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PubMed2002

Variability in infusion pressure and continuous flow rate delivered from pressurized bag pump flush systems.

Using 10 different infusion bag pressure pumps, indicated manometer pressures were compared with measured infusion pressures proximal to the flow-regulating device in an in vitro experiment. Flow rates delivered through the flow-regulating device were gravimetrically measured at different monitored pressure levels. Significant differences were found between manometer and measured infusion pressures among the tested pressure bagpumps (e.g. 500 ml bag volumepressurized to 300 mmHg manometerpressure: 219.6 +/- 7.8 to 407.2 +/- 2.7 mmHg). The infusion pressures were additionally affected by the vertical level of the infusion bag pump and by the volume of the infusion bag. Flow rates delivered through the flow-regulating device were directly correlated to the measured infusion pressure (r2= 0.9926). Differences inflow rates can have a considerable impact on maintaining catheter patency and avoidance of fluid overload and retrograde flushing into the central arterial circulation in neonates and small children. A simple manoeuvre using the invasive pressure transducer allows monitoring and adjustment of the infusion pressure in the clinical setting.

Humans↗

PubMed2001

Foot pressures during gait: a comparison of techniques for reducing pressure points.

PURPOSE: Various methods have been used to redistribute plantar surface foot pressure in patients with foot ulcers. This study was conducted to determine the effectiveness of four modalities (fracture walker, fracture walker with insert, and open and closed toe total contact casts) in reducing plantar foot pressure. METHODS: Ten healthy, normal volunteer subjects had an F-scan sensor (ultra thin shoe insert pressure monitor) placed under the right foot. They then ambulated on a flat surface, maintaining their normal gait. Dynamic plantar pressures were averaged over 10 steps at four different sites (plantar surface of great toe, first metatarsal head, base of fifth metatarsal, and plantar heel). All subjects repeated this sequence under five different testing conditions (barefoot, with a fracture walker, fracture walker with arch support insert, open and closed toe total contact cast). Each subject's barefoot pressures were then compared with the pressures during the different modalities. RESULTS: All four treatment modalities significantly reduced (p < 0.05) plantar pressure at the first metatarsal head (no method was superior). The fracture walker, fracture walker with insert, and open toe total contact cast significantly reduced pressure at the heel. Pressures at the base of the fifth metatarsal and great toe were not significantly reduced with any treatment form. CONCLUSION: The fracture walker, with and without arch support, and total contact cast can effectively reduce plantar pressure at the heel and first metatarsal head.

Adult↗

PubMed1985

Geographical and socioeconomic distribution of high blood pressure and borderline high blood pressure in a Swedish rural county.

This report on "high" blood pressure (HBP) and "borderline high" blood pressure (BHBP) is based on a cross-sectional study in a rural Swedish county. The study was initiated in the Spring of 1977, selecting 7986 individuals aged 25-75 years, in 5-year intervals, in the 16 municipalities of Skaraborg County. A combination of health examination and a survey using polling of the population by interview was used. The blood pressure values that are presented are based on a casual measurement taken after a 5-minute rest period. The limits of HBP and BHBP correspond to the Swedish standard limits. Only a few researchers in Sweden have focused on the correlation between socioeconomic factors and hypertension. Moreover, few examinations have been made internationally concerning the correlation between socioeconomic factors and borderline hypertension. There was a significant variation in mean values of high blood pressure when comparing socioeconomic groups and comparing occupations. These differences associated with educational level were more pronounced for women than for men. Workers, especially men and persons with less formal education, had the highest mean blood pressure. Significant differences between socioeconomic groups existed even after adjustment for age, sex, weight index, smoking and treatment of hypertension. The socioeconomic differences constitute the most plausible explanation of differences seen between municipalities. "Borderline high" blood pressure was more prevalent than "high" blood pressure. Socioeconomic differences were greater within the borderline high blood pressure group than in the high blood pressure group. i.e., the differences between workers and civil servants were somewhat greater in the borderline high blood pressure group. Since there are socioeconomic differences, it might be possible to concentrate preventive activities in local communities on risk groups.

Adult↗

PubMedDate not supplied

The effect of carotid sinus pressure changes on mean circulatory filling pressure in the anaesthetized rabbit.

The effect on mean circulatory filling pressure (MCFP) of changes in pressure within the vascularly isolated carotid sinus has been studied in anaesthetized rabbits. With the sinus exposed to arterial pressure (102 +/- 6 mm Hg; mean +/- SEM) MCFP was 6.18 +/- 0.40 mm Hg. At sinus pressures of 160 and 40 mm Hg, MCFP was 5.71 +/- 0.39 and 6.43 +/- 0.33 mm Hg respectively. The mean difference of 0.72 +/- 0.06 mm Hg between MCFP at these two sinus pressures was significant (P < 0.001). MCFP varied with blood volume when this was increased or reduced by 8%, but at each blood volume level the difference between MCFP at high and low sinus pressure remained significant (P < 0.01). The gradient for venous return, MCFP minus right atrial pressure, was altered by changes in carotid sinus pressure, being 0.60 +/- 0.12 mm Hg less at a sinus pressure of 160 mm Hg than at a sinus pressure of 40 mm Hg. This difference was significant (P < 0.01).

Anesthesia↗

PubMed1985

Effects of ischemia on pressure-velocity and pressure-volume relationships in the isolated rabbit left ventricle.

The pressure-velocity and pressure-volume relationships were determined in the isolated rabbit left ventricle in order to evaluate ventricular function during global ischemia (low pressure perfusion) and under reperfusion after a 10 min complete coronary occlusion (reperfusion after coronary occlusion). Reducing coronary perfusion pressure, the maximum isovolumic pressure (P0) decreased, but the maximum ejection velocity (Vmax) did not. The slope of the end-systolic pressure-volume relationship (Emax) decreased without any significant change in the volume-axis intercept. On the other hand, under reperfusion after coronary occlusion, both P0 and Vmax were depressed considerably, but Emax quickly recovered to the control level. Thus, Vmax and Emax show different behavior depending on the ischemic conditions. To analyze the relaxation process under low pressure perfusion and reperfusion after coronary occlusion, the pressure-velocity relations during the relaxation phase were determined by the isovelocity method. Similar to the relation for contraction phase, the relation obtained here could be adequately approximated by a hyperbolic equation. Under the control condition, the relaxation velocity was always lower than the contraction velocity at the corresponding pressure level, and the ratio of the maximum filling velocity (Rmax) to Vmax was relatively constant. Although both Rmax and Rmax/Vmax were little affected by the low pressure perfusion, Vmax and Rmax, especially Vmax, decreased when the ventricle was reperfused after coronary occlusion, resulting in an increased Rmax/Vmax.

Animals↗

PubMed1989

[Research related to pressures under dentures. The effect of differences in impression pressure with special reference to unilateral mandibular free-end edentulousness].

The purpose of this paper is to investigate the difference of impression pressure under denture bases made by the pressure impression-taking method, which considers the resiliency of ligaments under abutment teeth and mucosa under dentures, and under those made by the non-pressure impression-taking method, and then analyzed its influence on the distribution of pressure curve produced by bite force with the case of unilateral mandibular free-end edentulousness. The findings were as follows: 1. As for the pressures under the dentures, dentures made by the pressure impression-taking method in all cases showed an apparent increase at the mesial part, while at the distal part, a decrease was detected in three out of five patients. 2. The pressure curve caused by bite force tended to rise sharply immediately before the application of maximum bite force. 3. Ratio of pressures resulting from the increased bite force tended to increase with dentures using the non-pressure impression-taking method, while dentures using the pressure impression-taking method showed a clear tendency to equalize toward 0.5, regardless of the values of the bite force.

Bite Force↗

PubMed2000

Pressure support and pressure assist/control: are there differences? An evaluation of the newest intensive care unit ventilators.

BACKGROUND: Pressure support (PS) has been widely studied in both patients and lung models, but there is little data available evaluating pressure assist/control (P A/C, frequently referred to as PCV) and no data comparing the operational capabilities of these two modes on the newest generation of ICU ventilators. We used a spontaneously breathing lung model to evaluate the response of the following new generation ventilators to varying inspiratory demand in both PS and P A/C: Bear 1000, Dräger Evita 4, Hamilton Galileo, Nellcor Puritan-Bennett 840 and 740, Siemens Servo 300A, TBird AVS. METHODS: A bellows-in-a-box lung model was set at a respiratory rate of 12 breaths/min, inspiratory time of 1.0 second, and peak inspiratory flows (modified square wave) of 40, 60, and 80 L/min. Each ventilator was set at three levels of PS and P A/C: 10, 15, and 20 cm H(2)O. On all ventilators, flow-triggering was set as sensitive as possible without causing self-triggering. RESULTS: Trigger pressure, trigger pressure-time product, inspiratory trigger time delay, ventilator-delivered peak flow, inspiratory area as a percent of the ideal inspiratory area, expiratory time delay, supraplateau expiratory pressure change, and expiratory area all varied among ventilators and at different lung model peak flows (p < 0.01 and >/= 10% difference). However, PS and P A/C on a given ventilator only differed with regard to expiratory variables (p < 0. 01 and >/= 10% difference). CONCLUSION: In a given ventilator little difference exists in gas delivery and response variables between PS and P A/C, but performance differences do exist among the ventilators evaluated. Ventilator performance is diminished at high lung model peak flows and low pressure settings. (I)), whereas PS gives control over ending inspiration to the patient. What has not been clearly defined is the gas delivery and ventilator response differences, if any, between these two (PS and P A/C) pressure targeted assist modes. Most new generation intensive care unit (ICU) ventilators provide both pressure support (PS) and pressure assist/control (P A/C) ventilation.19,20 The specific operational difference between these two modes is the mechanism that transitions inspiration to expiration. With pressure support the primary mechanism is a decrease in peak inspiratory flow to a predetermined level, whereas with P A/C mechanical T(I) is preset.19,20 We compared the operation of seven of the newest generation ICU ventilators in a spontaneously breathing lung model in both PS and P A/C. We hypothesized that there would be no difference in variables assessed between PS and P A/C except for the transition to expiration and that there would be no difference in response among ventilators evaluated.

Equipment Safety↗

PubMed1998

[Energy metabolism of men in full pressure suit with additional pressure].

The energy metabolism of men in full pressure suit with additional pressure and without additional pressure were measured during rest and exercise. Results show that the rates of energy metabolism of men in full pressure suit with additional 28 kPa pressure and without additional pressure increased as the exercise load increased. The rates of energy metabolism of men in full pressure suit with additional 28kPa pressure had no significant difference during rest and 0.9W exercise, but significantly increased during 8.5 W exercise, as compared with that without additional pressure. It suggested that full pressure suit with 28 kPa did not affect human energy metabolism during rest, but affected during exercise.

Aerospace Medicine↗

PubMed1992

Blood pressure response to detrusor pressure elevation in patients with a reflex urinary bladder after a cervical or high thoracic spinal cord injury.

In 12 patients with a reflex urinary bladder after a cervical or high thoracic spinal cord injury, blood pressure was measured every 30 s during cystometry. Four consecutive cystometries were performed by means of suprapubical catheters and 50 ml/min filling rate. The aim was to improve the methodological basis for cystometrical studies of paroxysmal hypertension and its treatment. In each cystometry there was an elevation of the systolic (20-60 mmHg) and the diastolic (15-55 mmHg) blood pressure. The maximum blood pressure always occurred during the emptying phase and always in close relation to the peak of the detrusor pressure. The amplitude of the blood pressure response varied intraindividually, but did not change in any particular direction during the series of cystometries. Thus, a cystometrical method which stimulates the detrusor in a physiological way is sufficient to give the typical uninhibited blood pressure reaction in most patients with a reflex bladder and a spinal reflex vasomotor function after a high level spinal cord injury. The blood pressure reaction obtained with this method is probably representative for the daily reaction during physiological reflex emptying of the bladder. To describe the maximum blood pressure reaction, it has to be measured during a well defined emptying phase and close to the occurrence of the maximum detrusor pressure. Since repetition of cystometry did not change the blood pressure response, this cystometrical method is useful for evaluation of pharmacological intervention.

Adolescent↗

PubMed2005

Pressure breathing without a counter-pressure vest does not impair acceleration tolerance up to 9 G.

INTRODUCTION: This study was to determine whether safe and adequate G-protection by pressure breathing during G (PBG) could be maintained if the COMBAT EDGE counter-pressure vest were eliminated to ensure aircrew do not unnecessarily endure a possible in-flight discomfort or distraction. METHODS: Centrifuge exposures up to +9 Gz were completed by 11 subjects, including 5 F-15 aircrew, using PBG at 60 mmHg pressure with and without the counter-pressure vest. Additional G-exposures using pressures of 0, 30, and 45 mmHg were performed without the vest. RESULTS: Elimination of the COMBAT EDGE counter-pressure vest did not significantly reduce G-tolerance. During gradual onset G exposure, the mean G level reached with PBG was 8.4 G without the vest and 8.2 G with the vest. In comparison, 6.7 G was reached without PBG. Mean times at G with rapid onset G exposure were 59 and 60 s, respectively, compared with 49 s without PBG. PBG, with or without the vest, was preferred by all test subjects. PBG at 60 mmHg produced the highest G protection and was preferred by the test subjects over lesser pressures. Subjects reported no adverse effects from the use of PBG without chest counter-pressure. CONCLUSION: The use of PBG and the anti-G straining manuever (AGSM) together enhances G tolerance and comfort more than AGSM alone. Elimination of the counter-pressure vest during use of PBG does not hinder an individual's ability to reach +9 Gz or complete a short duration simulated aerial combat maneuver G exposure. Further research is needed to determine if use of PBG without chest counter-pressure increases fatigue during multiple sorties or produces other aeromedical problems in operational environments.

Acceleration↗

PubMedDate not supplied

'In situ' high pressure confocal Ca(2+)-fluorescence microscopy in skeletal muscle: a new method to study pressure limits in mammalian cells.

We combined 'in situ' high pressure microscopy with confocal laser scanning microscopy to directly study Ca2+ homeostasis in intact mammalian (murine) skeletal muscle fibres during high pressure exposure up to 35 MPa. Cytosolic Fluo-4 and mitochondrial Rhod-2 Ca2+ fluorescence were simultaneously monitored. To separate changes in Ca2+ and direct/indirect effects of pressure on the dye, experiments in permeabilized ('skinned') muscle fibres were performed at a fixed Ca2+ concentration. Normalized Fluo-4 fluorescence sharply declined up to 10 MPa but showed a plateau between 10 MPa and -35 MPa. In the intact fibre, Fluo-4 fluorescence exponentially decreased during pressurization to 35 MPa with a pressure constant of pi-5 MPa whereas mitochondrial Rhod-2 fluorescence exponentially increased with a four-fold larger pi. Holding the pressure at 35 MPa almost did not change Fluo-4 fluorescence. However, Rhod-2 fluorescence started to decrease after -40 min. Upon decompression, Rhod-2 and Fluo-4 fluorescence increased exponentially with similar pi. However, initial Fluo-4 fluorescence values were not restored. Our results are in agreement with pressure induced Ca2+ leakage from the sarcoplasmic reticulum. Ca2+ might then be taken up in large amounts by mitochondria preventing cytosolic increase in Ca2+. Prolonged pressure applications (-40 min at 35 MPa) seem to destabilize mitochondrial function with release of Ca2+ from mitochondria back into the cytosol and eventually mechanical activation resulting in irreversible contractures. The pressure induced disturbance of Ca2+ homeostasis might have important implications for the pressure exposure limits and/or dive profiles of deep sea mammals.

Aniline Compounds↗

PubMed1989

[The evaluation of pressure gradients of various aortic valve prostheses by Doppler ultrasound and influence of pressure gradients to left ventricular function].

Although the pressure gradients of heart valve prostheses has been discussed over the years, currently available valve prostheses are still not sufficient and may leave pressure gradients following aortic valve replacement. The selection of valve prosthesis and its size is still controversial. This study is aimed to measure the pressure gradients of 64 aortic valve prostheses noninvasively by means of doppler ultrasound and determine which size and what kind of valve prosthesis is suitable for aortic valve replacement. 1. Pressure gradients and LV function were serially assessed pre- and post operatively. Left ventricular mass index regressed to a normal range and the response to exercise test is quite satisfactory in the patients whose pressure gradients were less than 25 mmHg. In the cases that showed pressure gradients more than 25 mmHg, however, left ventricular hypertrophy significantly remained even 5 years after aortic valve replacement and the response to exercise was not good enough. From these results, it is concluded that the upper limit of acceptable pressure gradients is 25 mmHg in aortic valve prosthesis. 2. The pressure gradients of St. Jude Medical (SJM) valve (11 cases), Björk-Shiley (B-S) valve (7 cases), Lillehei-Kaster (L-K) valve (13 cases) and Omniscience (O-S) valve (33 cases) was evaluated to compare the hemodynamic characteristics in the long term follow-up periods. In SJM and B-S, a correlation between valve area index (geometrical valve orifice area/body surface area) and pressure gradients was significant. The valve area index more than 1.4 cm2/m2 in SJM or more than 1.7 cm2/m2 in B-S should be selected. Whereas for L-K and O-S, a correlation between valve area index and pressure gradients was not significant and it is suggested that his is due to suboptimal disc opening angle (L-K; 54 degree on the average, O-S; 46 degree on the average). For this reason, the use of these prostheses is not recommended for choice in the aortic position.

Adult↗

PubMed1978

Normal blood pressure and the evaluation of sustained blood pressure elevation in childhood: the Muscatine study.

This study describes the seated blood pressure distributions of 6,622 predominantly white schoolchildren in Muscatine, Iowa. Subjects with seated pressures equal to or greater than the 95th percentile for age and sex or 140 mm Hg systolic or 90 mm Hg diastolic were examined on repeated occasions. Approximately 13% of subjects were found to have blood pressures at these levels when first examined, but less than 1% were found to have persistent blood pressure elevations. Of 41 subjects found to have persistent blood pressure elevations, 23 were obese with relative weights in excess of 120%. Of the 18 lean subjects, 5 had secondary hypertension and 13 were considered to have essential hypertension. Mass screening of school-age children identifies many children with transient elevation of blood pressure and few with fixed high blood pressures. Children's blood pressures should be assessed during their continuing care where pressures can be measured over a period of time to identify those with fixed blood pressure elevations.

Adolescent↗

PubMed1983

High pressure NMR studies of hemoproteins. The effect of pressure on the tertiary and quaternary structures of human adult ferrous hemoglobin.

The effect of pressure on the tertiary and quaternary structures of human oxy, carbonmonoxy, and deoxyhemoglobin was examined by high pressure NMR spectroscopy at 300 MHz. The increased pressure displaced the ring current-shifted gamma 1-methyl resonance of beta E11 valine for oxy- and carbonmonoxyhemoglobin to the upfield side, whereas that of the alpha subunit was insensitive to pressure. Such a preferential pressure-induced upfield shift for the beta E11 valine gamma 1-methyl signal was also encountered for the isolated carbonmonoxy beta chain. For deoxyhemoglobin, hyperfine shifted resonances of the heme peripheral proton groups and the proximal histidyl NH proton for the beta subunit were pressure-dependent, in contrast to the pressure-insensitive responses for these resonances of the alpha subunit. These results indicate the structural nonequivalence of the pressure-induced structural changes in the alpha and beta subunits of hemoglobin. The exchangeable proton resonances due to the intra- and intersubunit hydrogen bonds which have been used as the oxy and deoxy quaternary structural probes were not changed upon pressurization. From all of above results, it was concluded that pressure induces the tertiary structural change preferentially at the beta heme pocket of the ferrous hemoglobin derivatives with the quaternary structure retained.

Adult↗

PubMed1984

Discrepancy between wedged hepatic venous pressure and portal venous pressure after acute propranolol administration in patients with alcoholic cirrhosis.

In patients with alcoholic cirrhosis, wedged hepatic venous pressure closely reflects portal venous pressure. This study was carried out to determine if propranolol-induced reductions in portal venous pressure are accurately evaluated by the measurement of wedged hepatic venous pressure. Hepatic venous cannulation and percutaneous transhepatic catheterization of the portal vein were simultaneously performed in 7 patients with alcoholic cirrhosis. One hour after oral administration of 40 mg of propranolol, wedged hepatic and portal venous pressures significantly decreased from 24.3 +/- 3.5 (mean +/- SD) to 19.0 +/- 3.0 mmHg, and from 24.7 +/- 3.9 to 22.4 +/- 3.6 mmHg, respectively. Although no significant difference was found between baseline wedged hepatic and portal venous pressures, a significant difference was found between these pressures after propranolol administration. We concluded that during acute administration of a drug acting on the splanchnic circulation, the measurement of wedged hepatic venous pressure may not provide a reliable estimation of the magnitude of the changes in portal venous pressure. There is, however, no evidence that the direction of the changes might not be adequately assessed by wedged hepatic venous pressure measurement.

Aged↗

PubMed1982

The relationship between tourniquet pressure and underlying soft-tissue pressure in the thigh.

UNLABELLED: Soft-tissue pressures in specimens of the lower extremities of cadavera, obtained following hip disarticulation, were measured directly beneath a pneumatic thigh tourniquet to establish the relationship between the tourniquet pressure and underlying soft-tissue pressure. It was found that the tissue pressure was consistently lower than the tourniquet pressure and that the percentage of tourniquet pressure reflected in the underlying tissue varied inversely with the circumference of the thigh. It was also found that the pressure decreased with increasing depth of the soft tissue. CLINICAL RELEVANCE: the use of a pneumatic tourniquet is potentially associated with injury to underlying muscles, vessels, and nerves if excessive pressure occurs beneath the tourniquet. In order to minimize the risk of soft-tissue injury, the lowest tourniquet pressure that maintains a bloodless field should be used. A nomogram based on data generated in this experiment is provided as a guide to determining appropriate tourniquet pressures.

Anthropometry↗

PubMed1995

The Bergen blood pressure study: offspring of two hypertensive parents have significantly higher blood pressures than offspring of one hypertensive and one normotensive parent.

OBJECTIVE: To study blood pressure and antihypertensive drug treatment in subjects with contrasting family histories of hypertension. SUBJECTS AND METHODS: We grouped 520 offspring examined in 1990 (mean +/- SD age 36 +/- 7 years) according to their parents' blood pressure screened in 1963-1964 as offspring of two normotensive (systolic/diastolic blood pressure < 135/70 mmHg) parents (group 1); offspring of one hypertensive (> or = 145/95 mmHg) and one normotensive (<135/70 mmHg) parent (group 2); and offspring of two hypertensive (> or = 140/90 mmHg) parents (group 3). Offspring blood pressure was measured with a conventional mercury sphygmomanometer by one observer. The mean of the last two of three seated measurements was used for analyses. Drug treatment was determined by interview. RESULTS: Mean +/- SD blood pressure was lowest in group 1 (121 +/- 12/72 +/- 10 mmHg), intermediate in group 2 (125 +/- 12/76 +/- 9 mmHg) and highest in group 3 (135 +/- 15/85 +/- 11 mmHg), P<0.01 for each. Of the subjects in groups 1, 2 and 3, 1.3, 2.4 and 11.7%, respectively, were taking antihypertensive drugs (P<0.01). CONCLUSIONS: Screening blood pressure in parents has implications for offspring blood pressure almost 30 years later. Offspring of hypertensive parents have higher blood pressure and are given antihypertensive drugs at higher rates than the offspring of normotensive parents. Also, substantial differences were seen between the offspring of one and of two hypertensive parents. Thus, risk associated with a family history of hypertension varies with the definition of the family history. To obtain maximum contrast in the predisposition to high blood pressure, comparative studies in offspring of hypertensive and normotensive families should be based on blood pressure data from both parents.

Adult↗

PubMed1997

Effect of intra-abdominally induced pressure on the urethral pressure profiles of healthy and incontinent bitches.

OBJECTIVE: To determine whether reduced pressure transmission is of importance in the pathophysiologic mechanism of urinary incontinence in bitches. ANIMALS: 20 sexually intact, continent bitches and 21 spayed, incontinent bitches. PROCEDURE: Urethral pressure profiles before (resting) and after (stressed) insufflation of gas in the abdominal cavity were recorded in bitches under general anesthesia. Differences (stressed minus resting) were calculated for all variables. On the basis of these values, the pressure transmission ratio was determined. RESULTS: Resting pressure profiles of incontinent bitches indicated significantly (P < 0.05) lower maximal closure pressure (4.5 +/- 3.0 cm of H2O) than did those of continent bitches (11.2 +/- 7.2 cm of H2O). The intra-abdominal pressure increase lead to a shortening of total profile length, which was equal in both groups and caused an increase in maximal urethral pressure. The change in maximal urethral pressure was significantly (P < 0.05) greater in incontinent bitches (12.4 +/- 4.1 cm of H2O) than in continent bitches (8.8 +/- 4.5 cm of H2O). The profile areas and the pressure transmission ratios did not differ significantly (P < 0.05) between the 2 groups. CONCLUSION: The effect of decreased pressure transmission on the urethra is not a factor in the pathophysiologic mechanism of urinary incontinence attributable to urethral incompetence in bitches.

Abdomen↗