Comparison between infrared and hot-blade beak trimming methods in white and brown pullets: performance, organ and bone development / [Comparativo entre debicagem infravermelha e por lâmina-quente em linhagens de frangas leves e semi-pesadas: desempenho, desenvolvimento ósseo e de órgãos]

The purpose of this study was to evaluate infrared beak trimming versus hot-blade beak trimming on performance, organ and bone development of laying pullets, using 240 birds, at 0-16 weeks of age, from two strains (white layer - Hy-Line W36 and brown layer - Hy-Line Brown). Infrared debeaking was performed on the first day of life in the hatchery, whereas hot-blade beak trimming was performed at eight days of age. Zootechnical performance at 6, 9, 12 and 15 weeks of age was analyzed. At the end of the trial, one Bird per experimental unit was euthanized for liver, gizzard, proventriculus, heart and small intestine relative weight evaluation. Both tibiotarsus were collected to measure bone breaking resistance, bone mineral content and bone densitometry. There was higher body weight and feed intake in both bird strains submitted to infrared beak trimming. Additionally, hot-blade white layers presented lower body development and feed intake. The debeaking methods did not influence relative organ weights or tibiotarsus parameters evaluated. We conclude that the infrared beak trimming method promotes better pullet body development than the conventional hot-blade method, improving feed intake, without compromising organ and bone development, being a more adequate debeaking method to be used in layer production.(AU)

Para avaliar a debicagem infravermelha versus a debicagem pelo método da lâmina quente no desempenho, no desenvolvimento de órgãos e na qualidade óssea de poedeiras em recria, foram utilizadas 240 aves, entre zero e 16 semanas de idade, em duas linhagens (branca - Hy-Line W36 e vermelha - Hy-Line Brown). A debicagem por infravermelho foi realizada no primeiro dia de vida no incubatório, enquanto a debicagem com lâmina quente foi realizada aos oito dias de idade. Analisou-se o desempenho zootécnico na sexta, nona, 12ª e 15ª semanas de idade. No final do estudo, uma ave por unidade experimental foi eutanasiada para avaliação do peso relativo do fígado, da moela, do proventrículo, do coração e do intestino delgado, e ossos do tibiotarso foram coletados para avaliação da resistência à ruptura, do conteúdo mineral e da densitometria óssea. Houve maior peso corporal e consumo alimentar nas aves pertencentes às duas linhagens quando submetidas à debicagem por infravermelho, sem haver influência sobre o peso relativo dos órgãos e a qualidade óssea. Conclui-se que o método de debicagem por radiação infravermelha promove melhor desenvolvimento corporal das frangas em relação à debicagem por lâmina quente, melhorando consumo de ração, sem comprometer o desenvolvimento de órgãos e ossos, sendo mais adequada para utilização na avicultura de postura comercial.(AU)

Is bladder voiding efficiency useful to evaluate voiding function in women older than 65 years?

AIMS: The aims of the study were to evaluate the reproducibility of bladder voiding efficiency (BVE) between free flow (FF) and intubated flow(IF) in old women, and to search for a relationship of this index with complaint and urodynamic diagnosis. METHODS: Urodynamic tracings of non-neurologic women referred for investigation of various lower urinary tract symptoms (LUTS) were analyzed. Urodynamic study included one FF followed by one cystometry and IF. Post void residual volume (PVR) was measured using a Bladder-scan. Exclusion criteria were voided volume<100ml and prolapse of grade>2. RESULTS: One hundred and ninety women met the study criteria. The mean age was 74±6 years [65-96years]. The main complaint was urinary incontinence: stress (26), urge (53) and mixed (56). Forty-four women had various complaints without incontinence. Overall BVE IF (77.6±25.8) was significantly lower than BVE FF (90.4±15.3) (P<.0001). Age sub-groups stratification led similar results. BVE IF was significantly lower than BVE FF in women with incontinence whatever the cause. Urodynamic diagnosis was posed according to the ICS/IUGA recommendations and 2 sub-groups defined according with involvement of detrusor. BVE IF was significantly lower than BVE FF for detrusor dysfunction, except for detrusor overactivity. CONCLUSION: In this large cohort of old non-neurologic women studied urodynamically for a variety of LUTS, BVE is higher when evaluated from a FF whatever age and for complaint of urinary incontinence. In addition, a low BVE value from an IF may suggest a detrusor dysfunction. LEVEL OF EVIDENCE: 4.

Do urodynamics provide a better understanding of voiding disorders in women over 80?

AIMS: Population ageing has as consequence an increasing number of women older than 80 years with lower urinary tract symptoms (LUTS). Despite old age, urodynamic study is often performed to diagnose the cause of LUTS. Our purpose is to discuss the contribution of urodynamics to manage that population. METHODS: Urodynamic studies of 169 consecutive women older than 80 years, respectively 124 non-neurological (non-N) and 45 neurological (N), were retrospectively analysed. RESULTS: Number of co-morbidities was lower in non-N (2.5 vs. 3.1) with predominance of cardiovascular and endocrinology while musculo-skeletal, cognitive and previous pelvic surgery predominated in N. Among main complaint, incomplete retention or dysuria was more frequent in N while incontinence and frequency were predominant in non-N. More frequent urodynamic diagnosis (UD) was "normal" i.e. non contributive (25.0%) and intrinsic sphincter deficiency (ISD=21.7%) in non-N, detrusor overactivity (DO=42.2%) and detrusor underactivity (DU=38.8%) in N. In non-N, there were 94 treatment proposals based on the complaint when UD was "normal" and on UD for DO, DU and ISD. In N, treatment proposals were mainly prompted voiding or self-catheterization based on DU diagnosis. CONCLUSION: Usefulness of urodynamics to manage LUT dysfunction in women older than 80 y is greatly dependent on their neurological status. In non-neurological women this is non debatable but proposed treatment needs to take into account existing co-morbidities. In neurological women the main usefulness is to unmask DU and to propose the best management in order to avoid complete retention. LEVEL OF EVIDENCE: 4.

Usefulness of ice water test to unmask detrusor overactivity.

PURPOSE: Ice Water Test (IWT) is not frequently used today. IWT triggers a non-inhibited involuntary detrusor contraction (NIDC) when the bladder is being filled with cold saline solution. NIDC is unmasked via a segmental reflex loop different from the physiological micturition reflex. Our purpose was to search for usefulness of IWT to expose detrusor overactivity (DO). METHODS: One hundred and seventy-nine IWT performed in patients with overactive bladder syndrome (OAB) and conventional cystometry (CC) non-contributive to diagnosis were retrospectively analyzed. An increase of detrusor pressure of 15cm H2O allowed defining positive IWT (with leakage) or intermediate (without leakage). RESULTS: The population comprised of 131 women (58.2±17.3 years) and 48 men (56.1±15.3 years). Main complaints were mixed or urge incontinence (76/179). Hundred and twenty-four patients had a history of neurological disease. From CC, detrusor behavior was founded uncategorized for 106, normal for 53 patients and underactive for 20. These results did not contribute to diagnose a DO. IWT was positive for 22 patients and intermediate for 20. DO was unmasked by IWT for 42 patients (23.4%) of whom 34 had neurological disease. The positive predictive value was 80.9%, the negative predictive value was 34.3%. CONCLUSION: In patients with OAB syndrome, IWT is contributory to unmask DO when CC is not contributive. Our study underlines the interest to perform IWT when urodynamic diagnosis is unclear.

Vascular injuries in supracondylar humeral fracture: an active approach to diagnosis and treatment.

AIM: The strategy with vascular complications of supracondylar humeral fractures (SHF) is under scrutiny since modern diagnostic techniques, particularly ultrasound investigations, provide earlier and more precise assessment and updated vascular surgical procedures, particularly microvascular ones, obtain excellent results. The purpose of this study was to look prospectively at what could be achieved by early systematic diagnostic investigations and, when appropriate, immediate arterial exploration and repair. METHODS: Sixty-three pediatric patients with SHF were admitted and treated in our Service between January 2007 and February 2014. Besides clinical examination, they were all investigated by color-coded Duplex scanning (CCDS) and ultrasound velocimetry (UV) of the hand. Eighteen patients were pulseless at first observation. Seven of them presented without signs of ischemia and regained their pulse post-reduction; only dislodgement and compression of the brachial artery (BA) was found in those children. In 11 patients, with pink hand in 7 and severe ischemia (white pulseless hand) in 4, lesions of the BA were detected. All were operated upon by various forms of arterial repair. CCDS and UV were used also intraoperatively and during follow-up (1 m-13 y). RESULTS: All patients had favorable early and long-term results: 8 came back to normal conditions, 2 had persistent paresthesia and weakness of the hand and 1 remained with partial disability of forearm and hand. All BA remained patent. CCDS correctly detected all the lesions preoperatively and showed the patency of the arteries after repair. CONCLUSION: Early assessment, use of ultrasound investigations and BA prompt repair seem to be the most logical and fruitful strategy at present time.

Post-occupational health surveillance of asbestos workers.

BACKGROUND: Italian law requires an extensive health surveillance of workers after cessation of their employment status in the case of occupational exposure to carcinogens, including asbestos. Nonetheless, Italian law does not specify the timeframe of these clinical checks, nor who has financial and organizational responsibility for this surveillance. A literature search confirmed a lack of consensus around the objectives and methods to follow up workers with past occupational exposure to asbestos. OBJECTIVES: To develop an updated evidence-based methodology for an appropriate health surveillance programme. METHODS: We present an overview of the field experience developed by the Veneto Region from 2000 to 2011, and new studies that could contribute to establishing a national policy for the medical surveillance of workers with past asbestos exposure. RESULTS: There were three specific topics: (1) definition of a reliable method to identify asbestos workers (through multiple sources and procedures that meet current confidentiality regulations); (2) detection of asbestos fibres in biological media (to support the etiological diagnosis of asbestos-related diseases); (3) creation of a national protocol of health surveillance (through the assessment of policies developed by other Regions in this field, and recruiting from these regions a cohort of past-exposed workers: the epidemiological study should offer relevant suggestions for specific surveillance approaches, based on either estimated cumulative asbestos exposure or detection of x-ray patterns of pleural plaques and/or asbestosis). CONCLUSIONS: These studies will support the Regions in setting up health care policies directed at workers with past asbestos exposure.

Single Walled Carbon Nanotubes/polypyrrole-GOx composite films to modify gold microelectrodes for glucose biosensors: Study of the extended linearity.

A glucose biosensor was assembled using gold microelectrodes (diameter of 250 µm) coated by Single-Walled Carbon Nanotubes (SWCNTs), via the Electrophoresis Deposition Process (EPD). This nanostructured platform was successfully used to deposit the poly(pyrrole)/glucose oxidase film (PPy/GOx). The most important result of this biosensors was the wide linear range of concentration, ranging from 4 to100 mM (covering the hypo- and hyper-glycemia range, useful in diabetes). This extended linearity offered the possibility to measure glucose from 0.560 to 12.0 mM, with a detection limit of 50 µM (useful for hypo-glycemia disease).

Hormone and genetic study in male to female transsexual patients.

BACKGROUND: Data of the literature demonstrated controversial results of a correlation between transsexualism and genetic mutations. AIM: To evaluate the hormone and gene profile of male-female (M-F) transsexual. SUBJECTS AND METHODS: Thirty M-F transsexuals aged 24-39. Seventeen had already undergone sex reassignment surgery, 13 were awaiting. All subjects had been undergoing estrogen and antiandrogen therapy. We studied hormones of the hypothalamus- pituitary-testicular axis, thyroid and adrenal profile, GH basal and after GHRH stimulation, IGF-I. The gene study analyzed SRY, AR, DAX1, SOX9, AZF region of the Y chromosome. RESULTS: Pre-surgery subjects had elevated PRL, reduced testosterone and gonadotropins. Post-surgery subjects showed reduced androgens, a marked increase in LH and FSH and normal PRL. Cortisol and ACTH were similar to reference values in pre- and post-surgery patients. There was a marked increase in the baseline and post-stimulation GH values in 6 of the 13 pre-surgery patients, peaking at T15. IGF-I was similar to reference values in both groups except for one post-surgery patient, whose level was below the normal range. There were no polymorphisms in the amplified gene region for SOX9, and a single nucleotide synonimous polymorphism for DAX1. No statistically significant differences were seen in the mean of CAG repeats between controls and transsexual subjects. SRY gene was present in all subjects. Qualitative analysis of the AZFa, AZFb, and AZFc regions did not reveal any microdeletions in any subject. CONCLUSIONS: This gender disorder does not seem to be associated with any molecular mutations of some of the main genes involved in sexual differentiation.

Diabetes and breast cancer risk: a meta-analysis.

BACKGROUND: The potential of an increased risk of breast cancer in women with diabetes has been the subject of a great deal of recent research. METHODS: A meta-analysis was undertaken using a random effects model to investigate the association between diabetes and breast cancer risk. RESULTS: Thirty-nine independent risk estimates were available from observational epidemiological studies. The summary relative risk (SRR) for breast cancer in women with diabetes was 1.27 (95% confidence interval (CI), 1.16-1.39) with no evidence of publication bias. Prospective studies showed a lower risk (SRR 1.23 (95% CI, 1.12-1.35)) than retrospective studies (SRR 1.36 (95% CI, 1.13-1.63)). Type 1 diabetes, or diabetes in pre-menopausal women, were not associated with risk of breast cancer (SRR 1.00 (95% CI, 0.74-1.35) and SRR 0.86 (95% CI, 0.66-1.12), respectively). Studies adjusting for body mass index (BMI) showed lower estimates (SRR 1.16 (95% CI, 1.08-1.24)) as compared with those studies that were not adjusted for BMI (SRR 1.33 (95% CI, 1.18-1.51)). CONCLUSION: The risk of breast cancer in women with type 2 diabetes is increased by 27%, a figure that decreased to 16% after adjustment for BMI. No increased risk was seen for women at pre-menopausal ages or with type 1 diabetes.

Use of CD9 and CD61 for the characterization of AML-M7 by flow cytometry in a dog*.

Acute megakaryoblastic leukaemia (AML-M7) is a rare myeloproliferative disorder in domestic animals. Recently, thanks to the greater availability of immunophenotype techniques, precise diagnosis is more easily made. The morphological evaluation has its limitations, especially in the study of poorly differentiated cells. Few reports have described AML-M7 in dogs using flow cytometry. This clinical case points out the utility of flow cytometry in the characterization of AML-M7 in a 3-year-old German Shepherd dog. Flow cytometry investigation has established megakaryocytic lineage involvement by showing the presence of two megakaryocyte/platelet associated antigens (CD9 and CD61). In human medicine CD9 may be used as a platelet and megakaryocyte marker. There is an evidence of cross-reactivity of human anti-CD9 monoclonal antibody with canine samples. To our knowledge, the use of CD9 has never been described before, for this purpose in the dog.

A conceptually new type of bio-hybrid scaffold for bone regeneration.

Magnetic bio-hybrid porous scaffolds have been synthesized, nucleating nano-apatite in situ on self-assembling collagen, in the presence of magnetite nano-particles. The magnetic phase acted as a sort of cross-linking agent for the collagen, inducing a chemico-physical-mechanical stabilization of the material and allowing us to control the porosity network of the scaffold. Gradients of bio-mineralization and magnetization were also developed for osteochondral application. The good potentiality of the material as a biomedical device, able to offer assistance to bone regeneration through scaffold reloading with specific factors guided by an external magnetic field, has been preliminarily investigated. Up to now the proof of this concept has been realized through in vitro assessments.

[Feasibility of a screening programme for lung cancer among workers previously heavily exposed to asbestos]. / Valutazione di un programma per la diagnosi precoce di cancro polmonare negli ex esposti ad asbesto.

BACKGROUND: We evaluated the feasibility and costs of a screening programme with spiral CT for the early diagnosis of lung cancer among workers previously heavily exposed to asbestos. METHODS: We invited 2000 workers, 1165 (58%) of whom accepted. Women and individuals with incomplete information were excluded; 1119 subjects (mean age, 57 years) entered the main analysis. Subjects with non-calcified lung nodules and/or dubious pleural plagues (No=338) entered a post-screening diagnostic protocol based on radiological follow-up. RESULTS: Twenty-five biopsies were performed (13 pulmonary, 9 pleural, 3 combined) revealed 5 cases of lung cancer (including 1 in stage IA). The positive predictive value of the screening test was low (31%) despite its known high sensitivity (100%) and specificity (99%). Incidence of lung cancer was similar to that registered among male residents of the Veneto Region aged 55 to 59 years. The cost of the programme was Euro 1,000 per screened subject and Euro 245,000 per diagnosis (total cost, Euro 1,181,310). The total radiation dose administered to healthy subjects was about 1,100 mSv (220 mSv per lung cancer diagnosis). CONCLUSIONS: This screening programme was ineffective due to the low participation rate, the small number of diagnoses, low predictive value, and high costs.

Trancranial Doppler: value in clinical practice.

The value of TCD in clinical practice is well established since it can be used to measure cerebral vasomotor reactivity and to detect and grade vasospasm (VSP) following subarachnoid haemorrhage and cerebral blood perfusion consequences of extracranial ICA stenosis or occlusion. Intracranial steno-occlusive disease can be detected more reliably by transcranial color-coded imaging (TCCI) that provides a two-dimensional imaging of parenchymal and vascular anatomy of brain too. In patients with suspected brain TCD diagnostic criteria for brain death have a sensitivity of 91 to 100% and specificity of 97 to 100% and they are particularly useful when clinical and EEG evaluations are difficult. TCD is a sensitive technique for real time detection of microembolic signals (MES) from prosthetic cardiac valves, myocardial infarction site, atrial fibrillation, aortic arch atheroma and this suggests the use of TCD for monitoring response to antithrombotic therapy. There is also a high correlation between contrast-enhanced TCD and trans-esophageal echocardiography for detecting paradoxical embolism through right-to-left cardiac or pulmonary shunts. Microembolization detected by TCD monitoring may confirm features of unstable carotid artery plaques as imaged by Duplex scanning and there is an increasing evidence that asymptomatic MES from unstable carotid plaques are an independent factor for ischemic stroke. TCD can be used as a monitoring tool during cardiac surgery and cerebrovascular operations to determine critical hemodynamic changes in cerebral arteries and to identify high-intensity transients referred to air or particulate emboli. Several research studies of the past 10 years have shown that MES may be detected by TCD during all phases of CEA and CAS and that sustained microembolism after carotid flow restoration is an indication of impending postoperative or post-procedural occlusion. Our series showed a clear difference between the number of patients with MES and the incidence rate of MES in each patient submitted to CAS (100% of cases with 35-250 MES in each case) and to CEA (74% of cases with 2-30 MES in each case). We also observed a decrease in the incidence rate of microembolic events by TCD during CAS with or without brain protection devices , 18.% and 40%, respectively. There is a statistically significant difference between the neurological deficit related to embolism during CEA (1.8% of cases) and during CAS(9 %). Furthermore DWI has shown a higher prevalence of postoperative small areas of brain ischemia due to asymptomatic embolism occurring during CAS than after carotid surgery according with a higher incidence of patients suffering from neuropsychological impairment after CAS as compared with those submitted to CEA . The use of TCD can provide new insights into pathophysiology of cerebral steno-occlusive and functional diseases, it can helps in risk stratifications of patients with cardio-embolic sources and in the choice and monitoring of medical, surgical or endovascular treatment. TCD monitoring during carotid revascularization either surgical or endovascular can alert the operator to take appropriate measures to avoid brain ischemia and provides useful data for choice and control of the different brain protection devices.

Contrast carotid ultrasound for the detection of unstable plaques with neoangiogenesis: a pilot study.

OBJECTIVES: To evaluate whether contrast ultrasonography can be used to distinguish asymptomatic from symptomatic carotid plaques and provide insight into underlying pathophysiological differences. DESIGN: Contrast carotid ultrasound was performed in both symptomatic and asymptomatic patients referred for carotid endarterectomy. MATERIALS AND METHODS: Of 77 consecutive patients referred for carotid artery evaluation, 64 underwent carotid endarterectomy for asymptomatic cerebrovascular disease and 9 underwent urgent surgery for acute neurological deficits with hemiparesis. The endarterectomy specimens were assessed immunohistologically. RESULTS: In all 9 patients undergoing urgent surgery, contrast ultrasonography showed the accumulation of diffuse microbubble contrast at the base of the carotid plaque. This pattern was observed only in 1/64 of the patients undergoing surgery for asymptomatic carotid disease. Immunohistologically staining of the endarterectomy specimens showed that the area of microbubble contrast at the base of the symptomatic plaques was associated with an increased number of small diameter (20-30 microm) microvessels staining for vascular endothelial growth factor (VEGF). CONCLUSIONS: Contrast carotid ultrasonography may allow the identification of microvessels with neoangiogenesis at the base of carotid plaques, and differentiate symptomatic from asymptomatic plaques.

Vascular training and endovascular practice in Europe.

OBJECTIVE: To evaluate the influence of the status of vascular surgery (VS) training paradigms on the actual practice of endovascular therapy among the European countries. METHODS: An email-based survey concerning vascular surgery training models and endovascular practices of different clinical specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. RESULTS: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1. Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted specifically to VS (3.9 vs 2.7 years, p=0.008). Among countries with independent certification an average of 76% of aortic and 50% of peripheral endovascular procedures are performed by vascular surgeons, while the corresponding values, for countries with a non-independent certification, are 69% and 36% respectively. Countries with independent vascular certification, despite their lower average endovascular index (procedures per 100,000 population), reported a higher growth rate of aortic endovascular procedures (VS independent 132% vs VS non-independent 87%), within a four-year period (2003-2007). Peripheral endovascular procedures, though, have similar growth rates in both country groups (VS independent 62% vs VS non-independent 60%). CONCLUSIONS: In European countries with VS as an independent specialty, vascular surgeons have a shorter total training period but spend more time in VS training, although they may not undertake a greater proportion of the endovascular procedures their countries appear to have adopted endovascular technologies more rapidly compared to the ones with non-independent VS curricula. Whether such differences influence patient outcomes requires investigation in future studies.

[Quantification of bladder-outlet obstruction in males: standard method vc VBN method]. / Quantification de l'obstruction chez l'homme: comparaison des méthodes usuelles avec la méthode VBN.

GOAL: To compare the merits of two methods, standard (Abrams-Griffiths number, Schafer's classification, etc.) and VBN, to study bladder-outlet obstruction in men with benign prostatic hyperplasia (BPH). MATERIAL AND METHODS: The parameters deduced from both methods and from repeated pressure-flow studies were computed for a population of patients with BPH. Correlation coefficients between standard and VBN parameters were systematically evaluated. Test-retest reliability and inter-rater reliability of the VBN parameters were investigated. RESULTS: The VBN obstruction parameter was linearly corelated to the A-G number (R = 0.992) and thus is related to the provisional ICS obstruction nomogram. A simple modification to the standard index projected isometric pressure (PIP) yields an mPIP parameter strongly correlated with the VBN detrusor contraction-strength parameter (R = 0.962). VBN analysis reveals minor phenomena such as premature fading of the detrusor contraction to be responsible for much of the void-to-void variability of pressure-flow studies. Consequently, the primary VBN obstruction and contraction-strength parameters exhibit better test-retest and inter-rater reliability than the standard parameters and are less sensitive to changes in testing circumstances (bladder volume, urethral catheter size and psychological factors). CONCLUSION: With the standard approach to test bladder obstruction, two values: A-G and mPIP, derived from pressure-flow studies, best qualify the patient's voiding status. These parameters are simple to calculate but are sensitive to testing variations and minor phenomena. The VBN approach is more complicated, but its parameters for obstruction and detrusor contraction strength are less dependent on testing variations.

[Urodynamics and uterine fibroid. Is there a specific parameter?]. / Urodynamique et fibrome utérin. Existe-t-il un paramètre spécifique?

AIM OF STUDY: To search for a urodymamical parameter and/or a VBN parameter (deduced from a modelized analysis of uroflows) which could characterize the voiding dysfunctions due to a uterine fibroid. POPULATION AND METHODS: Thirty women (31-69 years) with a uterine fibroid (exclusion criteria: neurological disease, diabetes mellitus, previous pelvic surgery, grade > I prolapse) underwent one urodynamic session which included the successive tests: free uroflow, urethral profilometry, cystometry and, if possible, a second free uroflow. Twenty-eight patients complained from stress urinary incontinence. Modelized analysis of the flow curves was performed in order to determine the value of two VBN parameters: urethral parameter g and recruitment ratio rr (which quantify the ratio of firing motor neurons during detrusor contraction). RESULTS: The fibroid (known for 23 subjects) was detected during gynaecological examination in seven cases. No significant change of the value of one urodynamical parameter which could be linked to the uterine fibroid rather than the urinary disorder has been found. Some urethral constrictive obstruction exists for 18 patients (g = 0.40 +/- 0.15) but is not meaningful. In the whole population, an effective abdominal pressure is found in 78% of the analyzed micturitions. CONCLUSION: Some urinary disorders result from the presence of a uterine fibroid; they are significantly improved by simple hysterectomy. If urodynamics does not have any specificity, concomitant physical examination allows to detect fibroids with only urinary symptomatology.

[Detrusor activity and motor neurons firing during micturition: analysis by means of modeling of urodynamic tracings]. / Comportement permictionnel du détrusor et activité des neurones moteurs : approche par analyse modélisée des enregistrements urodynamiques.

BACKGROUND: To use a computer assisted analysis of urodynamic tracings (VBN method) in order to propose a quantitative description of the relationship between detrusor activity and firing of efferent motor neurons. METHODS: Modeling of the nervous control implies three definitions of the detrusor excitation: (1) related to the contractile force (EF), (2) related to the calcium turnover (ECa) and (3) ratio of firing motor neurons (rr). The associate variables have been computed from each uroflow recording of healthy volunteers (male and female) and patients (107 men with lower urinary tract symptoms due to benign prostatic enlargement and 138 women with stress urinary incontinence). RESULTS: A "standard excitation" governs all the voidings of healthy volunteers. For 47% of male patients and 75% of female patients, a non-standard excitation is observed: beginning as the standard excitation, then sudden break at a time tc (9.7 +/- 2.5 s for male and 4.0 +/- 2.7 s for women). rr has an all-or-none value in case of standard excitation and exhibits a two steps behavior with after tc: = 0.53 +/- 0.21 for men and 0.41 +/- 0.18 for women (non-significant despite the difference in the origin of disease). CONCLUSION: VBN computer analysis of urodynamic tracings allows to propose a description of the detrusor nervous control: (1) an on-off nervous order rules the "standard" detrusor activity, and (2) a feedback, which probably starts at the urethral level, acts to switch an on-off reduction of the detrusor activity in the other cases.