radionuclide accumulation in the gastric mucosa which makes detection of ectopic mucosa, such as, in a Meckel's diverticulum substantially easier. Cimetidine should be given orally for 24 hours prior to imaging. However, in an emergency situation a single intravenous injection of cimetidine may be sufficient. In the pediatric age group, the dose of cimetidine should be 20 mg/kg/day, and the dose of radioactive pertechnetate should be 20 ~ Ci/kg. of body weight. The optimal time for demonstration of ectopic mucosa is 30 min following radionuclide injection.--Richard R. Ricketts
Snare polypectomy was performed easily for 13 polyps in 8 patients. No complications arose despite over 500 colonoseopic biopsies. The authors conclude that the technique is well-tolerated, reasonably quick, safe and allows accurate diagnosis. Abnormal Anal Sphincter Response in Chronically Constipated Children. V, A. Loening-Baucke and M. K. Younoszai.
J Pediatr 100:213-218, (February), 1982.
Paracentesis or peritoneal lavage was performed on 50 children for suspected intestinal gangrene or perforation. After antiseptic skin preparation, paracentesis was done using a 22-gauge or 25-gauge needle. The paracentesis site was either flank. The needle was advanced until 0.5 ml of peritoneal fluid was obtained. If no fluid was retrieved, peritoneal lavage using an 19-gauge plastic cannula with multiple perforations was utilized. Normal saline solution, 25 ml/kg, was injected into the peritoneal cavity. The peritoneal samples were analyzed for volume, color, clarity, RBC and WBC counts, differential count, gram's stain and cultured for aerobic and anaerobic bacteria. Using the criteria of brown peritoneal fluid and/or bacteria on gram's stain, all patients explored 'had intestinal gangrene. Among ten patients with negative findings on paracentesis who were explored, four had intestinal gangrene and six did not. Analysis of peritoneal fluid may improve the timing and accuracy of the operative decision .--George ,4. Rowe
Using a strain gauge, the authors measured anal sphincter function in 116 chronically constipated and 18 healthy children. Eighteen constipated children were reevaluated 2 mo later (receiving laxative), and 15 were again studied seven to 12 mo later. The anal resting tone varied along the length of the anal canal and was highest at 1-1.5 cm from the anal verge. This region was used to study the resting motor activity of the internal anal sphincter, the amplitude of the rectosphincteric reflex (RSR) after 30 and 60 ml rectal distension, and the rectosphincteric reflex threshold. The mean and resting tone was significantly lower in constipated than in control children (p < 0.001), but normalized in patients who recovered. Resting motor activity of the internal anal sphincter and the amplitude of RSR were significantly lower in constipated patients than were the corresponding values in control children (p < 0.001), and remained lower during and after treatment, even in patients who recovered. The length of the anal canal and the RSR threshold were comparable in control and constipated children. Thus, the basic problem in chronically constipated children appears to be an abnormal internal anal sphincter, which is weaker and less responsive to rectal distension than in nonconstipated children.--George Holcomb, Jr.
Double Purse String Suture Technique for Loop Colostomy Prolapse in Infants. J. 7". K. Lau, H. Saing, and G. B. Ong.
Role of Anorectal Sensation in Preserving Continence.
Paracentesis As An Aid To The Diagnosis of Intestinal Gangrene. ,4. M. Kosloske and J. F. Goldthorn. Arch Surg
177:571-575, (May), 1982.
Aust Paediatr J 18:58-59, (March), 1982. Loop colostomy in infants is a common procedure, performed mainly for lower large bowel obstruction. However, prolapse of the colostomy is a frequent complication. The authors describe a double purse string suture which they recommend to control the prolapse and which has produced encouraging results in 6 of 8 patients.--A. MacKellar Total Colonoscopy in Children. C, B. Williams, N. J. Laage,
C. ,4. Campbell, et al. Arch Dis Child 57:49-53, (January), 1982. One hundred and twenty-three fibreoptic colonoscopic examinations were performed on 115 children (64 males and 51 females) by one experienced endoscopist. Ages ranged from 3 mo to 16 yr, and the examinations, performed after bowel preparation and under sedation only (in 97%), took approximately 15 minutes. Total colonoscopy was performed in 188 instances: failure was due to stricture (3 cases) and poor bowel preparation (2 cases). Eighty percent of the examinations were regarded as "ordinary" or "easy," and the terminal ileum was examined in 63 cases. Indications for colonoscopy were; inflammatory bowel disease (79), bleeding per rectum (26), polyposis (4), polyp (3) and pain (3). The diagnosis was made and confirmed histologically in 96% of the patients with inflammatory bowel disease. The cause of bleeding was established in 38% of those with rectal bleeding.
M. G. Read and N. W. Read. Gut 23:345-347, (April), 1982. Nine healthy adult volunteers aged 19-25 yr underwent anal sphincteric function tests after the application of a topical anesthetic gel or KY jelly. The topical anesthetic successfully abolished sensation in all subjects and none of them could differentiate between air or water in the anal canal. The topical anesthesia did not impair continence to the rectal infusion of 1500 cc of saline. Topical anesthesia did not influence maximal basal sphincteric pressure, but it did significantly reduce maximum squeeze pressure and squeeze duration. These findings suggest that normal anal sensation is not essential for maintaining fecal continence, but that its major role may be to discriminate between flatus and feces and hence may act to indicate the necessity for defecation or to signal the end of defecation.--Richard R. Ricketts Triad of Anorectal, Sacral, and Presacral Anomalies.
G. Currarino, D. Coin, and T. Votteler. Am J Roentgenol 137:395-398, (August), 1981. Three infants (ages 5, 11, and 13 mo) presented with associated congenital anorectal stenosis, sacral defects and presacral masses (meningocele, teratoma and enteric cyst). The authors review similar patients in the literature and describe two possible embryologic events to explain the association of the lesions.--Randall W. Powell