References: Laxative
Dtsch Med Wochenschr. 1996 Aug 23;121(34-35):1040-5.
[Quality assurance in coloscopy in private practice and the hospital. The Gastroenterology Quality Circle (GEQC) Munich]
[Article in German]
Heldwein W, Birkner B, Strauch L, Konig A.
Medizinische Klinik, Klinikum Innenstadt, Universitat Munchen.
OBJECTIVE: As quality control in medicine is part of a doctor's professional duty, the "Munich Quality Circle" conducted a prospective feasibility study in which ten, previously defined, quality indicators were to be assessed. PATIENTS AND METHODS: Six specialised private practice groups and three specialised hospitals centers took part. Data on 2928 consecutive patients were collected by questionnaire and ten quality indicators assessed: concordance with the indication list; intestinal cleansing; premedication; duration and completeness of the study; sensation of pain; use of radiology; complications; diagnosis; and therapeutic intervention. RESULTS: Concordance with the indication list was present in 97.8% (range 93-100), premedication was given to 94.6% (77-100), midazolam to 77%. The proportion of patients who recorded no or only moderate pain correlated with the dose but not with the duration of advancing the coloscope. Mean time of advancing the instrument to the caecum was 8.0 min, the duration directly depending on the experience of the examiner. A mean time of less than 10 minutes was achieved only after more than 1200 examinations. The more a centre used fluoroscopic control the shorter the time of coloscopy. The examination was completed in 97.6% (92-99). There was no correlation between experience (assuming supervision) and dose of midazolam or frequency of fluoroscopy. CONCLUSIONS: Nowadays total coloscopy is a primary diagnostic method, but it needs an intensive learning phase. In clinical centers consequent supervision of less experienced examiners achieved comparable results to those with experience. Informative quality indicators for coloscopy can be documented with little co
J Am Pharm Assoc (Wash). 1996 Jul;NS36(7):439-42.
Therapeutic modalities for mechanical cleansing of the colon.
Messick CR, Danziger LH.
Mechanical cleansing of the colon is an accepted standard of practice prior to colon surgery, and endoscopic and radiographic procedures. Cleansing the bowel prior to these procedures increases the accuracy of the diagnostic procedures and decreases the morbidity and mortality following surgery, where fecal contamination is a concern. Mechanical cleansing agents are sometimes used for acute constipation, but because of the extent and harshness of the evacuation they induce, and because of their adverse effects, they are not used for long-term management of constipation. Dosages vary among products, procedures, and individuals. Manufacturer guidelines should be consulted for proper dosing and administration.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8840743&dopt=Abstract constipation laxative colon cleansing
Digestion. 1996 Nov-Dec;57(6):446-52.
Bacterial translocation in the course of acute pancreatitis: beneficial role of nonabsorbable antibiotics and lactitol enemas.
Marotta F, Geng TC, Wu CC, Barbi G.
Department of Internal Medicine, S. Anna Hospital, Como, Italy.
Two-hundred Wistar rats were allocated to 4 groups. The groups, 3 representing our acute pancreatitis model induced by intrabiliary injection of a trypsin/enterokinase mixture, were studied as follows: (A) no treatment; (B) given a daily 30-ml enema with 20 mg/kg rifaximin; (C) given a daily 30-ml enema with 20 mg/kg rifaximin plus lactitol 0.5 g/kg, and (D) given a daily 30-ml enema with warm saline. A further group of healthy rats was given an intrabiliary injection of 0.15 ml saline. Sacrifices were made after 6, 12, 24, 48 and 72 h of observation. Serial blood samples were drawn to measure pancreatic enzymes and endotoxin. At sacrifice, ascites, lymph nodes, pancreas, spleen, portal vein blood, arterial blood and bile were obtained for bacteriological culture. Both enema treatments brought about a significant improvement in survival. Enema treatments did not affect the serum level of pancreatic enzymes. A time-course increase in endotoxin level was observed in untreated rats. However, significantly decreased levels were observed after both enema treatments. Overall, ascites was the sample most frequently infected. Lymph nodes contiguous to the gut were found to be infected more frequently than those close to major vessels. The histological pancreatic damage was of a significantly lesser degree in both enema treatment groups. Virtually all severe necrotico-hemorrhagic pancreatic lesions were associated with bacterial infection. These data suggest that bacterial translocation plays a relevant role in the outcome of experimental necrotizing pancreatitis. Intra-abdominal spread and lymphatics seem to be the pathways most likely involved in such processes. Colonic cleansing by non-absorbable antibiotics and lactitol seems to exer
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