Pediatric Feeding Tube Research Articles

Devices designed to avoid wrong route administration of drugs

In March 2007 and November 2009 the National Patient Safety Agency (NPSA) published safety alerts with regards to ‘promoting safer measurements and administration of liquid medicines via oral and other enteral routes’ and ‘safer spinal (intrathecal), epidural and regional devices’ [1–3]. These alerts were prompted by several serious incidents of wrong-route administration of drugs over the years. Several action plans have been suggested to reduce the risk of wrong-route administration of drugs. The main proposal is to create and implement a system of medical devices for each route that cannot physically connect to devices meant for another route. This means we have to stop using medical devices with the standard Luer connectors other than for one specific route (probably intravenous) [4]. The NPSA recommended that specific oral/enteral syringes should be in use by March 2008 and that spinal/epidural/regional needles and syringes with safe connectors should be in use by April 2012 [1–3]. But with several different companies producing a variety of medical devices, it is clear that there will be some connections overlooked. Cook et al. demonstrated this during their study to evaluate the usability of two alternative systems in 2010; following feedback the connectors have been modified [5]. However, this is still an ongoing issue: recently we discovered it is possible to connect an oral/enteral syringe to spinal devices with the Surety® connectors (Intervene Limited, Chesterfield, UK) and to connect a spinal/epidural/regional syringe with the Surety® connector to a paediatric nasogastric feeding tube. Both these situations can occur despite the devices’ having different connectors and without too much additional force (2, 3). The oral/enteral syringe connected to a spinal needle with the Surety® connector. The spinal/epidural/regional syringe with the Surety® connector connected to a paediatric nasogastric feeding tube. Although the possibility of having oral/enteral syringes within the clinical area whilst performing a spinal procedure and accidentally administering their contents is very remote, it is possible and has even been hinted at in the February 2011 Neuraxial Update [6]. We believe it is pointless to change from an existing system, with a rare but potentially catastrophic consequence, to another with a differing, rare but potentially catastrophic consequence. Thus, in the presence of the reverse Luer connectors of enteral feeding devices, the adoption of the Surety® non-Luer fittings cannot be recommended. The other issue in relation to the development of non-Luer connectors is the quality of the new devices. This has been highlighted in a Joint Statement published by our profession earlier this year, raising concerns that there will be an increased risk to patients undergoing anaesthesia due to the introduction of new neuraxial connectors into clinical practice in England and Scotland without formal testing [7]. Our opinion is that these issues rather defeat the whole idea behind the NPSA’s recommendation of a different fitting for devices meant for each different route. More time is needed to test the connectors thoroughly to ensure no cross-connectivity and to ensure a high quality product to deliver medications.

Use of Continuous Marcaine Irrigation in the Management of Suppurative Flexor Tenosynovitis

We describe a surgeon, nursing, and patient-friendly method of treating acute pyogenic tenosynovitis using a 2-incision, closed sheath irrigation method and postoperative usage of a continuous marcaine ON-Q pain pump. The advantages of this technique include the ease of catheter placement intraoperatively and the use of a smaller diameter tubing within the flexor sheath. In addition, this technique eliminates the need for nursing staff to perform irrigation, and most importantly, the technique results in improved postoperative pain control allowing an early aggressive postoperative therapy protocol. We retrospectively reviewed 9 patients with an average age of 42.8 years (range: 20 to 66 y) who presented with acute pyogenic flexor tenosynovitis. All patients underwent surgery on the day of presentation to us with the described technique with the catheter left in place for 2 days. Outcome measurements included length of hospital stay, final range of motion, recurrence of infection, and complications. Average hospital stay was 2.8 days (range: 2 to 6 d). There were no recurrent infections. Seven patients regained full total active motion of the involved digit. The 2 patients with incomplete recovery of digital motion regained 125 and 105 degrees of total active motion, respectively. In addition, there were 3 minor complications including cold intolerance (2 patients) and local skin necrosis that responded to local wound care (1 patient). This novel method of managing acute flexor tenosynovitis seems to be safe, effective, and very friendly for surgeons, nurses as well as patients. Intraoperative pearls for catheter placement using a 22-guage wire inside a musical sharp5 pediatric French feeding tube are also described.

Prospective randomized pilot trial comparing closed suction drainage and gravity drainage of the pancreatic duct in pancreaticojejunostomy

Pancreaticojejunal anastomotic leakage remains a major complication after pancreatoduodenectomy, and various means of preventing pancreatic leakage have been studied over the past few decades. The purpose of this study was to determine whether closed suction drainage provided a better option than gravity drainage in pancreaticojejunostomy. Between 2004 and 2006, a total of 110 patients who underwent pancreaticojejunostomy at our institute were enrolled in this prospective randomized pilot study. Fifty-five patients were allocated to the closed suction drainage (CD) group and 55 to the gravity drainage (GD) group. In each patient a polyethylene pediatric feeding tube was inserted into the remnant pancreatic duct across a duct-to-mucosa type pancreaticojejunostomy and totally externalized. The tube was then connected to the aspiration bag of a Jackson-Pratt drain to generate negative pressure or to a bile bag for natural drainage. Pancreatic fistulas were defined and graded as A, B, or C according to the international study group for pancreatic fistulas (ISGPF) criteria. No differences were found between the GD and CD groups in age, sex distribution, or diagnosis. A pancreatic fistula occurred in 24 patients (43.6%) in the GD group and in 14 (25.5%) in the CD group (P = 0.045). In the GD group, grade B and C fistula occurred in 6 patients (10.9%), whereas in the CD group, this occurred in 5 patients (9.1%). In this study, temporary external drainage of the pancreatic duct with closed suction drainage significantly reduced the incidence of grade A pancreatic fistula. A follow-up randomized prospective multicenter study has been initiated.

Pancreaticoduodenectomy with External Drainage of the Pancreatic Remnant

Leakage of the pancreaticojejunal anastomosis is a serious complication after pancreaticoduodenectomy. External drainage of the pancreatic remnant is one of several methods for reducing pancreaticojejunal anastomotic leakage or fistula. We investigated complications after pancreaticoduodenectomy with and without external drainage of the pancreatic remnant. Patients who underwent pancreaticoduodenectomy at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from November 1991 to October 2007 were enrolled. Before 2001, no external pancreatic drainage was employed during pancreaticojejunal anastomosis (non-stented group). Since 2001, external drainage of the pancreatic remnant has been routinely performed with a paediatric feeding tube (stented group). There were 28 patients in the non-stented group and 45 in the stented group. Stented patients had undergone significantly more previous abdominal operations, pylorus preserving pancreaticoduodenectomy, and end to end anastomosis of the pancreatic remnant and jejunal limb. Leakage of the pancreaticojejunal anastomosis or pancreatic fistula, overall complications, and re-laparotomy rate were significantly higher in the non-stented group (leakage or fistula 21.4% vs. 6.7%, overall complications 50% vs. 33.3%, and re-laparotomy 18% vs. 2.2%). The only death was in the non-stented group. External drainage of the pancreatic remnant after pancreaticoduodenectomy is an effective method for prevention of pancreaticojejunal anastomosis leakage and other related complications.

A technique for intragastric gavage of radiolabeled liquid cholesterol in rabbits (Oryctolagus cuniculus) using a pediatric feeding tube

The author describes a method of intragastric gavage in rabbits using a pediatric feeding tube. Researchers used this technique to administer radiolabeled cholesterol in a pilot study of cholesterol efflux. The author discusses specific considerations for gavaging rabbits, emphasizing occupational safety and rabbit welfare.

Stability of Partial Doses of Omeprazole–Sodium Bicarbonate Oral Suspension

Omeprazole-sodium bicarbonate powder for oral suspension has recently been marketed. The manufacturer provides no information regarding the acceptability of using partial doses and recommends that the reconstituted suspension be administered immediately after preparation. To determine the stability of the powder for oral suspension over 45 days, evaluate the stability of a partial dose (<20 mg) following exposure to Simulated Gastric Fluid USP (SGF) over 2 hours, and determine the feasibility of administering the suspension through neonatal and pediatric nasogastric feeding tubes compared with lansoprazole. Three identical samples of omeprazole-sodium bicarbonate suspension 2 mg/mL were stored in the refrigerator (3-5 degrees C) and assayed by high-performance liquid chromatography immediately after preparation and at 7, 15, 30, and 45 days. Stability of a 1 mg/kg dose with an estimated volume of SGF for a simulated 12.7 kg pediatric patient was determined in triplicate over 2 hours at 37 degrees C. The ability to administer a typical dose of omeprazole suspension and lansoprazole suspension (microgranules and water compounded from lansoprazole oral disintegrating tablets) was assessed in triplicate using 3 different sizes of neonatal/pediatric nasogastric feeding tubes. At least 98% of the initial concentration of omeprazole remained throughout the 45 day study period in all suspensions. The suspension maintained at least 93% of the initial concentration following exposure to SGF for 2 hours. The lansoprazole bead mixture partially clogged the 6 French feeding tube and completely clogged the 5 French feeding tube. The omeprazole-sodium bicarbonate suspension was easily administered through all 3 sizes of neonatal/pediatric feeding tubes. Omeprazole-sodium bicarbonate suspension 2 mg/mL prepared from 20 mg packets was stable for at least 45 days when stored at 3-5 degrees C. A partial dose of 12.7 mg was stable following exposure to SGF for 2 hours at 37 degrees C. This suspension can be easily administered through 5, 6, and 8 French neonatal/pediatric feeding tubes and, when taking time and ease of preparation into account, it is cost competitive with simple omeprazole suspension.

Does Pancreatic Duct Stenting Decrease the Rate of Pancreatic Fistula Following Pancreaticoduodenectomy? Results of a Prospective Randomized Trial

Pancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two hundred thirty-eight patients were randomized to either receive a pancreatic stent (S) or no stent (NS), and stratified according to the texture of the pancreatic remnant (soft/normal versus hard). Four patients were excluded from the study; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed. Patients who randomized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis. In patients with a soft pancreas, 57 randomized to the S group and 56 randomized to the NS group. In patients with a hard pancreas, 58 randomized to the S group and 63 randomized to the NS group. The S and NS groups for the entire study population, as well as for the subgroup of high-risk patients with soft pancreata, were similar as regard to demographics, past medical history, preoperative symptoms, preoperative procedures, and intraoperative data. The pancreatic fistula rate for the entire study population was 9.4%. The fistula rates in the S and NS subgroups with hard pancreata were similar, at 1.7% and 4.8% (P = 0.4), respectively. The fistula rates in the S and NS subgroups with soft pancreata were also similar, at 21.1% and 10.7% (P = 0.1), respectively. A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation (e.g., anastomotic technique, anastomotic orientation, pancreatic duct size, and number of intra-abdominal drains placed). In patients with soft pancreata, 63% percent of the pancreatic fistulas in stented patients required adjustment to the clinical pathway (including two deaths), compared to 47% of the pancreatic fistulas in patients in the NS group (P = 0.3). Internal pancreatic duct stenting does not decrease the frequency or the severity of postoperative pancreatic fistulas.

Holocord intramedullary abscess due to dermal sinus in a 2-month-old child successfully treated with limited myelotomy and aspiration

This 2-month-old child presented with paraplegia. The authors observed a dermal sinus with purulent discharge in the lumbosacral area. Magnetic resonance (MR) imaging of the spine revealed an intramedullary enhancing cavity spanning C-1 to the conus medullaris. Intraoperatively the dermal sinus was seen to infiltrate the lower end of the conus medullaris, and it also communicated directly with the central canal. The L2-5 laminae were removed, and a myelotomy was undertaken on the conus medullaris. A No. 8 French pediatric feeding tube was passed into the abscess cavity and advanced rostrally to the level of C-1. Aspiration was applied via the feeding tube to drain the intramedullary abscess of the spinal cord (IASC). Postoperatively, a 6-week course of intravenous cloxacillin was instituted. Follow-up MR imaging revealed complete resolution of abscess. When the patient was 26 months of age, examination showed complete neurological recovery. The authors describe what, to their knowledge, is the first case of a holocord IASC treated successfully by the aforementioned technique, and review of the related literature.

Therapeutic amnioinfusion for intrapartum fetal distress using a pediatric feeding tube

Objective: To evaluate the role of therapeutic amnioinfusion using a pediatric feeding tube in cases of intrapartum fetal distress. Methods: A randomized clinical trial including 438 women admitted in labor at Assiut University Hospital with nonreassuring fetal heart rate tracing. Using sealed opaque envelopes, the women were randomized to 2 groups. In the amnioinfusion group they underwent transcervical amnioifusion (1000 mL of warmed sterile saline solution) in addition to conventional treatment. In the control group they received conventional treatment only. The primary outcome was cesarean section rate for fetal distress. The secondary outcomes were neonatal and maternal complications. Results: The amnioinfusion group showed a significant reduction in the rate of cesarean section for fetal distress (relative risk [RR], 0.7; 95% confidence interval [CI], 0.6–0.83), and a 30% reduction in abnormal fetal heart rate patterns (RR, 0.7; 95% CI, 0.6–0.83). Significantly fewer newborns had Apgar scores less than 7 at 1 and 5 min in the amnioinfusion group than in the control group (RR, 0.38; 95% CI, 0.26–0.55 and RR, 0.31; 95% CI, 0.15–0.64, respectively). Significantly fewer newborns had meconium below the vocal cords in the amnioinfusion group than in the control group (RR, 0.36; 95% CI, 0.13–0.97). Moreover, 14 newborns in the amnioinfusion group needed admission to the intensive care unit vs. 31 newborns in the control group. There were no significant differences between the 2 groups regarding the incidence rates of uterine hypertonus and maternal temperature higher than 38 °C. Conclusion: Therapeutic amnioinfusion is a simple and effective intervention that reduces the rates of cesarean section for intrapartum nonreassuring fetal heart tracing. In under-resourced settings, it can be performed using inexpensive catheters.

Minimizing central bile duct injury during radiofrequency ablation: use of intraductal chilled saline perfusion--initial observations from a study in pigs.

To determine whether intraductal perfusion with chilled saline reduces thermal injury to bile ducts during radiofrequency (RF) ablation. In swine, anesthesia was induced and the common bile duct was surgically cannulated with a pediatric feeding tube. RF thermal lesions were created adjacent to bile ducts by using an expandable-hook 2-cm RF electrode and 90-W generator. In three pigs, chilled saline was perfused through the ducts at 1.5 L/h (26 mL/min), and in another pig, room-temperature saline was perfused at the same rate. In three pigs (control group), RF lesions were created without perfusion. After 48 hours, animals were sacrificed. Periductal sections from all animals were reviewed by a liver pathologist. The degree of injury to biliary epithelium and subepithelial glands was assessed on a scale of 0%-100%. Significance of differences between degrees of injury was assessed with the Mann-Whitney test. In the control group, there was a mean of 100% injury to biliary ductal epithelium and 99.3% to subepithelial ductal glands. In the room-temperature saline group, there was a mean of 100% biliary epithelial injury and 84.4% glandular injury. In the chilled saline group, there was a mean of 52.9% ductal epithelial injury and 12.1% subepithelial glandular injury. In comparison with the control group, there was significantly less (P <.05) thermal injury to biliary epithelium in the chilled saline group and to subepithelial glands in both the room-temperature and chilled saline perfusion groups. RF-induced bile duct injury may be decreased significantly with an intraductal infusion of chilled saline.

Emergency dorsal slit for balanitis with retention

The two JRSM articles on foreskin disorders and their management1,2 prompt us to report the following case. A boy aged was seen after 48 hours of penile pain and retention of urine. In the past a non-retractile foreskin had been noted but there had been no previous episodes of balanitis. On examination, there was ballooning and erythema of the foreskin over the glans penis. After intravenous antibiotics, examination under anaesthesia revealed frank pus within the foreskin (which later yielded a growth of Escherichia coli). The phimotic foreskin was retracted, a dorsal slit was performed, and the bladder was emptied via a 6F paediatric feeding tube (Figure 1). The child left hospital next day with a prescription for a week of oral antibiotics. At outpatient review the wound had healed; the parents then opted for circumcision. Figure 1 Postoperative appearance Acute urinary retention secondary to balanitis-phimosis has not, to our knowledge, been described previously. We have found one report of chronic retention (with bilateral hydroureteronephrosis and vesicoureteral reflux) from this cause, with nocturnal enuresis as the presenting symptom.3 For management we favour the dorsal slit4 since it relieves the acute urinary obstruction, facilitates the drainage of pus and preserves the foreskin. Furthermore, emergency circumcision is technically difficult because of the gross oedema and it carries a greater risk of postoperative infection.

Experimental study of acid burden and acute oesophagitis.

The relationship of the pH of oesophageal refluxate and its pepsin content to injury of oesophageal mucosa remains unclear. A study was made of the earliest morphological alterations in the oesophageal mucosa secondary to varying concentrations of hydrochloric acid with or without pepsin. Adult cats had varying concentrations of acid with and without 1 per cent porcine pepsin infused into the oesophagus through a paediatric feeding tube placed 5 cm above the oesophagogastric junction at a rate of 1 ml/min for 30 min. At autopsy 24 h later, the oesophagus was removed intact and scored by an expanded modification of a previously published histopathological scoring system. This included estimates of the intensity and distribution of four morphological features: basal cell hyperplasia (BCH), intraepithelial leucocytes (IELs), subepithelial leucocytes and ulcers. Each of these four categories was scored from 0 to 4, with a maximum injury score of 16. Mean(s.e.m.) scores were as follows: pH 1, 15.0(1.0); pH 1 with pepsin, 13.3(1.4); pH 2, 15.3(0.7); pH 2 with pepsin, 11.7(1.1); pH 3, 1.8(1.6); pH 3 with pepsin, 3.7(1.9); pH 4 with or without pepsin, 0.6(0.2). Differences between pH 3 and 4 versus pH 1 and 2 were significant (P < 0.05). Injury to the oesophagus is more dependent on the pH of refluxate than on the presence of pepsin. Peptic injury appears to occur at a critical threshold of acid burden (pH < 3) as opposed to a graded level of injury based on a pH scale.

A Comparison of the Accuracy of Abdominal Ultrasound to Uterine Sounding to Determine Depth of Embryo Transfer

Objectives: Successful IVF requires attention to detail at the time of embryo transfer (ET). Our program has recently noted a significant, sustained increase in clinical (60%) and ongoing (51%) pregnancy rates. This improvement coincides with a decision to replace uterine sounding with abdominal ultrasound to determine depth of ET. The change in protocol may explain the observed improvement in outcome.Design: Retrospective chart review.Materials & Methods: From April through December 1999, pretreatment uterine sounding was performed on all IVF candidates with a calibrated 8 French pediatric feeding tube (Curity). Depth and axis of the endometrial cavity with a full bladder were recorded for future comparison.On the day of ET, abdominal ultrasound was used to determine optimum transfer depth. When possible, embryos were deposited 1 cm from the top of the endometrial stripe with a TDT (Laboratoire CCD) or Edwards-Wallace (Cooper Surgical) catheter. Length of the cavity was calculated as the sum of the length of catheter inserted through the external os plus the distance from catheter tip to the top of the endometrial stripe.Results: A discrepancy of at least 1 cm existed between sounding and ultrasound measurements in 21.8% of all cases. Tabled 1Transfers<1 cm discrepant≥1 cm discrepantNulliparous1169026Multiparous40328Total15612234 Open table in a new tab In multiparas, errors in uterine sounding underestimated the actual size of the cavity in all observed cases (8/8), increasing the likelihood of ET into the lower uterine segment. Sounding errors in nulliparas tended to overestimate cavity size (21/26) when compared to ultrasound measurement. No significant difference in overall incidence of discrepant measurements was noted between groups (20.0% vs. 22.4%).Conclusions: Uterine sounding to determine depth for ET may be misleading. Transabdominal ultrasonography with a full bladder at time of transfer suggests that, independent of parity, uterine sounding misrepresents the extent of the longitudinal axis of the endometrial cavity 21.8% of the time. A consequence of this imprecision may be lower pregnancy rates and, in some situations, increased risk for ectopic pregnancy. We conclude that implementation of ultrasound guided ET avoids the ambiguity of uterine sounding alone and may enhance IVF outcomes. Objectives: Successful IVF requires attention to detail at the time of embryo transfer (ET). Our program has recently noted a significant, sustained increase in clinical (60%) and ongoing (51%) pregnancy rates. This improvement coincides with a decision to replace uterine sounding with abdominal ultrasound to determine depth of ET. The change in protocol may explain the observed improvement in outcome. Design: Retrospective chart review. Materials & Methods: From April through December 1999, pretreatment uterine sounding was performed on all IVF candidates with a calibrated 8 French pediatric feeding tube (Curity). Depth and axis of the endometrial cavity with a full bladder were recorded for future comparison. On the day of ET, abdominal ultrasound was used to determine optimum transfer depth. When possible, embryos were deposited 1 cm from the top of the endometrial stripe with a TDT (Laboratoire CCD) or Edwards-Wallace (Cooper Surgical) catheter. Length of the cavity was calculated as the sum of the length of catheter inserted through the external os plus the distance from catheter tip to the top of the endometrial stripe. Results: A discrepancy of at least 1 cm existed between sounding and ultrasound measurements in 21.8% of all cases. Tabled 1Transfers<1 cm discrepant≥1 cm discrepantNulliparous1169026Multiparous40328Total15612234 Open table in a new tab In multiparas, errors in uterine sounding underestimated the actual size of the cavity in all observed cases (8/8), increasing the likelihood of ET into the lower uterine segment. Sounding errors in nulliparas tended to overestimate cavity size (21/26) when compared to ultrasound measurement. No significant difference in overall incidence of discrepant measurements was noted between groups (20.0% vs. 22.4%). Conclusions: Uterine sounding to determine depth for ET may be misleading. Transabdominal ultrasonography with a full bladder at time of transfer suggests that, independent of parity, uterine sounding misrepresents the extent of the longitudinal axis of the endometrial cavity 21.8% of the time. A consequence of this imprecision may be lower pregnancy rates and, in some situations, increased risk for ectopic pregnancy. We conclude that implementation of ultrasound guided ET avoids the ambiguity of uterine sounding alone and may enhance IVF outcomes.

Localization of Simian immunodeficiency virus-infected cells in the genital tract of male and female Rhesus macaques

The SIV/ Rhesus macaque model of HIV transmission has led to an increased understanding of the interactions between virus and host during the sexual transmission of HIV. SIV can be transmitted across the intact mucosa (stratified squamous epithelium) of the foreskin and glans of the penis of Rhesus macaques. SIV-infected cells can be found at all levels of the male Rhesus macaque reproductive tract and SIV can infect cells in the mucosal epithelium of the foreskin of the penis. SIV can be transmitted to female Rhesus macaques by infusing a cell-free virus suspension into the vaginal canal through a soft plastic pediatric nasogastric feeding tube. There does not appear to be any correlation between inoculation at any particular point in the menstrual cycle and the susceptibility of an animal to infection. Furthermore, the surgical removal of the cervix and uterus did not affect the dose of cell-free virus required for the genital transmission of SIV. Thus, target cells for SIV are present in the vaginal mucosa. In chronically-infected female Rhesus macaques, SIV-infected cells are present in the uterus, cervix and vagina. SIV-infected CD1a + and p55 + Langerhans cells are also found within the stratified squamous epithelium of the vagina. Taken together these results are consistent with the hypothesis that the virus initially infects antigen-presenting cells in the vagina (macrophages and Langerhans cells) and then subsequent rounds of replication occur in the draining lymph nodes prior to spreading to more proximal lymphoid nodes and finally to the bloodstream and distant lymphoid tissue.

The bioavailability of 26Al-labelled aluminium citrate and aluminium hydroxide in volunteers.

A study was undertaken to determine the fraction of ingested aluminium taken up by two male volunteers, following their ingestion of either aluminium citrate or aluminium hydroxide. In addition, the effects of simultaneous citrate ingestion on the gastrointestinal absorption of aluminium from its hydroxide was studied. Volunteers received three oral doses of 26Al-labelled aluminium compound in water. The doses were administered directly into the stomach using a paediatric feeding tube. Blood samples were collected from the volunteers at 1, 4 and 24 h after administration, and their daily output of urine and faeces was collected for 6 days. These samples were analysed for their 26Al content using either coincidence gamma-counting or accelerator mass spectrometry. The uptake of aluminium was greatest following its administration in the citrate form and was least following intake as the aluminium hydroxide suspension. The co-administration of citrate, with the aluminium hydroxide suspension, was found to enhance the levels of 26Al uptake in both volunteers. Using a urinary excretion factor based on the results of previous studies, the fractional aluminium uptake from each of the species was calculated: aluminium citrate, 5.23 x 10(-3); aluminium hydroxide, 1.04 x 10(-4); aluminium hydroxide with citrate, 1.36 x 10(-3).

Sonohysterography: a technique for endometrial evaluation.

Sonohysterography involves the instillation of sterile saline under continuous sonographic visualization to assess the endometrial cavity. The technique is most useful for evaluating women with fertility problems, postmenopausal bleeding, or an abnormal endometrial interface as seen at baseline sonography. The procedure is performed with saline instilled into the endometrial cavity through a 5-F pediatric feeding tube or a hysterosalpingography or insemination catheter. In the normal uterus, the endometrium appears symmetric, surrounding the anechoic, saline-distended endometrial cavity. Adhesions appear as bridging bands of tissue that distort the uterine cavity or as very thin, undulating membranes, best seen at real-time examination. An intracavitary polyp is seen surrounded by anechoic fluid, with the point of attachment and thickness of the stalk clearly demonstrated. The location of leiomyomas can be determined: Intramural lesions do not distort the endometrial cavity, whereas submucosal lesions often do, with the overlying normal layer of endometrium clearly seen. In women with abnormal bleeding, focal areas of asymmetric endometrial thickening can be identified. Sonohysterography allows differentiation of intracavitary, endometrial, and submucosal abnormalities without the use of ionizing radiation or contrast agents.

Pediatric Urology: Newborn Penile Glans Amputation During Circumcision and Successful Reattachment

Pediatric Urology: Newborn Penile Glans Amputation During Circumcision and Successful Reattachment

An original method of urethral catheter fixation in neonates and small children

The indications for use of a transurethral catheter are well known, but the type of catheter and type of external fixation used vary in the different pediatric age groups. In children under the age of 2 years we use a soft pediatric feeding tube for catheterization of the bladder and a silicone nipple for external fixation of the tube with excellent results.

The effect of a filling catheter during urodynamics

A prospective crossover study of 35 patients was performed to investigate the effect of a filling catheter upon closure pressure, functional length, and total urethral length. Urethral pressure profiles were done while the patients were in the sitting position with a full bladder, both with and without a 6 F pediatric feeding tube in the urethra. Both closure pressure and functional length were significantly higher with the filling catheter in situ. Urethral pressure profiles were different in all patients with the filling catheter in place. Urethral pressure profiles and cystometrograms should be done without filling catheters, using the smallest microtransducer catheters available, to avoid artifactual effects.

Loss of carbamazepine suspension through nasogastric feeding tubes

The apparent loss of carbamazepine suspension during administration through polyvinyl chloride nasogastric feeding tubes in vitro was studied. Twelve methods of administering carbamazepine suspension (100 mg/5 mL) were tested; the methods differed with respect to nasogastric tube size, presence and type of diluent, and type of flush solution. Undiluted or 50% diluted carbamazepine suspension 200 mg was drawn up in a syringe and forced through adult or pediatric nasogastric feeding tubes. The tubes were immediately flushed twice with 50 mL of sterile water, 0.9% sodium chloride solution, or 5% dextrose solution, by using the same syringe used to administer the suspension. Samples were collected and analyzed for carbamazepine concentration by high-performance liquid chromatography. Each administration method was tested six times, and the results were subjected to analysis of variance. Significant loss of carbamazepine was noted for four of the six methods in which undiluted suspension was administered. In these methods, adult and pediatric tubes were flushed with sterile water or 0.9% sodium chloride. No significant loss of drug occurred for any of the methods involving the use of diluent. Significant losses were associated with diluent and flush solution but not nasogastric tube size. Carbamazepine suspension should be mixed with an equal volume of diluent before being administered through nasogastric feeding tubes.