The purpose of this paper is to describe the nerve pathways, reflex arcs and sphincter muscles responsible for the sensory and motor mechanisms of rectal continence. The data from which the reflex arcs were deduced were obtained from anal and rectal pressure profiles in children with normal and malformed rectums, and in children with injuries and deformities of the spinal cord which affect the neuromuscular control. These profiles were correlated with the clinical state of continence and with the known anatomy of both normal and abnormal states.

The history is recorded of a seven‐year‐old boy who presented with a continuous murmur in the lower part of the chest on the right side. This proved to be due to a fistula from a systemic artery to a pulmonary vein. There was no associated broncho pulmonary or cardiac abnormality. The genesis of the condition is discussed, with a review of the relevant literature.

No abstract

acetylcholine from fine nerve endings (Wright and Shepherd, 1965), but nicotine does not produce contraction of normal human sphincter muscle at any concentration.I t is possible that the nerve supply at this level is predominantly inhibitory, with relatively few motor fibres. An alternative would be that the motor fibres are not cholinergic.In summary it is apparent that the autonomic nerve supply of the gut is more complex than was previously thought. Studies in vivo and in vitro indicate that there are inhibitory nerves to the internal anal sphincter, and that relaxation occurs on stimulation of the thoracolumbar outflow. Whether these nerves are adrenergic and what neurohumoral agents are involved in relaxation either of the sphincter or of the rest of the hindgut are matters open to tlou1,t. REFERENCESManometric studies oit normal and abnormal chaldren showed that the voluntarv cphiizctcr complex of the anal c a w 1 siibserzvd the most important role in the maintriaaitrr nf roiitiiiriir(' by three incrlznwsiii r--lzaincly, b y provadtiig a resting prrsrztrr t i t the sphinrtrr m i c higlacr than that in the rectzim, by reflex contractions in response to rectal dirtcnsioiz, with coiarequriit unconrciozts adjustment of thr anal presrure to preserve continonce, a i d bv t t c actioiz ac (2 ronscious reJponre to reinforce the anal canal and control defacattoit Fitrthermorc, rtrrtrlz receptors in the voluntary sphincter complex of the anal canal gave a wartizizq of impendinn defa?cation A f t e r rectoplasty procedures when the only sphincter prerent was thc lcvntor ant complex, the ~inconrcioiis rrflexes were abolished. but the childreit attained approprmtc sensory perceptiolt and a high degree of continence provided that the rertiiiq tone of thc puborectalis muscle war adequate

A total of 2,970 infants and children with symptoms suggestive of urinary tract infection (UTI) were investigated. Diagnosis was based on clinical, microbiological, radiological, and sometimes endoscopic investigations. Quantitative culture of an uncontaminated sample of urine is the most sensitive screening test. An additional 548 children had positive physical findings such as enlarged kidneys and/or bladder and were excluded from this study. There were 2,970 children with urinary symptoms but no definite positive physical findings, and this group is discussed in detail; 73% (2,168) were boys and 27% (802) were girls. The commonest presenting symptoms were frequency of micturition, enuresis, and straining on voiding. One hundred sixty-six had significant bacteriuria and were fully investigated. Only 148 children completed the investigations and treatment; 130 had an underlying structural abnormality causing stasis of urine. It is well known that removal of the cause of the stasis will help to prevent further infections in most patients, and also reduces the effects of back-pressure on the upper tracts. This study illustrates: (1) the importance of proper urine culture technique; (2) the high incidence (88%) of structural abnormalities causing UTI in children; and (3) the importance of investigating all children with proven UTI to determine the cause of stasis. In India, the patterns of UTIs and their causes are markedly different from those published in the English literature.