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Biomedical subjects

I Perkash

Publications and source records attributed to I Perkash.

At least 37 records · Page 2Linked to original sources
PubMed1987

Principles of modern urodynamic studies.

Modern urodynamic equipment should have at least three channels to record the cystometrogram, the electromyogram of the periurethral striated sphincter, and intrarectal pressure. The addition of simultaneous transrectal ultrasonography is helpful. The bladder should not be irritated when introducing the urodynamics catheter. Variables affecting the performance of the catheter used for measuring the urethral pressure profile include the size of the lumen, the size of the side hole, the speed with which the catheter is withdrawn, and the rate of infusion. The entire curve of the cystometrogram should be examined, not simply initial rise. Initial overshoots can occur if older apparatus is used or if the urodynamics catheter is partially blocked; such overshoots should be disregarded.

Diagnosis, Differential↗
PubMed1986

Posterior ledge at the bladder neck: crucial diagnostic role of ultrasonography.

A posterior ledge at the bladder neck was seen in 158 patients (107 of whom were undergoing intermittent catheterization) on a sonographic voiding cystourethrogram. In 117 patients, the ledge was 0.5 cm or longer; 66 patients were on intermittent catheterization, and 51 experienced difficulty with catheterization, including vigorous bleeding in 4. Ledges less than 0.5 cm were discovered in 41 patients, all on intermittent catheterization, none of whom had difficulty with this procedure. The duration of intermittent catheterization and of detrusor-sphincter dyssynergia was shown statistically to be an important factor leading to the formation of the longer obstructing ledges (P less than 0.0005, Mann-Whitney test). Sphincterotomies were performed in 74 patients through the periurethral striated sphincter at 10 and 2 o'clock and extended to the bladder neck. The operation was a success in 73 (98%), all of whom were catheter-free, and in all of whom sonography revealed that the ledge had receded and the catheter was no longer obstructed.

Adult↗
PubMed1986

Catheter-induced hyperreflexia in spinal cord injury patients: diagnosis by sonographic voiding cystourethrography.

In part 1 of this study, 77 consecutive patients with spinal cord injuries and reflex bladders were examined by combined urodynamic studies and sonographic voiding cystourethrography. Of the 15 (19%) who had hyperreflexic bladders (reflex bladders that contracted when containing 125 ml or less), eight (53%) had catheter-induced hyperreflexia (proved by sonographic voiding cystourethrography without catheterization). The significant overdiagnosis influenced patient care because catheter-induced hyperreflexia did not require treatment, whereas primary hyperreflexia caused by lesions above T-5 always required anticholinergic therapy to prevent potentially life-threatening autonomic dysreflexia. In part 2 of this study, 116 additional spinal cord injury patients with reflex bladders were studied, although in these patients the catheter was introduced under sonographic control. Seven (6%) of these patients had hyperreflexia, but in none was the hyperreflexia catheter induced, showing that use of sonography while introducing the catheter can prevent catheter-induced hyperreflexia.

Adult↗
PubMed1986

Electrostimulation of erection and ejaculation and collection of semen in spinal cord injured humans.

An electrostimulation system developed for early research with humans and the great apes, and a new constant-current stimulator specifically developed for human use, have been employed in studies with paraplegic men to produce erection and semen release by rectal probe electrostimulation (RPE). Catheter techniques for antegrade collection of the semen, uncontaminated by urine, have also been applied with moderate success. Details of the electronic instrumentation and catheter techniques are given. The procedure used with the patients and electrostimulation and semen collection results are presented.

Ejaculation↗
PubMed1985

Localization of sensory levels in traumatic quadriplegia by segmental somatosensory evoked potentials.

We studied the usefulness of cortical somatosensory evoked potentials (SEPs) elicited by segmental sensory stimulation in traumatic quadriplegia. By stimulating sensory branches of musculocutaneous (C5, C6), median (C7, C8), and ulnar nerves (C8), we studied 10 chronic traumatic quadriplegics and compared them with age-matched controls. In all traumatic quadriplegics tested, the SEP abnormalities provided a direct linear relationship with clinical localization of posterior column sensory levels. Our findings suggest that segmental SEPs can enhance the clinical assessment of posterior column sensory levels in chronic traumatic quadriplegia. Further studies may find this technique useful in acute quadriplegia, particularly during surgical monitoring.

Adult↗
PubMed1985

Reproductive biology of paraplegics: results of semen collection, testicular biopsy and serum hormone evaluation.

The fertility and urological status of 30 male paraplegics between 20 and 47 years old with lesions between the T2 and L3 levels were examined by studying serum hormone levels (estradiol-17 beta, testosterone, prolactin, and follicle-stimulating and luteinizing hormones), sperm and semen characteristics via testicular biopsy and rectal probe electrostimulation, and urodynamic evaluation. Of the patients 13 had reflexic, 4 hyperreflexic and 13 areflexic bladders. Nine of the 13 patients with reflexic and all 4 with hyperreflexic bladders had a positive external sphincter electromyogram with detrusor-sphincter dyssynergia. When catheters were not used to collect semen during rectal probe electrostimulation, retrograde semen flow into the bladder was the rule. A total of 22 patients could tolerate rectal probe electrostimulation, while 6 who could not were injured at the T12 level or lower. Seminal emissions were obtained from 35 to 42 studies in these 22 patients. Total sperm count was variable; in 22 studies it was greater than 20 million. Progressive motility usually was low; 77 per cent of the patients had less than 20 per cent motility. Of 13 biopsy specimens obtained 6 suggested normal testicular morphology, with tubule atrophy and spermatogenic activity only mildly reduced in 6 of the remaining 7. Serum testosterone and luteinizing hormone values were significantly higher (p less than 0.05) among the paraplegic patients than among intact male volunteers of the same age range. Other serum hormone levels were unchanged. Outcome of rectal probe electrostimulation and biopsy did not relate to the number of years of patient injury. Thus, the principal deterrent to the use of semen collected by rectal probe electrostimulation from paraplegics for artificial insemination resides in a predominantly low sperm motility. Suggestions for improvement of motility include 1) great care to minimize or prevent urinary tract infections, 2) selection of medications for urinary tract care that do not compromise sperm survival and 3) prevention of sperm stagnation in lower tract storage sites, perhaps by use of periodical rectal probe electrostimulation.

Adult↗
PubMed1985

Radioisotope renography in spinal cord injury.

Isotope renography was compared to excretory urography, voiding cystourethrography and endogenous creatinine clearances in 52 spinal cord injury patients. Renogram abnormalities were detected in 86 per cent of the cases. The most common abnormality was the delay of isotope excretion from the renal cortex and pelvis. Anticholinergic medication significantly reduced these excretion delays. A subgroup containing 22 newly injured patients was evaluated separately. Renogram abnormalities in this subgroup were associated with normal excretory urography and normal creatinine clearances. We postulate that the defect producing upper tract deterioration in spinal cord injury begins early, is obstructive to renal drainage, does not increase with time and probably requires early intervention with anticholinergic medication or transurethral sphincterotomy to prevent upper tract damage.

Adult↗
PubMed1985

Urinary tract infections in male spinal cord injured patients. Part one: Bacteriologic diagnosis.

Seventy-one paired samples of urine, obtained by collection of a clean voided specimen and by suprapubic aspiration of the bladder (SPA), were obtained from 53 male spinal cord injured patients who were free of indwelling catheters. A direct comparison of the number of colony forming units of bacteria within the paired specimens indicates that single voided specimen is adequate in 63 of 71 (88.7%) instances. While using a threshold of 10(4) organisms per cc of urine obtained by SPA, the presence of at least 10(4) organisms per cc of voided urine provided a sensitivity and specificity both of 100%. Such high degree of correlation between SPA and voided specimen is explained on the basis of altered urodynamics in these patients and repeated contamination and transmission of bacteria from anterior urethra into the bladder. In patients with colony counts of 10(2) to 10(4) per cc, in which the voided urine contains mixed flora or staphylococci, bladder urine is most likely to be sterile and accurate assessment may require SPA of the bladders. The lack of normal voluntary control of bladder emptying in these patients made collection of SPA samples easier than voided specimens. Conventionally accepted criteria for the diagnosis of urinary tract infection lack sensitivity when applied to this group of patients.

Bacteriological Techniques↗
PubMed1985

Urinary tract infections in male spinal cord injured patients. Part two: Diagnostic value of symptoms and of quantitative urinalysis.

Seventy paired samples of urine, obtained by collection of a clean voided specimen and by suprapubic aspiration (SPA) of the bladder, were obtained from 43 male SCI patients who were free of indwelling catheters. The relationship of the presence or absence of symptoms and the degree of pyuria (determined quantitatively using a haemocytometer) to the presence or absence of bacteriuria (SPA specimen) was determined. Symptoms were poorly predictive of bacteriuria with concordance seen only 40% of the time. Most bacteriuric episodes (37/51-72.5%) were asymptomatic. The quantity of WBC in voided urine accurately reflected that in SPA urine (r = 0.825), indicating that urodynamics in SCI patients who received sphincterotomies are different than in normal persons. Pyuria (greater than or equal to 10(4) WBC per cc urine) was an excellent predictor of UTI--37 of 38 (97.4%) had UTI. However, 40.6% of samples with WBC less than 10(4) were also culture positive. Overall, consideration of the presence or absence of pyuria in relation to the presence of bacteriuria provided a sensitivity of 74.0%, specificity of 95.9%, and predictive value of a positive test of 97.4%. The predictive value of a negative test (WBC less than 10(4), however, was only 59.4%. There was poor correlation between absolute bacterial and WBC count. The point of cutoff for bacterial count correlating with 10(4) WBC count was not statistically significant in these patients; this is possibly due to repeated bacterial contamination from anterior urethra. While symptom status was often misleading, the presence of greater than 10(4) WBC per cc of urine was highly predictive of the presence of bacteriuria in male SCI patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1985

Limited value of the Fairley test in urologic infections in patients with neuropathic bladders.

In an attempt to localize sites of urinary tract infection, a combined Fairley washout test and prostatic localization was performed on 110 spinal cord injured (SCI) patients with neurogenic bladder dysfunction and a history of recurrent bacteriuria. Analysis of 100 patients demonstrated both single and double site of localization. Single sites of localization involved: upper tract 21 of 92 (23%), bladder 15 of 92 (16%), prostate eight of 92 (9%), and 48 of 92 (52%) undetermined. In eight cases, double site of localization was documented: prostate and upper tract six of eight (75%), prostate and bladder one of eight (12%), and prostate and undetermined one of eight (12%). Eighty-seven patients were followed post localization with urine cultures on the fourth or tenth day post procedure; 27 patients (31%) became sterile post localization, 55 patients (63%) stayed infected (greater than or equal to 10(4) colonies/ml), and five patients (6%) had less than 10(4) colonies/ml. Limitation of the Fairley washout may be attributed to the following: difficulty in sterilizing large atonic and trabeculated bladders, TUR sphincterotomy with widely open bladder neck, and heavy urethral colonization from use of external urinary collecting devices. Our modification of Fairley's test included irrigation of the urethra in seven patients. The final bladder irrigant specimen was positive in only one patient compared to 16 of 37 patients without urethral irrigation. We conclude that the ability of the modified Fairley washout and prostatic localization to diagnose the site of urinary tract infection in an SCI population is limited. However, as a mechanical washout for asymptomatic bacteriuria, the Fairley test was found to be beneficial in 31% of the patients as a therapeutic modality.

Adult↗
PubMed1985

In vitro evaluation of current disinfectants for leg bags.

An in vitro study was performed investigating the bactericidal ability of five common cleaning agents for leg bags against organisms frequently causing urinary tract infection in spinal cord injured (SCI) patients. Individual disposable Uridrain leg bags were inoculated with urine containing greater than 10(5) colonies/ml of the selected organism. The organisms used were: Pseudomonas aeruginosa, Proteus mirabilis, Providencia stuartii, Klebsiella pneumoniae, Serratia marcescens, Herellea, and Enterococcus. Each pair of inoculated bags (one bag for immediate or 0 hour culture and one bag for 24 hour culture) was filled with 30 ml of the test solution, cleaned, drained, and then cultured. The tested solutions included: plain tap water, 1/4% acetic acid, 3% hydrogen peroxide, Sporicidin 1:16 dilution, and 0.06% sodium hypochlorite. The results demonstrated that plain tap water had no effect on reducing the bacterial counts and that 1/4% acetic acid and 3% hydrogen peroxide had only a marginal effect across the spectrum of organisms. Sporicidin and 0.06% sodium hypochlorite exhibited complete bactericidal ability. In the final analysis, 0.06% sodium hypochlorite is the most cost efficient and readily accessible to patients. In practical application, disinfecting daily with 0.06% sodium hypochlorite can decrease external contamination of urinary drainage appliances in SCI patients.

Disinfectants↗
PubMed1985

Prevention, treatment, and management of urinary tract infections in neuropathic bladders.

Urinary tract infection (UTI) continues to be a major cause of mortality in patients with neurogenic bladders. Even patients who void reflexly and have unobstructed voiding with external condom drainage have a high incidence of chronic recurrent bacteriuria. Our recent studies have described the difficulty of diagnosing and localizing UTI in patients with neurogenic bladders. Symptoms correlated poorly with significant bacteriuria (greater than or equal to 10(5) colonies/ml) and the use of the Fairley washout test gave less than optimal results in our studied population. Breakdown of endogenous host defenses, development of drug resistant organisms, and external contamination from urinary drainage appliances and fecal incontinence should be considered in diagnosis and management of these patients. Adequate bladder drainage is the most effective prophylactic measure against recurrent urinary tract infections. Our methods of bladder drainage include use of alpha blockers, transurethral sphincterotomy, and in selected paraplegics, long-term intermittent self-catheterization. We stress decreasing pathogenic bacterial skin colonization through daily perineal washing with soap and water, and cleaning drainage appliances at least once daily with 0.06% sodium hypochlorite. We treat the symptomatic patients and patients with positive urine cultures with potential stone forming organisms. Antibiotic therapy in asymptomatic patients should be guided by an inflammatory response with white blood cell count of greater than or equal to 10(4) colonies/ml in the urine and positive bacterial culture of greater than or equal to 10(5) colonies/ml.

Adrenergic alpha-Antagonists↗
PubMed1985

Skin blood flow changes and tissue deformations produced by cylindrical indentors.

Since skin blood flow as a function of applied pressure depends on many factors, one may find different curves within each group of subjects, making separation of groups difficult. A dimensional analysis has been out which indicates that the percent decrease in skin blood flow associated with external loading is primarily a function of only three variables: the ratios of bone depth and bone diameter to indentor diameter, and percent compression of the tissue overlying the bone. The load itself is found to be unimportant. It is concluded that measurement of bone depth, bone diameter, and tissue deformation are more important than pressure measurements. Measurements of skin displacement and average indentor pressure for four male subjects indicate that tissue stiffness increases with age, regardless of disability, so that higher pressures are required to produce the same displacement in older subjects.

Adult↗
PubMed1979

Urinary tract infections occurring in recent spinal cord injury patients on intermittent catheterization.

During a 28-month interval 70 spinal cord injury patients in the initial rehabilitation hospitalization underwent 5,052 days of intermittent catheterization. Intermittent catheterization was done with a sterile technique and a neomycin-polymyxin irrigant. At the time of transfer to our facility 39 patients were using Foley catheter drainage but no difficulty was encountered when these patients were changed to intermittent cateterization. While on intermittent catheterization 52 urinary tract infections occurred, half caused by gram-positive cocci, 24 by gram-negative bacilli and 2 by Candida albicans. These infections occurred in 38 patients (54 per cent) at an over-all rate of 10.3 infections per 1,000 patient-days of intermittent catheterization. Only 2 infections were symptomatic and these occurred in patients on pass who unilaterally discontinued intermittent catheterization. Only 6 infections were not cured by antimicrobial therapy. Urinary tract infection was less common in patients who had incomplete spinal cord injuries. Infections caused by organisms susceptible to the irrigant containing neomycin-polymyxin occurred almost exclusively in patients catheterized 3 or fewer times daily. Infection was rare after 3 months on intermittent catheterization. Intermittent catheterization with our technique poses little infection hazard and can be introduced readily in acute spinal cord injury patients before transfer to specialized facilities.

Adult↗
PubMed1979

Pressor response during cystomanometry in spinal injury patients complicated with detrusor-sphincter dyssynergia.

Herein attention is focused on the documentation of high blood pressure response with detrusor-sphincter dyssynergia in spinal cord injury patients and with its amelioration after extended sphincterotomy. During cystomanometric evaluation of the bladder the monitored blood pressure response in 53 spinal injury patients, 27 non-dyssynergic spinal injury patients and 18 non-spinal injury patients was compared. A high correlation was observed among the magnitudes of blood pressure increase, level of injury and the severity of detrusor-sphincter dyssynergia in spinal injury patients. During cystomanometry blood pressure increases of greater than 20 mm. Hg systolic and 10 mm. Hg diastolic in normotensive paraplegics (below T5) and also in non-spinal injury patients were significant to suspect detrusor-sphincter dyssynergia. In normotensive tetraplegic patients blood pressure increases of greater than 40 mm. Hg systolic and 20 mm. Hg diastolic were significant to suspect detrusor-sphincter dyssynergia. The mechanism of blood pressure increase is elucidated. The management of this high blood pressure response in patients with detrusor-sphincter dyssynergia by drug therapy and extended sphincterotomy is discussed. Based on our experience the use of carbon dioxide for cystomanometry seems preferable in patients with spinal lesions above T5 since expedient deflation of the bladder can prevent an inordinate blood pressure increase.

Adrenergic alpha-Antagonists↗