[Perforations during contrast enema]. / Perforationen beim Kontrasteinlauf.

During contrast enema, perforation into the retroperitoneal space can be differentiated from perforation into the peritoneum and perforation into the intestinal wall associated with formation of barium granulomas or submucosal spreading of the contrast medium. Other special forms are perforation with contrast medium embolism of diverticula; of the processus vermiformis; penetration of contrast medium into fistulous systems and from the operated area. Risk factors are: balloon catheter, intestinal tubes with a hard tip, preternatural anus, excessive enema pressure, contrast medium additions, preceding manipulations, intestinal diseases, advanced age and delegation of manipulations to assistants and unskilled staff. Children are particularly at risk.

[A method to transmucosal transport in the human esophagus (author's transl)]. / Ein Verfahren zur Messung transmuköser Transportvorgänge im menschlichen Osophagus.

A modified 9-luminal manometric tube served to perfuse the esophagus with 3.2 mmolar hydrochloric acid containing 2% polyethylene glycol (PEG) and to aspirate the esophageal contents. The esophageal secretion was calculated from the PEG dilution in the aspirates. Neutral red injected intravenously reddened selectively gastric juice. Red esophageal aspirates were discarded., In 6 health subjects esophageal secretion was 1.0/+-0.2 ml/min after 1 hour perfusion. It contained 38 /+-11 mmol/l na+, 3.3/+-1.4 mmol/l K+, 27/+-6 mmol/l Cl-, and 50/+-13 mumol/l N-acetylneuraminic acid (NANA). Thus this method allows measurement of the barrier function of the esophageal mucosa.

[Cardiotoxic effect of the tocolytic agent fenoterol (partusisten) in the neonate (author's transl)]. / Kardiotoxische Wirkung des Tokolytikums Fenoterol (Partusisten).

Forty-two children of mothers treated with beta-adrenergic drugs were investigated cardiologically during a period of 3 1/2 years. Eleven neonates were seen to suffer from severe toxic myocardiopathy associated with heart failure. The mothers had in part been given excessive fenoterol doses for 13 weeks on the average. One child died of regressive myocardial alterations as confirmed by autopsy. Suspicion of toxic myocardiopathy was suggested in another 16 children. Related to the very large number of mothers treated with tocolytic agents, fenoterol-induced myocardiopathy so far appears to be rare. In agreement with other reports, however, our observations suggest the possibility of severe, even perilous myocardial damage. Therefore, the indication and dosage of fenoterol should be subjected to more rigid criteria than so far applied.

Salivary secretion in reflux esophagitis.

It has been speculated that impaired salivary flow and contents contribute to abnormal acid clearance in patients with reflux esophagitis. To test this hypothesis, salivary secretion of volume, bicarbonate, and N-acetylneuraminic acid was measured in patients with reflux esophagitis, in age- and sex-matched controls, and in healthy young volunteers. Resting saliva was collected by permitting the saliva to drip into a flask every 30 s. Parotid saliva was collected by means of a Lashley capsule during stimulation by oral infusion of 1 ml/min of 2% citric acid. Total mixed saliva was collected by a dental sucker during esophageal perfusion with water and 10-mM hydrochloric acid. The volume of resting saliva and its concentration of bicarbonate were similar in the three groups. The concentration and the output of N-acetylneuraminic acid were higher in the young volunteers than in the two other groups. The volume flow and the composition of stimulated parotid saliva were similar in the three groups of subjects. Volume of total mixed saliva and concentration of bicarbonate and N-acetylneuraminic acid during esophageal perfusion with water were higher in patients with reflux esophagitis than in age- and sex-matched controls and were similar to the values found in young healthy volunteers. Acid perfusion increased the secreted volume of total mixed saliva by 150% and the concentration of bicarbonate by 30% in healthy young volunteers, but not in patients with reflux esophagitis and in the healthy age- and sex-matched controls; the concentration of N-acetylneuraminic acid was left unaffected by acid perfusion in all three groups. These findings disprove the hypothesis of impaired salivation in reflux esophagitis. The age-related loss of salivary response to acidic esophageal perfusion might be the reason why reflux esophagitis with peptic lesions affects predominantly elder people.