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

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

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CHRONIC

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 2004 by ICON Group International, Inc. Copyright 2004 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., 1960Chronic Constipation: 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: 0-497-00245-0 1. Chronic 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 chronic 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 CHRONIC CONSTIPATION ......................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Chronic Constipation.................................................................... 6 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND CHRONIC CONSTIPATION ............................................................... 37 Overview...................................................................................................................................... 37 Finding Nutrition Studies on Chronic Constipation................................................................... 37 Federal Resources on Nutrition ................................................................................................... 38 Additional Web Resources ........................................................................................................... 38 CHAPTER 3. ALTERNATIVE MEDICINE AND CHRONIC CONSTIPATION ........................................ 41 Overview...................................................................................................................................... 41 National Center for Complementary and Alternative Medicine.................................................. 41 Additional Web Resources ........................................................................................................... 46 General References ....................................................................................................................... 48 CHAPTER 4. PATENTS ON CHRONIC CONSTIPATION ..................................................................... 49 Overview...................................................................................................................................... 49 Patent Applications on Chronic Constipation ............................................................................. 49 Keeping Current .......................................................................................................................... 50 CHAPTER 5. BOOKS ON CHRONIC CONSTIPATION ......................................................................... 53 Overview...................................................................................................................................... 53 Book Summaries: Federal Agencies.............................................................................................. 53 Chapters on Chronic Constipation............................................................................................... 54 CHAPTER 6. PERIODICALS AND NEWS ON CHRONIC CONSTIPATION ........................................... 59 Overview...................................................................................................................................... 59 News Services and Press Releases................................................................................................ 59 Newsletter Articles ...................................................................................................................... 61 Academic Periodicals covering Chronic Constipation ................................................................. 61 CHAPTER 7. RESEARCHING MEDICATIONS .................................................................................... 63 Overview...................................................................................................................................... 63 U.S. Pharmacopeia....................................................................................................................... 63 Commercial Databases ................................................................................................................. 64 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 69 Overview...................................................................................................................................... 69 NIH Guidelines............................................................................................................................ 69 NIH Databases............................................................................................................................. 71 Other Commercial Databases....................................................................................................... 73 APPENDIX B. PATIENT RESOURCES ................................................................................................. 75 Overview...................................................................................................................................... 75 Patient Guideline Sources............................................................................................................ 75 Finding Associations.................................................................................................................... 80 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 83 Overview...................................................................................................................................... 83 Preparation................................................................................................................................... 83 Finding a Local Medical Library.................................................................................................. 83 Medical Libraries in the U.S. and Canada ................................................................................... 83 ONLINE GLOSSARIES.................................................................................................................. 89 Online Dictionary Directories ..................................................................................................... 89

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CHRONIC CONSTIPATION DICTIONARY............................................................................ 91 INDEX .............................................................................................................................................. 121

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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 chronic 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 chronic 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 chronic 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 chronic 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 chronic 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 chronic 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 CHRONIC CONSTIPATION Overview In this chapter, we will show you how to locate peer-reviewed references and studies on chronic 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 chronic 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 “chronic 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: •

Aging and Chronic Constipation Source: Geriatric Medicine Today. 9(3): 35-36, 41-43. March 1990. Summary: Constipation is a common complaint among older persons. This article describes aging and chronic constipation, covering topics including colonic motility; how chronic use of laxatives can contribute to constipation; evaluation of constipation, including the medical history; and approaches to treatment, including dietary modification, exercise, bulk-forming laxatives, lactulose, lubricants, saline cathartics, stimulant laxatives, and hyperosmotic cathartics. The author stresses that health care professionals must educate elderly patients about the risks and benefits of cathartics while directing an appropriate plan of therapy that includes dietary manipulation,

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Chronic Constipation

exercise, stimulation of the gastrocolic reflex, and elimination of constipating medication. 20 references. •

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 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).

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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 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. (AAM).

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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. 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).

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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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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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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 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).

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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.

Federally Funded Research on Chronic Constipation The U.S. Government supports a variety of research studies relating to chronic 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. 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 chronic 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 chronic constipation. The following is typical of the type of information found when searching the CRISP database for chronic constipation: •

Project Title: ROLE OF PROGESTERONE IN COLONIC MUSCLE DYSFUNCTION Principal Investigator & Institution: Behar, Jose; Professor of Medicine; Rhode Island Hospital (Providence, Ri) Providence, Ri 029034923 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-DEC-2008 Summary: (provided by applicant): Chronic constipation due to colonic inertia is common in females of reproductive age with a 20% prevalence in Western countries and a female: male ratio of 9:1. Its pathogenesis at the cellular level, however, is unknown. Constipation is a frequent complication of pregnancy and correlates with rising serum levels of progesterone (PC). PG affects the motility of the gastrointestinal smooth muscle primarily through genomic actions. Our preliminary studies have shown signal transduction abnormalities in muscle cells from female patients with colonic inertia

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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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similar to those induced by PG in human colonic muscle cells in vitro and in muscle cells from guinea pigs treated with PG in vivo and in vitro. The proposed studies are therefore aimed at extending these investigations on the mechanisms whereby PG impairs contraction and increases relaxation in normal colonic muscle from guinea pigs and humans and to test the hypothesis that female colonic inertia is due to a greater muscle response to PG due to an over expression of PG receptors. This hypothesis is based on an abnormal G protein pattern that affects the signal transduction that contributes to the genesis of basal colonic motility [MI] and mediates the actions of G protein coupled receptor (GPCR) dependent agonists and impairs their binding to receptors as well as an increased mRNA levels of PG receptors. We therefore propose to determine that: a) PG's genomic actions alter the signal transduction due to changes in heterotrimeric and monomeric G proteins, b) These G protein changes have significant functional consequences impairing the basal and agonist induced colonic motility and whether this abnormal motor response is confined to agonists that are G protein dependent, c) Prostaglandin's (PGF2a) contribute to the genesis of basal MI and its actions and synthesis inhibited by PC. d) PG treatment causes signal transduction abnormalities in normal human colonic muscle that appear to be similar to those present in females with colonic inertia, e) The muscle abnormalities in females with colonic inertia could be explained by an over expression of PG receptors. These studies will be conducted in muscle cells and strips from control, PG treated and pregnant guinea pigs, and in normal and PG treated human colonic muscle cells from free margins of the sigmoid colon of patients with adenocarcinoma and from female patients with colonic inertia and chronic constipation. 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 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 chronic constipation, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “chronic constipation” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for chronic constipation (hyperlinks lead to article summaries):

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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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"Putting back the bugs": bacterial treatment relieves chronic constipation and symptoms of irritable bowel syndrome. Author(s): Andrews PJ, Borody TJ. Source: The Medical Journal of Australia. 1993 November 1; 159(9): 633-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8155121

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12603355

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12683044

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Abnormalities in visceral evoked potentials from the anal canal in children with chronic constipation. Author(s): Kubota M, Suita S, Kamimura T. Source: Surgery Today. 1997; 27(7): 632-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9306566

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Action of glucomannans on complaints in patients affected with chronic constipation: a multicentric clinical evaluation. Author(s): Passaretti S, Franzoni M, Comin U, Donzelli R, Rocca F, Colombo E, Ferrara A, Dinelli M, Prada A, Curzio M, et al. Source: Ital J Gastroenterol. 1991 September-October; 23(7): 421-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1742540

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Allergy to cow's milk presenting as chronic constipation. Author(s): McGrath J. Source: British Medical Journal (Clinical Research Ed.). 1984 January 21; 288(6412): 236. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6419872

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Allergy to cows' milk presenting as chronic constipation. Author(s): Chin KC, Tarlow MJ, Allfree AJ. Source: British Medical Journal (Clinical Research Ed.). 1983 November 26; 287(6405): 1593. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6416515

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An in vitro electrophysiological study of the colon from patients with idiopathic chronic constipation. Author(s): Hoyle CH, Kamm MA, Lennard-Jones JE, Burnstock G. Source: Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society. 1992 October; 2(5): 327-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1330123

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An unusual case of colonic duplication causing chronic constipation in a child. Author(s): Shin KS, Lee NH, Kim SY. Source: Journal of Pediatric Surgery. 1999 September; 34(9): 1410-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10507440

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Anal endosonography in children with chronic constipation. Author(s): Suarez L, Olivares F, Lobo E, Camarero C, Kirschlager E, Escobar H. Source: Pediatric Radiology. 1999 January; 29(1): 28-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9880612

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Anismus in chronic constipation. Author(s): Preston DM, Lennard-Jones JE. Source: Digestive Diseases and Sciences. 1985 May; 30(5): 413-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3987474

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Anorectal manometry under anesthesia in the investigation of children with chronic constipation. Author(s): Constantinides CG, Nixon HH. Source: Diseases of the Colon and Rectum. 1982 March; 25(2): 125-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7067547

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Anorectal physiological parameters in chronic constipation of unknown aetiology (primary) and of cerebrovascular accidents--a preliminary report. Author(s): Ho YH, Goh HS. Source: Ann Acad Med Singapore. 1995 May; 24(3): 376-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7574418

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Antegrade colonic enema (ACE): a new therapeutic approach to chronic constipation. Author(s): Vos A, Cuesta M, Meuwissen S. Source: Acta Gastroenterol Latinoam. 1996; 26(4): 225-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9335926

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Assessment of chronic constipation: colon transit time versus defecography. Author(s): Prokesch RW, Breitenseher MJ, Kettenbach J, Herbst F, Maier A, Lechner G, Mahieu P. Source: European Journal of Radiology. 1999 December; 32(3): 197-203. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10632558

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Barium enema in chronic constipation: is it meaningful? Author(s): Patriquin H, Martelli H, Devroede G. Source: Gastroenterology. 1978 October; 75(4): 619-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=710831

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Changes in colorectal function in severe idiopathic chronic constipation. Author(s): Shouler P, Keighley MR. Source: Gastroenterology. 1986 February; 90(2): 414-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3940914

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Cholinergic stimulation and nonadrenergic, noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation. Author(s): Mitolo-Chieppa D, Mansi G, Rinaldi R, Montagnani M, Potenza MA, Genualdo M, Serio M, Mitolo CI, Rinaldi M, Altomare DF, Memeo V. Source: Digestive Diseases and Sciences. 1998 December; 43(12): 2719-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9881505

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Chronic constipation and fecal incontinence in children with neurological and neuromuscular handicap. Author(s): Di Lorenzo C. Source: Journal of Pediatric Gastroenterology and Nutrition. 1997; 25 Suppl 1: S37-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9285865

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Chronic constipation and soiling. Author(s): Mead D. Source: Nurs Mirror. 1983 July 20; 157(3): 25-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6554734

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Chronic constipation as a symptom of cow milk allergy. Author(s): Iacono G, Carroccio A, Cavataio F, Montalto G, Cantarero MD, Notarbartolo A. Source: The Journal of Pediatrics. 1995 January; 126(1): 34-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7815220

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11956774

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Chronic constipation following simple hysterectomy is rare. Author(s): Stanhope CR. Source: Gynecologic Oncology. 1991 August; 42(2): 114-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1894167

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Chronic constipation in adults. How far should evaluation and treatment go? Author(s): Marshall JB. Source: Postgraduate Medicine. 1990 September 1; 88(3): 49-51, 54, 57-9, 63. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2169048

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Chronic constipation in childhood. Author(s): Russel RI, Godding EW. Source: Lancet. 1978 July 15; 2(8081): 153. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=78348

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Chronic constipation in childhood. Author(s): Howard ER, Garrett JR. Source: Lancet. 1977 December 10; 2(8050): 1237. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=73941

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Chronic constipation in childhood: a longitudinal study of 186 patients. Author(s): Abrahamian FP, Lloyd-Still JD. Source: Journal of Pediatric Gastroenterology and Nutrition. 1984 June; 3(3): 460-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6737192

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Chronic constipation in children. Author(s): Yadav K. Source: Indian Pediatrics. 1982 August; 19(8): 669-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7174099

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Chronic constipation in children. Author(s): Loening-Baucke V. Source: Gastroenterology. 1993 November; 105(5): 1557-64. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8224663

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Chronic constipation in children: the need for hard data about normal stools. Author(s): Schuster MM. Source: Journal of Pediatric Gastroenterology and Nutrition. 1984 June; 3(3): 336-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6737176

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Chronic constipation in children: the need for hard data about normal stools. Author(s): Weaver LT. Source: Journal of Pediatric Gastroenterology and Nutrition. 1985 December; 4(6): 100910. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4067772

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Chronic constipation in infants and children. Author(s): Younoszai MK. Source: Indian J Pediatr. 1983 May-June; 50(404): 299-309. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6668039

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Chronic constipation management for institutionalized older adults. Author(s): Howard LV, West D, Ossip-Klein DJ. Source: Geriatric Nursing (New York, N.Y.). 2000 March-April; 21(2): 78-82; Quiz 82-3. Erratum In: Geriatr Nurs 2000 May-June; 21(3): 119. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10769331

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Chronic constipation with encopresis persisting beyond 15 years of age. Author(s): Rex DK, Fitzgerald JF, Goulet RJ. Source: Diseases of the Colon and Rectum. 1992 March; 35(3): 242-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1740069

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Chronic constipation. Author(s): Laughton J. Source: The New England Journal of Medicine. 2004 March 18; 350(12): 1259-60; Author Reply 1259-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15031864

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Chronic constipation. Author(s): Brisinda G, Cadeddu F, Maria G. Source: The New England Journal of Medicine. 2004 March 18; 350(12): 1259-60; Author Reply 1259-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15028834

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Chronic constipation. Author(s): Kreel L, al-Kutoubi MA. Source: Postgraduate Medical Journal. 1994 July; 70(825): 503-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7937429

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Chronic constipation. Author(s): Pettei MJ. Source: Pediatric Annals. 1987 October; 16(10): 796-800, 804-6, 811-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3317232

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Chronic constipation. Important aspects of workup and management. Author(s): Nivatvongs S, Hooks VH 3rd. Source: Postgraduate Medicine. 1983 November; 74(5): 313-19, 323. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6634529

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Chronic constipation. Manometric patterns and surgical considerations. Author(s): Mishalany HG, Woolley MG. Source: Archives of Surgery (Chicago, Ill. : 1960). 1984 November; 119(11): 1257-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6497628

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Chronic constipation: a cause of recurrent urinary tract infections. Author(s): Romanczuk W, Korczawski R. Source: Turk J Pediatr. 1993 July-September; 35(3): 181-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8165751

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Chronic constipation: a clinical conundrum. Author(s): Orr WC, Johnson P, Yates C. Source: Journal of the American Geriatrics Society. 1997 May; 45(5): 652-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9158596

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Chronic constipation: a therapeutic challenge. Author(s): Sobel J. Source: J Am Osteopath Assoc. 1971 May; 70(9): 978-81. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5207595

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Chronic constipation: assessment and management in the elderly. Author(s): Allison OC, Porter ME, Briggs GC. Source: Journal of the American Academy of Nurse Practitioners. 1994 July; 6(7): 311-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7946638

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Chronic constipation: causes and management. Author(s): Tremaine WJ. Source: Hosp Pract (Off Ed). 1990 April 30; 25(4A): 89-92, 95-6, 99-100. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2109759

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Chronic constipation--a lethal danger in patients with systemic scleroderma. Author(s): Exadaktylos A, Papagrigoriadis S. Source: European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine. 2001 December; 8(4): 333-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11785605

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Chronic neurogenic lesions of the external anal sphincter and abdomino-perineal dyssynergia in chronic constipation. Author(s): Habib FI, Inghilleri M, Badiali D, Corazziari E. Source: Ital J Gastroenterol Hepatol. 1999 October; 31(7): 574-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10604095

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Cisapride in neurologically impaired children with chronic constipation. Author(s): Staiano A, Del Giudice E, Simeone D, Miele E, Marino A. Source: Digestive Diseases and Sciences. 1996 May; 41(5): 870-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8625757

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Clinical epidemiology of chronic constipation. Author(s): Johanson JF, Sonnenberg A, Koch TR. Source: Journal of Clinical Gastroenterology. 1989 October; 11(5): 525-36. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2551954

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Clinical response to dietary fiber treatment of chronic constipation. Author(s): Voderholzer WA, Schatke W, Muhldorfer BE, Klauser AG, Birkner B, MullerLissner SA. Source: The American Journal of Gastroenterology. 1997 January; 92(1): 95-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8995945

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Clinical subgroups of chronic constipation: exploring the potential of polyethylene glycol. Author(s): Camilleri M. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S253-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10726230

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Colchicine is an effective treatment for patients with chronic constipation: an openlabel trial. Author(s): Verne GN, Eaker EY, Davis RH, Sninsky CA. Source: Digestive Diseases and Sciences. 1997 September; 42(9): 1959-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9331162

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Colectomy for severe chronic constipation. Author(s): Loening-Bauchke V, Anuras S. Source: Digestive Diseases and Sciences. 1988 September; 33(9): 1196-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3409806

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Collagenous colitis associated with chronic constipation. Author(s): Leigh C, Elahmady A, Mitros FA, Metcalf A, al-Jurf A. Source: The American Journal of Surgical Pathology. 1993 January; 17(1): 81-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8447512

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Colonic electromyography in chronic constipation. Author(s): Frieri G, Parisi F, Corazziari E, Caprilli R. Source: Gastroenterology. 1983 April; 84(4): 737-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6825984

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Colonic lavage solution (polyethylene glycol electrolyte lavage solution) as a treatment for chronic constipation: a double-blind, placebo-controlled study. Author(s): Andorsky RI, Goldner F. Source: The American Journal of Gastroenterology. 1990 March; 85(3): 261-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2178398

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Colonic mass movements in idiopathic chronic constipation. Author(s): Bassotti G, Gaburri M, Imbimbo BP, Rossi L, Farroni F, Pelli MA, Morelli A. Source: Gut. 1988 September; 29(9): 1173-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3197990

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Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Author(s): Attar A, Lemann M, Ferguson A, Halphen M, Boutron MC, Flourie B, Alix E, Salmeron M, Guillemot F, Chaussade S, Menard AM, Moreau J, Naudin G, Barthet M. Source: Gut. 1999 February; 44(2): 226-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9895382

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12041718

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12107785

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Controversies in the management of chronic constipation. Author(s): Loening-Baucke V. Source: Journal of Pediatric Gastroenterology and Nutrition. 2001; 32 Suppl 1: S38-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11321420

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Cow's milk and chronic constipation in children. Author(s): Shah N, Lindley K, Milla P. Source: The New England Journal of Medicine. 1999 March 18; 340(11): 891-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10084907

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Cow's milk and chronic constipation in children. Author(s): Eigenmann PA, Zamora SA, Belli DC. Source: The New England Journal of Medicine. 1999 March 18; 340(11): 891; Author Reply 892. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10084906

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Cow's milk and chronic constipation in children. Author(s): Daher S, Sole D, de Morais MB. Source: The New England Journal of Medicine. 1999 March 18; 340(11): 891; Author Reply 892. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10084905

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11846872

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Crohn's disease presenting as chronic constipation: a case report. Author(s): Arumugam R, Brandt ML, Jaksic T, Gilger M. Source: Clinical Pediatrics. 2000 June; 39(6): 369-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10879940

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Damage to the innervation of the pelvic floor musculature in chronic constipation. Author(s): Snooks SJ, Barnes PR, Swash M, Henry MM. Source: Gastroenterology. 1985 November; 89(5): 977-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4043677

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Dermatoglyphic patterns in children with chronic constipation. Author(s): Drongowski RA, Coran AG. Source: Digestive Diseases and Sciences. 1995 July; 40(7): 1420-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7628262

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Desmosis of the colon: a working hypothesis of primary chronic constipation. Author(s): Meier-Ruge WA. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 1998 October; 8(5): 299303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9825241

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Diagnosis of neuronal colonic dysplasia in primary chronic constipation and sigmoid diverticulosis endoscopic biopsy and enzyme-histochemical examination. Author(s): Stoss F, Meier-Ruge W. Source: Surgical Endoscopy. 1991; 5(3): 146-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1763402

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Diagnostic dilemmas and results of treatment for chronic constipation. Author(s): Keuzenkamp-Jansen CW, Fijnvandraat CJ, Kneepkens CM, Douwes AC. Source: Archives of Disease in Childhood. 1996 July; 75(1): 36-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8813868

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Diet and chronic constipation in children: the role of fiber. Author(s): Roma E, Adamidis D, Nikolara R, Constantopoulos A, Messaritakis J. Source: Journal of Pediatric Gastroenterology and Nutrition. 1999 February; 28(2): 16974. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9932850

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Dietary fiber, energy intake and nutritional status during the treatment of children with chronic constipation. Author(s): Speridiao PG, Tahan S, Fagundes-Neto U, Morais MB. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 2003 June; 36(6): 753-9. Epub 2003 June 03. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12792705

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Different patterns of intestinal transit time and anorectal motility in painful and painless chronic constipation. Author(s): Lanfranchi GA, Bazzocchi G, Brignola C, Campieri M, Labo G. Source: Gut. 1984 December; 25(12): 1352-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6510767

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11384776

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Disrupted peristalsis in a patient with colonic duplication and chronic constipation. Author(s): Sasaki Y, Mikami T, Sawaya M, Ishiguro Y, Tsuji T, Fukuda S, Munakata A, Morita T, Hada R. Source: Gastrointestinal Endoscopy. 2004 April; 59(4): 589-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15044908

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Dopaminergic defect of enteric nervous system in Parkinson's disease patients with chronic constipation. Author(s): Singaram C, Ashraf W, Gaumnitz EA, Torbey C, Sengupta A, Pfeiffer R, Quigley EM. Source: Lancet. 1995 September 30; 346(8979): 861-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7564669

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Economic aspects of pharmacotherapy for chronic constipation. Author(s): Passmore AP. Source: Pharmacoeconomics. 1995 January; 7(1): 14-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10155290

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Effect of the dietary fiber glucomannan on chronic constipation in neurologically impaired children. Author(s): Staiano A, Simeone D, Del Giudice E, Miele E, Tozzi A, Toraldo C. Source: The Journal of Pediatrics. 2000 January; 136(1): 41-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10636972

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Effects of a vioform-entobex preparation (Mexaform) on patients with chronic constipation. Author(s): Gjone E. Source: Scandinavian Journal of Gastroenterology. 1967; 2(4): 316-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4229620

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Effects of erythromycin on human colonic circular muscle in idiopathic chronic constipation. Author(s): Chieppa DM, Mansi G, Rinaldi R, Serio M, Nacci C, Montagnani M, Potenza MA, De Salvia MA, Mitolo CI, Rinaldi M, Altomare DF. Source: European Journal of Clinical Investigation. 2000 January; 30(1): 66-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10620004

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11929394

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Electrorectography in chronic constipation. Author(s): Shafik A. Source: World Journal of Surgery. 1995 September-October; 19(5): 772-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7571680

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Emergency sub total colectomy for chronic constipation. Author(s): Brombacher GD, Murray WR. Source: Scott Med J. 1998 February; 43(1): 21-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9533255

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Evaluation and surgical treatment of severe chronic constipation. Author(s): Pemberton JH, Rath DM, Ilstrup DM. Source: Annals of Surgery. 1991 October; 214(4): 403-11; Discussion 411-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1953096

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Evaluation of a dietary regimen for chronic constipation. Report of a pilot study. Author(s): Battle EH, Hanna CE. Source: Journal of Gerontological Nursing. 1980 September; 6(9): 527-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6251129

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Experience of posterior division of the puborectalis muscle in the management of chronic constipation. Author(s): Barnes PR, Hawley PR, Preston DM, Lennard-Jones JE. Source: The British Journal of Surgery. 1985 June; 72(6): 475-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4016517

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12712361

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11956799

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Frequency of digital rectal examination in children with chronic constipation. Author(s): Gold DM, Levine J, Weinstein TA, Kessler BH, Pettei MJ. Source: Archives of Pediatrics & Adolescent Medicine. 1999 April; 153(4): 377-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10201720

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Further improvements in the surgical treatment of severe chronic constipation. Author(s): Thirlby RC. Source: Gastroenterology. 1992 June; 102(6): 2172-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1587443

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Gram-negative meningitis and chronic constipation: an unusual presentation of caudal regression syndrome. Author(s): Benson S, King M, Coulter C, Boyle RS. Source: Postgraduate Medical Journal. 1993 September; 69(815): 733-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8255844

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Habit training as treatment of encopresis secondary to chronic constipation. Author(s): Lowery SP, Srour JW, Whitehead WE, Schuster MM. Source: Journal of Pediatric Gastroenterology and Nutrition. 1985 June; 4(3): 397-401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4020572

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11697720

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Hirschsprung's disease as a cause of chronic constipation in the elderly. Author(s): Rich AJ, Lennard TW, Wilsdon JB. Source: British Medical Journal (Clinical Research Ed.). 1983 December 10; 287(6407): 1777-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6416590

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Hirschsprung's disease: a cause of chronic constipation in children. Author(s): Worman S, Ganiats TG. Source: American Family Physician. 1995 February 1; 51(2): 487-94. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7840044

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10822520

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Hyperkinesis and chronic constipation. Author(s): Snow PG. Source: N Z Med J. 1975 June 11; 81(541): 515-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1057103

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Idiopathic chronic constipation is associated with decreased colonic vasoactive intestinal peptide. Author(s): Koch TR, Carney JA, Go L, Go VL. Source: Gastroenterology. 1988 February; 94(2): 300-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2446945

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11490798

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11298783

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Immunohistochemical study of the colonic muscle and innervation in idiopathic chronic constipation. Author(s): Park HJ, Kamm MA, Abbasi AM, Talbot IC. Source: Diseases of the Colon and Rectum. 1995 May; 38(5): 509-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7736882

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Increasing oral fluids in chronic constipation in children. Author(s): Young RJ, Beerman LE, Vanderhoof JA. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 1998 July-August; 21(4): 156-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849179

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12046055

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Intolerance of cow's milk and chronic constipation in children. Author(s): Iacono G, Cavataio F, Montalto G, Florena A, Tumminello M, Soresi M, Notarbartolo A, Carroccio A. Source: The New England Journal of Medicine. 1998 October 15; 339(16): 1100-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9770556

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Investigation and management of long-standing chronic constipation in childhood. Author(s): Clayden GS, Lawson JO. Source: Archives of Disease in Childhood. 1976 December; 51(12): 918-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1015844

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Is subtotal colectomy a viable option in the management of chronic constipation? Author(s): Vasilevsky CA, Nemer FD, Balcos EG, Christenson CE, Goldberg SM. Source: Diseases of the Colon and Rectum. 1988 September; 31(9): 679-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3168677

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Is the afferent pathway from the rectum impaired in children with chronic constipation and encopresis? Author(s): Loening-Baucke V, Yamada T. Source: Gastroenterology. 1995 August; 109(2): 397-403. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7615188

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12395895

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Lead intoxication in a child with chronic constipation. Author(s): Brunken RC, Guest JR, Bickers PC. Source: Nebr Med J. 1978 September; 63(9): 307-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=703897

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11052520

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10716682

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Long term results of anorectal myectomy for chronic constipation. Author(s): Pinho M, Yoshioka K, Keighley MR. Source: The British Journal of Surgery. 1989 November; 76(11): 1163-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2597974

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Long-term efficacy of polyethylene glycol 3350 for the treatment of chronic constipation in children with and without encopresis. Author(s): Pashankar DS, Bishop WP, Loening-Baucke V. Source: Clinical Pediatrics. 2003 November-December; 42(9): 815-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14686553

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Long-term management of chronic constipation in children. Author(s): Katz C, Drongowski RA, Coran AG. Source: Journal of Pediatric Surgery. 1987 October; 22(10): 976-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3681634

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Long-term results of anorectal myectomy for chronic constipation. Author(s): Pinho M, Yoshioka K, Keighley MR. Source: Diseases of the Colon and Rectum. 1990 September; 33(9): 795-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2390917

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Long-term results of surgery for chronic constipation. Author(s): Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Source: Diseases of the Colon and Rectum. 1997 March; 40(3): 273-9. Erratum In: Dis Colon Rectum 1997 May; 40(5): 529. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9118740

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Management of chronic constipation in infants and toddlers. Author(s): Loening-Baucke V. Source: American Family Physician. 1994 February 1; 49(2): 397-400, 403-6, 411-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8304261

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Management of chronic constipation. Author(s): Talley NJ. Source: Reviews in Gastroenterological Disorders. 2004 Winter; 4(1): 18-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15029107

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Management of chronic constipation. Author(s): Clayden GS. Source: Archives of Disease in Childhood. 1992 March; 67(3): 340-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1575563

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Managing geriatric chronic constipation. Author(s): Kovach T. Source: Home Healthcare Nurse. 1992 September-October; 10(5): 57-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1326501

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Manometric evaluation of children with chronic constipation using a suctionstimulating electrode. Author(s): Kubota M, Nagasaki A, Sumitomo K. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 1992 October; 2(5): 287-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1420075

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Measurement of low dietary fiber intake as a risk factor for chronic constipation in children. Author(s): Morais MB, Vitolo MR, Aguirre AN, Fagundes-Neto U. Source: Journal of Pediatric Gastroenterology and Nutrition. 1999 August; 29(2): 132-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10435648

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Medical management of chronic constipation. Author(s): Heffernon EW. Source: Mod Treat. 1971 November; 8(4): 870-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5159967

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Melanosis of the rectum in patients with chronic constipation. Author(s): Badiali D, Marcheggiano A, Pallone F, Paoluzi P, Bausano G, Iannoni C, Materia E, Anzini F, Corazziari E. Source: Diseases of the Colon and Rectum. 1985 April; 28(4): 241-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3979226

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Misoprostol is effective treatment for patients with severe chronic constipation. Author(s): Soffer EE, Metcalf A, Launspach J. Source: Digestive Diseases and Sciences. 1994 May; 39(5): 929-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8174433

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Motor activity of the sigmoid colon in chronic constipation: comparative study with normal subjects. Author(s): Meunier P, Rochas A, Lambert R. Source: Gut. 1979 December; 20(12): 1095-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=527885

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Mouth-to-cecum transit time in patients affected by chronic constipation: effect of glucomannan. Author(s): Marzio L, Del Bianco R, Donne MD, Pieramico O, Cuccurullo F. Source: The American Journal of Gastroenterology. 1989 August; 84(8): 888-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2547312

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Multiple endocrine neoplasia IIb: an unusual cause of chronic constipation. Author(s): Griffiths AM, Mack DR, Byard RW, Stringer DA, Shandling B. Source: The Journal of Pediatrics. 1990 February; 116(2): 285-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1967640

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10726224

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Neuronal anomalies and normal muscle morphology at the hypomotile ileocecocolonic region of patients affected by idiopathic chronic constipation. Author(s): Faussone-Pellegrini MS, Infantino A, Matini P, Masin A, Mayer B, Lise M. Source: Histology and Histopathology. 1999 October; 14(4): 1119-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10506928

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Neuronal dysplasia. Considerations for the pathogenesis and treatment of primary chronic constipation in adults. Author(s): Stoss F. Source: International Journal of Colorectal Disease. 1990 May; 5(2): 106-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2358735

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Neuropeptides in idiopathic chronic constipation (slow transit constipation). Author(s): Sjolund K, Fasth S, Ekman R, Hulten L, Jiborn H, Nordgren S, Sundler F. Source: Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society. 1997 September; 9(3): 143-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9347469

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Nitric oxide synthase and VIP distribution in enteric nervous system in idiopathic chronic constipation. Author(s): Cortesini C, Cianchi F, Infantino A, Lise M. Source: Digestive Diseases and Sciences. 1995 November; 40(11): 2450-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7587830

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11839328

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Paradoxical instruction in the treatment of encopresis and chronic constipation: an experimental analysis. Author(s): Bornstein PH, Sturm CA, Retzlaff PD, Kirby KL, Chong H. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1981 June; 12(2): 16770. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7276191

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Parameters of the rectoanal inhibitory reflex in patients with idiopathic fecal incontinence and chronic constipation. Author(s): Zbar AP, Aslam M, Gold DM, Gatzen C, Gosling A, Kmiot WA. Source: Diseases of the Colon and Rectum. 1998 February; 41(2): 200-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9556245

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11719867

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Patterns of colonic motility as recorded by a sham fecaloma reveal differences among patients with idiopathic chronic constipation. Author(s): Garcia-Olmo D, Sanchez PC. Source: Diseases of the Colon and Rectum. 1998 April; 41(4): 480-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9559634

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11174301

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Phenolphthalein: a review of the medical literature and a controlled evaluation of its use as a laxative in the treatment of chronic constipation. Author(s): Cass LJ, Frederik WS, Montilla E. Source: Curr Ther Res Clin Exp. 1965 September; 7(9): 571-89. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4953858

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Physiologic and psychologic characteristics of an elderly population with chronic constipation. Author(s): Merkel IS, Locher J, Burgio K, Towers A, Wald A. Source: The American Journal of Gastroenterology. 1993 November; 88(11): 1854-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8237932

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Physiologic investigation of primary chronic constipation in children: comparison with the barium enema study. Author(s): Meunier P, Louis D, Jaubert de Beaujeu M. Source: Gastroenterology. 1984 December; 87(6): 1351-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6489699

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Physiological studies in young women with chronic constipation. Author(s): Bannister JJ, Timms JM, Barfield LJ, Donnelly TC, Read NW. Source: International Journal of Colorectal Disease. 1986 July; 1(3): 175-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3611944

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Physiology of refractory chronic constipation. Author(s): Mertz H, Naliboff B, Mayer E. Source: The American Journal of Gastroenterology. 1999 March; 94(3): 609-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10086639

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Polyethylene glycol solution in subgroups of chronic constipation patients: experience in obstructed defaecation. Author(s): Bazzocchi G. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S257-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10726232

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Postprandial colonic transit and motor activity in chronic constipation. Author(s): Bazzocchi G, Ellis J, Villanueva-Meyer J, Jing J, Reddy SN, Mena I, Snape WJ Jr. Source: Gastroenterology. 1990 March; 98(3): 686-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2404826

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Proceedings: Physiological aspects and treatment of severe chronic constipation. Author(s): Lawson JO, Clayden GS, Scopes J. Source: Archives of Disease in Childhood. 1974 March; 49(3): 245. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4825638

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Prolonged manometric investigation of the colon in research on chronic constipation. Author(s): Bassotti G, Betti C, Erbella GS, Cavalletti ML, Pelli MA, Morelli A. Source: Ital J Gastroenterol. 1991 November; 23(8 Suppl 1): 13-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1756276

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12743445

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Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment. Author(s): Fisher SE, Breckon K, Andrews HA, Keighley MR. Source: The British Journal of Surgery. 1989 April; 76(4): 352-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2720344

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11215780

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Rectal sensitivity in chronic constipation. Author(s): De Medici A, Badiali D, Corazziari E, Bausano G, Anzini F. Source: Digestive Diseases and Sciences. 1989 May; 34(5): 747-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2714148

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Reflex anal dilatation associated with severe chronic constipation in children. Author(s): Clayden GS. Source: Archives of Disease in Childhood. 1988 July; 63(7): 832-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3415302

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Reflex anal dilatation associated with severe chronic constipation. Author(s): Priestley BL, Taitz LS. Source: Archives of Disease in Childhood. 1989 February; 64(2): 302-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2930238

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11805568

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12809835

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12860787

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Scintigraphic evaluation of colonic transit in two patients with idiopathic chronic constipation. Author(s): Ramachandran A, Gupta SM, Whelan T, Johns W. Source: Clinical Nuclear Medicine. 2000 February; 25(2): 123-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10656648

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Segmental dilatation of the colon, another cause of chronic constipation. Author(s): Etzioni A, Benderly A, Bar-Maor JA. Source: Diseases of the Colon and Rectum. 1980 November-December; 23(8): 580-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7460698

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Segmental dilation of the colon: a rare cause of chronic constipation. Author(s): Nguyen L, Shandling B. Source: Journal of Pediatric Surgery. 1984 October; 19(5): 539-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6502423

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Sensitivity of the sigmoid colon and rectum in children treated for chronic constipation. Author(s): Loening-Baucke VA. Source: Journal of Pediatric Gastroenterology and Nutrition. 1984 June; 3(3): 454-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6737191

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Sequential treatment of chronic constipation in paraplegic subjects. Author(s): Badiali D, Bracci F, Castellano V, Corazziari E, Fuoco U, Habib FI, Scivoletto G. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 1997 February; 35(2): 116-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9044520

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Seven years' experience with idiopathic unremitting chronic constipation. Author(s): Mishalany H. Source: Journal of Pediatric Surgery. 1989 April; 24(4): 360-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2732875

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Severe chronic constipation as a surgical problem. Author(s): Poisson J, Devroede G. Source: The Surgical Clinics of North America. 1983 February; 63(1): 193-217. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6298958

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Severe chronic constipation of young women: 'idiopathic slow transit constipation'. Author(s): Preston DM, Lennard-Jones JE. Source: Gut. 1986 January; 27(1): 41-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3949236

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11354689

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Sigmoid perforation in patients with chronic constipation. Author(s): Avinoah E, Ovnat A, Peiser J, Charuzi I. Source: Journal of Clinical Gastroenterology. 1987 February; 9(1): 62-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3559115

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Simple chronic constipation: pathophysiology and management. Author(s): Benson JA Jr. Source: Postgraduate Medicine. 1975 January; 57(1): 55-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=234009

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Slow transit chronic constipation (Arbuthnot Lane's disease). An immunohistochemical study of neuropeptide-containing nerves in resected specimens from the large bowel. Author(s): Dolk A, Broden G, Holmstrom B, Johansson C, Schultzberg M. Source: International Journal of Colorectal Disease. 1990 December; 5(4): 181-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2286799

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Sphincteromyectomy and sphincteroplasty in chronic constipation with megarectum. Author(s): Hata Y, Sasaki F, Uchino J. Source: Journal of Pediatric Surgery. 1988 February; 23(2): 141-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3343649

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11054754

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11370180

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11132477

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Symptoms and physiology in severe chronic constipation. Author(s): Mertz H, Naliboff B, Mayer EA. Source: The American Journal of Gastroenterology. 1999 January; 94(1): 131-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9934743

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Symptoms in chronic constipation. Author(s): Koch A, Voderholzer WA, Klauser AG, Muller-Lissner S. Source: Diseases of the Colon and Rectum. 1997 August; 40(8): 902-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9269805

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The action of cisapride on the chronic constipation of paraplegia. Author(s): Binnie NR, Creasey GH, Edmond P, Smith AN. Source: Paraplegia. 1988 June; 26(3): 151-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3419860

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12974147

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The investigation of chronic constipation for surgical management. Author(s): Ho YH, Goh HS. Source: Singapore Med J. 1996 June; 37(3): 291-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8942233

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11190896

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11723853

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The prevalence of hemorrhoids and chronic constipation. Author(s): Haas PA, Haas GP. Source: Gastroenterology. 1990 December; 99(6): 1856-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2227308

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The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Author(s): Johanson JF, Sonnenberg A. Source: Gastroenterology. 1990 February; 98(2): 380-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2295392

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The role of chronic constipation, diarrhea, and laxative use in the etiology of largebowel cancer. Data from the Melbourne Colorectal Cancer Study. Author(s): Kune GA, Kune S, Field B, Watson LF. Source: Diseases of the Colon and Rectum. 1988 July; 31(7): 507-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3391059

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The successful management of chronic constipation in infants and children. Author(s): Sarahan T, Weintraub WH, Coran AG, Wesley JR. Source: Journal of Pediatric Surgery. 1982 April; 17(2): 171-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7077499

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11742185

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The treatment of chronic constipation in adults. A systematic review. Author(s): Tramonte SM, Brand MB, Mulrow CD, Amato MG, O'Keefe ME, Ramirez G. Source: Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine. 1997 January; 12(1): 15-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9034942

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The utilization of colon transit scintigraphy in the diagnostic algorithm for patients with chronic constipation. Author(s): McLean RG, King DW, Talley NA, Tait AD, Freiman J. Source: Digestive Diseases and Sciences. 1999 January; 44(1): 41-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9952221

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Therapy of chronic constipation in a young child by rearranging social contingencies. Author(s): Lal H, Lindsley OR. Source: Behaviour Research and Therapy. 1968 November; 6(4): 484-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5714992

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Treating chronic constipation in children. Author(s): Wherry CA. Source: Nurs Times. 1977 November 24; 73(47): 1829-31. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=593914

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Treatment and cost concerns for chronic constipation. Author(s): Fox GN. Source: American Family Physician. 1994 November 15; 50(7): 1465. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7976979

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Treatment of acute and chronic constipation with bisoxatin acetate and bisacodyl. Double-blind crossover study. Author(s): Rider JA. Source: Curr Ther Res Clin Exp. 1971 June; 13(6): 386-92. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4996225

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Treatment of chronic constipation with cisapride and placebo. Author(s): Muller-Lissner SA. Source: Gut. 1987 August; 28(8): 1033-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3311905

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12809836

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Treatment of chronic constipation with lactitol sweetened yoghurt supplemented with guar gum and wheat bran in elderly hospital in-patients. Author(s): Rajala SA, Salminen SJ, Seppanen JH, Vapaatalo H. Source: Compr Gerontol [a]. 1988 June; 2(2): 83-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2852540

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Treatment of chronic constipation with lactulose syrup: results of a double-blind study. Author(s): Wesselius-De Casparis A, Braadbaart S, Bergh-Bohlken GE, Mimica M. Source: Gut. 1968 February; 9(1): 84-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4867936

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Treatment of internal rectal intussusception in patients with chronic constipation. Author(s): Christiansen J, Hesselfeldt P, Sorensen M. Source: Scandinavian Journal of Gastroenterology. 1995 May; 30(5): 470-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7638574

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Understanding idiopathic chronic constipation: an understated problem. Author(s): Rice PS, Phaosawasdi K. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 1989 Fall; 12(2): 90-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2487832

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Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Author(s): Loening-Baucke V. Source: Pediatrics. 1997 August; 100(2 Pt 1): 228-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9240804

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Use of erythromycin for the treatment of severe chronic constipation in children. Author(s): Bellomo-Brandao MA, Collares EF, da-Costa-Pinto EA. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 2003 October; 36(10): 1391-6. Epub 2003 September 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14502372

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

Finding Nutrition Studies on Chronic 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 “chronic constipation” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

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

Factors determining outcome in children with chronic constipation and faecal soiling. Author(s): Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City 52242. Source: Loening Baucke, V Gut. 1989 July; 30(7): 999-1006 0017-5749

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

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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/

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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/

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

Nutrition

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

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

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 chronic 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 “chronic 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 chronic 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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8234437

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10460984

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Abdominal wall massage: effect on colonic function in healthy volunteers and in patients with chronic constipation. Author(s): Klauser AG, Flaschentrager J, Gehrke A, Muller-Lissner SA. Source: Zeitschrift Fur Gastroenterologie. 1992 April; 30(4): 247-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1534955

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Abnormal rectoanal function in children recovered from chronic constipation and encopresis. Author(s): Loening-Baucke VA. Source: Gastroenterology. 1984 December; 87(6): 1299-304. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6092198

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An alternative biofeedback-based behavior modification treatment for a case of chronic constipation. Author(s): Singles JM, Mikulka PJ, Cox DJ, Mittal RK. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1992 September; 23(3): 231-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1487540

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An open, randomised, parallel group study of lactulose versus ispaghula in the treatment of chronic constipation in adults. Author(s): Rouse M, Chapman N, Mahapatra M, Grillage M, Atkinson SN, Prescott P. Source: Br J Clin Pract. 1991 Spring; 45(1): 28-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1931536

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Behavioral medicine treatment in chronic constipation with paradoxical anal sphincter contraction. Author(s): Dahl J, Lindquist BL, Tysk C, Leissner P, Philipson L, Jarnerot G. Source: Diseases of the Colon and Rectum. 1991 September; 34(9): 769-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1914742

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8434996

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7596696

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Biofeedback: its role in the treatment of chronic constipation. Author(s): Stessman M. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 2003 November-December; 26(6): 251-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14676613

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8256475

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Chronic constipation in children: can it be managed by diet alone? Author(s): Olness K, Tobin J Sr. Source: Postgraduate Medicine. 1982 October; 72(4): 149-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6289291

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8274909

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8219947

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14523145

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9118741

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Comparison of “Duphalac” and “irritant” laxatives during and after treatment of chronic constipation: a preliminary study. Author(s): Connolly P, Hughes IW, Ryan G.

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Source: Current Medical Research and Opinion. 1974-75; 2(10): 620-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4616802 •

Current treatment options for chronic constipation. Author(s): DiPalma JA. Source: Reviews in Gastroenterological Disorders. 2004; 4 Suppl 2: S34-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15184812

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12674840

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9269806

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Factors determining outcome in children with chronic constipation and faecal soiling. Author(s): Loening-Baucke V. Source: Gut. 1989 July; 30(7): 999-1006. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2759495

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10576011

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8840558

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Management of chronic constipation and “irritable bowel syndrome”: a clinical test. Author(s): McHardy G. Source: J La State Med Soc. 1971 December; 123(12): 405-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5127975


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New and emerging treatment options for chronic constipation. Author(s): Schiller LR. Source: Reviews in Gastroenterological Disorders. 2004; 4 Suppl 2: S43-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15184816

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Persistence of chronic constipation in children after biofeedback treatment. Author(s): Loening-Baucke V. Source: Digestive Diseases and Sciences. 1991 February; 36(2): 153-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1988258

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Probiotic beverage containing Lactobacillus casei Shirota improves gastrointestinal symptoms in patients with chronic constipation. Author(s): Koebnick C, Wagner I, Leitzmann P, Stern U, Zunft HJ. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2003 November; 17(11): 655-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14631461

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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. Source: Alimentary Pharmacology & Therapeutics. 1998 May; 12(5): 491-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9663731

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12715585

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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/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8234438

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The use of a new surfactant (superinone) with a purified hemicellulose in the treatment of chronic constipation. Author(s): STOUGH AR. Source: J Okla State Med Assoc. 1959 March; 52(3): 134-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13642156

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Treatment of chronic constipation by a bulk-forming laxative (Fibrolax). Author(s): Borgia M, Sepe N, Brancato V, Costa G, Simone P, Borgia R, Lugli R.

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Source: J Int Med Res. 1983; 11(2): 124-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6852360 •

Treatment of chronic constipation; electrotherapy and diet. Author(s): SCHOLZ H, SCHMIDT L. Source: Br J Phys Med. 1952 November; 15(11): 254-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12997653

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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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 chronic 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 Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Constipation Source: Healthnotes, Inc.; www.healthnotes.com


Constipation Source: Integrative Medicine Communications; www.drkoop.com Constipation Source: Prima Communications, Inc.www.personalhealthzone.com Hemorrhoids Source: Healthnotes, Inc.; www.healthnotes.com •

Alternative Therapy 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

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Herbs and Supplements 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 Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Ispaghula Source: Integrative Medicine Communications; www.drkoop.com Organ Mountain Crape Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca 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

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Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc.; www.healthnotes.com

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. PATENTS ON CHRONIC 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.5 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 “chronic constipation” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on chronic constipation, we have not necessarily excluded non-medical patents in this bibliography.

Patent Applications on Chronic Constipation As of December 2000, U.S. patent applications are open to public viewing.6 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 chronic constipation:

5Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm. 6 This has been a common practice outside the United States prior to December 2000.

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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 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

Keeping Current In order to stay informed about patents and patent applications dealing with chronic 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 “chronic 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 chronic constipation.

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You can also use this procedure to view pending patent applications concerning chronic 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 5. BOOKS ON CHRONIC CONSTIPATION Overview This chapter provides bibliographic book references relating to chronic constipation. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on chronic 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 “chronic 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 chronic 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;

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physiology of defecation; bowel anatomy; causes of constipation, including travel, 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.

Chapters on Chronic Constipation In order to find chapters that specifically relate to chronic constipation, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and chronic 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 “chronic constipation” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on chronic constipation: •

Disorders of Defecation Source: in Corman, M.L.; Allison, S.I.; Kuehne, J.P. Handbook of Colon and Rectal Surgery. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.225-245. 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. PRICE: $79.00 plus shipping and handling. ISBN: 0781725860. Summary: Chronic idiopathic constipation and abdominal pain are among the most common reasons for patients to solicit medical advice. This chapter addresses a number of conditions associated with bowel evacuation problems, the presenting complaint of which is often constipation. The chapter is from a handbook that addresses the entire range of diseases affecting the colon, rectum, and anus. Topics include physiology of the colon (absorption and propulsion), etiology of chronic constipation, clinical presentations, evaluation of the constipated patient, medical management (diet, exercise, laxatives, enemas, and suppositories), spastic pelvic floor syndrome, obstructed defecation, anismus, Hirschprung's disease, surgery in the management of constipation, intestinal pseudoobstruction, proctalgia fugax, and coccygodynia. 1 figure. 1 table.

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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

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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. •

Endoscopic Management of Small Bowel, Anastomotic, and Colonic Strictures in Crohn's Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 509-513. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: Historically, refractory (resistant to treatment) disease and obstruction are the most common indications for surgery in Crohn's disease, and obstruction refractory to medical management (such as drug therapy) is the most common indication for reoperation. This chapter on endoscopic management of strictures (narrowing of the intestine, usually as a result of scar tissue) of Crohn's disease (CD) is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with CD and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). Strictures in IBD can be symptomatic, featuring chronic constipation (obstipation), pain, and distention in small bowel; colonic or anastomotic stenoses; nausea, vomiting, and postprandial (after a meal) pain with gastroduodenal strictures. Alternatively, they may simply be radiographic or endoscopic areas of narrowing that preclude subsequent tissue sampling by virtue of their small diameter. Balloon dilation of Crohn's strictures, particularly anastomotic ones, appears reasonable in patients with persistent or rapidly recurring obstructive symptoms despite good medical therapy. The approach should be used prior to additional surgical intervention in most patients unless there is an acute obstruction with potentially compromised bowel, uncertainty about concomitant malignancy, or an associated fistula within the stenosis. Although yet to be proven, concomitant injection of a long-acting corticosteroid should be considered in patients intolerant of or unwilling to take oral corticosteroids, those who develop an anastomotic stricture within 6 months of surgical resection, or those patients who rapidly restenose following a technically successful balloon dilation. Finally, radial electrocautery is contraindicated in these patients, and use of expandable prostheses clearly is investigational. 4 figures. 4 tables. 11 references.

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Hirschsprung's Disease Source: in Snape, W.J., ed. Consultations in Gastroenterology. Philadelphia, PA: W.B. Saunders Company. 1996. p. 470-477. 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 Hirschsprung's disease (congenital megacolon), which represents the congenital absence of parasympathetic ganglion cells in the colon. Topics include the historical perspective, etiology, clinical presentation, variants, complications, evaluation, treatment options, surgical techniques and differential diagnosis. There are three important clinical presentations of Hirschsprung's disease: in the neonate, failure to pass meconium, abdominal distension, and intestinal obstruction; in the infant, failure to thrive and constipation; and in the adult, chronic constipation and associated anomalies. Treatment for Hirschsprung's disease is primarily surgical; treatment options include diversion, anorectal myectomy, Swenson technique, Duhamel technique, and the Soave technique. 4 figures. 7 tables. 21 references.

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Elimination Disorders Source: in Greydanus, D.E., and Wolraich, M.L., eds. Behavioral Pediatrics. New York, NY: Springer-Verlag. 1992. p. 280-297. Contact: Available from Springer-Verlag New York, Inc. P.O. Box 2485, Secaucus, NJ 07096-2485. (800) 777-4643 or (201) 348-4033. Fax (201) 348-4505. PRICE: $98.00. ISBN: 0387975470. Summary: This chapter on elimination disorders is from a medical text on behavioral pediatrics. The author discusses chronic constipation, with and without encopresis and enuresis. These elimination disorders frequently occur in childhood and may continue through adolescence and occasionally persist into adulthood. The author discusses pathophysiology, assessment and findings, management, prognosis, and referral considerations for these elimination disorders. Most patients with idiopathic constipation will benefit from a well-organized program designed to clear fecal impaction, prevent fecal impaction, and promote regular bowel habits. A regimen of treatment with positive reinforcement should be the initial course of management for most children with enuresis. Reassurance, periodic feedback, and encouragement of the parents and the child by the physician will optimize outcome in both disorders. 1 figure. 6 tables. 70 references. (AA-M).

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Your Digestive System Source: in Larson, D.E., ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company, Inc. 1996. p. 737-824. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $39.95 plus shipping and handling. ISBN: 0688144780. Summary: This chapter on the digestive system is from a family health guide published by the Mayo Clinic. The lengthy chapter features nine sections: the digestive system at work, esophageal problems, stomach problems, disorders of the small and large intestines, anorectal disorders, liver disease, gallbladder and bile duct disorders,

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pancreatic diseases, and hernias. Within each section, multiple entries each begin with a review of signs and symptoms of the problem. This is followed by a description of the disease and a discussion on how the physician might make a diagnosis. The authors often include reviews of the real or potential seriousness of the problem. Each section then discusses treatment options, including medications or surgery, and, when appropriate, self help strategies. Topics covered include heartburn, hiatal hernia, hiccups, swallowing problems, gastrostomy, esophageal stricture, foreign bodies, esophageal tumors, esophageal varices, esophageal rupture, indigestion, peptic ulcer, Zollinger Ellison syndrome, gastritis, drug induced stomach problems, gastrointestinal tract bleeding, stomach tumors, stomach dilation, Menetrier disease, eosinophilic gastroenteritis, infections of the gastrointestinal tract, antibiotic associated diarrhea, malabsorption problems, acute appendicitis, Meckel diverticulum, intussusception, protein losing enteropathy, primarily (idiopathic) intestinal pseudo-obstruction, carcinoid syndrome, Crohn's disease, ulcerative colitis, colostomy and ileostomy, tumors of the small intestine, ileo anal anastomosis, diverticulosis and diverticulitis, irritable bowel syndrome, chronic constipation, dietary fiber, laxative abuse, intestinal gas, fecal impaction, colon polyps, colonoscopy, colon cancer, megacolon, peritonitis, familial Mediterranean fever, intestinal obstruction, vascular problems of the bowel, hemorrhoids, anal itch, anal fissures and fistulas, rectal bleeding, anorectal abscess, anal pain, proctitis, fecal incontinence, acute viral hepatitis, alcoholic (and other drug related) hepatitis, chronic hepatitis, cirrhosis, liver biopsy, liver tumors, liver abscess, liver transplantation, gallstones, bile duct obstruction, choledochal cysts, acute and chronic pancreatitis, malignant pancreatic tumors, congenital pancreatic abnormalities, inguinal hernia, and other abdominal hernias. The chapter features line drawings, black and white photographs, and sidebars for additional information. •

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.

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CHAPTER 6. PERIODICALS AND NEWS ON CHRONIC CONSTIPATION Overview In this chapter, we suggest a number of news sources and present various periodicals that cover chronic constipation.

News Services and Press Releases One of the simplest ways of tracking press releases on chronic 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 “chronic 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 chronic 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 “chronic constipation” (or synonyms). The following was recently listed in this archive for chronic constipation: •

Novartis' Zelmac effective in chronic constipation study Source: Reuters Industry Breifing Date: May 20, 2003

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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. 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 “chronic 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 “chronic constipation” (or synonyms). If you know the name of a company that is relevant to chronic 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 “chronic constipation” (or synonyms).

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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 “chronic 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 chronic constipation: •

FDA Approval of Cisapride Source: APHS Newsletter. American Pseudo-Obstruction and Hirschsprung's Disease Society, Inc. Newsletter. 6(1): 1-2. Winter 1993-1994. 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 article discusses the FDA approval of cisapride (Propulsid, Janssen Pharmaceutica) for use in children with impaired gastrointestinal motility. The author notes that cisapride has been approved for use in adults who have nighttime heartburn due to gastroesophageal reflux disease (GERD). Topics include the symptoms of GERD in children; associated diseases and conditions; initial therapy for GERD in infants; results with cisapride in pediatric patients; the use of cisapride in children with chronic intestinal pseudo-obstruction (CIP); other prokinetic drugs; the use of cisapride in the treatment of chronic constipation; the pharmaceutical development of cisapride; and the anticipated progress through the FDA approval process.

•

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 Chronic Constipation Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to chronic constipation. In addition to these sources, you can search for articles covering chronic constipation that have

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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 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 7. 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 chronic 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 non-profit 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 chronic 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.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to chronic constipation: Laxatives •

Oral - U.S. Brands: Agoral; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Citroma; Citrucel Orange Flavor; Citrucel Sugar-Free Orange Flavor; Colace; Constilac; Constulose; Correctol; Correctol Caplets; Correctol Herbal Tea; Correctol Stool Softener Soft Gels; D.O.S. Softgels; DC Softgels; Diocto; Diocto-C; Dioeze; Diosuccin; Docu-K Plus; DOK; DOK Softgels; Dr. Caldwell Senna Laxative; D-S-S; D-S-S plus; Dulcolax; Emulsoil; Enulose; Epsom salts; Equalactin; Evac-U-Gen; Ex-Lax; Ex-Lax Chocolate; FemiLax; Fiberall; Fibercon Caplets; Fiber-Lax; FiberNorm; Fleet Laxative; Fleet Mineral Oil; Fleet Phospho-Soda; Fleet Soflax Gelcaps; Fleet Soflax Overnight Gelcaps; Fletcher's Castoria; Genasoft Plus Softgels; Gentle Laxative; Haley's M-O; Herbal Laxative; Hydrocil Instant; Kondremul Plain; Konsyl; Konsyl Easy Mix; Konsyl-D; KonsylOrange; Konsyl-Orange Sugar Free; Laxinate 100; Liqui-Doss; Mag-Ox 400; Maltsupex; Metamucil; Metamucil Apple Crisp Fiber Wafers; Metamucil Cinnamon Spice Fiber Wafers; Metamucil Orange Flavor; Metamucil Smooth Sugar-Free, Citrus Flavor; Metamucil Smooth Sugar-Free, Orange Flavor; Metamucil Smooth Sugar-Free, Regular Flavor; Metamucil Smooth, Citrus Flavor; Metamucil Smooth, Orange Flavor; Metamucil Sugar-Free, Lemon-Lime Flavor; Metamucil Sugar-Free, Orange Flavor; MiraLax; Modane; Modane Bulk; Mylanta Natural Fiber Supplement; Mylanta Sugar Free Natural Fiber Supplement; Nature's Remedy; Neoloid; Perdiem; Perdiem Fiber; Peri-Colace; Peri-Dos Softgels; Phillips' Chewable; Phillips' Concentrated; Phillips' Milk of Magnesia; Phillips' Stool Softner Laxative Softgels; Prompt; Purge; Reguloid Natural; Reguloid Natural Sugar Free; Reguloid Orange; Reguloid Orange Sugar Free; Senexon; Senna-Gen; Senokot; Senokot Children's Syrup; Senokot-S; SenokotXTRA; Senolax; Serutan; Serutan Toasted Granules; Silace; Silace-C; Sulfolax; Surfak; Syllact; Veracolate; V-Lax; X-Prep Liquid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202319.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. 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 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 Institute7: •

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/

7

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.8 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:9 •

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

8

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). 9 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 NLM Gateway10 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.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “chronic 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 2131 17 951 3 306 3408

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 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.14 Simply search by “chronic constipation” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

11

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). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

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 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.

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Coffee Break: Tutorials for Biologists15 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.16 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.17 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/.

15 Adapted 16

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

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. 17 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 chronic 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 chronic 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 chronic 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 “chronic constipation”:

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Anal and Rectal Diseases http://www.nlm.nih.gov/medlineplus/analandrectaldiseases.html Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Interstitial Cystitis http://www.nlm.nih.gov/medlineplus/interstitialcystitis.html 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 chronic 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: •

Restoring Control: Proven Solutions for Bladder and Bowel Control Problems Source: Redmond, WA: SRS Medical Systems, Inc. 1997. [2 p.]. Contact: Available from SRS Medical Systems, Inc. 14950 NE 95th Street, Redmond WA 98052. (800) 345-5642 or (425) 882-1101. PRICE: $40.00 for a package of 100; for health professionals only. Also available at www.srsmedical.com. Summary: Pelvic muscle dysfunction (PMD) includes urinary and fecal incontinence, chronic constipation, pelvic pain, and related disorders. This brochure discusses PMD and the use of a biofeedback system of muscle reeducation as treatment for PMD. The brochure first outlines the types and causes of incontinence, encouraging readers to obtain appropriate assessment and diagnosis from a health care provider. The brochure then describes the use of the Orion Continence System, a combination of computerized biofeedback, patented electromyographic sensors, and home training. The program begins with a thorough evaluation and physical examination, then explains pelvic floor muscles and how to do Kegel exercises. These muscle strengthening exercises help control the leakage of urine and feces. How much each person improves depends on how much time is devoted to the exercises, how properly they are done, and what each person's individual physical condition is. The Orion Continence System is designed to help patients ensure that they are doing the pelvic muscle exercises properly. The system uses a small patented Perry sensor (which is inserted vaginally or rectally like a tampon or suppository); the sensor is attached to an Orion computerized biofeedback instrument with a color monitor. This allows both the health care provider and the patient to see and measure even tiny changes in pelvic muscle activity. Other components of the program include keeping records of bladder and bowel activity,

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teaching skills that can help improve control, and learning how diet can affect bladder and bowel problems. The brochure notes that it usually takes three to six weekly office visits and 8 weeks of home training to realize a reduction of 70 to 100 percent in the most common types of incontinence. One sidebar lists the addresses and telephone numbers for government agencies and other organizations through which readers can get more information. 3 figures. •

Hemorrhoids: Questions and Answers Source: Arlington Heights, IL: American Society of Colon and Rectal Surgeons. 1996. [4 p.]. Contact: Available from American Society for Colon and Rectal Surgeons (ASCRS). 85 West Algonquin Road, Suite 550, Arlington Heights, IL 60005. (800) 791-0001 or (847) 290-9184. Website: www.fascrs.org. PRICE: Single copy free. Summary: This brochure describes hemorrhoids, enlarged bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids: external and internal. External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin. Internal (inside) hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. The exact causes are not known, but contributing factors include the upright posture of human beings, aging, chronic constipation or diarrhea, pregnancy, heredity, faulty bowel function, and spending long periods of time (e.g., reading) on the toilet. There is no relationship between hemorrhoids and cancer; however, the symptoms are similar to those of colorectal cancer and other diseases of the digestive system and therefore call for investigation by a health care provider. Mild symptoms can be relieved frequently by increasing the amount of fiber and fluids in the diet. Eliminating excessive straining reduces the pressure on hemorrhoids and helps prevent them from protruding. Severe hemorrhoids require treatment, much of which can be performed on an outpatient basis. The brochure describes treatment options, including ligation (rubber band treatment), injection and coagulation, hemorrhoidectomy, and other treatments, including cryotherapy (freezing). The brochure concludes with a brief description of the specialty of colon and rectal surgeons. 4 figures.

•

What Can Digestion Tell You About Your Health? Source: Asheville, NC: Great Smokies Diagnostic Laboratory. 1998. [2 p.]. Contact: Available from Great Smokies Diagnostic Laboratory. 63 Zillicoa Street, Asheville, NC 28801-1074. (800) 522-4762 or (704) 253-0621. Fax (704) 252-9303. E-mail: [email protected]. Website: www.greatsmokies-lab.com. PRICE: Single copy free. Summary: This brochure describes the Comprehensive Digestive Stool Analysis (CDSA), a group of 25 tests performed on a stool sample, which can reveal information about a patient's gastrointestinal health. The CDSA evaluates the digestion of food molecules and absorption of nutrients, the presence of hidden yeast or bacterial infections, intestinal flora balance, intestinal immune function, and dietary fiber intake. The brochure emphasizes that poor digestion or imbalances in the intestinal flora can result in many illnesses, from annoying complaints such as chronic constipation and abdominal pain, to more serious illnesses that may appear unrelated to digestion, such as asthma or migraines. The brochure reviews the role of some of the components of a healthy gastrointestinal tract, including stomach acid and other digestive enzymes, the bacteria in the digestive tract, and the immune system. For proper gastrointestinal health, the body must carefully coordinate the breakdown, absorption, and elimination

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of food. Bacteria must be in proper balance, and immune function must be adequate. The brochure includes a checklist readers can use to assess their own need for a CDSA. 1 figure. •

Rectal Prolapse: 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) 2909184. Fax (847) 290-9203. Price: Single copy free; bulk copies available. Summary: This brochure, from the American Society of Colon and Rectal Surgeons, provides basic information about rectal prolapse, a condition in which the rectum turns itself inside out. Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage and may result in leakage of stool or mucus. The brochure provides information about the etiology, symptoms, diagnosis, and treatment of the condition. Rectal prolapse may come from a lifelong habit of straining to have bowel movements or as a delayed result of stresses involved in childbirth. Diagnostic tests used include an anorectal examination, xray (videodefecogram), and anorectal manometry. Treatment of rectal prolapse depends on several factors, including the patient's age, physical condition, and extent of prolapse, and test results. Success of treatment depends on the status of a patient's anal sphincter muscle, whether the prolapse is internal or external, the overall condition of the patient, and the surgical method used. Chronic constipation and straining after surgical correction must be avoided. The brochure concludes with a brief description of the specialty practiced by colon and rectal surgeons. 2 figures. (AA-M).

•

You Can Do Something About Incontinence: A Physical Therapist's Perspective Source: Alexandria, VA: American Physical Therapy Association (APTA). 1998. 8 p. Contact: Available from American Physical Therapy Association (APTA). 111 North Fairfax Street, Alexandria, VA 22314-1488. (800) 999-APTA or (800) 999-2782. E-mail: [email protected]. Website: www.apta.org. PRICE: $18.75 per package of 25 for nonmembers; $12.50 per package of 25 for members. Order number PR-198. Summary: This illustrated brochure helps people who have urinary incontinence understand incontinence and the different kinds of physical therapy options available to manage the condition or regain complete continence. Urinary incontinence is the involuntary loss of urine. Besides leakage, symptoms include an urgent need to urinate, frequent urination, and nocturia (urinating at night). Many factors contribute to urinary incontinence, including childbirth, obesity, improper lifting of heavy objects, chronic constipation, or post-menopause. Urinary incontinence can be stress incontinence, the sudden involuntary loss of urine when exercising or moving in a certain way, or urge incontinence, defined as urine leakage that occurs as soon as a person senses the need to urinate. Treatments for urinary incontinence include patient education, bladder retraining and timed schedules for urinating, exercises or vaginal weights to strengthen the pelvic floor muscles, medication, dietary modifications, and surgery. One section of the brochure describes Kegel exercises (exercises to strengthen the pelvic floor muscles to help improve bladder control) in detail. A physical therapist may also use biofeedback or electrical stimulation of the pelvic floor muscles to strengthen those muscles. In addition, various lifestyle modifications may help reduce bladder irritation. The brochure is illustrated with simple line drawings and concludes with a brief

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description of the work of the American Physical Therapy Association (APTA). 7 figures. •

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 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 chronic 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.

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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: •


•

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

•

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

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

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

•

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

•

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 chronic constipation. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with chronic 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 chronic 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 “chronic 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

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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 “chronic constipation”. Type the following hyperlink into your 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 “chronic 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 “chronic 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.18

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

18

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)19: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

19

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

•

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

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

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/

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•

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/

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•

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

89

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).

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

91

CHRONIC CONSTIPATION DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 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 Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [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, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aetiology: Study of the causes of disease. [EU] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [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] 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]

92


Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [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] 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] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] 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] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH] 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] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Anus: The opening of the rectum to the outside of the body. [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]

Dictionary 93

Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autoimmune Hepatitis: A liver disease caused when the body's immune system destroys liver cells for no known reason. [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] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Balloon dilation: A treatment for benign prostatic hyperplasia or prostate enlargement. A tiny balloon is inflated inside the urethra to make it wider so urine can flow more freely from the bladder. [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] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Bilateral: Affecting both the right and left side of body. [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] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH]

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Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] 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] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [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] Body Fluids: Liquid components of living organisms. [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] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [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] 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] 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]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cascara: Component of the dried bark of a buckthorn (Rhamnus purshiana) that contains the anthraquinone emodin. It is used as a laxative. [NIH]

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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] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [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 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 proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] 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] 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] Choledochal Cyst: A congenital cystic dilatation of the common bile duct; this condition may be asymptomatic, or cause vomiting, fever, jaundice, or pain in the right upper quadrant. [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] 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] Cirrhosis: A type of chronic, progressive liver disease. [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

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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] 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] 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] Colitis: Inflammation of the colon. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colon Polyps: Small, fleshy, mushroom-shaped growths in the colon. [NIH] 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] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [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

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lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix '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] 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] Continence: The ability to hold in a bowel movement or urine. [NIH] 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] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [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]

Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH]

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Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] 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] Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cytotoxic: Cell-killing. [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] Defaecation: The act or process of defecating, discharge of feces. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Defecography: Radiographic examination of the process of defecation after the instillation of a contrast media into the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] 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] 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 Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] 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] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the

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alimentary enzymes of man. It comprises various polysaccharides and lignins. [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] Digital rectal examination: DRE. An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] 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] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] 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] Distention: The state of being distended or enlarged; the act of distending. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulosis: A condition marked by small sacs or pouches (diverticula) in the walls of an organ such as the stomach or colon. These sacs can become inflamed and cause a condition called diverticulitis, which may be a risk factor for certain types of cancer. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [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] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU]

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Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [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] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [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] Elimination Disorders: Excretory-related psychiatric disorders usually diagnosed in infancy or childhood. [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] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endometrium: The layer of tissue that lines the uterus. [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] Endosonography: Ultrasonography of internal organs using an ultrasound transducer sometimes mounted on a fiberoptic endoscope. In endosonography the transducer converts electronic signals into acoustic pulses or continuous waves and acts also as a receiver to detect reflected pulses from within the organ. An audiovisual-electronic interface converts the detected or processed echo signals, which pass through the electronics of the instrument, into a form that the technologist can evaluate. The procedure should not be confused with endoscopy which employs a special instrument called an endoscope. The "endo-" of endosonography refers to the examination of tissue within hollow organs, with reference to the usual ultrasonography procedure which is performed externally or transcutaneously. [NIH]

Enema: The injection of a liquid through the anus into the large bowel. [NIH] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [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 been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bed-wetting, nocturnal enuresis). [EU]

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Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilic: A condition found primarily in grinding workers caused by a reaction of the pulmonary tissue, in particular the eosinophilic cells, to dust that has entered the lung. [NIH] Eosinophilic Gastroenteritis: Infection and swelling of the lining of the stomach, small intestine, or large intestine. The infection is caused by white blood cells (eosinophils). [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [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]

Evacuation: An emptying, as of the bowels. [EU] 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] Faecal: Pertaining to or of the nature of feces. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Family Health: The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. [NIH]

Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH]

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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] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [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] 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] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastrocolic Reflex: Increase of muscle movement in the gastrointestinal tract when food enters an empty stomach. May cause the urge to have a bowel movement right after eating. [NIH]

Gastroduodenal: Pertaining to or communicating with the stomach and duodenum, as a gastroduodenal fistula. [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] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH]

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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]

Geriatric: Pertaining to the treatment of the aged. [EU] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally 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] 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] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Handicap: A handicap occurs as a result of disability, but disability does not always constitute a handicap. A handicap may be said to exist when a disability causes a substantial and continuing reduction in a person's capacity to function socially and vocationally. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemicellulose: A general term to describe those polysaccharides other than cellulose which are constituents of vegetable cell walls. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [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]

Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis, Chronic: A collective term for a clinical and pathological syndrome which has

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several causes and is characterized by varying degrees of hepatocellular necrosis and inflammation. Specific forms of chronic hepatitis include autoimmune hepatitis, chronic hepatitis B, chronic hepatitis C, chronic hepatitis D, indeterminate chronic viral hepatitis, cryptogenic chronic hepatitis, and drug-related chronic hepatitis. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] 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] 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] 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] Hysterectomy: Excision of the uterus. [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] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [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] 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] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] 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] 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

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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]

Inflammation: A pathological process characterized by injury or destruction of tissues 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]

Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [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] Instillation: . [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Flora: The bacteria, yeasts, and fungi that grow normally in the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [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] 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]

Involuntary: Reaction occurring without intention or volition. [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] 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] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes.

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[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] Lactulose: A mild laxative. [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] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Lethal: Deadly, fatal. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [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] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] 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]

Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Meconium: The thick green-to-black mucilaginous material found in the intestines of a fullterm fetus. It consists of secretions of the intestinal glands, bile pigments, fatty acids, amniotic fluid, and intrauterine debris. It constitutes the first stools passed by a newborn. [NIH]

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] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH]

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Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] 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] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [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] Mineral Oil: A mixture of liquid hydrocarbons obtained from petroleum. It is used as laxative, lubricant, ointment base, and emollient. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [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] 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] 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] 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] Mucilaginous: Pertaining to or secreting mucus. [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] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and

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smooth muscle. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myenteric: On stimulation of an intestinal segment, the segment above contracts and that below relaxes. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] 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] 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] Neoplasia: Abnormal and uncontrolled cell growth. [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] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] 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] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] 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] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Obstipation: Intractable constipation. [EU] Office Visits: Visits made by patients to health service providers' offices for diagnosis,

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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] 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] 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] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] 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] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Paradoxical: Occurring at variance with the normal rule. [EU] Paralysis: Loss of ability to move all or part of the body. [NIH] Paraneoplastic Syndromes: In patients with neoplastic diseases a wide variety of clinical pictures which are indirect and usually remote effects produced by tumor cell metabolites or other products. [NIH] Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU]

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Particle: A tiny mass of material. [EU] 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] Patient Education: The teaching or training of patients concerning their own health needs. [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] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid 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] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [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] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [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] 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] 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

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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] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [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] 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] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [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] 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] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] 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.

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[NIH]

Polyethylene Glycols: Alpha-Hydro-omega-hydroxypoly(oxy-1,2-ethanediyls). Additional polymers of ethylene oxide and water and their ethers. They vary in consistency from liquid to solid, depending on the molecular weight, indicated by a number following the name. Used as surfactants in industry, including foods, cosmetics and pharmaceutics; in biomedicine, as dispersing agents, solvents, ointment and suppository bases, vehicles, tablet excipients. Some specific groups are lauromagrogols, nonoxynols, octoxynols and poloxamers. [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] 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] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [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] 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] Proctalgia Fugax: Intense pain in the rectum that occasionally happens at night. Caused by muscle spasms around the anus. [NIH] Proctectomy: An operation to remove the rectum. [NIH] Proctitis: Inflammation of the rectum. [EU] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prokinetic Drugs: Medicines that cause muscles in the GI tract to move food. An example is cisapride (SIS-uh-pryd) (Propulsid). [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

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

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over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [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] 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] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] 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] 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] 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]

Pupil: The aperture in the iris through which light passes. [NIH] Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] 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] 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] 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] Recurrence: The return of a sign, symptom, or disease after a remission. [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] Refractory: Not readily yielding to treatment. [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] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [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] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [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] Salicylate: Non-steroidal anti-inflammatory drugs. [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] 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] Screening: Checking for disease when there are no symptoms. [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] 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] Sensor: A device designed to respond to physical stimuli such as temperature, light,

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magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [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] Side effect: A consequence other than the one(s) for which an agent or measure is used, as 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] 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] 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]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [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] 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]

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Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [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] 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] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] 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] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stercoral: Fecal. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] 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] 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 incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [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]

Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH]

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Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [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] 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] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [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]

Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [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] 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] 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] 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] Translocation: The movement of material in solution inside the body of the plant. [NIH]

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Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [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] 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] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [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] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

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 tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [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 the bladder, and leaves the body through the urethra. [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] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU]

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Vasculitis: Inflammation of a blood vessel. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoactive Intestinal Peptide: A highly basic, single-chain polypeptide isolated from the intestinal mucosa. It has a wide range of biological actions affecting the cardiovascular, gastrointestinal, and respiratory systems. It is also found in several parts of the central and peripheral nervous systems and is a neurotransmitter. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] 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] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] 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] 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]

X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [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] 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]

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INDEX A Abdominal, 41, 42, 54, 56, 57, 61, 77, 91, 95, 98, 105, 109, 110, 116, 118 Abdominal Pain, 54, 77, 91, 105, 110, 118 Abscess, 57, 91 Acoustic, 91, 100 Acrylonitrile, 91, 114 Action Potentials, 5, 91 Adenocarcinoma, 7, 91 Adolescence, 56, 91, 110 Adrenal Cortex, 91, 98, 112 Adverse Effect, 91, 115 Aetiology, 9, 91 Afferent, 23, 91 Affinity, 91, 115 Agonist, 7, 91 Algorithms, 4, 91, 94 Alimentary, 19, 45, 91, 99, 109 Alkaline, 91, 93, 94, 111 Alkaloid, 91, 96 Aloe, 50, 92 Alternative medicine, 60, 92 Amino Acids, 92, 101, 108, 110, 112, 113, 117, 118 Amniotic Fluid, 92, 106 Ampulla, 92, 100 Anal, 6, 8, 9, 14, 29, 32, 42, 57, 76, 78, 79, 92, 99, 102, 106, 113 Anal Fissure, 6, 57, 92 Analgesics, 6, 92 Anastomosis, 57, 92 Anatomical, 4, 27, 79, 92, 104 Androgens, 91, 92, 98 Anesthesia, 9, 92 Anomalies, 26, 56, 92 Anorectal, 9, 18, 19, 20, 23, 24, 27, 56, 78, 79, 92 Antiallergic, 92, 98 Antibiotic, 57, 92, 101 Anticoagulant, 92, 113 Anti-inflammatory, 92, 98, 103, 114 Anti-Inflammatory Agents, 92, 98 Antineoplastic, 92, 98 Anus, 54, 77, 92, 93, 94, 96, 100, 105, 110, 112, 113 Aponeurosis, 92, 102 Appendicitis, 57, 93 Arteries, 93, 94

Arterioles, 93, 94 Asymptomatic, 93, 95, 109 Autodigestion, 93, 109 Autoimmune Hepatitis, 93, 104 B Bacteria, 77, 92, 93, 101, 102, 105, 107, 117, 118 Bacterial Infections, 77, 93 Bacteriostatic, 93, 101 Balloon dilation, 55, 93 Barium, 4, 6, 10, 28, 79, 93 Barium enema, 4, 6, 10, 28, 79, 93 Basal Ganglia, 93, 94, 102 Base, 93, 106, 107, 111, 118 Benign, 93, 94, 102 Benign prostatic hyperplasia, 93 Bilateral, 93, 109 Bile, 56, 93, 94, 102, 104, 105, 106 Bile Acids, 93, 102 Bile Acids and Salts, 93 Bile duct, 56, 93, 94, 104 Bile Pigments, 94, 105, 106 Biliary, 94, 96, 109 Biliary Tract, 94, 109 Biopsy, 17, 57, 94 Biotechnology, 7, 60, 71, 94 Bladder, 76, 78, 93, 94, 104, 105, 108, 113, 118 Bloating, 94, 104, 105 Blood pressure, 94, 103, 107, 115 Blood vessel, 77, 94, 95, 111, 115, 118, 119 Body Fluids, 94, 99, 108, 115 Bowel, 4, 6, 19, 32, 33, 50, 54, 55, 56, 57, 61, 76, 77, 78, 92, 94, 97, 99, 100, 102, 105, 106, 110, 113, 116, 118 Bowel Movement, 4, 50, 61, 77, 78, 94, 97, 99, 102, 116 Brain Diseases, 94, 109 C Calcium, 94, 96, 115 Carbohydrate, 94, 98, 103 Carcinoid, 57, 94 Cardiac, 94, 100 Cardiovascular, 94, 115, 119 Cascara, 47, 50, 94 Case report, 5, 17, 95, 96 Catecholamine, 95, 110 Caudal, 20, 95, 112

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Cecostomy, 27, 95 Cecum, 25, 95, 106 Cell, 91, 93, 94, 95, 97, 98, 101, 102, 103, 105, 108, 109, 111, 113, 114, 115, 117, 119 Cell Differentiation, 95, 115 Cell Division, 93, 95, 111 Cell proliferation, 95, 115 Central Nervous System, 94, 95, 98, 102, 103, 107, 115 Cerebral, 93, 94, 95, 116 Cerebral Palsy, 95, 116 Cerebrovascular, 9, 95 Cerebrum, 95 Chamomile, 50, 95 Choledochal Cyst, 57, 95 Cholesterol, 93, 95 Choline, 95 Cirrhosis, 57, 95 Clinical study, 95, 97 Clinical trial, 6, 71, 96, 97, 99, 113 Cloning, 94, 96 Coagulation, 77, 94, 96, 103, 117 Colchicine, 15, 35, 96 Colectomy, 15, 16, 19, 22, 54, 96 Colitis, 15, 96, 105 Colon, 4, 9, 10, 12, 17, 20, 22, 23, 24, 25, 27, 29, 30, 32, 33, 34, 42, 43, 44, 50, 54, 55, 56, 57, 77, 78, 79, 93, 96, 99, 104, 105, 106, 115, 118 Colon Polyps, 57, 96 Colonic Inertia, 6, 79, 96 Colonoscopy, 57, 79, 96 Colorectal, 10, 26, 28, 32, 33, 77, 96 Colorectal Cancer, 33, 77, 96 Colostomy, 54, 57, 96 Common Bile Duct, 95, 96 Complement, 96, 97 Complementary and alternative medicine, 41, 48, 97 Complementary medicine, 41, 97 Computational Biology, 71, 97 Concomitant, 4, 55, 97 Connective Tissue, 55, 97, 102, 103, 117 Connective Tissue Cells, 97 Consciousness, 92, 97 Continence, 53, 76, 78, 97 Contraindications, ii, 97 Contrast Media, 97, 98 Controlled clinical trial, 29, 41, 97 Controlled study, 15, 97 Corpus, 97, 112 Corpus Luteum, 97, 112

Corticosteroid, 55, 98 Coumarins, 95, 98 Cryotherapy, 77, 98 Curative, 98, 117 Cytotoxic, 98, 115 D Decompression, 95, 98 Defaecation, 28, 98 Defecation, 4, 5, 29, 54, 61, 79, 98 Defecography, 10, 79, 98 Degenerative, 98, 103 Depolarization, 98, 115 Dextroamphetamine, 98, 107 Diabetes Mellitus, 5, 98, 103 Diagnostic procedure, 49, 60, 98 Diaphragm, 98, 104 Diarrhea, 33, 57, 77, 98, 105 Dietary Fiber, 14, 18, 25, 57, 77, 98 Digestion, 29, 77, 91, 93, 94, 98, 99, 100, 104, 105, 106, 110, 116 Digestive system, 56, 77, 99, 102 Digestive tract, 77, 99, 115 Digital rectal examination, 20, 99 Dilation, 30, 55, 57, 99 Direct, iii, 63, 99, 113 Discrete, 99, 117 Discriminant Analysis, 23, 99 Disease Progression, 99, 114 Distal, 99, 100, 102 Distention, 55, 99 Diverticula, 99 Diverticulitis, 57, 99 Diverticulosis, 17, 57, 99 Diverticulum, 57, 99 Dorsal, 99, 112 Dorsum, 99, 102 Double-blind, 15, 29, 34, 35, 99 Drug Interactions, 64, 65, 99 Duct, 57, 92, 96, 99, 114, 116 Duodenum, 93, 99, 100, 102, 109, 110, 116 Dura mater, 99, 107, 109 Dyspepsia, 100, 104 Dysplasia, 17, 26, 44, 100 E Efficacy, 23, 33, 45, 100, 118 Elastic, 100, 117 Electrocoagulation, 96, 100 Electrode, 25, 100 Electrolyte, 15, 23, 98, 100, 107, 108, 115, 118 Electromyography, 15, 32, 100 Elimination Disorders, 56, 100

123

Emodin, 92, 94, 100 Emollient, 100, 107, 109 Encopresis, 6, 12, 20, 23, 27, 42, 45, 56, 100 Endometrium, 100, 107 Endoscope, 100 Endoscopic, 17, 55, 96, 100 Endoscopy, 17, 18, 27, 100 Endosonography, 9, 100 Enema, 9, 26, 100 Energy Intake, 18, 100 Enteric Nervous System, 18, 26, 100 Enuresis, 56, 100 Environmental Health, 70, 72, 101 Enzyme, 17, 101, 107, 110, 115, 117, 119 Eosinophilic, 57, 101 Eosinophilic Gastroenteritis, 57, 101 Eosinophils, 101, 103 Epithelial, 91, 101, 104 Erythromycin, 19, 36, 101 Esophageal, 56, 101, 102 Esophageal Stricture, 57, 101 Esophageal Varices, 57, 101 Esophagitis, 101, 102 Esophagus, 99, 101, 102, 103, 106, 110, 111, 113, 116 Evacuation, 54, 101, 106, 113 Extracellular, 97, 101, 115 Extracellular Matrix, 97, 101 F Faecal, 29, 38, 44, 101 Failure to Thrive, 56, 101 Family Health, 56, 101 Family Planning, 71, 101 Fat, 93, 98, 101, 103, 117 Fatty acids, 101, 106 Fecal Incontinence, 6, 10, 27, 44, 57, 76, 102, 104 Feces, 76, 98, 100, 101, 102, 116 Fetus, 102, 106, 111, 118 Fibrin, 102, 110, 117 Fistula, 55, 102 Flatus, 102 G Gallbladder, 56, 91, 94, 99, 102 Ganglia, 100, 102, 108, 110 Ganglion, 56, 102 Gas, 57, 102, 104, 105, 114, 116 Gastric, 93, 102, 103, 110 Gastric Juices, 102, 110 Gastritis, 57, 102 Gastrocolic Reflex, 4, 102 Gastroduodenal, 55, 102

Gastroesophageal Reflux, 61, 102 Gastroesophageal Reflux Disease, 61, 102 Gastrointestinal, 6, 18, 26, 27, 45, 57, 61, 77, 79, 93, 94, 102, 115, 116, 119 Gastrointestinal tract, 57, 77, 93, 102, 115 Gastrostomy, 57, 102 Gene, 94, 103 Geriatric, 3, 12, 24, 45, 103 Glucocorticoids, 91, 98, 103 Glucose, 98, 103 Glucose Intolerance, 98, 103 Gout, 96, 103 Governing Board, 103, 112 Government Agencies, 77, 103, 112 Granulocytes, 103, 115, 119 Groin, 103, 105 H Handicap, 10, 103 Health Status, 101, 103 Heartburn, 57, 61, 103, 104 Hemicellulose, 45, 103 Hemorrhoidectomy, 77, 103 Hemorrhoids, 6, 33, 47, 57, 77, 103 Hemostasis, 21, 33, 103, 115 Hepatitis, 57, 103, 119 Hepatitis, Chronic, 57, 103 Hepatocellular, 104 Hepatocytes, 103, 104 Heredity, 77, 103, 104 Hiatal Hernia, 57, 104 Hormonal, 98, 104 Hormone, 98, 104, 112, 115 Hysterectomy, 11, 104 I Idiopathic, 5, 9, 10, 15, 18, 19, 20, 21, 22, 26, 27, 30, 31, 35, 54, 55, 56, 57, 104 Ileostomy, 54, 57, 104 Ileum, 95, 104 Immune response, 98, 104, 116, 119 Immune system, 77, 93, 104, 119 Impaction, 4, 54, 55, 56, 57, 104 Impairment, 104, 105 In vitro, 7, 9, 104 In vivo, 7, 104 Incision, 96, 104 Incompetence, 102, 104 Incontinence, 29, 35, 76, 78, 100, 104 Indigestion, 57, 104 Inertia, 5, 6, 79, 104 Infancy, 100, 104 Infection, 101, 104, 119

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Inflammation, 92, 93, 96, 99, 101, 102, 103, 104, 105, 107, 109, 110, 111, 112, 116, 118, 119 Inflammatory bowel disease, 18, 55, 105 Inguinal, 57, 105 Inguinal Hernia, 57, 105 Innervation, 17, 22, 105 Inorganic, 105, 107 Instillation, 98, 105 Internal Medicine, 34, 102, 105 Intestinal, 5, 18, 44, 50, 54, 55, 56, 57, 61, 77, 105, 106, 108, 119 Intestinal Flora, 77, 105 Intestinal Mucosa, 105, 119 Intestinal Obstruction, 55, 56, 57, 105 Intestinal Pseudo-Obstruction, 5, 57, 61, 105 Intestine, 5, 55, 93, 94, 96, 105, 106, 110, 119 Intoxication, 23, 105 Intracellular, 104, 105, 115 Intrinsic, 79, 91, 105 Intussusception, 35, 57, 105, 113 Involuntary, 6, 78, 100, 102, 105, 113, 115, 116 Ions, 93, 100, 105 Irritable Bowel Syndrome, 5, 8, 44, 57, 79, 105 J Jaundice, 95, 105 K Kb, 70, 106 L Lactulose, 3, 15, 16, 35, 41, 42, 43, 45, 106 Large Intestine, 56, 95, 96, 99, 101, 105, 106, 113, 115, 119 Laxative, 27, 33, 45, 50, 57, 64, 94, 100, 106, 107 Lethal, 14, 106 Ligation, 77, 106 Liver, 56, 91, 93, 94, 95, 99, 101, 102, 103, 104, 106 Liver Transplantation, 57, 106 Localized, 91, 104, 106, 111, 114 Longitudinal study, 11, 106 Lower Esophageal Sphincter, 102, 106 Lubricants, 3, 106, 110 M Malabsorption, 57, 106 Malignancy, 55, 106 Malignant, 57, 91, 92, 106 Malnutrition, 55, 106

Manometry, 9, 78, 106 Meconium, 56, 106 MEDLINE, 71, 106 Megacolon, 54, 55, 56, 57, 106 Membrane, 97, 98, 101, 106, 107, 109, 110, 112, 113, 115 Meninges, 95, 99, 106, 107, 116 Meningitis, 20, 107 Menopause, 78, 107 Menstrual Cycle, 54, 107, 112 Menstruation, 107 Metabolic disorder, 55, 103, 107 Methylphenidate, 6, 107 Microorganism, 107, 119 Mineral Oil, 6, 64, 107 Mineralocorticoids, 91, 98, 107 Modification, 3, 42, 107 Molecular, 71, 73, 94, 97, 107, 112, 114, 117 Molecule, 93, 97, 107, 113, 115, 119 Monitor, 76, 107, 108 Morphology, 26, 107 Motility, 3, 5, 6, 18, 26, 27, 61, 107, 115 Motion Sickness, 107, 108 Motor Activity, 28, 107 Mucilaginous, 106, 107 Mucinous, 102, 107 Mucosa, 32, 107 Mucus, 78, 107, 118 Muscular Diseases, 107, 109 Musculature, 17, 108 Mydriatic, 99, 108 Myenteric, 5, 108 N Narcolepsy, 98, 107, 108 Nausea, 55, 104, 108, 118 Necrosis, 104, 108 Neoplasia, 26, 108 Nervous System, 91, 95, 108, 110 Neural, 91, 108 Neurogenic, 5, 14, 108 Neurologic, 55, 108 Neuromuscular, 10, 108, 109, 118 Neuronal, 17, 26, 44, 108 Neurons, 102, 108, 117 Neuropeptide, 32, 108 Neurotransmitter, 108, 115, 116, 119 Nuclear, 30, 93, 102, 108 Nutritional Status, 18, 108 Nutritional Support, 102, 108 O Obstipation, 55, 108 Office Visits, 77, 108

125

Ointments, 95, 109 Osmolarity, 4, 109 Osmoles, 109 Osmosis, 109 Osmotic, 6, 109 Outpatient, 77, 109 Ovum, 97, 109, 112 P Pachymeningitis, 107, 109 Paediatric, 8, 45, 109 Palliative, 109, 117 Pancreas, 91, 99, 102, 109 Pancreatic, 57, 102, 109 Pancreatic Juice, 102, 109 Pancreatitis, 57, 109 Paradoxical, 27, 42, 109 Paralysis, 109, 116 Paraneoplastic Syndromes, 55, 109 Paraplegia, 31, 32, 109 Parenteral, 100, 109 Particle, 110, 117 Pathologic, 94, 110, 116 Pathophysiology, 21, 27, 31, 56, 110 Patient Education, 76, 78, 84, 86, 89, 110 Pediatrics, 10, 11, 16, 17, 18, 20, 23, 26, 30, 35, 38, 42, 56, 110 Pelvic, 17, 54, 57, 76, 78, 79, 110, 113 Pelvis, 110, 118 Pepsin, 110 Peptic, 57, 110 Peptic Ulcer, 57, 110 Peptide, 110, 112, 113 Perforation, 31, 55, 110, 119 Perineal, 14, 110 Perineum, 110 Peripheral Nervous System, 108, 109, 110, 116, 119 Peripheral Nervous System Diseases, 109, 110 Peristalsis, 18, 110 Peritoneum, 95, 110 Peritonitis, 57, 110, 119 Petroleum, 107, 110 Pharmacologic, 57, 92, 110, 117 Pharmacotherapy, 18, 110 Pharynx, 102, 111 Phenolphthalein, 27, 50, 111 Phospholipases, 111, 115 Photocoagulation, 96, 111 Physical Examination, 76, 111 Physical Therapy, 78, 111 Physiologic, 4, 28, 91, 107, 111, 113

Physiology, 28, 32, 54, 102, 111 Pilot study, 19, 111 Pituitary Gland, 98, 111 Placenta, 111, 112 Plants, 91, 95, 100, 103, 107, 111, 118 Plasma, 103, 107, 111 Platelet Activation, 111, 115 Pneumonia, 97, 111 Poisoning, 105, 108, 111 Policy Making, 103, 111 Polyethylene, 14, 15, 16, 23, 28, 30, 111, 112, 117 Polyethylene Glycols, 112, 117 Polypeptide, 112, 119 Polyposis, 96, 112 Posterior, 20, 92, 99, 109, 112 Postprandial, 6, 28, 55, 112 Postsynaptic, 112, 115 Potentiation, 112, 115 Practicability, 112, 118 Practice Guidelines, 72, 112 Prevalence, 6, 33, 112 Proctalgia Fugax, 54, 112 Proctectomy, 54, 112 Proctitis, 5, 57, 112 Progesterone, 6, 112 Progressive, 95, 108, 111, 112, 118 Prokinetic Drugs, 61, 112 Prolapse, 57, 78, 112 Prospective study, 106, 112 Prostate, 93, 113 Protein C, 7, 113 Protein S, 94, 101, 113 Proteins, 7, 92, 96, 101, 107, 110, 111, 113, 115 Psychiatric, 29, 100, 113 Psyllium, 45, 47, 113 Public Policy, 71, 113 Pulmonary, 94, 101, 113, 114, 117 Pulse, 107, 113 Pupil, 99, 108, 113 Purgative, 100, 106, 113 R Randomized, 35, 100, 113 Receptor, 7, 113, 115 Rectal, 5, 6, 29, 32, 35, 54, 57, 76, 77, 78, 113, 117 Rectal Prolapse, 78, 113 Recurrence, 113, 114 Refer, 1, 96, 113 Reflex, 27, 29, 45, 113 Reflux, 102, 113

126


Refractory, 28, 55, 100, 113 Regimen, 19, 56, 100, 110, 113 Regression Analysis, 99, 114 Regurgitation, 102, 103, 114 Reoperation, 55, 114 Resected, 32, 114 Resection, 55, 114 Respiration, 107, 114 Respiratory System, 114, 119 Risk factor, 25, 30, 99, 112, 114 Rubber, 54, 77, 91, 114 S Salicylate, 95, 114 Saline, 3, 114 Salivary, 99, 114 Salivary glands, 99, 114 Scleroderma, 14, 114 Screening, 29, 96, 114 Secretion, 98, 103, 107, 114 Senna, 43, 45, 48, 64, 114 Sensor, 76, 114 Serotonin, 108, 110, 115 Serum, 6, 96, 107, 110, 115 Sex Characteristics, 91, 92, 115 Side effect, 63, 91, 115, 117 Sigmoid, 7, 17, 25, 30, 31, 115 Sigmoid Colon, 7, 25, 30, 115 Signal Transduction, 6, 115 Signs and Symptoms, 57, 115, 118 Small intestine, 57, 95, 99, 101, 104, 105, 115 Smooth muscle, 6, 18, 97, 108, 115, 116 Sneezing, 115, 116 Sodium, 45, 50, 103, 107, 115 Solvent, 109, 115 Somatic, 91, 110, 116 Spastic, 54, 57, 105, 116 Spasticity, 116 Specialist, 8, 80, 99, 116 Species, 95, 96, 116 Sphincter, 14, 32, 42, 78, 79, 113, 116 Spinal cord, 95, 99, 100, 102, 106, 108, 109, 110, 113, 116 Spinal Cord Diseases, 109, 116 Stenosis, 55, 116 Stercoral, 55, 116 Steroids, 98, 116 Stimulant, 3, 98, 107, 116 Stimulus, 100, 105, 113, 116 Stomach, 56, 77, 91, 93, 99, 101, 102, 104, 106, 108, 110, 111, 113, 115, 116, 119

Stool, 4, 6, 29, 50, 61, 64, 77, 78, 79, 96, 104, 105, 106, 116 Stress, 78, 95, 105, 108, 114, 116 Stress incontinence, 78, 116 Stricture, 55, 116 Styrene, 114, 116 Substance P, 32, 101, 114, 116 Suction, 25, 116 Suppository, 76, 112, 117 Suppression, 98, 117 Surfactant, 45, 117 Symptomatic, 55, 109, 117 Synaptic, 108, 115, 117 Synergistic, 50, 117 Systemic, 14, 79, 94, 105, 114, 117 Systemic disease, 79, 117 T Tendon, 102, 116, 117 Therapeutics, 19, 45, 65, 117 Thrombin, 102, 113, 117 Thrombomodulin, 113, 117 Tissue, 20, 55, 93, 94, 96, 97, 100, 101, 106, 108, 109, 111, 114, 115, 116, 117, 118 Toxic, iv, 116, 117 Toxicity, 99, 100, 117 Toxicology, 72, 117 Transduction, 7, 115, 117 Transfection, 94, 117 Translation, 101, 117 Translocation, 101, 117 Trauma, 101, 108, 109, 118 Treatment Outcome, 4, 118 Trees, 114, 118 Tumour, 102, 118 Tunica, 107, 118 U Ulceration, 110, 118 Ulcerative colitis, 55, 57, 105, 118 Ultrasonography, 100, 118 Uraemia, 109, 118 Ureters, 118 Urethra, 93, 113, 118 Urinary, 13, 35, 76, 78, 100, 104, 118 Urinary tract, 13, 35, 118 Urinary tract infection, 13, 35, 118 Urinate, 78, 118 Urine, 76, 78, 93, 94, 97, 100, 104, 116, 118 Uterus, 97, 100, 104, 107, 112, 118 V Vagina, 107, 118 Vaginal, 78, 117, 118 Vascular, 57, 105, 111, 116, 118

127

Vasculitis, 109, 119 Vasoactive, 21, 119 Vasoactive Intestinal Peptide, 21, 119 Vector, 117, 119 Veins, 94, 101, 119 Venous, 103, 113, 119 Venules, 94, 119 Veterinary Medicine, 71, 119 Viral, 57, 104, 117, 119 Viral Hepatitis, 57, 104, 119 Virus, 117, 119 Visceral, 8, 110, 119 Viscosity, 50, 119

Vitro, 7, 119 Vivo, 119 Volition, 105, 119 Volvulus, 55, 119 W White blood cell, 101, 107, 119 X X-ray, 93, 108, 119 Y Yeasts, 105, 119 Z Zymogen, 113, 119

128


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