Comparison of pressure/flow studies with micturitional urethral pressure profiles in the diagnosis of urinary outflow obstruction

Computer technology has made it possible significantly to improve the technique and interpretation of the micturitional urethral pressure profile (MUPP). Thirty-nine patients with lower urinary tract symptoms have been investigated by this technique and the results compared with those of standard pressure/flow studies. A good correlation was found between the two methods of diagnosing outflow obstruction, but micturitional urethral pressure profiles offered practical advantages in patients who were elderly, immobile or who had severe involuntary voiding, and diagnostic advantages in patients with absent or poor detrusor contractility and those with equivocal pressure/flow studies.     

DNA repair synthesis in individuals with and without a family history of cancer

The influence of family history on DNA repair synthesis, unscheduledDNA synthesis (UDS), was assessed in volunteers with or withouta family history of cancer. UDS, following treatment of mononuclearleukocytes with N-acetoxy-2-acetylaminofluorene, was measuredas the incorporation of [³H] into DNA in the presence of hydroxyurea.The positive family history group (n=71) had an average of 2.4first-degree relatives with cancer, defined as any major cancer,excluding skin cancer: 31 participants reported that canceroccurred in both their parents. The ‘no family history’comparison group (n=29) had no family history of cancer throughthe second degree. There was a significant reduction in UDSin cells from individuals with family history, compared to thosewith no family history (P>0.002). This relationship was notexplained by factors known to influence UDS, such as age, smokingor hypertension. We conclude that reduced UDS in mononuclearleukocytes is associated with a family history of any majorcancer, and is not confined to a history of cancer of any singleorgan site. This conclusion is further supported by the observationthat individuals (n=13) with parents who had an earlier onsetof cancer (<60 years) also had a significantly lower DNArepair synthesis than those (n=18) whose parents had later diagnosisof cancer (>60 years).     

Oral and maxillofacial surgery in patients with chronic orofacial pain.

PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. Patients and Methods: The study population included patients seen at the Center for Oral, Facial and Head Pain at New York Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.     

Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities.

Cognitive function was examined in 227 patients three months after admission to hospital for ischaemic stroke, and in 240 stroke-free controls, using 17 scored items that assessed memory, orientation, verbal skills, visuospatial ability, abstract reasoning, and attentional skills. After adjusting for demographic factors with standardised residual scores in all subjects, the fifth percentile was used for controls as the criterion for failure on each item. The mean (SD) number of failed items was 3.4 (3.6) for patients with stroke and 0.8 (1.3) for controls (p < 0.001). Cognitive impairment, defined as failure on any four or more items, occurred in 35.2% of patients with stroke and 3.8% of controls (p < 0.001). Cognitive domains most likely to be defective in stroke compared with control subjects were memory, orientation, language, and attention. Among patients with stroke, cognitive impairment was most frequently associated with major cortical syndromes and with infarctions in the left anterior and posterior cerebral artery territories. Functional impairment was greater with cognitive impairment, and dependent living after discharge either at home or nursing home was more likely (55.0% with, v 32.7% without cognitive impairment, p = 0.001). In a logistic model examining the risks related to dependent living after stroke, cognitive impairment was a significant independent correlate (odds ratio, OR = 2.4), after adjusting for age (OR = 5.2, 80 + v 60-70 years) and physical impairment (OR = 3.7, Barthel index < or = 40 v > 40). It is concluded that cognitive impairment occurs frequently after stroke, commonly involving memory, orientation, language, and attention. The presence of cognitive impairment in patients with strike has important functional consequences, independent of the effects of physical impairment. Studies of stroke outcome and intervention should take into account both cognitive and physical impairments.