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PubMed1984

Laughter.

Knowledge of laughter, other than of its clinical manifestations, is tenuous. A unique, ubiquitous human phenomenon, laughter has largely been neglected by medical investigators and relegated to philosophers and naturalists, particularly Darwin. Clinical manifestations are well described, but the many physiological changes accompanying laughter are not. Neurological pathways remain speculative, and those described are based on pathological evidence. Laughter, as a behavior, has many causes, including humor, incongruity, relief, and a sense of well-being. Laughter may have developed for its cathartic effects and adaptive value. As an evolutionary device, laughter may have served to thwart aggression, spread information, and preserve social unity. Laughter's potential for a variety of clinical uses awaits future investigation.

Adolescent↗
PubMed1984

Surgical treatment of constipation.

A 30-year retrospective review of 544,354 Seattle area hospital admissions yielded 25 patients who underwent surgical therapy for the relief of intractable idiopathic constipation. All patients were refractory to conventional medical treatment consisting of the daily use of laxatives, cathartics, emollients or enemas. Long-term follow-up was available for 13 of the 25 patients. All 13 patients had clinical improvement as a result of the operation. This confirms results reported by other authors. Subtotal colectomy and left hemicolectomy are the procedures generally favored.

Adult↗
PubMed1984

Randomized study of the treatment of phenobarbital overdose with repeated doses of activated charcoal.

We performed a prospective randomized study of the effectiveness of repeated oral doses of activated charcoal in the treatment of phenobarbital overdose. Ten comatose patients who required intubation and mechanical ventilation completed the protocol. Five patients received repeated doses of activated charcoal and sorbitol. Five other patients who received a single dose of charcoal and cathartic served as control subjects. The serum half-life of phenobarbital (mean +/- SD, 36 +/- 13 hours) during repeated administration of charcoal and sorbitol was significantly shorter than that after charcoal administration was discontinued (93 +/- 7 hours) and shorter than the half-life in the single-dose group (93 +/- 52 hours). The length of time that patients in each group required mechanical ventilation, 39 +/- 24 hours (single-dose group) and 48 +/- 8 hours (repeated-dose group), did not differ significantly, nor did the time spent in the hospital. Although administration of repeated doses of activated charcoal to patients with phenobarbital overdose significantly increased the elimination of phenobarbital, it had no clear effects on the patients' clinical course.

Administration, Oral↗
PubMedDate not supplied

Managing acute toxicity from nonprescription stimulants.

The symptomatology and management of toxicity caused by nonprescription stimulants is reviewed. Nonprescription stimulants contain (singly or in combination) the same basic active ingredients: caffeine 100-200 mg, phenylpropanolamine 25-50 mg, and ephedrine 25 mg. Generally, toxic reactions involve excessive CNS stimulation (e.g., increased motor activity, anxiety, and agitation) and mildly elevated pulse rate and blood pressure that resolve in six to eight hours without specific treatment. However, reactions following the ingestion of these stimulants have included severe hypertension, possible renal failure, cerebral hemorrhage, and cardiac arrhythmias. Neither ephedrine nor caffeine ingested as single entities have been reported to produce increases in blood pressure associated with end-organ damage; however, severe hypertension has followed therapeutic doses of phenylpropanolamine. General management in the overdosed patient involves establishing respiration, initiating emesis, administering activated charcoal and a cathartic, and monitoring the patient's blood pressure, ECG, fluid intake, and urinary output. The increased availability of tablets and capsules containing substantial quantities of phenylpropanolamine, caffeine, and ephedrine creates a potential for drug-induced morbidity and mortality.

Adolescent↗
PubMed1983

Hypernatremia and lactulose therapy.

Lactulose is used in the treatment of portal-systemic encephalopathy. Although it is usually safe, a case of hypernatremia has been reported. To evaluate further the association of lactulose therapy and hypernatremia, records of patients with hepatic failure treated with lactulose for encephalopathy were analyzed. In 20 of 75 courses of lactulose treatment, serum sodium level exceeded 145 mEq/L. Mortality was 41% in patients in whom hypernatremia developed as compared with 14% in those who remained normonatremic. In persons who died, hypernatremia persisted; in patients who eventually recovered, the serum sodium level returned to normal. The precise mechanism of hypernatremia in these cases is not clearly defined. As an osmotic cathartic, however, lactulose may cause fecal water loss in excess of sodium, resulting in contraction of extracellular fluid volume and, therefore, hypernatremia.

Creatinine↗
PubMed1981

24-hour systemic antibiotic prophylaxis in large-bowel surgery.

In a prospective randomized double-blind trial the effect of a short prophylactic course of a systemically administered antibiotic combination was studied in a series of 53 consecutive patients undergoing elective colorectal surgery. Bowel preparation was performed conventionally with cathartics and saline enemas or with an elementary diet. Patients of both preparation groups were randomly divided into a treatment group and a control group. Treated patients received 3 doses of kanamycin 500 mg plus clindamycin 600 mg intramuscularly. Four patients were withdrawn from the study for various reasons, leaving 49 patients for analysis. Wound infections were regarded as slight (grade I) or clinically important (grade II). The frequency of all wound infections (grade I + grade II) was 8% in the treatment group (25 patients) versus 66.7% in the control group (24 patients). The frequency of the grade II wound infections alone was 4.0% versus 54.7%. The difference was significant in both cases (p less than 0.0005).

Adult↗
PubMed1978

Constipation.

Constipation pervades our society. It is associated with emotional stress, lack of dietary fiber, and ignorance. Laxative stimulants, bulk forming agents, stool softeners, and osmotic cathartics may all be needed to treat endstage constipation initially, but "weaning" should be possible in most cases. Endstage constipation, in rare cases, can be life threatening due to urinary tract or colonic obstruction or perforation.

Constipation↗
PubMed1982

Appendicitis.

The mortality from acute appendicitis has been reduced, but the sharp difference in the morbidity and complications associated with perforation demands a policy that will minimize the possibility of delay in operation or failure to diagnose acute appendicitis. The decrease in mortality is largely due to the quality of care within the hospital, and possibly to the less frequent use of cathartics, but not to a decreased incidence of perforation. The suggestion is made that the failure to decrease the incidence of perforation of the appendix may be related to the nature of pediatric practice.

Acute Disease↗
PubMed1981

The effect of a formula diet on preparation of the colon for barium enema examination. Impact on health care and costs.

A preliminary study of unselected ambulatory patients having barium enema examinations showed that 31.5% were optimally prepared for evaluation of polypoid mucosal lesions, but 29% had fecal material in the colon that could have obscured the lesions during examination. Although 38 of 42 patients took prescribed cathartics, 84% did not maintain a low-residue diet, as prescribed at this institution. Subsequently, 98 age-matched patients revealed detailed low-residue diet instructions or a formula diet before barium enema examination. Formula preparation resulted in 51% optimal and only 9.5% unacceptable studies compared with 25% optimal and 34% unacceptable examinations in the control group. Caloric intake averaged 700 kcal/day during low-residue diet preparation and was increased almost twofold with formula preparation; improvement was particularly noticeable in the elderly (556 vs 1,286 kcal/day). Prepackaged low-residue defined diets seem acceptable to patients when substituted for a low-residue diet. Bowel cleanliness is greatly enhanced before the barium enema examination, thus improving health care and reducing radiation exposure and costs.

Adult↗
PubMed1981

[Extraction of fecal lipids and identification of hydroxystearic acid by gas chromatography-mass spectrometry (GC/MS)].

Fatty acids and hydroxy fatty acids in the intestine are of interest because of their cathartic properties. We describe a method for extraction of lipids from freeze dried homogenized stools and identification of the hydroxy stearic acid in the fecal lipids pattern by GC-MS. Recovery of 90-95 % shows the efficacy of extraction . Quantitative data of fecal hydroxy stearic acid excretion in some normal and chronic diarrhea affected children are reported.

Child↗
PubMedDate not supplied

[Curing power, or the restoring myth (author's transl)].

Nowadays, occidental or traditional healers are gaining more attention. The author aimed at demonstrate that the healer can be classified between the physician and the soothsayer. Six manners of healing are described through examples: -- operating allurement (Quesalid); -- trip in the unconscious to subdue its forces (the Chaman); -- domination of Powers under hallucinogen substance(s) (Peytol); -- symbolic efficacity of words (Mûu); -- cathartic confession and trance through reintegration into a mythic structure. In every historical technique, a personage is found whose "doing" and "saying" express an exceptional experience, constituting a magical and therapeutic area, facilitating the inscription in a mythical structure, which provides a sense. Several kinds of healers are shortly described, as well as their personality and their patients. The border lines of their power are contiguous to the Sacred and the Religious (which mythical fragments are many "power-allurements") as well as articulated with credulity and belief, and finally built on the pattern of magical thoughts and acts. Healer and/or quack? Healer and/or physician? What are the analogies or differences according to the pattern of the relation "physician-patient"? It is not a "restoring-myth", universal, whose actuality is spotted every time for each act of healing (by a healer)? -- even if this myth is not clearly definite or legible. The power of the healer articulates itself on the pregnancy of this myth which guides the sufferer towards this personage whose power is nothing else but the power the sufferer hopes the healer possesses. It is this hope which the "restoring-myth" contains.

Africa↗
PubMed1980

The sociocultural dynamics of mass hysteria: a case study of social conflict in West Malaysia.

This discussion of an episode of mass hysteria in a Malay college in West Malaysia examines stress and conflict in relation to the interpretive process within a specific social setting. Unlike previous studies, which conceptualize mass hysteria as a cathartic response to accumulated stress, the present study treats stress as a matter of definition in a specific sociocultural context rather than as an objective given from which predictions can be made. Objections are raised to the logic of explanations that attribute mass hysteria to environmental stress. What is of concern is how meanings are assigned to events that are experienced as stressful, how participants and observers explain these events, and the consequences that follow from their interpretations.

Conflict, Psychological↗
PubMed1980

[Breaking the drinking habits of alcoholics with hypnosis. Psychological and technical dynamisms].

Hypnosis therapy, with its ego support and strengthening techniques, with its cathartic or hypoanalytic method (automatic writing, drawing, hypnodrama but, above all, age regression), by means of will strengthening technique, post-hypnotic comands, etc., represents an all-round system whose aims are not simply to reach a speedy analysis of the patient's inner recesses, but to decondition by negative stimuli and recondition by positive stimuli. Hypnotherapy is based essentially on the dynamism of visualisation. The role of perception as a moment of input or penetration of the pathogenic idea in different growth stages, is the same that is exploited when, in that moment of enhanced receptivity which is hypnosis, in that moment of "burning boats with respect to the subjective perception of reality", haemotigenous visualisations are inculcated which remain dynamically active and operative after long-standing distorted perceptions have been destructured.

Alcoholism↗
PubMed1980

[Paraquat poisoning; clinical toxicological aspects and a case description].

The clinical course of a young woman following the ingestion of the herbicide Paraquat in a suicide attempts is reported. Clinical signs of intoxication consisted at first in alterations of hepatic and renal functions, and later in progressive pulmonary failure. The patient died in severe respiratory distress on the 8th day due to cardiac arrest, probably anoxic. Treatment was initially on standard lines, with cathartics with the aim to prevent the absorption of Paraquat in the plasma and its accumulation in the lungs. In addition, high doses of steroids, immunosuppressive agents, prophylactic antibiotics and cardiotonics were given. Peritoneal dialysis and haemodialysis were concomitantly assured. The Authors suggest that in Paraquat poisoning an adequate therapeutic treatment could consist in specific sorbents such as Fuller's earth and bentonite, haemoperfusion over a coated charcoal system or cation exchange resins. Administration of drugs such as corticosteroids, immunosuppressants (bleomycine) and the enzyme superoxide dismutase may be also indicated. On the contrary, oxygen therapy should be carefully monitored: in fact hyperoxic atmospheres, by increasing the rate of generation of superoxide radicals, enhance cellular toxicity of Paraquat.

Adolescent↗
PubMed1981

Operations on the colon without preoperative oral antibiotic therapy.

The ideal preparation of the intestine prior to elective colonic resection has been a controversial subject. With the development of new and more effective antibiotics, many modalities of intestinal preparation preoperatively have been used in an effort to reduce the number of infectious complications. Mechanical cleansing of the intestine, when accompanied by perioperative parenteral antibiotics, is adequate preparation prior to resection of the intestine. One hundred consecutive operations upon the colon by one surgeon were the subject of this retrospective study. Approximately 70 per cent of the operations were for carcinoma and the remainder for inflammatory disease. Preparation consisted of the administration of cathartics and saline solution enemas combined with a liquid diet for 48 hours prior to operation. Perioperative parenteral antibiotic therapy was given for 48 to 72 hours or as long as intravenous fluids were administered. All anastomoses were the open, two layer type, using nonabsorbable suture material. All abdominal incisions were closed primarily. There were no operative deaths, anastomotic leaks, intra-abdominal abscesses or fistulas. There were six instances of wound infection. Our results with this type of management compare favorably with those of other surgeons using various modes of preoperative oral antibiotic therapy and suggest that oral preoperative antibiotic therapy may not be necessary in elective operations on the colon.

Administration, Oral↗
PubMed1995

Experimental oral inoculations in birds to evaluate potential definitive hosts of Neospora caninum.

Experimental oral inoculations to evaluate potential definitive hosts of Neospora caninum were conducted by feeding infected rodent tissues to 9 carnivorous birds of 4 species. Birds included 2 red-tailed hawks (Buteo jamaicensis), 2 turkey vultures (Cathartes aura), 2 barn owls (Tyto alba), and 3 American crows (Corvus brachyrhynchus). The rodents (mice or rats) had been inoculated with 100,000 culture-derived tachyzoites of N. caninum 1-6 mo before feeding to the birds. Fecal samples were collected from each bird daily for 1 mo after feeding rodents and examined for oocysts by fecal flotation. In addition, processed aliquots from all avian fecal samples were fed to BALB/c mice. Five weeks after feeding, mice were bled and sera were tested for antibodies against N. caninum. One to two months later, mice were killed and brain tissue was examined microscopically for protozoal cysts. While occasional oocysts were found in avian fecal samples, these were likely not N. caninum because they were not infective to BALB/c mice. It was concluded that the bird species tested are not likely to be definitive hosts of N. caninum.

Animals↗
PubMedDate not supplied

Neuronal intestinal dysplasia: a role for surgery?

Neuronal intestinal dysplasia (NID) is a poorly understood colonic motility disorder with characteristic histopathological findings and clinical presentation. It is often associated with Hirschsprung's disease (HD) and can constitute a cause of failure of clinical improvement after adequate resectional pull-through surgery. Other conditions associated with NID are: Chronic Intestinal Pseudo-obstruction (CIPO), anorectal malformations and Multiple Endocrine Neoplasia (MEN) II syndrome patients. To increase the diagnostic yield of NID the pathologist should be aware and use histochemistry evaluation of the rectal biopsy specimen in patients with history of constipation or unexplained bouts of diarrhea. Adequate sampling of the temporary proximal colostomy done to HD patients should be examined for NID pathological changes. Treatment has centered around the clinical picture with most cases managed medically with prokinetic agents, colonic irrigations, and bowel cathartics until improvement and normalization of histology occur. There is evidence of progressive maturation of the enteric nervous system with time. Surgery is indicated for patients with severe clinical deterioration after failed medical management.

Biopsy↗
PubMed1995

[Family secrets exemplified by heterologous insemination].

Potential consequences of intrafamilial concealment are discussed in the context of coping with the stigmatizing diagnosis of male infertility and its treatment by artificial insemination by donor. First results of a longitudinal study are presented. A 5-year follow-up was obtained from 40 out of 57 couples initially interviewed. 34 of the couples had kept donor insemination secret even towards their families. 10 of them considered themselves oppressed by the secrecy, especially at the time of insemination. Only two out of 26 successful couples intended to reveal details of conception to the child. These findings suggest that information of the children can follow different strategies. Children should be acquainted with details of their conception if friends or relatives of the parents are informed, in order to reduce the risk of the traumatic event of information by others. In all other cases the decision to inform children or not is to be left in the hands of the parents. Even though maximum candidness is considered desirable today, the "cathartic" revelation of family secrets can be as destructive as their conservation.

Adaptation, Psychological↗