laxative



References: Laxative






Am Rev Respir Dis. 1983 Jan;127(1):8-13.
The effects of protriptyline in sleep-disordered breathing.

Smith PL, Haponik EF, Allen RP, Bleecker ER.

The effects of therapy with the tricyclic antidepressant protriptyline were studied in 12 patients with hypersomnolence and moderately severe sleep apnea. After treatment there was no significant change in the duration or frequency of sleep-disordered breathing (SDB) during non-REM sleep, but there was an alteration in the breathing pattern characterized by a decrease in the amount of apnea during SDB events. Apnea, as a percent of disordered breathing time, fell from 60.4 +/- 27.2% to 35.5 +/- 26.7% (p less than 0.01) and was accompanied by a reduction in the peak fall in oxygen saturation from 16.2 +/- 6.2% to 9.2 +/- 4.7% (p less than 0.01). During REM sleep there was no change in the pattern, duration, or frequency of SDB, or reduction in the peak fall in oxygen saturation. However, there was a reduction in the amount of Stage REM sleep, thereby reducing the more severe SDB events (p less than 0.01) and further improving nocturnal oxygenation. In 10 of 12 patients, there was subjective improvement in daytime hypersomnolence, which was associated with an increase in median sleep onset time from 3.3 +/- 2.2 to 5.1 +/- 2.1 min (p less than 0.01). Although all patients developed mild side effects from the anticholinergic properties of protriptyline manifested by a dry mouth, 4 patients noted additional side effects including urinary hesitancy, mild constipation, and difficulty in maintaining an erection. One patient developed intolerable constipation that necessitated discontinuation of the drug. We conclude that protriptyline reduced daytime hypersomnolence and altered the pattern of SDB, thus improving gas exchange and oxygenation during sleep. Therefore, in selected patients with moderately severe obstructive sleep apnea, therapy with protriptyline is an alternative to surgical treatment with a tracheostomy.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6849555&dopt=Abstract constipation laxative [PubMed - indexed for M



Ciba Found Symp. 1981;83:326-54.
Myenteric plexus of the hind-gut: developmental abnormalities in humans and experimental studies.

Garrett JR, Howard ER.

Intraluminal pressure studies on patients with congenital aganglionosis showed that the aganglionic rectum contracted in an uncoordinated manner and failed to relax. Histochemical assessment of the innervation helped to explain the variable severity of the symptoms in this condition. It is concluded that (1) absence of ganglia prevents normal coordinated peristalsis and creates an obstructive element; (2) absence of reflex relaxation adds to the obstruction; (3) the degree of uncoordinated motor activity in distal aganglionic bowel probably relates to the number of cholinesterase-positive nerves in the circular muscle and adds another variable obstructive element; and (4) deficient innervation of distal ganglionic bowel probably creates a poor propulsive force and so accentuates more distal obstructive factors. Neurohistochemical and functional studies in the anorectum of cats reveal a somewhat different innervation pattern from that in humans but show that sphincteric tone is mainly due to alpha-adrenergic neural activity. Reflex relaxation of the internal anal sphincter is a complex function in which inhibitory responses override motor responses, and it involves an important non-adrenergic non-cholinergic component. The role of cholinergic nerves in the sphincter remains uncertain. Neurohistochemical assessment of full thickness biopsy specimens of rectal muscle from patients with disabling constipation shows that developmental neuronal dysplasias of the hind-gut may be divided into three main categories: (1) aganglionosis (Hirschsprung's disease), (2) hypoganglionosis and (3) hyperganglionosis, and that the different neuronal elements may be affected to differing degrees in individuals within each group. Resection of the aganglionic bowel is required in congenital aganglionosis but the combined diagnostic-therapeutic procedure of anorec



J Pediatr Surg. 1993 Aug;28(8):1054-8.
Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations.

Rintala R, Lindahl H, Marttinen E, Sariola H.

Department of Pediatric Surgery, Children's Hospital, University of Helsinki, Finland.

Anorectal function was clinically, manometrically, and radiologically followed-up in 40 patients who underwent an internal sphincter-saving posterior sagittal anorectoplasty in 1984 to 1989. The functioning internal sphincter was manometrically verified in 83% (33/40) of the patients. Soiling related to sphincter insufficiency was found in only 4 of the 33 patients with a functioning internal sphincter; 5 of the 7 patients without an internal sphincter had soiling. Symptomatic constipation was found in 73% (24/33) of the patients with a functioning internal sphincter, but in only 28% (2/7) of the patients without this structure. Constipation was not associated with a stenotic anal outlet in any patient. On anorectal manometry, there was no statistical difference in basal and pressures and internal sphincter reflex threshold values between constipated and nonconstipated patients. Histologically, ganglion cells were found in the proximal anal canal in all cases. The radiological size of the rectal pouch before closure of the protecting colostomy had a positive correlation with the severity of constipation. Medical treatment with diet and bulk-laxatives (13 patients) or with stimulant laxatives and occasional enemas (11 patients) successfully relieved constipation in 24 patients. In 2 patients, the symptoms were refractory to medical treatment and a resection of the megarectum was required. In conclusion, the preservation of the internal sphincter in patients with high or intermediate anorectal anomalies gives a good fecal continence outcome, but is associated with a high incidence of symptomatic constipation.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8229597&dopt=Abstract constipation laxative [PubMed - indexed for MEDLINE]<



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