Voiding camp: A successful and unique bladder rehabilitation program for children with urinary incontinence.

INTRODUCTION & BACKGROUND: Standard urotherapy is a well-established treatment for children with incontinence, although it is often challenging for both child and parents, and not always successful. As an alternative, several in- and outpatient bladder training programs have shown positive results on achieving continence. However, the disadvantage is the hospital environment, which can be more stressful for the child, and also quite expensive for society. OBJECTIVE: The aim was to evaluate the outcome on achieving continence following a voiding camp, where standard urotherapy was applied during a one-week stay at a regular summer youth camp, outside the hospital. STUDY DESIGN: Retrospective analysis of 105 children with urinary incontinence, followed in an expert centre for urinary incontinence for at least one year. Data at 7 different time points, before, during and until 6 months after voiding camp were collected. RESULTS: Even though all children had regular follow-up in an expert centre for urinary incontinence for at least one year before participating voiding camp, only 15% of the children reached the recommended amount of daily fluid intake (1.5 L/day). Once minimal daily fluid intake was re-established during the voiding camp, an immediate increase in the maximum voided volume (MVV), and a decrease in the number of wet days and wet nights per week was noted. This effect on a higher MVV remained even 3 months after voiding camp. DISCUSSION: Although sufficient daily fluid intake is a well-established part of standard urotherapy, up until now there was no data that proved the positive impact of sufficient daily fluid intake on bladder volume training and achieving continence in children. CONCLUSION: Voiding camp, as an unique bladder rehabilitation program for children with incontinence, is a successful alternative treatment option. Optimizing the daily fluid intake during voiding camp had a major positive impact on bladder volume training and achieving continence in children.

Patient information video: How to take care of your child after hypospadias surgery?

INTRODUCTION: Patient/parent education and participation helps improve post-operative care. Dressing and catheter care after hypospadias surgery varies widely and young parents are keen to use available media when seeking for help, especially if surgery is done in an outpatient setting. An information video about post-operative care after hypospadias is made available through a tertiary referral hospital's website. MATERIALS AND METHODS: Hypospadias surgery is an outpatient surgery in our setting. A double diaper system is used to prevent contamination of the urinary catheter and penile bandage with stools. A video explaining how the dressing works was made, helping parents maintaining the dressing and thereby solving possible questions/problems about dressing or medications while at home. Warning signs and symptoms are mentioned in which case parents should contact the urologist: fever, continuous blood loss and lack of urinary output. RESULTS: An information folder summarizing the latter, including a link to the video is given to all parents pre-operatively, providing reassurance according to parents' feedback. CONCLUSION: Parent participation can help improve post-operative care, especially in outpatient clinic setting. This video helps parents through post-operative care after hypospadias surgery. Its availability through informative folders and hospital's website is destined to educate and reassure parents.

Evaluation of response to various erythropoiesis--stimulating proteins using anemia management software.

BACKGROUND: European Best Practice Guidelines recommend haemoglobin (Hb) concentration >11 g/dl in patients with CKD stage 5. Hb can be increased with erythropoiesis-stimulating proteins (ESPs); however, 5-10% of patients respond poorly. The primary aim of this prospective observational study was to educate nurses to assess Hb response to ESPs and to identify potential causes of hyporesponse (blood loss, iron deficiency, infection and inflammation, inefficacious dialysis, medication, vitamin deficiency, malnutrition, secondary hyperparathyroidism, or pure red cell aplasia). The secondary aims were to follow anaemia parameters and identify the frequency and causes of hyporesponse to ESPs for 6 months. Lastly, the various ESPs used in the study population were analyzed separately. METHODS: Dialysis patients (n=402) from 18 centers in Belgium and the Grand Duchy of Luxembourg were included. Using anaemia management software (ARAMIS), nurses recorded Hb, ESP dose, and potential causes for hyporesponse every 4 weeks. RESULTS: The proportion of patients treated with darbepoetin alpha, epoetin alpha, and epoetin beta was 64%, 19%, and 17%, respectively. After 6 months, 79% of patients had Hb >11 g/dl. The patient incidence of hyporesponse during the study was 14%, and a mean 9% of patients were hyporesponsive at any given time. The most common potential causes of hyporesponse were iron deficiency (being reported in 39% of hyporesponse events), medication (immunosuppressive agents, ACE inhibitors), secondary hyperparathyroidism and inflammation/malnutrition. CONCLUSIONS: The ARAMIS tool served as an educational tool allowing efficient follow-up of Hb and ESP dose, and identification of potential causes of hyporesponse. Mean prevalence of hyporesponse was 9%, with iron deficiency as most commonly reported potential causative factor.

Diffuse unilateral subacute neuroretinitis in Africa.

PURPOSE: Diffuse unilateral subacute neuroretinitis (DUSN) is well known in endemic areas of the southeastern United States, South America, and the northern Midwestern United States. Two different categories of nematodes, according to their length, are related to endemic areas. We report the first case of DUSN caused by a small nematode in Africa. METHODS: We describe the case of a 12-year-old Senegalese girl who presented a long-standing diffuse unilateral subacute neuroretinitis and in whom the worm could be localized. RESULTS: The length of the unidentified worm measured using the software of the fundus camera was approximately 600 microm. This measurement corresponds to the smaller nematode usually found in patients from the southeastern United States and South America. CONCLUSION: Diffuse unilateral subacute neuroretinitis can also be observed in patients living in Africa.

Encephalomyelitis and bilateral optic perineuritis after influenza vaccination.

We report the case of one patient suffering from headache, urinary retention, bilateral optic disc swelling and a mild bilateral visual defect after influenza vaccination. The presumptive diagnosis was encephalomyelitis with bilateral optic perineuritis caused by influenza vaccination. We stress on the interest to search for this aetiology in unexplained optic neuropathy.

[Is treatment with corticotherapy or radiotherapy effective for involvement of ocular motility and for reduction of exophthalmos in Basedow's disease?]. / Le traitement par corticothérapie ou radiotherapie est-il efficace pour l'atteinte de la motilité oculaire et pour la réducion de l'exophtalme dans la maladie de Basedow?

It is acknowledged that high-dose corticotherapy, radiotherapy, or surgical decompression of the orbit are often efficient in dysthyroid optic neuropathy. Corticotherapy and radiotherapy are also given to patients with dysfunction of eye-muscle motility and/or proptosis in the absence of visual loss. The latter indication has been retrospectively evaluated in 13 patients. The limited character of our series is partially explainable by strict inclusion criteria (objective evaluation of muscle dysfunction and proptosis). We failed to demonstrate any significant functional improvement after oral corticotherapy and/or radiotherapy. It thus appears that our study sheds doubt on the actual efficacy of these treatments in patients presenting with not very evolutive involvement of eye-muscle motility. A larger study aimed at comparing the benefits and drawbacks of these treatments is consequently to be encouraged.

Bilateral tonic pupils and polyneuropathy in Sjögren's syndrome: a common pathophysiological mechanism?

One case associating tonic pupils and Sjögren's syndrome is reported. Neurophysiological examination also demonstrated a purely sensory neuropathy. This rare association raises the issue of a common process destroying the ciliary and spinal root ganglia in these patients.

[Optic nerve tract injuries (author's transl)]. / Les traumatismes des voies optiques.

The length of the optic nerve tracts exposes them to damage from cranial injuries. The intraorbital segment of the optic nerve is vulnerable, as bone protection is incomplete and frontal injuries frequent, while indirect lesions of the optic nerve due to trauma raise diagnostic problems in comatose patients. Study of photomotor reflexes and VEP supplies valuable information. Unilateral mydriasis is not a sign of blindness, but of a lesion of the IIIrd nerve, which, may be compressed during engagement of the temporal lobe in the tentorium cerebelli region. The mydriasis indicates the side of the lesion and the need for urgent treatments. Surgical decompression of the optic canal should be performed for indirect optic nerve injuries when visual deficiency appears or becomes worse during the few days following the trauma. Visual loss noted most characteristically in chiasma lesions is bitemporal hemianopsia. In cases of optic nerve injuries, temporal campimetric deficiency in the other eye is evidence of an associated chiasma lesion. The chiasma may also be damaged following apparently mild frontal blows. Campimetric deficiency in retrochiasmatic lesions indicates the side of the lesion and, on some occasions, its precise location.

The effects of nandrolone decanoate on rarefying bone tissue.

The effects of nandrolone decanoate on rarefying bone tissue were studied with the aid of microradiography and fluorescence microscopy in tetracycline-labelled preparations of the rabbit calcaneus and the long bones of old dogs. Osteoporosis was induced in the rabbit calcaneus by resecting of the Achilles tendon. In 20 of the 24 rabbits treated with nandrolone decanoate, the osteoporosis observed was less severe than in 8 untreated controls. Furthermore, in comparison with the controls, the signs of active osteogenesis in the treated groups increased systematically. In the old dogs, nandrolone decanoate caused a new opposition, identified by tetracycline labelling, to appear at the periphery of the medullary cavity. All the observations suggest that nandrolone decanoate has a favourable effect on osteogenetic phenomena and probably an inhibitory action on bone resorption. Consequently, nandrolone decanoate is capable of preventing or, at least, of partially correcting losses of bone mass.