A new simplified technique for pediatric anorectal manometry.

Using a new simple technique that is well tolerated and rapid for assessing anal sphincter functions in pediatric patients with fecal incontinence and constipation, 86 patients with varying degrees of anorectal dysfunction were tested. A microtip pressure transducer was used for recording anal sphincter responses to rectal balloon distension. Results were obtained within 15 to 30 minutes. In 17 patients, the internal anal sphincter showed no response or positive spike to balloon distension, consistent with the manometric diagnosis of aganglionic megacolon. These findings were confirmed by absence of ganglion cells on rectal biopsy. Sixty-nine children had normal internal sphincter relaxation to rectal distension. Ganglion cells were present in nine biopsy specimens. In the remaining 60 patients, no further workup of aganglionosis was necessary. There were no false-positive or false-negative results. This technique has proved to be effective for initial evaluation of infants and children with constipation and encopresis.

Further data on the acute effect of intravenous steroids on canine CSF secretion and absorption.

Considerable difference of opinion has arisen as to whether intravenously administered steroids affect cerebrospinal fluid (CSF) production in the acute laboratory animal undergoing ventriculocisternal perfusion. Our experiments with ventriculocisternal perfusion in dogs indicate that, when given intravenously, neither dexamethasone, methylprednisolone, hydrocortisone, nor aldosterone result in a significant, acute effect upon CSF production. Similarly, CSF absorption and outflow resistance mechanisms are not acutely affected by intravenous methylprednisolone, hydrocortisone, and aldosterone. Dexamethasone also probably does not produce an immediate effect upon CSF absorption.

Breaking strength and diameter of absorbable sutures after in vivo exposure in the rat.

Although absorbable sutures are commonly used in clinical practice, the rate of decay of strength in various tissues has not been studied. The purpose of this study was to assess breaking strength (BS) and diameter of monofilament (chromic gut, polydiaxanone, Maxon, Monocryl) and multifilament (Vicryl, Dexon, Polysorb) absorbable sutures implanted in various sites and measured at specific time intervals. A 15 cm length of 4-0 suture from a single lot of each material was implanted in the pleural space, rectus abdominus muscle, subcutaneous tissue, intravascular space, peritoneal cavity, and stomach lumen in the rat. A precipitous decrease in BS was noted in all multifilament sutures after 7 days, and in chromic gut and Monocryl sutures after 1 day. Polydiaxanone and Maxon sutures maintained the highest BS over the 28-day period, 71 per cent and 59 per cent of their initial BS, respectively. Suture diameter remained essentially unchanged except for chromic gut and the multifilament sutures which exhibited increased diameter. This increase was attributed to inflammatory tissue infiltration.

The effects of minidose heparin and low molecular weight heparin on peritonitis in the rat.

Intraperitoneal bacteria, ischemic tissue, and the inflammatory response have all been implicated in the development of intra-abdominal adhesions and abscess formation. Sprague Dawley rats were subjected to a peritonitis challenge induced by fecal contamination of the peritoneum in conjunction with necrotic ileal tissue in an attempt to further elucidate the role of these stimuli and to evaluate the potential protective effect of regular heparin and of low molecular weight heparin (LMWH) Lovenox. Rats treated with a subcutaneous minidose heparin and LMWH Lovenox showed a significant decrease in adhesion and abscess formation when compared with the nontreatment control rats. There was no statistical difference between the two treatment groups. These findings confirm the efficacy of minidose heparin in reducing both the grade and incidence of adhesion and abscess formation and suggest a similar role for LMWH Lovenox. No conclusions could be reached on the effect of heparin or LMWH Lovenox on survival time due to the high survival rate noted in the nontreatment control rats, despite severe peritonitis.

Anorectal manometry: a new simplified technique.

Several noninvasive techniques using anal balloons or catheter systems to measure anal sphincter function associated with rectal balloon distention have been used in differentiating functional constipation from aganglionic megacolon. We have developed a simplified method for anorectal manometry that uses a microtip pressure transducer to record anal sphincter responses. Seventy-three patients (51 children and 22 adults) with constipation have been studied with this technique. Normal responses of internal anal sphincter relaxation to rectal distentions were obtained in 60 patients (40 children and 20 adults), consistent with the diagnosis of functional constipation. Abnormal responses-no internal anal sphincter relaxation-were recorded in 13 patients (11 children and two adults), consistent with the diagnosis of Hirschsprung's disease. The manometric diagnosis was confirmed in all 21 patients biopsied. There were no false-positive or false-negative results. The technique is a simple, well tolerated, and rapid method for assessing anal sphincter function.