| 1. |
- Ertzgaard, Per, 1958-, et al.
(författare)
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Ryggmärgsskador och ryggmärgsbråck
- 2006. - 1
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Ingår i: Rehabiliteringsmedicin. - Lund : Studenlitteratur. - 9144045077 - 9789144045078 ; , s. 276-287
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.
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| 2. |
- Gladh, Gunilla, 1943-, et al.
(författare)
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Anogenital electrical stimulation as treatment of urge incontinence in children
- 2001
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Ingår i: BJU International. - 1464-4096 .- 1464-410X. ; 87:4, s. 366-371
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To evaluate retrospectively the result of anogenital afferent stimulation (AGAS) in neurological healthy children with therapy-resistant urge incontinence.Patients and method The study included 48 children (24 girls and 24 boys, 5–14 years old) with a diagnosis of bladder instability verified by cystometry in all. Anogenital afferent stimulations were applied using a battery-powered dual constant-current stimulator. The children were stimulated continuously at 10 Hz for 20 min once or twice daily and if required the children and/or the parents continued to apply the treatment at home. For home stimulation a single (anal) channel stimulator was used. The patients were instructed to stimulate for 20 min at maximum intensity two to three times a week until the effects were optimal. The outcome was evaluated retrospectively by comparing voiding/incontinence diaries obtained before and at the follow-up 6–12 months after the end of treatment.Results AGAS was applied at the clinic for a median (range) of 9 (4–20) times. Thirty-one children continued with home stimulation for another 25 (5–96) sessions. At the follow-up, 18 children were cured and another seven improved, with a leakage score of less than half that before treatment. The treatment was well tolerated by most children.Conclusions Anogenital afferent stimulation is an effective, potentially curative treatment in children with severe urge incontinence. Home stimulation is a well accepted adjuvant to treatment at the clinic and improves the outcome.
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| 3. |
- Gladh, Gunilla, 1943-, et al.
(författare)
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Intravesical electrical stimulation in the treatment of micturition dysfunction in children
- 2003
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Ingår i: Neurourology and Urodynamics. - : Wiley. - 0733-2467 .- 1520-6777. ; 22:3, s. 233-242
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Tidskriftsartikel (refereegranskat)abstract
- Aims To evaluate the results of intravesical electrical stimulation (IVES) in an open prospective study to treat underactive detrusor in children. The treatment was offered as an alternative to clean intermittent catheterization (CIC).Methods Forty-four children were included, 21 girls and 3 boys (6–16 years, md 10) with idiopathic, 9 girls and 11 boys (4–18 years; md 13) with neurogenic underactive detrusor. IVES was given by a catheter electrode in the bladder (cathode) with the anode attached to the suprapubic abdominal skin. Continuous stimulation at 20 or 25 Hz was delivered by battery powered stimulators giving unipolar square-wave pulses (0,2 or 0,7 ms). Stimulation intensity was adjusted individually according to the acceptance of the child (12–64 mA). IVES was initially given at the clinic but 18 children had additional treatment at home. Effect of treatment was monitored by micturiton/incontinence diary, reports of bladder sensation, recordings of urinary flow, residual volume and frequency of urinary tract infections.Results The IVES-treatment was completed by 39/44 children. Long term normalization of the voiding (md 2,5 years follow up) was obtained for 20/24 children with idiopathic problems (83%) and 8/20 with neurogenic problems (40%). Another four had much improved bladder function. The neurogenic group required more stimulation sessions than the idiopathic group. Of those on CIC, 11/15 who completed IVES could discontinue the catheterization. The frequency of urinary tract infections and incontinence decreased significantly (P < 0.01).Conclusions It is concluded that IVES is a promising method to treat the underactive detrusor in children.
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| 4. |
- Gladh, Gunilla, 1943-, et al.
(författare)
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Outcome of the bladder cooling test in children with nonneurogenic bladder problems
- 2004
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 172:3, s. 1095-1098
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:The bladder cooling test (BCT) engages a primitive neonatal spinal reflex that becomes suppressed by descending signals in older children and may reappear with suprasacral lesions. We assessed the outcome of the BCT in a large group of children with nonneurogenic bladder problems.Materials and Methods:The BCT was evaluated in a consecutive series of 178 girls and 106 boys, 1 month to 18 years old with bladder problems without overt neurology. The test was performed at the end of routine cystometry by a rapid control infusion of body warm saline followed, after fluid evacuation, by the same volume of cold saline (3 to 10C). The test was considered positive if a detrusor contraction greater than 30 cm H2O was evoked by the cold but not the warm fluid.Results:Most children younger than 4 years had a history of pyelonephritis (29 of 34) and/or had vesicoureteral reflux (grade IV to V in 26 of 34). For those younger than 2 years 87% of the BCTs were positive while only 21% of the tests were positive in 2 to 3-year-old children. Most children older than 4 years had idiopathic urge incontinence, and greater than 50% of the BCTs were positive in the youngest (less than 6 years) with a gradual decline to 0% at age 13 years.Conclusions:Conversion of positive to negative BCTs at about age 2 years presumably represents normal maturation while positive tests in older incontinent children suggest delayed maturation of the central neuronal control of the bladder.
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| 5. |
- Gladh, Gunilla, 1943-, et al.
(författare)
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Quality of life in neurologically healthy children with urinary incontinence
- 2006
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 95:12, s. 1648-1652
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To bring forward the arguments for active treatment of urine incontinence in otherwise healthy children, a quality-of-life (QoL) study was performed.Subjects and methods: A self-rating QoL questionnaire, child-adjusted and validated, was completed by 120 neurologically healthy children, aged 6–16 y, with urinary incontinence. Another 239 age-matched children made up a control group. The two groups were compared both totally and in age-related subgroups (6–8, 9–12, >12 y) concerning the index for all questions, for universal parts (without questions dealing with incontinence) as well as for specific key domains.Results: The patient group had a significantly lower index than the control group both with and without items related to incontinence (p <0.0001). Social situation, self-esteem and self-confidence were most influenced, particularly in the youngest children. Thirty-one children (13%) of the control group reported incontinence and did not score their QoL as good as their continent peers but better than the study patients.Conclusion: From the quality-of-life aspects, the study supports active treatment of urinary incontinence in children already at younger ages.
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| 6. |
- Mattsson, Sven, 1943-, et al.
(författare)
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Relative filling of the bladder at daytime voids in healthy school children
- 2003
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Ingår i: Journal of Urology. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5347 .- 1527-3792. ; 170:4 I, s. 1343-1346
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Tidskriftsartikel (refereegranskat)abstract
- PurposeWe analyzed how healthy children use their bladder storage capacity during everyday life, and how transient changes in diuresis affect bladder filling and voiding intervals.Materials and MethodsVoided volumes and times were recorded during 1 or 2 24-hour periods by 206 healthy school children 7 to 15 years old. For each individual voided volumes were expressed as percentage of maximum voided volume (MVV). Mean diuresis preceding each void was estimated by dividing voided volume by voiding interval. A total of 1,098 voids were analyzed.ResultsThe first void in the morning was the largest for a majority of the children (73%). Most daytime voids were considerably smaller than the individual MVV. Single voids less than half MVV occurred in 80% of the children, and more than one-third had voids smaller than 20% of their storage capacity. MVV was the same for children with different voiding frequency but the relative filling decreased with the number of voids per 24 hours. At high diuresis voids tended to occur at shorter intervals with somewhat larger relative filling of the bladder. Nighttime voids that occurred in 23 children were in most cases (19) much smaller than the individual MVV.ConclusionsHealthy children typically void when they want to, not necessarily when they need to, and only exceptionally with a full bladder. The voiding pattern is more dependent on social activities and convenience than on physiological factors such as bladder capacity, filling and diuresis.
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| 7. |
- Mattsson, Sven, 1943-, et al.
(författare)
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Tap-water enema for children with myelomeningocele and neurogenic bowel dysfunction
- 2006
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 95:3, s. 369-374
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the outcome of transrectal irrigation (TRI) using clean tap water without salt in children with myelomeningocele and neurogenic bowel problems.Methods: 40 children (21 boys and 19 girls; aged 10 mo to 11 y) with myelomeningocele and neurogenic bowel dysfunction were treated with TRI given by a stoma cone irrigation set daily or every second day. A questionnaire on the effects on faecal incontinence, constipation and self-management was completed by the parents, 4 mo–8 y (median 1.5 y) after start. Effects on rectal volume, anal sphincter pressure and plasma sodium were evaluated before and after the start of irrigation.Results: At follow-up, 35 children remained on TRI, four had received appendicostomy, while one defecated normally. For all children but five (35/40; 85%) the procedure worked satisfactorily, but a majority found the procedure very time consuming and only one child was able to perform it independently. All children were free of constipation; most (35/40) were also anal continent. Rectal volume and anal sphincter pressure improved, while plasma sodium values remained within the normal range.Conclusion: Transrectal irrigation with tap water is a safe method to resolve constipation and faecal incontinence in children with myelomeningocele and neurogenic bowel dysfunction, but it does not help children to independence at the toilet.
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| 8. |
- Mattsson, Sven, 1943-, et al.
(författare)
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Urethrovaginal reflux : A common cause of daytime incontinence in girls
- 2003
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 111:1, s. 136-139
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The objective of this study was to estimate the frequency of urethrovaginal reflux as the cause of daytime incontinence in school-age girls, and to study the characteristic symptoms and the effect of simple instructions intended to amend the problem.Material and Methods. Girls with urethrovaginal reflux were identified in a group of 169 girls, aged 7 to 15 years, referred to a specialist clinic because of daytime incontinence. They were evaluated by a noninvasive screening protocol, including a careful history and neurourologic examination, bladder diaries, urine analysis, uroflows, and residual urine determined by ultrasound. Girls with urethrovaginal reflux were instructed by a urotherapist on how to achieve better toilet habits.Results. Urethrovaginal reflux was found in 21 (12.4%) of 169 girls as the sole (19) or contributing (2) cause of their daytime urinary incontinence. They all had a typical history of small leakage 5 to 10 minutes after voidings during the day, confirmed by a specific bladder diary. All were neurologically healthy, and all but 2 had a normal bladder function. The latter 2 girls had residual urine and asymptomatic bacteriuria. At follow-up after median 2 years, all girls were free from postmicturition leakage, but the 2 with residual urine remained daytime incontinent with cystometrically proven phasic detrusor overactivity.Conclusions. Urethrovaginal reflux is a common cause of urinary incontinence in girls. The diagnosis is easily obtained by an adequate history, completed with a specific bladder diary. The problem is easily resolved by proper voiding instructions.
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| 9. |
- Gladh, Gunilla, 1943-
(författare)
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Effect of thoughtful preparation on the catheterization of children undergoing investigative studies
- 2003
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Ingår i: Neurourology and Urodynamics. - : Wiley. - 0733-2467 .- 1520-6777. ; 22:1, s. 58-61
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Tidskriftsartikel (refereegranskat)abstract
- Aims:To evaluate an anesthetic sedation free method of transurethral catheterization in children.Methods:The child and his or her parents are thoroughly prepared for the procedure by means of written and oral child-adapted information and practical instructions. To evaluate this routine, a simple questionnaire was given to 115 consecutive children undergoing transurethral catheterization.Results:The questionnaire was returned by 99 children (86%). Most children and parents (95) found the preparation“good”or“very good”and tolerated the catheterization procedure well. Only six children reported the catheterization to be“very painful”(without requiring that the procedure was terminated). Complications, such as urgency, smarting pain during voidings, or both, after withdrawal of the catheter, occurred in 12 children and urinary tract infections in 3. Unexpectedly, girls were affected more often than boys.Conclusions:Careful preparation of children and their parents allows the great majority of diagnostic studies that require urethral catheterization to be accomplished without anesthesia. Neurourol. Urodynam. 22:58–61, 2003. © 2003 Wiley-Liss, Inc.
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| 10. |
- Gladh, Gunilla, 1943-, et al.
(författare)
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Outcome of the bladder cooling test in children with neurogenic bladder dysfunction
- 1999
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Ingår i: Journal of Urology. - 0022-5347 .- 1527-3792. ; 161:1, s. 254-258
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Tidskriftsartikel (refereegranskat)abstract
- PurposeWe evaluated the diagnostic use of the bladder cooling test in children with neurogenic bladder dysfunction.Materials and MethodsWe performed 201 bladder cooling tests in 65 female and 43 male patients 5 days to 17 years old, including 70 with myelomeningocele, 12 with high spinal lesions, 9 with sacral spinal lesions and 17 with encephalopathy of various types. At the end of routine cystometry we rapidly infused body temperature saline to approximately a third of cystometric capacity, followed by the same volume of saline at 4 to 8C. The test was considered positive when a detrusor contraction greater than 30 cm. water was evoked by the cold but not the warm infusion.ResultsThe bladder cooling test was positive in 37 children younger than 4 years, at which age it is normally positive. The test was negative in only 2 patients, indicating a complete lower motor neuron lesion. It was positive in 34 of the 57 children older than 6 years, at which age it should be negative. Thus, the positive bladder cooling test confirmed neurogenic bladder dysfunction. Four of the 20 children with a negative test voided normally, while the remainder had no voiding contractions, suggesting a nonfunctional spinal sacral reflex arch to the bladder.ConclusionsThe bladder cooling test is a simple, reliable assessment that may serve to demonstrate a functional sacral reflex arch in young patients without voiding contractions or confirm a suspected lower motor neuron lesion. It may be used longitudinally to demonstrate changes in bladder function with growth.
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