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R. Gilliland - One of the best experts on this subject based on the ideXlab platform.

  • a prospective randomized single blind trial of Fleet phosphate Enema versus glycerin suppositories as preparation for flexible sigmoidoscopy
    Irish Journal of Medical Science, 2010
    Co-Authors: D Underwood, A. L. Gidwani, R. Makar, S M Najfi, P Neilly, R. Gilliland
    Abstract:

    This study compared the efficacy and patient acceptability of two methods of bowel preparation for flexible sigmoidoscopy. Patients attending for outpatient flexible sigmoidoscopy were prospectively randomized to receive one Fleet ready-to-use Enema or 2 × 4 g glycerin suppositories, 2 h preprocedure. Patient and endoscopist questionnaires were used to compare the outcomes. From November 2000 to August 2001, 203 (male = 95; female = 108) patients were randomized. Patient data available for 163 patients (Enema = 93; suppository = 70) revealed: ease of use (Enema = 52; suppository = 25; P < 0.02, Fisher’s exact); assistance required (Enema = 19; suppository = 3; P < 0.005, Fisher’s exact); grade of effectiveness (Enema = 83; suppository = 44; P < 0.0001, Fisher’s exact), and whether patients wished to try another preparation in future (Enema = 16; suppository = 24; P = 0.016, Fisher’s exact). Endoscopist data available for 151 patients (Enema = 76; suppository = 75) revealed: average depth of insertion (Enema = 53.6 ± 11.6 cm; suppository 46.3 ± 13.7 cm; P < 0.001, Student’s t test); acceptable (excellent + good) quality of preparation [Enema = 60 (78.9%); suppository = 34 (45.3%); P < 0.0001, Fisher’s exact]. Bowel preparation for flexible sigmoidoscopy using a single Fleet Enema is acceptable to patients and more effective than glycerin suppositories.

  • A prospective randomized single-blind comparison of three methods of bowel preparation for outpatient flexible sigmoidoscopy
    Surgical Endoscopy, 2007
    Co-Authors: A. L. Gidwani, R. Makar, D. Garrett, R. Gilliland
    Abstract:

    Background Preparation for outpatient flexible sigmoidoscopy using a self-administered phosphate Enema is the standard practice in our unit, but it provides acceptable bowel preparation in only 80% of patients. This study compared two methods of bowel preparation with the current standard in an attempt to improve efficacy and acceptability. Methods From January to September 2003, patients scheduled for out-patient flexible sigmoidoscopy were prospectively randomized to 3 groups: group 1: one Fleet Enema 2 h pre-procedure; group 2: two Fleet Enemas, one on the evening prior to sigmoidoscopy and one 2 h pre-procedure; group 3: lactulose 30 ml orally 48 and 24 h prior to sigmoidoscopy, plus a single Fleet Enema 2 h pre-procedure. A patient questionnaire was used to assess side effects and tolerance. The endoscopists questionnaire assessed the indication for the procedure, quality of preparation, depth of insertion, and pathological findings identified. Power calculations were based on the 80% acceptable preparation rate obtained using a single Enema. Results For this study, 305 patients were randomized to the three groups. Patient data were available for 261 patients (group 1 = 105; group 2 = 81; group 3 = 75), and endoscopist data were available for 251 patients (group 1 = 97; group 2 = 79; group 3 = 75). No difference was noted between the groups with regard to age, gender, procedure indication, grade of endoscopist, or patient acceptability variables (ease of use: p  = 0.09; assistance required: p  = 0.11; cramps experienced: p  = 0.84; alternative method: p  = 0.25). There was no significant difference between the groups in terms of depth of insertion ( p  = 0.42—chi-squared test) or abnormalities noted ( p  = 0.34—chi-squared test). Nor was there any difference in the quality of preparation of patients in group 1 versus group 2 ( p  = 0.39—Fishers exact test) or group 1 versus group 3 ( p  = 0.13—Fishers exact). However, lactulose + Fleet resulted in significantly fewer patients with acceptable preparation compared with those who administered two Fleet Enemas ( p  = 0.02— Fishers exact test). Conclusions The addition of a Fleet Enema or oral lactulose over and above a single Fleet Enema gives no significant improvement in the acceptability or efficacy of bowel preparation.

A. L. Gidwani - One of the best experts on this subject based on the ideXlab platform.

  • a prospective randomized single blind trial of Fleet phosphate Enema versus glycerin suppositories as preparation for flexible sigmoidoscopy
    Irish Journal of Medical Science, 2010
    Co-Authors: D Underwood, A. L. Gidwani, R. Makar, S M Najfi, P Neilly, R. Gilliland
    Abstract:

    This study compared the efficacy and patient acceptability of two methods of bowel preparation for flexible sigmoidoscopy. Patients attending for outpatient flexible sigmoidoscopy were prospectively randomized to receive one Fleet ready-to-use Enema or 2 × 4 g glycerin suppositories, 2 h preprocedure. Patient and endoscopist questionnaires were used to compare the outcomes. From November 2000 to August 2001, 203 (male = 95; female = 108) patients were randomized. Patient data available for 163 patients (Enema = 93; suppository = 70) revealed: ease of use (Enema = 52; suppository = 25; P < 0.02, Fisher’s exact); assistance required (Enema = 19; suppository = 3; P < 0.005, Fisher’s exact); grade of effectiveness (Enema = 83; suppository = 44; P < 0.0001, Fisher’s exact), and whether patients wished to try another preparation in future (Enema = 16; suppository = 24; P = 0.016, Fisher’s exact). Endoscopist data available for 151 patients (Enema = 76; suppository = 75) revealed: average depth of insertion (Enema = 53.6 ± 11.6 cm; suppository 46.3 ± 13.7 cm; P < 0.001, Student’s t test); acceptable (excellent + good) quality of preparation [Enema = 60 (78.9%); suppository = 34 (45.3%); P < 0.0001, Fisher’s exact]. Bowel preparation for flexible sigmoidoscopy using a single Fleet Enema is acceptable to patients and more effective than glycerin suppositories.

  • A prospective randomized single-blind comparison of three methods of bowel preparation for outpatient flexible sigmoidoscopy
    Surgical Endoscopy, 2007
    Co-Authors: A. L. Gidwani, R. Makar, D. Garrett, R. Gilliland
    Abstract:

    Background Preparation for outpatient flexible sigmoidoscopy using a self-administered phosphate Enema is the standard practice in our unit, but it provides acceptable bowel preparation in only 80% of patients. This study compared two methods of bowel preparation with the current standard in an attempt to improve efficacy and acceptability. Methods From January to September 2003, patients scheduled for out-patient flexible sigmoidoscopy were prospectively randomized to 3 groups: group 1: one Fleet Enema 2 h pre-procedure; group 2: two Fleet Enemas, one on the evening prior to sigmoidoscopy and one 2 h pre-procedure; group 3: lactulose 30 ml orally 48 and 24 h prior to sigmoidoscopy, plus a single Fleet Enema 2 h pre-procedure. A patient questionnaire was used to assess side effects and tolerance. The endoscopists questionnaire assessed the indication for the procedure, quality of preparation, depth of insertion, and pathological findings identified. Power calculations were based on the 80% acceptable preparation rate obtained using a single Enema. Results For this study, 305 patients were randomized to the three groups. Patient data were available for 261 patients (group 1 = 105; group 2 = 81; group 3 = 75), and endoscopist data were available for 251 patients (group 1 = 97; group 2 = 79; group 3 = 75). No difference was noted between the groups with regard to age, gender, procedure indication, grade of endoscopist, or patient acceptability variables (ease of use: p  = 0.09; assistance required: p  = 0.11; cramps experienced: p  = 0.84; alternative method: p  = 0.25). There was no significant difference between the groups in terms of depth of insertion ( p  = 0.42—chi-squared test) or abnormalities noted ( p  = 0.34—chi-squared test). Nor was there any difference in the quality of preparation of patients in group 1 versus group 2 ( p  = 0.39—Fishers exact test) or group 1 versus group 3 ( p  = 0.13—Fishers exact). However, lactulose + Fleet resulted in significantly fewer patients with acceptable preparation compared with those who administered two Fleet Enemas ( p  = 0.02— Fishers exact test). Conclusions The addition of a Fleet Enema or oral lactulose over and above a single Fleet Enema gives no significant improvement in the acceptability or efficacy of bowel preparation.

R. Makar - One of the best experts on this subject based on the ideXlab platform.

  • a prospective randomized single blind trial of Fleet phosphate Enema versus glycerin suppositories as preparation for flexible sigmoidoscopy
    Irish Journal of Medical Science, 2010
    Co-Authors: D Underwood, A. L. Gidwani, R. Makar, S M Najfi, P Neilly, R. Gilliland
    Abstract:

    This study compared the efficacy and patient acceptability of two methods of bowel preparation for flexible sigmoidoscopy. Patients attending for outpatient flexible sigmoidoscopy were prospectively randomized to receive one Fleet ready-to-use Enema or 2 × 4 g glycerin suppositories, 2 h preprocedure. Patient and endoscopist questionnaires were used to compare the outcomes. From November 2000 to August 2001, 203 (male = 95; female = 108) patients were randomized. Patient data available for 163 patients (Enema = 93; suppository = 70) revealed: ease of use (Enema = 52; suppository = 25; P < 0.02, Fisher’s exact); assistance required (Enema = 19; suppository = 3; P < 0.005, Fisher’s exact); grade of effectiveness (Enema = 83; suppository = 44; P < 0.0001, Fisher’s exact), and whether patients wished to try another preparation in future (Enema = 16; suppository = 24; P = 0.016, Fisher’s exact). Endoscopist data available for 151 patients (Enema = 76; suppository = 75) revealed: average depth of insertion (Enema = 53.6 ± 11.6 cm; suppository 46.3 ± 13.7 cm; P < 0.001, Student’s t test); acceptable (excellent + good) quality of preparation [Enema = 60 (78.9%); suppository = 34 (45.3%); P < 0.0001, Fisher’s exact]. Bowel preparation for flexible sigmoidoscopy using a single Fleet Enema is acceptable to patients and more effective than glycerin suppositories.

  • A prospective randomized single-blind comparison of three methods of bowel preparation for outpatient flexible sigmoidoscopy
    Surgical Endoscopy, 2007
    Co-Authors: A. L. Gidwani, R. Makar, D. Garrett, R. Gilliland
    Abstract:

    Background Preparation for outpatient flexible sigmoidoscopy using a self-administered phosphate Enema is the standard practice in our unit, but it provides acceptable bowel preparation in only 80% of patients. This study compared two methods of bowel preparation with the current standard in an attempt to improve efficacy and acceptability. Methods From January to September 2003, patients scheduled for out-patient flexible sigmoidoscopy were prospectively randomized to 3 groups: group 1: one Fleet Enema 2 h pre-procedure; group 2: two Fleet Enemas, one on the evening prior to sigmoidoscopy and one 2 h pre-procedure; group 3: lactulose 30 ml orally 48 and 24 h prior to sigmoidoscopy, plus a single Fleet Enema 2 h pre-procedure. A patient questionnaire was used to assess side effects and tolerance. The endoscopists questionnaire assessed the indication for the procedure, quality of preparation, depth of insertion, and pathological findings identified. Power calculations were based on the 80% acceptable preparation rate obtained using a single Enema. Results For this study, 305 patients were randomized to the three groups. Patient data were available for 261 patients (group 1 = 105; group 2 = 81; group 3 = 75), and endoscopist data were available for 251 patients (group 1 = 97; group 2 = 79; group 3 = 75). No difference was noted between the groups with regard to age, gender, procedure indication, grade of endoscopist, or patient acceptability variables (ease of use: p  = 0.09; assistance required: p  = 0.11; cramps experienced: p  = 0.84; alternative method: p  = 0.25). There was no significant difference between the groups in terms of depth of insertion ( p  = 0.42—chi-squared test) or abnormalities noted ( p  = 0.34—chi-squared test). Nor was there any difference in the quality of preparation of patients in group 1 versus group 2 ( p  = 0.39—Fishers exact test) or group 1 versus group 3 ( p  = 0.13—Fishers exact). However, lactulose + Fleet resulted in significantly fewer patients with acceptable preparation compared with those who administered two Fleet Enemas ( p  = 0.02— Fishers exact test). Conclusions The addition of a Fleet Enema or oral lactulose over and above a single Fleet Enema gives no significant improvement in the acceptability or efficacy of bowel preparation.

D. Garrett - One of the best experts on this subject based on the ideXlab platform.

  • A prospective randomized single-blind comparison of three methods of bowel preparation for outpatient flexible sigmoidoscopy
    Surgical Endoscopy, 2007
    Co-Authors: A. L. Gidwani, R. Makar, D. Garrett, R. Gilliland
    Abstract:

    Background Preparation for outpatient flexible sigmoidoscopy using a self-administered phosphate Enema is the standard practice in our unit, but it provides acceptable bowel preparation in only 80% of patients. This study compared two methods of bowel preparation with the current standard in an attempt to improve efficacy and acceptability. Methods From January to September 2003, patients scheduled for out-patient flexible sigmoidoscopy were prospectively randomized to 3 groups: group 1: one Fleet Enema 2 h pre-procedure; group 2: two Fleet Enemas, one on the evening prior to sigmoidoscopy and one 2 h pre-procedure; group 3: lactulose 30 ml orally 48 and 24 h prior to sigmoidoscopy, plus a single Fleet Enema 2 h pre-procedure. A patient questionnaire was used to assess side effects and tolerance. The endoscopists questionnaire assessed the indication for the procedure, quality of preparation, depth of insertion, and pathological findings identified. Power calculations were based on the 80% acceptable preparation rate obtained using a single Enema. Results For this study, 305 patients were randomized to the three groups. Patient data were available for 261 patients (group 1 = 105; group 2 = 81; group 3 = 75), and endoscopist data were available for 251 patients (group 1 = 97; group 2 = 79; group 3 = 75). No difference was noted between the groups with regard to age, gender, procedure indication, grade of endoscopist, or patient acceptability variables (ease of use: p  = 0.09; assistance required: p  = 0.11; cramps experienced: p  = 0.84; alternative method: p  = 0.25). There was no significant difference between the groups in terms of depth of insertion ( p  = 0.42—chi-squared test) or abnormalities noted ( p  = 0.34—chi-squared test). Nor was there any difference in the quality of preparation of patients in group 1 versus group 2 ( p  = 0.39—Fishers exact test) or group 1 versus group 3 ( p  = 0.13—Fishers exact). However, lactulose + Fleet resulted in significantly fewer patients with acceptable preparation compared with those who administered two Fleet Enemas ( p  = 0.02— Fishers exact test). Conclusions The addition of a Fleet Enema or oral lactulose over and above a single Fleet Enema gives no significant improvement in the acceptability or efficacy of bowel preparation.

Patrick C. Walsh - One of the best experts on this subject based on the ideXlab platform.

  • The Management of Rectal Injury During Radical Retropubic Prostatectomy
    The Journal of Urology, 1992
    Co-Authors: R. Neill Borland, Patrick C. Walsh
    Abstract:

    AbstractFrom May 1982 through March 1991, 10 rectal injuries were identified in 1,000 men who underwent radical retropubic prostatectomy for clinically localized adenocarcinoma. All rectal injuries occurred in nonirradiated patients. Of these patients 9 were identified during surgery and 1 was diagnosed on postoperative day 2. The 9 patients in whom the injury was recognized at operation underwent successful primary closure without a diverting colostomy. The patient who underwent delayed closure was treated with a temporary diverting colostomy. As a preoperative routine, all patients received a Fleet Enema without preoperative antibiotics. In all patients the rectal injury was closed in 2 layers, the anal sphincter was dilated, and a pedicle of omentum was mobilized through a small opening in the peritoneum and placed through the rectovesical cul-de-sac to cover the suture line. All patients received 7 to 14 days of broad-spectrum antibiotics. Postoperatively, no patient had a wound infection, pelvic absc...

  • The management of rectal injury during radical retropubic prostatectomy.
    The Journal of urology, 1992
    Co-Authors: R. Neill Borland, Patrick C. Walsh
    Abstract:

    From May 1982 through March 1991, 10 rectal injuries were identified in 1,000 men who underwent radical retropubic prostatectomy for clinically localized adenocarcinoma. All rectal injuries occurred in nonirradiated patients. Of these patients 9 were identified during surgery and 1 was diagnosed on postoperative day 2. The 9 patients in whom the injury was recognized at operation underwent successful primary closure without a diverting colostomy. The patient who underwent delayed closure was treated with a temporary diverting colostomy. As a preoperative routine, all patients received a Fleet Enema without preoperative antibiotics. In all patients the rectal injury was closed in 2 layers, the anal sphincter was dilated, and a pedicle of omentum was mobilized through a small opening in the peritoneum and placed through the rectovesical cul-de-sac to cover the suture line. All patients received 7 to 14 days of broad-spectrum antibiotics. Postoperatively, no patient had a wound infection, pelvic abscess or urethrorectal fistula. Overall hospital stay was increased by an average of 2 days. Rectal injuries recognized during surgery in previously nonirradiated patients undergoing radical retropubic prostatectomy can be managed successfully with primary closure alone, avoiding the morbidity of a diverting colostomy.