Bulk Agents Research Articles

Management of acute anal fissure with open and closed internal sphincterotomy

Introduction: An anal fissure is a lacerate tear in inner thin lining of anus. The tear exposes the muscle (anal sphincter) around the anus. The damage leads to muscle spasm, which pull the fissure edges even more. The spasms lead to pain and it also slow down the healing. An anal fissure is considered acute anal fissure if it occurs in less than 6 weeks or if it recently happened. Treatment done by breaking the cycle of spasm, relieving pain, and to avoid ischemia, which all are cause for anal fissure. First-line of treatment to minimize anal trauma includes stool softeners, bulk agents, and warm sitz baths(5) if not relived then sphincterotomy open or closed type surgery can be done. Material & Methods: We had conducted a comparative observational study from May 2019 to April 2021 at Dhiraj General Hospital, Vadodara in General Surgery department. In admitted patients posted for Sphincterotomy after consent & explaining risk factor, patients were operated. Detailed clinical history, clinical examination including per abdominal and per rectal examination, routine blood investigations & chest x-ray screening was done. In all the patients undergoing Sphincterotomy done either with open or closed method.

Roles of Long‐Chain Alkylamine Ligands in Triple‐Halide Perovskites for Efficient NiOx‐Based Inverted Perovskite Solar Cells

The passivation of perovskite bulk and heterointerface defects is one of the most significant ways to enhance the efficiency and operational stability of perovskite solar cells (PSCs). So far, ammonium‐based alkylamine halides have been considered as effective passivation materials to reduce defects of the perovskite absorber layer. Herein, roles of long‐chain alkylamine ligands (LALs) in triple‐halide perovskites are systematically studied for achieving efficient NiOx‐based inverted PSCs. Two kinds of LALs oleylammonium (OAm) and phenethylammonium (PEA), as perovskite bulk and interface passivation agents, respectively, are introduced. It is found that both OAm and PEA ligands cannot only assist their crystal growth with vertical orientation, but also suppress triple‐halide perovskite bulk and interface defects. As precursor additives, OAm ligands can be used as organic spacers to assist the generation of the 2D@3D perovskite bulk crystals. 2D@3D/2D perovskite heterostructures are further formed when the 2D@3D perovskite bulk film is post‐treated by PEA ligands. As a result, such strategies enable hysteresis‐free and highly efficient NiOx‐based triple‐halide inverted PSCs.

Microstructural, Physicochemical, Microbiological, and Organoleptic Characteristics of Sugar- and Fat-Free Ice Cream from Buffalo Milk.

Ice cream is a popular dessert product across the world. Structure, body, taste, and odor properties are created by adding non-milk ingredients and milk ingredients. The main aim of the study is to decrease the caloric value of ice cream by using sugar and fat replacements. Ice cream treatments were investigated based on microstructural, chemical, physical, microbiological, sensory, and calorific values. Four different ice creams were used (control ice cream (SC1), ice cream with stevia (SC2), ice cream with sucralose (SC3), and ice cream with sorbitol (SC4)). The chemical properties in all treatments of ice cream were significantly recorded (p < 0.05). The highest sucrose and fat levels were detected in the SC1 treatment compared with the other treatments (p < 0.05). The lowest fat and sugar amounts were observed in the SC2, SC3, and SC4 treatments (p < 0.05). The highest viscosity, overrun, and hardness values (p < 0.05) were detected in the control ice cream. Total aerobic mesophilic bacterial counts were not significantly recorded between different ice cream treatments (p < 0.05). The sensory scores were not significantly affected by sweeteners and bulk agents in the different treatments. The highest calorific value was calculated in the SC1 samples (p < 0.05). On the other hand, the lowest calorific value was calculated in SC2, followed by the SC3 and SC4 treatments. In scanning electron microscopy (SEM), the gel exhibited a homogeneous structure with a fine network within the SC2, SC3, and SC4 treatments, as it contained a cohesive structure with small-sized pores.

Ionic and poly(ionic liquid)s as perovskite passivating molecules for improved solar cell performances

Ionic liquids and poly(ionic liquid)s act as bulk and/or passivation agents when used as additives in methylammonium-free lead perovskites, leading to devices showing enhanced power conversion efficiencies, reduced hysteresis and improved stability.

Trends in surgical management and pre‐operative urodynamics in female medicare beneficiaries with mixed incontinence

We sought to examine the surgical trends and utilization of treatment for mixed urinary incontinence among female Medicare beneficiaries. Data was obtained from a 5% national random sample of outpatient and carrier claims from 2000 to 2011. Included were female patients 65 and older, diagnosed with mixed urinary incontinence, who underwent surgical treatment identified by Current Procedural Terminology, Fourth Edition (CPT-4) codes. Urodynamics (UDS) before initial and secondary procedure were also identified using CPT-4 codes. Procedural trends and utilization of UDS were analyzed. Utilization of UDS increased during the study period, from 38.4% to 74.0% prior to initial surgical intervention, and from 28.6% to 62.5% preceding re-intervention. Sling surgery (63.0%) and injectable bulking agents (28.0%) were the most common surgical treatments adopted, followed by sacral nerve stimulation (SNS) (4.8%) and Burch (4.0%) procedures. Re-intervention was performed in 4.0% of patients initially treated with sling procedures and 21.3% of patients treated with bulking agents, the majority of whom (51.7% and 76.3%, respectively) underwent injection of a bulking agent. Risk of re-intervention was not different among those who did or did not receive urodynamic tests prior to the initial procedure (8.5% vs. 9.3%) CONCLUSIONS: Sling and bulk agents are the most common treatment for MUI. Preoperative urodynamic testing was not related to risk of re-intervention following surgery for mixed urinary incontinence in this cohort. Neurourol. Urodynam. 36:422-425, 2017. © 2015 Wiley Periodicals, Inc.

Study on the Factors Influencing the Fluorescence Index of Internal Fluorescent Whitening Agent

This study analyzed the effects of specific factors on the fluorescence index of the fluorescent whitening agent (FWA) that is used for internal addition. The specific factors were identified by the literature review, and a statistical survey was carried out to analyze the effects of those factors on the fluorescence index. Bulk, grammage, fillers and internal sizing agents were selected as the specific factors. The paper samples were prepared with internal FWA in a laboratory. The fluorescence indices of the model papers were measured, and p-values of the specific factors on the fluorescence index were calculated by the SPSS program. Most of p-values were greater than 0.05, so the specific factors do not have a significant impact on the internal FWA fluorescence index.

In situ nitrogen removal in phase-separate bioreactor landfill

The feasibility of in situ nitrogen removal in phase-separate bioreactor landfill was investigated. In the experiment, two sets of bioreactor landfill systems, namely conventional two-phase and in situ nitrogen removal bioreactor landfills, were operated. The in situ nitrogen removal bioreactor landfill (NBL) was comprised of a fresh-refuse filled reactor (NBLF), a methanogenic reactor (NBLM) and a nitrifying reactor (NBLN), while the two-phase bioreactor landfill (BL) used as control was comprised of a fresh-refuse filled reactor (BLF) and a methanogenic reactor (BLM). Furthermore, the methanogenic and nitrifying reactors used aged refuse as bulk agents. The results showed that in situ nitrogen removal was viable by phase-separation in the bioreactor landfill. In total 75.8 and 47.5 g of nitrogen were, respectively, removed from the NBL and the BL throughout the experiment. The methanogenic reactor used the aged refuse as medium was highly effective in removing organic matter from the fresh leachate. Furthermore, the aged refuse was also suitable to use as in situ nitrification medium. The degradation of fresh refuse was accelerated by denitrification in the initial stage (namely the initial hydrolyzing stage) despite being delayed by denitrification in a long-term operation.

Influência de diferentes agentes de corpo nas características reológicas e sensoriais de chocolates diet em sacarose e light em calorias

Foram estudados diferentes agentes de corpo na substituição total da sacarose na formulação de chocolate, buscando-se obter um produto diet em sacarose e light em calorias (25% de redução calórica teórica em relação à formulação padrão, com sacarose) e com boa aceitação sensorial. Os agentes de corpo utilizados neste estudo foram: polidextrose, inulina, frutooligossacarídeos - FOS, lactitol e maltitol; como edulcorante de alta intensidade empregou-se a sucralose. Os chocolates light obtidos foram submetidos às análises de umidade (Karl Fisher), tamanho de partículas (micrômetro digital) e propriedades reológicas (viscosidade plástica - etaca e limite de escoamento de Casson - tauca). O teor de umidade dos chocolates light variou de 1,23 a 2,12%; o tamanho de partículas de 19 a 24 µm; o etaca de 6,60 a 11,00 Pa.s; e o tauca de 0,05 a 1,31 Pa. As formulações com polidextrose, polidextrose e lactitol e polidextrose e maltitol foram selecionadas para análise sensorial por apresentarem boa performance tecnológica e adequada maquinabilidade da massa de chocolate durante as diferentes etapas do processo. A análise sensorial indicou que as três formulações avaliadas não diferiram entre si ao nível de significância de 5% em relação à intensidade do aroma, dureza, derretimento na boca e sabor e, quanto à intenção de compra, as amostras diferiram entre si ao nível de significância de 5%, sendo que a formulação que continha 32,60% de Polidextrose e 15,57% de Maltitol foi a preferida.

Constipation of anorectal outlet obstruction: Pathophysiology, evaluation and management

Constipation is a subjective symptom of various pathological conditions. Incidence of constipation fluctuates from 2 to 30% in the general population. Approximately 50% of constipated patients referred to tertiary care centers have obstructed defecation constipation. Constipation of obstructed defecation may be due to mechanical causes or functional disorders of the anorectal region. Mechanical causes are related to morphological abnormalities of the anorectum (megarectum, rectal prolapse, rectocele, enterocele, neoplasms, stenosis). Functional disorders are associated with neurological disorders and dysfunction of the pelvic floor muscles or anorectal muscles (anismus, descending perineum syndrome, Hirschsprung's disease). However, this type of constipation should be differentiated by colonic slow transit constipation which, if coexists, should be managed to a second time. Assessment of patients with severe constipation includes a good history, physical examination and specialized investigations (colonic transit time, anorectal manometry, rectal balloon expulsion test, defecography, electromyography), which contribute to the diagnosis and the differential diagnosis of the cause of the obstructed defecation. Thereby, constipated patients can be given appropriate treatment for their problem, which may be conservative (bulk agents, high-fiber diet or laxatives), biofeedback training or surgery.

Medical treatment of constipation.

Various agents are used for the medical management of chronic constipation, but few of these have been adequately studied. This article specifically examines the medical treatment of chronic constipation and the available data concerning bulk agents, lubricating agents, stimulants, and osmotic laxatives, used alone and in combination. Most experts consider dietary fiber or medicinal bulk agents to be the initial therapeutic option for the treatment of chronic constipation. If fiber is not successful or poorly tolerated, subsequent treatments may include saline osmotic laxatives, lactulose, 5-hydroxytryptamine4 (5-HT(4)) agonists (tegaserod), or stimulants such as senna or bisacodyl. Recent data also demonstrate both polyethylene glycol laxative and tegaserod to be safe and effective as initial therapy for chronic constipation.

TREATMENT OF ANAL FISSURE WITH BALLOON DILATATION OF ANAL SPHINCTER

Purpose: Chronic anal fissures (AF) are associated with apersistent hyperto-nia and spasm of the internal anal sphincter causing severe rectal pain during and after defecation. Classic treatment is targeted to reduce the anal tone and eliminate sphincteric spasm. Lateral internal anal sphincterotomy, posterior anal sphincterotomy and manual sphincter dilatation are well-established surgical procedures. Several pharmacological means to treat AF have been explored with some success also. We evaluated efficacy and safety of balloon dilatation as a treatment of AF. Methods: Twenty patients from January 2001 to July 2003 (12 men age 48 ± 12 years, and eight women age 44 ± eight years) with AF (16 posterior and four anterior), diagnosed during colonoscopy and anal examination, were treated with balloon dilatation. Microvasive-Rigiflex, 10 cm long, 30 and 40 mm balloon, was used for dilatation. The anal sphincter was dilated from one to two minutes at 20 psi. Eighteen patients were treated once and two patients were treated twice. The patients were also treated with high-fiber diet, bulk agents like Metamucil, increased fluid intake, and sitz baths during this period. All patients were followed in the office and examined to assess the symptoms and healing of AF at four and eight weeks. Results: Twelve patients had healed in four weeks, five patients in eight weeks and two patients required re-treatment with balloon dilatation. Out of the two requiring retreatment, one healed in four weeks after the second treatment and the second patient was successfully treated with nifedip-ine/lidocaine ointment. One patient went for lateral internal anal sphincterotomy. None of the patients had fecal incontinence. Conclusions: Balloon dilatation is an effective and safe alternative to surgical intervention with a high cure rate and no fecal incontinence.

The use of thermal desorption in monitoring for the chemical weapons demilitarization program.

Under international treaty, the United States and Russia are disposing of their aging stockpile of chemical weapons. Incineration and chemical neutralization are options for sites in the United States, although Russia prefers the latter. The storage and disposal of bulk and chemical agents and weapons involve unique hazards of handling extremely toxic materials. There are three major areas of concern--the storage stockpile, the disposal area, and the discovery and destruction of "found" material not considered part of the stockpile. Methods have been developed to detect the presence of chemical agents in the air, and these are used to help assure worker protection and the safety of the local population. Exposure limits for all chemical agents are low, sometimes nanograms per cubic meter for worker control limits and picograms per cubic meter for general population limits. There are three types of monitoring used in the USA: alarm, confirmation, and historical. Alarm monitors are required to give relatively immediate real-time responses to agent leaks. They are simple to operate and rugged, and provide an alarm in near real-time (generally a few minutes). Alarm monitors for the demilitarization program are based on sorbent pre-concentration followed by thermal desorption and simple gas chromatography. Alarms may need to be confirmed by another method, such as sample tubes collocated with the alarm monitor and analyzed in a laboratory by more sophisticated chromatography. Sample tubes are also used for historical perimeter monitoring, with sample periods typically of 12 h. The most common detector is the flame photometric detector, in sulfur or phosphorous mode, although others, such as mass-selective detectors, also have been used. All agents have specific problems with collection, chromatography and detection. Monitoring is not made easier by interferences from pesticide spraying, busy roadways or military firing ranges. Exposure limits drive the requirements for analytical sensitivity. Lowering limits adds additional difficulties to the monitoring efforts. The various monitoring methods and the role they play in ensuring worker and general population safety are discussed.

3638 Randomized, prospective trial of endoscopic rubber band ligation compared to bipolar coagulation for bleeding internal hemorrhoids

Internal hemorrhoids are the most common cause of recurrent hematochezia (BRB) in ambulatory adults.We compared the efficacy and safety of bipolar coagulation (BICAP) with endoscopic rubber band ligation (RBL) for hemostasis of bleeding internal hemorrhoids (IH). Methods: This was a randomized prospective trial of patients with IH bleeding, documented by anoscopy and colonoscopy, who continued to have BRB inspite of at least 60 days of medical therapy (bulk agents, suppositories, stool softeners). Exclusions were rectal fissures, AIDS, inflammatory disease, or incidental IH and another source of bleeding found. After grading of IH with a slotted anoscope, patients were randomized to anoscopic treatment with BICAP (16W, 1 secs pulses) or RBL (via videoendoscope) and treatments were applied above the dentate line on 3 IH segments/session. Endpoints were control of BRB, severe complication or refusal to continue the treatment, and reduction of all IH segments to grade ≤ 1 in ≥ 3 treatment sessions. Failures were crossed over to other therapies. Results: 37 patients with mean age of 51 and chronic IH symptoms for ≤ 9 yrs were treated, 18 with BICAP and 19 with RBL. See table for results. Significantly fewer treatment sessions with RBL were required for control of BRB. Conclusions: For patients with chronic internal hemorrhoids and recurrent hematochezia unresponsive to medical therapy: 1) bipolar coagulation and rubber band ligation were similar in efficacy and safety for hemostasis, 2) non-significantly more bipolar than RBL patients had treatment failures and were crossed-over to other treatments, and 3) RBL required significantly fewer sessions to control hematochezia and reduce the size of internal hemorrhoids than bipolar coagulation. Funded in part by NIH DK41301 (Human Studies Core), American Digestive Health Foundation Endoscopy Research Award, and NIH-GCRC M01-RR008658.

Constipation in the Elderly

Constipation is a common concern in the elderly and accounts for significant expenditures on over-the-counter drugs. Although normal aging is not associated with abnormal bowel motility, pathologic and psychosocial conditions lead to increased symptoms in elderly patients. Careful clinical evaluation to eliminate serious conditions including colon neoplasia is important. Medical management with emphasis on fiber, bulk agents, fluid intake, and exercise, as well as appropriate use of laxatives is reviewed.

COMPLICATIONS OF STERILE ABSCESS FORMATION AND PULMONARY EMBOLISM FOLLOWING PERIURETHRAL BULKING AGENTS

Agents currently used in the treatment of urinary incontinence secondary to intrinsic sphincter deficiency are effective and minimally invasive. Ensuring a lack of sensitivity to the product or use of autologous material, such as fat, minimizes significant problems. However, local and systemic complications can occur with any bulking agent. We describe rare complications of periurethral bulk injections. Three cases of sterile abscess formation and 1 of pulmonary embolism after periurethral bulk injections were reviewed. Two patients with intrinsic sphincter deficiency were treated with transurethral injection of glutaraldehyde cross-linked collagen at the Mayo Clinic, 1 also treated with collagen for intrinsic sphincter deficiency was referred from elsewhere and 1 underwent periurethral injection of autologous fat for intrinsic sphincter deficiency elsewhere. Clinical information and patient followup were obtained from medical records and discussion with treating physicians. Three patients treated with collagen presented with sterile abscesses at the injection site after routine transurethral injection. Documentation of the abscesses included cystoscopic findings, magnetic resonance imaging of the pelvis and/or transvaginal ultrasound. Drainage procedures for relief of obstructive and irritative voiding symptoms were required in 2 patients. In 1 of these patients transurethral unroofing failed, and transvaginal incision and drainage were required while the other had slow spontaneous improvement but a mass remained at the injection site 3 months later. Repeat skin testing was negative in 2 of 3 cases. Currently, these 3 patients are asymptomatic except for continued urinary incontinence. Pulmonary embolism was documented in 1 patient who underwent periurethral autologous fat injection. This patient survived without long-term consequences but was maintained on ventilatory support for a short time. In general, periurethral injection of bulk agents is safe and effective. However, injectable bulk agents are not without risk of complications, some of which are life threatening and others of considerable morbidity that may require operative intervention.

Influence of dietary bulk agents (silica, cellulose and a natural zeolite) on protein digestibility, growth, feed intake and feed transit time in European seabass ( Dicentrarchus labrax) juveniles

The incorporation of various bulk agents by substitution of an equivalent amount of the basal mixture was studied in terms of protein digestibility, growth performance and body composition in European seabass ( Dicentrarchus labrax) juveniles. During the growth trial, triplicate groups of 40 seabass (mean initial weight: 7.0 g) were grown in seawater (salinity: 35; temperature: 18 °C) over 60 days. Fish were hand-fed, three times a day, one of seven experimental diets. Bulk agents tested at 10 or 20 % level of incorporation were silica, cellulose and a natural zeolite (chabamin). Feeding rates were adjusted in proportion to the percent dilution of the control diet without bulk incorporation. The incorporation of the bulk agents, at a 10 and 20 % level, did not affect protein digestibility or growth performance. Dietary bulk incorporation reduced feed efficiency values, particularly at the 20 % incorporation level. However, this reduction was mostly caused by the dietary nutrient dilution of the bulk-incorporated diets, rather than by a negative effect of the bulk agents as dietary ingredients. In comparison to the control treatment, bulk incorporation at 10 and 20 % level did not affect protein retention values. When compared with the control diet, 20 % bulk agent incorporation changed the evacuation profile of faeces and increased faecal egestion time.

Practice Guidelines for Cancer Pain Management

Practice Guidelines for Cancer Pain Management

Autonomic dysreflexia resulting from prolapsed hemorrhoids

This article reports a case of autonomic dysreflexia associated with hemorrhoidal disease in a patient with high spinal cord lesions and successful treatment by surgical hemorrhoidectomy. Following an unsuccessful attempt at conservative treatment which included bulk agents and warm compresses, the patient subsequently underwent three-column, closed surgical hemorrhoidectomy. The patient was symptom free and had normal bowel activity six weeks postoperatively, and five-year follow-up showed no recurrence of the hemorrhoidal prolapse or dysreflexia. Carefully controlled hemorrhoidectomy, when conservative measures fail, may be effective in managing autonomic dysreflexia in high spinal cord transection patients when prolapse serves as the stimulus.

The treatment of autonomic dysfunction.

Autonomic dysfunction is responsible for much of the morbidity associated with frequently encountered neurological disorders, such as Parkinson's disease, multiple sclerosis, cerebrovascular disease, and peripheral neuropathies, as well as with the rarer primary autonomic nervous system degenerations. We review the treatment of those aspects of autonomic dysfunction that often present to the neurologist, including orthostatic hypotension, urinary incontinence and retention, and bowel dysmotility syndromes. Pathophysiology is discussed in each instance as it relates to a rational approach to therapy. For management of orthostatic hypotension, we review the use of mineralocorticoids, direct and indirect sympathomimetic agents, other pressors, dopamine-blocking agents, vasopressin receptor agonists, and others. Treatment of urinary incontinence and retention is addressed, with attention to drugs that modulate bladder contractility and bladder outlet resistance. Therapies for bowel dysmotility syndromes (such as gastroparesis, diarrhea, and fecal incontinence) are described, including bulk agents, laxatives, prokinetic agents, and antidiarrheal drugs.

The Endorectal Pull‐Through Procedure in Children and Young Adults

SummaryAt our institution, proctocolectomy with rectal mucosectomy and ileoanal anastomosis with endorectal pull‐through is now the procedure of choice for young patients with chronic ulcerative colitis and familial polyposis. We have followed up 66 patients (37 male and 29 female, with a median age of 16 years) for at least 6 months after closure of the temporary ileostomy. The patients were seen regularly in follow‐up or were sent a comprehensive questionnaire to assess their condition. Twenty‐two patients had the construction of a J‐pouch. and 44 had a straight ileo‐anal pull‐through. Stool frequency, day (median 4 to 7 stools) and night (median 1 to 3 stools), was similar in the two groups. Voluntary continence was excellent in both groups during waking hours. Occasional night‐time incontinence in small volumes, mild perianal itching, and minimal bleeding from irritation were similar in both groups. Most of the patients could distinguish gas from stool. When medication was used, bulk agents were usually chosen, with a nonspecific anti‐diarrheal agent taken occasionally. A few patients with the straight ileo‐anal pull‐through expressed some dissatisfaction early during the follow‐up period: however, all but two patients expressed satisfaction later. Of the 66 patients, 41 had at least one complication during the postoperative period; however, in 26 the complications were minor. The more severe complications included small bowel obstruction (11 patients requiring surgical decompression), infection (one patient requiring surgery), and transient neuropathy (three patients).