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Biomedical subjects

A Stenberg

Publications and source records attributed to A Stenberg.

At least 37 records · Page 2Linked to original sources
PubMed1999

Osmoregulation and desmopressin pharmacokinetics in enuretic children.

OBJECTIVE: The aim was to compare responders and nonresponders to antienuretic treatment with desmopressin with respect to pharmacokinetics and renal effects of the drug. METHODS: Twelve children, aged 7.6 to 16.2 years, with nocturnal enuresis were examined. Six patients were nonresponders and 6 were responders to desmopressin treatment. The children were given 2 mg of desmopressin intravenously and plasma concentrations of the drug were monitored overnight. Urine parameters were followed for 24 hours after desmopressin administration. Ten patients also underwent a thirst provocation test. RESULTS: Desmopressin pharmacokinetics did not differ between the groups. Neither nocturnal urine production nor morning urine osmolality after desmopressin injection differed between responders and nonresponders, whereas the responders produced significantly larger amounts of significantly less concentrated urine during the day after the injection compared with the nonresponders (urine production, 2.02 +/- 0.84 and 0.77 +/- 0.20 mL/kg/h; urine osmolality, 558 +/- 271 and 883 +/- 134 mOsm/kg). Nonresponders voided with smaller bladder volumes (2.43 +/- 0.68 mL/kg body weight) than responders (4.70 +/- 1.21 mL/kg). The responders produced significantly less concentrated urine than the nonresponders during the thirst provocation test (607 +/- 185 and 922 +/- 217 mOsm/kg, respectively). CONCLUSION: Intravenous desmopressin pharmacokinetics and desmopressin renal effects did not differ between responders and nonresponders to desmopressin treatment. Nonresponders had a smaller spontaneous bladder capacity and responders produced less concentrated urine.

Adolescent↗
PubMed1999

Sleep of children with enuresis: a polysomnographic study.

OBJECTIVE: To evaluate relationships between bladder voiding and sleep in children with enuresis. METHODS: Polysomnographic recordings were obtained from 25 children, aged 7 to 17 years, with monosymptomatic nocturnal enuresis. During 52 recorded nights, 37 enuretic events were detected. Responders (n = 7) and nonresponders (n = 16) to desmopressin treatment were compared. RESULTS: The mean latency between sleep onset and the first bladder voiding was 3 hours 20 minutes (SD = 2 hours 5 minutes). The number of voidings were 19, 7, 10, and 1 occurring during stages 2, 3, and 4, and rapid-eye movement sleep, respectively. Desmopressin responders were found to void during the early or late part of the night, whereas the voidings of the nonresponders were dispersed evenly throughout the night (chi2 = 8.09). CONCLUSIONS: The enuretic event is a predominantly non-rapid eye movement sleep phenomenon. Responders and nonresponders to desmopressin treatment void during different parts of the night.

Adolescent↗
PubMed1999

DiHA Dextran Copolymer, a new biocompatible material for endoscopic treatment of stress incontinent women. Short term results.

BACKGROUND: This study was undertaken to investigate the safety and effect of DiHA, dextranomers in hyaluronan, a new biocompatible material for endoscopic treatment of stress incontinence, and to further develop the injection technique. METHODS: Twenty women aged 38 to 90 years with genuine stress incontinence participated. Seventeen were followed for a minimum of 6 months after treatment and three for a minimum of 3 months. The DiHA implants were administrered by transurethral endoscopically controlled submucosal injections under local anesthesia. Safety was assessed mainly in terms of infection, need for catheterization, residual urine and dysuria. The treatment efficacy was estimated objectively by a short-term pad test with standardized physical exercise and a 48 h pad-test, 7 days, and 1, 3 and 6 months after treatment. The patient's subjective experience of the effect was also studied. RESULTS: The implantation procedure was well accepted by the patients. Four patients required catheterization due to voiding problems during the first 24 postoperative hours. One patient had urinary retention 14 days postoperatively. No UTI or local infection was detected. Some patients had transient urgency. In 17 or 20 patients the treatment resulted in objective cure or improvement. CONCLUSIONS: This substance shows promising qualities for endoscopic treatment of stress incontinence.

Adult↗
PubMed1999

Depth of sleep and sleep habits among enuretic and incontinent children.

In order to evaluate differences in sleep factors between children with wetting problems and dry children, questionnaire data were obtained from 1,413 schoolchildren between the ages of 6 and 10 y. The analyses were performed using logistic regression, and adjusted odds ratios (ORs) were calculated to approximate the relative risk. Current enuresis was associated with a subjectively high arousal threshold, pavor nocturnus, nocturia and confusion when awoken from sleep (ORs 2.7, 2.4, 2.1 and 3.4, respectively), whereas children with current incontinence often experienced bedtime fears, onset insomnia or nocturia (ORs 2.4, 2.3 and 2.7, respectively). Children exhibiting urinary urgency were overrepresented among both children with current enuresis (OR 2.5) and those with current incontinence (OR 17.2). It is concluded that impaired arousal mechanisms and bladder instability are aetiological factors underlying nocturnal enuresis.

Arousal↗
PubMed1998

Sleep and night-time behaviour of enuretics and non-enuretics.

OBJECTIVE: To investigate connections between nocturnal enuresis and sleep factors such as the subjective depth of sleep and classical parasomnias. PATIENTS, SUBJECTS AND METHODS: One hundred school children aged 6-10 years answered a questionnaire, with their parents, and the same questions were asked of a group of 29 children of the same age suffering from severe nocturnal enuresis. RESULTS: There were significant differences in arousability, with the enuretic group being 'deep sleepers', and in the prevalence of onset insomnia, nightmares, interrupted sleep and bedtime struggles, which were all less common among the enuretics. The prevalence of classical parasomnias did not differ between the groups. CONCLUSION: A high arousal threshold is one of the pathogenetic factors underlying nocturnal enuresis and we propose that this group of therapy-resistant enuretic children might not only sleep more deeply than their nonenuretic peers, but perhaps have 'better' sleep.

Arousal↗
PubMed1998

Desmopressin in the treatment of severe nocturnal enuresis in adolescents--a 7-year follow-up study.

OBJECTIVES: To evaluate the role of long-term oral desmopressin (over a 7-year follow-up) in refractory enuretics, particularly in assessing the potential curative effect, and to analyse the results for specific types of patient to obtain clues about possible mechanisms of cure. PATIENTS AND METHODS: The effect of oral desmopressin was investigated in 25 adolescents (aged 11-21 years) with severe monosymptomatic nocturnal enuresis. The long-term study consisted of two 12-week treatment periods, with the efficacy of the drug assessed as the reduction in the number of wet nights per week. Subsequently, the patients were followed-up for up to 7 years. Close contact was maintained with the families over this period ('good doctoring' approach). At 3-, 5- and 7-year intervals after completing the study, patients were assessed for dryness, frequency, treatment and sleeping habits, using postal questionnaires and telephone follow-up. RESULTS: At the end of the long-term study, 35% of the patients remained dry without therapy. Within 2 years of ending treatment, 15 patients were dry, compared with an expected estimate of six by spontaneous resolution, and after 7 years, 19 patients were cured. Nocturia occurred in 75% of the enuretic patients but in only 5% of the healthy controls. CONCLUSIONS: Active treatment of primary nocturnal enuresis with oral desmopressin has a clinically significant effect on the cure rate, which is maintained after ceasing therapy. The cure rate was higher than would be expected from spontaneous recovery alone during the first 2 years of the study and there was a significant further increase in the cure rate 7 years after ending therapy, again greater than the expected spontaneous cure rate. There also seemed to be a better response to treatment when it was prolonged. Furthermore, this therapy is safe when administered in the long-term.

Administration, Oral↗
PubMed1997

Lack of distant migration after injection of a 125iodine labeled dextranomer based implant into the rabbit bladder.

PURPOSE: In recent years endoscopic treatment of stress incontinence and vesicoureteral reflux has been introduced. Reports of possible particle migration of the injected material to distant organs in humans and experimental animals have led to a search for biological nonmigration products. An implant found to have a good clinical effect in these conditions is dextranomer in hyaluronan. We performed this study in rabbits to investigate the possible migration of dextranomer particles. MATERIALS AND METHODS: 125Iodine labeled dextranomer particles were injected into the submucosal space of rabbit bladders, and samples of blood and various tissues were examined for radioactivity at scheduled intervals during a 28-day period. Furthermore, whole body autoradiography was performed 1 day, and 1 and 4 weeks after injection. RESULTS: Radioactivity was found in blood samples and in all tissues but it remained at the background activity level except in the thyroid, where uptake representing free 125iodine was detected. In the bladder 41 and 45% of the injected dose remained within the bladder wall 1 day and 4 weeks, respectively, after injection. The remainder of the dose probably disappeared from the bladder wall by leakage into the urine shortly after deposition, as indicated by the finding of 10-fold higher urine radioactivity levels at day 1 than at day 28 after injection. CONCLUSIONS: No distant migration of dextranomer particles occurs after submucosal injection of such an implant in the rabbit bladder wall.

Animals↗
PubMed1997

Diurnal plasma vasopressin and urinary output in adolescents with monosymptomatic nocturnal enuresis.

Plasma arginine vasopressin (AVP) levels, urinary flow and urine osmolality were investigated in a group of adolescents (20 boys and 5 girls), aged 11-21 y, with severe monosymptomatic nocturnal enuresis and a control group of healthy adolescents (16M and 4F) with similar age- and sex-distribution. Half of the control group was investigated twice, with an interval of 6 months. AVP samples were taken every fourth hour in all adolescents and half of the control group were also investigated every second hour to achieve more samples during controlled sleep. After the study the enuretic group were put on long-term oral desmopressin (DDAVP). The difference between day and night values of AVP was significant for both groups, but there was no difference in the day/night ratios of plasma-AVP. All the adolescents produced less urine while asleep, but the controls produced significantly more urine than the enuretics during day. The controls also had a significantly larger nocturnal elevation of urine osmolality than the enuretics, thus a tendency towards polyuria was found. We could not find any significant difference between responders to DDAVP treatment and non-responders in any of the parameters studied. AVP is secreted in a pulsatile fashion and with point hormone samples taken every fourth or second hour we were unable to find any difference in the diurnal AVP secretion between enuretics and normal controls.

Adolescent↗
PubMed1997

The genetics of primary nocturnal enuresis: inheritance and suggestion of a second major gene on chromosome 12q.

Primary nocturnal enuresis (PNE), or bedwetting at night, affects approximately 10% of 6 year old children. Genetic components contribute to the pathogenesis and recently one locus was assigned to chromosome 13q. We evaluated the genetic factors and the pattern of inheritance for PNE in 392 families. Dominant transmission was observed in 43% and an apparent recessive mode of inheritance was observed in 9% of the families. Among the 392 probands the ratio of males to females was 3:1 indicating sex linked or sex influenced factors. Linkage to candidate regions was tested in 16 larger families segregating for autosomal dominant PNE. A gene for PNE was excluded from chromosome 13q in 11 families, whereas linkage to the interval D13S263-D13S291 was suggested (Zmax = 2.1) in three families. Further linkage analyses excluded about 1/3 of the genome at a 10 cM resolution except the region around D12S80 on chromosome 12q that showed a positive two point lod score in six of the families (Zmax = 4.2). This locus remains suggestive because the material was not sufficiently large to give evidence for heterogeneity. Our pedigree analysis indicates that major genes are involved in a large proportion of PNE families and the linkage results suggest that such a gene is located on chromosome 12q.

Child↗
PubMed1996

Prevalence of genitourinary and other climacteric symptoms in 61-year-old women.

In a population-based cohort study, 1280 women, aged 61, were interviewed regarding their genitourinary and other postmenopausal symptoms by means of an anonymous questionnaire. The group selected was to constitute all women of 61 years of age living in Uppsala county, Sweden. The response rate was 84%. All were postmenopausal women. Seventy-three percent of the women answering admitted some degree of urinary incontinence and 33% more severe degree. Forty-nine percent reported some degree of stress incontinence, 25% a more severe degree. Thirty-one percent experienced urge incontinence, 14% severely. A minority (4%), had had more than two urinary infections during the last year. The majority (67%) had changed urinating habits, going to the toilet at night and a minority complained of increased frequency of micturation (8%). Of the participating women, 59% were still sexually active, 43% had trouble with vaginal dryness and 10% with vaginal burning. Vasomotor problems such as hot flushes (30%), daily (33%) and nightly sweating (36%) were all common troubles. Forty-seven percent of the women had asked for medical help for estrogen deficiency problems, 82% were satisfied with the help they had received. Thirty-four percent were on estrogen therapy, 16% had systemic therapy 18% low dose estrogen treatment.

Climacteric↗
PubMed1996

Bladder exstrophy in Sweden--a long-term follow-up study.

A retrospective review of all new cases of bladder exstrophy in Sweden in 1970 through 1989 is presented. The aim was to evaluate management of the malformation in Sweden and possibly identify factors that might improve the outlook. The incidence was 1:33,500 births. Records were reviewed of the 61 children (37 males and 24 females) treated at Sweden's four specialist centers of pediatric surgery. There was one perinatal death. Primary management was mainly early bladder closure (within 72 hours), late closure or perinatal urinary diversion. Subsequent measures included augmentation cystoplasty, bladder neck reconstruction, provision of continent urinary reservoir and penile reconstruction. The follow-up time was 4-19 years. In 15 cases renal scarring developed, though with impairment of total function in only three. Ten patients achieved continence, defined as 3-hour dry intervals, of whom four had urinary reservoirs with continent stoma. Urinary tract infections were recorded during follow-up in 43% of the surviving patients, though the true incidence of infection presumably was higher. To improve management of bladder exstrophy in sparsely populated Sweden, a nation-wide strategy of ongoing interhospital collaboration has been adopted. Results will be continuously presented.

Adolescent↗
PubMed1996

A national center for sexually abused women in Sweden.

Sexual violence is a significant global problem. The unequal power between men and women is considered to be the main reason for violence against women. Women who are exposed to sexual assault are great consumers of medical and social care. The Swedish government has reacted to the problem by establishing an expert center for battered and raped women. The center has three main tasks: treatment in a professional and empathic way; research into and development of medical and psychosocial treatment of patients and the underlying causes of sexual violence; education and information of the general public.

Adult↗
PubMed1995

The prevalence of urogenital symptoms in postmenopausal women.

Lower urogenital tract disorders, such as vaginal athropy, urethritis, dyspareunia, recurrent urinary tract infections and urinary incontinence symptoms, are more prevalent in postmenopausal women. While these disorders are attributed to the ageing process as well as estrogen deficiency, knowledge of the relationship between estrogen status and symptomatology is scarce and hard to investigate due to the complexity of the problem. Little is known about the epidemiology of urogenital symptoms and their relationship to estrogen status and treatment. Studies of the prevalence of urogenital symptoms in postmenopausal women have been rare and results divergent. Through reviewing existing literature and relating findings to our own prevalence studies of 61-, 71- and 81-year-old women, we can conclude that many of the symptoms accounted for in our study are those known to be due to the loss of estrogen and easily dealt with by estrogen therapy. However, there is a need for more adequate information about postmenopausal symptoms and the effect of estrogens, as only a minority of postmenopausal women are currently treated.

Aged↗
PubMed1995

A new bioimplant for the endoscopic treatment of vesicoureteral reflux: experimental and short-term clinical results.

We investigated the safety and clinical effects of a new biocompatible, biodegradable treatment, the Deflux system (dextranomer microspheres in sodium hyaluronan solution), for the endoscopic treatment of grades III and IV vesicoureteral reflux. In preclinical safety studies in pigs histopathological examination demonstrated excellent tolerance. Two weeks after submucous implantation in the pig bladder early ingrowth of fibroblasts and recently generated collagen were noted at the implantation sites. At 14 weeks of followup this ingrowth had slightly increased. Long-term followup in rats showed that the volume of subcutaneous implants was slightly reduced (23%) 1 year after implantation. In a clinical study we investigated the implantation technique and the short (3 months) and long-term (1 year) effects of Deflux implantation in 75 children (101 ureters) with grades III and IV vesicoureteral reflux. We report data from up to 3 months of followup. Implant volumes of 0.4 to 1.0 ml. were sufficient to create distinct boluses and crescent-like ureteral orifices. Although viscous, due to its viscoelastic properties the substance was easy to inject in a well controlled manner. At cystography 3 months later reflux had resolved in 68% of implants, was reduced to grades I and II in 13% of implants and was unchanged in 19% of treated ureters (grades III and IV reflux). No signs of ureteral obstruction or adverse reactions were noted. Results from 1 year of followup will be reported later. Our results indicate that the dextranomer microspheres act as micro-carriers that promote ingrowth of fibroblasts and generate new collagen. We conclude that the Deflux system may represent a new, safe, simple alternative to endoscopic treatment of vesicoureteral reflux in children.

Adolescent↗