OBJECTIVETo investigate the application value of colonic transit test (CTT) combined with anorectal manometry (ARM), barium enema (BE) and defecography (DFG) in accurately evaluating colonic lesions of slow transit constipation complicated with adult megacolon.

METHODSClinical data of 47 above patients admitted between October 2007 and February 2015 in the People's Hospital of Hunan Province were analyzed retrospectively. All the patients were examined with≥2 times of CTT combined with ARM and BE, and 42 cases received additional DFG at the same time, to evaluate colonic lesions before operation. Operative biopsy pathology was used as the standard. The sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of positioning in the ascending colon and caecum, transverse colon and descending colon were calculated, and the consistency was represented by Kappa test(Kappa value≥0.75 indicates good consistency, meanwhile higher Kappa value indicates better consistency). The Heikkinen score was used to evaluate defecation function at postoperative 6 months.

RESULTSThe age of 47 patients was from 18 to 56 years old. Compared with intraoperative findings and biopsy pathology, the diagnostic coincidence rate was 89.4% by CTT combined with BE and DFG positioning, which suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=12), transverse colon (n=26) and descending colon (n=9), while intraoperative findings and biopsy pathology suggested pathology-changed colonic segment locating in the ascending colon and cecum (n=11), transverse colon (n=23) and descending colon (n=13). The sensitivity was 88.3%, specificity 93.5%, PPV 92.1%, NPV 94.9% and Kappa value was 0.827(P<0.001). Procedures performed included segmental colectomy (n=8), subtotal colectomy (n=29), total colectomy (n=10). There was no serious complication during and after operation. Defecatory function was excellent in 24 cases (60.0%), good in 10 (25.0%), and moderate in 6 (15.0%) evaluated by Heikkinen score at postoperative 6 months. A total of 40 patients were followed up from 1 to 7 years (median 3 years) and there was no long-term diarrhea and recurrence of constipation or giant colon after operation.

CONCLUSIONPreoperative detection of CTT combined with ARM, BE and DFG in patients with slow transit constipation complicated with adult megacolon can make a more precise assessment of the extent of colonic lesions in advance, which has a good clinical predictive value.

Adolescent ; Adult ; Barium Enema ; Cecum ; pathology ; physiopathology ; surgery ; Colectomy ; methods ; Colon ; pathology ; physiopathology ; surgery ; Constipation ; complications ; diagnosis ; pathology ; surgery ; Defecography ; Female ; Gastrointestinal Transit ; physiology ; Humans ; Male ; Manometry ; Megacolon ; complications ; pathology ; surgery ; Middle Aged ; Predictive Value of Tests ; Preoperative Period ; Prognosis ; Recovery of Function ; physiology ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND/AIMS: A colon transit time test using radio-opaque markers (CTTRM) is considered the gold standard for evaluating colon transit function. A 24-hour delayed film of barium enema (BE) has been used as a supplementary method in structural evaluations. The aim of this study was to evaluate the utility of a 24-hour delayed BE film for assessing colon transit function in young children with constipation. METHODS: In total, 93 children with constipation who performed both single-contrast BE and CTTRM were enrolled in this study. Of these, the data from 70 children were analyzed (males 33, females 37; mean age [range], 5.63 ± 2.94 [2-14] years). The basic principle of the study is "velocity = distance/time". Time values were identified in both studies, and the colon length and distance of barium movement were measured on the 24-hour delayed BE film. Thus, colon transit velocity values could be calculated using both methods. The correlation between colon transit velocity using a 24-hour delayed BE film versus CTTRM was analyzed statistically. RESULTS: Median value (interquartile range) of colon transit velocity using CTTRM was 1.57 (1.07-2.89) cm/hr, and that using BE of that was 1.58 (0.94-2.07) cm/hr. The Spearman correlation coefficient was 0.438 (P < 0.001) for the overall group. The correlation was strongest in children younger than 4 years (r = 0.537, P = 0.032). CONCLUSIONS: Although the correlation between BE and CTTRM was not very strong, the 24-hour delayed BE film could provide broad information about colon transit function in young children, especially those under 4 years who usually cannot undergo CTTRM.
Barium* ; Child* ; Colon* ; Constipation* ; Enema* ; Female ; Humans ; Methods

OBJECTIVETo investigate the efficacy and mechanisms of Bawei Xilei Powder (BXP) in treating ulcerative colitis (UC).

METHODSTotally 103 patients with left hemicolon mild to moderate UC in the active phase at the outpatient clinics of West China Hospital from June 2009 to October 2010 were randomly assigned to the treatment group (55 cases) and the control group (48 cases). Patients in the treatment group were treated with BXP (adding 1 g in 60 mL worm boiled water) and those in the control group received by 50 mg/60 mL hydrocortisone edema solution (once every evening before sleep). The therapeutic course for all was 4 weeks. The disease activity degree (Mayo scoring), endoscopic, and histologic manifestations were compared between post-and pre-treatment in the two groups. The expression of toll-like receptor-4 (TLR4), nuclear factor-kappaB (NF-kappaB), and Occludin were detected.

RESULTSThe clinical remission rate and the response rate in the treatment group were 78.2% and 89.1% respectively, higher than those of the control group (58.3% and 72.9%, P < 0.05).The endoscopically mucosal healing rate was 50.9% in the treatment group and 31.3% in the control group (P < 0.05). The histological remission rate and the effective rate in the treatment group were 32.7% and 65.5% respectively, but higher than those of the control group (27.1% and 58.3%, P > 0.05). The rate of adverse events was 3.8% in the treatment (occurred in 2 cases) and 4.3% in the control group (occurred in 2 cases, P > 0.05). Compared with pre-treatment, the expression of TLR4 and NF-kappaB p65 significantly decreased (P < 0.05), while the expression of Occludin significantly increased (P < 0.05).

CONCLUSIONSBXP was effective and safe in patients with active mild to moderate UC. Its effects might be involved in regulating the expression of inflammatory factors and enhancing mucosa barrier functions. ulcerative colitis; Bawei Xilei Powder; enema therapy

Colitis, Ulcerative ; drug therapy ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Enema ; Humans ; NF-kappa B ; metabolism ; Occludin ; metabolism ; Phytotherapy ; methods ; Toll-Like Receptor 4 ; metabolism

PURPOSE: Transrectal ultrasound (TRUS)-guided biopsy of the prostate is usually safe. However, some patients are hospitalized owing to complications from TRUS biopsy. We identified the risk factors for complications and effective preventive measures for treating complications after TRUS biopsy. MATERIALS AND METHODS: Medical records and radiological images of 1,083 patients who underwent TRUS biopsy of the prostate over 10 years in Gyeongsang National University Hospital were examined retrospectively to investigate the correlation between complications after TRUS biopsy and preventive antibiotics, prebiopsy enema, number of biopsy cores, and pathological findings. RESULTS: Complications occurred in 69 patients (6.4%). The complication rates of the 1,008 patients who received antibiotics and the 75 patients who did not were 6.3% and 8.0%, respectively (p=0.469). Complication rates of the pre-biopsy enema group (n=658) and the group without prebiopsy enema (n=425) were 4.7% and 8.9%, respectively (p=0.007). Complication rates of the 6-core biopsy group (n=41) and the 12-core biopsy group (n=955) were 7.3% and 6.3%, respectively (p=0.891). Complication rates of the prostate cancer group (n=306) and the no prostate cancer group (n=713) were 6.2% and 6.6%, respectively (p=0.740). CONCLUSIONS: A prebiopsy enema was associated with a reduced risk of complications after TRUS biopsy. Preventive antibiotics, number of biopsy cores, and pathological findings did not significantly influence the complication rate.
Aged ; *Endosonography ; Enema/*methods ; Humans ; Image-Guided Biopsy/*adverse effects/methods ; Incidence ; Male ; Prostatic Neoplasms/*pathology ; Prostatitis/epidemiology/etiology/*prevention & control ; Rectum ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Syncope, Vasovagal/epidemiology/etiology/*prevention & control ; Urinary Retention/epidemiology/etiology/*prevention & control

OBJECTIVETo compare the impact of traditional and fast bowel preparation on the changes of gut flora in the patients following colorectal resection.

METHODSSixty patients undergoing colorectal resection from March 2010 to March 2011 in the Nanfang Hospital were randomly divided into the control group(n=27, 3 days of bowel preparation) and the experimental group(n=33, 1 day of bowel preparation). Fresh feces were collected before bowel preparation and on the first defecation after surgery. The postoperative changes in gut flora and septic complications were observed.

RESULTSGut flora disturbance was found in both groups. The postoperative population of Bifidobacterium and Lactobacillus decreased significantly(P<0.05), and the decrease was more significant in the experimental group compared to the control group(P<0.05), while E.coli and Staphylococcus were much higher than the preoperative level(P<0.05), which was more significant in the control group. The incidence of postoperative infection was 9.1%(3/33) in the experimental group, which was significantly lower than 29.6%(8/27) in the control group(P<0.05).

CONCLUSIONFast bowel preparation is effective in reducing gut flora disturbance and the incidence of postoperative infection.

Colorectal Neoplasms ; microbiology ; surgery ; Digestive System Surgical Procedures ; Enema ; methods ; Feces ; microbiology ; Female ; Humans ; Male ; Microbiota ; Middle Aged ; Postoperative Period ; Preoperative Care ; Prospective Studies

In the past several years of 21 century, there are many updates of concepts on the diagnosis and treatment of colorectal cancer, which indicates the era of experience-based medicine has been gradually replaced by that of evidence-based medicine. Despite emerging evidence from randomized controlled trials(RCT) and meta-analyses questioning its use, concurrent suggestion on the indication of preoperative bowel preparation has not been reached. The authors agree with the opinion of The Huang Jia-si Textbook of Surgery(7th Edition). Preoperative bowel preparation should be emphasized before the consensus is confirmed, though there are so many trials showing that bowel preparation before elective colorectal surgery was unnecessary. In the authors' consideration, compared with the Westerner, the Chinese prefer to the food style of low fat and high cellulose, which would make more food residue. So whether the oversea finding of the preoperative bowel preparation is fit for the colorectal patients in China is questioned. Therefore large-sample, multi-centre, prospective RCT is expected to be carried out by the national academic organization, by which high-ranking evidence suitable for the Chinese could be obtained.
Colorectal Surgery ; Elective Surgical Procedures ; Enema ; adverse effects ; methods ; Humans ; Preoperative Care

OBJECTIVETo study the clinical efficacy of Chinese herbal retention enema combined with intrauterine douching for patients with endometritis diagnosed by hysteroscopy. They failed in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) treatment.

METHODS131 patients received hysteroscopy after they failed in routine IVF/ICSI-ET treatment. Of them, 66 patients diagnosed as endometritis were enrolled as the test group and 65 patients without endometritis were enrolled as the control group. Chinese herbal retention enema combined with intrauterine douching was performed on patients in the test group before the next IVF/ICSI, while direct IVF/ICSI was performed on those in the control group. The embryo implantation rate and the clinical pregnancy rate were compared between the two groups.

RESULTSThe clinical pregnancy rate and the embryo implantation rate were 48.5% and 24.2% respectively, while they were 29.2% and 14.9% respectively in the control group, showing significant difference (P < 0.05).

CONCLUSIONChinese herbal retention enema combined with intrauterine douching could improve the embryo implantation rate and the clinical pregnancy in patients with endometritis.

Adult ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Embryo Transfer ; Endometritis ; therapy ; Enema ; methods ; Female ; Fertilization in Vitro ; Humans ; Hysteroscopy ; methods ; Pregnancy ; Pregnancy Rate ; Sperm Injections, Intracytoplasmic ; Therapeutic Irrigation ; methods ; Treatment Failure

OBJECTIVETo discuss the value of multi-slice CT dynamic enhancement scan in the diagnosis and treatment of colonic lymphomas.

METHODS16 patients with colonic lymphomas underwent multi-slice CT dynamic enhancement scans, images of axial and reconstructive images of VR, MPR and CTVE were analyzed, patients were respectively diagnosed.

RESULTSAppearances of primary colorectal lymphomas were categorized into focal and diffuse lesions. Focal and diffuse lesions were 6 and 10 patients, respectively. The accuracy rate of diagnosis was 87.5%.

CONCLUSIONMSCT dynamic scan has distinctive superiority in diagnosis and treatment of colonic lymphomas.

Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Barium Sulfate ; Child ; Colon ; diagnostic imaging ; drug effects ; surgery ; Colonic Neoplasms ; diagnosis ; drug therapy ; surgery ; Colonoscopy ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Enema ; Female ; Humans ; Lymphoma, B-Cell ; diagnosis ; drug therapy ; surgery ; Male ; Middle Aged ; Prednisone ; therapeutic use ; Radiographic Image Enhancement ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, Spiral Computed ; methods ; Vincristine ; therapeutic use

Recently, the availability of multidetector-row CT (MDCT) and continuous refinement in three-dimensional (3D) imaging process have greatly expanded the role of CT in evaluating patients with gastrointestinal diseases. MDCT is the latest advancement in CT technology and is now more readily available. This imaging modality can offer full examination of the entire intestinal tract as well as powerful information about the bowel itself and its surrounding structures, which are inherent advantages of CT over conventional barium or optical endoscopic studies. In most cases, MDCT with various 3D technologies can make an easy, rapid, and accurate diagnosis by one-stop imaging, and enables to avoid other examinations. Therefore, knowledge and awareness of valuable clinical applications and proper scan technique of MDCT imaging is essential to achieve the diagnostic goal of one-step imaging.
Barium Sulfate/diagnostic use ; Colonic Neoplasms/diagnosis/radiography ; Colonic Polyps/diagnosis/radiography ; Colonography, Computed Tomographic/instrumentation/*methods ; *Enema ; Humans ; Imaging, Three-Dimensional ; Tomography, Spiral Computed/instrumentation/*methods

OBJECTIVESTo investigate the feasibility and safety of one-day bowel preparation for colorectal surgery.

METHODSForty patients undergone colorectal surgery were divided randomly into the Control group and the Experimental group and received 3-day magnesium sulfate and 1-day sodium phosphate bowel preparations before the operation, respectively. The levels of hemoglobin, hematocrit, serum electrolytes, and anaerobe counts in the stool prior and post bowel preparation were examined. The general status, surgical complications, and structure of intestinal mucosa in the patients were observed after the operation.

RESULTSThere was no significant difference in the anastomoses healing, infectious complications, serum tests and intestinal mucosa structures between the two groups. Less diarrhea occurred prior and post the surgery in the experimental group, and they felt better with the bowel preparation. The anaerobe counts in stool were higher after the bowel preparation than before in both groups.

CONCLUSIONSOne-day bowel preparation with sodium phosphate is a safe and reliable method for colorectal surgery. The shortening of preparation time can reduce the degrees of uncomfortable feeling and disruptions of intestinal micro-ecology and barrier.

Colorectal Neoplasms ; surgery ; Enema ; Humans ; Intestinal Mucosa ; drug effects ; microbiology ; Magnesium Sulfate ; administration & dosage ; Middle Aged ; Phosphates ; administration & dosage ; Postoperative Complications ; Preoperative Care ; methods ; Prospective Studies