Search

Follicle-stimulating hormone (FSH), a glycoprotein secreted by the anterior pituitary, can regulate ovarian function through the FSH receptor (FSHR). To evaluate the effects of the FSHR gene on reproductive traits in pigs, polymorphisms in exon 10 of the FSHR gene were observed by polymerase chain reaction-single-strand conformation polymorphism, and 3 single nucleotide polymorphisms (C1491T, G1885A, and C1977T) in exon 10 of the porcine FSHR gene, and 3 genotypes (AA, AB, and BB) for C1491T and 2 haplotypes (D and E) for G1885A and C1977T were identified. Further analysis of single nucleotide polymorphism genotypes associated with reproductive traits including total number born (TNB) and number born alive (NBA) was carried out in 3 pig populations including Berkshire, Wannan Black (a Chinese indigenous pig breed), and BW pigs (two-way crossbred pigs produced from Berkshire ♂ and Wannan Black pig ♀). The results showed that the TNB and NBA of Wannan Black pigs with the AB genotype were significantly higher than in AA genotype sows (P < 0.01) in multiparity sows and all parities. The TNB and NBA of Berkshire pigs with the DE genotype were significantly higher than the DD and EE genotype sows (P < 0.01) in gilts, sows and all parities. Overall, TNB and NBA from the 3 identified genotypes was DE > DD > EE. The results showed that polymorphisms in exon 10 of the FSHR gene had a significant effect on litter size traits of Wannan Black and Berkshire pigs. These results can be applied for marker-assisted selection in the 2 swine breeds.

The aim of this study was to define the genotypes of UGT1A1 and ERCC1 and to examine their relationship with the efficacy and toxicity of a combination therapy of irinotecan and cisplatin in patients with advanced ovarian cancer. The allelic frequencies of the UGT1A1 and ERCC1 variants in a group of 89 patients with advanced ovarian cancer were determined. The relationship between the adverse events of irinotecan-based chemotherapy and the efficacy of cisplatin in patients with advanced ovarian cancer were analyzed. For patients who carried the UGT1A1*28 wild-type (WW) or the UGT1A1*28 heterozygous and homozygous mutant (WM+MM) genotypes, the incidences of grade 2 or 3 tardive diarrhea were 52.2 and 72.7% respectively, and the difference was statistically significant (P = 0.031, OR = 2.1, 95%CI = 1.6-9.2). For grade 3 or 4 tardive diarrhea, the incidence rates were 7.5 and 36.4% respectively; this difference was also statistically significant (P = 0.000, OR = 4.9, 95%CI = 3.3-15.8). The response rates of ERCC1 WW and ERCC1 WM+MM carriers were 30.3 and 20.2% respectively; this difference was significant (P = 0.032, OR = 3.2, 95%CI = 1.4-9.1). Together, the results from this study suggest that UGT1A1 is a target gene for tardive diarrhea, and that the UGT1A1*28 gene mutation might increase the risk of diarrhea with irinotecan-based chemotherapy. Furthermore, the results suggest that ERCC1 WW carriers might obtain a better rate of clinical response from a combined irinotecan and cisplatin regimen than ERCC1 WM+MM carriers.

The aim of this study was to determine the imprinting status of the Ras protein-specific guanine nucleotide-releasing factor 1 (Rasgrf1) gene in domestic pigs. In this study, a 228-bp partial sequence located in exon 14 and a 193-bp partial sequence located in exon 1 of the Rasgrf1 gene in domestic pigs were obtained. A novel single nucleotide polymorphism, a G/A transition, was identified in Rasgrf1 exon 14, and then the reciprocal Berkshire x Wannan black F1 hybrid model and the reverse transcription-polymerase chain reaction-restriction fragment length polymorphism method were used to detect the imprinting status of the porcine Rasgrf1 gene at the 1-day-old developmental stage. Imprinting analysis showed that, compared to the imprinted expression of the Rasgrf1 gene in mouse and rat, a variable imprinting status was observed in domestic pigs. In principle, the porcine Rasgrf1 gene was maternally expressed in the liver and small intestine, paternally expressed in the lung, and biallelically expressed in brain, heart, spleen, kidney, stomach, pancreas, fat, testis, ovary, longissimus dorsi, and pituitary tissues. In conclusion, our results indicated that the Rasgrf1 gene shows both species- and tissue-specific variation in imprinted expression.

Estrogen regulates reproductive behavior and drives the proliferation and differentiation of several cell types. These physiological functions of estrogen are mediated by estrogen receptors (ERs), and each ER isoform plays a distinct role. To clarify the molecular mechanism of estrogen action and to evaluate the effect of ERs on the secretion of ovalbumin (OVA) in pigeon oviduct epithelial cells (POECs), we determined the complete coding sequences encoding ER alpha (ERα) and ER beta (ERβ) in pigeons. The abundance of pigeon ERα and ERβ mRNA was detected using quantitative polymerase chain reaction. These results revealed that pigeon ERα is highly expressed in the oviduct, while pigeon ERb is highly expressed in the ovary and kidney. We hypothesize that ERα mRNA predominates over that of ERβ in the oviduct. The expression of ERα can be down-regulated by 17β-estradiol, and the knockdown of ERα promoted OVA mRNA expression in cultured POECs, indicating that ERα may play an important role in OVA secretion.

A measurement of the energy dependence of antineutrino disappearance at the Daya Bay reactor neutrino experiment is reported. Electron antineutrinos (ν¯(e)) from six 2.9  GW(th) reactors were detected with six detectors deployed in two near (effective baselines 512 and 561 m) and one far (1579 m) underground experimental halls. Using 217 days of data, 41 589 (203 809 and 92 912) antineutrino candidates were detected in the far hall (near halls). An improved measurement of the oscillation amplitude sin(2)2θ(13)=0.090(-0.009)(+0.008) and the first direct measurement of the ν¯(e) mass-squared difference |Δm(ee)2|=(2.59(-0.20)(+0.19))×10(-3)  eV2 is obtained using the observed ν¯(e) rates and energy spectra in a three-neutrino framework. This value of |Δm(ee)2| is consistent with |Δm(μμ)2| measured by muon neutrino disappearance, supporting the three-flavor oscillation model.

Background: It is unclear if the complex relationship between physical frailty and cognition varies across the severity of cognitive impairment., Objectives: We therefore aimed to explore if there are stage-specific differences in the relationship between frailty and cognitive impairment., Design: Cross-sectional study., Setting: A specialist Memory Clinic setting., Participants: Mild cognitive impairment (MCI) and mild-moderate Alzheimer's disease (AD) community-dwelling subjects., Measurements: We obtained data on demographics, multimorbidity, cognition-related measures, nutrition, neuroimaging measures, muscle mass, Vitamin D level, apolipoprotein - e (APOE) status and physical performance measures. Frailty measures of gait speed, hand grip strength, question on exhausation and weight loss, classified subjects according to the Buchmann criteria into non-frail and frail categories., Results: Forty-five MCI, 64 mild AD and 13 moderate AD subjects (total n=122) were studied. The prevalence of frailty for MCI, mild AD and moderate AD was 35.6%, 21.9% and 46.2% respectively, indicating a u-shaped trend. Significant differences were noted in fatigue, grip strength and gait speed frailty sub-items. Significant correlation of frailty with cognition were noted in mild-moderate AD (Spearman's coefficient 0.26, p<0.05) but not in MCI (0.01, p=0.6). No other differences in multimorbidity, Vitamin D, APOE, nutritional measures, white matter lesions were observed. Sarcopenia interestingly had an inverse stage-specific relationship unlike frailty., Conclusions: Our results suggest a U-shaped relationship between frailty and cognition, characterized by initial dissociation with cognitive impairment and subsequent convergence at later stages. Future studies incorporating immune markers and endocrine pathways with longitudinal follow-up could potentially elucidate intermediary mechanisms in the frailty cascade.

Human herpesvirus 8 (HHV8) is an important opportunistic infection of HIV/AIDS. However, very little is known about antibody seropositivities to HHV8 lytic and latent antigens among HIV-infected patients in China. Therefore, a cross-sectional study was conducted to explore HHV8 serostatus among 316 HIV-infected patients in a rural area of central China. The antibody seropositivity to HHV8 ORF65 (lytic) and LANA (latent) antigens was 12.7% and 10.4%, respectively. Patients who were naïve to antiretroviral therapy (ART) were more likely to be seropositive for antibodies to ORF65 (OR: 3.79; 95% CI: 1.71-8.42) and LANA (OR: 3.77; 95% CI: 1.55-9.14) than patients receiving ART. Patients having CD4+ cell counts less than 200 cells/mm3 were more likely to be seropositive for LANA antibody (OR: 3.53; 95% CI: 1.44-8.64) and to have lower LANA antibody titer (p = 0.007). They were also more likely to be seropositive for ORF65 antibody (OR: 2.12; 95% CI: 0.94-4.78) and to have a lower ORF65 antibody titer (p = 0.065), though the difference was marginally significant. No associations between other viral coinfections studied and antibody seropositivity to either latent or lytic HHV8 antigens were identified. Study findings suggest that antibody responses to both lytic and latent HHV8 antigens among HIV patients in China were fairly high and were associated with immunodeficiency status and ART.

A cross-sectional survey was conducted to determine seroprevalence and correlates of coinfections of hepatitis B virus (HBV), hepatitis C virus (HCV), Epstein-Bar virus (EBV), herpes simplex virus including type 1 (HSV-1) and type 2 (HSV-2) among human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in China. A total of 1,110 HIV/AIDS patients from Shanxi (Central area, n = 287), Zhejiang (Eastern area, n = 163), Yunnan (Southwestern area, n = 300) and Xinjiang (Northwestern area, n = 360) provinces were analyzed. The overall seroprevalence was 6.3% for HBsAg, 59.0% for anti-HCV IgG, 96.6% for anti-EBV IgG, 91.5% for anti-HSV-1 IgG, and 34.1% for anti-HSV-2 IgG. Eleven (1.0%) HIV/AIDS patients were coinfected with all five viruses, 177 (15.9%) with four viruses, 611 (55.0%) with three viruses, 288 (25.9%) with two viruses, 23 (2.1%) with single virus, and 1 (0.1%) with none of the five viruses. Multiple logistic regression analyses indicated that neither HBV, nor EBV and HSV-1 coinfection was associated with sociodemographic characteristics and HIV transmission mode, but HCV coinfection was associated with geographic region, age, gender, ethnicity, marital status, and HIV transmission mode, whereas HSV-2 coinfection was associated with geographic region, ethnicity and HIV transmission mode. This study suggests that HIV/AIDS patients with different regional and sociodemographic backgrounds and HIV transmission mode in China have different profiles of viral coinfections and should be subject to differential considerations in related health care programs.

The Health Promotion Board (HPB) and the Ministry of Health (MOH) publish clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the HPB-MOH clinical practice guidelines on Functional Screening for Older Adults in the Community, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website (http://www.hpb.gov.sg/uploadedFiles/HPB&#95;Online/Publications/CPGFunctionalscreening.pdf). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Introduction: Older persons are likely to develop functional impairment following hospitalisation. Several studies in the West have examined the factors associated with functional decline following the older person's discharge from hospital but there are little data on Asian populations. This study aims to look at the associated risk factors in our local population, following admission to an acute geriatric unit., Materials and Methods: This is a retrospective, cohort study. Patients who were discharged from an inpatient geriatric unit over a 3-month period were recruited. Data including their demographic information, functional status prior to admission and at the time of discharge, and medical conditions were obtained from the inpatient medical notes. A follow-up telephone interview was conducted at 3 months to determine the functional status of these patients at that point in time., Results: Following hospitalisation, 40.4% of patients developed functional decline. Of those discharged, 29.6% showed functional decline at 3 months. The principal diagnosis, hypoalbuminaemia, tendency to fall, premorbid functional independence and the length of hospitalisation were associated with functional decline during hospitalisation, while hypoalbuminaemia, the presence of bedsores, institutionalisation, the length of hospitalisation and premorbid functional dependence were important factors associated with functional decline between the time of discharge and 3 months after. In the multivariable predictive model, independent predictors of functional decline at the time of discharge included patient's tendency to fall, premorbid functional independence and the length of hospitalisation, while the presence of bedsores was the only significant predictor of functional decline 3 months post-discharge., Conclusions: Many elderly patients developed new functional impairment following hospitalisation. Several factors were found to be associated with this functional decline, though no single predictive model similar to the other published studies was identified.

Introduction: This study first aimed to determine the adequacy of the Diagnosis Related Grouping (DRG) model's ability to explain (1) the variance in the actual length of stay (LOS) of elderly medical inpatients and (2) the LOS difference in the same cohort between the departments of Geriatric Medicine (GRM) and General Medicine (GM). We then looked at how these explanatory abilities of the DRG changed when patients' function-linked variables (ignored by DRG) were incorporated into the model., Materials and Methods: Basic demographic data of a consecutively hospitalised cohort of elderly medical inpatients from GRM and GM, as well as their actual LOS, discharge DRG codes [with their corresponding trimmed average length of stay (ALOS)] and selected function-linked variables (including premorbid functional status, change in functional profile during hospitalisation and number of therapists seen) were recorded. Beginning with ALOS, function-linked variables that were significantly associated with LOS were then added into two multiple liner regression models so as to quantify how the functional dimension improved the DRGs' abilities to explain LOS variances and interdepartmental LOS differences. Forward selection procedure was employed to determine the final models. For the interdepartmental analysis, the study sample was restricted to patients who shared common DRG codes., Results: 114 GRM and 118 GM patients were studied. Trimmed ALOS alone explained 8% of the actual LOS variance. With the addition of function-linked variables, the adjusted R2 of the final model increased to 28%. Due to common code restrictions, the data of 79 GRM and 78 GM patients were available for the analysis of interdepartmental LOS differences. At the unadjusted stage, the median stay of GRM patients was 4.3 days longer than GM's and with adjustments made for the DRGs, this difference was reduced to 3.9 days. Additionally adjusting for the patients' functional features diminished the interdepartmental LOS discrepancy even further, to 2.1 days., Conclusion: This study demonstrates that for elderly medical inpatients, the incorporation of patients' functional status significantly improves the DRG model's ability to predict the patients' actual LOS as well as to explain interdepartmental LOS differences between GRM and GM.

Introduction: We study the impact of a pharmacist consult clinic on the care of elderly outpatients based on the Health Belief Model that the perceived benefits (improvement in medication knowledge, clinical status and perception) and attached barriers (cost and number of medication and adverse drug reactions) can influence health behaviour (medication compliance)., Materials and Methods: A randomised controlled study of 136 eligible patients with risk factors for non-compliance, using Zelen's design, was conducted in a hospital-based geriatric outpatient clinic from November 2001 to June 2002. All patients were assessed for outcome variables at baseline and 2 months later., Results: One hundred and twenty-six patients were included in the intention-to-treat analysis. There were 104 pharmacist interventions with a physician acceptance rate of 76%. There was a significant improvement in medication knowledge with regards to indication (P = 0.03) and the composite dose, frequency and indication score (P = 0.06), as well as a decrease in residual adverse drug reactions that persisted at month 2 and cost avoidance of dollars 387.28 over 2 months. There was no significant difference in perception, clinical status or decrease in number of medications. The intervention group showed an improvement in adjusted compliance (odds ration [OR] = 2.52; 90% confidence interval [CI], 1.09 to 5.83) based on the ordered logistic regression model. Perception of severity of illness at baseline (OR = 1.30; 90% CI, 1.04 to 1.62), number of medication remembering methods (OR = 1.87; 90% CI, 1.08 to 3.25) and the use of routine habits (OR = 4.48; 90% CI, 1.51 to 13.28) and medication aids (OR = 3.68; 90% CI, 1.04 to 13.06) significantly affected compliance., Conclusion: The addition of a pharmacist consult clinic to the management of selected geriatric outpatients can improve compliance, with the attendant benefits of improving medication knowledge, cost avoidance and reducing residual adverse drug reactions.

Introduction: Information about urinary retention in women is scarce. We conducted a case-control study to identify the symptoms and risk factors associated with urinary retention in hospitalised older women., Materials and Methods: Targeted history (especially lower urinary tract symptoms) and physical examination of 60 women (65 years or older) who had post-void residual urine volume (PRUV) (determined using a portable ultrasound Bladder Scan BVI-2500) of more than 100 mL were studied and compared with 60 controls., Results: Symptoms of voiding difficulties had low positive predictive value (PPV) and negative predictive value (NPV), except for poor stream, which has a PPV of 100%. Only one-third of the patients with high PRUV had a palpable bladder. Associated with high PRUV were: 1) constipation [odds ratio (OR), 4.12; 95% confidence interval (CI), 1.90-8.91; P = 0.0004]; 2) urinary tract infection (UTI) (OR, 3.36; 95% CI, 1.58-7.12; P = 0.002); 3) impaired mobility (OR, 2.37; 95% CI, 1.12-4.97; P = 0.02); 4) past history of UTI (OR, 3.5; 95% CI, 1.34-9.14; P = 0.014); 5) past history of urinary retention (OR, 6.33; 95% CI, 1.72-23.33; P = 0.004); 6) stroke (OR, 2.5; 95% CI, 1.24-5.41; P = 0.017); 7) diabetes mellitus with microvascular complications (OR, 2.76; 95% CI, 1.08-7.04; P = 0.042). Applying logistic regression analysis, the three best predictive variables for high PRUV were constipation, UTI and past history of urinary retention., Conclusion: Symptoms (except for positive history of poor stream) and signs were unreliable in diagnosing urinary retention in hospitalised older women. Patients with the above risk factors should have their PRUV ascertained, which can be done reliably non-invasively. Early detection with appropriate intervention can potentially prevent the morbidity and mortality associated with urinary retention.

Objectives: To study the profile of older persons with impaired mobility., Methods: A retrospective observational study that reviewed the case records of patients with impaired mobility at a geriatric assessment clinic. Data on mobility status, duration of decline in mobility, functional status, causes, intervention and short-term outcome (up to 16 weeks) were extracted and analysed., Results: The study included 78 patients (42 males) with the median age of 78 years (61 to 96). About 80% had independent premorbid mobility. At presentation, this declined to 45%. Delayed consultations (more than 2 years) were found in 17% of patients. One third had associated decline in transfer, dressing, toileting or bathing, while 19% also had decline in feeding. In each patient, cause(s), many which were potentially reversible, were identified to have contributed to the immobility. More than one cause was identified in half of the patients. Interventions were prescribed in 88% of these patients. Short-term follow-up (median 7 weeks) showed that 21 had an improvement, 35 had the same and 8 had decline in mobility. There was a significant trend towards better outcome when patient presented early during their course of decline in mobility (p=0.005, linear by linear association = 0.013)., Conclusion: Impaired mobility is a common pathway for many diseases, and is associated with significant functional decline. With proper evaluation, the offending causes can be identified. Early consultation is important for the application of appropriate intervention and can result in better outcome.

Background: This study was done to look at prevalence and factors affecting functional dependence. The data in this paper were part of the 'Community Study on State of Health, Function, Cognitive and Social State of Elderly People in Singapore' conducted in Singapore between September 1992 and December 1993., Patients: Four hundred and one elderly, aged 60 years and above were studied. Sixty-eight subjects (17%) were dependent in at least one function of Activities of Daily Living (ADL) as measured by the Barthel's Index (BI)., Results: The most common problem identified using this index was urinary incontinence. Forty subjects (10.4%) were dependent in at least one Instrumental Activities of Daily Living (IADL) function. The most common mode of transportation was by public transport, of which travelling by bus was the most common (59.9%) and mass rapid transit (MRT) was the least common (4%). Female gender and age > or = 75 were significant factors associated with dependence measured on Barthel's index but not on IADL., Conclusion: Results of this study were also compared with two previous surveys done in Singapore. Discrepancies in results noted could be attributed to different definitions in which the functions were assessed. We should aim to standardise the definition and measures of function in the local context in order to measure changes in the elderly population.

The uroflow and pressure-flow data of 67 men aged 65 years or more were compared. At best, the uroflow study applying the Liverpool nomogram (25th percentile) and Bristol nomogram (OSD) diagnosed bladder outlet obstruction with sensitivity of 62.5% and 62.5% and specificity of 48.8% and 74.4% respectively. Using the 50th percentile of the Liverpool nomogram as the cut-off resulted in a negative predictive value of 100.0% allowing about 10% of men to have this diagnosis ruled out. We conclude that the uroflow study is inaccurate in diagnosing bladder outlet obstruction in elderly men. However, it can be used to rule out this condition in the small subset of men with maximum flow rates above the 50th percentile of the Liverpool nomogram.

Majority (90.5%) of the elderly living in the community in Singapore had a positive (satisfactory to good) perception of their health. This study found that age (70 years or older), recent hospitalisation, regular medical follow-up, hearing impairment, presence of chronic medical conditions (like musculo-skeletal problems, hypertension, ischaemic heart disease and chronic obstructive lung disease), impairment in activities of daily living, history of falls, those on regular medications and those with financial difficulties all adversely influenced perception of health. Those able to participate in regular outdoor leisure activities have a positive influence. Factors that did not significantly influence perception of health were gender, health-promoting activities, work, poor eyesight, cognitive impairment, urinary incontinence, diabetes, history of stroke and the ability to use public transport.

Aim: Falling is a serious medical problem for elderly persons. This study was done to look at prevalence and risk factors for falls in community dwelling elderly in Singapore., Method: A random sample of 3,000 persons aged 60 years and above was chosen from a database based on the 1990 population census. Letters were sent out to 2,582 subjects who had local and complete addresses. In the letter, they were informed about the purpose of the survey, and invited to participate in a questionnaire and clinical health screening at an appointed date at a polyclinic. Participants were reminded the day before their appointment by telephone, and a new appointment could be given at the subject's convenience., Results: We found a prevalence rate of falls of 17.2%. Two-thirds of these had single falls, while one-third had recurrent falls, defined as having more than one fall within the previous one year. The following factors were found to be significantly associated with increase falling in the elderly: age > or = 75 years (O.R. = 1.82, 95% C.I. 0.95-3.50), female sex (O.R. = 2.5, 95% C.I. 1.40-4.48), Malay race (O.R. = 2.66, 95% C.I. 1.21-5.86), poor vision (O.R. = 1.7, 95% C.I. 0.99-2.90), Barthel's score of less than 20 (O.R. = 1.76, 95% C.I. 0.94-3.28), those taking 2 or more drugs daily (O.R. = 2.1, 95% C.I. 1.22-3.72) and the presence of hypertension (O.R. = 1.78, 95% C.I. 1.06-3.01). Fall rate is also twice as high in women as in men. At the same time, we found that women in the group we studied also tend to exercise less than the men. Fallers also had significantly more mobility and activities of daily living (ADL) disabilities (reflected by a lower Barthel's score) and this is consistent with other results. The only factor that reduced the risk of falling was regular exercise (O.R. = 1.64, 95% C.I. 0.93-2.93)., Conclusion: In our study, we found differences between the group with single and recurrent falls. In the group with single falls, the fall tend to occur outdoors (O.R. = 2.97, 95% C.I. 1.03-8.60) and during the day (O.R. = 3.47, 95% C.I. 1.20-10.0), tend to be accidental (O.R. = 3.16, 95% C.I. 1.05-9.50) and tend to seek medical attention (O.R. = 3.68, 95% C.I. 1.23-11.0). Overall, 32 persons (46.4%) seek medical treatment after their falls, and of these, 65.6% were women. Risk factors for falls should be screened for all elderly.

Aim: We sought to study the usefulness of lower urinary tract symptoms and postvoid residual urine volume in the diagnosis of voiding dysfunction in elderly men., Methods: The symptoms and postvoid residual urine volume of 126 men aged 65 years or older referred for urodynamic studies were obtained. Their accuracy in the diagnosis of detrusor instability, bladder outlet obstruction and impaired detrusor contractility was quantified., Results: For the diagnosis of detrusor instability, urgency and urge incontinence with frequency and/or nocturia had a sensitivity of 73.0% and a specificity of 60.0%. For the diagnosis of bladder outlet obstruction, poor stream with frequency and/or nocturia had a sensitivity of 51.9% and a specificity of 71.6%. Using poor stream and residual urine volume of more than 50 ml occurring together, the sensitivity was 31.1% and specificity was 89.7%. For the diagnosis of impaired detrusor contractility, poor stream had a sensitivity of 44.8% and a specificity of 56.7%. With residual urine volume of more than 50 ml, a sensitivity of 96.6% and specificity of 80.4% was obtained., Conclusion: Based on our findings, we conclude that the bladder does appear to be an "unreliable witness" in elderly men for the diagnosis of bladder outlet obstruction, though this is less so with impaired detrusor contractility. No conclusion can be drawn for the detrusor instability as we did not use ambulatory urodynamic studies.

Background: Post-voiding residual urine volume is an important investigation in the management of voiding dysfunction. Catheterisation is widely regarded as the "gold" standard method of measurement. We investigated the performance of a portable ultrasound scanner (Bladder Scan BVI-2500), as an alternative method of measurement., Methods: This study was prospective in nature. One hundred measurements of post-voiding residual urine volume by ultrasound were compared with measurements by catheterisation., Results: The mean absolute error of the scanner was 52 mL. For volumes below 200 mL and 100 mL, this was 36 mL and 24 mL respectively. A decision regarding whether to decompress the bladder by catheterisation would have also been correct in 86% to 89% of instances, depending on the cut-off value of the residual volume used. In other words, the ultrasound measurement would have been correct in 9 out of 10 clinical cases., Conclusion: We recommend the routine use of portable ultrasound scanners of similar accuracy in the measurement of post-voiding residual urine volume.

Carer-assisted clean intermittent urethral catheterisation is an effective and safe treatment option for persistent urinary retention in a study of 56 elderly female patients (aged 65 years and above) with cognitive impairment and other disabilities. With this method of treatment, 54% of the patients were able to void spontaneously and were continent after a median period of 6 weeks with a range of 1 to 40 weeks. Twenty-seven per cent had significant improvement in the symptoms of urinary incontinence and the residual urine volumes became progressively smaller. However, 19% failed the programme. The recovery of spontaneous voiding was found to be significantly influenced by the age of the patient, the carer performing the intermittent catheterisation and the development of catheter-related urinary tract infection. Twenty-five per cent of the study patients developed symptomatic urinary tract infection which was associated with a delay in the recovery of spontaneous voiding. Its development was also found to be significantly associated with the presence of pre-existing diabetes mellitus, the person doing the catheterisation, the presence of dementia and with more predisposing common medical conditions.

The aim of this study was to examine the efficacy of oxybutynin plus bladder training in the treatment of detrusor instability in frail elderly patients living independently in the community. It was a randomized, double-blind, placebo-controlled parallel-group trial of oxybutynin in 57 elderly patients (mean age 82.2, SD 6.06), with frequency and incontinence due to detrusor instability. After a 2-week run-in period patients received a bladder training and drug or placebo for the next 6 weeks. Outcome measures were changes in frequency and incontinence, recorded throughout on diary charts, and subjective evaluation of symptoms ('better'/'not better', and using a four-point scale 'cure' to 'no change'). Oxybutynin was superior to placebo in reducing daytime frequency [95% confidence interval (CI) of difference in change in frequencies totalled over 14 days was -27.0, -6.0; p = 0.003] and in producing subjective benefit (at day 29 only), when 24/28 (86%) patients on oxybutynin described benefit compared with 16/29 (55%) on placebo (p = 0.02). There was no difference between the groups in reduction of incontinent episodes. The median dose of oxybutynin titrated for therapeutic effect was 5 mg/day, and for placebo 10 mg/day (CI of difference 0.001, 5.001; p = 0.05). Side-effects reported were of similar frequency (50%) in the two groups. We conclude that oxybutynin with bladder training is superior to bladder training alone in reducing frequency due to detrusor instability in very elderly people living at home.

A five-month prospective study of urinary incontinence in the elderly was carried out in an acute assessment and rehabilitation geriatric ward to determine the incidence, underlying causes and outcome with management. The incidence in patients 65 years or older was 22%. Of these, 21% had transient incontinence which resolved after the precipitating medical cause was treated. Incontinence was resolved in 36% and improvement obtained in another 20%. Management of urinary incontinence in this population can result in a satisfactory outcome in more than half of patients and is worth pursuing.