Regular Bowel Movements Research Articles

헤어 미용사의 소화기계 건강에 영향을 미치는 요인에 관한 연구

This thesis aimed to determine the effecting factors(eating pattern, working condition, stress, health care) that help maintain the health of the cosmetologists' digestive system and the diseases involved (acid reflux, indigestion, gastritis, constipation & diarrhea). The research methods included survey and statistical analysis. The survey was conducted on 242 cosmetologists from August 30 to October 30 2014. The data analysis included frequency, cross table, <TEX>${\chi}^2$</TEX>-test, and regression with SPSS(V. 14). The results were as follows ; (1) The cosmetologists' health of digestive system and eating pattern are related. Regular and enough meal times cause less digestive disease. Acid reflux, indigestion, gastritis, constipation and diarrhea are differently related with the type of usual eating pattern, especially, instant food is not good for digestive health. (2) The cosmetologists' health of digestive system and working condition are related. Longer daily working hours and exposure time to chemical odors are more likely to be associated with digestive diseases; whereas, longer time of standing and talking with colleagues are less likely to be associated with digestive diseases. (3) The cosmetologists' health of digestive system and stress are related. Headache, boredom, conflict of pay and compensation, and insomnia are not good for digestive health. (4) The cosmetologists' health of digestive system and health care are related. Periodical medical examination and usual body stretching are correlated with digestive diseases; whereas, people who do regular exercise and bowel movement are less likely to have digestive diseases.

The Ineffectual Desire

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with no known organic cause, which is assuming epidemic proportions worldwide. Applying the concept of pathological general to a diagnosed case of IBS, of 7 years duration, <i>Nux vomica</i> was prescribed and the patient recovered remarkably in span of less than 2 months with regular bowel movements and no relapse.

Constipation and Encopresis in Childhood.

1. Jennifer M. Colombo, MD* 2. Matthew C. Wassom, PhD† 3. John M. Rosen, MD* 1. *Division of Gastroenterology, Children’s Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO. 2. †Division of Developmental & Behavioral Sciences, Children’s Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO. A recent study in Pediatrics concluded that 25% of children with functional constipation continued to experience symptoms at adult age, suggesting that referral to specialized clinics at an early stage for children who are unresponsive to first-line treatment may help improve outcomes. (1) After completing the article, the reader should be able to: 1. Know that constipation is a common problem in childhood with a diverse clinical presentation. 2. Understand that functional constipation is a symptom-based diagnosis that does not require extensive testing. 3. Recognize that most children who present with fecal incontinence or encopresis have associated constipation. 4. Describe the treatment of constipation and encopresis, which should include a medical-behavioral approach that focuses on maintaining soft and regular bowel movements and improving toileting behavior. What do the following children have in common? Answer: They share a familiar diagnosis: functional constipation. Constipation is a common pediatric problem and parental concern. In general, a complaint of constipation accounts for 5% of general pediatric office visits and 25% of all referrals to pediatric gastroenterologists. The estimated worldwide prevalence is 0.7% to 29.6%. (2) Constipation rarely signifies a serious disease, but it has an unfavorable impact on patient quality of life, parental satisfaction, and health-care costs. Children with constipation often complain of abdominal pain, decreased appetite, and painful stooling, which can be distressing to both the child and the parents. Common transient …

Characterization of Lactobacillus fermentum PL9988 Isolated from Healthy Elderly Korean in a Longevity Village.

In this work, we wanted to develop a probiotic from famous longevity villages in Korea. We visited eight longevity villages in Korea to collect fecal samples from healthy adults who were aged above 80 years and had regular bowel movements, and isolated lactic-acid-producing bacteria from the samples. Isolated colonies that appeared on MRS agar containing bromophenol blue were identified by means of 16S rRNA sequencing, and 102 of the isolates were identified as lactic-acid-producing bacteria (18 species). Lactobacillus fermentum was the most frequently found species. Eight isolates were selected on the basis of their ability to inhibit the growth of six intestinal pathogens (Escherichia coli O157:H7, Salmonella enterica subsp. enterica Typhimurium, Salmonella enterica subsp. enterica Enteritidis, Enterococcus faecalis, Staphylococcus aureus, and Listeria monocytogenes) and their susceptibility to 15 antimicrobial agents. Among these eight isolates, four Lactobacillus fermentum isolates were found not to produce any harmful enzymes or metabolites. Among them, Lactobacillus fermentum isolate no. 24 showed the strongest binding to intestinal epithelial cells, the highest immune-enhancing activity, anti-inflammation activity, and anti-oxidation activity as well as the highest survival rates in the presence of artificial gastric juice and bile solution. This isolate, designated Lactobacillus fermentum PL9988, has all the characteristics for a good probiotic.

Anterior perineal fistulectomy in repairing H-type rectovestibular fistula with a normal anus in female children

The purpose of this study was to review a 7-year operative experience of anterior perineal fistulectomy in repairing H-type rectovestibular fistula with a normal anus in female children. From January 2007 to December 2013, 105 female children with H-type rectovestibular fistula and a normal anus underwent anterior perineal fistulectomy in the Department of General Surgery, Beijing Children’s Hospital, Capital Medical University. Clinical data were retrospectively analyzed. Patients’ age ranged from 6months to 13years 10months, with an average age 5years 2months. The clinical feature of this disease was a definite history of vestibular infection at about 30days after birth and leakage of gas or loose stool through vestibular fistular orifice after the infection was controlled. All patients had a normal anus. Follow-up through telephone or outpatient visits from 6months to 7years (median, 5.2years), showed that all the patients were continent and had regular bowel movements. Among the 105 patients, 97 (92.4%) gained primary healing with a satisfactory appearance; 8 (7.6%) patients relapsed, among which 5 healed after hip bathing treatment within 3weeks, 2 required another anterior perineal fistulectomy 7months later and were cured, and the last one had another anterior perineal fistulectomy 1year 10months later but relapsed again, which healed after hip bathing treatment within 3weeks after the second surgery. Anterior perineal fistulectomy is a simple, safe and reliable surgical method to treat H-type rectovestibular fistula with a normal anus.

Effect of oral mesalamine on inflammatory response in acute uncomplicated diverticulitis.

To evaluate the impact of mesalamine administration on inflammatory response in acute uncomplicated diverticulitis. We conducted a single centre retrospective cohort study on patients admitted to our surgical department between January 2012 and May 2014 with a computed tomography -confirmed diagnosis of acute uncomplicated diverticulitis. A total of 50 patients were included in the analysis, 20 (study group) had received 3.2 g/d of mesalamine starting from the day of admission in addition to the usual standard treatment, 30 (control group) had received standard therapy alone. Data was retrieved from a prospective database. Our primary study endpoints were: C reactive protein mean levels over time and their variation from baseline (ΔCRP) over the first three days of treatment. Secondary end points included: mean white blood cell and neutrophile count over time, time before regaining of regular bowel movements (passing of stools), time before reintroduction of food intake, intensity of lower abdominal pain over time, analgesic consumption and length of hospital stay. Patients characteristics and inflammatory parameters were similar at baseline in the two groups. The evaluation of CRP levels over time showed, in treated patients, a distinct trend towards a faster decrease compared to controls. This difference approached statistical significance on day 2 (mean CRP 6.0 +/- 4.2 mg/dL and 10.0 +/- 6.7 mg/dL respectively in study group vs controls, P = 0.055). ΔCRP evaluation evidenced a significantly greater increment of this inflammatory marker in the control group on day 1 (P = 0.03). A similar trend towards a faster resolution of inflammation was observed evaluating the total white blood cell count. Neutrophile levels were significantly lower in treated patients on day 2 and on day 3 (P < 0.05 for both comparisons). Mesalamine administration was also associated with an earlier reintroduction of food intake (median 1.5 d and 3 d, study group vs controls respectively, P < 0.001) and with a shorter hospital stay (median 5 d and 5.5 d, study group vs controls respectively, P = 0.03). Despite its limitations, this study suggests that mesalamine may allow for a faster recovery and for a reduction of inflammatory response in acute uncomplicated diverticulitis.

Patient preferences for change in symptoms associated with opioid-induced constipation.

IntroductionWhile opioids have become a standard treatment option for those experiencing moderate to severe chronic pain, side effects of constipation and related symptoms have interfered with their usage in as many as 40–50% of treated patients. Prior research has elucidated the range of these symptoms, but no study has determined which of these symptoms patients most desire improving or whether improving constipation itself by as little as one more bowel movement per week is deemed an important change.MethodsWe conducted an online patient survey of 513 participants residing in one of six countries who reported having chronic pain, were taking opioids, and experiencing opioid-induced constipation (OIC) to address these questions.ResultsRespondents rank ordered their preferences and the following eight symptoms generated >80% endorsement as important to improve: improvement in having bowel movements without rectal pain, soft stools that are not loose or watery, regular bowel movements, a reduction in rectal straining, relief from feeling bloated, feeling less fear about having OIC when following their opioid medication regime, a desire to worry less overall about having a bowel movement, and with less ‘stomach’ area pain. When asked ‘how important is it you to have 1 more bowel movement per week”, over 90% endorsed it was ‘somewhat’, ‘very’, or ‘extremely important’ with nearly 70% (n = 354) endorsing the ‘extremely’ or ‘very important’ response options. In multivariate models, being in more overall pain or reporting fewer than 3 bowel movements per week were found to be independent predictors of the importance.ConclusionsThese results highlight the notable range of OIC symptoms most desired by patients to improve and demonstrate that bowel movements of only one more per week were important to register a meaningful improvement. The latter is particularly helpful for those assessing the minimal clinically important difference in treating this condition.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0169-x) contains supplementary material, which is available to authorized users.

Update on the management of anal fissure

Anal fissure is an ulceration of the anoderm in the anal canal. Its pathogenesis is due to multiple factors: mechanical trauma, sphincter spasm, and ischemia. Treatment must address these causative factors. While American and British scientific societies have published recommendations, there is no formal treatment consensus in France. Medical treatment is non-specific, aimed at softening the stool and facilitating regular bowel movements; this results in healing of almost 50% of acute anal fissures. The risk of recurrent fissure remains high if the causative factors persist. If non-specific medical treatment fails, specific medical treatment can be offered to reversibly decrease hypertonic sphincter spasm. Surgery remains the most effective long-term treatment and should be offered for cases of chronic or complicated anal fissure but also for acute anal fissure with severe pain or for recurrent fissure despite optimal medical treatment. Surgical treatment is based on two principles that may be combined: decreasing sphincter tone and excision of the anal fissure. Lateral internal sphincterotomy (LIS) is the best-evaluated technique and remains the gold standard in English-speaking countries. Since LIS is associated with some risk of irreversible anal incontinence, its use is controversial in France where fissurectomy combined with anoplasty is preferred. Other techniques have been described to reduce the risk of incontinence (calibrated sphincterotomy, sphincteroplasty). The technique of forcible uncalibrated anal dilatation is no longer recommended.

Experience of the MACE Procedure at A Regional Pediatric Surgical Unit: A 15-Year Retrospective Review

The Malone antegrade continence enema (MACE) procedure is an established treatment option for children with constipation or fecal incontinence. This study retrospectively analyses the management and outcomes of children who underwent MACE procedures at a regional pediatric surgery unit. Children who underwent a MACE procedure in our unit between 1998 and 2012 were identified. Demographic and clinical data were obtained from contemporaneous records. Using the continence scale described by Malone, overall outcomes were categorized as full, partial, or failure (full: totally clean or minor rectal leakage on night of washout; partial: clean but significant stoma or rectal leakage, occasional major leak and/or still wearing protection but perceived by child or parent to be an improvement; failure: regular soiling or constipation persisted, no perceived improvement, procedure was abandoned). Data entry and statistical analysis were performed using Excel and SPSS (IBM Corp., Armonk, New York, United States). A total of 40 children (29 male) were identified for inclusion. Underlying diagnoses were idiopathic constipation (16), anorectal anomalies (14) and Hirschprung's disease (10). The MACE procedure was performed laparoscopically in 26 cases and using an open technique in 14 cases. Mean age at the time of surgery was 8.9 years (range, 3-19 years) and mean follow-up time was 6.5 years (range, 1-10 years). Outcomes categorized as full were 62.5% for chronic idiopathic constipation (CIC), 71.4% for anorectal malformation (ARM), and 70% for Hirschsprung disease (HD). Overall success rates (full and partial outcomes combined) were 87.5% for CIC, 92.8% for ARM, 100% for HD, and 92.5% for all diagnoses taken together. Eleven MACE procedures (27.5%) were reversed, in seven (17.5%) due to the return of spontaneous and regular bowel movements and in four (10%) due to stomal problems. This study identified a high success rate (combining full and partial outcomes) of 92.5% for MACE procedures within our unit. An encouraging finding is that the procedure was reversed in a significant proportion of patients following the return of normal bowel habits.

Efficacy of Daily Cone-Beam Computed Tomography as Part of a Rescan Protocol for Large Offset to Reduce the Inter-Fractional Motion of the Prostate

Purpose: To prospectively analyze the inter-fractional motion of the prostate in patients with prostate cancer treated with intensity-modulated radiation therapy (IMRT) using image-guided radiotherapy (IGRT) with daily cone-beam computed tomography (CBCT) as part of a rescan protocol for large offset, and to evaluate the efficacy of our protocol. Materials and Methods: Eligible patients were treated with the following protocol: 1) magnesium oxide and dimethylpolysiloxane were administered to ensure that patients had regular bowel movements; 2) the patients were instructed to have an appropriately distended bladder during the planning CT and daily irradiation; 3) the daily CBCT image was fused with the planning CT image using the prostate outline; and 4) if large offset was recognized, a rescan CBCT image was obtained after appropriate countermeasures, such as the discharge of gas and defecation, and re-registration was performed. Three shifts for the inter-fractional motion of the prostate were analyzed, in the fractions which needed the CBCT rescan; the displacement data after the final rescan were used. Results: Sixty-one patients were eligible, and a total of 2302 fractions were available for the analysis. Rescans of the CBCT for large offset were performed in 113 (5%) of the 2302 fractions. After the first rescan, the large offset was resolved in 106 (94%) of the 113 fractions. Excessive rectal gas was the reason for the large offset in 94 (83%) of the 113 fractions. The total mean and standard deviation of the inter-fractional motion of the prostate in the AP, LR, and SI directions were 1.1 ± 2.4, -0.1 ± 2.3, and 0.7 ± 3.0 mm, respectively. Conclusion: Large offset was recognized in 5% of all fractions. Daily CBCT with our rescan protocol could resolve the large offset, which was mainly caused by excessive rectal gas, and it may therefore be promising to reduce the inter-fractional motion of the prostate.

The Dangers of Fleet Enema in Chronic Constipation

Purpose: The patient is a 46-year-old male with past medical history significant for cardiac sarcoidosis, systolic heart failure (EF 30%), type 2 diabetes mellitus, compression deformities secondary to chronic steroid use, and chronic constipation secondary to opioid use, who presented with a ventricular tachycardia storm. The patient was admitted and placed on an amiodarone drip and then transitioned to po amiodarone. During his admission, the patient complained that his back pain had worsened over the past couple of months. He was started on Morphine SA 30mg BID and Oxicodone 10mg. He was started on senna and colace for bowel movements (BMs), which initially regulated his BMs, but later became constipated again. Miralax and eventually lactulose were started. Again, he started having regular BMs, but the regimen was less effective as his need for opioid increased. Subsequently, he was started on soap enema prn. This slightly helped, but the constipation did not resolve. He was then given a fleet enema and the patient's BMs slightly improved. A couple of days later, the constipation returned. We tried to decrease his pain medication, but he complained of significant pain. He wanted to start fleet enemas again. After getting the fleet enema, he did not have a large BM, but six hours later, he started to complain of fatigue and confusion. Blood work was sent, which showed a Na 153, Ca of 5.2, PO4 12.4, and BUN/Cr of 45/3. He was transferred to the ICU, where he was given IV fluids. Patient started becoming bradycardiac, became unresponsive, and went into PEA arrest. ACLS protocol was followed but was unsuccessful. Physicians often use opioids to treat moderate to severe pain, but opioids induce constipation. Opioid-induced constipation is mediated by gastrointestinal μ-opioid receptors. Limiting opioid therapy can decrease the severity of opioid-induced constipation, but analgesia is worsened. Frequently, phosphate-containing enemas are widely used to combat opioid-induced constipation. The laxative action is created through fluid movement into the rectosigmoid induced by sodium phosphate. Normally, the response occurs within minutes, resulting in little absorption of the enema. However, phosphate can be absorbed by the colon following normal doses of fleet enema in humans if not excreted. Clinical manifestations of fleet enema intoxication include volume depletion, acute renal failure, hypernatremia, hyperphosphatemia with reciprocal hypocalcemia. Initial fluid resuscitation is mandatory. Hemodialysis is indicated if metabolic derangements and oligoanuria are present. Methylnaltrexone is a selective antagonism of peripheral μ-opioid receptors and helps relieve opioid-induced constipation, but maintains analgesia.

MAI, The Other Mycobacterium, as a Complication from Anti-TNF Therapy in IBD

Purpose: The patient is a 61-year-old male who presented with several weeks of malaise, weight loss, and several days of vomiting. He has a 25-year history of fibrostenotic Crohn's disease, for which he underwent an ileo-cecectomy in the past. Six months prior to presentation, the patient began having weight loss, abdominal pain, and was found to have strictures and ulcers in his small bowel. He had a negative Quantiferon Gold, and was started on infliximab therapy, 5 mg/kg with a standard initiation protocol. He received a total of six infusions prior to the current presentation, most recently 3 weeks prior. He was not taking any other medications for IBD, including a 5-ASA, immunologic or steroids. On presentation, the patient reported no fever, chills, nightsweats or cough. He had his baseline abdominal pain, but continued to have regular flatus and bowel movements, as well as a normal appetite. His physical exam demonstrated a thin man with notable pallor. His oropharynx was clear, and there was no palpable cervical lymphadenopathy. He had ronchi in his right lower lobe with deep inspiration. Abdominal exam was notable for a scaphoid abdomen with mild tympanic distention, and hyperactive bowel sounds. On labs, his WBC was 12.2 K/uL with a slight left shift, and his hemoglobin was 7.5 g/dL. He had a CT of the abdomen performed, where a 3-cm mass-like opacity was seen at the right lung base abutting the pleura. He also has some thickened small bowel loops in the left upper quadrant. Microbiology data was negative for legionella or strep pneumonia, as well as negative for histoplasmosis. The patient then underwent a video-assisted thoracic surgery with removal of the mass lesion. Pathology revealed areas of fibrosis, inflammation and foci with multinucleated giant cells suggestive of granulomas. Stains for AFB and fungus were negative. On sputum cultures, one-sixth grew Micobacterium avium-intracellulare (MAI). The patient was subsequently begun on multidrug treatment of his MAI with resolution of his symptoms and return to his normal weight. Anti-TNF therapy is a well-known risk factor for tuberculosis and other granulomatous diseases. Nontuberculosis mycobacterium has been reported in rheumatologic patients, usually in those taking corticosteroids or methotrexate concomitantly, but a specific warning or testing for MAI is not standard of care for IBD patients receiving anti-TNF therapy.

Constipation and a Low-Fiber Diet Are Not Associated With Diverticulosis

Asymptomatic diverticulosis is commonly attributed to constipation caused by a low-fiber diet, although evidence for this mechanism is limited. We examined the associations between constipation and low dietary fiber intake with risk of asymptomatic diverticulosis. We performed a cross-sectional study that analyzed data from 539 individuals with diverticulosis and 1569 without (controls). Participants underwent colonoscopy and assessment of diet, physical activity, and bowel habits. Our analysis was limited to participants with no knowledge of their diverticular disease to reduce the risk of biased responses. Constipation was not associated with an increased risk of diverticulosis. Participants with less frequent bowel movements (<7/wk) had reduced odds of diverticulosis compared with those with regular bowel movements (7/wk) (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.40-0.80). Those reporting hard stools also had reduced odds (OR, 0.75; 95% CI, 0.55-1.02). There was no association between diverticulosis and straining (OR, 0.85; 95% CI, 0.59-1.22) or incomplete bowel movement (OR, 0.85; 95% CI, 0.61-1.20). We found no association between dietary fiber intake and diverticulosis (OR, 0.96; 95% CI, 0.71-1.30) in comparing the highest quartile with the lowest (mean intake, 25 vs 8 g/day). In our cross-sectional, colonoscopy-based study, neither constipation nor a low-fiber diet was associated with an increased risk of diverticulosis.

Pelvic Inflammatory Disease

1. Maria Trent, MD, MPH* 1. *Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. * CDC: : Centers for Disease Control and Prevention CPP: : chronic pelvic pain CT: : computed tomography IM: : intramuscular IUD: : intrauterine device IV: : intravenous KOH: : potassium hydroxide NAAT: : nucleic acid amplification testing PEACH: : Pelvic Inflammatory Evaluation and Clinical Health PID: : pelvic inflammatory disease STI: : sexually transmitted infection 1. The U. S. Centers for Disease Control and Prevention (CDC) provides evidence-based, expert-driven guidelines for effective management of pelvic inflammatory disease (PID); however, clinician adherence to the guidelines has been problematic. 2. PID practice guideline adherence is an international problem, as evidenced by a 2012 audit in the United Kingdom demonstrating that 55.5% of patients with PID did not receive care according to the British Association of Sexual Health and HIV treatment recommendations. Clinician behavior can be enhanced with the use of institutionally driven protocols, especially those that include onsite dispensing of a full course of medications. 3. Women seeking infertility services who report a history of unexplained and untreated abdominal pain are significantly more likely to have tubal infertility than women without such history; therefore caution should be used in dismissing mild symptoms (mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia) among sexually active patients who may be at risk for PID. After completing this article, readers should be able to: 1. Describe the epidemiology and pathogenesis of pelvic inflammatory disease (PID). 2. Recognize the clinical features of PID. 3. Develop a management strategy for adolescent patients who have PID. 4. Carefully weigh the options for the disposition of patients who have PID. Justine is a 17-year-old girl who presents for evaluation of lower abdominal pain that has been increasing over the past few days. Earlier today she was eating and drinking, but has developed some nausea in the past couple of hours without vomiting. She has had soft, regular bowel movements that are free of blood and mucus. She denies dysuria, but has had some light vaginal discharge that started about 1 week ago. Justine continues to …

Gastric emptying of water in children with severe functional fecal retention

The objective of this study was to evaluate gastric emptying (GE) in pediatric patients with functional constipation. GE delay has been reported in adults with functional constipation. Gastric emptying studies were performed in 22 children with chronic constipation, fecal retention and fecal incontinence, while presenting fecal retention and after resuming regular bowel movements. Patients (18 boys, median age: 10 years; range: 7.2 to 12.7 years) were evaluated in a tertiary pediatric gastroenterology clinic. Gastric half-emptying time of water (reference range: 12 ± 3 min) was measured using a radionuclide technique immediately after first patient evaluation, when they presented fecal impaction (GE1), and when they achieved regular bowel movements (GE2), 12 ± 5 weeks after GE1. At study admission, 21 patients had reported dyspeptic symptoms, which were completely relieved after resuming regular bowel movements. Medians (and interquartile ranges) for GE1 and GE2 were not significantly different [27.0 (16) and 27.5 (21) min, respectively (P = 0.10)]. Delayed GE seems to be a common feature among children with chronic constipation and fecal retention. Resuming satisfactory bowel function and improvement in dyspeptic symptoms did not result in normalization of GE data.

A pilot study of extremely low-frequency magnetic fields in advanced non-small cell lung cancer: Effects on survival and palliation of general symptoms

The inhibitory effects of magnetic fields (MFs) on tumor cell proliferation in vitro and in vivo have been reported in previous studies. However, the effects of MFs in the treatment of cancer have not been described in clinical trials. We investigated the effects of 420 r/min, 0.4-T extremely low-frequency MFs (ELF-MFs) on the survival and palliation of general symptoms in 13 advanced non-small cell lung cancer (NSCLC) patients. Toxicity and side-effects were assessed according to WHO criteria. The treatment area included the primary tumor site, metastatic sites and metastatic lymph nodes. Additionally, the patients were treated 2 h per day, 5 days per week for 6-10 weeks. The changes in general symptoms were analyzed during ELF-MF treatment and 2 weeks after the completion of therapy. Results of physical examination, routine analysis of blood, ECG and liver function, biochemical and kidney function tests were evaluated before and following treatment. All 13 patients were followed up by outpatient service or telephone interview. Our results demonstrated that decreased pleural effusion, remission of shortness of breath, relief of cancer pain, increased appetite, improved physical strength, regular bowel movement and better sleep quality was detected in 2 (15.4%), 5 (38.5%), 5 (38.5%), 6 (46.2%), 9 (69.2%), 1 (7.7%) and 2 (15.4%) patients, respectively. However, the palliation of symptoms in 2 (15.4%) patients was observed during therapy and disappeared at treatment termination. No severe toxicity or side-effects were detected in our trial. The median survival was 6.0 months (95% CI, 1.0-11.0). The 1- and 2-year survival rates were 31.7 and 15.9%, respectively. This study is the first to describe survival and palliation of general symptoms in advanced NSCLC patients treated with ELF-MFs. As an effective, well-tolerated and safe treatment choice, ELF-MFs may prolong survival and improve general symptoms of advanced NSCLC patients. However, this treatment strategy requires further research.

Comparison of posterior internal anal sphincter myectomy and intrasphincteric botulinum toxin injection for treatment of internal anal sphincter achalasia: a meta-analysis

Internal anal sphincter (IAS) achalasia is a clinical condition with presentation similar to Hirschsprung's disease, but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made by anorectal manometry (ARM), which demonstrates the absence of the rectosphincteric reflex on rectal balloon inflation. The recommended treatment of choice is posterior IAS myectomy. Recently, intrasphincteric botulinum toxin (Botox) injection has been effectively used for treatment of IAS achalasia. The aim of this meta-analysis was to compare the efficacy of posterior IAS myectomy with intrasphincteric Botox injection for treatment of IAS achalasia. A systematic literature search for relevant articles was conducted using the following databases: MEDLINE( ® ), EMBASE(®), ISI Web of Science(SM) and the Cochrane Library. A meta-analysis was performed with the studies where IAS achalasia was diagnosed based on the results of ARM and RSB. Odds ratio (OR) with 95% confidence intervals were calculated. Sixteen prospective and retrospective studies, published from 1973 to 2009, were identified. A total of 395 patients with IAS achalasia were included in this meta-analysis. Fifty-eight percent of patients underwent IAS myectomy and 42% Botox injection. Regular bowel movements were significantly more frequent after IAS myectomy (OR 0.53, [95% CI 0.29-0.99]; p=0.04). There was no significant difference in continued use of laxatives or rectal enemas (OR 0.92, [95% CI 0.34-2.53], p=0.89) and in overall complication rates between both procedures (OR 0.68, [95% CI 0.38-1.21]; p=0.19). Looking at specific complications, the rate of transient faecal incontinence was significantly higher after Botox injection (OR 0.07, [95% CI 0.01-0.54]; p<0.01). Constipation and soiling were not significantly different between both procedures (OR 0.66, [95% CI 0.30-1.48]; p=0.31 and OR 0.24, [95% CI 0.03-2.07]; p=0.25). The rate of non-response was significantly higher after Botox injection (OR 0.52, [95% CI 0.27-0.99]; p=0.04). Subsequent surgical treatment was significantly more frequent after Botox injection (OR 0.18, [95% CI 0.07-0.44]; p<0.0001). Short- and long-term improvements were significantly more frequent after IAS myectomy (OR 0.56, [95% CI 0.32-0.97]; p=0.04 and OR 0.25, [95% CI 0.15-0.41]; p<0.0001). This meta-analysis indicates that in patients with IAS achalasia, posterior IAS myectomy appears to be a more effective treatment option compared to intrasphincteric Botox injection. After Botox injection, the rate of transient faecal incontinence, non-response and subsequent surgical procedures were significantly higher compared to IAS myectomy.

A 66-Year-old Man With Prostate-specific Antigen Recurrence and Lung Mass After Radical Prostatectomy

A67-year-old white male patient with a past medical history of prostate cancer status post nervesparing radical retropubic prostatectomy, malignant fibrohistiocytoma of the left hand, and basal cell carcinoma of the ear status post resection, presented for a follow-up visit to his urologist and was found to have an increased prostate-specific antigen (PSA). The patient had initially undergone a radical prostatectomy in December 1989 when he was 60 years old. Final pathology revealed a Gleason 6 adenocarcinoma with a focus of prostatic ductal carcinoma, organ confined (pT2) with negative margins (Figs. 1A, 1B). Initial postoperative PSA was undetectable, but in 1991, it became detectable and continued to increase to 0.8 in 1994. Bone scan and imaging of the pelvis were negative for metastatic disease. The patient received radiation therapy to his prostatic bed beginning July 1994 when the patient was 65 years old. His postradiation PSA was 0.8 and initially decreased, but in January 1997, it was 2.1. The patient denied any weight loss, fevers or chills, chest pain or shortness of breath, abdominal pain, bone pain, increased urinary frequency, urgency, or hesitancy, dysuria, or hematuria. He was having regular bowel movements. He was a lifetime nonsmoker. On examination, the patient was afebrile and his vital signs were stable. He was alert and generally appeared well. He had no cervical or axillary adenopathy. Lungs were clear to auscultation bilaterally. His abdomen was soft, nontender, and nondistended. He had a well-healed midline surgical scar. Rectal examination showed no palpable nodularity in the prostatic bed and good sphincter tone. Extremities were warm and well-perfused without edema, clubbing, or cyanosis. His laboratory test

Robotic Swenson Pull-Through for Hirschsprung's Disease in Infants

It has been demonstrated that infants with Hirschsprung's disease can be treated with a one-stage laparoscopic resection and coloanal pull-through. However, the feasibility and benefits of performing this operation using robotic technology have not yet been evaluated. We reviewed our experience with 12 infants diagnosed with Hirschsprung's disease and treated with laparoscopic-robotic assisted colonic resection with proctectomy and pull-through using the da Vinci robotic system. Patients were treated at a mean age/weight of 16 weeks/5.5 kg. The average operative time for the robotic procedure was 230 minutes, and average length of stay was 3 days. At discharge, all patients were having regular bowel movements and tolerating a completely oral diet. All patients received early postoperative anorectal dilation and six patients required dilations for an average of 12 weeks after surgery for management of minor rectal strictures. Only two patients developed postoperative enterocolitis with a mean follow-up of 36 months. A robotic approach for performing a Swenson-type resection and pull-through procedure can be performed safely and successfully in young infants. Robotic technology provided superior dexterity and visualization, essential in performing a more complete rectal dissection, thus allowing for a complete proctectomy and eliminating the risk of leaving a segment of aganglionic rectum behind.

Influence of Antiflatulent Dietary Advice on Intrafraction Motion for Prostate Cancer Radiotherapy

To evaluate the effect of an antiflatulent dietary advice on the intrafraction prostate motion in patients treated with intensity-modulated radiotherapy (IMRT) for prostate cancer. Between February 2002 and December 2009, 977 patients received five-beam IMRT for prostate cancer to a dose of 76 Gy in 35 fractions combined with fiducial markers for position verification. In July 2008, the diet, consisting of dietary guidelines to obtain regular bowel movements and to reduce intestinal gas by avoiding certain foods and air swallowing, was introduced to reduce the prostate motion. The intrafraction prostate movement was determined from the portal images of the first segment of all five beams. Clinically relevant intrafraction motion was defined as ≥50% of the fractions with an intrafraction motion outside a range of 3 mm. A total of 739 patients were treated without the diet and 105 patients were treated with radiotherapy after introduction of the diet. The median and interquartile range of the average intrafraction motion per patient was 2.53 mm (interquartile range, 2.2-3.0) without the diet and 3.00 mm (interquartile range, 2.4-3.5) with the diet (p < .0001). The percentage of patients with clinically relevant intrafraction motion increased statistically significant from 19.1% without diet to 42.9% with a diet (odds ratio, 3.18; 95% confidence interval, 2.07-4.88; p < .0001). The results of the present study suggest that antiflatulent dietary advice for patients undergoing IMRT for prostate cancer does not reduce the intrafraction movement of the prostate. Therefore, antiflatulent dietary advice is not recommended in clinical practice for this purpose.