Development of a non-invasive treatment system for urinary incontinence using a functional continuous magnetic stimulator (FCMS)

A system composed of a functional continuous magnetic stimulator (FCMS) and a saddle-type coil has been developed for non-invasive treatment of urinary incontinence, especially stress incontinence and urge incontinence. The FCMS conditions were as follows: 2 kW maximum electrical power consumption, 800 V maximum capacitor voltage, 720 μs pulsewidth (180 μs rise time), and 5–30 Hz frequency. A frequency between 5 and 10 Hz is used to treat urge incontinence and a frequency between 25 Hz and 30 Hz is used to treat urge incontinence. The coil (120 mm long, 90 mm wide and 50 mm thick) fits the most suitable region for this treatment, the region from the anus to the perineum. The coil is cooled to maintain a coil temperature between 20 and 25°C so that it can be used efficiently and safely. In experiments with anaesthetised dogs, it was confirmed that the urethral pressure increased when the circumference of the perineum received continuous magnetic stimulation of 720 μs pulsewidth (180 μs rise time), 10Hz frequency and about 520 V capacitor voltage. This result suggests that magnetic stimulation can be effective as a urinary incontinence therapy.     

Aortic Stenosis and Patent Ductus Arteriosus: Pressure Gradients Pre- and Posttranscatheter Ductal Occlusion

Three patients with patent ductus arteriosus and moderate aortic stenosis had a marked reduction in aortic valve gradient following transcatheter ductal occlusion. The hemodynamic effects of an aortopulmonary shunt on the severity of left ventricular outflow obstruction and the implications on intervention are discussed.     

四种小儿动脉导管未闭堵闭术的临床应用:附127例报告

本文采用四种不同的介入治疗方法堵闭动脉导管共127例,成功率海绵塞法为92％(23/25例),双面伞器法为98.6％(66/67例),钮扣式补片法为100％(26/26例),弹簧圈器法为100％(9/9例)。海绵塞法和弹簧圈器无残余分流;术后6个月双面伞器法残余分流为7％(5/67例),钮扣式补片法为15％(4/26例)。钮扣式补片法和弹簧圈器法无并发症,海绵塞法为24％(6/25例),双面伞器法为4％(3/67例)。我们认为,钮扣式补片法及弹簧圈器法在小儿动脉导管未闭的介入治疗中具有较大的应用价值。     

Transcatheter coil closure of large patent ductus arteriosus with 0.052-inch Gianturco coils using myocardial biopsy forceps in a 70-year-old woman

Small patent ductus arteriosus is generally closed in children using a transcatheter coil. This is done less often in older patients or those with large patent ductus arteriosus. We report successful antegrade transcatheter coil closure of patent ductus arteriosus in a 70-year-old woman. Into the patent ductus arteriosus, using flexible myocardial biopsy forceps, we placed two large 0.052-inch Gianturco coils, which were easily used as multipurpose vascular occlusion coils. The forceps and the coils were readily available and provided complete occlusion. Other delivery devices cannot deliver such large coils. Transcatheter coil closure thus appears to be safe and effective for closing large patent ductus arteriosus in the elderly.     

A simple technique for closure of the last laparoscopic working port

Closure of the last laparoscopic working port can be frustrating, particularly in the very obese. A technique is described that simplifies this procedure, using a grasping forcep to transfer the abdominal wall suture.     

A simple, inexpensive, life-saving way to perform iterative laparotomy in patients with severe intra-abdominal sepsis

Between 1 June 1993 and 31 December 1998, 17 patients underwent temporary abdominal closure with 3L urological irrigation bags, because in most cases, there was massive sepsis leading to the conclusion that primary closure was not advisable. Indicative of the seriousness of these conditions, Apache score averaged 19 (range 10–30). The technique consisted of suturing a double thickness of irrigation bags to each side of the wound, and joining the two bags in the midline with running sutures. Abdominal lavage with large quantities of fluid was performed every other day. This type of closure was used for a mean duration of 15 days. Mean length of hospitalization was 60 days. There were only three deaths (17.6%). No incisional hernia occurred after the iterative laparotomies. Deleting patients with acute pancreatitis would have reduced the death rate to only 7%. A 3L urological irrigation bag costs £11.60 (24.40$ CAN) while a Marlex mesh costs £81.40 (171.00$ CAN). We conclude that the usage of 3L urological plastic bags is a simple, safe and efficient method for temporary closure of the abdomen.     

Urethral pressure profile: Is it affected by position?

The aim of this study was to investigate the difference between sitting and standing passive urethral pressure measurements, and to determine the accuracy of urethral pressure profilometry in each position. Urethral pressure profilometry was performed in the sitting and standing position in 98 women. Stress incontinence due to urethral sphincter incompetence was demonstrated in 59 of whom 6 also had detrusor instability. The others were normal volunteers (7), women with a normal cystometrogram (23), and women with detrusor instability (9). MUCP tended to be higher in the standing than the sitting position but this did not reach statistical significance. Urethral lengthening appeared to occur on standing with a mean increase of FUL of 5 mm on standing. For both FUL and MUCP, there was a wide variation in the difference between sitting and standing values. There was poor reproducibility of measurements of MUCP and FUL in the standing position, limiting its clinical applicability. The difference between sitting and standing MUCP and FUL was not affected by age, parity, weight, height, BMI, or oestrogen status. In women with genuine stress incontinence, there was less difference between sitting and standing MUCP, but this explained only a small part of the variability. The increase in FUL in the standing position was unaffected by diagnosis.     

Prenatally detected gastroschisis presenting as jejunal atresia due to vanishing bowel

A case of gastroschisis complicated by vanishing bowel and presenting as jejunal atresia is reported that is uniquely different from previously reported cases. Following delivery, complete closure of the abdominal wall with a small fascial defect was observed. Complete healing of this fascial defect was observed at 1 month of age. Accepted: 5 January 1999     

Retropublic colpourethropexy with transabdominal anterior and/or posterior repair for the treatment of genuine stress urinary incontinence and genital prolapse

A new operative technique combining retropublic colpourethropexy with transabdominal internal anterior and/or internal posterior repair for the treatment of genuine stress incontinence (GSI) and genital prolapse is described in 75 cases. The overall success rate in correcting GSI was 92.0%, with a 94.8% success rate in the primary surgical group (n=58) and an 82.4% in the secondary group (n=17). Average follow-up has been 1.31 years (range 6 weeks–6 years). There was a 3.4% incidence of residual prolapse. Nine patients also underwent concomitant colpourethropexy. Overall surgical complications include febrile morbidity 4/75 (5.3%), wound infection 1/75 (1.3%), deep vein thrombosis 1/75 (1.3%) and partial ureteric obstruction 1/75 (1.3%). There were no statistically significant changes in multichannel urodynamic studies preoperatively and at 1 year following surgery. Onethird (2/6) of the GSI failures had low MUCP (<20 cm H₂O) prior to surgery and continued so at 1 year follow-up.EDITORIAL COMMENT: Genital prolapse is often present in patients who have GSI. If an operation is performed to correct the GSI, and those areas of weakness in the pelvic support system that are contributing to the genital prolapse are not treated, the genital prolapse will become more severe. In the operation which has been described, the colpopexy sutures will correct any cystourethrocele, and the removal of the wedge of tissue from the anterior superior vaginal wall will correct the cystocele. The removal of the wedge of tissue from the posterior superior vaginal wall will reduce the redundancy of the posterior vaginal fornix, but a culdeplasty of the Moschcowitz or Halban type is recommended to treat or prevent an enterocele and to place the vaginal apex in the hollow of the sacrum. Any coexistent rectocele must always be treated vaginally. If it is not treated, it will appear to be more advanced following elevation of the anterior vaginal wall by retropubic urethropexy and the anterior repair which has been recommended.Genital prolapse is best treated by a vaginal approach. When one must une an abdominal approach, ancillary procedures such as the authors have described should be considered. A bulbous upper vagina is ideal for childbearing but if the apical support system and vaginal wall is weakened it is predisposed to prolapse. If the surgeon, in operating for genital prolapse, which involves the upper vagina, will taper the vaginal apex and support it by obliteration of the cul-desac and shortening and reattachment of the uterosacralcardinal complex, postoperative prolapse will be less likely to recur.     

The immobilization response in rhesus monkey: a behavioral and electroencephalographic study.

Rhesus monkeys maintained in individual cages are rarely inactive when observed by humans unfamiliar to them. It has been observed that these animals display a greatly reduced behavioral repertoire after they are transferred to primate chairs. The present study used systemic behavioral observations to document those changes and to examine additional changes produced by arm restraint. Chair restraint was associated with a reduction in activity which was intensified when animals were further immobilized by arm restraint. This immobilization produced a reduction of tone in all limbs, a reduction of spontaneous behavior, and the appearance of eye closure. Electroencephalographic (EEG) correlates of the behavioral changes were examined also, using quantitative data generated through power spectral analysis of sensorimotor cortical EEG signals. Immobilization was accompanied by a significant increase in spectral density at 12 to 15 Hz which was most marked at mid and far lateral rholandic recording sites. No other significant changes were seen in the frequency bands studied. When the immobilized animal was alerted with novel stimuli, lower frequencies were attenuated but 12- to 15-Hz activity remained enhanced. These findings indicate that a unique immobilization response is elicited by restraint in the rhesus monkey which is associated with discrete changes in both behavior and accompanying EEG patterns.