Valeant did set up a list of those calling in about the medication to inform interested parties and it is assumed that this reaction by those who do need this medication is what prompted the return of Motofen despite the numerous instances of pushing back of the return date by Valeant. Motofen is now back on the market as of June 2011 and available only by prescription in the United States. References
External links
A comprehensive article about the subgroup of anti-diarrhoeal drugs including Motofen can be found at the article Diphenoxylate.
Dextrocardia with situs ambiguus
In contrast to dextrocardia situs inversus which is only rarely associated with congenital heart disease, dextrocardia situs ambiguus is often associated with intracardiac anomalies. Dextrocardia situs ambiguus presents a surgical challenge not per se due to associated cardiac malformation, but because achieving adequate exposure is difficult. Right sided structures such as right atrium, right ventricle and tricuspid valve are oriented posteriorly in dextrocardia situs ambiguus (in contrast to dextrocardia with situs inversus). This presents a challenge to the surgeons operating on the right-sided cardiac structures in a case of dextrocardia situs ambiguus. Diagnosis
Medical diagnosis of the two forms of congenital dextrocardia can be made by ECG or imaging. Technical dextrocardia
Technical dextrocardia refers to an ECG reading that has no basis in the patients anatomy. This apparent presentation is typically caused by the accidental lead placement of the left and right arm electrodes. Usually, this would show as an extreme axis deviation. Management
ECG leads must be placed in reversed positions on a person with dextrocardia. In addition, when defibrillating someone with dextrocardia, the pads should be placed in reverse positions. That is, instead of upper right and lower left, pads should be placed upper left and lower right.When heart transplantation is required in a person with situs inversus, reconstruction of the venous pathways to accommodate a normal donor heart is a major, but not insurmountable, challenge. Epidemiology
Dextrocardia is estimated to occur in approximately 1 in 12,019 pregnancies.A Japanese study of 1,753 fetal cardiac echocardiograms over five years revealed only two cases.