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Interventional radiology
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The antegrade and retrograde techniques are similar. We usually give the child a small amount (2–3 mL/kg) of barium sulfate suspension orally or by nasogastric tube the evening before the procedure, to opacify the colon. US is used to mark the position of the left lobe of the liver. A puncture site is selected, where possible lateral to rectus abdominis, about 2 cm from the left costal margin. Occasionally, anatomic considerations (e.g. scoliosis) require the use of a different puncture site. Local anesthetic is infiltrated and a short transverse incision is made in the skin. For antegrade gastrostomy, a snare is passed into the stomach through the mouth. The stomach is then inflated with air. This can be done via the snare catheter or a separate nasogastric tube. In children with esophageal atresia, the stomach can be inflated after percutaneous US-guided puncture with a 25-gauge needle. When the stomach is inflated, an 18-gauge trocar needle is inserted through the incision and used to puncture the stomach. This must be done quickly, before the air escapes from the stomach into the small bowel. The author finds biplane fluoroscopy useful at this point, but it is not essential. Some operators use IV glucagon (40 μg/kg, maximum 1 mg) to delay gastric emptying. The snare in the stomach is opened, and a 0.035-inch (0.89 mm) guidewire is advanced through the needle and grasped with the snare. The wire is then carefully pulled out of the mouth, and the tract dilated to permit the retrograde passage of the snare catheter through the abdominal wall to the mouth. The snare catheter is then used to pull the lubricated gastrostomy tube down the esophagus, and out through the anterior abdominal wall. The procedure is otherwise the same as for endoscopic gastrostomy (see Chapter 6).
The beneficial effects of subcutaneous Allium cepa injection on random flap survival in rats
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Dinçer Altınel, Merdan Serin, Havva Erdem, Burcu Biltekin, Mert Celikten, Sevgi Kurt Yazar, Gaye Toplu, Eymen Oruc
At the end of the 7-d follow-up period following the flap elevation histological samples was taken from the proximal and the distal ends of the flaps under surgical anesthesia. Afterward, the abdominal cavity was exposed to angiographic study. Cannulation of inferior vena cava and abdominal aorta was performed with a 20-gauge and 22-gauge cannulas, respectively. After the cannulation, high dose intravenous Pentothal Sodium (Abbott®, Chicago, IL) was injected to euthanasia the animals. The blood which remained in the vascular bed was removed with serum saline solution injection of 250 ml. An amount of 40 ml of 40% barium sulfate suspension (Radyobarit Suspension®; Bracco Österreich GmbH, Vienna, Austria) and 10 ml of 10% gelatin were mixed inside 100 cc serum saline solution with heating. The mixed solution was injected from aorta cannula into the vascular system. Afterward, the taps of both cannulas were closed to prevent leakage. At the end of the procedure, whole bodies of the animals were wrapped in plastic bags and kept in a freezer for overnight at −18 °C. The following day, the bodies were removed from the freezer, defrosted at room temperature and the dorsal flaps were separated from the body. The detached flap tissue was placed in +4 °C refrigerator for one more night. The next day the, remaining fascia and muscles were removed from the flap and the flap was stabilized on a cartoon board to prevent folding. High-resolution mammography machine (GE Health care, Chicago, IL) was used for the imaging of the flaps [11].
Evaluation of respiratory motion-corrected cone-beam CT at end expiration in abdominal radiotherapy sites: a prospective study
Published in Acta Oncologica, 2018
Russell E. Kincaid Jr., Agung E. Hertanto, Yu-Chi Hu, Abraham J. Wu, Karyn A. Goodman, Hai D. Pham, Ellen D. Yorke, Qinghui Zhang, Qing Chen, Gig S. Mageras
For the purposes of the analysis in this article, comparison of RMC-CBCT and NC-CBCT was different for each disease site: (1) In GEJ, patients received 200 cc oral contrast containing 2% barium sulfate suspension prior to the G-CBCT scan. The one-minute scan prior to treatment was used for RMC- and NC-CBCT, such that the oral contrast was visible in the gated, RMC- and NC-CBCT images. The approximate time between the gated and pretreatment one-minute scans was 9min. (2) In pancreas, the one-minute scan after treatment was used for RMC- and NC-CBCT. Pancreatic patients received intravenous (IV) contrast prior to the pretreatment one-minute scan, for evaluating a protocol study goal not analyzed in this article. Therefore, in order to minimize the influence of residual IV contrast in comparing to the G-CBCT (without contrast) the post-treatment one-minute scan (rather than the pretreatment scan) was used in the analysis of pancreatic cases. The approximate time between the gated and post-treatment one-minute scans was 20 min. In both disease sites, the G-CBCT image acquired before treatment served as a criterion standard in the comparison.
The relationship between posterior pharyngeal wall thickness and swallowing function after radiation therapy
Published in Acta Oto-Laryngologica, 2020
Lisa M. Evangelista, Ahmed Bayoumi, Brandon A. Dyer, Rakendu P. Shukla, Shyam D. Rao, Peter C. Belafsky
Our standardized VFSS protocol has been previously described [7]. As part of our standard protocol, patients swallow 1 and 20 mL liquid barium boluses (EZ-PAQUE barium sulfate suspension, 60 percent w/v; 40 percent w/w, E-Z-EM, Inc., Westbury, NY), 1 and 20 mL boluses, and 60-mL via sequential swallows of thin liquid barium (Varibar thin liquid barium sulfate suspension, 40 percent w/v; Bracco Diagnostics Inc., Princeton, NJ), and a 3 mL bolus of pudding barium (Varibar pudding barium sulfate esophageal paste; Bracco Diagnostics Inc., Princeton, NJ). Objective measurements were made using the SwallowTail software (Belldev Medical, LLC., Arlington Heights, IL).