References: Laxative
Am J Phys Med Rehabil. 1995 Sep-Oct;74(5):339-44.
Gut hormone release in patients after spinal cord injury.
Saltzstein RJ, Mustin E, Koch TR.
Department of Physical Medicine and Rehabilitation, Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee 53295, USA.
Gastrointestinal disorders including abdominal pain, abdominal distention, ileus, and constipation are common after spinal cord injury. In physiologic studies of patients with spinal cord injury, slow gastric emptying, ileal dilation, and abnormal rectosigmoid motility have been found. However, it is not yet known whether abnormal gut hormone release is important in the development of these abnormalities. In healthy volunteers, there are postprandial increases in plasma peptide YY and motilin levels, which appear related to neural mechanisms. We hypothesized that abdominal sympathetic pathways provide tonic inhibition of peptide YY and motilin release and that postprandial increases in these gut hormones are mediated through spinal pathways. Fasting serum was obtained from normal volunteers, paraplegic patients, and tetraplegic patients. In studies in which patients were fed, serum was obtained from normal volunteers, paraplegic patients, and tetraplegic patients before and at 30-min intervals after a 280 kcal meal. Serum motilin and peptide YY levels were measured by radioimmunoassays. In fasting studies, there was a trend (P = 0.23) toward increased fasting serum motilin in paraplegic patients, and this result did not support tonic inhibition of motilin release. Fasting peptide YY levels were not increased in spinal cord injury patients, which did not support tonic inhibition of peptide YY release. In fed studies, there were strong trends toward postprandial increases in serum peptide YY in volunteers and paraplegic patients and a significant postprandial rise in serum peptide YY in tetraplegic patients (P = 0.04). This was evidence against involvement of spinal pathways in postprandial release of peptide YY.(ABSTRACT TRUNCATED A
Dig Dis Sci. 1995 Oct;40(10):2286-92.
Idiopathic megarectum in adults. An assessment of manometric and radiologic variables.
Chiarioni G, Bassotti G, Germani U, Brunori P, Brentegani MT, Minniti G, Calcara C, Morelli A, Vantini I.
Divisione di Riabilitazione Gastroenterologica, Ospedale Clinicizzato di Valeggio sul Mincio, Universita degli Studi di Verona, Italy.
Outlet obstruction is thought to be one of the major factors responsible for idiopathic constipation. However, outlet obstruction itself may be due to several mechanisms. Among these, the presence of a megarectum is a leading one. Pathophysiological studies in adult patients with idiopathic megarectum are scarce. We studied by manometric and defecographic means 15 adult subjects with idiopathic megarectum and severe chronic constipation. Twenty-five healthy volunteers of both sexes acted as controls. Manometric variables showed significant differences between patients and controls with respect to internal anal sphincter pressure (P = 0.02), minimum relaxation volume (P < 0.001), defecatory sensory threshold (P < 0.001), mean rectal tolerable volume (P < 0.001), and rectal compliance (P < 0.001). An altered response to straining was observed in 46.6% of patients and in 12% of controls (P < 0.04); the ability to expel a 50-ml balloon per anum was 13.3% in patients and 100% in controls (P < 0.001). Although all patients opened the anorectal angle and had descent of the pelvic floor, thereby confirming an adequate expulsion effort, evacuation of contrast material appeared extremely difficult. In fact, no subject was able to expel more than 30% of the rectal contents during fluoroscopic screening. These results confirm previous hypotheses that idiopathic megarectum displays features of a neuropathic process as an underlying mechanism. Further studies are needed that also take into consideration the muscle tone component of the rectum in these patients.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7587802&dopt=Abstract constipation laxative colon cleansing
Surgery. 1995 Jul;118(1):1-7.
Mesenteric arterial bypass grafts: early and late results and suggested surgical approach for chronic and acute mesenteric ischemia.
Johnston KW, Lindsay TF, Walker PM, Kalman PG.
Department of Surgery, Toronto Hospital, University of Toronto, Ontario, Canada.
BACKGROUND. The purposes of this study were to determine the early and late results of placement of arterial bypass grafts in the treatment of chronic and acute intestinal ischemia and to ascertain whether multiple grafts provide better late results than a single graft. METHODS. Records of 34 patients who underwent mesenteric vascular graft placement were retrospectively reviewed. RESULTS. All 21 patients with chronic ischemia had a history of intestinal angina and weight loss. Food fear was reported by 33% of patients; also, diarrhea in 57%, constipation in 29%, acalculous cholecystitis in 19%, ischemic gastritis or peptic ulcer in 19%, and elevation of liver enzymes in 22% were reported. Angiogram showed more than 50% stenosis or occlusion of the superior mesenteric artery (SMA) in 100% of patients, celiac artery in 90%, and inferior mesenteric artery in 90%. Although not described previously, a reduction in collateral flow from the internal iliac arteries was caused by severe pelvic disease in 56% of patients. There were no in-hospital deaths. The rate of survival at 1 year was 100%; at 2 years it was 93% +/- 6%, at 3 years 86% +/- 9%, at 5 years 79% +/- 11%, and at 10 years 50% +/- 15%. During follow-up, graft thrombosis occurred in three patients. Of the patients who underwent only a single SMA or celiac bypass, two of five died of bowel infarction; only one of 16 patients who underwent both celiac and SMA bypass had to undergo a repeat surgical procedure because of graft occlusion. Three of 16 retrograde bypasses thrombosed, compared with zero of five prograde bypasses. In nine patients who underwent placement of mesenteric bypass grafts because of acute ischemia caused by acute mesenteric
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