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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Of 1,643 cranial computed tomography (CT) scans done in a primary-tertiary care private hospital over a 1-year period, 11 (0.67%) showed diffuse confluent white matter lucencies of less than 30 Hounsfield units. By retrospective analysis, at least 4 of the 11 were demented. Of these, 3 had clinical evidence of Binswanger's disease--characterized by progressive dementia, incontinence, variable pseudobulbar signs, and acute and subacute motor deficits. Two additional patients suffered only transient ischemic attacks or lacunar strokes; 2 had syncope; 1 had multiple sclerosis. The remaining patients were neurologically asymptomatic. In this small retrospective series, the severity of CT changes did not distinguish the patients with clinical Binswanger's syndrome from neurologically less symptomatic patients. Ten of the eleven patients had disordered blood pressure regulation--hypertension, labile systolic pressure, orthostatic hypotension, or a combination of these factors. The severity of CT changes correlated more clearly with blood pressure instability than with clinical encephalopathy. Asymptomatic adult patients with unexplained CT white matter hypodensity and blood pressure disorders may, however, be at risk for the development of subsequent subacute arteriosclerotic encephalopathy.
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PMID:White matter lucencies on computed tomography, subacute arteriosclerotic encephalopathy (Binswanger's disease), and blood pressure. 362 49

To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management.
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PMID:Assuring the quality of health care for older persons. An expert panel's priorities. 365

A clinical study of 5 children (3 boys and 2 girls) with primary sterile vesicoureteral reflux is presented. Their ages ranged from 8 to 11 years old. During the same period, we saw 14 children (6 boys and 8 girls) with primary infected vesicoureteral reflux. Their ages ranged from 1 to 13 years old. There were several distinctions between these two reflux groups. Manifestations of the infected reflux group were mainly fever attacks, while those of the sterile reflux group were hypertension, proteinuria and enuresis. The duration from onset to diagnosis was longer in the sterile reflux group because their manifestations did not appear to be severe especially in cases of enuresis. The grade of reflux tended to be more advanced in sterile reflux group. The renal scarrings were identified in all involved kidneys in the sterile reflux, while in 65.2% in the infected reflux group. It is difficult to detect sterile reflux early because the manifestations are not related with urinary tract infection. Recently, reflux nephropathy is a subject of frequent discussion and end stage of reflux nephropathy has been sporadically reported. Therefore, an effort should be made for early detection of sterile reflux. Based on our experiences as well as review of the literature, possible clues to detect sterile reflux are abnormal voiding patterns, such as nocturnal enuresis, incontinence, frequency and so on.
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PMID:[Clinical study of children with sterile vesicoureteral reflux]. 408 96

A computer-assisted review identified 184 patients with genitourinary tract injuries among 5,400 hospitalized for trauma. Particular attention was directed to the controversial groups of patients with blunt renal and posterior urethral injuries. Management of renal injuries was based on clinical criteria. Subsequent renal exploration was necessary in only 1 of 115 patients with renal contusions, or simple or deep lacerations who underwent initial expectant management. Followup was available in all patients with severe renal injuries and in 53 per cent with renal contusions or simple lacerations. Parenchymal loss was noted on an excretory urogram in only 1 patient and none suffered hypertension, hydronephrosis or other sequelae. A staged approach was preferable to immediate repair of posterior urethral injuries. Seven patients managed by initial cystostomy drainage followed by secondary urethral repairs did well. Primary realignment was complicated by stricture, incontinence or impotence in 3 of 6 patients.
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PMID:Urological trauma in the Pacific Northwest: etiology, distribution, management and outcome. 672 64

Multiple Sclerosis (MS) cases found at autopsy in patients who had died from other diseases and in whom no sign or symptom could be related to MS are called "asymptomatic". Three cases are reported. The first patient was a 62 year old man who presented with a slowly progressive disturbance of gait, incontinence and deterioration of intellectual function. A falx meningioma was surgically removed. The patient died 3 years later with an acute respiratory illness. Examination of the brain disclosed evidence of the operation and numerous old plaques disseminated through the cerebral hemispheres (centrum semi-ovale, periventricular regions, internal thalamus and junction between cortex and white matter) and in the brain stem. The second case, a 77 year old woman with diabetes mellitus and hypertension, presented with cortical blindness and disturbances of memory of acute onset. She died one year later. Examination of the brain showed multiple infarcts involving the territories of both posterior cerebral arteries and the left middle cerebral artery. Numerous old plaques were seen in the periventricular regions, in the corpus callosum and in the left middle cerebellar peduncle. The third case, a 60 year old woman with mitral and aortic stenosis, presented with cortical deafness and transient right hemiparesis. She died 5 years later. Brain examination showed infarcts involving both middle cerebral artery territories. There was also many old plaques in the periventricular areas, thalamus, internal capsule, centrum semi-ovale, brain stem and right nucleus dentatus. In the 3 cases, the optic tracts were normal. The spinal cord, examined only in the first case, was also normal. The asymptomatic character of these MS cases can be explained first by the location of the plaques and the lack of spinal cord and optic tract involvement. It could also be due to the small size of the plaques and to axonal preservation. Such features are rare since our 3 observations have been selected from a pathological collection of 125 MS cases and 9,300 general neuropathological records. Six other cases have been previously reported by other authors.
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PMID:[Asymptomatic multiple sclerosis - 3 cases (author's transl)]. 733 73

In 1991 the National Kidney and Urologic Diseases Advisory Board published a long-range plan entitled "Window on the 21st Century." In that plan the Board recommended that Congress establish a new National Institute of Kidney and Urologic Diseases (NIKUD). This recommendation stemmed from the Board's appreciation that patient morbidity and mortality from kidney and urologic diseases continue to increase and that a focused, well funded research endeavor is the only real hope for reversing this trend. In 1992 the Board established a special subcommittee to consider further the establishment of a National Institute of Kidney and Urologic Diseases. The subcommittee sought input from a wide variety of extramural and intramural sources. American Urological Association: A new devoted institute would provide coordination and expansion of basic research into kidney and urologic diseases now fragmented and underfunded within multiple institutes. The research areas of kidney and urologic diseases are not currently receiving adequate or appropriate attention proportionate to their prevalence and their adverse impact upon society. American Society of Nephrology: The Society supports the establishment of a separate kidney and urology institute. First and foremost, our primary interest is to obtain more support for kidney and urologic diseases. Such research does not receive the emphasis and prominence that it deserves at the National Institutes of Health. The Society believes that a separate institute would provide increased focus for these diseases. National Kidney Foundation: The creation of such an institute is the highest priority of the medical and lay constituencies of the Foundation. American Foundation for Urologic Disease: The creation of a new (kidney and urology) institute within the National Institutes of Health is by far the most expeditious way to centralize and advance the research efforts in this critical field. Scope of a New Kidney and Urologic Diseases Institute: NIKUD should develop an intramural and extramural research program that focuses on all aspects of kidney and urology diseases. NIKUD should be organized so that its activities address issues in pediatric and adult kidney and urologic diseases, including renal failure, transplantation, hypertension, diabetes, cancer, incontinence, sexual dysfunction and male reproduction. NIKUD must foster research training and career development. The integrated scientific programs of the new institute will enhance the treatment and cure of kidney and urologic diseases.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Proposal to establish a National Institute of Kidney and Urologic Diseases. Report of the National Kidney and Urologic Diseases Advisory Board. 801 99

Seven patients with psychiatric and behavioural manifestations of normal-pressure hydrocephalus are described. There is little disagreement about the classical triad of symptoms. However, it requires a high index of suspicion when a patient presents with non-specific psychiatric and behavioural symptoms. Clinicians must be alert to the possibility when positive findings point to the diagnosis of normal-pressure hydrocephalus, namely gait disturbance, incontinence, soft neurological signs, history of hypertension and no previous psychiatric history.
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PMID:Psychiatric and behavioural manifestations of normal-pressure hydrocephalus. 803 85

A cross-sectional research was done aiming at the assessment of geriatric daily activities, gait and balance, besides assessment of different presentation of common diseases which occur commonly in the elderly. Special Geriatric Unit has been established in Ain Shams University Hospitals in 1984. This study included all those consulting that clinic in the period from January to April 1992. Out of 516 elderly, 270 (52.3%) were males and 246 (47.7%) were females and 478 (70%) of them were in the age group 60-70 years. Eating and wearing Clothes without help decreases with aging from 60-80 years (P < 0.001). Musculoskeletal functional disorders (joint pain and backpain) were the most frequent findings in both sexes (P < 0.001). Incontinence was the most prevalent genitourinary disorder among females Diabetes in combination with other diseases as hypertension and ischemic heart diseases was the most prevalent systemic disorder (28%). Therefore, it is recommended that these findings should be put into consideration for preventive gerontology.
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PMID:An epidemiologic study of the health status among elderly in Ain Shams Geriatric Unit. 824 50

Bladder dysfunction with increased voiding frequency and incontinence is a common problem in patients with multiple sclerosis (MS). In the present study, the effect of the synthetic vasopressin analogue, desmopressin, was evaluated on the voiding frequency in 26 patients with MS suffering from socially handicapping voidings and incontinence problems during daytime. A two-week run-in observation period to establish normal voiding patterns was followed by a double-blind, placebo-controlled cross-over study with 20 micrograms intranasal desmopressin during daily activities. There was a significant decrease in the number of voidings during the 6-h period after intranasal intake of desmopressin. Side effects were well tolerated and there was no hyponatremia or hypertension registered. Intranasal desmopressin is an efficient and well-tolerated treatment of voiding problems in patients with MS during daily activities.
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PMID:Nasal spray desmopressin treatment of bladder dysfunction in patients with multiple sclerosis. 887 90

There have been occasional reports of female stress incontinence related to prazosin therapy for hypertension. This drug is now rarely used but recently longer acting alpha-adrenoceptor blocking drugs have been introduced. We have, therefore, investigated the prevalence of urinary incontinence in all our female patients who were receiving alpha-adrenoceptor blockers in comparison with women, matched for age and parity who were receiving other drugs. We identified a total of 49 women taking alpha-adrenoceptor blocking drugs (prazosin 4, terazosin 5, doxazosin 40) among current patients who were attending our hypertension clinic. Twenty of these (40.8%) reported some urinary incontinence whereas in the control patients, only 8 (16.3%) had this symptom (P = < 0.02, relative risk 2.5, 95% CI 1.22-5.13). alpha-Adrenoceptor blockers were withdrawn in 18 of the 20 patients with incontinence and in 13, their symptoms abated. Our results suggest that there is a significantly higher prevalence of urinary incontinence in women taking alpha-adrenoceptor antagonists with reversibility on withdrawal of these drugs. As both female urinary incontinence, hypertension and the use of alpha-adrenoceptor blocking drugs are common, this distressing side effect should be borne in mind so that gynaecological or urological treatment may be avoided in some women.
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PMID:Alpha-adrenoceptor blocking drugs and female urinary incontinence: prevalence and reversibility. 890 25


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