Intravesical electrostimulation in pediatric patients with spinal cord defects.

PURPOSE: Creating a low pressure continent urinary storage mechanism for the pediatric patient with neurogenic bladder is difficult. Current therapy, which is enterocystoplasty with intermittent catheterization, is not an ideal solution. In an effort to optimize storage we used intravesical electrostimulation in patients with spinal cord defects. MATERIALS AND METHODS: A retrospective review of all pediatric patients undergoing bladder stimulation was performed. Parameters reviewed included indication, patient age, initial age adjusted pressure specific bladder volume (less than 30 cm. H2O), initial leak point pressure, number of treatments, number of sessions per treatment, posttreatment age adjusted pressure specific bladder volume, voiding and continence status. RESULTS: Records of all 44 patients treated were reviewed. Indications for treatment included decreasing bladder storage pressures in 24 cases, increased continence between catheterization in 13 and achieving volitional voiding in 7. Patients who became continent had similar age at initiation of treatment, number of treatments, number of sessions, initial leak point pressure and final age adjusted pressure specific bladder volume compared to nonresponders. Nonresponders required surgical intervention to achieve continence with safe storage pressures. Overall, 16% (7 of 44) of patients were continent with safe storage pressures at the completion of treatment and 9% (4 of 44) achieved pretreatment goals. CONCLUSIONS: While some high risk patients were spared surgery due to intravesical electrostimulation, most were not. Spontaneous voiding to completion at safe pressures was not achieved. We were unable to clarify before treatment which patients would benefit from intravesical electrostimulation.

Mortality by cause among stationary engineers and stationary firemen.

Causes of death among 1,113 stationary engineers and firemen identified from union death benefit listings were analyzed to determine if there were conditions occurring with unusual frequency suggestive of exposure to hazards in the work environment. The relative frequencies of specific disease conditions in the study group were compared to the experience of the general population by the method of proportionate mortality. Deaths from cancer of the buccal cavity and pharynx and cancer of the rectum occurred twice as often as expected, each result being statistically significant at the 5% level. Lung cancer deaths were 20% higher than expected overall, and consistently excessive in each of four geographic subdivisions of the United States. Mortality from coronary heart disease was elevated in each region, particularly at ages under 55. No increase in the relative frequency of deaths from nonmalignant respiratory disease was found nor were fatal accidents more frequent than expected. Some of the findings may be important in view of potential exposure to carbon monoxide and several carcinogenic materials for these occupational groups.

Causes of death among construction machinery operators.

Causes of death among 2,190 deceased operating engineers identified from the 1967 International Union of Operating Engineers death benefit listing were analyzed to determine if there were conditions occurring with unusual frequency that might be indicative of hazardous conditions in the work environment. The most striking finding was a three-fold excess of fatal accidents occurring at places other than the home or resident institution. The increased risk was evident in each of four regions of the country and at all ages under 65. Significant excesses in deaths from lung cancer and intestinal cancer were seen also. Comparative mortality from lung cancer was directly related to age, with the greatest increase (two-fold) occurring after age 75. There was no evidence of a greater than expected frequency of deaths from non-malignant respiratory disease among operating engineers.