Preoperative bowel preparation

A survey of 500 clinically active, board-certified colon and rectal surgeons in the United States and Canada was conducted to obtain data regarding current methods of bowel preparation for elective colorectal surgery. A review of recent publications on preoperative bowel preparation was used to compare the current literature recommendations with the actual practice among the group surveyed. Responses were received from 352 of 500 colorectal surgeons to whom questionnaires were sent (70 percent response rate). All respondents used a mechanical preparation and some form of antibiotics. The favorite antibiotic regimen was oral antimicrobials combined with systemic antibiotics (88 percent). Concomitant administration of oral neomycin-erythromycin base and a systemic second generation cephalosporin active against both anaerobic and aerobic colonic bacteria, together with oral polyethelene glycol electrolyte mechanical colonic cleansing, was the most popular method of preoperative bowel preparation (58 percent). The second most frequent method of mechanical bowel cleansing consisted of conventional enemas, dietary restrictions, and cathartic preparations (36 percent). Mannitol solution (5 percent), and whole-gut irrigation per nasogastric tube (1 percent) were the least popular methods of mechanical bowel cleansing. The literature supports the current methods of preoperative bowel preparation used by the vast majority of surgeons surveyed.Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

电压门控钠通道亚单位在大鼠肠易激综合征模型中变化的研究

背景：电压门控钠通道（VGSC）在神经元动作电位的产生和传递中起着极为重要的作用。近年来它与内脏高敏感性的关系越来越受到重视。目的：探讨VGSC亚单位的变化与大鼠肠易激综合征（IBS）内脏高敏感性之间的关系。方法：以新生大鼠直肠内气囊扩张制作IBS的动物模型，在其成年后取L6-S2脊髓背根神经节，采用逆转录聚合酶链反应（RT-PCR）半定量法对背根神经节细胞表面VGSC Nav1．1、Nav1．6、Nav1．7、Nav1．8和Nav1．9五种α亚单位mRNA的含量进行检测．并以原位杂交的方法对Nav1．8的表达进一步加以确认；采用酶联免疫吸附试验（ELISA）法对大鼠肠道组织神经生长因子（NGF）的含量进行检测。结果：背根神经节细胞表面仅亚单位Nav1．8mRNA的表达增加，而Nav1．1、Nav1．6、Nav1．7和Nav1．9的表达没有改变，原位杂交定性分析也证实造模组Nav1．8含量增加；造模组肠道组织NGF的含量显著高于对照组。结论：新生大鼠直肠内气囊扩张使其脊髓背根神经节细胞Nay1．8mRNA的表达增加，而其他几种常见仅亚单位的含量均未发生改变。这种变化可能与肠道组织NGF表达的增加有关。     

Descending Perineum Syndrome: Are Abdominal Hysterectomy and Bowel Habits Linked?

PURPOSE This retrospective study evaluates the effect of abdominal hysterectomy on patients affected by descending perineum syndrome. METHODS Eighty-nine female patients affected by descending perineum syndrome and one group of 10 healthy women with normal bowel habits were studied retrospectively. Thirty-two descending perineum syndrome patients (Group 1) had received an abdominal hysterectomy for benign diseases, while 57 descending perineum syndrome patients (Group 2) had not undergone this surgery. All 99 subjects underwent clinical evaluation, computerized anorectal manometry, and defecography. RESULTS Dyschezia was found predominantly in Group 2 subjects (P < 0.05). Fecal incontinence was significantly higher in Group 1 than in Group 2 (P < 0.05). The worst anal resting pressure was found in the incontinent Group 1 patients (P < 0.01). Rectoanal intussusception was a significant defecographic sign in Group 1 subjects (P < 0.05). CONCLUSIONS Clinical evaluation and instrumental data suggested a possible link between fecal incontinence and abdominal hysterectomy in patients affected by descending perineum syndrome.     

Rheumatoid arthritis and anti-thyroid antibodies

The aim of this study was to evaluate the quality of B cell responses in patients with Inflammatory Bowel Disease (IBD) and healthy individuals of different ages, vaccinated with the pandemic (p)2009 influenza vaccine. The in vivo response was measured by the hemagglutination inhibition (HAI) assay, which represents the most established correlate with vaccine protectiveness. The in vitro response was measured by activation-induced cytidine deaminase (AID) in cultures of vaccine-stimulated PBMC. Both responses are somewhat impaired in IBD patients undergoing anti-TNF-α treatment but these are much more decreased in IBD patients undergoing treatment with anti-TNF-α and immunosuppressive (IS) drugs. These latter patients had in vivo and in vitro B cell responses similar to those of elderly individuals. Moreover, as we have previously demonstrated in healthy subjects, the in vitro response to the polyclonal stimulus CpG may be used as a biomarker for subsequent vaccine response and AID activation is correlated with the serum response in IBD patients, as it is in healthy individuals. These results altogether indicate that IBD patients on anti-TNF-α and IS have significantly impaired in vivo and in vitro B cell responses, as compared to those on monotherapy. This is the first report to demonstrate that B cell defects, as measured by the autonomous AID reporter, in IBD patients contribute to reduced humoral responses to the influenza vaccine, as we have previously shown for elderly individuals.     

The female pelvic floor through midlife and aging

Female pelvic floor is a complex functional unit involved in multiple functions that extend beyond the sole support of pelvic organs. Pelvic floor dysfunction globally affects micturition, defecation and sexual activity. Evolutionary modifications such ad adaptation to upright standing, walking and the need to deliver fetuses with larger head diameters made the fascial and muscle support of the pelvic floor vulnerable, therefore predisposing women to pelvic organ prolapse and incontinence. Different than in males, the female pelvic floor undergoes a number of adaptive changes related to life and endocrine events. Most of the clinical manifestations of these changes become apparent after menopause and throughout aging in women. This review article summarizes the key aspects of the pathophysiology and the clinics of the modifications of the pelvic floor in women through midlife and beyond. A particular focus is given to the relationship between urinary and bowel dysfunction.     

超声在肿瘤性肠梗阻诊断中的应用价值分析

目的：分析超声对肿瘤性肠梗阻进行诊断的应用价值。方法抽取98例肿瘤性肠梗阻患者,对手术、病理检查结果和超声进行回顾性分析。结果经分析98例肿瘤性肠梗阻患者中,经超声检查100％显示肠梗阻,患有肠道肿瘤的患者共86例,病因诊断率为87．75％,提示病变部位80例,定位符合率93．02％,定性诊断准确性为85．3％。结论超声检查可以作为手术和临床诊治的影像参考资料,为肿瘤性肠梗阻的治疗提供肿瘤定位、定性诊断。     

Small bowel obstruction via herniation through an iatrogenic defect of the falciform ligament following laparoscopic cholecystectomy

Internal herniation of the small bowel through a defect in the falciform ligament and subsequent small bowel obstruction is exceedingly rare with the majority of previous cases being attributed to congenital abnormalities. As laparoscopic techniques approach the forefront of modern surgery, an iatrogenic source for a falciform ligament defect has emerged over the last decade. In this case, a 50-year-old patient presented with signs of acute small bowel obstruction 10 days after a laparoscopic cholecystectomy. On diagnostic laparoscopy, part of the jejunum was found to have herniated through an opening in the falciform ligament. This was likely to have been caused by trauma during the cholecystectomy. Following relief of the obstruction, the defect was closed with polyglactin sutures.     

Bezoar: an Unusual Palpable Mass in the Right Iliac Fossa

A 64-year-old gentleman presented with a 12-h history of right iliac fossa pain. On examination, the patient had a tender 8 × 6 cm mass in the right iliac fossa with localised peritonitis. The working diagnosis at this time was an appendix mass or caecal cancer. A computed tomography scan revealed the characteristic ‘bird''s nest’ appearance of a bezoar. On further questioning, the patient confessed to regularly ‘binging’ on grapes. The patient described passing the mass and his symptoms completely resolved. This appears to be the only documented case of a bezoar affecting the ascending colon.     

Prevalence and Risk Factors for Fatigue in Adults With Inflammatory Bowel Disease: A Systematic Review With Meta-Analysis

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