Consistency of urodynamic parameters in children with detrusor instability: how many times should the bladder be filled?

INTRODUCTION: It is recommended that the bladder be filled at least twice to perform a standard urodynamic study. However, the procedure is time-consuming and distressing for both the patient and the professional. The impact of the number of fillings on urodynamic parameters in children with normal urodynamic results and those with detrusor instability is presented in this study. PATIENTS AND METHODS: Urodynamic data from 70 children with detrusor instability and 42 with normal urodynamic parameters who had undergone 3 consecutive fillings in a single session during a 2-year period were reviewed retrospectively. The variable parameters that were compared between the 2 groups were the mean bladder capacity ratio, maximum filling pressure and the number of contractions during the filling phase. RESULTS: In the normal group, no difference was found in bladder capacities between the 3 fillings, but there was a significant decrease in the maximum bladder filling pressures in the subsequent fillings. In children with detrusor instability, the number of contractions in the 1st filling was significantly higher than those in the subsequent fillings. Also in this group, a significant difference in the mean bladder capacities between fillings was noted as well as a decrease in the maximum bladder filling pressures in contrast to normal bladders. CONCLUSION: In patients with suspected detrusor instability the bladder should be filled at least twice for a reliable urodynamic assessment. Two normal fillings without contractions, with normal capacity and normal maximum bladder filling pressure are highly suggestive of a normal 3rd filling.     

The early steps of chloroform anaesthesia in Turkey during the Ottoman Empire in the 19th century

OBJECTIVE: The aim of this study was to research the pioneering steps for the employment of chloroform in Turkey in comparison with the developments in the West i.e. in the United States and in Europe. The development of anaesthesiology in the West started in the first half of the 19th century. As an anaesthetic substance, ether was first employed in a medical operation by R. Liston in December 1846. But taking into consideration of its bronchially irritant effect, British gynaecologist Dr. J.Y. Simpson preferred to utilize chloroform in obstetrical operations in 1847. The paper aims at shedding light on the earlier steps for modern anaesthesiology in Turkey in that sense. METHODS: The survey used evaluation of archival documents, first hand-original sources such as the annual medical reports of the Medical School, books, official journals, and newspapers of the time, and also secondary sources concerned with the subject. RESULTS: In view of the findings of the survey, chloroform, as an anaesthetic material, began to be administered surgically in Turkey much earlier than it was already known. It was experienced and used in operations at the surgical clinic of the Imperial School of Medicine at the Capital city, Istanbul in 1848. The Crimean War (1853-1855) induced to the prevalent surgical use of chloroform in Istanbul on the soldiers back from the front. In other words, it was evidenced that surgeons started to make use of this anaesthetic substance in the Ottoman Empire, shortly after it was put into medical practice in Europe. CONCLUSION: This study deals with that phenomenal progress of chloroform anaesthesia in the medical history in Turkey during the second half of the 19th century.     

Blood pressure and length of stay in Australia of Italian immigrants in the Australian National Blood Pressure Study.

Data obtained from 10,975 Australian-born and 1,717 Italian-born subjects aged 30-69 years in one centre of the Australian National Blood Pressure Study revealed that the Italians had lower systolic and diastolic blood pressures compared with Australians of the same age and sex. The Italians' blood pressures rose in successive age groups and at the same rate as in the Australians. After the effect of age was eliminated, the duration of residence of the Italians in Australia had a small but significant association with their blood pressures, possibly indicating exposure to blood pressure-elevating environmental factors in Australia.     

The Rate of Initiation of Treatment for Hypertension in a Community, 1971–1975

Summary: The rate of initiation of treatment for hypertension in a community, 1971–1975.
In 1971 persons aged 50–59 in a community were screened for hypertension and those with diastolic BP ≤ 110 mmHg were notified. On reviewing the sample in 1975 the treatment rate had doubled to 22%. Screening in 1971 was followed by an immediate rise in numbers starting treatment, most being notified cases. Thereafter initiation of treatment at a rate of 3–8 cases per 100 persons per year chiefly reflected identification of subjects deemed to need treatment in the ordinary course of medical practice. Of those starting treatment during the four years 25% had stopped it by 1975. The influence of screening and other factors on the rate of initiation of treatment and adherence to it are discussed. With an already high attendance rate at doctors, regular screening of this whole age group seems feasible within the framework of general practice. The high treatment rate found in 1975 underlines the urgent need for the indications currently used for starting treatment to be validated.     

Unwitting exposure of the therapist: transferential and countertransferential dilemmas

The unwitting exposure of the therapist's private life creates an unexpected rupture in the frame and puts both the therapist and the patient off balance. The exposure introduces into the therapy a moment of human sharing of vulnerability that has the potential to enrich the treatment. Clinical vignettes are presented to help therapists anticipate possible exposures and their consequences. The discussion encourages therapists to predict their reactions, obtain needed professional support, and make the most of opportunities for full exploration of patients' material.     

Familial vesicoureteral reflux in asymptomatic siblings

A prospective study was established to identify the incidence of vesicoureteral reflux in the asymptomatic siblings of patients with reflux in our region. Of 32 patients with reflux, 37 siblings were screened with urine analysis, urine culture and contrast voiding cystourethrograms, and six (16.2%) were found to have reflux. Renal scan revealed scarring in five. We concluded that siblings of children with vesicoureteral reflux are at high risk, and must be screened so that renal damage and associated morbidity secondary to reflux might be minimized.     

The effects of different intensity walking programs on serum blood lipids,high-sensitive C-reactive protein,and lipoprotein-associated phospholipase A2 in premenopausal women

Aim

This study examined the effects of 12 weeks of walking programs on serum lipids, high-sensitive C-reactive protein, and lipoprotein-associated phospholipase A2.

Methods

Twenty-six pre-menopausal women (30–49 years) completed 12 weeks of walking programs either at moderate or high intensity (50–55%, 70–75% maximum heart rate reserve, respectively). Estimated maximal oxygen consumption was assessed with a 2-km walking test; body composition, blood lipids, high-sensitive C-reactive protein, and lipoprotein-associated phospholipase A2 were measured before and after the study.

Results

Maximal oxygen consumption increased, favoring high-intensity group; body weights, percent body fat (p < 0.01) and body mass index (p < 0.05) decreased in both exercise groups. There were no significant changes in the measured blood lipids in any of the groups, except for a significant reduction in low-density lipoprotein-cholesterol in high-intensity group (p < 0.05). High-sensitive C-reactive protein and lipoprotein-associated phospholipase A2 levels reduced significantly in high-intensity (p < 0.01) and moderate-intensity (p < 0.05) groups, which were also different from the changes in the control group.

Conclusion

Walking programs with different intensity result in favorable changes; however, for protective effects against cardiovascular diseases, high-intensity walking may be advised due to greater reductions in low-density lipoprotein-cholesterol, and high-sensitive C-reactive protein and lipoprotein-associated phospholipase A2.     

Adipose tissue-derived FABP4 mediates glucagon-stimulated hepatic glucose production in gestational diabetes

Aims

One of the most common complications of pregnancy is gestational diabetes mellitus (GDM), which may result in significant health threats of the mother, fetus and the newborn. Fatty acid-binding protein 4 (FABP4) is an adipokine that regulates glucose homeostasis by promoting glucose production and liver insulin resistance in mouse models. FABP4 levels are increased in GDM and correlates with maternal indices of insulin resistance, with a rapid decline post-partum. We therefore aimed to determine the tissue origin of elevated circulating FABP4 levels in GDM and to assess its potential contribution in promoting glucagon-induced hepatic glucose production.

Materials and Methods

FABP4 protein and gene expression was determined in biopsies from placenta, subcutaneous (sWAT) and visceral (vWAT) white adipose tissues from GDM and normoglycaemic pregnant women. FABP4 differential contribution in glucagon-stimulated hepatic glucose production was tested in conditioned media before and after its immune clearance.

Results

We showed that FABP4 is expressed in placenta, sWAT and vWAT of pregnant women at term, with a significant increase in its secretion from vWAT of women with GDM compared with normoglycaemic pregnant women. Neutralizing FABP4 from both normoglycaemic pregnant women and GDM vWAT secretome, resulted in a decrease in glucagon-stimulated hepatic glucose production.

Conclusions

This study provides new insights into the role of adipose tissue-derived FABP4 in GDM, highlighting this adipokine, as a potential co-activator of glucagon-stimulated hepatic glucose production during pregnancy.     

Feeling older,walking slower—but only if someone’s watching. Subjective age is associated with walking speed in the laboratory,but not in real life

The huge inter-individual differences in how people age have prompted researchers to examine whether people’s own perception of how old they are—their subjective age—could be a better predictor of relevant outcomes than their actual chronological age. Indeed, how old people feel does predict mortality hazards, and health-related measures such as walking speed may account for this association. In the present study, we extended this line of work by investigating whether subjective age also predicts walking speed and running speed in daily life or whether the predictive effects of subjective age for behavior manifest only within a controlled performance situation. We used data from 80 older participants (age range 62–82 years; M = 69.50, SD = 4.47) from the Berlin Aging Study II (BASE-II). Subjective age was assessed by self-report. Walking speed in the laboratory was measured with the Timed Up and Go test, and walking speed and running speed in real life were measured with an accelerometer. Results showed that compared to participants who felt older, those who felt younger than they actually were indeed walked faster in the laboratory, but they did not walk or run faster in real life. These patterns of results held when age, gender, education, BMI, comorbidity, depression, physical activity, and cognition were covaried. We discuss the role of stereotype threat in accounting for these results.