Enema

MRI and CT scans for treatment planning were performed 7 days after fiducial implantation to ensure adequate tissue fixation and to allow for resolution of procedural edema/inflammation (Poggi et al., 2003 (link); Pouliot et al., 2003 (link); Kupelian et al., 2005 (link)). Precautions were taken to minimize prostate motion during the planning scans and treatment. Specifically, starting 5 days prior to acquisition of the planning scans until the end of treatment, patients maintained a low fiber diet to reduce intestinal gas (Smitsmans et al., 2008 (link)). Fasts were also initiated 4 h before both acquisition of the planning scans and each treatment session to minimize rectal movement. Enemas were performed 2 h prior to acquisition of the planning scans and each treatment session to minimize rectal volume. All patients were imaged and treated in the supine treatment position with a knee cushion to maximize patient comfort and limit prostate motion in response to respiration (Malone et al., 2000 (link)).
Fused thin cut CT images (1.25 mm) and high-resolution MR images were used for treatment planning (Figures 3A–C). MRI imaging was employed to define the target volume (Roach et al., 1996 (link)) and to aid in accurate localization of the bladder neck, membranous urethra, and penile bulb (Mclaughlin et al., 2005 (link)). Intra-prostatic fiducials were employed to guide image co-registration and limit fusion errors (Parker et al., 2003 (link)). MR images were obtained on a 1.5-T scanner in a phased-array torso coil. The MRI was quickly (<1 h) followed by a CT scan to minimize anatomical changes in the rectum that may interfere with image fusion. Two MRI sequences were employed to maximize visualization of the fiducials (susceptibility-weighted gradient-echo images) and the soft tissues (axial high-resolution turbo T2-weighted spin-echo images). Treatment planning included the prostate as the gross target volume (GTV). The CTV included the prostate and the proximal seminal vesicles. The PTV equaled the CTV expanded by 3 mm posteriorly and 5 mm in all other dimensions. Treatment planning was generally completed within 1 week of imaging and subsequent treatment was initiated within a 1- to 2-week window.

The study included 229 children who underwent emergency surgical treatment for AIO and who had previously (primarily) been operated on: acute appendicitis -137 (59.8%), introsusception -36 (15.7%), blunt abdominal trauma -34 (14.8%), necrotizing enterocolitis -15 (6.5%), liver echinococcosis -5 (2.2%), and Payer’s disease -2 (0.9%). Boys to girls ratio made 1.3:1. The average age of the patients was 9.8±1.7 years old. Group 1 included 116 children, Group 2–113. The study was conducted in the clinical facilities of Stavropol Regional Children’s Clinical Hospital, Grozny Children’s Clinical Hospital No 2, and Makhachkkala Republican Children’s Clinical Hospital.
On children with the signs of AIO, treatment was started with conservative measures in the form of nasogastric intubation, infusion therapy, cleansing, and saline enema. No effect of the conducted treatment was the indication for surgery. The surgical treatment consisted of the elimination of cause of the mechanical intestinal obstruction (dissection of adhesions, untwisting, and laying the sentinel loops in the physiological position, and so on). Children who underwent colostomy were not included in this study.
The author’s method was used for all Group 1 children within the first 4 days of the post-operative period. Then, for up to 5–6 days (11 patients) of the post-operative period, the procedure was continued for the patients that were somewhat difficult to activate due to their young age, degree of severity of the post-operative condition, patient, pronounced predisposition to adhesions.
In the post-operative period, the abdominal brain exposure to the variable magnetic field was used for Group 2 to arrest the intestinal distention. The device “Magniter” was applied to the anterior abdominal wall for 20 min daily during the first 4 days of the post-operative period. From 5 to 15 post-operative days, the control group of patients received electrophoresis with hyaluronidase 64 IU.
During the treatment efficacy assessment, the following criteria were considered: Subjective data (intensity of pain and asthenic syndrome and quality of life); objective data, including the dynamics of symptoms (pain, edema, and hyperemia) and period of the patients staying at the hospital.
The adhesive process in the abdomen was determined using the Androsov, Blonov, and Knokh position specimens. These specimens are based on the creation of the thrust vector during mechanical tractions causing the adhesion tensioning between points of its attachment to various sites of the abdomen. Pain appearance or intensification is clinically determined.
The ultrasound examination of the abdomen was performed on GE Pro series LOGIQ 500 and SonoAce PICO using the curvilinear transabdominal multifrequency transducers within the range from 3.5 to 7.5 MHz. The echostructure of the abdomen, mobility of parietal and visceral peritoneum, “return” symptoms and small bowel dyskinesia in the area of its fixation by adhesives were examined.