A visual motor psychological test as a predictor to treatment in nocturnal enuresis.

BACKGROUND AND AIMS: The neurological control of bladder function and the ability to be dry at night involves not only the acquisition of normal daytime control, but also the establishment of a circadian rhythm in vasopressin release and the ability to arouse to a full bladder during sleep. We postulated that in some children there might be a delay in maturation of the normal neurological pathways involved in establishment of nocturnal continence and examined this by using a specific neuropsychological test. METHODS: Children attending an established nocturnal enuresis clinic were examined using the Rey-Osterrieth test to assess the presence or absence of boundary errors in both copy and memory reproductions. The results of the test were scored independently and blind to the response to treatment with the vasopressin analogue DDAVP. RESULTS: A significant association was found between boundary type errors and response to DDAVP, with non-responders making significantly more errors. No child with three or more errors responded to DDAVP. Using this test, the ability to predict response to treatment was 70%. CONCLUSIONS: It is postulated that the Rey-Osterrieth test, through the presence or absence of boundary errors, reflects a delay in maturation and/or a disorganisation of the retinal-hypothalamic-cortical pathways in the brain. The association previously described with growth hormone neurosecretory dysfunction syndrome would be compatible with this.

A search for the evidence supporting community paediatric practice.

AIM: Controversy exists regarding the evidence base of medicine. Estimates range from 20% to 80% in various specialties, but there have been no studies in paediatrics. The aim of this study was to ascertain the evidence base for community paediatrics. METHODS: Twelve community paediatricians working in clinics and schools in Yorkshire, Manchester, Teesside, and Cheshire carried out a prospective review of consecutive clinical contacts. Evidence for diagnostic processes, prescribing, referrals, counselling/advice, and child health promotion was found by searching electronic databases. This information was critically appraised and a consensus was obtained regarding quality and whether it supported actions taken. RESULTS: Two hundred and forty-seven consultations and 1149 clinical actions were performed. Good evidence was found from a randomised controlled trial or other appropriate study for 39.9% of the 629 actions studied; convincing non-experimental evidence for 7%; inconclusive evidence for 25.4%; evidence of ineffectiveness for 0.2%; and no evidence for 27.5%. Prescribing and child health promotion activities had the highest levels of quality evidence, and counselling/advice had the lowest. CONCLUSIONS: An encouraging amount of evidence was found to support much of community paediatric practice. This study improved on previous research in other specialties because actions other than medications and surgery were included.

Antiemetic efficacy of prednisolone: a placebo-controlled trial in patients with advanced prostatic cancer treated with estramustine phosphate.

The antiemetic effect of prednisolone on nausea/vomiting was investigated in 67 patients with advanced prostatic cancer and a performance status of < or = 2. The study was a double-blind, placebo-controlled, randomized trial with a parallel group design. The objective was to compare the incidence and severity of nausea/vomiting between the two groups. Prednisolone or placebo was given twice daily for 3 weeks with the dose decreased during the third week from 15 mg/day to 10 mg for 3 days and finally to 5 mg/day during the last 4 days. EMP was given as two 140 mg capsules daily for 3 days at the beginning, then as four capsules for 4 days followed by six capsules for 21 days. Areas under curves (AUCs) for nausea and for nausea/vomiting scores were calculated based on the patient's diary notes: nausea (0-3), vomiting (0-6), nausea/vomiting (0-9). Control of emesis in terms of complete, moderate or poor control was registered. Pretreatment characteristics were evenly balanced. The results indicated that no statistical differences between the two groups of patients were present in AUCs for weeks 1-3 or weeks 1-4. We conclude that it was not possible to demonstrate a significant antiemetic efficacy of prednisolone. However, in all but one case the patients in the prednisolone group could be treated for at least 3 weeks without any major incidents of nausea/vomiting.

Effects of a calcium antagonist (nifedipine) on cats in live E. coli bacteriemic shock.

The effects of a calcium antagonist, nifedipine, on cardiovascular reactions and on gastrointestinal mucosal integrity was studied in a standardized feline bacteriemic model. Nifedipine pretreatment delayed the development of cardiovascular derangement and reduced the severity of the intestinal but not the gastric mucosal injury. The effect on the intestinal mucosa could be due to the delayed development of hypotensive shock but also to a protective effect on the superficial mucosal cells.

Increased survival with calcium antagonists in antibiotic-treated bacteremia.

This study was done to test the effectiveness of calcium antagonists on survival in a bacteremic model. Swiss albino mice were injected intraperitoneally with live Escherichia coli at an LD90 dose. When antibiotic treatment was delayed for 3 hr after E coli challenge, there was a mortality range of 30-50% for the gentamicin-treated mice and 40-60% for the cefoxitin-treated mice. A calcium antagonist, either nifedipine or verapamil, was added to this model in different dosages and at different time intervals. Nifedipine yielded a significantly lower mortality both with gentamicin and with cefoxitin. Verapamil did not affect mortality with cefoxitin but did improve survival with gentamicin. Effective dosages occur within a narrow range. The results are encouraging and call for further studies with calcium antagonists to ascertain their prospective usefulness as additives to septic shock treatment.

Verapamil improves cardiac function and increases survival in canine E. coli endotoxin shock.

The effects of verapamil, a calcium antagonist, on survival and on hemodynamic and metabolic parameters were studied in canines administered E. coli endotoxin. Shams, endotoxin controls, and endotoxin-shocked dogs treated with a 4-hour infusion of verapamil were studied. The animals were anesthetized, catheters and endotracheal tube were inserted, and an IV infusion was started after administration of endotoxin. All dogs were kept on a respirator for 4 hours while measurements were taken; they were then extubated and returned to their cages. Survival was considered permanent by 7 days. Eight of 13 treated dogs survived, in contrast with only one of 14 controls. Treated dogs had significantly higher cardiac index (4.64 vs 3.62 L/min/m2), pulmonary artery pressure (16 vs 13 mmHg), and left ventricular stroke work (44.3 vs 29.7 gm/m2 beat), and significantly lower heart rate and systemic vascular resistance at 4 hours. Serum glucose, acid phosphatase, pH, and Hct were also significantly improved by verapamil treatment.