RESUMEN
BACKGROUND: After Hirschsprung disease (HD) surgery, many children experience fecal incontinence caused by increased number of high-amplitude-propagating contractions (HAPCs) through the neorectum to the anal verge. The aim of this study was to determine whether children with HD have more HAPCs than children with colon transections for reasons other than HD. METHODS: We reviewed 500 colon manometries. Children (age 7.6â±â5.1 years, 275 boys) with functional constipation (nâ=â237, age 7.4â±â5.0 years, 126 boys) and chronic abdominal pain (nâ=â48, age 9.8â±â5.8 years, 25 boys) served as controls compared with subjects with HD (nâ=â56, age 6.9â±â4.1 years, 44 boys) and colon transection for other reasons (nâ=â24, age 6.1â±â5.8 years, 12 boys). We excluded 139 subjects without HAPCs. We documented HAPCs during 1-hour fasting and 1-hour postprandial. Results are in meanâ±âSD. RESULTS: During fasting, HD subjects had more HAPCs (2.2â±â3.4/hour) versus functional constipation (0.8â±â2.2/hour, Pâ=â0.0004) and chronic pain (0.5â±â1.1/hour, Pâ=â0.001), but not more than colon transection (1.9â±â3.2/hour, Pâ=â1.0). HD showed more postprandial HAPCs (4.0â±â5.4/hour) than functional constipation (1.5â±â2.5/hour, Pâ<â0.0001) and chronic pain (0.9â±â1.6/hour, Pâ<â0.0001), but not more than colon transection (2.4â±â3.0/hour, Pâ=â0.6). There were more HAPCs fasting and postprandial after colon transection (1.9â±â3.2/hour and 2.4â±â3.0/hour) than functional constipation (0.8â±â2.2/hour, Pâ=â0.3 and 1.5â±â2.5/hour, Pâ=â1.0) and chronic pain (0.5â±â1.1/hour, Pâ=â1.0 and 0.9â±â1.6, Pâ=â1.0). HD subjects were divided by chief complaint: fecal incontinence or constipation. HD subjects with incontinence (nâ=â23) only had more HAPCs fasting (Pâ=â0.01) and postprandial (Pâ=â0.01) than HD subjects with constipation (nâ=â28) only. CONCLUSIONS: Increased HAPCs followed colon transection, regardless of a cause. HD subjects with incontinence had more HAPCs than subjects with colon transection for other reasons.
Asunto(s)
Colon/inervación , Incontinencia Fecal/prevención & control , Enfermedad de Hirschsprung/fisiopatología , Nervios Periféricos/cirugía , Peristaltismo , Dolor Abdominal/complicaciones , Dolor Abdominal/cirugía , Adolescente , Niño , Preescolar , Dolor Crónico/complicaciones , Dolor Crónico/cirugía , Colon/fisiopatología , Estreñimiento/complicaciones , Estreñimiento/cirugía , Incontinencia Fecal/etiología , Femenino , Enfermedad de Hirschsprung/complicaciones , Enfermedad de Hirschsprung/cirugía , Humanos , Kansas , Los Angeles , Masculino , Manometría , Nueva Orleans , Periodo Posprandial , Estudios RetrospectivosRESUMEN
Examined the utility of CBT for childhood obsessive-compulsive disorder (OCD) including a preliminary exploration of predictors of response to this form of treatment. A total of 42 youngsters (mean age 11.8 years, 60% female, 52% on medication at baseline) with DSM-IV OCD were treated openly using a developmentally sensitive treatment protocol based on exposure plus response prevention (ERP). The treatment response rate (CGI < 2) was 79% with a mean decrease from baseline in NIMH global scores of 45%. Response was not related to age, gender, baseline medication status, comorbid symptomatology, or therapist experience. Poorer outcome was associated with more severe obsessions and greater OCD-related academic impairment at baseline. When presented in a developmentally appropriate manner, CBT is a useful treatment for childhood OCD. Controlled trials are needed to provide a more rigorous test of this treatment approach and provide better information regarding potential mediators and moderators of outcome.