Early rectal tube removal for improved patient tolerance during double-contrast barium enema examination

During a five year period, 62 patients each underwent two barium enema examinations. The length of time that the rectal tube remained in place varied in each subject. Early rectal-tube removal resulted in better patient acceptance of the double-contrast barium enema examination.

Gastric emptying of enteric-coated tablets

To evaluate the gastric emptying time of pharmaceutical dosage forms in a clinical setting, a relatively simple dual-radionuclide technique was developed. Placebo tablets of six different combinations of shape and size were labeled with indium-111 DTPA and enteric coated. Six volunteers participated in a single-blind and crossover study. Tablets were given in the morning of a fasting stomach with 6 oz of water containing 99mTc pertechnetate and continuously observed with a gamma camera. A scintigraph was obtained each minute. The results suggested that the size, shape, or volume of the tablet used in this study had no significant effect in the rate of gastric emptying. The tablets emptied erratically and unpredictably, depending upon their time of arrival in the stomach in relation to the occurrence of interdigestive myoelectric contractions. The method described is a relatively simple and accurate technique to allow one to follow the gastric emptying of tablets.

Enteroclysis in partial small bowel obstruction

In a 5 year period, 56 patients with suspected partial small bowel obstruction were evaluated by enteroclysis or the antegrade small bowel enema. Mechanical partial obstruction was diagnosed by enteroclysis in 38 of the patients, 24 of whom required surgery. The diagnosis by enteroclysis was confirmed in 23 of the patients. In the single patient with "false-positive" enteroclysis, the obstruction had been interpreted as minimal. The thirteen remaining patients were managed conservatively. The possibility of significant mechanical obstruction was excluded by enteroclysis in 19 patients. There were no complications associated with the procedure. Enteroclysis is a safe, rapid, and accurate method for the evaluation of patients with partial small bowel obstruction.

Detection of surgical lesions of the small bowel by enteroclysis

Enteroclysis is an examination in which barium is infused directly into the small intestine, and compression radiographs are taken on each segment. This method eliminates many of the inherent limitations of the conventional small bowel follow-through examination. This report concerns 45 patients with 48 small bowel lesions. They were missed on the conventional examination but detected within 3 months by subsequent enteroclysis and confirmed surgically. There were 15 patients with Meckel's diverticula, 7 with obstructive adhesive bands, 5 with Crohn's disease, 5 with blind pouch syndrome (1 with a leiomyoma inside the blind pouch), 2 with other leiomyomas, 3 with metastatic carcinoma, two with primary carcinoma 3 with radiation stricture, two with sinus tract lesions and fistulas, and 1 with another lesion. Improved intubation techniques and better barium mixtures make enteroclysis possible in most hospitals. As surgeons appreciate the value of enteroclysis, they can request this examination for appropriate patients to sooner find many surgical lesions of the small bowel which frequently go undiagnosed.

Esophageal food impaction: treatment with glucagon

Nineteen patients who had foreign bodies in the distal esophagus were examined prospectively to determine the efficacy of intravenous glucagon in relieving the obstruction. The administration of glucagon resulted in clearance of the impacted food in seven patients. Although the success rate is relatively low, the risk is minimal and justifiable. Use of intravenous glucagon is a safe, worthwhile initial step in the treatment of distal esophageal foreign bodies.

The effect of barium enemas and barium sulfate on healing of colorectal biopsy sites

Twelve mongrel dogs had superficial and deep colon biopsies above and below the peritoneal reflection. Six of the animals were given a barium enema; two had a barium enema immediately, two in three days, and two in six days. The animals were sacrificed 48 hours after the barium enema; the sigmoid was removed and tissue was examined macroscopically and microscopically. When healing rates of the biopsy sites were compared with those of control animals, there was no difference. The results suggest that barium has no deleterious effect on the healing of superficial or deep colorectal biopsies.

Colon and rectal carcinoma: spatial distribution and detection

Recent studies have challenged the concept that 50% of colon cancers are detectable by digital examination and two-thirds are within reach of the rigid sigmoidoscope. This is an important consideration because of the potential for failure of an otherwise appropriate screening method when evaluating a patient for carcinoma of the colon. An analysis of 2,298 cases of colorectal carcinoma diagnosed over 20 years showed that the most common sites were the rectum (34%) and sigmoid (25%). Over the 20 years, the incidence of cancer in the cecum increased and that in the rectum decreased. Cecal, ascending, and transverse colon cancers accounted for 34% of lesions - all beyond the range of the flexible sigmoidoscope. The changing site distribution emphasizes the need for an accurate and inexpensive technique to evaluate the entire colon. These data suggest that the barium pneumocolon examination should be included in the screening of high-risk patients.

Survey of the esophagus during the upper gastrointestinal examination in 500 patients

Of 500 patients referred for an examination of the upper gastrointestinal tract, 15% were found to have radiographic evidence of esophageal disease. A cursory esophageal survey appears to be insufficient. Thorough evaluation should consist of a minimal multiphasic approach involving double- and single-contrast radiography, fluoroscopic studies of motility, and a mucosal relief study.

The use of glucagon in hydrostatic reduction of intussusception: a double-blind study of 30 patients

Thirty patients were referred for hydrostatic reduction of ileocolic intussusception. Children with suspected gangrenous bowel or sensitivity to glucagon were excluded from the investigation. A standard protocol for the procedure was used in all patients, including the intravenous administration of glucagon or placebo (0.05 mg/kg) when the intussusception was encountered. Successful reduction was achieved in 53% of both control and glucagon-treated patients. Analysis of the length of the procedure and the ease of reduction of the intussusception indicated no difference in the two groups. This multicenter double-blind study failed to show any therapeutic value of glucagon in hydrostatic reduction of intussusception.

The minimum effective dose of glucagon in upper gastrointestinal radiography

The effect of small intravenous doses (0.025 and 0.05 mg) of glucagon was evaluated in 22 patients. All 12 patients given 0.05 mg demonstrated by hypotonicity of the stomach and duodenum at 1 min and beginning return of peristalsis at 2 1/2 min. Subsequently, 100 patients with radiographically normal upper gastrointestinal examinations who received 0.05 mg of glucagon intravenously were compared to 100 patients with normal examinations without it. Comparison was made to determine the effect of glucagon on gastric mucosal coating and distention of the stomach and duodenum. In all areas of the stomach, mucosal coating was significantly improved in the glucagon group. There was also increased distention of the distal antrum, duodenal bulb, and duodenal loop. No adverse effects were reported. Because of the short duration of action of glucagon, the examination needs to be coordinated and done rapidly. The routine use of a small dose of glucagon increased the performance time slightly with small additional cost but was compensated for by the increased diagnostic quality of the examination.

Barium enema after colorectal biopsies: experimental data

The appropriate interval between a colorectal biopsy and a barium enema is controversial. Superficial and deep biopsies, above and below the peritoneal reflection, were performed on 12 dogs. Six control dogs did not have a barium enema. Six study dogs had a barium enema at different postbiopsy time intervals: immediately, 3 days, and 6 days. After superficial biopsies, there was no barium extravasation in any study animal. Histological examination, 48 hr after enema, showed complete epithelialization of all superficial sites on both study and control dogs. When the barium enema was done after a deep biopsy, there was intramural extravasation of barium immediately after biopsy but not after 3 or 6 days. Focal ulcerations were seen microscopically at sites of deep biopsies when the barium enema was performed immediately and 3 days after the diagnostic procedure. All deep biopsy sites were reepithelialized in 6 days. There was no evidence of intraperitoneal or retroperitoneal perforation and no difference in healing of biopsy sites in subjects and control animals. This study in dogs suggests that a barium enema may be performed without hazard immediately after a superficial biopsy of nondiseased colon and 6 days after a deep biopsy.

Gastrointestinal response to minute doses of glucagon

Small doses of glucagon are effective when performing a biphasic gastrointestinal (GI) examination. The authors conducted a controlled double-blind crossover study to determine the optimum and smallest effective doses and the onset and duration of drug action. Fifteen men received a placebo and 0.025, 0.05, 0.1, and 0.2 mg of glucagon intravenously. Hypotonicity of the stomach, duodenum, and small bowel was adequate with 0.1 mg of glucagon. Low-dose glucagon makes the biphasic upper GI examination short and practical. There is no need to delay the second phase of the examination or the small-bowel follow-through.

Effect of D-Val1, D-Trp8-somatostatin on the motility of the stomach, duodenum and jejunum

D-Val1, D-Trp8-somatostatin was given to seven volunteers to relax the gastrointestinal tract. Doses of drug ranging from 1-250 mcg. were given intravenously, single blind, as one bolus. The seven subjects had a total of 23 studies. The stomach never became hypotonic in any subject. The onset of drug effect on the duodenum and jejunum of moderate hypotonicity after 10-100 mcg. was 4.8 minutes and at 150-250 mcg., was 10.1 minutes. Onset of atonicity after 10-100 mcg. wa 5.7 minutes and at 150-2509 mcg., was 13.0 minutes. Duration of moderate hypotonicity after 10-100 mcg. was 20.9 minutes and at 150-250 mcg., was 22.4 minutes. Duration of atonicity at 10-100 mcg. was 11.5 minutes and at 50-250 mcg., was 14.1 minutes. Preliminary results suggest that the onset and duration of effect, relative to dose, were so variable that the drug appeared to be an unsatisfactory hypotonic agent for upper gastrointestinal radiography.

Comparison of gastrointestinal effects of aspirin and fenoprofen. A double blind crossover study

Sixteen men received 3904 mg of aspirin, 2400 mg of fenoprofen, or placebo daily for 1 week in a double blind and crossover trial. Fecal blood loss was measured by 51Cr labeled red cells; gastric and duodenal pathology were observed endoscopically. There was more (P less than 0.05) blood loss (4.96 ml) after aspirin than after fenoprofen (2.46 ml) or placebo (0.79 ml). By endoscopic examination, aspirin induced more (P less than 0.05) gastrointestinal pathology than fenoprofen or placebo, and there was a correlation of 0.70 between the two methods used in this study.

Gastrointestinal radiography with glucagon

This report summarizes the results of nine diagnostic radiographic studies done double blind crossover comparing glucagon to placebo and to anticholinergic drugs in volunteers. In seven studies the subjects were administered drug intramuscularly and in two studies intravenously. There were five diagnostic studies of the upper gastrointestinal tract, one for esophageal varices and three of the colon. The results indicate that glucagon can be given intramuscularly and intravenously. When given intravenously it has a rapid onset and predictable length of action depending on the dose given. Reports of side effects were few consisting primarily of nausea and or vomiting. These results indicate that glucagon is the drug of choice for hypotonic diagnostic examinations.

Comparison of the effects of glucagon and atropine sulfate on gastric emptying

Six asymptomatic adult males cooperated in a study of gastric emptying. Each subject was given a test meal of 500 ml. of 3.5% glucose on a fasting stomach. Ten minutes prior to the meal each was given either 1 mg atropine sulfate, placebo, or 2 mg. glucagon, double-blind and crossover. Each drug was given twice, intravenously, in a random order. The meal was removed by a Salem sump tube half an hour after ingestion. When compared to placebo, the active drugs significantly (P less than 0.05) slowed gastric emptying; atropine sulfate was more effective (P less than 0.05) than glucagon. The active drugs significantly (P 0.05) decreased total gastric acid secretion and total gastric chloride as compared to placebo. Glucagon significantly (P 0.05) increased the blood glucose concentration as compared to placebo. These results indicate that both glucagon and atropine sulfate slow the gastric emptying of a liquid sugar meal from the stomach.

Double-blind radiographic study of dose response to intravenous glucagon for hypotonic duodenography

This study was undertaken to determine a dose response to glucagon during hypotonic duodenography. Fifteen male and female volunteers received placebo and 0.25 mg, 0.5 mg, 1 mg, and 2 mg of glucagon intravenously, double-blind, and crossover. Onset of drug effect occurred in approximately 45 seconds, regardless of the dose of glucagon given. There was a significant (p less than 0.01) decrease in gastrointestinal tonicity with all doses. The larger the dose, the greater the duration of drug action. Satisfactory stomach, duodenal, and small bowel hypotonicity for radiography were obtained with 0.25 to 0.5 mg of glucagon given intravenously with few side effects.

Dose response to intramuscular glucagon during hypotonic radiography

In a study to determine a dose response to glucagon during hypotonic duodenography, 15 male and female volunteers received placebo and 0.25 mg 1 mg and 2 mg glucagon intramuscularly, double-blind and cross-over. When 0.25 mg glucagon was given, the onset of drug effect was approximately 13--18 min: the mean duration of moderate hypotonicity was approximately 4--7 min. The larger the dose, the greater the duration of drug action. When 2 mg glucagon was given, the onset of drug effect occurred in approximately 4--7 min; the mean duration of moderate hypotonicity was 22--32 min. There were no changes in pulse or blood pressure attributable to the drug with these doses, and reports of nausea and diarrhea did not increase significantly until a dose above 1 mg was given. One mg glucagon given IM is useful in hypotonic upper Gl radiographic examinations. The onset of hypotonicity was 8--10 min with a duration of 12--27 min when this dose was given. Few reports of side effects were attributable to this dose.

A comparative double-blind study of esophageal barium pastes

To demonstrate esophageal varices barium sulfate suspensions must coat the lower esophagus for as long as 5 to 10 minutes. This study compared the ability of five barium sulfate preparations to resist disappearance by inadvertent swallowing. Three of the special preparations for esophageal examination, Esophatrast, Barosperse Esophageal Paste, and HD-5000 performed satisfactorily. Examiner skill, persistence, and careful technique are the most important factors in examining the lower esophagus. The authors' procedure for examination of the esophagus for varices is described. It takes into account position, time, phase of respiration, occasional use of drugs, and procedures to insure good coating and relaxation of the lower esophagus.

GLC determination of ethinamate and its hydroxy derivative in biological fluids

A sensitive, specific GLC assay was developed for the determination of ethinamate in plasma and its major metabolite, trans-4-hydroxyethinamate, in urine. The assay uses a mass internal standard of dimethylethinamate. Ethinamate is extracted from alkalinized plasma with dichloromethane. Urine samples require beta-glucuronidase hydrolysis prior to extraction of hydroxyethinamate. The dichloromethane is removed by evaporation, and the compounds are measured by GLC using a flame-ionization detector. By using GLC-chemical-ionization mass spectrometry, the compounds measured were identified as the intact ethinamates. Plasma and urine data are presented from a bioavailability study to demonstrate the utility of this method. From these data, the ethinamate plasma half-life was calculated as 1.9 +/- 0.3 hr.

Optimal visualization of esophageal varices

Twelve patients with known esophageal varices and willingness to cooperate were included in the study. Medications administered were placebo, 2 mg of glucagon, and 30 mg of propantheline bromide. All medications were given double-blind and crossover. On the basis of this study the authors believe that for optimal visualization of esophageal varices the following is the procedure of choice: (1) the patient should remain horizontal (this is best done in the left lateral position for comfort and ease of expectoration) for ten minutes after swallowing high density barium; (2) the patient should "clear his throat" frequently and expectorate all saliva (barium sticks to the pharynx and makes the patient want to swallow and "clearing his throat" by forced expiration helps the patient to expectorate this coating and prevents swallowing); (3) filming should be done in expiration in the supine (left posterior oblique to table top) position; and (4) in equivocal cases the examination can be repeated with an anticholinergic drug if the patient has no contraindications to its use. The patient should empty his bladder just before administration of the drug. The intelligent use of these factors should result in a saving of both fluoroscopic time and film, and give the radiologist a safe optimal diagnostic yield.

Response of normal subjects to a single 2-milligram dose of glucagon administered intramuscularly

Recently there has been increased interest in glucagon because in human radiographic and endoscopic studies it has been reported to relax the gallbladder, stomach, small bowel and colon. These results suggest it may be preferable as a diagnostic aid for these procedures. Therefore, we believed it important to assess the safety, and clinical laboratory responses after glucagon is given to normal subjects. Twenty normal subjects received 2 mg of glucagon and placebo intramuscularly at daily intervals, double-blind and crossover. After glucagon there was an increase in the WBC, bands, neutrophiles, fasting blood sugar, glucagon and insulin, and a decrease in the lymphocytes. There was no change in the pulse rate or blood pressure with minimal reports of side effects. These results tend to confirm other reports that glucagon is one of the stress hormones. Glucagon is remarkably safe and produces few, mild and transient side effects, not much greater than placebo.