Summary Urodynamic investigation was performed in 100 consecutive incontinent women. The clinical diagnosis was confirmed in only 65 women and management was significantly altered in 31 women. Pressure‐flow studies should precede, whenever possible, the treatment of incontinent patients.
The aim of this study was to assess the effect of a course of dexamethasone on postoperative pain and morbidity after adult tonsillectomy. We report the results of a double-blind, randomized, placebo-controlled trial of 200 adult patients undergoing elective tonsillectomy. Patients were randomized to three groups: one group received the non-steroidal anti-inflammatory drug piroxicam for 8 days postoperatively, one group received dexamethasone for the same period and the third group received both drugs. Patients recorded their pain scores and analgesic requirements daily for 10 days. Patients treated with a combination of piroxicam and dexamethasone recorded consistently lower pain scores than those treated with either drug alone. This difference was statistically significant (P < 0.05) on all days except the day of surgery and the second postoperative day. Patients treated with piroxicam alone had significantly higher analgesic requirements than in either of the other groups. Dexamethasone given in this regime reduces postoperative pain and analgesic requirements after adult tonsillectomy.
The effect of betahistine compared with cinnarizine on induced vestibular nystagmus was evaluated using a rotating chair, in 6 healthy volunteers. The subjects underwent a slow acceleration followed by a sudden stop. Electronystagmograph tracings were taken initially as pretreatment control values, and after betahistine 8 mg t.i.d. and cinnarizine 15 mg t.i.d. had been taken. The duration of nystagmus and average eye speed were measured. No difference was recorded in either parameter between the pretreatment rotation and that following betahistine (P greater than 0.05). A significant difference (P less than 0.05) was seen in the duration of nystagmus during initial acceleration, and in average eye speed following the sudden stop after treatment with cinnarizine.
A new questionnaire to assess the quality of life of urinary incontinent women Sir.We read with interest the article published by Con Kelleher et al. ' (Vol 104, December 1997). A number of different quality of life questionnaires are now available. They can be either general health questionnaires such as the Short Form 36 or they can be more disease specific and related to urinary continence such as the questionnaire presented by Kelleher et al. Other groups have also published incontinence disease-specific quality of life questionnaires?". Some of these have also been tested for psychometric validity, reliability, internal consistency and stability2. We fully recognise the importance of such questionnaires because outcome is often determined by the surgeon performing the operation and is measured in terms of surgical success. Surgical success often has little to do with patient satisfaction especially where the complication rate of a procedure is high or the side effects of a treatment are numerous (eg, although 85-90% of women undergoing colposuspension are cured of their incontinence only 50% are cured and complication free').Difficulty arises when different centres each develop their own questionnaire. The result is a large number of relatively small trials with no nationally agreed standardisation. If we are to make progress in the field of urogynaecological research we need an agreed method of standardising quality of life and other measures of outcome. A body, such as the International Continence Society, should be seen to lead the way in this important area. ' raises the possibility that increased sympathetic nervous activity is one of the pathways through which the genetic predisposition to pre-eclampsia is mediated. The findings presented by Schobel et al. I is in line with increased brachial vein plasma noradrenaline concentration in pre-eclampsia, since the brachial vein drains mainly muscle tissue in the forearm. In fact, an excellent correlation between neurogenic discharge in calf muscle and noradrenaline levels in a calf vein has been demonstrated in healthy subjects3. Despite the enhanced neurogenic activity, demonstrated by these authors, calf vascular resistance is, however, not increased in pre-eclampsia compared with normal pregnancy, as demonstrated by us4. Instead the vascular beds of greatest importance for the maintenance of the increased systemic vascular resistance in pre-eclampsia are the uteroplacental and renal vasculature. Whether the increased vascular resistance in these circulations is sustained by neurogenic factors or a deficient endothelial production of vasodilating prostanoids or nitric oxide is unknown.It is important to note that sympathetic outflow to skeletal muscle may not reflect sympathetic activity in other organs. Indeed, it has been demonstrated that sympathetic activity is highly differentiated5. For example during mental stress calf vascular resistance decreases substantially while systemic vascular resistance remains essentially unchanged in pre-eclampsia...
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