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References: Laxative






Eur J Pharmacol. 1996 Jul 4;307(3):283-9.
Modulation of the in vivo actions of morphine by the mixed CCKA/B receptor antagonist PD 142898.

Singh L, Field MJ, Hunter JC, Oles RJ, Woodruff GN.

Department of Biology, Parke-Davis Neuroscience Research Centre, Cambridge University Forvie Site, UK.

The ability of a mixed CCKA/B receptor antagonist PD 142898 (benzenebutanic acid, beta-[[3-(1 H-indol-3-yl)-2-methyl-2-[[[(2-methyl- cyclohexyl)oxy]carbonyl]amino]-1-oxopropyl]amino]-[1 S-[1 alpha [S*(R*)]-2 beta]]) to modulate the antinociceptive, positive reinforcing and gastrointestinal actions of morphine was investigated in the rat. PD 142898 antagonised the development and maintenance of morphine (2.0 mg/kg, s.c.) induced conditioned place preference at 0.1 mg/kg, i.p. However, it potentiated the antinociceptive action of a subthreshold dose of morphine in the radiant tail flick model at doses of 0.001 and 0.01 mg/kg, s.c. Furthermore, PD 142898 (0.0001-1.0 mg/kg, s.c.) also potentiated the antinociceptive action of morphine (1.0 mg/kg, s.c.) against the late phase of formalin response associated with inflammation at the dose of 0.001-1.0 mg/kg. PD 142898 (0.001 mg/kg, s.c.) blocked the development of tolerance to morphine in the formalin test. It failed (0.001-1.0 mg/kg, i.p.) to modulate the inhibitory action of morphine (5.0 mg/kg, s.c.) on gastrointestinal transit as measured using the charcoal meal test. It is argued that the effect of PD 142898 in the conditioned place preference test involves antagonism of CCKA receptors, whilst the potentiation of the antinociceptive action of morphine is mediated via blockade of CCKB receptors. These results suggest that the mixed CCKA/B receptor antagonist may potentiate the analgesic action of morphine, block the development of tolerance without a concomitant increase in constipation and may also reduce the abuse potential of the opiate.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8836616&dopt=Abstract constipation laxative colon cleansing



Scand J Gastroenterol. 1996 Aug;31(8):770-3.
Colectomy for severe slow-transit constipation in strictly selected patients.

Christiansen J, Rasmussen OO.

Dept. of Surgery D, Herlev Hospital, University of of Copenhagen, Denmark.

BACKGROUND: Colectomy for severe constipation has in up to 25% of patients given unsatisfactory results. Failure to cure constipation is in most patients due to rectal dysfunction. The aim of the present study was to evaluate the effect of colectomy in a group of patients who fulfil all the criteria which, with our present knowledge, should predict a favourable result. METHODS: Twelve patients with long-standing severe constipation incurable by dietary regulation and medical treatment with demonstrable slow-transit constipation and normal rectal function entered the study. RESULTS: Ten patients were relieved of their constipation. Two patients continued to be constipated after subtotal colectomy. One had a very highly compliant rectum (preoperatively) with a maximal tolerable volume of 700 ml but normal emptying at defecography and normal emptying of viscous fluid. The patient was subsequently treated with proctectomy and ileo-pouch-anal anastomosis with satisfactory result. One patient with opioid abuse due to abdominal pain was improved by the operation but was still constipated. The opioid abuse continued, however, after the operation owing to continuing abdominal pain. A further three patients complained of abdominal pain, and two developed diarrhoea, one of whom became incontinent. CONCLUSION: Subtotal or segmental colectomy should be considered in a small number of patients with severe constipation provided strict criteria are fulfilled. Excessively high rectal volume tolerability may in spite of normal emptying capacity indicate the risk of development of rectal inertia postoperatively and may be a contraindication for surgery.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8858745&dopt=Abstract constipation laxative colon cleansing



Adv Perit Dial. 1996;12:192-5.
Endogenous peritonitis and related outcome in peritoneal dialysis patients.

Suh H, Wadhwa NK, Cabralda T, Sorrento J.

Division of Nephrology and Hypertension, State University of New York at Stony Brook, USA.

Our objective was to study endogenous peritonitis and related catheter outcome in peritoneal dialysis (PD) patients. The study was designed to investigate endogenous peritonitis and related catheter loss in all end-stage renal disease (ESRD) patients who started peritoneal dialysis from January, 1989 to September, 1995. In a tertiary-referral university hospital, 192 ESRD patients (117 male, 75 female) who entered the home program from 1/89 to 9/95 were studied. Sixteen episodes of endogenous peritonitis occurred in 15 PD patients (7 male, 8 female) with a mean age of 63 years (range 33-81 years). Five patients were diabetic. Two hundred and seventeen episodes of peritonitis in 192 patients occurred over 4149 patient-months, resulting in one episode/19.1 patient-months. Sixteen episodes of endogenous peritonitis were encountered in 15 patients, accounting for 7% of all episodes of peritonitis. The mean duration of PD before contracting endogenous peritonitis was 24.2 months (range 7-52 months). Eleven episodes were related to diverticular leak/perforation, three to sigmoidoscopy/colonoscopy/PEG procedures, one to unknown etiology, and one to cholecystitis. During 11 episodes, severe constipation preceded. All the patients were initially treated conservatively with antibiotics. Five episodes (31%) responded to antibiotic therapy alongside antifungal prophylaxis and continued PD. One episode (6%) required cholecystectomy without catheter removal and resumed PD. Six episodes (38%) required catheter removal due to subsequent fungal peritonitis in a mean of 11 days (range 3-24 days): 4 patients transferred to hemodialysis and 2 patients resumed PD. Three patients underwent catheter removal along with colectomy and colostomy: 2 patients transferred to



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