Regenerative Strategy for Persistent Periprosthetic Leakage around Tracheoesophageal Puncture: Is It an Effective Long-Term Solution?

Autologous tissue-assisted regenerative procedures have been considered effective to close different types of fistula, including the leakage around tracheoesophageal puncture. The aim of this study was to retrospectively review 10 years of lipotransfer for persistent periprosthetic leakage in laryngectomized patients with voice prosthesis. Clinical records of patients who experienced periprosthetic leakage from December 2009 to December 2019 were reviewed. Patients receiving fat grafting were included. The leakage around the prosthesis was assessed with a methylene blue test. Twenty patients experiencing tracheoesophageal fistula enlargement were treated with fat grafting. At the one-month follow-up, all patients were considered improved with no leakage observed. At six months, a single injection was sufficient to solve 75% of cases (n 15), whereas 25% (n 5) required a second procedure. The overall success rate was 80% (n 16). Results remained stable for a follow-up of 5.54 ± 3.97 years. Fat grafting performed around the voice prosthesis, thanks to its volumetric and regenerative properties, is a valid and lasting option to solve persistent periprosthetic leakage.

INFLUENCE OF EARTH COMPOSITION ON ADSORPTION CAPACITY OF METHYLENE BLUE DYE

Final properties of unfired earth are influenced by composition of earth mixtures. Methylene blue test could be useful method for analysis of earth composition. This would facilitate of designing unfired earth building structures because composition of natural earth is various. Principle of methylene blue test is measure of amount of adsorbed methylene blue dye by clay. The essential component of earth mixtures is clay because clay fulfils a function of binder. Experimental measure of adsorption capacity of individual kind of clay is described in this paper. Adsorption capacity was investigated in montmorillonite, kaolinite, illite-kaolinite and illite clays. The obtained results show that the adsorption capacity of clays is significantly different.

COMPOSITION AND QUALITY OF FRESH COW MILK OFFERED FOR SALE IN PARTS OF PLATEAU STATE OF NIGERIA.

The gross composition and quality of fresh cow milk purchased from Fulani milk vendors in three locations of Plateau State were investigated. Milk quality was assessed by the methylene blue reduction test while bacterial contamination was by the agar plate count and the direct microscopic count. The mean contents of total solids, butterfat, protein and ash of a total of 100 samples from Barkin Ladi, Jos and Bukuru markets were 12.45, 4.77, 3.90, 0.92; 12.85, 4.50, 3.68, 0.93; and 12.41, 5.26, 3.72, 0.91% respectively. The proximate constituents did not differ significantly between locations. The methylene blue test indicated that only 23.5% of the sample were of good quality while 41.2 and 35.3% were rated fair and poor respectively. No sample merited excellent rating. The agar plate count showed a range of 1.97 x 106 for Bukuru to 2.54 x 106 cells/ml for Jos market. The direct microscopic count showed the highest mean bacteria value for Barkin Ladi samples. The high bacterial counts as observed were probably indicative of poor milking hygiene and handling. It is suggested that such milk should be properly pasteurized before consumption and delivered/marketed early at source to reduce the time for microbial multiplication.

THE ROUTINE USE OF THE METHYLENE BLUE TEST IN SLEEVE GASTRECTOMY: WHY NOT?

ABSTRACT Background: Although considered a safe procedure, sleeve gastrectomy (SG) has a non-negligible risk of major postoperative complications related to it, with special attention to gastric leaks. Aim: Evaluate the clinical value of the methylene blue test (MBT) in predicting the occurrence of post-SG leaks. Methods: Retrospective study that included 1136 patients who underwent SG with intraoperative MBT between 2012 and 2016. Sensitivity, specificity, positive predictive value (PPV) and negative predicted value (NPV) were calculated to determine the clinical correlation between the MBT and the occurrence of postoperative leaks. Staple line oversewing was performed in all patients who presented positive MBT. Results: Laparoscopic SG was performed in 97.0% of cases; open in 2.3%, and robotic in 0.7%. MBT was positive in 19 cases (1.67%). One positive MBT occurred during an open SG and the other 18 at laparoscopy. Moreover, there were nine cases (0.8%) of postoperative leaks, among which, only two presented positive MBT. MBT diagnostic value was evaluated through the calculation of sensitivity (22.0%), specificity (98.0%), PPV (11.0%) and NPV (99.0%). There were no cases of allergic reaction or any other side effect with the use of the methylene blue solution. Conclusion: MBT showed high specificity and negative predictive value, thus presenting an important value to rule out the occurrence of postoperative leaks.

Endourological Management of Iatrogenic Ureterovaginal Fistula following Obstetric and Gynecological Surgeries at Tertiary Referral Center

Aims: To evaluate the outcome of endourological management of iatrogenic ureterovaginal fistula caused by gynecological and obstetric surgeries. Methods: This is a retrospective analysis of uretorovaginal fistula (UVF) patients who underwent UVF management with endourology technique from February 2014 to November 2019. All data were taken from fistula database. All non-obstetric/gynaecological cases and open surgical procedures leading to UVF were excluded. Diagnostic evaluation by cystoscopy and ureterorenoscopy; and use of guide wire, C-arm and DJ stent were recorded. Three to six months post-operative follow up status was also recorded. Results: There were 14 cases managed by retrograde DJ stenting. Both hysterectomy (n=10) and Cesarean Sections (n=4) were the past surgeries. Diagnosis was made by history, methylene blue test, cystoscopy, intravenous urography and CT urogram. Treatment was retrograde DJ stenting. All of them had unilateral distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. All were continent at the end. Conclusions: Endourological approach with retrograde DJ stenting had successful outcome in iatrogenic UVF. Keywords: double J stent, endourological technique, iatrogenic ureterovaginal fistula, ureterorenoscope.

Does the Methylene Blue Test Give Equally Satisfactory Results in All Studied Igneous Rocks Relative to the Identification of Swelling Clay Minerals?

The presence or the absence of swelling clay minerals in rocks, which are used in various construction applications, constitutes a determinant factor for their strength, and consequently, in their general behavior in various construction applications, as they have the ability to swell up to 400 times of their usual volume, causing failures to any application in which they participate. The aim of this study is to respond to the question of whether the empirical method of methylene blue yields equally safe and correct results in different types of igneous rocks and if not, which is the determining factor affecting the results. The answer to this complex question is feasible by investigating the microscopic structure and the mineralogy of the studied rocks, and particularly, using the content of specific phyllosilicate minerals which may be related or not with the methylene blue values. According to the results, the methylene blue test seems to work correctly for the intermediate (Group I) and mafic (Group II) examined rocks, but it seems to be wrong for the highly serpentinized ultramafic rocks (up to 70% of serpentine) (Group III).

DIAGNOSTICS OF UNFIRED EARTH WITH METHYLENE BLUE TEST

Unfired earth is important historic building material. Final properties of unfired earth constructions are influenced by amount and kind of clay in earth mixtures. Methylene blue test is a method that helps determining the type and amount of clay in earth mixtures. This paper describes research focused on using methylene blue test for analysis of methylene blue dye absorption by montmorillonite clay. The first part of the paper describes principle of methylene blue test and course of experimental measurement. The second part deals with analysis of obtained results. On the basis of experimental measurement it can be stated that methylene blue test is influenced by the stirring time of earth samples with methylene blue solution and dependence between amount of methylene blue dye absorption and amount of montmorillonite clay in earth samples is linear.

Gastrointestinal perforation in a critically ill patient with COVID-19 pneumonia

Gastrointestinal complications in critically ill patients during the COVID-19 pandemic pose a diagnostic and treatment dilemma. We present a case of a 74-year-old male who was brought to our emergency department with worsening shortness of breath, fever, and dry cough and was found to have COVID-19 pneumonia. Early in his hospital course, he was admitted to the intensive care unit, and was found to have significant abdominal distension with large amounts of simple fluid on bedside ultrasound. Bedside paracentesis returned succus and enteric feeds, and a methylene blue test confirmed a likely gastrointestinal perforation. The patients’ family refused surgical intervention and the patient underwent bedside drainage. This case represents several critical dilemmas clinicians faced during the recent surge of the COVID-19 pandemic.