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References: Laxative

J Pediatr Surg. 1999 Mar;34(3):450-3.
Endosonographic study of anal sphincters in patients after surgery for Hirschsprung's disease.

Kuwahara M, Iwai N, Yanagihara J, Tokiwa K, Fukata R.

Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Japan.

PURPOSE: This study was performed to evaluate the relationship between endosonographic findings of anal sphincters and anorectal function in patients after surgery for Hirschsprung's disease. In addition, whether internal sphincterotomy or sphincterectomy was accomplished was examined in each procedure by anal endosonography. METHODS: Fifteen patients, aged 11 to 20 years, were examined. Nine patients underwent modified Duhamel's operation, three underwent Rehbein's operation with anorectal myectomy, and three underwent modified Martin's operation. All 15 patients were examined by anal endosonography using a sonographic scanner (Aloka SSD 2000) with a 7.5-MHz radial rotating endoprobe, clinical bowel assessment, and manometric study. RESULTS: After the modified Duhamel operation, anal endosonography showed an interruption of the external anal sphincter (EAS) in eight of the nine patients, as a high, mixed, or low echoic lesion in the hyperechoic band correlated to the EAS. The locations of the interruption were wide in patients with mild constipation. An interruption of the internal anal sphincter (IAS) was observed in all nine patients, as a hyperechoic lesion in the hypoechoic band correlated to IAS, which indicated internal sphincterotomy. After Rehbein's operation with anorectal myectomy, an interruption of EAS was observed in all three patients as a high or low echoic lesion in the hyperechoic band. An interruption of IAS was observed in all three patients. After the modified Martin's operation, an interruption of EAS was observed in two of the three patients as a high or low echoic lesion in the hyperechoic band. An interruption of IAS was observed in all three patients. CONCLUSION: Anal endosonograph

Chemotherapy. 1999 May-Jun;45(3):197-204.
Intrapleural administration of cisplatin and etoposide to treat malignant pleural effusions in patients with non-small cell lung cancer.

Tohda Y, Iwanaga T, Takada M, Yana T, Kawahara M, Negoro S, Okishio K, Kudoh S, Fukuoka M, Furuse K.

Fourth Department of Internal Medicine, Kinki University, Osaka, Japan.

BACKGROUND: To determine the efficacy, toxicity and pharmacokinetics of intrapleural cisplatin (CDDP) and etoposide as a treatment for malignant pleural effusions (MPE) in patients with non-small cell lung cancer (NSCLC). METHODS: Seventy patients with MPE associated with NSCLC were enrolled in this study. In 68 patients, a catheter was inserted into the pleural cavity, within 24 h after complete drainage of the pleural effusion, CDDP (80 mg/m2) and etoposide (80 mg/m2) were simultaneously administered successfully via the catheter and the catheter was clamped. Seventy-two hours later, the catheter was unclamped to allow drainage. The catheter was removed when the accumulated intrapleural fluid decreased to 20 ml or less per day. RESULTS: The pharmacokinetic profiles showed high maximum concentrations of CDDP (free form, 88 microg/ml) and etoposide (182. 4 microg/ml) in intrapleural fluids. CDDP did not remain for a long period (free form, beta-phase half-life = 10.51 h) in the fluids, while etoposide persisted for a long period (beta-phase half-life = 62.53 h). The overall response rate was 46.2%, the median survival time 32.3 weeks, the 1-year survival rate 28.7% and the 2-year survival rate 12.8%. The most serious adverse reactions were WHO grade 3 anemia (3 patients), grade 3 nausea and vomiting (17 patients), grade 3 constipation (1 patient), grade 3 pulmonary toxicity (1 patient), grade 4 fever (1 patient), grade 3 infection (1 patient) and grade 3 mental disorder (1 patient). CONCLUSION: Intrapleural administration of CDDP and etoposide was an effective and acceptable regimen for patients with MPE due to NSCLC.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10224342&dopt=Abstract constipation laxative [PubMed

Eur J Pediatr Surg. 1999 Apr;9(2):67-74.
A correlative morphometric and clinical investigation of hypoganglionosis of the colon in children.

Meier-Ruge WA, Brunner LA, Engert J, Heminghaus M, Holschneider AM, Jordan P, Piket G, Posselt HG, Scharli A.

Institute of Pathology, Univ. Med. School Basel, Switzerland.

Hypoganglionosis of the myenteric plexus of the colon is not clearly defined and seldom investigated. Colon segments from 15 children with an extended oligoeuronal hypoganglionosis up to the proximal resection end were morphometrically studied and compared to normally innervated colon segments. The study was performed with resected specimens from 7 children with isolated hypoganglionoses, 8 children with a Hirschsprung-associated hypoganglionosis, and 12 colon segments with normal innervation. The resected colon specimens were caudo-cranial coiled. The native tissue was frozen at -80 degrees C on a cryostat carrier and cut at -20 degrees C in 15 microns-thick sections (equivalent to 4-5-micron-thick paraffin sections). The air-dried sections underwent an enzyme-histochemical procedure for an acetylcholinesterase reaction to stain the parasympathetically innervated myenteric plexus. For histological identification and morphometric measurements, ganglia and nerve cells were selectively stained using a lactic dehydrogenase reaction. The morphometric measurements were performed with an optic-electronic image analysis system that determined ganglion size, ganglion distances, nerve cell number per ganglion, and ganglion number per mm colon. The results showed that hypoganglionosis of the myenteric plexus is characterised by a 42% decrease in plexus area and a 55% decrease of the nerve cell number per mm length of colon. The number and area of myenteric ganglia showed a decrease of 59% and a doubling of the ganglion distances. The histopathological diagnosis of a hypoganglionosis of the colon was not necessarily an indication of a chronic constipation, but rather an indication of a dispositi

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