Sex differences in kinetic and neuromuscular control during jumping and landing.

In the present study, we analysed the kinetic profile together with the lower limb EMG activation pattern during a countermovement jump and its respective landing phase in males and females. Twenty subjects (10 males and 10 females) took part in the study. One experimental session was conducted in order to record kinetic and electromyographic (EMG) parameters during a countermovement jump (CMJ) and the subsequent landing phase. During the CMJ, males recorded a higher (p<0.001) performance than females in terms of jump height and power production. Stiffness values were lower in males than females due to greater centre of mass displacement during the countermovement (p<0.01). According to the EMG activity, males demonstrated greater (p<0.05) activation during the concentric phase of the jump. However, females revealed a higher co-contraction ratio in the plantar flexors during the push-off phase. During landings males showed higher (p<0.01) peak ground reaction forces (Fpeak), greater (p<0.05) stiffness and a higher maximal displacement of the CoM (p<0.05) than females. EMG analysis revealed greater EMG activity in the tibialis anterior (p<0.05) and rectus femoris (p=0.05) muscles in males. Higher plantar flexor co-activation during landing has also been found in males. Our findings demonstrated different neuromuscular control in males and females during jumping and landing.

[Usefulness of endoscopic retrograde cholangiopancreatography in diagnosis of choledochal cysts in children]. / La utilidad de la pancreatocolangiografía endoscópica retrógrada en el diagnóstico del quiste de colédoco en la infancia.

We report 11 infants with choledochal cyst confirmed during surgery. In none of the patients an abdominal mass was palpated during physical examination. In 10 (91%) of the patients, ERCP showed the cyst. Ultrasound was positive in 82% (9/11) of the cases. Two patients had acute relapsing pancreatitis with severe anatomical abnormalities at the pancreatobiliary junction. Multiple biliary lithiasis were seen in four cysts. ERCP is of significant value in establishing the diagnosis, defining anatomic abnormalities and complications. ERCP should be the procedure of choice in patients with suspected choledochal cyst.

[Chronic constipation. Use of cisapride]. / Estreñimiento crónico. Uso del cisapride.

We studied the effect of Cisapride (10 mg vo every 8 hours) on the characteristics of the evacuations, orocoecal transit time and motility trough rectoanal manometry in patients diagnosed with chronic constipation. The patients (N = 51) received placebo and/or drug in a controlled, randomized, double blind, crossed study during two treatment phases of 30 days each. The end of each phase was followed by a clinical evaluation, a rectoanal manometry and hydrogen breath test. Cisapride increased the rhythm of ecacuations (5.53 days +/- 3.11 vs 1.59 days +/- 1.15 p < 0.05) improved the frequency of evacuations and diminished the consistency of the feces (p < 0.05), shortened the orocoecal transit time (271.57 min +/- 9.87 vs 201.18 min +/- 29.30 p < 0.05) and improved the parameters of the rectoanal manometry readings such as the pressure of internal anal sphincter (58.14 mmHg 7.33 vs 53.90 mmHg 5.19 p < 0.05), and its relaxation percentage (73.41% +/- 15.30 vs 66.84% +/- 11.83 p < 0.05). Side effects associated with Cisapride were not significant. It is concluded that Cisapride improves intestinal motility in chronic constipation.

[Anorectal manometry. Experience of 5 years]. / Manometría anorectal. Experiencia de 5 años.

Anorectal manometry is a non invasive, safe and useful procedure for exploring anorectal function in several disease. The anorectal studies made in our service the last five years in children, were reviewed. There were made 234 procedures in patients 21 year old or less 93.25% of the studies could be finished and 72.64% of the patients were from other hospitals or centers. The age average was 5.62 +/- 4.72 years and the main indication was constipation (78.20%). We didn't find any statistical difference in the manometrical findings of the internal anal sphincter between the patients with only constipation, only encopresis, constipation plus encopresis and normal values. The main manometrical diagnostic in the constipated patient without Hirschsprung disease was "Normal Study" even though between 30 and 55% of the studies showed "inspecific motor dysfunction". The patients with anorectal malformations had a main internal and pressure statistically lower (Z = 3.29 p = 0.03) and "Non concluyent Study" percentage higher (Z03.44 p = 0.02) than the constipated ones. The main external anal pressure was not different between groups. In 43 patients the manometrical study showed "Suggestive of Hirschsprung Disease". We recovered the histological reports in 55.88% with aganglionosis in the 91.66%. There were no statistical differences in the other manometrical parameters. Our finding agree with the ones reported in the specialized literature and support the anorectal manometry as an useful tool for exploring the anal sphincter integrity in anorectal malformations.

The role of ERCP in the diagnosis and treatment of idiopathic recurrent pancreatitis in children and adolescents.

ERCP was performed in 51 patients, aged 1 to 18 years, as part of diagnostic evaluation for recurrent pancreatitis without obvious cause or as therapeutic intervention. ERCP was successful in 50 patients (98%). Thirty-four patients (68%) had anatomic findings indicating a possible cause of recurrent pancreatitis. Three patients (6%) had findings suggestive of sphincter of Oddi dysfunction. Eighteen of the 37 patients (49%) with ductal abnormalities underwent endoscopic therapy, with a favorable outcome in 15 (83%). Eleven patients were treated surgically, and 8 of these patients (73%) improved symptomatically. Eight patients received no treatment, and 6 of them (67%) had recurrent bouts of clinical pancreatitis. One mild case of pancreatitis (1.9%) occurred after ERCP, and 3 mild cases followed endoscopic therapy. In conclusion, ERCP is a relatively safe technique that produces opacification of the desired ductal system with a high degree of accuracy and provides useful information in the evaluation of children with idiopathic recurrent pancreatitis. These data suggest that endoscopic pancreatic therapy may result in symptomatic improvement, eliminating the need for surgery in selected children. Furthermore, the study demonstrates that manipulation of the pancreatic duct is comparatively safe and less hazardous than formerly believed.

Prevalence of Helicobacter pylori in neonates and young infants undergoing ERCP for diagnosis of neonatal cholestasis.

This study was carried out to determine the prevalence of Helicobacter pylori infection in 20 neonates and young infants from lower socioeconomic background undergoing endoscopic retrograde cholangiopancreatography (ERCP) examination for diagnosis of neonatal cholestasis. One young asymptomatic infant (5%) who was breast-feeding with complementary formula had H. pylori infection. Endoscopy showed a normal appearing mucosa and histology demonstrated mild superficial acute gastritis. A follow-up gastroscopy performed 14 months after the initial study showed normal histology without evidence of H. pylori, suggesting that the infection was transient. Nineteen (95%) of the 20 mothers had H. pylori infection, including the mother with the infant positive for H. pylori. All mothers had gastritis on biopsy specimens. Despite the high prevalence of H. pylori in the mothers, infection in neonates and young infants was uncommon.

ERCP and endoscopic sphincterotomy in infants and children with jaundice due to common bile duct stones.

ERCP was performed in two infants (29 and 62 days old) and eight children (5 to 12 years old) with jaundice due to common bile duct stones. Seven patients had hemolytic anemia and three patients had a family history of gallstone disease. Successful cannulation of the common bile duct demonstrating stones was accomplished in all patients. Four patients had coexisting gallstones and were treated surgically. Six children who had previously undergone cholecystectomy were treated by endoscopic sphincterotomy and stone extraction without complication. We believe that ERCP should be utilized by expert endoscopists in children with evidence of extra-hepatic cholestasis, and endoscopic sphincterotomy should be the treatment of choice in children who have previously undergone cholecystectomy, and who are jaundiced secondary to common bile duct stones.

ERCP in the diagnosis of extrahepatic biliary atresia.

This study assessed the usefulness of ERCP in the diagnosis of biliary atresia. We evaluated 57 infants with prolonged cholestasis with abdominal ultrasound, liver biopsy, and ERCP. Using clinical observations alone, 22 infants were thought to have biliary atresia; whereas 35 children were thought to have neonatal hepatitis. The ERCP was performed with a prototype duodenoscope and was successful in all infants except two with biliary atresia. In 20 infants three types of radiological findings consistent with biliary atresia were seen: type 1, no visualization of biliary tree (35%); type 2, opacification of the distal common duct and gallbladder without visualization of the main hepatic duct (35%); and type 3, opacification of the distal common duct, the gallbladder, and a segment of the main hepatic duct with biliary lakes at the porta hepatis (30%). Twenty-five of 35 infants with suspected neonatal hepatitis were excluded because of a liver biopsy that was diagnostic. In the remaining 10 infants the liver biopsy had some features of extrahepatic biliary atresia and ERCP was performed prior to surgery. A normal extrahepatic biliary tree was obtained in all of them. In conclusion, ERCP permits the visualization of the biliary tree in young infants and is useful in selecting those infants who should be considered for exploratory laparotomy.

Normal and anomalous pancreaticobiliary union in children and adolescents.

BACKGROUND: The normal length of the pancreaticobiliary union (common channel) in the pediatric population is not known, nor is the frequency of anomalous pancreaticobiliary union and the extent to which it is associated with pancreaticobiliary disease. METHODS: ERCP was performed on 136 patients younger than 1 year (group 1) and 128 older than 1 year (group 2). RESULTS: In group 1 the average length of the common channel was 1.8 +/- 0.61 mm with a maximal length of 3 mm (mean plus 2 standard deviations). In group 2 the average length and maximal length of the common channel increased with age. In the 1 to 3 year age range the average length was 2.2 +/- 0.47 mm with a maximal length of 2.7 mm, in the 4 to 6 year range it was 2.8 +/- 0.40 mm (3.6 mm maximal), in the 7 to 9 year range it was 3.2 +/- 0.43 mm (4.1 mm maximal), in the 10 to 12 year range it was 3.9 +/- 0.5 mm (4.4 mm maximal), and in the 13 to 15 year range it was 4.0 +/- 0.51 mm (5 mm maximal). The prevalence of the anomalous pancreaticobiliary union was 25% (66/264). In group 1 the anomaly was present in 4.4% (6 of 136) of patients, 1.3% (1/76) with neonatal hepatitis, 4.6% (3/44) with biliary atresia, and 100% (2/2) with choledochal cyst. In group 2 the anomaly was present in 46.9% (60/128) of patients, 100% (57/57) with choledochal cyst and 15.7% (3/19) with idiopathic recurrent pancreatitis without bile duct dilatation. CONCLUSIONS: The mean length of the common channel increases with age. The maximum normal length of the common channel in neonates and infants younger than 1 year is 3 mm. It increases with age to a maximum of 5 mm in children and adolescents between 13 and 15 years of age. Anomalous pancreaticobiliary union is relatively common among children and adolescents undergoing ERCP in our center, including those with idiopathic recurrent pancreatitis (15.7%). ERCP is valuable in the diagnosis of this anomaly.

Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept.

BACKGROUND: The exact cause of recurrent pancreatitis among patients with anomalous pancreaticobiliary union is not known. Sphincter of Oddi dysfunction has been implicated as a mechanism. This study evaluated sphincter of Oddi function in children with anomalous pancreaticobiliary union and recurrent pancreatitis and assessed the results of endoscopic sphincterotomy in the management of this condition. METHODS: We retrospectively reviewed 128 endoscopic retrograde cholangiopancreatographic (ERCP) studies performed on children older than 1 year and adolescents with pancreaticobiliary disease. In 64 instances, ERCP was performed because of recurrent pancreatitis. Nine patients underwent sphincter of Oddi manometry followed by endoscopic sphincterotomy, and these patients were included in this study. A basal pressure greater than 35 mm Hg was considered diagnostic for sphincter of Oddi dysfunction. Follow-up data were obtained retrospectively from the patients' relatives and referring physicians. RESULTS: An anomalous pancreaticobiliary union was found in 18 of 64 (28%) patients with recurrent pancreatitis. The 9 patients who underwent sphincter manometry and endoscopic sphincterotomy were 5 girls and 4 boys 2.9 to 17 years of age (mean 7.8 years). A choledochal cyst was found in 7 of these 9 patients. Two patients had anomalous pancreaticobiliary union without common bile duct dilatation. All 9 patients had sphincter of Oddi dysfunction (mean basal pressure 96 +/- 37.8 mm Hg, range 48 to 156 mm Hg). The length of the common channel was 22.8 +/- 5.5 mm, and the length of the sphincter of Oddi segment was 12.1 +/- 1.9 mm (p < 0.001). In all patients the sphincter of Oddi segment was located within the duodenal wall. The mean follow-up period after endoscopic sphincterotomy was 26.4 months (range 18 to 38 months). Eight patients had excellent results defined as absence of symptoms and no subsequent episodes of acute pancreatitis. Treatment of 1 patient was considered moderately successful because the patient still had occasional pain without pancreatic enzyme elevation but no subsequent episodes of acute pancreatitis. One patient had mild postprocedural pancreatitis. CONCLUSIONS: Recurrent pancreatitis and anomalous pancreaticobiliary union are associated with sphincter of Oddi dysfunction in children and adolescents. Endoscopic sphincterotomy is beneficial to these patients.

Endoscopic cholangiopancreatography in the infant: evaluation of a new prototype pediatric duodenoscope.

The usefulness of a new pediatric duodenoscope PJF in the diagnosis of neonatal cholestasis was studied in 23 infants with ages ranging from 19 to 150 days. In 22 of 23 infants the papilla was cannulated. In 13 of 14 neonates (93%) with neonatal hepatitis, the common bile duct was opacified and biliary atresia was excluded. In one of two neonates with choledochal cyst, the common bile duct was demonstrated. In six of seven neonates (86%) with biliary atresia, only the pancreatic duct was demonstrated and the diagnosis was suspected. Although absence of a common bile duct opacification does not rule out biliary atresia, ERCP with the new duodenoscope proved to be most useful in the diagnosis of normal biliary tree and served to avoid unnecessary surgery in most infants with neonatal cholestasis.

Trastornos motores esofágicos en pacientes pediátricos con estenosis cáustica

Objetivo: evaluar la función motora esofágica en niños con antecedente de dilataciones esofágicas endoscópicas por estenosis cáustica. Método: Estudio transversal prospectivo que incluyó: endoscopia digestiva superior con toma de biopsia en esófago distal, manometría esofágica y pHmetría intraesofágica de 24 horas. Resultados: Seis pacientes presentaron esofagitis cáustica IIB, cuatro esofagitis cáustica IIIA y uno esofagitis cáustica IIIB en el momento del accidente. Seis (54,5%) pacientes mostraron motilidad inefectiva y 4 (36,3%) aperistalsis del cuerpo esofágico. Al correlacionar la lesión esofágica al momento de ingerir el caústico con la alteración en la motilidad del esófago observada en la manometría no se apreció asociación estadística (p=0,2). Tampoco hay asociación entre la alteración de la motilidad esofágica y el tiempo de evolución desde el accidente hasta el momento de este estudio (p=0,9). Se demostró asociación estadística significativa entre la alteración motora esofágica y el número de dilataciones esofágicas endoscópicas, asi como con el tiempo que ameritó el paciente para resolver la estenosis. Conclusiones: Los pacientes que ingieren cáusticos y sufren lesiones esofágicas de moderadas a severas tienen una alta probabilidad de presentar trastornos motores importantes. Se demuestra la asociación entre el número de dilataciones necesarias para resolver la estenosis cáustica y la aperistalsis de todo el esófago.

Objective: to evaluate esophageal motor function in children with a history of endoscopic esophageal dilations due to caustic stenosis. Method: a prospective cross-sectional study that included: upper GI endoscopy with biopsy taken at the distal esophagus, esophageal manometry and 24 hours pH metry. Results: Six patients presented/displayed caustic esophagitis IIB, four caustic esophagitis IIIA and one caustic esophagitis IIIB at the moment of the accident. Six (54.5%) patients showed inefective motility and 4 (36.3%) aperistalsis of the esophageal body. When correlating the esophageal injury at the time of ingesting the caustic with the motility disorder of the esophagus shown during manometry there was no statistical association (p=0, 2). There is also no correlation between the alteration of the esophageal motility and the time of evolution from the accident to the moment of this study (p=0,9). A statistical significant association was demonstrated between the esophageal motor disorder and the number of endoscopic dilations, as well as with the time needed to solve the stenosis. Conclusions: Patients who ingest caustics and suffer moderate to severe esophageal injuries have a high probability of presenting/displaying important motor disorders. We demonstrate the association between the number of dilations necessary to solve the stenosis and the aperistalsis of the esophagus.

Sobrecrecimiento bacteriano del intestino delagado: presentación clínica en la edad pediátrica / Bacterial overgrowth of the intestine small: clinical presentation in pediatric age

El sobrecrecimiento bacteriano es la colonización del intestino delgado por microrganismos gram-negativos y anaerobios. Las bacterias del sobrecrecimiento bacteriano del intestino delgado pueden provenir tanto de la flora bacteriana colónica como del ambiente (ingestión de agua y alimentos contaminados). En la enteropatía ambiental, por ejemplo, el SCBID es debido al aumento de la carga bacteriana ingerida. La prueba de hidrógeno en aire espirado con lactulosa se utiliza cada vez más para el diagnóstico de SCBID, sobre todo en pacientes pediátricos. Determinar la incidencia de SCBID y precisar sus formas de presentación clínica. Estudio longitudinal prospectivo realizado desde marzo de 2002 hasta noviembre de 2003. Se incluyeron los pacientes que consultaron por presentar: distensión abdominal, gases, dispepsia, diarrea crónica y dolor abdominal. El plan de estudio incluyó: historia clínica, categorización socio-económica, evaluación antropométrica, examen de heces, endoscopia digestiva superior y prueba de hidrógeno en aire espirado con lactulosa. Los pacientes con diagnóstico SCBID recibieron metronidazol por 14 días. Se incluyeron 88 pacientes (6,88±4,03 años y 63,63 por ciento femenino). La prueba de hidrógeno en aire espirado con lactulosa fue positiva en 73 pacientes (82,95 por ciento). La forma clínica de presentación de los pacientes con SCBID fue: dispepsia en 57,14 por ciento, dolor abdominal en 28,57 por ciento, dispepsia con distensión abdominal en 3,57 por ciento, dolor abdominal con distensión en 3,57 por ciento y diarrea en 7,14 por ciento. La incidencia de SCBID fue de 5.2 por cada 100 pacientes referidos. Dispepsia y dolor abdominal fueron las formas clínicas de presentación más frecuentes en la edad pediátrica.

Sensibilidad rectal en pacientes con encopresis / Sensibility rectal in patients with encopresis

Se han descrito diferencias significativas en la sensibilidad rectal de pacientes estreñidos funcionales con encopresis al compararlos con individuos normales. Hasta la fecha no existen reportes en la literatura que evalúen estas anomalias fisiológicas comparando estreñidos funcionales con y sin encopresis, por lo cual diseñamos el siguiente trabajo de investigación. Estudio transversal prospectivo en un lapso de 48 meses, de 65 pacientes con estreñimiento funcional (20 encopréticos y 45 sin encopresis), a los que se les realizó manometría anorectal con sistema capilar neumohidráulico de infusión continua de baja compliance (bomba de Armdorfer y polígrafo Sinetics). Más del 70 por ciento de los pacientes reportó un umbral de sensación rectal con un volumen de 5 mL en sendos grupos (p=0,53). El umbral de defecación en el 35 por ciento de los pacientes encopréticos es mayor de 240 mL, mientras que los no encopréticos mostraron valores superiores a 240 mL, sólo en el 2,5 por ciento de los casos(p=0,002; Odds 0,052). El 60 por ciento de los pacientes encopréticos reportaron un volumen crítico superior a 240 mL, mientras que los estreñidos funcionales sin encopresis mostraron volúmenes superiores a este valor sólo en el 28,8 por ciento de los casos (p=0,05). Los resultados sugieren que la encopresis en los pacientes con estreñimiento funcional no es secundaria a una alteración de la sensación, sino a la severidad y tiempo de evolución de la enfermedad (recto más dilatado y con mayor compliance)