References: Laxative
Braz J Med Biol Res. 1995 Jul;28(7):751-7.
Relationship between the degree of cardiovascular autonomic dysfunction and symptoms of neuropathy and other complications of diabetes mellitus.
Neumann C, Schmid H.
Servico de Endocrinologia, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brasil.
A cross-sectional study was designed to identify a relationship between the presence of symptoms usually related to nervous system involvement as well as other chronic complications of diabetes with three objectively defined degrees of autonomic neuropathy (AN). Symptoms usually related to peripheral sensitive neuropathy and AN were assessed using a questionnaire applied to 132 diabetics (38 IDDM and 94 NIDDM), 65 without and 67 with AN. AN was classified as follows according to 5 cardiovascular autonomic tests described by Ewing: 1) early involvement-1 abnormal test (N = 27); 2) definite involvement-2 or 3 abnormal tests (N = 26); 3) severe involvement-4 or 5 abnormal tests (N = 14). A statistically significant association was observed between degree of autonomic involvement and the presence of the following symptoms: dizziness on standing, dysphagia, vomiting, diarrhea, fecal incontinence, gustatory sweating, urinary retention, numbness and hyperesthesia of the feet or legs. Constipation and cystitis were not significantly related to cardiovascular AN. Only 3% of the patients without neuropathy and with early involvement had four or more than four of the symptoms. The prevalence of proliferative retinopathy and nephropathy was increased among patients with more severe degrees of AN. For IDDM patients there was a positive correlation between the degree of cardiovascular AN and the duration of diabetes. We conclude that: 1) severe cardiovascular AN is usually related to 4 or more of the evaluated symptoms and those patients usually have the other complications of diabetes; 2) severe AN could be a risk factor or an indicator of the same underlying process that determines the
Nippon Eiseigaku Zasshi. 1995 Dec;50(5):959-67.
[Health consideration and defecation tendencies of elderly people]
[Article in Japanese]
Hirai K, Takezoe R, Ogoshi K.
Department of Nutritional Biochemistry, Faculty of Human Life Science, Osaka City University, Japan.
Elderly people (males 742, 65-91 years old; females 371, 65-84 years old) were asked to answer a questionnaire on health and defecation tendencies. 1. Ninety-four percent of the males and 95% of the females considered their food intake sufficient to maintain their health (no difference between sexes). As for their food intake requirements, 68% of the males and 70% of the females answered that they knew about them, while 9% of the males and 6% of the females answered that they did not (no difference between sexes). 2. Of those with regular defecation every day, there were more males (68%) than females (49%). Seventeen percent of the males and 35% of the females defecated from four to six times per week, while 14% of the males and 13% of the females did so less than three times per week, with the difference between sexes being significant (p < 0.001). Both males (93%) and females (92%) tended to consider that constipation could affect their health condition. When asked about defecation, 92% of males and 83% of females answered that they should do so every day. The time for defecation was between when they arose and after breakfast for 76% of the males and 53% of the females. More females (25%) than males (8%) defecated irregularly (p < 0.001, difference between sexes). 3. Of those who did not have defecate every day, the percentage for those who answered that they should do so every day was low, whereas the percentage of those who answered that regularity did not matter was high. A significant relationship between awareness and degree of defecation was found for both males and females (p < 0.001 in both sexes). Those who regularly defecated every day did so in the time between when they arose and after breakfast, while th
Anaesthesist. 1995 Dec;44 Suppl 3:S549-58.
[The effects of long-term sedation on intestinal function]
[Article in German]
Zielmann S, Grote R.
Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universitat Gottingen.
Gastrointestinal integrity with intact function are of main importance in critically ill patients, and not only as a route of nutritional support. Drugs used for long-term sedation can lead to disordered gastrointestinal motility. In this study we compared the influence of different combinations of analgesics and sedatives on the intestinal function in mechanically ventilated, critically ill patients. METHODS. A total of 190 patients were evaluated retrospectively. All patients required controlled mechanical ventilation and deep sedation (Ramsay Score 5-6) for 7 days or more due to acute respiratory failure or elevated intracranial pressure. In none of these patients was enteric tube feeding contraindicated. Intact intestinal function was assumed when full enteric tube feeding was achieved on days 5 and 6 of the treatment period. Furthermore, other gastrointestinal motility disorders (e.g. constipation) had to be absent. In all patients the feeding tube was placed in the stomach by the nasogastric route. Corresponding to different combinations of analgesics and sedatives, the 190 patients were divided into 11 groups. The following combinations were used: group 1 (n = 20), fentanyl+flunitrazepam; group 2 (n = 20), fentanyl+midazolam; group 3 (n = 20), fentanyl+thiopentone; group 4 (n = 20) piritramide+midazolam; group 5 (n = 20), piritramide and continuous epidural administration of bupivacaine+midazolam; group 6 (n = 20), piritramide+gamma-aminobutyric acid (GABA); group 7 (n = 20), ketamine+midazolam; group 8 (n = 10), ketamin+methohexitone; group 9 (n = 20), ketamine+propofol; group 10 (n = 10), ketamine+midazolam and GABA; group 11 (n = 10), sufentail+midazolam and methohexitone. Patients in groups 3, 8, 9, 10, and 11 all had severe head injury and ele
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