Rectum perforation during transanal irrigation: a case story.

STUDY DESIGN: Case report. OBJECTIVES: Report a case of rectum perforation during transanal irrigation (TAI). SETTING: Clinic for Spinal Cord Injuries, and Departments of Gastroenterological Surgery and Radiology. CASE REPORT: A 54-year-old woman with spinal cord lesion for 35 years emptied for years her bowel using oral laxative. This became more difficult and took more than 2 h three times a week with reflex stimulation after a chlysma. She wanted to try TAI, and went through the procedure with a nurse one time. The next time she performed the TAI by herself without difficulty. Two hours later she started shivering with a temperature at 38.3 degrees C with normal blood pressure (BP). At rectal exploration, a spoonful fresh blood was found. After another 2 h, she became septic and was transferred to a gastroenterological surgical department. An abdominal X-ray gave no suspicion of free air in the abdomen. Sigmoideoscopy showed 3-5 cm oral to the dentate line a 1 x 1 cm transmural circular lesion. A colon X-ray with water contrast showed a perforation of approximately 2 x 0.5 cm. CONCLUSION: Even in experienced individuals who are proper trained, TAI can cause rectal perforation, which always have to be born in mind.

Regional differences in neurogenic signal transduction pathway of cholera toxin-induced fluid, electrolyte and serotonin accumulation in the porcine jejunum.

Serotonin, acetylcholine and substance P are mediators involved in the secretory response to cholera toxin in the small intestine. The aim of this study was to investigate the regional difference in the effect of a serotonin receptor type 3 antagonist (ondansetron), a nicotinic receptor antagonist (hexamethonium), and a substance P antagonist (the neurokinin receptor type 1 antagonist, CP 99,994) on the cholera toxin-induced fluid accumulation in the porcine jejunum. A dose-range of cholera toxin (0.32-56.00 microg/loop) was instilled for 4 hr in ligated loops in two regions of the proximal jejunum in 6-8-week-old pigs. Ondansetron (200 microg/kg), hexamethonium (10 mg/kg), CP 99,994 (1 mg/kg), or saline alone (control) were given intravenously 10 min. before cholera toxin instillation. Cardiovascular parameters, blood gas data, net fluid accumulation, serotonin and electrolyte concentration in the accumulated fluid were measured. Cardiovascular and blood gas parameters were within the normal range in all treatments. The apparent maximal response in fluid accumulation was reduced 20% in case of ondansetron, and by 33% using CP 99,994 in the aboral region compared to control, whereas no effect was observed in the oral region. Hexamethonium reduced the apparent maximal secretory response in both the oral and aboral regions by 45%. None of the treatments with antagonists changed the luminal content of serotonin or the electrolyte concentrations in the accumulated fluid. The results demonstrate that the involvement of serotonin receptor type 3 and neurokinin type 1 receptors in the transductional pathway of cholera toxin-induced fluid accumulation vary significantly within the jejunum, while the cholinergic (nicotinic) transmission plays an even role.

Secretory response to cholera toxin in the porcine jejunum under different types of general anaesthesia.

Investigations of intestinal secretion are often performed under anaesthesia. This study evaluates the influence of anaesthetic agents on the intestinal secretion induced by cholera toxin (CT) in the pig. CT was instilled for 4 h in ligated jejunal loops under anaesthesia with halothane, saffan, alpha-chloralose, or propofol. Cardiovascular parameters, blood gas data, plasma cortisol levels, net fluid accumulation, intraluminal mediators (serotonin (5-HT), prostaglandin E2 (PGE2)) and electrolyte concentrations in the accumulated fluid were determined. The systolic blood pressure and heart rate was highest for saffan-anaesthetized pigs (blood pressure: saffan > alpha-chloralose > propofol = halothane; heart rate: saffan > alpha-chloralose = propofol = halothane), while blood gases and cortisol levels were within the same range. CT induced a dose-dependent fluid accumulation under all four anaesthetics. The fluid accumulation was significantly higher in pigs treated with saffan, alpha-chloralose and propofol than in halothane-treated pigs (saffan = alpha-chloralose > propofol > halothane). There was no significant difference in electrolyte concentrations in the accumulated fluid or in the luminal content of 5-HT and PGE2 between anaesthetics. The results demonstrate that anaesthetic agents profoundly influence the secretory response in the small intestine and indicate the importance of the choice of anaesthetic in this type of experiment.

A normal initial colonoscopy after age 50 does not predict a polyp-free status for life.

OBJECTIVES: The prevalence of colon polyps increases with age in the general population. It is unknown whether a lack of adenomatous polyps determined at one time point after the age of 50 is predictive of a subsequent low risk of polyp development. METHODS: Twenty-nine patients between ages 50 and 70 who had no prior history of polyps and had a normal colonoscopy at least 5 yr previously were recruited for follow-up colonoscopy to evaluate the incidence of neoplastic disease in this presumably low-risk group. RESULTS: The incidence of adenomatous polyps after a mean of 5.74 yr was 41.4% (95% confidence interval: 23.5-61.1%). A total of 20 adenomatous polyps were found in 12 patients. Seven polyps were 5 mm or more in size. CONCLUSIONS: We conclude that in patients with no history of colonic neoplasia who are 50 yr old, or older, the finding of a normal colonoscopy does not predict diminished risk of neoplasia.

Techniques and complications of esophageal foreign body extraction in children and adults.

To assess the success rates and complications of esophageal foreign body extraction in adult and pediatric patients, the charts of 76 adults and 116 children with endoscopically or radiographically documented esophageal foreign body impaction were retrospectively reviewed. Success rates for rigid esophagoscopy (100%) and flexible endoscopy (96.2%) were not significantly different (p > 0.05). Overall, rigid esophagoscopy had a higher complication rate than flexible endoscopy (10% versus 5.1%, p > 0.05), but this trend did not reach statistical significance. The Foley catheter technique was used predominantly in children with proximally located blunt objects. Our study shows that flexible and rigid esophagoscopy are both safe and effective methods of removing esophageal foreign bodies, but rigid esophagoscopy carries a higher complication rate and therefore should be reserved for patients in whom flexible endoscopy is unsuccessful. The Foley catheter technique is suited only for proximally located blunt objects, and its routine use is not recommended.

Clonazepam (Rivotril) and carbamazepine (Tegretol) in psychomotor epilepsy: a randomized multicenter trial.

The antiepileptic properties of carbamazepine (Tegretol) and clonazepam (Rivotril) were compared in a double-blind randomized study comprising 36 patients with newly diagnosed, untreated psychomotor epilepsy (partial seizures with complex symptomatology). No significant differences were found between the two drugs during the 6 months of treatment. Measurements of concentrations in plasma confirmed that the patients exceeded the accepted lower limit for therapeutic range of the drugs.