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Lateralized effects of medial prefrontal cortex lesions on neuroendocrine and autonomic stress responses in rats.

The medial prefrontal cortex (mPFC) is highly activated by stress and modulates neuroendocrine and autonomic function. Dopaminergic inputs to mPFC facilitate coping ability and demonstrate considerable hemispheric functional lateralization. The present study investigated the potentially lateralized regulation of stress responses at the level of mPFC output neurons, using ibotenic acid lesions. Neuroendocrine function was assessed by plasma corticosterone increases in response to acute or repeated 20 min restraint stress. The primary index of autonomic activation was gastric ulcer development during a separate cold restraint stress. Restraint-induced defecation was also monitored. Plasma corticosterone levels were markedly lower in response to repeated versus acute restraint stress. In acutely restrained animals, right or bilateral, but not left mPFC lesions, decreased prestress corticosterone levels, whereas in repeatedly restrained rats, the same lesions significantly reduced the peak stress-induced corticosterone response. Stress ulcer development (after a single cold restraint stress) was greatly reduced by either right or bilateral mPFC lesions but was unaffected by left lesions. Restraint-induced defecation was elevated in animals with left mPFC lesions. Finally, a left-biased asymmetry in adrenal gland weights was observed across animals, which was unaffected by mPFC lesions. The results suggest that mPFC output neurons demonstrate an intrinsic right brain specialization in both neuroendocrine and autonomic activation. Such findings may be particularly relevant to clinical depression which is associated with both disturbances in stress regulatory systems and hemispheric imbalances in prefrontal function.

Adrenal Glands↗

A clinical study on compound da huang (radix et Rhizoma rhei) preparations for improvement of senile persons' memory ability.

By comparison of the effects of the Compound Tong Jiang Oral Liquid with Da Huang added (TJ [symbol: see text]) and Qi Yin Oral Liquid (QY [symbol: see text]) without Da Huang on senile persons' memory ability, it is discovered that the effects of TJ on shortening the interval between defecations and the duration of defecation, and on improving senile persons' memory ability are significantly better than that of QY (P < 0.05). In addition, TJ can also decrease the serum content of lipid peroxidase and increase the superoxide dismutase activity in red blood cells (RBC). Thus, it is demonstrated that Dahuang and its agents possess the action of anti-senility and can improve mentality.

Aged↗

[Pathophysiology of chronic constipation and new therapy recommendation].

Three causes of constipation are known: Chagas' disease, congenital megacolon (Hirschsprung's disease) and continent obstipation. Those diseases are rare, they can be treated successfully by drugs, surgery or psychotherapy. More common is the idiopathic chronic constipation, observed manly in females. A frequent cause is the laxative abuse for many years. The possible etiologic factors are discussed. Based on the fact, that constipation never occurs in patients with a colostomy, reasons for the development of chronic idiopathic constipation are presumed in a disturbance in the distal colon and the anorectum. A possible explanation for the malfunction of defecation could be a different calibre between the usually tight pelvic colon and the wide rectum. In contrast to the apolar structure of the large bowel, the rectum shows a polar fibrous configuration. An additional disorder in the feedback mechanism between continence and defecation could impede the bowel passage. Because of these observations and thoughts, we performed a deep resection of the rectum in 18 patients instead of resecting the dilated and elongated colon. All patients operated that way experienced a major improvement of their bowel function. Postoperatively the bowel movements were regular and normal.

Adult↗

[Sphincter-preserving surgery for lower rectal cancer aimed at improving postoperative bowel function].

Much attention has been focused on sphincter-preserving surgery for patients with lower rectal cancer, leading to renewed interest in the outcome of postoperative bowel function. Some patients who undergo sphincter-preserving surgery experience bowel dysfunction, such as frequent stools, severe constipation, soiling, and incontinence. These symptoms were thought to be correlate with lower resting pressure, lower rectal compliance, sensory disturbance of the anal canal, spasm, and delayed transit in the colon above the anastomosis. To improve postoperative bowel function, reconstruction with the colonic J-pouch has been performed, which results in a satisfactory functional outcome. About 80% of patients with a J-pouch were able to tolerate over 10 minutes after feeling the desire to defecate. An anorectal manometric study showed no abnormal spastic movement of the neorectum and a transit study showed that the J-pouch group was superior to the straight group with respect to the smoothness of movement of radiopaque markers from the cecum to anal ring, although a small number of markers were retained in the colonic J-pouch. Patients who received a colonic J-pouch had fewer defecation problems in daily life. Further study is need to improve postoperative bowel movement in patients who undergo sphincter-preserving surgery.

Anal Canal↗

[Functional outcome after reservoir surgery in ulcerative colitis].

BACKGROUND: The aim of this study was to examine whether the functional result of restorative proctocolectomy for ulcerative colitis deteriorated by postponing follow-up from three to eight years after pouch surgery. MATERIAL AND METHODS: All patients (n = 58) operated for ulcerative colitis from 1984-97, who still had intact reservoir, responded to a questionnaire on defecating pattern, stool leakage, perianal irritation, urinary function, workload, sexual life, social life, and the patient's opinion on outcome. The results for the first 29 patients were compared to last 29 patients operated. Median follow-up was eight for the first 29 patients and three years for the last 29. RESULTS: There were no significant difference in functional outcome and patient opinion after pouch surgery between the first 29 and last 29 patients (n = 58). Respective figures for median 24-hour stool frequency were 7.0 and 6.3, leakage of stool 48% and 38%, ability to defer defecation 86% and 97%, perianal irritation 59% and 48%, use of antidiarrhoeal medication 55% and 52%, and wearing of pad 28% and 38%. Sexual life (n = 57) had improved for 11 (19%) and deteriorated for seven patients (12%). Potency was reduced in five (15%) and ejaculation in four patients (12%), one of whom (3%) had retrograde ejaculation. Three (5%) had received a disability pension and five (9%) had reduced workload. After the pouch operation 48 (91%) felt better and three (6%) felt worse because of frequent bowel emptying (n = 3), perianal eczema (n = 1) and pouch fistula (n = 1). INTERPRETATION: The results do not demonstrate any significant deterioration of functional outcome after pouch surgery for ulcerative colitis by postoperative increase of follow-up from three to eight years.

Adolescent↗

[Subtotal colectomy for the treatment of obstructive left colon cancer. Follow-up results].

AIM: Subtotal colectomy (STC) involves an extended resection of the large bowel over the splenic flexure. In a period of 8 years, a total of 72 subtotal colectomies (STC) were performed for the treatment of large bowel obstructions or symptomatic stenosis caused by cancer of the left colon. A primary ileocolic latero-terminal anastomosis was made in each case. The aim of study was to evaluate the late results of procedure. PATIENTS AND METHODS: In a non-prospective, non-randomized study of 23 of the total of 72 STC cases, authors investigated the postoperative quality of life, the changes in the intestinal bacterial flora, and signs of a nutritional deficiency or of an accelerated bowel transit. METHODS: 1) H2 excretion test, 2) UDCA-PABA and 3) Schilling test for contaminated small bowel syndrome and bowel transit time, studied by means of a 4) barium meal and 5) radiopaque marker passage, and 6) registration of the number of defecations/day. RESULTS: The laboratory findings were in the normal range in each case. The daily number of defecations gradually decreased during the 3 months after the operation (mean 1.9/day). The lack of an ileocoecal valve did not result in bacterial overgrowth in the small bowel and the investigations did not reveal contaminated bowel syndrome. The oro-anal transit time was reduced in only four cases. Three months postoperatively, no patient had a deteriorated quality of life. CONCLUSIONS: STC offers 1) one-stage treatment for colonic obstruction in emergency surgery, 2) tumour removal with sufficient oncological radicality, and 3) primary reconstruction of the digestive tract, with a safe ileocolic anastomosis even in emergency cases. The follow-up study of 23 of the patients proved that loss of 60-80% of the colon did not cause any symptomatic disturbance of the digestive functions. The quality of life after surgery was normal, the slightly increased number (mean 1.9) of daily defecations was acceptable, and bacterial colonization of the small bowel did not occur.

Aged↗

[Effect on gastrointestinal functions of Polygonum paleaceum].

OBJECTIVE: To study the effect on gastrointestinal functions of Polygonum paleaceum Wall. METHODS: Defecation reflex, gastric emptying, motility of the gastroinestinal tract of mice and isolated intestinal smooth muscle of rabbits were used. RESULTS: Polygonum paleaceum Wall could inhibit defecation reflex and depress the motility of the gastrointestinal tract, delay gastric emptying in mice. It also had analgesia action, but didn't affect rabbit intestinal contraction spontaneously or induced by acetylcholine (Ach) in vitro. CONCLUSION: It suggested that Polygonum paleaceum Wall possessed the action on gastrointestinal functions.

Animals↗

[Functional childhood gastrointestinal disorders. III. Constipation and solitary encopresis; diagnostic work-up and therapy].

A detailed medical history in combination with a thorough physical examination, including rectal examination, form the cornerstone in the diagnostic work-up for children with functional defecation disorders. Additional investigations are often not informative and have only minor diagnostic or therapeutic implications. Medical therapy in children with functional constipation and solitary encopresis is primarily based on clinical experience. In both patient groups, the role of education, the use of diary cards and toilet training is important. In some patients behaviour interventions are important. Oral laxatives are the basis of treatment of children with functional constipation, whereas they are contra-indicated in children with solitary encopresis. In both groups, biofeedback training appears to be of little additional benefit. Long-term follow-up of children with functional defecation disorders shows that complaints continue far beyond puberty in many children.

Cathartics↗

Update on the biology of Triatoma dimidiata Latreille (Hemiptera: Reduviidae) under laboratory conditions.

Feeding time, postfeeding defecation delay, and life cycle for each stage of a cohort of recently colonized Mexican Triatoma dimidiata were evaluated, and results were compared to existing published information on this species. Seventy-five nymphs (41.7%) completed a cycle with an average time from N-I to adult of 142 +/- 64 days. The average span in days for each stage was 20.2 for N-I, 17.9 for N-II, 10.1 for N-III, 43.6 for N-IV, and 55.1 for N-V. First-stage nymphs had the highest mean feeding time (25 min) and the longest postfeeding defecation delay (45 min). Differences among biological data from previous studies and the present study confirm the importance of conducting research on the behavior of the indigenous triatomine species from various countries.

Animals↗

Ethnomedical value of Cissampelos pareira extract in experimentally induced diarrhoea.

The antidiarrhoeal activity of the ethanolic extract of Cissampelos pareira (Menispermaceae) roots was assessed on experimental animals. The hydroethanolic extract (25-100 mg dry extract kg(-1) body mass, p.o.) exhibited a dose dependent decrease in the total number of faecal droppings (control 65, reduced to 26-46) and 29.2-60.0% inhibition in castor oil-induced diarrhoea. Further, C. pareira produced a significant (p < 0.01) and dose dependent reduction in intestinal fluids accumulation (26.0-59.0%). The extract showed a greater inhibitory effect on the concentration of Na+ (20.0 and 34.5%) than on the concentration of K+ (6.7 and 9.4%). The extract also reduced dose dependently the gastrointestinal transit from 46.4 and 38.7%, equivalent to 53.6 and 61.3%. However, C. pareira significantly reduced the lipid peroxidation and inhibited the decrease in antioxidant enzyme levels (superoxide dismutase and catalase) on prior administration to castor oil-induced fluid accumulation. The extract of C. pareira had no effect on normal defecation at 25 mg kg(-1) in mice. However, 50 and 100 mg kg(-1) inhibited defecation by 100% in the initial 2 h and the activity was reduced to 40.0 and 73.0%, respectively, in the third hour.

Animals↗

Radiofrequency coagulation versus rubber band ligation in early hemorrhoids: pain versus gain.

OBJECTIVE: Band ligation of internal hemorrhoids is a well-established and accepted office procedure. However, there are several reports focusing on problems associated with this technique, which is perceived by many to be risk-free. This randomized study is aimed to compare radiofrequency coagulation and rubber band ligation of hemorrhoids on the parameters of effectiveness and comfort. MATERIAL AND METHODS: Eighty patients of 2nd degree bleeding piles were randomized prospectively for band ligation (44 patients) or radiofrequency coagulation (36 patients) technique. Parameters measured included postoperative discomfort and pain, time taken to return to work, complications accompanying the procedure and recurrence rate. RESULTS: The post defecation pain was more severe with band ligation (p=0.01) and so was rectal tenesmus (p=0.01). The patients from radiofrequency coagulation group resumed their duties early (2 versus 5 days, p=0.05). Recurrence rate was higher in radiofrequency coagulation group. CONCLUSION: Rubber band ligation is associated with significantly higher post treatment pain and discomfort. As against this, radiofrequency coagulation results in significantly less pain and post defecation discomfort. However, chances of recurrence of bleeding and prolapse of hemorrhoids are comparatively higher using radiofrequency coagulation of hemorrhoids.

Adolescent↗

Pathogenesis of slow transit and pelvic floor dysfunction: from bench to bedside.

The colon and anorectum function together to provide intraluminal mixing, absorption of water, electrolytes, and short chain fatty acids, dehydration of fecal material, storage, and ultimately, elimination in a socially appropriate manner. Normal function and continence require accommodation of the colon and rectum to the entry of fecal materials, which includes receptive relaxation, perception, and discrimination of rectal contents, and voluntary and reflex motor function of the anorectum. Defecation, on the other hand, requires the reflex relaxation of the internal anal sphincter, voluntary and reflexive relaxation of the external anal sphincters and pelvic floor structures, and adequate rectosigmoid tone to allow funneling of contents through the anal canal. The sensation of urgency with rectal filling, and the motivation and prior learning of the appropriate responses are also required. Continence and defecation, therefore, involve complex sensory, structural, and motor mechanisms that involve both the colon and pelvic floor. These mechanisms and their relative importance to the pathogenesis of slow-transit constipation and pelvic floor dysfunction will be reviewed.

Chronic Disease↗

[Bowel control of anus-preserving operation for low rectal cancer in elderly patients over 75 years].

OBJECTIVE: To evaluate the bowel control of the anus-preserving operation for elderly patients over 75 years with low rectal cancer. METHODS: Thirty-nine elderly patients over 75 years with low rectal carcinoma (4-7 cm from anal verge) were treated during the study period. The patients were divided into different groups according to the surgical procedures and anastomotic locations. The bowel control and patients satisfaction were compared. RESULTS: The time of recovering normal defecation frequency was (9.8+/- 2.9) months. There were no differences in bowel control and anorectal manometric findings between the lower anastomosis group and super-lower anastomosis group, the lower anastomosis group and anorectal anastomosis group. The patients in anorectal anastomosis group displayed significantly better bowel control and anorectal manometric findings than those in the super-lower anastomosis group (P< 0.05). The time of recovering normal defecation frequency in colonic J-pouch-anal anastomosis group was (7.7+/- 1.7) months, shorter than (10.6+/- 2.8) months in direct anastomosis group (P< 0.01). The complication rate of I degree incontinence was 36.1%, but there was no difference between the two groups. The anorectal manometric findings were better in J-pouch-anal anastomosis group than those in direct anastomosis group (P< 0.05). CONCLUSION: Colonic J-pouch-anal anastomosis for lower rectal carcinoma can significantly improve the bowel control in a short term without increasing the complication rate.

Aged↗

[Reoperation for postoperative constipation recurrences of Hirschsprung disease].

OBJECTIVE: To summarize the causes and treatment experiences of postoperative constipation recurrences of Hirschsprung disease. METHODS: Clinical data of 37 cases receiving operation again for postoperative constipation recurrences of Hirschsprung disease were collected. The recurrent causes, reoperation procedures and therapeutic efficacy were analyzed. RESULTS: Among 37 cases, the recurrent causes included insufficient resection of the intestine in 14 cases, co-existent intestinal neural hypogenesis in 6, gate syndrome in 5, and others in 12 cases. There was no postoperative death. Thirty-one cases (83.8%) were followed-up from 6 months to 11 years. The defecation frequency was 1-2 times per day in 15 cases, one times per two days in 7, one times per three days in 6 cases. Two cases could defecate with the help of laxative purgatives. Nobody had incontinence. CONCLUSION: The main cause of postoperative constipation recurrences of Hirschsprung disease is insufficient resection of the intestine,and reoperation can get better results.

Child↗

[Steatorrhea and its treatment with pancreatic enzymes in endocrine tumors of the pancreas (pancreatic adenomas)].

We report the treatment of steatorrhea with pancreatic enzymes in four pancreatic endocrine tumors treated in our hospital. All four patients were males, with a mean age of 50 +/- 4.6, a basal steatorrhea of 10.8 +/- 3.7 g/24 h (N: less than 5 g/24 h), and a defecation rate of 1.8 +/- 0.8 (mean +/- SD). They were treated for one week with Pankreon 700 in the form of pills of 700 mg pancreatin (28,000 U lipase PIF, 22,000 U amylase PIF and 1,500 U protease PIF). They were given 15 pills/day divided into three doses. The mean steatorrhea dropped to 7.1 +/- 1.5 g/24 h. Then the patients were given Creon capsules with 300 mg pancreatin in pellets (8,000 U lipase PIF, 9,000 U amylase PIF and 450 U protease PIF). They were given six capsules/day divided into three doses, and the steatorrhea dropped to 7.2 +/- 4.1 g/24 h, while the rate of defecation dropped to 1/day. On comparison of the two products (Pankreon-- a classic form of pancreatin, and Creon-- a modern galenical in pellets), it was found that Creon achieved the same results as Pankreon 700 in a doses 2.5 times lower. This pilot study demonstrates that exocrine pancreatic insufficiency can be frequent in endocrine tumors of the pancreas, and although underestimated, it can be partially corrected with pancreatic enzymes.

Amylases↗

Supplementation of baby formula with native inulin has a prebiotic effect in formula-fed babies.

OBJECTIVES: In this study we investigated the effects of native inulin on formula-fed babies. The influence of inulin on the microbial composition, pH, consistency and amount of faeces, and on frequency of defecation was assessed. METHODS: In this study a daily dosage of 0.25 g/kg/d was used: 3 weeks of inulin consumption were inulin followed by 3 weeks without or vice versa. The study group consisted of 14 babies with an average age of 12.6 weeks (+/-6.4 weeks) and the average intake of inulin was 1.5 (+/-0.3) g/d. RESULTS: The consumption of inulin increased the content of Bifidobacterium and Lactobacillus in the faeces of formula-fed babies, without affecting the number of Bacteroides or the total anaerobic count. With inulin a trend for stools becoming softer and the amount of faeces increased significantly. Frequency of defecation was not affected by the consumption of inulin. No adverse effects were reported during the periods of inulin consumption. CONCLUSIONS: We conclude that with native inulin a prebiotic effect can be observed in formula-fed babies. Inulin may therefore be a useful ingredient in the formulation of baby formula to enhance the nutritional properties.

Bacteria, Anaerobic↗

Internal intussusception of the rectum: a changing perspective.

Internal intussusception of the rectum is the funnel-shaped infolding of the rectum during straining to defecate. Patients present with multiple symptoms; most commonly rectal pressure and pain in association with constipation and straining. Defecography (videofluoroscopy during defecation) is the method of choice for diagnosing this problem. Rectal mobility from the sacrum, infolding of the rectum and sphincter relaxation can be used to grade the findings on defecography (Grade I-IV). The optimal therapy for internal intussusception of the rectum is unknown because the cause of the problem is unknown. Conservative management is recommended in all but the most severely symptomatic patients.

Defecation↗

Anorectal manometry in active and quiescent ulcerative colitis.

Anorectal function was measured in 11 patients with active medically intractable ulcerative colitis, seven patients with quiescent ulcerative colitis, and 18 healthy subjects. The anal resting pressure, squeeze pressure, and ability to defecate a balloon were similar in all groups. Significantly lower rectal distention volumes were required for rectal sensation, critical volume, and to induce rectal contractility in patients with active disease compared to controls or patients with quiescent disease. Rectal compliance was significantly reduced in patients with active and quiescent disease. The increased rectal sensitivity and contractility in patients with active colitis appear to be related to active mucosal inflammation and ulceration. Episodes of mucosal inflammation may be responsible for chronic changes in the rectal wall resulting in fibrosis and decreased compliance in patients with quiescent disease. The frequency and urgency of defecation and the fecal incontinence may be due to a hypersensitive, hyperactive, and poorly compliant rectum.

Adult↗