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PubMed2003

[Nursing measures against adverse reaction from anti-cancer chemotherapy].

Combination chemotherapy for leukemia develops bone marrow suppression. Infection or hemorrhage disorders the treatment, and may influence the clinical result. The caring staff must understand the pathology of bone marrow suppression. Visitors observe the hospital rules. Foods are also limited, city water and uncooked foods are prohibited. To keep oral cavity clean, pretreatment of some decayed teeth, and frequent gargling with sterilized water are needed. Defecation control is important. Sitz bath or shower toilet is helpful. Hand cleaning is essential for before a meal, after defecation and after a going out. Bathing is fundamental to cleaning body. No bathing is dirty. Medical catheters are checked up every day. Thrombocytopenia(< 30,000/microliter) develops a spontaneous bleeding. Severe thrombocytopenia(< 10,000/microliter) does a fatal organ bleeding.

Antineoplastic Agents↗
PubMed2003

[Colostoma with reflex evacuation--a new approach in rehabilitation of stoma patients].

Involuntary evacuation of the stoma is the problem of social rehabilitation of stomed patients. In 17 patients during formation of colostoma reservoir-holding mechanism was created. Strain of parietal peritoneum led to subjective feelings predicting colostoma evacuation that were seen 10-20 min before defecation and presented as heaviness in projection of external end of stoma in 15 (88.2%) or elements of intestinal colic in 2 (11.8%) patients. This permitted 9 patients to control colostoma evacuation. Five (29.4%) patients demonstrated ability to control defecation for 10-15 min with tension of the muscles of the anterior abdominal wall.

Colorectal Neoplasms↗
PubMedDate not supplied

[The intestinal microflora of persons subjected to a radiation lesion].

The content of large intestine has been studied in persons exposed to radiation injury in consequence of the accident at the Chernobyl Atomic Power Plant. It is stated that bifidobacteria (10(7)-10(10) cells in 1 g of feces) prevailed (as in healthy people), Bifidobacterium indicum being a dominating species. Amount of lactic-acid bacteria in 1 g of defecations of examined patients was within the range of 10(6)-10(9) cells and in certain persons it reached 10(10) cells (primarily fecal Enterococci). A considerable amount of patients with acute radiation sickness of the 3d degree had in their intestine 10(9)/g of lactic-acid bacteria, Lactobacillus casei and L. plantarum prevailing there. The frequency of yeast isolation from defecations of patients constituted 83%, while the number of cells in 1 g of feces--from 10 to 10(4). Yeast of the Candida genus, mainly Candida parapsilosis, prevailed. The species composition of isolated microorganisms has no substantial differences from microcenosis of healthy people. The content of intestine of persons suffered from radiation is characterized only by greater amount of lactic-acid bacteria and enterococci as compared with healthy adults.

Accidents↗
PubMed2003

Irritable bowel syndrome in health care professionals in Pakistan.

OBJECTIVE: To evaluate the symptomatology of irritable bowel syndrome (IBS) among health care professionals attending an IBS symposium in a tertiary care university hospital. METHOD: A questionnaire designed to incorporate Manning and Rome II criteria was distributed among participants of an IBS symposium, most of them were health care professionals. A total of 100 questionnaires were distributed, 41 had symptoms fulfilling criteria of IBS. In these patients male: female ratio was 28:13 with age range 18-68. RESULTS: The predominant symptom was abdominal pain 87.8 % (36/41) which was aggravated post-prandially 72.2% (29/41), relieved following defecation in 87% (35/41) with a sense of incomplete evacuation 85.3% (35/41) and distention after defecation in 80.4% (33/41). Anxiety and depression was present in 80% (33/41) as an extraintestinal symptom. CONCLUSION: Irritable bowel syndrome is common in health care workers with intestinal and extraintestinal manifestations being equally common.

Adolescent↗
PubMed2003

[Cardiac arrest in severe acute respiratory syndrome: analysis of 15 cases].

OBJECTIVE: To investigate the causes for cardiac arrest in severe acute respiratory syndrome (SARS) patients. METHODS: Retrospective analysis of the epidemiological history, clinical presentation, the change of laboratory tests, chest radiography, and treatment of 15 SARS patients with cardiac arrest. RESULTS: The average age of the patients was 60 years. Eight had a history of exposure to SARS patients, among them 6 were household contacts. Eight patients had no underlying diseases, and another 8 complained of extreme anxiety. Abnormalities of cardiac enzymes were present in 10 patients. Myocardial ischemia and arrhythmia were present in 5 patients. Bilateral, multifocal lung infiltrates were present in 13 of the 15 patients. Four patients died after defecation and 9 died during relatively stable periods. CONCLUSIONS: It was suggested that the causes for cardiac arrest in SARS patients may include: (1) the lung injury caused by the SARS virus leads to hypoxemia and thus an unsteady state of the myocardial electricity; (2) SARS virus directly causes injury to the myocardial cells and/or the conduct system; (3) SARS infection aggravates the original myocardial pathological change, worsening the conduct block; (4) extreme anxiety leads to extra secretion of catecholamine, which causes instability of myocardial electricity; (5) defecation worsens hypoxemia, which induces arrhythmia (ventricular fibrillation) and causes cardiac arrest.

Adult↗
PubMed2003

[Clinical factors associated with response to biofeedback therapy for patients with chronic constipation].

BACKGROUND/AIMS: Biofeedback therapy has been widely used for the treatment of constipated patients. However, there are only a few reports about the clinical factors that can predict the effectiveness of biofeedback therapy. The aim of this study was to evaluate prognostic factors before the initiation of biofeedback treatment in constipated patients. METHODS: Biofeedback treatment was performed in 114 patients with constipation. After classifying the patients into two groups, responder and non-responder by subjective and objective parameters, univariate and multivariate analysis were performed to evaluate the factors associated with effectiveness of biofeedback therapy. RESULTS: Eighty-five patients (74.6%) responded to biofeedback therapy. Pre-treatment balloon expulsion test, paradoxical contraction on manometry, defecation index and anal residual pressure during straining were the factors that influenced the results of biofeedback treatment. On multivariate analysis, defecation index (odds ratio=67.5, p<0.05) and paradoxical contraction on manometry (odds ratio=0.053, p<0.05) were the factors that showed significant difference between the responders and non-responders. CONCLUSIONS: This study suggests that several pre-treatment prognostic factors are associated with response to biofeedback for the constipated patients. Using prognostic factors, we may be able to evaluate the patterns of pelvic floor dysfunction and responsiveness of biofeedback therapy for the patients with constipation.

Biofeedback, Psychology↗
PubMed2003

[Randomized controlled clinical study on effect of Chinese compound changjitai in treating diarrheic irritable bowel syndrome].

OBJECTIVE: To verify the clinical efficacy and safety of the proven Chinese Compound Changjitai (CJT), in treating the diarrheic irritable bowel syndrome (DIBS). METHODS: Randomized controlled open clinical trial design was adopted, 45 patients were randomly divided into two groups, CJT and pinaverium bromide (PVB) were given as treated and control agent respectively. IBS scoring system (BSS), defecation state questionnaire (DSQ) were used to record the changes of the patients' main symptoms before and after treatment. RESULTS: The total effective rate of CJT group was 83.3%, while that of PVB was 73.3%. CJT was superior in efficacy to that of PVB in improving stool quality, reducing defecation episodes of diarrheic patients, alleviating tenesmus symptoms, decreasing bellyache days and ameliorating abdominal distention. Any drug-related adverse reaction was not seen. CONCLUSION: The efficacy of CJT in treating DIBS is definite and without any toxic and adverse effects.

Adult↗
PubMed2003

[Clinical study of 102 cases of abdominal-anus resection with telescopic anastomosis of colon rectal mucosa for lower segment of rectal cancer].

OBJECTIVE: To investigate the reliability and feasibility of abdominal-anus resection with preservation of anal sphincter by telescopic anastomisis of colon rectal mucosa for middle-lower segment of rectal cancer. METHODS: A retrospective analysis was made for abdominal-anus resection with telescopic anastomosis of colon rectal mucosa in 102 cases of middle-lower segment of rectal cancer. RESULTS: No anastomotic fistula and anastomotic stenosis occurred in the 102 cases. The increased defecation was found during early stage of postoperation, about 6-12 times per day. But this was easily controlled by antidiarrheal drugs. Twelve to 18 weeks later, defecation returned to normal. Follow-up was performed in 91 patients, and the follow-up rate was 89.2%. Mean follow-up period was 4.7 years. Local recurrence rate of the carcinoma was 5.4% (5/91), and hepatic metastasis rate was 13.1% (12/91). Three-year survival rate of postoperation was 86.9% (60/80), and five-year survival rate was 70.7% (29/41). CONCLUSIONS: With telescopic anastomosis of colon rectal mucosa, colon stoma can be avoided, and anastomotic fistula can be prevented. The operation is safety and effective in preservation of anal sphincter for rectal cancer therapy.

Adult↗
PubMed2004

[Long-term outcomes of individualized biofeedback training based on the underlying dysfunction for patients with imperforate anus].

OBJECTIVE: Although better anorectal function was achieved due to the advanced operation procedures, the fecal incontinence and constipation still remain as major postoperative complications. The aim of this study was to design a individualized biofeedback program based on the underlying dysfunctions and to assess the short-term and long-term clinical and quality of life outcomes for patients with imperforate anus. METHODS: Thirty-one patients were treated using individualized biofeedback program according to their different dysfunctions after completed assessment of anorectal function. The many of special biofeedback training methods that consisted of the strengthening perianal muscles biofeedback, sensory discrimination biofeedback, synchronizing external sphincter contraction biofeedback and improving defecation dynamic biofeedback were selected to make up the individualized biofeedback training program. The clinical scores and quality of life scores were assessed at short-term and long-term follow-up. RESULTS: The clinical scores and quality of life scores in patients at before training group, after biofeedback training group, short-term follow-up group and long-term follow-up group were 3.2 +/- 1.1 and 8.7 +/- 1.1, 5.2 +/- 0.6 and 11.0 +/- 0.8, 5.0 +/- 0.6 and 10.8 +/- 0.9, and 4.6 +/- 0.7 and 10.0 +/- 0.7 respectively. After biofeedback training, the first leak volume and all parameters that evaluated the function of the perianal muscles were increased significantly, the abnormal rectal threshold sensations and defecation dynamics were reverted to normal, and 82% patients who have not external anal sphincter reflex acquired the new reflex. The latencies of pudendo-anal reflex have significant difference in patients with poor response compared with those patients with good response before and after the biofeedback training. At short-term follow-up 12 patients (57%) maintained the clinical outcome and only 9 patients (43%) have regressions slightly. At long-term follow-up 7 patients (33%) maintained the clinical outcome very well and 14 patients (67%) have regressions. Although the clinical and quality of life scores have decreased slightly at follow-up, they were still increased significantly compared with before biofeedback training group. CONCLUSION: The causes of postoperative fecal dysfunction in patients with imperforate anus are multifactorial, and the individualized biofeedback is more suitable for improvement of the clinical outcome and the quality of life, and it maintain good clinical outcome and quality of life at short-term and long-term follow-up.

Adolescent↗
PubMed2003

Rectal invagination due to rectal carcinoma--case report.

Rectal invagination has been considered an important cause of defecation difficulties and blockade (obstructed defecation). The most common the intra-rectal and intra-anal invagination is reported. In this paper authors present a case of a 61 year-old woman with intrarectal invagination due to 6.0-cm tumour localized in the rectum. The computed tomography and colonoscopy were performed for diagnosis of the rectal carcinoma. Histopathological analysis confirmed diagnosis. The patient was treated successfully with radiotherapy followed by rectal anterior resection with lymphadenectomy and adjuvant chemotherapy.

Carcinoma↗
PubMed2004

Surgical treatment of constipation.

Constipation is a common symptom in clinical practice. Definition of constipation includes abnormal bowel frequency, difficulty during defecation and abnormal stool consistency. There are many classifications of constipation based on constipation etiology (constipation in healthy people caused by life style, constipation as a symptom of digestive tract diseases, secondary constipation in the course of systemic disorders or associated with drugs) and/or constipation mechanisms (functional, mechanical). The numerous disorders leading to constipation make often diagnostic management difficult and complicated. Treatment of constipation includes dietary and behavioral approaches, pharmacologic therapy and in selected patient surgical treatment. Surgical treatment is recommended in young patients with severe slow transit constipation refractory to conservative treatment. Confirmation of indication to surgical treatment requires studies of colonic and anorectal function (colonic transit studies, anorectal manometry, studies of defecation). Preferred surgical technique is colectomy with ileorectal anastomosis. Authors reported good results and patient satisfaction in 50-100 percent of cases. Postoperative complications include intestinal obstruction, abdominal pain, flatulence, diarrhea.

Colectomy↗
PubMed2005

Relation between botulinum toxin and nitric oxide donors in the treatment of chronic anal fissure.

Although the pathogenesis of fissure is not fully understood, we do know that surgical and/or pharmacological sphincterotomy promotes the healing of chronic anal fissures. A number of studies support the hypothesis that local ischemia is the reason for failure to heal in anal fissure. Therefore, sphincterotomy may work because it decreases anal canal resting pressure and enhances microcirculation at the fissure site. The vasomotor tone of arterioles controlled by metabolic and endothelial factors determines perfusion of tissue and fissure healing. In a novel approach, this paper proposes mechanisms for nitric oxide synthesis, regulation and action in the internal anal sphincter. The design demonstrates the direct interdependence between the activity mechanisms of botulinum toxin and nitric oxide. Endothelial lining can modulate not only vascular tone but also internal anal sphincter (IAS) tone. The application of botulinum toxin likely releases the blockage in glyceryl trinitrate bioactivation in smooth muscle cells and suppresses basal continuous sympathetic activity, causing IAS relaxation. Sufficient distension of the IAS during defecation also reduces the risk of trauma during defecation and complication after the trauma. Both eruption of tissue in the fissure region and release of contraction vessel mediators tend to arrest fissure healing.

Anal Canal↗
PubMed2005

Acute rehabilitation program after laparoscopic colectomy using intravenous lidocaine.

BACKGROUND: The concept of postoperative acute rehabilitation was introduced to accelerate postoperative recovery and improve outcome. We investigated whether intravenous lidocaine infusion, which decreases postoperative pain and speeds the return of bowel function, can be used instead of epidural analgesia in an acute rehabilitation protocol for patients undergoing laparoscopic colectomy. METHODS: Twenty eight consecutive patients scheduled for laparoscopic colectomy were prospectively included in this case series study. Segmental colectomy was performed only for benign pathology. Intraoperative opioid use was restricted. After a bolus injection of lidocaine 1.5 mg x kg(-1), an infusion (2 mg x kg(-1) x h(-1), i.v.) was started before pneumoperitoneum. Balanced analgesia was used to reduce postoperative opioid consumption. Patients were allowed to drink 6 h postoperatively. The day after surgery, patients were allowed to eat a normal breakfast. Enforced mobilisation and ambulation were required from the patients. Our goal was to discharge patients within 3 days after surgery. Postoperative pain was measured. Time to first flatus, defecation, and hospital discharge were recorded. RESULTS: Mean postoperative pain at rest and mobilisation remained below 30 mm on a 100 mm visual analogue scale. Time to first flatus, defecation, and hospital discharge were 29 +/- 13 h, 38 +/- 13 h, and 3.0 +/- 1.0 days, respectively. CONCLUSION: Acute rehabilitation after laparoscopic colectomy using i.v. lidocaine gives similar outcomes to those reported using epidural analgesia.

Anesthetics, Local↗
PubMed2005

[Importance of three triatoma vectors of Trypanosoma cruzi in Mexico].

Observations made in the field and in the laboratory on three vectors of Trypanosoma cruzi: Triatoma barberi, T. pallidipennis and T. dimidiata are here presented. Results are compared in relation with their ecotopes, vectorial capacity, biological characteristic, entomological indexes and capture places. In relation with their ecotopos T. barberi has preference for the interior of the human home, in walls, directly in contact with beds; T. pallidipennis, when it is inside the houses, prefers floors and among clothes, although their main ecotope is wild; T. dimidiata has localization in floors, specially under the beds, in the angle between wall and floor; T. barberi and T. dimidiata are attracted by the light. The cycles of life were of 523, 171 and 510 days, respectively for Triatoma barberi, T. pallidipennis and T. dimidiata. The vectorial capacity was determined according to the time taken in defecating during or after its sucking blood: T. barberi defecates during its feeding, while T. pallidipennis and T. dimidiata make it from 10 to 20 and of 20 to 30 minutes after starting the process, respectively. The indexes of natural infection were of 56.6 for T. barberi, 29 for T. pallidipennis and 15.6 for T. dimidiata, The metacyclogenics indexes that indicate percentages of metacyclics trypomastigotes in later intestine of vectors was in T. barberi 76.6, T. pallidipennis 15 and T. dimidiata 26, with what it can be concluded that the first species is the best transmitter of T. cruzi in Mexico.

Animals↗
PubMedDate not supplied

[Efficacy of topical use of 0.2% glyceryl trinitrate in reducing post-haemorrhoidectomy pain and improving wound healing].

The aim of the study was to evaluate whether topical application of 0.2% glyceryl trinitrate ointment could reduce post-haemorrhoidectomy healing time and pain both at rest and during defecation. Thirty patients with grade III and IV haemorrhoids were included in the study and divided into two groups. All patients underwent Milligan-Morgan haemorrhoidectomy, and anorectal manometry was performed before surgery and after 5 and 30 days. In one group a placebo ointment was applied to the perianal wounds, while in the other group a 0.2% glyceryl trinitrate ointment was used. Maximum resting pressure was reduced in the glyceryl trinitrate group and increased in the placebo group after 5 days. Postoperative pain both at rest and during defecation, and the time to healing and return to normal activity were significantly reduced in the glyceryl trinitrate group, whilst analgesic consumption was similar. An elevated incidence of headache was observed In the glyceryl trinitrate group. Topical application of glyceryl trinitrate was effective in reducing postoperative pain and healing time, but the substantial incidence of side effects may limit its extensive use.

Administration, Cutaneous↗
PubMedDate not supplied

Early oral feeding should be resumed following the resolution of gastric ileus.

BACKGROUND/AIMS: The main aim of the study was to assess the feasibility of early mobilization and early feeding following the resolution of gastric ileus in patients who have elective open colonic surgery. METHODOLOGY: This was a randomized controlled trial of patients who were assigned to one of the following two groups. Group 1: patients were encouraged to mobilize postoperatively. A radiopaque marker was given orally on the first postoperative morning and X-ray film was taken daily until more than 70% of the markers had been emptied out of the stomach. Then patients received a diet regardless of flatus or defecation. Group 2: patients were not enforced to mobilize and allowed a diet following flatus or defecation. RESULTS: No significant differences were noted in age, sex, and type of procedures in either group. No patient in group 1 vomited postoperatively, while postoperative time to oral diet was significantly shorter than that to the resumption of bowel function. No significant difference was seen in the incidence of complications. The time to first flatus in group 1 (median, 48 hours) was significantly shorter than that in group 2 (median, 67 hours). The length of hospitalization in group 1 (median, 7 days) was significantly shorter than that in group 2 (median, 10 days). CONCLUSIONS: Early mobilization and early feeding following the resolution of gastric ileus is safe and feasible without vomiting in patients who have elective colonic surgery.

Adult↗
PubMedDate not supplied

Role of anorectal myectomy in the treatment of short segment Hirschsprung's disease in young adults.

Basic pathological disorder in Hirschsprung's disease (HD) comes into being by the abnormal innervations of the aganglionic distal intestine. The nonserious forms of this congenital disease may reach the young by proceeding with chronic, obstinate constipation that does not respond to diet. Myectomy of the short segment of aganglionic part may provide diagnostic and therapeutic value. Between 1993 and 2003, anorectal posterior myectomy was performed in 19 patients diagnosed with HD. The mean age of patients was 23 years. Previous or concomitant anterior resection was added to the procedure in seven cases due to dolicomegacolon. In addition to the deficiency of anorectal inhibitor reflex (ARIR) among all patients, the frequency of defecation was 12.5 days (range, 6-30 days) before operation. Anorectal length before widening was an average of 5.5 cm (range, 2-8 cm). All pathologic specimens were found to be aganglionic. Postoperatively, the mean of first regular defecation interval was 1.5 days (range, 1-3 days). Involution of rectum was evaluated with a rectal examination and barium enema X-rays during follow-up. ARIR of patients also returned to normal. In conclusion, anorectal posterior myectomy is an effective operation in diagnosis and treatment of short-segment HD. Furthermore, colon resection annexed to this operation, in the condition of dolicomegacolon, is also used to remove obstinate constipation.

Adolescent↗
PubMed2006

Phloroglucinol in irritable bowel syndrome.

OBJECTIVE: To determine the efficacy and tolerability of phloroglucinol, an antispasmodic agent in the treatment of Irritable Bowel Syndrome (IBS). METHODS: It was an open label (quasi interventional) study. One hundred patients coming to the gastroenterology clinics of Aga Khan University Hospital with IBS as defined by the Rome II criteria were enrolled between February 2004 and September 2004 to participate in the trial and were treated as outpatients. Phloroglucinol (Himont) 50mg orally three times daily was given for two months. Symptoms were assessed before and during treatment using a questionnaire. RESULTS: One hundred patients were enrolled in the study. Of them 61% (61/100) were males and 39% (39/100) were females. Their mean age was 41 +/- 14 years. Sixty-eight patients completed the study and 28 dropped out. On Phloroglucinol treatment there was an overall statistically significant improvement in abdominal pain (p<0.001), frequency of stools per day (p<0.001), urgency (p<0.001), passage of mucus per rectum (p<0.001), sense of incomplete defecation (p=0.001) and bloating (p=0.001). However, no response was seen in the feature of straining in both genders (p=0.676). The difference in response to treatment according to gender separately showed statistically significant improvement in the sense of incomplete defecation in females alone (p=0.003). CONCLUSION: Phloroglucinol in a dose of 50mg three times daily is effective and well tolerated by the IBS patients. It relieves most of the symptoms of IBS.

Administration, Oral↗