Search PubMed⌕ Search

Biomedical subjects

I Richards

Publications and source records attributed to I Richards.

28 records · Page 2Linked to original sources
PubMed1988

The urological manifestations of the tethered spinal cord.

The tethered spinal cord is an entity with potentially grave neurourological implications. Presenting urological symptoms include incontinence, symptomatic urinary tract infections and stool soiling. These symptoms may be the first to herald a tethered cord. The patients with previously repaired myelodysplastic defects are particularly prone to development of this lesion. We correlated urological history with preoperative and postoperative cystometry in 20 myelodysplastic children. In this study we noted that clinical symptomatology and urodynamic parameters improved in 60 per cent of those children who underwent cord untethering. A better result was evident in children whose condition was repaired promptly.

Fecal Incontinence↗
PubMed1988

Screening for proteinuria in a rheumatology clinic: comparison of dipstick testing, 24 hour urine quantitative protein, and protein/creatinine ratio in random urine samples.

Measurements of protein/creatinine ratio in 'spot' urine samples were compared with measurements of 24 hour quantitative proteinuria and side room 'dipstick' testing in 104 samples from 90 patients presenting consecutively to a rheumatology unit. Linear regression analysis showed a highly significant correlation between the random urinary protein/creatinine ratio and total protein excretion in 24 hour urine samples (r = 0.92, p less than 0.001, y = 6.55x + 0.04). Although an approximation of 24 hour urinary protein excretion could have been made from the regression line: 24 hour urine protein = 6.55 x protein/creatinine ratio + 0.04 (g/l), there was a wide scatter of values, particularly in patients with greater than 1 g/24 h urinary protein excretion. Nevertheless, significant proteinuria (greater than 300 mg/24 h) could have been confirmed or excluded with a sensitivity and specificity of 97% by adopting random protein/creatinine values of less than 0.04 as 'normal'. Specificity and sensitivity could have been increased to 100%, however, by excluding patients with values lying between 0.01 and 0.10 as all the false negatives (n = 3) and false positives (n = 3) lay within this range. In comparison, dipstick testing, although 100% sensitive, had a poor specificity due to the high false positive rate (40/83 (48%] in patients with 1+ to 3+ readings. Assessment of random urinary protein/creatinine ratio may obviate the need for 24 hour urine collections in the initial assessment of suspected proteinuria. A wider application of this technique seems indicated in view of the obvious advantages in terms of cost, time, and patient convenience.

Creatinine↗
PubMed1987

Reliability of the psychosocial axes of DSM-III in an adolescent population.

Three psychosocial variables were rated independently by two clinicians for 140 adolescent referrals to a psychiatric unit. Overall, intraclass correlations for DSM-III Axis IV, Axis V and a psychosocial adversity index (PSAI) were respectively 0.44, 0.58 and 0.68. The main source of unreliability is probably the operational definitions, rather than their application by clinicians; indices similar to the PSAI may be preferable.

Adaptation, Psychological↗
PubMed1987

The urologic manifestation of the tethered spinal cord.

The tethered spinal cord is an entity with potentially grave neurologic implications. Presenting urologic symptoms include incontinence, symptomatic urinary tract infections and stool soiling. These symptoms may be the first to herald a tethered cord. The patients with previously repaired myelodysplastic defects are particularly prone to develop this lesion. This study was designed to correlate urologic history with pre and post operative cystometry in 20 myelodysplastic children. In this study, it was noted that clinical symptomatology and urodynamic parameters improved in 60% of those children who had cord untethering. A better result was evident in children who were repaired promptly.

Child↗
PubMed1986

Intravesical transurethral electrotherapy for the neurogenic bladder.

Intravesical transurethral bladder stimulation is a rehabilitative and diagnostic technique for the neurogenic bladder. The goal of therapy is 3-fold: 1) to achieve the sensation of bladder filling or the urge to void, 2) to initiate a detrusor contraction and 3) to achieve conscious urinary control. The procedure combines direct electrical stimulation of bladder receptors with visual biofeedback using patient observance of a water manometric representation of the detrusor response. Since November 1984 we have evaluated and/or treated 24 patients with a neurogenic bladder. An electrocatheter is passed transurethrally into the bladder and the bladder is filled to a third of its capacity with normal saline. We then deliver 2 to 6 mA. every 3 seconds for 90 minutes. Full treatment usually requires 30 to 90 sessions. Of the 24 patients 13 had only 1 evaluation and 10 had 3 to 39 sessions. Of those 10 patients 7 had significant detrusor activity that had not been present before treatment and 4 have a sensation to void. The remaining child underwent 110 sessions. He has controlled detrusor contractions resulting in a normal voiding pattern. It appears that intravesical transurethral bladder stimulation may be helpful diagnostically to determine the stimulus response of bladder function and therapeutically to rehabilitate the neurogenic bladder toward full control.

Biofeedback, Psychology↗
PubMed1986

Intravesical transurethral bladder stimulation.

Intravesical transurethral bladder stimulation is a rehabilitative and diagnostic technique for the neurogenic bladder. The goal of therapy is threefold: to achieve the sensation of bladder filling or the urge to void, to initiate a detrusor contraction and to achieve conscious urinary control. The procedure combines the direct electrical stimulatory effect to bladder receptors, with the significant use of visual biofeedback by the patient's observation of a water manometric representation of their detrusor response. It appears that intravesical transurethral bladder stimulation may be helpful to determine diagnostically, the stimulus response of bladder function, and therapeutically, to rehabilitate the neurogenic bladder toward full control. It is not intended to replace clean intermittent catheterisation in all patients. However, it may allow selected children to void rather than be catheterised and may be used in conjunction with intermittent catheterisation to improve a child's level of continence.

Biofeedback, Psychology↗
PubMed1986

Decreased autologous mixed lymphocyte reaction in myasthenia gravis.

Myasthenia gravis is an autoimmune disease in which the autoantigen, the acetylcholine receptor at the neuromuscular junction, is well characterized. As with many other autoimmune diseases, however, the basic cause of immune malfunction is unknown. The autologous mixed lymphocyte reaction (AMLR) involves the proliferation of T lymphocytes when co-cultured with autologous non-T cells and may reflect in vivo mechanisms of immune control. We have measured the AMLR in 22 patients with myasthenia gravis and found the magnitudes of the peak responses to be significantly depressed compared to those of 41 normal healthy controls. Proliferative responses of T cells from myasthenic patients to the mitogens, Concanavalin A and Phytohaemagglutinin-P, were also found to be significantly depressed relative to controls. These abnormal immune cell responses can be, in part, interpreted in terms of defective suppressor cell functions in myasthenia gravis.

Acetylcholinesterase↗