Urinary catheterization from 1997 to 2018: a Dutch population-based cohort

Background: Our aim was to evaluate the use of indwelling, intermittent and external urinary catheters in neurogenic and non-neurogenic bladder patients in the Netherlands from 1997 to 2018. Methods: Data were retrieved from a population-based cohort containing information about the extramural use of medical devices in the insured population in the Netherlands. The insured population increased from 9.9 million people in 1997 to 17.1 million people in 2018 (64–100% of the Dutch population). Users are expressed by users per 100,000 insured people and total users, corrected for the overall Dutch population. The expenditures are corrected for inflation and expressed by total costs and costs per user. Results: During this 21-year period, indwelling catheter (IC) users doubled from 159 per 100,000 people (24,734 users) to 315 per 100,000 people (54,106 users). Clean intermittent catheter (CIC) users increased from 92 per 100,000 people (14,258 users) in 1997 to 267 per 100,000 people (45,909 users) in 2018. Of all users, 20.7% had an associated neurogenic disorder and 44.9% a non-neurogenic disorder in 2018. The total expenditure on extramural use of urinary catheters increased from 27.7 million euros in 1997 to 84.4 million euros in 2018. IC costs increased from 6.0 million euros in 1997 to 6.7 million euros in 2018, while CIC costs rose from 16.4 million euros to 74.6 million euros. Urine drainage bag costs decreased from 17.2 million in 2001 to 5.3 million in 2018. Conclusions: IC use has increased substantially over the past 21 years, despite the fact that CIC use increased as well. It seems that the main driver behind the prevalence in IC and CIC use, is the rise in incontinence care in older patients and the adaption of preferred CIC use in professional guidelines. At least one fifth of all users catheterize due to neurogenic reasons.

Case 13

Thoracic outlet syndrome remains a controversial syndrome despite being described more than a century ago. This syndrome has neurogenic, vascular, and disputed types. True neurogenic thoracic outlet syndrome is relatively rare syndrome often associated with a cervical rib or cervical band. Symptoms include pain, hand and forearm numbness, and hand weakness and atrophy. The true neurogenic disorder has classical electrodiagnostic presentations. This case highlights the anatomy of the brachial plexus and distinguishes true neurogenic thoracic outlet syndrome from carpal tunnel syndrome, cubital tunnel syndrome, C8 radiculopathy, T1 radiculopathy, and post-median sternotomy brachial plexopathy, with emphasis on the electrodiagnostic findings.

PENGARUH PENYAKIT GINJAL KRONIK TERHADAP DISFUNGSI EREKSI PRIA

Chronic kidney disease is decreased in kidney function that persistent and irreversible. Chronic kidney disease can lead to problems in the erectile function of men because of disorders on some factors, that are the endocrine system, the vascular system, psychological factor, and neurogenic disorder. WHO estimated that there will be an increasing number of patients with chronic kidney disease by 41.4% between the years 1995-2025 in Indonesia. Research on erectile dysfunction in patients with chronic kidney disease has not been done yet in Indonesia, especially in Manado. The Aim of this research is to know the effect of chronic kidney disease to erectile dysfunction of men. The research design for this study is observasional descriptive. The number of samples obtained as many as 34 samples of patients with stage 5 chronic kidney disease, be found 18 people (52.95%) suffering from mild erectile dysfunction, 12 people (35.29%) suffering from mild-moderate erectile dysfunction, a man (2.94%) suffering from moderate erectile dysfunction, 2 people (5.88%) suffering from severe erectile dysfunction, and a man (2.94%) with no erectile dysfunction. The conclusion is patients with chronic kidney disease can lead to problems in the erectile function, because of influence from the above factors. Suggestion on this research is necessary to check blood testosterone levels and find more samples. Key word : Chronic kidney disease, erectile dysfunction Abstrak: Penyakit ginjal kronik adalah penurunan fungsi ginjal yang bersifat persisten dan ireversibel. Penyakit ginjal kronik dapat mengakibatkan masalah pada fungsi ereksi pria karena gangguan pada beberapa faktor, yaitu sistem endokrin, sistem vaskuler, faktor psikologis, dan kelainan neurogenik. WHO memperkirakan di Indonesia akan terjadi peningkatan jumlah penderita penyakit ginjal kronik sebesar 41,4% diantara tahun 1995-2025. Penelitian tentang disfungsi ereksi pada penderita penyakit ginjal kronik belum banyak dilakukan di Indonesia terutama di Manado. Penelitian ini bertujuan untuk mengetahui pengaruh penyakit ginjal kronik terhadap disfungsi ereksi pria. Desain penelitian yang digunakan adalah observasional deskriptif. Jumlah sampel yang didapat sebanyak 34 sampel penderita ginjal kronik stadium 5, didapatkan 18 orang (52,95%) menderita disfungsi ereksi ringan, 12 orang (35,29%) menderita disfungsi ereksi sedang-ringan, 1 orang (2,94%) menderita disfungsi ereksi sedang, 2 orang (5,88%) menderita disfungsi ereksi berat, dan 1 orang (2,94%) tidak disfungsi ereksi. Kesimpulan yang diperoleh adalah dapat terjadi gangguan fungsi ereksi pada penderita penyakit ginjal kronik, karena dipengaruhi oleh faktor diatas. Saran pada penelitian ini adalah perlu dilakukan pemeriksaan kadar testosteron darah dan mencari sampel yang lebih banyak. Kata kunci : Penyakit ginjal kronik, disfungsi ereksi

Benign fasciculations and Corticosteroid use: possible association? An update

Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose) indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation’s, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation’s are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS).We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation’s, especially due to the changes that this causes on the ionic channels. Fasciculation’s are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation’s, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously.

Differential Language and Neurologic Characteristics in Cerebral Involvement

Four groups of 10 patients, each group having a different neurogenic disorder of communication, were tested for impairment in 10 language categories. Five categories—auditory comprehension, adequacy of response, arithmetic, syntax, and naming—although impaired to some degree in all groups, did not sharply differentiate them. The most strongly differentiating disabilities in the four groups were aphasia—auditory retention span and fluency; apraxia of speech—fluency; confused language—relevance, reading comprehension, and writing of words to dictation; and general intellectual impairment—reading comprehension and auditory retention span (with preservation of relevance). The groups differed also in the onset and duration of the communication difficulty, and in the nature and locus of the neurologic problem.