A small cohort of ‘high-risk for stroke’ patients will undoubtedly benefit from intervention and our goal must be to identify and treat these individuals, rather than continuing with a policy of mass intervention that benefits very few patients in the long term.”
“Aims: Intradetrusor botulinum toxin type-A injections are a novel therapy for treatment of neurogenic overactive bladder resistant to parasympatholytic treatment. In rare cases, however, it may be associated with generalized muscle weakness. Single-fiber electromyographic (SFEMG) analysis of neuromuscular jitter (NJ) was used to study OnabotulinumtoxinA (BOTOX (R)) migration to striated muscle. Methods:

learn more This study comprised a prospective, single-center investigation of 21 spinal cord find more injured patients receiving intradetrusor OnabotulinumtoxinA. Clinical tolerance was assessed through muscle testing and para-clinical tolerance by systematic analysis of NJ in muscles distant from the bladder. Results: Twenty-one patients (13 males, 8 females) received one intradetrusor injection of 300U OnabotulinumtoxinA. Mean age was 42.1 +/- 14.4 and mean number of injections prior to study inclusion was 2.6 +/- 1.7. Clinical and para-clinical assessments were performed on average 26 days +/- 8 days post-OnabotulinumtoxinA injection. Seven patients had abnormal NJ results

on SFEMG, but no patient had evidence of blocking. Four patients complained of tiredness (one with NJ abnormalities). Conclusions: Patients showed good tolerance to intradetrusor OnabotulinumtoxinA injections. Tiredness was not associated with generalized muscle weakness since testing remained unchanged

and NMJ was normal in three of four patients. NJ analysis was abnormal in 7 of 21 patients, but this was not considered serious and there was no evidence of muscle fiber block. These results support the safety of bladder injections of OnabotulinumtoxinA and suggest that, although migration of OnabotulinumtoxinA to other muscle groups may impair NJ function in a minority of patients, this does not correlate with symptoms of tiredness selleck products or muscle weakness. Neurourol. Urodynam. 30:1533-1537, 2011. (C) 2011 Wiley Periodicals, Inc.”
“Vertical-banded gastroplasty (VBG) was once a common bariatric procedure. It has fallen out of favor due to the emergence of the adjustable gastric band and late complications including band erosion and stenosis. Options for revision include conversion to a Roux-en-Y gastric bypass (RYGB) or VBG reversal via gastrogastrostomy. Patients undergoing revision of a previous VBG were identified. VBG reversal was performed laparoscopically. Conversion to RYGB was performed by both laparotomy and laparoscopy. Perioperative outcomes and long-term weight loss were evaluated. A total of 34 patients with a previous open VBG underwent revision over a nearly 8-year period (January 2003 to September 2010).