PubMed Health⌕ Search

Biomedical subjects

M Mizunaga

Publications and source records attributed to M Mizunaga.

At least 19 recordsLinked to original sources
PubMed1998

Neuropathic bladder dysfunction in patients with ossification of the posterior longitudinal ligament.

BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) may cause neuropathic bladder dysfunction due to spinal cord involvement. OPLL, unlike a traumatic spinal cord lesion, progresses insidiously and sometimes affects longer cord segments. As the manifestation of bladder dysfunction may depend on the development of OPLL, we studied the relationship between bladder function and roentgenographic changes in the spinal canals of OPLL patients. PATIENTS AND METHODS: Eighteen surgical candidates (11 males and 7 females, 34 to 85 years old) were studied urodynamically. Sixteen underwent CO2-filling cystometry, uroflowmetry and measurement of their residual urine volume. Cystometry was omitted in the remaining 2 patients. The vertical extent of OPLL and the degree of stenosis in the spinal canal was estimated by x-ray films and CT. RESULTS: The cystometric study revealed detrusor hyperreflexia in 2 patients and areflexic or underactive detrusors in 5 patients. Intermittent flows or considerable amounts of residual urine were also observed in the arefilexia/underactive group. Uroflowmetry showed a normal flow with little residual urine in both patients in whom cystometry was omitted. Bladder sensation was maintained in all patients. The occurrence of abnormal detrusor activity had no relationship to the degree of canal stenosis, while the occurrence of an areflexic or underactive detrusor correlated with the vertical extent of OPLL. CONCLUSION: Although detrusor hyperreflexia is common in an upper spinal cord lesion, attention should also be paid to the development of detrusor underactivity in patients with a wide vertical extent of OPLL.

Adult↗
PubMed1997

[Transurethral microwave thermotherapy for benign prostatic hyperplasia].

BACKGROUND: We studied the clinical efficacy of transurethral microwave thermotherapy (TUMT) using Endotherm UMW system (OLYMPUS). METHODS: TUMT was performed in 28 patients with benign prostatic hyperplasia (BPH). Three patients of them were catheterized because of urinary retention. The treatment was performed in a single session for an hour. The urethral surface temperature was set at 39 degrees C, and the coolant flow of the urethral applicator (21 Fr balloon catheter) was set at 30 ml/min, to heat up the broad area of the prostate up to 45 degrees C. The clinical efficacy was evaluated by analyzing subjective responses, using the International Prostate Symptom Score (I-PSS) scale (S) and QOL score (L), and objective responses, using peak urinary flow rate (Qmax), average flow rate (Qave), residual urine volume and prostate volume following the treatment. RESULTS: At 24 weeks after the treatment, significant improvement were observed in S score (41%), L score (37%), Qmax (53%) and Qave (62%). Although there was no significant decrease in residual urine and prostate volume. The three patients, with a catheter indwelled because of urinary retention, were all free of the catheter within 4 weeks after the treatment. During and after the treatment, no severe adverse effects, including transient urinary retention needed for indwelling a catheter, was detected. CONCLUSION: A single session of TUMT by Endotherm UMW considered to be safe and useful for symptomatic BPH patients, even who are not indicated for transurethral resection of the prostate (TUR-P) because of underlying disorders.

Aged↗
PubMed1996

Clinical applicability of a new tactile sensor for evaluating rigidity of the penis: a comparative study with Rigiscan.

BACKGROUND: A new tactile sensor was developed for detecting hardness of living tissue by Omata et al. in 1992. This paper reports applicability of the sensor for evaluation of penile rigidity. METHODS: Nine patients from a group of 12 patients with penile erectile dysfunction were selected as subjects of this study. All patients agreed to artificial erection and monitoring of penile rigidity by a new tactile sensor and the Rigiscan system. The 9 patients selected all developed more than 1 cm circumferential expansion of the penis after an injection of smooth muscle relaxant into the corpus cavernosum. The sensor equipment consisted of a piezoelectric element that vibrated, and a pickup that detected vibration frequency. When the end of the sensor was pressed against a surface of the penis, the resonance frequency of the sensor changed and indicated rigidity of the organ. Rigidity of the penile shaft was simultaneously monitored with the sensor and the Rigiscan system before and after an injection of 40 mg papaverine or 20 micrograms prostaglandin E1. The sensor's measurements of rigidity were compared with those of Rigiscan. RESULTS: Reproducibility of rigidity measured with the tactile sensor was satisfactory. Statistical analysis was made on 85 simultaneous pairs of rigidity values from the tactile sensor and Rigiscan. The analysis indicated significant correlation between the values. CONCLUSION: The tactile sensor as well as Rigiscan will be of use for evaluating rigidity of the penis.

Adult↗
PubMed1996

[Intravesical oxybutynin hydrochloride in the treatment of urge incontinence in the elderly].

PURPOSE: This study was carried out to determine the effectiveness of intravesical oxybutynin hydrochloride on urinary urge incontinence in elderly people. METHODS: The subjects consisted of 13 patients with an average age of 75 years who demonstrated uninhibited detrusor contraction on cystometrogram. The trial protocol consisted of a pretreatment cystometrogram followed by the intravesical administration of 10 ml solution containing 5 mg oxybutynin hydrochloride (pH 5.85). The urodynamic studies were repeated one hour later. RESULTS: The mean bladder capacity before and after one hour of intravesical oxybutynin hydrochloride was 161 +/- 62 ml and 196 +/- 71 ml (mean +/- 1 S.D., n.s.). The rate of improvement was 15.4% (2 cases) in all 13 patients. Four patients out of 13 patients continued intravesical administration of the solution twice daily. Urinary incontinence disappeared in two patients and incontinence was markedly decreased in one. In the remaining patient, urinary incontinence did not change because of increased residual urine. Three patients have continued this therapy over one years and no side effects were observed. In these patients, residual urine volume did not increase. CONCLUSION: It is suggested that intravesical oxybutynin hydrochloride is an effective option of therapy for intractable urge incontinence in elderly people, however, the immediate posttreatment cystometrogram was not predictive of the response to intravesical therapy on overactive bladder in the elderly.

Administration, Intravesical↗
PubMed1996

[Pharmacokinetics of 99mTc-MAG3 and 131I-OIH: comparative study based on 2 compartment model analysis].

We studied 50 patients with mild to moderate renal dysfunction to compare pharmacokinetics of 99mTc-MAG3 with that of 131I-OIH. After simultaneous bolus injection of both 99mTc-MAG3 and 131I-OIH, 8-point venous blood sampling was performed from 2 to 44 min post injection. Aliquoted plasma samples were counted for radioactivity along with the injected standard to obtain % injected dose/ml plasma for each tracer. Using obtained time-concentration data, classical 2 compartment model analysis was performed for both tracers to obtain various pharmacokinetic parameters, including distribution volumes (Vds), inter-compartmental rate constants, and plasma clearance. In these parameters, Vd of central compartment, Vd at steady state, central to peripheral inter-compartmental rate constant, and plasma clearance were significantly larger for 131I-OIH. In all parameters, significant correlation was found between 99mTc-MAG3 and 131I-OIH. The best correlation was seen in plasma clearance (r = 0.891, p < 0.0001). Plasma clearance ratio (99mTc-MAG3/131I-OIH), however, showed weak but significant negative correlation with serum creatinine, although this correlation was not likely to affect the overall correlation of clearance between 131I-OIH and 99mTc-MAG3. From these results, we confirmed that 99mTc-MAG3 clearance could be used as an alternative to 131I-OIH clearance, although pharmacokinetic behavior of 99mTc-MAG3 was not exactly the same as that of 131I-OIH.

Adult↗
PubMed1995

[A case of psychological non-neuropathic bladder successfully diagnosed by continuous monitoring of detrusor pressure].

We report a case of psychological non-neuropathic bladder difficult to diagnose and treat. A 44-year-old woman was admitted to the Department of Urology of the Asahikawa Medical College Hospital with complaints of difficulty in micturition and urinary incontinence. Urodynamic studies revealed underactive function of the detrusor and incompetent urethra. She was instructed in self intermittent catheterization for difficulty in micturition. Drug therapy, electrical stimulation and vesicourethral suspension were not effective to control urinary incontinence. Since uninhibited detrusor contraction was elicited by psychogenic stress during continuous monitoring of the detrusor function, she was diagnosed as psychological non-neuropathic bladder closely related to psychogenic factor. She had a careful counselling and medical treatment designed by her psychiatrist, urinary incontinence was remitted in about one year and a half.

Adult↗
PubMed1994

Intravesical instillation of oxybutynin hydrochloride therapy for patients with a neuropathic bladder.

Intravesical oxybutynin hydrochloride was administered to 17 patients with a neuropathic bladder (myelomeningocele in 15 and spinal cord tumour in two) and urinary incontinence refractory to intermittent catheterisation. Therapy consisted of instillation of a 10 ml solution containing 5 mg oxybutynin hydrochloride twice daily. The cystometric bladder capacity before and after 1 hour of intravesical oxybutynin hydrochloride was 132 +/- 45 ml and 193 +/- 71 ml (mean +/- 1 standard deviation, p < 0.01) in all 17 patients. In 13 patients with low compliant bladders, the mean bladder compliance before and after 1 hour of instillation was 4.2 +/- 2.4 ml/cmH2O and 8.5 +/- 6.4 ml/cmH2O respectively (p < 0.01). The period of the intravesical oxybutynin hydrochloride treatment ranged from 2 to 16 months (mean 11.1 months). The improvement rate of 'moderately improved' and better response was 76.5% in all 17 patients. One patient complained of slight lower abdominal pain, which receded as treatment continued. Since the pH value of the solution appeared to be so low as to irritate the vesical mucosa, the value was adjusted to 5.85. No local or systemic side effects were observed thereafter. These encouraging results suggest that intravesical instillation of oxybutynin hydrochloride is an attractive alternative in patients with a neuropathic bladder, who are either unresponsive to or have intolerable side effects from oral medications.

Adolescent↗
PubMed1994

[Clinical study of TZP-4238 on patients with benign prostatic hypertrophy--with special reference to urodynamics].

Twenty four cases of benign hypertrophy with bladder outlet obstruction were treated with 17 alpha-acetoxy-6-chloro-2-oxa-4,6-pregnadiene-3,20-dione (TZP-4238), and the effects on urodynamic parameters, clinical efficacy, safety, and usefulness were evaluated. Improvement rate of subjective rate of subjective symptoms was 52.9%. Obstructive symptoms improved more prominently than irritation symptoms. A significant improvement in flow rate of nomograms for maximum flow rate (MFR) and average flow rate (AFR) accompanied with the decrease in the prostatic weight were observed. However, no changes were observed on the urethral sphincter electromyography and the urethral pressure profile. A significant decrease of maximum cystometric capacity was observed, although the effective cystometric capacity was not changed. The overall improvement rate for urodynamic parameters was 43.7%. A significant decrease in weight and diameter of the prostate was observed. The prostatic weight decreased in 57.1%, and the average reduction rate was 15.4%. The overall improvement rate concerning clinical efficacy evaluating both subjective symptoms and objective parameters was 58.8%. Adverse reactions were observed in 5 cases. They were judged as not clinically problematic. Taking into account clinical safety and clinical efficacy, the clinical usefulness was 50.0%. TZP-4238 was considered to be an appropriate agent for treating patients with benign prostatic hypertrophy with bladder outlet obstruction.

Aged↗
PubMed1991

Automatic analysis of urethral electromyography for accurate diagnosis of voiding dysfunction.

An electromyogram contains much more information than observed in the gross pattern of an electromyogram simultaneously recorded with a cystometrogram. Being able to pick up some of the information would be helpful in the accurate diagnosis of ambiguous patients showing a discrepancy between clinical symptoms and laboratory data. This study analyzed electromyograms of the urethral and anal sphincter during the filling phase of the cystometrogram by means of automatic turns-amplitude analysis with a computer-assisted analyzer. In normal subjects, turns and amplitudes of an urethral electromyogram had increased frequency and size as the subjects felt a greater sensation of fullness. In patients with abnormal vesical function, the characteristics of the urethral electromyogram varied. Some of the patients with normal vesical activity and coordinated urethral sphincter, though their clinical symptoms strongly suggested neuropathic vesical dysfunction, showed a low frequency and low amplitude pattern of the urethral sphincter electromyogram. Anal sphincter electromyogram did not always show the same patterns as the urethral sphincter even in the normal subjects. The turns-amplitude analysis of urethral sphincter electromyogram will be of use for accurate diagnosis of vesical dysfunction.

Anal Canal↗
PubMed1991

[Percutaneous management of benign ureteroileal anastomotic strictures after ileal conduit urinary diversion].

We report our experience with the endourological treatment of 4 patients with 5 benign ureteroileal anastomotic strictures after ileal conduit urinary diversion. The treatment was successful in 4 of the 5 renal units without restenosis with a mean follow up of 10 months. The strictures were dilated by ureteral dilators and/or balloon dilation catheters using guide wires through percutaneous nephrostomies in an antegrade fashion. A 9 or 12 Fr. percutaneous splint catheter or a 12 Fr. double pig tail catheter was placed for 3-8 weeks after a successful dilation. Two renal units underwent repeated dilations. In 1 renal unit, a guide wire was hardly passed through the stricture and the treatment was unsuccessful. No serious complications were encountered. Percutaneous endourological managements of ureteroileal anastomotic strictures seemed to be quite versatile techniques which should be tried as the initial approach in many cases.

Anastomosis, Surgical↗
PubMed1991

[Continuous monitoring of penile rigidity and tumescence in Japanese without erectile dysfunction].

Continuous monitoring of penile rigidity and tumescence has been proved to be of use for accurate diagnosis of erectile impotence, since it provides objective recording of penile rigidity as well as circumferential expansion. Prior to clinical use of this procedure in Japan, a study was performed to clarify normal features of nocturnal penile tumescence of Japanese and to ensure safety of this procedure. The subjects consisted of 16 normal volunteers, aged from 24 to 44 years. With fully informed consent of the volunteers, nocturnal penile rigidity and circumferential expansion were simultaneously measured for three consecutive nights by means of RigiScan at the base of the penis (base) and at about five millimeters proximal to the coronary sulcus (tip). The minimum circumference of the penis was 62.7 +/- 4.6 mm (mean +/- SD) at the tip and 65.4 +/- 9.3 mm at the base. The maximum circumference, which meant full erection in the normal volunteers, was 102.5 +/- 14.2 mm at the tip and 108.6 +/- 14.7 mm at the base. The mean duration of tumescence, i.e. circumference expansion more than 10 mm, was 23.0 +/- 6.9 minutes at the tip and 38.3 +/- 12.0 minutes at the base. The mean rate of episodes of circumference expansion more than 10 mm was 0.75 +/- 0.27 per hour at the tip and 0.70 +/- 0.26 per hour at the base. The maximum rigidity lasting more than 10 minutes was 82.9 +/- 10.1% at the tip and 85.4 +/- 8.4% at the base.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[A case of Menkes' kinky hair disease with a renal calculus and diverticula of the bladder].

Menkes' kinky hair disease is a poor prognostic congenital disease with X-linked recessive inheritance. This disease is clinically characterized by seizures, friable hair, growth failure, mental retardation and others. Recently it has been known that this disease is also characterized by multiple diverticula of the bladder and other urological abnormalities. A 6-year-old boy was diagnosed as having Menkes' kinky hair disease at another hospital several weeks after birth because of seizures, friable hair and low serum copper level. He voided by Credé's maneuver by the nurse because he could not void for himself. He was referred to our hospital for macrohematuria and micturition pain on October 8, 1989. Right renal staghorn calculus and multiple diverticula of the bladder were found by roentgenographic examination. He has been treated conservatively after discharge because of his poor condition.

Child↗
PubMed1991

[Diagnosis of penile erectile dysfunction: simultaneous recording of nocturnal penile rigidity and circumferential expansion].

This paper briefly reviews diagnostic examinations for penile erectile dysfunction and mainly refers to a newly developed ambulatory system of RigiScan which enables simultaneous recording of penile circumferential expansion and rigidity, introducing the latest values of variables of penile tumescence and rigidity in the Japanese without erectile dysfunction.

Adult↗
PubMed1990

[Micturition and uroflowmetric analysis of adult females].

Voiding parameters on the Uroflow Diagnostic Interpretation (UDI) were analysed in relation to the voided volume in 58 micturitions of 36 healthy adult females. The maximum flow rate (Qmax) and the mean flow rate during central 90% of the voided volume (QM90) increased linearly up to the voided volume of 400 ml. The voiding time (T100) took a value within a certain range independently of the voided volume from 100 to 400 ml and never exceeded 21 seconds in all micturitions. Voiding time for the central 90% of the voided volume (T90), time to Qmax (TQmax) and time from Qmax to 95% of the voided volume (Tdesc) were independent of the volume voided. The maximum rate of increase of flow rate (dQ/dT max) and the estimated bladder wall contraction velocity at 40 ml bladder contents (dL/dT 40) showed a tendency to increase depending on the volume voided. T100 showed a prolongation in 84.0% of 25 micturitions in 20 neurogenic bladder patients and in 66.7% of 27 in 21 chronic cystitis patients, always accompanied by a prolongation of T90. No other parameters were clearly different between healthy women and patients and/or between the two groups of patients. Voiding time is a useful parameter representing female micturition.

Adult↗
PubMed1990

[Analysis of nocturnal penile tumescence with continuous monitoring of penile rigidity].

By continuous and simultaneous recording of nocturnal penile rigidity and circumferential expansion (tumescence), nocturnal penile rigidity and tumescence have been classified into 6 patterns: normal, dissociation, uncoupling, short episode, low amplitude and flat trace. The monitoring will be helpful to diagnose underlying disorders involving erectile impotence, if the pattern of nocturnal penile rigidity and tumescence are related with the disorders. This study analyzed the relationship between the pattern of nocturnal penile rigidity and tumescence and associated disorders in 105 patients with erectile impotence. Of 15 patients with central nervous system disorders, 9 (60%) had a pattern of short episode of rigidity. In 29 patients with cardiovascular disorders, the patterns of dissociation, low amplitude and flat trace were the main findings and observed in 41, 41, 35% of the group, respectively. No patients with diabetes mellitus showed normal pattern. Although the group of non insulin dependent diabetes mellitus (21 patients) had various patterns of rigidity and tumescence, the insulin dependent group (14 patients) mainly showed patterns of low amplitude (21%) and/or flat trace (71%). The continuous and simultaneous monitoring of penile rigidity and tumescence will be helpful, with an integral analysis of its pattern and other examinations, for accurate diagnosis of underlying disorders of organic impotence, besides for differentiation of organic impotence from psychogenic one.

Adult↗
PubMed1990

[Urologic management of spinal cord injury by subarachnoid phenol block].

Subarachnoid phenol block was applied to four traumatic spinal cord injury patients who had been suffering from urinary incontinence caused by detrusor hyperreflexia. Two were females with complete thoracic cord injury, the others were males with incomplete cervical cord injury. In all patients, detrusor hyperreflexia and urinary incontinence disappeared after 0.3-0.6 ml injection of 10% phenol glycerin. Vesicoureteral reflux observed in three ureters of two patients disappeared or improved. Two obtained sufficient bladder capacity for urine storage, while the others who had been treated by continuous urine drainage for a long time prior to the block could not obtain sufficient bladder compliance. The cause seemed to be organization of the bladder wall.

Adolescent↗
PubMed1989

[Histochemical study of external urethral sphincter in the rabbit. Analysis with construction of histograms].

Male rabbit's external urethral sphincter was examined by histochemical muscle fiber typing (myosin ATP-ase staining), and the analysis with construction of histograms regarding to muscle fiber types were performed. Rabbit's external urethral sphincter was predominantly composed of fast twitch (type 2) fibers (87.3%) as a whole. But the proportion of constituent fiber types varied according to the layers, i.e., the slow twitch (type 1) fibers constituted a relatively high percentage (33.4%) in the inner third layer, while few of the type 1 fibers were found in the outer third layer. The all histograms regarding to fiber type in different layers were normal bell-shaped distribution curves. The mena diameter of type 2 fibers (14.7 microns) was evidently larger than that of type 1 fibers (20.5 microns). All three kinds of muscle fibers equally tended to increase in size toward the outer direction, and in every three layers, the diameter of type 2 was larger than that of type 1 also. The definite differences in the proportion of fiber types and fiber sizes between layers may implicate that the inner and outer layers play different roles, i.e., continuous tonic constriction in the former and sporadic strong constriction of short duration in the latter, under different neural regulations. As far as rabbit's external urethral sphincter is concerned, sporadic strong constriction should be mainly dependent on the muscle fibers of large size composing the outer layer, especially the fast twitch fibers. It is possible that the rabbit is so adapted that it could interrupt urination promptly.

Animals↗