Neurogenic Detrusor Overactivity in Patients With Spinal Cord Injury: Evaluation and Management

Lower urinary tract dysfunction can have a significant impact on patients with spinal cord injury. Over the years, many treatment options have become available. This article reviews the assessment and management of neurogenic detrusor overactivity, with a particular focus on articles from the recent literature. Recent guidelines on the subject will be discussed. Management options include antimuscarinics and bladder emptying measures, botulinum toxin A, and neuromodulation in refractory cases and surgery for intractable cases. Recent and relevant publications in these areas will be summarized and discussed.     

Intraoperative transillumination to determine the extent of frontal sinus in subcranial approach to anterior skull base

We sought to determine the extent of the frontal sinus by intraoperative transillumination through the superomedial orbital wall in a subcranial approach to the anterior skull base. After raising a bicoronal flap, the frontal sinus was transilluminated through the superomedial orbital wall with a fiber-optic light source, delineating the extent of the frontal sinus. The frontal sinus boundary was marked with a marker pen. A frontal sinus anterior wall osteotomy was performed with a sagittal saw, staying within the confines of the frontal sinus marking. A bone flap was removed, and the posterior wall was drilled out. The remaining procedure was performed in a standard fashion. At the end of the procedure, the bone flap was fixed with a titanium plate. A total of 58 patients had undergone craniofacial resection from January 2004 to December 2007. In 13 patients, a subcranial approach was employed using the transillumination technique. Transillumination was successful in delineating the frontal sinus periphery in all 13 patients. Intraoperative transillumination of the frontal sinus through the superomedial orbital wall is a simple and effective method to delineate the frontal sinus periphery in a subcranial approach to the anterior skull base.     

Role of red cell distribution width in classifying microcytic hypochromic anaemia

Red cell distribution width (RDW) is an automated laboratory determination of red cell anisocytosis. The aim of the study was to analyse the role of RDW in differentiating iron deficiency anaemia (IDA) from thalassaemia trait. There were 500 patients who were screened for the study. Selection criteria of microcytic anaemia were Hb < 13 g/dl in males, Hb < 12 g/dl in females with mean corpuscular volume (MCV) < 80fl. These cases were subjected to complete iron profile and haemoglobin chromatography for definite diagnosis. The values of RDW were analysed in all these cases to see the utility of RDW in classifying microcytic anaemia; especially differentiating iron deficiency anaemia from thalassaemia minor cases. There were 133 out of 500 cases anaemic; 105/133 cases had microcytic anaemia, of which 53 had iron deficiency anaemia, 39 were thalassaemia traits, 6 were thalassaemia major, and 7 had other haemoglobinopathies. Thirty-six cases (67.92%) out of 53 iron deficiency anaemia had increased RDW, 32.08% (n = 17) had normal RDW; 71.79% (n = 28) of thalassaemia trait had increased RDW, 28.21% (n =11) had normal RDW. Evaluation of RDW as screening test to detect microcytic anaemia had sensitivity of 71.42% and specificity of 40%, Evaluation of RDW as a screening test for IDA had sensitivity of 67.9% and specificity 25%. It was found uniform increase in RDW in all cases of microcytosis. It is concluded that RDW adds useful but limited information in classifying microcytic anaemia.     

Psychological distress and associated risk factors in bronchial asthma patients in Kuwait

Context: Recent literature shows a high prevalence of psychological distress in bronchial asthma. Aim: To find the extent of psychological distress and associated risk factors in bronchial asthma patients in Kuwait. Design: Case-control study. Materials and Methods: In a study at Kuwait's allergy center, 102 patients aged 20-60 years with asthma (67%), asthma with allergic rhinitis (33%) completed a self-administered questionnaire (WHO-Five Well-being Index). A score below 13 was considered as psychological distress; and 13 and above, as normal. An equal number of controls, matched for age, gender, nationality, were also enrolled. Statistical Analysis: The data were analyzed using SPSS software, and proportions were tested with Chi-square or Fisher's test. Odds ratio (OR) with 95% confidence interval (CI) was calculated to quantify the risk factors. Results: A significantly large proportion (69%) of patients were found to be psychologically distressed, compared to 24% among controls (P Conclusions: We found a high rate of poor well-being and psychological distress in patients suffering from asthma. Young patients and those with relatively short duration of illness, as well as asthmatic females, are more vulnerable to distress and need further psychological evaluation.     

Variation in the origin of the inferior alveolar nerve

The inferior alveolar nerve and maxillary artery were studied in 40 human heads through infratemporal dissection; in one specimen, a unusual variation in the origin of the inferior alveolar nerve and its relationship with the surrounding structures was observed. The inferior alveolar nerve originated from the mandibular nerve by two roots and the second part of the maxillary artery was incorporated between them. An embryologic origin of this variation and its clinical implications is discussed. Because the maxillary artery ran between the two roots of the inferior alveolar nerve, and the nerve was fixed between the foramen ovale and mandibular foramen, tension and compression of the nerve from arterial pulsation could cause mandibular neuralgia.     

Limb lead interchange in thorough QT/QTc studies

The investigators analyzed 85,133 electrocardiograms (ECGs) recorded in 484 subjects from 5 thorough QT/QTc studies (3 using Holter devices, 2 using 12-lead ECGs) for inadvertent limb lead interchanges using a dedicated quality control process in a central ECG laboratory. Limb lead interchanges were present in 2919 (3.4%) ECGs in 17.9% of subjects and were more frequent with Holter devices (7.5% vs 0.8%, P < .0001), where leads remain connected for prolonged periods, affecting data from several time points. Left arm-left leg interchange was seen in 54% of 12-lead ECGs and right arm-left arm interchange in 38%. The ECG device itself could identify 21.7% of interchanges, whereas experienced readers blinded to subject and visit identified 79% of interchanges; 21% of interchanges were identified only during the quality control process. If correctly identified, QT measurement could be performed in a precordial lead. If undiagnosed, incorrect QT interval measurements and morphological diagnosis may confound results.