RESUMO
RESUMEN Las ascitis quilosa (AQ) es una entidad poco común producida por el acúmulo de linfa en la cavidad peritoneal. Su incidencia se describe en aumento progresivo, asociándose a una mortalidad de 40-70%. Se incluyeron 3 pacientes con diagnóstico de AQ evaluados en la visita de asistencia nutricional del Hospital Clínico de la Universidad Católica (UC) durante el año 2019. Caso 1: Paciente mujer de 47 años, consulta por dolor abdominal agudo realizándose apendicectomía. Estudio de líquido peritoneal con triglicéridos (TG) de 1.362 mg/dL. Inicia Nutrición Parenteral Total (NPTC) progresando luego a régimen oral. Estudio no revela lesiones de vasos linfáticos ni otras causas. Caso 2: Paciente varón de 68 años con cirrosis por alcohol, Child Pugh B. Ingresa por disnea y ascitis refractaria. Estudio de líquido ascítico y pleural, con TG de 439 mg/dL y 592 mg/dL respectivamente. Se manejó con toracocentesis y paracentesis evacuadoras, tratamiento con régimen hipograso y aporte de triglicéridos de cadena media (MCT) vía oral. Evolución tórpida requiriendo apoyo con NPTC, realizándose drenajes sucesivos, por lo que se instala TIPS. Caso 3: Paciente mujer de 63 años consulta por dolor hipogástrico con masa palpable subcostal derecha. Estudio confirma masa pancreática por lo que se realiza Whipple. Reingresa por náuseas y vómitos profusos, evidenciándose líquido ascítico con TG de 251 mg/dl. Se inicia NPTC, escasos débitos del drenaje iniciándose realimentación progresiva por vía oral. El análisis del líquido tras la paracentesis establece el diagnóstico de AQ pues la clínica es inespecífica. Las principales complicaciones están dadas por la pérdida de quilo: desnutrición, infecciones y sepsis. Las opciones de tratamiento incluyen: medidas dietéticas, fármacos e intervenciones percutáneas o quirúrgicas; siempre orientadas al alivio sintomático, con foco en tratar la causa. Si la tolerancia oral es óptima la primera medida es la supresión de la grasa y la suplementación con MCT para evitar déficit energético. Con el empleo de estas medidas se ha reportado el cierre espontáneo de fístulas y/o defectos de vasos linfáticos en un 75%-80%. Se concluye que no hay guías de recomendación y los estudios se basan en series de pocos casos clínicos. La ascitis quilosa es una entidad patológica rara, que representa una situación clínica crítica con consecuencias inmunológicas y nutricionales; y el tratamiento debe ser etiológico y el paso clave inicial es optimizar el estado nutricional del paciente.
ABSTRACT Chylous ascites (CA) is an uncommon entity caused by the accumulation of lymph in the peritoneal cavity, its incidence has been gradually increasing; being associated with a mortality of 40-70%. This work includes 3 patients with CA diagnosis evaluated by the Nutritional Assistance team in the Hospital Clínico of the Universidad Católica, Chile during 2019. Case 1: 47-year-old female, with acute abdominal pain that resulted in an appendectomy. Peritoneal fluid study showed triglycerides (TG) of 1362 mg/dL. Total Parenteral Nutrition (TPN) was initiated with successive changes to an oral regimen. The case was negative for lymphatic vessel injuries or other causes of AQ. Case 2: 68-year-old male with alcoholic cirrhosis, Child-Pugh B. The patient was admitted for dyspnea and refractory ascites. Ascites and pleural fluid study showed TG of 439 mg/dL and 592 mg/dL, respectively, whichwas managed with thoracentesis and evacuating paracentesis, treatment with a low-fat regimen, and oral medium chain triglycerides (MCT). Case 2 had a poor evolution requiring TPN and successive evacuations, with TIPS installed. Case 3: A 63-year-old female patient with hypogastric pain and palpable right subcostal mass. Study confirmed a pancreatic tumor and Whipple Surgery was performed. Case 3 was readmitted for nausea and vomiting, showing ascitic fluid with TG of 251 mg/dl. TPN was started, with decrease in drainage fluids and successful progressive oral refeeding. The analysis of the paracentesis fluid established the diagnosis of CA since the symptoms were nonspecific. The main complications were due to the loss of chyle: malnutrition, infections and sepsis. Treatment options included: dietary measures, drugs, and percutaneous or surgical interventions; always oriented to symptomatic relief, focused on etiologic treatment. If oral tolerance is optimal, the first measure should be fat suppression and supplementation with MCT to avoid energy deficit. With the use of these measures, spontaneous closure of fistulas and / or lymphatic vessel defects has been reported in 75% -80% of patients. There are no recommendation guidelines for CA and studies are based on series of a few clinical cases. CA is a rare disease, representing a critical clinical situation with immunological and nutritional consequences. Etiologic treatment must be prioritized with a focus on optimization of the nutritional status of the patient
RESUMO
OBJECTIVE: The aim of this randomized double-blind and placebo-controlled study was to assess if periodontal treatment with or without systemic antibiotic would change the mean level of Archaea. METHODS: Fifty-nine (59) subjects were randomly assigned to receive scaling and root planing (SRP) alone or combined with metronidazole (MTZ; 400 mg/TID) or either with MTZ and amoxicillin (AMX; 500 mg/TID) for 14 days. Clinical and microbiological examinations were performed at baseline and at 6 months post-SRP. Six subgingival plaque samples per subject were analysed for the presence and levels of Archaea using quantitative polymerase chain reaction. RESULTS: Scaling and root planing alone or combined with MTZ or MTZ + AMX significantly reduced the prevalence of subjects colonized by Archaea at 6 months post-therapy, without significant differences among groups (P > .05). Both therapies led to a statistically significant decrease in the mean percentage of sites colonized by Archaea (P < .05). The MTZ and MTZ + AMX group had a significantly lower mean number of sites colonized by Archaea and lower levels of these micro-organisms at sites with probing depth ≥5 mm at 6 months compared with SRP group (P < .05). CONCLUSION: Periodontal treatments including adjunctive MTZ or MTZ + AMX are more effective than mechanical treatment alone in reducing the levels and prevalence of sites colonized by Archaea in subjects with chronic periodontitis.
Assuntos
Amoxicilina/administração & dosagem , Archaea/isolamento & purificação , Biofilmes , Periodontite Crônica/microbiologia , Periodontite Crônica/terapia , Placa Dentária/microbiologia , Raspagem Dentária , Gengiva/microbiologia , Metronidazol/administração & dosagem , Aplainamento Radicular , Adulto , Terapia Combinada , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Objective: To determinate dietary habits and physical condition of physical activity students from the Autonomous University of Chile, Temuco, relating these to their fitness level. Methods: An observational cross-sectional study was conducted among 239 students (76.5 % males). Assessment included a food questionnaire, anthropometric measurements and physical condition. Results: In a sample of 239 students, 35.6% of them were overweight or obese as well as having unhealthy dietary habits independent of the academic year at university. Only 4.7 % of the students used the national recommendations for fruit intake and only 30% ate breakfast daily. In men weight, waist circumference and BMI were negatively associated with the Nvette Course test (R = -0.203, R= -0.249 and R= -0.196, p<0.01 respectively). Conclusion: Physical activity education students have poor dietary habits throughout the university academic years while their fitness decreases irregularly as studies progress. This is a major concern since they will become healthy life style role models for their future students.
Objetivo: Determinar los hábitos alimentarios y condición física de los estudiantes de pedagogía en educación física de la Universidad Autónoma de Chile, sede Temuco y relacionarlos con el nivel de condición física. Sujetos y métodos: Estudio transversal observacional, se evaluaron 239 estudiantes de educación física, de los cuales 76,5% eran hombres, aplicándoles una encuesta alimentaria, antropometría y evaluación de la condición física. Resultados: El 35,6% de los estudiantes presentaba sobrepeso/obesidad, además tenían malos hábitos alimentarios independientes del año de ingreso. Sólo 4,7% consumía las recomendaciones de frutas y 30% tomaba desayuno todos los días. En hombres el peso, la circunferencia de la cintura e IMC correlacionan negativamente con la prueba de Course navette (R=-0,203; R=-0,249; R=-0,196, p<0,01 respectivamente). Conclusión: Los estudiantes universitarios presentan malos hábitos alimentarios durante toda la carrera universitaria, mientras que su condición física disminuye de manera irregular a medida que avanzan los estudios, situación preocupante ya que ellos se transformaran en modelos de estilos de vida saludable especialmente a nivel escolar.
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Adulto , Estudantes , Aptidão Física , Universidades , Adulto Jovem , Comportamento Alimentar , Pesos e Medidas Corporais , Inquéritos NutricionaisRESUMO
Although revegetation using native flora is a low cost way to stabilize soil and restore the landscape contaminated with metals, little is known regarding the Pb-tolerance of many of these species. For this purpose, we evaluated the tolerance of Erica andevalensis to Pb by growing plants in nutrient solutions with increasing concentrations of Pb (up to 100 microM). Plant growth and different physiological parameters were determined to ascertain tolerance to metal stress. Additionally, an electron microscopy study coupled with EDX-analysis was performed to get clues on the Pb uptake and translocation from roots into stem and leaves. The LOEC (the lowest observed effect concentration) of Pb was 40 microM while the IC50 (inhibition concentration) was 80 microM Pb. Chemical analysis revealed a root > stem > leaf accumulation pattern. There was a severe reduction in fresh biomass and chlorophyll concentration at the highest Pb dose. The SEM-EDX study indicated that Pb was mostly located in root epidermal tissues. The blockage of Pb on the root probably avoided its toxic effects by limiting Pb transport to other tissues.
Assuntos
Ericaceae/metabolismo , Chumbo/toxicidade , Peroxidase/metabolismo , Poluentes do Solo/metabolismo , Biodegradação Ambiental , Transporte Biológico , Biomassa , Ericaceae/efeitos dos fármacos , Ericaceae/crescimento & desenvolvimento , Hidroponia , Chumbo/metabolismo , Folhas de Planta/efeitos dos fármacos , Folhas de Planta/crescimento & desenvolvimento , Folhas de Planta/metabolismo , Proteínas de Plantas/metabolismo , Raízes de Plantas/efeitos dos fármacos , Raízes de Plantas/crescimento & desenvolvimento , Raízes de Plantas/metabolismo , Caules de Planta/efeitos dos fármacos , Caules de Planta/crescimento & desenvolvimento , Caules de Planta/metabolismo , Poluentes do Solo/toxicidadeRESUMO
The AIDS epidemic has transformed not only the mortality at some younger ages, but also the perception of the needs in health that we may have, since the rapid spread of HIV/AIDS, coupled with a prognosis fatal disease until the mid-1990s. The eyes of demography, here allows to highlight the characteristics of AIDS mortality in Switzerland, and changes the pattern of mortality that Switzerland experienced by AIDS. The author also suggests, drawing on traditional demographic tools, a method to attempt to measure the impact of AIDS mortality on life expectancy at birth in Switzerland. A parallel with the analysis of mortality from tumors reinforces the importance of the impact of AIDS mortality.
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Síndrome da Imunodeficiência Adquirida/mortalidade , Feminino , Humanos , Expectativa de Vida , Masculino , Neoplasias/mortalidade , Distribuição por Sexo , Suíça/epidemiologiaRESUMO
The effects of Tinto River water on Erica andevalensis growth, biochemical indicators and elemental concentration and distribution were investigated under laboratory conditions. High levels of toxic elements such as B, Fe and S and acidic pH characterized the river water. Plant analysis revealed that the concentration of Al, B, S and Fe increased in all plant organs reaching in some cases values in the toxicity range. Plants transferred into river water stopped growing and stress was manifested by plant water loss, increase in peroxidase activity and decrease of chlorophyll a concentration. Significant decreases of free amino acid concentration were found in shoots and roots of plants grown in diluted river water. The results indicated that Tinto River water acidity and its excess in soluble elements produced altogether severe alterations in roots affecting plant water and nutrient uptake and leading to the massive entry of some metals (e.g. Fe, Al) with toxic effects. Scanning-electron microscopy (cryoSEM and ESEM) observations showed that E. andevalensis had not exclusion mechanisms of Cu, Fe and S therefore it was not able to reduce translocation to aerial parts.
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Ericaceae/efeitos dos fármacos , Estresse Fisiológico/efeitos dos fármacos , Poluentes Químicos da Água/toxicidade , Aminoácidos/efeitos dos fármacos , Aminoácidos/metabolismo , Clorofila/química , Clorofila A , Ericaceae/crescimento & desenvolvimento , Ericaceae/metabolismo , Concentração de Íons de Hidrogênio , Microscopia Eletrônica de Varredura , Mineração , Peroxidase/efeitos dos fármacos , Peroxidase/metabolismo , Rios , Espanha , Água/metabolismo , Poluentes Químicos da Água/químicaRESUMO
Erica andevalensis is an endemic shrub from an area in the southwest of Spain (Andalucia) characterized by acidic and contaminated soils. Scanning electron microscopy (SEM) of samples after conventional or cryo-fixation preparation protocols was used for morphological and anatomical studies. SEM coupled with EDX-analysis was employed to localise and quantify different elements within plant parts (leaves, stems and roots) in samples collected in the field. Morphological studies revealed that the species has typical adaptive structures to drought-stress such as rolled needle-like leaves, sunken stomata and a thick waxy cuticle on the upper epidermis. Roots were associated with fungi which formed intra and extra-cellular mycelia. The SEM studies showed that Cu was not sequestrated into the root tissues and was uniformly distributed in leaf tissues. Meanwhile, Pb was only localised within epidermal root tissues which indicates that its sequestration in an external matrix might represent a tolerance mechanism in this species. Iron was uniformly distributed throughout the leaves, while in roots it was predominantly retained on the epidermal cell walls. The exclusion and tolerance mechanisms adopted by this species to survive in mining areas indicate that it can be used successfully in the re-vegetation of contaminated areas.
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Ericaceae/metabolismo , Metais Pesados/farmacocinética , Poluentes do Solo/farmacocinética , Ericaceae/química , Ericaceae/ultraestrutura , Metais Pesados/análise , Microscopia Eletrônica de Varredura , Folhas de Planta/química , Folhas de Planta/metabolismo , Folhas de Planta/ultraestrutura , Raízes de Plantas/química , Raízes de Plantas/metabolismo , Raízes de Plantas/ultraestrutura , Caules de Planta/química , Caules de Planta/metabolismo , Caules de Planta/ultraestrutura , Distribuição TecidualRESUMO
Total concentrations of Al, Ba, Ca, Cr, Cu, Fe, K, Mg, Mn, Pb and Zn have been estimated in soil (A-horizon) and in leaves and stem samples of two Mediterranean species (Nerium oleander L. and Pinus pinea L.) growing in an industrial area in Spain (Huelva). Both species showed a different behaviour for the elements studied. Bark and leaves of both species acted as excluders of Al, Ba, Cr, Fe and Pb, N. oleander acted as indicator of Cu and Zn and, needles and bark of P. pinea behaved as accumulators of Cu. The enrichment ratio data indicated that Cu in soil and plant was enhanced with anthropogenic activities, with industrial activities being the primary contributor for Cu. All the other elements studied were controlled by natural source variations, but Pb could also be anthropogenically enhanced. Wood did not accumulate pollutants, with the translocation from bark being rather reduced. Uptake patterns of metals into foliage and bark tissues were more or less the same in both species for almost all the studied elements, which indicates that both plant parts could be indifferently used as biomonitors.
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Poluentes Atmosféricos/metabolismo , Resíduos Industriais , Metais Pesados/metabolismo , Plantas/metabolismoRESUMO
Presentamos nuestra experiencia de 6 pacientes con metrorragia a repetición, portadoras de patologías médicas que representaban un riesgo desde el punto de vista anestésico y quirúrgico, en las cuales se insertó DIU-LNG como alternativa a la histerectomía. Todas evolucionan satisfactoriamente y sin complicaciones, con disminución significativa de las pérdidas hemáticas desde el tercer mes de uso, objetivadas por pictogramas. Se concluye que el DIU-LNG es un excelente método para el control de metrorragias en pacientes con patologías médicas relevantes.
We present our experience with 6 patients with menorrhagia and medical conditions considered high risk patients for anaesthesia and surgical procedures. We inserted LNG-IUD as alternative to hysterectomy. Three months later, all of them reduced menstrual blood loss as it was shown by pictorial charts, without complications. LNG-IUD is an excellent alternative to hysterectomy in this group of patients.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Dispositivos Intrauterinos Medicados , Levanogestrel/uso terapêutico , Menorragia/tratamento farmacológico , Metrorragia/tratamento farmacológico , Anticoncepcionais Femininos/uso terapêutico , Evolução Clínica , Coleta de Dados , Seguimentos , Hemorragia Uterina/tratamento farmacológico , Levanogestrel/administração & dosagem , Satisfação do PacienteRESUMO
A classical definition of automaticity establishes that automatic processing occurs without attention or consciousness, and cannot be controlled. Previous studies have demonstrated that semantic priming can be reduced if attention is directed to a low-level of analysis. This finding suggests that semantic processing is not automatic since it can be controlled. In this paper, we present two experiments that demonstrate that semantic processing may occur in the absence of attention and consciousness. A negative semantic priming effect was found when a low-level prime-task was required and when a masked lexical decision prime-task was performed (Experiment 1). This paper also discusses the limitations of the inhibitory mechanism involved in negative semantic priming effect.
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Automatismo , Cognição , Mascaramento Perceptivo , Semântica , Adolescente , Adulto , Atenção , Estado de Consciência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação , VocabulárioRESUMO
The concentration of 11 elements, Ba, Cd, Cr, Cu, Fe, Mg, Mn, Ni, Pb, Zn and V, have been determined in leaves of Ligistrum lucidum Ait. f. growing in Palermo, by simultaneous inductively coupled plasma mass spectrometry. A total of 72 samples from six different sites were investigated to deduce the bioindicator ability of this species. Differences were found in the element concentrations in the leaves from the different sites and, in general, anthropogenic pollutant patterns match traffic levels. This paper describes and discusses the spatio-variations of the different elements. Cluster analyses established three different groups giving an idea about the origins of the elements. Results demonstrate that this species is useful as a bioindicator in a Mediterranean climate, especially as it has the added advantage of being an evergreen tree.
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Poluentes Atmosféricos/análise , Monitoramento Ambiental/métodos , Ligustrum/química , Folhas de Planta/química , Análise por Conglomerados , Itália , Espectrometria de Massas , Padrões de ReferênciaRESUMO
Se evalúa el cálculo de volumen pulmonar fetal con ultrasonografía 3D y la aplicación del software VOCAL (Virtual Organ Computer Aided-Analysis) en dos casos clínicos. Uno de ellos corresponde a un hidrops fetal e hidrotórax bilateral y el segundo caso de rotura prematura de membranas a las 22 semanas de gestación. Correlacionándolo con el resultado postnatal.
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Humanos , Feminino , Gravidez , Recém-Nascido , Hidrotórax/diagnóstico , Diagnóstico Pré-Natal , Pulmão/anormalidades , Ultrassonografia Pré-Natal , Evolução Fatal , Medidas de Volume PulmonarRESUMO
The title product (I) is synthesized currently from 7-aminocephalosporanic acid, and diphenyldiazomethane (DDM) is used as a protective reagent of the acid function for further reactions. When DDM was prepared from benzophenone hydrazone by reaction with chloramine T, it was resulted impure by p-toluenesulfonamide, formed as side product, which cannot be removed during the final purification step carried out according to the literature procedure. Two simple methods are proposed here to obtain I with the suitable degree of purity necessary for a drug.
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Benzeno/síntese química , Compostos Benzidrílicos/síntese química , Derivados de BenzenoRESUMO
(Z)-2-(2-formamido-4-thiazolyl)-2-(substituted alkoxyimino) acetic acids were synthesized by a new method based on the following sequence of reactions: treatment of the tert-butyl acetoacetate with sodium nitrite, alkylation of the oxime formed with an appropriate alkyl halide, halogenation of methyl alpha-keto group and simultaneous cleavage of tert-butyl ester with sulfuryl chloride, protection of the obtained acid function with diphenyldiazomethane, formation of the 2-aminothiazole ring by the Hantzsch method with thiourea, formylation of the amino group and selective final cleavage of the diphenylmethyl ester by treatment with trifluoroacetic acid and anisol. The developed procedure allows the synthesis of (Z)-2-(2-formamido-4-thiazolyl)-2-(substituted alkoxyimino) acetic acids, with an ester function in the alkoxyimino group employing a simple method and obtaining higher yields in comparison with the habitually used classic method.
Assuntos
Acetatos/síntese química , Acetatos/química , Cromatografia em Camada Fina , Espectroscopia de Ressonância MagnéticaAssuntos
Analgésicos/farmacologia , Anti-Inflamatórios não Esteroides/farmacologia , Diclofenaco/farmacologia , Atividade Motora/efeitos dos fármacos , Dor/complicações , Animais , Cafeína/farmacologia , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Masculino , Ratos , Ratos Wistar , Fatores de Tempo , Ácido Úrico/efeitos adversosRESUMO
The present report described the hematologic and molecular study of the second case of Hb D-Punjab associated with a beta zero-thalassemia found in Spain and the first case in which the mutations have been identified at molecular level. A family from India is studied, which is constituted by mother (I2) and 3 children (II1, II2 and II3). The molecular characterization of the hemoglobinopathy was made by electrophoretic and chromatographic techniques and confirmed by sequencing of the beta-globin gene. The mutation causer of the beta-thalassemia was studied by PCR-ARMS. The mother (I2) and one of her child (II2) are carriers of the gene for beta zero-thalassemia owing to the frameshift CD 8/9 mutation (+ G). Other of them (II1) is heterozygous for Hb D-Punjab without beta-thalassemia association. The third child (II3) knows a double heterozygote state for Hb D-Punjab/beta zero-thalassemia (hemoglobin D-thalassemia). In spite of the patient with hemoglobin D-thalassemia has 94.5% of Hb D, without Hb A, the hematologic picture belongs to thalassemia trait with moderate haemolytic anemia, intense microcytosis and hypochromia and numerous target cells. This hematologic picture discloses the mildness of the Hb D-Punjab, but the reliable responsible for the phenotype is the disbalance in the synthesis of globin chains, because of frameshift CD 8/9 mutation (+ G) beta zero-thalassemia mutation.
Assuntos
Hemoglobinas Anormais/análise , Talassemia beta/sangue , Adulto , Criança , Pré-Escolar , DNA/sangue , DNA/genética , Feminino , Hemoglobinas Anormais/genética , Humanos , Índia/etnologia , Masculino , Mutação , Reação em Cadeia da Polimerase , Espanha/epidemiologia , Talassemia beta/etnologia , Talassemia beta/genéticaRESUMO
Rectal administration of diazepam is a good alternative to intravenous acute treatment in severe epileptic crises, but there is scarce information about its usefulness in status epilepticus. Treatment with rectal diazepam, 0.6 to 0.8 mg x kg of body weight as a single drug, in 10 children with 13 episodes of status epilepticus, defined as epileptic crises lasting 30 or more minutes (ten of these were generalized tonic and clonic, two were unilateral tonic and clonic, and one was of the partial complex type) is described. Nine status epilepticus episodes subsided at an average 4.4 minutes after the drug was given; in 3 cases there were no favourable effects, and one case recurred after initial response. There were no significant complications, with the exception of slight respiratory depression in a patient with encephalitis. In spite of the small size of the sample, these results suggest that rectal diazepam is an effective alternative to intravenous drug administration in the management of status epilepticus whenever venous access is difficult.
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Diazepam/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Administração Retal , Criança , Pré-Escolar , Diazepam/administração & dosagem , Humanos , Lactente , Masculino , RecidivaRESUMO
Clinical and urodynamic findings in 50 children with normal neurologic examination and: enuresis (n = 5), vesical incontinence (n = 2), recurrent urinary tract infection (n = 10) or association of these abnormalities (n = 33) are described. Renal ultrasonography showed bilateral hydronephrosis in a girl with hypotonic bladder. Reflux nephropathy was detected in two children with vesical hyperactivity and in one patient with hypotonic bladder. Vesical residue was evident in 5 patients with hyperactive bladder. Increased bladder capacity occurred in two children with hypotonic response. Vesical neck formation was observed along micturition in 6 patients with hyperactive bladder. Hyperactive bladder response occurred in 5/5 patients with enuresis, in 1/2 children with vesical incontinence (VI), in 8/10 cases of recurrent urinary tract infection (RUTI) and in 23/33 patients with combined symptoms (CS). Hypertonic response was seen in 1/2 VI, 1/10 RUTI and 5/33 CS patients. Finally in 1/10 RUTI and in 5/33 CS cases bladders were hypotonic and 4/33 CS showed normal urodynamic findings.