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Nocturnal enuresis (NE) is a common health problem. Approximately 10% of 7-year-old children wet the bed regularly during sleep. Enuresis can be categorized into monosymptomatic (MEN) and nonmonosymptomatic (NMEN) forms. MEN occurs without any other symptoms of bladder dysfunction. NMEN is associated with dysfunction of the lower urinary tract with or without daytime incontinence. The rate of comorbid gastrointestinal, behavioral, and emotional disorders is elevated depending upon the subtype of NE. A careful clinical history is fundamental to the evaluation of enuresis. Diagnostic procedures include medical history and psychological screening with questionnaires, bladder and bowel diary, physical examination, urinalysis, ultrasound, and examination of residual urine. The mainstay of treatment is urotherapy with information and psychoeducation about normal lower urinary tract function, the underlying cause of MEN, disturbed bladder dysfunction in the child with NMEN and instructions about therapeutic strategies. Alarm therapy and the use of desmopressin have been shown to be effective in randomized trials. Children with NMEN first need treatment of the underlying daytime functional bladder problem before treatment of nocturnal enuresis. In patients with findings of overactive bladder, besides urotherapy, anticholinergic drugs may be useful. [ABSTRACT FROM AUTHOR]

Background: Finger nerve lesions lead to a sensory deficit with para-anesthesia or anesthesia and impair hand functions. In daily clinical practice, the diagnosis of an injured finger nerve can be challenging. This study aims at evaluating if the two-point discrimination (2PD) test is a good predictor of nerve lesions to indicate operative treatments in hand trauma patients. Methods: Based on the record of patients with an acute hand and finger injury, it was evaluated whether a pathological 2PD test in the clinical examination corresponds to the intraoperative findings of a severed nerve. From 2008 and 2014, patients with isolated finger nerve lesions were included, while patients with concomitant bone or tendon injuries were excluded. Results: As many as 113 patients with a total of 131 nerve injuries of the hand and fingers were suitable for this study. The statistical analysis revealed a sensitivity of 98% among them for the 2PD test. Further, a positive predictive value of 96% was demonstrated. Conclusions: The results of our study showed that the 2PD test is a valuable examination to diagnose nerve injuries of fingers in hand trauma patients. It is a simple, reliable, and available examination tool and therefore can be suggested in daily clinical practice. Level of Evidence: Level III, diagnostic study. [ABSTRACT FROM AUTHOR]

To test the hypothesis whether genetic over-expression of the Cu/Zn-superoxide dismutase (SOD-1) prevents the sepsis-related impairment of myocardial function and norepinephrine responsiveness in a resuscitated murine model of septic shock. Fifteen hours after cecal ligation and puncture or sham-operation wild type, heterozygous and homozygous SOD-1 over-expressing mice were anesthetized, ventilated and instrumented with central venous and left ventricular pressure-conductance catheters, to assess heart function at 18, 21, and 24 h after CLP or sham-operation. Hydroxyethylstarch and noradrenaline (in the CLP-mice only) were infused to maintain normotensive hemodynamics. Fluid resuscitation and noradrenaline requirements did not differ between the mouse strains. While total myocardial SOD activity was five- and ninefold higher in the heterozygous and homozygous over-expressing animals, respectively, tissue catalase activity was not different. Anesthesia and fluid resuscitation alone caused left ventricular dilatation and a progressive fall in left ventricular end-systolic pressure and maximal systolic contraction (d p/d tmax), while stroke volume and cardiac output increased. Due to the noradrenaline infusion heart rate, end-systolic pressure as well as d p/d tmax and d p/d tmax were significantly higher and relaxation time significantly lower in the CLP-mice, again without difference between the genetic strains. We conclude that neither hetero- nor homozygous SOD-1 over-expression caused a sustained improvement of the sepsis-related impairment of myocardial norepinephrine responsiveness, possibly due to the lacking increase of the tissue catalase and the mitochondrial SOD activity as well as the ongoing i.v. noradrenaline. [ABSTRACT FROM AUTHOR]

Invasive fungal infections (IFI) remain a leading cause of morbidity and mortality in immunocompromised patients. This retrospective single-center study analyzed incidence, treatment and outcome of invasive fungal infections in 1,095 patients with hematological malignancies receiving either cytoreductive chemotherapy or autologous or allogeneic hematopoietic stem cell transplantation at our institution between 1995 and 2004. IFI occurred in 167/1,095 (15%) patients with a significant increase over time (12.7% between 1995 and 2000 vs. 18.1% in the later IFI cohort, P = 0.0134). Fifty-four (32%) patients had proven, 70 (42%) patients had probable, and 43 (26%) patients suffered from possible IFI according to EORTC/MSG criteria. In 108/124 (87%) cases with proven or probable IFI, moulds were the causative pathogens. Both, Aspergillus fumigatus (n = 46) and Aspergillus terreus (n = 41) were predominant. Yeast infections (Candida spp.) were documented in 16/124 (10%) cases with proven or probable IFI. Median overall survival of the entire IFI cohort was 7 (3-17) months. Overall survival was significantly better in patients with probable or possible IFI (37 and 38%, respectively) compared with patients with proven IFI (28%, P = 0.019). In 35% of patients, IFI was the principal cause of death with a significant decrease over time (44% in time cohort 1995-2000 vs. 28% in the later IFI cohort, P = 0.018) accompanied by an increased use of novel antifungals. By multivariate analysis, only proven IFI was significantly predictive for death (HR 1.7, P = 0.018). A significant decrease in fungus-related deaths was observed despite a significant increase of IFI over time, probably due to improved diagnostic and therapeutic approaches. [ABSTRACT FROM AUTHOR]

This study investigated the ability and efficacy of an Er:YAG laser with a fluorescence feedback system for caries removal in deciduous teeth. Seventy-nine carious lesions were excavated using a fluorescence-controlled Er:YAG laser. Endpoint of treatment was defined by emission of fluorescence from the dentine surface below the pre-selected threshold level of 7 units and the subsequent termination of Er:YAG laser radiation. Dentine samples were obtained from the cavity floor, and viable counts of both Streptococcus mutans and Lactobacilli, expressed as colony forming units (log CFU), were evaluated. Preparation time was recorded to assess efficacy of the treatment procedure. S. mutans and/or Lactobacilli were found in 25 out of 79 lesions. Regarding the counts for S. mutans and Lactobacilli, the median log CFU was 0 (min, 0; max, 5.5) and 0 (min, 0; max, 6), respectively, with 2.4% of all samples yielding more than 100 CFU S. mutans and 4.8% yielding more than 100 CFU Lactobacilli. In 8 out of 79 cases, laser excavated cavities were not judged being caries-free using the conventional tactile criterion for assessing caries tissue. Focussing on these teeth, the median log CFU was 0 (min, 0; max, 0.5) for S. mutans and 0 (min, 0; max, 1.6) for Lactobacilli. The mean time for treatment was 2.3 ± 1.2 min. Of the children, 93.8% rated the laser treatment to be comfortable. The study indicates that the fluorescence feedback-controlled Er:YAG laser might be an appropriate device for caries removal in children using the suggested threshold level of 7 units. [ABSTRACT FROM AUTHOR]

Background: The treatment of Parkinson's disease (PD) is complex and highly individual. The choice between available treatment options depends on clinical characteristics such as the patient's age, disease severity and presence of comorbidities, lifestyle characteristics and preferences, costs of different medications and awareness and perception of available treatment options, and education of the treating physician. The impact of PD treatment regimens on patients' health-related quality of life (QOL) is also an important healthcare feature. The objective of the present study was to assess treatment options, treatment satisfaction and opinions about treatment improvements in patients with PD and neurologists treating the disease. Methods: Two surveys using face-to-face interviews and an additional phone survey were carried out in the US and five European countries (France, Germany. Italy, Spain and the UK). Patients with early and advanced stages of PD were included. To participate in the neurologist survey, neurologists were required to personally treat ten or more PD patients per month, including both early and advanced stage patients. Interviews consisted of a mix of closed and open-ended questions; some of these questions involved show cards. Results: Of the 500 patients who were surveyed, 49% had early and 51% had advanced PD. Early-stage PD patients, both in the US and Europe, take a mean of 3.2 tablets daily of PD-medication. In contrast, the mean daily tablet load of PD medication is much higher for advanced-stage patients (9.9 and 8.4 tablets in the US and Europe, respectively). Tablet load was perceived as a major problem; the majority of patients wished to see improvements regarding daily medication intake and expressed interest in other delivery systems such as patches. Overall, patients rated their treatment with a score of 6.6 points (6.7 for early-stage and 6.6 for advanced-stage patients) [scale of 1-10; l0 being highest]. Physicians (n = 592) were satisfied with a number of current PD medications and assumed they improve the QOL of the patients. They regarded efficacy and safety as the most important features for the improvement of PD medication. Conclusion: Further research is needed into PD treatment options not only for symptom alleviation but for better delivery systems that could improve compliance and QOL for patients with PD. Treatment guidelines need to incorporate QOL aspects and general communication between the health professional and the patient. [ABSTRACT FROM AUTHOR]

To examine prevalence of movement disorders (MDs) such as tardive dyskinesia (TD), parkinsonism or akathisia in an adolescent population with schizophrenia and in relationship to predominantly atypical antipsychotic treatment. Ninety-three patients (aged 19.6±2.2 years) were ascertained in this cross-sectional/retrospective study. 76 patients (81.7%) received atypical, 10 (10.8%) typical antipsychotics and 7 (7.5%) combinations of atypical/typical antipsychotics. MD symptoms were assessed using Tardive Dyskinesia Rating Scale (TDRS), Abnormal Involuntary Movement Scale (AIMS), Extrapyramidal Symptom Scale (EPS), Barnes Akathisia Scale (BAS). Movement disorder symptoms were found in 37 patients (39.8%) fulfilling strict/subthreshold criteria for TD (5.4/11.8%), parkinsonism (2.2/25.8%) or akathisia (1.1/11.8%), respectively. Patients treated with typical antipsychotics displayed a significantly higher EPS-score ( P=0.036) and a tendency towards a higher BAS-score ( P=0.061) compared to patients with atypical antipsychotics. Treatment durations with typical/atypical antipsychotics showed trends towards advantages of atypical antipsychotics with regard to parkinsonism/akathisia symptoms ( P=0.061; P=0.054), but not with regard to TD symptoms ( P=0.003), possibly due to confounding effects. Under treatment with atypical antipsychotics MD symptoms are less prevalent and less pronounced than under typical antipsychotics. We speculate that the finding of relatively high prevalence rates of subthreshold MD symptoms may be, at least partially, explained by previous or combined therapy with typical antipsychotics. [ABSTRACT FROM AUTHOR]

The forward bending test according to Adams and rib hump quantification by scoliometer are common clinical examination techniques in idiopathic scoliosis, although precise data about the change of axial surface rotation in forward bending posture are not available. In a pilot study the influence of leg length inequalities on the back shape of five normal subjects was clarified. Then 91 patients with idiopathic scoliosis with Cobb-angles between 20° and 82° were examined by rasterstereography, a 3D back surface analysis system. The axial back surface rotation in standing posture was compared with that in forward bending posture and additionally with a scoliometer measurement in forward bending posture. The changes of back shape in forward bending posture were correlated with the Cobb-angle, the level of the apex of the scoliotic primary curve and the age of the patient. Averaged over all patients, the back surface rotation amplitude increased from 23.1° in standing to 26.3° in forward bending posture. The standard deviation of this difference was high (6.1°). The correlation of back surface rotation amplitude in standing with that in forward bending posture was poor ( R 2=0.41) as was the correlation of back surface rotation in standing posture with the scoliometer in forward bending posture measured rotation ( R 2=0.35). No significant correlation could be found between the change of back shape in forward bending and the degree of deformity ( R 2=0.07), likewise no correlation with the height of the apex of the scoliosis ( R 2=0.005) and the age of the patient ( R 2=0.001). Before forward bending test leg length inequalities have to be compensated accurately. Compared to the standing posture, forward bending changes back surface rotation. However, this change varies greatly between patients, and is independent of the type and degree of scoliosis. Furthermore remarkable differences were found between scoliometer measurement of the rib hump and rasterstereographic measurement of the vertebral rotation. Therefore the forward bending test and the identification of idiopathic scoliosis rotation by scoliometer can be markedly different compared to rasterstereographic surface measurement in the standing posture. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) is used in the treatment of severe psychiatric disorders. It involves the induction of a seizure for therapeutic purposes by the administration of a variable-frequency electrical stimulus via electrodes applied to the scalp. The original application of ECT in non-anaesthetised patients resulted in many traumatic effects and was replaced, in the early 1960s, with a modified ECT regimen that used anaesthesia with neuromuscular blockade. This remains the worldwide standard today. The development of modern ECT devices, with improved impulse modes, has also reduced the incidence of post-interventional cognitive adverse effects. The variety of centrally-acting co-medications administered and the cardiovascular effects occurring during the procedure make patients receiving ECT a challenge for the anaesthetist. The efficacy of ECT depends on the production of adequate seizures; however, the anaesthetic agents commonly used during ECT suppress the generation of convulsions. Therefore, the efficacy of ECT requires knowledge of anaesthetic precepts, understanding of the interaction between anaesthetic drugs and seizure activity, and awareness of the physiological effects of ECT as well as the treatment of those effects. Successful and safe ECT depends on the correct choice of anaesthetic drugs for the individual patient, which have to be chosen with respect to the individual concomitant medication and pre-existing diseases. This review provides information for the optimal selection, set-up and practice of anaesthetic drug treatment in ECT. [ABSTRACT FROM AUTHOR]

Purpose. Gemcitabine (2′,2′-difluorodeoxycytidine) is a cytotoxic agent with a low toxicity profile and proven activity against a number of solid tumors. It is not known whether gemcitabine is safe to administer to patients with kidney failure, and if dose adjustment is necessary. We determined the tolerability and pharmacokinetics of gemcitabine and its noncytotoxic metabolite 2′,2′-difluorodeoxyuridine (dFdU) in a patient with end-stage renal disease on maintenance hemodialysis therapy. Patient and methods. A 64-year-old patient with pancreatic cancer and end-stage renal disease received two cycles of gemcitabine at a standard dose of 1000 mg/m2 given as a 30-min infusion on days 1 and 10. A regular 3.5-h hemodialysis treatment was performed 24 h after each infusion. Plasma and dialysate concentrations of gemcitabine and dFdU were determined by HPLC. The tolerability of gemcitabine treatment was assessed by clinical and laboratory parameters. Results. For gemcitabine, the maximal plasma concentration, terminal half-life (t1/2) and area under the concentration-time curve (AUC) were similar to those reported for patients with normal renal function. In contrast, end-stage renal disease resulted in a five- to tenfold prolongation of terminal half-life and a distinct increase in the AUC of plasma dFdU in this patient. Plasma dFdU was effectively eliminated by hemodialysis treatment. Both cycles of gemcitabine were tolerated well with no unexpected side effects observed. Conclusions. Gemcitabine treatment in end-stage renal disease with intermittent standard hemodialysis treatment is safe and well tolerated. The pharmacokinetic data suggest that dose adjustment of gemcitabine should be avoided to ensure its full cytotoxic activity, and that hemodialysis treatment should be initiated 6–12 h after its administration to minimize the potential side effects of the metabolite dFdU. [ABSTRACT FROM AUTHOR]

Unlabelled: Platinum complexes are essential tools for cancer treatment despite their toxic side effects. Here we describe a new platinum complex with sulphurs as complexing atoms (thioplatin).Purpose: To demonstrate that the antitumoral activity of a new sulphur-containing platinum compound (thioplatin) depends on a slightly acidic pH.Methods: Platinum uptake by tumour cells and interaction with DNA was determined at slightly acidic or alkaline pH. To demonstrate low in vivo toxicity the effects of thioplatin on body weight, blood urea nitrogen, white blood cell count and the histopathological appearance of small intestines and kidneys were evaluated at doses that displayed antitumoral effects against human small-cell lung cancer and human colorectal cancer xenotransplants in nude mice.Results: The slightly acidic pH optimum of thioplatin was proven by the altered electrophoretic mobility of plasmid DNA, quantitation of the platinum content in the DNA of tumour cells and cytotoxicity studies. Thioplatin displayed antitumoral activity without severe side effects such as weight loss, renal ischaemia, destruction of villi in the small intestine or leukopenia as observed at comparable doses of cisplatin. Furthermore, probably due to its lipophilic nature, thioplatin was taken up readily even by cisplatin-resistant cells. In vivo studies with human tumour xenografts in nude mice showed a therapeutic index of thioplatin five to ten times higher than that of cisplatin. [ABSTRACT FROM AUTHOR]

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Purpose: A new hemostatic puncture closure device (HPCD) was evaluated following femoropopliteal angioplasty. Efficacy in hemostasis and complications were compared between manual compression and the new system.Methods: One hundred patients undergoing percutaneous interventional procedures were randomly assigned to receive either manual compression or HPCD. The time to complete hemostasis (when a compression bandage was applied) was noted as well as complications such as hematoma or arterial stenosis at the puncture site. Follow-up was by clinical examination and color-coded duplex sonography (CCDS).Results: With the HPCD, immediate hemostasis was achieved in 22 patients (44%). Discrete oozing without the necessity of external compression or further consequences was observed in 11 patients. Mean manual compression time was 25 (+/- 20) min including application of the pressure bandage. Eleven patients needed additional manual compression and technical failures were observed in 6 patients (12%). The compression time in these 17 cases was 27 (+/- 12) min. Subcutaneous hematomata with a diameter of more than 5 cm developed in 15 of 48 patients in the HPCD group and in 14 of 48 patients in the manual compression group. No surgical or percutaneous intervention was necessary. The complication rate was comparably low in the experimental and control groups.Conclusion: Compared with manual compression HPCD is faster and more accurate for sealing the arterial puncture defect following angioplasty. After an initial learning curve, it is easy to handle and time-saving as well as convenient for the patient. Furthermore, immediate and full anticoagulation is possible and arterial inflow is not compromised. A drawback is the necessity of an 8 Fr sheath. Nevertheless, the complication rate is comparably low for both methods. [ABSTRACT FROM AUTHOR]

Five-year follow-up studies in patients with superficial femoral arterial occlusions and iliac artery stenoses have demonstrated a high success rate with percutaneous transluminal angioplasty performed by the Dotter technique. The special balloon catheters developed by Grüntzig, a standardized accessory pharmaceutical regimen, and more exact indications have further increased the rate of long-term success; the patency rates now approach 70% after three years. Clinical follow-up studies by Doppler ultrasound are useful for assessing the hemodynamic effects of the procedure. [ABSTRACT FROM AUTHOR]

To date, dacarbazine (DTIC) has been the most effective drug in the treatment of advanced metastatic melanoma, achieving response rates of up to 28% (mean, 21%). Multidrug responses were generally no better than those obtained using monotherapy. A quite promising clinical trial was conducted using the new nitrosourea fotemustine. A total of 19 patients presenting with advanced malignant melanoma (clinical stage IV according to the 1987 UICC classification system) underwent treatment involving a more rapid infusion of the drug and a reduction in the rest period from 5 to 3 weeks. This monotherapy with fotemustine yielded two complete responses and seven partial responses; in addition, four patients showed no change and six cases progressed after the induction cycle (median duration of response to date, 7.6 months, including four cases that have not relapsed). Fotemustine was well tolerated by the patients, with the only mild side effects being thrombocytopenia, leukocytopenia and easily controlled nausea/vomiting. Preclinical studies performed previously indicated that fotemustine inhibits enzymes involved in the ribonucleotide reduction pathway (i.e. DNA synthesis), whereby responding patients (n = 3) appeared to favor the thioredoxin reductase/thioredoxin electron transfer to ribonucleotide reductase, whereas non-responders (n = 4) expressed the alternate glutathione reductase/glutaredoxin mechanism. The 47% response rate obtained in these studies vs the 24% reported previously for fotemustine may reflect variations in enzymes in the ribonucleotide reduction pathway in different patients. However, the efficacy of fotemustine against advanced melanoma warrants more extensive trials of this drug, especially since the quality of life of the patients during and after chemotherapy was not severely affected. [ABSTRACT FROM AUTHOR]

Blood pressure lowering has clear beneficial effects in terms of reducing the risk of stroke, cardiovascular events and cardiovascular mortality in the general population, but it is unclear whether treating hypertension in individuals aged >80 years is beneficial. This Practice Point commentary discusses a recent randomized, prospective study by Beckett et al., which found that antihypertensive therapy with indapamide--with or without perindopril--was associated with significant decreases in the rate of death from stroke, rate of heart failure and risk of all-cause mortality in individuals aged 80 years or older. These results indicate that treating hypertension in individuals in this age-group is no longer contraindicated because of a lack of evidence. [ABSTRACT FROM AUTHOR]

Imatinib mesylate (STI571) is a very effective treatment option for Ph+ chronic myeloid leukemia (CML) in chronic phase. Secondary treatment failures have mostly been observed in patients with advanced stages of disease. We report the case of a patient who unexpectedly experienced blast crisis of the central nervous system although having achieved complete cytogenetic remission in the bone marrow. The levels of STI571 and its metabolite N-desmethyl STI were 40-fold lower in the cerebral spine fluid than in plasma. The risk of CNS disease has to be kept in mind when patients with CML in chronic phase who are at an increased risk for blastic transformation are treated with imatinib mesylate. [ABSTRACT FROM AUTHOR]