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PubMed1990

The role of intraarterial vasodilators in the treatment of inadvertent intraarterial injection injuries.

Inadvertent arterial injections, both in cases of drug addiction and in iatrogenic situations, often result in significant loss of tissue and, eventually, loss of function distal to the injection site. Previous experimental studies regarding the effectiveness of agents to reverse vasospasm have been inconclusive. A recent clinical report, however, suggested that intraarterial injection of reserpine was affective in limiting tissue necrosis. This experiment was designed to study the affect of intraarterially injected reserpine and tolazoline hydrochloride in a rabbit ear model of necrosis following intraarterial injection of pentothal. Six groups of 5 rabbits each were studied. Animals in Group 1 received intraarterial saline injections. Animals in Group 2 received intraarterial pentothal. Animals in Group 3 received intraarterially injected pentothal plus intraarterial reserpine 30 minutes later. Animals in Group 4 received intraarterially injected pentothal plus intraarterial tolazoline 30 minutes later. Animals in Group 5 received intraarterially injected pentothal plus intraarterially injected reserpine and intraarterially injected tolazoline both administered immediately. Animals in Group 6 received intraarterially injected pentothal plus intraarterially injected reserpine and intraarterially injected tolazoline, both administered 30 minutes later. Results showed no significant difference in the amount of tissue necrosis between treated and untreated animals. We conclude that the use of intraarterial spasmolytic agents has no effect on the course of tissue necrosis after inadvertent intraarterial injections.

Animals↗

PubMed1993

Effect of transdermal clonidine on spinal spasticity. A case series.

Clonidine, a centrally acting alpha 2 receptor adrenergic agonist, has been successfully used as adjunctive therapy in patients with spinal cord injury with problematic spasticity not adequately controlled by recognized spasmolytic agents. A transdermal system providing approximately constant and continuous systemic delivery of clonidine has been recently introduced to enhance patient compliance. However, experience with transdermal clonidine in the management of spasticity is limited. Three cases are presented of patients with spasticity as the result of cervical spinal cord injury, inadequately managed by oral baclofen, in whom transdermal clonidine was administered. Significant improvement in spastic hypertonia was observed in all three cases. Transdermally delivered clonidine was well tolerated, with reported side effects limited to dryness of the mouth.

Administration, Cutaneous↗

PubMed1999

Relaxant effect of magnesium and zinc on histamine-induced bronchoconstriction in dogs.

OBJECTIVE: Magnesium sulfate (MgSO4) has been reported to produce bronchodilation in asthmatic patients. In vitro studies have suggested that divalent cations inhibit L-type voltage-sensitive calcium ion (Ca2+) channels in cardiac and smooth muscles. In this study, we evaluated the in vitro and in vivo effects of magnesium ion (Mg2+) and zinc ion (Zn2+) on the airway contracted by histamine. SETTING: A university research laboratory. SUBJECTS IN VITRO: Tracheal smooth muscle from guinea pigs. IN VIVO: Mongrel dogs. MEASUREMENTS AND MAIN RESULTS IN VITRO STUDY: The tension of isolated guinea pig tracheal strips was measured isometrically with a force displacement transducer. The specimen was contracted with histamine (10 microM). Then, MgSO4 (n = 6), zinc sulfate (ZnSO4, n = 6), or sodium sulfate (Na2SO4, n = 6) was cumulatively added to the organ bath. IN VIVO STUDY: The bronchial cross-sectional area of mongrel dogs was measured by a direct visualization method demonstrated previously. The dogs were randomly assigned to three groups: group Mg (n = 7), group Zn (n = 7), and group Na (n = 7). Bronchoconstriction was elicited with histamine (10 microg/kg plus 500 microg/kg/hr iv). Thirty minutes after the start of histamine infusion, 0 (saline), 1, 10, and 100 micromol/kg ZnSO4 or 1, 10, 100, and 1000 micromol/kg MgSO4 or Na2SO4 were administered intravenously in group Zn, Mg, or Na, respectively. The bronchial cross-sectional area was assessed before (basal) and 30 mins after the start of histamine infusion and 5 mins after each dose of ZnSO4, MgSO4, or Na2SO4. Arterial blood was also obtained to measure plasma levels of epinephrine and norepinephrine by gas chromatography-mass spectrometry. All data are expressed as mean +/- SEM. The doses of the divalent cations that reversed histamine-induced contraction by 50% were calculated by GraphPad Prism. MgSO4 and ZnSO4 (9.38+/-0.28 and 1.84+/-0.30 mM, respectively) relaxed histamine-contracted tracheal strip in a concentration-dependent manner, whereas Na2SO4 did not. Similarly, the in vivo study showed that MgSO4 and ZnSO4 dose-dependently reversed histamine-induced bronchoconstriction (potency, ZnSO4 > MgSO4), whereas Na2SO4 did not. In groups Mg and Zn, the plasma catecholamine levels also dose-dependently increased except when 1000 micromol/kg MgSO4 was administered. CONCLUSION: Because the divalent cations tested produced a spasmolytic effect on the contracted airway, infusion of divalent cations might be effective against asthmatic attack. However, high concentrations of these cations produce significant toxicity, so dosage will be an important concern in development of these agents.

Animals↗

PubMedDate not supplied

Helical hydro-CT for diagnosis and staging of gastric carcinoma.

PURPOSE: The purpose of this work was to define the accuracy of helical hydro-CT (HHCT) in the diagnosis and staging of gastric carcinoma. METHOD: One hundred twelve patients with gastric carcinoma were preoperatively imaged by HHCT. Gastric distension was achieved by ingestion of up to 1,500 ml of water. Bolus tracking was performed, and peristalsis was minimized by intravenously administered spasmolytics. Contrast material was then injected, and helical scanning was performed at the time of peak enhancement of the liver. CT images were analyzed for tumor infiltration of the gastric wall, and TNM staging criteria were applied according to the International Union Against Cancer (UICC) classification. The results were correlated with histopathologic findings. RESULTS: One hundred two of 115 (89%) gastric carcinomas were correctly diagnosed by HHCT. Small malignant ulcers (< or =2 cm) that corresponded to early gastric carcinoma were not visible on CT scans. T and N staging accuracies were 51% each; abdominal M staging was correct in 79% of all cases. The positive and negative predictive values of HHCT to foresee curative resection of gastric carcinoma were 75 and 84%, respectively. CONCLUSION: Mural thickening as well as marked contrast enhancement of the gastric wall are firmly related to gastric carcinoma. The accuracy of HHCT is acceptable for M staging but inadequate for local staging of gastric carcinoma. Nonetheless, HHCT is a useful guide for choosing between tumor resection and nonoperative treatment of patients. We therefore recommend HHCT as the method of choice for preoperative imaging of gastric carcinoma.

Adult↗

PubMed1993

Trefoil peptide gene expression in small intestinal Crohn's disease and dietary adaptation.

We examined the patterns of trefoil peptide gene expression in the ulcer-associated cell lineage (UACL) and mucosa adjacent to Crohn's disease in humans and during gastrointestinal adaptation to enteral feeding in rats. In the UACL, human spasmolytic polypeptide (hSP) mRNA and peptide are present in the acinar and proximal duct cells, whereas pS2 mRNA and peptide are found in the distal duct cells and in the surface cells. In mucosa adjacent to UACL, pS2 mRNA and peptide are expressed ectopically by goblet cells and neuroendocrine cells. Intestinal crypts associated with the UACL showed marked neuroendocrine cell hyperplasia. Ultrastructural immunolocalization showed pS2 to be copackaged in the mucous cell and neuroendocrine granules. The copackaging of a secretory protein in both mucous and neuroendocrine granules, which have different functions, is unusual and indicates an important role for pS2 in the secretory process itself or as a ligand delivered to its receptor via multiple routes. We also cloned the newest trefoil peptide, intestinal trefoil factor (ITF), from human and rat intestinal mucosa. Using in situ hybridization we demonstrated its synthesis by normal rat intestinal goblet cells. RNAse protection analysis revealed that the level of mRNA for rat ITF in small and large intestine was affected by the process of enteral feeding. We conclude that trefoil peptides are widely distributed in the intestine in human inflammatory bowel disease and are of considerable potential functional importance.

Animals↗

PubMed1997

Trefoil peptides: mitogens, motogens, or mirages?

Healing of mucosal damage occurs in two phases: restitution of mucosal integrity followed by remodeling with recreation of mucosal architecture. Models of these phenomena include cryoprobe-induced ulcers, NSAID lesions, and surgical anastomosis. Three trefoil peptides are expressed constitutively by epithelial cells in specific regions of the GI tract: pS2 (gastric), spasmolytic polypeptide (SP, gastric and Brunner's glands), and intestinal trefoil factor (ITF, goblet cells). Altered expression occurs in reparative epithelium and adjacent mucosa. In cryoprobe ulceration, rSP mRNA abundance doubles within 2 h, with rITF mRNA becoming detectable after 2-3 days. TGF-alpha and EGF mRNAs do not increase as rapidly as rSP or to the same extent as rITF. Indomethacin lesions of gastric mucosa show increased SP immunoreactivity deep in damaged glands within hours. Surgical anastomotic damage increases rITF mRNA levels at the ulcer edge and sometimes rSP mRNA and peptide in para-anastomotic crypts. Initially, trefoil peptides were viewed as mitogens. However, they are in fact motogens, able to promote cell migration, and may possibly be morphogens. Interactions occur between trefoils and other wound healing peptides (FGFs and EGF). Trefoil peptides appear to be of considerable importance to mucosal healing and might constitute a biologic target of therapeutic relevance.

Animals↗

PubMed1986

Intussusception of the vermiform appendix: a preoperative diagnosis in an adolescent girl.

Intussusception of the vermiform appendix (IVA) in a 14-year-old girl is reported. The diagnosis was made preoperatively, which is rare: only five other cases have been reported. IVA can present with variable symptoms. This patient presented with episodes of recurrent severe paroxysmal pain and vomiting, each episode being separated by several uneventful weeks. The diagnosis of IVA could be made at the fourth attack of colic by the radiological visualization of a "spiral shell" filling defect at the bottom of the cecum that was reducible by intravenous injection of a spasmolytic. Laparotomy with appendectomy rescued the patient from these distressing episodes. Although IVA is an uncommon condition, one should be aware of its existence and include it in the differential diagnosis of acute abdominal syndromes. When confronted with a clinical picture of intussusception in older children or adolescents, one should especially remember this entity as a differential diagnosis with other causes of intussusception, especially tumors.

Adolescent↗

PubMedDate not supplied

Pharmacological studies on cadralazine: a new antihypertensive vasodilator drug.

Cadralazine is a new, orally effective antihypertensive vasodilator. Acute experiments indicate that the compound reduces blood pressure and increases heart rate. The doses which reduce systolic blood pressure by 25% (ED25) are very similar after oral and intravenous administration (spontaneously hypertensive rats, 1.8 mg/kg, p.o.; 2.3 mg/kg, i.v.; renal hypertensive dogs, 0.26 mg/kg, p.o.; 0.24 mg/kg, i.v.; awake normotensive dogs, 0.98 mg/kg, p.o.; 1.01 mg/kg, i.v.). By both routes the peak effect is reached after 3-5 hr, and the activity lasts more than 24 hr. Repeated oral administration in spontaneously hypertensive rats reduces blood pressure with no evidence of tolerance. Cadralazine reverses hypertensive responses to epinephrine in awake normotensive dogs and anesthetized cats. The inhibition of the increase in blood pressure induced by sympathetic outflow activation in pithed rats parallels the antihypertensive activity in onset, intensity, and duration. The effects of cadralazine are not due to a blockade of alpha-adrenoceptors, sympathetic neurons, or ganglionic transmission. Cadralazine has no antihistaminic, anticholinergic, or spasmolytic activity and no specific effect on behavioral tests. In comparison with hydralazine, cadralazine has less acute toxicity and a greater activity by the oral route.

Animals↗

PubMedDate not supplied

Prostacyclins are only weak antagonists of coronary vasospasm induced by authentic thromboxane A2 and serotonin.

The actions of prostacyclin and its synthetic analog iloprost on the release and action of platelet-derived serotonin (5-HT) and thromboxane (TX) A2 were studied in vitro. Washed human platelet suspensions (WPS) (4 X 10(8) platelets/ml) were stimulated with arachidonic acid (AA) (30 mumol/L) and the incubate transferred into an organ bath containing bovine coronary arteries (BCA) in Krebs-Henseleit buffer supplemented with a mixture of blocking agents, including indomethacin. This resulted in a biphasic contraction of the coronary arteries, consisting of first, a TXA2-mediated response and second, a 5-HT-mediated response. The 5-HT-mediated reaction was dose-dependently inhibited by methysergide (IC50: 80 nmol/L). Treatment of the WPS with prostacyclin (PGI2) or iloprost prior to stimulation by AA resulted in a dose-dependent inhibition of the 5-HT-mediated contraction, due to inhibition of 5-HT release. The TXA2-mediated component, as well as the concentration of immunoreactive TXB2 in the bath medium, remained unchanged. Addition of PGI2 or iloprost to the BCA prior to transfer of stimulated WPS to the bath medium was followed by a dose-dependent inhibition of both phases. This, however, required concentrations of 100 nmol/L 5-HT and greater than 300 nmol/L TXA2 (IC50), which already produced a nearly complete direct relaxation of the vessel preparations (EC50: 30 nmol/L). It is concluded that a significant spasmolytic action of prostacyclins against platelet-derived vasoconstrictors in vivo might only be obtained at concentrations that already produce considerable direct effects on vessel tone.

Animals↗

PubMed1988

Short- and long-term cerebrovascular effects of nitrendipine in hypertensive patients.

The aim of our studies was to evaluate the effect of acute treatment in hypertensive emergencies and of chronic and acute treatment in uncomplicated hypertensives with calcium antagonists on blood pressure (BP) and cerebral blood flow (CBF). Ten patients with high blood pressure requiring emergency reduction were randomized to treatment with oral nifedipine or intravenous clonidine. The effect on CBF was investigated using xenon-133. Twenty-one patients with mild to moderate hypertension were randomly assigned to nitrendipine (n = 10) and to verapamil treatment for 4 weeks. After 14 days of washout, all patients received chlorthalidone for 4 weeks. CBF was measured before calcium antagonists, after 4 weeks, after washout, and after 4 weeks of chlorthalidone. Until now, five patients with mild to moderate hypertension entered in an ongoing study. After 14 days of placebo, CBF and BP reduction were measured 2 h and 6 weeks after nitrendipine. In hypertensive emergencies, nifedipine and clonidine lowered BP significantly, whereas CBF increased after nifedipine and decreased after clonidine. After chronic treatment with nitrendipine and verapamil and after chlorthalidone, the BP-lowering effect was significant whereas CBF remained unchanged. Two hours after nitrendipine, BP decreased and CBF remained unchanged. The reason for increasing CBF in hypertensive emergencies after nifedipine is due to its spasmolytic effect on cerebral vessels. The unchanged CBF after short- and long-term treatment with nitrendipine is due to the fact that in these patients the autoregulatory mechanism is intact.

Adult↗

PubMed1988

The mode of action of pinacidil and its analogs P1060 and P1368: results of studies in rat blood vessels.

In rat portal vein and aorta, pinacidil (0.3-100 microM) inhibited spontaneous mechanical activity (portal vein) and responses to norepinephrine (0.001-100 microM) and to KCl (5-80 mM). Pinacidil and its analogs P1060 and P1368 inhibited established contractions to 20 mM KCl but had little effect on responses to 80 mM KCl. The order of spasmolytic potency was P1060 greater than pinacdil greater than P1368. Intracellular electrical recording showed that in a portal vein, pinacidil (0.3-10 microM) abolished spontaneous electrical activity and hyperpolarised the cells to the region of the calculated EK. Pinacidil (3-10 microM) produced a similar hyperpolarisation in rat aorta, and in both tissues the hyperpolarisation was maintained in the continuing presence of pinacidil. Using 86Rb as a K+ marker, pinacidil increased 86Rb exchange in both the rat portal vein and aorta. The analog P1060 also increased 86Rb efflux in the rat portal vein; P1368 had no significant effect. It is concluded that the inhibitory effects of pinacidil in rat blood vessels are associated with the opening of 86Rb-permeable K+ channels. This mechanism produces a low-resistance pathway in the membrane and this inhibits the ability of pressor agents to produce smooth muscle contraction.

Animals↗

PubMed2002

In vivo characterization of the molecular-genetic changes in gastric mucosa during the development of acute gastritis and stress ulceration.

BACKGROUND: Trauma patients are at risk for the development of stress ulceration. Stress ulceration should be associated with increased heat-shock gene (iHSP70) and an inhibition of the trefoil peptide, spasmolytic polypeptide (SP), and mucin (MUC5AC) gene expressions. METHODS: Male Sprague-Dawley rats (10 weeks old) were restrained for 0-, 4-, 8-, 12-, and 24-hour periods of time. Gastric ulcers were graded using a one- to three-point scoring system. The level of mucosal gene expression was determined at each time point for three genes: iHSP70, SP, and MUC5AC. RESULTS: Gastric ulceration developed in direct proportion to the duration of restraint. Gastric ulceration was preceded by increased iHSP70 and decreased SP and MUC5AC gene expressions. CONCLUSION: Restraint-induced gastric ulceration was preceded by an up-regulation of iHSP70 and a down-regulation of SP and MUC5AC gene expressions.

Acute Disease↗

PubMed1994

Vascular freezing--a new method for immediate and permanent vasospasm relief: an experimental study in the rat.

Although much work has been done on the etiology and prevention of vasospasm, a spasmolytic agent capable of firmly protecting against or reversing vasospasm has not yet been found. In this paper, we describe a new physical method of treating vasospasm. It consists of directly freezing the arterial walls. Experiments were performed on the epigastric artery of 40 female Sprague-Dawley rats. A vasospasm was created by mechanical vessel manipulation. The vasospasm was treated by freezing the vessel walls with a dermatologic hand-held liquid nitrogen spray. Vascular spasm and patency controls were made immediately after thawing and 30 minutes and 3, 10, and 120 days after freezing. Epigastric island flaps were harvested based on the frozen artery at 3, 10, and 120 days after the freezing procedure. Histologic studies also were effectuated 3, 10, and 120 days after the freezing procedure. Relief from vasospasm was instantaneous and permanent. After freezing, almost all the cells in the media and endothelium died and the adrenergic fibers degenerated. This was followed by a phagocytic debridement, complete regeneration of the endothelium, and a limited regeneration of the muscle fibers in the media. The adrenergic innervation was recovered, and no alterations in the adrenergic fibers distal to the lesion were noted at any time. None of the arteries examined underwent thrombosis, and all the flaps harvested survived very well, indicating that the vascular bed distal to the site of the freezing was normal. This vascular freezing technique may well have clinical applications for microsurgical transfers and for the prophylactic treatment of vasospasm disease. However, its indications still require clarification.

Animals↗

PubMed1997

Drug-induced vasodilation in an in vitro and in vivo study: the effects of nicardipine, papaverine, and lidocaine on the rabbit carotid artery.

Extreme arterial vasoconstriction (vasospasm) is a common problem encountered in microvascular surgery. An ideal pharmacologic tool able to counteract ischemia during microsurgery should be easy to apply and exert its action both locally and distally in the microcirculation of the flap. We have compared in vitro and in vivo vascular properties of nicardipine, papaverine, and lidocaine in the rabbit carotid artery. In vitro, rings from the rabbit carotid artery (n = 7) were bathed in Krebs-Ringers solution and stretched progressively to an optimal tension of 3.7 to 4.2 g. The specimens were contracted with norepinephrine (1 microM), and a cumulative dose response curve was established. In vivo, microvascular anastomoses were performed bilaterally in the rabbit carotid artery in 35 animals using 9-0 nylon suture and standard microsurgical techniques. During and after the anastomoses, nicardipine (0.1, 0.01 mg topical, or 0.1 mg/hour IV), papaverine (30 mg/cc topical), and lidocaine (2% with and without epinephrine) were applied (blinded) at the anastomotic site in five rabbits each. Heparinized sodium chloride was used as topical irrigation for control and to clean the anastomosis. Blood flow changes were monitored continuously with the transonic Doppler for 30 minutes after the procedure. The systemic blood pressure was also monitored in a group of pilot experiments. A documented decrease in blood flow was noted in all animals after the microvascular anastomosis. Nicardipine and papaverine evoked a concentration-dependent relaxation to precontracted rings to norepinephrine. Nicardipine was greater than papaverine in inducing relaxation. Lidocaine demonstrated a biphasic response with low concentrations potentiating contraction. Systemic nicardipine and papaverine significantly increased the blood flow in the rabbit carotid artery. Topical application of nicardipine and lidocaine did not significantly alter the blood flow; however, the application of nicardipine demonstrates a trend toward increased flow. Lidocaine with epinephrine significantly decreased the blood flow. No drug was found to alter the blood pressure of the animals. Our results demonstrate that nicardipine and papaverine seem to be pharmacologic tools able to increase the blood flow in anastomotic arteries. In contrast, the use of 2% lidocaine as a spasmolytic agent should be re-evaluated, since this substance may act as a partial agonist.

Administration, Topical↗

PubMed1995

Treatment of Spasticity in Spinal Cord Injury with Dronabinol, a Tetrahydrocannabinol Derivative.

Spinal-cord-injured patients and the medical literature have increasingly reported anecdotes regarding tetrahydrocannabinol (THC)-induced spasmolysis. These reports motivated this trial of dronabinol, a THC derivative, for the treatment of spasticity in the spinal-cord-injured population. Five made quadriplegic patients were given oral dronabinol in escalating doses from 5 mg BID to 20 mg TID in addition to their current, but ineffective, spasmolytic regime. The pendulum drop test was used to quantify spasticity (stiffness) in the knees. The Weschler Memory Scale (WMS), Profile of Mood States (POMS), and personal interviews were administered by the clinical psychologist to evaluate any changes in the subjects' cognition and/or emotional states. Spasticity was markedly improved in two of the five subjects, unchanged in a third, fluctuated in a fourth and made progressively worse in a fifth. The WMS revealed improvement in memory skills of two subjects and no change in the other. Psychological interviews and the POMS indicated decreased vigor in all subject, but otherwise demonstrated highly individualized emotional changes as indicated by increases and/or decreases in the dysphoric mood scales.

Journal Article↗

PubMed2003

Differential protein analysis of spasomolytic polypeptide expressing metaplasia using laser capture microdissection and two-dimensional difference gel electrophoresis.

Full analysis of cellular protein constituents is a valuable tool in the evaluation of tissues. Traditional methods of evaluation, however, are time-consuming and difficult to reproduce. Two-dimensional difference gel electrophoresis (2D-DIGE), a recently developed proteomic system, affords the ability to compare and evaluate protein extracts from multiple sources. Coupled with laser capture microdissection (LCM), this technology is a powerful tool in comparing the protein profiles of separate pure cell populations. Proteins are labeled in vitro with reactive cyanine dyes that fluoresce at differential wavelengths, and after comigration on two-dimensional gels, differing protein populations become apparent. The unique aspect of this technology is the ability to identify and quantify proteins from separate preparations without issues of gel-to-gel differences. These techniques coupled with the systems for robotic acquisition of specific spots on the gel, tryptic digestion, and MALDI mass spectrometry permit identification of proteins differentially expressed in two pure cell populations. The authors used these new technologies to analyze the protein constituents of spasmolytic polypeptide expressing metaplasia (SPEM), a gastric mucosal metaplasia (fundic antralization or pseudopyloric metaplasia) that develops in the atrophic fundus mucosa of mice infected with Helicobacter felis and in humans infected with Helicobacter pylori. In addition, SPEM has been identified in the atrophic mucosa surrounding a high percentage of gastric adenocarcinomas and may represent a precursor lineage of malignancy. This technology recognized 28 differentially expressed proteins between SPEM and surface cells. Identification of novel SPEM-related proteins would allow the development of new immunohistochemical antibodies to further study this important metaplasia.

Animals↗

PubMedDate not supplied

Computed tomography-guided anterior approach to the superior hypogastric plexus for noncancer pelvic pain: a report of two cases.

The objective of this study was to evaluate the possibility and describe the methodology of a computed tomography-guided anterior approach to superior hypogastric plexus block for noncancer pain. A computed tomography-guided anterior approach to the superior hypogastric plexus was used in 2 patients with pelvic pain and anatomic disturbance of the lumbar spine, which was a contraindication to the conventional dorsal approach. The first case was a 43-year-old patient suffering from burning pain of the urethra. Pain relief using analgesics and antidepressants was insufficient. The posterior approach was excluded due to coexisting irritation of the L5 nerve root. The second case was a 68-year-old man suffering from chronic burning and itching pain of the urethra and glans penis. Conservative therapy (anti-inflammatory drugs, tramadol, spasmolytics) failed to provide satisfactory pain relief. The posterior approach was contraindicated because of laterally prominent L5 vertebral body osteophytes. Both patients received a prognostic block to the superior hypogastric plexus via the anterior approach guided by computed tomography. Visual analog scale scores prior to the block were 6 to 7 and 5 to 6, respectively. The visual analog scale scores 24 hours after the block were 1 and 0, respectively. The second patient received a permanent neurolytic block via the anterior approach to provide long-term pain relief. In conclusion, the authors describe the computed tomography-guided anterior approach to the superior hypogastric plexus for chronic pelvic pain. The technique is simple to perform, and the analgesic effect is satisfactory. More extensive studies are necessary to evaluate the safety of this approach.

Adult↗

PubMed2003

Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones.

PURPOSE: We evaluated the efficacy of the alpha1-adrenergic antagonist tamsulosin for conservative expulsive therapy in patients with ureteral colic due to juxtavesical stones. MATERIALS AND METHODS: A total of 60 consecutive symptomatic patients with stones located in the juxtavesical tract of the ureter were randomly divided into group 1--30 who received oral floroglucine-trimetossibenzene 3 times daily and group 2--30 who received 0.4 mg tamsulosin daily. The 2 groups received 30 mg deflazacort daily for 10 days plus cotrimoxazole 2 times daily for 8 days and 75 mg diclofenac injected intramuscularly on demand. Ultrasound followup and medical visits were performed weekly for 4 weeks. Stone passage rate and time, analgesic use, hospitalization and endoscopical intervention were evaluated. Statistical analysis was performed using the Student t test. RESULTS: The stone expulsion rate was 70% for group 1 and 100% for group 2. Mean stone size was 5.8 and 6.7 mm, respectively (p = 0.001). Mean expulsion time was 111.1 hours for group 1 and 65.7 hours for group 2 (p = 0.020). The mean number of diclofenac injections was 2.83 for group 1 and 0.13 for group 2 (p <0.0001). Ten group 1 patients were hospitalized, of whom 9 underwent ureteroscopy, compared with none in group 2 (p <0.0001 and 0.001, respectively). CONCLUSIONS: Tamsulosin used as a spasmolytic drug during renal colic due to juxtavesical calculi increased the stone expulsion rate and decreased expulsion time, the need for hospitalization and endoscopic procedures, and provided particularly good control of colic pain.

Administration, Oral↗