Is the barium enema preparation a good preparation for echography?

A comparative study of 50 patients without previous preparation and 50 who were prepared by a barium enema and low residue diet demonstrated that this method of preparing for ultrasonography improved visibility of the pancreas and the overall quality of the examination. However, the difference in patients with or without previous preparation was not sufficient to justify its routine use.     

Pain after barium enema: effect of CO2 and air on double-contrast study

One hundred fifty-one consecutive patients scheduled for double-contrast barium enema studies were assigned randomly to insufflation with either air or carbon dioxide (CO2) in a double-blind, prospective trial. Within 24 hours after the enema study, the patients were contacted by telephone by an interviewer, who completed a standard questionnaire. Radiographs from the enema studies were assessed for quality by two radiologists. Pain experienced after the procedure was graded from 0 (none) to 4 (severe). Clinically relevant (grades 2-4) pain was experienced by 30% of patients after insufflation with room air, compared with 11% of patients in whom CO2 was used for insufflation (P = .005). The mean pain score for CO2 was 0.4, and for room air, 1.2 (P less than .005). Although five patients experienced grade 4 pain after insufflation with air, no patient reported severe pain after CO2 insufflation. Post-evacuation films confirmed there was significantly less residual gas in the CO2 group. The quality of radiographs was equal in the two groups. CO2 has advantages for use in the double-contrast barium enema examination.     

复方血竭制剂与5-氨基水杨酸在溃疡性结肠炎临床维持缓解治疗中的疗效比较

目的比较复方血竭灌肠液及口服5-氨基水杨酸(SASP)在溃疡性结肠炎(UC)临床维持缓解治疗中的疗效。方法以血竭、白芨为原料制备复方血竭灌肠液,对51例UC患者(血竭组)进行灌肠治疗6个月;SASP组给予SASP1.5g1次/d口服维持6个月,比较两组患者的复发率及治疗中的副作用。结果血竭组和SASP组疗效间差别无显著性意义(P>0.05);血竭组消化道反应、血液系统毒性、肝肾功能损害明显小于对照组(P<0.01)。结论复方血竭灌肠可用于高危患者及SASP治疗无效者的维持治疗方案。     

间歇性低氧和运动对高脂饮食诱导胰岛素抵抗大鼠血清内脂素的影响

目的:探讨间歇性低氧和运动对高脂饮食诱导的胰岛素抵抗大鼠血清内脂素的影响。方法:将72只雄性SD大鼠随机分为普通对照组(12只)和高脂造模组(60只),高脂造模组给予高脂饲料。6周末随机取12只高脂造模组大鼠处死,普通对照组同期处死,测试其空腹血糖和胰岛素水平,根据胰岛素抵抗指数(HOMA-IR)确定造模成功后,将其余48只高脂造模组大鼠分为常氧安静组、低氧安静组、常氧运动组和低氧运动组,每组各12只。低氧组暴露在14.5%氧浓度的环境中,4h/d,7d/w;运动组常氧状态下以20m/min进行跑台运动,1h/d,5d/w。4周末,测试各组大鼠血糖、血胰岛素、血清内脂素和内脏脂肪总量等指标。结果:6周高脂饮食后,高脂组大鼠胰岛素抵抗指数显著升高,造模成功。与常氧安静组比较,低氧安静组、常氧运动组胰岛素抵抗指数和血清内脂素均显著下降(P<0.01);低氧运动组血清内脂素较常氧运动组显著升高(P<0.01),与常氧安静组比较无显著性差异(P>0.05)。结论:间歇低氧和有氧运动均可有效改善胰岛素抵抗,并降低血清内脂素水平;而间歇低氧和运动双重作用对血清内脂素的影响不显著。     

Beer as colon lavage preparation

Six patients received beer preparation prior to double contrast barium enema. The beer group scored slightly better (though not statistically significantly) both in the cleanliness and in the mucosal coating of the bowel than the control group with standard preparation. The fluid balance was unaltered. The patients in the beer group felt surprisingly well, likely due to the good fluid and energy balance provided by the beer. The beer preparation could be used in cases, when the patients are ready to intake beer and want to maintain a good nutritional status.     

Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation

Although the number of clinical applications for fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) cardiac positron emission tomography (PET) has continued to grow, there remains a lack of consensus regarding the ideal method of suppressing normal myocardial glucose utilization for image optimization. This review describes various patient preparation protocols that have been used as well as the success rates achieved in different studies. Collectively, the available literature supports using a high-fat, no-carbohydrate diet for at least two meals with a fast of 4-12 hours prior to ¹⁸F-FDG PET imaging and suggests that isolated fasting for less than 12 hours and supplementation with food or drink just prior to imaging should be avoided. Each institution should adopt a protocol and continuously monitor its effectiveness with a goal to achieve adequate myocardial suppression in greater than 80% of patients.     

A comparison of Golytely and standard preparation for barium enema

A randomized prospective trial was performed comparing Golytely (with bisacodyl) with our standard two-day catharsis and bowel washout regimen as colon preparation for double-contrast barium enema examinations. Of the 107 patients who participated, 50 received the standard preparation and 57 Golytely. Two radiologists reviewed the enema films without knowledge of which preparation had been used. No significant difference was detected either in the number of failed preparations or in the quality. We conclude that routine use of Golytely is preferable to methods involving catharsis and standard tap water enemas for barium enema examination, on the grounds that it is equally effective, yet more convenient for patients and for the radiology department, and reduces total costs.     

水合氯醛给药途径对视网膜母细胞瘤患儿镇静效果的观察

 目的 探讨口服法和灌肠法应用水合氯醛对视网膜母细胞瘤患儿进行检查时的镇静效果.方法 将203例需应用水合氯醛镇静的视网膜母细胞瘤患儿随机分为2组:口服法给药102例,灌肠法给药101例,观察2组患儿的镇静效果.结果 口服组显效92例,有效8例,无效2例.灌肠组显效75例,有效12例,无效14例.两组之间比较差异非常显著(P<0.01).结论 对于视网膜母细胞瘤患儿做辅助检查时,口服法使用水合氯醛的镇静效果优于灌肠法.     

胃肠系统淋巴瘤的X线与CT诊断(附20例分析)

目的分析胃肠系统淋巴瘤的CT、胃肠造影表现。材料与方法回顾性分析了20例胃肠系统淋巴瘤的胃肠道造影及CT影像资料，其中男16例，女4例，年龄25～71岁。20例均行胃肠道造影检查，15例行腹部CT检查。所有病例均经病理证实。结果1．胃肠道气钡造影检查①浸润型胃8例，小肠1例；②肿块型胃5例；③溃疡型胃2例；④息肉型近端空肠1例，末端回肠及盲肠3例。2．CT表现向心性壁厚20～25mm局限性肿块，脾大，脾内低密度灶2例；淋巴结增大。结论1．气钡双重造影是诊断胃肠系统淋巴瘤的首选方法，CT检查可以补充其他器官及淋巴结情况。2．胃肠系统淋巴瘤应与其他疾病相鉴别。     

Comparison of a new colon lavage solution (Golytely-RSS) with a standard preparation for air-contrast barium enema

Golytely is a balanced electrolyte solution for per oral whole-gut lavage. It has been an accepted alternative to standard preparations for barium enema. Golytely-RSS is a new formulation designed to taste better through reduction in sodium and sulfate content. In addition, a slight increase in osmolality is intended to decrease further the net absorption/secretion ratio. One hundred outpatients who were to undergo air-contrast barium enema examinations were randomly assigned one of two colon-cleansing preparations. A standard 1-day diet/cathartic method was compared with Golytely-RSS plus oral bisacodyl. Radiographs were evaluated for the amount of fecal material present and the degree of mucosal coating by two radiologists independently of each other and without knowledge of the preparation used. Good to excellent feces removal was provided by Golytely-RSS in 98% of patients and by the standard method in 95% (p greater than .1, not significant). Mucosal coating also was similar between groups. Unpleasant side effects were reported significantly more often in the lavage group. Unwillingness to use the preparation a second time was reported in 36% of the Golytely-RSS group and in 8% of the standard preparation group (p = .03). Golytely-RSS is an acceptable alternative method to standard colon-cleansing methods for air-contrast barium enema and may be preferable in patients with certain renal or cardiovascular diseases. Side effects may preclude the use of this colon-cleansing regimen routinely.     

中西医结合治疗溃疡性结肠炎65例报告

目的　观察中药灌肠配合西药柳氮磺胺吡啶口服治疗溃疡性结肠炎的近期及远期疗效。方法　将纤维肠镜确诊的 10 5例溃疡性结肠炎患者随机分为中西医结合治疗组和西医治疗组。中西医结合治疗组(6 5例 )用清热解毒、活血化瘀的中药灌肠 ,益气健脾化湿的中药内服 ,配合西药柳氮磺胺吡啶口服治疗 ;西医治疗组 (4 0例)单用柳氮磺胺吡啶治疗。治疗 2个疗程后 ,观察两组的近期疗效、远期疗效。结果　中西医结合治疗组的临床治愈率为 94 6 % ,西医治疗组的临床治愈率为 82 5 % ,两组比较差异有统计学意义 (P <0 0 5 ) ;2年后的复发率中西医结合治疗组明显低于西医治疗组 (P <0 0 5 )。结论　中药内服、灌肠 ,配合柳氮磺胺吡啶口服治疗溃疡性结肠炎的疗效优于单用柳氮磺胺吡啶 ,且复发率更低     

Prospective study of preparation for colon double-contrast studies with enemas compared to oral mannitol/Na-picosulfate administration with the same diet

In preparation for the colon double contrast method two groups of patients, both with identical dietary regimen, were compared. In one case an oral mannitol dose (20%) plus sodium picosulphate was given, in the other enema plus bisacodyl was applied. In a total of 132 patients, the group which was treated with mannitol showed significantly better cleansing results and a better coating with the contrast medium. Considerable side effects did not occur. Further advantages: reduced number of personnel required, less trouble for the patients, out-patient investigation possible.     

Sucralfate versus Mesalazine versus Hydrocortisone in the Prevention of Acute Radiation Proctitis during Conformal Radiotherapy for Prostate Carcinoma

PURPOSE: To assess whether the topical use of steroids or 5-aminosalicylic acid (5-ASA) is superior to sucralfate in preventing acute rectal toxicity during three-dimensional conformal radiotherapy (3DCRT) to 76 Gy. PATIENTS AND METHODS: Patients undergoing 3DCRT for prostate carcinoma at our institution were offered to be randomized to sucralfate 3 g in 15 ml suspension enema (Antepsin, mesalazine 4 g gel enema (Enterasyn, or hydrocortisone 100 mg foam enema (Colifoam. Randomization was blind to the treating physician but not to the patient. Sucralfate was chosen as control arm. Topical treatment had to be performed once daily, starting on day 1 of 3DCRT. Acute rectal toxicity was scored weekly according to RTOG criteria. Time to occurrence of grade 2+ acute rectal toxicity was taken as endpoint. RESULTS: The trial was opened in August 1999, and after the first 24 patients had been treated, arm 2 was discontinued because of eight patients receiving mesalazine, seven actually developed acute rectal toxicity (five patients grade 3 and two patients grade 2).Until May 2001, 134 consecutive patients were randomly assigned to sucralfate (63 patients), mesalazine (eight patients) or hydrocortisone (63 patients). The cumulative incidence of acute rectal toxicity at the end of treatment by arm is 61.9 +/- 6.1%, 87.5 +/- 11.7%, and 52.4 +/- 6.2% for arms 1, 2, and 3, respectively. The difference between the mesalazine group and the sucralfate group is highly significant (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.1-5.7; p = 0.03). At both uni- and multivariate analysis taking into account several patients and treatment covariates, the difference between hydrocortisone and sucralfate is not significant (HR 0.7, 95% CI 0.5-1.2; p = 0.2). CONCLUSION: Topical mesalazine is contraindicated during radiotherapy. Hydrocortisone enema is not superior to sucralfate in preventing acute rectal toxicity.     

Detection of cerebral {beta}-hydroxy butyrate, acetoacetate, and lactate on proton MR spectroscopy in children with diabetic ketoacidosis

BACKGROUND AND PURPOSE: Ketone bodies provide important alternate fuel for brain metabolism, and their transport into the brain increases with prolonged fasting. During diabetic ketoacidosis (DKA), serum ketone concentrations markedly increase; however, little is known about whether ketone bodies accumulate in cerebral tissues during DKA. We used proton MR spectroscopy (MRS) to detect cerebral beta-hydroxy butyrate (betaOHB) and acetone/acetocaetate (AcAc) in children with DKA. METHODS: Twenty-five children underwent brain MRS: nine within 4 hours of the start of treatment for DKA; 11, at 4-8 hours; and five, at 8-12 hours. MRS was repeated after their recovery from the DKA episode at > or =72 hours after the start of treatment. MRS was evaluated for peaks corresponding to betaOHB (doublet centered on 1.20 ppm) and lactate (doublet centered on 1.33 ppm). Difference spectroscopy was used to identify the AcAc peak at 2.22-2.26 ppm. RESULTS: betaOHB was detected in 13 children (52%), more frequently within 4 hours (eight children, 89%) than after 4 hours (five children, 31%). AcAc was detected in 15 children (60%), more frequently at >4 hours after the start of treatment (12 patients, 75%) than in the first 4 hours (three patients, 33%). Lactate was detected in five children (18%), all within the first 8 hours of treatment. CONCLUSION: In children, betaOHB and AcAc accumulate in the brain during DKA, and they can be detected on MRS. Care should be taken in interpreting MRS results in patients with DKA to avoid erroneously attributing betaOHB peaks to lactate.     

Colorectal cancer screening with CT colonography,colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences

PURPOSE: To prospectively assess and compare perceptions of and preferences for computed tomographic (CT) colonography, colonoscopy, and double-contrast barium enema examination (DCBE) by asymptomatic patients undergoing colorectal cancer screening. MATERIALS AND METHODS: A total of 696 asymptomatic patients at higher-than-average risk undergoing colorectal cancer screening were consecutively recruited to undergo both CT colonography and colonoscopy (group 1), and a like group of 617 patients was separately recruited to undergo both CT colonography and DCBE (group 2). Standard bowel preparations were different between the groups undergoing colonoscopy and DCBE. Each patient completed a questionnaire that assessed preparation inconvenience and discomfort, examination discomfort, willingness to repeat examinations, and examination preference. Survey results were compared for significance by using the Wilcoxon rank sum or chi2 test. RESULTS: The majority of patients considered the preparation to be uncomfortable (group 1, 460 of 515 [89%]; group 2, 482 of 538 [90%]) and inconvenient (group 1, 393 of 502 [78%]; group 2, 427 of 527 [81%]). Reported discomfort was similar at CT colonography and colonoscopy (P =.63) but was less at CT colonography than at DCBE (P <.001). Patients experienced significantly less discomfort than expected at both CT colonography and colonoscopy but not at DCBE. Patients' willingness to undergo frequent rescreening was significantly greater for CT colonography than for either colonoscopy or DCBE. The acceptable time interval between screenings was significantly shorter for all examinations if the bowel preparation could be avoided. Overall, patients preferred CT colonography to colonoscopy (group 1, 72.3% vs 5.1%; P <.001) or to DCBE (group 2, 97.0% vs 0.4%; P <.001). CONCLUSION: Patients undergoing colorectal cancer screening prefer CT colonography to both colonoscopy and DCBE. The majority of patients experience discomfort and inconvenience with cathartic bowel preparation.     

Barium enemas are a headache

The frequency of headache after Picolax (sodium picosulphate, Nordic Ltd) preparation for barium enema was investigated and its association with dehydration, as assessed by haemoconcentration, was determined. Eleven out of 41 patients (26.8%) complained specifically of headaches. Although patients with and without headaches developed significant increases in haemoglobin concentration after Picolax preparation, the rise in haemoglobin in those with headaches was significantly greater than in those without (P less than 0.05). In both groups the haemoglobin concentration returned to normal after a bowel washout. These results suggest an association between dehydration and headache developing after a Picolax regimen. It may be possible to prevent this symptom by advising on the intake of specific volumes of fluid during preparation for barium enema.     

Intussusception in infancy and childhood

Experiences of the diagnosis and treatment of 41 patients with intussusception are presented. The most common signs and symptoms upon presentation were vomiting (83%), colicky pain (83%), rectal bleeding (66%) and abdominal mass (51%). All four features occurred together in only 20% of cases. Ultrasound was the primary mode of investigation in four children, giving a finding characteristic of intussusception. 27 patients were examined with barium enema, and hydrostatic reduction was tried. A barium enema gave the correct diagnosis on all cases and a successful reduction of sign and symptoms in 12 patients (44%). In the other 29 cases laparotomy was performed to achieve reduction, primarily in 14 patients and after an unsuccessful barium edema in 15.84% of the patients presenting after a delay of more than 24 hours needed surgery, compared with 59% of those presenting earlier.     

A comparative study of methods of preparing the colon for a double-contrast study: Prepacol versus ricinus capsules with a cleansing enema

In a controlled study, we analyzed the efficiency of cleansing out the colon and the best contrast medium of two different regimens (total n = 237) for preparing the colon for double-contrast examination. The recommendations regarding diet and liquid intake, contrast medium and examination technique were identical in both groups. The combination laxative Prepacol without cleansing enema resulted in a more thoroughly cleaned colon that ricinol with cleansing enema (very good/good cleanliness: Prepacol, 92.4%; ricinol, 83.2%, p less than 0.05). However, the quality of contrast medium (good: Prepacol 71.2% as opposed to ricinol 74.8%) was (independent of the preparation method) below standard regarding cleansing of the colon. Better patient compliance was accomplished by Prepacol because the medication was easier to take, and omitting the cleansing enema was a reduction in burden for both patients and medical staff. Written instructions for diet is essential and was of help to the patients.     

扫描式葡萄糖监测系统在糖尿病患者围术期血糖管理中的应用

 目的 分析扫描式葡萄糖监测系统(FGM)对糖尿病患者围术期血糖控制的影响。方法 选取2019年6－12月在解放军总医院第七医学中心泌尿外科住院手术的2型糖尿病患者60例,空腹血糖≥8 mmmol/L或餐后2 h 血糖≥12 mmmol/L。按照随机数字表法分为观察组与对照组,各30例。两组均接受4次皮下注射胰岛素强化治疗,观察组依据FGM实时葡萄糖值及图谱每日多次调整胰岛素量,对照组每日多次指血糖监测(monitoring of blood glucose,MMBG)。对比分析两组患者的血糖控制水平、血糖达标时间和术后第1、2、3天达标率。结果 观察组有1例、对照组有2例未完成观察。观察组日人均调整血糖次数(2.20±0.77)次,明显高于对照组的(0.80±0.45)次。两组术后第1、2天空腹血糖、餐后2 h血糖差异均有统计学意义(P<0.05);观察组术前、术后血糖达标时间[(4.72±2.39)d、(2.59±1.18)d]均明显短于对照组[(6.21±2.46)d、(3.57±1.23)d],术后第1、2日观察组血糖控制明显好于对照组。观察组术后第2、3天血糖达标率(48.3%、79.3%)均明显高于对照组(17.9%、42.9%),差异均有统计学意义(P<0.05)。结论 FGM对围术期应用4次皮下注射胰岛素强化治疗的2型糖尿病患者的临床效果优于MMBG,可在临床推广。     

Anisakiasis of the colon: radiologic and endoscopic features in six patients.

The radiologic and endoscopic findings in six patients with anisakiasis of the colon were analyzed. The diagnosis was based on the demonstration of Anisakis larvae at radiography or on elevated serum levels of antibodies to this parasite. All patients reported abdominal symptoms 12-23 hours after the ingestion of raw fish. Double-contrast barium enema examination, performed 2-4 days after the onset of syptoms in all the patients, revealed that the right side of the colon was frequently affected by edema, which was radiographically demonstrated as luminal narrowing and thumbprinting. In addition, the worm was shown at radiography in four patients. Colonoscopy, performed 1-7 days after the onset of symptoms, revealed edematous mucosa, characterized by narrowing and multiple smooth and round protrusions, in all four of the patients studied, but it failed to demonstrate the worm in any patient. The authors believe that the demonstration of these features, together with a history of raw fish ingestion, is essential for the diagnosis of this disorder.