Can a congenital dysfunctional bladder be diagnosed from a smile? The Ochoa syndrome updated

During the last 40 years over 100 patients have been reported with a dysfunctional lower urinary tract associated with a peculiar distortion of the facial expression. This most unusual disorder was initially considered a local observation. Time, however, has proven otherwise, since patients with this syndrome have now been reported from various countries throughout the world. This association of lower urinary tract and bowel dysfunction with an abnormal facial expression was named the urofacial (Ochoa) syndrome. Genetic studies have demonstrated that this condition is inherited as an autosomal recessive trait, and a potential gene has been mapped to chromosome 10q23-q24. There is also enough evidence to suggest that patients with this syndrome as well as those with subclinical neurological bladder, occult neuropathic bladder, non-neurogenic neurogenic bladder or Hinman syndrome, dysfunctional voiding, or dysfunctional elimination may be affected by the same congenital disorder of neurological origin.     

The “Kergin pneumonectomy”

Out of a series of 211 stage III (A and B) lung cancers radically resected with routine lymphadenectomy from 1971 to 1987, a total of 11 were squamous cell carcinomas invading the right main bronchus and lateral portion of the trachea. These patients were managed using a particular technique that we have always arbitrarily called, Kergin pneumonectomy, after the Toronto surgeon who described it in 1952. These patients, today, are staged III B. There was no operative mortality and only 2 minor complications. Two patients survived 3 years and 1 is alive and free of disease 7 years from surgery. This technique should be considered before embarking on more perilous surgery such as sleeve pneumonectomy, a procedure which still carries high mortality and morbidity rates and requires special equipment and intensive postoperative care.

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Resumen En una serie de 211 casos de cáncer pulmonar en estado III (A y B) sometidos a resección radical con linfadenectomía rutinaria entre 1971 y 1987, un total de 11 eran carcinomas escamocelulares que invadían el bronquio principal derecho y la porción lateral de la tráquea. Estos pacientes fueron manejados utilizando una técnica quirúrgica particular que arbitrariamente hemos denominado la neumonectomía de Kergin, según el cirujano de Toronto que la describió en 1952. Estos pacientes actualmente son estadificados como III B. No se presentó mortalidad operatoria y sólo hubo 2 complicaciones menores. Dos pacientes sobrevivieron 3 años y uno se encuentra vivo y libre de enfermedad 7 años después de la operación. Esta técnica debe ser considerada antes de embarcarse en operaciones más peligrosas taies como la neumonectomía en manga, un procedimiento que todavía conlleva elevadas tasas de mortalidad y morbilidad y que requiere equipo especial y cuidado intensivo postoperatorio.

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Résumé Dans une série de 211 cancers bronchopulmonaires de stade III (A et B), réséqués de façon radicale avec lymphadénectomie systématique, entre 1971 et 1987, 11 étaient des cancers épithéliaux envahissant la bronche souche droite et la partie latérale de la trachée. Les patients ont été opérés selon une technique que nous avons nommée arbitrairement la pneumectomie de Kergin, selon le nom du chirugien de Toronto qui l'a décrite pour la première fois en 1952. A présent, ces patients sont de stade III B. Il n'y a pas eu de mort à l'opération et il y a eu seulement 2 complications mineures. Deux patients ont survécu 3 ans et le troisème est vivant et sans récidive à 7 ans. Cette technique est à considérer avant d'envisager la pneumectomie avec enmanchonnage, technique encore accompagnée de mortalité et morbidité élevées et demandant des soins postopératoires intensifs spécifiques.

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Presented at the Société Internationale de Chirurgie in Toronto, Ontario, Canada, September, 1989.     

The caudal block: The “no turn” technique

The caudal block is an effective technique that is very common and popular in pediatric regional anesthesia. To perform this block safely, good anatomic knowledge and accurate guidelines about techniques and drugs administration must be followed. The usual approach is well-known and often described, but in some cases is not without risks. The “no turn” technique is a very easy approach that reduces these risks and is useful for teaching hospitals that are minimizing the time of the learning curve. In this article, the technique is shown and the doses of local anesthetics and adjuvants are described. Copyright 2002, Elsevier Science (USA). All rights reserved.     

The “bother” of urinary incontinence

Introduction and hypothesis

Patient reported measures are important for the evaluation of symptom-specific bother and the distinction between different types of urinary incontinence. The aim of the study was to assess the validity of physician administered visual analogue scales (VAS) for the bother from stress urinary incontinence (SUI) and urge urinary incontinence (UUI).

Methods

In this prospective cohort study based at a tertiary urogynecological unit, women attending for investigation of lower urinary tract symptoms (n?=?504) were asked to indicate their subjective bother from SUI and UUI on a 10-cm VAS. Clinical assessment, including multichannel urodynamic testing and 4D translabial ultrasound was performed for clinical diagnosis. Linear regression was used to model the average increase in VAS bother score of SUI and UUI for each explanatory variable.

Results

74 % (n?=?375) reported symptoms of SUI, with mean bother of 5.7 out of 10 (SD 2.8), and 73 % (n?=?370) symptoms of UUI, with a mean bother of 6.5 out of 10 (SD 2.6). Bother from UUI was positively associated with the symptoms of nocturia (p?<?0.0001) and frequency (p?=?0.002), and the urodynamic findings of detrusor overactivity (p?<?0.0001). Bother from SUI was positively related to the urodynamic diagnosis of USI (p?<?0.0001) and a low abdominal leak point pressure (ALPP) (p?=?0.002), as well as to the ultrasound findings of cystourethrocele (p?<?0.0001) and funnelling (p?=?0.04). All univariate associations remained highly significant on multivariate analysis, controlling for age, BMI, parity, previous incontinence/prolapse surgery and previous hysterectomy.

Conclusions

Physician-administered VAS are a valid, reliable and practicable tool to measure bother related to SUI and UUI.     

The Mistakes of Surgeons: “Gossypiboma”

Purpose: A foreign body retained in the abdominal cavity following surgery is a serious and medicolegal problem. To emphasize the importance of this operative iatrogenic complication, we reviewed our experience with six patients who had retained abdominal gossypibomas.

Methods: The records of six patients with a confirmed diagnosis of gossypiboma after abdominal surgery at Dicle University Hospital, between January 1994 and December 2000, were retrospectively reviewed. Results: Four of the six patients were female and two male. Previously, of the patients, three underwent elective operations and three were operated on for emergency. Types of previous operation were gynaecological in three cases, gastrointestinal in two cases and hepatobiliary in one case. The most common symptoms were mass, nausea, vomiting, abdominal distension and pain. The intestinal obstructions and pseudotumoral syndrome were determined in three and two cases, respectively. Abdominal ultrasonography clearly demonstrated the gossypiboma in four of our patients and CT demonstrated a more precise image of forgotten surgical sponges in the other two patients. One patient died due to ventricular fibrillation, the other five patients were discharged healthfully.

Conclusion: Small sponges should not be used during laparotomy. Compresses should only be used intraperitoneally, one by one, mounted on a forceps. Before closing the peritoneum, the surgeon should completely explore the abdominal cavity.