CONVENTIONAL AND AMBULATORY URODYNAMIC FINDINGS IN WOMEN WITH SYMPTOMS SUGGESTIVE OF BLADDER OVERACTIVITY

PURPOSE: We compared ambulatory urodynamics and conventional video cystometry findings in women with symptoms of bladder overactivity. MATERIALS AND METHODS: In a prospective randomized crossover study 106 women with symptoms of urinary urgency with or without incontinence were comprehensively investigated by video cystometry and ambulatory urodynamics in random order. In addition, all women completed a validated symptoms questionnaire and voiding diary. RESULTS: Involuntary detrusor activity was detected in 32 and 70 cases on video cystometry and ambulatory urodynamics, respectively (p <0.001). Video cystometry done according to International Continence Society standards diagnosed detrusor instability in 4 women with no involuntary detrusor activity on ambulatory urodynamics. Involuntary detrusor activity resulting in incontinence was observed in 39 cases on ambulatory urodynamics, including 20 (51%) with stable video cystometry results. Stress incontinence was diagnosed in 42 cases on video cystometry and in 34 on ambulatory urodynamics (p = 0.629). Increasingly severe urge and stress incontinence reported in the symptoms questionnaire correlated positively with the subsequent detection of detrusor overactivity and stress incontinence, respectively, on the 2 urodynamic tests. CONCLUSIONS: In contrast to video cystometry, ambulatory urodynamics provides objective evidence of clinically important bladder overactivity in the majority of women with symptoms suggestive of bladder overactivity. The correlation of symptoms with ambulatory urodynamic findings implies that greater reliance may be placed on symptomatic diagnosis of bladder overactivity. Improved objective assessment of detrusor function provided by ambulatory urodynamics has implications for the definition of bladder overactivity and relevance of conventional cystometry in this context. In women who complain of urgency stable conventional cystometrography findings should be interpreted with caution.     

Central Clinical Research Issues in Electrophysiology: Report of the NASPE Committee

DOMANSKI, M.J., et al. : Central Clinical Research Issues in Electrophysiology: Report of the NASPE Committee. This article contains the results of an attempt by appointed members of the North American Society of Pacing and Electrophysiology to define the research frontier in electrophysiology and suggest areas of study as an aid in setting the research agenda.     

Multiple peptide synthesis using a single support (MPS3)

An automated multiple peptide synthesis method to synthesize, cleave, and purify several peptides simultaneously in a single batch has been developed. The technique is based on the synthesis of multiple peptides on a single solid phase support and is easily adapted to manual or to automated methods. The approach relies on coupling of amino acid mixtures to the resin and it has been found that DCC/HOBt gives the best coupling performance. Fast Atom Bombardment Mass Spectrometry (FAB-MS) was used to rapidly and efficiently identify the peptides in each synthetic mixture which significantly assisted the purification process by HPLC. The method has been successfully applied to the synthesis of magainin 2 and angiotensinogen peptides.     

Echocardiographic Detection of a Congenital Diverticulum of the Right Ventricular Outflow Tract

Congenital diverticula of the right ventricle are extremely rare and may be life threatening. The ultrasound demonstration and recognition of such an abnormality and the important differential features are discussed.     

Threatening and violent incidents in community pharmacies: (2) Implications for pharmacists and community pharmacy services

This paper reports the second stage of a study into threatening and violent incidents in community pharmacies. The first stage, an investigation of the frequency and nature of incidents, found that a high proportion of practising pharmacists had been threatened and/or assaulted while at work (see p136). The implications of security issues for pharmacists, and how these affect the services they are prepared to offer, are addressed in this paper. Data were collected in semi-structured interviews with pharmacists who had reported one or more threatening or violent incidents. Many respondents described serious events with lasting psychological effects, including anxiety about their own safety and changed attitudes towards clients. Pharmacists' concerns about personal safety influenced them in their decisions regarding the services they offered. Pharmacists felt vulnerable at opening and closing times and believed that services to intravenous drug users increased the risks of an event; many incidents did actually occur at these times and involve this group of people. Concerns about safety and security affected late-night and out-of-hours dispensing, services to IV drug users and domiciliary visits. More surprisingly, pharmacists also reported effects on their general dispensing and advice-giving activities. The role of pharmacists in primary health care is becoming more prominent as the Government promotes community based care and encourages individuals to take more responsibility for their own health. Concerns about safety and security could hamper the continuation and development of professional services. The profession must acknowledge the potential impact of these issues in its aspirations and recommendations regarding its future primary care role.     

Conformation and structure of acidic dipeptides

The crystal structures of the dipeptides L-alanyl-L-aspartic acid, C₇H₁₂N₂O₅, and α-L-glutamyl-L-aspartic acid, C₉H₁₄N₂O₇, have been determined from three-dimensional X-ray diffractometer data. Alanylaspartic acid crystallizes in the orthorhombic space group P2₁2₁2₁ with four formula units in a cell of dimensions a = 13.389(5), b = 14.467(3), c = 4.782(1)Å. Glutamylaspartic acid also crystallizes in space group P2₁2₁2₁ with four formula units in a cell of dimensions a = 13.709(5), b = 16.126(7), c = 4.939(5)Å. Both structures were solved by direct methods and refined by full-matrix least squares methods; the final value of the weighted R-factors (on F) were 0.040 based on 790 independent intesities with I-2s?(I) for Ala-Asp and 0.033 based on 1105 intensities with I-2s?(I) for Glu-Asp. Each dipeptide occurs as a zwitterion with the amino terminus protonated and the main chain carboxyl group deprotonated. The conformation of the peptide linkage is trans in both molecules, the ω torsion angle being -175.9° in Ala-Asp and 174.3° in Glu-Asp. There is considerable intermolecular, but not intramolecular, hydrogen bonding in the crystals. The conformations and structures of Ala-Asp and Glu-Asp are compared to those of other structurally characterized acidic dipeptides.     

Purification and primary structure of ostrich insulin

Insulin has been isolated from ostrich pancreas by a procedure of acid ethanol extraction, adsorption onto SP-Sephadex, gel permeation chromatography and HPLC. The primary structure of the ostrich insulin is identical to that reported for the chicken hormone. The isoelectric point as determined by polyacrylamide gel isoelectric focusing was significantly higher than that of the bovine hormone.     

PELVI-URETERIC JUNCTION OBSTRUCTION IN CHILDREN

Thirty-six children aged between two months and 15 years presented with pelvi-ureterlc junction obstruction between the years 1975 and 1980. This paper discusses the results of surgery, the use of the Cummlngs catheter and emphasises the radiographic assessment and follow-up of these patients.     

THE EFFECTS OF SUBMAXIMAL ENDURANCE EXERCISE UPON LH PULSATILITY

The acute effects of submaximal endurance exercise (three consecutive 20-min runs on a treadmill at 50, 60 and 70% of the subjects' maximum oxygen uptake) upon the pulsatile release of LH were compared with those accompanying leisurely strolling for a similar period in seven normally menstruating young women. All trials were conducted during the early to mid-luteal phase, as determined by body temperature patterns, ultrasonic scans of the ovaries, detection of the LH surge in first morning urine specimens, and serial measurements of plasma progesterone. Blood was sampled every 10 min via an indwelling cannula for 8 h before and 12 h after exercise and serum LH measured by radioimmunoassay. LH pulsations were analysed by a time series method. Following cannulation, mean LH levels declined but then rose to reach a maximum 2 h before the beginning of the exercise bout. LH concentrations remained virtually unchanged during exercise itself, and exhibited a declining trend throughout the post-exercise period. The findings in the two groups were similar in all respects, except that in the control study the rate of LH pulsatility was significantly diminished (P less than 0.05) during the first 2 h of sampling as compared with the subsequent 2-h period. The approximate half-life of LH varied from 27 to 57 min, with a mean of 41 min.