Successful management of radiation cystitis with sodium pentosanpolysulfate.
Pentosanpolysulfate was given to 5 patients with chronic gross hematuria secondary to pelvic irradiation. All 5 patients had significant control of the bleeding.
Aged↗
Biomedical subjects
C L Parsons
Publications and source records attributed to C L Parsons.
Group reminiscence therapy and levels of depression in the elderly.
The purpose of this research was to study the differences in levels of depression in the elderly after group reminiscence therapy. The hypothesis that depressed elderly patients participating in group reminiscence therapy have decreased post-treatment levels of depression was supported. Findings suggest that group reminiscence therapy may provide an effective form of treatment for moderately depressed elderly people.
Aged↗
Pathogenesis of urinary tract infections. Bacterial adherence, bladder defense mechanisms.
Bacterial virulence depends upon the ability of bacteria to adhere to mucosal cells. The risk of infection is increased by bacterial factors promoting this adherence and the fact that bacterial surface structures seek epithelial receptors. The host's ability to inactivate bacterial virulence factors and to "mask" its own cell receptors determines whether infections are to be warded off successfully. The current knowledge of these processes is reviewed in this article.
Adhesins, Escherichia coli↗
Bladder surface glycosaminoglycan: efficient mechanism of environmental adaptation.
A series of experiments has indicated that the bladder surface is lined with a sulfated polysaccharide that is capable of acting as a nonspecific antiadherence factor. It is capable of preventing the interaction of the transitional cells with many substances in urine, including bacteria, calcium, protein, and potential carcinogens. This interface of urine and transitional epithelium may be clinically important in many urologic disease states, since a malfunction of this layer could be involved in a spectrum of urologic diseases that includes irritable bladder syndromes (e.g., detrusor instability, interstitial cystitis, urethritis, radiation cystitis, cyclophosphamide-induced cystitis), carcinoma in situ, calculus disease, infections, and even carcinogenesis. It is important to point out that these investigations have shown that the natural surface mucus can be replaced by any of several substitutes that are as capable of preventing adherence as the natural glycosaminoglycans. One such substance, pentosanpolysulfate, is available in an oral form that is excreted in urine. To date, it has been used to successfully treat one disease of the urinary bladder, interstitial cystitis.
Adaptation, Biological↗
Inhibition of sodium urate crystal adherence to bladder surface by polysaccharide.
Bladder surface glycosaminoglycan (polysaccharide) has been shown to act in a nonspecific manner as an antiadherence factor and may potentially be important in the pathogenesis (and prevention) of renal calculi. It has been shown that when present, bladder surface GAG will reduce the adherence of both calcium and calcium oxalate crystals. This study was conducted to see if a similar effect would be found with uric acid crystals, in that the presence of the normal bladder mucus with its contained GAG and exogenously supplied polysaccharide, pentosanpolysulfate, would be inhibitory to crystal adherence. Radioactively labeled uric acid crystals were made by dissolving 14C labeled sodium urate to a point of saturation at pH 7.5 and then rapidly lowering the pH to 5.5. These crystals were placed into four groups of bladders: 1) normal bladders, 2) bladders rendered mucus deficient with hydrochloric acid, 3) mucus deficient bladders which were pre-treated with sodium pentosanpolysulfate prior to crystal addition and 4) mucus deficient bladders to which were added crystals pretreated with pentosanpolysulfate. There was a significant rise in crystal adherence after acid treatment of the bladder, a 2.3-fold increase, which was blocked with prior treatment of the crystals with pentosanpolysulfate and to a lesser degree by pretreating mucus deficient bladders with pentosanpolysulfate.
Animals↗
Urinary tract infections in the female patient.
Recent investigations into the pathogenesis of urinary tract infections have led to significant understanding of the interaction between uropathogens and the urogenital tract. This understanding provides the potential for the development of new types of therapy. A practical approach to the management of lower urinary tract infections in female patients is discussed, as are new therapies for nonbacterial cystitis, including the urgency-frequency syndrome.
Adhesiveness↗
Urinary tract infections.
Recent investigations into the pathogenesis of urinary tract infections has led to significant understanding in the interaction between uropathogens and the urogenital tract. From this understanding there is already the potential for new types of therapy. Reviewed here are these mechanisms since they offer future potential pragmatic approaches to infection. In addition, a practical approach to management of lower urinary tract infections in females is discussed, to provide a physician with methods to treat infection. Non-bacterial cystitis, or the urgency-frequency syndrome, also has new developments that offer new therapy of these diseases. Some of these findings are discussed as well as the current methodologies used to treat it.
Anti-Bacterial Agents↗
Case profile: pseudodiverticulum of transplant ureter.
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Adult↗
Urinary tract infections and P blood group antigens.
The glycolipids of the P blood groups have been isolated from human urothelial cells and have proved to be likely receptor sites for Escherichia coli. The presence or absence of these antigens may be a factor influencing the adherence of bacteria to the urothelial cells. Therefore, an experimental group of 27 infection-prone premenopausal women, ranging in age from seventeen to thirty-six years, received blood group typing in the ABO and P systems. These women were found to have a normal distribution in the ABO system. Eighty-five per cent were found to be the P2 phenotype compared with the expected frequency of 21 per cent in the general population. These data suggest that there is a genetic influence at the cellular level which may make certain women more prone to urinary tract infections and differences in bacterial adherence.
Adolescent↗
Effect of ammonium on bacterial adherence to bladder transitional epithelium.
The virulence of urease-producing bacteria depends on the ability of urease to degrade urea into ammonia and thereby to alkalinize the urine. Infections caused by urease-producing organisms such as Proteus mirabilis are particularly difficult to manage clinically. We have shown that the layer of glycosaminoglycans at the bladder surface protects against infection by blocking the adherence of bacteria to the epithelium. To determine whether urease-producing urinary pathogens owe their virulence in part to an ability to inactivate the protective effect of the glycosaminoglycan layer, we tested the ability of ammonium chloride to alter bacterial adherence to the normal vesical mucosa. We used an in vivo adherence assay that we have described previously in rabbits. Control animals received sodium chloride adjusted to the same pH as the ammonium chloride. We found that 0.25 M ammonium chloride significantly increases bacterial adherence to normal vesical mucosa as compared to adherence in controls receiving 0.25 M sodium chloride (p less than 0.05). These data suggest that urease plays a hitherto undescribed role in bacterial virulence by altering the antiadherence activity of the glycosaminoglycan layer present at the transitional cell surface.
Adhesiveness↗
The effect of testicular torsion on contralateral testis and the production of antisperm antibodies in rabbits.
It has been previously shown that unilateral testis torsion can cause disruptive anatomic changes in the contralateral testis of rats. This study was conducted to duplicate these findings in rabbits and analyze their serum for the production of the immunoglobulin G class of antisperm antibodies and determine whether the proposed immune response demonstrated by contralateral anatomic testis changes was mediated by these antibodies. New Zealand white rabbits were divided into 8 groups. One had a sham operation, 1 had testis biopsy, 3 groups had ligation of the right testicular vessels with subsequent orchiectomy in 2 groups at 36 and 72 hours, and 3 groups had 720-degree torsion of the right testis. Half of the animals were sacrificed after 4 weeks and the other half after 8 weeks. Contralateral histology was analyzed in all rabbits and only those with torsion showed abnormal tubular architecture and defective spermatogenesis. Detorsion at 36 hours and 96 hours did not protect against contralateral testis damage. No animal whose vessels were ligated, no matter what treatment protocol was employed, showed contralateral damage. All rabbit sera were tested for the presence of immunoglobulin G antiserum antibodies against a control rabbit that was a known antibody former, using an enzyme-linked immunosorbent technique. No experimental animal had detectable levels of antisperm immunoglobulin G when compared to controls. Three male rabbits who were converted to antisperm antibody formers by injection of sperm did not show anatomic changes in their testes.
Animals↗
Successful treatment of interstitial cystitis with sodium pentosanpolysulfate.
The surface of the bladder is lined by a layer of sulfonated glycosaminoglycans, of which the nonspecific anti-adherence effect is reproduced by synthetic sulfonated glycosaminoglycans. This mucous layer appears to be the most important line of defense between the transitional cells and all harmful substances in the urine. Many disease states may be associated with a deficiency in the anti-adherence activity of the glycosaminoglycan layer and may benefit from treatment with synthetic glycosaminoglycans. One such disease is interstitial cystitis. We administered oral sodium pentosanpolysulfate (Elmiron), a synthetic analogue of a sulfonated glycosaminoglycan, to 24 patients with interstitial cystitis. Within 4 to 8 weeks of initiation of treatment 20 patients experienced a decrease of at least 80 per cent in pain, urgency and nocturia, and 2 experienced a 50 to 80 per cent decrease in these symptoms. The 22 patients who responded continue to experience progressive improvement with time.
Humans↗
Inactivation of antiadherence effect of bladder surface glycosaminoglycan by a complete urinary carcinogen (N-methyl-N-nitrosourea).
The glycosaminoglycan layer at the bladder surface nonspecifically blocks the adherence of bacteria, ions and molecules to the epithelium. It may be an important element in the 1st line of defense against infection, calculi and even carcinogens for the transitional cells of the bladder. To determine whether the bladder glycosaminoglycan layer plays a role in preventing carcinogenesis, we tested the effect of a complete urinary carcinogen, N-methyl-N-nitrosourea, on the glycosaminoglycan barrier in our in vivo adherence assay. Bacterial adherence was significantly greater in carcinogen-treated bladders than in control bladders, indicating that N-methyl-N-nitrosourea inactivates the antiadherence effect of the surface glycosaminoglycan. The bladder glycosaminoglycan layer may help protect the bladder from carcinogens present in the urine. Qualitative or quantitative defects in the glycosaminoglycan(s) present may influence an individual's susceptibility to the development of bladder tumors.
Adhesiveness↗
Surgical treatment of Peyronie disease with dacron graft.
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Adult↗
Erectile impotence associated with transurethral prostatectomy.
A prospective study was done on the erectile function of 35 randomly-selected patients undergoing transurethral prostatectomy for benign prostatic hypertrophy. A preoperative sexual history was obtained, and the erectile function of each patient was recorded using a nocturnal penile tumescence monitor. Four to six weeks postoperatively, a repeat sexual history was taken and the erectile function was reassessed. In 12 of the 35 patients we noted a discordance between the erectile potency they reported in their sexual histories and the objective testing. There was no significant difference between the preoperative and postoperative nocturnal penile tumescence recordings for any given patient.
Aged↗
Retrospective study of ureteral obstruction following vascular bypass surgery.
Although several cases of ureteral obstruction after vascular bypass surgery for aortoiliac disease have been reported, the incidence of this potentially critical complication has not been established. In this study, 57 selected patients who had undergone vascular bypass surgery were examined with ultrasound for evidence of ureteral obstruction. Hydronephrosis was discovered in 1 of 57 patients (1.75 per cent) over-all (symptomatic and asymptomatic); no evidence of obstruction was found in the asymptomatic patients. These results fail to corroborate the impression of several investigators that undetected ureteral obstruction may be present in a significant number of patients after vascular bypass surgery.
Humans↗
Control of recurrent lower urinary tract infection in the postmenopausal woman.
There were 5 postmenopausal women with severe recurrent cystitis who were placed on a protocol of intravaginal estrogen in an effort to control infection. Before therapy all patients had colonization of the vagina by 1 or more species of Enterobacteriaceae and an associated elevation of vaginal pH greater than 5.2 (normal range 4.0 to 4.5). After acute antibiotic treatment and continuous low dose intravaginal estrogen all 5 patients showed a return of vaginal pH to the normal range and disappearance of vaginal bacterial pathogens. Of the 5 women 4 have had no further urinary tract infection off antibiotics and on low dose intravaginal estrogen. One patient had a urinary tract infection in association with a flare in colitis, which was controlled with reinstitution of antibiotics and high dose intravaginal estrogen therapy.
Aged↗
Prevention of urinary tract infection by the exogenous glycosaminoglycan sodium pentosanpolysulfate.
The transitional cells at the surface of the urinary bladder secrete and bind to their surfaces 1 or more glycosaminoglycans whose presence prevents bacterial adherence to the mucosa. Because it is believed that adherence is prerequisite to infection, we did the current studies to determine whether the antiadherence effect of natural and synthetic glycosaminoglycans prevents infection. We exposed intact rabbit bladders, mucin deficient rabbit bladders, and rabbit bladders treated with sodium pentosanpolysulfate, a similar but synthetic substitute for the surface glycosaminoglycan(s), to bacteria in vivo. We measured infection rates 48 hours after exposure. The infection rate was significantly higher in mucin deficient bladders than in controls (p less than 0.02). There was no significant difference between infection rates in controls and infection rates in bladders treated with sodium pentosanpolysulfate. These results support our impression that a bladder with an intact mucin layer is better able to resist infection than is a mucin deficient bladder. The natural surface glycosaminoglycan(s) and the synthetic substitutes that reproduce their antiadherence effect appear to be protecting factors.
Animals↗