Biomedical subjects

A Esa

Publications and source records attributed to A Esa.

At least 37 records · Page 2Linked to original sources

PubMed1994

[A new method of measurement of the urinary bladder blood flow in patients with low compliant bladder].

Laser-doppler blood flowmetry, a new instrument for measurement of tissue blood flow, was used to evaluate the changes occurring in the bladder blood flow and the intravesical pressure during bladder distension in 4 patients with normal detrusor function, 4 patients with neurogenic bladder dysfunction and one patient with non-neurogenic contracted bladder. In patients with normal detrusor function and normal compliance, the bladder blood flow relatively decreased, but the intravesical pressure was not affected by the bladder distension. On the other hand, the bladder distension in patients with low compliant bladder caused a significant decrease of the bladder blood flow and marked increase of the intravesical pressure. These observations suggest that the reduction of the bladder compliance is related to the decrease of the bladder blood flow. Furthermore, the bladder over distension and the high intravesical pressure in patients with low compliant bladder are thought to induce deterioration of bladder compliance and upper urinary tract.

Atrophy↗

PubMed1993

[Anticholinergic therapy of urinary incontinence and urinary frequency associated with the elderly--with special reference to dementia].

Pharmacotherapy with anticholinergic agents was studied in a total of 80 patients aged 65 years or older with chief complaints of urinary frequency (4 patients) and/or ugency incontinence (76 patients). The subjects were 45 men and 35 women at the age ranging between 65 and 92 (mean 73.7). The patients received anticholinergic agents (terodiline hydrochloride 24 mg/day, oxybutynin hydrochloride 6 mg/day, propantheline bromide 60 mg/day separately or in combination) for more than two weeks. Subjective symptoms and objective findings were assessed before and after the administration. In addition, according to the result of Hasegawa's dementia rating scale the patients were divided into dementia group and non-dementia group for further evaluation of the study drugs. As a result, cystometrogram revealed significant increase of maximum bladder capacity in either dementia group or non-dementia group. There was no significant difference in rate of objective improvement between both groups. On the other hand, rate of subjective improvement was significantly higher in non-dementia group (40%) than in dementia group (15%). As mentioned above, improvement of cystometrogram findings was not associated with improvement of subjective symptoms in the demented patients. This suggests that the major cause of incontinence in demented patients is not the bladder dysfunction but the specific conditions of demented patients such as agnosia and apraxia.

Aged↗

PubMed1993

[Quantitative electromyographic analysis of the external urethral sphincter using automatic decomposition electromyography on normal subjects].

Motor unit action potentials (MUPs) of the external urethral sphincter muscle during cystometry were analysed on six normal males. Electrodes were of concentric needle type having the exposed tip surface of 0.07 mm2, and the potential changes were analysed by automatic decomposition electromyography (ADEMG), for isolation and characterization of unit discharges. Number of analysed units was as follows: Two at rest, 4 at first desire to void, and 6 at maximum desire to void. Number of the recorded units and the firing rate were increased along with the degree of bladder filling. Average MUP figures as follows: Amplitude of 206 microV, 8.3 msec. duration, and 5.4 Hz firing rate at rest; 246 microV, 9.7 msec and 7.3 Hz at first desire to void; 277 microV. 9.7 msec and 7.2 Hz at maximum desire to void, respectively. It is concluded that external urethral sphincter maintains its urinary continence by excitation of the neuromuscular units, and by the increase in the firing rate of individual MUP during bladder filling.

Action Potentials↗

PubMed1993

[Quantitative electromyographic analysis of the human external urethral sphincter: effect of alpha-adrenergic agents].

External urethral sphincter electromyography (EMG) during bladder filling was quantitatively analysed using automatic decomposition electromyography (ADEMG). These include 7 normal volunteers, 7 patients with outlet obstruction, 9 with sphincter dyssynergia, and 7 with pelvic nerve injury (PNI). Recruited number of participated motor unit action potentials (MUPs) at maximum bladder filling was significantly larger than that at rest in the normal volunteers, patients with outlet obstruction, and sphincter dyssynergia. In patients with PNI, MUPs were not increased. The MUP amplitude did not differ significantly among groups during bladder filling. In PNI group, MUP duration at rest tended to be larger than those in other groups. Firing rates at first desire to void and at maximum desire to void were significantly increased than that at rest in every groups except the PNI group. Effect of alpha-1 adrenergic blocking agent, phentolamine (5 mg intravenously), was examined on 3 patients with benign prostatic hypertrophy (BPH), and in 4 patients with sphincter dyssynertia. Effect of an alpha-1 adrenergic stimulating agent, norepinephrine (5 microgram/min intravenously), was also evaluated on 5 patients with PNI during bladder filling. Immediately after administration of phentolamine, number of MUPs was decreased in BPH and sphincter dyssynertia groups. But in 2 paraplegic patients having reflex bladder with sphincter dyssynergia, number of MUPs did not decrease. Even with the continuous intravenous administration of norepinephrine for the elevation of the blood pressure, number of MUPs did not increase in any PNI patients. Effect of intravenous administration of phentolamine to induce urethral pressure elevation and the recording of the evoked EMG from external urethral sphincter by electrical stimulation of the penile dorsal nerve was tested on 4 patients without PNI before and after the administration. Phentolamine lowered urethral pressure at membranous urethra, but no significant change of evoked urethral pressure response and EMG activities was observed. It is concluded that the decrease of MUP after phentolamine administration is due to the relaxation of periurethral part of external urethral sphincter, and clinical denervation supersensitivity of the external urethral sphincter after norepinephrine administration was not demonstrated in the PNI groups.

Action Potentials↗

PubMed1993

[Transurethral teflon paste injection for vesicoureteral reflux in neurogenic bladder dysfunction].

We experienced transurethral teflon paste injection for 12 refluxing ureters of 7 patients with neurogenic bladder dysfunction. Preoperative assessment of cystometry showed hypoactive bladder function with normal bladder compliance in 4 patients, and low compliance bladder (< 10 ml/cmH2O) in 1. Voiding cystography revealed grade 1 reflux in 2 ureters, grade 2 in 3, grade 3 in 2, grade 4 in 2, and grade 5 in 2. One ureter did not show reflux. Zero point two to 1.6 ml of teflon paste was injected on each ureter under cystoscopic observation. These patients were followed for a mean of 25.1 months. Reflux disappeared immediately after the first operations in all patients, however recurrence was observed in 2 ureters, in which improvement of reflux (grade 5 to 2) was achieved in 1 ureter but no improvement (grade 2 to 2) in another. Pyelonephritis was not encountered in any patients after injection. No complication was observed through the follow up period. In conclusion, we advocate that endoscopic teflon paste injection is a useful alternative to ureteroneocystostomy in the treatment of reflux in patients with neurogenic bladder dysfunction.

Aged↗

PubMed1993

[Clinical study of the timed voiding schedule for urinary incontinence in demented elders].

Fourty-one demented elderly patients who had been diapered because of urinary incontinence in Hanwa-Senboku Hospital were treated with the one-week timed voiding schedule. Finally 14 patients (34%) became dry, and free from diapers for more than 1 week after the treatment. With regard to their cystometrogram findings, 10 (67%) of 15 patients having normoactive detrusor function, 3 (14%) of 21 patients having overactive detrusor function and 1 (20%) of 5 patients having underactive detrusor function became free from diapers after the treatment. Therefore a patient with normoactive detrusor function is thought to be a good candidate for the timed voiding schedule. Regardless of their detrusor function, those who showed good responsiveness to the treatment had better activities in daily life (better than D in the Katz index) and small amount of residual urine (less than 80 ml), indicating that not only the detrusor function but also both activities in daily life and the amount of residual urine are the important factors to reestablish voiding behavior in demented elderly patients. The timed voiding schedule is thought to be a useful method to treat incontinence in demented elderly patients, and should be tried first of all, although intermittent catheterization and/or other alternatives would be necessary for those with a large amount of residual urine with poor activities in daily life.

Activities of Daily Living↗

PubMed1991

Functional electrical stimulation in the management of incontinence: studies of urodynamics.

Intermittent functional electrical stimulation (FES) was employed for the control of incontinence. One FES session lasted for 30 minutes. It was repeated at intervals of 3 days to 1 week via an anal plug electrode. The success rate was 64% in 41 patients with pollakiuria, urgency and/or urge incontinence, and 43% in 7 patients with stress incontinence. Detrusor activity measured by cystometry did not correlate significantly with the effect on subjective symptoms and the urethral pressure did not increase. The remarkable clinical effect was observed in patients with overactive detrusor function. It seems that FES indirectly inhibits detrusor contraction by suppressing the intrasacral pathway for detrusor activity.

Adult↗

PubMed1991

Edema and lower leg perfusion in patients with post-traumatic dysfunction.

Impedancegraphy and laser Doppler flowmetry were used to measure whether limb circulation changes following post-traumatic immobilization and edema. Intermittent pneumatic compression was used for edema treatment. Limb blood flow due to edema was unchanged compared to the contralateral healthy leg. Intermittent pneumatic compression reduced edema very significantly (p less than 0.001). Intermittent compression showed a slight but significant (p less than 0.01) improvement in impedancegraph blood flow after treatment. Laser Doppler skin blood flow decreased non-significantly following the compression treatment.

Adult↗

PubMed1991

[Management of vesicoureteral reflux in patients with neurogenic bladder dysfunction].

We studied 20 cases of neurogenic bladder with vesico-ureteral reflux retrospectively. Seven patients voided with Valsalva's maneuver and 12 patients were managed with clean intermittent catheterization, but one patient required permanent urinary diversion because of uncontrollable urinary tract infection. The patients were followed by intravenous pyelography, radioisotope renogram, voiding cystourethrography, determination of serum creatinine level and urodynamic study. Anti-reflux surgery was performed in 22 ureters and reflux resolved in 19 ureters. Among 12 ureters not treated by anti-reflux surgery, reflux disappeared in 5 ureters and improved in 2 ureters. Of 5 ureters, reflux resolved after clean intermittent catheterization in 2 ureters, and remained stable without recurrent infection or renal deterioration in the remaining 5 ureters. Regardless whether antireflux surgery was done or not, most of the patients who had high grade reflux and obstructive renal damage on radioisotope examinations had marked low compliance bladders. Our experience suggested the necessity of a suitable treatment to improve bladder compliance before considering anti-reflux surgery.

Adolescent↗

PubMed1991

[Effect of the cerebro-metabolism activator (bifemelane hydrochloride) on urinary incontinence and pollakisuria associated with cerebrovascular dementia].

A cerebral metabolic activator was administered to patients with cerebrovascular dementia to treat urinary incontinence or pollakisuria. The results are of interest as discussed in this paper. This study was carried out on 35 patients (15 males and 20 females) with cerebrovascular dementia with the chief complaint of incontinence or pollakisuria averaging in age 78.1 years with a range of 65 to 92. The underlying disease was cerebral hemorrhage in 4 cases, cerebral embolism in 21 cases and sequelae of cerebral apoplexy in 10 cases. ADL was assessed in all cases by cerebral CT or MRI and Hasegawa's test, a simple test for dementia. Bladder function was evaluated by determining urodynamic tests (CMG, UFM, UPP) before and after medical treatment. Test drug was bifemelane hydrochloride, a cerebrovascular metabolic activator. It was administered at a dose of 150 mg/day for periods of 2 months or more. As a result, bladder symptoms improved in 16/35 patients (45.7%), and mental symptoms in 21/35 (60%). Urine voiding and holding as bladder functions determined by urodynamics tests were not affected at all. The effect of this drug on bladder symptoms is secondary to improvement of mental symptoms, and its most pronounced clinical effect was on dementia.

Aged↗

PubMed1990

[Urolithiasis due to renal tubular acidosis associated with Sjögren's syndrome].

We encountered 4 patients with urolithiasis due to renal tubular acidosis (RTA) associated with Sjögren's syndrome. Laboratory results about RTA in 4 patients with Sjögrenhs syndrome were not significantly different from those in patients who suffered from urolithiasis due to RTA without Sjögren's syndrome. The incidence of urolitiasis in these cases was suspected to be higher than that in RTA patients without Sjögren's syndrome, because all 4 patients in this study had urolithiasis. When we examine patients with bilateral and multiple urolithiasis, particularly in middle-aged women, we should bear in mind that RTA and Sjögren's syndrome may exist in the background.

Acidosis, Renal Tubular↗

PubMed1990

[Review of a 14-year experience of augmentation enterocystoplasty. Observations on bowel dynamics].

Fifteen patients with low compliance bladder of varying etiologies (neurogenic bladder, radiation induced contracted bladder after radical hysterectomy, bladder tuberculosis and interstitial cystitis) underwent augmentation enterocystoplasty. The ileocecal tubular segment was used in 12 patients, ileal-patch in 2 and ileal-cup patch in 1. In all patients in whom partial reconstruction was done, the functional bladder capacity satisfactorily increased and the maximum detrusor pressure was low. The upper urinary tract did not deteriorate in 12 patients. Three died from recurrence of uterine or bladder cancer. Five neurogenic patients were managed by intermittent self-catheterization postoperatively. Another 10 patients was dry without voiding difficulty. Of 18 ureteral reimplantations in ileocecal cystoplasty, 13 had reflux without resultant progressive hydronephrosis. In 3 patients ureteral reimplantation was not required without reflux after ileal-patch and ileal-cup patch cystoplasty.

Adult↗

PubMed1990

[A case of metastatic ureteral tumor].

We report a case of metastatic ureteral tumor resulting from gastric cancer in a 56-year-old female. She had undergone distal gastrectomy for gastric cancer in our hospital 3 years earlier, on the histological diagnosis of poorly differentiated adenocarcinoma with absolute curative resection. In March, 1987, she visited our hospital complaining of microscopic hematuria and lumbago. Intravenous pyelography and left retrograde pyelography revealed the stenotic change of the left ureter and hydronephrosis. Endoscopic ureteral biopsy was performed, and the histological diagnosis was an inflammatory change of the ureter. But the hydronephrosis increased, so partial ureterectomy was performed. The histological examination confirmed adenocarcinoma in the left ureter resulting from gastric cancer. From the 340th postoperative day, she complained of general fatigue and vomiting, and gastroscopy revealed recurrent gastric cancer.

Adenocarcinoma↗

PubMed1990

[Neurogenic bladder after operation of rectal cancer].

Of the patients who had had a urodynamic examination during the five year period from 1982 to 1987 in our clinic, 48 patients underwent operations for rectal cancer prior to the study. In 35 of them, the operation mode was known. If the pelvic nerve is damaged by operative modes for rectal cancer, urinary disturbances of severe kinds may occur. In spite of such disturbances, 71.4% of those who had had excision of the low anterior part and 51.9% of those with Miles' operation could be weaned from the clean intermittent self-catheterization and take up spontaneous urination. Even in patients who developed severe dysuria, if catheterized at an early stage, many of them could urinate by abdominal pressure with in several months after operation, without the aid of a catheter. This transition took place mostly within one year after operation. When a patient develops dysuria after radical surgery for rectum cancer, treatment mainly with self-catheterization is an effective method at present.

Adult↗

PubMed1989

Long-term results and curative mechanisms of vesicoureteral reflux by endoscopic injection of blood.

We describe our new endoscopic procedure for correction of ureterovesical reflux by endoscopic injection of the patient's own heparinized blood behind the ureteral orifice. Before drawing out the needle, small amounts of thrombin and protamine were injected to prevent the injected blood from leaking. Of the 16 ureters treated (13 patients) with international grade I-III reflux, 9 showed complete absence of reflux. The technique is advantageous because it is technically simple and injection can be repeated until the reflux had disappeared. Furthermore, no complications such as distant migration of injected material or escape from the bladder mucosa have been observed. However, the treatment is not consistently successful in cases of high-grade reflux. After the operation, mucosal swelling of ureteral orifice and narrowing of the intramuscular ureter were observed by ultrasonography. The mean pressure of the intramuscular ureter increased 10 cm H2O after the operation. These consequences of the operation may prevent vesicoureteral reflux.

Blood↗

PubMed1989

[A study of urinary incontinence after prostatectomy].

With respect to prostatectomies carried out in clinic since the opening of the Kinki University Hospital in 1975, incontinence after prostatectomy was investigated with 470 patients as subjects for whom a follow-up study after the operation was possible. Also, the usefulness of the urodynamic tests for diagnosing underlying diseases was investigated. 1) Overall incidence of incontinence after transurethral resection of the prostate (TUR-P), retropubic prostatectomy (RPP) and cryoprostatectomy was 5.7 percent. 2) The incidence of incontinence was 7.1 percent of the patients with TUR-P and 3.5 percent of patients with RPP. The incidence of incontinence after cryoprostatectomy was none. 3) There was no clear differences among the incidence of incontinence after prostatectomy and the weight of resected tissues. 4) There was no clear differences among various types of incontinence after each procedures of prostatectomies. 5) The incontinence was satisfactorily treated and disappeared in 18 patients within one year after the operation. In patients who failed to get continence within a year, the incontinence was likely to persist furthermore. 6) The cure rate was low in patients with abnormal findings in a cystometrogram performed prior to the operation. Associated diseases which could cause disorders in nervous system were frequently encountered in such patients. 7) Drugs and functional electrical stimulation (FES) were introduced for the treatment of incontinence after prostatectomy. FES was effective in 36.4 percent in which drug therapy was not effective. Since multiple drug regimen was administered in most of the patients, it was difficult to make a precise evaluation of judgement for effect of each of drugs.

Cryosurgery↗

PubMed1989

[Experimental studies on sympathetic innervation of lower urinary tract. Quantitation of nerve terminals and urethral pressure response after hypogastric denervation].

On 6 female mongrel dogs (denervated group), bilateral hypogastric nerves were cut distally to the inferior mesenteric ganglion. Five dogs were kept intact as a control group. After 2-5 months, urethral pressure response to continuous noradrenaline infusion (0.1 microgram/kg/min) was monitored. The urethral pressure rose significantly after noradrenaline loading in each group, however there was no significant difference in the degree of the response between the denervated group and control group. Subsequently, the bladder and the urethra were extirpated to determine the intrinsic noradrenaline content. The tissue noradrenaline concentration was highest in the posterior urethra, intermediate in the bladder base and lowest in the bladder dome. Although these values tended to be lower in the denervated group than in the control group, no significant difference was obtained between the groups in each portion. These results suggest that the majority of sympathetic components which consists in the hypogastric nerve may involve short adrenergic neurons. Thus, chronic hypogastric denervation alone does not induce sympathetic denervation supersensitivity. Simultaneous decentralization of the pelvic nerve may be necessary for inducing sympathetic denervation supersensitivity.

Animals↗

PubMed1989

[Significance of ultrasonography in detecting renal cell carcinoma].

Eighty-one cases of renal cell carcinoma in last twelve years (1975-1987) have been reviewed and examinations contributing to initial diagnosis of renal cell carcinoma were studied retrospectively. In earlier 5 years from 1975 to 1980, ultrasonography less contributed to detection of renal cell carcinoma than computed tomography. Conversely in the last 3 years from 1984 to 1987, the number of cases were detected by ultrasonography. Since ultrasonography is useful diagnosing renal cell carcinoma of various growth patterns and can detect small space occupying lesions, recently ultrasonography has become a routine examination, and a chance of detecting incidental renal cell carcinoma has been increasing. Ultrasonography should be made at first for screening of renal cell carcinoma.

Carcinoma, Renal Cell↗