Gastric emptying of water in children with severe functional fecal retention

The objective of this study was to evaluate gastric emptying (GE) in pediatric patients with functional constipation. GE delay has been reported in adults with functional constipation. Gastric emptying studies were performed in 22 children with chronic constipation, fecal retention and fecal incontinence, while presenting fecal retention and after resuming regular bowel movements. Patients (18 boys, median age: 10 years; range: 7.2 to 12.7 years) were evaluated in a tertiary pediatric gastroenterology clinic. Gastric half-emptying time of water (reference range: 12 ± 3 min) was measured using a radionuclide technique immediately after first patient evaluation, when they presented fecal impaction (GE1), and when they achieved regular bowel movements (GE2), 12 ± 5 weeks after GE1. At study admission, 21 patients had reported dyspeptic symptoms, which were completely relieved after resuming regular bowel movements. Medians (and interquartile ranges) for GE1 and GE2 were not significantly different [27.0 (16) and 27.5 (21) min, respectively (P = 0.10)]. Delayed GE seems to be a common feature among children with chronic constipation and fecal retention. Resuming satisfactory bowel function and improvement in dyspeptic symptoms did not result in normalization of GE data.

A functional study of caustic strictures of the esophagus in children

The objective of the present study was to assess esophageal motor function in 21 children (7.5 ± 2.9 years) with caustic strictures. Esophageal manometry was performed using a water-infusion system interfaced with a polygraph and displayed on a computer screen. The data were compared with those obtained from 9 healthy children. Radionuclide transit was determined by studying deglutition of a single bolus of 99mTc pertechnetate in 10 ml of water. Non-peristaltic low-amplitude and long-duration waves were the most common findings detected in patients with strictures longer than 20 percent of esophageal length (N = 11). Compared with the control group, these patients presented lower mean amplitude and longer mean duration of waves (24.4 ± 11.2 vs 97.9 ± 23.7 mmHg, P < 0.05, and 6.7 ± 2.4 vs 1.6 ± 0.1 s, P < 0.05, respectively). Six patients presented low-amplitude waves just below the constricted site. Ten children presented delayed esophageal transit. There was an association between dysphagia and abnormalities on manometry (P = 0.02) and between symptoms and scintigraphy data (P = 0.01). Dysphagia in caustic strictures is due to esophageal motility abnormalities, which are closely related to the scarred segment.

The role of videolaparoscopy in the diagnostic and therapeutic approach of nonpalpable testis

OBJECTIVE: Evaluate the results from the first 5 years of experience with laparoscopy for diagnosis and treatment of nonpalpable testes. MATERIALS AND METHODS: Medical records of 51 patients submitted to laparoscopic testicular exploration, during a 5-year period, were retrospectively analyzed. Patients' mean age was 65.7 months (median = 48) on the first procedure. The youngest patient was 10 months and the oldest was 14 years old on the first surgery. Twenty-four (47 percent) patients presented nonpalpable testes bilaterally, 7 (14 percent) only at the right side and 20 (39 percent) at the left, totaling 75 testicular units assessed. Patients who had their testes palpated after anesthetic induction were excluded from the study, and in all other cases, surgical management was based on the testicular position and viability. During the post-operative follow-up, surgical success was classified as palpable testis in scrotal sac, with adequate consistency and volume. RESULTS: Nine (12 percent) testes were not localized, but their vessels and deferent duct were atrophic. Two (3 percent) testes were intra-abdominal and atrophic, and 2 (3 percent) gonads, in the same patient, had a dysmorphic aspect. Nineteen (25 percent) testicular units were located close to the internal inguinal ring (peeping testes) and, in 22 (29 percent) units, the spermatic vessels and deferent duct penetrated the internal inguinal ring. Eight (10 percent) testes were located at a distance of less than 2 cm from the internal inguinal ring and 13 (17 percent) at a distance greater than 2 cm. The 2 intra-abdominal atrophic testes were removed. Inguinotomy was performed in a total of 41 (54 percent) cases, reaching a surgical success of 89 percent. Laparoscopic orchiopexy in one stage, without vascular ligation, was performed in 9 (12 percent) testes, which presented a distance of less than 2 cm from the internal inguinal ring, also with a surgical success index of 89 percent. Orchiopexy in 2 stages, with ligation of the spermatic vessels, was performed in 13 (17 percent) testicular units located at a distance greater than 2 cm from the internal inguinal ring, reaching 77 percent of good results. CONCLUSION: Videolaparoscopy is a safe and effective method for diagnosis and treatment of nonpalpable testis.

PHmetria esofagica abreviada: correlacion de valores del indice de reflujo (IR) en examenes de 8 a 24 hs / Eigth hours pHmetry: correlation of the GE reflux index

Los trazados de 23 pHmetrias esofagicas realizadas entre Enero y Agosto de 1995 fueron analizados retrospectivamente para determinar si un periodo mas corto de evaluacion (8hs) podria producir los indices determinador por la monotorizacion de 24 hs. Fueron analizados los siguientes indices en las primeras 8 hs. de trazado y en el trazado completo de 24 hs: IR; indice de reflujo (por ciento de tiempo con pH menor de 4), AUC; rea bajo la curva de pH<4 y 10 indice oscilatorio (por ciento tiempo con pH entre 3,75 y 4,25). Los valores normales indicados en la literatura para cada uno de estos par metros (IR<4 por ciento AUC<2000 y 10<10 por ciento) fueron utilizados para clasificar los trazados en "normales" y "alterados". El IR se mostro "alterado" en 11 trazados de 8 hs. y en 11 de 24 hs. Hubo un falso positivo y un falso negativo. La sensibilidad y especificidad fueron calculadas respectivamente en 90,9 por ciento y 91,6 por ciento y el valor predictivo positivo en 90,9 por ciento. Los valores de AUC y OI se encontraron "normales" en todos los trazados a las 8 y 24 hs y no fue posible analizarlos. Aunque muchos trabajos afirman que la pHmetria abrevida tiene indices de sensibilidad inferiores a los observados en ex menes de 24 hs, segun nuestros resultados podemos afirmar que el IR tomado en un periodo de 8hs durante el dia es representativo de 24 hs. y se puede utilizar para confirmarel diagnostico de reflujo de la infancia