[Intraindividual variability of uroflowmetry in women]. / Intraindividuální variabilita uroflowmetrického vysetrení u zen.

OBJECTIVE: The objective of this study was to determine the intraindividual variability of uroflowmetric measurement in women with normal lower urinary tract function. DESIGN: Prospective study. SETTING: Departure of obstetrics and gynecology University Hospital and Medical Faculty Ostrava. METHODS: 35 women without lower urinary tract dysfunction were enrolled into the study. Every subject uderwent 3 uroflowmetric examinations. We processed all numeric results. RESULTS: We assessed maximum and average urine flow rate - Qmax, Qave, voided volume - VV, corrected maximum urine flow and corrected average urine flow rate in every of 105 uroflowmetric´s measurements. We did not find any statistically significant difference for evaluation of intraindividual dispersion in studied parameters. CONCLUSION: Intraindividual variability of uroflowmetric´s measurement in healthy female subjects is low. One uroflowmetric´s measurement is adequate for assessment of uroflowmetric´s parameters.. KEYWORDS: uroflowmetry, intraindividual variability, lower urinary tract.

Incidence of the urological tumours in patients suffering from multiple sclerosis.

OBJECTIVES: The goal of this study was to evaluate the incidence of urological malignancies in MS patients using active screening. MATERIAL AND METHODS: A total of 495 MS patients (141 men, 354 women, age of 42±13.4) were included in the study. The duration of disease was 12.3±11 years, and the EDSS score was 4.3 (±2.5). Patients, regardless of specific urological symptoms, were referred for urological evaluation. The outcomes of these evaluations were compared with data from the 2009 National Oncology Register of the Czech Republic. RESULTS: The standardized incidence ratio (SIR) for the whole MS study population was 38.8 (95% CI 12.6-90.6). This incidence of urological malignancies in the MS study population was higher (statistically significant) than that of the general population. The SIR for females was 66.0 (95% CI 18.0-169.1) in the MS study population, representing a statistically significant increase over that of the general female population. The increase in incidence of urological malignancies in men with MS did not reach statistical significance over that of the general male population (SIR 14.7, 95% CI 0.4-81.7). CONCLUSIONS: The incidence of urological cancer in MS patients as determined by active screening is significantly higher than that found in general population.

[Status of bone mineral density after the long-standing application of contraception Depo-Provera]. / Stav kostní minerální denzity po mnohaleté aplikaci antikoncepce Depo-Provery.

OBJECTIVE: The objective of this study was to assess bone mineral density (BMD) on a cohort of women who used depot medroxyprogesterone acetate (DMPA) (Depo-Provera) contraception uninterruptedly between 3 and 10 years. DESIGN: Retrospective study with review of the literature. SETTINGS: Office gynecology Velké Mezirící; Osteocentrum Brno; Department of Obstetrics and Gynecology, Hospital Nové Mesto na Morave. METHODS: The study included 21 healthy women aged between 26 and 43 years (the mean age 31 years) who started long-term continual application of depot medroxyprogesterone acetate (DMPA) in contraception (Depo-Provera) (the mean time of using 7 years, range 3-10 years). The women underwent lumbar spine, hip, femoral neck and forearm BMC (g) (bone mass content), BMD (g/cm2)(bone mass density), T-score, PR (%) (peak reference), Z-score, AM (%)(age matched) evaluation using Hologic dual-energy X-ray absorptiometry. Age of women, time of application of Depo-Provera and body mass index (BMI) were collected. Randomly from this cohort of users DMPA (n = 11) were determined levels of serum folicle stimulating hormone (FSH) and estradiol (E2), mostly shortly before next application of DMPA. RESULTS: At average 7 years of treatment, as compared to baseline, the mean BMD of DMPA users was in total lumbar spine AM (age matched) 96.48%, total hip AM 100%, femoral neck AM 97.62%, total forearm (radius+ulna) AM 99.81%. Concentrations of serum estradiol varied from 94.3-294 pmol/l (25.7-80.1 pg/ml) with average level 190.3 pmol/l(51.9 pg/ml), seen in the early follicular phase. CONCLUSION: There are probably several reasons, but not at least, why mean bone loss even after long use of DMPA is low. The loss of BMD is more pronounced during the first 2 years of use DMPA and its fall subsequently gradually stabilises due to new balance between extrinsic and intrinsic factors that influence bone resorption and formation. After the two years bone loss in DMPA users nears under 1% per year and practically copies level of physiological bone loss. Another hypothetical compensation mechanisms of bone remodelling in the hypoestrogenic time during DMPA use may be reason of higher levels of BMD 4-5 years after discontinuing the use of contraceptive injections than that of nonusers (rebound phenomenon).

Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study.

STUDY DESIGN: This was a multicentre, prospective, randomised study. OBJECTIVES: To compare the outcomes of intradetrusor and suburothelial onabotulinumtoxinA injections in patients with spinal cord injury and refractory neurogenic detrusor overactivity (NDO). SETTING: Urology departments of two tertiary hospitals in the Czech Republic. METHODS: A total of 32 spinal cord injury patients with severe NDO refractory to the standard anticholinergic treatment were randomised to receive either intradetrusor or suburothelial 300 IU onabotulinumtoxinA injections. Subjective satisfaction, bladder diary data and urodynamic data were compared in both groups before treatment and at 3 months post treatment. RESULTS: In all, 64.3% patients in the intradetrusor group and 88.8% patients in the suburothelial group were subjectively satisfied with the treatment. There was a significant post-treatment improvement in both groups regarding the number of catheterisations over 24 h, number of incontinence episodes over 24 h, catheterised volume, cystometric capacity, volume at first involuntary detrusor contraction, maximal detrusor pressure during filling and detrusor compliance. No significant differences between the groups were observed, with the exception of improvement of detrusor compliance, which was better in the intradetrusor group. There was one adverse effect comprising transient muscle weakness that was reported by one patient in the intradetrusor group. CONCLUSION: Results in both groups were comparable. The authors favour suburothelial onabotulinumtoxinA injection because this method allows more precise toxin localisation.

[Combination therapy with anticholinergics and alpha-blockers for the treatment of overactive bladder in female patients--pilot study]. / Kombinovaná lécba symptomu hyperaktivního mechýre anticholinergiky a alfalytiky u zen--pilotní studie.

INTRODUCTION: Overactive bladder (OAB) is one of the most common medical conditions with an estimated 16 percent of adult population being affected in Europe. The administration of anticholinergics is considered as the most frequent and most effective treatment. There is a evidence that alpha-blockers affect a detrusor function. The aim of the study is to investigate if the combinant therapy consisting of anticholinergics plus alpha-blockers could be beneficial for women suffering from OAB. MATERIAL AND METHODS: 28 female patients with OAB were included into the pilot study. Mean age of the patients was 54.8 (42-77) years. Patients have been randomised into two groups: one group of patients has been treated by propiverin 30 mg daily, another group of patients has been treated by combination of both propiverin 30 mg daily and tamsulosin 0.4 mg daily. Satisfaction with the treatment has been evaluated by I-QoL questionnaire. Semi-objective parameters have been obtained by analysis of 3-days voiding diaries (number of micturitions, number of urgency episodes, voided volume). Peak flow (Qmax) has been measured as a objective parameter. RESULTS: We observed a decrease of frequency by 2.833 (-23.43%) comparing to base-line, decrease of number of urgency episodes by 1.417 (-36.22%), increase of voided volume by 33.333 ml (+19.14%), increase of quality of life index by 22.583 (+51.52%) and increase of Qmax by 0.17 ml/s (+0.58%) in the propiverin group. We observed decrease of frequency by 3.813 (-30.48%), decrease of number of urgency episodes by 1.875 (-45.52%), increase of voided volume by 51.250 ml (+26.88%), increase of quality of life index by 33.438 (+76.0%) and increase of Qmax by 2.13 ml/s (+7.87%) in the combination treatment group. No significant difference has been found between both groups except the quality of life index. CONCLUSION: Our results can not show explicitly higher efficacy of combination treatment using anticholinergics plus alpha-blockers comparing to standard therapy by anticholinergics alone. Further randomised placebo-controlled studies are needed for final evaluation of the role of alpha-blockers in the treatment of OAB.

Pressure drop characteristics of poly(high internal phase emulsion) monoliths.

Today, monoliths are well-accepted chromatographic stationary phases due to several advantageous properties in comparison with conventional chromatographic supports. A number of different types of monoliths have already been described, among them recently a poly(high internal phase emulsion) (PolyHIPE) type of chromatographic monoliths. Due to their particular structure, we investigated the possibility of implementing different mathematical models to predict pressure drop on PolyHIPE monoliths. It was found that the experimental results of pressure drop on PolyHIPE monoliths can best be described by employing the representative unit cell (RUC) model, which was originally derived for the prediction of pressure drop on catalytic foams. Models intended for the description of particulate beds and silica monoliths were not as accurate. The results of this study indicate that the PolyHIPE structure under given experimental condition is, from a hydrodynamic point of view, to some extent similar to foam structures, though any extrapolation of these results may not provide useful predictions of pressure versus flow relations and further experiments are required.

Use of polymerase chain reaction to diagnose the fifth reported US case of autochthonous transmission of Trypanosoma cruzi, in Tennessee, 1998.

In July 1998, the mother of an 18-month-old boy in rural Tennessee found a triatomine bug in his crib, which she saved because it resembled a bug shown on a television program about insects that prey on mammals. The gut contents of the Triatoma sanguisuga were found, by light microscopy and polymerase chain reaction (PCR), to be infected with Trypanosoma cruzi; PCR products hybridized with T. cruzi-specific oligonucleotide probes. Whole-blood specimens obtained from the child in July and August were negative by buffy-coat examination and hemoculture but positive by PCR and DNA hybridization, suggesting that he had low-level parasitemia. Specimens obtained after treatment with benznidazole were negative. He did not develop anti-T. cruzi antibody; 19 relatives and neighbors also were seronegative. Two of 3 raccoons trapped in the vicinity had positive hemocultures for T. cruzi. The child's case of T. cruzi infection-the fifth reported US autochthonous case-would have been missed without his mother's attentiveness and the availability of sensitive molecular techniques.

An assessment of collections at the University of Wisconsin-Madison Health Sciences Libraries: drug resistance.

In December 1997, the authors completed an in-depth collection assessment project at the University of Wisconsin-Madison Health Sciences Libraries. The purpose was to develop a framework for future collection assessment projects by completing a multifaceted evaluation of the libraries' monograph and serial collections in the subject area of drug resistance. Evaluators adapted and synthesized several traditional collection assessment tools, including shelflist measurement, bibliography and standard list checking, and citation analysis. Throughout the project, evaluators explored strategies to overcome some of the problems inherent in the application of traditional collection assessment methods to the evaluation of biomedical collections. Their efforts resulted in the identification of standard monographs and core journals for the subject area, a measurement of the collections' strength relative to the collections of benchmark libraries, and a foundation for future collection development within the subject area. The project's primary outcome was a collection assessment methodology that has potential application to both internal and cooperative collection development in medical, pharmaceutical, and other health sciences libraries.

Candidal splenic abscess in a renal transplant patient.

Despite the large number of organ transplants performed yearly, to date there have been no reports of candidal splenic abscess. We describe here the first case of candidal splenic abscess in a renal transplant recipient treated successfully by splenectomy and amphotericin B. Despite a lengthy illness, the patient recovered with preservation of renal function.

Medical abortion complications. An epidemiologic study at a mid-Missouri clinic.

PIP: A study of 420 cases of vacuum aspiration abortions in a central Missouri family planning clinic found 33 postabortal complications, 14 of which occurred over 10 weeks; 12 under 7. Most patients were white nulliparous females under 30. 41.5% of complications were incomplete abortions, only one of which occurred between 7 1/2-9 1/2 weeks, 4 times more at less than 7 weeks, 11 times more for women over 10 weeks. 25% were cervical lacerations, which occurred less frequently at advanced stages of gestation, 21.2% were postabortal hemorrhage, occurring most frequently over 10 weeks. The optimum time for less risk of postabortal complications is 7 1/2-9 1/2 weeks gestation. 18% complications, 7% incomplete abortions occurred at 7 1/2-9 1/2 weeks. During early pregnancy the progesterone block influences uterine motility and may be a survival mechanism for the fetus. The corpus luteum of pregnancy secretes large amounts of progesterone for the first 60 days and lesser quantities for the next 30 days.^ieng