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Aim: To detect effects of desmopressin on sleep in enuretic children and to look for polysomnographical differences between responders and non-responders to desmopressin treatment.Methods: Twenty-one children with primary nocturnal enuresis were examined polysomnographically before treatment. All but one of the children then received treatment with desmopressin in standard dosage, and the response was documented. Seven of the children underwent a second polysomnographic registration while on treatment.Results: The time interval (+/- 1 SD) between sleep onset and the enuretic episode was 92 +/- 67 min without medication and 372 +/- 157 min when desmopressin was given (p = 0.003). Standard polysomnographic variables were not affected by the drug. Ten children were desmopressin responders and 10 were non-responders. The total sleep time was 455 +/- 56 min in the former and 408 +/- 31 min in the latter group (p = 0.04). The responders spent 27.4 +/- 5.5% of their total sleep time in rapid eye movement sleep, compared with 18.2 +/- 6.5% in the non-responder group (p = 0.004).Conclusion: Desmopressin has no major effects on sleep as such but does delay bladder emptying. Enuretic children responding to desmopressin treatment have more rapid eye movement sleep than therapy-resistant children. [ABSTRACT FROM AUTHOR]

Introduction: Dysphagia is not unusual following repair of esophageal atresia (EA). The lack of a uniform definition has led to a variance when it comes to reporting the prevalence of dysphagia among patients operated on for EA. Our aim is to estimate the occurrence and degree of dysphagia, using a numerical score with its statistical versatility independent of a specific definition. The results are used to find early risk factors of dysphagia within this patient group. The results are also used to see whether we can find a correlation between dysphagia and symptoms of gastroesophageal reflux (GER) and quality of life (QoL). Methods: 79 consecutive survivors operated on for EA in Gothenburg between 1968 and 1983 were located. Hospital charts were reviewed and patients received questionnaires on dysphagia, symptoms of GER and QoL. Dysphagia was measured by a numerical score, symptoms of GER were extracted using a predetermined questionnaire (GerdQ), and QoL was determined using the generic questionnaire SF-36. Results: 73 patients (92.4 % ) returned the questionnaires. In order to make the study group as homogeneous as possible with regard to the malformation we choose to study the 63 patients representing the vast majority: those with Gross type C. 36 patients (57 % ) had symptoms of dysphagia to varying degrees. We did not find any aggravating factors in their hospital charts nor did we find any correlation to the most recent demographics. There was a significant difference in dysphagia scores when we compared Gross type C to the often more complex type A (p < 0.05). We did not find any correlation to heartburn but a strong correlation to regurgitation with an OR of 2.8 (95 % CI: 1.2 - 6.6). The QoL was good for this patient group, and we did not find any correlation between QoL and the dysphagia score. Conclusions: The dysphagia score provides easy-to-use results when it comes to evaluating the potential influence of dysphagia. Dysphagia is common within this patient group. Patients operated on for EA Gross type A seem to do worse when it comes to dysphagia. Regurgitation is associated with dysphagia, which could imply that GER is an aggravating factor. Further studies to support this finding will show whether there is a correlation between the dysphagia score and the results of 24-h pH-monitoring. If so, this could mean that treating GER might decrease dysphagia, at least in this patient group. [ABSTRACT FROM AUTHOR]

Aims: A study was undertaken to examine whether poor self-rated health (SRH) can independently predict all-cause mortality during 22-year follow-up in middle-aged men and women. Subjects and methods: Data are derived from a population-based study in Malmö, Sweden. This included baseline laboratory testing and a self-administered questionnaire. The question on global SRH was answered by 15,590 men (mean age 46.4 years) and 10,089 women (49.4 years). Social background characteristics (occupation, marital status) were based on data from national censuses. Mortality was retrieved from national registers. Results : At screening 4,261 (27.3%) men and 3,085 (30.6%) women reported poor SRH. Among subjects rating their SRH as low, 1,022 (24.0%) men and 228 (7.4%) women died during follow-up. Corresponding figures for subjects rating their SRH as high were 1801 (15.9%) men and 376 (5.4%) women. An analysis of survival in subjects reporting poor SRH revealed an age-adjusted hazard risk ratio (HR, 95%CI) for men HR 1.5 (1.4-1.7), and for women HR 1.4 (1.2-1.6). The corresponding HR after adjusting for possible social confounders was for men HR 1.3 (1.1-1.4), and women HR 1.1 (0.9-1.4). When additional adjustment was made for biological risk factors the association for men was still significant, HR 1.2 (1.1-1.3). Conclusion: Poor SRH predicts increased long-term mortality in healthy, middle-aged subjects. For men the association is independent of both social background and selected biological variables. The adjustment for biological variables can be questioned as they might represent mediating mechanisms in a possible causal chain of events. [ABSTRACT FROM AUTHOR]

Vesico-ureteric reflux and non-neurogenic bladder dysfunction are closely related, although a causal relationship has been established only for severe forms of detrusor-sphincter dyscoordination. There are several urodynamic studies reporting high frequency of bladder instability and/or detrusor-sphincter dyscoordination in children with reflux. The latter includes an element of functional outflow obstruction and is the most serious, since it accompanies kidney damage. When instability is the only urodynamic abnormality damage is absent. There are indications that treatment of bladder dysfunction increases spontaneous resolution of reflux and, furthermore, that bladder dysfunction is a negative prognostic factor following antireflux surgery. Recently also, gross reflux in infant boys was seen to associate with bladder dysfunction in addition to earlier finding of congenital malformation of the ureterovesical junction. However, no comparisons have emerged on the outcome following treatment of bladder dysfunction and following observation only. In conclusion, children with reflux on chemoprophylaxis prior to reimplantation must always be assessed for bladder dysfunction. This is especially important when there are recurrent urinary tract infections. [ABSTRACT FROM AUTHOR]

Objective To study the long-term efficacy and safety of desmopressin treatment in children with primary monosymptomatic nocturnal enuresis. Patients and methods Children (aged 6–12 years) with nocturnal enuresis were recruited into an open multicentre trial. All children underwent an observation period of 4 weeks before starting a 6-week dose-titration period with desmopressin. If the number of wet nights decreased by more than half during medication, they began long-term treatment on 20–40 μg desmopressin. To test for cure and avoid overtreatment, the medication was interrupted for one week every third month. Results Of the 399 children forming the intention-to-treat cohort, 245 halved their number of wet nights and started long-term treatment. During the periods off medication, 77 children were dry and at the end of the study another 73 (still on medication) reduced the number of wet nights to ≤10% of that during the observation period. A further 51 children halved the number of wet nights compared with the observation period. No serious adverse events occurred. Conclusion Long-term treatment with nasal desmopressin at a main dose of 40 μg is an effective and safe treatment for monosymptomatic nocturnal enuresis. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate Kock reservoir function in children and adolescents operated for congenital urinary incontinence and to determine the complication rate. Reservoir function was investigated in 13 children (age range 10.8-16 years) and 7 adolescents (age range 16-18 years) through enterocystometry, enterocystoscopy and patient history. Patients were followed up for 3-10 years. The follow-up was reported as early (3 months-2 years) and late (2-10 years) postoperative periods. At early follow-up reservoir capacity was high in four patients and normal in the remaining patients. A low reservoir pressure was accompanied by high capacity and compliance. On enterocystometry first sensation for emptying was experienced in 82% of patients at early follow-up and 92% at late follow-up. Reservoir contractions were recorded in 60% of patients at early follow-up and 65% at late follow-up. The contractions were recorded at an average reservoir capacity of 270 ml at early follow-up and 340 ml at late follow-up. The complication rate was high in the child group compared with that in adolescents. Of 13 patients with at least one reservoir complication 10 were from the child group. Nipple dysfunction (angled nipple, prolapsed or stenosed stoma) occurred in 35% of patients, stones in 40% and bleeding during catheterization in 15%. Revision was performed in 38% of the child group and 15% of the adolescents. Reservoir perforation was observed in two patients at 6 and 9 years postoperatively. At late follow-up continence was excellent in 17 of 19 patients and good in 2. We conclude that the Kock reservoir is a good modality for urinary diversion, but the complication incidence is high in the child group (<16 years). Stability of the reservoir in terms of volume and low internal pressures was achieved one year after operation, except in the patients with infrequent reservoir emptying. A time-related increase in the reservoir sensitivity and contractility was... [ABSTRACT FROM AUTHOR]

Isometric recordings of mechanical activity in muscle strips from rat and human detrusor were performed and the effect of μ- and δ-opioid receptor stimulation and blockade on detrusor contraction induced by electrical field stimulation was tested. Stimulation of the opioid μ-receptor with morphine (10-13-10-4 M) and DAGO (10-13-10-6 M) had no significant effect on electrical field stimulation except at one concentration of morphine (10-6 M). Naloxone (10-10-10-5 M) caused a significant facilitation of the electrical field stimulation-induced contraction, which was counteracted by morphine (10-8 M) and the δ-agonist DPDPE (10-8 M) in both rat and human detrusor. Addition of atropine (10-6 M) or hexamethonium chloride (10-6 M) or spantide (10-6 M) did not alter the facilitating effect of naloxone in the rat detrusor. Hexamethonium (10-5 M) decreased the facilitating effect of naloxone on electrical field stimulationinduced contractions in the human detrusor, indicating involvement of ganglionic mechanisms. In human detrusor about 15% of the contractile response was found to be atropine-resistant (10-6 M) and one third of this was found to be resistant to tetrodotoxin (1.5 × 10-6 M). The atropine resistant-response in human detrusor was facilitated by naloxone to the same extent as the atropine-sensitive part. Adrenergic blockade per se, achieved with phentolamine mesylate (10-6 M) and propranolol (10-6 M), caused a significant facilitation of the electrical field stimulation-induced contraction in the rat detrusor but did not affect the facilitating effect of naloxone (10-13-10-5 M). Addition of the δ-agonist DPDPE (10-13-10-5 M) did not significantly change the detrusor response to electrical field stimulation in rat detrusor, but the δ-antagonist naltrindole (10-13-10-5 M) caused a significant facilitation at the highest concentration. In human detrusor, DPDPE 10-8 M significantly reduced the response induced by electrical field stimulation. Conclusion: Blockade of the opioid receptors with naloxone facilitates the detrusor contraction elicited by electrical field stimulation. The existence of a tonic, inhibitory action on the detrusor nerve mediated detrusor contraction by opioid μ- and possibly δ-receptors is suggested. [ABSTRACT FROM AUTHOR]

Motility recordings in muscle strips from rat urinary bladder were performed and the effect of the opiate agonist loperamide on motor activity was studied. Loperamide induced a concentration-dependent (10−7-10−3M) inhibition of the contractile response of the detrusor strip of the same order of magnitude after activation of intramural nerves, stimulation of cholinergic receptors with acetylcholine and after direct depolarisation of the cell with potassium. Pretreatment with the opiate-antagonist naloxone (10−5M) did not antagonise the inhibitory action of loperamide on bladder motility regardless of the type of activation. Naloxone per se, however, facilitated the nerve-mediated motor response. The inhibitory action of loperamide on the potassium-induced contraction could partly be counteracted by elevation of the calcium concentration in the medium. It is suggested that the demonstrated inhibitory effect of loperamide on bladder motility is a calcium-dependent direct smooth muscle action, without any significant opiate-receptor-mediated action in the present in vitro preparation. [ABSTRACT FROM AUTHOR]

Cystometric recordings were performed in pentobarbitone anaesthetized rats and the effects of baclofen on urinary bladder function were evaluated as their influence on bladder hyperactivity induced by 1-dihydroxyphenylalanine ( l-dopa) after peripheral decarboxylase inhibition. The bladder response was inhibited by intracerebroventricularly (i.c.v., 4th ventricle, 0.1 μg) as well as by systemically administered (10 mg/kg i.v.) baclofen. Intravenous naloxone but not i.v. bicuculline i.c.v. substance P or i.c.v. glutamate antagonized the inhibitory actions of i.c.v. or/and i.v. baclofen. It is suggested that baclofen depresses the hyperactive bladder by a central action that is unrelated to bicuculline sensitive gamma aminobutyric acid mechanisms, substance P or glutamate neurotransmission but that is possibly related to interference with opioid mechanisms. [ABSTRACT FROM AUTHOR]