Abstract:
PURPOSE:To review current management of intractable constipation. DATA SOURCES:Original articles and reviews published in the English-language literature between 1965 and 1993 identified by MEDLINE search. Verbal feedback from attendees after presentation of the document as a clinical symposium at the 14th International Symposium on Gastrointestinal Motility in September 1993. STUDY SELECTION:Key words included constipation, epidemiology, colonic inertia, pseudo-obstruction, pelvic floor dysfunction, and results of therapeutic interventions, particularly the effects of biofeedback training and subtotal colectomy. RESULTS:In most patients, constipation is usually due to lack of dietary fiber and responds to simple measures to correct these factors, often without consulting a physician. In some, probably fewer than 10% of patients who consult their physicians, structural diseases of the colon and rectum, systemic disease, or medications that slow gut transit should be excluded, and regular exercise, dietary fiber, and an osmotic laxative prescribed. In a series of 277 highly selected patients from a tertiary referral center who had intractable constipation, only 29% had a definable abnormality; identification of abnormal transit facilitates selection of patients for further investigations identifying colonic inertia or pelvic floor dysfunction. CONCLUSION:An algorithmic approach can carefully select patients with intractable constipation for behavioral modification and biofeedback; the long-term outcome is excellent, with at least 75% success in several series. In a minority of patients with slow transit constipation unresponsive to medical treatment, subtotal colectomy with ileorectostomy is indicated and effective.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Camilleri M,Thompson WG,Fleshman JW,Pemberton JHdoi
10.7326/0003-4819-121-7-199410010-00008subject
Has Abstractpub_date
1994-10-01 00:00:00pages
520-8issue
7eissn
0003-4819issn
1539-3704journal_volume
121pub_type
杂志文章,评审abstract:Background:Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults. Objective:To determine the epidemiology and clinica...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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更新日期:2017-12-05 00:00:00
abstract::Hypophosphatemic osteomalacia that remits after resection of a coexisting tumor has been described in 35 patients. Because the associated neoplasms have been of mesenchymal origin, it has been inferred that this tumor-induced osteomalacia syndrome is uniquely related to tumours of this derivation. However, in the pres...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-2-275
更新日期:1980-08-01 00:00:00
abstract::Neuroblastoma, the second commonest solid tumor in children, is a neoplasm of the peripheral autonomic nervous system that usually occurs before children are 6 years old. Therapy of localized tumor (clinical stage I and II) and of a special form of metastatic tumor (clinical stage IV-S) is usually successful, but trea...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-97-6-873
更新日期:1982-12-01 00:00:00
abstract::Low back pain is common, but a herniated intervertebral disk is the cause in only a small percentage of cases. Most symptomatic disk herniations result in clinical manifestations (pain, reflex loss, muscle weakness) that resolve with conservative therapy, and only 5% to 10% of patients require surgery. Sciatica is usu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-8-598
更新日期:1990-04-15 00:00:00
abstract:BACKGROUND:The fecal immunochemical test (FIT) is a common method for colorectal cancer (CRC) screening, yet its acceptability and performance over several rounds of annual testing are largely unknown. OBJECTIVE:To assess FIT performance characteristics over 4 rounds of annual screening. DESIGN:Retrospective cohort s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
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abstract::In April 1976 the attack rate of chills and fever with or without falls in blood pressure increased in association with cardiac catheterizations. Fevers were associated with coronary angiography and right and left heart catheterizations. Blood cultures were negative, and reactions did not correlate with amounts of con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-93-1-32
更新日期:1980-07-01 00:00:00
abstract:OBJECTIVE:To determine the effect of treating Helicobacter pylori infection on the recurrence of gastric and duodenal ulcer disease. DESIGN:Follow-up of up to 2 years in patients with healed ulcers who had participated in randomized, controlled trials. SETTING:A Veterans Affairs hospital. PARTICIPANTS:A total of 109...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-116-9-705
更新日期:1992-05-01 00:00:00
abstract:DESCRIPTION:New U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for chronic kidney disease (CKD). METHODS:The USPSTF reviewed evidence on screening for CKD, including evidence on screening, accuracy of screening, early treatment, and harms of screening and early treatment. POPULATIO...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/0003-4819-157-8-201210160-00533
更新日期:2012-10-16 00:00:00
abstract:STUDY OBJECTIVE:To determine whether patients with Parkinson disease are at an increased risk for postoperative confusion. DESIGN:Retrospective chart review of patients with Parkinson disease who remained in the hospital at least 48 hours after their surgery. Current data were compared with published historical contro...
journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-111-3-218
更新日期:1989-08-01 00:00:00
abstract::Axial, dual spin-echo magnetic resonance (MR) images, taken at the level of the pulmonary arteries and gated to the cardiac cycle, were qualitatively and quantitatively evaluated in nine patients with primary pulmonary arterial hypertension and six controls. In controls and patients, intravascular signal intensity was...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-103-3-317
更新日期:1985-09-01 00:00:00
abstract::Because of difficulties in antemortem diagnosis of systemic aspergillosis, a radioimmunoassay to an Aspergillus fumigatus carbohydrate was developed and evaluated in patients with mycotic or bacterial infections. Antigenemia was detected in sera obtained antemortem from four of seven patients with systemic aspergillos...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-92-6-793
更新日期:1980-06-01 00:00:00
abstract::In the 5 years since its release for clinical use, acyclovir (9-[2-hydroxyethoxymethyl]guanine) has proved to be a safe and effective agent for therapy of herpes simplex and varicella-zoster infections. The drug's availability in topical, oral, and intravenous preparations has allowed its use in a range of clinical si...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-107-6-859
更新日期:1987-12-01 00:00:00
abstract::Wilson's disease is an inherited disorder of copper accumulation that is fatal if untreated. Because penicillamine, the established treatment, is toxic in a substantial number of patients, we studied the efficacy of zinc treatment. We induced a negative or neutral copper balance in five out of five patients with Wilso...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-3-314
更新日期:1983-09-01 00:00:00
abstract:BACKGROUND:Although viral rebound follows cessation of suppressive antiretroviral therapy in chronic HIV infection, a viremic clinical syndrome has not been described. OBJECTIVE:To describe a retroviral syndrome associated with cessation of effective antiretroviral therapy in chronic HIV infection. DESIGN:Case report...
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更新日期:2000-09-19 00:00:00
abstract:BACKGROUND:National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year. OBJECTIVE:To evaluate the incidence of EOL care discussions for patients with stage IV lung or colorectal cancer and where, when, and with whom these dis...
journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-156-3-201202070-00008
更新日期:2012-02-07 00:00:00
abstract:Background:In 1994, 40% of U.S. gun owners who had recently acquired a firearm did so without a background check. No contemporary estimates exist. Objective:To estimate the proportion of current U.S. gun owners who acquired their most recent firearm without a background check, by time since and manner of acquisition, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M16-1590
更新日期:2017-02-21 00:00:00
abstract:OBJECTIVE:To determine whether a cytogenetic response after interferon-alpha therapy in patients with chronic myelogenous leukemia is independently associated with improved survival. DESIGN:Retrospective analysis. PATIENTS:274 patients with a diagnosis of Philadelphia chromosome-positive chronic myelogenous leukemia ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-122-4-199502150-00003
更新日期:1995-02-15 00:00:00
abstract::A discrete evoking factor or presumed pathophysiologic mechanism is not recognized in the majority of patients with chronic urticaria or angioedema. Two cases are reported in which chronic urticaria was the main manifestation of an immune cutaneous vasculitis associated with hypocomplementemia attributable to classic ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-86-5-534
更新日期:1977-05-01 00:00:00
abstract:BACKGROUND:Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or at increased risk but not in other patient populations. PURPOSE:To update the 2005 and 2007 systematic reviews for the U.S. Preventive Serv...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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更新日期:2014-12-16 00:00:00
abstract:BACKGROUND:Sleep-related accidents often involve healthy young persons who are driving at night. Coffee and napping restore alertness, but no study has compared their effects on real nighttime driving performances. OBJECTIVE:To test the effects of 125 mL of coffee (half a cup) containing 200 mg of caffeine, placebo (d...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-144-11-200606060-00004
更新日期:2006-06-06 00:00:00
abstract::Five patients with chronic renal failure who were undergoing maintenance hemodialysis developed a self-limited bullous dermatosis restricted to light exposed areas, primarily involving the dorsa of the hands. Porphyrin levels and phototesting were normal, but histologic sections of the bullae showed thickening of venu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-83-4-480
更新日期:1975-10-01 00:00:00
abstract::We describe a sporadic, vitamin-D-resistant osteomalacic syndrome in 19 patients undergoing hemodialysis. The syndrome was found in less than 1.5% of patients from referring dialysis centers. All 19 patients had multiple fractures, severe myopathy, and many developed spontaneous hypercalcemia. Severe osteomalacia with...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-5-629
更新日期:1981-05-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the safety of withholding anticoagulant therapy in pregnant patients with clinically suspected deep-vein thrombosis who have negative results by serial impedance plethysmography. DESIGN:Prospective study evaluating prognosis by long-term follow-up to 3 months postpartum in all patients. S...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-112-9-663
更新日期:1990-05-01 00:00:00
abstract:Background:Little is known about whether insurance expansion affects the location and type of emergency department (ED) use. Understanding these changes can inform state-level decisions about the Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). Objective:To investigate the effect of the 2...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/M16-0086
更新日期:2017-02-07 00:00:00
abstract::To describe more explicitly the components of competence required of the internist, The American Board of Internal Medicine has analyzed the medical encounter and defined the major variables involved: the abilities required of the internist, the tasks that must be performed to solve a medical problem, the medical illn...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-3-402
更新日期:1979-03-01 00:00:00
abstract:OBJECTIVE:To determine if polyvalent IgG is promising therapy for severe IgG nephropathy. DESIGN:Open prospective cohort study. SETTING:Referral nephrology unit. PATIENTS:11 adult patients with severe IgA nephropathy (9 who had idiopathic disease and 2 who had Henoch-Schönlein purpura) and indicators of poor prognos...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-120-6-199403150-00005
更新日期:1994-03-15 00:00:00
abstract:Background:High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose:To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/M16-2562
更新日期:2017-05-16 00:00:00
abstract::Opioid dependence is a chronic relapsing medical condition with substantial health and societal complications. Recent federal initiatives are designed to enhance the medical treatment of patients with opioid dependence and will expand the role of internists in the care of these patients. These initiatives include a pr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-137-8-200210150-00014
更新日期:2002-10-15 00:00:00
abstract:PURPOSE:To integrate information from the various disciplines that contribute to the understanding of the cause and prevention of sudden cardiac death: identification of new approaches from applied clinical epidemiology; identification and control of transient risk factors; and evaluation of the results of intervention...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-119-12-199312150-00006
更新日期:1993-12-15 00:00:00
abstract::Studies of circulating T- and B-lymphocyte rosettes were done in 20 healthy controls and 29 patients with pulmonary tuberculosis, including 18 receiving rifampin chemotherapy. Eight of the 18 patients in the rifampin group (44%) had significant suppression of their T-cell rosettes as compared with patients with tuberc...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-82-4-484
更新日期:1975-04-01 00:00:00