OBJECTIVE:The purpose of this study was to determine whether constipation is a disorder of defecation or of impaired motility by using defecography and transit studies.MATERIALS AND METHODS:Thirty-five patients (34 women, one man) with severe constipation underwent defecography and colonic transit studies in a 2-month period. Transit studies included the use of orally administered radiopaque markers and plain abdominal radiographs obtained up to 4 days later. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum.RESULTS:Normal colonic transit time was observed in seven (20%) of the 35 patients. Abnormal findings included colonic inertia in six (17%) patients, hindgut dysfunction in 10 (29%) patients, and outlet obstruction in 12 (34%) patients. Rectocele, enterocele, descending perineum syndrome, and dyskinetic puborectalis were found equally in both groups of patients. Rectal prolapse was more commonly found in patients with hindgut dysfunction and outlet obstruction (p < .05).CONCLUSION:Surgical or medical management of severely constipated patients relies on objectively identifying the underlying pathophysiology. Our findings suggest that constipation is often a disorder of defecation rather than an impairment of colonic motility.

The purpose of our investigation was to compare external sphincterotomy, the traditional method of treatment of detrusor-external sphincter dyssynergia (DESD), with two newer methods, balloon dilatation or internal stenting of the external sphincter. Sixty-one spinal cord injured (SCI) men were prospectively evaluated. The indications for treatment were DESD and voiding pressure greater than 60 cmH2O demonstrated during video-urodynamic study. Twenty patients were treated with balloon dilatation of the external sphincter, 26 with an internal stent prosthesis, and 15 with traditional external sphincterotomy. Age and duration of SCI were similar among the three treatment groups. A significant decrease in both voiding pressure and residual urine from presurgery levels persisted during the follow-up period of 3 to 26 months (mean, 15 months) in all three groups. Bladder capacity remained constant, renal function improved or stabilized, and autonomic dysreflexia (AD) improved in all three groups. Balloon dilatation and prosthesis placement are associated with a significantly shorter length of surgery (p = 0.045), length of hospitalization (p = 0.005), decrease in hospitalization cost (p = 0.01), and decrease in hemoglobin postoperatively (p = 0.046) when compared to external sphincterotomy. Complications of stent insertion included device migration (three patients) and secondary bladder neck obstruction (two patients). In the balloon dilatation group, three recurrent sphincter obstructions, one case of bleeding requiring transfusion, and one case of bulbous urethral stricture occurred. After external sphincterotomy, two patients developed recurrent obstruction, two required blood transfusion, and 1 patient noted erectile dysfunction. Balloon dilatation and prosthesis placement both proved to be as effective as external sphincterotomy in the treatment of DESD.(ABSTRACT TRUNCATED AT 250 WORDS)

Annals of the New York Academy of SciencesVolume 562, Issue 1 p. 358-359 Cocaine and Pregnancy: Maternal and Infant Outcome SUSAN LIVESAY, SUSAN LIVESAY Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this authorSAUNDRA EHRLICH, SAUNDRA EHRLICH Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this authorLYNN RYAN, LYNN RYAN Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this authorLORETTA P. FINNEGAN, LORETTA P. FINNEGAN Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this author SUSAN LIVESAY, SUSAN LIVESAY Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this authorSAUNDRA EHRLICH, SAUNDRA EHRLICH Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this authorLYNN RYAN, LYNN RYAN Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this authorLORETTA P. FINNEGAN, LORETTA P. FINNEGAN Department of Pediatrics Jefferson Medical College Thomas Jefferson University Philadelphia, Pennsylvania 19107Search for more papers by this author First published: June 1989 https://doi.org/10.1111/j.1749-6632.1989.tb21038.xCitations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume562, Issue1Prenatal Abuse of Licit and Illicit DrugsJune 1989Pages 358-359 RelatedInformation

Newborns exposed in-utero to opiates and/or nonopiates frequently undergo NAS. This study evaluated:1)the relationship between the type of maternal drug use and the incidence of NAS and 2)which of 3 treatment drugs was most effective-- paregoric, phenobarbitol, or diazepam. NAS was assessed by a scoring system related to drug dose. Successful treatment was considered when one drug controlled the NAS. Of the 300 infants, 176(59%) were treated for NAS and 124(41%) required no treatment. Maternal drug use consisted of opiates(33%), non-opiates(14%)and varying combinations of both(53%). Infants exposed to non-opiates in-utero were less likely to undergo abstinence(36%) than those exposed to opiates(58%) or both(70%). The mean number of days to control symptoms of NAS was 7.6, and duration of treatment averaged 38,6 days, The efficacy of treatment drug for NAS depended upon the type of drug exposure in-utero. If maternal drug use included opiates alone, paregoric was the drug most successful in controlling NAS (87% of infants). In maternal non-opiate use, phenobarbital was most effective(100%). In maternal opiate and non-opiate use, paregoric was most effective(88%). Treating an infant with diazepam indicated the need for a second treatment drug in 70% of cases, regardless of maternal drug use (p=.001). These data suggest that:1)effective NAS treatment is related to the type of maternal drug use, 2)there is a higher incidence of NAS in infants prenatally exposed to opiates alone or in combinnation with non-opiates, and 3)diazepam is Ineffective as a treatment agent for NAS.

Little is known about TCA use in pregnancy and infant outcome. This study evaluated Infants born to MM women who were concurrently prescribed TCA's for the treatment of depression. Subjects included:1)18 infants born to MM women also exposed in-utero to imipramine(N=3) or doxepin(N=15) in doses ranging from 25mg, to 100mg. and 2)18 infants born to MM women not exposed to TCA's in-utero. The women were similar with regard to age, race, gravidity, parity, methadone dose, number of prenatal visits and socioeconomic status. Although types of illicit drug use in pregnancy differed between groups, these differences were taken into account in the analysis. The infant variables compared in the 2 groups were: gestational age, birth weight, head circumference, intrauterine growth, 1 and 5 min. Apgar scores, length of hospital stay, infant complications and neonatal abstinence. Infants in the TCA group were born earlier than controls(37.1 wks. VB, 38,7wka., p<.05), other differences between groups included lower birth weight, smaller head circumferences and lower Apgar scores, and were attributable to gestational age differences. The groups were found similar on other variables. Within the TCA group, when comparisons were made according to trimester prescribed, infants exposed during the 3rd trimester were found to be born earlier and somewhat smaller than infants with 1st and/or 2nd trimester exposure. These results suggest continued caution in prescribing TCA's in MM pregnant women. Their use can only be jxistified when the benefits outweigh the potential risks.

Maternal drug abuse during pregnancy exposes the fetus to the possibility of toxic or addicting effects. At a methadone hydrochloride maintenance program providing medical care to drug-dependent women and their infants, ophthalmologic examinations of all infants born during a 36-month period were performed. Twenty-nine infants prenatally exposed to psychoactive drugs were seen at birth and on follow-up. The 24% prevalence of strabismus found in the drug-exposed infants was significantly greater than that of 2.8% to 5.3% reported in the general population. These data suggest that maternal drug abuse and increased methadone dosage during pregnancy may predispose infants to the development of strabismus.

The outcome of infants born to cocaine-using drug dependent women was compared to that of infants of non-cocaine using drug dependent and non-drug dependent women. The study population included 150 pregnant women: 50 women used heroin and methadone plus cocaine, 50 used heroin and methadone minus cocaine, and 50 were non-drug dependent women. Significant differences were found between the cocaine and drug-free groups in infant birth weight, length, head circumference and Apgar scores, with the cocaine group having lower values for each variable. Average gestational age did not vary between the 3 groups. The cocaine group included 1 spontaneous abortion and 4 fetal deaths; non-cocaine drug dependent women had 2 fetal deaths, with none in the control group. Mean abstinence scores for 19 of the physiological and behavioral parameters were lower in the cocaine group than in the non-cocaine drug dependent women with the exception of vomiting and convulsions. These data suggest that: (1) infants born to drug dependent women have a poorer general outcome than those born to non-drug dependent women; (2) maternal cocaine use does not appear to increase the incidence of severe neonatal abstinence symptomatology; (3) pregnancies complicated by cocaine abuse have a greater chance for fetal loss resulting from both spontaneous abortions and fetal death; (4) infants born to cocaine abusing women had infants with decreased birth weight, head circumference, length and Apgar scores.

Cross-sectional USM of brain structures were done to evaluate the brain growth of infants undergoing abstinence due to narcotic exposure in-utero in comparison to that of control infants. The groups were comparable in sex, race, socioeconomic status, birth weight, gestational age and Apgar scores. Mathers of the drug exposed infants had been maintained on methadone during pregnancy and many were known to use undetermined quantities of other psychoactive drugs. USM were performed at 72 hours, 1 month and 6 months after birth. Transaxial images were done at two levels: 1) the maximal circumference of the thalami and 2) the margins of the lateral ventricles where they parallel the midline. Intracranial hemidiameter (ICHD) was recorded at this level. Head circumferences (HC) were also measured. Results revealed significant differences in the overall pattern of brain growth between the two groups (p=.05). No increase in the incidence of hemorrhage, structural abnormalities or dampened arterial pulsations was noted. However, at 72 hours and 1 month, both right and left thalamic areas were smaller in the drug exposed infants than in the controls. The ICHD's were slightly smaller, but no differences were found in HC. Between 1 and 6 months of age, the rate of thalamic growth for drug exposed infants more than doubled that of the controls, resulting in greater thalamic circumferences at 6 months and HC were also somewhat greater. The data suggest a suppression of brain growth, particularly thalamic growth, in drug exposed infants during the first month of life, with a greater than normal growth rate of the thalami occurring at 6 months. Although growth occurred, the ICHD's of the drug exposed infants continued to remain smaller than the controls at 6 months of age. Additional USM and clinical evaluations are needed to ascertain the disparity in hemispheric and thalamic growth and its long-term effects.