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PubMed2004

The importance of gut motility in the metabolic control of propionic acidemia.

We hypothesized that gut motility likely plays a critical role in the metabolic stability in propionic acidemia (PA). Therefore, 4 known patients with PA (aged 47 months to 185 months) were prospectively studied over 7 days in the Clinical Research Center at Children's Hospital, Boston. Determinations of ammonia, bicarbonate, and amino acids in blood; organic acids and propionylglycine in urine; and a lactulose breath test were conducted under two study conditions: on regular therapy (for 4 days) and on regular therapy plus Senekot (Purdue Frederick Company, Norwalk, Conn), an intestinal motility agent (for 3 days). The total gastrointestinal transit time was calculated using 20 nonabsorbable, inert, radio-opaque markers. The addition of an intestinal motility agent resulted in a significant decrease in blood ammonia, urinary excretion of propionylglycine, and a rise in the ratio of free to total carnitine over baseline. We concluded that enhancement of gut motility can improve metabolic stability in patients with PA.

Adolescent↗
PubMed2005

Prevalence, symptoms and outcome of constipation in infants and toddlers.

OBJECTIVE: To determine the prevalence of constipation in children <or=2 years, describe the symptoms of constipation, and review how often specific interventions were effective. STUDY DESIGN: Retrospective chart review. RESULTS: Of 4,157 children <2 years of age, 185 children had constipation. The prevalence rate for constipation in the first year of life was 2.9%, and in the second year of life, the rate was 10.1%. Functional constipation was the cause in 97% of the children. Boys and girls were affected with equal frequency. Constipation was caused by an underlying organic disease in 1.6% of cases, and 97% of the children had functional constipation. Dietary changes and corn syrup were the initial treatment suggestions for 116 children; 93% of these children underwent follow-up examinations, and the constipation resolved in 25% of the children. Of 100 children treated with milk of magnesia or polyethylene glycol 3350 without electrolytes, 93 children underwent follow-up examinations, and the constipation was resolved with treatment in 92% of the children. CONCLUSIONS: Dietary changes, corn syrup, or both resolved constipation in 25% of children, and laxatives resolved constipation in 92% of children. Both milk of magnesia and polyethylene glycol were efficient and safe in infants and toddlers.

Cathartics↗
PubMed2005

Functional constipation in infants: a follow-up study.

Our objective of this study was to describe the clinical course of severe functional constipation in early childhood. Eligible patients were 47 children (60% boys; median age, 3.5 months) who had constipation in their first year of life. Follow-up data were obtained through a standardized questionnaire. Success was defined as a period of at least 4 weeks with > or =3 painless bowel movements per week. Six months after initial evaluation, 69% of the children were recovered. After initial success, a relapse occurred in 15% of the children within 3 years. A duration of symptoms <3 months before referral correlated significantly with better outcome. We conclude that most infants with severe constipation evaluated at a tertiary center are recovered after 6 months. Early therapeutic intervention may beneficially contribute to the resolution of constipation.

Cathartics↗
PubMed2006

Clinical outcome of cystic fibrosis presenting with or without meconium ileus: a matched cohort study.

OBJECTIVE: This matched case-control study compared the nutritional and the pulmonary long-term outcomes of cystic fibrosis (CF) patients presenting a history of meconium ileus (MI) with early-diagnosed symptomatic CF without MI (non-MI). MATERIAL AND METHOD: Twenty-six patients with CF treated for MI between 1980 and 1997 have been matched for sex, birth date, and earliest CF symptomatic diagnosis for the children with non-MI CF. Clinical characteristics, genotype and complications were evaluated as well as the progression of the CF disease from infancy to 15 years old by nutritional status (z score weight, z score height), pulmonary function tests (PFTs) (FVC and FEV1), and Pseudomonas aeruginosa acquisition. RESULTS: Median duration of the follow-up was 12.5 years (range, 10-17 years). Genotype identification showed no significant difference. Further on, the rate of complications and the occurrence of chronic P. aeruginosa colonization did not differ. At age of 15 years (n = 13), nutritional status and PFTs did not demonstrate any significant difference. CONCLUSION: These results suggest that adequate initial nutritional and medical management of MI allows further similar nutritional status and PFTs compared with other early-diagnosed symptomatic CF patients. In this study, MI did not represent an additional risk factor for the patient's life.

Adolescent↗
PubMed2006

Is bowel preparation required before cystoplasty in children?

PURPOSE: We evaluated whether bowel preparation is required before augmentation cystoplasty in children. MATERIALS AND METHODS: A total of 46 consecutive children underwent cystoplasty using detubularized ileum between 1998 and 2004. Group 1 (24 patients) underwent standard mechanical bowel preparation with sodium picosulfate, a bowel enema (sodium phosphate) if required and clear fluids for 24 hours preoperatively. Group 2 (22 patients) received no bowel preparation and was on a normal diet preoperatively. One dose of parenteral triple antibiotics was administered at induction of anesthesia in both groups. The surgical technique was similar in both groups. Postoperatively, group 1 had a nasogastric tube in situ, while group 2 had no nasogastric tube. The main outcome measures were hospital stay (days), time to commencing fluids postoperatively (hours), incidence of urinary tract infection during hospitalization and incidence of wound infection. RESULTS: Median postoperative stay was 5 days (range 4 to 7) in group 1 and 4 days (3 to 6) in group 2. Median time to intake of oral fluids was 48 hours (range 24 to 72) in group 1 and 24 hours (12 to 48) in group 2. Three patients in group 1 and 2 in group 2 had a symptomatic urinary tract infection during the postoperative course. One patient in each group had a superficial wound infection. CONCLUSIONS: There were no significant differences in hospital stay or postoperative complications between the 2 groups. This series suggests that bowel preparation is unnecessary for children undergoing cystoplasty.

Adolescent↗
PubMed2004

Did some 18th and 19th century treatments for mental disorders act on the brain?

Review of 18th and 19th century psychiatric therapies raises the possibility that several may have altered the activity of vasopressin or Na-K-ATPase. Bleeding, whirling, nausea created by medicines, and vagus nerve stimulation by application of electricity through the skin all perturb the hypothalamic hormone, arginine vasopressin, while helleborus and digitalis inhibit the sodium pump enzyme, Na-K-ATPase. These approaches were used with reported benefit many years ago, acting on the brain in ways ongoing research suggests may play a role in affective disorders. Study of long-abandoned treatments may clarify their mechanisms of action and the characteristics of responsive patients.

Bloodletting↗
PubMed2005

Effects of thickened beverages fortified with inulin on beverage acceptance, gastrointestinal function, and bone resorption in institutionalized adults.

OBJECTIVES: We wanted to develop thickened beverages that contain soluble fiber (inulin) with acceptable consistency, taste, and texture and to determine the effects of these beverages on bone resorption markers (to determine calcium retention), bowel frequency, and indicators of gastrointestinal function in institutionalized adults bound to wheelchairs. METHODS: A double-blind, 3-wk, cross-over study testing 13-g/d inulin-fortified versus isocaloric standard modified starch-thickened beverages was conducted in institutionalized adults who were bound to wheelchairs and had dysphagia or did not have dysphagia. Beverage acceptability, as assessed by discriminative and descriptive sensory testing, bowel frequency, fecal output, and laxative use, were determined by direct testing or by nursing charts. Bone resorption was measured by using the urinary excretion of fasting calcium and of cross-linked N-telopeptides of collagen. RESULTS: Sensory panelists were unable to detect a difference between beverages thickened with modified starch and those fortified with inulin. Few differences were found between the control and inulin-fortified beverages for sensory descriptors. No significant difference was found in frequency of bowel movements between treatments; however, weighted bowel movement frequency increased by 13% with inulin (P < 0.01), whereas enema and laxative administration decreased by 13% (P < 0.05). Bone resorption, as an indicator of calcium retention, remained unchanged. CONCLUSIONS: Inulin was incorporated into thickened beverages, with no decrease in acceptability; when consumed, perceived stool output increased in residents of long-term care facilities.

Adult↗
PubMed2006

Konjac acts as a natural laxative by increasing stool bulk and improving colonic ecology in healthy adults.

OBJECTIVE: Konjac glucomannan (KGM) has been shown to relieve constipation, which could be associated with increased stool bulk and improved colonic ecology. METHODS: This placebo-controlled study consisted of a 21-d placebo period, a 7-d adaptation period when volunteers consumed KGM progressively, and a 21-d KGM-supplemented period (1.5 g/meal, 4.5 g/d). Eight healthy adults consumed 7-d cycle menus of typical low-fiber Chinese food throughout the study. The gastrointestinal response was monitored daily. Stools were fully collected on days 15 to 21 of placebo and KGM periods to determine the fecal mass, components, microflora, and short-chain fatty acid contents. RESULTS: The KGM supplement significantly increased the mean defecation frequency (number/day), wet stool weight, and dry stool weight (g/d) by approximately 27.0% (P < 0.05), 30.2% (P < 0.05), and 21.7% (P < 0.05), respectively. The dry fecal mass increased mainly in the plant and soluble material, whereas bacterial mass tended to increase from 12.9 +/- 1.6 to 13.6 +/- 2.7 g/d (P > 0.05). However, KGM significantly promoted the fecal concentrations (log counts/g wet feces) of lactobacilli (P < 0.05) and total bacteria (P < 0.05), and promoted the daily output (log counts per day) of bifidobacteria (P < 0.05), lactobacilli (P < 0.05), and total bacteria (P < 0.05) as evaluated by the fluorescence in situ hybridization method. KGM supplement also promoted colonic fermentation as shown in the decreased fecal pH (P < 0.05) and increased fecal short-chain fatty acid concentrations (P < 0.05). CONCLUSION: Supplementation of KGM into a low-fiber diet promoted the defecation frequency in healthy adults, possibly by increasing the stool bulk, thus promoting the growth of lactic acid bacteria and colonic fermentation.

Adult↗
PubMed2005

Senna and the formation of aberrant crypt foci and tumors in rats treated with azoxymethane.

Chronic use of anthraquinone laxatives has been blamed for the induction of habituation and the development of colonic cancer, but there are no definitive studies which have demonstrated this. To evaluate the carcinogenic potential of anthraquinones, the effect of long-term senna pod extract (SE) treatment on either healthy rats or rats treated with an initiating tumor agent (azoxymethane--AOM) has been studied. SE (30 and 60mg/kg), administered for 110 weeks, did not induce the development of aberrant crypt foci (ACF) and tumors in healthy rats. The development of ACF and tumors in rats treated with AOM were significantly reduced by SE (30 and 60 mg/kg). These results suggest that a chronic SE use does not predispose to colon cancer. By contrast, SE might exert an anti-tumoral activity on rat colon carcinogenesis.

Adenocarcinoma↗
PubMed2006

Interaction between Shaoyao-Gancao-Tang and a laxative with respect to alteration of paeoniflorin metabolism by intestinal bacteria in rats.

Shaoyao-Gancao-Tang (SGT), a traditional Chinese herbal medicine (Kampo formulation) containing Shaoyao (Paeoniae Radix) and Gancao (Glycyrrhizae Radix), is co-administered with laxative sodium picosulfate as a premedication for relieving the pain accompanying colonoscopy. Paeoniflorin (PF), an active glycoside of SGT, is metabolized into the antispasmodic agent paeonimetabolin-I (PM-I) by intestinal bacteria after oral administration. The objective of the present study was to investigate whether the co-administered laxative (sodium picosulfate) influences the metabolism of PF to PM-I by intestinal bacteria. We found that the PF-metabolizing activity of intestinal bacteria in rat feces was significantly reduced to approximately 34% of initial levels by a single sodium picosulfate pretreatment and took approximately 6 days to recover. Repeated administration of SGT after the sodium picosulfate pretreatment significantly shortened the recovery period to around 2 days. Similar results were also observed for plasma PM-I concentration. Since PM-I has muscle relaxant activity, the present results suggest that repetitive administration of SGT after sodium picosulfate pretreatment might be useful to relieve the pain associated with colonoscopy.

Analgesics↗
PubMed2006

Specific oral medications decrease the need for surgery in adhesive partial small-bowel obstruction.

BACKGROUND: Nothing by mouth (NPO) is the standard treatment for small-bowel obstruction. Whether oral medications should be prohibited during treatment of adhesive, partial small-bowel obstruction is unclear. The goal of this study was to determine whether a combination of specific oral medications in adhesive, partial small-bowel obstruction will decrease the need for operative intervention. METHODS: Of 266 consecutive adult patients with partial small-bowel obstruction admitted at a tertiary medical center, 236 were randomized into 2 groups. Group I patients were treated with intravenous hydration, nasogastric tube decompression, and NPO. Group II patients were placed on intravenous hydration, nasogastric tube decompression, and oral fluids incorporating an oral laxative, a digestant, and a defoaming agent. We compared differences between the groups in (1) the number of patients having a successful nonoperative treatment, (2) complications, and (3) recurrence of symptoms. RESULTS: A total of 116 and 120 patients comprised groups I and II, respectively. The number of patients treated successfully by a nonoperative approach was less in group I than in group II (77% vs 90%, P < .01). The complications and recurrence rate for groups I and II did not differ (4% vs 5% and 5% vs 4%, respectively). CONCLUSIONS: The NPO status for patients with adhesive, partial small-bowel obstruction may not be necessary. This cocktail of oral medications can decrease the need for operative intervention in patients with presumed adhesive, partial small-bowel obstruction.

Administration, Oral↗
PubMed2005

Early removal of nasogastric tube after cystectomy with urinary diversion: does postoperative ileus risk increase?

OBJECTIVES: To examine the risk factors of postoperative ileus and investigate whether the duration of postoperative nasogastric tube (NGT) use affects the rate of postoperative ileus in patients undergoing radical cystectomy with urinary diversion. METHODS: A total of 101 patients underwent radical cystectomy with urinary diversion from 1999 to 2003. We examined the demographic and perioperative variables of the patients who did and did not develop postoperative ileus. We divided the patients into two groups--those who had the NGT removed within 24 hours and those who had the NGT removed at first flatus. We compared the two groups for the incidence of ileus and clinical variables. RESULTS: Postoperative ileus was observed in 23 patients (23%). The demographic data of both groups were not different in terms of age or American Society of Anesthesiologists score. Also, the operative time, estimated blood loss, type of diversion, and postoperative complication rate were not significantly different between the two groups (P >0.05). However, the risk of postoperative ileus was significantly greater in those who took polyethylene glycol for bowel preparation than in those who took sodium phosphate (40% versus 18%, respectively, P = 0.02). No significant difference in the prevalence of ileus was found between the patients whose NGT was removed within 1 day and those in whom it was removed after 2 days (25% versus 22%, respectively, P >0.05). CONCLUSIONS: The results of our study suggest that the use of sodium phosphate for bowel preparation may reduce the incidence of postoperative ileus and that early NGT removal after cystectomy is not correlated with ileus.

Aged↗
PubMed2005

A canine purgation study and risk factor analysis for echinococcosis in a high endemic region of the Tibetan plateau.

The Tibetan plateau of western China has been shown to have a very high prevalence of human cystic echinococcosis (CE) caused by Echinococcus granulosus and human alveolar echinococcosis (AE) caused by Echinococcus multilocularis. The domestic dog is suspected to be the primary definitive host for the transmission of both E. granulosus and E. multilocularis to humans in this locality. A purgation study of 371 dogs in Shiqu County, Sichuan Province during 2002-2003 resulted in an E. multilocularis prevalence of 12% and an E. granulosus prevalence of 8%. These crude prevalences were then adjusted, based on the known sensitivity of arecoline purgation for the detection of E. granulosus and a suggested sensitivity for the detection of E. multilocularis. In addition, it was assumed that some immature parasites of either species could be misidentified morphologically and wrongly assigned. This resulted in credible true prevalence intervals of between 13-33% for E. multilocularis and 8-19% for E. granulosus. Prevalences of other intestinal helminthes found on purgation were: Taenia spp. 31%, Dipylidium caninum 1%, and ascarids 8%. Risk factors associated with the acquisition of canine echinococcosis were evaluated based on responses to a questionnaire administered to dog owners. Male dogs were more likely to be infected with Echinococcus spp. than female dogs (P<0.05) and dogs allowed to roam were more likely to be infected with E. multilocularis (P<0.05).

Animals↗
PubMed2004

Diagnosis of cystic echinococcosis on sheep farms in the south of Argentina: areas with a control program.

In 2000 Guarnera et al. proposed using ELISA in canine faeces collected from the ground to detect dogs infected with Echinococcus granulosus, thus determining sheep farms with active transmission. The objective was to evaluate the prevalence of E. granulosus infection in sheep farms of the Patagonia. Sheep farms were randomly selected in the Provinces of Río Negro, Chubut, Neuquén, Santa Cruz and Tierra del Fuego (areas with control programs) and La Pampa (comparison area). From one to three samples of fecal matter were obtained for each sheep farm, which were processed by means of copro-ELISA test with confirmation of positive samples by copro-Western blot. A total of 1042 samples were obtained from 352 sheep farms, 26 (7.3%) proving positive. Of these 5 (6.3%) were from La Pampa, 9 (13.8%) from Neuquén, 4 (4.7%) from Río Negro, 2 (2.9%) from Chubut, 1 (5.9%) from Santa Cruz and 5 (13.9%) from Tierra del Fuego. The identification of parasitized dogs is an essential activity upon which rests the strategy of control and surveillance. Arecoline tests or coproantigen test with fecal matter obtained directly from the dog contribute information on individual prevalence, while the use of coproantigens detected in ground-collected samples transfers the dog unit of observation to units of greater epidemiological value. In the present experience, the technique employed seems promising for its application in systems of epidemiological surveillance of cystic echinococcosis and in drawing a baseline on which to measure the progress of control programs in the Argentine Patagonia in subsequent years.

Animals↗
PubMed2003

Combined approach to functional constipation in children.

BACKGROUND/PURPOSE: The authors' 15-year experience with children shows a high percentage of recurrence of functional constipation (FC) with conventional treatment. These data, confirmed in the international literature, led them to develop a new therapeutic approach. The aim of this study was to achieve intestinal control and avoid recurrence of FC in children through use of medical-psychological treatment. METHODS: The authors studied 25 children (18 boys; mean age, 4.7 years; range, 2.10 to 7), 20% of whom had anal fissure, 30% retentive soiling, 52% pain on defecation, and 88% fecal retention owing to FC. Children and parents were questioned about eating and sleeping habits, school, toilet training, and daily routine. Treatment included increasing water and fiber intake, laxatives, and family therapy including making rules and working on autonomy and paternal role. RESULTS: Mean onset of FC was 3.5 years, after "stressful events" in 88%. The questionnaire shows that 68% lacked parental autonomy and authority; 84% of children decided on their own about eating habits and sleeping; 68% had a "peripheral" father with a mother-child symbiotic relationship. After one month of therapy, 92% of children showed a modification of at least 2 behavioral patterns; after 3 months, 88% had regular bowel movements. During follow-up (range, 6 to 28 months), 48% had 2 or 3 recurrent episodes. After one year, 68% had reinforced the new behavioral patterns with resolution of the pathologic aspects. CONCLUSIONS: A multidisciplinary approach in the treatment of childhood functional constipation showed consistent therapeutic results by making rules and by equalizing family roles.

Cathartics↗
PubMed2002

High-soluble-fiber foods in conjunction with a telephone-based, personalized behavior change support service result in favorable changes in lipids and lifestyles after 7 weeks.

OBJECTIVE: To evaluate whether an intervention of foods high in soluble fiber from psyllium and/or oats plus a telephone-based, personalized behavior change support service improves serum lipids and elicits cholesterol-managing lifestyle changes vs usual care. DESIGN: 7-week randomized, controlled intervention. SUBJECTS/SETTING: 150 moderately hypercholesterolemic men and women, age range 25 to 70 years. INTERVENTION: The intervention group consumed 4 servings/day of high-fiber foods and had weekly telephone conversations with a personal coach who offered support and guidance in making lifestyle changes consistent with the National Cholesterol Education Program's (NCEP) cholesterol-lowering guidelines. The usual care group received a handout describing the NCEP Step-1 diet. MAIN OUTCOME MEASURES: Serum lipids and lipoproteins and self-reported lifestyle changes. STATISTICAL ANALYSES: For physiologic and dietary changes, mixed linear models for repeated measures were applied. Models were simplified using analysis of covariance where age in years was the covariate. Traditional general linear models were used to assess lifestyle changes. RESULTS: In the intervention group total cholesterol (TC) decreased 5.6%, low-density lipoprotein (LDL) cholesterol 7.1%, LDL/high-density lipoprotein (HDL) cholesterol ratio 5.6%, and triglycerides (TG) 14.2% (P<.0167); decreases in TC and LDL were significantly different from the usual care group. In the usual care group TC decreased 1.9%, LDL 1.2%, LDL/HDL 1.9%, and TG 4.4% (all not significant). The intervention group also reported an increase in their knowledge, ability, and confidence to make cholesterol-managing diet and exercise changes compared with the usual care group (P<.05). The intervention group had a greater decrease in energy intake from saturated fat (-1.6%) and increase in soluble fiber intake (7.3%) than the usual care group (P<.05). The intervention group reported an increase in exercise vs the usual care group (P<.05). Both intervention and control groups had a minimal reduction (<1%) in body weight compared with baseline (P<.0167). APPLICATIONS/CONCLUSIONS: A 7-week intervention that includes both functional foods and individualized, interactive support for behavior change could be an effective model for dietitians to use with patients at risk for CVD, pending results of long-term studies.

Adult↗