Pediatric urology

Development of the genital and urinary systems is interwoven. Developmental abnormalities may cause problems in both systems, although the presenting problem may be ambiguous genitalia, hypospadias, undescended testis, or a urinary tract infection. The primary care physician must understand the underlying significance of pediatric urologic problems and seek appropriate consultation in a timely manner.     

Vestibular testing in comatose patients

The analysis of vestibular responses in a comatose patient often provides the critical information for making a correct preliminary diagnosis and directing the subsequent laboratory evaluation. Because of some uncertainties about what is being tested with the various bedside maneuvers that are used to elicit vestibular responses, we review the physiologic basis for the oculomotor responses that occur with head rotation or with caloric stimuli. We further urge precise and unambiguous terminology to describe both stimulus and response. We suggest using physiologically well-defined terms such as vestibulo-ocular reflex and cervico-ocular reflex and avoiding potentially misleading terms such as the doll's head and the oculocephalic maneuvers.     

Opsoclonus in organophosphate poisoning

Transient opsoclonus was observed in a patient who attempted suicide with the organophosphate insecticide Malathion (diethyl[dimethoxyphosphinothioyl]thiobutanedioate). Several toxins can cause opsoclonus, and these must be considered in its differential diagnosis. Eye movement disorders are one of the more common manifestations of organophosphate intoxication, and opsoclonus should now be included among these. Acetylcholine may be a neurotransmitter in the ocular motor pathway.     

The antecedents and benefits of achieving abstinence in opioid addicts: a 2.5-year follow-up study

This report examines long-term and short-term benefits of achieving abstinence from opioids in a sample of opioid addicts who were reevaluated 2.5 years following seeking treatment. Extensive assessment of drug use history and drug-associated problems had been obtained when the subjects applied for treatment. At follow-up evaluations, detailed information was obtained on intervening course of drug use, treatment, legal problems, psychological problems, social functioning, occupational functioning, and medical status. The results were as follows: (1) Achieving abstinence from illicit opioids was associated with concurrent improvement in other aspects of functioning including reduction of criminal activity, improved medical status, improved social functioning, and reduced abuse of other psychoactive substances. However, many of these improvements were reversed immediately if relapse to opioid use occurred. (2) Achieving abstinence was associated with being in drug treatment, especially treatment in a methadone maintenance program. (3) Achievement of abstinence was not successfully predicted by client characteristics measured at entrance into treatment. (4) Long-range benefits of abstinence were detectable in social functioning even for those who had relapsed at the time of follow-up reevaluation.     

Endurance training does not affect diaphragm mitochondrial respiration

We sought to determine if chronic endurance training would increase mitochondrial respiration or protein content in rat diaphragm muscle. To this end, 20 male Wistar rats were randomly assigned to control (C) or an 8-week endurance training (T) group, n = 10 per group. At the end of T, VO2 max was 13% greater in T (83.3 vs 73.8 ml X kg-1 X min-1) and peak max power output was 32% greater (2.63 vs 1.98 kg X m X min-1). Mitochondrial specific activities of pyruvate-malate and cytochrome oxidase (expressed per mg mitochondrial protein) in both plantaris and diaphragm were similar in C and T rats, as were ADP/O and respiratory control ratios. When expressed per gram wet weight, whole muscle homogenate oxygen uptake (pyruvate + malate) and cytochrome oxidase activity increased 36 and 23%, respectively (P less than 0.05) in plantaris from T rats but did not change in diaphragm. Control oxidative capacity and mitochondrial protein content in the diaphragm were ca. 2-fold those in control plantaris. Plantaris mitochondrial protein content increased ca. 50% with T while the diaphragm was unaffected. We conclude that: plantaris muscle oxidative capacity adapts to training by increasing mitochondrial protein content, since there was no evidence for functional improvement of existing mitochondria, and in the face of a substantial training effect in whole animal and plantaris, the T stimulus was not sufficient to induce mitochondrial protein changes in the diaphragm. This finding is the result of either a 'pre-adaptation' secondary to the diaphragm's high chronic activity, or a sub-threshold increase in diaphragm recruitment during the exercise conditions studied.     

Paratesticular desmoid tumor

A primary intrascrotal mass clinically mimicking a testicular tumor was found to be a desmoid tumor originating from the spermatic cord. To our knowledge, this is the first reported case of a paratesticular desmoid tumor.     

Clonidine in the treatment of Tourette's syndrome exacerbation due to haloperidol withdrawal

A patient with long-standing Tourette's syndrome had a dramatic exacerbation of symptoms following the rapid withdrawal of haloperidol. Clonidine administration resulted in a disappearance of tics, which recurred 6 days later. The role of clonidine in blocking withdrawal-induced symptoms in patients with Tourette's syndrome treated with long-term neuroleptics is discussed from a clinical and neurobiological perspective. The implications of this case for the treatment of supersensitivity psychosis and tricyclic withdrawal states with clonidine are also discussed.