The development of the Port-a-Bidet: a portable bidet for people with minimal hand function.

Our Institute has investigated the expressed needs of many severely disabled people. One requirement was for a portable bidet that would fit on a standard toilet, so that they could still have some of the advantages of their automatic washing/drying/flushing toilet when away from their own house. Potential users were consulted, from the specification stage through to final production model testing, to ensure that the desired device was produced. The Port-a-Bidet is a lightweight device, with its own water container, spray unit, pump and power supply. It allows a user with very weak arms to wash themselves with warm water, and a hands-free drying method is explained in the instruction booklet. The whole unit is transported in a discreet carrying bag, and can easily be set up by an unskilled person. The Port-a-Bidet can be controlled by commercially available single switch activators, so that any user can operate it.

Observations on the BT PABA/14C-PABA tubeless test of pancreatic function.

The diagnostic accuracy of the BT PABA/14C-PABA tubeless test of pancreatic function was assessed in a prospective study of 140 patients. Drug or isotopic interference invalidated 16 tests (11.4%). The sensitivity of the PABA/14C excretion index was 76.7% and the specificity 85.7% using the mean -2 SD value of 0.82 as the cut-off point; 74.4% sensitivity and 95.7% specificity using the mean -3 SD value of 0.76. The potential usefulness and limitations of this modern version of the PABA test are discussed.

Relationship between PABA and Lundh tests: lack of influence of duodenal pH in vivo.

Twenty-five patients with chronic pancreatitis and 25 patients with non-pancreatic abdominal disorders were investigated by Lundh and BT PABA/14C-PABA tests of pancreatic function. The following results emerged: (1) There was a strong positive linear relationship between mean trypsin activity (MTA) and mean chymotrypsin activity (MCA) in duodenal aspirates after a Lundh test meal. (2) There was a strong positive linear relationship between chymotrypsin activity measured with BTEE, or BT PABA as substrate. (3) There was a strong positive correlation between MTA, or MCA, in duodenal juice after a Lundh meal and urinary PABA recovery, or the PABA/14C excretion index (PEI) in patients with chronic pancreatitis, but not in controls. (4) There was no correlation between the pH of duodenal juice in Lundh tests and PABA recovery, or PEI, in patients with or without pancreatic disease. We conclude that the Lundh and BT PABA/14C-PABA tests are equally discriminatory methods of assessing pancreatic exocrine function. The rate limiting effect of pH on BT PABA hydrolysis reported in in-vitro studies does not affect the practical clinical value of the BT PABA/14C-PABA test.

A comparison of the pepsin stimulating effects of secretin preparations.

1. The peptic responses to Boots, GIH and synthetic secretins have been compared in fasting anaesthetized cats in which the pylorus and bile duct were occluded to prevent the release of duodenal hormones by acid and bile salts. A quantity of dilute acid introduced into the stomach at regular intervals ensured the total recovery of viscid secretions and preserved peptic activity. 2. The mean peak outputs of pepsin obtained in response to Boots secretin were significantly greater than the mean peak outputs of pepsin stimulated by equipotent doses of GIH secretin (4 Crick-Harper-Raper units of Boots secretin have been shown to stimulate a flow of juice and bicarbonate from the pancreas equal to that produced by 1 clinical unit of GIH secretin). The maximum output of pepsin stimulated by Boots secretin, 16 C.H.R. u./kg hr was 3 times the observed maximum output in response to the 4 times more potent dose of GIH secretin, 16 c.u./kg hr. The slopes of the log dose-response lines were significantly different for these two products indicating that their modes of action in stimulating pepsin may not be identical. 3. The outputs of pepsin following GIH and synthetic secretin were similar. Both these secretins stimulated the secretion of pepsin when infused in doses which stimulated the pancreas supramaximally. The less pure product Boots secretin evoked significantly higher peptic responses at doses submaximal for pancreatic stimulation, suggesting that a substance other than secretin exists in Boots preparations which contributes significantly to the overall output of pepsin in response to this product. The peptic response which was accompanied by a slight increase in acid output, but without any increase in pancreatic lipolytic activity, was not inhibited by atropine. This substance which is not present in highly purified GIH secretin does not appear to be cholic acid, gastrin, pancreozymin, glucagon or insulin. 4. The possibility that a vasodilator substance is present in Boots secretin which by expanding the splanchnic bed increases the concentration of secretin at target sites in the stomach and pancreas seems unlikely, as the flow of pancreatic juice does not increase proportionately with the vast increase in pepsin. A vasodilator substance which specifically affects the gastric vasculature remains a theoretical but unlikely explanation for our observation.