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STIMULANT LAXATIVES Studies of stimulant laxatives have shown that they produce physiologic effects in patients with constipation and in controls. In a study of 18 patients with slow-transit constipation, bisacodyl elicited pelvic colon peristaltic waves in 11 patients.21 In another study, bisacodyl produced more rapid and frequent high-amplitude propagating contractions in patients with slow-transit constipation and controls, with the effect more pronounced in controls.22 A study evaluating the effects of senna in 24 volunteers found that senna plus fiber was superior to fiber alone in stimulating colonic transit.23 The study also found that senna reversed constipation induced by loperamide Imodium; McNeil Consumer Healthcare, Fort Washington, Pa ; . Other studies assessing the effects of stimulant laxatives on constipation symptoms found that senna produced additive effects. In a study of 42 nursing home patients, senna plus dicotylsodium sulfosuccinate with fiber and fluid produced satisfactory defecation in 86%.24 In another study, psyllium husk plus senna increased stool water and produced an adequate laxative effect in 63% of patients with constipation compared to 48% for psyllium husk alone.25 OVER-THE-COUNTER VERSUS PRESCRIPTION LAXATIVES The prescription laxatives lactulose and PEG are addressed in detail elsewhere in this monograph, but are briefly mentioned in this section because they have been compared to OTC agents or with each other in various studies. Results from some studies comparing lactulose with various fiber supplements or bulking agents have suggested that fiber and other agents produced more satisfactory responses than lactulose.26-28 One study found that lactulose was superior to ispaghula, 29 whereas another found no difference between lactulose and sorbitol in preference and symptomatic relief, leading the investigators to recommend sorbitol because of its lower cost.30 An early study essentially placebo-controlled because it compared lactulose to glucose, which has no independent laxative effect ; found that lactulose was very effective in increasing stool frequency and decreasing constipation-associated symptoms.31 Results from several studies evaluating PEG have been favorable. A physiologic study showed that it increased stool frequency without any adverse effects.
Received for publication February 12, 1997. 1 This work was supported in part by National Institutes of Health Grants T32-HL07609, NCRR GCRC M01-RR026376 and P01-AC00059916. 2 Present address: University of Manitoba, Health Sciences Centre Department of Internal Medicine, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada. 3 Present address: Lilly Research Laboratories, Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285.

TAKE MEDICINE, BUT ONLY IF YOU NEED IT Since some drugs used to control cancer pain can also cause constipation, some cancer patients use over-the-counter laxatives and stool softeners. But these medications can cause diarrhea, so reduce or avoid their use if possible. It's a bit of a balancing act, and if you're having a problem, talk to your doctor. You should also discuss with him or her any herbal treatments you are using. Some herbs, such as milk thistle, saw palmetto, or Siberian ginseng, can contribute to diarrhea. Over-the-counter medicines You're probably familiar with over-the-counter brands of anti-diarrhea liquids and tablets, such as Kaopectate kaolin and pectin ; , Pepto-Bismol bismuth subsalicylate ; , and Imoium AD or Maalox Antidiarrheal Caplets loperamide ; . These drugs should be used carefully, and always with your doctor's knowledge and supervision. Even though you can buy these drugs without a prescription, they and loperamide.

Documentation so that health authorities can be notified. Conse- quently, notification on some aliens arriving with TB is missed, with resultant breaks in continuity of care and possible development of drug-resistant disease. Objective: Improve the process of notifying state and local health depart- ments about aliens arriving with TB. Responsible Start Implementation steps organization date -1. Identify the top 10 immigrant- CDC 1992 processing POEs not currently staffed by CDC. 2. Assign part-time staff to the top 10 CDC 1993 POEs to coordinate TB medical docu- mentation and notification. SCREENING AND PREVENTIVE THERAPY Identify persons who are infected with or at risk of developing MDR-TB and prevent them from developing clinically active TB. In addition to treating patients with active TB, patients who are infected with the TB organism but are not yet sick must be treated. Because many persons remain in this latent stage for years and then develop active disease, treatment of such persons will prevent many future cases of TB. In the treatment of active TB, noncompliance with therapy leads to the development of drug-resistant disease; however, this problem can be reduced by preventing active disease from developing. In addition, the development of active disease among persons infected with MDR-TB can be reduced if a standard approach to the evaluation and management of persons exposed to MDR-TB can be developed. Problem 19 A standard approach to the evaluation and management of persons exposed to MDR-TB is lacking. Objective: Develop and publish an approach to the evaluation and management of persons exposed to MDR-TB. Responsible Start Implementation steps organization date -1. Develop and disseminate guidelines CDC 1992 for evaluating and managing persons exposed to MDR-TB. Problem 20 Many persons in populations at high risk for TB may also be at risk for noncompliance with therapy if active TB develops; as a result, drug-resistant TB may develop. Objective. Attended meeting with Jt. Secretary, Health and indomethacin, for instance, imodium prescription. Author Affiliations: Department of Pediatrics, Sections of Cardiology Drs Das, Wolfe, Chan, and Ivy ; and Pulmonary Medicine Dr Larsen ; , The Children's Hospital, and Section of Critical Care Dr Reeves University of Colorado Health Science Center, Denver. Deceased. House of Commons 2005 ; "The influence of the pharmaceutical industry report by Health Committee" London: The Stationary Office Limited. Irish Medicines Board Lazarou, J. et al Martinez, C. et al 2002 ; "Annual Report and ismo. Corixa bought Coulter for $900 million for cancer drug Bexxar. "Corixa's market value dropped from several billion to a couple hundred million, on a delay in Bexxar's approval. Saba et potential increased imodium spread the principles and monoket. Treatment of diarrhoea with imodium is only symptomatic.
Our Corporate Boycott Target for this month is: Johnson & Johnson Operations: pharmaceuticals, dental care, baby care, feminine products, sunburn prevention, Sesame Street vitamins, Tylenol products, Purpose, Persagel, Affinity, Motrin, Simply Cough, Neutrogena, Simply Stuffy, Evian Nizoral, Nizorelle, Aveeno, Acuvue, Surevue Sine-Aid, Nu-Gel, Medipren, Pepcid AC, Imodihm A-D, Benecol, Splenda, Lactaid, Clean & Clear, Serenity, Band-Aid products, Mylanta, Mylicon, OneTouch, Direct Access Diagnostics, RoC S.A., Advanced Care Products, Ethicon, Endo-Surgery, Janssen Pharmaceuticals, Cilag, Centocor, Cordis, DePuy, Janssen-Cilag, ALZA, Noramco, LifeScan, McNeil Specialty Products, McNeil Consumer Products, Ortho-Clinical Diagnostics, Ortho Biotech, Independence Technology, Ortho Dermatological, Indigo Medical, Penaten, Ortho-McNeil Pharmaceuticals, McNeil Nutritionals, Therakos, Vistakon, & R.W. Johnson Pharmaceutical Research Institute. Contact: Mr. William C, Weldon, chairman & CEO, Johnson & Johnson Inc., 1 Johnson & Johnson Plaza, New Brunswick, NJ 08933-0001; 732 ; 524-0400, or jnj Our charitable organization boycott target is: the Cystic Fibrosis Foundation. The CF Foundation does not have policy positions on stem cells or related issues, as they "believe these personal issues are best left to individuals in consultation with their religious and medical advisors". They comply with "federal research regulations" they will conduct any legal research ; Contact: The CF National Office: 6931 Arlington Road, Bethesda, Maryland 20814 - PHONE 301-951-4422 or 800-FIGHT CF 800-344-4823; FAX 301951-6378 Internet address: cff ; E-mail: info cff and imdur. Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT David Wonderling lecturer in health economics Richard Grieve lecturer in health economics Integrative Medicine Service, Biostatistics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA Andrew J Vickers assistant attending research methodologist Department of Psychological Medicine, Imperial College London, London W2 1PD Rob McCarney research officer Correspondence to: D Wonderling David.Wonderling lshtm.ac, for example, imodum dogs.

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Showed up. I suggested that he might be immune or sensitive to the Septra he was still on. A test indicated that Nicholas might be having an allergic reaction to Septra, but the physician was skeptical. They finally decided to take him off the Septra. When the Septra was discontinued, the fevers stopped almost immediately. Before we left San Antonio in May, 1991, the physicians ordered the gamma interferon and taught us how to give the shots. This trip was supposed to last one week. So, needless to say, we were flat broke and ready to go home. In September, 1991, we moved to San Antonio, Texas. The military physicians felt we were better off near a major medical facility which was lacking where we were located in Missouri. Since moving to San Antonio, Nicholas has had an ear infection and a slight bout with pneumonia in January, 1992. We caught it very early and he was only on intravenous medications for four days and oral medications for three weeks. Everything was going great until May 1, 1992 when I noticed a swelling in Nicholas' left groin area. We took him to the physicians immediately. He was admitted to the hospital and started on intravenous antibiotics. Within four days there was a reduction in the size of the lymph gland. At that point, they sent us home with two oral antibiotics. The next Monday, we returned. The swelling had increased. Even though a needle biopsy was done and the resulting culture was negative, the physician felt it was a Staphylococcus infection based upon a scrape on his leg. They didn't feel surgery was necessary to obtain a conclusive diagnosis. They treated him with two different intravenous antibiotics. Everything went well and we went home on May 22, 1992. We are giving him intravenous medications at home with the help of a home health service. While we did all the traveling, our other son, Stephen, stayed with my parents in Wisconsin. Stephen was born June 3, 1986 and does not have CGD. Along with us, he is learning to live with his brother's illness. At this time, I don't think any of us fully understand how sick his brother could get. We have problems with friends and family not fully understanding our feelings. All our immediate family lives in Wisconsin. We have had to make new friends here in Texas and the people we have met are terrific. Nicholas' physicians have been wonderful also. I just sorry his physicians will be leaving soon, so we will have replacements. Since this last hospitalization, the physicians are now fighting over who will follow him. They like him so much. We did find a parents support group here. Although it isn't specifically for CGD, anyone who has a "special" child can belong. It is called "Any Baby Can.

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