Annick Viaene

Urinary plasma protein patterns in acute prostatitis.

Abstract We evaluated the diagnostic utility of urinary α1-microglobulin, α2-macroglobulin and albumin in the diagnosis of acute prostatitis. We studied 133 men (43±17 years) with, and a reference population (n=36, 41±16 years) without, urinary tract infection. Prostatectomy samples were used to study the potential interference between prostatic proteins and protein analysis. Urinary α2-macroglobulin/albumin ratio was significantly lower in prostatitis compared to the reference population, cystitis or acute pyelonephritis (p <0.0001). Low α2-macroglobulin concentrations in prostatitis are due to inhibition (p = 0.0001) of the immune reaction between α2-macroglobulin in presence of polyclonal rabbit antibodies (used for immunonephelometry) by soluble prostatic proteins (± 60 kDa) which appear in urine in acute prostatitis. The urinary α1-microglobulin/creatinine ratio diagnoses acute pyelonephritis (sensitivity 100% and specificity 87%) and the urinary α2-macroglobulin/albumin ratio diagnoses acute prostatitis (sensitivity 100% and specificity of 90%). Stepwise multinomial logistic regression analysis reveals that urinary α1-microglobulin, α2-macroglobulin, albumin and creatinine provide optimal differentiation between acute pyelonephritis and acute prostatitis (pseudo R2=0.83; Loglikelihood −30.55, p <0.000001). In conclusion, the combination of hematuria and absence of urinary alpha-2-macroglobulin is diagnostic for acute prostatitis. Even without hematuria, α2-macroglobulin remains lower compared to patients without prostatitis.

Circadian Rhythms in Water and Solute Handling in Adults with a Spinal Cord Injury

Purpose: We evaluated nocturnal urine production and circadian rhythms of renal function (glomerular filtration, and water and solute diuresis) in adults with spinal cord injury compared to controls. Materials and Methods: This prospective observational study was done at Ghent University Hospital, Belgium. Participants were asked to perform a 24‐hour urine collection. A blood sample was taken to calculate the diuresis rate and the renal clearance of creatinine, free water, solutes, sodium and urea. Results: A total of 119 patients were divided into 32 with spinal cord injury, and 68 controls with and 19 without nocturnal polyuria. Spinal cord injured patients showed no circadian rhythms in the diuresis rate or in the renal clearance of creatinine, free water, solutes, sodium or urea. Controls without nocturnal polyuria reported a lower nighttime diuresis rate and lower nighttime clearance of creatinine, solutes, sodium and urea compared to daytime levels. Controls with nocturnal polyuria had no circadian rhythms in the diuresis rate or creatinine clearance and a significant increase in nocturnal free water clearance compared to daytime levels. Conclusions: Comparing the mechanisms underlying nocturnal urine production between patients with spinal cord injury and controls revealed important differences. Spinal cord injured patients showed absent circadian rhythms in the renal clearance of creatinine (glomerular filtration), free water (water diuresis) and solutes such as sodium and urea (solute diuresis). Future research must be done to evaluate the role of patient stratification to find the most effective and safe treatment or combination of treatments for spinal cord injured patients with complaints or complications related to nocturnal polyuria.

Secondary Voice Restoration After Laryngotracheal Separation (LTS) for Dysphagia with Intractable Aspiration

Intractable aspiration is a serious, often life-threatening condition due to its potential impact on pulmonary function. Aspiration requires therapeutic measures, starting with conservative management but often necessitating surgical treatment. The basic surgical principle is to separate the alimentary and respiratory tracts through a variety of procedures which, unfortunately, nearly all result in the loss of phonation, with the exception of total laryngectomy (TL) which includes the placement of an indwelling voice prosthesis. In this study, we present a modified laryngotracheal separation (LTS) technique that, we believe, offers multiple advantages compared to standard TL. After reviewing the medical records of 35 patients with intractable aspiration who have undergone LTS, we describe the surgical technique and present the postoperative result. In a second surgical procedure about two months following LTS, we aimed to achieve voice restoration by placement of an indwelling voice prosthesis. Intractable aspiration was successfully treated in all patients. Placement of an indwelling voice prosthesis during a second operation was successful in 15 patients, representing the largest reported cohort thus far. LTS is a reliable surgical technique to treat intractable aspiration, with restoration of oral intake, thereby improving the general condition and quality of life of these unfortunate patients. Furthermore, voice restoration can be achieved in selected patients, by placement of a voice prosthesis.

OnabotulinumtoxinA injections in detrusor facilitate self-catheterisation in a patient with paraplegia and bladder outlet dyssynergia

This case report describes the case of improvement of clean intermittent catheterisation procedures after each intradetrusor administration of onabotulinumtoxinA in a 45-year-old man with L1 paraplegia with neurogenic detrusor overactivity and bladder outlet dyssynergia.On three occasions, improvement on clean intermittent catheterisation procedures appeared 10 to 14 days after intradetrusor injections of onabotulinumtoxinA and lasted for 9 months. We hypothesise a possible influence of intravesical injections of onabotulinumtoxinA on the storage reflex. We also discuss the possibility of a dispersion of onabotulinumtoxinA towards contiguous structures such as the urethral sphincter.

Het guillain-barrésyndroom tijdens de zwangerschap: een casus

Een 30-jarige vrouw, 28 weken zwanger, ontwikkelt het guillain-barresyndroom. Er ontstaat een opstijgende tetraparese met noodzaak tot intubatie en ventilatie. Bij 2 op de 3 patienten gaat een infectie het syndroom vooraf. Bij deze patiente was dit het cytomegalovirus. Deze infectie vernietigt de myelineschede rond de zenuwen door een reactie van „molecular mimicry”. De aanpak van het guillain-barresyndroom bestaat uit het ondersteunen en controleren van de vitale functies, het behandelen van hinderlijke symptomen zoals paresthesieen via het toedienen van corticoiden en intraveneuze immunoglobulinen (IVIG) en eventueel plasmaferese, gevolgd door de revalidatie. Deze behandeling is bij zwangere vrouwen multidisciplinair. Er moet meer aandacht gegeven worden aan de identificatie en aanpak van de eventuele infectieuze component, preventie van diepe veneuze trombose en longembolie, pijnbehandeling en psychologische begeleiding. Het beeindigen van de zwangerschap om een sneller herstel te bekomen is onnuttig. Er zijn momenteel nog geen richtlijnen in verband met de beste bevallingsmethode. In de literatuur is men er in het algemeen wel over eens dat een keizersnede niet strictu sensu noodzakelijk is. Enkel indien er sprake is van deterioratie van de maternale of foetale toestand, is een keizersnede noodzakelijk. De patiente in deze casus beviel spontaan van een gezonde zoon en revalideerde daarna volledig. Momenteel heeft ze geen uitvalsverschijnselen meer.

Autonomic dysreflexia after manipulation of the scrotum

A 42-year-old male with autonomic dysreflexia after touching his scrotum was seen at the outward department. Radiological imaging showed a renal mass at the right side. After radical nephrectomy his symptoms disappeared. Such a case has never been described before. Our hypothesis is that autonomic dysreflexia is elucidated by stimulation of the testis as both testis and kidney have the same vascularisation and sensory innervation.