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Am Surg. 1995 Feb;61(2):135-8.
Malrotation in the older child: surgical management, treatment, and outcome.

Maxson RT, Franklin PA, Wagner CW.

Arkansas Children's Hospital, Little Rock 72202.

Malrotation in the neonate is an anomaly for which there are clear indications for surgery. However, the management of the older patient with this entity is not well defined. At Arkansas Children's Hospital, we reviewed our patients who were older than two years of age with malrotation. Between 1978 and 1993, 22 cases ages 2-23 years were identified. The most common presenting symptoms were vomiting 15 (68%), colicky abdominal pain 12 (55%), and diarrhea 2 (9%). Other symptoms were hematemesis 1 (5%), and constipation 1 (5%). The duration of symptoms averaged 28 months, range 2-96 months. All diagnoses were made by upper gastrointestinal (UGI) series, except for one that was recognized during an exploratory laparotomy for an intestinal duplication. A Ladd's procedure with appendectomy was performed in all cases. A significant number of patients in our series (41%) were found to have either a volvulus or internal hernia at exploration that was not clearly demonstrated by the diagnostic studies. Intestinal resection was performed in two patients for ischemic bowel. There were no perioperative deaths. Postoperative complications consisted of a wound infection in one patient. Total relief of symptoms occurred in 64% of patients. All patients with volvulus or internal hernia had resolution of symptoms, and all patients reported partial relief of their chronic symptoms. Surgical therapy eliminates the possibility of loss of bowel from volvulus or internal hernia, which is not always evident on diagnostic radiographic examination. Surgery is also highly effective in alleviating the chronic symptoms in these children. We believe, therefore, that surgical treatment is clearly indicated in the older child with proven malrotation.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7856973&dopt=Abstract constipation laxative colon cleansing

Indian Pediatr. 1994 Jan;31(1):55-7.
Mothers' beliefs and practices regarding prevention and management of diarrheal diseases.

Kaur A, Chowdhury S, Kumar R.

Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh.

PIP: In India, 48 mothers with at least one child aged less than 5 years living in two villages of Raipur Rani block in Haryana were interviewed to determine whether their beliefs and practices had changed after the diarrheal diseases control program was implemented. The researchers planned to use the findings to improve the program's promotional strategy. 23% believed that eating uncovered food, eating dirty or stale food, eating mud, and dirty feeding bottles were causes of diarrhea. Other perceived causes of diarrhea to be excessive heat (75%), specific foods (52%), over-eating (22.9%), excessive cold (14.5%), teething (14.5%), side effects of medication (6.2%), top milk (4.2%), and constipation (4.1%). Only 10.4% knew specific ways to prevent diarrhea. 85.5% approved of continuing breast feeding during diarrhea, while, before the program, most mothers withheld breast milk. Previously, 98.1% would restrict foods during diarrhea, now only 35% would do so. 50% believed less fluids than the normal amount should be given during diarrhea. 65% thought that the usual amount of food should be given. 68.8% would administer home remedies to treat diarrhea. 18.8% would begin oral rehydration therapy at home. If diarrhea is serious or home remedies do not work, 83.7% would seek a local medical practitioner and 16.3% would go to government health facilities. 54% had used oral rehydration solution in the past. 42.9% of them knew how to prepare it correctly and 70.5% knew how to administer it correctly. Recognized danger signs during diarrhea included lethargy (54.1%), at least eight watery stools/day (41.6%), frequent vomiting (27.1%), weakness (20.8%), dry and sunken eyes (16.6%), anorexia (12.5%), loose skin (6.2%), fever (4.

J Nucl Med. 1995 Mar;36(3):513-7.
Gallium-67 complexes as radioactive markers to assess gastric and colonic transit.

Bellen JC, Chatterton BE, Penglis S, Tsopelas C.

Nuclear Medicine Department, Royal Adelaide Hospital, Australia.

Constipation and gastroparesis are gastrointestinal tract disorders that can be assessed by using radioactive markers in conjunction with scintigraphic techniques. Indium-111-DTPA is the radiopharmaceutical of choice for treating colonic transit in constipated patients, but it is an expensive product and its availability has been unreliable. Indium-113m-DTPA was the tracer used in our study to determine the liquid gastric emptying rate in dual-isotope solid/liquid emptying studies, however, cessation of the 113Sn/113mIn generator production makes it unavailable. Thus, development of alternative tracers to 111In-DTPA and 113mIn-DTPA was essential. METHODS: Gallium-67-citrate and 67-Ga-EDTA were compared to 111In-DTPA to assess their efficacy for exclusive retention in the Gl tract. These markers were orally administered into rats and their three-day cumulative fecal excretion, urine excretion and carcass retention were measured. An in vitro gastric emptying model was used to determine liquid phase partitioning of 113mIn-DTPA, 67Ga-citrate and 67Ga-EDTA at 37 degrees. RESULTS: Gallium-67-citrate was predominantly excreted in the feces (97.2% +/- 0.2%) after three days, with negligible urine excretion (0.1% +/- 0.0%) and carcass retention (0.6% +/- 0.2%). These results are analogous to those obtained for 111In-DTPA for fecal excretion (96.7% +/- 2.6%), urine excretion (0.6% +/- 0.0%) and retention in the carcass (0.2% +/- 0.0%). Gallium-67-EDTA showed similar partitioning in the liquid phase of the gastric emptying model compared with 113mIn-DTPA. CONCLUSION: Gallium-67-citrate is an economical and readily available alternative to 111In-DTPA as a colonic transit radiopharmaceutical. Gallium-67-EDTA is also an alternative to 113mIn-DTPA for assessing liquid-phas

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