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References: Laxative

J Thorac Cardiovasc Surg. 1993 Dec;106(6):1088-91.
Management of delayed esophageal perforation with mediastinal sepsis. Esophagectomy or primary repair?

Salo JA, Isolauri JO, Heikkila LJ, Markkula HT, Heikkinen LO, Kivilaakso EO, Mattila SP.

Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.

Ninety patients with esophageal perforations were operated on at our institutions between 1970 and 1992. Thirty-four of them were seen after delayed diagnosis (> 24 hours) with mediastinal sepsis caused by perforation of the thoracic esophagus. There were 18 patients with spontaneous ruptures, 11 with instrumental perforations (including one caused during laparotomy), and 3 perforations caused by foreign bodies. One patient had perforation of an esophageal ulcer into the pericardium and another had perforation of an esophageal diverticulum into the mediastinum. Nineteen patients underwent primary repair of the perforation with cleansing and drainage of the mediastinum and the pleural cavity. The remaining 15 had primary extirpation of the thoracic esophagus, irrigation of the mediastinum with antibiotics, cervical esophagostomy, gastrostomy, and drainage of the mediastinum and pleural cavity. Nineteen of the 34 patients survived (hospital mortality 44%). Of patients with primary repair, only six survived (in-hospital mortality 68%), whereas only two patients treated with esophagectomy died (in-hospital mortality 13%). The difference was highly significant (p = 0.001). The most common cause of death was multiorgan failure resulting from sepsis. Postoperative complications developed in four patients treated with primary repair (two sepsis, one empyema, and one anuria) and in seven patients treated with esophagectomy (two empyema, two sepsis, one pneumonia, one mediastinal abscess, and one brain abscess). After healing of the mediastinitis, the esophagogastric continuity was reconstructed with colon in 11 patients and stomach in two patients. In the management of del

Gastroenterol Nurs. 1993 Dec;16(3):106-9.
Colon cleanout preparations in children and adolescents.

Barrish JO, Gilger MA.

To determine the effectiveness and associated side effects of a variety of bowel cleansing preparations before colonoscopy, 52 children, ages 4 months to 18 years, were evaluated. Data gathered included type of cleanout preparation used, adequacy of the preparations, and side effects. Twenty-two combinations of laxatives, lavages, enemas, and rectal suppositories were used. Side effects were reported in 90% of patients. In 79% of the patients the colon was clean or clean with some liquid feces, allowing a complete examination of the colon. Formed feces were present in 21% of the subjects, and cleanout preparations were so inadequate in 9% of the subjects that the procedure had to be rescheduled. The most effective preparations were X-Prep liquid+Adult Fleet enema, GoLYTELY, and GoLYTELY+Adult Fleet enema, all of which allowed a complete examination of the colon. Pediatric Fleet ready-to-use enema was the least effective when used alone. X-Prep liquid+Adult Fleet enema caused the highest number of side effects (18%), while Pediatric Fleet ready-to-use enema alone caused the least (4%). The most effective cleanout preparation with the fewest side effects was GoLYTELY, used alone or in combination with enemas. These results suggest that many typical cleanout preparations yield inadequate results, wasting time or money, and argue in favor of the use of more effective preparations with fewer side effects, such as GoLYTELY.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8286425&dopt=Abstract constipation laxative colon cleansing

Radiology. 1993 Aug;188(2):578-80.
Preparation of the colon for single- and double-contrast barium enema examination: a simplified method.

Tham RT, Korte JH, Bom EP, van Kints MJ, Zwinderman AH.

Department of Diagnostic Radiology, Catharina Ziekenhuis, Eindhoven, The Netherlands.

A commercially available prepackaged liquid diet was prescribed to 112 patients to use in combination with laxatives in a 1-day preparation regimen before single- and double-contrast barium enema examination. Cleansing enemas were not performed before the examination. Colon radiographs were evaluated with regard to amount of residual stool, mucosal detail, coating, and overall quality. Results were excellent in 92% (103 of 112) of patients and fair in 5% (six of 112). Cleansing enemas can be avoided through use of this preparation protocol.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8327719&dopt=Abstract constipation laxative colon cleansing

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