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PubMed1979

Diagnosis of gonorrhoea in women.

The results of Gram stains and cultures from 145 women with uncomplicated ano-genital gonorrhoea are presented. The site which gave the highest yield of gonococci was the cervix. Equally good results were obtained with Stuart's transport medium and direct plating in the clinic. Positive results from rectal specimens alone were obtained from 8.4% of the 119 women in whom the rectum was examined. In 89 women the results of rectal specimens taken through a proctoscope were compared with those of swabs passed blindly up the anal canal. When Stuart's transport medium was used swabs taken through a proctoscope gave better results than the swabs taken blindly; the latter gave more positive results when direct plating was used. Thus when Stuart's medium is used a proctoscope is essential for the collection of rectal samples. Up to three sets of investigations were carried out where necessary, but 95% of the 145 cases were diagnosed on the results of the first set. However, only 54% of those patients diagnosed at their first visit had positive Gram-stain results. Further refinement of culture results is unlikely to improve diagnostic yield; what is needed is better, rapid diagnosis in the clinic.

Anal Canal↗
PubMedDate not supplied

Survey of physicians' attitudes and practices in early cancer detection.

Most primary care physicians are already involved in some form of cancer detection in asymptomatic patients, and most say their involvement is increasing. With the exception of the proctoscopic examination and mammography, major detection procedures are being used with asymptomatic patients by a majority of physicians. In many instances, physicians' use of detection procedures does not conform with guidelines for the cancer-related checkup recommended by the American Cancer Society. Although they may disagree with some guidelines, most physicians agree they are generally helpful. Physicians disagree with guidelines for mammography, because they feel the cost of the test and radiation exposure associated with its use argue against patients' being tested annually, or being tested at all in the absence of symptoms. In contrast, belief that testing is needed at least once a year is the basis for physicians' disagreement with Pap test guidelines. Physicians also resist discontinuing use of the chest x-ray for early cancer detection, because they want to screen smokers annually. While there is substantial agreement on the value of proctoscopy in cancer detection in asymptomatic people, many physicians are not doing a proctoscopic exam if a patient's stool blood test is negative. Patient fear, discomfort, and the cost of testing influence physician decisions against proctoscopic examination. However, the growing interest in flexible sigmoidoscopy may change attitudes and influence practice toward more general use of proctoscopy. Primary care physicians widely support cancer education, both for the public and with patients in their own practice.

Adult↗
PubMed1975

Rectal biopsy in clindamycin-associated colitis. An analysis of 23 cases.

The findings on rectal biopsy and proctoscopic examination in 23 cases of clindamycin-associated pseudomembranous colitis are summarized. On proctoscopic examination, discrete 2- to 5-mm raised plaques are seen adherent ot an edematous, friable mucosa. Rectal biopsy shows pseudomembrane formation and inflammation of the underlying rectal mucosa. Necrosis of the surface epithelium is a frequent finding; however, true ulcers were not observed. Vasculitis or thrombosis is not a feature of any of the cases. Frequently, the pseudomembrane is observed to be dislodged from the mucosal surface. In five of 23 cases, characteristic pseudomembranes are not present in the biopsy specimen in spite of the fact that they are evident proctoscopically.

Adolescent↗
PubMed2002

Efficacy of Daflon in the treatment of hemorrhoids.

OBJECTIVE: To demonstrate the value of Daflon in the management of hemorrhoidal symptoms in Saudi patients attending the Surgical clinic. METHODS: This is a prospective clinical study of 105 consecutive patients suffering from hemorrhoidal problems including thrombosed piles. Detailed history and proctoscopic examination to determine position, size, and degree of hemorrhoids was conducted in all patients attending the Surgical Clinic at Dammam Central Hospital, Dammam, Kingdom of Saudi Arabia (KSA). The study was conducted over a 6-months period (December 2000 to May 2001). All were started on Daflon; 2 tablets twice daily for 4 weeks and were followed up weekly during the study period and proctoscopic examination was conducted at each consultation. RESULTS: The mean age was 35 (range 19-70) years. The majority (77%) suffered congested hemorrhoidal disease and only 8% had thrombosed piles. Previous surgery for piles was noted in 11%. Concomitant medical diseases were present in 10%. The degrees of piles were first degree (23 patients), 2nd degree (73), 3rd degree (9) and 4th degree (0). There was a statistically significant (p<0.001) improvement in pain, heaviness, bleeding, pruritus, and mucosal discharge from baseline to last visit. There was also a significant (p<0.001) improvement on the proctoscopic appearance. Five patients failed to improve on Daflon; therefore, they underwent surgery. The side effects of Daflon (mainly gastrointestinal symptoms) were encountered in 5 patients but did not force interruption of the medication. CONCLUSION: Daflon is a very safe and effective drug in the treatment of all hemorrhoidal symptoms in the population of Eastern KSA.

Adult↗
PubMed1993

Perceptions of colorectal cancer in a socioeconomically disadvantaged population.

This study examined 500 low socioeconomic adults' perceptions and practices regarding bowel cancer. At least 20 percent of respondents incorrectly believed homosexual men are more likely to develop bowel cancer, exercising regularly will not affect bowel cancer, bowel cancer does not run in families, and eating foods high in fat does not increase bowel cancer risks. Approximately 7 in 10 respondents did not perceive themselves as more susceptible to developing bowel cancer even though the same number of respondents acknowledged that poor people are more likely to develop bowel cancer. The majority (54 percent) believed that if you develop bowel cancer, it will kill you. The majority of respondents did not believe that fecal occult blood tests could help save their lives if they had bowel cancer since 90 percent perceived bowel cancer as incurable even if found early. The main barriers to screening for bowel cancer identified by the respondents were: being too embarrassed to have a proctoscopic exam (77%), not wanting to know if they had bowel cancer (78%), preferring to die rather than have their bowel removed for cancer (80%), and trouble with transportation (81%). Thirty percent of the respondents had personally done a stool occult blood test and the same number claimed they had a proctoscopic exam. The results of this survey indicate that there is considerable room for improvement in knowledge, perceptions, and practices of economically disadvantaged subjects regarding bowel cancer.

Adult↗
PubMed1990

Testing nicotine gum for ulcerative colitis patients. Experience with single-patient trials.

Epidemiologic studies have documented an association between nonsmoking and ulcerative colitis and case reports have demonstrated that symptoms improve with smoking and worsen with removal of a nicotine source. A double-blind randomized crossover trial for individual ulcerative colitis patients (single-patient trial, or N of 1 clinical trial) was designed to study the safety, patient acceptance, and the effectiveness of nicotine gum in improving patient symptoms and proctoscopic appearance of involved colon. Seven nonsmoking patients chewed up to 10 squares/day (20 mg) of nicotine gum or placebo gum for two weeks. Therapy was crossed-over every two weeks over the eight-week trial. Effectiveness was judged from comparisons between nicotine-gum and placebo-gum periods of patient self-reported symptoms at the conclusion of each two-week period using visual analog scales and proctoscopic appearance using ordered categorical scales. Three of seven patients, all three of whom were former smokers, demonstrated sufficient improvement without adverse effects to warrant institution of nicotine gum into their drug treatment regimens. Three patients demonstrated an uncertain response, despite tolerating the drug, and have not had nicotine gum added to their regimens. One patient could not tolerate the medication and was withdrawn from the study. No serious side effects were noted. We conclude that a randomized trial for an individual patient is a useful method for evaluating treatment regimens for ulcerative colitis and that nicotine gum may be effective therapy for individual patients with ulcerative colitis who demonstrate an objective response with few adverse effects.

Adult↗
PubMed1994

Development of invasive adenocarcinoma following colectomy with ileoanal anastomosis for familial polyposis coli. Report of a case.

PURPOSE: Proctocolectomy with ileoanal anastomosis has gained increasing acceptance for the prophylactic treatment of patients with familial polyposis coli. Long-term surveillance of the ileal pouch and the pouch-anal anastomosis has not been emphasized despite concern regarding retained rectal mucosa following the procedure. METHODS: A 34-year-old patient with a strong family history of familial polyposis coli was treated at 14 years of age by single-stage proctocolectomy with straight ileoanal anastomosis. Follow-up proctoscopic examinations revealed development of adenomatous changes at the ileoanal anastomosis. RESULTS: This report presents a patient with familial polyposis coli who developed invasive adenocarcinoma at the ileoanal anastomosis 20 years after proctocolectomy with ileoanal anastomosis. CONCLUSIONS: We stress the need for lifelong proctoscopic surveillance in patients with familial polyposis coli treated by proctocolectomy with ileoanal anastomosis.

Adenocarcinoma↗
PubMed2004

Pneumomediastinum after dilatation of anal stricture following stapled hemorrhoidopexy.

Stapling procedure is a new technique for the surgical management of prolapsing haemorrhoids. Some articles have reported severe adverse effects of this operation. We describe a case of an excessive staple-line stenosis followed stapled haemorrhoidopexy. Proctoscopic dilatation resulted in complications of retropneumoperitoneum, pneumomediastinum, subcutaneous emphysema and perianal abscess. Drainage of the abscess was performed, allowing quick recovery. After discharge from the hospital, the patient continued to perform periodic dilatation. Simple proctoscopic dilatation was conducted in an outpatient setting.

Abscess↗
PubMed1985

Radiation protection considerations for endocavitary X ray units.

Application of a contact X ray therapy unit for endocavitary irradiation of selected rectal carcinomas is gaining acceptance as a treatment of choice. The patient is placed on a proctoscopic table in the surgical suite and the anus is anesthetized and dilated to allow insertion of a 3 cm diameter proctoscope designed to admit the X ray tube. The measured half-value layer for 50 kVp X rays filtered by 1.0 mm of aluminum was determined to be 0.65 mm of aluminium. The dose rate at the end of the 4.0 cm source-skin-distance (SSD) cone was measured to be on the order of 1000 rad/minute. Radiation surveys performed for several treatment geometries indicate that exposure rate levels in the environs immediately around the patient can be quite high. Radiation measurements were made for the following locations: where the radiotherapist stands holding the X ray tube; at the side of the patient where the technologist or any supporting personnel might stand; and at the patient's posterior surface in the direction where the anesthesiologist might stand. Radiation levels ranged from 0.001 to 1.0 roentgen (R) per hour and depend primarily on the depth and angle of the X ray tube inserted into the rectum.

Brachytherapy↗
PubMed2005

Comparing measures of acute bowel toxicity in patients with prostate cancer treated with external beam radiation therapy.

PURPOSE: This study strives to compare early measures of bowel toxicity in patients with prostate cancer receiving definitive or adjuvant 3D conformal external beam radiation therapy and concurrent daily endorectal application of amifostine. METHODS: Eighteen patients were enrolled in the clinical study with a median follow-up of 12 months. Prescription doses ranged from 66 Gy to 76 Gy with a daily fractionation of 2 Gy. Acute bowel toxicity was measured at baseline, at Weeks 5 and 7 of radiotherapy, and at 1 and 3 months after the completion of therapy. Measures of acute bowel toxicity included the Radiation Therapy Oncology Group (RTOG) acute radiation morbidity scoring criteria, Expanded Prostate Cancer Index Composite (EPIC) self-assessment questionnaires, and proctoscopic examinations. RESULTS: The mean EPIC bowel scores changed significantly through the course of therapy and follow-up (p < 0.0001), with a progressive decrease in scores at Weeks 5 and 7 of treatment, a partial recovery at 3 months, and a correlation to the gold standard RTOG grade (p = 0.004). Proctoscopic toxicity scores were low, did not vary over time, and did not correlate with either EPIC or RTOG scores. CONCLUSION: The EPIC questionnaire measurements are most sensitive to changes in acute bowel toxicity through a course of radiotherapy and correlate with RTOG acute toxicity scores. Endoscopic examination of the rectal mucosa at the end and immediate follow-up of a course of therapy does not seem to be informative or reproducible between observers in the acute setting.

Aged↗
PubMed2004

Daflon for haemorrhoids: a prospective, multi-centre observational study.

BACKGROUND: Daflon, a phlebotropic agent, is of proven efficacy in the treatment of various venous disorders. Although it has been tried in the treatment of haemorrhoids, its efficacy in alleviating various haemorrhoidal symptoms has not been assessed properly. The aim of this study was to confirm the efficacy of Daflon in the treatment of haemorrhoidal symptoms. METHODS: Two hundred and sixty eight patients presenting with haemorrhoidal symptoms were recruited. This was a multicentre non-randomised observational study with no placebo arm. After establishing the extent of their symptoms and determining the position, size and degree of haemorrhoids by proctoscopy, all patients were started on Daflon, four tablets per day, in two divided doses for four weeks. Patients were seen weekly during the study period and carefully questioned as regard to symptoms, and a proctoscopy was carried out. RESULTS: There was a statistically significant improvement (p<0.001) in all haemorrhoidal symptoms (pain, heaviness, bleeding, pruritus and anal discharge) and in the proctoscopic appearance of the 'piles,' comparing baseline visit findings with the last visit four weeks after treatment with Daflon. CONCLUSIONS: Daflon has been shown to be effective in alleviating (variable degree) haemorrhoidal symptoms and improving the proctoscopic appearance of haemorrhoids. Therefore, it should be considered initially for patients presenting with haemorrhoidal symptoms. However, prospective randomised trials and longer follow-up are needed to confirm the findings of this study and delineate more precisely the role of Daflon in the management of haemorrhoidal disease

Adolescent↗
PubMed2005

Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case-control study.

BACKGROUND: Recently, outbreaks of anorectal lymphogranuloma venereum (LGV) have occurred among men who have sex with men (MSM). This study identifies risk factors and clinical predictors of LGV to determine the implications for clinical practice. METHODS: The Chlamydia trachomatis serovars for all MSM who had anorectal chlamydia diagnosed at a sexually transmitted infection clinic in Amsterdam, The Netherlands, in 2002 and 2003 were retrospectively typed; 87 persons were infected with C. trachomatis serovar L2b and received a diagnosis of LGV. MSM infected with C. trachomatis serovars A-K and who thus had non-LGV anorectal chlamydia (n = 377) and MSM who reported having receptive anorectal intercourse but who did not have anorectal chlamydia (n = 2677) served as 2 separate control groups. Risk factors and clinical predictors were analyzed by multivariate logistic regression. Receiver operating characteristic curves were used to determine clinical relevance. RESULTS: HIV seropositivity was the strongest risk factor for LGV (odds ratio for patients with LGV vs. those with non-LGV chlamydia, 5.7 [95% confidence interval, 2.6-12.8]; odds ratio for patients with LGV vs. control subjects without chlamydia, 9.3 [95% confidence interval, 4.4-20.0]). Proctoscopic findings and elevated white blood cell counts in anorectal smear specimens were the only clinically relevant predictors for LGV infection (area under the curve of the receiver operating characteristic curve, > 0.71). Use of these 2 parameters and HIV infection status provided the highest diagnostic accuracy (for MSM with anorectal chlamydia, the area under the curve was > 0.82; sensitivity and specificity were 89% and 50%, respectively). CONCLUSIONS: LGV testing is recommended for MSM with anorectal chlamydia. If routine LGV serovar typing is unavailable, we propose administration of syndromic LGV treatment for MSM with anorectal chlamydia and either proctitis detected by proctoscopic examination, > 10 white blood cells/high-power field detected on an anorectal smear specimen, or HIV seropositivity.

Adult↗
PubMed2006

A prospective study of outcome from rubber band ligation of piles.

OBJECTIVE: With the recent introduction of stapled anopexy it is timely to review the benefits of existing treatment options for piles. This study investigates the effectiveness and safety of rubber band ligation (RBL) of piles in the outpatient setting. PATIENTS AND METHODS: Two hundred and fifty-two consecutive patients referred with piles in an 18-month period were studied prospectively. In those patients deemed suitable for banding of piles, data were collected on symptoms, proctoscopic appearance and degree of piles. Short and long-term outcome data were recorded for success of treatment and complications. RESULTS: Of 203 patients considered suitable and who attended for RBL, 176 kept their follow-up appointment. One hundred and forty-eight (84%) had been rendered symptom-free. A third of patients, however, had proctoscopic evidence of persistent piles, whilst in half of those patients with continuing symptoms the anal cushions appeared normal. Six (3%) patients had suffered a complication. Long-term follow-up by questionnaire found that 44% of respondents remained asymptomatic at a median of 46 months from banding. Six (5%) of 117 responders to the questionnaire had, though previously normal, suffered a postbanding impairment of continence. CONCLUSION: Most patients with piles of any degree can be safely managed by rubber band ligation, but return of symptoms in the long term affects more than half of patients treated.

Adult↗
PubMed1982

Barium enema examination following biopsy of the rectum or colon.

A four-component study was designated to evaluate the possible risk of perforation during barium enema examination following biopsy of the rectum or colon. The study included a survey of gastrointestinal radiologists, an in vitro study of pig colons after biopsy, colon pressure measurements in human subjects, and histological analysis of human colonoscopic biopsy specimens. The results suggest that superficial biopsy of the rectum of colon performed with small colonoscopic forceps is a safe procedure and no waiting period is necessary before performing a barium enema study. However, biopsy of the colon or rectum with proctoscopic forceps appears to have greater potential for perforation and a waiting period between biopsy and barium enema study is recommended. Radiologists should distinguish between proctoscopic and colonoscopic biopsy procedures before determining when a barium enema study will be performed following biopsy.

Animals↗
PubMed2005

Formalin instillation for hemorrhagic radiation proctitis.

Although formalin instillation has been proven to be an effective treatment of hemorrhagic radiation proctitis, different techniques with varying success rates have been reported. The aim of this study was to assess our experience with formalin instillation for the treatment of radiation proctitis. After Institutional Review Board approval, all patients who presented with radiation proctitis and were treated with 4% formalin instillation were identified from a prospective database. Techniques of instillation were as follows: a formalin-soaked sponge stick was applied via a proctoscope (SS) and placed at each quadrant with a mean contact of 2.5 minutes (range, 0.5-3 minutes), or the formalin solution was introduced through a proctoscope in aliquots for a total of 350 to 400 mL irrigation (IR), with a mean contact time of 30 seconds in each aliquot. The patients were divided into two groups according to the method of formalin instillation and their outcomes were compared. Between March 1995 and September 2003, 21 patients who underwent formalin treatment were identified: 17 patients were in the SS and 4 patients were in the IR group. The mean age was 74.8+/-6.4 years and 70.5+/-6.8 years and the male/female ratio was 16:1 and 3:1 in the SS and IR groups, respectively. Indications for radiation therapy were prostate cancer in 19 patients: 16 (95.1%) SS patients and 3 (75%) IR patients. Four (23.5%) patients in the SS group were receiving anticoagulants or antiplatelet medications before the procedure. The mean duration of bleeding before formalin instillation was 11.7 months (range, 2-48 months) in the SS and 10.5 months (range, 7-12 months) in the IR group. Sixteen (94.1%) patients in the SS and 4 (100%) in the IR group had previous treatments for radiation proctitis, including hydrocortisone enema, 5-aminosalicylate mesalamine, and endoscopic coagulation. Eight (47.1%) patients in the SS and 2 (50%) in the IR group received a preprocedural blood transfusion, and 1 patient in the SS group required a blood transfusion after the formalin instillation. This patient subsequently underwent restorative proctosigmoidectomy because of persistent bleeding. The mean length of the procedure was 27.1+/-10.8 minutes in the SS group and 22.5+/-6.5 minutes in the IR group. The bleeding was successfully stopped on the first attempt in 14 patients (82.4%) in the SS group and 3 (75%) in the IR group. The instillation was repeated in 1 patient (5.9%) in the SS group and in 1 (25%) in the IR group. Four patients (23.5%) in the SS group experienced rectal pain after the procedure. One patient (5.9%) developed a new onset of fecal incontinence, while another (5.9%) had anococcygeal pain accompanied by worsening of fecal incontinence. One patient (25%) in the IR group developed acute colitis consistent with formalin instillation, which was managed by intravenous antibiotics. The patients were followed for a mean of 10 months (range, 1 to 38 months). Formalin instillation is effective in controlling refractory hemorrhage secondary to radiation proctitis.

Administration, Rectal↗
PubMed1982

Amebic colitis: correlation of proctoscopy before treatment and barium enema after treatment.

Twenty-seven patients with severe acute amebic dysentery were studied at the International Centre for Diarrhoeal Diseases Research Hospital in Dacca, Bangladesh. Patients were divided into two groups according to their pretreatment proctoscopic mucosal pattern. Those with mild lobular patterns (five patients) had a milder illness; posttreatment air-contrast barium enema examinations were normal except for subtle mucosal abnormalities in two (40%). In contrast, patients with necrotic ulceration proctoscopic patterns (22 patients) had a more severe illness; 19 (86%) had ulcerations, haustral abnormalities, and/or strictures demonstrated on posttreatment barium enema examinations. Persistent strictures were found in eight of 10 patients with necrotic ulceration patterns who had sequential barium enema examinations up to 9 months after treatment. These observations indicate that despite successful therapy with metronidazole, there is a high incidence of persisting colonic abnormalities in patients with the necrotic ulceration pattern. Since proctoscopy has a useful predictive value, it should be performed in all patients with severe amebic dysentery.

Barium Sulfate↗
PubMed2005

Contemporary applications of transanal endoscopic microsurgery: technical innovations and limitations.

PURPOSE: Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure used to transanally excise select benign and malignant tumors of the rectum. In properly selected patients, TEM can provide for decreased postoperative morbidity without compromising oncologic outcome. This report summarizes the recent literature concerning TEM, comprehensively analyzes the authors' experience with TEM, and describes recent technical innovations and indications. PATIENTS AND METHODS: Thirty-two consecutive patients scheduled for TEM were identified from our prospectively maintained colorectal service database. Clinicopathologic factors, postoperative complications, and oncologic outcomes were analyzed for all patients. In addition, a PubMed literature search was performed with use of the key words "transanal endoscopic microsurgery," "TEM," "rectal tumor," and "rectal cancer." RESULTS: Transanal endoscopic microsurgery was performed for rectal adenocarcinoma (n = 17; 53%), adenoma (n = 12; 38%), and carcinoid tumors (n = 3; 9%). Median tumor location was 9 cm from the anal verge (range, 3-15 cm). Of the 32 attempted TEM procedures, 27 (84%) were completed. Reasons for inability to complete TEM included narrow rectal lumen or contour of bony pelvis prohibiting passage of the operating proctoscope into the upper rectum and inability to maintain the proctoscope in the rectal lumen with carbon dioxide insufflation because of the distal location of the tumor. Innovations used in the excision of rectal tumors via TEM included the use of the harmonic scalpel, closure of the rectal defect with an extracorporeal slip knot, and a hybrid approach incorporating TEM and traditional transanal techniques. CONCLUSION: Transanal endoscopic microsurgery provides for low morbidity and does not appear to impair oncologic outcome in properly selected patients.

Adenocarcinoma↗
PubMed2002

Treatment of chronic bacterial prostatitis with amikacin through anal submucosal injection.

AIM: To assess the efficacy and safety of anal submucosal injection (ASI) of amikacin in chronic bacterial prostatitis (CBP). METHODS: Fifty male outpatients with CBP were randomly divided into two groups. Thirty cases of ASI group were given amikacin 400 mg daily by ASI for ten times and the other twenty cases of intramuscular injection (IM) group were given the same drug daily by IM. All patients were evaluated with NIH-Chronic prostatitis symptom index (NIH-CPSI), the bacteria culture of the expressed prostate secretion (EPS), proctoscopic examination, rectal biopsy and the clinical manifestation were checked at pretreatment and on day 7 and 90 after cessation of therapy. RESULTS: The cure rate, apparent effective rate and effective rate of ASI group and IM group were 33.3% vs 5% (P<0.05), 43.3% vs 10% (P<0.05) and 16.7% vs 20% (P>0.05), respectively. The score of NIH-CPSI in both of ASI group and IM group decreased significantly 7 days after cessation of therapy, both ASI and IM of amikacin could relieve symptoms within a short time. However, 3 months after cessation of therapy the score of NIH-CPSI in ASI group continued down in spite of no significant differences compared with 7 days after cessation of therapy, but the score of IM group was rebound nearly closed to level of pretreatment at 23.8 8.5 and significantly higher than that of ASI group. The amount of white blood cell (WBC) of EPS in ASI group increased slightly at 7 days after cessation of therapy without significant difference with pretreatment (P>0.05), but it significantly decreased at 3 months after cessation of therapy, the amount of WBC of EPS in ASI group was lower than that of IM group at 3 months after cessation of therapy (P<0.05). Proctoscopic examination of anal canal were normal after ASI therapy and the rectum biopsy showed no obvious histopathologic abnormality at the site of injection except mild focal submucosal infiltration of lymphocytes and plasma cells at 7 days after cessation of therapy which disappeared on 3 months after cessation of therapy. All patients had no evident complications. CONCLUSION: ASI could be recommended as a new safe, effective, painless method of antibiotics administration in the treatment of CBP.

Adult↗