Revisão sistemática e metanálise do uso de procinéticos no refluxo gastroesofágico e na doença do refluxo gastroesofágico em Pediatria / Systematic review and meta-analysis of the use of prokinetics in gastroesophageal reflux and in gastroesophageal reflux disease in Pediatrics

OBJETIVO: Avaliar, por meio de revisão sistemática e metanálise, estudos randomizados que comparam os procinéticos domperidona, bromoprida, metoclopramida e betanecol ao placebo no tratamento do refluxo gastroesofágico (RGE) e da doença do refluxo gastroesofágico (DRGE) em crianças. MÉTODOS: BUsca bibliográfica de ensaios clínicos randomizados (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). O desfecho primário foi eficácia na modificação dos sintomas de refluxo, conforme definição de autores das fontes primárias. Outras variáveis de interesse foram: complicações relacionadas ao RGE, alterações nos exames laboratoriais de controle, qualidade de vida, eventos adversos e abandono do tratamento. RESULTADOS: Foram incluídos quatro estudos com domperidona, dois com metoclopramida, um com betanecol. Nenhum estudo com bromoprida foi localizado. O risco de não resposta ao tratamento foi significativamente menor para os procinéticos quando comparados ao placebo (RR 0,35; IC95 por cento 0,14-0,88). A vantagem terapêutica individual em relação ao placebo se manteve para a domperidona (n=126; RR 0,27; IC95 por cento 0,14-0,52; NNT 3; I2 0 por cento) e betanecol (n=44, RR 0,19, IC95 por cento 0,05-0,55, NNT 2), mas não para metoclopramida (n=71; RR 0,63; IC95 por cento 0,07-5,71, I2 92,2 por cento). CONCLUSÕES: A evidência para o uso de procinéticos no RGE e na DRGE em crianças é limitada, pois os poucos estudos são ensaios preliminares de resposta em curto prazo e com limitações metodológicas.

OBJECTIVE: To evaluate, by systematic review and meta-analysis, randomized studies comparing the prokinetics (domperidone, bromopride, metoclopramide and bethanechol) to placebo in the treatment of gastroesophagic reflux (GER) and gastroesophagic reflux disease (GERD) in children. METHODS: Bibliographic search for randomized clinical trials (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). The primary outcome was the modification of reflux symptoms. Other outcomes were: GER-related complications, alterations in control exams, life quality, adverse events and abandon of treatment. RESULTS: The metanalysis included four studies on domperidone, two on metoclopramide, and one on bethanechol. No study of bromopride was retrieved. The risk of non-response to the treatment was significantly smaller in children that received prokinetics in comparison to placebo (RR 0.35, 95 percentCI 0.14-0.88). Individual therapeutic advantage regarding placebo was related to domperidone (n=126; RR 0.27; 95 percentCI 0.14-0.52, NNT 3; I2 0 percent) and bethanechol (n=44; RR 0.19; 95 percentCI 0.05-0.55; NNT 2), but not to metoclopramide (n=71; RR 0.63; 95 percentCI 0.07-5.71; I2 92.2 percent). CONCLUSIONS: The evidence for prokinetic use in GER and GERD in children is limited because the few studies report preliminary trials that evaluate short-term responses and show methodological limitations.

Diabetic neurogenic bladder / 대한비뇨기과학회지

During the last ten years, 7.384 patients with diabetes mellitus were managed at Seoul National University Hospital. Among them 1,026 patients (13.9%) were diagnosed as diabetic neuropathy and 84 (1.1%) as diabetic neurogenic bladder with severe voiding dysfunction. We analyzed clinical informations. laboratory and radiologic findings. results of urodynamic study and treatment modalities and outcomes. Thirty one patients were eligible, including 13 men and 18 women. The mean duration of diabetes was 9.4 years before severe voiding dysfunctions developed. Significant amount of residual urine was detected in all patients ranging from 300cc to 1,900 cc. Urodynamic study was done in 16 patients, all showed flaccid neurogenic pattern with increased bladder capacity over 500cc. Bacteriuria was found in 24 patients (77.4%), including 8 mixed infections. Hydronephrosis was identified in 7 out of 11 radiologically evaluated patients. Other diabetic chronic complications were found in most of the patients. diabetic retinopathy in 24 (77.4%). nephropathy in 13 (41.9%). and peripheral neumpathy in 24 (77.4%). They were managed successfully with timed voiding and double voiding in 2 patients, and urecholine medication with or without phenoxybenzamine in 6. and intermittent catheterization in l8. Education of the patients and high suspicion and full recognition of medical persons about diabetic neurogenic bladder is necessary for decrement of the development of diabetic neurogenic bladder, for early detection and prevention of severe complication such as renal and bladder impairment.

Uso de medicamentos proquinéticos del tubo digestivo en niños / Use of prokinetic drugs of the digestive tract in children

Se revisan las bases anatómicas, bioquímicas y neurofisiológicas del aparato digestivo. Asimismo, se analiza la farmacología de las principales drogas con acción procinética a nivel del tracto gastrointestinal, sus indicaciones, efectos secundarios y dosis en pediatría.

Bethanechol-induced restricted stimulation of pancreatic juice secretion in mice

La liberación ("out-put") de enzimas y el volumen de secreción pancreática fueron estudiados "in vivo" en ratones, bajo estimulación con betanecol. La curva dosis-respuesta para ambos parámetros se ajustó a un patón bifásico, implicando que el flujo de jugo pancreático participa también en el fenómeno de estimulación restringida

Estudio in vivo de la secreción de calcio por el páncreas exocrino del raton: relación con la secreción enzimática / In vivo study of the calcium secretion by the exocrine pancreas of mice: relationship with enzymatic secretion

La secreción de calcio y su relación con la secreción de quimiotripsina (QT) por el páncreas del ratón, in vivo, fueron determinadas en jugo pancreático puro colectado bajo tres condiciones de estimulación: secretina 32 mU/gm; secretina 32 mU/mg más colecistocinina 16 mU/gm y secretina 32 mU/gm más betanecol 0.2 ug/gm. En las muestras obtenidas se determinó actividad de quimotripsina y calcio secretado en 30 minutos luego de la estimulación. La secreción de calcio y QT fue mayor en ratones tratados con secretina más CCK y secretina más betanecol. En estos dos últimos grupos, entre ambos parámetros se estableció una correlación positiva. Las rectas obtenidas no fueron diferentes de una recta única y la extrapolación al origen indica que existe calcio en el jugo pancreático aún ausencia de secreción enzimática. Los resultados obtenidos concuerdan con la existencia de al menos dos mecanismos diferentes de secreción de calcio por el páncreas exocrino del ratón

Malacoplaquia del colon: utilidad del betanecol. / Malakoplakia of the colon usefullness of bethanechol

Se presenta un caso de malacoplaquia del colon en un nino de ocho anos siete meses de edad, cuya evolucion clinica fue torpida a pesar del manejo intensivo presentando mejoria clinica muy evidente al asociar betanecol al tratamiento. Asi mismo se revisa la literatura medica sobre la experiencia en ninos y se comentan los aspectos bigentes en relacion a la fisiopatologia del padecimiento asi como el posible efecto especifico del medicamento en esta enfermedad. Finalmente, se sugiere que el tratamiento debe hacerse con: antibioticos de amplio espectro, betanecol y acido ascorbico, asociacion el manejo intensivo

Bethanechol chloride and urinary retention in anorectal surgery: a prospective randomised study

Between July 1982 and June 1983, 300 patients undergoing anorectal operations for benign conditions were selected to evaluate the role of Bethanechol Chloride [BC] in the prevention of Urinary Retention [UR]. One hundred fifty patients received 6 doses of BC, 25mg. Q 6hours postoperatively. The other 150 patients were used as control. All patients were otherwise managed identically. Major UR was significantly lowered in patients receiving BC. Other factors contributing to UR were also evaluated. The incidence of UR was found to be high in patients having Hemorrhoidectomy, in patients undergoing general anesthesia and in the 40-49 yr. age group

Bladder Dysfunction after Radical Abdominal Hysterectomy / 대한비뇨기과학회지

Bladder dysfunction is a common occurrence following radical hysterectomy. It is a direct consequence of the intraoperative disruption of the autonomic nerve supply to the bladder. We herein evaluated 158 patients who underwent radical hysterectomy for carcinoma of cervix in the Dept. of Obstet.-Gynecol., Seoul National University Hospital into two separate part. In Part 1,140 patients who received the surgery from Jan. 1980 to Dec 1981 were subjected to this study. The records and the follow-up results were analysed retrospectively. Immediate postoperatively, 44.7% of patients presented bladder dysfunction such as large residual urine over 100 cc and delayed perception of bladder filling sensation. In 6 month follow-up group, 15.8% of patients complained urologic symptoms such as strain. stress incontinence, urgency and sensory loss. In 1 year follow-up group, the same symptoms were persisted in 11.5% of patients. In Part 2, urodynamic test was performed in 10 patients preoperatively and 18 patients postoperatively. No differences were found between two groups except marked increase of bladder volume at the first voiding sensation. Urecholine denervation test of Lapides was done in 18 patients postoperatively and three patients revealed positive test, which means partial parasympathetic detrusor denervation. To decrease the incidence of bladder dysfunction, the use of suprapubic cystostomy, subcutaneous injection of urecholine, intermittent self catheterization are recommended rather than indwelling urethral catheter. Urodynamic test is necessary to define the nature and to manage the patients with bladder dysfunction after radical hysterectomy.

Bladder Dysfunction after Radical Abdominal Hysterectomy / 대한비뇨기과학회지

Bladder dysfunction is a common occurrence following radical hysterectomy. It is a direct consequence of the intraoperative disruption of the autonomic nerve supply to the bladder. We herein evaluated 158 patients who underwent radical hysterectomy for carcinoma of cervix in the Dept. of Obstet.-Gynecol., Seoul National University Hospital into two separate part. In Part 1,140 patients who received the surgery from Jan. 1980 to Dec 1981 were subjected to this study. The records and the follow-up results were analysed retrospectively. Immediate postoperatively, 44.7% of patients presented bladder dysfunction such as large residual urine over 100 cc and delayed perception of bladder filling sensation. In 6 month follow-up group, 15.8% of patients complained urologic symptoms such as strain. stress incontinence, urgency and sensory loss. In 1 year follow-up group, the same symptoms were persisted in 11.5% of patients. In Part 2, urodynamic test was performed in 10 patients preoperatively and 18 patients postoperatively. No differences were found between two groups except marked increase of bladder volume at the first voiding sensation. Urecholine denervation test of Lapides was done in 18 patients postoperatively and three patients revealed positive test, which means partial parasympathetic detrusor denervation. To decrease the incidence of bladder dysfunction, the use of suprapubic cystostomy, subcutaneous injection of urecholine, intermittent self catheterization are recommended rather than indwelling urethral catheter. Urodynamic test is necessary to define the nature and to manage the patients with bladder dysfunction after radical hysterectomy.

Post-spinal Cauda Equina Syndrome / 대한마취과학회지

Cauda equina syndrome is characterized by urinary retention, loss of sexual function, loss of sensation in the perineal region and incontinence of feces. It had been reported by Courville, Kennedy, et al early in 1950. Since then Dripps, Vandam, Philips and others have reviewed many thousands of cases for evalustion of neurologic complications following spinal anesthesia, but there has not been a single case of permanent neurologic sequels reported. This 32 year old male with this postspinal neurologic complication was admitted to this institution on the twelveth post-operative day. His surgery had been carried out under spinal anesthesia for removal of an exostosis of the left knee at a local clinic. According to the history at the local clinic, a lumbar tap was performed at the level between L4-5, then 5% lidocaine in 5% D/W was injected into the subarachnoid space and the surgery was finished untevenfully. He developed pain in his buttocks and coccygeal region 6 hours after the surgery was done, so morphine sulfate was injected into the epidural space. After that, the pain was relieved for a while but he again started having the same pain associated with loss of sensation of the lower extremities, urinary retention, constipation and penile impotence on the 10th post-operative day. He came to this institution for 3 months with the above symptoms on the twelveth post-operative day. A cystoscopy and cystometry was done and showed a neurogenic bladder. He was treated with Urecholine for urinary retention and Dexamethasone for arachnoiditis for 2 months. He also had enemas intermittently for severe constipation and a Foley catheter was inserted. He was trained to void by himself by pressing his lower abdomen. He went home with the same symptoms after the Foley catheter was removed. The possible complications and preventions were listed in tabel l and ll. We will follow the patient.

Urinary Retention as a Complication of Spinal Anesthesia / 대한마취과학회지

Urinary retention has been well documented as a complication of spinal anesthesia. This occurs somewhat more frequently than after general anesthesia because the bladder wall, supplied by the parasympathetic system is paralysed by local anesthetics and its fibers from S2 are very susceptihle to analgesic solution. For 5 years since 1974, 127 cases of urinary retention were recorded from 4733 cases of spinal analgesia performed at the Dong San Medical Center. The incidence of urinary retention is 2.7% in our data. In this article, two cases of prolonged urinary retention due to spinal anesthesia are described. Case l A 44 year old female was scheduled for a vaginal hysterectomy because of a prolapse of the uterine cervix. Spinal tapping was performed at L(4~5), and 16 mg of 0.4% Pontocaine was administered. The surgery was uneventful and the patient slept from Nembutal during the whole procedure. Postoperatively the patient developed retention of urine without any abnormality observed by cystoscopy, so that she was treated with urecholine orally and recovered on the 14 th postoperative day. Case ll The patient was a 39 year old female, scheduled for a cholecystectomy. Spinal analgesia was performed and the patient was put to sleep by Nembutal and the surgery was uneventful during the whole procedure. She complained of the difficulty of voiding postoperatively. She was started on urecholine 20 mg tid orally from the 7th postoperative day, then she started voiding on the 10th postoperative day. Since then there have been no problems. The mechanism and the precipitating factors are described.