The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children.

OBJECTIVE: To describe the tolerability and efficacy of clean intermittent catheterization (CIC) in the management of dysfunctional voiding in patients who are neurologically and anatomically normal. PATIENTS AND METHODS: The medical records were reviewed in 23 patients (16 girls, mean age 9 years, range 6-14.5, and seven males, mean age 8 years, range 5-20.5) with urinary incontinence and/or urinary tract infection (UTI) who were offered CIC because they had a large postvoid residual urine volume (PVR). All had extensive instruction before starting CIC. All patients underwent urodynamic studies, and urinary and fecal elimination habits were recorded. Detrusor hyperactivity, when present, was treated with anticholinergic medication. The follow-up evaluation included tolerance of CIC, continence status and the incidence of UTI. Behavioural modification or biofeedback training was not used in any patient. RESULTS: Of the 23 patients, 13 presented with both UTI and urinary incontinence, five with incontinence only, four with UTI only, one with frequency and no incontinence, and one with haematuria. Associated symptoms included frequency/urgency, constipation or soiling, and straining to void or incomplete emptying (in nine each), and infrequent voiding in six. CIC was performed within 2 days by 15 patients, while four others required up to 2 weeks to master CIC. However, three of the four patients (all older girls) who needed 2 weeks to learn the technique did not tolerate CIC and discontinued it within 3 weeks. Four other adolescents (three girls and one boy) refused to learn CIC. Of the 16 patients remaining on CIC only three had cystitis; no patient had a febrile UTI. Once successfully instituted, all patients became continent while on CIC. Six boys (mean follow-up 4 months) had a marked decrease in their PVR. CIC was discontinued in three girls who voided normally to emptiness within 6 months of starting CIC; they remained dry and infection-free 16 months (two) and 6 years later. CONCLUSION: CIC is a viable therapeutic option for the treatment of dysfunctional voiding, associated with a large PVR, in the absence of any neurological abnormality. CIC is well tolerated in the sensate patient and provides a means for expeditiously achieving continence and improving bladder emptying cost-effectively.

Monensin poisoning in horses - an international incident.

Several hundred Michigan horses were accidentally exposed to varying levels of monensin. Severity of effects was proportional to the level of feed contamination; sudden death resulted on at least two premises. Acute signs of cardiovascular impairment occurred on one premises having received feed containing over 200 grams of monensin per tonne. Gross and histological postmortem lesions consisted of acute myocardial necrosis. Although only circumstantially confirmed, investigations led to the suspicion that the source of poisoning was a ration formulation error in a feedmill in southwestern Ontario. Concern over possible undetected heart damage in exposed horses led to clinical monitoring on one farm over a period of several months. Electrocardiographic and serum enzyme monitoring were used soon after the incident to implicate exposure in some horses; they were poor prognostic indicators. Applicable legislation, the cooperative role of government departments, and legal implications relative to potential prosecution and lawsuits arising from sale of contaminated feed between Canada and the USA are summarized.