Giggle incontinence in children: a manifestation of detrusor instability

PURPOSE: To our knowledge the prevalence and cause of giggle incontinence in children is not known. We hypothesized that laughter may induce unstable detrusor contractions in children susceptible to detrusor instability. We evaluated the prevalence of diurnal voiding symptoms of urinary urgency, urge incontinence, pelvic withholding maneuvers and hesitancy in patients with giggle incontinence, the prevalence of giggle incontinence in patients with diurnal voiding symptoms, the prevalence of the 2 conditions in first degree relatives of patients with giggle incontinence, the influence of treatment for detrusor instability on the frequency of giggle incontinence and the prevalence of diurnal voiding symptoms in control children with giggle incontinence. MATERIALS AND METHODS: Of 1,421 children 5 to 15 years old referred to the pediatric nephrology department for various problems 109 were diagnosed with giggle incontinence and 460 had diurnal voiding symptoms. A total of 627 children visiting the pediatrician office whose parents completed a survey questionnaire served as controls. RESULTS: Diurnal voiding symptoms were noted in 95% of the patients with giggle incontinence, while giggle incontinence was noted in 23% of those with diurnal voiding symptoms. Of the patients with giggle incontinence a positive family history for that entity and diurnal voiding symptoms was noted in 13% and 28%, respectively. Giggle incontinence improved in all patients after treatment for detrusor instability and it resolved completely in 89%. Giggle incontinence recurred with a relapse of diurnal voiding symptoms in 28 cases and improved with improved diurnal voiding symptoms during modification of therapy. Diurnal voiding symptoms were present in 43% of the 157 controls with giggle incontinence. CONCLUSIONS: Giggle incontinence results from detrusor instability induced by laughter and it improves with effective treatment of detrusor instability.     

Fraser-Cryptophthalmos syndrome

Fraser or Cryptophthalmos syndrome is a variable syndrome to the extent that cryptophthalmos might not be present in all cases. However, the main features are a “hidden eye”, other craniofacial abnormalities, renal abnormalities, syndactyly and abnormal genitalia. It may be classified as isolated cryptophthalmos or cryptophthalmos sequence and cryptophthalmos syndrome. The cryptophthalmos syndrome has an autosomal recessive mode of inheritance. Isolated cryptophthalmos has been reported as an autosomal dominant trait. Prenatal diagnosis is possible using ultrasonography and fetoscopy. We report three cases of cryptophthalmos. One with renal agenesis had cryptophthalmos syndrome and the other two had isolated cryptophthalmos or cryptophthalmos sequence.     

Inhibition of glycolysis and mitochondrial respiration of ehrlich ascites carcinoma cells by methylglyoxal

The effect of methylglyoxal (MG) on the aerobic glycolysis of Ehrlich ascites carcinoma (EAC) cells has been tested. Methylglyoxal inhibited glucose utilization and glucose 6-phosphate (G6P) and L-lactate formation in whole EAC cells. Methylglyoxal strongly inactivated glyceraldehyde 3-phosphate dehydrogenase (GA3PD) of the malignant cells, whereas MG has little inactivating effect on this enzyme from several normal sources. Methylglyoxal also inactivated only the participate hexominase of the EAC cells, but this inactivation was less pronounced than the effect on GA3PD. Methylglyoxal has little inactivating effect on glucose 6-phosphate dehydrogenase (G6PD), and no effect on L-lactate dehydrogenase (LDH) of the malignant cells. Glucose-dependent L-lactic acid formation of EAC-cell-free homogenate was strongly inhibited by MG, but when GA3PD of normal cells was added to this homogenate, significant lactate formation was observed even in the presence of MG. Methylglyoxal also inhibited the respiration of EAC-cell mitochondria. Respiration of mitochondria isolated from liver and kidney of normal mice, however, remained unaffected. As a consequence of the inhibition of glycolysis and mitochondrial respiration, the ATp level of the EAC cells was drastically reduced. Studies reported herein strongly suggest that the tumoricidal effect of MG is mediated at least in part through the inhibition of mitochondrial respiration and inactivation of GA3PD, and this enzyme may play an important role in the high glycolytic capacity of the malignant cells.     

Conductometric titrations of anionic polyelectrolytes with metachromatic dyes and effects of organic solvents

Metachromatic color change induced in a suitable dye by the polyanionic chromotrope involves (i) the formation of electrostatic bonds between the dye cations and polyanions and (ii) effective aggregation of the dye cations due to their occupying the adjacent sites on the polyanion. Parallel studies are made on the effects of reagents like ethanol, dioxane and urea on the destruction of metachromasia and the binding of the dye cations on the polyanion. Conductometric titrations of chondroitin sulfate with methylene blue indicate that the dye binding on the chromotropes is less susceptible to these reagents than the metachromasia of the dye as studied spectrophotometrically. This indicates that it is not the electrostatic bond that is responsible for the metachromatic spectral shift of the dye but rather the aggregation of dye ions; and these reagents preferably attack the bonds involved in the dye-dye interaction rather than the dye-polyanion electrostatic bond. Comparison of the equivalent weights of heparin as estimated from conductometric titrations with metachromatic dyes and estimated analytically indicates that all ionic sites in heparin, unlike chondroitin sulfate, are not occupied by dye ions; this may be due to the high charge density of heparin.     

Socio-demographic co-relates of psychiatric disorders

Objective: To find out the magnitude of probable psychopathology in children and study association of psychopathology with demographic, developmental and social factors.Methods: Childhood Psychopathology Measurement Schedule (CPMS) was used to measure the magnitude of probable psychopathology in 620 children from an urban slum of Miraj (Maharashtra). A second schedule recorded demographic, developmental and social factors.Results: CPMS score >10 was observed in 102 children (16.5%). It was significantly higher in children aged 7–10 years, in males, belonging to lower socioeconomic status, large families, being first born, having low birth weight (LBW); body mass index (BMI) less than 18.5. Low maternal education and alcohol abuse in father also had significant association with CPMS score >10.Conclusion: Findings suggest a need to educate the community about psychological implications of LBW, large family size and overcrowding in children. Improving maternal education and controlling alcoholism could help in reducing childhood psychopathology.     

Proximal Type I Endoleak After Endovascular Abdominal Aortic Aneurysm Repair: Predictive Factors

Proximal type I endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) are associated with a high risk of rupture. Risk factors for developing this complication are not fully elucidated. We aimed to define preoperative predictors for proximal type I endoleak and describe its clinical outcome. From a consecutive series of 257 patients who underwent EVAR, we selected 202 who had available pre- and postoperative CT scan studies. Proximal neck diameter, length, angulation, calcification, thrombus load (thickness, percentage of neck circumference coverage, percentage of neck area occupancy), and maximum aneurysm diameter were evaluated on preoperative CT scans. All postoperative CT and duplex ultrasound scans, supplemented with angiograms in selected cases, were reviewed for the presence or absence of endoleak. Device overlap and oversizing (relative to the proximal neck) were also determined. Type I proximal endoleak rates were estimated using the Kaplan-Meier method. The associations between the variables listed above and proximal type I endoleak were evaluated by use of Cox proportional hazards models. Proximal type I endoleak occurred in eight patients, corresponding to a 3-year incidence rate of 4% (SE = 1.5%). The median follow-up was 340 days (range, 22-1954). Univariate analyses found significant associations between proximal type I endoleak and the following variables: percentage of calcified neck circumference (hazards ratio = 2.19 for a 25% increase, p = 0.019), aneurysm maximum diameter (hazards ratio = 1.98 for a 1-cm increase, p = 0.006) and proximal neck and device overlap (hazards ratio = 0.53 for a 5-mm increase, p = 0.007). The mean overlap among cases with and without type I proximal endoleak was 15.6 mm and 29.3 mm, respectively. When these variables were included in a multivariate model, all remained statistically significant. No significant association could be documented for neck thrombus-related variables. Thirty-nine (19.3%) patients had a neck angle inferior to 120°. There was a trend toward a higher incidence of proximal type I endoleaks in these patients (p = 0.057). Device oversize relative to proximal neck diameter did not affect the probability of this type of endoleak. One patient survived an emergency open repair of a ruptured aneurysm after significant expansion. Six patients underwent endovascular reinterventions (4 additional proximal cuff placements, 2 proximal angioplasties). The mean interval for reintervention was 389 days. Distal migration (5 mm) was identified in four cases (50%). Proximal type I endoleak is a rare complication after EVAR, but it is associated with a high number of reinterventions and potentially serious consequences. Patients with short and heavily calcified aneurysmal necks and large aneurysms are at increased risk of proximal type I endoleaks.Presented at the 13th Annual Winter Meeting of the Peripheral Vascular Surgery Society, Steamboat Springs, CO, January 31-February 2, 2004.S.M. Sampaio is a recipient of the Edward S. Rogers Clinical Research Fellowship in Vascular Surgery.     

Quantitative polymerase chain reaction analysis of fungi in dust from homes of infants who developed idiopathic pulmonary hemorrhaging

Fungal concentrations were measured in the dust of 6 homes in Cleveland, Ohio, where an infant developed pulmonary hemorrhage (pulmonary hemorrhage homes [PHH]) and 26 reference homes (RH) with no known fungal contamination. Quantitative polymerase chain reaction assays for 82 species (or assay groups) were used to identify and quantify fungal concentrations. The ratios of the geometric means of PHH to RH were >1 for 26 species (group I). However, the same ratios were <1 for 10 species (group II). Probit analysis of the sum of the logs of the concentrations of these 2 groups resulted in a 95% probability range for separating PHH from RH homes. The same 82 fungal species were also tested for hemolysin production on sheep's blood agar (incubated at 37 degree C). Hemolysins were more commonly produced by group I species (42%) compared with group II species (10%).     

The thalamic intergeniculate leaflet modulates photoperiod responsiveness in Siberian hamsters

Siberian hamsters are seasonal breeders that use changes in day length to synchronize their reproductive effort with those times of the year most favorable for successful reproduction. The ability of Siberian hamsters to measure and respond to changes in day length depends upon accurate photoentrainment of the circadian clock in the suprachiasmatic nucleus (SCN) of the hypothalamus. Two pathways have been characterized through which entraining stimuli reach the SCN: the retinohypothalamic tract (RHT), which transmits light information from the retinae, and the geniculohypothalamic tract (GHT) from the intergeniculate leaflet of the thalamus (IGL), which is involved in transmitting both photic and nonphotic cues. Ablating the IGL/GHT results in only modest alterations in entrainment to static day lengths and fails to interfere with seasonal responses induced by transfer from static long day to static short day lengths. Because several studies suggest that the IGL may be involved in tracking the time of dusk and dawn, we sought to determine whether an intact IGL is necessary for hamsters to respond to a simulated natural photoperiod (SNP) in which the time of dusk and dawn gradually changes in a pattern approximating the rate of change in day length that occurs during autumn at the latitude this species inhabits in nature. The results indicate that neurochemical lesions of the IGL alter both the pattern of circadian entrainment and photoperiodic responsiveness of Siberian hamsters to an SNP. Both intact and IGL-lesioned hamsters exhibited testicular regression in shortening day lengths, but only IGL-intact hamsters exhibited seasonal pelage molt.