Mannitol clinical observation instead of cleansing enema Saline or 0.2% soapy water enema. The two groups showed no significant difference in age and sex.
1.2 Methods: Patients in Group A began oral intake of 20% mannitol (125ml) the afternoon before the procedure, followed by drinking warm water (488-500ml). After taking mannitol, patients usually defecated within 2-3 hours. On the preoperative afternoon, more than 20% mannitol (125ml) was administered, with 6 hours interval, along with boiling water at a temperature of 400-500ml. Group B underwent conventional enema treatment with 0.2% soapy water or 0.9% saline enema on the night before surgery.
1.3 Assessment Criteria: Satisfaction: Bowel cleansing achieved an ideal effect similar to a cleansing enema. Dissatisfaction: Fecal residue remained in the intestine, not meeting the cleansing enema effect. In Group A (50 cases), satisfaction was reported in 48 cases, while dissatisfaction was reported in 2 cases. In Group B (50 cases), satisfaction was reported in 47 cases, while dissatisfaction was reported in 3 cases. Statistical analysis: P>0.05, indicating no significant difference between the two methods.
3 Discussion: Mannitol is a polyol sugar mainly composed of six alcohols. Due to its high osmotic pressure and resistance to intestinal absorption, it can rapidly absorb intestinal water, leading to watery stools shortly after ingestion, thus achieving a cleansing enema effect for the entire colon, even the terminal ileum. In contrast, soapy water enemas only ensure irrigation up to the descending colon, sigmoid colon, and rectum. Mannitol not only acts quickly and provides minimal intestinal irritation but also avoids exposing patients, making it more acceptable. Clinical application has proven this method to be safe, reliable, user-friendly, and cost-effective. It protects patients' physical and mental health while achieving the effect of preoperative cleansing enemas. However, caution should be exercised in frail elderly individuals and pregnant women. Additionally, due to oral mannitol causing increased bowel movements and defecation frequency, attention should be paid to potential water and electrolyte loss.
CT Diagnosis of Aseptic Necrosis of the Femoral Head - Fang Guixian, Linkou Second People's Hospital (Linkou 157 600)
[CLC] R683.4 [-A, the author collected 24 cases of aseptic necrosis of the femoral head to investigate its causes and CT features, aiming to raise awareness of this disease.
1 Materials and Methods
1.1 General Information: Among the 24 cases (20 males, 4 females), ages ranged from 17 to 72 years, with a mean age of 33.4 years. Duration of symptoms ranged from 3 to 48 months, averaging 11.3 months. Main clinical symptoms included hip pain, intermittent claudication, lower extremity pain, and occasional radiation pain to the knee. Eight cases had a clear history of trauma, five cases had a history of hormone use, six cases had a history of alcohol abuse, one case was caused by ankylosing spondylitis, and the remaining cases were unexplained.
1.2 Imaging Methods: All patients underwent bilateral hip axial scans (scan range including the acetabulum and femoral neck) using a GE/e body spiral CT machine. Scanning conditions: voltage 120KV, current 130mA, scan time 2s, slice thickness 5mm, layer spacing 5mm.
2 Results: Among the 24 cases, 35 lesions were found; unilateral in 13 cases (54.2%), bilateral in 11 cases (45.8%). CT findings were as follows: (1) Irregular femoral head with varying sizes of scattered cystic low-density necrosis accounted for 100%; (2) Varying degrees of femoral head trabecular bone thickening, fusion accounted for 94.3%; (4) Collapse of femoral head deformation, fragmentation accounted for 57.2%; (5) Thinning and interruption of the cortical bone of the femoral head accounted for 54.3%; (6) Other changes: Hip joint space narrowing accounted for 20%, acetabular rim sclerosis accounted for 14.3%, intra-articular loose bodies in the hip accounted for 8.6%.
3 Discussion:
3.1 Pathogenesis of Aseptic Necrosis of the Femoral Head: Literature summarizes the mechanism of aseptic necrosis into the following three points: (1) Compromised vessel wall integrity (e.g., trauma, vasculitis); (2) Bone and blood vessels being compressed (such as increased bone marrow composition and elevated marrow cavity pressure); (3) Vascular obstruction (such as thrombosis, embolism, etc.). In the 24 cases presented here, eight cases with a history of hormone use may have been related to factors such as hormones stimulating platelet production, increasing blood viscosity and coagulation force, causing hyperlipidemia and intravascular fat embolization, inhibiting osteoblast activity, disrupting bone matrix formation, leading to osteoporosis, collapse, and compression. Additionally, six cases (25%) had a history of alcohol abuse, making alcoholism, following trauma and hormone use, another leading cause. Modern research shows that chronic alcoholism is closely associated with aseptic necrosis of the femur.