Spinal dysraphism (SD) is a congenital malformation that to a varying extent, often severely, affects the life of the child and the family. Most individuals with SD suffer from neurogenic bladder a ...

Introduction Four-hour voiding observation with provocation test (VOP) using a scale, a damp detector and ultrasound for determination of residuals, is an easily performed non-invasive method for the evaluation of bladder function in newborns. Neonatal bladder function evaluated with VOP has been described for healthy newborns (HN) but not for children with spinal dysraphism (SD), for whom early bladder evaluation is essential for decisions regarding Clean Intermittent Catheterization and follow-up. The aim of the present study was to describe voiding observation with provocation test in newborns with spinal dysraphism and compare with corresponding data for healthy newborns. Methods and materials At a tertiary hospital, a 4 h voiding observation with provocation (VOP) was performed in 50 neonates (22 girls, 28 boys) with spinal dysraphism (37 open SD, 13 closed SD) consecutively evaluated for possible neurogenic bladder-sphincter dysfunction (1998-2019). All newborns with open SD and 4/13 with closed SD had been through postnatal neurosurgery before the test. Mean age was 10 days. Voiding observation was performed during 4 h with visual observation the fourth hour recording behavior and urinary flow (e.g. stream, dribbling). Finally, bladder provocations (e.g. suprapubic compression) were performed, and any leakage was noted. Findings were compared to those of 50 healthy newborns (HN) earlier published (Gladh et al., 2002). There were no significant differences in background data such as gender, age or diuresis between newborns with SD and HN. Results and discussion Voiding observation with provocation test of children with SD revealed significant differences compared to HN see summary table. Some children with SD had frequent small voids/leakages and low bladder volumes while three had no voiding and high volumes. Leakage during bladder provocation test and not voiding with a stream was not seen in HN but were common in newborns with SD (69% resp. 74%) (p < 0.01). A child with these findings should thus be investigated further. Identifying children needing Clean Intermittent Catheterization is important as well as being able to postpone or refrain from invasive urodynamic studies if not strongly indicated. VOP may give valuable information for these judgements. Conclusion Newborns with spinal dysraphism differ from healthy newborns in many aspects of bladder function. Bladder function varies between newborns with closed and open spinal dysraphism. Many newborns with spinal dysraphism leak at bladder provocation and void without a stream but healthy newborns do not. Early determination of post-void residuals is mandatory in children with spinal dysraphism and non-invasive VOP gives this information in a standardized way, also adding information on frequency, voiding with a stream and leakage at provocation. [GRAPHICS]

The way forward in addressing abusive head trauma in infants : current perspectives from Sweden

AimThe aim was to evaluate and compare different bowel regimes with regard to satisfaction, faecal incontinence and independence, and the relationship to quality of life among children with myelomeningocele (MMC).MethodsA questionnaire, including the health-related quality of life instrument PedsQL 4.0, was sent to all children aged seven to 16years (n=172) with MMC, treated at two centres in Sweden and one in Norway. The three centres cover a third of the population in the two countries. The response rate was 62%.ResultsParents of children (30%) using antegrade colonic enemas (ACE) reported higher satisfaction (p=0.01) than the parents of those (47%) using transanal irrigation (TAI). The children reported no significant difference. Children and parents in the ACE group reported more complete evacuation of the bowels than the TAI group. No significant difference was found in faecal incontinence or independent toileting. The children (40%) who emptied their bowels independently reported a higher quality of life. Children using TAI or ACE spent around one hour on the toilet at every bowel emptying.ConclusionTAI and ACE are effective treatments, but time-consuming and difficult to perform independently. Higher parental satisfaction is obtained with ACE. Irrespective of method the children who can use the toilet independently report a higher quality of life, which makes efforts to support independence valuable.

Purpose: Neurogenic bladder-sphincter dysfunction (NBSD) constitutes the major reason for morbidity in children with spina bifida. The aim of this study was to identify risk factors for renal damage in children with NBSD followed according to the Swedish national guidelines.Materials and Methods: Records and cystometries from 6 to 16 years (median 11) follow up of 41 consecutive children born 1993-2003 with NBSD were evaluated. The children were divided into a high pressure group (baseline pressure above 30 cmH(2)O at maximal clean intermittent catheterization volume in at least two cystometries) and a low pressure group. Most children (34/41) were followed from birth.Results: Although renal scarring on DMSA-scintigraphy was found in 5/41 children, all but one had normal renal function. Two already had renal scars on entering the follow-up program at age 2.5 and 3 years. Renal scarring was more frequent in the high pressure group (P < 0.01). Most children with renal scars (4/5) had a combination of low compliant bladder and insufficient compliance with treatment and follow up.Conclusion: High baseline pressure is confirmed as a risk factor that, in combination with complex social issues, creates a demanding situation for families and professionals. A structured early follow up with treatment compliance effectively prevents renal damage. (C) 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

The emerging technology-required increase of human complementary systems is being of high technology-human symbiosis that will be able to provide an additive information-flow and is considered being human related improvement. The expected increased values in quality improvements are foreseen in parts of population by the use of artificial sensor systems. These devices may convincingly perceive and act in symbiotic relationship between user and artificial abilities. A major impact is expected in the aged population that can improve their perceptual sensations. The task-related adaptive and augmented applications that indeed provide high performance in the interaction between operator and a connected system are of importance to convey the complementary concept of interfacing information. The introduction of sensor prosthesis is viewed in the context that a user may exhibit in its close proximity or in a global arena in order to complement non-existing sensing properties. The individual's ability to enhance the symbiotic effects is discussed and a future perspective of this scientific area is reflected.

On behalf of the organizing committee, it is our pleasure to welcome all participants to the 2010 IEEE International Workshop on Robotic and Sensors Environments (ROSE), being held in Tempe, Arizona, USA, on October 15-16, 2010. The IEEE ROSE is sponsored by the Institute of Electrical and Electronic Engineers (IEEE) Instrumentation and Measurement Society (IMS). It is organized in collaboration with the IMS’ TC-15 Virtual Systems in Measurements, TC-22 Intelligent Measurements Systems, TC-27 HumanComputer Interfaces and Interaction, TC-28 Instrumentation for Robotics and Automation, and TC-30 Security and Contraband Detection technical committees.

Background Constipation is a major problem in children with myelomeningocele and may result in a range of problems from impaired growth to faecal incontinence. Treatment regimes differ between countries and comparisons between the different methods are rare. Apart from effectiveness aspects as time needed and factors related to possibilities of independence are also important. Dominating treatment regimes are oral laxatives, transrectal irrigation (TRI) and different kinds of irrigation via appendicostomy.