An effective treatment for functional urinary incoordination

Twenty women diagnosed with functional urinary incoordination were randomly assigned to one of two treatment groups: biofeedback or progressive muscle relaxation. Ten subjects who were placed on a waiting list prior to treatment allocation served as a comparison group. The biofeedback intervention focused specifically on retraining of pelvic floor musculature (PFM). Patients were assessed pretreatment, posttreatment, and at 2-month follow-up. Outcome measures included self-reported symptomatology, psychological functioning, psychophysiological assessment of the PFM, and urologist ratings of problem severity and treatment efficacy. Both treatment approaches proved effective in improving symptomatology and psychological state. Subjects on the waiting list demonstrated no change in urological difficulties. No differences were found between the two treatment groups on any of the outcome measures. Theoretical and practical implications of the results are discussed.     

Hematocrit in relation to Apgar scores in SGA infants

SGA infants have an increased incidence of low Apgar scores. At the same time they frequently have a high hematocrit. Since both affect outcome, it is important to know if a relationship exists between these two factors. In a study of 139 SGA newborns many had low Apgar scores at one minute: 63% of the preterms and 29% of the fullterms. Frequent abnormal hematological findings included high hematocrit. We found a positive correlation between hematocrit and the Apgar score at one minute of life that was statistically significant. The babies with a high hematocrit had significantly more often good Apgar scores. The correlation was present in preterm babies (r = 0.55) as well as in fullterms (r = 0.32). It is concluded that a high hematocrit probably protects the SGA newborn against acute perinatal asphyxia. It is possible that both low Apgar scores and "normal" hematocrit are signs of a chronically impaired SGA fetus.     

Human duodenal motor activity in response to acid and different nutrients

Duodenal motor activity in response to intraduodenal infusion of small volumes of acid and nutrients of different chemical composition was studied in 10 healthy humans, using a water-perfused catheter incorporating 20 antropyloroduodenal sideholes. Saline and dextrose did not affect motility. Acid very rapidly (in 39 ± 11 sec) increased the number of pressure waves (P = 0.035) and antegradely propagated pressure waves (P = 0.02). After lipid infusion a considerable lag time (163 ± 81 sec) was observed, followed by a prominent increase in duodenal pressure waves (P = 0.02) and antegradely propagated pressure waves (P = 0.002). Furthermore, lipid-induced propagated pressure waves traveled over significantly longer distances (4.5 to 6 cm) than those induced by acid infusion (3 cm). We conclude that the motor response to small amounts of intraduodenal nutrients and acid is dependent on the chemical composition of the stimulus. The findings suggest that chemoreceptors in the duodenal wall provide input to local or regional control mechanisms involved in the regulation of duodenal motility.     

Neuromotor function and school performance in 7-year-old children born as high-risk preterm infants

Neuromotor behavior was studied in 63 children at a mean age of 7 years. They were born at a gestational age less than 32 weeks and/or birthweight under 1500 g and were categorized according to their medical history in conformance with the Neonatal Medical Index (from category I to V, from few to serious complications). We included only children considered at high risk as categorized in III to V. The neuromotor behavior study focuses on different subcategories, such as hand function, quality of walking, posture, passive muscle tone, coordination, and diadochokinesia. Hand preference and/or lateralization, the presence of associated movements, and/or asymmetry were noted, as was school performance. Then gender, gestational age, birthweight, and dysmaturity were investigated as confounding factors. The outcome at 7 years was correlated with the Neonatal Medical Index and the neonatal brain ultrasonography classification. None of the children scored 100% on the combined subcategories. Nineteen children (30%) had an overall score between 75 and 99%. Significant relationships between all different subcategories were found. Lack of hand preference, poor lateralization, and male gender were related to poor overall outcome. Poor motor control was correlated to special schooling and education below age level. The Neonatal Medical Index proved to have a significant influence on total outcome and the subcategories at the age of 7 years, with the worst outcome in children formerly classified in category V. Neuromotor behavior at 7 years of age was not related to birthweight, gestational age, dysmaturity, and neonatal brain ultrasonography classification only.     

Treatment of severely delayed gastric emptying

For the drug treatment of gastroparesis, domperidone, metoclopramide and cisapride may be prescribed as prokinetics. Positive effects on the rate of emptying of the stomach, dyspeptic symptoms and quality of life are best documented for cisapride. Simultaneous use of cisapride with substances that inhibit the metabolism of cisapride or that may lengthen the QT interval, is contraindicated because of the risk of arrhythmias. Erythromycin is a powerful prokinetic, but because of its antibiotic effects it is usually prescribed only for a brief period. For patients who in spite of drug treatment have persistent unacceptable symptoms and keep losing weight, invasive treatment should be considered. The first step is then insertion of a jejunal tube, followed, if necessary, by antrectomy with Billroth-I reconstruction. The next step is subtotal gastrectomy with Roux-Y reconstruction, this may result in abatement of the symptoms, which, however, rarely disappear altogether.     

Familial mitochondrial encephalopathy with fetal ultrasonographic ventriculomegaly and intracerebral calcifications

In two sibs antenatal ultrasonography revealed identical intracranial calcification, ventricular widening and microcephaly. The first pregnancy was artificially terminated at 19 weeks. Post-mortem examination of the brain revealed destructive calcification and extracerebral neuronal heterotopia. The second sib went to term but died 48 h after birth from irreversible lactic acidosis. Autopsy showed extensive encephalopathy with cavitation and calcification in the cerebral hemispheres, polymicrogyria, multiple neuronal heterotopia, partial callosal dysgenesis, and severe Leigh syndrome, together forming a continuum of early and late brain disruption. Mitochondrial respiratory chain abnormalities, mainly affecting complexes I and IV, and deficiency of pyruvate dehydrogenase complex were detected in skeletal muscle and in liver. A normal functioning of the respiratory chain was found in the fibroblasts. Analysis of mtDNA from muscle, liver and blood revealed normal amounts of intact mtDNA without any of the known point mutations associated with MELAS, MERRF or Leigh syndromes. The early fetal disruption and necrotic changes in the brains of sibs indicate a specific genetically determined disorder which affects neuronal migration, a finding not previously associated with respiratory chain disorders. The present disorder may mimic antenatal congenital infectious encephalopathy because of the combined finding of microcephaly and destructive intracerebral calcification.     

Vestibulospinal component of postural control (vestibular function) in very preterm infants (25 to 27 weeks) at 3, 6, and 12 months corrected age

Postural control, which is important for the development of all movement, balance, and locomotion, depends a great deal on the vestibulospinal component of vestibular function in early childhood. Vestibulospinal input is important for muscle power regulation, which, in turn, influences postural control. The aim of this study was to focus particularly on this component of vestibular function during the first year of life in 67 infants with a very short gestational age (25-27 weeks), to search for possible neonatal confounders, and to see whether it influences the course of muscle power development in preterm infants. Outcome was described as being optimal, suspect, or abnormal. The infants were categorized into the Neonatal Medical Index according to the severity of neonatal illness and separately into three groups for neonatal brain ultrasonography findings (normal to severe abnormalities). At the age of 3 months, 20 infants performed optimally on all items testing vestibular function, increasing to 40 at 6 months and 48 at 12 months. This significant improvement (also seen in muscle power regulation) was primarily caused by better head control (during the traction response and prone position), whereas less shoulder retraction and hyperextension were found in the sitting position. Vestibular function was significantly related to brain ultrasonography classification but not to gestational age, birthweight, the Neonatal Medical Index, or gender.     

Small intestinal glucose absorption and duodenal motility in type 1 diabetes mellitus

OBJECTIVE: Small intestinal glucose absorption is increased in animal models of diabetes mellitus, but little data are available in humans. Small intestinal motility is reported to be frequently abnormal in patients with diabetes and could potentially affect glucose absorption. Our aim was to evaluate small intestinal glucose absorption and duodenal motor responses to intraduodenal nutrients, in patients with type 1 diabetes and controls. METHODS: Eight type 1 patients (two with autonomic neuropathy) and nine controls were studied during euglycemia. A manometric catheter was positioned across the pylorus, and nutrient infused intraduodenally (90 kcal over 30 min), followed by a bolus of 3-O-methylglucose (3-OMG). Blood was sampled to measure glucose and 3-OMG concentrations. RESULTS: During nutrient infusion, the number of duodenal waves did not differ between patients and controls. After the infusion, patients with diabetes had more propagated duodenal wave sequences (p < 0.05). The area under the plasma 3-OMG curve did not differ between the groups but correlated with both the blood glucose concentration at the time of 3-OMG administration (r = 0.64, p < 0.005) and the number of duodenal waves (r = 0.52, p < 0.05) and antegrade propagated duodenal sequences (r = 0.51, p < 0.05) preceding the 3-OMG bolus. CONCLUSIONS: During euglycemia, duodenal motor responses to small intestinal nutrient are comparable in patients with relatively uncomplicated type 1 diabetes and healthy subjects, but duodenal motility after nutrient infusion is increased in patients. Small intestinal glucose absorption is similar in patients and controls, but may be dependent on the blood glucose concentration and duodenal motor activity.     

Validation of a disease‐specific quality‐of‐life questionnaire in a large sample of Dutch achalasia patients

SUMMARY. The aim of this study was to validate a translated version of an achalasia‐specific quality‐of‐life questionnaire (achalasia‐DSQoL) by examining its psychometric properties in a Dutch cohort of achalasia patients. The achalasia‐DSQoL was administered to 171 treated achalasia patients together with a clinical symptom score and the RAND‐36. Validation methods included factor analysis, known‐group techniques, Cronbach's alpha and Spearman rank correlation with other questionnaires and feasibility. About 72.5% of the achalasia patients completed the questionnaires. The achalasia‐DSQoL showed evidence of an underlying construct and seems reliable with a Cronbach's alpha of 0.77. The question concerning heartburn did not correlate with the other items on the questionnaire. Known‐group techniques demonstrated that the achalasia‐DSQoL discriminates between achalasia patients in clinical remission and patients who are not. There was a moderate correlation between the achalasia‐DSQoL and the RAND‐36 subscales. The questionnaire was easy in use. The translated version of the achalasia‐DSQoL is a valid and reliable instrument to compare groups of achalasia patients although the question concerning heartburn should be excluded.