ABSTRACT
PURPOSE: Sleep enuresis (SE) is the second most common sleep complaint in childhood. It has been associated with bladder hyperactivity, excessive urine production and deeper sleep. Several sleep disorders have been described in association with SE like parasomnias and sleep apnea. The aim of this study was to analyze the presence of sleep disturbances in children with SE through the use of Sleep Disturbance Scale for Children (SDSC) compared to normal children matched for age and sex. METHODS: A questionnaire evaluation was performed in 76 enuretic and 112 normal children through the Sleep Disturbance Scale for Children (SDSC) validated for Portuguese language. The Scale is grouped into six subscales: Disorders in Initiating and Maintaining Sleep (DIMS), Sleep Breathing Disorders (SBD), Disorders of Arousal (DA), Sleep-Wake Transition Disorders (SWTD), Disorders Of Excessive Somnolence (DOES), and Nocturnal Hyperhidrosis (SHY). Children with renal and neurological problems were excluded from both groups. RESULTS: Enuretics scored higher in several of the subscales (SBD, DOA, SWTD) and also in the total scale scores while scored low in the DIMS subscale. No differences were found for the DOES and SHY subscales. CONCLUSIONS: Enuretic children showed a high comorbidity with other sleep disturbances like sleep disordered breathing and parasomnias. The novel finding of this study is that we found a decreased incidence of DIMS that is consistent with the parental perception of a more deep sleep and a high arousal threshold in SE.
Subject(s)
Nocturnal Enuresis/complications , Nocturnal Enuresis/epidemiology , Sleep Wake Disorders/complications , Sleep Wake Disorders/epidemiology , Child , Child, Preschool , Comorbidity , Female , Humans , Incidence , Male , Surveys and QuestionnairesABSTRACT
Vinte crianças portadoras de micção incoordenada foram tratadas por meio de treinamento vesicoesfincteriano, utilizando-se técnicas fisioterapêuticas associadas com equipamento de eletromiografia com eletrodos de superfície biofeedback (EMGbiofeedback). O grupo foi composto por 16 meninas e quatro meninos (média de idade 10 anos). O diagnóstico de micção incoordenada MINI baseou-se no histórico, exame físico, ultra-som, uretrocistografia miccional e avaliação urodinâmica. Os parâmetros avaliados antes e depois do tratamento foram: troca de roupas íntimas ao dia, resíduo pós-miccional, fluxo urinário máximo, número dos episódios de infecção do trato urinário e alteração no grau de refluxo vesicoureteral. O treinamento envolveu a monitorização da atividade eletromiográfica da musculatura da parede abdominal e Musculatura do Assoalho Pélvico (MAP), por meio de eletrodos de superfície. O tratamento consistiu em ensinar a criança a relaxar a musculatura pélvica durante a micção. Ao final de cada sessão, realizou-se um estudo com urofluxometria + EMG, visando identificar eventuais contrações da musculatura pélvica durante a micção. O protocolo de tratamento incluiu uma sessão semanal de fisioterapia com treinamento do assoalho pélvico, durante um período médio de 25 semanas (variando de 20 a 35 sessões). Os dados do estudo demonstraram que houve diminuição significativa no número de trocas de roupas íntimas diárias, diminuição dos episódios de infecção no trato urinário, melhora do fluxo miccional, diminuição do resíduo pós-miccional e do grau de refluxo vesicoureteral. O treinamento fisioterapêutico com o EMG-biofeedback no tratamento da micção incoordenada em crianças demonstrou-se uma opção terapêutica não invasiva, segura e de resultados satisfatórios no presente estudo.
Twenty children with uncoordinated voiding were treated through bladder sphincter training, using physiotherapy associated with electromyography with surface electrodes - biofeedback (EMG - biofeedback). The group included 16 girls and four boys (mean age 10 y.o.). Diagnosis of uncoordinated voiding (MINI) was based on medical history, physical evaluation, ultrasonography, cystogram to evaluate reflux, and urodynamic evaluation. Outcome measures included changes of underwear during the day, post-voiding residue, maximum urinary flow, number of episodes of urinary tract infection, and change in the level of vesicoureteral reflux. The training included monitoring electromyographic activity of abdominal wall and pelvic floor muscles, through electrodes located on the surface. The children were taught to relax pelvic floor muscles while voiding. At the end of each session, urinary flow measure and EMG were performed to identify pelvic floor muscle contractions during voiding. The protocol of treatment included a weekly physiotherapy session training pelvic floor muscles, spanning a mean period of 25 weeks (ranging from 20 to 35 sessions). Study findings demonstrated a significant reduction in the number of daily changes of underwear, a decrease in the number of urinary tract infection episodes, an improvement in urinary flow, a decrease of post-voiding residue and an improvement in the level of vesicoureteral reflux. This study showed that physiotherapeutic training associated with EMG-biofeedback in the treatment of children with uncoordinated voiding to be a safe, non-invasive therapeutic method, yielding satisfactory results.
Subject(s)
Electromyography/classification , Electromyography/methods , Electromyography , Physical Therapy Modalities/classification , Physical Therapy Modalities , Pelvic Floor , UrinationABSTRACT
Os autores relatam dois casos de fístula gastrocólica causada por uso crônico de indometacina em pacientes com síndrome de Bartter, em acompanhamento no Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O diagnóstico foi realizado por meio de trânsito intestinal, que evidenciou passagem de contraste da grande curvatura gástrica para o cólon transverso. O tratamento foi cirúrgico em ambos os casos.
The authors report two cases of gastrocolic fistula caused by chronic therapy with indometacin in patients with Bartter's syndrome followed at the outpatients clinic of "Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo", Brazil. The diagnosis was suggested by a barium meal that showed a gastrocolic fistula between the greater curvature of the stomach and the transverse colon. Treatment was surgical in the both cases.
