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Biomedical subjects

K E Shuttleworth

Publications and source records attributed to K E Shuttleworth.

At least 19 recordsLinked to original sources
PubMed1990

Effects of acid-base changes on human ureteric smooth muscle contractility.

Wide fluctuations of both urinary pH and the partial pressure of CO2 (PCO2) occur in normal physiological circumstances and in a variety of pathological conditions. However, the effect of extracellular pH on the contractility of human ureteric muscle has not been clearly defined. This study has established, using a microsuperfusion technique, that an increased superfusate PCO2 increases the magnitude of the phasic contraction to electrical field stimulation. A similar extracellular acidosis induced by alteration of the [HCO3-], at constant [Na+] and free [Ca2+], was without significant effect. Furthermore, when both superfusate PCO2 and [HCO3-] were simultaneously increased at constant pH the contractile response was similar to that when PCO2 alone was raised. These observations suggest that the changes of tension were mediated by intracellular pH changes, providing it is assumed that the ureteric smooth muscle cell membrane is permeable to CO2 but impermeable to H+ and HCO3-. The occurrence of an increase of force in the presence of an acidosis is a highly significant and unusual finding, since it has been assumed that the classical association between acidosis and negative inotropy, seen in cardiac muscle, was also applicable to smooth muscle.

Acid-Base Equilibrium↗
PubMed1989

Indomethacin as prophylaxis against ureteral colic following extracorporeal shock wave lithotripsy.

Ureteral colic occurs in 24 to 34 per cent of all patients following extracorporeal shock wave lithotripsy. Recent research has shown prostaglandin synthetase inhibitors to be effective in relieving the pain associated with ureteral colic. Our prospective, controlled, double-blind, randomized study was designed to test the efficacy of indomethacin in the prophylactic treatment of pain after extracorporeal shock wave lithotripsy. Patients undergoing extracorporeal shock wave lithotripsy were randomized into 2 groups. Group 1 received 100 mg. indomethacin suppositories twice daily and group 2 received placebo suppositories. After extracorporeal shock wave lithotripsy 2 analgesics were available to the patients: oral co-dydramol or intramuscular pethidine was offered in the normal manner by the nursing staff. The pre-extracorporeal shock wave lithotripsy x-ray was used to make a quantitative estimate of the total stone burden in each patient. The post-extracorporeal shock wave lithotripsy analgesic requirement was used to compare the 2 groups. Of 112 patients recruited to the study 55 received indomethacin and 57 received placebo. The request for analgesia in the 2 groups was not different (28 of 55 and 33 of 57, respectively). However, in the indomethacin group only 6 patients required pethidine (10 doses), compared to 18 (41 doses) in the placebo group. This difference is statistically significant (p less than 0.01). There was no difference between the 2 groups in the occurrence of ureteral steinstrasse. Indomethacin has been shown to be effective in the prophylactic treatment of ureteral colic after lithotripsy.

Adult↗
PubMed1989

Does extracorporeal shockwave lithotripsy cause hypertension?

Several series have suggested that the incidence of hypertension following extracorporeal shockwave lithotripsy (ESWL) may be as high as 8%. In this study, changes in blood pressure and the incidence of hypertension have been observed in 733 patients 12 to 44 months after renal ESWL on the Dornier HM3. The incidence of hypertension following ESWL was 8.1%. In patients with a pre-ESWL diastolic pressure less than 90 mmHg, the incidence of those with a diastolic greater than or equal to 100 mm Hg post-operatively was significantly greater than that predicted by historical data. There was no overall change in the mean blood pressure of the group. The hypertensive risk of ESWL remains unclear. However, blood pressure surveillance should be performed following ESWL and a prospective study is required.

Adolescent↗
PubMed1988

Is extracorporeal shockwave lithotripsy suitable treatment for lower ureteric stones?

Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone-free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The retreatment rate, post-treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.

Adolescent↗
PubMed1988

The action of the prostaglandins on isolated human ureteric smooth muscle.

A study has been carried out on the actions of the prostaglandins E2 and F2 alpha and their synthesis inhibitors, indomethacin and diclofenac sodium, upon isolated human ureteric smooth muscle, using the technique of microsuperfusion designed to ensure good tissue viability. Indomethacin and diclofenac sodium were shown to abolish almost completely the contractile response of ureteric muscle to electrical field stimulation. Contractile activity, in the presence of the inhibitors, could be restored by prostaglandin E2 or F2 alpha or by increasing the external potassium concentration, [K+]O, of the superfusate. Prostaglandin E2 or F2 alpha alone were shown to increase dramatically both the phasic and tonic component of the electrically stimulated contractions, on occasions inducing spontaneous activity. A possible mechanism of action was elucidated with an electrophysiological technique using intracellular microelectrodes. The mean membrane potential recorded was 54.7 mV (SD +/- 10 mV, n = 15). The depolarising action of raising [K+]O was demonstrated and prostaglandin F2 alpha (3 x 10(-6) M) was shown to produce a small depolarisation of the ureteric muscle cell membrane.

Diclofenac↗
PubMed1986

Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy.

Since March 1985, over 1000 patients have been treated on the lithotripter at St Thomas' Hospital. Since it is the only machine in the country offering treatment to National Health Service patients at no cost to the referring Health Authority, there has been a heavy demand for treatment and 97% of referrals have been accepted. Analysis of the first 1000 patients shows extracorporeal shockwave lithotripsy (ESWL) to be a safe procedure with a low morbidity rate and no mortality. The number of patients who were stone-free 3 months after treatment was low (44.1%) compared with the numbers reported in other series. The most likely reasons for this are the poor follow-up rate (48.9%), the stringent criteria for the diagnosis of "stone-free" and a possible skewed referral and follow-up pattern.

Female↗
PubMed1984

A new in vitro microsuperfusion technique for investigation of human detrusor muscle.

There is a paucity of information regarding the behaviour of human detrusor muscle in vitro. This is mainly due to the dependence of muscle bath techniques on large strips of material, which can be obtained only at open operations and which may not be viable because of limited diffusion of oxygen and metabolites through the tissue. We report a new technique for the in vitro study of muscle obtained during endoscopic procedures by cup biopsy. The results obtained from normal muscle show that this technique gives consistent and reproducible results.

Atropine↗
PubMed1983

Pelvic evoked responses.

An electrophysiological method to measure the sacral reflex arc has been developed and is described in detail. The latencies of 15 normal subjects are recorded. The electromyographic responses were abolished in seven multiple sclerotic patients with unstable bladders after subtrigonal phenol injection.

Adult↗
PubMed1982

Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis.

That urine might reflux into the prostatic ducts during micturition has never before been proved. Using a suspension of carbon particles it has been demonstrated that this can occur. It is suggested that this may be important both as a route of infection in bacterial prostatitis and as a cause of the inflammatory process in abacterial prostatitis.

Carbon↗
PubMed1980

Clinical experience with intravesical prostaglandin E2. A prospective study of 36 patients.

In a prospective study, intravesical prostaglandins were given to 36 patients who had urinary symptoms associated with a poorly functioning detrusor; 67% of these patients were found to be in chronic retention. Using standard urodynamic techniques, 72% showed objective evidence of an immediate improvement in detrusor function and there was prolonged therapeutic benefit in 39%. A prolonged response occurred only in patients who had an intact sacral reflex arc and urodynamic evidence of a pathologically enlarged bladder, and who did not have radiologically demonstrable outflow obstruction. The use of intravesical prostaglandin to stimulate the detrusor was also found to be of value as a urodynamic technique for the investigation of the lower urinary tract.

Adult↗
PubMed1977

The results of urinary diversion in multiple sclerosis.

Out of a total of 78 patients with multiple sclerosis who underwent urological assessment, 12 (15%) were treated by ileal loop diversion. The results of surgery were highly satisfactory in spite of a high incidence of postoperative complications. The surgical trauma that occurs from the operation does not necessarily result in neurological deterioration of the patient. The only absolute contra-indication to urinary diversion is decubitus ulceration. Urinary diversion should be considered much earlier in the treatment of incontinence in multiple sclerosis rather than offered as a last resort.

Adult↗
PubMed1976

Single dose intravesical thiotepa as an adjuvant to cystodiathermy in the treatment of transitional cell bladder carcinoma.

Tumour cell implantation may be a factor in the aetiology of recurrent well-differentiated superficial bladder tumours. A prospective trial is reported in which single dose intravesical thiotepa was administered to a group of randomly selected patients immediately after cystodiathermy. A control group of patients was treated by cystodiathermy alone and tumour recurrence in the 2 groups was compared. Significantly fewer patients in the thiotepa-treated group developed recurrent tumour and there was also a significantly reduced incidence of pure vault recurrence in this group. The beneficial effects of adjuvant thiotepa were apparent after 1 treatment. In this series of patients no benefit resulted from the continued use of adjuvant thiotepa once a patient developed a recurrent tumor.

Carcinoma, Transitional Cell↗
PubMed1976

Clinical and experimental studies on the action of prostaglandins and their synthesis inhibitors on detrusor muscle in vitro and in vivo.

Experiments on muscle strips have shown that prostaglandin is naturally produced by the detrusor, and acts to increase the tone and spontaneous activity. An intimate relation between acetylcholine and prostaglandin has been demonstrated. Therapeutic application of prostaglandins has been successful in the treatment of chronic retention in women.

Animals↗