Can irritable bowel syndrome be detected by ultrasound?

Functional gastrointestinal disease is one in which gastrointestinal symptoms persist chronically or recurrently. This disease is challenging because it does not have an organic cause that can be detected in routine laboratory tests. Among them, the symptoms of irritable bowel syndrome (IBS), which is a type of functional gastrointestinal tract disease, include abnormal bowel movements associated with abdominal pain. However, no specific test has been established to definitively diagnose these diseases, including IBS. The traditional Rome IV diagnostic criteria are used to diagnose IBS by assessing subjective symptoms. However, it has been suggested that IBS is difficult to diagnose using the Rome IV criteria among unconscious or cognitively impaired patients. It is recommended that abdominal ultrasonography be used to assess IBS with diarrhea and constipation. Previously, constipation among elderly people who ingested food orally was objectively assessed by ultrasound, and colonic fecal distribution patterns were classified in constipated patients and healthy people. Objective visualization of the large intestine was used to assess constipation. Therefore, fecal retention among adults and elderly individuals was reported using ultrasonography. It was suggested that stool retention could be confirmed by observing the hyperechoic region of the rectum. Strong hyperechoic regions with acoustic shadows in the rectum indicate the presence of hard stools, thus enabling medical workers to identify constipation. In the future, ultrasonography may be useful for diagnosing IBS in unconscious patients or those with cognitive decline.

Improvement of Constipation Symptoms in an Older Adult Patient by Defecation Care Based on Using a Handheld Ultrasound Device in Home Care Settings: A Case Report.

BACKGROUND: Although previous studies have demonstrated the ability of ultrasound to detect stool in the colon and rectum, the clinical utility of evaluating constipation via ultrasonic imaging by nurses has not been determined. In this case report, we observed fecal retention, assessed the presence of constipation, and performed defecation care in an older adult patient in a home care setting in a city near the metropolitan area in Japan. CASE: An 85-year-old male with advanced stage prostate cancer and multiple metastases was diagnosed with fecal impaction via digital rectal examination and evaluation of stool consistency. He was managed by regular digital evacuation of stool, but ultrasonic imaging indicated constipation with fecal retention in both the rectum and the colon despite this bowel evacuation program. When faced with this situation, we advocate a bowel management program that considers both intestinal elimination dysfunction and fecal transport dysfunction. Based on ultrasonic imaging, stool consistency was altered by promoting water intake, and we promoted self-defecation by asking the patient to attempt to move his bowels (regardless of cues to defecation) by sitting on the toilet every morning. As a result, the number of weekly enemas and digital dis-impaction episodes decreased while the number of spontaneous defecations increased. CONCLUSION: This case report demonstrated that ultrasonography improved bowel management in this patient with clinically severe chronic constipation.

Twenty-year outcome of aortic valve replacement with St. Jude Medical mechanical valves in Japanese patients.

BACKGROUND: Bioprostheses have become increasingly popular for aortic valve replacement (AVR) in recent years, but mechanical valves are still the standard choice, especially for younger patients. The aim of this study was to assess the very long-term outcomes in Japanese patients who underwent AVR with St. Jude Medical (SJM) mechanical valves. METHODS AND RESULTS: From 1991 to 2001, a total of 816 patients underwent AVR with SJM mechanical valves in 5 hospitals. Of these, 801 patients (mean age, 58.3±11.7 years) were analyzed in this study. There were 24 in-hospital deaths (3.0%). Mean follow-up duration was 11.6±6.7 years and the 10-year follow-up rate was 84.1%. Freedom from valve-related death at 5, 10, 15, and 20 years was 96.2%, 92.7%, 88.8%, and 86.6%, respectively. The linearized ratio of major bleeding events and thromboembolic events was 1.1% per patient-year and 1.0% per patient-year, respectively. Freedom from reoperation for the aortic prosthesis was 98.0% and 94.8% at 10 and 20 years, respectively. CONCLUSIONS: The SJM mechanical valve provided excellent long-term freedom from valve-related death and reoperation in patients undergoing AVR. Therefore, this valve should be recommended to younger patients who wish to avoid reoperation.

Long-term durability of pericardial valves in the aortic position in younger patients: when does reoperation become necessary?

BACKGROUND: We sought to assess the long-term durability of pericardial valves in patients at age <65 years undergoing aortic valve replacement (AVR), and to determine the timing of redo operations due to structural valve deterioration (SVD). METHODS: From 1986 to 2001, a total of 574 adult patients underwent AVR with pericardial valves in nine hospitals in Japan. Of these, 53 patients were at age <65 years (group Y). These patients were compared with those of age ≥ 65 (group O, n = 521). RESULTS: The mean follow-up duration was 9.5 years in group Y and 8.1 years in group O. Freedom from reoperation due to SVD was 100% at five years, 90.8% at 10 years, and 47.2% at 15 years in group Y, and 99.3% at five years, 97.4% at 10 years, and 94.4% at 15 years in group O (log-rank test, p < 0.01). In those who required redo AVR in group Y (n = 12), the mean time from initial operation to reoperation was 12.1 years. The reoperation-free survival curve started to decline after eight years postoperation in group Y. CONCLUSIONS: Redo AVR started to become necessary eight years after surgery in the patients who underwent AVR with pericardial valve at age <65 years. In addition, approximately half of those patients required reoperation due to SVD by 15 years postoperatively.

Total and subtotal aortic replacement for extensive aortic dissection in patients with or without Marfan's syndrome.

OBJECTIVES: Extensive aortic dissection with multiple entries often found in Marfan's syndrome patients ultimately requires replacement of the whole aorta. We present a surgical strategy and results for total and subtotal aortic replacement. METHODS: Subjects were 18 patients, including 14 Marfan's patients undergoing total (n = 13) or subtotal (excluding aortic arch) aortic replacement (n = 5), for DeBakey type I aortic dissection (n = 13) and DeBakey type IIIb aortic dissection with annuloaortic ectasia (n = 5) between February 1991 and April 2001. Mean age was 39.9 +/- 0.8 years--34.9 +/- 6.6 years in Marfan's patients vs. 57.7 +/- 4.7 years in non-Marfan patients. All operations were staged, with the mean number required per patient 3.1 +/- 0.8. RESULTS: Early mortality was 0% and late mortality 11% (2 of 18). Paraplegia or paraparesis occurring in 11%. Except for these patients, all current survivors enjoy good quality of life. CONCLUSIONS: Total and subtotal aortic replacement for extensive aortic dissection may decrease mortality due to rupture or associated disease.