Administration Of Barium Sulfate Research Articles

Cisplatin-induced gastrointestinal dysmotility is aggravated after chronic administration in the rat. Comparison with pica

Chemotherapy induces nausea/emesis and gastrointestinal dysmotility. Pica, the ingestion of non-nutritive substances, is considered as an indirect marker of nausea/emesis in non-vomiting species, like the rat. Cisplatin is the most emetogenic antitumoral drug. In the rat, acute cisplatin induces pica and gastric dysmotility in a temporally related manner, but the effects of chronic cisplatin are not well known. This study analyzed the effects of chronic cisplatin on pica and on gastrointestinal motor function in the rat, using radiographic, non-invasive methods. Rats received saline or cisplatin (1-3 mg kg(-1), i.p.) once a week for four consecutive weeks. Serial X-rays were taken 0-8 h after administration of barium sulfate, which was given intragastrically immediately after the first and last cisplatin administrations and 1 week after treatment finalization. Pica (i.e., kaolin intake) was measured in isolated rats. Cisplatin delayed gastric emptying and induced acute (during the 24 h following each administration) pica. Upon chronic administration, these effects were exacerbated. In addition, basal kaolin intake was enhanced (facilitated) and gastric distension induced. Delayed gastric emptying and gastric distension were not apparent 1 week after treatment, but basal kaolin intake was still elevated. Whereas gastric dysmotility induced by cisplatin is parallel to the development of acute pica and might underlie facilitation of pica throughout chronic treatment, it does not explain its long-term maintenance. These findings should be taken into account in the search for new antiemetic strategies.

Clinical Investigation of the Portacaval Shunt

In 83 patients with liver cirrhosis, an esophagogram after administration of barium sulfate, an endoscopic examination of the esophagus, and a portogram after percutaneous injection of an opaque material into the spleen were compared for diagnostic value in demonstrating esophageal varices. The diagnosis was established by esophagoscopy in 81, by splenoportography in 61, and by barium esophagogram in 55. Large varices were frequently missed by barium esophagograms as well as by splenoportograms. The mean splenic-pulp pressure was similar when patients with endoscopically demonstrated varices and normal portograms were compared with those whose portogram showed varices. Moreover, there was no apparent relation between portal pressure and variceal size. A time lapse between studies of as long as two months had no apparent influence on the incidence of positive diagnoses obtained.

A method of double-contrast roentgen examination of the small intestine.

Advances in accuracy of diagnosis of lesions in the esophagus, stomach, duodenal bulb, and colon have far surpassed achievements in demonstration of organic lesions of the jejunum and ileum. Though great strides have been made by Mackie (25), Snell and Camp (39), Golden (19), Pendergrass and Comroe (31) and others in the demonstration of functional changes in the bowel, adequate examination of the small intestine and satisfactory delineation and demonstration of its lesions remain a challenge to the radiologist. There are three principal reasons for lack of progress in roentgen diagnosis of small bowel lesions: (1) the time-consuming nature of the examination; (2) difficulty in interpretation of minor changes in the bowel; (3) the extremely low incidence of organic disease in this part of the digestive tract, so that the examiner has little to show, in the way of positive diagnoses, for the effort expended in many examinations. It is the purpose of this paper to review the various methods of examination of the small intestine, furnishing a background for the development of the double-contrast technic used in selected cases in the University Hospitals (Minneapolis). Current Methods of Examination of the Small Bowel and Review of the Literature Oral Administration of Barium: The method most frequently employed in the roentgen examination of the small intestine is the so-called “motor meal,” more recently designated by Golden as “the intestinal study” (19). It is based on the administration of barium sulfate by mouth in varying quantities and concentration. Morse and Cole (29) described a standard technic for the procedure in 1927 and Golden subsequently modified this, administering a mixture of 120 gm. of barium sulfate suspended in 4 or 5 ounces of physiological saline solution. He recommended that films be made at half-hour intervals for a period of five to six hours, with fluoroscopy two or three times during this interval and spot films to demonstrate areas of suspected anatomical variations. Weber and Kirklin (43, 44, 45) use 8 ounces of a mixture of equal parts (by volume) of water and barium sulfate. The patient is examined roentgenoscopically at fifteen-minute intervals, spot films being obtained as indicated. When the stomach is almost empty, a palatable meal is given for the purpose of stimulating peristalsis and accelerating the passage of the head of the meal into the terminal ileum and colon. The usual delay in filling of the terminal ileum is thus avoided. Åkerlund (6) uses a thinner mixture, consisting of three parts of barium sulfate to four parts of water and stresses especially the fluoroscopic examination. In 1937 Pansdorf (30) advocated fractional filling of the small intestine by administering the barium mixture in four 1-ounce doses at fifteen-minute intervals. Hodges (23), aware of the time-consuming nature of small bowel examination, adopts a practical approach for screening of patients.

Malignant Tumors of the Small Intestine

Hough malignant tumors occur much more uncommonly in the small intestine than in other parts of the gastrointestinal tract, they are no longer considered so rare as in the past. As a result of renewed interest in the study of the small bowel during the past decade, they are being discovered preoperatively with increasing frequency. Roentgen examination is of prime importance in their diagnosis, and generally speaking no other method approaches it in accuracy of localization and differentiation. Tumors of the duodenum and upper jejunum are frequently discovered during routine gastric examination, but those occurring below that level usually require a special small bowel study. Roentgen examination of the small intestine is a time-consuming procedure, demanding the utmost attention to detail. The observer must constantly bear in mind the possibility of a tumor and must be alert for the roentgen signs which indicate its presence. The procedure varies somewhat with the individual patient, but in general is as follows. On the morning of the examination, breakfast is omitted and the patient is also requested to abstain from fluids if possible. Four ounces of barium sulfate suspended in 8 ounces of water are administered, and a fluoroscopic study of the esophagus and stomach is made, as much barium as possible being forced through into the duodenum so that a complete duodenal examination can also be accomplished at this time. Fluoroscopy is then carried out at thirty-minute intervals, and films are obtained, until all the barium has left the small bowel, except when there is evidence of obstruction, in which event the time between observations and the total examination time are determined by the motility as observed at the interval examinations. The fluoroscopic study is of the greatest value in demonstrating all of the intestinal coils and calling attention to any suspicious areas. Films are made routinely in the prone position. Golden (4) states that he has never encountered any damage from the administration of barium sulfate by mouth in the presence of lesions of the small intestine. The small bowel contents remain fluid and can be removed by suction if necessary. A preliminary barium enema to rule out lesions of the colon is advisable in all cases with a history suggesting possible obstruction. General Considerations Pathology: Ewing (2) mentions three forms of small intestinal carcinoma: (i) a part of a local or generalized intestinal polyposis, (ii) localized adenocarcinoma with carcinomatous variations in structure, and (iii) carcinoid tumor. These tumors tend to produce various changes in the intestinal lumen depending upon their origin and mode of growth. Two principal types occur: (a) the constricting type, which consists essentially of a small, localized, infiltrating growth producing early mechanical obstruction by narrowing the intestinal lumen