Cross-sectional study of urinary problems in adults with cerebral palsy: awareness and impact on the quality of life.

We aimed to assess the functional status, urinary problems, and awareness of these problems in adults with cerebral palsy (CP) and their relationship with the quality of life. One-hundred-seventeen adults with CP (53 women, 64 men) were included in this study. Subjects were asked to fill out a urological questionnaire which dealt with urinary symptoms, awareness of urinary problems, and pharmacological treatment they received. Subjects were also assessed with the Gross Motor Function Classification System (GMFCS), Functional Independence Measures (FIM), Functional Mobility Scale (FMS), and King's Health Questionnaire (KHQ). The mean age of the subjects was 25.3 ± 7.8 years. Of the patients, 83.8% were currently unemployed, 95.7% were single, and 96.5% were living with family. Of the patients, 20.5% had experienced frequency, 38.5% had nocturia, 48.7% had urgency, and 36.8% had urge urinary incontinence. Approximately 80% of the patients did not refer to physician due to urinary problems, and 60% of patients were not recorded history about urinary problem by any physician. Urge urinary incontinence was statistically more frequent in females than males (54.7 and 21.9%,respectively, p < 0.05).Female patients had significantly higher KHQ incontinence impact, role limitation, physical limitation, emotion, incontinence severity measures, and symptom severity subgroup scores than male patients (p < 0.05). Urge urinary incontinence was most frequent (65.4%) in spastic quadriplegic CP (p < 0.05). All functional status scores (GMFCS, FIM-toilet transfer, and FMSs) were worse in spastic quadriplegic patients than other topographical involvement of CP (p < 0.0125). Although the urinary problems are common in adult with CP, it is yet an overlooked condition that could affect quality of life. Therefore, health care professionals, patients, and their caregivers should be aware of the increased risk of urinary problems in these patients

Cross-sectional study of urinary problems in adults with cerebral palsy: awareness and impact on the quality of life

We aimed to assess the functional status, urinary problems, and awareness of these problems in adults with cerebral palsy (CP) and their relationship with the quality of life. One-hundred-seventeen adults with CP (53 women, 64 men) were included in this study. Subjects were asked to fill out a urological questionnaire which dealt with urinary symptoms, awareness of urinary problems, and pharmacological treatment they received. Subjects were also assessed with the Gross Motor Function Classification System (GMFCS), Functional Independence Measures (FIM), Functional Mobility Scale (FMS), and King’s Health Questionnaire (KHQ). The mean age of the subjects was 25.3 ± 7.8 years. Of the patients, 83.8% were currently unemployed, 95.7% were single, and 96.5% were living with family. Of the patients, 20.5% had experienced frequency, 38.5% had nocturia, 48.7% had urgency, and 36.8% had urge urinary incontinence. Approximately 80% of the patients did not refer to physician due to urinary problems, and 60% of patients were not recorded history about urinary problem by any physician. Urge urinary incontinence was statistically more frequent in females than males (54.7 and 21.9%,respectively, p < 0.05).Female patients had significantly higher KHQ incontinence impact, role limitation, physical limitation, emotion, incontinence severity measures, and symptom severity subgroup scores than male patients (p < 0.05). Urge urinary incontinence was most frequent (65.4%) in spastic quadriplegic CP (p < 0.05). All functional status scores (GMFCS, FIM-toilet transfer, and FMSs) were worse in spastic quadriplegic patients than other topographical involvement of CP (p < 0.0125). Although the urinary problems are common in adult with CP, it is yet an overlooked condition that could affect quality of life. Therefore, health care professionals, patients, and their caregivers should be aware of the increased risk of urinary problems in these patients. © 2017, Springer-Verlag Italia

Stratigraphy and tectonic evolution of the Kazdağı Massif (NW Anatolia) based on field studies and radiometric ages

The Kazda Massif was previously considered as the metamorphic basement of the Sakarya Zone, a microcontinental fragment in NW Anatolia. Our new field mapping, geochemical investigations, and radiometric dating lead to a re-evaluation of previous suggested models of the massif. The Kazda metamorphic succession is subdivided into two major units separated by a pronounced unconformity. The lower unit (the Tozlu metaophiolite) is a typical oceanic crust assemblage consisting of ultramafic rocks and cumulate gabbros. It is unconformably overlain by a thick platform sequence of the upper group (the Sarkz unit). The basement ophiolites and overlying platform strata were subjected to a single stage of high-temperature metamorphism under progressive compression during the Alpine orogeny, accompanied by migmatitic metagranite emplacement. Radiometric age data obtained from the Kazda metamorphic succession reveal a wide range of ages. Metagranites of the Kazda metamorphic succession define a U-Pb discordia upper intercept age of ca. 230Ma and a lower intercept age of 24.8 +/- 4.6Ma. This younger age agrees with Pb-207/Pb-206 single-zircon evaporation ages of 28.2 +/- 4.1 to 26 +/- 5.6Ma. Moreover, a lower intercept age of 28 +/- 10Ma from a leucocratic metagranite supports the Alpine ages of the massif within error limits. Reconnaissance detrital zircon ages constrain a wide range of possible transport and deposition ages of the metasediments in the Sarkz unit from ca. 120 to 420Ma. Following high-temperature metamorphism and metagranite emplacement, the Kazda sequence was internally imbricated by Alpine compression, and the lowermost Tozlu ophiolite thrust southward onto the Sarkz unit. Field mapping, internal stratigraphy, and new radiometric age data show that the Sarkz unit is the metamorphic equivalent of the Mesozoic platform succession of the Sakarya Zone. The underlying metaophiolites are remnants of the Palaeo tethys Ocean, which closed during the early Alpine orogeny. After strong deformation attending nappe emplacement, the unmetamorphosed Miocene Evciler and Kavlaklar granites intruded the tectonic packages of the Kazda Massif. During Pleistocene time, the Kazda Massif was elevated by EW trending high-angle normal faults dipping to Edremit Gulf, and attained its present structural and topographic position. Tectonic imbrication, erosion and younger E-W-trending faulting were the main cause of the exhumation of the massif