Central nervous system lesion causing urethral instability and urinary incontinence

We report on a girl in whom urinary incontinence developed after surgery for a cerebral arteriovenous fistula. Urodynamic evaluation demonstrated periodic decreases in urethral pressure and external anal sphincter electromyographic activity. These episodes were associated with entry of radiographic contrast material into the urethra and urinary incontinence. Treatment with ephedrine sulfate prevented entry of urine into the proximal urethra and resulted in complete daytime continence, despite persisting urodynamic evidence of urethral and electromyographic abnormalities.     

Suprapubic endoscopic vesical neck suspension (Stamey procedure) for control of urinary incontinence in a woman following cauda equina injury

Suprapubic endoscopic suspension of the vesical neck is a popular and effective procedure for the treatment of stress urinary incontinence in women. A woman who suffered a traumatic cauda equina injury had areflexic detrusor dysfunction with normal intravesical filling pressure. The patient had moderate proximal urethral dysfunction resulting in incontinence despite an adequate intermittent self-catheterization regimen and treatment with an alpha-sympathomimetic drug. Following suprapubic endoscopic vesical neck suspension she has remained totally continent on intermittent self-catheterization.     

Biologic markers and bipolar disease in children

The diagnosis of manic depressive or bipolar disease is difficult in adolescents. Poorly defined nosology, and a high incidence of schizophrenia-like symptoms contribute to this difficulty. The authors discuss the use of the Dexamethasone Suppression Test (DST) in the diagnosis of bipolar disease in adolescents, presenting three case studies. The existence of phase-dependent DST non-suppression is described for the first time in adolescents.     

Uncooked cornstarch--efficacy in type I glycogenosis

Uncooked cornstarch (UCCS) loads in 14 patients with type 1 glycogenosis revealed that satisfactory glycaemia was achieved for a median of 4.25 hours (range 2.5 to 6). Length of glycaemia was related weakly to UCCS dose, but not to patient age or measures of metabolic control. Careful monitoring is required during UCCS treatment.     

Temporomandibular joint arthrography: comparison of morbidity with ionic and low osmolality contrast media

We compared patient morbidity associated with temporomandibular joint (TMJ) arthrography using both meglumine/sodium diatrizoate (60%) and the new monoacidic dimer, Hexabrix, in a double-blind randomized clinical trial in 31 patients. Patients experienced maximal discomfort from TMJ arthrography with the initial joint filling and joint distension; this rapidly resolved over 10 minutes. Delayed exacerbation of pain is less than described for shoulder arthrography. The newer contrast media promise to decrease patient morbidity with arthrography.