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Biomedical subjects

A C Kinn

Publications and source records attributed to A C Kinn.

At least 55 records · Page 3Linked to original sources
PubMed1987

Pad test with fixed bladder volume in urinary stress incontinence.

A pad-weighing test of urinary stress incontinence during a set program of physical exercises is presented. The test was begun at a fixed bladder volume (75% of maximum capacity) and was repeated once. The duration of the exercises was approx. 15 min. Leakage was greater in the second test, but statistical analysis showed highly significant intraindividual correlation between the two amounts. Degree of leakage was not correlated to subjective assessment of incontinence. The test can be done as part of a routine urodynamic investigation.

Adult↗
PubMed1987

Changes in cholinergic innervation and neuropharmacologic properties in idiopathic hypotonic urinary bladders.

Tissue specimens from hypotonic and normotonic human urinary bladders were investigated histochemically, chemically and neuropharmacologically. In hypotonic bladders the density of acetylcholinesterase (AChE)-positive nerves was markedly reduced and the nerve AChE staining intensity was weak. The concentration of acetylcholine was significantly lower than in specimens from normotonic bladders. At field stimulation the contractions were weak. The observations indicated that sparse cholinergic innervation and reduced acetylcholine synthesis are important for the impaired contractility in idiopathic dystonic bladder.

Acetylcholine↗
PubMed1987

Co-localization of tachykinins and calcitonin gene-related peptide in capsaicin-sensitive afferents in relation to motility effects on the human ureter in vitro.

Tachykinin- and calcitonin gene-related peptide (CGRP) immunoreactivities were localized by immunohistochemistry in the same nerves of the kidney, renal pelvis and ureter as well as in spinal ganglion cells of both the guinea-pig and man. The tachykinin and CGRP-immunoreactive nerves in the ureter were present within the smooth muscle layers, around blood vessels, close to and within the lining epithelium. The levels of neurokinin A-, substance P- and CGRP-like immunoreactivity per tissue weight, as determined by radioimmunoassay, were about 30-100-fold higher in the guinea-pig than in the human ureter, which was in good agreement with the relative density of immunoreactive nerve fibres, as seen by immunohistochemistry. Capsaicin treatment caused an almost total disappearance of both neurokinin A-, substance P- and CGRP-immunoreactive nerve fibres in the guinea-pig ureter and a 90% depletion of neurokinin A, substance P- and CGRP-like immunoreactivity, further supporting a sensory origin of these nerves. Reversed-phase high performance liquid chromatography of water extracts of the human ureter revealed the presence of neurokinin A- and eledoisin-like material using antiserum K12, which does not cross-react with substance P. Most of the CGRP-like immunoreactivity in human ureter extracts co-eluted with synthetic human CGRP. Capsaicin both caused inhibition of spontaneous motility of the human ureter in vitro and initiated contractions in some preparations. Neurokinin A and neuropeptide K potently initiated phasic contractions of the ureter, while substance P had only minor contractile effects. CGRP inhibited both spontaneous and neurokinin A-induced ureteric contractions. In conclusion, peptides with potent opposite motility effects are present in the same, presumably sensory nerves of the ureter in both the guinea-pig and man. It will be of importance to determine whether local release of neuropeptides can account for ureteric motility changes accompanying sensory nerve activation upon ureteral obstruction, by e.g. renal calculi.

Animals↗
PubMed1986

Urethral stricture complicating transurethral prostatic surgery.

The incidence of urethral stricture was 9 per cent among 336 patients after transurethral prostatic resection for benign hyperplasia. The strictures were mostly in the penile part of the urethra and could be treated with regular dilation, internal urethrotomy or meatal incision. Bacteriuria or indwelling catheter preoperatively did not seem to predispose to stricture formation. When there is an indication of a narrow urethra before TUR, a fine-calibre resectoscope should be used and a preliminary internal urethrotomy is advisable.

Aged↗
PubMed1986

Bladder and sexual function after surgery for rectal cancer.

Bladder function and sexual potency were studied before and after surgery for rectal carcinoma. Urinary voiding after postoperative removal of indwelling catheter was impaired in seven of 22 men, leading to prostatic surgery in four. Two years later, eight of 16 men reported disturbed voiding, but no significant changes were found in bladder capacity, residual volume, flow rate, or detrusor pressure. Sexual potency was reduced in five of ten men, in one with retrograde ejaculation; and three did not achieve erection. Objective postoperative bladder disturbance was surprisingly rare. Symptoms of denervation were more commonly attributable to sympathetic rather than parasympathetic lesions, possibly as a result of more energetic dissection in the anteroposterior plane than along the lateral pelvic walls. No patient had total autonomic denervation. Wide indications are advocated for prostatic resection in patients who have prostatic symptoms in association with surgery for rectal carcinoma.

Aged↗
PubMed1986

Therapeutic ureteral occlusion in advanced pelvic malignant tumors.

A technique for ureteral occlusion, combining insertion of nylon plugs with injection of polidocanol, is described. The method was used in 15 patients with vesicovaginal fistulas after operation and irradiation for advanced gynecological malignancy, or with severe malfunction and fibrosis of the bladder after radiotherapy for bladder carcinoma. The urinary leakage ceased in 11 patients, was greatly diminished in 2 and was unchanged in 2. Migration of plugs to the renal pelvis was the most serious complication and may have been the cause of pyelonephritis in 1 case. The technique is recommended for patients with a short life expectancy and uncontrolled, distressing leakage of urine.

Adult↗
PubMed1986

The effect of noradrenaline on the contractile response of the urinary bladder. An in vitro study in man and cat.

In this study, bladder muscle strips from the detrusor of man and cat were used to evaluate the modulating effects of adrenergic agonist and antagonists on the field stimulation induced contractile response. Noradrenaline (NA) inhibited and phentolamine enhanced the contraction in a dose-dependent manner. Propranolol did not influence the field stimulation response. When a study of the combined effect of adrenergic drug influence was performed, the NA-induced inhibition was partly reversed by propranolol but a further increase of the contractile response compared to the control was seen, when phentolamine was added. No species differences were found. The conclusion drawn from these results is, that the inhibiting effect of NA on the contractile response is mediated via alpha- and beta-adrenergic receptors. The former could be located on the short parasympathetic intramural neurons while the latter probably are located on muscle cells.

Aged↗
PubMed1985

The lazy bladder--appraisal of surgical reduction.

Ten patients with abnormally large bladder capacity and large volumes of residual urine, but without neurologic or obstructive bladder disease, were urodynamically investigated. Detrusor contractility was defective in the male patients as compared with healthy men, but in this respect the women did not differ significantly from controls. After reductive cystoplasty with fundus invagination or detrusor duplication, detrusor efficiency did not improve but there was less residual urine and previous urinary tract infections did not recur. Strict indications for cystoplasty are recommended. The operation should preferably be limited to men with tendency to urinary tract infection or dilatation of the renal pelves. Bladder neck incision should be performed at the same operation.

Adult↗
PubMed1984

Vitamin B12 deficiency after irradiation for bladder carcinoma.

Vitamin B12 deficiency was found in 10 of 41 patients who underwent radiotherapy before cystectomy with Bricker urinary diversion for carcinoma of the bladder. Of 13 patients given full irradiation because of inoperable bladder cancer 5 had malabsorption of vitamin B12. Serum folic acid was normal in these patients, indicating predominantly ileal irradiation sequelae. Routine evaluation of serum vitamin B12 after radiotherapy is recommended so that appropriate medication can be given, if possible before neurological symptoms appear.

Aged↗
PubMed1983

Experience with two-stage scrotal flap urethroplasty for stricture.

A series of 50 men with variously-caused stricture of the bulbar and/or membranous urethra is presented. The 2-stage scrotal flap urethroplasty described by Blandy was used. As a rule the operation was technically simple. Post-operative incontinence was not a problem. Recurrence or new stricture appeared in 7 cases, but 5 of these strictures were short and could be corrected with internal urethrotomy. Timed micturition showed improved voiding in all of the 18 patients studied before and after urethroplasty. Urodynamic studies in the last 8 cases of the series before and after urethroplasty showed significantly improved urinary flow and voiding post-operatively, with reduction of detrusor pressure and residual urine.

Adult↗
PubMed1983

Neurotransmission in activation of the contractile response in the human urinary bladder.

The endogenous contracting transmitter at the neuromuscular junction in strips from human urinary bladder has been investigated using field stimulation and selective antagonists. Atropine in low concentrations was found to inhibit bladder contractions whereas higher concentrations of the drug sometimes had the opposite effects. Indomethacin inhibited, phentolamine enhanced and methysergide had no dose-dependent effect on the field stimulation response. It is proposed that acetylcholine is one of the transmitter substances responsible for the contraction of the human detrusor. Species differences which could be responsible for the alleged atropine-resistance of the bladder are discussed. It is concluded that anticholinergic drugs should be of therapeutic value for treatment of muscular hyperactivity in the human urinary bladder.

Acetylcholine↗
PubMed1983

Renal function in idiopathic hydronephrosis.

In 11 patients who underwent Anderson-Hynes pyeloplasty for unilateral hydronephrosis, renal function was examined with split-clearance technique immediately after the operation and 2-5 years postoperatively. The studies shortly after pyeloplasty showed decreased glomerular filtration rate (GFR) and renal plasma flow (RPF) in most of the hydronephrotic kidneys. GFR improved slightly during the follow-up period, but RPF did not increase. The tubular dysfunction, expressed as moderately increased fractional excretion of electrolytes, showed significant improvement only as regards magnesium. The study indicates that reconstructive surgery is not warranted if the aim is to improve renal function in an asymptomatic patient with normal total GFR. On the other hand, patients with pain caused by the renal obstruction should always be subjected to surgery.

Adolescent↗
PubMed1983

Renal structural and functional changes after unilateral ureteral obstruction in rabbits.

Renal structural and functional changes following unilateral ureteral ligation for periods of 3 days to 6 weeks were studied in rabbits. The renal pelvic pressure increased to 20 cm H2O within 3 days of obstruction and in contrast to some previous investigations it was still raised after 6 weeks. Interstitial oedema, collapse of proximal tubules and dilatation of distal tubules were the earliest observed histological changes. Later findings were interstitial fibrosis, widespread atrophy of proximal tubules and, in the latest stages, dilatation of the collecting duct system. Thus, the distal tubules appeared considerably less resistant than the collecting ducts, to the increased pressure. Renal functional changes were studied one hour after release of obstruction of 3 days, 1-2-4 or 6 weeks' duration. In comparison to the contralateral kidney a rapid decrease of blood flow and glomerular filtration occurred in spite of a normal glomerular structure and collapsed proximal tubules and were probably related to haemodynamic disturbances such as arteriolar constriction. Although absolute electrolyte excretion was much reduced, the fractional excretion of several electrolytes, especially magnesium was increased already after 3 days of obstruction. These findings can presumably be correlated to the dilatation and early epithelial alterations in the distal tubules in which magnesium is predominantly reabsorbed.

Animals↗
PubMed1982

Effects of narcotic analgesics, especially pethidine and norpethidine, on renal pelvic smooth muscle in patients with hydronephrosis.

Relaxation of the renal pelvic smooth muscle is usually attempted as a symptomatic treatment in painful colic of the upper urinary tract. The spasmolytic potency of morphine, pethidine, pentazocine, fentanyl, naloxone and papaverine was evaluated using noradrenaline-contracted pelvic strips from hydronephrotic patients. The order of spasmolytic potency was found to be fentanyl greater than pethidine = papaverine greater than pentazocine = naloxone. Morphine produced a dual effect, starting with contraction followed by relaxation. Norpethidine, which is the only metabolite of pethidine occurring in human plasma, had the same relaxing potency as its parent compound, pethidine. Thus, an active metabolite may play a role in the outcome of spasmolytic drug treatment.

Analgesics, Opioid↗