The practical assessment and management of bladder outflow obstruction

The initial management of bladder outflow obstruction typically related to benign prostatic hyperplasia (BPH) falls to a large extent within the remit of general practice. Referral onwards to secondary care typically arises following the failure to respond to conservative measures or when complications have supervened; the most significant of which is urinary retention. In the hospital setting, anaesthesia, constipation and immobility are the common precipitants. What follows is a practical guide to the management of these situations and provides an overview of the conservative, medical, minimally invasive and surgical treatments available.     

Antral and duodenal motor responses to duodenal feeding in preterm and term infants.

In the fasting state, antral motor activity is similar in preterm and term infants, but the antral responses to feeding have not been compared in preterm and term infants. The purpose of this study was to use low-compliance, continuous perfusion manometry to compare antral and duodenal feeding responses in 13 preterm and nine term infants within the first 14 days of life. Confirming our previous studies, fasting antral motor activity was similar in preterm and term infants, but duodenal activity differed. Individual duodenal cluster activity was of shorter duration in preterm than in term infants (p less than 0.01). Motor activity in antrum and duodenum changed in both groups of infants in response to an intraduodenal milk infusion of 4 ml/kg/2 h; however, the nature of the change varied in the two regions. In term infants, the number of antral pressure waves, the duration of antral clusters, and the antral motility index decreased by one third or more during feeding when compared with fasting (all p less than 0.05). In contrast to the decrease in antral activity in response to feeding, the duodenal motility index and cluster activity increased significantly during feeding compared with fasting (both p less than 0.05). The divergent response of antral and duodenal motor activity in response to feedings was also seen in preterm infants. Antral pressure waves, the duration of antral clusters, and the antral motility index were decreased during feeding (all p less than 0.005 or less).(ABSTRACT TRUNCATED AT 250 WORDS)     

Measuring maternal mortality: An overview of opportunities and options for developing countries

Background  

There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015.     

The CTLA-4 gene region of chromosome 2q33 is linked to, and associated with, type 1 diabetes. Belgian Diabetes Registry

Susceptibility to autoimmune insulin-dependent (type 1) diabetes mellitus is determined by a combination of environmental and genetic factors, which include variation in MHC genes on chromosome 6p21 (IDDM1) and the insulin gene on chromosome 11p15 (IDDM2). However, linkage to IDDM1 and IDDM2 cannot explain the clustering of type 1 diabetes in families, and a role for other genes is inferred. In the present report we describe linkage and association of type 1 diabetes to the CTLA-4 gene (cytotoxic T lymphocyte associated-4) on chromosome 2q33 (designated IDDM12). CTLA-4 is a strong candidate gene for T cell- mediated autoimmune disease because it encodes a T cell receptor that mediates T cell apoptosis and is a vital negative regulator of T cell activation. In addition, we provide supporting evidence that CTLA-4 is associated with susceptibility to Graves' disease, another organ- specific autoimmune disease.