What is the variability between 2 consecutive cystometries in the same child?

PURPOSE: We compared the results of 2 cystometrograms (CMGs) performed during a single session in the same child to determine the variability between consecutive cystometries. MATERIALS AND METHODS: Subjects underwent 2 consecutive bladder fillings performed at the same rate and position. Maximum cystometric bladder capacity (CBC), pressure at CBC, leak point pressure, maximum flow rate, pressure at maximum flow, maximum voiding pressure, residual urine and pressure specific volumes (PSV) less than 20, 30 and 40 cm water were compared between studies. Uninhibited detrusor contractions (UICs), defined by the previous and new International Children's Continence Society definitions of UIC, were also compared. Data were analyzed using paired t test, chi-square and interclass correlation. RESULTS: CMGs in 32 male and 34 female children were available for analysis. Mean subject age was 7.4 years (range 1 month to 18 years). Of the children 43 (65%) had spinal dysraphism, 4 (6%) had cerebral palsy, 5 (8%) had posterior urethral valves, and 14 (21%) had recurrent urinary tract infection, daytime incontinence and frequency/urgency symptoms. Maximum CBC, pressure at CBC, leak point pressure, maximum flow rate, pressure at maximum flow, maximum voiding pressure and residual urine did not differ between the 2 studies. PSVs less than 20, 30 and 40 cm water were highly correlated between the 2 CMGs (interclass correlation coefficients 0.795, 0.683 and 0.850, respectively). There were more UICs on the first than the second study (p = 0.02 and 0.03) as defined by the previous and new definitions of UIC. UIC threshold volume was less on the first CMG (p = 0.00 and 0.03). UICs were either present or absent on both studies in 56 of the 66 (85%) children by the previous UIC definition and in 51 (77%) by the new UIC definition. CONCLUSIONS: There is no difference in CBC, PSV and pressure flow parameters when performing consecutive urodynamic studies in the same child. However, UICs are more frequent on the first study. We conclude that repeat cystometry is not indicated in the absence of UICs on the first study and suggest that the second consecutive CMG be used for clinical interpretation when repeat studies are performed in the same session.

The changing profile of acute childhood illness: a need for the development of family nursing knowledge.

The profile of the acutely ill child and family has undergone dramatic changes in recent years. Advances in medical technology have substantially altered the life-death trajectory for ill children and their families; however, they have also left families to endure increasingly difficult situations with uncertain outcomes for prolonged periods of time. Nurses are interested in understanding how families manage in the face of serious illness, yet a review of the literature has revealed little progress in this area. While the importance of the family has been repeatedly documented, theoretical developments regarding family process during acute illness have been limited. This paper analyses those factors that have limited nursing knowledge development and, as a result, contributed to gaps in current thinking regarding the acutely ill child. They include: (a) a history of theoretical nursing models which, until recently, focused on the individual; (b) research that has focused on the individual parent or child while virtually ignoring family variables; (c) an outdated definition of acute illness which does not reflect the current population of hospitalized children; (d) limited use of theoretical frameworks borrowed from other disciplines; and (e) unresolved methodological issues related to the study of families in nursing.

Computerized axial tomography of the brain in neonates and young infants.

Twenty critically ill infants with abnormal head growth and/or seizures underwent CAT of the brain. Signs of birth asphyxia or respiratory distress were present in all. Six out of ten infants with abnormal size of the head had abnormal CAT scans. Nine out of ten infants with seizures had abnormal scans. Abnormalities included hydrocephalus, intraventricular hemorrhage, cerebral edema, subarachnoid hemorrhage and porencephaly. Six infants required neurosurgical procedures. Development at two to 15 months of age in the 19 surviving infants was normal in nine, suspect in eight, and severely delayed in two patients. Until the prognosis of the various CNS disorders discussed is clearly defined, aggressive management appears indicated.

Computed tomography in head trauma.

Retrospective analysis of 200 cases of documented head trauma demonstrated an accuracy approaching 100% in the diagnosis of intra- and extracerebral collections of blood. Caution must be exercised in the evaluation of trauma 1 to 5 weeks old, since subdural hematomas have the same density as normal brain tissue, and angiography may be necessary. The clinical diagnosis of brainstem contusion is associated with a remarkably high level (54%) of surgically correctable lesions. The use of computed tomography in the evaluation of other traumatic intracranial lesions is discussed.

Spontaneous rupture of an iliac artery aneurysm into a ureter: a case report and review of the literature.

A case of massive hematuria from spontaneous rupture of an iliac artery aneurysm into a ureter is reported. The vascular causes for gross hematuria are reviewed and the various arterial aneurysms are discussed. The need to consider vascular abnormalities when dealing with massive hematuria is emphasized.

Failure of computerized axial tomography to demonstrate a chronic subdural hematoma.

A chronic subdural hematoma may present in a computerized axial tomography (CAT) scan with the same density as normal brain tissue. The presence of a lesion may be suggested only by its mass effect. The lack of contrast enhancement or edema may help to differentiate a chronic subdural hematoma for a neoplasm or a cerebrovascular accident.