Compensation psychosis.
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Biomedical subjects
Publications and source records attributed to D Rowan.
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This investigation reveals that there is a marked reduction in the rotational speed of the transducer disc as the stream flowrate is increased, although the non-linearity is partly reduced by electronic compensation within the instrument. The inaccuracy at low flowrates is probably unimportant in routine clinical applications. However, significant errors are recorded at high flowrates when the stream strikes the grid intersections or when the point of impact is close to the edge of the rotating disc. For these reasons, it is desirable that the patient should avoid micturating directly on to the grid. To obtain acceptable clinical recordings, an instrument time constant of 0-5 sec must be used. Although some characteristic tracings can be identified, the clinical measurements indicate that the effects of the volume voided and stream movement must be taken into consideration when the flow patterns are being interpreted.
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A technical evaluation of the Exeter recording nappy has been carried out with particular reference to (a) linearity, (b) reproducibility of calibration, (c) the effect of variation in the position of moistened zones produced by consecutive leakages and (d) the effect of variation in the electrical conductivity of the liquid detected. The clinical use of the nappy is also discussed. A miniature alarm coupled to a similar pad arrangement has been developed as a training system for the geriatric incontinent patient and patients with neurogenic bladders. A 'pad and pant' version of an enuresis alarm has also been designed which had advantages over the conventional under-sheet type.
Maximum stimulation of the pelvic floor has been advocated for the treatment of urinary incontinence associated with defective urethral closure mechanisms. Information in the literature was imprecise as to what constitutes a maximum stimulation. With one exception, published results are not encouraging when analysed. None of our 19 patients showed improvement. One had enhanced contraction when using an anal plug electrode following maximum stimulation, and this effect may warrant further study.
The terminology of lower urinary tract function will be standardized by the ICS. This report contains the recommendations dealing with urinary incontinence, procedures related to the evaluation of urine storage (cystometry, urethral closure pressure profile) and units of measurement.
The routine use in 500 consecutive patients of a barium enema cannula incorporating stimulating electrodes is described. Barium retention was improved by the electrically maintained contraction of the anal sphincter. The cannula was connected to a battery-powered control unit which provided the stimulus; pulse width was 1 msec and frequency was 20 pulses/sec. The pulse amplitude, adjusted for each patient, was in the range of 5--17V. A standard procedure was adopted throughout the trial without the use of colonic relaxants (such as anticholinergic drugs). The barium suspension and water were in stilled at body temperature. A comparison with a control series of 200 patients showed a significant reduction in the failure rate from 20% to 4%. No unpleasant side effects were encountered apart from a tingling sensation in the anal region which was expected. The principal factors contributing to failure were fecal impaction and diverticular disease.
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