Management principles of organic causes of childhood constipation.

Constipation is extremely common in the pediatric population; however, it is a symptom and not a disease. Organic causes of constipation include Hirschprung's disease, anorectal malformation, and spina bifida. This article also discusses constipation and urinary tract pathology and dysfunction. The function of the gastrointestinal and urinary tracts are intertwined, and this concept will assist the practitioner in managing patients accordingly. Children and adolescents who experience bowel dysfunction require patience and sensitive support from their health care providers so that they can live productive and emotionally healthy lives.

Safety of gentamicin bladder irrigations in complex urological cases.

PURPOSE: Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary tract. The purpose of this study was to assess the safety of this therapy. MATERIALS AND METHODS: A retrospective study was performed of all children treated with gentamicin bladder irrigations from 1999 to 2004. The dose was 14 mg gentamicin in 30 ml saline instilled via catheter once or twice daily. Serum creatinine and random gentamicin levels were obtained according to a protocol based on risk of gentamicin toxicity. Patient demographics, laboratory results and outcomes were abstracted from the medical records. RESULTS: A total of 80 patients (38 males and 42 females) were identified. Median patient age was 10 years and median duration of treatment was 90 days. No patient had detectable serum gentamicin levels greater than 0.4 mg/dl. Small increases in serum creatinine were seen in 3 patients, all of whom had chronic renal insufficiency. A total of 21 patients (26%) had breakthrough UTIs, of which 5 (24%) were gentamicin resistant. No adverse events were documented. CONCLUSIONS: Gentamicin bladder irrigations are a helpful adjunct in the management of complex pediatric urological cases involving recurrent symptomatic bacteriuria. We no longer require intensive laboratory monitoring of low risk patients at our institution.

Effects of steric constraint on chromium(III) complexes of tetraazamacrocycles, 2. Comparison of the chemistry and photobehavior of the trans-dichloro- and trans-dicyano- complexes of cyclam, 1,4-C2-cyclam, and 1,11-C3-cyclam.

The synthesis and characterization of several Cr(III) complexes of the constrained macrocyclic ligand 1,11-C3-cyclam (1,4,8,11-tetraazabicyclo[9.3.3]heptadecane) is reported. Only trans complexes are formed, and the structure of trans-[Cr(1,11-C3-cyclam)Cl2]PF6 is presented. The chemical and photophysical behavior of the 1,11-C3-cyclam complexes are compared with those of the corresponding cyclam (1,4,8,11 tetraazacyclotetradecane) and 1,4-C2-cyclam (1,4,8,11-tetraazabicyclo[10.2.2]hexadecane) complexes. The aquation rate of trans-[Cr(1,11-C3-cyclam)Cl2]+ is similar to that of the corresponding 1,4-C2-cyclam complex and is more than 5 orders of magnitude faster than the cyclam counterpart. A monotonic increase in the extinction coefficient is observed on going from the cyclam complexes to the 1,11-C3-cyclam complexes to the 1,4-C2-cyclam complexes, and this is related to the degree of centrosymmetry in each complex. The trans-[Cr(1,11-C3-cyclam)(CN)2]+ complex is a weak emitter in aqueous solution with a room-temperature emission maximum at 724 nm (tau=23 micros). Like the corresponding 1,4-C2-cyclam complex (tau=0.24 micros), the 1,11-C3-cyclam complex shows no deuterium-isotope effect in room-temperature solution. This is in marked contrast to the corresponding cyclam complex which has an emission lifetime of 335 micros and a significant deuterium isotope effect in room-temperature solution. Low temperature (77K) data are also presented in an attempt to understand the differences in photophysical behavior.