Congenital neuropathic bladder: practicalities and possibilities of conservational management.

Upper urinary tract and renal deterioration in the child with congenital neuropathy is due to high intravesical pressure associated with urinary retention. Preservation of kidney function often can be achieved when bladder emptying is improved by lowering the urethral resistance, when reflux is cured, and when infection is controlled. Since incontinence is most often of the overflow type, complete bladder evacuation can allow the child to remain dry for a socially acceptable period of time between voidings. Success depends greatly on the child's motivation and on his cooperation in a bladder training regimen. Diversion is sometimes unavoidable but should be considered only when conservational methods have failed.

Transureteroureterostomy for urinary diversion in children.

Transureteroureterostomy with cutaneous ureterostomy has been used effectively as a method of external urinary diversion in ten children. Of the 20 renal units involved, 15 showed pyelographic improvement and 5 stabilized after diversion. The method requires that at least one ureter is sufficiently dilated to provide a stoma of adequate caliber. It avoids the disadvantages or complications associated with most other forms of external diversion.

Infection stones in children: a twenty-seven-year review.

OBJECTIVE: The objective of this study was to determine the relationship between urinary tract infection and pediatric urolithiasis and to characterize the pediatric infection stone former. METHODS: Two hundred seventy consecutive pediatric stone formers presenting over a twenty-seven-year period were studied. Of these, 161 children (60%) had infection-related stones. Account was taken of stone composition, anatomic location, associated anatomic lesions, and the rate of stone recurrence over a median follow-up of three years. RESULTS: The mean age of children with infection stones was 4.9 years, with two-thirds being under six years of age. Proteus mirabilis accounted for 82 percent of pure urine cultures. Seventy percent of stones were renal and 30 percent were ureteral or intravesical. One-third of patients had anatomic lesions (pelviureteric obstruction, primary obstructed megaureter, and others) contributing to stone formation. Recurrent stones occurred in 14 percent of cases. CONCLUSIONS: This study reaffirms the predominance of urinary tract infection secondary to P. mirabilis as the leading cause of pediatric urolithiasis in the United Kingdom. The significant recurrence rate suggests the importance of prophylactic antibiotics, surgical correction of congenital anomalies, and long-term follow-up of this patient population.

Neonatal solitary renal cysts associated with posterior urethral valves.

Large simple cysts of the kidney are common findings in adults but are extremely rare in neonates. Three cases of large solitary renal cysts in newborn boys associated with posterior urethral valves are described. The pathogenesis, diagnosis, treatment, and differentiation from urinoma secondary to spontaneous urinary extravasation are discussed.

Inflammatory processes mimicking bladder tumors in children.

Tumor-like proliferative lesions were discovered on cystourethrography and cystoscopy in two children, one with severe bacterial urinary tract infection and the other with painless terminal hematuria. Histologically, these lesions were characterized by inflammatory infiltration and proliferative changes of the bladder epithelium. Appropriate treatment, including antibiotics, resulted in complete disappearance of the bladder lesions in both patients. The development of such lesions is related to the potential for nonneoplastic proliferation and metaplasia of the bladder epithelium and is considered to be the result of irritation associated with infection or other chemical and physical factors. The known malignant potential of such bladder pathology indicates a need for careful, long-term follow-up in such patients, including children.

Pelviureteric obstruction in infancy.

Of 33 infants with pelviureteric obstruction, most presented in the first month of life with an abdominal mass and most were males. Half of these patients had bilateral renal pathology. The association between cystic dysplasia in the hydronephrotic kidney and contralateral cystic renal abnormality in patients with unilateral pelviureteric obstruction is noted. There were 34 pyeloureteroplasties performed on 27 patients, mostly with good results, even in patients with bilateral renal pathology.

Vigilant and hypervigilant decision making.

Recent studies have argued that deficient decision making under stress is due to adoption of a hypervigilant style of decision making, which has been characterized as disorganized and inefficient. However, under the conditions that characterize many real-world or naturalistic tasks, a hypervigilant pattern of decision making may be adaptive, because the decision maker does not have the luxury of implementing a more elaborate analytic procedure. This study examined the effectiveness of vigilant and hypervigilant decision-making strategies on a naturalistic task. Results indicated that participants who used a hypervigilant decision-making strategy performed better than those who used a vigilant strategy. Implications for decision making in naturalistic environments are discussed.

Effects of preparatory information on enhancing performance under stress.

Research conducted largely in medical and clinical settings suggests that receiving preparatory information prior to a stressful event can reduce negative responses to stress. Although results within this domain have been promising, little research has examined the efficacy of preparatory information on enhancing performance in a more applied task environment. This study examined the effect of preparatory information on reducing stress reactions and enhancing performance on a realistic decision-making task. Results indicated that those who received preparatory information prior to performing under high-stress conditions reported less anxiety, were more confident in their ability to perform the task, and made fewer performance errors than those who received no preparatory information.

The effect of stress inoculation training on anxiety and performance.

Stress inoculation training is an intervention that has shown considerable promise; however, many questions arise regarding the application of this clinically based approach to more applied workplace settings. A meta-analysis was conducted to determine the overall effectiveness of stress inoculation training and to identify conditions that may moderate the effectiveness of this approach. The analysis was based on a total of 37 studies with 70 separate hypothesis tests, representing the behavior of 1,837 participants. Results indicated that stress inoculation training was an effective means for reducing performance anxiety, reducing state anxiety, and enhancing performance under stress. Furthermore, the examination of moderators such as the experience of the trainer, the type of setting in which training was implemented, and the type of trainee population revealed no significant limitations on the application of stress inoculation training to applied training environments.

Mitral valve prolapse:--the facts.

Mitral Valve Prolapse does not cause chest pain or other symptoms and is extremely unlikely to give rise to complications. In practice it is difficult to differentiate a 'prolapsing' valve from one that is 'normal' no matter what methods are used. Since diagnosing 'heart disease' is itself a well known cause of ill health, the most stringent criteria must be adopted before the mitral valve is labelled as being abnormal. The need for the diagnosis at all is, in most cases, doubtful.

Potential recruits in medical outpatients--an audit.

A retrospective study was made of 309 randomly selected potential service recruits seen over five years by different consultant physicians in an Army hospital. Only nine of 133 referred with a history of asthma were turned down because of an abnormality in their exercise lung function test. Only four of 92 referred for a systolic heart murmur were rejected. Only one was turned down because of a headache or migraine out of 30 referred with that diagnosis. None of nine with supposed high blood pressure nor of five with a past history of pneumothorax was rejected. Of seven referred because of epilepsy, all five with definite evidence of this were turned down. The predictability of the specialist decision in these conditions suggests that more than 80% of all potential recruits referred to hospital with medical problems (at least 800 people yearly in UK) do not need to attend.

Leptospirosis--an occupational disease of soldiers.

Two cases of leptospirosis are described in soldiers who fell into a river together. One developed Weil's disease due to icterohaemorrhagiae serogroup and the other "Mud-Fever" due to grippotyphosa serogroup. The organisms were initially cultured in standard blood culture media. There were six cases of leptospirosis in BAOR in the 10 years to 1980 giving an incidence 10 times greater than in the civil population of UK and West Germany. Leptospirosis is an occupational disease of soldiers in BAOR and the health risks of fresh water immersion should be publicised.