Betel nut and smoking. Are they both protective in ulcerative colitis? A pilot study.

Two-hundred and twenty-three Asian patients with inflammatory bowel disease were sent a questionnaire about smoking and betel nut chewing habits. The 116 responses from patients with ulcerative colitis were compared with answers from 79 healthy members of the community. Twelve per cent of male patients were currently smokers compared with 31% of healthy controls (chi 2 = 20.

The effect of temporary cutaneous diversion on ultimate bladder function.

We evaluated the effect of temporary cutaneous diversion on bladder function in cases of various congenital uropathies. The clinical courses of patients who underwent reversal of vesicostomy or pyelostomy/ureterostomy in a 7-year period were reviewed. Indications for diversion included azotemia, massive hydronephrosis, high grade reflux and/or incomplete bladder emptying.

Concomitant bladder neck closure and Mitrofanoff diversion for the management of intractable urinary incontinence.

In a 7-year period 28 patients 1 to 20 years old have undergone bladder neck closure in conjunction with Mitrofanoff diversion for the management of severe incontinence. Surgery was performed as a salvage procedure in 19 patients and as a primary anti-incontinence procedure in 9. At a mean followup of 29 months 27 of 28 patients (96%) were totally continent, requiring no pads.

Histologic studies of intravesical oxybutynin in the rabbit.

Intravesically applied oxybutynin has been reported to have no significant systemic anticholinergic side effects, with excellent efficacy in the treatment of neurogenic bladder dysfunction. Currently, the morphologic effects of intravesical oxybutynin on the local bladder tissue are not well established. It is the purpose of this study to address this issue in an animal model.

Functional characteristics of the reconstructed neourethra after island flap urethroplasty.

To test the neourethra objectively in cases judged to be clinical successes after transverse island flap hypospadias repair, we analyzed uroflowmetry data (peak flow, voided volume and ultrasonically determined post-void residuals) after repair. Patients were included if they were old enough to void volitionally and flow data were available after fistula or stricture repair. Flow data were then plotted on previously published age-dependent nomograms from normal controls.

Extravesical detrusorrhaphy for refluxing ureters associated with paraureteral diverticula.

Objectives: To demonstrate the effectiveness of an extravesical approach to refluxing ureters associated with paraureteral diverticula.

Methods: Over a 39-month period, 23 children underwent repair of Hutch diverticula with refluxing ureters using an extravesical approach. Seventeen had unilateral reflux with an ipsilateral diverticulum, 4 had bilateral reflux with a unilateral diverticulum, and 2 had bilateral reflux with bilateral diverticula.

Bilateral congenital midureteral adynamic segments.

Two cases of congenital midureteral adynamic segments are presented. Both children were successfully managed with excision of the lesions and primary reanastomosis. Pathologic examination revealed probe-patent ureters with muscular disarray, suggesting functional obstruction.

A modified extravesical technique for megaureter repair.

Objective: To report on the use of extravesical detrusorraphy for megaureter repair.

Patients And Methods: Twenty-three children underwent an extravesical megaureter repair over a 25 month period. There were 17 boys and 6 girls with an average age of 4.

The sensitivity of pressure specific bladder volume versus total bladder capacity as a measure of bladder storage dysfunction.

Assessment of bladder storage function requires an accurate measure of bladder capacity and pressure. Pressure specific bladder volume is the volume that a bladder can accommodate at a specific pressure. A total of 21 consecutive children with neurogenic bladders who were candidates for bladder augmentation based on standard clinical criteria (upper urinary tract deterioration, incontinence and infection) was studied to determine the efficacy of pressure specific bladder volume as a measure of bladder dysfunction.

Can previously relocated penile skin be successfully used for salvage hypospadias repair?

Between 1986 and 1992, 39 boys underwent 44 pedicle flap urethroplasties as a salvage procedure using penile skin that had been relocated during prior hypospadias repair(s). All previous operations had resulted in a meatus in an unacceptable position. The salvage pedicle flap procedure used for these boys was either a Mathieu urethroplasty or an island flap repair.

Bladder augmentation: ureterocystoplasty versus ileocystoplasty.

The primary advantages of augmentation ureterocystoplasty include the absence of mucus, lack of electrolyte absorption from the augmenting segment and the avoidance of gastrointestinal complications. We tested whether the ureteral patch offers sufficient biomaterial to increase adequately the storage efficiency of dysfunctional bladders. Between April 1989 and November 1992, 8 children with unilaterally dilated and tortuous ureters underwent bladder augmentation using detubularized reconfigured megaureter.

Loss of elasticity in dysfunctional bladders: urodynamic and histochemical correlation.

To store adequate volumes of urine at low safe pressures an elastic bladder wall is required. We developed 2 new techniques to measure this ability in our urodynamic laboratory: pressure specific bladder volume, which measures the bladder capacity at a given pressure, and dynamic analysis of bladder compliance. Recently, morphometric and histochemical techniques have been used to determine the relative volume of connective tissue in the bladder wall and to measure the 2 major types (I and III) of collagen within the bladder wall.

Contradictory supranormal differential renal function during nuclear renographic investigation of hydroureteronephrosis.

We selected a group of children with unilateral hydroureteronephrosis to assess the significance of the differential renal function as determined by nuclear renography as a factor in defining obstructive dilatation. All children who presented to our institution during a 21-month period with unilateral hydroureteronephrosis and a normal contralateral kidney were reviewed. Patients with reflux or bladder pathology were excluded, resulting in 13 evaluable patients younger than age 2 years.

Traumatic eventration of diaphragm complicated by mesenteroaxial volvulus of the stomach.

Diaphragmatic disruption is an uncommon consequence of blunt trauma and is often overlooked unless there is a high index of clinical suspicion. A case of eventration of left dome of diaphragm following trauma with mesenteroaxial volvulus of the stomach is presented. Anatomical considerations on levels of diaphragm on chest x-ray has been elaborated.

Budd Chiari syndrome and pericaval filariasis.

A young girl presented with Budd-Chiari syndrome (BCS) with narrowing of the retrohepatic segment of inferior vena cava (VC). Dorsal cavoatrial bypass (DCAB) was unsuccessful due to thrombotic occlusion of the graft. A limited autopsy revealed occlusion of the retrohepatic segment of IVC and the terminal parts of the three major hepatic veins.

Infertility, obstetric and gynaecological problems in coeliac sprue.

There is now substantial evidence that coeliac sprue is associated with infertility both in men and women. In women it can also lead to delayed menarche, amenorrhoea, early menopause, recurrent abortions, and a reduced pregnancy rate. In men it can cause hypogonadism, immature secondary sex characteristics and reduce semen quality.

Oesophageal manometry in noncardiac chest pain.

Chest pain of oesophageal origin is an important differential diagnosis in patients with cardiac chest pain. A preliminary survey of 40 patients with noncardiac chest pain (NCCP) revealed oesophageal motility disorder in 47.5%; achalasia cardia being the most frequent disease (47.

Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire.

The family history of patients identified during incidence studies in Leicestershire were investigated and the prevalence and comparative risks calculated; 1254 patients aged 15 to 80 years were sent a questionnaire about their family history. All cases with a positive family history were reviewed and confirmed cases included in the study. In Europeans the standardised prevalence of Crohn's disease was 75.

British gastroenterologists' care profile for patients with inflammatory bowel disease: the need for a patients' charter.

The follow-up of patients with inflammatory bowel disease (IBD) was investigated using a postal questionnaire sent to 359 members of the British Society of Gastroenterology (BSG), of whom 235 replied. Of patients with IBD, 96% were weighed on each out-patient clinic review and over 60% had their full blood count checked. Although few centres (20%) have computerized recall of their patients for cancer surveillance, 96% did perform such surveillance on patients with ulcerative colitis.