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Br J Surg. 2003 Jul;90(7):860-6.
Clinical and physiological findings, and possible aetiological factors of rectal hyposensitivity.
Gladman MA, Scott SM, Williams NS, Lunniss PJ.
Academic Department of Surgery and Gastrointestinal Physiology Unit, St Bartholomew's and The London School of Medicine and Dentistry, London, UK. m.a.gladmamul.ac.uk
BACKGROUND: Rectal hyposensitivity (RH) relates to insensitivity of the rectum on anorectal physiological investigation and appears common in functional bowel disorders. The clinical significance of this physiological abnormality is unclear. METHOD: RH was defined as one or more sensory threshold volumes raised beyond the normal range (mean plus two standard deviations) on rectal balloon distension. Clinical information and results of other anorectal physiological investigations were evaluated in 261 patients with RH. RESULTS: Patients with RH most commonly presented with constipation (48 per cent), constipation and incontinence in combination (27 per cent), or faecal incontinence (20 per cent). Thirty-eight per cent of patients had a history of previous pelvic surgery, 22 per cent a history of anal surgery and 13 per cent a history of spinal trauma. In patients with RH presenting with symptoms of constipation or incontinence, impaired rectal sensation was the only abnormality on physiological investigation in 48 per cent and 31 per cent respectively. CONCLUSION: Patients with RH display marked heterogeneity in terms of presenting symptoms. The exact causes of RH are unknown, but there is evidence to suggest that pelvic nerve injury and spinal trauma are possible aetiological factors. RH appears important in the aetiology of both constipation and faecal incontinence, and may be useful as a predictor of surgical outcome. 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12854114&dopt=Abstract [PubMed - in process]
Gastroenterol Clin North Am. 2003 Jun;32(2):507-29.
Irritable bowel syndrome: evaluation and treatment.
Somers SC, Lembo A.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
Irritable bowel syndrome is a common gastrointestinal disorder characterized by abdominal pain, bloating, and disturbed defecation in the absence of other medical conditions with similar presentations. Because physical findings and currently available diagnostic tests lack sufficient specificity for clinical use, the diagnosis of IBS is based on characteristic symptoms as outlined in several symptom-based criteria for IBS. When used in combination with a detailed history, physical examination, and limited diagnostic testing, these criteria are a valid method of diagnosing IBS. Once a confident diagnosis of IBS has been made, treatment of IBS should be based on the predominant symptom while taking into account the severity of symptoms and the degree of functional impairment both physically and psychologically. Most patients with IBS have mild symptoms and education, reassurance, dietary and lifestyle changes, and a therapeutic physician-patient relationship form the backbone of treatment. A smaller number of patients have moderate symptoms, which are typically intermittent, but may at times interrupt their normal activities. In addition to dietary and lifestyle modifications, pharmacologic intervention based on the predominant symptom (diarrhea, constipation, or pain) may be used to relieve symptoms. Finally, a small subset of patients has severe or intractable symptoms. These patients, often seen in tertiary referral centers, often have constant pain symptoms and psychosocial impairments. A multidisciplinary approach including pharmacologic treatments, psychologic treatments, and possibly a mental health or pain center involvement may be beneficial.
online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12858604&dopt=Abstract [PubMed - in process]
Gastroenterol Clin North Am. 2003 Jun;32(2):619-58.
Diagnosis and treatment of chronic gastroparesis and chronic intestinal pseudo-obstruction.
Smith DS, Williams CS, Ferris CD.
Division of Gastroenterology, Department of Medicine, Vanderbilt University Medical Center, Nashville Veterans Affairs Medical Center, Nashville, TN 37232, USA.
Chronic gastroparesis and CIP are debilitating disorders that are difficult to treat with currently available therapies. Failure of proper migration and differentiation of enteric neurons or ICC can result from specific genetic mutations and lead to phenotypes of CIP with or without concomitant gastroparesis. Intestinal dysfunction in diabetes may reflect a depletion of NO production (and perhaps other neurotransmitters or modulators), which is manifest as a syndrome of gastroparesis, diarrhea, or constipation in individual patients. As the key molecular changes underlying these disorders are defined, clinicians will begin to understand their precise etiology and rational medical therapy may become possible. In the future, testable hypotheses regarding the etiology of other functional bowel disorders (e.g., functional dyspepsia, irritable bowel syndrome, and so forth) may be developed.
online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12858609&dopt=Abstract [PubMed - in process]
The most ostensive feature that distinguishes us human from chimps and other primates is the lack of bodily hair. During evolutionary process, we have lost the majority of hair. Hair is no longer an essential part of our body, just like appendix. What little hair we still have on our scalp and a few other bodily parts is still regarded as significant for reasons other than biological necessity. Hair loss is naturally accompanied by aging process, although the extent of hair loss and the timing of onset vary widely among individuals. Thus, loss of hair and baldness is considered as a symbol of maturity or old age. Like winkles and other signs of aging, hair loss is not welcome by most people, because we don't welcome aging, and being perceived as an aging person. However, it is alopecia, or premature hair loss that especially concerns certain people.
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