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PubMed1996

Evaluation of surgical options in difficult gall bladder stone disease.

Mirizzi syndrome (17%), shrunken gall bladder (32%) and frozen Calot's triangle (51%) were encountered in 41 cases of cholelithiasis. Difficult gall bladder stone disease was recognised at operation. Peroperative cholangiogram was done in 70% of the cases, CT scan in 27% cases and percutaneous transhepatic cholangiography (PTC) in 17% cases were done to rule out cancer. Operative procedures included removal of stones and cholecystostomy (5%), partial cholecystectomy (12%), subtotal cholecystectomy (52%), choledochoduodenostomy (22%), choledochoplasty (7%) and cholecystocholedochoduodenostomy (2%). Cholecystectomy (5%) was done in 2nd stage. There was no operative mortality. Postoperative complications included biliary leak (5%), septicaemia (2%) wound dehiscence (5%) and pulmonary infection (2%). It is concluded that subtotal cholecystectomy is an ideal, safe and simple procedure for difficult gall bladder stone disease.

Adult↗
PubMed1994

Continent urinary diversion using the Mitrofanoff principle.

OBJECTIVE: To review the clinical and symptomatic outcome of patients undergoing cystectomy and continent urinary diversion using the Mitrofanoff principle. PATIENTS AND METHODS: There were seven men and five women (median age 62 +/- 21 years: range 21-79). The underlying diagnoses were: bladder carcinoma (8), neuropathic bladder disease (1), bladder exstrophy (1), tuberculosis (1) and interstitial cystitis (1). An ileo-caecal segment was used for construction of the reservoir. The appendix was used as a catheterizable conduit in 11 patients and a narrowed ileal tube in one patient. Symptomatic outcome was assessed by using a modified Visick grading. The median follow-up period was 15 +/- 10 months (range 6-39). RESULTS: The median hospital stay was 22 days. There were no post-operative deaths, but major post-operative complications developed in three patients and included intra-abdominal lymphocele (1), intra-abdominal abscess formation (1) and prolonged ileus (1). In the late post-operative period (> 30 days), four patients developed stenosis of the mucocutaneous junction and required dilatation. The overall symptomatic outcome was satisfactory in 11 patients. There were no deaths in the peri-operative period and none of the patients has since required revision. Urinary continence was achieved in all 12 patients during the day. One patient reported minimal, occasional leakage at nights. The median catheterization interval was 4 +/- 1 hours during the day (range 3-5) and 7 +/- 1 hours at night (range 6-9). CONCLUSION: Our experience with the Mitrofanoff procedure has been limited to a small number of patients. Despite this, the clinical outcome of the procedure was satisfactory. The procedure potentially offers an effective continence mechanism with acceptable post-operative morbidity.

Adult↗
PubMed2003

[Phenotypic changes in human bladder smooth muscle cell].

Tissue specimens were resected from 15 patients (age 7 to 82, average 52.2 years old) with bladder diseases; i.e., 2 with neurogenic bladder, 6 recipients of kidney transplantation with defunctionalized bladder, 3 with benign prostatic hypertrophy, 3 with bladder cancer and 1 with vesicoureteral reflux. We investigated the phenotypic expression of the bladder smooth muscle cells with bladder diseases. The ratio of non-contractile to contractile phenotypes (nc/c ratio) showed a rising tendency with aging. The increase of nc/c ratio was especially notable with neurogenic bladder. Phenotypic expression was observed in human bladder smooth muscle cells as reported in vascular smooth muscle cells. Several bladder diseases cause a conversion of contractile smooth muscle cell phenotype from contractile type to non-contractile type, and this modulation of smooth muscle cell phenotype may play an important role in detrusor function.

Adolescent↗
PubMed1982

Functional evaluation of bladder neck disease.

22 patients diagnosed as having bladder neck disease were evaluated retrospectively point of view. Urodynamic study including intravesical pressure, rectal pressure, intrinsic detrusor pressure and urine flow was performed in every case. A relation was established between the findings and the definite etiology. Two urodynamic patterns were found, one with high pressures and low voiding flow, and one with low pressures and low voiding flow. Functional differences were not found between the two etiological groups, i.e. fibrotic and idiopathic.

Adult↗
PubMedDate not supplied

Health-related concerns and experiences of employed perimenopausal women in Alexandria, Egypt.

Our purpose in conducting this descriptive study was to assess the health-related concerns and experiences of a sample of employed perimenopausal women in Alexandria, Egypt. In addition, we explored their help-seeking behavior and their perception of symptoms. We interviewed two hundred working women ages 40-60 years, 42% of whom were nurses, using a semistructured interview form as well as Koos's list of symptoms. The commonly mentioned concerns, in order of frequency, were chronic headaches, chronic fatigue, transportation and phone communication problems, financial problems, job dissatisfaction, backaches, hypertension, kidney disease and gall bladder disease, gastritis/indigestion, menstrual disturbances, arthritis, AIDS, and hepatitis B. With respect to the problems experienced by the women in the past 6 months, there was a high self-reported prevalence of headaches, fatigue, transportation and communication problems, backaches, job dissatisfaction, dissatisfaction with health insurance, financial problems, menstrual disturbances, gastritis/indigestion, gall bladder disease, anxiety, disturbed sleep, and hypertension. Women attempted to manage their problems mainly by taking over-the-counter drugs and self-prescribing (75.5%), doing nothing or using traditional remedies (56.5%), and going to a doctor or health insurance office (40%). Symptoms perceived by the majority of the women as not needing medical attention included loss of appetite, persistent backache, bleeding gums, chronic fatigue, persistent headaches, and loss of weight. The influence of education and occupation on women's perceptions and practices is discussed.

Adult↗
PubMed2005

Urinary disease in 2 Dogon populations with different exposure to Schistosoma haematobium infection: progression of bladder and kidney diseases in children and adults.

BACKGROUND: Schistosoma haematobium infection causes severe urinary disease and considerable mortality. The factors that determine disease progression from mild to severe stages are not fully understood. METHODS: Here we describe a cross-sectional epidemiological study of kidney and bladder diseases in 2 Dogon populations with different exposure to S. haematobium infection. RESULTS: Early and high exposure resulted in more-severe disease, especially among young subjects, without clear evidence of a more-rapid development of immunity. Nevertheless, 50%-60% of subjects of all age classes in both villages showed no evidence of disease. Kidney and bladder disease peaked biphasically among young subjects and adults >25 years old. The first peak corresponded with infections of maximum intensity, whereas the second peak occurred among adults with infections of very low intensity. Kidney disease was correlated with circulating anodic antigen concentration in serum, whereas bladder disease was correlated with egg count and eosinophil cationic protein concentration in urine. Kidney and bladder disease did not correlate. Severe kidney disease was more frequent in certain families. CONCLUSIONS: The frequency of urinary disease is increased by infections acquired early during life, is regulated by strong clinical immunity in certain subjects, and may be dependent on hereditary factors. Kidney and bladder disease may involve different mechanisms of pathogenesis, which may differ between children and adults.

Adolescent↗
PubMed1997

Cytokeratin-19 fragment (CYFRA 21-1) in bladder cancer.

The present study was designed to evaluate the role of the cytokeratin-19 fragment (CYFRA 21-1) as a tumor marker in bladder cancer. The bladder cancer cell line JMSU1 was used in the preclinical study. Subjects comprised 120 healthy volunteers, 20 patients with benign bladder diseases including acute cystitis and bladder stones, 12 patients with chronic renal failure, and 117 patients with histologically confirmed primary bladder cancer. CYFRA 21-1 concentrations were measured by a sandwich enzyme-linked immunosorbent assay. The preclinical study in vitro and in vivo showed that JMSU1 produced and released CYFRA 21-1 in the culture supernants and serum of JMSU1-bearing nude mice. The cutoff level was set at 3.5 ng/ml (mean + 3 SD) by the analysis in the healthy volunteers. Under this condition, sensitivity was 0% in benign bladder diseases, 83% in chronic renal failure, and 41.9% in bladder cancer. Serum CYFRA 21-1 levels increased significantly as tumor stage advanced or tumor grade increased. A serial follow-up study demonstrated that patients with progressive showed a gradual increase in serum CYFRA 21-1 levels while patients who responded to the treatments had a marked decrease in serum CYFRA 21-1 levels. Higher serum CYFRA 21-1 levels were related to poor survival. The present study suggest that serum CYFRA 21-1 is a useful marker to monitor the clinical course of bladder cancer and to provide prognostic information.

Adult↗
PubMed1987

Intragastric bile acid concentrations are unrelated to symptoms of flatulent dyspepsia in patients with and without gallbladder disease and postcholecystectomy.

It has been proposed that duodenogastric reflux may be the basic underlying mechanism which gives rise to symptoms of flatulent dyspepsia. Fasting and postprandial gastric juice bile acid concentrations were measured in patients with flatulent dyspepsia with and without gall bladder disease and postcholecystectomy. There were 13 patients with gall bladder disease, 12 with normal gall bladders and 13 postcholecystectomy. Gastric juice was obtained by intubation. Bile acid concentrations were compared with 21 controls and 15 asymptomatic subjects with gall bladder disease. For 21 patients with gall bladder disease who underwent cholecystectomy, levels were again assessed postoperatively to allow correlation with outcome. The occurrence of reflux and the resultant gastric juice bile acids did not correlate with symptoms. Concentrations postcholecystectomy, including asymptomatic subjects were significantly higher than controls (p less than 0.01). It is concluded that limited duodenogastric reflux is common and need not be associated with symptoms even when the resultant intra-gastric concentrations are higher than normal.

Adult↗
PubMed2002

A functional food product for the management of weight.

More than half of Americans have a body mass index of 25 kg/m2 or more, which classifies them as overweight or obese. Overweight or obesity is strongly associated with comorbidities such as type 2 diabetes mellitus, hypertension, heart disease, gall bladder disease, and sleep apnea. Clearly, this is a national health concern, and although about 30 to 40% of the obese claim that they are trying to lose weight or maintain weight after weight loss, current therapies appear to have little effect. None of the current popular diets are working, and there is room for innovation. With the advancing science of nutrition, several nutrients - low-glycemic-index carbohydrates, 5-hydroxytryptophan, green tea extract, and chromium - have been identified that may promote weight loss. The first two nutrients decrease appetite, green tea increases the 24-h energy expenditure, and chromium promotes the composition of the weight lost to be fat rather than lean tissue. These have been assembled in efficacious doses into a new functional food product and described in this review. The product is undergoing clinical testing; each component has already been shown to promote weight loss in clinical trials.

5-Hydroxytryptophan↗
PubMed1996

Physiological principles for surgical correction of detrusor dysfunction.

Urinary incontinence may be the result of various forms of detrusor overactivity. Several surgical therapies have been devised, but with the exception of procedures to relieve urethral obstruction, none abolishes the overactivity or restores normal micturition. In general, ablative neurosurgery is considered only in patients with chronic neurologic disease. Bladder augmentation is useful in selected patients. The indications for urinary diversion in patients with detrusor overactivity and urge incontinence are quite limited.

Animals↗
PubMed2004

[Acute complications of diabetes and the gastrointestinal tract].

Acute metabolic decompensation of diabetes, hypoglycemia and gastrointestinal tract disease are often connected. Hyperglycemic crisis can be induced by an infectious disease of the gastrointestinal tract, ulcerative disease, gall bladder disease, pancreas disease, and gastrointestinal tract tumours. It can result from diabetic visceral neuropathy manifested especially by impaired patency of the gastrointestinal tract. Metabolic decompensation of diabetes is often accompanied by gastrointestinal symptoms and abnormal laboratory findings. Some of them (especially abdominal pain and increased levels of amylases in serum) can evoke diagnostic and therapeutic hesitation. Insufficient nutrition as a result of gastrointestinal tract disease or adverse reaction to drugs used for its treatment can induce both metabolic decompensation and hypoglycemia.

Acute Disease↗