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Biomedical subjects

M L Godley

Publications and source records attributed to M L Godley.

14 recordsLinked to original sources
PubMed1995

Natural filling cystometry in infants and children.

OBJECTIVE: To evaluate natural filling cystometry in infants and young children. PATIENTS AND METHODS: The study group comprised 37 infants and young children (mean age, 4.1 years) with various urological conditions. Suprapubic catheters were used in all patients with urethral sensation. Natural filling urodynamic (NFU) studies were performed using an ambulatory recorder and with an observer present throughout. For comparison, 17 of the 37 patients also had slow filling conventional cystometry (CMG). RESULTS: All NFU studies were successfully completed and the great majority of patients were unaffected by the investigation procedures. In comparison with conventional cystometry there were significant differences. For NFU, there was a lower bladder capacity (means, NFU 122 mL vs CMG 188 mL, P < 0.03); lower pressure rise on filling (means, NFU 5.7 cmH2O vs CMG 16.1 cmH2O, P < 0.001) and higher maximum detrusor pressures during micturition (means, NFU 130 cmH2O vs CMG 78 cmH2O, P < 0.01). Voiding efficiency was also slightly greater with NFU compared with CMG. Detrusor instability was recorded in five patients only during NFU and in two other patients only during CMG. CONCLUSION: A natural filling cystometry method which incorporates an unobtrusive recording system is likely to be superior to conventional CMG for assessing bladder function in infants and children. This is because (i) bladder function is investigated in near to natural conditions, (ii) the patients are mostly unaffected by the investigation procedures, (iii) there are significant differences between NFU and CMG in the measurements obtained, indicating that CMG may give false indices of bladder function.

Child↗
PubMed1995

Some new insights into bladder function in infancy.

OBJECTIVES: To evaluate normal bladder function and micturition patterns in infants. PATIENTS, SUBJECTS AND METHODS: Twenty-one infants (16 boys, five girls; mean age 5.9 months) with no lower urinary tract pathology underwent natural filling cystometry. Micturition patterns were also observed simultaneously with polysomnography in 26 healthy neonates (16 boys, 10 girls; mean age 7.4 days). RESULTS: In infants, cystometry showed (95% CI) a capacity of 42-53 mL, a maximum rise in detrusor pressure during voiding of 95-120 cmH2O and a voiding efficiency (voided volume/capacity) of 0.86-0.91. On micturition, urinary flow was discoordinated from peak detrusor pressures in 10 infants. Detrusor instability occurred in one of 21 infants. Micturition was observed only during wakefulness or on arousal from sleep. In neonates, 17 of 61 recorded voids (28%) were during full wakefulness and 44 (72%) during arousal from sleep. Notably, none of the recorded voids occurred during quiet sleep. CONCLUSIONS: The normal infant's bladder was stable and emptied almost completely. Voiding with incomplete co-ordination between detrusor contraction and urinary sphincter relaxation could be normal. Micturition never occurred during quiet sleep. There was cortical arousal in response to a full bladder even in new-born infants. This contradicts the traditional concept of a totally uninhibited bladder in infancy. There are potential implications for the management of children with nocturnal enuresis.

Female↗
PubMed1994

99Tcm-DMSA as a dynamic imaging agent for estimating renal blood flow. A comparison with 99Tcm-DTPA.

A technique for estimating fractional renal blood flow (RBF) from the early part of the 99Tcm-diethylenetriaminepentaacetate (DTPA) renogram has been described previously and its reproducibility validated in the pig model. The technique is assumed to be applicable to any recirculating gamma-emitting tracer compound. The aim of this study was to determine whether the same method could be applied to 99Tcm-dimercaptosuccinic acid (DMSA) which has been largely neglected as a dynamic imaging agent. Paired estimates of fractional RBF were obtained in Large White (n = 16) and Göttingen miniature pigs (n = 6) in three groups: group 1, paired 99Tcm-DTPA studies; group 2, paired 99Tcm-DMSA studies; group 3, alternate 99Tcm-DTPA and 99Tcm-DMSA studies. The results showed good agreement between paired results independent of whether 99Tcm-DTPA or 99Tcm-DMSA was used, supporting the assumption that the technique is applicable to any recirculating gamma-emitting tracer compound. The demonstration that fractional RBF can be reliably estimated from the DMSA renogram means that, if required, it may be combined in a single nuclear medicine procedure with conventional static DMSA renal imaging.

Animals↗
PubMed1992

Urinary endothelin (ET1) in complete ureteric obstruction in the miniature pig.

Segmental renal scarring occurs in experimental obstructive uropathy in the multipapillary porcine kidney, and segmental abnormalities in renal perfusion are likely to be responsible. This preliminary study examines the urinary excretion of the potent locally active vasoconstrictor endothelin 1 (ET 1) in a pig model of renal obstruction and subsequent relief. Significant urinary excretion of ET 1 from the postobstructive kidney was found to occur after longstanding obstruction. Preglomerular arteriolar stenosis may be the cause of the renal ischaemia in obstruction that is at first reversible but later becomes irreversible if the stimulus persists. ET 1 may be implicated in the pathogenesis of this injury.

Animals↗
PubMed1990

Quantitation of vesico-ureteral reflux by radionuclide cystography and urodynamics.

A method is described for the quantitation of vesico-ureteral reflux by synchronous combined direct radionuclide cystography and urodynamics. Intravesical pressures and volumes are co-ordinated with volumes of reflux. Peak reflux volumes in 11 children diagnosed as having severe (grades 3-4) reflux on conventional contrast cystography ranged from 1 to 50 ml/kidney. A number of different patterns of reflux were observed. Reflux may occur progressively throughout low pressure filling or incrementally with unstable bladder contractions. Reflux during voiding may be maximal as detrusor pressure falls. The method requires wider application to explore the potential for a functional classification of the reflux problem.

Child↗
PubMed1989

Renal imaging with 99Tcm-labelled DMSA in the detection of acute pyelonephritis: an experimental study in the pig.

Serial renal 99Tcm-labelled dimercaptosuccinic acid (DMSA) scintigrams were acquired 2-58 days after the introduction of urinary tract infection in 33 pigs with experimentally induced vesicoureteric reflux (VUR). In 29 animals VUR was unilateral and in four bilateral, a total of 37 refluxing systems. Animals were killed either at varying intervals after a scintigraphic defect was noted (24 refluxing kidneys) or after a period when sequential scintigrams were normal (13 refluxing kidneys). The appearance of the scintigram acquired on the day prior to death was compared with the renal pathology, each kidney and renal image being divided into three zones (upper, middle, lower) for separate consideration. Of the 37 refluxing systems pyelonephritic lesions were seen in 27, in a total of 61 zones. In the remaining ten kidneys no scintigraphic defect was detected and no pathological lesions were identified either macroscopically or microscopically. Where an abnormality was detected on the scintigram a lesion was always identified in the kidney (sensitivity 100%). Small pyelonephritic lesions in a total of 12 zones in six kidneys were not detected on the scintigram (specificity 82%). Of the lesions undetected by scintigraphy only one occurred in the upper pole.

Acute Disease↗
PubMed1989

Effect of unilateral vesicoureteric reflux on renal growth and the uptake of 99mTc DMSA by the kidney. An experimental study in the minipig.

The influence of unilateral vesicoureteric reflux (VUR) on renal growth and the uptake of 99mTc DMSA by the kidney has been investigated in a 2-kidney model in the growing minipig over a period of approximately 5 months. Animals with reflux in association with low voiding pressures and normal bladder function (n = 5), as well as those with raised voiding pressures and abnormal bladder function (n = 7), were investigated with appropriate non-refluxing controls (n = 12). Urinary infection and renal scarring were avoided since these factors may affect kidney function and growth independently. Statistical tests of difference failed to demonstrate any effect of VUR on renal growth or renal uptake of 99mTc DMSA even in the presence of elevated voiding pressures and abnormal detrusor function.

Animals↗
PubMed1987

Effects of vesicoureteric reflux on renal growth and function as measured by GFR, plasma creatinine and urinary concentrating ability. An experimental study in the minipig.

The influence of vesicoureteric reflux (VUR) on renal growth and function measured by glomerular filtration rate (GFR), plasma creatinine concentration and urinary concentrating ability has been examined in a simple one-kidney model in the growing minipig over a period of approximately 5 months. Animals with reflux in association with low voiding pressures and normal bladder function (n = 6), as well as those with raised voiding pressures and abnormal bladder function (n = 5), were investigated together with appropriate non-refluxing controls (n = 12). Urinary infection and renal scarring were avoided since these factors may affect kidney function and growth independently. Statistical tests of difference failed to demonstrate any effect of VUR on 51Cr EDTA GFR or renal growth even in the presence of elevated voiding pressures and abnormal detrusor function. However, a significant association between VUR and reduced urinary concentrating ability was shown.

Animals↗
PubMed1985

The relationship between renal parenchymal mass and absolute quantitation of 99Tcm-DMSA uptake. An experimental study in the growing pig.

Five Gottingen minipigs from the same litter aged 1 month entered the study and right nephrectomies were performed at staggered intervals between weeks 1 and 5. Absolute renal uptake of 99Tcm-DMSA, expressed as a percentage of the administered dose, was recorded in each animal weekly before right nephrectomy and at weekly intervals for 5 weeks post-nephrectomy. Before nephrectomy absolute renal uptake of 99Tcm-DMSA ranged between 16.8 and 21.5% (mean 18.6%) per kidney with no difference between right and left kidneys. After right nephrectomy, uptake in the left kidney approximately doubled within 1 week. No correlation was shown between renal parenchymal mass and absolute 99Tcm-DMSA uptake in paired or solitary normal kidneys undergoing growth or compensatory growth.

Animals↗
PubMedDate not supplied

Cardiovascular effects of neuromuscular blockade during induced hypothermia.

Young lambs were used to study the effects of progressive cooling and rewarming on cardiovascular function during neuromuscular blockade induced by gallamine. Initially, it was shown that gallamine exerted no immediate, direct haemodynamic effect in normothermic or hypothermic lambs (cooled by 10 degrees C). By comparison with hypothermic controls, neuromuscular blockade was associated with increases in left ventricular (LV) max dP/dt (153%; P less than 0.02) as cooling progressed, and even greater increases (232%; P less than 0.001) during rewarming. It was concluded that these changes seem likely to represent enhanced myocardial contractility since preload did not closely follow LV max dP/dt (heart rate and mean aortic pressure fell gradually during cooling but values were restored in the rewarming phase). LV max dP/dt in lambs given gallamine only after cooling also showed a similar response during rewarming. Results of this study may have clinical relevance relating to the mechanical recovery of the hypothermic heart in patients receiving neuromuscular blockade during cardiac surgery, and they argue against using gallamine as such an agent.

Animals↗