Severe barium sulphate aspiration: a report of two cases and review of the literature

Aspiration of barium sulphate is a well-recognized complication, occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Rarely, large amounts of barium sulphate are inadvertently aspirated into the lung. Certain conditions affecting the anatomical and functional integrity of the oropharynx and oesophagus suggest predisposing factors. Aspiration of barium sulphate is not expected to cause severe lung injury due to its relatively non-irritant matter. On the other hand, acute inflammation or even death attributed either to high or low density preparations of barium sulphate, have been reported. We present two patients, both with a history of schizophrenia, who developed acute respiratory failure requiring mechanical ventilation, following aspiration of large amounts of barium, during an upper gastrointestinal radiographic contrast study. One patient died following massive aspiration which led to multiple organ dysfunction syndrome, while the other, although sub- acutely complicated by pneumonia, was successfully treated. Beside presentation of cases, several aspects of investigation, differential diagnosis, treatment and prevention are discussed. Complications of barium sulphate aspiration depend upon the density and quantity of the aspirated solution, the extent of tracheobronchial distribution and the general physical condition of the patient. In severe cases, early treatment and close follow up with high-resolution computed tomography are mandatory to prevent progression towards fibrosis. Patients with psychiatric disorders, apart from other conditions predisposing to aspiration, should be dealt with particular caution, when performing the above-mentioned procedures

Severe barium sulphate aspiration: a report of two cases and review of the literature

Aspiration of barium sulphate is a well-recognized complication, occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Rarely, large amounts of barium sulphate are inadvertently aspirated into the lung. Certain conditions affecting the anatomical and functional integrity of the oropharynx and oesophagus suggest predisposing factors. Aspiration of barium sulphate is not expected to cause severe lung injury due to its relatively non-irritant matter. On the other hand, acute inflammation or even death attributed either to high or low density preparations of barium sulphate, have been reported. We present two patients, both with a history of schizophrenia, who developed acute respiratory failure requiring mechanical ventilation, following aspiration of large amounts of barium, during an upper gastrointestinal radiographic contrast study. One patient died following massive aspiration which led to multiple organ dysfunction syndrome, while the other, although sub- acutely complicated by pneumonia, was successfully treated. Beside presentation of cases, several aspects of investigation, differential diagnosis, treatment and prevention are discussed. Complications of barium sulphate aspiration depend upon the density and quantity of the aspirated solution, the extent of tracheobronchial distribution and the general physical condition of the patient. In severe cases, early treatment and close follow up with high-resolution computed tomography are mandatory to prevent progression towards fibrosis. Patients with psychiatric disorders, apart from other conditions predisposing to aspiration, should be dealt with particular caution, when performing the above-mentioned procedures

A hairy-root transformation protocol for Trigonella foenum-graecum L. as a tool for metabolic engineering and specialised metabolite pathway elucidation

The development of genetic transformation methods is critical for enabling the thorough characterization of an organism and is a key step in exploiting any species as a platform for synthetic biology and metabolic engineering approaches. In this work we describe the development of an Agrobacterium rhizogenes-mediated hairy root transformation protocol for the crop and medicinal legume fenugreek (Trigonella foenum-graecum). Fenugreek has a rich and diverse content in bioactive specialised metabolites, notably diosgenin, which is a common precursor for synthetic human hormone production. This makes fenugreek a prime target for identification and engineering of specific biosynthetic pathways for the production of triterpene and steroidal saponins, phenolics, and galactomanans. Through this transformation protocol, we identified a suitable promoter for robust transgene expression in fenugreek. Finally, we establish the proof of principle for the utility of the fenugreek system for metabolic engineering programs, by heterologous expression of known triterpene saponin biosynthesis regulators from the related legume Medicago truncatula in fenugreek hairy roots

Die Auflösung der Differenz

Cette contribution est consacrée à la représentation du monde animal et du monde humain dans les romans de Marcel Beyer Flughunde (1996) et Kaltenburg (2008). Elle interroge les frontières entre l’homme et l’animal à partir du discours anthropologique et bioéthique contemporain. Ce cadre théorique questionne l’ancrage historique des romans, tant dans la période national-socialiste que dans celle de la République Fédérale. Dans tous les cas, ces deux romans se jouent au cœur d’une sphère liminale où humanité et animalité ne cessent d’interférer, rendant caduque toute tentative de définir l’humain en tant que tel.Gegenstand dieser Studie ist die Literarisierung von menschlicher und tierischer Welt in Marcel Beyers Erinnerungsromanen Flughunde (1996) und Kaltenburg (2008). Die Grenzlinie zwischen Animalischem und Humanischem wird in beiden Romanen im Kontext von anthropologischem und biopolitischem Diskurs untersucht, da durch historische Referenzen auf die Totalitarismen des Nationalsozialistischen Deutschlands und der DDR vor allem auf die Abwesenheit der Humanität fokussiert wird. In beiden Romanen verläuft die Grenzlinie zwischen Mensch und Tier durchlässig: Diese Vermischung von Animalischem und Humanen stellt die Frage danach auf, was den Menschen als Menschen definiert

Intravitreal bevacizumab for macular edema due to proton beam radiotherapy: Favorable results shown after eighteen months follow-up

Eleni Loukianou, Dimitrios Brouzas, Eleni Georgopoulou, Chrysanthi Koutsandrea, Michael ApostolopoulosEye Department, University of Athens, Athens, GreecePurpose: To evaluate the safety and efficacy of intravitreal injections of bevacizumab (Avastin®) as a treatment option for radiation maculopathy secondary to proton beam radiotherapy for choroidal melanoma.Case: A 61-year-old woman presented with a gradual decrease in left eye visual acuity (VA) 29 months after proton beam radiotherapy for choroidal melanoma. On presentation, her best-corrected VA (BCVA) was 2/10 in the left eye and the intraocular pressure was 15 mmHg. Fundoscopy revealed cystoid macular edema, intraretinal hemorrhages, epiretinal membrane in the posterior pole, and residual tumor scar with exudative retinal detachment and hard exudates in the periphery of the superotemporal quadrant. A treatment with intravitreal injections of bevacizumab (Avastin®) was recommended. The injections were performed on a six-weekly basis.Results: The central retinal thickness prior to the treatment was 458 μm. After the first intravitreal injection of bevacizumab, the retinal thickness at the centre of the fovea was reduced to 322 μm. After the third injection, the central retinal thickness was 359 μm and 18 months after presentation, it reduced to 334 μm. The BCVA increased to 3/10 after the intravitreal injections of bevacizumab and remained stable during the follow-up period. The intraocular pressure was within normal range during the follow-up period.Conclusion: Bevacizumab should be regarded as a treatment option for macular edema due to proton beam radiotherapy for choroidal melanoma. By reducing the central retinal thickness, intravitreal bevacizumab can improve VA or ameliorate further decline caused by radiation maculopathy.Keywords: bevacizumab (Avastin®), choroidal melanoma, macular edema, radiation retinopath