Fatal iatrogenic BaSO4 embolism: Morphological and ultrastructural findings confirmed by X-ray microanalysis and ICP-AES

Vaginal laceration during barium enema with extraperitoneal extravasation: Case report and literature review

Unrecognized vaginal intubation during the barium enema procedure with subsequent balloon inflation and contrast instillation is a potentially fatal complication of an otherwise common and routine procedure. We describe a patient who, while undergoing a routine barium enema, had misplacement of the enema catheter into the vagina, subsequent rupture of the superior/lateral vagina upon inflation of the catheter retention balloon, and injection of barium contrast into the retroperitoneum. The patient was admitted for surgical repair of the vaginal laceration and monitoring for chemical peritonitis; and was managed without exploratory laparotomy. We review the existing literature, summarize 18 reported cases from worldwide literature, detail potential complications and propose management and prevention strategies based on the mechanism of injury.

Rare and lethal complication of barium enema intravasation

Barium enema investigation is regarded as a safe investigative procedure. Rarely, it may cause complications such as colonic perforation and barium intravasation. Barium intravasation may be caused by the inadvertent introduction of the catheter into the vagina, thereby into the vaginal venous plexus. It may also occur through mechanical colonic perforation with the catheter, or via diseased bowel conditions. This may lead to complications such as liver microabscesses, massive pulmonary embolism, hypovolemic shock, disseminated intravascular coagulopathy and even sudden death. With that in mind, we would like to report an interesting case of barium intravasation into the portal venous system via the vagina venous plexus. The patient experienced abdominal discomfort with mild per vaginal bleed and went into disseminated intravascular coagulopathy. She received supportive management and she made a full recovery.

Alginate-matrigel microencapsulated schwann cells for inducible secretion of glial cell line derived neurotrophic factor

Controlled expression of glial cell line derived neurotrophic factor (Gdnf) can be integrated in the development of a system for repair of injured peripheral nerves. This delivery strategy was demonstrated via inducible Gdnf from microencapsulated cells in barium alginate. The Schwann cell line RT4-D6P2T was initially modified utilizing an ecdysone-based stable transfection system to produce RT4-Gdnf cells. During construct preparation, it was found that C6 cells (where Gdnf cDNA was isolated) make three Gdnf transcript variants. Additionally, the importance of 5' untranslated region to drive biologically-functional Gdnf synthesis was shown. Encapsulation of RT4-Gdnf in 1% alginate was then performed. It was determined that cells were able to survive at least 1 month in vitro using starting densities of 20, 200 and 2000 cells/capsule and barium ion concentrations of 10, 50, 100 and 200 mM. Most importantly, encapsulated cells secreted exogenous Gdnf upon ponasterone A induction. Mixture of basement membrane extract Matrigel to alginate promoted increased proliferation, cell spreading and Gdnf release. Finally, compression tests showed that cell-loaded microcapsules fractured at 75% diameter compression with 38 kPa of stress. Regulated Gdnf release from these microcapsules in vivo may potentially aid in the regeneration of damaged nerves.