Treating nocturnal enuresis.

Nocturnal enuresis, commonly known as bedwetting, is described in documents dating from 1550 BC. Derived from the Greek word enourein, meaning "in urine" or "inability to control urination," it occurs in 15 to 20 per cent of five year olds and is twice as common in boys as girls. Indeed, no cure has yet been found and thousands of children and their families live with the distress the condition causes. Among affected children, this often includes behavioral problems and low self-esteem.

The surgical management of urinary incontinence in myelodysplastic children.

Over a 4-year period, 69 patients with intractable urinary incontinence secondary to myelodysplasia have undergone surgical therapy to try to achieve continence. Preoperative evaluation used uroradiological and urodynamic studies, including measurement of leak point pressure and leak point volume. Twenty-one patients had a procedure to increase outlet resistance, 30 patients had bladder augmentation, and 18 patients had both procedures performed. Fifty-seven of the 69 patients have achieved total continence for a success rate of 83%.

Constipation associated with vesicoureteral reflux.

Seventeen children who had vesicoureteral reflux underwent urodynamic and rectal manometric studies. All had uninhibited bladder contractions. All had rectal dilatation confirming the presence of constipation by rectal balloon manometry. The recurrent association of constipation with ureteral reflux suggests the possibility of a nonfortuitous association.

Effects of oxybutynin on vesicoureteral reflux in children.

We reviewed retrospectively 40 children seen from 1980 to 1984 with vesicoureteral reflux in 53 ureters. All patients had a hyperreflexic bladder on urodynamic evaluation with or without vesicoperineal dyssynergia but they were otherwise neurologically normal. All except 1 child received prophylactic antibiotics. Of the children 37 received oxybutynin therapy for bladder hyperreflexia for 3 to 18 months. Reflux disappeared or became grade I in 62.3 per cent of the ureters. Of the children manifesting urinary incontinence at the time of urodynamic study reflux disappeared or became grade I in 78.6 per cent. Reflux resolved or became grade I in 20 per cent of the children with no urinary incontinence. Of those patients with recurrent reflux at the onset of urinary incontinence and bladder instability reflux resolved or became grade I in 80 per cent. Oxybutynin therapy for hyperreflexic bladder resulted in an average increase in bladder capacity of 97 cc (54.2 per cent), which was maintained after cessation of treatment. These data suggest that bladder instability can be an important factor in causing and perpetuating reflux. Therapy aimed at decreasing intravesical pressure will enhance resolution or downgrading of reflux.

Long-term treatment of acromegaly with bromocryptine: postprandial HGH levels and response to TRH and glucose administration.

Fourteen patients with acromegaly were treated with bromocryptine (CB 154, Sandoz), 4 X 2.5 mg, for periods of up to eleven months. One patient did not tolerate the drug, ten of the remaining thirteen experienced considerable clinical improvement. There was a dose-dependent suppression of plasma growth hormone levels, but growth hormone response to TRH injection and to glucose administration was still present during therapy although reduced. TSH response to TRH was not significantly altered. The suppressive power of bromocryptine on growth hormone appears to be related to the mechanism by which TRH stimulates growth hormone secretion in acromegaly, but long-term administration of this drug may be successful in spite of an absent response to TRH in some cases. Bromocryptine appears to be a safe and effective drug for the treatment of acromegaly.

Effects of growth hormone release-inhibiting hormone and bromocryptine (CB 154) in states of abnormal pituitary-adrenal function.

Growth hormone release-inhibiting hormone (GHR-IH) was administered to five patients with abnormal pituitary-adrenal function. There was immediate suppression by about 50% of ACTH levels in two patients who had undergone bilateral adrenalectomy because of Cushing's disease; one of them had Nelson's syndrome. Bromocryptine (2-5 mg) suppressed ACTH levels by 62-67% for more than 6 h in these patients. GHR-IH did not significantly influence cortisol secretion by an adrenal carcinoma and only slight changes were seen in two patients with Addison's disease. The possible therapeutic implications are discussed.

Pilot trials with a fluorescent whitening agent of the bis(triazoly) stilbene-disulfonic acid type in golden orfes.

Golden orfes were examined for uptake, distribution, and elimination of radioactivity administered in the form of a 14C-labelled fluorescent whitening agent (FWA) of the bis(triazolyl)stilbenedisulfonic acid type. Results of these studies are given below. Pilot trials using FWA concentrations of 10 and 100 ppb and a population density of 1 fish per liter show that an equilibrium between uptake and elimination of the FWA develops in the animals within a period of one week; i.e., the incorporated traces of the FWA are not irreversibly bound. The radioactivity is mainly located in the gall bladder and in the intestinal contents, as well as in the liver, throat, and gills. The muscular system (filet) is virtually free from activity. Approximately 1-2% of the FWA amount administered per animal (corresponding to the concentration factors of 7-14) can be temporarily detected in the fish. Radioactivity is eliminated comparatively quickly. Two days following the transfer of the fish into water free from FWA a concentration factor as low as 1 is reached, i.e. from this time the FWA concentration in the animals decreases to less than 10 resp. 100 ppb.