Nocturnal enuresis—theoretic background and practical guidelines

Nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds are central in the pathogenesis of enuresis. An underlying mechanism on the brainstem level is probably common to these mechanisms. Enuretic children have an increased risk for psychosocial comorbidity. The primary evaluation of the enuretic child is usually straightforward, with no radiology or invasive procedures required, and can be carried out by any adequately educated nurse or physician. The first-line treatment, once the few cases with underlying disorders, such as diabetes, kidney disease or urogenital malformations, have been ruled out, is the enuresis alarm, which has a definite curative potential but requires much work and motivation. For families not able to comply with the alarm, desmopressin should be the treatment of choice. In therapy-resistant cases, occult constipation needs to be ruled out, and then anticholinergic treatment—often combined with desmopressin—can be tried. In situations when all other treatments have failed, imipramine treatment is warranted, provided the cardiac risks are taken into account

Bowel management for the treatment of pediatric fecal incontinence

Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a bowel management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process

Investigations of the output energy deviation and other parameters during commissioning of the four-rod radio frequency quadrupole at the Fermi National Accelerator Laboratory

After 30 years of operation, the Cockcroft-Walton based injector at the Fermi National Accelerator Laboratory has been replaced by a new beam line including a dimpled magnetron 35 keV source in combination with a 750 keV four-rod radio frequency quadrupole (RFQ). The new injector is followed by the existing drift tube linac. Prior to installation, a test beam line was built which included the magnetron source and the four-rod RFQ with a number of beam measurement instrumentation. The first beam test with the RFQ showed an output energy deviation greater than 2.5%. Other problems also showed up which led to investigations of the output energy, power consumption and transmission properties using rf simulations which were complemented with additional beam measurements. The sources of this deviation and the mechanical modifications of the RFQ to solve this matter will be presented in this paper. Meanwhile, the nominal output energy of 750 keV has been confirmed and the new injector with the four-rod RFQ is in full operation