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Biomedical subjects

A Cucchi

Publications and source records attributed to A Cucchi.

At least 19 recordsLinked to original sources
PubMed2006

Urgency degree and bladder contraction velocity: sequential changes in women with idiopathic detrusor overactivity.

AIMS: In patients with idiopathic detrusor overactivity (DO) who showed storage symptoms worsening with time, we checked whether and which urodynamic parameter changes are associated with an increased urgency degree. MATERIALS AND METHODS: We analyzed retrospectively the urodynamic findings in 54 women -27 with storage symptoms (Group A, mean age 32 +/- 7 years) and 27 controls (Group B, mean age 30 +/- 9 years). These latter had a history of recurrent UTIs (urinary tract infections), but when seen by us had no UTI, DO, lower urinary tract symptoms, or any other pathological finding. Group A had a first urodynamic examination when first referred (time 1) and were re-assessed a mean of 16 months later (time 2) for worsened storage symptoms. RESULTS: In Group A, an idiopathic DO was shown at both times 1 and 2; urgency of voiding could be delayed during cystometry for >or=2 min (= moderate urgency) at time 1 and for <2 min (= severe urgency) at time 2; detrusor contraction strength or contractility proved higher than in Group B (P < 0.001) and increased from time 1 to time 2 (P < 0.001), detrusor shortening velocity being always the major component of the higher contractility levels. CONCLUSIONS: A DO-related increase in bladder contractility may have been further enhanced by severe urgency through a positive feedback mechanism. The urgency degree proved closely associated in DO patients with the level of detrusor shortening velocity rather than with detrusor pressure.

Adult↗
PubMed2005

Urgency of micturition and detrusor contractility in men with prostatic obstruction and overactive bladders.

AIMS: In men with prostatic obstruction and detrusor overactivity (DO), to ascertain whether urgency of micturition affects bladder contractility. MATERIALS AND METHODS: We urodynamically assessed five groups of 20 men each who had bladder outflow obstruction (BOO) from benign prostatic enlargement-Groups 1 (with no DO and no urgency), 2 (with DO and no urgency), 3A (with DO and moderate urgency), 3B (with DO and severe urgency), and 4 (with DO, severe urgency and chronic ischemic cerebral lesions). Urgency was graded as moderate or severe by the ability to avert an urgent void at cystometry for > or =2 or <2 min, respectively. BOO was assessed by the "Abrams-Griffiths number" (AG) and bladder contractility by the parameters PIP and WF(max). RESULTS: AG did not differ significantly in Groups 2, 3A, and 3B, proved higher in such groups than in Group 1, and was nearly the same in Groups 1 and 4. PIP and WF(max) were significantly higher in Groups 2, 3A, and 3B than in Groups 1 and 4, had the highest levels in Group 3B, and did not differ significantly in Groups 1-4 and 2-3A. CONCLUSIONS: In DO patients with prostatic obstruction there seems to be a DO-related facilitation of bladder contractility. In the same patients, severe urgency of micturition might over-amplify (i.e., enhance a DO-related facilitation of) bladder contractility, provided there are no neurogenic (chronic ischemic cerebral) lesions.

Aged↗
PubMed2004

Urgency of voiding and abdominal pressure transmission in women with mixed urinary incontinence.

AIMS: To ascertain whether abdominal pressure transmission (a.p.t.) to the urethra would be affected by urgency of voiding in women with mixed urinary incontinence. METHODS: We urodynamically assessed 80 consecutive women. Group 1 (n = 40), with stress incontinence, had stable bladders and no urgency. Group 2 (n = 40), with mixed (stress + urge) incontinence and overactive bladders, were split into Groups 2A (n = 20) and 2B (n = 20) according to the delay time of urgent void at cystometry (CMG) equating at least 2 min (taken as an index of moderate urgency) or, respectively, less than 2 min (taken as an index of severe urgency). Nonparametric statistics checked for significant differences in a.p.t. and in pelvic floor (peri-urethral) muscle strength level. We defined a.p.t. at stress (cough) urethral pressure profilometry (UPP) by the pressure transmission ratio (PTR). Pelvic floor muscle strength was defined at "holding" UPP by the maximum urethral pressure developed during attempts "to hold urine" (hMUP). RESULTS: PTR was reduced in all women, but PTR (and hMUP) proved relatively higher in Group 2, though nonsignificantly different values of PTR (and hMUP) were seen in Groups 2B and 1. CONCLUSIONS: Transmission of abdominal pressure to the urethra was reduced in all of the incontinent women. The mixed incontinence group, however, had a relatively less reduced (active component of) a.p.t., most likely dependent on a greater pelvic floor (peri-urethral) muscle strength level secondary to frequent contractions in response to urgency. Yet, of the same mixed incontinence patients, those with the most severe urgency degrees had relatively low pelvic floor (peri-urethral) muscle strength levels (eventually resulting from muscle fatigue? or primarily due to peri-urethral tissue atrophy?), which prevented (the active component of) a.p.t. from increasing.

Abdomen↗
PubMed2003

Voiding urgency and detrusor contractility in women with overactive bladders.

AIMS: To check whether the contractility of overactive bladders would be affected by voiding urgency. METHODS: We urodynamically studied 100 women: 20 normal controls (group 1), 60 patients with idiopathic detrusor overactivity (DO), and 20 with neurogenic DO from intracerebral lesions. The idiopathic DO groups 2A (n = 20), 2B (n = 20), and 3 (n = 20) had moderate, severe, and no voiding urgency, respectively. The neurogenic DO group 4 had severe urgency. The delay time of urgent void at cystometry (2 minutes or more or, respectively, less than 2 minutes) defined moderate or severe urgency. Detrusor contractility was defined by the maximum bladder external voiding power (WF(max)). RESULTS: WF(max) was higher in the idiopathic DO patients than in the controls, had the highest values in group 2B, and did not differ significantly between groups 1-4 and 2A-3. CONCLUSIONS: We inferred from our data that idiopathic DO suggests a facilitation of voiding contractions and that such facilitation might be centrally amplified by severe urgency. This amplifying effect would probably be impaired in cases of neurogenic DO from intracerebral lesions.

Adult↗
PubMed2001

Impact of early pelvic floor rehabilitation after transurethral resection of the prostate.

We examined the results of teaching pelvic floor muscle exercises (PME) on micturition parameters, urinary incontinence, post-micturition dribbling, and quality of life in patients after transurethral prostatectomy (TURP). Fifty-eight consecutive patients who were selected to undergo TURP for benign prostatic hyperplasia (BPH) were admitted into the study: 28 were randomly assigned to a control group (A), 30 formed the investigational group (B) during an initial visit conducted before surgery. In group B patients, perineal exercises were demonstrated in detail, and tested for their correct use via simultaneous rectal and abdominal examination. After the removal of the urethral catheter, these patients were instructed to perform pelvic floor muscle exercises at home and were evaluated before the exercises and at weekly intervals postoperatively. The American Urological Association Symptom Score improved significantly after TURP in both groups. The average quality of life score improved more significantly in group B after TURP, from 5.5 to 1.5 (P < 0.001). The grade of muscle contraction strength after 4 weeks of PME increased from 2.8 to 3.8 in group B (P < 0.01); it was unchanged in the group A. The number of patients with incontinence episodes and post-micturition dribbling was significantly lower in the group B at weeks 1, 2, and 3 (P < 0.01). Our results show that pelvic floor muscle re-education produces a quicker improvement of urinary symptoms and of quality of life in patients after TURP. Its early practice reduces urinary incontinence and post-micturition dribbling in the first postoperative weeks. The exercises are simple and easy to perform in the clinical setting and at home, and therefore should be recommended to all cooperative patients after TURP.

Aged↗
PubMed2001

Spatial distribution of microorganisms and measurements of oxygen uptake rate and ammonia uptake rate activity in a drinking water biofilter.

The biofilm characteristics (population dynamics and biofilm composition) in a biological filter for the removal of iron, manganese and ammonium were studied in a drinking water treatment plant. The objective was to examine the spatial distribution and biological composition of active biomass that grows in a biological filter and to verify the effect of the backwashing on the quantity of fixed biomass and on the density and activity of the biological population. Heterotrophic microorganisms activity was higher in the upper layer of the filter. Nitrifying microorganisms colonized the biofilter in a stratified manner and their activity was higher in the second layer of the filter. A total of 14 species of ciliated protozoa and 7 species of filamentous microorganisms were found in the biofilters. Ciliates were concentrated in the filterbed layer in which the heterotrophic activity was higher. The grazing activity of ciliates on heterotrophic bacteria reduced the competition pressure on nitrifying microorganisms, supporting their growth and thus raising the ammonium removal efficiency. In general, filamentous microorganisms appeared to be indifferent to operating changes in the plant such as backwashing and filtering cycles. Crenothrix was the prevalent filamentous microorganism in terms of both frequency and abundance; it was found prevalently in the first layer where the oxidisation of iron and manganese occurred.

Ammonia↗
PubMed1999

Sequential changes in voiding dynamics related to the development of detrusor instability in women with stress urinary incontinence.

We evaluated 31 women who had undergone a conservative treatment regimen for stress urinary incontinence and who, during the treatment period, were assessed twice urodynamically (by cystometry and pressure/flow study) at an interval of months between the two examinations. Seventeen (Group 1) had stable bladders at time 1 and detrusor instability (DI) after a mean of 12 months (time 2). Fourteen (Group 2) had stable bladders both at time 1 and after a mean of 15 months. Of the urodynamic parameters evaluated, the opening detrusor pressure (pdet.op) reflected the height of the bladder neck pressure rise that normally occurs during the opening phase of micturition and that is overcome by the detrusor contraction pressure at the onset of flow. At the second testing, Group 1 patients showed greater detrusor strength. They also showed a more elevated pdet.op (= a more elevated bladder neck pressure rise during the onset of voiding detrusor contraction), which may have been necessary to ensure an enhanced bladder contractility level. Indeed, a higher rise in pressure, hence in muscular tension, at the bladder neck region should obviously lead to increased afferent signals from tension receptors, and positive feedback to the detrusor of such increased signals may yield more intense neural stimulation. This would amplify the facilitating effect on bladder contractility of a possible DI-related decrease in electrical resistance between the detrusor smooth muscle cells.

Adult↗
PubMed1998

Different voiding dynamics in stable and unstable bladders with and without outlet obstruction.

Of 120 men with benign prostatic enlargement who were evaluated urodynamically, 60 had stable bladders, with (n=30) and without (n=30) outlet obstruction (OO), whereas 60, both obstructed (n=30) and unobstructed (n=30), had detrusor instability (DI). The unstable bladders, wither in the absence or presence of OO, always showed a greater mechanical capability. In particular, compared to the stable bladders, the unstable ones not only had greater strength, but also showed a higher maximum shortening velocity (as well as a shorter opening time and not significantly higher internal work). In the obstructed unstable series, compared to the obstructed stable one, such findings paralleled a more severely increased urethral impedance, which suggests that a functional "compensatory" response to a greater OO was facilitated. All such data were hypothesized to result from microstructural changes yielding an easier electrical coupling between the detrusor smooth muscle cells and hence both a state of DI and better synchronized (thus, stronger and faster) micturition contractions. At least, the latter would be the case should there be no heavy bladder collagenosis upsetting the spread of the depolarization wave.

Aged↗
PubMed1998

A possible link between stress urinary incontinence and detrusor instability in the female--urodynamic (pressure/flow) data and speculative considerations.

The aim of the present investigation was to check voiding mechanics in women with stress urinary incontinence (SUI) for differences between patients with stable bladders and those with detrusor instability (DI). There were 70 females, 35 with stable and 35 with unstable bladders, who had urodynamically proven SUI. All underwent medium-fill water cystometry and pressure/flow studies. A relatively enhanced detrusor contractility, mirrored by higher values of maximum external voiding power and shortening velocity, could be found in the unstable patients. Of these, 27 were reassessed urodynamically following surgical cure of the SUI. After the operative treatment 17 of the 27 showed stable bladders and a reduced detrusor contractility, but no reduced contractility was found in the other 10, whose bladders remained unstable. The data reported may suggest that the factor responsible for 'idiopathic' DI in SUI patients would also be able to yield enhanced bladder mechanical capability. It was tentatively assumed that this factor involves an increased urethral sensitivity, possibly secondary to incompetence of the urethral closure mechanism, and persisting at times even should SUI be surgically relieved.

Aged↗
PubMed1998

SASP (small, acid-soluble spore proteins) and spore properties in Bacillus thuringiensis israelensis and Bacillus sphaericus.

Entomopathogenic bacilli B. thuringiensis israelensis (Bti) and B. sphaericus (Bf) exhibit low survival on field application. It was previously shown that their spores are very sensitive to different stress effectors (heat, UV light) and especially to osmotic variations. Since SASP (Small, Acid-Soluble Spore Proteins), alpha/beta and gamma type, are involved in spore tolerance to heat, UV light, peroxide, and salt, they were analyzed in Bti and Bf. The molecular weight, migration pattern and amino acid composition of different SASP were determined and compared with other bacilli, in particular to B. subtilis. A relation between spore osmotolerance, SASP content, and amino acid composition was shown. In addition, the absence of gamma SASP in Bti and Bf is discussed.

Bacillus↗
PubMed1997

Detrusor instability as an energy-saving device in prostatic obstruction.

PURPOSE: We assessed whether voiding dynamics differ in patients with infravesical obstruction from benign prostatic hyperplasia between those with detrusor instability and those with stable bladders. MATERIALS AND METHODS: A total of 50 such patients with (25) and without (25) detrusor instability was investigated urodynamically by cystometry and pressure-flow study. RESULTS: In the unstable group there was greater obstruction (as assessed by the linear passive urethral resistance relation pressure-flow nomogram) but the detrusor expended less energy (p = 0.001) for voiding the unit volume (54.4 +/- 22.8 mJ./ml versus 74.4 +/- 31.8 mJ./ml. in the stable series). Spared energy was converted into more powerful micturition contractions and more efficient voiding, with a mean maximum contraction power and mean fraction of bladder volume voided of 17.9 +/- 4.9 microW./mm.2 and 93 +/- 11%, respectively, in the unstable population versus 12.7 +/- 2.1 microW./mm.2 (p < 0.001) and 79 +/- 13% (p < 0.001) in the stable subjects. CONCLUSIONS: Detrusor instability possibly works within physiological limits as an energy-saving device, preventing voiding efficiency in patients with prostate disease from decreasing too much with increasing obstruction.

Aged↗
PubMed1996

Detrusor contractility in hyperreflexic bladders (from intracerebral neuropathies) versus unstable and stable unobstructed ones.

Three male patient groups of 20 subjects each have been assessed urodynamically by pressure flow study, namely, patients with detrusor hyperreflexia (DH) due to intracerebral neuropathies were compared with subjects bearing a condition of idiopathic detrusor instability, as well as with a control group of males showing normal urodynamic findings. Detrusor contractility proved greater in the unstable patients, but did not differ significantly between those with DH and the controls. Such results may suggest that intracerebral neuropathies leading to DH have no influence on, whilst the factors responsible for detrusor instability are strongly related to, the degree of activation of bladder muscle mechanical capability.

Aged↗
PubMed1995

Some observations on a condition of relatively lower detrusor contractility in stable versus unstable unobstructed bladders.

The study comprised 30 consecutive benign prostatic hypertrophy patients--15 with detrusor instability, and 15 with stable bladders--who had a relatively lower detrusor contractility with no obvious obstruction of the vesical outlet. Compared with the stable bladders, those with detrusor instability showed lower filling volumes, along with a relatively greater voiding efficiency and relatively higher values of detrusor contraction strength and contraction velocity. Micturition contractions proved to be more well sustained until the end of voiding in the unstable group. It has been assumed that the factors responsible for detrusor instability also caused bladder contractile capability to relatively increase. In other words, it seemed even this extreme case could possibly support the view that detrusor instability always involves a tendency to enhanced contractile function.

Humans↗
PubMed1995

ssp genes and spore osmotolerance in Bacillus thuringiensis israelensis and Bacillus sphaericus.

It was shown previously that spores and vegetative cells of Bacillus sphaericus (Bf) and Bacillus thuringiensis israelensis (Bti) are very sensitive to osmotic variations. Since spore osmotolerance has been associated with their SASP (small acid soluble spore proteins) content coded by ssp genes, hybridization assays were performed with sspE and sspA genes from B. subtilis as probes and showed that Bti and Bf strains could lack an sspE-like gene. The B. subtilis sspE gene was then introduced into Bti 4Q2 strain; spores were obtained and showed a 65 to 650 times higher level of osmotolerance to NaCl, without affecting other important properties: hypoosmotic resistance in vegetative cells, spore UV resistance, and larvicidal activity against diptera larvae.

Animals↗
PubMed1995

A possible condition of pre-instability in prostatic obstruction.

There were 40 patients with benign prostatic hypertrophy (mean age 66 +/- 9 years) who had an obstructed stable bladder on a pressure-flow study. After a mean of 18 months (range 5 to 64) urodynamic studies were repeated and 20 men (group 1, mean age 60 +/- 7 years) had a stable bladder, while 20 (group 2) who were older (mean age 71 +/- 7 years) had detrusor instability. In the latter 20 patients greater outflow obstruction was noted at the second assessment. What seems most interesting is that at time 1 group 2 patients had a significantly higher rate of increase in opening pressure, which would possibly characterize an early stage in the development of structural changes leading to detrusor instability. This finding might prove a reliable clue to predict the latter condition in men with a proximally obstructed stable bladder.

Aged↗
PubMed1994

Bladder contractility and idiopathic detrusor instability in males.

Thirty males (mean age 54 +/- 13 years) with an "idiopathic" detrusor instability and fully compensated bladders (no post-micturition residuals) were assessed urodynamically at a short distance of time (3 months, on average) from the beginning of clinical symptoms. Thirty age-matched controls were also investigated. Detrusor shortening velocity was found to be increased in the unstable patients (P < 0.001), which seemed to derive from enhanced contractile capability in the presence of normal urethral resistance. Such data confirm the results of previous investigations in males with obstructive detrusor instability as well as in women with idiopathic unstable bladders. The significance of these findings was discussed. In particular, it was suggested that detrusor instability may involve changes leading both to more excitable bladder smooth muscle cells and to an easier electrical coupling between the same cells, thus, to enhanced contractile capability. It was also suggested that if an impaired contractile function in unstable bladders may be the final result of a process of detrusor collagenosis, increased bladder contractility would rather characterize an initial phase in the natural history of detrusor instability.

Humans↗
PubMed1994

The development of detrusor instability in prostatic obstruction in relation to sequential changes in voiding dynamics.

We studied 34 patients with benign prostatic hypertrophy who had infravesical obstruction with a high opening pressure and a stable bladder. No treatment was given except for intermittent short courses of plant extracts. There were no factors other than prostatic obstruction that could affect the mechanics of micturition. The patients were reassessed after a mean of 21 months (range 7 to 62). Voiding dynamics were unchanged in 12 patients who had a stable obstructed bladder, while 22 had an unstable obstructed bladder with a significantly greater opening pressure. Peak flow pressure was also increased but much less so that at the onset of voiding. The driving pressure and bladder volume were decreased. Despite this fact, urine flow rates were unchanged and maximum external voiding power was enhanced. The significance of such findings is discussed.

Aged↗