Functional enuresis: pharmacological versus behavioral treatment

Treatment of childhood enuresis requires a careful anamnesis, physical examination, urinalysis, and urine culture to determine if a subject is affected with functional or organic enuresis. Functional enuresis (FE) was present in the majority of our patients (168/204). These 168 subjects, aged from 6 to 11 years, were randomly divided into three therapy groups (pharmacological therapy, behavioral therapy, and behavioral therapy with the aid of a personal computer). Our study shows that behavioral therapy gave better results in FE than did pharmacological therapy. We point out the usefulness of combining bladder retention training and behavioral therapy to improve the general maturity and autonomous behavior of the child, and the resultant positive effects on his personality.     

Utility of voice therapy in the management of vocal fold polyps and cysts.

OBJECTIVE: To evaluate the efficacy of voice therapy in the management of vocal fold polyps and cysts. STUDY DESIGN AND SETTING: Retrospective review of vocal fold cysts and polyps undergoing voice therapy in a tertiary care center. Symptom resolution or persistence resulting in surgical intervention was the main outcome measure. RESULTS: Fifty-seven patients were identified, of which 49.1% achieved symptom resolution with voice therapy alone. Patients with complete glottal closure and muscle tension dysphonia did not have a better response than those with incomplete glottal closure and without muscle tension dysphonia (P = 0.1, chi(2), respectively). Patients with translucent polyps more commonly responded to voice therapy than fibrotic, hyaline, or hemorrhagic polyps, 81.8% versus 15.4% and 25.0% response rate, respectively (P = 0.002, chi(2)). CONCLUSIONS: Voice therapy is an effective treatment modality for vocal fold polyps and cysts. SIGNIFICANCE: A multidisciplinary approach including a trial of voice therapy is warranted.     

Renin secretion by the spontaneously diabetic rat

Renal function studies and measurements of in vivo plasma renin activity (PRA), kidney renin content, and renin secretion by isolated, perfused kidneys were performed in spontaneously diabetic and nondiabetic BioBreeding/Worcester (BB/W) rats. Diabetic animals evidenced hyperglycemia, glycosuria, and plasma volume expansion. After dietary sodium deprivation, plasma volume fell to levels equivalent to those of sodium-deprived, nondiabetic rats. Dietary sodium deprivation evoked a larger proportional increase in PRA among diabetic than nondiabetic animals, although PRA before sodium restriction was equivalent in the two groups. Basal renin release (RR) was higher from isolated, perfused kidneys from diabetic rats than from nondiabetic kidneys. Diabetic kidneys, moreover, displayed increased kidney renin content (KRC). By contrast, while isoproterenol (10(-5) M) stimulated a nearly fivefold increment in RR from nondiabetic, perfused kidneys, a negligible effect was observed in diabetic kidneys. The dose-response curve of renin secretion (as a proportion of total renal content) in response to isoproterenol was shifted downward. Hence, while KRC and spontaneous RR by isolated, perfused kidneys were increased, the increment in PRA with salt depletion and the renin-secretory response to isoproterenol in vitro were impaired. We propose that specific defects in renin secretion, in particular, the response to beta-adrenergic stimulation, may be operative in diabetes.     

Brachial plexitis complicating disseminated gonococcal infection

A patient with brachial plexitis associated with disseminated gonococcal infection is presented. This is, to the best of our knowledge, the first case to be reported of this association.     

Effects of diflubenzuron on limb regeneration and molting in the fiddler crab, Uca pugilator

Fiddler crabs, Uca pugilator, were exposed to the insect growth regulator diflubenzuron (Dimilin^®) at 0.5, 5, and 50 μg/l after multiple autotomy of one chela and five walking legs. Regeneration of the first walking leg was monitored, and time to ecdysis, mortality, and morphology of the regenerated limbs observed. Continuous exposure to the chemical produced a dose-dependent retardation of regeneration. Animals molting in the higher concentrations exhibited significant mortality at ecdysis. Exposure to the pesticide for a single week produced similar but less severe effects. However, if crabs molted while in the pesticide, significant mortality was observed. The presence of sediment in the container with the crab moderated the effects of the pesticide, but did not eliminate them.

The regenerated limbs of the crabs that survived ecdysis were found to have lesions in the form of black areas in which the cuticle was improperly developed. These lesions were seen in crabs that had been in the pesticide for only one week (week 2 or week 3) as well as those that had had continuous exposure. They were also seen in crabs that regenerated in Dimilin with sediment. In addition, the number of setae on limbs was reduced compared to the number on limbs that had regenerated in clean sea water.     

Patterns of lens care practices and lens product contamination in contact lens associated microbial keratitis

A prospective study of 24 contact lens patients with culture- or histopathology-proven microbial keratitis was performed between July and December 1987 to determine associated lens care practices and patterns of lens care product contamination. A questionnaire was used to document methods of lens care. Bacterial cultures were performed on all available contact lenses, lens cases, and solutions (including saline, disinfectant, daily cleaner and wetting agents), in addition to standard smears and cultures of the corneal ulcer. Failure to follow standard recommendations regarding contact lens care was widespread (21 of 24, 88%). In the majority of patients (20 of 24, 83%) bacterial contamination of the contact lens, case, and/or solutions was present. Almost two-thirds (15 of 24, 62%) of patients used solutions that were more than 3 months old. Cosmetic extended wear lens patients were most likely (7 of 8, 88%) to use solutions that were more than 3 months old and very likely (6 of 8, 85%) to have contaminated solutions. Efforts to improve lens care and decrease lens product contamination are necessary to prevent contact lens associated corneal ulcers.     

Levels of high energy phosphates in human lung cancer cell lines by 31P nuclear magnetic resonance spectroscopy

Human lung cancers are divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) based on established criteria. SCLC differs from NSCLC by the expression of biomarkers, including creatine kinase-BB isoenzyme (EC 2.7.3.2). Subtypes of SCLC are referred to as classic and variant, both of which have elevated levels of creatine kinase-BB isoenzyme. We, therefore, applied 31P nuclear magnetic resonance spectroscopy to cell lines of classic SCLC, variant SCLC, and NSCLC human tumors, using continuous perfusion to identify any differences in the detectable levels of intracellular high-energy phosphate compounds. The spectra indicate that only the variant SCLC cells maintain high levels of phosphocreatine. Additionally, the classic SCLC cells express elevated levels of a diphosphodiester. Neither phosphocreatine nor diphosphodiesters are found in the NSCLC cell spectra.     

Diagnosis of schizophrenia. Prediction of short-term outcome

Seven systems for the diagnosis of schizophrenia were compared in their ability to predict short-term outcome at follow-up: with each other, with selected specific symptoms, and with a simple additive composite symptom score. None of the systems nor the symptoms predicted strongly, but DSM-III and Schneiderian First Rank Symptoms and the composite score performed somewhat better than the other predictors.     

Animal model of acute pericarditis and its progression to pericardial fibrosis and adhesions: Ultrastructural studies

To study the evolution of pericardial inflammation, we have developed a model of pericarditis in sheep by surgically injecting heat-killed staphy-lococci and Freund's adjuvant into the pericardial cavity under sterile conditions. The pericarditis evolved through the following phases: (1) inflammatory response, (2) mesothelial cell injury and desquamation, and (3) fibrotic phase. At 3–24 hr there was increased microvascular permeability, which resulted in the exudation of fluid, neutrophils, macrophages, ami fibrin into the pericardial cavity and the pericardial intersti-tium. By 72 hr, large numbers of inflammatory cells were aggregated on the mesothelial surfaces and dispersed throughout the pericardial cavity, either as free-floating cells or located between strands of fibrin. At 6 days, fibrinolysis was apparent along the mesothelial surfaces; and newly formed collagen fibrils were deposited throughout the interstitial spaces and among the aggregated cells. These fibrils provided a matrix for the growth of new blood and lymphatic vessels into new connective tissue on both parietal and visceral pericardial surfaces. At 2 weeks, intrapericardial fibrosis had produced focal adhesions between the pericardial surfaces. By 1 month, extensive areas of the pericardial cavity were obliterated. By 9 months, there was a marked reduction in the numbers of cells and blood vessels and increased deposition of collagen and elastic fibers. The intrapericardial injection of heat-killed staphylococci and adjuvant provides a reproducible animal model to study the time course of pericardial inflammation.