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The measurement of total body water (TBW) by bio-electrical impedance (BEI) in a group of renal patients was evaluated against the tritium dilution method. The effect of haemodialysis and the presence of peritoneal dialysate on the impedance were also investigated. The correlation between the two methods was r = 0.9, with the standard deviation of the differences being 3.66 l (TBW typically 40 l). The BEI method overestimated the actual weight loss after haemodialysis, but underestimated the volume of peritoneal dialysate in situ. The BEI method would not be appropriate for use in assessing total body water and monitoring acute volume changes in patients with renal failure who are on strict fluid restriction.

Although not a cause of progressive renal damage, loin pain and haematuria syndrome is nevertheless associated with significant morbidity. The management of pain often presents a formidable problem to urologists, physicians and general practitioners. An earlier study noted hold-up of urine in the renal pelvis and implicated this in the pathogenesis of pain. In this study we have failed to demonstrate an excess incidence of disordered urinary peristalsis in loin pain and haematuria syndrome.

Twenty-five children with exstrophy/epispadias who had had at least one bladder neck operation (but no augmentation) for incontinence underwent cystometrography (CMG) and urethral pressure profile (UPP) studies. The purpose of this study was to examine all components of lower urinary tract function and to determine how the properties of the bladder and the properties of the bladder neck/urethra interacted to achieve continence or to result in incontinence in the individual child. Examination of detrusor function during filling revealed involuntary contractions in 12 children and an end-fill pressure > 10 cm H2O in 8. Of the 21 children in whom voiding could be evaluated only 6 could initiate a detrusor contraction. In the 18 incontinent children leak pressure could be measured and was > or = 15 cm H2O in 12. Five of the 7 continent children also demonstrated at least one abnormality in lower tract function. The maximum pressure of the UPP did not agree with the leak pressure and may not be a valid measure of the closing pressure of the bladder neck/urethra in this patient population. Detailed urodynamic investigation is necessary in these children to guide the next step of management and to evaluate objectively each form of treatment.

The measurement of total body water by bioelectrical impedance in a group of renal patients was evaluated against the tritium dilution method. The effect of haemodialysis and the presence of peritoneal dialysate on the impedance were also investigated. The correlation between the two methods is r = 0.90 with a residual standard deviation of 3.7. The standard deviation of the differences between the two methods against the means was 3.66 which means that total body water (TBW) estimated by the bioelectrical impedance (BEI) method may be 6.18 l (X +/- 2 SD) above or 8.38 l below the 3H2O method. The BEI method overestimated the actual weight loss after haemodialysis (3.87 +/- 1.7 l versus 2.43 +/- 1.8 l) but underestimated the volume of peritoneal dialysate in situ. The BEI method would not be appropriate for use in assessing total body water and monitoring acute volume changes in patients with renal failure who are on strict fluid restriction.

A system is described that has been developed to measure the surgical diathermy current passing through the patient during each cut of a trans-urethral resection of the prostate gland (TURP), with 1.5% glycine solution as irrigant. The immediate aim was to distinguish capsular tissue of the male prostate gland from the hyperplastic adenomatous tissue within it. The ultimate aim was to prevent resection into the surgical capsule which can easily result in excessive blood loss and absorption of irrigant. The system was used in a conventional theatre setting with a commercial diathermy system (Eschmann TD 411-S) of known output characteristics. Measurements were made in 12 patients during resection with a standard loop, involving typically 75 cuts in each patient (60 in adenoma and 15 in capsule). In 8 of these patients this was followed by roller ball placement on typically 10 sites each of capsule or residual adenoma at very low diathermy settings. The results showed great variability both between patients, and between different cuts in the same patient, with no consistent difference between tissues identified under direct vision as adenoma and surgical capsule. Physical reasons are suggested for the observed variability, and it is concluded that it is not possible to use this technique to guide tissue resection in the prostate.

Twenty-eight children with bladder exstrophy, prior to surgery for continence, underwent a urodynamic evaluation, cystogram, ultrasound and dimercaptosuccinic acid scan, to define parameters of lower urinary tract function that are a risk for upper tract damage and/or impair development of bladder capacity. The bladders in 7 of 28 demonstrated no storage function [leak pressure)LP) = 0]; but storage parameters could be measured in the other 21. Their LP was 10-35 cm H2O; 17 of 21 revealed involuntary contractions and 7 of 21 had an end-fill pressure greater than 10 cm H2O. Bladder capacity was better in those with a higher LP and those with no involuntary contractions. The 4 patients with bilateral hydronephrosis (3 of whom also had bilateral multiple scars) were among the 6 with LP greater than 30 cm H2O. Of the 7 with an end-fill pressure greater than 10 cm H2O, 5 had upper tract damage. Involuntary contractions may impair development of capacity. A LP of greater than 30 cm H2O is a risk factor for upper tract damage and an end-fill pressure greater than 10 cm H2O may also be a factor.

Insufficient milk supply syndrome is a complex phenomenon and a major reason reported by mothers worldwide for early termination of breastfeeding. A review of the literature suggests possible explanations for insufficient milk but fails to indicate conclusively why it is such a problem. Nursing management of real and perceived insufficient milk syndrome (IMS) is an important part of encouraging breastfeeding success.

Bladder exstrophy and epispadias are congenital abnormalities of the urinary bladder. Evaluation of bladder function before and after bladder-neck reconstruction has not been done in patients with these conditions. We report the preliminary results of a prospective study of lower-urinary-tract function in 36 children (10 girls, 26 boys; age range 1.5-16 years) with bladder exstrophy and epispadias. Children's bladder function was measured by cystometry and cystography, and their upper urinary tracts were examined by ultrasound imaging. Normal bladder function was seen in children with primary epispadias but this was severely impaired in children who had had conventional bladder-neck surgery for continence, implying that this may not be the optimal treatment. Contrary to current assumption, children with closed exstrophy bladders are not capable of normal function, and the abnormalities we identified may be a major cause of upper-urinary-tract damage and may impair development of bladder capacity. Although unrecognised in the past, involuntary bladder contractions are a primary cause of urine leakage persisting in children with exstrophy and epispadias after continence surgery. Detailed functional testing should become a routine part of the evaluation of children with exstrophy and epispadias.

Eight commercially available urodynamic machines from 6 major manufacturers (Aspen Medical, Dantec, Electro-Medical Supplies (EMS), Uro-gyn, Ormed and Wiest) were assessed for accuracy, construction and user-friendliness. There was less than 10% inaccuracy with regard to fill volume, void rate and pressure measurements. The Wiest 6000 plus system was between 11 and 14% inaccurate during voided volume measurement and other systems were less than 10% inaccurate. User-friendliness was assessed during routine cystometry and is mainly dependent on the software supplied with the equipment. The merits and faults of each urodynamic system with regard to performing a urodynamic investigation, running a urodynamic service and data management are compared with an "ideal" urodynamic system.

A comprehensive protocol was developed for assessing urodynamics instrumentation and applied to eight commercial urodynamics systems obtained on short-term loan. Assessment covered the areas of design and construction, measurement accuracy, and software performance. The measurement performance of virtually all systems was found to be adequate for the application. The main areas of weakness were susceptibility to artefact, poor user-friendliness, and lack of physical ruggedness.

The Redness Edema Ecchymosis Discharge Approximation (REEDA) tool, devised to evaluate postpartum healing of the perineum following an episiotomy/laceration, was used to evaluate the effects of heat and cold on the perineum during the first 24 hours after delivery. Ninety patients were randomly assigned to one of three treatment groups. Treatment consisted of 30 subjects applying a warm perineal pack, 30 applying a cold perineal pack, and 30 taking a warm sitz bath. Analysis of variance indicated no difference in the REEDA score before or two hours after treatment. A Pearson r correlation indicated the REEDA score was associated with a laceration and not with infant weight. Although these findings do not support assumptions from the literature, this study provides baseline data and trends for future study.

This study investigated effects of a prenatal breastfeeding education program on the success of breastfeeding among low-income pregnant women. The sample population was comprised of 64 subjects who delivered at a university hospital in the Midwest. A pretest and posttest were used to measure breastfeeding knowledge in the treatment group. Six weeks following delivery the subjects completed the Telephone Interview Survey (TIS) to determine their method of infant feeding and their perception of success at breastfeeding. Subjects in the treatment group were more knowledgeable about breastfeeding after instruction. However, there was no difference in breastfeeding duration and perception of success between subjects in the treatment and control groups.

This is a study of the incidence and possible predisposing stress factors of Scheuermann's disease (S.D.). 500, 17 and 18 year old, students from the local larger schools, from one country town school and from the local Teachers' Training College, took part. Each student filled in a questionnaire, underwent a simple spinal examination including a clinical assessment of the available passive hamstring stretch, and had a lateral X-ray of the dorsal and upper lumbar spine. 56.3% of the males and 30.3% of the females had X-ray evidence of previous S.D., in varying degrees of severity. Dynamic stress, such as playing sports involving a lot of potential compression stress, weight lifting, and heavy lifting work in spare time and holidays, seem to play little if any part in the pathogenesis of S.D. Tall males and males who had spent more than 2 weeks in bed, due to sickness or injury, were more prone to S.D. Hamstring tightness showed a significant relationship to X-ray evidence for males. In the absence of possible dynamic stress factors it is suggested that prolonged sitting may be an important factor in the pathogenesis of end plate breakdown and thus S.D.

This study, over a five year period in a general practice, has shown that grieving is resolved in a much more desirable way if a dying patient is nursed at home by relatives rather than by strangers in a hospital.

A review of the literature reveals the phenomenon of insufficient milk supply (IMS) as being the most likely potential problem for the breastfeeding mother. This article discusses possible determinants and indicators of insufficient milk supply and proposes a conceptual definition and model.

Disopyramide (2 mg/kg intravenously in 10 minutes) was administered to 14 patients with myocardial infarction within 36 hours of their infarct. Heart rate (HR) increased significantly five minutes after completion of the injection, but profound tachycardia was not seen. Mean wedge pressure (WP) rose and stroke volume (SV) fell. Disopyramide therefore showed a negative inotropic effect on the heart. Systemic vascular resistance (SVR) increased but blood pressure was not significantly altered. Diastolic and mean pulmonary arterial (PA) pressure was also increased by disopyramide. Peak plasma disopyramide level was reached five minutes after injection. The implications of the haemodynamic effects of disopyramide are discussed.