Die überaktive Blase. Differenzialdiagnostik und therapeutisches Management

Die über- oder hyperaktive Blase kann die Befindlichkeit der Betroffenen erheblich stören. Abklärung und Therapie sollen patientinnenorientiert in verschiedenen Stufen erfolgen. Bei Therapieversagen trotz Verhaltensänderung, Blasentraining und Anticholinergika als primäre Therapien ist die intravesikale Injektion von Botulinumneurotoxin, aber auch Neuromodulation eine sehr wirksame Option. Neu erweitern β3-Adrenozeptor- Agonisten in Europa seit 2013* das therapeutische Spektrum

Agronomic and environmental impacts of a single application of heat-dried sludge on an Alfisol

A field experiment was conducted on Alfisols in South-West France to assess the agronomic and environmental impacts of a single application of heat-dried sludge pellets at 11.1 Mg dry matter ha-1. The sludge pellets, with a moisture level of 9.5%, were spread on an irrigated crop of maize (Zea mays L.). This treatment was compared with inorganic fertilization (urea and diammonium phosphate mixed with KCl). Soil properties, yield and the composition of maize and the quality of drained water were monitored over 1 year to detect any changes resulting from sludge application. Amongst several determined soil properties, only two were significantly modified by the sludge application: The nitric nitrogen stock of the soil was higher in the inorganic fertilized plot, whereas Olsen-P soil content was higher in the sludge-amended plot. Agronomic recovery rates of N and P added by sludge were high: For the first crop following application, total amounts of N and P supplied by the sludge had the same efficiency as approximately 45% of the N and P amounts supplied by inorganic fertilizer. This ratio was 7% for the N uptake by the second maize crop. The quality and quantity of maize were equally good with both types of fertilization. During the 2 years following sludge spreading, N leaching remained as low in the sludged plot as in the inorganically fertilized one. The Cu, Zn, Cr, Cd, Pb and Ni composition of the drainage water was affected by neither of the types of amendment. From the heavy-metal contents of the soil, water and maize monitored over 1 year in the field experiment and from literature data for cow manure and atmospheric emissions, a theoretical balance between crop soil heavy-metal input and output over one century was drawn up. The long-term impact of cow manure on Zn, Ni and Cr in soil is higher than that of the studied heat-dried sludge. Obviously, sludge tended to cause a strong increase in soil Cu storage, valued for these soils, which are otherwise very Cu deficient

Spéciation du Carbone, de l'Azote et du Phosphore de différentes boues de stations d’épuration au cours de leurs incubations contrôlées dans deux types de sol

La caractérisation des particularités des boues de station d'épuration des eaux et la problématique agro - économique et environnementale liée à leur élimination, ont constitué les motivations principales de ce travail. La première partie de ce travail est destinée à mesurer la qualité du carbone des boues, à évaluer sa vitesse de dégradation et à établir des relations entre la qualité de la matière organique et sa dégradation afin d'expliquer et de prévoir le comportement du carbone des boues dans deux sols fréquemment répandus dans la région du Midi-Pyrénées. Dans une seconde partie, la vitesse de minéralisation de l'azote des boues a été déterminée, ainsi que son potentiel de volatilisation. Afin de conclure l'étude sur le carbone et l'azote, l'effet de la taille des particules sur la dynamique de dégradation a été évalué. Finalement, l'évolution des phosphates provenant des boues a été étudiée durant une expérience d'incubation et leur analyse a été effectuée. La spéciation chimique, l'extraction séquentielle, les analyses de routine (Olsen, Bray 1, Mehlich 3) et l'extraction par la plante ont été choisies comme méthodes de caractérisation du P. La composition densimétrique de la matière organique a permis d'expliquer les différences observées dans le dégagement de CO2. L'émission du CO2 a montré une relation étroite avec la quantité de carbone dans la fraction de densité intermédiaire du carbone exogène. La mineralisation de l'azote des boues est conditionnée par la proportion d'azote ammoniacal, la relation C:N de la boue et par la proportion de carbone dans la fraction intermédiaire. La volatilisation est en relation directe avec la proportion d'azote ammoniacal et inversement proportionnelle à la relation C : N de la boue. Les expériences réalisées afin de déterminer l'effet de la taille des particules ont montré l'efficacité de ce paramètre en tant qu'outil pour determiner la vitesse de décomposition d'une boue. Les sources de P testées ont montré des différences principalement en relation aux fractions de P du sol enrichi. Le phosphate et la boue chaulée sont les deux sources qui ont le plus enrichi la fraction la plus mobile. Parmi les analyses de routine, la méthode Mehlich-3 a été confirmée comme la plus adaptée à la détermination de changements dans la bio-disponibilité du phosphore dans des sols recevant des boues. ABSTRACT : Behaviour of Carbon, Nitrogen and Phosphorus present in different biosolids in the soil. The aim of this work was the characterization of the biosolids and of the agricultural, economical and environmental problematic derived from their elimination. The first part of this work is focused in measuring the quality of the organic carbon present in the biosolids, its degradation speed, as well as to establish the relationships between both of them in order to explain and predict the behaviour of the carbon of the biosolids in the two soils most frequent in the region. In the second part, the mineralization speed and the potential volatilization of the nitrogen of the biosolids were determined. In order to finish the study on carbon and nitrogen, the effect of particle size on the degradation dynamics was evaluated. Finally, the evolution of phosphates of the biosolids was determined by means of an incubation experiment and the corresponding analyses. To characterize the P, the methods chosen were the chemical fractionation, sequential extraction, routine analyses (Olsen, Bray 1, Mehlich 3), and vegetal extractions. Organic matter densitometric composition explained the differences that were observed in the emission of C-CO2. This last aspect was tightly related to the quantity of carbon in the intermediate density fraction of exogenous carbon. The availability of the nitrogen in biosolids depends on the proportion of nitrogen in ammonium form, the ratio C:N of the biosolids and by the proportion of carbon in the intermediate fraction. The volatilization is directly proportional to the fraction of ammonia nitrogen and inversely proportional to the ratio C:N in the biosolids The experiments carried out to ascertain the effect of the particle size showed the efficiency of this parameter to control the decomposition speed of a biosolid. The different sources of P that were tested showed differences, mainly in relation to how the different fractions of P in the soil increased. Phosphate and limed biosolids were the two sources that most augmented the most labile fraction. Among the different routine analyses, the Mehlich-3 method was confirmed as the best fit to ascertain the changes in the bioavailability of phosphorus in the soils receiving biosolids

FDG uptake in vaginal tampons is caused by urinary contamination and related to tampon position

Purpose: The aim of the study was to determine the aetiology of FDG uptake in vaginal tampons (VT), a known artefact in premenopausal women evaluated by PET/CT. Methods: This Institutional Review Board approved study consisted of retrospective and prospective parts. The retrospective analysis included 685 women examined between January 2008 and December 2009 regarding VT presence. PET/CT images were analysed to determine the localization and the standardized uptake value (SUV) of VTs. We prospectively recruited 24 women (20-48years old) referred for staging or follow-up in an oncology setting between February and April 2010, who were provided a commercial VT to be used during the entire examination after obtaining written informed consent. After image acquisition, VTs were individually analysed for creatinine concentration and blood traces. Statistical significance was tested with the Mann-Whitney U test. Results: In the retrospective part, 38 of 685 women were found to have a VT of which 17 (45%) were FDG positive. A statistically significant correlation was found between FDG activity and VT position below the pubococcygeal line (PCL) (13 ± 11.2mm). In the prospective study, 7 of 24 (29%) women had increased FDG activity in their VTs (SUV 18.8 ± 11g/ml) but were not menstruating. FDG-positive VTs were significantly lower in position (14.6 ± 11.4mm,below the PCL) than FDG-negative VTs (p = 0.039). The creatinine concentration was significantly increased in all seven positive VTs (931 ± 615μmol/l). Conclusion: FDG uptake in VTs is caused by urine contamination, which is likely related to localization below the PCL resulting in contact with urine during voidin

Phenotypic plasticity of body pigmentation in Drosophila: correlated variations between segments

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Twelve months effect on voiding function of retropubic compared with outside-in and inside-out transobturator midurethral slings

Introduction and hypothesis: The purpose of this study is to compare retropubic tension-free vaginal tape (TVT) with transobturator out-in TOT and in-out TVT-O for female stress urinary incontinence. Uroflow rate was primary; continence rates, quality of life (QoL) and complication pattern were secondary endpoints. Methods: A prospective randomised trial with 2:1:1 randomisation at two Swiss teaching hospitals. Patients were followed up at 12months. Results: Eighty TVT, 40 transobturator tape (TOT) and 40 TVT-O were randomised. At 12months, there was no difference in Qmax among the groups. Continence was comparable (≥89%). QoL was improved significantly in all groups (P < 0.05). Five vaginal tape exposures occurred (one TVT, four TOT, zero TVT-O; P = 0.028). Two percent (1/52) of sexually active patients after TVT, 17% (5/29) after TOT, but 0% (0/25) after TVT-O reported de novo female sexual dysfunction (P = 0.011). We considered this clinically important enough to stop enrolment. Conclusions: There was no difference for Qmax at 12months between TVT, TOT and TVT-O. Female sexual dysfunction and tape exposure may be higher with a transobturator tap

Patient satisfaction after retropubic and transobturator slings: first assessment using the Incontinence Outcome Questionnaire (IOQ)

Introduction and hypothesis: The aim of the Incontinence Outcome Questionnaire (IOQ) is to assess quality of life and patient-reported outcome after midurethral slings. Methods: In this retrospective study, 626 patients with a minimum follow-up period of 1year were sent the IOQ. Four hundred twenty-two of 626 (67.4%) patient responses were evaluated. Results: The mean IOQ QoL extended score was 33.7 ± 17.5 and comparable for tension-free vaginal tape (TVT), outside-in transobturator tape (TOT), and inside-out transobturator vaginal tape (TVT-O). Evaluation of IOQ question about readmission revealed a total of 32 patients (18 TVT, 12 TOT, and 2 TVT-O) who underwent a subsequent operation due to sling-related complications. Freedom from reoperation for recurrent SUI at 1, 2, and 5years was 100%, 99.7 ± 0.3%, and 99.7 ± 0.3% for TVT, 100% for TVT-O, and 94.2 ± 2.5%, 91.9 ± 2.9%, and 89.9 ± 3.5% for TOT, respectively (p < 0.001). Conclusions: Patient satisfaction, assessed using the IOQ, is high after retropubic and transobturator slings. In our collective, relapse incontinence is higher after TO

Popularity of endocrine endometriosis drugs and limited alternatives in the present and foreseeable future: A survey among 1420 affected women

Objectives: Endocrine drugs represent an important cornerstone of endometriosis therapy. Pharmaceutical alternatives with similar efficacy remain out of sight in the near future. Aim of this study is to investigate attitudes and perceptions concerning endocrine therapies among affected women. Study design: An online survey was distributed via social media in Austria, Germany, and Switzerland. Primary endpoints were satisfaction, attitudes and perceptions towards endocrine endometriosis drugs and secondary outcomes differences regarding demographic variables. Results: Of 1420 respondents, 63.5 % (n = 901) described their own attitude towards these drugs as rather negative. The most frequently reported unfavorable associations and experiences were sideeffects in general (85.5 %, n = 1181), change in libido (67.5 %, n = 932), hormone cycle disruptions (65.9 %, n = 910), and inefficiency at alleviating symptoms (38.2 %, n = 527). In total, 66.1 % (n = 935) were not satisfied with endocrine drugs for endometriosis. Age ≤ 30 years, living in a large city, and having an academic degree were significantly correlated to a more negative perception of these drugs and greater dissatisfaction with current endocrine endometriosis drugs. Conclusions: Among women with endometriosis - and particularly among those aged ≤30 years, being large-city residents, or holding an academic degree - there appears to be a relevant degree of rejection and wariness towards endocrine endometriosis drugs. Given the prevalence of endometriosis and the few pharmaceutical alternatives on the horizon, these data point a growing need for further research and development of non-hormonal drugs for the treatment of endometriosis. Keywords: Endometriosis; Endometriosis drug therapy; Endometriosis social media; Endometriosis survey