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Electromyography of Urethral Sphincter in Women With Urinary Retention
IV!ETABOLISl\4, El'
human sources will be antibodies of animal produced in ever increasing numbers in the future. With the results of kidney grafting at good centers now achieving 80 per cent 1-year survival for cadaver grafts and 60 per cent 3-year survival, small improvements may be difficult to demonstrate. However, some monoclonal antibodies appear to be able to improve the results of grafts and, particularly, to reverse early rejection. E. D. W. 5 references
1381
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Acquired Immunodeficiency Syndrome
K. V. I. ROLSTON AND G. P. BODEY, Section of Infectious Diseases, Department of Internal Medicine, The University of Texas M. D. Anderson Hospital and Tumor Institute, Houston, Texas Sem. Surg. Oncol., 2: 53-71, 1986
URODYNAMICS, PHYSIOLOGY AND EMBRYOLOGY Electromyography of Urethral Sphincter in Women With Urinary Retention
C. J. FOWLER AND R. S. KIRBY, Departments of Clinical Neurophysiology and Urology, Middlesex Hospital, London, England Lancet, 1: 1455-1457 (June 28) 1986 A total of 48 women with a long-standing history of urinary retention underwent concentric needle electromyography of the external urethral sphincter. Of the patients 16 had abnormal motor units showing polyphasic wave forms or increased amplitude consistent with reinnervation. Associated diseases that might have explained the neural damage were found in 12 of these patients but in 4 no cause for the findings could be identified. In 19 patients deceleration bursts and complex repetitive discharges were recorded. The pathogenesis of these findings remains unclear to date but they may be related to spasticity of the sphincter. The electromyographic findings were normal in 13 patients. Because of the high incidence of abnormal electromyographic findings in these patients the concept of psychogenic retention as a cause of urinary retention in women should be used with caution. T. D. A. 1 table, 20 references
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY P!f'e-P:rostatectomy Int:ravenm.1.s Urography-fa it a Must? M. H. MuzAFER, Manor House Hospital, London, England
Int. Urol. Nephrol., 18: 65-69, 1986 It is customary to perform an excretory urogram (IVP) as a routine preoperative diagnostic procedure in patients with infravesical obstruction. The author determines whether an IVP is a justified routine investigation in patients with prostatism. The value of the IVP as a preoperative necessity in patients with an enlarged prostate is discussed. Based on the findings of 150 IVPs studied retrospectively, he concluded that the IVP still is an important investigation in patients with prostatism: 13.3 per cent showed impaired renal function and back pressure changes, 21.3 per cent showed coexistence of abnormalities and pathological conditions of the urinary tract, and 59.3 per cent suggested an enlarged prostate. G. P. M. 2 tables, 12 references
More than 16,000 cases of the acquired immunodeficiency syndrome (AIDS) have been reported in the United States in the last 5 years. Roughly half of the reported patients are known to have died. This epidemic most certainly is the most devastating to confront man in modern times. Approximately 65 per cent of AIDS patients are homosexuals and 25 per cent are intravenous drug abusers. Hemophiliac patients and heterosexual contacts of AIDS patients each comprise approximately l per cent of the total known cases. Transfusion-related AIDS has occurred in 261 patients (2 per cent of the total). Generally, these patients received considerably more blood than the general transfusion population. Approximately 6 per cent of the patients with AIDS have no identifiable risk factor but the history of illicit drug use or homosexual behavior often is difficult to obtain. To date antibody to human T lymphotropic retrovirus (HTL V-III) can be detected in all patients with AIDS, and the virus itself has been cultured from the blood, bone marrow, lymph nodes, saliva, semen and brain of affected victims. Transplacental transmission of the virus from mother to child does occur as does transmission via heterosexual contact. The HTL V-HI virus appears to infect selectively the T-4 (helper/inducer) lymphocyte, which has a central role in regulating the immune response. Disruption of the normal immune response explains why AIDS patients most often present with opportunistic infections typical of immunosuppressed patients. Kaposi's sarcoma and central nervous system lymphoma also are hallmarks of AIDS and point to disordered immune regulation. Lymphadenopathy, weight loss, fatigue and fever are frequent prodomal symptoms but the opportunistic infections most commonly are responsible for the morbidity and mortality of AIDS. Pneumocystis carinii pneumonia is the most common infection and is present in 60 per cent of the patients at diagnosis. Toxoplasma gondii encephalitis and Cryptosporidium enteritis are other protozoal infections that commonly are found in AIDS patients. Histoplasma, Candida and Cryptococcus fungal infections can be seen with some regularity in this disease. Cytomegalovirus is the most common viral infection in patients with AIDS but herpes and papovavirus infections also are detected. Mycobacterium avium intracellulare previously was not found in human disease but it is a particularly difficult infection to treat in the AIDS patient, since the organism is resistant to all conventional antituberculous drugs. About a third of the patients will present with Kaposi's sarcoma. Although death infrequently is caused by this tumor, it is responsible for considerable morbidity. The exact frequency of lymphoma in AIDS patients is unknown but there does seem to be some relationship of importance. Health care workers are at risk and transmission via a needle stick has been implicated as causing AIDS in at least 1 case. The precautions necessary to prevent such spread are similar to those recommended to prevent spread of hepatitis-B. Although opportunistic infections can be treated as they
human sources will be antibodies of animal produced in ever increasing numbers in the future. With the results of kidney grafting at good centers now achieving 80 per cent 1-year survival for cadaver grafts and 60 per cent 3-year survival, small improvements may be difficult to demonstrate. However, some monoclonal antibodies appear to be able to improve the results of grafts and, particularly, to reverse early rejection. E. D. W. 5 references
1381
METABOLISM, ENDOCRINOLOGY AND IMMUNOLOGY Acquired Immunodeficiency Syndrome
K. V. I. ROLSTON AND G. P. BODEY, Section of Infectious Diseases, Department of Internal Medicine, The University of Texas M. D. Anderson Hospital and Tumor Institute, Houston, Texas Sem. Surg. Oncol., 2: 53-71, 1986
URODYNAMICS, PHYSIOLOGY AND EMBRYOLOGY Electromyography of Urethral Sphincter in Women With Urinary Retention
C. J. FOWLER AND R. S. KIRBY, Departments of Clinical Neurophysiology and Urology, Middlesex Hospital, London, England Lancet, 1: 1455-1457 (June 28) 1986 A total of 48 women with a long-standing history of urinary retention underwent concentric needle electromyography of the external urethral sphincter. Of the patients 16 had abnormal motor units showing polyphasic wave forms or increased amplitude consistent with reinnervation. Associated diseases that might have explained the neural damage were found in 12 of these patients but in 4 no cause for the findings could be identified. In 19 patients deceleration bursts and complex repetitive discharges were recorded. The pathogenesis of these findings remains unclear to date but they may be related to spasticity of the sphincter. The electromyographic findings were normal in 13 patients. Because of the high incidence of abnormal electromyographic findings in these patients the concept of psychogenic retention as a cause of urinary retention in women should be used with caution. T. D. A. 1 table, 20 references
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY P!f'e-P:rostatectomy Int:ravenm.1.s Urography-fa it a Must? M. H. MuzAFER, Manor House Hospital, London, England
Int. Urol. Nephrol., 18: 65-69, 1986 It is customary to perform an excretory urogram (IVP) as a routine preoperative diagnostic procedure in patients with infravesical obstruction. The author determines whether an IVP is a justified routine investigation in patients with prostatism. The value of the IVP as a preoperative necessity in patients with an enlarged prostate is discussed. Based on the findings of 150 IVPs studied retrospectively, he concluded that the IVP still is an important investigation in patients with prostatism: 13.3 per cent showed impaired renal function and back pressure changes, 21.3 per cent showed coexistence of abnormalities and pathological conditions of the urinary tract, and 59.3 per cent suggested an enlarged prostate. G. P. M. 2 tables, 12 references
More than 16,000 cases of the acquired immunodeficiency syndrome (AIDS) have been reported in the United States in the last 5 years. Roughly half of the reported patients are known to have died. This epidemic most certainly is the most devastating to confront man in modern times. Approximately 65 per cent of AIDS patients are homosexuals and 25 per cent are intravenous drug abusers. Hemophiliac patients and heterosexual contacts of AIDS patients each comprise approximately l per cent of the total known cases. Transfusion-related AIDS has occurred in 261 patients (2 per cent of the total). Generally, these patients received considerably more blood than the general transfusion population. Approximately 6 per cent of the patients with AIDS have no identifiable risk factor but the history of illicit drug use or homosexual behavior often is difficult to obtain. To date antibody to human T lymphotropic retrovirus (HTL V-III) can be detected in all patients with AIDS, and the virus itself has been cultured from the blood, bone marrow, lymph nodes, saliva, semen and brain of affected victims. Transplacental transmission of the virus from mother to child does occur as does transmission via heterosexual contact. The HTL V-HI virus appears to infect selectively the T-4 (helper/inducer) lymphocyte, which has a central role in regulating the immune response. Disruption of the normal immune response explains why AIDS patients most often present with opportunistic infections typical of immunosuppressed patients. Kaposi's sarcoma and central nervous system lymphoma also are hallmarks of AIDS and point to disordered immune regulation. Lymphadenopathy, weight loss, fatigue and fever are frequent prodomal symptoms but the opportunistic infections most commonly are responsible for the morbidity and mortality of AIDS. Pneumocystis carinii pneumonia is the most common infection and is present in 60 per cent of the patients at diagnosis. Toxoplasma gondii encephalitis and Cryptosporidium enteritis are other protozoal infections that commonly are found in AIDS patients. Histoplasma, Candida and Cryptococcus fungal infections can be seen with some regularity in this disease. Cytomegalovirus is the most common viral infection in patients with AIDS but herpes and papovavirus infections also are detected. Mycobacterium avium intracellulare previously was not found in human disease but it is a particularly difficult infection to treat in the AIDS patient, since the organism is resistant to all conventional antituberculous drugs. About a third of the patients will present with Kaposi's sarcoma. Although death infrequently is caused by this tumor, it is responsible for considerable morbidity. The exact frequency of lymphoma in AIDS patients is unknown but there does seem to be some relationship of importance. Health care workers are at risk and transmission via a needle stick has been implicated as causing AIDS in at least 1 case. The precautions necessary to prevent such spread are similar to those recommended to prevent spread of hepatitis-B. Although opportunistic infections can be treated as they