Constipation - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

CONSTIPATION A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Constipation: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83842-9 1. Constipation-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on constipation. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON CONSTIPATION ......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Constipation................................................................................ 23 The National Library of Medicine: PubMed ................................................................................ 44 CHAPTER 2. NUTRITION AND CONSTIPATION ............................................................................... 89 Overview...................................................................................................................................... 89 Finding Nutrition Studies on Constipation................................................................................. 89 Federal Resources on Nutrition ................................................................................................... 98 Additional Web Resources ........................................................................................................... 99 CHAPTER 3. ALTERNATIVE MEDICINE AND CONSTIPATION ....................................................... 103 Overview.................................................................................................................................... 103 The Combined Health Information Database............................................................................. 103 National Center for Complementary and Alternative Medicine................................................ 104 Additional Web Resources ......................................................................................................... 120 General References ..................................................................................................................... 137 CHAPTER 4. CLINICAL TRIALS AND CONSTIPATION .................................................................... 139 Overview.................................................................................................................................... 139 Recent Trials on Constipation ................................................................................................... 139 Keeping Current on Clinical Trials ........................................................................................... 140 CHAPTER 5. PATENTS ON CONSTIPATION .................................................................................... 143 Overview.................................................................................................................................... 143 Patents on Constipation............................................................................................................. 143 Patent Applications on Constipation ......................................................................................... 164 Keeping Current ........................................................................................................................ 184 CHAPTER 6. BOOKS ON CONSTIPATION........................................................................................ 185 Overview.................................................................................................................................... 185 Book Summaries: Federal Agencies............................................................................................ 185 Book Summaries: Online Booksellers......................................................................................... 186 The National Library of Medicine Book Index ........................................................................... 188 Chapters on Constipation........................................................................................................... 190 Directories.................................................................................................................................. 193 CHAPTER 7. MULTIMEDIA ON CONSTIPATION ............................................................................. 195 Overview.................................................................................................................................... 195 Video Recordings ....................................................................................................................... 195 Bibliography: Multimedia on Constipation ............................................................................... 196 CHAPTER 8. PERIODICALS AND NEWS ON CONSTIPATION .......................................................... 197 Overview.................................................................................................................................... 197 News Services and Press Releases.............................................................................................. 197 Newsletters on Constipation...................................................................................................... 199 Newsletter Articles .................................................................................................................... 200 Academic Periodicals covering Constipation ............................................................................. 202 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 205 Overview.................................................................................................................................... 205 U.S. Pharmacopeia..................................................................................................................... 205 Commercial Databases ............................................................................................................... 206 Researching Orphan Drugs ....................................................................................................... 207 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 211 Overview.................................................................................................................................... 211 NIH Guidelines.......................................................................................................................... 211

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NIH Databases........................................................................................................................... 213 Other Commercial Databases..................................................................................................... 217 APPENDIX B. PATIENT RESOURCES ............................................................................................... 219 Overview.................................................................................................................................... 219 Patient Guideline Sources.......................................................................................................... 219 Finding Associations.................................................................................................................. 230 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 233 Overview.................................................................................................................................... 233 Preparation................................................................................................................................. 233 Finding a Local Medical Library................................................................................................ 233 Medical Libraries in the U.S. and Canada ................................................................................. 233 ONLINE GLOSSARIES................................................................................................................ 239 Online Dictionary Directories ................................................................................................... 241 CONSTIPATION DICTIONARY............................................................................................... 243 INDEX .............................................................................................................................................. 313

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with constipation is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about constipation, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to constipation, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on constipation. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to constipation, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on constipation. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON CONSTIPATION Overview In this chapter, we will show you how to locate peer-reviewed references and studies on constipation.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and constipation, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “constipation” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Diarrhea-Constipation-Pain: When is It Irritable Bowel Syndrome? Source: Consultant. 41(8): 1089-1091, 1095-1096. July 2001. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: Central to the diagnosis of irritable bowel syndrome (IBS) are the symptoms of abdominal pain and disordered defecation of at least 3 months' duration. This article helps physicians determine when the symptoms of diarrhea, or constipation, or pain are indeed due to IBS. Either diarrhea or constipation can predominate, although the defecation pattern may vary from day to day in some patients. In the absence of evidence of more serious disease, diagnosis is based largely on the results of a thorough history and examination. For most patients, general screening tests include a complete

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blood cell count, erythrocyte sedimentation rate, serum chemistry panel, stool guaiac test, and stool examination for ova (eggs) and parasites. For patients older than 50 years, flexible sigmoidoscopy, colonoscopy, or barium enema may be indicated. Management of IBS consists of patient education and reassurance; dietary modification, including increased fiber intake in patients with constipation; and in some cases, judicious use of medications or psychological interventions. 2 tables. 35 references. •

Correcting Constipation: A Regimen That Works Source: Senior Patient. 3(1): 37-41. January-February 1991. Summary: Chronic, untreated constipation can cause abdominal discomfort and rectal pain or tenesmus, and can lead to fecal impaction, fecal and urinary incontinence, and volvulus. This article presents a regimen for correcting constipation that moves the focus away from chronic use of laxatives in high dosages. Topics discussed include the importance of taking a detailed patient history, the physical examination and lab work required for diagnosis, the definitions and causes of constipation, starting treatment, notably for fecal impaction, and the roles of fluid intake, diet, exercise, and private toilet facilities in managing chronic constipation. A recipe for an easy-to-prepare supplement, to use as a source of fiber and a colonic stimulant, is included. 2 figures. 2 tables. 10 references.

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Constipation in the Elderly Source: American Family Physician. 58(4): 907-914. September 15, 1998. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Constipation affects as many as 26 percent of older men and 34 percent of older women and is a problem that has been related to diminished perception of quality of life. This article reviews the problem of constipation in older people and encourages family physicians to learn about and address this problem in their patients. Constipation may be a sign of a serious problem such as a mass lesion, a manifestation of a systemic disorder such as hypothyroidism, or a side effect of medications such as narcotic analgesics. The patient with constipation should be questioned about fluid and food intake, medications, supplements, and homeopathic remedies. The physical examination may reveal local masses or thrombosed hemorrhoids, which may be contributing to the constipation. Visual inspection of the colon is useful when no obvious cause of constipation can be determined. Treatment should address the underlying abnormality. The chronic use of certain treatments, such as laxatives, should be avoided. First-line therapy should include bowel retraining, increased dietary fiber and fluid intake, and exercise when possible. Laxatives, stool softeners, and nonabsorbable solutions may be needed in some patients with chronic constipation. 1 figure. 4 tables. 17 references. (AAM).

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Functional Childhood Constipation: A Practical Approach Source: Practical Gastroenterology. 23(12): 16, 20-22, 24-26, 33-34. December 1999. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: Constipation is a common childhood problem and is frequently encountered by the primary care physician and the pediatric gastroenterologist alike. Although the presentation of constipation in infancy raises concerns about organic etiologies, the large

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majority of infantile and childhood presentations of constipation have a functional basis. This review article emphasizes the concepts basic to the recognition and management of functional childhood constipation from the perspective of a primary care physician. Data obtained through a careful history and physical examination should enable the physician in most cases to confidently establish the diagnosis of functional constipation and exclude less common organic disorders. Infants and older children with atypical features or intractable constipation may require diagnostic investigations. Most children recover satisfactorily after being managed with a combination of incentive based behavior modification and stool softeners. The authors note that early recognition and initiation of behavior modification and pharmacotherapy in children favorably influences prognosis. Children with intractable constipation and those suspected of having underlying organic etiologies can therefore be identified by the primary care physician and referred to a subspecialist for further evaluation. 1 figure. 3 tables. 15 references. •

Therapy of Constipation Source: Alimentary Pharmacology and Therapeutics. 15(6): 749-763. June 2001. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: Constipation is a common symptom that may be idiopathic (of unknown cause) or due to various identifiable disease processes. This article reviews the current recommendations for treating constipation. Laxatives are agents that add bulk to intestinal contents, that retain water within the bowel lumen by virtue of osmotic effects, or that stimulate intestinal secretion or motility, thereby increasing the frequency and ease of defecation. Drugs which improve constipation by stimulating gastrointestinal motility (movement) by direct actions on the enteric nervous system are under development. Mineral oil is a lubricating agent that facilitates defecation by altering stool consistency and by forming a slippery layer around fecal pellets. Other modalities used to treat constipation include biofeedback and surgery. Laxatives and lavage (cleaning) solutions are also used for colon preparation and evaluation of the bowels after toxic ingestions. Most patients with constipation will try to treat this condition themselves before seeking medical attention. Therefore, it is important for the health care provider to obtain a good history of the treatments that have been tried previously in addition to trying to develop a good understanding of exactly what problems the patient is having with defecation. A detailed physical examination, including a thorough rectal examination is also important. 3 tables. 133 references.

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Constipation Management: An In-Service Source: Journal of Nurse Assistants. p. 28-29, 32. July 2000. Contact: Available from Journal of Nurse Assistants. P.O. Box 23365, Chagrin Falls, OH 44023. (440) 247-5668. Fax (440) 247-8925. Summary: Constipation is a very common problem among the elderly. This article helps nurse assistants to understand the causes of constipation and the current recommendations for managing constipation in the elderly population, particularly those living in long term care facilities. The author first discusses the impact of aging on the gastrointestinal system, the problems associated with less exercise and activity, the continued need for adequate hydration (consumption of fluids), the use of medications that may cause or worsen constipation, changes in nutrition and food habits, and the

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impact of alcohol abuse. The author defines constipation as a delay in the routine of defecation, or the elimination of hard dry stool. Nursing facilities often cite a three day limit without stools as the guideline for intervention. The author describes three general types of constipation: atonic (weakness of the muscles of the colon and rectum), obstructive (blockage of the intestines), and spastic (contraction of the muscles of the intestinal wall). The goal for any treatment of the patient with constipation is to develop a regular pattern of bowel elimination and develop methods to prevent constipation. The nurse assistant and home health assistant should learn the patient's bowel pattern and help the patient keep to the pattern. In addition, patients should be encouraged to eat foods that contain fiber, such as fruits and vegetables, grains and cereals. It is essential to provide for privacy and time to defecate. Bedpan use should be avoided if possible. Appropriate hygiene for hands and perineal skin after bowel movements is essential. The author concludes that there are many things that the nurse assistant can do to promote successful elimination. Attention to routines, documentation of results, and reporting to the charge nurse are vital to maintaining normal bowel habits for the residents. Appended to the article is an inservice quiz for readers to test the knowledge gained from reading the article. •

Methylnaltrexone for Reversal of Constipation Due to Chronic Methadone Use: A Randomized Controlled Trial Source: JAMA. Journal of American Medical Association. 283(3): 367-372. January 19, 2000. Summary: Constipation is the most common chronic adverse effect of opioid pain medications in patients who require long term opioid administration, such as patients with advanced cancer, but conventional measures for ameliorating constipation often are insufficient. This article reports on a study undertaken to evaluate the efficacy of methylnaltrexone, the first peripheral opioid receptor antagonist, in treating chronic methadone induced constipation. The double blind, randomized placebo controlled trial was conducted between May 1997 and December 1998 at the clinical research center of a university hospital. The subjects (n = 22, 9 men and 13 women) had a mean age of 43.2 years and were enrolled in a methadone maintenance program and had methadone induced constipation. The 11 subjects in the placebo group showed no laxation response, and all 11 subjects in the intervention group had laxation response after intravenous methylnaltrexone administration. The oral cecal transit times at baseline for subjects in the treatment and placebo groups averaged 132.3 and 126.8 minutes, respectively. The average (standard deviation) change in the treatment group was minus 77.7 minutes, significantly greater than the average change in the placebo group of minus 1.4 minutes. No opioid withdrawal was observed in any subject, and no significant adverse effects were reported by the subjects during the study. The authors conclude that intravenous methylnaltrexone can induce laxation and reverse slowing of oral cecal transit time in subjects taking high opioid dosages. Low dosage methylnaltrexone may have clinical utility in managing opioid induced constipation. 3 figures. 1 table. 37 references.

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Chronic Constipation in Adults: How Far Should Evaluation and Treatment Go? Source: Postgraduate Medicine. 88(3): 49-50, 57-59, 63. September 1, 1990. Summary: Constipation needs to be evaluated in all patients who complain of infrequent or difficult bowel movements. This article outlines the diagnostic effort that should be expended, depending on the patient's age, duration, and severity of constipation, and presence of concomitant symptoms. The author also offers advice on

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treating constipation that is primarily functional. The author stresses that structural evaluation of the entire colon by barium enema should be considered when constipation is of recent onset, is severe, or does not resolve with simple measures. One sidebar illustrates the anatomical function of normal defecation. The author also lists some bulkforming agents and laxatives for treating constipation. 2 figures. 21 references. (AA-M). •

Constipation and Fecal Incontinence in the Elderly Source: Gastroenterology Clinics of North America. 30(2): 497-515. June 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: Continence and defecation are complex functions that require the interaction of visceral and pelvic muscles and the nerves that regulate their activity. These activities may be abnormal in elderly patients and can produce symptoms, such as chronic constipation or fecal incontinence (involuntary loss of stool). This article, from a special issue on gastrointestinal (GI) disorders in the elderly, addresses constipation and fecal incontinence in this population. The author emphasizes that, contrary to widespread opinion, much can be done to improve constipation and incontinence in the elderly and relieve a considerable burden in these patients. Relatively little research has been done to differentiate physiologic changes in rectoanal function resulting from aging and pathologic changes resulting from diseases occurring as patients age. Treatment includes identification and treatment of the underlying disease, if possible, protective skin care, continence aids, psychologic support, drug therapy (for stimulation of defecation at intervals, antidiarrheal drugs), biofeedback, and surgical therapy. Results of therapy often can be good, leading to alleviation of suffering and the ability to lead a fuller life. 1 figure. 4 tables. 92 references.

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Functional Constipation Source: Seminars in Pediatric Surgery. 4(1): 26-34. February 1995. Contact: Available from W.B. Saunders Company. Curtis Center, Independence Square West, Philadelphia, PA 19106-3399. (800) 654-2452. Summary: In this article, the author explains the differential diagnosis of constipation in childhood; develops an algorithm for the evaluation of children with severe constipation to identify patients who need surgical therapy or might benefit from surgical therapy; outlines the nonsurgical treatment of constipation; and reports on treatment outcome in children with functional constipation. The treatment program for functional constipation includes various forms of behavioral therapy and psychological approaches, and consists of education, disimpaction, prevention of reaccumulation of stools with fiber and laxatives, and reconditioning to normal bowel habits with frequent toileting. 4 figure. 1 table. 47 references. (AA-M).

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Chronic Constipation in Children Source: Gastroenterology. Volume 105(5): 1557-1564. November 1993. Summary: In this article, the author reviews chronic constipation in children. The author describes the symptoms of chronic constipation in infants and older children; presents the differential diagnosis and algorithms for the evaluation of these children; and explains treatment and treatment outcomes. She notes that constipation in very young children and in older children differs considerably from that in adults. Most patients will benefit from a program designed to clear stools, to prevent further impaction, and

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to promote regular bowel habits. Fifty percent of patients will be cured after 1 year and 65 to 70 percent after two years. 2 figures. 2 tables. 61 references. (AA-M). •

Chronic Idiopathic Constipation: Pathophysiology and Treatment Source: Journal of Clinical Gastroenterology. 22(3): 190-196. April 1996. Summary: In this article, the authors consider the pathophysiology and treatment of chronic idiopathic constipation, a common occurrence in the general population, especially in women. Topics include the need for more consistent definitions and terminology, the primary and secondary forms of constipation, the clinical and pathophysiological patterns of slow-transit constipation and normal-transit constipation, treatment issues, dietary and pharmacologic treatment, psychological and behavioral treatment, and surgical treatment. The authors conclude that conservative nonsurgical measures, including biofeedback, are indicated for the great majority of constipated patients, whereas more aggressive (surgical) options are available for a distinct and increasingly identifiable minority of patients with disabling and intractable symptoms. 2 tables. 92 references. (AA-M).

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Constipation and Fecal Incontinence in the Elderly Population Source: Mayo Clinic Proceedings. 71(1): 81-92. January 1996. Summary: In this article, the authors describe the assessment and management of constipation and fecal incontinence in elderly patients. The authors review the recent medical literature and outline management strategies for these problems. Constipation is classified into two syndromes: functional constipation and rectosigmoid outlet delay. Evaluation consists of a detailed history, directed physical examination, and selected laboratory tests. Management involves nonpharmacologic (such as exercise and fiber) and pharmacologic measures. Fecal incontinence in elderly patients can be due to stool impaction, medications, dementia, or neuromuscular dysfunction. The authors stress that management of these disorders should be highly individualized and dependent on cause, coexisting morbidities, and cognitive status. 10 tables. 73 references. (AA-M).

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Functional Colonic and Anorectal Disorders: Detecting and Overcoming Causes of Constipation and Fecal Incontinence Source: Postgraduate Medicine. 98(5): 115-119, 124-126. November 1995. Summary: In this article, the fourth of four articles on diseases of the colon, the author discusses functional colonic and anorectal disorders, notably constipation and fecal incontinence. The author encourages readers to overcome reluctance to discuss defecation disorders and pursue thorough history taking. The author summarizes methods for determining the underlying cause of these disorders and describes approaches to management to help restore confidence and dignity to patients. Readers can qualify for continuing medical education credits by completing the posttest after the article. 1 figure. 1 table. 40 references. (AA-M).

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Increasing Oral Fluids in Chronic Constipation in Children Source: Gastroenterology Nursing. 21(4): 156-161. July-August 1998. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555.

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Summary: Increasing the amount and type of fluid intake in children with simple constipation remains a common intervention recommended by both the medical profession and lay consumers. However, there is no research or physiologic basis for increasing overall water intake and or high osmolarity liquid intake in order to produce softer or more frequent stools. This article reports on a project undertaken to identify whether a concerted effort to increase liquid intake would lead to an effect on stooling characteristics. Ninety children completed the entire study as assigned (59 girls, 31 boys). Neither increasing water intake nor increasing hyperosmolar liquid intake significantly increased stool frequency or decreased consistency or difficulty with passage. The authors conclude that nurses need to be proactive in changing commonly held thoughts regarding the treatment of pediatric constipation. Advising new parents of what is acceptable in stooling patterns is important. Encouraging a high insoluble fiber intake is more beneficial in promoting healthy stool patterns than any amount of increased liquid intake. Advising parents of constipated children to increase liquid intake is not helpful and should not be recommended unless history suggests that the child's liquid intake is inadequate for a normal child of that age and activity level. 3 figures. 4 tables. 19 references. (AA-M). •

Chronic Idiopathic Constipation: A Psychological Enquiry Source: European Journal of Gastroenterology and Hepatology. 13(1): 39-44. January 2001. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London SE1 1GB, UK 44(0)20-7940-7502. Fax: 44(0)20-7940-7574. Website: http://www.eurojgh.com/. Summary: Intractable idiopathic (of undetermined cause) constipation in women is often associated with psychosocial problems. This article reports on a study undertaken to determine the past and current psychological factors associated with slow and normal transit constipation. Consecutive female patients (n = 28) referred for biofeedback treatment were interviewed before the procedure. Transit studies revealed that 12 had slow transit constipation (STC) and 16 had normal transit constipation (NTC). Patients were assessed for evidence of previous and current psychiatric diagnoses; family and social history was noted; and self-rating scales were used to measure psychological distress, abnormal attitudes to eating, and current psychosocial functioning. The mean age of the 28 patients was 38.2 years (plus or minus 10.8 years) with a mean duration of symptoms of 17.6 years (plus or minus 16.9 years). Seventeen (61 percent) had a current psychiatric disorder and 18 (64 percent) a previous episode of psychiatric illness. The mean age of the 16 NTC patients was 38.4 years (plus or minus 10.1 years) with a mean duration of symptoms of 12.4 years (plus or minus 15.9 years). By contrast, the 12 STC patients had a much longer mean duration of constipation (24.3 years; plus of minus 16.4 years), a mean age of 37.9 years (plus of minus 12.1 years), with half having an onset in childhood. The STC patients reported more psychosocial distress on the rating scales than those with NTC, and only one did not experience some form of adverse life event or gynecological procedure in the 6 months before the onset of constipation. Eleven (39 percent) of the 28 women had had a hysterectomy at a mean age of 36 years, but only four (14 percent) reported a history of sexual abuse. Of the nine (32 percent) patients who reported markedly distorted attitudes to food, six had NTC and three had STC. The authors conclude that although STC is a chronic disorder accompanied by high rates of psychological distress, it does not appear to be associated with gross functional impairment. The authors suggest that patients who present to surgical

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departments with chronic intractable constipation should routinely have a psychological assessment. 2 figures. 3 tables. 31 references. •

Randomized, Double-blind, Placebo-Controlled Trial of Tegaserod in Female Patients Suffering from Irritable Bowel Syndrome With Constipation Source: Alimentary Pharmacology and Therapeutics. 16(11): 1877-1888. November 2002. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which affects up to 20 percent of the population, with a predominance in females. This article reports on a study undertaken to evaluated the effectiveness and safety of the drug tegaserod in female patients with IBS characterized by symptoms of abdominal pain or discomfort and constipation. In the randomized, double-blind, multicenter study, 1519 women received either tegaserod, 6 milligrams twice a day (n = 767), or placebo (n = 752) for 12 weeks, preceded by a 4 week baseline period without treatment and followed by a 4 week open withdrawal period. The primary effectiveness evaluation was the patient's symptomatic response as measured by the Subject's Global Assessment of Relief. Other efficacy variables included abdominal pain or discomfort, bowel habits, and bloating. Results showed that tegaserod produced significant improvements in the Subject's Global Assessment of Relief and other efficacy variables. These improvements were seen within the first week, and were maintained throughout the treatment period. After withdrawal of treatment, the symptoms rapidly returned. Overall, tegaserod was well tolerated. Diarrhea was the most frequent adverse event; however, this led to discontinuation in only 1.6 percent of tegaserod-treated patients. The authors conclude that tegaserod produced rapid and sustained improvement of symptoms in female irritable bowel syndrome patients and was well tolerated. 4 figures. 2 tables. 31 references.

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Childhood Constipation: Finally Some Hard Data About Hard Stools! (editorial) Source: Journal of Pediatrics. 136(1): 4-7. January 2000. Contact: Available from Mosby, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351 or (314) 453-4351. Fax (314) 432-1158. Website: www.mosby.com. Summary: It is estimated that 55 million adults in the United States (approximately 28 percent of the population) are constipated. Similar data are not available on the prevalence in children, although it has been reported that 34 percent of toddlers in the United Kingdom and 37 percent of Brazilian children younger than 12 were considered by their parents to be constipated. This editorial offers a review of the literature on childhood constipation, focusing on research studies that quantified the prevalence of the problem. The editorial also serves as an introduction to two related articles in the same issue of Journal of Pediatrics. The author notes that the most common cause of constipation in pediatrics is a decision made by the child to delay defecation after experiencing a painful or frightening evacuation. Treatment is based on addressing all the factors that have contributed to its development. The evacuations are made more pleasant by stool softeners. The fear of defecation is overcome by avoiding anally invasive procedures (such as enemas) and by using positive reinforcement to make the process less intimidating. Key to successful treatment is a thorough understanding by the family of the pathophysiology of childhood constipation. The author applauds the

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authors of the other articles for addressing this poorly studied subject. Progress in the understanding of colonic motility disorders and the pathophysiologic mechanisms responsible for treatment failures will help in the selection of patients who may benefit from the use of cisapride and dietary changes. Development of safe prokinetics with a more selective action on colonic motility will undoubtedly facilitate their use in the treatment of childhood constipation. 12 references. •

Prucalopride, a Systemic Enterokinetic, for the Treatment of Constipation Source: Alimentary Pharmacology and Therapeutics. 16(7):1347-1356. July 2002. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: Laxatives are frequently ineffective in treating constipation. An alternative therapeutic approach is to target serotonin 4 receptors, which are involved in initiating peristalsis. This article reports on a study undertaken to assess the effectiveness and safety of a systemically active serotonin 4 agonist, prucalopride. In the study, 74 women with constipation were stratified into slow or normal transit groups, and each group was randomized to receive either placebo or 1 milligram prucalopride daily for 4 weeks. Prucalopride, not placebo, increased spontaneous stool frequency and reduced time to first stool. Prucalopride reduced the number of retained markers in all patients compared to placebo. Prucalopride reduced the mean number of retained markers in slow transit, but did not alter the marker count in normal transit. Orocecal transit was accelerated by prucalopride, not placebo. Prucalopride, not placebo, increased rectal sensitivity to distension and electrical stimulation. Prucalopride significantly improved several domains of the Short Form Health Status Survey and the disease specific quality of life. Adverse effects were similar for prucalopride and placebo. 1 figure. 3 tables. 39 references.

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Constipation in Imperforate Anus Source: Pull-Thru Network News. 8(1): 1-2. February 1999. Contact: Available from Pull-Thru Network. 4 Woody Lane, Westport, CT 06880. Summary: Most of the patients who are born with imperforate anus and undergo a repair that preserves their rectum will be constipation. This newsletter article reviews the problem, which seems to be the clinical manifestation of a hypomotility disorder of the rectosigmoid colon. After colostomy closure, proper treatment of the constipation is imperative. When it is not treated properly (meaning that the rectum is emptied every day), the megasigmoid worsens. The author notes that constipation can be a serious problem because it eventually provokes fecal incontinence, even in patients who were born with a potential for bowel control. The author also discusses the diagnosis of Hirschsprung's disease and imperforate anus, stressing that this condition is overdiagnosed. Patients with poor potential for bowel control and constipation should be treated with an enema every day, with close monitoring until the regimen is established. Patients with a good potential for bowel control and constipation should be treated with laxatives; however, it is important to establish the proper amount of laxatives for the individual patient. The author concludes with a brief discussion of the complication of tethered cord.

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Outpatient Quality Assurance Monitor: Constipation/Encopresis Source: Gastroenterology Nursing. 17(2): 57-60. September-October 1994. Summary: Quality Assurance (QA) programs assure that patients get the appropriate care, information, and support needed to produce better health outcomes. In this article, the authors describe monitoring the nursing process by documentation of care in patients with constipation and encopresis. Topics include treatment methods used to monitor the health care; data collection; and a discussion, including recommendations for other facilities hoping to undertake a QA program. The authors also employed a longitudinal follow-up to monitor patient outcomes. They note that the process portion of the monitor program was very successful, but the results of the outcome monitor were disappointing. 2 figures. 2 tables. 5 references. (AA-M).

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Chronic Constipation: Causes and Management Source: Hospital Practice. p. 89-100. April 30, 1990. Summary: Since the term constipation represents symptoms rather than a disease, an individual's definition of constipation is bound to be highly subjective. This article discusses the causes and management of chronic constipation. The author describes three syndromes with unidentified causes: idiopathic chronic constipation; irritable bowel syndrome; and idiopathic intestinal pseudo-obstruction. The author also discusses some identifiable causes of constipation, including: dietary factors and physical inactivity, diabetes mellitus, drug-induced constipation, and specific motility disorders. Three final sections cover the diagnostic approach, medical treatment, and surgical treatment for chronic constipation. 2 tables. 2 figures. 6 references.

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Slow Transit Constipation: A Disorder of Pelvic Autonomic Nerves? Source: Digestive Diseases and Sciences. 46(2): 389-401. February 2001. Contact: Available from Kluwer Academic/Plenum Publishers. 233 Spring Street, New York, NY 10013-1578. (212) 620-8000. Fax (212) 807-1047. Summary: Slow transit constipation (STC) is a severe motility disorder, which in the majority of cases is of unknown etiology. In some patients, symptoms arise in childhood, but a proportion of patients present in later life, including after pelvic surgery or childbirth. In this article, the authors describe the current knowledge of the anatomy and function of the pelvic autonomic nerves with respect to colonic motility (experimental and observational studies); discuss evidence for pelvic nerve injury in STC arising after pelvic surgery or childbirth; and, on the basis that such patients are clinically indistinguishable from patients with chronic idiopathic (of unknown cause) STC, to evaluate whether there is evidence that pelvic autonomic neuropathy (nerve damage or disease) has an etiologic role in patients with chronic idiopathic STC. The authors document the clear importance of the pelvic autonomic nerves in colonic motor function. While there is an association between pelvic surgery and childbirth, and the onset of STC, there is little direct anatomical evidence that pelvic denervation occurs in these patients. However, the phenotype of these patients is similar to results of experimental and observational studies. The authors present evidence for possible pathogenetic mechanisms underlying the pelvic autonomic neuropathy in chronic idiopathic STC. 1 figure. 3 tables. 162 references.

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American Gastroenterological Association Medical Position Statement: Guidelines on Constipation Source: Gastroenterology. 119(6): 1761-1766. December 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: Symptoms of constipation are extremely common; the prevalence has been reported to be as high as 20 percent. Many people seek medical care for constipation, but fortunately, most do not have a life threatening or disabling disorder, and the primary need is for control of symptoms. This document presents the official recommendations of the American Gastroenterological Association (AGA, May 2000) on managing patients with constipation. Recommendations focus on more rational and less invasive diagnostic approaches, and more rational and effective therapies that will improve the patient's quality of life; both of these approaches should have beneficial fiscal and logistic impacts on the health care system. The document first defines constipation and its clinical subgroups, including slow transit constipation (colonic inertia), pelvic floor dysfunction, and combination syndromes, then reviews the recommended clinical evaluation of the patient who presents with constipation. The remainder of the document briefly reviews the diagnostic tests, medical management, and the place of surgery and pelvic floor retraining programs for this patient population. 3 figures. 1 reference.

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Long-term Safety of Tegaserod in Patients with Constipation-Predominant Irritable Bowel Syndrome Source: Alimentary Pharmacology and Therapeutics. 16(10): 1701-1708. October 2002. Contact: Available from Alimentary Pharmacology and Therapeutics. Blackwell Science Ltd., Osney Mead, Oxford OX2 OEL, UK. +44(0)1865 206206. Fax +44(0)1865 721205. Email: [email protected]. Website: www.blackwell-science.com. Summary: The oral administration of the drug tegaserod causes gastrointestinal (GI) effects resulting in increased gastrointestinal motility (movement of contents through the GI tract) and attenuation of visceral sensation. This article reports on a study undertaken to determine the long term safety and tolerability of tegaserod in patients with irritable bowel syndrome (IBS) with constipation as the predominant symptom of altered bowel habits. The multicenter, open label study included 579 patients. Of these, 304 (53 percent) completed the trial. The most common adverse events, classified as related to tegaserod for any dose, were mild and transient diarrhea (10.1 percent), headache (8.3 percent), abdominal pain (7.4 percent), and flatulence (5.5 percent). Forty serious adverse events were reported in 25 patients (4.4 percent of patients) leading to discontinuation in 6 patients. There was one serious adverse event, acute abdominal pain, classified as possibly related to tegaserod. There were no consistent differences in adverse events between patients previously exposed to tegaserod and those treated for the first time in this study. The authors conclude that tegaserod appears to be well tolerated in the treatment of patients with constipation-predominant IBS. The adverse event profile, clinical laboratory evaluations, vital signs, and electrocardiogram recordings revealed no evidence of any unexpected adverse events, and suggest that treatment is safe over a 12 month period. 1 figure. 4 tables. 23 references.

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Use of Soluble Fiber in Constipation-Predominant IBS: A Non-Controversy Source: Practical Gastroenterology. 20(9): 64, 66-68, 70. September 1996.

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Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article defines the use of soluble fiber in constipation predominant irritable bowel syndrome (IBS). The author contends that the physiologic and clinical evidence confirms the value of soluble fiber in the treatment of this condition. When soluble fiber is appropriately employed as a dietary supplement in graded doses with adequate fluid intake, benefit may be seen in the form of increased stool weight, improved consistency of stools, reduced transit time, better-lubricated stools, and improved rectal satisfaction. The author stresses that close attention must be given to variations in individual diets, particularly with regard to total intake of 'natural' fiber. The dose of dietary fiber should be adjusted to each patient's response, allowing enough time to evaluate that response effectively. Practitioners should also distinguish between excessive rectal gas (which indicates excessive gas production) and feelings of bloating (which are usually unrelated to excessive gas production). 19 figures. (AA-M). •

Anorectal Manometry, EMG, Defecography and Colonic Transit Studies to Evaluate Constipation Source: Practical Gastroenterology. 23(8): 52, 54, 58, 60, 62. August 1999. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article discusses tests used to evaluate constipation, including anorectal manometry, electromyography, defecography, and colonic transit studies. Anorectal manometry provides information about the pressure activity of the rectum and the anal canal, together with an evaluation of the rectal sensation, the recto anal reflexes, and the rectal compliance. Electromyography (EMG) is used in the investigation of the internal and external sphincters as well as pelvic floor muscles. Defecography is the functional fluroscopic evaluation of rectal emptying, using both fluoroscopy and videotape. Defecography clearly defines the anorectal angle and its paradoxical increase in pelvic floor dyssynergia. The colonic transit study is most helpful in evaluating a constipated patient with infrequent defecation. This test can use scintigraphy, a single marker bolus technique, or a multiple marker bolus technique. Colonic transit studies can distinguish between colonic inertia and outlet delay. The author stresses that accurate diagnosis can then result in specific treatment being offered and succeeding. 3 figures. 1 table. 10 references.

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Constipation, Part II: Remedies Source: Harvard Health Letter. 16(5): 5-6. March 1991. Summary: This article discusses the various treatments for constipation. The author stresses that people with essentially normal bowel function who are going through a period of transitory discomfort can probably help themselves most effectively by increasing their dietary fiber intake, drinking plenty of water, and getting moderate amounts of exercise. For each of these measures, the author considers the advantages, disadvantages, and arguments supporting or rejecting their use. The author also discusses laxatives, suppositories, enemas, and surgery as treatment for constipation. One sidebar details four categories of oral laxatives.

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Treating Constipation in the Patient With Diabetes Source: Diabetes Educator. 21(3): 223-232. May-June 1995.

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Contact: Available from American Association of Diabetes Educators. 444 North Michigan Avenue, Suite 1240, Chicago, IL 60611-3901. (312) 644-2233. Summary: This article explains how to treat constipation in the patient with diabetes. These patients have a significant risk of developing severe constipation, often due to dysfunction of the autonomic nervous system. The author addresses epidemiology and risk factors; the clinical features of constipation; patient evaluation; the pathophysiology of constipation in diabetes; and treatment options, including nonpharmacologic and lifestyle interventions, and drug treatment. Four tables summarize the disorders commonly associated with constipation; drugs that may cause constipation; food sources of dietary fiber; and the pharmacologic treatments for constipation. The author concludes that prokinetic agents, particularly cisapride, provide a legitimate choice when more conservative management has failed and should be considered second line therapy in the patient with diabetes who has evidence of autonomic dysfunction. 5 tables. 43 references. (AA-M). •

Hirschsprung's Disease: A Cause of Chronic Constipation in Children Source: American Family Physician. 51(2): 487-494. February 1, 1995. Summary: This article for primary care physicians explains the problem of Hirschsprung's disease as a cause of chronic constipation in children. Hirschsprung's disease is characterized by an absence of the intramural ganglionic cells at the submucosal and myenteric levels of the intestine. The course of the disease is variable, with five distinct patterns of varying severity. Without treatment, mortality approaches 50 percent by one year of age, but early diagnosis and intervention are associated with a favorable outcome. Topics include definition, etiology, clinical course, differential diagnosis, treatment, and prognosis. A brief case report is presented. The authors also review the surgical treatment involved. 3 figures. 6 tables. 24 references. (AA-M).

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Dealing with Irregularity: Constipation, Diarrhea, Excessive Gas and Foul-Smelling Gas Source: Digestive Health and Nutrition. 3(1): 16-20. January-February 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email: [email protected]. Summary: This article offers strategies for dealing with problems of bowel irregularity, including constipation, diarrhea, excessive gas, and foul-smelling gas. The author notes that bowel habits vary greatly among individuals, so each person's perception of whether there even is a problem and how to deal with it best is different. The author stresses that too little fiber and liquid in the diet are by far the most common reasons for constipation among people living in western cultures. The fiber found in foods such as fruits, grains, and vegetables adds bulk to the stool, making it easier to move through the colon (large intestine). Liquids add both bulk and fluid to the stool. Exercise helps prevent constipation by maintaining energy levels and promoting intestinal activity. A number of pain medications; antidepressants; antacids that contain aluminum; diuretics; and antiinflammatory and antiseizure medications are some of the many medications that can contribute to constipation. Changes in routines can also cause irregularity. The author explores the role of aging as a cause of constipation. Laxatives are an effective remedy for constipation, but they should be used with caution. As with constipation, diarrhea means different things to different people. Bacterial and viral infections are the most common causes of acute diarrhea; food intolerance is another frequent cause of

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both diarrhea and gas. Regardless of the cause, diarrhea usually lasts only a few days and ends on its own without the need for medical attention. The author reviews the concerns regarding dehydration, which can be a consequence of diarrhea, particularly in children and in the elderly. Gas comes from two sources: swallowed air and the breakdown of certain undigested foods in the large intestine. Simple ways of reducing the gas from swallowed air include eating and drinking more slowly, not chewing gum, and having dentures properly fitted. For episodes of excessive or smelly intestinal gas, the use of a food diary may help identify the offending items. The author concludes by reiterating the importance of adequate fiber and fluid intake. The websites of four information resource organizations are listed. •

Constipation, Part I: The Hard Facts Source: Harvard Health Letter. 16(4): 1-4. February 1991. Summary: This article presents a general introduction to the most common gastrointestinal complaint in the United State, constipation. The author delineates five main categories of constipation, discusses possible causes of constipation, explains the typical diagnostic tests used, and reviews some of the basic facts of the biological processes of digestion and excretion. The author also briefly mentions the role of psychological factors in constipation. 1 figure.

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Clinical Management of Intractable Constipation Source: Annals of Internal Medicine. 121(7): 520-528. October 1994. Summary: This article presents a review of the current management of intractable constipation. The authors identified by MEDLINE search original articles and reviews published in the English-language literature between 1965 and 1993. Key words included constipation, epidemiology, colonic inertia, pseudo-obstruction, pelvic floor dysfunction, and results of therapeutic interventions, particularly the effects of biofeedback training and subtotal colectomy. The authors conclude that, in most patients, constipation is usually due to lack of dietary fiber and responds to simple measures to correct these factors, often without need to consult a physician. In some, probably fewer than 10 percent of patients who consult their physicians, structural diseases of the colon and rectum, systemic disease, or medications that slow gut transit should be excluded, and regular exercise, dietary fiber, and an osmotic laxative prescribed. They present an algorithmic approach that can carefully select patients with intractable constipation for behavioral modification and biofeedback. The long-term outcome is excellent, with at least 75 percent success in several series. 2 figures. 2 tables. 73 references. (AA-M).

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Pediatric Constipation Source: Gastroenterology Nursing. 19(3): 88-95. May-June 1996. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-6423 or (410) 528-8555. Summary: This article presents an overview of pediatric constipation. The author defines constipation from a medical and nursing point of view. Intestinal pathophysiology as well as etiological theories of pediatric constipation are reviewed. The author presents current research and describes clinical treatment and experience in this area. The author also suggests topics for patient education (for family members), including normal GI anatomy and physiology; suspected etiology and alterations in

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physiology with constipation; variability of stool patterns and stool characteristics; proper positioning for stooling; dietary factors; and the potential harm of some laxatives and manual stimulation techniques. 2 figures. 1 table. 93 references. (AA-M). •

Colectomy for Slow-Transit Constipation: Preoperative Functional Evaluation Is Important but Not a Guarantee for a Successful Outcome Source: Diseases of the Colon and Rectum. 44(4): 577-580. April 2001. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. Summary: This article reports on a study designed to assess the results of preoperative functional evaluation of patients with severe slow transit constipation in relation to functional outcome. The study included 439 patients with chronic intractable constipation who were evaluated by marker studies. Of these patients, 21 underwent colectomy (removal of a portion of the colon) and ileorectal anastomosis (reconnection of the ileum portion of the small intestine to the rectum) for slow transit constipation. Mean colorectal transit time was 156 hours (normal time is usually less than 45 hours). Small bowel transit time was normal in 10 patients and delayed in 5 patients. Six patients were nonresponders. Morbidity (illness or complications) was 33 percent. Small bowel obstruction occurred in 6 patients; relaparotomy was done in 4 patients. Follow up varied from 14 to 153 months. After three months, defecation frequency was increased in all patients. mean stool frequency improved from one bowel movement per 5.9 days to 2.8 times per day. Sixteen patients felt improved after surgery. Seventeen patients continued to experience abdominal pain, and 13 still used laxatives and enemas. Satisfaction rate was 76 percent (16 patients). After one year, defecation frequency was back at the preoperative level in 5 patients. An ileostomy was created in two more patients because of incontinence and persistent diarrhea. Eleven patients (52 percent) still felt improved. A relation between small bowel function and functional results could not be demonstrated. The authors conclude that preoperative evaluation is important but not a guarantee for successful outcome. Colectomy remains an ultimate option for patients with disabling slow transit constipation, but patients should be informed that, despite an increased defecation frequency, abdominal symptoms might persist. Any common use of colectomy to treat constipation should be discouraged. 1 table. 16 references.

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Electrorectogram in Chronic Constipation, Ulcerative Proctitis, Hirschsprung's Disease, and Neurogenic Rectum Source: Practical Gastroenterology. 20(12): 13-20. December 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article reports on a study in which recordings of rectal electrical activity (electrorectography, or ERG) were made in 23 healthy volunteers, 22 patients with chronic constipation (CC), 11 patients with ulcerative proctitis, 14 patients with Hirschsprung's disease (HD), and 28 patients with neurogenic rectum (NR). Normal ERG was manifested as regular slow waves or pacesetter potentials (PPs), which had constant frequency. Pacesetter potentials were followed randomly by action potentials (APs), which were associated with a mild increase of rectal pressure. In CC, two ERG patterns were identified: bradyrectia in inertia constipation and tachyrectia in obstructive constipation. Ulcerative proctitis manifested with tachyrectia and HD with 'silent' ERG (no PPs or APs). In NR, ERG of patients with upper motor neuron lesions

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exhibited rectoarrhythmia (irregular PPs), and patients with lower motor neuron lesions showed silent ERG. No complications occurred. The author concludes that rectal motility seems to be controlled by PPs. Disorders of rectal electrical rhythm or 'dysrhythmia' may cause rectal dysmotility and defecation disorders. The electrorectogram is noninvasive and nonradiologic and can be used as an effective investigational tool in rectal disorders. 8 figures. 1 table. 43 references. (AA-M). •

Constipation in an Elderly Community: A Study of Prevalence and Potential Risk Factors Source: American Journal of Gastroenterology. 91(1): 19-25. January 1996. Summary: This article reports on a study of the prevalence of and potential risk factors for constipation in a representative elderly community, using symptom-based diagnostic criteria. An age-and gender-stratified random sample of 1,833 residents of Olmsted County, MN, aged 65 years and over, was mailed a valid self-report questionnaire; 1,375 responded (75 percent). The overall age-and gender-adjusted prevalence (per 100) of any constipation was 40.1; for functional constipation and outlet difficulty or delay, the prevalence was 24.4 and 20.5, respectively. Self-reported constipation did not reliably identify functional constipation or outlet delay. Nonsteroidal anti-inflammatory drugs and other medications were significant risk factors in subjects with functional constipation and outlet delay combined. 3 figures. 3 tables. 21 references. (AA-M).

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Cisapride for the Treatment of Constipation in Children: A Double-Blind Study Source: Journal of Pediatrics. 136(1): 35-40. January 2000. Contact: Available from Mosby, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146-3318. (800) 453-4351 or (314) 453-4351. Fax (314) 432-1158. Website: www.mosby.com. Summary: This article reports on a study undertaken to determine whether cisapride is effective in treating children with constipation. The double blind, placebo controlled study included children with chronic constipation who were randomly assigned to treatment with cisapride or placebo for 12 weeks. Forty children were enrolled, and 36 completed the therapy. Treatment successes occurred in 13 of 17 subjects in the cisapride group (76 percent) and 8 of 19 subjects in the placebo group (37 percent). The odds ratio for response after cisapride administration was 8.2 times higher. During cisapride therapy, there was a significant improvement in the number of spontaneous bowel movements per week and a significant decrease in the number of fecal soiling episodes per day, percentage with encopresis, number of laxative doses per week, percentage using laxatives, and total gastrointestinal transit time. With placebo, there were no significant changes in the number of spontaneous bowel movements, percentage with encopresis, or total gastrointestinal time; but there was a significant decrease in the number of fecal soiling episodes per day and the number of laxative doses per week. The authors conclude that cisapride was effective in treating children with constipation. The authors note, however, that cisapride is not recommended as the first line drug for children with constipation. Dietary fiber and other behavior changes are recommended first. 1 figure. 2 tables. 27 references.

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Chronic Constipation in Children: Rational Management Source: Consultant. 42(12): 1723-1732. November 2001.

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Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: This article reviews a strategy of rational management of chronic constipation in children. The authors note that irregular bowel habits are a common cause of chronic constipation in children; illness and travel are among the disruptions in daily routine that can result in stool withholding. Medical conditions, such as diabetes and Hirschsprung disease, and medications, including methylphenidate, analgesics, and cough syrups, can also cause constipation. Encopresis (fecal incontinence, or involuntary loss of stool), anal outlet bleeding, and rectal pain caused by anal fissures are associated with chronic constipation; hemorrhoids rarely develop in children. Barium enemas, survey films, and colonic transit studies can detect and define functional or structural obstruction. Physicians should recommend regular postprandial (after a meal) toilet visits; moderate exercise; and increased fluid and fiber intake, using a 'medicinal' fiber product if necessary. Parents should be discouraged from excessive use of laxatives and cathartics. Options for long term therapy include mineral oil and osmotic laxatives. 3 tables. 69 references. •

Medication-Induced Colonic Disease, Radiation Proctitis, Colonic Metabolism, and the Treatment of Diarrhea and Constipation Source: Current Opinion in Gastroenterology. 8: 57-62. February 1992. Summary: This article reviews large intestine-related recent articles on several topics, including medication-induced colonic disease, radiation proctitis, colonic metabolism, and the treatment of diarrhea and constipation. Medication-induced diseases discussed include injury from detergent enemas, analgesic suppositories containing acetylsalicylic acid and paracetamol, injury from nonsteroidal anti-inflammatory drugs, and colonic pseudoobstruction due to oral amphetamines. Articles dealing with radiation proctitis include a review of long-term complications, an animal model of proctitis cystica profunda, and treatment of chronic bleeding with hyperbaric oxygen. Studies of the role of short-chain fatty acids in colonic blood flow and on the treatment of chronic constipation with sorbitol are also reviewed. 3 figures. 26 annotated references. (AA-M).

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Slow Transit Constipation Source: Gastroenterology Clinics of North America. 30(1): 77-95. March 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: This article reviews slow transit constipation, a clinical syndrome characterized by intractable constipation poorly responsive to dietary fiber and laxatives. Other gastrointestinal manifestations include abdominal pain, bloating, malaise, nausea, anorectal symptoms suggestive of difficult fecal expulsion, and delayed colonic transit without megacolon. Extragastrointestinal symptoms in this syndrome include painful or irregular menses, hesitancy in initiating micturition (urination), and somatic symptoms such as cold hands or blackout. The authors briefly discuss terminology and stress that slow transit constipation is the term used to define a disorder of colonic motor function, and is generally used for patients with delayed colonic transit but no underlying systemic disorder or pelvic floor dysfunction that explains their symptoms. The authors discuss epidemiology, pathophysiology, histology, clinical features, differential diagnosis, radiopaque marker diagnostic methods, scintigraphic techniques, medical treatments, surgical treatment, and the special situation of colonic dysfunction after spinal cord injury. The authors note that

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the disorder spans a spectrum of variable severity, ranging from patients who have relatively mild delays in transit but who are otherwise indistinguishable from irritable bowel syndrome patients at one extreme, to patients with colonic inertia or chronic megacolon at the other extreme. Potential mechanisms for impaired colonic propulsion include fewer colonic HAPCs (high amplitude propagated contractions) or a reduced colonic contractile response to a meal. The treatment is primarily medical; surgery is reserved for patients with severe disease or colonic inertia. 3 figures. 1 table. 85 references. •

Childhood Constipation: Evaluation and Treatment Source: Journal of Clinical Gastroenterology. 33(3): 199-205. 2001. Contact: Available from Lippincott Williams and Wilkins, Inc. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Summary: This article reviews the evaluation and treatment of childhood constipation, a common condition. The authors estimate that between 5 and 10 percent of pediatric patients have constipation or encopresis (fecal soiling). Constipation is the second most referred condition in pediatric gastroenterology practices, accounting for up to 25 percent of all visits. The authors lay out a practical approach for those physicians not familiar with constipation in children. The diagnosis of constipation requires careful history taking and interpretation. Diagnostic tests are not often needed and are reserved for those who are severely affected. The daily bowel habits of children are extremely susceptible to any changes in routine environment. Constipation and subsequent fecal retention behavior often begins soon after a child has experienced a painful evacuation. Childhood constipation can be difficult to treat and often requires prolonged support by physicians and parents, explanation, medical treatment, and most importantly, the child's cooperation. 1 figure. 5 tables. 31 references.

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Preventing Constipation in Older People Source: Professional Nurse. 11(12): 816-819. September 1996. Contact: Available from Macmillan Magazines, Ltd. Porters South, Crinan Street, London N1 9XW, England. 0171-833-4000. Fax 0171-843-4699. Summary: This article reviews the problem of constipation in older people in hospitals and nursing homes and describes the nurse's role in preventing and treating the problem. Topics include research into bowel emptying, the causes of constipation, and prevention and treatment. Although diet, fluid intake, medication, and mobility can resolve this problem, laxative misuse is widespread. Nurses rarely consider bowel management as a central part of their role. However, by working with older people to restore normal bowel habits, nurses can help reduce laxative use and abuse, improve the health and well being of patients, and reduce nursing workload. 1 table. 22 references. (AA-M).

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Biofeedback Training in Children with Functional Constipation: A Critical Review Source: Digestive Diseases and Sciences. 41(1): 65-71. January 1996. Summary: This article reviews the use of biofeedback training in children with functional constipation. Many uncontrolled studies suggest that biofeedback training is an effective adjunctive therapy in improving the outcome of functional constipation and/or encopresis in children. This could not be confirmed in controlled studies. Adding biofeedback training after conventional treatment had failed did not provide

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benefits. The author concludes that the results of biofeedback treatment in children with functional constipation and/or encopresis are disappointing. 1 figure. 2 tables. 31 references. (AA-M). •

Basics of Constipation Source: Gastroenterology Nursing. 20(4): 125-128. July-August 1997. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (410) 528-8555. Summary: This continuing education article updates gastroenterology nurses on the physiology and etiology of constipation. The author defines and describes the causes of constipation, reviews the physiology of the colon, and outlines the nurse's role in helping patients with constipation. Constipation is clinically defined as fewer than three bowel movements per week, which may also imply that stools are too small, too infrequent, hard in nature, difficult to expel, or that the individual has a feeling of incomplete evacuation after defecation. Extrinsic factors such as decreased activity, lack of privacy or time for defecation, dietary habits (e.g., low fiber intake), and a lack of fluids by mouth can result in primary constipation. Pharmacologic agents can alter colonic motility. The author stresses that constipation is usually the result of combined causes rather than a single factor. The nursing assessment of the patient should gather information about the patient's personal beliefs regarding elimination practices, what is viewed as a normal pattern, laxative use, diet, oral fluid intake, exercise habits, sleep patterns, recent illnesses, treatments, and present medications. Especially in elderly patients, the family may be a vital link to patient education. If the family can understand some of the combined causes of constipation, they are in a prime position to provide emotional, physical, and financial support to the patient. Instructions for a high fiber diet, increased fluid intake, laxative use, and exercise guidance tailored for age and mental and physical levels of ability need to be addressed with the patient and family. 3 tables. 9 references. (AA-M).

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What You Can Do to Prevent and Treat Constipation Source: Guide to Women's Health. 12, 14. April 2001. Contact: Available from Springhouse Corporation. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477. (215) 646-8700. Fax (215) 540-0668. Summary: This fact sheet reviews strategies that readers can follow to prevent and treat constipation. Most cases of constipation are temporary and not serious. Poor diet and lack of exercise are usually to blame, and in most cases, simple dietary and lifestyle changes will relieve symptoms and help prevent constipation from recurring. A diet with enough fiber (20 to 35 grams each day) helps form soft, bulky stool. Good sources of fiber include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. Other changes that can help treat and prevent constipation include: drinking enough water and other liquids; engaging in daily exercise; reserving enough time to have a bowel movement; and not ignoring the urge to have a bowel movement. Health care providers may recommend laxatives or enemas for a limited time in patients who have a slow response to these lifestyle changes. The fact sheet outlines different types of laxatives, including bulk forming laxatives, stimulants, stool softeners, and saline laxatives. For chronic constipation or constipation caused by problems such as rectal prolapse, anorectal dysfunction, or colonic inertia, surgical options may be recommended by the health care provider. One sidebar lists the common causes of constipation.

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Constipation: Common-Sense Care of the Older Patient Source: Geriatrics. 51(12): 28-32, 34, 36. December 1996. Summary: This gerontology article discusses constipation, a common complaint in older patients. Contributing factors are impaired general health, use of medications, and decreased mobility and physical activity. The authors note that diet has an indeterminate effect. Many patients become gradually more constipated with age and self-treat with over-the-counter laxatives. Investigation is warranted if defecation is associated with pain or bloating, or if it represents a recent change in bowel habit. Although constipation is usually just an annoyance, it can have more serious consequences, such as impaction and ulceration. A combination of bowel training, dietary management, and regular exercise is the first phase of treatment. Bulk laxatives are recommended as second-line treatment, followed by other laxatives if needed. The authors also recommend that, once a good regimen is achieved, dosages of laxatives should be reduced to the minimally effective range, particularly if laxatives with potentially dangerous side effects are used. Indeed, lifestyle changes alone (bowel training, exercise, and diet) may ultimately be adequate therapy for most older patients suffering from this common condition. 1 figure. 2 tables. 20 references. (AA-M).

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Surgical Treatment of Constipation and Fecal Incontinence Source: Gastroenterology Clinics of North America. 30(1): 131-166. March 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32821-9816. (800) 654-2452. Summary: This lengthy article reviews the surgical treatment of constipation and fecal incontinence. The authors emphasize that success in the management of constipation depends on an accurate determination of the cause. Because there are many extracolonic causes that can produce constipation, a detailed clinical history should be taken. Before physiologic investigation, patients must discontinue the use of medications that may cause or exacerbate their symptoms. A proper diet should be maintained, and patients must be supervised by a dietitian or a physician for a minimum of 3 to 6 months before any extensive physiologic evaluation is undertaken and before any surgery is considered. Diagnostic tests may include anorectal examination, colonic transit study, proctography and cinedefecography, electromyography, manometry, small bowel transit study, Minnesota Multiphasic Personality Inventory, and rectal biopsy. Surgery for constipation is reserved for a highly select group of patients; the authors review the indications for patients with pelvic outlet obstruction, with colonic inertia (slow transit throughout the colon), and with combined outlet obstruction and colonic inertia. The authors then discuss fecal incontinence, noting that obstetric injury (during childbirth) is a major cause and one amenable to surgical correction. Diagnostic tests can include physical examination, manometry, electromyography, pudendal nerve terminal motor latency, anal ultrasonography, and magnetic resonance imaging (MRI). The treatment of fecal incontinence should always be directed to the cause; many individuals can be managed adequately by noninvasive means. Surgical treatment can include sphincter repair, muscle transplant, the use of synthetic material, and diversion (the creation of a stoma). 4 figures. 9 tables. 297 references.

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Anorectal and Pelvic Floor Function: Relevance to Continence, Incontinence, and Constipation Source: Gastroenterology Clinics of North America. 25(1): 163-182. March 1996.

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Contact: Available from W.B. Saunders Company. Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: This review article discusses anorectal and pelvic floor function; its relevance to continence, incontinence, and constipation; and tests that assess said function. The authors note that diagnostic tests are most useful when they identify anatomic or physiologic abnormalities for which there are successful treatments. For the incontinent patient, anal manometry is the most useful test. Sphincter injuries should be repaired, whereas neurogenic incontinence is best treated initially with biofeedback. Three tests are most useful for the constipated patients: colonic transit time; degree of pelvic floor descent on straining; and balloon expulsion. Colonic inertia responds to total colectomy and pelvic floor dysfunction to biofeedback. Meanwhile, patients found to have irritable bowel syndrome (IBS) need to be re-referred to their physicians. 4 figures. 2 tables. 102 references. (AA-M). •

AGA Technical Review on Constipation Source: Gastroenterology. 119(6): 1766-1778. December 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: This technical review identifies a rational, effective, and cost effective approach to the patient presenting with constipation. The authors review the epidemiology of constipation, risk factors, the economic impact of constipation, the clinical features and pathophysiology, clinical evaluation, secondary encounters and referral consultations, diagnostic tests (balloon expulsion test, defecography, colonic transit, and anorectal manometry), medical management, and the role of surgery in treating constipation. Constipation is associated with inactivity, low caloric intake, the number of medications being taken, low income, and a low education level. Constipation is also associated with depression as well as with physical and sexual abuse. These are noted as risk factors, not necessarily as causative agents. The review summarizes three patient care algorithms. After the initial history and physical examination, patients can be classified into one of several subgroups. Standard blood tests and a colonic structural evaluation should be performed to rule out organic causes of the constipation. If the initial evaluation is normal or negative, an empiric trial of fiber (and or dietary changes) can be followed by simple osmotic laxatives. Most patients will obtain symptom relief with these measures. Patients who fail to respond to this initial approach are appropriate candidates for more specialized testing. 5 tables. 95 references.

Federally Funded Research on Constipation The U.S. Government supports a variety of research studies relating to constipation. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions.

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to constipation. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore constipation. The following is typical of the type of information found when searching the CRISP database for constipation: •

Project Title: OUTCOMES

A

CAREGIVER

INTERVENTION

TO

IMPROVE

HOSPICE

Principal Investigator & Institution: Mcmillan, Susan C.; Professor; None; University of South Florida 4202 E Fowler Ave Tampa, Fl 33620 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 30-JUN-2003 Summary: Although hospice family caregivers receive support from the hospice team, research indicates that a greater level of support and education are needed to assist them with the enormous responsibility they bear for physical and emotional care. If the caregiver is not adequately prepared to assess patients and provide needed care, the patient's quality of life may suffer, and the caregiver may experience feelings of inadequacy, anxiety, and depression leading to decreased caregiver quality of life. The primary aim of this experimental study, based on the stress-process model, is to improve the quality of life of hospice caregivers by helping them to master the skills needed to better assess and manage specific problems experienced by cancer patients (pain, dyspnea, constipation), thus enhancing caregiver coping and self-appraisal of stressfulness of patient symptoms and quality of life for both patients and caregivers. The sample of 480 patient/caregiver dyads will be drawn from a large hospice in the local area and screened using measures of functional status and mental status. After consenting, subjects will be randomly divided into three groups, a control group receiving standard care (Group I), a group receiving standard care plus friendly visits (Group II), and a group receiving standard care plus the intervention (Group III). The intervention will be based on the COPE method (Creativity, Optimism, Planning, Expert Information). Groups II and III will receive visits on the same schedule to control for the effects of researcher time and attention. On visit one, caregivers in Group III will be taught to use the COPE method of managing patient problems. Visit one will last approximately 90 minutes; visits two and three will reinforce and extend learning and last approximately 30 minutes each. Group III caregivers will receive a copy of the Home Care Guide for Advanced Cancer and receive two supportive telephone calls from the RA-intervention nurse, one after visit one and one after visit two. Group III caregivers will be taught how to assess patient symptom intensity and given a preformatted diary in which to record symptom intensity scores twice daily. Data will be collected from patients about symptom intensity, symptom distress, and quality of life. Caregiver data will include coping, self-appraisal, and quality of life including mastery. Data will be collected from all three groups on admission to the study, immediately post intervention (day 16), and four weeks after admission to the study (day 30). One year after admission to hospice, all caregivers again will be contacted for data collection (patients are expected to be deceased). Quantitative data will be analyzed using repeated measures multivariate analysis of variance and structural equation modeling. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BIOFEEDBACK FOR FECAL INCONTINENCE AND CONSTIPATION Principal Investigator & Institution: Whitehead, William E.; Professor of Medicine; Medicine; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 30-NOV-2004 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BLADDER AND BOWEL CONTROL USING NEUROPROSTHETIC DEVICES Principal Investigator & Institution: Creasy, Graham; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: Electrical stimulators resembling pacemakers were designed to improve bladder emptying following spinal cord injury, by stimulating the nerve roots at the base of the spine. This causes contraction of the bladder and has been shown in about 90% of the patients on whom it has been used to improve bladder emptying and reduce urine infection. It can also improve continence. This project will document these results accurately in the United States. The stimulator also causes contraction of the rectum and most of the patients in whom it has been used report a reduction in constipation. Techniques for more selective stimulation of the bladder and bowel have been developed by the investigators at CWRU. This project provides an opportunity for evaluating the functional benefit to be gained in human subjects for these techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CONTRACTILE SIGNAL TRANSDUCTION IN ULCERATIVE COLITIS Principal Investigator & Institution: Cao, Weibiao; Rhode Island Hospital (Providence, Ri) Providence, Ri 02903 Timing: Fiscal Year 2003; Project Start 10-JAN-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Ulcerative colitis is a chronic inflammatory condition affecting the large bowel: Although it is most frequent in the rectosigrnoid area, it may involve the whole colon. Inflammation in ulcerative colitis is histologically limited to the mucosa, and its effects have been better characterized in the superficial than in the deeper layers such as muscularis propria. Inflammation, however, may affect the muscle layer, leading to motor dysfunction, which contributes to key clinical symptoms, including diarrhea, constipation, and crampy abdominal pain. To define inflammation, associated changes in motor function we will examine the circular muscle from the sigmoid colon from patient with active ulcerative colitis and compare it with muscle from disease-free margins of histologically normal colon tissue from cancer resections. The sigmoid is most often involved and frequently resected, and this avoids variations associated with different anatomical locations of the disease. In preliminary experiments, we find that inflammatory mediators such as interleukin-1beta and hydrogen peroxide are present in the muscularis propria. Our central hypothesis is that inflammatory mediators, first produced by inflammatory cells in the mucosa, may induce production of additional mediators by the target cells themselves, and that in time the muscularis propria becomes affected leading to motor disturbances. We therefore propose to: A) Define inflammation-induced changes in contractile signal

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transduction pathways of human sigmoid colon. B) Test the effect of selected inflammatory mediators, known to be present in ulcerative colitis mucosa, to determine their individual contribution to the observed changes in colonic motor function. C) Determine whether inhibition of selected inflammatory mediators may reverse inflammation-mediated changes in colonic motor function. Examining the relationship between inflammatory mechanisms and changes in motor function may help in understanding the functional disturbances associated with ulcerative colitis and identifying new targets for therapeutic intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CONTROL OF RECTOANAL MOTILITY Principal Investigator & Institution: Keef, Kathleen D.; Professor; Physiology and Cell Biology; University of Nevada Reno Reno, Nv 89557 Timing: Fiscal Year 2001; Project Start 15-AUG-2000; Project End 31-JUL-2004 Summary: The rectoanal region of the GI tract regulates the final storage, transport and evacuation of the GI contents. These functions require substantial differences in the contractile behavior of progressively more distal segments of this region. This study investigates the mechanisms underlying spontaneous motility patterns and the actions of excitatory nerves in rectoanal circular muscle of the dog and mouse gastrointestinal tract. The overall hypothesis for these studies is that fundamental changes occur in the nature of pacemaker activity, neuronal innervation and the actions of norepinephrine (NE) and acetylcholine (ACh) which permit adjacent portions of the rectoanal region to perform complimentary but distinct functions. Membrane potential and contractile activity will be measured as well as receptor density using radioligand binding techniques. These data will be compared to immunohistochemical and immunocytochemical measurements to identify putative pacemaker cells (i.e., interstitial cells of Cajal or ICC) and their relationship to intrinsic and extrinsic nerves. An 8 cm region of the canine model and a 1 cm region of the mouse model encompassing both the rectum and internal anal sphincter (IAS) will be used. The specific aims of this proposal are: 1) To compare the spatial distribution of pacemaker potentials to ICC, 2) To characterize the changes which occur in functional motor innervation with distance in the rectoanal region, 3) To determine the anatomical distribution of nerves and their relationship to the distribution of ICC, 4) To evaluate postjunctional adrenergic and muscarinic responses in the rectoanal region using functional measurements and radioligand binding techniques, 5) To evaluate pacemaking using knockout mice and organ culture techniques. Millions of Americans suffer from diseases of the rectoanal region which lead to either constipation or fecal incontinence. The experiments outlined in this proposal will provide important new information regarding the anatomical and physiological characteristics which underlie rectoanal motility and its nervous control. In so doing we may aid future studies directed toward understanding how these functions become altered in disease states. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEVELOPMEMT OF NOVEL TREATMENTS FOR NICOTINE ADDICTION Principal Investigator & Institution: Dwoskin, Linda P.; Professor; Pharmaceutical Sciences; University of Kentucky 109 Kinkead Hall Lexington, Ky 40506 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-JUN-2008

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Summary: (provided by applicant): Tobacco smoking is the number one health problem accounting for more illnesses and deaths in the US than any other factor. Despite efficacy of some current pharmacotherapies (i.e., nicotine replacement and bupropion), relapse rates continue to be high, indicating that novel medications are needed. Research in the current application proposes to develop a new class of subtype-selective nicotinic receptor (nAChR) antagonists as therapeutic agents with efficacy for tobacco use cessation and for treatment of nicotine dependence. As much as tobacco use behavior and nicotine addiction have links to depression, these novel drug candidates may also prove to be new treatments for depression. Based on the observations that the bupropion acts as a nAChR antagonist and that the nonselective nAChR antagonist, mecamylamine, has some efficacy as a tobacco use cessation agent, but is limited by its peripherally-mediated side-effect of constipation, we predict that the subtype-selective nAChR antagonists, which we propose to develop, may have therapeutic advantages and efficacy as tobacco use cessation agents in the treatment of nicotine addiction. We hypothesize that quaternizing the pyridine-N atom of the nicotine molecule with a lipophillic N-substituent to afford N-nicotinium analogs and/or by connecting these quaternary ammonium moieties with a lipophillic linker to afford N,N'-bis-analogs will result in subtype-selective nAChR antagonists, which will inhibit either nicotine-evoked dopamine, norepinephrine or serotonin release, and thus, inhibit nicotineinduced behaviors, indicating their potential as nicotine addiction treatments. Brain bioavailability, pharmacokinetics and metabolism of the lead candidates will also be evaluated. Comparison of results using native and recombinant nAChRs will provide new insights into the subunit composition of nAChRs mediating these functions. Drug candidates will be assessed for their ability to decrease nicotine self-administration, to decrease nicotine-induced reinstatement of nicotine seeking behavior, and to precipitate withdrawal in nicotine-dependent animals. Thus, an integrative approach (i.e., medicinal chemistry, pharmacokinetics, metabolism, pharmacology, psychology and neuroscience) will be used to increase our understanding of the underlying mechanisms of tobacco use and nicotine addiction, with focus on pharmacotherapeutic candidate development. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISCOVERY OF K OPIOID ANALGESICS USING CHIMERIC RECEPTOR Principal Investigator & Institution: Dehaven, Robert N.; Adolor Corporation 371 Phoenixville Pike Malvern, Pa 19355 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 28-FEB-2002 Summary: (provided by applicant): Pain is a serious, debilitating condition that is under treated because of the dose limiting side effects of currently used opiate therapeutics including respiratory depression, constipation, nausea, and physical dependence at therapeutic doses. Although arylacetamide K opioid agonists do not cause these side effects, they produce visual hallucinations and dysphoria. The endogenous agonist of the K opioid receptor, dynorphin A, and a stable peptide analog, E2078, produce analgesia in humans without causing dysphoria. The arylacetamides and dynorphins bind to different domains of the K receptor, which may result in the different in vivo pharmacological and clinically meaningful side effect profiles observed for these structurally diverse molecules. We propose to develop novel K receptor agonists that do not cause dysphoria by using differential binding to a chimeric receptor as a highthroughput screening tool. Compounds that bind to the K receptor in the same manner as dynorphin A and E2078 will then be tested in animals to determine whether they

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induce analgesia without causing the dysphoric side effects of previously developed arylacetamides that have been tested in man. Compounds that possess the desired pharmacological profile will be rapidly advanced into preclinical and clinical development. PROPOSED COMMERCIAL APPLICATION: Chronic pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTION OF THE ENTERIC NERVOUS SYSTEM Principal Investigator & Institution: Wood, Jackie D.; Professor and Chairman; Physiology and Cell Biology; Ohio State University 1800 Cannon Dr, Rm 1210 Columbus, Oh 43210 Timing: Fiscal Year 2003; Project Start 01-SEP-1985; Project End 30-JUN-2008 Summary: (provided by applicant): This 5-year project of research on the enteric nervous system is designed to improve understanding of the cellular and molecular neurophysiology of secretomotor neurons in the intestinal submucosal plexus and inhibitory and excitatory motor neurons in the myenteric plexus that innervate the intestinal musculature. Cellular neurophysiology underlies functions of secretomotor neurons that are basic to control of fluidity of the intestinal contents in states of health and to diarrhea and constipation in disordered states. Cellular neurophysiology of musculomotor neurons is basic to control of muscular contraction in normal motility and disordered motility in disease states. Aims of the project are based on pilot/feasibility results, which suggest that slow excitatory neurotransmission in enteric motor neurons is specialized and different from this form of synaptic transmission in other kinds of enteric neurons. The pilot/feasibility data for secretomotor and musculomotor neurons suggest that this class of neurons express in common the properties of uniaxonal morphology, S-type electrophysiological behavior, increased ionic conductance during slow excitatory neurotransmission, and a metabotropic signal transduction cascade that involves calmodulin kinases and protein kinase C, but not cAMP and protein kinase A. The project has five specific aims. Aim 1 is organized to test the hypothesis that opening of non-selective cationic and perhaps chloride conductance channels accounts for the membrane depolarization seen during the slow EPSP in neurons identified morphologically and immunohistochemically as motor neurons in the myenteric and submucosal plexuses. Aim 2 tests the hypothesis that activation of phospholipase C, IP3 release and mobilization of intraneuronal calcium are steps in the signal transduction cascade for the newly recognized slow EPSP in enteric motor neurons. Aim 3 tests the hypothesis that calcium binding to calmodulin is a key step in the signaling mechanisms that underlie the specialized slow EPSP. Aim 4 tests the expectation that calmodulin kinases II & IV and activation of protein kinase C are steps in the calcium signaling cascade for the EPSP. Aim 5 tests suggestions that activation of protein kinase C by calmodulin kinases leads to phorphorylation and opening of the ionic channels that underlie depolarization of the membrane potential and enhanced excitability that occurs during slow synaptic excitation in enteric motor neurons. Dephosphorylation of the channels by the phosphatase, calcineurin, terminates slow EPSP. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GASTROINTESTINAL SMOOTH MUSCLE IN HEALTH AND DISEASE Principal Investigator & Institution: Szurszewski, Joseph H.; Professor and Chair; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905

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Timing: Fiscal Year 2001; Project Start 01-DEC-1976; Project End 31-JAN-2002 Summary: The long term objective is to provide a quantitative understanding of the myogenic and neurogenic processes which regulate gastrointestinal smooth muscle activity in experimental animals and in man. Smooth muscle from the internal anal sphincter, ileocolonic/ileocecal sphincter, muscularis mucosa of the esophagus, small and large intestines and the inner and outer circular muscle lamellae will be used. The areas of particular interest are: (1) the electrophysiological properties of the smooth muscle cell membrane in each of these areas; (2) the electrophysiological characteristics of neuroeffector responses; (3) the pattern of intramural innervation; (4) the identity of the neurotransmitters which cause excitation and inhibition; and (5) the electrophysiological and neurotransmission processes in normal and diseased human GI smooth muscle. The methods of approach will involve recording simultaneously mechanical and intracellular electrical activity, the recording of contractility of strips of muscle, radio-immunoassay of muscle to identify the type and content of peptides and radio-immunological and immunological techniques to identify the excitatory and inhibitiory transmitters. In vitro studies are planned. Dogs, cats, rabbits, guinea pigs and human GI smooth muscle will be used. These studies may be particularly relevant to understanding motor disturbances involving hypoganglionosis of the intrinsic plexuses in man. They man also be relevant to disturbances in anal continence in man. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC STUDY OF C ELEGANS HOST RESPONSE TO A PATHOGEN Principal Investigator & Institution: Yook, Karen J.; University of Oxford University Office, Wellington Sq Oxford, Timing: Fiscal Year 2001; Project Start 27-JAN-2001 Summary: elegans is well characterized and is amenable to forward genetic analysis and molecular dissection. Thus, worm genes that are required for the bacterial infection to proceed can be mutated and studied. Mutations in these genes will confer resistance to M. nematophilum infection. For example, mutations in genes required for the proper expression of extracellular proteins on the cuticle of the worm, confer resistance to the bacteria. This suggests that the bacteria (provided by applicant): How does an animal respond to a bacterial infection? Caenorhabditis elegans is a free-living soil nematode that can be infected by the bacterium Microbacterium nematophilum. Unlike other bacterial pathogens of C. elegans, M nematophilum does not kill the worm, rather, the bacteria adheres to the tail of the worm causing constipation and a distinct deformed anal region phenotype. Therefore, this interaction is reminiscent of a chronic disease state rather than a general toxicity response. Although M nematophilum is in the poorly characterized coryneform family of bacteria, C. rely on these cuticle factors during pathogenesis. In addition, 11 other bacterial resistance-conferring mutations termed bus for bacterial unswollen were mapped in the Hodgkin laboratory. These genes remain to be characterized. Alternatively, worm genes used to defend against the bacterial pathogen can be mutated and studied. Mutations in these genes will confer hypersensitivity to M. nematophilum infection. Screens for these genes uncovered three mutations that fall into two classes, gmp (growth impaired by M nematophilum pathogen) and emp (excess deformation by M nematophilum pathogen). These genes also remain to be cloned and characterized. Thus characterization of mutations that alters the host response to this pathogen should not only uncover the molecular pathways required for a bacterial infection process but also the molecular pathways used by the host to fight infection. To fully understand how C. elegans responds to M

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nematophilum, the bacterial resistance and hypersensitive screens will be saturated to find all of the genes involved in this process. In addition the genes already isolated will be cloned and characterized. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GRADUAL EXPOSURE TREATMENT FOR IRRITABLE BOWEL SYNDROME Principal Investigator & Institution: Decola, Joseph P.; Psychology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-APR-2001 Summary: The most commonly used non-medical treatment for Irritable Bowel Syndrome (IBS) is a combination of traditional stress management techniques and nonspecific cognitive therapy methods. This general approach is used to treat patients with divergent target symptoms (i.e., constipation and diarrhea). A limitation of this approach is that the treatment is not derived from a clear theoretical model that identifies a specific process underlying the disorder or treatment. The present study is based on a strong theoretical model that offers specific predictions and treatment methods. The model assumes that hypervigilance and hypersensitivity to internal sensations in the gut are the critical perceptual mechanisms underlying IBS. These perceptual filters are the result of learning and conditioning processes and can be reversed with a cognitive-behavioral treatment that incorporates gradual exposure to internal sensations. Subject recruitment will be limited to IBS patients with diarrhea as the predominant symptom and the treatment will be implemented with a multiple baseline across subject design. The treatment will consist of several phases: education about the role of learning in the development of IBS symptoms; relaxation training; cognitive restructuring for overestimation and catastrophization errors; exposure to the feared internal sensations; and exposure to avoided situations. The goal of this treatment is to reverse the hypersensitivity and hyperviligance through gradual exposure to these stimuli. The broad objective of this research is to enhance the treatment for IBS and to test the predictions of this theoretical model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IDENTIFICATION & ANALYSES OF THE UROFACIAL SYNDROME GENE Principal Investigator & Institution: She, Jin-Xiong; Professor and Director; Pathology, Immunol & Lab Med; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2001; Project Start 01-JUN-1998; Project End 31-MAY-2003 Summary: (Adapted from the applicant's abstract) The Urofacial (Ochoa) syndrome (UFS, OMIM #236730) is an autosomal recessive disease characterized by congenital obstructive uropathy due to a neurogenic bladder, constipation and abnormal facial expression. Pedigree analysis has shown that a single gene is responsible for the syndrome. Because muscular function of multiple organs or tissues is involved (i.e., bladder, bowel and facial muscles), it is believed that the lesion may reside in the brain regions that coordinate muscle actions, such as micturition, defecation and facial muscle movement. Our recent genome screen has mapped the UFS gene to an interval of approximately 1cM (1Mb) between D10S184 and D10S603 on 10q23-q24. The goal of this proposal is to identify the disease gene using fine-mapping, positional candidate and positional cloning techniques. Three specific aims are proposed: 1. To further reduce the size of the genomic interval containing the UFS gene. Three complementary approaches

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will be used to accomplish this aim. The first two approaches are based on linkage disequilibrium analyses and the third approach seeks to identify possible deletions/insertions of genomic DNA fragments involving the UFS gene. 2. To identify the UFS gene using positional candidate approach and/or positional cloning. Candidate genes in the UFS interval will be evaluated by identifying mutations and assessing their correlation with the occurrence of disease phenotype and carrier status. If candidate gene analyses fail to identify the UFS gene, additional coding sequences in the UFS interval will be identified using several positional cloning techniques including exon trapping, cDNA selection and genomic sequencing. 3. To characterize the structure, expression, regulatory elements, and function of the disease gene. The proposed studies should permit revelation of the gene responsible for UFS. Identification of the gene may provide important insight for a large number of voiding dysfunctions and other related neurologic uropathies that are major health problems in the US and the world. The gene may also be important for understanding the molecular basis and normal physiology of the coordination of muscle actions by the nervous system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING OF CARE BY REVERSAL OF OPIOID CONSTIPATION Principal Investigator & Institution: Yuan, Chun-Su; Anesthesia and Critical Care; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2001; Project Start 18-FEB-2000; Project End 31-JAN-2004 Summary: Morphine and other opioids are widely used analgesics in advanced cancer patients, and constipation is the most common treatment-associated side effect of opioid pain medications. Conventional measures for opioid-induced constipation are often insufficient, and constipation becomes a limiting factor in opioid use and opioid dose in these patients. A significant number of hospice patients receiving chronic opioids for pain would rather endure their pain than face the severe incapacitating constipation that opioids cause. Thus, opioid-induced constipation, a symptom secondary to the treatment, has a significant negative impact on the quality of life of these terminal patients. Palliative care and end of life management practices have received insufficient attention in the past, and the need to enhance palliative care of dying patients has become apparent in this country. In this proposed project, the efficacy of a novel peripheral opioid receptor antagonist, methylnaltrexone, in the treatment of chronic opioid-induced constipation, will be evaluated. Specific Aim 1 and 2 studies will utilize a clinical pharmacology approach (Phase II/III trials) to evaluate the efficacy and doseresponse of intravenous and oral methylnaltrexone in reversing chronic opioid-induced gut motility changes and constipation in methadone addicts and patients with advanced malignant conditions. These trials will be randomized, double-blind, placebocontrolled studies. In these studies, the oral-cecal transit time will be measured using the lactulose hydrogen breath test, and positive laxation response and opioid analgesic effect will be evaluated. In addition, subjective visual analog scale (VAS) scores for constipation, stool frequency and consistency, and "overall well being" will be recorded. Pharmacokinetic data will also be collected. In these studies, mechanisms underlying opioid gastrointestinal pharmacology in humans, an issue that has not been addressed before, will be investigated, since translation of data from previous animal experiments to humans may be problematic due to differences in the physiology of the opioid systems. Bringing methylnaltrexone, the first selective peripheral opioid receptor antagonist, to clinical application will be a significant advance in palliative care. Successful completion of this project will lead to a number of future studies in which

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other applications of methylnaltrexone, as well as its mechanisms of action of both opioids and their antagonism in humans, can be explored. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTICENTER TRIAL OF FUNCTIONAL BOWEL DISORDERS Principal Investigator & Institution: Drossman, Douglas Arnold.; Medicine; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 30-SEP-1995; Project End 31-AUG-2003 Summary: The primary aim of this study is to compare the efficacies of clinical treatments for the group of chronic, painful functional bowel disorders (FBD) that predominantly affect women. Secondary aims include 1) determination of demographic, psychosocial, physiologic and symptomatic predictors of clinical improvement and 2) analysis of significant relationships among physiologic markers of FBD, psychosocial status, symptoms and treatment effects. The Principal Investigator and his colleagues propose to compare cognitive-behavioral psychological treatment with antidepressant drug therapy (desipramine) and education/attention placebo in over 300 women. Interrelationships between psychological and physiological factors on the development, clinical expression and treatment of FBD have long been recognized, but this is the first large-scale study designed both to isolate therapeutic effects, and to investigate interactions among physiologic measures, psychologic and sociodemographic factors, severity of symptoms, and therapeutic improvement including quality of life. In the proposed plan of research, at least 300 female patients (aged 18- 65) with FBD (irritable bowel syndrome, painful constipation and/or functional abdominal pain) will be enrolled in clinics at UNC-Chapel Hill and Toronto, Canada. A severity index will determine recruitment into the group of moderate FBD (200 patients) and severe FBD (100 patients). Each group will be randomized into the three treatment arms (cognitivebehavioral treatment, desipramine, and education/attention placebo), treated over a 12week period, and followed for one year. Outcome measures will include symptoms (standardized abdominal pain, stool form, and frequency) using diary cards, daily functional status (Sickness Impact Profile), depression (HAM-D), and psychological distress (SCL-90), physiological measures (enhanced rectal motility and visceralsensation), and health care use. Multivariate statistical methods with a hierarchical design will be applied to the data to assure maintenance of statistical power over multiple tests of overlapping groups. The results of this study may significantly improve an understanding of this complicated syndrome that lowers the quality of life and economic productivity of large numbers of women. The clinical impact of the study, in providing physicians with scientific evidence of the efficacy of treatments of FBD that are commonly used in practice, may be significant. This study may provide clinicians with predictors of success among types of FBD patients and types of therapy that will improve symptoms and quality of life and reduce the health care costs associated with this common syndrome, while improving patient-physician satisfaction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROCHEMISTRY OF NOCICEPTION Principal Investigator & Institution: Mantyh, Patrick W.; Professor; Polymer Science & Engineering; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 30-JUN-2003

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Summary: (Applicant's Abstract) Management of chronic painful syndromes presents a tremendous challenge to the medical field as current pain management approaches with narcotics, such as morphine, carry adverse side effects such as sedation, constipation, tolerance and addiction. Therefore, a greater understanding of pathophysiological mechanisms that lead to a chronic pain state is needed for development of novel and effective therapies with minimal side effects. Recently, we demonstrated that when a conjugate of substance P (SP) and the ribosome-inactivating protein saporin (SAP) is infused into the spinal cord, the SP-SAP conjugate is specifically internalized and cytotoxic to lamina I spinal cord neurons that express the substance P receptor (SPR). This treatment leaves responses to mild noxious stimuli unchanged, but profoundly attenuates responses to highly noxious stimuli and to mechanical and thermal hyperalgesia. Using the intrathecal infusion of SP-SAP in the rat spinal cord as our model we propose: to investigate whether this treatment can alleviate inflammatory and/or neuropathic persistent pain states (Aim 1); to further define the rostral brain areas these neurons project to and the other receptors and neurotransmitters that are expressed by lamina I SPR-expressing neurons (Aim 2); to determine the functional role of neurons that express the SPR in nociceptive processing and hyperalgesia, and whether these SPR expressing neurons are functionally different from nociceptive neurons that do not express the SPR (Aim 3); and to determine whether reorganization of the spinal cord and dorsal root ganglia occurs following SP-SAP treatment and whether morphine is still effective in attenuating nociceptive responses (Aim 4). Information from these investigations will provide significant insight into the neurochemistry of spinal nociceptive signaling and whether SP-SAP treatment shows promise for developing non-opioid therapies to control chronic pain in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROHUMORAL CONTROL OF INTERNAL ANAL SPHINCTER Principal Investigator & Institution: Rattan, Satish C.; Professor; Medicine; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2002; Project Start 01-JUL-1985; Project End 30-JUN-2006 Summary: (provided by applicant): Disorders of the internal anal sphincter (IAS) underlie many clinical abnormalities, such as fecal incontinence and constipation, and emphasize its role in continence and defecation. Disorders of the IAS occur more frequently in the rapidly expanding population of the elderly, and thus give increased urgency to understanding its function. Therefore, the objectives of this research proposal are: 1) to investigate intracellular mechanisms that regulate the basal tone of the LAS, and 2) to determine the role of cellular and biochemical elements in the nonadrenergic noncholinergic (NANC)-mediated relaxation of the IAS. Relations between electrical and mechanical activities will be determined by simultaneous recordings in IAS isolated from the external anal sphincter (EAS), in vivo and in vitro. Correlations between intracellular biochemistry and contraction-relaxation of the IAS will be obtained by measurements of changes in membrane potentials, flux in free intracellular Ca2turnover of Pt, G-proteins, activities of protein kinase C, myosin light chain kinase (MLCK) and MLC-phosphatase, and the state of phosphorylation of myosin light chain (MLC20-P). In addition, we will determine cyclic nucleotides, immunocytochemical localization, direct release of the mediators, and enzymatic activities involved in their biosynthesis. Murine models with targeted disruption of a specific gene which render them deficient in either intramuscular interstitial cells of Cajal (ICC-IM; WWV), nNOS (nNOS-/-), or HO-2 (HO-2-/-) will be used to determine cellular and biochemical elements which regulate the basal tone and the nature of inhibitory neurotransmission

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Constipation

in the LAS. Either mice or opossums will be used in almost all of the above studies, as these are well-characterized animal models for the study of the LAS. Our multidisciplinary approach to the study of the IAS will define: (1) the cellular bases and signaling pathways most critical to the regulation of the LAS tone, and (2) the nature of inhibitory neurotransmission in the IAS. Information produced by these studies will permit an understanding of the pathophysiology that underlies disorders of the LAS, and provide a rationale for development of therapies to treat disorders of the IAS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEFECATION

NEUROMUSCULAR

CONDITION

THERAPY-DYSSYNERGIC

Principal Investigator & Institution: Rao, Satish S.; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 30-JUN-2005 Summary: Constipation affects 4 million Americans, predominantly women and the elderly. Its pathophysiology is incompletely understood and its treatment is unsatisfactory. Laxative-dependent, and unable to accomplish natures' call, many resort to desperate treatments. About 50 percent of patients with constipation exhibit uncoordinated or dyssynergic defecation. Uncontrolled studies suggest that biofeedback therapy may improve symptoms in these patients. But, whether the improvement is due to the behavioral intervention or a consequence of excess attention is not known. Biofeedback therapy is labor-intensive, expensive and only available in a few centers. In order to treat the many patients in the community, a home-based, self-training program is essential. Our proposal addresses three objectives; 1) to determine the efficacy of biofeedback therapy by performing a randomized controlled study in patients with dyssynergic defecation. After diagnostic evaluation with colon transit study, anorectal manometry and stool diaries, 90 patients will be randomized to receive standard treatment consisting of diet, habit-training and laxatives or biofeedback therapy consisting of neuromuscular conditioning or sham feedback therapy. Short-term (3 month) and long-term (12 month) assessments of anorectal physiology-defecation index, anal relaxation, fecom expulsion time and colon transit time and symptomatologybowel satisfaction score, straining effort, laxative consumption score and stool form and consistency will be performed. 2) To investigate the efficacy of home-training versus office-based biofeedback therapy and if it is cost-effective, 100 patients will be randomized to receive either home-training using a hand-held portable device and a silicon probe or biofeedback therapy for 3 months. Anorectal physiology and symptoms will be assessed and actuarial costs of each treatment will be compared. 3) For a condition that is entwined with psyche there is no information on quality of life or psychosocial function. We wish to investigate these parameters with validated instruments, SF-36 and SCL-90-R in 90 patients, before and after treatment and compare this with two controlled groups. This may provide impetus for new treatments such as psychotherapy. This first controlled study will determine the efficacy and scientific basis for a safe and alternative therapy for difficult defecation, provide new information that could facilitate home self-training and assess the impact of treatment on anorectal physiology, symptoms, quality of life and psychosocial aspects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NICOTINE & MORPHINE EFFECTS ON DIABETES ONSET & COMPLICATIONS Principal Investigator & Institution: Obih, Patience O.; Xavier University of Louisiana Box 121-C New Orleans, La 70125 Timing: Fiscal Year 2001 Summary: This study is undertaken to investigate the effect of drugs of abuse, morphine and nicotine on diabetes mellitus. Diabetes mellitus is the most common endocrine disease and consumes about 15% of annual health care expenditure in the United States. At the same time 36% of the population smokes cigarette and the opiates also rank high among the commonly abused agents. The long term goal of this study is to examine the hypothesis 1) Acutely or chronically administered nicotine or morphine accelerates the onset of diabetes. 2) Complications of diabetes worsen under the influence of chronically ingested nicotine/morphine. 3) the degenerative processes of diabetes will alter the receptor binding characteristics of morphine and nicotine receptor (ie. opioid receptors, nicotinic receptors and muscarinic receptors). We will examine these hypotheses with the following specific aims in mind: A) To evaluate the effect of morphine and nicotine on the onset of diabetes, rats will be treated with nicotine and morphine acutely or chronically and thereafter challenged with varying doses of streptozotocin (20, 40, 60 mg/kg)) intraperitoneally to induce diabetes. B) To examine the impact of morphine and nicotine on diabetic state, rats will first of all be made diabetic with intraperitonial injection of 60 mg/kg of streptozotocin (STZ). These diabetic rats will then be subjected to chronic administration of nicotine (8 weeks). Some groups of these rats will also be treated with insulin. The control will receive the vehicle. During the eight weeks, parameters to be monitored include: possible occurrence of diarrhea/constipation, body weight, fluid consumption, blood glucose level from an incision on the tail. At the end of the treatment period, animals will be killed by decapitation and parameters such as blood insulin and glucose level, by specific diagnostic kits will be measured, histopathology of the pancreas will also be examined. C) Radio ligand binding studies will be carried out to determine the receptor density of opioid receptors, nicotinic receptors, and muscarinic receptors in the treated and untreated rats. Examining the impact of attention since a significant number of US population and the world population suffer from addiction and may also have diabetes at the same time. The proposed study may increase the understanding of basic mechanisms of drug abuse in diabetes and may provide important practical information for developing new strategies for treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NOVEL THERAPY AND MEASURE OF OPIOID-INDUCED CONSTIPATION Principal Investigator & Institution: Liu, Maywin; St. Joseph Medical Center (Towson, Md) 7620 York Rd Towson, Md 21204 Timing: Fiscal Year 2001; Project Start 29-SEP-1999; Project End 30-JUN-2002 Summary: Dr. Maywin Liu, Assistant Professor of Anesthesia at the University of Pennsylvania Medical Center, is applying for a Mentored Patient-Oriented Research Career Development Grant. Dr. Liu is committed to an academic career in clinical research, examining the mechanisms and adverse effects of opioids. This proposal will allow Dr. Liu to expand from her previous training in experimental pain research to clinically-based research to become an independent, funded academic investigator. Pain affects up to 80 percent of cancer patients. Many patients can obtain adequate relief with

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Constipation

the proper use of opioids, however, opioid-related adverse effects often substantially limit pain therapy. Side effects of opioids are difficult to treat as the same receptors responsible for production of analgesia are believed to be responsible for producing the side effects. Constipation is the most common opioid-induced side effect occurring in up to 85 percent of patients. Constipation appears to be chiefly a peripheral effect arising from stimulation of the opioid receptors of the gastrointestinal tract. In our first study, we will evaluate the efficacy of methyl-naltrexone, a peripherally-selective opioid antagonist, for the treatment of opioid-induced constipation in cancer patients. In a double-blind, placebo-controlled, randomized trial, subjects will receive either placebo or active drug for 3 weeks after baseline data is obtained. Efficacy will be assessed using changes in bowel frequency, oral-cecal transit time, and constipation-related symptoms. Constipation has objective, i.e., bowel frequency, and subjective components, e.g., abdominal pain, difficulty passing stool. Although difficult to measure, constipationrelated symptoms are usually the primary concern to patients. Assessing for both bowel frequency and subjective symptoms will result in a more appropriate measurement scale. No scale combining both the clinical signs and subjective symptoms of constipation currently exists. As a result, we have developed the Constipation Measurement Scale (CMS) to assess both the symptoms and clinical signs. In this proposal, we will test the reliability, validity, and responsiveness of the CMS. Using a case-control design, patients who respond "yes" to the question "are you constipated?" and age-matched controls who answer "no" will be asked to complete the CMS daily for one week. Total scores of the CMS and subscores of each part will be correlated to the screening question to assess validity. Comparison of daily response will assess the reliability. Patients who are constipated will be treated with lactulose and asked to continue the daily CMS during this time. Pre- and post-treatment scores will be compared to assess for responsiveness of the scale. These studies will serve as a foundation for future studies examining the role of adverse effects of treatment on pain control. In addition, the mechanisms of opioid adverse effects and analgesia will be further explored with the use of methyl-naltrexone, e.g., contribution of peripheral opioid receptors to analgesia and peripheral vs. central mechanisms of other side effects. The methodologic techniques and research skills developed through formal training and conducting the clinical trials will serve as a foundation for pursuing related research questions as Dr. Liu matures into a fully independent academic clinical investigator. In addition, the study will provide important information about the appropriate treatment of opioid-induced constipation which will have an immediate relevance to the care of the cancer patient. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NURSING MANAGEMENT OF IBS: IMPROVING OUTCOMES Principal Investigator & Institution: Heitkemper, Margaret M.; Professor & Director; Biobehavioral Nursing and Health Systems; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2003; Project Start 01-AUG-1996; Project End 31-JAN-2007 Summary: (provided by applicant): The proposed application is a competitive supplement to the NINR funded project titled "Nursing Management of IBS: Improving Outcomes". In the United States, it is estimated that 10-20% of the population experience symptoms compatible with a diagnosis of irritable bowel syndrome (IBS). IBS is a functional condition characterized by change in bowel patterns, (e.g., constipation, diarrhea), interfering with functional activities and increasing health care utilization. Current recommended therapies include diet manipulation, self-management, psychotherapy, and motility and pain modulation via pharmacological therapy. The

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purpose of the parent project funded in 2002 is 1) to determine whether the CSM intervention is equally effective in men and peri- and postmenopausal women and 2) to determine whether the CSM intervention is as effective when delivered over the telephone as compared to a face-to-face approach. A three-group randomized clinical trial with longitudinal follow-up will be used to test the effectiveness of a face-to-face versus telephone comprehensive self-management (CSM) program relative to a usual care control group. Outcome variables will be measured during the assessment phase (T1) then 6 months (T2) and 12 months (T3) after the randomization phase. The primary aim of this supplement is to compare the distribution of SET polymorphisms across predominate bowel pattern subgroups and gender in people with IBS. We hypothesize that the distribution of SERT polymorphisms (5'-flanking promoter region [5-HTTLPR] and in exon 2 [VNTR]) will differ across predominate bowel pattern subgroups and the distribution of SERT polymorphisms will differ by gender. Exploratory aims of this study include: 1) Evaluate the relationship of SERT polymorphisms to symptom experiences and psychological profile; 2) Test whether the degree of improvement in response to the CSM therapy differs by SERT polymorphism; and 3) Evaluate the relationship of platelet rich plasma 5-HT levels to SERT polymorphisms, predominate bowel pattern. This study will provide information on the potential role of serotonin processing in IBS as well as potential gender and bowel symptom predominance. Such results may ultimately be used to tailor therapies for this common health problem. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OPIOIDS WITH REDUCED POTENTIAL FOR TOLERANCE Principal Investigator & Institution: Thatcher, Linn N.; Pharmaceutical Sciences; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 01-JUL-2002 Summary: The treatment for the pain associated with terminal cancer remains poorly treated. Although opioids, such as morphine, can trat the pain, chronic treatment with morphine leads to severe constipation. The goal of this research is to develop novel opioids which will treat severe pain, without leading to constipation. The approach to be used consists of developing opioids with a profile of mu agonism and delta antagonism, a profile shown to reduce the development of tolerance to the antinociceptiv4 effects of mu agonists. Thus the ever increasing dose of opioid will not b required, leading to lower levels of constipation. The current hypotheses is that the aromatic ring of the indolomorphinans and benzylidene-type delta selective opioids leads to a profile of low delta efficience. Thus, if a suitably placed aromatic ring is introduced into the structure of the orvinols (a class of opioids known to bind with high affinity to both mu and delta receptors), a profile of potent mu agonism and delta antagonism will result. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ORAL R108512 FOR CONSTIPATION IN CHILDREN Principal Investigator & Institution: Winter, Harland S.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ORPHANIN FQ (OFQ) EFFECTS ON RAT COLONIC MOTILITY Principal Investigator & Institution: Takahashi, Toku; Associate Professor; Surgery; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2004 Summary: The endogenous opioid receptor-like 1 (ORL1) ligand, orphanin FQ (OFQ), a heptadecapeptide structurally resembling dynorphin A, has recently been identified in rat brain. However, the physiological role of OFQ in gastrointestinal (GI) tract is unknown. Our preliminary studies have shown that OFQ preferentially stimulates muscular contraction in colon without affecting the motility of upper GI tract in rats. We have demonstrated that OFQ accelerates colonic transit and evokes propulsive colonic movements. In contrast, dynorphin A delays colonic transit and produces nonpropulsive movements. Based on our preliminary studies, we hypothesized that OFQ acts on colonic myenteric plexus and causes contractions by inhibiting an inhibitory ATP neural pathway of the colonic myenteric plexus. Inhibition of this inhibitory neural pathway will result in colonic muscle contraction and accelerates colonic transit. In contrast, Dynorphin A inhibits ACh, SP, NO, VIP and PACAP release and stimulates random non-coordinated muscle contraction resulting in delayed colonic transit. To test this hypothesis, we plan to perform immunohistochemistry to demonstrate that OFQ is present in abundance in the colonic myenteric plexus and demonstrate that OFQ receptors are expressed in the colonic myenteric plexus by in situ hybridization. We will then characterize the neural pathways responsible for the stimulatory action of OFQ on colonic motility and investigate the cellular mechanism mediating the inhibition of an inhibitory pathway by electrophysiological studies. Finally, the inhibitory neurotransmitter inhibited by OFQ will be identified by pharmacological studies as well as immunocytochemistry. In addition, we also plan to compare and contrast the mechanisms of action of OFQ versus dynorphin A on colonic motility. We will demonstrate that OFQ, but not dynorphin A, causes propulsive colonic movements and accelerates colonic transit in vivo. Dynorphin A, but not OFQ, inhibits ACh/SP/NO/VIP/PACAP pathway which mediates the peristaltic reflex. In addition, we will perform combined procedure of in situ hybridization and (immuno)histochemistry to demonstrate that OFQ receptors are present on ATP containing neurons whereas kappa receptors are present on ACh-, SP-, NOS-, VIP-, or PACAP-containing neurons. These studies will shed light on the mechanisms of action of OFQ and dynorphin A on colonic motility. This may have important clinical implications since OFQ or its analogues may be beneficial for the treatment of refractory constipation in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PILOT--DEVELOPING CLINICAL TRIALS OF NOVEL OPIOID PEPTIDES Principal Investigator & Institution: Carr, Daniel; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2001 Summary: Rapid, fur-reaching research advances in preclinical opioid chemistry and pharmacology have generated ample, persuasive data that several well-characterized opioid peptide analogs have potential clinical utility. Advantages suggested from preclinical studies of two such compounds, DPDPE and biphalin, compared to opioids is current clinical use include diminished addiction liability, fewer mu-opioid side effects shci as constipation or urinary retention, and therapeutic efficacy in patients

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with tolerance to mu-opioid analgestics such as after prior morphine therapy for chronic cancer pain. However, no clinical datanow exist regarding the clinical safety and efficacy of these analgesic peptides, particularly after intrathecal applicaiton although that route is the most appropriate choice for their initial clinical use. Hence, we now request funding for preliminary evaluation of the safety and efficacy of PDDPE and biphalin prior to their initial clinical trials in two clinical pain models, postoperative pain in otherwise healthy patients, and chronic cancer pain in patients with pre-existing intrathecal catheters for morphine delivery. It is our intention, upon successful completion of preclinical toxicologic, kinetic, and distribution studies by our collaborators, to apply for an IND (after a pre-IND meeting at the invitation of the FDA). We shall then seek supplementary funding for Phase 1 and Phase 2 trials in healthy volunteers and patients, respectively. The Phase 2 trials will be prospective, doubleblind, randomized and controlled (controls will receive standard analgesics), conducted in our NIH-funded General Clinical Research Center. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PYRIDOSTIGMINE FOR CONSTIPATION IN PATIENTS W/ AN AUTONOMIC NEUROPATHY Principal Investigator & Institution: Bharucha, Adil E.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001 Summary: Patients with an autonomic neuropathy frequently have severe constipation unresponsive to our current therapeutic armementarium. We recently demonstrated that i.v. neostigmine increases colonic contractility and transit in healthy volunteers; neostigmine also increased colonic tone and improved symptoms in one patient with autonomic neuropathy and intractable constipation. Pyridostigmine is an acetylcholinesterase inhibitor with higher bioavailability than neostigmine. Hypotheses1) In patients with slow transit constipation due to an autonomic neuropathy resulting from diabetes, pure autonomic failure, an immune-mediated process or multiple system atrophy, the acetylcholinesterase inhibitor pyridostigmine is safe, well tolerated, will improve colonic transit and satisfaction with bowel habits, 2) The effect of intravenous neostigmine on colonic tone during a motility study will predict treatment success with pyridostigmine. Aims - To assess the safety, tolerability, effect on symptoms, colonic transit and satisfaction with bowel movements of pyridostigmine in patients with constipation due to an autonomic neuropathy, and to determine if neostigmine's effects on the colonic pressure-volume relationship during a motility study predict the therapeutic response to pyridostigmine. Methods - Open-label, phase II pilot study of an escalating dose of pyridostigmine (60 mg t.i.d. to 180 mg t.i.d) in 10 patients with an autonomic neuropathy and constipation. A two-week run-in single-blind placebo phase will be followed by a 6-week single-blind treatment phase. Standard clinical assessments and a radionuclide whole-gut transit study will be performed at the beginning and end of the study. The effect of i.v. neostigmine on colonic tone and compliance will be assessed prior to the therapeutic trial. Primary endpoints are the effect of pyridostigmine on colonic transit and patient reported satisfaction with bowel movements during the last 2 weeks of the treatment period. Secondary endpoints are derived from the Rome Criteria for constipation (number of stools/week, stool consistency, frequency of straining and incomplete evacuation) and the proximal colonic emptying rate. A total of 10 patients in this pilot study should provide sufficient information to estimate the response magnitude and variability of the quantitative primary response variable, colonic transit. Significance - A successful therapeutic

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Constipation

response in >6/10 patients in this pilot study will lead to an placebo-controlled study of pyridostigmine in a similar patient population and perhaps other patient groups with constipation due to an autonomic neuropathy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: R108512.03MG/KG SOLUTION IN SUBS WITH FECAL RETENTION Principal Investigator & Institution: Gilger, Mark A.; Associate Professor; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001 Summary: Single-dose pharmacokinetic study of 0.03 mg/kg of oral R108512 solution in a minimum of 24 pediatric patients aged >= 4 to <= 12 years who are diagnosed with FFR. PK analysis will be performed for 72 hours post trial medication administration. Tolerability and safety of the trial medication will also be monitored. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: R108512 AND CONSTIPATION OR IBS

GI/COLONIC

TRANSIT

IN

FUNCTIONAL

Principal Investigator & Institution: Camilleri, Michael L.; Professor of Medicine and Physiology; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001 Summary: The hypothesis is that R108512 dose dependently accelerates colonic transit in patients with functional constipation or constipation-predominant irritable bowel syndrome. The specific aim of this study is to measure gastric, small bowel, and colonic transit in 40 patients with functional constipation or constipation-predominant irritable bowel syndrome randomized to placebo, 0.5, 2.0, or 4.0 mg per day as a single dose of R108512. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: R108512 SOLUTION IN PEDIATRIC SUBJECTS W/ FUNCTIONAL FECAL RETENTION Principal Investigator & Institution: Blumer, Jeffrey L.; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: In the pediatric population, constipation is the chief complaint in about 3% of all pediatric outpatient visits; as many as 25% of referrals to pediatric gastroenterologists are for children with constipation. The majority of these children have a form of functional constipation, referred to as FFR or functional fecal retention. The primary objective of this trial is to characterize the pharmacokinetics of a single oral dose of 0.03 mg/kg prucalopride in pediatric subjects aged greater than 4 to less than 12 years with FFR. This dose corresponds to an adult dose of.15 - 2.0 mg of prucalopride. The secondary objective is to evaluate the safety and the tolerability (adverse experiences) of a single oral dose of prucalopride solution, 0.03 mg/kg, given to pediatric subjects with FFR. No efficacy will be evaluated in this trial. Pharmacokinetic studies were done on the GCRC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RECURRENT ABDOMINAL PAIN IN CHILDREN Principal Investigator & Institution: Shulman, Robert; Pediatrics; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 30-APR-2007 Summary: (provided by applicant) Ten to 17 percent of children between the ages of 4 and 16 years meet the criteria for recurrent abdominal pain (RAP) a condition that accounts for at least 5 percent of all pediatric office visits and often leads to significant disability (e.g., school absence). From 30-60 percent of children with RAP will go on to experience similar pain as adults leading to the suggestion that RAP and irritable bowel syndrome (IBS) may be the same syndrome at different developmental stages. Similar to IBS, 20-68 percent of children reporting abdominal pain also experience alterations in bowel patterns (constipation and/or diarrhea). Although the cause(s) of RAP (as well as IBS) are unknown, factors contributing to the symptom experience, including health care seeking, are likely to include both physiological and psychosocial. The relationships among physiologic abnormalities, psychological makeup, and parental responses/behaviors in RAP are largely unexplored (undefined). To study the contributions of these sets of factors and their potential interplay, we propose to compare three groups of children: those with RAP who are referred to tertiary medical attention (RAP-GI); who have RAP but do not seek medical attention beyond their pediatrician (RAP-Ped); and those who do not have RAP symptoms (Controls). Our Specific Aims are to describe and compare among these children (ages 7-10): 1) GI symptoms (abdominal pain and bowel patterns) and functional disability (pain interfering with activity, school absences) using retrospective and prospective symptom measures; 2) autonomic nervous system function (spectral and non-spectral analysis of heart rate variability and urine catecholamines); 3) child and parent pain coping skills, parent modeling and reinforcement of illness behavior; and 4) psychological distress (anxiety, depression, and somatization). Children will be recruited from pediatric practices in Houston. This proposed interdisciplinary study will be the first in children to examine concurrently both physiologic and psychosocial factors related to RAP, and its functional consequences, and to compare these to a sample of children with RAP who do not seek tertiary medical attention. Because so many children with RAP are identified as having IBS when they reach adulthood, this study may provide insight into the developmental progression of this disorder. These data could be used to develop guidelines for use by health care providers to intervene early with children who have this common complaint in order to prevent health care seeking behavior with its attendant financial and emotional cost. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGULATION OF CALCIUM RELEASE IN INTESTINAL MYOCYTES Principal Investigator & Institution: Bielefeldt, Klaus; Associate Professor; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 24-AUG-1998; Project End 31-MAY-2003 Summary: The normal gastrointestinal motility depends on a cascade of intracellular signals that translate a signal at the cell membrane into muscle contraction. The calcium ion plays a central role in this process of excitation-contraction coupling. Changes in the calcium homeostasis of smooth muscle cells may thus contribute to common gastrointestinal diseases, such as constipation, diarrhea, or gastroesophageal reflux disease. Increases in the cytosolic calcium level can be due to calcium influx through ion channels in the cell membrane or calcium release from intracellular stores. Two

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intracellular calcium release channels have been identified in intestinal smooth muscle cells: the inositol 1,4,5-trisphosphate receptor channel and the ryanodine receptor channel. Little is known about the mechanisms that modulate the activity of these intracellular calcium release channels. We hypothesize that ryanodine receptor channel isoforms are differentially expressed in gastro-intestinal smooth muscle from anatomically and functionally distinct areas; associated modulatory proteins further increase this heterogeneity, thereby affecting intestinal motor function. The proposed experiments will investigate the regulation of calcium release from intracellular stores. The following specific goals will be addressed: (1) Biochemical and functional characterization of calcium release channels expressed in intestinal smooth muscle cells. (2) Identification of proteins associated with ryanodine receptor channels in intestinal smooth muscle cells. (3) Characterization of the functional role of proteins associated with the ryanodine receptor channel. A better understanding of mechanisms that control the calcium homeostasis may provide important insight into the etiology of diseases or lead to the development of novel treatment strategies for functional abnormalities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SYMPTOM MANAGEMENT IN LIFE-THREATENING ILLNESS Principal Investigator & Institution: Nail, Lillian M.; Professor; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001; Project Start 15-SEP-2001; Project End 31-AUG-2004 Summary: from applicant's Abstract): Symptom management is an important component of nursing practice across care settings, client populations, and type of practice. Although the value of symptom management is widely recognized, the research base supporting practice is uneven with extensive research on pain and pain management and little research addressing symptoms like constipation, thirst, itching, hot flashes in men, and fatigue in chronic heart failure. Symptom management research is quite broad in scope. It includes identification of previously uncharacterized symptoms, examination of approaches to symptom reporting, describing symptom appraisals and symptom interpretation, documenting the pattern of a specific symptom or examining the patterns of relationships among a variety of symptoms, testing interventions designed to prevent or ameliorate a symptom or those aimed at modifying responses to symptoms, and the systematic evaluation of strategies for translating knowledge about symptom management into practice. The experience of lifethreatening illness is especially relevant to the science of symptom management because symptoms are a key element of the illness experience. The aims of the proposed exploratory center are to advance the state-of-the-art for knowledge development and utilization on symptom management in life-threatening illness (cancer, cardiac disease, and end-of-life care), establish a new methodologic standard for symptom management research, develop an infrastructure to symptom management research at the OHSU SON, and enhance the existing research environment. The Center will provide funding for three pilot/feasibility studies each year for three years and provide shared resources to support these pilot studies in the areas of Statistical Analysis, Methodologic Support, and Logistical Support. The Center is built on a strong research base that includes two NIH-funded R01's and additional NIH funded symptom management studies as well as foundation funded projects. The leadership team includes two senior level and one experienced mid-career scientist, all of whom address aspects of symptom management in their own programs of research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SYNAPTIC TRANSMISSION IN DIABETIC ENTERIC NERVOUS SYSTEM Principal Investigator & Institution: Lepard, Kathy J.; Physiology; Midwestern University 555 31St St Downers Grove, Il 60515 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-AUG-2003 Summary: (Applicant's abstract): Gastrointestinal (GI) disturbances are not normally life-threatening but do profoundly affect quality of life. Diabetic patients often experience a wide range of GI discomforts including heartburn, nausea, vomiting, diarrhea, constipation, fecal incontinence and abdominal pain. Many patients have abnormalities in motility arising from identifiable conditions; but over 50% of GI complaints are idiopathic and are indicative of autonomic neuropathy. Both enteric nerves in and sympathetic nerves to the GI tract undergo neuropathy in animal models of diabetes as supported by immunohistochemical, histological, and functional data. A streptozotocin-induced diabetic guinea pig model will be used to isolate and evaluate alterations in sympathetic and enteric nerve activity at the histochemical, functional and cellular level. Neuropathy of enteric neurons will be investigated immunohistochemically by quantifying enzyme and peptide content of the small intestine, functionally by recording contractions/ relaxations from circular/ longitudinal smooth muscle strips of small intestine and cellularly by recording junction potentials from smooth muscle cells. Neuropathy of sympathetic neurons will be evaluated histochemically by quantifying norepinephrine (NE) content of small intestine and cellularly by recording NE mediated inhibitory postsynaptic potentials from submucosal neurons and by evaluating presynaptic inhibition of enteric neurotransmission by NE. Experimental data will be correlated with metabolic indices (body weight, glycosylated hemoglobin and plasma glucose) to determine normal control deviations and degree of diabetic severity with the intent of identifying a threshold for GI dysfunction. By defining the individual contribution of sympathetic and enteric neuropathies to dysfunctional GI motility, targets for therapeutic intervention to improve patient quality of life will be pinpointed. Adaptations of enteric neurons to diabetes will provide insight into enteric plasticity occurring in other GI diseases such as neuronal intestinal dysplasia, achalasia, scleroderma, pyloric stenosis, idiopathic constipation, diverticular disease, Parkinson's disease, and paraneoplastic syndromes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSGENIC MOUSE MODEL OF GUT DYSMOTILITY IN AGING Principal Investigator & Institution: Bush, Toby G.; Physiology and Cell Biology; University of Nevada Reno Reno, Nv 89557 Timing: Fiscal Year 2003; Project Start 30-SEP-2001; Project End 29-SEP-2003 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSGENIC MOUSE MODEL OF GUT DYSMOTILITY IN AGING Principal Investigator & Institution: Spencer, Nicholas; Physiology and Cell Biology; University of Nevada Reno Reno, Nv 89557 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-DEC-2003 Summary: There is no text on file for this abstract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OF EARLY CHILDHOOD CONSTIPATION AND ENCOPRESIS Principal Investigator & Institution: Cox, Daniel J.; Psychiatric Medicine; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2001; Project Start 01-APR-1992; Project End 30-JUN-2006 Summary: (provided by applicant): It is estimated that 3-5 percent of children suffer from fecal incontinence. One of the most effective ways of treating encopresis is through Enhanced Toilet Training (ETT). ETT is twice as effective as intensive medial management alone at 3, 6, and 12-month follow-up when delivered by skilled and knowledgeable clinicians. Although this finding is a clear indication that ETT can be effective in treating encopretic children, there are 5 major barriers to its implementation: 1) availability of a knowledgeable and skilled clinician, 2) parental acceptance of referral to a mental health professional, 3) expense for this available service, 4) burden of time and distance to access such specialty services, and 5) child resistance to disclosure of embarrassing material. We have attempted to circumvent these barriers by operationalizing the treatment components of ETT in creating an interactive Internetbased program, which we demonstrated significantly enhances treatment provided by primary care physicians. We have developed a theoretical model for therapeutic behavior change achieved by web-based interventions, and completed a feasibility study demonstrating the acceptance, function and effectiveness of such an intervention for children with encopresis. We propose a 5-year, 4-phase project: Expert Optimization Phase 1 will bring together clinical and website experts to identify optimal web and treatment elements as well as issues in need of experimental investigation. Experimental Optimization Phase 2 (years 1-2) will investigate how to enhance internet-based interventions with a series of experimental investigations. Clinical Trial Phase 3 (years 34) will evaluate the relative benefit of adding the internet treatment to clinical services provided by generalists and specialists in the fields of medicine and mental health. CostBenefit/ Dissemination Phase 4 (Years 4-5) will investigate the relative long-term benefits of adding such an internet based intervention to professional interventions, to determine impact on symptom improvement, generalization of symptom impact, relapse prevention, quality of life, and cost-effectiveness. Phase 4 will also assess to what extent the program is disseminated world wide when made generally available on the Internet. After 5 years we will have documented basic elements and dissemination patters of web-based pediatric behavior change programs generally, and, in particular Enhanced Toilet Training. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to 3

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with constipation, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “constipation” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for constipation (hyperlinks lead to article summaries): •

A 6-year follow-up study of chronic constipation and soiling in a specialist paediatric service. Author(s): Procter E, Loader P. Source: Child: Care, Health and Development. 2003 March; 29(2): 103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12603355&dopt=Abstract

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A clinical approach to constipation. Author(s): Faigel DO. Source: Clinical Cornerstone. 2002; 4(4): 11-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739323&dopt=Abstract

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A comparison between dynamic pelvic magnetic resonance imaging and videoproctography in patients with constipation. Author(s): Matsuoka H, Wexner SD, Desai MB, Nakamura T, Nogueras JJ, Weiss EG, Adami C, Billotti VL. Source: Diseases of the Colon and Rectum. 2001 April; 44(4): 571-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11330585&dopt=Abstract

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A guide to helping the patient who complains of constipation. Author(s): Barrett JA. Source: The Practitioner. 2000 November; 244(1616): 982-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11116746&dopt=Abstract

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A national audit of chronic constipation in the community. Author(s): Addison R, Davies C, Haslam D, Powell M, Stowers L. Source: Nurs Times. 2003 March 18-24; 99(11): 34-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683044&dopt=Abstract

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A new weapon for the arsenal in the war against constipation? Author(s): Lasch HM, Bozymski EM. Source: The American Journal of Gastroenterology. 2000 February; 95(2): 341-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10685733&dopt=Abstract

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A new, highly sensitive assay for C-reactive protein can aid the differentiation of inflammatory bowel disorders from constipation- and diarrhoea-predominant functional bowel disorders. Author(s): Poullis AP, Zar S, Sundaram KK, Moodie SJ, Risley P, Theodossi A, Mendall MA. Source: European Journal of Gastroenterology & Hepatology. 2002 April; 14(4): 409-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11943955&dopt=Abstract

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A novel treatment for constipation-predominant irritable bowel syndrome using Padma Lax, a Tibetan herbal formula. Author(s): Sallon S, Ben-Arye E, Davidson R, Shapiro H, Ginsberg G, Ligumsky M. Source: Digestion. 2002; 65(3): 161-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12138321&dopt=Abstract

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A population-based study on bowel habits in a Swedish community: prevalence of faecal incontinence and constipation. Author(s): Walter S, Hallbook O, Gotthard R, Bergmark M, Sjodahl R. Source: Scandinavian Journal of Gastroenterology. 2002 August; 37(8): 911-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12229965&dopt=Abstract

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A protocol for treating acute constipation in the community setting. Author(s): Withell B. Source: British Journal of Community Nursing. 2000 March; 5(3): 110, 112, 114-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12589238&dopt=Abstract

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A randomized, double-blind, placebo-controlled trial of tegaserod in female patients suffering from irritable bowel syndrome with constipation. Author(s): Novick J, Miner P, Krause R, Glebas K, Bliesath H, Ligozio G, Ruegg P, Lefkowitz M. Source: Alimentary Pharmacology & Therapeutics. 2002 November; 16(11): 1877-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12390096&dopt=Abstract

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A six-year old suffering from constipation. Author(s): Brown S, Kerrigan P, Waterston T. Source: The Practitioner. 2000 February; 244(1607): 63-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10892039&dopt=Abstract

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A treatment for constipation. Author(s): Engel HO. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1999 September; 49(446): 755. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10756629&dopt=Abstract

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Abdominal compartment syndrome from intractable constipation. Author(s): Gorecki PJ, Kessler E, Schein M. Source: Journal of the American College of Surgeons. 2000 March; 190(3): 371. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10703865&dopt=Abstract

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Abnormalities of left colonic motility in ambulant nonconstipated patients with irritable bowel syndrome. Author(s): Clemens CH, Samsom M, Van Berge Henegouwen GP, Smout AJ. Source: Digestive Diseases and Sciences. 2003 January; 48(1): 74-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12645793&dopt=Abstract

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Accuracy of clinical variables in the identification of radiographically proven constipation in children. Author(s): Beckmann KR, Hennes H, Sty JR, Walsh-Kelly CM. Source: Wmj. 2001; 100(1): 33-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11315444&dopt=Abstract

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Acetylcholinesterase distribution and refractory constipation - a new criterion for diagnosis and management. Author(s): Kobayashi H, Li Z, Yamataka A, Lane GJ, Yokota H, Watanabe A, Miyano T. Source: Pediatric Surgery International. 2002 September; 18(5-6): 349-53. Epub 2002 May 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415353&dopt=Abstract

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Adult constipation: a review and clinical guide. Author(s): Jacobs TQ, Pamies RJ. Source: Journal of the National Medical Association. 2001 January; 93(1): 22-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653377&dopt=Abstract

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Advances in the management of pediatric constipation. Author(s): Nurko S. Source: Current Gastroenterology Reports. 2000 June; 2(3): 234-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10957935&dopt=Abstract

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AGA technical review on constipation. American Gastroenterological Association. Author(s): Locke GR 3rd, Pemberton JH, Phillips SF. Source: Gastroenterology. 2000 December; 119(6): 1766-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11113099&dopt=Abstract

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Allergic constipation: association with infantile milk allergy. Author(s): Vanderhoof JA, Perry D, Hanner TL, Young RJ. Source: Clinical Pediatrics. 2001 July; 40(7): 399-402. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11491136&dopt=Abstract

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Alleviating constipation in the elderly improves lower urinary tract symptoms. Author(s): Charach G, Greenstein A, Rabinovich P, Groskopf I, Weintraub M. Source: Gerontology. 2001 March-April; 47(2): 72-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287730&dopt=Abstract

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Altered periodic rectal motor activity: a mechanism for slow transit constipation. Author(s): Rao SS, Sadeghi P, Batterson K, Beaty J. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2001 December; 13(6): 591-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903920&dopt=Abstract

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American Gastroenterological Association Medical Position Statement: guidelines on constipation. Author(s): Locke GR 3rd, Pemberton JH, Phillips SF. Source: Gastroenterology. 2000 December; 119(6): 1761-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11113098&dopt=Abstract

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An elderly man with chest pain, shortness of breath, and constipation. Author(s): Fisher AA, Davis MW. Source: Postgraduate Medical Journal. 2003 March; 79(929): 180, 183-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12697928&dopt=Abstract

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An epidemiological survey of constipation in canada: definitions, rates, demographics, and predictors of health care seeking. Author(s): Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L. Source: The American Journal of Gastroenterology. 2001 November; 96(11): 3130-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11721760&dopt=Abstract

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Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury. Author(s): Yang CC, Stiens SA. Source: Archives of Physical Medicine and Rehabilitation. 2000 May; 81(5): 683-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10807111&dopt=Abstract

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Antegrade continence enemas in the treatment of slow-transit constipation. Author(s): Marshall J, Hutson JM, Anticich N, Stanton MP. Source: Journal of Pediatric Surgery. 2001 August; 36(8): 1227-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11479862&dopt=Abstract

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Aromatherapy massage for joint pain and constipation in a patient with Guillian Barre. Author(s): Shirreffs CM. Source: Complementary Therapies in Nursing & Midwifery. 2001 May; 7(2): 78-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11855776&dopt=Abstract

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Assessment of behavioral mechanisms maintaining encopresis: Virginia EncopresisConstipation Apperception Test. Author(s): Cox DJ, Ritterband LM, Quillian W, Kovatchev B, Morris J, Sutphen J, Borowitz S. Source: Journal of Pediatric Psychology. 2003 September; 28(6): 375-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904449&dopt=Abstract

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Association between physical activity, fiber intake, and other lifestyle variables and constipation in a study of women. Author(s): Dukas L, Willett WC, Giovannucci EL. Source: The American Journal of Gastroenterology. 2003 August; 98(8): 1790-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907334&dopt=Abstract

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Automated quantitative analysis of nocturnal jejunal motor activity identifies abnormalities in individuals and subgroups of patients with slow transit constipation. Author(s): Scott SM, Picon L, Knowles CH, Fourquet F, Yazaki E, Williams NS, Lunniss PJ, Wingate DL. Source: The American Journal of Gastroenterology. 2003 May; 98(5): 1123-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809838&dopt=Abstract

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Biofeedback avoids surgery in patients with slow-transit constipation: report of four cases. Author(s): Brown SR, Donati D, Seow-Choen F, Ho YH. Source: Diseases of the Colon and Rectum. 2001 May; 44(5): 737-9; Discussion 739-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11357038&dopt=Abstract

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Biofeedback treatment of constipation: a critical review. Author(s): Heymen S, Jones KR, Scarlett Y, Whitehead WE. Source: Diseases of the Colon and Rectum. 2003 September; 46(9): 1208-17. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972965&dopt=Abstract

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Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome. Author(s): Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Albanese A. Source: Diseases of the Colon and Rectum. 2000 March; 43(3): 376-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10733120&dopt=Abstract

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By the way, doctor. For years, I've been taking the same dose of Synthroid for hypothyroidism, and recent tests place me in the normal range. However, I still have several symptoms of low thyroid--fatigue, difficulty losing weight, sensitivity to cold, and constipation. My doctor doesn't seem concerned with the symptoms, as long as my blood tests are normal. But I'm frustrated. Is there anything I can do? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2001 January; 8(5): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11137975&dopt=Abstract

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Case study to evaluate a standing table for managing constipation. Author(s): Hoenig H, Murphy T, Galbraith J, Zolkewitz M. Source: Sci Nurs. 2001 Summer; 18(2): 74-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12035465&dopt=Abstract

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Childhood constipation. Author(s): Rubin GP. Source: American Family Physician. 2003 March 1; 67(5): 1041-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643364&dopt=Abstract

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Childhood constipation: evaluation and treatment. Author(s): Youssef NN, Di Lorenzo C. Source: Journal of Clinical Gastroenterology. 2001 September; 33(3): 199-205. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11500607&dopt=Abstract

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Childhood constipation: longitudinal follow-up beyond puberty. Author(s): van Ginkel R, Reitsma JB, Buller HA, van Wijk MP, Taminiau JA, Benninga MA. Source: Gastroenterology. 2003 August; 125(2): 357-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891536&dopt=Abstract

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Chronic constipation due to Hirschsprung's disease and desmosis coli in a family. Author(s): Marshall DG, Meier-Ruge WA, Chakravarti A, Langer JC. Source: Pediatric Surgery International. 2002 March; 18(2-3): 110-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956774&dopt=Abstract

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Chronic constipation. Author(s): Lembo A, Camilleri M. Source: The New England Journal of Medicine. 2003 October 2; 349(14): 1360-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523145&dopt=Abstract

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Chronic idiopathic slow transit constipation: pathophysiology and management. Author(s): El-Salhy M. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 July; 5(4): 288-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12814404&dopt=Abstract

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Colchicine for persistent constipation after total abdominal colectomy with ileorectostomy for colonic inertia. Author(s): Rajapakse R, Warman J, Korelitz BI. Source: Journal of Clinical Gastroenterology. 2001 July; 33(1): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11418801&dopt=Abstract

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Collagenous colitis: constipation or diarrhoea? Author(s): Barta Z, Toth L, Szabo GG, Szegedi G. Source: Gut. 2003 August; 52(8): 1230. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865295&dopt=Abstract

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Colonic diversion for intractable constipation in children: colonic manometry helps guide clinical decisions. Author(s): Steffen RM. Source: Clinical Pediatrics. 2002 July-August; 41(6): 449-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180433&dopt=Abstract

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Comparison of efficacy and safety of two doses of two different polyethylene glycolbased laxatives in the treatment of constipation. Author(s): Chaussade S, Minic M. Source: Alimentary Pharmacology & Therapeutics. 2003 January; 17(1): 165-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492746&dopt=Abstract

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Comparison of polyethylene glycol 3350 and lactulose for treatment of chronic constipation in children. Author(s): Gremse DA, Hixon J, Crutchfield A. Source: Clinical Pediatrics. 2002 May; 41(4): 225-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12041718&dopt=Abstract

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Completely laparoscopic total colectomy for chronic constipation: report of a case. Author(s): Inoue Y, Noro H, Komoda H, Kimura T, Mizushima T, Taniguchi E, Yumiba T, Itoh T, Ohashi S, Matsuda H. Source: Surgery Today. 2002; 32(6): 551-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12107785&dopt=Abstract

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Constipation and fecal incontinence in the elderly. Author(s): Schiller LR. Source: Gastroenterology Clinics of North America. 2001 June; 30(2): 497-515. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11432302&dopt=Abstract

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Constipation and its management. Author(s): Kamm MA. Source: Bmj (Clinical Research Ed.). 2003 August 30; 327(7413): 459-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946949&dopt=Abstract

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Constipation and lack of colonic interstitial cells of Cajal. Author(s): Sabri M, Barksdale E, Di Lorenzo C. Source: Digestive Diseases and Sciences. 2003 May; 48(5): 849-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772778&dopt=Abstract

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Constipation as a cause of scrotal pain in children. Author(s): Fein JA, Donoghue AJ, Canning DA. Source: The American Journal of Emergency Medicine. 2001 July; 19(4): 290-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11447515&dopt=Abstract

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Constipation care. Author(s): Ansell S. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2003 April 30-May 6; 17(33): 26-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744121&dopt=Abstract

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Constipation during pregnancy. Fiber and fluid are keys to self-management. Author(s): Morgan C. Source: Adv Nurse Pract. 2001 October; 9(10): 57-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12400339&dopt=Abstract

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Constipation in children. Author(s): Castiglia PT. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2001 July-August; 15(4): 200-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11462128&dopt=Abstract

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Constipation in children: avoiding hospital admissions by the use of a specialist community nurse. Author(s): Bartle D, Finlay F, Atherton F. Source: J Fam Health Care. 2003; 13(4): 107-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14528651&dopt=Abstract

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Constipation in the elderly. Routine equals regularity. Author(s): Kennedy KL. Source: Adv Nurse Pract. 2002 July; 10(7): 32-4, 37. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420548&dopt=Abstract

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Constipation in very-low-birth-weight children at 10 to 14 years of age. Author(s): Cunningham C, Taylor HG, Minich NM, Hack M. Source: Journal of Pediatric Gastroenterology and Nutrition. 2001 July; 33(1): 23-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11479403&dopt=Abstract

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Constipation overview: evaluation and management. Author(s): Douglas J. Source: Curr Womens Health Rep. 2002 August; 2(4): 280-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150755&dopt=Abstract

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Constipation revisited. Author(s): Enck RE. Source: Am J Hosp Palliat Care. 2002 November-December; 19(6): 367-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442967&dopt=Abstract

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Constipation with acquired megarectum in children with autism. Author(s): Afzal N, Murch S, Thirrupathy K, Berger L, Fagbemi A, Heuschkel R. Source: Pediatrics. 2003 October; 112(4): 939-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523189&dopt=Abstract

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Constipation, anthranoid laxatives, melanosis coli, and colon cancer: a risk assessment using aberrant crypt foci. Author(s): Nascimbeni R, Donato F, Ghirardi M, Mariani P, Villanacci V, Salerni B. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2002 August; 11(8): 753-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12163329&dopt=Abstract

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Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Author(s): Wald A. Source: Gastroenterology Clinics of North America. 2003 March; 32(1): 309-22, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635420&dopt=Abstract

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Constipation, laxative use, and colon cancer in a North Carolina population. Author(s): Roberts MC, Millikan RC, Galanko JA, Martin C, Sandler RS. Source: The American Journal of Gastroenterology. 2003 April; 98(4): 857-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738468&dopt=Abstract

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Constipation, polyuria, polydipsia, and edema associated with orlistat. Author(s): Packard KA, Wurdeman RL, Reyes AP. Source: The Annals of Pharmacotherapy. 2002 July-August; 36(7-8): 1168-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12086548&dopt=Abstract

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Constipation. Author(s): Rubin G. Source: Clin Evid. 2002 June; (7): 292-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230652&dopt=Abstract

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Constipation: evaluation and management. Author(s): Borum ML. Source: Primary Care. 2001 September; 28(3): 577-90, Vi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11483445&dopt=Abstract

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Constipation: is there a new approach? Author(s): Sondheimer J. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 April; 34(4): 357-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11930088&dopt=Abstract

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Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting. Author(s): Tytgat GN, Heading RC, Muller-Lissner S, Kamm MA, Scholmerich J, Berstad A, Fried M, Chaussade S, Jewell D, Briggs A. Source: Alimentary Pharmacology & Therapeutics. 2003 August 1; 18(3): 291-301. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12895213&dopt=Abstract

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Coping strategies, illness perception, anxiety and depression of patients with idiopathic constipation: a population-based study. Author(s): Cheng C, Chan AO, Hui WM, Lam SK. Source: Alimentary Pharmacology & Therapeutics. 2003 August 1; 18(3): 319-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12895216&dopt=Abstract

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Cow's milk protein intolerance and childhood constipation. Author(s): Mora W. Source: American Family Physician. 2003 September 15; 68(6): 1016. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14524391&dopt=Abstract

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Cow's milk protein intolerance and chronic constipation in children. Author(s): Daher S, Tahan S, Sole D, Naspitz CK, Da Silva Patricio FR, Neto UF, De Morais MB. Source: Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology. 2001 December; 12(6): 339-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11846872&dopt=Abstract

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Death from clozapine-induced constipation: case report and literature review. Author(s): Levin TT, Barrett J, Mendelowitz A. Source: Psychosomatics. 2002 January-February; 43(1): 71-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927763&dopt=Abstract

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Decreased tyrosine kinase C expression may reflect developmental abnormalities in Hirschsprung's disease and idiopathic slow-transit constipation. Author(s): Facer P, Knowles CH, Thomas PK, Tam PK, Williams NS, Anand P. Source: The British Journal of Surgery. 2001 April; 88(4): 545-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11298623&dopt=Abstract

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Development of a protocol to prevent opioid-induced constipation in patients with cancer: a research utilization project. Author(s): Robinson CB, Fritch M, Hullett L, Petersen MA, Sikkema S, Theuninck L, Timmer K. Source: Clinical Journal of Oncology Nursing. 2000 March-April; 4(2): 79-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11107380&dopt=Abstract

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Development of constipation in nursing home residents. Author(s): Robson KM, Kiely DK, Lembo T. Source: Diseases of the Colon and Rectum. 2000 July; 43(7): 940-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10910239&dopt=Abstract

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Diagnosis of constipation in family practice. Author(s): Ferrazzi S, Thompson GW, Irvine EJ, Pare P, Rance L. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2002 March; 16(3): 159-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11930193&dopt=Abstract

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Diarrhea and constipation. Author(s): Hartmann JT, Bokemeyer C. Source: Antibiot Chemother. 2000; 50: 184-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10874466&dopt=Abstract

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Diarrhea- and constipation-predominant IBS patients differ in postprandial autonomic and cortisol responses. Author(s): Elsenbruch S, Orr WC. Source: The American Journal of Gastroenterology. 2001 February; 96(2): 460-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11232691&dopt=Abstract

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Dietary fiber intake, stool frequency and colonic transit time in chronic functional constipation in children. Author(s): Guimaraes EV, Goulart EM, Penna FJ. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 2001 September; 34(9): 1147-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11514838&dopt=Abstract

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Dietary fibre intake and constipation in children with severe developmental disabilities. Author(s): Tse PW, Leung SS, Chan T, Sien A, Chan AK. Source: Journal of Paediatrics and Child Health. 2000 June; 36(3): 236-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10849223&dopt=Abstract

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Differential alterations in tachykinin NK2 receptors in isolated colonic circular smooth muscle in inflammatory bowel disease and idiopathic chronic constipation. Author(s): Menzies JR, McKee R, Corbett AD. Source: Regulatory Peptides. 2001 June 15; 99(2-3): 151-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11384776&dopt=Abstract

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Differential therapy of constipation--a review. Author(s): Wanitschke R, Goerg KJ, Loew D. Source: Int J Clin Pharmacol Ther. 2003 January; 41(1): 14-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12564741&dopt=Abstract

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Does treatment of constipation improve faecal incontinence in institutionalized elderly patients? Author(s): Chassagne P, Jego A, Gloc P, Capet C, Trivalle C, Doucet J, Denis P, Bercoff E. Source: Age and Ageing. 2000 March; 29(2): 159-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10791451&dopt=Abstract

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Double-blind placebo-controlled crossover study of sacral nerve stimulation for idiopathic constipation. Author(s): Kenefick NJ, Vaizey CJ, Cohen CR, Nicholls RJ, Kamm MA. Source: The British Journal of Surgery. 2002 December; 89(12): 1570-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12445068&dopt=Abstract

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Dyspepsia, irritable bowel syndrome, and constipation: review and what's new. Author(s): Camilleri M. Source: Reviews in Gastroenterological Disorders. 2001; 1(1): 2-17. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120117&dopt=Abstract

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Dysplasia of the submucous nerve plexus in slow-transit constipation of adults. Author(s): Voderholzer WA, Wiebecke B, Gerum M, Muller-Lissner SA. Source: European Journal of Gastroenterology & Hepatology. 2000 July; 12(7): 755-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10929902&dopt=Abstract

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Early constipation and toilet training in children with encopresis. Author(s): Fishman L, Rappaport L, Cousineau D, Nurko S. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 April; 34(4): 385-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11930094&dopt=Abstract

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Easing the pain of constipation. Author(s): Crouch D. Source: Nurs Times. 2003 March 18-24; 99(11): 22-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12683039&dopt=Abstract

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Economic impact of low dose polyethylene glycol 3350 plus electrolytes compared with lactulose in the management of idiopathic constipation in the UK. Author(s): Christie AH, Culbert P, Guest JF. Source: Pharmacoeconomics. 2002; 20(1): 49-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11817992&dopt=Abstract

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Effect of bowel cleansing on colonic transit in constipation due to slow transit or evacuation disorder. Author(s): Sloots CE, Felt-Bersma RJ. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2002 February; 14(1): 55-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11874554&dopt=Abstract

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Effect of colectomy on gastric emptying in idiopathic slow-transit constipation. Author(s): Macdonald A. Source: The British Journal of Surgery. 2001 May; 88(5): 730. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11360965&dopt=Abstract

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Effect of colectomy on gastric emptying in idiopathic slow-transit constipation. Author(s): Hemingway DM, Finlay IG. Source: The British Journal of Surgery. 2000 September; 87(9): 1193-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10971427&dopt=Abstract

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Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly. Author(s): Ouwehand AC, Lagstrom H, Suomalainen T, Salminen S. Source: Annals of Nutrition & Metabolism. 2002; 46(3-4): 159-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12169860&dopt=Abstract

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Effect of subtotal colectomy on gastric emptying of a solid meal in slow-transit constipation. Author(s): Mollen RM, Hopman WP, Oyen WJ, Kuijpers HH, Edelbroek MA, Jansen JB. Source: Diseases of the Colon and Rectum. 2001 August; 44(8): 1189-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535861&dopt=Abstract

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Effectiveness of acupuncture for treatment of childhood constipation. Author(s): Broide E, Pintov S, Portnoy S, Barg J, Klinowski E, Scapa E. Source: Digestive Diseases and Sciences. 2001 June; 46(6): 1270-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11414304&dopt=Abstract

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Effects of a meal and bisacodyl on colonic motility in healthy volunteers and patients with slow-transit constipation. Author(s): De Schryver AM, Samsom M, Smout AI. Source: Digestive Diseases and Sciences. 2003 July; 48(7): 1206-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870774&dopt=Abstract

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Effects of carbonated water on functional dyspepsia and constipation. Author(s): Cuomo R, Grasso R, Sarnelli G, Capuano G, Nicolai E, Nardone G, Pomponi D, Budillon G, Ierardi E. Source: European Journal of Gastroenterology & Hepatology. 2002 September; 14(9): 991-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352219&dopt=Abstract

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Effects of prucalopride on colonic transit, anorectal function and bowel habits in patients with chronic constipation. Author(s): Sloots CE, Poen AC, Kerstens R, Stevens M, De Pauw M, Van Oene JC, Meuwissen SG, Felt-Bersma RJ. Source: Alimentary Pharmacology & Therapeutics. 2002 April; 16(4): 759-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11929394&dopt=Abstract

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Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. Author(s): Pashankar DS, Bishop WP. Source: The Journal of Pediatrics. 2001 September; 139(3): 428-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11562624&dopt=Abstract

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Efficacy and tolerability of prucalopride in patients with constipation due to spinal cord injury. Author(s): Krogh K, Jensen MB, Gandrup P, Laurberg S, Nilsson J, Kerstens R, De Pauw M. Source: Scandinavian Journal of Gastroenterology. 2002 April; 37(4): 431-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11989834&dopt=Abstract

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Efficiency of biofeedback therapy for chronic constipation in children. Author(s): Sunic-Omejc M, Mihanovic M, Bilic A, Jurcic D, Restek-Petrovic B, Maric N, Dujsin M, Bilic A. Source: Coll Antropol. 2002 December; 26 Suppl: 93-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674840&dopt=Abstract

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Electroacupuncture treatment for constipation due to spasmodic syndrome of the pelvic floor--a report of 36 cases. Author(s): Wang S. Source: J Tradit Chin Med. 2001 September; 21(3): 205-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11789328&dopt=Abstract

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Empirically supported treatments in pediatric psychology: constipation and encopresis. Author(s): Banez GA, Steffen RM. Source: Clinical Pediatrics. 2001 August; 40(8): 471-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11516059&dopt=Abstract

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Empirically supported treatments in pediatric psychology: constipation and encopresis. Author(s): McGrath ML, Mellon MW, Murphy L. Source: Journal of Pediatric Psychology. 2000 June; 25(4): 225-54; Discussion 255-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10814690&dopt=Abstract

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Enteric nerves and interstitial cells of Cajal are altered in patients with slow-transit constipation and megacolon. Author(s): Wedel T, Spiegler J, Soellner S, Roblick UJ, Schiedeck TH, Bruch HP, Krammer HJ. Source: Gastroenterology. 2002 November; 123(5): 1459-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12404220&dopt=Abstract

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Evaluation and treatment of constipation. Author(s): Dosh SA. Source: The Journal of Family Practice. 2002 June; 51(6): 555-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12100780&dopt=Abstract

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Evaluation of constipation. Author(s): Arce DA, Ermocilla CA, Costa H. Source: American Family Physician. 2002 June 1; 65(11): 2283-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12074527&dopt=Abstract

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Evaluation of myenteric ganglion cells and interstitial cells of Cajal in patients with chronic idiopathic constipation. Author(s): Yu CS, Kim HC, Hong HK, Chung DH, Kim HJ, Kang GH, Kim JC. Source: International Journal of Colorectal Disease. 2002 July; 17(4): 253-8. Epub 2002 January 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12073074&dopt=Abstract

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Factors influencing constipation in advanced cancer patients: a prospective study of opioid dose, dantron dose and physical functioning. Author(s): Bennett M, Cresswell H. Source: Palliative Medicine. 2003 July; 17(5): 418-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12882260&dopt=Abstract

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Fecal continence in patients having undergone posterior sagittal anorectoplasty procedure for a high anorectal malformation improves at adolescence, as constipation disappears. Author(s): Rintala RJ, Lindahl HG. Source: Journal of Pediatric Surgery. 2001 August; 36(8): 1218-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11479860&dopt=Abstract

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Fecoflowmetric evaluation of anorectal function and ability to defecate in children with idiopathic chronic constipation. Author(s): Kayaba H, Hebiguchi T, Yoshino H, Mizuno M, Saitoh N, Kobayashi Y, Adachi T, Chihara J, Kato T. Source: Pediatric Surgery International. 2003 June; 19(4): 251-5. Epub 2003 April 24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12712361&dopt=Abstract

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Fiber intake, constipation, and risk of varicose veins in the general population: Edinburgh Vein Study. Author(s): Lee AJ, Evans CJ, Hau CM, Fowkes FG. Source: Journal of Clinical Epidemiology. 2001 April; 54(4): 423-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11297893&dopt=Abstract

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Fluids, fibre and constipation. Author(s): Bush S. Source: Nurs Times. 2000 August 3; 96(31 Suppl): 11-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11963695&dopt=Abstract

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Four cases of desmosis coli: severe chronic constipation, massive dilatation of the colon, and hypoperistalsis due to of changes in the colonic connective-tissue net. Author(s): Hubner U, Meier-Ruge W, Halsband H. Source: Pediatric Surgery International. 2002 March; 18(2-3): 198-203. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956799&dopt=Abstract

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Function of hollow viscera in children with constipation and voiding difficulties. Author(s): Lucanto C, Bauer SB, Hyman PE, Flores AF, Di Lorenzo C. Source: Digestive Diseases and Sciences. 2000 July; 45(7): 1274-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10961703&dopt=Abstract

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Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence. Author(s): De Lillo AR, Rose S. Source: The American Journal of Gastroenterology. 2000 April; 95(4): 901-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10763934&dopt=Abstract

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General geriatrics and gastroenterology: constipation and faecal incontinence. Author(s): Muller-Lissner S. Source: Best Practice & Research. Clinical Gastroenterology. 2002 February; 16(1): 11533. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11977932&dopt=Abstract

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Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. Author(s): Wiesel PH, Norton C, Roy AJ, Storrie JB, Bowers J, Kamm MA. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2000 August; 69(2): 240-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896701&dopt=Abstract

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Health-related quality of life in functional GI disorders: focus on constipation and resource utilization. Author(s): Irvine EJ, Ferrazzi S, Pare P, Thompson WG, Rance L. Source: The American Journal of Gastroenterology. 2002 August; 97(8): 1986-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190165&dopt=Abstract

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Hemostasis in children with dysbacteriosis in chronic constipation. Author(s): Kirgizov IV, Sukhorukov AM, Dudarev VA, Istomin AA. Source: Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2001 October; 7(4): 335-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11697720&dopt=Abstract

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Histochemical changes in the rectal mucosa of diabetic patients with and without diarrhea or constipation. Author(s): Ivandic A, Prpic-Krizevac I, Dmitrovic B, Vcev A, Kurbel S, Peljhan V, Bacun T. Source: Wiener Klinische Wochenschrift. 2000 January 14; 112(1): 21-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10689736&dopt=Abstract

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Hostility in patients with chronic constipation. Author(s): Dumitrascu DL, Acalovschi M, Pascu O. Source: Rom J Intern Med. 1998 July-December; 36(3-4): 239-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10822520&dopt=Abstract

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How useful is docusate in patients at risk for constipation? A systematic review of the evidence in the chronically ill. Author(s): Hurdon V, Viola R, Schroder C. Source: Journal of Pain and Symptom Management. 2000 February; 19(2): 130-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10699540&dopt=Abstract

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Idiopathic chronic constipation: pathophysiology, diagnosis and treatment. Author(s): Candelli M, Nista EC, Zocco MA, Gasbarrini A. Source: Hepatogastroenterology. 2001 July-August; 48(40): 1050-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11490798&dopt=Abstract

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Idiopathic chronic constipation: tachykinins as cotransmitters in colonic contraction. Author(s): Mitolo-Chieppa D, Mansi G, Nacci C, De Salvia MA, Montagnani M, Potenza MA, Rinaldi R, Lerro G, Siro-Brigiani G, Mitolo CI, Rinaldi M, Altomare DF, Memeo V. Source: European Journal of Clinical Investigation. 2001 April; 31(4): 349-55. Erratum In: Eur J Clin Invest 2001 July; 31(7): 647. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11298783&dopt=Abstract

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Idiopathic constipation management pathway. Author(s): Gordon J, Reid P, Thompson C, Watford C. Source: Nurs Times. 2002 October 22-28; 98(43): 48-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12432731&dopt=Abstract

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Idiopathic slow transit constipation and megacolon are not associated with neurturin mutations. Author(s): Chen B, Knowles CH, Scott M, Anand P, Williams NS, Milbrandt J, Tam PK. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2002 October; 14(5): 513-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358679&dopt=Abstract

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Idiopathic slow-transit constipation is not associated with mutations of the RET proto-oncogene or GDNF. Author(s): Knowles CH, Gayther SA, Scott M, Ramus S, Anand P, Williams NS, Ponder BA. Source: Diseases of the Colon and Rectum. 2000 June; 43(6): 851-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10859088&dopt=Abstract

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Image of the month. Cause and mechanism of constipation in a 58-year-old woman. Author(s): Lee JS, Camillieri M. Source: Gastroenterology. 2000 September; 119(3): 614, 883. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11023358&dopt=Abstract

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Impaired gastrocolonic response and peristaltic reflex in slow-transit constipation: role of 5-HT(3) pathways. Author(s): Bjornsson ES, Chey WD, Hooper F, Woods ML, Owyang C, Hasler WL. Source: American Journal of Physiology. Gastrointestinal and Liver Physiology. 2002 August; 283(2): G400-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12121888&dopt=Abstract

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Incidence of colonic ischemia, hospitalized complications of constipation, and bowel surgery in relation to use of alosetron hydrochloride. Author(s): Miller DP, Alfredson T, Cook SF, Sands BE, Walker AM. Source: The American Journal of Gastroenterology. 2003 May; 98(5): 1117-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809837&dopt=Abstract

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Incontinence and constipation after low anorectal malformations in a boy. Author(s): Laboure S, Besson R, Lamblin MD, Debeugny P. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2000 February; 10(1): 23-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10770243&dopt=Abstract

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Infantile cystinosis presenting as chronic constipation. Author(s): Assadi FK, Sandler RH, Wong PW, Salem M, Simenauer L. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 June; 39(6): E24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12046055&dopt=Abstract

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Information for patients. What you should know about constipation. Author(s): Dosh SA. Source: The Journal of Family Practice. 2002 June; 51(6): 560. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12108407&dopt=Abstract

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Insights into the pathophysiology and mechanisms of constipation, irritable bowel syndrome, and diverticulosis in older people. Author(s): Camilleri M, Lee JS, Viramontes B, Bharucha AE, Tangalos EG. Source: Journal of the American Geriatrics Society. 2000 September; 48(9): 1142-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10983917&dopt=Abstract

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Interventions for treating constipation in pregnancy. Author(s): Jewell DJ, Young G. Source: Cochrane Database Syst Rev. 2000; (2): Cd001142. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796250&dopt=Abstract

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Introducing abdominal massage in palliative care for the relief of constipation. Author(s): Preece J. Source: Complementary Therapies in Nursing & Midwifery. 2002 May; 8(2): 101-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12188155&dopt=Abstract

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Investigation and management of constipation. Author(s): Lamparelli MJ, Kumar D. Source: Clinical Medicine (London, England). 2002 September-October; 2(5): 415-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12448587&dopt=Abstract

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Investigations for incontinence and constipation after surgery for Hirschsprung's disease in children. Author(s): Keshtgar AS, Ward HC, Clayden GS, de Sousa NM. Source: Pediatric Surgery International. 2003 April; 19(1-2): 4-8. Epub 2002 November 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721712&dopt=Abstract

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Is it more than just constipation? Author(s): Gereige RS, Frias JL. Source: Pediatrics. 2002 May; 109(5): 961-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986463&dopt=Abstract

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Ischemic colitis probably induced by refractory constipation after voglibose administration in a patient with total gastrectomy. Author(s): Nagai Y, Yamashita H, Nohara E, Takamura T, Kobayashi K. Source: Intern Med. 2000 October; 39(10): 861. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11030217&dopt=Abstract

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Lack of objective evidence of efficacy of laxatives in chronic constipation. Author(s): Jones MP, Talley NJ, Nuyts G, Dubois D. Source: Digestive Diseases and Sciences. 2002 October; 47(10): 2222-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12395895&dopt=Abstract

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Laparoscopic antegrade continence enema in situ appendix procedure for refractory constipation and overflow fecal incontinence in children with spina bifida. Author(s): Van Savage JG, Yohannes P. Source: The Journal of Urology. 2000 September; 164(3 Pt 2): 1084-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10958747&dopt=Abstract

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Laparoscopic cecostomy for anterior ectopic anus with constipation: a new and technical proposal. Author(s): Yeung CK, Lund L. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2000 August; 10(4): 276-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11034520&dopt=Abstract

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Laparoscopically assisted subtotal colectomy for slow-transit constipation. Author(s): Athanasakis H, Tsiaoussis J, Vassilakis JS, Xynos E. Source: Surgical Endoscopy. 2001 October; 15(10): 1090-2. Epub 2001 August 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11727076&dopt=Abstract

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Laxatives should be the last resort in constipation. Author(s): Merchant M. Source: Nurs Times. 2003 September 16-22; 99(37): 35. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533323&dopt=Abstract

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Level of classification performance of KESS (symptom scoring system for constipation) validated in a prospective series of 105 patients. Author(s): Knowles CH, Scott SM, Legg PE, Allison ME, Lunniss PJ. Source: Diseases of the Colon and Rectum. 2002 June; 45(6): 842-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12072642&dopt=Abstract

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Linear discriminant analysis of symptoms in patients with chronic constipation: validation of a new scoring system (KESS). Author(s): Knowles CH, Eccersley AJ, Scott SM, Walker SM, Reeves B, Lunniss PJ. Source: Diseases of the Colon and Rectum. 2000 October; 43(10): 1419-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11052520&dopt=Abstract

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Liquid paraffin: a reappraisal of its role in the treatment of constipation. Author(s): Sharif F, Crushell E, O'Driscoll K, Bourke B. Source: Archives of Disease in Childhood. 2001 August; 85(2): 121-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11466186&dopt=Abstract

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Long term efficacy, safety, and tolerabilitity of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Author(s): Corazziari E, Badiali D, Bazzocchi G, Bassotti G, Roselli P, Mastropaolo G, Luca MG, Galeazzi R, Peruzzi E. Source: Gut. 2000 April; 46(4): 522-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10716682&dopt=Abstract

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Long-term safety of tegaserod in patients with constipation-predominant irritable bowel syndrome. Author(s): Tougas G, Snape WJ Jr, Otten MH, Earnest DL, Langaker KE, Pruitt RE, Pecher E, Nault B, Rojavin MA. Source: Alimentary Pharmacology & Therapeutics. 2002 October; 16(10): 1701-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12269961&dopt=Abstract

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Low-dose oral naloxone reverses opioid-induced constipation and analgesia. Author(s): Liu M, Wittbrodt E. Source: Journal of Pain and Symptom Management. 2002 January; 23(1): 48-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11779668&dopt=Abstract

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Macrogol 3350/electrolyte improves constipation in Parkinson's disease and multiple system atrophy. Author(s): Eichhorn TE, Oertel WH. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2001 November; 16(6): 1176-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11748757&dopt=Abstract

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Management of chemotherapy-induced diarrhea and constipation. Author(s): Cope DG. Source: Nurs Clin North Am. 2001 December; 36(4): 695-707, Vi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11726348&dopt=Abstract

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Management of common symptoms in terminally ill patients: Part II. Constipation, delirium and dyspnea. Author(s): Ross DD, Alexander CS. Source: American Family Physician. 2001 September 15; 64(6): 1019-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11578023&dopt=Abstract

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Management of constipation in children with disabilities. Author(s): Elawad MA, Sullivan PB. Source: Developmental Medicine and Child Neurology. 2001 December; 43(12): 829-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11769270&dopt=Abstract

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Management of faecal incontinence and constipation in adults with central neurological diseases. Author(s): Wiesel PH, Norton C, Brazzelli M. Source: Cochrane Database Syst Rev. 2001; (4): Cd002115. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11687140&dopt=Abstract

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Management of intractable constipation with antegrade enemas in neurologically intact children. Author(s): Youssef NN, Barksdale Jr E, Griffiths JM, Flores AF, Di Lorenzo C. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 April; 34(4): 402-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11930097&dopt=Abstract

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Management of opioid-induced constipation. Author(s): Thorpe DM. Source: Current Pain and Headache Reports. 2001 June; 5(3): 237-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11309211&dopt=Abstract

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Managing children with constipation: a community perspective. Author(s): Burnett C, Wilkins G. Source: J Fam Health Care. 2002; 12(5): 127-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12449063&dopt=Abstract

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Managing constipation in a pediatric patient: it is more than a simple problem. Author(s): Abel E. Source: Clin Excell Nurse Pract. 2001 July; 5(4): 211-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11458316&dopt=Abstract

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Managing constipation that's opioid-induced. Author(s): Scholz M. Source: Rn. 2000 June; 63(6): 103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10897756&dopt=Abstract

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Manometric variables in rectocele patients with symptomatic constipation. Author(s): Zbar AP, Beer-Gabel M. Source: Techniques in Coloproctology. 2003 April; 7(1): 65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769062&dopt=Abstract

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Measurement of colonic transit time in patients with chronic idiopathic constipation. Author(s): Benages A. Source: Rev Esp Enferm Dig. 2003 March; 95(3): 176-80, 171-5. English, Spanish. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760707&dopt=Abstract

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Measuring colonic transit time in chronic idiophatic constipation. Author(s): Husni-Hag-Ali R, Gomez Rodriguez BJ, Mendoza Olivares FJ, Garcia Montes JM, Sachez-Gey Venegas S, Herrerias Gutierrez JM. Source: Rev Esp Enferm Dig. 2003 March; 95(3): 186-90, 181-5. English, Spanish. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760708&dopt=Abstract

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Mechanisms of action of low doses of polyethylene glycol in the treatment of functional constipation. Author(s): Chaussade S. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S242-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726227&dopt=Abstract

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Megarectum in constipation. Author(s): van der Plas RN, Benninga MA, Staalman CR, Akkermans LM, Redekop WK, Taminiau JA, Buller HA. Source: Archives of Disease in Childhood. 2000 July; 83(1): 52-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10869000&dopt=Abstract

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Methylnaltrexone reverses opioid-induced constipation. Author(s): Stephenson J. Source: The Lancet Oncology. 2002 April; 3(4): 202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12067677&dopt=Abstract

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Motions and emotions: the treatment of depression causes constipation. Author(s): Bassotti G. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2000 April; 12(2): 113-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10771493&dopt=Abstract

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Motor and sensory function of the rectum in different subtypes of constipation. Author(s): Penning C, Steens J, van der Schaar PJ, Kuyvenhoven J, Delemarre JB, Lamers CB, Masclee AA. Source: Scandinavian Journal of Gastroenterology. 2001 January; 36(1): 32-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11218237&dopt=Abstract

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Movicol in treatment of constipation and faecal impaction. Author(s): Ungar A. Source: Hosp Med. 2000 January; 61(1): 37-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10735152&dopt=Abstract

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Need of the ideal drug for the treatment of chronic constipation. Author(s): Corazziari E. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S232-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726224&dopt=Abstract

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Neurotrophin-3 improves functional constipation. Author(s): Parkman HP, Rao SS, Reynolds JC, Schiller LR, Wald A, Miner PB, Lembo AJ, Gordon JM, Drossman DA, Waltzman L, Stambler N, Cedarbaum JM; Functional Constipation Study Investigators. Source: The American Journal of Gastroenterology. 2003 June; 98(6): 1338-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818279&dopt=Abstract

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New polyethylene glycol electrolyte solution for the treatment of constipation and faecal impaction. Author(s): Ferguson A, Culbert P, Gillett H, Barras N. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S249-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726229&dopt=Abstract

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New polyethylene glycol laxative for treatment of constipation in adults: a randomized, double-blind, placebo-controlled study. Author(s): Cleveland MV, Flavin DP, Ruben RA, Epstein RM, Clark GE. Source: Southern Medical Journal. 2001 May; 94(5): 478-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11372795&dopt=Abstract

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New thiazole derivatives as potent and selective 5-hydroxytriptamine 3 (5-HT3) receptor agonists for the treatment of constipation. Author(s): Imanishi N, Iwaoka K, Koshio H, Nagashima SY, Kazuta K, Ohta M, Sakamoto S, Ito H, Akuzawa S, Kiso T, Tsukamoto S, Mase T. Source: Bioorganic & Medicinal Chemistry. 2003 April 3; 11(7): 1493-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12628674&dopt=Abstract

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Nurses' knowledge of prevention and management of constipation. Author(s): Richmond JP, Devlin R. Source: British Journal of Nursing (Mark Allen Publishing). 2003 May 22-June 11; 12(10): 600-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819574&dopt=Abstract

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Nursing management of constipation in housebound older people. Author(s): Edwards M, Bentley A. Source: British Journal of Community Nursing. 2001 May; 6(5): 245-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11893950&dopt=Abstract

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Older people seeking solutions to constipation: the laxative mire. Author(s): Annells M, Koch T. Source: Journal of Clinical Nursing. 2002 September; 11(5): 603-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12201887&dopt=Abstract

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Oligoneuronal hypoganglionosis in patients with idiopathic slow-transit constipation. Author(s): Wedel T, Roblick UJ, Ott V, Eggers R, Schiedeck TH, Krammer HJ, Bruch HP. Source: Diseases of the Colon and Rectum. 2002 January; 45(1): 54-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11786765&dopt=Abstract

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Opioid antagonists in the treatment of opioid-induced constipation and pruritus. Author(s): Friedman JD, Dello Buono FA. Source: The Annals of Pharmacotherapy. 2001 January; 35(1): 85-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11197589&dopt=Abstract

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Opioid antagonists: a review of their role in palliative care, focusing on use in opioidrelated constipation. Author(s): Choi YS, Billings JA. Source: Journal of Pain and Symptom Management. 2002 July; 24(1): 71-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12183097&dopt=Abstract

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Opioid-induced constipation. Management is necessary but prevention is better. Author(s): Plaisance L, Ellis JA. Source: The American Journal of Nursing. 2002 March; 102(3): 72-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11976532&dopt=Abstract

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Oral methylnaltrexone for opioid-induced constipation. Author(s): Yuan CS, Foss JF. Source: Jama : the Journal of the American Medical Association. 2000 September 20; 284(11): 1383-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10989399&dopt=Abstract

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Outcome in children under 5 years of age with constipation: a prospective follow-up study. Author(s): Elshimy N, Gallagher B, West D, Stringer MD, Puntis JW. Source: Int J Clin Pract. 2000 January-February; 54(1): 25-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10750255&dopt=Abstract

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Outcome of segmental colonic resection for slow-transit constipation. Author(s): Lundin E, Karlbom U, Pahlman L, Graf W. Source: The British Journal of Surgery. 2002 October; 89(10): 1270-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12296895&dopt=Abstract

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Outcome of the antegrade colonic enema procedure in children with chronic constipation. Author(s): Kokoska ER, Keller MS, Weber TR. Source: American Journal of Surgery. 2001 December; 182(6): 625-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11839328&dopt=Abstract

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Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit constipation. Author(s): Lyford GL, He CL, Soffer E, Hull TL, Strong SA, Senagore AJ, Burgart LJ, Young-Fadok T, Szurszewski JH, Farrugia G. Source: Gut. 2002 October; 51(4): 496-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235070&dopt=Abstract

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Pathophysiology of chronic constipation in anorectal malformations. Long-term results and preliminary anatomical investigations. Author(s): Holschneider AM, Koebke J, Meier-Ruge W, Land N, Jesch NK, Pfrommer W. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2001 October; 11(5): 30510. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11719867&dopt=Abstract

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Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia. Author(s): Wiesel PH, Dorta G, Cuypers P, Herranz M, Kreis ME, Schnegg JF, Jornod P. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2001 March 24; 131(11-12): 152-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11416888&dopt=Abstract

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Patients with constipation-predominant irritable bowel syndrome (IBS) may have elevated serotonin concentrations in colonic mucosa as compared with diarrheapredominant patients and subjects with normal bowel habits. Author(s): Miwa J, Echizen H, Matsueda K, Umeda N. Source: Digestion. 2001; 63(3): 188-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11351146&dopt=Abstract

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Percutaneous colonoscopic cecostomy for management of chronic constipation in children. Author(s): Rivera MT, Kugathasan S, Berger W, Werlin SL. Source: Gastrointestinal Endoscopy. 2001 February; 53(2): 225-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11174301&dopt=Abstract

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Percutaneous endoscopic cecostomy for management of refractory constipation in an adult patient. Author(s): Wills JC, Trowbridge B, Disario JA, Fang JC. Source: Gastrointestinal Endoscopy. 2003 March; 57(3): 423-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612536&dopt=Abstract

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Permanent sacral nerve stimulation for treatment of idiopathic constipation (Br J Surg 2002; 89: 882-8). Author(s): Chan CL, Saunders J, Williams NS. Source: The British Journal of Surgery. 2002 November; 89(11): 1482. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12390398&dopt=Abstract

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Permanent sacral nerve stimulation for treatment of idiopathic constipation. Author(s): Kenefick NJ, Nicholls RJ, Cohen RG, Kamm MA. Source: The British Journal of Surgery. 2002 July; 89(7): 882-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12081738&dopt=Abstract

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Persistence of abdominal symptoms after successful surgery for idiopathic slow transit constipation. Author(s): El-Tawil AM. Source: Southern Medical Journal. 2002 September; 95(9): 1042-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12356105&dopt=Abstract

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Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation. Author(s): Sarli L, Costi R, Sarli D, Roncoroni L. Source: Diseases of the Colon and Rectum. 2001 October; 44(10): 1514-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11598483&dopt=Abstract

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Plasma cholecystokinin, plasma peptide YY and gallbladder motility in patients with slow transit constipation: effect of intestinal stimulation. Author(s): Mollen RM, Hopman WP, Kuijpers HH, Jansen JB. Source: Digestion. 2000; 62(2-3): 185-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11025367&dopt=Abstract

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Polyethylene glycol 3350 for constipation in children with dysfunctional elimination. Author(s): Erickson BA, Austin JC, Cooper CS, Boyt MA. Source: The Journal of Urology. 2003 October; 170(4 Pt 2): 1518-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501649&dopt=Abstract

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Polyethylene glycol without electrolytes for children with constipation and encopresis. Author(s): Loening-Baucke V. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 April; 34(4): 372-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11930092&dopt=Abstract

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Posterior sagittal approach: megasigmoid resection and anal reconstruction for severe constipation and fecal incontinence after anoplasty. Author(s): Li L, Yan-Xia W, Xia-Na W, Jin-Zhe Z. Source: Journal of Pediatric Surgery. 2000 July; 35(7): 1058-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10917296&dopt=Abstract

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Practice guidelines for the management of constipation in adults. Author(s): Folden SL. Source: Rehabilitation Nursing : the Official Journal of the Association of Rehabilitation Nurses. 2002 September-October; 27(5): 169-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12242866&dopt=Abstract

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Precipitants of constipation during early childhood. Author(s): Borowitz SM, Cox DJ, Tam A, Ritterband LM, Sutphen JL, Penberthy JK. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2003 May-June; 16(3): 213-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755248&dopt=Abstract

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Predictive factors for short-term symptom persistence in children after emergency department evaluation for constipation. Author(s): Patel H, Law A, Gouin S. Source: Archives of Pediatrics & Adolescent Medicine. 2000 December; 154(12): 1204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11115303&dopt=Abstract

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Presacral ganglioneuroma arising in an elderly man with persistent constipation. Author(s): Okai T, Minamoto T, Ohtsubo K, Takahashi Y, Kitagata H, Kadoya M, Oda Y, Sawabu N. Source: Abdominal Imaging. 2001 March-April; 26(2): 215-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11178704&dopt=Abstract

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Presence and severity of constipation in hospice patients with advanced cancer. Author(s): McMillan SC. Source: Am J Hosp Palliat Care. 2002 November-December; 19(6): 426-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442981&dopt=Abstract

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Prevalence of constipation in continuous ambulatory peritoneal dialysis patients and comparison with hemodialysis patients. Author(s): Yasuda G, Shibata K, Takizawa T, Ikeda Y, Tokita Y, Umemura S, Tochikubo O. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 June; 39(6): 1292-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12046044&dopt=Abstract

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Prevention of constipation through risk management. Author(s): Richmond J. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2003 January 2-7; 17(16): 39-46; Quiz 47-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12600129&dopt=Abstract

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Prospective study of biofeedback retraining in patients with chronic idiopathic functional constipation. Author(s): Wang J, Luo MH, Qi QH, Dong ZL. Source: World Journal of Gastroenterology : Wjg. 2003 September; 9(9): 2109-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970917&dopt=Abstract

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Proximal and distal gut hormone secretion in slow transit constipation. Author(s): Penning C, Delemarre JB, Bemelman WA, Biemond I, Lamers CB, Masclee AA. Source: European Journal of Clinical Investigation. 2000 August; 30(8): 709-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10964163&dopt=Abstract

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Proximal gastric motor and sensory function in slow transit constipation. Author(s): Penning C, Vu MK, Delemarre JB, Masclee AA. Source: Scandinavian Journal of Gastroenterology. 2001 December; 36(12): 1267-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11761015&dopt=Abstract

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Prucalopride accelerates gastrointestinal and colonic transit in patients with constipation without a rectal evacuation disorder. Author(s): Bouras EP, Camilleri M, Burton DD, Thomforde G, McKinzie S, Zinsmeister AR. Source: Gastroenterology. 2001 February; 120(2): 354-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11159875&dopt=Abstract

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Prucalopride is effective in patients with severe chronic constipation in whom laxatives fail to provide adequate relief. Results of a double-blind, placebo-controlled clinical trial. Author(s): Coremans G, Kerstens R, De Pauw M, Stevens M. Source: Digestion. 2003; 67(1-2): 82-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12743445&dopt=Abstract

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Prucalopride, a systemic enterokinetic, for the treatment of constipation. Author(s): Emmanuel AV, Roy AJ, Nicholls TJ, Kamm MA. Source: Alimentary Pharmacology & Therapeutics. 2002 July; 16(7): 1347-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12144586&dopt=Abstract

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Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Author(s): Nehra V, Bruce BK, Rath-Harvey DM, Pemberton JH, Camilleri M. Source: The American Journal of Gastroenterology. 2000 July; 95(7): 1755-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10925980&dopt=Abstract

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Psychological morbidity in women with idiopathic constipation. Author(s): Mason HJ, Serrano-Ikkos E, Kamm MA. Source: The American Journal of Gastroenterology. 2000 October; 95(10): 2852-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11051359&dopt=Abstract

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Psychological state and quality of life in patients having behavioral treatment (biofeedback) for intractable constipation. Author(s): Mason HJ, Serrano-Ikkos E, Kamm MA. Source: The American Journal of Gastroenterology. 2002 December; 97(12): 3154-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492203&dopt=Abstract

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Quality of life after subtotal colectomy for slow-transit constipation: both quality and quantity count. Author(s): FitzHarris GP, Garcia-Aguilar J, Parker SC, Bullard KM, Madoff RD, Goldberg SM, Lowry A. Source: Diseases of the Colon and Rectum. 2003 April; 46(4): 433-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12682533&dopt=Abstract

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Quantitation of defecation function using radionuclide artificial stool in children with chronic constipation. Author(s): Kiristioglu I, Akbunar T, Kilic N, Ozel I, Alper E, Dogruyol H. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 2000 December; 10(6): 3826. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11215780&dopt=Abstract

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Radiology case of the month. Constipation since birth. Hirschsprung's disease. Author(s): Neitzschman HR, Gupta AS. Source: J La State Med Soc. 2000 December; 152(12): 597-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191022&dopt=Abstract

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Radionuclide colon transit study in patients with idiopathic constipation. Author(s): Wang SJ, Lin WY, Ko CY, Chen GH. Source: Hepatogastroenterology. 2002 September-October; 49(47): 1262-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12239920&dopt=Abstract

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Re: naloxone, constipation and analgesia. Author(s): Meissner W, Ullrich K. Source: Journal of Pain and Symptom Management. 2002 September; 24(3): 276-7; Author Reply 277-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12458100&dopt=Abstract

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Recombinant human neurotrophic factors accelerate colonic transit and relieve constipation in humans. Author(s): Coulie B, Szarka LA, Camilleri M, Burton DD, McKinzie S, Stambler N, Cedarbaum JM. Source: Gastroenterology. 2000 July; 119(1): 41-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10889153&dopt=Abstract

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Rectal hyposensitivity: prevalence and clinical impact in patients with intractable constipation and fecal incontinence. Author(s): Gladman MA, Scott SM, Chan CL, Williams NS, Lunniss PJ. Source: Diseases of the Colon and Rectum. 2003 February; 46(2): 238-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576898&dopt=Abstract

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Rectal mucosal biopsy compared with laparoscopic seromuscular biopsy in the diagnosis of intestinal neuronal dysplasia in children with slow-transit constipation. Author(s): Imaji R, Kubota Y, Hengel P, Hutson JM, Chow CW. Source: Journal of Pediatric Surgery. 2000 December; 35(12): 1724-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11101723&dopt=Abstract

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Rectal pacing in patients with constipation due to rectal inertia: technique and results. Author(s): Shafik A, El-Sibai O, Shafik AA. Source: International Journal of Colorectal Disease. 2000 April; 15(2): 100-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10855552&dopt=Abstract

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Rectal sensorimotor characteristics in female patients with idiopathic constipation with or without paradoxical sphincter contraction. Author(s): Sloots CE, Felt-Bersma RJ. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2003 April; 15(2): 187-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680917&dopt=Abstract

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Rectoanal reflex parameters in incontinence and constipation. Author(s): Kaur G, Gardiner A, Duthie GS. Source: Diseases of the Colon and Rectum. 2002 July; 45(7): 928-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12130882&dopt=Abstract

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Reflexology in the management of encopresis and chronic constipation. Author(s): Bishop E, McKinnon E, Weir E, Brown DW. Source: Paediatric Nursing. 2003 April; 15(3): 20-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715585&dopt=Abstract

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Regulation of the enteric nervous system in the colon of patients with slow transit constipation. Author(s): Tomita R, Tanjoh K, Fujisaki S, Ikeda T, Fukuzawa M. Source: Hepatogastroenterology. 2002 November-December; 49(48): 1540-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397730&dopt=Abstract

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Reproducibility of colonic transit study in patients with chronic constipation. Author(s): Nam YS, Pikarsky AJ, Wexner SD, Singh JJ, Weiss EG, Nogueras JJ, Choi JS, Hwang YH. Source: Diseases of the Colon and Rectum. 2001 January; 44(1): 86-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11805568&dopt=Abstract

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Research-based protocol. Management of constipation. Author(s): Hinrichs M, Huseboe J, Tang JH, Titler MG. Source: Journal of Gerontological Nursing. 2001 February; 27(2): 17-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11915262&dopt=Abstract

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Response to Dr. V. Loening-Baucke's paper “Polyethylene glycol without electrolytes for children with constipation and encopresis”. Author(s): Geraint M. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 November; 35(5): 707; Author Reply 707-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12454593&dopt=Abstract

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Review article: the therapy of constipation. Author(s): Schiller LR. Source: Alimentary Pharmacology & Therapeutics. 2001 June; 15(6): 749-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380313&dopt=Abstract

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Review of the treatment literature for encopresis, functional constipation, and stooltoileting refusal. Author(s): Brooks RC, Copen RM, Cox DJ, Morris J, Borowitz S, Sutphen J. Source: Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 2000 Summer; 22(3): 260-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11211851&dopt=Abstract

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Risk factors for chronic constipation based on a general practice sample. Author(s): Talley NJ, Jones M, Nuyts G, Dubois D. Source: The American Journal of Gastroenterology. 2003 May; 98(5): 1107-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809835&dopt=Abstract

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Role of nitric oxide in the colon of patients with slow-transit constipation. Author(s): Tomita R, Fujisaki S, Ikeda T, Fukuzawa M. Source: Diseases of the Colon and Rectum. 2002 May; 45(5): 593-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12004206&dopt=Abstract

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Safety of enteral naloxone and i.v. neostigmine when used to relieve constipation. Author(s): Thomas MC, Erstad BL. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 June 15; 60(12): 1264-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845923&dopt=Abstract

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Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children. Author(s): Pashankar DS, Loening-Baucke V, Bishop WP. Source: Archives of Pediatrics & Adolescent Medicine. 2003 July; 157(7): 661-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860787&dopt=Abstract

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Scintigraphic assessment of colonic transit in women with slow-transit constipation arising de novo and following pelvic surgery or childbirth. Author(s): Scott SM, Knowles CH, Newell M, Garvie N, Williams NS, Lunniss PJ. Source: The British Journal of Surgery. 2001 March; 88(3): 405-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11260108&dopt=Abstract

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Scintigraphic assessment of retrograde colonic washout in fecal incontinence and constipation. Author(s): Christensen P, Olsen N, Krogh K, Bacher T, Laurberg S. Source: Diseases of the Colon and Rectum. 2003 January; 46(1): 68-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12544524&dopt=Abstract

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Severe juvenile chronic constipation. Author(s): Goh J, Byrne P, McDonald G, Stephens R, Keeling P. Source: Ir Med J. 2001 March; 94(3): 81-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11354689&dopt=Abstract

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Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. Author(s): Malouf AJ, Wiesel PH, Nicholls T, Nicholls RJ, Kamm MA. Source: World Journal of Surgery. 2002 February; 26(2): 166-70. Epub 2001 December 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11865344&dopt=Abstract

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Signs and symptoms of slow-transit constipation versus functional retention. Author(s): Shin YM, Southwell BR, Stanton MP, Hutson JM. Source: Journal of Pediatric Surgery. 2002 December; 37(12): 1762-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12483651&dopt=Abstract

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Slow transit constipation in children. Author(s): Hutson JM, McNamara J, Gibb S, Shin YM. Source: Journal of Paediatrics and Child Health. 2001 October; 37(5): 426-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11885703&dopt=Abstract

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Slow transit constipation. Author(s): Bharucha AE, Phillips SF. Source: Gastroenterology Clinics of North America. 2001 March; 30(1): 77-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394038&dopt=Abstract

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Slow transit constipation: a disorder of pelvic autonomic nerves? Author(s): Knowles CH, Scott SM, Lunniss PJ. Source: Digestive Diseases and Sciences. 2001 February; 46(2): 389-401. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11281190&dopt=Abstract

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Slow transit constipation: a model of human gut dysmotility. Review of possible aetiologies. Author(s): Knowles CH, Martin JE. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 2000 April; 12(2): 181-96. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10877606&dopt=Abstract

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Slow transit constipation: more than one disease? Author(s): Pehl C, Schmidt T, Schepp W. Source: Gut. 2002 October; 51(4): 610; Author Reply 610. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235091&dopt=Abstract

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Slow-transit constipation after radical hysterectomy type III. Author(s): Possover M, Schneider A. Source: Surgical Endoscopy. 2002 May; 16(5): 847-50. Epub 2002 February 08. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11997835&dopt=Abstract

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Smooth muscle inclusion bodies in slow transit constipation. Author(s): Knowles CH, Nickols CD, Scott SM, Bennett NI, de Oliveira RB, Chimelli L, Feakins R, Williams NS, Martin JE. Source: The Journal of Pathology. 2001 March; 193(3): 390-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11241421&dopt=Abstract

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Standardization of anal sphincter electromyography: effect of chronic constipation. Author(s): Podnar S, Vodusek DB. Source: Muscle & Nerve. 2000 November; 23(11): 1748-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11054754&dopt=Abstract

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Stroke, catheters and constipation: action plans. Author(s): Addison R, Dodd L, Abili J, McGurrin F, Jones V. Source: Nurs Times. 2001 July 26-August 1; 97(30): 54-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11957959&dopt=Abstract

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Strumal carcinoid tumor of the ovary: a case exhibiting severe constipation associated with PYY. Author(s): Matsuda K, Maehama T, Kanazawa K. Source: Gynecologic Oncology. 2002 October; 87(1): 143-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468356&dopt=Abstract

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Study of the motile activity of the colon in rectal inertia constipation. Author(s): Shafik A, Ahmed I. Source: Journal of Gastroenterology and Hepatology. 2002 March; 17(3): 270-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11982696&dopt=Abstract

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Study of the role of the second defecation reflex: anorectal excitatory reflex in the pathogenesis of constipation. Author(s): Shafik A, Shafik AA, El-Sibai O, Ahmed I. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 729-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742205&dopt=Abstract

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Substance P in rectal mucosa of children with chronic constipation. Author(s): Granot E, Wengrower D, Lysy J, Waldbaum C, Karmeli F, Goldin E. Source: Acta Gastroenterol Latinoam. 2001 March; 31(1): 41-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11370180&dopt=Abstract

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Surgical aspects of chronic constipation in children. Author(s): Bajpai M, Lall A. Source: Indian J Pediatr. 1999; 66(1 Suppl): S89-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11132477&dopt=Abstract

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Surgical management of chronic unremitting constipation and fecal incontinence associated with megarectum: A preliminary report. Author(s): Lee SL, DuBois JJ, Montes-Garces RG, Inglis K, Biediger W. Source: Journal of Pediatric Surgery. 2002 January; 37(1): 76-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11781991&dopt=Abstract

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Surgical treatment of constipation and fecal incontinence. Author(s): Rotholtz NA, Wexner SD. Source: Gastroenterology Clinics of North America. 2001 March; 30(1): 131-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394027&dopt=Abstract

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Teenage constipation: a case study. Author(s): Streeter BL. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 2002 November-December; 25(6): 253-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12488688&dopt=Abstract

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Tegaserod accelerates orocecal transit in patients with constipation-predominant irritable bowel syndrome. Author(s): Prather CM, Camilleri M, Zinsmeister AR, McKinzie S, Thomforde G. Source: Gastroenterology. 2000 March; 118(3): 463-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10702196&dopt=Abstract

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Tegaserod for the treatment of constipation-predominant irritable bowel syndrome. Author(s): Baker DE. Source: Reviews in Gastroenterological Disorders. 2001; 1(4): 187-98. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120185&dopt=Abstract

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Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Author(s): Muller-Lissner SA, Fumagalli I, Bardhan KD, Pace F, Pecher E, Nault B, Ruegg P. Source: Alimentary Pharmacology & Therapeutics. 2001 October; 15(10): 1655-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11564007&dopt=Abstract

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Tegaserod: a review of its use in the management of irritable bowel syndrome with constipation in women. Author(s): Wagstaff AJ, Frampton JE, Croom KF. Source: Drugs. 2003; 63(11): 1101-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749744&dopt=Abstract

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The assessment of constipation in monosymptomatic primary nocturnal enuresis. Author(s): Cayan S, Doruk E, Bozlu M, Duce MN, Ulusoy E, Akbay E. Source: International Urology and Nephrology. 2001; 33(3): 513-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230285&dopt=Abstract

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The barium enema in constipation: comparison with rectal manometry and biopsy to exclude Hirschsprung's disease after the neonatal period. Author(s): Reid JR, Buonomo C, Moreira C, Kozakevich H, Nurko SJ. Source: Pediatric Radiology. 2000 October; 30(10): 681-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11075600&dopt=Abstract

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The causes and management of constipation in children. Author(s): Rogers J. Source: Community Nurse. 2000 April; 6(3): 39-40. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778506&dopt=Abstract

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The effect of anorectal manometry on the outcome of treatment in severe childhood constipation: a randomized, controlled trial. Author(s): van Ginkel R, Buller HA, Boeckxstaens GE, van Der Plas RN, Taminiau JA, Benninga MA. Source: Pediatrics. 2001 July; 108(1): E9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11433088&dopt=Abstract

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The effect of constipation on rectal dosimetry following prostate brachytherapy. Author(s): Merrick GS, Butler WM, Dorsey AT, Dorsey JT 3rd. Source: Medical Dosimetry : Official Journal of the American Association of Medical Dosimetrists. 2000 Winter; 25(4): 237-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11150696&dopt=Abstract

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The efficacy of cisapride vs. placebo and diet in patients with chronic constipation. Author(s): Altabas K, Bilic A, Jurcic D, Dorosulic Z, Mihanovic M, Sunic-Omejc M, Restek-Petrovic B, Tolj N. Source: Coll Antropol. 2003 June; 27(1): 197-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974147&dopt=Abstract

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The management of constipation in people with advanced cancer. Author(s): Campbell T, Draper S, Reid J, Robinson L. Source: International Journal of Palliative Nursing. 2001 March; 7(3): 110-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12192327&dopt=Abstract

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The nurse's role in managing constipation. Author(s): Day A. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2001 November 7-13; 16(8): 41-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11974784&dopt=Abstract

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The nursing management of diarrhoea and constipation before and after the implementation of a bowel management protocol. Author(s): McKenna S, Wallis M, Brannelly A, Cawood J. Source: Aust Crit Care. 2001 February; 14(1): 10-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11899755&dopt=Abstract

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The peculiar features of changing the hemostasis in children with chronic constipation. Author(s): Kirgizov IV, Sukhorukov AM, Dudarev VA, Sipkin DN. Source: Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2001 January; 7(1): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11190896&dopt=Abstract

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The Pediatric Bowel Management Clinic in children with severe chronic constipation. Personal experience. Author(s): Fabbro MA, D'Agostino S, Romanini MV, Cracco A, Musi L, Pigato E, Costantini A. Source: Pediatr Med Chir. 2001 May-August; 23(3-4): 175-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723853&dopt=Abstract

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The physiology of continence: idiopathic fecal constipation and soiling. Author(s): Griffiths DM. Source: Semin Pediatr Surg. 2002 May; 11(2): 67-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11973758&dopt=Abstract

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The prevalence of constipation in institutionalized people with intellectual disability. Author(s): Bohmer CJ, Taminiau JA, Klinkenberg-Knol EC, Meuwissen SG. Source: Journal of Intellectual Disability Research : Jidr. 2001 June; 45(Pt 3): 212-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11422645&dopt=Abstract

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The prevalence of faecal incontinence and constipation in a general New Zealand population; a postal survey. Author(s): Lynch AC, Dobbs BR, Keating J, Frizelle FA. Source: N Z Med J. 2001 October 26; 114(1142): 474-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11760243&dopt=Abstract

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The surgical management of chronic constipation. Author(s): Platell C. Source: Diseases of the Colon and Rectum. 2001 December; 44(12): 1898-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11742185&dopt=Abstract

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The yield of lower endoscopy in patients with constipation: survey of a university hospital, a public county hospital, and a Veterans Administration medical center. Author(s): Pepin C, Ladabaum U. Source: Gastrointestinal Endoscopy. 2002 September; 56(3): 325-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196767&dopt=Abstract

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Total and segmental colonic transit time and anorectal manometry in children with chronic idiopathic constipation. Author(s): Gutierrez C, Marco A, Nogales A, Tebar R. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 July; 35(1): 31-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12142807&dopt=Abstract

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Traveler's constipation. Author(s): Mearin F, Zarate N, Sardi JA, Moreno-Osset E, Salis G. Source: The American Journal of Gastroenterology. 2003 February; 98(2): 507-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12591084&dopt=Abstract

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Treating diarrhoea and constipation. Author(s): Shepherd M. Source: Nurs Times. 2000 February 10; 96(6 Suppl): Suppl 15-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11962065&dopt=Abstract

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Treatment of chronic constipation with colchicine: randomized, double-blind, placebo-controlled, crossover trial. Author(s): Verne GN, Davis RH, Robinson ME, Gordon JM, Eaker EY, Sninksy CA. Source: The American Journal of Gastroenterology. 2003 May; 98(5): 1112-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809836&dopt=Abstract

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Treatment of outlet obstruction constipation in Parkinson's disease with botulinum neurotoxin A. Author(s): Albanese A, Brisinda G, Bentivoglio AR, Maria G. Source: The American Journal of Gastroenterology. 2003 June; 98(6): 1439-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818293&dopt=Abstract

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Understanding constipation. Author(s): Blight K. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2001 March 14-20; 15(26): 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12216235&dopt=Abstract

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Use of a self-report constipation questionnaire with older adults in long-term care. Author(s): Frank L, Flynn J, Rothman M. Source: The Gerontologist. 2001 December; 41(6): 778-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723346&dopt=Abstract

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Use of cisapride with magnesium oxide in chronic pediatric constipation. Author(s): Ni YH, Lin CC, Chang SH, Yeung CY; Taiwan Pediatric Constipation Study Group. Source: Acta Paediatr Taiwan. 2001 November-December; 42(6): 345-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11811223&dopt=Abstract

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Use of isomalto-oligosaccharide in the treatment of lipid profiles and constipation in hemodialysis patients. Author(s): Wang HF, Lim PS, Kao MD, Chan EC, Lin LC, Wang NP. Source: Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation. 2001 April; 11(2): 73-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11295027&dopt=Abstract

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Use of low dose polyethylene glycol solutions in the treatment of functional constipation. Author(s): Badiali D, Corazziari E. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S245-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726228&dopt=Abstract

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Use of polyethylene glycol solution in functional and organic constipation in children. Author(s): Staiano A. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S260-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726233&dopt=Abstract

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Use of polyethylene glycol solution in slow transit constipation. Author(s): Bassotti G, Fiorella S, Roselli P, Modesto R. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S255-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726231&dopt=Abstract

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Using the Internet to teach parents and children about constipation and encopresis. Author(s): Borowitz SM, Ritterband L. Source: Medical Informatics and the Internet in Medicine. 2001 October-December; 26(4): 283-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11783712&dopt=Abstract

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What is the best therapy for constipation in infants? Author(s): Ellis MR, Meadows S, Easton BT, Graves SE. Source: The Journal of Family Practice. 2002 August; 51(8): 682. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184963&dopt=Abstract

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What is the role of stimulant laxatives in the management of childhood constipation and soiling?. Author(s): Price KJ, Elliott TM. Source: Cochrane Database Syst Rev. 2001; (3): Cd002040. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11687009&dopt=Abstract

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What's the 'best buy' for treatment of constipation? Results of a systematic review of the efficacy and comparative efficacy of laxatives in the elderly. Author(s): Petticrew M, Watt I, Brand M. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1999 May; 49(442): 387-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10736891&dopt=Abstract

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When fiber is not enough: current thinking on constipation management. Author(s): Doughty DB. Source: Ostomy Wound Manage. 2002 December; 48(12): 30-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490751&dopt=Abstract

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CHAPTER 2. NUTRITION AND CONSTIPATION Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and constipation.

Finding Nutrition Studies on Constipation The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.4 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “constipation” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following is a typical result when searching for recently indexed consumer information on constipation: •

A resistant protein, sericin improves atropine-induced constipation in rats. Source: Sasaki, M. Yamada, H. Kato, N. Food-sci-technol-res. Tsukuba, Ibaraki : Japanese Society for Food Science and Technology, c1999-. November 2000. volume 6 (4) page 280-283. 1344-6606

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A six-year old suffering from constipation. Source: Brown, S Kerrigan, P Waterston, T Practitioner. 2000 February; 244(1607): 63-8 0032-6518

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Advances in the management of pediatric constipation. Author(s): Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Boston, MA 02115, USA. [email protected] Source: Nurko, S Curr-Gastroenterol-Repage 2000 June; 2(3): 234-40 1522-8037

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Amitriptyline-induced constipation in cynomolgus monkeys is beneficial for the evaluation of laxative efficacy. Author(s): Research and Development, Otsuka Pharmaceutical Factory, Inc., Naruto, Tokushima, Japan. [email protected] Source: Tsusumi, K Kishimoto, S Koshitani, O Kohri, H Biol-Pharm-Bull. 2000 May; 23(5): 657-9 0918-6158

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Anal manometric predictors of significant rectocele in constipated patients. Author(s): Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA. Source: Rotholtz, N A Efron, J E Weiss, E G Nogueras, J J Wexner, S D Tech-Coloproctol. 2002 September; 6(2): 73-6; discussion 76-7 1123-6337

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Can I safely use powdered fiber drinks such as Metamucil to relieve constipation without my body becoming reliant on them? Source: Feinberg, A W Health-News. 2000 January; 6(1): 10 1081-5880

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Chronic constipation in adults. How far should evaluation and treatment go? Author(s): Gastroenterology Division, University of Missouri, Columbia School of Medicine. Source: Marshall, J B Postgrad-Med. 1990 September 1; 88(3): 49-51, 54, 57-9, 63 00325481

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Chronic constipation management for institutionalized older adults. Author(s): Department of Community and Preventive Medicine, Cancer Center, University of Rochester School of Medicine, USA. Source: Howard, L V West, D Ossip Klein, D J Geriatr-Nurs. 2000 Mar-April; 21(2): 7882; quiz 82-3 0197-4572

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Clinical subgroups of chronic constipation: exploring the potential of polyethylene glycol. Author(s): Mayo Clinic, Rochester, MN, USA. [email protected] Source: Camilleri, M Ital-J-Gastroenterol-Hepatol. 1999 November; 31 Suppl 3S253-4 1125-8055

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Constipation and the use of laxatives: a comparison between transdermal fentanyl and oral morphine. Author(s): Department of Anaesthesiology, University of Cologne, Germany. [email protected] Source: Radbruch, L Sabatowski, R Loick, G Kulbe, C Kasper, M Grond, S Lehmann, K A Palliat-Med. 2000 March; 14(2): 111-9 0269-2163

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Constipation during pregnancy. Fiber and fluid are keys to self-management. Source: Morgan, C Adv-Nurse-Pract. 2001 October; 9(10): 57-8 1096-6293

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Constipation in elderly patients attending a polyclinic. Author(s): Department of Biostatistics, University of the Orange Free State, Bloemfontein. Source: Meiring, P J Joubert, G S-Afr-Med-J. 1998 July; 88(7): 888-90 0038-2469

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Constipation in infants and children. Source: Dilliway, G Practitioner. 2001 September; 245(1626): 761-3 0032-6518

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Constipation in the elderly. Routine equals regularity. Author(s): K.L. Kennedy Inc., Byron Health Center, Fort Wayne, Ind., USA. Source: Kennedy, K L Adv-Nurse-Pract. 2002 July; 10(7): 32-4, 37 1096-6293

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Constipation overview: evaluation and management. Author(s): Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA. [email protected] Source: Douglas, J Curr-Womens-Health-Repage 2002 August; 2(4): 280-4 1534-5874

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Constipation, diarrhea, and irritable bowel syndrome. Author(s): Attending Colon and Rectal Surgeon, Department of Surgery, Wilford Hall Medical Center, San Antonio, Texas, USA. Source: Browning, S M Prim-Care. 1999 March; 26(1): 113-39 0095-4543

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Constipation, fibre intake and the menstrual cycle. Source: Davies, J. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. 1998. (4/5) page 272-274. 0034-6659

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Constipation, laxative use, and colon cancer among middle-aged adults. Author(s): Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98104 USA. Source: Jacobs, E J White, E Epidemiology. 1998 July; 9(4): 385-91 1044-3983

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Constipation. 1. The hard facts. Source: Harv-Health-Lett. Boston, Mass. : Harvard Medical School Health Publications Group. February 1991. volume 16 (4) page 1-4. ill. 1052-1577

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Constipation-2. Treatment. Author(s): Continence Care, West Cumbria Health Care NHS Trust. Source: Colley, W Nurs-Times. 1999 May 26-June 1; 95(21): suppl 1-2 0954-7762

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Cow's milk protein intolerance and chronic constipation in children. Author(s): Divisions of Allergy, Clinical Immunology and Rheumatology, UNIFESP EPM, Sao Paulo, SP, Brazil. [email protected] Source: Daher, S Tahan, S Sole, D Naspitz, C K Da Silva Patricio, F R Neto, U F De Morais, M B Pediatr-Allergy-Immunol. 2001 December; 12(6): 339-42 0905-6157

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Effectiveness of wheat bran in preventing constipation of hospitalized orthopaedic surgery patients. Source: Schmelzer, M Orthop-Nurs. 1990 Nov-December; 9(6): 55-9 0744-6020

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Electroacupuncture treatment for constipation due to spasmodic syndrome of the pelvic floor--a report of 36 cases. Author(s): People's Hospital of Longhu District, Shantou City, Guangdong Province, 515041. Source: Wang, S J-Tradit-Chin-Med. 2001 September; 21(3): 205-6 0254-6272

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Evaluation of a constipation risk assessment scale. Author(s): Royal Brisbane Hospital, Herston, Queensland, Australia. Source: Zernike, W Henderson, A Int-J-Nurs-Pract. 1999 June; 5(2): 106-9 1322-7114

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Fluids, fibre and constipation. Author(s): Thames Gateway NHS Trust, Gillingham, Kent. Source: Bush, S Nurs-Times. 2000 August 3; 96(31 Suppl): 11-2 0954-7762

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General geriatrics and gastroenterology: constipation and faecal incontinence. Author(s): Humboldt University Berlin, Department of Internal Medicine, Park-Klinik Weissensee, Germany. Source: Muller Lissner, Stefan Best-Pract-Res-Clin-Gastroenterol. 2002 February; 16(1): 115-33 1521-6918

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Hemostasis in children with dysbacteriosis in chronic constipation. Author(s): Krasnoyarsk State Medical Academy, The City's Clinical Hospital No. 20, The Department of Children Surgery of the Advanced Medical Courses, Russia. [email protected] Source: Kirgizov, I V Sukhorukov, A M Dudarev, V A Istomin, A A Clin-Appl-ThrombHemost. 2001 October; 7(4): 335-8 1076-0296

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How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Author(s): Gastroenterology Service, Brooke Army Medical Center, San Antonio, Texas 78234, USA. [email protected] Source: Wong, P W Kadakia, S Postgrad-Med. 1999 November; 106(6): 199-200, 203-4, 207-10 0032-5481

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I seem to be more constipated since I started taking a calcium supplement. What can I do? Source: Anonymous Mayo-Clin-Health-Lett. 1999 May; 17(5): 8 0741-6245

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Idiopathic chronic constipation: pathophysiology, diagnosis and treatment. Author(s): Department of Internal Medicine, Gemelli Hospital, Catholic University, Rome, Italy. Source: Candelli, M Nista, E C Zocco, M A Gasbarrini, A Hepatogastroenterology. 2001 Jul-August; 48(40): 1050-7 0172-6390

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Interventions for treating constipation in pregnancy. Author(s): Division of Primary Health Care, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK. [email protected] Source: Jewell, D J Young, G Cochrane-Database-Syst-Revolume 2000; (2): CD001142 1469-493X

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Is America really constipated? Source: Cerrato, P L RN. 1989 May; 52(5): 81-2, 84, 86 0033-7021

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Management of faecal incontinence and constipation in adults with central neurological diseases (Cochrane Review). Author(s): Division de Gastroenterologie & Hepatologie CHUV/pmu, PMU, 19 Rue Cesar-Roux, Lausanne, SWITZERLAND, 1005 LAUSANNE. [email protected] Source: Wiesel, P H Norton, C Brazzelli, M Cochrane-Database-Syst-Revolume 2001; 4: CD002115 1469-493X

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Managing children with constipation: a community perspective. Author(s): Department of Paediatrics, John Radcliffe Hospital, Oxford. Source: Burnett, C Wilkins, G J-Fam-Health-Care. 2002; 12(5): 127-32 1474-9114

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Managing constipation that's opioid-induced. Author(s): Northwest Neuroscience Institute, Seattle, USA. Source: Scholz, M RN. 2000 June; 63(6): 103 0033-7021

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New polyethylene glycol electrolyte solution for the treatment of constipation and faecal impaction. Author(s): Department of Medicine, Western General Hospital, University of Edinburgh, UK. Source: Ferguson, A Culbert, P Gillett, H Barras, N Ital-J-Gastroenterol-Hepatol. 1999 November; 31 Suppl 3S249-52 1125-8055

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Non-surgical treatment for constipation in adults: the place of biofeedback. Author(s): Department of Surgery, Academic Hospital St. Radboud, Catholic University, Nijmegen, The Netherlands. Source: Kuijpers, J H Bleijenberg, G Neth-J-Surg. 1991; 43(6): 218-21 0167-2487

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Obesity, weight-reducing programmes and constipation. Source: Anderson, E. Davies, J. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. Nov/December 1999. (6) page 303-306. 0034-6659

•

On constipation and other digestive problems. Source: Weber, Hans U. Healthline. San Mateo, Calif. : Robert A. McNeil Foundation for Health Education. June 1984. volume 3 (6) page 16-17. charts. 0736-7929

•

Study of constipation in a geriatric hospital, day hospital, old people's home and at home. Author(s): Department of Public Health Science, University of Oulu, Finland. Source: Kinnunen, O Aging-(Milano). 1991 June; 3(2): 161-70 0394-9532

•

Teenage constipation: a case study. Author(s): Guthrie Clinic Endoscopy Center, Guthrie Square, Sayre, PA 18840, USA. [email protected] Source: Streeter, B L Gastroenterol-Nurs. 2002 Nov-December; 25(6): 253-6 1042-895X

•

Tegaserod for the treatment of constipation-predominant irritable bowel syndrome. Author(s): Drug Information Center, College of Pharmacy, Washington State University, Spokane, WA, USA. Source: Baker, D E Rev-Gastroenterol-Disord. 2001; 1(4): 187-98 1533-001X

•

The nurse's role in managing constipation. Author(s): School of Health Care Practice, Anglia Polytechnic University, 40 Park Road, Chelmsford, Essex CM1 1LL. [email protected] Source: Day, A Nurs-Stand. 2001 November 7-13; 16(8): 41-4 0029-6570

•

Therapeutic proposals for the treatment of idiopathic constipation. Author(s): Dept of Medical Pathology, Covadonga Hospital and School of Medicine, Oviedo, Spain. Source: Saez, L R Ital-J-Gastroenterol. 1991 November; 23(8 Suppl 1): 30-5 0392-0623

•

Understanding constipation. Source: Blight, K Nurs-Stand. 2001 March 14-20; 15(26): 26 0029-6570

•

Validity and reliability of the Constipation Assessment Scale. Source: McMillan, S C Williams, F A Cancer-Nurs. 1989 June; 12(3): 183-8 0162-220X

•

Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Author(s): Department of Internal Medicine, Catholic University, Policlinico A. Gemelli, Rome.

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Source: Anti, M Pignataro, G Armuzzi, A Valenti, A Iascone, E Marmo, R Lamazza, A Pretaroli, A R Pace, V Leo, P Castelli, A Gasbarrini, G Hepatogastroenterology. 1998 May-June; 45(21): 727-32 0172-6390 •

When fiber is not enough: current thinking on constipation management. Author(s): Emory University Wound Ostomy Continence Nursing Education Center, Atlanta, GA 30322, USA. [email protected] Source: Doughty, D B Ostomy-Wound-Manage. 2002 December; 48(12): 30-41 0889-5899

•

Why am I constipated? Source: Anonymous Lippincotts-Prim-Care-Pract. 1998 Jul-August; 2(4): 428-9 1088-5471

The following information is typical of that found when using the “Full IBIDS Database” to search for “constipation” (or a synonym): •

A resistant protein, sericin improves atropine-induced constipation in rats. Source: Sasaki, M. Yamada, H. Kato, N. Food-sci-technol-res. Tsukuba, Ibaraki : Japanese Society for Food Science and Technology, c1999-. November 2000. volume 6 (4) page 280-283. 1344-6606

•

A six-year old suffering from constipation. Source: Brown, S Kerrigan, P Waterston, T Practitioner. 2000 February; 244(1607): 63-8 0032-6518

•

Advances in the management of pediatric constipation. Author(s): Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Boston, MA 02115, USA. [email protected] Source: Nurko, S Curr-Gastroenterol-Repage 2000 June; 2(3): 234-40 1522-8037

•

Amitriptyline-induced constipation in cynomolgus monkeys is beneficial for the evaluation of laxative efficacy. Author(s): Research and Development, Otsuka Pharmaceutical Factory, Inc., Naruto, Tokushima, Japan. [email protected] Source: Tsusumi, K Kishimoto, S Koshitani, O Kohri, H Biol-Pharm-Bull. 2000 May; 23(5): 657-9 0918-6158

•

Anal manometric predictors of significant rectocele in constipated patients. Author(s): Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA. Source: Rotholtz, N A Efron, J E Weiss, E G Nogueras, J J Wexner, S D Tech-Coloproctol. 2002 September; 6(2): 73-6; discussion 76-7 1123-6337

•

Can I safely use powdered fiber drinks such as Metamucil to relieve constipation without my body becoming reliant on them? Source: Feinberg, A W Health-News. 2000 January; 6(1): 10 1081-5880

•

Chronic constipation in adults. How far should evaluation and treatment go? Author(s): Gastroenterology Division, University of Missouri, Columbia School of Medicine. Source: Marshall, J B Postgrad-Med. 1990 September 1; 88(3): 49-51, 54, 57-9, 63 00325481

•

Clinical subgroups of chronic constipation: exploring the potential of polyethylene glycol. Author(s): Mayo Clinic, Rochester, MN, USA. [email protected] Source: Camilleri, M Ital-J-Gastroenterol-Hepatol. 1999 November; 31 Suppl 3S253-4 1125-8055

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•

Constipation and the use of laxatives: a comparison between transdermal fentanyl and oral morphine. Author(s): Department of Anaesthesiology, University of Cologne, Germany. [email protected] Source: Radbruch, L Sabatowski, R Loick, G Kulbe, C Kasper, M Grond, S Lehmann, K A Palliat-Med. 2000 March; 14(2): 111-9 0269-2163

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Constipation during pregnancy. Fiber and fluid are keys to self-management. Source: Morgan, C Adv-Nurse-Pract. 2001 October; 9(10): 57-8 1096-6293

•

Constipation in elderly patients attending a polyclinic. Author(s): Department of Biostatistics, University of the Orange Free State, Bloemfontein. Source: Meiring, P J Joubert, G S-Afr-Med-J. 1998 July; 88(7): 888-90 0038-2469

•

Constipation in infants and children. Source: Dilliway, G Practitioner. 2001 September; 245(1626): 761-3 0032-6518

•

Constipation in the elderly. Routine equals regularity. Author(s): K.L. Kennedy Inc., Byron Health Center, Fort Wayne, Ind., USA. Source: Kennedy, K L Adv-Nurse-Pract. 2002 July; 10(7): 32-4, 37 1096-6293

•

Constipation overview: evaluation and management. Author(s): Washington Hospital Center, 110 Irving Street NW, Washington, DC 20010, USA. [email protected] Source: Douglas, J Curr-Womens-Health-Repage 2002 August; 2(4): 280-4 1534-5874

•

Constipation, diarrhea, and irritable bowel syndrome. Author(s): Attending Colon and Rectal Surgeon, Department of Surgery, Wilford Hall Medical Center, San Antonio, Texas, USA. Source: Browning, S M Prim-Care. 1999 March; 26(1): 113-39 0095-4543

•

Constipation, fibre intake and the menstrual cycle. Source: Davies, J. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. 1998. (4/5) page 272-274. 0034-6659

•

Constipation, laxative use, and colon cancer among middle-aged adults. Author(s): Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98104 USA. Source: Jacobs, E J White, E Epidemiology. 1998 July; 9(4): 385-91 1044-3983

•

Constipation. 1. The hard facts. Source: Harv-Health-Lett. Boston, Mass. : Harvard Medical School Health Publications Group. February 1991. volume 16 (4) page 1-4. ill. 1052-1577

•

Constipation-2. Treatment. Author(s): Continence Care, West Cumbria Health Care NHS Trust. Source: Colley, W Nurs-Times. 1999 May 26-June 1; 95(21): suppl 1-2 0954-7762

•

Cow's milk protein intolerance and chronic constipation in children. Author(s): Divisions of Allergy, Clinical Immunology and Rheumatology, UNIFESP EPM, Sao Paulo, SP, Brazil. [email protected] Source: Daher, S Tahan, S Sole, D Naspitz, C K Da Silva Patricio, F R Neto, U F De Morais, M B Pediatr-Allergy-Immunol. 2001 December; 12(6): 339-42 0905-6157

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Effectiveness of wheat bran in preventing constipation of hospitalized orthopaedic surgery patients. Source: Schmelzer, M Orthop-Nurs. 1990 Nov-December; 9(6): 55-9 0744-6020

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Electroacupuncture treatment for constipation due to spasmodic syndrome of the pelvic floor--a report of 36 cases. Author(s): People's Hospital of Longhu District, Shantou City, Guangdong Province, 515041. Source: Wang, S J-Tradit-Chin-Med. 2001 September; 21(3): 205-6 0254-6272

•

Evaluation of a constipation risk assessment scale. Author(s): Royal Brisbane Hospital, Herston, Queensland, Australia. Source: Zernike, W Henderson, A Int-J-Nurs-Pract. 1999 June; 5(2): 106-9 1322-7114

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Fluids, fibre and constipation. Author(s): Thames Gateway NHS Trust, Gillingham, Kent. Source: Bush, S Nurs-Times. 2000 August 3; 96(31 Suppl): 11-2 0954-7762

•

General geriatrics and gastroenterology: constipation and faecal incontinence. Author(s): Humboldt University Berlin, Department of Internal Medicine, Park-Klinik Weissensee, Germany. Source: Muller Lissner, Stefan Best-Pract-Res-Clin-Gastroenterol. 2002 February; 16(1): 115-33 1521-6918

•

Hemostasis in children with dysbacteriosis in chronic constipation. Author(s): Krasnoyarsk State Medical Academy, The City's Clinical Hospital No. 20, The Department of Children Surgery of the Advanced Medical Courses, Russia. [email protected] Source: Kirgizov, I V Sukhorukov, A M Dudarev, V A Istomin, A A Clin-Appl-ThrombHemost. 2001 October; 7(4): 335-8 1076-0296

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How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Author(s): Gastroenterology Service, Brooke Army Medical Center, San Antonio, Texas 78234, USA. [email protected] Source: Wong, P W Kadakia, S Postgrad-Med. 1999 November; 106(6): 199-200, 203-4, 207-10 0032-5481

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I seem to be more constipated since I started taking a calcium supplement. What can I do? Source: Anonymous Mayo-Clin-Health-Lett. 1999 May; 17(5): 8 0741-6245

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Idiopathic chronic constipation: pathophysiology, diagnosis and treatment. Author(s): Department of Internal Medicine, Gemelli Hospital, Catholic University, Rome, Italy. Source: Candelli, M Nista, E C Zocco, M A Gasbarrini, A Hepatogastroenterology. 2001 Jul-August; 48(40): 1050-7 0172-6390

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Interventions for treating constipation in pregnancy. Author(s): Division of Primary Health Care, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK. [email protected] Source: Jewell, D J Young, G Cochrane-Database-Syst-Revolume 2000; (2): CD001142 1469-493X

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Is America really constipated? Source: Cerrato, P L RN. 1989 May; 52(5): 81-2, 84, 86 0033-7021

•

Management of faecal incontinence and constipation in adults with central neurological diseases (Cochrane Review). Author(s): Division de Gastroenterologie & Hepatologie CHUV/pmu, PMU, 19 Rue Cesar-Roux, Lausanne, SWITZERLAND, 1005 LAUSANNE. [email protected]

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Source: Wiesel, P H Norton, C Brazzelli, M Cochrane-Database-Syst-Revolume 2001; 4: CD002115 1469-493X •

Managing children with constipation: a community perspective. Author(s): Department of Paediatrics, John Radcliffe Hospital, Oxford. Source: Burnett, C Wilkins, G J-Fam-Health-Care. 2002; 12(5): 127-32 1474-9114

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Managing constipation that's opioid-induced. Author(s): Northwest Neuroscience Institute, Seattle, USA. Source: Scholz, M RN. 2000 June; 63(6): 103 0033-7021

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New polyethylene glycol electrolyte solution for the treatment of constipation and faecal impaction. Author(s): Department of Medicine, Western General Hospital, University of Edinburgh, UK. Source: Ferguson, A Culbert, P Gillett, H Barras, N Ital-J-Gastroenterol-Hepatol. 1999 November; 31 Suppl 3S249-52 1125-8055

•

Non-surgical treatment for constipation in adults: the place of biofeedback. Author(s): Department of Surgery, Academic Hospital St. Radboud, Catholic University, Nijmegen, The Netherlands. Source: Kuijpers, J H Bleijenberg, G Neth-J-Surg. 1991; 43(6): 218-21 0167-2487

•

Obesity, weight-reducing programmes and constipation. Source: Anderson, E. Davies, J. Nutr-food-sci. Bradford, West Yorkshire, England : MCB University Press. Nov/December 1999. (6) page 303-306. 0034-6659

•

On constipation and other digestive problems. Source: Weber, Hans U. Healthline. San Mateo, Calif. : Robert A. McNeil Foundation for Health Education. June 1984. volume 3 (6) page 16-17. charts. 0736-7929

•

Study of constipation in a geriatric hospital, day hospital, old people's home and at home. Author(s): Department of Public Health Science, University of Oulu, Finland. Source: Kinnunen, O Aging-(Milano). 1991 June; 3(2): 161-70 0394-9532

•

Teenage constipation: a case study. Author(s): Guthrie Clinic Endoscopy Center, Guthrie Square, Sayre, PA 18840, USA. [email protected] Source: Streeter, B L Gastroenterol-Nurs. 2002 Nov-December; 25(6): 253-6 1042-895X

•

Tegaserod for the treatment of constipation-predominant irritable bowel syndrome. Author(s): Drug Information Center, College of Pharmacy, Washington State University, Spokane, WA, USA. Source: Baker, D E Rev-Gastroenterol-Disord. 2001; 1(4): 187-98 1533-001X

•

The nurse's role in managing constipation. Author(s): School of Health Care Practice, Anglia Polytechnic University, 40 Park Road, Chelmsford, Essex CM1 1LL. [email protected] Source: Day, A Nurs-Stand. 2001 November 7-13; 16(8): 41-4 0029-6570

•

Therapeutic proposals for the treatment of idiopathic constipation. Author(s): Dept of Medical Pathology, Covadonga Hospital and School of Medicine, Oviedo, Spain. Source: Saez, L R Ital-J-Gastroenterol. 1991 November; 23(8 Suppl 1): 30-5 0392-0623

•

Understanding constipation. Source: Blight, K Nurs-Stand. 2001 March 14-20; 15(26): 26 0029-6570

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•

Validity and reliability of the Constipation Assessment Scale. Source: McMillan, S C Williams, F A Cancer-Nurs. 1989 June; 12(3): 183-8 0162-220X

•

Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Author(s): Department of Internal Medicine, Catholic University, Policlinico A. Gemelli, Rome. Source: Anti, M Pignataro, G Armuzzi, A Valenti, A Iascone, E Marmo, R Lamazza, A Pretaroli, A R Pace, V Leo, P Castelli, A Gasbarrini, G Hepatogastroenterology. 1998 May-June; 45(21): 727-32 0172-6390

•

When fiber is not enough: current thinking on constipation management. Author(s): Emory University Wound Ostomy Continence Nursing Education Center, Atlanta, GA 30322, USA. [email protected] Source: Doughty, D B Ostomy-Wound-Manage. 2002 December; 48(12): 30-41 0889-5899

•

Why am I constipated? Source: Anonymous Lippincotts-Prim-Care-Pract. 1998 Jul-August; 2(4): 428-9 1088-5471

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

•

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to constipation; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Provitamin A Alternative names: Beta-Carotene Source: Integrative Medicine Communications; www.drkoop.com Vitamin C Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904,00.html Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,905,00.html

•

Minerals Calcium Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: Integrative Medicine Communications; www.drkoop.com Calcium Source: Prima Communications, Inc.www.personalhealthzone.com

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Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Chondroitin Alternative names: chondroitin sulfate, sodium chondroitin sulfate Source: Integrative Medicine Communications; www.drkoop.com Iron Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html Magnesium Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com •

Food and Diet Artichoke Alternative names: Cynara scolymus Source: Healthnotes, Inc.; www.healthnotes.com Blackberries Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,142,00.html Complex Carbohydrates Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,993,00.html Flaxseeds Source: Healthnotes, Inc.; www.healthnotes.com High-fiber Diet Source: Healthnotes, Inc.; www.healthnotes.com Polyunsaturated Fats Source: Healthnotes, Inc.; www.healthnotes.com Rhubarb Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Soy Source: Healthnotes, Inc.; www.healthnotes.com

Nutrition

Tea Source: Healthnotes, Inc.; www.healthnotes.com Water Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND CONSTIPATION Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to constipation. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “constipation” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: •

Complementary Therapies: Overview and State of the Art Source: Cancer Nursing. 22(1): 85-90. February 1999. Summary: This journal article provides an overview of the benefits and potential problems of complementary therapies for cancer. The author distinguishes between alternative and complementary therapies, noting that alternative therapies are used instead of conventional cancer treatment, whereas complementary therapies are used as adjuncts to mainstream care. In the author's opinion, alternative therapies can be dangerous clinically and also because their use may delay patient's receipt of mainstream care. The first part of this article reviews the evidence regarding the seven categories of alternative therapies established by the Office of Alternative Medicine. The second part describes the potential benefits of selected complementary therapies for some of the difficulties associated with cancer diagnosis, treatment, and survival including therapies for stress and anxiety, constipation, depression, diarrhea, and nausea. The third part outlines the risks associated with certain herbal products,

104 Constipation

including products with potentially harmful effects, products that are ineffective, products that are fake or highly contaminated, products with inaccurate labeling, and products based on unverified evidence. The article has 5 references.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to constipation and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “constipation” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to constipation: •

A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Author(s): Passmore AP, Davies KW, Flanagan PG, Stoker C, Scott MG. Source: Pharmacology. 1993 October; 47 Suppl 1: 249-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8234437&dopt=Abstract

•

A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Author(s): Dettmar PW, Sykes J. Source: Current Medical Research and Opinion. 1998; 14(4): 227-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9891195&dopt=Abstract

•

A novel treatment for constipation-predominant irritable bowel syndrome using Padma Lax, a Tibetan herbal formula. Author(s): Sallon S, Ben-Arye E, Davidson R, Shapiro H, Ginsberg G, Ligumsky M. Source: Digestion. 2002; 65(3): 161-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12138321&dopt=Abstract

•

A six-year old suffering from constipation. Author(s): Brown S, Kerrigan P, Waterston T. Source: The Practitioner. 2000 February; 244(1607): 63-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10892039&dopt=Abstract

•

Abdominal massage therapy for chronic constipation: A systematic review of controlled clinical trials. Author(s): Ernst E. Source: Forschende Komplementarmedizin. 1999 June; 6(3): 149-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10460984&dopt=Abstract

•

Acupuncture treatment of habitual constipation. Author(s): Zhu Z, Li H, Chen L, Wang G, Kan C.

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Source: J Tradit Chin Med. 2003 June; 23(2): 133. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875080&dopt=Abstract •

Advances in the management of pediatric constipation. Author(s): Nurko S. Source: Current Gastroenterology Reports. 2000 June; 2(3): 234-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10957935&dopt=Abstract

•

Amitriptyline-induced constipation in cynomolgus monkeys is beneficial for the evaluation of laxative efficacy. Author(s): Tsusumi K, Kishimoto S, Koshitani O, Kohri H. Source: Biological & Pharmaceutical Bulletin. 2000 May; 23(5): 657-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10823684&dopt=Abstract

•

Anorectal and pelvic floor function. Relevance of continence, incontinence, and constipation. Author(s): Sagar PM, Pemberton JH. Source: Gastroenterology Clinics of North America. 1996 March; 25(1): 163-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8682571&dopt=Abstract

•

Aromatherapy massage for joint pain and constipation in a patient with Guillian Barre. Author(s): Shirreffs CM. Source: Complementary Therapies in Nursing & Midwifery. 2001 May; 7(2): 78-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11855776&dopt=Abstract

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Behavioural treatment (biofeedback) for constipation following hysterectomy. Author(s): Roy AJ, Emmanuel AV, Storrie JB, Bowers J, Kamm MA. Source: The British Journal of Surgery. 2000 January; 87(1): 100-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10606919&dopt=Abstract

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Biofeedback avoids surgery in patients with slow-transit constipation: report of four cases. Author(s): Brown SR, Donati D, Seow-Choen F, Ho YH. Source: Diseases of the Colon and Rectum. 2001 May; 44(5): 737-9; Discussion 739-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11357038&dopt=Abstract

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Biofeedback for constipation? Author(s): Wexner SD. Source: Diseases of the Colon and Rectum. 1998 May; 41(5): 670-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9593258&dopt=Abstract

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Biofeedback is effective therapy for fecal incontinence and constipation. Author(s): Ko CY, Tong J, Lehman RE, Shelton AA, Schrock TR, Welton ML. Source: Archives of Surgery (Chicago, Ill. : 1960). 1997 August; 132(8): 829-33; Discussion 833-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9267265&dopt=Abstract

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Biofeedback provides long-term benefit for patients with intractable, slow and normal transit constipation. Author(s): Chiotakakou-Faliakou E, Kamm MA, Roy AJ, Storrie JB, Turner IC. Source: Gut. 1998 April; 42(4): 517-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9616314&dopt=Abstract

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Biofeedback retraining in patients with functional constipation and paradoxical puborectalis contraction: comparison of anal manometry and sphincter electromyography for feedback. Author(s): Glia A, Gylin M, Gullberg K, Lindberg G. Source: Diseases of the Colon and Rectum. 1997 August; 40(8): 889-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9269803&dopt=Abstract

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Biofeedback training in children with functional constipation. A critical review. Author(s): Loening-Baucke V. Source: Digestive Diseases and Sciences. 1996 January; 41(1): 65-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8565768&dopt=Abstract

•

Biofeedback training in chronic constipation. Author(s): Benninga MA, Buller HA, Taminiau JA. Source: Archives of Disease in Childhood. 1993 January; 68(1): 126-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8434996&dopt=Abstract

•

Biofeedback training in treatment of childhood constipation: a randomised controlled study. Author(s): van der Plas RN, Benninga MA, Buller HA, Bossuyt PM, Akkermans LM, Redekop WK, Taminiau JA. Source: Lancet. 1996 September 21; 348(9030): 776-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8813983&dopt=Abstract

•

Biofeedback training is useful in fecal incontinence but disappointing in constipation. Author(s): Keck JO, Staniunas RJ, Coller JA, Barrett RC, Oster ME, Schoetz DJ Jr, Roberts PL, Murray JJ, Veidenheimer MC. Source: Diseases of the Colon and Rectum. 1994 December; 37(12): 1271-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7995157&dopt=Abstract

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•

Biofeedback treatment for chronic constipation and encopresis in childhood: longterm outcome. Author(s): Loening-Baucke V. Source: Pediatrics. 1995 July; 96(1 Pt 1): 105-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7596696&dopt=Abstract

•

Biofeedback treatment of constipation: a comparison of two methods. Author(s): Bleijenberg G, Kuijpers HC. Source: The American Journal of Gastroenterology. 1994 July; 89(7): 1021-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8017359&dopt=Abstract

•

Biofeedback treatment of constipation: a critical review. Author(s): Heymen S, Jones KR, Scarlett Y, Whitehead WE. Source: Diseases of the Colon and Rectum. 2003 September; 46(9): 1208-17. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972965&dopt=Abstract

•

Biofeedback: a first-line treatment for idiopathic constipation. Author(s): Storrie JB. Source: British Journal of Nursing (Mark Allen Publishing). 1997 February 13-26; 6(3): 152-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9104120&dopt=Abstract

•

Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Author(s): Dodi G, Pietroletti R, Milito G, Binda G, Pescatori M. Source: Techniques in Coloproctology. 2003 October; 7(3): 148-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14628157&dopt=Abstract

•

Body acupuncture: effect on colonic function in chronic constipation. Author(s): Klauser AG, Rubach A, Bertsche O, Muller-Lissner SA. Source: Zeitschrift Fur Gastroenterologie. 1993 October; 31(10): 605-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8256475&dopt=Abstract

•

Botulinum toxin in the treatment of outlet obstruction constipation caused by puborectalis syndrome. Author(s): Maria G, Brisinda G, Bentivoglio AR, Cassetta E, Albanese A. Source: Diseases of the Colon and Rectum. 2000 March; 43(3): 376-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10733120&dopt=Abstract

•

Can I safely use powdered fiber drinks such as Metamucil to relieve constipation without my body becoming reliant on them? Author(s): Feinberg AW.

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Source: Health News. 2000 January; 6(1): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11019667&dopt=Abstract •

Childhood constipation. Author(s): Rubin GP. Source: American Family Physician. 2003 March 1; 67(5): 1041-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12643364&dopt=Abstract

•

Chronic constipation in elderly patients. Author(s): Mack DJ, Erwin L, Fulton JD. Source: Bmj (Clinical Research Ed.). 1993 November 27; 307(6916): 1425-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8274909&dopt=Abstract

•

Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. Author(s): Passmore AP, Wilson-Davies K, Stoker C, Scott ME. Source: Bmj (Clinical Research Ed.). 1993 September 25; 307(6907): 769-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8219947&dopt=Abstract

•

Chronic constipation. Author(s): Lembo A, Camilleri M. Source: The New England Journal of Medicine. 2003 October 2; 349(14): 1360-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523145&dopt=Abstract

•

Chronic constipation--is the work-up worth the cost? Author(s): Rantis PC Jr, Vernava AM 3rd, Daniel GL, Longo WE. Source: Diseases of the Colon and Rectum. 1997 March; 40(3): 280-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9118741&dopt=Abstract

•

Chronic idiopathic constipation: a psychological enquiry. Author(s): Dykes S, Smilgin-Humphreys S, Bass C. Source: European Journal of Gastroenterology & Hepatology. 2001 January; 13(1): 39-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11204807&dopt=Abstract

•

Chronic idiopathic constipation: pathophysiology and treatment. Author(s): Velio P, Bassotti G. Source: Journal of Clinical Gastroenterology. 1996 April; 22(3): 190-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8724256&dopt=Abstract

•

Clinical and experimental studies on the treatment of senile constipation with shenshen wan. Author(s): Zhang S, Chang Y, Wang N, Xu D, Liu Z.

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Source: J Tradit Chin Med. 1996 September; 16(3): 182-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9389115&dopt=Abstract •

Clinical and physiologic effects of biofeedback in outlet obstruction constipation. Author(s): Ho YH, Tan M, Goh HS. Source: Diseases of the Colon and Rectum. 1996 May; 39(5): 520-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8620801&dopt=Abstract

•

Clinical management of constipation. Author(s): Lennard-Jones JE. Source: Pharmacology. 1993 October; 47 Suppl 1: 216-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8234432&dopt=Abstract

•

Clinical management of intractable constipation. Author(s): Camilleri M, Thompson WG, Fleshman JW, Pemberton JH. Source: Annals of Internal Medicine. 1994 October 1; 121(7): 520-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8067650&dopt=Abstract

•

Constipation and biofeedback in children. Author(s): Wald A. Source: Digestive Diseases and Sciences. 1996 August; 41(8): 1653-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8769296&dopt=Abstract

•

Constipation and dietary fiber intake in children. Author(s): McClung HJ, Boyne L, Heitlinger L. Source: Pediatrics. 1995 November; 96(5 Pt 2): 999-1000. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7494681&dopt=Abstract

•

Constipation and fecal incontinence in the elderly. Author(s): Wald A. Source: Semin Gastrointest Dis. 1994 October; 5(4): 179-88. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7834251&dopt=Abstract

•

Constipation caused by functional outlet obstruction. Author(s): Sanmiguel CP, Soffer EE. Source: Current Gastroenterology Reports. 2003 October; 5(5): 414-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959723&dopt=Abstract

•

Constipation causing lead poisoning? Author(s): Hodge D, Puntis JW.

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Source: Journal of Pediatric Gastroenterology and Nutrition. 1999 November; 29(5): 6079. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10554134&dopt=Abstract •

Constipation during pregnancy. Fiber and fluid are keys to self-management. Author(s): Morgan C. Source: Adv Nurse Pract. 2001 October; 9(10): 57-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12400339&dopt=Abstract

•

Constipation in children. Author(s): Leung AK, Chan PY, Cho HY. Source: American Family Physician. 1996 August; 54(2): 611-8, 627. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8701840&dopt=Abstract

•

Constipation in Parkinson's disease: objective assessment and response to psyllium. Author(s): Ashraf W, Pfeiffer RF, Park F, Lof J, Quigley EM. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 1997 November; 12(6): 946-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9399219&dopt=Abstract

•

Constipation in the elderly. Author(s): Schaefer DC, Cheskin LJ. Source: American Family Physician. 1998 September 15; 58(4): 907-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9767726&dopt=Abstract

•

Constipation overview: evaluation and management. Author(s): Douglas J. Source: Curr Womens Health Rep. 2002 August; 2(4): 280-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12150755&dopt=Abstract

•

Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy. Author(s): Wald A. Source: Gastroenterology Clinics of North America. 2003 March; 32(1): 309-22, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635420&dopt=Abstract

•

Constipation. Author(s): Rubin G. Source: Clin Evid. 2002 June; (7): 292-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230652&dopt=Abstract

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•

Constipation. Author(s): Wald A. Source: The Medical Clinics of North America. 2000 September; 84(5): 1231-46, Ix. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11026926&dopt=Abstract

•

Constipation. Pathogenesis and management. Author(s): Shafik A. Source: Drugs. 1993 April; 45(4): 528-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7684673&dopt=Abstract

•

Constipation: a physiological approach. Author(s): Thompson WG. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 November; 14 Suppl D: 155D-162D. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110630&dopt=Abstract

•

Constipation: an approach to diagnosis, treatment, referral. Author(s): Soffer EE. Source: Cleve Clin J Med. 1999 January; 66(1): 41-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9926630&dopt=Abstract

•

Constipation: evaluation and treatment. Author(s): Rao SS. Source: Gastroenterology Clinics of North America. 2003 June; 32(2): 659-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858610&dopt=Abstract

•

Controlled randomised trial of visual biofeedback versus muscle training without a visual display for intractable constipation. Author(s): Koutsomanis D, Lennard-Jones JE, Roy AJ, Kamm MA. Source: Gut. 1995 July; 37(1): 95-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7672690&dopt=Abstract

•

Decreased substance P levels in rectal biopsies from patients with slow transit constipation. Author(s): Tzavella K, Riepl RL, Klauser AG, Voderholzer WA, Schindlbeck NE, MullerLissner SA. Source: European Journal of Gastroenterology & Hepatology. 1996 December; 8(12): 1207-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8980942&dopt=Abstract

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Diagnosis and management of irritable bowel syndrome, constipation, and diarrhea in pregnancy. Author(s): West L, Warren J, Cutts T. Source: Gastroenterology Clinics of North America. 1992 December; 21(4): 793-802. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1478735&dopt=Abstract

•

Differential therapy of constipation--a review. Author(s): Wanitschke R, Goerg KJ, Loew D. Source: Int J Clin Pharmacol Ther. 2003 January; 41(1): 14-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12564741&dopt=Abstract

•

Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly. Author(s): Ouwehand AC, Lagstrom H, Suomalainen T, Salminen S. Source: Annals of Nutrition & Metabolism. 2002; 46(3-4): 159-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12169860&dopt=Abstract

•

Effect of supplements of partially hydrolyzed guar gum on the occurrence of constipation and use of laxative agents. Author(s): Patrick PG, Gohman SM, Marx SC, DeLegge MH, Greenberg NA. Source: Journal of the American Dietetic Association. 1998 August; 98(8): 912-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9710664&dopt=Abstract

•

Effectiveness of acupuncture for treatment of childhood constipation. Author(s): Broide E, Pintov S, Portnoy S, Barg J, Klinowski E, Scapa E. Source: Digestive Diseases and Sciences. 2001 June; 46(6): 1270-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11414304&dopt=Abstract

•

Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Author(s): Ashraf W, Park F, Lof J, Quigley EM. Source: Alimentary Pharmacology & Therapeutics. 1995 December; 9(6): 639-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8824651&dopt=Abstract

•

Effects of yogurt supplemented with brewer's yeast cell wall on constipation and intestinal microflora in rats. Author(s): Nakamura T, Nishida S, Mizutani M, Iino H. Source: J Nutr Sci Vitaminol (Tokyo). 2001 December; 47(6): 367-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11922109&dopt=Abstract

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Efficiency of biofeedback therapy for chronic constipation in children. Author(s): Sunic-Omejc M, Mihanovic M, Bilic A, Jurcic D, Restek-Petrovic B, Maric N, Dujsin M, Bilic A. Source: Coll Antropol. 2002 December; 26 Suppl: 93-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12674840&dopt=Abstract

•

Electroacupuncture treatment for constipation due to spasmodic syndrome of the pelvic floor--a report of 36 cases. Author(s): Wang S. Source: J Tradit Chin Med. 2001 September; 21(3): 205-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11789328&dopt=Abstract

•

Electromyographic assessment of biofeedback training for fecal incontinence and chronic constipation. Author(s): Patankar SK, Ferrara A, Larach SW, Williamson PR, Perozo SE, Levy JR, Mills J. Source: Diseases of the Colon and Rectum. 1997 August; 40(8): 907-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9269806&dopt=Abstract

•

Empirically supported treatments in pediatric psychology: constipation and encopresis. Author(s): McGrath ML, Mellon MW, Murphy L. Source: Journal of Pediatric Psychology. 2000 June; 25(4): 225-54; Discussion 255-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10814690&dopt=Abstract

•

Epidemiology of constipation in elderly patients. Drug utilisation and costcontainment strategies. Author(s): Lederle FA. Source: Drugs & Aging. 1995 June; 6(6): 465-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7663066&dopt=Abstract

•

Functional colonic and anorectal disorders. Detecting and overcoming causes of constipation and fecal incontinence. Author(s): Rao SS. Source: Postgraduate Medicine. 1995 November; 98(5): 115-9, 124-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7479446&dopt=Abstract

•

Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. Author(s): Wiesel PH, Norton C, Roy AJ, Storrie JB, Bowers J, Kamm MA.

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Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2000 August; 69(2): 240-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10896701&dopt=Abstract •

How effective is nonlaxative treatment of constipation? Author(s): Klauser AG, Muller-Lissner SA. Source: Pharmacology. 1993 October; 47 Suppl 1: 256-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8234439&dopt=Abstract

•

How to deal with chronic constipation. A stepwise method of establishing and treating the source of the problem. Author(s): Wong PW, Kadakia S. Source: Postgraduate Medicine. 1999 November; 106(6): 199-200, 203-4, 207-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10576011&dopt=Abstract

•

Identification of patients likely to benefit from biofeedback for outlet obstruction constipation. Author(s): Wexner SD. Source: The British Journal of Surgery. 1999 November; 86(11): 1484. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10617365&dopt=Abstract

•

Identification of patients likely to benefit from biofeedback for outlet obstruction constipation. Author(s): McKee RF, McEnroe L, Anderson JH, Finlay IG. Source: The British Journal of Surgery. 1999 March; 86(3): 355-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10201778&dopt=Abstract

•

Idiopathic Constipation and Fecal Incontinence. Author(s): Krevsky B. Source: Current Treatment Options in Gastroenterology. 1998 December; 1(1): 20-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11096560&dopt=Abstract

•

Incontinence and constipation: pelvic floor disorders of gastrointestinal motility and urodynamics. Author(s): Floch MH, Dowd J. Source: Journal of Clinical Gastroenterology. 1998 July; 27(1): 4-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9706763&dopt=Abstract

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Influence of senna, fibre, and fibre + senna on colonic transit in loperamide-induced constipation. Author(s): Ewe K, Ueberschaer B, Press AG.

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Source: Pharmacology. 1993 October; 47 Suppl 1: 242-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8234436&dopt=Abstract •

Interventions for treating constipation in pregnancy. Author(s): Jewell DJ, Young G. Source: Cochrane Database Syst Rev. 2001; (2): Cd001142. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11405974&dopt=Abstract

•

Interventions for treating constipation in pregnancy. Author(s): Jewell DJ, Young G. Source: Cochrane Database Syst Rev. 2000; (2): Cd001142. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796250&dopt=Abstract

•

Intestinal neuronal dysplasia. Defining a new cause for chronic constipation. Author(s): Hutson JM. Source: Aust Fam Physician. 1996 September; 25(9): 1357. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8840558&dopt=Abstract

•

Introducing abdominal massage in palliative care for the relief of constipation. Author(s): Preece J. Source: Complementary Therapies in Nursing & Midwifery. 2002 May; 8(2): 101-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12188155&dopt=Abstract

•

Management of childhood constipation. Author(s): Beach RC. Source: Lancet. 1996 September 21; 348(9030): 766-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8813977&dopt=Abstract

•

Management of constipation and encopresis in infants and children. Author(s): Seth R, Heyman MB. Source: Gastroenterology Clinics of North America. 1994 December; 23(4): 621-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7698824&dopt=Abstract

•

Management of faecal incontinence and constipation in adults with central neurological diseases. Author(s): Wiesel PH, Norton C, Brazzelli M. Source: Cochrane Database Syst Rev. 2001; (4): Cd002115. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11687140&dopt=Abstract

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Managing morphine-induced constipation: a controlled comparison of an Ayurvedic formulation and senna. Author(s): Ramesh PR, Kumar KS, Rajagopal MR, Balachandran P, Warrier PK. Source: Journal of Pain and Symptom Management. 1998 October; 16(4): 240-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9803051&dopt=Abstract

•

Mechanisms of constipation in older persons and effects of fiber compared with placebo. Author(s): Cheskin LJ, Kamal N, Crowell MD, Schuster MM, Whitehead WE. Source: Journal of the American Geriatrics Society. 1995 June; 43(6): 666-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7775727&dopt=Abstract

•

Outcome and predictors of success of biofeedback for constipation. Author(s): Gilliland R, Heymen S, Altomare DF, Park UC, Vickers D, Wexner SD. Source: The British Journal of Surgery. 1997 August; 84(8): 1123-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9278659&dopt=Abstract

•

Outlet dysfunction constipation. Author(s): Wald A. Source: Current Treatment Options in Gastroenterology. 2001 August; 4(4): 293-297. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11469987&dopt=Abstract

•

Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia. Author(s): Wiesel PH, Dorta G, Cuypers P, Herranz M, Kreis ME, Schnegg JF, Jornod P. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2001 March 24; 131(11-12): 152-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11416888&dopt=Abstract

•

Pharmacological basis for the use of peach leaves in constipation. Author(s): Gilani AH, Aziz N, Ali SM, Saeed M. Source: Journal of Ethnopharmacology. 2000 November; 73(1-2): 87-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11025143&dopt=Abstract

•

Polyethylene glycol 3350 for constipation in children with dysfunctional elimination. Author(s): Erickson BA, Austin JC, Cooper CS, Boyt MA. Source: The Journal of Urology. 2003 October; 170(4 Pt 2): 1518-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501649&dopt=Abstract

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Portable biofeedback apparatus for treatment of anal sphincter dystonia in childhood soiling and constipation. Author(s): Griffiths P, Dunn S, Evans A, Smith D, Bradnam M.

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Source: Journal of Medical Engineering & Technology. 1999 May-June; 23(3): 96-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10425608&dopt=Abstract •

Predictive factors for short-term symptom persistence in children after emergency department evaluation for constipation. Author(s): Patel H, Law A, Gouin S. Source: Archives of Pediatrics & Adolescent Medicine. 2000 December; 154(12): 1204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11115303&dopt=Abstract

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Prospective study of biofeedback for treatment of constipation. Author(s): Rieger NA, Wattchow DA, Sarre RG, Saccone GT, Rich CA, Cooper SJ, Marshall VR, McCall JL. Source: Diseases of the Colon and Rectum. 1997 October; 40(10): 1143-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9336108&dopt=Abstract

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Prospective study of biofeedback retraining in patients with chronic idiopathic functional constipation. Author(s): Wang J, Luo MH, Qi QH, Dong ZL. Source: World Journal of Gastroenterology : Wjg. 2003 September; 9(9): 2109-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970917&dopt=Abstract

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Prospective, randomized trial comparing four biofeedback techniques for patients with constipation. Author(s): Heymen S, Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Source: Diseases of the Colon and Rectum. 1999 November; 42(11): 1388-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10566525&dopt=Abstract

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Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Author(s): Nehra V, Bruce BK, Rath-Harvey DM, Pemberton JH, Camilleri M. Source: The American Journal of Gastroenterology. 2000 July; 95(7): 1755-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10925980&dopt=Abstract

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Psychological state and quality of life in patients having behavioral treatment (biofeedback) for intractable constipation. Author(s): Mason HJ, Serrano-Ikkos E, Kamm MA. Source: The American Journal of Gastroenterology. 2002 December; 97(12): 3154-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492203&dopt=Abstract

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Psyllium is superior to docusate sodium for treatment of chronic constipation. Author(s): McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M.

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Source: Alimentary Pharmacology & Therapeutics. 1998 May; 12(5): 491-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9663731&dopt=Abstract •

Reflexology in the management of encopresis and chronic constipation. Author(s): Bishop E, McKinnon E, Weir E, Brown DW. Source: Paediatric Nursing. 2003 April; 15(3): 20-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715585&dopt=Abstract

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Review article: the therapy of constipation. Author(s): Schiller LR. Source: Alimentary Pharmacology & Therapeutics. 2001 June; 15(6): 749-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380313&dopt=Abstract

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Review of the treatment literature for encopresis, functional constipation, and stooltoileting refusal. Author(s): Brooks RC, Copen RM, Cox DJ, Morris J, Borowitz S, Sutphen J. Source: Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 2000 Summer; 22(3): 260-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11211851&dopt=Abstract

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Role of colonic motility in guiding therapy in patients with constipation. Author(s): Snape WJ Jr. Source: Digestive Diseases (Basel, Switzerland). 1997; 15 Suppl 1: 104-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9177949&dopt=Abstract

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Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Author(s): Kinnunen O, Winblad I, Koistinen P, Salokannel J. Source: Pharmacology. 1993 October; 47 Suppl 1: 253-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8234438&dopt=Abstract

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Short-term effects of sacral nerve stimulation for idiopathic slow transit constipation. Author(s): Malouf AJ, Wiesel PH, Nicholls T, Nicholls RJ, Kamm MA. Source: World Journal of Surgery. 2002 February; 26(2): 166-70. Epub 2001 December 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11865344&dopt=Abstract

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Simple electromyographic biofeedback treatment for chronic pediatric constipation/encopresis: preliminary report. Author(s): Cox DJ, Sutphen J, Borowitz S, Dickens MN, Singles J, Whitehead WE. Source: Biofeedback Self Regul. 1994 March; 19(1): 41-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8167163&dopt=Abstract

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Slow transit constipation. Author(s): Wald A. Source: Current Treatment Options in Gastroenterology. 2002 August; 5(4): 279-283. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095475&dopt=Abstract

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Slow transit constipation: more than one disease? Author(s): Pehl C, Schmidt T, Schepp W. Source: Gut. 2002 October; 51(4): 610; Author Reply 610. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235091&dopt=Abstract

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Surgery for constipation: a review. Author(s): Pfeifer J, Agachan F, Wexner SD. Source: Diseases of the Colon and Rectum. 1996 April; 39(4): 444-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8878507&dopt=Abstract

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Surgical treatment of constipation and fecal incontinence. Author(s): Rotholtz NA, Wexner SD. Source: Gastroenterology Clinics of North America. 2001 March; 30(1): 131-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394027&dopt=Abstract

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The effect of anorectal manometry on the outcome of treatment in severe childhood constipation: a randomized, controlled trial. Author(s): van Ginkel R, Buller HA, Boeckxstaens GE, van Der Plas RN, Taminiau JA, Benninga MA. Source: Pediatrics. 2001 July; 108(1): E9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11433088&dopt=Abstract

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The effect of oral vancomycin on chronic idiopathic constipation. Author(s): Celik AF, Tomlin J, Read NW. Source: Alimentary Pharmacology & Therapeutics. 1995 February; 9(1): 63-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7766746&dopt=Abstract

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The physiology of continence: idiopathic fecal constipation and soiling. Author(s): Griffiths DM. Source: Semin Pediatr Surg. 2002 May; 11(2): 67-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11973758&dopt=Abstract

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Treating constipation in the patient with diabetes. Author(s): Haines ST. Source: Diabetes Educ. 1995 May-June; 21(3): 223-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7758391&dopt=Abstract

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Treatment of constipation in adults associated with idiopathic megarectum by behavioural retraining including biofeedback. Author(s): Mimura T, Nicholls T, Storrie JB, Kamm MA. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2002 November; 4(6): 477-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12790924&dopt=Abstract

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Use of breakfast cereals for constipation in elderly persons. Author(s): Creelman PC. Source: American Family Physician. 1999 March 15; 59(6): 1402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10193585&dopt=Abstract

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Water supplementation enhances the effect of high-fiber diet on stool frequency and laxative consumption in adult patients with functional constipation. Author(s): Anti M, Pignataro G, Armuzzi A, Valenti A, Iascone E, Marmo R, Lamazza A, Pretaroli AR, Pace V, Leo P, Castelli A, Gasbarrini G. Source: Hepatogastroenterology. 1998 May-June; 45(21): 727-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9684123&dopt=Abstract

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When fiber is not enough: current thinking on constipation management. Author(s): Doughty DB. Source: Ostomy Wound Manage. 2002 December; 48(12): 30-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490751&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to constipation; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Alcoholism Source: Integrative Medicine Communications; www.drkoop.com Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Anemia Source: Integrative Medicine Communications; www.drkoop.com Anxiety Source: Integrative Medicine Communications; www.drkoop.com Ascariasis Source: Integrative Medicine Communications; www.drkoop.com Benign Prostatic Hyperplasia Source: Integrative Medicine Communications; www.drkoop.com Bph Source: Integrative Medicine Communications; www.drkoop.com Bulimia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Chronic Candidiasis Source: Healthnotes, Inc.; www.healthnotes.com Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Constipation Source: Healthnotes, Inc.; www.healthnotes.com Constipation Source: Prima Communications, Inc.www.personalhealthzone.com Depression Source: Integrative Medicine Communications; www.drkoop.com Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com

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Diverticular Disease Source: Healthnotes, Inc.; www.healthnotes.com Diverticular Disease Source: Integrative Medicine Communications; www.drkoop.com Dysmenorrhea Source: Healthnotes, Inc.; www.healthnotes.com Dysmenorrhea Source: Integrative Medicine Communications; www.drkoop.com Epilepsy Source: Integrative Medicine Communications; www.drkoop.com Food Poisoning Source: Integrative Medicine Communications; www.drkoop.com Gallstones Source: Healthnotes, Inc.; www.healthnotes.com Gastroesophageal Reflux Disease Source: Integrative Medicine Communications; www.drkoop.com Guinea Worm Disease Source: Integrative Medicine Communications; www.drkoop.com Heartburn Source: Integrative Medicine Communications; www.drkoop.com Hemorrhoids Source: Healthnotes, Inc.; www.healthnotes.com Hemorrhoids Source: Integrative Medicine Communications; www.drkoop.com Hemorrhoids Source: Prima Communications, Inc.www.personalhealthzone.com High Blood Pressure Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com Hookworm Source: Integrative Medicine Communications; www.drkoop.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com

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Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Integrative Medicine Communications; www.drkoop.com Hypochondriasis Source: Integrative Medicine Communications; www.drkoop.com Hypothyroidism Source: Healthnotes, Inc.; www.healthnotes.com Hypothyroidism Source: Integrative Medicine Communications; www.drkoop.com Iron-deficiency Anemia Source: Healthnotes, Inc.; www.healthnotes.com Irritable Bowel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Irritable Bowel Syndrome Source: Integrative Medicine Communications; www.drkoop.com Irritable Bowel Syndrome Alternative names: Spastic Colon Source: Prima Communications, Inc.www.personalhealthzone.com Loiasis Source: Integrative Medicine Communications; www.drkoop.com Lupus Source: Integrative Medicine Communications; www.drkoop.com Lymphatic Filariasis Source: Integrative Medicine Communications; www.drkoop.com Menstrual Pain Source: Integrative Medicine Communications; www.drkoop.com Multiple Sclerosis Source: Integrative Medicine Communications; www.drkoop.com Parasites Source: Healthnotes, Inc.; www.healthnotes.com Parkinson's Disease Source: Healthnotes, Inc.; www.healthnotes.com Parkinson's Disease Source: Integrative Medicine Communications; www.drkoop.com

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Pinworm Source: Integrative Medicine Communications; www.drkoop.com Pms Alternative names: Premenstrual Stress Syndrome Source: Prima Communications, Inc.www.personalhealthzone.com Proctitis Source: Integrative Medicine Communications; www.drkoop.com Prostate Enlargement Source: Integrative Medicine Communications; www.drkoop.com Rectal Inflammation Source: Integrative Medicine Communications; www.drkoop.com River Blindness Source: Integrative Medicine Communications; www.drkoop.com Roundworms Source: Integrative Medicine Communications; www.drkoop.com Rubella Source: Integrative Medicine Communications; www.drkoop.com Seizure Disorders Source: Integrative Medicine Communications; www.drkoop.com Spastic Colon Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.drkoop.com Threadworm Source: Integrative Medicine Communications; www.drkoop.com Trichinosis Source: Integrative Medicine Communications; www.drkoop.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com Visceral Larva Migrans Source: Integrative Medicine Communications; www.drkoop.com Vitamin B12 Deficiency Source: Healthnotes, Inc.; www.healthnotes.com Whipworm Source: Integrative Medicine Communications; www.drkoop.com

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Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Acupuncture Source: Integrative Medicine Communications; www.drkoop.com Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672,00.html Colon Therapy Source: Healthnotes, Inc.; www.healthnotes.com Colon Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682,00.html Ehretism Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/e.html Homeopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,703,00.html Hydrotherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,705,00.html Medical Graphology Alternative names: grapho-diagnostics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Osteopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724,00.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733,00.html

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Traditional Chinese Medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10085,00.html Yoga Source: Integrative Medicine Communications; www.drkoop.com •

Chinese Medicine Badou Alternative names: Croton Fruit; Fructus Crotonis Source: Chinese Materia Medica Badoushuang Alternative names: Defatted Croton Seed Powder; Semen Crotonis Pulveratum Source: Chinese Materia Medica Baiziren Alternative names: Chinese Arborvitae Kernel; Semen Platycladi Source: Chinese Materia Medica Baochi San Alternative names: Baochi Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Bimazi Alternative names: Castor Seed; Semen Ricini Source: Chinese Materia Medica Binglang Sixiao Wan Alternative names: Binglang Sixiao Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Dahuang Alternative names: Rhubarb; Radix et Rhizoma Rhei Source: Chinese Materia Medica Daii Alternative names: Japanese Thistle Herb; Herba Cirsii Japonici Source: Chinese Materia Medica Danggui Alternative names: Chinese Angelica; Radix Angelicae Sinensis Source: Chinese Materia Medica

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Danggui Longhui Wan Alternative names: Danggui Longhui Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Daochi Wan Alternative names: Daochi Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Fangfeng Tongsheng Wan Alternative names: Fangfeng Tongsheng Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Fengmi Alternative names: Honey; Mel Source: Chinese Materia Medica Fuzi Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae Source: Chinese Materia Medica Gansui Alternative names: Gansui Root; Radix Kansui Source: Chinese Materia Medica Gualou Alternative names: Snakegourd Fruit; Fructus Trichosanthis Source: Chinese Materia Medica Gualouzi Alternative names: Snakegourd Seed; Semen Trichosanthis Source: Chinese Materia Medica Heizhima Alternative names: Black Sesame; Semen Sesami Nigrum Source: Chinese Materia Medica Heshouwu Alternative names: Fleeceflower Root; Radix Polygoni Multiflori Source: Chinese Materia Medica Hongdaii Alternative names: Knoxia Root; Radix Knoxiae Source: Chinese Materia Medica Houpo Alternative names: Officinal Magnolia Bark; Cortex Magnoliae Officinalis Source: Chinese Materia Medica

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Huomaren Alternative names: Hemp Seed; Semen Cannabis Source: Chinese Materia Medica Jingdaii Alternative names: Peking Euphorbia Root; Radix Euphorbiae Pekinensis Source: Chinese Materia Medica Juemingzi Alternative names: Cassia Seed; Semen Cassiae Source: Chinese Materia Medica Kuxingren Alternative names: Bitter Apricot Seed; Semen Armeniacae Amarum Source: Chinese Materia Medica Laifuzi Alternative names: Radish Seed; Semen Raphani Source: Chinese Materia Medica Liuhuang Alternative names: Sulfur; Sulfur Source: Chinese Materia Medica Liuwei Anxiao San Alternative names: Liuwei Anxiao Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Luhui Alternative names: Aloes; Luhui (Lu Hui); Aloe Source: Chinese Materia Medica Luohanguo Alternative names: Grosvenor Momordica Fruit; Fructus Momordicae Source: Chinese Materia Medica Maidong Alternative names: Liriope Root Tuber; Shanmaidong; Radix Liriopes Source: Chinese Materia Medica Mangxiao Alternative names: Sodium Sulfate; Natrii Sulfas1 Source: Chinese Materia Medica Maren Runchang Wan Alternative names: Maren Runchang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Mengshi Guntan Wan Alternative names: Mengshi Guntan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Muxiang Binglang Wang Alternative names: Muxiang Binglang PillsMuxiang Binglang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Pangdahai Alternative names: Boat-fruited Sterculia Seed; Semen Sterculiae Lychnophorae Source: Chinese Materia Medica Qianjinzi Alternative names: Caper Euphorbia Seed; Semen Euphorbiae Source: Chinese Materia Medica Qianniuzi Alternative names: Pharbitis Seed; Semen Pharbitidis Source: Chinese Materia Medica Qingfei Yihuo Wan Alternative names: Qingfei Yihuo Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qingfen Alternative names: Calomel; Calomelas Source: Chinese Materia Medica Qingning Wan Alternative names: Qingning Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Reyanning Keli Alternative names: Reyanning Granules; Reyanning Keli(Rey Yan Ning Ke Li) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Sangshen Alternative names: Mulberry Fruit; Fructus Mori Source: Chinese Materia Medica Shanglu Alternative names: Pokeberry Root; Radix Phytolaccae Source: Chinese Materia Medica Shanmaidong Alternative names: Liriope Root Tuber; Radix Liriopes Source: Chinese Materia Medica

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Shanzha Huazhi Wan Alternative names: Shanzha Huazhi Pills; Shanzha Huazhi Wan(Shan Zha Hua Zhi Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Taoren Alternative names: English Walnut Seed; Hetaoren; Semen Juglandis Source: Chinese Materia Medica Tiandong Alternative names: Cochinchinese Asparagus Root; Radix Asparagi Source: Chinese Materia Medica Tianwang Buxin Wan Alternative names: Tianwang Buxin Pills; Tianwang Buxin Wan(Ti An Wang Bu Xin Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Xuanmingfen Alternative names: Exsiccated Sodium Sulfate; Natrii Sulfas Exsiccatus Source: Chinese Materia Medica Xuanshen Alternative names: Figwort Root; Radix Scrophulariae Source: Chinese Materia Medica Yamazi Alternative names: Linseed; Semen Lini Source: Chinese Materia Medica Yuliren Alternative names: Chinese Dwarf Cherry Seed; Semen Pruni Source: Chinese Materia Medica Zhimu Alternative names: Common Anemarrhena Rhizome; Rhizoma Anemarrhenae Source: Chinese Materia Medica Zhishi Alternative names: Immature Orange Fruit; Fructus Aurantii Immaturus Source: Chinese Materia Medica Zhuyazao Alternative names: Chinese Honeylocust Abnormal Fruit; Fructus Gleditsiae Abnormalis Source: Chinese Materia Medica

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Zisuzi Alternative names: Perilia Fruit; Fructus Perillae Source: Chinese Materia Medica •

Homeopathy Bryonia Source: Healthnotes, Inc.; www.healthnotes.com Calcarea Carbonica Source: Healthnotes, Inc.; www.healthnotes.com Causticum Source: Healthnotes, Inc.; www.healthnotes.com Graphites Source: Healthnotes, Inc.; www.healthnotes.com Lycopodium Source: Healthnotes, Inc.; www.healthnotes.com Nux Vomica Source: Healthnotes, Inc.; www.healthnotes.com Sepia Source: Healthnotes, Inc.; www.healthnotes.com Silicea (silica) Source: Healthnotes, Inc.; www.healthnotes.com Sulphur Source: Healthnotes, Inc.; www.healthnotes.com

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Herbs and Supplements Acidophilus and Other Probiotics Source: Prima Communications, Inc.www.personalhealthzone.com Activated Charcoal Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,832,00.html Agrimony Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,833,00.html Aloe Alternative names: Aloe vera, Aloe barbadensis Source: Healthnotes, Inc.; www.healthnotes.com

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Aloe Vera Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10001,00.html Angelica Sinensis Source: Integrative Medicine Communications; www.drkoop.com Atropine Source: Healthnotes, Inc.; www.healthnotes.com Barberry Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca B-carotene Alternative names: Beta-Carotene Source: Integrative Medicine Communications; www.drkoop.com Beta-carotene Alternative names: b-carotene Source: Integrative Medicine Communications; www.drkoop.com Betacarotenum Alternative names: b-carotene Source: Integrative Medicine Communications; www.drkoop.com Bisacodyl Source: Healthnotes, Inc.; www.healthnotes.com Bismuth Subsalicylate Source: Healthnotes, Inc.; www.healthnotes.com Blessed Thistle Alternative names: Cnicus benedictus Source: Healthnotes, Inc.; www.healthnotes.com Blue Flag Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Butcher's Broom Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10010,00.html Cardiac Glycosides Source: Integrative Medicine Communications; www.drkoop.com

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Cascara Alternative names: Cascara sagrada, Rhamnus purshiani cortex Source: Healthnotes, Inc.; www.healthnotes.com Cascara Sagrada Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Cascara Sagrada Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10013,00.html Chinese Angelica Source: Integrative Medicine Communications; www.drkoop.com Chlorophyll Source: Healthnotes, Inc.; www.healthnotes.com Culver's Root Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Dandelion Source: Prima Communications, Inc.www.personalhealthzone.com Dandelion Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10021,00.html Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Docusate Source: Healthnotes, Inc.; www.healthnotes.com Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com

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Fenugreek Alternative names: Trigonella foenum-graecum Source: Healthnotes, Inc.; www.healthnotes.com Fenugreek Source: Prima Communications, Inc.www.personalhealthzone.com Fiber Source: Healthnotes, Inc.; www.healthnotes.com Fiber Source: Integrative Medicine Communications; www.drkoop.com Flaxseed Alternative names: Linum usitatissimum, Linseed Source: Integrative Medicine Communications; www.drkoop.com Fos Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10026,00.html Fo-ti Alternative names: Polygonum multiflorum Source: Healthnotes, Inc.; www.healthnotes.com Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Glycyrrhiza Glabra Source: Integrative Medicine Communications; www.drkoop.com Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Grapefruit Seed Extract Source: Healthnotes, Inc.; www.healthnotes.com Gymnema Alternative names: Gymnema sylvestre Source: Healthnotes, Inc.; www.healthnotes.com Gymnema Sylvestre Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10034,00.html He Shou Wu Source: Prima Communications, Inc.www.personalhealthzone.com

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Hydantoin Derivatives Source: Integrative Medicine Communications; www.drkoop.com Hypericum Perforatum Source: Integrative Medicine Communications; www.drkoop.com Ispaghula Source: Integrative Medicine Communications; www.drkoop.com Klamathweed Source: Integrative Medicine Communications; www.drkoop.com Lactulose Source: Healthnotes, Inc.; www.healthnotes.com Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Linseed Source: Integrative Medicine Communications; www.drkoop.com Linum Usitatissimum Source: Integrative Medicine Communications; www.drkoop.com Lipoic Acid Source: Prima Communications, Inc.www.personalhealthzone.com Loop Diuretics Source: Integrative Medicine Communications; www.drkoop.com Marshmallow Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10042,00.html Methylcellulose Source: Healthnotes, Inc.; www.healthnotes.com Milk Thistle Source: Prima Communications, Inc.www.personalhealthzone.com Oak Alternative names: Quercus spp. Source: Healthnotes, Inc.; www.healthnotes.com Organ Mountain Crape Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Peppermint Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812,00.html Picrorhiza Alternative names: Picrorhiza kurroa Source: Healthnotes, Inc.; www.healthnotes.com Plantago Isphagula Source: Integrative Medicine Communications; www.drkoop.com Plantago Psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.drkoop.com Psyllium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,814,00.html SAMe (s-Adenosylmethionine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818,00.html Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc.; www.healthnotes.com Slippery Elm Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10056,00.html Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.drkoop.com St. John's Wort Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824,00.html

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Tang Kuei Source: Integrative Medicine Communications; www.drkoop.com Trans-beta-carotene Alternative names: Beta-Carotene Source: Integrative Medicine Communications; www.drkoop.com Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc.; www.healthnotes.com Verapamil Source: Healthnotes, Inc.; www.healthnotes.com Yellow Dock Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. CLINICAL TRIALS AND CONSTIPATION Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning constipation.

Recent Trials on Constipation The following is a list of recent trials dedicated to constipation.5 Further information on a trial is available at the Web site indicated. •

Constipation in Pediatric Cancer Patients Receiving Vinca Alkaloids or Narcotics Condition(s): Constipation; Neoplasms Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: This study will evaluate a questionnaire for measuring constipation in children with cancer. The questionnaire used in this study (Constipation Assessment Scale) reliably predicts the presence and severity of constipation in adult patients, but has not been tested in children. The answers to the questionnaire will be used to determine the child's level of constipation and to plan and provide appropriate care. Patients up to 21 years of age who are enrolled in National Cancer Institute trials and are taking weekly vinca alkaloids or narcotics twice a day or more may be eligible for this study. On admission to the study, participants will undergo the following procedures: - The child (or the child's parent) will be interviewed about the child's bowel habits. - The results of the child's most recent physical examination related to bowel function will be obtained from the medical record for review. - A registered dietitian will interview the child or parent about the child's eating habits. During the study, participants will undergo the following procedures: - A registered nurse will interview the child or parent about the child's bowel movements. This will be done every other day for hospitalized children and three times a week (by phone) for outpatients. - The child or parent will complete a daily diary of bowel movements. - A registered dietitian will evaluate the child's nutritional status periodically (by phone).

5

These are listed at www.ClinicalTrials.gov.

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Children who are not constipated when they enter the study will receive a stool softener every day to prevent constipation. Children who become constipated during the study will be treated as needed. Patients will be followed for 7 days after the last dose of vinca alkaloid or narcotic for a maximum of 6 weeks. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00032682 •

Treatment of Functional Bowel Disorders Condition(s): Irritable Bowel Syndrome; Constipation; Abdominal Pain; Functional Colonic Diseases Study Status: This study is completed. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The primary purpose for this study is to compare clinical treatments for patients with functional bowel disorders (irritable bowel syndrome, abdominal pain, painful constipation) in women. We also plan to: 1) determine what clinical features (medical or psychological) determine which patients will improve to these treatments, and 2) understand if there are any physiological features that relate to improvement in symptoms and response to the treatments. We will compare a psychological treatment (cognitive-behavioral therapy - CBT) with education/attention placebo, and an antidepressant drug (desipramine) with a pill placebo. This is the first large-scale study designed to determine the therapeutic effects of these methods, and to also determine interactions among physiologic measures, psychologic and sociodemographic factors, severity of symptoms, and therapeutic improvement including quality of life. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006157

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “constipation” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials:

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For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON CONSTIPATION Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.6 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “constipation” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on constipation, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Constipation By performing a patent search focusing on constipation, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 6Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on constipation: •

Alleles of the human mu opioid receptor and diagnostic methods based thereon Inventor(s): Kreek; Mary Jeanne (New York, NY), LaForge; Karl Steven (New York, NY), Tischfield; Jay A. (Carmel, IN), Yu; Lei (Cincinnati, OH) Assignee(s): The Advanced Research and Technology Institute, Inc. (Bloomington, IN), The Rockefeller University (New York, NY) Patent Number: 6,335,168 Date filed: July 9, 1999 Abstract: Provided herein are variant alleles of a gene encoding a mu opioid receptor, along with cloning vectors for replicating such variant alleles, expressing vectors for expressing the variant alleles to produce variant mu opioid receptors, and antibodies to such variant receptors. Also disclosed are binding characteristics of such variant receptors regarding binding to opioid ligands, and the using of such binding characteristics to diagnose a subjects susceptibility to pain, susceptibility to an addictive disease, selecting an appropriate pain reliever along with a therapeutically effective amount of the reliever to administer to a subject suffering from pain. In addition, diagnostic methods for diagnosing a disease or disorder such as infertility, constipation, diarrhea, decreased immune response relative to a standard, and decreased ability to withstand stress relative to a standard, along with commercial kits for diagnosing such diseases or disorders. Furthermore, the invention is also directed to identification of targeted prevention methods, early therapeutic intervention, and improved treatment of opioid addiction, infertility, constipation, diarrhea, impaired immune responsiveness, and stress. Excerpt(s): This invention relates generally to alleles of the human mu opioid receptor gene, along with products derived from such alleles. Also included herein are methods of diagnosing various susceptibilities using such alleles and determining treatment for certain diseases based upon the presence of specific alleles of the human mu opioid receptor gene, and various diseases or disorders related to physiological functions regulated by the hypothalamus pituitary adrenal axis (HPA) or the hypothalamus pituitary gonadal axis (HPG). Opioid drugs have various effects on perception of pain, consciousness, motor control, mood, autonomic function, and can also induce physical dependence. The endogenous opioid system plays an important role in modulating endocrine, cardiovascular, respiratory, gastrointestinal functions, and immune functions. Opioids, either exogenous or endogenous, exert their actions by binding to specific membrane-associated receptors. Examples of exogenous opioids presently known include, opium, heroin, morphine, codeine, fentanyl, and methadone, to name only a few. Moreover, a family of over 20 endogenous opioid peptides has been identified, wherein the members possess common structural features, including a positive charge juxtaposed with an aromatic ring that is required for interaction with an opioid receptor. It has been determined that most, if not all the endogenous opioid peptides are derived from the proteolytic processing of three precursor proteins, i.e., prbopiomelanocortin, proenkephalin, and prodynorphin. In addition, a fourth class of endogenous opioids, the endorphins, has been identified (the gene encoding these proteins has not yet been cloned). In the processing of the endogenous opioid precursor proteins, initial cleavages are made by membrane-bound proteases that cut next to pairs of positively charged amino acid residues, and then trimming reactions produce the

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final endogenous opioids secreted from cells in vivo. Different cell types contain different processing enzymes so that, for example proopiomelanocortin can be processed into different endogenous peptides by different cells. For example, in the anterior lobe of the pituitary gland, only corticotropin (ACTH),.beta.-lipotropin, and.beta.-endorphin are produced. Both pro-enkephalin and pro-dynorphin are similarly processed by specific enzymes in specific cells to yield multiple opioid peptides. Web site: http://www.delphion.com/details?pn=US06335168__ •

Apparatus and method for transferring dry oil and gas well drill cuttings Inventor(s): Hollier; Glynn M. (Aberdeenshire, GB), Reddoch; Jeffrey (Lafayette, LA) Assignee(s): Baker Hughes Incorporated (Houston, TX) Patent Number: 6,585,115 Date filed: November 28, 2000 Abstract: An apparatus and method for removing and recovering up to 98 percent of the residual drilling mud and fluids from drill cuttings for reuse and storing the drill cuttings in a relatively dry state thereby reducing cuttings volume requirements for storage and transport thereby reducing constipation of the drilling process due to disposal congestion. The present invention further provides methods for collecting and transferring drill cuttings in either dry or wet states to various locations on or adjacent the rig for processing, containerization, transport and disposal, thereby reducing handling and contamination thus simplifying recycling while reducing cost. Excerpt(s): This is a continuation application of United Kingdom application 9913567.5 filed in the U.K., Jun. 11, 1999, now pending. Priority is claimed to PCT application No. GB 99/04097 filed Dec. 10, 1999. This invention relates generally to handling of waste materials especially particulate solids. A method of transferring such materials from one location to another, and an apparatus suitable for performing the method, is described hereinafter. The invention finds particular utility in the oil and gas industry for disposal of well or drill cuttings ("hereinafter cuttings") discharged from the solids control system on a well drilling site. Cuttings are typically pieces of rock, which have been chipped, ground or scraped out of a formation by a drill bit. Various types of drill cutting tools_are in use for this purpose and the invention hereinafter described is not limited to use of any particular type. Web site: http://www.delphion.com/details?pn=US06585115__

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Apparatus and method for treating chronic constipation Inventor(s): Bardy; Gust H. (Seattle, WA) Assignee(s): Medtronic, Inc. (Minneapolis, MN) Patent Number: 6,026,326 Date filed: January 13, 1997 Abstract: An anticonstipation apparatus, and method, that may include using an implanted stimulus generator that may supply electrical stimuli to the muscles associated with a target portion of the patient's gut, from the esophagus to the anus, through an electrical lead and several pairs of electrodes. The electrical stimuli may be

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provided to nerves in the autonomic nervous system that are associated with the muscles, or the stimuli may be provided directly to the muscles themselves. The stimuli may be provided sequentially, in a proximal to caudad direction, in order to initiate, enhance or artificially produce peristalsis in the gut's target portion in a proximal to caudad direction. If the gut's target portion is in the descending colon, such stimulation may be coordinated with similar stimulation of the muscles associated with the rectum and anus. A sensor may be provided to detect when the target portion is experiencing constipation. Excerpt(s): The present invention relates generally to apparatus and methods for treating constipation in humans. More particularly, it relates to treating chronic, severe constipation by using an anticonstipation apparatus to electrically stimulate the muscles associated with the afflicted portion of the gut. This may be done by stimulating portions of the autonomic nervous system associated with those muscles, or by directly stimulating those muscles themselves. Constipation is a life-disturbing problem that afflicts millions of Americans, from the very young to the elderly. Although relatively rare among the young, it is a very common problem in middle age, and is a nearly ubiquitous problem in the elderly. Chronic constipation is a major problem for many individuals, and frequently causes extreme discomfort to the afflicted. Such discomfort may be a major obstacle to leading a normal life, and may consume an enormous amount of the afflicted person's energy and time. Web site: http://www.delphion.com/details?pn=US06026326__ •

Capsules for oral preparations and capsule preparations for oral administration Inventor(s): Aoki; Jun (Ibaraki, JP), Nakanishi; Masaru (Ibaraki, JP), Tanida; Norifumi (Ibaraki, JP) Assignee(s): Hisamitsu Pharmaceutical Co., Inc. (Saga, JP) Patent Number: 6,214,378 Date filed: March 8, 1999 Abstract: This invention offers capsules for oral preparation which is useful for colon diseases such as colon cancer, ulcerative colitis, constipation and diarrhea and for systemic diseases such as osteoporosis and which does not undergo any change at all in stomach and in small intestine but firstly start to disintegrate upon arriving at large intestine and, at the same time, quickly release the drug therefrom wherein the capsule base therefor is hydroxypropylmethylcellulose (HPMC) or polyethyleneglycolcompounded HPMC, gelatin or agar and, on the surface of said capsule base in which powder or liquid containing a pharmacologically active substance is encapsulated, a double-coated structure comprising an inner layer consisting of a cationic copolymer and an outer layer consisting of anionic copolymer is formed. Excerpt(s): This invention relates to capsules for preparations for oral administration and also to capsule preparations for oral administration using said capsules. More particularly, this invention relates to capsules being able to be administered orally in which pharmacologically active substance depending upon the object can be encapsulated and which is firstly disintegrated upon arriving at the large intestine whereby the pharmacologically active substance can be efficiently released therefrom and also relates to capsule preparations using said capsules where said preparations are pharmaceutical preparations useful for colon diseases such as colon cancer, ulcerative colitis, constipation and diarrhea and for systemic diseases such as osteoporosis. In

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recent years, great effort has been made for developing the intestinal delivery art where the preparation after oral administration is not disintegrated in stomach and small intestine but is disintegrated just upon arriving at the large intestine. The reason is that such a method in place of conventional intravenous administration, transnasal administration, rectal administration, etc. greatly reduces the burden of the patients as compared with those conventional methods. Examples of the known intestinal delivery art which have been known up to now are an oral preparation where a polymer which is soluble only at pH 5.5 or higher and an insoluble polymer are combined whereby large intestine is a target for releasing the drug (European Patent 49,590); a solid oral dosage form coated with an appropriate amount of anionic polymer (trade name: Eudragit S; manufactured by Rohm) which is soluble at pH 7.0 or higher (International Laid-Open Patent WO 83/00435); an oral preparation coated with a composition in an appropriate ratio of anionic copolymer which is soluble at pH 7.0 or higher (trade name: Eudragit S or L; manufactured by Rohm) and a methacrylate copolymer which is hardly soluble in water (trade name: Eudragit RS; manufactured by Rohm) (European Patent 225,189); an osmotic pressure pump preparation which is coated with an enteric coating polymer (Belgian Patent 903,502); and an oral pharmaceutical preparation delivering to large intestine where an internal layer which is soluble at pH 7.0 or higher is coated with a gelled polymer layer as an intermediate layer and then further coated with a stomachresisting external layer which is soluble at pH 5.5 or higher (Japanese Laid-Open Patent Hei-04/501,411). Web site: http://www.delphion.com/details?pn=US06214378__ •

Extracts of mixed arctium lappa L., carrot and whole radish for treating hypertension, constipation and detoxification Inventor(s): Shi; Yuan (Little Neck, NY), Xu; Dong (Jiangxi, CN), Yang; Yongsen (Jiangxi, CN) Assignee(s): Chengzhi Life Science Company, Ltd. (Beijing, CN) Patent Number: 6,428,822 Date filed: April 3, 2001 Abstract: A mixed substance for treating hypertension, constipation, detoxification, boost immune system produced by extracting arctium lappa L., carrot, and whole radish with water one or two hours at temperature 70.degree. C. 100.degree. C. under agitating, separated the extracts and solid by-products, vacuum condensed the extracts, then at low temperature lyophilized condensed extracts to powder, encapsulated powder or pressed powder to tablet. Patient taking a daily dosage of this vegetable medicine have shown greatly improved healthy condition. Excerpt(s): This invention relates to vegetable medicine, specifically to cure sickness and improve healthy condition. This invention relates to extracts of arctium lappa L., carrot and whole radish (radish and radish leaves) substance having anti hypertension, detoxification and treating constipation properties. Hypertension is the medical term for high blood pressure. It is defined in an adult as a blood pressure greater than or equal to 140 mmHg systolic pressure or greater than or equal to 90 mmHg diastolic pressure. Blood pressure is measured in millimeters of mercury (mmHg). High blood pressure directly increases the risk of coronary heart disease (which leads to heart attack) and stroke, especially along with other risk factors. High blood pressure can occur in children or adults, but it's more common among people over age 35. Medical science does not understand why most cases of high blood pressure occur, it's hard to

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say how to prevent it. Current pharmaceutical treatments for essential hypertension include diuretics, beta-blockers, ACE inhibitors, angaotensin converting enzyme inhibitors, thiazid and calcium antagonists. Some of them were patented, such as U.S. Pat. Nos. 4,559,340. The patent refers to make an antihypertension agents. There are disclosed benzothiadiazinyl and quinazolinyl substituted carboxylalkyl dipeptides, wherein the benzothiodiazinyl oror quinazolinyl portions are joined to the dipeptide portions by an aminocarbonyl group. Compounds of this patent are used for the treatment of congestive heart failure and glaucoma. In addition, compounds of this patent also have diuretic activity. Web site: http://www.delphion.com/details?pn=US06428822__ •

Fatty acid delivery system comprising a hydrolyzable bond Inventor(s): Annison; Geoffrey (The Concourse, SG), Illman; Richard J. (O'Halloran Hill, AU), Topping; David L. (O'Halloran Hill, AU) Assignee(s): Commonwealth Scientific and Industrial Research Organization (AU) Patent Number: 5,840,860 Date filed: September 5, 1996 Abstract: Delivery to the colon of fatty acids especially Short Chain Fatty Acids (SCFA) can be effected by covalently linking SCFA to a carrier that is preferably a form of carbohydrate, by an ester link. The SCFA is protected by its link with the carbohydrate through the small intestine, and where the carbohydrate is digestible in the small intestine such as a digestible starch, the starch can also be protected from digestion in the small intestine by the substitution. Levels of SCFA such as acetate, propionate and butyrate may be elevated to have beneficial effects in the prevention of colonic disorders such as rectal cancer, diverticulities, colitis, diarrhea and constipation. Excerpt(s): This application claims benefit of international application PCT/GB94/00713, filed Nov. 17, 1994, published as WO95/13801 May 26, 1995. This invention relates to an agent for use in food, dietary, and the like preparations, and to preparations, formulations and dietary compositions containing the agent. The invention is also concerned with a method of and pharmaceutical preparations for reducing the risk of certain colon disorders or for treating said disorders. Colonic health is associated with a number of factors, and a well known strategy in recent time to promote large bowel health has been by increased consumption of "fibre", a large proportion of which is not digested at all and acts, at least in part, by giving rise to greater bulk and moisture retention in the colon. This will be described below in more detail. Web site: http://www.delphion.com/details?pn=US05840860__

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Fermentation compositions having superoxide dismutating activity and an antihypertensive agent for treatment of constipation each having the superoxide dismutating activity Inventor(s): Ishikawa; Naoto (Aichi, JP), Kimura; Akihiko (Aichi, JP), Takada; Atsushi (Aichi, JP) Assignee(s): Toyo Hakko Co., Ltd. (Obu, JP) Patent Number: 5,776,756 Date filed: August 31, 1995 Abstract: The present invention provides a fermentation composition which makes use of rice brans, soybeans and sources of carbon as starting materials and which is innoxious, has a good SOD action (the action of effectively eliminating O.sub.2.sup.which is harmful to the living body and the action of preventing diseases), and can prevent degradation of vitamin C. The invention also relates to an antihypertensive agent and constipation improver which are innoxious and have a good SOD action. The fermentation composition comprises a fermentation liquid obtained by inoculating and cultivating, under aerating and agitating conditions, bacillus natto or grass bacilli in a liquid medium,a pH of the medium is controled in the range of from 7.5 to 10 by alkaline agents, containing a rice bran, a soybean, a source of carbon and water, and filtering the resultant cultivation broth, or an evaporation residue of the fermentation liquid, vitamin C and, optionally, an extract of green tea or its evaporation residue. Excerpt(s): The present invention provides a fermentation compositions which have a good SOD action and more particularly, to fermentation compositions which comprises, at least, a specific type of fermented liquid and vitamin C. The other invention relates to an antihypertensive agent and an improver for constipation which also have a good SOD action. The compositions of the present invention have wide utility in the fields of treatment and improvement such as of various types of diseases caused by active oxygen (O.sub.2.sup.-) including diseases caused by bloodstream troubles such as myocardial infarction, cerebral apoploxy,hypertension, menstrul pain, the stiffness of the shoulders, nerve pain, lambagos, crapulence and the like, adult and internal diseases such as cancer, nephritis, hepatitis,diabetes and the like, and beauty cares and dermatoses such as spots, epherides, skin chapping, anematosis, constipation, wrinkles, atopic dermatitis and the like. If O.sub.2.sup.- - is harmful to the living body, SOD which is an enzyme for eliminating O.sub.2.sup.- is considered to exist in order to protect the living body from thetoxicity of the active oxygen, so that SOD is useful in treating diseases considered to result from the active oxygen. From this standpoint, studies have been recently made on the reaction mechanism and the physiological mechanism of the SOD ("Active Oxygen--Molecular Mechanism of the Formation, Bleaching and Function in Living Bodies", the new and second edition, edited by Minoru NAKANO et al., and published by Kyoritsu Pub. Co. , Ltd., p. 223 to 230). It is known that the SOD activity is low in cancer cells. Although the direct causal relation between the SOD and the carcinogenesis has not been clearly elucidated, it has been reported that when injected into cancer cells, SOD and SOD analogues inhibit proliferation (the above "Active Oxygen", p. 64). Web site: http://www.delphion.com/details?pn=US05776756__

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Fiber-water--water containing soluble fiber Inventor(s): Stillman; Suzanne Jaffe (264 S. Linden Dr., Beverly Hills, CA 90212) Assignee(s): none reported Patent Number: 6,248,390 Date filed: February 22, 2000 Abstract: A shelf stable, ready to use, essentially tasteless and odorless water-like fluid for humans/animals comprised of safe water and a significant quantity of one or more water-soluble dietary fibers. Fiber-water is intended to be consumed by drinking or by enteral feeding alone, and/or in combination. The inventive liquid may be consumed directly hot or cold or after use, at any required temperature, in the preparation/reconstitution of beverages or liquid food product (e.g. coffee, tea, concentrates such as "HAWAIIAN PUNCH.RTM.", frozen concentrates such as lemonade/orange juice, soups and pet food). It can be used to enrich foods with soluble fiber through cooking, moistening, reconstituting or imbibing dried foods (e.g. oatmeal, rice, dried fruits, powdered soups, powdered beverages, powdered milks, nutritional shakes, "GATORADE.RTM./TANG.RTM./KOOL-AID.RTM." products, gelatins, custards, puddings, and pet food). Fiber-water can be consumed in the frozen state either indirectly by adding it to a beverage as a cube or crushed "ice", or directly by licking a frozen "POPSICLE.RTM." product). Fiber-water is safe water fiber enriched intending to be a replacement and/or adjunct to other water to ensure proper hydration while at the same time provide significant soluble fiber. Depending on the soluble fiber(s) used, and the user's individual metabolism, the invention is non-caloric or extremely low in calories. The soluble fiber(s) used are proven to moderate the postprandial rise in blood glucose (diabetes), address weight loss (obesity), lower serum cholesterol level (cardiovascular/heart), and address constipation and bowel regularity (colon cancer). Excerpt(s): The present application concerns generally components of the human diet and more specifically water and fiber. Many of the major problems in human health revolve around which dietary components are truly essential for animal and human health and which components are merely hyped by various companies to sell product. A related problem is that of the accuracy of information regarding the appropriateness of a given food, nutrient or nutraceutical for a given individual. Certainly the "one size fits all" scenario is untrue when it comes to pharmaceuticals and nutrition. Further, the Federal Drug Administration has very little control over dietary supplements so that companies compete in making claims and launching new products, which may or may not be helping humans or animals that consume the products. New information constantly comes forth warning of serious potential interactions between nutritional supplements, ethical pharmaceuticals and various disease states. The present inventor is concerned with providing a composition that can be extremely beneficial to humans and animals with few, if any, dangers or drawbacks. In the following description consumption by humans should also be taken to include consumption by domestic animals--primarily dogs and cats. While many of the concepts discussed are applicable to other animals, the digestive systems of herbivores, particularly ruminates, varies tremendously from that of humans. Therefore, the thrust of the present invention is towards carnivores and omivores whose digestive systems more closely resemble those of humans. One of the conundrums of human health is that dietary components, which may appear mundane, are actually incredibly essential. One such vital component that is frequently overlooked or given insufficient importance is water. Although water is not metabolized, it is absolutely essential for metabolism. A majority of the weight of the

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body is water which serves as the solvent for the chemical reactions of life. Water is the largest component of many living cells, and various nutrients needed for cellular growth and survival enter the cells dissolved in water. After metabolism, the waste products are carried away by water. If water intake is grossly neglected death can occur in as little as three to five days. Web site: http://www.delphion.com/details?pn=US06248390__ •

Food bars containing nutritional supplements and anti-constipation and regularity maintaining-agents Inventor(s): Manning; Paul B. (Keswick, VA), McGrath, Jr.; James W. (Keswick, VA), Schramm; Jack H. (Gordonsville, VA) Assignee(s): PBM Pharmaceuticals, Inc. (Gordonsville, VA) Patent Number: 6,569,445 Date filed: December 5, 2000 Abstract: The present invention provides food bars for consumption by pregnant women, lactating women or women of childbearing potential that are attempting to become pregnant containing one or more vitamins and/or minerals, and one or more anti-constipation and regularity-maintaining agents, methods for preparing these food bars, and methods for supplementing the dietary requirements of pregnant women, lactating women or women of childbearing potential that are attempting to become pregnant. The food bars of the invention generally comprise one or more vitamins and minerals recommended for consumption by pregnant women, lactating women or women of childbearing potential that are attempting to become pregnant in an amount that is effective for enhancing the nutrition of pregnant women, lactating women or women of childbearing potential that are attempting to become pregnant, and that is not harmful to developing fetuses or breast-feeding babies, one or more anti-constipation and regularity-maintaining agents in an amount that is effective for reducing or eliminating constipation, and that is not harmful to developing fetuses or breast-feeding babies, from about 0 to about 99 weight percent of carbohydrates, from about 0 to about 80 weight percent of proteins, and from about 0 to about 60 weight percent of fats. Excerpt(s): The present invention relates to food bars for consumption by pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant containing one or more vitamins and/or minerals, and one or more anti-constipation and regularity-maintaining agents, to methods for preparing these food bars, and to methods for enhancing the nutrition of pregnant women and their developing fetuses, of lactating women and their babies, and of women having childbearing potential that are attempting to become pregnant. In particular, the present invention relates to food bars comprising one or more vitamins and/or minerals recommended for consumption by pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant in an amount that is effective for enhancing the nutrition of pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant, or of their developing fetuses or babies, and one or more anti-constipation and regularitymaintaining agents in an amount that is effective for reducing or eliminating constipation, and/or for maintaining regularity of bowel movements, in pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant. The daily Recommended Dietary Allowances of water-soluble vitamins for non-pregnant and pregnant women, and the rationale for increased

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allowances during pregnancy, is set forth in Nutrition During Pregnancy (Nat'l Academy Press, 1990), and below. Morning sickness generally causes a loss of appetite and a feeling of nausea, and is experienced by a significant number of pregnant women. Because they experience morning sickness, and because the pills that contain the full dose of recommended prenatal vitamins and minerals generally are very large in size, many pregnant women are often reluctant to take their prenatal vitamin and mineral pills. Further, when they do take these pills, these pregnant women often experience difficulty swallowing and retaining these pills, and take the pills without food. Vitamins and minerals that are taken without food are not absorbed as well as those taken with some food. Problems, thus, arise concerning patient compliance (the daily consumption of vitamin and mineral supplements), maintaining or enhancing the health of pregnant woman, and the absorption of the quantity of vitamins and minerals that are associated with proper fetal development. Moreover, regurgitation after consuming a vitamin and mineral pill causes loss of some or all of the nutrients that were originally present in the pill. Web site: http://www.delphion.com/details?pn=US06569445__ •

Galenic composition containing opioid antagonists Inventor(s): Profitlich; Thomas (Munich, DE), Walter; Kersten (Munich, DE) Assignee(s): Klinge Pharma GmbH (Munich, DE) Patent Number: 6,419,959 Date filed: August 10, 1999 Abstract: A pharmaceutical composition for oral administration contains naloxone-, Nmethylnaloxone- and/or N-methylnaltrexone-containing particles which release the active substance depending on the ambient pH. This ensures the liberation of the active substance over the whole gastrointestinal tract. The side effects caused by the use of analgesic opioids, such as constipation, are thus eliminated without reducing the analgesic effect. Excerpt(s): The invention relates to new galenic compositions with opioid antagonistic activity and their use in opioid-induced constipation. In particular, the invention relates to pellet, granulate or microtablet compositions comprising the active ingredients naloxone, N-methylnalaxone or N-methylnaltrexone as the active ingredients with opioid antagonistic activity. Constipation arising through medication with the use of strongly effective analgesics of the morphine type represents a large problem. It is considered as one of the most frequent side effects and is an undesired concomitant symptom particularly in continual therapy. This problem arises during treatment in approximately 85% of the patients given morphine. In contrast to other side effects caused by for example morphine, this is a chronic phenomenom that does not loose intensity during the course of treatment [Saller R., Hellenbrecht D. "Schmerzen-Therapie in Praxis und Klinik", 1st Ed. (1991) Marseille Publishers, Munich]. The paralytic effect of opioids on intestine motility has been known for a long time and is also therapeutically used, for example, in the case of diarrheal illnesses [Manara L., Bianchetti A. "The central and peripheral influences of opioids on gastrointestinal propulsion", Ann. Rev. Pharmacol. Toxicol. 25, 249-273 (1985)]. Although the mode of action of opioids on intestine motility is not yet completely understood, it is seen in connection with the binding of the opioid to opioid receptors in the intestine. Aside from in the brain, these opioid receptors are also to be found at high density in the gastrointestinal tract above all [Manara L., Bianchetti A. "The central and peripheral

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influences of opioids on gastrointestinal propulsion", Ann. Rev. Pharmacol. Toxicol. 25, 249-273 (1985)]. In a series of pharmacological experiments, it could be demonstrated that opioids (morphine was mostly chosen as a model substance) have a direct effect on the smooth musculature of the intestine and, thus, muscle tonicity in intestine segments increases. The enhancement of segmental tonicity leads to a significant prolongation of gastrointestinal passage time with simultaneous decrease of the propulsive motility of the intestine [Cameron J. C. "Constipation related to narcotic therapy", Cancer Nurs. 15, 372-377 (1992)]. Web site: http://www.delphion.com/details?pn=US06419959__ •

Magnesium citrate solution Inventor(s): Murphy; William R. (Murfreesboro, TN) Assignee(s): Cumberland Swan Holdings, Inc. (Smyrna, TN) Patent Number: 6,514,537 Date filed: May 29, 2001 Abstract: A magnesium citrate oral solution comprising citric acid in an amount greater than 10% weight/volume; magnesium hydroxide in an amount ranging from about 1.55% weight/volume; and water. Most preferably, the citric acid is present in an amount of about 10.9% weight/volume. Another embodiment of the present invention is a method of treating constipation in a patient in need thereof. The method of this embodiment comprises administering an effective amount of an oral composition that comprises citric acid in an amount greater than 10% weight/volume. Preferably, the composition of this embodiment comprises citric acid in an amount of 10.9% weight/volume. Excerpt(s): The present invention relates to a novel magnesium citrate solution. The therapeutic use of magnesium citrate as a gentle laxative is well known. Magnesium citrate oral solutions are considered saline laxatives that are widely available over the counter. Magnesium citrate attracts and retains water in the intestine, softening stools and inducing the urge to defecate. A typical dose for adults is about 10 to 14 ounces daily in 1 or more doses. Relevant background information and prior art oral solutions are discussed below. Web site: http://www.delphion.com/details?pn=US06514537__

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Method of achieving overnight laxation and control of bowel function Inventor(s): Cleveland; Mark vB. (Duxbury, MA), Pelham; Russell W. (Duxbury, MA) Assignee(s): Braintree Laboratories, Inc. (Braintree, MA) Patent Number: 6,645,481 Date filed: September 28, 2000 Abstract: Overnight relief of constipation symptoms is achieved, and control of bowel function is enhanced by oral administration of an effective or sufficient amount of a composition comprising polyethylene glycol (PEG), preferably dispersed and or dissolved in an aqueous medium. The PEG compositions used for the present invention are preferably substantially free of ancillary electrolytes.

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Excerpt(s): The present invention relates to the field of laxatives and laxative-based treatments. More particularly, the present invention relates to promoting overnight laxation and control of bowel function in individuals who are otherwise prone to constipation. Constipation is a syndrome (a collection of symptoms) that includes the inability to have a bowel movement in a regular fashion, excess flatus or intestinal gas that exists as trapped bubbles that cause feelings of pain, bloating and cramping in the abdominal area. Constipation is the most common gastrointestinal complaint in the United States. Over 4,000,000 people (approximately 2% of the population) have frequent constipation as determined by self-assessment surveys. Current treatments of constipation fall into two main categories, each with distinct disadvantages. One category, which includes the cathartics or purgatives and the osmotic agents, causes a bowel movement to occur generally within a few hours, in an uncontrollable fashion. That is, a patient who takes a purgative or cathartic laxative has an obligatory bowel movement within minutes to a few hours. The patient is unable to ignore the sensation of urgency, and risks soiling of their garments or gastrointestinal distress from the sense of urgency if they so attempt. The bowel movement due to a cathartic or purgative laxative is characterized by unpredictability and urgency in the patients so that the patients' control of when or where the bowel movement occurs is virtually nonexistent. Examples of these laxatives are bisacodyl, senna, lactulose, saline laxatives and GI lavages. Web site: http://www.delphion.com/details?pn=US06645481__ •

Method of stimulating gastrointestinal motility with ellagic acid Inventor(s): Khambe; Deepa Ashok (Bombay, IN), Rajagopalan; Tuticorin Govindachari (Bombay, IN) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,843,987 Date filed: October 31, 1997 Abstract: The present invention relates to the use of ellagic acid for the treatment of gastrointestinal disorders by stimulating the motility of the GI tract. In particular the present invention relates to a method of treatment of constipation, heartburn, non ulcer dyspepsia, GERD, and/or esophagitis, with a pharmaceutical composition comprising a safe and effective amount of ellagic acid or pharmaceutically acceptable salts or esters thereof. Preferably the ellagic acid is administered perorally. Excerpt(s): The present invention relates to the use of ellagic acid and pharmaceutically acceptable salts or esters thereof for the treatment or prevention of gastrointestinal disorders requiring stimulation of the motility of the gastrointestinal (GI) tract, e.g. for enhancing esophageal contractility, for stimulating gastric emptying, and for stimulating small intestinal transit time. In particular the present invention relates to a method of treatment or prevention of constipation, heartburn, NUD (non ulcer dyspepsia), GERD (gastroesophageal reflux disease), esophagitis, gastric ulcers, and/or duodenal ulcers, in a human or other animal, with a safe and effective amount of ellagic acid and pharmaceutically acceptable salts or esters thereof. This application claims priority under Title 35, United States Code 119(e) from Provisional Application Ser. No. 60/030,421, filed Oct. 31, 1996. Ellagic acid, is also known as 2,3,7,8Tetrahydroxy›1!benzopyrano-›5,4,3-cde!›1!benzopyran-5,10-dione; 4,4', 5,5', 6,6'-hexahydrodiphenic acid 2,6,2', 6'-dilactone, benzoaric acid, Lagistase, hexahydroxydiphenic acid-dilactone, and olyphenolic acid. The chemical formula is C.sub.14 H.sub.6 O.sub.8.

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Ellagic acid is a naturally occurring plant phenol, occurring in its free form or in the form of ellagitannins or glucosides. It is found in certain fruits, nuts and vegetables, such as grapes, strawberries, blackberries, raspberries, cranberries, walnuts, guavas, mangoes, green tea, and pecans. It is also found in dicotyledonous plants in the genera of castenea, eucalyptus, eugenia, euphorbia, gerinimum, mangifera, platycarya, quercus, rhus and terminalia. Dhingra et al., Determination of free ellagic acid by reversed-phase high-performance liquid chromatography. Journal of Chromatography, 447 (1988) 284286. Ellagic acid is present in plants as ellagitannins, which consist of a central core of glucose esterified with hexahydroxydiphenic acid. These precursor molecules may undergo hydrolysis with acid or base to yield ellagic acid. Physico-chemical properties of ellagic acid are described in: Press, Hardcastle, J. Appl. Chem. 19, 247 (1969). Web site: http://www.delphion.com/details?pn=US05843987__ •

Methods and compositions involving opioids and antagonists thereof Inventor(s): Farrar; John J. (Chester Springs, PA) Assignee(s): Adolor Corporation (Exton, PA) Patent Number: 6,451,806 Date filed: November 29, 2000 Abstract: Novel methods and compositions comprising opioids In preferred embodiments, the methods and compositions peripheral mu opioid antagonist compounds. The methods particularly suitable for treating and/or preventing side effects including, for example, constipation, vomiting and/or nausea.

and opioid antagonists. comprise opioids and and compositions are associated with opioids

Excerpt(s): The present invention relates to novel methods and compositions comprising opioids and opioid antagonists. More particularly, the present invention relates to novel methods and compositions comprising opioids and peripheral mu opioid antagonist compounds. It is well known that opioid drugs target three types of endogenous opioid receptors (i.e., mu, delta and kappa receptors) in biological systems. Most opioids, such as morphine, are mu opioid agonists that are often used as analgesics for the treatment of severe pain due to their activation of mu opioid receptors in the brain and central nervous system (CNS). Opioid receptors are, however, not limited to the CNS, and may be found in other tissues throughout the body. A number of side effects of opioid drugs may be caused by activation of these peripheral receptors. Administration of mu opioid agonists often results in intestinal dysfunction due to the large number of receptors in the wall of the gut (Wittert, G., Hope, P. and Pyle, D., Biochemical and Biophysical Research Communications 1996, 218, 877-881; Bagnol, D., Mansour, A., Akil, A. and Watson, S. J., Neuroscience 1997, 81, 579-591). Specifically, opioids are generally known to cause nausea and vomiting as well as inhibition of normal propulsive gastrointestinal function in animals and man (Reisine, T., and Pasternak, G., Goodman & Gilman's The Pharmacological Basis of Therapeutics Ninth Edition 1996, 521-555) resulting in side effects such as, for example, constipation. It has been reported that acute nausea or vomiting may occur in up to about 33% of patients who receive oral narcotic analgesics and in up to about 80% of patients who receive injectable narcotics following surgery or trauma. This is due, at least in part, to direct effects of narcotics on the gastrointestinal (GI) tract. Opioid-induced side effects, such as nausea, vomiting, and inhibited gastrointestinal propulsive activity remain serious problems for patients being administered opioid analgesics for both short term and long term pain management. Opioid antagonist compounds that do not readily cross the blood-brain barrier

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(peripherally acting drugs) have been tested for use in curbing opioid-induced side effects. For instance, the peripheral mu opioid antagonist compound methylnaltrexone and related compounds have been suggested for use in curbing opioid-induced side effects in patients. U.S. Pat. Nos. 5,972,954, 5,102,887, 4,861,781, and 4,719,215 disclose the use of methylnaltrexone and related compounds in controlling opioid-induced pruritus, nausea, and/or vomiting. Additionally, methylnaltrexone has been shown to effectively reduce the incidence of opioid-induced nausea and pruritus as disclosed by Yuan, C. -S. et al. Drug and Alcohol Dependence 1998, 52, 161. Similarly, U.S. Pat. Nos. 5,250,542, 5,434,171, 5,159,081, and 5,270,328, disclose peripherally selective piperidineN-alkylcarboxylate opioid antagonists as being useful for the treatment of the opioid side effects constipation, nausea or vomiting, as well as irritable bowel syndrome and idiopathic constipation. Web site: http://www.delphion.com/details?pn=US06451806__ •

Methods for treating gastrointestinal motility dysfunction using optically pure (--) cisapride Inventor(s): Gray; Nancy M. (Marlborough, MA), Young; James W. (Palo Alto, CA) Assignee(s): Sepracor Inc. (Marlborough, MA) Patent Number: 5,955,477 Date filed: November 21, 1996 Abstract: The optically pure (-) isomer of cisapride is useful for the treatment of dyspepsia and such other conditions as may be related to the activity of (-) cisapride as a prokinetic agent, such as gastroparesis, constipation, post-operative ileus, and intestinal pseudo-obstruction, without the concomitant liability of adverse effects associated with the racemic mixture of cisapride. The (-) isomer of cisapride also exhibits longer duration of action than does racemic cisapride and is useful for treatment of disorders of the central nervous system. Excerpt(s): This invention relates to novel compositions of matter containing optically pure (-) cisapride. These compositions possess potent activity in treating gastroesophageal reflux disease while substantially reducing adverse effects associated with the administration of the racemic mixture of cisapride including but not limited to diarrhea, abdominal cramping and elevations of blood pressure and heart rate. Additionally, these novel compositions of matter containing optically pure (-) cisapride are useful in treating emesis and such other conditions as may be related to the activity of (-) cisapride as a prokinetic agent, including but not limited to dyspepsia, gastroparesis, constipation, and intestinal pseudo-obstruction, while substantially reducing adverse effects associated with the administration of the racemic mixture of cisapride. Also disclosed are methods for treating the above-described conditions in a human while substantially reducing adverse effects that are associated with the racemic mixture of cisapride, by administering the (-) isomer of cisapride to a human in need of such treatment. The active compound of these compositions and methods is an optical isomer of racemic cis-cisapride, which is described in European Patent Application No. 0,076,530 A2 published Apr. 13, 1983 and U.S. Pat. Nos. 4,962,115 and 5,057,525. Chemically, the active compound, of the presently disclosed compositions and methods, is the (-) isomer of cis-4-amino-5-chloro-N-›1-›3-(4-fluorophenoxy) propyl!-3-methoxy-4piperidinyl!-2-methoxybenzamide, hereinafter referred to as (-) cisapride. The term "(-) isomer of cisapride" and particularly the term "(-) cisapride" encompass optically pure and substantially optically pure (-) cisapride. Similarly, as used herein, the terms

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"racemic cisapride" or "racemic mixture of cisapride" refer to the cis diastereomeric racemate. Web site: http://www.delphion.com/details?pn=US05955477__ •

Methods for treating gastrointestinal motility dysfunction using optically pure (+) cisapride Inventor(s): Gray; Nancy M. (Marlborough, MA), Young; James W. (Palo Alto, CA) Assignee(s): Sepracor Inc. (Marlborough, MA) Patent Number: 5,955,478 Date filed: November 21, 1996 Abstract: Methods are disclosed utilizing the optically pure (+) isomer of cisapride. The optically pure (+) isomer of cisapride is useful for the treatment of dyspepsia and such other conditions as may be related to the activity of (+) cisapride as a prokinetic agent, such as gastroparesis, constipation, post-operative operative ileus, and intestinal pseudo-obstruction, without the concomitant liability of adverse effects associated with the racemic mixture of cisapride. The (+) isomer of cisapride also exhibits longer duration of action than does racemic cisapride and is useful for treatment of disorders of the central nervous system. Excerpt(s): This invention relates to novel compositions of matter containing optically pure (+) cisapride. These compositions possess potent activity in treating gastroesophageal reflux disease while substantially reducing adverse effects associated with the administration of the racemic mixture of cisapride including but not limited to diarrhea, abdominal cramping and elevations of blood pressure and heart rate. Additionally, these novel compositions of matter containing optically pure (+) cisapride are useful in treating emesis and such other conditions as may be related to the activity of (+) cisapride as a prokinetic agent, including but not limited to dyspepsia, gastroparesis, constipation, and intestinal pseudo-obstruction, while substantially reducing adverse effects associated with the administration of the racemic mixture of cisapride. Also disclosed are methods for treating the above-described conditions in a human while substantially reducing adverse effects that are associated with the racemic mixture of cisapride, by administering the (+) isomer of cisapride to a human in need of such treatment. The active compound of these compositions and methods is an optical isomer of racemic cis-cisapride, which is described in European Patent Application No. 0,076,530 A2 published Apr. 13, 1983 and U.S. Pat. Nos. 4,962,115 and 5,057,525. Chemically, the active compound, of the presently disclosed compositions and methods, is the (+) isomer of cis-4-amino-5-chloro-N-›1-›3-(4-fluorophenoxy) propyl!-3-methoxy4-piperidinyl!-2-methoxybenzamide, hereinafter referred to as (+) cisapride. The term "(+) isomer of cisapride" and particularly the term "(+) cisapride" encompass optically pure and substantially optically pure (+) cisapride. Similarly, as used herein, the terms "racemic cisapride" or "racemic mixture of cisapride" refer to the cis diastereomeric racemate. Cisapride, which is the subject of the present invention, is available commercially only as the 1:1 racemic mixture of the cis diastereomeric racemate. Cisapride is available only as a mixture of optical isomers, called enantiomers, i.e., a mixture of cis(+) and cis(-) cisapride. Web site: http://www.delphion.com/details?pn=US05955478__

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Natural laxative Inventor(s): Galat; Alexander (126 Buckingham Rd., Yonkers, NY 10701) Assignee(s): none reported Patent Number: 5,811,125 Date filed: August 30, 1996 Abstract: A medicine for relieving constipation, the medicine having an effective dose of the edible portion of the caraway plant. The effective dose is combined with filler agents, or in one embodiment, with a bulk-producing agent to increase the effectiveness of the laxative, in an orally ingestible form. The medicine is gentle-acting, natural and has no known adverse side-effects associated with its use. A method for using the medicine is also provided. Excerpt(s): The present invention relates to a new laxative compound, and in particular to a laxative compound containing caraway which is effective yet gentle in its action on the human digestive system. Constipation is the most common chronic digestive problem occurring in humans. It is estimated that over five million people suffer from frequent constipation, and that almost one billion dollars is spent annually on laxative products. A common cause of this problem is the weakening of the colon and intestines of humans with age. Normal intestinal contractions (peristalsis) weaken, and food is not properly moved through the digestive tract, resulting in constipation. Web site: http://www.delphion.com/details?pn=US05811125__

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Nuritional formula containing hydrolyzed protein and a fiber blend Inventor(s): Berk; David F. (Columbus, OH), Breen; Merlin D. (Westerville, OH), Chmura; James N. (Canal Winchester, OH), Huston; Todd A. (Columbus, OH), Malone; William T. (Columbus, OH), Ostrom; Karin M. (Reynoldsburg, OH) Assignee(s): Abbott Laboratories (Abbott Park, IL) Patent Number: 6,017,550 Date filed: April 14, 1998 Abstract: The use of fiber to control infantile colic and diarrhea and adult constipation and diarrhea is well accepted. This invention is specifically directed to liquid nutritional formulas which contain hydrolyzed protein and/or amino acids and dietary fiber. This invention overcomes the problems of product physical stability and high viscosities through the use of soluble/non-fermentable fibers in combination with a blend of insoluble/non-fermentable and soluble/fermentable fibers. The invention is also directed to the use of physiologically effective levels of fibers in nutritional products that use hydrolyzed protein and/or free amino acids for the source of amino nitrogen to treat colic, diarrhea, short gut syndrome and other gastrointestinal maladies. Excerpt(s): The present invention generally relates to liquid nutritional products that contain fiber, and more particularly, to infant formulas with hydrolyzed protein which contain a fiber blend that is useful in the management of infantile colic. The invention also relates to medical nutritional products that contain hydrolyzed protein and/or amino acids, and high levels of total dietary fiber that are useful in the management of diarrhea and other maladies. Fiber is an important component in the treatment of humans with colic, diarrhea, short gut syndrome, impaired bowel function, Chron's disease, gastrointestinal intolerance and malabsorption. Colic is one of the most

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confusing subjects facing pediatrics today. In the absence of a standard definition of "colic," it is difficult to compare one study on "colicky infants" with another. Furthermore, given the absence of a standard definition, studies assessing the causes and/or management of colic undoubtedly involve a heterogeneous group of infants with both a variety of problems as well as no problems at all. Web site: http://www.delphion.com/details?pn=US06017550__ •

Psyllium-hydrocolloid gum composition Inventor(s): Sander; Eugene H. (Hayfield, MN) Assignee(s): Johnson & Johnson. Merck Consumer Pharmaceuticals, Co. (New Brunswick, NJ) Patent Number: 6,312,730 Date filed: October 26, 1994 Abstract: A rapidly dispersible powder having use as a laxative and fiber supplement, comprising psyllium particles coated with gum arabic. The present invention also includes a method for making the powder that includes providing an effective quantity of gum arabic to a fluidized bed having the psyllium particles to make the rapidly dispersible powder. The present invention further includes a method for making a constipation treatment and a treatment for fiber supplementation. Excerpt(s): The present invention relates to a powder that comprises psyllium particles coated with gum arabic. Psyllium seed husk has use as a fiber supplement and a bulk laxative drug because the psyllium seed husk has a capacity for substantial swelling when ingested. This swelling makes the psyllium husk a useful bulking agent. Ingestion of psyllium seed husk has been demonstrated to yield a number of benefits to the consumer, including Taxation, appetite suppression and cholesterol reduction. The psyllium seed includes a husk portion that is a cleaned, dried seed coat of the psyllium seed. The husk portion is separated from the seed by winnowing and thrashing. Typically, the husk portion of the psyllium seed is ground into a powder to make the bulk laxative drug. The psyllium bulk laxative drug powder is then ingested by a consumer after the consumer stirs the powder into a glass of water. Web site: http://www.delphion.com/details?pn=US06312730__

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Substituted pyridines useful as modulators of acethylcholine receptors Inventor(s): Cosford; Nicholas D. (La Jolla, CA), Vernier; Jean-Michel (San Diego, CA) Assignee(s): SIBIA Neurosciences, Inc. (La Jolla, CA) Patent Number: 5,852,041 Date filed: June 7, 1995 Abstract: In accordance with the present invention, there provided a class of pyridine compounds which are modulators of acetylcholine receptors. The compounds of the invention displace acetylcholine receptor ligands from their binding sites. Invention compounds may act as agonists, partial agonists, antagonists or allosteric modulators of acetylcholine receptors, and are useful for a variety of therapeutic applications, such as the treatment of Alzheimer's disease and other disorders involving memory loss and/or dementia (including AIDS dementia); disorders of attention and focus (such as attention

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deficit disorder); disorders of extrapyramidal motor function such as Parkinson's disease, Huntington's disease, Gilles de la Tourette syndrome and tardive dyskinesia; mood and emotional disorders such as depression, panic, anxiety and psychosis; substance abuse including withdrawal syndromes and substitution therapy; neuroendocrine disorders and dysregulation of food intake, including bulimia and anorexia; disorders of nociception and control of pain; autonomic disorders including dysfunction of gastrointestinal motility and function such as inflammatory bowel disease, irritable bowel syndrome, diarrhea, constipation, gastric acid secretion and ulcers; pheochromocytoma; cardiovascular dysfunction including hypertension and cardia arrhythmias, comedication in surgical procedures, and the like. Excerpt(s): The present invention relates to novel compounds which are capable of modulating acetylcholine receptors. Invention compounds are useful, for example, for treatment of dysfunction of the central or autonomic nervous systems including dementia, cognitive disorders, neurodegenerative disorders, extrapyramidal disorders, convulsive disorders, cardiovascular disorders, endocrine disorders, pain, gastrointestinal disorders, eating disorders, affective disorders, and drug abuse. In addition, the present invention relates to pharmaceutical compositions containing these compounds, as well as various uses therefor. By modulation of neurotransmitter release (including dopamine, norepinephrine, acetylcholine and serotonin) from different brain regions, acetylcholine receptors are involved in the modulation of neuroendocrine function, respiration, mood, motor control and function, focus and attention, concentration, memory and cognition, and the mechanisms of substance abuse. Ligands for acetylcholine receptors have been demonstrated to have effects on attention, cognition, appetite, substance abuse, memory, extrapyramidal function, cardiovascular function, pain and gastrointestinal motility and function. The distribution of acetylcholine receptors that bind nicotine, i.e., nicotinic acetylcholine receptors, is widespread in the brain, including the basal ganglia, limbic system, cerebral cortex and mid- and hind-brain nuclei. In the periphery, the distribution includes muscle, autonomic ganglia, the gastrointestinal tract and the cardiovascular system. Acetylcholine receptors have been shown to be decreased, inter alia, in the brains of patients suffering from Alzheimer's disease or Parkinson's disease, diseases associated with dementia, motor dysfunction and cognitive impairment. Such correlations between acetylcholine receptors and nervous system disorders suggest that compounds that modulate acetylcholine receptors will have beneficial therapeutic effects for many human nervous system disorders. Thus, there is a continuing need for compounds which can selectively modulate the activity of acetylcholine receptors. In response to such need, the present invention provides a new family of compounds which modulate acetylcholine receptors. Web site: http://www.delphion.com/details?pn=US05852041__ •

Therapeutic use and formulation Inventor(s): Huckle; Richard Michael (Cambridge, GB) Assignee(s): Darwin Discovery, Ltd. (GB) Patent Number: 6,297,286 Date filed: November 8, 2000 Abstract: Substantially single-enantiomer(-)-tramadol, and its metabolites and structural and/or functional analogues, are useful for the prevention and/or treatment of one or more symptoms selected from nausea, vomiting, dizziness, blurred vision, drowsiness,

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somnolence, hallucinations, respiratory depression, constipation and euphoria. In particular, substantially single enantiomer (-)-tramadol, and its o-desmethyl metabolite, have been found to be potent anti-emetics. Excerpt(s): This invention relates to new therapeutic uses of tramadol and its structural and/or functional analogues, and to new formulations thereof. Tramadol has the chemical name (+/-)-trans (RR,SS)-2-[(di-methylamino)methyl]-1-(3-methoxyphenyl) cyclohexanol, and which is generally, and erroneously, referred to in literature as the cis(RS,SR) diastereomer, is a centrally acting, binary analgesic that is neither opiatederived, nor is a non-steroidal, anti-inflammatory drug (NSAID). It is used to control moderate pain in chronic pain settings, such as osteoarthritis and postoperative cases, and acute pain, such as dental pain. Used in therapy as a racemic mixture, the (+)enantiomer binds to the.mu.-opioid receptor, and both enantiomers inhibit 5hydroxytryptamine (serotonin) and noradrenaline (norepinephrine) reuptake. Tramadol's major active metabolite, O-desmethyltramadol (M1), shows higher affinity for the.mu.-opioid receptor and has at least twice the analgesic potency of the parent drug. Web site: http://www.delphion.com/details?pn=US06297286__ •

Therapeutic uses of verapamil enantiomers Inventor(s): Greaves; Jane Lizbeth (Cambridge, GB), Harding; Deborah Phyllis (Cambridge, GB) Assignee(s): Darwin Discovery Limited (GB) Patent Number: 5,932,246 Date filed: August 6, 1997 Abstract: Substantially single enantiomer (R or S) verapamil, or a pharmaceuticallyacceptable salt thereof provides an improved treatment for patients having a condition susceptible to treatment with racemic verapamil and who are disposed to constipation. Excerpt(s): This invention relates to improved treatment of patients having conditions which are susceptible to treatment with racemic verapamil, but who are disposed to constipation as a side effect thereof. The opposite enantiomers of verapamil have different biological activities and different potencies. The pharmacological profile is determined by stereoselectivity of pharmacodynamics and pharmacokinetics. The (R)enantiomer may be of benefit for the reversal of multi-drug resistance in cancer chemotherapy (see Eliason, Int. J. Cancer (1990) 46: 113). Web site: http://www.delphion.com/details?pn=US05932246__

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Therapeutically active compositions Inventor(s): Gardiner; Fiona Kate (Beverley, GB) Assignee(s): Reckitt & Colman Products Limited (Windsor, GB) Patent Number: 6,201,014 Date filed: December 7, 1999 Abstract: A pharmaceutical composition for the treatment of irritable bowel syndrome, diarrhoea, constipation, abdominal pain and/or bloating or abdominal distension, the

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composition including a carrier vehicle and a vanilloid compound. The carrier vehicle enables the vanilloid compound to be released in the lower gastrointestinal tract. The vanilloid compound has the effect of desensitizing nerves in the lower gastrointestinal tract, thereby leading to symptomatic relief. Preferred vanilloid compounds are capsaicin and resiniferatoxin. Excerpt(s): The present invention relates to compositions for the treatment of irritable bowel syndrome (IBS) and more particularly to locally acting compositions which are active in the post-stomach region of the gastro-intestinal (GI) tract. Irritable Bowel Syndrome (IBS) is part of a spectrum of diseases known generally as Functional Gastrointestinal Disorders which include diseases such as non-cardiac chest pain, nonulcer dyspepsia, and chronic constipation or diarrhoea. These diseases are all characterised by chronic or recurrent gastrointestinal symptoms for which no structural or biochemical cause can be found. Irritable bowel syndrome in the UK alone is responsible for 30-50% of all gastroenterology referrals to secondary care. 2. two or more of the following on at least a quarter of occasions: altered stool frequency, altered stool form, altered stool passage, passage of mucus, and/or bloating or feeling of abdominal distension. Web site: http://www.delphion.com/details?pn=US06201014__ •

Therapy for constipation Inventor(s): Borody; Thomas Julius (144 Great North Road, Five Dock NSW 2046, AU) Assignee(s): none reported Patent Number: 6,426,338 Date filed: December 17, 1999 Abstract: Compositions comprising colchicine and at least one amino-salicylic acid derivative, preferably olsalazine is used for treatment of prophylaxis of constipation. Excerpt(s): This application is a 371 of PCT/AU98/00332 filed May 7, 1998. This invention relates to methods and compositions for the treatment of bowel disorders characterised by constipation. Such disorders include segments of Irritable Bowel Syndrome (IBS) characterised by constipation, chronic pseudo-obstruction, chronic abdominal bloating syndrome and functional constipation. Symptoms include abdominal pain, constipation, bloating, acid reflux, flatulence, nausea and vomiting, chronic lethargy and sleep disorders. Constipation is a very common condition in the west, affecting about 20% of the population. Yet, to date no effective therapy is available. Chronic constipation is a condition largely confined to women and is of unknown etiology. Diet, psychology, motility disturbances and enteric nervous dysplasia have been identified as possible causes or factors. However, for the majority of patients the cause of constipation remains obscure. The pathogenesis of irritable bowel syndrome has also hitherto been unknown. Conventional treatments have been unsatisfactory as instanced by the very large number of therapies available and recommended from time to time. These have included psychotherapy, dietary regimens, and laxatives. To date, there is no evidence that any such therapies influence the underlying mechanism of the disorder and certainly cure is not possible. Web site: http://www.delphion.com/details?pn=US06426338__

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Use of a chemical agent for reducing the changes in waistline and the effect of constipation due to the taking of other agents Inventor(s): Salkin; Andre (134 Avenue du 14 Juillet, 76300 Sotteville les Rouen, FR) Assignee(s): none reported Patent Number: 5,948,824 Date filed: November 7, 1997 Abstract: The invention relates to the use of a chemical agent of organic origin for reducing or eliminating changes in waistline or for reducing or eliminating constipation due to the taking of other agents. A preferred agent is a polyvinylpyrrolidone or povidone. By virtue of the invention, changes in waistline are reduced or eliminated during the day, as well as constipation which can be generated by the taking of other agents such as clays. Excerpt(s): Use of a chemical agent reducing the changes in waistline and the effect of constipation due to the taking of other agents. The invention relates to the use of at least one organic chemical compound for reducing or making changes in waistline disappear during the day. The invention also relates to a induction of the constipating effect of certain chemical compounds. Web site: http://www.delphion.com/details?pn=US05948824__

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Use of tropical root crops in effective intervention strategies for treating difficult and complex cases and chronic diseases Inventor(s): Slimak; Karen M. (P.O. Box 2444, Springfield, VA 22152) Assignee(s): none reported Patent Number: 6,632,461 Date filed: July 12, 2001 Abstract: This invention relates to an effective intervention plan. In one aspect, the invention relates to the treatment of various symptoms, conditions or diseases, such as diarrhea, constipation, congestion, eczema, asthma, fatigue, muscle weakness, tension and spasms, irritable bowel syndrome, swelling, anxiety, multiple chemical sensitivities, moderate to excessive and moderate to severe symptoms due to food allergies, sensitivities and intolerances, bloating, pain, headaches, leaky gut, hypersensitivity, sleep difficulties, severe under weight, eating disorders, obsessive, compulsive disorders, panic attacks, sensory sensitivities, Alzheimer's disease, acid refulx, irritability, delayed motor skills, delayed social skills, autism, PDD, infantile spasms and seizures by withholding for a period of at least 5 days all foods except for root crops. Excerpt(s): This invention relates to an effective dietary intervention plan. In one aspect all food is withheld for a period of at least 5 days, except for tropical root crops. In another aspect the invention relates to the treatment of various symptoms, conditions or diseases such as diarrhea, constipation, congestion, eczema, asthma, fatigue, muscle weakness, tension, and spasms, irritable bowel syndrome, swelling, anxiety, multiple chemical sensitivities, moderate to extensive and moderate to severe symptoms due to food allergies, sensitivities, and intolerances, bloating, pain, headaches, leaky gut, hyperactivity, sleeping difficulties, severe underweight, eating disorders, obsessive, compulsive disorders, panic attacks, sensory sensitivities, Alzheimer's disease, acid reflux, irritability, delayed motor skills, delayed social skills, autism, PDD, infantile

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spasms, seizures by withholding from the patient for a period of at least 5 days all food except for concentrated forms of concentrated tropical root crops. Preferably the patient is also removed from external environmental sources of allergens. After the initial withholding period new foods may be introduced according to a particular selection and schedule. In another aspect of the invention the subject undergoes an effective dietary intervention plan in which at least five (5) tropical root crops are selected, each eaten on a successive day, along with selected other meat, vegetables, and oils that the subject has never eaten before, eating a different selection of meat, vegetables, and oils each from different food families each day, with no food or food family being repeated for at least 5 days. In another aspect the invention relates to the treatment of various symptoms, conditions or diseases such as Diarrhea, constipation, congestion, eczema, asthma, fatigue, muscle weakness, tension, and spasms, irritable bowel syndrome, swelling, anxiety, multiple chemical sensitivities, moderate to extensive and moderate to severe symptoms due to food allergies, sensitivities, and intolerances, bloating, pain, headaches, leaky gut, hyperactivity, sleeping difficulties, severe underweight, eating disorders, obsessive, compulsive disorders, panic attacks, sensory sensitivities, Alzheimer's disease, acid reflux, irritability, delayed motor skills, delayed social skills, autism, PDD, infantile spasms, seizures by withholding from the patient for a period of at least 5 days all food except for concentrated forms of concentrated tropical root crops. Preferably the patient is also removed from external environmental sources of allergens. After the initial withholding period new foods may be introduced according to a particular selection and schedule. In another aspect of the invention the subject undergoes an effective dietary intervention plan in which at least seven (7) tropical root crops are selected, each eaten on a successive day, along with selected other meat, vegetables, and oils that the subject has never eaten before, eating a different selection of meat, vegetables, and oils each from different food families each day, with no food or food family being repeated for at least 7 days. In another aspect the invention relates to the treatment of various symptoms, conditions or diseases such as Diarrhea, constipation, congestion, eczema, asthma, fatigue, muscle weakness, tension, and spasms, irritable bowel syndrome, swelling, anxiety, multiple chemical sensitivities, moderate to extensive and moderate to severe symptoms due to food allergies, sensitivities, and intolerances, bloating, pain, headaches, leaky gut, hyperactivity, sleeping difficulties, severe underweight, eating disorders, obsessive, compulsive disorders, panic attacks, sensory sensitivities, Alzheimer's disease, acid reflux, irritability, delayed motor skills, delayed social skills, autism, PDD, infantile spasms, seizures by withholding from the patient for a period of at least 5 days all food except for concentrated forms of concentrated tropical root crops. Preferably the patient is also removed from external environmental sources of allergens. After the initial withholding period new foods may be introduced according to a particular selection and schedule. Web site: http://www.delphion.com/details?pn=US06632461__

Patent Applications on Constipation As of December 2000, U.S. patent applications are open to public viewing.7 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to constipation: 7

This has been a common practice outside the United States prior to December 2000.

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3-azabicyclo[3.1.0]hexane derivatives useful in therapy Inventor(s): Banks, Bernard Joseph; (Kent, GB), Critcher, Douglas James; (Kent, GB), Fenwick, Ashley Edward; (Kent, GB), Gethin, David Morris; (Kent, GB), Gibson, Stephen Paul; (Kent, GB) Correspondence: Paul H. Ginsburg; Pfizer Inc; 20th Floor; 235 East 42nd Street; New York; NY; 10017-5755; US Patent Application Number: 20020025948 Date filed: June 18, 2001 Abstract: Compounds of formula I, 1where the substituents are as defined herein, and the pharmaceutically or veterinarily acceptable derivatives or prodrugs thereof, are pharmaceutically and veterinarily useful, in particular they bind to opiate receptors (e.g. mu, kappa and delta opioid receptors). They are likely to be useful in the treatment of diseases or conditions modulated by opiate receptors, for example irritable bowel syndrome; constipation; nausea; vomiting; pruritic dermatoses, such as allergic dermatitis and atopy; eating disorders; opiate overdoses; depression; smoking and alcohol addiction; sexual dysfunction; shock; stroke; spinal damage; and head trauma. Excerpt(s): This invention relates to pharmaceutically useful compounds, in particular compounds that bind to opiate receptors (e.g. mu, kappa and delta opioid receptors). Compounds that bind to such receptors are likely to be useful in the treatment of diseases modulated by opiate receptors, for example irritable bowel syndrome; constipation; nausea; vomiting; and pruritic dermatoses, such as allergic dermatitis and atopy in animals and humans. Compounds that bind to opiate receptors have also been indicated in the treatment of eating disorders, opiate overdoses, depression, smoking and alcohol addiction, sexual dysfunction, shock, stroke, spinal damage and head trauma. There is a particular need for an improved treatment of itching. Itching, or pruritus, is a common dermatological symptom that can give rise to considerable distress in both humans and animals. Pruritus is often associated with inflammatory skin diseases which may be caused by hypersensitivity reactions, including reactions to insect bites, such as flea bites, and to environmental allergens, such as house dust mite or pollen; by bacterial and fungal infections of the skin; or by ectoparasite infections. Existing treatments that have been employed in the treatment of pruritus include the use of corticosteroids and antihistamines. However, both of these treatments are known to have undesirable side effects. Other therapies that have been employed include the use of essential fatty acid dietary supplements, though these have the disadvantages of being slow to act, and of offering only limited efficacy against allergic dermatitis. A variety of emollients such as soft paraffin, glycerine and lanolin are also employed, but with limited success. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Active compounds of Bao-Ji-Wan for anti-diarrhea and relieving gastrointestinal symptoms Inventor(s): But, Paul Pui-Hay; (Tai Po, HK), Chan, Hsiao Chang; (Shatin, HK), Chung, Yiu Wa; (Ma On Shan, HK), Song, Jing Mei; (Richmond, VA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030152657 Date filed: December 6, 2002 Abstract: The invention provides methods for treating medical conditions caused by abnormal chloride ion flux with compositions containing active ingredients isolated from the traditional Chinese medicine Bao-Ji-Wan (BJW). The compositions comprise any one, two, or three of the following: magnolol, honokiol, imperatorin, isoimperatorin or only magnolol, honokiol, imperatorin, isoimperatorin and a physiologically acceptable carrier. In preferred embodiments, the medical conditions include disorders of the gastrointestinal tract, such as diarrhea and constipation. Excerpt(s): The present application claims priority to U.S. Ser. No. 60/339,752, filed Dec. 17, 2001, herein incorporated by reference in its entirety. Not applicable. This invention relates to methods of using pharmaceutical compositions containing active ingredients of the traditional Chinese medicine Bao-Ji-Wan (BJW) for treatment of conditions with abnormal chloride ion flux. In particular, the present invention is directed towards gastrointestinal conditions like diarrhea and constipation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Anti-constipation composition Inventor(s): Ueno, Ryuji; (Potomac, MD) Correspondence: Sughrue, Mion, Zinn, Macpeak & Seas, Pllc; 2100 Pennsylvania Avenue, N.W.; Washington; DC; 20037-3213; US Patent Application Number: 20030040528 Date filed: May 6, 2002 Abstract: An object of the present invention is to provide an anti-constipation composition containing a halogenated-bi-cyclic compound as an active ingredient in a ratio of bi-cyclic/mono-cyclic structure of at least 1:1. The halogenated-bi-cyclic compound is represented by Formula (I): 1where X.sub.1 and X.sub.2 are preferably both fluorine atoms. The composition can be used to treat constipation without substantive side-effects, such as stomachache. Excerpt(s): The present invention relates to a novel therapeutic composition that contains halogenated bi-cyclic structures for treatment of constipation and use thereof. and the like. Further, they are classified into PG.sub.1s containing a 13,14-double bond; PG.sub.2s containing, 5,6- and 13,14-double bonds; and PG.sub.3s containing 5,6-, 13, 14and 17,18-double bonds. That is, in the basic skeleton, the constituent carbon atoms are numbered in such a way that the carbon atom in the carboxyl group is C-1, and the.alpha.-chain contains C-2-C-7, the number increasing toward the ring, the fivemembered ring contains C-8-C-12, and the o-chain contains C-13-C-20. When the carbons of.alpha.-chain are fewer, the numbers of the carbon atoms ensuing C-2 should be properly shifted, and when more than 7, the compound is named provided that

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carbon at the C-2 position has substituent instead of carboxyl group (at the C-1 position). When the.omega.-chain contains fewer carbon atoms they should be numbered correspondingly smaller than 20, and when more than 8, the carbon atoms at the 21 position and thereafter should be regarded as a substituent. As configuration, it is considered according to that of the above essential skeleton unless otherwise described. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Anti-constipation method and device Inventor(s): Reydel, Boris; (Passaic, NJ), Siyagine, Anatoly; (New York, NY) Correspondence: Breiner & Breiner, L.L.C.; P.O. Box 19290; Alexandria; VA; 22320-0290; US Patent Application Number: 20030019020 Date filed: July 27, 2001 Abstract: A device and method for treatment of constipation wherein a horizontal bar is positioned a sufficient distance above a toilet that a person using the toilet can passively "semi-hang". The act of passively "semi-hanging" partially removes weight from the perianal area and straightens the torso thereby unfolding the sigmoid colon, increasing the sigmoid-rectal angle and the anorectal angle to facilitate defecation. Excerpt(s): This invention relates to a method and device for treatment of constipation. More specifically, the invention provides for treatment of constipation caused by outlet obstruction by partially removing weight from the perianal area, unfolding the sigmoidrectal angle, maintaining an open anorectal angle, increasing intra-abdominal pressure and relaxing the muscle of the pelvic floor and anal sphincters. The invention is accomplished by straightening a person's torso while the person passively "semi-hangs" from a bar stationed above a toilet. Multiple internal structure-including the pelvic floor muscles, the extrinsic and intrinsic anal sphincters, the puborectalis and levator ani muscles, must act in a very coordinated fashion in order to sufficiently increase intraabdominal pressure to expel fecal material. Also playing an important role in defecation are the anorectal angle in the anterior-posterior plane of the body and the acute angulation of the sigmoid part of the colon in the transverse plane of the body. When the aforementioned structures are not optimally positioned within the body for defecating, the amount of straining and exertion required for complete expulsion of fecal matter is increased. The amount of exertion and straining needed to expel fecal matter is compounded when the person also suffers from constipation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Colonic motor dysfunction remedies comprising aminothiazole derivatives as active ingredients Inventor(s): Hori, Yuko; (Osato-gun, JP), Matsunaga, Yugo; (Osato-gun, JP), Murata, Masakazu; (Osata-gun, JP), Nagasawa, Masaaki; (Osato-gun, JP), Nishioka, Hiroyasu; (Osato-gun, JP), Ueki, Shigeru; (Osato-gun, JP) Correspondence: Oblon Spivak Mcclelland Maier & Neustadt PC; Fourth Floor; 1755 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20020051805 Date filed: May 14, 2001 Abstract: Remedies effective for the improvement of colonic motor dysfunction such as irritable bowel syndrome, constipation or intestinal atony without causing side effects on the central nerve system. These colonic motor dysfunction remedies comprise, as active ingredients, aminothiazole derivatives represented by the following formula (I) or a salt or hydrate thereof: 1wherein R.sup.1, R.sup.2 and R.sup.3 may be the same or different and each independently represent a hydrogen atom or a hydroxyl, lower alkyl, lower alkoxy, amino, nitro or cyano group, R.sup.4 and R.sup.5 may be the same or different and each independently represent a hydrogen atom or a lower alkyl group, and n stands for an integer of from 2 to 4. Excerpt(s): This invention relates to remedies for colonic motor dysfunction, and more specifically to colonic motor dysfunction remedies comprising aminothiazole derivatives as active ingredients. This invention is also concerned with a treatment method for colonic motor dysfunction. From the anatomical viewpoint, the digestive tract is divided roughly into an upper digestive tract and a lower digestive tract. The upper digestive tract includes the esoplagus, the stomach and the duodenum, while the lower digestive tract includes the small intestine, the large intestine and the rectal. To diseases and symptoms which occur in the respective regions, treatments are applied correspondingly. Illustrative of diseases of the upper digestive tract are diseases in the esophageal region, such as esophageal carcinoma, esophagostenosis and reflux esophagitis; diseases in the gastric region, such as gastric ulcer, gastritis and gastric cancer; diseases in the duodenal region, such as duodenal ulcer and duodenal cancer; and as diseases occurring commonly in the gastric region and duodenal region, NUD (Non-Ulcer Dyspepsia) and gastroduodenal motor dysfunction. Examples of symptoms of such diseases of the upper digestive tract with which gastroduodenal motor dysfunction is associated include epigastric malaise, nausea, vomitting, brash, anorexia, bellyache, and dilatation of the stomach. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Dosage unit comprising a prostaglandin analog for treating constipation Inventor(s): Patchen, Myra L.; (Fairfax, VA), Ueno, Ryuji; (Montgomery, MD) Correspondence: Sughrue Mion, Pllc; 2100 Pennsylvania Avenue, N.W.; Washington; DC; 20037; US Patent Application Number: 20030119898 Date filed: November 14, 2002 Abstract: A dosage unit for treating constipation in a human patient is described. The dosage unit of the invention comprises a halogenated prostaglandin analog and a

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pharmaceutically suitable excipient. The dosage unit relieves constipation without substantial side effects. Excerpt(s): The present invention relates to a novel dosage unit of a halogenated prostaglandin analog for the treatment and prevention of constipation in human patients. Constipation is generally defined as infrequent and difficult passage of stool. Medical reporting estimates that one of every 50 people in the United States suffers from constipation, making it one of the most common disorders among Americans. Constipation is more likely to affect females than males and more likely to occur in older adults, showing an exponential increase after the age of 65. The actual occurrence of constipation is likely higher than reported, as many individuals suffer at home without seeking professional care. Although in some instances constipation may be caused by obstruction, most constipation can be associated with factors such as a diet low in soluble and insoluble fibers, inadequate exercise, medication use (in particular, opiate analgesics, anticholinergic antidepressants, antihistamines, and vinca alkaloids), bowel disorders, neuromuscular disorders, metabolic disorders, poor abdominal pressure or muscular atony. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Effervescent laxatives Inventor(s): Daggy, Bruce P.; (Slough, GB), Mandel, Kenneth G.; (Parisppany, NJ) Correspondence: Glaxosmithkline; Corporate Intellectual Property - Uw2220; P.O. Box 1539; King OF Prussia; PA; 19406-0939; US Patent Application Number: 20020085990 Date filed: February 7, 2002 Abstract: The present invention is directed to a novel osmotic/effervescent system for the treatment of constipation and fecal impaction in a human or mammal in need thereof. Excerpt(s): The present invention is directed to a novel over-the-counter (OTC) laxative as an improved, replacement therapy to current stimulant laxatives. Within the next 2 to 3 years, the Food and Drug Administration (FDA) appears likely to discontinue OTC approval of several current stimulant laxatives. Over the last decade, positive carcinogenicity and/or genotoxicity results have resulted in FDA banning danthron (mid-1980's) and in 1997, the FDA delisted phenolphthalein as an OTC laxative due to safety issues. Specifically, in June 1998, the FDA has continued to pressure the OTC stimulant laxative category, reclassifying remaining approved stimulants: senna, cascara, aloe, bisacodyl, from Category I (safe and effective) to Category III (more data needed), and requiring manufacturers to provide updated carcinogenicity and genotoxicity evaluations for these laxative actives. Failure to meet this mandate, and/or prove safety will result in further delisting of laxative actives from the tentative final monographs (TFM), (Fed. Reg. 63: 33592-33595, Jun. 19, 1998). Indeed, in a recent review of scientific literature, van Gorkom et al., concluded that anthranoid laxatives, which include the active moieties in senna extracts, and the chemical laxatives phenolphthalein bisacodyl, can have a potential role in both promotion and initiation of tumorgenesis, and may be associated with increased risk for colorectal cancer (van Gorkom, B. A. P.; de Vries, E. G. E.; Karrenbeld, A.; Kleibeuker, J. H. Anthranoid laxatives and their potential carcinogenic effects. Alimentary Pharmacology & Therapeutics, Vol. 13: pp. 443-452, 1999. Hence the potential for further delistings are strong. Hence, there is a

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strong potential for dramatic change to this segment of the OTC laxative market over the next several years. If the events which followed the FDA action to ban phenolphthalein recur, any FDA action will be followed by similar delisting in other countries. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Encapsulated prune powder to relieve constipation Inventor(s): Ayres, Roger Ravi; (Springfield, NJ) Correspondence: DR. Roger Ravi Ayres; 353 Hillside Avenue; Springfield; NJ; 07081; US Patent Application Number: 20030012862 Date filed: June 24, 2002 Abstract: An ingestible capsule consisting of dried prune powder for relieving constipation. The prune powder is prepared basically by pulverizing prunes until a low moisture prune powder results. The powder is then encapsulated and bottled. The user may take anywhere from 3 to 9 capsules daily where each capsule consists of approximately 750 milligrams of prune powder. Excerpt(s): Over recent years it has become apparent that people who eat low-fiber diets are more prone to constipation. Other important causes include lack of exercise, stress and anxiety, pregnancy, ignoring the urge to defecate, pain from hemorrhoids, or simply a side effect from medication. Constipation is defined as infrequent (fewer than three a week) bowel movements. Many will report hard, dry stools that are difficult and painful to pass and some the sensation of a full rectum even after they have had a bowel movement. All of this can cause a tight, bloated feeling which can make many feel quite uncomfortable. Many of the available treatments on the market today are helpful but are not fast and safe. Fiber supplements (bulk-forming laxatives such as psyllium) are safe but may take weeks before taking effect. Continuous use of emollient laxatives (mineral oil, docusate salts), hyperosmolar agents (lactulose, sorbitol), saline laxatives, stimulant laxatives (castor oil, senna, phenolphthalein, bisacodyl) can lead to damage to the colon itself in addition to psychological dependence. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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FOOD BARS CONTAINING NUTRITIONAL SUPPLEMENTS AND ANTICONSTIPATION AND REGULARITY -MAINTAINING AGENTS Inventor(s): Manning, Paul B.; (Keswick, VA), McGrath, James W. JR.; (Keswick, VA), Schramm, Jack H.; (Gordonsville, VA) Correspondence: Lord, Bissell & Brook; 115 South Lasalle Street; Chicago; IL; 60603; US Patent Application Number: 20020102330 Date filed: December 5, 2000 Abstract: The present invention provides food bars for consumption by pregnant women, lactating women or women of childbearing potential that are attempting to become pregnant containing one or more vitamins and/or minerals, and one or more anti-constipation and regularity-maintaining agents, methods for preparing these food bars, and methods for supplementing the dietary requirements of pregnant women, lactating women or women of childbearing potential that are attempting to become

Patents 171

pregnant. The food bars of the invention generally comprise one or more vitamins and minerals recommended for consumption by pregnant women, lactating women or women of childbearing potential that are attempting to become pregnant in an amount that is effective for enhancing the nutrition of pregnant women, lactating women or women of childbearing potential that are attempting to become pregnant, and that is not harmful to developing fetuses or breast-feeding babies, one or more anti-constipation and regularity maintaining agents in an amount that is effective for reducing or eliminating constipation, and that is not harmful to developing fetuses or breast-feeding babies, from about 0 to about 99 weight percent of carbohydrates, from about 0 to about 80 weight percent of proteins, and from about 0 to about 60 weight percent of fats. Excerpt(s): The present invention relates to food bars for consumption by pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant containing one or more vitamins and/or minerals, and one or more anti-constipation and regularity-maintaining agents, to methods for preparing these food bars, and to methods for enhancing the nutrition of pregnant women and their developing fetuses, of lactating women and their babies, and of women having childbearing potential that are attempting to become pregnant. In particular, the present invention relates to food bars comprising one or more vitamins and/or minerals recommended for consumption by pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant in an amount that is effective for enhancing the nutrition of pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant, or of their developing fetuses or babies, and one or more anti-constipation and regularitymaintaining agents in an amount that is effective for reducing or eliminating constipation, and/or for maintaining regularity of bowel movements, in pregnant women, lactating women, or women having childbearing potential that are attempting to become pregnant. The daily Recommended Dietary Allowances of water-soluble vitamins for non-pregnant and pregnant women, and the rationale for increased allowances during pregnancy, is set forth in Nutrition During Pregnancy (Nat'l Academy Press, 1990), and below. 1 Non- pregnant Pregnant Rationale for Increased Vitamin Women Women Allowance for Pregnancy Vitamin C 60 mg 70 mg To provide for fetal needs. At term, fetal plasma levels are 50% higher than maternal levels. Thiamin 1.1 mg 1.5 mg To accommodate maternal and fetal growth and increased energy allowance during pregnancy. Riboflavin 1.3 mg 1.6 mg To provide for increased maternal and fetal synthesis. Niacin (NE).sup.1 15 mg 17 mg Based upon energy increase of 300 kcal/day for pregnancy. Vitamin B.sub.6 1.6 mg 2.2 mg Based partially on the additional protein allowance of 10 g/day for pregnancy. Folate 190.mu.g 400.mu.g Based on 50% food folate absorption. To build or maintain maternal folate stores and to provide for increased folate turnover in rapidly growing tissue. Vitamin B.sub.12 2.0.mu.g 2.2.mu.g Fetal needs (0.1-0.2.mu.g/day) based on analysis of stillborn fetuses. Metabolic needs of pregnancy estimated at 0.2.mu.g/day.sup.11 NE (niacin equivalent) = 1 mg of niacin or 60 mg of tryptophan. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Herbal laxative preparation Inventor(s): Babu, Uddagiri Venkanna; (Karnataka, IN), Mitra, Shankar Kumar; (Karnataka, IN), Ranganna, Marikunte Venkata; (Karnataka, IN) Correspondence: Stephan A. Pendorf; Pendorf & Cutliff; P.O. Box 20445; Tampa; FL; 33622-0445; US Patent Application Number: 20020150639 Date filed: February 12, 2001 Abstract: A laxative/medicinal preparation obtained of a selective bioactive extract from the rhizomes and roots of PICRORRHIZA KURROA and its method for manufacture and also to a method for treatment of human beings for relieving constipation using the same. In particular the laxative preparation comprises bioactive chloroform or methanolic extract of rhizomes or roots of Picrorrhiza Kurroa and optionally pharmaceutically acceptable carrier thereof. Preferably, the laxative preparation comprises 50 to 500 mg preferably 50 to 250 mg of bioactive chloroform extract of rhizomes or roots of Picrorrhiza Kurroa or 50 to 500 mg of bioactive methanolic extract of rhizomes or roots of Picrorrhiza Kurroa in a pharmaceutically acceptable form with or without a pharmaceutically acceptable carrier thereof. The process involves selective extraction of the active from rhizomes or roots of Picrorrhiza Kurroa using either methanol or chloroform as the selective solvents. The laxative preparation is gentle, safe and effective, free of undesirable side effects and capable of relieving severe constipation. Importantly serves as a herbal laxative for humans on a commercial scale. The laxative can be administered in various dosage forms as may be applicable. Excerpt(s): The present invention relates in general to a laxative preparation obtained of a selective bioactive exact from the rhizomes and roots of PICRORRHIZA KURROA and its method for manufacture and also to a method for treatment of human beings for relieving constipation using the same comprising administering the laxative preparation in selective suitable pharmaceutical dosage forms to human beings and other non-human mammals. One of the most commonest digestive problems encountered amongst human beings, particularly amongst children and aged people, is constipation, which usually occurs due to abnormal motility pattern in the colon and thus, delayed propulsion of the intestinal contents. It also occurs due to weak peristaltic movements or defecation reflex leading to hindrance in propagation. Laxatives known to be used for treatment of constipation include synthetic chemical compounds such as phenolphalein, bisacodyl (diphenyl methane laxatives), milk of magnesia and the like. These laxatives, although effective, have been found to exhibit undesirable side effects, the commonest of which are abdominal pain, cramps, nausea, skin rash, intestinal and rectal bleeding. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Infant formula with improved protein content Inventor(s): Bindels, Jacob Geert; (Zoetermeer, NL), Dumon, Liliane Marie-Rose Louisa Dominique; (Dilbeek, BE), Hageman, Robert Johan Joseph; (Wageningen, NL), Huybers, Peti; (Cuyk, NL), Van Baalen, Antonie; (Arnhem, NL) Correspondence: Young & Thompson; 745 South 23rd Street 2nd Floor; Arlington; VA; 22202 Patent Application Number: 20030072865 Date filed: October 11, 2002 Abstract: An improved infant formula resulting in reduced constipation, abdominal discomfort and gastrointestinal problems, comprises at least one protein component having a phosphorus content of less than 0.75 g P/100 g protein, and at least one lipid component that can be easily digested by an infant Preferably, it further comprises at least one prebiotic component, and at least one viscosity-improving component. The protein fraction of the formula is preferably a hydrolysate prepared by hydrolysing a protein starting material, especially a whey protein with a combination of at least one endo- and at least one exoproteinase. Excerpt(s): The present invention relates to an improved infant formula containing at least an easily digestible lipid component and an improved protein component. In infants, in particularly in infants of less than 6 months old, the digestive system has to develop and adapt to food. Because of this, for the first months of their lives, infants are usually fed specialised infant formulas. Usually, such infant formulas are well tolerated. However, in a limited number of cases, conventional formulas may lead to minor problems, in a particular with respect to the processes that occur in the gastrointestinal tract. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Ingestible laxative beverage Inventor(s): Yu, Chun; (Los Angeles, CA) Correspondence: James E. Brunton; Suite 860; P.O. Box 29000; 700 North Brand BLVD.; Glendale; CA; 91029; US Patent Application Number: 20020187235 Date filed: April 30, 2001 Abstract: A non-habit forming and ecologically beneficial laxative in beverage form that exhibits a novel synergistic effect in relieving and preventing both temporary and chronic constipation without pains or hurting the mucous lines in the colon. The primary constituents of the ingestible laxative beverage comprise a water-soluble, low viscosity fiber selected from a group consisting of fractocligosaccharides, maltodextrin and polydextrose and any qualified one and an herbal laxative selected from a group consisting of cascara sagrada and rhubarb extracts. The secondary active constituents of the ingestible beverage laxative are selected from a group consisting of chamomile, aloe vera and licorice extracts. Excerpt(s): The present invention relates generally to ingestible laxative beverages. More particularly, the invention concerns beverages such as coffee and cocoa that have been fortified with water-soluble fiber and an herbal laxative such as cascara sagrada. Constipation, which is defined as the infrequent and difficult passage of stool, is

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suffered from time to time by both the young and old. To relieve constipation a number of different types of ingestible laxative compositions have been suggested in the past. These compositions include chemical laxative compositions and so called "natural" laxative compositions. Exemplary of the so called "natural" laxative compositions is a composition disclosed in U.S. Pat. No. 5,516,524 issued to Kais et al. This composition comprises specified amounts of dioctyl sulfosuccinate and bulk fiber. Exemplary of the prior art chemical laxative compositions is a composition sold by Sterling Winthrop, Inc. of New York, N.Y. under the name and style "Phillips". The active constituents in this product comprise phenolphthalein and docusate sodium. By way of background, the frequency of bowel movements among healthy people varies greatly, ranging from three movements a day to three a week. As a rule, if more than three days pass without a bowel movement, the intestinal contents may harden, and a person may have difficulty or even pain during elimination. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Intestine dysfunction treatment apparatus Inventor(s): Forsell, Peter; (Menzingen, CH) Correspondence: Nixon & Vanderhye P.C.; 1100 North Glebe Road, 8th Floor; Arlington; VA; 22201; US Patent Application Number: 20030009221 Date filed: June 29, 2001 Abstract: An intestine dysfunction treatment apparatus comprises an electric stimulation device (56) implanted in a patient, who suffers from intestine dysfunction. The stimulation device comprises electric conductors adapted to directly engage with a muscle that directly or indirectly affects the transportation of the content of the patient's intestines, for example the anal sphincter (58) or a portion of the muscle that contracts the bowels, to electrically stimulate the muscle to increase the tonus thereof. A control device (62) is provided for controlling a source of energy (64), which may or may not be implanted, to release electric energy for use in connection with the power of the stimulation device. The apparatus can be used for treating patients suffering from anal incontinence or constipation. Excerpt(s): Intestine dysfunction may involve disability of controlling the muscle that contracts the bowels, colon or rectum to provide transportation of the content thereof. Such a disability usually causes constipation. In particular paralysed patients may suffer from constipation. Furthermore, intestine dysfunction may involve anal incontinence, i.e disability to close the anal sphincter. Anal incontinence is a widespread disease. Several kinds of sphincter plastic surgery are used today to remedy anal incontinence. There is a prior manually operated sphincter system in an initial clinical trial phase where a hydraulic sphincter system connected to an elastic reservoir (balloon) placed in the scrotum is developed. A disadvantage of this system is that thick, hard fibrosis is created around the reservoir by pump movements making the system useless sooner or later. Another disadvantage is that the use of hydraulic fluid always entails a risk of fluid leaking from the implanted hydraulic system. Furthermore, it is a rather complicated task to manually pump the reservoir when defecation is needed. U.S. Pat. No. 5,593,443 discloses hydraulic anal sphincter under both reflex and voluntary control. An inflatable artificial sphincter with the pump system in scrotum is disclosed in U.S. Pat. No. 4,222,377.

Patents 175

Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Irradiation of ispaghula Inventor(s): Al-Assaf, Saphwan; (Wrexham, GB), Dettmar, Peter William; (Patrington, GB), Havler, Michael Edward; (Long Riston, GB), Phillips, Glyn Owen; (Cardiff, GB) Correspondence: Fish & Richardson; Suite 2800; 45 Rockefeller Plaza; New York; NY; 10111; US Patent Application Number: 20030156972 Date filed: March 25, 2003 Abstract: Ispaghula (material from the plant Plantago ovata, useful as an agent in relieving constipation, is subjected to treatment with -radiation at a dose of up to 13 kGy, and preferably in the range 5-10 kGy. As well as effecting sterilisation of the ispaghula, this dose of irradiation has been shown to offer surprising rheological advantages. Excerpt(s): The present invention relates to a method for the production of medicinal compositions, in particular to a method for the production of ispaghula-containing compositions wherein the ispaghula is sanitised and optimised for inclusion in ingestible compositions. Ispaghula is obtained from the plant species Plantago ovata. Ispaghula is sometimes referred to as psyllium. Ingestible ispaghula-containing compositions for the relief of gastric and digestive dysfunctions are known. The efficacy of ispaghula for the relief of such dysfunctions, including constipation, is well recognised and commercial formulations are readily available. Examples of such compositions include particulate ispaghula intended to be stirred in measured amount into a volume of liquid, usually water or a soft drink. After stirring, the drinking composition is intended to be quickly imbibed due to the propensity of the ispaghula to absorb water readily and swell to form a viscous gel-like mass. It is the property of water absorption which is the desired characteristic of ispaghula in compositions for gastric and digestive dysfunctions. Once the ispaghula has absorbed water to produce the gel-like mass, the mass is relatively insoluble and fibrous, and is transported through the gut quickly with minimal digestion, helping to alleviate constipation and the like. Other forms, such as tablet forms for ingestion, are also available, such tablets being designed to be broken down in the gut, wherein the released ispaghula absorbs water from the gut to form the viscous mass. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method for providing a cathartic effect Inventor(s): Ueno, Ryuji; (Montgomery, MD) Correspondence: Sughrue Mion, Pllc; 2100 Pennsylvania Avenue, NW; Washington; DC; 20037-3213; US Patent Application Number: 20030022933 Date filed: May 20, 2002 Abstract: The present invention relates to a novel method for providing a cathartic effect to a patient in need of cathartic induction, which comprises administering to the patient a cathartic-inducing effective amount of halogenated bioactive lipid comprising the

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following partial structure (I): 1The method is useful for relieving or preventing constipation, and also for cleansing the gastrointestinal tract. Excerpt(s): The present invention relates to a novel method for providing a cathartic effect. The method is useful for relieving or preventing constipation, and also for cleansing the gastrointestinal tract. Constipation is classified into a functional constipation such as atonic constipation, spastic constipation and rectal constipation, an organic constipation caused by a bowel disease and a stenosis due to postoperative adhesion and the like, and a drug-induced constipation. Cathartics conventionally used for relieving these constipating conditions include, for example, 1) large bowelstimulant anthraquinone cathartics, 2) small bowel-stimulant castor oil, 3) bulking cathartics such as carboxymethyl cellulose, 4) salt cathartics such as magnesium sulfate and 5) saccharide cathartics such as sugar alcohol. However, these cathartics work by forcible activation due to stimulating the bowel, so that they bring diarrhea like feces and induce side effects such as stomachache when evacuating. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for treating drug-induced constipation Inventor(s): Ueno, Ryuji; (Montgomery, MD) Correspondence: Sughrue Mion, Pllc; 2100 Pennsylvania Avenue, N.W.; Washington; DC; 20037-3213; US Patent Application Number: 20030073746 Date filed: May 1, 2002 Abstract: Provided is a method for treating drug-induced constipation comprising a step of administering an effective amount of a 15-keto-prostaglaindin compound to a subject suffering from drug-induced constipation or a subject having a strong possibility of suffering from it. According to the present invention, a strong antagonistic action against drug-induced constipation can be obtained without substantially losing the main effect of the drug. Excerpt(s): The present invention relates to a novel use of a 15-keto-prostaglandin compound for treating drug-induced constipation. Constipation is classified into functional constipation such as an atonic constipation, spastic constipation, rectal constipation, organic constipation such as caused by bowel disease and by stenosis due to postoperative adhesion, drug-induced constipation and the like. Drug-induced constipation occurs as a side effect caused by using a drug. The drug may cause constipation not directly but indirectly. For example, constipation may be due to hard feces caused by fluid excretion outside the body with a diuretic. Further, it may be caused by an additive or synergistic effect of using plural drugs, each of which does not introduce constipation if administrated individually. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 177

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METHOD OF TREATMENT Inventor(s): Gibson, Karen; (Sheffield, GB) Correspondence: Arter & Hadden, Llp; 1100 Huntington Building; 925 Euclid Avenue; Cleveland; OH; 44115-1475; US Patent Application Number: 20030139396 Date filed: March 27, 2002 Abstract: There is described a method of treatment of a patient suffering from constipation characterised in that the method comprises the administration of a therapeutically effective amount of devazepide.There is also described a method of treatment of a patient requiring analgesia which comprises the separate, simultaneous or sequential administration of a therapeutically effective amount of an analgesic and a stool softening amount of devazepide.The use of devazepide in the manufacture of a medicament is also described. Excerpt(s): This invention relates to a novel method of treatment related thereto and a novel use related thereto. International Patent Application No. WO 99/18967 describes pharmaceutical compositions for treating chronic and neuropathic pain which comprises an analgesic amount of an opioid and an opioid potentiating amount of a CCK antagonist. WO '967 describes the use of both CCK-A antagonists and CCK-B antagonists, although it is described that, generally, CCK-B antagonists are preferred. Moreover, page 2, lines 6 to 8 of WO '967 describes that CCK-A antagonists may be suitable, but only at relatively higher dosages. One specific CCK-A antagonist which is mentioned in WO 99/18967 is devazepide (Devacade.RTM.), which is 3s-(-)-1,3-dihydro3-(2-indolecarbon- ylamino)-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Neutral antagonists and use thereof in treating drug abuse Inventor(s): Sadee, Wolfgang; (Ross, CA), Wang, Danxin; (San Francisco, CA) Correspondence: Caroly S. Elmore; Hamilton, Brook, Smith & Reynolds, P.C.; Two Militia Drive; Lexington; MA; 02421-4799; US Patent Application Number: 20010049375 Date filed: March 15, 2001 Abstract: The invention relates to the use of naltrexone and naloxone analogs, which are neutral antagonists at the.mu. opioid receptor, for the treatment of drug dependency in a drug-dependent individual. Surprisingly, it has been found that administration of a therapeutically effect amount of the naloxone or naltrexone analogs described herein for the treatment of a drug dependency, can result in reduction of undesirable side effects resulting from current treatments using naloxone and naltrexone. For example, the treatment described herein can result in a reduction in the withdrawal symptoms and aversion encountered in the use of naloxone and naltrexone in the treatment of drug dependency. In addition, the naltrexone and naloxone analogs of the invention can be used for the treatment of pain in an individual in need thereof by modulating opoid pain treatment using neutral antagonists, for example, reversing respiratory depression withough causing other adverse effects. In addition, during chronic use of opioid drugs for pain therapy, neutral antagonists can be used to diminish constipation peripherally without effecting the central analgesic effects.

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Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/189,372 filed on Mar. 15, 2000. The entire teachings of the above application are incorporated herein by reference. Endogenous opiate receptors were discovered in the 1970s, and have been intensely studied in seeking the mechanisms by which particular drugs lead to addiction. However, such mechanisms have remained elusive. See, for example, J. Neurosci., 12(7): 2349-2450 (1992). A number of different opioid receptor types have been identified. Known receptor types include, for example, the mu.mu. (MOR), delta.delta. (DOR), and.kappa. kappa receptors. Narcotic analgesics act at the opioid.mu. receptor to produce analgesia. The.mu. receptor mediates analgesia, respiratory depression, and inhibition of gastrointestinal transit. As such, narcotic analgesics act at the.mu. receptor to produce analgesia. However, continued use of narcotic analgesics typically leads to habit or addiction, and use of one leads to crosstolerance/dependence for the others. Despite their therapeutic uses, undesirable side effects such as physical dependence and drug craving can develop. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel methods and compositions involving opioids and antagonists thereof Inventor(s): Farrar, John J.; (Chester Springs, PA) Correspondence: David A. Cherry, Esquire; Woodcock Washburn Kurtz; Mackiewicz & Norris Llp; One Liberty Place-46th Floor; Philadelphia; PA; 19103; US Patent Application Number: 20010047005 Date filed: November 29, 2000 Abstract: Novel methods and compositions comprising opioids In preferred embodiments, the methods and compositions peripheral mu opioid antagonist compounds. The methods particularly suitable for treating and/or preventing side effects including, for example, constipation, vomiting and/or nausea.

and opioid antagonists. comprise opioids and and compositions are associated with opioids

Excerpt(s): The present invention relates to novel methods and compositions comprising opioids and opioid antagonists. More particularly, the present invention relates to novel methods and compositions comprising opioids and peripheral mu opioid antagonist compounds. It is well known that opioid drugs target three types of endogenous opioid receptors (i.e., mu, delta and kappa receptors) in biological systems. Most opioids, such as morphine, are mu opioid agonists that are often used as analgesics for the treatment of severe pain due to their activation of mu opioid receptors in the brain and central nervous system (CNS). Opioid receptors are, however, not limited to the CNS, and may be found in other tissues throughout the body. A number of side effects of opioid drugs may be caused by activation of these peripheral receptors. Administration of mu opioid agonists often results in intestinal dysfunction due to the large number of receptors in the wall of the gut (Wittert, G., Hope, P. and Pyle, D., Biochemical and Biophysical Research Communications 1996, 218, 877-881; Bagnol, D., Mansour, A., Akil, A. and Watson, S. J., Neuroscience 1997, 81, 579-591). Specifically, opioids are generally known to cause nausea and vomiting as well as inhibition of normal propulsive gastrointestinal function in animals and man (Reisine, T., and Pasternak, G., Goodman & Gilman's The Pharmacological Basis of Therapeutics Ninth Edition 1996, 521-555) resulting in side effects such as, for example, constipation. It has been reported that acute nausea or vomiting may occur in up to about 33% of patients who receive oral narcotic analgesics and in up to about 80% of patients who receive injectable narcotics following surgery or trauma. This is due, at least in part, to direct effects of narcotics on the gastrointestinal

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(GI) tract. Opioid-induced side effects, such as nausea, vomiting, and inhibited gastrointestinal propulsive activity remain serious problems for patients being administered opioid analgesics for both short term and long term pain management. Opioid antagonist compounds that do not readily cross the blood-brain barrier (peripherally acting drugs) have been tested for use in curbing opioid-induced side effects. For instance, the peripheral mu opioid antagonist compound methylnaltrexone and related compounds have been suggested for use in curbing opioid-induced side effects in patients. U.S. Pat. Nos. 5,972,954, 5,102,887, 4,861,781, and 4,719,215 disclose the use of methylnaltrexone and related compounds in controlling opioid-induced pruritus, nausea, and/or vomiting. Additionally, methylnaltrexone has been shown to effectively reduce the incidence of opioid-induced nausea and pruritus as disclosed by Yuan, C. -S. et al. Drug and Alcohol Dependence 1998, 52, 161. Similarly, U.S. Pat. Nos. 5,250,542, 5,434,171, 5,159,081, and 5,270,328, disclose peripherally selective piperidineN-alkylcarboxylate opioid antagonists as being useful for the treatment of the opioid side effects constipation, nausea or vomiting, as well as irritable bowel syndrome and idiopathic constipation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pharmacological composition containing yeast cell wall fraction Inventor(s): Nakamura, Tomohiko; (Takasaki-shi, JP), Shirasu, Yoshiharu; (Takasaki-shi, JP), Wakabayashi, Hideyuki; (Takasaki-shi, JP) Correspondence: Venable; P.O. Box 34385; Washington; DC; 20043-9998; US Patent Application Number: 20020155126 Date filed: February 13, 2001 Abstract: The present invention provides a pharmacological composition as a composition as a raw material capable of preventing or treating the symptoms of inflammatory bowel diseases such as ulcerative colitis, constipation, allergic diseases such as atopic dermatitis, and so on, and which has little side effect and thereby safe, high water dispersibility, and can be ingested easily.A yeast cell wall fraction, which comprises yeast extracts residue and being superior in water dispersibility and swelling properties, is used as an active constituent. As a yeast cell wall fraction, a yeast cell wall fraction obtained with a simple operation of water cleansing of yeast cell after alkali processing yields superior effects for preventing or treating the symptoms of inflammatory bowel diseases such as ulcerative colitis, constipation, allergic diseases such as atopic dermatitis, and so on, as well as such yeast cell wall fraction without foreign taste and odor characteristic to autolysis and suitable for ingestion. Excerpt(s): The present invention generally relates to a pharmacological composition containing cell residue obtained by removing soluble cell substance from enzymegenated yeast, preferably cell residue obtained by conducting water cleansing after alkali treatment, and having as its active constituent a yeast cell wall fraction containing abundant protein and dietary fiber. Particularly, the present invention relates to an agent and/or a food product having as its active constituent the aforementioned yeast cell wall fraction and capable of preventing and/or treating the symptoms of inflammatory bowel diseases such as ulcerative colitis, constipation, allergic diseases such as atopic dermatitis, and so on. Conventionally, as technology directed to a pharmacological composition having as its active constituent yeast or a yeast cell component substance, known are a manufacturing method of a polysaccharide ester sulfate compound and the alkali metal saline thereof having a anti-digestive ulcer agent

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effect and an anti-arterial sclerosis effect, obtained by sulfating a yeast cell wall in a basic organic solution with chlorosulphonic acid or sulfur trioxide, or sulfating a yeast cell wall by blending it with cooled and levigated strong sulfuric acid and thereafter making it an alkali salt (Japanese Patent Application Laid-Open No. 49-48894); a manufacturing method of a polysaccharide ester sulfate compound and the alkali metal saline thereof obtained by sulfating a yeast cell wall in a basic organic solution with chlorosulphonic acid or sulfur trioxide, or sulfating a yeast cell wall by blending it with cooled and levigated strong sulfuric acid and thereafter making it an alkali salt (Japanese Patent Application Laid-Open No. 56-31955); a manufacturing method of a new physiologically active substance peptide mannan A which extracts peptide mannan A from a yeast cell belonging to Saccharomyces and ingests peptide mannan A from such extract (Japanese Patent Laid-Open Publication No. 49-69808); a manufacturing method of a compound protein SP-1 having an anti-ulcer effect and containing amino acids and mannose by making the pepsin act upon the yeast cell wall (Japanese Patent Application Laid-Open No. 62-39527); an anti-allergic agent having as its active constituent mannan deriving from yeast and the like (Japanese Patent Application Laid-Open No.63-119427); an antiulcer agent having as its active constituent dried brewer's yeast with no concern of side effects as it is a natural product (Japanese Patent Application Laid-Open No. 1-313434); a nutrition supplement composition to be administered to mammals and containing a sufficient amount of.beta.-glucan deriving from yeast for supplying a fiber source in foods, fecal-increasing agent, and short-chain fatty acid, and which improves the digestion in mammals, decreases the serum cholesterol level, and fortifies the decrease in weight (Japanese Patent Application Laid-Open No. 4-505997); food, beverage and medical product containing magnesium supplement material which connotes magnesium salt within a yeast cell wall prepared by eluting and separating intercellular cell constituents (Japanese Patent Application Laid-Open No. 9-107919); an inhibitor of antibody-producing cell containing yeast-related polymer, and a composition such as food or medical product for autoimmune disease containing this inhibitor of antibodyproducing cell (Japanese Patent Laid-Open Publication No. 9-188626); and a skin condition improving composition suitable for preventing and treating the likes of atopic dermatitis and containing protease hydrolysate of brewer's yeast and diuretic (Japanese Patent Laid-Open Publication No. 9-227390). Further, conventionally, as technology directed to making the autolytic residue of yeast tasteless and odorless, known are a method of improving the flavor of brewer's yeast by moisture distillation and organic solvation of brewer's yeast (Japanese Patent Application Laid-Open No. 63-22177), a method of decolorizing and deodorizing yeast extract residue, or yeast autolytic residue, wherein yeast extract residue is processed with alkali and acid, high concentration ozone treatment is conducted thereafter, and ethanol treatment is further implemented (Japanese Patent Application Laid-Open No. 4-248968); a method of reducing the foreign taste and odor characteristic to yeast by conducting acid treatment and heat treatment to yeast or a yeast-processed product (Japanese Patent Application Laid-Open No. 6-70751); and a method of making a yeast autolytic insoluble substance tasteless and odorless by suspending a yeast autolytic insoluble substance in ethanol, carrying the stirring treatment under alkaline conditions and eluting the causative agent of foreign taste and odor thereby, and eliminating the eluted material pursuant to centrifugation and eliminating the foreign taste and odor characteristic to a yeast autolytic insoluble substance thereby (Japanese Patent Application Laid-Open No. 9-103266). In addition, as technology directed to the treatment method of yeast cells and yeast cell walls, known is a manufacturing method of a seasoning wherein yeast cells are crushed with a highpressure spray-impact homogenizer, hot water extraction is conducted thereto, and centrifugation is performed to the yeast cell walls which could not be made into particulates (Japanese Patent Application Laid-Open No. 9-117263).

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Polymer conjugates of opioid antagonists Inventor(s): Bentley, Michael David; (Huntsville, AL), Cheng, Lin; (Huntsville, AL), Roberts, Michael James; (Williamsburg, VA), Shen, Xiaoming; (Madison, AL) Correspondence: Alston & Bird Llp; Bank OF America Plaza; 101 South Tryon Street, Suite 4000; Charlotte; NC; 28280-4000; US Patent Application Number: 20030124086 Date filed: October 18, 2002 Abstract: The invention provides polymer conjugates of opioid antagonists comprising a polymer, such as poly(ethylene glycol), covalently attached to an opioid antagonist. The linkage between the polymer and the opioid antagonist is preferably hydrolytically stable. The invention also includes a method of treating one or more side effects associated with the use of opioid analgesics, such as constipation, nausea, or pruritus, by administering a polymer conjugate of the invention. Excerpt(s): This application claims the benefit of Provisional Application Serial No. 60/330,400, filed Oct. 18, 2001, which is incorporated herein by reference in its entirety. This invention relates to water-soluble polymer conjugates of biologically active molecules, and in particular, to water-soluble polymer conjugates of opioid antagonists, such as naloxone, and related pharmaceutical compositions and uses thereof. Natural and synthetic alkaloids of opium (i.e., opioids) are useful as analgesics for the treatment of severe pain. Opioids target three types of endogenous opioid receptors:.mu.-,.delta.-, and.kappa.-receptors. Many opioids, such as morphine, are Preceptor agonists that are highly efficacious analgesic compounds due to their activation of opioid receptors in the brain and central nervous system (CNS). Opioid receptors are, however, not only limited to the CNS, but may be found in other tissues throughout the body. These receptors located outside the CNS are referred to as peripheral receptors. A number of side effects associated with opioid use are caused by activation of these peripheral receptors. For example, administration of opioid agonists often results in intestinal dysfunction due to action of the opioid agonist upon the large number of receptors in the intestinal wall. Specifically, opioids are generally known to cause nausea and vomiting as well as inhibition of normal propulsive gastrointestinal function in animals, resulting in side effects such as constipation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Serotonin 5-HT, receptor partial activator Inventor(s): Iwamatsu, Katsuyoshi; (Kanagawa, JP), Kobayashi, Kazuko; (Kanagawa, JP), Konno, Fukio; (Kanagawa, JP), Sato, Yasuo; (Kanagawa, JP), Shudo, Koichi; (Tokyo, JP), Yamada, Megumi; (Kanagawa, JP) Correspondence: Sughrue, Mion, Zinn, Macpeak & Seas, Pllc; 2100 Pennsylvania Avenue, N.W.; Washington; DC; 20037; US Patent Application Number: 20010016579 Date filed: March 2, 2001

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Abstract: This invention provides a serotonin 5-HT.sub.3 receptor partial activator which has a serotonin 5-HT.sub.3 receptor activating action, in addition to its serotonin 5-HT.sub.3 receptor antagonism, and does not cause constipation as a side effect.Particularly, based on the finding that newly synthesized benzoxazole derivatives typified by the compounds of the following formula (2) have strong serotonin 5HT.sub.3 receptor antagonism and serotonin 5-HT.sub.3 receptor activating action, this invention provides these benzoxazole derivatives as serotonin 5-HT.sub.3 receptor partial activators. 1In the above formula, R.sub.1 to R.sub.4 may be the same or different from one another and each represents a hydrogen atom, a halogen atom, a substituted or unsubstituted lower alkyl group, a substituted or unsubstituted lower alkenyl group or a substituted or unsubstituted amino group, or two groups of R.sub.1 and R.sub.2 may be linked together to form a ring structure, namely benzene ring; R.sub.5 represents a hydrogen atom, a substituted or unsubstituted lower alkyl group or a substituted or unsubstituted lower alkenyl group; and m is an integer of 1 to 4. Excerpt(s): This invention relates to novel and known benzoxazole derivatives, more particularly to a serotonin-5-HT.sub.3 receptor antagonist or a serotonin 5-HT.sub.3 receptor partial activator, which has been developed on the basis of the effective and selective action of said derivatives upon serotonin 5-HT.sub.3 receptors that are distributed in smooth muscles such as of digestive organs and the like and in central nervous system, intestinal nervous system and the like. It has been revealed that serotonin 5-HT.sub.3 receptor antagonists can inhibit nausea and emesis as side effects caused by the use of cisplatin and the like carcinostatic agents and by radiation treatments, and several compounds thereof are now used in the clinical field. In addition to this, development on their use as digestive organ function controlling drugs has recently been examined. The inventors of the present invention have already found that certain benzoxazole derivatives are possessed of serotonin 5-HT.sub.3 receptor antagonism (JP-A-6-345744; the term "JP-A" as used herein means an "unexamined published Japanese patent application"). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Therapeutic agents Inventor(s): Birch, Alan Martin; (Nottingham, GB), Bradley, Paul Anthony; (Nottingham, GB) Correspondence: Herbert B. Keil; Keil & Weinkauf; 1101 Connecticut Avenue, N.W.; Washington; DC; 20036; US Patent Application Number: 20010008903 Date filed: December 27, 2000 Abstract: Compounds of formula I 1and pharmaceutically acceptable salts thereof in which A is methylene or --O--; B is methylene or --O--; G.sub.1-G.sub.2-G.sub.3 form a heteroaromatic or heteroaliphatic chain; g is 0, 1 or 2; U is an alkylene chain optionally substituted by one or more alkyl; Q represents a divalent group containing nitrogen atoms; and T is an optionally substituted aryl or heteroaryl group, have utility in the treatment of central nervous system disorders, for example depression, anxiety, psychoses (for example schizophrenia), tardive dyskinesia, Parkinson's disease, obesity, hypertension, Tourette's syndrome, sexual dysfunction, drug addiction, drug abuse, cognitive disorders, Alzheimer's disease, senile dementia, obsessive-compulsive behaviour, panic attacks, social phobias, eating disorders and anorexia, cardiovascular and cerebrovascular disorders, non-insulin dependent diabetes mellitus,

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hyperglycaemia, constipation, arrhythmia, disorders of the neuroendocrine system, stress, and spasticity. Excerpt(s): The present invention relates to novel dioxinoindole and thienobenzodioxin compounds which have affinity for 5-HT.sub.1A and/or D.sub.2-like (D.sub.2, D.sub.3 and/or D.sub.4 sub-types) receptors, to processes for their preparation, to pharmaceutical compositions containing them and to their use in the treatment, of central nervous system disorders, for example depression, anxiety, psychoses (for example schizophrenia), tardive dyskinesia, Parkinson's disease, obesity, hypertension, Tourette's syndrome, sexual dysfunction, drug addiction, drug abuse, cognitive disorders, Alzheimer's disease, senile dementia, obsessive-compulsive behaviour, panic attacks, social phobias, eating disorders and anorexia, cardiovascular and cerebrovascular disorders, non-insulin dependent diabetes mellitus, hyperglycaemia, constipation, arrhythmia, disorders of the neuroendocrine system, stress, and spasticity. and T is an optionally substituted aromatic group optionally containing one or more N atoms. These compounds are described as being useful in the treatment of central nervous system disorders. T represents phenyl, 1- or 2-naphthyl, 1-naphth[2,1d][1,2,3]oxadia- zolyl, 2-, 3- or 4-pyridyl, 2-, 4- or 5-pyrimidinyl, 2- or 3-thienyl, 2- or 3furyl, 2-, 3- or benzo[b]furanyl, 2,3-dihydro-7-benzo[b]furanyl, 2-, 3- or 7benzo[b]thiophenyl, 3-, 4-5-pyrazolyl, 1,2,3-triazol-4-yl, 1,2,3-triazol-5-yl, 1,2,4-triazol-2yl, 5-tetrazolyl, 2-, 3- or 4-quinolinyl, 2- or 4-quinazolinyl, 3-, 4- or 5-isoxazolyl, 2-, 4- or 5-oxazolyl, 3 isothiazolyl or 2-, 4- or 5-thiazolyl each of which may be optionally substituted by one or more substituents selected from a) halo, b) an alkyl group containing 1 to 4 carbon atoms optionally substituted by one or more halo, c) an alkoxy group containing 1 to 3 carbon atoms optionally substituted by one or more halo, d) an alkylthio group containing 1 to 3 carbon atoms optionally substituted by one or more halo, e) hydroxy, f) an acyloxy group containing 1 to 3 carbon atoms, g) hydroxymethyl, h) cyano, i) an alkanoyl group containing 1 to 6 carbon atoms, j) an alkoxycarbonyl group containing 2 to 6 carbon atoms, k) a carbamoyl group or carbamoylmethyl group each optionally N-substituted by one or two alkyl groups each containing 1 to 3 carbon atoms, I) a sulphamoyl or sulphamoylmethyl group each optionally N-substituted by one or two alkyl groups each containing 1 to 3 carbon atoms, m) an amino group optionally substituted by one or two alkyl groups each containing 1 to 5 carbon atoms, n) 1-pyrrolidinyl or 1 -piperidinyl, o) nitro or p) acetamido. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Use of cox-2 inhibitors for constipation Inventor(s): Mangel, Allen Wyane; (Chapel Hill, NC), Naylor, Alan; (Stevenage, GB) Correspondence: David J Levy, Corporate Intellectual Property; Glaxosmithkline; Five Moore DR., PO Box 13398; Research Triangle Park; NC; 27709-3398; US Patent Application Number: 20030013717 Date filed: July 25, 2002 Abstract: The invention provides a COX-2 inhibitor or a pharmaceutically acceptable derivative thereof for use in the treatment of constipation. Excerpt(s): The invention relates to a new medical use for compounds which act as inhibitors of cyclooxygenase-2(COX-2). It is only recently that the enzyme COX has been discovered to exist in two isoforms, COX-1 and COX-2. COX-1 corresponds to the originally identified constitutive enzyme while COX-2 is rapidly and readily inducible

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by a number of agents including mitogens, endotoxin, hormones, cytokines and growth factors. Prostaglandins generated by the action of COX have both physiological and pathological roles. It is generally believed that COX-1 is largely responsible for the important physiological functions such as maintenance of gastrointestinal integrity and renal blood flow. In contrast the inducible form, COX-2, is believed to be largely responsible for the pathological effects of prostaglandins where rapid induction of the enzyme occurs in response to such agents as inflammatory agents, hormones, growth factors and cytokines. A selective inhibitor of COX-2 would therefore have anti-antiinflammatory, anti-pyretic and analgesic properties, without the potential side effects associated with inhibition of COX-1. COX-2 inhibitors may be identified by methods well known in the art, for example as described in WO99/12930(especially pages 25 and 26). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with constipation, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “constipation” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on constipation. You can also use this procedure to view pending patent applications concerning constipation. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON CONSTIPATION Overview This chapter provides bibliographic book references relating to constipation. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on constipation include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “constipation” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on constipation: •

Let's Get Things Moving: Overcoming Constipation Source: Woollahra, New South Wales, Australia: Health Books, Gore and Osment Publications. 1992. 72 p. Contact: Available from Health Books, Gore and Osment Publications, Private Box 427, 150 Queen Street, Woollahra, NSW 2025, Australia. (02) 361-5244. Fax (02) 360-7558. PRICE: $9.95 (Australian). ISBN: 1875531238. Also available from National Association for Continence (formerly Help For Incontinent People). P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. PRICE: $9.95 plus $2.00 shipping (as of 1996). Summary: This book on managing constipation is from a series of health books that provide straightforward, easy to understand information on a variety of health issues. Eleven chapters address the definition of constipation, its symptoms, and incidence; physiology of defecation; bowel anatomy; causes of constipation, including travel,

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changes in routine, food and nutrition, pain, the menstrual cycle, and pregnancy; acute and chronic constipation in children; causes of constipation in the elderly; self-help strategies; the role of fiber; slow transit constipation; obstructed defecation; pelvic floor muscles; good defecation dynamics; diagnostic tests used to confirm bowel dysfunction; and surgical options for treatment, including rubber banding, sphincterotomy, rectopexy, proctectomy, colectomy, colostomy, and ileostomy. The book concludes with a glossary of terms. Simple, sometimes humorous, line drawings illustrate many of the concepts presented.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “constipation” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “constipation” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “constipation” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

All You Wanted to Know About Constipation by Savitri Ramaiah; ISBN: 812072223X; http://www.amazon.com/exec/obidos/ASIN/812072223X/icongroupinterna

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Chronic Constipation by Giuseppe Gizzi (Editor), et al; ISBN: 0702020885; http://www.amazon.com/exec/obidos/ASIN/0702020885/icongroupinterna

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Conquer Constipation-The Father and Mother of All Diseases: Confidential Report by Edwin Flatto; ISBN: 0935540008; http://www.amazon.com/exec/obidos/ASIN/0935540008/icongroupinterna

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Conquering constipation : the natural guide to intestinal health by Alan Moyle; ISBN: 0722503202; http://www.amazon.com/exec/obidos/ASIN/0722503202/icongroupinterna

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Constipation by Michael A. Kamm, John E. Lennard-Jones (Editor) (1994); ISBN: 1871816246; http://www.amazon.com/exec/obidos/ASIN/1871816246/icongroupinterna

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Constipation by Gary S. Ross; ISBN: 1891875000; http://www.amazon.com/exec/obidos/ASIN/1891875000/icongroupinterna

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Constipation and Anto-Rectal Insufficiency (Falk Symposium , Vol 95) by K. Ewe (Editor), et al (1997); ISBN: 0792387279; http://www.amazon.com/exec/obidos/ASIN/0792387279/icongroupinterna

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Constipation and Fecal Incontinence and Motility Disturbances of the Gut (Progress in Pediatric Surgery, Vol 24) by J. Yokoyama, T.A. Angerpointner (Editor); ISBN: 0387508139; http://www.amazon.com/exec/obidos/ASIN/0387508139/icongroupinterna

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Constipation and Indigestion: Prevention and Cure by L. Ramachandran; ISBN: 0318363607; http://www.amazon.com/exec/obidos/ASIN/0318363607/icongroupinterna

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Constipation Control: An Exercise Program to Achieve Regularity by Richard R. Fuller; ISBN: 0682496901; http://www.amazon.com/exec/obidos/ASIN/0682496901/icongroupinterna

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Constipation in childhood by Graham Clayden; ISBN: 0192620274; http://www.amazon.com/exec/obidos/ASIN/0192620274/icongroupinterna

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Constipation, piles, and other bowel disorders by Richard Heatley; ISBN: 0443029156; http://www.amazon.com/exec/obidos/ASIN/0443029156/icongroupinterna

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Constipation: A New Reading on the Subject by J. H. Tilden, Dr John H. Tilden (1997); ISBN: 1564598101; http://www.amazon.com/exec/obidos/ASIN/1564598101/icongroupinterna

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Constipation: Etiology, Evaluation and Management by Steven D. Wexner, David C.C. Bartolo (Editor); ISBN: 0750607769; http://www.amazon.com/exec/obidos/ASIN/0750607769/icongroupinterna

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Constipation--World-Wide Afflictions: Index of New Information and Guide-Book for Consumers, Reference and Research by Brenda Yola, Dr Brandis (2002); ISBN: 0788326457; http://www.amazon.com/exec/obidos/ASIN/0788326457/icongroupinterna

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Definite Cure of Chronic Constipation Also Overcoming Constipation Naturally by Arnold Ehret (2002); ISBN: 0879040327; http://www.amazon.com/exec/obidos/ASIN/0879040327/icongroupinterna

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Diarrhoea and Constipation (Gastrocare) by R.C. Spiller; ISBN: 1858730236; http://www.amazon.com/exec/obidos/ASIN/1858730236/icongroupinterna

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Diarrhoea and Constipation in Geriatric Practice by Ranjit N. Ratnaike (Editor); ISBN: 0521653886; http://www.amazon.com/exec/obidos/ASIN/0521653886/icongroupinterna

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Diets to help constipation by Alan Moyle; ISBN: 072250151X; http://www.amazon.com/exec/obidos/ASIN/072250151X/icongroupinterna

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Gastrointestinal Health : A Self-Help Nutritional Program to Prevent, Cure, or Alleviate Irritable Bowel Syndrome, Ulcers, Heartburn, Gas, Constipation by Steven R. Peikin; ISBN: 0060984058; http://www.amazon.com/exec/obidos/ASIN/0060984058/icongroupinterna

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Gastrointestinal Health Third Edition : The Proven Nutritional Program to Prevent, Cure, or Alleviate Irritable Bowel Syndrome (IBS), Ulcers, Gas, Constipation, Heartburn, and Many Other Digestive Disorders by Steven R. Peikin (Author); ISBN: 0060585323; http://www.amazon.com/exec/obidos/ASIN/0060585323/icongroupinterna

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Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson (Author); ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna

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Healthy Digestion: A Natural Approach to Relieving Indigestion, Gas, Heartburn, Constipation, Colitis & More by David Hoffmann, David Hoffman; ISBN: 1580172504; http://www.amazon.com/exec/obidos/ASIN/1580172504/icongroupinterna

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Herbs for constipation by William Smith; ISBN: 0722503245; http://www.amazon.com/exec/obidos/ASIN/0722503245/icongroupinterna

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Inner Hygiene: Constipation and the Pursuit of Health in Modern Society by James C. Whorton (2000); ISBN: 0195135814; http://www.amazon.com/exec/obidos/ASIN/0195135814/icongroupinterna

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Let's Get Things Moving: Overcoming Constipation (Robinson Family Health Series) by Pauline Chiarelli, Sue Markwell; ISBN: 185487389X; http://www.amazon.com/exec/obidos/ASIN/185487389X/icongroupinterna

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Management of constipation by Francis Avery Jones; ISBN: 063206580X; http://www.amazon.com/exec/obidos/ASIN/063206580X/icongroupinterna

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Natural Relief from Constipation by Donna Dimarco; ISBN: 0879839589; http://www.amazon.com/exec/obidos/ASIN/0879839589/icongroupinterna

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Pointers to the Common Remedies: Stomach and Digestive Disorders, Constipation, Acute Diarrhoea, Acute Intestinal Conditions and Colic, Epidemic Diarrhoea of Children, Acute Dysentery, Cholera by M.L. Tyler (1981); ISBN: 0946717311; http://www.amazon.com/exec/obidos/ASIN/0946717311/icongroupinterna

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Put Hemorrhoids and Constipation Behind You: New Treatment and Technology for 2 of Today's Most Common Yet Least Talked-About Problems by Kenneth Yasny, Kenneth Yasney (1997); ISBN: 1884820220; http://www.amazon.com/exec/obidos/ASIN/1884820220/icongroupinterna

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Superbowl: Constipation and Other Bowel Disorders by Kathryn Marsden; ISBN: 0722529163; http://www.amazon.com/exec/obidos/ASIN/0722529163/icongroupinterna

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The 2002 Official Patient's Sourcebook on Constipation: A Revised and Updated Directory for the Internet Age by Icon Health Publications (2002); ISBN: 059783265X; http://www.amazon.com/exec/obidos/ASIN/059783265X/icongroupinterna

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Traitements naturels de la constipation : Une affection concernant une femme sur deux et un homme sur cinq by Jean-Luc Darrigol (Author); ISBN: 2703302177; http://www.amazon.com/exec/obidos/ASIN/2703302177/icongroupinterna

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Users Guide to Healthy Digestion: Learn How You Can Put an End to Heartburn, Indigestion, Constipation, and Other Digestive Problems by Victoria Toews Dolby, Victoria Dolby Toews (2003); ISBN: 1591200857; http://www.amazon.com/exec/obidos/ASIN/1591200857/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “constipation” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:8 8 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created

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Banish constipation and colitis. Author: Graves, William H.; Year: 1966; Los Angeles, [1950]

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Banish constipation; a layman's guide, by W. H. Graves, D. C. Author: Graves, William H.; Year: 1958; Los Angeles, Cal., Dr. W. H. Graves [c1930]

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Cause and cure of headaches, backaches and constipation, by William S. Sadler. and Lena K. Sadler. Author: Sadler, William Samuel,; Chicago, American publishers corporation, 1938

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Chronic constipation, the most insidious and the most deadly of diseases, its cause, grave consequences and natural cure. Author: Barker, J. Ellis,; Year: 1962; London, Murray [1927]

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Conquering constipation: the natural guide to intestinal health Author: Moyle, Alan.; Year: 1938; Wellingborough, Eng.: Thorsons, c1976; ISBN: 0722503202 http://www.amazon.com/exec/obidos/ASIN/0722503202/icongroupinterna

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Constipation & diarrhoea. Author: Sharp, Percival Henry.; Year: 1965; London, Homoeopathic Pub. Co. [1951]

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Constipation: its causes and cures Author: Thiroloix, Jacques.; Year: 1931; New York: St. Martin's Press, c1976

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Constipation and commonsense. Author: Scott, Cyril,; Year: 1972; [Truro, Eng., 1956?]

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Constipation and our civilisation, by James C. Thomson. Illustrations by C. Leslie Thomson. Author: Thomson, James C. (James Charles); Year: 1971; London, Thorsons, ltd. [1943]

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Constipation in health and disease. Author: Farrar, William Ross.; Year: 1963; London, Heinemann, 1960 [c1959]

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Constipation, how to cure yourself. Author: Sadler, William Samuel,; Year: 1928; Chicago, McClurg, 1925

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Constipation; its prevention and natural cure. Author: Trueman, Kenneth.; Year: 1970; [Lewes, Sussex, 1949]

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Control of constipation. Author: Cantor, Alfred Joseph,; Year: 1959; New York, Messner [c1962]

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Diets to help constipation. Author: Moyle, Alan.; Year: 1930; London, Thorsons [1970]; ISBN: 072250151X http://www.amazon.com/exec/obidos/ASIN/072250151X/icongroupinterna

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Disorders of the intestines; the causes and cures of constipation and diarrhoea. Author: Vander, Adrián,; Year: 1939; London, Pearson [1939]

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Habitual constipation and its treatment; an account of a new therapeutic method. Authorized translation, by Herbert Child. Author: Burnier, Michel Henri.; Year: 1930; London, Baillière, Tindall and Cox, 1929

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Help your doctor to help you when you have constipation. Author: Alvarez, Walter C. (Walter Clement),; Year: 1964; New York and London, Harper; brothers [1942]

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Herbs for constipation Author: Smith, William.; Year: 1927; Wellingborough, Eng.: Thorsons, 1976; ISBN: 0722503245 http://www.amazon.com/exec/obidos/ASIN/0722503245/icongroupinterna

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How to overcome nervous and other forms of constipation. Author: Montague, Joseph Franklin,; Year: 1955; Chicago, Nelson-Hall [c1956]

between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Management of constipation. Edited by Sir Francis Avery Jones and Edmund W. Godding. Author: Jones, Francis Avery,; Year: 1954; Oxford, Blackwell [c1972]; ISBN: 063206580X http://www.amazon.com/exec/obidos/ASIN/063206580X/icongroupinterna

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The Labb system for health; new outlook about health, by H. K. Whitehorn together with Constipation and piles, by A. Long. Author: Whitehorn, H. K.; Year: 1965; London, True Health Pub. Co., 1949

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The lazy colon, newer methods and latest advances of science in the treatment of constipation, by Charles M. Campbell associated with Albert K. Detwiller, M. D. Author: Campbell, Charles Milton,; Year: 1972; New York, The Educational press, 1928

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The lazy colon; newer methods and latest advances of science in the treatment of constipation, by Charles M. Campbell associated with Albert K. Detwiller. Author: Campbell, Charles Milton,; Year: 1970; New York, The Educational Press, 1924

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The natural treatment of constipation. Author: Campanella, M.; Year: 1974; Graham, Fla. [c1965]

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The new physiologic approach in the treatment of gastrointestinal dysfunction and constipation; a series of pertinent original monographs. Author: Professional Laboratories, inc., New York.; Year: 1956; [New York, c1937]

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Two health problems: constipation and our civilisation. Author: Thomson, James C. (James Charles); Year: 1968; London, Thorsons [1954]

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Youth regained by intestinal gardening; or, Constipation conquered nature's way, by James Empringham. Author: Empringham, James,; Year: 1961; Los Angeles, E. E. Empringham [c1933]

Chapters on Constipation In order to find chapters that specifically relate to constipation, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and constipation using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “constipation” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on constipation: •

Approach to the Patient with Constipation Source: in Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 894-910. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-6423. Fax: (301) 223-2400. Website: www.lww.com. PRICE: $289.00. ISBN: 781728614. Summary: Although constipation is a common gastrointestinal complaint in clinical practice, some uncertainty exists as to the precise definition of the term. This lack of objectivity has contributed to the controversy concerning the incidence, pathogenesis, and treatment of constipation and defecation disorders. Furthermore, the availability of over-the-counter laxatives and their long-term and often inappropriate use may result in laxative dependence, may damage the bowel, and may lead to problems where none

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previously existed. This chapter on the approach to patients with constipation is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. Topics include definitions, the socioeconomic and medical consequences of constipation, pathophysiological considerations, evaluation of constipation, diagnostic strategies, and treatment options. The author notes that there is general agreement that selecting treatment strategies requires understanding of the whole patient, fiber supplements should be added to the diet, establishing proper toileting arrangements can help certain patients, and long-term use of stimulant laxatives should be judicious. Surgery has a role in selected patients with severe constipation in whom abnormal bowel function can be ameliorated by operative intervention. 2 figures. 5 tables. 185 references. •

Constipation, Megacolon, and Fecal Impaction Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume One. Philadelphia, PA: Current Medicine. 1999. p. 626-636. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Constipation is a common symptom and is most common in women and persons with underlying medical conditions, limited diets, immobility, and advanced age. Although constipation is usually mild and is often little more than a nuisance, megacolon (abnormally large or dilated colon) and impaction can become difficult management problems and may lead to life threatening complications such as volvulus (intestinal obstruction caused by twisting of the bowel), stercoral ulcers, perforation, and malnutrition. This chapter on constipation, megacolon, and fecal impaction is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. The authors contend that the major clinical challenge presented by the patient complaining of constipation is differentiating mild, inconsequential symptoms from more severe problems. The authors discuss definitions of constipation, epidemiology, mechanisms of constipation (secondary constipation and megacolon, medications, metabolic disorders, neurologic disorders, connective tissue disorders, paraneoplastic syndromes, acute colonic pseudoobstructions), primary or idiopathic chronic constipation, the diagnostic approach to constipation, and treatment options including retraining and biofeedback, and surgery for chronic constipation. 4 figures. 3 tables. 26 references.

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Constipation in Infants and Children: Evaluation and Treatment Source: in American Academy of Pediatric. Pediatric Clinical Practice Guidelines and Policies: A Compendium of Evidence-based Research for Pediatric Practice. Elk Grove Village, IL: American Academy of Pediatrics. 2001. p. 95-128. Contact: Available from American Academy of Pediatrics. P.O. Box 927, 141 Northwest Point Boulevard, Elk Grove Village, IL 60009-0927. (800) 433-9016. PRICE: $47.95 (members) plus $6.25 shipping and handling; $52.95 for nonmembers; plus $8.95 shipping and handling. ISBN: 1581100701. Summary: Constipation, defined as a delay or difficulty in defecation, present for two or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. This publication offers clinical practice guidelines for the

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management of pediatric constipation. The guidelines were formulated by the Constipation Subcommittee of the Clinical Guidelines Committee of the North American Society for Pediatric Gastroenterology and Nutrition. The Constipation Subcommittee, consisting of two primary care pediatricians, a clinical epidemiologist, and pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. The Subcommittee developed two algorithms to assist with medical management, one for older infants and children, and the second for infants less than one year of age. The guidelines provide recommendations for management by the primary care provider, including evaluation, initial treatment, follow up management, and indications for consultation by a specialist. The report is designed as a general guideline to assist providers of medical care in the evaluation and treatment of constipation in children. 77 references. •

Irritable Bowel Syndrome and Constipation Source: in Snape, W.J., ed. Consultations in Gastroenterology. Philadelphia, PA: W.B. Saunders Company. 1996. p. 496-501. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. PRICE: $125.00. ISBN: 0721646700. Summary: This chapter from a gastroenterology text covers irritable bowel syndrome (IBS) and constipation. The IBS is a heterogeneous group of functional gastrointestinal tract disorders involving the small intestine and colon; central to the definition of IBS is abdominal pain. The author focuses on patients with IBS who have constipation as their primary bowel complaint. Topics include pathophysiology, diagnosis, definition, history and physical examination, diagnostic tests including those of colonic function, and treatment options, including general measures, treatment for abdominal pain, gas and bloating, and psychologic and behavioral therapy. The general treatment measures recommended include developing a therapeutic relationship, providing reassurance and education, and dietary interventions including fiber supplementation. Patients who fail to respond adequately to these general treatment measures should receive additional diagnostic testing and therapy directed at their predominant symptoms. 1 table. 12 references.

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Diarrhea and Constipation Source: in Janowitz, H.D. Good Food for Bad Stomachs. New York, NY: Oxford University Press. 1997. p. 110-127. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. PRICE: $12.95 plus shipping and handling. ISBN: 0195126556. Summary: This chapter on diarrhea and constipation is from a book that presents a detailed look at present knowledge about the role of eating habits in preventing, causing, and treating the many disorders that plague the gastrointestinal tract and its associated digestive glands, the liver, the gallbladder, and the pancreas. Diarrhea is defined as bowel movements that occur too often and are too loose, constipation as difficulty in moving one's bowels. To put these definitions into proper perspective, the author notes that the number of bowel movements that normal people in good health can pass varies tremendously, ranging from two to three a day to two to three a week. Therefore, instead of comparing themselves with others, people should look for

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deviations from their ordinary routines both in number and consistency of the stool. Topics include acute diarrhea, its symptoms, causes, and treatment; what to eat during acute episodes of diarrhea; food poisoning; traveler's diarrhea and how to avoid it; parasites in the stool; secretory diarrhea; food intolerance as a cause of diarrhea; antibiotic associated diarrhea; constipation, its causes and treatments; the role of dietary fiber and treatment with a high fiber diet; the unique role of bran; lubricants; enemas; and fluid intake. 2 tables. •

Managing Constipation Source: in King, B.D. and Harke, J. Coping with Bowel and Bladder Problems. San Diego, CA: Singular Publishing. 1994. p. 149-161. Contact: Available from Singular Publishing Group, Inc. 401 West A Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. PRICE: $18.95. ISBN: 1565930681. Summary: This chapter, from a book in the Coping with Aging Series, a group of books written for men and women coping with the challenges of aging, addresses the management of constipation. The authors focus on three main areas: diet and fluid intake, exercise, and toilet habits. Specific topics in the chapter include the role of dietary fiber; sources of fiber; fiber supplements; fluid intake; the role of regular exercise; toilet habits; and laxative use, including stimulant laxatives, saline cathartics, lubricants, hyperosmotic laxatives, enemas, and suppositories. The authors stress that the simple measures of adequate fiber and fluid intake and exercise, as well as good toilet habits, can often eliminate constipation. 4 tables.

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Constipation: Moving Things Along at a Low Cost Source: in Barkin, J.S., and Rogers, A.I., eds. Difficult Decisions in Digestive Diseases. 2nd ed. St. Louis, MO: Mosby-Year Book, Inc. 1994. p. 277-284. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 633-6699 or (800) 325-4177 or (314) 872-8370. Fax (314) 432-1380. PRICE: $84 (as of 1995). ISBN: 0801680190. Summary: This chapter, from a medical text on difficult decisions in digestive diseases, provides information about constipation. The chapter explains the initial evaluation of chronic constipation; the initial management of functional constipation; the patient with chronic severe constipation; drugs associated with constipation; young adults with megacolon; idiopathic megacolon in adults; constipation in the elderly; and therapy for severe constipation, including behavioral, pharmacologic, and surgical approaches, for severe hypotonic constipation, rectocele, rectal intussusception and prolapse, pelvic floor dyssynergia, Hirschsprung's disease, and spastic constipation. 5 figures. 3 tables. 15 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to constipation have been published that consolidate information across

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various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:9 •

Directory of Plain Language Health Information Source: Ottawa, Ontario: Canadian Public Health Association. 1999. 104 p. Contact: Available from Canadian Public Health Association. 400-1565 Carling Avenue, Ottawa, Ontario, K1Z 8R1. (613) 725-3769. Fax (613) 725-9826. E-mail: [email protected]. PRICE: $19.95 plus shipping and handling. Also available at www.pls.cpha.ca for free. ISBN: 189432403X. Summary: Patient education materials are often written at a level that is higher than the reading level of the people who need the materials. This directory lists 'plain language' patient education materials. An extensive introductory chapter in the directory describes how patient education materials are evaluated and offers specific information about the best strategies to create plain language materials. Each piece of health information in the directory is rated according to its design assessment, in order to help readers make informed decisions about choosing materials. Part I is a list of health subjects presented in alphabetical order, in the style of a typical index. The page number after a listing notes where to find that piece of health information in Part II. Part II is a list of organizations and their contact information. Below the contact information is a list of the plain language health titles produced by the organization. Each title is grouped under a grade level heading, is numbered, and has a design rating. Part III is an alphabetical list of all the organizations in Part II. Materials related to digestive system diseases include allergies, constipation and soiling in children, cholesterol, hepatitis, constipation, diabetes and diet therapy, exercise for weight control, food choices, nutrition, heart health, immunization, low fat cooking, nausea, vomiting, diarrhea, smoking, and weight loss. Appendices to the directory include a guide to the S.M.O.G. readability formula, clear design tips, and plain language tips. The Directory is also available at www.pls.cpha.ca on the Internet.

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You will need to limit your search to “Directory” and “constipation” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “constipation” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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CHAPTER 7. MULTIMEDIA ON CONSTIPATION Overview In this chapter, we show you how to keep current on multimedia sources of information on constipation. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on constipation is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “constipation” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “constipation” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on constipation: •

What You Really Need to Know About Constipation Source: [Toronto, Ontario, Canada]: Videos for Patients. 1995. (videocassette). Contact: Available from Medical Audio Visual Communications, Inc. Suite 240, 2315 Whirlpool Street, Niagara Falls, NY 14305. Or P.O. Box 84548, 2336 Bloor Street West, Toronto, Ontario M6S 1TO, Canada. (800) 757-4868 or (905) 602-1160. Fax (905) 602-8720. PRICE: $99.00 (Canadian); contact producer for current price in American dollars. Order Number VFP035. Summary: This patient education videotape provides information about constipation. The videotape begins with a brief sketch featuring comedian John Cleese and narrator Dr. Robert Buckman illustrating the difficulties sometimes experienced by patients during the traditional doctor's explanation. Topics include the anatomy and physiology of the digestive tract and bowels, a definition of constipation and its causes, the symptoms and the effects of constipation, how changes in diet and lifestyle can remedy constipation, medications that may be used at the beginning to help constipation, and

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when to seek medical advice and treatment. Dr. Buckman presents the medical facts, using models, simple diagrams, and graphics to supplement his explanation, and avoiding medical jargon as much as possible.

Bibliography: Multimedia on Constipation The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in constipation (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on constipation: •

Constipation [videorecording]: a daily problem Source: [presented by] Marshfield Medical Foundation and Marshfield Clinic; Year: 1981; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, 1981

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Constipation and encopresis [videorecording] Source: Department of Pediatrics, Emory University, School of Medicine; Year: 1980; Format: Videorecording; Atlanta: Emory Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1980

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Hirschsprung's disease [videorecording]: constipation and megacolon Source: presented by the Department of Pediatrics, Emory University, School of Medicine; Year: 1985; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1985

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New techniques for totally laparoscopic anastomosis (TLA) after colon resection [videorecording]; Laparoscopic suture rectopexy for rectal prolapse without constipation; Unusual intraoperative complications in laparoscopic sigmoidectomy; Endoscopic transrectal resection of rectal villous tumors using the urologic resectoscope Year: 1996; Format: Videorecording; Woodbury, Conn.: Distributed by Ciné-Med, 1996

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Recent advances in managing severe constipation [sound recording]: recorded at DDW 1995 in San Diego Source: AGA, American Gastroenterological Association; Year: 1995; Format: Sound recording; [Bethesda, Md.]: The Association, [1995?]

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CHAPTER 8. PERIODICALS AND NEWS ON CONSTIPATION Overview In this chapter, we suggest a number of news sources and present various periodicals that cover constipation.

News Services and Press Releases One of the simplest ways of tracking press releases on constipation is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “constipation” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to constipation. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “constipation” (or synonyms). The following was recently listed in this archive for constipation: •

Constipation with colonic inertia may be due to weak electrical activity Source: Reuters Medical News Date: October 21, 2003

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Novartis' Zelmac effective in chronic constipation study Source: Reuters Industry Breifing Date: May 20, 2003

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Sparkling water may help indigestion, constipation Source: Reuters Health eLine Date: November 28, 2002

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Sucampo to begin second phase III trial of constipation drug Source: Reuters Industry Breifing Date: November 12, 2002

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Drug for opioid constipation effective in phase III trial Source: Reuters Medical News Date: November 11, 2002

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Segmental resection shows promise as treatment for slow transit constipation Source: Reuters Medical News Date: October 30, 2002

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Sacral nerve stimulation treats both constipation and fecal incontinence Source: Reuters Medical News Date: August 05, 2002

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Women twice as likely as men to be constipated Source: Reuters Health eLine Date: January 02, 2002

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Constipation may signal Parkinson's risk: study Source: Reuters Health eLine Date: August 13, 2001

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Constipation linked to increased risk of Parkinson's disease Source: Reuters Medical News Date: August 13, 2001

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Improvement in constipation with biofeedback linked to gut-specific effects Source: Reuters Medical News Date: July 25, 2001

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Chronic constipation linked to anxiety, depression Source: Reuters Health eLine Date: July 12, 2001

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Anorectal manometry provides no additional benefit for constipated children Source: Reuters Medical News Date: July 12, 2001

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Tegaserod relieves abdominal pain and constipation in women with IBS Source: Reuters Medical News Date: May 24, 2001 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine.

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Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “constipation” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “constipation” (or synonyms). If you know the name of a company that is relevant to constipation, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “constipation” (or synonyms).

Newsletters on Constipation Find newsletters on constipation using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “constipation.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “constipation” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Constipation: Causes, Treatment and Prevention Source: Intestinal Fortitude. 4(2): 2-3. Summer 1993.

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Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: This article, from a newsletter for people with intestinal diseases, reviews the causes, treatment, and prevention of constipation. Topics include the possible causes of constipation, including lifestyle changes, diet, eating habits, bowel habits, medications, laxatives, and exercise; the medical causes of constipation; and psychological disorders. The article concludes with a brief discussion of the role of gastroenterologists who specialize in the evaluation and treatment of intractable constipation. •

Evaluation of Severe Constipation Source: Intestinal Fortitude. 4(2): 4-5. Summer 1993. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: This brief article, from a newsletter for people with intestinal diseases, discusses the diagnostic tests used in the evaluation of severe constipation. Topics include the difference between functional constipation and that with an organic cause; the two types of functional constipation, notably motility dysfunctions and outlet obstructions or defecatory disorders; the use of a colonic transit study; anorectal manometry; evacuation proctography; and colon motility. The author emphasizes that patients with severe constipation, and their treating physician, are advised to work with specialists in the field of constipation, in order to take advantage of the available technology and knowledge.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “constipation” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on constipation: •

Rectocele: Symptoms Include Vaginal Pain or Constipation Source: Participate. 10(3): 5. Fall 2001. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: A rectocele is a bulge from the rectum into the vagina and may be present without any other abnormalities. This brief article on rectocele is from a newsletter from the International Foundation for Functional Gastrointestinal Disorders. The author describes the causes of rectocele, the typical symptoms, how rectocele is diagnosed, when treatment for rectocele should be considered, and treatment options. Treatment should be considered for rectocele when it causes significant symptoms. Rectoceles that are not causing symptoms do not need to be treated, as advised by the patient's physician. In general, one should avoid constipation by eating a high fiber diet and

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drinking plenty of fluids. Patients should also avoid prolonged straining at defecation. If symptoms persist with medical therapy, then surgical repair may be indicated. Both colorectal surgeons and gynecologists are trained to deal with these problems. •

Constipation: How to Find Relief Without Laxatives Source: Environmental Nutrition. 22(9): 2. September 1999. Contact: Available from Environmental Nutrition, Inc. 52 Riverside Drive, New York, NY 10024-6599. (800) 829-5384. Summary: Constipation is defined as infrequent or difficult bowel movements, typically three consecutive days without a movement. This brief article offers strategies for dealing with constipation without resorting to the use of laxatives. The author notes that, most often, constipation is temporary, triggered perhaps by a change in routine (like travel) and requires no real intervention beyond a cup of prune juice or a bowl of bran flakes. The author reviews the causes of constipation, including sedentary habits, diets of processed, low fiber foods, and a tendency to drink too few fluids. Additional contributors to constipation, especially for older people, include muscle weakness, poor dentition (which makes it hard to chew high fiber foods), and certain medications, including antidepressants, antacids, antihistamines, diuretics, opiates, tranquilizers, iron supplements, and calcium supplements. Three sidebars offer practical strategies for coping with constipation, preventing problems, and being cautious with herbal remedies.

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Childhood Defecation Disorders: Constipation and Soiling Source: Participate. 9(3): 4-6. Fall 2000. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: This article is the second in a two part series on pediatric functional gastrointestinal (GI) disorders that may prompt parents to bring their child to the doctor for constipation or fecal soiling. In this article, the author focuses on non retentive fecal soiling and functional fecal retention. Functional refers to a disorder where the primary problem is not due to disease or visible tissue damage or inflammation; in this article, the author uses functional to refer to symptoms that occur within the expected range of the body's behavior. Functional fecal retention is defined in children by the passage of large or enormous bowel movements at intervals less than twice per week, and the attempt to avoid having bowel movements on purpose. Accompanying symptoms include soiling of the underclothes, irritability, abdominal cramps, and decreased appetite. Functional fecal retention begins when there is a painful bowel movement and the child learns to fear the urge to have a bowel movement. After diagnosis, treatment goals include family and patient education, medication as necessary to assure painless defecation, and the provision of continued availability and interest in the child's problem. Fecal soiling refers to passage of bowel movements into the underclothing, or other inappropriate places. Fecal soiling commonly accompanies functional fecal retention, or after a chronic problem with diarrhea. Functional non retentive (not associated with fecal retention) fecal soiling is diagnosed in children older than 4, who have bowel movements in places and at times that are inappropriate, at least once a week for 3 months, in the absence of a disease to explain it. Treatment goals are to help the parent to understand that there is no medical disease, and to accept a referral to a

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mental health professional. Parents need guidance to understand that soiling is a symptom of emotional upset, not simply bad behavior. 1 table. •

Fighting Constipation Source: APHS Newsletter. American Pseudo-Obstruction and Hirschsprung's Society Newsletter. 7(1): 17. Spring 1995. Contact: Available from APHS. 158 Pleasant Street, North Andover, MA 01845-2797. (508) 685-4477. Fax (508) 685-4488. E-mail: [email protected]. Summary: This brief newsletter article reminds parents and other caregivers of ways to avoid constipation in children. The author's introduction stresses that physical activity, stress, daily routine, medications, and general body tone can affect bowel function. The authors address fluid intake; fiber consumption; foods that can contribute to constipation; foods that can stimulate the intestinal system; the role of physical activity; and the importance of regular toileting habits. The article also includes three recipes for Fruit Blend, Carrot Bread for Kids, and a constipation-fighting liquid made from milk, baby cereal, and fruit, simply called 'The Recipe.'.

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What is Constipation Anyway? Source: Participate. 11(3): 1-3. Fall 2002. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: This newsletter article notes that constipation is one of the most difficult gut symptoms to define. The difficulty lies in the many features of constipation. Since more than 98 percent of people have at least 3 bowel movements per week, less is often invoked as abnormal. Many people happily manage will fewer, while others within that range are decidedly uncomfortable with what they believe is constipation. The author stresses that frequency of defecation cannot be considered in isolation. Other factors of equal importance are the consistency or form of the stool, the effort required to expel it, and the accompany abdominal discomfort and distension. The author also discusses acute versus chronic constipation, and different perspectives of constipation, including those of patients, physicians, and physiologists. 1 figure. 2 tables. 8 references.

Academic Periodicals covering Constipation Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to constipation. In addition to these sources, you can search for articles covering constipation that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical

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periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for constipation. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with constipation. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to constipation: Alosetron •

Systemic - U.S. Brands: Lotronex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500107.html

Glycerin •

Systemic - U.S. Brands: Glyrol; Osmoglyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202263.html

Laxatives •

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202319.html

•

Rectal - U.S. Brands: Bisco-Lax; Ceo-Two; Dacodyl; Deficol; Dulcolax; Fleet Babylax; Fleet Bisacodyl; Fleet Enema; Fleet Enema for Children; Fleet Enema Mineral Oil; Fleet Glycerin Laxative; Fleet Laxative; Sani-Supp; Senokot; Theralax; Therevac Plus; Therevac-SB http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202320.html

Thiamine (Vitamin B 1 ) •

Systemic - U.S. Brands: Biamine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202560.html

Vincristine •

Systemic - U.S. Brands: Oncovin; Vincrex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202594.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to constipation by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “constipation” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for constipation: •

Human Gammaglobulin http://www.rarediseases.org/nord/search/nodd_full?code=1303

•

Methylnaltrexone http://www.rarediseases.org/nord/search/nodd_full?code=9

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA

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through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “constipation” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “constipation” (or synonyms) into the “For these words:” box. The following is a sample result: •

Revisiting IBS: Perspectives for the New Millennium: Special Report Source: New York, NY: McMahon Publishing Group. 2001. 8 p. Contact: Available from Gastroenterology and Endoscopy News. McMahon Publishing Group, 545 W. 45th St., 8th floor, New York, NY 10036 (800) 526-0828. Website: www.mcmahonmed.com. PRICE: $5.00 plus shipping and handling. Summary: Recent discoveries in the field of irritable bowel syndrome (IBS) have important implications for gastroenterologists. Research is underway into functional brain imaging techniques to assess activation of brain regions during visceral stimulation, as well as clinical examinations focusing on the relationship between infection and IBS. This report brings gastroenterologists and primary care practitioners up to date on the current approaches in drug therapy for patients with IBS. The authors explain the use of brain imaging techniques to understand how patients with IBS may be more sensitive to gut stimuli, discuss the theory that an acute outbreak of gastroenteritis may lead to long term chronic IBS, and discuss the latest treatment options that can be use for both IBS and the related abdominal pain and discomfort. Treatments for IBS are targeted to symptoms including abdominal pain, diarrhea, constipation, and bloating. The main choices for patients with pain predominant symptoms include antispasmodics, tricyclic antidepressants, and selective serotonic reuptake inhibitors (SSRIs), and 5HT3 antagonists and 5HT4 agonists. Patients with constipation predominant symptoms would be treated with fiber, laxatives, or 5HT4 agonists; for patients with diarrhea predominant symptoms, opioid agonists, 5HT3 antagonists, and possibly cholestyramine will be used. Each of these treatments is discussed, with the relevant literature briefly reviewed. A posttest is appended, with which readers can qualify for continuing education credits. References are provided in the text of the report.

•

Comprehensive Maternal - Child HIV Management and Research Center Contact: Los Angeles County University of Southern California, Medical Center, Comprehensive Maternal - Child HIV Management and, Research Center, 1640 Marengo St 2nd Fl, Los Angeles, CA, 90089-9260, (323) 226-2200.

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Summary: This handbook describes the services and schedule of the Maternal and Child HIV Clinic of the Comprehensive Maternal- Child HIV Management & Research Center in Los Angeles, CA. It also provides general information on care of children who are HIV positive. It discusses what HIV is, how children and adolescents may get infected, testing, and prevention. Problems associated with HIV infection in children are listed, including cytomegalovirus, thrush, ear or sinus infections, and hepatitis. Guidelines are presented for immunizations, when to call the doctor, and dental care. A section on medical care for HIV-positive children discusses measles and chicken pox, and specifies treatments for fever, vomiting, diarrhea, and constipation. •

Good Nutrition Makes A Difference Contact: Children's Medical Center of Dallas, 1935 Motor St, Dallas, TX, 75235, (214) 6402000. Summary: This manual explains that good nutrition is especially important for people with special needs. It addresses nutrition throughout childhood, focusing on these topics: good nutrition, safe feeding of preschoolers, and the special supplemental food program for women, infants, and children (WIC). After discussing the four major food groups, it suggests nutritious meals for brown bagging to work or school, discusses how to make the food dollar stretch for the most nutritious foods, and explains how to eat defensively to prevent illness. It emphasizes special diets for special situations: nausea and vomiting, constipation and diarrhea, and times when it hurts to eat or food tastes funny. It also provides a section on delicious high-calorie recipes and a basic food groups coloring book.

•

Sensitive Gut: A Harvard Health Letter Special Report Source: Boston, MA: Harvard Medical School Health Publications Group. 1996. 39 p. Contact: Available from Harvard Medical School Health Publications Group. Department GUT, P.O. Box 380, Boston, MA 02117. (617) 432-1485. Fax (617) 432-1506. PRICE: $16.00 (as of 1996); bulk discounts available. Summary: This report focuses on five functional gastrointestinal (GI) disorders: gastroesophageal reflux disease (GERD), nonulcer dyspepsia, irritable bowel syndrome (IBS), constipation, and excessive gas. The author first introduces the anatomy and physiology of the GI tract, emphasizing the process of digestion. The following five sections present a discussion of the definition, causes, diagnosis, and therapy for each of the disorders. Specific topics include the hiatal hernia connection to GERD, antireflux drug therapy, surgery, Helicobacter pylori infection, psychological factors in dyspepsia, the role of stress in IBS, the types of constipation, belching, and flatulence. The report concludes with an overview of recommended good gut hygiene, an appendix summarizing drugs used to treat functional gastrointestinal disorders, and a glossary of terms. 10 figures. 5 tables.

•

AIDS : Palliative Care: UNAIDS Technical Update Contact: World Health Organization, Joint United Nations Programme on HIV/AIDS, 20 Avenue Appia, CH-1211 Geneva, http://www.unaids.org. Summary: This report, for health professionals, governmental agencies, and international organizations, discusses palliative care for individuals with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Palliative care is a combination of therapies with the aim of achieving the best quality of

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life for patients (and their families) suffering from life-threatening and ultimately incurable illnesses. This report describes the following symptoms for people with HIV/AIDS: (1) pain; (2) diarrhea and constipation; (3) nausea, vomiting, anorexia, and weight loss; (4) cough and shortness of breath; (5) malaise, weakness, and fatigue; (6) fever, (7) skin problems; and (8) brain impairment. Psychological support through voluntary testing and counseling, spirituality, preparation for death, challenges HIV/AIDS poses to palliative care, and ways to overcome these challenges are discussed. These challenges include perceptions and recognition of palliative care; organizing palliative care training and; providing quality palliative care services. The report discusses current projects initiatives in Zambia, Uganda, the United Kingdom, Cambodia, and India.

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “constipation” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 9329 303 739 20 1 10392

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “constipation” (or synonyms) at the following Web site: http://text.nlm.nih.gov. 13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 18 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 19

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on constipation can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to constipation. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to constipation. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “constipation”:

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•

Other guides Dietary Fiber http://www.nlm.nih.gov/medlineplus/dietaryfiber.html Diverticulosis and Diverticulitis http://www.nlm.nih.gov/medlineplus/diverticulosisanddiverticulitis.html Infant and Newborn Care http://www.nlm.nih.gov/medlineplus/infantandnewborncare.html Spinal Cord Injuries http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html Toilet Training and Bedwetting http://www.nlm.nih.gov/medlineplus/toilettrainingandbedwetting.html

Within the health topic page dedicated to constipation, the following was listed: •

General/Overviews Constipation Source: American Gastroenterological Association http://www.gastro.org/clinicalRes/brochures/constipation.html

•

Diagnosis/Symptoms Abdominal Pain, Acute: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/527.html Abdominal Pain, Chronic: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/528.html Colonoscopy http://www.nlm.nih.gov/medlineplus/tutorials/colonoscopyloader.html Colonoscopy Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/colonoscopy/index.htm Elimination Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/532.html Flexible Sigmoidoscopy Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/sigmoidoscopy/index.htm Radiography-Lower GI Tract (Barium Enema “BE”) Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/lower_gi.htm

Patient Resources

•

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Treatment Lowdown on Laxatives: Know Your Options Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00088 Psyllium (Fiber Supplement) Source: American Cancer Society http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Psyllium.asp?sitearea= ETO Why Am I Constipated? Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/constipation_ez/index.htm

•

Nutrition Fiber: How to Increase the Amount in Your Diet Source: American Academy of Family Physicians http://familydoctor.org/handouts/099.html

•

Specific Conditions/Aspects Gastrointestinal Complications (PDQ) Source: National Cancer Institute http://www.cancer.gov/cancerinfo/pdq/supportivecare/gastrointestinalcomplica tions/patient/

•

Children Are Your Bowels Moving? Source: Nemours Foundation http://kidshealth.org/kid/stay_healthy/body/bowel.html Constipation in Children Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/index.htm Elimination Problems in Infants and Children: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/533.html Stool Soiling in Children (Encopresis) Source: American Academy of Family Physicians http://familydoctor.org/handouts/166.html

•

From the National Institutes of Health Constipation Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/index.htm

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Organizations American Gastroenterological Association http://www.gastro.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on constipation. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Constipation in Children Source: Flourtown, PA: American Society for Pediatric Gastroenterology, Hepatology and Nutrition. 2003. 1 p. Contact: Available from North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). PO Box 6, Flourtown, PA 19031. (215) 2330808. Fax: (215) 233-3939. Website: www.naspgn.org. PRICE: Full-text available online at no charge; contact organization for print copies. Summary: Constipation is defined as either a decrease in the frequency of bowel movements, or the painful passage of bowel movements. This brief fact sheet considers the problem of constipation in children. The fact sheet defines the condition, outlines etiology (causes), the symptoms that can accompany the constipation (including stomach pain, poor appetite, crankiness) and epidemiology (how common the condition is), then discusses treatment options. Constipation can begin when there are changes in the diet, the time of toilet training, following travel, or after a viral illness. In most cases, there is no need for diagnostic testing prior to treatment for constipation. Treatment of constipation varies according to the source of the problem and the child's age and personality. Some children may only require changes in diet such as an increase in fiber, fresh fruits, or in the amount of water they drink each day. For more information, readers are encouraged to visit www.naspghan.org (the web site of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition).

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Constipation and Encopresis in Children Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders (IFFGD). 1997. 2 p.

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Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $0.50 plus shipping and handling; bulk copies available. Order number: 140. Summary: Constipation or encopresis account for approximately 10 to 25 percent of children who are referred to a pediatric gastroenterologist. This fact sheet reviews the problems of constipation and encopresis (involuntary fecal soiling) in children. The fact sheet first describes the diseases with which the symptom of constipation is associated, also noting the role of diet and evacuation habits in the etiology of constipation problems. All children with constipation, but especially those with encopresis, should be evaluated by their physicians. Evaluation may include a thorough physical examination; blood work to include thyroid, calcium, and lead level; and sometimes a barium enema and anal manometry. Treatment of constipation usually involves two steps. First, enemas are required if there is a stool mass in the rectum. The next step is to use oral medicines to ensure a soft daily bowel movement. Stool softeners, such as mineral oil or lactulose, are frequently used. Diet also plays an important role in the treatment of constipation. Since many of the children in whom constipation is a problem do not have normal rectal sensation, they must be encouraged to sit on the toilet at least two times a day. The best time to sit on the toilet is after a meal, usually after breakfast and after dinner. The fact sheet stresses that by the time constipation is perceived as a problem it has usually been going on for some time. Treatment will take time and patience to be effective. •

Constipation and You Source: Cincinnati, OH: Marion Merrell Dow, Inc. 1990. 3 p. Contact: Available from SmithKline Beecham Consumer Brands. P.O. Box 1467, Pittsburgh, PA 15230. (800) 245-1040. Bulk order available to physicians by calling (800) 233-2426. PRICE: Free. Summary: This booklet is designed to serve as an easy guide to the understanding and treatment of constipation. Guidelines are included to rule out serious causes of constipation (diabetes, uremia, abnormal bowel structure, constipating drugs), and to prevent ordinary constipation with dietary fiber. A commercially available product (Citrucel) for treating constipation also is described.

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Why Am I Constipated? Source: Bethesda, MD: National Digestive Diseases Information Clearinghouse (NDDIC). 1997. 9 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389 or (301) 6543810. Fax (301) 634-0716. E-mail: [email protected]. Website: www.niddk.nih.gov. PRICE: Full-text available online at no charge; single copy free; bulk copies available. Order number: DD-168. Summary: This booklet provides basic information about constipation. The booklet is easy to read and notes that each person's body finds its own normal number of bowel movements, depending on the food eaten, how much exercise is performed, and other factors. Constipation is defined as three bowel movements or fewer per week; the stool is hard and dry and can be painful to pass. The booklet provides suggestions for using food and drink and exercise to relieve and prevent constipation. Suggestions include the

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following: eat more fiber (a list of high fiber foods is provided), drink plenty of water and other liquids, get enough exercise, allow enough time to have a bowel movement, use laxatives only under a doctor's recommendation, and check with a doctor about medications that may contribute to constipation. The booklet includes the contact information for the International Foundation for Bowel Dysfunction and the Intestinal Disease Foundation. The booklet concludes with a brief description of the National Digestive Diseases Information Clearinghouse, a Government agency that provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The booklet is illustrated with colorful graphics. 1 table. •

Relief from Constipation: Recognizing Symptoms, Relieving Discomfort Source: Cincinnati, OH: Procter and Gamble. 1994. 12 p. Contact: Available from Metamucil-Procter and Gamble. P.O. Box 9032, Cincinnati, OH 45209-9970. PRICE: Single copy free; bulk copies available. Summary: This brochure provides a general overview of constipation. Topics include the typical symptoms of constipation; the physiology of the digestive system; the causes of constipation; the role of food and stress in constipation; diagnostic tests used to confirm constipation; treatment and prevention options; the role of a high fiber diet; facts about fiber; and the use of fiber supplements, including the product Metamucil. The brochure is produced by the manufacturer of Metamucil. The brochure includes a reply card to obtain more information about Metamucil products. 2 figures. 1 table.

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Constipation Source: Fort Worth, TX: Konsyl Pharmaceuticals, Inc. 1998. [2 p.]. Contact: Available from Konsyl Pharmaceuticals, Inc. 4200 South Hulen Street, Suite 513, Fort Worth, TX 76109-4912. (800) 356-6795 or (817) 763-8011. Fax (817) 731-9389. Website: www.konsyl.com. PRICE: Single copy free. Summary: This brochure provides basic information about constipation, a symptom and side effect of many diseases. Among Western populations, the range for 'normal' bowel evacuation is as often as two times a day to once every two days. However, as a generalization, five stools weekly may be considered normal. Also considered constipation are straining at the toilet, incomplete evacuation, or stools that are too small or too hard. The four major causes of constipation are lack of adequate water intake, lack of adequate fiber intake, lack of adequate exercise, and use of prescription or over the counter drugs that tend to cause constipation as a side effect. Constipation may also be a problem during pregnancy and among the elderly. The brochure recommends a physical examination and appropriate diagnostic tests to indicate the cause of constipation, then outlines a regimen for modifying diet and lifestyle to address constipation problems. The author discusses the use of fiber supplements, such as Konsyl (the manufacturer of which is the producer of this brochure). The brochure is illustrated with full color drawings and photographs. 1 table. 4 figures.

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Constipation: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1996. 2 p. Contact: Available from American Society of Colon and Rectal Surgeons. 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-

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9184. Fax (847) 290-9203. E-mail: [email protected]. Website: www.fascrs.org. PRICE: Full-text available online at no charge; Single copy free; bulk copies available. Summary: This brochure, from the American Society of Colon and Rectal Surgeons, provides basic information about constipation. Constipation is defined as infrequent bowel movements, but it may also refer to a decrease in the volume or weight of stool, the need to strain to have a movement, a sense of incomplete evacuation, or the need for enemas, suppositories, or laxatives in order to maintain regularity. The brochure provides information about the causes of constipation, how to know when to consult a health care provider, diagnostic tests used to confirm constipation, and treatment options. Common causes of constipation include inadequate fiber and fluid intake, a sedentary lifestyle, environmental changes (including travel), pregnancy, or colon disease. Many medications, including pain killers, antidepressants, tranquilizers, and other psychiatric medications, blood pressure medication, diuretics, iron supplements, calcium supplements, and aluminum-containing antacids can cause or worsen constipation. The brochure stresses that any persistent change in bowel habit, including increase or decrease in frequency or size of stool or an increased difficulty in evacuating, warrants medical advice. Diagnostic tests used include digital examination of the anorectal area, barium xrays, endoscopy, and other physiologic tests. The brochure concludes that the majority of patients with constipation are successfully treated by adding high fiber foods to the diet, along with increased fluids. In some cases, biofeedback may help to retrain poorly functioning anal sphincter muscles. Only in rare circumstances are surgical procedures necessary to treat constipation. (AA-M). •

Interstitial Cystitis and Constipation Source: Rockville, MD: Interstitial Cystitis Association (ICA). 2001. 2 p. Contact: Available from Interstitial Cystitis Association (ICA). 110 N. Washington Street, Suite 340, Rockville, MD 20850. (301) 610-5300. Fax (301) 610-5308. E-mail: [email protected]. Website: www.ichelp.org. PRICE: $1.00 for members; $1.25 for nonmembers. Item number: RFQ01. Summary: This fact sheet describes the interrelationship between constipation and interstitial cystitis (IC), a chronic inflammatory condition of the bladder. The fact sheet considers the possible causes of constipation in IC patients, why constipation can be a concern in patients with IC, methods for alleviating constipation in patients who do not have irritable bowel syndrome (IBS) or who are not coping with medication-related constipation, and methods for alleviating constipation that is related to IBS. Readers are referred to the Interstitial Cystitis Association (www.ichelp.org) for more information. 4 references.

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Treating Diarrhea and Constipation Source: San Bruno, CA: Krames Communications. 1998. 2 p. Contact: Available from Krames Communications. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Fax (415) 244-4512. PRICE: $12.50 for pad of 50 sheets. Summary: This fact sheet provides suggestions on treating diarrhea and constipation in patients receiving chemotherapy and radiation therapy. These side effects occur because the treatment affects normal cells as well as cancer cells. The fact sheet lists tips to control diarrhea: limit the amount of fiber and milk in the diet; eat foods rich in potassium (bananas and oranges); eat small, frequent meals; drink plenty of fluids; and avoid coffee, tea and alcohol. The fact sheet notes that diarrhea may also be helped with

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medication. Advise on when to contact a health care provider is given as are the following strategies to avoid constipation: eat high-fiber foods, drink plenty of fluids, and exercise often. The fact sheet is illustrated with full-color line drawings and includes blank space for notes or special instructions. The fact sheet is one of a series of patient education materials on the complications of cancer treatment. •

Evaluation and Treatment of Constipation Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders. 1994. 4 p. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $0.50. Summary: This fact sheet reviews the evaluation and treatment of constipation, one of the most common gastrointestinal complaints in the United States. Although constipation represents an abnormality of bowel function, the author notes that it is difficult to present a definition of 'normal' bowel function. The author first reviews the physiology of the colon and anorectal area, focusing on the function of the colon in reducing fluid from the digestive tract. Dietary fiber retains water in the stool and is responsible for stools that are bulkier, softer, and easier to pass. Continence is promoted by the pelvic floor muscles and contraction of the internal and external anal sphincters. Both nerves and muscles regulate the transit time of the colon; changes in either element may seriously disturb colonic function. The fact sheet lists conditions associated with constipation (colonic disorders, hormonal changes, and neurological conditions) and medications that may cause constipation. Diagnosis involves a detailed history and physical examination, as well as diagnostic tests that investigate the structure and function of the colon (including endoscopy and anorectal manometry). The management of constipation includes patient education about bowel function and diet, behavior modification, drug therapy, and infrequently, surgery. Patients should be encouraged to exercise regularly, eat a diet high in fiber, and respond to the urge to defecate. Patients should also be educated about laxatives and their side effects. 1 figure. 2 tables. (AA-M).

•

Constipation: Getting Relief Source: San Bruno, CA: StayWell Company. 1998. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail: [email protected]. Website: www.staywell.com. PRICE: $17.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes constipation and its treatment. Written in nontechnical language, the brochure first defines constipation as bowel movements that occur less often than usual or the need to strain to pass hard, dry stool. Symptoms of constipation include a feeling of fullness in the rectum, bloating and gas, feeling the urge but being unable to pass stool, abdominal pain and cramping, and nausea. One of the main causes of constipation is a diet that is too low in dietary fiber and water. Other causes can include travel (and changes in diet and bowel habits), pregnancy, too little exercise, misuse of laxatives, side effects of certain medications, systemic diseases (diabetes or hyperthyroidism, for example), and ignoring the urge to have a bowel movement. Diagnosis will include the patient's medical history and some diagnostic tests such as sigmoidoscopy and barium enema. Most treatment plans focus on increasing dietary fiber, getting regular exercise, and avoiding chronic laxative use. One section of the brochure illustrates and describes the physiology of normal bowel

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movements and what happens in constipation. The last page of the brochure summarizes the recommendations for increasing dietary fiber. The brochure is illustrated with full color line drawings. 7 figures. •

Taking Care of Constipation Source: Santa Cruz, CA: ETR Associates. 1997. 4 p. Contact: Available from ETR Associates. 4 Carbonero Way, Scotts Valley, CA 950664200. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. PRICE: Single copy free; $16.00 for 50 copies, discounts for larger orders. Order number: 005. Summary: This patient education brochure explains the basics of constipation and its treatment. Constipation is defined as hard, dry or painful bowel movements or less than 3 bowel movements per week. The brochure briefly describes the causes of constipation, and stresses three simple actions to prevent problems: get regular exercise, drink plenty of fluids, and eat enough fiber. The brochure explains each of these three steps in detail, and then describes how to make changes in one's diet without striving for perfection. One sidebar lists the most common causes of constipation. Another sidebar notes the recommended amounts of fiber (including USDA, American Dietetic Association, and National Cancer Institute guidelines), the role of fiber in the diets of people who are trying to lose weight, and the use of fiber supplements. The brochure concludes with a list of symptoms for which a health care provider should be consulted. (AA-M).

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Constipation: Keeping Your Bowels Moving Smoothly Source: Kansas City, MO: American Academy of Family Physicians. 1993. 4 p. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. PRICE: $22.00 for 100 copies for members, $33.00 for 100 copies for nonmembers. Summary: This patient education brochure helps readers understand constipation and how they can keep their bowels moving smoothly. Constipation is defined as trouble having bowel movements, with stools that may be very hard, or the feeling that one still needs to have a bowel movement even after having one. The brochure discusses the 'normal' range of bowel movements, the causes of constipation, how constipation is treated, the role of fiber-rich foods, the use of laxatives and problems associated with long-term use of laxatives, bulk-forming laxatives, the use of mineral oil and castor oil, weaning oneself off enema or laxative use, and tips for preventing constipation. The causes of constipation can include drinking enough fluids, not eating enough fiber, not being active enough, taking certain drugs, not going to the bathroom when there is an urge to have a bowel movement, and regular laxative use. The brochure emphasizes that laxative use should usually be avoided. An exception to this is bulk-forming laxatives which work naturally to add bulk and water to the stools so that the stool can pass more comfortably through the intestines. The brochure reiterates the importance of adequate fluid intake and exercise or activity. One table lists fiber-rich foods. 3 tables. (AA-M).

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When Your Child is Constipated Source: American Family Physician. 54(2): 627. August 1996. Summary: This patient education handout helps parents manage their child's constipation. Three sections discuss symptoms; causes; and management options, including diet, bowel habit training, and drug therapy. The handout is designed to be photocopied and distributed to parents by health care providers.

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Constipation, Colonic Inertia, and Colonic Marker Studies Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders (IFFGD). 2000. [4 p.]. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217-8076. (888) 964-2001 or (414) 964-1799. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $1.00 for nonmembers; single copy free to members. Summary: Treatment for the common condition of constipation often includes lifestyle modifications such as increasing fluid intake, consuming more fiber, and exercising regularly. At times, the symptom of constipation can represent serious illness. This fact sheet discusses constipation, colonic inertia, and the colonic marker studies used to diagnose the causes (epidemiology) of constipation. The symptoms of colonic inertia include long delays in the passage of stool accompanied by lack of urgency to move the bowels. Because there are a large number of potential causes for the symptoms of constipation, the physician may perform blood tests looking for systemic disease, as well as a colonoscopy or barium enema to look for intrinsic abnormalities of the colon. A review of medications will help determine if the patient is taking medicines that are affecting the functioning of the colon. In addition, testing of the anorectal function may be performed, including defecography (a radiographic test to identify anatomical defects during defecation) and electromyogram (EMG) to determine if a disorder of this region is present. One sidebar discusses the interplay between functional constipation (the symptoms of constipation present without a known cause) and irritable bowel syndrome (IBS). Another sidebar reviews pelvic floor dyssynergia, the failure of pelvic floor muscles to relax with defecation. The role of biofeedback therapy in the treatment of chronic constipation is emerging. Biofeedback therapy involves training the patient by using special equipment to relax pelvic floor and anal sphincter muscles. Surgical techniques have now been found to be effective in some patients who have colonic inertia. If organic disease is ruled out as the cause, then changes in diet, increased intake of fiber and liquids, and regular exercise can often help. 1 figure. 1 table. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “constipation” (or synonyms). The following was recently posted: •

American Gastroenterological Association medical position statement: guidelines on constipation Source: American Gastroenterological Association - Medical Specialty Society; 2000 May 21 (reviewed 2001); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3061&nbr=2287&a mp;string=constipation

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Constipation in infants and children: evaluation and treatment Source: North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - Professional Association; 1999 November; 15 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3595&nbr=2821&a mp;string=constipation

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Management of constipation Source: University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core - Academic Institution; 1996 (revised 1998 Jun); 49 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1369&nbr=543&am p;string=constipation

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Practice guidelines for the management of constipation in adults Source: Association of Rehabilitation Nurses - Professional Association; 2002; 51 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3687&nbr=2913&a mp;string=constipation The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to constipation. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than patients, you can view the current list of health topics covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to constipation. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with constipation. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about constipation. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “constipation” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “constipation”. Type the following hyperlink into your

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Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “constipation” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “constipation” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

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Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

237

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

238 Constipation

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

239

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on constipation: •

Basic Guidelines for Constipation Constipation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003125.htm

•

Signs & Symptoms for Constipation Abdominal cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Bloating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003123.htm Blood in the stool Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003130.htm

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Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Tenesmus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003131.htm Unexplained weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm •

Diagnostics and Tests for Constipation ANA Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003535.htm Barium enema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003817.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Colonoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003886.htm Proctosigmoidoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003885.htm PT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003652.htm PTT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003653.htm Upper GI series Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003816.htm X-rays of the abdomen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003815.htm

•

Nutrition for Constipation Bulk Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm Coffee Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm Fiber Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002470.htm

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•

Background Topics for Constipation Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Bowel retraining Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003971.htm Endocrine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002351.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Meconium Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002262.htm Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

243

CONSTIPATION DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Administration, Rectal: The insertion of drugs into the rectum, usually for confused or incompetent patients, like children, infants, and the very old or comatose. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids,

244 Constipation

androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergens: Antigen-type substances (hypersensitivity, immediate). [NIH]

that

produce

immediate

hypersensitivity

Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH]

Dictionary 245

Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Angulation: Deviation from the normal long axis, as in a fractured bone healed out of line. [NIH]

Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anionic: Pertaining to or containing an anion. [EU]

246 Constipation

Ankle: That part of the lower limb directly above the foot. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]

Antipruritic: Relieving or preventing itching. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the

Dictionary 247

movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Articular: Of or pertaining to a joint. [EU] Aseptic: Free from infection or septic material; sterile. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atony: Lack of normal tone or strength. [EU] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition,

248 Constipation

or hormonal changes. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autolysis: The spontaneous disintegration of tissues or cells by the action of their own autogenous enzymes. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium enema: A procedure in which a liquid with barium in it is put into the rectum and colon by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Belching: Noisy release of gas from the stomach through the mouth. Also called burping.

Dictionary 249

[NIH]

Belladonna: A species of very poisonous Solanaceous plants yielding atropine (hyoscyamine), scopolamine, and other belladonna alkaloids, used to block the muscarinic autonomic nervous system. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Blackout: A condition characterized by failure of vision and momentary unconsciousness, due to diminished circulation to the brain and the retina. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH]

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Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Burden: The total amount of a chemical, metal or radioactive substance present at any time after absorption in the body of man or animal. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

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Brash: An uneasy burning sensation in the stomach and associated with the eructation of an acid fluid. [NIH] Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Calcineurin: A calcium- and calmodulin-binding protein present in highest concentrations in the central nervous system. Calcineurin is composed of two subunits. A catalytic subunit, calcineurin A, and a regulatory subunit, calcineurin B, with molecular weights of about 60 kD and 19 kD, respectively. Calcineurin has been shown to dephosphorylate a number of phosphoproteins including histones, myosin light chain, and the regulatory subunit of cAMP-dependent protein kinase. It is involved in the regulation of signal transduction and is the target of an important class of immunophilin-immunosuppressive drug complexes in T-lymphocytes that act by inhibiting T-cell activation. EC 3.1.3.-. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Signaling: Signal transduction mechanisms whereby calcium mobilization (from outside the cell or from intracellular storage pools) to the cytoplasm is triggered by external stimuli. Calcium signals are often seen to propagate as waves, oscillations, spikes or puffs. The calcium acts as an intracellular messenger by activating calcium-responsive proteins. [NIH]

Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH]

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Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH]

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Carcinostatic: Pertaining to slowing or stopping the growth of cancer. [NIH] Cardia: That part of the stomach surrounded by the esophagogastric junction, characterized by the lack of acid-forming cells. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Cascara: Component of the dried bark of a buckthorn (Rhamnus purshiana) that contains the anthraquinone emodin. It is used as a laxative. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Castor Oil: Oil obtained from seeds of Ricinus communis that is used as a cathartic and as a plasticizer. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cecostomy: Surgical construction of an opening into the cecum with a tube through the abdominal wall (tube cecostomy) or by skin level approach, in which the cecum is sewn to the surrounding peritoneum. Its primary purpose is decompression of colonic obstruction. [NIH]

Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH]

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Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrovascular Disorders: A broad category of disorders characterized by impairment of blood flow in the arteries and veins which supply the brain. These include cerebral infarction; brain ischemia; hypoxia, brain; intracranial embolism and thrombosis; intracranial arteriovenous malformations; and vasculitis, central nervous system. In common usage, the term cerebrovascular disorders is not limited to conditions that affect the cerebrum, but refers to vascular disorders of the entire brain including the diencephalon;

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brain stem; and cerebellum. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chamomile: Common name for several daisy-like species native to Europe and Western Asia, now naturalized in the United States and Australia. The dried flower-heads of two species, Anthemis nobilis (Chamaemelum nobile) and Matricaria recutita, have specific use as herbs. They are administered as tea, extracts, tinctures, or ointments. Chamomile contains choline, coumarins, cyanogenic glycosides, flavonoids, salicylate derivatives, tannins, and volatile oils. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chloroform: A commonly used laboratory solvent. It was previously used as an anesthetic, but was banned from use in the U.S. due to its suspected carcinogenecity. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholestyramine: Strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium as Cl(-) anion. It exchanges chloride ions with bile salts, thus decreasing their concentration and that of cholesterol. It is used as a hypocholesteremic in diarrhea and biliary obstruction and as an antipruritic. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chondroitin sulfate: The major glycosaminoglycan (a type of sugar molecule) in cartilage. [NIH]

Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis,

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it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Citric Acid: A key intermediate in metabolism. It is an acid compound found in citrus fruits. The salts of citric acid (citrates) can be used as anticoagulants due to their calcium chelating ability. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coal: A natural fuel formed by partial decomposition of vegetable matter under certain environmental conditions. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Coenzymes: Substances that are necessary for the action or enhancement of action of an enzyme. Many vitamins are coenzymes. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Cognitive Therapy: A direct form of psychotherapy based on the interpretation of situations (cognitive structure of experiences) that determine how an individual feels and behaves. It is based on the premise that cognition, the process of acquiring knowledge and forming beliefs, is a primary determinant of mood and behavior. The therapy uses behavioral and

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verbal techniques to identify and correct negative thinking that is at the root of the aberrant behavior. [NIH] Colchicine: A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (periodic disease). [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colonic Inertia: A condition of the colon. Colon muscles do not work properly, causing constipation. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Comatose: Pertaining to or affected with coma. [EU] Common causes of constipation: Problems with the colon and rectum. [NIH] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix

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'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH]

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Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continence: The ability to hold in a bowel movement or urine. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Convulsive: Relating or referring to spasm; affected with spasm; characterized by a spasm or spasms. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the

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internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Coumarins: Synthetic or naturally occurring substances related to coumarin, the deltalactone of coumarinic acid. Coumarin itself occurs in the tonka bean. The various coumarins have a wide range of proposed actions and uses including as anticoagulants, pharmaceutical aids, indicators and reagents, photoreactive substances, and antineoplastic agents. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Criterion: A standard by which something may be judged. [EU] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Culture Media: Any liquid or solid preparation made specifically for the growth, storage, or transport of microorganisms or other types of cells. The variety of media that exist allow for the culturing of specific microorganisms and cell types, such as differential media, selective media, test media, and defined media. Solid media consist of liquid media that have been solidified with an agent such as agar or gelatin. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources,

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including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Abutments: Natural teeth or teeth roots used as anchorage for a fixed or removable denture or other prosthesis (such as an implant) serving the same purpose. [NIH]

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Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Dermatitis: Any inflammation of the skin. [NIH] Descending Colon: The part of the colon where stool is stored. Located on the left side of the abdomen. [NIH] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Devazepide: A derivative of benzodiazepine that acts on the cholecystokinin A (CCKA) receptor to antagonize CCK-8's (sincalide) physiological and behavioral effects, such as pancreatic stimulation and inhibition of feeding. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH]

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Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary tract spasms. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydroxy: AMPA/Kainate antagonist. [NIH] Dilatation: The act of dilating. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Dipeptides: Peptides composed of two amino acid units. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discriminant Analysis: A statistical analytic technique used with discrete dependent variables, concerned with separating sets of observed values and allocating new values. It is sometimes used instead of regression analysis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense

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mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretic: A drug that increases the production of urine. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Domesticated: Species in which the evolutionary process has been influenced by humans to meet their needs. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Dosimetry: All the methods either of measuring directly, or of measuring indirectly and computing, absorbed dose, absorbed dose rate, exposure, exposure rate, dose equivalent, and the science associated with these methods. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

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Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dynorphins: A class of opioid peptides including dynorphin A, dynorphin B, and smaller fragments of these peptides. Dynorphins prefer kappa-opioid receptors (receptors, opioid, kappa) and have been shown to play a role as central nervous system transmitters. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphoria: Disquiet; restlessness; malaise. [EU] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Electroplating: Coating with a metal or alloy by electrolysis. [NIH] Ellagic Acid: A fused four ring compound occurring free or combined in galls. Isolated from

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the kino of Eucalyptus maculata Hook and E. Hemipholia F. Muell. Activates Factor XII of the blood clotting system which also causes kinin release; used in research and as a dye. [NIH]

Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Emetics: Agents that cause vomiting. They may act directly on the gastrointestinal tract, bringing about emesis through local irritant effects, or indirectly, through their effects on the chemoreceptor trigger zone in the postremal area near the medulla. [NIH] Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Emulsions: Colloids of two immiscible liquids where either phase may be either fatty or aqueous; lipid-in-water emulsions are usually liquid, like milk or lotion and water-in-lipid emulsions tend to be creams. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Enteric Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have

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been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bed-wetting, nocturnal enuresis). [EU] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithalamus: The dorsal posterior subdivision of the diencephalon. The epithalamus is generally considered to include the habenular nuclei (habenula) and associated fiber bundles, the pineal body, and the epithelial roof of the third ventricle. The anterior and posterior paraventricular nuclei of the thalamus are included with the thalamic nuclei although they develop from the same pronuclear mass as the epithalamic nuclei and are sometimes considered part of the epithalamus. [NIH] Eructation: The ejection of gas or air through the mouth from the stomach. [NIH] Erythrocyte Indices: Quantification of size and cell hemoglobin content or concentration of the erythrocyte, usually derived from erythrocyte count, blood hemoglobin concentration, and hematocrit. Includes the mean cell volume (MCV), mean cell hemoglobin (MCH), and mean cell hemoglobin concentration (MCHC). Use also for cell diameter and thickness. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethylene Glycol: A colorless, odorless, viscous dihydroxy alcohol. It has a sweet taste, but is poisonous if ingested. Ethylene glycol is the most important glycol commercially available and is manufactured on a large scale in the United States. It is used as an antifreeze and coolant, in hydraulic fluids, and in the manufacture of low-freezing dynamites and resins. [NIH]

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Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exon: The part of the DNA that encodes the information for the actual amino acid sequence of the protein. In many eucaryotic genes, the coding sequences consist of a series of exons alternating with intron sequences. [NIH] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Facial: Of or pertaining to the face. [EU] Faecal: Pertaining to or of the nature of feces. [EU]

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Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feasibility Studies: Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fertilizers: Substances or mixtures that are added to the soil to supply nutrients or to make available nutrients already present in the soil, in order to increase plant growth and productivity. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system.

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It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Food Habits: Acquired or learned food preferences. [NIH] Food Preferences: The selection of one food over another. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gasoline: Volative flammable fuel (liquid hydrocarbons) derived from crude petroleum by processes such as distillation reforming, polymerization, etc. [NIH] Gastrectomy: An operation to remove all or part of the stomach. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating

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food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrointestinal Transit: Passage of food (sometimes in the form of a test meal) through the gastrointestinal tract as measured in minutes or hours. The rate of passage through the intestine is an indicator of small bowel function. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally

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occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycosaminoglycan: A type of long, unbranched polysaccharide molecule. Glycosaminoglycans are major structural components of cartilage and are also found in the cornea of the eye. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Granule: A small pill made from sucrose. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Guinea Pigs: A common name used for the family Caviidae. The most common species is Cavia porcellus which is the domesticated guinea pig used for pets and biomedical research. [NIH]

Gum Arabic: Powdered exudate from various Acacia species, especially A. senegal (Leguminosae). It forms mucilage or syrup in water. Gum arabic is used as a suspending agent, excipient, and emulsifier in foods and pharmaceuticals. [NIH] Gyrus Cinguli: One of the convolutions on the medial surface of the cerebral hemisphere. It surrounds the rostral part of the brain and interhemispheric commissure and forms part of the limbic system. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of

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habit, customary. [EU] Haematemesis: The vomiting of blood. [EU] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels

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of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeopathic remedies: Small doses of medicines, herbs, or both that are believed to stimulate the immune system. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH]

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Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydration: Combining with water. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Breath Test: A test for lactose intolerance. It measures breath samples for too much hydrogen. The body makes too much hydrogen when lactose is not broken down properly in the small intestine. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypersensitivity, Immediate: Hypersensitivity reactions which occur within minutes of exposure to challenging antigen due to the release of histamine which follows the antigenantibody reaction and causes smooth muscle contraction and increased vascular permeability. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to

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cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodiffusion: Technique involving the diffusion of antigen or antibody through a semisolid medium, usually agar or agarose gel, with the result being a precipitin reaction. [NIH]

Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunophilin: A drug for the treatment of Parkinson's disease. [NIH]

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Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Imperforate Anus: A birth defect in which the anal canal fails to develop. The condition is treated with an operation. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Inertia: Inactivity, inability to move spontaneously. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues

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caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inositol 1,4,5-Trisphosphate: Intracellular messenger formed by the action of phospholipase C on phosphatidylinositol 4,5-bisphosphate, which is one of the phospholipids that make up the cell membrane. Inositol 1,4,5-trisphosphate is released into the cytoplasm where it releases calcium ions from internal stores within the cell's endoplasmic reticulum. These calcium ions stimulate the activity of B kinase or calmodulin. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of

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diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestinal Pseudo-Obstruction: Obstruction of the intestines that is functional, not mechanical. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Embolism: The sudden obstruction of a blood vessel by an embolus. [NIH] Intracranial Embolism and Thrombosis: Embolism or thrombosis involving blood vessels which supply intracranial structures. Emboli may originate from extracranial or intracranial sources. Thrombosis may occur in arterial or venous structures. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. [NIH] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells.

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This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lactose Intolerance: The disease state resulting from the absence of lactase enzyme in the musocal cells of the gastrointestinal tract, and therefore an inability to break down the disaccharide lactose in milk for absorption from the gastrointestinal tract. It is manifested by indigestion of a mild nature to severe diarrhea. It may be due to inborn defect genetically conditioned or may be acquired. [NIH] Lactulose: A mild laxative. [NIH] Lanolin: A yellow fat obtained from sheep's wool. It is used as an emollient, cosmetic, and pharmaceutic aid. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lead Poisoning: Disease caused by the gradual accumulation of a significant body burden of lead. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU]

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Ligands: A RNA simulation method developed by the MIT. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Linkage Disequilibrium: Nonrandom association of linked genes. This is the tendency of the alleles of two separate but already linked loci to be found together more frequently than would be expected by chance alone. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loperamide: 4-(p-Chlorophenyl)-4-hydroxy-N.N-dimethyl-alpha,alpha-diphenyl-1piperidine butyramide hydrochloride. Synthetic anti-diarrheal agent with a long duration of action; it is not significantly absorbed from the gut, has no effect on the adrenergic system or central nervous system, but may antagonize histamine and interfere with acetylcholine release locally. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lubricants: Oily or slippery substances. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph

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nodes, that produce and store cells that fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnesium Hydroxide: Magnesium hydroxide (Mg(OH)2). An inorganic compound that occurs in nature as the mineral brucite. It acts as an antacid with cathartic effects. [NIH] Magnesium Oxide: Magnesium oxide (MgO). An inorganic compound that occurs in nature as the mineral periclase. In aqueous media combines quickly with water to form magnesium hydroxide. It is used as an antacid and mild laxative and has many nonmedicinal uses. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Mecamylamine: A nicotinic antagonist that is well absorbed from the gastrointestinal tract and crosses the blood-brain barrier. Mecamylamine has been used as a ganglionic blocker in treating hypertension, but, like most ganglionic blockers, is more often used now as a research tool. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megacolon: Pathological enlargement of the colon. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by

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means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanin: The substance that gives the skin its color. [NIH] Melanosis: Disorders of increased melanin pigmentation that develop without preceding inflammatory disease. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Potentials: Ratio of inside versus outside concentration of potassium, sodium, chloride and other ions in diffusible tissues or cells. Also called transmembrane and resting potentials, they are measured by recording electrophysiologic responses in voltagedependent ionic channels of (e.g.) nerve, muscle and blood cells as well as artificial membranes. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metabotropic: A glutamate receptor which triggers an increase in production of 2 intracellular messengers: diacylglycerol and inositol 1, 4, 5-triphosphate. [NIH] Methacrylate: A vinyl monomer. [NIH] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms

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appear to be similar to those of dextroamphetamine. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micturition: The passage of urine; urination. [EU] Milligram: A measure of weight. A milligram is approximately 450,000-times smaller than a pound and 28,000-times smaller than an ounce. [NIH] Mineral Oil: A mixture of liquid hydrocarbons obtained from petroleum. It is used as laxative, lubricant, ointment base, and emollient. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU]

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Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor Neurons: Neurons which activate muscle cells. [NIH] Motor Skills: Performance of complex motor acts. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Muscarine: A toxic alkaloid found in Amanita muscaria (fly fungus) and other fungi of the Inocybe species. It is the first parasympathomimetic substance ever studied and causes profound parasympathetic activation that may end in convulsions and death. The specific antidote is atropine. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myenteric: On stimulation of an intestinal segment, the segment above contracts and that below relaxes. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH]

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Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural Pathways: Neural tracts connecting one part of the nervous system with another. [NIH]

Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to

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stimulation of the nervous system. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by

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volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonulcer Dyspepsia: Constant pain or discomfort in the upper GI tract. Symptoms include burning, nausea, and bloating, but no ulcer. Possibly caused by muscle spasms. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleolus: A small dense body (sub organelle) within the nucleus of eukaryotic cells, visible by phase contrast and interference microscopy in live cells throughout interphase. Contains RNA and protein and is the site of synthesis of ribosomal RNA. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Assessment: Evaluation of the nature and extent of nursing problems presented by a patient for the purpose of patient care planning. [NIH] Nursing Process: The sum total of nursing activities which includes assessment (identifying needs), intervention (ministering to needs), and evaluation (validating the effectiveness of the help given). [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH]

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Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opioid Peptides: The endogenous peptides with opiate-like activity. The three major classes currently recognized are the enkephalins, the dynorphins, and the endorphins. Each of these families derives from different precursors, proenkephalin, prodynorphin, and proopiomelanocortin, respectively. There are also at least three classes of opioid receptors, but the peptide families do not map to the receptors in a simple way. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orlistat: A lipase inhibitor used for weight loss. Lipase is an enzyme found in the bowel that assists in lipid absorption by the body. Orlistat blocks this enzyme, reducing the amount of fat the body absorbs by about 30 percent. It is known colloquially as a "fat blocker." Because more oily fat is left in the bowel to be excreted, Orlistat can cause an oily anal leakage and fecal incontinence. Orlistat may not be suitable for people with bowel conditions such as irritable bowel syndrome or Crohn's disease. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal

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osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a direct-acting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paraneoplastic syndrome: A group of symptoms that may develop when substances released by some cancer cells disrupt the normal function of surrounding cells and tissue. [NIH]

Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH]

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Patient Care Planning: Usually a written medical and nursing care program designed for a particular patient. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

PDQ: Physician Data Query. PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information is available on the CancerNet Web site, and more specific information about PDQ can be found at http://cancernet.nci.nih.gov/pdq.html. [NIH] Pediatric Gastroenterologist: A doctor who treats children with digestive diseases. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penicillin: An antibiotic drug used to treat infection. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs

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are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacodynamics: The study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of actions and effects of drugs with their chemical structure; also, such effects on the actions of a particular drug or drugs. [EU] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenolphthalein: An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phobias: An exaggerated and invariably pathological dread of some specific type of stimulus or situation. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and

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function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH]

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Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Pollen: The male fertilizing element of flowering plants analogous to sperm in animals. It is released from the anthers as yellow dust, to be carried by insect or other vectors, including wind, to the ovary (stigma) of other flowers to produce the embryo enclosed by the seed. The pollens of many plants are allergenic. [NIH] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH]

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Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Povidone: A polyvinyl polymer of variable molecular weight; used as suspending and dispersing agent and vehicle for pharmaceuticals; also used as blood volume expander. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Proctectomy: An operation to remove the rectum. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Pro-Opiomelanocortin: A precursor protein, MW 30,000, synthesized mainly in the anterior pituitary gland but also found in the hypothalamus, brain, and several peripheral tissues. It incorporates the amino acid sequences of ACTH and beta-lipotropin. These two hormones, in turn, contain the biologically active peptides MSH, corticotropin-like intermediate lobe peptide, alpha-lipotropin, endorphins, and methionine enkephalin. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH]

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Prophylaxis: An attempt to prevent disease. [NIH] Propulsive: Tending or having power to propel; driving onward or forward; impelling to action or motion. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or

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vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Pyloric Stenosis: Obstruction of the pyloric canal. [NIH]

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Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego

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function. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Nicotinic: One of the two major classes of cholinergic receptors. Nicotinic receptors were originally distinguished by their preference for nicotine over muscarine. They are generally divided into muscle-type and neuronal-type (previously ganglionic) based on pharmacology, molecular biology, and biophysical properties of the channels. [NIH] Receptors, Opioid: Cell membrane proteins that bind opioids and trigger intracellular changes which influence the behavior of cells. The endogenous ligands for opioid receptors in mammals include three families of peptides, the enkephalins, endorphins, and dynorphins. The receptor classes include mu, delta, and kappa receptors. Sigma receptors bind several psychoactive substances, including certain opioids, but their endogenous ligands are not known. [NIH] Receptors, Opioid, kappa: A class of opioid receptors recognized by its pharmacological profile. Kappa opioid receptors bind dynorphins with a higher affinity than endorphins which are themselves preferred to enkephalins. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Reconstitution: 1. A type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. The restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Prolapse: Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of

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treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Resected: Surgical removal of part of an organ. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Ristocetin: An antibiotic mixture of two components, A and B, obtained from Nocardia lurida (or the same substance produced by any other means). It is no longer used clinically because of its toxicity. It causes platelet agglutination and blood coagulation and is used to assay those functions in vitro. [NIH]

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Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Ryanodine: Insecticidal alkaloid isolated from Ryania speciosa; proposed as a myocardial depressant. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH]

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Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Sella: A deep depression in the shape of a Turkish saddle in the upper surface of the body of the sphenoid bone in the deepest part of which is lodged the hypophysis cerebri. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septal Nuclei: Neural nuclei situated in the septal region. They have afferent and cholinergic efferent connections with a variety of forebrain and brainstem areas including the hippocampus, the lateral hypothalamus, the tegmentum, and the amygdala. Included are the dorsal, lateral, medial, and triangular septal nuclei, septofimbrial nucleus, nucleus of diagonal band, nucleus of anterior commissure, and the nucleus of stria terminalis. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as

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the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Sincalide: A polypeptide hormone present in the intestine and brain. When secreted from the gastric mucosa, it stimulates the release of both bile from the gallbladder, and the release of digestive enzymes from the pancreas. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH]

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Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somnolence: Sleepiness; also unnatural drowsiness. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU]

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Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Stercoral: Fecal. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU]

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Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Submucous: Occurring beneath the mucosa or a mucous membrane. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sulfuric acid: A strong acid that, when concentrated is extemely corrosive to the skin and mucous membranes. It is used in making fertilizers, dyes, electroplating, and industrial explosives. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic

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discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic pressure: The highest pressure to which blood pressure rises with the contraction of the ventricles. [NIH] Tachykinins: A family of biologically active peptides sharing a common conserved Cterminal sequence, -Phe-X-Gly-Leu-Met-NH2, where X is either an aromatic or a branched aliphatic amino acid. Members of this family have been found in mammals, amphibians, and mollusks. Tachykinins have diverse pharmacological actions in the central nervous system and the cardiovascular, genitourinary, respiratory, and gastrointestinal systems, as well as in glandular tissues. This diversity of activity is due to the existence of three or more subtypes of tachykinin receptors. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Telencephalon: Paired anteriolateral evaginations of the prosencephalon plus the lamina terminalis. The cerebral hemispheres are derived from it. Many authors consider cerebrum a synonymous term to telencephalon, though a minority include diencephalon as part of the cerebrum (Anthoney, 1994). [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups.

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[NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tobacco Use Cessation: Cessation of the habit of using tobacco products for smoking or chewing, including the use of snuff. [NIH] Toilet Facilities: Facilities provided for human excretion, often with accompanying handwashing facilities. [NIH] Toilet Training: Conditioning to defecate and urinate in culturally acceptable places. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH]

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Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicologic: Pertaining to toxicology. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH]

Dictionary 309

Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tubocurarine: A neuromuscular blocker and active ingredient in curare; plant based alkaloid of Menispermaceae. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in

310 Constipation

the bladder, and leaves the body through the urethra. [NIH] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Villous: Of a surface, covered with villi. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH]

Dictionary 311

Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] War: Hostile conflict between organized groups of people. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

312 Constipation

Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

313

INDEX A Abdomen, 240, 243, 249, 250, 256, 261, 266, 278, 280, 290, 304, 307, 311 Abdominal Cramps, 201, 243 Aberrant, 53, 243, 256 Acetylcholine, 26, 159, 160, 243, 254, 280, 286 Acetylcholinesterase, 39, 47, 243 Acrylonitrile, 243, 300 Actin, 243, 284, 285 Action Potentials, 17, 243 Adaptation, 243, 292 Adenosine, 243, 292 Adjunctive Therapy, 20, 243 Adjuvant, 243, 270 Administration, Rectal, 147, 243 Adolescence, 61, 243, 290 Adrenal Cortex, 243, 259 Adrenal Medulla, 244, 252, 266, 287 Adrenergic, 26, 244, 247, 263, 266, 280, 305 Adverse Effect, 6, 35, 156, 157, 177, 244, 255, 302 Affinity, 37, 161, 183, 244, 255, 261, 298, 303 Agar, 146, 244, 259, 275 Agonist, 11, 27, 82, 181, 244, 263, 285, 286 Algorithms, 7, 23, 192, 244, 249 Alimentary, 5, 10, 11, 13, 46, 51, 54, 55, 59, 66, 75, 78, 82, 112, 118, 119, 169, 244, 262 Alkaline, 149, 180, 244, 248, 251, 291 Alkaloid, 140, 244, 248, 251, 256, 283, 284, 286, 289, 300, 309 Alleles, 144, 244, 280 Allergens, 164, 165, 244 Aloe, 128, 131, 132, 169, 173, 244 Alpha Particles, 244, 297 Alternative medicine, 199, 244 Aluminum, 15, 225, 245 Alveoli, 245, 261 Ameliorated, 191, 245 Ameliorating, 6, 245 Amino Acid Sequence, 245, 246, 267, 294 Amino Acids, 158, 180, 245, 290, 293, 295, 299, 305, 308, 309 Amphetamine, 245, 261 Ampulla, 245, 265 Amygdala, 245, 280, 301 Anaesthesia, 245, 276

Anal Fissure, 19, 245 Analgesic, 19, 31, 39, 152, 161, 177, 181, 184, 245, 255, 265, 283, 288, 308 Analog, 27, 31, 168, 169, 245 Analogous, 245, 293, 308 Anastomosis, 17, 196, 245 Anatomical, 7, 12, 25, 26, 72, 168, 228, 245, 247, 250, 276, 300 Angulation, 167, 245 Animal model, 19, 34, 43, 245 Anionic, 146, 147, 245 Ankle, 246, 310 Anorectal, 8, 14, 19, 21, 22, 23, 34, 59, 61, 64, 72, 81, 83, 85, 105, 112, 113, 119, 167, 198, 200, 225, 226, 228, 246 Anorexia, 160, 168, 182, 183, 216, 246, 269 Antagonism, 32, 37, 182, 246, 255 Antibacterial, 246, 304, 310 Antibiotic, 193, 246, 290, 299, 304 Antibodies, 144, 246, 272, 275, 292 Antibody, 180, 244, 246, 256, 259, 272, 273, 274, 275, 276, 279, 281, 283, 297, 304, 311 Anticholinergic, 169, 246, 292 Anticoagulant, 246, 295 Antidepressant, 32, 140, 246, 251 Antigen, 244, 246, 257, 273, 274, 275, 276, 281 Antihypertensive, 149, 246 Anti-infective, 246, 274, 302 Anti-inflammatory, 18, 19, 161, 184, 246, 289, 300 Antineoplastic, 246, 259, 310 Antineoplastic Agents, 246, 259, 310 Antipruritic, 246, 254 Antipsychotic, 246, 255, 286 Antispasmodic, 247, 262, 288 Antitussive, 247, 288 Anus, 11, 65, 145, 245, 246, 247, 248, 250, 265, 268, 273, 278, 290, 298 Anxiety, 24, 41, 55, 103, 121, 160, 163, 170, 182, 183, 198, 247, 289 Aponeurosis, 247, 269 Aqueous, 153, 247, 248, 259, 265, 274, 281 Arachidonic Acid, 247, 295 Arginine, 247, 286 Aromatic, 37, 144, 183, 247, 291, 305, 306 Arrhythmia, 183, 247, 310

314 Constipation

Arterial, 180, 247, 250, 253, 258, 274, 278, 295, 306 Arteries, 247, 250, 253, 258, 283, 284, 296 Arteriovenous, 247, 253 Articular, 247, 288 Aseptic, 247, 288, 304 Assay, 46, 247, 275, 299 Astringents, 247, 267, 282 Atmospheric Pressure, 247, 274 Atony, 168, 169, 247 Atopic, 149, 179, 247 Atrial, 247, 258, 309 Atrioventricular, 247, 258 Atrium, 247, 258, 309, 310 Atrophy, 39, 67, 247 Atropine, 90, 94, 132, 248, 249, 284 Attenuation, 13, 248 Atypical, 5, 248, 255 Autoimmune disease, 180, 248, 284 Autolysis, 179, 248 Autonomic Nervous System, 15, 41, 146, 160, 248, 249, 290, 303, 305 Autonomic Neuropathy, 12, 39, 43, 248 B Bacillus, 149, 248 Bacteria, 29, 246, 248, 261, 265, 266, 268, 283, 304, 308, 310 Bactericidal, 248, 266 Bacteriophage, 248, 308 Bacterium, 29, 248 Barium, 4, 7, 19, 83, 220, 223, 225, 226, 228, 240, 248 Barium enema, 4, 7, 19, 83, 223, 226, 228, 240, 248 Basal Ganglia, 160, 247, 248, 269, 280 Base, 25, 42, 146, 155, 248, 260, 279, 283, 291 Belching, 215, 248 Belladonna, 248, 249 Benign, 121, 249, 252, 269, 272, 297 Benzene, 182, 249 Bifida, 249 Bile, 249, 254, 269, 270, 276, 280, 302, 304 Bile Acids, 249, 270, 304 Biliary, 249, 254, 262 Binding Sites, 159, 249 Bioavailability, 27, 39, 249 Biochemical, 33, 42, 155, 162, 178, 244, 249, 288, 291, 301 Biological therapy, 249, 271 Biopsy, 22, 77, 83, 249 Biosynthesis, 33, 247, 249

Biotechnology, 44, 188, 199, 213, 249 Blackout, 19, 249 Bladder, 25, 30, 193, 225, 248, 249, 259, 276, 284, 286, 295, 309, 310 Bloating, 10, 14, 19, 22, 82, 154, 161, 162, 163, 192, 214, 226, 239, 249, 270, 276, 279, 287 Blood Cell Count, 4, 249, 272 Blood Coagulation, 249, 250, 251, 299, 307 Blood Glucose, 35, 150, 250, 272, 277 Blood Platelets, 250, 301 Blood pressure, 147, 156, 157, 225, 246, 250, 254, 262, 269, 274, 283, 296, 303, 306 Blood vessel, 250, 251, 252, 253, 258, 265, 267, 270, 273, 278, 279, 302, 303, 304, 307, 310 Blood Volume, 250, 294 Blood-Brain Barrier, 155, 179, 250, 281, 285, 292 Body Burden, 250, 279 Body Fluids, 250, 263, 303 Body Regions, 250, 256 Bolus, 14, 250 Bolus infusion, 250 Bone Marrow, 249, 250, 275, 280, 283 Brachytherapy, 83, 250, 278, 279, 297, 311 Bradykinin, 250, 286 Brain Ischemia, 250, 253 Brain Stem, 250, 253, 254 Branch, 237, 250, 264, 289, 303, 305, 307 Brash, 168, 251 Breakdown, 16, 251, 262, 269 Bronchitis, 251, 267 Bulimia, 121, 160, 251 Bupropion, 27, 251 C Calcineurin, 28, 251 Calcium, 28, 41, 92, 96, 99, 100, 148, 201, 223, 225, 251, 255, 256, 277, 289, 302, 310 Calcium channel blocker, 251, 310 Calcium Signaling, 28, 251 Calmodulin, 28, 251, 277 Caloric intake, 23, 251 Capsaicin, 162, 251 Capsules, 146, 170, 251, 263, 268, 270 Carbohydrate, 148, 251, 293 Carbon Dioxide, 251, 299, 310 Carcinogenesis, 149, 251 Carcinogenic, 169, 249, 252, 277, 294, 304 Carcinogens, 252, 288 Carcinoid, 81, 252 Carcinoma, 168, 252

Index 315

Carcinostatic, 182, 252 Cardia, 160, 252 Cardiac, 42, 132, 162, 252, 258, 266, 267, 284, 289, 304 Cardiovascular, 144, 150, 160, 182, 183, 245, 248, 252, 262, 301, 303, 306 Cardiovascular System, 160, 248, 252, 262 Carotene, 99, 132, 137, 252 Cascara, 133, 169, 173, 252 Case report, 15, 55, 252, 255 Castor Oil, 170, 176, 227, 252 Catecholamine, 252, 263, 291 Catheters, 39, 81, 252, 276, 278 Caudal, 252, 262, 274, 293 Causal, 149, 252 Cecostomy, 65, 72, 252 Cecum, 252, 279 Cell Cycle, 252, 255 Cell Differentiation, 253, 302 Cell Division, 248, 252, 253, 271, 281, 292, 294 Cell membrane, 29, 41, 253, 261, 269, 277, 292, 298 Cell proliferation, 253, 302 Cell Respiration, 253, 299 Cell Survival, 253, 271 Cellobiose, 253 Cellulose, 176, 253, 292 Central Nervous System Infections, 253, 272 Centrifugation, 180, 253, 272 Cerebellum, 253, 254 Cerebral, 149, 160, 248, 250, 253, 254, 260, 266, 267, 271, 289, 296, 297, 303, 306, 307 Cerebral Infarction, 253 Cerebral Palsy, 253, 303 Cerebrovascular, 182, 183, 253 Cerebrovascular Disorders, 182, 183, 253 Cerebrum, 253, 254, 306 Chamomile, 173, 254 Character, 254, 260 Chemoreceptor, 247, 254, 265 Chemotherapy, 67, 161, 225, 254 Chest Pain, 48, 162, 254 Chloroform, 172, 254 Cholecystokinin, 73, 254, 261 Cholesterol, 122, 150, 159, 180, 194, 249, 254, 258, 304 Cholestyramine, 214, 254 Choline, 243, 254 Cholinergic, 247, 254, 286, 298, 301 Chondroitin sulfate, 100, 254

Chromosome, 254, 272, 280 Chronic Disease, 29, 163, 254 CIS, 156, 157, 161, 254 Cisplatin, 182, 254 Citric Acid, 153, 255 Citrus, 255 Clinical Medicine, 65, 255, 294 Clinical study, 255, 258 Clinical trial, 24, 36, 39, 139, 140, 174, 213, 255, 258, 284, 290, 295, 297 Cloning, 30, 144, 249, 255 Clozapine, 55, 255 Coagulation, 249, 255, 273 Coal, 249, 255 Codeine, 144, 255, 288 Coenzymes, 255, 286 Cofactor, 255, 295, 307 Cognition, 160, 255, 286 Cognitive restructuring, 30, 255, 304 Cognitive Therapy, 30, 255 Colchicine, 51, 85, 162, 256 Colectomy, 16, 17, 23, 51, 52, 58, 66, 73, 76, 186, 256 Colic, 158, 188, 256 Colitis, 25, 51, 65, 148, 179, 187, 189, 256, 279 Collagen, 256, 270, 292 Collapse, 251, 256 Colonic Inertia, 13, 14, 16, 20, 21, 22, 51, 197, 228, 256 Colonoscopy, 4, 220, 228, 240, 256 Colorectal, 17, 51, 60, 77, 90, 94, 120, 121, 169, 201, 256 Colorectal Cancer, 121, 169, 256 Colostomy, 11, 186, 256 Comatose, 243, 256 Common causes of constipation, 21, 225, 227, 256 Communis, 252, 256 Complement, 256, 257, 270 Complementary and alternative medicine, 103, 104, 137, 257 Complementary medicine, 104, 257 Computational Biology, 213, 257 Concomitant, 6, 152, 156, 157, 257 Cone, 257, 305 Confusion, 257, 262, 274, 286, 309 Congestion, 145, 163, 247, 257 Congestive heart failure, 148, 257 Connective Tissue, 191, 250, 256, 257, 268, 269, 270 Connective Tissue Cells, 257

316 Constipation

Consciousness, 144, 245, 257, 260, 263 Constriction, 257, 279 Consultation, 192, 257 Consumption, 5, 34, 35, 93, 98, 120, 148, 150, 151, 170, 171, 202, 257, 269, 287, 289 Contamination, 145, 258 Continence, 7, 22, 23, 25, 29, 33, 48, 49, 61, 65, 84, 91, 94, 95, 98, 105, 119, 185, 226, 258 Contractility, 29, 39, 154, 258 Contraindications, ii, 258 Control group, 24, 37, 258, 297 Controlled clinical trial, 75, 104, 258 Controlled study, 18, 34, 40, 70, 106, 258 Conventional therapy, 258 Conventional treatment, 20, 162, 258 Convulsive, 160, 258 Coordination, 31, 253, 258, 284 Cor, 145, 258, 294 Coronary, 147, 258, 283, 284 Coronary heart disease, 147, 258 Coronary Thrombosis, 258, 283, 284 Cortex, 127, 133, 160, 258, 259, 267, 273, 297 Cortical, 259, 267, 301 Corticosteroids, 165, 259 Cortisol, 56, 259 Coumarins, 254, 259 Cranial, 253, 259, 272, 290 Craniocerebral Trauma, 259, 272 Criterion, 47, 259 Crowns, 259, 261 Culture Media, 244, 259 Curative, 259, 286, 307 Cyclic, 33, 166, 251, 259, 271, 286, 295, 300 Cysteine, 259, 305 Cystitis, 225, 259 Cytokines, 184, 259 Cytomegalovirus, 215, 259 Cytoplasm, 251, 253, 259, 271, 277, 283, 299 Cytotoxic, 33, 251, 259, 297, 302 Cytotoxicity, 255, 259 D Data Collection, 12, 24, 259 Databases, Bibliographic, 213, 260 De novo, 79, 260 Decompression, 252, 260 Decubitus, 260, 302 Decubitus Ulcer, 260, 302 Degenerative, 35, 260, 273, 288 Dehydration, 16, 260

Delirium, 67, 246, 260 Delivery of Health Care, 260, 272 Delusions, 260, 296 Dementia, 8, 159, 160, 182, 183, 246, 260 Dendrites, 260, 286 Density, 26, 35, 152, 253, 260, 288, 293 Dental Abutments, 260, 261 Dental Care, 215, 261 Dental Caries, 261, 268 Dentition, 201, 261 Dentures, 16, 261 Depolarization, 28, 261, 302 Dermatitis, 149, 165, 179, 261, 264 Descending Colon, 146, 261 Desipramine, 32, 140, 261 Detergents, 261, 302 Detoxification, 147, 261 Deuterium, 261, 274 Devazepide, 177, 261 Dextroamphetamine, 245, 261, 283 Diabetes Insipidus, 261, 293 Diabetes Mellitus, 12, 35, 182, 183, 261, 271, 272, 293 Diagnostic procedure, 143, 199, 261 Dialyzer, 261, 272 Diaphragm, 262, 273 Diarrhoea, 46, 51, 84, 85, 161, 162, 187, 188, 189, 262, 269 Diastole, 262 Diastolic, 147, 262, 274 Diastolic pressure, 147, 262, 274 Dicyclomine, 262 Diencephalon, 253, 262, 266, 274, 306, 307 Dietary Fiber, 4, 14, 15, 16, 19, 109, 150, 158, 179, 193, 220, 223, 226, 262 Dietitian, 22, 139, 262 Digestive system, 141, 150, 158, 173, 194, 224, 262, 270 Digestive tract, 158, 168, 195, 226, 248, 262, 302 Dihydroxy, 262, 266 Dilatation, 61, 168, 262, 294 Dimethyl, 262, 280 Dipeptides, 148, 262 Diploid, 262, 292 Direct, iii, 5, 12, 33, 149, 153, 155, 178, 205, 255, 262, 263, 289, 298, 306 Discriminant Analysis, 66, 262 Disinfectant, 262, 266 Disorientation, 257, 260, 262 Dissection, 29, 262 Dissociation, 244, 262

Index 317

Distal, 26, 75, 263, 270, 296 Diuretic, 148, 176, 180, 263, 303 Dizziness, 160, 263 Domesticated, 263, 271 Dopamine, 27, 160, 245, 247, 251, 255, 261, 263, 291 Dorsal, 33, 263, 266, 293, 301 Dorsum, 263, 269 Dosage Forms, 172, 263 Dosimetry, 83, 263 Drug Interactions, 206, 207, 263 Drug Resistance, 161, 263 Drug Tolerance, 263, 307 Duct, 245, 263, 267, 276, 300 Duodenal Ulcer, 154, 168, 263 Duodenum, 168, 249, 263, 264, 265, 269, 289, 304 Dyes, 264, 305 Dynorphins, 27, 264, 288, 298 Dyskinesia, 160, 182, 183, 247, 264 Dyspepsia, 57, 59, 154, 156, 157, 162, 168, 215, 264, 276 Dysphoria, 27, 264 Dysphoric, 28, 264 Dysplasia, 43, 57, 77, 115, 162, 264 Dyspnea, 24, 67, 264 Dystonia, 116, 247, 264 E Eating Disorders, 160, 163, 165, 182, 183, 264 Ectopic, 65, 264 Eczema, 163, 264 Edema, 54, 264 Effector, 243, 256, 264, 286 Effector cell, 264, 286 Electrocardiogram, 13, 264 Electrolyte, 66, 67, 70, 93, 97, 260, 264, 293, 303 Electromyography, 14, 22, 81, 106, 264 Electrons, 248, 264, 278, 297 Electrophysiological, 28, 29, 38, 264 Electroplating, 264, 305 Ellagic Acid, 154, 264 Embryo, 253, 265, 268, 276, 293 Emesis, 156, 157, 182, 265 Emetics, 161, 265 Emodin, 244, 252, 265 Emollient, 170, 265, 279, 283, 287 Empiric, 23, 265 Emulsions, 244, 265 Encapsulated, 146, 147, 170, 265 Endocrine System, 265, 285

Endometrium, 265, 282 Endorphin, 145, 265 Endoscope, 265 Endoscopic, 72, 196, 256, 265, 302 Endoscopy, 66, 72, 80, 85, 93, 97, 214, 225, 226, 265 Endothelial cell, 250, 265, 307 Endothelium, 265, 286 Endothelium-derived, 265, 286 Endotoxin, 184, 265 Enema, 11, 48, 65, 71, 206, 220, 227, 265 Enkephalin, 145, 265, 294 Enteric Nervous System, 5, 28, 78, 265 Enuresis, 83, 265 Environmental Exposure, 266, 288 Environmental Health, 212, 214, 266 Enzymatic, 33, 251, 252, 257, 261, 266, 273 Enzyme Inhibitors, 148, 266 Epidemiological, 48, 266 Epigastric, 168, 266, 289 Epinephrine, 244, 263, 266, 287, 309 Epithalamus, 262, 266, 280 Eructation, 251, 266 Erythrocyte Indices, 249, 266 Erythrocytes, 249, 250, 266 Esophageal, 154, 156, 157, 168, 266, 270 Esophagitis, 154, 168, 266, 270 Esophagus, 29, 145, 262, 266, 270, 272, 280, 291, 298, 304 Ethanol, 180, 266, 268 Ethylene Glycol, 181, 266 Eucalyptus, 155, 265, 267 Eukaryotic Cells, 267, 276, 287, 288 Euphoria, 161, 267 Evacuation, 10, 20, 21, 26, 39, 58, 75, 76, 117, 200, 223, 224, 225, 257, 267, 269, 279, 296 Evoke, 267, 304 Excipient, 169, 267, 271 Excitability, 28, 267, 285 Excitation, 28, 29, 41, 254, 267 Excitatory, 26, 28, 29, 81, 267, 271 Exhaustion, 246, 267 Exocrine, 254, 267, 289 Exogenous, 144, 264, 267 Exon, 31, 37, 267 Expander, 267, 294 Expiration, 267, 299 External-beam radiation, 267, 278, 297, 311 Extracellular, 29, 257, 267, 303 Extracellular Matrix, 257, 267

318 Constipation

Extraction, 172, 180, 267 Extrapyramidal, 160, 247, 263, 267 Exudate, 267, 271, 288 F Facial, 30, 267, 303 Faecal, 46, 57, 62, 67, 69, 70, 84, 92, 93, 96, 97, 113, 115, 262, 267 Family Planning, 213, 268 Family Practice, 56, 60, 64, 74, 87, 268 Fat, 194, 247, 250, 252, 258, 260, 268, 279, 280, 284, 288, 303 Fatigue, 42, 50, 163, 216, 268, 272 Fatty acids, 19, 148, 268, 295, 302 Feasibility Studies, 42, 268 Fecal Incontinence, 7, 8, 11, 19, 22, 26, 33, 43, 44, 48, 52, 61, 65, 74, 77, 79, 82, 106, 109, 113, 114, 119, 186, 198, 268, 276, 288 Feces, 176, 257, 265, 267, 268, 304 Fentanyl, 90, 95, 144, 268 Fermentation, 149, 268 Fertilizers, 268, 305 Fetal Development, 152, 268 Fetus, 268, 294, 310 Fibrosis, 174, 268, 300 Filler, 158, 268 Fistula, 268, 269 Flatulence, 13, 162, 215, 268 Flatus, 154, 268, 269 Flavoring Agents, 267, 268 Fluorine, 166, 268 Fluoroscopy, 14, 268 Folate, 171, 268, 269 Folic Acid, 268 Food Habits, 5, 269 Food Preferences, 269 Forearm, 250, 269 G Gallbladder, 73, 187, 192, 243, 249, 254, 262, 269, 270, 302 Gamma Rays, 269, 297 Ganglia, 33, 160, 243, 265, 269, 285, 290, 305 Ganglion, 60, 269 Ganglionic Blockers, 269, 281 Gap Junctions, 269, 306 Gasoline, 249, 269 Gastrectomy, 65, 269 Gastric, 40, 58, 75, 154, 160, 168, 175, 263, 269, 270, 272, 273, 290, 302 Gastric Acid, 160, 269 Gastric Emptying, 58, 154, 269, 270 Gastrin, 269, 273

Gastritis, 168, 269 Gastroduodenal, 168, 269 Gastroenteritis, 214, 269 Gastroesophageal Reflux, 41, 122, 154, 215, 270 Gastroesophageal Reflux Disease, 41, 122, 154, 215, 270 Gastrointestinal Transit, 18, 178, 270 Gastroparesis, 156, 157, 270 Gelatin, 146, 259, 270, 305 Gene, 30, 33, 144, 188, 244, 249, 270, 288, 292 Generator, 145, 270 Genetic Engineering, 249, 255, 270 Genetics, 270, 290 Genital, 248, 270 Genitourinary, 270, 306 Genotype, 270, 291 Geriatric, 61, 93, 97, 118, 187, 270 Germ Cells, 270, 281, 289, 303 Gland, 243, 244, 270, 289, 292, 295, 300, 304, 307 Glomerulus, 270, 285 Glucose, 35, 43, 155, 250, 253, 261, 270, 271, 272, 274, 277, 303 Glucose Intolerance, 261, 271 Glutamate, 271, 282 Glycosaminoglycan, 254, 271 Gonad, 271 Gonadal, 144, 271, 304 Gout, 256, 271 Governing Board, 271, 294 Grade, 194, 271 Graft, 271, 273 Granule, 271, 299 Granulocytes, 271, 302, 311 Gravis, 271, 285 Growth, 29, 151, 171, 184, 243, 246, 252, 253, 259, 268, 271, 281, 288, 292, 300, 307, 309 Growth factors, 184, 271 Guanylate Cyclase, 271, 286 Guinea Pigs, 29, 271 Gum Arabic, 159, 271 Gyrus Cinguli, 271, 280 H Habitual, 104, 189, 254, 271 Haematemesis, 265, 272 Handwashing, 272, 307 Haploid, 272, 292 Haptens, 244, 272 Headache, 13, 68, 272, 274

Index 319

Headache Disorders, 272 Health Care Costs, 32, 272 Health Expenditures, 272 Heart attack, 147, 272 Heart failure, 42, 272 Heartburn, 43, 122, 154, 187, 188, 272, 273, 276 Hematocrit, 249, 266, 272 Hemodialysis, 74, 86, 261, 272 Hemoglobin, 43, 249, 266, 272, 273, 279 Hemoglobin A, 43, 273 Hemorrhage, 259, 272, 273, 304 Hemorrhoid, 273, 307 Hemostasis, 62, 84, 92, 96, 273, 301 Hepatic, 260, 273 Hepatitis, 149, 194, 215, 273 Hepatocytes, 273 Heredity, 270, 273 Heterogeneity, 42, 244, 273 Hiatal Hernia, 215, 273 Hippocampus, 273, 280, 301 Histamine, 247, 273, 274, 280 Histology, 19, 273, 289 Homeopathic remedies, 4, 273 Homeostasis, 41, 273, 303 Homologous, 244, 273, 306 Hormonal, 226, 248, 273 Hormone, 75, 259, 266, 269, 273, 277, 300, 302, 307 Hospice, 24, 31, 74, 273 Host, 29, 248, 273, 275, 310 Hybrid, 273, 274 Hybridization, 38, 274 Hydration, 5, 150, 274 Hydrogen, 25, 31, 168, 182, 248, 251, 261, 274, 283, 286, 287, 296 Hydrogen Breath Test, 31, 274 Hydrogen Peroxide, 25, 274 Hydrolysis, 155, 243, 253, 254, 274, 291, 293, 295 Hygienic, 274, 302 Hyperalgesia, 33, 274 Hyperbaric, 19, 274 Hyperbaric oxygen, 19, 274 Hyperglycaemia, 183, 274 Hypersensitivity, 29, 30, 163, 165, 244, 274 Hypersensitivity, Immediate, 244, 274 Hypertension, 123, 147, 149, 160, 182, 183, 272, 274, 281 Hyperthyroidism, 226, 274 Hypertrophy, 258, 274, 309 Hypoglycaemia, 260, 274

Hypothalamus, 144, 248, 262, 265, 274, 280, 292, 294, 301, 307 Hypothyroidism, 4, 50, 123, 274 Hypoxia, 250, 253, 260, 275 Hysterectomy, 9, 80, 105, 275 I Id, 99, 120, 221, 228, 229, 236, 238, 275 Ileostomy, 17, 186, 275 Ileum, 17, 252, 275 Ileus, 156, 157, 275 Immune function, 144, 275 Immune response, 144, 243, 246, 248, 272, 275, 305, 311 Immune Sera, 275 Immune system, 147, 249, 264, 273, 275, 276, 281, 284, 310, 311 Immunization, 194, 275 Immunoassay, 29, 275 Immunodeficiency, 215, 275 Immunodiffusion, 244, 275 Immunoelectrophoresis, 244, 275 Immunohistochemistry, 38, 275 Immunologic, 275, 297 Immunology, 55, 91, 95, 243, 244, 275 Immunophilin, 251, 275 Immunosuppressive, 251, 276 Impaction, 4, 7, 8, 22, 61, 69, 70, 93, 97, 169, 191, 276 Impairment, 9, 160, 216, 253, 260, 264, 276, 278, 282, 296 Imperforate Anus, 11, 276 Implant radiation, 276, 278, 279, 297, 311 In situ, 38, 65, 276 In Situ Hybridization, 38, 276 In vitro, 29, 33, 276, 299 In vivo, 27, 33, 38, 145, 276 Incision, 35, 256, 276, 278 Incompetence, 270, 276 Indicative, 43, 186, 276, 289, 310 Indigestion, 186, 187, 188, 198, 276, 279 Induction, 163, 175, 184, 246, 269, 276 Inertia, 17, 20, 22, 23, 77, 81, 228, 276 Infancy, 4, 276 Infantile, 5, 48, 64, 158, 163, 276 Infarction, 250, 253, 276 Infection, 25, 29, 214, 215, 247, 249, 259, 260, 269, 275, 276, 281, 286, 290, 305, 311 Infertility, 144, 276 Inflammatory bowel disease, 56, 160, 179, 277 Infusion, 33, 277 Ingestion, 159, 175, 179, 277, 282, 293

320 Constipation

Inhalation, 277, 293 Initiation, 5, 169, 277 Inner ear, 277, 310 Innervation, 26, 29, 277 Inorganic, 254, 277, 281, 284 Inositol, 42, 277, 282, 300 Inositol 1,4,5-Trisphosphate, 42, 277 Inotropic, 263, 277 Insight, 31, 33, 41, 42, 43, 277 Insulator, 277, 284 Insulin, 35, 182, 183, 277 Insulin-dependent diabetes mellitus, 277 Interleukin-1, 25, 277 Interleukin-2, 277 Intermittent, 277, 280, 291 Internal Medicine, 16, 34, 41, 72, 92, 93, 96, 98, 109, 116, 270, 277 Internal radiation, 278, 279, 297, 311 Interstitial, 26, 33, 52, 60, 72, 225, 250, 278, 279, 285, 299, 311 Intestinal Obstruction, 191, 278 Intestinal Pseudo-Obstruction, 12, 156, 157, 278 Intoxication, 260, 278, 311 Intracellular, 29, 33, 41, 251, 276, 277, 278, 282, 286, 293, 295, 298, 300, 302 Intracranial Embolism, 253, 278 Intracranial Embolism and Thrombosis, 253, 278 Intramuscular, 33, 278 Intraoperative Complications, 196, 278 Intrathecal, 33, 39, 278 Intravenous, 6, 31, 39, 147, 277, 278 Intrinsic, 26, 29, 167, 228, 244, 278 Intussusception, 193, 278, 298 Invasive, 10, 13, 278, 281 Involuntary, 7, 19, 223, 265, 268, 278, 284, 298, 303 Ion Channels, 41, 278, 286, 306 Ions, 248, 251, 254, 262, 264, 274, 277, 278, 282, 283 Irradiation, 175, 278, 311 Ischemia, 64, 247, 250, 260, 279 J Joint, 49, 105, 215, 247, 279, 288, 305 K Kb, 212, 279 Keto, 176, 279 Kinetic, 39, 279 L Lactose Intolerance, 274, 279

Lactulose, 31, 36, 51, 57, 104, 108, 118, 135, 154, 170, 223, 279 Lanolin, 165, 279 Large Intestine, 15, 19, 29, 146, 168, 252, 256, 262, 278, 279, 298, 302, 311 Latency, 22, 279 Lavage, 5, 279 Lead Poisoning, 109, 279 Lesion, 4, 30, 279, 280, 306, 309 Lethargy, 162, 274, 279 Leucine, 279, 290 Leukocytes, 249, 250, 259, 271, 279, 283 Library Services, 236, 279 Ligament, 279, 295 Ligands, 144, 159, 160, 280, 298 Limbic, 160, 245, 271, 280 Limbic System, 160, 245, 271, 280 Linkage, 31, 181, 253, 280 Linkage Disequilibrium, 31, 280 Lipase, 280, 288 Lipid, 86, 173, 175, 254, 265, 277, 279, 280, 284, 288 Lipid A, 280, 288 Liver, 63, 192, 243, 247, 249, 259, 262, 268, 269, 270, 273, 280, 309 Lobe, 145, 245, 253, 280, 294 Localization, 33, 275, 280 Localized, 250, 261, 265, 276, 280, 292, 300, 307, 309 Locomotion, 280, 292 Long-Term Care, 86, 280 Loperamide, 114, 280 Lower Esophageal Sphincter, 270, 280 Lubricants, 193, 280, 291 Lumen, 5, 280 Lymphatic, 123, 265, 276, 280, 293, 304, 307 Lymphoid, 246, 259, 281 M Macrophage, 277, 281 Magnesium Hydroxide, 100, 153, 281 Magnesium Oxide, 86, 281 Magnetic Resonance Imaging, 22, 45, 281 Malabsorption, 158, 281 Malaise, 19, 168, 216, 240, 264, 281 Malformation, 61, 281 Malignant, 31, 246, 281, 297 Malnutrition, 191, 247, 281 Manic, 246, 281, 296 Manic-depressive psychosis, 281, 296 Manometry, 14, 22, 23, 34, 51, 83, 85, 106, 119, 198, 200, 223, 226, 281

Index 321

Meat, 164, 281 Mecamylamine, 27, 281 Medial, 44, 271, 281, 288, 300, 301 Mediate, 263, 281 Mediator, 254, 277, 281, 301 Medicament, 177, 281, 305 MEDLINE, 16, 213, 281 Megacolon, 19, 60, 63, 191, 193, 196, 281 Meiosis, 281, 306 Melanin, 282, 291, 309 Melanosis, 53, 282 Membrane Potentials, 33, 282 Memory, 159, 160, 246, 260, 282 Meninges, 253, 259, 282 Menopause, 282, 293 Menstrual Cycle, 91, 95, 186, 282 Menstruation, 282 Mental Disorders, 141, 282, 296 Mental Health, iv, 23, 44, 141, 202, 212, 216, 282 Mental Processes, 263, 282, 296 Mercury, 147, 282 Metabolic disorder, 169, 191, 261, 271, 282 Metabolite, 161, 262, 282, 294 Metabotropic, 28, 282 Methacrylate, 147, 282 Methanol, 172, 282 Methionine, 262, 282, 294, 305 Methylphenidate, 19, 282 MI, 241, 283 Microbe, 283, 308 Microbiology, 243, 248, 283 Microorganism, 255, 283, 289, 311 Micturition, 19, 30, 283 Milligram, 11, 283 Mineral Oil, 19, 170, 206, 223, 227, 283 Mobility, 20, 22, 283 Mobilization, 28, 251, 283 Modeling, 24, 41, 283 Modification, 4, 5, 16, 226, 270, 283, 297 Molecular, 28, 29, 31, 149, 213, 217, 249, 251, 257, 267, 283, 294, 298, 300, 305, 309 Molecular Structure, 283, 309 Monitor, 12, 283, 287 Monoclonal, 279, 283, 297, 311 Monocytes, 277, 279, 283 Morphine, 31, 33, 35, 37, 39, 90, 95, 116, 144, 152, 155, 178, 181, 255, 283, 285, 288 Morphology, 28, 283 Motion Sickness, 284, 285 Motor Activity, 48, 49, 284 Motor Neurons, 28, 284

Motor Skills, 163, 284 Mucinous, 269, 284 Mucosa, 25, 29, 62, 72, 81, 254, 284, 302, 305 Mucus, 162, 284, 309 Multicenter study, 10, 284 Multiple sclerosis, 62, 113, 284 Multivariate Analysis, 24, 284 Muscarine, 284, 298 Muscle Contraction, 38, 41, 284 Muscle Fibers, 284, 285 Muscle relaxant, 284, 285 Muscle Relaxation, 284 Musculature, 28, 153, 284 Musculoskeletal System, 284, 288 Myasthenia, 284, 285 Myelin, 284 Myenteric, 15, 28, 38, 60, 284 Myocardial infarction, 149, 258, 283, 284 Myocardium, 283, 284 Myosin, 33, 251, 284, 285 N Naloxone, 67, 77, 79, 152, 177, 181, 285 Naltrexone, 36, 177, 285 Narcolepsy, 261, 282, 285 Narcosis, 285 Narcotic, 4, 140, 153, 155, 178, 268, 283, 285, 308 NCI, 1, 141, 211, 254, 285, 290 Necrosis, 253, 276, 283, 284, 285 Neonatal, 83, 285 Neonatal period, 83, 285 Neostigmine, 39, 79, 285 Nephritis, 149, 285 Nervous System, 31, 155, 156, 157, 160, 178, 181, 182, 183, 243, 245, 248, 249, 251, 253, 254, 255, 261, 264, 269, 280, 281, 282, 283, 284, 285, 286, 290, 292, 301, 305, 306 Neural, 38, 261, 269, 285, 301 Neural Pathways, 38, 285 Neuroendocrine, 160, 183, 285 Neurogenic, 17, 23, 29, 30, 48, 286, 309 Neuroleptic, 246, 255, 286 Neurologic, 31, 191, 286 Neuromuscular, 8, 34, 169, 243, 286, 309 Neuromuscular Junction, 243, 286 Neuronal, 26, 43, 77, 115, 285, 286, 298 Neurons, 28, 33, 38, 43, 260, 267, 269, 284, 286, 305, 306 Neuropathy, 12, 39, 43, 248, 286 Neurophysiology, 28, 261, 286

322 Constipation

Neurotoxin, 85, 286 Neurotransmitters, 29, 33, 286, 303 Neutrons, 244, 278, 286, 297 Niacin, 171, 286, 309 Nicotine, 27, 35, 160, 286, 298 Nitric Oxide, 79, 286 Nitrogen, 158, 182, 244, 286, 309 Nonulcer Dyspepsia, 215, 287 Nonverbal Communication, 287, 296 Norepinephrine, 26, 27, 43, 160, 161, 244, 261, 263, 287 Nuclear, 248, 264, 267, 269, 280, 285, 287, 306 Nuclei, 160, 244, 245, 264, 266, 270, 281, 286, 287, 296, 301 Nucleic acid, 274, 276, 287 Nucleic Acid Hybridization, 274, 287 Nucleolus, 287, 299 Nucleus, 259, 261, 267, 269, 282, 283, 286, 287, 294, 296, 301, 303 Nursing Assessment, 21, 287 Nursing Process, 12, 287 Nutritional Status, 139, 287 O Odds Ratio, 18, 287 Odour, 247, 287 Office Visits, 41, 287 Ointments, 254, 263, 287, 289, 302 Oncogene, 63, 288 Opacity, 260, 288 Opioid Peptides, 144, 264, 288 Opium, 144, 181, 283, 288, 289 Optic Chiasm, 274, 288 Organ Culture, 26, 288 Organelles, 253, 259, 283, 288 Orlistat, 54, 288 Orthopaedic, 91, 95, 288 Osmolarity, 9, 288 Osmoles, 288 Osmosis, 288 Osmotic, 5, 16, 19, 23, 147, 154, 169, 288 Osteoarthritis, 161, 288 Osteoporosis, 146, 288 Outpatient, 12, 40, 289 Ovary, 81, 271, 289, 293 Oxygen Consumption, 289, 299 P Pacemaker, 26, 289 Paediatric, 45, 78, 118, 289 Palliative, 31, 60, 64, 71, 83, 115, 215, 289, 307

Pancreas, 35, 192, 243, 262, 270, 277, 280, 289, 302 Pancreatic, 254, 261, 270, 289 Pancreatic Juice, 270, 289 Panic, 160, 163, 182, 183, 289 Papaverine, 288, 289 Paraffin, 66, 165, 289 Paralysis, 289, 303 Paraneoplastic syndrome, 43, 191, 289 Particle, 289, 308 Patch, 289, 308 Pathogen, 29, 289 Pathogenesis, 29, 81, 111, 162, 190, 289 Pathologic, 7, 249, 258, 274, 289 Pathophysiology, 8, 10, 15, 16, 19, 23, 34, 51, 63, 64, 72, 92, 96, 108, 192, 289 Patient Care Planning, 287, 290 Patient Compliance, 152, 290 Patient Education, 4, 16, 21, 194, 195, 201, 222, 226, 227, 234, 236, 241, 290 PDQ, 221, 290 Pediatric Gastroenterologist, 4, 40, 192, 223, 290 Pediatrics, 10, 18, 41, 48, 51, 53, 59, 60, 65, 74, 79, 83, 107, 109, 117, 119, 159, 191, 196, 290 Penicillin, 246, 290 Pepsin, 180, 290 Pepsin A, 180, 290 Peptide, 27, 38, 43, 73, 180, 254, 288, 290, 293, 294, 295, 307 Perception, 4, 15, 55, 144, 257, 290, 300 Perforation, 191, 290, 311 Perianal, 167, 290 Perineal, 6, 290 Perineum, 290 Peripheral Nervous System, 290, 305 Peristalsis, 11, 146, 158, 290 Peritoneal, 74, 290, 291 Peritoneal Cavity, 290, 291 Peritoneal Dialysis, 74, 291 Peritoneum, 252, 290, 291 Peritonitis, 291, 311 Petroleum, 269, 283, 289, 291 Pharmaceutical Preparations, 146, 148, 253, 266, 270, 291 Pharmaceutical Solutions, 263, 291 Pharmacodynamics, 161, 291 Pharmacokinetic, 31, 40, 291 Pharmacologic, 8, 15, 21, 193, 291, 308, 309 Pharmacotherapy, 5, 54, 71, 291 Pharynx, 270, 291

Index 323

Phenolphthalein, 169, 170, 174, 291 Phenotype, 12, 29, 31, 291 Phenyl, 177, 183, 291 Phenylalanine, 290, 291, 309 Phobias, 182, 183, 291 Phospholipases, 291, 302 Phospholipids, 268, 277, 291 Phosphorus, 173, 251, 292 Phosphorylation, 33, 292 Physical Examination, 4, 5, 8, 22, 23, 139, 192, 223, 224, 226, 292 Physiologic, 7, 9, 14, 22, 23, 32, 41, 109, 140, 190, 225, 244, 249, 268, 282, 292, 295, 298 Physostigmine, 285, 292 Pigmentation, 282, 292 Pigments, 252, 292 Pilot study, 39, 73, 292 Pituitary Gland, 145, 292, 294 Plague, 192, 292 Plants, 155, 244, 248, 249, 251, 254, 255, 265, 271, 283, 287, 292, 293, 308 Plasma, 37, 43, 73, 171, 246, 250, 253, 267, 270, 271, 272, 273, 292, 298, 301 Plasma cells, 246, 292 Plasticity, 43, 292 Platelet Activation, 292, 302 Platelet Aggregation, 286, 292 Platelets, 286, 292, 293 Platinum, 254, 293 Plexus, 28, 38, 57, 293 Poisoning, 122, 193, 260, 269, 278, 282, 285, 293 Pollen, 165, 293 Polydipsia, 54, 293 Polyethylene, 51, 57, 59, 66, 68, 70, 73, 78, 79, 86, 90, 93, 94, 97, 116, 153, 293 Polymorphism, 37, 293 Polypeptide, 245, 256, 274, 290, 293, 302, 312 Polyposis, 256, 293 Polysaccharide, 179, 246, 253, 271, 293 Polyuria, 54, 293 Posterior, 61, 74, 167, 245, 253, 263, 266, 289, 293 Postmenopausal, 37, 288, 293 Postoperative, 39, 161, 176, 293 Postprandial, 19, 56, 150, 293 Postsynaptic, 43, 293, 302, 306 Potassium, 225, 282, 293, 302 Potentiates, 261, 277, 293 Potentiating, 177, 293

Potentiation, 294, 302 Povidone, 163, 294 Practicability, 268, 294, 308 Practice Guidelines, 191, 216, 228, 294 Preclinical, 28, 38, 294 Precursor, 144, 155, 247, 254, 263, 264, 266, 287, 291, 294, 309 Prenatal, 152, 265, 294 Presynaptic, 43, 294, 306 Prevalence, 10, 13, 18, 46, 74, 77, 84, 287, 294 Probe, 34, 294 Proctectomy, 186, 294 Prodrug, 294 Progression, 41, 245, 294 Progressive, 253, 260, 263, 271, 285, 288, 292, 294, 299, 309 Projection, 287, 294 Prolapse, 193, 294 Promoter, 37, 294 Prone, 154, 170, 294 Pro-Opiomelanocortin, 288, 294 Prophase, 294, 306 Prophylaxis, 162, 295, 299 Propulsive, 38, 153, 155, 178, 181, 295 Prospective study, 60, 75, 117, 295 Prostaglandin, 168, 169, 176, 295 Prostaglandins A, 295 Prostate, 83, 124, 295 Protease, 180, 295 Protein C, 46, 173, 245, 248, 295, 309 Protein S, 33, 173, 188, 249, 295, 299 Proteolytic, 144, 256, 295 Protocol, 46, 55, 78, 84, 295 Protons, 244, 274, 296, 297 Proximal, 39, 75, 146, 263, 294, 296, 301 Pruritic, 165, 264, 296 Pruritus, 71, 156, 165, 179, 181, 296 Psychiatric, 9, 44, 225, 282, 296 Psychiatry, 62, 114, 296, 304 Psychic, 296, 301 Psychogenic, 296, 309 Psychology, 27, 30, 49, 60, 113, 162, 262, 296 Psychomotor, 260, 286, 296 Psychosis, 160, 246, 296 Psychotherapy, 34, 36, 162, 255, 296, 298 Psyllium, 110, 112, 117, 136, 159, 170, 175, 221, 296 Puberty, 50, 296 Public Policy, 213, 296 Pulmonary, 250, 257, 258, 296, 310

324 Constipation

Pulmonary Artery, 250, 296, 310 Pulmonary hypertension, 258, 296 Pulse, 283, 296 Purgative, 154, 265, 279, 296 Pyloric Stenosis, 43, 296 Pyramidal Tracts, 267, 297 Q Quality of Life, 4, 11, 13, 24, 31, 32, 34, 43, 44, 62, 76, 117, 140, 216, 297, 305 Quaternary, 27, 297 R Race, 156, 157, 161, 297 Radiation, 19, 175, 182, 225, 266, 267, 269, 274, 278, 297, 311 Radiation therapy, 225, 267, 274, 278, 279, 297, 311 Radioactive, 250, 274, 276, 278, 279, 287, 297, 311 Radiolabeled, 279, 297, 311 Radiopharmaceutical, 270, 297 Radiotherapy, 250, 279, 297, 311 Random Allocation, 297 Randomization, 37, 297 Randomized, 6, 10, 11, 31, 32, 34, 36, 37, 39, 40, 46, 70, 83, 85, 117, 119, 264, 297 Randomized clinical trial, 37, 297 Reality Testing, 296, 297 Reassurance, 4, 192, 298 Receptors, Nicotinic, 35, 298 Receptors, Opioid, 264, 298 Receptors, Opioid, kappa, 264, 298 Receptors, Serotonin, 298, 301 Recombinant, 27, 77, 298, 310 Reconstitution, 150, 298 Rectal Prolapse, 21, 196, 298 Recur, 170, 298 Refer, 1, 157, 201, 225, 256, 263, 280, 286, 296, 298 Reflex, 38, 63, 77, 78, 81, 118, 172, 174, 298 Reflux, 54, 156, 157, 162, 163, 168, 270, 298 Refraction, 298, 304 Refractory, 38, 47, 65, 72, 298 Regeneration, 298 Regimen, 4, 11, 22, 224, 264, 290, 291, 298 Regression Analysis, 262, 299 Regurgitation, 152, 270, 272, 299 Relapse, 27, 44, 299 Reliability, 36, 93, 98, 299 Renal failure, 260, 299 Resected, 25, 299 Resection, 71, 74, 196, 198, 299 Respiration, 160, 251, 254, 283, 299

Restoration, 259, 298, 299 Retina, 249, 288, 299, 300 Retinoids, 299, 311 Retrograde, 79, 299 Retrospective, 41, 299 Ribosome, 33, 299, 308 Rigidity, 292, 299 Risk factor, 15, 18, 23, 79, 147, 295, 299 Ristocetin, 299, 310 Rod, 248, 300 Rubber, 186, 243, 300 Ryanodine, 42, 300 S Sagittal, 61, 74, 300 Salicylate, 254, 300 Salicylic, 162, 300 Saline, 21, 153, 154, 170, 179, 193, 300 Salivary, 259, 262, 300 Salivary glands, 259, 262, 300 Schizoid, 300, 311 Schizophrenia, 182, 183, 300, 311 Schizotypal Personality Disorder, 300, 311 Scleroderma, 43, 300 Sclerosis, 123, 180, 284, 300 Screening, 3, 27, 36, 255, 290, 300 Scrotum, 174, 300, 306 Second Messenger Systems, 286, 300 Secretion, 5, 75, 160, 262, 273, 275, 277, 284, 300, 301 Secretory, 193, 300, 306 Sedative, 255, 300 Sedentary, 201, 225, 300 Segmental, 71, 85, 153, 198, 300 Segmentation, 300, 301 Seizures, 163, 164, 260, 301 Sella, 263, 292, 301 Semen, 126, 127, 128, 129, 130, 295, 301 Senile, 108, 182, 183, 289, 301 Senna, 108, 114, 116, 118, 136, 154, 169, 170, 206, 301 Sensibility, 245, 274, 301 Sensor, 146, 301 Septal, 280, 301 Septal Nuclei, 280, 301 Sequencing, 31, 301 Serologic, 275, 301 Serotonin, 11, 27, 37, 72, 160, 161, 181, 182, 247, 255, 261, 291, 298, 301, 309 Serum, 4, 150, 180, 256, 275, 291, 298, 301 Sex Characteristics, 243, 296, 301 Shock, 165, 301, 308 Sigmoid, 25, 167, 302

Index 325

Sigmoid Colon, 25, 167, 302 Sigmoidoscopy, 4, 220, 226, 302 Signal Transduction, 26, 28, 251, 277, 302 Signs and Symptoms, 299, 302 Silicon, 34, 302 Silicon Dioxide, 302 Sincalide, 261, 302 Skeleton, 166, 243, 279, 295, 302 Skin Care, 7, 302 Small intestine, 17, 43, 146, 147, 148, 168, 192, 252, 263, 264, 273, 274, 275, 278, 302, 310 Smooth muscle, 29, 41, 43, 56, 81, 182, 257, 273, 274, 283, 289, 302, 303, 305 Soaps, 302 Social Environment, 297, 302 Social Support, 303, 304 Sodium, 100, 117, 128, 130, 174, 271, 282, 302, 303 Soft tissue, 250, 302, 303 Solitary Nucleus, 248, 303 Solvent, 151, 249, 254, 266, 282, 288, 291, 303 Soma, 303 Somatic, 19, 243, 280, 282, 290, 303 Somnolence, 161, 303 Sorbitol, 19, 170, 303 Spasm, 247, 258, 303 Spasmodic, 59, 91, 96, 113, 243, 303 Spastic, 6, 123, 124, 176, 193, 279, 303 Spasticity, 183, 303 Spatial disorientation, 263, 303 Specialist, 45, 53, 192, 230, 303 Specificity, 244, 304 Spectrum, 20, 162, 304 Sperm, 254, 293, 304, 306 Sphincter, 22, 23, 26, 29, 33, 77, 81, 106, 116, 174, 225, 228, 298, 304 Spina bifida, 65, 304 Spleen, 259, 280, 304 Stercoral, 191, 304 Sterility, 276, 304 Steroid, 259, 304 Stimulant, 4, 87, 169, 170, 176, 191, 193, 245, 261, 273, 282, 304 Stimulus, 145, 258, 264, 267, 277, 278, 279, 291, 298, 304, 307 Stoma, 22, 304 Stress management, 30, 304 Stroke, 81, 141, 147, 165, 212, 304 Stupor, 279, 285, 304 Styrene, 300, 305

Subacute, 276, 305 Subarachnoid, 272, 305 Subclinical, 276, 301, 305 Subcutaneous, 264, 305 Submucous, 57, 305 Subspecies, 303, 305 Substance P, 81, 180, 250, 282, 298, 299, 300, 305 Substrate, 266, 305 Sulfur, 128, 180, 282, 305 Sulfuric acid, 180, 305 Superoxide, 149, 305 Supplementation, 93, 98, 120, 159, 192, 305 Supportive care, 290, 305 Suppositories, 14, 19, 193, 225, 270, 305 Suppression, 159, 305 Sympathetic Nervous System, 248, 305 Sympathomimetic, 245, 261, 263, 266, 287, 305 Symphysis, 295, 305 Symptomatic, 10, 32, 54, 68, 110, 162, 305 Symptomatology, 34, 305 Synapses, 286, 306 Synapsis, 306 Synaptic, 28, 286, 302, 306 Synaptic Transmission, 28, 286, 306 Synergistic, 173, 176, 306 Systemic disease, 16, 146, 226, 228, 306 Systolic, 147, 274, 306 Systolic pressure, 147, 306 T Tachykinins, 63, 306 Tardive, 160, 182, 183, 247, 306 Telencephalon, 248, 306 Tenesmus, 4, 240, 306 Testicles, 300, 306 Thalamus, 262, 266, 280, 306 Thermal, 33, 262, 286, 307 Third Ventricle, 266, 274, 306, 307 Thorax, 243, 307 Threshold, 43, 267, 274, 307 Thrombin, 292, 295, 307 Thrombomodulin, 295, 307 Thrombosed, 4, 307 Thrombosis, 62, 84, 278, 295, 304, 307 Thymus, 275, 280, 307 Thyroid, 50, 223, 274, 307, 309 Thyroid Gland, 274, 307 Thyrotropin, 275, 307 Time Management, 304, 307 Tobacco Use Cessation, 27, 307 Toilet Facilities, 4, 307

326 Constipation

Toilet Training, 44, 57, 220, 222, 307 Tolerance, 33, 37, 39, 178, 271, 307 Tonicity, 153, 264, 307 Tonus, 174, 307 Topical, 247, 266, 274, 289, 302, 308 Toxic, iv, 5, 248, 249, 259, 266, 267, 282, 284, 286, 305, 308, 310 Toxicity, 29, 263, 265, 282, 292, 299, 308 Toxicologic, 39, 308 Toxicology, 214, 308 Toxins, 246, 276, 308 Trace element, 268, 302, 308 Trachea, 291, 307, 308 Tramadol, 160, 161, 308 Transdermal, 90, 95, 308 Transduction, 28, 251, 302, 308 Transfection, 249, 308 Transfer Factor, 275, 308 Translating, 42, 308 Translation, 31, 189, 308 Transmitter, 243, 263, 278, 281, 287, 306, 308 Transplantation, 275, 308 Trauma, 155, 165, 178, 260, 266, 285, 308 Treatment Failure, 11, 308 Treatment Outcome, 7, 308 Trees, 267, 300, 308 Tricuspid Atresia, 258, 309 Tricyclic, 214, 261, 309 Trigger zone, 247, 265, 309 Tryptophan, 171, 256, 301, 309 Tuberculosis, 257, 300, 309 Tubocurarine, 285, 309 Tumour, 269, 309 Tyrosine, 55, 263, 309 U Ulcer, 154, 162, 168, 179, 260, 263, 287, 309, 310 Ulceration, 22, 260, 309 Ulcerative colitis, 25, 146, 179, 277, 309 Ultrasonography, 22, 309 Unconscious, 275, 309 Urea, 309 Uremia, 223, 299, 309 Ureters, 309 Urethra, 295, 309, 310 Urinary, 4, 38, 48, 124, 259, 262, 265, 270, 276, 293, 309 Urinary Retention, 38, 309 Urinary tract, 48, 262, 309 Urinate, 307, 309

Urine, 25, 41, 249, 258, 261, 263, 265, 276, 283, 293, 309, 310 Urodynamics, 114, 310 Uterus, 265, 275, 282, 310 V Vaccine, 243, 296, 310 Vagina, 200, 282, 310 Vancomycin, 119, 310 Varicose, 61, 310 Varicose vein, 61, 310 Vascular, 253, 265, 272, 274, 276, 286, 307, 310 Vasculitis, 253, 310 Vasodilator, 250, 263, 273, 289, 310 VE, 50, 310 Vector, 308, 310 Vein, 61, 247, 278, 287, 307, 310 Venous, 247, 249, 253, 278, 295, 309, 310 Venous blood, 249, 253, 310 Ventricle, 245, 247, 258, 273, 296, 306, 307, 309, 310 Ventricular, 258, 309, 310 Verapamil, 137, 161, 310 Vertebrae, 304, 310 Vertebral, 249, 304, 310 Veterinary Medicine, 213, 310 Villi, 310 Villous, 196, 310 Vinca Alkaloids, 139, 169, 310 Viral, 15, 222, 308, 310 Virulence, 308, 310 Virus, 215, 248, 253, 270, 308, 310, 311 Viscera, 61, 303, 311 Visceral, 7, 13, 124, 214, 248, 280, 291, 311 Visceral Afferents, 248, 311 Viscosity, 173, 311 Vitamin A, 152, 277, 311 Vitro, 311 Vivo, 311 Volition, 278, 311 Volvulus, 4, 191, 311 W Wakefulness, 260, 311 War, 45, 311 White blood cell, 246, 279, 281, 284, 292, 311 Windpipe, 291, 307, 311 Withdrawal, 6, 10, 27, 160, 177, 260, 311 X Xenograft, 245, 311 X-ray, 240, 248, 268, 269, 278, 287, 297, 311 X-ray therapy, 279, 311

Index 327

Y Yeasts, 291, 311

Z Zymogen, 295, 312

328 Constipation