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PubMed1989

Epidemiology of constipation in the United States.

In the present study, the epidemiology of constipation in the United States and an assessment of its impact on national health are presented. This analysis was based on four different surveys, i.e., the National Health Interview Survey, the National Hospital Discharge Survey, the National Ambulatory Medical Care Survey, and the Vital Statistics of the United States. These surveys have estimated that over 4 million people in the United States have frequent constipation, corresponding to a prevalence of about 2 percent. Constipation was the most common digestive complaint in the United States, outnumbering all other chronic digestive conditions. Cathartics and laxatives were prescribed to 2 to 3 million patients yearly by general and family practitioners or internists. In 92,000 annual hospitalizations, constipation was listed among the discharge diagnoses. About 900 persons die annually from diseases associated with or related to constipation. Constipation was three times more common in women than men. It showed a marked increase after the age of 65 years. It appeared to affect nonwhites 1.3 times more frequently than whites. In addition, constipation was more frequent in people living in the South than elsewhere in the United States, and in people from families with low income or brief education of the head of family than in people from families with high income or a high educational level of their family head. These data suggest that there are other factors involved in the cause of constipation in addition to dietary fiber content and psychogenic influences. The frequent occurrence of constipation and its impact on public health stress the need for further studies devoted to the epidemiology and basic pathophysiology of this condition.

Age Factors↗
PubMed1998

Elemental profiles in feather samples from a mercury-contaminated lake in central california

Flight feathers from six bird species at Clear Lake, CA were analyzed to determine the extent and distribution of mercury contamination from an abandoned mercury mine and associated levels of 14 other elements. Feather samples were collected from adult and juvenile osprey (Pandion haliaetus), including juvenile osprey from three additional comparison sites; adult western grebes (Aechmophorus occidentalis); adult great blue herons (Ardea herodias); adult mallards (Anas platyrhynchos); adult turkey vultures (Cathartes aura); and juvenile double-crested cormorants (Phalacrocorax auritus). Samples were analyzed by a multielemental x-ray fluorescence method. The osprey from Clear Lake showed significantly elevated mercury concentrations relative to the comparison sites. Different species at Clear Lake had different mercury concentrations based on trophic status; osprey exhibited the highest mercury concentrations and the mallards showed the lowest. Lastly, we quantified differences in elemental concentrations, including mercury, between adult and juvenile osprey from Clear Lake. Elements known to be nutrients, such as sulfur and zinc, did not vary significantly among species or sites. Reproductive success of osprey at Clear Lake was monitored from 1992 to 1996 to determine if osprey reproduction was depressed. During this five-year period, the breeding population grew from 10 to 20 nesting pairs and the average reproductive rate was 1.4 fledglings per nesting attempt. Although the osprey showed the highest mercury levels of any species sampled, their reproduction does not appear to be depressed.

Journal Article↗
PubMedDate not supplied

CT colonography: examination prerequisites.

CT colonography is likely to play an important role in colorectal cancer screening. The ability of this new technique to detect colorectal polyps and cancer is predicated on an optimally cleansed and distended colon. Whereas the most common reported colonic cleansing regimen employed for CT colonography is polyethylene glycol lavage solution, saline cathartics such as sodium phosphate and magnesium citrate offer the advantage of a drier cleansed colon. Positive labeling of residual stool and fluid combined with electronic substraction of tagged material is under investigation. This new technique would eliminate purgative bowel cleansing and increase patient acceptance of CT colonography. Colonic distention is easily and reliably achieved with atmospheric air, although carbon dioxide is being evaluated as a more comfortable alternative. The use of antispasmodics for CT colonography is controversial. Glucagon is no longer used at centers where a clear benefit has not been found. Intravenous contrast may be useful in a specific subset of patients undergoing CT colonography, although it is doubtful that it will be used routinely for CT colonography.

Colon↗
PubMed1999

Repeat charcoal hemoperfusion treatments in life threatening carbamazepine overdose.

A 16-month-old female experienced a massive carbamazepine ingestion resulting in a peak serum carbamazepine concentration of 55 microg/ml. Clinical manifestations included generalized seizures, coma, shock, and gastrointestinal hypomotility. Gut decontamination was attempted using multiple-dose activated charcoal and cathartics. Because of the severity of illness, charcoal hemoperfusion was initiated. The patient underwent three sessions of charcoal hemoperfusion, each utilizing a fresh cartridge, with one session immediately following the other. Serum carbamazepine and carbamazepine-10,11-epoxide concentrations decreased from 54 microg/ml to 23 microg/ml, and 30 microg/ml to 17 microg/ml, respectively, during charcoal hemoperfusion. There were no complications. The patient recovered completely and was discharged on the 4th hospital day. Charcoal hemoperfusion should be considered for life-threatening carbamazepine intoxication, especially when drug-induced gastrointestinal hypomotility prevents elimination via the gut.

Carbamazepine↗
PubMed2007

Extracolonic tumors of the gastrointestinal tract detected incidentally at screening CT colonography.

PURPOSE: The aim of this article is to report our experience with incidental detection of extracolonic tumors of the gastrointestinal tract identified prospectively at screening CT colonography. METHODS: A total of 2014 patients (1097 females, 917 males; mean age, 56.9 years) underwent primary CT colonography evaluation at our institution over an 18-month period. Following cathartic preparation and colonic distention, supine and prone multidetector CT scans were obtained with thin-collimation low-dose technique without intravenous contrast. We reviewed our database for lesions of the extracolonic gastrointestinal tract that were detected during the prospective reading. RESULTS: Focal extracolonic gastrointestinal tract lesions were prospectively detected in 10 (0.5 percent) of 2014 patients (8 females; 2 males; mean age, 58.5 years). All patients were asymptomatic. Tumor locations included ileum (n = 3), stomach (n = 3), jejunum (n = 2), and appendix (n = 2). Mean tumor size was 2.2 (range, 0.8-3.4) cm. Lesions in eight patients were subsequently confirmed by conventional or capsule endoscopy and/or by intravenous contrast-enhanced CT. Seven lesions were surgically excised and one was removed at endoscopy; two patients with lipomas did not undergo further evaluation or treatment. Final diagnoses were benign in all cases and included lipoma (n = 3), small-bowel hamartoma (n = 2), appendiceal mucinous cystadenoma (n = 2), gastric leiomyoma (n = 1), small-bowel lymphangioma (n = 1), and gastric fundic gland polyp (n = 1). CONCLUSIONS: Incidental extracolonic tumors of the gastrointestinal tract detected at screening CT colonography were all asymptomatic and benign but often prompted more invasive workup. Although the incidence of these tumors was relatively low, widespread population screening with CT colonography would result in new surgical referrals for these findings.

Aged↗
PubMed2006

Catharsis and moral therapy I: a Platonic account.

This paper aims at analysing the ancient Greek notions of catharsis (clearing up, cleaning), to holon (the whole) and therapeia (therapy, treatment, healing) to assess whether they may be of help in addressing a set of questions concerning the didactics of medical ethics: What do medical students actually experience and learn when they attend classes of medical ethics? How should teachers of medical ethics proceed didactically to make students benefit morally from their teaching? And finally, to what extent and in what forms and formats can the kind of cathartic treatment envisaged by Plato still be considered a necessary preliminary to moral learning? The three questions will be addressed by means of a reconstructive analysis and assessment of the Platonic notions of catharsis and holistic therapy present in the Charmides and the Sophist. Besides, the didactic potential of Plato's dialogue form and moral regimen will be tried out. The ultimate aim is to investigate the possibilities of developing a therapeutic conception of medical ethics.

Adult↗
PubMed1990

A pilot study for a structured, time-limited therapy group for sexually abused pre-adolescent children.

The critical role of specific types of mastery skill development in the treatment of sexually abused children is explored, and defense mechanisms of "invulnerable children," who function adequately despite trauma and stress, are described. The authors describe their development of structured group therapy techniques designed to foster these types of mastery skills with sexually abused children aged 6 to 8. These techniques include development of intellectualization defenses through original coloring books and therapeutic board games, cathartic exploration of feelings through structured art and storytelling exercises, cognitive relabeling and self-esteem building through role-play, "chants and cheers," homework shared with mothers, and other structured group procedures designed to develop specific coping skills.

Adaptation, Psychological↗
PubMed1979

On the molecular structure of some prostaglandin receptors.

Hypotheses are presented of the detailed molecular structure of two prostaglandin receptors both concerned in tumor-promotion processes. These structures have been derived by the comparison of the molecular structure of agents active at the site with (i) a simple theoretical protein structure and (ii) the known x-ray structure of phospholipase A2. The first model receptor is stimulatory to the tumor-promotion process and may be located on the control system for ornithine decarboxylase. The binding of PG here is cooperative with the binding of Ca++. Naturally-occurring agonists at this receptor may include members of the cathartic class of drugs such as colocynth, chrysarobin, etc. Naturally-occurring antagonists at this site may include a number of anti-tumor compounds such as datiscoside. The second model receptor (PGE1) is inhibitory to the tumor-promotion process and is located at a specific allosteric site on the x-ray-determined structure of phospholipase A2. This site overlaps for one for lysolecithin (excitatory), for which tumor-promoting phorbol esters such as TPA are agonists and some anti-tumor drugs such as maytansine may be antagonists.

Antineoplastic Agents↗
PubMed1995

Suicide attempts, age and duration of illness in recurrent affective disorders.

One of the strongest predictors of suicide is a suicide attempt in the history of the patient. The question, however, is to what extent age and duration of the illness affects the risk of a suicide attempt. In this study, we examined the course of 310 patients with primary affective disorders before lithium prophylaxis and compared the clinical data of those with and without suicide attempts in their history. In a subgroup of 98 patients with suicide attempts, measures for both suicide attempts and inpatient episodes were investigated. Comparing patients with suicide attempts and those without, we found no difference between duration of illness and number of previous episodes between the two groups. However, those with a suicide attempt in their history had an earlier onset of the illness. In the group of 98 suicide attempters, we found no significant correlation between age and rates for both episodes and suicide attempts, which indicates that these rates were not declining as the illness progressed and the patient aged. Dividing the sample into three different age groups, episode rates and rates of attempted suicide were found to be positively correlated in all age groups, again indicating that as long as episodes occur, the suicide risk does not decline. The results are not in favor of findings which suggest that the risk of attempting suicide might manifest itself primarily in the early course of the illness or that suicide attempts in the early course of illness provide a 'cathartic effect' which leads to a lower risk in the later course of the illness. Rather, the findings support the view that the risk of suicide attempts in recurrent affective disorders is unchanged in all age groups and throughout all stages of untreated illness.

Adult↗
PubMed1991

Nurses' interpersonal skills: a study of nurses' perceptions.

Six Category Intervention Analysis was used as the framework of a study which involved asking 117 trained nurses to rate their interpersonal skills along six dimensions. The findings suggested that the nurses viewed themselves as being more skilled in offering support, information and prescription in their dealings with patients and less skilled in being catalytic, cathartic and confronting in similar circumstances. The findings in this study were similar to those of previous studies in this field. The study has implications for the development of interpersonal skills training programmes for nurses.

Clinical Competence↗
PubMed1992

Subchronic (13-week) toxicity studies of oral phenolphthalein in Fischer 344 rats and B6C3F1 mice.

Phenolphthalein is a cathartic agent that is widely used in over-the-counter laxatives. Thirteen-week toxicity studies of phenolphthalein were performed using F344/N rats and B6C3F1 mice. Rats and mice were fed ad libitum with a NIH 07 diet containing 0; 3000; 6000; 12,000; 25,000; or 50,000 ppm phenolphthalein. On a milligram per kilogram body weight basis, rats and mice fed 50,000 ppm phenolphthalein ingested more drug than would be expected during human laxative abuse. Phenolphthalein produced little evidence of toxicity in rats. There was slightly lower weight gain among the 25,000 and 50,000 ppm groups. Treated rats showed elevated relative kidney weights (males only) and elevated absolute and relative liver weights at 12,000-50,000 ppm phenolphthalein. Rat serum bile acids were depressed early (Days 5 and 6) by phenolphthalein treatment. Several treatment-related toxic effects, however, were identified in mice who received more phenolphthalein per unit body weight than rats. Although there were no effects on body weight gain, elevated liver weights were noted in female mice receiving 6000-50,000 ppm phenolphthalein. The primary treatment-related findings that occurred during the mouse studies involved the reproductive and hematopoietic systems. Reproductive changes including depressed testis and right epididymal weights and sperm density, an elevated production of abnormal sperm, and morphologic alterations in seminiferous tubules occurred at all levels of exposure (3000-50,000 ppm). Hematopoietic changes included bone marrow hypoplasia (12,000-50,000 ppm), increased splenic hematopoiesis (males only; 25,000 and 50,000 ppm), and an elevated incidence of micronucleated erythrocytes (6000-50,000 ppm).

Animals↗
PubMed1995

Effects of polyethylene glycol 400 (PEG 400) following 13 weeks of gavage treatment in Fischer-344 rats.

Fischer-344 rats (10/group/sex) were administered polyethylene glycol 400 (PEG 400) by gavage at 1.0, 2.5 or 5.0 ml/kg (1.1, 2.8 and 5.6 g/kg, respectively) body weight/day 5 days/wk for 13 wk. Animals in the control group received water by gavage (5.0 ml/kg body weight/treatment day). An additional 10 rats/sex/group were assigned to the control and high-dose groups for a 6-wk recovery period. Evaluation of potential renal toxicity was identified as a primary objective. There was no mortality or changes in haematology or clinical chemistry measurements attributed to PEG 400 toxicity. Loose faeces in the mid- and/or high-dose group of both sexes were attributed to bulk cathartic effects of PEG 400. Slight decreases in food consumption and body weights in the mid- and/or high-dose group of male rats and female rats were attributed to the physical presence of PEG 400 in the intestinal tract. However, a direct effect of PEG 400 on the intestinal tract was not ruled out. Increased water consumption was attributed to a possible increase in serum osmolality due to the absorption of the PEG 400 or a reflection of the water dosing received by the control animals. Increased urinary concentration and decreased urinary pH were at least partially attributed to absorption, possible metabolism, and urinary excretion of PEG 400. Small increases in absolute and/or relative kidney weights observed in many dose groups, were attributed to the osmotic effect of the test substance and/or metabolites in the urine. The significance of a slight increase in relative kidney weights in female rats following the recovery period was unknown. Although no microscopic changes were observed in the kidneys or urinary bladder, a slight, reversible renal toxicity may have resulted in male rats treated by gavage with 2.5 ml/kg/day and rats of both sexes treated by gavage with 5.0 ml PEG 400 kg/day. This was based on the increased concentration of protein and bilirubin, urinary vascular cell findings and N-acetyl-beta-D-glucosaminidase activity.

Acetylglucosaminidase↗
PubMed1995

Toxicological studies on ratanjyot oil.

Ratanjyot (Jatropha curcas) grows wild in many parts of India and Brazil. Experimental studies on the toxicity of its oil are scarce despite its use as a cathartic purgative, for treatment of many ailments in human medicine and in industrial applications. This study aims to provide data on its toxicity. The proximate composition of the kernels and physicochemical characteristics of its oil were determined. The kernels constitute 62% of the seed and contain 52% oil, which is reported to contain phorbol esters. A toxic fraction (2.4%) containing the phorbol esters was isolated from the oil. The acute oral LD50 of the oil was found to be 6 ml/kg body weight in rats. The oil caused severe diarrhoea and gastro-intestinal inflammation. The isolated toxic fraction, when applied to the skin of rabbits and rats, produced a severely irritant reaction followed by necrosis; in mice, this fraction had a dermally toxic and lethal effect. The oil and the toxic fraction at 25 and 1 mg respectively in 10 ml saline showed haemolytic activity, disrupting red blood cells. Detoxification or complete removal of the potent toxins present in ratanjyot oil is essential before its use in industrial applications or in human medicine can be considered.

Administration, Oral↗
PubMed1989

Sennosides do not kill myenteric neurons in the colon of the rat or mouse.

Effects of senna on the myenteric plexus of the colon were investigated in view of earlier reports that this anthraquinone cathartic depletes the plexus of its intrinsic neurons. Rats and mice were given purgative doses of sennosides in their drinking water for 4 and 5 months, respectively. Body growth was reduced, and the weight of the colon with its contents was increased relative to the weight of the whole body in the treated animals. The latter change was attributed to depressed propulsive motility of the large intestine. Total numbers of myenteric neurons were determined from whole-mount preparations stained with Cuprolinic Blue-magnesium chloride, which selectively coloured the neuronal somata. The number of neurons in the rat's colon was unaffected by treatment with senna, but the colons of the treated mice contained significantly more neurons than those of their controls. Staining with antisera to 10 putative neurotransmitters or their associated enzymes revealed immunoreactive somata and axons in the myenteric plexus. Treatment with senna was not associated with absence of neuronal somata or fibres stainable with any of the antisera in either species. Thus, there was no evidence of toxic destruction of any identifiable population of neurons that might have been too small to affect the total counts. We conclude that senna does not kill myenteric neurons in the colon of the rat or mouse.

Administration, Oral↗
PubMed1985

Atrioventricular block following overdose of decongestant cold medication.

A 24-year-old man developed high-degree atrioventricular (A-V) block with a pulse rate of 40 beats per minute and hypertension following an overdose of a combination decongestant cold medication that contained phenylpropanolamine, phenylephrine, chlorpheniramine, and phenyltoloxamine. The patient was treated with ipecac, activated charcoal, and cathartics in the emergency department (ED). After his admission to the coronary care unit, the A-V block gradually resolved to sinus rhythm with periods of second-degree block, Mobitz types I and II. No treatment was required. The patient had a normal sinus rhythm and normal blood pressure prior to discharge.

Adult↗
PubMedDate not supplied

Heroin body packers.

Fourteen body packers carrying 2-112 heroin packages are reported. Nine people swallowed the packets, and five inserted them rectally. The ingested packages were large and radio-opaque; they consisted of hard lumps of concentrated heroin usually covered with glove latex, white adhesive tape, and a toy balloon. There were two complications in the 14 patients. One patient developed a bowel obstruction; at laparotomy 8 packages were found in the stomach and 27 at the ileo-cecal valve. Another patient, with heroin wrapped only with black electrician's tape and no latex inner or outer wrappings, developed heroin intoxication, noncardiogenic pulmonary edema, and a bowel obstruction. Eighteen packages were surgically removed from his stomach and 26 from his bowel. We recommend bisacodyl suppositories, activated charcoal mixed with a 3% sodium sulfate cathartic, and phosphosoda enemas for package removal; close observation for heroin toxicity or bowel obstruction; and surgical intervention for continuing toxicity, retention of packages in the stomach, or bowel obstruction.

Administration, Oral↗
PubMed1991

A longitudinal evaluation of drug use in an ambulatory elderly population.

Participants in a geriatric health screening program were studied longitudinally to determine the patterns of drug use over a 10 year period. There were 314 (34.0%) men and 610 (66.0%) women who completed 10 yearly health screening evaluations. The mean number of prescribed and non-prescribed drugs used per participant increased from 2.90 in 1978-79 to 4.08 in 1987-88 (p less than 0.0001). There was no significant difference between men and women in the rate of increased drug use. There was no significant increase in the mean number of drug ingredients per participant used over the 10 year period. The most frequently reported therapeutic categories for 1978-79 were antihypertensives, analgesic-antipyretics, antirheumatics, multiple vitamins, cathartics and vitamin E, which represented 10.2, 7.2, 6.5, 4.9, 4.8 and 3.8% of all categories used. There was a decline in all of these categories between interval 1 and 10. Increased use of drugs, particularly prescribed medications, by the elderly population may present problems of adverse drug reactions, drug interactions and medication compliance in the future. Changing patterns of drug use may have resulted, in part, from introduction of new therapeutic classes and from new treatment concepts over the 10 year study period.

Aged↗