[Causes of infectious gastro-enteritis in children in Dakar]

Between February 1983 and May 1988, 1,157 stools from children aged under 15 years presenting with diarrhoea and admitted to a paediatric hospital in Dakar, Senegal, were examined for the presence of bacterial and parasitic agents. We looked for Campylobacter and rotavirus in only 245 and 111 samples respectively. Enterobacteria were detected most frequently (162/264; 61.3 per cent). Among these, we found 92 (34.8 per cent) strains of enteropathogenic E. coli; 40 strains (15.1 per cent) of Salmonella spp. and 30 strains (11.3 per cent) of Shigella spp. V. cholerae was present in only 2 faecal specimens (0,7 per cent). Eighty-one (30.6 per cent) parasitic agents were isolated, including a high proportion (13.6 per cent) of flagellae. Campylobacter jejuni and retroviruses were found in 2 (0.8 percent) and 15 (13.5 percent) stool respectively. The frequency with which these enteropathogenic agents were isolated remains in keeping with the global situation usually observed in Dakar for several years.

Effects of external and direct pudendal nerve maximal electrical stimulation in the treatment of the uninhibited overactive bladder

Maximal electrical stimulation (MES) administered from a laboratory device designed to deliver stimulation pulses of relatively high voltages and currents was performed in 29 patients. All had suffered from bladder overactivity for several years, either idiopathic detrusor instability or an uninhibited overactive bladder, and all had failed to respond to conservative treatment. MES was performed in female patients by means of intravaginal and intra-anal electrode carriers and in males by anal electrodes only. In some cases additional stimulation was administered by means of a single needle bipolar electrode inserted directly into the pudendal nerve. Maximal amplitude was attained after gradual increases in amplitude and the patient's adaptation to this. Stimulation was administered by the therapist but the amplitudes were determined by the patient and limited by his/her pain threshold. Alternating rectangular constant voltage pulses at a repetition rate of 10 Hz were used. Treatment consisted of 4 sessions of stimulation with intervals of 1 week between each application. All patients showed a significant increase in functional bladder capacity and 11 reported a 30% decrease in the frequency of micturition. Two patients were unaffected by stimulation with external electrodes but responded well to direct pudendal nerve stimulation. MES seems to be an effective first-line treatment for the uninhibited overactive bladder.

Terodiline: a dose titrated, multicenter study of the treatment of idiopathic detrusor instability in women

Idiopathic detrusor instability is a common cause of lower urinary tract symptoms at all ages and in both sexes. Treatment initially is conservative and often includes drug therapy. Terodiline has the theoretical advantage of being a drug with anticholinergic and calcium channel blocking effects. Theoretically, by using a drug with dual action the beneficial effect of reduced detrusor overactivity might occur at a dosage below that likely to lead to the troublesome side effects experienced by patients who take pure anticholinergic agents. A total of 70 female patients completed a study characterized by extremely strict inclusion criteria and a tight protocol. Other novel elements to the study were the extensive use of urinary diaries for symptom evaluation, standardized urodynamic studies agreed upon by the participating centers and the dose titration design of the trial. Terodiline has been demonstrated to be a safe, well tolerated and effective drug in the treatment of idiopathic detrusor instability. Drug treatment led to significant decreases in urinary frequency and incontinence episodes. Pre-micturition symptoms, such as urgency, were markedly reduced and the voided volume was significantly increased. Although there were consistent trends towards greater improvement in the urodynamic measurements, when the terodiline and placebo groups were compared these did not reach statistical significance, partly due to a large improvement in the placebo group. Nevertheless, terodiline has been shown to be a useful drug for conservative management of patients with detrusor instability.

The neurogenic overactive bladder. Classification based on urodynamics

The aetiology and pathogenesis of bladder overactivity are very variable and the classification is rather crude. By careful interpretation of clinical findings and urodynamic assessments, refinement of the diagnosis is possible. From a therapeutic and prognostic stand-point, it is of interest to distinguish between "idiopathic detrusor instability" and the "uninhibited overactive bladder". Based on neurological investigation and cystometric recordings, including the ice water test, characteristics of the 2 entities are described.

[Bacterial meningitis in a pediatric hospital in a tropical zone]

Purulent bacterial meningitides are a very important pediatric problem in tropical areas. From February 1983 to February 1988, 409 cerebrospinal fluid samples from children with purulent meningitides, aged under 15 years, admitted to the Pediatric Hospital Albert Royer, Dakar, were examined for the presence of bacterial agents. In 222 (54.2%) samples, one bacterial agent or soluble antigens were detected. Among these, 3 bacterial agents were most frequently identified: 94 (42.3%) Haemophilus influenzae, 71 (31.9%) Streptococcus pneumoniae and 25 (11.2%) Neisseria meningitidis. The increase in bacterial meningitides observed during cool and dry seasons was essentially due to Haemophilus influenzae and Streptococcus pneumoniae. The bacterial strains were found to be susceptible to antibiotics usually administered. However, almost 22% of Haemophilus influenzae strains were resistant to ampicillin or chloramphenicol. A high mortality (33%) was observed, especially with Streptococcus pneumoniae. The purulent bacterial meningitides are a most important pediatric problem in tropical areas.

Histamine and mucosal mast cells in interstitial cystitis

Interstitial cystitis (IC) is a chronic inflammatory disorder of the urinary bladder of unknown aetiology and pathogenesis. The classic form (Hunner's ulcer) is characterized by high mast cell numbers in the detrusor muscle and an expansion of mucosal mast cells in the lamina propria and also in the epithelium. Such cells can be recovered in bladder washings and in the urine in single cell suspensions. We have counted the mast cells and measured the histamine in bladder washings from 16 patients with classic IC and from a control group of 15 patients with so-called early, non-ulcerative IC. The bladder washings from all patients with classic IC contained well preserved mast cells (median 2.16, range 0.5-8.6 x 10(3) cells/I) and histamine (median 14.3, range 6-66 ng/l), while only occasional mast cells and traces of histamine were found in washings from patients with non-ulcerative IC. The histamine content was strongly correlated to the number of mast cells (r = 0.87). The mean histamine content per mast cell was estimated at 7.6 +/- 0.65 (SEM) pg/cell. The high histamine content per mast cell in relation to previously published data (2.8-4.6 pg/cell) can be attributed to the mild and rapid handling of the specimens.

Scanning electron microscopic findings in interstitial cystitis

Scanning electron microscopy (SEM) was performed on transurethral resection biopsies from 13 patients with classic interstitial cystitis. Biopsies from 9 patients with stress incontinence served as controls. The SEM appearance of the bladder surface in interstitial cystitis varied considerably, exhibiting small round and large polygonal cells. The proportion of cells displaying round uniform and pleomorphic microvilli was high and sometimes dominated the area examined. SEM characteristics earlier assigned to bladder tumours were detected in patients with interstitial cystitis and, at a lower frequency, also in control patients. The mucin layer covering the urothelial cells seemed reduced in interstitial cystitis compared with control specimens. Surface characteristics specific for interstitial cystitis were, however, not detected by SEM.

Thymulin (facteur thymique serique) and zinc contents of the thymus glands of malnourished children

Protein-energy malnutrition (PEM) leads to an immune deficiency, which is now well documented. Some investigators have suggested that the associated zinc deficiency is important in thymic involution and changes in cellular immunity. To evaluate the respective roles of nutritional deficiency, infection, and zinc in the alteration of thymic function, we measured the amounts of thymulin (facteur thymic serique, or FTS) and of Zn in the thymus glands of 58 Senegalese children who died in various stages of malnutrition. In the severe forms (marasmus, kwashiorkor, and marasmic kwashiorkor) the thymus was tiny and contained very little thymulin. The Zn content of the thymus was high whatever the nutritional state of the subject and was related significantly only to the presence of infections. In Senegalese children thymic atrophy and depleted thymulin content are associated with severe PEM but not systemic infection or depleted thymic Zn content.

Thymulin (Zn-FTS) activity in protein-energy malnutrition: new evidence for interaction between malnutrition and infection on thymic function

The combined effects of protein-energy malnutrition (PEM) and infection on thymic function evaluated by specific plasma thymulin activity were studied in Senegalese children: 29 hospitalized in Dakar for severe malnutrition and various diseases; 9 infected without sign of severe PEM, living in Dakar; 13 apparently healthy, uninfected, living in Dakar; and 7 apparently healthy, uninfected, living in Paris. Most of the free-living children in Dakar suffered from mild to moderate PEM. The specific thymulin activity (total plasma activity minus the activity recorded after adsorption of the plasma with a monoclonal antithymulin antibody) was almost undetectable in the infected children and was normal only in the children living in Paris. Such activity might be decreased by moderate and severe PEM and severe malnutrition may not be the only underlying cause of depressed level of thymulin in malnourished children from the Third World. Concurrent infections are important factors.

Treatment of ulcer and nonulcer interstitial cystitis with sodium pentosanpolysulfate: a multicenter trial

The effect of sodium pentosanpolysulfate (Elmiron) in the treatment of interstitial cystitis was observed in an open controlled multicenter trial. We studied 87 patients with symptoms for more than 2 years at 17 centers in Finland and Sweden. Patient selection was based on the typical chronic symptomatology but the material subsequently was stratified according to objective cystoscopic findings. The medication (400 mg. daily in 2 oral doses) was discontinued after 6 months. The response was evaluated every 4 weeks during treatment and every 3 months thereafter. Most patients responded favorably, many with diminution of pain within only 4 weeks from the start of treatment. The frequency of micturition decreased significantly and the mean volume per void per 24 hours increased in the patients without bladder ulceration but such changes were not found in the patients with ulcer. The bladder capacity was smaller in the ulcer group. In these patients the pre-treatment intensity of pain was somewhat greater than in those without bladder ulcer but the pain was alleviated in both groups and this effect was stable at the 3-month followup. The differences in responses in the 2 groups indicate a probable fundamental difference between ulcerative and nonulcerative interstitial cystitis. Side effects of the drug were few, slight and transient. Therefore, the study indicates that a significant number of patients with interstitial cystitis can be expected to benefit from treatment with sodium pentosanpolysulfate.

Chronic interstitial cystitis: a heterogeneous syndrome

A series of 28 patients with interstitial cystitis and 14 healthy volunteers were studied. We found marked histopathological differences between classic (ulcerative) interstitial cystitis and early (nonulcerative) interstitial cystitis. The bladder mucosa of patients with classic disease exhibited focal ulceration, edema and perineural-perivascular infiltrates. There was a marked increase in 2 distinct mast cell populations. Mast cells increased in the detrusor muscle and mucosa. Mucosal mast cells, unlike those in the muscular coat, are susceptible to aldehyde fixation, and require special fixation and staining techniques for proper demonstration. These cells were numerous in the epithelium and were recovered in bladder washings, consistent with the finding that they have a migratory capacity. In nonulcerative interstitial cystitis all signs of mast cell activation were absent, and the histopathological changes were few and fairly uncharacteristic. We also observed some marked clinical differences between ulcerative and nonulcerative interstitial cystitis. These 2 conditions appear to represent separate entities and should be evaluated separately in clinical studies.

Microsurgical epididymovasostomy in the treatment of occlusive azoospermia

In principle, azoospermia has two explanations: occlusion of the duct system and serious dysfunction of the testicular parenchyma. Some cases of duct occlusion are suitable for reconstructive surgery. The authors describe a reconstructive technique based on full mobilization of a single loop of the epididymal duct as caudally as possible with two-layer side-to-end anastomosis to the vas deferens. To ensure follow-up evaluation of each anastomosis, unilateral anastomosis was done primarily. In a few cases, cross-over anastomosis was necessary. In cases of reoperation, if possible, this was performed on the same side. When the epididymal duct system was found empty, the contralateral epididymis was explored. Patients with postoperative oligozoospermia were offered a supplementary contralateral operation. From 1980 to 1984, 41 patients underwent epididymovasostomy. At follow-up evaluation, 35 (85%) presented sperms in repeated tests. Fifteen of these patients (37%) have fathered children. Patients with postoperative normospermia and no antisperm antibodies had an excellent fertility prognosis. The single-loop dissection technique provides anatomic specificity and a high percentage of patent anastomoses and does not interfere with the possibilities of reoperation.

Proliferation and transepithelial migration of mucosal mast cells in interstitial cystitis

The distribution and abundance of mast cells, as well as their fixation, staining and ultrastructural properties, were studied in the urinary bladders of 16 patients with interstitial cystitis (IC) and in 14 normal subjects. Tissues were fixed in both standard formaldehyde solution and a special fixative, IFAA, optimized for the preservation of mucosal mast cells. An expansion of two distinct mast cell populations was observed in IC. One of these, comprising formaldehyde-sensitive cells, was found only in the mucosa underlying lesions of IC. They were most numerous in the lamina propria but were also frequent in the epithelial layer as well as in the bladder washings, indicating a migratory capacity for these cells. The other mast cell population was visualized equally well irrespective of fixation and staining procedure. In control subjects, such cells were found both in the lamina propria and detrusor muscle, but not in the epithelium nor in bladder washings. In lesions of IC they were increased in the detrusor muscle only. Both types of mast cell contained granules with the highly characteristic lamellar arrays and scrolls, distinguishing human mast cell granules from those of blood basophils. The proliferation and intraepithelial distribution of mucosal mast cells are unusual findings, but prominent features of helminth responses and human mucosal allergic reactions. These findings thus suggest that the mucosal mast cell-IgE system may be involved in the pathogenesis and/or aetiology of IC.

Contelle: pelvic floor stimulator for female stress-urge incontinence. A multicenter study

The clinical efficacy of a new device for treatment of female incontinence was studied in a multicenter trial. The device consists of an inflatable electrode carrier and an external stimulator unit. Forty women were treated: 10 had primary or recurrent genuine stress incontinence, 15 had urge incontinence due to idiopathic detrusor instability, not responding to drug treatment, and 15 had stress incontinence combined with detrusor instability. Twenty-five patients were improved by the treatment. Another 8 reported an excellent result of treatment and remained free of symptoms for more than six months after withdrawal of the treatment. The results were more favorable in patients with bladder hyperactivity than in genuine stress incontinence. The patients' general ratings of treatment efficacy correlated well with their recordings of urinary frequency and consumption of incontinence pads. The functional bladder capacity increased in improved patients, but normalization of urodynamic parameters was no prerequisite for clinical improvement. We found intravaginal electrical stimulation to be a valuable alternative to medical and surgical intervention in patients with detrusor instability.

Blue spotted bladder--a manifestation of bladder amyloidosis. A case report

Bladder amyloidosis may represent a life-threatening condition, but may also be associated with milder clinical symptoms. Herein, we report two older males with a different type of apparently mild bladder amyloidosis, presenting as the "blue spotted bladder".

A clinicopathological and virological study of interstitial cystitis

We studied 41 patients with chronic interstitial cystitis. Histological examination of bladder lesions revealed mucosal ulceration, pancystitis and perineural inflammatory infiltrates. Perineural cell infiltration is related probably to the characteristic symptoms of the disease. A search for a viral etiology, particularly herpes simplex virus, rendered negative results.

Conservative management of chronic interstitial cystitis: transcutaneous electrical nerve stimulation and transurethral resection

Transcutaneous electrical nerve stimulation was used in a prospective series of 23 patients with classical interstitial cystitis. This treatment reduced pain in 18 patients and urinary frequency returned to normal in 8. Four women with a history of cystitis for 1 or 2 decades had no symptoms during transcutaneous electrical nerve stimulation for 7 or more years and lesions disappeared or were hardly detectable. A 2 to 3-fold increase in bladder capacity with anesthesia also was registered. Complete transurethral resection of visible lesions in 30 patients resulted in initial disappearance of pain in all and a decrease in urinary frequency in 21. The mode of action of the 2 methods and registered complications are discussed.

Urodynamic consequences of a direct pyelocystostomy at autotransplantation of the kidney

The urodynamic consequences of renal autotransplantation and pyelocystostomy were studied in 17 male and 3 female patients. The indications of the procedure were urothelial tumor of the upper urinary tract, remaining outflow obstruction after conventional pyeloplasty and recurrent stones. The mean observation time was 31 months (range 3-50 months). The micturition flow rate was unchanged. There was an insignificant increase in residual urine. No evidence of any clinically significant disturbance of the sensory or motor bladder innervation or reduction of the functional bladder capacity was found. Urethrocystography showed transient dilatation of calyces at micturition. Urinary tract infections, when present, had the same pattern as preoperatively. Thus, autotransplantation of the kidney with a wide, direct pyelocystostomy is consistent with essentially normal urodynamics of the transplanted renal pelvis and the bladder.

Electrical stimulation of the conus medullaris for bladder emptying in a paraplegic

Nashold et al. (1972) have developed a surgically implantable system for activating the micturition reflex in the paraplegic by electrical stimulation of the spinal cord at the conus level. This communication describes the long-term course in a paraplegic patient who has used conus stimulation to achieve bladder emptying for 7 years. A 42-year-old man sustained a complete transverse lesion at the C6 level. Ten months after the accident he developed some spasticity in his legs but his urinary bladder remained completely flaccid. A device for electrical stimulation of the conus was implanted. This enabled the patient to empty his bladder without significant residual urine. His bladder remained flaccid. Seven years after the implant he developed reflex micturition and he is no longer dependent upon electrical stimulation.

Does electrostimulation cure urinary incontinence?

A followup study is presented of a prospective series of women treated with an inflatable intravaginal electrode carrier and an external pulse generator. The devices were individually adjustable with respect to electrode positioning and stimulation parameters. The study included 40 women with detrusor instability and/or genuine stress incontinence. The primary results for urge symptoms were favorable. Of the patients 73 per cent were primarily free of symptoms during treatment and 45 per cent remained free of symptoms after withdrawal of treatment, including two-thirds in whom re-education persisted during the followup of 6 years. Of the patients with genuine stress incontinence 40 per cent exhibited persistent re-education. There were considerable discrepancies between symptomatic cure or improvement, and the urodynamic findings at followup. Intravaginal electrical stimulation may be regarded as the treatment of choice for urge incontinence due to detrusor instability, and in mixed stress and urge incontinence. The method also is an alternative to an operation in some women with genuine stress incontinence.

Cortical evoked potentials obtained after stimulation of the lower urinary tract

Cortical evoked potentials following stimulation of the lower urinary tract have been recorded in humans. Of 26 patients investigated 9 had no urinary signs or symptoms except genuine stress incontinence, while the remaining 17 had various neurogenic bladder disorders. Monopolar and bipolar stimulation of the bladder and urethra was performed using conventional and newly designed suction-type electrodes. While no cortical evoked potentials could be obtained from patients with complete transverse spinal cord lesions polyphasic cortical evoked potentials (N45, P60, N80 and P100 msec.) were recorded in response to monopolar bladder stimulation in all patients with stress incontinence. Following bipolar stimulation a response with lower amplitude and with latencies slightly divergent could be recorded. This response is assumed to be evoked only from bladder afferent nerves, while the monopolar response could include activity from adjacent structures. The most consistent pattern was recorded at the Cz site. Cortical evoked potentials following stimulation of the urethra were more difficult to evoke but they resembled those obtained after bipolar stimulation of the bladder. The method, when fully developed, may be helpful in the clinical investigation of patients affected by various neurogenic disorders of the lower urinary tract. So far, in our limited series a delayed response at P2 has been observed in patients with uninhibited neurogenic bladders.

Evaluation of history and simple supine cystometry as a preoperative test in stress urinary incontinence

In a follow-up study the accuracy of a simple preoperative screening including history, Bonney 's test and supine cystometry was evaluated in patients with stress urinary incontinence. Based upon preoperative history alone, the patients were divided into two different groups, pure stress incontinence, and mixed stress and urge incontinence. All patients accepted had a normal supine cystometry at the preoperative work-up. The results of the operation were good in pure stress incontinence. In patients with mixed stress and urge incontinence the results were unsatisfactory and most of them presented a variety of urodynamic abnormalities postoperatively. Thus, in patients with pure stress incontinence, acceptance for surgery may be based upon a careful history, a simple supine cystometry and Bonney 's test, but in patients with mixed stress and urge incontinence a comprehensive clinical and urodynamic evaluation is mandatory. It seems that combination of detrusor instability and a history of pronounced urgency preoperatively calls for other therapeutic alternatives than operation.

Rhythmic activity in pelvic efferents to the bladder: an experimental study in the cat with reference to the clinical condition 'unstable bladder'

Efferent nerve activity was recorded from pelvic nerve filaments to the urinary bladder of the cat. At intravesical pressures below 5-7 cm H2O there was no activity, but at higher pressure levels the parasympathetic neurones discharged in 10- to 15-second-long rhythmic bursts separated by silent periods. The frequency of the burst varied from about 1/min at 5 cm H2O to 6-7/min at 15-20 cm H2O. Each burst of activity was followed by a small bladder contraction. The nervous activity preceded the contraction by several seconds, indicating that the bladder response was caused by the efferent discharge. Prolonged continuous efferent activity could occur immediately after pressure changes, at pressures above 20-25 cm H2O or after inhibition caused by intravaginal stimulation. In these situations, rhythmic activity resumed as inhibition of the tonic discharge. This behaviour indicates that the rhythmicity is primarily determined by a central inhibitory mechanism. The findings are discussed in relation to the normal function of the neuronal feedback systems of the bladder and their possible role in the development of the clinical condition 'unstable bladder'.

Mycoplasma hominis and interstitial cystitis

Antibodies to Mycoplasma hominis were detected by indirect hemagglutination in nine (56%) of 16 patients with chronic interstitial cystitis. In seven patients (44%), titers of greater than or equal to 160 were found. Antibodies to Ureaplasma urealyticum were detected in three (19%) of these patients; in only one patient was a high titer, i.e., greater than or equal to 160, found. M. hominis was isolated from voided urine of two patients, and U. urealyticum was recovered from the urine of three patients. A similar incidence of antibodies to M. hominis was found in 20 age- and sex-matched women treated transurethrally for bladder tumors. The high incidence of indirect hemagglutination antibodies to M. hominis found in these two groups of urologic patients who were subjected to repeated instrumentation of the urinary tract remains unexplained.

The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation

Intravaginal electrical stimulation (IVS) induces a profound bladder inhibition and is successful in the treatment of incontinence due to detrusor instability. In this experimental study in cats, direct recordings of the efferent activity in thin hypogastric and pelvic nerve filaments to the bladder were used to analyze the neuronal mechanisms underlying this bladder inhibition. A longlasting reflex discharge, with a latency of 35 to 50 msec., was evoked in the hypogastric nerve by IVS. The reflex discharge was unaffected by imposed changes in intravesical pressure or by micturition contractions, but the response was very frequency-sensitive with an optimal transmission at about 5 Hz of stimulation. A "spontaneous" efferent activity could be recorded in the pelvic nerve filaments when the bladder pressure was elevated above 5 to 7 cm. H2O. The pelvic activity occurred in 10 to 20-second bursts, each followed by an abortive detrusor contraction. IVS of 5 to 10 Hz completely abolished this efferent pelvic activity by central inhibition. The findings are discussed in relation to the normal neuronal control of the bladder and to the clinical application of IVS.

Microsurgical end-to-end and end-to-side epididymovasostomy to correct occlusive azoospermia

Reconstruction of the duct system using microsurgical technique represents an anatomically more attractive approach to correction of occlusive azoospermia than the conventional sperm fistula operations. The microsurgical technique of Silber entails transection of the entire epididymis in progressively more cranial planes. After microsurgical dissections of testicle specimens, we developed a different technique: dissection of a single loop of the ductus epididymis and connection to the ductus deferens, performed either as a two-layer end-to-end or as an end-to-side anastomosis. To reveal patency of each single anastomosis, the operations were performed unilaterally. Twenty-eight men were operated upon. They were referred from urology departments after standard investigations including repeated sperm tests. In 7 patients (25%) the prerequisites for an anastomosis were not present. Twelve patients were primarily operated upon with the end-to-end technique. Six of them have produced sperms in their specimens. Nine patients were operated upon with the end-to-side anastomosis. So far, five of these have presented positive sperm tests but the follow-up period is relatively short in this part of the series. During the investigation, it became evident that both the identification of sperms or fragments in the epididymal fluid and an adequate flow are prerequisites for successful surgery.

The simplified Lapides' operation for stress incontinence

Forty-one women were operated on for stress incontinence using the simplified Lapides' operation. Twenty-six had pure stress incontinence and fifteen had mixed stress and urge incontinence. Follow-up studies, 2-6 years after surgery, included interviews according to a special protocol and urodynamic analyses. The cure rate was high in the patients with pure stress incontinence (all cured or improved), while the results were not satisfactory in the patients with mixed stress and urge incontinence (7 of 15 cured or improved). A variety of urodynamic abnormalities were found in the group of failures. In some patients who considered themselves cured or improved there was a discrepancy between the result of the interview and the urodynamic findings. The technical advantages and disadvantages of the simplified Lapides' operation are discussed.

Cortical evoked potentials following stimulation of the urinary bladder in man

Techniques are described for recording evoked potentials in humans in response to stimulation of the urinary bladder. Twenty patients with various disorders of their urinary function were investigated. Evoked cortical potentials following stimulation of the urinary bladder could be recorded from all patients except subjects with complete transverse spinal cord lesions. The response was most evident at the central site (Cz) and had its most prominent peaks at 45, 65, 82 and 102 msec. This technique may become a useful diagnostic tool in the study of neurogenic bladder dysfunctions.

Funneled ureteroileal anastomosis

We analyzed the functional results of urinary diversion in 21 patients who had a funneled ureteroileal anastomosis to avoid stricture and stenosis. No attempt was made to avoid reflux from the conduit to the ureter but special care was taken to construct a cutaneous stoma to prevent reflux from the appliance. The results of the procedure were satisfactory. No urinary leakage, or stricture of the ureters or ureteroileal anastomosis was observed in any patient and kidney function was preserved. One of the main advantages of this technique is simplicity in construction, which means increased safety when used by surgeons not extensively trained in urinary diversion operations.

Electrical stimulation in interstitial cystitis

We treated 14 women with chronic interstitial cystitis with long-term intravaginal or transcutaneous nerve stimulation. Clinical and urodynamic evaluations were done after 6 months to 2 years. Improvement was not immediate but required a considerable period of continuous, daily use of electrical stimulation. The results were favorable--a substantial decrease in pain and frequency of micturition in all patients after long-term treatment. Since the methods seem effective and are simple, cheap and non-destructive electrical stimulation is recommended for all patients with chronic interstitial cystitis.

Ureteral complications after intravesical formalin instillation

Results of formalin therapy for hemorrhage owing to post-radiation cystitis have been studied with special reference to the frequency and severity of ureteral complications. Gross bleeding stopped in 25 of 27 patients within 48 hours. However, 5 patients became anuric immediately after the instillation and in another 7 patients a transient increase in the serum creatinine level was observed. Urinary diversion was necessary in 11 of the 27 patients. The complication rate in the present study is considerably higher than reported previously. Complications may be explained by vesicoureteral reflux of a too strong formalin-alcohol solution. To avoid future complications we suggest that 1) a high diuresis should be induced peroperatively, 2) a 1 to 2 per cent formalin solution without alcohol should be used and 3) the instillation pressure should not exceed 15 cm. water.

Effects of electrical intravaginal stimulation on bladder volume: an experimental and clinical study

Clinical observations have indicated that not only stress incontinence due to defective urethral closure but also urge incontinence due to bladder hyperactivity can be successfully treated by electrical stimulation of the pelvic floor. Clinical investigations revealed that intravaginal electrical stimulation caused bladder inhibition registered as a volume increase. This inhibition was most marked at a low stimulation frequency (10 Hz). Animal experiments indicated that the bladder inhibition was achieved by autonomic spinal reflex mechanisms activated by stimulation of pudendal afferents.

[Hemoglobin C -- beta-thalassemia disease and homozygous beta-thalassemia in a black African family (author's transl)]

The study of a Malian family has allowed to prove existence of two types of beta-thalassemia genes: the beta0 gene which suppresses the synthesis of the beta chain into cis position and the beta+ gene which slows down only partially this synthesis. The difference between this two genes has been possible owing to the hemoglobin C found in this family and induced by the betaC mutated gene. The segregation of the four genes betaA, betaC, beta0 thal, and beta+ thal. has allowed to compare all the possible phenotypes deriving from the combinations by two of these allelic genes.