An Unusual Presentation of Intussusception.

This is the case of a 9-month-old female infant who presented to the emergency department with a history of several episodes of nonbilious and nonbloody emesis. The patient was found to be afebrile with normal vital signs and an otherwise normal physical examination. Initial plain film radiography was concern for possible obstruction. Imaging studies with ultrasonogram demonstrated intussusception. This was an unusual case of intussusception because children are typically more ill-appearing with vomiting, diarrhea, fevers, lethargy, and blood in stool. Management options included surgery, pneumatic enema reduction, and barium enema reduction. Pneumatic enema reduction was performed. This procedure has been shown to have superior outcomes in infants with intussusception. Advanced practice providers need to provide a detailed history, complete a thorough physical examination, order the appropriate diagnostics, and be vigilant of the clinical manifestation of intussusception.

Zinc oxide eugenol and Endoflas pulpectomy in primary molars: 24-month clinical and radiographic evaluation.

CONTEXT: Despite modern advancement in material and technical aspect, management of infected primary molars is of prime concern in pediatric endodontics. An effective root canal material plays the major role in achieving the fluid impervious seal by defending against variant microflora and maintaining the tooth in function for longer duration. AIMS: This study aims to evaluate and compare the success of endoflas as root canal filling material in infected primary molars with zinc oxide eugenol (ZOE). MATERIALS AND METHODS: Primary molars with necrotic pulp in healthy, cooperative children were selected. Ethical clearance and informed consent was obtained. Standardized pulpectomy procedure was done and root canals were filled with either ZOE or endoflas. Further follow-up with clinical and radiographic evaluation was carried at 0, 3, 6, 12, and 24 months. The findings obtained were statistically analyzed using Chi-square test. RESULTS: Endoflas showed acceptable results as root canal filling material in primary molars even at 2-year follow-up, though overfilling of root canals led to low success rate compared to teeth with combined optimal and under fillings. There was no significant difference between the two materials (P > 0.05). CONCLUSIONS: Endoflas could be a potential alternative to ZOE for preserving infected primary molars.

Caracterización fluoroscópica en rata de la dismotilidad colónica asociada a tratamiento con morfina / Fluoroscopic characterization of colonic dysmotility in rat associated with morphine treatment

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Emergency surgery due to diaphragmatic hernia: case series and review.

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a congenital abnormality, rare in adults with a frequency of 0.17-6%. Diaphragmatic rupture is an infrequent consequence of trauma, occurring in about 5% of severe closed thoraco-abdominal injuries. Clinical presentation ranges from asymptomatic cases to serious respiratory or gastrointestinal symptoms. Diagnosis depends on anamnesis, clinical signs and radiological investigations. METHODS: From May 2013 to June 2016, six cases (four females, two males; mean age 58 years) of diaphragmatic hernia were admitted to our Academic Department of General Surgery with respiratory and abdominal symptoms. Chest X-ray, barium studies and CT scan were performed. RESULTS: Case 1 presented left diaphragmatic hernia containing transverse and descending colon. Case 2 showed left CDH which allowed passage of stomach, spleen and colon. Case 3 and 6 showed stomach in left hemithorax. Case 4 presented left diaphragmatic hernia which allowed passage of the spleen, left lobe of liver and transverse colon. Case 5 had stomach and spleen herniated into the chest. Emergency surgery was always performed. The hernia contents were reduced and defect was closed with primary repair or mesh. In all cases, post-operative courses were uneventful. CONCLUSION: Overlapping abdominal and respiratory symptoms lead to diagnosis of diaphragmatic hernia, in patients with or without an history of trauma. Chest X-ray, CT scan and barium studies should be done to evaluate diaphragmatic defect, size, location and contents. Emergency surgical approach is mandatory reducing morbidity and mortality.

A comparative assessment of different techniques for obturation with endoflas in primary molars: An In vivo Study.

PURPOSE: The rationale of this in vivo study was to evaluate and compare different obturation techniques for the intracanal conveyance of Endoflas in the primary molars using conventional radiography. MATERIALS AND METHODS: Thirty-eight children (4-9 years old) with total of 45 pulpally infected primary mandibular molars indicated for pulpectomy were categorized into three groups (i) endodontic pluggers, (ii) lentulospirals, and (iii) NaviTips, respectively, for obturation with Endoflas. The level of obturation and the presence of voids were evaluated radiographically, and the obtained data were statistically analyzed using Chi-square test. RESULTS: The results showed no significant difference between the three techniques to deliver Endoflas. Motor-driven lentulospirals showed better results (64.4% optimal fillings) compared to the pluggers (62.2%), but NaviTips showed poor results (48.9%) for the level of obturation (P > 0.05). Voids were observed in all the techniques used. Pluggers and lentulospirals showed similar results with greater void-free canals, whereas NaviTip system showed more voids which was statistically not significant (P > 0.05). CONCLUSION: Motor-driven lentulospiral and pluggers were almost equally efficient to fill Endoflas to an optimal level, devoid of voids, and both were considered better compared to NaviTip system.

High-dose barium impaction therapy for the recurrence of colonic diverticular bleeding: a randomized controlled trial.

OBJECTIVE: We compared the clinical efficacy of barium therapy and conservative therapy in preventing recurrence in patients with diverticular bleeding. BACKGROUND: Previous case reports have indicated that barium impaction therapy provides initial hemostasis for diverticular bleeding and prevention against rebleeding. METHODS: After spontaneous cessation of bleeding, patients were randomly assigned to conservative treatment (n = 27) or high-dose barium impaction therapy (n = 27). Patients were followed up for 1 year after enrollment of the last patient. The main outcome measure was rebleeding. RESULTS: Median follow-up period was 584.5 days. The probability of rebleeding at 30-day, 180-day, 1-year, and 2-year follow-up in all patients was 3.7%, 14.8%, 28.4%, and 32.7%, respectively. By group, probability at 1 year was 42.5% in the conservative group and 14.8% in the barium group (log-rank test, P = 0.04). After adjustment for a history of hypertension, the hazard ratio of rebleeding in the barium group was 0.34 (95% confidence interval, 0.12-0.98). No complications or laboratory abnormalities due to barium therapy were observed. Compared with the conservative group, the barium group had significantly (P < 0.05) fewer hospitalizations per patient (1.7 vs 1.2), units of blood transfused (1.9 vs 0.7), colonoscopies (1.4 times vs 1.1 times), and hospital stay days (15 days vs 11 days) during the follow-up period. No patients died and none required angiographic or surgical procedures in either group. CONCLUSIONS: High-dose barium impaction therapy was effective in the long-term prevention of recurrent bleeding, and reduced the frequency of rehospitalization and need for blood transfusion and colonoscopic examination. ClinicalTrials.gov Identifier, UMIN 000002832.

A therapeutic barium enema is a practical option to control bleeding from the appendix.

BACKGROUND: Acute lower gastrointestinal hemorrhage originating from the appendix is rare and often intractable, because it is almost impossible to approach the bleeding point by endoscopy. We herein describe the first case of bleeding from the appendix, which was successively controlled by a therapeutic barium enema administered into the appendix. CASE PRESENTATION: A 71-year-old male visited our hospital because of melena. He has been receiving an anti-coagulation drug, ticlopidine hydrochloride, for 10 years. By an emergency colonoscopy, a hemorrhage was detected in the appendix, and the lesion responsible for the bleeding was regarded to exist in the appendix. Two hundred milliliters of 50 W/V% barium was sprayed into the orifice of the appendix using a spraying tube. The bleeding could thus be immediately stopped, and a radiological examination revealed the accumulation of barium at the cecum and the orifice of the appendix. The barium accumulation disappeared by the next day, and no obvious anal bleeding was observed. Two weeks after stopping the bleeding from the appendix, an appendectomy was performed to prevent any further refractory hemorrhaging. The patient has had no complaints of any abdominal symptoms or anal bleeding for 10 months. CONCLUSIONS: A therapeutic barium enema is a useful procedure to control bleeding from the appendix and to avoid emergency surgery, such as partial cecectomy and hemicolectomy.

Clinical efficacy of various root canal obturating methods in primary teeth: a comparative study.

AIM: The purpose of this in vivo study was to evaluate and compare the efficacy of different obturating methods used in primary teeth, when obturated using a combination of zinc oxide and iodoform paste (Endoflas F.S.). MATERIALS AND METHODS: A group of 29 patients aged 3-9 years and a total of 64 teeth were selected. These 64 teeth (32 anterior teeth=32 canals, and 32 posterior teeth=80 canals) were randomly divided into 4 groups. Teeth were obturated with Lentulo spiral, pressure syringe, bi-directional spiral and Pastinject. Post-operative evaluation was done for: quality of canal obturation, (underfilled, optimally filled, overfilled) and presence of voids. RESULTS: Pastinject exhibited the highest number of optimally filled canals, while the highest number of underfilled canals were observed with bi-directional spiral, and the highest number of overfilled canals were observed with pressure syringe. A minimum number of voids was present in canals filled with the Pastinject technique and pressure syringe. CONCLUSION: These results suggest that Pastinject was the most effective technique for obturation of primary teeth.

Intussusception in children: experience with 105 patients in a department of paediatric surgery, Turkey.

AIM: The aim of this study was to present our experience in patients with intussusception (IN). MATERIALS AND METHODS: One hundred and five cases of IN treated between 1991 and 2007 were analysed. Age, gender, symptoms, signs, diagnostic and treatment methods, types of IN including leading point, and postoperative complications were evaluated. RESULTS: The mean age of the patients was 2.5 years (range 1 month - 15 years). Fifty-nine per cent (62/105) were under 1 year of age, and of these 28% were receiving therapy for upper respiratory tract infection. The most common symptom was colicky abdominal pain. Rectal bleeding was present in all patients under 2 years of age. In 23 children (21.9%) leading points were detected. Thirty per cent of the patients were older than 4 years, and 76.6% of these had leading points. Ultrasonography demonstrated the invaginated segment in 93 patients. Hydrostatic reduction was attempted in 71.4% (75) of the patients and was successful in 48% (36), 70% of whom were under 1 year of age. Of the patients with unsuccessful hydrostatic reduction, 11 required intestinal resection and primary anastomosis and 35 manual reduction. Twenty-four patients were diagnosed by means of ultrasonography and were operated on immediately. Ten of these patients had signs of peritonitis on admission and were treated by resection-primary anastomosis. CONCLUSION: In patients with IN under 2 years of age, hydrostatic or pneumatic reduction may be successful. Considering the high incidence of leading points in older children, one should not persist with reduction but should rather design a treatment plan accordingly, i.e. laparotomy with manual reduction or resection.

Apical limit of root canal filling and its relationship with success on endodontic treatment of a mandibular molar: 11-year follow-up.

OBJECTIVE: This article discusses the relationship between apical limit of root canal filling and success on endodontic treatment of a mandibular molar. STUDY DESIGN: A mandibular right first molar with vital pulp was endodontically treated, and 3 years later periapical lesions on mesial and distal roots were detected. The canals were retreated and obturated to the same levels as in the previous treatment. RESULTS: An 8-year radiographic follow-up showed repair of the periapical lesions on both roots. CONCLUSIONS: Results suggest that the apical limit of obturation seems to have no influence in the repair of periapical tissues in mandibular molars.

Clinical and radiographic evaluation of pulpectomies using three root canal filling materials: an in-vivo study.

Various root canal filling materials are used to preserve a pulpally involved carious primary tooth. But there is no single material so far available to fulfill all the requirements of an ideal root canal filling material for a primary tooth. Hence this study was undertaken to evaluate clinically and radiographically the efficacy of three obturating materials - Calcium hydroxide with Iodoform (METAPEX), Zinc Oxide Eugenol with Iodoform (RC FILL) and Zinc Oxide Eugenol and Calcium hydroxide with Iodoform (ENDOFLAS) for a period of 9 months. Results show ENDOFLAS gave an overall success rate of 95.1%, METAPEX - 90.5% and RC FILL - 84.7%. In our study, we conclude that ENDOFLAS, a mixture of Zinc Oxide Eugenol and Calcium hydroxide with Iodoform fulfills most of the required properties of an ideal root canal filling for primary teeth.

Internal barium shielding to minimize fetal irradiation in spiral chest CT: a phantom simulation experiment.

PURPOSE: To use a phantom to prospectively examine the attenuating effect of barium sulfate as an internal shield to protect the fetus. MATERIALS AND METHODS: In an adult-size phantom, 1- and 2-cm-thick acrylic slabs containing 315 or 630 mL of water, 2% or 40% barium sulfate suspension, and a 1-mm lead sheet were placed under the diaphragm. In 17 experiments, fetal dose was measured by using thermoluminescent dosimeters that were placed immediately under (near field) and 10 cm below (far field) the water slab (eight experiments), barium sulfate slab (eight experiments), and lead sheet (one experiment). In a pulmonary embolism protocol, the phantom was scanned with single-detector spiral computed tomography (CT) at 130 kVp and 230 mAs. RESULTS: The control radiation dose was 3.60 mSv+/-0.54 (standard deviation) with the water slab at near field, where the uterus dome is at near term, and 0.507 mSv+/-0.07 with the water slab at far field, the uterus position during early gestation. Scattered radiation was attenuated 13% and 21% with 2% barium sulfate and 87% and 96% with 40% barium sulfate, as calculated in the near and far fields, respectively, and 99% with the 1-mm lead sheet. The extrapolated attenuations for 5%-40% barium sulfate suspensions indicated that beyond a 30% suspension, attenuation increased further only slightly. CONCLUSION: Study results in the phantom experiment suggest that fetal irradiation during maternal chest CT can be reduced substantially with barium shielding.

Barium sulphate with a negative zeta potential accelerates skin permeability barrier recovery and prevents epidermal hyperplasia induced by barrier disruption.

BACKGROUND: Barium sulphate, a stable inorganic material, has been used in contrast media and cosmetic products because of its stability. As a negative external electric potential accelerates the skin barrier repair after barrier disruption, we hypothesized that topical application of barium sulphate may affect the skin barrier recovery rate depending on its zeta potential. OBJECTIVES: To investigate whether barium sulphate particles in aqueous solution have different zeta potentials depending on their surface structure, and to investigate the possible relation between zeta potential and skin barrier recovery rate. METHODS: Mice were subjected to tape stripping to disrupt barrier function, or were treated with acetone and kept in a dry environment to induce epidermal hyperplasia. They were then treated with different forms of barium sulphate, and barrier recovery was monitored by measurements of transepidermal water loss. RESULTS: There was a significant correlation between the barrier recovery rate and zeta potential of barium sulphate applied topically. Barium sulphate with a negative zeta potential significantly accelerated barrier recovery, but barium sulphate with a positive zeta potential did not accelerate or even delayed barrier repair. Barium sulphate with a negative zeta potential had an X-ray diffraction pattern different from that with a positive potential. The distribution of calcium in the epidermis was also influenced by the polarity of zeta potential. CONCLUSIONS: These findings suggest a new pharmacological approach towards altering barrier function or epidermal hyperplasia with inorganic particles in healthy and diseased skin.

Radiologic diagnosis of benign esophageal strictures: a pattern approach.

Benign esophageal strictures are a leading cause of dysphagia. Therefore, radiologists have an important role in detecting esophageal strictures and determining their cause. The most common cause of strictures in the distal esophagus is gastroesophageal reflux disease. Reflux-induced ("peptic") strictures may be associated with sacculations, fixed transverse folds, or esophageal intramural pseudodiverticula. In addition, scleroderma, nasogastric intubation, Zollinger-Ellison syndrome, and alkaline reflux esophagitis may be associated with stricture formation in the distal esophagus. Upper and midesophageal strictures may be caused by Barrett esophagus, mediastinal irradiation, ingestion of drugs or caustic substances, congenital esophageal stenosis, skin diseases, or esophageal intramural pseudodiverticulosis. Other unusual causes of esophageal stricture formation include Crohn disease, Candida esophagitis, graft-versus-host disease, eosinophilic esophagitis, Behçet disease, endoscopic sclerotherapy for esophageal varices, and glutaraldehyde contamination at endoscopy. Esophageal strictures are best evaluated with biphasic esophagography that includes both single- and double-contrast spot images. When esophageal strictures are detected at barium examination, the underlying cause can often be determined with a pattern approach that takes into account the clinical history, the appearance and location of the strictures, and the presence of other associated radiographic findings.

[Reduction of acute intestinal intussusception: when and how?]. / Invagination intestinale aiguë: la désinvagination, quand et comment?

After sonographic diagnosis, non-surgical therapy for intussusception in children uses pneumatic or hydrostatic (barium or water soluble) reduction. The purpose of this paper, in the light of our experience, is to answer the questions raised by general radiologists in emergency activity about the technique, indications, sedation and risks.

The radiological management of oesophageal food bolus obstruction using a gas-forming agent and barium.

Removal of an impacted food bolus in the lower oesophagus at rigid oesophagoscopy is challenging and carries a significant risk of perforation. We present two cases which were successfully disimpacted radiologically, in order to raise awareness among otolaryngologists of this therapeutic option.

Gastric volvulus and gastroduodeno-jejunal intussusception (an unusual cause of acute abdomen).

An elderly man who presented with colicky abdominal pain had gastric volvulus which was reduced after barium meaL More than a year later the symptoms recurred and at laparotomy a gastroduodenojejunal intussusception was found and its apex was formed by a polypoidal gastric tumour (leiomyoma). The patient did very well without any recurrence after the resection of the tumour.