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Two cases of vena caval thrombosis in infants were successfully treated with low dose (0-01-0-05 mg/kg/hour) local infusions oftissue plasminogen activator after conventional anticoagulant treatment had been unsuccessful. This approach is useful for clots associated with indwelling intravascular catheters, and a low dose infusion of tissue plasminogen activator as a regional application is recommended to achieve clot lysis with minimal systemic effects. (Arch Dis Child 1992;67:1483-4) An infusion ofrecombinant tissue plasminogen activator was started through the Hickman line at a dose of 0-01 mg/kg/hour. This was increased to 0-05 mg/kg/hour after four hours, and after 24 hours of treatment improvement in the swelling and oedema was noted. An ultrasound examination showed blood flow through the innominate veins and superior vena cava.After 48 hours of treatment there was some bleeding from the Hickman line insertion site. Six weeks after the operation an ultrasound examination of the inferior vena cava showed a large thrombus extending from the tip of a right femoral vein catheter and occupying most of the inferior vena cava. Warfarin was discontinued and recombinant tissue plasminogen activator given through the femoral vein catheter at an initial dose of 0 01 mg/kg/hour. This was increased to 0-02 mg/kg/hour after six hours and was continued for six days. Serial ultrasound examinations showed complete lysis of the clot over this period. The infant was then treated with an intravenous infusion of heparin followed by warfarin by mouth.There was no bleeding during the infusion of tissue plasminogen activator. The fibrinogen concentration was always greater than 1 5 g/l and the D-dimer concentration between 0-2 and 4 mg/I. Discussion Tissue plasminogen activator is a naturally occurring protein which plays a part in the fibrinolytic cascade. It catalyses the conversion of the inactive proenzyme plasminogen into the active serine protease plasmin. Tissue plasmino-

A study was made of the defecatory sensation in 130 patients with normal rectums. By means of a specially designed balloon inserted into the rectum, determinations were made of intrarectal pressure, rectal diameter and rectal tension. The desire to defecate was correlated with the levels of these measurements. There was a progressive rise with age in the threshold for these factors. Rectal sensitivity to distention was lower in the constipated patients than in those who were not constipated.

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