Bowel preparation for flexible sigmoidoscopy: which method yields the best results?

BACKGROUND: Bowel preparation is a significant aspect of the flexible sigmoidoscopy procedure. Clear visibility of the bowel mucosa is critical for a thorough examination. The combination of a light breakfast in the morning and the application of 2 phosphate enemas a few hours before the examination is a safe and commonly used method of preparing a patient for a flexible sigmoidoscopy procedure. However, there is a paucity of objective data on the efficacy of this method of bowel preparation. It has been practiced on the basis of intuition and clinical experience. METHODS: In this prospective single-blinded randomized study, 429 consecutive patients were assigned to receive 1 of 4 different bowel preparations before elective 60-cm flexible sigmoidoscopy. After completion of the procedure, the examiner gave a subjective rating of the quality of the preparation. The rating was determined on the basis of the percentage of bowel mucosa that was visible. RESULTS: Statistical analysis of results suggests no significant difference in frequency of favorable ratings between the 4 bowel preparations. CONCLUSIONS: This study substantiates the practice of having a light breakfast and 2 phosphate enemas as a method of bowel preparation for a flexible sigmoidoscopy procedure. Additional preparatory measures such as dietary restrictions and ingestion of phospho-soda oral saline laxative did not significantly enhance the quality of the examination.

Effect of clenbuterol on productive performance, body composition and muscle biochemistry in the rabbit.

Twenty New Zealand White rabbits (INRA 1077 strain) were given a complete and balanced diet including a clenbuterol additive (100 µg per day) between 70 and 98 days. They were compared with 20 control rabbits. The treatment improved the growth performance (29.90 vs 26.07 g/day), the feed conversion (5.45 vs 6.46 g feed per g gain) and the carcass yield (64.37 vs 61.11%), by decreasing the relative weights of the skin and the digestive tract. Moreover, all organs in which development is precocious, were found to be relatively lighter. The muscle/bone ratio of the carcass was improved (7.56 vs 6.38), resulting in a greater relative development of muscle tissue, without any change in bone tissue weight. Perirenal and interscapular fat percentages in the carcass were reduced (3.23 vs 3.83 and 0.68 vs 0.86, respectively). Clenbuterol, a repartitioning agent, had therefore modified the growth allometry of the organs and tissues. In the hindleg region (Biceps femoris, Tensor fasciae latae, Semimembranosus accessorius), the ultimate muscular pH was increased, (+0.31 pH units on average), while the cooking loss was reduced (24.23 vs 24.88%). In the m. longissimus lumborum, the increase of ultimate pH (+0.31 units of pH), under the effect of clenbuterol, was explained by a relative increase in the oxidative metabolic pathway represented by aldolase/ICDH ratio (246 vs 284) and by a decrease in glucidic content (total glycosyl residues) of muscle (16.6 vs 26.2 µ mol g ). Due to its effects on muscular biology, clenbuterol is thus likely to cause a change in meat quality.

The role of imaging techniques in stress testing.

The addition of various cardiac imaging techniques to standard ECG stress testing has permitted enhanced diagnostic capability in the evaluation of patients with suspected coronary artery disease. In addition, the prognostic and pathophysiologic information provided by such imaging modalities has given us insight not previously available by standard stress testing alone. This has been helpful in guiding management decisions in patients with known coronary artery disease. The modalities include myocardial perfusion imaging, stress echocardiography, and radionuclide ventriculography. These techniques can provide complementing and unique information in the evaluation of myocardial blood flow, function, and viability.