Carcinosarcoma of the urinary bladder in an adult male.

Carcinosarcoma of the urinary bladder in a 64-year-old man is described. Total cystectomy with bilateral ureteroileostomy was performed. The patient is in good health 12 months after the operation. Histologically the main bulk of the tumour tissue was rhabdomyosarcomatous, but in some areas atypical glands were intermingled with the rhabdomyoblasts. This histologic pattern has not previously been described. The histologic features, clinical manifestations and treatment of these rare bladder tumours are discussed in relation to the literature.     

Pedobarometric evaluation of the normal adult male foot

Static and dynamic pedobarometric evaluations were performed on the feet of 100 normal adult white men aged from 20 to 49 years old (mean = 29.9 +/- 6.9), using version 3.848 of the F-SCAN system. All evaluations were performed using new pressure sensor insoles with standardized conditions. Maximum vertical forces and plantar peak pressure measurements were taken during 7.88 seconds each of walking in a straight line at subject's own pace and standing. Feet were separated based on their side and lower limb dominance. The means of three consecutive and three alternate tests provided quantitative data. Maximum static and vertical dynamic forces were found to be greater on the dominant side and were significantly correlated with body weight. There were significant differences between dominant and non-dominant sides in static plantar peak pressure evaluations at the forefoot and midfoot, and in the dynamic evaluations at the midfoot. There was a significant correlation between dynamic plantar peak pressures at the midfoot and body weight.     

Filling mechanics of obstructed and de-obstructed rat urinary bladders.

Chronic bladder distension occurs after partial outlet obstruction and can lead to decompensation and impaired function. To quantify the degree of chronic bladder distension, we previously defined the zero pressure volume (ZPV), the largest contained volume at zero transmural pressure. In the current study, we investigated the short- and long-term effects of outlet obstruction and de-obstruction on chronic distension and passive bladder filling mechanics. Voiding patterns were measured 10 days (short term) or 6 weeks (long term) after partial bladder outlet obstruction and the bladders were tested in vitro at that time. De-obstructed bladders were obstructed for 6 weeks, and voiding patterns were measured 10 days or 6 weeks after de-obstruction, followed by in vitro testing. Mean voided volume was increased in de-obstructed bladders but not obstructed bladders. The volume of urine in the bladder at euthanasia was greater than mean voided volume in obstructed bladders and less than mean voided volume in de-obstructed bladders, indicating large residual urine in the obstructed bladders. ZPV was significantly increased only after long-term obstruction or de-obstruction. Similarly, intravesical pressure and mean bladder wall stress were increased only after long-term obstruction or de-obstruction. We conclude that tissue remodeling occurs in the bladder wall after long-term obstruction, possibly both as a result of and leading to chronic overdistension and high residual urine. Tissue remodeling occurs in the bladder wall after long-term de-obstruction, possibly due to large voided volumes. Neurourol. Urodynam. 18:659-671, 1999.     

Peptidergic innervation of the normal and obstructed human pyeloureteral junctions.

The neuropeptidergic innervation of the normal and obstructed human pyeloureteral junction was investigated using immunohistochemical techniques. A dense innervation of neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) in the intrinsic obstruction type was demonstrated. NPY and VIP formed networks in the muscular layer. NPY was also found in perivascular plexuses and VIP adjacent to the epithelium. Calcitonin gene-related peptide, galanin and substance P nerves were also seen in the muscular layer, although sparsely. It is proposed that NPY and VIP have a role in the pathophysiology of the intrinsic obstruction type of the human pyeloureteral junction. The innervation pattern of the junction with the external type of obstruction was similar to that of the normal pyeloureteral junction.     

Vardenafil‐induced relaxation and cyclic nucleotide levels in normal and obstructed rat urinary bladder

OBJECTIVE

To study the effects of the phosphodiesterase‐5 inhibitor, vardenafil, on contraction and cyclic nucleotide levels in isolated detrusor preparations with and without mucosa, from control rats and rats with partial urethral obstruction (PUO) and intact mucosa.

MATERIALS AND METHODS

Female Sprague‐Dawley rats were divided into groups subjected to PUO for 14 days (six), and sham‐operated control rats (12). Detrusor preparations were mounted in organ baths and effects of increasing concentrations of vardenafil (1 nm to 100 µm ) assessed on carbachol‐activated (1 µm ) preparations, and on contractions induced by transmural activation of nerves (electrical field stimulation, EFS). Levels of cGMP and cAMP were determined using radioimmunoassays.

RESULTS

Vardenafil caused concentration‐dependent relaxations of carbachol‐contracted detrusor, the mean (sd ) of which at 100 µm was 91 (4)% in control and 100% in PUO rats. The ?log 50% inhibitory concentration (IC₅₀) was 4.41 (0.08) and 4.73 (0.05) (P < 0.01), respectively. Removing the mucosa increased the relaxant effect of vardenafil at 1–10 µm (P < 0.05) although ?log IC₅₀ values were unaffected compared to the control. The cGMP levels ( pmol/mg protein) in control preparations increased from 2.5 (0.6) to 5.0 (0.8), and from 1.4 (0.2) to 7.2 (1.3) in obstructed bladders. In mucosa‐denuded preparations the cGMP content increased from 0.6 (0.1) to 1.6 (0.4) in response to vardenafil. In control rats, the levels of cAMP increased from 12.8 (2.5) to 18.9 (0.9) (P < 0.05) after vardenafil. In mucosa‐denuded preparations the cAMP levels after vardenafil increased from 16.5 (2.11) to 37.8 (3.4) (P < 0.01). In PUO bladders, the tissue content of cAMP increased from 12.6 (2.4) to 20.6 (3.4) (P < 0.01). Vardenafil concentration‐dependently inhibited nerve‐induced contractions in all groups studied. At 100 µm 19 (3)% of the control contraction remained, vs 8 (1)% for preparations from obstructed rats, and 11 (4)% in mucosa‐denuded preparations.

CONCLUSION

In normal rats, vardenafil relaxed carbachol‐ and inhibited EFS‐induced contractions of detrusor preparations with and without urothelium, and in PUO rats with urothelium. Relaxations were accompanied by increases in both cAMP and cGMP content. It is proposed that vardenafil‐induced relaxation of rat detrusor, also in obstructed and mucosa‐denuded preparations, is mediated via cAMP.     

Amikacin concentration in the severely obstructed urinary tract

Urinary amikacin concentration was determined in 9 patients with severely unilateral ureteral obstruction. Serum levels were within the normal range. The average concentration of amikacin in the urine from obstructed urinary tract was 118.9 mcg/ml 6 hours after 100 mg amikacin iv infusion. Urine concentration from the normal kidney was 155.9 mcg/ml at the first 2 hours after intravenous infusion, 98.8 at the second 2 hours 83.3 at the third 2 hours. Urinary amikacin excretion from severely obstructed urinary tract was about one third of the total excretion from a normal system. In summary, the urinary level in severely obstructed urinary tract after iv infusion of 100 mg amikacin may be enough prophylactically. But at the onset of infection in severely obstructed urinary tract, the administration of at least 200 mg amikacin intravenously is required.     

A new aspect of voiding dynamics: the relationship between flow rate and the frequency of drops in the external urinary stream.

The method of drop spectrometry gives the possibility of registering the instantaneous trend drop frequency and the instantaneous trend flow rate. By plotting the flow rate against the frequency, patterns are obtained which depend on the flow and the elasticity of the external meatus.     

The effect of oral bethanechol chloride on the cystometrogram of the normal male adult.

A double-blind study of the effects of placebo and oral bethanechol chloride (25, 50 and 100 mg.) on the carbon dioxide cystometrogram of the normal male adult was done. Statistical analysis of the data showed no significant dose-response relationship for any of the parameters measured.     

Functional obstructed voiding in the neurologically normal patient

Voiding dysfunction is common and often is the result of urethral obstruction to urine flow. Obstruction can be due to failure of the sphincteric mechanism to sufficiently relax. Such functional obstructions may have smooth and/or striated muscle components. Identifying and characterizing functional bladder outlet obstruction enables the physician to effectively treat these symptomatic patients.     

Long-term outcome of adult patients with minimal urinary abnormalities and normal renal function.

AIM: To define the long-term outcome of patients with minimal urinary abnormalities (defined by the presence of microscopic hematuria with no or less than 1 gm/day proteinuria), and normal renal function (defined by a serum creatinine < 1.3 mg/dl), we retrospectively studied patients who fulfilled the above criteria and had a kidney biopsy done before the year of 1992 (i.e. at least followed up for 5 years), with a definite pathological diagnosis. METHODS: A total of 41 cases among 719 cases of primary glomerulonephritis (5.7%) were enrolled into the study. There were 19 males and 22 females with a mean age of 35.4+/-14.7 years at biopsy. The duration of renal disease was 116.0+/-60.5 months and the duration of follow-up post biopsy was 100.2+/-38.1 months. The pathological diagnosis was: IgA nephropathy (21 cases), focal glomerulosclerosis (9 cases), mesangial proliferative glomerulonephritis (8 cases), membranous glomerulonephritis (2 cases) and acute glomerulonephritis (1 case). RESULTS: At the end of follow-up, 8 cases (19.5%) had a certain degree of renal insufficiency including 2 (4.9%) in end-stage renal disease. The other cases were either in complete remission (6 cases) or stable condition (27 cases) with persistent microscopic hematuria and normal renal function. The long-term outcome was not correlated with any of the following parameters: age, sex, disease duration, serum creatinine at presentation, daily protein loss at presentation, degree of glomerular change and degree of interstitial inflammatory cell infiltration. However, a poor long-term outcome was correlated with tubular atrophy (p < 0.05) and interstitial fibrosis (p < 0.05). CONCLUSION: We conclude that a minimal urinary abnormality with normal renal function at presentation does not necessarily imply a favorable long-term outcome in certain patients. Tubular atrophy and interstitial fibrosis but not glomerular change correlates with a worse prognosis. This further emphasizes the importance of renal biopsy in such cases.     

Elastin morphology in normal and obstructed guinea-pig bladders

Summary Elastin is the major component of elastic fibers in aortic tissue and has been suggested to be important for the stretch and recoil of the bladder. We have mapped the histologic distribution of elastin throughout the entire guinea-pig bladder as well as changes in the distribution of elastin during bladder-outlet obstruction. We used an animal model in which a jeweler's ring is placed around the urethra of the young guinea pig. As the animal grows, outlet obstruction is gradually induced, and the bladder gradually increases in total weight to as much as 8-fold that of controls. We localized the elastin histologically in normal and obstructed bladders by serially sectioning entire bladders and staining the sections with an elastin-specific stain, Verhoff-van Gieson stain (VVG). Surprisingly, we found that the elastin was predominantly localized only to the trigone of the bladder and that the elastin in this area was increased during obstruction. These results are consistent with the predominantly mesodermal embryologic origin of the trigone, since mesodermal tissues are more often associated with elastin expression.     

汉族正常年轻成年女性外鼻软组织测量及比较研究

目的 通过对汉族正常年轻成年女性外鼻软组织的测量和分析,将其同LG Farkas等针对北美白人女性的外鼻软组织测量数据进行比较,为外鼻部整形手术提供客观可靠的数据参考.方法 选择长沙地区就读的汉族正常女大学生63例.年龄18～25岁,平均23岁.以LG Farkas的头面部测量研究为基础,选择10个测量标记点和6个比例指数,对13个测量项目(10个线性距离,3个角度)进行测量.结果 计算测量项目和比例指数的均数和标准差,并进行种族间的比较.其中,5个线性距离较大(P<0.01),5个线性距离较小(P<0.01);鼻额角及鼻尖角较大,鼻唇角较小(P<0.01);6个比例指数中,鼻深-鼻宽指数、鼻翼长-鼻高指数、鼻小柱宽-鼻宽指数及鼻小柱高度-鼻深指数较小(P<0.01),鼻指数较小(P<0.05),鼻梁指数较小,其差异无统计学意义(P>0.05).结论 中国汉族女性与北美白人女性的外鼻软组织存在明显的差异.本研究可以为外鼻部整形手术提供有参考价值的外鼻软组织的正常值.     

Urodynamic exploration of the upper urinary tract. III. Recovery of obstructed kidney function

In cases of severe obstructive nephropathy, the quantification and potential reversability of a hydronephrotic atrophy is a fundamental factor in the choice between conservative and radical surgery. The information provided by non-invasive techniques, like excretory urography and the modern isotopic techniques, is limited by intercurrent phenomena, like infection and/or additional obstructive phenomena, which are frequent in patients presenting with hydronephrotic atrophy. It is therefore necessary, in such cases, to rely on direct procedures giving precise information concerning individual renal function, and, more particularly on percutaneous nephrostomy. The author's personal experience suggests that this procedure greatly improves the prognosis. But its results may be predictable in the light of a comparison of the analytical, manometric and radiological data provided by a transcutaneous punction of the kidney. In that event, it follows that the percutaneous nephrostomy is, of course, no longer indicated.     

成年男性患者气囊导尿管置管长度的探讨

目的探讨成年男性患者留置气囊导尿管置管的适宜长度。方法将587例非尿道畸形成年男性患者随机分为观察组(297例)和对照组(290例)。观察组置入导尿管至气囊入口与引流接口分叉处;对照组置入导尿管见尿液流出,再置入7～10cm,均充盈气囊后,轻拉导尿管至有阻力感后固定。比较两组患者24h内的不适感及血尿、尿道口流血、排尿困难发生率。结果两组患者不适感比较,差异无统计学意义(P0.05);血尿、尿道口流血和排尿困难发生率比较,差异有统计学意义(P0.05,P0.01)。结论置入气囊导尿管至气囊入口与引流接口分叉处再注入0.9%氯化钠溶液更加安全,能有效减轻患者痛苦。     

Clinical study concerning of latamoxef concentration in the obstructed urinary tract

Urinary LMOX concentration was studied in 18 patients with unilateral ureteral obstruction. The concentration of LMOX in the urine from the mild obstructed kidney was 124 to 2,140 micrograms/ml and 10 micrograms/ml in the severely obstructed ones. The difference was probably due to the intensity and the duration of the obstruction. The patient with 99mTc-DMSA renal uptake of less than 3% also had a urinary LMOX concentration of less than 7 micrograms/ml. The above results seem to show that 7 micrograms/ml in urinary LMOX concentration is a significant figure for treatment of UTI. 99mTc-DMSA renal uptake and renal echogram were used to estimate the excretion rate of antibiotics into the urine.     

Fatty acid profiles in normal and obstructed rabbit bladder smooth muscle and mucosa.

Partial bladder outlet obstruction results in progressive loss in contractile and specific cellular and subcellular membrane functions. There is evidence that ischemic activation of proteolytic and lipolytic enzymes play a major role in the etiology of bladder dysfunction secondary to partial outlet obstruction. The specific aims of the current study were to determine the fatty acid profiles in normal rabbit bladder smooth muscle and mucosa and to determine the effect of partial outlet obstruction on the distribution and content of free and total fatty acids. Fatty acids were isolated by extraction from obstructed and normal bladder smooth muscle and mucosal homogenates, and samples were analyzed by gas chromatography. All samples contained palmitic, stearic, oleic, linoleic, and arachidonic acids. A 100% increase in total fatty acid concentration was observed in the obstructed bladder muscle tissue relative to normal bladders, although the concentration of total arachidonic acid remained constant in the two groups. Significantly higher levels of free arachidonic acid were observed in the obstructed bladder muscle group compared to the normal group. No changes were observed in fatty acid concentrations or distributions in bladder mucosa. These data show that fatty acid composition is altered as a result of bladder obstruction and support the idea that obstruction increases the activity of lipase activity and/or decreases acyl transferase activity. Neurourol. Urodynam. 18:697-711, 1999.