References: Laxative
Dis Colon Rectum. 1997 Mar;40(3):273-9.
Long-term results of surgery for chronic constipation.
Nyam DC, Pemberton JH, Ilstrup DM, Rath DM.
Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
BACKGROUND: Developments in anorectal physiologic testing have facilitated better understanding of the process of defecation and factors that might cause chronic constipation. AIM: Patients with severe idiopathic chronic constipation were evaluated using colonic transit and pelvic floor function in an attempt to identify those patients suitable for aggressive surgical intervention. MATERIALS AND RESULTS: Among 1,009 patients studied using either a marker or scintigraphic transit technique and tests of pelvic floor function, 52 with slow-transit constipation (STC) were identified and underwent abdominal colectomy and ileorectostomy (IRA). Twenty-two patients had pelvic floor dysfunction and STC; these patients underwent initial pelvic floor retraining followed by IRA. A total of 249 patients had pelvic floor dysfunction without evidence of slow-transit and were offered pelvic floor retraining alone. The remaining 597 patients had no quantifiable abnormality of colon or pelvic floor dysfunction; these patients had normal transit constipation/irritable bowel syndrome and were treated medically. There were, thus, 74 patients operated on, 68 women, with a mean age of 53 years and a mean follow-up of 56 months. There was no operative mortality, seven patients (9 percent) had small-bowel obstruction, and nine patients (12 percent) had prolonged ileus. All patients were able to pass a stool spontaneously, 97 percent of patients were satisfied with the results of surgery, and 90 percent have a good or improved quality of life. There was no difference in the outcome of surgery in patients with STC alone compared with STC and pelvic floor dysfunction. CONCLUSION: Physiologic evaluation reliably identified patients with severe chronic constipation who might benefit from surgery.
Dis Colon Rectum. 1997 Mar;40(3):280-6.
Chronic constipation--is the work-up worth the cost?
Rantis PC Jr, Vernava AM 3rd, Daniel GL, Longo WE.
Department of Surgery, Saint Louis University School of Medicine, MO 63110-0250, USA.
BACKGROUND: Chronic constipation can be a disabling condition that may require colectomy. Evaluation has been included as a way to select appropriate patients for colectomy and may also be extensive, unrevealing, and costly. AIMS: This study was undertaken to determine the cost and use of evaluation and outcome of patients with chronic constipation. METHODS: Patients with chronic constipation were reviewed for severity of symptoms, diagnostic studies performed, treatment, and outcome. The costs of the diagnostic studies were determined at our institution. Fifty-one patients were identified with chronic constipation; all were referred by other physicians. Mean age was 54 (range, 21-81) years; 59 percent were females. Average number of bowel movements per week was two (range, 0-4), and average duration of symptoms was five years (range, 1-20). Forty-three of 51 (84 percent) colonoscopies or barium enemas were normal. Thirteen of 51 (25 percent) colonic transit studies were abnormal. Twenty-six of 51 (51 percent) patients underwent defecography; 12 (46 percent) were abnormal. Thirty-seven of 51 (74 percent) underwent anal manometry; 5 (14 percent) were abnormal. One of 18 (6 percent) rectal biopsies demonstrated Hirschsprung's disease. Overall, 8 patients (16 percent) were diagnosed with outlet obstruction, 12 (24 percent) with colonic inertia, and 31 (61 percent) with constipation of unclear etiology. Overall mean cost of diagnosis was $2,752 (range, $1,150-$4,792). Fiber, cathartics, or biofeedback therapy was successful in 33 of 51 (65 percent) patients. Among the remaining 18 patients, 12 underwent surgery, of which 10 were successful. The remaining eight patients were constipated, despite treatment. CONCLUSION: A cost of $140,369 was expended on extensive diagnos
Nippon Koshu Eisei Zasshi. 1997 Feb;44(2):113-22.
[Risk factors for gallbladder cancer in Chilean females]
[Article in Japanese]
Endoh K, Nakadaira H, Yamazaki O, Yamamoto M, Tajima K, Serra I, Calvo A, Baez S.
Department of Hygiene and Preventive Medicine, Niigata University School of Medicine.
A case-control study of gallbladder cancer was conducted with 90 Chilean cases registered at one hospital in Santiago city, Chile from January, 1992 to August, 1994. Controls were selected among outpatients of the hospital who received abdominal echography. Each case was assigned 2 age- and sex-matched controls; either with or without gallstone(s). Study subjects were all directly interviewed by well-trained medical students. The present study focused on 74 female pairs and the following findings were obtained: 1) Odds Ratio(OR)s were significantly high for education years less than or equal to 6, body mass index greater than or equal to 24.0, constipation, and consumption of egg, fried meals, green and red chili. Chili pepper consumption of both types in cases showed significantly elevated risks with higher frequency. 2) While high ORs were observed, biliary symptoms such as dyspepsia and past history of cholelithiasis were strongly involved with present gallstone(s) and may not be independent factors for gallbladder cancer. 3) Significantly low ORs were seen for past history of intestinal parasitosis and surgical operation, hormone therapy, all industrial workers and workers in clothes & textile industry. However results may be influenced by more years of education or recall bias. 4) When a conditional logistic model was applied and controls with gallstone(s) were taken as reference, those with the habit of constipation showed a significantly high risk of 2.10 (95% CI: 1.01-4.38), and the consumers of red chili with a frequency > or = 1 time/day had elevated risks of 2.16 (1.27-3.66) vs those < 1 time/day and 4.66 (1.63-13.40) vs non-consumers, respectively. From the above results, the occu
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