Colic

Objective: Use of analgesic drugs in acute renal colic varies widely in dierent countries. In order to assess the prescribing patterns in acute renal colic in French emergency departments (EDs), the present study compared intentions of prescription, real prescription and evidence-based data in a sample of emergency practitioners. Methods: A sample of 51 emergency practitioners (27 medical doctors and 24 residents) randomly selected in nine EDs in the southwest of France participated in this observational study. In a ®rst step (January 2000), participants were asked about a simulated case of acute renal colic. In a second step, real prescriptions for the same indication were retrospectively identi®ed and collected among hospital medical databases during a period of 6 months (July±December 1999). Results: In simulated cases, non-steroidal anti-in¯ammatory drugs (NSAIDs) were prescribed in 100% of cases, in addition to propacetamol (70%), antispasmodic drugs (53%) and opiate analgesics (100%). Daily dose of these drugs was underestimated in approximately 30% of cases. In real prescription, there was no signi®cant difference in the use of NSAIDs, propacetamol and antispasmodic drugs. However, daily doses were more frequently underestimated, and opiate analgesics were less prescribed. Several points could explain these discrepancies: lack of knowledge about pharmacological properties, inadequate daily review of drug intake, un-derutilisation of opiates and insucient clinical evaluation of pain in several centres. Conclusion: These results show a clear dierence between intention to treat and real prescriptions for patients suffering from acute renal colic.

MEN-1 patients and in 77% of those who were symptomatic. In 68% of patients complications of urolithiasis (renal/ureteric colic, urinary tract infection) were the presenting clinical manifestations of MEN-1, whereas in 50% they constituted the only clinical manifestation of the syndrome. The mean time from the onset of symptoms of urolithiasis to the diagnosis of the polyendocrinopathy was 17.2 years. Initial failure to recognize the presence of MEN-1 in patients with primary hyperparathyroidism led to conservative parathyroid surgery, with subsequent relapse of the hyperparathyroidism, requiring re-operation. Serious renal morbidity included one case of pyonephrosis necessitating nephrectomy. While urolithiasis was a cardinal clinical manifestation of MEN-1, there was otherwise considerable phenotypic polymorphism, even among patients bearing the same MEN1 gene mutation. CONCLUSION In patients with familial MEN-1 the complications of urolithiasis are the commonest presenting clinical manifestations and the cause of significant morbidity. In the presence of a family history of renal stones, appropriate investigations may lead to the timely diagnosis of this important, albeit rare, disorder. KEYWORDS urolithiasis, multiple endocrine neoplasia type 1, hyperparathyroidism, hypercalcaemia, pyonephrosis OBJECTIVE To study the urological manifestations of familial multiple endocrine neoplasia type 1 (MEN-1). PATIENTS AND METHODS The study included 26 adults (median age 38.5 years, range 18-80) from two unrelated MEN-1 pedigrees. In 15 of the patients the diagnosis was confirmed by genetic analysis, while in the rest the diagnosis was based on clinical criteria combined with genealogy data. RESULTS Urolithiasis associated with primary hyperparathyroidism was present in 65% of

Multiple logistic regression was used to investigate prognosis in 308 horses referred to the University of Minnesota veterinary teaching hospital with colic. Bivariate results identified the following significant individual parameters: absent or hypomotile abdominal sounds, medical or surgical classification, peritoneal fluid total protein, anion gap, serum glucose, capillary refill time, blood pH, heart rate, packed cell volume, base excess, serum chloride, plasma bicarbonate, serum urinary nitrogen and age. Two multivariable

We studied the role of duplex Doppler ultrasonography in the diagnosis of renal obstruction caused by ureteral calculi. Using duplex Doppler sonography, we evaluated the intrarenal hemodynamics of 27 patients who presented to the emergency department with renal colic. We performed Doppler ultrasonography on patients in whom US did not reveal any pathology causing renal colic and calculated and compared mean RI values of normal and obstructed kidneys and ΔRI values of each group. Threshold levels for the diagnosis of urinary tract obstruction (mean RI ≥ 0.70 and ΔRI ≥ 0.08) were used to determine the sensitivity and specificity of Doppler sonography for the diagnosis of urinary tract obstruction. Patients were investigated for revealing calculi diagnosis either by stone excretion history, intravenous pyelography or non contrast enhanced urinary computed tomography. A total of 162 intrarenal arterial Doppler recordings were made on 54 kidneys. Of the 16 patients with urinary obstruction, 11 (68%) had sonographic evidence of pelvicalyceal dilatation. The mean RI of the 16 obstructed and 11 unobstructed kidneys was 0.69 ± 0.04 and 0.61 ± 0.06 (mean ± standard deviation), respectively. The difference between the mean RI values for each group was statistically significant (P P P 

Background: Colic, regurgitation and constipation are common feeding problems in formula-fed infants that might benefit from dietary treatment. A formula containing fructo-and galactooligosaccharides, partially hydrolysed proteins, low levels of lactose and palmitic acid in the b position and higher density has been tested to reduce the occurrence of these symptoms. The aim of this prospective study was to describe the effects of such a formula in infants with minor gastrointestinal disorders. Methods: An observational prospective trial involving practising Italian paediatricians was performed. Formula fed-infants up to 90 d of age with minor gastrointestinal problems such as infantile colics and/or regurgitation and/or constipation were enrolled in the study from January 2001 to May 2001. The study was completed within 14 d of treatment. On days 1, 7 and 14 the infants were visited by the paediatricians. Parents were given a structured diary to record daily episodes of colic, regurgitation and type and number of stools. Results: Of the 932 infants enrolled, 604 completed the study. Of the 214 infants with colic, 169 (79%) demonstrated a reduction in frequency of colic from 4.1 AE 2.0 per day at the beginning of the study to 2.0 AE 1.8 at the end of the study (I.C. 95%: 1.72-2.39; p < 0.005). A reduction in the number of episodes of colic of 1.8 per day at the beginning of the study (I.C. 95%: 1.49-2.11; p < 0.05) was recorded between day 1 and day 7, and of 0.26 (I.C. 95%: 0.15-0.37; p < 0.05) between day 7 and day 14. Of the 201 infants with regurgitation problems, 141 (70%) demonstrated a reduction of frequency of the symptoms from 4.2 AE 2.0 per day at the beginningof the study to 2.1 AE 2.2 at the end of the study (I.C. 95%: 1.75-2.35; p < 0.005). A reduction of 1.87 in the number of regurgitation episodes was reported between day 1 and day 7 (I.C. 95%: 1.57-2.16; p < 0.05) and of 0.18 (I.C. 95%: 0.06-0.31; p < 0.05) between day 7 and day 14. Of the 232 infants with constipation, 147 (63%) demonstrated an increase in the daily number of stools of 0.42 (I.C. 95%: 0.5-0.3; p < 0.005). An increase in stool frequency of 0.41 (I.C. 95%: 0.51-0.23; p < 0.05) was reported between day 1 and day 7, and of 0.04 (I.C. 95%: 0.22-0.14; p = ns) between day 7 and day 14. Parents' evaluation of the formula was 7.9 AE 1.8 (score 0-10); 550 parents (91%) gave a positive judgement (score >6). The evaluation by the paediatricians of the improvement in symptoms after the treatment was 8.2 AE 1.5; 574 (95%) a positive effect (score >6).

Los lactantes sanos, durante el primer año de vida, suelen presentar varios síntomas funcionales gastrointestinales, como cólicos, regurgitaciones y constipación. El llanto, tan habitual en esta etapa de la vida, puede interpretarse como dolor o malestar de origen digestivo, y la preocupación por esto genera conductas inapropiadas, como sobrealimentación, interrupción de la lactancia, múltiples cambios de fórmulas, innumerables consultas y medicaciones innecesarias. El objetivo de este trabajo es actualizar los conocimientos sobre la fisiopatología de los trastornos funcionales digestivos más frecuentes con el fin de evitar sobrediagnósticos y seleccionar el enfoque terapéutico y las intervenciones nutricionales más apropiadas.

Colic in infants is a common but short-lived problem. Many different theories and treatments for this distressing ailment have been tried over the years, yet the definitive cure remains elusive. Although the risks associated with the use of atropine and its derivatives are well known, they are still prescribed by some in the management of colic. We report a case of serious side effects from the treatment of colic with an atropine containing mixture, in which an error in preparation was identified. In view of the potential for serious toxicity resulting from either inappropriate prescription, preparation or administration, alternative methods of treatment should be employed.

Transient lactose intolerance has been identi®ed as a possible causative factor in infant colic. A double-blind randomised placebocontrolled crossover study to investigate this has been undertaken in 53 babies with symptoms of colic. Pre-incubation of the feed with lactase resulted in breath hydrogen levels and total crying time which were both at least 45% lower than ®gures with placebo treatment, in 26% of the full trial group (95% con®dence interval 12.9% to 44.4%), and in 38% of compliers (95% con®dence interval 18.8% to 59.4%). The remainder did not respond to the same extent. These ®ndings suggest that infant colic may have a multiple aetiology, and that in a signi®cant number of cases the immediate cause is transient lactose intolerance, in which cases pretreatment of feeds with lactase can result in considerable symptomatic bene®ts.

BACKGROUND: Complementary and alternative medicines often are advocated for infantile colic, yet there has been no synthesis of the evidence to inform current practice about their use. OBJECTIVE: To critically evaluate all randomized clinical trials of nutritional supplements and other complementary and alternative medicines as a treatment for infantile colic. METHODS: Five electronic databases were searched from their inception to February 2010 to identify all relevant randomized clinical trials of complementary and alternative medicines and supplements for infantile colic. Reference lists of retrieved articles were hand searched. Data were extracted by two independent reviewers, and methodological quality was assessed using the Jadad score and key aspects of the Cochrane risk of bias. RESULTS: Fifteen randomized clinical trials met the inclusion criteria and were included. Thirteen studies were placebo controlled. Eight were of good methodological quality. Eleven trials indicated ...

Acute flank pain is a common and complex clinical problem. In addition to flank pain caused by ureterolithiasis, other urinary and extraurinary abnormalities can result in a similar clinical picture. Unenhanced CT can rapidly, accurately, and safely determine the presence or absence of ureteral obstruction. When obstruction is caused by ureterolithiasis, CT allows precise determination of stone size and location. These are the two most important factors used for patient management. In addition to direct stone visualization, there are many secondary CT signs of ureteral obstruction that are direct manifestations of the underlying pathophysiology. On the other hand, when obstruction is absent, CT can diagnose or exclude most other abnormalities that result in flank pain. As a result of its many advantages, unenhanced helical CT should become the dominant imaging modality for evaluation of all patients with acute flank pain in whom a clinical diagnosis is uncertain.

OBJECTIVE. To report the prevalence and stability of cry-fuss problems during the first 4 months of life and sleep problems from 2 to 24 months and relationships between the persistence of cry-fuss and sleep problems and outcomes at 24 months.

Curtailing the time for which a baby feeds at the first breast, in order to encourage intake from the second breast, may maximise milk production by the mother. With escalation of this situation a point may be reached at which the infant, because of the constraint of his stomach capacity, is unable to consume sufficient calories at a feed, since foremilk is lower in calories than hindmilk. The result will be symptoms of hunger (crying, fretfulness) and maybe even failure to thrive. The low fat content of the diet may cause rapid gastric emptying. This in turn may lead to lactose reaching the small bowel in concentrations that may tax the infant's lactase potential, with resulting diarrhoea. A simple change in breastfeeding patterns may alleviate some instances of undernutrition or diarrhoea.

(EFE) is one of the more common causes of colic in horses, but recent reports suggest a poor prognosis after surgical treatment. Hypothesis: That EFE has a good prognosis compared with other small intestinal strangulating lesions. Methods: Surgical findings, surgical procedures and shortterm outcome were recorded for 157 horses that underwent surgery for strangulating lesions of the small intestine at the University of Illinois from 1994 to 2003. Horses were assigned to 3 groups for comparison; those with EFE, strangulation by lipoma and miscellaneous strangulating lesions. A logistic regression model and Monte Carlo tests of the binomial proportions were used to examine survival rates. The Kruskal-Wallis test was used to determine differences in usage of surgical treatments. Measurements of length and viability indices were analysed using a one-way analysis of variance followed by Tukey's HSD test, and viability scores were analysed using an exact Kruskal-Wallis test. Significance was set at P<0.05. Results: Horses with EFE were significantly more likely to be discharged (95%) than those with the other conditions (P<0.05). The proportion of horses with ileal involvement was greater in horses with EFE than in the other 2 groups (P<0.05), although this did not affect outcome. The distributions of viability grades for EFE and lipoma differed significantly (P<0.05).

Objective: The purpose of this study was to determine the efficacy of chiropractic manual therapy for infants with unexplained crying behavior and if there was any effect of parental reporting bias. Methods: Infants with unexplained persistent crying (infant colic) were recruited between October 2007 and November 2009 at a chiropractic teaching clinic in the United Kingdom. Infants younger than 8 weeks were randomized to 1 of 3 groups: (i) infant treated, parent aware; (ii) infant treated, parent unaware; and (iii) infant not treated, parent unaware. The primary outcome was a daily crying diary completed by parents over a period of 10 days. Treatments were pragmatic, individualized to examination findings, and consisted of chiropractic manual therapy of the spine. Analysis of covariance was used to investigate differences between groups. Results: One hundred four patients were randomized. In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 1.4-45.0) and at day 10 (adjusted OR, 11.8; 95% CI, 2.1-68.3). The number needed to treat was 3. In contrast, the odds of improvement in treated infants were not significantly different in blinded compared with nonblinded parents (adjusted ORs, 0.7 [95% CI, 0.2-2.0] and 0.5 [95% CI, 0.1-1.6] at days 8 and 10, respectively). Conclusions: In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent. (J Manipulative Physiol Ther 2012;35:600-607)

articles and guidelines. 6,19-22 In contrast, more recent theories de-emphasize these anatomic mechanisms, and instead posit inflammation, microbiome shifts, visceral hypersensitivity, and abnormal motility as potential etiologic factors, especially for chronic diverticular disease.

We evaluated the effect of an herbal tea preparation on Infantile colic in a prospective double-blind study. The use of tea eliminated the colic in 49 (57%) of 33 infants, whereas placebo was helpful in only 9 (26%) of 35 (p < 0.04). The mean colic score was significantly improved in tea-treated infants. No significant differences were noted between groups regarding number of night wakings. (J PEDIAI'R 1993;122:650"2)

Food intolerance is an adverse reaction to a particular food or ingredient that may or may not be related to the immune system. A deficiency in digestive enzymes can also cause some types of food intolerances like lactose and gluten intolerance. Food intolerances may cause unpleasant symptoms, including nausea, bloating, abdominal pain, and diarrhea, which usually begin about half an hour after eating or drinking the food in question, but sometimes symptoms may delayed up to 48 h. There is also a strong genetic pattern to food intolerances. Intolerance reactions to food chemicals are mostly dose-related, but also some people are more sensitive than others. Diagnosis can include elimination and challenge testing. Food intolerance can be managed simply by avoiding the particular food from entering the diet. Babies or younger children with lactose intolerance can be given soy milk or hypoallergenic milk formula instead of cow's milk. Adults may be able to tolerate small amounts of troublesome foods, so may need to experiment. Eosinophilic esophagitis (EE) is defined as isolated eosinophilic infiltration in patients with reflux-like symptoms and normal pH studies and whose symptoms are refractory to acid-inhibition therapy. Food allergy, abnormal immunologic response, and autoimmune mechanisms are suggested as possible etiological factors for EE. This article is intended to review the current literature and to present a practical approach for managing food intolerances and EE in childhood.

Colic is the most common emergency in equine practice with approximately 4 out of every 100 horses having an episode of colic each year. 1 Of the horses that are evaluated by a veterinarian in private practice, approximately 7% to 10% have a lesion that requires surgical correction. 2 Although this may be obvious with severe, acute strangulating obstructions, most colic cases are not quite as black and white. Early identification and referral of horses with a surgical lesion is critical to obtain a successful outcome. Early referral allows general anesthesia and surgery to occur while the horse is systemically stable and intestinal damage is mild, and this decreases postoperative morbidity and mortality and reduces client cost. Many owners would consider taking their horse to a referral hospital for evaluation of colic, and with the excellent success in treatment of geriatric horses with colic, 3 age should not be considered a negative factor in the decision to refer.

Zusammenfassung: Ziel der vorliegenden Arbeit ist die Analyse von Fohlen, die in der Chirurgischen Tierklinik Leipzig aufgrund intestinaler sowie extraintestinaler Krankheiten laparotomiert wurden. Hierzu wurden die Krankenakten aller Fohlen bis zu einem Alter von einem Jahr, die von 2001 bis 2011 in der Chirurgischen Tierklinik Leipzig laparotomiert wurden, geprüft. Neben intestinalen Erkrankungen wurden auch die Operationsindikationen Uroperitoneum und Nabelerkrankungen berücksichtigt. Ausgewertet wurden das Signalement, die Jahreszeit bei Klinikeinweisung, die Diagnose, die chirurgische Therapie, die Operationskomplikationen sowie das Ergebnis der chirurgischen Therapie. Von den 98 laparotomierten Fohlen waren über zwei Drittel Hengste. Warmblüter waren mit 70,4 % am häufigsten vertreten. Bei 59,2 % der Fohlen handelte es sich um Neonaten. 32,7 % der Patienten waren Saugfohlen. Dagegen bildeten Absetzer mit nur 8,2 % die kleinste Frak-tion. Zu den häufigsten Diagnosen gehörten Mekoniumobstipationen mit 20,4 %, Nabelerkrankungen mit 19,4 % und Dünndarmverschlüsse mit 17,3 %. Die chirurgische Therapie wurde in 37,8 % der Fälle als wenig invasiver und in 44,9 % der Fälle als invasiver Eingriff klassifiziert. 17,3 % der Fohlen verstarben während der Operation oder mussten aufgrund einer schlechten bzw. infausten Prognose eingeschläfert wer-den. Bei 28 Fohlen traten postoperativ Komplikationen auf. 9 Fohlen mussten relaparotomiert werden. Nach dem chirurgischen Eingriff konn-ten 70 Fohlen aus der Klinik entlassen werden. Die Überlebensrate beträgt bezogen auf die Gesamtzahl der laparotomierten Fohlen 71,4% und auf die 81 Fohlen mit abgeschlossener Laparotomie 86,4 %. Die höchsten Überlebensraten wurden bei Konglobaten sowie bei Meko-niumobstipationen erzielt. Die schlechtesten Überlebensraten zeigten Dünndarmverschlüsse und Missbildungen. Schlüsselwörter: Pferd / Fohlen / Kolik / Abdominalchirurgie / Laparotomie / Gastroenterologie Laparotomy in the foal – evaluation of 98 cases (2001– 2011) Aim of the study is the analysis of cases of laparotomy in foals with an anamnesis of intestinal or extraintestinal disease at the Large Animal Clinic for Surgery, University of Leipzig. Clinical files of the years 2001 until 2011 were screened for cases of foals up to one year of age, which had undergone laparotomy for intestinal disease, uroperitoneum or umbilical disease. Parameters for evaluation were signalement, season of admission, diagnosis, surgical therapy, surgical complications and success of surgical therapy. 98 foals had undergone laparotomy, of which over two thirds were colts. The predominant breed were Warmbloods (70,4 %), while the predominant age was the neonate foal (59,2 %). Suckling foals represented 32,7 % of the patients, whereas weanling foals were the smallest fraction (8,2 %). Predominant diagnoses were meconium impaction (20,4 %), umbilical disease (19,4 %) and ileus of the small intestine (17,3 %). Surgical interventions were classified little invasive in 37,8 % of the cases and invasive in 44,9 %. Intra-operative death or euthanasia supra tabulam due to bad prognosis was recorded in 17,3 % of the cases. Post-operative complications occurred in 28 foals. Re-laparotomy had to be performed in 9 foals. Of the 98 foals which underwent laparotomy, 70 could be discharged from the hospital. Survival rates were 71,4 % on the basis of all cases and 86,4 % on the basis of a completed laparotomy. Highest survival rates were recorded when conglobate or meconium impaction caused the indication for surgery, while small intestinal ileus and congenital malformation were the diagnoses yielding the worst outcome.

The Rome II pediatric criteria for functional gastrointestinal disorders (FGIDs) were defined in 1999 to be used as diagnostic tools and to advance empirical research. In this document, the Rome III Committee aimed to update and revise the pediatric criteria. The decisionmaking process to define Rome III criteria for children aged 4 -18 years consisted of arriving at a consensus based on clinical experience and review of the literature. Whenever possible, changes in the criteria were evidence based. Otherwise, clinical experience was used when deemed necessary. Few publications addressing Rome II criteria were available to guide the committee. The clinical entities addressed include (1) cyclic vomiting syndrome, rumination, and aerophagia; 2) abdominal pain-related FGIDs including functional dyspepsia, irritable bowel syndrome, abdominal migraine, and functional abdominal pain; and (3) functional constipation and non-retentive fecal incontinence. Adolescent rumination and functional constipation are newly defined for this age group, and the previously designated functional fecal retention is now included in functional constipation. Other notable changes from Rome II to Rome III criteria include the decrease from 3 to 2 months in required symptom duration for noncyclic disorders and the modification of the criteria for functional abdominal pain. The Rome III child and adolescent criteria represent an evolution from Rome II and should prove useful for both clinicians and researchers dealing with childhood FGIDs. The future availability of additional evidence-based data will likely continue to modify pediatric criteria for FGIDs.

Palliative medical treatment Surgery Stents Nasogastric suction Symptom control A B S T R A C T Malignant bowel obstruction (MBO) is a common and distressing outcome particularly in patients with bowel or gynaecological cancer. Radiological imaging, particularly with CT, is critical in determining the cause of obstruction and possible therapeutic interventions. Although surgery should be the primary treatment for selected patients with MBO, it should not be undertaken routinely in patients known to have poor prognostic criteria for surgical intervention such as intra-abdominal carcinomatosis, poor performance status and massive ascites. A number of treatment options are now available for patients unfit for surgery. Nasogastric drainage should generally only be a temporary measure. Self-expanding metallic stents are an option in malignant obstruction of the gastric outlet, proximal small bowel and colon. Medical measures such as analgesics according to the W.H.O. guidelines provide adequate pain relief. Vomiting may be controlled using anti-secretory drugs or/and anti-emetics. Somatostatin analogues (e.g. octreotide) reduce gastrointestinal secretions very rapidly and have a particularly important role in patients with high obstruction if hyoscine butylbromide fails.

To describe the behavioral and physiological responses associated with colic, the responses of 20 two-monthold infants with and 20 without colic were studied during a physical examination. Parents kept a diary of infant behaviors (including crying and fussing) for 3 days following the visit. Using Wessel, Cobb, Jackson, Harris, & Detwiler criteria, colic was defined as fussing/crying for 3 hr or more on each of the 3 days. Behavioral data coded by "blind" observers showed that during the physical exam, colic infants cried twice as much, cried more intensely, and were more inconsolable than were control infants. Despite these behavioral differences, heart rate, vagal tone, and cortisol measures indicated no appreciable difference in physiological responsivity for the two groups. At home, parents collected saliva cortisol samples at wakeup, midmorning, midafternoon, and evening for 2 days. In a finding similar to that shown by the laboratory data, the colic and control infants did not have different levels of daily average cortisol. These laboratory and home data provide no evidence of greater responsivity in the physiological substrate of difficult temperament for colic infants and are consistent with evidence of similarity in temperament once colic is resolved. At home, compared with control infants, colic infants did display a blunted rhythm in cortisol production. By diary, they also slept about 2 hr less per day than did control infants. Nighttime sleep was still significantly different when fussing/crying was statistically controlled. These data suggest that colic might be associated with a disruption or delay in the establishment of the circadian rhythm in activity of the hypothalamic-pituitary-adrenocortical axis and associated sleep-wake activity.

Daria is a 15-year-old girl who has a 2-year history of migraine headaches. Her headaches occur on most days, particularly if she has had insufficient sleep, excessive stress, or exposure to tobacco smoke. She has been evaluated by a neurologist, dentist, and ophthalmologist. All of her physical examinations, computed tomography scan of the head, magnetic resonance imagining, and blood tests have yielded normal results. She has tried multiple medications, including acetaminophen, ibuprofen (which she tries to limit to once or twice weekly), triptans, imipramine, propranolol, and a short course of prednisone. She missed 20 days of school in the past 3 months, and her parents are in the midst of a separation (her father moved about 10 months ago). Her mother has read about natural remedies, including feverfew, riboflavin, and magnesium, and wants to know if they might help.

AIMS: To retrospectively evaluate the medical and surgical records of horses with acute small intestinal obstructions associated with Parascaris equorum infection; to describe the gastrointestinal lesions; and to determine the outcome of cases with such lesions.

Objective: To determine the presence of intestinal coliform bacteria in colicky vs healthy infants. Study design: We isolated coliform strains from faeces and performed quantitative bacterial cultures in 41 colicky and 39 healthy breastfed infants, identified using PCR with species-specific primers, strain-specific Automated Ribotyping and the API-50E kit for Enterobacteriaceae to identify the most frequent strains. Results: Coliform strains were more abundant in colicky infants (median 6.04 log 10 CFU ⁄ g faeces, range 2.00-8.76) vs controls (median 4.47 log 10 CFU ⁄ g faeces, range 1.00-8.08) (p = 0.026).

Background: Many colic horses are compromised due to the disease state and from hours of starvation and sometimes long trailer rides. This could influence their muscle energy reserves and affect the horses' ability to recover. The principal aim was to follow metabolic parameter before, during, and up to 7 days after anaesthesia in healthy horses and in horses undergoing abdominal surgery due to colic.

Are babies divine, or do they have the devil in them? Should parents talk to their infants, or is it a waste of time? This book provides answers to these and many other questions about the nature and nurturing of infants. In fact, it provides several distinct answers to each one.

These answers appear as advice to parents in seven societies around the world. The authors of this book have imagined what a foreign-born Dr. Spock might have written if he (or she) were a healer from Bali . . . or an Aboriginal grandmother from the Australian desert . . . or a diviner from a rural village in West Africa. As the seven “manuals” that make up this book reveal, experts from elsewhere offer intriguingly different advice to new parents.

The creative format of this book brings alive a rich fund of ethnographic knowledge about seven societies, vividly illustrating a simple but powerful truth: there are many models of babyhood, each shaped by deeply held values and widely varying cultural contexts.

After reading this book, child-rearing may never again seem a matter of “common sense.”

Gastrointestinal (GI) distress is common during ultrarunning. To determine if race diet is related to GI distress in a 161-km ultramarathon. Fifteen (10 male, 5 female) consenting runners in the Javelina Jundred (6.5 loops on a desert trail) participated. Body mass was measured immediately prerace and after each loop. Runners reported if they had nausea, vomiting, abdominal cramps, and/or diarrhea after each loop. Subjects were interviewed after each loop to record food, fluid, and electrolyte consumption. Race diets were analyzed using Nutritionist Pro. Nine (8 male, 1 female) of 15 runners experienced GI distress including nausea (89%), abdominal cramps (44%), diarrhea (44%), and vomiting (22%). Fluid consumption rate was higher (p = .001) in runners without GI distress (10.9 ± 3.2 ml · kg-1 · hr-1) than in those with GI distress (5.9 ± 1.6 ml · kg-1 · hr-1). Runners without GI distress consumed a higher percentage fat (p = .03) than runners with GI distress (16.5 ± 2.6 vs. 11.1 ±...

Although non-steroidal anti-inflammatory drugs (NSAID) and spasmolytics have been used to relieve biliary colic, the role of these drugs in the natural history of biliary colic has not been clarified. The objective of the present study is to compare the efficacy of intramuscular diclofenac with intramuscular hyoscine in the treatment of pain of acute biliary colic, and to study their role in the natural history of biliary colic and in the prevention of cholelithiasis-related complications. Seventy-two consecutive patients with biliary colic were enrolled in this prospective, randomized, double-blind study. They received either a single 75 mg intramuscular dose of diclofenac (n = 36) or similarly administered 20 mg of hyoscine (n = 36). Pain severity was recorded on a visual analogue scale 30 min, 1 h, 2 h and 4 h after injection of the drug. Patients were then followed closely for the next 72 h for persistence or relapse of pain, or development of acute cholecystitis, or drug relate...

Several studies support the use of probiotics for the treatment of minor gastrointestinal problems in infants. Positive effects on newborn colics have been evidenced after administration of Lactobacillus strains, whereas no studies have been reported regarding the use of bifidobacteria for this purpose. This work was therefore aimed at the characterization of Bifidobacterium strains capable of inhibiting the growth of pathogens typical of the infant gastrointestinal tract and of coliforms isolated from colic newborns. Among the 46 Bifidobacterium strains considered, 16 showed high antimicrobial activity against potential pathogens; these strains were further characterized from a taxonomic point of view, for the presence and transferability of antibiotic resistances, for citotoxic effects and adhesion to nontumorigenic gut epithelium cell lines. Moreover, their ability to stimulate gut health by increasing the metabolic activity and the immune response of epithelial cells was also studied. The examination of all these features allowed to identify three Bifidobacterium breve strains and a Bifidobacterium longum subsp. longum strain as potential probiotics for the treatments of enteric disorders in newborns such as infantile colics. A validation clinical trial involving the selected strains is being planned.

Purpose of the research: The aim of this study was to investigate the effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening. Methods and sample: In this pretesteposttest longitudinal study, Turkish men over 40 years of age were given an interactive educational session on prostate cancer and prostate cancer screening, and were then given related web-assisted education and consultation for a period of 6 months. As well as the Internet, reminders such as desk calendar, booklets, e-mails and cell phone messages were used in the study. Changes in the screening behaviors, the health belief and knowledge level of patients were examined 3 and 6 months after the interventions. Key results: During the study, participants' prostate examination rate increased from 9.3% to 19.1% and PSA measurement rate increased from 6.7% to 31.4%. The interventions raised the susceptibility perception on prostate cancer and prostate cancer screening while decreasing the barrier perception (p < 0.05). No change was observed in other health belief components and the level of knowledge. Conclusion: Web-assisted education and reminders provided positive changes in the barrier and susceptibility perceptions of individuals. Participation in the screening also increased.

To determine whether dietary and other management factors were associated with development of colic in horses. Prospective matched case-control study. 2,060 horses examined by veterinarians in private practice in Texas for colic and noncolic emergencies. Each month for 12 months, participating veterinarians were sent forms to collect information on 1 horse with colic and 1 horse that received emergency treatment for a condition other than colic, information collected included signalment, farm management and characteristics, diet, medical and preventive medical factors, transport, and activity or use. Case and control horses were compared by means of conditional logistic regression to identify factors associated with colic. Recent change in diet, recent change in type of hay, history of previous episode of colic, history of abdominal surgery for colic, recent change in weather conditions, recent change in housing, Arabian breed, administration of an anthelmintic during the 7-day peri...

Objective To conduct a pilot study to assess the feasibility of a proposed design of an acupuncture trial to relieve symptoms of infantile colic. Method An open randomised single-blinded controlled trial, using standardised bilateral treatment of the acupuncture point ST36. Infants fulfi lling Wessel's defi nition of infantile colic were included. Patients were randomised to active treatment or to no-treatment control. General practitioners (GPs) educated in Western medical acupuncture did the interventions. Parents and GPs' assistants were blinded. Active treatment was the bilateral insertion of 0.20×15 mm Seirin needles to 12 mm depth at ST36. The intervention consisted of daily treatments of 30 s duration for three consecutive workdays. Blinding was done with a red point mark on the skin and circular adhesive dressing covering. The parents were asked two blinding validation questions in the course of the study period. The primary end point was the effect of the intervention assessed as change in crying time per 24 h measured with a crying registration form. Results The authors improved the standardisation and changed the blinding procedure as a result of the pilot study. Blinding validation questions were considered necessary. The changes made in the main study protocol are discussed. Conclusion The pilot study led to important changes that were implemented into the fi nal trial protocol. Blinding validation is essential in no-treatment controlled trials of acupuncture on infants, where the parents are blinded assessors of symptom reduction. The authors suggest that blinding validation questions, and the answers to these questions, should be reported. Clinical Trial Registry Identifi er: NCT00907621.

A two-part population-based study investigating the occurrence of infantile colic was undertaken. in which %!YO ofmothers with newborn healthy infants were reached. In the prospective part I52 mothers ("diary group") registered crying and fussing in their infants during I2 weeks. In the retrospective part 224 mothers ("interview group") were contacted by telephone at an infant age of5-7 months. The colic occurrence was determined according to four different definitions; the rates varied from 3.3 to 17.1 O h . The classical "Wessel-type" colic was present in 9.3%. Colic defined as "crying seen as a problem by parent" was present in 12.

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.