Study design: Laboratory investigation using serial slow-®ll cystometrograms. Objectives: To examine the acute e ects of di erent modes of dorsal penile nerve stimulation on detrusor hyperre¯exia, bladder capacity and bladder compliance in spinal cord injury (SCI). Setting: Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. Methods: Fourteen SCI patients were examined. Microtip transducer catheters enabled continuous measurement of anal sphincter, urethral sphincter and intravesical pressures. Control cystometrograms were followed by stimulation of the dorsal penile nerve at 15 Hz, 200 ms pulse width and amplitude equal to twice that which produced a pudendo-anal re¯ex. Stimulation was either continuous or in bursts of one minute triggered by a rise in detrusor pressure of 10 cm water (conditional). Further control cystometrograms were then performed to examine the residual e ects of stimulation. Results: Bladder capacity increased signi®cantly during three initial control ®lls. Continuous stimulation (n=6) signi®cantly increased bladder capacity by a mean of 110% (+Standard Deviation 85%) or 173 ml (+146 ml), and bladder compliance by a mean of 53% (+31%). Conditional stimulation in a di erent group of patients (n=6) signi®cantly increased bladder capacity, by 144% (+127%) or 230 ml (+143 ml). In the conditional neuromodulation experiments, the gap between suppressed contractions fell reliably as bladder volume increased, and the time from start of stimulation to peak of intravesical pressure and 50% decline in intravesical pressure rise was 2.8 s (+0.9 s) and 7.6 s (+1.0s) respectively. The two methods of stimulation were compared in six patients; in four out of six conditional neuromodulation resulted in a higher mean bladder capacity than continuous, but the di erence was not signi®cant. Conclusions: Both conditional and continuous stimulation signi®cantly increase bladder capacity. The conditional mode is probably at least as e ective as the continuous, suggesting that it could be used in an implanted device for bladder suppression. Spinal Cord (2001) 39, 420 ± 428

India has a large geriatric population (60+ years) of 77 millions, comprising 7.7% of its total population. One of the major handicaps in the elderly is loss of teeth, affecting their mastication, dietary intake and nutritional status. The present study was planned to assess the level of edentulousness, denture wearing and denture needs of the elderly in the community and to study the correlation between oral health parameters and socio-demographic variables, diet and body mass index (BMI). A total of 1240 (716 urban and 524 rural) elderly people were studied. It was found that 60% were dissatisfied with their function of mastication because of loss of teeth and lack of dentures. The level of edentulousness was found to be high, more so in rural than in urban people and more so in advancing age, with no significant difference between male and females. The striking finding of this study was the very low level of denture wearing. Only <50% of those needing complete dentures and <13% of those needing partial dentures were wearing dentures. The denture needs of the rural elderly were higher than those of the urban elderly. Vegetarians had a higher level of edentulousness compared with non-vegetarians. The BMI was not correlated with level of edentulousness.

Background:Two of the most critical factors affecting the prognosis of an avulsed tooth after replantation are extra oral dry time and the storage medium in which the tooth is placed before treatment is rendered. However, the ability of a storage/transport medium to support cell viability can be more important than the extra oral time to prevent ankylosis and replacement resorption.Aim:Purpose of this study was evaluation and comparison of efficacy of a new storage medium, oral rehydration solution (ORS) with coconut water, and propolis in maintaining the viability of periodontal ligament (PDL) cells by using a collagenase-dispase assay.Materials and Methods:40 teeth were selected with intact crown which were advised for Orthodontic extraction having healthy PDL. Teeth were then randomly divided into three experimental storage solution groups. Other 10 were divided into positive and negative control groups (5 each).Statistical Analysis and Result:The results were statistically analyzed with analysis of variance and multiple range by using post hoc tests. The results of the prevailing study indicated that coconut water group demonstrated a significantly higher number of viable PDL cells than propolis 50%, and ORS. There was no significant difference between coconut water and propolis 50% groups.

Background:Identification of men harbouring insignificant prostate cancer (PC) is important in selecting patients for active surveillance. Tools have been developed in PSA-screened populations to identify such men based on clinical and biopsy parameters.Methods:Prospectively collected case series of 848 patients was treated with radical prostatectomy between July 2007 and October 2011 at an English tertiary care centre. Tumour volume was assessed by pathological examination. For each tool, receiver operator characteristics were calculated for predicting insignificant disease by three different criteria and the area under each curve compared. Comparison of accuracy in screened and unscreened populations was performed.Results:Of 848 patients, 415 had Gleason 3+3 disease on biopsy. Of these, 32.0% had extra-prostatic extension and 50.2% were upgraded. One had positive lymph nodes. Two hundred and six (24% of cohort) were D'Amico low risk. Of these, 143 had more than two biopsy cores involved. None of the tools evaluated has adequate discriminative power in predicting insignificant tumour burden. Accuracy is low in PSA-screened and -unscreened populations.Conclusions:In our unscreened population, tools designed to identify insignificant PC are inaccurate. Detection of a wider size range of prostate tumours in the unscreened may contribute to relative inaccuracy.

Objective: To establish the ecacy of Macroplastique 1 in treating vesico-ureteric re¯ux (VUR) in adults with neuropathic bladder dysfunction. Patients and methods: Fifteen patients (12 male and three female), age range 19 to 80 years (mean age 38) were included in this study. Diagnosis was con®rmed by videourodynamics. In seven patients re¯ux was present bilaterally. Twenty-two re¯uxing ureters were treated. Twelve patients had detrusor hyper-re¯exia, two had are¯exic bladders and one had loss of bladder wall compliance. According to the International Grading System, 10 ureters had grade IV re¯ux, ®ve had grade III re¯ux, ®ve had grade II re¯ux, and two had grade I re¯ux. Macroplastique 1 (0.5 ± 1.5 ml) was injected submucosally under each ureteric ori®ce to convert the opening to a slit like shape. The patients were followed up from 9 to 68 months. Results: VUR was completely resolved in 72.7% (16) ureters following a single injection and in a further 4.5% (1) ureter following a second injection. 9.1% (2) ureters were improved and treatment failed in 13.7% (3) ureters. Two patients showed a recurrence of re¯ux 1 and 4 years after primary injection and subsequently had a curative second injection. Most of the patients in whom VUR was cured or improved showed a reduction in laboratory proven urinary infection rates. Conclusion: Macroplastique 1 produced an excellent result (86% with complete resolution or improvement of re¯ux) in treating VUR in adult neuropathic bladders. This is comparable to larger studies carried out on the paediatric population. This is an easy procedure, which avoids major surgery and can be performed as a day case. In cases of failure or recurrence, repeat injection or open surgery can be undertaken without any added complications. Spinal Cord (2001) 39, 92 ± 96