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[Dysphagia] Re:barium and gastrografin
O/H dysphagia-request@b9.com ??????:
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>Today's Topics:
>
> 1. Pica (Irene Campbell-Taylor)
> 2. Re: Phlegm (kathleen wright)
> 3. barium and gastrographine (Patricia and David)
> 4. Re: barium and gastrographine (dgrabo@nycap.rr.com)
> 5. Re: barium and gastrographine (LOBSTERPAM@aol.com)
> 6. Re: Phlegm (Sarah Ware)
> 7. Re: barium and gastrographine (Sarah Ware)
> 8. Re: barium and gastrographine (jspeer111@aol.com)
> 9. Re: Phlegm (JoAnn Eaton)
>
>
>----------------------------------------------------------------------
>
>Message: 1
>Date: Wed, 2 Nov 2005 11:49:32 -0800 (PST)
>From: Irene Campbell-Taylor <eripley@yahoo.com>
>Subject: [Dysphagia] Pica
>To: dysphagia@b9.com
>Message-ID: <20051102194933.84782.qmail@web30214.mail.mud.yahoo.com>
>Content-Type: text/plain; charset=iso-8859-1
>
>It is necessary to distinguish between geophagia (eating dirt and clay) and swallowing objects. The former is often, as noted, due to iron and other mineral deficiencies. The latter is something else. I have had patients with the following found in the stomach and intestine: combs, stones, pins, rubber gloves, bottle caps, toothbrush, small toys, and on and one. One wonders how they got through the pylorus.
>Also, mouthig to the point of biting hands, fingers, arms is often a sign of the pain of GER.
>A couple of refs. re iron deficiency:
>
>Giudicelli J; Combes JC .Pica and iron deficiency in adolescence . Arch Fr Pediatr 1992 Nov;49(9):779-83
>
> BACKGROUND. Pica is a habit disorder involving the compulsive, irrational ingestion of nutrient or non-nutrient substances which usually, in young infants, include clay and earth. Pica is rare in adolescents but is more likely to occur in subjects with severe iron deficiency. POPULATION AND METHODS. 17 (16 girls, 1 boy) cases of pica were recognized over a period of 4 years in an adolescent unit. 15 of the cases presented with anemia and/or iron deficiency. Hematological and biochemical investigations included measurements of hemoglobin content, MCV, serum iron and ferritin, transferrin saturation and serum iron-binding capacity. Blood loss was considered as a possible cause in all patients. RESULTS. 13 of the patients ingested large amounts of raw rice and 11 ingested ice cubes; 10 patients ingested both substances. Their mean serum ferritin was 7.17 ng/ml and the mean hemoglobin was 8.7 g/dl. One out of 7 patients showed intestinal blood loss. Excessive menstrual bleeding!
> occurred
> in 8 girls. All patients were treated with adequate amounts of iron. Pica disappeared within a few weeks, although biochemical evidence of iron deficiency persisted in some patients. In one case, pica persisted despite correction of the iron deficiency
>
>
>McLoughlin IJ; Hassanyeh F Pica in a patient with anorexia nervosa. Br J Psychiatry 1990 Apr;156:568-70 A case of an unusual pica in a patient with anorexia nervosa is described. The patient was also found to have iron-deficiency anaemia. The relationship of mineral deficiency to pica and anorexia nervosa is discussed.
>
>
>Dr I Campbell-Taylor
>Clinical Neuroscientist
>Exclusive Distributor:
>www.interactivetherapy.com
>
>------------------------------
>
>Message: 2
>Date: Wed, 2 Nov 2005 17:04:38 -0500
>From: "kathleen wright" <hillivie423@adelphia.net>
>Subject: Re: [Dysphagia] Phlegm
>To: "M. Tervo" <tervomm@yahoo.com>, <dysphagia@b9.com>
>Message-ID: <004201c5dff9$6d8b8cc0$d6acaa44@DD34HY41>
>Content-Type: text/plain; format=flowed; charset="iso-8859-1";
> reply-type=original
>
>GERD is a strong possibility.
>----- Original Message -----
>From: "M. Tervo" <tervomm@yahoo.com>
>To: <dysphagia@b9.com>
>Sent: Wednesday, November 02, 2005 12:21 PM
>Subject: [Dysphagia] Phlegm
>
>
>
>
>>I've had several referrals for pts with vague complaints of swallowing
>>problems due to increased phlegm. No other hx that would indicate
>>swallowing problems. Does anyone have any ideas on where this "mystery
>>phlegm" is coming from and why it would be causing swallowing
>>difficulties. Could it be related to GERD?
>>
>>
>>---------------------------------
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>>
>
>
>
>
>------------------------------
>
>Message: 3
>Date: Thu, 3 Nov 2005 00:10:59 +0200
>From: "Patricia and David" <guapa@otenet.gr>
>Subject: [Dysphagia] barium and gastrographine
>To: <dysphagia@b9.com>
>Message-ID: <000d01c5dffa$4e653200$b4efcdd4@computer>
>Content-Type: text/plain; charset="windows-1250"
>
>One of the doctors I work with has mentioned that barium should no
>longer be used in VFSS because of the effects to the lungs it has if
>aspirated, and gastrographine should be used instead. Could anyone
>comment or give me titles of articles I could look up.
>
>Thank you
>
>Patricia Giannika
>
>HYPERLINK
>"http://promos.hotbar.com/promos/promodll.dll?RunPromo&El=&SG=&RAND=1244
>3&partner=hbtools"Upgrade Your Email - Click here!
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>
Its well known that gastrografin is a water soluble iodine contrast
medium that is hyperosmotic. Consequently, it leads to hyperosmotic
water diffusion into the airspaces when aspirated, and that can result
in a pulmonary edema - like situation.
Of course , that happens only in aspirating large amounts of the
substance and also depends on the cardiac and pulmonary reserves of the
individual (esp. in danger are children, debilitated and old age people
especially if low ejection fraction or cardiac insufficiency coexists).
In the peritoneal cavity, gastrografin is rapidly absorbed by the
peritoneal surfaces , causing no much discomfort, even in persons with
ascites.
Barium is a inorganic substance, causing peritoneal granulation if
leaking from GI tract.
If barum is aspirated causes also some reaction to the air-exchange
membranes and is phagocyted from pneumonocytes.
It depends of the amount of the aspirated contast medium.
In VFSS we use Iopamiro gastro-which is also a iodine water soluble
material- less hyperosmotic than gastrografin. We dilute the medium 20%
with water and it comes nearly to iso-osmolar state. We of course are
following our observations and stop giving liquids after detection of
any serious aspiration at the first detected volume (eg first bolus of 2
ml). Then we begin the swallowing strategies and postures and finally
change to other viscosities.
Barium in a way is more safe than water soluble iodine materials in
general, has better contrast and much more cheaper.
Its only difficulty is that it comes not in pre-prepared forms in
Greece-it is not a pharmaceutical imported- and is difficult and time
consuming to prepare it in several viscosities. Plus it comes sticky and
gives false positive results in VFSS.
L.Dagdilelis MD PhD
Radiologist
Gen.Hosp."G.Papanikolaou"
Dysphagia Interdisciplinary Team
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