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References: Laxative

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J Pediatr (Rio J). 1996 Jul-Aug;72(4):254-7.
[Tubular duplication of the colon: a case report and review of the literature]

[Article in Portuguese]

Salvador II, Modelli ME, Pereira CR.

Unidade de Cirurgia Pediatrica, Hospital de Base do DF, Brasilia.

Among Gastrointestinal Duplications, colonic duplications are the less common. The case presented here consist of a duplication of the transverse colon, difficult to diagnose, which had abdominal distension as the main symptom. A 4-year-old child was referred to the Unity of Pediatric Surgery, Hospital de Base, Brasilia, DF with a history of progressive abdominal distension. Plain X-Rays of the abdomen demonstrated a large fecaloma, which demanded removal. A Barium Enema was done suggesting Congenital Megacolon. A rectal biopsy was performed under general anesthesia, demonstrating normal ganglion cells. Medical treatment was instituted for chronic constipation in the Pediatric Gastroenterology clinic. The patient returned three months later with the same complaints. A new rectal biopsy was done; normal ganglion cells were described, ruling out Hirschsprung's disease. The parents were told to insist on the medical treatment diets. Four years later the patient was seen in the Emergency Room with signs and symptoms of low intestinal obstruction. Exploratory Laparotomy was undertaken as an emergency and the findings were complete volvulus of the large bowel involving the transverse colon up to the splenic flexure, demonstrating a large duplication of the transverse colon. A resection of the duplication and end-to-end colonic anastomosis was performed with an uneventful postoperative care. Discharged on excellent conditions.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14688938&dopt=Abstract [PubMed]

temp/constipation-1.matches:chuv.hospvd.ch

Intestinal neuronal dysplasia is a controversial form of dysganglionosis that has been described both as an isolated disorder and in association with Hirschsprung's disease. It has been blamed for the bad outcome of bowel function in patients operated on for Hirschsprung's disease. According to various authors, intestinal neuronal dysplasia could be a primary disorder or secondary to other diseases of the bowel. The aim of this study was to assess the plasticity of the enteric nervous system in patients with Hirschsprung's disease-associated intestinal neuronal dysplasia and its ability to evolve spontaneously to normal innervation patterns. Since we prospectively introduced the assessment of the enteric nervous system of the ganglionated bowel in patients operated on for Hirschsprung's disease, 31 patients have been operated on for Hirschsprung's disease in our institution between 1995 and 2002. Among these patients, nine suffered postoperatively from severe constipation and five from bouts of entocolitis. IND was found in eight of them. We studied the evolution of the innervation in three of these patients by repeated serial full-thickness biopsies of the colon. All three patients underwent a colostomy before or after the pull-through procedure. Histopathological assessment of the enteric nervous system was made with conventional acetylcholinesterase histochemistry, rapid acetylcholinesterase histochemistry and immunohistochemistry for the Protein Gene Product 9.5 and the antigen CD56. This evolution was compared with the clinical outcome of bowel function. In our three patients with Hirschsprung's disease-associated intestinal neuronal

temp/constipation-1.matches:

J Pediatr Surg. 2004 Jan;39(1):73-7.
Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation?

Youssef NN, Pensabene L, Barksdale E Jr, Di Lorenzo C.

Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

PURPOSE: The aim of this study was to assess benefit of surgery in the treatment of childhood constipation in children without aganglionosis or anorectal malformations. METHODS: Retrospective chart review and follow-up questionnaire of 19 children (10 girls, age 7.6 +/- 3.9 years) who underwent surgery after colonic and anorectal manometry had documented abnormal motility. Children at the time of manometric evaluation had symptoms of intractable constipation a mean of 5.1 +/- 2.5 years. Follow-up questionnaires were administered to caregivers a mean of 11.4 +/- 9.3 months after surgical intervention. RESULTS: Proximal colonic abnormalities were seen in 2 patients, abnormalities involving the distal colon and rectosigmoid region in 13 patients, pancolonic abnormalities in 2 patients, and incomplete relaxation of the internal anal sphincter in 2 patients. Surgery led to increase in frequency of bowel movements per week (8.1 v 1.9; P <.005), decrease in soiling episodes per week (2.20 v 4.7; P <.01), and decrease in daily use of medications for constipation (0.8 v 2.3; P <.05). Adverse events included skin breakdown at site of ostomy (9%), fecal incontinence after pull-through procedure (13%), and persistent constipation (4.5%). Parents felt that the symptoms after surgery were completely resolved in 89% of patients. CONCLUSIONS: Surgery may be beneficial in the management children with chronic intractable constipation and documented abnormalities in motility.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14694375&dopt=Abstract

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