Urodynamic aspects of continent urinary diversion. Review

Continence following urinary diversion depends on factors related to the reservoir and outlet. The reservoir should possess good compliance and no or atmost low pressured phasic contractions. The outlet should provide adequate outflow resistance to allow expulsion of urine under voluntary control and at convenient intervals. Overcoming high intra-reservoir pressures by producing high outlet resistance may endanger the upper urinary tracts. There is evidence that a low pressure reservoir may be constructed from any part of the bowel as long as detubularization of the segment is performed. All types of intussuscepted valves possess an inherent tendency to dessuscept despite various techniques which are employed to stabilize them. The causes are discussed and a recently described technique to overcome this problem is reviewed.     

Effects of serotonin on the internal anal sphincter: in vivo manometric study in rats.

The effects of serotonin (5-hydroxytryptamine, 5-HT) on the internal anal sphincter were studied in anaesthesized rats. Serotonin induced a dose dependent relaxation of the internal anal sphincter. Methysergide blocked this relaxation, but did not affect the rectoanal reflex. Methysergide did not antagonise the actions of cholinergic and adrenergic agonists on the internal anal sphincter. Other 5-HT antagonists such as cyproheptadine, ketanserin, chlorpromazine, amitriptyline and ergotamine failed to reduce or block the internal anal sphincter relaxation due to 5-HT, nor did they alter the rectoanal reflex. Adrenergic and cholinergic antagonists had no effect on the 5-HT-induced relaxation of the internal anal sphincter, suggesting that 5-HT acts upon the internal anal sphincter via a non-adrenergic, non-cholinergic mechanism. Tetrodotoxin reduced or blocked the relaxation of the internal anal sphincter produced by 5-HT, implying that 5-HT acts through neural pathways rather than directly on the muscle. It is concluded that although 5-HT relaxes the internal anal sphincter, it does not participate in the rectoanal reflex.     

Bullous pemphigoid and cholestatic hepatitis associated with Castleman's disease.

The case of a 21-yr-old woman admitted with a two-week history of icterus, fever, multiple peripheral lymphadenopathy and pruritic eruption is presented. A full evaluation including computed tomography, endoscopic retrograde cholangiography, liver, skin and lymph node biopsies and biochemical tests confirmed the diagnosis of multicentric Castleman's disease (angiofollicular lymph node hyperplasia). All symptoms improved within four weeks of commencing prednisone therapy. Castleman's disease should be considered in the differental daignosis of cholestatic hepatitis and bullous pemphigoid.     

Cholinergic properties of soy

OBJECTIVES: Soybeans have been shown to have numerous health benefits, but the underlying mechanisms are poorly understood. The aim of this study was to characterize some pharmacologic properties of active substances in aqueous soy extract. METHODS: The pharmacologic actions of the extract were tested by measuring mechanical activity of isolated guinea-pig ileum in an organ bath. RESULTS: The ileum contracted in response to soy extract in a concentration-dependent manner. This response was unaffected by the nerve blocker tetrodotoxin (10(-6) M) but was completely inhibited by atropine (10(-9) M), indicating an action via muscarinic receptors on the muscle. In the presence of the M(3) muscarinic antagonist 1,1-dimethyl-4-diphenylacetoxypiperidinium iodide and to a lesser extent in the presence of the M(2) muscarinic antagonist 11-([2-[(diethylamino)methyl]-1-piperidinyl]acetyl)-5,11-dihydro-6H-pyrido[2,3-b][1,4]benzodiazepine-6-one, the response was decreased. When acetylcholine (ACh) esterase inhibitors were added to the medium before the addition of soy extract, the response to the extract was potentiated. Preincubation of the extract with exogenous ACh esterase reduced its activity. The response to choline, ACh, and phosphorylcholine was also tested, and none of these substances accurately replicated the response to soy extract. However, some qualitative similarities were observed between the effect of choline and ACh to that of the extract. CONCLUSION: These results indicate the presence of an ACh-like substance in soy. Due to the abundance and importance of muscarinic receptors, the presence of a cholinergic substance in soy could have numerous implications. The role of this substance in the beneficial effect of soy on various body systems merits further investigation.     

The Effect of Helicobacter Pylori on Gastroesophageal Reflux Disease

Background and Objectives:

Helicobacter pylori infection represents one of the most common and medically prominent infections worldwide. Gastroesophageal reflux disease (GERD) has a multifactorial etiology. The nature of the relationship between Helicobacter pylori infection (HP) and reflux esophagitis is still not clear. This study is designed to find the influence of HP on GERD.

Patients and Methods:

The study was conducted retrospectively at Sakarya Newcity Hospital between January 2006 and January 2009. Data were collected on patient''s age, sex, weight, the grade of GERD and the severity of HP.

Results:

There were 1,307 women and 1,135 men in this review with a mean age of 39,54 (range, 17 to 70) years. Helicobacter pylori positive (1 to 3 severity) was frequently seen in patients with GERD. A statistically significant relationship was found between HP positivity and the grade of GERD. The Helicobacter pylori infection (1 to 3 severity) was found in 1,437 (82.5%) of patients with GERD in our series.

Conclusions:

Controversy still exists about the association between GERD and HP infection. Based on our findings, significant evidence suggests the potential role of HP infection in the development of GERD. Also, the current data provide sufficient evidence to define the relationship between GERD and HP infection.     

Complementary and alternative medicine use by patients chronically infected with hepatitis C virus.

Complementary and alternative medicine (CAM) is becoming increasingly popular in North America. The use of CAM is also popular in patients with chronic liver disease but is not well documented. The extent of use of CAM in chronic hepatitis C virus (HCV) infected patients was determined, and the demographic and clinical data between users and nonusers of CAM was compared. Seventy-six patients (30% female) with chronic HCV were interviewed. The mean age was 43+/-8 years. Current use of CAM for HCV was reported by 35 of 76 patients (46%). Eighteen of 76 patients within this group used herbal supplements (24%). The most commonly used herb was Silybum marianum (milk thistle), reported by 10 of 76 patients (13.2%). Commonly reported benefits of CAM use included reduction in fatigue, boost in the immune system and improved gastrointestinal function. No adverse effects of CAM use were reported. In the present study, four of 18 patients (22%) with chronic liver disease taking herbal therapies were on herbs that increased bleeding time. The use of CAM in chronic HCV patients is significant. Patients should be asked specifically about their use of CAM. CAM use may have implications affecting conventional treatment and management of HCV.     

The effect of bariatric surgery on inflammatory markers in women with polycystic ovarian syndrome

Aim

The aims of this study is to address the improvement in CRP and adiponectin in obese PCOS and non PCOS after bariatric surgery, and to show that obese PCOS women have a slower rate of improvement when compared to obese non PCOS women.

Modulation of dye coupling among glial cells in the myenteric and submucosal plexuses of the guinea pig.

Dye coupling among glial cells in the ganglia of the myenteric and submucosal plexuses of the guinea-pig ileum was studied by intracellular injection of the dye Lucifer yellow (LY), which crosses gap junctions. The injection of a single glial cell with LY resulted in the staining of many glia. The mean number of cells coupled to the injected one was 87.0 +/- 7.9 in the myenteric plexus, and 20.7 +/- 5.6 in the submucosal plexus. As previously shown for myenteric plexus, injection of horseradish peroxidase into submucosal glia resulted in the staining of only a single cell. Dye coupling was significantly reduced in both plexuses by lowering intracellular pH, by replacing 100 mM of the chloride ions with propionate ions or by bubbling the solution with 100% CO2. Octanol (0.3 mM) also markedly diminished dye coupling in the two preparations. These treatments are known to block gap junctions in a variety of tissues. It is concluded that, like central glial cells, enteric glia are extensively coupled. This coupling is apparently mediated by gap junctions.     

The actions of substance P and serotonin on myenteric neurons in tissue culture

Intracellular recordings were made from guinea-pig myenteric neurons in tissue culture. The responses to substance P (SP) and serotonin were compared. Putative transmitters were ejected by pressure from micropipettes. The response to SP was, in the majority of cases, a prolonged depolarization, with a latency of 1-5 s and a duration of 1-2 min. During the depolarization there was an increase in the input resistance of the cells, and the excitability was augmented. In two neurons the response to SP was hyperpolarization followed by depolarization. In about 30% of the cells the response to SP was relatively fast, with a duration of less than 10 s and a latency of less than 100 ms. These responses did not show desensitization. Serotonin induced relatively fast responses only, with durations of 0.3-3 s and latencies of 20-50 ms. These responses were usually depolarizing, but in 3 cells were hyperpolarizing. Two types of behaviour were observed during repetitive ejection of serotonin. Some cells showed strong desensitization while in others there was no desensitization and there was even summation. The actions of SP and serotonin were compared by their ejection in the same experiments. The same general properties described above were observed. It is concluded that the two putative transmitters act via distinct response mechanisms. The SP-induced depolarizations in tissue culture resemble in several respects the slow synaptic potentials recorded previously in myenteric neurons in freshly isolated preparations.     

Relationship between subjective complaints and urinary flow

Two hundred six patients were examined with urine flowmetry and residual urine measurements to determine if a relationship exists between pathologic urine flowmetry determinations and specific subjective patient complaints. A statistical correlation exists in men with the complaint of frequency and in women with the complaint of frequency and incontinence. Possible explanation for these findings is discussed.