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Gutfoundation.comAn Information Brochure by The Gut Foundation Diverticular disease
What is it?
Diverticular disease affects the large bowel. The disease
is usually confined to the sigmoid colon although it can
involve all the colon.
Diverticula are small pockets or sacs that protrude beyond the wall of the bowel and vary in size from that of a pinhead to a small grape. The mouth of the diverticulum is often narrow giving it a teardrop shape. The local bowel wall is thickened.
The internal diameter of the bowel is considerablynarrowed. This may account for narrow, ribbon-like stools that are sometimes passed.
The Digestive System
LININg MuSCLE AREA
What causes diverticular disease?
Diverticular disease occurs when the fibre content
of the diet is low. Physics suggests the narrower a tube,
the higher the pressure inside it. A high fibre diet
produces a large volume of stool and colons with wide
diameters. This means lower pressure. In societies where
much less fibre is eaten, the colon diameter is smaller
and the pressure is higher. This increased pressure literally
pushes the pockets of bowel lining out between the
thickened muscle bundles forming diverticula.
How common is it?
In developed countries diverticular disease is present in
1/3 of the population by the age of 50 years and in
2/3 of the population by the age of 80 years.
The majority have no symptoms but 10-20% may developdiverticulitis or diverticular bleeding.
What are the symptoms?
There are often no symptoms. Cramping or left lower
abdominal discomfort may occur especially in the
morning. Diarrhoea associated with some urgency is
common. Some people have watery diarrhoea containing
hard faecal pellets. Urgency can be so great that
incontinence may occur particularly if the stool is liquid.
This is often a problem in women who have had
a difficult or complicated childbirth.
Abscess If the mouth of the diverticulum becomes
blocked, infection may occur within the pocket and result
in an abscess. This will cause more severe pain, fever and
either constipation or diarrhoea. Quite rarely the abscess
can burst resulting in peritonitis requiring urgent surgery.
Haemorrhage If the diverticulum becomes infected
the inflammation may damage small arteries around the
mouth of the diverticulum which causes bright red blood
to pass from the rectum. This bleeding may be heavy.
How is the diagnosis made?
Major symptoms are pain and altered bowel habit. These
symptoms and the complication of bleeding also occur
with other diseases. To exclude conditions such as bowel
polyps and cancers, internal inspection of the bowel is
necessary. This is called a colonoscopy. Before such a test
the bowel must be prepared to totally clear its contents
and allow careful inspection of the entire surface. This has
the advantage that any polyps found in the bowel can be
removed at the same time. An abscess is usually treated
with antibiotics and colonoscopy delayed for two months.
What is the treatment?
1. No complications
The key is to increase stool bulk by increasing dietary
fibre and taking a bulking agent. This reduces the pressure
within the colon.
High fibre foods include wholemeal bread,
wholegrain cereals, legumes (dried beans, peas
and lentils), vegetables, fruits (but not juices),
nuts and seeds.
Although you may already consume more fibre than yourfriends, those who are susceptible to diverticular diseaseneed to consume a lot more fibre than the rest of thepopulation. A minimum of 30g of dietary fibre a day isusually required, which is considerately more than theaverage Australian eats. Women, in particular, may eat avariety of healthy fibre containing foods but in relativelysmall quantities so their total daily intake of fibre is stillinadequate. Dietary fibre is not simply consumingunprocessed bran. This may upset many people producingbloating, excessive wind and anal discomfort. If bran istolerated, it is a good source of fibre, but there are manygood sources of fibre that are more suitable.
For more information on dietary fibre see The Gut
Foundation's publication Dietary Fibre and Health,
also available on www.gutfoundation.com.au
As well as adequate dietary fibre, a bulking agent is oftenhelpful. A convenient bulking agent is psyllium, Metamucilor Agiofibe. We recommend a daily intake of 2 teaspoonswith water each morning. Other bulking agents includecompressed bran tablets, ispaghula husk derivatives suchas Fybogel and sterculia-based products such as Normafibe and Alvercol. Movicol may also be valuableparticularly if constipation is prominent. If left lower painor bowel incontinence is a problem, antispasmodics maybe required. Mebeverine (eg. Colofac) is often effectivein relieving pain and urgency. It needs to be taken on along-term basis. Unfortunately, it is expensive and not on
the current Pharmaceutical Benefit Schedule.
Tricyclic compounds (Tryptanol or Amitriptyline) weredeveloped as antidepressants but have a separate effecton the muscles and nerves in the bowel and bladder. In general, such drugs are only used when Mebeverine hasfailed. If the predominant problem is watery diarrhoea,non-specific anti-diarrhoeal tablets such as Imodium orLomotil may be effective. Codeine compounds shouldgenerally be avoided. If incontinence is present,mebeverine should be tried first. If this is ineffective, atricyclic is added and if the stool is still liquid, Imodiummay be necessary.
If incontinence occurs when the stool is well
formed you should see a doctor to evaluate your
anal sphincter function.
2. Treatment of Complications
Abscess – appropriate antibiotics. Reduce dietary fibre
until the inflammation settles. This will often take several
weeks. A high fibre diet can then be resumed. Rarely,
an abscess may rupture. This requires urgent surgery and
emergency hospital admission is needed.
Haemorrhage can be frightening. The bleeding may
be sudden and heavy. The blood passed from the bowel
appears to be a larger volume than it actually is but the
bleeding can be severe enough to lower blood pressure
and cause fainting. A large volume bleed is an emergency
and blood transfusion or surgery may be needed.
Seek urgent medical attention.
3. Surgical treatment
Surgery may be necessary for the small group of patients
who do not respond adequately to appropriate medical
treatment. This does not usually require a temporary
colostomy (bag) as the affected segment of the bowel can
be removed and the ends joined together in one operation.
A good healthy diet is essential for everyone
Eat Most fruits, vegetables, wholemeal breads and
cereals (preferably wholegrain), legumes, seeds and nuts.
Eat Moderately lean meat, chicken, fish, milk, cheese,
yoghurt and eggs.
Eat Least fatty, salty and sugary foods.
High fibre foods include:
• Wholegrain cereals
• Legumes (beans, peas and lentils)
• Fruits (but not juices)
• Nuts and seeds
• Vegetables (cooked vegetables often have more
fibre than salads) Windy foods include:
• Lactose in milk (especially fat reduced fortified
milk or ice cream).
• Cabbage, Brussels sprouts and cauliflower or legumes (beans and peas).
• Sorbitol and mannitol (in some low kilojoule foods). Check the label.
A high fibre diet and bulking supplements are
as valuable for treating diarrhoea as they are
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