Soon it would be discovered that the theory about the corpus striatum would not be completely incorrect.By the late 19th century, a few hyperkinesias such as Huntingtons chorea, post-hemiplegic choreoathetosis, Tourettes syndrome, and some forms of both tremor and dystonia were described in a clinical orientation. However, the common pathology was still a mystery. British neurologist William Richard Gowers called these disorders "general and functional diseases of the nervous system" in his 1888 publication entitled A Manual of Diseases of the Nervous System. It was not until the late 1980s and 1990s that sufficient animal models and human clinical trials were utilized to discover the specific involvement of the basal ganglia in the hyperkinesia pathology. In 1998, Wichmann and Delong made the conclusion that hyperkinesia is associated with decreased output from the basal ganglia, and in contrast, hypokinesia is associated with increased output from the basal ganglia. This generalization, however, still leaves a need for more complex models to distinguish the more nuanced pathologies of the numerous diverse hyperkinesias which are still being studied today.In the 2nd century, Galen was the first to define tremor as "involuntary alternating up-and-down motion of the limbs." Further classification of hyperkinetic movements came in the 17th and 18th centuries by Franciscus Sylvius and Gerard van Swieten. Parkinsons disease was one of the first disorders to be named as a result of the recent classification of its featured hyperkinetic tremor. The subsequent naming of other disorders involving abnormal motions soon followed.
Vesicouterine fistula refers to an abnormal communication between the bladder and uterus. The first case of vesicouterine fistula was reported in 1908. It was however first described in 1957 by Abdel Fattah Youssef, an obstetrician and gynaecologist in Kasr el-Aini hospital, Cairo, Egypt. It is characterized by a vesicouterine fistula above the level of the internal os, absence of menstrual bleeding, cyclical presence of blood in urine and absence of urinary incontinence with a patent cervical canal following a lower segment caesarean section. Six of such cases had been reported by other clinicians before the term Menouria was coined by Youssef. Pathology
Vesicouterine fistula is the least common type of urogenital fistula accounting for 1-4% of urogenital fistulas. It occurs following lower segment caesarean section and the incidence is increasing due to the increasing incidence of caesarean deliveries. The occurrence of menoruria in the absence of vaginal bleeding or passage of urine from the vagina is attributed to a sphincteric mechanism of the uterine isthmus.Jozwik and Jozwik classified vesicouterine fistula into three types based on the route of menstrual flow;I - Menstrual flow from the bladder only without urinary incontinence
II - Menstrual flow from both the bladder and vagina with urinary incontinence
III - Normal menstrual flow from the vagina only (no menouria) with urinary incontinence
Youssef syndrome corresponds to a type I vesicouterine fistula. Causes
Vesicouterine fistulas occur most commonly after lower segment caesarean sections (about 83-93% of cases).