Cool water vs warm water immersion for minimal sedation colonoscopy: a double-blind randomized trial

AIM

Water-aided insertion as an alternative colonoscopy technique reduces patient discomfort. Warm water has been used in most published trials, but the use of cool water is easier and, if equally effective, could support the use of the water-aided technique in routine practice.

METHOD

A double-blind, randomized, single-centre study was performed in which 201 patients were randomized to either cool (20-24 °C) or warm (37 °C) water immersion insertion. The primary outcome was caecal intubation time. The success rate of minimal sedation and patient discomfort were also assessed.

RESULTS

The caecal intubation time for cool and warm water was similar (6.9 ± 3.5 vs 7.0 ± 3.4 min, P = 0.64). The respective success rates of minimal sedation colonoscopy (89.1% vs 90%, P = 1.00) and discomfort (P = 0.51) were no different. All other outcomes except a greater need for abdominal compression in the cool water arm (P = 0.04) were similar including the total procedure time, terminal ileum intubation rate, adenoma detection, length of the inserted scope, water volume, non-standard position rate, difficulty of the procedure and the patient's temperature sensation.

CONCLUSION

The use of cool water did not modify the caecal intubation time compared with warm water. Exception for abdominal compression, all other end-points were no different. Cool water immersion is an alternative to the technically more demanding warm water immersion colonoscopy.

[Intraindividual variability of uroflowmetry in women]

OBJECTIVE

The objective of this study was to determine the intraindividual variability of uroflowmetric measurement in women with normal lower urinary tract function.

DESIGN

Prospective study.

SETTING

Departure of obstetrics and gynecology University Hospital and Medical Faculty Ostrava.

METHODS

35 women without lower urinary tract dysfunction were enrolled into the study. Every subject uderwent 3 uroflowmetric examinations. We processed all numeric results.

RESULTS

We assessed maximum and average urine flow rate - Qmax, Qave, voided volume - VV, corrected maximum urine flow and corrected average urine flow rate in every of 105 uroflowmetric´s measurements. We did not find any statistically significant difference for evaluation of intraindividual dispersion in studied parameters.

CONCLUSION

Intraindividual variability of uroflowmetric´s measurement in healthy female subjects is low. One uroflowmetric´s measurement is adequate for assessment of uroflowmetric´s parameters..

KEYWORDS

uroflowmetry, intraindividual variability, lower urinary tract.

[Bone mineral density in patients with chronic renal failure at the start of haemodialysis therapy]

AIM

To determine bone mineral density (BMD) in nephrology patients at the start of haemodialysis therapy and its dependence on some laboratory and clinical characteristics of the study set.

METHODS

There were 73 newly haemodialyzed patients accepted in the 3 months period from the beginning of the chronic haemodialysis program. Each patient underwent measurements BMD with DXA method in the area of lumbar spine and the left hip. Ca, P and parathormone values were measured once per month during 3 months before BMD determination. 25-OH vitamin D, estradiol and blood pH were determined only once before the densitometry examination.

RESULTS

BMD in the osteoporosis zone was measured most often in the area of femoral neck in the whole group (prevalence 35 %) and also in the single groups of patients (men, women, non-diabetics, diabetics). In women, BMD findings corresponding to osteoporosis values in the total hip were significantly more often (p < 0.01). In the area of femoral neck and lumbar spine the percentage of women and men in single groups (osteoporosis, osteopenia and normal values) was without any statistical differentiation. Diabetics and non-diabetics did not distinguish in the number of findings osteoporosis and osteopenia in any followed areas of skeleton. As the significant factors predicating BMD there were found: calcium level and sex for the area of the total hip, calcium level, blood pH and height for the femoral neck, and sex for the lumbar spine only. The certain degree of vitamin D deficiency was measured in nearly all patients (mean 11.5 ± 7.4 µg/l), and hypocalcaemia was demonstrated in one fifth of patients.

CONCLUSION

Bone mineral density values and some laboratory parameters affecting bone metabolism are often abnormal in the patients entering the chronic haemodialysis program and must be taken into consideration.

[Current state of diagnostics and treatment of overactive bladder in the Czech Republic - five years ago and today]

INTRODUCTION

Overactive bladder (OAB) presents one of the most frequent medical problems among the current adult population, with a significant impact on the quality of life of the affected patients. A questionnaire survey was carried out in 2006, with the aim to assess the level of knowledge regarding the problem of OAB among gynaecologists and urologists in the Czech republic, as well as to evaluate the currently applied methods of OAB diagnostics and treatment. The aim of this work was to perform a repeated survey after five years, and to evaluate, whether there have been any changes achieved in the monitored parameters.

MATERIALS AND METHODS

A total of 290 respondents (181 gynaecologists, 109 urologists) were included in the survey in 2006; the study group in 2011 included a total of 285 respondents (180 gynaecologists, 105 urologists). The questionnaire used for the survey in 2011 was identical to the document utilized in the initial survey performed five years ago, with minimal changes. The anonymous questionnaire was designed as "multiple-choice", i.e. with a possible selection from proposed answers; the questions were targeted at the topics of definition, diagnostics and therapy of OAB. The obtained results were processed with the methods of descriptive statistics; the concordance of proportions was evaluated with the Fishers exact test.

RESULTS

A total of 114 gynaecologists (63.3%), and 65 urologists (61.9%) were able to determine the correct definition of OAB, which presents a significant increase when compared to 2006 (p<0.0001). The most frequently applied methods of OAB diagnostics were patient history (gynaecologists: 97.8% in 2011 vs. 96.5% in 2006, urologists: 99.0% in 2011 vs. 99.0% in 2006), local examination (gynaecologists: 57.8% vs. 76.4%, urologists: 86.7% vs. 87.2%), bladder diaries (gynaecologists: 62.8% vs. 40.3%, urologists: 79.0% vs. 60.5%), and urine examination (gynaecologists: 71.1% vs. 82.3%, urologists: 96.2% vs. 97.1%). Anticholinergic medication is the first-choice in the OAB treatment in our conditions, which has been confirmed by 146 (81.1%) gynaecologists, and 89 (84.4%) urologists. In cases when the physicians use anticholinergic medication for the treatment of OAB, the first-choice medication is trospium, among both gynaecologists and urologists. In case of failure of the first-choice treatment, twenty-six (14.4%) gynaecologists from the addressed respondents try to continue with a treatment according to their own decision, 154 (85.6%) gynaecologists refer the patient to a specialist. Similarly, a total of 90 (85.7%) urologists try to manage the further course of treatment by their own means, 15 urologists (14.3%) refer the patient to a specialist.

CONCLUSION

The level of understanding and awareness about the problem of OAB among the Czech gynaecologists and urologists has significantly improved during the past five years. The applied diagnostic and treatment methods for OAB are being harmonized with the International Continence Society (ICS) recommendations. Taking into consideration the prevalence of OAB among the population, it is desirable to increase the number of clinical departments who deal with the problem of OAB in a complex manner. The remaining significant task lies in the improvement of foreknowledge about the current possibilities and effectiveness of the OAB treatment among the patient population.

[Vaccination against hepatitis B in patients with chronic renal failure--twenty years follow-up]

AIM

The efficacy of vaccination against hepatitis B was evaluated in patients with chronic renal failure from 4 dialysis units in 1988-2010.

PATIENTS AND METHODS

Hepatitis B vaccination was started in 1 271 patients with chronic renal failure (606 female, 665 male). Patients received intramuscularly 3 doses of plasma-derived or since 1990, recombinant vaccine at the interval 0, 1 and 2 months for dialysis patients and 0, 1 and 6 months for pre-dialysis patients. Each vaccine contained 40 microg of hepatitis B surface antigen (HBsAg) in 1 002 patients, however only 20 microg HBsAg in 269 patients till 2000. Blood samples were obtained at the beginning of vaccination, 1-2 month after immunization and biannual thereafter. Serum samples were tested using ELISA methods for HBsAg and antibodies against hepatitis B surface and core antigens (anti-HBs, anti-HBc). The patients without protective anti-HBs level and the patients with waning of anti-HBs antibodies were revaccinated.

RESULTS

Anti-HBs antibodies after the third vaccine were investigated in 786 patients. Protective anti-HBs levels (> or = 10 IU/l) were proved in 49%, 65% and 74% patients after the third, fourth and fifth vaccine. The waning of protective anti-HBs antibodies was detected in 47% and 68% of patients during 3 and 5 years after vaccination. The new infections with HBsAg positive status were proved in 28 patients, in 27 of them in period 1988-1994. Anti-HBc seroconversion was observed in 10 patients.

CONCLUSION

Vaccination considerably reduced hepatitis B incidence in the patients with chronic renal failure during nineties. However still approximately one quarter of patients did not produce protective anti-HBs level after immunization with recombinant vaccine and new form of vaccination against hepatitis B may be considered also in the Czech Republic.

[Hepatitis B immunization of patients with inherited bleeding disorders: personal experiences]

Hepatitis B immunization of patients with inherited bleeding disorders: personal experiences Hepatitis B vaccination was initiated in 55 patients with inherited bleeding disorders in 1994-2009. Patients received three doses of subcutaneous recombinant vaccine containing 20 mg HBsAg (hepatitis B surface antigen) at 0, 1 and 6 months. Blood samples were obtained at the starting of vaccination, 1-3 months after immunization, and biennially thereafter. The samples were tested for HBsAg, hepatitis B surface and core antibodies (anti-HBs, anti-HBc). Protective anti-HBs level (≥10 IU/l) after immunization was proved in 50 of 51 patients (98 %). Waning of protective anti-HBs antibodies was detected in 4 % and 24 % of patients within 5 and 10 years after vaccination. No HBsAg carrier status or anti-HBc seroconversion were detected. Subcutaneous vaccination against hepatitis B provides long-term protection in patients with inherited bleeding disorders.

[Combination therapy with anticholinergics and alpha-blockers for the treatment of overactive bladder in female patients--pilot study]

INTRODUCTION

Overactive bladder (OAB) is one of the most common medical conditions with an estimated 16 percent of adult population being affected in Europe. The administration of anticholinergics is considered as the most frequent and most effective treatment. There is a evidence that alpha-blockers affect a detrusor function. The aim of the study is to investigate if the combinant therapy consisting of anticholinergics plus alpha-blockers could be beneficial for women suffering from OAB.

MATERIAL AND METHODS

28 female patients with OAB were included into the pilot study. Mean age of the patients was 54.8 (42-77) years. Patients have been randomised into two groups: one group of patients has been treated by propiverin 30 mg daily, another group of patients has been treated by combination of both propiverin 30 mg daily and tamsulosin 0.4 mg daily. Satisfaction with the treatment has been evaluated by I-QoL questionnaire. Semi-objective parameters have been obtained by analysis of 3-days voiding diaries (number of micturitions, number of urgency episodes, voided volume). Peak flow (Qmax) has been measured as a objective parameter.

RESULTS

We observed a decrease of frequency by 2.833 (-23.43%) comparing to base-line, decrease of number of urgency episodes by 1.417 (-36.22%), increase of voided volume by 33.333 ml (+19.14%), increase of quality of life index by 22.583 (+51.52%) and increase of Qmax by 0.17 ml/s (+0.58%) in the propiverin group. We observed decrease of frequency by 3.813 (-30.48%), decrease of number of urgency episodes by 1.875 (-45.52%), increase of voided volume by 51.250 ml (+26.88%), increase of quality of life index by 33.438 (+76.0%) and increase of Qmax by 2.13 ml/s (+7.87%) in the combination treatment group. No significant difference has been found between both groups except the quality of life index.

CONCLUSION

Our results can not show explicitly higher efficacy of combination treatment using anticholinergics plus alpha-blockers comparing to standard therapy by anticholinergics alone. Further randomised placebo-controlled studies are needed for final evaluation of the role of alpha-blockers in the treatment of OAB.

Perceptual differences regarding health and environmental problems and their remedies in two states of the former Czechoslovakia

In the framework of the Central European Study on Air pollution and Respiratory Health (CESAR), a risk perception and risk communication study was carried out in a total of 25 areas in Bulgaria, the Czech Republic, Hungary, Poland, Romania and the Slovak Republic. This paper is focused on the differences of perception between the Czech (CR) and the Slovak Republic (SR), and the other involved countries. The analysis is based on the data of a structured risk perception questionnaire survey of a random population sample. 6,043 completed questionnaires were collected from the total number of 14,400 distributed ones in 25 areas of the 6 countries. The risk perception was different in the CR and the SR, mainly concerning local environment and health of children in the CR and drug abuse including alcohol consumption and AIDS in the SR. In both countries environmental and health problems were seen as important, but the perceived responsibility for finding a solution was placed with different kinds of institutions.