bluuebunny/crossref_metadata_2025 huggingface dataset:
Oocyte maturation in Xenopus laevis is blocked by the hormonal herbicide, 2,4‐dichlorophenoxy acetic acid
Authors: Stebbins‐Boaz Barbara , Fortner Katherine , Frazier Jessie , Piluso Suzanne , Pullen Samuel , Rasar Melissa , Reid William , Sinclair Kristin , Winger Elisa
Published: December 2003

Oocyte maturation is dependent on a complex program of morphological, ultrastructural, and biochemical signaling events, and if disrupted could lead to decreased fertility and population decline. The in vitro sensitivity of amphibian oocytes and oocyte maturation to plant growth factor and widely used hormonal herbicide, 2,4‐dichlorophenoxyacetic acid (2,4‐D), was examined in this study to determine its potential impact on early development and possible contribution to the global amphibian decline. Progesterone, which acts through a membrane receptor, triggers meiotic maturation in full grown (stage VI) Xenopus oocytes, characterized by cytoskeletal reorganization, nuclear dissolution, chromosome condensation, and spindle formation. Biochemically, the Mos/MAPK/MPF signaling pathway is activated, in part dependent on translational activation of specific maternal mRNAs such as c‐Mos. Light microscopy revealed unusual asymmetric morphotypes in oocytes exposed to 2,4‐D alone characterized by a white spot and bulge, termed coning, in the animal pole where the germinal vesicle (nucleus) persisted intact. Treatment of oocytes with cytochalasin B, a microfilament inhibitor, blocked these morphotypes but nocodazole, a microtubule depolymerizing agent, did not. Confocal microscopy showed that 2,4‐D, itself, caused substantial depolymerization of perinuclear microtubules. Importantly, 2,4‐D blocked progesterone‐induced maturation as measured by the lack of nuclear breakdown, confirmed by the lack of Mos expression, MPF activation, and cytoplasmic polyadenylation of cyclin B1 mRNA. However, Western blot analysis and U0126 inhibitor studies showed that 2,4‐D, either alone or in the presence of progesterone, induced MAPK phosphorylation through MAPKK. These results show that 2,4‐D disrupts oocyte cytoskeletal organization and blocks maturation while stimulating an independent MAPK signaling pathway. Mol. Reprod. Dev. 67:233–242, 2004. © 2004 Wiley‐Liss, Inc.
Expression of heat shock protein in broiler embryo tissues after acute cold or heat stress
Authors: Leandro Nadja Suzana Mogyca , Gonzales Elisabeth , Ferro Jesus Aparecido , Ferro Maria Inês Tiraboschi , Givisiez Patrícia Emília Naves , Macari Marcos
Published: December 2003

This study evaluated the expression of heat shock protein 70 kD (hsp70) in broiler chicken embryos subjected to cold (Experiment I) or high incubation temperature (Experiment II). In each experiment, fertile eggs were distributed in three incubators kept at 37.8°C. At day 13 (D13), D16, and D19 of incubation, the embryos were subjected to acute cold (32°C) or heat (40°C) for 4–6 hr. Immediately after cold or heat exposure, samples from the liver, heart, breast muscle, brain, and lungs of 40 embryos were taken per age and treatment (control or stressed embryos). A tissue pool from 10 embryos was used as 1 replication. The levels of hsp70 in each tissue sample was quantified by Western blot analysis. The data were analyzed in a 3 × 2 factorial arrangement of treatments with four replications. hsp70 was detected in all embryo tissues, and the brain contained 2‐ to 5‐times more hsp70 protein compared to the other tissues in either cold or heat stressed embryos. hsp70 increases were observed in the heart and breast muscle of cold stressed embryos at D16 and D19, respectively. Heat stressed embryos showed an increase of hsp70 in the heart at D13 and D19, and in the lung at D19 of incubation. Younger embryos had higher hsp70 synthesis than older embryos, irrespective of the type of thermal stressor. The results indicate that the expression of hsp70 in broiler chicken embryos is affected by cold and heat distress, and is tissue‐ and age‐dependent. Mol. Reprod. Dev. 67:172–177, 2004. © 2004 Wiley‐Liss, Inc.
Sphincter electromyography in diagnosis of multiple system atrophy: technical issues
Authors: Podnar Simon , Fowler Clare J.
Published: December 2003

Possible technical reasons for the controversy over the role of sphincter electromyography (EMG) in the diagnosis of multiple system atrophy (MSA) were analyzed. In a review of the literature, a high sensitivity (>60%) was found reported in 11 studies that included late components, and no value of the test was found in 4 studies that excluded them. This was also corroborated in a pilot study of 5 patients with probable MSA. With late components included, the mean motor unit potential (MUP) duration was prolonged in all 4 patients with an adequate single‐MUP analysis sample and, with late components excluded, in 2 of 5 patients on multi‐MUP analysis. At least in diagnostic EMG of MSA patients, late components should be included in the measurement of MUP duration. Muscle Nerve 2003
Pulmonary complications of chronic neuromuscular diseases and their management
Authors: Perrin Christophe , Unterborn John N. , Ambrosio Carolyn D' , Hill Nicholas S.
Published: December 2003

Chronic neuromuscular diseases may affect all major respiratory muscles groups including inspiratory, expiratory, and bulbar, and respiratory complications are the major cause of morbidity and mortality. Untreated, many of these diseases lead inexorably to hypercapnic respiratory failure, precipitated in some cases by chronic aspiration and secretion retention or pneumonia, related to impairment of cough and swallowing mechanisms. Many measures are helpful including inhibition of salivation, cough‐assist techniques, devices to enhance communication, and physical therapy. In addition, ventilatory assistance is an important part of disease management for patients with advanced neuromuscular disease. Because of its comfort, convenience, and portability advantages, noninvasive positive pressure ventilation (NPPV) has become the modality of first choice for most patients. Patients to receive NPPV should be selected using consensus guidelines, and initiation should be gradual to maximize the chances for success. Attention should be paid to individual preferences for interfaces and early identification of cough impairment that necessitates the use of cough‐assist devices. For patients considered unsuitable for noninvasive ventilation, invasive mechanical ventilation should be considered, but only after a frank but compassionate discussion between the patient, family, physician, and other caregivers. Muscle Nerve 29: 5–27, 2004
Acquired rippling muscle disease with myasthenia gravis
Authors: Greenberg Steven A.
Published: December 2003

Rippling muscle disease (RMD) is a rare disorder that occurs in both familial and sporadic forms. Seven patients have previously been reported with myasthenia gravis and sporadic RMD. There have been conflicting reports of the electrophysiological characteristics of rippling muscles in this acquired form. Another such patient is reported, and the clinical, electrophysiological, and laboratory features of this disorder are described. In addition, this patient had alopecia areata and recurrent metastatic thymoma, years after resection of a benign thymoma. This report emphasizes the clinical manifestations of RMD in association with myasthenia gravis (RMD‐MG), and its distinctive features, in this and previously reported patients. Muscle Nerve 29: 143–146, 2004
Peripheral neuropathy, episodic myoglobinuria, and respiratory failure in deficiency of the mitochondrial trifunctional protein
Authors: Spiekerkoetter Ute , Bennett Michael J. , Ben‐Zeev Bruria , Strauss Arnold W. , Tein Ingrid
Published: December 2003

Mitochondrial trifunctional protein (TFP) deficiency is a rare disorder of the fatty acid β‐oxidation cycle with heterogeneous phenotypes and occurs secondary to either α‐ or β‐subunit mutations. We characterized the neuromyopathic phenotype of TFP deficiency through adolescence or adulthood in 11 patients, 8 with β‐subunit mutations and 3 with α‐subunit mutations. Two independent clinical features occurred: infantile‐onset progressive peripheral neuropathy and episodic exercise‐, illness‐ or fasting‐induced rhabdomyolysis accompanied by respiratory failure (in five patients). The combination of episodic rhabdomyolysis and peripheral neuropathy occurred in 10 of the 11 patients. The neuromyopathic phenotype is common in TFP deficiency (11 of 27 families from our cohort). Therefore, this disorder must be considered in the differential diagnosis of progressive peripheral neuropathy with or without episodic myoglobinuria. Muscle Nerve 29: 66–72, 2004
Bilateral neurogenic thoracic outlet syndrome
Authors: Tilki Hacer Erdem , Stålberg Erik , Incesu Lütfi , Başoğlu Ahmet
Published: December 2003

We report a case of bilateral neurogenic thoracic outlet syndrome (TOS). Electrophysiological examination suggested the presence of bilateral lower brachial plexus neuropathy. Radiography showed rudimentary bilateral cervical ribs. In the cases reported in the literature to date, the clinical findings are typically unilateral despite the common presence of bilateral bony abnormalities. Neurogenic TOS should be considered in young women, even if they present with bilateral symptoms, when they have occupations requiring strenuous activity of the upper limbs. Muscle Nerve 29: 147–150, 2004
Assessment of voluntary activation by stimulation of one muscle or two synergistic muscles
Authors: Williams David M. , Bilodeau Martin
Published: December 2003

In order to test the hypothesis that suboptimal activation of synergistic muscles explains the nonlinear nature of the interpolated twitch–voluntary torque relationship, we evaluated differences between stimulating a single muscle [biceps brachii (BB)] and two synergists simultaneously [BB and brachioradialis (BR)] on variables related to the estimation of voluntary activation. Ten subjects performed maximal and submaximal voluntary contractions while electrical stimulation was applied either to the BB, or BB and BR simultaneously, to assess voluntary activation. Simultaneous stimulation of the two synergistic muscles produced significantly greater torque at rest and a significantly greater activation index (95% vs. 91.7% for stimulation of BB only). However, simultaneous stimulation of BB and BR did not consistently elicit greater additional torque during contraction, nor did it improve the linearity of the interpolated twitch–voluntary torque relationship. The greater activation index observed for the simultaneous stimulation of BB and BR compared to BB is explained by the greater torque elicited at rest. We conclude that the nonlinear relationship between interpolated and voluntary elbow flexion torque is not explained by suboptimally activated synergistic muscles. Muscle Nerve 29: 112–119, 2004
Isolated sensory manifestations in neuralgic amyotrophy: Report of eight cases
Authors: Seror P.
Published: December 2003

A series of eight patients with isolated clinical and electrophysiological sensory deficit related to neuralgic amyotrophy (NA) is reported. NA was diagnosed by clinical and electrodiagnostic features and disease course. Imaging and laboratory investigations excluded other disorders. The results showed mild to severe involvement of eight individual sensory nerves: lateral antebrachial cutaneous nerve lesions in three instances and partial lesions of the median nerve in five cases. Our findings suggest that isolated clinical and electrodiagnostic sensory involvement in NA is not exceptional but rather is unrecognized. The pattern of these nerve lesions agrees with the most typical pattern of NA, which is a mononeuritis or mononeuritis multiplex. The present study also shows that the spectrum of NA is diverse and may vary from pure motor to pure sensory deficit, according to the nature of the involved nerve fibers. Muscle Nerve 29: 134–138, 2004
Satellite cells and myonuclei in young and elderly women and men
Authors: Kadi Fawzi , Charifi Nadia , Denis Christian , Lexell Jan
Published: December 2003

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20–32 years;n= 31) and elderly (age range, 70–83 years;n= 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192–241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P< 0.011) number of satellite cells per muscle fiber but a significantly higher (P< 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women. Muscle Nerve 29: 120–127, 2004
Exercise‐induced gene expression in soleus muscle is dependent on time after spinal cord injury in rats
Authors: Dupont‐Versteegden Esther E. , Houlé John D. , Dennis Richard A. , Zhang Junming , Knox Micheal , Wagoner Gail , Peterson Charlotte A.
Published: December 2003

Cycling exercise attenuates atrophy in hindlimb muscles and causes changes in spinal cord properties after spinal cord injury in rats. We hypothesized that exercising soleus muscle expresses genes that are potentially beneficial to the injured spinal cord. Rats underwent spinal cord injury at T10 and were exercised on a motor‐driven bicycle. Soleus muscle and lumbar spinal cord tissue were used for messenger RNA (mRNA) analysis. Gene expression of brain‐derived neurotrophic factor (BDNF) and glial cell line‐derived neurotrophic factor (GDNF) was elevated 11‐ and 14‐fold, respectively, in soleus muscle after one bout of exercise performed 5 days after spinal cord transection. Also, c‐fos and heat shock protein‐27 (HSP27) mRNA abundance were increased 11‐ and 7‐fold, respectively. When exercise was started 2 days after the injury, the changes in gene expression were not observed. By contrast, at 2 but not at 5 days after transection, expression of the HSP27 gene was elevated sixfold in the lumbar spinal cord, independent of exercise. Electromyographic activity in soleus muscles was also decreased at 2 days, indicating that the spinal cord was less permissive to exercise at this early time. Long‐term exercise for 4 weeks attenuated muscle atrophy equally well in rats started at 2 days or 5 days after injury. We conclude that BDNF and GDNF released from exercising muscle may be involved in exercise‐induced plasticity of the spinal cord. Furthermore, the data suggest that the lumbar spinal cord undergoes time‐dependent changes that temporarily impede the ability of the muscle to respond to exercise. Muscle Nerve 29: 73–81, 2004
Evoked potentials elicited by stimulation of the lateral and anterior femoral cutaneous nerves in meralgia paresthetica
Authors: Cordato Dennis J , Yiannikas Con , Stroud Jill , Halpern Jean‐Pierre , Schwartz Raymond S. , Akbunar Mehmet , Cook Melissa
Published: December 2003

Seventy‐five consecutive patients with clinical symptoms and signs of meralgia paresthetica underwent bilateral somatosensory evoked potential (SEP) studies involving stimulation of skin areas innervated by the lateral and anterior femoral cutaneous nerves of the thighs. The most common abnormality was an absolute lateral femoral cutaneous SEP latency > 40 ms in 35 patients (47%), followed by an absent response in 14 patients (19%), an absolute latency < 40 ms but amplitude reduction > 50% compared with the contralateral response in 8 patients (11%), and an absolute latency < 40 ms but > 5 ms interside latency difference in 5 patients (7%). Anterior femoral cutaneous SEPs were of value in distinguishing meralgia paresthetica from a proximal lumbar radiculopathy in an additional 4 patients and confirming bilateral meralgia paresthetica in 10 patients. Muscle Nerve 29: 139–142, 2004
Muscle‐fiber conduction velocity and electromyography as diagnostic tools in patients with suspected inflammatory myopathy: A prospective study
Authors: Blijham Paul J. , Hengstman Gerald J.D. , Ter Laak Henk J. , Van Engelen Baziel G.M. , Zwarts Machiel J.
Published: December 2003

Combinations of different techniques can increase the diagnostic yield from neurophysiological examination of muscle. In 25 patients with suspected inflammatory myopathy, we prospectively performed needle electromyography (EMG) and measured muscle‐fiber conduction velocity (MFCV) in a single muscle, using a technique with direct muscle‐fiber stimulation and recording. Results of MFCV were compared with final diagnosis, EMG, and needle muscle biopsy. Diagnostic accuracy of combined MFCV and EMG studies was 72%, compared to 60% for EMG alone. This improvement was due to a gain in specificity. The MFCV did not prove useful in discriminating inflammatory myopathy from other myopathies. Furthermore, we found a correlation of 92% between variability of MFCV and myopathic changes in muscle biopsy. We conclude that the utility of electrodiagnostic examination can be increased if EMG examination is combined with MFCV studies. Muscle Nerve 29: 46–50, 2004
Electroneurography index based on nerve conduction study data: Method and findings in control subjects
Authors: Tacconi Paolo , Manca Davide , Tamburini Giorgio , Ferrigno Paola , Cossu Gianni , Cannas Antonino , Giagheddu Marcello
Published: December 2003

We developed a summary score of data obtained from nerve conduction studies (NCS). The principle of such approach is that when a nonrandom trend to lower amplitudes or conduction velocities is present, it may be revealed by a summary nerve conduction score. In a group of normal subjects, peroneal, sural, ulnar, and superficial radial nerves were studied; age‐ and height‐related F‐wave and soleus H‐reflex latencies were also examined. Z‐scores of distal latencies, amplitudes, conduction velocities, F‐wave latencies, and H‐index were averaged in order to obtain three electroneurography (ENG) indices: a simple arithmetic (ENG index 1) and two weighted means (index 2 and index 3), assigning a double or triple weight to lower limb z‐scores. Reference limits were established using multiple regression equations of ENG indices against age and height. This technique could be useful in providing a better cut‐off between normal and diseased populations and in improving test–retest variability of NCS when follow‐up studies are required. Muscle Nerve 29: 89–96, 2004
Neuromuscular expression of the BTB/POZ and zinc finger protein myoneurin
Authors: Cifuentes‐Diaz Carmen , Bitoun Marc , Goudou Daniele , Seddiqi Nadia , Romero Norma , Rieger François , Perin Jean‐Pierre , Alliel Patrick M.
Published: December 2003

Myoneurin belongs to the BTB/POZ and zinc finger protein family whose members have been implicated in regulatory functions of gene expression. Myoneurin has been identified in various tissues, but muscle is a privileged site of myoneurin gene transcription. We examined the neuromuscular expression of myoneurin during development and after axotomy. Myoneurin expression is developmentally regulated in mouse muscle and appeared to be associated with neuromuscular junctions during the late embryonic period. Myoneurin is located in and around synaptic myonuclei in mouse and human adult muscle. The expression of myoneurin is dysregulated after nerve section. Thus, the restricted myoneurin expression in synaptic myonuclei appeared to be controlled by muscle electrical activity. Myoneurin is identified within the peripheral condensed chromatin and the euchromatin/heterochromatin regions, and thus fulfills structural and expression criteria to represent a synaptic gene regulator. Muscle Nerve 29: 59–65, 2004
Creatine monohydrate supplementation does not increase muscle strength, lean body mass, or muscle phosphocreatine in patients with myotonic dystrophy type 1
Authors: Tarnopolsky Mark , Mahoney Douglas , Thompson Terry , Naylor Heather , Doherty Timothy J.
Published: December 2003

Creatine monohydrate (CrM) supplementation may increase strength in some types of muscular dystrophy. A recent study in myotonic muscular dystrophy type 1 (DM1) did not find a significant treatment effect, but measurements of muscle phosphocreatine (PCr) were not performed. We completed a randomized, double‐blind, cross‐over trial using 34 genetically confirmed adult DM1 patients without significant cognitive impairment. Participants received CrM (5 g, ∼0.074 g/kg daily) and a placebo for each 4‐month phase with a 6‐week wash‐out. Spirometry, manual muscle testing, quantitative isometric strength testing of handgrip, foot dorsiflexion, and knee extension, handgrip and foot dorsiflexion endurance, functional tasks, activity of daily living scales, body composition (total, bone, and fat‐free mass), serum creatine kinase activity, serum creatinine concentration and clearance, and liver function tests were completed before and after each intervention, and muscle PCr/β‐adenosine triphosphate (ATP) ratios of the forearm flexor muscles were completed at the end of each phase. CrM supplementation did not increase any of the outcome measurements except for plasma creatinine concentration (but not creatinine clearance). Thus, CrM supplementation at 5 g daily does not have any effects on muscle strength, body composition, or activities of daily living in patients with DM1, perhaps because of a failure of the supplementation to increase muscle PCr/β‐ATP content. Muscle Nerve 29: 51–58, 2004
Na+,K+‐ATPase concentration and fiber type distribution after spinal cord injury
Authors: Ditor D.S. , Hamilton S. , Tarnopolsky M.A. , Green H.J. , Craven B.C. , Parise G. , Hicks A.L.
Published: December 2003

Complete spinal cord injury (SCI) is characterized, in part, by reduced fatigue‐resistance of the paralyzed skeletal muscle during stimulated contractions, but the underlying mechanisms are not fully understood. The effects of complete SCI on skeletal muscle Na+,K+‐adenosine triphosphatase (ATPase) concentration, and fiber type distribution were therefore investigated. Six individuals (aged 32.0 ± 5.3 years) with complete paraplegia (T4–T10; 1–19 years since injury) participated. There was a significantly lower Na+,K+‐ATPase concentration in the paralyzed vastus lateralis (VL) when compared to either the subjects' own unaffected deltoid or literature values (from our laboratory, utilizing the same methodology) of VL Na+,K+‐ATPase concentration for the healthy able‐bodied (141.6 ± 50.0, 213.4 ± 23.9, 339 ± 16 pmol/g wet wt., respectively; P < 0.05). There was also a significant negative correlation between the Na+,K+‐ATPase concentration in the paralyzed VL and years since injury (r = −0.75, P < 0.05). These findings are clinically relevant as they suggest that reductions in Na+,K+‐ATPase contribute to the fatigability of paralyzed muscle after SCI. Unexpectedly, the VL muscles of our subjects had a higher proportion of their area represented by type I fibers compared to literature values for the VL of the healthy able‐bodied (52.6 ± 25.3% vs. 36 ± 11.3%, respectively; P < 0.05). As all our subjects had upper motor neuron injuries and, therefore, experienced muscle spasticity, our findings warrant further investigation into the relationship between muscle spasticity and fiber type expression after SCI. Muscle Nerve 29: 38–45, 2004
Lower urinary tract dysfunctions in patients with spinal cord tumors
Authors: Uchiyama Tomoyuki , Sakakibara Ryuji , Hattori Takamichi , Yamanishi Tomonori
Published: December 2003

Aims

The objective of this study was to elucidate the incidence and pathophysiology of lower urinary tract dysfunctions (LUTS) in patients with spinal cord tumors.

Methods

Urinary questionnaire and urodynamic studies were done in 76 patients with spinal cord tumors.

Results

The patients included 56 with cervical‐thoracic (C1 to T11) and 20 with lumbosacral tumors. The lumbosacral tumors consisted of 12 epiconus/conus medullaris (below T11) and 8 cauda equina tumors. These tumors were further subdivided into intramedullary, intradural extramedullary, and dumbbell‐type. More than 83% of the patients had urinary symptoms. Patients with cervical‐thoracic tumors commonly had voiding symptoms (75%). Detrusor hyperreflexia (39%), and detrusor areflexia on voiding (21%) were the main urodynamic features. Patients with epiconus/conus medullaris tumors commonly had voiding symptoms as well (58%), but decreased urge to void (50%), detrusor‐sphincter dyssynergia (42%), and detrusor areflexia on voiding (32%) were the main features. Patients with cauda equina tumors commonly had storage symptoms (88%), of which sensory urgency was most common (63%). Severe LUTS occurred in the epiconus/conus medullaris tumors and in the intramedullary tumors. These dysfunctions tended to appear late and rarely appeared as the initial symptom in the course of the disease. There was no significant relationship between neurologic abnormalities and LUTS. Urodynamics showed that spinal cord tumors cause a variety of LUTS, depending on the location and the type of the tumor.

Conclusion

Spinal cord tumors are commonly accompanied by LUTS. Clinical and urodynamic evaluation is crucial to diagnosis and management since there is little relationship between symptoms and findings. Neurourol. Urodynam. 23:68–75, 2004. © 2003 Wiley‐Liss, Inc.
Acupuncture reflexotherapy in the treatment of sensory urgency that persists after transurethral resection of the prostate: A preliminary report
Authors: Ricci Luigi , Minardi Daniele , Romoli Marco , Galosi Andrea B. , Muzzonigro Giovanni
Published: December 2003

Aims

In this study, we wanted to evaluate whether acupuncture reflexotherapy is able to treat the sensory irritative components of LUTS (lower urinary tract symptoms) that persist after transurethral resection of the prostate.

Methods

We have evaluated 42 patients, randomly selected into three groups: 14 patients received placebo, 15 patients received oxybutynin, and 13 patient were treated with electrostimulation by acupuncture reflexotherapy.

Results

Before treatment, the mean maximum flow rate (Qmax) was 21.0 ± 3.2 mL/sec, the mean International Prostate Symptom Score (I‐PSS) score was 12.9 ± 4.2, the mean I‐PSS Quality of Life (IPSS QoL) score was 3.6 ± 1.2. At the first check‐up performed after 3 months, we could observe that the I‐PSS and QoL scores were 12.6 ± 4.3 and 3.8 ± 1.3 in the group who received placebo; the scores decreased to 11.1 ± 3.2 and to 3.1 ± 1.0, respectively, in the 15 patients treated with oxybutynin and decreased to 6.1 ± 2.6 and 1.3 ± 1.1, respectively, in the 13 patients who underwent acupuncture reflexotherapy. At 1‐year follow‐up, these parameters were practically similar. The voiding diaries allowed us to deduce that the average number of daytime voidings decreased by 8% in patients who received oxybutynin and decreased by 20% in 13 patients who underwent reflexotherapy; the average number of nocturnal micturitions decreased by approximately 20% and 60%, respectively, in patients who received oxybutynin and reflexotherapy.

Conclusions

This study has pointed out that acupuncture reflexotherapy has a real benefit in patients with sensory urgency that persists after transurethral resection of the prostate. Neurourol. Urodynam. 23:58–62, 2004. © 2003 Wiley‐Liss, Inc.
Theoretical analysis of the effects of viscous losses and abdominal straining on urinary outlet function
Authors: Mijailovich Srboljub M. , Sullivan Maryrose P. , Yalla Subbarao V. , Venegas Jose G.
Published: December 2003

Aims

The aim of this study was to theoretically explore the relationship between the tube law (TL) of the urethra and the pressure–flow (p–Q) relationship during micturition. The understanding of this relation is important for the evaluation of outlet obstruction by urodynamic interpretation of p–Q plots.

Methods

We simulated the outlet function by a lumped theoretical model, and suggested how the TL can be used to quantitatively predict the p–Q relationship of the system. Our analysis considered the relation between the TL and the steady state p–Q plot for various TLs including the hysteresis of the pressure–area relationship.

Results and Conclusions

The inclusion of pressure losses distal to the flow controlling zone and experimentally measured p–A relations of the urethra in the model lead to the predictions that flow in the flow controlling zone is not always critical but is often in the sub‐critical range, that an increase in abdominal pressure can increase the flow under certain conditions, and that hysteresis in the pressure–area relation is correlated to the hysteresis in the p–Q plot. Neurourol. Urodynam. 23:76–85, 2004. Published 2003 Wiley‐Liss, Inc.
Observations on the function of the female urethra: II: Relation between maximum urethral closure pressure at rest and the degree of urethral incompetence
Authors: Schick Erik , Bertrand Pierre E. , Jolivet‐Tremblay Martine , Dupont Charles , Tessier Jocelyne
Published: December 2003

Aims

To study the relation between maximum urethral closure pressure (MUCP) at rest and the degree of urethral incompetence in the female.

Patients and Methods

Two hundred fifty five patients aged 20 years or older, with stable bladders on multichannel urodynamics, without known neurological pathology, and with no previous history of pelvic or anti‐incontinence surgery were included in the study. Resting urethral pressure profile (UPP) and the grade of urethral incompetence was registered.

Results

Mean age of the group was 45.6±12.7 years; mean MUCP was 62.7±28.5 cm of water. There was a statistically significant difference in the MUCP when the different grades of urethral incompetence were compared to each other, the higher grades being associated with a lower maximal closure pressure.

Conclusions

This study demonstrates that there is a highly significant relationship between MUCP and between all grades of urethral incompetence. This supports previous observations that MUCP decreases when abdominal leak point pressure (ALPP) is low and that this might be secondary to some mechanical failure in the pressure transmission from the abdominal cavity to the urethra. Studies should never compare continent to incontinent cohorts without considering their ALPP because in doing so they are comparing groups that are functionally heterogeneous. Neurourol. Urodynam. 23:16–21, 2004. © 2003 Wiley‐Liss, Inc.
Observations on the function of the female urethra: III: An overview with special reference to the relation between urethral hypermobility and urethral incompetence
Authors: Schick Erik , Jolivet‐Tremblay Martine , Tessier Jocelyne , Dupont Charles , Bertrand Pierre E.
Published: December 2003

Aims

To analyze the relation between urethral hypermobility and urethral incompetence, and to summarize the interdependence between maximum urethral closure pressure (MUCP), urethral hypermobility, and urethral incompetence.

Patients and Methods

A group of 255 patients was selected from a large bank of cases. Inclusion criteria were age 20 years or above, no neurological disease, stable bladder, and no previous incontinence surgery or hysterectomy. The degree of hypermobility (cysto‐urethrocele) and the degree of urethral incompetence (abdominal leak point pressure (ALPP)) were determined. Statistical analyses between urethral hypermobility and incompetence were performed with Spearman's correlation and the Jonckherre‐Terpstra test.

Results

The Spearman's rank correlation test showed a statistically significant relation between urethral hypermobility and the degree of urethral incompetence (P = 0.0049).

Conclusions

The statistically significant relation between urethral incompetence and hypermobility suggests that urethral incompetence will increase as the degree of urethral hypermobility does. Optimal conditions for urinary continence include a high maximum urethral closure pressure, absence of hypermobility, and a low degree of urethral incompetence. This last factor is assured by a strong support underneath the urethra permitting compression of the latter during straining. Failure of the urethral closure mechanism is highly probable with a diminished maximum closure pressure accompanied by urethral hypermobility often associated with a high degree of urethral incompetence. Clinically significant urinary incontinence may appear in many intermediate circumstances between these two extreme states, but stress urinary incontinence is essentially an activity‐related phenomenon. Neurourol. Urodynam. 23:22–26, 2004. © 2003 Wiley‐Liss, Inc.
Primary nocturnal enuresis persistent to adulthood, functional evaluation
Authors: Wadie Bassem S.
Published: December 2003

Introduction and Objectives

The incidence of nocturnal enuresis (NE) in adults (over 18 years of age) ranges from 0.5 to 2% for most authors. NE is a multifactorial disease. Lack of circadian rhythm of antidiuretic hormone (ADH) is one of the commonly accepted causes, however, disorders affecting bladder function is another important pathophysiologic factor that has not been settled. The target of the present study is to define bladder function in adults having persistent NE.

Methods

Fifty two adult patients were included. Mean age was 23.6 ± 6.9 years. All of them had primary NE persistent to adulthood. No treatment was received within 2–7 days prior to the urodynamic examination. All of them had intact neuro‐urological examination. Filling (in all patients) and voiding cystometry (in 29 patients) were carried out, using 8 F urodynamic and 8 F rectal catheters. Pressure flow analysis was interpreted using Schafer's nomogram.

Results

Overall mean maximum cystometric capacity was 419.2 ± 142 ml, mean bladder compliance was 51.3 ± 39.7 ml/cmH2O. In males (n = 25), mean maximum cystometric capacity was 453 ± 173 ml and compliance was 56 ± 42 ml/cmH2O, while in females (n = 27), mean capacity was 388 ± 98 ml and compliance was 46.7 ± 36.7 ml/cmH2O. Twenty patients had detrusor instability (38.5%). Twelve out of 27 (44.4%) females had instability while only 8 out of 25 (32%) males had the same finding. Differences relevant to maximum bladder capacity and compliance between the patients with and without instability were significant (P < 0.0001). Mean detrusor opening pressure was 55.3 ± 25 cmH2O, mean detrusor pressure at maximum flow and maximum detrusor pressure, were 53.5 ± 21 and 78.9 ± 35 cmH2O respectively.

Conclusions

Urodynamic studies in adults with persistent NE reveals a relatively high incidence of instability, normal capacity and compliance. The presence of instability was associated with smaller bladder and poorer compliance and with diurnal urgency. Voiding bladder function in adult enuretics was found to be normal. Neurourol. Urodynam. 23:54–57, 2004. © 2003 Wiley‐Liss, Inc.
The association between overactive bladder symptoms and objective parameters from bladder diary and filling cystometry
Authors: van Brummen H.J. , Heintz A.P.M. , Vaart C.H. van der
Published: December 2003

Aims

To investigate the association between overactive bladder symptoms and objective parameters from the bladder diary and conventional filling cystometry.

Methods

We reviewed the records of the 95 consecutive patients presenting at our center for urodynamic investigation. These women were asked to self‐complete a questionnaire and a bladder diary for 48 hr. Urogenital symptoms and disease‐specific quality of life were assessed with standardized questionnaire, namely the Dutch version of the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ).

Results

The frequency symptom as well as the urge incontinence symptom is significantly associated with the presence of detrusor overactivity. In univariate analysis both frequency and urgency symptoms are associated with lower micturition and bladder sensation volumes. In multivariate (ANOVA) analysis, the frequency symptom is associated with a higher 24‐hr frequency, lower maximum volume voided, and mean volume voided per micturition on the bladder diary. It is also associated with lower sensation volumes on the filling cystometry.

Conclusions

Of the four symptoms that are currently considered to be part of the overactive bladder syndrome, the frequency symptom is the best associated with objective parameters from the bladder diary, filling cystometry, and with the occurrence of detrusor overactivity. Therefore, we would like to suggest that reporting subjective symptoms frequency is obligatory for considering one to have an overactive bladder. Neurourol. Urodynam. 23:38–42, 2004. © 2003 Wiley‐Liss, Inc.
Measuring the severity of stress urinary incontinence using the Incontinence Impact Questionnaire
Authors: Handa Victoria L. , Massof Robert W.
Published: December 2003

Aims

Questionnaires, including the Incontinence Impact Questionnaire (IIQ), have been used to assess the severity of urinary incontinence in clinical trials. However, the summed score derived from the IIQ does not have any inherent clinical meaning. Also, a summed score does not have interval properties, complicating the interpretation of changes in severity. The purpose of this study is to test the hypothesis that incontinence‐related disability is a measurable variable and that the IIQ can measure that variable accurately.

Methods

We used Rasch analysis, a logistic regression technique, to estimate an interval scale of incontinence severity. Rasch analysis is based on the mathematical assumption that each subject's response to any given item is a function of (a) the individual's inherent level of disability and (b) the inherent difficulty of that item.

Results

Twenty‐seven women with urodynamic stress urinary incontinence (USUI) completed the IIQ. Using Rasch analysis, we found that women with USUI had the most difficulty engaging in “physical recreational activities” and the least difficulty participating in “relationship with family.” We also assessed the ability of the IIQ to discriminate between individuals with respect to disease severity. We found that most of the items in the IIQ are useful for discriminating incontinence severity among women with mild or moderate incontinence, but very few IIQ items distinguish among women with severe incontinence.

Conclusions

Our results have important implications for clinical trials using the IIQ: among women treated for severe incontinence, the standard IIQ summed score will underestimate the magnitude of any change in incontinence severity. Neurourol. Urodynam. 23:27–32, 2004. © 2003 Wiley‐Liss, Inc.
Surgical complications and medium‐term outcome results of tension‐free vaginal tape: A prospective study of 313 consecutive patients
Authors: Levin Ishai , Groutz Asnat , Gold Ronen , Pauzner David , Lessing Joseph B. , Gordon David
Published: December 2003

Objective

A prospective study was undertaken to examine the incidence of surgical complications and medium‐term outcomes of tension‐free vaginal tape (TVT) surgery in a large, heterogeneous group of stress‐incontinent women.

Methods

Surgery was tailored according to preoperative clinical and urodynamic findings: stress‐incontinent women underwent TVT surgery, whereas those with concomitant urogenital prolapse underwent combined TVT and prolapse repair. Post‐operatively the patients were scheduled for evaluation at 1, 3, 6, and 12 months, and annually thereafter. All underwent urodynamics at 3 months post‐operatively.

Results

Three hundred and thirteen consecutive patients were prospectively studied. The mean follow‐up period was 21.4 ± 13.5 months. Sixteen (5.1%) cases of intravesical passage of the prolene tape occurred in our series, two of which were diagnosed at 3 and 15 months post‐operatively. Eight (2.5%) patients had post‐operative voiding difficulties, necessitating catheterization for more than 7 days. However, transvaginal excision of the tape was required in one case only. Vaginal erosion of the tape was diagnosed in four (1.3%) patients, all of whom were successfully treated by local excision of the eroded tape. Outcome analysis was restricted to 241 consecutive patients with at least 12 months of follow‐up. Subjectively, 16 (6.6%) patients had persistent mild stress urinary incontinence, although urodynamics revealed asymptomatic sphincteric incontinence in 17 (7%) other patients. De‐novo urge incontinence developed post‐operatively in 20 (8.3%) patients.

Conclusions

The TVT procedure is associated with good medium‐term cure rates, however, it is not free of troublesome complications and the patients should be informed accordingly. Only well‐trained surgeons, familiar with pelvic anatomy, surgical alternatives, and endoscopic techniques should perform the operation. Neurourol. Urodynam. 23:7–9, 2004. © 2003 Wiley‐Liss, Inc.
Opening detrusor pressure and the influence of age on success following colposuspension
Authors: Dolan Lucia M. , Smith Anthony R.B. , Hosker Gordon L.
Published: December 2003

Objective

Women with urodynamic stress incontinence (USI) have lower opening and closing detrusor pressures than women without USI. This study was undertaken to determine whether a change occurs in opening and closing detrusor pressures after colposuspension, whether cure is associated with change, and whether age influences cure.

Design

Retrospective cohort study.

Setting

Tertiary referral urogynaecology department.

Participants

Consecutive women who had undergone colposuspension between 1998–2000 and 1993–1995.

Methods

Pre‐ and post‐operative urodynamic records were reviewed. Eighty eight women were included. Objective cure was defined as an absence of USI and subjective cure as an absence of symptoms of stress incontinence.

Results

Mean age was 52.4 (11.0) years. Sixty nine percent (61/88) were objectively cured and 48% (42/88) were subjectively cured. Postoperatively, opening detrusor pressure increased (P = 0.0001) and maximum flow rate decreased (P= 0.0464) in women objectively cured but these parameters did not change in the not cured group (P > 0.05). Women had a 4.5 times higher chance of failed surgery if post‐op opening detrusor pressure was ≤20 cmH2O (P = 0.035). Opening detrusor pressure declined with age (P < 0.001) and women who were objectively cured were on average almost 7 years younger (P = 0.0330).

Conclusions

Increase in opening detrusor pressure occurs only in women who are cured following colposuspension. Change in opening detrusor pressure is dependent on age and objective cure is higher in younger women. The effects of ageing on sub‐ urethral supports might explain why surgery is more likely to fail in older women. Neurourol. Urodynam. 23:10–15, 2004. © 2003 Wiley‐Liss, Inc.
Cesarean section: Does it really prevent the development of postpartum stress urinary incontinence? a prospective study of 363 women one year after their first delivery
Authors: Groutz Asnat , Rimon Eli , Peled Simona , Gold Ronen , Pauzner David , Lessing Joseph B. , Gordon David
Published: December 2003

Aims

Stress urinary incontinence (SUI) in young women is usually the result of pelvic floor injury during vaginal delivery. Whether cesarean section delivery may prevent such injury is questionable. We undertook a prospective study to compare the prevalence of SUI among primiparae 1 year after spontaneous vaginal delivery versus elective cesarean section, or cesarean section performed for obstructed labor.

Methods

Three hundred and sixty‐three consecutive primiparae were recruited immediately after delivery and were followed for 1 year. Women were asked upon recruitment whether they had ever experienced SUI before pregnancy. Those who had SUI before pregnancy were excluded. Thus, only cases of de novo childbirth‐associated SUI were analyzed. Patients were divided into three subgroups according to the mode of delivery: spontaneous vaginal delivery (n = 145), elective cesarean section (n = 118), and cesarean section performed for obstructed labor (n = 100). Patients who underwent elective cesarean section were not given a trial of labor. Cesarean sections for obstructed labor were performed at a mean cervical dilatation of 8.7 ± 1.6 cm and arrest of 184 ± 24 min. Prevalence, frequency, and severity of postpartum SUI, as well as demographic and obstetric parameters, were analyzed in each subgroup.

Results

The three subgroups were comparable with respect to maternal age, weight, and height. Prevalence of postpartum SUI was similar after spontaneous vaginal delivery (10.3%) and cesarean section performed for obstructed labor (12%). However, SUI was significantly less common following elective cesarean section with no trial of labor (3.4%, P < 0.05). Approximately half of the symptomatic patients in each subgroup reported either moderate or severe symptoms, however, only 15–18% expressed their desire for further evaluation.

Conclusions

Prevalence of postpartum SUI is similar following spontaneous vaginal delivery and cesarean section performed for obstructed labor. It is quite possible that pelvic floor injury in such cases is already too extensive to be prevented by surgical intervention. Conversely, elective cesarean section, with no trial of labor, was found to be associated with a significantly lower prevalence of postpartum SUI. Whether the prevention of pelvic floor injury should be an indication for elective cesarean section is yet to be established. Neurourol. Urodynam. 23:2–6, 2004. © 2003 Wiley‐Liss, Inc.
A review of non‐invasive electro neuromodulation as an intervention for non‐neurogenic bladder dysfunction in children
Authors: Bower W.F. , Yeung C.K.
Published: December 2003

Aims

The use of electrotherapeutics to improve filling and emptying dysfunction of the adult bladder has been well established, however the practice in children is less well known. The purpose of this review is to summarize the rationale behind the use of electro neuromodulation in children, examine the reported efficacy of the intervention for different presentations of dysfunction, and establish the current limitations to knowledge and practice.

Materials and Methods

A modified systematic review was carried out on all Medline studies identified as considering the use of electrotherapy or neuromodulation in children with bladder problems. Literature relating to use of this approach in adults was also searched in order to present current understanding of the treatment rationale and modes of application.

Results

A Medline search and handsearch of relevant conference proceedings revealed six studies of neuromodulation in children with non‐neurogenic bladder dysfunction. There were no reports of the intervention in children with isolated pelvic floor dyssynergia, irritative symptoms, structural changes predisposing the pelvic floor to weakness, or monosymptomatic nocturnal enuresis. One report of the favorable effect of neuromodulation on gut dysmotility was identified. Study design and quality generated level 4 evidence. Positive post‐intervention changes reported included: increased bladder capacity, decreased severity of urge, improved continence, and decrease frequency of urinary tract infection. Significant improvement in the urodynamic parameters of bladder compliance, number of uninhibited contractions, and bladder volume at first detrusor contraction were also reported.

Conclusions

There are clear benefits from the use of electroneuromodulation in children with differing forms of voiding dysfunction. The treatment approach is independent of cognitive and pharmacological therapy, is minimally invasive, and free of side effects. To date, there are no clinical variables that reliably predict efficacy of electrotherapy in the various presentations of over and under active detrusor, sphincter dyssynergia, or irritative symptoms. Neurourol. Urodynam. 23:63–67, 2004. © 2003 Wiley‐Liss, Inc.