation with NaD, but did not have an obvious effect on several other targets associated with cell death/survival. However, incubation of HK-2 cells with darbepoetin for a further 22 h after prior exposure to NaD (75 mg I/mL, for 2 h) and subsequent immunoblotting showed that darbepoetin: caused recovery of the activity (phosphorylation) of pro-proliferative/survival signalling molecules, such as Akt (Ser473), STAT (signal transducer and activator of transcription)3(Tyr705); decreased activation of the pro-apoptotic transcription factor FOXO3a by increasing its phosphorylation at Thr32; decreased phosphorylation (activation) of p38 Mitogen activated protein kinase; and reduced poly(ADP-ribose)polymerase (PARP)-1 cleavage. In summary, we present here a beneficial nonerythropoietic effect of darbepoetin alfa against radiocontrast-induced toxicity together with modulation of signalling molecules that play a crucial role in determining cell fate.

[Accelerated Degradation of Aqueous Recalcitrant Iodinated Contrasting Media Using a UV/SO32- Advanced Reduction Process].

Based on the formation of free radical-hydrated electrons by the activation of sulfite (SO32-), the UV/SO32- process is an advanced reduction process that can reduce pollutants. This study investigated the degradation kinetics, mechanism, influencing factors, and degradation pathways of sodium diatrizoate (DTZ), an iodinated contrasting media, during the UV/SO32- process. The degradation kinetics of DTZ were well fitted by the pseudo-first-order model, the degradation rate of which was higher than that of UV only and UV/H2 O2. The degradation rate of DTZ during the UV/SO32- process was positively correlated with the initial SO32- concentration. Weakly alkaline and alkaline conditions promoted the degradation of DTZ, while organic matter inhibited degradation during the UV/SO32- process. The degradation mechanism included direct photolysis and free radical attack, whereby free radical attack played a more important role than direct photolysis. Sulfite radicals dominated DTZ degradation efficiency, and hydrated electrons controlled the deiodination efficiency. The degradation pathways of DTZ during the UV/SO32- process included substitution, decarboxylation-hydroxylation, and amide bond cleavage.

Clinical Application of Oral Meglumine Diatrizoate Esophagogram in Screening for Esophageal Fistula During Radiotherapy or Chemoradiotherapy for Esophageal Cancer.

Background: This study aimed to investigate the specificity and sensitivity of oral meglumine diatrizoate esophagogram in screening for esophageal fistula during radiotherapy or chemoradiotherapy for esophageal cancer and determine if early detection and intervention could improve the prognosis of esophageal fistulas. Methods: Esophageal cancer patients undergoing radiotherapy or chemoradiotherapy were included. Weekly oral meglumine diatrizoate esophagograms were performed to screen for esophageal fistulas during radiotherapy. When an esophageal fistula was detected, fibroesophagoscopy and computed tomography (CT) were used for confirmation; once confirmed, radiotherapy was discontinued, and the patient received intervention. The esophagogram results were reviewed weekly to assess the recovery of the esophageal fistula. If the fistula was healed, the patient resumed and completed radiotherapy. Results: A total of 206 patients with cancer of the esophagus undergoing chemotherapy/radiotherapy were included. During radiotherapy, 10 cases of esophageal fistula were detected or suspected based on the oral meglumine diatrizoate esophagography findings, and eight of those cases were confirmed by CT and esophagoscopy. All patients with esophageal fistula received intervention; among them, 62.5% (5/8) recovered after 1 to 2 weeks of treatment and continued radiotherapy to completion. The sensitivity and specificity of oral meglumine diatrizoate esophagography in screening for esophageal fistulas during radiotherapy or chemoradiotherapy were 100 and 98.9%, respectively. The median survival period of patients with esophageal fistulas was 6.4 months. Conclusion: Oral meglumine diatrizoate esophagography has high sensitivity and specificity in screening for esophageal fistulas during radiotherapy or chemoradiotherapy with minimal side effects. Early diagnosis and timely intervention can significantly improve the prognosis and prolong the survival period of patients. Trial Registration: Chictr.org.cn, Identifier: ChiCTR-DDD-17012617. Registered on September 7, 2017. The first participant was enrolled on September 25, 2017. http://www.chictr.org.cn/showproj.aspx?proj=21526.

Electrochemical Processes Coupled to a Biological Treatment for the Removal of Iodinated X-ray Contrast Media Compounds.

Iodinated X-ray contrast media (ICM) compounds are a form of intravenous radiocontrast containing iodine, which are rapidly eliminated via urine or feces. The issue with the accumulation of ICM has received considerable critical attention since they are ubiquitously distributed in municipal wastewater effluents and in the aquatic environment and are not significantly eliminated by most biological sewage treatment processes. Among the methods that have been tested to eliminate ICM, electrochemical methods have significant advantages, since they can selectively cut the carbon-iodine bonds that are suspected to decrease their biodegradability. On the production sites, the recovery of iodine ions due to the carbon-iodine cleavage can be envisaged, which is particularly interesting to reduce the cost of the ICM production process. The coupling of an electrochemical process and a biological treatment can be carried out to mineralize the organic part of the formed by-products, allowing the recovery of the iodide ions. Therefore, the degradation of diatrizoate, a typical ionic ICM compound, by an electrochemical process was the purpose of this study. The electrochemical reduction of diatrizoate was performed using a flow cell with a graphite felt electrode at different potentials. The removal yield of diatrizoate reached ~100% in 2 h and the main product, 3,5-diacetamidobenzoic acid, was quantitatively formed, showing that diatrizoate was almost completely deiodinated. According to the BOD5/COD ratio, the biodegradability of diatrizoate after electrolysis was considerably improved. Cyclic voltammetry analysis of the electroreduced solution showed several oxidation peaks. The electrochemical oxidation of the by-products formed after the first treatment by electroreduction was then performed at three different potentials to study the influence of electrochemical oxidation on biodegradability. Results showed that the degradation yield of the deiodinated by-products increased with the potential and reached 100% at 1.3 V/SCE. Four different biological treatments were implemented during 21 days in stirred flasks with fresh activated sludge. The evolution of the mineralization during the biological treatment highlighted the biorecalcitrance of diatrizoate as previously estimated by the BOD5/COD ratio. Interestingly, the mineralization yield increased from 41 to 60% when electrochemical oxidation at 1.3 V/SCE was implemented after electroreduction.

Oral Gastrografin Facilitates Delineation of Intestinal Tracts in CT-Based Brachytherapy for Uterine Cervical Cancer.

Three-dimensional image-guided brachytherapy (3D-IGBT) using computed tomography (CT) is an essential component of definitive radiation therapy for uterine cervical cancer (UCC). Treatment planning for CT-based 3D-IGBT requires delineating the high-risk clinical target volume (CTVHR) and the organs at risk (OARs), which is difficult when the small intestine is adjacent to those delineation targets. Uncertainty in target delineation threatens the validity of 3D-IGBT treatment plans. To address this issue, we introduce the use of diatrizoate meglumine and diatrizoate sodium (gastrografin), an orally administrable iodine-based radiopaque contrast agent. We present two cases of UCC treated with CT-based 3D-IGBT and describe how intraluminal enhancement of the small intestine by oral gastrografin pretreatment facilitated discrimination between the small intestine and the adjacent CTVHR (case no.1) or the rectosigmoid colon (case no. 2). Oral gastrografin pretreatment is a simple and cost-effective method that allows distinguishing the small intestine from the adjacent delineation target (i.e., CTVHR and the OARs) in CT-based 3D-IGBT for UCC.

Inhibiting PKCß2 protects HK-2 cells against meglumine diatrizoate and AGEs-induced apoptosis and autophagy.

BACKGROUND: Contrast induced diabetic nephropathy (CIN) is an important cause of hospital-acquired acute renal failure. Our aim was to observe the effect of protein kinase C ß2 (PKCß2) knockdown on human proximal tubular epithelial cells (HK-2 cells) against meglumine diatrizoate and advanced glycation end products (AGEs)-induced apoptosis and autophagy. METHODS: Cell viability was detected using cell counting kit-8 (CCK-8) assay in HK-2 cells after disposal with meglumine diatrizoate and AGEs with or without PKCß2 siRNA/inhibitor LY333531. Flow cytometry and western blot were used to test cell apoptosis and the related protein levels in meglumine diatrizoate and AGEs co-treated HK-2 cells with or without PKCß2 siRNA/inhibitor LY333531. Autophagy related proteins were detected using western blot. Immunofluorescence staining was used to examine the autophagy-specific protein light chain 3 (LC3), and autophagosome and autolysosome formation was observed under a transmission electron microscopy. RESULTS: CCK-8 assay results showed that meglumine diatrizoate inhibited AGEs-induced HK-2 cell viability. Furthermore, meglumine diatrizoate promoted cell apoptosis and the expression level of caspase3 in AGEs-induced HK-2. Western blot results showed that meglumine diatrizoate elevated the expression levels of PKCß2 and p-PKCß2 in AGEs-induced HK-2 cells, and up-regulated the expression level of Beclin-1 and the ratio of LC3 II/LC3 I, and down-regulated the expression level of p62 in AGEs-induced HK-2 cells. We found that PKCß2 knockdown alleviated meglumine diatrizoate and AGEs-induced HK-2 cell apoptosis and autophagy. Intriguingly, PKCß2 inhibitor LY333531 reversed 3-methyladenine (3-MA)-induced autophagy inhibition in meglumine diatrizoate and AGEs-induced HK-2 cells. CONCLUSIONS: Our findings reveal that inhibiting PKCß2 protects HK-2 cells against meglumine diatrizoate and AGEs-induced apoptosis and autophagy, which provide a novel therapeutic insight for CIN in diabetic patients.

Comparison of two Meglumine-Diatrizoate based bowel preparations for computed tomography colonography: Comparison of patient symptoms and bowel preparation quality.

INTRODUCTION: To investigate the impact of two Meglumine-Diatrizoate based bowel preparation regimes for computed tomography colonography (CTC) on the patient experience and image quality. METHODS: 100 patients consumed Meglumine-Diatrizoate at 24 h and 12 h prior to the CTC examination. 50 patients followed regime 1 (50:50), 50 ml of Meglumine-Diatrizoate at both 24 and 12 h prior to the examination. 50 patients followed regime 2 (75:25), 75 ml of Meglumine-Diatrizoate at 24 h prior to the examination and 25 ml of Meglumine-Diatrizoate at 12 h prior to the examination. All patients completed a questionnaire to indicate the time of onset of adverse effects and when they were most severe. Five advanced practitioners assessed the image quality in a visual grading study. Visual grading characteristic (VGC) analysis was applied with regime 1 as the reference condition and regime 2 and test condition; test alpha was set at 0.05. RESULTS: Image quality was assessed with successful bowel cleansing as the scoring criteria for the visual grading study. The bowel cleansing as provided by the two Meglumine-Diatrizoate regimes was revealed not to be statistically different, with the area under the VGC curve and 95% confidence intervals 0.487 (0.287, 0.701), p = 0.887. Patients taking the 75:25 bowel preparation experienced a shorter median time to the onset of adverse effects. CONCLUSION: There was no observed difference in Image quality criteria score for the two Meglumine-Diatrizoate based bowel preparation with more predictable adverse effects of Meglumine-Diatrizoate with the 75:25 preparation. IMPLICATIONS FOR PRACTICE: Providing patients with a higher contrast burden 24 h prior to CTC may have a positive impact on the patient experience without compromising image quality.

Efficacy of small-volume gastrografin videofluoroscopic screening for detecting pharyngeal leaks following total laryngectomy.

OBJECTIVES: Pharyngocutaneous fistulae are dreaded complications following total laryngectomy. This paper presents our experience using 3-5 ml gastrografin to detect pharyngeal leaks following total laryngectomy, and compares post-operative videofluoroscopy with clinical follow-up findings in the detection of pharyngocutaneous fistulae. METHODS: A retrospective case-control study was conducted of total laryngectomy patients. The control group (n = 85) was assessed clinically for development of pharyngocutaneous fistulae, while the study group (n = 52) underwent small-volume (3-5 ml) post-operative gastrografin videofluoroscopy. RESULTS: In the control group, 24 of 85 patients (28 per cent) developed pharyngocutaneous fistulae, with 6 requiring surgical correction. In the study group, 24 of 52 patients (46 per cent) had videofluoroscopy-detected pharyngeal leaks; 4 patients (8 per cent) developed pharyngocutaneous fistulae, but all cases resolved following non-surgical management. Patients who underwent videofluoroscopy had a significantly lower risk of developing pharyngocutaneous fistulae; sensitivity and specificity in the detection of pharyngocutaneous fistulae were 58 per cent and 100 per cent respectively. CONCLUSION: Small-volume gastrografin videofluoroscopy reliably identified small pharyngeal leaks. Routine use in total laryngectomy combined with withholding feeds in cases of early leaks may prevent the development of pharyngocutaneous fistulae.

Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay.

OBJECTIVES: Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes. METHODS: The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis. RESULTS: A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1-20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17-0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08-0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99). CONCLUSIONS: Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay. KEY POINTS: • Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders. • At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy. • Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.

Using Meglumine Diatrizoate to improve the accuracy of diagnosis of cracked teeth on Cone-beam CT images.

AIM: To explore in a laboratory setting the feasibility of using Meglumine Diatrizoate (MD) to improve the accuracy of diagnosis of cracked teeth on cone-beam CT (CBCT) images. METHODOLOGY: Twenty-four teeth were cracked artificially by soaking them cyclically in liquid nitrogen and hot water. The number and position of crack lines were evaluated with a dental operating microscope and used as the gold standard. The artificially cracked teeth were then examined using routine scanning (RS) and enhanced scanning (ES) modes, respectively. For the ES mode, MD was painted on the surface of the crack lines, and then, CBCT scanning with the same parameters was performed after 10 min. A radiological graduate student and an experienced radiologist evaluated the presence or absence of crack lines, respectively. The differences between the RS and ES modes were determined and assessed using McNemar's test. Inter-examiner agreement and intra-examiner agreement were assessed using kappa analysis. RESULTS: Fifty-seven crack lines were found in the 24 cracked teeth. In the RS mode, the accuracy of detection of crack lines was 23% (radiological graduate student) and 32% (experienced radiologist), whereas in the ES mode, the accuracy was 61% (radiological graduate student) and 65% (experienced radiologist). The inter-examiner agreement was 0.693 in RS mode and 0.849 in ES mode. The intra-examiner agreement was 0.872 and 0.949 for the radiological graduate student in RS and ES mode respectively; and one for the experienced radiologist both in RS and ES mode. CONCLUSIONS: Compared with routine scanning mode, more crack lines could be detected in enhanced scanning mode using Meglumine Diatrizoate as a contrast medium. MD could be a potential contrast medium to improve the accuracy of detection of crack lines on CBCT images.

Aerobic removal of iodinated contrast medium by nano-sized zero-valent iron: A combination of oxidation and reduction.

The removal performance and mechanisms of diatrizoate (DTA), a typical iodinated contrast medium, from water by nano-sized zero-valent iron (nZVI) under aerobic conditions were investigated in this study. Reactive oxygen species (ROS) and transformation products were detected with electron spin resonance and liquid chromatography electrospray ionization tandem mass spectrometry, respectively. Furthermore, the effects of several operational parameters on DTA removal were illustrated. The results showed that nZVI had a much higher DTA removal ability compared to microscale zero-valent iron (mZVI) in the presence of oxygen. Moreover, the detection of ROS and I- as well as the analysis of intermediate products suggested a combination of oxidation and reduction pathways for DTA removal by nZVI under aerobic conditions. Additionally, a high dosage of nZVI and acidic conditions led to the enhancement of DTA removal, while nZVI aging, as well as chloride and nitrate ions in the solution, had negative effects on the degradation of DTA by nZVI in the presence of oxygen.

Catalytic Degradation of Diatrizoate by Persulfate Activation with Peanut Shell Biochar-Supported Nano Zero-Valent Iron in Aqueous Solution.

An emerging pollutant, diatrizoate (DTZ) has been frequently detected in aqueous solution. Unique reticular peanut shell biochar (BC)-supported nano zero-valent iron (nZVI) composite (nZVI/BC) was successfully synthesized and used as a catalyst for activating persulfate (PS) to promote the removal of DTZ. The structure and morphology of the nanocomposite materials were characterized by scanning electron microscopy, X-ray diffraction, Brunauer-Emmett-Teller measurements, and Fourier transform infrared spectroscopy. The degradation of DTZ (20 mg L-1) was achieved by activating PS with the nanocomposite material. The removal of DTZ reached nearly 100% using 25 mM PS and 0.45 g L-1 nZVI/2BC (mass ratio of nZVI and BC at 1:2) nanocomposite material at pH 3.0 and 25 °C. Influencing factors, such as dosages of nZVI/2BC and PS, temperature, and pH were also investigated. The mechanisms of PS activation with nZVI/2BC were discussed, including BC property, electron transfer, and the identification of free radicals in the reaction. The findings demonstrated that nZVI/BC-PS (peanut shell BC-supported nZVI activating PS) is a promising material for the treatment of refractory organic pollutants.