Efficacy of tolterodine as a first-line treatment for non-neurogenic voiding dysfunction in children

OBJECTIVE

To assess the effect of antimuscarinic treatment with tolterodine combined with behavioural modification as a first-line treatment, before invasive investigation, in children with non-neurogenic voiding dysfunction but no obvious anatomical or neurogenic cause.

PATIENTS AND METHODS

The study comprised 44 children presenting with voiding dysfunction (30 girls and 14 boys, mean age 7 years, range 5-14); all had a noninvasive evaluation consisting of a history, urine analysis, renal and bladder ultrasonography and physical examination, with specific emphasis on the voiding pattern. Anticholinergic treatment with tolterodine (1 mg twice daily) was started in all patients; they were also informed about conservative management, including timed voiding, double voiding and relaxation of the pelvic floor during voiding. At the start and after 3 months, the dysfunctional voiding symptom score (DVSS) was completed twice by all patients.

RESULTS

For all patients the mean (sd) DVSS was 14.0 (2.67) and 6.68 (3.67) before and after treatment, respectively; the difference was statistically significant (P < 0.001). The mean scores for girls and boys, respectively, were 13.8 (2.79) and 14.5 (2.44) before and 6.43 (3.79) and 7.50 (3.34) after treatment.

CONCLUSION

Tolterodine combined with behavioural modification for dysfunctional voiding in children with no neurological or anatomical abnormality can be recommended as a first-line treatment before invasive evaluation. Additionally, the DVSS appears to provide accurate and objective data for monitoring the effect of treatment in such children.

Epidermoid cyst in the renal pelvis

Epidermoid cysts are benign cysts localizing rarely in solid organs with an unclear pathogenesis. A 55 years old woman having an epidermoid cyst in the renal pelvis was evaluated according to the literature.

Predictors of outcome after in situ anterior vaginal wall sling surgery

Pubovaginal sling procedures are being performed with increased frequency for stress urinary incontinence. The vaginal wall sling was introduced in 1989 by Raz et al., and its success rate has been reported as being 61%-100%. A number of recent studies have identified that some patient factors may influence the likelihood of a successful outcome. In the present study, we evaluated whether preoperative Valsalva leak-point pressure and urethral pressure profile can be used as predictors of success after surgery. We identified the preoperative characteristics of 58 women who underwent an isolated in situ anterior vaginal wall sling procedure by the same surgeon. Patients' ages, previous anti-incontinence procedures, hormone replacement status and previous hysterectomies were determined and patients underwent urodynamics, including cystometry, measurement of the Valsalva leak-point pressure and urethral pressure profile (maximal urethral pressure). After the vaginal wall sling procedure, success was defined as a significant improvement in stress urinary incontinence symptoms or no symptoms at all. The 58 women ranged from 41 to-71 years old (average 52.3) and average follow-up was 26 months (range 16-34). An anti-incontinence procedure had been done previously in 15% of cases. The success rate was 65.4% in patients with Valsalva leak-point pressure < 50 cmH2O and maximal urethral pressure < 30 cmH2O, but it was 90.6% in patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more. Patients with Valsalva leak-point pressure 50 cmH2O or higher and maximal urethral pressure 30 cmH2O or more had a 90.6% success rate, and it was significantly higher than the success rate of patients with lower values for both parameters. We concluded that preoperative Valsalva leak-point pressure and maximal urethral pressure can be used to estimate the success rate of anterior vaginal wall sling procedures. When of these parameters are concurrently high, the outcome of surgery seems more favorable.

A case of hydatid disease: urinary retention due to an isolated retrovesical hydatid cyst in a boy

A 13-y-old male patient presented with acute urinary retention and bilateral lumbar pain. The routine laboratory tests were normal. Casoni's skin test and indirect haemagglutination assay (1/160) were positive. Evidence of hydatid disease was found during surgery. Histopathological examination confirmed hydatid disease in the surgical specimens.

Role of genital mycoplasmata and other bacteria in urolithiasis

Urease-producing bacteria have been shown to affect the formation of infection stones by splitting urea into ammonia, bicarbonate and carbonate. An increase in alkaline pH results in urinary supersaturation of the ions. The increase in ammonia also causes injury to the urothelial glycosaminoglycan layer. Non-urease-producing bacteria have been speculated to form urinary stones. Midstream voided bladder urine and fractured stone nidus samples from 72 patients undergoing surgery for urolithiasis were cultured on specific media for genital mycoplasmata and on conventional media. Urine samples were obtained from a control group of 40 healthy subjects. Genital mycoplasmata and other bacteria were evaluated with regard to the composition of urinary stones. Compared with other origins of stones, the relation between isolation of Ureaplasma urealyticum and infection stone disease was statistically proven. Isolation of genital mycoplasmata was significantly higher in women than in men in the study group. The urinary stones comprised 84.7% calcium stones, 8.3% uric acid stones and 6.9% infection (magnesium ammonium phosphate) stones. Coagulase-negative Staphylococci, Escherichia coli, Corynebacterium spp., Enterobacterium spp. and U. urealyticum were cultured from stone samples. The results suggests that non-urease-producing bacteria, as well as urease-producing bacteria, may influence the formation of urinary stones.

Genitourinary tuberculosis: a review of 174 cases

In 174 cases of genitourinary tuberculosis diagnosed and treated in our clinic we evaluated, retrospectively, age and sex distributions, symptoms, physical and laboratory findings, primary focus, surgical and medical treatments. Flank pain and non-specific urinary complaints, e.g. dysuria, were the major symptoms. Although some authors prefer short-term medical therapy for the treatment of genitourinary tuberculosis, the relapse rate in our series after 12 months of therapy was 19% and we therefore suggest that therapy should be continued for at least 12 months. The poor nutritional status and social conditions characteristic of subjects from our region may, however, have influenced this high relapse rate.

[Surgical treatment of penil fractures]

BACKGROUND

Patients diagnosis as penil fracture and treated with surgical methods were evaluated retrospectively between January 1990-February 2002.

METHODS

Patients were evaluated by age, trauma type, time passed after the trauma, physical examination and radiologic data.

RESULTS

The cause of trauma was blunt trauma in all patients. 14 trauma (60.8%) were during sexual activity, 6 trauma (26%) were during handling the erective penis in morning erection, 3 of trauma (13%) were due to the rolling on to the penis. Urethral bleeding was seen in 1 patient and microscopic hematuria was detected in 5 patients. Subcoronal circular incision was carried out in 16 patients (69.5%), semicircular incision was done directly on the injury in 6 patients (26%) and from penis radix to scrotum was done in 1 patient (4.3%). There was unilateral corpus cavernosum injury in 21 patients. Bilateral corpus cavernosum injury in 1 patient, corpuscavernosum, corpus spongiosum and incomplent urethral injury in 1 patient. Wound infection was detected only in 2 patients at postoperatively early period. After evaluating 20 patients with medical history and physical examination in postoperative control penil curvature permitting sexual activity was detected in 3 patients.

CONCLUSION

We concluded that patients with penil fracture may be treated with low complication rate by early surgical procedure.

Adenomatoid tumors of testis and epididymis: a report of two cases

Adenomatoid tumors are rare benign tumors of female and male genital tracts. In this paper, we reported an epididymal and a testicular adenomatoid tumor in two patients presented with enlarged intrascrotal mass.

Cranial blind-ending branch of a bifid ureter

A case of cranial blind-ending branch of bifid ureter is presented in a woman. There were no associated complications requiring surgery. The anomaly was best shown with intravenous urography.

Analysis of cyanobacterial toxins by physicochemical and biochemical methods

Cyanobacteria (blue-green algae) produce a wide range of low molecular weight metabolites that include potent neurotoxins, hepatotoxins, and cytotoxins. The accumulation of such toxins in freshwaters, and in brackish and marine waters presents hazards to human and animal health by a range of exposure routes. A review is presented of developments in the detection and analysis of cyanobacterial toxins, other than bioassays, including application of physicochemical, immunoassays, and enzyme-based methods. Analytical requirements are considered with reference to recently derived guideline levels for the protection of health and to the availability, or otherwise, of purified, quantitative cyanobacterial toxin standards.

Isolation of new protein phosphatase inhibitors from two cyanobacteria species, Planktothrix spp

Two new protein phosphatase inhibitors, oscillamide B (1) and C (2), were isolated from the cyanobacteria Planktothrix (Oscillatoria) agardhii and P. rubescens. The structures of the inhibitors were elucidated by analysis of HRFABMS, 1D and 2D NMR spectra, and chemical degradation. These inhibitors are ureido-containing cyclic peptides and inhibited serine/threonine protein phosphatases PP1 and PP2A. The inhibitory activities were closely related to the Arg and N-Me-Hty residues in the peptides.

Isolation and identification of the cyanotoxin cylindrospermopsin and deoxy-cylindrospermopsin from a Thailand strain of Cylindrospermopsis raciborskii (Cyanobacteria)

A strain of Cylindrospermopsis (Cyanobacteria) isolated from a fishpond in Thailand was examined for its taxonomy based upon morphology and 16S rRNA gene sequence. It was also examined for production of the hepatotoxic cyanotoxin called cylindrospermopsin (CYN) and deoxycylindrospermopsin (deoxy-CYN). The strain (CY-Thai) was identified as C. raciborskii (Woloszynska) Seenaya and Subba Raju based upon morphological examination which was confirmed by 16S rRNA gene sequences and phylogenetic comparisons based upon its 16S rRNA gene. The alkaloid heptatotoxin CYN was confirmed using mouse bioassay, HPLC and HPLC-MS/MS while deoxy-CYN was confirmed using HPLC-MS/MS. The mouse bioassay gave a minimum lethal dose at 250mg dry weight cells/kg body weight within 24h and 125mg/kg at 72h, with signs of poisoning the same as in literature reports for CYN. HPLC chromatographic comparison of the CY-Thai toxin with standard CYN gave the same retention time and an absorbance maximum at 262nm. HPLC-MS/MS confirmed the presence of CYN (M+H 416) and deoxy-CYN (M+H 400). The CYN content in strain CY-Thai was estimated at 1.02mg/g and approximately 1/10 of this amount for deoxy-CYN. This is the first report from Asia of a CYN, deoxy-CYN producing Cylindrospermopsis raciborskii.

An unusual cause of incontinence: urethral coitus

Megalourethra and incontinence due to urethral coitus are very rare phenomena in women. In this paper, we report two cases of urinary incontinence due to urethral coitus where there was no vaginal anomaly or dysfunction.

[D-Leu1]Microcystin-LR, from the cyanobacterium Microcystis RST 9501 and from a Microcystis bloom in the Patos Lagoon estuary, Brazil

[D-Leu1]Microcystin-LR was identified as the most abundant microcystin from a laboratory strain of the cyanobacterium Microcystis sp. isolated from a hepatotoxic Microcystis bloom from brackish waters in the Patos Lagoon estuary, southern Brazil. Toxicity of [D-Leu1]microcystin-LR, according to bioassay and protein phosphatase inhibition assay, was similar to that of the commonly-occurring microcystin-LR, which was not detectable in the Patos Lagoon laboratory isolate. This is the first report of a microcystin containing [D-Leu1] in the cyclic heptapeptide structure of these potent cyanobacterial toxins.

High-resolution computed tomography in cases with environmental exposure to asbestos in Turkey

BACKGROUND AND OBJECTIVES

Although all parts of the lung can be affected as a consequence of asbestos exposure, most CT protocols tend to scan only the middle and lower parts of the thorax. The aim of this study was to investigate parenchymal and pleural lesions of persons exposed to environmental asbestos, using a high-resolution computed tomography (HRCT) protocol scanning the whole thorax.

METHODS

We analyzed the chest radiographs and HRCT scans of 26 patients who presented bilaterally with multiple pleural plaques related to environmental asbestos exposure.

RESULTS

Twenty-four cases (92%) had an abnormal HRCT suggestive of asbestosis. Apart from common HRCT changes related to asbestosis, we detected apical pleural thickening (APT) in 9 cases as well as a coarse honeycomb pattern adjacent to APT in 7 of these cases. Cavitary lesions due to pulmonary tuberculosis were observed on HRCT scans from 4 patients in total. Neither apical pulmonary fibrosis nor cavitary lesions were visible on chest radiographs.

CONCLUSIONS

We suggest that the HRCT protocol for examining asbestos-exposed individuals with pleural plaques on chest X-rays should include the whole thorax, since the asbestos-related pathologies may involve all parts of the lung.

The cyanobacterium Nodularia PCC 7804, of freshwater origin, produces [L-Har2]nodularin

The cyanobacterium Nodularia PCC 7804, an axenic, non gas-vacuolate strain from a freshwater source, produces several metabolites with cyanobacterial hepatotoxin characteristics. The most abundant is a cyclic pentapeptide, [L-Homoarginine2]nodularin. [L-Har2]nodularin is of similar toxicity, in terms of bioassay in vivo, and the inhibition of protein phosphatase-1 in vitro to nodularin, which was present in lesser amounts in the cultures.

[A case of idiopathic intussusception of the stomach]

A 73-year-old man was admitted to our hospital because of vomiting. A fist-sized tumor with tenderness was palpated on his epigastric region. Fluoroscopic examination of the stomach showed narrow body and dilated antrum with intussusception. Endoscopic findings revealed fold convergence to the antrum. Intraoperatively, the body of the stomach was invaginated into the antrum with hepatoduodenal ligament. It was difficult to repair or resect, and a gastrojejunostomy was performed. On the 10th operative day, fluoroscopic examination of the stomach showed no intussusception of the stomach and no lesion in the upper gastrointestinal tract. To our knowledge, such cases of idiopathic intussusception of the stomach are rare.