Dieta normocalórica e pobre em fibras, para preparo de colonoscopia, é melhor aceita e não inferior que uma dieta líquida hipocalórica: ensaio randomizado controlado / A normocaloric, low-fiber diet for colonoscopy preparation is more acceptable and non-inferior to a liquid, low-calorie diet: a randomized controlled trial

ABSTRACT Background: Several publications have shown greater acceptance of less restrictive diets for colonoscopy preparation, without impairing the quality of the preparation, when compared to the clear liquid diet. Objective: To evaluate the quality, tolerance and preference regarding the colonoscopy preparation of a low-fiber, normocaloric diet compared with a hypocaloric liquid diet. Methods: This is a randomized, controlled, observer-blind study to compare two low-fiber colonoscopy preparation diets (hypocaloric liquid diet vs. normocaloric diet). The Boston Bowel Preparation Scale was used to evaluate the qua­lity of the preparations, being considered adequate BBPS ≥6 in the global assessment and ≥2 in each segment. The same laxative was used in both groups as well as the "split-dose" regimen. Results: A total of 136 individuals were enrolled in each group. Adequate preparation was achieved in 90.4% of the individuals allocated to the liquid diet group and 92.6% to the normocaloric group. There was no significant difference in the quality of preparation and tolerance between groups. A higher patient acceptance to repeat the procedure if necessary was observed in the normocaloric diet group compared with the liquid diet group (P=0.005). Conclusion: The normocaloric diet has shown to be not inferior to the liquid diet regarding the quality of the colonoscopy preparation. Patient tolerance rates were similar between both diets, but a higher accep­tance rate was observed with the normocaloric diet as compared with the liquid diet.

RESUMO Contexto: Diversas publicações têm evidenciado uma maior aceitação de dietas menos restritivas para preparo de colonoscopia, sem prejuízo na sua qualidade, quando comparadas com a dieta de líquidos claros. Objetivo: Avaliar a qualidade, tolerância e preferência do preparo para colonoscopia de uma dieta líquida hipocalórica, quando comparada com uma dieta normocalórica, ambas pobres em fibras. Métodos: Trata-se de um estudo randomizado, controlado, observador "cego", para comparar duas dietas de preparo para colonoscopia (dieta líquida hipocalórica e dieta normocalórica, ambas pobres em fibras). Foi utilizada a escala de Boston para avaliar a qualidade do preparo, sendo considerado adequado BBPS ≥6 na avaliação global e ≥2 em cada segmento. Foram prescritos o mesmo laxativo e o regime "dose fracionada" para ambos os grupos. Resultados: Foram incluídos 136 indivíduos em cada grupo. O preparo adequado foi alcançado em 90,4% dos indivíduos alocados no grupo da dieta líquida e 92,6% da normocalorica. Não houve diferença significativa na qualidade do preparo e na tolerância entre ambas as dietas. Observou-se maior aceitação de repetir o procedimento se necessário, no grupo da dieta normocalórica quando comparado ao da dieta líquida (P=0,005). Conclusão: A dieta normocalórica não é inferior que à líquida na qualidade do preparo para colonoscopia, ambas apresentam tolerância similar, porém com maior aceitação da dieta normocalórica quando comparada à líquida.

Bifidobacterium bifidum CCFM1163 Alleviated Cathartic Colon by Regulating the Intestinal Barrier and Restoring Enteric Nerves.

Cathartic colon (CC), a type of slow-transit constipation caused by the long-term use of stimulant laxatives, does not have a precise and effective treatment. This study aimed to evaluate the ability of Bifidobacterium bifidum CCFM1163 to relieve CC and to investigate its underlying mechanism. Male C57BL/6J mice were treated with senna extract for 8 weeks, followed by a 2-week treatment with B. bifidum CCFM1163. The results revealed that B. bifidum CCFM1163 effectively alleviated CC symptoms. The possible mechanism of B. bifidum CCFM1163 in relieving CC was analyzed by measuring the intestinal barrier and enteric nervous system (ENS)-related indices and establishing a correlation between each index and gut microbiota. The results indicated that B. bifidum CCFM1163 changed the gut microbiota by significantly increasing the relative abundance of Bifidobacterium, Faecalibaculum, Romboutsia, and Turicibacter as well as the content of short-chain fatty acids, especially propionic acid, in the feces. This increased the expression of tight junction proteins and aquaporin 8, decreased intestinal transit time, increased fecal water content, and relieved CC. In addition, B. bifidum CCFM1163 also increased the relative abundance of Faecalibaculum in feces and the expression of enteric nerve marker proteins to repair the ENS, promote intestinal motility, and relieve constipation.

Fitting Degrees of Cathartic Colon Animal Models with Disease Characteristics of Western Medicine and Syndrome Characteristics of Traditional Chinese Medicine / 中国实验方剂学杂志

Cathartic colon （CC） is a common and refractory digestive system disease， with the pathogenesis not fully clarified. The effective therapies other than laxatives and surgery remain to be developed for CC. Therefore， establishing the CC animal models that fit the disease characteristics of western medicine and syndrome characteristics of traditional Chinese medicine （TCM） is an important link to promote the research on this disease. The fitting degree of animal models with the latest Chinese and western medical diagnostic criteria is an indicator to assess the effectiveness of the animal models in simulating the disease characteristics of western medicine and syndrome characteristics of TCM. The literature review showed that the model animals， drugs and their dosage forms， doses， administration methods， and modeling period of CC varied in different studies， and the available CC animal models presented different fitting degrees with the disease characteristics of western medicine and syndrome characteristics of TCM. Rats were the preferred animals for the modeling of CC. Rhei Radix et Rhizoma preparations were commonly used for model inducing， which， however， may cause water electrolyte disorders， decreased immunity， and even death of animals at the late stage of modeling. The animals were modeled by gradually increasing the starting dose， while the starting dose and increasing dose varied. The maintenance dose was determined based on 50% of the animals having loose stools， and the end for a cycle was determined as the time when loose stools disappeared in 80% of animals. The modeling always lasted for 2-3 cycles， approximately 2-4 months. The CC models established with Rhei Radix et Rhizoma granules and rhein had high fitting degrees with the disease and syndrome characteristics. In addition， the CC animal models of TCM syndromes were still in the exploration stage. There were only the animal models of four TCM syndromes： liver depression and spleen deficiency， both Qi and Yin deficiency， Qi stagnation and blood stasis， and spleen and kidney deficiency. Efforts should be made to establish the animal models that meet the characteristics of disease of western medicine and syndromes of TCM， so as to facilitate the research on CC mechanism and drug development.

Personality characteristics and medical impact of stimulant laxative abuse in eating disorder patients-a pilot study.

BACKGROUND: Stimulant laxative abuse as a purging behavior can be profound in those with eating disorders. However, the psychopathology leading to stimulant laxative abuse is poorly understood. Furthermore, the medical impact of stimulant laxative abuse has not been studied in this population. METHODS: Six individuals abusing stimulant laxatives underwent a barium enema to assess for evidence of the cathartic colon syndrome and 29 individuals engaging in any purging behaviors completed the Tri-dimensional Personality Questionnaire-Short Form, Sensitivity to Punishment/Sensitivity to Reward Questionnaire-Short Form, Beck Depression Inventory, and the State Trait Anxiety Inventory questionnaires. RESULTS: Three of the six patients completing the barium enema had the radiographic findings consistent with cathartic colon. Individuals engaging in laxative abuse showed higher Novelty Seeking compared to those engaging in other forms of purging, and those engaging in any form of purging behavior showed greater Sensitivity to Punishment compared to Sensitivity to Reward. There was also the presence of greater Harm Avoidance than Reward Dependence in this population. CONCLUSION: There may be different psychopathology that contributes to the abuse of stimulant laxatives than that associated with other forms of purging. Regardless of the driving factor, further research is warranted to discover best therapeutic interventions given the potential to develop the cathartic colon syndrome with ongoing use of stimulant laxatives. Cathartic colon is a condition whereby the colon, or lower intestine, is converted into an inert tube incapable of propagating fecal matter. It is thought to develop due to over-use of stimulant laxatives. However, it is unclear if this condition truly exists and whether it contributes to the constipation experienced by individuals with eating disorders who have extensive past histories of abusing laxatives. It is also unclear if laxative abuse presents with different medical complications than other forms of purging. The purpose of this study is to determine whether radiographic evidence of cathartic colon can be found in eating disorder patients abusing stimulant laxatives, whether there are different medical complications with laxative abuse versus other forms of purging, and to examine the psychological composition of individuals who engage in severe laxative abuse. Specifically, the authors investigated the interrelationship between Harm Avoidance and Reward Dependence, with emphasis on gaining a better understanding of Reward Dependence by examining both Sensitivity to Reward and Sensitivity to Punishment in patients who engage in severe laxative abuse. Our findings suggest that stimulant laxative abuse may cause the development of cathartic colon changes and that there may be unique psychopathology that contributes to the abuse of stimulant laxatives. Given the higher Novelty Seeking personality-dimension in those abusing laxatives, it is possible that this purging behavior may be considered addiction-like in nature, which would have distinct treatment implications.

Animal models of cathartic colon.

The incidence of cathartic colon has been increasing, but satisfactory treatments are still lacking. In order to study the pathological mechanisms of the disorder and identify effective treatment methods, researchers have established different animal models of cathartic colon. This minireview briefly summarizes several common cathartic colon animal models, induced with anthraquinone laxatives such as rhubarb, total anthraquinone, rhein, and emodin, or induced with diphenylmethane laxatives such as phenolphthalein. The advantages and limitations of these models are evaluated and analyzed. We hope that this review will facilitate the selection of suitable models and improve relevant modeling methods. We anticipate the development of more convenient and stable models that can reflect the characteristics of cathartic colon in humans, and serve as useful tools for further studies.

Undiagnosed Wilson's Disease and Fibromyalgia Masking Bowel Perforation.

Wilson's disease is a complex multi-organ disease characterized by impaired biliary excretion of copper and resulting deposition of excess copper in the liver and other organs. It has a wide range of clinical presentations, and diagnosis often requires a high degree of clinical suspicion, especially in patients with multiple other comorbidities. We present the case of a 37-year-old woman with a complex medical and psychiatric history who was admitted for chronic diarrhea, hepatic enzyme elevation, electrolyte abnormalities, hyperammonemia, and methicillin-sensitive Staphylococcus aureus bacteremia. She was eventually found to have low serum ceruloplasmin level and elevated urine copper levels. Though confirmatory liver biopsy was not performed due to bowel wall rupture and septic shock, most of her symptoms and lab abnormalities could be explained by an underlying diagnosis of Wilson's disease. We present this case primarily as a cautionary tale. This patient was not lacking in medical attention prior to this prolonged hospitalization; however, her psychiatric issues and fibromyalgia management were the predominant foci during her frequent primary care office visits and likely distracted from the patient's chronic laboratory abnormalities. More vigilant laboratory evaluation of underlying medical conditions in psychiatric patients may be warranted in order to prevent serious complications of such conditions.

Role of Jiawei Shenqi-wan in Treatment of Cathartic Colon on the Basis of Interstitial Cells of Cajal / 胃肠病学

Background: Cathartic colon belongs to the category of 'constipation' in Traditional Chinese Medicine, and its pathogenesis is related to deficiency of kidney temperament and weak promotion ability, which has become a hot spot of global medical attention. Aims: To investigate the effect and possible mechanism of Jiawei Shenqi-wan (JSQW) on intestinal transmission function and pathological changes of interstitial cells of Cajal (ICCs) in rats with cathartic colon. Methods: Forty rats were randomly divided into blank group, model group, prucalopride group and JSQW group. Fecal moisture content, fecal particle number and intestinal transit rate were detected. The pathological changes of ICCs were observed under transmission electron microscope. RT-qPCR was used to detect the mRNA expressions of water channel proteins (AQP3 and AQP9) and SCF/c-kit pathway. Immunohistochemistry was used to measure the expressions of α-smooth muscle actin (α-SMA), inducible nitric oxide synthase (iNOS) and 5-hydroxytryptamine (5-HT)

Integrated assessment of medicinal rhubarb by combination of delayed luminescence and HPLC fingerprint with emphasized on bioactivities based quality control.

BACKGROUND: To promote herbal medicine depends largely on its quality. Chromatographic fingerprint is a frequent approach for quality assessment of herbs however with challenges on robust and reproducibility. To develop rapid, cheap and comprehensive measurements as complementary tools for herbal quality control are still urgently needed. Moreover, biological activities are essential for herbal quality, and should be taken into consideration with emphasized in quality control. METHODS: In this research, HPLC fingerprint and delayed luminescence (DL, a rapid and systematic tool) were used to measure the rhubarb samples of multiple species. Statistics were explored to classify these rhubarb samples using data obtained from two analytic methods. In addition, DL properties were linked to specific chemical components which may reflect bioactivities of rhubarb using Spearman's rank correlation. Moreover, mice model was used to evaluate the cathartic effect between rhubarb samples stratifying by two analytic methods. RESULTS: We found that there was no significant difference of chemical fingerprints and DL signals among the different species of medicinal rhubarb. However, our results show a high similarity between HPLC fingerprint analysis and DL measurements in classification of these rhubarb samples into two sub-groups. In addition, the two sub-groups of rhubarb samples that may have different cathartic activities. CONCLUSION: This approach provides new leads for development of herbal quality assessment based on bioactivity. In conclusion, integrated assessment by measuring HPLC fingerprint and DL with emphasized on bioactivity may provide novel strategy for herbal quality control.

Severe hypermagnesemia induced by magnesium oxide ingestion: a case series.

Hypermagnesemia is generally considered an exceptional iatrogenic condition usually caused by magnesium-containing cathartics. In particular, this condition often develops when magnesium-containing cathartics are administered to elderly patients with renal insufficiency or bowel movement dysfunction. Although magnesium oxide (MgO) is widely prescribed as a laxative, serum magnesium concentration has not been examined in most cases. In this report, we present the cases of four elderly patients with constipation and symptomatic hypermagnesemia caused by MgO ingestion, one of which had a lethal course. All of the patients were older than 65 years and with renal dysfunction. In addition, they had difficulties in expressing their symptoms because of cerebrovascular events or dementia. These cases suggest that hypermagnesemia caused by magnesium-containing cathartics is more likely to develop than previously recognized and that physicians should be aware that patients with chronic kidney disease and the elderly are at risk of hypermagnesemia on magnesium administration. We recommend serum magnesium monitoring for high-risk patients after initial prescription or dose increase.

Mechanism of aqueous fructus aurantii immaturus extracts in neuroplexus of cathartic colons.

AIM: To examine the effect of aqueous fructus aurantii immaturus (FAI) extracts on the intestinal plexus of cathartic colons. METHODS: Cathartic colons were induced in rats with dahuang, a laxative used in traditional Chinese medicine. Once the model was established (after approximately 12 wk), rats were administered mosapride (1.54 mg/kg) or various doses of aqueous FAI extracts (1-4 g/kg) for 14 d. Transit function was assessed using an ink propulsion test. Rats were then sacrificed, and the ultramicrostructure of colonic tissue was examined using transmission electron microscopy. The expression of the 5-hydroxytryptamine receptor 4 (5-HTR4) and neurofilament-H was assessed in colon tissues using real-time PCR, Western blot, and immunohistochemistry. RESULTS: Mosapride and high dose (4 g/kg) of aqueous FAI extracts significantly improved the bowel movement in cathartic colons compared to untreated model colons as measured by the intestinal transit rate (70.06 ± 7.25 and 72.02 ± 8.74, respectively, vs 64.12 ± 5.19; P < 0.05 for both). Compared to controls, the ultramicrostructure of cathartic colons showed signs of neural degeneration. Treatment with mosapride and aqueous FAI extracts resulted in recovery of ultrastructural pathology. Treatment with mosapride alone upregulated the gene and protein expression of 5-HTR4 compared to untreated controls (P < 0.05 for both). Treatment with aqueous FAI extracts (≥ 2 g/kg) increased 5-HTR4 mRNA levels (P < 0.05), but no change in protein level was observed by Western blot or immunohistochemistry. The mRNA and protein levels of neurofilament-H were significantly increased with mosapride and ≥ 2 g/kg aqueous FAI extracts compared to controls (P < 0.05 for all). CONCLUSION: Aqueous FAI extracts and mosapride strengthen bowel movement in cathartic colons via increasing the expression of 5-HTR4 and neurofilament-H.

Opioid receptors and associated regulator of G protein signaling are involved in the cathartic colon of rats.

A cathartic colon is characteristic of slow transit constipation (STC), which can result following the long-term use of irritant laxatives. In the present study, the involvement of three opioid receptor subtypes (µ, MOR; δ, DOR; and κ, KOR), regulator of G protein signaling 4 (RGS-4) and ß-arrestin-2 were investigated in the cathartic colon of rats. A rat model of a cathartic colon was established by feeding the animals with phenolphthalein, while normal rats were used as a control. The mRNA and protein expression levels of the opioid receptors, RGS-4 and ß-arrestin-2 were detected in the rat colon using semi-quantitative reverse transcription polymerase chain reaction and western blot analysis, respectively. The rat model of a cathartic colon was successfully established using the phenolphthalein stimulus, and was shown to result in shrunken myenteric neurons and loose muscle fibers in the intestinal wall. The mRNA and protein expression levels of the three opioid receptor subtypes, RGS-4 and ß-arrestin-2 were significantly higher in the cathartic colon group when compared with the levels in the normal control group (all P<0.01). With regard to the protein expression levels, MOR protein increased 2.4 fold, DOR expression increased 1.5 fold, KOR levels increased 1.5 fold, RGS-4 protein increased 3.5 fold and ß-arrestin-2 expression increased 2.0 fold. Therefore, the expression levels of opioid receptors were found to increase in the cathartic colons of the rats, indicating that opioid receptors and downstream RGS-4 and ß-arrestin-2 signaling may play an important role in the pathogenesis of STC.

Transference and katharsis, Freud to Aristotle.

Aristotle's theory of tragic katharsis is the most ancient and debated theory of the effect of the theatrical experience on the audience. It affirms that tragedy effects the katharsis of fear and pity, engaging readers with the controversy whether by katharsis Aristotle meant purification of the emotions (i.e. their perfection within the mind) or purification of the mind from the emotions (i.e. their abreaction from the mind). In this paper I will explore how Freud's theory of transference can suggest a new interpretation of Aristotle's tragic katharsis. Transference allows for the representation and expression of repressed emotions through the re-enactment of past relational dynamics. Although this process is essential to the psychoanalytic method, it is the subsequent analytic endeavour which allows for the "working through" of repressed emotions, bringing into effect the transference cure. I argue that the dynamic between emotional arousal in re-enactment and emotional distancing in analysis offers an effective parallel of the dynamic between katharsis of fear and katharsis of pity in Aristotle's theory. Such interpretation of tragic katharsis suggests that the theatrical effect in audiences may be an opportunity for self-analysis and the 'working through' of unconscious psychic dynamics.

Freud, Breuer y aristóteles: catarsis y el descubrimiento del edipo / Freud, Breuer and aristotle: catharsis and the discovery of oedipus

Psychoanalysis was originated from the cathartic method first practiced by Breuer and then by Freud. There are no hard data that can explain why Freud took so long in using it and why he associated it regularly with hypnosis rather than apply as the exclusive psychotherapeutic tool. It is argued that its creation was closely related to the concept of catharsis, as Aristotle understood it, that is to say, as the emotions that the audience discharge when attend a tragedy. The friendship and partnership between Breuer and Freud ended in a bitter breakup, delaying Freud's intellectual development. It is postulated that the breakdown was the result of an unresolved Oedipus complex of Freud in relation to an ambivalent father figure: a persecutory, tyrannical, angry one, that represented Breuer, and a good, sublimated, idealized one, that personified Freud's close friend Wilhelm FlieB.

El psicoanálisis nació a partir del método catártico practicado primero por Breuer y luego por Freud. No se tienen datos para saber porqué Freud demoró tanto tiempo en utilizarlo y también se desconoce porqué lo asoció regularmente a la hipnosis en lugar de aplicarlo como psicoterapia única. Se plantea que su creación estuvo estrechamente vinculada al concepto de catarsis desarrollada por Aristóteles, es decir, la descarga de emociones que los espectadores experimentan cuando acuden a presenciar una tragedia. La amistad y el trabajo conjunto entre Breuer y Freud terminaron en una áspera ruptura, la que retrasó el desarrollo intelectual de Freud. Se postula que el quiebre fue producto de un complejo de Edipo no resuelto de Freud en relación a una figura de padre escindida entre un objeto interno persecutorio, tiránico, rabioso que proyectó en Breuer, y otro bueno, sublimado, idealizado que desplazó en la persona de su amigo íntimo Wilhelm FlieB.

Blood gas analysis, anion gap, and strong ion difference in horses treated with polyethylene glycol balanced solution (PEG 3350) or enteral and parenteral electrolyte solutions / Hemogasometria, anion gap e diferença de íons fortes em equinos tratados com solução balanceada contendo polietilenoglicol (PEG 3350) ou soluções eletrolíticas enteral e parenteral

Large volumes of different electrolytes solutions are commonly used for ingesta hydration in horses with large colon impaction, but little is known about their consequences to blood acid-base balance. To evaluate the effects of PEG 3350 or enteral and parenteral electrolyte solutions on the blood gas analysis, anion gap and strong ion difference, five adult female horses were used in a 5x5 latin square design. The animals were divided in five groups and distributed to each of the following treatments: NaCl (0.9% sodium chloride solution); EES (enteral electrolyte solution), EES+LR (EES plus lactated Ringer's solution); PEG (balanced solution with PEG 3350) and PEG+LR (PEG plus lactated Ringer's solution). Treatments PEG or PEG + LR did not change or promoted minimal changes, while the EES caused a slight decrease in pH, but its association with lactated Ringer's solution induced increase in AG and SID values, as well as caused hypernatremia. In turn, the treatment NaCl generated metabolic acidosis. PEG 3350 did not alter the acid-base balance. Despite it's slight acidifying effect, the enteral electrolyte solution (EES) did not cause clinically relevant changes.

Grandes volumes de diferentes soluções eletrolíticas são comumente usados na hidratação da ingesta em equinos com compactação, mas pouco se sabe sobre suas consequências sobre o equilíbrio ácido base sanguíneo. Para avaliar os efeitos do PEG 3350 e soluções eletrolíticas enterais e parenterais sobre a hemogasometria, anion gap e diferença de íons fortes, foram utilizadas cinco fêmeas adultas em um quadrado latino 5x5. Os animais foram distribuídos em cinco grupos e submetidos a cada um dos seguintes tratamentos: solução NaCl (cloreto de sódio 0,9%); EES (solução eletrolítica enteral); EES + RL (solução eletrolítica enteral mais Ringer lactato); PEG 3350 (solução balanceada com PEG 3350) e PEG + RL (PEG 3350 mais Ringer lactato). Os tratamentos PEG ou PEG + RL não alteraram ou promoveram alterações mínimas, enquanto a EES ocasionou discreta diminuição no pH, mas sua associação com Ringer lactato induziu o aumento nos valores do AG e DIF, além de ocasionar hipernatremia. Por sua vez, o tratamento NaCl resultou em acidose metabólica hiperclorêmica. O PEG 3350 não alterou o equilíbrio ácido base. Apesar do seu discreto efeito acidificante, a solução eletrolítica enteral (EES) não promoveu alteração clínica relevante.

What is the best strategy for successful bowel preparation under special conditions?

Adequate bowel preparation is important for successful colonoscopic examination. Several effective colonic cleansing agents are available and routinely prescribed, but each carries its own limitations and benefits from particular dosing regimens. The most frequently prescribed colonic cleansing agent, the polyethylene glycol (PEG) cathartic solution, suffers from low patient compliance in general, due to its unpalatable taste and smell coupled with the large ingested volumes required. However, PEG is preferred over other cathartics for use in individuals of advanced age, sufferers of chronic kidney disease, heart failure and inflammatory bowel disease, and women who are pregnant or lactating. The laxative agents sodium phosphate (NaP) and sodium picosulfate plus magnesium citrate have been applied and have improved patient compliance and tolerance. NaP, however, should be avoided in individuals with impaired renal function or plasma clearance, such as those with chronic kidney disease, who are taking drugs that affect renal function, or who suffer from heart failure. Other special conditions that may affect an individual's tolerance of the cathartic agent or ability to complete the administration routine include stroke, severe constipation, hematochezia, suspicious lower gastrointestinal bleeding, and mental disorders such as dementia. All ingestible bowel preparation solutions can be instilled into the stomach and duodenum through nasogastric tube or esophagogastroduodenoscope with the aid of a water irrigation pump for patients with difficulties swallowing or ingesting the large volumes of fluid required. In addition, dietary regimens based on clear liquids and low-residue foods for 1-4 d prior to the colonoscopy may be supplemental bowel preparation strategies. Achieving an effective and safe cleansing of the bowel is important for successful colonoscopy in all patients, so full knowledge of the individual's condition and capabilities is necessary to select the most appropriate colonic cleansing agent and delivery regimen.

Sobre o legado de Breuer e Anna O / On the legacy of Breuer and Anna O

Este artigo parte da investigação do laço de trabalho entre Freud e Breuer em torno do caso de Anna O. para se perguntar sobre o legado de Breuer, que situamos em duas modalidades: uma vertente técnica, representada pelos procedimentos do método catártico; outra, dos resultados, caracterizada pelo produto da aplicação dessa técnica. A respeito dos resultados, destacamos o interesse maior de Freud por indicações fragmentadas e laterais que emergem do relato de Breuer do que por sua teorização. Nessa transmissão, equívocos, lacunas e lapsos são de extrema importância. Freud, ao seu turno, não só foi capaz de escutar essas indicações, como também de acolhê-las e elaborá-las a partir de sua práxis.(AU)

This paper investigates the association between Breuer and Freud around the treatment of Anna O. We situate Breuer's legacy in two modalities: a technical modality, represented by the cathartic method's procedures, and a result's modality, characterized by the product of the application of this technique. Regarding the results, we underline a more intensive interest of Freud for fragmented and lateral indications that emerge from Breuer's text rather than for Breuer's theorization itself. In this transmission, mistakes, gaps and lapses are extremely important. Freud, for his part, was not only able to hear these statements, but also to accept them and elaborate them in his practice.(AU)

Sobre o legado de Breuer e Anna O / On the legacy of Breuer and Anna O

Este artigo parte da investigação do laço de trabalho entre Freud e Breuer em torno do caso de Anna O. para se perguntar sobre o legado de Breuer, que situamos em duas modalidades: uma vertente técnica, representada pelos procedimentos do método catártico; outra, dos resultados, caracterizada pelo produto da aplicação dessa técnica. A respeito dos resultados, destacamos o interesse maior de Freud por indicações fragmentadas e laterais que emergem do relato de Breuer do que por sua teorização. Nessa transmissão, equívocos, lacunas e lapsos são de extrema importância. Freud, ao seu turno, não só foi capaz de escutar essas indicações, como também de acolhê-las e elaborá-las a partir de sua práxis.

This paper investigates the association between Breuer and Freud around the treatment of Anna O. We situate Breuer's legacy in two modalities: a technical modality, represented by the cathartic method's procedures, and a result's modality, characterized by the product of the application of this technique. Regarding the results, we underline a more intensive interest of Freud for fragmented and lateral indications that emerge from Breuer's text rather than for Breuer's theorization itself. In this transmission, mistakes, gaps and lapses are extremely important. Freud, for his part, was not only able to hear these statements, but also to accept them and elaborate them in his practice.

Study on SP,VIP expression in the 'cathartic colon' rats / 中国医师杂志

ObjectiveObserving the distribution and the change of the quantity of SP,VIP in the colon tissue of 'cathartic colon'rats.MethodsWe divided the 32 wistar rats weighted (200 ±10)g into 2 groops randomly:the blank group( n =8) and model group( n =8).we induced the 'cathartic colon'rats with the suspension of dahuang.The blank group were given the distilled water for contrast.After one week during the time Dahuang was stopped.We killed them,measured the carbon powder propulsion rates in the intestine and then took Specimen after the 8 rats were fasted 24 hours as well as the blank group,but water were given.We compared the variation of SP,VIP distribution between two groups.ResultsThe carbon powder propulsion rates in the model group were slower than that in the saline control group.The distribution of SP,VIP are all more than that in the blank group.ConclusionThe distribution of SP,VIP are all more than that in the blank group.

A Case of Falling of Taiki from the Upper Aspect of the Body Caused by Taking a Kind of Cathartic Drug / 日本東洋医学雑誌

Taiki is a kind of fundamental vital energy filling the upper aspect of the body, and it can fall because of stress, heavy labor, diarrhea, excessive intake of drugs for regulating the flow of vital energy, or extreme deficiency in vital energy.We report the case of a 39 year old female patient who complained of dyspnea, psychic enervation, and other symptoms of falling taiki from the upper aspect of the body, caused by taking a cathartic drug (mashiningan) for constipation, while being treated for agitation and emotional incontinence. Shokanto improved this state of falling taiki from the upper aspect of the body.

The changes of electrophysiology of the rat with cathartic colon and reaction to acetylcholine / 第三军医大学学报

Objective To explore the etiopathology of slow transit constipation(STC). Methods The model of rat with cathartic colon was established and the changes of colonic electromyography and reaction to acetylcholine(Ach) were examined. Result The frequency, amplitude of slow wave and colon reaction to Ach of rats with cathartic colon decreased markedly. Conclusion Long term abuse of stimulant laxatives could damage enteric nervous system(ENS) and accelerate the pathological changes of STC.