Biomedical subjects
K S Chary
Publications and source records attributed to K S Chary.
Possible use of indoramin in patients with chronic neurogenic bladder dysfunction.
Indoramin, which has great selectivity for alpha-1-receptors, was administered orally for 10 days to 21 patients with urinary retention or residual urine caused by neurogenic vesicourethral dysfunction. After indoramin therapy 17 patients were able to empty the bladder with residual urine less than 50 ml. There was a significant decrease in the maximum urethral pressure (23.87 plus or minus 4.13 cm. water) and in the functional profile length (0.53 plus or minus 0.19 cm.). A diminution in the sphincter electromyography activity was observed in 3 patients. Two paraplegics who were investigated during spinal shock could not achieve voiding after indoramin therapy. However, involuntary urine leakage associated with a change of posture occurred in 2 patients but subsided after the dosage of indoramin was decreased. No other side effect was observed. It may be desirable to use drugs with selective action upon alpha-1-receptors since blockade of noradrenergic autoreceptors (alpha-2) also by nonspecific alpha-adrenoceptor blocking agents, namely phentolamine, phenoxybenzamine and so forth, causes the overflow of norepinephrine, which would produce symptoms such as tachycardia by stimulating beta-receptors.
Fatal renal haemorrhage following haemodialysis in a patient with obstructive uropathy.
A 22-year-old male with obstructive uropathy and renal failure was given pre-operative haemodialysis. He collapsed five hours later. Autopsy revealed massive intrarenal haemorrhage and rupture of a dilated superior calyx intraperitoneally. Anticoagulation employed during haemodialysis was probably responsible for this spontaneous renal haemorrhage and subsequent calyceal rupture.
Emphysematous infection of the urinary tract. (Report of 3 cases).
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Vesicopyelostomy using a tubed bladder flap-multiple psoas hitch technique to an orthotopic kidney.
A case is reported in which a long upper ureteral stricture, resulting from a failed pyeloureteroplasty, was repaired using a pedicle bladder tube. A vesico-psoas hitch was performed as the initial procedure. A 17 cm. long bladder flap was based posteriorly and extended across the dome and the anterior wall onto the contralateral posterolateral aspect of the bladder. Stepwise stretching and hitching of the bladder flap to the psoas major muscle at 5 places ensured successful bridging of the gap without compromising its vascularity. At followup cystography the bladder tube was noted to accommodate the reflux of contrast material, preventing its entry into the pelviocaliceal system. The patient regained a bladder capacity of about 300 ml. This procedure should be considered before ileal ureteral replacement or autotransplantation in cases of extensive ureteral loss.
Detrusor supersensitivity to 15 (S) 15-methyl prostaglandin F2-alpha in chronic neurogenic vesical dysfunction.
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A modulation of vesicourethral function with naloxone in traumatic paraplegics during the spinal shock phase: preliminary report.
Experimental studies have suggested that endorphins released in response to spinal injury might play a part in the pathogenesis of spinal shock and that an interaction might occur between the endorphin systems and central parasympathetic centres in such circumstances. To investigate the role of endorphins in the causation of detrusor areflexia during spinal shock, the effect of intravenous administration of 10 mg of naloxone upon vesicourethral function was studied in eight traumatic paraplegics during the spinal shock phase. Naloxone caused a significant rise in detrusor pressure during bladder distension in the post-naloxone cystometrogram. The compliance decreased in six patients. Voiding occurred in one patient although it was transient and did not result in complete emptying of the bladder. An increase in the sphincter electromyographic activity in response to bulbocavernosus stimulation was observed after naloxone in three patients. In conclusion, the significant increase observed in detrusor pressure in traumatic paraplegics during the spinal shock phase subsequent to naloxone (10 mg intravenously) provides evidence for the role of endorphins in the causation of detrusor areflexia in spinal shock.
Decentralization supersensitivity of the urethra: a urodynamic study with urethral instillation of phenylephrine.
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Study of intravesical instillation of 15(S)-15 methyl prostaglandin F2-alpha in patients with neurogenic bladder dysfunction.
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Enhancement of detrusor reflex activity by naloxone in patients with chronic neurogenic bladder dysfunction. Preliminary report.
An intravenous injection of 0.4 mg. naloxone enhanced detrusor reflex activity in 5 patients with chronic neurogenic bladder dysfunction caused by incomplete suprasacral spinal lesions. The intravesical volume at which detrusor reflex occurred showed a decrease from 498.2 to 346.2 ml. The naloxone-induced effect was short-lived, being absent 1 hour after the injection. In the same dosage naloxone did not induce detrusor reflex in 2 patients with areflexic bladder caused by complete suprasacral spinal lesions.
Clinical import of serotonin activity in the bladder and urethra.
It has been observed in animal studies that 5-hydroxytryptamine produces bladder contractions. The role of 5-hydroxytryptamine in human vesicourethral function was studied by administering 75 mg. clomipramine daily for 4 days to 8 patients with neurogenic bladder dysfunction. Clomipramine inhibits the uptake of serotonin into 5-hydroxytryptamine containing presynaptic nerve endings and, thus, makes more neurotransmitter available to the postsynaptic site. The intravesical volume, at which first detrusor reflex activity was observed, showed a decrease from 329.5 to 178.5 ml. after clomipramine therapy. The residual urine also decreased from 111.25 to 30.0 ml. No side effect was observed. Further investigations involving a larger number of patients are indicated to study the possible use of serotonin activity in the bladder for promoting bladder emptying.
Urethro-cavernous fistula from blunt penile trauma.
An unusual case of traumatic urethro-cavernous fistula from the fall of a heavy object upon the flaccid penis is described. In the absence of clinical evidence of urinary extravasation, prompt performance of corpus cavernosography helped detect the existence of such a fistulous communication. Institution of prompt suprapubic urinary diversion avoided occurrence of undesirable sequelae to intracorporeal urinary leak and ensured uncomplicated spontaneous closure of the fistula.
Creation of caverno-glandular shunt for treatment of priapism.
Caverno-glandular shunt was performed in 8 patients with priapism during the past 3 years. Complete and sustained detumescence was achieved immediately in all patients. Only one case developed a complication, viz. cavernositis which responded to antibiotic administration systemically as well as locally. This procedure was performed under local anaesthesia in 5 patients. The technical details and advantages of this procedure over conventional operations for priapism are discussed.
Lowering of maximum urethral closure pressure by phentolamine and by terbutaline.
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Clinical import of beta-adrenergic activity in the proximal urethra.
Beta-adrenergic activity of the proximal urethra was studied in 11 patients. Maximum urethral pressure was recorded before, and 20 and 60 minutes after the intravenous administration of 0.5 mg. orciprenaline sulfate. There was a 40 per cent or more decrease in the maximum urethral pressure in 6 of the 11 patients. Beta-adrenoreceptor agonists could prove useful in facilitating vesical emptying by reducing urethral resistance in patients with neurogenic bladder dysfunction.
Beta-adrenergic activity in human proximal urethra: a study with terbutaline.
Beta-adrenergic activity in the proximal urethra was studied in 15 patients with neurogenic bladder dysfunction owing to spinal cord injury or to neurogenic disease. Maximum urethral closure pressure was recorded before and after the administration of terbutaline, a beta-2 agonist. The average decrease in maximum urethral closure pressure after subcutaneous injection of terbutaline was 40.46 per cent and this was significant (p less than 0.001). The clinical implications of this finding are discussed.
Use of clonidine in the management of patients with neurogenic bladder dysfunction.
Clonidine, a centrally acting hypotensive agent was shown to decrease peak urethral pressure and facilitate vesical emptying in patients with neurogenic bladder dysfunction due to low spinal lesion. Selection of patients, side effects of therapy, and its mode of action are discussed.
Role of dopamine receptors in vesicourethral function. A urodynamic study with dopamine receptor antagonist metoclopramide.
The effect of intravenous administration of 20 mg metoclopramide, a dopamine receptor antagonist upon cystometry, urethral pressure profile and external urethral sphincter electromyography (EMG) was investigated in 10 patients with neurogenic bladder dysfunction. No significant change was noticed in detrusor reflex activity or in peak urethral pressure. This suggests that dopamine receptors are not important in vesicourethral function. The increase in sphincter EMG activity observed was probably due to the cholinergic effect of metoclopramide.