BACKGROUND:Neurogenic detrusor overactivity (NDO) leads to impaired health-related quality of life (HRQoL), productivity, and greater healthcare resource burden. The humanistic and economic burden may be more apparent in NDO patients with urinary incontinence (UI). The objective of this study was to compare the HRQoL, productivity, and health resource use (HRU) between continent and incontinent NDO patients.METHODS:A retrospective database analysis was conducted using the Adelphi Overactive Bladder (OAB)/UI Disease Specific Programme, a multi-national, cross-sectional survey reported from both patients' and physicians' perspectives. The population for this analysis included NDO patients with or without UI. General and disease-specific HRQoL were assessed using the EuroQoL-5D (EQ-5D), Incontinence Quality of Life questionnaire (I-QOL), and the Overactive Bladder Questionnaire (OAB-q). Productivity and daily activity impairment were measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. HRU indicators included OAB-related surgery, OAB-related hospitalizations, incontinence pad usage, switching anticholinergics used for OAB due to inadequate response or adverse effects, and OAB-related physician visits. Bivariate analyses, multivariate ordinary least squares (OLS) regression analyses and published minimal clinically important differences (MCID) were used to assess relationships between incontinent status and the aforementioned outcome measures.RESULTS:A total of 324 NDO patients with or without urinary incontinence were included, averaging 54years of age (SD 16), of whom 43.8 percent were male. Bivariate analyses detected no significant relationship between incontinent status and HRU variables. Regression analyses revealed that incontinent patients had clinically and statistically lower disease-specific HRQoL and greater impairment in daily activities as compared to continent patients. On average, incontinent patients scored 10 points lower on the I-QOL total score, 9 points lower on the OAB-q HRQoL score, 15 points higher on OAB-q symptom severity, and experienced 8.2 percent higher activity impairment due to their bladder condition (all p <0.001).CONCLUSIONS:Incontinent NDO patients experience significantly lower HRQoL and activity impairment as compared to continent NDO patients.

L’exagération de l’activité contractile spontanée (ACS) et les tumeurs de vessie (TV) sont des modifications morphologiques vésicales observées à moyen et long terme chez les patients ayant une hyperactivité détrusorienne neurogène. Cependant la carcinogénèse vésicale chez les patients neurologiques n’a jamais été étudiée à ce jour et la signification de l’ACS est non élucidée. Nos buts étaient d’étudier la carcinogénèse des vessies neurologiques (en particulier le rôle de l’inflammation chronique) et d’étudier les mécanismes de l’ACS.Nous rapportons que l’expression immunohistochimique de Foxp3 est caractéristique des patients neurologiques ayant une TV agressive de différenciation épidermoïde. Ainsi Foxp3 pourrait être une cible pour le développement d’immunothérapies anti-tumorales. Par une étude en bains d’organes sur des fragments de vessies fraîches issus de patients ayant une hyperactivité détrusorienne neurogène réfractaire, nous observons que l’ACS vésicale in vitro est corrélée à l'âge et la présence de muqueuse vésicale. La modulation pharmacologique de la communication intercellulaire médiée par les connexines 40, 43 et 45 n’inhibe pas l’ACS. La traduction clinique de ces résultats préliminaires est encore difficile. Cependant la compréhension de la signification de l’ACS pourrait identifier de nouvelles voies thérapeutiques pour l’hyperactivité détrusorienne neurogène. Nos résultats ne peuvent pas être argumentés par la littérature encore pauvre à ce sujet. Ce programme de recherche innovant sur les modifications morphologiques à moyen et long terme des vessies neurologiques est poursuivi grâce à une collaboration nationale et à la transversalité des domaines d’expertises des chercheurs impliqués. / Increased spontaneous contractile activity (SCA) and bladder cancer are medium and long-term morphological changes of the bladder observed in patients with neurogenic detrusor overactivity. However, urothelial carcinogenesis in neurological patients has never been studied and the signification of ACS remains unknown. Our objectives were to study the bladder carcinogenesis in neurological patients (in particular the role of chronic inflammation), and the mechanisms of SCA in neurogenic bladders. We report that Foxp3 expression appears to be a characteristic of neurological patients presenting with aggressive bladder cancer and squamous cell differentiation. Thus, targeting Foxp3 may represent an interesting strategy to improve anti-tumor immunotherapy for bladder cancer. By conducting organ bath studies on bladder strips from patients with refractory neurogenic detrusor overactivity, we observe that the in vitro SCA may be modulated by age and the presence of mucosa. The pharmacological modulation of intercellular communication, targeting connexins 40, 43 and 45, cannot inhibit the SCA of neurogenic bladder strips. These results are still difficult to translate into clinical practice. However, understanding the origin of bladder SCA could help identify new therapeutic strategies for detrusor overactivity. Our results are still preliminary and cannot be supported by the literature due to paucity of data. This research program on medium and long-term morphological changes of human neurogenic bladders is pursued through a national collaboration and cross-disciplinary areas of expertise of the researchers involved.

Introdução: A investigação dos sintomas do trato urinário inferior se inicia, geralmente, pela história, exame físico e testes clínicos simples. Entretanto, esta investigação, muitas vezes, se mostra insuficiente para o diagnóstico correto da incontinência urinária. Nestes casos, a avaliação, ou estudo, urodinâmica (o) é realizada para confirmação do diagnóstico. No entanto, o melhor método para avaliação urodinâmica ainda não foi bem estabelecido. Apesar de a cistometria convencional ser considerada padrão ouro, e ser o método mais aceito para investigação de hiperatividade detrusora, o método de enchimento (retrógrado) da urodinâmica convencional permanece controverso. Por ser um enchimento não fisiológico, vários estudos têm demonstrado altos índices de falsos negativos em relação ao diagnóstico de hiperatividade detrusora. Objetivo: Estimar a prevalência de hiperatividade detrusora durante avaliação urodinâmica ambulatorial de pacientes encaminhadas ao ambulatório de uroginecologia do Hospital de Clínicas de Porto Alegre com sintoma de urgência e avaliação urodinâmica convencional normal. Métodos: Estudo transversal, no qual foram incluídas mulheres com idade superior a 19 anos, apresentando queixa de urgência, urge-incontinência ou incontinência mista, atendidas no ambulatório de uroginecologia do Hospital de Clínicas de Porto Alegre e que já realizaram avaliação urodinâmica convencional, cuja cistometria não tenha detectado hiperatividade detrusora. O cálculo do tamanho da amostra foi realizado no programa WinPEPI (Programs for Epidemiologists for Windows) versão 11.43 , baseado nos achados de um estudo piloto com 6 pacientes. Para um nível de confiança de 95%, uma prevalência de hiperatividade em avaliação urodinâmica ambulatorial estimada em 83% e uma margem de erro de 17%, obtevese um total mínimo de 19 pacientes. O nível de significância adotado foi de 5% (p≤0,05) e as análises foram realizadas no programa SPSS versão 21.0. Resultados: Vinte pacientes com sintomas de urgência e cistometria convencional normal foram submetidas à avaliação urodinâmica ambulatorial. A média de idade foi de 56 anos. Os sintomas mistos de urgência e incontinência por esforço foram mais prevalentes do que sintomas puros de urgência (18/20). A prevalência de hiperatividade detrusora em avaliação urodinâmica ambulatorial de pacientes com sintoma de urgência e com avaliação urodinâmica convencional normal foi de 70% (14/20). O intervalo de 95% de confiança para a verdadeira prevalência na população é de 48% a 87% Conclusão: A avaliação urodinâmica ambulatorial parece ter um papel importante na avaliação adicional de casos mais complexos de pacientes com disfunções do trato urinário, quando há falha diagnóstica e terapêutica – em especial na avaliação de hiperatividade detrusora. Foi encontrado um falso negativo de 70% na avaliação urodinâmica convencional. No entanto, tendo em vista o maior custo do equipamento e das sondas em relação ao convencional, mais estudos são necessários para a incorporação deste exame na prática clínica brasileira. / Introduction: The investigation of lower urinary tract symptoms usually starts with the history, physical exam and simple clinical tests. However, quite often this investigation is not sufficient for the correct diagnosis of urinary incontinence. In these cases, the urodynamic test is accomplished to confirm it. The best method to evaluate the urodynamic has not been established. In spite of the conventional cystometry being considered as the gold standard and being the most accepted investigative method for detrusor overactivity, the conventional retrograde filling urodynamic method of remains controversial. Since it is a non-physiologic filling, several studies have shown high rates of false negatives concerning the diagnosis of detrusor overactivity. Objective: To estimate the prevalence of detrusor overactivity during ambulatory urodynamic tests in symptomatic patients whose results of conventional urodynamic evaluation were normal. Methodology: The research subjects were women referred to the urogynecology service of Hospital de Clínicas, Porto Alegre, Brazil for further investigation due to urinary incontinence symptoms (overactive bladder syndrome, urge incontinence or mixed incontinence), whose conventional urodynamics results did not show any detrusor overactivity. The sample size was calculated using the WinPEPI program (Programs for Epidemiologists for Windows) 11.43 version and was based on the findings of a pilot study with 6 patients. Using a 95% confidence interval and an estimated urodynamic detrusor overactivity prevalence of 83% with a standard error of 17%, a sample size of 19 patients was obtained. A level of significance of 5% (p≤0.05) was considered. SPSS 21.0 version program was used to accomplish the statistical analysis. Results: A total of 20 women were included in this study. The mean age was 56.1 years, the mean body mass index was 29.7 and the mean time of the symptoms was 5 years. We found mixed urinary incontinence in 18 (90%) and urge incontinence in 2 (10%) patients. All conventional cystometry tests were normal; however, in 14 (70%) patients the ambulatory urodynamics was able to diagnose detrusor overactivity. Conclusion: The ambulatory urodynamics evaluation seems to have a major role in the additional evaluation of more complex cases of urinary tract dysfunctions, when there is a diagnostic and therapeutic flaw – especially in the evaluation of detrusor overactivity. We found 70 % of false negative in the conventional cystometry. However, having in mind the higher cost of the equipment and catheters in relation to the conventional one, more studies are necessary for the incorporation of this test in the Brazilian clinical practice.

Introdução: A investigação dos sintomas do trato urinário inferior se inicia, geralmente, pela história, exame físico e testes clínicos simples. Entretanto, esta investigação, muitas vezes, se mostra insuficiente para o diagnóstico correto da incontinência urinária. Nestes casos, a avaliação, ou estudo, urodinâmica (o) é realizada para confirmação do diagnóstico. No entanto, o melhor método para avaliação urodinâmica ainda não foi bem estabelecido. Apesar de a cistometria convencional ser considerada padrão ouro, e ser o método mais aceito para investigação de hiperatividade detrusora, o método de enchimento (retrógrado) da urodinâmica convencional permanece controverso. Por ser um enchimento não fisiológico, vários estudos têm demonstrado altos índices de falsos negativos em relação ao diagnóstico de hiperatividade detrusora. Objetivo: Estimar a prevalência de hiperatividade detrusora durante avaliação urodinâmica ambulatorial de pacientes encaminhadas ao ambulatório de uroginecologia do Hospital de Clínicas de Porto Alegre com sintoma de urgência e avaliação urodinâmica convencional normal. Métodos: Estudo transversal, no qual foram incluídas mulheres com idade superior a 19 anos, apresentando queixa de urgência, urge-incontinência ou incontinência mista, atendidas no ambulatório de uroginecologia do Hospital de Clínicas de Porto Alegre e que já realizaram avaliação urodinâmica convencional, cuja cistometria não tenha detectado hiperatividade detrusora. O cálculo do tamanho da amostra foi realizado no programa WinPEPI (Programs for Epidemiologists for Windows) versão 11.43 , baseado nos achados de um estudo piloto com 6 pacientes. Para um nível de confiança de 95%, uma prevalência de hiperatividade em avaliação urodinâmica ambulatorial estimada em 83% e uma margem de erro de 17%, obtevese um total mínimo de 19 pacientes. O nível de significância adotado foi de 5% (p≤0,05) e as análises foram realizadas no programa SPSS versão 21.0. Resultados: Vinte pacientes com sintomas de urgência e cistometria convencional normal foram submetidas à avaliação urodinâmica ambulatorial. A média de idade foi de 56 anos. Os sintomas mistos de urgência e incontinência por esforço foram mais prevalentes do que sintomas puros de urgência (18/20). A prevalência de hiperatividade detrusora em avaliação urodinâmica ambulatorial de pacientes com sintoma de urgência e com avaliação urodinâmica convencional normal foi de 70% (14/20). O intervalo de 95% de confiança para a verdadeira prevalência na população é de 48% a 87% Conclusão: A avaliação urodinâmica ambulatorial parece ter um papel importante na avaliação adicional de casos mais complexos de pacientes com disfunções do trato urinário, quando há falha diagnóstica e terapêutica – em especial na avaliação de hiperatividade detrusora. Foi encontrado um falso negativo de 70% na avaliação urodinâmica convencional. No entanto, tendo em vista o maior custo do equipamento e das sondas em relação ao convencional, mais estudos são necessários para a incorporação deste exame na prática clínica brasileira. / Introduction: The investigation of lower urinary tract symptoms usually starts with the history, physical exam and simple clinical tests. However, quite often this investigation is not sufficient for the correct diagnosis of urinary incontinence. In these cases, the urodynamic test is accomplished to confirm it. The best method to evaluate the urodynamic has not been established. In spite of the conventional cystometry being considered as the gold standard and being the most accepted investigative method for detrusor overactivity, the conventional retrograde filling urodynamic method of remains controversial. Since it is a non-physiologic filling, several studies have shown high rates of false negatives concerning the diagnosis of detrusor overactivity. Objective: To estimate the prevalence of detrusor overactivity during ambulatory urodynamic tests in symptomatic patients whose results of conventional urodynamic evaluation were normal. Methodology: The research subjects were women referred to the urogynecology service of Hospital de Clínicas, Porto Alegre, Brazil for further investigation due to urinary incontinence symptoms (overactive bladder syndrome, urge incontinence or mixed incontinence), whose conventional urodynamics results did not show any detrusor overactivity. The sample size was calculated using the WinPEPI program (Programs for Epidemiologists for Windows) 11.43 version and was based on the findings of a pilot study with 6 patients. Using a 95% confidence interval and an estimated urodynamic detrusor overactivity prevalence of 83% with a standard error of 17%, a sample size of 19 patients was obtained. A level of significance of 5% (p≤0.05) was considered. SPSS 21.0 version program was used to accomplish the statistical analysis. Results: A total of 20 women were included in this study. The mean age was 56.1 years, the mean body mass index was 29.7 and the mean time of the symptoms was 5 years. We found mixed urinary incontinence in 18 (90%) and urge incontinence in 2 (10%) patients. All conventional cystometry tests were normal; however, in 14 (70%) patients the ambulatory urodynamics was able to diagnose detrusor overactivity. Conclusion: The ambulatory urodynamics evaluation seems to have a major role in the additional evaluation of more complex cases of urinary tract dysfunctions, when there is a diagnostic and therapeutic flaw – especially in the evaluation of detrusor overactivity. We found 70 % of false negative in the conventional cystometry. However, having in mind the higher cost of the equipment and catheters in relation to the conventional one, more studies are necessary for the incorporation of this test in the Brazilian clinical practice.

Introdução: A investigação dos sintomas do trato urinário inferior se inicia, geralmente, pela história, exame físico e testes clínicos simples. Entretanto, esta investigação, muitas vezes, se mostra insuficiente para o diagnóstico correto da incontinência urinária. Nestes casos, a avaliação, ou estudo, urodinâmica (o) é realizada para confirmação do diagnóstico. No entanto, o melhor método para avaliação urodinâmica ainda não foi bem estabelecido. Apesar de a cistometria convencional ser considerada padrão ouro, e ser o método mais aceito para investigação de hiperatividade detrusora, o método de enchimento (retrógrado) da urodinâmica convencional permanece controverso. Por ser um enchimento não fisiológico, vários estudos têm demonstrado altos índices de falsos negativos em relação ao diagnóstico de hiperatividade detrusora. Objetivo: Estimar a prevalência de hiperatividade detrusora durante avaliação urodinâmica ambulatorial de pacientes encaminhadas ao ambulatório de uroginecologia do Hospital de Clínicas de Porto Alegre com sintoma de urgência e avaliação urodinâmica convencional normal. Métodos: Estudo transversal, no qual foram incluídas mulheres com idade superior a 19 anos, apresentando queixa de urgência, urge-incontinência ou incontinência mista, atendidas no ambulatório de uroginecologia do Hospital de Clínicas de Porto Alegre e que já realizaram avaliação urodinâmica convencional, cuja cistometria não tenha detectado hiperatividade detrusora. O cálculo do tamanho da amostra foi realizado no programa WinPEPI (Programs for Epidemiologists for Windows) versão 11.43 , baseado nos achados de um estudo piloto com 6 pacientes. Para um nível de confiança de 95%, uma prevalência de hiperatividade em avaliação urodinâmica ambulatorial estimada em 83% e uma margem de erro de 17%, obtevese um total mínimo de 19 pacientes. O nível de significância adotado foi de 5% (p≤0,05) e as análises foram realizadas no programa SPSS versão 21.0. Resultados: Vinte pacientes com sintomas de urgência e cistometria convencional normal foram submetidas à avaliação urodinâmica ambulatorial. A média de idade foi de 56 anos. Os sintomas mistos de urgência e incontinência por esforço foram mais prevalentes do que sintomas puros de urgência (18/20). A prevalência de hiperatividade detrusora em avaliação urodinâmica ambulatorial de pacientes com sintoma de urgência e com avaliação urodinâmica convencional normal foi de 70% (14/20). O intervalo de 95% de confiança para a verdadeira prevalência na população é de 48% a 87% Conclusão: A avaliação urodinâmica ambulatorial parece ter um papel importante na avaliação adicional de casos mais complexos de pacientes com disfunções do trato urinário, quando há falha diagnóstica e terapêutica – em especial na avaliação de hiperatividade detrusora. Foi encontrado um falso negativo de 70% na avaliação urodinâmica convencional. No entanto, tendo em vista o maior custo do equipamento e das sondas em relação ao convencional, mais estudos são necessários para a incorporação deste exame na prática clínica brasileira. / Introduction: The investigation of lower urinary tract symptoms usually starts with the history, physical exam and simple clinical tests. However, quite often this investigation is not sufficient for the correct diagnosis of urinary incontinence. In these cases, the urodynamic test is accomplished to confirm it. The best method to evaluate the urodynamic has not been established. In spite of the conventional cystometry being considered as the gold standard and being the most accepted investigative method for detrusor overactivity, the conventional retrograde filling urodynamic method of remains controversial. Since it is a non-physiologic filling, several studies have shown high rates of false negatives concerning the diagnosis of detrusor overactivity. Objective: To estimate the prevalence of detrusor overactivity during ambulatory urodynamic tests in symptomatic patients whose results of conventional urodynamic evaluation were normal. Methodology: The research subjects were women referred to the urogynecology service of Hospital de Clínicas, Porto Alegre, Brazil for further investigation due to urinary incontinence symptoms (overactive bladder syndrome, urge incontinence or mixed incontinence), whose conventional urodynamics results did not show any detrusor overactivity. The sample size was calculated using the WinPEPI program (Programs for Epidemiologists for Windows) 11.43 version and was based on the findings of a pilot study with 6 patients. Using a 95% confidence interval and an estimated urodynamic detrusor overactivity prevalence of 83% with a standard error of 17%, a sample size of 19 patients was obtained. A level of significance of 5% (p≤0.05) was considered. SPSS 21.0 version program was used to accomplish the statistical analysis. Results: A total of 20 women were included in this study. The mean age was 56.1 years, the mean body mass index was 29.7 and the mean time of the symptoms was 5 years. We found mixed urinary incontinence in 18 (90%) and urge incontinence in 2 (10%) patients. All conventional cystometry tests were normal; however, in 14 (70%) patients the ambulatory urodynamics was able to diagnose detrusor overactivity. Conclusion: The ambulatory urodynamics evaluation seems to have a major role in the additional evaluation of more complex cases of urinary tract dysfunctions, when there is a diagnostic and therapeutic flaw – especially in the evaluation of detrusor overactivity. We found 70 % of false negative in the conventional cystometry. However, having in mind the higher cost of the equipment and catheters in relation to the conventional one, more studies are necessary for the incorporation of this test in the Brazilian clinical practice.

Orientador: Paulo Cesar Rodrigues Palma, Viviane Herrmann / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T10:39:24Z (GMT). No. of bitstreams: 1 Bellette_PatriciaOdila_M.pdf: 1141308 bytes, checksum: 2b1b008fc3d9ef462a5114d38968193e (MD5) Previous issue date: 2007 / Resumo: O objetivo deste estudo foi avaliar a eficácia da eletroestimulação do nervo tibial posterior em mulheres com hipótese diagnóstica de Bexiga Hiperativa e suas repercussões na qualidade de vida. Sujeitos e métodos: para este ensaio clínico prospectivo, controlado e randomizado foram convidadas a participar do estudo 37 mulheres consultadas no ambulatório de uro-ginecologia do Hospital das Clínicas (HC) da UNICAMP, que cumpriram os critérios de inclusão e exclusão. Foram aleatoriamente alocadas em dois grupos. Grupo tratamento: as mulheres foram tratadas com o uso da eletroestimulação transcutânea do nervo tibial posterior (n = 21) e Grupo placebo: as mulheres tiveram os eletrodos alocados, mas sem passagem de corrente elétrica (n = 16). No primeiro contato com a paciente foi feito o convite para participar do estudo e realizada uma avaliação fisioterapêutica, incluindo preenchimento do diário miccional de três dias e dos questionários de qualidade de vida (ICIQ, KHQ e OABq). Na aplicação da técnica utilizou-se oito sessões de eletroestimulação transcutânea do nervo tibial posterior. Resultados: A noctúria apresentou melhora significativa no grupo tratamento (p=0,003) e uma tendência de maior melhora no grupo tratado (p=0,054). A frequência urinária diminuiu significativamente no grupo tratamento (p=0,003) e a urgência miccional diminuiu também em ambos os grupos (placebo:p=0,025 e tratamento:p=0,002). Com relação aos questionários utilizados, apenas o OABq foi responsivo, tanto no escore total (p=0,037), quanto no escore severidade (p=0,018). Conclusão: A eletroestimulação transcutânea do nervo tibial posterior é uma ferramenta eficaz no tratamento fisioterapêutico da Bexiga Hiperativa. / Abstract: The aim of this study was to evaluate the effect of the electrical stimulation of the posterior tibial nerve on the quality of life in women with overactiv bladder syndrome. Subjects and methods: thirty seven women from to Urogynecology Division of the Hospital das Clínicas de Campinas (HC/UNICAMP) were invited to participate in a prospective randomized trial. After screening inclusion and exclusion criteria, they were randomly placed in one of two groups: Treatment group: the women were submitted to tibial posterior nerve electrical stimulation (n = 21) and Sham group: the women had electrodes placed on the tibial posterior nerve, without stimulation (n = 16). At first, the patients were invited to participate in the study and submitted to a physiotherapeutic evaluation, including fulfilling a three days diary, quality of life questionnaires (ICIQ, KHQ an OABq). The approach of the treatment was eigth sessions of electrical stimulation on the posterior tibial nerve. Results: noctury was significantly improved in the treatment group (p=0,003). The urinary frequency was significantly improved in treatment group (p=0,003) and the urgency decreased significantly in both groups (sham:p=0,025 and treatment p=0,002). Comparing the questionnaires applied only the OABq was responsive in both scores, total score (p=0,037) and severity score (p=0,018). Conclusion: The posterior tibial nerve electrical stimulation is an effective physiotherapeutic treatment in overactive bladder. / Mestrado / Mestre em Cirurgia

Spinal cord injury (SCI) remains a significant cause for morbidity and mortality in North America. Bladder dysfunction following SCI is very common and could lead to severe complications including renal failure and autonomic dysreflexia (AD). AD involves life threatening episodes of hypertension in patients with SCI above T6 level. Current management protocols for AD are symptomatic and usually ineffective. Botulinum toxin-A (BTX-A), has been successfully used recently in SCI patients because it reduces the detrusor contractility via inhibiting acetylcholine release from efferent nerve endings. Recent evidence, however, suggests a sensory involvement via modulation of sensory neuropeptides, neurotransmitters, and receptors. It is still, however, unclear whether BTX-A can affect putative spinal neurons involved in AD. In this study we demonstrated that intravesical BTX-A treatment has blocked AD in rats with T4-SCI, and also provided a novel mechanism for the control of autonomic dysreflexia via a minimally invasive treatment modality.

Spinal cord injury (SCI) remains a significant cause for morbidity and mortality in North America. Bladder dysfunction following SCI is very common and could lead to severe complications including renal failure and autonomic dysreflexia (AD). AD involves life threatening episodes of hypertension in patients with SCI above T6 level. Current management protocols for AD are symptomatic and usually ineffective. Botulinum toxin-A (BTX-A), has been successfully used recently in SCI patients because it reduces the detrusor contractility via inhibiting acetylcholine release from efferent nerve endings. Recent evidence, however, suggests a sensory involvement via modulation of sensory neuropeptides, neurotransmitters, and receptors. It is still, however, unclear whether BTX-A can affect putative spinal neurons involved in AD. In this study we demonstrated that intravesical BTX-A treatment has blocked AD in rats with T4-SCI, and also provided a novel mechanism for the control of autonomic dysreflexia via a minimally invasive treatment modality.

No description available.

The thesis is focuced on the origin of the syndrom ADHD and its influence and impact on ensuant life of the pre-schoolers in kindergarten. The main terms connected with ADHD are explained at the beginning of the work, containig terminology, partial symptoms such as hyperaktivity, impulsivity and attention deficit, atc. Furthermore, there are mentioned its possible etiologies, various ways of rectification and treatment and convenient and professional approaches to hyperactive children. The describtion of the the procedures and ways of the revealing and later professional assignment of the diagnosis of this disorder is also mentioned in these thesis. The practical part of the thesis is focused just on the proces and proceeding to the professional assignment of ADHD and its causes and circumstances for this decision , who did that and how the diagnosis influenced life of that child and his/her surroundings.