Diameter of the external urethral sphincter as a predictor of detrusor-sphincter incoordination in children：Comparative study of voiding cystourethrography

Elsevier, HIDEHIRO, KAKIZAKI ; KIMIHIKO, MORIYA ; KANAME, AMEDA ; TAKASHI, SHIBATA ; HIROSHI, TANAKA ; TOMOHIKO, KOYANAGI, The Journal of urology, 169(2), 2003, 655-658. authorPurpose: Voiding cystourethrography is a diagnostic procedure widely used to evaluate lower urinary tract abnormalities in children. In children with and without suspected voiding dysfunction we measured the internal diameter of the external urethral sphincter on voiding cystourethrography to evaluate its diagnostic accuracy as a predictor of detrusor-sphincter incoordination. Materials and Methods: In part 1 of the study 59 boys and 37 girls with normal voiding function underwent voiding cystourethrography. In each child 1 to 6 voiding cystourethrograms (mean 2.1) were performed as a part of urological evaluation. Thus, a total of 200 voiding cystourethrograms were obtained. Underlying urological disease was primary vesicoureteral reflux in 57 cases, congenital hydronephrosis in 9, urinary tract infection in 6, ureteral anomalies in 11 and other in 13. To determine external urethral sphincter inner diameter on a given voiding cystourethrogram the sphincter was measured on consecutive images and the widest diameter was chosen. In part 2 of the study 43 children with suspected voiding dysfunction underwent voiding cystourethrography and external urethral sphincter electromyography. Electromyography results were comparatively analyzed with external urethral sphincter data. Results: In part 1 an age dependent increase in external urethral sphincter inner diameter was noted in children with normal voiding function. External urethral sphincter inner diameter in mm. was determined by the formula, 0.166 × age in years + 4.31 in boys (p = 0.0001, r = 0.374) and 0.222 × age in years + 2.73 in girls (p <0.0001, r = 0.595). Overall the incidence of an external urethral sphincter inner diameter of less than 3 mm. was only 4% (8 of 200 patients). In part 2 external urethral sphincter electromyography documented detrusor-sphincter incoordination in 15 children (35%). When we defined an external urethral sphincter inner diameter of less than 3 mm. as a cutoff value for predicting detrusor-sphincter incoordination, the sensitivity, specificity, positive and negative predictive values were 93%, 89%, 82% and 96%, respectively

Questionnaire analysis on sex difference in lower urinary tract symptoms

Elsevier, Hidehiro, Kakizaki ; Shinobu, Matsuura ; Takahiko, Mitsui ; Kaname, Ameda ; Hiroshi, Tanaka ; Tomohiko, Koyanagi, Urology, 59(1), 2002, 58-62. authorObjectives. To examine the sex difference in the prevalence and severity of lower urinary tract symptoms in Japanese men and women. Methods. Of 970 individuals who attended the public lectures by urologists and a famous veterinarian that were organized as a public service of the 88th Annual Meeting of the Japanese Urological Association (June 2000, Sapporo, Japan), 677 (70%) completed the self-administered International Prostate Symptom Score (IPSS) questionnaire. The scores of 653 attendees aged 30 to 79 years (446 men, mean age 67.5 and 207 women, mean age 60.7) were the basis of this study. Results. A significant age-related increase in IPSS and quality-of-life score was observed in both men and women. The ratio of moderate (IPSS 8 to 19) to severe (IPSS 20 or greater) symptoms in the 50s, 60s, and 70s was 52%, 72%, and 80% in men and 27%, 36%, and 55% in women, respectively. Additional analysis in each decade showed that at age 50 years and older the total score and voiding symptom score of IPSS, as well as the quality-of-life score, were significantly greater in men than in women. Conclusions. The total IPSS and quality-of-life score correlated highly with age in both sexes. At the age of 50 years and older, men had severer voiding symptoms than did women. Although the age-related changes in bladder function predispose both men and women equally to lower urinary tract symptoms, the higher incidence of bladder outlet obstruction in men having a prostate may have a significant influence on the higher voiding symptom score in men

Urodynamic effects of α1-blocker tamsulosin on voiding dysfunction in patients with neurogenic bladder

Blackwell Publishing, HIDEHIRO, KAKIZAKI ; KANAME, AMEDA ; SHINYA, KOBAYASHI ; HIROSHI, TANAKA ; TAKASHI, SHIBATA ; TOMOHIKO, KOYANAGI, International journal of urology, 10(11), 2003, 576-581.Backgroud: The therapeutic role of α-blockers in the treatment of voiding disorders due to benign prostatic hyperplasia has been extensively examined. To investigate a possible effect of α1-blocker on urodynamic voiding parameters in patients with neurogenic bladder, we conducted a clinical trial using tamsulosin. Methods: Twenty-four patients (14 men and 10 women) ranging from 24 to 82 years of age (mean age 61 years) with neurogenic bladder were analyzed. Urodynamic studies were performed before and after treatment with 0.4 mg tamsulosin daily for 4 weeks. Results: On uroflowmetry, the average flow rate (from 4.6 ± 3.3 to 6.7 ± 3.0 mL/s, P = 0.04), maximum flow rate (from 9.4 ± 6.8 to 14.1 ± 7.0 mL/s, P = 0.016) and residual urine rate (from 46 ± 29 to 32 ± 21%, P = 0.02) improved significantly. In patients with detrusor contraction during voiding, detrusor opening pressure and detrusor pressure at maximum flow decreased significantly from 69.0 ± 36.2 to 49.2 ± 26.4 cmH2O (P = 0.046) and from 66.7 ± 34.6 to 53.6 ± 26.5 cmH2O (P = 0.007), respectively. On the other hand, in patients with detrusor areflexia, vesical opening pressure (from 78.2 ± 23.4 to 61.6 ± 25.2 cmH2O), or vesical pressure at maximum flow (from 68.6 ± 23.2 to 62.9 ± 25.2 cmH2O) did not change significantly after treatment. Conclusion: Tamsulosin reduces functional urethral resistance during voiding and improves flow rate in patients with neurogenic bladder. It has more beneficial urodynamic effects in patients with detrusor contraction during voiding than in patients with detrusor areflexia

Autoimmune Hepatitis: Diagnostic Dilemma in the Setting of Suspected Iron Overload

Autoimmune hepatitis (AIH) is an inflammatory condition of the liver that has a multitude of clinical presentations from chronic hepatitis to acute fulminant hepatitis. AIH diagnosis is typically suspected after ruling out other causes of hepatitis (such as vial hepatitis, hemochromatosis, Wilson’s disease, and primary biliary cirrhosis) through serological tests and by findings of high titers of certain autoantibodies (ANA and anti-SMA for type 1 AIH and anti-LKM-1 for type 2 AIH). AIH like most inflammatory conditions is associated with increased ferritin levels (acute-phase reactant) but typically near-normal transferrin saturation. The presence of excessive ferritin level in absence of high-transferrin saturation helps differentiate secondary iron overload from hemochromatosis where transferrin saturation is typically high. We herein describe a case of AIH that presented with high ferritin levels and transferrin saturation suggesting a diagnosis of hemochromatosis and needed arduous work-up to arrive at accurate diagnosis of AIH

High frequency of cardiovascular abnormalities in chest x-rays in Ugandan children hospitalised with severe pneumonia

Objectives: This was a cross sectional study aimed at describing chest x-ray findings among children hospitalised with clinically diagnosed severe pneumonia and hypoxaemia (SpO2<92%) in three tertiary facilities in Uganda. Methods: We studied chest x-rays of 375 children aged 28 days to 12 years enrolled into the Children’s Oxygen Administration Strategies Trial (COAST)(ISRCTN15622505). Radiologists blinded to the clinical findings reported chest x-rays using the standardized World Health Organization methodology for paediatric chest Xray reporting. We summarised clinical data and chest x-ray findings using descriptive statistics. Chi-square and proportion tests were used to compare proportions and quantile regression compared medians. Results: We found 172, (45.8%) children had radiological pneumonia, 136 (36.3%) normal chest radiographs while 123 (32.8%) non-pneumonia findings, the major one being cardiovascular abnormalities,106 (28.3%); 56 (14.9%) chest radiographs had both pneumonia and other abnormalities. There was no difference in the prevalence of radiological pneumonia, cardiovascular abnormalities, and mortality between the group with severe hypoxaemia (SpO2<80%) and that with mild hypoxaemia (SpO280 to <92%), (95% CI: -13.2,7.1, -6.1,15.9) and -37.2, 20.4) respectively. Conclusion: This study highlights a relatively high prevalence of cardiovascular abnormalities in children who fulfill the WHO clinical criteria for severe pneumonia and have hypoxaemia. We recommend that chest x-ray examinations be routinely done for all children in this population because information concerning cardiovascular and respiratory systems can be obtained in one sitting and guide management better. We hope that these findings can prompt discussions into refining the clinical criteria used to classify and manage pneumonia in children in limited resource settings