Clinical and Diagnostic Significance of Enteroclysis Through Nasointestinal Decompression Intubation

To study the clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation, thirty-five patients with small bowel obstruction were enrolled. A nasointestinal catheter of 300 cm was placed through the nasal cavity then pushed to the upper jejunum under X-ray realtime monitoring. The patients underwent intra-small-intestinal suction therapy reducing or relieving the obstruction after 3 days. As the catheter reached the lesions, we conducted selective imaging. Using fluoroscopy, we injected 20–100 ml meglumine diatrizoate 76 % and 50–200 ml air via the decompression suction port to produce a double-contrast radiography. The catheter was then retrieved to the upper jejunum, and the X-ray of the small intestine was obtained. All 35 patients had successful intubations. The decompression treatment resolved symptoms in 20 cases and alleviated symptoms in 15 cases. Ten cases underwent surgery. The images obtained by infusing meglumine diatrizoate through the decompression catheter were of good quality. Among the 35 cases, six were absent of any distinct abnormal signs on the X-ray, 15 had adhesive ileus, four had small bowel tumor (three metastatic tumor, one small bowel cancer), three had Crohn’s disease, three had radiation enteritis (one of the three was mistaken for small bowel metastatic tumor), two had enteric intussusception, one had a polyp in the small intestine, one had ascending colon cancer. The nasointestinal decompression intubation under X-ray monitoring serves a dual function for patients with intestine obstruction, by decompressing the small bowel and examining the small intestinal radiographically. The X-rays can confirm the obstruction and provide guidelines for surgery.     

A study of small bowel tumors; with special emphasis on clinical aspects

Ninety-eight patients with 100 different tumors of the small bowel were studied. There were more malignant than benign tumors. Adenocarcinoma was the commonest lesion and the ileum the most frequent anatomical site of all tumors. Except for carcinoid tumors, the lesions were observed more often in male than in female patients. The average age of patients in this series was higher than that reported in most other series. Loss of weight, and abdominal pain were the most constant symptoms. Clinical syndromes of anemia and bleeding, small bowel obstruction, biliary obstruction, perforation with peritonitis, abdominal tumor, melanosis with small bowel polyposis, and cutaneous von Recklinghausen's disease with small bowel neurofibromatosis were encountered either alone or in combination. In the group operated upon, a resection of the involved segment with end-to-end anastomosis was done when feasible. None of the patients operated upon before 1946 lived as much as five years after operation. The most common causes of death were extension of the primary tumor and metastasis, peritonitis due to perforation, associated bronchopneumonia, and hemorrhage.     

A STUDY OF SMALL BOWEL TUMORS—With Special Emphasis on Clinical Aspects

Ninety-eight patients with 100 different tumors of the small bowel were studied. There were more malignant than benign tumors. Adenocarcinoma was the commonest lesion and the ileum the most frequent anatomical site of all tumors. Except for carcinoid tumors, the lesions were observed more often in male than in female patients. The average age of patients in this series was higher than that reported in most other series. Loss of weight, and abdominal pain were the most constant symptoms. Clinical syndromes of anemia and bleeding, small bowel obstruction, biliary obstruction, perforation with peritonitis, abdominal tumor, melanosis with small bowel polyposis, and cutaneous von Recklinghausen''s disease with small bowel neurofibromatosis were encountered either alone or in combination.In the group operated upon, a resection of the involved segment with end-to-end anastomosis was done when feasible. None of the patients operated upon before 1946 lived as much as five years after operation. The most common causes of death were extension of the primary tumor and metastasis, peritonitis due to perforation, associated bronchopneumonia, and hemorrhage.     

Radiation Enteropathy of the Small Bowel

The features of radiation injury of the small bowel are reviewed to focus attention on this uncommon but persistent problem which usually arises in women undergoing treatment for gynecological malignancy and which may be confused with recurrence of the malignant growth. Intestinal perforation, bleeding, obstruction and fistulas have all been observed in patients with radiation enteropathy. Three cases in which these complications occurred are reported. Early excisional surgery is considered to be the preferred treatment, although conservative surgical procedures have been used for patients who are very ill or for those with diffuse bowel changes. Medical measures alone have not been successful but have been utilized in preoperative preparation.     

Synthesis of hybrid distamycin-cysteine labeled with 99mTc: a model for a novel class of cancer imaging agents

The synthesis of a hybrid constituted by distamycin A and cysteine labeled with the gamma-emitting radionuclide 99mTc to afford the conjugate complex 5 is reported. This new radiopharmaceutical is of potential interest as tumor imaging agent in diagnostic nuclear medicine. The preparation of the hybrid distamycin A-cysteine 4 has been achieved by coupling deformyldistamycin A and Boc-Dmt-OH. Compound 4 was then successfully labeled with 99mTc by reaction with the novel, high-electrophilic, metal-containing fragment [99mTc(N)(PP)]2+ (PP = diphosphine ligand) yielding the 1:1 complex 5.     

Evaluation of axillary lymph nodes from the results of radioisotopic study

The purpose of the investigation was to study the pattern of 99mTc (MIBI) technitrile uptake in the metastatically involved lymph nodes in breast cancer, by applying the plain scintigraphic technique. The scintigraphic study of the breast and regional metastatic areas by means of the radionuclide 99mTc (MIBI) technitrile was made on a Millennium GE tomographic gamma chamber. The radiotracer 550 (MBq) dissolved in 10-20 ml of saline solution was intravenously injected into the arm cubital vein contralaterally to the lesion. Following 20 minutes of injection of the agent, plain scintigraphy was carried out in three standard projections: frontal and two oblique ones. The scintigraphy was performed using a high-resolution collimator recording a 128 x 128 matrix image. The detector was maximally approximated to the organ being examined. A plain scintigraphic scan was recorded on each side for 10 minutes. By the degree of axillary lymph nodal involvement, the patients were divided into 3 groups in accordance with the international TNM classification: N0 (n = 55), N1 (n = 13), N2 (n = 4). Among 72 patients, axillary lymph nodes could be detected in 6, in 2 of them changes were not diagnosed by X-ray and ultrasound studies. The final pathomorphological study of intraoperative materials revealed axillary lymph nodal metastatic involvement in 17 patients. A micrometastasis in one lymph node was found in 1 patient. None of the radionuclide studies showed tumor spread in 5 cases. The sensitivity, specificity, and precision of the technique were 35.3, 100, and 84.7%, respectively. Thus, a combination of the high cost of the procedure, its radiation load on a patient, and its low sensitivity make the use of plain scintigraphy of axillary regions inexpedient in the complex of studies of the extent of breast cancer in the present development of technology.     

术后早期炎性肠梗阻的诊治体会（附32 例报告）

目的:探讨术后早期炎性肠梗阻的临床特点和治疗方法。方法:回顾性分析32例术后早期炎性肠梗阻患者的临床资料和治疗结果。结果:31例患者经保守治疗痊愈,1例手术治疗后痊愈,其中2例复发后再次住院而经非手术治疗治愈,平均住院时间11.8 d。结论:术后早期炎性肠梗阻应以保守治疗为主,通过禁食、经鼻肠梗阻导管胃肠减压、胃肠外营养、生长抑素及激素等的综合应用具有较佳的疗效。     

Radionuclide evaluation of the degree of tissue ischemia in acute thrombosis of the main arteries of the lower extremities

The authors ascertained the value of three-phase scintigraphy using 99mTc pyrophotech (intravenously injected in a dose of 370-500 MBq, radiation exposure 2.1-2.85 mZv) in the diagnosis of disorders of great blood flow and soft tissue blood supply in patients with acute thrombosis of the main arteries, including acute thrombosis caused by injury. Examination of 68 patients with critical ischemia of the lower limbs identified 5 types of 99mTc pyrophotech incorporation into ischemic tissues in main artery thrombosis, embolism and atherosclerotic occlusions. The radionuclide technique in combination with ultrasonography and X-ray contrast angiography has shown it possible to choose adequate treatment policy and to specify the level of amputation and the scope of necrectomy when local muscle necrosis is developed.     

A role and a place of ultrasound diagnosis of acute ileus

The main purpose of the authors is to present their view of a place of present-day ultrasonography in the diagnosis of acute small and large intestinal obstruction. A comparatively sizable material covering 218 verified cases of acute ileus, including 77 patients with large intestinal obstruction and 141 patients with impaired passage of the intestinal contents along the small bowel was used to outline the aspects of ultrasound techniques and the symptomatology of ileus, by differentiating its some types. Along with the general assessment of the methodological and semiotic aspects of ultrasound diagnosis of acute uleus, the authors emphasizes a role of sonography in the detection of large intestinal obstruction by outlining their modified procedure of ultrasound irrigoscopy. For greater objectivization of their positive assessment of the place of ultrasound in the diagnosis of acute ileus and large intestinal obstruction, the authors comparatively studied X-ray and ultrasound studies to reveal this pathology. In addition to their purely personal assessment of a role of ultrasound in the diagnosis of large intestinal obstruction, the lecture also shows its authors' opinion as to the organizational issues associated with the necessity of correcting the existing diagnostic algorithm to detect large intestinal obstruction.     

A new method for protein labeling with 99mTc

A method is described for labeling proteins with ^99mTc, the radionuclide of choice in diagnostic nuclear medicine. Labeling efficiency, stability of label attachment and retained biological behaviour, e.g. immunoreactivity of monoclonal antibodies after radiolabeling are demonstrated. An application of a ^99mTc-labeled anti-fibrin monoclonal antibody in radioimmunoimaging of thrombi is presented.     

Late effects in the mouse small intestine after a clinically relevant multifractionated radiation treatment

Late radiation effects were investigated in the mouse small intestine after a daily fractionated radiation treatment. Mice were given 14 X 3 Gy in 2 weeks over a partial abdominal irradiation field. There was evidence for late injury in the intestinal epithelium, the submucosa, and the subserosa. Late damage in the epithelium was shown histologically by a reduced crypt number and villus atrophy at 3 and 6 months but not at 24 h after the end of treatment. The reduction in crypt number was significant in the ileum at 3 and 6 months after irradiation: 100 +/- 4 and 98 +/- 5 (SEM) per circumference, respectively, versus 132 +/- 3 and 146 +/- 6 in age-matched controls (P less than 0.01, t test). The mitotic activity in the crypts of the irradiated animals was significantly increased at all investigated times, suggesting a prolonged but insufficient compensatory response to maintain the mucosal integrity. The repercussion on intestinal epithelial function was, at least in part, reflected by a progressively reduced body weight gain up to 5 g at 3 months after treatment. The ability of the surviving crypt stem cells to form microcolonies after irradiation, however, was not impaired. Evidence for injury in the submucosa was provided from macroscopic and histological examination. Macroscopically, at 6 months after treatment, narrowed and rigid bowel segments surrounded by fibrotic adhesions were observed, causing partial intestinal obstruction. In addition, sometimes focal areas of hemorrhage and infarction in small bowel segments were present. Histologically, diffuse and pronounced submucosal edema without increased fibrosis was seen, together with markedly dilated small blood vessels in focal areas of macroscopic intestinal infarction. The intestinal perfusion, as assessed by 86Rb extraction, was significantly but transiently reduced at 3 months after irradiation. These data suggest mainly late effects in the small intestine after this daily fractionated irradiation treatment. The reduced number of epithelial cells and the submucosal edema are possibly mediated by radiation injury in the intestinal microvasculature.     

CT 与X线诊断肠梗阻的临床价值探讨

目的：探讨腹部X 线与CT 扫描鉴别急性肠梗阻的准确性,为临床诊断提供参考。方法：选取2011年8 月-2013 年8 月我院 收治的66 例急性肠梗阻患者的临床资料进行回顾分析。所有患者均经手术活检或病理诊断证实为急性肠梗阻。术后患者均行腹 部X 线及CT扫描检查,对两种方法判断肠梗阻的发生、梗阻部位、类型及病因与手术病理结果进行比较,评价并分析两种检查 方法的准确率。结果：66 例肠梗阻患者中,X线检出率为89.39%,CT 检出率为95.45%。X 线诊断小肠梗阻准确率为72.10%,CT 为86.05%;X线诊断结肠梗阻准确率为69.57%,CT 为86.96%。X线诊断肿瘤准确率为69.57%,CT 为86.96%;X线诊断肠粘连 准确率为67.86%,CT 为82.14%;X 线诊断肠套叠准确率为60.00%,CT 为80.00%;X线诊断单纯性机械性肠梗阻准确率为78.72%,CT为82.98%;X线诊断绞窄性肠梗准确率为73.68%,CT 为78.95 %。CT 对肠梗阻部位、病因及类型的诊断准确率高于腹部X 线片,差异具有统计学意义(P<0.05)。结论：腹部X 线与CT 用于诊断急性肠梗阻具有较高的准确率,但CT 对于肠梗阻部位、梗阻类型及梗阻病因的诊断优于X线片。     

CT与X线诊断肠梗阻的临床价值探讨

目的：探讨腹部X线与CT扫描鉴别急性肠梗阻的准确性,为临床诊断提供参考。方法：选取2011年8月-2013年8月我院收治的66例急性肠梗阻患者的临床资料进行回顾分析。所有患者均经手术活检或病理诊断证实为急性肠梗阻。术后患者均行腹部X线及CT扫描检查,对两种方法判断肠梗阻的发生、梗阻部位、类型及病因与手术病理结果进行比较,评价并分析两种检查方法的准确率。结果：66例肠梗阻患者中,X线检出率为89．39％,CT检出率为95．45％。X线诊断小肠梗阻准确率为72．10％,CT为86．05％;X线诊断结肠梗阻准确率为69．57％,CT为86．96％。X线诊断肿瘤准确率为69．57％,CT为86．96％;X线诊断肠粘连准确率为67．86％,CT为82．14％;X线诊断肠套叠准确率为60．00％,CT为80．00％;X线诊断单纯性机械性肠梗阻准确率为78．72％,CT为82．98％;X线诊断绞窄性肠梗准确率为73．68％,CT为78．95％。CT对肠梗阻部位、病因及类型的诊断准确率高于腹部X线片,差异具有统计学意义（P〈0．05）。结论：腹部X线与CT用于诊断急性肠梗阻具有较高的准确率,但CT对于肠梗阻部位、梗阻类型及梗阻病因的诊断优于X线片。     

Radiation diagnosis of interstitial lung diseases

The authors analyzed the results of complex radiation study of 1192 patients with various interstitial lung diseases (ILD). An algorithm of differential diagnosis of diffuse and disseminated lesions of the lung was derived by using the findings. The X-ray morphological principle underlies the algorithm. The level of structural lesions of the lung and tissue reactions and the presence of granuloma shadows are the governing criteria for evaluating the gross structure in the differential diagnostic complex. Great emphasis is laid on the significance of computed tomography (CT), high performance CT in particular, which is becoming the priority radiation diagnostic technique in pulmonology. Morphofunctional studies, 99mTc AMA and 67Ga citrate pulmonary scintigraphy in particular, specify the magnitude of changes in the microcirculatory bed and the activity of intrathoracic lymph nodes.     

Technetium-99m distribution into Klebsiella pneumoniae.

Bacteria labelled with radionuclide has been the subject of much investigation and has been applied in microbiological research. Technetium-99m (99mTc) may be an alternative radionuclide for the labelling of bacteria employed in various microbiological procedures. This radionuclide is easily available, is not expensive and presents important physical and biological characteristics. 99mTc-labelled bacteria are stable and their cell viability and biological properties are not modified. Study of the distribution of radioactivity in 99mTc-labelled Klebsiella pneumoniae cultures, after homogenization and differential centrifugation of the cells fractions, showed that this radionuclide was present inside the cell, mainly in a ribosomal fraction. Treatment of these fractions with enzymes and detergent revealed a high sensitivity to pronase and Triton X-100. After phenol extraction, a large percentage of radioactivity was detected in the phenol phase. Treatment of the soluble fraction with trichloroacetic acid at different temperatures showed that the concentration of 99mTc in the precipitate was lower at 100 degrees than at 4 degrees C. These results suggest that 99mTc binds mainly to the proteins in Klebsiella pneumoniae.     

Usefulness of bile cytology in the diagnostic management of patients with biliary tract obstruction

Eighteen patients with evidence of biliary tract obstruction had a total of 29 satisfactory bile samples submitted for diagnostic cytology during a two-year period. These 29 specimens were reviewed in order to determine if bile cytology is useful in the diagnostic management of patients with obstructive biliary tract disease. Twenty-one of the bile specimens were from patients with malignant biliary stricture, and eight were from patients with benign biliary obstruction. Bile cytology was positive for carcinoma in eight samples from patients with malignant stricture and was inconclusive for malignancy in two. There were no false positives. The diagnostic specificity of bile cytology was 100%, the diagnostic sensitivity was 48%, and the diagnostic accuracy was 62%. When carefully collected and promptly processed, bile proved an excellent specimen for cytologic evaluation and was a valuable adjunct to other diagnostic procedures for the detection of carcinoma causing biliary tract obstruction.     

Impact of Carcinomatosis on Clinical Outcomes after Self-Expandable Metallic Stent Placement for Malignant Gastric Outlet Obstruction

BackgroundIt is still unclear whether the peritoneal carcinomatosis had a negative effect on the clinical outcomes of patients who underwent self-expandable metallic stent (SEMS) placement for malignant gastric outlet obstruction (GOO). Although carcinomatosis may be associated with the development of multifocal gastrointestinal (GI) tract obstruction or decreased bowel movement, previous studies investigated the occurrence of stent failure only and thus had limitation in evaluating clinical outcomes of patients with carcinomatosis.MethodsBetween 2009 and 2013, 155 patients (88 patients without carcinomatosis and 67 patients with carcinomatosis) underwent endoscopic SEMS placement for malignant GOO. Factors affecting clinical success and obstructive symptom-free survival (time period between SEMS placement and the recurrence of obstructive symptoms due to multifocal GI tract obstruction or decreased bowel movement as well as stent failure) were assessed.ResultsPatients with carcinomatosis showed higher Eastern Cooperative Oncology Group (ECOG) scale than those without carcinomatosis. Clinical success rates were 88.1% in patients with carcinomatosis and 97.7% in patients without carcinomatosis. In multivariate analysis, only ECOG scale was identified as an independent predictor of clinical success. During follow-up period, patients with carcinomatosis showed significantly shorter obstructive symptom-free survival than those without carcinomatosis. In multivariate analysis, the presence of carcinomatosis, chemotherapy or radiation therapy after SEMS placement, and obstruction site were identified as independent predictors of obstructive symptom-free survival. For patient without carcinomatosis, stent failure accounted for the recurrence of obstructive symptoms in 84.6% of cases. For patients with carcinomatosis, multifocal GI tract obstruction or decreased bowel movement accounted for 37.9% of cases with obstructive symptom recurrence and stent failure accounted for 44.8% of cases.ConclusionsCarcinomatosis predicts unfavorable long-term clinical outcomes in patients undergoing SEMS placement for malignant GOO. This is mainly due to the development of multifocal GI tract obstructions or decreased bowel movement as well as stent failure.     

Detection of inflammatory bowel disease in adults and children: evaluation of a new isotopic technique.

The distribution of radioactivity after the oral administration of sucralfate labelled with technetium-99m was studied in 33 patients with Crohn''s disease (13 adults, 20 children), 10 with ulcerative colitis (four adults), and 29 controls (23 with upper intestinal disease, four irritable bowel, one hypolactasia, and one malrotation of the gut). Positive scans were obtained in all patients with ulcerative colitis and 29 of 31 with active Crohn''s disease. The scans of two patients with inactive Crohn''s disease were negative. There were two false negative scans in patients with Crohn''s colitis and one false positive scan. Overall, sensitivity was 95% and specificity 97%. Comparison with radiology in 39 patients showed similar distribution of disease in 24 and more extensive disease in 12. The scan was inexpensive, simple to perform, well tolerated, allowed small and large bowel to be visualised simultaneously, and used a lower dose of radiation than barium studies. It may prove useful as a screening test for inflammatory bowel disease and in the serial assessment of disease activity.     

Cumulative radiation dose estimates from medical imaging in paediatric patients with non-oncologic chronic illnesses. A systematic review

Paediatric patients with non-oncologic chronic illnesses often require ongoing care that may result in repeated imaging and exposure to ionizing radiation from both diagnostic and interventional procedures. In this study the scientific literature on cumulative effective dose (CED) of radiation accrued from medical imaging among specific cohorts of paediatric, non-oncologic chronic patients (inflammatory bowel disease, cystic fibrosis, congenital heart disease, shunt-treated hydrocephalus, hemophilia, spinal dysraphism) was systematically reviewed.We conducted PubMed/Medline, Scopus and EMBASE searches of peer-reviewed papers on CED from diagnostic and therapeutic radiological examinations. No time restriction was introduced in the search. Only studies reporting CEDs accrued for a period >1 year were included.We found that the annual CED was relatively low (<3 mSv/year) in cystic fibrosis, congenital heart disease, patients with cerebrospinal fluid shunts and hemophilia, while being moderate (>3–20 mSv/year) in Crohn's patients.This extra yearly radiation exposure accrues over the lifetime and can reach high values (>100 mSv) in selected cohorts of paediatric chronic patients.     

Ultrasound study in the diagnosis of small and large intestinal obstruction

The results of ultrasound study were analyzed in 148 and 26 patients with acute small and intestinal obstruction, respectively, the causes of the latter included different diseases of the intestine and abdominal organs. The commonest ultrasound symptoms based on the diameter of the bowel, on the thickness and structure of the intestinal wall, on the status of mucosal motility folds of intestinal loops and on the pattern of motility were defined. They enable one to differentiate large and small intestinal obstruction and to define its degree with a high degree of validity. Abdominal ultrasonography used in the emergency surgical setting may rapidly solve problem in the diagnosis of abnormal changes, differential mechanical and functional ileus in most cases. Dynamic ultrasound monitoring allows the efficiency of the treatment performed to be evaluated.