Randomized comparison of two preoperative methods for preparation of the colon: oral administration of a solution of polyethylene glycol plus electrolytes and total parenteral nutrition.

BACKGROUNDS/AIMS: Two colon preparation methods were compared for their efficacy. The comparison was carried out between whole bowel irrigation using polyethylene glycol-electrolyte lavage solution (PEG-ELS) and total parenteral nutrition (TPN). METHODOLOGY: Twenty-six consecutive patients suffering from colorectal cancer without apparent obstruction were randomly divided into two groups. Twelve patients received 2 litres of PEG-ELS one day before the operation following two tablets of sennoside (24 mg) two days before the operation without restriction of food until PEG-ELS. Fourteen patients received magnesium citrate (34 g) and sennoside (24 mg) on the day before the operation with 7 days' TPN and fasting. RESULTS: The average time of defecation was 9 in the PEG-ELS group and 5 in the TPN group (p < 0.001), with little difference between the necessary times to complete defecation (PEG-ELS: 280 min. vs. TPN: 260 min.). However, although half of the PEG-ELS group complained of side effects of abdominal fullness the overall incidence of side effects in both groups were the same of 50%. There were no significant changes between the data of blood test and routine chemistry before and after the bowel preparation in both groups. The purity of the colorectum judged at operation in both groups were excellent, no residue at all, except in one patient of the TPN group. The total bacterial counts of the rectal samples obtained at operation of PEG-ELS group were fewer than that of TPN group but not statistically significant. CONCLUSION: Colon preparation using PEG-ELS is just as good as the 7-days' TPN treatment and fasting, and exceeds from the standpoint of saving time.

[Informed consent in anesthesia].

Informed consent is required for not only operative procedures but also anesthesia. One hundred and sixty-two patients, including those in a control group, were interviewed between the 3rd and 10th days after operations. An information sheet describes the anesthetic management and complications (possibilities of teeth damage, hoarseness and sore throat) in a simple style. This survey showed that those who had received the information sheet before operation showed significantly deeper understanding of anesthesia (56.2%) compared with those who had not received the information sheet (40.3%) (P < 0.05). The information sheet did not cause or increase anxiety about anesthesia. Those who had anxiety about anesthesia before the operation needed detailed printed information (63.8%) compared with those without anxiety (36.6%) (P < 0.01). An information sheet describing the anesthetic management and complications is useful for obtaining informed consent.

[A case of esophagopleural fistula successfully cured by conservative therapy after middle and lower lobectomy of right lung].

We experience a case of esophagopleural fistula successfully cured by conservative therapy after the lung cancer operation. A 46-year-old man was received middle and lower lobectomy for adenoid cystic carcinoma of the right lung. Complication of empyema associated with an esophagopleural fistula occurred on postoperative 4th day. Conservative therapy of nothing by mouth, intravenous hyperalimentation and antibiotics was started. Three thoracic drains were inserted and the thoracic irrigation of total 3,000 ml warm saline per day twice on one day was continued. The esophagopleural fistula was closed on 6th week and the patient was discharged on 11th week after the therapy start. This complication is much rare, but recent advance in the diagnostic methods seemed to increase the indication of conservative therapy in future.

Interradicular dentin dysplasia associated with amelogenesis imperfecta.

Very few reports are available on the occurrence of dysplasia of both enamel and dentin. This report concerns a rare association of amelogenesis imperfecta with a dysplasia of dentin in the interradicular area in sisters of Japanese descent who have no other morphologic anomalies. Retarded tooth eruption was also a clinical feature in both sisters. Histologic examination of several teeth revealed that the anomalous interradicular dentin consisted of a mass of small, onion-like calcified bodies. The absence of any dental abnormalities in both parents, who are related as first cousins, supports the concept of autosomal recessive inheritance for this trait.

A clinical and histologic observation of enamel hypoplasia in a case of epidermolysis bullosa hereditaria.

The nature of the enamel defects in a patient with epidermolysis bullosa hereditaria dystrophica was observed by light microscopy, microradiography, and scanning electron microscopy (SEM) so that by these means more detailed information could be obtained. The random distribution of the round shape of the hypoplastic defects of enamel with hypomineralization, in which there is a continuity of the incremental lines, suggested the possibility that some ameloblasts maintained hypoactivity of their secretory function during their total life span.

Clinical, genetic, and histologic features of the trichoonychodental (TOD) syndrome.

A syndrome of scanty, fine, curled hair, thin dysplastic nails, taurodontic molars, hypoplastic-hypomature enamel, dysplasia of dentin, and hypohidrosis segregating as an autosomal dominant trait is described in a Japanese family. The patients received repeated doses of tetracycline during odontogenesis which fortuitously assisted in interpreting the pathogenesis of the dentin defect. The condition was previously described as familial congenital ectodermal dysplasia by Westerholm and as odontogenesis imperfecta by Siirilä and Heikinheimo. It is suggested that the name trichoonychodental (TOD) syndrome is a better descriptive term for the condition.

Dentinogenesis imperfecta: evidence of qualitative alteration in the organic dentin matrix.

Deciduous teeth affected by dentinogenesis imperfecta were obtained from two patients with osteogenesis imperfecta. Electronmicroscopy of the dentin revealed some structural alterations. The striation of the collagen fibrils was not clear, and the crystals were less dense than in normal dentin. The amino acid analysis of dentin collagen was slightly different from normal dentin. There were slight increases in the amounts of hydroxylysine, serine and acidic acids. On the other hand, lysine and arginine were reduced. The elevation of hexosyllysine content and an increase of carbohydrate were also observed. These results indicate that either dentin collagen is altered, or noncollagenous matrices associated with collagen are increased in dentinogenesis imperfecta dentin.