References: Laxative
Depress Anxiety. 1998;7(2):83-6.
Tolerability of oral loading of divalproex sodium in the treatment of acute mania.
Martinez JM, Russell JM, Hirschfeld RM.
Department of Psychiatry, University of Texas Medical Branch, Galveston 77555, USA.
OBJECTIVE: To conduct a pilot study on the safety and tolerability of a dosage strategy for divalproex sodium beginning with 30 mg/kg/day. It is hypothesized that loading at this level will reach therapeutic levels of valproate more quickly, which in turn will decrease the latency of the therapeutic effect. METHOD: We conducted a retrospective chart review of all acutely manic patients admitted to our facility over a 12-month period. Those inpatients treated with initial divalproex sodium dosages of 30 mg/kg/day for 2 days, followed by 20 mg/kg/day thereafter, were then included in the study. The serum valproate levels and daily Brief Psychiatric Rating Scale (BPRS) scores were documented for each subject. Any adverse changes in daily vital signs, serum liver enzymes, and blood cell counts were noted as well. Nursing and physician notes were then reviewed for any observed or reported adverse effects. RESULTS: Twelve acutely manic inpatients were enrolled in the study. Three subjects did not complete the treatment and are not included in this analysis. The remaining nine subjects completed the treatment, had a mean decrease in BPRS scores of 33.3%, and were discharged at least in partial remission. Six subjects had serum valproate levels drawn within 48-72 h of the initial dose, with a mean valproate level of 93.5 mcg/ml. All nine subjects tolerated the treatment reasonably well, with one subject reporting sedation, one reporting sedation and constipation, and one reporting nausea, emesis, and urinary frequency. A transient, asymptomatic decrease in white blood cell count and a low granulocyte count were also noted in one subject. CONCLUSION: A divalproex dosage strategy beginning with 30 mg/kg/day for 2 days, followed by 20 mg/kg/day thereafter, wa
Eur J Gastroenterol Hepatol. 1998 May;10(5):415-21.
Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS). Patients' description of diarrhea, constipation and symptom variation during a prospective 6-week study.
Ragnarsson G, Bodemar G.
Department of Health and Environment, Faculty of Health Services, Linkoping University, Sweden.
OBJECTIVES: To study the intensity and variation of pain and its temporal relation to eating and defaecation. Furthermore, what irritable bowel (IBS) patients mean by constipation and diarrhea and how bowel symptoms vary. DESIGN: Prospective daily symptom recording over 6 weeks. SETTING: The primary catchment area of University Hospital of Linkoping. PARTICIPANTS: Eighty consecutive patients fulfilling the Rome criteria; 63 finished the study. RESULTS: Fifty-nine of 63 patients recorded an average of 29 pain periods and 24 days with pain during the 6 weeks. Over-all pain burden decreased slightly over the study period. At inclusion 38 (64%) patients claimed that pain was relieved by defaecation. However, on average, only 10% of each patient's recorded pain periods were relieved by defaecation. At inclusion 29 (49%) patients claimed postprandial worsening of pain. On average, 50% of each patient's recorded pain periods worsened postprandially. The patients defined constipation as hard stools and diarrhea as loose stools and urgency. Stool frequency did not differ. Bowel symptoms varied within, but not between, fortnightly periods. CONCLUSIONS: Postprandial worsening of pain should be included as a criterion in the clinical definition of IBS while the criterion 'pain relieved by defaecation' should be re-evaluated. IBS patients can probably be divided into subgroups based on stool consistency, not frequency. Daily records are superior to structured clinical interviews or questionnaires for a detailed study of symptoms in IBS.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9619389&dopt=Abstract constipation laxative colon cleansing
J Nucl Med. 1998 Jun;39(6):1062-6.
Differentiation of prolonged colonic transit using scintigraphy with indium-111-labeled polystyrene pellets.
Eising EG, von der Ohe MR.
Clinic for Internal Medicine/Department of Gastroenterology, University of Essen, Germany.
Prolonged colonic transit can be caused either by slow transit constipation or by pelvic outlet obstruction needing different therapeutic regimes. The aim of this study was to prove the value of scintigraphic assessment. METHODS: Colon scintigraphy was performed in 32 patients (28 women, 4 men; age range 8-68 yr) with idiopathic constipation at 8, 24 and 48 hr in ventral and dorsal projection after oral administration of a pH-sensitive, methacrylate-coated capsule of nonresorbable 111In-labeled polystyrene (cathion exchanger) micropellets (3.5 MBq/capsule). The geometric center (GC) as the sum of products of colon segment activity and colon segment number (1 = colon ascendens; 2 = transverse colon; 3 = colon descendens; 4 = rectosigmoid colon; and 5 = stool) dividing by the total counts was used to determine the velocity of colonic transit at least at 24 hr as the proximal colonic emptying (PCE) rates. Stool activity was evaluated indirectly as decay-corrected colon activity loss between two examinations. Results were compared with data obtained from 22 healthy subjects. RESULTS: Twenty-six patients had a significant prolongation of colonic transit after 24 and 48 hr (the 95% confidence interval of the patient's GC showed no overlap to the 95% confidence interval of GC calculated from 22 healthy controls as normal range) revealing slow transit constipation. Six patients had normal or accelerated transit (GCs and PCE rates) up to the rectum but delayed rectal emptying indicating pelvic outlet obstruction. CONCLUSION: By the help of this method it was possible to differentiate the two subtypes of colon transit prolongation by use of the reported scintigraphic technique, which leads to different therapeutic management of the patien
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