Genitourinary Problems Research Articles

Hemoperitoneum secondary to rupture of a superficial uterine artery overlying a subserous myoma with no predisposing factors in a young woman

Uterine leiomyomas (fibroids, myomas) are common pelvic tumors in women of reproductive age [1], whereas spontaneous intraperitoneal hemorrhage due to uterine leiomyoma is extremely rare [2]. The origin of spontaneous intraperitoneal hemorrhage of uterine myomas is often derived from veins, and may cause anemia and hypovolemic shock afterward [3]. From the perspective of gynecology, hemoperitoneum is usually caused by ectopic pregnancy, ruptured corpus luteum, or adnexal torsion [4e6], and the bleeding is usually venous in origin and can be severe or even life threatening. The diagnosis is often delayed to the time of operation. Recently, we encountered a case of spontaneous hemorrhage of hemoperitoneum resulting from a uterine leiomyoma in a young woman. This hemorrhage was secondary to a spontaneous rupture of a superficial uterine artery overlying a subserous myoma without any predisposing factors. A 22-year-old woman, gravida 0, with no gynecologic or medical condition, surgery, or prior sexual experience, was sent to the emergency department with a sudden onset of acute abdominal pain that was accompanied by bilateral shoulder pain. The patient’s last menstruation occurred 7 days before she presented to the emergency department. No trauma or other associated gastrointestinal or genitourinary system problems were noted. Urine pregnancy test was negative. Examination revealed an afebrile woman in moderate distress (blood pressure: 90/ 60 mmHg; pulse rate: 96 beats/min). Hemoglobin measured 10.6 g/dL. Transabdominal ultrasound showed excessive free fluid at the Morrison pouch and the Douglas pouch, as well as

Genitourinary tract problems encountered in human immunodeficiency virus (HIV) infection and/or acquired immunodeficiency syndrome (AIDS) – a review of the literature

Background. Acquired immunodeficiency syndrome (AIDS) affects all organs of the genitourinary tract. In view of this, clinicians need to be aware of the ways in which AIDS affects each of these organs. Aim. The aim of this article is to review the literature regarding human immunodeficiency virus (HIV) infections and/or AIDS and its impact on the genitourinary tract. Methods. An internet search was carried out to document the reported associations between HIV infection or AIDS and the urinary tract. The search engines used were Google, Google Scholar and PubMed. Scrutiny of manuscripts which discussed in detail the association between HIV infection or AIDS and the organs of the genitourinary tract formed the basis for the review. Results. The organs of the genitourinary tract may be affected by AIDS in a number of ways, as follows: Urethra A number of patients infected with HIV or suffering from AIDS develop dysuria and urinary frequency as a result of cytomegalovirus infection. Other patients may develop B- or T-cell lymphoma involving the urethra. Prostate Opportunistic infections of the prostate gland may be encountered. Scrotum Atypical organisms associated with Fournier's gangrene may be encountered. Epididymis Opportunistic infections of the epididymis may occur. Testis Opportunistic infections of the testis, testicular atrophy and hypogonadism have been reported. Penis Kaposi's sarcoma and squamous cell carcinoma of the penis have been reported. Bladder Voiding dysfunction and acute retention of urine may develop. Urodynamics may show areflexia, hyporeflexia or hyperreflexia. Ureter Renal colic and ureteric obstruction may result from the deposition of concrements of antiretroviral drugs in the ureter. Kidney Structural renal problems including opportunistic infections, tumours and nephropathy may develop. Functional renal problems may include hyponatraemia, hypokalaemia and acute renal failure. Sexual function Primary or secondary gonadal failure in the HIV-infected patient may result in impotence. Malignancies Kaposi's sarcoma, non-Hodgkin's lymphoma and squamous cell carcinoma may develop. Obstruction of the upper urinary tract may necessitate creation of a nephrostomy. Conclusions A number of genitourinary problems have documented associations with HIV infection and AIDS, including opportunistic infections of genitourinary tract organs; functional and structural renal problems; tumours of the penis, bladder and other organs of the genitourinary tract; voiding problems including urinary retention; ureteric obstruction; and impotence.

Visual Diagnosis: A 16-year-old Female With Menstrual Cramps and a History of Anorexia

1. Joseph A. Sykes, MD* 2. Keneisha Bailey, MD† 3. Tej Phatak, MD‡ 4. Nishith Bhattacharyya, MD§ 5. Meena Kalyanaraman, MD* 1. Divisions of *Pediatric Critical Care 2. ‡Pediatric Radiology, and 3. §Pediatric Surgery 4. †Department of Pediatrics, Children’s Hospital of New Jersey, Newark Beth Israel Medical Center, Newark, NJ. A 16-year-old African American girl presents to the emergency department with severe cramping and pain in all quadrants of her abdomen, with the most severe pain located in her right upper quadrant. The pain had started 24 hours previously and initially was dull and diffuse. The pain has worsened progressively with sudden, more severe pain developing in the right upper quadrant 5 to 6 hours before she came to the emergency department. She has had three episodes of nonbilious brown emesis over the past 24 hours. Her last bowel movement was 7 days ago, and she denies any blood or mucus in the stool. She reports having mild abdominal cramps over the past week that she attributes to her recent menstrual period; her last spotting was 8 days ago. There is no history of recent fever, diarrhea, or genitourinary problems. She is not sexually active, and there is no history of alcohol or illicit drug use. The patient has occasionally taken a combined medication of acetaminophen, aspirin, and caffeine for her pain. She has no allergies. She is an excellent student, and there are no known psychosocial stressors in the family. The girl has a chronic history of vague abdominal pain while eating, followed by nonbilious, nonbloody emesis and subsequent relief of pain. These episodes of pain started in early childhood and continued until age 12 years. However, her abdominal pain returned at age 14 years; although that pain was severe, there was no emesis. The pain was unrelated to meals but would present sometimes 2 weeks before menses and sometimes during menses. The pain also was …

December 2012: This Month in JoVE

Here are some highlights from the December 2012 issue of Journal of Visualized Experiments (JoVE). This month, Smith and Thayer combine two classical methods-bromodeoxyuridine (BrDU) incorporation and fluorescence in situ hybridization (FISH)-to examine replication timing of individual mammalian chromosomes. By analyzing differences in BrDU incorporation, our authors can detect how chromosomal rearrangements cause asynchronous replication between homologous chromosomes of a single cell. In JoVE Neuroscience, McManus et al. study neuromuscular activity in the California sea slug (Aplysia californica), and the movements of its feeding apparatus during feeding. Our authors show us how to isolate the slug's mouthparts, induce feeding programs (such as biting and swallowing, and analyze the activity of nerves, muscles, and individual neurons during feeding. Also in JoVE Neuroscience, Mujagic et al. take honeybees (Apis mellifera) from the hive to the lab, where they allow the bees to scan different metal surfaces with their antennae. Then, the researchers feed the bees sugar water after certain tactile stimuli. This trains the bees to extend their proboscises, in anticipation of sugar water, when their antennae touch particular surfaces. Our authors then analyze how changes in antennal movement correspond to associative or non-associative tactile learning. In JoVE Bioengineering, Raza and Lin demonstrate a procedure for generating encapsulated β-cell spheroids in a crosslinked polymer hydrogel. After recovering the aggregates, our authors can use the β-cell spheroids to study cell- and tissue-based therapies for regenerative medicine research. In JoVE Clinical & Translational Medicine, Lessey et al. use methylene blue dye to identify areas of endometriosis, a condition that causes pelvic pain and other genitourinary problems in women. By staining peritoneal surfaces with methylene blue, our authors can identify areas of subtle endometriosis that might otherwise be missed during laparoscopy. This allows our authors to remove all affected tissue, greatly improving surgical outcome for endometriosis patients. In JoVE Immunology and Infection, we learn that wax moths (Galleria mellonella), also known as honeycomb moths, have a lot in common with us mammals. In fact, wax moths have complex innate immune systems that can be used to characterize microbial virulence factors that are relevant to mammalian infections. Ramarao et al. show us how to raise the larvae and infect them with microbes or microbial toxins for pathogenesis assays. This preview summarizes just a few notable video-articles in the December 2012 issue of JoVE. For full-length versions of these and many more video-articles, please visit www.jove.com.

Effect of Age on the Clinical Presentation of Incident Symptomatic Urolithiasis in the General Population

We characterized variation in the clinical presentation between older and younger first time symptomatic stone formers in the general population. We studied a random sample of Olmsted County, Minnesota residents with their first diagnostic code for urolithiasis between 1984 and 2003. Chart validated symptomatic stone formers had a confirmed stone by imaging or stone passage. Clinical presentation characteristics were compared between age groups. Among the 3,473 charts reviewed there were 1,590 validated incident symptomatic stone formers (mean age 43 years, range 18 to 96). Older individuals were more likely to present with atypical or no pain, fever, diarrhea, pyuria, urinary tract infections and bacteremia (p <0.001). Stone size and location did not differ by patient age. Calcium phosphate stone disease was associated with younger age, while uric acid stone and atypical stone composition was associated with older age (p <0.001). Older individuals were less likely to pass the stone spontaneously and were more likely to require surgical intervention (p <0.001). Surgical intervention was required in 516 (32.5%) individuals. Younger individuals were more likely to undergo ureteroscopy while older individuals were more likely to undergo shock wave lithotripsy, temporizing stent placement and percutaneous nephrolithotomy. The detection of stone disease in older individuals can be challenging due to atypical pain or absence of pain, as well as the presence of other comorbid conditions such as urinary tract infections and diarrhea. A higher index of suspicion for urolithiasis may be needed in the elderly for a more timely diagnosis and intervention to prevent morbidity.

A survey on spinal cord injuries resulting from stabbings; a case series study of 12 years' experience

:Background:Penetrating spinal cord injuries (SCIs) are an uncommon injury and not reported very frequently. SCIs cause sensory, motor and genitourinary system problems or a combination of sensorimotor dysfunctions. These are among the most debilitating kinds of disorders and negatively affect quality of life, not only for the patient, but also for their family members. Therefore, the present study aims to evaluate complete or incomplete SCIs and the course of the injury and the prognosis for SCIs caused by stab wounds.Methods:This case-series design study was performed on 57 patients attending the emergency department of Taleqani Trauma Center (Kermanshah, Iran) due to SCIs caused by violent encounters involving sharp objects such as a knife, dagger, whittle and Bowie-knife between 1999 and 2011. An assessment of sensory and motor functions was performed as part of the neurological examination on admission, and during the treatment, using the Frankel Classification grading system, and the results were recorded.Results:The average age of patients was 27 years (SD= 7.9, Range=17 to 46 years). The results of the study showed a proportion of cervical, thoracic and lumbar injuries of 23 (40%), 24 (42%) and 10 (18%), respectively. There was no case of cerebrospinal fluid leakage (CSF) or infection at the wound site in the subjects. Regarding the extent of the SCI, the combined neurological assessment showed that several patients (43%) had a complete SCI with no sensory and motor functions in the sacral segments and the segments below the site of injury. In 32 patients (57%) incomplete injuries were observed; i.e. they showed only some degrees of sensory-motor functions that were below the neurological level.Conclusions:Both complete and incomplete SCIs are of great importance because the prognosis of SCI is directly associated with the location and extent of injury. It should be considered that partial recovery from SCIs is possible in few cases of complete injuries. Therefore, all the patients should be treated carefully and seriously.

4. The Epidemiology of Pelvic Inflammatory Disease in a Pediatric Emergency Department

Lower abdominal pain and genitourinary problems are common chief complaints in adolescent females presenting to emergency departments. We have demonstrated previously that sexually transmitted infections (STI) are common in this population. Pelvic inflammatory disease (PID) is a potentially severe complication of lower genital tract infections, which involves inflammation of the female upper genital tract secondary to ascending STIs. PID has been associated with severe sequelae including infertility, ectopic pregnancy, and chronic pelvic pain.

Transition from childhood to adulthood in Duchenne muscular dystrophy (DMD)

Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy, affecting 1 in 3500 live male births. Mutations in the X chromosome result in an absence of dystrophin, causing progressive muscle degeneration and loss of ambulation by the early teens with respiratory, orthopaedic and cardiac complications. Without intervention these complications lead to death at a mean age of 19 years. However, the natural history of DMD is well-known and can be changed with proactive multidisciplinary management to address predictable complications[1]. Better care has led to a growing adult DMD population, challenging the notion of DMD as a “paediatric” disease. This population faces particular challenges, not only medical (e.g. associated with long-term steroid usage, orthopaedic, ventilation, and cardiac, gastrointestinal or genitourinary problems), but those associated with wider issues of transition. These include medical transfer from paediatric to adult services, and social transition to independent living and full societal inclusion. Transfer arrangements to adult facilities, which vary considerably between clinics and countries, are usually needed due to regulations governing access to paediatric services. As DMD requires co-ordinated care, this move from cohesive paediatric clinics to disjointed adult services is often problematic, and a successful transfer should be the culmination of a period of planned transition. Wider social transition, enabling independent living and further education/employment, is also very important[2]. However, as with many other disabilities, adults with DMD face obstacles to full participation. Planning is crucial, and preparation for adulthood should be considered in partnership with families as part of a comprehensive package of psychosocial care from diagnosis. Recent research suggests that despite legal and health frameworks, DMD transition care in the UK is highly diverse and sometimes lacking[3]. Positive experiences were characterised by forward planning and long-standing relationships between the family and healthcare professionals. In Denmark an integrated model of care is provided by the National Rehabilitation Centre for NMDs (RCfM), which supports families from diagnosis with a comprehensive programme of courses and interventions at significant life milestones[4]. Patient advocacy groups also play a very important role in transition, particularly through programmes such as the MDA Transitions Center. Although there is no one-size-fits-all model for DMD transition care, some features seem particularly important to successful transitions. These include continuity and stability in care; the integration of wider social issues; the involvement of the young man and his family in decision-making; and the support of patient advocacy groups.

Genitourinary Infections after a Routine Pelvic Exam

To determine if genitourinary problems are more common in women in the first 1 to 2 months after a routine pelvic examination. This was a historical cohort study in 2 family medicine teaching clinics at an urban university. Participants included all women who received a Papanicolaou smear during calendar year 2006. Subjects included all participants for weeks 1 to 7 after their Papanicolaou smear. Controls were all participants in weeks 8 to 52 after their Papanicolaou smear. The independent variable was time after Papanicolaou smear, and dependent variables included frequency of visits for urinary complaints, diagnosed urinary tract infections (UTIs), vaginal complaints, diagnosed vaginitis, and sexually transmitted diseases. Relative frequencies compared using 2-tailed t tests. UTIs and urinary complaints were significantly more frequent during the first 7 weeks after a Papanicolaou smear compared with weeks 8 to 14, 8 to 48, and 8 to 52. The overall rate of UTIs was 7.33 per 100 person-years; the attributable risk during the first 7 weeks was 0.82 per 100 person-years, or 11% of observed UTIs. Combined Candidal and bacterial vaginitis was marginally more frequent during the first 7 weeks compared with weeks 8 to 48 and 8 to 52 only. The incidence of sexually transmitted diseases combined was 1.13 per 100 person-years, distributed evenly over the study period unrelated to time. The risk of UTI is increased in the 7 weeks after a Papanicolaou smear.

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul

Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. The three most prevalent reported general health problems were associated with genito-urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one-third of the subjects had not been to the dentist within the previous 5-10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two-thirds of denture-wearing subjects wore their dentures only during eating. There was significant perceived dental treatment and care need for the sample population of elderly studied.

Ambient Exposure to Criteria Air Pollutants and Risk of Death From Bladder Cancer in Taiwan.

PP-30-014 Background/Aims: To investigate the relationship between air pollution and risk of death from bladder cancer, the authors conducted a matched case-control study using deaths that occurred in Taiwan from 1995 through 2005. Methods: Data on all eligible bladder cancer deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of people who died from causes other than cancer or diseases associated with genitourinary problems. The controls were pair matched to the cases by sex, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. Classification of exposure to municipality air pollution was based on the measured levels of nitrogen dioxide and sulfur dioxide. Results: The results of the present study show that there is a significant positive association between the levels of air pollution and bladder cancer mortality. The adjusted odds ratios (95% confidence interval) were 1.37 (1.03–1.82) for the group with medium air pollution level and 1.98 (1.36–2.88) for the group with high air pollution level when compared to the group with the low air pollution level. Trend analyses showed statistically significant trend in risk of death from bladder cancer with increasing air pollution level. Conclusion: The findings of this study warrant further investigation of the role of air pollutants in the etiology of bladder cancer.

Use of Alcoholic Beverages and Other Psychoactive Substances Among Women in Turkey: Medical, Biological, and Social Consequences. A Pilot Study

This research was planned for determining the genitourinary health problems of alcohol and other psychoactive substance-dependent women. This research was conducted using a descriptive method at the Alcohol-Substance Research, Treatment and Education Center (ASRTEC). The research sample comprised 126 women who presented at ASRTEC clinic between September 15, and March 15, 2007, and were diagnosed as being alcohol/drug dependent according to DSM-IV. The data were collected using an Addicted Women's Genitourinary Health Evaluation Form and the Arizona Sexual Experiences Scale. In this study 37.3% of the women were alcohol dependent and 62.7% were substance dependent. It was determined that alcohol and other psychoactive substance-dependent women experience a high rate of genitourinary health problems, such as unprotected sexual intercourse with multiple partners, irregular menstrual cycles, sexual dysfunction, unwanted pregnancies, and abortions.

Milnacipran and venlafaxine at flexible doses (up to 200 mg/day) in the outpatient treatment of adults with moderate-to-severe major depressive disorder: a 24-week randomized, double-blind exploratory study

The objective of this exploratory, multicenter, randomized, double-blind study, was to evaluate the efficacy and safety/tolerability of milnacipran and venlafaxine administered at flexible doses (100, 150 or 200 mg/day, bid administration) for 24 weeks (including 4 weeks up titration period) in the outpatient treatment of adults presenting with a moderate or severe episode of major depressive disorder (MDD) without high suicidal risk (MINI-DSM IV-TR). Of the 195 patients included, 134 (68.7%) completed the study. At baseline the two groups were similar, except there was a higher proportion of patients whose episode was severe-DSM IV in the milnacipran group (63.3% versus 54.0% in the venlafaxine group). The initial MADRS score (mean 31.0) decreased progressively during the study, and this decrease was in the two treatment groups (n = 177: 90 milnacipran; 87 venlafaxine) at week 24 (observed case/OC, mean change -23.1 milnacipran; -22.4 venlafaxine). The rate of MADRS response (reduction >/= 50%) at week 8 and week 24-last observation carried forward/LOCF was similar in the two groups (week 8: 64.4% milnacipran; 65.5% venlafaxine; week 24: 70% milnacipran; 77% venlafaxine), as was the rate of MADRS remission (score </= 10) (week 8: 42.2% milnacipran; 42.5% venlafaxine; week 24: 52.2% milnacipran; 62.1% venlafaxine). In both groups, the most common adverse events were: nausea, dizziness, headache, hyperhidrosis and, in males, genito-urinary problems. The overall safety/tolerability and efficacy profiles of milnacipran and venlafaxine administered at flexible dosages (up to 200 mg/day) were similar in the long term treatment of adults during episodes of MDD in an outpatient setting.

Traffic Air Pollution and Risk of Death from Bladder Cancer in Taiwan Using Petrol Station Density as a Pollutant Indicator

To investigate the relationship between air pollution and risk of death from bladder cancer, a matched cancer case-control study was conducted using deaths that occurred in Taiwan from 1997 through 2006. Data for all eligible bladder cancer deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of individuals who died from causes other than cancer or diseases associated with genitourinary problems. The controls were pair matched to the cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. Data for the number of petrol stations in study municipalities were collected from the two major petroleum supply companies, Chinese Petroleum Corporation (CPC) and Formosa Petrochemical Corporation (FPCC). The petrol station density (per square kilometer) (PSD) for study municipalities was used as an indicator of a subject's exposure to benzene and other hydrocarbons present in ambient evaporative losses of petrol or to air emissions from motor vehicles. The subjects were divided into tertiles according to PSD in their residential municipality. The present study showed that individuals who resided in municipalities with high PSD levels were at an increased risk of death from bladder cancer compared to subjects living in municipalities with a low PSD level; however, the differences are not statistically significant. The findings of this study warrant further investigation of the role of vehicular air pollutant emissions in the etiology of bladder cancer development.

Milnacipran et venlafaxine à posologie flexible (jusqu’à 200 mg/j) dans le traitement ambulatoire des épisodes dépressifs majeurs modérés à sévères de l’adulte : étude exploratoire de 24 semaines, randomisée en double insu

Resume L’objectif de cet essai exploratoire multicentrique, randomise, en double insu, etait d’evaluer l’efficacite et la tolerance du milnacipran (MLN) et de la venlafaxine (VLF) administres a posologie flexible (100, 150 ou 200 mg/j en deux prises journalieres) pendant 24 semaines (dont quatre semaines de titration croissante) dans le traitement ambulatoire de l’adulte presentant un episode depressif majeur modere a severe sans risque suicidaire eleve (MINI–DSM IV-TR). Parmi les 195 patients inclus, 134 (68,7 %) ont complete l’essai. Les caracteristiques basales des deux groupes etaient similaires hormis une proportion sensiblement superieure de patients sous MLN presentant un episode severe-DSM IV (63,3 % versus 54,0 % de patients sous VLF). Le score MADRS initial (moyenne : 31,0) a progressivement diminue et de facon superposable dans les deux groupes analyses (n = 177 : 90/MLN, 87/VLF) jusqu’a semaine 24 (S24-OC ; moyenne : –23,1/MLN ; –22,4/VLF). Les taux de reponse MADRS (reduction ≥ 50 %) a S8 et S24-last-observation-carried-forward (LOCF) etaient similaires dans les deux groupes (S8 : 64,4 %/MLN, 65,5 %/VLF ; S24 : 70 %/MLN, 77 %/VLF), ainsi que les taux de remission MADRS (score ≤ 10) (S8 : 42,2 %/MLN, 42,5 %/VLF ; S24 : 52,2 %/MLN, 62,1 %/VLF). Dans les deux groupes, les evenements indesirables les plus frequents etaient nausees, sensation vertigineuse, cephalees, hyperhidrose et troubles urogenitaux masculins. MLN et VLF administres a posologie flexible (jusqu’a 200 mg/j) ont montre des profils d’efficacite et de tolerance globalement similaires dans le traitement ambulatoire au long terme de l’episode depressif majeur de l’adulte.

The prevalence of and the related factors for urinary and fecal incontinence among older residing in nursing homes

To determine the prevalence of urinary incontinence and fecal incontinence among older people residing in nursing homes in Istanbul. Urinary incontinence (UI) is a multifactorial condition associated with age-related changes and disorders of the genitourinary system and systemic problems affecting normal micturition. The impact of UI and fecal incontinence (FI) on older people living in nursing homes is more significant than those living in the community. Cross-sectional study. This study was performed with 1110 older people who were 60 years and older residing in five government rest homes on the European side of Istanbul in Turkey. An interview was conducted with the residents that had sufficient cognitive function and agreed to participate. Demographic findings and complaints about incontinence were analyzed using a special questionnaire. The total number of older people who participated was 694; 56.5% females and 43.5% males; 43.4% of females and 20.9% of males. Urge incontinence was common in both groups. FI was more common among females (14%, males 6%) and the mean duration of symptoms was longer. The related factors for UI among older females revealed that history of an episiotomy, frequency, urgency, fecal incontinence and functional incapacity among males; whereas history of stroke and pulmonary disorders were independent variables that increased the incidence of frequency, recurrent urinary tract infections and fecal incontinence. The related factors for fecal incontinence among older females included history of stroke and functional status. Diabetes mellitus requiring medical treatment, frequency, functional incapacity and urinary incontinence were significant related factors for fecal incontinence among males. According to similar studies, the urinary and fecal incontinence rates in nursing home residents were lower compared to the other countries. Incontinence was more common among females according to males. Understanding related factors of incontinence are important for providing care and counseling in nursing homes. Nurses can provide appropriate information and support at each step in the protecting, screening, diagnosis and treatment process so that elders' incontinence is minimized.

Screening for Genitourinary Abnormalities in Adolescent Males

1. Robert M. Cavanaugh Jr, MD* 1. *Professor of Pediatrics, Director of Adolescent Medicine, SUNY Upstate Medical University, Syracuse, NY After completing this article, readers should be able to: 1. Describe the importance of screening for genitourinary problems in adolescent boys. 2. Delineate the essential components of screening urology in adolescent boys. 3. Explain when and how to perform sexually transmitted infection testing in adolescent boys. 4. Counsel adolescent boys on sexuality-related issues. Pediatricians and other pediatric clinicians are in an ideal position to screen for genitourinary problems in adolescent boys. Much information can be gathered by screening for sexuality-related issues and by investigating specific genitourinary symptoms as they occur. Routine inspection of the genitalia should be considered an essential component of the regular examination for adolescent boys. This article reviews important asymptomatic genitourinary conditions in young men that can be detected in the pediatric office. The routine history for adolescent boys should address reproductive health-care issues, including questions about the dramatic physical changes, intense emotional feelings, and sexual experiences that occur during puberty as well as any specific genitourinary complaints. These and other sensitive issues should be discussed privately with the clinician, unless the patient specifically requests otherwise. Most parents understand the importance of their adolescent having time alone with the examiner and respect his need for privacy. In certain circumstances and in accordance with state laws (see Guttmacher Institute, www.guttmacher.org), confidentiality and treatment of minors younger than 18 years of age may be permitted without parental or legal guardian consent, although open communication always should be encouraged. For an in-depth discussion on confidential health care for adolescents, the reader is referred to the position paper published by The Society for Adolescent Medicine cited in the Suggested Reading list. Clinicians can screen quickly for reproductive health care issues in adolescent boys by asking “trigger” questions (Table 1). General questions regarding pubertal changes are a useful lead into a more detailed sexual history. To …

Unveiling the less explored side of Parkinson's disease

Although only recognised in very few studies, non-motor symptoms (NMS) are one of the most disabling aspects of Parkinson's disease, often outweighing the burden of dyskinesias and substantially affecting quality of life of patients, as well as precipitating hospitalisation. NMS include dementia, depression, apathy, constipation, pain, genitourinary and gastrointestinal problems, and sleep disorders. Unfortunately, these symptoms are generally under-reported and are overshadowed by the more prominent report of motor symptoms. Chaudhuri, Tolosa, Schapira, and Poewe have edited a book with more than 60 co-authors and 29 chapters to update and review NMS in Parkinson's disease. After an introductory review on the topic, the first three chapters address NMS according to different stages of disease. Starting with the premotor stage, the authors describe symptoms that are considered premonitory of the diagnosis, subsequently discussing those observed during the early stages and ultimately those that appear during the final or advanced stages. The next two chapters deal with diagnosis of NMS by use of current scales and imaging techniques. In addition to reviewing diagnostic tools for NMS, these chapters offer interesting material on current hypotheses underlying the pathophysiology of such symptoms, a topic that I would have liked to have seen discussed more thoroughly in the chapter on NMS and premotor diagnosis later in the book. Several chapters individually outline different NMS, with two chapters that review the effect of deep brain stimulation on these symptoms and fluctuations of these symptoms that are associated with antiparkinsonian medication. Treatment-related NMS are also included here, as is a separate chapter on impulse control disorders and dopamine dysregulation syndrome. Focusing on NMS in this way has enabled the editors to put together a most comprehensive review. When reading the book from beginning to end, this approach induces certain overlap in content between the first four chapters and later ones dedicated to a particular symptom. However, this approach is very helpful in terms of consultation on specific NMS issues, and the wide range of topics covered widens readers' interest to include not only movement disorders specialists but also the general practitioner. The chapter on NMS and the genetic forms of parkinsonism is novel, with a large batch of new material that I found particularly enjoyable reading. More than 350 papers are reviewed, suggesting that the number of cases of NMS in genetic forms of Parkinson's disease might be lower than sporadic forms, with some exceptions. These include dementia in the parkinsonism caused by the mutation in ATP13A2, psychiatric disorders caused by the mutation in PINK1, and the well known preservation of the sense of smell in patients with mutations in PARK2. However, following the intuitive outline of the text as a whole, this chapter would perhaps have been better placed at the end of the book. The work is fully referenced and contains more than 60 well-considered tables with excellent summaries of most clinically relevant information, helping the reader to rapidly consult key chapter facts. The introduction and purpose of a second order of tables outlined as boxes was not as clear to me. Initially, I thought that these boxes were intended for the display of take-home messages, accepted clinical criteria, or clinical vignettes but, in the end, the authors mixed together all kinds of different information. As a minor point, seborrheic dermatitis is mentioned on only three occasions throughout the book; bearing in mind that this symptom affects a substantial number of patients, this sign should have deserved a little more attention. In my opinion, this book is an enjoyable read and represents a great effort and an important addition to increasing awareness of the long list of NMS that burdens patients with Parkinson's disease.

Lecture Notes: Emergency Medicine, 3rd edn

This is the third edition of a text that was born in 1985 as Lecture Notes in Accident and Emergency Medicine, under the co-authorship of Professors David Yates and Anthony Redmond. Following seven reprints, it was completely rewritten in 1999 by Chris Moulton and David Yates. Again, after several reprints, they have endeavoured to present an up-to-date approach to emergency medicine based on progressive improvements in clinical practice albeit in the light of enormous change in the delivery of healthcare in the UK. The authors point out that, although they have attempted to use the best available evidence, they have not been slaves to an evidential doctrine when there are no clear recommendations for commonly occurring problems. It very successfully presents current core knowledge in the field of accident and emergency medicine in a logical manner with a significant amount of cross-referencing between chapters particularly where boxed sections presenting key elements to assist diagnosis and management are relevant to the specific text. For example, the chapter on burns includes a valuable summary box on fluid replacement and provides cross references to radiation injury within a later chapter on poisoning. In addition, the chapter on cardiac arrest and dysrhythmias includes the latest guidelines from the Resuscitation Council. The introductory chapter on the principles of emergency medicine includes a helpful section on sedation and general anaesthesia with important guidance for the discharge of patients who have received sedative drugs in the emergency department. Following an outline of the management of major trauma and multiple injuries, the text proceeds in a logical anatomical manner through injuries to the head, face and neck: the trunk (including chest and abdomen) and upper and lower limbs, with a separate chapter covering the hand. Cardiac arrest, chest pain, respiratory distress, collapse and sudden illness are followed by abdominal pain, obstetric, gynaecological, genito-urinary and perineal problems before moving on to sensitively constructed chapters on children's problems, disturbed patients and medicolegal aspects of emergency medicine. The penultimate chapter on small wounds and localised infections emphasises that ‘small does not mean trivial’ and covers a comprehensive field including transmission of blood-borne viruses very succinctly. The concluding section covering ophthalmic, ENT and dental conditions together with facial pain reminds us that over 5% of emergency department attendances involve eye-related problems. The comprehensive index extends over 20 pages and helpfully has separate italicised entries referring to figures and tables. Although aimed at undergraduates, junior doctors on foundation programmes, trainees in accident and emergency medicine, and doctors and nurses in the primary care setting, there is little doubt that this book will have a wider interest for those in early years surgical training and for more senior colleagues wishing to update themselves in the management of patients presenting with acute conditions outside their immediate field of specialist expertise.

Lecture Notes: Emergency Medicine, 3rd edn

This is the third edition of a text that was born in 1985 as Lecture Notes in Accident and Emergency Medicine, under the co-authorship of Professors David Yates and Anthony Redmond. Following seven reprints, it was completely rewritten in 1999 by Chris Moulton and David Yates. Again, after several reprints, they have endeavoured to present an up-to-date approach to emergency medicine based on progressive improvements in clinical practice albeit in the light of enormous change in the delivery of healthcare in the UK. The authors point out that, although they have attempted to use the best available evidence, they have not been slaves to an evidential doctrine when there are no clear recommendations for commonly occurring problems. It very successfully presents current core knowledge in the field of accident and emergency medicine in a logical manner with a significant amount of cross-referencing between chapters particularly where boxed sections presenting key elements to assist diagnosis and management are relevant to the specific text. For example, the chapter on burns includes a valuable summary box on fluid replacement and provides cross references to radiation injury within a later chapter on poisoning. In addition, the chapter on cardiac arrest and dysrhythmias includes the latest guidelines from the Resuscitation Council. The introductory chapter on the principles of emergency medicine includes a helpful section on sedation and general anaesthesia with important guidance for the discharge of patients who have received sedative drugs in the emergency department. Following an outline of the management of major trauma and multiple injuries, the text proceeds in a logical anatomical manner through injuries to the head, face and neck: the trunk (including chest and abdomen) and upper and lower limbs, with a separate chapter covering the hand. Cardiac arrest, chest pain, respiratory distress, collapse and sudden illness are followed by abdominal pain, obstetric, gynaecological, genito-urinary and perineal problems before moving on to sensitively constructed chapters on children's problems, disturbed patients and medicolegal aspects of emergency medicine. The penultimate chapter on small wounds and localised infections emphasises that ‘small does not mean trivial’ and covers a comprehensive field including transmission of blood-borne viruses very succinctly. The concluding section covering ophthalmic, ENT and dental conditions together with facial pain reminds us that over 5% of emergency department attendances involve eye-related problems. The comprehensive index extends over 20 pages and helpfully has separate italicised entries referring to figures and tables. Although aimed at undergraduates, junior doctors on foundation programmes, trainees in accident and emergency medicine, and doctors and nurses in the primary care setting, there is little doubt that this book will have a wider interest for those in early years surgical training and for more senior colleagues wishing to update themselves in the management of patients presenting with acute conditions outside their immediate field of specialist expertise.