Biomedical subjects

K Everaert

Publications and source records attributed to K Everaert.

At least 19 recordsLinked to original sources

PubMed2005

Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial.

OBJECTIVES: To compare the performance of SpeediCath hydrophilic-coated catheters versus uncoated polyvinyl chloride (PVC) catheters, in traumatic spinal cord injured patients presenting with functional neurogenic bladder-sphincter disorders. METHODS: A 1-year, prospective, open, parallel, comparative, randomised, multi centre study included 123 male patients, > or =16 y and injured within the last 6 months. Primary endpoints were occurrence of symptomatic urinary tract infection (UTI) and hematuria. Secondary endpoints were development of urethral strictures and convenience of use. The main hypothesis was that coated catheters cause fewer complications in terms of symptomatic UTIs and hematuria. RESULTS: 57 out of 123 patients completed the 12-month study. Fewer patients using the SpeediCath hydrophilic-coated catheter (64%) experienced 1 or more UTIs compared to the uncoated PVC catheter group (82%) (p = 0.02). Thus, twice as many patients in the SpeediCath group were free of UTI. There was no significant difference in the number of patients experiencing bleeding episodes (38/55 SpeediCath; 32/59 PVC) and no overall difference in the occurrence of hematuria, leukocyturia and bacteriuria. CONCLUSIONS: The results indicate that there is a beneficial effect regarding UTI when using hydrophilic-coated catheters.

Adolescent↗

PubMed2004

Catalytic combustion of volatile organic compounds.

Despite the success of adsorption and thermal incineration of (C)VOC emissions, there is still a need for research on techniques which are both economically more favorable and actually destroy the pollutants rather than merely remove them for recycling elsewhere in the biosphere. The catalytic destruction of (C)VOC to CO2, H2O and HCl/Cl2 appears very promising in this context and is the subject of the present paper. The experiments mainly investigate the catalytic combustion of eight target compounds, all of which are commonly encountered in (C)VOC emissions and/or act as precursors for the formation of PCDD/F. Available literature on the different catalysts active in the oxidation of (C)VOC is reviewed and the transition metal oxide complex V2O5-WO3/TiO2 appears most suitable for the current application. Different reactor geometries (e.g. fixed pellet beds, honeycombs, etc.) are also described. In this research a novel catalyst type is introduced, consisting of a V2O5-WO3/TiO2 coated metal fiber fleece. The conversion of (C)VOC by thermo-catalytic reactions is governed by both reaction kinetics and reaction equilibrium. Full conversion of all investigated VOC to CO2, Cl2, HCl and H2O is thermodynamically feasible within the range of experimental conditions used in this work (260-340 degrees C, feed concentrations 30-60 ppm). A first-order rate equation is proposed for the (C)VOC oxidation reactions. The apparent rate constant is a combination of reaction kinetics and mass transfer effects. The oxidation efficiencies were measured with various (C)VOC in the temperature range of 260-340 degrees C. Literature data for oxidation reactions in fixed beds and honeycomb reactors are included in the assessment. Mass transfer resistances are calculated and are generally negligible for fleece reactors and fixed pellet beds, but can be of importance for honeycomb monoliths. The experimental investigations demonstrate: (i) that the conversion of the hydrocarbons is independent of the oxygen concentration, corresponding to a zero-order dependency of the reaction rate; (ii) that the conversion of the hydrocarbons is a first-order reaction in the (C)VOC; (iii) that the oxidation of the (C)VOC proceeds to a higher extent with increasing temperature, with multiple chlorine substitution enhancing the reactivity; (iv) that the reaction rate constant follows an Arrhenius dependency. The reaction rate constant kr (s(-1)) and the activation energy E (kJ/mol) are determined from the experimental results. The activation energy is related to the characteristics of the (C)VOC under scrutiny and correlated in terms of the molecular weight. The kr-values are system-dependent and hence limited in design application to the specific VOC-catalyst combination being studied. To achieve system-independency, kr-values are transformed into an alternative kinetic constant K (m3/(m2u)) expressed per unit of catalyst surface and thus independent of the amount of catalyst present in the reactor. Largely different experimental data can be fitted in terms of this approach. Results are thereafter used to define the Arrhenius pre-exponential factor A*, itself expressed in terms of the activation entropy. Destruction efficiencies for any given reactor set-up can be predicted from E- and A*-correlations. The excellent comparison of predicted and measured destruction efficiencies for a group of chlorinated aromatics stresses the validity of the design approach. Since laboratory-scale experiments using PCDD/F are impossible, pilot and full-scale tests of PCDD/F oxidation undertaken in Flemish MSWIs and obtained from literature are reported. From the data it is clear that: (i) destruction efficiencies are normally excellent; (ii) the efficiencies increase with increasing operating temperature; (iii) the higher degree of chlorination does not markedly affect the destruction efficiency. Finally, all experimental findings are used in design recommendations for the catalytic oxidation of (C)VOC and PCDD/F. Predicted values of the a)VOC and PCDD/F. Predicted values of the acceptable space velocity correspond with the cited industrial values, thus stressing the validity of the design strategy and equations developed in the present paper.

Catalysis↗

PubMed2004

A prospective randomized trial comparing the 1-stage with the 2-stage implantation of a pulse generator in patients with pelvic floor dysfunction selected for sacral nerve stimulation.

OBJECTIVE: The aim of this study was to evaluate in a prospective, randomized setting if the 2-stage implant, compared to a 1-stage implant, leads to a superior subjective or objective outcome of sacral nerve stimulation after implantation of the pulse generator in patients with lower urinary tract symptoms. PATIENTS AND METHODS: We implanted a sacral (S3) foramen lead and a pulse generator (model 3023, Medtronic Inc, Minneapolis, MN, USA) in 42 patients. They were randomized in a 1-stage or a 2-stage implant if a more than 50% improvement in voided volume or reduction of residual urine was seen during the test stimulation phase as compared to baseline. RESULTS: At 24 months follow-up, subjective (visual analogue scale) and objective (voided volume or residual urine) assessment were significantly better in the 2-stage group. Ten patients (24%) failed therapy, 7 in the 1-stage implant and 3 in the 2-stage group. Two patients were lost to follow-up. Logistic regression analysis revealed that failure was positively related to the 1-stage implant and negatively to the age of the patients. 76% of the treated patients had sustained clinical benefit with 23 revisions performed. The mean cost is respectively for the PNE (2006 Euro), for the 2-stage implant (10826 Euro) and for the 1 stage implant (8505 Euro). CONCLUSION: With this study, we demonstrated that the 2-stage implantation technique of the sacral neuromodulation therapy performed as a longer test stimulation phase has a higher success rate.

Algorithms↗

PubMed2004

Removal of PCDD/F from flue gases in fixed or moving bed adsorbers.

Whereas the PCDD/F-abatement in MSWIs is mostly achieved through entrained-phase adsorption upon activated carbon, the other thermal processes are more bending towards fixed/moving bed adsorption or catalytic destruction. The treatment of entrained-phase adsorption has been previously dealt with. The present paper focuses upon fixed/moving bed adsorption as abatement alternative. The characteristics of granular carbonaceous adsorbents are reviewed and commented upon, and stress some advantages of the fixed/moving bed operation. The equilibrium adsorption characteristics are expressed in terms of the number of active sites of the adsorbent and its saturation capacity. The breakthrough calculations for a fixed/moving bed adsorber are based upon these adsorption characteristics and expressed in terms of the relevant operating parameters of the flue gases to be treated. Although detailed literature data on these adsorbers are scarce, application of the design equations predicts meaningful results, thus demonstrating the predictive capacity of the design method.

Adsorption↗

PubMed2004

Randomized, double-blind placebo- and tolterodine-controlled trial of the once-daily antimuscarinic agent solifenacin in patients with symptomatic overactive bladder.

OBJECTIVE: To assess in a phase 3a trial the efficacy of solifenacin succinate, a once-daily oral antimuscarinic agent in development at 5-mg and 10-mg dosage strengths, for the treatment of overactive bladder (OAB) (Yamanouchi Pharmaceutical Co. Ltd, Tokyo, Japan) compared with placebo in patients with symptoms of OAB, i.e. urgency, incontinence, and frequency, with additional objectives being to assess the safety and tolerability of solifenacin and to compare the efficacy and safety of solifenacin with tolterodine 2 mg twice daily. PATIENTS AND METHODS: The study was an international, multicentre, randomized, double-blind, tolterodine- and placebo-controlled trial conducted at 98 centres. Adult patients with symptomatic OAB for > or = 3 months were eligible; after a single-blind 2-week placebo run-in period patients were randomized equally to a 12-week double-blind treatment with either tolterodine 2 mg twice daily, placebo, solifenacin 5 mg or 10 mg once daily. Efficacy variables included change from baseline in the mean number of urgency, incontinence and urge incontinence episodes, and change from baseline in voids/24 h and mean volume voided/void. RESULTS: In all, 1281 patients were enrolled, 1081 randomized and 1077 treated; 1033 were evaluated for efficacy. Compared with placebo, the change from baseline (-1.41, -32.7%) in the mean number of urgency episodes per 24 h was statistically significantly lower with solifenacin 5 mg (-2.85, -51.9%) and 10 mg (-3.07, -54.7%; both P < 0.001), but not with tolterodine (-2.05, -37.9%; P = 0.0511). There was a statistically insignificant decrease in episodes of incontinence with tolterodine (-1.14; P = 0.1122) but a significant decrease in patients treated with solifenacin 5 (-1.42; P = 0.008) and 10 mg (-1.45; P = 0.0038). Compared with placebo (-1.20, -8.1%) the mean number of voids/24 h was significantly lower in patients receiving tolterodine (-1.88, -15%; P = 0.0145), solifenacin 5 (-2.19, -17%) and 10 mg (-2.61, -20%; both P < 0.001). The mean volume voided/void was also significantly higher with all three active treatments (P < 0.001). Solifenacin was well tolerated; compared with placebo (4.9%), dry mouth (the most common side-effect), mostly mild, was reported in 18.6% of patients receiving tolterodine, 14.0% receiving 5 mg and 21.3% receiving 10 mg solifenacin. CONCLUSION: Solifenacin 5 and 10 mg once daily improved urgency and other symptoms of OAB, and was associated with an acceptable level of anticholinergic side-effects. Solifenacin demonstrated significantly favourable efficacy to side-effect ratio in treating symptomatic OAB.

Administration, Oral↗

PubMed2003

Entrained phase adsorption of PCDD/F from incinerator flue gases.

The emission abatement of polychlorinated dioxins and furans (PCDD/F) issued from municipal solid waste incineration (MSWI) is growing in importance because of more stringent emission standards and general health concern. These substances cannot be separated by conventional gas cleanup processes. They are successfully removed through adsorption onto carbonaceous materials, and the entrained-phase injection of pulverized adsorbents in the flue gas, followed by high-efficiency separation, is widely applied. Operating conditions and results obtained in Flemish MSWIs are given. The results illustrate the excellent overall removal efficiency: the regulation limit of 0.1 ng TEO/Nm3 dry gas at 11% O2 can be achieved. Furans are adsorbed to a slightly higher extent than the dioxins. The PCDD/F removal by carbonaceous adsorbents is thereafter modeled from first principles for the contribution of both entrained-phase (eta1) and cake filtration (eta2) to the overall efficiency (etaT), with dominant parameters being the operating temperature, the dosage and activity of adsorbent, and the fraction of adsorbent in the filter cake. Application of the model equations and comparison of measured and predicted overall efficiencies for the Flemish MSWIs demonstrate the validity of the model, which enables the MSWI operators both to predict the adsorption efficiencies for combinations of major operating parameters and to assess the sensitivity of the process to varying operating conditions. Finally, some practical difficulties encountered with the entrained-phase adsorption are discussed.

Adsorption↗

PubMed2003

Urinary infections in patients with spinal cord injury.

STUDY DESIGN: A retrospective study concerning urinary tract infections in spinal cord injury (SCI) patients. OBJECTIVES: To check whether the regular (1/week) urine cultures allow a more accurate treatment of urinary tract infections in SCI patients compared to empiric treatment. SETTING: Ghent University Hospital, East-Flanders, Belgium. METHODS: Group 1: 24 tetraplegic patients; group 2: 22 paraplegic patients; group 3: 28 other polytrauma patients as controls. These groups were chosen as catheterisation and other voiding methods differ according to the underlying pathology. RESULTS: An average of four clinically significant episodes of bacteriuria were found for groups 1 and 2, while group 3 experienced very few urinary infections. The mean species turnover of the first two groups was 2. No statistically significant difference was found in antibiotic-resistance patterns of organisms isolated. CONCLUSION: Despite different catheterisation techniques in para- and tetraplegic patients, we conclude that: (1) the number of episodes of clinical significant nosocomial urinary infections is not different; (2) the mean species turnover is the same; (3) because of the species turnover, the value of regular urine cultures for 'documented' treatment of clinical relevant urinary infections seems to be limited. So urine culture could be performed less frequently or only when therapy becomes mandatory; (4) No oral antibiotic with superior activity was found: treatment is best started empirically (after sampling for urine culture) and adjusted to the resulting antibiotic sensitivity screening.

Adolescent↗

PubMed2003

Urinary retention after hysterectomy for benign disease: extended diagnostic evaluation and treatment with sacral nerve stimulation.

OBJECTIVE: To detect prospectively neurogenic damage in patients with urinary retention responding to sacral nerve stimulation (SNS) after hysterectomy for benign disease. PATIENTS AND METHODS: From August 1995 to February 2002, 13 of 15 patients (mean age 43 years, sd 7) with urine retention for a mean (sd, range) of 25 (22, 6-240) months after hysterectomy for benign disease, were prospectively evaluated and treated with SNS. They were assessed using urodynamics at baseline and during the test stimulation. Sensory evoked potentials (SEPs), electrical sensory threshold (EST) measurements of the pudendal nerve, bladder neck and the bladder (2 Hz, 0-300 V), and needle electromyography of the external urethral sphincter (EUS) were undertaken in all patients. RESULTS: De-afferentiation (EST >/= 200 V) was limited to the bladder in four of the 13 patients and extended to the bladder neck in one other, and was matched by no response at the SEP. Relative ESTs of the bladder neck correlated inversely with residual urine (r = - 0.76, P = 0.01, x = 546, fx = 1.22) and bladder capacity (r = - 0.77, P = 0.01, x = 611, fx = 1.26) at diagnosis. Complex repetitive discharges and decelerating bursts of the EUS were seen in these five patients. Unilateral SNS was applied in 10 patients (bilateral in three). A revision was needed in six patients. Uroflowmetry at the last follow-up showed a mean (sd) maximum urinary flow rate of 22 (18) mL/s (not significantly different from during trial stimulation) with residual urine of 50-100 mL in two and 200-400 mL in three patients. Intermittent catheterization was needed in four patients. CONCLUSION: Urinary retention after hysterectomy for benign disease is associated with de-afferentiation of the bladder wall in some patients and is correlated inversely with the relative EST of the bladder neck. A Fowler syndrome was detected in five patients. For residual urine, about half the patients have a good and a third a partial long-term effect; we now offer SNS as a further treatment option.

Adult↗

PubMed2003

Chronic prostatitis and male accessory gland infection--is there an impact on male infertility (diagnosis and therapy)?

The aim of this article was to discuss by means of a review of the literature and own study material the multifactorial aetiology of male infertility, extrapolate this hypothesis to male accessory gland infection (MAGI) and relate it to chronic prostatitis and its treatment. Infertility is a multifactorial disease and diagnosis and therapy must be oriented as such. Although the relationship between prostatitis and infertility remains unclear, bacteria, viruses, leucocytes, reactive oxygen species, cytokines, obstruction and immunological abnormalities must be seen as cofactors in the development of infertility in patients with MAGI and prostatitis. Infection, trauma, allergy, neurogenic damage, chemical or mechanical factors can lead to a long-lasting inflammation of the prostate or pelvic organs even after eradication of the aetiological agent, and is potentially related to infertility through cytokines. In relation to treatment of infertility, antibiotics play a role in bacterial prostatitis whereas in abacterial prostatitis other treatments like antioxidants, sacral nerve stimulation and anti-inflammatory treatment are worth to be studied in the future.

Chronic Disease↗

PubMed2002

The formation and emission of dioxins in large scale thermal processes.

The paper assesses extensive data of PCDD/F measurements on flue gas emissions from thermal processes, including, e.g. municipal solid waste incinerators (MSWIs), combustors of wood and industrial waste, coal fired powerplants and boilers, ferro and non-ferro processes. Numerous investigators have conducted laboratory experiments to assess the formation mechanisms of PCDD/F. The results, obtained from fixed-bed experiments, have been critically evaluated and indicate that de novo synthesis is the dominant mechanism in actual thermal processes where conditions that favour the precursor formation are not experienced. The analysis of PCDD/F profiles from the large scale thermal processes in general, and MSWIs in particular, supports the dominant role of the de novo synthesis, irrespective of the type of thermal process considered. The PCDF/PCDD ratio exceeds 1 and the degree of chlorination points towards the dominant presence of HpCDD and OCDD within the dioxin group, and of PeCDF, HxCDF and HpCDF within the furan group. Since real-time measurement of PCDD/F is impossible, the correlation of PCDD/F emissions with operating parameters and/or emission levels of other more easily measured pollutants could be a tool in predicting the PCDD/F formation levels. Data of Flemish MSWIs were used to statistically assess such correlations. From an evaluation of the data at a given operating temperature, misleading conclusions can be drawn. Only the effect of temperature is evident. After converting all data at a reference temperature of, e.g. 230 degrees C, PCDD/F concentrations achieve nearly constant values, irrespective of the values of other parameters, thus stressing that the major controlling parameter for the PCDD/F emission is the temperature of the ESP. The PCDD/F concentrations increase with temperature in the range up to 280 degrees C. The ESP temperature should be kept preferably between 180 degrees C and 200 degrees C, where de novo synthesis is reduced and where PCDD/Fs are increasingly adsorbed on the fly ash, in line with the standard temperature dependence of adsorption isotherms.

Air Pollutants↗

PubMed2002

A high easy-to-treat complication rate is the price for a continent stoma.

OBJECTIVE: To evaluate the conduit-related complications and their treatment in Mitrofanoff continent urinary diversion and antegrade colonic enema (ACE) procedures. PATIENTS AND METHODS: The files of 53 patients (18 men and 35 women) in whom 58 continent stomas were created were retrospectively reviewed. Gender, age, age at the time of surgery, underlying disease, concomitant surgery, abdominal position of the stoma, follow-up, complications and treatment were assessed. The mean (sd) age at the time of surgery was 19 (13) years; 30 patients were aged <15 years and the mean follow-up was 2.8 (1.9) years. Fifty-three continent vesicostomy-type Mitrofanoff stomas were constructed and five ACE procedures performed. Forty-five stomas were in the umbilicus and 13 on the abdominal wall. For 45 conduits the appendix was used; in the other 13 a transverse tubularized ileal segment according to Monti was created. RESULTS: There were stoma-related complications in 19 patients (36%), with 27 in all and stomal stenosis accounting for more than half. Five patients had urinary leakage. The median time to the first complication was 9 months. Multiple regression analysis showed that gender and stoma location were the only significant determinants of the complication/follow-up ratio. Women had more complications than men and umbilical stomas fared worse than those on the abdominal wall. Age, underlying disease and type of stoma were not significantly related to the complication/follow-up ratio. The complication was treated by one procedure in 13 patients; four needed two and two needed three surgical revisions. Most complications were relatively easy to treat, i.e. dilatation in five, endoscopic incision in one, re-anastomosis in four, Y-V plasty in seven, a new channel in two, reimplantation in three, a bladder cuff in two for stomal leakage, and abdominoplasty in two. Only one stoma had to be abandoned. CONCLUSION: The complication rate for continent small-diameter stoma is high. However, most complications are relatively easy to treat. Despite these complications, patient satisfaction remains high.

Adolescent↗

PubMed2002

Removal of PCDD/F from incinerator flue gases by entrained-phase adsorption.

The emission abatement of polychlorinated dioxins and furans (PCDD/F) Issued from municipal solid waste incineration is growing in importance because of more stringent emission standards and general concern about their toxic characteristics. These substances cannot be separated by conventional gas cleanup processes but are successfully removed through adsorption onto carbonaceous materials. The simplest technique is the entrained-phase injection of pulverized adsorbents in the flue gas, followed by fabric filter separation. The various related techniques are briefly reviewed here. Operating conditions and results obtained from Flemish MSWIs are given. The results illustrate the excellent overall removal efficiency. Furans are adsorbed to a slightly higher extent than dioxins. PCDD/F removal by carbonaceous adsorbents is thereafter modeled from first principles for the contribution of both entrained-phase (eta1) and cake filtration (eta2) to the overall efficiency (etaT). Application of the model equations and comparison of measured and predicted overall efficiencies for the Flemish municipal solid waste incinerators (MSWIs) demonstrate that the approach is meaningful and that the dominant parameters are the operating temperature, the dosage and activity of adsorbent, and the fraction of adsorbent in the filter cake. The model equations enable the MSWI operators to predict the adsorption efficiencies for any combination of operating parameters and to assess the sensitivity of the process to varying operating conditions.

Adsorption↗

PubMed2001

The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes.

The aim of the study was to report our results of sacral nerve stimulation in patients with pelvic pain after failed conservative treatment. From 1992 to August 1998 we treated 111 patients (40 males, 71 females, ages 46 +/- 16 years) with chronic pelvic pain. All patients with causal treatment were excluded from this study. Pelvic floor training, transcutaneous electrical nerve stimulation (TENS) and intrarectal or intravaginal electrostimulation were applied and sacral nerve stimulation was used for therapy-resistant pain. The outcome of conservative treatment and sacral nerve stimulation (VAS <3/10; >50% pain relief) was related to symptoms of voiding dysfunction and dyschezia, and urodynamic proof of dysfunctional voiding, not to the pain localization or treatment modality. Outcome was inversely related to neuropathic pain. When conservative treatment failed, a test stimulation of the S3 root was effective in 16/26 patients, and 11 patients were implanted successfully with a follow-up of 36 +/- 8 months. So far no late failures have been seen. A longer test stimulation is needed in patients with pelvic pain because of a higher incidence of initial false positive tests. Our conclusion is that sacral nerve stimulation is effective in the treatment of therapy-resistant pelvic pain syndromes linked to pelvic floor dysfunction.

Adult↗

PubMed2001

Correlation of PCDD/F emissions with operating parameters of municipal solid waste incinerators.

Municipal solid waste incinerator (MSWI) operators frequently have expressed the need for an indirect indication of the expected production of PCDD/F and associated abatement procedures through a possible correlation with other real-time data, through using marker pollutants (e.g., penta/hexachlorinated aromatics), or through other indications. Since real-time measurement of PCDD/F is impossible, a correlation of PCDD/F emissions with other operating parameters could help in achieving these goals. Literature data of large-scale MSWIs concerning these correlations are scarce and seldom conclusive. Extensive data of Flemish MSWIs are used to statistically assess possible correlations of PCDD/F and other operating parameters. The effect of temperature in the electrostatic precipitator (ESP) is of major importance. When converting values measured between 180 and 270 degrees C to a reference temperature of, for example, 230 degrees C, PCDD/F concentrations achieve nearly constant values, stressing that the major correlating parameter is the temperature of the ESP. High temperatures that enhance de novo synthesis should be avoided.

Air Pollutants↗

PubMed2001

Impact of urinary tract infection and detrusor pressure on renal tubular function in patients with vesicoureteral reflux.

OBJECTIVE: The aim of this study was to evaluate prospectively the impact of bacteriuria with or without pyuria and/or detrusor pressure on renal tubular function in patients with secondary vesicoureteral reflux. METHODS: From October 1994 to December1998, we evaluated 54 patients with secondary vesicoureteral reflux (26 men and 28 women; age 30+/-24 years), of whom 28 had a neurogenic and 26 a nonneurogenic voiding dysfunction. In a reference population (n = 48; 28 men, 20 women; age 38+/-14 years), 43 had a neurogenic and 5 a nonneurogenic voiding dysfunction. Urinary alpha-1-microglobulin was measured immunonephelometrically. Statistical analysis was performed by multiple regression analysis. RESULTS: Patients with vesicoureteral reflux had a significantly higher urinary alpha-1-microglobulin/creatinine ratio. Urinary alpha-1-microglobulin excretion was related to the grade of vesicoureteral reflux, detrusor pressure and compliance, but not to bacteriuria or pyuria, and was diagnostic for vesicoureteral reflux with a sensitivity of 90%, a specificity of 70% and a negative predictive value of 97%. CONCLUSION: Urinary alpha-1-microglobulin excretion is diagnostically useful in patients with secondary vesicoureteral reflux. The use of urinary alpha-1-microglobulin excretion in the follow-up of patients with vesicoureteral reflux has yet to be established.

Adult↗

PubMed2001

The Belgian PCB and dioxin incident of January-June 1999: exposure data and potential impact on health.

In January 1999, 500 tons of feed contaminated with approximately 50 kg of polychlorinated biphenyls (PCBs) and 1 g of dioxins were distributed to animal farms in Belgium, and to a lesser extent in the Netherlands, France, and Germany. This study was based on 20,491 samples collected in the database of the Belgian federal ministries from animal feed, cattle, pork, poultry, eggs, milk, and various fat-containing food items analyzed for their PCB and/or dioxin content. Dioxin measurements showed a clear predominance of polychlorinated dibenzofuran over polychlorinated dibenzodioxin congeners, a dioxin/PCB ratio of approximately 1:50,000 and a PCB fingerprint resembling that of an Aroclor mixture, thus confirming contamination by transformer oil rather than by other environmental sources. In this case the PCBs contribute significantly more to toxic equivalents (TEQ) than dioxins. The respective means +/- SDs and the maximum concentrations of dioxin (expressed in TEQ) and PCB observed per gram of fat in contaminated food were 170.3 +/- 487.7 pg, 2613.4 pg, 240.7 +/- 2036.9 ng, and 51059.0 ng in chicken; 1.9 +/- 0.8 pg, 4.3 pg, 34.2 +/- 30.5 ng, and 314.0 ng in milk; and 32.0 +/- 104.4 pg, 713.3 pg, 392.7 +/- 2883.5 ng, and 46000.0 ng in eggs. Assuming that as a consequence of this incident between 10 and 15 kg PCBs and from 200 to 300 mg dioxins were ingested by 10 million Belgians, the mean intake per kilogram of body weight is calculated to maximally 25,000 ng PCBs and 500 pg international TEQ dioxins. Estimates of the total number of cancers resulting from this incident range between 40 and 8,000. Neurotoxic and behavioral effects in neonates are also to be expected but cannot be quantified. Because food items differed widely (more than 50-fold) in the ratio of PCBs to dioxins, other significant sources of contamination and a high background contamination are likely to contribute substantially to the exposure of the Belgian population.

Animals↗

PubMed2001

Transcutaneous neuromodulation for the urge syndrome in children: a pilot study.

PURPOSE: Neuromodulation has been used to treat voiding dysfunction in adults. Due to its invasiveness it has rarely been used in children until now with the availability of transcutaneous neurostimulation. We evaluated clinical effects of transcutaneous neuromodulation on detrusor overactivity in children with the urge syndrome. MATERIALS AND METHODS: Between May 1, 1998 and February 28, 1999, 15 girls (mean age 10.2 years) and 26 boys (mean age 10.7 years) with proved detrusor hyperactivity on videourodynamic study underwent neuromodulation. All children had been given anticholinergic therapy previously. Neurostimulation only was used in children in whom anticholinergics had no effect and those who had significant side effects. Anticholinergics were continued in children in whom they had a partial effect. Stimulation of 2 Hz. was applied for 2 hours every day. Surface electrodes were placed at the level of sacral root S3. After 1 month of trial stimulation those children who responded continued the treatment for 6 months, and were evaluated every 2 months. RESULTS: Of the 41 children 15 boys and 13 girls responded after 1 month of trial therapy with an increase in bladder capacity, decrease in urgency, decrease in incontinence and/or better sensitivity. Of the 13 children who did not respond 9 lacked motivation and 4 had no clinical effect despite motivation. After 6 months of therapy a significant increase in bladder capacity, decrease in voiding frequency and decrease in incontinence periods were noted. Adverse effects were not observed. One year after therapy relapse was noted in 7 patients, leaving 21 of 41 children definitively cured. CONCLUSIONS: Although preliminary, our results indicate that transcutaneous neuromodulation can improve symptoms of detrusor overactivity, as response to stimulation was noted in 76% of our patients and 56% were cured after 1 year. This therapeutic option is attractive for children because of its noninvasiveness and absence of adverse effects.

Child↗

PubMed2000

Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation.

The aim of the study was to determine the success rate, the complications, the failures and the solutions found in troublesome cases. A retrospective study was performed in three university centers in Belgium. Between March 1994 and April 1998, a quadripolar electrode and a pulse generator were implanted in 53 patients (8 men, 45 women, 43 +/- 12 years, mean follow-up 24 +/- 8 months, range 13-39 months). During the first few months, 45 (85%) of the 53 patients had an objective response. Eight late failures occurred, with a mean failure delay of 9 +/- 5 months. We performed 15 revisions in 12 patients. Major complications were pain and current-related troubles. The outcome was significantly better (P = 0.001) in post-stress incontinence surgery patients. Device-related pain was found more frequently in patients with dysuria and/or retention or perineal pain, and the test stimulation was less reliable (P = 0.025) in patients with a psychiatric history. Sacral nerve stimulation is efficient in treating patients with refractory lower urinary tract symptoms and/or perineal pain.

Adult↗