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Biomedical subjects

M B Chancellor

Publications and source records attributed to M B Chancellor.

14 recordsLinked to original sources
PubMed1992

Fine-needle aspiration of a periurethral Teflon-filled cyst following radical prostatectomy.

Periurethral Teflon injections are being used increasingly for the treatment of urinary incontinence after radical prostatectomy. We report a case of a man who developed increasing obstructive urinary symptoms and stress incontinence following radical retropubic prostatectomy. Six months earlier, he had undergone periurethral Teflon injections. On transrectal ultrasound and magnetic resonance imaging, a 3.2-cm cystic lesion was noted at the prostatic bed near the bladder neck where the Teflon had been injected. Ultrasound-guided transperineal fine-needle aspiration of the cyst yielded a specimen with numerous birefringent crystalline Teflon particles. Although previous reports have described granulomatous tissue reaction, no multinucleated giant cells were present to suggest granuloma formation. To our knowledge, this is the first reported case of Teflon cyst formation following periurethral Teflon injections. The patient's history, imaging studies, cytopathology, and review of the literature are presented in this report.

Aged↗
PubMed1992

Technique of external sphincter balloon dilatation.

We report on our technique and early experience with balloon dilatation of the external sphincter in 7 spinal cord-injured men with detrusor external sphincter dyssynergia and elevated voiding pressure. Following dilatation, bladder emptying into condom catheters was achieved in all patients without dribbling incontinence.

Adult↗
PubMed1992

The cholinergic and purinergic components of detrusor contractility in a whole rabbit bladder model.

Whole rabbit bladders were suspended in a bath chamber and stimulated with ATP, bethanechol, electrical field stimulation, and bethanechol + ATP. Detrusor pressure and fluid expelled by the bladder were recorded, synchronized, and digitized. Detrusor work and power were calculated with a computer program. Maximum work was 61.4 +/- 28.7, 83.3 +/- 17.0, 85.0 +/- 15.0, 90.8 +/- 13.1 cm. H2O, ml. for ATP, bethanechol, electrical and bethanechol + ATP, respectively. Maximum power generated by ATP was 4.8 +/- 3.0 cm. H2O, ml./sec and was approximately 66% of that generated by bethanechol, and 50% of that generated by electrical stimulation, and bethanechol + ATP. ATP cannot empty the bladder with moderate outlet resistance while bethanechol and electrical stimulation can. Our results suggest that ATP is able to generate detrusor power and achieve work in bladder emptying. However, ATP generated power and work is considerably less than that of electrical stimulation or bethanechol alone. ATP mediated contraction is not inhibited by atropine or tetrodotoxin but is inhibited by P2 purinoceptor desensitization, suggesting a functional role of purine receptors on detrusor smooth muscle. Since ATP generated pressure is more rapid than with bethanechol alone, we support the hypothesis that ATP may be important in the initiation of micturition.

Adenosine Triphosphate↗
PubMed1991

Bladder and sphincter behavior in patients with spinal cord lesions.

To ascertain the relationship between the clinical neurological level, and bladder and sphincter behavior, the video-urodynamic studies of 489 patients with spinal cord lesions due to a variety of causes were retrospectively analyzed. Patients were classified based on the clinical neurological level, etiology of the lesion and presence or absence of signs of sacral cord involvement. Urodynamic findings were classified as either detrusor hyperreflexia, detrusor-external sphincter dyssynergia, detrusor areflexia or normal. The results indicate that although there was a general correlation between the neurological level of injury and the expected vesicourethral function, it was neither absolute nor specific. For example, 20 of 117 cervical cord lesions had detrusor areflexia, 42 of 156 lumbar cord lesions had detrusor-external sphincter dyssynergia and 26 of 84 sacral cord had either detrusor hyperreflexia or detrusor-external sphincter dyssynergia. However, if one considers the presence of neurological abnormalities, 84% of the suprasacral cord lesions with detrusor areflexia have sacral cord signs. In contrast, all suprasacral cord lesions with no evidence of sacral cord involvement have either detrusor hyperreflexia or detrusor-external sphincter dyssynergia. The positive predictive value for positive sacral cord signs and detrusor areflexia was 87%. The positive predictive value for negative sacral cord signs and detrusor hyperreflexia/detrusor-external sphincter dyssynergia was 81%. These data suggest that the clinical neurological examination alone is not an adequate barometer to predict neurourological dysfunction and that video-urodynamic evaluation provides a more precise diagnosis for each patient.

Adolescent↗
PubMed1991

Bladder outlet obstruction versus impaired detrusor contractility: the role of outflow.

The uroflow curves of 45 men with either bladder outlet obstruction or impaired detrusor contractility were retrospectively reviewed. The definitive diagnoses were attained by clinical and video-urodynamic studies with simultaneous detrusor pressure and uroflow measurements. Eight parameters were analyzed to determine if uroflow can differentiate obstruction from impaired contractility. There were no differences between the 2 groups in any of the parameters. This finding suggests that uroflowmetry as a single examination cannot distinguish between bladder outlet obstruction and impaired detrusor contractility.

Aged↗
PubMed1990

Lyme disease presenting as urinary retention.

We report a case of Lyme disease that presented with urinary retention. The individual then experienced lower extremity paralysis. Paralysis and urinary retention resolved with intravenous ceftriaxone antibiotic. To our knowledge this is the first report of a urological manifestation as the initial clinical presentation of Lyme disease. Recognition of clinical symptoms and urological complications of Lyme disease also are discussed.

Adult↗
PubMed1990

The role of yohimbine for the treatment of erectile impotence.

A double-blind crossover study of yohimbine vs. placebo was carried out in 40 patients. Eleven of 33 patients (33%) who completed the study had subjective improvement of erection while taking yohimbine alone, five of 33 (15%) responded while taking both yohimbine and placebo, five of 33 (15%) responded to placebo alone, and 12 of 33 (36%) responded to neither. Of 215 impotent patients subsequently treated with yohimbine, 38% reported some subjective improvement, but only 5% were completely satisfied. The physiologic response of yohimbine appears to occur in the central nervous system. Recent experience suggests that the typical dose has little side effect and higher doses achieves better results, but this conclusion requires more evaluation.

Administration, Oral↗
PubMed1990

Detrusor-external sphincter dyssynergia.

Detrusor-external sphincter dyssynergia (DESD) is characterized by involuntary contractions of the external urethral sphincter during an involuntary detrusor contraction. It is caused by neurological lesions between the brainstem (pontine micturition centre) and the sacral spinal cord (sacral micturition centre). These include traumatic spinal cord injury, multiple sclerosis, myelodysplasia and other forms of transverse myelitis. There are three main types of DESD. In Type 1 there is a concomitant increase in both detrusor pressure and sphincter EMG activity. At the peak of the detrusor contraction the sphincter suddenly relaxes and unobstructed voiding occurs. Type 2 DESD is characterized by sporadic contractions of the external urethral sphincter throughout the detrusor contraction. In Type 3 DESD there is a crescendo-decrescendo pattern of sphincter contraction which results in urethral obstruction throughout the entire detrusor contraction. In patients with sufficient manual dexterity the most reasonable treatment option is to abolish the involuntary detrusor contractions (to ensure continence) and then to institute intermittent self-catheterization (in order to empty the bladder). The bladder may be paralysed pharmacologically or may be surgically converted to a low pressure urinary reservoir by the technique of augmentation enterocystoplasty. In quadriplegic men, transurethral external sphincterotomy may be performed and the incontinence managed with an external urinary appliance. Without proper treatment over 50% of men with DESD develop serious urological complications within about five years. In women these complications are much less common.

Humans↗
PubMed1989

Diagnostic value of routine bone scintigraphy renal imaging in renal cell carcinoma.

Technetium-99m-phosphate compounds used in bone scanning are excreted by the kidney, and excellent renal images can be obtained on routine bone scintigrams. The preoperative bone scans of 49 patients who underwent radical nephrectomy for renal cell carcinoma between 1981 and 1985 were reviewed for renal imaging. Ninety-four percent of the patients had abnormal bone scan renal images (82% had focal decreased uptake, and 12% had focal increased uptake). Six percent of the renal images were symmetrical bilaterally. When bone scans are employed in the postoperative follow-up of patients with renal cancer, they can be used to assess the status of the remaining kidney.

Adult↗
PubMed1977

Effects of cigarette smoke components on in vitro chemotaxis of human polymorphonuclear leukocytes.

Some ciliostatic components of cigarette smoke were studied as inhibitors of in vitro chemotaxis of human polymorphonuclear leukocytes (PMNs). In comparison to their concentration in an inhibitory level of cigarette smoke, the unsaturated aldehydes acrolein and crotonaldehyde were the most potent inhibitors, whereas nicotine, cyanide, acetaldehyde, and furfural were the next strongest inhibitors. In contrast, sulfide, propionaldehyde, butyraldehyde, and the phenols (phenol and o-, m-, and p-cresol) were relatively weak inhibitors of PMN chemotaxis. Acrolein and crotonaldehyde mimicked whole cigarette smoke in their effects on PMNs by not causing loss of PMN viability, yet their effects were prevented by the addition of cysteine. On the other hand, addition of nicotine, cyanide, acetaldehyde, and furfural to PMN suspensions resulted in a limited loss of cellular viabilities, and their effects on PMNs were not prevented by cysteine. Of the tested components, only cyanide significantly altered PMN glucose metabolism by increasing carbon flow via the glycolytic and hexose monophosphate pathways in a manner similar to that observed with whole cigarette smoke. The results of this study suggest that the unsaturated aldehydes, including acrolein and crotonaldehyde, are major contributors to the inhibitory properties of cigarette smoke. The inhibitory effects of these unsaturated aldehydes are probably due to a direct interaction of these oxidants and/or thiol-alkylating agents with PMNs, yet the glucose metabolism of these cells is unaffected. One interpretation of these data is that PMN chemotaxis is dependent upon particular cellular proteins containing one or more essential thiol group(s) but that these proteins are unrelated to glucose metabolism.

Chemotaxis, Leukocyte↗