Lavage Tube Research Articles

Technique for guttural pouch bead removal using a novel three-dimensional (3D)-printed instrument.

The aim of the present study was to determine if a three-dimensional (3D)-printed instrument technique would improve lavage removal of plastic beads (guttural pouch [GP] chondroid mimics) through a dorsal pharyngeal recess (DPR) fenestration. We hypothesized that using a 3D-printed instrument placed through the DPR fenestration would remove more beads, reduce lavage time and incur less soft tissue damage than using a lavage tube control or instrument placement through the salpingopharyngeal ostium (SPO). Experimental cadaveric study. A total of 30 cadaveric equine heads. DPR fenestration was performed using transendoscopic laser and 50 plastic 12 mm beads were placed into one GP of horse heads. Four removal procedures using a 3D-printed instrument or lavage tube control placed through the DPR fenestration or the SPO were compared. Number of beads removed and number of 2-min lavage cycles to recover ≥96% of beads or three consecutive no-yield cycles were recorded. Endoscopic soft tissue damage was graded. Data were compared by generalized estimating equations (GEE) model and Fisher's exact test (p < .05). More beads (median 48 beads; range 0-49) were removed faster (median 24 beads/cycle; range 12-50) using the 3D-printed instrument compared to control (median 6 beads; range 0-29, 0.66 beads/cycle, range 0-49). There was no difference between total beads removed or removal speed between placement sites. There was no difference in soft tissue damage between procedures. Our 3D-printed instrument enabled efficient plastic bead removal. DPR fenestration and use of our 3D-printed instrument represents an alternative to current chondroid removal techniques, warranting investigation in clinical cases.

Surfactant Protein A Can Affect Macrophage Phagocytosis: An Important Pathogenic Mechanism of Otitis Media with Effusion.

Otitis media with effusion (OME), also known as secretory otitis media, is a common condition in otorhinolaryngology. The main manifestations include middle ear effusion and conductive hearing loss. Recently, increasing attention has been paid to the etiology of OME, wherein immune dysfunction is one important pathogenic mechanism. However, it is unknown whether changes in surfactant protein A (SPA) secretion affect the phagocytic activity of macrophages in the Eustachian tube, thereby altering pathogen clearance, during the pathogenesis of OME. In our study, an OME animal model was established and evaluated. Differences in SPA levels in Eustachian tube lavage fluid between the experimental and control groups were analyzed. Cell-based experiments revealed that SPA decreased the expression of CD64 and SYK and inhibited phagocytosis by RAW264.7 cells. By using flow cytometry and immunofluorescence, we confirmed that macrophage phagocytosis decreased with increasing SPA levels. Finally, we concluded that SPA affects macrophage function and plays a role in the occurrence and development of OME.

Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage.

Upper endoscopy is the definitive treatment for upper gastrointestinal haemorrhage (UGIH). However, up to 13% of people who undergo upper endoscopy will have incomplete visualisation of the gastric mucosa at presentation. Erythromycin acts as a motilin receptor agonist in the upper gastrointestinal (GI) tract and increases gastric emptying, which may lead to better quality of visualisation and improved treatment effectiveness. However, there is uncertainty about the benefits and harms of erythromycin in UGIH.To evaluate the benefits and harms of erythromycin before endoscopy in adults with acute upper gastrointestinal haemorrhage, compared with any other treatment or no treatment/placebo.We used standard, extensive Cochrane search methods. The latest search date was 15 October 2021.We included randomised controlled trials (RCTs) that investigated erythromycin before endoscopy compared to any other treatment or no treatment/placebo before endoscopy in adults with acute UGIH.We used standard Cochrane methods. Our primary outcomes were 1. UGIH-related mortality and 2. serious adverse events. Our secondary outcomes were 1. all-cause mortality, 2. visualisation of gastric mucosa, 3. non-serious adverse events, 4. rebleeding, 5. blood transfusion, and 5. rescue invasive intervention. We used GRADE criteria to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included 11 RCTs with 878 participants. The mean age ranged from 53.13 years to 64.5 years, and most participants were men (72.3%). One RCT included only non-variceal haemorrhage, one included only variceal haemorrhage, and eight included both aetiologies. We defined short-term outcomes as those occurring within one week of initial endoscopy. Erythromycin versus placebo Three RCTs (255 participants) compared erythromycin with placebo. There were no UGIH-related deaths. The evidence is very uncertain about the short-term effects of erythromycin compared with placebo on serious adverse events (risk difference (RD) -0.01, 95% confidence interval (CI) -0.04 to 0.02; 3 studies, 255 participants; very low certainty), all-cause mortality (RD 0.00, 95% CI -0.03 to 0.03; 3 studies, 255 participants; very low certainty), non-serious adverse events (RD 0.01, 95% CI -0.03 to 0.05; 3 studies, 255 participants; very low certainty), and rebleeding (risk ratio (RR) 0.63, 95% CI 0.13 to 2.90; 2 studies, 195 participants; very low certainty). Erythromycin may improve gastric mucosa visualisation (mean difference (MD) 3.63 points on 16-point ordinal scale, 95% CI 2.20 to 5.05; higher MD means better visualisation; 2 studies, 195 participants; low certainty). Erythromycin may also result in a slight reduction in blood transfusion (MD -0.44 standard units of blood, 95% CI -0.86 to -0.01; 3 studies, 255 participants; low certainty). Erythromycin plus nasogastric tube lavage versus no intervention/placebo plus nasogastric tube lavage Six RCTs (408 participants) compared erythromycin plus nasogastric tube lavage with no intervention/placebo plus nasogastric tube lavage. There were no UGIH-related deaths and no serious adverse events. The evidence is very uncertain about the short-term effects of erythromycin plus nasogastric tube lavage compared with no intervention/placebo plus nasogastric tube lavage on all-cause mortality (RD -0.02, 95% CI -0.08 to 0.03; 3 studies, 238 participants; very low certainty), visualisation of the gastric mucosa (standardised mean difference (SMD) 0.48 points on 10-point ordinal scale, 95% CI 0.10 to 0.85; higher SMD means better visualisation; 3 studies, 170 participants; very low certainty), non-serious adverse events (RD 0.00, 95% CI -0.05 to 0.05; 6 studies, 408 participants; very low certainty), rebleeding (RR 1.13, 95% CI 0.63 to 2.02; 1 study, 169 participants; very low certainty), and blood transfusion (MD -1.85 standard units of blood, 95% CI -4.34 to 0.64; 3 studies, 180 participants; very low certainty). Erythromycin versus nasogastric tube lavage Four RCTs (287 participants) compared erythromycin with nasogastric tube lavage. There were no UGIH-related deaths and no serious adverse events. The evidence is very uncertain about the short-term effects of erythromycin compared with nasogastric tube lavage on all-cause mortality (RD 0.02, 95% CI -0.05 to 0.08; 3 studies, 213 participants; very low certainty), visualisation of the gastric mucosa (RR 1.19, 95% CI 0.79 to 1.79; 2 studies, 198 participants; very low certainty), non-serious adverse events (RD -0.10, 95% CI -0.34 to 0.13; 3 studies, 213 participants; very low certainty), rebleeding (RR 0.77, 95% CI 0.40 to 1.49; 1 study, 169 participants; very low certainty), and blood transfusion (median 2 standard units of blood, interquartile range 0 to 4 in both groups; 1 study, 169 participants; very low certainty). Erythromycin plus nasogastric tube lavage versus metoclopramide plus nasogastric tube lavage One RCT (30 participants) compared erythromycin plus nasogastric tube lavage with metoclopramide plus nasogastric tube lavage. The evidence is very uncertain about the effects of erythromycin plus nasogastric tube lavage on all the reported outcomes (serious adverse events, visualisation of gastric mucosa, non-serious adverse events, and blood transfusion).We are unsure if erythromycin before endoscopy in people with UGIH has any clinical benefits or harms. However, erythromycin compared with placebo may improve gastric mucosa visualisation and result in a slight reduction in blood transfusion.

A design of anti-reflux gastric lavage tube with built-in airbag

At present, the gastric lavage tube used in clinical practice only has a few liquid orifices at the distal end of the lumen, and its structure has defects such as residual liquid reflux and aspiration in clinical practice. This article aims to solve the shortcomings of the existing technology and design a gastric lavage tube with built-in airbag with reasonable structure and high safety, in order to optimize the design and apply it to the actual clinical work, and further reduce the complications caused by the gastric lavage tube.

The proteome of human Fallopian tube lavages during the phase of embryo transit reveals candidate proteins for the optimization of preimplantation embryo culture.

Are there phase-specific changes in the early secretory (ES) phase human tubal lavage proteome that can inform and potentially optimize IVF culture media? The human tubal lavage proteome during the ES phase relative to the menstrual phase reveals substantial differential protein abundance in pathways such as glycolysis, redox homeostasis and activation of 14-3-3 zeta-mediated signaling. The Fallopian tube is uniquely suited to the development of the preimplantation embryo as it transits the tube during the ES phase of the menstrual cycle. Euploid cleavage-stage embryo arrest may reflect incomplete recapitulation of in-vivo conditions by current media formulations. Proteome-wide analysis of distal tubal lavage specimens collected from 26 healthy women undergoing open microtubal anastomosis surgery from January 2013 to January 2018 was performed. Specimens were grouped by menstrual cycle phase in order to analyze phase-specific differences in protein abundance. For the murine embryo assay, single-cell embryos (N = 482) were collected from superovulated wild type C57BL/6 female mice and cultured in microdrops over 5 days for the assessment of blastocyst development. Human tubal lavage specimens were processed for label-free mass spectrometry. Reported menstrual cycle day was confirmed by measuring serum hormones. Key protein targets in the ES phase were validated via immunoblot. The ES phase-specific increase in 14-3-3 zeta protein was confirmed via ELISA of conditioned media obtained from primary human Fallopian tube epithelial cell culture. A murine embryo assay was performed to investigate the impact of graduated concentrations of 14-3-3 zeta on the blastocyst development rate. Comparison of the ES and menstrual phase human tubal lavage proteomes revealed 74 differentially expressed proteins with enrichment of pathways and biological processes involved in the regulation of carbohydrate metabolism, oxidative stress and cell survival. The adapter-regulator protein 14-3-3 zeta was among the most significantly increased in the ES phase. Supplementation of embryo culture media with 14-3-3 zeta at concentrations tested did not significantly improve the murine blastocyst development. Although select associations were recapitulated in the conditioned media from sex steroid exposed primary human tubal epithelial cells, cell culture represents an in-vitro approximation. Changes to embryo culture media, such as protein supplementation, must undergo rigorous preclinical safety testing prior to adoption for human use. This study represents the first description of the human Fallopian tube lavage proteome across the menstrual cycle, revealing a unique proteomic signature during the ES phase. Although supplementation of culture media with 14-3-3 zeta at appropriate concentrations showed no significant impact on the murine blastocyst development rate, other biologically plausible candidate proteins for individual or high throughput testing strategies are identified. This work was funded in part by an Army Medical Department Advanced Medical Technology Initiative grant from the United States Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center. There are no competing interests. N/A.

S2325 Splenic Trauma After Endoscopic Retrograde Cholangiopancreatography: Can It Really Happen?

INTRODUCTION: Splenic injury following endoscopy occurs very rarely but can be potentially fatal. There have been only twenty cases reported of ERCP-related splenic trauma since 1989. We present a rare case of post-ERCP splenic laceration and decapsulation. CASE DESCRIPTION/METHODS: 86-year-old man presented with a 4-day history of worsening painless jaundice. Medical history included advanced dementia, coronary artery disease, and hypertension. CT scan of the abdomen/pelvis with IV contrast showed intrahepatic biliary duct dilation (left greater than right) with concern for hilar cholangiocarcinoma. On presentation, the patient was afebrile and hemodynamically stable. Physical examination showed scleral icterus and jaundice. Labs: bilirubin 25.2 mg/dL, ALP 1,361 U/L, ALT 244 U/L, and AST 475 U/L. An ERCP was completed. A J-shaped stomach was observed but the duodenum was intubated without difficulty. Cholangiogram showed complete obstruction at the level of the hilum consistent with Bismuth-Corlette IIIb. Biliary sphincterotomy and balloon dilation, to 6 mm, were performed at the level of the hilum and left main. Bilateral plastic stents were successfully placed in the left and right main duct. Six hours post-procedure, the patient became lethargic and unresponsive. Vital signs: Systolic BP 60 mmHg, HR 40. Abdomen had decreased bowel sounds and was diffusely tender; NG tube lavage showed bile; stool was brown. Labs: Hgb 6.3 g/dL (baseline 10.3 g/L), lactic acid 5.9 mmol/L, WBC 11.4 K/µL. CT scan of the abdomen/pelvis showed active hemorrhage along the posteromedial aspect of the spleen with adjacent blood (Figure 1). Due to many comorbidities, he was a high risk for splenectomy. He underwent embolization of the proximal splenic artery (Figures 2 and 3). An avascular portion of the spleen consistent with splenic laceration and decapsulation was noted during angiography. Despite successful embolization, the patient developed multi-system organ failure and was placed on hospice care. DISCUSSION: Despite an uneventful ERCP, the patient suffered a splenic laceration and decapsulation. Possible mechanisms of injury include excess traction on the gastrosplenic ligament, direct trauma, prolonged procedure time, long scope position, and adhesions. A high index of suspicion for splenic injury is required in any patient who has severe abdominal pain, anemia, or hemorrhagic shock after ERCP.Figure 1.: Cross-sectional view of abdominal CT abdomen/pelvis showing splenic hemorrhage with hemoperitoneum.Figure 2.: Angiogram of splenic artery.Figure 3.: Status post proximal splenic artery embolization.

Protective Role of Lycopene Extracted from Tomato (Tomato pomace) against Gamma Irradiation or Carbon Tetrachloride-Induced Brain and Liver Toxicity in Male Albino Rats

Background: Based on the effect of substance possessing antioxidant effect previously reported, it was hypothesized that lycopene extracted from tomato (Tomato pomace), a substance possessing antioxidant activity, might be able to protect against oxidative stress induced by either carbon tetrachloride or gamma radiation. Materials and Methods: A total of 72 experimental male albino rats were randomly divided into equal six groups of twelve rats each. Group 1: served as the control group. Group 2: rats were administrated with (5 gm) tomato extract/kg body weight by gastric lavage tube for 15 days. Group 3: rats were exposed to single dose (10 Gy) whole body gamma irradiation. Group 4: rats were administered with CCl4 only in groundnut oil (1:1) at a dose of 3 ml/kg body weight by single intraperitoneal administration. Group 5: rats were treated with lycopene extract for 15 days before exposure to single dose (10 Gy) whole body gamma irradiation. Group 6: rats were treated with lycopene extract for 15 days before administered with CCl4 for 15 days. Results: showed highly significant increase in activities of alanine transferase (ALT), aspartate amino transferase (AST) and alkaline phosphatase (ALP) in serum, 24 hours after CCl4 administration or radiation exposure. Highly significant decrease in activities of superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) content in the brain tissues. Meanwhile, highly significant increase in MDA content in the brain tissues. Supplementation with lycopene before CCl4 intraperitoneal administration or radiation exposure, exerted marked amelioration of CCl4 and ionized radiation induced disturbances in all the investigated parameters. Histopathological evaluation of the tissues also demonstrated a significant decrease in cellular degeneration and infiltration parameters after lycopene administration. Therefore, lycopene could have a beneficial role in modulating oxidative stress by improving the natural antioxidant mechanism. Conclusion: Administration of lycopene by using suitable stomach tube pre-CCl4 intraperitoneal administration or gamma irradiated has significantly ameliorated the disturbances induced in all the investigated parameters.

Protective Role of Lycopene Extracted from Tomato (Tomato pomace) against Gamma Irradiation or Carbon Tetrachloride-Induced Brain and Liver Toxicity in Male Albino Rats

Background: Based on the effect of substance possessing antioxidant effect previously reported, it was hypothesized that lycopene extracted from tomato (Tomato pomace), a substance possessing antioxidant activity, might be able to protect against oxidative stress induced by either carbon tetrachloride or gamma radiation. Materials and Methods: A total of 72 experimental male albino rats were randomly divided into equal six groups of twelve rats each. Group 1: served as the control group. Group 2: rats were administrated with (5 gm) tomato extract/kg body weight by gastric lavage tube for 15 days. Group 3: rats were exposed to single dose (10 Gy) whole body gamma irradiation. Group 4: rats were administered with CCl4 only in groundnut oil (1:1) at a dose of 3 ml/kg body weight by single intraperitoneal administration. Group 5: rats were treated with lycopene extract for 15 days before exposure to single dose (10 Gy) whole body gamma irradiation. Group 6: rats were treated with lycopene extract for 15 days before administered with CCl4 for 15 days. Results: showed highly significant increase in activities of alanine transferase (ALT), aspartate amino transferase (AST) and alkaline phosphatase (ALP) in serum, 24 hours after CCl4 administration or radiation exposure. Highly significant decrease in activities of superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) content in the brain tissues. Meanwhile, highly significant increase in MDA content in the brain tissues. Supplementation with lycopene before CCl4 intraperitoneal administration or radiation exposure, exerted marked amelioration of CCl4 and ionized radiation induced disturbances in all the investigated parameters. Histopathological evaluation of the tissues also demonstrated a significant decrease in cellular degeneration and infiltration parameters after lycopene administration. Therefore, lycopene could have a beneficial role in modulating oxidative stress by improving the natural antioxidant mechanism. Conclusion: Administration of lycopene by using suitable stomach tube pre-CCl4 intraperitoneal administration or gamma irradiated has significantly ameliorated the disturbances induced in all the investigated parameters.

2770 A Unique Case of Bezoar and Incidental Situs Ambiguus

INTRODUCTION: Situs ambiguous refers to abnormal arrangement of thoracoabdominal organs along left-right body axis, and is associated with multiple complex congenital cardiac as well as non-cardiac anomalies. This abnormal arrangement is different from orderly arrangement seen in situs solitus or situs inversus. We report a unique case of incidental situs ambiguous discovered during management of aspiration pneumonia caused by gastric outlet obstruction. CASE DESCRIPTION/METHODS: 62-year-old gentleman presented with one month history of multiple episodes of non-bilious vomiting and watery diarrhea, two weeks of abdominal distension and discomfort. Semi-urgent esophagogastroduodenoscopy (EGD) revealed partially digested food particles with inadequate views (bezoar). Placement of a nasogastric tube (NGT) triggered gag reflux resulting in vomiting and aspiration of gastric contents, causing hypoxia needing emergent intubation. Chest x-ray revealed bilateral infiltrates with loss of lung volume on the right. Urgent bronchoscopy revealed food particles predominantly in right bronchus intermedius. Patient developed acute respiratory distress and septic shock from aspiration pneumonia. CT abdomen showed a grossly enlarged stomach (gastric outlet obstruction) on the right side of the abdomen (situs ambiguous) with bezoar. EGD revealed voluminous amount of residue in markedly distended stomach; three liters were suctioned using a large bore Edlich gastric lavage tube. Benign appearing tight stenosis was noted in the duodenal bulb. Biopsies were negative for Helicobacter pylori or lymphoma. Although endoscopic dilation of stricture was initially considered, gastrojejunostomy was performed to bypass the stricture given severity of illness and prolonged recovery. DISCUSSION: Situs ambiguus is classified into two groups. Group I has isomerism of right atrial appendage and is usually associated with absence of spleen (Asplenia syndrome). Group II has isomerism of left atrial appendage and is usually associated with multiple spleens (Polysplenia syndrome). Liver is usually centrally placed or may remain in right or left hypochondrium. Mortality up to 40% at a very young age up was reported. Our patient remained asymptomatic due to absence of cardiac anomalies. Edlich tube is a large bore 36Fr NGT, 36” long, with a closed tip and multiple eyes, a 140cc syringe with a quick connect adapter on the tube. It is used to irrigate or lavage the stomach and plays an essential role in breakdown and evacuation of bezoars.

Unusually late presentation esophageal perforations and ruptures

The aim of this study is to present the treatment modalities of unusual late esophageal perforations and ruptures. The reason for diagnostic delay was misinterpretation of pleural collection, overlooked sclerotherapy, foreign body extraction, and delayed recognition of the true origin of empyema after pneumonectomy. In all instances of transthoracic reinforced or temporary excluded primary repair were successful. In a 6- week-old iatrogenic perforation with localised empyema, Urschel-Ergin type exclusion with tube thoracostomy and lavage was used. In a 13-day-old rupture, and in a late postpulmonectomy perforation, Johnson type exclusion, decortication, and/or fenestration and second-stage colonic or Roux-en-Y by-pass were carried out. One patient was lost in deep sepsis for a delayed recognised transfixion esophageal injury. It is never too late to attempt to repair and salvage a perforated or ruptured healthy esophagus.

Potential pharmacobezoar formation of large size extended-release tablets and their dissolution – an in vitro study

Objective: Extended release (ER) tablets/capsules in massive ingestion overdoses are prone to form pharmacobezoars potentially increasing the risk of late-appearing toxic effects and prolonged symptoms. Oral activated charcoal is often sufficient to prevent drug absorption, but in a recent massive ingestion of highly toxic substances, prior orogastric lavage might be considered. The disintegration characteristics of ER preparations in overdose situations is valuable to understand if the time line and course of the intoxication might be prolonged, but information on these characteristics are unavailable. Slow disintegration and/or pharmacobezoar formation, and the large size makes ER preparation impossible to evacuate using a 30F orogastric lavage tube. This study evaluates the disintegration and pharmacobezoar formation of a simulated massive ER tablet ingestion in an in vitro model, using a selection of extended release tablets, with different disintegrating characteristics when present in therapeutic numbers. Furthermore, the sizes of the formed pharmacobezoars were compared with the dimensions of a 30F orogastric lavage tube.Method: A standardized model mimicking the physical effects on pharmaceutical preparations in simulated gastric fluid (SGF) was developed and tested on three mono-depot ER tablets (quetiapine/Seroquel®XR 50 mg, paracetamol/Pinex®Retard 500 mg, verapamil/Isoptin®Retard 240 mg), one poly-depot ER tablet (carbamazepine/Tegretol®Retard 200 mg), and one immediate-release tablet (paracetamol/Panodil® 500mg). Thirty tablets were placed in polyamide mesh bags, either together in one bag or in separate bags, immersed in 1 L SGF, and incubated at 37 °C for 48 h. Released drugs were quantified at 0.5–48 h.Results: Visual inspection showed that Seroquel®XR, Pinex®Retard, and Isoptin®Retard tablets formed firm pharmacobezoars stable for more than 4 h and intact fractions remained for up to 24 h. Drug releases were reduced by 53%, 40%, and 31%, respectively, for up to 8 h compared to separated tablets. Light microscopy showed that contact with SGF transformed the coating of Seroquel®XR and Pinex®Retard to a diffusion-controlled swelled gel-layer, and the Isoptin®Retard tablets into a rigid and slow-releasing matrix. Tegretol®Retard disintegrated into microspheres within 30 min, and Panodil® disintegrated within minutes.Discussion: The developed pharmacobezoars of mono-depot ER tablets demonstrated prolonged drug release. Neither the formed pharmacobezoars, nor the single tablets of the tested mono-depot ER preparations, would pass through the lumen of a standard orogastric lavage tube, rendering this modality ineffective for tablet removal in gastrointestinal decontamination.

A New Way to Promote Molecular Drug Release during Medical Treatment: A Polyelectrolyte Matrix on a Piezoelectric-Dielectric Energy Conversion Substrate.

Enhanced drug releases in a timely manner during urgent medical treatments would significantly enhance the prognosis of patients. Inspired by the facilitated molecular transports by the potentials, an enhanced drug release strategy driven by mechanical disturbances that widely exist in medical treatment processes is proposed. This strategy is enabled by a functional material comprised of multilayers of dendrimers as the drug reservoir, which are built on a piezoelectric-dielectric flexible film with reduced graphene oxide fillers. The generated voltages are higher and last longer than that in regular piezoelectric films. Photochemical crosslinking leads to a stable drug matrix which is even sustained in electric fields and high ionic strengths. The device enhances releases of positively, negatively, and zwitterionically charged molecules in response to mechanical stimuli and supports high cell viabilities. An illustrative application is demonstrated by preparing the material on the surface of a gastric lavage tube. The results show that the release of antiemetic drug increased by 200% within 60 min in response to forces mimicking human swallowing. This study contributes an integrative material that can realize electrically triggered releases that are previously only realized using complicated electrochemical setups. It is believed that this material can facilitate medicine applications in various emergent situations.

The value of polymerase chain reaction assay in ventilator-associated pneumonia in children undergoing congenital heart disease operation

Objective To explore the value of polymerase chain reaction(PCR) to detect pathogens in ventilator-associated pneumonia(VAP) in children undergoing congenital heart disease(CHD) operation. Methods Forty-eight children selected from 95 cases with VAP underwent CHD operation were admitted in the department of CICU in our hospital from November 2016 to July 2017.Sputum specimens were separately collected by the bronchoalveolar lavage(BAL) and endotracheal tube attracts(ETA) methods, and the pathogens were detected by culture and PCR assay. Results Nineteen specimens were found to be positive after 72 h of culture.A total of 20 pathogens were detected and 2 samples were mixed infection(more than one pathogen), and the positive rate was 39.2%(19/48). For PCR assay, 44 pathogens from 31 samples were detected for just 24 h, 22 samples were single pathogen infection, 9 samples were mixed pathogen infection, and the positive rate was 65.3%(31/48). Compared with culture method, PCR assay could sharply increase the detection rate of every pathogen.Besides, the positive rate of the BAL or ETA for PCR assay was almost the same(45/48). Conclusion PCR assay for detecting pathogens is rapid, accurate and effective, which should be combined with culture method to detect for infectious pathogen.The ETA is the desired method to collect the sputum of the patients. Key words: Polymerase chain reaction; Congenital heart disease; Ventilator-associated pneumonia; Pathogens; Endotracheal tube attracts; Bronchoalveolar lavage

Cecostomy tube lavage for treatment of fulminant clostridium difficile colitis in a recent transplanted patient

Cecostomy tube lavage for treatment of fulminant clostridium difficile colitis in a recent transplanted patient

Develepment and application of the inserted mouth gag

Objective To evaluate the effectiveness of mouth gag which can inserted into lavage tube during gastric lavage. Methods The Sixty-six cases of acute poisoning patients with gastric lavage according to random number table method were randomly divided into two groups, 33 cases in each group. Observation group used the inserted mouth gag, and the control group used the metal ones. Results The observation group were lower than the control group at the time required to insert the lavage tube [(2.23±0.19) s to (3.26±0.30) s] and the incidence of complication rate [18.2%(6/33)to 45.5%(15/33)], the oral cavity bleeding [6.0%(2/33) to 30.3%(10/33)], lavage tube displacement [0 (0/33)to 24.2%(8/33)], lavage tube twisting[0(0/33) to 24.2%(8/33)], the difference was statistically significant (P<0.01), while higher in the rate of successful intubation[100.0%(33/33)] to [54.5%(18/33)], the difference was statistically significant, χ2= 19.4, P<0.01. Conclusions The application of the mouth gag which can insert into gastric lavage improved the successful intubation rate, saved the rescue time, reduced the complication and improved the nursing quality. Key words: Gastric lavage; Complication; Mouth gag

A New Technique for Safe and Efficient Treatment of Acute Esophageal Obstruction in Achalasia

Introduction: Achalasia is a motility disorder of esophagus that can cause impaction of large amount of food in patients causing megaesophagus. These patients typically present with acute onset of dysphagia. While endoscopic retrieval of the material is usually safe, but it can be very time-consuming and challenging. It can take hours to clean the esophagus with traditional Roth net and suction technique. We describe a new technique for safe and efficient removal of impacted food from megaesophagus using overtube and large bore gastric lavage tube. Case Description: Our case is a 73-year-old female who presented with acute dysphagia for both solids and liquids, including saliva for one day. She had similar episodes in the past and her esophagus was dilated with a 51 French Savary dilator one year ago. She did not have any recurrence until present episode. During work up chest X-ray showed air-fluid level overlying the upper mediastinum within a dilated esophagus. Patient was intubated for airway protection and upper endoscopy was performed, which showed large amount of food in a severely dilated esophagus. After placing an overtube, a large bore tube was placed and advanced close to gastro esophageal (GE) junction. Water lavage with 2-3 liters of normal saline was performed. This maneuver was able to clear the esophagus in less than 20 minutes. After clearing the esophagus, scope was advanced through the tight GE junction and retroflexion in the cardia did not reveal any mass. Patient eventually underwent esophageal manometry and esophagogram, which confirmed the diagnosis of achalasia. Subsequently patient underwent forceful balloon dilation of esophagus. Conclusion: In achalasia, acute obstruction may result in large amount of food retention in esophagus. Calcium channel blocker, nitrates, phosphodiesterase inhibitors, and glucagon reduce the lower esophageal sphincter (LES) pressure and may be used as a supportive therapy for patients with achalasia. The use of hot water may improve symptoms but should be avoided in acute esophageal obstruction, and endoscopic clearance of impacted food remains the method of choice. While endoscopic retrieval of impacted food by traditional Roth net and suction technique is usually safe, it is challenging and can take hours to clean the esophagus. Pushing the material through the LES can be hazardous and best be avoided to prevent perforation. Our new technique is safe, effective, and efficient and takes about 20 minutes to clean the entire esophagus. It can be tried after the airway is secured with endotracheal intubation. Further studies on technical methods and long-term follow-up is required before recommending it as method of choice.

Evaluating the Efficiency of Flushed Stomach-tube Lavage for Collecting Stomach Contents from Dogfish Sharks

Concern over the use of lethal techniques to collect basic biological data from sharks has necessitated the development of nonlethal methods of data collection. We evaluated the nonlethal method of removing stomach contents using acrylic tubes. Stomach contents of Spiny Dogfish (Squalus acanthias) captured with bottom trawls and longlines were collected using acrylic tubes flushed with seawater. The largest tube used during the trawl survey was 30 mm in diameter, while a larger tube (37 mm in diameter) was used during longline sampling due to catches of larger dogfish. The average ef- ficiency of stomach content removal was 79.5% overall, and improved to 93% with the addition of the larger tube. Selection of a tube with a diameter 10-20 mm less than mouth width can be reasonably expected to recover over 90% of stomach contents. Stomach- tube lavage is a useful and efficient method for nonlethal sampling of stomach contents from Spiny Dogfish, and perhaps other small sharks.

12 ways to take a temperature

12 ways to take a temperature

Baseline Proton Pump Inhibitor Use to Predict Need for Clinical Intervention for Patients with Nonvariceal Upper Gastrointestinal Tract Bleeding

Purpose: Early endoscopy (within 24 hour of admission) has been advocated for the management of acute upper gastrointestinal bleeding (UGIB) and identifies many patients who may be safely treated without hospitalization. Proton Pump inhibitor (PPI) therapy is associated with significant expense and there is little evidence to support that PPI usage prior to presentation with UGIB (baseline PPI use) leads to less likely need for early clinical intervention. We hypothesized that those patients taking PPIs prior to admission will be less likely need early endoscopy when they are admitted for overt UGIB. Methods: A retrospective chart review was performed from January 2005 to December 2008 on patients presenting for endoscopic evaluation of overt UGIB defined as hematemesis, bloody nasogastric tube lavage, melena, hematochezia +/- acute hematocrit drop or orthorstasis. Patients who had UGIB secondary to varices, portal hypertensive gastropathy, and patients who had no significant finding on upper endoscopy were excluded. Eligible patients were assigned to two groups: patients who were taking a PPI prior to admission and patients who were not taking a PPI prior to admission. Logistic regression analysis was performed using treatment with a PPI within the last 4 weeks prior to admission as a predictor variable in both groups. Peptic ulcer disease, erosions, esophagitis, gastritis, duodenitis and arterial bleeding were considered to be a cause of non-variceal UGIB. Results: 843 consecutive patients were referred for endoscopic evaluation of UGIB, 658 patients met the inclusion criteria. There were 110 patients who were on PPI prior to admission and 548 patients who were not on PPI prior to admission. Demographic and clinical data are shown in Table.Table: No Caption available.Conclusion: Patients taking a PPI prior to admission were less likely to have an early endoscopy (p=0.01) when admitted for overt UGIB.

Obstetrical Management of Fulminant Viral Hepatitis in Late Pregnancy

Objective: To set up a routine perinatal treatment guideline for fulminant viral hepatitis in late pregnancy (FVHLP). Method: A summary of literature of successful treatment at various clinical stages. Due to the limited number of prospective studies, retrospective, observational studies and case reports were analyzed and pathophysiological mechanisms were summarized as well. Results: A comprehensive obstetrical treatment guideline was proposed as follows: (a) Awareness of FVHLP should be reinforced among medical staff; (b) Patients diagnosed with FVHLP should be transported to regional expert centers before labor onset; (c) Supportive medication should be administered to prepare the patients for incoming delivery. A central venous line should be maintained to provide rapid intravenous access and monitor central venous pressure before operation start; (d) Caesarean section is recommended for the mode of delivery, followed by peripartum hysterectomy to control postpartum hemorrhage; (e) Peritoneal/abdominal lavage and drainage tube placement are recommended following operation to decrease abdominal pressure and detect post-operational bleeding; (f) Hypertonic glucose along with insulin topical injection is recommended to promote the healing of wound; (g) Supportive medication, replenishment of coagulation factors, preventive antibiotics should be given as needed. Adjust the amount and order of intravenous fluid according to the character and amount of drainage and urine. Conclusion: Vital obstetrical measures taken include supportive treatments, delivery at appropriate time by cesarean section, and prevent and control of various complications. Guidelines developed with more robust research are still needed