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Barium embolisation is a very rare complication of barium enema, but carries a mortality of about 50%. We report a case of 70-year-old woman with Lesniowski-Crohn disease, who survived after barium intravasation into the portal circulation produced during a barium enema.
To determine which of two types of barium preparation, a dry powder (AC-14, E-Z-EM, Montreal) or a premixed suspension (Liquid Polibar Plus, E-Z-EM), gives better mucosal coating for double-contrast enema studies, the authors compared the results of two series of 80 examinations each, one for each of the preparations. The films were retrospectively reviewed by two independent observers, who did not know which preparation had been used for a given examination. Mucosal coating was graded on a five-point scale and the amount of barium on a three-point scale. Each area of the colon--the cecum, the ascending, the transverse and the descending colon and the rectosigmoid--was rated separately. The premixed barium suspension yielded significantly better mucosal coating than the dry powder in all areas of the colon (p < 0.01). There was no significant difference between the two preparations in the amount of barium deposited in any region of the colon (p > 0.05) or in the proportion of unsatisfactory examinations (p > 0.05). The authors conclude that the premixed suspension yielded better-quality mucosal coating than a suspension made from the dry powder and resulted in a similar high proportion of technically satisfactory studies.
Radiography and manometry of the esophagus were compared in 77 patients consecutively referred for manometric investigation on suspicion of esophageal motility disorder. Radiography and manometry were carried out simultaneously, and the results were assessed blindly. The examination comprised barium swallow, bread barium swallow, and barium swilling. Considering manometry as the standard, the overall sensitivity and specificity of the radiologic examinations were 90.4% and 92.0%, respectively. We conclude that radiology is an excellent investigation for the separation of patients with and without esophageal motility disorders, but correct subclassification often required manometry.
The International Commission on Radiological Protection has recommended the use of a new dose quantity "effective dose". The doses to 22 organs of the human body are required for a formal calculation of this quantity. This paper shows that a quick estimate of the effective dose received by a patient from a barium meal or a barium enema can be made by multiplying the measured dose-area product for the complete examination by an appropriate conversion coefficient. Despite the varied techniques used for barium examinations, such an estimate is unlikely to be in error by more than 25%.
A 64-year-old woman visited my clinic with complaints of abdominal distension, constipation, and nausea. Since abdominal X-ray showed severe obstructive ileus following the upper GI barium swallow study, the patient was sent immediately to Saga Medical School Hospital for the emergency operation. As the result of the left hemicolectomy, two obstructive lesions were found at the sigmoid colon and the transverse colon. Nowadays, as the population of aged people increases and Japanese diet changes, colon cancers are increasing more rapidly. Since the half of colon cancers doesn't have any clinical symptoms of obstruction, the upper GI barium swallow study with condensed barium might lead a patient to some type of dangerous situation.
The mucosal coating properties, liability to bubble formation and palatability of a new barium sulphate suspension (Micropaque HD) were compared with those of the barium suspension shown by previous trials to produce the best results (E-Z-HD). The results show that E-Z-HD gave significantly better mucosal coating and was less liable to bubble formation. There was no significant difference in the palatability of the two preparations.
Perforation above the peritoneal reflection is a rare complication of a barium enema. We describe a case in which perforation in the transverse colon during a double contrast study resulted in intramural extravasation of barium, pneumoperitoneum and omental emphysema.
The radiation doses received by patients during 41 barium meal (BM) and 42 barium enema (BE) examinations in two Greek hospitals are presented. Radiation dose was measured in terms of the dose area product (DAP). The effective dose and doses to certain organs were estimated using the ODS-60 software. Mean total DAP values were found to be 25 +/- 11 Gy cm2 for BM and 60 +/- 35 Gy cm2 for BE examinations, whereas the estimated mean values of effective dose were 8.6 +/- 4.0 and 24 +/- 16 mSv respectively. DAP to effective dose conversion coefficients were estimated to be 0.34 mSv per Gy cm2 for BM and 0.41 mSv per Gy cm2 for BE.
Five cases of colonic retention of barium with severe constipation occurring in elderly patients after a barium-meal examination were seen in a two-year period and it is suggested that this complication may be unrecognized. Lactulose 50% (Duphalac) was an effective agent in inducing bowel evacuation in these patients, who were resistant to more generally used methods.
A new medium density barium suspension is described for the biphasic contrast examinations of the upper gastrointestinal tract. It is designed for the bubbly barium method, and combines good mucosal coating properties in the double contrast phase of the examination with transparency in the single contrast graded-compression phase.
Severe glucagon-resistant spasm on double-contrast barium enema (DCE) examinations may occasionally lead to a nondiagnostic examination or erroneously suggest colonic disease. In such cases, this glucagon-resistant spasm may be overcome by refilling the colon with single-contrast barium immediately after completion of the DCE examination.
Patient doses for barium meal and barium enema examinations, performed at two Greek hospitals, were measured using a dose-area product meter. The results were analysed to obtain the contributions of fluoroscopy and radiography to the dose as well as a number of other dose related parameters for each examination. The doses observed are within the range of values reported by other authors and comply with the dose reference levels (DRLs), proposed from relevant surveys in the UK and The Netherlands. However, comparison between the two hospitals revealed significant differences in the contributions to dose from the various parts of the examinations. To determine the reasons for these differences, measurements of dose related parameters were made using a Plexiglas phantom and standard clinical X-ray machine settings. Factors contributing to increased dose delivery were determined and recommendations have been made concerning ways in which doses might be reduced in each hospital, without degradation of the diagnostic quality of these examinations.
Venous intravasation of contrast is a potentially life-threatening complication of the barium enema examination. A patient in whom portal venous contrast intravasation was nearly fatal is presented, and the significant morbidity and mortality from this unusual event is reviewed. Since barium infiltration into the venous system almost always occurs in the setting of altered mucosal integrity, this examination should be used cautiously in patients with inflammatory bowel disease or diverticulitis. Prompt recognition and rapid resuscitation are critical to the survival of patients with contrast intravasation.
Sixty cases of extraperitoneal intramural and perirectal extravasation of barium during a barium enema examination are reviewed. Approximately half the patients were asymptomatic and of these only one experienced serious complications. In the remaining patients, symptoms included pain, bleeding, fever, sepsis, mass and/or discharge. Morbidity and mortality was considerable despite aggressive treatment in many cases. Delay of treatment resulted in increase mortality and morbidity.
In order to improve lead-barium exchangeability of barium hydroxyapatite (BaHAp), the effects of the recycle employment of BaHAp and the introduction of HCl into the exchange solution have been investigated at 293 K. The ion exchange capacity of BaHAp was evidently improved by use of the recycle experiments to reach levels approximately twice that obtained via the batch experiment. XPS analyses revealed that the ion exchange appears to proceed from the surface to the bulk of the apatite. The addition of HCl to the exchange solution also resulted in the enhancement of the ion exchangeability of BaHAp. Based on the apparent solubility of BaHAp, which was estimated from the dissolution of BaHAp for 4 h, together with the results of that experiment, it is suggested that the dissolution-precipitation mechanism appears to be possible for ion exchange. Copyright 2001 Academic Press.
In the title compound [systematic name: triaqua(1,4,7,10,13,16-hexaoxacyclooctadecane-kappa(6)O)(2-nitrophenolato-kappaO)barium(II)-aqua(1,4,7,10,13,16-hexaoxacyclooctadecane-kappa(6)O)bis(2-nitrophenolato-kappa(2)O,O')barium(II)-2-nitrophenolate (1/1/1)], [Ba(C(12)H(24)O(6))(C(6)H(4)NO(3))(H(2)O)(3)][Ba(C(12)H(24)O(6))(C(6)H(4)NO(3))(2)(H(2)O)](C(6)H(4)NO(3)), the two Ba(II) atoms encapsulated by the 18-crown-6 rings have different coordinations. Although both Ba(II) atoms are coordinated to the six O atoms of the crowns, in the neutral moiety, the Ba(II) atom is coordinated to one terminal O atom from a water molecule, two phenolate O atoms and two nitro-group O atoms, while in the cationic moiety, the Ba(II) atom is coordinated to three terminal O atoms from water molecules and one phenolate O atom. Both the crowns are eclipsed and translated along the b direction. In the asymmetric unit, the three components are interconnected by four O-H.O interactions. The packing is stabilized by two intermolecular C-H.O interactions and by one O-H.O interaction.
The effect of viscosity of barium sulphate suspensions on coating was assessed by glass slides as in vitro, and the rat as in vivo models. It was found that below a certain viscosity (as measured by a cup viscometer) coating was impaired. As increasing viscosity is associated with increasing bubble retention and, eventually, when very high viscosities are reached, poor surface flow of suspension, it is recommended that the viscosity of the medium employed should be kept within a narrow range, approximately equal to 70% w/v Baritop, 80% Micropaque, 115% E--Z-paque, 150% Barosperse, or 200% HD 200.
The inconsistency among current thermodynamic data of Ba3(AsO4)2(c) and BaHAsO4.H2O(c) led the authors to obtain independent solubility data of barium arsenate by both precipitation and dissolution experiments. Low and neutral pH (3.63-7.43) favored the formation of BaHAsO4.H2O(c). Both BaHAsO4.H2Oc and Ba3(AsO4)2(c) formed at the neutral pH conditions (7.47, 7.66), whereas Ba3(AsO4)2(c) was the only solid phase precipitated at high pH (13.03, 13.10). The Ba3(AsO4)2(c) precipitate acquired at 50 degrees C appeared as small leafy crystal, while the Ba3(AsO4)2(c) solid precipitated at 25 degrees C comprised granular aggregate with some smaller crystal clusters. XRD and SEM analyses of Ba3(AsO4)2(c) and BaHAsO4.H2O(c) indicated that the solids were indistinguishable before and after the dissolution experiments. In the present work, the solubility products (Ksp) for Ba3(AsO4)2(c) and BaHAsO4.H2O(c) were determined to be 10(-23.53)(10(-23.01) to 10(-24.00)) and 10(-5.60)(10(-5.23) to 10(-5.89)), respectively. DeltaGf degrees for Ba3(AsO4)2(c) and BaHAsO4.H2O(c) were calculated to be -3113.40 and -1544.47 kJ/mol, respectively. There was no difference between the solubility products of the leafy and the granular Ba3(AsO4)2(c) solids.