Brain function assessment in different conscious states

Background: The study of brain functioning is a major challenge in neuroscience fields as human brain has a dynamic and ever changing information processing. Case is worsened with conditions where brain undergoes major changes in so-called different conscious states. Even though the exact definition of consciousness is a hard one, there are certain conditions where the descriptions have reached a consensus. The sleep and the anesthesia are different conditions which are separable from each other and also from wakefulness. The aim of our group has been to tackle the issue of brain functioning with setting up similar research conditions for these three conscious states.Methods: In order to achieve this goal we have designed an auditory stimulation battery with changing conditions to be recorded during a 40 channel EEG polygraph (Nuamps) session. The stimuli (modified mismatch, auditory evoked etc.) have been administered both in the operation room and the sleep lab via Embedded Interactive Stimulus Unit which was developed in our lab. The overall study has provided some results for three domains of consciousness. In order to be able to monitor the changes we have incorporated Bispectral Index Monitoring to both sleep and anesthesia conditions.Results: The first stage results have provided a basic understanding in these altered states such that auditory stimuli have been successfully processed in both light and deep sleep stages. The anesthesia provides a sudden change in brain responsiveness; therefore a dosage dependent anesthetic administration has proved to be useful. The auditory processing was exemplified targeting N1 wave, with a thorough analysis from spectrogram to sLORETA. The frequency components were observed to be shifting throughout the stages. The propofol administration and the deeper sleep stages both resulted in the decreasing of N1 component. The sLORETA revealed similar activity at BA7 in sleep (BIS 70) and target propofol concentration of 1.2 μg/mL.Conclusions: The current study utilized similar stimulation and recording system and incorporated BIS dependent values to validate a common approach to sleep and anesthesia. Accordingly the brain has a complex behavior pattern, dynamically changing its responsiveness in accordance with stimulations and states. © 2010 Ozgoren et al; licensee BioMed Central Ltd

Is intravesical instillation of hyaluronic acid and chondroitin sulfate useful in preventing recurrent bacterial cystitis? A multicenter case control analysis

Objective: Urinary tract infections (UTIs) are common in the female population and, over a lifetime, about half of women have at least one episode of UTI requiring antibiotic therapy. The aim of the current study was to compare two different strategies for preventing recurrent bacterial cystitis: intravesical instillation of hyaluronic acid (HA) plus chondroitin sulfate (CS), and antibiotic prophylaxis with sulfamethoxazole plus trimethoprim. Materials and methods: This was a retrospective review of two different cohorts of women affected by recurrent bacterial cystitis. Cases (experimental group) were women who received intravesical instillations of a sterile solution of high concentration of HA + CS in 50 mL water with calcium chloride every week during the 1st month and then once monthly for 4 months. The control group included women who received traditional therapy for recurrent cystitis based on daily antibiotic prophylaxis using sulfamethoxazole 200 mg plus trimethoprim 40 mg for 6 weeks. Results: Ninety-eight and 76 patients were treated with experimental and control treatments, respectively. At 12 months after treatment, 69 and 109 UTIs were detected in the experimental and control groups, respectively. The proportion of patients free from UTIs was significantly higher in the experimental than in the control group (36.7% vs. 21.0%; p = 0.03). Experimental treatment was well tolerated and none of the patients stopped it. Conclusion: The intravesical instillation of HA + CS is more effective than long-term antibiotic prophylaxis for preventing recurrent bacterial cystitis

Botox (R) for idiopathic overactive bladder: efficacy, duration and safety. Effectiveness of subsequent injection

Purpose To test the efficacy, duration and safety of 100 U of botulinum toxin type A (BoNT/A) in women affected by idiopathic detrusor overactivity (IDO) and the effectiveness of subsequent injections. Methods In this double centre, prospective study con- ducted from March 2008 to March 2010, we selected women affected by IDO who failed to respond to various antimuscarinic agents, reported intolerable anticholinergic side-effects or contraindication to their use, also without any response to tibial stimulation. Medical history, physi- cal examination, standard urodynamic examination, uri- nalysis, urine culture, a 4-day voiding diary and a quality of life questionnaire were requested for all patients. A total amount of 100 U of BoNT/A were injected into the detrusor muscle. A second injection of BoNT/A was sug- gested to patients who experienced a relapse of initially improved symptoms. Results We enrolled a total number of 68 women. All patients showed significant improvement in urodynamic parameters, clinical features and quality of life, after the first injection of Botox until the 9 months of follow-up. Even after the second injection, with a follow-up of 3 months, we obtained results comparable with the first injection. Side-effects include an increase in post-void residual volume, dysuria and urinary infections. Conclusions We considered the dose of 100U of Botox, for treatment of IDO, as an efficacious and safe solution compared to other therapeutic options, without serious and lasting adverse effects for women, even after a second injection

LAPAROSCOPIC RETROPUBIC COLPOSUSPENSION FOR THE TREATMENT OF GENUINE STRESS INCONTINENCE. LONG TERM FOLLOW-UP

Objectives: The minimal surgical treatment of stress urinary incontinence with endoscopic operation has four basic advantages compared with traditional open procedures: decreased blood loss due to better visualization of the space of Retzius, decreased postoperative pain, shorter hospitalization and faster recovery. Comparative studies have shown a higher subjective and objective cure rate for the retropubic urethropexy(Burch procedure) than for the anterior colporraphy or endoscopic needle urethropexy(1). The aim of this study is to evaluate the safety, the efficacy and morbility of laparoscopic Burch procedure for the surgical treatment of genuine stress incontinence. Methods: We reviewed the results of 87 patients who underwent L.B. between 1997 and 2003 by the same surgeon. The main age was 52 years (range 42-71), the mean body weight was 65 Kg.(range 50-73) and the mean parity was 3 (range 1-5) . 55 post menopausal pts. (63,5%) were taken a systemic or local estrogen therapy. All pts. preoperativelly underwent a complete urogynaecological work-up (Q tip test, Vaginal profile, Pad test, Urodynamic investigation and Urethrocystoscopy). All the pts. showed S.U.I. mainly grade II (according to Ingelman Sundeberg) and urethral hypermobility nearly always associated with cystocele of I-II degree and uterus-prolapse or vault prolapse of different degree. For this reason we performed associated laparoscopic procedures like total hysterectomy on 52 pts(60%), Mc Call culdoplasty on 70 pts (80%), paravaginal repair on 35 pts (40%) and colposacropexy on 24 pts.(28%). We perfomed LPS Burch alone on 10 of the patients (9%). A follow-up questionaire on urinary function and quality of life was obtained. Results: The main operative time for L.B. was 67 minutes (range 40-120), estimated blood loss was minimum and mean hospital stay was 24 hours. The foley catheter was removed after 6-12 h. No bladder or uretheral injures occurred. At 5 years followup 60 pts (69%) were continent, 5 pts. (5.7%) de novo instability, 6 pts (%) were somewhat improved and 17 pts were complete failures. Conclusions: Laparoscopic Burch procedure seems to be a feasible alternative to the open Burch today for a different and less traumatic approach, for a lower morbility and for a shorter hospital sta

Use of trans-labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered.

AIM: To demonstrate effectiveness of trans-labial ultrasound (TL-US) in the evaluation of female urethral diverticula (UD). METHODS: In the study period, 20 UD were diagnosed and treated. All data on demographic characteristics, presenting symptoms, physical examination findings, diagnostic and operative procedures, were considered. Patients were referred to TL-US for diverticular evaluation, using a 2D 7.5-MHz endfire probe. For each UD, size, complexity, echogenicity content, and presence of diverticular neck were considered. Follow-up controls were carried out at 1, 6 and 12 months after surgery, to evaluate outcome and need for further intervention. RESULTS: Mean patient age was 46 years (range, 35-55 years) and mean parity was 1 (range, 0-3). The principal symptoms associated with the diverticular mass was dysuria (25%). In all evaluated cases, UD was single (simple in 15 cases and complex in 5). The mean size of the diverticula was 28 mm (range, 8-50 mm). Nineteen diverticula were diagnosed on TL-US, and urethrocystoscopy was carried out for confirmation. Treatment consisted of diverticulectomy. At 1-, 6- and 12-month follow up after surgery, TL-US showed no recurrence of UD in any of the patients. CONCLUSIONS: TL-US is a valid, mini-invasive and reproducible method to diagnose UD