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Biomedical subjects

W Månsson

Publications and source records attributed to W Månsson.

At least 19 recordsLinked to original sources
PubMed1995

Long-term metabolic effects of urinary diversion on skeletal bone: histomorphometric and mineralogic analysis.

OBJECTIVES: To evaluate the long-term influence of different types of intestinal urinary diversion on skeletal bone and its mineral content. METHODS: Densitometry was used to estimate bone mineral content, and bone biopsies were analyzed with histomorphometric technique. The study comprised 20 patients with conduit urinary diversion and 19 with cecal continent reservoir, all followed up for more than 5 years, with normal or near-normal renal function. RESULTS: Bone mineral content did not differ significantly between the patients with cecal continent urinary reservoir and those with conduit diversion or between these groups and a reference group. At the cellular level, the histomorphometric analysis revealed no defective bone mineralization or increased bone resorption in either group of patients. The trabecular bone volume was greater than normal in the reservoir group, but not in the conduit group. The appositional rate was significantly below normal in both groups of patients, but did not differ between conduit and reservoir patients. CONCLUSIONS: Subtle changes in electrolytes and acid-base homeostasis identified in adults with intestinal segments incorporated in the urinary tract and with largely normal renal function do not seem to influence bone mineralization in the long term. At the cellular level, a lower than normal appositional rate was found in the patients with conduit or continent urinary diversion. In the latter group, this finding, together with increased trabecular bone volume, may indicate a decrease of bone turnover.

Acid-Base Equilibrium↗
PubMed1995

Long-term metabolic and nutritional effects of urinary diversion.

OBJECTIVES: To evaluate the long-term metabolic and nutritional consequences of interposing intestinal segments in the urinary tract. METHODS: Comprehensive analyses of blood and urine were performed in 20 patients with conduit urinary diversion and in 19 with continent cecal reservoir for urine, all with normal or near-normal renal function. The mean follow-up time was 15 years in the conduit group and 9 years in the reservoir group. RESULTS: In both patient groups, arterial blood gas analysis revealed a tendency to metabolic acidosis with respiratory compensation. Although no hyperchloremia was found in either group, the mean value of serum chloride was significantly higher (P < 0.05) in the reservoir group than in the conduit group. The calciotropic factors, plasma lipids, lipoproteins, and liver function values were normal in both groups. Serum vitamin B12 levels were subnormal in 3 conduit and 2 reservoir patients, but other studied variables of intestinal absorption were within normal limits. Conduits utilizing colonic segments showed calcium excretion on the same level as in reservoirs, which was significantly higher than in conduits made from ileal segments. CONCLUSIONS: Except for increased risk of vitamin B12 deficiency, no major adverse metabolic or nutritional effects of conduit or continent urinary diversion were found at long-term observation in patients with well-preserved renal function. Lifelong surveillance of vitamin B12 levels is necessary in these patients.

Acid-Base Equilibrium↗
PubMed1994

Absorption of sodium and chloride in continent reservoirs for urine: comparison of ileal and colonic reservoirs.

The absorptive capacity of urinary reservoir mucosa was studied by measuring the fractions of 22sodium and 36chloride absorbed after instillation into reservoirs constructed from an ileal or a colonic segment. The absorption of 22sodium did not differ between the 2 reservoir types but absorption of 36chloride was greater in the colonic reservoirs. The levels of chloride in serum were significantly higher in patients with a colonic than in those with an ileal reservoir. In the ileal reservoirs the absorptive capacity was greater for 22sodium than for 36chloride.

Absorption↗
PubMed1992

Tapering of intussuscepted ileal nipple valve or ileocecal valve to correct secondary incontinence in patients with urinary reservoir.

Malfunction of the outlet mechanism, that is leakage of urine or difficulty in catheterization, has been the main problem in the evolution of continent urinary reservoirs. Urinary leakage in 3 patients with a right colonic reservoir (2 with an intussuscepted ileal nipple valve and 1 with a plicated ileal segment as a continence mechanism) was managed with tapered narrowing of the nipple valve and the ileocecal valve, respectively, using stapling techniques. Continence was thereby reestablished without impeding catheterization. Tapering is easy to perform and, when applicable, can obviate the need for a major surgical procedure.

Adult↗
PubMed1992

Renal parenchymal function evaluated by scintillation camera renography before and after pyeloplasty for hydronephrosis.

Scintillation camera renography with Tc-DTPA was performed before and after pyeloplasty on 16 kidneys with urographic signs of pelviureteric obstruction causing hydronephrosis. Regional parenchymal renograms were generated, and the passage of Tc-DTPA through the parenchyma was measured and correlated to the change in separate glomerular filtration rate. Preoperative parenchymal passage of DTPA was significantly slower (p = 0.02) in kidneys with improved glomerular filtration rate after pyeloplasty than in those without such improvement. Postoperative passage of DTPA in parenchyma was almost identical with that in a reference series. This method seems to be clinically useful for evaluating cases of hydronephrosis and for predicting the outcome of pyeloplasty.

Adult↗
PubMed1991

Cystourethrometric findings in patients with detubularized right colonic segment for bladder replacement.

Urodynamic evaluation was performed in 13 men 4 to 18 months after cystoprostatectomy and bladder replacement using a detubularized right colonic segment. All patients are continent by day and only 3 are incontinent during the night to a degree that necessitates use of a condom catheter. Two patients awaken every 2 to 3 hours to void and the remainder have nocturia comparable to normal men of their age. The residual volume was 0 to 70 ml. The urethral closure pressure was normal, and in 3 patients studied preoperatively and postoperatively no significant change was observed other than shortening of the profile length. Maximal flow rates were normal although the pattern was intermittent. In 2 patients no cystoplasty contractions were recorded and in all but 2 patients the amplitude of the contractions was less than 40 cm. water. Simultaneous bladder and urethral pressure recordings during bladder filling demonstrated no change in urethral pressure in 10 patients. Although creation of a reservoir with a low pressure and careful preservation of the infraprostatic urethra are important for continence in these patients, we believe that the absence of normal sacral route reflexes after cystoprostatectomy is an important contributing cause to nocturnal incontinence.

Colon↗
PubMed1991

Psychosocial adjustment to cystectomy for bladder carcinoma and effects on interpersonal relationships.

Postoperative adjustment and the psychosocial consequences of cystectomy were studied in 34 patients with bladder carcinoma. Urinary diversion was accomplished via a conduit in 20 patients and a continent caecal reservoir in 14. Interviews with the patients were conducted according to a semistructured outline. The great majority adjusted fairly well, mainly due to support from family members. Help was provided by medical staff in only a few cases. While relationships with friends were unchanged, those with spouse/partner were commonly disturbed by sexual problems and presence of a urostoma. The mode of urinary diversion had no influence on the studied variables. Despite a high acceptance level of their malignant affliction, several patients did not accept their present situation. Lack of psychologic support from the health services was a common experience.

Adaptation, Psychological↗
PubMed1991

Bacillus Calmette-Guérin treatment of 39 patients with superficial transitional cell carcinoma of the bladder.

The effect of intravesical Pasteur-F strain Bacillus Calmette-Guérin (BCG) on bladder carcinoma was studied in 39 patients. Multiple recurrent superficial transitional cell carcinoma was present in 36 cases, including 11 with concomitant carcinoma in situ (CIS), and primary CIS in three. The mean age of the 27 men and 12 women was 72 years. A 6-week induction course was given, beginning usually 4-6 weeks after transurethral tumor resection (TUR) or random biopsies, with periodic followup cystoscopies and cytologic analyses. A second 6-week course was given only to patients with incomplete response (positive urinary cytology or recurrent tumor). Three patients received maintenance intravesical BCG. If there was no response at the first cystoscopy after the induction course, no further BCG was given. Side effects were mostly local, moderate and transient, subsiding spontaneously or responding to symptomatic treatment. Severe systemic side effects occurred in three patients. Two with arthritis/arthralgia were managed as out-patients, while one with BCG pneumonitis/hepatitis required hospitalization, triple antituberculosis medication, cloxacillin and prednisolone. Complete response, defined as negative cystoscopy, cytology and histology, was obtained in 11 of 21 cases of papillary carcinoma without concomitant CIS. These patients were followed up for 8-47 months. Of the ten non-responders, two died and eight underwent further TUR. Of the 11 patients with concomitant CIS, six showed complete and five no response. Two of the latter died and three had further TUR. In all three cases of primary CIS there was complete response.

Administration, Intravesical↗
PubMed1991

Perforation of continent caecal reservoir for urine twice in one patient.

Perforation of a continent caecal reservoir, presumably during catheterization, occurred twice in a 64-year-old woman, 52 and 59 months after urinary diversion, during hyperglycemic confusion. Acute overdistension of the reservoir, creating high tension in its wall, with resulting weakness, could have been an underlying cause of the perforation. Awareness of this potentially lethal complication in patients with augmented bladder or continent urinary reservoir is necessary.

Cecum↗
PubMed1990

The detubularized right colonic segment as urinary reservoir: evolution of technique for continent diversion.

Continent diversion of urine via a cecal-right colonic reservoir has been performed at our university hospital since 1977. Several modifications of surgical technique have been devised to prevent problems of urinary leakage and difficulties in catheterization. The current technique, used during the last 3 years on 14 patients, involves use of a detubularized right colonic segment as a reservoir, ileal mesenteric exclusion, fashioning the intussuscepted ileal nipple valve with staples and anchoring of a fascia strip sling around the nipple base to the anterior rectus sheath. Complication from the reservoir outlet occurred in only 1 patient.

Cecum↗
PubMed1990

Mucosal ultrastructure of continent cecal reservoir for urine and its ileal nipple valve 2-9 years after construction.

Biopsy specimens from continent cecal reservoir for urine and from its ileal nipple valve were studied with electron microscopy after two to nine years of function in ten patients. In the colonic mucosa from the reservoir there was shortening of microvilli, in some cases with random orientation and numerical reduction-changes unrelated to the time from reservoir construction. Filamentous core rootlets were also randomly oriented and numerically diminished. Glycocalyceal bodies were present in most cases. Mucosal edema and reduced numbers of goblet cells were found in six cases and increased amount of collagen in two. In the ileal nipple valve mucosa there were no microvillous changes, but metaplastic formation of glycocalyceal bodies was interpreted as adaptation to physiologic conditions comparable with those in the reservoir's colonic mucosa. Collagen increase was found in two of the nipple valves. Neurogenic processes, enterochromaffin cells and Paneth cells were always well preserved in normal amounts in the cecal as well as the ileal mucosa.

Biopsy↗
PubMed1990

Intravesical mitomycin C for carcinoma in situ of the urinary bladder.

Mitomycin C was given intravesically over periods of 2-32 months to 34 patients with carcinoma in situ of the urinary bladder. Initial complete response was obtained in 17 patients, 14 of whom remained without evidence of disease during follow-up averaging 28 months from cessation of mitomycin therapy. In three responding patients malignant cells reappeared in the urine during follow-up, although no recurrence of carcinoma could be proven in bladder biopsy specimens. In eight of the 17 non-responders, muscle invasion and/or metastatic disease developed during or after mitomycin treatment. The prostatic urethra was involved in five cases. Chemotherapy had to be discontinued because of chemical cystitis in three cases. Mitomycin C appears to be effective for intravesical treatment of carcinoma in situ of the urinary bladder. Close surveillance of these patients is mandatory, however, and must include monitoring not only of the bladder, but also of the prostatic urethra and the upper urinary tract.

Administration, Intravesical↗
PubMed1990

Experience with a detubularized right colonic segment for bladder replacement.

A detubularized right colonic segment was used as bladder substitute in ten men who underwent cystoprostatectomy for carcinoma of the bladder. Postoperative complications unrelated to the replacement procedure occurred in three cases. Stricture of the urethrocaecal anastomosis developed during follow-up in one case. Day-time continence with convenient micturition intervals was achieved in all cases. Nocturnal continence was also maintained if the patients awoke once or twice to void. Urodynamic studies revealed adequate capacity, little or no residual urine and pressure waves of low amplitude at high-level filling. The technique employed for creation of a bladder substitute offers the advantage of technical simplicity. The bowel it utilizes is of secondary importance for intestinal absorption, and the result is a low-pressure, capacious neobladder.

Adult↗
PubMed1989

Cystic dilatation of Cowper's gland duct--an overlooked cause of urethral symptoms?

Dilatation of Cowper's gland duct was diagnosed in four men with symptoms including post-voiding dribbling, frequency of micturition, dysuria and hematuria. Cystourethrography gave the correct diagnosis in all cases. Treatment consisted of transurethral incision of the cystic excretory duct, providing marsupialization into the urethra. Investigation of longstanding or recurrent episodes of urethral symptoms in men should include cystourethrography with this lesion in mind. It seems to be less rare than was previously assumed.

Adult↗