Mucosal colonic tube fistula with antireflux wrap for antegrade colonic enema

Antegrade enemas can provide children with excellent faecal continence in situations where adequate control has been compromised because of underlying congential anomaly or poor surgical outcome in their treatment. The enema is often delivered through an appendicostomy. If the appendix is absent or utilized for another purpose, then placement of a chait tube or caecostomy button can provide access to the colon for the enema. However, these devices may be associated with breakages, accidental removal and leakage and replacement may require another operative procedure under a general anaesthetic. Full thickness colonic tubes can also be constructed at any point along the colon but in the author’s experience, they can be associated with significant leakage of both gas and faecal material. The construction of a mucosal colonic tube with anti-reflux wrap is a technique that avoids the above problems and offers a distinctive advantage in selected situations. The technique relies on tabularising mucosa alone to create a continent fistula. Six children with severe soiling underwent the technique. The outcomes were evaluated using a modified quality of life score (QOLI) [1, 2]. The score included assessment of soiling, staining, odour, self-esteem and socialization measure. Technical evaluation included analysis of the ease of catheterization and continence of the mucosal fistula site. All six patients had dramatic improvement in their faecal continence with complete resolution of soiling in all six. Follow up median is 42 months and the range is 6–48 months. QOLI scores improved from a total of 4.75 to 18.5. Possible range is 0–21. All the six fistula sites catheterize easily and no stenosis or faecal leakage has occurred. Two patients required treatment of minor granulations at the entry site of the fistula during the early healing phase.     

中药保留灌肠联合吡喹酮治疗血吸虫性结肠病

采用中药保留灌肠联合吡喹酮治疗血吸虫性结肠病并观察其临床疗效，结果显示，经过1～2个疗程治疗后总有效率可达95％。     

一种新的清洁灌肠卧位及应用

目的：探讨一种新的清洁灌肠卧位。方法：选择100例需要清洁灌肠的妇科手术病人随机分成传统卧位和改良卧位两组，进行肠道清洁情况、灌肠次数、总灌肠量，术后血便的比较。结果：两种卧位效果存在显著性差异（P〈0．01），改良卧位明显优于传统卧位。结论：改良卧位灌肠次数少，灌肠效果好，副作用少，值得临床推广。     

Intussusception: recurrence following gas (oxygen) enema reduction

Over a 38-month period, prospective data were collected on all episodes of intussusception treated at the Royal Children's Hospital, Melbourne. There were 170 initial episodes for which a gas enema was performed, 127 of which were reduced successfully. Recurence occured in 10 patients following initial successful gas enema reduction, a recurrence rate of 7.9%, which compares with a recurrence rate of 8.9% with barium (P = 0.896). We conclude that the gas enema does not have a higher rate of recurrence than barium and that there is no evidence of a significant incidence of incomplete reduction unrecognised at the time of gas enema. Correspondence to: S. W. Beasley     

Enema reduction of intussusception with a small dose of iopamidol may have advantages over barium

Barium enema (B-enema) has been the standard method for hydrostatic reduction of intussusception, although recently air enema has been used due to the lower risk when perforation occurs. Recently, we have administered a small dose of iopamidol during enema reduction (I-enema) in children with intussusception. From November 1989 to December 1993, we treated 50 children with intussusception at Kiyama Hospital. Barium was used in the first half of the period, and iopamidol in the second half. Reduction was successful in 22 of 24 patients with barium (92%) and 23 of 26 with iopamidol (88%); 25 children had the ileocolic type and 25 the ileoileocolic (-cecal) type of intussusception. Operations were carried out in 3 patients from each group. I-enema avoids some of the drawbacks of barium and air enemas. It is a new method of enema reduction, as a contrast medium is injected first. It is possible to obtain a good image of the advanced portion with a small dose of contrast medium, which is important for treatment. For institutions performing B-enemas, I-enemas can be performed easily with the same equipment and technique. It causes less contamination upon leakage than a B-enema, and also has less influence on the intestinal membrane with very few risks if perforation occurs. Better images are obtained than with air. A large dose of contrast medium is not needed, thereby reducing medical expenses to a minimum. Iopamidol can be used safely for enema reduction of intussusception with an expected high success rate.     

The diagnostically difficult intussusception: its characteristics and consequences

In the absence of classical symptomatology, the diagnosis of intussusception may be difficult to make. A retrospective review of 630 episodes of intussusception admitted to the Royal Children's Hospital, Melbourne, over a 15-year period revealed difficulties in diagnosis in 318 cases. The adverse effect of an incorrect initial diagnosis on duration of symptoms at the commencement of treatment, need for surgery, resection rate, complications, and hospital stay is examined. Problems in the assessment of children with intussuception are identified and discussed in the hope that an increased awareness of the diagnostic difficulties and potential pitfalls will reduce the morbidity of this common paediatric condition. Offprint requests to: S. W. Beasley     

The perirhinal cortex and long-term spatial memory in rats

Two experiments examined the effects of perirhinal cortex and hippocampal neurotoxic lesions on the retention of allocentric information. Perirhinal (Expt. 1) and hippocampal rats (Expt. 2) were trained on an allocentric task until they reached a performance equal to that of the control groups. Results showed that 24 days after acquisition, during a retraining period, only the hippocampal rats presented a deficit in retention. These results suggest that the perirhinal cortex and the hippocampus can be functionally dissociated in terms of their participation in the formation of long-term spatial memory. Also, the allocentric spatial memory functions of the hippocampus seem not to depend on their afferent connections with the perirhinal cortex.     

Retention of spatial information in hippocampally damaged rats overtrained on a cartographic task

Hippocampal rats were overtrained on a cartographic task until they reached a performance equal to that of the control group. Twenty-four days later, during a retraining period, lesioned rats showed a profound retention deficit as compared to controls. However, Expt. 2 shows no retention deficit when a guidance strategy is used to acquire the spatial task. These results suggest that the hippocampus is crucial for long-term retention/consolidation of allocentric spatial information.     

缓冲型套筒冠在口腔修复中的应用研究

缓冲型套筒冠是一种新型的固定-活动修复体,其独特的修复机制和固位原理使其越来越多的应用于临床,同时给疑难病例提供了一种可选择的有效的治疗方法。本文就缓冲型套筒冠口腔修复的生物力学机制理论、影响固位的因素及影响使用寿命的因素予以综述。     

Treatment of postpartum retention of urine by electroacupuncture in 100 cases

Treatment of 100 cases of postpartum retention by electroacupuncture Sanyinjiao (SP 6), Yinlingquan (SP 9), Zigong (Ex-CA I), Liniao (Ex-CA), Zhongji (CV 3) and Hegu (LI 4), and the effective rate was 98%. Author: SU Ai-lan (1968- ), female, attending physician Translator: XIAO Yuan-chun