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The efficacy of betamethasone 17-valerate (5 mg) and prednisolone 21-phosphate (20 mg) retention enemata in the outpatient treatment of distal proctocolitis was compared in a formal clinical trial. The two treatments were equally effective in inducing remissions of the disease, but the betamethasone valerate enema produced less adrenal suppression.
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Radiation risk is estimated from the values on radiation risk of the International Council on Radiation Protection and from our own measurements. According to these, 1 malignant growth induced by radiation is found in about 160,000 urograms, 300,000 contrast enemata or 500,000 contrast meals. In radiodiagnosis of the central nervous system the values for carotid angiograms is about 60,000, for vertebral angiograms about 16,000, for computer tomography about 50,000 and about 500,000 examinations of the skull in two planes. A mutation-induced deformity due to radiation occurs in about 4,300--26,000 colon contrast enemata, about 43,000 to 280,000 contrast meals and about 41,000 respectively 14,000 urograms in men and women in the reproductive years.
The medication prescribed for 269 mentally handicapped hospital residents aged 60 years and over on 1 January 1987, including five with Down's syndrome, and for 31 residents aged 50 years or over with Down's syndrome was analysed.Fifty of the 269 elderly residents were receiving no medication but the mean number of prescriptions for the remaining 219 was four. Of the total sample of 269 residents, 32% were taking drugs for psychiatric and psychological disorders; 11% regular antiepileptic drugs; 62% long-term drugs for other problems (diuretics and laxatives were the most common); 29% had long-term prescriptions for topical preparations, enemata or suppositories; 23% were on shortterm prescriptions for other problems; and 17% had short-term prescriptions for topical preparations, enemata or suppositories. For the 31 Down's syndrome residents the commonest prescriptions were for skin preparations.Particular care is needed in making a diagnosis and monitoring the effects of treatment on mentally handicapped patients because a complete history and full cooperation on examination may not be forthcoming. These findings have implications for primary health care teams who will be responsible for the mentally handicapped when hospitals close and the residents live in the community.
OBJECTIVES: To document the changes in bowel habit in patients who have undergone enterocystoplasty. PATIENTS AND METHODS: Sixty-nine patients with neuropathic (NP) and 44 with non-neuropathic (NNP) bladder dysfunction (mean age 26 years, range 13-61, 93.6% socially continent), followed for at least 36 months after cystoplasty, were assessed using a questionnaire addressing faecal frequency, consistency, method of evacuation and incontinence episodes before and after surgery. RESULTS: Of the patients with NP bladder dysfunction, 26 (38%) had more and seven (10%) less frequent bowel action after surgery, with 36 (52%) unchanged; 38 (55%) of patients had unchanged consistency, 26 (38%) were looser and five (7%) more constipated; 41 (59%) opened their bowels as before, 16 (23%) needed more help and 12 (17%) less help to evacuate; 16 (23%) patients had more and 17 (25%) less episodes of incontinence; 21 (30%) patients felt their bowels had not become normal after their operation and only 24 (35%) that they had returned to normal within 3 months of their operation. The bowel segment used was ileum in 44 patients, ileocaecal in 11 and sigmoid cystoplasty in 14. Patients with intact ileum did not have the same degree of diarrhoea, with only three of the 14 patients with a sigmoid cystoplasty being adversely affected. Of the patients with NNP bladder dysfunction, 18 patients (41%) had a more and five (11%) a less frequent bowel action; 20 (46%) had more loose and five (11%) less loose bowel action; similar numbers (five and four) needed either an increase or a decrease in laxatives or enemata: surprisingly, 12 patients (27%) felt they had an increase in the episodes of incontinence; 17 (39%) patients felt their bowels returned to normal within 3 months of surgery and 30% felt their bowels had not become normal after surgery. Only one patient in this group had a sigmoid cystoplasty and she did not find that the operation interfered with her bowel function. CONCLUSIONS: Ileal resection results in malabsorption of bile acids, maldigestion of fat and an imbalance of water and electrolytes. Patients with neurogenic bladders are finely balanced between acceptable bowel function and choas, and surgery often tips this balance the wrong way. In 30% of the present patients, bowel problems persisted after surgery, with 38% having increased frequency. 38% having looser consistency and 23% more incontinence episodes following surgery. More surprisingly, a high percentage of NNP patients had bowel problems after cystoplasty.