[Female orgasm during neurological disorders]. / L'orgasme féminin dans les pathologies neurologiques.

INTRODUCTION: Sexual dysfunctions, particularly orgasm dysfunction, were not routinely assessed in daily practice in neurological women. OBJECTIVE: To assess type, frequency and impact of neurological women orgasm dysfunction. METHOD: A systematic review was conducted with Medline via Pubmed and The Cochrane Database of Systematic Review. RESULTS: Neurological women's orgasm dysfunction is poorly assessed. The most of these were clinical small retrospective studies assessed by general questionnaires and some with electrophysiological assessments. Multiple sclerosis (MS) and Spinal cord injury (SCI) were the two most studied conditions. Orgasm dysfunction is observed in one third of neurological women, associated with arousal troubles, voiding and anal dysfunction. Orgasm alteration seriously impact quality of life of these patients. CONCLUSION: Specific studies could be conducted in this specific field in order to increase quality of life of these neurogenic patients suffered from such sexual dysfunction.

[Urinary tract symptoms in Lewy body dementia: About 19 cases]. / Les troubles urinaires de la maladie à corps de Lewy. À propos de 19 cas.

INTRODUCTION: Lewy Body Dementia (LBD) is a Parkinsonian disorder which often leads to Lower Urinary Tract Symptoms (LUTS), especially an Overactive Bladder (OAB). There have been few LBD related LUTS depictions in the literature, which is why we did this retrospective study. METHODS: Retrospective single institution study. RESULTS: Nineteen patients with confirmed LBD diagnosis were found, (63% of men, mean age 74 years old). The main symptom was OAB (100% of patients) with frequent stress urinary incontinence (94%) associated with detrusor overactivity (93%) with pressure elevation (79%). Voiding difficulties were found in 16% of medical interviews, and in 53% of urodynamics. In total, 92% of patients complained of constipation, with 44% suffering from fecal incontinence. DISCUSSION: LBD is characterized by alpha-synuclein aggregates in the cerebral cortex, thus explaining associated cognitive impairment. The most commonly found LUTS is stress incontinence. We also found voiding difficulties in smaller proportion, sometimes associated with prostatism. Topographically, these symptoms could be explained by alpha-synuclein aggregates in the frontal and temporal cortex and the pons. Anorectal disorder and sexual dysfunction were frequently associated. Urological complications are scarce in this population, screening is focused in increasing quality of life, and the possibility to discriminate the different types of Parkinsonisms. CONCLUSION: OAB is the most common lower urinary tract symptom in LBD often associated with detrusor overactivity, and less frequently voiding difficulties sometimes associated to prostatism. LEVEL OF EVIDENCE: 3.

Effect of need to void on Parkinsonian gait.

AIMS: Beside motor control alteration and tremor, the main symptoms in Parkinsonian disorders, lower urinary tract dysfunction is very common and thus often associated with gait disorder. No studies have assessed their association yet. The aim of this study was to assess the effect of the need to void on walking speed in this particular population. The secondary aim was to assess the effect of desire to void in a double task condition on the walking speed, and on the time to raise up from the floor. METHODS: This prospective study included all Parkinsonian disorders who had a follow-up for overactive bladder (OAB). We invited them to drink until a desire to void or equivalent (DV), then they performed three ten-meters walk tests, one double-task ten-meters walk test, one timed-up-and-go test (TUG), one timed raise of the floor (GMT). We repeated the same tests just after bladder emptying. RESULTS: Nine men and two women (age 69±6) were included in the study (seven Parkinson's Diseases, two multisystem atrophies, two not yet characterized). Mean scores of UPDRS-III were 17±6.5, Hoehn & Yahr scale were 1.9±0.7, time since onset 7±4.4 years, levodopa daily equivalent 691±478mg. Patients performed the walking tests at DV with a mean bladder volume from 220±189mL. The mean speed was 1m/s at DV and 1.1m/s at PV (P<0.001). TUG was also increased for patients at DV: mean 9.8 s at DV versus 8.8sec at PV (P<0.003). CONCLUSION: In Parkinsonian disorders, need to void may impact the walking speed, a strong desire to void worsening gait velocity. LEVEL OF EVIDENCE: 4.

[Self-intermittent-catheterization and urinary retentions in Parkinsonian syndromes]. / Auto-sondages intermittents et rétentions urinaires des syndromes parkinsoniens.

INTRODUCTION: Lower urinary tract symptoms are common in Parkinson diseases, especially chronic urinary retention. In case of significant and symptomatic postvoid residual, a specific treatment is necessary in order to empty the bladder and nowadays the gold standard of such neurogenic bladder is based on self-intermittent-catheterizations, if possible at all. We carried out a retrospective study about feasibility and outcomes of self-intermittent-catheterizations in this population. METHODS: Retrospective study with qualitative and quantitative, clinical and instrumental (urodynamic) assessment, of lower urinary tract symptoms as urinary retention in extrapyramidal syndromes. RESULTS: Overall, 42 patients with parkinsonian syndrome performing self-intermittent-catheterization were assessed. Twenty-one had idiopathic Parkinson's disease, 17 multiple system atrophy, 1 vascular Parkinson, 1 iatrogenic Parkinson and 2 not yet determined parkinsonian syndromes. All the patients had urinary retention characterized by a postvoiding residual volume more than 150mL. All the patients were symptomatic and reported voiding dysfunction (30/42), overactive bladder syndrome (20/42), stress urinary incontinence (6/42). The cystometry showed detrusor overactivity (15/42), bladder-sphincter dyssynergia (15/42), detrusor underactivity (14/42), sphincter deficiency (4/42) or bladder compliance alteration (3/42). Each patient have learned and well controlled self-intermittent-catheterization technique. Fourteen (33%) stopped self-intermittent-catheterization prematurely in the following months because of functional impact of neurological worsening. CONCLUSION: Even if one third of the patients had stopped self-intermittent-catheterization because of neurological deterioration, this technique remains the gold standard for the treatment of urinary chronic retention in parkinsonian patients. LEVEL OF EVIDENCE: 4.

Management of Amelogenesis Imperfecta: A 15-Year Case History of Two Siblings.

OBJECTIVE: Amelogenesis imperfecta (AI) is a heterogenous genetic disorder that interferes with normal enamel formation in the absence of systemic disorders. The patients' main concerns are caries susceptibility, poor esthetics, and generalized sensitivity. There is a broad clinical spectrum, from discolorations to consequent enamel alterations. This case report describes the 15-year case study and the full-mouth rehabilitation of two siblings affected by a hypocalcified AI. Clinical Considerations: In these two patients, conservative care with stainless steel crowns and direct composite restorations was undertaken to restore function and esthetics and to reduce sensitivities in primary and mixed dentitions. The difficulties in monitoring resulted in severe infectious complications (dental abscess with cutaneous fistula), important dental defects, and loss of spaces with subsequent malocclusion. In the young adult dentition, they were treated by extractions, root canal therapies, and new restorations: stainless steel crowns for permanent molars, direct composite restorations (with strip crowns) for incisors and maxillary canines (to improve the crown morphology as well as to mask the discolorations and the malpositions), and adjusted composite crown molds using a thermoforming procedure for premolars and the mandibular canines. The main difficulties were rapid tooth surface loss, bonding to atypical enamel, developing dentition, long-term follow-up. CONCLUSION: Restoring function and esthetics in AI-affected patients is a challenge from primary to adult dentition. Early corrections are essential to avoid dental damage and for psychological benefits. This clinical report highlights the adhesive rehabilitation for anterior and premolar areas and the difficulty of patient follow-up.

Radioimmunoassay for detection of antibodies to Neisseria gonorrhoeae.

A radioimmunoassay has been developed and evaluated for the serological diagnosis of gonorrhea. Purified gonococcal antigen was obtained from a culture of Neisseria gonorrhoeae (B370) and labeled with 125I for use in a double-antibody test system. The test was evaluated in populations segregated by sex and risk. The specificity of the assay in females was 90.2% (55/61) in low risk, 82.2% (2,245/ 2,732) in medium risk, and 54.1% (335/619) in high risk. The sensitivity was 69% (20/29) in medium risk and 78.3% (288/367) in high risk. In males, test specificity was 92.3% (24/26) in low risk and 50% (48/96) in high risk. The sensitivity was 70.8% (143/202) in the high-risk group. The data in this study indicate that this assay should not be employed for screening of either high- or medium-risk populations.