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

ENEMAS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N. P A...

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Enemas: 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: 0-597-83703-1 1. Enemas-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 enemas. 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 ENEMAS .................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Enemas.......................................................................................... 4 E-Journals: PubMed Central ......................................................................................................... 4 The National Library of Medicine: PubMed .................................................................................. 5 CHAPTER 2. NUTRITION AND ENEMAS........................................................................................... 47 Overview...................................................................................................................................... 47 Finding Nutrition Studies on Enemas......................................................................................... 47 Federal Resources on Nutrition ................................................................................................... 51 Additional Web Resources ........................................................................................................... 51 CHAPTER 3. ALTERNATIVE MEDICINE AND ENEMAS .................................................................... 53 Overview...................................................................................................................................... 53 National Center for Complementary and Alternative Medicine.................................................. 53 Additional Web Resources ........................................................................................................... 58 General References ....................................................................................................................... 61 CHAPTER 4. CLINICAL TRIALS AND ENEMAS ................................................................................. 63 Overview...................................................................................................................................... 63 Recent Trials on Enemas.............................................................................................................. 63 Keeping Current on Clinical Trials ............................................................................................. 64 CHAPTER 5. PATENTS ON ENEMAS ................................................................................................. 67 Overview...................................................................................................................................... 67 Patents on Enemas....................................................................................................................... 67 Patent Applications on Enemas ................................................................................................... 90 Keeping Current .......................................................................................................................... 92 CHAPTER 6. BOOKS ON ENEMAS ..................................................................................................... 93 Overview...................................................................................................................................... 93 Book Summaries: Federal Agencies.............................................................................................. 93 Book Summaries: Online Booksellers........................................................................................... 94 The National Library of Medicine Book Index ............................................................................. 95 Chapters on Enemas..................................................................................................................... 95 CHAPTER 7. MULTIMEDIA ON ENEMAS ........................................................................................ 103 Overview.................................................................................................................................... 103 Video Recordings ....................................................................................................................... 103 Bibliography: Multimedia on Enemas ....................................................................................... 104 CHAPTER 8. PERIODICALS AND NEWS ON ENEMAS ..................................................................... 105 Overview.................................................................................................................................... 105 News Services and Press Releases.............................................................................................. 105 Newsletter Articles .................................................................................................................... 107 Academic Periodicals covering Enemas ..................................................................................... 108 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 111 Overview.................................................................................................................................... 111 U.S. Pharmacopeia..................................................................................................................... 111 Commercial Databases ............................................................................................................... 113 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 117 Overview.................................................................................................................................... 117 NIH Guidelines.......................................................................................................................... 117 NIH Databases........................................................................................................................... 119 Other Commercial Databases..................................................................................................... 121 APPENDIX B. PATIENT RESOURCES ............................................................................................... 123

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Overview.................................................................................................................................... 123 Patient Guideline Sources.......................................................................................................... 123 Finding Associations.................................................................................................................. 125 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 127 Overview.................................................................................................................................... 127 Preparation................................................................................................................................. 127 Finding a Local Medical Library................................................................................................ 127 Medical Libraries in the U.S. and Canada ................................................................................. 127 ONLINE GLOSSARIES................................................................................................................ 133 Online Dictionary Directories ................................................................................................... 133 ENEMAS DICTIONARY.............................................................................................................. 135 INDEX .............................................................................................................................................. 175

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

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

End of Barium Enemas? (editorial) Source: New England Journal of Medicine. 342(24): 1823-1824. June 15, 2000. Summary: This editorial comments on an article published in the same journal describing the use of barium enema versus colonoscopy for diagnostic uses. The editorial author notes that whether or not colonoscopy is a better way to examine the colon, it has been replacing barium enemas in recent years. The appeal of endoscopic technology, the ability to detect and remove lesions during a single procedure, and the influence of the gastroenterology community have been persuasive. In the research article on the accuracy of barium enema versus colonoscopy, barium enema did not fare well, especially in the identification of small polyps. The commentary author discusses the generalization of results, the problem of translating the procedures to typical clinical practice (rather than the research procedures, which were performed by a hand picked

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group of top technicians), and the recent finding that some colorectal cancers may arise from flat adenomas. The author concludes that the ability of barium enema to detect clinically important polyps is not good enough to use this method for the surveillance of patients who are increased risk for polyps or for a diagnostic evaluation of the colon. Barium enema may still have a role in screening (where expectations regarding the accuracy of findings are not as high) but it is unclear exactly what this role should be. 9 references.

Federally Funded Research on Enemas The U.S. Government supports a variety of research studies relating to enemas. 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 enemas. 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 enemas.

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “enemas” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for enemas in the PubMed Central database: •

A randomised trial of hospital versus home administered enemas for flexible sigmoidoscopy. by Lund JN, Buckley D, Bennett D, Maxwell-Armstrong C, Smith A, Tierney G, Scholefield J.; 1998 Oct 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28703

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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). 3 Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 4

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

Studies

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Single blind, randomised trial of efficacy and acceptability of oral Picolax versus self administered phosphate enema in bowel preparation for flexible sigmoidoscopy screening. by Atkin WS, Hart A, Edwards R, Cook CF, Wardle J, McIntyre P, Aubrey R, Baron C, Sutton S, Cuzick J, Senapati A, Northover JM.; 2000 Jun 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27392

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.6 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 enemas, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “enemas” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for enemas (hyperlinks lead to article summaries): •

4-Aminosalicylic acid enemas for ulcerative colitis. Author(s): Sharma MP, Duphare HV. Source: Lancet. 1989 February 25; 1(8635): 450. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2563834&dopt=Abstract

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4-Aminosalicylic acid retention enemas in treatment of distal colitis. Author(s): Gandolfo J, Farthing M, Powers G, Eagen K, Goldberg M, Berman P, Kaplan M. Source: Digestive Diseases and Sciences. 1987 July; 32(7): 700-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3297574&dopt=Abstract

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5-Aminosalicylic acid as enemas or suppositories in distal ulcerative colitis? Author(s): Campieri M, Gionchetti P, Belluzzi A, Brignola C, Tabanelli GM, Miglioli M, Barbara L. Source: Journal of Clinical Gastroenterology. 1988 August; 10(4): 406-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3418088&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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5-Aminosalicylic acid enemas in distal colitis. Author(s): Rao SS. Source: Gastroenterology. 1988 December; 95(6): 1698-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3181693&dopt=Abstract

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5-Aminosalicylic acid enemas in patients with active ulcerative colitis. Influence of acidity on the kinetic pattern. Author(s): Bondesen S, Nielsen OH, Jacobsen O, Rasmussen SN, Hansen SH, Halskov S, Binder V, Hvidberg EF. Source: Scandinavian Journal of Gastroenterology. 1984 July; 19(5): 677-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6382570&dopt=Abstract

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5-Aminosalicylic acid enemas in refractory distal ulcerative colitis: a randomized, controlled trial. Author(s): Friedman LS, Richter JM, Kirkham SE, DeMonaco HJ, May RJ. Source: The American Journal of Gastroenterology. 1986 June; 81(6): 412-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3518408&dopt=Abstract

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5-Aminosalicylic acid enemas in refractory distal ulcerative colitis: long-term results. Author(s): Guarino J, Chatzinoff M, Berk T, Friedman LS. Source: The American Journal of Gastroenterology. 1987 August; 82(8): 732-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3496786&dopt=Abstract

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5-Aminosalicylic acid enemas in treatment of distal ulcerative colitis and proctitis in Canada. Author(s): Sutherland LR, Martin F. Source: Digestive Diseases and Sciences. 1987 December; 32(12 Suppl): 64S-66S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3319459&dopt=Abstract

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5-Aminosalicylic acid enemas to maintain remission in left-sided ulcerative colitis: a meta- and economic analysis. Author(s): Trallori G, Messori A, Scuffi C, Bardazzi G, Silvano R, d'Albasio G, Pacini F. Source: Journal of Clinical Gastroenterology. 1995 April; 20(3): 257-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7797841&dopt=Abstract

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5-Aminosalicylic acid enemas: effective agent in maintaining remission in left-sided ulcerative colitis. Author(s): Biddle WL, Greenberger NJ, Swan JT, McPhee MS, Miner PB Jr. Source: Gastroenterology. 1988 April; 94(4): 1075-9. Erratum In: Gastroenterology 1989 June; 96(6): 1630. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3278942&dopt=Abstract

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5-ASA enemas for refractory distal ulcerative colitis. An open trial. Author(s): Kandel G, Prokipchuk EJ. Source: Journal of Clinical Gastroenterology. 1987 October; 9(5): 536-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3680902&dopt=Abstract

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A case of diversion colitis treated with 5-aminosalicylic acid enemas. Author(s): Tripodi J, Gorcey S, Burakoff R. Source: The American Journal of Gastroenterology. 1992 May; 87(5): 645-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1595655&dopt=Abstract

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A comparison of bowel preparations for flexible sigmoidoscopy: oral magnesium citrate combined with oral bisacodyl, one hypertonic phosphate enema, or two hypertonic phosphate enemas. Author(s): Fincher RK, Osgard EM, Jackson JL, Strong JS, Wong RK. Source: The American Journal of Gastroenterology. 1999 August; 94(8): 2122-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10445538&dopt=Abstract

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A comparison of conventional and double contrast barium enemas. Author(s): Young JR, Stabler J, Hazeldine WM, Duncan AW, Simpson W, Clarke PA. Source: Clinical Radiology. 1973 July; 24(3): 318-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4730222&dopt=Abstract

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A comparison of prednisolone enemas with low-dose oral prednisolone in the treatment of acute distal ulcerative colitis. Author(s): Hamilton I, Pinder IF, Dickinson RJ, Ruddell WS, Dixon MF, Axon AT. Source: Diseases of the Colon and Rectum. 1984 November; 27(11): 701-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6499602&dopt=Abstract

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A comparison of sucralfate and prednisolone enemas in the treatment of active distal ulcerative colitis. Author(s): Riley SA, Gupta I, Mani V. Source: Scandinavian Journal of Gastroenterology. 1989 October; 24(8): 1014-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2688065&dopt=Abstract

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A controlled randomized trial of budesonide versus prednisolone retention enemas in active distal ulcerative colitis. Author(s): Danielsson A, Hellers G, Lyrenas E, Lofberg R, Nilsson A, Olsson O, Olsson SA, Persson T, Salde L, Naesdal J, et al. Source: Scandinavian Journal of Gastroenterology. 1987 October; 22(8): 987-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3317784&dopt=Abstract

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A controlled trial of beclomethasone versus betamethasone enemas in distal ulcerative colitis. Author(s): Halpern Z, Sold O, Baratz M, Konikoff F, Halak A, Gilat T. Source: Journal of Clinical Gastroenterology. 1991 February; 13(1): 38-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2007742&dopt=Abstract

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A double-blind randomised, placebo-controlled trial evaluating the influence of oral long-acting muscle relaxant (Mebeverine MR), and insufflation with CO(2) on pain associated with barium enema. Author(s): Lowe AS, Chapman AH, Wilson D, Culpan AG. Source: European Radiology. 2003 July; 13(7): 1664-8. Epub 2003 January 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835983&dopt=Abstract

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A new positioning technique for barium enemas. Author(s): Hughes T. Source: The British Journal of Radiology. 1990 September; 63(753): 723. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2400899&dopt=Abstract

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A new universal colostomy tip for barium enemas of the colon. Author(s): Williams JT, Scott RL. Source: Ajr. American Journal of Roentgenology. 2003 May; 180(5): 1330-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12704045&dopt=Abstract

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A new, disposable catheter for selective guided barium enemas. Contrast examinations in patients with colostomies, rectal lesions and fistulas and for pediatric colon studies. Author(s): Pochaczevsky R, Meyers PH. Source: Am J Roentgenol Radium Ther Nucl Med. 1972 June; 115(2): 392-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5037802&dopt=Abstract

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A placebo-controlled trial of cyclosporine enemas for mildly to moderately active leftsided ulcerative colitis. Author(s): Sandborn WJ, Tremaine WJ, Schroeder KW, Batts KP, Lawson GM, Steiner BL, Harrison JM, Zinsmeister AR. Source: Gastroenterology. 1994 June; 106(6): 1429-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8194687&dopt=Abstract

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A prospective randomized double blind trial comparing prednisolone and 4aminosalicylic acid enemas in acute distal ulcerative colitis. Author(s): Sharma MP, Duphare HV, Dasarathy S. Source: Journal of Gastroenterology and Hepatology. 1992 March-April; 7(2): 173-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1571500&dopt=Abstract

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A randomised trial comparing mesalazine and prednisolone foam enemas in patients with acute distal ulcerative colitis. Author(s): Lee FI, Jewell DP, Mani V, Keighley MR, Kingston RD, Record CO, Grace RH, Daniels S, Patterson J, Smith K. Source: Gut. 1996 February; 38(2): 229-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8801202&dopt=Abstract

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A randomised trial of hospital versus home administered enemas for flexible sigmoidoscopy. Author(s): Lund JN, Buckley D, Bennett D, Maxwell-Armstrong C, Smith A, Tierney G, Scholefield J. Source: Bmj (Clinical Research Ed.). 1998 October 31; 317(7167): 1201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9794856&dopt=Abstract

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A re-audit of examination dose and screening time of radiographer-performed barium enemas. Author(s): Robertson MA, Bleakney RR, Duncan KA. Source: Clinical Radiology. 2000 June; 55(6): 492. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10873702&dopt=Abstract

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A survey of double contrast barium enemas at Bristol Royal Infirmary. Author(s): Stoddart PG, Virjee J. Source: Bristol Med Chir J. 1983 October; 98(368): 173-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6640379&dopt=Abstract

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Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind, randomized clinical trial. Author(s): Uribe M, Campollo O, Vargas F, Ravelli GP, Mundo F, Zapata L, Gil S, Garcia-Ramos G. Source: Hepatology (Baltimore, Md.). 1987 July-August; 7(4): 639-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3301614&dopt=Abstract

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Acute colonic necrosis associated with sodium polystyrene sulfonate (Kayexalate) enemas in a critically ill patient: case report and review of the literature. Author(s): Rogers FB, Li SC. Source: The Journal of Trauma. 2001 August; 51(2): 395-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11493807&dopt=Abstract

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Acute hepatotoxicity of tannic acid added to barium enemas. Author(s): Eshchar J, Friedman G. Source: Am J Dig Dis. 1974 September; 19(9): 825-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4850412&dopt=Abstract

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Addition of enemas to oral lavage preparation for colonoscopy is not necessary. Author(s): Lever EL, Walter MH, Condon SC, Balasubramaniam K, Chen YK, Mitchell RD, Herber R, Collen MJ. Source: Gastrointestinal Endoscopy. 1992 May-June; 38(3): 369-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1607091&dopt=Abstract

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Air versus carbon dioxide insufflation in double contrast barium enemas: the role of active gaseous drainage. Author(s): Jobling JC. Source: The British Journal of Radiology. 1996 January; 69(817): 89-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8785634&dopt=Abstract

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Air versus carbon dioxide insufflation in double contrast barium enemas: the role of active gaseous drainage. Author(s): Farrow R, Jones AM, Wallace DA, Virjee JP. Source: The British Journal of Radiology. 1995 August; 68(812): 838-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7551779&dopt=Abstract

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An alternative method of bowel preparation for barium enemas. Author(s): King DM, Downes MO, Heddle RM. Source: The British Journal of Radiology. 1979 May; 52(617): 388-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=376027&dopt=Abstract

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An analysis of 200 patients with negative small bowel enemas. Author(s): Vallance R, Smith RM. Source: Clinical Radiology. 1981 March; 32(2): 183-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7214834&dopt=Abstract

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An efficacy study of the use of clysodrast in barium enemas. Author(s): Janower ML. Source: Radiology. 1973 March; 106(3): 704. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4567836&dopt=Abstract

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An open-labeled, randomized study comparing systemic interferon-alpha-2A and prednisolone enemas in the treatment of left-sided ulcerative colitis. Author(s): Madsen SM, Schlichting P, Davidsen B, Nielsen OH, Federspiel B, Riis P, Munkholm P. Source: The American Journal of Gastroenterology. 2001 June; 96(6): 1807-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11419834&dopt=Abstract

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Antegrade colonic enemas. Author(s): Dick AC, McCallion WA, Brown S, Boston VE. Source: The British Journal of Surgery. 1996 May; 83(5): 642-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8689207&dopt=Abstract

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Antegrade continence enemas in the management of intractable faecal incontinence. Author(s): Kiely EM, Ade-Ajayi N, Wheeler R. Source: Journal of the Royal Society of Medicine. 1995 February; 88(2): 103P-104P. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7769583&dopt=Abstract

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

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Antegrade enemas for the treatment of severe idiopathic constipation. Author(s): Hughes SF, Williams NS. Source: The British Journal of Surgery. 1995 April; 82(4): 567. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7613913&dopt=Abstract

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Antegrade enemas for the treatment of severe idiopathic constipation. Author(s): Hill J, Stott S, MacLennan I. Source: The British Journal of Surgery. 1994 October; 81(10): 1490-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7820481&dopt=Abstract

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Antispasmodic drugs to reduce discomfort and colonic spasm during barium enemas: comparison of oral hyoscyamine, i.v. glucagon, and no drug. Author(s): Bova JG, Jurdi RA, Bennett WF. Source: Ajr. American Journal of Roentgenology. 1993 November; 161(5): 965-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8273637&dopt=Abstract

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Are enemas given before abdominal operations useful? A prospective randomised trail. Author(s): Mosimann F, Cornu P. Source: The European Journal of Surgery = Acta Chirurgica. 1998 July; 164(7): 527-30; Discussion 531-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9696975&dopt=Abstract

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Are enemas justified for women in labor? Author(s): Whitley N, Mack E. Source: The American Journal of Nursing. 1980 July; 80(7): 1339. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6901585&dopt=Abstract

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Are enemas necessary? Author(s): Duffin HM, Castleden CM, Chaudhry AY. Source: Nurs Times. 1981 November 4-10; 77(45): 1940-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6914576&dopt=Abstract

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Are short-chain fatty acid enemas effective for left-sided ulcerative colitis? Author(s): Sandborn WJ. Source: Gastroenterology. 1998 January; 114(1): 218-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9428236&dopt=Abstract

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Availability of mesalazine (5-aminosalicylic acid) from enemas and suppositories during steady-state conditions. Author(s): Jacobsen BA, Abildgaard K, Rasmussen HH, Christensen LA, Fallingborg J, Hansen SH, Rasmussen SN. Source: Scandinavian Journal of Gastroenterology. 1991 April; 26(4): 374-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2034991&dopt=Abstract

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Avascular necrosis of bilateral knees secondary to corticosteroid enemas. Author(s): Braverman DL, Lachmann EA, Nagler W. Source: Archives of Physical Medicine and Rehabilitation. 1998 April; 79(4): 449-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9552113&dopt=Abstract

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Avoidance of leakage and strictures when creating an invisible conduit for antegrade colonic enemas. Author(s): Shaul DB, Harrison EA, Muenchow SK. Source: Journal of Pediatric Surgery. 2002 December; 37(12): 1768-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12483653&dopt=Abstract

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Barium enemas are a headache. Author(s): Spencer JA, Nolan DJ. Source: Clinical Radiology. 1988 May; 39(3): 355. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3396295&dopt=Abstract

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Barium enemas are a headache. Author(s): Kutt E, Hall MJ, Booth A, Virjee J. Source: Clinical Radiology. 1988 January; 39(1): 9-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3338244&dopt=Abstract

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Barium enemas in older patients. Author(s): Merine D. Source: Ajr. American Journal of Roentgenology. 1991 July; 157(1): 197. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2048523&dopt=Abstract

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Barium enemas in the frail elderly. Author(s): Gurwitz JH, Noonan JP, Sanchez M, Prather W. Source: The American Journal of Medicine. 1992 January; 92(1): 41-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1731508&dopt=Abstract

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Barium enemas of carcinoma of the colon: sensitivity of double- and single-contrast studies. Author(s): Johnson CD, Carlson HC, Taylor WF, Weiland LP. Source: Ajr. American Journal of Roentgenology. 1983 June; 140(6): 1143-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6602483&dopt=Abstract

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Barium enemas, latex balloons, and anaphylactic reactions. Author(s): Gelfand DW. Source: Ajr. American Journal of Roentgenology. 1991 January; 156(1): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1898540&dopt=Abstract

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Barium-hypaque enemas--a reasonable approach? A controlled double blind study. Author(s): Moskowitz M, Spitz HB, King A, Bahr GK. Source: J Can Assoc Radiol. 1973 September; 24(3): 223-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4584649&dopt=Abstract

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Beclomethasone dipropionate (3 mg) enemas combined with oral 5-ASA (2.4 g) in the treatment of ulcerative colitis not responsive to oral 5-ASA alone. Author(s): D'Arienzo A, Manguso F, Castiglione GN, Vicinanza G, Scaglione G, Bennato R, Sanges M, Mazzacca G. Source: Ital J Gastroenterol Hepatol. 1998 June; 30(3): 254-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9759590&dopt=Abstract

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Beclomethasone dipropionate (3 mg) versus 5-aminosalicylic acid (2 g) versus the combination of both (3 mg/2 g) as retention enemas in active ulcerative proctitis. Author(s): Mulder CJ, Fockens P, Meijer JW, van der Heide H, Wiltink EH, Tytgat GN. Source: European Journal of Gastroenterology & Hepatology. 1996 June; 8(6): 549-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8823568&dopt=Abstract

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Beclomethasone dipropionate enemas for treating inflammatory bowel disease without producing Cushing's syndrome or hypothalamic pituitary adrenal suppression. Author(s): Kumana CR, Seaton T, Meghji M, Castelli M, Benson R, Sivakumaran T. Source: Lancet. 1982 March 13; 1(8272): 579-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6121181&dopt=Abstract

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Beclomethasone dipropionate enemas versus prednisolone sodium phosphate enemas in the treatment of distal ulcerative colitis. Author(s): Campieri M, Cottone M, Miglio F, Manenti F, Astegiano M, D'Arienzo A, Manguso F, D'Albasio G, Bonanomi A, Galeazzi R, Orlando A, Castiglione GN, Gionchetti P. Source: Alimentary Pharmacology & Therapeutics. 1998 April; 12(4): 361-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9690726&dopt=Abstract

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Best practice in barium enemas. Author(s): Conteh AK, Henwood S. Source: Nurs Times. 2000 June 1-7; 96(22): 34-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11962794&dopt=Abstract

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Bioavailability of hydrocortisone retention enemas in normal subjects. Author(s): Lima JJ, Giller J, Mackichan JJ, Jusko WJ. Source: The American Journal of Gastroenterology. 1980 March; 73(3): 232-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7405924&dopt=Abstract

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Bioavailability of hydrocortisone retention enemas in relation to absorption kinetics. Author(s): Lima JJ, Jusko WJ. Source: Clinical Pharmacology and Therapeutics. 1980 August; 28(2): 262-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7398193&dopt=Abstract

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Bismuth carbomer foam enemas for active chronic pouchitis: a randomized, doubleblind, placebo-controlled trial. Author(s): Tremaine WJ, Sandborn WJ, Wolff BG, Carpenter HA, Zinsmeister AR, Metzger PP. Source: Alimentary Pharmacology & Therapeutics. 1997 December; 11(6): 1041-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9663827&dopt=Abstract

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Bowel preparation for barium enemas. Author(s): Farrow R, Troughton AH. Source: Clinical Radiology. 1994 December; 49(12): 905. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7828405&dopt=Abstract

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Budesonide versus prednisolone retention enemas in active distal ulcerative colitis. Author(s): Lofberg R, Ostergaard Thomsen O, Langholz E, Schioler R, Danielsson A, Suhr O, Graffner H, Pahlman L, Matzen P, Moller-Petersen JF, et al. Source: Alimentary Pharmacology & Therapeutics. 1994 December; 8(6): 623-9. Erratum In: Aliment Pharmacol Ther 1995 April; 9(2): 213. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7696452&dopt=Abstract

Studies

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Caecal flap conduit for antegrade continence enemas. Author(s): Kiely EM, Ade-Ajayi N, Wheeler RA. Source: The British Journal of Surgery. 1994 August; 81(8): 1215. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7953366&dopt=Abstract

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Carbon dioxide methods of double contrast barium enemas. Author(s): Pochaczevsky R. Source: Clinical Radiology. 1989 November; 40(6): 656-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2513161&dopt=Abstract

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Catheters for barium enemas. Author(s): Janower ML. Source: Ajr. American Journal of Roentgenology. 1991 July; 157(1): 196. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2048521&dopt=Abstract

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Cecal access for antegrade colon enemas in medically refractory slow-transit constipation: a prospective study. Author(s): Rongen MJ, van der Hoop AG, Baeten CG. Source: Diseases of the Colon and Rectum. 2001 November; 44(11): 1644-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11711737&dopt=Abstract

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Cecal perforation associated with sodium polystyrene sulfonate-sorbitol enemas in a 650 gram infant with hyperkalemia. Author(s): Bennett LN, Myers TF, Lambert GH. Source: American Journal of Perinatology. 1996 April; 13(3): 167-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8688109&dopt=Abstract

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Changes in the rectal mucosa induced by hypertonic enemas. Author(s): Leriche M, Devroede G, Sanchez G, Rossano J. Source: Diseases of the Colon and Rectum. 1978 May-June; 21(4): 227-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=657932&dopt=Abstract

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Choice and predictability in the preparation for barium enemas: a person-by-situation approach. Author(s): Wallston BS, Smith RA, Wallston KA, King JE, Rye PD, Heim CR. Source: Research in Nursing & Health. 1987 February; 10(1): 13-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3644367&dopt=Abstract

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Cleansing enemas after sodium polystyrene sulfonate enemas. Author(s): Shepard KV. Source: Annals of Internal Medicine. 1990 May 1; 112(9): 711. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2334084&dopt=Abstract

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Colon perforations occurring during sigmoidoscopic examinations and barium enemas. Author(s): Kiser JL, Spratt JS Jr, Johnson CA. Source: Mo Med. 1968 December; 65(12): 969-74. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5724177&dopt=Abstract

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Colonic cleansing, fluid absorption, and discomfort following tap water and soapsuds enemas. Author(s): Schmelzer M, Case P, Chappell SM, Wright KB. Source: Applied Nursing Research : Anr. 2000 May; 13(2): 83-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10842904&dopt=Abstract

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Colonic mucosal slough following detergent enemas. Author(s): Toffler RB, Barry JM. Source: The American Journal of Gastroenterology. 1972 December; 58(6): 638-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4648408&dopt=Abstract

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Colonic necrosis with Kayexalate-sorbitol enemas after renal transplantation. Author(s): Wootton FT, Rhodes DF, Lee WM, Fitts CT. Source: Annals of Internal Medicine. 1989 December 1; 111(11): 947-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2817643&dopt=Abstract

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Colonic spread of 5-ASA enemas in healthy individuals, with a comparison of their physical and chemical characteristics. Author(s): Otten MH, De Haas G, Van den Ende R. Source: Alimentary Pharmacology & Therapeutics. 1997 August; 11(4): 693-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9305477&dopt=Abstract

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Colonoscopy and barium enemas. Author(s): Aldridge MC, Sim AJ. Source: Lancet. 1986 December 6; 2(8519): 1331-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2878193&dopt=Abstract

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Colonoscopy and barium enemas. Author(s): Marshak RH. Source: Annals of Internal Medicine. 1979 May; 90(5): 856-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=434705&dopt=Abstract

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Combined therapy with 5-aminosalicylic acid tablets and enemas for maintaining remission in ulcerative colitis: a randomized double-blind study. Author(s): d'Albasio G, Pacini F, Camarri E, Messori A, Trallori G, Bonanomi AG, Bardazzi G, Milla M, Ferrero S, Biagini M, Quaranta S, Amorosi A. Source: The American Journal of Gastroenterology. 1997 July; 92(7): 1143-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9219787&dopt=Abstract

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Combined therapy with 5-aminosalicylic tablets and enemas for maintaining remission in ulcerative colitis. Author(s): d'Albasio G, Trallori G, Gavazzi O, Bardazzi G, Vannozzi G, Frittelli G, Cini E, Falai T, Varini C, Morettini A. Source: Ital J Gastroenterol. 1991 January; 23(1): 12-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1747494&dopt=Abstract

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Comparative efficacy of glycerin enemas and suppository chips in neonates. Author(s): Zenk KE, Koeppel RM, Liem LA. Source: Clin Pharm. 1993 November; 12(11): 846-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8275649&dopt=Abstract

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Comparative trial of sodium cromoglycate enemas with prednisolone enemas in the treatment of ulcerative colitis. Author(s): Grace RH, Gent AE, Hellier MD. Source: Gut. 1987 January; 28(1): 88-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3102323&dopt=Abstract

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Comparison of 5-aminosalicylic acid (3 g) and prednisolone phosphate sodium enemas (30 mg) in the treatment of distal ulcerative colitis. A prospective, randomized, double-blind trial. Author(s): Mulder CJ, Tytgat GN, Wiltink EH, Houthoff HJ. Source: Scandinavian Journal of Gastroenterology. 1988 October; 23(8): 1005-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3059450&dopt=Abstract

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Comparison of beclomethasone dipropionate (2 and 3 mg) and prednisolone sodium phosphate enemas (30 mg) in the treatment of ulcerative proctitis. An adrenocortical approach. Author(s): Mulder CJ, Endert E, van der Heide H, Houthoff HJ, Wiersinga W, Wiltink EH, Tytgat GN. Source: The Netherlands Journal of Medicine. 1989 August; 35(1-2): 18-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2779692&dopt=Abstract

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Comparison of beclomethasone dipropionate and prednisolone 21-phosphate enemas in the treatment of ulcerative proctitis. Author(s): van der Heide H, van den Brandt-Gradel V, Tytgat GN, Endert E, Wiltink EH, Schipper ME, Dekker W. Source: Journal of Clinical Gastroenterology. 1988 April; 10(2): 169-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3047215&dopt=Abstract

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Comparison of bismuth citrate and 5-aminosalicylic acid enemas in distal ulcerative colitis: a controlled trial. Author(s): Pullan RD, Ganesh S, Mani V, Morris J, Evans BK, Williams GT, Rhodes J. Source: Gut. 1993 May; 34(5): 676-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8504970&dopt=Abstract

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Comparison of budesonide and 5-aminosalicylic acid enemas in active distal ulcerative colitis. Author(s): Lemann M, Galian A, Rutgeerts P, Van Heuverzwijn R, Cortot A, Viteau JM, Elewaut A, Belaiche J, Froguel E, Modigliani R. Source: Alimentary Pharmacology & Therapeutics. 1995 October; 9(5): 557-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8580278&dopt=Abstract

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Comparison of rigid and flexible fibreoptic sigmoidoscopy with double contrast barium enemas. Author(s): Vellacott KD, Amar SS, Hardcastle JD. Source: The British Journal of Surgery. 1982 July; 69(7): 399-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7104610&dopt=Abstract

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Computerized planimetry in the objective assessment of the antispasmodic effect of Zamifenacin in double contrast barium enemas. Author(s): Hughes T, Wright AR, Owen JP, Keir MJ. Source: The British Journal of Radiology. 1996 April; 69(820): 301-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8665128&dopt=Abstract

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Connatal rickets following repeated administration of phosphate enemas in pregnancy: a case report. Author(s): Rimensberger P, Schubiger G, Willi U. Source: European Journal of Pediatrics. 1992 January; 151(1): 54-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1728548&dopt=Abstract

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Constipation in long-stay elderly patients: its treatment and prevention by lactulose, poloxalkol-dihydroxyanthroquinolone and phosphate enemas. Author(s): Brocklehurst JC, Kirkland JL, Martin J, Ashford J. Source: Gerontology. 1983; 29(3): 181-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6852545&dopt=Abstract

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Contrast enemas after necrotising enterocolitis: a case for prophylaxis? Author(s): Brand IR, Arthur RJ. Source: Pediatric Radiology. 1992; 22(8): 571-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1491930&dopt=Abstract

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Contrast enemas in cystic fibrosis: implications of appendiceal nonfilling. Author(s): Fletcher BD, Abramowsky CR. Source: Ajr. American Journal of Roentgenology. 1981 August; 137(2): 323-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6789640&dopt=Abstract

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Cost effectiveness of barium enemas performed by radiographers. Author(s): Troughton A. Source: Clinical Radiology. 2002 September; 57(9): 866; Author Reply 866. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12384124&dopt=Abstract

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Cost-effectiveness of barium enemas performed by radiographers. Author(s): Brown L, Desai S. Source: Clinical Radiology. 2002 February; 57(2): 129-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11977946&dopt=Abstract

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Cyclosporin A retention enemas in refractory distal ulcerative colitis and 'pouchitis'. Author(s): Winter TA, Dalton HR, Merrett MN, Campbell A, Jewell DP. Source: Scandinavian Journal of Gastroenterology. 1993 August; 28(8): 701-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8210986&dopt=Abstract

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Cyclosporine enemas for treatment-resistant, mildly to moderately active, left-sided ulcerative colitis. Author(s): Sandborn WJ, Tremaine WJ, Schroeder KW, Steiner BL, Batts KP, Lawson GM. Source: The American Journal of Gastroenterology. 1993 May; 88(5): 640-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8480724&dopt=Abstract

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Dangers of hydrogen peroxide in enemas or lavage. Author(s): Shaw A, Danis R. Source: Pediatrics. 1967 January; 39(1): 146. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6016225&dopt=Abstract

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Dexpanthenol enemas in ulcerative colitis: a pilot study. Author(s): Loftus EV Jr, Tremaine WJ, Nelson RA, Shoemaker JD, Sandborn WJ, Phillips SF, Hasan Y. Source: Mayo Clinic Proceedings. 1997 July; 72(7): 616-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9212762&dopt=Abstract

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Diagnosis of colorectal neoplasms on double-contrast barium enemas: interpretive aspects. Author(s): Levine MS, Rubesin SE. Source: Semin Roentgenol. 2000 October; 35(4): 357-69. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11060922&dopt=Abstract

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Diagnostic yield from barium enemas: a study among patients referred by general practitioners and hospital outpatient departments. Author(s): Wafula JM. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1992 August; 42(361): 330-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1457154&dopt=Abstract

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Disodium cromoglycate and prednisolone enemas in the treatment of ulcerative colitis. Author(s): Bianchi Porro G, Petrillo M. Source: Gut. 1987 October; 28(10): 1323. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3119433&dopt=Abstract

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Distribution of mesalamine enemas in patients with active distal ulcerative colitis. Author(s): Chapman NJ, Brown ML, Phillips SF, Tremaine WJ, Schroeder KW, Dewanjee MK, Zinsmeister AR. Source: Mayo Clinic Proceedings. 1992 March; 67(3): 245-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1545592&dopt=Abstract

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Distribution of mesalazine enemas in active and quiescent ulcerative colitis. Author(s): van Bodegraven AA, Boer RO, Lourens J, Tuynman HA, Sindram JW. Source: Alimentary Pharmacology & Therapeutics. 1996 June; 10(3): 327-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8791959&dopt=Abstract

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Dose-ranging study of mesalamine (PENTASA) enemas in the treatment of acute ulcerative proctosigmoiditis: results of a multicentered placebo-controlled trial. The U.S. PENTASA Enema Study Group. Author(s): Hanauer SB. Source: Inflammatory Bowel Diseases. 1998 May; 4(2): 79-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9589293&dopt=Abstract

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Double blind, controlled trial of 4-aminosalicylic acid and prednisolone enemas in distal ulcerative colitis. Author(s): O'Donnell LJ, Arvind AS, Hoang P, Cameron D, Talbot IC, Jewell DP, Lennard-Jones JE, Farthing MJ. Source: Gut. 1992 July; 33(7): 947-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1644335&dopt=Abstract

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Double reading of certain examinations such as barium enemas and mammograms can increase sensitivity at the expense of specificity. Author(s): Federle MP, Gur D. Source: Ajr. American Journal of Roentgenology. 1995 May; 164(5): 1291-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7717250&dopt=Abstract

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Double-contrast enemas in children: the “knee-chest” view of the rectosigmoid colon. Author(s): Bowen A 3rd. Source: Pediatric Radiology. 1979 October; 8(4): 225-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=514678&dopt=Abstract

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Effect of butyrate enemas on the colonic mucosa in distal ulcerative colitis. Author(s): Scheppach W, Sommer H, Kirchner T, Paganelli GM, Bartram P, Christl S, Richter F, Dusel G, Kasper H. Source: Gastroenterology. 1992 July; 103(1): 51-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1612357&dopt=Abstract

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Effect of treatment on symptoms and quality of life in patients with ulcerative colitis: comparative trial of hydrocortisone acetate foam and prednisolone 21-phosphate enemas. Author(s): Somerville KW, Langman MJ, Kane SP, MacGilchrist AJ, Watkinson G, Salmon P. Source: British Medical Journal (Clinical Research Ed.). 1985 September 28; 291(6499): 866. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3931745&dopt=Abstract

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Efficacy of 5-aminosalicylic acid enemas versus hydrocortisone enemas in ulcerative colitis. Author(s): Campieri M, Gionchetti P, Belluzzi A, Brignola C, Migaldi M, Tabanelli GM, Bazzocchi G, Miglioli M, Barbara L. Source: Digestive Diseases and Sciences. 1987 December; 32(12 Suppl): 67S-70S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3319460&dopt=Abstract

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Efficacy of barium enemas in the elderly. Author(s): Rai GS. Source: The American Journal of Medicine. 1992 October; 93(4): 476. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1415315&dopt=Abstract

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Emergency treatment of portal-systemic encephalopathy with lactulose enemas. A controlled study. Author(s): Van Waes L, van Egmond J, Demeulenaere L. Source: Acta Clin Belg. 1979; 34(3): 122-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=506621&dopt=Abstract

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Encopresis, enemas, and gold stars. Author(s): Fleisher DR. Source: Pediatrics. 1978 January; 61(1): 155-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=263861&dopt=Abstract

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Enemas and myasthenia gravis. Author(s): Russell JG. Source: The British Journal of Radiology. 1983 June; 56(666): 431. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6850232&dopt=Abstract

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Enemas during labor. Author(s): Cuervo LG, Rodriguez MN, Delgado MB. Source: Cochrane Database Syst Rev. 2000; (2): Cd000330. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796195&dopt=Abstract

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Enemas for IBD maintenance therapy. Author(s): Sutherland LR, Martin F. Source: Digestive Diseases and Sciences. 1989 May; 34(5): 803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2714154&dopt=Abstract

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Enemas in management of acute diverticulitis. Author(s): Soled M. Source: Hosp Pract (Off Ed). 1991 April 30; 26(4A): 14. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2016374&dopt=Abstract

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Enemas not needed after oral lavage colonoscopy preparation. Author(s): Norfleet RG. Source: Gastrointestinal Endoscopy. 1993 May-June; 39(3): 466. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8514090&dopt=Abstract

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Enemas. Author(s): Kemp R. Source: The Practitioner. 1971 January; 206(231): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5540198&dopt=Abstract

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Enemas. Author(s): Tillery B, Bates B. Source: The American Journal of Nursing. 1966 March; 66(3): 534-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5175294&dopt=Abstract

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Epidermal growth factor enemas with oral mesalamine for mild-to-moderate leftsided ulcerative colitis or proctitis. Author(s): Sinha A, Nightingale J, West KP, Berlanga-Acosta J, Playford RJ. Source: The New England Journal of Medicine. 2003 July 24; 349(4): 350-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878742&dopt=Abstract

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Estimation of effective dose from dose-area product measurements for barium meals and barium enemas. Author(s): Hart D, Wall BF. Source: The British Journal of Radiology. 1994 May; 67(797): 485-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8193896&dopt=Abstract

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Evaluation of double contrast barium enemas performed by radiographic technologists. Author(s): Somers S, Stevenson GW, Laufer I, Gledhill L, Nugent J. Source: Can J Radiogr Radiother Nucl Med. 1982 May-June; 13(3): 110-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10255472&dopt=Abstract

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Evaluation of double contrast barium enemas performed by radiographic technologists. Author(s): Somers S, Stevenson GW, Laufer I, Gledhill L, Nugent J. Source: J Can Assoc Radiol. 1981 December; 32(4): 227-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7328102&dopt=Abstract

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Evaluation of enemas for exposing Aedes aegypti to suspensions of dengue-2 virus. Author(s): Putnam JL, Scott TW. Source: J Am Mosq Control Assoc. 1995 September; 11(3): 369-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8551311&dopt=Abstract

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Evaluation of short-chain fatty acid enemas: treatment of radiation proctitis. Author(s): al-Sabbagh R, Sinicrope FA, Sellin JH, Shen Y, Roubein L. Source: The American Journal of Gastroenterology. 1996 September; 91(9): 1814-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8792704&dopt=Abstract

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Failure of 5-aminosalicylic acid enemas to improve chronic radiation proctitis. Author(s): Baum CA, Biddle WL, Miner PB Jr. Source: Digestive Diseases and Sciences. 1989 May; 34(5): 758-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2714149&dopt=Abstract

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Fatal hypocalcemia from sodium phosphate enemas. Author(s): Selva O'Callaghan A, San Jose A, Simeon CP, Arruche M, Galicia M, Benavente V, Vilardell M. Source: Journal of the American Geriatrics Society. 1995 December; 43(12): 1447-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7490408&dopt=Abstract

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Five-aminosalicylic acid enemas in treatment of ulcerative colitis. Author(s): Fedotin MS. Source: Mo Med. 1985 June; 82(6): 301-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4010664&dopt=Abstract

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Fluid and serum electrolyte disturbances as a complication of enemas in Hirschsprung's disease. Author(s): Moseley PK, Segar WE. Source: Am J Dis Child. 1968 June; 115(6): 714-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5654519&dopt=Abstract

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Hair loss and 5-aminosalicylic acid enemas. Author(s): Kutty PK, Raman KR, Hawken K, Barrowman JA. Source: Annals of Internal Medicine. 1982 November; 97(5): 785-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7137750&dopt=Abstract

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Hazards connected with emptying of the colon. Abnormal hemodynamic reactionsfollowing enemas and laxatives in a patients with hyperactive carotid sinus reflexes. Author(s): Lonnum I. Source: J Oslo City Hosp. 1969 February-March; 19(2): 21-54. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5804935&dopt=Abstract

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Hematochezia associated with the use of hypertonic sodium polystyrene sulfonate enemas in premature infants. Author(s): Milley JR, Jung AL. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 1995 March-April; 15(2): 139-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7595773&dopt=Abstract

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High doses of 5-aminosalicylic acid enemas in chronic radiation proctitis: comparison with betamethasone enemas. Author(s): Triantafillidis JK, Dadioti P, Nicolakis D, Mericas E. Source: The American Journal of Gastroenterology. 1990 November; 85(11): 1537-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2239891&dopt=Abstract

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Hot, high and horrible. Should routine enemas still be given to women in labour? Author(s): Rutgers S. Source: Cent Afr J Med. 1993 June; 39(6): 117-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8131199&dopt=Abstract

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How do you prep the bowel without enemas? Author(s): Murray S, Preuss M, Schultz F. Source: The American Journal of Nursing. 1992 August; 92(8): 66-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1524111&dopt=Abstract

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How to administer enemas and suppositories. Author(s): Addison R. Source: Nurs Times. 2000 February 10; 96(6 Suppl): Suppl 3-4. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11962066&dopt=Abstract

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Hypernatremic dehydration from hypertonic enemas in congenital megacolon. Author(s): Fonkalsrud EW, Keen J. Source: Jama : the Journal of the American Medical Association. 1967 February 20; 199(8): 584-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6071327&dopt=Abstract

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Hyperphosphataemia after enemas in childhood: prevention and treatment. Author(s): Hunter MF, Ashton MR, Griffiths DM, Ilangovan P, Roberts JP, Walker V. Source: Archives of Disease in Childhood. 1993 February; 68(2): 233-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8481047&dopt=Abstract

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Hypocalcemic coma following two pediatric phosphate enemas. Author(s): Sotos JF, Cutler EA, Finkel MA, Doody D. Source: Pediatrics. 1977 September; 60(3): 305-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=896360&dopt=Abstract

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Hypocalcemic tetany following hypertonic phosphate enemas. Author(s): Honig PJ, Holtzapple PG. Source: Clinical Pediatrics. 1975 July; 14(7): 678-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1139852&dopt=Abstract

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Hypokalemia after hypertonic phosphate enemas. Author(s): Forman J, Baluarte HJ, Gruskin AB. Source: The Journal of Pediatrics. 1979 January; 94(1): 149-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=758398&dopt=Abstract

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Hyponatremia and perforation of the bowel following a series of water enemas. A case report in a 14-month-old infant. Author(s): Jacob J, Tully SB, Chapman B. Source: Clinical Pediatrics. 1976 September; 15(9): 776-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=954332&dopt=Abstract

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Ileoanal pouches: comparison of CT, scintigraphy, and contrast enemas for diagnosing postsurgical complications. Author(s): Thoeni RF, Fell SC, Engelstad B, Schrock TB. Source: Ajr. American Journal of Roentgenology. 1990 January; 154(1): 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2104730&dopt=Abstract

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Inadequate barium enemas in hospitalized elderly patients. Incidence and risk factors. Author(s): Tinetti ME, Stone L, Cooney L, Kapp MC. Source: Archives of Internal Medicine. 1989 September; 149(9): 2014-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2774779&dopt=Abstract

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Intermittent therapy with high-dose 5-aminosalicylic acid enemas for maintaining remission in ulcerative proctosigmoiditis. Author(s): d'Albasio G, Trallori G, Ghetti A, Milla M, Nucci A, Pacini F, Morettini A. Source: Diseases of the Colon and Rectum. 1990 May; 33(5): 394-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1970284&dopt=Abstract

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Intermittent therapy with high-dose 5-aminosalicylic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis. Author(s): Mantzaris GJ, Hatzis A, Petraki K, Spiliadi C, Triantaphyllou G. Source: Diseases of the Colon and Rectum. 1994 January; 37(1): 58-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8287749&dopt=Abstract

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Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. Author(s): Lillemoe KD, Romolo JL, Hamilton SR, Pennington LR, Burdick JF, Williams GM. Source: Surgery. 1987 March; 101(3): 267-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3824154&dopt=Abstract

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Intracolonic pressure and enemas in children: form follows function. Author(s): Shiels WE 2nd. Source: Radiology. 1995 July; 196(1): 19-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7784566&dopt=Abstract

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Intussusception: ability of fluoroscopic images obtained during air enemas to depict lead points and other abnormalities. Author(s): Miller SF, Landes AB, Dautenhahn LW, Pereira JK, Connolly BL, Babyn PS, Alton DJ, Daneman A. Source: Radiology. 1995 November; 197(2): 493-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7480700&dopt=Abstract

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Irrigation kit for barium enemas. Author(s): Pochaczevsky R. Source: Appl Radiol. 1981 January-February; 10(1): 54, 56. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10255046&dopt=Abstract

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Is it worth doing barium enemas on patients with unexplained iron deficiency anaemia? Author(s): Guthrie JA, Saifuddin A, Simpkins KC, deDombal FT. Source: Clinical Radiology. 1994 June; 49(6): 375-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8045059&dopt=Abstract

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Is topical therapy necessary in acute distal colitis? Double-blind comparison of highdose oral mesalazine versus steroid enemas in the treatment of active distal ulcerative colitis. Author(s): Cobden I, al-Mardini H, Zaitoun A, Record CO. Source: Alimentary Pharmacology & Therapeutics. 1991 October; 5(5): 513-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1793782&dopt=Abstract

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John Caffey Award. Colonic perforation by air and liquid enemas: comparison study in young pigs. Author(s): Shiels WE 2nd, Kirks DR, Keller GL, Ryckman FR, Daugherty CC, Specker BL, Summa DW. Source: Ajr. American Journal of Roentgenology. 1993 May; 160(5): 931-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8470606&dopt=Abstract

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Lactose enemas plus placebo tablets vs. neomycin tablets plus starch enemas in acute portal systemic encephalopathy. A double-blind randomized controlled study. Author(s): Uribe M, Berthier JM, Lewis H, Mata JM, Sierra JG, Garcia-Ramos G, Ramirez Acosta J, Dehesa M. Source: Gastroenterology. 1981 July; 81(1): 101-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7239110&dopt=Abstract

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Lactulose enemas. Author(s): Walker FA. Source: Annals of Internal Medicine. 1973 May; 78(5): 784-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4711793&dopt=Abstract

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Lactulose enemas. Author(s): Kersh ES, Rifkin H. Source: Annals of Internal Medicine. 1973 January; 78(1): 81-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4682313&dopt=Abstract

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Large bowel diseases in New Zealand based on 1118 air contrast enemas. Author(s): Sim GP, Scobie BA. Source: N Z Med J. 1982 September 8; 95(715): 611-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6957779&dopt=Abstract

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Latex retention balloon for barium enemas. Author(s): Kikuchi Y. Source: Ajr. American Journal of Roentgenology. 1992 March; 158(3): 691. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1739026&dopt=Abstract

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Letter: Adverse reactions of enemas. Author(s): Burnum JF. Source: Jama : the Journal of the American Medical Association. 1976 February 2; 235(5): 476. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=946094&dopt=Abstract

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Life-threatening hyperphosphatemia and hypocalcemic tetany following the use of fleet enemas. Author(s): Korzets A, Dicker D, Chaimoff C, Zevin D. Source: Journal of the American Geriatrics Society. 1992 June; 40(6): 620-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1587983&dopt=Abstract

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Liver function studies in patients receiving enemas containing tannic acid. Author(s): Burhenne JH, Vogelaar P, Arkoff RS. Source: Am J Roentgenol Radium Ther Nucl Med. 1966 February; 96(2): 510-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5908407&dopt=Abstract

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Long-term control of radiation proctitis following treatment with sucralfate enemas. Author(s): Stockdale AD, Biswas A. Source: The British Journal of Surgery. 1997 March; 84(3): 379. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9117314&dopt=Abstract

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Long-term efficacy of bismuth carbomer enemas in patients with treatment-resistant chronic pouchitis. Author(s): Gionchetti P, Rizzello F, Venturi A, Ferretti M, Brignola C, Peruzzo S, Belloli C, Poggioli G, Miglioli M, Campieri M. Source: Alimentary Pharmacology & Therapeutics. 1997 August; 11(4): 673-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9305474&dopt=Abstract

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Long-term use of mesalamine enemas to induce remission in ulcerative colitis. Author(s): Biddle WL, Miner PB Jr. Source: Gastroenterology. 1990 July; 99(1): 113-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1971605&dopt=Abstract

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Making sense of enemas. Author(s): Clarke B. Source: Nurs Times. 1988 July 27-August 2; 84(30): 40-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3419956&dopt=Abstract

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Male infertility related to 5-ASA enemas. Author(s): Friedman LS. Source: Digestive Diseases and Sciences. 1989 May; 34(5): 803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2565799&dopt=Abstract

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Malone antegrade continence enemas for autonomic dysreflexia secondary to neurogenic bowel. Author(s): Teichman JM, Barber DB, Rogenes VJ, Harris JM. Source: J Spinal Cord Med. 1998 July; 21(3): 245-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9863936&dopt=Abstract

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

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Manometrically guided colon insufflation during double-contrast barium enemas. Author(s): Short WF, Moss G, Crowther JC, Friedman RC, Horwitz RL, Manco LG, Silk PR. Source: Gastrointest Radiol. 1985; 10(1): 85-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3972219&dopt=Abstract

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Meconium ileus relieved by 40 per cent water-soluble contrast enemas. Author(s): Frech RS, McAlister WH, Ternberg J, Strominger D. Source: Radiology. 1970 February; 94(2): 341-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5412800&dopt=Abstract

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Nicotine carbomer enemas--pharmacokinetics of a revised formulation. Author(s): Green JT, Rhodes J, Thomas GA, Evans BK, Feyerabend C, Russell MA, Sandborn WJ. Source: Ital J Gastroenterol Hepatol. 1998 June; 30(3): 260-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9759592&dopt=Abstract

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Nicotine enemas for active ulcerative colitis--a pilot study. Author(s): Green JT, Thomas GA, Rhodes J, Williams GT, Evans BK, Russell MA, Feyerabend C, Rhodes P, Sandborn WJ. Source: Alimentary Pharmacology & Therapeutics. 1997 October; 11(5): 859-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9354193&dopt=Abstract

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Nicotine tartrate liquid enemas for mildly to moderately active left-sided ulcerative colitis unresponsive to first-line therapy: a pilot study. Author(s): Sandborn WJ, Tremaine WJ, Leighton JA, Lawson GM, Zins BJ, Compton RF, Mays DC, Lipsky JJ, Batts KP, Offord KP, Hurt RD, Green J. Source: Alimentary Pharmacology & Therapeutics. 1997 August; 11(4): 663-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9305473&dopt=Abstract

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No soapsuds enemas! Author(s): Rousseau P. Source: Postgraduate Medicine. 1988 March; 83(4): 352-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3353344&dopt=Abstract

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Obliteration of thumbprinting with double-contrast enemas in acute ischemic colitis. Author(s): Bartram CI. Source: Gastrointest Radiol. 1979 January 30; 4(1): 85-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=761750&dopt=Abstract

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Obturator intestinal obstruction following renal allotransplantation: relief with hyperosmolar enemas. Author(s): Berger M, Schuessler JS, Carajal HF, Lorentz WB Jr, Travis LB, Tyson KR. Source: Surgery. 1974 May; 75(5): 746-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4596206&dopt=Abstract

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On the efficacy of ready-made-up commercially available salicylazosulphapyridine enemas in the treatment of proctitis, proctosigmoiditis and ulcerative colitis involving rectum, sigmoid and descending colon. Author(s): Fruhmorgen P, Demling L. Source: Hepatogastroenterology. 1980 December; 27(6): 473-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6110627&dopt=Abstract

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Optimal bowel preparation for flexible sigmoidoscopy--are two enemas better than one? Author(s): Preston KL, Peluso FE, Goldner F. Source: Gastrointestinal Endoscopy. 1994 July-August; 40(4): 474-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7926539&dopt=Abstract

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Optimum dosage of 5-aminosalicylic acid as rectal enemas in patients with active ulcerative colitis. Author(s): Campieri M, Gionchetti P, Belluzzi A, Brignola C, Tampieri M, Iannone P, Miglioli M, Barbara L. Source: Gut. 1991 August; 32(8): 929-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1885075&dopt=Abstract

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Patient dose reduction by audit of grid usage in barium enemas. Author(s): Seymour R. Source: The British Journal of Radiology. 1997 May; 70(833): 489-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9227230&dopt=Abstract

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Peroxide enemas in obstipation. Author(s): Marks JH. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1983 January 8; 63(2): 31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6849156&dopt=Abstract

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Pharmacokinetics and retrograde colonic spread of budesonide enemas in patients with distal ulcerative colitis. Author(s): Nyman-Pantelidis M, Nilsson A, Wagner ZG, Borga O. Source: Alimentary Pharmacology & Therapeutics. 1994 December; 8(6): 617-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7696451&dopt=Abstract

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Pharmacokinetics of nicotine carbomer enemas: a new treatment modality for ulcerative colitis. Author(s): Green JT, Thomas GA, Rhodes J, Evans BK, Russell MA, Feyerabend C, Fuller GS, Newcombe RG, Sandborn WJ. Source: Clinical Pharmacology and Therapeutics. 1997 March; 61(3): 340-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9084459&dopt=Abstract

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Phosphate absorption from fleet enemas in adults. Author(s): Schuchmann GD, Barcia PJ. Source: Current Surgery. 1989 March-April; 46(2): 120-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2736963&dopt=Abstract

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Phosphate enemas in childhood: cause for concern. Author(s): McCabe M, Sibert JR, Routledge PA. Source: Bmj (Clinical Research Ed.). 1991 May 4; 302(6784): 1074. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2036507&dopt=Abstract

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Potassium permanganate enemas. Author(s): van Zyl JB. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1981 May 30; 59(23): 816. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7233296&dopt=Abstract

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Prednisolone metasulphobenzoate foam retention enemas suppress the hypothalamopituitary-adrenal axis. Author(s): Luman W, Gray RS, Pendek R, Palmer KR. Source: Alimentary Pharmacology & Therapeutics. 1994 April; 8(2): 255-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8038357&dopt=Abstract

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Preliminary studies with acid enemas and their effect on hepatic coma. Author(s): Jackson H, Riegel N, Shastri S, Bongiovanni E. Source: J Med Soc N J. 1974 November; 71(11): 855-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4530867&dopt=Abstract

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Preoperative shock secondary to severe hypokalemia and hypocalcemia from recreational enemas. Author(s): Simodynes E. Source: Anesthesia and Analgesia. 1981 October; 60(10): 762-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7197481&dopt=Abstract

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Proctocolitis unresponsive to conventional therapy. Response to 5-aminosalicylic acid enemas. Author(s): McPhee MS, Swan JT, Biddle WL, Greenberger NJ. Source: Digestive Diseases and Sciences. 1987 December; 32(12 Suppl): 76S-81S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3319462&dopt=Abstract

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Pumps in double-contrast enemas. Author(s): Hall FM. Source: Ajr. American Journal of Roentgenology. 1990 July; 155(1): 195. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2112848&dopt=Abstract

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Quality of barium enemas. Author(s): Williams CB, Nishigami T. Source: Lancet. 1983 July 2; 2(8340): 48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6134913&dopt=Abstract

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Quantitative distribution of radiolabeled 5-aminosalicylic acid enemas in patients with left-sided ulcerative colitis. Author(s): Vitti RA, Meyers F, Knight LC, Siegel JA, Malmud LS, Fisher RS. Source: Digestive Diseases and Sciences. 1989 November; 34(11): 1792-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2582990&dopt=Abstract

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Radionuclide enemas for localization of gastrointestinal bleeding sites. Author(s): Cohen AJ, McCalley M, Braunstein P. Source: Gastrointest Radiol. 1983; 8(4): 349-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6357935&dopt=Abstract

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Re: Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? Author(s): Terris MK. Source: The Journal of Urology. 2002 May; 167(5): 2145-6; Author Reply 2146. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956466&dopt=Abstract

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Rectal bleeding due to enemas. Author(s): Caos A, Flood B, Morrell M. Source: The American Journal of Gastroenterology. 1989 January; 84(1): 87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2783529&dopt=Abstract

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Rectal perforations during administration of barium enemas: report of three cases. Author(s): Geigle CF. Source: Diseases of the Colon and Rectum. 1970 January-February; 13(1): 29-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5414548&dopt=Abstract

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Reduction of cecal volvulus by multiple barium enemas. Author(s): Schwab FJ, Glick SN, Teplick SK. Source: Gastrointest Radiol. 1985; 10(2): 185-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3996836&dopt=Abstract

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Refractory distal ulcerative colitis responsive to 5-aminosalicylate enemas. Author(s): Barber GB, Lee DE, Antonioli DA, Peppercorn MA. Source: The American Journal of Gastroenterology. 1985 August; 80(8): 612-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2862789&dopt=Abstract

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Releif of severe fecal impactions with water-soluble contrast enemas. Author(s): Culp WC. Source: Radiology. 1975 April; 115(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1090980&dopt=Abstract

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Retention balloon catheters and barium enemas: attitudes, current practice and relative safety in the UK. Author(s): Blakeborough A, Sheridan MB, Chapman AH. Source: Clinical Radiology. 1997 January; 52(1): 62-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9022584&dopt=Abstract

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Retrograde colonic spread of sulphasalazine enemas. Author(s): Kruis W, Bull U, Eisenburg J, Paumgartner G. Source: Scandinavian Journal of Gastroenterology. 1982 October; 17(7): 933-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6130596&dopt=Abstract

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Retrograde colostomy and ileostomy enemas in neonates and infants: a simple combination of techniques. Author(s): Kushner DC, Cleveland RH, Herman TE, Foglia RP, Kim SH. Source: Gastrointest Radiol. 1988; 13(2): 180-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3360253&dopt=Abstract

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Retrograde spread of 5-aminosalicylic acid enemas in patients with active ulcerative colitis. Author(s): Campieri M, Lanfranchi GA, Brignola C, Bazzocchi G, Gionchetti P, Minguzzi MR, Cappello IP, Corbelli C, Boschi S. Source: Diseases of the Colon and Rectum. 1986 February; 29(2): 108-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3943419&dopt=Abstract

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Retrograde spread of therapeutic enemas in patients with inflammatory bowel disease. Author(s): van Buul MM, Mulder CJ, Wiltink EH, van Royen EA, Tytgat GN. Source: Hepatogastroenterology. 1989 August; 36(4): 199-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2807138&dopt=Abstract

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Ridogrel enemas in distal ulcerative colitis. Author(s): Auwerda JJ, Zijlstra FJ, Tak CJ, van den Ingh HF, Wilson JH, Ouwendijk RJ. Source: European Journal of Gastroenterology & Hepatology. 2001 April; 13(4): 397-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11338069&dopt=Abstract

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Risky enemas: what's the ideal solution? Author(s): Schmelzer M, Wright K. Source: The American Journal of Nursing. 1993 July; 93(7): 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8322850&dopt=Abstract

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Roentgenographic reversibility of ulcerative colitis in children treated with steroid enemas. Author(s): Goldberg HI, Carbone JV, Margulis AR. Source: Am J Roentgenol Radium Ther Nucl Med. 1968 June; 103(2): 365-79. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5656232&dopt=Abstract

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Role of rectal formulations: enemas. Author(s): Campieri M, Gionchetti P, Belluzzi A, Brignola C, Tampieri M, Iannone P, Petronelli A, Miglioli M, Barbara L. Source: Scandinavian Journal of Gastroenterology. Supplement. 1990; 172: 63-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2353173&dopt=Abstract

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Routine contrast enemas for diagnosing and managing strictures following nonoperative treatment of necrotizing enterocolitis. Author(s): Born M, Holgersen LO, Shahrivar F, Stanley-Brown E, Hilfer C. Source: Journal of Pediatric Surgery. 1985 August; 20(4): 461-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4045676&dopt=Abstract

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Safety of contrast enemas in assessing the integrity of large bowel anastomoses. Author(s): Everett WG. Source: The British Journal of Surgery. 1983 May; 70(5): 307. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6850264&dopt=Abstract

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Saline enemas--a potential hazard in newborns. Author(s): Singh Y, Singh N, Narasimhan KL, Mitra SK. Source: Indian Pediatrics. 1998 August; 35(8): 799-800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10216581&dopt=Abstract

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Self-administered disposable micro-enemas before outpatient sigmoidoscopy. Author(s): Marsh SK, Huddy SP. Source: Journal of the Royal Society of Medicine. 1996 November; 89(11): 616-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9135589&dopt=Abstract

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Serial liver function studies following barium enemas containing 1 percent tannic acid. Author(s): Harper RA, Pemberton J, Tobias JS. Source: Clinical Radiology. 1973 July; 24(3): 315-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4730221&dopt=Abstract

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Severe colitis induced by soap enemas. Author(s): Orchard JL, Lawson R. Source: Southern Medical Journal. 1986 November; 79(11): 1459-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3775481&dopt=Abstract

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Severe hypermagnesaemia due to magnesium sulphate enemas in patients with hepatic coma. Author(s): Collinson PO, Burroughs AK. Source: British Medical Journal (Clinical Research Ed.). 1986 October 18; 293(6553): 10134. Erratum In: Br Med J (Clin Res Ed) 1986 November 8; 293(6556): 1222. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3768664&dopt=Abstract

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Short-chain fatty acid enemas in the treatment of distal ulcerative colitis. Author(s): Cummings JH. Source: European Journal of Gastroenterology & Hepatology. 1997 February; 9(2): 14953. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9058625&dopt=Abstract

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Short-chain fatty acid enemas stimulate plasminogen activator inhibitor-1 after abdominal aortic graft surgery: a double-blinded, placebo-controlled study. Author(s): Mortensen FV, Jorgensen B, Christiansen HM, Sloth-Nielsen J, Wolff B, Hessov I. Source: Thrombosis Research. 2000 June 1; 98(5): 361-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10828475&dopt=Abstract

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Short-chain fatty acid enemas: a cost-effective alternative in the treatment of nonspecific proctosigmoiditis. Author(s): Senagore AJ, MacKeigan JM, Scheider M, Ebrom JS. Source: Diseases of the Colon and Rectum. 1992 October; 35(10): 923-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1395977&dopt=Abstract

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Should radiographers perform barium enemas? Author(s): Chapman AH. Source: Clinical Radiology. 1992 July; 46(1): 69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1643792&dopt=Abstract

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Should technologists perform barium enemas? Author(s): Stevenson G. Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 2000 April; 51(2): 79-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10786914&dopt=Abstract

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Simplified technique for antegrade continence enemas for fecal retention and incontinence. Author(s): Fonkalsrud EW, Dunn JC, Kawaguchi AI. Source: Journal of the American College of Surgeons. 1998 October; 187(4): 457-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9783795&dopt=Abstract

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Single- or double-contrast barium enemas: another opinion. Author(s): Rice RP. Source: Ajr. American Journal of Roentgenology. 1983 June; 140(6): 1271-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6602501&dopt=Abstract

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Sodium polystyrene-sorbitol enemas. Author(s): Burnett RJ. Source: Annals of Internal Medicine. 1990 February 15; 112(4): 311-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2297214&dopt=Abstract

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Sorbitol, prostaglandins, and ulcerative colitis enemas. Author(s): Zijlstra FJ. Source: Lancet. 1981 October 10; 2(8250): 815-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6116945&dopt=Abstract

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Successful treatment of Sodium PolyStyrene Sulfonate bezoars with serial watersoluble contrast enemas. Author(s): Koneru P, Kaufman RA, Talati AJ, Jenkins MB, Korones SB. Source: Journal of Perinatology : Official Journal of the California Perinatal Association. 2003 July-August; 23(5): 431-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847543&dopt=Abstract

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Sucralfate and hydrocortisone enemas in the treatment of active ulcerative proctitis--a randomized single-blind comparative study. Author(s): Ardizzone S, Petrillo M, Antonacci CM, Bianchi Porro G. Source: Alimentary Pharmacology & Therapeutics. 1996 December; 10(6): 957-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8971294&dopt=Abstract

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Sucralfate and methylprednisolone enemas in active ulcerative colitis: a prospective, single-blind study. Author(s): Wright JP, Winter TA, Candy S, Marks IS. Source: Digestive Diseases and Sciences. 1999 September; 44(9): 1899-901. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10505732&dopt=Abstract

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Sucralfate enemas in the treatment of chronic postradiation proctitis. Author(s): Ladas SD, Raptis SA. Source: The American Journal of Gastroenterology. 1989 December; 84(12): 1587-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2596467&dopt=Abstract

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Sucralfate enemas in ulcerative colitis. Author(s): Winter TA, Marks IN. Source: Alimentary Pharmacology & Therapeutics. 1997 August; 11(4): 821-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9305494&dopt=Abstract

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Sucralfate retention enemas in solitary rectal ulcer. Author(s): Zargar SA, Khuroo MS, Mahajan R. Source: Diseases of the Colon and Rectum. 1991 June; 34(6): 455-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2036924&dopt=Abstract

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Sulfasalazine-induced abnormal sperm penetration assay reversed on changing to 5aminosalicylic acid enemas. Author(s): Chatzinoff M, Guarino JM, Corson SL, Batzer FR, Friedman LS. Source: Digestive Diseases and Sciences. 1988 January; 33(1): 108-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2892654&dopt=Abstract

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Sulphasalazine rectal enemas: topical method of inducing remission of active ulcerative colitis affecting rectum and descending colon. Author(s): Serebro H, Kay S, Javett S, Abrahams C. Source: British Medical Journal. 1977 November 12; 2(6097): 1264. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=22378&dopt=Abstract

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Sulphasalazine retention enemas in ulcerative colitis. Author(s): Serebro HA, Kay S. Source: British Medical Journal (Clinical Research Ed.). 1981 July 11; 283(6284): 144-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6114768&dopt=Abstract

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Sulphasalazine retention enemas in ulcerative colitis: a double-blind trial. Author(s): Palmer KR, Goepel JR, Holdsworth CD. Source: British Medical Journal (Clinical Research Ed.). 1981 May 16; 282(6276): 1571-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6113021&dopt=Abstract

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Tetany and enemas: report of a case. Author(s): Swerdlow DB, Labow S, D'Anna J. Source: Diseases of the Colon and Rectum. 1974 November-December; 17(6): 786-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4434823&dopt=Abstract

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Tetany following phosphate enemas in chronic renal disease. Author(s): Chesney RW, Haughton PB. Source: Am J Dis Child. 1974 April; 127(4): 584-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4821324&dopt=Abstract

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The case for radiographers performing barium enemas. Author(s): Chapman AH. Source: Br J Hosp Med. 1993 October 6-19; 50(7): 370-2, 374. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8261281&dopt=Abstract

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The effect of laxatives and enemas on the sonographic visibility of the pancreas. Author(s): Nilsson A, Forsberg L. Source: European Journal of Radiology. 1990 March-April; 10(2): 124-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2186917&dopt=Abstract

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The effect of screening sonography on the positive rate of enemas for intussusception. Author(s): Henrikson S, Blane CE, Koujok K, Strouse PJ, DiPietro MA, Goodsitt MM. Source: Pediatric Radiology. 2003 March; 33(3): 190-3. Epub 2002 December 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12612819&dopt=Abstract

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The end of barium enemas? Author(s): Fletcher RH. Source: The New England Journal of Medicine. 2000 June 15; 342(24): 1823-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10853006&dopt=Abstract

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The role of decubitus films in double-contrast barium enemas. Author(s): Stoddart PG, Virjee J. Source: Clinical Radiology. 1983 November; 34(6): 681-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6673889&dopt=Abstract

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The single-layer continuous polypropylene colon anastomosis. A prospective assessment using water-soluble contrast enemas. Author(s): Skakun GB, Reznick RK, Bailey HR, Smith KW, Max E. Source: Diseases of the Colon and Rectum. 1988 March; 31(3): 163-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3280270&dopt=Abstract

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The use of alum in pediatric barium enemas: a preliminary report. Author(s): Swales DW, Dunbar JS. Source: J Can Assoc Radiol. 1966 December; 17(4): 224-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5334359&dopt=Abstract

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The use of antispasmodic drugs during barium enemas. Author(s): Skucas J. Source: Ajr. American Journal of Roentgenology. 1994 June; 162(6): 1323-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8191992&dopt=Abstract

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The use of contrast enemas in the diagnosis of neonatal intestinal obstruction. Author(s): Moore CC. Source: The Medical Journal of Australia. 1974 March 9; 1(10): 347-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4207742&dopt=Abstract

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The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis. Author(s): Gottesman L, Zevon SJ, Brabbee GW, Dailey T, Wichern WA Jr. Source: Diseases of the Colon and Rectum. 1984 February; 27(2): 84-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6697835&dopt=Abstract

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Topical administration of 5-aminosalicylic acid enemas in patients with ulcerative colitis. Studies on rectal absorption and excretion. Author(s): Campieri M, Lanfranchi GA, Boschi S, Brignola C, Bazzocchi G, Gionchetti P, Minguzzi MR, Belluzzi A, Labo G. Source: Gut. 1985 April; 26(4): 400-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3979912&dopt=Abstract

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Topical salicylate therapy (4-ASA and 5-ASA enemas). Author(s): Ginsberg AL. Source: Gastroenterology Clinics of North America. 1989 March; 18(1): 35-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2563990&dopt=Abstract

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Topical treatment of distal ulcerative colitis with 4-amino-salicylic acid enemas. Author(s): Selby WS, Bennett MK, Jewell DP. Source: Digestion. 1984; 29(4): 231-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6381186&dopt=Abstract

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Toxicity studies on tannic acid administered by enema. 3. Studies on the retention of enemas in humans. IV. Review and conclusions. Author(s): Zboralske FF, Harris PA, Riegelman S, Rambo ON, Margulis AR. Source: Am J Roentgenol Radium Ther Nucl Med. 1966 February; 96(2): 505-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5907131&dopt=Abstract

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Transanal anastomosis in the treatment of low rectal strictures due to tribal enemas. Author(s): Cooke SA, Hamilton DG, Gritzman MC. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1978 November 4; 54(19): 769-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=741307&dopt=Abstract

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Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications? Author(s): Carey JM, Korman HJ. Source: The Journal of Urology. 2001 July; 166(1): 82-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11435829&dopt=Abstract

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Treatment of active distal ulcerative colitis with immunoglobulin G enemas. Author(s): Jarlov AE, Munkholm P, Schmidt PN, Langholz E, Vestergaard BF, Bech RM. Source: Alimentary Pharmacology & Therapeutics. 1993 October; 7(5): 561-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8280825&dopt=Abstract

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Treatment of chronic proctosigmoiditis with cyclosporin enemas. Author(s): Ranzi T, Campanini MC, Velio P, Quarto di Palo F, Bianchi P. Source: Lancet. 1989 July 8; 2(8654): 97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2567886&dopt=Abstract

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Treatment of defecation disorders by colonic enemas in children with spina bifida. Author(s): Scholler-Gyure M, Nesselaar C, van Wieringen H, van Gool JD. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 1996 December; 6 Suppl 1: 32-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9008818&dopt=Abstract

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Treatment of distal ulcerative colitis (proctosigmoiditis) in relapse: comparison of hydrocortisone enemas and rectal hydrocortisone foam. Author(s): Ruddell WS, Dickinson RJ, Dixon MF, Axon AT. Source: Gut. 1980 October; 21(10): 885-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7002739&dopt=Abstract

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Treatment of distal ulcerative colitis with beclomethasone enemas: high therapeutic efficacy without endocrine side effects. A prospective, randomized, double-blind trial. Author(s): Bansky G, Buhler H, Stamm B, Hacki WH, Buchmann P, Muller J. Source: Diseases of the Colon and Rectum. 1987 April; 30(4): 288-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3030678&dopt=Abstract

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Treatment of distal ulcerative colitis with nonsystemic corticosteroid enemas. Author(s): Danielsson A. Source: Scandinavian Journal of Gastroenterology. 1996 October; 31(10): 945-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8898413&dopt=Abstract

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Treatment of distal ulcerative colitis with short-chain fatty acid enemas. A placebocontrolled trial. German-Austrian SCFA Study Group. Author(s): Scheppach W. Source: Digestive Diseases and Sciences. 1996 November; 41(11): 2254-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8943981&dopt=Abstract

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Treatment of diversion colitis with 5-aminosalicylic acid enemas: comparison with betamethasone enemas. Author(s): Triantafillidis JK, Nicolakis D, Mountaneas G, Pomonis E. Source: The American Journal of Gastroenterology. 1991 October; 86(10): 1552-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1928058&dopt=Abstract

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Treatment of intestinal graft-versus-host disease using betamethasone enemas. Author(s): Wada H, Mori A, Okada M, Takatsuka H, Tamura A, Seto Y, Iwata N, Fujimori Y, Okamoto T, Takemoto Y, Kakishita E. Source: Transplantation. 2001 October 27; 72(8): 1451-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11685119&dopt=Abstract

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Treatment of left-sided ulcerative colitis with 4-aminosalicylic acid enemas. A double-blind, placebo-controlled trial. Author(s): Ginsberg AL, Beck LS, McIntosh TM, Nochomovitz LE. Source: Annals of Internal Medicine. 1988 February; 108(2): 195-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3277506&dopt=Abstract

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Treatment of left-sided ulcerative colitis with butyrate enemas: a controlled trial. Author(s): Steinhart AH, Hiruki T, Brzezinski A, Baker JP. Source: Alimentary Pharmacology & Therapeutics. 1996 October; 10(5): 729-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8899080&dopt=Abstract

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Treatment of radiation-induced proctitis with sucralfate enemas. Author(s): Melko GP, Turco TF, Phelan TF, Sauers NM. Source: The Annals of Pharmacotherapy. 1999 December; 33(12): 1274-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10630828&dopt=Abstract

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Treatment of refractory distal ulcerative colitis with short chain fatty acid enemas. Author(s): Patz J, Jacobsohn WZ, Gottschalk-Sabag S, Zeides S, Braverman DZ. Source: The American Journal of Gastroenterology. 1996 April; 91(4): 731-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8677939&dopt=Abstract

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Treatment of refractory ulcerative colitis with cyclosporin enemas. Author(s): Brynskov J, Freund L, Thomsen OO, Andersen CB, Rasmussen SN, Binder V. Source: Lancet. 1989 April 1; 1(8640): 721-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2564527&dopt=Abstract

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Treatment of refractory ulcerative proctosigmoiditis with butyrate enemas. Author(s): Steinhart AH, Brzezinski A, Baker JP. Source: The American Journal of Gastroenterology. 1994 February; 89(2): 179-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8304299&dopt=Abstract

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Treatment of ulcerative colitis with high-dose 5-aminosalicylic acid enemas. Author(s): Campieri M, Lanfranchi GA, Bazzocchi G, Brignola C, Sarti F, Franzin G, Battocchia A, Labo G, Dal Monte PR. Source: Lancet. 1981 August 8; 2(8241): 270-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6114321&dopt=Abstract

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Treatment of ulcerative colitis with hydrocortisone alcohol retention enemas: a topical and systemic anti-inflammatory agent. II. Author(s): Sherman LF, Tenner RJ, Schottler JL. Source: Diseases of the Colon and Rectum. 1967 January-February; 10(1): 43-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6018350&dopt=Abstract

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Treatment of ulcerative colitis with hydrocortisone enemas. Comparison of absorption and clinical response with hydrocortisone alcohol and hydrocortisone acetate. Author(s): Farmer RG, Schumacher OP. Source: The American Journal of Gastroenterology. 1970 September; 54(3): 229-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5507287&dopt=Abstract

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Treatment of ulcerative colitis with hydrocrotisone enemas: relationship of hydrocortisone absorption, adrenal suppression, and clinical response. Author(s): Farmer RG, Schumacher OP. Source: Diseases of the Colon and Rectum. 1970 September-October; 13(5): 355-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5472850&dopt=Abstract

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Tripotassium dicitrato bismuthate enemas in the treatment of ulcerative proctitis. Author(s): Srivastava ED, Swift GL, Wilkinson S, Williams GT, Evans BK, Rhodes J. Source: Alimentary Pharmacology & Therapeutics. 1990 December; 4(6): 577-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2129645&dopt=Abstract

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Tween 80/diatrizoate enemas in bowel obstruction. Author(s): Wood BP, Katzberg RW. Source: Ajr. American Journal of Roentgenology. 1978 April; 130(4): 747-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=416689&dopt=Abstract

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Use of a Monti channel for administration of antegrade continence enemas. Author(s): Yerkes EB, Rink RC, Cain MP, Casale AJ. Source: The Journal of Urology. 2002 October; 168(4 Pt 2): 1883-5; Discussion 1885. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352382&dopt=Abstract

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Washout versus non-washout (Picolax) preparation for double-contrast barium enemas. Author(s): Bartram CI, Mootoosamy IM, Lim IK. Source: Clinical Radiology. 1984 March; 35(2): 143-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6697655&dopt=Abstract

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What are the indications for use of water-soluble contrast agent enemas in colon distension? Author(s): Dachman AH. Source: Ajr. American Journal of Roentgenology. 1996 April; 166(4): 988. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8610587&dopt=Abstract

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When patient preparation is the key to success. In barium enemas and small bowel studies, timely prep is the decisive factor. Author(s): Stiklorius C. Source: Rn. 1982 April; 45(4): 64-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6917368&dopt=Abstract

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Why barium enemas fail to identify colorectal cancers. Author(s): McDonald S, Lyall P, Israel L, Coates R, Frizelle F. Source: Anz Journal of Surgery. 2001 November; 71(11): 631-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11736819&dopt=Abstract

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Why radiologists should perform barium enemas. Author(s): Simpkins KC. Source: Br J Hosp Med. 1993 October 6-19; 50(7): 374-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8261282&dopt=Abstract

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

Finding Nutrition Studies on Enemas 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.7 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 “enemas” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 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 “enemas” (or a synonym): •

A comparison of bowel preparations for flexible sigmoidoscopy: oral magnesium citrate combined with oral bisacodyl, one hypertonic phosphate enema, or two hypertonic phosphate enemas. Author(s): Department of Gastroenterology, Walter Reed Army Medical Center, Washington, DC 20307, USA. Source: Fincher, R K Osgard, E M Jackson, J L Strong, J S Wong, R K Am-JGastroenterol. 1999 August; 94(8): 2122-7 0002-9270

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A comparison of sucralfate and prednisolone enemas in the treatment of active distal ulcerative colitis. Author(s): Dept. of Gastroenterology, Leigh Infirmary, Greater Manchester, England. Source: Riley, S A Gupta, I Mani, V Scand-J-Gastroenterol. 1989 October; 24(8): 1014-8 0036-5521

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A critique of the rationale for cancer treatment with coffee enemas and diet. Author(s): Zol Consultants, Inc, New York, NY. Source: Green, S JAMA. 1992 December 9; 268(22): 3224-7 0098-7484

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A new oral lavage solution vs cathartics and enema method for preoperative colonic cleansing. Author(s): Department of General Surgery, Wilford Hall USAF Medical Center, Lackland Air Force Base, Tex 78236. Source: Beck, D E DiPalma, J A Arch-Surg. 1991 May; 126(5): 552-5 0004-0010

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A placebo-controlled trial of cyclosporine enemas for mildly to moderately active leftsided ulcerative colitis. Author(s): Inflammatory Bowel Disease Clinic, Mayo Clinic, Rochester, Minnesota. Source: Sandborn, W J Tremaine, W J Schroeder, K W Batts, K P Lawson, G M Steiner, B L Harrison, J M Zinsmeister, A R Gastroenterology. 1994 June; 106(6): 1429-35 0016-5085

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Acidifying enemas (lactitol and lactose) vs. nonacidifying enemas (tap water) to treat acute portal-systemic encephalopathy: a double-blind, randomized clinical trial. Source: Uribe, M Campollo, O Vargas, F Ravelli, G P Mundo, F Zapata, L Gil, S Garcia Ramos, G Hepatology. 1987 Jul-August; 7(4): 639-43 0270-9139

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Are short-chain fatty acid enemas effective for left-sided ulcerative colitis? Source: Sandborn, W J Gastroenterology. 1998 January; 114(1): 218-9 0016-5085

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Colonic cleansing for radiographic detection of neoplasia: efficacy of the magnesium citrate-castor oil-cleansing enema regimen. Author(s): Department of Radiology, Bowman Gray School of Medicine, WinstonSalem, NC 27103. Source: Gelfand, D W Chen, Y M Ott, D J AJR-Am-J-Roentgenol. 1988 October; 151(4): 705-8 0361-803X

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Colonic complications after toxic tribal enemas. Author(s): Department of Surgery, University of Cape Town, South Africa. Source: Dunn, J P Krige, J E Wood, R Bornman, P C Terblanche, J Br-J-Surg. 1991 May; 78(5): 545-8 0007-1323

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Effect of butyrate enemas on the colonic mucosa in distal ulcerative colitis. Author(s): Department of Medicine, University of Wurzburg, Germany. Source: Scheppach, W Sommer, H Kirchner, T Paganelli, G M Bartram, P Christl, S Richter, F Dusel, G Kasper, H Gastroenterology. 1992 July; 103(1): 51-6 0016-5085

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Efficacy of 5-aminosalicylic acid enemas versus hydrocortisone enemas in ulcerative colitis. Author(s): Istituto di Clinica Medica e Gastroenterologia, Universita di Bologna, Italy. Source: Campieri, M Gionchetti, P Belluzzi, A Brignola, C Migaldi, M Tabanelli, G M Bazzocchi, G Miglioli, M Barbara, L Dig-Dis-Sci. 1987 December; 32(12 Suppl): 67S-70S 0163-2116

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Hypocalcemia and hyperphosphatemia after phosphate enema use in a child. Author(s): Department of Surgery, School of Medicine, The University of Missouri, Columbia 65212, USA. Source: Helikson, M A Parham, W A Tobias, J D J-Pediatr-Surg. 1997 August; 32(8): 1244-6 0022-3468

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Is administration of n-3 fatty acids by mucosal enema protective against trinitrobenzene-induced colitis in rats? Author(s): Celal Bayar University, Department of Gastroenterology, Manisa, Turkey. Source: Yuceyar, H Ozutemiz, O HuseyiNovember, A Saruc, M Alkanat, M Bor, S Coker, I Batur, Y Prostaglandins-Leukot-Essent-Fatty-Acids. 1999 December; 61(6): 33945 0952-3278

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Juices, coffee enemas, and cancer. Source: Reed, A James, N Sikora, K Lancet. 1990 September 15; 336(8716): 677-8 01406736

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L-glutamine enemas attenuate mucosal injury in experimental colitis. Author(s): Department of Surgery, Uludag University School of Medicine, Bursa, Turkey. Source: Kaya, E Gur, E S Ozguc, H Bayer, A Tokyay, R Dis-Colon-Rectum. 1999 September; 42(9): 1209-15 0012-3706

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Life-threatening hyperphosphatemia and hypocalcemic tetany following the use of fleet enemas. Author(s): Department of Nephrology, Golda Medical Center, Petach-Tiqua, Israel. Source: Korzets, A Dicker, D Chaimoff, C Zevin, D J-Am-Geriatr-Soc. 1992 June; 40(6): 620-1 0002-8614

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Long-term control of radiation proctitis following treatment with sucralfate enemas. Author(s): Department of Radiotherapy, Walsgrave Hospital, Coventry, UK. Source: Stockdale, A D Biswas, A Br-J-Surg. 1997 March; 84(3): 379 0007-1323

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Management of neurogenic fecal incontinence in myelodysplastic children by a modified continent appendiceal stoma and antegrade colonic enema. Author(s): Department of Urology, University of Essen Medical School, Germany. Source: Goepel, M Sperling, H Stohrer, M Otto, T Rubben, H Urology. 1997 May; 49(5): 758-61 0090-4295

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Morphologic and morphometric analyses of acetic acid-induced colitis in rats after treatment with enemas from Myracrodruon urundeuva Fr. All. (Aroeira do Sertao). Author(s): Department of Surgery, Federal University of Ceara, Fortaleza, Brazil. Source: Rodrigues, L V Ferreira, F V Regadas, F S Matos, D Viana, G S Phytother-Res. 2002 May; 16(3): 267-72 0951-418X

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New enema treatments for inflammatory bowel disease. Author(s): UCLA Department of Medicine, Division of Gastroenterology 90024. Source: Karp, L C Targan, S R Dig-Dis-Sci. 1988 March; 33(3 Suppl): 85S-87S 0163-2116

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Nicotine carbomer enemas--pharmacokinetics of a revised formulation. Author(s): Department of Gastroenterology, University Hospital of Wales, Cardiff.

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Source: Green, J T Rhodes, J Thomas, G A Evans, B K Feyerabend, C Russell, M A Sandborn, W J Ital-J-Gastroenterol-Hepatol. 1998 June; 30(3): 260-5 1125-8055 •

Paediatric enema syndrome in a rural African setting. Author(s): Hlabisa Hospital, Kwazulu Natal, Republic of South Africa. Source: Moore, D A Moore, N L Ann-Trop-Paediatr. 1998 June; 18(2): 139-44 0272-4936

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Patient dose variation investigated in four Irish hospitals for barium meal and barium enema examinations. Author(s): UCD School of Diagnostic Imaging, St Anthony's Dublin, Ireland. [email protected] Source: Carroll, E Brennan, P C Radiat-Prot-Dosimetry. 2001; 97(3): 275-8 0144-8420

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Preventive efficacy of butyrate enemas and oral administration of Clostridium butyricum M588 in dextran sodium sulfate-induced colitis in rats. Author(s): Second Department of Internal Medicine, Shiga University of Medical Science, Seta, Otsu, Japan. Source: Okamoto, T Sasaki, M Tsujikawa, T Fujiyama, Y Bamba, T Kusunoki, M JGastroenterol. 2000; 35(5): 341-6 0944-1174

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Retrograde spread of therapeutic enemas in patients with inflammatory bowel disease. Author(s): Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands. Source: van Buul, M M Mulder, C J Wiltink, E H van Royen, E A Tytgat, G N Hepatogastroenterology. 1989 August; 36(4): 199-201 0172-6390

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Ridogrel enemas in distal ulcerative colitis. Author(s): Department of Internal Medicine and Pathology, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands. [email protected] Source: Auwerda, J J Zijlstra, F J Tak, C J van den Ingh, H F Wilson, J H Ouwendijk, R J Eur-J-Gastroenterol-Hepatol. 2001 April; 13(4): 397-400 0954-691X

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Short-chain fatty acid enemas fail to decrease colonic hypersensitivity and inflammation in TNBS-induced colonic inflammation in rats. Author(s): Service de Gastro-Enterologie, Hotel-Dieu, 63000 Clermont-Ferrand, France. Source: Tarrerias, A L Millecamps, M Alloui, A Beaughard, C Kemeny, J L Bourdu, S Bommelaer, G Eschalier, A Dapoigny, M Ardid, D Pain. 2002 November; 100(1-2): 91-7 0304-3959

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Sucralfate and methylprednisolone enemas in active ulcerative colitis: a prospective, single-blind study. Author(s): Gastrointestinal Clinic, University of Cape Town, South Africa. Source: Wright, J P Winter, T A Candy, S Marks, I S Dig-Dis-Sci. 1999 September; 44(9): 1899-901 0163-2116

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Sucralfate enema in ulcerative rectosigmoid lesions. Author(s): Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Source: Kochhar, R Mehta, S K Aggarwal, R Dhar, A Patel, F Dis-Colon-Rectum. 1990 January; 33(1): 49-51 0012-3706

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Treatment of defecation disorders by colonic enemas in children with spina bifida. Author(s): Spina Bifida Team, University Children's Hospital, Utrecht, The Netherlands. Source: Scholler Gyure, M Nesselaar, C van Wieringen, H van Gool, J D Eur-J-PediatrSurg. 1996 December; 6 Suppl 132-4 0939-7248

Nutrition

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Treatment of radiation-induced proctitis with sucralfate enemas. Author(s): Regulatory Affairs, Rhone-Poulenc Rorer, Collegeville, PA, USA. Source: Melko, G P Turco, T F Phelan, T F Sauers, N M Ann-Pharmacother. 1999 December; 33(12): 1274-6 1060-0280

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/

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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The following is a specific Web list relating to enemas; 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: •

Food and Diet Cartilage (bovine and Shark) Source: Healthnotes, Inc.; www.healthnotes.com Low-allergen Diet Source: Healthnotes, Inc.; www.healthnotes.com

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

A critique of the rationale for cancer treatment with coffee enemas and diet. Author(s): Green S. Source: Jama : the Journal of the American Medical Association. 1992 December 9; 268(22): 3224-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1433763&dopt=Abstract

•

A multidisciplinary approach to ritual enema scenes on ancient Maya pottery. Author(s): de Smet PA, Hellmuth NM. Source: Journal of Ethnopharmacology. 1986 June; 16(2-3): 213-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3528674&dopt=Abstract

•

A multidisciplinary overview of intoxicating enema rituals in the western hemisphere. Author(s): de Smet PA.

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Source: Journal of Ethnopharmacology. 1983 December; 9(2-3): 129-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6677814&dopt=Abstract •

Acute cyanide poisoning following administration of Laetrile enemas. Author(s): Ortega JA, Creek JE. Source: The Journal of Pediatrics. 1978 December; 93(6): 1059. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=722426&dopt=Abstract

•

Antegrade continent enema management of chronic fecal incontinence in children. Author(s): Meier DE, Foster ME, Guzzetta PC, Coln D. Source: Journal of Pediatric Surgery. 1998 July; 33(7): 1149-51; Discussion 1151-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9694112&dopt=Abstract

•

Anyone for a coffee enema? Author(s): McBryde B. Source: Nurs Times. 2000 December 14-2001 January 3; 96(50): 27-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11965801&dopt=Abstract

•

Bacteria-mediated cyanide toxicity after laetrile enemas. Author(s): Carter JH, Goldman P. Source: The Journal of Pediatrics. 1979 June; 94(6): 1018. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=448522&dopt=Abstract

•

Chamomile tea enema anaphylaxis. Author(s): Thien FC. Source: The Medical Journal of Australia. 2001 July 2; 175(1): 54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11476211&dopt=Abstract

•

Cleansing of the colon without enemas. Author(s): Rosengren JE, Aberg T. Source: Der Radiologe. 1975 November; 15(11): 421-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1215526&dopt=Abstract

•

Colonic complications after toxic tribal enemas. Author(s): Dunn JP, Krige JE, Wood R, Bornman PC, Terblanche J. Source: The British Journal of Surgery. 1991 May; 78(5): 545-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2059802&dopt=Abstract

•

Deaths related to coffee enemas. Author(s): Eisele JW, Reay DT.

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Source: Jama : the Journal of the American Medical Association. 1980 October 3; 244(14): 1608-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7420666&dopt=Abstract •

Does peppermint oil relieve spasm during barium enema? Author(s): Sparks MJ, O'Sullivan P, Herrington AA, Morcos SK. Source: The British Journal of Radiology. 1995 August; 68(812): 841-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7551780&dopt=Abstract

•

Fatal outcome of anaphylaxis to camomile-containing enema during labor: a case study. Author(s): Jensen-Jarolim E, Reider N, Fritsch R, Breiteneder H. Source: The Journal of Allergy and Clinical Immunology. 1998 December; 102(6 Pt 1): 1041-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9847448&dopt=Abstract

•

Herbal enemata. Author(s): Ntombela R. Source: Sa Nurs J. 1965 December; 32(12): 38-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5175642&dopt=Abstract

•

Herbal-enema colitis and stricture. Author(s): Young WS. Source: The British Journal of Radiology. 1980 March; 53(627): 248-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7378683&dopt=Abstract

•

Hypnotherapeutic explorations of early enema experience. Author(s): Freytag FF. Source: Am J Clin Hypn. 1971 July; 14(1): 24-31. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5163561&dopt=Abstract

•

Irritable bowel syndrome: clinical presentations, enema users and dosage schedules of Ispaghula. Author(s): Agarwal BD. Source: J Assoc Physicians India. 1990 August; 38(8): 604. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2246220&dopt=Abstract

•

Is administration of n-3 fatty acids by mucosal enema protective against trinitrobenzene-induced colitis in rats? Author(s): Yuceyar H, Ozutemiz O, Huseyinov A, Saruc M, Alkanat M, Bor S, Coker I, Batur Y.

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Source: Prostaglandins, Leukotrienes, and Essential Fatty Acids. 1999 December; 61(6): 339-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10718105&dopt=Abstract •

Ispaghula (Vi-Siblin) versus standard preparation for barium enema. Author(s): Burchardt AJ, Carstensen JM, Roikjaer O, Burcharth F. Source: Acta Radiologica (Stockholm, Sweden : 1987). 1997 March; 38(2): 311-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9093172&dopt=Abstract

•

Juices, coffee enemas, and cancer. Author(s): Reed A, James N, Sikora K. Source: Lancet. 1990 September 15; 336(8716): 677-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1975864&dopt=Abstract

•

Morphologic and morphometric analyses of acetic acid-induced colitis in rats after treatment with enemas from Myracrodruon urundeuva Fr. All. (Aroeira do Sertao). Author(s): Rodrigues LV, Ferreira FV, Regadas FS, Matos D, Viana GS. Source: Phytotherapy Research : Ptr. 2002 May; 16(3): 267-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12164275&dopt=Abstract

•

MR colonography: optimized enema composition. Author(s): Luboldt W, Frohlich JM, Schneider N, Weishaupt D, Landolt F, Debatin JF. Source: Radiology. 1999 July; 212(1): 265-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10405751&dopt=Abstract

•

Na2 ethylenediaminetetraacetic acid retention enema in dogs. Biochemical and histological response. Author(s): Rabau MY, Baratz M, Rozen P. Source: General Pharmacology. 1991; 22(2): 329-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1905249&dopt=Abstract

•

Not such distant mirrors. Coffee enemas may be effective shock treatment. Author(s): Watts JC. Source: Bmj (Clinical Research Ed.). 2000 February 5; 320(7231): 383. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10712032&dopt=Abstract

•

Oral laxatives in barium enema preparation. Author(s): Ennis JT, Mitchell AV. Source: The British Journal of Radiology. 1970 April; 43(508): 242-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4909956&dopt=Abstract

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•

Paediatric enema syndrome in a rural African setting. Author(s): Moore DA, Moore NL. Source: Annals of Tropical Paediatrics. 1998 June; 18(2): 139-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9924575&dopt=Abstract

•

Polymicrobial enteric septicemia from coffee enemas. Author(s): Margolin KA, Green MR. Source: The Western Journal of Medicine. 1984 March; 140(3): 460. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6710988&dopt=Abstract

•

Radiological manifestations of ritual-enema-induced colitis. Author(s): Segal I, Solomon A, Mirwis J. Source: Clinical Radiology. 1981 November; 32(6): 657-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7307437&dopt=Abstract

•

Ritual-enema-induced colitis. Author(s): Segal I, Tim LO, Hamilton DG, Lawson HH, Solomon A, Kalk F, Cooke SA. Source: Diseases of the Colon and Rectum. 1979 April; 22(3): 195-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=446256&dopt=Abstract

•

Single-dose ceftriaxone, ornidazole, and povidone-iodine enema in elective left colectomy. A randomized multicenter controlled trial. The French Association for Surgical Research. Author(s): Fingerhut A, Hay JM. Source: Archives of Surgery (Chicago, Ill. : 1960). 1993 February; 128(2): 228-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8431124&dopt=Abstract

•

Spasmolytic effect of peppermint oil in barium during double-contrast barium enema compared with Buscopan. Author(s): Asao T, Kuwano H, Ide M, Hirayama I, Nakamura JI, Fujita KI, Horiuti R. Source: Clinical Radiology. 2003 April; 58(4): 301-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12662951&dopt=Abstract

•

Supplementary data on ritual enemas and snuffs in the western hemisphere. Author(s): de Smet PA, Lipp FJ Jr. Source: Journal of Ethnopharmacology. 1987 May; 19(3): 327-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3669692&dopt=Abstract

•

The psyllium colloid contrast enema--a method for evaluating anal sphincteric continence. Author(s): Bunt TJ, Pakiam I, Dragstedt LR 2nd.

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Source: Am J Proctol Gastroenterol Colon Rectal Surg. 1982 February; 33(2): 30, 32. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7102831&dopt=Abstract •

Traditional enema therapy in rural African children. Author(s): Reed R. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1995 February; 85(2): 113-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7597519&dopt=Abstract

•

Treating cancer with coffee enemas and diet. Author(s): Brown BT. Source: Jama : the Journal of the American Medical Association. 1993 April 7; 269(13): 1635-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8455291&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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

The following is a specific Web list relating to enemas; 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:

Alternative Medicine 59

•

General Overview Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Bulimia Nervosa Source: Integrative Medicine Communications; www.drkoop.com Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Constipation Source: Integrative Medicine Communications; www.drkoop.com Constipation Source: Prima Communications, Inc.www.personalhealthzone.com Crohn's Disease Source: Integrative Medicine Communications; www.drkoop.com Cystic Fibrosis Source: Integrative Medicine Communications; www.drkoop.com Diverticular Disease Source: Integrative Medicine Communications; www.drkoop.com Food Poisoning Source: Integrative Medicine Communications; www.drkoop.com Gallstones Source: Healthnotes, Inc.; www.healthnotes.com Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.drkoop.com Proctitis Source: Integrative Medicine Communications; www.drkoop.com Prostate Cancer Source: Healthnotes, Inc.; www.healthnotes.com Rectal Inflammation Source: Integrative Medicine Communications; www.drkoop.com Skin Cancer Source: Integrative Medicine Communications; www.drkoop.com Ulcerative Colitis Source: Healthnotes, Inc.; www.healthnotes.com Ulcerative Colitis Source: Integrative Medicine Communications; www.drkoop.com

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•

Alternative Therapy Apple Diet Alternative names: apple-cleansing regimen apple-diet cleansing routine apple-diet regimen apple-diet 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/a.html 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 Gerson Therapy Alternative names: Gerson dietary regime GDR Gerson method Gerson treatment 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/g.html Hippocrates Health Program Alternative names: Hippocrates 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/h.html Mucusless Diet Healing System Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Naturopathy Source: Integrative Medicine Communications; www.drkoop.com 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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Urine Therapy Alternative names: amaroli auto-urine-therapy shivambu kalpa uropathy 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/u.html Urine Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,744,00.html •

Herbs and Supplements Arnica Alternative names: Arnica montana L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Chamomile Alternative names: Matricaria recutita Source: Healthnotes, Inc.; www.healthnotes.com Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com

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

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

Recent Trials on Enemas The following is a list of recent trials dedicated to enemas.8 Further information on a trial is available at the Web site indicated. •

Clotrimazole Enemas for Pouchitis in Children and Adults Condition(s): Ulcerative Colitis; Pouchitis; Ileitis; Inflammatory Bowel Disease Study Status: This study is currently recruiting patients. Sponsor(s): FDA Office of Orphan Products Development Purpose - Excerpt: Colectomy with creation of an ileal pouch (IPAA) is now the treatment of choice for patients with ulcerative colitis that is resistant to existing medical therapies. The development of inflammation in these ileal reservoirs, a clinical entity referred to as pouchitis, is the most common long-term complication of this procedure and can affect 50-60% of adults and children. We have previously demonstrated that clotrimazole (delivered as a rectal suppository) is generally safe, effective, and displays poor systemic absorption when used in pediatric and adults with active pouchitis. We saw clinical benefit in patients with pouch disease that had previously failed to respond to standard antibiotic, steroid, or immunosuppressive therapies. The clinical trial outlined here will define the effectiveness and safety of topical clotrimazole therapy (delivered as a rectal enema) in pediatric (aged greater than two years) and adult patients with pouchitis. Subjects in this study will be randomly assigned to receive either placebo (no active drug, 4 subjects) or one of two clotrimazole therapy groups: 2500 mg/day (8 subjects) or 4000mg/day (8 subjects). No washout period is required, and subjects will be allowed to continue their existing anti-inflammatory medications during their participation in the study. Clotrimazole will be delivered nightly in the form of an enema. Subjects will undergo flexible sigmoidoscopy (pouchoscopy) prior to

8

These are listed at www.ClinicalTrials.gov.

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and again after completing one month of study therapy, and pouch disease activity will be graded at after each procedure using the Pouchitis Disease Activity Index (PDAI). Clinical improvement will be defined as a drop in PDAI score. If the drop in PDAI scores between placebo and either active clotrimazole treatment group is not significant, and no subject experiences what are determined to be study-related adverse effects, a second cohort of subjects will be recruited and studied after receiving one month of either placebo (4 subjects), 6000 mg/day clotrimazole (8 subjects), or 7500mg/day clotrimazole (8 subjects). Subjects will be assessed for adverse effects at the midpoint of the study. Clotrimazole blood levels will be measured during the first and last day of study participation. In addition, adults will complete a health related quality of life assessment at baseline and after completing study drug therapy. All subjects will be eligible for one month of open-label study drug therapy after completing one month of study drug therapy. Phase(s): Phase I; Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00061282 •

Comparison of Barium Enema, Computed Tomographic Colonography, and Colonoscopy in Detecting Colon Cancer Condition(s): Colon Cancer; Rectal Cancer Study Status: This study is currently recruiting patients. Sponsor(s): Duke Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Screening tests may help doctors detect cancer cells early and plan more effective treatment for cancer. New diagnostic procedures such as computed tomographic colonography may provide a less invasive method of identifying patients who have colon cancer. PURPOSE: Diagnostic and screening trial to compare the effectiveness of barium enema, computed tomographic colonography, and colonoscopy in detecting of colon cancer. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00016029

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “enemas” (or synonyms).

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While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

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

•

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

•

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

•

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

•

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

•

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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CHAPTER 5. PATENTS ON ENEMAS 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.9 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 “enemas” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on enemas, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Enemas By performing a patent search focusing on enemas, 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

9Adapted

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 enemas: •

Anal sphincter device and barium enema plug Inventor(s): Fischer; Boguslav H. (251 E. 32nd St., New York, NY 10016), Wexler; Paul (110-45 Queens Blvd., New York, NY 11375) Assignee(s): none reported Patent Number: 3,943,938 Date filed: February 27, 1974 Abstract: An apparatus for stimulating the anal sphincter is provided in order to maintain the anal sphincter in a substantially continuously contracted condition. The apparatus includes a plug which is inserted in the anus such that a portion of the plug is surrounded by the anal sphincter. Electrodes are mounted on the plug in contact with anal sphincter and a signal generator generates a biphasic output signal having a positive pulse portion, a negative pulse portion and a zero output portion. The output signal is applied to the anal sphincter through the electrodes, thus causing the anal sphincter to contract and remain in a substantially contracted condition. The signal generator comprises a timer circuit which is used to operate a counter and an output driver which is controlled by the counter. The output signal from the output driver is applied to the anal sphincter through the electrodes. The plug comprises a suppository member which has an enlarged forward portion, a narrower central portion and an enlarged rear portion. The device may be used in conjunction with a barium enema to maintain the anal sphincter in a substantially contracted condition during barium enema examinations. In this arrangement, the plug has a channel which passes through the center along the axis thereof. The contrast material is then passed through this channel into the rectum and colon. The contrast material is held in the body because of the maintained contraction of the anal sphincter. Excerpt(s): This invention relates to an apparatus for holding the anal sphincter in a substantially continually contracted condition and more particularly to an apparatus for applying an electrical signal to the anal sphincter to stimulate the anal sphincter such that it is maintained in a substantially contracted position. Devices have been developed for applying an electrical signal to the anal sphincter in order to contract this muscle and hold it in a substantially contracted condition. One such device is disclosed in U.S. Pat. No. 3,650,275. In devices of this type, a square wave signal at a frequency between 18 and 90 Hz is applied to the anal sphincter. Each cycle of the square wave signal consists of a positive pulse portion followed by a negative pulse portion wherein the amplitude of the positive and negative portions are the same. The square wave signal does not have a zero output portion but rather instantaneously passes through zero when switching from the positive to negative portion. The signal applied to the anal sphincter, however, has a number of disadvantages. At a given constant current, pain or discomfort is a result of the frequency of the signal. It has been found that frequencies below 100 Hz may cause great discomfort. The signal applied to the anal sphincter by this device has a further disadvantage in that it provides no period for relaxation of the anal sphincter. Since the wave shape of the output is a square wave, it is either positive or negative at all times and has no period of zero output. The anal sphincter is thus constantly being stimulated with either the positive or negative portion of the signal and there is no time for the muscle to relax. Thus a signal of this type may cause great fatigue to the anal sphincter. One of the problems resulting from anal muscle weakness,

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that is, the inability of the anal sphincter to maintain a substantially contracted condition, is that it is not possible to give patients having this problem a barium enema examination. As is readily apparent, in order to give a barium enema examination, the patient's anal sphincter must be capable of contracting and holding itself in the substantially contracted condition in order to keep the contrast fluid in the rectum and colon. No successful techniques have been developed in the prior art for giving barium enema examinations to patients suffering from anal incontinence. Web site: http://www.delphion.com/details?pn=US03943938__ •

Barium enema insufflation system Inventor(s): Zimmet; Arthur (Centerport, NY), Goodman; John (Huntington, NY), Froehlich; Matthew (Kings Park, NY) Assignee(s): E-Z-EM, Inc. (Westbury, NY) Patent Number: 5,322,070 Date filed: August 21, 1992 Abstract: An improved enema insufflation system includes a source of barium sulfate suspension connected, by tubing, to a multi-lumen enema tip and a source of carbon dioxide, connected to the enema tip. The carbon dioxide source contains compressed carbon dioxide. The source is connected to a carbon dioxide reservoir capable of holding a pre-determined volume of carbon dioxide at a relatively low pressure. A hand actuated insufflation bulb is connected to the carbon dioxide reservoir. The insufflation bulb can draw carbon dioxide from the reservoir for delivery, through the enema tip, to a patient. The compressed, high-pressure carbon dioxide is functionally isolated from the patient to ensure patient safety. Excerpt(s): The present invention relates to an improved insufflation system for use in double contrast barium enema studies. Barium enemas are used by radiologists to diagnose abnormalities of the colon. There are both single and double contrast studies. Presently the double contrast study is the more practiced form of barium enema study. In a double contrast barium enema, a barium sulfate suspension is delivered, transrectally, into the patient's colon. The suspension is delivered through the central lumen of a multi-lumen enema tip. The barium sulfate suspension is held in a plastic bag which is suspended above the patient on a pole. The barium flow is controlled with a hand activated tubing clamp located on a tube that couples the plastic bag to the enema tip. In a double contrast study, barium sulfate suspension is delivered into the colon to coat the colon lining. The colon is a collapsible, sack-like structure. To better visualize the colon after delivery of the barium, air is delivered to the colon through a separate lumen in the enema tip. The barium coating on the walls of the colon provide radiopacity to the colon and the air serves to expand the colon. Together the barium and the air provide a clinically useful radiographic image. Web site: http://www.delphion.com/details?pn=US05322070__

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Collapsible portable enema seat Inventor(s): Oates; Otto G. (106 Glen Springs Drive, Scarborough, Ontario, CA) Assignee(s): none reported Patent Number: 4,613,994 Date filed: May 30, 1985 Abstract: A portable enema seat is provided, comprising a base, foldable support secured at one end of the base, and a foldable seat supported by the base and positioned from the foldable support to create a space in which the user can easily access or egress the seat. The seat has a downwardly directed opening therethrough, said seat being discontinuous at a central rearward position remote the pivotable support. The foldable support secures the user of the enema seat when the user is leaning on or against it. A waste receptacle support is also provided to sustain a waste receptacle below the downwardly directed opening. A pair of arms is pivotally secured to the foldable support (one arm on each side) and which arms are each pivotable laterally, one at a time from positions securing the seat to the support, (thereby rigidifying the structure), to a position laterally away from one side of the seat to permit the paraplegic to enter the space between the support and seat by grasping the opposite secured arm, and the foldable front support or seat for supporting and pulling himself/herself onto the seat. Thereafter, the pivoted arm is moved to a position securing the support to the seat. Excerpt(s): This invention relates to a collapsible portable enema seat. Because some paraplegics have no muscle control of the anus, they are incapable of having regular bowel movements and must, as a result, be given regular enemas every few days. Unless the paraplegic is able to administer the enema himself/herself, or is attended by someone skilled in giving enemas, he/she must attend regularly at for example, a hospital for the administration of an enema--an inconvenient necessity. When attending at for example, the paraplegic's olympics, these paraplegics because of their number, must literally make an appointment at the local hospital for their enemas. It is therefore, an object of this invention to provide a portable enema seat, which is easily folded for travel and easily unfolded for use at the paraplegic's destination for the administration of an enema by the paraplegic himself/herself, or by a third party to the paraplegic. Web site: http://www.delphion.com/details?pn=US04613994__

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Compositions for use in the regulation of subnormal pH values in the intestinal tract and for treatment of bowel diseases Inventor(s): Halskov; S.o slashed.ren (Virum, DK), Jepsen; Svenn Kluver (Copenhagen, DK) Assignee(s): Farmaceutisk Laboratorium Ferring A/S (Vanlose, DK) Patent Number: 5,716,648 Date filed: December 21, 1995 Abstract: Compositions for use in the regulation of subnormal pH values in intestinal tract and for treatment of bowel diseases. The compositions comprise a coating and a substantially insoluble alkaline material confined within said coating, the composition being adapted so as to ensure the availability of an amount of said pH regulating alkaline material in the lumen of the gastrointestinal tract exhibiting subnormal pH values. E.g. In the proximal small intestine, the mid small intestine, the distal small

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intestine, the caecum, the ascending colon, the transverse colon, the descending colon, the sigmoid colon and/or the rectum. The compositions may also comprise a medicament for treatment of bowel disease, e.g. 5-aminosalicylic acid for the treatment of Crohn's disease and colitis ulcerosa. The administration may be oral composition or enemas or suppositories. Excerpt(s): This application is a 371 of PCT/DK94/00223 filed Jun. 8, 1994. The present invention provides compositions for oral or rectal administration having pH-regulating effect, in particular for raising a subnormal pH in the intestine to a pH close to the pH usually found in the intestine, and/or the use of a composition in the treatment of bowel diseases e.g. inflammatory bowel diseases and/or for obtaining ulcer healing in the intestine. In particular, the composition according to the invention optionally contains an active medicament for the treatment of Crohn's disease or colitis ulcerosa, e.g. 5aminosalicylic acid (5-ASA). Web site: http://www.delphion.com/details?pn=US05716648__ •

Disposable device for fixation of the barium enema tip Inventor(s): Young; Ruperto S. (Amsterdam, NY) Assignee(s): Young; Janis Marie (Amsterdam, NY), Wessendorf; Roberta H. (Guilderland, NY) Patent Number: 4,325,370 Date filed: April 14, 1981 Abstract: Discloses a device for the external fixation of the barium enema tip inserted into the patient's rectum. The device has a waist band, anterior and posterior straps suitably attached to the waist band a locking ring for releasable and removable locking engagement with a locking groove on the barium enema tip. The barium enema tip has a lumen communicating with side holes, a proximal end having a raised ridge to thereby receive and retain enema-bag tubing, a distal end, and an hour-glass shaped cuff having a concave portion whereby the anal sphincter complementally receives and locks thereon to prevent leakage of barium liquid. Excerpt(s): This invention relates to a disposable device fo fixation of the barium enema tip. Barium enema is an x-ray procedure where a contrast material, barium sulfate, is introduced through the rectum and the examination is performed after the colon is filled with an adequate amount of the liquid barium. The introduction of this liquid is accomplished with a certain amount of pressure to overcome the natural colonic resistance to distension and to overcome the natural flow of intestinal contents. Consequently, the prior-art tube or tip used for this study can be easily dislodged by the pressure and more so with the positioning and manipulation of the patient, which is necessary for such study. On occasion, the tip may be inserted too far into the rectum and cause bowel injury. In the present state of the art, an intrarectal balloon is used for retention of the enema tip. This prior-art device has been known to cause injury and perforation of the rectum and is also known to obscure anal or rectal pathology, in that, it creates an intrarectal abnormal shadow on radiologic film. Accordingly, the object of the invention is to contribute to the solution of the problems of the prior art by providing a device for external fixation of the barium enema tip where there is no inconvenience to the patient or for personnel, with a vastly simpler procedure; where overextension of the barium enema tip into the rectum resulting in perforation of the rectum is checked; where dislodgement of the enema tip during examination is

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prevented; where the use of the balloon-type enema tip which can obscure pathology is avoided; where barium leakage around the tip is prevented. Web site: http://www.delphion.com/details?pn=US04325370__ •

Disposable enema evacuant collection system Inventor(s): Klecker; James D. (1879 Fairmount Ave., St. Paul, MN 55105) Assignee(s): none reported Patent Number: 3,974,533 Date filed: October 3, 1974 Abstract: This is a disposable enema evacuant collection system comprising a bedpan having an interior bottom surface sloping toward a large discharge opening and a transparent plastic multi-compartmented receptacle with a conduit extending therebetween, and having controllable divider branches communicating with the respective compartments of the receptacle and means for selecting the respctive branch into which the evacuant is discharged thereby facilitating respective measurement of the evacuant, providing a more efficient and less demeaning manner of enema administration, and also greatly facilitating the obtaining of a fecal specimen for analysis. Excerpt(s): At present enema administration it is best a demeaning, inefficient and unprofessional medical procedure. It requires extensive moving of the patient and the physical labor of at least three medical personnel to accomplish it. The existing method is often personally embarrassing to the patient and equally distasteful to the medical personnel involved. Enema administration on a bedridden patient frequently produces spillage on the bed clothes, the surrounding hospital area and on the patient himself. In addition to the personal and efficiency difficulties, there is a distinct problem in the medical determination of enema evacuant, and the administrating personnel has little empirical evidence of the evacuant progress oftentimes causing an unnecessary and prolonged enema procedure. There is also the problem of obtaining representative and undiluted stool specimens as they are now usually secured from the bedpan or toilet and are difficult and messy to get into a container, and also frequently include excessive dilution. This type of specimen lowers the quality needed for accurate laboratory evaluation. In addition, this invention provides a conveniently positioned specimen container removably attached to the discharge opening of one of the compartments. Therefore, it is an object of this invention to provide a disposable sealed enema evacuant collection system which permits a less demeaning, more efficient, and medically more professional method of enema administration. It is another object of this invention to prevent extensive and unnecessary movement of the patient and embarrassment and accidental spillage of the evacuant. Web site: http://www.delphion.com/details?pn=US03974533__

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Disposable enema syringe for one hand use Inventor(s): Silver; Jules (Rte. 32, North Franklin, CT 06254) Assignee(s): none reported Patent Number: 4,248,228 Date filed: October 19, 1979 Abstract: There is provided a disposable enema syringe for self-application and/or one hand use wherein the syringe is of the type having a barrel with a transversely extending flange at least partially disposed about the open end thereof, a movable piston disposed within the bore of the barrel and a plunger having one end connected to the piston and the other end extending out of the bore and terminating in a digit receiving pressure pad. The pressure pad is at a distance from the flange such that the syringe may be controllably grasped by one hand between the thumb and a finger around the barrel and next to the flange and the index or second finger on the pressure pad. The syringe has a soft and flexible cannula which is sufficiently long that it may be inserted into the rectum and past the sphincter muscles and sufficiently short that it may be inserted into the rectum with only one hand. Thus, the cannula may be inserted into the rectum and the enema fluid injected from the syringe into the rectum with the use of only one hand. Excerpt(s): The present invention relates to an enema syringe for easy, convenient and aesthetic administration unassisted or assisted by the user. More particularly, the invention relates to such syringe wherein operation of the syringe, i.e., expelling its contents, may be accomplished with one hand, and without direct contact of the hand with the anal opening. The injection of a liquid into the colon by way of the anus is commonly referred to as an enema and is used in a variety of therapeutic and presurgical procedures. However, due to the nature of the enema, there is a strong resistance by patients to the use of an enema, even though the therapeutic and presurgical procedures are often well-advised. A primary cause for this resistance to the enema is the difficulty and inconvenience of self-application of the enema and the corresponding often required assistance for application of the enema. In addition, there is substantial resistance to the use of an enema which is applied by re-usable devices, since these devices not only suffer from the psychological impact of prior use but require cleaning after use. To mitigate these difficulties associated with enemas, the art has proposed a number of disposable enema devices, which avoid the above-noted psychological impact of prior use and the requirement for subsequent cleaning. Some of the proposed devices, in addition to being of a disposable nature, are constructions which can be referred to as self-application devices, but these devices are either difficult to operate in a self-application mode or are inconvenient for self-application due to special considerations which must be observed in that self-application. These devices also involve direct contact or close proximity to the anal opening during administration which increases psychological user resistance. Web site: http://www.delphion.com/details?pn=US04248228__

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Disposable enema unit Inventor(s): Hussey; Richard P. (West Boxford, MA) Assignee(s): Aid-Pack, Inc. (Gloucester, MA) Patent Number: 4,752,288 Date filed: July 14, 1986 Abstract: A one-piece sealed disposable enema unit with a lubricated rectal tip is disclosed. The rectal tip of the unit is sealed with a break-off tab. Attached to the tab is a sleeve which covers the exterior of the rectal tip and prevents contamination of the lubricant. Before use, the break-off tab must be twisted off and the tab with the attached sleeve removed. Therefore, the unit is tamper proof and security of the contents is insured. Excerpt(s): This invention relates to medical apparatus and, in particular, to disposable enema units. Conventional disposable enema units consist of a flexible bottle made out of plastic or other material containing an appropriate liquid. The bottle is closed with a screw cap which has an elongated rectal tip that is generally lubricated to ease insertion. Preventing the lubricant on the rectal tip and and the enema fluid from becoming contaminated is of primary importance in the safety and ease of use in such an enema unit. One prior art approach to maintaining sterility of the enema fluid is to utilize a rubber diaphragm mounted in the screw-on cap. The diaphragm contains a slit which allows the enema fluid to exit from the bottle yet maintains a satisfactory seal to inhibit contaminants from entering the bottle and contaminating the fluid. Web site: http://www.delphion.com/details?pn=US04752288__

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Douche-enema pump Inventor(s): Taylor; Edward J. (201 Pecan Grove Court, San Jose, CA 95123) Assignee(s): none reported Patent Number: 3,960,466 Date filed: February 10, 1975 Abstract: The invention is concerned with a peristaltic action pump useful for douche and enema purposes and capable of delivering a uniform flow of liquid. The pump comprises a flexible tube affixed in a hemicircular shape and having a fluid input port at one end thereof and a fluid exit port at the other end thereof. A rotatable member is provided adjacent to and generally parallel to the plane of the hemicircle, the rotatable member being rotatable about an axis in line with the axis of the hemicircle. Means are also provided, coupled with the rotatable member for rotatingly driving it. A pair of levers are provided pivotally mounted intermediate thereof to the rotatable member, each at an equal and non-zero distance from the rotational axis of the member, a line from the mounting of one of the pair of levers to the mounting of the other of the pair of levers passing through the rotational axis of the member. A pair of rollers are provided, one of the rollers being pivotally attached to one of the ends of each of the levers, the rollers extending sufficiently from the one ends of the levers to press upon and to temporarily deform the flexible tube, a line from the attachment of one of the pair of rollers to the attachment of the other of the pair of rollers passing generally through the rotational axis of the member. Also spring means are provided between the other ends of the pair of levers biasing said other ends of said pair of levers towards one another, a

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line from said other end of one of said levers to said other end of the other of said levers passing generally through said rotational axis. The pump may also include cam means for selectively lifting one of the pair of rollers away from the flexible tube whereby pulsating flow of fluid is obtained from the pump. Excerpt(s): The invention is concerned with a pump which is useful for douche and enema purposes. More particularly a peristaltic action pump is contemplated which provides a uniform flow of liquid due to a unique mounting of the rollers which provide the peristaltic action and which also supplies, via a unique cam arrangement, a pulsating flow of liquid. Prior art apparatus for douche and enema purposes has generally consisted of simply a hanging vessel such as an elastomeric bag or the like from which liquid flows through tubing under the impetus of gravity. The use of such apparatus has often been highly inconvenient because of lack of suitable places for hanging the vessel, the necessity for placing the vessel high above the user thereof to obtain a sufficient hydrostatic head, the frequent requirement that the user of the bas assume an uncomfortable position because of the relatively low pressure of fluid obtainable from the gravity flow and the like. Peristaltic action pumps are known to the prior art but not for douche and enema purposes. Typical prior art patents which show peristaltic pumps include U.S. Pat. Nos. 3,402,673; 3,726,613; 3,799,702; 3,822,948; 3,826,593; and 3,829,251. Since these prior art peristaltic pumps have not been designed to solve some of the problems and provide some of the advantages desirable in a peristaltic pump for douche and enema purposes, they have not provided, in combination, the structure of the peristaltic pump of the present invention nor its advantages. Web site: http://www.delphion.com/details?pn=US03960466__ •

Electro-motive enema Inventor(s): Chu; Ven-Chung (3 Fl. 3, Lane 42, Yu Hsi Street, Yung Ho City, Taipei Hsien, TW) Assignee(s): none reported Patent Number: 5,199,945 Date filed: July 23, 1990 Abstract: It is an enema device, in which an electro-motive pump is used for adapting to different water containers, and a power supply unit in the device may be a rectifier or a car power supply; a rubber tube is connected with a rectal pipe or a washing nozzle, which is to be mounted on a stool bag before performing an enema operation. Excerpt(s): Most of the conventional enema equipment might be classified as an automatic-flowing type, a hand-press type, and a syringe type, among which the automatic-flowing type is deemed the most popular type; however, such a type has to be, in operation, hung on a support and must have a special container; further, as a result of a pressure in the rectum, the washing water is often difficult to flow into the rectum. The hand-press type is considered a reliable type, but it takes time and manpower to operate, and therefore it is merely used as a spore device. The syringe type can not be used by a user himself (or herself); in other words, the aforesaid three types of equipment are unable to meet the requirement of a user on occasions, such as at home, traveling (in a hotel) and camping (or in a car). In order to satisfy the general requirements and the requirement of a user who has an artificial anus, the inventor has developed "A D.I.Y. Type of Electro-motive Enema", which comprises an electro-motive

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pump to be sunk in water; the power supply unit of the present invention can use the commercial A.C. power, a car power supply, a rechargeable battery or a dry battery. Since the pump can be sunk in a water, no special water container is required; since a pressure valve is furnished in the present invention, a bottle or the like may be used as a water container. The present invention also comprises a washing nozzle, it makes the washing work much easy; Moreover, the fixed pad for the artificial anus has been improved by means of rubber and a clamp. A user can operate it without touching the water and stool and without smelling the odour at all; therefore, the present invention is deemed a reliable and sanitary enema device to meet the requirements on all occasions, such as at home, travelling, camping or others. To operate the enema of the present invention, fasten the belt 43 to the buckles on both sides of the fixed pad 42; let the fixed pad 42 align with a round hole on the stool bag 41, and then push the rubber washer 44 into the round hole until the same is fixed to the stool bag 41; then, let the small hole on the pad 42 align with the artificial anus, and put the stool bag 41 into a close stool. The opening of the stool bag 41 is closed with a clamp 49; then, the enema operation can be started. Web site: http://www.delphion.com/details?pn=US05199945__ •

Enema Inventor(s): Wada; Kaoru (12-905, 41, Nishishinjuku 4-chome, Shinjuku-ku, Tokyo, JP) Assignee(s): none reported Patent Number: 6,478,782 Date filed: February 11, 2000 Abstract: An enema has liquid amount controlling component, namely a rotary valve, having an outer tube with a cylindrical concave part at its center and is provided with an insertion opening fitting a connecting tube and a discharge opening fitting a conduit on a side wall of the concave part of the outer tube. A rotator is provided with opening parts corresponding to the positions of the insertion opening and the discharge opening of the outer tube, and a knob part on an upper part of the rotator. Two fitting spring are integrally formed to extend on both sides of a fixture (8), and the fixture has a penetration hole for inserting a beak tube. The fixture slides on the said beak tube for controlling the length of the beak tube to be inserted into an anus. The rotator rotates in the outer tube according to the operation of the knob part of the rotator, and an amount of an injection liquid in a tank to be injected into the anus from the beak tube via the conduit is controlled according to the relationship between the opening parts of the rotator and the insertion opening and the discharge opening of the outer tube based on the rotation of the rotator. Excerpt(s): The present invention relates to an enema to be inserted into the anus of the human body to inject a fluid such as warm water into the intestines of the human body. An enema to be inserted into the anus has been constituted so as to inject a certain amount of a liquid, such as warm water and a chemical liquid, into the intestines to perform evacuation, and has been employed with a view towards improving fermentation in the intestines or to combat constipation. Thus, the conventional enema has disadvantages associated with the operation of the cocks and the inconvenience of requiring the use of hands during injection. Moreover, a patient cannot apply an enema without the help of a nursing person. Web site: http://www.delphion.com/details?pn=US06478782__

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Enema and enterically-coated oral dosage forms of azathioprine Inventor(s): Sandborn; William J. (Rochester, MN) Assignee(s): Mayo Foundation for Medical Education & Research (Rochester, MN) Patent Number: 6,432,967 Date filed: December 21, 2000 Abstract: This invention relates to enema and enterically-coated dosage forms having an amount of azathioprine effective to prevent colorectal adenomas without dose-limiting systemic toxicity. Excerpt(s): Inflammatory bowel disorders or diseases (IBD) encompass a spectrum of overlapping clinical diseases that appear to lack a common etiology. IBD, however, are characterized by chronic inflammation at various sites in the gastrointestinal (GI) tract. Illustrative IBD are regional enteritis (or Crohn's disease), idiopathic ulcerative colitis, idiopathic proctocolitis, and infectious colitis. Most hypotheses regarding the pathogenesis of IBD concern the implication of immunologic, infectious, and dietary factors. Colorectal cancer is the most common visceral cancer in the United States. The colorectal cancer progresses through clinically recognizable stages from normal mucosa through enlarging and increasingly dyplastic polyps to carcinoma. The precursor relationship of colorectal adenomatous polyps to carcinoma and the high prevalence of adenomas make them an attractive target in chemoprevention trials. Furthermore, endoscopic or surgical removal of polyps does not change the pathogenetic milieu responsible for their growth and development. The recurrence rate for colorectal adenomas ranges from 20-60% by two years. Patients who have undergone surgical resection of a primary colorectal cancer have also been shown to be at high risk of developing metachronous adenomas. Chemoprevention by pharmacologic intervention remains to be established in clinical practice, and there is a continuing need to develop new chemopreventive treatments for colorectal adenomas. 6-mercaptopurine (6MP) and its prodrug azathioprine (AZA) have been used in the treatment of inflammatory bowel disease (IBD) for over 25 years. Multiple controlled trials and a recent meta-analysis support the efficacy of 6MP and AZA in Crohn's disease. See, J. M. T. Willoughby et al., Lancet, ii 944 (1971); J. L. Rosenberg et al., Dig. Dis., 20, 721 (1975). Several controlled trials support the use of AZA in ulcerative colitis, the most recent by Hawthorne and colleagues, in Brit. Med. J., 305, 20 (1992). Both azathioprine and 6-mercaptopurine have also demonstrated anti-tumor activity against a wide variety of transplantable rodent tumors and against hematologic malignancies in man. However, use of 6MP and AZA has been limited by concerns about their toxicities. Dose-related leukopenia is seen in 25% of patients treated long-term with 6MP or AZA for IBD. See, for example, D. H. Present et al., Am. Int. Med., 111, 641 (1989); W. R. Connell et al., Gut, 34, 1081 (1993). Therefore, a need exits for effective, nontoxic therapies for IBD. Furthermore, there is also a need for new chemopreventative treatments for colorectal adenomas. Web site: http://www.delphion.com/details?pn=US06432967__

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Enema apparata improvements relating double contrast studies Inventor(s): Miller; Roscoe E. (7400 W. 88th St., Indianapolis, IN 46278) Assignee(s): none reported Patent Number: 4,333,460 Date filed: April 4, 1980

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Abstract: An enema administering apparatus insertable into the rectum for delivery of a contrast medium to internal portions of a patient's anatomy includes an enema tube joined at an enema tip wherein the enema tube and enema tip have a common contrast medium passageway extending therethrough and an air passageway which is exterior of the contrast medium passageway and is able to be coupled to a source of air for double contrast studies. The air passageway may be a passageway disposed within the enema tube and enema tip construction or may be a separate tubing member joined therewith in a suitable arrangement to introduce air for the double contrast studies once the barium has been evacuated from the patient. Air introduction means and contrast medium introduction means are provided by various arrangements suitable for use with the main enema administering apparatus concept disclosed. Excerpt(s): This invention relates in general to enema administering procedures and apparata and in particular to enema tip improvements and administering techniques associated with double contrast studies. Enema administering apparata are often used to control the rectal introduction of a contrast medium such as barium for such procedures as X-ray examination of the colon. While a variety of problems may be encountered with incontinent patients, one problem involves the inability of such patients to retain the enema tip during a fluoroscopy examination. Various solutions to this problem have been provided by the improved enema administering apparata disclosed in my copending patent application, Ser. No. 39,280, filed on May 16, 1979. Another problem which is applicable to virtually all patients is the time lapse between preevacuation and postevacuation X-ray films when an air contrast study is required. Frequently referred to as a "double contrast" enema or fluoroscopy procedure, such a routine involves a conventional barium enema first, followed by an injection of air once the barium is evacuated. X-ray films are taken just prior to evacuation, air is then injected and postevacuation X-ray films are taken. An undue elapse of time between the preevacuation and postevacuation films allows the barium to dehydrate partially on the walls of the bowel when the air is injected. This results in highly unsatisfactory radiographs. Therefore, it would be an improvement to the various apparata currently used, as well as the procedures presently followed, if means were available for a rapid evacuation and prompt injection of air. Web site: http://www.delphion.com/details?pn=US04333460__ •

Enema bag Inventor(s): Field; Peter W. (Concord, AU) Assignee(s): Field Group Research Pty. Ltd. (New South Wales, AU) Patent Number: 4,636,412 Date filed: December 12, 1984 Abstract: There is provided a container useful for both storage and administration of a liquid medical composition for example as a barium enema the container comprising a flexible wall (1) and having a port (10) adapted for connection to a tube and having a composite wall including an innermost layer (11) which is inert to the content and is heat sealed with the port and a non innermost layer (12) which is resistant to water vapor transmission, the composite having a resistance to tear propogation in excess of 50 g/mil. Excerpt(s): This invention relates to a container useful for storage and administration of medical compositions. For various medical procedures it is necessary to dispense a

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liquid composition from a reservoir via a tube to a patient or to transfer a composition from a patient to a reservoir via a tube. Examples involving such procedures include the administration of saline solutions from a reservoir to a patient, the continuous collection of urine for analysis in a pouch reservoir and the administration of a barium enema prior to radiography from an enema bag. The specialized reservoirs used for administration of solutions and suspensions have in common that they are provided with at least one integral delivery tube or means for connection to a delivery tube. Usually they have been provided in addition with a filling port and have been made from glass, rubber, PVC and even metal according to administration requirements. The reservoirs and associated fittings are manufactured in many forms and sizes each adapted to serve a particular function. Some are part of highly specialized apparatus. Others are simple PVC or polyethylene bags with integral tubular fittings. Web site: http://www.delphion.com/details?pn=US04636412__ •

Enema extension Inventor(s): Singo; Ronald C. (3985 Glades Pike, Somerset, PA 15501), Singo; Janet L. (3985 Glades Pike, Somerset, PA 15501) Assignee(s): none reported Patent Number: 6,110,150 Date filed: April 9, 1998 Abstract: Generally, the present invention comprises an enema extension designed to fit onto existing enema application bottle designs. The extension connects a conventional enema applicator nozzle to a conventional enema bottle cap which seals the applicator nozzle to the enema bottle. The extension is preferably made of plastic and is of a length sufficient to allow the enema applicator nozzle to be inserted into the patient's rectum as the enema bottle is removed to a remote location for manipulation by the administering party. Excerpt(s): The present invention relates to medical equipment designed to assist health care workers in providing an enema to patients, and in particular to an extension adapted for use with existing enema application devices to allow the delivery of an enema to patients occupying a supine or immobilized position. An enema is a common medical procedure whereby fluid is injected into the rectum of a patient in order to induce bowel movement. The need for such a procedure typically arises in patients suffering from certain physical ailments in which voluntary bowel control is impaired. Medical equipment currently exists in the art for administering an enema to patients in need of this medical procedure. Typically this equipment consists of an enema squeeze bottle filled with the fluid intended to induce bowel movement, which is capped by a short applicator nozzle to be inserted into the patient's rectum. This type of conventional enema application device suffers a major disadvantage caused by the length of the applicator nozzle, in that the nozzle is too short to allow medical personnel to easily administer the enema to the patient who occupies a supine or immobilized position. The short length of the applicator nozzle gives rise to a lack of clearance between the patient's buttocks and the enema bottle, which makes manipulation of the applicator nozzle into the rectum difficult, causing discomfort to the patient. Web site: http://www.delphion.com/details?pn=US06110150__

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Enema nozzle with self-adhesive securing means Inventor(s): Goodin; Daniel S. (431 Lamar, #56, West Columbia, TX 77486), Aguilar; John M. (Rte. 1, Box 161, Sweeny, TX 77480) Assignee(s): none reported Patent Number: 5,578,017 Date filed: May 1, 1995 Abstract: A disposable flexible plastic enema nozzle with self-adhesive securing means for convenient attachment to the patient's buttocks is disclosed. The securing means comprises an annular positioning collar disposed about the enema tip or tube. The positioning collar has an elongated self-adhesive plastic sheet with easily removable protective tabs covering the adhesive. In one embodiment of the invention the positioning collar is fixed near the distal end of the tube, while in another embodiment the positioning collar is slidable along the tube for adjusting the insertion length of the tube. The invention is particularly applicable to diagnostic enema procedures, such as barium enema for radiological examination, performed on infants, small children, the infirm and the elderly. Excerpt(s): This invention relates to disposable enema nozzles and more particularly to nozzles with adhesive means for securing the conduit to the body during the enema procedure. Still more particularly, the invention relates to an enema nozzle having an attached external positioning means that permits the technologist to adjust the insertion length of an enema tube. Enema tubes that are conventionally used in medical procedures such as administration of a barium enema for radiological examination, intrarectal administration of medicine, or other procedures where the tube necessarily remains in place for a period of time, typically comprise a smooth rigid or flexible tip or a tip with an inflatable retention cuff. Tips of these types are available, for example, from Lafayette Pharmaceuticals Incorporated, Lafayette, Ind. Problems are frequently encountered with traditionally used enema tubes particularly when left in place for an extended period of time. Such problems include expulsion of the tip prior to completion of the procedure. Expulsion can occur due to pressure arising from colonic resistance due to distension by the enema fluid or from the opposing natural flow of intestinal contents. Also, some types of enema tubes can be easily dislodged while the technologist is positioning the patient or by the patient's movements during the procedure. This is frequently the case with pediatric patients, particularly infants. Additionally, in some patients, particularly infants and the elderly, the anal sphincter is functionally unable to retain the tip or to close tightly around the tip. As a result, leakage of the enema fluid commonly occurs, often causing insufficient colonic filling. Imperfect procedural results may be obtained as a consequence, or an insufficient dosage of medicine may be received by the patient. Another drawback of known enema nozzles having inadequate securing means is that they can travel too far into the patient's rectum. A particular concern with pediatric patients, who commonly move about during the enema procedure, is avoiding having the tube rupture a fragile rectum wall. Infants expecially have highly variable colonic dimensions which defy uniform treatment methods and materials. Web site: http://www.delphion.com/details?pn=US05578017__

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Enema tip Inventor(s): Dodds; Wylie J. (Brookfield, WI), Mather; Byron L. (Milwaukee, WI) Assignee(s): Plastronics, Inc. (Milwaukee, WI) Patent Number: 3,990,448 Date filed: February 23, 1976 Abstract: An enema tip comprising an acorn portion at the end thereof, a distal staff portion connected to the acorn portion and a stop or locator portion connected to the distal staff. The acorn portion has a rounded tip which tapers to a head portion and a retainer shoulder formed adjacent the head portion. The locator portion is of a diameter greater than the distal shaft and is provided with a locating shoulder spaced approximately one inch from the retainer shoulder on the acorn tip. Excerpt(s): This invention relates to enema tip and more particularly to an enema tip designed for introduction of a barium enema into a patient. The principal advantages of the enema tip of this invention over prior configurations known to applicants are the provisions in the tip construction for proper location and retention of the acorn tip in the patient. More specifically, the tip construction itself provides a locating feature to thus make it unnecessary for the user to perform this function. An enema tip having a central passageway located on the horizontal axis thereof comprising an acorn portion having a smoothly rounded tip at the end thereof and a tapered surface extending from the tip to a smoothly rounded head portion. A retaining shoulder is formed on the acorn portion and extends substantially transversely of the axis of the tip immediately to the rear of the head portion. The acorn portion has at least one transverse port which communicates with the central passageway of the enema tip. A distal shaft portion having a diameter less than that of the head of the acorn portion is connected at one end to the acorn tip and has a locator portion connected to the other end thereof. The locator portion has a locating shoulder formed thereon which extends substantially transversely of the axis of the enema tip immediately adjacent the distal shaft. Web site: http://www.delphion.com/details?pn=US03990448__

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Enema tip retention apparatus Inventor(s): Miller; Roscoe E. (7400 W. 88th St., Indianapolis, IN 46278) Assignee(s): none reported Patent Number: 4,248,229 Date filed: May 16, 1979 Abstract: An enema tip retention apparatus for retaining an inserted enema tip in a patient during the administering of an enema to the patient includes an adjustable belt for encompassing the waist of the patient and including depending straps which couple to a substantially flat mounting plate. The mounting plate has a clamp disposed thereon and a clearance aperture therethrough and includes two collar buttons which are arranged for connection to the two depending straps. The clamp has a ratcheted arrangement such that its clearance aperture diameter may be varied, depending upon the enema tube outside diameter which is inserted therethrough. With the depending straps coupled to the collar buttons, the mounting plate may be drawn adjacent the rectal opening of the patient and with the enema tip and tube anchored by the clamp, this tip and tube may be held in position throughout a fluoroscopy examination and will

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be retained in its desired position, regardless of the movements and the maneuvers the patient is subjected to. Excerpt(s): An enema tip retention apparatus for retaining an inserted enema tip in a patient during the administering of an enema to the patient includes an adjustable belt for encompassing the waist of the patient and including two depending straps which couple to a substantially flat mounting plate. The mounting plate has an adjustable, releasable clamp disposed thereon and a first clearance aperture therethrough. The mounting plate further includes two collar buttons which are arranged on opposite sides of the releasable clamp for connection to the two depending straps. The clamp includes a second clearance aperture extending therethrough and defined by a partcircular portion, a deformable tab portion and cooperating locking portion. The tab portion and locking portion are arranged relative to each other such that the second clearance aperture diameter may be varied, depending upon the outside diameter of the enema tube which is inserted therethrough. The first and second clearance apertures are substantially coincident with each other. With the depending straps coupled to the collar buttons, the mounting plate may be drawn adjacent the rectal opening of the patient and with the enema tip and tube anchored by the clamp, this tip and tube may be held in position throughout a fluoroscopy examination and will be retained in its desired position, regardless of the movements and the maneuvers the patient is subjected to. Most radiologists have had barium spill on the examining table when they conduct colon examinations of incontinent, seriously ill and hard-to-manage patients. Such patients include the mentally retarded, the mentally ill, the aged, the uncooperative, the severely handicapped, the paraplegic and the patient with an extremely relaxed anal canal. One problem with such patients involves their inability to retain an enema tip which is inserted for the administration of a diagnostic contrast medium for either cleansing or medication purposes. The enema tip frequently slips out because of the turning of the patient and the various maneuvers required, after the barium has been introduced, as part of the fluoroscopy X-ray examination. One retention technique which has often been employed is to insert and then inflate a balloon on either or on both sides of the rectum. However, some physicians object to these balloons because of the dangers of perforation or over inflation. Therefore, it would be an improvement to enema tip retention devices and procedures if a means and structure could be devised to securely hold an enema tip in position without reliance on inflatable balloons. A further improvement would be to structure such a device so that it would be suitable for use with remotely controlled fluoroscopy tables where the operator (technician and/or physician and/or radiologist) is some distance from the patient. A retention device such as the suggested improved device is beneficial in that such attending medical personnel do not have to hold the device in the patient while Xrays are taken and subject themselves to additional radiation exposure. Web site: http://www.delphion.com/details?pn=US04248229__ •

Enema waste receptacle and frame Inventor(s): Sandonato; Saverio (50 Evans St., New Hyde Park, NY 11040) Assignee(s): none reported Patent Number: 4,101,991 Date filed: January 26, 1977 Abstract: Described herein is a bed attachment useful for preventing soiling of bedding by waste matter and enema fluid when bedridden patients have recieved an enema. It is

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comprised of a flexible leak-proof receptacle which is held in an open position to receive the wastes by a frame about the perimeter of said receptacle. The receptacle is maintained flush with the side of the bed and level with its upper surface, and has a portion extending for a short distance over the surface of the bed for insertion beneath the patient. The frame which holds the receptacle flush with the side of the bed has a corresponding, substantially parallel, base portion inserted between the mattress and the mattress support means of the bed to support the article. These parallel portions of the frame form the article of this invention when joined to a section perpendicular to each of the parallel portions of the frame. The perpendicular section of the frame is held flush with the side of the mattress by said base portion during administration of the enema. Excerpt(s): Traditionally, the most prevalent waste receptacle for bedridden patients in hospitals was the bedpan. While it was quite useful as a receptacle for most ordinary wastes such as urine and feces, it was less than satisfactory when an enema had been administered to the patient. In order for hospital personnel to administer an enema the patient must be either reclining on his side or on his back. After the patient has received the enema he must turn over and be lifted upon the bedpan. For many patients this is a trying experience because many are too incapacitated to really sit up easily and the maneuver is accompanied with a great deal of pain. While this shifting of the patient is occurring, enema fluid and waste material is leaking from the patient onto the bed. This virtually necessitates changing of the bed covers and cleansing the patient after each enema. As a result, the patient is subjected to a great deal of unnecessary discomfort and embarrassment. An additional problem inherent in the use of a bedpan occurred when the patient's condition was such that he was incapable of being moved from a reclining position and therefore unable to sit on the bedpan. In these cases, when a patient is subject to such incapacity a bedpan is totally unsatisfactory. The prior art contains numerous, generally unsatisfactory, attempts to develop an apparatus which facilitates the discharge of wastes by bedridden patients after they have received an enema. Unfortunately, these prior art devices were cumbersome and involved a relatively large outlay of capital. The central theme in a great number of prior art devices is the incorporation of the waste receptacle into the center of the bed or mattress. A hospital was then faced with a difficult problem. If all the beds incorporate the prior art design, unnecessary expenses are incurred because not every bed needs to have a waste receptacle incorporated into it. On the other hand, if only a portion of the hospital's beds contain a waste receptacle, the attentions of hospital personnel must be diverted from patient care while a proper allotment of the prior art beds to the necessary patients is made. While hospitals in the past may have been able to make these expenditures, this is no longer the case. It has been increasingly apparent that, as inflation is driving up the cost of medical services, a more economical and easier to use device is needed to assist in keeping hospital costs in an affordable range for the public. Examples of the numerous attempts by other workers to solve the problem of waste receptacles for bedridden patients are typified in such U.S. Pat. Nos. as Ishikawa, 3,943,583; Kappel, 3,323,146; Dickson, 2,618,787; Delisi et al, 2,533,774 and Marsan, 2,384,325. Each of these prior art patents incorporates a receptacle for wastes in the center of the bed. Ishikawa, 3,943,583, for instance, discloses a bed in which the main mattress is provided with a "through-hole" into which a commode or an auxiliary mattress may be positioned. On the other hand, Kappel, U.S. Pat. No. 3,323,146 teaches a hospital bed having a bedspring which is provided with an opening approximately at its center shaped to admit a bedpan. A receptacle in a cut-out center portion of the bed permits a patient to merely sit up to use the apparatus. These devices are satisfactory for ordinary patients who are capable of sitting upright but for those who must receive an enema or who are

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unable to leave a reclining position these devices may be used only with difficulty. An enema is administered to the patient while he is reclining on his side or on his back as previously noted. As the administration of an enema is often accompanied by leakage of the fluid and concomitant soiling of the bed as the patient is shifted to an upright position, these prior art devices were not satisfactory for they did not adequately prevent soiling when an enema was administered. Web site: http://www.delphion.com/details?pn=US04101991__ •

Hand-pumped enema apparatus and method Inventor(s): Phan; Han Ngoc (10407 New Hampshire Ave., Silver Spring, MD 20903) Assignee(s): none reported Patent Number: 6,544,237 Date filed: December 21, 2001 Abstract: An enema apparatus, including a container for liquid, an inlet situated within the container, a first conduit connected to the inlet and passing outside the container, a hand pump connected to the first conduit, a second conduit connected to the hand pump and passing inside the container, an outlet connected to the second conduit, the outlet being situated in and passing through a side of the container, and a third conduit, having a first end connected to the outlet, and a second end connected to a syringe. When a user activates the hand pump, liquid passes from the container, through the inlet to the first conduit, through the first conduit to the hand pump, through the hand pump to the second conduit, through the second conduit to the outlet, through the outlet to the third conduit, through the third conduit to the syringe, and out the syringe. Excerpt(s): The present invention relates to enema devices, specifically, enema devices that are hand-pumped. U.S. Pat. No. 331,128, issued on Nov. 24, 1885, to John Wesley Gordon and George Turner Blanchard, discloses a vaginal irrigator, having a cylindrical container with an open top, an intake submerged in liquid in the container and connected to a tube connected to a hand pump connected to another tube connected to a syringe. The present invention is distinguishable, in that the intake and tubing are attached to and pass through the sides of the container, thus reducing the chance of liquid being spilled. U.S. Pat. No. 493,208, issued on Mar. 7, 1893, to Arthur B. Cruikshank, discloses a vaginal syringe, with a hand pump divided into two compartments, that pumps liquid both into and out of the vagina. Web site: http://www.delphion.com/details?pn=US06544237__

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Method for stomach lavage Inventor(s): Kingston; Richard L. (1577 E. 6th St., St. Paul, MN 55106), Benusa; John E. (1383 Temple Hills Dr., Laguna Beach, CA 92651) Assignee(s): none reported Patent Number: 4,525,156 Date filed: February 16, 1983 Abstract: A sanitary, disposable, gastric lavage closed system is disclosed that quickly and effectively flushes material from a patient's stomach. The system includes an elevated, plastic reservoir bag connected through a feed line having a specified bore

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range, to a T-connection. A gastric tube is fitted to the T-connection and is adapted for insertion into the patient's stomach. A fixed volume of liquid from the reservoir bag is admitted to the patient by pump or by hand control of the feed line over a short, measured period of time.Material in the patient's stomach is then quickly removed into a disposable container that forms a closed system with the rest of the components.An injection syringe may be employed to inject treatment materials into the stomach, remove test samples, and maintain the system free of clogged material.An attachment for colonic irrigation and enemas may be employed to replace and/or by-pass the gastric tube. Excerpt(s): This invention relates to a new and improved lightweight, gastric lavage system, and more specifically to a disposable gastric lavage system that can quickly dispense a fixed quantity of liquid into a patient's stomach and remove the material therefrom in a sanitary manner. Various publications disclose the use of gastric lavage systems, and typical ones include: U.S. Pat. Nos. 386,603; 1,349,766; 2,919,695 3,233,609; 3,756,237; 3,885,567; and, 4,190,059. Other publications in this field include: "New Tube For The Diagnosis and Treatment of Upper Gastrointestinal Hemorrhage", by Paul Robert Liebman and Yanek S. Y. Chiu, presented at the Twenty-Second Annual Symposium of the Society of Air Force Clinical Surgeons, Apr. 8-10, 1974, Los Vegas, Nev.; "Gastric Lavage For Hemorrhage In The Upper Part Of The Gastrointestinal Tract", by Robert Joseph Atkenson and Lloyd M. Nyhus, Surgery, Gynecology & Obstetrics, 798, May 1978, Vol 146; "Comparison Of Ice Water With Iced Saline Solution For Gastric Lavage In Gastroduodenal Hemorrhage" by Bryant, Mobin-Uddin, Dillon and Griffen, The American Journal of Surgery, Vol. 124, November 1972, Page 570; and, "Gastric Aspiration and Lavage in Acute Poisoning", by atthew, Mackintosh, Tompsett and Cameron, BR.MED.J.1966,1,1333-1337. Web site: http://www.delphion.com/details?pn=US04525156__ •

Packaged stable enema solution or suspension containing 5-aminosalicyclic acid Inventor(s): Halskov; Soren (Helsinge, DK) Assignee(s): Farmaceutisk Laboratorium Ferring A/S (Vanlose, DK) Patent Number: 4,664,256 Date filed: October 2, 1985 Abstract: A packaged enema solution or suspension consisting essentially of an effective amount of 5-ASA or a pharmaceutically acceptable salt or ester thereof, a chelating agent, an antioxidant and a buffer, the solution or suspension having a pH value of from 4 to 7 and being contained in a plastic bottle under an inert gas, the plastic bottle being packaged in a diffusion-tight light-impervious package in the same inert gas as is present in the bottle. Excerpt(s): This invention concerns an enema solution or suspension which is suitable for rectal administration of 5-aminosalicyclic acid (5-ASA) in mammals. The present enema solutions are useful in the treatment of bowel diseases, in particular, ulcerative colitis, Crohn's disease located in the colon and proctoigmoiditis. Salicyclazosulfapyridine (SASP) has for a long period of time been a cornerstone in the treatment of ulcerative colitis and has been used in various pharmaceutical dosage forms including enemas. When SASP reaches the colon, it is split by bacteria into sulfapyridine (SP) and 5-ASA and, as explained in detail in copending U.S. application Ser. No. 555,533, filed Nov. 28, 1983, which is a continuation application of Ser. No.

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270,517, filed May 29, 1981, now abandoned, and based on International Application No. WO 81/02671, both of which are incorporated by reference, most experts now hold the active moiety of SASP to be 5-ASA. Azad Khan et al, Lancet, 1977, pp. 892-95, compared suspensions of SASP, SP and 5-ASA administered rectally and concluded that the therapeutic active moiety was 5-ASA and that SP only acts as a carrier to ensure that 5ASA is not released until it has reached the colon. Stability tests showed that SASP and SP suspensions were stable at room temperature while the 5-ASA suspension showed some decay and had to be made up in fresh batches every three months and stored in a refrigerator until used. Web site: http://www.delphion.com/details?pn=US04664256__ •

Pharmaceutical enema preparation Inventor(s): De Jong; Adrianus P. (Driehuis, NL), Wittebrood; Adrianus (Velserbroek, NL), Bron; Jan (Giessenburg, NL) Assignee(s): BYK Nederland BV (Zwanenburg, NL) Patent Number: 5,352,681 Date filed: December 7, 1993 Abstract: The light, oxidation and storage stability of aqueous 5-ASA suspensions is increased by incorporating in such suspensions an effective amount of titanium dioxide. The resulting stabilized aqueous suspensions are suitable for enema preparations. Excerpt(s): The invention relates to an enema preparation for 5-aminosalicylic acid. 5Aminosalicylic acid (5-ASA) is a known active compound which is employed, in particular, for the treatment of inflammatory intestinal disorders, such as ulcerative colitis. The administration of 5-ASA as an enema preparation is particularly convenient, since the active principle can hereby be brought directly to the site of the pathological changes. In these preparations, however, the known chemical instability of 5-ASA in solutions or suspensions presents considerable difficulties. In the past, various paths were followed to get to grips, in particular, with the light and oxygen sensitivity of 5ASA. U.S. Pat. No. 4,657,900 thus proposes an enema preparation in which highly pure 5-ASA is present as an aqueous suspension which, after preparation with exclusion of oxygen and addition of bisulphite as an anti-oxidant, is sealed into an opaque polyethylene rectal applicator which, for its part, is heat-sealed into a polyester/aluminum film/polyethylene bag. Web site: http://www.delphion.com/details?pn=US05352681__

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Sanitary rectal catheter and method of use Inventor(s): McClusky; Kenneth D. (10046 Springfield Cir., Davisburg, MI 48350) Assignee(s): none reported Patent Number: 5,217,439 Date filed: June 8, 1992 Abstract: A sanitary catheter particularly designed for the administration of barium enemas. The catheter includes a protective sheath formed of a fluid-impervious, flexible material, which may be extended over those portions of the catheter which have been

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inserted into a patient so that the sheath completely encloses contaminated portions of the catheter to prevent leakage of contaminated fluids therefrom. Excerpt(s): This invention concerns the field of catheters insertable into a body orifice to dispense fluid thereinto and, more particularly, to catheters used for the administration of fluids for radiographic studies. Following the x-ray examination of the colon, the catheter is removed from the patient's rectum. Of course, even though the flow of fluid has been stopped, some fluid remains within the catheter. Furthermore, the patient's own intestinal fluids will have mixed with the radiographic fluid and will generally be present inside the catheter after it is removed. Frequently, removal of the catheter causes some of the radiographic fluid contaminated with body fluids to splash onto medical personnel in charge of the procedure, particularly the radiographic technologist. Obviously, splashing of this contaminated fluid onto medical personnel is not only highly undesirable from an aesthetic viewpoint, but can expose them to the risk of contracting numerous infectious diseases, including AIDS and hepatitis. There are a number of patents relating to covers for protecting enema dispenser tips prior to use. See, for example, U.S. Pat. Nos.: 3,234,945; 3,486,503; 3,882,866; and 4,752,288. However, none of these references discuss the problem of covering used dispensers. Clearly, the need for covering the tip of the enema dispenser after use is just as acute as protecting it prior to use. Web site: http://www.delphion.com/details?pn=US05217439__ •

Stable budesonide solutions, method of preparing them and use of these solutions as enema preparations and pharmaceutical foams Inventor(s): Otterbeck; Norbert (Uberlingen, DE), Kuhn; Reimund (Freiamt, DE) Assignee(s): Dr. Falk Pharma GmbH (Freiburg, DE) Patent Number: 5,914,122 Date filed: June 27, 1997 Abstract: A stable budesonide solution with a pH not exceeding 6.0 in which the budesonide is dissolved in a solvent which may be water, an alcohol such as ethanol, isopropanol or propylene glycol, or a water/alcohol mixture. The solution preferably also contains a stabilizer such as sodium ethylenediaminetetraacetic acid, cyclodextrins or mixtures thereof. The stable budesonide solution is useful as the active ingredient in a rectal enema or a rectal foam. Excerpt(s): The present invention relates to stable budesonide solutions, the process for their preparation, and their use for producing pharmaceutical preparations, in particular enemas and pharmaceutical foams. Budesonids (INN; 16.alpha.,17-butylidenedioxy11.beta.,21-dihydroxy-1,4-pregnadiene-3,20-di one) is a known active substance of the corticoid series which is employed in particular for the treatment of bronchial disorders, but also in cases of inflammatory bowel disorders such as Crohn's disease and, in particular, ulcerative colitis. It has proven particularly suitable for the last-mentioned indication to administer rectal drug forms such as enema preparations or pharmaceutical foams in compressed gas packs, because the active substance is employed directly at the site of the disorder, and budesonide is especially topically effective. Budesonide is a racemate consisting of a mixture of the two diastereomers 22R and 22S. The racemate can be employed for the purposes of the present invention, but the 22R diastereomer is preferably employed because this is more active in

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pharmacological respects by a factor of about 2-3. Processes for fractionating the enantiomers are known, for example from EPA 92.901023.9. Web site: http://www.delphion.com/details?pn=US05914122__ •

Steady-temperature water heater and enema device Inventor(s): Khalaf; Majid Z. (1817 S. Harlem Ave. Apt 8, Berwyn, IL 60402) Assignee(s): none reported Patent Number: 6,292,628 Date filed: January 19, 2000 Abstract: A heater for providing steady-temperature heated water for domestic hot water or hygienic purposes. Water is heated in a drum-shaped tank that is divided into two chambers by a piston that can slide longitudinally within the tank. Attached to the tank is a reverse value that can direct cold water from an inlet into either chamber and direct heated water from the other chamber to an outlet leading to a heated water use. Electric component and a cycle regulator control the direction of water flow through the reverse valve and the direction of motion of the piston. When there is a demand for heated water, the cycle regulator causes the piston to move to expel heated water from one chamber while concurrently cold water enters the other chamber. After heated water is expelled from that chamber, the cycle is reversed. Because cold water and heated water are in separate chambers steady-temperature heated water can be maintained. Either electricity or gas can be used in heat water in the tank. When the use of the heated water is for an enema, a flexible connection means, attached to a handgrip and nozzle, is attached to the outlet. When the water heater is used for domestic hot water, the tank is much larger than when used as an enema device. Excerpt(s): This invention relates to water heaters used for kitchen, bathroom and hygienic purposes. More specifically to water heaters that save energy and water. Conventional hot water heaters usually heat water up to an average temperature of 80.degree. C. This temperature is too hot for many uses so that it is then mixed with cold water when used in baths and showers, in douches or in enemas. It is wasteful of energy to heat water to too a high temperature and then dilute it as there is a loss of energy during the adjustment in temperature. Another disadvantage of conventional hot water heaters is that water temperature is difficult to control if there are multiple users. If one person is taking a shower and a concurrent user suddenly starts using cold water, the person in the shower could be scalded. Conversely, if the concurrent user suddenly stops using cold water, the person in the shower could be chilled by a sudden slug of cold water. Another disadvantage associated with high temperature water heaters is vulnerability to explosion and fire. This invention overcomes these disadvantages by providing hot water with a steady temperature regardless of multiple concurrent use or duration of use. The temperature of the water can be set to be in the range of 3042.degree. C. according to the season and personal preferences so that it need not be mixed with cold water. The temperature of the hot water can be set as high as in a conventional hot water heater if desired. Web site: http://www.delphion.com/details?pn=US06292628__

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Use of alkanoyl L-carnitines for the therapeutical treatment of chronic inflammatory bowel disease Inventor(s): Cavazza; Claudio (Rome, IT) Assignee(s): Sigma-Tau Industrie Farmaceutiche Riunite S.p.A. (Rome, IT) Patent Number: 6,143,785 Date filed: November 16, 1999 Abstract: The use of lower alkanoyl L-carnitines is disclosed for preparing pharmaceutical compositions (particularly foams and enemas) for treating chronic inflammatory bowel diseases, in particular ulcerative colitis. Excerpt(s): The present invention relates to a new therapeutic use of the lower alkanoyl L-carnitines and their pharmacologically acceptable salts to produce pharmaceutical compositions for the treatment of chronic inflammatory bowel diseases, and, in particular, ulcerative colitis. The present invention also relates to pharmaceutical compositions suitable for rectal administration, particularly in the form of foams or enemas, containing the above-mentioned alkanoyl L-carnitines. Ulcerative colitis is an inflammatory, ulcerative disease of the colon of unknown aetiology, very often characterised by haematic diarrhoea. Web site: http://www.delphion.com/details?pn=US06143785__

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Use of phage associated lytic enzymes for treating bacterial infections of the digestive tract Inventor(s): Fischetti; Vincent (West Hempstead, NY), Loomis; Lawrence (Columbia, MD) Assignee(s): New Horizons Diagnostics Corporation (Columbia, MD) Patent Number: 6,254,866 Date filed: September 1, 2000 Abstract: A method for treatment of bacterial infections of the digestive tract is disclosed which comprises administering a lytic enzyme specific for the infecting bacteria. The lytic enzyme is preferably in a carrier for delivering said lytic enzyme. The bacteria to be treated is selected from the group consisting of Listeria, Salmonella, E. coli, Campylobacter, and combinations thereof. The carrier for delivering at least one lytic enzyme to the digestive tract is selected from the group consisting of suppository enemas, syrups, or enteric coated pills. Excerpt(s): The present invention discloses a method and composition for the treatment of bacterial infections by the use of a lysing enzyme blended with an appropriate carrier suitable for the treatment of the infection. In the past, antibiotics have been used to treat various infections. The work of Selman Waksman in the introduction and production of Streptomycetes, Dr. Fleming's discovery of penicillin are well known as well as the work of numerous others in the field of antibiotics. Over the years, there have been additions and chemical modifications to the "basic" antibiotics in attempts to make them more powerful, or to treat people allergic to these antibiotics. Others have found new uses for these antibiotics. U.S. Pat. No. 5,260,292 (Robinson et al.) discloses the topical treatment of acne with aminopenicillins. The method and composition for topically treating acne and acneiform dernal disorders includes applying an amount of an antibiotic selected from the group consisting of ampicillin, amoxicillin, other aminopenicillins, and

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cephalosporins, and derivatives and analogs thereof, effective to treat the acne and acneiform dermal disorders. U.S. Pat. No. 5,409,917 (Robinson et al.) discloses the topical treatment of acne with cephalosporins. Web site: http://www.delphion.com/details?pn=US06254866__

Patent Applications on Enemas As of December 2000, U.S. patent applications are open to public viewing.10 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 enemas: •

A Composition for treatment of a bacterial infection of the digestive tract Inventor(s): Fischetti, Vincent; (West Hempstead, NY), Loomis, Lawrence; (Columbia, MD) Correspondence: Jonathan E. Grant; Suite 210; 2120 L Street, N.W.; Washington; DC; 20037; US Patent Application Number: 20020098234 Date filed: February 27, 2002 Abstract: A composition for treatment of bacterial infections of the digestive tract is disclosed which comprises a lytic enzyme composition specific for the infecting bacteria, and a carrier for delivering said lytic enzyme. The bacteria to be treated is selected from the group consisting of Listeria, Salmonella, E. coli, Campylobacter, and combinations thereof. The carrier for delivering at least one lytic enzyme to the digestive tract is selected from the group consisting of suppository enemas, syrups, or enteric coated pills. Excerpt(s): The following application is a continuation-in-part of Ser. No. 09/497,495 filed Apr. 18, 2000 which is a continuation of Ser. No. 09/395,636 filed Sep. 14, 2000, now U.S. Pat. No. 6,056,954 which is a continuation-in-part of U.S. patent application Ser. No. 08/962,523, filed Oct. 31, 1997, now U.S. Pat. No. 5,997,862. The present invention discloses a method and composition for the treatment of bacterial infections by the use of a lysing enzyme blended with an appropriate carrier suitable for the treatment of the infection. In the past, antibiotics have been used to treat various infections. The work of Selman Waksman in the introduction and production of Streptomycetes, Dr. Fleming's discovery of penicillin, are well known as well as the work of numerous others in the field of antibiotics. Over the years, there have been additions and chemical modifications to the "basic" antibiotics in attempts to make them more powerful, or to treat people allergic to these antibiotics. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

10

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

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Compositions and methods for non-parenteral delivery of oligonucleotides Inventor(s): Cook, Phillip Dan; (Fallbrook, CA), Teng, Ching-Leou; (San Diego, CA), Ecker, David J.; (Encinitas, CA), Manoharan, Muthiah; (Carlsbad, CA), Tillman, Lloyd; (Carlsbad, CA), Hardee, Gregory E.; (Rancho Sante Fe, CA) Correspondence: Michael P. Straher; Woodcock Washburn LLP; One Liberty Place-46th Floor; Philadelphia; PA; 19103; US Patent Application Number: 20030040497 Date filed: December 21, 2001 Abstract: The present invention relates to compositions and methods which enhance the local and systemic uptake and delivery of oligonucleotides and nucleic acids via nonparenteral routes of administration. Pharmaceutical compositions comprising oligonucleotides disclosed herein include, for systemic delivery, emulsion and microemulsion formulations for a variety of applications and oral dosage formulations. It has also surprisingly been discovered that oligonucleotides may be locally delivered to colonic sites by rectal enemas and suppositories in simple solutions, e.g., neat or in saline. Such pharmaceutical compositions of oligonucleotides may further include one or more penetration enhancers for the transport of oligonucleotides and other nucleic acids across mucosal membranes. The compositions and methods of the invention are utilized to effect the oral, buccal, rectal or vaginal administration of an antisense oligonucleotide to an animal in order to modulate the expression of a gene in the animal for investigative, therapeutic, palliative or prophylactic purposes. Excerpt(s): This application is a continuation of patent application Ser. No. 09/315,298, filed on May 20, 1999, which is a continuation of patent application Ser. No. 09/108,673, filed Jul. 1, 1998, which is a continuation-in-part of patent application Ser. No. 08/886,829, filed Jul. 1, 1997, now abandoned, the disclosures of which are incorporated by reference herein in their entirety. The present invention relates to compositions and methods which enhance the local and systemic uptake and delivery of nucleic acids via non-parenteral routes of administration. More particularly, the methods and compositions enhance the transport of oligonucleotides and other nucleic acids across mucosal membranes through the use of one or more penetration enhancers. The compositions of the present invention are solutions, emulsions, and related mixtures that facilitate the uptake and delivery of oligonucleotides and other nucleic acids. The present invention is directed to the use of various fatty acids, bile salts, chelating agents and other penetration enhancers, as well as carrier compounds, to enhance the stability of oligonucleotides and other nucleic acids and/or their transport across cell walls and/or into cells. More specific objectives and advantages of the invention will hereinafter be made clear or become apparent to those skilled in the art during the course of explanation of preferred embodiments of the invention. Advances in the field of biotechnology have led to significant advances in the treatment of diseases such as cancer, genetic diseases, arthritis and AIDS that were previously difficult to treat. Many such advances involve the administration of oligonucleotides and other nucleic acids to a subject, particularly a human subject. The administration of such molecules via parenteral routes has been shown to be effective for the treatment of diseases and/or disorders. See, e.g., Draper et al., U.S. Pat. No. 5,595,978, Jan. 21, 1997, which discloses intravitreal injection as a means for the direct delivery of antisense oligonucleotides to the vitreous humor of the mammalian eye. See also, Robertson, Nature Biotechnology, 1997, 15, 209, and Genetic Engineering News, 1997, 15, 1, each of which discuss the treatment of Crohn's disease via intravenous infusions of antisense oligonucleotides. Non-parenteral routes for administration of oligonucleotides and other nucleic acids

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(such as oral or rectal delivery or other mucosal routes) offers the promise of simpler, easier and less injurious administration of such nucleic acids without the need for sterile procedures and their concomitant expenses, e.g., hospitalization and/or physician fees. There thus is a need to provide compositions and methods to enhance the availability of novel drugs such as oligonucleotides when administered via non-parenteral routes. It is desirable that such new compositions and methods provide for the simple, convenient, practical and optimal non-parenteral delivery of oligonucleotides and other nucleic acids. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Personal Bede-Enema Inventor(s): Cherepahov, Yuriy; (New York, NY), Jouk, Iouri; (New York, NY), Jouk, Iouri; (New York, NY), Cherepanov, Yuriy; (New York, NY) Correspondence: Yuriy Cherepanov; 2317 First AVE # 2A; New York; NY; 10035; US Patent Application Number: 20030130629 Date filed: June 11, 2001 Abstract: Personal Bede Enema is used for washing away feces and cleaning the intestines of a body. Personal Bede Enema includes a soft and flexible plastic or rubber tube of varying lengths and diameters, depending on the user. At one end it includes a speed adapter to connect it to the tap of a local water supply system. At the other end, the tube has an oval tip with a hole for irrigation of water. The key idea is to apply pressure from the local water supply system. In sum, Personal Bede Enema is very simple and convenient in use for personal care. Excerpt(s): used for washing out and washing away of bodies perineum and thick intestines of a body of the person, individually directly from a city or local water supply system pure(clean) warm water suitable for drink. Invention is personal bede-enema. Personal bede-enema it is a plastic or rubber soft of tube of necessary length and diameter. 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 enemas, 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 “enemas” (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 enemas. You can also use this procedure to view pending patent applications concerning enemas. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON ENEMAS Overview This chapter provides bibliographic book references relating to enemas. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on enemas 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 “enemas” (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 enemas: •

Bowel Continence and Spina Bifida Source: Washington, DC: Spina Bifida Association of America. 1995. 53 p. Contact: Available from Spina Bifida Association of America. 4590 MacArthur Boulevard, NW, Suite 250, Washington, DC 20007-4226. (202) 944-3285. Fax (202) 9443295. PRICE: Single copy free. Summary: This booklet is designed to help parents, caregivers, and people with spina bifida understand bowel continence and how people with spina bifida can achieve it. The authors emphasize the need for ongoing assessment of bowel continence status through life. The booklet has three sections: an overview of bowel continence programs and goals for those programs, bowel management by development (infancy through adulthood), and bowel management techniques. Components of a bowel program covered include bowel cleanout, keeping records, determining readiness, balancing diet and fluids, and the role of regular exercise. Bowel management techniques discussed

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include types of programs (enemas, suppositories, habit-training, and digital stimulation), medications, behavioral aspects, constipation and diarrhea, independence, and the consequences of not having a bowel program. The authors emphasize that a bowel program that is effective for one person may not work well for another. The appropriate program will aid the bowel to empty at regular intervals and keep accidents and constipation to a minimal level. The booklet includes an appendix (reminder sheet, sample menus, bowel tracking sheet, behavior management calendar), a glossary of terms, and a bibliography of related materials. 5 figures. 13 references. (AA-M).

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 “enemas” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “enemas” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “enemas” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Blink-182: Enema of the State by Blink-182 (2000); ISBN: 0634012258; http://www.amazon.com/exec/obidos/ASIN/0634012258/icongroupinterna

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Double Contrast Barium Enema: The Genoa Approach by Giorgio Cittadini (1997); ISBN: 8847000033; http://www.amazon.com/exec/obidos/ASIN/8847000033/icongroupinterna

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Enema (My House) [LARGE PRINT] by Helen Morris, et al (1999); ISBN: 1580841589; http://www.amazon.com/exec/obidos/ASIN/1580841589/icongroupinterna

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Enema As an Erotic Art and Its History by David Barton-Jay (1984); ISBN: 0910409005; http://www.amazon.com/exec/obidos/ASIN/0910409005/icongroupinterna

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Enema Story by Normane Cobbleson (2000); ISBN: 1587211629; http://www.amazon.com/exec/obidos/ASIN/1587211629/icongroupinterna

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Is Your Enema Really Necessary?; ISBN: 1870129407; http://www.amazon.com/exec/obidos/ASIN/1870129407/icongroupinterna

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Love Thine Enemas & Heal Thyself by Ba Dc Knox (2002); ISBN: 075967597X; http://www.amazon.com/exec/obidos/ASIN/075967597X/icongroupinterna

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Love Thine Enemas & Heal Thyself by J. Glenn Knox; ISBN: 0962590819; http://www.amazon.com/exec/obidos/ASIN/0962590819/icongroupinterna

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Love Thine Enemas & Heal Thyself: 5th Ed. [DOWNLOAD: ADOBE READER] by Ba DC Knox, Rebecca Letourneau; ISBN: B0000CBX52; http://www.amazon.com/exec/obidos/ASIN/B0000CBX52/icongroupinterna

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Ritual Enemas and Snuffs in the Americas by Peter Smet; ISBN: 9067651656; http://www.amazon.com/exec/obidos/ASIN/9067651656/icongroupinterna

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The Concrete Enema: And Other News of the Weird Classics by Chuck Shepherd; ISBN: 0836221818; http://www.amazon.com/exec/obidos/ASIN/0836221818/icongroupinterna

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The Enema: A Textbook and Reference Manual by Jeremy. Agnew; ISBN: 0918944015; http://www.amazon.com/exec/obidos/ASIN/0918944015/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 “enemas” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

All about enemas. Author: Winchester, H. C.; Year: 1966; Washington, 1966

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Ritual enemas and snuffs in the Americas Author: Smet, Peter A. G. M. de.; Year: 1985; [Amsterdam, Netherlands: Centrum voor Studie en Documentatie van Latijns Amerika, 1985?]

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Sensitivity of double and single contrast barium enemas in carcinoma of the colon Author: Johnson, Charles Daniel.; Year: 1984; [Minneapolis?: s.n.], 1984

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

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

11

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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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. •

Constipation Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 179-187. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Constipation is the most common digestive complaint in the United States, accounting for 2.5 million physician visits annually. This chapter on constipation is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include incidence and definitions of constipation, principal diagnoses, key history and physical examination, specialized testing of colonic and anorectal function, treatment options, patient education, common errors, and emerging concepts. Treatments discussed include exercise and fiber; pharmacology, including nonabsorbable disaccharides, saline cathartics, lubricants, stool softeners, oral stimulants, enemas, prokinetic agents, and other pharmacologic treatments; biofeedback therapy; and surgical treatment. The chapter includes an outline for quick reference and selected references. 5 tables. 22 references.

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Refractory Distal Colitis Source: Jewell, D.P.; Warren, B.F.; Mortensen, N.J., eds. Challenges in Inflammatory Bowel Disease. Malden, MA: Blackwell Science, Inc. 2001. p.140-156. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $145.95. ISBN: 0632051698. Summary: Refractory (resistant to treatment) distal colitis presents a common clinical dilemma, but just how common is uncertain, as are the reasons for refractoriness and the optimum management. This chapter on refractory distal colitis is from a book that offers an approach to the subject of inflammatory bowel disease (IBD) that highlights current areas of controversy. The author discusses the definition of refractoriness, pathophysiology, and a recommended management approach. The author stresses that the management strategy is primarily to avoid haphazard therapeutic trials of treatment in refractory distal colitis. The author reviews conventional treatment of active distal colitis, differential diagnosis, the use of topical salicylates, proximal constipation, intensive treatment, maintaining remission, alternative therapies, and indications for surgery. The author concludes that combination of oral and topical therapy, using salicylates suppositories as an adjunct to enemas, admission for intensive treatment, and maintenance of remission with immunosuppression should be effective in the vast

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majority, without resorting to alternative therapies or surgery. 3 figures. 2 tables. 95 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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Diarrhea and Constipation Source: in Janowitz, H.D. Good Food for Bad Stomachs. New York, NY: Oxford University Press. 1997. p. 110-127. Contact: Available from Oxford University Press. Order Department, 2001 Evans Road, Cary, NC 27513. (800) 451-7556. Fax (919) 677-1303. PRICE: $12.95 plus shipping and handling. ISBN: 0195126556. Summary: This chapter on diarrhea and constipation is from a book that presents a detailed look at present knowledge about the role of eating habits in preventing, causing, and treating the many disorders that plague the gastrointestinal tract and its associated digestive glands, the liver, the gallbladder, and the pancreas. Diarrhea is defined as bowel movements that occur too often and are too loose, constipation as difficulty in moving one's bowels. To put these definitions into proper perspective, the author notes that the number of bowel movements that normal people in good health can pass varies tremendously, ranging from two to three a day to two to three a week. Therefore, instead of comparing themselves with others, people should look for deviations from their ordinary routines both in number and consistency of the stool. Topics include acute diarrhea, its symptoms, causes, and treatment; what to eat during

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acute episodes of diarrhea; food poisoning; traveler's diarrhea and how to avoid it; parasites in the stool; secretory diarrhea; food intolerance as a cause of diarrhea; antibiotic associated diarrhea; constipation, its causes and treatments; the role of dietary fiber and treatment with a high fiber diet; the unique role of bran; lubricants; enemas; and fluid intake. 2 tables. •

Hepatic Encephalopathy Source: in Friedman, L.S. and Keeffe, E.B., eds. Handbook of Liver Disease. Philadelphia, PA: Churchill-Livingstone. 1998. p. 185-195. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. Email: [email protected]. PRICE: $73.00 plus shipping and handling. ISBN: 0443055203. Summary: This chapter on hepatic encephalopathy is from a comprehensive handbook in outline format that offers easy access to information on the full range of liver disorders and covers symptoms, signs, differential diagnoses, and treatments. Hepatic encephalopathy is defined as a wide spectrum of neuropsychiatric abnormalities occurring in patients with significant liver dysfunction. The author notes that the key to the diagnosis is recognition that significant liver disease is present. The occurrence of any neuropsychiatric symptoms or signs in a patient with significant liver dysfunction should be considered hepatic encephalopathy until proven otherwise. Patients with suspected overt hepatic encephalopathy are managed by means of a three pronged strategy: Other causes for encephalopathy are ruled out, precipitating factors are corrected, and empirical therapy is instituted. Acute liver failure associated hepatic encephalopathy is rare, and its clinical course and treatment are distinct from those seen in chronic liver disease. The diagnosis of hepatic encephalopathy is clinical and not based on blood ammonia levels. Empirical therapy includes gut cleansing with enemas and gastric aspiration or lavage, a low or zero protein diet, and delivery of lactulose by mouth or nasogastric tube. In virtually every case of overt hepatic encephalopathy in chronic liver disease, it should be possible to reverse the encephalopathy. 1 table. 20 references. (AA-M).

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Perianal Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 501-507. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on perianal disease is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). The reported incidence of perianal involvement in patients with Crohn's disease ranges from 18 to 94 percent. This variation is a consequence of case selection and differences in criteria used to define anal lesions. The incidence increases with more distal CD, involving over 80 percent of patients with Crohn's proctitis. Anorectal lesions occur as the only manifestation of Crohn's disease in 5 to 10 percent of patients. Anorectal lesions in the setting of IBD may be the only way to differentiate between CD and Ulcerative Colitis (UC). In general, any atypical lesion should be regarded as

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resulting from CD and not Ulcerative Colitis (UC). Multiple lesions, painless lesions, eccentric lesions, and wounds that fail to heal after surgical intervention all are features that raise the possibility of CD. It is particularly critical to distinguish between mucosal Ulcerative Colitis (UC) and CD if the patient is being considered for a colectomy (surgery to remove part or all of the colon) for colonic IBD. The surgical strategy for treating perianal CD depends on the chronicity of the problem, the presence of suppuration, the condition of the rectum, and the status of any small bowel disease. Conservative interventions include stool softeners, psyllium bulking agents, topical steroids, antidiarrheal agents, steroid and 5 ASA suppositories, with or without enemas, and warm sitz baths. The authors stress that the aim of management of perianal CD may not necessarily be to eradicate the condition but rather to preserve the anus with an acceptable level of function. The authors discuss treatment of specific conditions, including fissures (clefts), abscesses (pockets of infection), fistulae (abnormal passageways), rectovaginal fistulae, fecal incontinence (involuntary loss of stool), anorectal strictures (narrowing), and hemorrhoids. A patient care management algorithm is provided in the chapter. 3 figures. 10 references. •

Management of Distal Colitis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 69-71. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on the management of distal colitis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). Distal colitis is defined as UC limited to the distal 30 to 50 cm of the large intestine (involving the rectum, sigmoid, and descending colon) and not extending beyond the splenic flexure. Distal colitis is the most common clinical scenario of UC, accounting for 60 to 70 percent of outpatients. From the management perspective, and also due to other physiologic and prognostic features, it is best to separate distal colitis from proctitis, in which the inflammatory process is confined to the rectum. Proctitis often demonstrates more extensive mucosal inflammation, both macroscopic and histologic, compared to more extensive disease (disease in longer parts of the intestines) and thus may require a more prolonged therapeutic approach. Topical treatment is the initial therapy of choice for patients with distal colitis. Enemas are most effective for disease proximal to the rectum, whereas suppositories are both effective and well tolerated in the setting of proctitis. There remains significant controversy and differences of approach regarding dosing, available formulations, and duration of topical versus oral therapy in different parts of the globe. 12 references.

•

Use of Nicotine and Tobacco in Colitis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 99-101. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220.

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Summary: This chapter on the use of nicotine and tobacco for treating colitis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). Previous epidemiological observations suggested a beneficial effect of smoking in patients with UC and led to the investigational use of nicotine as a therapeutic agent. Ulcerative colitis is a disease of nonsmokers. Treatment with transdermal (skin patch) nicotine appears to be effective for active UC at the highest tolerated dose of nicotine (22 to 25 milligrams every 24 hours ) but it is not effective at low doses as maintenance therapy. Uncontrolled pilot studies showed that nicotine enemas may be of clinical benefit for left-sided colitis. Controlled studies with topical nicotine treatment (enemas or delayed-release oral capsules) are awaited. Adverse reactions are a limiting factor for long-term transdermal nicotine therapy, particularly in life-long nonsmokers, whereas nicotine enemas have low systemic absorption and are well tolerated. At present, transdermal nicotine is not a first-line therapy for UC and should be reserved for patients who have failed other medical therapies. Although smoking is reported to be beneficial for the course of UC, prescription of smoking must be tempered by the significant and potentially fatal consequences of its effects on other body systems; in their clinical practice, the authors strongly discourage patients from smoking. 1 table. 9 references. •

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?

•

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

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intake, exercise, and toilet habits. Specific topics in the chapter include the role of dietary fiber; sources of fiber; fiber supplements; fluid intake; the role of regular exercise; toilet habits; and laxative use, including stimulant laxatives, saline cathartics, lubricants, hyperosmotic laxatives, enemas, and suppositories. The authors stress that the simple measures of adequate fiber and fluid intake and exercise, as well as good toilet habits, can often eliminate constipation. 4 tables.

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CHAPTER 7. MULTIMEDIA ON ENEMAS Overview In this chapter, we show you how to keep current on multimedia sources of information on enemas. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on enemas is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “enemas” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “enemas” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on enemas: •

Ulcerative Colitis: The Disease and Enema Therapy Source: Marietta, GA: Solvay Pharmaceuticals, Inc. 1996. (videocassette). Contact: Available from Solvay Pharmaceuticals, Inc. 901 Sawyer Road, Marietta, GA 30062. (800) 354-0026. PRICE: Single copy free. Summary: This videotape program provides information and reassurance for people recently diagnosed with ulcerative colitis (UC). The program notes that UC can have a great impact on a person's life, but that following the prescribed treatment can help relieve symptoms and return a sense of normalcy. The narrator reviews the possible causes of UC, including genetic, infectious, and autoimmune theories, noting that UC is not contagious or caused by stress or food sensitivity. UC is most often found in the developing world, and people are usually diagnosed in their teens or twenties. The program then features brief interviews with six women who describe how they felt when they first received the diagnosis. Reactions ranged from fear and anxiety to relief that they finally had a name for their symptoms. The narrator then lists the common

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symptoms of UC: diarrhea, rectal bleeding, bloody stool, loss of appetite, anemia, abdominal pain, weight loss, fever, and gas (flatulence). Less common symptoms can include joint pain, skin lesions, and eye inflammation. The program then features a man and two women talking about symptoms, particularly urgency and frequency, and the impact of these symptoms on their lifestyles. The narrator notes that there are rectal agents, oral medications, antibiotics, and combination therapies, but that the video will focus on enema therapy. The program then interviews three patients who use Rowasa (mesalamine in a rectal suspension enema form). The patients talk about enema therapy and the improved quality of life they have found using this form of the drug. The program then uses line drawings to demonstrate how to give oneself an enema. The medication should be given when the patient can stay prone for 30 minutes or, preferably, overnight. The program concludes by encouraging viewers to ask their health care provider to answer any questions they may have. The address and tollfree telephone number (800-343-3637) of the Crohn's and Colitis Foundation of America are also provided.

Bibliography: Multimedia on Enemas 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 enemas (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 enemas: •

Administration of enemas [filmstrip] Source: Robert J. Brady Co; Year: 1970; Format: Filmstrip; Washington: Brady; [Chatsworth, Calif.: for sale by Career Aids], c1970

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CHAPTER 8. PERIODICALS AND NEWS ON ENEMAS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover enemas.

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

Inflamed colon improves with special enema Source: Reuters Health eLine Date: July 24, 2003

•

Epidermal growth factor enema may reduce disease activity of ulcerative colitis Source: Reuters Industry Breifing Date: July 24, 2003

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•

Colonoscopy superior to barium enema for postpolypectomy surveillance Source: Reuters Industry Breifing Date: June 15, 2000 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “enemas” (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 “enemas” (or synonyms). If you know the name of a company that is relevant to enemas, 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 “enemas” (or synonyms).

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “enemas” (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 enemas: •

Inflammatory Bowel Disease: Making Sense of a Mystery Ailment Source: Harvard Health Letter. 22(2): 4-6. December 1996. Contact: Available from Harvard Health Letter. P.O. Box 380, Boston, MA 02117. (617) 432-1485. Summary: This article introduces general readers to the symptoms and causes of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis (UC). The authors discuss the differential diagnosis of IBD, including ruling out irritable bowel syndrome (IBS) and bacterial infections, and the diagnostic tests that are commonly used to confirm IBD. The authors note that IBD appears to run in families, and they report on current genetic research in this area as well as on research into a possible environmental stimulus that can trigger the disease in genetically susceptible people. The choice of therapy is largely determined by which part of the bowel is affected by IBD and whether the problem is Crohn's or UC. People can use topical therapy such as steroid suppositories or enemas to treat the inflammation directly if only the rectum or lower portion of the colon is affected. However, oral medication often becomes necessary. The first choice for drug therapy is sulfasalazine (Azulfidine). The authors conclude with a brief discussion of the surgical options available for people with IBD who don't respond to drug therapy. 1 table. (AA-M).

•

Sympathetic Approach to Fecal Incontinence in the Elderly Source: Participate. 1(4): 3. Winter 1992. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. Summary: This brief article reminds readers of the importance of a sympathetic approach to fecal incontinence in older adults. The author notes that fecal soiling can have a devastating impact on the older patient, leading to isolation. The author explores the prevalence of this problem; the multifaceted nature of fecal continence; problems with fecal impaction; the use of anal manometry and defocography; and management options including an increase in dietary fiber, the use of enemas, the use of antidiarrheal agents, biofeedback, and surgery. The author concludes that there are often simple non-surgical methods that can help improve patients' quality of life.

•

By the Way, Doctor [Severe Constipation] Source: Harvard Health Letter. 24(6): 8. April 1999.

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Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail: [email protected]. Summary: This brief newsletter article is one in a regular column in which readers can pose a question to a medical doctor. In this entry, the question asks, 'I've heard that there is an operation that can cure severe constipation. Are there any drawbacks to it?' The doctor, Stephen Goldfinger, M.D., replies that the operation is serious and involves removing the entire colon and then attaching the small bowel to the rectum. Such surgery is reserved for people with debilitating constipation that defies all conventional treatment methods, which include high fluid and roughage intake, strong laxatives, periodic enemas, and bowel training exercises. When patients are selected properly (including the use of a diagnostic test that checks intestinal motility), almost everyone who has the surgery will be relieved of constipation. However, postoperative problems such as bowel obstruction, persisting abdominal pain, and infections are encountered often enough for the author to be cautious about recommending the operation to any but the most severely affected patients. •

Clay Therapy for Encopresis Source: Messenger. 8(3): 7. 1997. Contact: Available from American Pseudo-obstruction and Hirschsprung's Disease Society (APHS). 158 Pleasant Street, North Andover, MA 01845. (978) 685-4477. Fax (978) 685-4488. E-mail: [email protected]. Summary: This newsletter article describes the use of modeling clay therapy for treating children with encopresis (fecal soiling). The author reports on a study in which researchers examined the effect of this clay therapy on encopretic children who had not benefited from traditional behavioral (laxatives, enemas, dietary fiber, toilet sitting) and psychological (reinforcement, positive practice, overcorrection, biofeedback) interventions. The researchers describe clay therapy as an Ericksonian intervention, meaning that there is no need for the patient to recognize the problem as such for it to be resolved. Erickson helped patients by using modeling clay as a metaphor for feces to treat a small sample of six boys (ages 4 to 12) who had failed to respond to other therapies. The children were placed together for 1 hour for 3 months and were given no instructions on how to play with the modeling clay; the children eagerly interacted with one another. The author notes that the treatment of encopresis must include an explanation to the child, in terms he or she can understand, of why the body is producing feces and the problems that can accompany this process (e.g., impaction, overflow incontinence). Modeling clay is an effective tool to help children realize what is happening to them. The author also describes using the Playdoh Fun Factory to help children understand the movement of feces through the bowel. The author contends that group therapy is an effective way to demystify encopresis, and that some children may be more willing to accept information from peers than from an adult authority figure, especially if they are engaged in an emotional power struggle for control of defecation.

Academic Periodicals covering Enemas Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to enemas. In addition to these

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sources, you can search for articles covering enemas 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 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for enemas. 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 enemas. 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 enemas: Albendazole •

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

Corticosteroids •

Rectal - U.S. Brands: Anucort-HC; Anu-Med HC; Anuprep HC; Anusol-HC; Anutone-HC; Anuzone-HC; Cort-Dome; Cortenema; Cortifoam; Hemorrhoidal HC; Hemril-HC Uniserts; Proctocort; Proctosol-HC; Rectosol-HC http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203366.html

Laxatives •

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

Mebendazole •

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

Mesalamine •

Rectal - U.S. Brands: Canasa; Rowasa http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202351.html

Niclosamide •

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

Sulfasalazine •

Systemic - U.S. Brands: Azulfidine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202537.html

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Thiabendazole •

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

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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 Institute12: •

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/

12

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

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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.13 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:14 •

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

13

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

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•

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

•

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

The NLM Gateway15 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.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “enemas” (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 5385 59 211 6 1 5662

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 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.19 Simply search by “enemas” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

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

16

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). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 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.22 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/.

20 Adapted 21

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 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 enemas 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 enemas. 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 enemas. 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 “enemas”:

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•

Other guides Colonic Diseases http://www.nlm.nih.gov/medlineplus/colonicdiseases.html Colonic Polyps http://www.nlm.nih.gov/medlineplus/colonicpolyps.html Colorectal Cancer http://www.nlm.nih.gov/medlineplus/colorectalcancer.html Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Ulcerative Colitis http://www.nlm.nih.gov/medlineplus/ulcerativecolitis.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 enemas. 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: •

Enemas Source: in Sodeman, W.A., Jr. Instructions for Geriatric Patients. Philadelphia, PA: W.B. Saunders Company. 1995. p. 129-130. 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 enemas, defined as any injection of fluid into the rectum. An enema can be used for the administration of drugs, for the purpose of diagnosis, in preparation for diagnostic procedures, or, most commonly, for the stimulation of a bowel movement. Properly done, an enema is not harmful to health or the colon. Improperly done, or done with toxic or harsh constituents, it can harm the intestine or one's general health, or both. There is no evidence that cleansing enemas are necessary or desirable for maintenance of good health and well-being. The author cautions against introducing infection with improperly cleaned enema devices. The volume of an enema should also be carefully controlled. The author mentions that enemas can be used to manage minor constipation, but that it is important to ascertain the underlying cause of the constipation. The information sheet concludes by reminding readers to contact their

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health care provider if they have any change in bowel habit, notably constipation that recurs. 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 enemas. 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 enemas. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with enemas. 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 enemas. 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.

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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 “enemas” (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 “enemas”. 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 “enemas” (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 “enemas” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

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

23

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)24: •

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/

24

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

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

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

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ENEMAS 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] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] 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] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acremonium: A mitosporic fungal genus with many reported ascomycetous teleomorphs. Cephalosporin antibiotics are derived from this genus. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Aetiology: Study of the causes of disease. [EU] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and

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stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alkalosis: A pathological condition that removes acid or adds base to the body fluids. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [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] Alum: A type of immune adjuvant (a substance used to help boost the immune response to a vaccine). Also called aluminum sulfate. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [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 acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] 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] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-

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spectrum antibiotic. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaemia: A reduction below normal in the number of erythrocytes per cu. mm., in the quantity of haemoglobin, or in the volume of packed red cells per 100 ml. of blood which occurs when the equilibrium between blood loss (through bleeding or destruction) and blood production is disturbed. [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] 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] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

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] Antiemetics: Drugs used to prevent nausea or vomiting. Antiemetics act by a wide range of mechanisms. Some act on the medullary contol centers (the vomiting center and the chemoreceptive trigger zone) while others affect the peripheral receptors. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH]

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Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimycotic: Suppressing the growth of fungi. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Appendectomy: An operation to remove the 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] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Asbestos: Fibrous incombustible mineral composed of magnesium and calcium silicates with or without other elements. It is relatively inert chemically and used in thermal insulation and fireproofing. Inhalation of dust causes asbestosis and later lung and gastrointestinal neoplasms. [NIH] Ascending Colon: The part of the colon on the right side of the abdomen. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Dysreflexia: That part of the nervous system concerned with the unconscious regulation of the living processes of the body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba,

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atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium enema: A procedure in which a liquid with barium in it is put into the rectum and colon by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray. [NIH] Barium Sulfate: Sulfuric acid, barium salt (1:1). A compound used as an x-ray contrast medium that occurs in nature as the mineral barite. It is also used in various manufacturing applications and mixed into heavy concrete to serve as a radiation shield. [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] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Beclomethasone: An anti-inflammatory, synthetic glucocorticoid. It is used topically as an anti-inflammatory agent and in aerosol form for the treatment of asthma. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bezoars: Concretions of swallowed hair, fruit or vegetable fibers, or similar substances found in the alimentary canal. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [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] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an

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active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bladder: The organ that stores urine. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Fluids: Liquid components of living organisms. [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] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] 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] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Budesonide: A glucocorticoid used in the management of asthma, the treatment of various skin disorders, and allergic rhinitis. [NIH] Bulking Agents: Laxatives that make bowel movements soft and easy to pass. [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]

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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] Camping: Living outdoors as a recreational activity. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] 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] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] 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] Carotid Sinus: The dilated portion of the common carotid artery at its bifurcation into external and internal carotids. It contains baroreceptors which, when stimulated, cause slowing of the heart, vasodilatation, and a fall in blood pressure. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Castor Oil: Oil obtained from seeds of Ricinus communis that is used as a cathartic and as a plasticizer. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [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]

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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] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cephalosporins: A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus Acremonium (Cephalosporium acremonium). They contain the betalactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chelating Agents: Organic chemicals that form two or more coordination bonds with a central metal ion. Heterocyclic rings are formed with the central metal atom as part of the ring. Some biological systems form metal chelates, e.g., the iron-binding porphyrin group of hemoglobin and the magnesium-binding chlorophyll of plants. (From Hawley's Condensed Chemical Dictionary, 12th ed) They are used chemically to remove ions from solutions, medicinally against microorganisms, to treat metal poisoning, and in chemotherapy protocols. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemopreventive: Natural or synthetic compound used to intervene in the early precancerous stages of carcinogenesis. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [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] 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]

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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] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [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] Clotrimazole: An imidazole derivative with a broad spectrum of antimycotic activity. It inhibits biosynthesis of the sterol ergostol, an important component of fungal cell membranes. Its action leads to increased membrane permeability and apparent disruption of enzyme systems bound to the membrane. [NIH] Cod Liver Oil: Oil obtained from fresh livers of the cod family, Gadidae. It is a source of vitamins A and D. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] 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] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [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] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] 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]

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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] Colorectal Neoplasms: Tumors or cancer of the either the colon or rectum or both. The most frequent malignant tumor in the United States. Etiological factors which increase the risk of colorectal cancer include chronic ulcerative colitis, familial polyposis of the colon, exposure to asbestos, irradiation of the cervix. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] 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, 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

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theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomographic colonography: CTC. A procedure in which a detailed picture of the colon is created by an x-ray machine linked to a computer. Also called computed tomography (CT) scan or computerized axial tomography (CAT) scan of the colon. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] 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] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continence: The ability to hold in a bowel movement or urine. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] 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] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [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] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex

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hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [NIH] 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] Cyclodextrins: A homologous group of cyclic glucans consisting of alpha-1,4 bound glucose units obtained by the action of cyclodextrin glucanotransferase on starch or similar substrates. The enzyme is produced by certain species of Bacillus. Cyclodextrins form inclusion complexes with a wide variety of substances. [NIH] 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] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Descending Colon: The part of the colon where stool is stored. Located on the left side of the abdomen. [NIH]

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Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diatrizoate: A commonly used x-ray contrast medium. As Diatrizoate meglumine and as Diatrizoate sodium, it is used for gastrointestinal studies, angiography, and urography. [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] Dihydroxy: AMPA/Kainate antagonist. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disaccharides: Sugars composed of two monosaccharides linked by glycoside bonds. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dispenser: Glass, metal or plastic shell fitted with valve from which a pressurized formulation is dispensed; an instrument for atomizing. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] 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] Dosage schedule: A scheme set up to determine and regulate size, frequency and number of

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doses. [EU] Dose-limiting: Describes side effects of a drug or other treatment that are serious enough to prevent an increase in dose or level of that treatment. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Douche: A procedure in which water or a medicated solution is used to clean the vagina and cervix. [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] Duodenum: The first part of the small intestine. [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] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] 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 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] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] 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] Enhancers: Transcriptional element in the virus genome. [NIH] Enteritis: Inflammation of the intestine, applied chiefly to inflammation of the small intestine; see also enterocolitis. [EU] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH]

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

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Extracellular: Outside a cell or cells. [EU] Faecal: Pertaining to or of the nature of feces. [EU] Familial polyposis: An inherited condition in which numerous polyps (tissue masses) develop on the inside walls of the colon and rectum. It increases the risk for colon cancer. [NIH]

Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] 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] Fermentation: An enzyme-induced chemical change in organic compounds that takes place

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in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] 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] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] 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] 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] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH]

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Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [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] Gastric: Having to do with the stomach. [NIH] Gastritis: Inflammation of the stomach. [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 tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucans: Polysaccharides composed of repeating glucose units. They can consist of branched or unbranched chains in any linkages. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [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] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid

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(glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glutamine: A non-essential amino acid present abundantly throught the body and is involved in many metabolic processes. It is synthesized from glutamic acid and ammonia. It is the principal carrier of nitrogen in the body and is an important energy source for many cells. [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] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [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] Graft-versus-host disease: GVHD. A reaction of donated bone marrow or peripheral stem cells against a person's tissue. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Hematologic malignancies: Cancers of the blood or bone marrow, including leukemia and lymphoma. Also called hematologic cancers. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the

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rectum. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Encephalopathy: A condition that may cause loss of consciousness and coma. It is usually the result of advanced liver disease. Also called hepatic coma. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatotoxicity: How much damage a medicine or other substance does 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] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time

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unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperreflexia: Exaggeration of reflexes. [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] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] 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] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune adjuvant: A drug that stimulates the immune system to respond to disease. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Incision: A cut made in the body during surgery. [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] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [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,

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or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] 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] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [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]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin

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or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Ischemic Colitis: Decreased blood flow to the colon. Causes fever, pain, and bloody diarrhea. [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] Kinetic: Pertaining to or producing motion. [EU] 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]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukopenia: A condition in which the number of leukocytes (white blood cells) in the blood is reduced. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life cycle: The successive stages through which an organism passes from fertilized ovum or

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spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] 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] 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] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Maintenance therapy: Treatment that is given to help a primary (original) treatment keep working. Maintenance therapy is often given to help keep cancer in remission. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [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] Megacolon: Pathological enlargement of the colon. [NIH] Meglumine: 1-Deoxy-1-(methylamino)-D-glucitol. A derivative of sorbitol in which the hydroxyl group in position 1 is replaced by a methylamino group. Often used in conjunction with iodinated organic compounds as contrast medium. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mercaptopurine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU]

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Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] 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] Methylprednisolone: (6 alpha,11 beta)-11,17,21-Trihydroxy-6-methylpregna-1,4-diene-3,2dione. A prednisolone derivative which has pharmacological actions similar to prednisolone. [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] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] 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] Motility: The ability to move spontaneously. [EU] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [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] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH]

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Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [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] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [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] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] 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] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic

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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] 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] 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] Nursing Care: Care given to patients by nursing service personnel. [NIH] Obstipation: Intractable constipation. [EU] Odour: A volatile emanation that is perceived by the sense of smell. [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] 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] Ornidazole: A nitroimidazole antiprotozoal agent used in ameba and trichomonas infections. It is partially plasma-bound and also has radiation-sensitizing action. [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] 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] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overcorrection: A complication of refractive surgery where the achieved amount of correction is more than desired. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and

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phosphorus. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] 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 Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perianal: Located around the anus. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral stem cells: Immature cells found circulating in the bloodstream. New blood cells develop from peripheral stem cells. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [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,

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they do not fall into another group of products. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] 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] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] 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]

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Polyethylene Glycols: Alpha-Hydro-omega-hydroxypoly(oxy-1,2-ethanediyls). Additional polymers of ethylene oxide and water and their ethers. They vary in consistency from liquid to solid, depending on the molecular weight, indicated by a number following the name. Used as surfactants in industry, including foods, cosmetics and pharmaceutics; in biomedicine, as dispersing agents, solvents, ointment and suppository bases, vehicles, tablet excipients. Some specific groups are lauromagrogols, nonoxynols, octoxynols and poloxamers. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [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] Postoperative: After surgery. [NIH] Povidone: A polyvinyl polymer of variable molecular weight; used as suspending and dispersing agent and vehicle for pharmaceuticals; also used as blood volume expander. [NIH] Povidone-Iodine: An iodinated polyvinyl polymer used as topical antiseptic in surgery and for skin and mucous membrane infections, also as aerosol. The iodine may be radiolabeled for research purposes. [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] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Preoperative: Preceding an operation. [EU]

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Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Proctalgia Fugax: Intense pain in the rectum that occasionally happens at night. Caused by muscle spasms around the anus. [NIH] Proctitis: Inflammation of the rectum. [EU] Proctocolitis: Inflammation of the rectum and colon. [NIH] Proctosigmoiditis: Irritation of the rectum and the sigmoid colon. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propylene Glycol: A clear, colorless, viscous organic solvent and diluent used in pharmaceutical preparations. [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] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protein 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] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU]

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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 Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] 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] Quiescent: Marked by a state of inactivity or repose. [EU] 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] Radioactive: Giving off radiation. [NIH] Radiographer: A person specializing in the practical application of radiation in diagnostic radiology, radiotherapy or industrial radiography. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [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] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a

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favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] 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] Rectovaginal Fistula: Abnormal communication between the rectum and the vagina. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regional enteritis: Inflammation of the intestines, but usually only of the small intestine. Also called Crohn's disease. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [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] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and

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sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [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] Rotator: A muscle by which a part can be turned circularly. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [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] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [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]

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Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sitz Bath: A special plastic tub. A person sits in a few inches of warm water to help relieve discomfort of hemorrhoids or anal fissures. [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 Bowel Enema: X-rays of the small intestine taken as barium liquid passes through the organ. Also called small bowel follow-through. [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]

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] Solitary Rectal Ulcer: A rare type of ulcer in the rectum. May develop because of straining to have a bowel movement. [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] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [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

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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] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] 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] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] 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] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stridor: The loud, harsh, vibrating sound produced by partial obstruction of the larynx or

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trachea. [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] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] 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] Sulfapyridine: Antibacterial, potentially toxic, used to treat certain skin diseases. [NIH] Supine: Having the front portion of the body upwards. [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] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppuration: A pathologic process consisting in the formation of pus. [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] Symphysis: A secondary cartilaginous joint. [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] 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

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in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Systemic: Affecting the entire body. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [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] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] 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] Traction: The act of pulling. [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] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] 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] Transverse Colon: The part of the colon that goes across the abdomen from right to left. [NIH]

Trauma: Any injury, wound, or shock, must frequently physical or structural shock,

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producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trichomonas Infections: Infections in birds and mammals produced by various species of Trichomonas. [NIH] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [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] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [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] 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] Urography: Radiography of any part of the urinary tract. [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] 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] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the

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body through the aorta. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] 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] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitreous Humor: The transparent, colorless mass of gel that lies behind the lens and in front of the retina and fills the center of the eyeball. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

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

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INDEX A Abdomen, 100, 135, 138, 140, 143, 146, 149, 155, 157, 161, 169, 171 Abdominal, 11, 36, 95, 104, 108, 135, 147, 160, 161, 172 Abdominal Pain, 95, 104, 108, 135, 161, 172 Acceptor, 135, 160 Acetylcholine, 135, 142, 159 Acidity, 6, 135 Acne, 89, 135 Acremonium, 135, 142 Acrylonitrile, 135, 167 Adjustment, 88, 135 Adrenal Cortex, 135, 145, 153, 164 Adverse Effect, 64, 135, 167 Aerosol, 135, 139, 163, 170 Aetiology, 89, 135 Affinity, 135, 168 Agonist, 135, 159 Algorithms, 136, 139 Alimentary, 14, 16, 18, 20, 27, 29, 30, 31, 32, 38, 41, 43, 44, 136, 139, 147, 161 Alkaline, 70, 136, 138, 141, 162, 171 Alkaloid, 136, 159 Alkalosis, 136, 171 Allergen, 52, 136 Allergic Rhinitis, 136, 140 Alpha Particles, 136, 165 Alpha-1, 136, 146 Alternative medicine, 106, 136 Alum, 40, 136 Aluminum, 86, 136, 170 Amine, 136, 153 Amino acid, 136, 151, 152, 153, 164, 171 Ammonia, 98, 136, 152 Amoxicillin, 89, 136 Ampicillin, 89, 136 Ampulla, 137, 148 Anaemia, 27, 137 Anal, 57, 68, 71, 73, 80, 82, 97, 98, 107, 137, 149, 150, 166, 168 Anal Fissure, 97, 137, 168 Anaphylaxis, 54, 55, 137 Anaplasia, 137, 159 Anastomosis, 40, 41, 137 Androgens, 135, 137, 146 Anemia, 104, 137

Angiography, 137, 147 Anorectal, 96, 97, 98, 137 Antibacterial, 137, 169, 170 Antibiotic, 63, 89, 98, 136, 137, 140, 141, 159, 161, 169 Antibody, 135, 137, 144, 153, 154, 155, 156, 165, 169 Antidiarrheals, 100, 137 Antiemetics, 100, 137 Antigen, 135, 137, 144, 153, 154, 155 Anti-infective, 137, 153, 156 Anti-inflammatory, 43, 63, 137, 139, 146, 151, 167 Anti-Inflammatory Agents, 138, 146 Antimycotic, 138, 143 Antineoplastic, 138, 146 Antioxidant, 85, 138 Antiseptic, 138, 163 Antispasmodic, 11, 18, 40, 138 Antiviral, 138, 155 Anus, 68, 70, 73, 75, 76, 96, 99, 137, 138, 139, 140, 143, 148, 150, 152, 155, 161, 164, 166 Anxiety, 103, 138 Aperture, 81, 82, 138 Appendectomy, 100, 138 Aqueous, 86, 138, 139, 148, 153, 156 Arachidonic Acid, 138, 164 Arterial, 138, 154, 164 Arteries, 138, 140, 145, 158 Artery, 138, 140, 141, 145, 165, 172 Asbestos, 138, 144 Ascending Colon, 71, 138 Aseptic, 138, 169 Aspiration, 85, 98, 138 Assay, 38, 138 Atypical, 98, 138 Autonomic, 29, 135, 138 Autonomic Dysreflexia, 29, 138 B Bacteria, 54, 85, 89, 90, 137, 138, 139, 149, 158, 169, 172 Bacterial Infections, 89, 90, 107, 138, 142 Bactericidal, 138, 149 Barium Sulfate, 69, 71, 139 Base, 48, 70, 83, 136, 139, 146, 151, 156, 161, 162 Baths, 88, 139

176 Enemas

Beclomethasone, 8, 13, 14, 17, 18, 42, 139 Benign, 97, 139, 152, 159, 165 Bezoars, 37, 139 Bifida, 50, 93, 139 Bilateral, 12, 139 Bile, 91, 100, 139, 151, 154, 157, 169, 170 Bile Acids, 139, 169 Bile Acids and Salts, 139 Bile duct, 100, 139, 154 Biological response modifier, 139, 155 Biopsy, 33, 41, 139 Biotechnology, 4, 5, 91, 95, 106, 119, 139 Biotransformation, 139 Biphasic, 68, 140 Bismuth, 14, 18, 29, 140 Bladder, 100, 140, 154, 159, 164, 172 Blood pressure, 140, 141, 154, 168 Blood vessel, 137, 140, 142, 152, 168, 169, 170, 171, 172 Blood Volume, 140, 163 Body Fluids, 87, 136, 140, 148, 168 Bone Marrow, 140, 146, 152, 157 Bowel Movement, 70, 79, 97, 124, 140, 145, 147, 168, 169 Bowel Prep, 5, 7, 10, 31, 48, 140 Branch, 72, 131, 140, 151, 161, 168, 171 Breakdown, 140, 147, 151 Broad-spectrum, 136, 137, 140, 141, 142 Bronchi, 140 Bronchial, 87, 140, 153 Buccal, 91, 140 Budesonide, 7, 14, 18, 31, 87, 140 Bulking Agents, 99, 140 Bypass, 100, 140 C Caecum, 71, 140 Calcium, 112, 138, 141, 144, 160, 171 Camping, 75, 141 Cannula, 73, 141 Capillary, 141, 163 Capsules, 100, 141, 147, 151 Carbohydrate, 141, 146, 152 Carbon Dioxide, 10, 69, 141, 146, 150, 166 Carcinogenesis, 141, 142 Carcinogenic, 141, 169 Carcinoma, 13, 77, 95, 141 Cardiac, 141, 158, 169 Carotid Sinus, 24, 141 Case report, 9, 18, 26, 141 Castor Oil, 48, 141 Catheter, 8, 86, 87, 100, 141 Caudal, 141, 154, 163

Cecum, 141, 156 Ceftriaxone, 57, 141 Cell, 91, 136, 138, 139, 141, 142, 143, 144, 147, 149, 151, 155, 159, 162, 166, 170, 173 Cell Division, 138, 141, 162 Cell membrane, 142, 143 Central Nervous System, 135, 142, 152 Central Nervous System Infections, 142, 152 Cephalosporins, 90, 142 Cerebral, 142, 149, 150, 168 Cerebral Cortex, 142, 149, 150 Cerebral Palsy, 142, 168 Cervix, 142, 144, 148 Chelating Agents, 91, 142 Chemoprevention, 77, 142 Chemopreventive, 77, 142 Chemotherapy, 142 Chin, 142, 157 Chlorophyll, 142, 151 Cholesterol, 139, 142, 169 Cholinergic, 100, 142, 160 Chronic, 14, 23, 24, 29, 38, 39, 41, 54, 77, 89, 95, 98, 142, 143, 144, 148, 149, 155, 170, 172 Chronic renal, 39, 143 Clamp, 69, 76, 81, 82, 143 Clinical Medicine, 143, 163 Clinical trial, 4, 63, 65, 119, 143, 145, 146, 148, 165 Cloning, 139, 143 Clotrimazole, 63, 143 Cod Liver Oil, 143, 148 Cofactor, 143, 164 Colectomy, 57, 63, 99, 143 Collagen, 136, 143, 151, 153 Collagen disease, 143, 153 Collapse, 137, 140, 143 Colloidal, 143, 149, 161, 170 Colonoscopy, 3, 10, 16, 22, 64, 106, 140, 143 Colorectal, 4, 20, 45, 59, 77, 124, 143, 144 Colorectal Cancer, 4, 45, 59, 77, 124, 144 Colorectal Neoplasms, 20, 144 Colostomy, 8, 34, 144 Communis, 141, 144 Complement, 144 Complementary and alternative medicine, 53, 61, 144 Complementary medicine, 53, 144 Complete remission, 144, 166 Computational Biology, 119, 144

Index 177

Computed tomographic colonography, 64, 145 Computed tomography, 145 Conception, 145, 169 Concomitant, 84, 92, 145 Cone, 145, 170 Connective Tissue, 140, 143, 145, 146, 150, 151 Consciousness, 145, 153 Constipation, 11, 15, 18, 29, 59, 76, 94, 95, 96, 97, 100, 107, 108, 124, 145, 160, 161 Constitutional, 145, 158 Contamination, 74, 145 Continence, 11, 15, 29, 37, 44, 57, 93, 107, 145 Contraindications, ii, 145 Contrast medium, 78, 82, 137, 139, 145, 147, 157 Controlled study, 21, 27, 36, 145 Conventional therapy, 32, 145 Conventional treatment, 96, 108, 145 Coordination, 142, 145 Coronary, 145, 158 Coronary Thrombosis, 145, 158 Corpus, 145, 164, 173 Corticosteroid, 12, 42, 145, 163 Cranial, 146, 152 Craniocerebral Trauma, 146, 152 Curare, 146, 158 Curative, 146, 167, 171 Cyanide, 54, 146 Cyclic, 146 Cyclodextrins, 87, 146 Cyclosporine, 8, 19, 48, 146 D Decarboxylation, 146, 153 Decubitus, 40, 146 Defecation, 42, 50, 95, 96, 108, 146 Degenerative, 146, 153 Dehydration, 25, 146 Density, 146, 162, 168 Dermal, 90, 146 Dermis, 146, 171 Descending Colon, 31, 38, 71, 99, 146 Deuterium, 147, 153 Diagnostic procedure, 64, 67, 106, 124, 147 Diaphragm, 74, 147 Diarrhea, 94, 97, 104, 137, 147, 156 Diarrhoea, 89, 147 Diatrizoate, 44, 147 Dietary Fiber, 98, 101, 107, 108, 147

Digestion, 41, 136, 139, 140, 147, 155, 157, 161, 169 Digestive system, 65, 147, 151 Digestive tract, 89, 90, 100, 147, 168 Dihydroxy, 87, 147 Dilution, 72, 147 Direct, iii, 73, 88, 91, 111, 143, 147, 153, 166 Disaccharides, 96, 147 Disinfectant, 147, 149 Dispenser, 87, 147 Diverticula, 147 Diverticulitis, 22, 147 Diverticulum, 147 Dorsal, 147, 163 Dosage Forms, 77, 85, 147 Dosage schedule, 55, 147 Dose-limiting, 77, 148 Double-blind, 8, 9, 14, 17, 27, 36, 39, 42, 43, 48, 148 Double-blinded, 36, 148 Douche, 74, 75, 148 Drug Interactions, 113, 148 Duct, 100, 137, 141, 148, 149, 160, 167, 169 Duodenum, 139, 148, 169 E Efficacy, 5, 10, 17, 21, 29, 31, 42, 48, 49, 50, 77, 148 Elective, 57, 148 Electrolyte, 24, 146, 148, 158, 168 Empirical, 72, 98, 148 Emulsion, 91, 148, 150 Encephalopathy, 9, 21, 27, 48, 98, 148 Encopresis, 22, 108, 148 Endoscope, 148 Endoscopic, 3, 77, 143, 148, 168 End-stage renal, 143, 148 Enhancers, 91, 148 Enteritis, 148 Enterocolitis, 19, 148 Environmental Health, 118, 120, 149 Enzymatic, 136, 141, 144, 149, 153 Enzyme, 89, 90, 143, 146, 149, 162 Epidemiological, 100, 149 Epigastric, 149, 160 Erythrocytes, 137, 140, 149 Esophageal, 100, 149 Esophagitis, 149, 170 Esophagus, 100, 147, 149, 151, 166, 169 Ethanol, 87, 149, 150 Evacuation, 76, 78, 95, 145, 149, 156, 165 Evoke, 149, 169 Exocrine, 149, 160

178 Enemas

Exogenous, 139, 149 Expander, 149, 163 Extracellular, 145, 149, 168, 171 F Faecal, 11, 147, 149 Familial polyposis, 144, 149 Family Planning, 119, 149 Fat, 138, 139, 140, 146, 149 Fatigue, 68, 149 Fatty acids, 49, 55, 91, 149, 164 Fecal Incontinence, 49, 54, 97, 99, 107, 149, 154 Feces, 83, 92, 108, 145, 148, 149, 169 Fermentation, 76, 149 Fibrin, 150, 161, 162 Fibrinogen, 150, 162 Fibrosis, 19, 59, 150 Fissure, 97, 144, 150 Fistula, 97, 150 Fixation, 71, 97, 150 Flatulence, 104, 150 Flatus, 149, 150, 151 Fluoroscopy, 78, 81, 82, 150 Flush, 83, 150 Flushing, 100, 150 Fold, 150, 157 Fovea, 150 Frail Elderly, 13, 150 Free Radicals, 138, 150 Fungus, 142, 151 G Gallbladder, 97, 100, 135, 147, 151 Gas, 85, 87, 88, 104, 136, 141, 150, 151, 153, 155, 160, 170, 172 Gastric, 84, 85, 98, 136, 147, 151, 153, 161 Gastritis, 151, 170 Gastrointestinal, 10, 22, 31, 33, 50, 70, 77, 85, 97, 107, 138, 139, 147, 149, 150, 151, 169, 170 Gastrointestinal tract, 70, 97, 139, 149, 150, 151, 169 Gelatin, 151, 170 Gene, 91, 95, 139, 151 General practitioner, 20, 151 Generator, 68, 151 Genetic Code, 151, 160 Gland, 135, 151, 160, 162, 164, 167, 169 Glucans, 146, 151 Glucocorticoid, 139, 140, 151, 153, 163 Glucose, 146, 151, 152, 167, 168 Glutamic Acid, 151, 152, 159 Glutamine, 49, 152

Glycoside, 147, 152, 167 Gonadal, 152, 169 Governing Board, 152, 163 Graft, 36, 42, 152, 153 Graft-versus-host disease, 42, 152 Gravis, 22, 152 Growth, 23, 77, 105, 137, 138, 152, 155, 157, 159, 162 H Half-Life, 141, 152 Headache, 12, 152 Headache Disorders, 152 Hematologic malignancies, 77, 152 Hemoglobin, 137, 142, 149, 152 Hemoglobin A, 142, 152 Hemorrhage, 85, 146, 152, 170 Hemorrhoid, 97, 152 Hemorrhoidectomy, 100, 153 Hepatic, 32, 36, 98, 153, 163 Hepatic Encephalopathy, 98, 153 Hepatitis, 87, 153 Hepatocytes, 153 Hepatotoxicity, 9, 153 Heredity, 151, 153 Hernia, 100, 153 Histamine, 100, 153 Histidine, 153 Homologous, 146, 153, 170 Hormonal, 146, 153 Hormone, 146, 153, 156, 160, 164 Hospital Charges, 153 Hospital Costs, 83, 153 Host, 153, 173 Hydrocortisone, 14, 21, 38, 42, 43, 44, 49, 153 Hydrogen, 19, 135, 136, 139, 141, 147, 153, 158, 159, 160, 164 Hydrogen Peroxide, 19, 153 Hygienic, 88, 154 Hyperreflexia, 154, 171 Hypersensitivity, 50, 136, 137, 154 Hypertension, 152, 154 Hypothalamic, 13, 154 Hypothalamus, 154, 162 I Id, 51, 58, 125, 130, 132, 154 Idiopathic, 11, 77, 95, 154 Ileal, 63, 154 Ileostomy, 34, 154, 159 Ileum, 140, 141, 154 Ileus, 30, 154 Imidazole, 143, 153, 154

Index 179

Immersion, 139, 154 Immune adjuvant, 136, 154 Immune response, 136, 137, 146, 154, 173 Immune system, 154, 172, 173 Immunoglobulin, 41, 154 Immunologic, 77, 154, 165 Immunosuppressive, 63, 151, 154 Impaction, 34, 107, 108, 154 Impairment, 154, 155, 157 Incision, 143, 154, 155 Incontinence, 11, 37, 69, 97, 108, 148, 154 Indicative, 94, 154, 161, 172 Infancy, 93, 154, 166 Infarction, 145, 154, 158 Infection, 89, 90, 99, 124, 138, 139, 155, 157, 161, 170, 172, 173 Infertility, 29, 155 Inflammatory bowel disease, 13, 34, 49, 50, 71, 77, 89, 96, 97, 98, 99, 100, 107, 155 Ingestion, 150, 155, 162, 171 Inhalation, 135, 138, 155, 162 Inner ear, 141, 155 Insufflation, 8, 10, 29, 69, 155 Interferon, 10, 155 Interferon-alpha, 10, 155 Internal Medicine, 15, 16, 24, 26, 27, 28, 37, 43, 50, 151, 155 Intestinal, 26, 30, 40, 42, 70, 71, 80, 86, 87, 96, 97, 100, 108, 148, 155 Intestinal Mucosa, 148, 155 Intestinal Obstruction, 30, 40, 155 Intestine, 70, 71, 124, 139, 140, 144, 148, 155, 156, 173 Intracellular, 155 Intramuscular, 155, 161 Intravenous, 91, 155, 161 Intussusception, 27, 39, 155, 166 Invasive, 64, 155 Involuntary, 99, 149, 156, 158, 168 Iodine, 156, 163 Ions, 135, 139, 142, 148, 153, 156 Irradiation, 144, 156 Irrigation, 27, 85, 92, 156 Ischemic Colitis, 30, 156 J Joint, 104, 156, 170 K Kb, 118, 156 Kinetic, 6, 156 L Lactulose, 18, 21, 27, 28, 98, 156

Large Intestine, 99, 140, 141, 144, 147, 155, 156, 166, 168, 173 Lavage, 10, 19, 22, 48, 84, 85, 98, 156 Laxative, 101, 112, 156, 168 Lens, 156, 173 Lethal, 138, 146, 156 Leukemia, 152, 156 Leukocytes, 140, 155, 156 Leukopenia, 77, 156 Library Services, 130, 156 Life cycle, 140, 156 Ligament, 157, 164 Liver, 28, 36, 97, 98, 100, 135, 138, 139, 147, 148, 149, 151, 153, 157 Localization, 33, 157 Localized, 150, 155, 157, 162, 172 Loop, 153, 154, 157 Lubricants, 96, 98, 101, 157 Lumen, 69, 70, 71, 141, 157 Lymphatic, 155, 157 Lymphoma, 152, 157 Lytic, 89, 90, 157 M Maintenance therapy, 22, 100, 157 Malignant, 138, 144, 157, 159, 165 Malignant tumor, 144, 157 Manometry, 107, 157 Medical Staff, 148, 157 Medicament, 71, 157, 170 MEDLINE, 119, 157 Medullary, 137, 157 Megacolon, 25, 157 Meglumine, 147, 157 Membrane, 136, 142, 143, 144, 157, 158, 163, 166, 172, 173 Meninges, 141, 142, 146, 157 Mental, iv, 4, 65, 118, 120, 142, 149, 157, 164, 165 Mental Disorders, 65, 157, 164 Mercaptopurine, 77, 157 Mesenteric, 157, 163 Meta-Analysis, 77, 158 Metabolite, 140, 158, 164 Metastasis, 158, 159 Methylprednisolone, 38, 50, 158 MI, 86, 133, 158 Microbe, 158, 171 Microbiology, 138, 158 Mineralocorticoids, 135, 146, 158 Modeling, 108, 158 Modification, 136, 158, 165

180 Enemas

Molecular, 119, 121, 139, 145, 149, 150, 158, 162, 163, 167, 170 Molecule, 137, 139, 144, 152, 158, 160, 165, 166 Motility, 108, 158 Motor nerve, 158 Mucosa, 15, 21, 48, 77, 158, 170 Mucus, 158, 172 Muscle relaxant, 8, 158 Muscle tension, 158 Myasthenia, 22, 158 Myocardium, 158 N Nasogastric, 98, 159 Nausea, 137, 147, 159 NCI, 1, 65, 117, 159 Necrotizing Enterocolitis, 35, 159 Need, 3, 77, 79, 87, 88, 92, 93, 95, 97, 100, 103, 107, 108, 126, 143, 159 Neomycin, 27, 159 Neonatal, 40, 159 Neoplasia, 48, 159 Neoplasms, 97, 138, 159, 165 Neoplastic, 137, 153, 157, 159 Nerve, 142, 158, 159, 166, 169 Nervous System, 138, 142, 159, 171 Neurogenic, 29, 49, 159 Neurologic, 97, 159 Neurons, 158, 159, 160, 170 Neurotransmitter, 135, 136, 152, 153, 159, 170 Neutrons, 136, 156, 159, 165 Nicotine, 30, 31, 49, 99, 100, 159 Nitrogen, 136, 137, 150, 152, 160 Nucleic acid, 91, 151, 160 Nursing Care, 160, 161 O Obstipation, 31, 160 Odour, 76, 160 Ointments, 147, 160 Ophthalmology, 150, 160 Ornidazole, 57, 160 Ossification, 160, 166 Ostomy, 100, 160 Outpatient, 20, 36, 160 Overcorrection, 108, 160 Oxidation, 86, 135, 138, 140, 160 P Palliative, 91, 160, 171 Pancreas, 39, 97, 135, 147, 151, 160, 169 Paralysis, 146, 160, 168 Parathyroid, 160, 167, 171

Parathyroid Glands, 160, 167 Parenteral, 91, 161 Partial remission, 161, 166 Patch, 100, 161, 171 Pathogenesis, 77, 161 Pathologic, 139, 145, 154, 161, 170 Pathophysiology, 96, 161 Patient Care Management, 99, 161 Patient Education, 96, 124, 128, 130, 133, 161 Pelvic, 96, 97, 161, 164 Pelvis, 135, 161, 172 Penicillin, 89, 90, 136, 161 Peptic, 161, 170 Perforation, 15, 26, 27, 71, 82, 138, 161, 173 Perianal, 98, 161 Perineum, 92, 161 Peripheral blood, 155, 161 Peripheral stem cells, 152, 161 Peritoneum, 161 Peritonitis, 40, 161, 173 Petrolatum, 148, 161 Phallic, 150, 161 Pharmaceutical Preparations, 87, 149, 151, 161, 164 Pharmaceutical Solutions, 147, 161 Pharmacokinetic, 162 Pharmacologic, 77, 96, 152, 162, 171 Phenolphthalein, 148, 162 Physical Examination, 96, 162 Physiologic, 99, 136, 152, 162, 166 Physiology, 96, 97, 151, 162 Pilot study, 19, 30, 162 Pituitary Gland, 146, 162 Plague, 97, 162 Plants, 136, 141, 142, 151, 152, 162, 167, 171, 172 Plasma, 140, 142, 149, 150, 151, 152, 158, 160, 162, 167 Plasmin, 162 Plasminogen, 36, 162 Plasminogen Activators, 162 Pneumonia, 145, 162 Poisoning, 54, 59, 85, 98, 142, 159, 162, 167 Polyethylene, 79, 86, 162, 163, 170 Polyethylene Glycols, 163, 170 Polyposis, 144, 163 Port, 74, 78, 79, 81, 163 Port-a-cath, 163 Portal System, 27, 163 Portal Vein, 100, 163 Posterior, 71, 137, 147, 160, 163

Index 181

Postoperative, 108, 163 Povidone, 57, 163 Povidone-Iodine, 57, 163 Practice Guidelines, 120, 163 Precancerous, 142, 163 Precipitating Factors, 98, 152, 163 Precursor, 77, 138, 149, 162, 163, 164 Prednisolone, 7, 8, 9, 10, 14, 17, 18, 20, 21, 32, 48, 158, 163 Preoperative, 32, 48, 163 Prevalence, 77, 107, 164 Proctalgia Fugax, 96, 164 Proctitis, 6, 13, 17, 18, 23, 24, 26, 28, 31, 38, 43, 44, 49, 51, 59, 98, 99, 164 Proctocolitis, 32, 77, 164 Proctosigmoiditis, 20, 26, 31, 36, 41, 42, 43, 164 Prodrug, 77, 164 Progesterone, 164, 169 Progressive, 143, 152, 164 Prolapse, 97, 164 Prone, 104, 164 Prophylaxis, 19, 164 Propylene Glycol, 87, 164 Prospective study, 15, 164 Prostaglandins, 37, 49, 56, 138, 164 Prostate, 33, 41, 59, 164 Protein S, 95, 139, 151, 159, 164 Proteins, 136, 137, 142, 143, 144, 158, 160, 162, 164, 167, 171 Protons, 136, 153, 164, 165 Proximal, 70, 71, 96, 99, 147, 164 Psychiatry, 150, 164 Psychic, 157, 164 Psychotherapy, 165 Psyllium, 57, 99, 165 Public Policy, 119, 165 Pulse, 68, 165 Purgative, 156, 165 Q Quality of Life, 21, 64, 104, 107, 165 Quiescent, 20, 165 R Radiation, 23, 24, 28, 43, 49, 51, 82, 139, 150, 156, 160, 165, 173 Radioactive, 152, 153, 156, 165 Radiographer, 9, 165 Radiography, 79, 137, 165, 172 Radiolabeled, 33, 156, 163, 165 Radiological, 57, 80, 165 Radiologist, 82, 165 Radiopharmaceutical, 151, 165

Radiotherapy, 49, 156, 165 Randomized, 6, 7, 8, 9, 10, 14, 17, 27, 38, 42, 48, 57, 148, 165 Randomized clinical trial, 9, 48, 165 Reassurance, 103, 165 Receptor, 100, 137, 145, 166 Rectal Prolapse, 97, 166 Rectovaginal Fistula, 99, 166 Recurrence, 77, 142, 166 Refer, 1, 140, 144, 150, 157, 159, 166 Reflux, 166, 170 Refraction, 166, 169 Refractory, 6, 7, 15, 19, 34, 43, 96, 166 Regimen, 48, 60, 148, 166 Regional enteritis, 77, 166 Relapse, 42, 166 Relaxant, 166 Remission, 6, 17, 26, 29, 38, 96, 157, 166 Resection, 77, 100, 166 Respiration, 141, 146, 166 Restoration, 166, 167 Retina, 156, 166, 167, 173 Retrograde, 31, 34, 50, 166 Rickets, 18, 166 Risk factor, 26, 164, 167 Rod, 143, 167 Rotator, 76, 167 Rubber, 74, 75, 76, 79, 92, 135, 167 S Salicylate, 41, 167 Salicylic, 41, 167 Salivary, 147, 167 Salivary glands, 147, 167 Sanitary, 76, 84, 85, 86, 167 Saponins, 167, 169 Screening, 4, 5, 9, 39, 64, 143, 167 Secretion, 146, 153, 158, 167 Secretory, 98, 167, 170 Semen, 164, 167 Semisynthetic, 136, 167 Septicemia, 57, 167 Serum, 24, 136, 144, 158, 161, 167 Shock, 32, 56, 137, 153, 167, 171 Side effect, 42, 100, 111, 135, 148, 167, 171 Sigmoid, 31, 71, 99, 164, 167, 168 Sigmoid Colon, 71, 164, 167, 168 Sigmoidoscopy, 4, 5, 7, 9, 18, 31, 36, 48, 63, 168 Signs and Symptoms, 166, 168 Sitz Bath, 99, 168 Skeletal, 137, 143, 146, 168 Skeleton, 156, 168

182 Enemas

Small Bowel Enema, 10, 168 Small intestine, 70, 141, 148, 153, 154, 155, 159, 166, 168 Smooth muscle, 153, 168 Social Environment, 165, 168 Sodium, 9, 14, 15, 17, 24, 26, 37, 50, 87, 112, 147, 158, 168 Solitary Rectal Ulcer, 38, 168 Solvent, 87, 149, 161, 164, 168 Sorbitol, 15, 16, 26, 37, 157, 168 Sound wave, 165, 168 Spasm, 11, 55, 138, 168, 171 Spastic, 96, 168 Spasticity, 168 Specialist, 125, 168 Species, 146, 168, 171, 172, 173 Specificity, 21, 135, 169 Spectrum, 77, 98, 143, 169 Sperm, 38, 137, 169 Sphincter, 68, 71, 73, 80, 100, 166, 169 Spina bifida, 42, 50, 93, 169 Splenic Vein, 163, 169 Stabilizer, 87, 169 Steel, 143, 169 Stenosis, 169 Stent, 160, 169 Sterile, 92, 138, 160, 169 Sterility, 74, 155, 169 Steroid, 27, 35, 63, 99, 107, 139, 167, 169 Stimulant, 101, 153, 169 Stimulus, 107, 169 Stoma, 49, 160, 169 Stomach, 84, 85, 100, 135, 147, 149, 151, 153, 156, 159, 166, 168, 169, 173 Stool, 72, 75, 76, 96, 97, 99, 104, 143, 146, 154, 156, 169 Stress, 99, 101, 103, 150, 159, 167, 169, 172 Stricture, 55, 169 Stridor, 169, 171 Stroke, 65, 118, 170 Styrene, 167, 170 Subacute, 155, 170 Subarachnoid, 152, 170 Subclinical, 155, 170 Subcutaneous, 161, 170 Sucralfate, 7, 28, 38, 43, 48, 49, 50, 51, 170 Sulfapyridine, 85, 170 Supine, 79, 170 Suppositories, 5, 12, 25, 71, 91, 94, 96, 97, 99, 101, 107, 151, 170 Suppository, 17, 63, 68, 89, 90, 163, 170 Suppression, 13, 44, 146, 170

Suppuration, 99, 170 Suspensions, 23, 79, 86, 170 Symphysis, 142, 164, 170 Symptomatic, 137, 170 Symptomatic treatment, 137, 170 Synaptic, 159, 160, 170 Synaptic Transmission, 160, 170 T Tetany, 25, 28, 39, 49, 160, 171 Therapeutics, 14, 16, 18, 20, 27, 29, 30, 31, 32, 38, 41, 43, 44, 113, 171 Thoracic, 147, 171 Thorax, 135, 171 Thrombolytic, 162, 171 Thrombosis, 36, 164, 170, 171 Tissue, 137, 139, 140, 141, 143, 145, 149, 150, 151, 152, 153, 156, 157, 158, 159, 160, 162, 166, 167, 169, 171 Tomography, 145, 171 Topical, 27, 38, 40, 41, 43, 63, 89, 96, 99, 100, 107, 149, 153, 161, 163, 171 Toxic, iv, 48, 54, 124, 146, 159, 170, 171 Toxicity, 41, 54, 77, 148, 170, 171 Toxicokinetics, 171 Toxicology, 120, 171 Toxins, 137, 155, 167, 171 Traction, 143, 171 Transdermal, 100, 171 Transfection, 139, 171 Translating, 3, 171 Translation, 136, 159, 171 Transplantation, 16, 42, 143, 171 Transverse Colon, 71, 171 Trauma, 9, 97, 149, 171 Trees, 167, 172 Trichomonas, 160, 172 Trichomonas Infections, 160, 172 Trigger zone, 137, 172 Tunica, 158, 172 U Ulcer, 71, 168, 170, 172 Unconscious, 138, 154, 172 Urethra, 164, 172 Urinary, 141, 154, 172 Urinary tract, 141, 172 Urine, 61, 79, 83, 140, 145, 154, 172 Urography, 147, 172 Urticaria, 137, 172 Uterus, 142, 145, 164, 172 V Vaccine, 136, 172 Vagina, 84, 142, 148, 166, 172

Index 183

Vaginal, 84, 91, 170, 172 Vascular, 12, 137, 146, 152, 155, 162, 172 Vasodilatation, 141, 172 Vasodilator, 153, 172 VE, 11, 108, 172 Vein, 155, 163, 169, 172 Venous, 164, 172 Ventricle, 154, 165, 172 Vertebral, 139, 169, 173 Veterinary Medicine, 119, 173 Virulence, 171, 173 Virus, 23, 142, 148, 155, 173

Visceral, 77, 161, 173 Vitreous, 91, 156, 166, 173 Vitreous Body, 166, 173 Vitreous Humor, 91, 173 Volition, 156, 173 Volvulus, 33, 173 W White blood cell, 137, 156, 158, 173 X X-ray, 71, 78, 82, 87, 139, 140, 145, 147, 150, 156, 165, 168, 169, 173

184 Enemas

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