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Natural transmission routes of Neospora caninum between farm dogs and cattle.

Twelve dairy herds with evidence of post-natal infection with Neospora caninum were compared with 21 control herds with no evidence of post-natal infection. On the former farms, dogs consumed placenta or licked uterine discharge in 75 and 67% of the farms, respectively, while on control farms these activities occurred in 38 and 24% of the farms, respectively. On all control farms and all but three post-natally infected farms the dogs were fed colostrum or milk. Defecation of dogs on the feeding alley was observed in 92% of the post-natally infected farms and in 24% of the control farms. The same trend was observed for defecation of dogs in grass silage, in 75% of the post-natally infected farms and in 19% of the control farms; and in corn silage, in 50% of the post-natally infected farms and in 10% of the control farms. Consumption of placenta, material of aborted foetuses or uterine discharge in combination with defecation on the feeding alley, storage of grass or corn silage was observed in 19% of the control farms and in 75% of the post-natally infected farms. This study supports the hypothesis that farm dogs may become infected by foetal fluids or placental material of infected cattle, and may subsequently cause a post-natal infection of cattle in the herd by shedding oocysts.

Animal Feed↗

Rectal prolapse, rectal intussusception, rectocele, and solitary rectal ulcer syndrome.

Rectal prolapse can be diagnosed easily by having the patient strain as if to defecate. A laparoscopic rectopexy should be recommended. Intussusception is more an epiphenomenon than a cause of defecatory disorder and should be managed conservatively. Solitary rectal ulcer syndrome is a consequence of chronic straining, and therapy should include restoring a normal defecation habit. Rectocele should be left alone; an operation may be considered if it is larger than 3 cm and is causing profound symptoms despite maximizing medical therapy for the associated defecation disorder.

Female↗

Longterm outcomes and quality of life after Z-shaped anastomosis for Hirschsprung's disease.

BACKGROUND: Z-shaped anastomosis is one of the modifications of Duhamel's procedure that was designed to eliminate the blind rectal pouch and to achieve complete resection of the colorectal septum. It has been the most widely performed operation in Japan for many years. The longterm postoperative function of evacuation and quality of life of the patients are considered important to evaluate this procedure. METHODS: At Kyushu University Hospital, from 1963 to 1997, 127 patients with Hirschsprung's disease underwent Z-shaped anastomosis. As a result, 122 out of 127 patients (96%) survived. The present status and symptoms, and anorectal functions, including a manometric study and barium enema, were evaluated during the clinical followup. RESULTS: A total of 99 of the 122 surviving patients (81%) were available for this study, and the mean postoperative period was 16 years. Evacuation scores in all patients were as follows; excellent, 62.2%; good, 28.6%; fair, 8.2%; and poor, 1.0%. The percentage of the patients who showed severe symptoms was 4.1% for diarrhea, 3.1% for constipation, 5.1% for incontinence, and 7.1% for soiling. The evacuation score improved chronologically and tended to reach a plateau at 10 to 15 years after operation, at which time 73% of the patients showed excellent outcomes and 95% were satisfactory (good or excellent). The appearance of a sense of defecation and an increase in the pressure difference between the anal canal and the rectum substantially contributed to the improvement in the defecation score. The appearance of the rectosphincteric reflex, including the atypical one, was seen in 40.5% of patients, but the appearance of a reflex did not seem to be related to the clinical status of defecation. Twenty-two of 30 patients older than 20 years were married, and 8 patients had children. CONCLUSIONS: The evacuation scores of in-patients undergoing Z-shaped anastomosis improved with age and were satisfactory (good or excellent) in most patients at least 10 years after operation. Most of the patients adapted to a normal social life.

Adolescent↗

Ontogeny and interdependence of genetically selected behaviors in rats: avoidance response and open field.

Ontogeny and interdependence of genetically selected avoidance and open-field behaviors were investigated in six genetic lines, involving 1,018 animals, and three developmental models (longitudinal, cross sectional, and generational). In selected lines, behaviors varied with age, depending upon the genetic selection; in the control (random bred) line, no such effects were found. Between the lines selected for high (RHA) and low (RLA) rates of two-way-active avoidance, ontogenetic differences in the selected behavior emerged as the animals grew older, whereas between the lines selected for high (MR) and low (MNR) frequency of open-field defecation, the differences in the selected behavior were present at all stages of development. In unconditioned escape response to footshock, which shows an inverse relation to avoidance response in the RHA and RLA lines, and in general activity (number of sections crossed in an open field), which shows inverse relation to defecation in the MNR and MR lines, the differences were present at all stages. The relation between avoidance response and open-field defecation (emotional reactivity) was not linear but suggestive of curvilinear inverted-U-function.

Aging↗

Strain differences among chickens in tonic immobility: evidence for an emotionality component.

Substantial strain differences in tonic immobility were found between different breeds of chickens. Crossbreeding between strains showing different immobility durations yielded hybrids that exhibited intermediate reactions. For purpose of relating the strain differences in tonic immobility to more conventional measures of emotionality, data were collected on open-field activity, defecation, and adrenal weight. Overall, the results implicated strain-specific differences in emotionality as being the basis for the observed differences in immobility. Latency to defecate in an open field, however, was highly correlated with latency to ambulate. It was argued that defecation, rather than being an absolute measure of fear or emotionality, may in fact be an intermediate response to gradual fear reduction.

Adrenal Glands↗

Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury.

Amongst complications arising from spinal cord injury (SCI), chronic gastrointestinal (G-I) problems and bowel dysfunction have not received as much research attention as many other medical and rehabilitation problems, even although their incidence is not negligible. We therefore investigated chronic G-I problems and bowel dysfunction in SCI patients where the degree of these was such that activities of daily living (ADL) were significantly affected and/or long-term medical management was required. Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. The history of SCI was longer than 6 months, bowel habits had settled, and neurological recovery was completed. The incidence of chronic G-I problems was very high (62.5%), most were associated with defecation difficulties such as severe constipation, difficult with evacuation, pain associated with defecation, or urgency with incontinence. These problems had an extensive impact on ADL, and in particular, restricted diet (80%), restricted outdoor ambulation (64%) and caused unhappiness with bowel care (62%). Bowel care was performed once per 2.85 +/- 1.96 days and occupied an average of 42.1 +/- 28.7 min. To improve bowel habits, 43% of the patients took oral medication, and 36.1% controlled their diet. The usual methods of bowel care were anal massage (34.7%), unaided self-defecation with or without oral medication and abdominal massage (29.2%), finger enema (18.1%), rectal suppository (15.2%) and in two patients a colostomy tube had been inserted because of rectal cancer and traumatic colorectal injury. These chronic G-I symptoms were vague and very subjective, but significant enough to affect the quality of life. Bowel dysfunction was not related to age, duration of, or the neurological level of injury, ASIA score of ADL level, and bowel habits had generally settled within 6 months of SCI. With regard to frequency, time, and method of defection, bowel care habits varied considerably amongst individuals, and in relation to the extent to which practical results matched the level of expectation generated by physicians' recommended care program. Individual satisfaction was also very subjective. We therefore suggest that during the early stage of rehabilitation, an appropriate bowel program should be properly designed and adequate training provided.

Activities of Daily Living↗

Neurogenic bowel dysfunction score.

STUDY DESIGN: Cross-sectional questionnaire study. OBJECTIVES: To develop and validate a symptom-based score for neurogenic bowel dysfunction (NBD): NBD score. SETTING: University Hospital of Aarhus, Denmark. METHODS: A questionnaire including questions about background parameters (n=8), faecal incontinence (n=10), constipation (n=10), obstructed defecation (n=8), and impact on quality of life (QOL) (n=3) was sent to 589 Danish spinal cord injured (SCI) patients. The reproducibility and validity of each item was tested in 20 and 18 patients, respectively. Associations between items and impact on QOL were determined by logistic regression analysis. The NBD score was constructed from items with acceptable reproducibility and validity that were significantly associated with impact on QOL. Based on odds ratios for associations between items and impact on QOL, each item was given a corresponding number of points in the NBD score. RESULTS: A total of 424 SCI patients responded. The following 10 items met the criteria above: frequency of bowel movements (0-6 points), headache, perspiration or discomfort before or during defecation (0-2 points), tablets and drops against constipation (0-2 points each), time used for each defecation (0-7 points), frequency of digital stimulation or evacuation (0-6 points), frequency of faecal incontinence (0-13 points), medication against faecal incontinence (0-4 points), flatus incontinence (0-2 points) and perianal skin problems (0-3 points). Differences in NBD score among patients reporting no, little, some or major impact on QOL were statistically significant (all P<0.001). CONCLUSION: Based on valid and reproducible questions, we have constructed a score for NBD that is correlated to impact on QOL.

Adolescent↗

Lack of effficacy of botulinum toxin in chronic anal fissure.

BACKGROUND AND AIM: Hypertonicity of internal anal sphincter plays a major role in the persistence of chronic anal fissure. Botulinum toxin could induce internal anal sphincter relaxation without the adverse effects of surgery (long-term faecal incontinence) or topical nitrates (anal burning, headaches, hypotension). METHODS: We conducted a placebo-controlled, randomised, double-blind study to assess the efficacy of a single injection of botulinum toxin in the internal anal sphincter of patients with chronic anal fissure in six ambulatory care clinics. Eligibility criteria included a mean value of post-defecation anal pain >or= 30 mm on a 100 mm visual analogue scale over the week preceding inclusion. Main endpoint was the proportion of patients with symptomatic improvement during the fourth week after inclusion (post-defecation anal pain below 10 mm). RESULTS: Forty-four patients (22 in each group) were included. At inclusion, there was no significant difference between groups on age, sex ratio, pain duration, post-defecation anal pain, analgesic consumption and stool frequency. Ten (45%) and 11 (50%) patients reported symptomatic improvement on the main endpoint (P=0.76) in placebo and botulinum toxin groups, respectively. Ten patients (five in each group) had healed fissure at week 4 and ten patients (five in each group) required surgical treatment between weeks 4 and 12. Similarly, there was no significant difference between groups on other variables between weeks 4 and 12. CONCLUSIONS: The efficacy of a single injection of botulinum toxin in the internal anal sphincter does not differ from that of a placebo in patients with chronic anal fissure.

Adolescent↗

[MR defecography at 1.5 Tesla with radial real-time imaging and reduced image field].

PURPOSE: To evaluate a new technique for MR defecography with real-time imaging using radial k-space profiles. MATERIALS AND METHODS: A catheter-mounted condom was inserted into the rectum of 16 patients and filled in situ by a mixture of Nestargel and Gadolinium. After multiplanar imaging of the pelvis by high resolution T2-weighted turbo-spin echo sequences, defecation was imaged by a gradient echo sequence with radial k-space filling using a reduced field of view (rFOV) in real-time. The documentation was performed on an S-VHS recorder. RESULTS: At a constant background signal, radial k-space filling yields a real-time impression. An interactive software allowed the operator to modify the slice thickness, slice plane, flip angle and slice angulation during scanning, resulting in an optimum imaging quality of the defecation. CONCLUSIONS: This new imaging technique allows real-time MR defecography in a high-field scanner and provides all anatomical und functional information of the defecation.

Adult↗

Prevalence of gastrointestinal symptoms in young and middle-aged diabetic patients.

BACKGROUND: Gastrointestinal disorders have been reported in patients with diabetes mellitus. The present investigation was carried out to evaluate the frequency of gastrointestinal symptoms in out-clinic diabetic patients in the county of Umeå, Sweden. METHODS: Diabetic patients aged 24-59 years residing in Umeå County (population, 136,000) were included in the study (n = 489), as were 200 sex- and age-matched healthy controls. A questionnaire was mailed to the patients and controls, and a reminder was sent 5 months later. The questionnaire contained 28 questions concerning gastrointestinal symptoms, bowel habits, and medication during the preceding year. RESULTS: Fifty-nine per cent of the patients and 53% of the controls responded. The total number of reported gastrointestinal symptoms was significantly greater in patients (1.25 +/- 0.10; mean +/- standard deviation) than in control subjects (0.50 +/- 0.08). This increase was seen in both type-1 (1.12 +/- 0.11) and type-2 (1.52 +/- 0.25) diabetic patients. Female diabetic patients reported significantly more symptoms than did male patients (1.59 +/- 0.17 and 0.81 +/- 0.12, respectively). Patients with neuropathy had significantly more symptoms than the other patients. Symptom frequency was not correlated with nephropathy or retinopathy or with the duration of diabetes, body mass index, glycosylated haemoglobin, or insulin dose. Heartburn, constipation, and nocturnal urge to defecate were significantly more frequent in patients than in controls. Furthermore, a feeling of incomplete defecation, a need to strain at defecation, and urgency were significantly more common in patients. CONCLUSION: Diabetic patients had more gastrointestinal symptoms than non-diabetic population. These symptoms did not correlate with duration of the disease, metabolic control, or any other complication except neuropathy. Heartburn and constipation were among the symptoms that occurred more frequently in diabetic patients than in the non-diabetic population.

Adult↗

Long-term symptoms after external beam radiation therapy for prostate cancer with three or four fields.

The aim of this study was to investigate whether external beam radiation treatment with three or four fields affects the risk of long-term distressful symptoms. The study included 145 patients who had been treated in Stockholm from 1993 to 1996 for localized prostate cancer. Bowel, urinary and sexual function as well as symptom-induced distress were assessed by means of a postal questionnaire 29-59 months after therapy. Among patients treated with a multileaf collimator, defecation urgency, diarrhoea and loose stools were more common after four fields than after three fields, but faecal leakage necessitating the use of pads and distress from the gastrointestinal tract were less common (although not statistically significantly so). Among bowel symptoms, the strongest association with gastrointestinal distress was found for faecal leakage. Three fields without a multileaf collimator entailed a higher risk of defecation urgency than three fields with a multileaf collimator. We conclude that the choice of three or four fields may imply a contrasting risk scenario for defecation urgency or diarrhoea in comparison with faecal leakage.

Adenocarcinoma↗

Constipation: a different entity for patients and doctors.

BACKGROUND: Medical definitions of constipation vary. Some are specific, based on the interval between defecations, with three days or twice weekly as the upper limit of normality. Others are vague. OBJECTIVE: This study investigates patients definitions, attitudes and management of 'constipation' and compares their definitions with physicians' criteria. METHODS: Survey of 1) 531 randomized patients of family clinics of the sick Fund of the General Federation of Labor of Israel, and 2) 100 randomized specialists and residents in family medicine. RESULTS: The present survey showed that constipation is more common in women and in the older (> 40 years) age group. The most important finding of this investigation was the wide discrepancy in the criteria used by doctors and patients to diagnose constipation. Fifty per cent of the patients defined constipation differently from accepted medical definitions--27% of the patients defined it as defecation every 2 days or less and 25% as hard stool alone. All 57 doctors who were asked the same question defined constipation as defecation every 3 or 4 days or less, sometimes in combination with hard stool. CONCLUSIONS: This study suggests that patients and doctors refer to different entities when they talk of 'constipation'. It is the doctor's responsibility to ensure that this misunderstanding is avoided so that unnecessary tests and treatment are not undertaken and, patient-doctor acrimony is avoided.

Adult↗

Mutations in the clk-1 gene of Caenorhabditis elegans affect developmental and behavioral timing.

We have identified three allelic, maternal-effect mutations that affect developmental and behavioral timing in Caenorhabditis elegans. They result in a mean lengthening of embryonic and postembryonic development, the cell cycle period and life span, as well as the periods of the defecation, swimming and pumping cycles. These mutants also display a number of additional phenotypes related to timing. For example, the variability in the length of embryonic development is several times larger in the mutants than in the wild type, resulting in the occasional production of mutant embryos developing more rapidly than the most rapidly developing wild-type embryos. In addition, the duration of embryonic development of the mutants, but not of the wild type, depends on the temperature at which their parents were raised. Finally, individual variations in the severity of distinct mutant phenotypes are correlated in a counterintuitive way. For example, the animals with the shortest embryonic development have the longest defecation cycle and those with the longest embryonic development have the shortest defecation cycle. Most of the features affected by these mutations are believed to be controlled by biological clocks, and we therefore call the gene defined by these mutations clk-1, for "abnormal function of biological clocks."

Alleles↗

Pyriproxyfen effects on newly engorged larvae and nymphs of the lone star tick (Acari:Ixodidae).

Newly engorged larvae and nymphs of the lone star tick, Amblyomma americanum (L.), were exposed to 9 treatments of pyriproxyfen in glass vials consisting of dosages of 4, 8, and 16 micrograms/cm2 for 7 d, 14 d, and continuous exposure periods at each concentration. Treatment of newly engorged larvae resulted in decreased molting, altered postmolt defecation, and nymphal survival with results being dose and exposure dependent. Molting inhibition ranged from 35.9 to 68.4%. Successfully molted nymphs were lethargic, exhibited altered defecation patterns, and were short-lived compared with untreated adults. By 65 d after treatment, cumulative inhibition of molting and hastened mortality of molted adults resulted in 82.6-100% control, depending on dosage and exposure. Treatment of newly engorged nymphs showed minimal to no effect on molting; however, adults were lethargic and displayed altered postmolt defecation patterns. Subsequent adult longevity was most dramatically affected with 87.9-100% control achieved by 82-84 d after treatment. Fecal patterns and survivorship were dose and exposure dependent. Estimates of subsequent feeding success of adults treated as engorged nymphs, show reduced capacities of attachment, engorgement and reproduction.

Animals↗

Empirically supported treatments in pediatric psychology: constipation and encopresis.

OBJECTIVE: To review the empirical research examining behavioral and medical treatments for constipation and fecal incontinence. METHOD: Sixty-five articles investigating intervention efficacy were identified and reviewed. Twenty-three of the studies were excluded because they were case studies or were less well-controlled single-case designs. The intervention protocol for each study was identified and coded, with studies employing the same interventions matched and evaluated according to the Chambless criteria. RESULTS: From the literature base to date, no well-established interventions have emerged. However, four probably efficacious treatments and three promising interventions were identified. Two different medical interventions plus positive reinforcement fit the criteria for the probably efficacious category (one with fiber recommendation and one without). Three biofeedback plus medical interventions fit efficacy category criteria: one probably efficacious for constipation with abnormal defecation dynamics (full medical intervention plus biofeedback for paradoxical contraction), and two fit the promising intervention criteria for constipation and abnormal defecation dynamics (full medical intervention plus biofeedback for EAS strengthening, correction of paradoxical contraction and home practice; and biofeedback focused on correction of paradoxical contraction, medical intervention without fiber recommendation, and positive reinforcement). Two extensive behavioral interventions plus medical intervention also met efficacy criteria for constipation plus incontinence (medical intervention without laxative maintenance plus positive reinforcement, dietary education, goal setting, and skills building presented in a small-group format fits criteria for a promising intervention; and positive reinforcement and skills building focused on relaxation of the EAS during defecation, but without biofeedback, plus medical intervention meets the probably efficacious criteria). CONCLUSIONS: A discussion of the current weaknesses in this research area follows. Specific recommendations for future research are made including greater clarity in treatment protocol and sample descriptions, reporting cure rates rather than success rates, utilization of adherence checks, and investigation of potential differential outcomes for subgroups of children with constipation and incontinence.

Behavior Therapy↗

Endemicity of toxoplasmosis in Costa Rica.

Toxoplasma infection can be transmitted to humans by ingestion of tissue cysts in meat or by ingestion of oocysts in cat feces or fecally contaminated soil. since meat is traditionally well cooked in Costa Rica and the authors were able to exclude meat and eggs from playing a role in transmission, they postulated that ingestions of oocysts should entirely explain transmission. To test this hypothesis, they studied seven populations in Costa Rica and serologically tested 883 people between 15 and 26 years of age. By interviews and surveys, they determined mode of living, soil contact, cat contact, and cat density. The infection rate in cats was studied by stool and serologic examination, and soil availability for defecation was determined from aerial photographs. Antibody was taken as indicating infection and was found to be acquired most actively in children and young cats. In a retrospective analysis, antibody prevalence in humans correlated highly with individual cat contact (both owned and stray), with cat density, with living in houses with wood floors and a crawl space underneath, and with living with cats on a cement floor. antibody prevalence in humans correlated negatively with soil availability to cats for defecation and with soil contact by humans, suggesting that oocysts may be transmitted optimally near house in areas where most terrain is covered by asphalt and concrete and little soil is available for defecation or for human soil contact. Cats acquire infection by eating intermediate hosts; 16% sparrows, 3.5% of mice and 12.5% of rats have been found infected. Favoring transmission are young non-immune cat populations, shade and moisture, older intermediate hosts, a high percentage of which have become infected, and concentration of houses in city blocks. Transmission is diminished when houses are dispersed or arranged along a road in an open rural setting, permitting dispersal of cat fecal deposits.

Adolescent↗

Anal and neorectal function after ileal pouch-anal anastomosis.

Bowel function varies markedly among patients with colectomy and ileal pouch-anal anastomosis. Little is known of the mechanisms controlling fecal continence and frequency of defecation after operation. The aim of this study was to determine which features of the anal sphincter and neorectum accounted for the variation in clinical outcome. Twenty patients were studied 4 to 35 months after operation and compared to 12 healthy volunteers. Despite several patients exhibiting impaired fecal continence, anal sphincteric length and pressures and ileal pouch capacity and distensibility were similar in patients and controls. Patients with poor results, however, had rapid filling of their ileal pouch, which resulted in early onset of high amplitude propulsive pressure waves in the pouch. As these waves became more frequent, defecation resulted. Patients with poor results also were not able to empty adequately their pouch. The poorer the completeness of evacuation, the more frequent the defecation (r = 0.62, p less than 0.01). The authors conclude that rapid pouch filling and impaired pouch evacuation can lead to increased stool frequency in patients after ileal pouch-anal anastomosis.

Adult↗

Neuropathophysiology of irritable bowel syndrome.

Widespread symptoms associated with the irritable bowel syndrome (IBS) are abnormal defecation and abdominal pain, both of which can be exacerbated by psychogenic stress. Disordered defecation may present as diarrhea or constipation. A subgroup of IBS patients alternate from one to the other over time. Urgency to stool often accompanies the diarrheal-state, and patients with the constipation-predominant form of IBS report straining and the feeling of incomplete evacuation. Basic scientific research aims for improved understanding of the physiology and pathophysiology of the digestive systems from which the arrays of IBS symptoms emerge. The key systems for the defecation-related symptoms are the intestinal secretory glands, the musculature, and the nervous system that controls and integrates their activity. Abdominal pain and discomfort arising from these systems adds the dimension of sensory neurophysiology. This review details current concepts of the underlying pathophysiology in terms of the physiology of intestinal secretion, motility, nervous control, sensing function, immuno-neural communication, and the brain-gut axis.

Abdominal Pain↗