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Biomedical subjects

A J Kirshen

Publications and source records attributed to A J Kirshen.

12 recordsLinked to original sources
PubMed1993

Desmopressin acetate and nocturnal enuresis: how much do we know?

OBJECTIVES: Desmopressin acetate (DDAVP) is promoted to treat nocturnal enuresis but indications for its use are unclear. We reviewed all randomized controlled trials to determine (1) short- and long-term efficacy, (2) responders, (3) dose-response curve, (4) side effects, and (5) comparative efficacy with other treatments. METHODS: A Medline search of the English language literature from January 1966 to August 1992, supplemented by contact with the drug companies, yielded 18 articles which were true randomized controlled trials (11 cross-over and 7 parallel studies). RESULTS: The 18 randomized controlled trials included 689 subjects for most of whom some other type of treatment had failed. All studies found decreased mean frequency of wetting ranging from 10% to 91%, but only 24.5% of subjects achieved short-term dryness. One study of DDAVP responders directly tested long-term dryness and 21% stayed dry. In three studies that incidentally reported on long-term effects 5.7% stayed dry after stopping DDAVP: There was wide variation in the type of patient included. Seven studies addressed prognostic factors. Children more than 9 years old and with fewer initial wet nights do better. Four studies seem to include almost exclusively monosymptomatic children with nocturnal enuresis (ie, primary nocturnal enuresis, positive family history, and no urinary symptoms). Results were no better than those which included mixed symptoms. Five studies attempted to address the dose-response issue. Despite some methodological issues, there is probably some dose-response effect. Side effects were infrequent in the 589 subjects who received DDAVP as opposed to placebo. No cases of water intoxication and no significant shifts in electrolytes were reported in the four studies which measured them. Nasal stuffiness, headache, epistaxis, and mild abdominal pain seem to be the only side effects noted, and these were uncommon. Only one study compared DDAVP with conditioning alarms. Alarm patients had 10% fewer wet nights and a better long-term result. CONCLUSIONS: DDAVP reduces wet nights in children for whom other treatments have failed but it produces complete dryness in a minority, and this is often a temporary effect. The literature focuses on short-term efficacy. The true role of DDAVP will be known when samples are carefully selected, prognostic factors are examined, and more comparisons with other treatments are conducted focusing on long-term outcomes. On the basis of current knowledge, DDAVP is inferior to conditioning alarms as a primary therapy.

Child↗
PubMed1985

A new definition of Alzheimer's disease: a hippocampal dementia.

Preliminary data support the hypothesis that the decline of all higher cognitive functions in senile dementia of the Alzheimer type is attributable to histopathological changes in the hippocampal formation, with or without neocortical neuronal lesions. Previous literature amply supports the critical role of this "locus minoris resistentiae" in memory processing and cognitive physiology. New observations include quantitative morphometric evaluations of the hippocampal formation from a longitudinal study of prospectively tested patients and histological and neurochemical data from patients with a clinical presentation consistent with typical Alzheimer's disease, in whom the only neuropathological abnormality was devastating nerve cell loss and gliosis in the hippocampi.

Aged↗
PubMed1983

Urinary incontinence in the elderly: a review.

About 20% of the aging population of Canada is incontinent of urine, at a minimum annual cost of $150 million for incontinence pads alone. The inability of the individual or the family to cope with the problem is often the sole reason for placing the individual in an institution. Until recently, the subject received only sporadic attention from groups of urologists, gynaecologists and internists. The physiology and pathophysiology of micturition and urinary incontinence in the elderly are reviewed as the basis for appropriate management strategies. Geriatric urinary incontinence can be adequately evaluated, in most cases, by a clinical history in combination with a neurologic and urologic examination and cystometry.

Age Factors↗