laxative



References: Laxative






J Am Geriatr Soc. 1994 Sep;42(9):947-52.
Constipation: assessment and management in an institutionalized elderly population.

Harari D, Gurwitz JH, Avorn J, Choodnovskiy I, Minaker KL.

Division on Aging, Harvard Medical School.

OBJECTIVES: To examine prescribing and utilization patterns of laxatives, stool softeners, and enemas in a large, long-term care facility, to compare self-reports of constipation with specific, bowel-related symptoms in residents of this facility, and to examine concordance between bowel symptoms reported by residents and the assessments of the nursing staff. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: All individuals residing in an academically oriented long-term care facility in the United States for at least 1 month (n = 694). MEASUREMENTS: Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews regarding bowel-related symptoms were conducted with all able participants (n = 456 (66%)) and their respective primary nurses, and concordance was determined. The study definition of symptom-specific constipation was no more than 2 bowel movements per week and/or straining on more than 1 in 4 bowel movements. RESULTS: Fifty percent (n = 367) of all residents used at least 1 daily laxative, stool softener or enema during a 1-month study period. Over half of all laxative users (n = 200) took more than 60 doses per month. Stool softeners were most commonly prescribed, followed by saline laxatives, stimulant laxatives, hyperosmolar laxatives, and bulk laxatives. Forty-seven percent (n = 213) of the 456 interview responders reported constipation ("self-reporters"), but only 62% of self-reporters met the study criteria for symptom-specific constipation. Concordance between resident's and nurse's report regarding specific bowel symptoms was only fair to slight (kappa 0.12-0.38). Self-reporters of constipation took almost twice as many laxatives, stool softeners, and enemas as residents who did not rep



Arch Surg. 1994 Sep;129(9):920-4; discussion 924-5.
Limited surgery for lower-segment Hirschsprung's disease.

Sawin R, Hatch E, Schaller R, Tapper D.

Department of Surgery, Children's Hospital and Medical Center, University of Washington, Seattle.

OBJECTIVE: To determine if rectal myectomy is an effective treatment for a specific group of patients with Hirschsprung's disease. DESIGN: Retrospective series with follow-up of 6 to 132 months (mean follow-up, 37.1 months). SETTING: Children's hospital. PATIENTS: Fourteen children aged 2 to 14 years with chronic constipation and nondiagnostic barium enema contrast study findings. INTERVENTION: Posterior rectal myectomy. MAIN OUTCOME MEASURES: Laxative use, frequency of stools, incidence of soiling or incontinence, and patient's assessment of improvement. RESULTS: The conditions of all 14 patients improved regardless of the presence of ganglion cells in the myectomy specimen; there were six excellent, six good, and two fair assessments. laxatives were used intermittently by seven of 14 patients. No patients complained of incontinence or soiling. CONCLUSIONS: Rectal myectomy is an effective, less-extensive operation that should be considered for older children with Hirschsprung's disease.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8080373&dopt=Abstract constipation laxative



Nephrol Dial Transplant. 1995;10(9):1607-13.
Chronic hypokalaemia of adults: Gitelman's syndrome is frequent but classical Bartter's syndrome is rare.

Gladziwa U, Schwarz R, Gitter AH, Bijman J, Seyberth H, Beck F, Ritz E, Gross P.

Department of Internal Medicine, University of Heidelberg, Germany.

We evaluated 27 adult patients with chronic hypokalaemia (K+ = 2.9 +/- 0.2 mmol/l), documented over at least 5 years, in whom the cause of the hypokalaemia had not been clarified in spite of previous testing. In 15 patients it was possible to establish a diagnosis by a thorough outpatient workup (diuretic abuse (n = 5), surreptitious vomiting (n = 8), laxative abuse (n = 1), renal tubular acidosis (n = 1)). Commonly utilized tests such as measurements of plasma renin activity, plasma aldosterone, and urinary potassium concentration proved not to be useful in the differential diagnosis of these patients. In contrast the following were diagnostically important: in surreptitious vomiting the hypochloraemia, the mild renal insufficiency, and the extremely low urinary chloride concentration; in diuretic abuse the high urinary concentration of chloride together with repeatedly positive toxicology screens for diuretics; in laxative abuse the high stool weight and extremely low urinary sodium concentration. In the remaining 12 patients none of these diagnoses applied and further tests for suspected Bartter's syndrome were done in the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8559478&dopt=Abstract constipation laxative



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