Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CATHARTICS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 433 records · Page 24Linked to original sources

Lactitol in the treatment of chronic hepatic encephalopathy: an open comparison with lactulose.

Lactulose is currently the drug of choice for the treatment of hepatic encephalopathy. It is, however, only available as a syrup which is contaminated with other sugars. Consequently patients may express aversion to its excessively sweet taste and many experience nausea because of its hyperosmolarity. Lactitol is a disaccharide analogue of lactulose which can be produced as a pure crystalline powder with a low relative sweetness. Theoretically it should have the same therapeutic effects as lactulose but fewer side effects. Five patients with chronic hepatic encephalopathy on maintenance lactulose were monitored clinically, psychometrically, and by measurement of venous blood ammonia, electroencephalogram mean cycle frequency, and cerebral blood flow during three months treatment with lactulose and a similar period on lactitol. Lactitol was at least as efficacious as lactulose but was more acceptable because its cathartic effect was more predictable, its formulation was more convenient and its less sweet taste preferred. Lactitol is the ideal successor to lactulose for treatment of this condition.

Adult↗

Effects of acetorphan, an enkephalinase inhibitor, on experimental and acute diarrhoea.

Acetorphan is an orally active inhibitor of enkephalinase (EC 3.4.24.11) with antidiarrhoeal activity in rodents apparently through protection of endogenous enkephalins and a purely antisecretory mechanism. Its antidiarrhoeal activity in man was assessed in an experimental model of cathartic induced secretory diarrhoea as well as in acute diarrhoea of presumed infectious origin. In six healthy volunteers receiving castor oil and pretreated with acetorphan or placebo in a crossover controlled trial, the drug significantly decreased the number and weight of stools passed during 24 hours. About 200 outpatients with severe acute diarrhoea (more than five stools per day) were included in a randomised double blind study of acetorphan against placebo. The significant antidiarrhoeal activity of acetorphan was established using a variety of criteria: (i) the duration of both diarrhoea and treatment were diminished; (ii) no acetorphan treated patient withdrew from the study whereas five dropped out because of worsening in the placebo group; (iii) the frequency of symptoms associated with diarrhoea--for example, abdominal pain or distension, nausea and anorexia--remaining after two weeks was nearly halved; (iv) using visual analogue scales acetorphan treatment was found more effective than placebo by both investigators and patients. There was statistically no significant difference between acetorphan and placebo in respect of side effects, particularly constipation, which often accompanies the antidiarrhoeal activity of mu opioid receptor agonists this difference is attributable to the lack of antipropulsive activity of acetorphan in man. The efficacy and tolerance of acetorphan suggest that enkephalinase inhibition may represent a novel therapeutic approach for the symptomatic management of acute secretory diarrhoea without impairing intestinal transit.

Adolescent↗

Colorectal cancer screening with CT colonography, colonoscopy, and double-contrast barium enema examination: prospective assessment of patient perceptions and preferences.

PURPOSE: To prospectively assess and compare perceptions of and preferences for computed tomographic (CT) colonography, colonoscopy, and double-contrast barium enema examination (DCBE) by asymptomatic patients undergoing colorectal cancer screening. MATERIALS AND METHODS: A total of 696 asymptomatic patients at higher-than-average risk undergoing colorectal cancer screening were consecutively recruited to undergo both CT colonography and colonoscopy (group 1), and a like group of 617 patients was separately recruited to undergo both CT colonography and DCBE (group 2). Standard bowel preparations were different between the groups undergoing colonoscopy and DCBE. Each patient completed a questionnaire that assessed preparation inconvenience and discomfort, examination discomfort, willingness to repeat examinations, and examination preference. Survey results were compared for significance by using the Wilcoxon rank sum or chi2 test. RESULTS: The majority of patients considered the preparation to be uncomfortable (group 1, 460 of 515 [89%]; group 2, 482 of 538 [90%]) and inconvenient (group 1, 393 of 502 [78%]; group 2, 427 of 527 [81%]). Reported discomfort was similar at CT colonography and colonoscopy (P =.63) but was less at CT colonography than at DCBE (P <.001). Patients experienced significantly less discomfort than expected at both CT colonography and colonoscopy but not at DCBE. Patients' willingness to undergo frequent rescreening was significantly greater for CT colonography than for either colonoscopy or DCBE. The acceptable time interval between screenings was significantly shorter for all examinations if the bowel preparation could be avoided. Overall, patients preferred CT colonography to colonoscopy (group 1, 72.3% vs 5.1%; P <.001) or to DCBE (group 2, 97.0% vs 0.4%; P <.001). CONCLUSION: Patients undergoing colorectal cancer screening prefer CT colonography to both colonoscopy and DCBE. The majority of patients experience discomfort and inconvenience with cathartic bowel preparation.

Adult↗

Cleansing enema prior to double-contrast barium enema examination: is it necessary?

In a prospective study, 443 patients referred for double-contrast barium enema examination were allocated to one of four regimens consisting of either 24 or 48 hours of clear liquids in combination with a cathartic laxative (magnesium sulfate), an irritant laxative (bisacodyl), and hydration. One regimen from each time group included a preliminary cleansing enema. Significantly higher bowel cleanliness scores were given to the 48-hour regimen with no cleansing enema (P < .0002). Scores for overall quality of the barium enema examination (based on detectability of a 1-cm lesion) showed no significant differences between a 24- and a 48-hour regimen, with or without a cleansing enema. No differences emerged in patient acceptance of the regimens, and 54%-57% of patients had no complaints about the preparation. The authors recommend a 48-hour preparation to minimize the risk of interfering fecal material, especially in subjects with colonic dysmotility. A time-consuming cleansing enema can be omitted.

Barium Sulfate↗

Effect of phenolphthalein on monkey intestinal water and electrolyte transport.

To assess Na-K-ATPase inhibiton and prostaglandin synthesis stimulation as the mechanism of the secretory (cathartic) action of phenolphthalein in the primate, we investigated water and electrolyte transport and Na-K-ATPase levels in monkey intestine. Both jejunum and colon were studied with in vivo perfusion and in vitro Ussing chamber techniques. Water, Na, and Cl absorption was inhibited or secretion was induced by phenolphthalein (10(-3) M) in the jejunum and colon when the drug was present in the mucosal bathing (perfusion) solution. Serosal addition of phenolphthalein (10(-4) or 10(-3) M) induced Na and anion absorption in the jejunum but not in the colon. Phenolphthalein inhibited Na-K-ATPase activity in the test tube, but assays of intestine previously perfused or bathed in the drug showed no inhibiton. Indomethacin, in doses sufficient to inhibit prostaglandin synthesis in the intestine, inhibited the secretion induced by phenolphthalein in the jejunum but not in the colon. These inconsistencies cast doubt on the role of Na-K-ATPase inhibition or the role of prostaglandin synthesis stimulation in the mechanism of action of phenolphthalein.

Animals↗

Unsuspected morbid hypermagnesemia in elderly patients.

This study was designed to determine the incidence, etiology and consequences of severe hypermagnesemia. We retrospectively reviewed all hospital admissions over a 5-year period from 1984 to 1989 and identified 8 cases of severe hypermagnesemia (serum Mg > or = 6.0 mg/dl) due to magnesium ingestion. All but 1 patient were elderly (mean age 70 +/- 6 years). The etiology when identified was due to magnesium-containing cathartics (n = 3) or antacids (n = 3). The total amount of magnesium ingested was not excessive, but bowel disorders that may have enhanced absorption (such as active ulcer disease, gastritis, colitis, perforated viscus, massive gastric dilatation) were present in 7 of the 8 patients. Unexpectedly, only 1 had preexisting renal failure. Renal function was found to be normal in 1, only mildly to moderately impaired in 5 (creatinine < 3.6 mg/dl) and severely impaired in 2 (creatinine 7.6, 15.7 mg/dl). Clinical sequelae of hypermagnesemia were hypotension (n = 7), bradycardia (n = 2), respiratory depression (n = 3), EKG abnormalities (n = 6), depressed mental status (n = 5). Hypocalcemia (range 5.7-7.4 mg/dl) more severe than could be attributed to either hypoalbuminemia or acute renal failure was present in 7. A low anion gap (range-2 to 9) was present in 5. Most striking was the fact that despite clinical sequelae, the hypermagnesemia was unsuspected in 6 of the 8 cases. Hypermagnesemia can occur without severe renal insufficiency in association with bowel disease, particularly in elderly individuals, and may be a clinically unrecognized cause of cardiovascular dysfunction, hypocalcemia and neurologic or respiratory depression.

Aged↗

Monastic incorporation of classical botanic medicines into the Renaissance pharmacopeia.

Ancient Greek physicians believed that health resulted from a balance of natural forces. Many, including Dioscorides, made compilations of plants and medicines derived from them, giving prominence to diuretics, cathartics and emetics. During the Roman Empire, although Greek physicians were highly valued, the Roman matron performed many medical functions and magic and astrology were increasingly used. In Judaic and later Christian societies disease was equated with divine disfavor. After the fall of Rome, the classical Greek medical texts were mainly preserved in Latin translation by the Benedictine monasteries, which were based around a patient infirmary, a herb garden and a library. Local plants were often substituted for the classical ones, however, and the compilations became confused and inaccurate. Greek medicine survived better in the remains of the Eastern Roman Empire, and benefitted from the influence of Arab medicine. Intellectual revival, when it came to Europe, did so on the fringes of the Moslem world, and Montpellier and Salerno were among the first of the new medical centers. Rather than relying on ancient experts, the new experimental method reported the tested effects of substances from identified plants. This advance was fostered by the foundation of universities and greatly aided by the later invention of the printing press, which also allowed wider dissemination of the classical texts.

Byzantium↗

Nonverbal and verbal emotional expression and health.

The spontaneous nonverbal expression of emotion is related to immediate reductions in autonomic nervous system activity. Similar changes in specific autonomic channels occur when individuals are encouraged to verbally express their emotions. Indeed, these physiological changes are most likely to occur among individuals who are either verbally or nonverbally highly expressive. These data suggest that when individuals must actively inhibit emotional expression, they are at increased risk for a variety of health problems. Several experiments are summarized which indicate that verbally expressing traumatic experiences by writing or talking improves physical health, enhances immune function, and is associated with fewer medical visits. Although less research is available regarding nonverbal expression, it is also likely that the nonverbal expression of emotion bears some relation to health status. We propose that the effectiveness of many common expressive therapies (e.g., art, music, cathartic) would be enhanced if clients are encouraged to both express their feelings nonverbally and to put their experiences into words.

Adaptation, Psychological↗

Effects of oleic and ricinoleic acids on net jejunal water and electrolyte movement. Perfusion studies in man.

To examine the effects of oleic acid and ricinoleic acid on jejunal absorption, steady-state jejunal perfusions were performed in healthy volunteers. Taurocholate, used to solubilize the fatty acids, did not influence absorption. Both fatty acids (concentration, 10 mM) reversed electrolyte and water net movement; that is, they induced fluid secretion; this effect was rapidly reversible. Ricinoleic acid (the active principle of castor oil) was the more potent, producing fluid secretion when perfused at concentrations at which oleic acid was without effect. However, ricinoleic acid was absorbed more slowly than was oleic acid, and hence was associated with higher intraluminal concentrations. Addition of lecithin and monoolein did not diminish the secretory effect of ricinoleic acid; addition of a secretory bile acid (taurodeoxycholate) did not enhance the effect. The response of the jejunal mucosa to a known cathartic provides observations pertinent to the pathophysiology of steatorrheal diseases in man. Dietary fatty acid also has secretory properties with respect to the human intestine; bacterial hydration, to hydroxy fatty acids, is not required to induce fluid secretion.

Body Water↗

Models of the mind: their role in the clinical teaching of psychoanalytic psychotherapy.

In acquiring psychoanalytic ideas, psychotherapy trainees are often hampered by preconceptions about what constitutes a psychoanalytic perspective. These preconceptions can even constitute unarticulated models of pathogenesis and cure, which organize how trainees assimilate a supervisor's suggestions. We have identified two such models: the "passive-learning" model and the "cathartic" model. Realizing that trainees are operating under one of these models can help the supervisor to understand many of their errors. A traditional model emphasizing conflict and compromise formation addresses the deficiencies of these models and provides an initial framework for a psychoanalytic understanding of psychopathology and change. Certain guidelines for technique arise from this model: understanding rather than trying to change behavior, attending to the patient's emotional set, and using the therapist's emotional set. We describe one resident's use of the compromise-formation model to overcome an impasse in his treatment of a patient, and discuss some implications for clinical supervision.

Adult↗

The inconstant "principle of constancy".

A review of the principle of constancy, as it appeared in Freud's writings, shows that it was inspired by his clinical observations, first with Breuer in the field of cathartic therapy and then through experiences in the early usage of psychoanalysis. The recognition that memories repressed in the unconscious created increasing tension, and that this was relieved with dischargelike phenomena when the unconscious was made conscious, was the basis for his claim to originality in this area. The two principles of "neuronic inertia" Freud expounded in the Project (1895), are found to offer the key to the ambiguous definition of the principle of constancy he was to offer in later years. The "original" principle, which sought the complete discharge of energy (or elimination of stimuli), became the forerunner of the death drive; the "extended" principle achieved balances that were relatively constant, but succumbed in the end to complete discharge. This was the predecessor of the life drives. The relation between the constancy and pleasure-unpleasure principles was maintained for twenty-five years largely on an empirical basis which invoked the concept of psychophysical parallelism between "quantity" and "quality." As the links between the two principles were weakened by clinical experiences attendant upon the growth of ego psychology, a revision of the principle of constancy was suggested, and it was renamed the Nirvana principle. Actually it was shifted from alignment with the "extended" principle of inertia to the original, so that "constancy" was incongruously identified with self-extinction. The former basis for the constancy principle, the extended principle of inertia, became identified with Eros. Only a few commentators seem aware of this radical transformation, which has been overlooked in the Standard Edition of Freud's writings. Physiological biases in the history and conception of the principle of constancy are noted in the Standard Edition. The historical antecedents of the principle of constancy, especially in relation to the teachings and influence of J. F. Herbart (1776-1841), do much to bridge the gap between psychological and neurophysiological aspects of Freud's ideas about constancy and its associated doctrine, psychic determinism. Freud's later teachings about the Nirvana principle and Eros suggest a continuum of "constancies" embodied in the structural and functional development of the mental apparatus as it evolves from primal unity with the environment (e.g., the mother-child unit) and differentiates in patterns that organize the inner and outer worlds in relation to each other.

Abreaction↗

Psychoanalysis and its neighboring sciences: paradigms and opportunities.

Breuer and Freud's prepsychoanalytic cathartic treatment proved to be generally ineffective. Consequently, both the treatment and the theory adduced to support it were revised to accommodate the issue of wishes and their expression. But the new treatment, too, had only limited success, which resulted in a further revision of the supporting theory to emphasize the "resistances," or the control and modulation of drives. There is an irony in these progressive shifts: as the therapy's limitations became more apparent, the theory became more expansive, and extended itself beyond its beginnings in neurotic symptoms, and into slips, dreams, character formation, and sociology. In short, it encompassed more of normal behavior as its expectations for the therapy of pathological behavior were increasingly called into question. The paper explores some implications of this historical turn for a scientific data base with opportunities to test and revise the various psychoanalytic hypotheses. One view would have it that psychoanalysis has been lamed by the physicalistic language of its metapsychology, by its isolation from the neurosciences and the cognitive sciences, and by a compartmentalization of practice and knowledge that has kept its practitioners focused on the worried well and unimpressed by the knowledge at its borders. Another view would propose that the restiveness of some current and past theorists to claim the mantle of "science" continues to lead to premature and awkward attempts to couple psychoanalysis with putative neighbors rather than stick to its last of shaping its own findings into a language reflecting a coherent theory capable of validation.

Europe↗

What was wrong with Anna O?

The case of Fräulein Anna O (Bertha Pappenheim) was the first detailed by Breuer and Freud in 'Studien über Hysteria' (1895). The case history is examined and an organic causation postulated. The fallacies of psychogenesis and of hysteria as a disease are mentioned. Breuer's claim of cure by the cathartic method appears unfounded.

Diagnosis, Differential↗

Bioavailability of magnesium diglycinate vs magnesium oxide in patients with ileal resection.

BACKGROUND: Patients who have undergone ileal resection are at risk for developing magnesium depletion/deficiency because of poor absorption and decreased intake as well as increased endogenous losses. Magnesium repletion is difficult to accomplish because of the cathartic action of most oral magnesium supplements at therapeutic doses. The results of in vitro and in situ studies show that magnesium diglycinate (chelate) represents a highly available form of magnesium that is absorbed in part as an intact dipeptide in the proximal small intestine. METHODS: We conducted a double-blind, randomized crossover trial with 12 patients who had ileal resections in order to compare the bioavailability of a 100-mg dose of 26Mg-labeled chelate with MgO in this patient population. RESULTS: For the patient group as a whole, 26Mg absorption was low but was not different for the two supplements (23.5% vs 22.8% for magnesium chelate and MgO, respectively). However, 26Mg absorption was substantially greater from the chelate (23.5% vs 11.8%; p < .05) in the four patients who showed the greatest impairment of magnesium absorption with MgO and was better tolerated by all patients. Peak isotope enrichment also occurred significantly earlier after 26Mg chelate than after 26MgO ingestion (mean difference 3.2 +/- 1.3 hours; p < .05), and the area under the enrichment vs time curve was greater after chelate ingestion (p < .05). CONCLUSIONS: Data from this study support the suggestion that some portion of magnesium diglycinate is absorbed intact, probably via a dipeptide transport pathway. Magnesium diglycinate may be a good alternative to commonly used magnesium supplements in patients with intestinal resection.

Administration, Oral↗

Treatment of constipation with chenodeoxycholic acid.

The aim of this study was to investigate whether the cathartic effect of chenodeoxycholic acid (CDCA) could be helpful in the management of chronic constipation. Twenty cholesterol gall-stone patients with chronic constipation were randomly treated with either CDCA (750 mg/day in three divided doses at meals) or placebo for a period of 4 weeks. The administration of CDCA produced a significant increase of stool frequency and a decrease of stool consistency, while placebo was not effective in improving the bowel habit of the patients. As some patients complained of diarrhoea, and some had no modification of bowel frequency, further studies are needed to determine the most appropriate dose for each patient.

Adult↗

Efficacy of whole bowel irrigation using solutions with or without adsorbent in the removal of paraquat in dogs.

1. The efficacy of whole bowel irrigation with a solution containing either polyethylene glycol (PEG) with electrolyte or an adsorbent (Kayexalate with a cathartic (sorbitol) was investigated in 18 dogs who had been given 250 mg kg-1 paraquat dichloride via a jejunal tube to eliminate the influence of gastric absorption. 2. Plasma paraquat concentrations 2 and 3 h after the initiation of bowel irrigation and at the end of the study (5 h later) were significantly lower in the bowel irrigation groups than in the control (no bowel irrigation) group. 3. The total body clearances of paraquat in the bowel irrigation groups were significantly greater than in the control group. 4. There were no significant differences between the two different irrigation solution groups in plasma paraquat concentration, the area under the plasma concentration time curve and the total body clearance. 5. In the PEG with electrolyte group, about 70% of the administered dose of paraquat was removed by means of bowel irrigation (n = 4). 6. The adjunction of the adsorbent had no beneficial effects. 7. Haemodynamic changes associated with whole bowel irrigation were unremarkable except that right atrial and pulmonary arterial pressures were elevated in the latter part of the study.

Animals↗

Elevated amylase is related to the development of respiratory failure in organophosphate poisoning.

1. A retrospective study of organophosphate (OP) poisoning in the intensive care unit was performed to analyze the incidence of respiratory failure. 2. The patients were treated initially with gastrointestinal decontamination including gastric lavage and the administration of activated charcoal with cathartic. Further management included intravenous pralidoxim and atropine and ventilatory support. 3. Of the 32 OP poisoning patients, 16 patients developed respiratory failure and received ventilatory support. 4. An increase in plasma amylase above the normal range on the day of admission was related to the development of respiratory failure. 5. In OP poisoning, the elevation of amylase level was predictive of the subsequent respiratory failure.

Adult↗

Reflective practice: nursing ethics through story telling.

Reflection is a method of learning and teaching professional maturity through the critical analysis of experience. An illuminative research approach was used over a period of five years in collaboration with students on a palliative care course to investigate the effects of learning moral and ethical reasoning by reliving clinical experiences through story telling. This study concludes that: self-concept is enhanced; communication skills are increased; and insight development is part of learning to reason fairly and ethically, and is achieved through a cathartic process, leading to the conceptualization and discovery of theories of nursing through reflective practice.

Communication↗