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Biomedical subjects

M Fall

Publications and source records attributed to M Fall.

At least 73 records · Page 4Linked to original sources
PubMed1995

The ice-water test in the diagnosis of detrusor-external sphincter dyssynergia.

The ice-water test (IWT) implies rapid intravesical infusion of 100 ml of sterile ice-water during continuous pressure measurement and registration of fluid leakage. In a typical positive test, there is fluid leakage around the catheter(s) during the peak of detrusor contraction elicited by cold stimulation. Seventy-six patients, the majority with different forms of spinal disorders and a clinical and urodynamically suspected detrusor-external sphincter dyssynergia, were subjected to cystometry, needle electromyography (EMG) and an ice-water test. Detrusor-external sphincter dyssynergia was found in 44 (59%) patients and 41 of them had a positive IWT. A positive test with a high detrusor pressure indicates detrusor-external sphincter dyssynergia whereas the contrary applies to the negative test. Eighteen patients who responded to cold stimulation with detrusor contraction but without fluid leakage, called positive non-leakage IWT, all presented detrusor-external sphincter dyssynergia according to EMG. In this situation, the cheap, non-invasive and simple IWT can replace a needle EMG study.

Adolescent↗
PubMed1995

Clinical and urodynamic effects of intravesical capsaicin treatment in patients with chronic traumatic spinal detrusor hyperreflexia.

PURPOSE: We administered capsaicin, a neurotoxic substance causing a reversible suppression of C fiber afferent neuronal activity, in an attempt to decrease bladder hyperreflexia. MATERIALS AND METHODS: Capsaicin solution (2 mM.) dissolved in 30% alcohol was instilled into the bladders of 10 men with traumatic chronic spinal lesions and left in place for 30 minutes. Effects on bladder function, including response to cold stimulation, were recorded during treatment, immediately after instillation and at followup. RESULTS: Bladder function improved in all but 1 patient, which was expressed as an increase in cystometric capacity and/or a decrease in maximal detrusor pressure. The effects lasted for 2 to 7 months. Immediately after capsaicin administration the ice water test was negative in half of the patients. CONCLUSIONS: The positive effects on bladder function of capsaicin treatment can be explained by the blocking of C fiber afferents. The optimum dose and treatment interval are presently not established. The ice water test might possibly be used as an instrument to monitor the ideal dosage.

Adolescent↗
PubMed1995

Vaginal wall bipedicled flap and other techniques in complicated urethral diverticulum and urethrovaginal fistula.

BACKGROUND: Repair of a urethral diverticulum in females may be a rather simple operation or it may represent an operative challenge, depending on the site of the lesion and previous treatment. Thirty women operated upon during a 15-year-period and with a variety of complicating factors, such as proximal location of diverticula or the presence of a urethrovaginal fistula, were reviewed. A new procedure using a transverse bipedicled vaginal flap to cover the urethral repair was used routinely. STUDY DESIGN: The long-term results were evaluated by clinical, endoscopic, and urodynamic methods. A follow-up postal survey was obtained reporting the presence of urethral pain, incontinence, frequency of micturition, postoperative sexual complaints, and subsequent operations. RESULTS: Repeated operations were rather common. The end result of operative repair was satisfactory in all but three patients, two of whom underwent multiple operations (four and seven times, respectively). These patients were left with residual symptoms of incontinence and recurrent urethral syndrome. However, the majority of patients who were operated upon repeatedly were cured. One patient who had impaired detrusor contractility had a relative urethral stricture. CONCLUSIONS: The successful treatment of complicated diverticula and fistula requires some basic technical steps during repair. When recurrence develops, it is important to interpret carefully urethral pressure profiles, cystometry, and other functional tests.

Adult↗
PubMed1995

[Congenital cardiopathies: anatomo-clinical, prognostic, and therapeutic features apropos of 103 cases seen at the Cardiology Clinic of the Dakar University Hospital Center].

We have studied retrospectively 103 patients with congenital heart disease from july 1989 to december 1991. The mean age is 7.8 years +/- 8.6. Epidemiological factors, clinical, morphological and prognostic data have been reviewed. All the patients had been evaluated with echocardiography based on an anatomical and segmental approach. Sex-ratio is 1.11. Situs is solitus in 101 cases (98%). Atrio-ventricular connexions are concordant in 97 patients (94%). The ventriculo-arterial connexions are concordant in 91 patients (88%). We found an anomaly of the spatial relation between great vessels in 9 cases (8.7%). Echocardiographic diagnosis have been confirmed by catheterism and at surgery in 10 patients, and by post-mortem examination in 2 cases. Isolated ventricular septal defect is the most frequent anomaly (19.4%), followed by Tetralogy of Fallot (17.5%). Only 13 patients among the 75 (17.3%) needing surgery have been operated. Six patients (5.8%) died following complications of the malformation. The prognosis without surgery is poor for the majority of our patients with congenital heart disease. Improved early detection and acquisition of adequate diagnosis technology are needed to realize surgical corrections.

Adolescent↗
PubMed1994

Positive bladder cooling test in neurologically normal young children.

The bladder cooling test, which consists of rapid infusion of 0 to 8C saline into the bladder with simultaneous pressure measurement, was performed in 50 neurologically intact infants and children 6 months to 13 years old. The patients were referred for urodynamic investigation because of various disorders of the lower urinary tract. A positive bladder cooling test was defined as a sustained reflex detrusor contraction of about the same magnitude as the micturition contraction. The test was positive during the first 4 years of life but typically negative in children older than 5 years. These findings indicate that a positive bladder cooling test is an infant reflex response that, with the maturation of the central nervous system, becomes suppressed by descending signals from higher centers.

Adolescent↗
PubMed1994

Pressure, volume and infusion speed criteria for the ice-water test.

OBJECTIVE: To define pressure, volume and infusion speed criteria for the ice-water test (IWT). PATIENTS AND METHODS: In this prospective clinical study, cystometry and IWTs were performed in 115 patients. RESULTS: The critical response for a positive IWT was found to be a peak detrusor pressure above 30 cm H2O, with or without fluid leakage. Neither the infusion speed nor the infused volume was critical for the outcome of the test provided that the bladder wall was sufficiently cooled. CONCLUSION: The IWT is a rapid, simple and robust test, whose results are easy to interpret. The test increases the precision of urodynamic diagnosis, especially in patients with an overactive detrusor dysfunction, at a small cost.

Administration, Intravesical↗
PubMed1994

[Non typhoidic salmonellosis in the African pediatric population].

The study of non-typhoidic salmonellosis in A. royer pediatric Hospital (Dakar) during a five year term (1985-1989) was realised on thirty five medical records. This pathology accounts for 0.4% of admissions and occurs mainly on children under 3 years old (83%) essentially with a pathologic background. The main clinical forms were septicemia (46%) and gastro-enteritis (31%). Purulent meningitidis represented 45% of all the localized forms. Only one case of asymptomatic carriage has been identified. The seventeen serotypes of Salmonella identified belong to eight serogroups. S. enteritidis and S. typhimurium represented 51% of the isolates. Susceptibility to antibiotics of these different serotypes were variable, the third generation cephalosporins and gentamycin having inhibited more than 80% of the strains. The mean duration of antibiotherapy was 21 days with a mortality rising to 17%. The association ampicilline-gentamycin although criticable, remains indication as first treatment because of the availability of these drugs.

Bacteremia↗
PubMed1994

[Place on information in health services use by mothers in Guediawaye].

The authors report the results of a survey in a suburban healthcare structure. The purpose was to evaluate the knowledge of mothers about the healthcare delivered through a childhood and maternal healthcare program in Senegal. 244 women were selected at random. The consultant mothers came more for their children than for themselves (79% of consultations were for their children, 49% for themselves). 60% to 80% of women are unaware of basic notions currently teached through the "Information-Education-Communication (I.E.C)" program. All that requires to elaborate with these women healthcare strategies, which are in adequacy with their needs in these peripheral healthcare structures, and which are supported by an adequate and regularly evaluated I.E.C.

Adult↗
PubMed1994

Quality of minor surgery by general practitioners in 1990 and 1991.

BACKGROUND: The 1990 contract for general practitioners encouraged them to undertake minor surgical procedures in their practices. AIM: A study was undertaken to determine whether the subsequent expansion of general practitioner minor surgery activity was accompanied by changes in quality of care. METHOD: Data were analysed relating to minor operations conducted in 22 practices during April-June 1990 and April-June 1991. RESULTS: The volume of general practitioner minor surgery increased by 41% between the two study periods. Waiting time, accuracy of diagnosis, use of histology, adequacy of excision, complications and the need for corrective treatment in hospital did not change significantly between the two periods. CONCLUSION: The findings do not support suggestions that the expansion of general practitioner minor surgery activity following the 1990 contract has been associated with an erosion of quality of care.

Clinical Competence↗
PubMed1994

Pathology of interstitial cystitis.

Morphologic changes, including light microscopy and ultrastructural, immunologic, and immunohistochemical findings in interstitial cystitis are described. The results indicate that biopsies are useful as an aid in the diagnosis of interstitial cystitis.

Adult↗
PubMed1994

[Medico-social problems of young adolescents in Guediawaye (suburban area of Dakar-Senegal)].

A survey in the district of Guediawaye, towards teenagers from 12 to 16 years old, recruited according to a stratified risky method of sampling in 4 different areas has been carried out in order to evaluate their main medico-social problems. It ended up to the following findings: the majority live in hard socio-economic conditions stamping by promiscuity, a weak family income and a low level of education of the parents. 39.2% have been placed under the guardianship of a relative other than the parents. 98.8% do not find spare time structures in their environment. The usage of tobacco and drug is respectively 14% and 1%; 79.4% of students have hardly access to the school stationery, while the teenagers in job apprenticeship have constraints linked to long hours of work (95%). The morbid affections are too varied, dominated by stomach aches (37.8%) far before traumatics (6%); the most frequent therapeutic is resort traditional or empiric treatment. The authors advocate the setting up of a medico-social center making interfere all persons, implied resources in the undertake of the teenagers.

Adolescent↗
PubMed1994

[Purulent pleurisy in the child].

We studied 122 cases of empyema in children. The mean age was 3 years. We found malnutrition in 33% of the patients. 60% of them had large pleural effusion and 56% associated pneumonia. Staphylococcus aureus (51%) and Streptococcus pneumoniae (18%) were the most frequently isolated bacterias in pleural fluid. The mortality rate was 6.5%. 53% of the children had closed chest tube drainage. There were minor abnormalities in pulmonary function tests. The best treatment of empyema in children is closed chest tube drainage and an antimicrobial therapy with antistaphylococcus antibiotic.

Adolescent↗
PubMed1994

[Cardiovascular manifestations of Marfan's syndrome apropos of 6 cases].

We reported six patients with Marfan's syndrome, studied retrospectively from May 1990 to April 1992 in the department of Cardiology in Dakar. Morphological, cardiovascular, skeletal and ocular abnormalities have been reviewed. All the patients had been evaluated by echocardiography. Prevalence of Marfan's syndrome among congenital heart diseases during this period was 4.8%. The mean age was 27.6 years. The mean height was 1.80 m (range 1.38-2.02 m) for a mean weight of 62.8 kg. All the patients had dolichostenomely and arachnodactyly. Kyphosis or scoliosis was present in 5 cases. Chest deformities (pectus carinatum and excavatum) were present in 5 cases. 5 patients had hyperextensible joints. 5 patients had ocular abnormalities. Cardiac pathology was found in 5: mitral prolapse with insufficiency in 2; mitral prolapse with aortic dystrophy in 2; and isolated dilatation of ascending aorta in an other. One patient with diffuse Marfan's syndrome died of cardiac failure. Our study confirm polymorphic manifestations of Marfan's syndrome and the frequency of cardiac abnormalities which are the major determinants of life-prognosis in these patients. Echocardiography is very useful as a noninvasive method for defining the extent of cardiovascular involvement and following its course, for more appropriate treatment.

Adult↗
PubMed1993

Minor surgery by general practitioners under the 1990 contract: effects on hospital workload.

OBJECTIVE: To determine the extent to which minor surgery undertaken by general practitioners after the introduction of the 1990 contract substituted for hospital outpatient workload. DESIGN: Before and after observational study. SETTING: Four English family health services authorities. SUBJECTS: Patients in 22 practice populations who were operated on by their general practitioner or referred to hospital for minor surgery during April to June 1990 or April to June 1991. MAIN OUTCOME MEASURES: Numbers of minor surgical procedures undertaken in general practice and in hospital, numbers of referrals to hospitals for conditions treatable by a minor surgical procedure, and the mix of diagnoses and procedures undertaken in each setting. RESULTS: General practitioners claimed reimbursement for 600 minor surgical procedures during April to June 1990 and for 847 during April to June 1991, an increase of 41%. Referrals to hospital for comparable conditions showed no compensatory decrease (385 during April to June 1990 and 388 during April to June 1991, 95% confidence interval for change in referrals -51 to 57), and the number of hospital procedures resulting from those referrals also remained constant (187 in the first period, 189 in the second, 95% confidence interval for change in procedures -36 to 40). The mix of procedures did not change significantly from one study period to the next in either setting. CONCLUSIONS: Many or all of the additional patients receiving minor surgery under the terms of the 1990 contract may not have previously been referred to hospital. General practitioners seem not to have systematically shifted towards treating the more trivial cases. The overall increase in minor surgical activity may reflect an improvement in accessibility of care or changes in patients' perceptions and attitudes.

Contract Services↗
PubMed1993

Subtypes of overactive bladder in old age.

The prevalence of urinary incontinence increases dramatically with age and is mainly related to urge incontinence and bladder overactivity. It is a reasonable hypothesis that bladder overactivity primarily results from a disturbed central neuronal control of the lower urinary tract. Different sites and extents of neurogenic lesions or dysfunctions should result in different functional and urodynamic characteristics. We have recently identified three distinct urodynamic subtypes of bladder overactivity, and we report a retrospective study of the distribution of these subtypes in elderly patients. Eight hundred and fourteen patients aged 65 years or older with symptoms of urgency and/or urge incontinence underwent cystometry and the ice-water test. Two hundred and sixty-seven of them (33%) presented an overactive bladder. The prevalence of overactive bladder was constant up to the age of 65. A marked increase above this age was almost entirely ascribed to an increase of the so-called uninhibited overactive bladder subtype. This dysfunction occurred in 70% of the older patients. Patients with this condition have a coordinated reflex micturition at normal bladder volumes, but an abnormal perception of bladder fullness and lack of voluntary inhibitory control. This constellation of symptoms and signs indicates a suprapontine dysfunction.

Aged↗
PubMed1993

The bladder cooling reflex in man--characteristics and sensitivity to temperature.

The ice-water test is a simple supplementary urodynamic test that increases the precision of the diagnosis of overactive bladder subtypes. A similar bladder cooling reflex has recently been characterised in the cat and was found to originate from specific cold receptors in the bladder wall. In the present study, the threshold temperature of the human bladder cooling reflex was determined in patients with positive ice-water tests. Estimated threshold values were somewhat lower than those of the cat but still well above the temperatures required for cold stimulation of nociceptors. As in the cat, the strength of the cooling reflex varied inversely with the bladder temperature. These findings indicate that the human bladder cooling reflex is in principle organised in the same way as that of laboratory animals. The human bladder thus seems to be endowed with cold receptors with excitatory reflex connections to the detrusor.

Adult↗