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PubMed1991

A trial to assess the effectiveness of bowel preparation prior to intravenous urography.

A randomized prospective trial was undertaken to compare the relative effectiveness of two commonly used bowel preparations (senna tablets and sodium picosulphate powder) administered to patients before they underwent out-patient intravenous urography. Their 'control' films were compared with plain 'kidneys, ureters, and bladder' (KUB) radiographs of patients who had had no bowel preparation. The results show no significant difference in the degree of faecal shadowing between those receiving a bowel preparation and the unprepared patients. Nor is there any difference between the two laxatives. We conclude that the routine administration of a bowel preparation is unlikely to improve the diagnostic quality of out-patient intravenous urograms. In addition, 40% of the urogram patients found the effects of the laxatives to be unpleasant or very unpleasant.

Adolescent↗
PubMed1994

Potassium supplements prevent serious hypokalaemia in colon cleansing.

The association between colonic cleansing and hypokalaemia was studied prospectively by monitoring the serum potassium levels in four groups of patients: groups 1 (55 patients), 2 (72 patients), and 3 (97 patients) received the same 2-day preparation of 15 g magnesium sulphate and 10 mg bisacodyl twice daily; group 4 (96 patients) received a 1-day preparation of 2.4 mg sennoside per kg of bodyweight. Groups 1 and 2 were on diuretics, but only group 2 received potassium supplementation. Serum potassium levels were measured before and after bowel preparation. Hypokalaemia was present prior to cleansing in six (11%), and after cleansing in 20 (36%) of the 55 patients in the group 1 patients on diuretics but without potassium supplements. There was, after cleansing, no significant fall in serum potassium in the group 2 patients on diuretics who received potassium supplements. No hyperkalaemia resulted from supplementation. A significant fall of the mean level of serum potassium occurred in patients in both group 3 (2-day-preparation) and group 4 (1-day-preparation). We conclude that both 1 day and 2 days of cleansing with cathartics may result in a significant fall in serum potassium, which can be prevented by oral potassium supplements. Potassium supplements (three times a day 15 ml of potassium chloride with 0.9 mmol K per ml during the preparation) in patients on diuretics may be prudent to avoid the risk of cardiac arrhythmia.

Aged↗
PubMed1999

A new magnesium-containing PEG-electrolyte solution for the oral lavage of the colon.

AIM: The aim of the present study was to verify whether the addition of magnesium ions to an electrolyte solution containing polyethylene glycol (PEG-ELS) for the oral lavage of the colon increases barium mucosal coating at the time of double-contrast barium enema (DCBE) examination. MATERIALS AND METHODS: The two patients from 60 pairs of patients undergoing DCBE with a standardized technique were randomly subjected to bowel preparation with sennosides and an isotonic PEG-ELS (SELG, Promefarm, Italy), or sennosides and a modified isotonic SELG preparation to which 7.5 g/l of magnesium sulphate were added. Mucosal coating, residual fluid and colon cleansing were assessed independently by three radiologists. The null hypothesis was tested by means of Wilcoxon's signed-rank test. RESULTS: Barium mucosal coating was judged to be significantly better in the SELG-Mg members (P<0.0001). The amount of residual fluid was significantly lower in SELG-Mg members (P<0.0001). There was no difference in colon cleansing (P = 0.690). These results demonstrate, in a simple way, that magnesium ions increase barium coating of the colon mucosa in vivo. The underlying mechanism seems to be the increase in viscosity of barium suspension by free water subtraction owing to the hydrophilia of magnesium ions. CONCLUSION: The integration of magnesium in a newly designed isotonic PEG-ELS could be the correcting factor for the poor barium mucosal coating that normal solutions for the oral colon lavage induce.

Administration, Oral↗
PubMed1999

Bowel preparation for the double-contrast barium enema: how to maintain coating with cleansing?

AIM: Poor mucosal coating, due to excess of fluid in the colon lumen, is a problem when the oral lavage method (4 litres of an iso-osmotic saline solution containing polyethylene glycol) is used as a preparation for double-contrast barium enema. Our aim was to assess the value of prior administration of sennosides to obtain a clean colon with a reduced volume of polyethylene glycol (PEG)-saline solution, but maintaining good mucosal coating. MATERIALS AND METHODS: After a 2-day low-residue diet, three different oral preparations were compared: (i) 4 litres of a PEG-saline solution (SELG) and 15 mg of bisacodyl (116 patients, SELG-4 group); (ii) 156 mg of sennosides, 15 g of magnesium sulphate, and 2 litres of water (116 patients, SennMg group); (iii) 156mg of sennosides and 2 litres of SELG (116 patients, SennSELG group). Compliance, complaints, cleansing, mucosal coating, and fluid retention were evaluated. RESULTS: Compliance was > 94% in every group. A higher percentage of mild nausea was observed in SELG-4 group, of mild abdominal cramping in SennMg group, of substantial abdominal cramping in SennSELG group (P < 0.02). Cleansing was better in SennSELG than in both the SELG-4 (P = 0.0003) and SennMg (P = 0.0353) group. Mucosal coating was better in SennMg than both SELG-4 (P = 0.0034) and SennSELG (P < 0.0001) group. There was more residual fluid in the SennSELG group than both in SELG-4 (P = 0.0029) and SennMg (P = 0.0059) group. CONCLUSION: For colon cleansing, the combination of sennosides and PEG-saline solution was better than either the 4 litre PEG protocol or the combination of sennosides and magnesium sulphate. For mucosal coating, the protocol combining sennosides and magnesium sulphate was more effective than either protocols using the PEG-saline solution. This may be due to the interaction of residual magnesium ions in the colon lumen with the barium suspension.

Aged↗
PubMed1997

The role of constitutive and inducible nitric oxide synthase in senna- and cascara-induced diarrhoea in the rat.

The role of constitutive and inducible nitric oxide (NO) synthase in rats treated with senna and cascara was studied. Senna (60 mg/kg p.o.) and cascara (800 mg/kg p.o.) ex vivo significantly increased Ca(2+)-dependent constitutive NO synthase activity in the rat colon. Induction of NO synthase (12% of the total NO synthase) was associated with cascara, but not senna, administration. Dexamethasone (0.03-0.3 mg/kg i.p.), which inhibits the expression of inducible NO synthase, significantly and dose-dependently reduced cascara-(but not senna-) induced diarrhoea and colonic fluid secretion. These findings suggest that senna probably exerts its laxative effect through stimulation of the constitutive isoform of NO synthase, while the inducible isoform of NO synthase also seems to be involved in the laxative effect of cascara.

Administration, Oral↗
PubMed1982

Castor oil or senna preparation before colonoscopy for inactive chronic ulcerative colitis.

Few clinically apparent clinical relapses of colitis occurred in 340 patients with previously extensive ulcerative colitis in an inactive phase submitted to total colonoscopy for dysplasia screening after bowel preparation with castor oil or senna. A prospective trial in 46 such patients showed both preparations to be equally safe and effective. Minor untreated disturbances of bowel habit occurred in 14 patients (30%), and three patients (7%) required a short period of oral corticosteroids. No patient with inactive colitis in either the retrospective series or the trial group had a serious exacerbation of colitis as a result of the bowel preparation, which was considered necessary and clinically justified for the purposes of cancer screening.

Adult↗
PubMedDate not supplied

Addition of senna improves colonoscopy preparation with lavage: a prospective randomized trial.

Attempts have been made to further improve the widely performed colonoscopy preparation with lavage. In a prospective study, 120 outpatients and inpatients scheduled for total colonoscopy were randomized to two preparatory regimens. The day before endoscopy either extractum sennae (N = 60) or a placebo solution (N = 60) was given. Just before examination all patients underwent whole gut irrigation with a polyethylene glycol electrolyte lavage solution (PEG-ELS). Adequacy of preparation, patient tolerance, and the necessary amount of PEG-ELS were assessed. Physician assessment of colon cleansing showed superiority in the group with additional laxative. The colon was free of solid debris in 66.7% of patients after PEG-ELS and in 90% after senna/PEG-ELS administration (p less than 0.01). Patient tolerance was similar in both groups with 86.7% vs. 83.3% of subjects rating the preparation as tolerable. Severe adverse events were not observed. In the senna/PEG-ELS group, significantly less (p less than 0.05) lavage fluid was needed. We conclude that the combination of senna and PEG-ELS is more effective than PEG-ELS in cleansing the colon for colonoscopy.

Adolescent↗
PubMed1997

The pigment of melanosis coli: a lectin histochemical study.

BACKGROUND: The compositional nature of the pigment of melanosis coli is essentially unknown. Previous histochemical studies suggested that this pigment has certain similarities with lipofuscin (i.e., age-dependent pigment) and ceroids (i.e., pathologically derived pigments) and that it may contain, therefore, polymerized glycolipids and glycoproteins. However, the saccharide composition of this pigment was never explored by lectin histochemical procedures, which was the main object of this study. METHODS: Colonoscopic biopsy specimens from eight patients with melanosis coli and from three normal control subjects were studied by fluorescent microscopy and by standard and lectin histochemistry. The number of apoptoses in the lining colonic epithelium was also evaluated histologically. RESULTS: Apoptotic bodies were significantly more numerous in patients with melanosis coil than in control subjects. The pigment that accumulates in macrophages of the lamina propia showed autofluorescence, sudanophilia, acid-fastness, and positiveness to PAS and Schmorl's reactions, all of which are common to lipofuscin and ceroids, plus an intense argentaffin reaction abolished by bleaching, indicative of a melanic substance. Lectin histochemistry showed, in decreasing order of frequency, the presence of alpha-D-mannose, sialic acid, beta-D-galactose (lactose), gal-beta-(1-3)acetyl-galactosamine, alpha-D-galactose, and alpha-L-fucose, but no terminal alpha-D-acetyl-galactosaminyl residues. CONCLUSIONS: The significant increase of apoptotic bodies in the lining colonic epithelium indicated that this type of cell death is not due to the natural programmed cell renewal, but to the action of laxatives. Because the autofluorescent pigment of melanosis coli contains melanin (as well as glycoconjugates) and is not dependent on age but on the use of anthranoid laxatives, it should be categorized as a "melanized ceroid." The lectin affinities of this pigment indicated that it contains a substantial number of saccharide residues almost similar to those found in the ceroid pigment of human aortic atheromas. These findings and considerations on the metabolism and pharmacokinetics of anthranoids suggested that the apoptotic epithelial cells, rather than the laxatives, may be the source of the pigment saccharides, whereas the precursors of the melanic substance may be derived from the anthranoids.

Adult↗
PubMed1997

Experimental mitochondrial myopathy induced by chronic intoxication by Senna occidentalis seeds.

Histochemical and electron microscopic studies of biceps femoris, pectoralis major and rectus femoris of chronically treated birds with seeds of the poisonous plant Senna occidentalis (0.2% external/internal tegment), were performed. The muscles had similar features of human mitochondrial myopathy as ragged-red fibers, cytochrome-oxidase negative fibers, and weak activity of the oxidative enzymes. Fibers with lipid storage were also present. Acid phosphatase activity in rare muscle fibers was also detected, and represents probably a secondary degenerative process. By electron microscopy, enlarged mitochondria with disrupted or excessively branched cristae were seen. The present study presents a new experimental model of mitochondrial myopathy that may be useful for the best knowledge of this group of diseases and for experimental trials of drugs that could reverse the mitochondrial impairment in the mitochondrial myopathies.

Animals↗
PubMed1988

The excretory urogram bowel preparation--is it necessary?

A prospective randomized study was undertaken to determine whether prior bowel preparation improves the diagnostic quality of the excretory urogram. From August 1986 to May 1987, 107 outpatients having an excretory urogram on an elective basis were randomized into 3 groups: group 1 received castor oil, group 2 received x-ray preparation and group 3 received clear fluids 24 hours before the study. The quality of the bowel preparation and the excretory urogram was graded separately on a scale of 1 to 5. More than 71 per cent of the bowel preparations were graded as 4 (very good) or 5 (excellent) and more than 91 per cent of the films were graded as 4 or 5 in all 3 groups. The quality of the excretory urogram was graded as 5/5 in a greater number of group 3 cases. Patients reported a high incidence of side effects from both bowel preparations, while no adverse effects were reported from those in group 3. The administration of a bowel preparation compared to that of clear fluids alone made no difference to either the quality of the bowel preparation or the diagnostic quality of the film.

Adolescent↗