Epidemiological characteristics of surgically treated civilian traumatic brachial plexus injuries in Serbia.

BACKGROUND: Traumatic brachial plexus injuries are generally severe, and in many cases associated with surrounding tissue injuries, which makes them hard to diagnose at the right time. This paper presents etiological and epidemiological characteristics of surgically treated civilian traumatic brachial plexus injuries. METHODS: This retrospective study included 68 patients, operated due to the traumatic brachial plexus injuries at Clinic for Neurosurgery, Clinical Center of Serbia, during the 11-year period. RESULTS: The vast majority of injured patients were men in full working maturity. In our study, there were seven different etiological factors. The road traffic accidents were the most common-41 (60.3%), while the motorcycle accidents were the most dominant subtype (53.7%) of all road traffic accidents, and also representing 32.4% of all causes of trauma. Supraclavicular elements of the brachial plexus were injured in more than 80% of patients. A total of 49 (72.1%) patients from our study had one or more associated injuries. The most common associated injuries were bone fractures, brain contusions, and vascular injuries. CONCLUSION: Although rare, non-war-related severe brachial plexus injuries represent a group of patients carrying high risk of insufficient functional recovery regardless of treatment modality, or surgical technique. Epidemiological and etiological data are therefore very important to identify the groups in risk and to induce preventive actions aimed at these patients.

Efficacy of pelvic floor muscle exercises in women with stress, urge, and mixed urinary incontinence.

OBJECTIVES: Our purpose was (1) to evaluate the efficacy on an intent-to-treat basis of a 3-month course of pelvic floor muscle exercises as first-line therapy for urinary incontinence in consecutive women seen in a tertiary care center with stress, urge, and mixed urinary incontinence and (2) to evaluate whether a specially designed audiotape improves compliance and efficacy of the exercises. STUDY DESIGN: A prospective randomized trial wa conducted with 71 women seen for treatment of urinary incontinence in two tertiary care center referral clinics (in the departments of gynecology and urology). The primary outcome measure was the number of incontinent episodes, as documented with a 3-day voiding diary. Statistical analysis included t tests and Wilcoxon signed-ranks test, as appropriate. A value of p < or = 0.05 was considered significant. RESULTS: Forty-four percent of all enrollees had a > or = 50% improvement in the number of incontinent episodes per day. This increased to 56% of enrolles who completed the treatment course. For all enrollees the mean number of incontinent episodes per day decreased from 2.6 to 1.7 for genuine stress incontinence, from 3.5 to 2.3 for detrusor instability, and from 3.9 to 3.2 for mixed incontinence. For enrollees who completed the 3-month course the mean number of incontinent episodes per day decreased from 2.5 to 1.4 for genuine stress incontinence, from 2.8 to 0.5 for detrusor instability, and from 3.0 to 1.7 for mixed incontinence. Six months after completing the course of exercises approximately one third of all enrollees reported that they continued to note good or excellent improvement and desired no further treatment. There was no difference in outcome measures and no difference in compliance between the women who exercised with the aid of the audiotape and those who exercised according to our usual office routine (p > 0.05). CONCLUSIONS: One third of all participants remained improved to the patient's satisfaction 6 months after completion of a risk-free, inexpensive, simply provided therapy. Our audiotape did not improve our success rate or decrease the dropout rate. In this study the exercises were equally effective for all three urodynamic diagnoses. Inexpensive methods that could be used by primary care providers to improve the success rate of this therapy merits further attention.