1/4. Secondary enuresis: post-traumatic stress disorder in children after car accidents.BACKGROUND: In our experience, secondary enuresis nocturna is a common complaint among children after a motor vehicle accident. However, as these children are often brought for examination as part of an insurance compensation claim, this complaint is not always reliable. OBJECTIVE: To describe a series of children in whom secondary enuresis occurred after a motor vehicle accident. methods AND RESULTS: Five children were brought to our clinic for evaluation of secondary nocturnal enuresis. review of past history revealed a car accident preceding the onset of the enuresis. All but one had additional behavioral symptoms typical of post-traumatic stress disorder. Four children had evidence of head trauma, and one had psychological but no physical trauma. CONCLUSIONS: nocturnal enuresis can occur after a motor vehicle accident due either to purely psychological trauma or organic head trauma. While nocturnal enuresis is generally attributed to organic causes, psychological mechanisms also play a significant role.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Management of intrinsic sphincter deficiency in adolescent females with normal bladder emptying function.PURPOSE: Intrinsic sphincter deficiency is rare in adolescent females with normal bladder emptying function. Information regarding the long-term outcome of therapy in this group of patients is sparse. We report our long-term experience with 3 adolescent females with intrinsic sphincter deficiency and normal bladder function who were treated with an artificial urinary sphincter. We critically reviewed the literature regarding experience with anti-incontinence surgery in adolescent females, not only regarding the outcome of the surgical technique, but also issues not usually considered in older adults, including the impact of physical development and future childbearing. MATERIALS AND methods: The charts of 3 adolescent females with intrinsic sphincter deficiency were reviewed. In addition, relevant peer reviewed articles were selected by a medline search. The results of the artificial urinary sphincter, pubovaginal sling and periurethral injection of bulking agents were reviewed. Long-term efficacy, the complication rate, impact of pregnancy and physical development were assessed. RESULTS: The 3 patients had an excellent long-term outcome with the artificial urinary sphincter, including 1 with 2 pregnancies that ended in a normal vaginal delivery. The literature showed that a good long-term outcome was consistently achieved with the artificial urinary sphincter. An equally good outcome was achieved with the pubovaginal sling but long-term data are lacking. While periurethral injection of a bulking agent provides good initial results, they do not appear to be durable. In addition, the artificial urinary sphincter does not appear to impact pregnancy or physical development negatively. CONCLUSION: Data support the artificial urinary sphincter and pubovaginal sling as effective therapies in adolescent females with intrinsic sphincter deficiency. However, long-term data on the pubovaginal sling are not available. When considering the impact on future childbearing and physical development, the artificial urinary sphincter is a favorable option.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
3/4. Treatment of long-standing nocturnal enuresis by mandibular advancement.Enuresis, the involuntary release of urine during sleep, is one of the most common disorders of childhood. More common in boys than girls, this condition is characterized by night-time wetting in the presence of normal urinalysis and physical examination. At present, treatment can be divided into behavioral modification and pharmacological therapy, despite which many enuretic children remain untreated or are treated ineffectively. Treatment of long-standing chronic enuresis by orthodontic appliances could be used more frequently to give relief to those not responding to conventional treatment. mandibular advancement therapy is especially beneficial in the treatment of enuretic patients presenting with anteroposterior skeletal discrepancies.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. risk factors for hypothermia in psychiatric patients.hypothermia occurs when the core body temperature falls below 95 degrees F (35 degrees C). Several conditions which can occur in the psychiatric population increase the risk of hypothermia: nocturnal enuresis, seizure disorder, debilitating physical illness, and mental retardation. The risk of hypothermia is further increased by the use of several classes of medications used to treat psychiatric disorders: antipsychotics, beta-adrenergic antagonists, benzodiazepines, and other sedatives. air-conditioning is also identified as a risk factor for hypothermia. hypothermia is posited as a possible link between antipsychotic medication and sudden unexplained death. Suggestions for further investigation are made, and clinical recommendations are offered to reduce the risk of hypothermia in the psychiatric patient population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |