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Biomedical subjects

G S Clayden

Publications and source records attributed to G S Clayden.

At least 19 recordsLinked to original sources
PubMed2002

Investigations for incontinence and constipation after surgery for Hirschsprung's disease in children.

Surgery for Hirschsprung's disease is associated with high rate of morbidity, in the form of either constipation or incontinence or a combination of the two. This study investigates the mechanisms responsible for incontinence and/or constipation following the pull-through operation for Hirschsprung's disease. There were 19 children (15 boys and 4 girls), who at the time of study; 16 had undergone Duhamel, 1 Rehbein, and 2 Soave operation. We classified patients according to their symptoms into 3 groups: Group A was incontinent of faeces; Group B was constipated and incontinent of faeces, and Group C was constipated only. The median age at referral was 6 years, and the median period after operation was 5 years. All patients were investigated by intestinal transit study, endoanal sonography and anorectal manometry. Group A had normal or rapid transit study, as opposed to Groups B and C, who had delayed-transit study. On endoanal sonography, all children had an intact internal and an external anal sphincter, below the level of pull-through operation. The anorectal manometry showed a significantly lower resting anal pressure in the incontinent Group A as compared to the constipated children with or without incontinence in Group B or C (38 mmHg versus 57 or 66 mmHg respectively). The rectal pressure was also significantly higher in children in Group A as compared to those in Group B or C (71 mmHg versus 42 or 36 mmHg). The ratio of rectal/anal pressure was higher in incontinent children in Group A, as compared to constipated children in Group B or C. Therefore, constipation can be caused by high anal resting pressure and a weak rectal peristalsis, while faecal incontinence can be secondary to poor compliance and elevated rectal pressure in the presence of normal or low anal sphincter resting pressure. Aperients are the mainstay of treatment of constipation, however, children with incontinence are more difficult to treat. We did not attempt to define the pattern of nerve plexus because of poor results of revision operation for residual hypoganglionic segment and intestinal neuronal dysplasia. Treatment of these children can become more rational, if furnished with detailed functional studies. We advocate investigation of the anorectal function at an early stage in symptomatic children after surgery for Hirschsprung's disease, and less invasive treatment should be considered before embarking on major surgery.

Child↗
PubMed2002

Evaluation of dysfunction following reconstruction of an anorectal anomaly.

To evaluate the utility of anorectal manometry (ARM) and magnetic resonance imaging (MRI) with an endocoil in the assessment of dysfunction in children with repaired anorectal anomalies (ARA), 15 patients aged 1 to 15 years with repaired ARAs and chronic faecal incontinence or constipation were prospectively recruited. They underwent clinical assessment using a modified Wingfield score (MWS). ARM and MRI with an endocoil and conventional external coil were carried out. The results of ARM alone, MRI alone, and a combination of ARM and MRI were correlated with the MWS. Manometric internal anal sphincter (IAS) scores determined from sphincter length and activity correlated with MWS (r = 0.56, P = 0.02); manometric scores of rectal peristaltic activity did not. Overall manometric score (IAS and rectal scores combined) showed a correlation with MWS (r = 0.55, P = 0.02). Endoanal MRI sphincter scores did not correlate with MWS, but the presence of a megarectum on MRI did (r = 0.44, P = 0.05). Overall MRI score did not correlate with MWS. Minor neurosacral anomalies were shown on MRI in 3 children who had poor functional scores. Combined manometric and MRI scores showed a correlation with MWS (r = 0.58, P = 0.01). ARM and MRI are potentially useful in the assessment of dysfunction of children with repaired ARAs. Both modalities require refinement and further assessment in the context of directing management.

Adolescent↗
PubMed1994

The clinical value of solid marker transit studies in childhood constipation and soiling.

Assessment of constipation in childhood is difficult, particularly when the presenting symptom is spurious diarrhoea or faecal incontinence. We have therefore assessed the clinical usefulness, reliability and acceptability of a solid marker transit technique in 52 patients with constipation (median age 8.0 years; range 2-13.5 years) at two referral centres. Median duration of symptoms was 60 months. Soiling was a prominent feature in 43 children (83%). Ten, 3 mm pieces of 6FG radio-opaque Silastic tubing were given orally at 9am on days 1, 2 and 3 and a plain abdominal film taken on day 5. Laxative treatment was not interrupted. Each film was divided into right colon, left colon and rectosigmoid areas, using bony landmarks, and the marker content of each area counted. The coefficient of variation of intra and inter-observer errors was 3.1% and 2.1% respectively. By day 5, 7% (group median) of markers were still in the right colon, 17% in the left colon and 42% in the rectosigmoid. Twenty-one patients (40%) had normal transit, 4 (8%) mild delay, 9 (17%) moderate and 18 (35%) severe transit delay. Marker distribution indicated slow pan-colonic transit in 29% and slow segmental transit in 10%. In 21%, clustering of markers in the rectosigmoid suggested outlet obstruction. A significant correlation was found between both transit delay and marker distribution and the severity of clinical symptoms of constipation and soiling. Repeat studies in six children following colonic evacuation revealed significant improvement (P < 0.05) in marker transit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Anorectal function of children with neurological problems. I: Spina bifida.

Anorectal function was assessed with anorectal manometry in 45 children with spina bifida (21 girls and 24 boys, mean age 11 1/2 years). 24 enuretic children served as controls. The pressure in the first and second centimeters of the anal canal was lower among index children than controls and also lower among those with high spinal lesions compared with those with low lesions. Rectal activity (rectal sensation and trace appearance) during rectal distension appeared to be reduced among index children; sensation was particularly poor among those with high spinal lesions. Manometry may be useful in children with spina bifida as it provides a clearer understanding of sphincter function and leads to a more rational approach to the management of bowel problems.

Adolescent↗
PubMed1993

Anorectal function of children with neurological problems. II: cerebral palsy.

In response to the frequent complaint of difficulties with defecation experienced by children with cerebral palsy, 34 children (13 girls and 21 boys, mean age 10 years) with cerebral palsy were investigated by questionnaire and anorectal manometry. 24 enuretic children served as controls for the anorectal manometry. Constipation affected 26 of 29, defecation distress eight and faecal incontinence 16 of the index children, but incontinence was mild in most cases. Index children had a low resting pressure in the first centimetre of the anal canal, slow anal rhythmical activity and a pressure increase in the first centimetre during maximum rectal distension. These findings suggest anal sphincter and/or pelvic floor muscle incoordination, but no evidence of abnormal rectal function. The authors conclude that surgical intervention was not indicated for the index children, but that medical treatment could be improved.

Adolescent↗
PubMed1988

Reflex anal dilatation associated with severe chronic constipation in children.

Data were collected from children with severe chronic constipation, and the appearance of the anus at presentation was noted. A visibly relaxed sphincter (indicating a degree of reflex anal dilatation) was seen in 20 children out of the 129 in whom this sign was sought. The only differentiating characteristic in this group of children was the greater degree of faecal loading judged on palpation of the abdomen. This evidence supports the hypothesis that constipation of such severity that it was referred to a specialised clinic can produce signs that may lead to an erroneous diagnosis of sexual abuse by anal penetration.

Adolescent↗
PubMed1988

Computer-assisted learning in medical education.

The advent of cheap and powerful micros has opened the possibility of computer-assisted learning (CAL) in medical education. This article attempts to demonstrate the educational value of CAL, with illustrations of its use. Four styles of CAL are examined, and the danger of trivializing the learning process discussed. The ultimate CAL package which enables students to take charge of their own learning is considered. There are considerable advantages in distance learning, self-assessment, computer-marked examinations and 'audit'. Some of the main problems are considered; these are decisions which must be taken about the choice of hardware and software. The use of various peripheral devices such as slide projectors and videodisc players greatly enhances the value of CAL material, as do alternative input devices. Some thought is given to software style in the presentation of material, and also to the question of the keeping of student records. The use of an author language facilitates program development, and the construction of content-free 'shell' programs enables new material to be added to existing frameworks. Other advantages of CAL include student access to JANET and the possibility of on-line searching of databases. CAL in medical education can help to liberate students from the burden of the rote learning of facts, and enhance the role of reason and imagination in the learning process.

Computer-Assisted Instruction↗
PubMed1984

The effect of ketamine anesthesia on anorectal manometry.

Two hundred and twenty-five patients aged from neonate to 15 years presenting with chronic constipation and soiling had anorectal manometry without sedation, and 142 patients in the same age range and with a similar range of presenting complaints had anorectal manometry using ketamine as an anesthetic. There were no significant differences between the groups in the resting pressures recorded in the anal canal, in the amount of inhibition with rectal distension, or in the frequency or amplitude of rhythmical activity of the internal anal sphincter. Classical inhibitory troughs were seen when expected in both groups as were signs of external sphincter activity. Ketamine anaesthesia is a suitable sedative which enables anorectal manometry to be performed on young or nervous patients and does not alter the qualitative or quantitative responses.

Adolescent↗
PubMed1982

Gastrointestinal permeability changes in the preterm neonate.

The lactulose/L-rhamnose urinary excretion ratio during continued infusion of milks containing both sugars was used as an index of the permeability of the neonatal bowel to large and small molecules. Healthy infants of gestational age 31-36 weeks proved to have a period of enhanced permeability to lactulose during the first week of life, the lactulose/L-rhamnose excretion ratio being significantly higher on day 2 than on days 9 or 16 when a mature pattern of permeability could be seen. In infants traumatised by asphyxia or sepsis this change was much less pronounced. Healthy preterm infants of gestational age 26-29 weeks showed a 'mature' pattern of permeability at birth, followed by a temporary period of enhanced permeability after 3-4 weeks of life. It is proposed that enhanced permeability to larger molecules is a specific temporary condition of the neonatal bowel in man as in other mammals, but the immunological implications in man remain to be established.

Digestive System Physiological Phenomena↗
PubMed1982

Metastatic duodenojejunal carcinoma from ovarian primary.

A 55-year-old woman presented with symptoms of progressive sub-acute high gastrointestinal obstruction. Barium studies, upper gastrointestinal endoscopy, ultrasound and ERCP were normal. Diagnosis was therefore delayed. At laparotomy, malignant tumours were found at the duodenojejunal flexure and left ovary, which were histologically identical and consistent with an ovarian primary. Endoscopic techniques for visualization of the third and fourth parts of the duodenum should be employed after barium studies, including careful screening in this area, have failed to reveal pathology.

Adenocarcinoma↗