Role and significance of pelvic four-contrast defecography in the diagnosis of outlet obstructive constipation / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the changes in pelvic floor morphology and relationships of the pelvic organs in patients with outlet obstructive constipation (OOC).</p><p><b>METHODS</b>Fifty-nine OOC patients and 12 healthy volunteers were examined by simultaneous pelvic four-contrast defecography, including pelvicography, vaginal opacification, voiding cystography and defecography. The levels of perineum, peritoneum and bladder, and anorectal angle were measured and recorded.</p><p><b>RESULTS</b>Among the 59 OOC patients, 46 cases of internal rectal prolapse (IRP), 29 cases of pelvic floor hernia, 7 cases of rectocele (RC), 7 cases of spastic pelvic floor syndrome (SPFS), 5 cases of descending perineum syndrome were diagnosed by pelvic four-contrast defecography. Six cystoceles and 10 uterine prolapses were also found by pelvic four-contrast defecography. Compared with healthy volunteers, OOC patients had significantly large anorectal angles during defecation (P<0.05), abnormality descending of perineum during rest and defecation (P<0.05, P<0.01), and a deep pouch of Douglas during defecation (P<0.01). OOC patients combined with urinary system symptoms had an abnormal descent of the bladder during rest and defecation (P<0.05, P<0.01).</p><p><b>CONCLUSION</b>Pelvic four-contrast defecography is an effective method for the diagnosis of IRP, RC, pelvic floor hernia, peritoneocele, cystocele and uterine prolapse, and is helpful in the selection of proper surgical procedures for the treatment of OOC.</p>

Image analysis of puborectalis syndrome and its clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical value and application range of defecography, CT and MRI in diagnosis of puborectalis syndrome (PRS).</p><p><b>METHODS</b>The clinical data of 83 PRS patients, including defecography, CT and MRI scanning in pelvic floor resting and defecation at maximum exertion, measurement of anorectal angle (ARA), length and depth of ARA impression and the thickness of the puborectalis muscle, were collected, and compared with those of 56 normal persons.</p><p><b>RESULTS</b>For normal persons, ARA at maximum exertion was more significantly increased than that at resting. In 62 cases with PRS, ARA at maximum exertion was more obviously reduced than that at resting and associated with puborectalis muscle (PRM) impression. In the other 21 cases, ARA showed no changes at either maximum exertion or resting, a little or no excretion of barium appeared and "shelving syndrome" was showed. The cross-sectional images of CT and MRI showed that the puborectalis of PRS patients were thicker than that of normal persons (P<0.01). PRS patients also showed clear pelvic floor muscle, fasciae and peripheral crevice.</p><p><b>CONCLUSIONS</b>Defecography, manifested the abnormal function of the puborectalis muscles, is a reliable method for diagnosis of PRS. In the meantime, CT and MRI are able to clearly display the position, growth status and size of the puborectalis muscles as well as its relation with adjacent structures, which provide further understandings on anatomical changes, abnormal adjacent structure and other functional diseases of pelvic floor in PRS patients. Therefore, an appropriate combination of the 3 methods play an important role in the early diagnosis of PRS and guidance for surgical treatment.</p>

Comparative study between dynamic MRI and pelvic organography in diagnosis of pelvic floor disorders / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical value of simultaneously combined pelvic floor dynamic MRI and pelvic organography in diagnosing female pelvic floor disorders and search for the best imaging model for diagnosing pelvic floor disorders.</p><p><b>METHODS</b>Thirty women with pelvic floor disorders received pelvic floor dynamic MRI and simultaneously combined pelvic organography including cystourethrography, peritoneography, vaginography and defecography. Clinical diagnostic value was compared between this two methods.</p><p><b>RESULTS</b>The diagnostic accuracy of pelvic floor dynamic MRI and simultaneously combined pelvic organograph for cystocele,anorectal junction abnormal descent, pelvic floor hernia,uterocervical prolapse was 100%, 95.2 %, 86.7%, 85.7% respectively. Rectocele and prolapse of rectal were diagnosed by pelvic organograph in 12 and 28 cases respectively, while only 6 and 0 cases were diagnosed by pelvic floor dynamic MRI respectively. The mean examining time of pelvic floor dynamic MRI and simultaneously combined pelvic organography was (16 +/- 3)min, (34 +/- 9)min respectively (P< 0.01).</p><p><b>CONCLUSION</b>Pelvic floor dynamic MRI combined with defecography is the best imaging model for diagnosing pelvic floor disorders.</p>

Clinical application of meglucamine diatrizoate mucilage in 500 cases of bronchography / 第三军医大学学报

Objective　To evaluate the effects of meglumine diatrizoate mucilage (MDC) used as contrast medium in bronchography. Methods A total of 500 patients undergoing bronchography were reviewed, including male 346, female 154, with an average age of 42 (ranged 5～71). Among them, 415 were examined with bilateral bronchography in a dose of 20～30 ml, 85 with unilateral bronchography in 10～15 ml of MDC. Results　In 487 cases (97.4%), the lobes, segments, subsegment bronchi were revealed very well, and 456 cases (91.2%) had no cough. Conclusion　MDC is regarded as an ideal bronchial contrast medium, and may replace dionosil and iodized oil.

Clinical application of meglucamine diatrizoate mucilage in 500 cases of bronchography / 第三军医大学学报

Objective　To evaluate the effects of meglumine diatrizoate mucilage (MDC) used as contrast medium in bronchography. Methods A total of 500 patients undergoing bronchography were reviewed, including male 346, female 154, with an average age of 42 (ranged 5～71). Among them, 415 were examined with bilateral bronchography in a dose of 20～30 ml, 85 with unilateral bronchography in 10～15 ml of MDC. Results　In 487 cases (97.4%), the lobes, segments, subsegment bronchi were revealed very well, and 456 cases (91.2%) had no cough. Conclusion　MDC is regarded as an ideal bronchial contrast medium, and may replace dionosil and iodized oil.

Evaluation on levator ani muscle injuries after vaginal delivery with MRI / 中华放射学杂志

Objective To explore the MRI finding of female normal levator ani muscle and the levator ani muscle injuries and to evaluate the correlation between childbirth and levator ani muscle injuries. Methods One hundred asymptomatic nulliparous women(control group)and 200 vaginally primiparous women(study group)were selected as the object of this study.Moreover,the study group was divided into two subgroups:group A(100 cases)with stress incontinence,group B(100 cases)without clinical symptoms.Multiplanar proton density magnetic resonance images were obtained at 0.5 cm intervals from these study individuals.All images were used to analyze the differentiation of MRI features between normal levator ani muscle and levator ani muscle injuries.Results No levator ani injuries were identified in the control group.Fifty-four primiparous women(27%)had visible injuries in their levator ani muscles,42 in group A and 12 in group B.Injuries were identified in the puborectalis muscle in 49 cases and in the iliococeygeus muscle in 5 cases(X~2=41.447,P