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

LAXATIVES 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., 1960Laxatives: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84001-6 1. Laxatives-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 laxatives. 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 LAXATIVES ................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Laxatives ....................................................................................... 4 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND LAXATIVES ...................................................................................... 23 Overview...................................................................................................................................... 23 Finding Nutrition Studies on Laxatives ...................................................................................... 23 Federal Resources on Nutrition ................................................................................................... 27 Additional Web Resources ........................................................................................................... 27 CHAPTER 3. ALTERNATIVE MEDICINE AND LAXATIVES ................................................................ 29 Overview...................................................................................................................................... 29 National Center for Complementary and Alternative Medicine.................................................. 29 Additional Web Resources ........................................................................................................... 33 General References ....................................................................................................................... 40 CHAPTER 4. PATENTS ON LAXATIVES ............................................................................................. 41 Overview...................................................................................................................................... 41 Patents on Laxatives .................................................................................................................... 41 Patent Applications on Laxatives ................................................................................................ 59 Keeping Current .......................................................................................................................... 64 CHAPTER 5. BOOKS ON LAXATIVES ................................................................................................ 67 Overview...................................................................................................................................... 67 Book Summaries: Federal Agencies.............................................................................................. 67 Book Summaries: Online Booksellers........................................................................................... 68 The National Library of Medicine Book Index ............................................................................. 68 Chapters on Laxatives .................................................................................................................. 69 CHAPTER 6. MULTIMEDIA ON LAXATIVES ...................................................................................... 77 Overview...................................................................................................................................... 77 Bibliography: Multimedia on Laxatives....................................................................................... 77 CHAPTER 7. PERIODICALS AND NEWS ON LAXATIVES ................................................................... 79 Overview...................................................................................................................................... 79 News Services and Press Releases................................................................................................ 79 Newsletters on Laxatives ............................................................................................................. 81 Newsletter Articles ...................................................................................................................... 82 Academic Periodicals covering Laxatives..................................................................................... 84 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................... 85 Overview...................................................................................................................................... 85 U.S. Pharmacopeia....................................................................................................................... 85 Commercial Databases ................................................................................................................. 88 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 91 Overview...................................................................................................................................... 91 NIH Guidelines............................................................................................................................ 91 NIH Databases............................................................................................................................. 93 Other Commercial Databases....................................................................................................... 96 APPENDIX B. PATIENT RESOURCES ................................................................................................. 97 Overview...................................................................................................................................... 97 Patient Guideline Sources............................................................................................................ 97 Finding Associations.................................................................................................................... 99 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 103 Overview.................................................................................................................................... 103

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Preparation................................................................................................................................. 103 Finding a Local Medical Library................................................................................................ 103 Medical Libraries in the U.S. and Canada ................................................................................. 103 ONLINE GLOSSARIES................................................................................................................ 109 Online Dictionary Directories ................................................................................................... 111 LAXATIVES DICTIONARY ........................................................................................................ 113 INDEX .............................................................................................................................................. 157

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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 laxatives 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 laxatives, 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 laxatives, 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 laxatives. 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 laxatives, 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 laxatives. 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 LAXATIVES Overview In this chapter, we will show you how to locate peer-reviewed references and studies on laxatives.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and laxatives, 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 “laxatives” (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: •

Myths Fueling Widespread Abuse of OTC Laxatives Source: Medical World News. 31(1): 19. January 8, 1990. Summary: Abuse of over-the-counter laxatives has developed into a major health problem that often goes undetected and improperly treated. Patients risk nutrient deficiencies, metabolic disorders, and potentially severe damage to the gastrointestinal tract with regular, long-term use of laxatives. Estimates of the number of laxative abusers range from 5 to 15 percent of the U.S. population, primarily young women and older adults. Much of the problem is attributed to misconceptions about constipation and regularity of bowel movements, especially among the elderly. The myths have been perpetuated by marketing and advertising strategies for laxatives. Laxative abuse is difficult to diagnose. The diagnostic problem is compounded by the fact that symptoms of laxative abuse may mimic those of other disorders. Common complaints include

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diarrhea, nausea, and vomiting. A thorough medical history and physical exam usually can provide clues of laxative abuse. The history should focus on not only symptoms and medication use, but also on the patient's definition of constipation, which may differ dramatically from a doctor's definition. •

Laxative Abuse Can Cause Ammonium Urate Renal Calculi Source: Journal of Urological Nursing. 11(3): 193-197. July-August-September 1992. Summary: Ammonium urate calculi may be seen in patients with urinary tract infection in association with struvite in the stone and in patients with laxative abuse. This article discusses this problem, noting that the finding of an ammonium urate calculus should alert the health care provider to the possibility of laxative abuse. With intake of phenolphthalein laxatives, there can be significant loss of gastrointestinal fluids and electrolytes, leading to a state of mild dehydration and metabolic acidosis. The authors present evidence from eight patients, including one case study presented in detail. 1 table. 16 references. (AA-M).

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Overuse Hazardous: Laxatives Rarely Needed Source: FDA Consumer. Food and Drug Administration Consumer. 25(3): 33-35. April 1991. Summary: This article reminds the consumer of the hazards associated with regular use of laxatives to control or change bowel habits. The author stresses that contrary to popular belief, there is no evidence that a daily bowel movement is necessary for good health. Topics covered include alternative ways to manage bowel habits, notably diet and exercise; recent changes in federal regulations of the ingredients in many laxatives; the types of prescription and non-prescription laxatives; the adverse effects of prolonged laxative use; and the role of lifestyle changes in maintaining good health.

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

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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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Project Title: MAGNESIUM AND ASTHMA - CLINICAL TRIALS Principal Investigator & Institution: Stern, Judith S.; Professor of Medicine and Nutrition; Nutrition; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2001; Project Start 18-SEP-2000; Project End 30-JUN-2005 Summary: Over the past twenty years a number of studies of acute bronchial asthma have shown that i.v. or nebulized MgS04 may improve symptoms over a course of hours. With respect to dietary supplementation, short term (3 wk) oral Mg has been associated with a significant decrease in symptoms but no significant effect on measurements like FEV1 or bronchial hyperactivity by methacholine challenge. Although a large number of studies have attempted to address this issue, we believe that major gaps still exist. One of the gaps is in the comparison of large numbers of asthmatics and non-asthmatics, with regards to dietary intake, and a variety of measures of Mg status. We will evaluate baseline Mg intake (diet, tap and bottled drinking water, vitamin-mineral supplements, laxatives, and antacids), and multiple measures of Mg status, such as total and free plasma Mg, and total and free erythrocyte Mg, and urinary Mg. Furthermore there are no large-scale studies evaluating the effects of Mg supplementation on asthma control and clinical markers, and markers of inflammation. We propose to assess the effects of one year of oral Mg on clinical markers of asthma control (asthma symptom diary, morning and evening peak flow and asthma quality of life questionnaire (QOL)), indirect biomarkers of inflammation (exhaled nitric oxide and serum eosinophil cationic protein) and bronchial hyperresponsiveness (methacholine challenge). Dietary Mg will be assessed using three different methods: I) food frequency questionnaire, 2) 4 day food diary - done every other day over a seven day period and 3) 24 hr recall. Our hypotheses are that l.) subjects with mild asthma, as defined by National Institutes of Health National Asthma Education and Prevention Program (NIH NAEPP) clinical guidelines will have poorer Mg status than nonasthmatics, and 2.) that marginal Mg intake and status may modulate the severity of asthma. Thus subjects with asthma who have marginal intake/status and thus relatively lower total and free plasma Mg, lower erythrocyte total and free Mg, and lower urinary Mg will show improvement in the aforementioned clinical and indirect biomarkers. In contrast, Mg supplements will have little effect in subjects with highest intakes and Mg status. This study will use the services of the Clinical/Pulmonary Core to recruit, evaluate, assign and monitor subjects and the Inflammation Core for measures of inflammation. We do not anticipate that Mg supplementation will replace conventional treatment, but may complement and decrease the need for conventional medications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEFECATION

NEUROMUSCULAR

CONDITION

THERAPY-DYSSYNERGIC

Principal Investigator & Institution: Rao, Satish S.; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 30-JUN-2005 Summary: Constipation affects 4 million Americans, predominantly women and the elderly. Its pathophysiology is incompletely understood and its treatment is unsatisfactory. Laxative-dependent, and unable to accomplish natures' call, many resort to desperate treatments. About 50 percent of patients with constipation exhibit uncoordinated or dyssynergic defecation. Uncontrolled studies suggest that biofeedback therapy may improve symptoms in these patients. But, whether the improvement is due

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to the behavioral intervention or a consequence of excess attention is not known. Biofeedback therapy is labor-intensive, expensive and only available in a few centers. In order to treat the many patients in the community, a home-based, self-training program is essential. Our proposal addresses three objectives; 1) to determine the efficacy of biofeedback therapy by performing a randomized controlled study in patients with dyssynergic defecation. After diagnostic evaluation with colon transit study, anorectal manometry and stool diaries, 90 patients will be randomized to receive standard treatment consisting of diet, habit-training and laxatives or biofeedback therapy consisting of neuromuscular conditioning or sham feedback therapy. Short-term (3 month) and long-term (12 month) assessments of anorectal physiology-defecation index, anal relaxation, fecom expulsion time and colon transit time and symptomatologybowel satisfaction score, straining effort, laxative consumption score and stool form and consistency will be performed. 2) To investigate the efficacy of home-training versus office-based biofeedback therapy and if it is cost-effective, 100 patients will be randomized to receive either home-training using a hand-held portable device and a silicon probe or biofeedback therapy for 3 months. Anorectal physiology and symptoms will be assessed and actuarial costs of each treatment will be compared. 3) For a condition that is entwined with psyche there is no information on quality of life or psychosocial function. We wish to investigate these parameters with validated instruments, SF-36 and SCL-90-R in 90 patients, before and after treatment and compare this with two controlled groups. This may provide impetus for new treatments such as psychotherapy. This first controlled study will determine the efficacy and scientific basis for a safe and alternative therapy for difficult defecation, provide new information that could facilitate home self-training and assess the impact of treatment on anorectal physiology, symptoms, quality of life and psychosocial aspects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE DEVELOPMENT OF EATING DISORDERS IN MALES AND FEMALES Principal Investigator & Institution: Field, Alison E.; Assistant Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: This proposal is to follow 9,039 girls and 7,843 boys, currently ages 14- 19., through their transition to late adolescence and early adulthood. The girls and boys are members of the Growing Up Today Study, which was established in 1996 when the participants were 9 to 14 years of age. The cohort was initially funded by NIDDK to assess predictors of dietary intake, activity, and weight gain during a four year period. We now seek to follow the cohort for five additional years to investigate determinants of purging (i.e., use of vomiting or laxatives) and eating disorders of at least subsyndromal severity. The mothers of the children are participants in the ongoing Nurses' Health Study II and have been followed biennially since 1989. We will obtain information annually from the participants, as well as continue to collect information from the mothers on their weight, concern with weight, weight control behaviors, and concern with their child's weight. Using this data we will assess the predictiveness of personal factors, peer influences, family influences and media influences on the development and course of purging and eating disorders of at least subsyndromal severity. Eating disorders are difficult to treat, Therefore, we believe it is essential to identify and quantify their risk factors so that better means of prevention can be developed. Not only do eating disorders have serious physical health consequences, but also their precursors, weight concerns, are associated with obesity and can lead young

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people to adopt unhealthy weight control behaviors, such as smoking. Thus eating disorders and their precursors are associated with two serious public health problems among young people in the United States. Due to the paucity of prospective cohort studies, little is known about the etiology and course of development of eating disorders in young women and much less is known in men. This study will have sufficient power to detect associations of at least moderate magnitude (e.g., RR> 1.7). By following the approximately 16,000 adolescents in the Growing Up Today Study for five additional years we will have the largest prospective cohort study capturing the time periods of highest risk of developing disordered eating. The size of the cohort and the length of follow-up (9 years) will enable us to answer many questions about the development and course of purging and eating disorders that no other prospective study has the statistical power to address. Moreover, since this is the only large prospective cohort study to assess the development of eating disorders in males, our results will make a lasting contribution to the field. 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 laxatives, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “laxatives” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for laxatives (hyperlinks lead to article summaries): •

5300 years ago, the Ice Man used natural laxatives and antibiotics. Author(s): Capasso L. Source: Lancet. 1998 December 5; 352(9143): 1864. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9851424&dopt=Abstract

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A laxative ingredient is linked to CA. Author(s): Chase SL. Source: Rn. 1997 December; 60(12): 72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9429545&dopt=Abstract

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

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A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Author(s): DiPalma JA, DeRidder PH, Orlando RC, Kolts BE, Cleveland MB. Source: The American Journal of Gastroenterology. 2000 February; 95(2): 446-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10685748&dopt=Abstract

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A volunteer model for the comparison of laxatives in opioid-related constipation. Author(s): Sykes NP. Source: Journal of Pain and Symptom Management. 1996 June; 11(6): 363-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8935140&dopt=Abstract

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Acute toxicity and mutagenicity study on branched corn syrup and evaluation of its laxative effect in humans. Author(s): Kishimoto Y, Wakabayashi S, Matsuda I, Fudaba H, Ohkuma K. Source: J Nutr Sci Vitaminol (Tokyo). 2001 April; 47(2): 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11508703&dopt=Abstract

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Adverse effects of laxatives. Author(s): Xing JH, Soffer EE. Source: Diseases of the Colon and Rectum. 2001 August; 44(8): 1201-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535863&dopt=Abstract

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Alterations in colonic anatomy induced by chronic stimulant laxatives: the cathartic colon revisited. Author(s): Joo JS, Ehrenpreis ED, Gonzalez L, Kaye M, Breno S, Wexner SD, Zaitman D, Secrest K. Source: Journal of Clinical Gastroenterology. 1998 June; 26(4): 283-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9649012&dopt=Abstract

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Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study. Author(s): Nusko G, Schneider B, Schneider I, Wittekind C, Hahn EG. Source: Gut. 2000 May; 46(5): 651-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10764708&dopt=Abstract

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Apoptosis induction by sennoside laxatives in man; escape from a protective mechanism during chronic sennoside use? Author(s): van Gorkom BA, Karrenbeld A, van der Sluis T, Zwart N, de Vries EG, Kleibeuker JH. Source: The Journal of Pathology. 2001 August; 194(4): 493-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523059&dopt=Abstract

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Association of bowel movement frequency and use of laxatives with the occurrence of symptomatic gallstone disease in a prospective study of women. Author(s): Dukas L, Leitzmann MF, Willett WC, Colditz GA, Giovannucci EL. Source: The American Journal of Gastroenterology. 2001 March; 96(3): 715-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11280540&dopt=Abstract

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Bowel movement, use of laxatives and risk of colorectal adenomatous polyps among women (United States). Author(s): Dukas L, Platz EA, Colditz GA, Willet WC, Giovannucci EL. Source: Cancer Causes & Control : Ccc. 2000 December; 11(10): 907-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11142525&dopt=Abstract

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Classification, pharmacology, and side-effects of common laxatives. Author(s): Muller-Lissner S. Source: Ital J Gastroenterol Hepatol. 1999 November; 31 Suppl 3: S234-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726225&dopt=Abstract

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Clinical pharmacology and use of laxatives and lavage solutions. Author(s): Schiller LR. Source: Journal of Clinical Gastroenterology. 1999 January; 28(1): 11-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9916658&dopt=Abstract

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Colonic perforation with volume laxatives. Author(s): Langdon DE. Source: The American Journal of Gastroenterology. 1996 March; 91(3): 622-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8633537&dopt=Abstract

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

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Complications of Fleet enema administration and suggested guidelines for use in the pediatric emergency department. Author(s): Harrington L, Schuh S. Source: Pediatric Emergency Care. 1997 June; 13(3): 225-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9220514&dopt=Abstract

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Congestive heart failure caused by digitalis toxicity in an elderly man taking a licorice-containing chinese herbal laxative. Author(s): Harada T, Ohtaki E, Misu K, Sumiyoshi T, Hosoda S. Source: Cardiology. 2002; 98(4): 218. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566654&dopt=Abstract

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Constipation and the use of laxatives: a comparison between transdermal fentanyl and oral morphine. Author(s): Radbruch L, Sabatowski R, Loick G, Kulbe C, Kasper M, Grond S, Lehmann KA. Source: Palliative Medicine. 2000 March; 14(2): 111-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10829145&dopt=Abstract

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

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Constipation, laxative use, and colon cancer among middle-aged adults. Author(s): Jacobs EJ, White E. Source: Epidemiology (Cambridge, Mass.). 1998 July; 9(4): 385-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9647901&dopt=Abstract

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

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Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis. Author(s): Cox DJ, Sutphen J, Borowitz S, Kovatchev B, Ling W. Source: Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 1998 Spring; 20(2): 70-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9989311&dopt=Abstract

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Correlates of regular laxative use by frail elderly persons. Author(s): Harari D, Gurwitz JH, Avorn J, Choodnovskiy I, Minaker KL. Source: The American Journal of Medicine. 1995 November; 99(5): 513-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7485209&dopt=Abstract

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Cytotoxicity of rhein, the active metabolite of sennoside laxatives, is reduced by multidrug resistance-associated protein 1. Author(s): van Gorkom BA, Timmer-Bosscha H, de Jong S, van der Kolk DM, Kleibeuker JH, de Vries EG. Source: British Journal of Cancer. 2002 May 6; 86(9): 1494-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986786&dopt=Abstract

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Detection and importance of laxative use in adolescents with anorexia nervosa. Author(s): Turner J, Batik M, Palmer LJ, Forbes D, McDermott BM. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2000 March; 39(3): 378-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10714059&dopt=Abstract

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Detection of laxative abuse by urine analysis with HPLC and diode array detection. Author(s): Stolk LM, Hoogtanders K. Source: Pharmacy World & Science : Pws. 1999 February; 21(1): 40-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10214668&dopt=Abstract

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Dietary potassium and laxatives as regulators of colonic potassium secretion in endstage renal disease. Author(s): Mathialahan T, Sandle GI. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 February; 18(2): 341-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543890&dopt=Abstract

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Effect of anthraquinone-laxatives on the proliferation and urokinase secretion of normal, premalignant and malignant colonic epithelial cells. Author(s): Schorkhuber M, Richter M, Dutter A, Sontag G, Marian B. Source: European Journal of Cancer (Oxford, England : 1990). 1998 June; 34(7): 1091-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9849460&dopt=Abstract

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

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Effectiveness of laxatives in adults. Author(s): Petticrew M, Rodgers M, Booth A. Source: Quality in Health Care : Qhc. 2001 December; 10(4): 268-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11743157&dopt=Abstract

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Estimation of intestinal trehalase activity from a laxative threshold of trehalose and lactulose on healthy female subjects. Author(s): Oku T, Nakamura S. Source: European Journal of Clinical Nutrition. 2000 October; 54(10): 783-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11083487&dopt=Abstract

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Evaluation of thin-layer chromatography methods for laxative detection. Author(s): Duncan A, Phillips IJ. Source: Annals of Clinical Biochemistry. 2001 January; 38(Pt 1): 64-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11270846&dopt=Abstract

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Evidence for long-term pancreatic damage caused by laxative abuse in subjects recovered from anorexia nervosa. Author(s): Brown NW, Treasure JL, Campbell IC. Source: The International Journal of Eating Disorders. 2001 March; 29(2): 236-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11429987&dopt=Abstract

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Excessive fluid gain in a chronic laxative abuser: “pseudo-idiopathic” oedema. Author(s): Korzets Z, Hasdan G, Podjarny E, Bernheim J. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 January; 17(1): 161-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11773486&dopt=Abstract

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Honey, fructose absorption, and the laxative effect. Author(s): Ladas SD, Raptis SA. Source: Nutrition (Burbank, Los Angeles County, Calif.). 1999 July-August; 15(7-8): 5912. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10422093&dopt=Abstract

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Hyperphosphatemia associated with phosphorus-containing laxatives in a patient with chronic renal insufficiency. Author(s): Escalante CP, Weiser MA, Finkel K. Source: Southern Medical Journal. 1997 February; 90(2): 240-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9042182&dopt=Abstract

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Intestinal adsorption of levothyroxine by antacids and laxatives: case stories and in vitro experiments. Author(s): Mersebach H, Rasmussen AK, Kirkegaard L, Feldt-Rasmussen U. Source: Pharmacology & Toxicology. 1999 March; 84(3): 107-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10193669&dopt=Abstract

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Is chronic use of stimulant laxatives harmful to the colon? Author(s): Wald A. Source: Journal of Clinical Gastroenterology. 2003 May-June; 36(5): 386-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12702977&dopt=Abstract

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Ischemic colitis caused by oral hyperosmotic saline laxatives. Author(s): Oh JK, Meiselman M, Lataif LE Jr. Source: Gastrointestinal Endoscopy. 1997 March; 45(3): 319-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9087846&dopt=Abstract

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Lack of benefit of laxatives as adjunctive therapy for functional nonretentive fecal soiling in children. Author(s): van Ginkel R, Benninga MA, Blommaart PJ, van der Plas RN, Boeckxstaens GE, Buller HA, Taminiau JA. Source: The Journal of Pediatrics. 2000 December; 137(6): 808-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11113837&dopt=Abstract

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

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Laxative effects of fresh baker's yeast. Author(s): Wenk R, Bertolino M, Ochoa J, Cullen C, Bertucelli N, Bruera E. Source: Journal of Pain and Symptom Management. 2000 March; 19(3): 163-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858087&dopt=Abstract

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Laxative induced hypoalbuminemia. Author(s): Jayaprakash DG, Raghu Raman TS, Singh D, Raja LN. Source: Indian Pediatrics. 1995 September; 32(9): 1037-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8935275&dopt=Abstract

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Laxative misuse and behavioral disinhibition in bulimia nervosa. Author(s): Bruce KR, Koerner NM, Steiger H, Young SN. Source: The International Journal of Eating Disorders. 2003 January; 33(1): 92-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12474204&dopt=Abstract

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Laxative poisoning: toxicological analysis of bisacodyl and its metabolite in urine, serum, and stool. Author(s): Kudo K, Miyazaki C, Kadoya R, Imamura T, Jitsufuchi N, Ikeda N. Source: Journal of Analytical Toxicology. 1998 July-August; 22(4): 274-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9681329&dopt=Abstract

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Laxative prescribing in relation to opioid use and the influence of pharmacy-based intervention. Author(s): Bouvy ML, Buurma H, Egberts TC. Source: Journal of Clinical Pharmacy and Therapeutics. 2002 April; 27(2): 107-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975694&dopt=Abstract

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Laxative withdrawal in eating disorders: treatment protocol and 3 to 20-month followup. Author(s): Colton P, Woodside DB, Kaplan AS. Source: The International Journal of Eating Disorders. 1999 April; 25(3): 311-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10191996&dopt=Abstract

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Laxative-induced dermatitis of the buttocks incorrectly suspected to Be abusive burns. Author(s): Leventhal JM, Griffin D, Duncan KO, Starling S, Christian CW, Kutz T. Source: Pediatrics. 2001 January; 107(1): 178-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11134455&dopt=Abstract

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Laxative-induced hypokalemia. Author(s): Chin RL. Source: Annals of Emergency Medicine. 1998 October; 32(4): 517-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9774942&dopt=Abstract

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Laxatives and faecal incontinence in long-term care. Author(s): Brocklehurst J, Dickinson E, Windsor J. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1999 September 15-21; 13(52): 32-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10693509&dopt=Abstract

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Laxatives and faecal incontinence in long-term care. Author(s): Brocklehurst J, Dickinson E, Windsor J. Source: Elder Care. 1998 August-September; 10(4): 22-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9855925&dopt=Abstract

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Laxatives and rectal preparations. Author(s): Butler M. Source: Nurs Times. 1998 January 21-27; 94(3): 56-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9510770&dopt=Abstract

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Laxatives and the Ice Man. Author(s): Poder R, Peintner U. Source: Lancet. 1999 March 13; 353(9156): 926. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10094008&dopt=Abstract

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Laxatives and the Ice Man. Author(s): Tunon H, Svanberg I. Source: Lancet. 1999 March 13; 353(9156): 925-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10094007&dopt=Abstract

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

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Laxatives. Author(s): Rockney R. Source: Pediatric Annals. 1999 July; 28(7): 412. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10884850&dopt=Abstract

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Laxatives. Author(s): Bursey RF. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 1999 January-February; 13(1): 21-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10099813&dopt=Abstract

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Lessons to be learned: a case study approach diuretic therapy and a laxative causing electrolyte and water imbalance, loss of attention, a fall and subsequent fractures of the tibia and fibula in an elderly lady. Author(s): Sankar NS, Donaldson D. Source: J R Soc Health. 1998 August; 118(4): 237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10076675&dopt=Abstract

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Miracle laxative? Author(s): Bishop WP. Source: Journal of Pediatric Gastroenterology and Nutrition. 2001 May; 32(5): 514-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11455948&dopt=Abstract

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Movers and shakers: a clinician's guide to laxatives. Author(s): Lowe JR, Parks BR Jr. Source: Pediatric Annals. 1999 May; 28(5): 307-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10341351&dopt=Abstract

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

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Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative. Author(s): Basse L, Madsen JL, Kehlet H. Source: The British Journal of Surgery. 2001 November; 88(11): 1498-500. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11683748&dopt=Abstract

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Of tubes and men: studying manometrically the effects of laxatives on colonic motility. Author(s): Bassotti G, Fratini M. Source: European Journal of Gastroenterology & Hepatology. 2001 June; 13(6): 631-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11434586&dopt=Abstract

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Older people and laxative use: literature review and pilot study report. Author(s): Koch T, Hudson S. Source: Journal of Clinical Nursing. 2000 July; 9(4): 516-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11261131&dopt=Abstract

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

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OTC laxative woes. Author(s): Shuster J. Source: Nursing. 2000 June; 30(6): 88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10865678&dopt=Abstract

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Overnight efficacy of polyethylene glycol laxative. Author(s): Di Palma JA, Smith JR, Cleveland M. Source: The American Journal of Gastroenterology. 2002 July; 97(7): 1776-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135034&dopt=Abstract

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Patient and physician evaluation of a new bulk fiber laxative tablet. Author(s): Smith C, Hellebusch SJ, Mandel KG. Source: Gastroenterology Nursing : the Official Journal of the Society of Gastroenterology Nurses and Associates. 2003 January-February; 26(1): 31-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12582295&dopt=Abstract

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Pharmacokinetic and pharmacodynamic drug interactions between digoxin and macrogol 4000, a laxative polymer, in healthy volunteers. Author(s): Ragueneau I, Poirier JM, Radembino N, Sao AB, Funck-Brentano C, Jaillon P. Source: British Journal of Clinical Pharmacology. 1999 September; 48(3): 453-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10510161&dopt=Abstract

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Phenolphthalein laxatives and risk of cancer. Author(s): Coogan PF, Rosenberg L, Palmer JR, Strom BL, Zauber AG, Stolley PD, Shapiro S. Source: Journal of the National Cancer Institute. 2000 December 6; 92(23): 1943-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11106687&dopt=Abstract

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Phenolphthalein: an unacceptable laxative. Author(s): Thirumalaikolundusubramanian P, Uma A. Source: J Indian Med Assoc. 2000 October; 98(10): 646. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11258497&dopt=Abstract

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Phenolphthalein-containing laxative use in relation to adenomatous colorectal polyps in three studies. Author(s): Longnecker MP, Sandler DP, Haile RW, Sandler RS. Source: Environmental Health Perspectives. 1997 November; 105(11): 1210-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9370521&dopt=Abstract

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Prospective study of bowel movement, laxative use, and risk of colorectal cancer among women. Author(s): Dukas L, Willett WC, Colditz GA, Fuchs CS, Rosner B, Giovannucci EL. Source: American Journal of Epidemiology. 2000 May 15; 151(10): 958-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10853634&dopt=Abstract

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

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Reactive nitrogen species modulate the effects of rhein, an active component of senna laxatives, on human epithelium in vitro. Author(s): Raimondi F, Santoro P, Maiuri L, Londei M, Annunziata S, Ciccimarra F, Rubino A. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 May; 34(5): 529-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12050580&dopt=Abstract

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Recent findings on the mode of action of laxatives: the role of platelet activating factor and nitric oxide. Author(s): Izzo AA, Gaginella TS, Mascolo N, Capasso F. Source: Trends in Pharmacological Sciences. 1998 October; 19(10): 403-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9803830&dopt=Abstract

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Reduction in constipation and laxative requirements following opioid rotation to methadone: a report of four cases. Author(s): Daeninck PJ, Bruera E. Source: Journal of Pain and Symptom Management. 1999 October; 18(4): 303-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10534971&dopt=Abstract

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Review article: anthranoid laxatives and their potential carcinogenic effects. Author(s): van Gorkom BA, de Vries EG, Karrenbeld A, Kleibeuker JH. Source: Alimentary Pharmacology & Therapeutics. 1999 April; 13(4): 443-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10215727&dopt=Abstract

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Risk of ovarian cancer in relation to use of phenolphthalein-containing laxatives. Author(s): Cooper GS, Longnecker MP, Sandler DP, Ness RB. Source: British Journal of Cancer. 2000 August; 83(3): 404-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10917559&dopt=Abstract

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Screening for surreptitious laxative abuse. Author(s): Duncan A. Source: Annals of Clinical Biochemistry. 2000 January; 37 ( Pt 1): 1-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10672367&dopt=Abstract

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Self-prescribed laxative use: a drug-utilization review. Author(s): Motola G, Mazzeo F, Rinaldi B, Capuano A, Rossi S, Russo F, Vitelli MR, Rossi F, Filippelli A. Source: Adv Ther. 2002 September-October; 19(5): 203-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12539880&dopt=Abstract

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Severe hypermagnesemia as a result of laxative use in renal insufficiency. Author(s): Zaman F, Abreo K. Source: Southern Medical Journal. 2003 January; 96(1): 102-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602733&dopt=Abstract

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Significant increase in prostaglandin E-main urinary metabolite by laxative administration: comparison with ulcerative colitis. Author(s): Fujiwara M, Okayasu I, Oritsu M, Komatsu J, Yoshitsugu M, Katoh Y, Bandoh T, Toyoshima H, Kase Y, Sugihara K, Kanno J, Hayashi Y. Source: Digestion. 2000; 61(3): 201-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10773726&dopt=Abstract

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Skin breakdown and blisters from senna-containing laxatives in young children. Author(s): Spiller HA, Winter ML, Weber JA, Krenzelok EP, Anderson DL, Ryan ML. Source: The Annals of Pharmacotherapy. 2003 May; 37(5): 636-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708936&dopt=Abstract

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Surgical treatment of oesophageal obstruction after ingestion of a granular laxative. Author(s): Brown DC, Doughty JC, George WD. Source: Postgraduate Medical Journal. 1999 February; 75(880): 106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10448474&dopt=Abstract

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Surreptitious abuse of magnesium laxatives as a cause of chronic diarrhoea. Author(s): Duncan A, Forrest JA. Source: European Journal of Gastroenterology & Hepatology. 2001 May; 13(5): 599-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11396544&dopt=Abstract

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Surreptitious laxative abuse: keep it in mind. Author(s): Phillips SF. Source: Semin Gastrointest Dis. 1999 October; 10(4): 132-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10548406&dopt=Abstract

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Systematic review of the effectiveness of laxatives in the elderly. Author(s): Petticrew M, Watt I, Sheldon T. Source: Health Technology Assessment (Winchester, England). 1997; 1(13): I-Iv, 1-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9483163&dopt=Abstract

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The dilemma of laxative abuse. Author(s): Eastwood M. Source: Lancet. 1995 October 28; 346(8983): 1115. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7475598&dopt=Abstract

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The effect of stimulant laxatives and polyethylene glycol-electrolyte lavage solution for colonoscopy preparation on serum electrolytes and hemodynamics. Author(s): Sharma VK, Schaberg JW, Chockalingam SK, Vasudeva R, Howden CW. Source: Journal of Clinical Gastroenterology. 2001 March; 32(3): 238-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11246353&dopt=Abstract

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The relationship between opioid use and laxative use in terminally ill cancer patients. Author(s): Sykes NP. Source: Palliative Medicine. 1998 September; 12(5): 375-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9924600&dopt=Abstract

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Toxicity of commonly used laxatives. Author(s): Hallmann F. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2000 May-June; 6(3): 618-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11208382&dopt=Abstract

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Transitory laxative threshold of trehalose and lactulose in healthy women. Author(s): Oku T, Okazaki M. Source: J Nutr Sci Vitaminol (Tokyo). 1998 December; 44(6): 787-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10197310&dopt=Abstract

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Urothelial cancer at different tumour sites: role of smoking and habitual intake of analgesics and laxatives. Results of the Berlin Urothelial Cancer Study. Author(s): Pommer W, Bronder E, Klimpel A, Helmert U, Greiser E, Molzahn M. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1999 December; 14(12): 2892-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10570093&dopt=Abstract

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US to ban sale of many laxatives over the counter. Author(s): Josefson D. Source: Bmj (Clinical Research Ed.). 1997 September 13; 315(7109): 627. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9310560&dopt=Abstract

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Use of laxatives in institutions for the mentally retarded. Author(s): Van Winckel M, Vander Stichele R, De Bacquer D, Bogaert M. Source: European Journal of Clinical Pharmacology. 1999 February; 54(12): 965-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10192759&dopt=Abstract

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

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

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

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

Finding Nutrition Studies on Laxatives 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 “laxatives” (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 “laxatives” (or a synonym): •

5300 years ago, the Ice Man used natural laxatives and antibiotics. [Correspondence]. Author(s): Department of Anthropology, National Archaeological Museum, 66100 Chieti (Italy) Source: Capasso, L. Lancet,-British-edition (United Kingdom). (1998). volume 352(9143) page 1864.

Additional physician-oriented references include: •

A multi-centre, general practice comparison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Author(s): Reckitt & Colman Products Ltd, Hull, UK. Source: DettMarch, P W Sykes, J Curr-Med-Res-Opin. 1998; 14(4): 227-33 0300-7995

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A strategy to reduce laxative use among older people. Author(s): Royal Cornhill Hospital, Aberdeen. Source: Stewart, E Innes, J Mackenzie, J Downie, G Nurs-Times. 1997 January 22-28; 93(4): 35-6 0954-7762

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Abdominal ultrasonography: improved image quality with the combined use of a diet and laxatives. Author(s): Department of Diagnostic Radiology, University Hospital Leiden, The Netherlands. Source: Vogel, H J Schipper, J Hermans, J J-Clin-Ultrasound. 1990 October; 18(8): 627-30 0091-2751

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Adverse effects of laxatives. Author(s): Department of Gastroenterology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Source: Xing, J H Soffer, E E Dis-Colon-Rectum. 2001 August; 44(8): 1201-9 0012-3706

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

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An audit of laxative use and fibre/fluid intakes in a care of the elderly rehabilitation ward. Source: Grant, E. J-hum-nutr-diet. Oxford : Blackwell Science Ltd. October 1999. volume 12 (5) page 409-413. 0952-3871

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Apoptosis induction by sennoside laxatives in man; escape from a protective mechanism during chronic sennoside use? Author(s): Department of Gastroenterology, University Hospital, 9700 RB Groningen, The Netherlands. Source: van Gorkom, B A Karrenbeld, A van der Sluis, T Zwart, N de Vries, E G Kleibeuker, J H J-Pathol. 2001 August; 194(4): 493-9 0022-3417

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Changing bowel hygiene practice successfully: a program to reduce laxative use in a chronic care hospital. Author(s): Sisters of Charity of Ottawa (SCO) Hospital, Ontario, Canada.

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Source: Benton, J M O'Hara, P A Chen, H Harper, D W Johnston, S F Geriatr-Nurs. 1997 Jan-February; 18(1): 12-7 0197-4572 •

Classification, pharmacology, and side-effects of common laxatives. Author(s): Park-Klinik Weissensee, Berlin, Germany. Source: Muller Lissner, S Ital-J-Gastroenterol-Hepatol. 1999 November; 31 Suppl 3S234-7 1125-8055

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Clinical pharmacology and use of laxatives and lavage solutions. Author(s): Baylor University Medical Center, Dallas, Texas 75246, USA. Source: Schiller, L R J-Clin-Gastroenterol. 1999 January; 28(1): 11-8 0192-0790

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

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

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Consumer's guide to laxatives. Source: Cullen, Mark. Veg-Times. New York : Vegetarian Life & Times, Inc. March 1985. (91) page 49-51, 53, 54.

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Cytotoxicity of rhein, the active metabolite of sennoside laxatives, is reduced by multidrug resistance-associated protein 1. Author(s): Department of Gastroenterology, University Hospital, PO Box 30.001, 9700 RB Groningen, The Netherlands. Source: van Gorkom, B A P Timmer Bosscha, H de Jong, S van der Kolk, D M Kleibeuker, J H de Vries, E G E Br-J-Cancer. 2002 May 6; 86(9): 1494-500 0007-0920

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Diagnosis of the abuse of magnesium and stimulant laxatives. Author(s): Gastroenterology Unit, Royal Infirmary, Glasgow, Scotland, UK. Source: Duncan, A Cameron, A Stewart, M J Russell, R I Ann-Clin-Biochem. 1991 November; 28 ( Pt 6)568-73 0004-5632

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Effect of anthraquinone-laxatives on the proliferation and urokinase secretion of normal, premalignant and malignant colonic epithelial cells. Author(s): Institute of Tumour Biology--Cancer Research, University of Vienna, Austria. Source: Schorkhuber, M Richter, M Dutter, A Sontag, G Marian, B Eur-J-Cancer. 1998 June; 34(7): 1091-8 0959-8049

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Effects of fiber laxatives and calcium docusate on regional water content and viscosity of digesta in the large intestine of the pig. Author(s): Procter & Gamble Company, Cincinnati, Ohio 45224, USA. Source: McRorie, J Pepple, S Rudolph, C Dig-Dis-Sci. 1998 April; 43(4): 738-45 0163-2116

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Effects of long-term laxative treatment on neuropeptides in rat mesenteric vessels and caecum. Author(s): Department of Anatomy and Developmental Biology, University College London, UK. Source: Milner, P Belai, A Tomlinson, A Hoyle, C H Sarner, S Burnstock, G J-PharmPharmacol. 1992 September; 44(9): 777-9 0022-3573

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Ischemic colitis caused by oral hyperosmotic saline laxatives. Author(s): Department of Medicine, Evanston Hospital of Northwestern University Medical School, Illinois, USA. Source: Oh, J K Meiselman, M Lataif, L E Gastrointest-Endosc. 1997 March; 45(3): 319-22 0016-5107

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Laxatives. Are we making the best choice? Source: Osis, M Gerontion. 1987 Fall; 2(3): 5-7 0829-8297

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Movers and shakers: a clinician's guide to laxatives. Author(s): University of Mississippi Medical Center, Jackson 39216, USA. Source: Lowe, J R Parks, B R Pediatr-Ann. 1999 May; 28(5): 307-10 0090-4481

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Prospective study of bowel movement, laxative use, and risk of colorectal cancer among women. Author(s): Department of Nutrition, Harvard School of Public Health, Boston, MA, USA. Source: Dukas, L Willett, W C Colditz, G A Fuchs, C S Rosner, B Giovannucci, E L Am-JEpidemiol. 2000 May 15; 151(10): 958-64 0002-9262

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Pseudohyperaldosteronism from liquorice-containing laxatives. Author(s): Istituto di Semeiotica Medica, University of Padova, Italy. Source: Scali, M Pratesi, C Zennaro, M C Zampollo, V Armanini, D J-Endocrinol-Invest. 1990 November; 13(10): 847-8 0391-4097

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Reactive nitrogen species modulate the effects of rhein, an active component of senna laxatives, on human epithelium in vitro. Author(s): Department of Pediatrics, University Federico II, Naples, Italy. [email protected] Source: Raimondi, F Santoro, P Maiuri, L Londei, M Annunziata, S Ciccimarra, F Rubino, A J-Pediatr-Gastroenterol-Nutr. 2002 May; 34(5): 529-34 0277-2116

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Risk of ovarian cancer in relation to use of phenolphthalein-containing laxatives. Author(s): Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709, USA. Source: Cooper, G S Longnecker, M P Sandler, D P Ness, R B Br-J-Cancer. 2000 August; 83(3): 404-6 0007-0920

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Significant increase in prostaglandin E-main urinary metabolite by laxative administration: comparison with ulcerative colitis. Author(s): Department of Clinical Pathology, Japanese Red Cross Medical Center, Hiroo, Shibuya-ku, Tokyo, Japan. Source: Fujiwara, M Okayasu, I Oritsu, M Komatsu, J Yoshitsugu, M Katoh, Y Bandoh, T Toyoshima, H Kase, Y Sugihara, K Kanno, J Hayashi, Y Digestion. 2000; 61(3): 201-6 0012-2823

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Stimulation of enterocyte protein kinase C by laxatives in-vitro. Author(s): Department of Experimental and Clinical Pharmacology, Karl-FranzensUniversity, Graz, Austria. Source: Beubler, E Schirgi Degen, A J-Pharm-Pharmacol. 1993 January; 45(1): 59-62 00223573

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Systematic review of the effectiveness of laxatives in the elderly. Author(s): NHS Centre for Reviews and Dissemination, University of York. Source: Petticrew, M Watt, I Sheldon, T Health-Technol-Assess. 1997; 1(13): i-iv, 1-52 1366-5278

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The potential of foods containing inulin as laxatives for older Australians--a pilot study. Source: Hunter, W. Jones, G.P. Devereux, H. Stewart, A. Aust-j-nutr-diet. Deakin ACT, Australia : Dietitians Association of Australia. June 2000. volume 57 (2) page 95-97. 10321322

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

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

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

Vitamins Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com

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Minerals Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com Magnesium Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com

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Food and Diet Burdock Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,235,00.html Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Flaxseeds Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND LAXATIVES Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to laxatives. 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 laxatives 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 “laxatives” (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 laxatives: •

5300 years ago, the Ice Man used natural laxatives and antibiotics. Author(s): Capasso L. Source: Lancet. 1998 December 5; 352(9143): 1864. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9851424&dopt=Abstract

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

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Additive benefits of laxative, toilet training, and biofeedback therapies in the treatment of pediatric encopresis. Author(s): Cox DJ, Sutphen J, Ling W, Quillian W, Borowitz S.

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Source: Journal of Pediatric Psychology. 1996 October; 21(5): 659-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8936895&dopt=Abstract •

Adverse effects of laxatives. Author(s): Xing JH, Soffer EE. Source: Diseases of the Colon and Rectum. 2001 August; 44(8): 1201-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11535863&dopt=Abstract

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

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Assessment of the genotoxic risk from laxative senna products. Author(s): Brusick D, Mengs U. Source: Environmental and Molecular Mutagenesis. 1997; 29(1): 1-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9020301&dopt=Abstract

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Can I safely use powdered fiber drinks such as Metamucil to relieve constipation without my body becoming reliant on them? Author(s): Feinberg AW. Source: Health News. 2000 January; 6(1): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11019667&dopt=Abstract

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Congestive heart failure caused by digitalis toxicity in an elderly man taking a licorice-containing chinese herbal laxative. Author(s): Harada T, Ohtaki E, Misu K, Sumiyoshi T, Hosoda S. Source: Cardiology. 2002; 98(4): 218. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566654&dopt=Abstract

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Contribution of behavior therapy and biofeedback to laxative therapy in the treatment of pediatric encopresis. Author(s): Cox DJ, Sutphen J, Borowitz S, Kovatchev B, Ling W. Source: Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 1998 Spring; 20(2): 70-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9989311&dopt=Abstract

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Diuretic, laxative and toxicity studies of Cocculus hirsutus aerial parts. Author(s): Ganapaty S, Dash GK, Subburaju T, Suresh P.

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Source: Fitoterapia. 2002 February; 73(1): 28-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11864760&dopt=Abstract •

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

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Effects of fiber laxatives and calcium docusate on regional water content and viscosity of digesta in the large intestine of the pig. Author(s): McRorie J, Pepple S, Rudolph C. Source: Digestive Diseases and Sciences. 1998 April; 43(4): 738-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9558028&dopt=Abstract

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Endoscopic diagnosis and treatment of an esophageal bezoar resulting from bulk laxative ingestion. Author(s): Perez-Piqueras J, Silva C, Jaqueti J, Saez MA, Martinez D, Santa JM, Peralba I. Source: Endoscopy. 1994 October; 26(8): 710. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7859686&dopt=Abstract

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Genotoxicity of the laxative drug components emodin, aloe-emodin and danthron in mammalian cells: topoisomerase II mediated? Author(s): Muller SO, Eckert I, Lutz WK, Stopper H. Source: Mutation Research. 1996 December 20; 371(3-4): 165-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9008718&dopt=Abstract

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Initial description of gastric melanosis in a laxative-abusing patient. Author(s): Mitty RD, Wolfe GR, Cosman M. Source: The American Journal of Gastroenterology. 1997 April; 92(4): 707-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9128333&dopt=Abstract

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Lack of benefit of laxatives as adjunctive therapy for functional nonretentive fecal soiling in children. Author(s): van Ginkel R, Benninga MA, Blommaart PJ, van der Plas RN, Boeckxstaens GE, Buller HA, Taminiau JA. Source: The Journal of Pediatrics. 2000 December; 137(6): 808-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11113837&dopt=Abstract

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Laxatives and the Ice Man. Author(s): Poder R, Peintner U.

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Source: Lancet. 1999 March 13; 353(9156): 926. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10094008&dopt=Abstract •

Laxatives and the Ice Man. Author(s): Tunon H, Svanberg I. Source: Lancet. 1999 March 13; 353(9156): 925-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10094007&dopt=Abstract

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Older people and laxative use: literature review and pilot study report. Author(s): Koch T, Hudson S. Source: Journal of Clinical Nursing. 2000 July; 9(4): 516-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11261131&dopt=Abstract

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Pharmacological basis for the use of the antivenene water soluble extract of Diodia scandens as a laxative, oxytocic agent and a possible aphrodisiac in traditional medicine practice in eastern nigeria. Author(s): Onuaguluchi G, Nwafor P. Source: Phytotherapy Research : Ptr. 1999 September; 13(6): 459-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10479753&dopt=Abstract

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Psyllium laxative-induced anaphylaxis, asthma, and rhinitis. Author(s): Vaswani SK, Hamilton RG, Valentine MD, Adkinson NF Jr. Source: Allergy. 1996 April; 51(4): 266-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8792925&dopt=Abstract

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Review article: anthranoid laxatives and their potential carcinogenic effects. Author(s): van Gorkom BA, de Vries EG, Karrenbeld A, Kleibeuker JH. Source: Alimentary Pharmacology & Therapeutics. 1999 April; 13(4): 443-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10215727&dopt=Abstract

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Review: behavioral interventions plus laxatives are effective for defecation disorders, but biofeedback does not add benefit. Author(s): Moffatt ME. Source: Acp Journal Club. 2002 July-August; 137(1): 28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12093227&dopt=Abstract

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Review: behavioural interventions plus laxatives are effective for defecation disorders in children, but biofeedback does not add benefit. Author(s): Secco L. Source: Evidence-Based Nursing. 2002 July; 5(3): 76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12123260&dopt=Abstract

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Rhein and aloe-emodin kinetics from senna laxatives in man. Author(s): Krumbiegel G, Schulz HU. Source: Pharmacology. 1993 October; 47 Suppl 1: 120-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8234418&dopt=Abstract

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

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Skin breakdown and blisters from senna-containing laxatives in young children. Author(s): Spiller HA, Winter ML, Weber JA, Krenzelok EP, Anderson DL, Ryan ML. Source: The Annals of Pharmacotherapy. 2003 May; 37(5): 636-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708936&dopt=Abstract

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Systematic review of the effectiveness of laxatives in the elderly. Author(s): Petticrew M, Watt I, Sheldon T. Source: Health Technology Assessment (Winchester, England). 1997; 1(13): I-Iv, 1-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9483163&dopt=Abstract

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The mechanism underlying the laxative properties of parsley extract. Author(s): Kreydiyyeh SI, Usta J, Kaouk I, Al-Sadi R. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2001 September; 8(5): 382-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11695882&dopt=Abstract

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

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/

•

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

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•

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

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

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

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

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

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

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

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

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

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

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

The following is a specific Web list relating to laxatives; 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 Anemia Source: Integrative Medicine Communications; www.drkoop.com Appendicitis Source: Integrative Medicine Communications; www.drkoop.com Breast Cancer Source: Healthnotes, Inc.; www.healthnotes.com Bulimia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Colon Cancer 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 Crohn's Disease Source: Healthnotes, Inc.; www.healthnotes.com

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Diarrhea Source: Integrative Medicine Communications; www.drkoop.com Diverticular Disease Source: Healthnotes, Inc.; www.healthnotes.com Diverticular Disease Source: Integrative Medicine Communications; www.drkoop.com Eating Disorders Source: Healthnotes, Inc.; www.healthnotes.com Hemorrhoids Source: Integrative Medicine Communications; www.drkoop.com Irritable Bowel Syndrome Source: Healthnotes, Inc.; www.healthnotes.com Irritable Bowel Syndrome Source: Integrative Medicine Communications; www.drkoop.com Spastic Colon Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Ayurveda Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,672,00.html Clean-me-out Program Alternative names: Arise Shine Cleanse Thyself Program 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/c.html Colon Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682,00.html Panchakarma Alternative names: Pancha Karma therapy rejuvenation therapy 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/p.html

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•

Herbs and Supplements Aloe Alternative names: Aloe vera L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Aloe Alternative names: Aloe vera, Aloe barbadensis Source: Healthnotes, Inc.; www.healthnotes.com Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aloe Source: Prima Communications, Inc.www.personalhealthzone.com Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aloe Vera Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10001,00.html Angelica Sinensis Source: Integrative Medicine Communications; www.drkoop.com Bisacodyl Source: Healthnotes, Inc.; www.healthnotes.com Blue Flag Alternative names: Iris versicolor Source: Healthnotes, Inc.; www.healthnotes.com Blueberry Alternative names: Vaccinium spp. Source: Healthnotes, Inc.; www.healthnotes.com Calendula Alternative names: Calendula officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Cascara Alternative names: Cascara sagrada, Rhamnus purshiani cortex Source: Healthnotes, Inc.; www.healthnotes.com Cascara Sagrada Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10013,00.html

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Chinese Angelica Source: Integrative Medicine Communications; www.drkoop.com Crataegus Alternative names: Hawthorn; Crataegus oxyacantha L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Damiana Alternative names: Turnera diffusa Source: Healthnotes, Inc.; www.healthnotes.com Damiana Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Dandelion Alternative names: Taraxacum officinale Source: Healthnotes, Inc.; www.healthnotes.com Dandelion Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10021,00.html Danggui Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Digoxin Source: Healthnotes, Inc.; www.healthnotes.com Docusate Source: Healthnotes, Inc.; www.healthnotes.com Dong Quai Alternative names: Angelica sinensis, Chinese Angelica, Dang Gui, Danngui, Dong Qua, Tang Kuei, Tan Kue Bai zhi(Note: Dong quai should not be confused with Angelica root or Angelica seed.) Source: Integrative Medicine Communications; www.drkoop.com Dong Quai (angelica) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,774,00.html Elderberry Source: Prima Communications, Inc.www.personalhealthzone.com Fiber Source: Integrative Medicine Communications; www.drkoop.com

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Flaxseed Alternative names: Linum usitatissimum, Linseed Source: Integrative Medicine Communications; www.drkoop.com Fo-ti Alternative names: Polygonum multiflorum Source: Healthnotes, Inc.; www.healthnotes.com Fringetree Bark Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Golden Seal Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ispaghula Source: Integrative Medicine Communications; www.drkoop.com Linseed Source: Integrative Medicine Communications; www.drkoop.com Linum Usitatissimum Source: Integrative Medicine Communications; www.drkoop.com Liquorice Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Lubricant Laxatives Source: Integrative Medicine Communications; www.drkoop.com Menadione Source: Integrative Medicine Communications; www.drkoop.com Menaphthone Source: Integrative Medicine Communications; www.drkoop.com Menaquinone Source: Integrative Medicine Communications; www.drkoop.com Methylcellulose Source: Healthnotes, Inc.; www.healthnotes.com

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Milk Thistle Alternative names: Silybum marianum, Carduus marianus Source: Healthnotes, Inc.; www.healthnotes.com Milk Thistle Alternative names: Silybum marianum, St. Mary's Thistle Source: Integrative Medicine Communications; www.drkoop.com Oral Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Organ Mountain Crape Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com Plantago Isphagula Source: Integrative Medicine Communications; www.drkoop.com Plantago Psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.drkoop.com Psyllium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,814,00.html Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc.; www.healthnotes.com Silybum Marianum Source: Integrative Medicine Communications; www.drkoop.com St. Mary's Thistle Source: Integrative Medicine Communications; www.drkoop.com Stimulant Laxatives Source: Integrative Medicine Communications; www.drkoop.com

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Tang Kuei Source: Integrative Medicine Communications; www.drkoop.com Yellow Dock Alternative names: Rumex crispus Source: Healthnotes, Inc.; www.healthnotes.com Yellow Dock Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

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

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CHAPTER 4. PATENTS ON LAXATIVES 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 “laxatives” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on laxatives, we have not necessarily excluded non-medical patents in this bibliography.

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

5Adapted

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

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on laxatives: •

Aqueous laxative syrup comprising lactulose and lactitol and/or maltitol Inventor(s): Pearson; Julita (West Wickham, GB), Saunders; David (Farnham, GB) Assignee(s): Xyrofin Oy (Helsinki, FI) Patent Number: 6,251,875 Date filed: March 19, 1999 Abstract: An aqueous laxative syrup is provided comprising one part by weight of lactulose and 0.66-1.5 parts by weight of a polyol selected from lactitol and/or maltitol. The syrup has a viscosity of 5-70 mPa.s. Preferably the polyol is lactitol. The syrup is less viscous than a lactulose-only syrup and has a pleasant balance of tastes between sweetness, acidity and bitterness. Further, it does not suffer from an overly medicinal taste. This balance of characteristics makes the syrup pleasant to take and so improves patient compliance. Excerpt(s): The present invention relates to an aqueous laxative syrup which possesses a balance of characteristics including taste and viscosity which makes it palatable to a wide range of individuals. The disaccharide lactulose (4-.beta.-D-galatosyl-D-fructose) is known to be pharmacologically active as a laxative. It is 0.5-0.6 times as sweet as sucrose. Lactulose is generally marketed as a syrup because its crystallisation and drying are difficult and costly. When used to treat constipation, it is normally administered in the form of such a syrup. Lactulose syrups which are presently marketed for the treatment of constipation or portal systemic encephalopathy (PSE) contain 620-740 g/l of lactulose. These syrups also contain about 50 g/l and 100 g/l respectively of lactose and galactose. These two sugars are by-products of the usual synthetic pathway used to produce lactulose. These sugars increase the viscosity of the syrup. Constipation is usually treated by taking 15 ml of lactulose syrup twice daily at the beginning of the treatment. This dosage is reduced according to the patient's needs. For the treatment of PSE, initially, 30-50 ml are taken three times daily, the dosage being subsequently adjusted to produce 2-3 soft stools daily. Web site: http://www.delphion.com/details?pn=US06251875__

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Combination osmotic and bulk forming laxatives Inventor(s): Olinger; Philip M. (St. Charles, IL), Pearson; Julita (West Wickham, GB), Saunders; David (Guildford, GB) Assignee(s): Xyrofin Oy (Helsinki, FI) Patent Number: 5,651,988 Date filed: August 18, 1995 Abstract: A combination bulk-forming and osmotic laxative is provided by combining a bulk-forming laxative in the form of psyllium hydrophilic mucilloid with an osmotic laxative such as lactitol. The addition of the osmotic laxative to the bulk-forming laxative with a binder solution and subsequent drying produces an improved laxative in granulate form which is directly compressible into tablets.

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Excerpt(s): The present invention relates generally to laxatives. Particularly, the present invention relates to a combination laxative which includes an osmotic laxative and a bulk-forming laxative. Still more particularly, the present invention relates to the granulated combination of an osmotic laxative in the form of a sugar alcohol, such as lactitol, with a bulk forming laxative such as psyllium to provide a laxative form which is directly compressible. There are four general types of laxatives that are currently available: 1) bulk-forming; 2) osmotic; 3) stimulatory; 4) softening agents. The present application is directed toward the bulk-forming and osmotic types and specifically towards the use of an osmotic laxative in enhancing and correcting deficiencies found in bulk-forming laxatives. While bulk-forming laxatives such as those formed from psyllium husks provide generally safe and effective laxatives, psyllium laxatives generally suffer from three primary deficiencies. First, bulk-forming laxatives such as psyllium are not directly compressible and lack the ability to be readily formulated in tabletted form. Second, they do not disperse well and often form lumps of psyllium material, the interiors of which are still substantially dry. Third, psyllium seed husk has very poor wetting qualities and therefore does not mix well. Web site: http://www.delphion.com/details?pn=US05651988__ •

Compositions containing psyllium Inventor(s): Colliopoulos; John A. (Cincinnati, OH), Cregier; Melissa M. (Cincinnati, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,258,181 Date filed: March 2, 1992 Abstract: The present invention relates to compositions comprising psyllium fiber and peanut paste, and the use of these compositions as laxatives and/or for cholesterol reduction benefits. The compositions are a convenient, portable, highly palatable, and well tolerated dosage form for administering psyllium fiber. Excerpt(s): The present invention relates to novel compositions containing psyllium and peanut paste. The compositions have excellent texture, mouthfeel and palatability, and are well tolerated by the gastrointestinal tract. They are useful as dietary aids in the control of bowel function (including use as laxatives) and/or for reducing blood cholesterol levels and/or for weight control or other indications where fiber may be beneficial. Several U.S. patents describe non-baked compositions in which psyllium is an optional or essential ingredient: U.S. Pat. No. 4,778,676, to Yang et al., issued Oct. 18, 1988 (describes chewable compositions comprising a precoated active and a confectionery matrix); U.S. Pat. No. 4,766,004, to Moskowitz, issued Aug. 23, 1988 (describes dietary fiber supplement compositions comprising whole psyllium husks having a particle size of from 12 to 70 mesh, food grade vegetable fat which is a solid at room temperature, sweetening agent and flavoring agent); U.S. Pat. No. 4,737,364, to Kalogris, issued Apr. 12, 1988 (describes low calorie dry food concentrate); U.S. Pat. No. 4,698,232, to Sheu et al., issued Oct. 6, 1987 (describes fiber-containing confectionery compositions comprising dietary fiber pretreated with a lubricant, a foamed matrix, and an amorphous matrix); and U.S. Pat. No. 4,551,331, to Rudin, issued Nov. 5, 1985 and R. E. 32,811, issued Dec. 27, 1988 (describe dietary fiber products comprising a dietary fiber coated with a food grade emulsifier). Peanut Butter Ultra Eat'n Lose.RTM. Nutrition Bars (sold by CCA Industries, Inc.) is said to be a peanut butter coated and containing, high fiber and mineral supplemented nutrition bars wherein the fiber component is a

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mixture of brans (e.g., corn, oat, wheat) and other fibers, including a low amount of psyllium. Naturacil.RTM. (sold by Mead Johnson) is an artificial chocolate flavored, caramel-like laxative product containing psyllium; the ingredients listed for this product include sugar, glycerin, nonfat milk, and partially hydrogenated vegetable oil. U.S. Pat. No. 4,784,861, to Gori, issued Nov. 15, 1988, describes powders formed of a mixture of oat, wheat and corn bran mixed with pectin, guar gum, psyllium and cutin to which mineral supplements have been added. U.S. Pat. No. 4,619,831, to Sharma, issued Oct. 28, 1986, describes dietary fiber products comprising insoluble dietary fiber (92-98.5%) coated or enrobed with soluble dietary fiber (1.5-8%; psyllium is mentioned as one of many soluble fibers). U.S. Pat. No. 4,565,702, to Morley et al., issued Jan. 21, 1986, describes dietary fiber compositions comprising dietary fibers which are insoluble fibers coated with soluble fiber. U.S. Pat. No. 4,348,379, to Kowalsky et al., issued Sep. 7, 1982, describes dietetic compositions comprising psyllium seed, linseed, and wheat bran. European Patent Application Publication No. 144,644, published Jun. 19, 1985 by G. D. Searle and Co., describes high fiber food compositions comprising psyllium and other dietary fiber sources. Web site: http://www.delphion.com/details?pn=US05258181__ •

Confectionery delivery system for laxatives, vitamins and antacids Inventor(s): Sharma; Shri C. (40 Oak Knoll Rd., Mendham, NJ 07945), Shaw; James J. (34 Valley View St., Morristown, NJ 07960), Sheu; Shan-Shan (20 Jean Ter., Parsippany, NJ 07054), Yang; Robert K. (12 Roc Etam Rd., Randolph, NJ 07869) Assignee(s): none reported Patent Number: 4,882,152 Date filed: October 14, 1988 Abstract: A chewable delivery system for actives comprising:(a) an active pre-coatd with at least one material selected from the group consisting of lecithin, polyoxyalkylenes having chain lengths of about 4 carbons or less, glycerides having a melting point of 100.degree. C. or less, polyalkyleneglycols having a molecular weight of 3,700 or less, synthetic and natural waxes and mixtures thereof; and p1 (b) a confectionery matrix comprising a binder system comprising gelatin and a humectant material selected from the group consisting of glycerin and its lower alkyl (C.sub.2-7) ester derivatives; a sweetener; and about 1% to about 30% by weight water. Excerpt(s): The present invention relates to a novel confectionery delivery system for actives such as fiber and drugs. The confectionery delivery system comprises a chewable matrix and an active material, the combination of which is preferably both fat free and non-sucrose-containing, and therefore low in calories. Active materials such as dietary fiber and/or drugs can be incorporated and effectively masked in the delivery system. The unpleasant taste and mouthfeel of the fiber and/or drug is effectively masked and substantial hydration of the active is delayed until the delivery system passes through the oral cavity. The resultant products are substantially more palatable, and are essentially devoid of graininess, bitterness or fibrous texture. The pleasant taste of the delivery system and products made therefrom encourages patient compliance with a recommended therapy. Prescribed daily dosage amounts for fiber are often very high, requiring the patient to administer the fiber or fiber composition several times per day. While their benefits are well known to the consuming public, the unpleasant fibrous mouthfeel and texture of products containing dietary fiber have resulted in reluctance of patients to comply with prescribed dosages. Patient compliance with prescribed drug

Patents 45

therapies is also a problem particularly when the drug has an unpleasant taste, aftertaste or gritty mouthfeel. Drugs such as cholestryamine and potassium chloride are known to taste umpleasant. The prior art has disclosed products to mask the taste of these drugs, but the products themselves often suffer from their own unpleasant tastes. Web site: http://www.delphion.com/details?pn=US04882152__ •

Dispenser for granular materials Inventor(s): Weaver; Steven K. (567 Industrial Dr., Carmel, IN 46032) Assignee(s): none reported Patent Number: 6,293,440 Date filed: November 14, 2000 Abstract: A dispenser which is specially adapted for use with a container for granular materials such as laxatives. The dispenser includes an outer housing and an open or hollowed-out shaft. The shaft is easily separable from the housing for simplified assembly, disassembly and cleaning. The open shaft has a selected volume for receipt of granular materials. The overall unit is designed so that a certain desired volume of material can be dispensed by turning the shaft to different positions. Excerpt(s): The present invention is generally related to the dispenser arts and, in particular, to a system and method for dispensing granular materials such as laxatives. As is known in the art, laxatives are typically sold in cylindrical containers and so it is often difficult to dispense a certain desired amount of the laxative material. Dispenser units are known in the art but such are typically difficult to use accurately and costly to manufacture for widespread commercial appeal and use. Web site: http://www.delphion.com/details?pn=US06293440__

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Fat substitute compositions including waxes for a reduced laxative effect Inventor(s): Campbell; Michael L. (Kent, WA), Meyer; Richard S. (Federal Way, WA) Assignee(s): Curtis-Burns, Inc. (Rochester, NY) Patent Number: 5,338,564 Date filed: September 8, 1992 Abstract: A fat substitute composition includes an edible, substantially non-digestible fat substitute material having a melting point of about 37.degree. C. or less in combination with a wax as an anti-laxative agent to reduce an undesirable laxative effect associated with the fat substitute material. The wax may be an animal or insect wax, a vegetable wax, a mineral wax, or a synthetic wax. In a preferred embodiment, the wax is present at a level of less than or equal to 10% by weight of the fat substitute material. Excerpt(s): The present invention relates generally to the field of fat substitute compositions, more particularly to those exhibiting reduced laxative effects after ingestion by a mammal. Fats contribute from 30% to 40% of the total calories consumed by most Americans. One of the most common nutritional problems in the United States today is obesity, which results from the consumption of more calories than are expended. Consumption of fat is related to many disease states, such as heart disease. Successful reduction of fat consumption has not been achieved because of the dietary

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habits of the traditional American. Therefore, the search for fat substitutes or low-calorie fats has attracted attention in recent years. Among the possible low-calorie fats or fat substitutes synthesized to date are polyglycerol esters, sucrose polyesters (SPE), neopentyl-type alcohols and other sugar derivatives such as sorbitol and mannitol, glycerol dialkyl ethers, triglyceride esters of alpha carboxylic acids, diglyceride esters of short-chain dibasic acids, trialkoxytricarballyate, polydextrose, palatinose, polygalactose, N-oil (tapioca dextrin), microbiologically derived products, nonabsorbable synthetic polymers with properties similar to edible oil, tree-derived products, low-metabolized natural fats and oils, biopolymers, branched polysaccharides and jojoba oil. Many of these are reviewed by Hamm, J. Food Sci. 49 419 (1984). Web site: http://www.delphion.com/details?pn=US05338564__ •

Laxative composition based on lactulose and its preparation process Inventor(s): Aubard; Gilbert G. (Palaiseau, FR), Calvet; Alain P. (Versailles, FR), Doat; Bernard J. M. (Angers, FR), Junien; Jean-Louis (Paris, FR), Letavernier; Jean-Francois J. (Angers, FR), Llull; Jean B. (Morsang sur Orge, FR) Assignee(s): Jouveinal S.A. (Paris, FR) Patent Number: 4,761,400 Date filed: January 6, 1986 Abstract: Lactulose-based laxative composition which is in the form of a jelly with a viscosity at 20.degree. C. measured on the Brookfield viscosimeter between 15,000 and 30,000 centipoises, a refractive index at 20.degree. C. between 1.430 and 1.445 and a pH between 3 and 4. Excerpt(s): The present invention relates to a novel lactulose-based composition, essentially intended for the treatment of constipation in man. Constipation very frequently occurs and affects a large number of individuals with no distribution as regards sex or age. Its causes and consequences vary considerably. In numerous simple cases, a correction to the diet is sufficient to reestablish a normal state. However, laxative drugs are necessary and/or indispensable in the more serious cases, such as functional constipation or in special situations, such as certain radiological examinations, the consequences of operations or confinements, as well as in the treatment of young children and elderly people. Web site: http://www.delphion.com/details?pn=US04761400__

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Laxative composition comprising psyllium seeds and senna fruits Inventor(s): Gorler; Klaus (Bensberg-Refrath, DE), Madaus; Rolf (Koln-Bruck, DE) Assignee(s): Dr. Madaus & Co. (Cologne, DE) Patent Number: 4,511,561 Date filed: June 22, 1983 Abstract: Laxative compositions having particularly mild and well-tolerated action, not accompanied by toxic or side-effects, based on psyllium seeds and senna fruits are prepared by mixing separately ground psyllium seeds and senna fruits in a dry state, moistening the resulting ground mixture rapidly and uniformly with water, quickly granulating the resulting mixture and drying same in a manner preventing substantial

Patents 47

swelling of the product to a residual moisture content of no more than 3.5% and then coating the composition with a pharmacologically acceptable material. Excerpt(s): The invention relates to a laxative composition, more specifically a laxative comprising psyllium seeds and senna fruits, and to a method of preparing the same. The use of psyllium seeds (Plantago psyllium L.) for preparations for the regulation of intestinal activity is known. Psyllium seed has a considerable capacity for swelling and thus stimulates physical dilation of sensitive receptors of the intestinal wall. In accordance with a known method (German Pat. No. 1,103,520), psyllium seed is finely ground, moistened with water to form a very viscous paste, and dried in strand form, then broken up and finally sugar coated. The action of senna fruits (Cassia angustifolia) as a vegetable laxative is also known. Web site: http://www.delphion.com/details?pn=US04511561__ •

Laxative compositions Inventor(s): Colliopoulos; John A. (Cincinnati, OH) Assignee(s): The Proctor & Gamble Company (Cincinnati, OH) Patent Number: 5,232,699 Date filed: June 19, 1992 Abstract: The present invention relates to laxative compositions comprising psyllium and sennoside wherein sennoside is dispersed in a palatable food grade fat having a melting point within the range of from about 30.degree. C. to about 50.degree. C. Excerpt(s): The present invention relates to laxative compositions containing sennosides and psyllium, wherein sennoside is dispersed in a palatable food grade fat having a melting point within the range of from about 30.degree. C. to about 50.degree. C., and to methods for treating constipation by ingesting compositions of the present invention. The use of senna, sennosides, and psyllium as natural laxatives is known. In fact, a senna/psyllium product is commercially available in dry granule form (Perdiem.RTM., sold by Rorer). Negative aesthetics and performance attributes are recognized with using senna-containing laxative compositions. Madaus et al. U.S. Pat. No. 4,511,561, issued Apr. 16, 1985, reports that undesirable side effects such as convulsions and pain production may be observed with the use of sennosides. This U.S. Patent describes certain compositions containing psyllium and senna resulting from a specific granulation procedure. U.S. Pat. No. 4,857,331, issued Aug. 15, 1989, to Shaw et al., teaches ingestible gels confectionary delivery system which is said to include a pectin gel component, an algin gel component and a polymer network gel component, as well as an active ingredient. It is stated therein that sennosides are known to taste unpleasant. Web site: http://www.delphion.com/details?pn=US05232699__

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Laxative compositions Inventor(s): Kajs; Theresa M. (Loveland, OH), Sagel; Paul J. (West Chester, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,397,573 Date filed: June 4, 1993

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Abstract: Laxative compositions containing sennoside and menthol, pharmaceuticallyacceptable esters of menthol, or mixtures thereof, preferably as peppermint oil; and methods for treating constipation by orally concurrently administering to the lower gastrointestinal tract of a person in need of such treatment sennoside and menthol. Excerpt(s): The present invention relates to laxative compositions containing sennoside and menthol, preferably as peppermint oil, and the methods for treating constipation by orally concurrently administering to the lower gastrointestinal tract of a person in need of such treatment sennoside and menthol. The use of senna and sennosides as natural laxatives is known. Negative aesthetics and performance attributes are recognized with using senna-containing laxative compositions. U.S. Pat. No. 4,511,561, issued Apr. 16, 1985, to Madaus et al. reports that undesirable side effects may be observed with the use of sennosides. This U.S. Patent describes certain compositions containing psyllium and senna resulting from a specific granulation procedure. It also describes the use of peppermint oil as a flavor oil. In spite of this and other work to develop laxative products containing sennosides, there continues to be a need for new compositions which have improved aesthetics and/or reduced undesirable side effects (e.g., reduced cramping and/or reduced gas and/or reduced bloating) and/or improved consumer acceptability to encourage regular compliance for treating constipation; which are in convenient dosage forms; and which are effective as laxatives. It has been discovered by the present invention that the use of higher levels of menthol, preferably as part of peppermint oil, delivered to the lower gastrointestinal tract in combination with sennosides satisfies these needs. Web site: http://www.delphion.com/details?pn=US05397573__ •

Laxative compositions Inventor(s): Brown; Adrian (Cambridge, GB2), Leslie; Stewart T. (Cambridge, GB2), Malkowska; Sandra T. A. (Cambridge, GB2), Miller; Ronald B. (Basel, CH), Prater; Derek A. (Cambridge, GB2) Assignee(s): Euro-Celtique, S.A. (Luxembourg, LU) Patent Number: 5,525,355 Date filed: September 12, 1994 Abstract: A method for the manufacture of a laxative composition in dosage unit form which comprises the steps of melting a normally solid stool softener; dispersing and/or dissolving a stimulant laxative compound in the molten stool softener and mixing to obtain a uniform mixture; filling the molten dispersion into hard gelatin capsule shells; and allowing the capsules to cool and the melt or dispersion to solidify. Excerpt(s): This invention is concerned with improvements in and relating to laxative compositions and the manufacture thereof. Orally administrable compositions containing a stool softener in combination with a stimulant laxative are known and such compositions may, for example, take the form of suspensions containing the active ingredients in appropriate liquid carriers for oral administration. It has now been found, in accordance with the present invention, that a surprisingly high dose of a laxative composition can be incorporated in a small size of hard gelatin capsule by dispersing and dissolving the stimulant laxative in molten stool softener and filling the resultant molten dispersion into capsules. The resultant composition thus provides an unexpectedly high unit dose of the laxative composition in a pharmaceutical form which and shape for elegant, convenient and reliable administration to patients.

Patents 49

Web site: http://www.delphion.com/details?pn=US05525355__ •

Laxative compositions and a process for producing them Inventor(s): Chicouri; Marcel (174 Boulevard Saint-Germain, 75006 Paris, FR) Assignee(s): none reported Patent Number: 5,167,959 Date filed: November 2, 1990 Abstract: This invention has as a subject matter pharmaceutical compositions with laxative action characterized in that they contain as active ingredients an emollient laxative of mucilagineous character from vegetal origin and a lubrefiant laxative in the powder form, consisting of hardened microbedlets incorporating liquid paraffin in admixture or combination with one or several inert diluents or carriers. Excerpt(s): This invention relates to a combination of active ingredients endowed with laxative action. It includes more particularly a pharmaceutical composition containing as active ingredients a laxative with emollient action and a lubrificating nonmetabolisable laxative, in admixture or confunction with one or several inert non-toxic pharmaceutically-acceptable carrier or diluents-specifically it has as a subject malter, a fluid, powdery composition with laxative action characterized in that it contains as active ingredients, one or several mucilageous laxatives of vegetal origin and a lubrifiant laxative in the form of a powder in admixture or conjunction with inerts carriers or diluents, appropriate for the administration through digestive tract. It is known that treatment of constipation preferably utilizes bulk laxatives which increase the volume of the alimentary bolus and hence improve the transit or osmotic laxatives which cause a pull of water in the alimentary bolus at the level of the large intestine or still but to a lessened proportion, irritant laxatives which cause an increase of the colon motility, an increase of the peristaltism and finally an increase of the speed of evacuation-Lubrefiant laxatives are also used since they facilitate the slipping of the alimentary bolus in the digestive tract and allow to overcome the disturbances bound to the dysfunctionning of the anal sphincter. Web site: http://www.delphion.com/details?pn=US05167959__

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Laxative compositions containing bulk fiber Inventor(s): Kais; Theresa M. (Loveland, OH), Sagel; Paul J. (Maineville, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,516,524 Date filed: December 20, 1993 Abstract: An ingestible laxative composition comprising specified amounts of dioctyl sulfosuccinate and bulk fiber selected from the group consisting of psyllium, methylcellulose, polycarbophil, calcium polycarbophil, bran, malt soup extract, karaya, guar gum, and mixtures thereof, preferably in single dose form, is described. Excerpt(s): Bulk fibers such as psyllium and methylcellulose are known effective laxatives. Bulk fiber laxatives are often powders which are mixed in water and consumed. Another type of laxative is a stimulant laxative, which is typically available in tablet or capsule form. These include senna, phenolphthalein, casanthranol, and

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bisacodyl. Benefits of bulk laxatives relative to stimulant laxatives include: mildness, naturalness, minimal to no diarrhea, and/or a more normal, bulked bowel movement. However, bulk laxatives traditionally work slower than stimulant laxatives. Although stimulant laxatives can be harsh and are sometimes associated with cramping, the constipated person is often quite uncomfortable and does not want to wait the several days it may take for a bulk fiber to provide relief. Stimulant laxatives ordinarily provide overnight relief from constipation. An ideal laxative would be one which provides the benefits of bulk fiber, yet also provides speed to relief. The active ingredient in some commercially available stool softeners is dioctyl sulfosuccinate, which is an anionic medicinal surfactant. Dioctyl sulfosuccinates combined with stimulant laxatives such as phenolphthalein, casanthranol, and senna are permitted active ingredients, according to the Federal Register, vol. 40, No. 56, Part II Over-the-Counter-Drugs, "Proposed Establishment of Monographs for OTC Laxative, Antidiarrheal, Emetic and Antiemetic Products", p. 12941. Also included therein is dioctyl sulfosuccinate (docusate sodium) in combination with sodium carboxymethylcellulose. It is believed that there is no commercially available laxative composition with both dioctyl sulfosuccinate and the bulk fibers herein as the active ingredients. Web site: http://www.delphion.com/details?pn=US05516524__ •

Liquid paraffin oil and lactulose-based hypocaloric laxative jelly and method for its preparation Inventor(s): Doat; Bernard (Residence La Pleiade, 67 bd Jacques Millot, Angers, FR) Assignee(s): none reported Patent Number: 5,817,330 Date filed: February 4, 1997 Abstract: Paraffin oil and lactulose-based jellied clear laxative emulsion containing from 75 to 85 parts by weight of liquid paraffin oil and from 25 to 15 parts by weight of an edulcorated lactulose aqueous solution. The invention also concerns a method for the preparation of said emulsion. Excerpt(s): This application is a continuation of PCT/FR95/00219 published Feb. 25, 1995. The object of the present invention is a new emulsified composition based on liquid paraffin oil and lactulose, produced in the form of a smooth, non-sticky jelly and intended for oral administration for the treatment of constipation in humans. Constipation is a common pathological phenomenon which affects a considerable number of individuals with no real distinction as to sex or age. Recent publications indicate that this phenomenon chronically affects at least 10% of the French and British populations (Chaussade, S. and Guerre, J., Traitement de la constipation ›Treatment of constipation!, Encycl. Med. Chir., Paris, France, Estomac-Intestin, 9071 A.sup.10, 6-1985, 6 pp.; Taylor, R., Br. Med. J., 1990, 300, 1063-64), and that his percentage is even higher in the United States, Japan, and the northern European countries. It is also known that almost 50% of persons afflicted medicate themselves with laxatives, some of which are considered potentially dangerous. Web site: http://www.delphion.com/details?pn=US05817330__

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Low calorie fat substitute compositions resistant to laxative side effect Inventor(s): Howard; Norman B. (Hilton Head Island, SC), Kleinschmidt; David C. (Fairfield, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,006,360 Date filed: June 27, 1988 Abstract: The present invention relates to low calorie fat substitute compositions that are useful as fat replacements in low calorie foods, and as pharmaceutical compositions. Sucrose fatty acid esters are preferred low calorie fat substitutes. The compositions are highly resistant to an undesirable laxative side effect. These benefits are achieved by formulating compositions comprising a liquid polyol fatty acid polyester, at least about 10% solid low calorie fat substitute by weight of the liquid polyester, and at least about 1% of a cohesive network of polysaccharide fibrils and microfibrils, for example microfibrillated cellulose, by weight of the liquid polyester. Excerpt(s): The present invention relates to the field of low calorie fat and oil substitutes. Specifically, the invention relates to low calorie fat substitute compositions that contain polysaccharide fibrils and microfibrils such as microfibrillated cellulose. The compositions are particularly useful as fat replacements in foods. The consumption of large amounts of triglyceride fats has been linked to various health problems. For example, one of the most common metabolic problems among people today is obesity. This condition is primarily due to ingestion of a greater number of calories than are expended. Fat is the most concentrated form of energy in the diet, with each gram of fat supplying approximately 9 calories, and triglyceride fats constitute about 90% of the total fat consumed in the average diet. The National Institutes of Health Consensus Development Conference, "Lowering Blood Cholesterol to Prevent Heart Disease", JAMA, Vol. 253, No. 14, pp. 2080-2086 (1985), concluded that elevation of blood cholesterol levels is a major cause of coronary artery disease, and recommended a reduction in the amount of fat eaten to reduce blood serum cholesterol levels. Web site: http://www.delphion.com/details?pn=US05006360__

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Low calorie, high fiber laxative Inventor(s): Meer; E. Harvey (Cresskill, NJ), Mountain; Frank (Ridgewood, NJ), Schultz; Herbert V. (Jersey City, NJ) Assignee(s): Meer Corporation (North Bergen, NJ) Patent Number: 4,996,051 Date filed: November 23, 1988 Abstract: A natural fiber laxative is provided which consists of psyllium husk, apple fiber, fructose, gum arabic and flavorants. The psyllium husk and the apple fiber constitute together at least 75% by weight of the composiiton. The granular components are controlled to have a particle size less than that determined by a No. 50 mesh, thereby improving mouthfeel. The composition is, in addition to being all natural, low in calorie and high in fiber and when mixed with water has a palatable mouthfeel. Excerpt(s): The present invention relates to a low calorie, high fiber laxative and more specifically to such a laxative which is mixable with water for use as a laxative and which may be used in conjunction with a medically supervised dietary program to

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impart a felling of satiety. Dietary fiber is that portion of plant substances which are resistant to digestion. There is both soluble and insoluble fiber. Insoluble fiber passes through the digestive system substantially intact. It passes through more quickly than does soluble fiber and as such helps prevent constipation and also helps in treatment of diverticulosis and irritable bowel syndrome. It has recently been suggested that insoluble fiber may lessen the risk of colon cancer by passing carcinogens through the system more quickly. Soluble fiber absorbs water. It does not dissolve in water but rather acts like a sponge in the small intestine and stomach, giving a feeling of satiety and permitting slow food absorption so as to make it useful in weight control and the treatment of diabetes. Soluble fiber is found in fruits and vegetables, especially in citrus fruits and apples. Web site: http://www.delphion.com/details?pn=US04996051__ •

L-sugar laxatives Inventor(s): Apgar; Joan L. (Hummelstown, PA), Koch; Kenneth L. (Hershey, PA), Shively; Carol A. (Mechanicsburg, PA), Tarka, Jr.; Stanley M. (Hershey, PA) Assignee(s): Hershey Foods Corporation (Hershey, PA) Patent Number: 5,219,573 Date filed: October 17, 1989 Abstract: The present invention relates to novel monosaccharide sweeteners which are capable of acting as laxatives when administered in dose-effective amounts. The present invention also contemplates monosaccharides with laxative properties which have a natural carbohydrate structure. More specifically, the present invention contemplates monosaccharide substances capable of producing laxative effects in humans and having the advantages of being only minimally absorbed from the intestine; and having osmotic laxative effects on the small bowel and colon. The present invention allows for improved laxative formulations with increased palatability and better dosing for all age groups. The present invention can be used to induce mild laxation six to ten hours after ingestion. Excerpt(s): The present invention relates to a novel monosaccharide sweetener which is capable of acting as a laxative when administrated in dose-effective amounts. The present invention also contemplates monosaccharides with laxative properties which have a natural carbohydrate structure. More specifically, the present invention contemplates a monosaccharide capable of producing laxative effects in humans and having the advantages of being only minimally absorbed from the intestine; and having osmotic laxative and stool softening effects on the small bowel and colon. The present invention allows for improved laxative formulations with increased palatability and better dosing for all age groups. The present invention can be used to induce mild laxation six to ten hours after ingestion. The treatment of constipation problems has been a concern of physicians for years. Constipation has been defined as less than one bowel movement per week. Other components of constipation include difficulties with defecation and stool hardness. Web site: http://www.delphion.com/details?pn=US05219573__

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Magnesium trisilicate suitable for preparation of medicament adsorbates of nutritional supplements and laxatives Inventor(s): Denick, Jr.; John (Newton, NJ), Peters; David (Long Valley, NJ), Talwar; Anil K. (Long Valley, NJ) Assignee(s): Warner-Lambert Company (Morris Plains, NJ) Patent Number: 4,643,898 Date filed: December 19, 1985 Abstract: A medicament adsorbate containing a magnesium trisilicate having a surface area of at least 400 m.sup.2 /g and having a flake-like structure with multiple interstitial spaces, and having adsorbed therein from about 1% to about 20% by weight of the adsorbate of a medicament drug, wherein the medicament drug is a nutritional supplement or laxative. Excerpt(s): This invention relates to a medicament adsorbate composition containing magnesium trisilicate and in particular to a medicament adsorbate which employs a magnesium trisilicate having a surface area of at least 400 m.sup.2 /g with a surface structure having multiple interstitial-flaked spaces. The use of magnesium trisilicates in the preparation of medicament adsorbates has been taught in the literature as a method to render bitter drug principles tasteless in liquid, tablet and chewable dosage forms which become readily bioavailable when the adsorbate reaches the low pH acid media of the stomach. U.S. Pat. No. 3,085,942 to Magid discloses the formation of an antitussive composition using dextromethorphan and its acid addition salts adsorbed, in part, on magnesium trisilicate. Magid notes that particle size of the magnesium trisilicate is not critical in preparing the adsorbates and that average particle sizes of about 0.1 to about 150 microns are usable. Magid also notes that when the ingredients are intimately mixed, the bitter taste associated with dextromethorphan is reduced or eliminated. The adsorbate may be mixed with other ingredients to form compressed tablets, candy lozenges, chewing gum tablets and the like. Web site: http://www.delphion.com/details?pn=US04643898__

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Method of playing a game for fostering personal relationships Inventor(s): Peacock; Marlin L. (604 Topeka St., Mansfield, LA 71052) Assignee(s): none reported Patent Number: 5,230,517 Date filed: March 16, 1992 Abstract: A game designed to aid in fostering personal relationships using a board, a pair of dice, several stacks of question and command cards, a timer, a box of laxatives, and several other related objects. The purpose of the game is to force the fostering of personal knowledge between couples through the forced answering of random questions dealing with personal relationships upon certain random occurrences. Excerpt(s): The invention herein disclosed relates generally to a board game and more specifically to a game using a board, a pair of dice, several stacks of question and command cards, a timer, a box of laxatives, and several other related objects. The game herein described, which will be called "Quiz-N-Match" or some other appropriate name, is so designed to provide amusement while addressing a serious problem. It is the purpose of this game to allow strangers of the opposite sex to get to know one another

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through the answering of random questions asked according to random events, thereby presenting the elements of chance, excitement, and amusement to the acquaintance process. There have been many board games designed for the purpose of allowing participants to get better acquainted, however, these games have traditionally lacked the proper combination of fun, candor, and sincerity that is necessary in today's vastly more complex society. The society in which we live today, replete with a host of pitfalls such as divorce, date rape, and AIDS gives rise to a need for a game that will entertain yet inform the participants of the true feelings and personality traits of those who would wish to associate closely with one another. The invention as herein described provides such a mechanism. The invention herein described comprises a game utilizing a board, a pair of dice, six stacks of question cards, one stack of command cards, score pads, pencils, name tags, and various articles such as a box of laxatives related to the command cards. The game is designed to be played by up to ten males and ten females. There are seperate stacks of question cards for the male and female players. Each player is given a chance to ask two questions of a player of the opposite sex during each of his or her turns. The question cards are divided into six stacks, three pink stacks for the females and three blue stacks for the males. One pink and one blue stack contains questions relating to communication. One pink and one blue stack contains questions relating to sex, and one pink and one blue stack contains questions relating to commitment. An example of a communication question would be "Your date wants to see a movie that you have no desire to see. How do you handle it?". An example of a sex related question would be "You are interested in someone, but are concerned about AIDS. How do you talk to them about it?". An example of a commitment question would be "You are out of town on a trip and run into an old friend. He or she suggest that you should get together. You are in a steady relationship. How do you handle it?". Web site: http://www.delphion.com/details?pn=US05230517__ •

Method of processing aloe leaves Inventor(s): Avalos; Ramiro Estrada (Calle Mendez #501, Jaumave Tam, MX), Danhof; Ivan E. (222 SW. 2nd St., Grand Prairie, TX 75051) Assignee(s): none reported Patent Number: 6,083,508 Date filed: May 19, 1998 Abstract: A process for forming an aloe product from only the leaf residue obtained after filleting aloe leaves having an internal fillet which is removed therefrom. Further, the residue is formed into a slurry by grinding and the aloe product is generated from the slurry. Hand filleting of the aloe leaves to remove the internal fillet may be performed as a preferable alternative to machine filleting. In addition the steps of preparing the aloe product comprises cleansing an aloe leaf before filleting it, separating the slurry formed into a liquid and solids, and further treating the separated liquid to remove laxatives before forming the aloe product. Also a process including all of the above steps may also be performed in order to form the liquid. Excerpt(s): The present invention relates in general to a method for producing aloe products and in particular to a process for utilizing the waste residue from the handfilleted process of aloe leaves to produce an aloe liquid that has calcium, magnesium, malic acid, and total solids in quantities that generally far exceed the parameters of quality established by the International Aloe Science Council. The growing, preparation, and medicinal uses of the yellow sap of the aloe plant were known to the natives of the

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cape region of Africa long before it was made known to the European colonists and long before the early 1770's. The aloe leaf consists of three layers. The first is the thick outer green rind. The second is a viscous, jelly-like mucilage layer into which vascular bundles, attached to the inner surface of the rind, protrude. The third is the fillet proper which has a structural integrity consisting of hexagonal structures containing the fillet fluid. Web site: http://www.delphion.com/details?pn=US06083508__ •

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

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Orally administered pharmaceutical composition for use in gastrointestinal washes, in particular for diagnostic use, or as a cathartic laxative Inventor(s): Castagnola, deceased; Virginio (late of Milan, IT), Frigerio; Giuliano (Bresso, IT), Giorgetti; Enzo (Milan, IT) Assignee(s): Giuliani S.p.A. (Milan, IT) Patent Number: 5,124,144 Date filed: April 11, 1990 Abstract: The invention provides an orally administered pharmaceutical composition for use in gastrointestinal washes, particularly for diagnostic use, or as a cathartic laxative, of the type containing polyethyleneglycol, anhydrous sodium sulphate, sodium bicarbonate, sodium chloride and potassium chloride, characterized by also containing the following components: saccharin, acesulfame-K and a flavoring chosen from the following: mandarin, fresh fruit flavoring.

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Excerpt(s): Preparations consisting of aqueous solutions of polyethyleneglycol and electrolytes, such as, anhydrous sodium sulfate, sodium bicarbonate, sodium chloride and potassium chloride are known for use in the rapid washing of the colon for diagnostic purposes. When a powerful gastrointestinal wash is required, this preparation is generally administered orally in a quantity of about four liters, the composition per liter being typically the following: polyethyleneglycol 59 g, sodium sulphate 5.68 g, sodium bicarbonate 1.68 g, sodium chloride 1.46 g, potassium chloride 0.745 g and water to make up to 1 liter. The advantages of using such preparations are a drastic reduction in the wash time (from 2-3 days to 4-5 hours) and the minimization of water and electrolyte losses. These represent substantial improvements which derive from two essential characteristics of the preparation, namely its isoosmoticity with the physiological liquids, and the balance of the ionic species in solution, so as to compensate the transport mechanisms which regulate gastrointestinal absorption. Web site: http://www.delphion.com/details?pn=US05124144__ •

Phosphosoda buffered saline laxative Inventor(s): Curro; Frederick A. (Emerson, NJ), Parashos; Demetra E. (Flushing, NY), Wood; Thomas G. (Morris Plains, NJ) Assignee(s): Block Drug Company, Inc. (Jersey City, NJ) Patent Number: 5,498,425 Date filed: March 17, 1995 Abstract: A laxative composition in powder or tablet form, having a pleasant odor and taste. The composition comprises sodium bicarbonate, monobasic sodium phosphate in stoichiometric excess, and a pineapple flavoring composition containing also Magnasweet 185 and sodium saccharin. A minor amount of citric or malic acid may be present. Excerpt(s): Purgatives (laxatives or cathartics) are widely used as self medications to satisfy the patient's desire for an altered or more regular bowel habit. They are also used for bowel clearance before radiological examination, surgery, or childbirth. Purgatives used in the treatment of functional constipation include phenolphthalein, senna, cascara, bisacodyl, and sodium picosulfate. Salts of inorganic acids which are not extensively absorbed from the gastrointestinal tract, such as sodium phosphate, retain water in the lumen of the bowel by an osmotic effect and are also used as purgatives. Prolonged use of purgatives may produce excessive loss of water and electrolytes, particularly potassium. A commonly used oral lavage solution is Fleet's concentrated phosphosoda solution which is manufactured according to the National Formulary monograph for Sodium Phosphates Oral Solution. This product, as described in the National Formulary (USP 23/NF 18, p. 1430), contains disbasic sodium phosphate and monobasic sodium phosphate or phosphoric acid in water. The marketed product, which claims a gingerlemon flavor, in fact, has a very strong salty and sour taste. No other flavoring is evident, even as an aftertaste. The present invention provides a laxative composition having a pleasant odor and taste. The composition comprises sodium bicarbonate, monobasic sodium phosphate and a pineapple flavoring, the monobasic sodium phosphate being present in stoichiometric excess. The pineapple flavoring composition contains pineapple flavor, Magnasweet 185 and sodium saccharin. A minor proportion of citric or malic acid may be present. The composition may be in powder dosage form or in the form of a tablet. An excess of monobasic sodium phosphate monohydrate is used to react with a calculated amount of sodium bicarbonate so that with the addition

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of water the amount of dibasic sodium phosphate required by the NF Monograph for Sodium Phosphate Oral Solution is produced. The reaction product is a buffer system of monobasic sodium phosphate and dibasic sodium phosphate. A non-gas producing powder pineapple flavoring formula is added. All components are in powder form and are mixed well together, so that a homogeneous mixture ensures before the addition of water. The final solution has a pleasant odor and taste. Web site: http://www.delphion.com/details?pn=US05498425__ •

Plastic container Inventor(s): Mattheis; Harley H. (Verona, NJ), Potter; Edward J. (Madison, OH) Assignee(s): Ethyl Development Corporation (Baton Rouge, LA) Patent Number: 4,098,430 Date filed: May 11, 1976 Abstract: An integrally formed, one-piece, generally rectangular, plastic container particularly adapted for holding medicines is disclosed. The container includes a generally rectangular bottom section which is connected to a rectangular top section by means of an integrally formed, flexible, plastic hinge at the rear of the two sections. In the closed position, the top section overlies the bottom section and latch means lock the two sections together. The closed container requires that equal pressure be applied to the rear corners thereof in order to disengage the latch means. The container provides a substantially childproof safety closure for tableted medicines such as aspirin, laxatives, cold tablets, prescription drugs, etc. Excerpt(s): This invention relates to a one-piece, integrally formed, generally rectangular, plastic box particularly suited for packaging medicines. Many medicines such as aspirin have conventionally been packaged in generally rectangular, two-piece, metal containers having a top rectangular section which is hingedly connected to a rectangular bottom section. Earlier boxes utilized a conventional pinned hinge arrangement at the rear thereof to join the two components together. More recent twopiece boxes are connected by means of matching projections and recesses provided on each sidewall of the box slightly forward of the rear thereof (see U.S. Pat. No. 2,906,428). These boxes are opened by applying pressure to the rear of the box. Recent FDA regulations will require that aspirin tablets and a number of items be packaged in special containers which have "childproof" features. These containers must not be openable by children under a certain age in a certain number of attempts to open the containers. Satisfactory closures have been developed for bottle-type containers for aspirin and prescription drugs and other items which may be potentially dangerous to children. However, difficulty has been encountered in producing a satisfactory rectangular, two-piece, hinged, conventional container for packaging tablets. The problem has primarily been one of developing a container which has a consistent opening pressure, such that only pressure applied by an adult can open the container. Erratic opening pressures utilizing the conventional engaging means for the closure, i.e., the projection on the front of the lower portion of the container which is engaged in a recess in the front wall of the upper portion of the container, together with the difficulty in producing the recesses and protrusions which form the hinge mechanism of the container, have prevented the conventional metal tablet box from qualifying as a childproof container. Web site: http://www.delphion.com/details?pn=US04098430__

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Process for obtaining laxative compounds from senna drugs Inventor(s): Hietala; Pentti (Helsinki, FI) Assignee(s): Dr. Madaus & Co. (Cologne, DE) Patent Number: 4,595,592 Date filed: November 28, 1984 Abstract: The present invention provides a process for obtaining laxative compounds from senna drug, wherein(a) the senna drug is extracted with aqueous methanol by countercurrent percolation and the extract concentrated at a temperature of.ltoreq.50.degree. C. until the methanol has been completely removed from the extract;(b) the extract obtained is purified by continuous liquid-liquid extraction with an organic solvent;(c) the refined material (raffinate) obtained is transferred to a crystallization apparatus, acidified, while stirring, to a pH of 1.5 to 2.0, seeded with sennoside crystals, left to crystallize while stirring and the crystalline crude sennoside obtained separated off;(d) whereafter, the crude sennoside are, if desired, recrystallized and optionally converted with a pharmacologically compatible base into a pharmacologically compatible salt. Excerpt(s): The present invention is concerned with a process for obtaining laxative compounds from senna drug. Senna drug consists of the dried leaves and pods of the senna plant, for example, of Indian senna (Cassia angustifolia) and of Egyptian senna (Cassia acutifolia). The laxative action of the senna drug is due to a chemical compound, namely, the sennoside. The laxative-active substances in the senna drug are bimolecular glycoside derivatives of the two anthracene compounds rhein and aloe-emodin. The most important are sennosides A, B, A.sub.1, C and D. Sennosides A, B and A.sub.1 are bis-glucosylrhein anthrones and sennosides C and D are glycosylrhein-glycosyaloeemodin dianthrone compounds. Web site: http://www.delphion.com/details?pn=US04595592__

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Sugar-free dry mix cellulose ether compositions as bulk laxatives Inventor(s): Collier; Julie L. (Indianapolis, IN), Phadke; Deepak S. (Olathe, KS) Assignee(s): Merrell Dow Pharmaceuticals Inc. (Cincinnati, OH) Patent Number: 5,266,334 Date filed: July 29, 1992 Abstract: Water-dispersible sugar-free powdered, bulk laxative compositions containing cellulose ethers as the active agent are disclosed. These bulk laxative compositions form smooth, palatable dispersions in water which dispersions contain a therapeutically effective amount of the cellulose ether. Excerpt(s): This invention relates to sugar-free, dry mix cellulose ether bulk laxative compositions. It has been long known that cellulose ethers, such as carboxymethylcellulose and methylcellulose are effective bulk laxatives. The cellulose ethers relieve constipation by increasing the bulk of the stool, increasing the water content of the stool, and it is believed, by a lubricating effect on the stool. Previously, cellulose ethers have been administered as bulk laxatives in the form of tablets, powders, and suspensions in highly concentrated sugar solutions. Each of these methods of administration has significant disadvantages which have limited the acceptance of these products by consumers.

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Web site: http://www.delphion.com/details?pn=US05266334__

Patent Applications on Laxatives 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 laxatives: •

Effervescent laxatives Inventor(s): Daggy, Bruce P.; (Slough, GB), Mandel, Kenneth G.; (Parisppany, NJ) Correspondence: Glaxosmithkline; Corporate Intellectual Property - Uw2220; P.O. Box 1539; King OF Prussia; PA; 19406-0939; US Patent Application Number: 20020085990 Date filed: February 7, 2002 Abstract: The present invention is directed to a novel osmotic/effervescent system for the treatment of constipation and fecal impaction in a human or mammal in need thereof. Excerpt(s): The present invention is directed to a novel over-the-counter (OTC) laxative as an improved, replacement therapy to current stimulant laxatives. Within the next 2 to 3 years, the Food and Drug Administration (FDA) appears likely to discontinue OTC approval of several current stimulant laxatives. Over the last decade, positive carcinogenicity and/or genotoxicity results have resulted in FDA banning danthron (mid-1980's) and in 1997, the FDA delisted phenolphthalein as an OTC laxative due to safety issues. Specifically, in June 1998, the FDA has continued to pressure the OTC stimulant laxative category, reclassifying remaining approved stimulants: senna, cascara, aloe, bisacodyl, from Category I (safe and effective) to Category III (more data needed), and requiring manufacturers to provide updated carcinogenicity and genotoxicity evaluations for these laxative actives. Failure to meet this mandate, and/or prove safety will result in further delisting of laxative actives from the tentative final monographs (TFM), (Fed. Reg. 63: 33592-33595, Jun. 19, 1998). Indeed, in a recent review of scientific literature, van Gorkom et al., concluded that anthranoid laxatives, which include the active moieties in senna extracts, and the chemical laxatives phenolphthalein bisacodyl, can have a potential role in both promotion and initiation of tumorgenesis, and may be associated with increased risk for colorectal cancer (van Gorkom, B. A. P.; de Vries, E. G. E.; Karrenbeld, A.; Kleibeuker, J. H. Anthranoid laxatives and their potential carcinogenic effects. Alimentary Pharmacology & Therapeutics, Vol. 13: pp. 443-452, 1999. Hence the potential for further delistings are strong. Hence, there is a strong potential for dramatic change to this segment of the OTC laxative market over the next several years. If the events which followed the FDA action to ban phenolphthalein recur, any FDA action will be followed by similar delisting in other countries. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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This has been a common practice outside the United States prior to December 2000.

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Herbal laxative preparation Inventor(s): Babu, Uddagiri Venkanna; (Karnataka, IN), Mitra, Shankar Kumar; (Karnataka, IN), Ranganna, Marikunte Venkata; (Karnataka, IN) Correspondence: Stephan A. Pendorf; Pendorf & Cutliff; P.O. Box 20445; Tampa; FL; 33622-0445; US Patent Application Number: 20020150639 Date filed: February 12, 2001 Abstract: A laxative/medicinal preparation obtained of a selective bioactive extract from the rhizomes and roots of PICRORRHIZA KURROA and its method for manufacture and also to a method for treatment of human beings for relieving constipation using the same. In particular the laxative preparation comprises bioactive chloroform or methanolic extract of rhizomes or roots of Picrorrhiza Kurroa and optionally pharmaceutically acceptable carrier thereof. Preferably, the laxative preparation comprises 50 to 500 mg preferably 50 to 250 mg of bioactive chloroform extract of rhizomes or roots of Picrorrhiza Kurroa or 50 to 500 mg of bioactive methanolic extract of rhizomes or roots of Picrorrhiza Kurroa in a pharmaceutically acceptable form with or without a pharmaceutically acceptable carrier thereof. The process involves selective extraction of the active from rhizomes or roots of Picrorrhiza Kurroa using either methanol or chloroform as the selective solvents. The laxative preparation is gentle, safe and effective, free of undesirable side effects and capable of relieving severe constipation. Importantly serves as a herbal laxative for humans on a commercial scale. The laxative can be administered in various dosage forms as may be applicable. Excerpt(s): The present invention relates in general to a laxative preparation obtained of a selective bioactive exact from the rhizomes and roots of PICRORRHIZA KURROA and its method for manufacture and also to a method for treatment of human beings for relieving constipation using the same comprising administering the laxative preparation in selective suitable pharmaceutical dosage forms to human beings and other nonhuman mammals. One of the most commonest digestive problems encountered amongst human beings, particularly amongst children and aged people, is constipation, which usually occurs due to abnormal motility pattern in the colon and thus, delayed propulsion of the intestinal contents. It also occurs due to weak peristaltic movements or defecation reflex leading to hindrance in propagation. Laxatives known to be used for treatment of constipation include synthetic chemical compounds such as phenolphalein, bisacodyl (diphenyl methane laxatives), milk of magnesia and the like. These laxatives, although effective, have been found to exhibit undesirable side effects, the commonest of which are abdominal pain, cramps, nausea, skin rash, intestinal and rectal bleeding. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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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

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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 •

Laxative composition Inventor(s): Burruano, Brid T.; (King of Prussia, PA), Jacobs, Steven A.; (Hatfield, PA), Le Storti, Anthony J.; (Doylestown, PA), Li, Shun Por; (Lansdale, PA), McNally, Gerard P.; (Berwyn, PA), Mertzman, Michael E.; (New Jersey, PA), Pendley, Charles E. II; (Abington, PA), Rainey, Nancy B.; (Villanova, PA), Wynn, David W.; (Abington, PA) Correspondence: Audley A. Ciamporcero JR.; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20020071872 Date filed: August 8, 2001 Abstract: The present invention provides a composition comprising a) a laxative selected from the group consisting of bisacodyl and enteric coated vanilloid compounds; and b) simethicone in an amount effective to enhance the efficacy of the laxative. The simethicone enhances the transit of the laxatives through the small bowel. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/390,813, filed Sep. 7, 1999, which is hereby incorporated by reference. The present invention relates to a laxative composition, more particularly a laxative composition containing a therapeutic amount of simethicone or dimethicone. Laxative compositions are typically categorized by the mechanism in which they work, such as bulk, saline, stool softener, lubricant, or stimulant as per the U.S. Food and Drug Administration's

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monograph, Laxatives, Martindale, page 1070; or Goodman and Gilman page 914. Bulk laxatives contain materials such as psyllium, cellulose, polycarbophil, bran, karaya and malt soup extract. Saline laxatives, such as magnesium, hydroxide, sulfate, phosphate, and citrate salts act by drawing water into the intestines. Stool softeners include docusate salts and mineral oils. Lubricant laxatives include mineral oil, and certain digestible plant oils. Lubricants coat the fecal contents, preventing excess absorption of water in the colon. Stimulants include bisacodyl, cascara sagrada, senna, aloe, castor oil and dehydrocholic acid. Stimulant laxatives work to increase intestinal motility by either increasing peristaltic activity as a result of local irritation, or by selective stimulation of the nerves, which activate intestinal smooth muscle. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Non-fermented osmotic laxative and method for treating and preventing colorectal cancers Inventor(s): Corpet, Denis; (Toulouse, FR), Parnaud, Geraldine; (Baixas, FR), Tache, Sylviane; (Leguevin, FR) Correspondence: Schnader Harrison Segal & Lewis; 36th Floor; 1600 Market Street; Philadelphia; PA; 19103; US Patent Application Number: 20010051659 Date filed: April 18, 2001 Abstract: Use of a non-fermented osmotic laxative as an active agent for preparation of a medicinal product for treating and/or preventing colon and/or rectum cancers. A method of treating or preventing colon or rectum cancer comprising administering to a mammal a therapeutically effective amount of a non-fermented osmotic laxative. Excerpt(s): This is a continuation of International Application No. PCT/FR99/01065, with an international filing date of May 5, 1999, which is based on French Patent Application No. 98/13450, filed Oct. 27, 1998, and French Patent Application No. 99/03240, filed Mar. 16, 1999. This invention concerns the prevention and treatment of adenomas and cancers of the colon and rectum. These tumors, in non-smokers, are the leading cause of cancer deaths. The treatments currently available are based on surgical excision of the tumors, with adjunct chemotherapy, using 5-Fluorouracil, for example. These treatments have numerous drawbacks among which particular mention may be made of the high failure rate (40 % survival rate after five years), the high cost for public funds and considerable patient suffering. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Substituted norbornylamino derivatives, processes for their preparation, their use as medicaments or diagnostics, and a medicament comprising them Inventor(s): Heinelt, Uwe; (Wiesbaden, DE), Jansen, Hans-Willi; (Niederhausen, DE), Kleemann, Heinz-Werner; (Bischofsheim, DE), Lang, Hans-Jochen; (Hofheim, DE), Schwark, Jan-Robert; (Kelkheim, DE), Wirth, Klaus; (Kriftel, DE) Correspondence: Finnegan, Henderson, Farabow,; Garrett And Dunner; Franklin Square BLDG., Suite 700; 1300 I Street, N.W.; Washington; DC; 20005-3315; US Patent Application Number: 20010023257 Date filed: December 12, 2000 Abstract: The application discloses substituted norbornylamino derivatives, processes for their preparation, their use as medicaments or diagnostics and a medicament comprising themSubstituted norbornylamino derivatives having exo-configured nitrogen and an endo-fused five-membered ring of the formula I, or having exoconfigured nitrogen and an exo-fused five-membered ring of the formula I a 1in which R1, R2, R3, R4, R5, A, B, S1, and S2 are as defined in the claims, are highly suitable for use as antihypertensive agents, for reducing or preventing ischemically induced damage, for use as medicaments for surgical interventions for the treatment of ischemias of the nervous system, of stroke and cerebral edema, of shock, of impaired respiratory drive, for the treatment of snoring, as laxatives, as agents against ectoparasites, for the prevention of the formation of biliary calculus, as antiatherosclerotics, as agents against late diabetic complications, carcinomatous disorders, fibrotic disorders, endothelial dysfunction, and organ hypertrophies and hyperplasias.They are inhibitors of the cellular sodium/proton antiporter. They have an influence on serum lipoproteins and can therefore be used for the prophylaxis and regression of atherosclerotic changes. Excerpt(s): except for benzyl(octahydro-4,7-methanoinden-5-yl)amine, and their pharmaceutically acceptable salts or trifluoroacetates. except for benzyl(octahydro)-4,7methanoinden-5-yl)amine, and their pharmaceutically acceptable salts or trifluoroacetates. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Water containing soluble fiber Inventor(s): Stillman, Suzanne Jaffe; (Los Angeles, CA) Correspondence: Reed Smith Crosby Heafey Llp; 1901 Avenue OF The Stars, Suite 700; Los Angeles; CA; 90067; US Patent Application Number: 20030211201 Date filed: April 2, 2003 Abstract: A water-like fluid containing safe water and a significant quantity of soluble dietary fiber. The resulting solution is generally optically clear and has physical properties similar to potable water. The fluid is intended as a replacement for bottled, or other water, as a means to ensure proper hydration. Depending on the soluble fiber used the fluid is either non-caloric or extremely low in calories. The amount of soluble fiber is adjusted to a specific amount of water so that consumption of an adequate amount of fluid ensures hydration (e.g., eight 8 oz. glasses per day) will also providing an optimal amount of dietary fiber. This is particularly valuable in stressed situations where the diet may not provide adequate fiber without supplementation. The constant

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metered supply of fiber provided throughout the day is preferable to, and more convenient than, "bolus" administration of fiber through laxatives, etc. Additionally, the constant presence of soluble fiber in the digestive tract provides the known beneficial effects of moderating the postprandial increase in blood glucose, modulating serum lipid levels, and suppressing appetite. Excerpt(s): The present Application is a Continuation-in-Part of the U.S. patent application Ser. No. 09/510,400 filed Feb. 22, 2000, entitled "FIBER-WATER-WATER CONTAINING SOLUBLE FIBER," the contents of which are incorporated herein by reference in its entirety. The present application concerns generally components of the human diet and more specifically water and fiber. Many of the major problems in human health revolve around which dietary components are truly essential for animal and human health and which components are merely hyped by various companies to sell product. A related problem is that of the accuracy of information regarding the appropriateness of a given food, nutrient or nutraceutical for a given individual. Certainly the "one size fits all" scenario is untrue when it comes to pharmaceuticals and nutrition. Further, the Federal Drug Administration has very little control over dietary supplements so that companies compete in making claims and launching new products, which may or may not be helping humans or animals that consume the products. New information constantly comes forth warning of potential interactions between herbal supplements, ethical pharmaceuticals and various disease states. The present inventor is concerned with providing a composition that can be extremely beneficial to humans and animals with few, if any, dangers or drawbacks. In the following description consumption by humans should also be taken to include consumption by domestic animals--primarily dogs and cats. While many of the concepts discussed are applicable to other animals, the digestive systems of herbivores, particularly ruminates, varies tremendously from that of humans. Therefore, the thrust of the present invention is towards carnivores and omnivores whose digestive systems more closely resemble those of humans. One of the conundrums of human health is that dietary components, which may appear mundane are actually incredibly essential. One such vital component that is frequently overlooked, or given insufficient importance, is water. Although water is not metabolized, it is absolutely essential for metabolism. A majority of the weight of the body is water which serves as the solvent for the chemical reactions of life. Many living cells are more water than anything else. The various nutrients needed for cellular growth and survival enter the cells dissolved in water. After metabolism, the waste products are carried away by water, and death can occur in as little as three to five days without water. 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 laxatives, 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 “laxatives” (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 laxatives.

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You can also use this procedure to view pending patent applications concerning laxatives. 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 LAXATIVES Overview This chapter provides bibliographic book references relating to laxatives. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on laxatives 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 “laxatives” (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 laxatives: •

101 Medication Tips for People with Diabetes Source: Alexandria, VA: American Diabetes Association. 1999. 122 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400329. Order number 483301. Summary: This book answers 101 of the most commonly asked questions about diabetes and medications to help readers become active members of their health care team, maximize their diabetes management, and stay well. Questions in chapter one provide general information on medications used to treat diabetes. Chapter two focuses on how to get the most out of oral medications. The third chapter deals with common side effects of oral medications, including gastrointestinal and liver problems, weight gain, lactic acidosis, and hypoglycemia. Questions in chapter four provide general

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information on the use of insulin in type 2 diabetes. This is followed by a chapter that explains how to get the most out of insulin therapy. Chapter six identifies the common side effects of insulin, including weight gain. Questions in the next chapter deal with the meditations used to treat complications, including nonprescription analgesics, tricyclic antidepressants, capsaicin cream, angiotensin converting enzyme inhibitors, laxatives, and calcium channel blockers. This is followed by chapters that answer questions about the effect of medications on diabetes; the use of nonprescription medications such as aspirin, cold and allergy medications, herbal supplements, weight loss products, and vitamin and mineral supplements; and common drug interactions that occur with diabetes medications. The final chapter answers miscellaneous questions. The book also includes a glossary and an index.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “laxatives” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “laxatives” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “laxatives” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Laxatives: A Practical Guide by Francesco Capasso, Timothy S. Gaginella; ISBN: 3540750371; http://www.amazon.com/exec/obidos/ASIN/3540750371/icongroupinterna

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Mental Laxatives for a Constipated Mind by Donald E. Pederson, Reverend Donald E. Pederson; ISBN: 0966581903; http://www.amazon.com/exec/obidos/ASIN/0966581903/icongroupinterna

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Overuse hazardous : laxatives rarely needed (SuDoc HE 20.4010/a:L 45/2) by Mike Cummings; ISBN: B00010A0VS; http://www.amazon.com/exec/obidos/ASIN/B00010A0VS/icongroupinterna

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The Natural Laxative Cookbook by Edith White (Contributor), et al; ISBN: 0806913444; http://www.amazon.com/exec/obidos/ASIN/0806913444/icongroupinterna

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US LAXATIVES REPORT 2002 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B00006SLFI; http://www.amazon.com/exec/obidos/ASIN/B00006SLFI/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “laxatives” (or synonyms) into the search box, and select “books only.”

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From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:7 •

Effectiveness of laxatives in adults. Author: University of York. NHS Centre for Reviews; Dissemination.; Year: 2001; York [England]: University of York, NHS Centre for Reviews and Dissemination; [London]: Published in association with Royal Society of Medicine Press, c2001

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

Approach to the Patient with Constipation Source: in Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 894-910. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-6423. Fax: (301) 223-2400. Website: www.lww.com. PRICE: $289.00. ISBN: 781728614. Summary: Although constipation is a common gastrointestinal complaint in clinical practice, some uncertainty exists as to the precise definition of the term. This lack of objectivity has contributed to the controversy concerning the incidence, pathogenesis, and treatment of constipation and defecation disorders. Furthermore, the availability of over-the-counter laxatives and their long-term and often inappropriate use may result in laxative dependence, may damage the bowel, and may lead to problems where none previously existed. This chapter on the approach to patients with constipation is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. Topics include definitions, the socioeconomic and medical consequences of constipation, pathophysiological considerations, evaluation of constipation, diagnostic strategies, and treatment options. The author notes that there is general agreement that selecting treatment strategies requires understanding of the whole patient, fiber supplements should be added to the diet, establishing proper toileting arrangements can help certain patients, and long-term use of stimulant laxatives should be judicious. Surgery has a role in selected patients

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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with severe constipation in whom abnormal bowel function can be ameliorated by operative intervention. 2 figures. 5 tables. 185 references. •

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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Motility Disorders in the Elderly Source: in Gelb, A.M., ed. Clinical Gastroenterology in the Elderly. New York, NY: Marcel Dekker, Inc. 1996. p. 115-132. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701-5185. (800) 228-1160 or (914) 796-1919. Fax (914) 796-1772. E-mail: [email protected]. Website: www.dekker.com. PRICE: $135.00 plus shipping and handling. ISBN: 0824793986. Summary: Gastrointestinal motility disorders are common and often unrecognized in older people. This chapter on motility disorders is from a textbook that offers an up to date reference source on geriatric gastroenterology. The author notes that aging in itself has little effect on gut motility, although there is some evidence that there may be minor changes in gastric emptying. Motility conditions can be chronic and difficult to treat, with successful management often based on a good relationship between physician and patient. The author first reviews the physiology of gastric motility and then discusses disorders of gastric emptying, including gastroparesis. The next section covers small intestine motility and then abnormalities of intestinal motility, which can lead to constipation, diarrhea, pseudoobstruction, and malabsorption. The final section considers the colon and its associated motility disorders, notably constipation, fecal impaction, gas, and chronic diarrhea. Colonic motility varies with eating; i.e., there is increased activity after meals, particularly in the sigmoid colon. The author emphasizes the importance of a thorough workup for accurate diagnosis of constipation problems. When dietary measures and fiber supplements are not effective in treating constipation, laxatives will usually be needed. One of the goals of treating constipation is avoiding fecal impaction. For each condition, the author reviews symptoms, etiology, complications, and patient care management, including drug therapy and surgery. 19 references.

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Melanosis Coli Source: in Stein, E. Anorectal and Colon Diseases: Textbook and Color Atlas of Proctology. New York, NY: Springer-Verlag. 2003. p. 307-309. Contact: Available from Springer-Verlag New York, Inc. 175 Fifth Avenue, New York, NY 10010. (800) SPRINGER or (212) 460-1500. Fax (800) 777-4643 or (201) 348-4505. Email: [email protected]. Website: www.springer-ny.com. PRICE: $199.00 plus shipping and handling. ISBN: 3540430393. Summary: Melanosis coli is a relatively common brown-black irregular pigmentation of the bowel mucosa, first described in 1829. Women are far more often affected than men; most patients are middle-aged or elderly. Melanosis coli is usually the result of long term use of laxatives containing anthraquinone compounds. Anthraquinones are also found in rhubarb, cholagogues (agents stimulating bile flow), diet pills and diet teas. This chapter on melanosis coli is from a multidisciplinary reference book and atlas that covers all aspects of anorectal and colon disease (proctology). Topics include etiology, clinical features, diagnosis, therapy, and prognosis. The chapter includes full-color and black-and-white illustrations and photographs, to support the heavily-visual aspects of proctology. 7 figures. 20 references.

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Pill-Induced Esophagitis Source: in Brandt, L., et al., eds. Clinical Practice of Gastroenterology. Volume One. Philadelphia, PA: Current Medicine. 1999. p. 91-96. 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: Numerous medications injure the esophagus by a variety of means. This chapter on pill induced esophagitis is from a textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. Some drugs, including immunosuppressive agents, xanthines, and calcium channel blockers, injure the esophagus because of their systemic side effects; nonsteroidal antiinflammatory drugs predispose to reflux damage through incompletely explained mechanisms; and bulk laxatives and sucralfate occasionally form obstructing esophageal bezoars (a concretion of hair or vegetable fibers). Other potentially caustic medications taken in pill form may fail to transit the esophagus, dissolve, and cause local esophageal injury. This chapter focuses on this last type of injury. Most pill induced esophageal injuries occur in patients with normal esophageal structure and function. The presentation is dominated by pain and may be so severe as to prevent adequate oral hydration. No diagnostic procedure is usually necessary; endoscopy is indicated when symptoms are gradual in onset, atypical, or persistent. The first step in treatment is to stop taking the offending pill, if possible, thus preventing exacerbation of the injury. Pain subsides within days to weeks in most uncomplicated cases of pill induced esophageal injury. Esophageal perforation and hemorrhage are rare but life threatening complications that require immediate specific, aggressive treatment. The author reviews injuries caused by specific pills, including antimicrobial and antiviral pills, antiinflammatory pills, potassium chloride, quinidine, alprenolol, and ferrous sulfate or succinate, alendronate and pamidronate pills, and sustained release pills. A few simple steps can reduce the incidence of pill induced esophagitis: all oral medications taken in pill form should be taken with at least 120 mL of fluid and patients

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should remain upright for at least 10 minutes after swallowing pills. 5 figures. 4 tables. 23 references. •

Anorectal Diseases of the Elderly Source: in Gelb, A.M., ed. Clinical Gastroenterology in the Elderly. New York, NY: Marcel Dekker, Inc. 1996. p. 101-113. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701-5185. (800) 228-1160 or (914) 796-1919. Fax (914) 796-1772. E-mail: [email protected]. Website: www.dekker.com. PRICE: $135.00 plus shipping and handling. ISBN: 0824793986. Summary: The anorectal area increases in importance as a person gets older. A fixation on normal bowel habits leads older people to perform many ritual acts such as taking oral laxatives as well as using various types of enemas and suppositories. Many conditions result from the use and abuse of these preparations. In addition, certain diseases tend to become more prevalent as people age. This chapter on anorectal diseases is from a textbook that offers an up to date reference source on geriatric gastroenterology. Topics include anorectal and anorectal physiology, anal incontinence (fecal incontinence), rectal prolapse (procidentia), hemorrhoids, fissure in ano (anal fissures), fistula in ano, anorectal inflammation, and benign neoplasms of the rectum, including hyperplastic and adenomatous polyps. The management of older patients with fecal incontinence is based on treating the initiating cause; alleviating diarrhea and constipation will often eliminate the need for more aggressive care such as surgery. The predisposing factors in rectal prolapse are straining associated with intractable constipation or diarrhea, numerous past pregnancies, pelvic operations, and neurologic diseases. Constipation can also lead to hemorrhoid problems, so treating diarrhea, constipation, and intestinal inflammation may ease and resolve hemorrhoids without surgical intervention. Causes of anal fissures in the elderly population include constipation, diarrhea, straining at stool, inflammatory bowel disease, and local trauma such as enema abuse. Again, treating these causes can resolve the fissure. However, treatment of a fistula in ano most often requires surgery, since medical therapy alone rarely leads to healing. 11 figures. 2 references.

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Medications Used To Treat Complications of Diabetes Source: in Carlisle, B.A.; Kroon, L.A.; Koda-Kimble, M.A. 101 Medication Tips for People with Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 66-75. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400329. Order number 483301. Summary: This chapter answers questions about the meditations used to treat diabetes complications, including nonprescription analgesics, tricyclic antidepressants, capsaicin cream, angiotensin converting enzyme (ACE) inhibitors, laxatives, and calcium channel blockers. Nonprescription analgesics, antidepressants, and narcotic analgesics can be used to treat the pain associated with diabetic neuropathy. Capsaicin cream, a chemical found in hot chili peppers, can be applied to the feet to relieve pain. ACE inhibitors can be used to treat microalbuminuria, an early sign of kidney damage. The symptoms of gastroparesis, a condition that affects the nerves of the stomach, can be treated with metoclopramide, cisapride, and erythromycin. These medications increase the stomach's ability to contract and aid in digestion. Constipation can be treated by increasing the

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amount of fluid and fiber in a person's diet. Laxatives may also be useful in treating constipation. Men who have diabetes and experience impotence can use the medications alprostadil and sildenafil to maintain an erection. People who have diabetes and high blood pressure can be treated with ACE inhibitors, diuretics, and calcium channel blockers. Angiotensin receptor II antagonists and calcium channel blockers can be used to treat kidney disease. People who have diabetes should take any medications their doctor prescribes for other conditions, such as high blood pressure, heart disease, high cholesterol or triglycerides, obesity, and insulin resistance. •

Digestive System: Keeping it Efficient Source: in Mattox, R. Fifty and Holding: Slow the Aging Process. Winter Haven, FL: Fifty and Holding. 1992. p. 115-117. Contact: Available from Fifty and Holding. P.O. Box 917, Winter Haven, FL 33882. PRICE: $7 plus $3 shipping and handling. Summary: This chapter is from a book that explains the diseases that are affected by nutrition and exercise, as well as the rest required during the aging process. The author considers the digestive system and presents suggestions for keeping it at peak efficiency. Specific topics include the role of dietary fiber; problems with constipation; the importance of exercise; limiting the use of antacids and laxatives; diarrhea; flatulence; gastritis; and diverticular disease. The chapter concludes with a list of warning symptoms for problems associated with the digestive system. The book is written in clear, easy-to-understand language and designed for an audience of people who are 50 years of age or older.

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Crohn's Disease and Ulcerative Colitis Source: in King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 99-114. Contact: Available from Mayo Clinic Health Information. 5505 36th Street, SE, Grand Rapids, MI 49512. (800) 291-1128. Website: www.mayoclinic.com. PRICE: $14.95 plus shipping and handling. ISBN: 1893005046. Summary: This chapter on Crohn's disease and ulcerative colitis (the two most common inflammatory bowel diseases, IBD) is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of IBD, including diarrhea, abdominal pain and cramping, blood in the stool (feces), fatigue, reduced appetite, weight loss, and fever. The authors note that although these diseases often cannot be cured, they can be treated. There are several therapies that may drastically reduce the patient's symptoms, and possibly even bring about a long term remission. The chapter outlines the differences between the two diseases (Crohn's disease can strike anywhere from the mouth to the anus; ulcerative colitis is typically limited to the colon and rectum), reviews theories about the causes of these problems, and offers classification systems to determine if the disease is mild, moderate or severe. Diagnostic tests used to confirm the presence of IBD include blood tests, X rays, and colonoscopy (which can include biopsy). Medications can effectively reduce symptoms in most people with IBD; drugs used include antiinflammatory drugs (sulfasalazine, mesalazine, olsalazine, corticosteroids), immunosuppressants (such as

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azathioprine, methotrexate, and cyclosporine), antibiotics (notably metronidazole and ciprofloxacin), nicotine patches, antidiarrheals, laxatives, pain relievers, iron supplements, and vitamin B12 injections. The chapter concludes with suggestions for lifestyle modifications that can help people cope with IBD and a section explaining the surgical options that may be used for IBD that is not responsive to other treatments. 1 figure. •

Toileting: Encopresis Source: in Schroeder, C.S., and Gordon, B.N. Assessment and Treatment of Childhood Problems: A Clinician's Guide. New York, NY: Guildford Press. 1991. p. 176-200. Contact: Available from Guildford Press. 72 Spring Street, New York, NY 10012. (212) 431-9800. Fax (212) 966-6708. PRICE: $42.00. ISBN: 0898625653. Summary: This chapter on encopresis (fecal incontinence) is from a clinical guide to the assessment and treatment of childhood problems. The authors briefly review the definition and prevalence of encopresis, and then present recommended diagnostic and therapeutic procedures. Topics include assessment tools, information sharing with the parents and child, physical intervention (laxatives and cathartics), development of toileting skills, environmental interventions, changing the consequences of the behavior, family dynamics, retentive encopresis, diarrhetic encopresis, and manipulative encopresis. The chapter concludes with a detailed case study of an 8-year-old child with encopresis. 5 figures. 1 table.

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Approach to the Patient with Drug or Alcohol Dependency Source: in Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 1107-1119. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-6423. Fax: (301) 223-2400. Website: www.lww.com. PRICE: $289.00. ISBN: 781728614. Summary: This chapter on the approach to patients with drug or alcohol dependency is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. The authors of this chapter are concerned with the neurobiology and clinical presentations of traditional drugs of abuse, such as alcohol, sedative-hypnotics, narcotics, stimulants and hallucinogens, and cannabis, as well as tobacco, laxatives, diuretics, and anabolic steroids. Topics covered include drugs of abuse and brain reward systems, principles of treatment, individual drugs of abuse, bulimia and substance abuse, diagnosis of patients with suspected substance abuse, and management of acute drug overdose or toxicity. 1 figure. 8 tables. 162 references.

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Digestive System Source: in Hagan, P.T., ed. Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems. New York, NY: Kensington Publishers. 1999. p. 56-67. 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: $16.95 plus shipping and handling. ISBN: 0962786578.

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Summary: This chapter on the digestive tract is from a self care handbook on everyday health problems. Published by the Mayo Clinic, this handbook offers readers a guide to symptoms, diagnosis, and treatment (particularly self care strategies and tips for handling these problems in children) for common problems. The chapter begins with a brief overview of the anatomy and physiology of the digestive system. Following are discussions of abdominal pain, colic, constipation, diarrhea, excessive gas and gas pains, gallstones, gastritis (burning or sour stomach), hemorrhoids and rectal bleeding, hernias, indigestion and heartburn, irritable bowel syndrome (IBS), nausea and vomiting, and ulcers. Sidebars cover appendicitis, excessive use of laxatives, and a new dual drug treatment for peptic ulcers. The chapter concludes with the address and telephone number for the National Digestive Diseases Information Clearinghouse (NDDIC) for further information. The book is focused on how to prevent illness, how to detect illness before it becomes a serious, costly problem, and how to avoid unnecessary trips to the clinic or emergency room. 7 figures. •

Treating Digestive Tract Disorders Source: in Daly, S., ed. Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corporation. 1996. p. 131-192. Contact: Available from Springhouse Publishing. 1111 Bethlehem Pike, P.O. Box 908, Springhouse, PA 19477. (800) 331-3170 or (215) 646-4670 or (215) 646-4671. Fax (215) 6468716. PRICE: $24.95. ISBN: 0874348218. Summary: This chapter on treating digestive tract disorders is from a consumer reference book on medical treatments. Treatments include drug therapies, including antacids, histamine-2-receptor antagonists, cholinergic blockers, laxatives, antiemetics, and antidiarrheals; surgeries, including esophageal surgery, hernia repair, stomach resection, bowel surgery with ostomy, bowel resection, hemorrhoidectomy, appendectomy, gallbladder surgery, liver transplant, liver resection, portal vein bypass, and parotidectomy; and other treatments, including bowel training, enemas, removal of intestinal contents through a nasal tube, stomach flushing, tube compression of the esophagus and stomach, insertion of a catheter to relieve bile duct obstruction, widening of the bile duct sphincter, and removal of fluid from the abdomen. For each treatment, the text answers these essential questions: Why is this treatment done? When shouldn't this treatment be done? What happens before, during, and after the treatment? What are the side effects or complications of this treatment?

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Managing Constipation Source: in King, B.D. and Harke, J. Coping with Bowel and Bladder Problems. San Diego, CA: Singular Publishing. 1994. p. 149-161. Contact: Available from Singular Publishing Group, Inc. 401 West A Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. PRICE: $18.95. ISBN: 1565930681. Summary: This chapter, from a book in the Coping with Aging Series, a group of books written for men and women coping with the challenges of aging, addresses the management of constipation. The authors focus on three main areas: diet and fluid intake, exercise, and toilet habits. Specific topics in the chapter include the role of dietary fiber; sources of fiber; fiber supplements; fluid intake; the role of regular exercise; toilet habits; and laxative use, including stimulant laxatives, saline cathartics, lubricants, hyperosmotic laxatives, enemas, and suppositories. The authors stress that the simple

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measures of adequate fiber and fluid intake and exercise, as well as good toilet habits, can often eliminate constipation. 4 tables. •

Digestive Tract Source: in Daugirdas, J.T. and Ing, T.S., eds. Handbook of Dialysis. 2nd ed. Boston, MA: Little, Brown and Company. 1994. 623-634. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $37.95. ISBN: 0316173835. Summary: This chapter, from a physician's handbook of dialysis, reviews digestive problems and concerns related to dialysis. Topics include common gastrointestinal symptoms in patients on dialysis, including anorexia, nausea, vomiting, dyspepsia, constipation, and diarrhea; acute abdominal conditions; upper gastrointestinal disease, including gastritis, duodenitis, and peptic ulcer disease; lower gastrointestinal disease, including bleeding, bowel disease, bowel obstruction, and hernia; hemodialysisassociated ascites and cirrhotic ascites; liver disease; and pancreatitis. The chapter also addresses the use of gastrointestinal drugs in dialysis patients, including antihistamines and antacids, antidiarrheal drugs and laxatives, bowel preparation for surgery or diagnostic testing, and drugs for inflammatory bowel disease. 33 references.

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CHAPTER 6. MULTIMEDIA ON LAXATIVES Overview In this chapter, we show you how to keep current on multimedia sources of information on laxatives. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Bibliography: Multimedia on Laxatives The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in laxatives (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on laxatives: •

Laxatives-phenolphthalein [videorecording]: without Temple. Year: 1997; Format: Videorecording; [Atlanta, Ga.: CNN, 1997?]

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Phenolphthalein-laxatives [videorecording]: Dr. Temple on camera. Year: 1997; Format: Videorecording; [United States: s.n., 1997?]

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CHAPTER 7. PERIODICALS AND NEWS ON LAXATIVES Overview In this chapter, we suggest a number of news sources and present various periodicals that cover laxatives.

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

Italy: Inquiry opened on over-the-counter laxatives Source: Reuters Health eLine Date: August 15, 2002

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Italy opens inquiry on over-the-counter laxatives Source: Reuters Medical News Date: August 15, 2002

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FDA to ban use of aloe, cascara sagrada in over-the-counter laxatives Source: Reuters Industry Breifing Date: May 08, 2002

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Laxative use not associated with increased colorectal cancer risk in women Source: Reuters Medical News Date: June 07, 2000

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Polyethylene glycol laxative effective for short-term treatment of constipation Source: Reuters Medical News Date: February 29, 2000

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Biochemical screening for laxative use recommended in anorexic adolescents Source: Reuters Medical News Date: February 29, 2000

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FDA Ban On OTC Sale Of Phenolphthalein-Based Laxatives Proposed; Novartis Halts Ex-Lax Shipments Source: Reuters Medical News Date: September 01, 1997

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FDA Moves to Ban Laxative Ingredient Source: Reuters Health eLine Date: August 29, 1997

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Laxative Pulled: Possible Cancer Link Source: Reuters Health eLine Date: June 04, 1997

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FDA Takes Second Look at Laxative Drug Source: Reuters Health eLine Date: May 01, 1997

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FDA Panel Told That Laxative Ingredient Is Carcinogenic Source: Reuters Medical News Date: May 01, 1997

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Chronic Stimulant Laxative Use Causes Loss Of Haustral Folds In Colon Source: Reuters Medical News Date: October 23, 1996

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FDA Says Common Laxative Ingredients May Be Carcinogenic Source: Reuters Medical News Date: May 22, 1996

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OTC Laxative Ingredient Carcinogenic In Mice Source: Reuters Medical News Date: December 08, 1995 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine.

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Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “laxatives” (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 “laxatives” (or synonyms). If you know the name of a company that is relevant to laxatives, 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 “laxatives” (or synonyms).

Newsletters on Laxatives Find newsletters on laxatives using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “laxatives.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “laxatives” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Constipation: Causes, Treatment and Prevention Source: Intestinal Fortitude. 4(2): 2-3. Summer 1993.

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Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888. Summary: This article, from a newsletter for people with intestinal diseases, reviews the causes, treatment, and prevention of constipation. Topics include the possible causes of constipation, including lifestyle changes, diet, eating habits, bowel habits, medications, laxatives, and exercise; the medical causes of constipation; and psychological disorders. The article concludes with a brief discussion of the role of gastroenterologists who specialize in the evaluation and treatment of intractable constipation. •

Bowel Management Medication Source: Pull-Thru Network News. 2(3): 4-5. Spring 1993. Contact: Available from Greater New York Pull-Thru Network. c/o Scott and Karen Brownlow, 4 Woody Lane, West Port, CT 06880. (201) 221-7530. Summary: This newsletter article provides information for parents about using various bowel management medications in their children. The introduction discusses the problems with differentiating between medications; the variety of medications on the market; how the FDA approves drugs; long-term usage and possible side effects; and using generic products. The remainder of the article is divided into two sections: laxatives and antidiarrheals. The laxative section covers bulk-forming laxatives, hyperosmotic laxatives (saline), lubricants, stimulant (contact) laxatives, and stool softeners. The antidiarrheal sections discusses opiates, polycarbophil, loperamide hydrochloride, aluminum powder (hydrated), bismuth subsalicylate, attapulgite, kaolin, activated charcoal, lactobacillus, and pectin. For each agent discussed, the author provides the brand name of product(s) that include that agent. The article concludes with a list of books and the address and telephone number for the National Digestive Diseases Information Clearinghouse for obtaining additional information.

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 “laxatives” (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 laxatives: •

Constipation: How to Find Relief Without Laxatives Source: Environmental Nutrition. 22(9): 2. September 1999. Contact: Available from Environmental Nutrition, Inc. 52 Riverside Drive, New York, NY 10024-6599. (800) 829-5384. Summary: Constipation is defined as infrequent or difficult bowel movements, typically three consecutive days without a movement. This brief article offers strategies for dealing with constipation without resorting to the use of laxatives. The author notes that, most often, constipation is temporary, triggered perhaps by a change in routine (like travel) and requires no real intervention beyond a cup of prune juice or a bowl of

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bran flakes. The author reviews the causes of constipation, including sedentary habits, diets of processed, low fiber foods, and a tendency to drink too few fluids. Additional contributors to constipation, especially for older people, include muscle weakness, poor dentition (which makes it hard to chew high fiber foods), and certain medications, including antidepressants, antacids, antihistamines, diuretics, opiates, tranquilizers, iron supplements, and calcium supplements. Three sidebars offer practical strategies for coping with constipation, preventing problems, and being cautious with herbal remedies. •

Management of Laxative Abuse in Eating Disorders Source: SCAN'S PULSE. 18(3): 7-8. Fall 1999. Contact: Available from American Dietetic Association. SCAN Office, 90 S. Cascade Avenue, Suite 1230, Colorado Springs, CO 80903. (719) 475-7751. Fax (719) 475-8748. Summary: Health professionals who treat eating disorders eventually encounter clients with anorexia nervosa or bulimia who use laxatives as a method of weight control. This article reviews the management of laxative abuse in patients with eating disorders. Women who abuse laxatives believe that taking laxatives after food consumption prevents the absorption of calories in the intestine. However, studies show that laxative use only decreases caloric absorption by 12 percent, because laxatives primarily exert their effect in the large intestine. In addition to being ineffective in weight control, chronic laxative use is also medically dangerous. Serious problems that may occur include electrolyte and fluid imbalance leading to metabolic acidosis or alkalosis, permanent structural and functional damage to the colon, interstitial renal (kidney) disease, and rectal prolapse. The successful management of chronic laxative abuse requires a team of professionals that includes a physician, nutrition therapist, and psychotherapist. The author reviews the treatment protocol for these patients, which includes adequate dietary fiber and fluids intake, limited consumption of high sodium and gas forming foods, regular exercise, and patient education. During weekly appointments, the nutrition therapist should evaluate the client's compliance with the prescribed treatment plan. The author cautions that discontinuing long term laxative abuse is extremely difficult, and some clients may require inpatient treatment to be successful. Body image issues become predominant as the client experiences severe fluid retention, often in the range of 10 to 20 pounds, until natural diuresis occurs after about 4 to 6 weeks of laxative abstinence. 9 references.

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Laxatives: Overuse Leads to Trouble Source: Mayo Clinic Women's Healthsource. 3(4): 6. April 1999. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This brief newsletter article on the use and overuse of laxatives to treat constipation begins by emphasizing that bowel habits vary widely and that not having a bowel movement every day does not mean a person is constipated. Having bowel movements only three times a week may be perfectly normal. More important, overreliance on laxatives might cause the very problem that is being treated, constipation. The article first helps readers define their own bowel habits and then outlines the complications that frequent use of laxatives can cause, including dependence (a laxative must be used for the person to have a bowel movement), abdominal cramping, nausea and vomiting, bloating, decreased absorption of nutrients, dehydration, diarrhea, weakened intestinal muscles, interference with absorption of

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other medications, damage to the colon, gastrointestinal bleeding, and constipation. The article concludes by reinforcing four strategies that can help readers stay regular: eat regular meals, include high fiber foods in the diet, exercise regularly, and drink 8 to 10 glasses of fluid a day.

Academic Periodicals covering Laxatives Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to laxatives. In addition to these sources, you can search for articles covering laxatives that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical 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 8. 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 laxatives. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with laxatives. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to laxatives: Albendazole •

Systemic - U.S. Brands: Albenza; Eskazole; Zentel http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202668.html

Alosetron •

Systemic - U.S. Brands: Lotronex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500107.html

Antacids •

Oral - U.S. Brands: Advanced Formula Di-Gel; Alamag; Alamag Plus; Alenic Alka; Alenic Alka Extra Strength; Alka-Mints; Alkets; Alkets Extra Strength; Almacone; Almacone II; AlternaGEL; Alu-Cap; Aludrox; Alu-Tab; Amitone; Amphojel; Antacid Gelcaps; Antacid Liquid; Antacid L http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202047.html

Charcoal, Activated •

Oral - U.S. Brands: Actidose with Sorbitol; Actidose-Aqua; CharcoAid; CharcoAid 2000; CharcoAid G; Insta-Char in an Aqueous Base; Insta-Char in an Aqueous Base with Cherry Flavor; Insta-Char Pediatric in an Aqueous Base with Cherry Flavor; Insta-Char Pediatric with Cherry http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202120.html

Cholecystographic Agents, Oral •

Diagnostic - U.S. Brands: Bilivist; Bilopaque; Cholebrine; Oragrafin Calcium; Oragrafin Sodium; Telepaque http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202136.html

Citrates •

Systemic - U.S. Brands: Bicitra; Citrolith; Oracit; Polycitra Syrup; Polycitra-K; Polycitra-K Crystals; Polycitra-LC; Urocit-K http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202144.html

Laxatives •

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202319.html

•

Rectal - U.S. Brands: Bisco-Lax; Ceo-Two; Dacodyl; Deficol; Dulcolax; Fleet Babylax; Fleet Bisacodyl; Fleet Enema; Fleet Enema for Children; Fleet Enema Mineral Oil; Fleet Glycerin Laxative; Fleet Laxative; Sani-Supp; Senokot; Theralax; Therevac Plus; Therevac-SB http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202320.html

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Lithium •

Systemic - U.S. Brands: Cibalith-S; Eskalith; Lithane; Lithobid; Lithonate; Lithotabs http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202330.html

Mebendazole •

Systemic - U.S. Brands: Vermox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202339.html

Niclosamide •

Oral - U.S. Brands: Niclocide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202406.html

Phosphates •

Systemic - U.S. Brands: K-Phos M. F.; K-Phos Neutral; K-Phos No. 2; K-Phos Original; Neutra-Phos; Neutra-Phos-K; Uro-KP-Neutral http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202463.html

Polyethylene Glycol and Electrolytes •

Local - U.S. Brands: Co-Lav; Colovage; Colyte; Colyte-flavored; Go-Evac; GoLYTELY; NuLYTELY; OCL http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202636.html

Potassium Supplements •

Systemic - U.S. Brands: Cena-K; Effer-K; Gen-K; Glu-K; K+ 10; K+ Care; K+ Care ET; K-8; Kaochlor 10%; Kaochlor S-F 10%; Kaon; Kaon-Cl; Kaon-Cl 20% Liquid; Kaon-Cl-10; Kato; Kay Ciel; Kaylixir; K-Dur; K-Electrolyte; K-G Elixir; K-Ide; KLease; K-Lor; Klor-Con 10; Klor-Con 8; Kl http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202473.html

Praziquantel •

Systemic - U.S. Brands: Biltricide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202474.html

Pyrantel •

Oral - U.S. Brands: Pin-X http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202490.html

Thiabendazole •

Systemic - U.S. Brands: Mintezol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202558.html

Vincristine •

Systemic - U.S. Brands: Oncovin; Vincrex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202594.html

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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/.

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 Institute8: •

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/

8

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.9 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:10 •

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

9

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). 10 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “laxatives” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “laxatives” (or synonyms) into the “For these words:” box. The following is a sample result: •

Revisiting IBS: Perspectives for the New Millennium: Special Report Source: New York, NY: McMahon Publishing Group. 2001. 8 p. Contact: Available from Gastroenterology and Endoscopy News. McMahon Publishing Group, 545 W. 45th St., 8th floor, New York, NY 10036 (800) 526-0828. Website: www.mcmahonmed.com. PRICE: $5.00 plus shipping and handling. Summary: Recent discoveries in the field of irritable bowel syndrome (IBS) have important implications for gastroenterologists. Research is underway into functional brain imaging techniques to assess activation of brain regions during visceral stimulation, as well as clinical examinations focusing on the relationship between infection and IBS. This report brings gastroenterologists and primary care practitioners up to date on the current approaches in drug therapy for patients with IBS. The authors explain the use of brain imaging techniques to understand how patients with IBS may be more sensitive to gut stimuli, discuss the theory that an acute outbreak of gastroenteritis may lead to long term chronic IBS, and discuss the latest treatment options that can be use for both IBS and the related abdominal pain and discomfort. Treatments for IBS are targeted to symptoms including abdominal pain, diarrhea, constipation, and bloating. The main choices for patients with pain predominant symptoms include antispasmodics, tricyclic antidepressants, and selective serotonic reuptake inhibitors (SSRIs), and 5HT3 antagonists and 5HT4 agonists. Patients with constipation predominant symptoms would be treated with fiber, laxatives, or 5HT4 agonists; for patients with diarrhea predominant symptoms, opioid agonists, 5HT3 antagonists, and possibly cholestyramine will be used. Each of these treatments is discussed, with the relevant literature briefly reviewed. A posttest is appended, with which readers can qualify for continuing education credits. References are provided in the text of the report.

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The NLM Gateway11 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.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “laxatives” (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 13117 58 923 3 0 14101

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 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.15 Simply search by “laxatives” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists16 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 11

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

12

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). 13 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 14 15

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

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staff.17 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.18 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/.

17

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. 18 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 laxatives 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 laxatives. 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 laxatives. 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 “laxatives”:

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•

Other guides Cancer http://www.nlm.nih.gov/medlineplus/cancer.html Cancer Chemotherapy http://www.nlm.nih.gov/medlineplus/cancerchemotherapy.html Colonic Diseases http://www.nlm.nih.gov/medlineplus/colonicdiseases.html Colorectal Cancer http://www.nlm.nih.gov/medlineplus/colorectalcancer.html Dietary Fiber http://www.nlm.nih.gov/medlineplus/dietaryfiber.html Diverticulosis and Diverticulitis http://www.nlm.nih.gov/medlineplus/diverticulosisanddiverticulitis.html Eating Disorders http://www.nlm.nih.gov/medlineplus/eatingdisorders.html Irritable Bowel Syndrome http://www.nlm.nih.gov/medlineplus/irritablebowelsyndrome.html Nutritional Support http://www.nlm.nih.gov/medlineplus/nutritionalsupport.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 laxatives. 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: •

Laxatives Source: in Sodeman, W.A., Jr. Instructions for Geriatric Patients. Philadelphia, PA: W.B. Saunders Company. 1995. p. 131-132. 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: $38.95. ISBN: 0721643353. Summary: This chapter, from a book of instructions for geriatric patients, provides a basic information sheet on laxatives and the treatment of constipation. The author notes

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that the range of normal frequency of bowel movements is wide, from three bowel movements daily to three times per week; both greater and lesser frequency rates occur in normal people. The author emphasizes that far more significant is a change in one's customary frequency or regularity, or both. Treatment of simple constipation is most effective if it addresses the probable cause of the constipation. Laxative preparations are available in many varieties, including bulk-forming agents, chemical stimulants, contact stimulants, stool softeners, and saline cathartics. All can be effective in stimulating a bowel movement, but only the careful matching of a laxative with the cause of constipation can provide a return to one's normal bowel habit, after which the use of the laxative should be stopped altogether. The information sheet concludes by reminding readers to contact their health care provider if they have any change in bowel habit. The instructions are designed to supplement and reinforce physician instructions to their patients. (AA-M).

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 laxatives. 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. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

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 laxatives. By consulting all of associations listed in

100 Laxatives

this chapter, you will have nearly exhausted all sources for patient associations concerned with laxatives. 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 laxatives. 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 “laxatives” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “laxatives”. 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 “laxatives” (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 “laxatives” (or a synonym) into the search box, and click “Submit Query.”

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103

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.19

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

19

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)20: •

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/

20

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

109

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on laxatives: •

Basic Guidelines for Laxatives Laxative overdose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002586.htm

•

Signs & Symptoms for Laxatives Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Collapse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Coma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm

110 Laxatives

Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Emesis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Flushing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003241.htm Muscle weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm Painful urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Rash Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Thirst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003085.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm •

Diagnostics and Tests for Laxatives Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm EKG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm

•

Background Topics for Laxatives Choking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000047.htm Electrolyte Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm Electrolytes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002350.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm

Online Glossaries 111

Vital signs Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002341.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

113

LAXATIVES DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] 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] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

114 Laxatives

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] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Alendronate: A nonhormonal medication for the treatment of postmenopausal osteoporosis in women. This drug builds healthy bone, restoring some of the bone loss as a result of osteoporosis. [NIH] 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] Alkalosis: A pathological condition that removes acid or adds base to the body fluids. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alprostadil: A potent vasodilator agent that increases peripheral blood flow. It inhibits platelet aggregation and has many other biological effects such as bronchodilation, mediation of inflammation, etc. [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] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH]

Dictionary 115

Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] 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] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anabolic Steroids: Chemical derivatives of testosterone that are used for anabolic promotion of growth and repair of body tissues and the development of male sexual characteristics. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [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]

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Anginal: Pertaining to or characteristic of angina. [EU] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Anthelmintics: Agents destructive to parasitic worms. They are used therapeutically in the treatment of helminthiasis in man and animal. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidiarrheals: Miscellaneous agents found useful in the symptomatic treatment of diarrhea. They have no effect on the agent(s) that cause diarrhea, but merely alleviate the condition. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH]

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Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antipruritic: Relieving or preventing itching. [EU] Antispasmodics: Medicines that help reduce or stop muscle spasms in the intestines. Examples are dicyclomine (dy-SY-klo-meen) (Bentyl) and atropine (AH-tro-peen) (Donnatal). [NIH] Antitussive: An agent that relieves or prevents cough. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Appendectomy: An operation to remove the appendix. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aspartate: A synthetic amino acid. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [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] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] 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]

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Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bezoar: A ball of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach. Bezoars can cause blockage, ulcers, and bleeding. [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 Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioavailable: The ability of a drug or other substance to be absorbed and used by the body. Orally bioavailable means that a drug or other substance that is taken by mouth can be absorbed and used by the body. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopolymers: Polymers, such as proteins, DNA, RNA, or polysaccharides formed by any living organism. [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] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bismuth Subsalicylate: A nonprescription medicine such as Pepto-Bismol. Used to treat diarrhea, heartburn, indigestion, and nausea. It is also part of the treatment for ulcers caused by the bacterium Helicobacter pylori (HELL-uh-koh-BAK-tur py-LOH-ree). [NIH] Bladder: The organ that stores urine. [NIH]

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Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [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] Body Regions: Anatomical areas of the body. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bowel Prep: The process used to clean the colon with enemas and a special drink. Used before surgery of the colon, colonoscopy, or barium x-ray. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH]

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Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caecum: The blind pouch in which the large intestine begins and into which the ileum opens from one side. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Cannabis: The hemp plant Cannabis sativa. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH] Carboxylic Acids: Organic compounds containing the carboxy group (-COOH). This group of compounds includes amino acids and fatty acids. Carboxylic acids can be saturated, unsaturated, or aromatic. [NIH] Carboxymethylcellulose: It is used as an emulsifier, thickener, suspending agent, etc., in cosmetics and pharmaceuticals; in research as a culture medium; in chromatography as a stabilizer for reagents; and therapeutically as a bulk laxative with antacid properties. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU]

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Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cascara: Component of the dried bark of a buckthorn (Rhamnus purshiana) that contains the anthraquinone emodin. It is used as a laxative. [NIH] Castor Oil: Oil obtained from seeds of Ricinus communis that is used as a cathartic and as a plasticizer. [NIH] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] 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 Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] 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] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH]

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Chemotherapy: Treatment with anticancer drugs. [NIH] Chloroform: A commonly used laboratory solvent. It was previously used as an anesthetic, but was banned from use in the U.S. due to its suspected carcinogenecity. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholestyramine: Strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium as Cl(-) anion. It exchanges chloride ions with bile salts, thus decreasing their concentration and that of cholesterol. It is used as a hypocholesteremic in diarrhea and biliary obstruction and as an antipruritic. [NIH] Cholic Acid: A major primary bile acid produced in the liver and usually conjugated with glycine or taurine. It facilitates fat absorption and cholesterol excretion. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cod Liver Oil: Oil obtained from fresh livers of the cod family, Gadidae. It is a source of vitamins A and D. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH]

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Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] 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] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix '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,

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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] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [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] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [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] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [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] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU]

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Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] 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] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Dehydration: The condition that results from excessive loss of body water. [NIH] Dehydrocholic Acid: A semisynthetic bile acid made from cholic acid. It is used as a cholagogue, hydrocholeretic, diuretic, and as a diagnostic aid. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Dermatitis: Any inflammation of the skin. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased

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risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary tract spasms. [NIH] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] 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] Digitalis: A genus of toxic herbaceous Eurasian plants of the Scrophulaceae which yield cardiotonic glycosides. The most useful are Digitalis lanata and D. purpurea. [NIH] Dilatation: The act of dilating. [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] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dispenser: Glass, metal or plastic shell fitted with valve from which a pressurized formulation is dispensed; an instrument for atomizing. [NIH] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [NIH] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate

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precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] 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] Duodenitis: An irritation of the first part of the small intestine (duodenum). [NIH] Duodenum: The first part of the small intestine. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] 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] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [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] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous

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phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enema: The injection of a liquid through the anus into the large bowel. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophil: A polymorphonuclear leucocyte with large eosinophilic granules in its cytoplasm, which plays a role in hypersensitivity reactions. [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] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] 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]

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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]

Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [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] Extraction: The process or act of pulling or drawing out. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Faecal: Pertaining to or of the nature of feces. [EU] 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] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fertilizers: Substances or mixtures that are added to the soil to supply nutrients or to make available nutrients already present in the soil, in order to increase plant growth and productivity. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH]

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Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatulence: Production or presence of gas in the gastrointestinal tract which may be expelled through the anus. [NIH] Flatus: Gas passed through the rectum. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] 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]

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Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal Agents: Drugs used for their effects on the gastrointestinal system, as to control gastric acidity, regulate gastrointestinal motility and water flow, and improve digestion. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrointestinal Transit: Passage of food (sometimes in the form of a test meal) through the gastrointestinal tract as measured in minutes or hours. The rate of passage through the intestine is an indicator of small bowel function. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genital: Pertaining to the genitalia. [EU] Geriatric: Pertaining to the treatment of the aged. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Ginger: Deciduous plant rich in volatile oil (oils, volatile). It is used as a flavoring agent and has many other uses both internally and topically. [NIH] Gland: An organ that produces and releases one or more substances for use in the body.

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Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [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] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granule: A small pill made from sucrose. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gum Arabic: Powdered exudate from various Acacia species, especially A. senegal (Leguminosae). It forms mucilage or syrup in water. Gum arabic is used as a suspending agent, excipient, and emulsifier in foods and pharmaceuticals. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Hallucinogens: Drugs capable of inducing illusions, hallucinations, delusions, paranoid ideations, and other alterations of mood and thinking. Despite the name, the feature that distinguishes these agents from other classes of drugs is their capacity to induce states of altered perception, thought, and feeling that are not experienced otherwise. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue,

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breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [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] Host: Any animal that receives a transplanted graft. [NIH] Hydration: Combining with water. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypotension: Abnormally low blood pressure. [NIH]

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Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileum: The lower end of the small intestine. [NIH] Illusions: The misinterpretation of a real external, sensory experience. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive Agents: Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of suppressor T-cell populations or by inhibiting the activation of helper cells. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of interleukins and other cytokines are emerging. [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] Impotence: The inability to perform sexual intercourse. [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] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

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

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and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interleukins: Soluble factors which stimulate growth-related activities of leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [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] 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]

Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [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] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH]

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Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [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] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Levothyroxine: Levo isomer of the thyroid hormone thyroxine. It is used for replacement therapy in reduced or absent thyroid function. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability,

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requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Loperamide: 4-(p-Chlorophenyl)-4-hydroxy-N.N-dimethyl-alpha,alpha-diphenyl-1piperidine butyramide hydrochloride. Synthetic anti-diarrheal agent with a long duration of action; it is not significantly absorbed from the gut, has no effect on the adrenergic system or central nervous system, but may antagonize histamine and interfere with acetylcholine release locally. [NIH] Loperamide hydrochloride: An antidiarrheal drug. [NIH] Lubricants: Oily or slippery substances. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control osmolarity. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Melanin: The substance that gives the skin its color. [NIH] Melanosis: Disorders of increased melanin pigmentation that develop without preceding inflammatory disease. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Menthol: An alcohol produced from mint oils or prepared synthetically. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH]

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Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Methanol: A colorless, flammable liquid used in the manufacture of formaldehyde and acetic acid, in chemical synthesis, antifreeze, and as a solvent. Ingestion of methanol is toxic and may cause blindness. [NIH] Methylcellulose: Methylester of cellulose. Methylcellulose is used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry. It is used therapeutically as a bulk laxative. [NIH] Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microfibrils: Components of the extracellular matrix consisting primarily of fibrillin. They are essential for the integrity of elastic fibers. [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] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH]

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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] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multidrug resistance: Adaptation of tumor cells to anticancer drugs in ways that make the drugs less effective. [NIH] Mutagenicity: Ability to damage DNA, the genetic material; the power to cause mutations. [NIH]

Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myometrium: The smooth muscle coat of the uterus, which forms the main mass of the organ. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] 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]

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Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] 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] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH]

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Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] 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] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxytocic: 1. Pertaining to, characterized by, or promoting oxytocia (= rapid labor). 2. An agent that hastens evacuation of the uterus by stimulating contractions of the myometrium. [EU]

Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pamidronate: A drug that belongs to the family of drugs called bisphosphonates. Pamidronate is used as treatment for abnormally high levels of calcium in the blood. [NIH] 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] 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] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to

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therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Peak flow: The maximum amount of air breathed out; the power needed to produce this amount. [EU] Pelvic: Pertaining to the pelvis. [EU] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Peripheral blood: Blood circulating throughout the body. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield

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combustible fuels, petrochemicals, and lubricants. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] 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] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] 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] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pilot study: The initial study examining a new method or treatment. [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 Activating Factor: A phospholipid derivative formed by platelets, basophils, neutrophils, monocytes, and macrophages. It is a potent platelet aggregating agent and inducer of systemic anaphylactic symptoms, including hypotension, thrombocytopenia, neutropenia, and bronchoconstriction. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form.

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Also called thrombocytes. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyesters: Polymers of organic acids and alcohols, with ester linkages--usually polyethylene terephthalate; can be cured into hard plastic, films or tapes, or fibers which can be woven into fabrics, meshes or velours. [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. [NIH]

Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Portal System: A system of vessels in which blood, after passing through one capillary bed, is conveyed through a second set of capillaries before it returns to the systemic circulation. It pertains especially to the hepatic portal system. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Chloride: Potassium chloride. A white crystal or crystalline powder used as an electrolyte replenisher, in the treatment of hypokalemia, in buffer solutions, and in fertilizers and explosives. [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]

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Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [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] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Proctalgia Fugax: Intense pain in the rectum that occasionally happens at night. Caused by muscle spasms around the anus. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Prophylaxis: An attempt to prevent disease. [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 over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the

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lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [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] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood 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] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and

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has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [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] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [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] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [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]

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Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saccharin: Flavoring agent and non-nutritive sweetener. [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] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] 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] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Self Administration: Administration of a drug or chemical by the individual under the direction of a physician. It includes administration clinically or experimentally, by human or animal. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Self Medication: The self administration of medication not prescribed by a physician or in a manner not directed by a physician. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [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] 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

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reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as 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] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Simethicone: A mixture of dimethyl polysiloxanes and silica gel used as an antiflatulent. Without the addition of silica gel (dimethicone), it is used as an ointment base ingredient and skin protectant. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] 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]

Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [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] Sodium Bicarbonate: A white, crystalline powder that is commonly used as a pH buffering agent, an electrolyte replenisher, systemic alkalizer and in topical cleansing solutions. [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] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs

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naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] 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] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [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] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [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] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Struvite: A type of kidney stone caused by infection. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU]

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Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Sucralfate: A basic aluminum complex of sulfated sucrose. It is advocated in the therapy of peptic, duodenal, and prepyloric ulcers, gastritis, reflux esophagitis, and other gastrointestinal irritations. It acts primarily at the ulcer site, where it has cytoprotective, pepsinostatic, antacid, and bile acid-binding properties. The drug is only slightly absorbed by the digestive mucosa, which explains the absence of systemic effects and toxicity. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] 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]

Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]

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Systemic: Affecting the entire body. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Toilet Training: Conditioning to defecate and urinate in culturally acceptable places. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] 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] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trehalase: An enzyme that catalyzes the conversion of alpha,alpha-trehalose and water to

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D-glucose. EC 3.2.1.28. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Trichuris: A genus of nematode worms comprising the whipworms. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [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] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] 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.

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[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] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [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] Utilization Review: An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use. [NIH] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host 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] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the

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cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xanthines: Purine bases found in body tissues and fluids and in some plants. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

157

INDEX A Abdomen, 75, 113, 119, 135, 136, 142, 150, 152 Abdominal, 24, 60, 70, 73, 75, 76, 83, 94, 109, 113, 123, 131, 135, 137, 141, 142, 153 Abdominal Pain, 60, 70, 73, 75, 94, 113, 131, 135, 153 Aberrant, 10, 113 Acetylcholine, 113, 122, 137, 140 Acidosis, 4, 67, 83, 113 Adenosine, 113, 143 Adjunctive Therapy, 13, 31, 113 Adjuvant, 113, 131 Adolescence, 6, 113 Adrenergic, 113, 114, 116, 127, 137, 146 Adrenergic beta-Antagonists, 113, 116 Adsorption, 13, 113 Adsorptive, 113 Adverse Effect, 4, 113, 149 Aerosol, 113, 151 Affinity, 114, 126, 149 Age Groups, 52, 114 Age of Onset, 114, 153 Aged, 80 and Over, 114 Agonist, 114, 127, 140 Alendronate, 71, 114 Algorithms, 114, 118 Alimentary, 9, 18, 32, 49, 59, 114, 126, 142 Alkaline, 113, 114, 115, 117, 120, 143 Alkaloid, 114, 117, 120, 138, 140, 146 Alkalosis, 83, 114 Allylamine, 114, 115 Aloe, 31, 33, 36, 54, 58, 59, 61, 62, 80, 114 Alprenolol, 71, 114 Alprostadil, 73, 114 Alternative medicine, 81, 114 Aluminum, 82, 114, 151 Alveoli, 115, 125 Amebiasis, 115, 138 Ameliorated, 70, 115 Amenorrhea, 115, 116 Amine, 63, 115, 133 Amino Acids, 115, 120, 128, 146, 152, 153 Ammonia, 115 Anabolic, 74, 115 Anabolic Steroids, 74, 115 Anaesthesia, 115, 134 Anal, 6, 49, 72, 115, 129, 130, 147

Anal Fissure, 72, 115 Analgesic, 115, 122, 136, 138, 141, 146 Analog, 115, 126 Anaphylactic, 115, 143 Anaphylatoxins, 115, 123 Anaphylaxis, 32, 115 Anaplasia, 115 Anesthesia, 115 Anginal, 114, 116 Angiotensin converting enzyme inhibitor, 68, 116 Angiotensin-Converting Enzyme Inhibitors, 116 Anionic, 50, 116 Anorectal, 6, 71, 72, 116 Anorexia, 11, 12, 76, 83, 116, 131, 153 Anorexia Nervosa, 11, 12, 83, 116 Anthelmintics, 116 Antibiotic, 116, 128 Antibody, 114, 116, 123, 125, 134 Antidiarrheals, 74, 75, 82, 116 Antiemetic, 50, 116, 138 Antigen, 114, 115, 116, 123, 133, 134 Antigen-Antibody Complex, 116, 123 Antihypertensive, 63, 114, 116 Antihypertensive Agents, 63, 116 Anti-inflammatory, 116, 117, 141, 148 Anti-Inflammatory Agents, 116, 117 Antimicrobial, 71, 117, 122 Antipruritic, 117, 122 Antispasmodics, 94, 117 Antitussive, 53, 117, 126, 141 Antiviral, 71, 117 Anus, 70, 73, 115, 116, 117, 119, 128, 130, 133, 145, 147 Appendectomy, 75, 117 Appendicitis, 34, 75, 117 Aqueous, 42, 50, 56, 58, 86, 117, 125, 127 Arachidonic Acid, 117, 145 Arginine, 115, 117, 140 Aromatic, 117, 120 Arterial, 114, 117, 133, 146 Arteries, 117, 119, 124, 138 Ascites, 76, 117, 140 Aspartate, 117, 126 Aspirin, 57, 68, 117 Asymptomatic, 115, 117, 141 Atropine, 117

158 Laxatives

Atypical, 71, 117 Autodigestion, 117, 141 B Bacteria, 113, 116, 117, 118, 129, 131, 132, 136, 138, 153, 154 Bacteriostatic, 117, 128 Bacterium, 117, 118 Barium, 117, 119 Base, 58, 86, 114, 117, 125, 135, 138, 142, 143, 149, 153 Basophils, 118, 143 Behavior Therapy, 10, 30, 118 Benign, 72, 118, 139 Bezoar, 31, 118 Bile, 71, 75, 118, 122, 125, 130, 134, 136, 151 Bile Acids, 118 Bile Acids and Salts, 118 Bile Ducts, 118, 130 Biliary, 63, 118, 120, 122, 126, 141 Biliary Tract, 118, 120, 141 Bilirubin, 118, 130 Bioavailable, 53, 118 Biomarkers, 5, 10, 118 Biopolymers, 46, 118 Biopsy, 73, 118 Biotechnology, 7, 69, 81, 93, 118 Bismuth, 82, 118 Bismuth Subsalicylate, 82, 118 Bladder, 75, 118, 134, 145, 153, 154 Bloating, 48, 83, 94, 119, 131, 134, 135 Blood Coagulation, 119, 120 Blood Glucose, 64, 119, 135 Blood pressure, 73, 110, 116, 119, 130, 133, 138, 149 Blood vessel, 116, 119, 120, 121, 128, 129, 133, 137, 149, 150, 152, 154 Body Fluids, 114, 118, 119, 120, 127, 149, 153 Body Regions, 119, 123 Bolus, 49, 64, 119 Bolus infusion, 119 Bone Marrow, 119, 125, 137, 138 Bowel, 3, 4, 6, 9, 17, 24, 26, 43, 50, 52, 56, 61, 69, 70, 71, 72, 75, 76, 82, 83, 99, 115, 119, 126, 128, 131, 135, 136, 147, 150, 153 Bowel Movement, 3, 4, 9, 17, 26, 50, 52, 61, 82, 83, 99, 119, 126, 150 Bowel Prep, 76, 119 Bradykinin, 119, 140 Branch, 26, 107, 119, 142, 146, 150, 151, 152 Breakdown, 19, 33, 119, 126, 130 Bronchi, 119

Bronchial, 5, 119, 133 Bronchoconstriction, 119, 143 Bulimia, 13, 34, 74, 83, 119 Burns, 14, 45, 119, 120 Burns, Electric, 119, 120 Bypass, 75, 120 C Caecum, 25, 120 Calcium, 25, 31, 49, 54, 68, 71, 72, 83, 86, 116, 120, 123, 141 Calcium channel blocker, 68, 71, 72, 116, 120 Calcium Channel Blockers, 68, 71, 72, 116, 120 Calculi, 4, 120 Cannabis, 74, 120 Capillary, 119, 120, 132, 144 Capsaicin, 68, 72, 120 Capsules, 48, 120, 127, 129, 131, 132 Carbohydrate, 52, 120, 132, 144 Carbon Dioxide, 120, 125, 130, 147 Carboxy, 120 Carboxylic Acids, 46, 120 Carboxymethylcellulose, 50, 58, 120 Carcinogen, 120, 138 Carcinogenic, 18, 32, 59, 80, 120, 135 Carcinoma, 120, 121 Cardiac, 113, 114, 121, 129, 131, 139, 146 Cardiotonic, 121, 126 Cascara, 36, 56, 59, 61, 62, 80, 121 Castor Oil, 62, 121 Caustic, 71, 121 Cecum, 121, 136 Cell, 114, 115, 117, 118, 120, 121, 123, 125, 126, 128, 129, 132, 134, 135, 136, 137, 139, 140, 143, 145, 147, 151 Cell Division, 117, 121, 143 Cell membrane, 120, 121, 143 Cellobiose, 121 Cellulose, 51, 58, 62, 121, 138, 143 Central Nervous System, 113, 121, 130, 137, 138 Cerebral, 63, 121, 124, 130, 150 Cerebral Palsy, 121, 150 Cerebrovascular, 120, 121 Cerebrum, 121 Chamomile, 61, 121 Character, 49, 121 Chemotactic Factors, 121, 123 Chemotherapy, 62, 98, 122 Chloroform, 60, 122 Cholesterol, 43, 51, 73, 118, 122, 130

Index 159

Cholestyramine, 94, 122 Cholic Acid, 122, 125 Choline, 121, 122 Cholinergic, 75, 122, 140 Chronic renal, 12, 122, 153 Ciprofloxacin, 74, 122 Citrus, 52, 122 Clear cell carcinoma, 122, 126 Clinical study, 122, 124 Clinical trial, 4, 93, 122, 124, 125, 139, 146, 147 Cloning, 118, 122 Cod Liver Oil, 122, 128 Codeine, 122, 126, 141 Cofactor, 122, 146 Cohort Studies, 7, 122 Colic, 75, 123 Colitis, 13, 26, 73, 123, 135 Collagen, 123, 131, 143 Collapse, 109, 115, 119, 123 Colloidal, 123, 142, 151 Colonoscopy, 20, 73, 119, 123 Colorectal, 8, 9, 17, 26, 59, 62, 80, 98, 123 Colorectal Cancer, 17, 26, 59, 62, 80, 98, 123 Communis, 121, 123 Complement, 5, 115, 123, 124 Complementary and alternative medicine, 29, 40, 123 Complementary medicine, 29, 124 Complete remission, 124, 147 Computational Biology, 93, 124 Concretion, 71, 120, 124 Cone, 124, 151 Conjunctiva, 124 Conjunctivitis, 124 Connective Tissue, 119, 123, 124, 130, 131 Consciousness, 115, 124 Consumption, 6, 21, 33, 45, 51, 63, 64, 83, 124, 131, 147 Contraindications, ii, 124 Controlled clinical trial, 18, 124 Controlled study, 6, 16, 124 Conventional therapy, 124 Conventional treatment, 5, 124 Convulsions, 47, 124 Coronary, 51, 124, 125, 138 Coronary Thrombosis, 125, 138 Cortex, 36, 125, 130 Corticosteroids, 39, 73, 125 Coumarins, 121, 125 Crystallization, 58, 125

Curative, 125, 152 Cyclic, 125, 132, 140, 145 Cyclosporine, 74, 125 Cytokines, 125, 134 Cytoplasm, 118, 121, 125, 128, 138, 140 Cytotoxic, 120, 125, 134 D Databases, Bibliographic, 93, 125 Decarboxylation, 125, 133 Defecation, 5, 32, 52, 60, 69, 70, 125 Dehydration, 4, 83, 125 Dehydrocholic Acid, 62, 125 Delusions, 125, 132 Density, 125, 144 Dentition, 83, 125 Dermatitis, 14, 125 DES, 115, 125 Dextromethorphan, 53, 126 Diagnostic procedure, 41, 71, 81, 126 Dialyzer, 126, 133 Diarrhea, 4, 35, 50, 70, 72, 73, 75, 76, 83, 94, 109, 115, 116, 118, 122, 126, 135 Diarrhoea, 19, 126, 131 Dicyclomine, 117, 126 Dietary Fiber, 43, 44, 63, 73, 75, 83, 98, 126 Digestion, 18, 19, 26, 52, 72, 114, 118, 119, 126, 127, 131, 134, 135, 136, 142, 150 Digestive system, 52, 55, 64, 73, 75, 126, 131 Digestive tract, 49, 55, 64, 75, 126, 149 Digitalis, 10, 30, 126 Dilatation, 126, 145 Dilation, 47, 119, 126 Dimethyl, 126, 137, 149 Diploid, 126, 143 Direct, iii, 85, 126, 127, 131, 147 Dispenser, 45, 126 Diuresis, 83, 126 Diuretic, 15, 30, 125, 126, 137, 150 Diuretics, Thiazide, 116, 126 Dopamine, 126, 138 Dosage Forms, 48, 53, 60, 127 Drive, ii, vi, 23, 63, 71, 82, 98, 127 Drug Interactions, 17, 68, 88, 127 Duct, 75, 127, 134, 141, 148 Duodenitis, 76, 127 Duodenum, 118, 127, 131, 150 Dyspepsia, 76, 127, 134 E Eating Disorders, 6, 12, 13, 14, 35, 83, 98, 127 Edema, 63, 127, 136, 140, 153

160 Laxatives

Effector, 113, 123, 127 Efficacy, 6, 8, 9, 13, 17, 21, 24, 30, 33, 61, 127 Electrolyte, 15, 20, 56, 83, 87, 110, 127, 144, 149, 153 Electrons, 117, 127, 135, 147 Embryo, 127, 134 Emodin, 31, 33, 58, 114, 121, 127 Emollient, 49, 127, 132, 138, 140 Emulsion, 50, 127, 130 Encephalopathy, 42, 128 Encopresis, 10, 29, 30, 74, 128 Endoscopy, 13, 31, 71, 94, 128 Endothelium, 128, 140 Endothelium-derived, 128, 140 Endotoxins, 123, 128 End-stage renal, 11, 122, 128 Enema, 10, 72, 86, 128 Environmental Health, 17, 26, 92, 94, 128 Enzymatic, 120, 123, 128, 133 Enzyme, 72, 127, 128, 132, 137, 142, 146, 152, 154 Eosinophil, 5, 128 Eosinophilic, 128 Epidural, 16, 128 Epithelial, 11, 25, 128 Epithelial Cells, 11, 25, 128 Epithelium, 18, 26, 128, 131 Erectile, 128 Erection, 73, 128 Erythromycin, 72, 128 Esophageal, 31, 71, 75, 128 Esophagitis, 71, 129, 151 Esophagus, 71, 75, 126, 128, 129, 131, 133, 147, 150 Ether, 58, 129 Evacuation, 49, 70, 124, 129, 131, 136, 141, 146 Excipient, 129, 132 Excitability, 129, 139, 146 Exogenous, 113, 129, 153 Extracellular, 124, 129, 138, 149 Extracellular Matrix, 124, 129, 138 Extraction, 58, 60, 129 Exudate, 129, 132, 141 F Faecal, 14, 126, 129 Family Planning, 93, 129 Fat, 43, 44, 45, 47, 51, 117, 118, 119, 122, 129, 136, 151, 153 Fatigue, 73, 129, 132 Fatty acids, 120, 129, 145

Fecal Incontinence, 72, 74, 129, 134 Feces, 73, 124, 128, 129, 150 Fentanyl, 10, 25, 129 Fertilizers, 129, 144 Fibula, 15, 129 Filler, 55, 129 Fissure, 72, 123, 130 Fistula, 72, 130 Fixation, 72, 130 Flatulence, 73, 130 Flatus, 129, 130 Flushing, 56, 75, 110, 130 Fold, 130, 137 Forearm, 119, 130 Fovea, 130 Frail Elderly, 11, 130 Fructose, 12, 42, 51, 130, 132, 135 G Gallbladder, 75, 113, 118, 126, 130, 131 Gallstones, 75, 118, 130 Ganglia, 113, 130, 139 Ganglionic Blockers, 116, 130 Gas, 48, 57, 70, 75, 83, 115, 120, 130, 133, 134, 135, 140, 151 Gastric, 31, 70, 117, 127, 131, 133, 142 Gastric Acid, 131 Gastric Emptying, 70, 131 Gastric Juices, 131, 142 Gastric Mucosa, 131, 142 Gastritis, 73, 75, 76, 131, 151 Gastroenteritis, 94, 131 Gastroenterology, 8, 9, 10, 13, 15, 16, 17, 18, 19, 20, 24, 25, 31, 69, 70, 71, 72, 74, 94, 131 Gastrointestinal Agents, 131 Gastrointestinal tract, 3, 43, 48, 56, 130, 131, 150, 153 Gastrointestinal Transit, 16, 131 Gastroparesis, 70, 72, 131 Gelatin, 44, 48, 131, 151 Gels, 47, 131 Gene, 69, 118, 131 Genital, 122, 131 Geriatric, 33, 70, 72, 98, 131 Giardiasis, 131, 138 Ginger, 56, 131 Gland, 131, 141, 145, 148, 150, 152 Glomerular, 132, 135, 137 Glomerular Filtration Rate, 132, 137 Glucose, 119, 121, 132, 135, 150, 153 Glutamate, 126, 132 Glycerol, 46, 132, 143

Index 161

Glycoside, 58, 132 Governing Board, 132, 144 Grade, 43, 47, 132 Graft, 132, 133 Gram-positive, 132, 136 Granule, 47, 132 Growth, 64, 113, 115, 117, 129, 132, 135, 137, 139, 143, 152, 153 Guanylate Cyclase, 132, 140 Gum Arabic, 51, 132 H Habitual, 20, 121, 132 Hallucinogens, 74, 132 Haploid, 132, 143 Heart failure, 10, 30, 116, 132, 140 Heartburn, 73, 75, 118, 133, 134 Helminthiasis, 116, 133 Hemodialysis, 76, 126, 133, 136 Hemodynamics, 20, 133 Hemorrhage, 71, 133, 150 Hemorrhoid, 72, 133 Hemorrhoidectomy, 75, 133 Hepatic, 133, 144 Heredity, 131, 133 Hernia, 75, 76, 133 Histamine, 75, 115, 133, 137 Histidine, 133 Histology, 133, 141 Homogeneous, 57, 133, 143 Hormone, 125, 133, 135, 136, 152 Host, 54, 133, 154 Hydration, 44, 63, 71, 133 Hydrogen, 113, 115, 117, 120, 133, 138 Hydrophilic, 42, 133 Hypersensitivity, 115, 128, 133 Hypertension, 113, 116, 120, 133, 153 Hypoglycemia, 67, 133 Hypotension, 124, 130, 133, 143 I Id, 27, 33, 99, 106, 108, 134 Idiopathic, 12, 70, 134 Ileum, 120, 121, 134 Illusions, 132, 134, 148 Immune function, 134 Immune system, 134, 154 Immunosuppressive, 71, 134 Immunosuppressive Agents, 71, 134 Impaction, 59, 70, 134 Impotence, 73, 128, 134 In vitro, 13, 18, 26, 134 In vivo, 134 Incontinence, 14, 72, 126, 128, 134

Indicative, 68, 134, 142, 154 Indigestion, 75, 118, 134 Induction, 9, 24, 130, 134 Infant, Newborn, 114, 134 Infarction, 125, 134, 138 Infection, 94, 115, 121, 131, 134, 137, 140, 150, 151, 153, 154 Inflammation, 5, 72, 114, 116, 117, 123, 124, 125, 129, 131, 134, 141, 148, 150, 153, 154 Inflammatory bowel disease, 72, 73, 76, 134 Ingestion, 19, 31, 45, 51, 52, 135, 138, 144 Inhalation, 113, 135, 144 Initiation, 59, 135 Inorganic, 56, 135, 139 Insulin, 68, 73, 135, 153 Insulin-dependent diabetes mellitus, 135 Interleukins, 134, 135 Intermittent, 135, 137 Internal Medicine, 5, 131, 135 Interstitial, 53, 83, 135 Intestinal, 12, 13, 47, 55, 60, 61, 62, 70, 72, 75, 81, 82, 83, 135, 136, 137 Intestine, 52, 83, 118, 119, 123, 131, 135, 136, 142 Intoxication, 135, 155 Intracellular, 120, 134, 135, 140, 144, 145 Intussusception, 135, 147 Inulin, 27, 132, 135 Involuntary, 129, 135, 139, 147 Ions, 117, 122, 126, 127, 133, 135, 138 Irritable Bowel Syndrome, 35, 52, 75, 94, 98, 135 J Joint, 122, 135 K Kb, 92, 135 Kidney Disease, 73, 92, 136 Kidney Failure, 128, 136, 137 Kidney stone, 136, 150 Kinetics, 33, 136 L Labile, 123, 136 Lactobacillus, 82, 136 Lactulose, 8, 12, 20, 24, 29, 33, 42, 46, 50, 136 Large Intestine, 25, 31, 49, 83, 120, 121, 123, 126, 135, 136, 147, 149 Lavage, 9, 20, 25, 56, 136 Leucocyte, 128, 136 Levorphanol, 126, 136

162 Laxatives

Levothyroxine, 13, 136 Library Services, 106, 136 Ligaments, 124, 136 Linkages, 136, 142, 144 Lipid, 64, 122, 132, 135, 136, 153 Liver, 67, 75, 76, 113, 117, 118, 122, 126, 128, 129, 130, 131, 133, 136 Localized, 130, 134, 136, 140, 143, 153, 154 Locomotion, 136, 143 Long-Term Care, 14, 136 Loop, 133, 137 Loperamide, 82, 137 Loperamide hydrochloride, 82, 137 Lubricants, 62, 75, 82, 137, 143 Lumen, 56, 137 Lymphatic, 128, 134, 137, 140 Lymphoid, 125, 136, 137 M Malabsorption, 70, 137 Malignant, 11, 25, 137, 139 Mannitol, 46, 137 Manometry, 6, 137 Medicament, 53, 63, 137, 151 MEDLINE, 93, 137 Medullary, 126, 137 Melanin, 137 Melanosis, 10, 31, 71, 137 Membrane, 121, 123, 124, 126, 129, 137, 139, 141, 143, 144, 147, 148 Memory, 116, 137 Mental Health, iv, 4, 92, 95, 137, 146 Menthol, 48, 137 Mesenteric, 25, 137, 144 Mesentery, 137, 150 Metabolic disorder, 3, 137 Metabolite, 11, 14, 19, 25, 26, 126, 138 Metastasis, 138 Methanol, 58, 60, 138 Methylcellulose, 38, 49, 58, 138 Metoclopramide, 72, 138 Metronidazole, 74, 138 MI, 73, 111, 138 Microbe, 138, 152 Microbiology, 117, 138 Microfibrils, 51, 138 Microorganism, 122, 138, 154 Mineral Oil, 62, 86, 138 Modification, 138, 146 Molecular, 30, 44, 93, 96, 118, 124, 138, 153 Molecular Structure, 138, 153 Molecule, 116, 117, 123, 127, 128, 132, 138, 147

Monitor, 5, 20, 138 Monocytes, 138, 143 Morphine, 10, 25, 122, 138, 139, 141 Motility, 16, 49, 60, 62, 70, 131, 139 Motion Sickness, 139 Motor Activity, 124, 139 Mucosa, 71, 131, 139, 151 Mucus, 118, 139, 153 Multicenter study, 8, 139 Multidrug resistance, 11, 25, 139 Mutagenicity, 8, 139 Mydriatic, 126, 139 Myocardium, 138, 139 Myometrium, 139, 141 N Narcosis, 139 Narcotic, 72, 129, 136, 138, 139 Nausea, 4, 60, 75, 76, 83, 116, 118, 127, 131, 134, 139, 153 Necrosis, 134, 138, 139 Need, 3, 5, 48, 54, 59, 67, 69, 72, 75, 81, 82, 94, 100, 122, 139 Neoplasia, 8, 139 Neoplasm, 139, 153 Nephropathy, 136, 139 Nerve, 113, 115, 131, 139, 150 Nervous System, 63, 116, 121, 139, 140, 151 Neurologic, 72, 139 Neuromuscular, 6, 113, 139, 153 Neuronal, 139, 140 Neurons, 130, 139, 140, 151 Neuropathy, 72, 140 Neuropeptides, 25, 140 Neurotoxicity, 126, 140 Neutropenia, 140, 143 Neutrophils, 140, 143 Nicotine, 74, 140 Nitric Oxide, 5, 18, 140 Nitrogen, 18, 26, 63, 114, 115, 130, 140 Nonverbal Communication, 140, 146 Nucleic acid, 140 Nucleus, 118, 125, 138, 140, 150 Nursing Care, 140, 142 O Oedema, 12, 140 Ointments, 121, 127, 140, 141 Oliguria, 136, 137, 140 Ophthalmology, 130, 141 Opium, 138, 141 Osmolarity, 137, 141 Osmosis, 141

Index 163

Osmotic, 42, 43, 49, 52, 56, 59, 62, 141 Osteoporosis, 114, 141 Ostomy, 75, 141 Overdose, 74, 109, 141 Oxytocic, 32, 141 P Palate, 141, 149, 154 Palliative, 10, 20, 141, 152 Pamidronate, 71, 141 Pancreas, 113, 118, 126, 131, 135, 141, 150, 153 Pancreatic, 12, 141 Pancreatitis, 76, 141 Paraffin, 49, 50, 141 Paralysis, 141, 150 Parasitic, 116, 133, 141 Partial remission, 141, 147 Particle, 43, 51, 53, 142 Patch, 142, 152 Pathogenesis, 69, 142 Pathologic, 113, 118, 124, 133, 142 Pathophysiology, 5, 142 Patient Care Management, 70, 142 Patient Compliance, 42, 44, 142 Patient Education, 83, 98, 104, 106, 111, 142 Peak flow, 5, 142 Pelvic, 70, 72, 142, 145 Pepsin, 142 Pepsin A, 142 Peptic, 75, 76, 142, 151 Peptic Ulcer, 75, 76, 142 Perception, 124, 132, 142, 148 Perforation, 9, 71, 142 Peripheral blood, 114, 142 Peristalsis, 55, 142 Peritoneal, 117, 140, 142 Peritoneal Cavity, 117, 140, 142 Petrolatum, 128, 142 Petroleum, 138, 141, 142 Phallic, 130, 143 Pharmaceutical Preparations, 121, 131, 143 Pharmaceutical Solutions, 127, 143 Pharmacodynamic, 17, 143 Pharmacologic, 115, 143, 152 Phenolphthalein, 4, 17, 18, 26, 49, 56, 59, 61, 77, 80, 128, 143 Phospholipids, 129, 143 Phosphorus, 12, 120, 143 Physiologic, 114, 135, 143, 145, 147 Physiology, 6, 70, 72, 75, 131, 143

Pigment, 118, 143 Pigmentation, 71, 137, 143 Pilot study, 16, 27, 32, 143 Plants, 114, 117, 120, 122, 126, 127, 132, 135, 143, 152, 155 Plasma, 5, 121, 131, 132, 136, 143 Platelet Activating Factor, 18, 143 Platelet Aggregation, 114, 115, 140, 143 Platelets, 140, 143, 152 Pleural, 140, 144 Pleural cavity, 140, 144 Poisoning, 14, 131, 135, 139, 144 Polyesters, 46, 144 Polyethylene, 8, 9, 16, 17, 20, 80, 87, 144 Polymers, 46, 118, 144, 146 Polyposis, 123, 144 Polysaccharide, 51, 116, 121, 144 Portal System, 42, 144 Portal Vein, 75, 144 Posterior, 115, 141, 144, 154 Postmenopausal, 114, 141, 144 Postprandial, 64, 144 Potassium, 11, 45, 55, 56, 71, 87, 126, 144, 146 Potassium Chloride, 45, 55, 56, 71, 144 Practice Guidelines, 95, 144 Precancerous, 145 Premalignant, 11, 25, 145 Prevalence, 74, 145 Probe, 6, 145 Proctalgia Fugax, 70, 145 Progressive, 122, 132, 139, 145, 153 Projection, 57, 145 Prolapse, 72, 145 Prophylaxis, 63, 145, 148 Prospective study, 7, 9, 17, 26, 145 Prostaglandin, 19, 26, 116, 145 Prostaglandins A, 145 Prostate, 118, 145, 153 Protective Agents, 120, 146 Protein S, 69, 118, 128, 146 Proteins, 115, 116, 118, 121, 123, 125, 128, 138, 140, 142, 143, 144, 146, 148, 152 Proteolytic, 123, 146 Protocol, 14, 83, 146 Psychiatry, 11, 130, 146, 150 Psychotherapy, 6, 146 Psyllium, 32, 39, 42, 43, 46, 47, 48, 49, 51, 62, 146 Public Health, 7, 26, 95, 146 Public Policy, 93, 146 Pulmonary, 5, 119, 124, 128, 136, 146, 151

164 Laxatives

Pulmonary Artery, 119, 146 Pulse, 110, 138, 146 Pupil, 126, 139, 146 Purgative, 127, 136, 146 Q Quality of Life, 5, 6, 146 Quinidine, 71, 146 Quinine, 146 R Radiation, 138, 147, 155 Radiological, 46, 56, 147 Radiology, 24, 147 Randomized, 6, 8, 16, 127, 147 Rape, 54, 147 Receptor, 73, 75, 116, 124, 126, 127, 147 Rectal, 15, 60, 70, 72, 75, 83, 86, 147 Rectal Prolapse, 72, 83, 147 Recur, 59, 147 Refer, 1, 123, 130, 136, 147 Reflex, 60, 147 Reflux, 71, 147, 151 Regimen, 127, 142, 147 Regurgitation, 133, 147 Remission, 73, 147 Resection, 16, 75, 147 Respiration, 120, 138, 147 Retinoids, 148, 154 Rhinitis, 32, 148 Rigidity, 143, 148 Risk factor, 6, 8, 145, 148 Rod, 117, 136, 148 S Saccharin, 55, 56, 148 Salicylate, 121, 148 Saline, 13, 26, 56, 61, 75, 82, 99, 148 Salivary, 126, 148 Salivary glands, 126, 148 Schizoid, 148, 154 Schizophrenia, 148, 154 Schizotypal Personality Disorder, 148, 154 Screening, 18, 80, 122, 148 Secretion, 11, 25, 126, 133, 135, 139, 148 Sedative, 74, 122, 148 Sedentary, 83, 148 Self Administration, 148 Self Care, 75, 148 Self Medication, 56, 148 Semisynthetic, 125, 148 Senna, 18, 19, 26, 30, 33, 39, 46, 47, 48, 49, 56, 58, 59, 62, 86, 148 Serum, 5, 14, 20, 51, 63, 64, 115, 123, 148 Sex Characteristics, 113, 148, 152

Shock, 63, 115, 149, 152 Side effect, 47, 48, 51, 60, 67, 71, 75, 82, 85, 113, 149, 152 Sigmoid, 70, 149 Sigmoid Colon, 70, 149 Signs and Symptoms, 73, 147, 149, 153 Silicon, 6, 149 Silicon Dioxide, 149 Simethicone, 61, 149 Skeletal, 146, 149 Skeleton, 135, 145, 149 Small intestine, 52, 70, 118, 121, 127, 131, 133, 134, 135, 149 Smooth muscle, 62, 114, 115, 120, 133, 138, 139, 149, 151 Snoring, 63, 149 Social Environment, 146, 149 Sodium, 50, 55, 56, 61, 63, 83, 86, 126, 146, 147, 149 Sodium Bicarbonate, 55, 56, 149 Solvent, 58, 64, 122, 132, 138, 141, 143, 149 Somatic, 113, 149 Sorbitol, 46, 86, 137, 149 Spastic, 35, 70, 135, 150 Spasticity, 150 Specialist, 100, 126, 150 Species, 18, 26, 56, 120, 121, 131, 132, 136, 141, 146, 150, 151, 152, 153, 154 Sphincter, 49, 75, 147, 150 Spinal cord, 121, 122, 128, 139, 140, 147, 150 Splenic Vein, 144, 150 Stabilizer, 120, 150 Stent, 141, 150 Steroids, 125, 150 Stimulant, 8, 13, 20, 21, 25, 39, 48, 49, 59, 61, 69, 75, 80, 82, 133, 150 Stimulus, 127, 147, 150, 152 Stoma, 141, 150 Stomach, 52, 53, 72, 75, 113, 117, 118, 126, 128, 129, 131, 133, 136, 139, 142, 147, 149, 150 Stool, 6, 14, 21, 33, 48, 50, 52, 58, 61, 72, 73, 82, 99, 134, 135, 136, 150 Strand, 47, 150 Stress, 75, 130, 131, 135, 139, 150, 154 Stroke, 63, 92, 150 Struvite, 4, 150 Stupor, 139, 150 Subacute, 134, 150 Subclinical, 134, 151 Subcutaneous, 127, 140, 151

Index 165

Subspecies, 150, 151 Substance P, 128, 138, 148, 151 Sucralfate, 71, 151 Supplementation, 5, 21, 33, 63, 151 Suppositories, 70, 72, 75, 131, 151 Surfactant, 50, 151 Survival Rate, 62, 151 Suspensions, 48, 58, 151 Symptomatic, 9, 116, 141, 151 Symptomatic treatment, 116, 151 Symptomatology, 6, 151 Synaptic, 140, 151 Synaptic Transmission, 140, 151 Synergistic, 61, 151 Systemic, 71, 86, 87, 115, 119, 133, 134, 140, 143, 144, 149, 151, 152 T Testosterone, 115, 152 Therapeutics, 9, 14, 18, 32, 59, 88, 152 Thorax, 113, 152 Threshold, 12, 20, 129, 133, 152 Thrombocytopenia, 143, 152 Thrombosis, 146, 150, 152 Thyroid, 136, 152 Thyroxine, 136, 152 Toilet Training, 29, 152 Topical, 141, 142, 149, 152 Toxic, iv, 46, 49, 117, 126, 138, 140, 152 Toxicity, 8, 10, 20, 30, 74, 127, 151, 152 Toxicology, 13, 14, 94, 152 Toxins, 116, 128, 134, 152 Trace element, 149, 152 Transdermal, 10, 25, 152 Transfection, 118, 152 Translation, 128, 152 Translocation, 128, 152 Transplantation, 11, 12, 20, 122, 152 Trauma, 72, 129, 139, 141, 152 Trehalase, 12, 152 Trichomoniasis, 138, 153 Trichuris, 153 Tricyclic, 68, 72, 94, 153 Trigger zone, 153 Triglyceride, 46, 51, 153 Tuberculosis, 124, 153

Tumor marker, 118, 153 Tumour, 20, 25, 153 Type 2 diabetes, 68, 153 U Ulcer, 142, 151, 153 Ulcerative colitis, 19, 26, 73, 135, 153 Ultrasonography, 24, 153 Unconscious, 134, 153 Uraemia, 141, 153 Ureters, 136, 153 Urethra, 145, 153, 154 Urinary, 4, 5, 19, 26, 120, 122, 126, 134, 140, 153 Urinary tract, 4, 126, 153 Urinary tract infection, 4, 153 Urinate, 152, 154 Urine, 11, 14, 118, 126, 134, 136, 140, 153, 154 Urokinase, 11, 25, 154 Urticaria, 115, 154 Uterus, 139, 141, 154 Utilization Review, 19, 154 Uvula, 149, 154 V Vaccine, 113, 146, 154 Vagina, 126, 136, 154 Vascular, 55, 114, 115, 120, 128, 134, 140, 154 Vasculitis, 141, 154 Vasodilator, 114, 116, 119, 127, 133, 154 Vein, 144, 150, 154 Venous, 140, 146, 154 Veterinary Medicine, 93, 154 Virulence, 152, 154 Viruses, 113, 117, 138, 154 Visceral, 94, 154 Viscosity, 25, 31, 42, 46, 61, 154 Vitamin A, 68, 154 Vitro, 26, 154 W Weight Gain, 6, 67, 154 Withdrawal, 14, 154 X Xanthines, 71, 155 X-ray, 119, 147, 150, 155

166 Laxatives

Index 167

168 Laxatives