A novel surgical technique for implanting a new electrostimulation system for treating female overactive bladder: a preliminary report

OBJECTIVE: To assess the results of peripheral electrostimulation of pelvic floor muscles in patients with overactive bladder (OAB) symptoms, and to describe a novel surgical technique for inserting a specially designed implantable electrostimulator which can deliver different forms of muscle stimulation through a para-urethral electrode. PATIENTS AND METHODS: The study included seven women with OAB (mean age 59 years) who had frequency (including nocturia), urgency and urge incontinence for > or = 1 year, and in whom conventional treatment failed. The antepubic technique was used to implant the electrostimulator and a para-urethral electrode. The patients' urinary symptoms and quality of life (King's College Hospital incontinence questionnaire) were compared before and after surgery, and possible complications monitored. RESULTS: The mean (range) follow-up was 14.5 (13-17) months in six and 10 months in the seventh patient (stimulator removed because of infection). The mean (range) frequency of 15 (13-23) voids/24 h before surgery decreased to 9 voids/24 h (i.e. by 40%) afterward. All patients had leakage episodes because of urgency (4-15 times/day) before surgery, which ceased in five afterward; these patients used no further pads. In the remaining two patients urgency incontinence continued after surgery, but with significantly fewer leakage episodes, from 15 and 12 per day before to 6.7 and 4 afterward, respectively. The mean degree of urgency (graded 0-3) decreased from 2 to 1.4 after surgery, and quality of life improved significantly. Urodynamic studies showed a greater mean maximum detrusor capacity, from 135 mL before to 189 mL after implanting the stimulator. CONCLUSIONS: The good results (over a follow-up of 1 year) in patients with OAB symptoms treated by the present electrostimulator should encourage further clinical studies in such patients. A trial to evaluate the efficacy of pelvic floor muscle electrostimulation in a broad spectrum of diseases of the lower urinary tract causing symptoms similar to OAB has been started.     

Combined training of GPs and practice-assistants on peripheral arterial disease: positive effects after six months

OBJECTIVES: To improve the use of the ankle-brachial index (ABI) measurement, and management of patients with peripheral arterial disease (PAD) a combined training, targeting GPs and practice assistants (PAs) was developed. To measure the effect of the combined training on the management of patients with PAD, a cross-sectional study was performed. METHODS: Fifty consecutive patients referred by GPs to a vascular surgery out-patient clinic were analysed. Six months after the training an additional fifty patients were included. In all patients the ABI measurement, risk factor management, and treatment as performed by the GP, prior to referral, were analysed. RESULTS: The measurement of the ABI significantly increased from 10% before the training to 53% after the training (GPs with training: 83%, GPs without training: 35%; P: 0.001). The referral of patients with actual PAD significantly increased from 32% before the training to 70% after the training (GPs with training: 83%, GPs without training: 59%; P: 0.05). The presence and treatment of risk factors did not differ between the groups. CONCLUSIONS: Within the limitations of a before and after study the combined training of GPs and PAs appears to be an effective method to increase ABI measurements and significantly improve adequate diagnostics.     

Artificial attenuation of ECG voltage produces shortening of the corresponding QRS duration: clinical implications for patients with edema

BACKGROUND: Prolonged QRS duration (QRSd) is a useful index for the management of patients with congestive heart failure (CHF). QRSd is affected by changes in the ECG voltage (ECGV) in the context of development and amelioration of peripheral edema (PERE), independent of underlying pathology. Nowadays, physicians accept QRSd measured by computer techniques. The latter offers the possibility of testing the hypothesis that artificial alteration of the ECGV, simulating effects of PERE, could lead to changes in the QRSd. METHODS: To this end, voltage was attenuated by 25%, 50%, and 75% in 100 digital ECGs recorded from normal subjects and in 20 patients with complete left bundle branch block (LBBB), by merely increasing the calibration strength by 4/3, 2, and 4, respectively, and by using the same data. RESULTS: All ECGs were analyzed by the same computer program and this led to a reduction of global QRSd by 2.3 +/- 2.9%, 5.7 +/- 4.0%, and 11.9 +/- 6.2%, respectively, in the normal subjects, and 1.6 +/- 1.4%, 3.4 +/- 1.7%, and 8.2 +/- 3.6%, respectively, in the patients with LBBB. Correlation of the percent change in the global QRSd and the percent change in ECGV was good with an r = 0.65, and P = 0.00005 in the normal subjects, and an r = 0.74 and P = 0.00005 in the patients with LBBB. CONCLUSIONS: Apparent shortening in QRSd as a function of ECGV attenuation due to PERE could have implications in the follow-up of patients with CHF, and their selection for implantable cardioverter/defibrillators, or cardiac resynchronization therapy.     

Morphological Observations of Peripheral Nerves by the Scanning Electron Microscope

Abstract: In order to observe a normal peripheral nerve and a changed peripheral nerve by means of a scanning electron microscope, the present study was carried out. In the changed nerve fibers, they were enveloped by many processes of hypertrophied Schwann cells, and the processes of the Schwann cells seemed to make a pseudosyntitium-like structure with each other. From this finding, it was speculated that these Schwann cells seemed to follow the reverse process in the development of normal peripheral nerve fibers.     

Spatial-Temporal progress of peripheral nerve regeneration within a silicone chamber: Parameters for a bioassay

The spatial-temporal progress of peripheral nerve regeneration across a 10-mmgap within a silicone chamber was examined with the light and electron microscope at 2-mm intervals. A coaxial, fibrin matrix was observed at 1 week with a proximal-distal narrowing that extended beyond the midpoint of the chamber. At 2 weeks, Schwann cells, fibroblasts, and endothelial cells had migrated into the matrix from both nerve stumps. There was a delay of 7–14 days after nerve transection and chamber implantation before regenerating axons appeared in the chamber. At 2 weeks, nonmyelinated axons were seen only in the proximal 1–5 mm of the chamber in association with Schwann cells. Axons reached the distal stump by 3 weeks and a proximal-distal gradient of myelination was observed. These observations define the parameters of a morphologic assay for regeneration in this chamber model which can be used to investigate cellular and molecular mechanisms underlying the success of peripheral nerve regeneration.     

State of the nervous apparatus of the meninges after bilateral ligation of the common carotid arteries

Bilateral ligation of the common carotid arteries was followed by marked changes in the nervous apparatus of the meninges, leading in some places to the reorganization of neurovasal relations.Department of Histology and Embryology, Kiev Medical Institute. (Presented by Academician of the Academy of Medical Sciences of the USSR A. P. Romodanov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 82, No. 9, pp. 1135–1138, September, 1976     

Strong linkage disequilibria among HLA-Bw50, Bfs1, and HLA-DR3/DR7, and mapping of the Bf locus

Based on genotypic and phenotypic studies we have found strong linkage disequilibria in Caucasians among the genes HLA-Bw50, Bf^s1, and HLA-DR3 and/or -DR7. The relative disequilibria, which are among the highest described in man, are Δ_r(Bf^s1, DR7) = 0.51, Δ_r (Bw50, Bf^s1, DR7) = 0.36, Δ_r (Bw50, DR3 or 7) = 0.72, Δ_r (Bf^s1, DR3 or 7) = 0.91, Δ_r (Bw50, Bf^s1, DR3 or 7) = 0.73. The previously described high Δ_r (Bw50, Bf^s1) andΔ_r (Bw50, DR7) have also been confirmed. A B//DR crossover family is also presented that, together with previously reported recombinant families, confirms that the Bf locus resides between HLA-B and HLA-DR. These data suggest the existence of a supergene complex of Bw50, Bf^s1. DR3/7 (or MB2), and hypotheses to account for the observed disequilibria are discussed.     

Compared properties of central and peripheral binding sites for phencyclidine

Phencyclidine and its derivatives bind specifically and reversibly to rat brain and peripheral organs. Binding characteristics are different in brain, lung, kidney, heart and liver. Affinities of phencyclidines for the brain receptor but not those for peripheral organs are correlated with the pharmacological activities of phencyclidines as measured in the rotarod test.