Going Dutch in nocturnal enuresis

Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry-bed training in a group setting may follow; over 13 years of age, clinical dry-bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.

[IgA deficiency: clinical ans immunological evaluation of 28 patients]

Seventeen patients with total IgA deficiency and II with partial IgA deficiency were investigated. Symptoms associated with IgA deficiency were retrospectively studied, and the levels of other immunoglobulins were measured in blood and in saliva. The most important associated complaints were recurrent upper respiratory infections. More than 50% of the symptomatic patients recovered clinically, associated with a recovery of the IgA level or with compensatory humoral immunological mechanisms (such as elevated IgG subclasses or strongly positive secretory IgM). The necessary diagnostic procedures, follow-up of patients and families are described.