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PubMed1980

Hydrodynamic aspects of bladder-outlet obstruction: consequences of functional micturition disorders.

Functional disturbances of micturition lead to secondary structural changes. Both factors may change the physical properties--shape, elasticity and consistency--of the posterior urethra and of the bladder neck. In order to demonstrate their influence on urodynamics experimental studies were undertaken, elastic models, straight tubes of equal diameter throughout their length, were used. One model was a straight elastic tube of PVC material, three other models had nonelastic segments of different shape but with the same square area as the undeformed elastic parts. Perfusion was performed under equal conditions. The experiments showed firstly that nonelastic segments in an elastic system reduce the flow rate and secondly, that flow depends on cross section versus circumference, which is expressed by the so-called hydraulic diameter. Elasticity, consistency and shape of the bladder-outlet, frequently altered in patients with neurogenic bladder disease, are therefore important factors regarding loss of friction. Our results support the clinical experience, that a functional obstruction has to be eliminated before secondary structural changes occur which alter the physical properties of the bladder outlet and therefore make flow conditions even worse.

Elasticity↗
PubMed1996

Comparison of real-time ultrasonography and magnetic resonance imaging in the assessment of urinary bladder volume.

OBJECTIVE: To compare estimates of bladder volume obtained by conventional real-time ultrasonography with those obtained from magnetic resonance imaging (MRI) by the Cavalieri method of unbiased stereology. SUBJECTS AND METHODS: The study comprised nine subjects (four men and five women, mean age 23 years, range 18-34) with no history of bladder disease. Before micturition, each volunteer underwent ultrasonography, immediately followed by MRI. The volunteers then voided the true voided volume of urine was measured and the imaging protocols were repeated in the same order after micturition. The bladder volume was estimated from ultrasonography using the formula: volume = 0.7 (L x TS x AP), (where L is the maximum supero-inferior diameter. AP the maximum anteroposterior diameter and TS the maximum transverse diameter) and from MRI using the Cavalieri method. For each imaging modality, the volume of urine voided was estimated as the difference in the volume estimate before and after micturition. RESULTS: The mean percentage coefficient of variation for the estimates of bladder volume by ultrasonography was 2.17 before and 4.43 after micturition. There was no significant difference in the replicate estimates of each bladder diameter by ultrasonography before and after micturition (P = 0.98). The MRI method consistently underestimated the voided volume: the mean discrepancy between the estimated voided volume and the true voided volume was 7.7 ml, and -67.7 ml for the ultrasonographic and MRI estimates, respectively, which are significantly different (P = 0.02) when assessed using a multifactor ANOVA. Further analysis using multiple-range tests showed a significant difference between the voided volume estimated by MRI and the corresponding true voided volume. There was no difference between the voided volume estimated by ultrasonography and the corresponding true volume. CONCLUSION: Ultrasonographic estimates of voided volume were more reliable than the those obtained using the MRI method. This is possibly due to a delay between micturition and the acquisition of MR images after micturition, which allowed the bladder to partly refill with urine. The empirical approach using measurements from ultrasonograms provides a fast and reliable technique: ultrasonography remains the recommended imaging modality for estimating bladder volume.

Adolescent↗
PubMed2006

A feasibility study of using gold seeds as fiducial markers for bladder localization during radical radiotherapy.

Target localization and verification of the treatment position is important for the accurate delivery of conformal radiotherapy. The bladder in particular is a deformable structure whose shape and position continually varies throughout a course of radiation treatment as a result of bladder filling. We report a novel technique of organ localization using gold seeds as fiducial markers that are implanted into the bladder using a specially adapted applicator that is passed through a rigid cystoscope. The seeds are readily apparent on electronic portal imaging taken at the time of radiotherapy and can thus act as a surrogate for bladder position. The feasibility and technical aspects of performing such a procedure on eight patients were assessed. In all of the patients, some of the seeds were visible on the planning CT scan and remained within the bladder wall throughout the course of radiotherapy treatment. The drop-out rate was minimized by the use of cystodiathermy at the site of seed insertion. It was possible to place the seeds in both areas of normal and diseased bladder tissue. The procedure was associated with minimal toxicity. This technique will form the basis for planning further studies on bladder localization.

Cystoscopy↗
PubMed2002

[Fluorescence cystoscopy in bladder cancer: what future?].

Bladder transitional cell carcinoma, limited to the lamina propria, or superficial in 80% of the cases, is characterized by a high recurrence rate up to 70% in the three years following the first treatment. However, the constant evolution of the endoscopic techniques, useful to its diagnosis and treatment, contributed to reduce about by half this recurrence rate at three months. The actual development concerns new fluorescence detection methods, adapted to the standard endoscopic equipment. This new technique or fluorescence cystoscopy aims at improving the visual contrast between tumor and normal tissue in order to obtain a precise mapping of the diseased bladder. Thus, it allows to detect a carcinoma in situ (CIS) with a sensitivity around 80 to 90%. Its impact on the progression of the disease remains however to be demonstrated.

Aminolevulinic Acid↗
PubMed2006

Cysteinyl leukotriene D4 increases human detrusor muscle responsiveness to histamine.

PURPOSE: Leukotriene D(4) and histamine are proinflammatory mediators that are released concomitantly by activated mast cells. There is the possibility of mutual potentiation of their actions in inflammatory diseases such as interstitial cystitis. We investigated whether human detrusor smooth muscle cells showed increased responsiveness to histamine in the presence of leukotriene D(4). MATERIALS AND METHODS: Cold cup detrusor biopsies were obtained from patients undergoing cystoscopy for benign noninvasive bladder diseases. Human detrusor smooth muscle cells in culture were obtained using an explantation technique and subcultivated for a maximum of 3 passages. The cytosolic free Ca(2+) concentration and contractile force were measured by spectrofluorometry and myograph techniques, respectively. RESULTS: Low doses of leukotriene D(4) (10 nM or less), which usually do not produce a significant effect on the free Ca(2+) concentration or on muscle contraction when administered 30 to 60 seconds beforehand, significantly enhanced the transient increase in the free Ca(2+) concentration and isometric force induced by 50 to 200 nM histamine. Increased histamine responses were associated with an upward shift in the fura-2 fluorescence ratio, suggesting that histamine hyperresponsiveness was due to the appearance of additional histamine receptors on the sarcolemma or to more efficient signaling per receptor. Leukotriene D(4) concentrations greater than 10 nM had no potentiating effects. CONCLUSIONS: To our knowledge this is the first demonstration in the human detrusor that leukotriene D(4) potentiates the effect of histamine. These inflammatory mediators, which are often released concomitantly from mast cells, may interact mutually to potentiate the spasmogenic effect of histamine. These results suggest that the combination of leukotriene D(4) and histamine H1 receptor antagonists may be more effective for the treatment of interstitial cystitis than when given alone.

Calcium↗
PubMed1999

Preliminary study on urinary cytokine levels in interstitial cystitis: does intravesical bacille Calmette-Guérin treat interstitial cystitis by altering the immune profile in the bladder?

OBJECTIVES: To obtain preliminary urinary cytokine data on subjects with active interstitial cystitis (IC), subjects with IC in remission after bacille Calmette-Guérin (BCG), and control (non-IC) subjects. IC is a severe, debilitating bladder disease of unknown etiology and no cure. In controlled clinical trials, intravesical BCG has been shown to be an effective and durable treatment for IC. The durability of this treatment led us to speculate on the mechanism by which intravesical BCG may treat IC. Evidence exists that IC may be mediated by an abnormal immune profile within the bladder. Intravesical BCG is known to stimulate the immune system of the bladder. METHODS: Fresh voided urine was collected from 15 subjects with active IC, 9 subjects with IC who received intravesical BCG and had been in remission for an average of 2.6 years, and 11 non-IC subjects. The urine was immediately centrifuged, aliquoted, and frozen in liquid nitrogen. At the time of urine collection, a validated IC questionnaire was completed. The enzyme-linked immunosorbent assay technique was used to determine levels of urinary cytokines interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, IL-12, tumor necrosis factor (TNF), human granulocyte-macrophage colony stimulating factor (hGM-CSF), IL-1beta, and interferon-gamma (IFN-gamma). RESULTS: Cytokines IL-4, IL-10, IL-12, TNF, hGM-CSF, IL-1beta, and IFN-gamma were not detected. Significant elevations in symptom scores and IL-2, IL-6, and IL-8 were found in the urine of subjects with active IC compared with subjects with IC in remission and control subjects. The urinary cytokine levels and symptom scores were identical in the IC group who had received BCG and the control group. CONCLUSIONS: Elevations in symptom scores and urinary cytokine levels were seen in subjects with active IC, suggesting an abnormal immune profile in this disease. Subjects with IC in remission after receiving BCG had identical cytokine levels and symptom scores as non-IC control subjects. Intravesical BCG may be effective in treating IC by correcting an aberrant immune imbalance in the bladder, leading to long-term symptomatic improvement. A prospective study is ongoing to further investigate the role of the immune system in IC.

Adjuvants, Immunologic↗
PubMed1989

[New aspects of gallbladder pathology in children].

We have reviewed in a retrospective study 38 children treated in our Hospital, during the last seven years, because of non congenital gall-bladder disease. The diagnosis established were cholelithiasis 58 for 100, hydrops 26 for 100, acalculous cholecystitis 13 for 100 and hemobilia in one child. Cholelithiasis was more frequent in females at a rate of 2/1. Just the opposite incidence was found for acalculous gall-bladder pathology. Mean age at time of first hospitalization was 7.6 years for the cholelithiasis group and 6.6 years for the rest. Symptoms in order of frequency were abdominal pain, vomiting and fever. Abdominal sonography has been basic in establishing to correct diagnosis in practically all cases. Our most interesting finding has been the clinical manifestations of patients with "Hydrops", consisting of abdominal pain which disappears spontaneously after 24 to 48 hours. The diagnosis has been established only after performing abdominal sonographic studies in children with abdominal pain of unclear etiology.

Acute Disease↗
PubMed1976

Non-nutritive sweeteners and human bladder cancer: preliminary findings.

The non-nutritive sweeteners, saccharin and cyclamate, were not associated with the risk of human bladder cancer in a controlled investigation. The prior intake of such sweeteners in any and all forms was not greater or more prolonged among 209 recently diagnosed bladder cancer patients than among 209 otherwise similar patients without bladder disease. These findings were unaffected by case-control differences in diabetic histories or smoking practices.

Animals↗
PubMed1989

Percutaneous transhepatic cholecystoscopy and biliary endoscopic lithotripsy.

We have been developing procedures for percutaneous transhepatic cholecystoscopy (PTCCS) through the sinus tract of percutaneous transhepatic cholecystostomy since 1981, and have used this method on 67 patients with gall bladder diseases. We also performed biliary endoscopic lithotripsy with PTCCS and percutaneous transhepatic cholangioscopy (PTCS) using a Nd-YAG laser or electrohydraulic shock wave lithotripter to non-operatively treat 83 patients with cholangiolithiasis, 11 with cholecystolithiasis, and four with cholecysto-choledocholithiasis. The present paper reports the PTCCS procedures and their usefulness for the precise diagnosis of early carcinoma of the gall bladder, and the usefulness and safety of biliary endoscopic lithotripsy techniques.

Bile Duct Diseases↗
PubMed1979

Techniques of urinary undiversion surgery in children.

During the past eight years, reestablishment of previously diverted urinary tracts has become more frequent. During the past three years, 11 patients have been evaluated and 7 subsequently operated on to reestablish continuity of the urinary tract. Four patients were eliminated from surgical consideration because of the extent of renal disease. The surgical procedures involve the use of ileum as well as the transureteroureterostomy with the psoas hitch procedure to reestablish urinary continuity. Examination of the over-all results illustrates urinary undiversion surgery in children is worthwhile. The initial results with neuropathic bladder disease has been a little discouraging, and more data will be required before a conclusion can be reached.

Adolescent↗
PubMed1987

Monoclonal antibody 486 P 3/12: a valuable bladder carcinoma marker for immunocytology.

Monoclonal antibodies directed against tumor-associated antigens of bladder carcinoma were used to identify tumor cells in bladder washout specimens of 40 patients with bladder carcinoma (group 1), 41 with no bladder disease or with urinary tract infections (group 2), 41 who received long-term mitomycin C instillation therapy after excision of the tumors (group 3) and 39 who received no prophylaxis after excision of the tumors (group 4). In all groups the same bladder washout specimen was used for standard urinary cytological and immunocytological tests. True positive results were obtained in 90 per cent of the patients in group 1 according to our immunocytological criteria and in 43 per cent according to standard cytology studies. No urine specimens in group 2 (controls) were immunocytologically positive, while 16 of 41 in group 3 and 17 of 39 in group 4 were positive immunocytologically but only 4 and 5, respectively, were positive according to standard cytology studies. Further followup of these patients will show whether cells positive for monoclonal antibody 486 P 3/12 will permit early detection of recurrent bladder cancer and whether one can identify patients who require prophylaxis after removal of the superficial bladder tumors.

Antibodies, Monoclonal↗
PubMed2006

Preliminary study of p53 and c-erbB-2 expression in gallbladder cancer in Indian patients manuscript id: 8962091628764582.

BACKGROUND: The inactivation of the tumour suppressor gene and activation of the proto-oncogene are the key steps in the development of the human cancer. The p53 and c-erbB-2 are the best examples of it. In the present study, our aim was to determine the role of these genes in the carcinogenesis of gallbladder by immunohistochemistry. METHODS: In all 78 consecutive patients of gall bladder diseases were studied for p53 and c-erbB-2 expression immunohistochemically and their expression was correlated with the age, grades and stages of the disease and presence of stone. An informed consent was obtained in each case. Chi square and z test were applied to see the association of p53 and c-erbB-2 over expression with other clinicopathological factors. RESULTS: Eight (20%) patients of gall bladder cancer were positive for p53 expression and 10 (25%) patients for c-erbB-2. The p53 positivity increased with increasing grade while cerbB-2 positivity decreased with increasing grade of gall bladder cancer. Mean age in cerbB-2 positive cases were lesser as compared to negative cases while p53 did not show such association with age. CONCLUSION: Only one case of gall bladder cancer co-expressed the p53 and c-erbB-2, thereby suggesting that p53 and c-erbB-2 may have independent role in carcinogenesis of gall bladder cancer. c-erbB-2 over expression in adenoma and younger age group indicates its role as an early event in carcinogenesis of gallbladder. However study of larger sample is required to further validate the results.

Adenocarcinoma↗
PubMed1996

The effect of NG-monomethyl-L-arginine on bladder function.

Recent studies have demonstrated the presence of nitric oxide synthase (NO synthase) in lower urinary tract tissues, however, its role in the detrusor is unclear. The current study was designed to determine if NO synthase inhibition alters detrusor activities, including micturition volume threshold, and inhibition of pelvic nerve-evoked contractions by various stimuli. In naive, anesthetized adult cats, inhibition of pelvic nerve-evoked bladder contractions, induced by hypogastric nerve stimulation or the intraarterial administration of NA, ATP, adenosine, beta,gamma-methylene ATP and 2-methylthio ATP, was measured before and after inhibition of NO synthase. The micturition volume threshold was also measured before and after NO synthase inhibition. L-NMMA decreased the micturition volume threshold by 38% (2 mg intravesical administration) or 80% (4 mg/kg i.a.). The magnitude of the micturition contractions was modestly increased. These results, and information in the literature, indicate that NO may play a role in the collection phase of the bladder cycle and any alteration of nitric oxide availability could induce or allow development of various bladder malfunctions, such as small bladder diseases, like interstitial cystitis.

Animals↗
PubMed1997

Helicobacter pylori among Egyptian patients with chronic liver diseases. A comparative study.

The prevalence of Helicobacter pylori in Egyptian patients with different stages of liver diseases was compared to those with normal liver status. Eighty patients subjected to upper gastrointestinal endoscopy were enrolled. They were divided according to their liver status into two groups; the first patients with liver cirrhosis and the second who had no liver affection. Gall bladder diseases were excluded by abdominal ultrasound examinations. Endoscopic antral mucosal biopsies were used for H. pylori screening by both culture and urease test, and for histopathological examinations. Both groups were matched as regards age, sex, and socioeconomic conditions. Culture was positive in 42.2% and 40.7% of patients in both groups respectively (P > 0.05). Urease test showed positive results in 58% and 76.6% in both groups respectively (P > 0.05). Helicobacter pylori prevalence showed no significant differences between both studied groups as regards age, sex, or type of gastric lesions. Furthermore, liver status in patients with chronic liver diseases does not play a role in distribution of infection. The study shows the high prevalence of H. pylori among Egyptians and the absence of a relation between H. pylori and chronic liver diseases.

Adult↗
PubMed1991

[Tumors of the urethra].

For a period of 6 years 416 men with bladder tumors have been treated by transurethral resections and hemotherapy. The bladder disease was associated with tumors of the urethra: 15.6 per located in its prostate portion and 3.1 per cent in the cavernous part. The urethral tumors were also treated by transurethral resections, ureterotomy and total cystectomy. It was shown that the numerous transurethral resections of bladder tumors contribute to the appearance of urethral tumors: 79 per cent of these developed after the 5. transurethral resection. The results of this study led to a number of inferences: Tumors in the cavernous portion of the male urethra appeared at a relatively younger age (mean 57.8 years); the membranous portion of the urethra is a particular borderline in the histologic structure and the prognosis; appearance of tumors in the cavernous part of the urethra is a poor prognostic sign--tumors in this zone may run a fulminant course with rapid lethal outcome. Inferences were drawn on the methods of choice of treatment of combined bladder tumors and tumors in the cavernous portion of the urethra.

Aged↗
PubMed1992

Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state.

SOS (Swedish obese subjects) is an on-going intervention trial designed to determine whether the mortality and morbidity rates among obese individuals who lose weight by surgical means (gastric banding, vertical banded gastroplasty and gastric by-pass) differ from the rates associated with conventional treatment. For this purpose, the study is recruiting a sample of obese men and women who constitute a registry of potential subjects from which the participants are drawn. Eligibility criteria for participation in the registry were: age at application 37-57 years and BMI greater than or equal to 34 kg/m2 for men and greater than or equal to 38 kg/m2 for women. Before receiving a health examination, all patients complete extensive questionnaires on current and past health status, utilization of medical care and medications, socio-economic status, psychological profiles, dietary habits, physical activity, weight history, and familial disposition to obesity. Each surgical case is matched to its optimal control in the registry, to ensure that the two groups do not differ systematically with respect to any of 18 matching variables that may affect prognosis. The first 1006 subjects included in the registry have been studied with respect to morbidity and compared with on-going population studies of men and women in Göteborg, Sweden. The relative risks of prevalent disease and symptoms associated with obesity in 50-year-old males and females respectively were 4.3 and 4.7 (dyspnoea), 14.7 and 11.8 (angina), 6.3 (myocardial infarction, males only), 2.1 and 4.5 (hypertension), 5.2 and 6.6 (diabetes), 4.6 and 26.1 (claudication) and 1.7 and 1.8 (gall bladder disease). Correspondingly, obese males and females display elevations of systolic and diastolic blood pressure, fasting glucose, insulin, triglyceride, and uric acid levels. However, total cholesterol was not increased in obese males and was in fact significantly lower in obese compared with reference women. HDL-cholesterol was lower in obese than reference men (data were not available in reference women). The rate of taking sick pensions was over twice as high in SOS obese patients than in population controls. Finally, comparison of measurements with self-reported prevalence estimates revealed a considerable amount of previously undiagnosed hypertension and diabetes in the obese subjects. These data suggest that the excess health risks associated with obesity may not be fully appreciated.

Adipose Tissue↗