Repeatability of cystometry and pressure-flow parameters in female patients.

The repeatability of cystometric and pressure-flow data was studied in 31 female patients. The measured parameters had poor correlation coefficients, and logarithmic transforming of the data was generally not warranted. Previous studies and statistical methods of reliability measurement are reviewed. It is suggested as a subject for future studies, that urodynamic measurements are repeated in each patient so that confidence limits can be established within disease entities.

Urinary incontinence in elite female athletes and dancers.

The aim of this study was, to determine the frequency of urinary loss in elite women athletes and dancers. Elite athletes in eight different sports, including ballet, filled in an evaluated questionnaire about urinary incontinence while participating in their sport/dancing and during daily life activities. A total of 291 women with a mean age of 22.8 years completed the questionnaire, providing a response rate of 73.9%. Overall, 151 women (51.9%) had experienced urine loss, 125 (43%) while participating in their sport and 123 (42%) during daily life. The proportion of urinary leakage in the different sports was: gymnastics 56%, ballet 43%, aerobics 40%, badminton 31%, volleyball 30%, athletics 25%, handball 21% and basketball 17%. During sport 44% had experienced leakage a few times, 46.4% now and then, and 9.6% frequently. During daily life the figures were: 61.7% a few times, 37.4% now and then, and 0.8% frequently. Of those who leaked during sport, 95.2% experienced urine loss while training versus only 51.2% during competition (P<0.001). The activity most likely to provoke leakage was jumping. Sixty per cent (91/151) occasionally wore pads or panty shields because of urine loss. Urinary leakage is common among elite athletes and dancers, particularly during training, but also during daily life activities.

A new intravaginal device for stress incontinence in women.

OBJECTIVE: To compare two versions of the same type of disposable intravaginal device (the Conveen Continence Guard, CCG, and the Contrelle Continence Tampon, CCT, Coloplast a/s, Humlebaek, Denmark) for treating stress incontinence in women. PATIENTS AND METHODS: Women with the predominant symptom of stress incontinence were recruited from four centres in Denmark, Australia and the UK. The women were assessed using a 24-h pad-test, uroflowmetry, postvoid residual urine volume and a voiding diary before treatment, and after 5 weeks using each of the two devices. Vaginal swabs and specimens of urine were sent for culture, and a questionnaire about the subjective effect and adverse events completed at each visit. In all, 94 women were recruited, of whom 62 (66%) completed the study. RESULTS: Both devices reduced the amount of leakage significantly, but the CCT reduced urine loss significantly more than the CCG. Uroflowmetry values and residual urine volume were unchanged when using the two devices. Vaginal culture showed no abnormality during the study period, and only one woman was treated for a urinary tract infection. Side-effects were few and not serious. The women found both devices easy to prepare, insert and use; two-thirds preferred the CCT to the CCG. CONCLUSION: The new intravaginal device (CCT) is more effective for treating stress incontinence than the currently available version (CCG), and patient acceptability of the new device seems to be superior.

[The effect of a vaginal device on urinary leakage and quality of life of women with stress urinary incontinence]. / Effekten på urinlaekage og livskvalitet af et vaginalt hjaelpemiddel hos kvinder med stress-inkontinens.

The aim of this study was to assess the effect of a vaginal device (Continence Guard) on urine leakage and its impact on quality of life (QoL). Fifty-five women participated in a three month study using the Continence Guard. QoL was assessed by an incontinence specific questionnaire (IIQ), two incontinence specific questions and the generic SF-36 health questionnaire. A total of 41 (74.5%) women completed the study. Use of the vaginal device was associated with subjective cure in 11 women (27%) and improvement in 27 (66%). The mean 24-hour pad test leakage decreased significantly. QoL measured by the IIQ and the two incontinence specific questions showed highly significant improvements. The SF-36 questionnaire showed no significant changes. In conclusion treatment with the Continence Guard significantly decreases leakage and improves QoL in women with the symptom of urinary stress incontinence. The SF-36 questionnaire was not sensitive enough to detect alterations in QoL in patients with stress urinary incontinence.

A vaginal device (continence guard) in the management of urge incontinence in women.

The aim of the study was to assess the efficacy of a disposable vaginal device in the management of urge incontinence. A total of 38 women with urge incontinence and uninhibited bladder contractions during cystometry were included. They wore the device from morning to night. Before, and again after, using the device for 1 month the women were assessed by pelvic examination, uroflowmetry, postvoid residual urine, two 24-hour pad-tests, a 3-day voiding diary and vaginal and urine cultures. A questionnaire about the subjective effect and adverse events was completed. Thirty women (79%) completed the study. Two (6.7%) were subjectively cured when using the device, 15 (50%) were improved, and 13 (43.3%) experienced unchanged incontinence. The 24-hour pad-test leakage showed a statistically significant decrease (P=0.001) - in 11 women (36.7%) the decrease was more than 50%. The other urodynamic results were unchanged. A significant decrease in the number of daily micturitions was found in the group of responders (P=0.02). No vaginal infections were found; 4 women (13%) had uncomplicated urinary tract infection during the test-period. Subjective complaints were few, and 21 women (70%) wanted to continue the treatment with the device. The vaginal device constitutes a new option in the management of urge incontinence, with a subjective and objective cure/improvement rate of 56.7%. The device is easy to use and well accepted.

Effect of a vaginal device on quality of life with urinary stress incontinence.

OBJECTIVE: To assess the effect of a vaginal device (Continence Guard) on urine leakage and quality of life. METHODS: Fifty-five women with stress incontinence participated in a 3-month study. They were assessed by the Incontinence Impact Questionnaire, two incontinence-related quality-of-life questions, a generic quality-of-life questionnaire (Short Form-36), two 24-hour home pad weighing tests, a 2-day voiding diary, uroflowmetry, urine cultures, and a questionnaire about subjective effectiveness of the device. RESULTS: Forty-one (74.5%) women completed the study. Estimated on an intent-to-treat basis, the vaginal device was associated with subjective cure in 11 women (20%) and improvement in 27 (49%). The mean 24-hour pad test leakage and leakage episodes in the voiding diary decreased significantly. Fifty-eight percent of the 55 women enrolled wanted to continue using the device after 3 months. The quality of life measured by the Incontinence Impact Questionnaire showed highly significant improvement, and the results of the two incontinence-related quality of life questions also showed significant improvement. Responses to the Short Form-36 general health questionnaire showed no significant changes. Improvement on the Incontinence Impact Questionnaire correlated with improvements in incontinence, whereas the Short Form-36 scores were unchanged. CONCLUSION: Treatment with the Continence Guard significantly decreases leakage and improves quality of life in women with symptoms of urinary stress incontinence. An incontinence-specific, rather than a generic, quality-of-life questionnaire was important in assessing treatment outcomes.

Long-term efficacy and safety of a disposable vaginal device (continence guard) in the treatment of female stress incontinence.

The aim of the study was to evaluate the long-term efficacy and safety of a new disposable vaginal device in the treatment of female stress incontinence. Nineteen out of 22 women with stress incontinence were subjectively and objectively cured or improved in a short-term study, and continued the treatment with the device for 1 year. All 19 completed the study: 13 (68%) were subjectively dry, 5 (26%) were improved and 1 (5%) reported unchanged incontinence. All but 1 had decreased leakage at the 24-hour pad test, and 67% a greater than 50% decrease. No significant changes were found in the other urodynamic tests. The gynecologic examination showed no signs of irritation or erosion from the device, and the subjective complaints were modest and few. It was concluded that the disposable vaginal device maintains its positive effect in alleviating the symptoms of stress incontinence in the long term, it is safe and patient compliance is good.

Evidence for fluid volume depletion in hyponatraemic patients with bacterial meningitis.

Since the mechanisms underlying hyponatraemia in meningitis are poorly understood, we retrospectively reviewed the records of 187 paediatric patients with bacterial meningitis treated at the Department of Pediatrics, University of Bern, Switzerland, between 1982 and 1994. The degree of dehydration calculated from naked weight on admission and at 5 days was consistently (by 2.8 x 10(-2) and significantly more pronounced in 30 hyponatraemic (plasma sodium 130 mmol l-1 or less) than in 157 normonatraemic patients (plasma sodium 131 mmol l-1 or more). Furthermore, a tendency towards reduced sodium excretion was noted in hyponatraemic patients. The results suggest that in bacterial meningitis hyponatraemia is mostly induced by clinically latent fluid volume depletion.

New disposable vaginal device (continence guard) in the treatment of female stress incontinence. Design, efficacy and short term safety.

BACKGROUND: To develop a new disposable vaginal device for use during the daytime, and test its efficacy and short-term safety in the treatment of stress incontinence. METHODS: The intravaginal support device was designed from polyurethane, a foam product with documented high tissue compatibility. It was tested in 26 women with the symptom of stress incontinence. Before and after one month's use of the device, a 24-hour home pad weighing test, uroflowmetry, postvoid residual urine and a 3-days voiding diary were made. A questionnaire about the subjective effect and adverse events was filled in. In vitro and in vivo microbiology testing were performed. RESULTS: Four women discontinued the treatment because of discomfort or difficulties in using the device. Out of 22 women who completed the study nine (41%) were subjectively cured of incontinence, ten (45%) improved while three (14%) claimed unchanged incontinence. With the device in place all had decreased leakage at the 24-hour pad weighing test and unchanged urodynamic tests. The subjective complaints were few, and no vaginal or urinary infections were found. All women whose condition both subjectively and objectively improved, (19/22) wanted to continue treatment with the device. CONCLUSIONS: The new disposable vaginal device is effective in alleviating the symptoms of stress incontinence. It is well accepted and safe.

[Elimination of human chorionic gonadotropin in serum and urine after uncomplicated induced abortion during the first trimester]. / Elimination af humant choriongonadotropin i serum og urin efter ukompliceret provokeret abort i første trimester.

Serum chorion gonadotropin was measured weekly in 12 women from the time of legal first trimester abortion until values were below 10 IU/L. The elimination followed a 2-component curve. The half-life in the first few days was 1.1 day, hereafter 4.2 days. Serum-HCG decreased to less than 10 IU/L within 22 to 40 days. The elimination of serum-HCG was found to decrease so uniformly, that values which do not decrease must be considered abnormal. A sensitive bedside urine-HCG test was found to be positive from 13 to 31 days after the abortion.

PIP: Serum chorionic gonadotropin was measured weekly in 12 women from the time of legal first-trimester abortion until values were below 10 IU. The elimination followed a 2-component curve. The half-life in the first few days was 1.1 day, hereafter 4.2 days. Serum HCG decreased to less than 10 IU within 22-40 days. The elimination of serum HCG was found to decrease so uniformly that values which do not decrease must be considered abnormal. A sensitive bedside urine HCG test was found to be positive from 13-31 days after the abortion. (author's)

Three highly sensitive "bedside" serum and urine tests for pregnancy compared.

We examined three enzyme-linked immunosorbent assay (ELISA) kits for human choriogonadotropin (hCG) (pregnancy tests) for use with urine and serum samples: the Tandem Icon II hCG Urine and Tandem Icon II hCG Serum, the NovoClone Target hCG Test, and the Abbott TestPacks hCG-urine and hCG-serum. Paired comparison of the results from each kit indicated that the NovoClone Target assay showed significantly lower diagnostic sensitivity (P less than 0.05) than did the Tandem Icon II or Abbott TestPack, both for urine and for serum samples. None of the products demonstrated any significant difference (P greater than 0.05) in diagnostic specificity, but the NovoClone Target kit showed several serious false-negative results with both urine and serum. Paired testing of urine kits vs serum kits also showed no significant differences (P greater than 0.05) in diagnostic sensitivity or specificity. We found the Abbott kits to be the most convenient to use and to read.

Single dose pharmacokinetics and pharmacodynamics of oral oxazepam during concomitant administration of propranolol and labetalol.

1. The oral kinetics of oxazepam after a single 15 mg oral dose was investigated in six healthy volunteers before and during concomitant administration of the beta-adrenoceptor antagonists propranolol (80 mg) and labetalol (200 mg) (racemates). 2. A possible pharmacodynamic interaction between oxazepam and the beta-adrenoceptor antagonists was examined using a simple reaction time test (SRT) and by measurement of postural sway. 3. The kinetics of oxazepam were not affected significantly by propranolol or labetalol, although oxazepam and labetalol share the glucuronidation pathway. 4. The SRT was increased by combination of both beta-adrenoceptor antagonists with oxazepam, with the greatest increase after the coadministration of oxazepam with propranolol. Administration of the beta-adrenoceptor antagonists alone had no significant effect. 5. Postural sway was affected significantly only by the combination of oxazepam and propranolol.

Therapeutic doses of codeine have no effect on acetaminophen clearance or metabolism.

In nine healthy volunteers, the clearance and metabolism of acetaminophen 1000 mg i.v. was evaluated with and without two concomitant oral doses of codeine in order to investigate a possible interaction. Plasma acetaminophen was followed for 720 min and urine was collected for 24 h after each dose for determination of metabolites. When codeine was coadministered, the average total clearance of acetaminophen and its clearance by glucuronidation, sulphation and mercapturate formation were 0.58 to 1.12-times the control values. It is concluded that therapeutic doses of codeine do not influence the clearance or metabolism of acetaminophen.

Gait with light and heavy fracture bandages on the lower leg.

Using an instrumented treadmill which measured ground reaction forces, ten normal subjects were tested wearing conventional plaster-of-Paris bandages on the lower leg and lightweight crus-plastic bandages. Two different types of heels were also tested. From calculation of gait parameters it was found that the free walking speed was lowest with a conventional bandage with heel. The external work of gait was lowest with the lightweight bandage. Ataxia was least while wearing the lightweight bandage. The lightweight bandage is preferable from a biomechanical point of view, in accordance with the opinion of the subjects.

Gait analysis after intake of increasing amounts of alcohol.

The ability to walk after intake of increasing amounts of alcohol was studied. Sixteen normal persons were tested on a computer-assisted treadmill. Ataxia or unsteadiness of gait was found to decrease during a blood alcohol concentration (BAC) of less than 0.4 mg/ml. Stride length was found to increase by increasing BAC.

Synovial fluid and blood monocyte influence on lymphocyte proliferation in rheumatoid arthritis and traumatic synovitis.

The influence of synovial fluid and blood monocytes on autologous lymphocyte proliferation in vitro was investigated in patients with rheumatoid arthritis (RA) and traumatic synovitis (TS). In cultures stimulated with PHA, PWM and ConA, thymidine incorporation by RA blood mononuclear cells (BMC) increased considerably in most cases after addition of 10% or 30% synovial fluid monocytes and a similar effect was seen after stimulation with Candida extract or PPD. A comparable helper activity was observed after addition of synovial fluid monocytes to monocyte-depleted blood cells in RA. The augmenting effect of synovial fluid monocytes was likewise demonstrated in TS patients. Synovial fluid mononuclear cells (SMC) from RA and TS patients displayed low proliferative responses to PHA and ConA in comparison with BMC, while the responses to microbial antigens were similar or greater. The proliferative activity of SMC or of monocyte-depleted synovial fluid cells after polyclonal and antigenic stimulation was not affected by addition of blood monocytes. This was observed in both RA and TS patients. It is concluded that the regulatory properties of synovial fluid monocytes in RA and TS do not explain the low proliferative responses of SMC to polyclonal activators.

Normal ranges and reproducibility for the quantitative Romberg's test.

Postural stability was measured in 100 healthy people by a quantitative, computer calculated Romberg's test. The persons were aged 20-69 years, and a table of normal ranges is provided. Older men are found to have higher sway figures than young men, while this was not significant in the group of women. In a second part of the study the reproducibility of the method was studied in 10 healthy people. Sway was measured twice a day during 5 consecutive days of work. No significant alterations in the sway measurements were found. The individual variation coefficients ranged from 11-29% (mean value: 18%). By the present study it is concluded that the quantitative Romberg's test is a reasonable way of measuring postural stability.