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Sample records for bladder outflow obstruction

  1. Surgical therapy for benign prostatic hypertrophy/bladder outflow obstruction

    PubMed Central

    Thiruchelvam, Nikesh

    2014-01-01

    Monopolar transurethral resection of the prostate (TURP) with endoscopic electrocautery remains the gold standard surgical technique for benign prostatic hypertrophy (BPH) by which all new procedures are compared. We reviewed the current literature, and international urological guidelines and consensus opinion on various surgical options for BPH and present a brief overview of alternative techniques including bipolar TURP, transurethral incision of the prostate, transurethral vaporization of the prostate, laser prostatectomy (with holmium, thulium and potassium titanyl phosphate greenlight lasers) and open prostatectomy (with mention of new techniques including laparoscopic and robotic prostatectomy). Emerging, experimental and less established techniques are also described including endoscopic heat generation (transurethral microwave thermotherapy, radiofrequency transurethral needle ablation of the prostate, high intensity focused ultrasound, hot water induced thermotherapy, pulsed electromagnetic radiofrequency), injection therapy (transurethral ethanol ablation and botulinum toxin) and mechanical devices (intraprostatic stents and urethral lift devices). Despite a plethora of surgical options, none have realistically improved outcomes in the long-term compared with TURP. Improvements have been made on improving surgical morbidity and time in hospital. Questions remain in this area, including what specific elements of bladder outflow obstruction (BOO) result in damage to the urinary tract, how does BPH contribute to BOO and how much prostate volume reduction is necessary to relieve BOO or lower urinary tract symptoms. Given these unanswered questions and the multitude of procedures available, it is clear that appropriate counselling is necessary in all men who undergo BPH surgery. PMID:24744521

  2. Sham versus transurethral microwave thermotherapy in patients with symptoms of benign prostatic bladder outflow obstruction

    SciTech Connect

    Ogden, C.W.; Reddy, P.; Johnson, H.; Ramsay, J.W.; Carter, S.C. . Dept. of Urology)

    1993-01-02

    Transurethral microwave thermotherapy (TUMT) is a single-session, minimally invasive outpatient treatment for patients with symptoms of benign prostatic bladder outflow obstruction. The authors designed a prospective randomized trial to identify any placebo response. Patients with a Madsen symptom score over 8 for at least 6 months were eligible for study. Patients with renal dysfunction, upper urinary tract disease, co-existing bladder disease and malignant prostatic change were excluded. 43 patients were studied: 21 were randomized to receive a sham treatment and 22 to thermotherapy. The thermotherapy group showed a 70% decrease in the mean Madsen score, a 53% increase in flow-rate, and 92% decrease in residual urine volume. No Significant change was seen in these mean indices in the sham group. There was no difference in the main complication of transient hematuria between the two groups. However, there was a 22% frequency of acute retention in the TUMT group. The results show a little significant placebo component to the subjective and objective improvement that occurs in patients who have received TUMT.

  3. The novel β3-adrenoceptor agonist mirabegron reduces carbachol-induced contractile activity in detrusor tissue from patients with bladder outflow obstruction with or without detrusor overactivity.

    PubMed

    Svalø, Julie; Nordling, Jørgen; Bouchelouche, Kirsten; Andersson, Karl-Erik; Korstanje, Cees; Bouchelouche, Pierre

    2013-01-15

    β(3)-Adrenoceptors are major players in detrusor relaxation and have been suggested as a new putative target for the treatment of overactive bladder syndrome. We determined the effects of mirabegron (YM178), a novel β(3)-adrenoceptor agonist, on carbachol-induced tone in isolated human detrusor preparations from patients with bladder outflow obstruction (BOO) with and without detrusor overactivity (DO), and from patients with normal bladder function. We compared the effects to those of isoprenaline, a non-selective β-adrenoceptor agonist. Detrusor specimens were obtained from patients with benign prostatic hyperplasia undergoing cystoscopy and from patients undergoing radical prostatectomy/cystectomy (in total 33 donors). Detrusor contractility was evaluated by organ bath studies and strips were incubated with carbachol (1μM) to induce and enhance tension. Both mirabegron and isoprenaline reduced carbachol-induced tone in tissues from all groups. Isoprenaline decreased tension with higher potency than mirabegron in normal, BOO and BOO+DO detrusor strips with pIC(50) values of 7.49 ± 0.16 vs. 6.23 ± 0.26 (P=0.0002), 6.89 ± 0.34 vs. 6.04 ± 0.31 (P=0.01), and 6.57 ± 0.20 vs. 5.41 ± 0.08 (P<0.0001, n=4), respectively. The maximal relaxant effect of isoprenaline and mirabegron in the normal, BOO and BOO+DO detrusor was 37.7 ± 14.4% and 36.1 ± 23.3%, 14.4 ± 12.2% vs. 33.4 ± 21.0% and 18.3 ± 10.0% vs. 28.3 ± 12.2% (n=4, P>0.05), respectively. Mirabegron and isoprenaline reduced carbachol-induced tone in both normal bladders and obstructed bladder with and without DO. Isoprenaline had higher potency than mirabegron, but the efficacy of mirabegron effect was the same as that of isoprenaline. PMID:23246623

  4. Urethral duplication with unusual cause of bladder outlet obstruction

    PubMed Central

    Venkatramani, Vivek; George, Arun Jacob Philip; Chandrasingh, J.; Panda, Arabind; Devasia, Antony

    2016-01-01

    A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy. PMID:27127361

  5. Bladder outlet obstruction number: a good indicator of infravesical obstruction in patients with benign prostatic enlargement?

    PubMed

    Aganovic, Damir; Spahovic, Hajrudin; Prcic, Alden; Hadziosmanovic, Osman

    2012-08-01

    The objective of our study was to evaluate bladder outlet obstruction number (BOON) in order to predict infravesical obstruction in patients with benign prostatic enlargement (BPE). Two hundred patients with proven BPE from daily urological practice at the Urology Department of the Sarajevo University Clinical Centre were covered by a prospective study in period 2009-2011. All patients completed International Prostatic Symptom Score, their mean voided volume urine was determined from frequency-volume chart and their prostate volume was determined by transabdominal ultrasound. Subsequently, the patients had free uroflowmetry and they underwent complete urodynamic studies. BOON was calculated using the formula: prostate volume (cc)-3 x Qmax (ml/s)-0.2 x mean voided volume (ml). A satisfactory area under the curve (AUC) was obtained for the prediction of obstruction according to bladder outlet obstruction index, Schaefer obstruction class nomogram and group specific urethral resistance factor , with AUC of 0.83 (p<0.001). Following the comparison of different cut-off values of BOON according to the obstruction, the BOON >-20 has been found to be the most accurate obstruction indicator (sensitivity 76.5% and specificity 68.2%), with posttest probability of 77%. The BOON may be used in daily urological practice as a valid, non-invasive indicator of infravesical obstruction in patients with BPE, with a possibility of correct classification of obstruction in approximately 75% of the cases. Transabdominal ultrasound has shown to be applicable to the BOON formula in determining prostate volume. PMID:22938540

  6. Bladder outlet obstruction treated with transurethral ultrasonic aspiration

    NASA Astrophysics Data System (ADS)

    Malloy, Terrence R.

    1991-07-01

    Fifty-nine males with bladder outlet obstruction were treated with transurethral ultrasonic aspiration of the prostate. Utilizing a 26.5 French urethral sheath, surgery was accomplished with a 10 French, 0-700 micron vibration level ultrasonic tip with an excursion rate of 39 kHz. Complete removal of the adenoma was accomplished, followed by transurethral electrocautery biopsies of both lateral lobes to compare pathologic specimens. One-year follow-up revealed satisfactory voiding patterns in 57 of 59 men (96%). Two men developed bladder neck contractures. Pathologic comparisons showed 100% correlation between aspirated and TUR specimens (56 BPH, 3 adeno-carcinoma). Forty-sevel men were active sexually preoperatively (6 with inflatable penile prostheses). Post ultrasonic aspiration, 46 men had erectile function similar to preoperative levels with one patient suffering erectile dysfunction. Forty men (85%) had antegrade ejaculation while 7 (15%) experienced retrograde or retarded ejaculation. No patients were incontinent.

  7. Proteomic profile of an acute partial bladder outlet obstruction

    PubMed Central

    Alsaikhan, Bader; Fahlman, Richard; Ding, Jie; Tredget, Edward; Metcalfe, Peter D.

    2015-01-01

    Introduction: Partial bladder outlet obstruction (pBOO) is a ubiquitous problem in urology. From posterior urethral valves to prostatic hypertrophy, pBOO results in significant morbidity and mortality. However, the pathophysiology is not completely understood. Proteomics uses mass spectrometry to accurately quantify change in tissue protein concentration. Therefore, we have applied proteomic analysis to a rodent model to assess for protein changes after a surgically induced pBOO. We hypothesize that proteomic analysis after an acute obstruction will determine the most prevalent initial protein response and, potentially, novel molecular pathways. Methods: Sprague Dawley rats underwent a surgically induced pBOO (n = 3 per group) for 3, 7, or 14 days. Bladders were assessed for weight and urodynamic parameters. Proteomics used liquid-chromatography based mass spectrometry. Polymerase chain reaction (PCR) was performed on tissue samples to confirm increased mRNA transcription. Results: Bladder weight and capacity increased over the experimental period, but no changes were seen in bladder pressure. Statistically significant increases in protein quantities were seen in 3 proteins related to endoplasmic reticulum stress: GRP-78 (3.66-fold), RhoA (1.90-fold), and RhoA-GDP (1.95-fold), and 2 cytoskeleton molecules: actin (1.7-fold) and tubulin a/b (3.01-fold). Decorin and lumican, members of the small leucine rich proteoglycan (SLRP) family, were also elevated (0.35- and 0.34-fold, respectively). Real-time PCR data confirmed protein elevation. Conclusion: Our experiment confirms that molecular changes occur very soon after the initiation of pBOO, and implicates several molecular pathways. We believe these insights may provide insight into novel prevention and treatment strategies targeted at the pathophysiology of pBOO. PMID:25844096

  8. Work Capacity of the Bladder During Voiding: A Novel Method to Evaluate Bladder Contractile Function and Bladder Outlet Obstruction

    PubMed Central

    Liu, Ning; Man, Li-Bo; He, Feng; Huang, Guang-Lin; Zhou, Ning; Zhu, Xiao-Fei

    2015-01-01

    Background: Work in voiding (WIV) of the bladder may be used to evaluate bladder status throughout urination rather than at a single time point. Few studies, however, have assessed WIV owing to the complexity of its calculations. We have developed a method of calculating work capacity of the bladder while voiding and analyzed the associations of bladder work parameters with bladder contractile function and bladder outlet obstruction (BOO). Methods: The study retrospectively evaluated 160 men and 23 women, aged >40 years and with a detrusor pressure at maximal flow rate (Pdet Qmax) of ≥40 cmH2O in men, who underwent urodynamic testing. The bladder power integration method was used to calculate WIV; WIV per second (WIV/t) and WIV per liter of urine voided (WIV/v) were also calculated. In men, the relationships between these work capacity parameters and Pdet Qmax and Abrams-Griffiths (AG) number were determined using linear-by-linear association tests, and relationships between work capacity parameters and BOO grade were investigated using Spearman's association test. Results: The mean WIV was 1.15 ± 0.78 J and 1.30 ± 0.88 J, mean WIV/t was 22.95 ± 14.45 mW and 23.78 ± 17.02 mW, and mean WIV/v was 5.59 ± 2.32 J/L and 2.83 ± 1.87 J/L in men and women, respectively. In men, WIV/v showed significant positive associations with Pdet Qmax (r = 0.845, P = 0.000), AG number (r = 0.814, P = 0.000), and Schafer class (r = 0.726, P = 0.000). Conversely, WIV and WIV/t showed no associations with Pdet Qmax or AG number. In patients with BOO (Schafer class > II), WIV/v correlated positively with increasing BOO grade. Conclusions: WIV can be calculated from simple urodynamic parameters using the bladder power integration method. WIV/v may be a marker of BOO grade, and the bladder contractile function can be evaluated by WIV and WIV/t. PMID:26668148

  9. [Dynamic obstruction to left ventricular outflow during dobutamine stress echocardiography: the probable mechanisms and clinical implications].

    PubMed

    Scandura, S; Arcidiacono, S; Felis, S; Barbagallo, G; Deste, W; Drago, A; Calvi, V; Giuffrida, G

    1998-11-01

    We observed the development of left ventricular outflow tract dynamic obstruction in some patients during dobutamine stress echocardiography. The purpose of this study was to identify the possible mechanisms and to consider the clinical implications. From 11/04/94 to 01/09/97 we studied 547 patients; 42 patients developed dynamic obstruction, defined as a late peak Doppler velocity profile that exceeded baseline outflow velocity by at least 1 m/s. The encountered mechanisms were: increased myocardial contractility; systolic anterior motion of the mitral valve; decreased venous return to the left ventricle, and peculiar characteristics of the left ventricular geometry. The results of this study show that the dynamic obstruction is mainly due to the first mechanism and secondarily to some characteristics of the left ventricular geometry. The hypotension observed in a few cases is not related to the dynamic obstruction but to beta 2 receptor hypersensibility to dobutamine. The symptoms, like dyspnea and chest pain, experienced by these patients are related to the dynamic obstruction rather than to the presence of coronary artery disease. In conclusion, we think that patients who develop dynamic obstruction, without wall motion abnormalities, during dobutamine stress echocardiography, may behave pathophysiologically as patients with obstructive hypertrophic cardiomyopathy, in whom diastolic dysfunction and outflow tract obstruction are responsible for symptoms. Therefore, these patients require a pharmacological treatment with beta blockers and/or non-dihydropyridine calcium channel blockers. PMID:9922586

  10. Changes in Aquaporin 1 Expression in Rat Urinary Bladder after Partial Bladder Outlet Obstruction: Preliminary Report

    PubMed Central

    Kim, Sun-Ouck; Song, Seung Hee; Ahn, Kuyoun; Kwon, Dongdeuk; Ryu, Soo Bang

    2010-01-01

    Purpose Aquaporins (AQPs) are membrane proteins that facilitate water movement across biological membranes. AQPs are also called water channels, and they have recently been reported to be expressed in rat and human urothelium. The purposes of this study were to investigate the effect of bladder outlet obstruction (BOO) on the rat urothelium and AQP1 expression in rat urothelium. Materials and Methods Female Sprague-Dawley rats (230-240 g each, n=20) were divided into 2 groups: the sham group (the Con group, n=10) and the partial BOO group (the BOO group, n=10). The BOO group underwent a partial BOO. The expression and cellular localization of AQP1 were determined by performing Western blotting and immunohistochemistry on the rat urinary bladder. Results AQP1 immunoreactivity in both the control and the BOO groups was localized in the capillaries, arterioles, and venules of the lamina propria of the urinary bladder. The protein expression of AQP1 was significantly increased in the BOO group. Conclusions This study showed that BOO causes a significant increase in the expression of AQP1. This may imply that AQP1 has a functional role in the detrusor instability that occurs in association with BOO. PMID:20428433

  11. Right Ventricular Outflow Tract Obstruction Caused by Isolated Sinus of Valsalva Aneurysm.

    PubMed

    Abu Saleh, Walid K; Lin, Chun Huie; Reardon, Michael J; Ramlawi, Basel

    2016-08-01

    Isolated sinus of Valsalva aneurysm is a rare occurrence, with an incidence of <1.5% among congenital heart disease repairs in the world. We recount the case of a 64-year-old man who presented with right-sided heart failure symptoms caused by a severely dilated right coronary sinus of Valsalva aneurysm that substantially obstructed the right ventricular outflow tract. Successful surgical repair involved right ventricular outflow tract resection and subcoronary patch repair. PMID:27547152

  12. Unruptured Sinus of Valsalva Aneurysm Obstructing the Left Ventricular Outflow Tract: An Uncommon Presentation in Childhood.

    PubMed

    Murli, Lakshmi; Shah, Prashant; Sekar, Prem; Surya, Karthik

    2016-01-01

    Congenital aneurysms of the sinus of Valsalva are uncommon abnormalities that are usually silent and slowly progressive without symptoms of cardiac dysfunction unless catastrophic rupture occurs. However, in rare cases, unruptured aneurysms can produce symptoms resulting from compression of adjacent structures, ventricular outflow tract obstruction, heart block, and coronary and valvular insufficiency. We report a case of a single unruptured sinus of Valsalva aneurysm producing left ventricular outflow tract obstruction in an 8-year-old boy who presented with chest pain on exertion.

  13. [Obstruction of the right ventricular outflow tract on the obstructive hypertrophic cardiomyopathy. Case report and literature review].

    PubMed

    Soriano, Patricia Pérez; Estrada, Catalina Lomelí; Peralta, Martin Rosas; Negrete, J Antonio Lorenzo; González, Celso Mendoza; Ortiz, Arturo Méndez; Attié, Fause

    2008-01-01

    OHC is a disorder with a broad spectrum of morphological, functional and genetics abnormalities. The Obstruction on the Right Ventricular Outflow (OHCRV) is not expected most of the time, that's way it is not usually detected and rarely mentioned in the cardiological literature. Its clinical presentation may include basically systemic venous hypertension symptoms that come with the hypertrophic cardyomiopathy manifestations. The manifestations of an apparent Right Ventricular Hypertrophic (RVH) in the ECG are probably due to the huge septal vector that activates the septum with a major thickness. The clinical confirmation of the obstruction on the OHCRV produced by a considerable asymmetric septal hypertrophic is easily shown with bidimensional an Doppler echocardiography.

  14. Intestinal obstruction due to migration of a thermometer from bladder to abdominal cavity: a case report.

    PubMed

    Nie, Jing; Zhang, Bo; Duan, Yan-Chao; Hu, Yue-Hua; Gao, Xin-Ying; Gong, Jian; Cheng, Ming; Li, Yan-Qing

    2014-03-01

    Intraperitoneal foreign bodies such as retained surgical instruments can cause intestinal obstruction. However, intestinal obstruction due to transmural migration of foreign bodies has rarely been reported. Here, we report a case of intestinal obstruction due to a clinical thermometer which migrated from the bladder into the abdominal cavity. A 45-year-old man was admitted to our hospital with a one-year history of recurrent lower abdominal cramps. Two days before admission, the abdominal cramps aggravated. Intestinal obstruction was confirmed with upright abdominal radiography and computerized tomography scan which showed dilation of the small intestines and a thermometer in the abdominal cavity. Then laparotomy was performed. A scar was observed at the fundus of the bladder and a thermometer was adhering to the small bowels and mesentery which resulted in intestinal obstruction. Abdominal cramps were eliminated and defecation and flatus recovered soon after removal of the thermometer.

  15. Upregulation of heme oxygenase and collagen type III in the rat bladder after partial bladder outlet obstruction.

    PubMed

    Inaba, Mitsuhiko; Ukimura, Osamu; Yaoi, Takeshi; Kawauchi, Akihiro; Fushiki, Shinji; Miki, Tsuneharu

    2007-01-01

    The objective of the study was to evaluate possible changes of the gene expression and localization of the enzymes, heme oxygenase and nitric oxide synthase (NOS), with reference to increase of collagen type III in response to the partial obstruction of the bladder. Following initial obstruction, whole rat bladders were removed for real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Real-time RT-PCR demonstrated significantly enhanced expression of HO (p < 0.01) and collagen type III (p < 0.001) gene on postoperative day 14. Enhanced expression of NOS gene was seen only on postoperative day 4 (p < 0.01). Immunohistochemistry revealed that immunoreactivity to HO-1 had much in common in neural cells and fibers, although immunoreactivity to HO-2 and iNOS was relatively weak. This study suggested gene expression of HO, especially HO-1, was more dramatically changed than NOS, and was upregulated simultaneously with increase of collagen type III after obstruction. HO systems could be involved in the pathogenesis of bladder dysfunction related to increase of collagen type III after obstruction. PMID:17406140

  16. Mir-29 repression in bladder outlet obstruction contributes to matrix remodeling and altered stiffness.

    PubMed

    Ekman, Mari; Bhattachariya, Anirban; Dahan, Diana; Uvelius, Bengt; Albinsson, Sebastian; Swärd, Karl

    2013-01-01

    Recent work has uncovered a role of the microRNA (miRNA) miR-29 in remodeling of the extracellular matrix. Partial bladder outlet obstruction is a prevalent condition in older men with prostate enlargement that leads to matrix synthesis in the lower urinary tract and increases bladder stiffness. Here we tested the hypothesis that miR-29 is repressed in the bladder in outlet obstruction and that this has an impact on protein synthesis and matrix remodeling leading to increased bladder stiffness. c-Myc, NF-κB and SMAD3, all of which repress miR-29, were activated in the rat detrusor following partial bladder outlet obstruction but at different times. c-Myc and NF-κB activation occurred early after obstruction, and SMAD3 phosphorylation increased later, with a significant elevation at 6 weeks. c-Myc, NF-κB and SMAD3 activation, respectively, correlated with repression of miR-29b and miR-29c at 10 days of obstruction and with repression of miR-29c at 6 weeks. An mRNA microarray analysis showed that the reduction of miR-29 following outlet obstruction was associated with increased levels of miR-29 target mRNAs, including mRNAs for tropoelastin, the matricellular protein Sparc and collagen IV. Outlet obstruction increased protein levels of eight out of eight examined miR-29 targets, including tropoelastin and Sparc. Transfection of human bladder smooth muscle cells with antimiR-29c and miR-29c mimic caused reciprocal changes in target protein levels in vitro. Tamoxifen inducible and smooth muscle-specific deletion of Dicer in mice reduced miR-29 expression and increased tropoelastin and the thickness of the basal lamina surrounding smooth muscle cells in the bladder. It also increased detrusor stiffness independent of outlet obstruction. Taken together, our study supports a model where the combined repressive influences of c-Myc, NF-κB and SMAD3 reduce miR-29 in bladder outlet obstruction, and where the resulting drop in miR-29 contributes to matrix remodeling and

  17. Mir-29 Repression in Bladder Outlet Obstruction Contributes to Matrix Remodeling and Altered Stiffness

    PubMed Central

    Ekman, Mari; Bhattachariya, Anirban; Dahan, Diana; Uvelius, Bengt; Albinsson, Sebastian; Swärd, Karl

    2013-01-01

    Recent work has uncovered a role of the microRNA (miRNA) miR-29 in remodeling of the extracellular matrix. Partial bladder outlet obstruction is a prevalent condition in older men with prostate enlargement that leads to matrix synthesis in the lower urinary tract and increases bladder stiffness. Here we tested the hypothesis that miR-29 is repressed in the bladder in outlet obstruction and that this has an impact on protein synthesis and matrix remodeling leading to increased bladder stiffness. c-Myc, NF-κB and SMAD3, all of which repress miR-29, were activated in the rat detrusor following partial bladder outlet obstruction but at different times. c-Myc and NF-κB activation occurred early after obstruction, and SMAD3 phosphorylation increased later, with a significant elevation at 6 weeks. c-Myc, NF-κB and SMAD3 activation, respectively, correlated with repression of miR-29b and miR-29c at 10 days of obstruction and with repression of miR-29c at 6 weeks. An mRNA microarray analysis showed that the reduction of miR-29 following outlet obstruction was associated with increased levels of miR-29 target mRNAs, including mRNAs for tropoelastin, the matricellular protein Sparc and collagen IV. Outlet obstruction increased protein levels of eight out of eight examined miR-29 targets, including tropoelastin and Sparc. Transfection of human bladder smooth muscle cells with antimiR-29c and miR-29c mimic caused reciprocal changes in target protein levels in vitro. Tamoxifen inducible and smooth muscle-specific deletion of Dicer in mice reduced miR-29 expression and increased tropoelastin and the thickness of the basal lamina surrounding smooth muscle cells in the bladder. It also increased detrusor stiffness independent of outlet obstruction. Taken together, our study supports a model where the combined repressive influences of c-Myc, NF-κB and SMAD3 reduce miR-29 in bladder outlet obstruction, and where the resulting drop in miR-29 contributes to matrix remodeling and

  18. Unusual appearance for urinary bladder obstruction detected with 99mTc-MDP bone scintigraphy.

    PubMed

    Wright, Chadwick L; Sharma, Akash

    2015-12-01

    Unanticipated but clinically significant nonosseous findings can be detected during routine bone scintigraphy. We present a case of an 83-year-old man who presented with a pathologic fracture of the right femur. Whole-body bone scintigraphy for osseous staging revealed intense radiotracer accumulation in the kidneys and ureters but no activity within the urinary bladder. The patient had not voided for 14 hours. A Foley catheter was inserted, and more than 2000 mL of urine was drained, most consistent with urinary bladder obstruction. Subsequent repeat images demonstrated marked reduction of the renal and ureteral activity with trace activity in the urinary bladder.

  19. Urinary bladder matrix promotes site appropriate tissue formation following right ventricle outflow tract repair

    PubMed Central

    Remlinger, Nathaniel T; Gilbert, Thomas W; Yoshida, Masahiro; Guest, Brogan N; Hashizume, Ryotaro; Weaver, Michelle L; Wagner, William R; Brown, Bryan N; Tobita, Kimimasa; Wearden, Peter D

    2013-01-01

    The current prevalence and severity of heart defects requiring functional replacement of cardiac tissue pose a serious clinical challenge. Biologic scaffolds are an attractive tissue engineering approach to cardiac repair because they avoid sensitization associated with homograft materials and theoretically possess the potential for growth in similar patterns as surrounding native tissue. Both urinary bladder matrix (UBM) and cardiac ECM (C-ECM) have been previously investigated as scaffolds for cardiac repair with modest success, but have not been compared directly. In other tissue locations, bone marrow derived cells have been shown to play a role in the remodeling process, but this has not been investigated for UBM in the cardiac location, and has never been studied for C-ECM. The objectives of the present study were to compare the effectiveness of an organ-specific C-ECM patch with a commonly used ECM scaffold for myocardial tissue repair of the right ventricle outflow tract (RVOT), and to examine the role of bone marrow derived cells in the remodeling response. A chimeric rat model in which all bone marrow cells express green fluorescent protein (GFP) was generated and used to show the ability of ECM scaffolds derived from the heart and bladder to support cardiac function and cellular growth in the RVOT. The results from this study suggest that urinary bladder matrix may provide a more appropriate substrate for myocardial repair than cardiac derived matrices, as shown by differences in the remodeling responses following implantation, as well as the presence of site appropriate cells and the formation of immature, myocardial tissue. PMID:23974174

  20. Accessory mitral valve without subaortic obstruction of left ventricular outflow tract in a middle-aged male

    PubMed Central

    Golias, Christos; Bitsis, Theodosis; Krikidis, Dimitrios; Charalabopoulos, Konstantinos

    2012-01-01

    Accessory mitral valve (AMV) is a rare congenital abnormality with a usually early-age clinical onset, being potentially a cause of subvalvular obstruction of the left ventricular outflow tract. This report describes the case of a 60-year-old patient presented with palpitations and chest pain. Primary evaluation revealed a ventricular tachycardia episode while transthoracic echocardiography showed an intracardiac additional structure at the level of the left ventricular outflow tract. After transoesophageal echocardiography and paraclinical investigations this structure was proven to be an AMV tissue which did not provoke left ventricular outflow obstruction. This case presents an unusual late-age clinical onset of AMV without a clinically significant LVOT (left ventricular outflow tract) obstruction and highlights the importance of transthoracic and transoesophageal echocardiography in the diagnosis of this rare cardiological entity. PMID:23175008

  1. Latent Left Ventricular Outflow Tract Obstruction Due to Accessory Mitral Valve in a 12-Year-Old Boy

    PubMed Central

    Yun, Kyung Won; Park, Yong Hyun; Lee, Sang Hyun; Kim, Jeong Su; Kim, June Hong; Chun, Kook Jin

    2016-01-01

    Accessory mitral valve (AMV) is a rare congenital anomaly which can cause left ventricular outflow tract (LVOT) obstruction. Patients with isolated AMV usually present with exertional dyspnea, chest pain, or syncope during the first ten years of life. In patients with AMV, detection of latent LVOT obstruction can be clinically challenging. We here present a case of AMV causing latent LVOT obstruction in an adolescent, which was diagnosed by echocardiography with dobutamine provocation and finally treated by successful surgical resection. PMID:27471367

  2. Bilateral ureteral complete obstruction with huge spontaneous urinoma formation in a patient with advanced bladder cancer.

    PubMed

    Jou, Yeong-Chin; Shen, Cheng-Huang; Cheng, Ming-Chin; Lin, Chang-Te; Chen, Pi-Che

    2012-02-01

    Spontaneous rupture of the collecting system with extravasation of urine and urinoma formation is usually associated with urinary tract obstruction by a ureteral calculus. Tumor growth is an extremely rare cause of urinary extravasation. Here we report a case of bilateral obstructive uropathy with a huge spontaneous left retroperitoneal urinoma caused by advanced infiltrative transitional cell carcinoma of the urinary bladder. The point of leakage was located in the left renal pelvis. The urinary leakage ceased after percutaneous nephrostomy drainage, and the patient subsequently underwent radical cystoprostatectomy. Histopathology revealed a high-grade urothelial carcinoma of the urinary bladder with pelvic lymph node metastasis. The patient refused any adjuvant treatment and expired 6 months after the operation from disseminated metastasis from bladder cancer.

  3. Combined uterine and urinary bladder rupture: an unusual complication of obstructed labor in a primigravida

    PubMed Central

    Takai, Idris Usman; Abubakar, Abdulkadir

    2016-01-01

    Background Combined uterine and urinary bladder rupture following prolonged obstructed labor is indeed a momentous uro-obstetric emergency. The urinary bladder involvement is distinctly rare in the absence of factors that predispose the bladder to be adherent to the lower uterine segment and is quite unusual in a primigravida. Objective To report a rare case of uterine rupture involving urinary bladder secondary to a prolonged obstructed labor in a primigravida from a low resource setting. Case A 17-year-old married unbooked primigravida who presented with a 3-day history of spontaneous onset of labor at term that was initially managed at home and later in a primary health care center where she had fundal pressure and oxytocin augmentation, respectively. The labor was complicated by combined uterine and urinary bladder rupture with sepsis. She was resuscitated and had exploratory laparotomy with uterine and urinary bladder repair. The postoperative period was uneventful and she was followed-up at the gynecology and family planning clinics. Conclusion There is a need for community reawakening on the inherent risks of teenage pregnancy, bad obstetric practices, and unsupervised pregnancy, labor, and delivery, particularly in the rural settings as in the index patient. A high index of suspicion and prompt appropriate intervention will reduce the sequel of morbidity and occasional mortality from this predicament. PMID:27499647

  4. Effect of Left Ventricular Outflow Tract Obstruction on Left Atrial Mechanics in Hypertrophic Cardiomyopathy

    PubMed Central

    Williams, Lynne K.; Chan, Raymond H.; Carasso, Shemy; Durand, Miranda; Misurka, Jimmy; Crean, Andrew M.; Ralph-Edwards, Anthony; Gruner, Christiane; Woo, Anna; Lesser, John R.; Maron, Barry J.; Maron, Martin S.; Rakowski, Harry

    2015-01-01

    Left atrial (LA) volumes are known to be increased in hypertrophic cardiomyopathy (HCM) and are a predictor of adverse outcome. In addition, LA function is impaired and is presumed to be due to left ventricular (LV) diastolic dysfunction as a result of hypertrophy and myocardial fibrosis. In the current study, we assess the incremental effect of outflow tract obstruction (and concomitant mitral regurgitation) on LA function as assessed by LA strain. Patients with HCM (50 obstructive, 50 nonobstructive) were compared to 50 normal controls. A subset of obstructive patients who had undergone septal myectomy was also studied. Utilising feature-tracking software applied to cardiovascular magnetic resonance images, LA volumes and functional parameters were calculated. LA volumes were significantly elevated and LA ejection fraction and strain were significantly reduced in patients with HCM compared with controls and were significantly more affected in patients with obstruction. LA volumes and function were significantly improved after septal myectomy. LVOT obstruction and mitral regurgitation appear to further impair LA mechanics. Septal myectomy results in a significant reduction in LA volumes, paralleled by an improvement in function. PMID:26788503

  5. Acromegaly-induced cardiomyopathy with dobutamine-induced outflow tract obstruction.

    PubMed

    Abdelsalam, Mahmoud A; Nippoldt, Todd B; Geske, Jeffrey B

    2016-01-01

    A 50-year-old man with a history of acromegaly was referred for preoperative cardiac evaluation preceding trans-sphenoidal resection of a pituitary macroadenoma. Dobutamine stress echocardiography was negative for myocardial ischaemia. Resting left ventricular (LV) LV ejection fraction (LVEF) was 64% and there was hypertrophy of ventricular septum (18 mm) without resting LV outflow tract obstruction. With 40 µg/kg/min of dobutamine, the LVEF became hyperdynamic at 80%, and there was a maximal instantaneous LV outflow tract gradient of 77 mm Hg. There was no delayed myocardial enhancement on cardiac MRI and the pattern of hypertrophy was concentric. Acromegaly-induced cardiomyopathy can mimic hypertrophic cardiomyopathy in the setting of dobutamine provocation. Because cardiomyopathy is an important cause of mortality in acromegaly, diagnosis and appropriate management are critical to improve survival. PMID:26961727

  6. Unruptured Sinus of Valsalva Aneurysm with Right Ventricular Outflow Tract Obstruction and Supracristal Ventricular Septal Defect: A Rare Case.

    PubMed

    Sridhar, Ganiga Srinivasaiah; Sadiq, Muhammad Athar; Ahmad, Wan Azman Wan; Supuramaniam, Chitra; Watson, Timothy; Abidin, Imran Zainal; Chee, Kok Han

    2015-10-01

    Unruptured right sinus of Valsalva aneurysm that causes severe obstruction of the right ventricular outflow tract is extremely rare. We describe the case of a 47-year-old woman who presented with exertional dyspnea. Upon investigation, we discovered an unruptured right sinus of Valsalva aneurysm with associated right ventricular outflow tract obstruction and a supracristal ventricular septal defect. To our knowledge, only 2 such cases have previously been reported in the medical literature. Although treatment of unruptured sinus of Valsalva aneurysm remains debatable, surgery should be considered for extremely large aneurysms or for progressive enlargement of the aneurysm on serial evaluation. Surgery was undertaken in our patient because there was clear evidence of right ventricular outflow tract obstruction, right-sided heart dilation, and associated exertional dyspnea.

  7. Angiographic evidence of absent ductus arteriosus in severe right ventricular outflow obstruction.

    PubMed

    Lacina, S J; Hamilton, W T; Thilenius, O G; Bharati, S; Lev, M; Arcilla, R A

    1983-01-01

    The angiocardiograms of 5 newborn infants with autopsy and/or surgically-proven congenital absence of the ductus arteriosus (ADA) and right ventricular outflow obstruction (Group A), and of 14 neonates with pulmonary atresia complex and patent ductus arteriosus (Group B) were reviewed. Aortic size was similar in both groups; however, the diameters of the right and left pulmonary arteries were much smaller in Group A than in Group B (right pulmonary artery: 2.6 vs 4.5 mm, P less than 0.005; left pulmonary artery: 2.5 vs 4.3 mm, P less than 0.005). Extensive bronchial collaterals were observed in Group A but not in Group B. Tricuspid aortic valve stenosis was present in 2 patients in Group A but in none in Group B. The diagnosis of ADA may be made in newborn infants with severe right ventricular outflow obstruction if the angiocardiograms reveal hypoplasia of the pulmonary arteries, extensive bronchial collaterals, and nonvisualization of the ductus arteriosus. Other suggestive features include aortic valve stenosis and/or right aortic arch with aberrant left subclavian artery.

  8. Sulforaphane Ameliorates Bladder Dysfunction through Activation of the Nrf2-ARE Pathway in a Rat Model of Partial Bladder Outlet Obstruction

    PubMed Central

    Liu, Chong; Xu, Huan; Fu, Shi; Chen, Yanbo; Chen, Qi; Cai, Zhikang; Zhou, Juan; Wang, Zhong

    2016-01-01

    Purpose. We evaluated the effect of sulforaphane (SFN) treatment on the function and changes of expression of Nrf2-ARE pathway in the bladder of rats with bladder outlet obstruction (BOO). Materials and Methods. A total of 18 male Sprague-Dawley rats at age of 8 weeks were divided into 3 groups (6 of each): the sham operated group, the BOO group, and the BOO+SFN group. We examined histological alterations and the changes of oxidative stress markers and the protein expression of the Nrf2-ARE pathway. Results. We found that SFN treatment could prolong micturition interval and increase bladder capacity and bladder compliance. However, the peak voiding pressure was lower than BOO group. SFN treatment can ameliorate the increase of collagen fibers induced by obstruction. SFN treatment also increased the activity of SOD, GSH-Px, and CAT compared to the other groups. The level of bladder cell apoptosis was decreased in BOO rats with SFN treatment. Moreover, SFN could reduce the ratio of Bax/Bcl-2 expression. Furthermore, SFN could activate the Nrf2 expression with elevation of its target antioxidant proteins. Conclusions. The sulforaphane-mediated decrease of oxidative stress and activation of the Nrf2-ARE pathway may ameliorate bladder dysfunction caused by bladder outlet obstruction. PMID:27433291

  9. Guinea worm infection of urinary bladder manifesting as obstructive uropathy in rural Maharashtra.

    PubMed

    Birare, Shivaji D; Kamble, M H; Lanjewar, D N; Parija, S C; Girji, D D; Kulkarni, P V; Gupta, Rashmi S; Abdul Jabbar, A M

    2005-10-01

    Guinea worm or Dracunculus medinensis is a well-documented helminthic infestation in many areas of Asia. In this report, we describe a rare case of guinea worm infestation in a 25-year-old woman who had developed symptoms of obstructive uropathy, in whom fragments of guinea worm were removed after urethral catheterization. To the best of our knowledge, adult guinea worm occurring in the urinary bladder has not been previously described.

  10. Overexpression of Aquaporin-1 and Caveolin-1 in the Rat Urinary Bladder Urothelium Following Bladder Outlet Obstruction

    PubMed Central

    Song, Seung Hee; Park, Kwangsung; Kwon, Dongdeuk

    2013-01-01

    Purpose This study was designed to investigate the effect of detrusor overactivity induced by partial bladder outlet obstruction (BOO) on the expression of aquaporin 1 (AQP1) and caveolin 1 (CAV1) in the rat urinary bladder, and to determine the role of these molecules in detrusor overactivity. Methods Female Sprague-Dawley rats were divided into control (n=30) and experimental (n=30) groups. The BOO group underwent partial BOO, and the control group underwent a sham operation. After 4 weeks, an urodynamic study was performed to measure the contraction interval and contraction pressure. The expression and cellular localization of AQP1 and CAV1 were determined by western blot and immunofluorescence experiments in the rat urinary bladder. Results In cystometrograms, the contraction interval was significantly lower in the BOO group (2.9±1.5 minutes) than in the control group (6.7±1.0 minutes) (P<0.05). Conversely, the average contraction pressure was significantly higher in the BOO group (21.2±3.3 mmHg) than in the control group (13.0±2.5 mmHg) (P<0.05). AQP1 and CAV1 were coexpressed in the capillaries, arterioles, and venules of the suburothelial layer. AQP1 and CAV1 protein expression was significantly increased in the BOO rats compared to the control rats (P<0.05). Conclusions Detrusor overactivity induced by BOO causes a significant increase in the expression of AQP1 and CAV1, which were coexpressed in the suburothelial microvasculature. This finding suggests that AQP1 and CAV1 might be closely related to bladder signal activity and may have a functional role in BOO-associated detrusor overactivity. PMID:24466464

  11. Refractory Hypotension after Liver Allograft Reperfusion: A Case of Dynamic Left Ventricular Outflow Tract Obstruction

    PubMed Central

    Essandoh, Michael; Otey, Andrew Joseph; Dalia, Adam; Dewhirst, Elisabeth; Springer, Andrew; Henry, Mitchell

    2016-01-01

    Hypotension after reperfusion is a common occurrence during liver transplantation following the systemic release of cold, hyperkalemic, and acidic contents of the liver allograft. Moreover, the release of vasoactive metabolites such as inflammatory cytokines and free radicals from the liver and mesentery, compounded by the hepatic uptake of blood, may also cause a decrement in systemic perfusion pressures. Thus, the postreperfusion syndrome (PRS) can materialize if hypotension and fibrinolysis occur concomitantly within 5 min of reperfusion. Treatment of the PRS may require the administration of inotropes, vasopressors, and intravenous fluids to maintain hemodynamic stability. However, the occurrence of the PRS and its treatment with inotropes and calcium chloride may lead to dynamic left ventricular outflow tract obstruction (DLVOTO) precipitating refractory hypotension. Expedient diagnosis of DLVOTO with transesophageal echocardiography is extremely vital in order to avoid potential cardiovascular collapse during this critical period. PMID:26909349

  12. Simple Modification of the Bladder Outlet Obstruction Index for Better Prediction of Endoscopically-Proven Prostatic Obstruction: A Preliminary Study

    PubMed Central

    Han, Jang Hee; Yu, Ho Song; Lee, Joo Yong; Kim, Joohan; Kang, Dong Hyuk; Kwon, Jong Kyu; Choi, Young Deuk; Cho, Kang Su

    2015-01-01

    Purpose The bladder outlet obstruction index (BOOI), also known as the Abrams-Griffiths (AG) number, is the most widely used index for predicting BOO. However, the obstructed prostatic urethra determined by the BOOI is often inconsistent with endoscopically-proven obstruction. We assessed abdominal straining pattern as a novel parameter for improving the prediction of BOO. Materials and Methods We retrospectively reviewed the pressure-flow studies (PFS) and cystourethroscopy in 176 BPH/LUTS patients who were unresponsive to medical therapy. During PFS, some groups of patients tried to urinate with abdominal straining, which can increases intravesical pressure and underestimate BOOI theoretically. Accordingly, the modified BOOI was defined as (PdetQmax+ΔPabd)-2Qmax. Results Ultimately, 130 patients were eligible for the analysis. In PFS, ΔPabd (PabdQmax-initial Pabd) was 11.81±13.04 cmH2O, and it was 0–9 cmH2O in 75 (57.7%), 10–19 cmH2O in 23 (17.7%) and ≥20 cmH2O in 32 (24.6%) patients. An endoscopically obstructed prostatic urethra in 92 patients was correctly determined in 47 patients (51.1%) by the original BOOI versus 72 patients (78.3%) based on the modified BOOI. Meanwhile, an “unobstructed” urethra according to the original BOOI was present in 11 patients (12.0%), whereas according to the modified BOOI, only 2 (2.1%) would be labeled as “unobstructed”. In receiver operating characteristic curves, the area under the curve was 0.906 using the modified BOOI number versus 0.849 in the original BOOI (p<0.05). Conclusions The change in abdominal pressure was correlated with endoscopically-proven obstruction. Our simple modification of the BOOI on the basis of this finding better predicted bladder outlet obstruction and, therefore, should be considered when evaluating BOO in patients with LUTS/BPH. PMID:26505196

  13. [Morphologic and functional heterogeneous changes of the urinary bladder different parts at rats with infravesical obstruction of the urinary tracts].

    PubMed

    Kudriavtsev, Iu V; Kirpatovskiĭ, V I; Mudraia, I S; Khromov, R A; Kudriavtseva, L V

    2012-01-01

    Infravesical obstruction of the lower urinary tracts of 30 rats was carried out by the measured constriction of the urethral prevesical parts. Morphologic and functional changes of the urinary bladder different parts were studied in 1 week and in 3 months. Compensatory hypertrophy of the detrusor was accompanied increasing of hypertrophied, atrophic and native forms of leiomyocytes, as so their transformation into myofibroblasts with connective tissue formation between the muscle fibers mainly in the neck of urinary bladder Contractility of the detrusor decreased with their tonus increasing mainly in the neck of urinary bladder too. Weakening effect of adrenalin in 3 month after obstruction significantly decreased, while in the body and neck of urinary bladder it virtually disappeared. Blockade of alpha-adrenoreceptors after noradrenalin stimulation resulted in enchancement of the hypertrophic detrusor contraction when tonus of the urinary neck decreased. On the contrary, in the intact urinary bladder the similarly influence resulted in weakening of contraction.

  14. Compensatory Paracrine Mechanisms That Define The Urothelial Response to Injury in Partial Bladder Outlet Obstruction

    SciTech Connect

    Bassuk, James; Lendvay, Thomas S.; Sweet, Robert; Han, Chang-Hee; Soygur, Tarkan; Cheng, Jan-Fang; Plaire, J. Chadwick; Charleston, Jay S.; Charleston, Lynne B.; Bagai, Shelly; Cochrane, Kimberly; Rubio, Eric; Bassuk, James A.; Fuchs, Elaine

    2007-06-21

    Diseases and conditions affecting the lower urinary tract are a leading cause of dysfunctional sexual health, incontinence, infection, and kidney failure. The growth, differentiation, and repair of the bladder's epithelial lining are regulated, in part, by fibroblast growth factor (FGF)-7 and -10 via a paracrine cascade originating in the mesenchyme (lamina propria) and targeting the receptor for FGF-7 and -10 within the transitional epithelium (urothelium). The FGF-7 gene is located at the 15q15-q21.1 locus on chromosome 15 and four exons generate a 3.852-kb mRNA. Five duplicated FGF-7 gene sequences that localized to chromosome 9 were predicted not to generate functional protein products, thus validating the use of FGF-7-null mice as an experimental model. Recombinant FGF-7 and -10 induced proliferation of human urothelial cells in vitro and transitional epithelium of wild-type and FGF-7-null mice in vivo.To determine the extent that induction of urothelial cell proliferation during the bladder response to injury is dependent on FGF-7, an animal model of partial bladder outlet obstruction was developed. Unbiased stereology was used to measure the percentage of proliferating urothelial cells between obstructed groups of wild-type and FGF-7-null mice. The stereological analysis indicated that a statistical significant difference did not exist between the two groups, suggesting that FGF-7 is not essential for urothelial cell proliferation in response to partial outlet obstruction. In contrast, a significant increase in FGF-10 expression was observed in the obstructed FGF-7-null group, indicating that the compensatory pathway that functions in this model results in urothelial repair.

  15. Transcatheter stenting of the right ventricular outflow tract augments pulmonary arterial growth in symptomatic infants with right ventricular outflow tract obstruction and hypercyanotic spells.

    PubMed

    McGovern, Eimear; Morgan, Conall T; Oslizlok, Paul; Kenny, Damien; Walsh, Kevin P; McMahon, Colin J

    2016-10-01

    We retrospectively reviewed all the children with right ventricular outflow tract obstruction, hypoplastic pulmonary annulus, and pulmonary arteries who underwent stenting of the right ventricular outflow tract for hypercyanotic spells at our institution between January, 2008 and December, 2013; nine patients who underwent cardiac catheterisation at a median age of 39 days (range 12-60 days) and weight of 3.6 kg (range 2.6-4.3 kg) were identified. The median number of stents placed was one stent (range 1-4). The median oxygen saturation increased from 60% to 96%. The median right pulmonary artery size increased from 3.3 to 5.5 mm (-2.68 to -0.92 Z-score), and the median left pulmonary artery size increased from 3.4 to 5.5 mm (-1.93 to 0 Z-scores). Among all, one patient developed transient pulmonary haemorrhage, and one patient had pericardial tamponade requiring drainage. Complete repair of tetralogy of Fallot +/- atrioventricular septal defect or double-outlet right ventricle was achieved in all nine patients. Transcatheter stent alleviation of the right ventricular outflow tract obstruction resolves hypercyanotic spells and allows reasonable growth of the pulmonary arteries to facilitate successful surgical repair. This represents a viable alternative to placement of a systemic-to-pulmonary artery shunt, particularly in small neonates.

  16. Time Dependent Bladder Apoptosis Induced by Acute Bladder Outlet Obstruction and Subsequent Emptying is Associated with Decreased MnSOD Expression and Bcl-2/Bax Ratio

    PubMed Central

    Li, Wen Ji; Shin, Mi-Kyung

    2010-01-01

    Ischemia/reperfusion (I/R) injury-induced oxidative stress plays an important role in the functional impairment of the bladder following acute bladder outlet obstruction (BOO) via induction of apoptosis. The purpose of this study was to investigate the time course of the bladder apoptosis, and apoptosis related molecular changes in the early stage of acute BOO. Twelve-week-old male Sprague Dawley rats were divided into control, acute BOO only (I), and acute BOO plus subsequent emptying (I/R) for 30, 60, 120 min, 3 days and 2 weeks. We examined the extent of bladder apoptosis, expression of Mn-superoxide dismutase (Mn-SOD), Bcl-2, Bax, caspase 3 and poly (ADP-ribose) (PAR) in the bladder. Bladder apoptosis was significantly increased in the I/R group at 30, 60, and 120 min following bladder emptying. BOO plus subsequent emptying for 30, 60, 120 min showed significant decrease in MnSOD and Bcl-2 expression, and significant increase in caspase 3, Bax expression, and amounts of PAR. These results indicate that bladder apoptosis, induced by acute BOO and subsequent emptying, is associated with decreased MnSOD expression, increased PARP activity and imbalance in apoptosis pathways. PMID:21060756

  17. Heterogeneity of morphological and functional changes in various compartments of rat urinary bladder in infravesical obstruction of the urinary tract.

    PubMed

    Kirpatovskii, V I; Kudryavtsev, Yu V; Mudraya, I S; Belik, S M; Khromov, R A

    2009-01-01

    Infravesical obstruction of the lower urinary tract was simulated in rats by dosed constriction of the prevesical portion of the urethra. The functional and morphological changes in various urinary bladder compartments were evaluated after 1 week and 3 months. The development of compensatory hypertrophy of the detrusor was associated with an increase in the number of hypertrophic, atrophic, and young leiomyocyte forms and their transformation into myofibroblasts, with the formation of connective tissue laminae between myofibril bundles mainly in the zone of urinary urinary bladder neck. Specific contractility of the detrusor strips decreased with increasing their tone, which was most pronounced in the neck zone. The relaxing effect of norepinephrine was significantly lower after 3 months of obstruction and virtually disappeared in the zone of the urinary bladder body and neck. Blockade of a-adrenoceptors after adrenostimulation with norepinephrine stimulated contractions of the hypertrophic detrusor against the background of reduced tone of the urinary bladder neck, in contrast to intact urinary bladder where this treatment reduced contractions.

  18. Effect of detrusor overactivity on the expression of aquaporins and nitric oxide synthase in rat urinary bladder following bladder outlet obstruction

    PubMed Central

    Kim, Sun-Ouck; Choi, Dongjune; Song, Seung Hee; Ahn, Kyu Youn; Kwon, Dongdeuk; Park, Kwangsung; Ryu, Soo Bang

    2013-01-01

    Background: Aquaporins (AQPs) have recently been reported to be expressed in rat and human urothelium. Nitric oxide (NO) is thought to play a role in the bladder overactivity related to bladder outlet obstruction (BOO). The purpose of this study is to investigate the effect of BOO on the expression of AQP2-3 and nitric oxide synthase (NOS) isoforms in rat urothelium. Methods: Female Sprague-Dawley rats (230–240 g, n = 60) were divided into 2 groups. The control group (n = 30) and the partial bladder outlet obstruction (BOO) group (n = 30). After 4 weeks, we performed a urodynamic study to measure the contraction interval and contraction pressure. The expression and cellular localization of AQP2-3, endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) were determined by Western blot and immunohistochemistry. Results: On the cystometrogram, the estimated contraction interval time (minutes, mean ± SE) was significantly lower in the BOO group (3.0 ± 0.9) than in the control group (6.3 ± 0.4; p < 0.05). AQP2 was localized in the cytoplasm of the epithelium, whereas AQP3 was found only in the cell membrane of the epithelium. The protein expression of AQP2-3, eNOS and nNOS was significantly increased in the BOO group. Conclusion: Detrusor overactivity induced by BOO causes a significant increase in the expression of AQP2-3, eNOS, and nNOS in rat urinary bladder. This may imply that the AQPs and NOS isoforms have a functional role in the bladder dysfunction that occurs in association with BOO. PMID:23766828

  19. Impairment of ATP hydrolysis decreases adenosine A1 receptor tonus favoring cholinergic nerve hyperactivity in the obstructed human urinary bladder.

    PubMed

    Silva-Ramos, M; Silva, I; Faria, M; Magalhães-Cardoso, M T; Correia, J; Ferreirinha, F; Correia-de-Sá, P

    2015-12-01

    This study was designed to investigate whether reduced adenosine formation linked to deficits in extracellular ATP hydrolysis by NTPDases contributes to detrusor neuromodulatory changes associated with bladder outlet obstruction in men with benign prostatic hyperplasia (BPH). The kinetics of ATP catabolism and adenosine formation as well as the role of P1 receptor agonists on muscle tension and nerve-evoked [(3)H]ACh release were evaluated in mucosal-denuded detrusor strips from BPH patients (n = 31) and control organ donors (n = 23). The neurogenic release of ATP and [(3)H]ACh was higher (P < 0.05) in detrusor strips from BPH patients. The extracellular hydrolysis of ATP and, subsequent, adenosine formation was slower (t (1/2) 73 vs. 36 min, P < 0.05) in BPH detrusor strips. The A(1) receptor-mediated inhibition of evoked [(3)H]ACh release by adenosine (100 μM), NECA (1 μM), and R-PIA (0.3 μM) was enhanced in BPH bladders. Relaxation of detrusor contractions induced by acetylcholine required 30-fold higher concentrations of adenosine. Despite VAChT-positive cholinergic nerves exhibiting higher A(1) immunoreactivity in BPH bladders, the endogenous adenosine tonus revealed by adenosine deaminase is missing. Restoration of A1 inhibition was achieved by favoring (1) ATP hydrolysis with apyrase (2 U mL(-1)) or (2) extracellular adenosine accumulation with dipyridamole or EHNA, as these drugs inhibit adenosine uptake and deamination, respectively. In conclusion, reduced ATP hydrolysis leads to deficient adenosine formation and A(1) receptor-mediated inhibition of cholinergic nerve activity in the obstructed human bladder. Thus, we propose that pharmacological manipulation of endogenous adenosine levels and/or A(1) receptor activation might be useful to control bladder overactivity in BPH patients.

  20. Intra-aortic balloon pump associated with dynamic left ventricular outflow tract obstruction after valve replacement for aortic stenosis.

    PubMed

    Morewood, G H; Weiss, S J

    2000-03-01

    An unstable patient with critical aortic stenosis had an intra-aortic balloon pump placed preoperatively for hemodynamic support and alleviation of symptoms. After separation from cardiopulmonary bypass following aortic valve replacement, the patient was hypotensive with increased pulmonary artery pressures. Transesophageal echocardiography revealed left ventricular outflow tract obstruction associated with systolic anterior motion of the mitral valve and severe mitral regurgitation. This pathophysiology was present when ventricular systole was preceded by balloon counterpulsation, but was absent during unassisted systole. This case report demonstrates a potentially significant untoward effect of intra-aortic balloon pump augmentation after aortic valve replacement for aortic stenosis. The timely diagnosis of this iatrogenic condition in the operating room permitted the prompt implementation of appropriate management strategies and avoided unnecessary surgical intervention.

  1. Targeted Laser Ablation of the Zebrafish Larval Heart Induces Models of Heart Block, Valvular Regurgitation, and Outflow Tract Obstruction

    PubMed Central

    Matrone, Gianfranco; Maqsood, Sana; Taylor, Jonathan; Mullins, John J.; Tucker, Carl S.

    2014-01-01

    Abstract Mammalian models of cardiac disease have provided unique and important insights into human disease but have become increasingly challenging to produce. The zebrafish could provide inexpensive high-throughput models of cardiac injury and repair. We used a highly targeted laser, synchronized to fire at specific phases of the cardiac cycle, to induce regional injury to the ventricle, atrioventricular (AV) cushion, and bulbus arteriosus (BA). We assessed the impact of laser injury on hearts of zebrafish early larvae at 72 h postfertilization, to different regions, recording the effects on ejection fraction (EF), heart rate (HR), and blood flow at 2 and 24 h postinjury (hpi). Laser injury to the apex, midzone, and outflow regions of the ventricle resulted in reductions of the ventricle EF at 2 hpi with full recovery of function by 24 hpi. Laser injury to the ventricle, close to the AV cushion, was more likely to cause bradycardia and atrial–ventricular dysfunction, suggestive of an electrical conduction block. At 2 hpi, direct injury to the AV cushion resulted in marked regurgitation of blood from the ventricle to the atrium. Laser injury to the BA caused temporary outflow tract obstruction with cessation of ventricle contraction and circulation. Despite such damage, 80% of embryos showed complete recovery of the HR and function within 24 h of laser injury. Precision laser injury to key structures in the zebrafish developing heart provides a range of potentially useful models of hemodynamic overload, injury, and repair. PMID:25272304

  2. Summary of Clinical Experience of Modified Double Root Translocation in the Management of Complete Transposition of Great Arteries With Left Ventricular Outflow Tract Obstruction.

    PubMed

    Yang, Bin; Xu, Jing; Zhou, Zhiming; Wang, Ke; Chen, Jianchao; Chen, Hongling; Wen, Meng; Liang, Qiaoru

    2016-07-27

    To summarize the therapeutic effects of modified double root translocation (MDRT) in the management of congenital heart disease-transposition of great arteries (TGA) with ventricular septum defect (VSD) and left ventricular outflow tract obstruction (LVOTO). From May 2013 to March 2015, we treated 6 patients (4 males, 2 females, aged from 1 year and 8 months old to 5 years old) with complete transposition of great arteries with left ventricular outflow tract obstruction, SaO2 54 ± 7.3%; the outflow velocity of the left ventricular or pulmonary valve measured by Doppler was 4.46 ± 0.15 m/s, and the Nakata index was 217 ± 32 cm(2)/m(2). We carried out a double root translocation operation on these 6 patients.One patient developed low cardiac output syndrome 4 hours after the operation. Extracorporeal membrane oxygenation (ECMO) was performed, but the patient died of multiple organ failure. The other 5 patients all recovered and were discharged from the hospital. During the 3-month to 2-year follow-up period, these 5 patients all demonstrated NYHA Class I or NYHA Class II LVEF (65 ± 2.7) %; 4 had mild pulmonary regurgitation, 1 moderate pulmonary regurgitation; 3 no aortic regurgitation, and 2 micro aortic regurgitation, SaO2 99 ± 0.4%.Modified double root translocation is an effective treatment method in the management of complete transposition of great arteries with left ventricular outflow tract obstruction.

  3. Obstructive uropathy

    MedlinePlus

    ... suddenly, or be a long-term problem. Common causes of obstructive uropathy include: Bladder stones Kidney stones Benign prostatic hyperplasia (enlarged prostate) Bladder or ureteral cancer Colon cancer Cervical cancer Uterine cancer Any cancer ...

  4. Relaxant and contractile responses of detrusor muscle strips obtained from bladder outlet-obstructed rats treated with doxazosin enantiomers.

    PubMed

    Wang, Miao; Ren, Xue-Jiao; Zhao, Qing-Hua; Lin, Li-Xin; Wang, Xue; Zhao, Yan; Ren, Lei-Ming

    2011-12-01

    (-)Doxazosin, one of (±)doxazosin enantiomers, was speculated to have a pharmacological enantioselectivity between the cardiovascular system and the urinary system by comparison with (+)doxazosin. Therefore, to evaluate the potential benefits of (-)doxazosin in the treatment of benign prostate hyperplasia, we compared the effects of the 3 agents, using rat mesenteric artery preparations and obstructed bladder strips. Concentration-response curves for carbachol (contractile response) and isoprenaline (relaxant response) in detrusor muscle strips of the bladder outlet obstruction (BOO) rats were shifted to the left, with significant increases in the Emax values, and significant decreases in the EC50 values by comparison with the sham-operated rats (P < 0.05, n = 10). The enhanced responses in detrusor muscle strips of the BOO rats treated with (±)doxazosin and its enantiomers at 3 mg·(kg body mass)(-1)·day(-1) for 2 weeks returned to normal levels, and the 3 agents inhibited the enhanced responses to carbachol and isoprenaline to the same extent. On the other hand, the 3 agents uncompetitively inhibited the vasoconstrictive response curves for NA in the rat isolated mesenteric artery, and the pKB value of (-)doxazosin at vascular α1-adrenoceptors was significantly smaller (P < 0.05, n = 6) than that of (+)doxazosin or (±)doxazosin. In conclusion, although (-)doxazosin inhibits vascular functional α1-adrenoceptors more weakly than (+)doxazosin, both agents equally ameliorate the enhanced responses in detrusor muscle of BOO rats, suggesting that the chiral carbon atom in the molecular structure of doxazosin does not affect its beneficial effects in the bladder smooth muscle of BOO rats.

  5. Effects of Spinal and Peripheral Injection of α1A or α1D Adrenoceptor Antagonists on Bladder Activity in Rat Models with or without Bladder Outlet Obstruction

    PubMed Central

    Kim, Jae Heon; Shim, Ji Sung; Kang, Seung Chul; Shim, Kang Soo; Park, Jae Young; Moon, Du Geon; Lee, Jeong Gu

    2011-01-01

    Purpose Antagonists of α1-adrenergic receptors (α1ARs) relax prostate smooth muscle and relieve voiding and storage symptoms. Recently, increased expression of α1ARs with change of its subtype expression has been proved in bladder outlet obstruction (BOO). To search for the evidence of changes in α1ARs subtype expression and activity in the peripheral and spinal routes, the effects of spinal and peripheral administration of tamsulosin (an α1A/D-selective AR), naftopidil (an α1A/D-selective AR), and doxazosin (non-selective AR) on bladder activity were investigated in a rat model with or without BOO. Methods A total of 65 female Sprague-Dawley rats were divided into the BOO surgery group (n=47) and the sham surgery group (n=18). After 6 weeks, cystometry was assessed before and after intrathecal and intra-arterial administrations of tamsulosin, naftopidil, and doxazosin. Results After intra-arterial administrations of all three drugs, bladder capacity (BC) was increased and maximal intravesical pressure (Pmax) was decreased in both BOO and the sham rat models (P<0.05). After intrathecal administration of all three drugs, BC was increased and Pmax was decreased in only the BOO group. The episodes of involuntary contraction in the BOO rat models were decreased by intra-arterial administration (P=0.031). The increase of BC after intrathercal and intra-arterial administrations of α1ARs was significantly greater in the BOO group than in the sham group (P=0.023, P=0.041). In the BOO group, the increase of BC and decrease in Pmax were greater by intra-arterial administration than by intrathecal administration (P=0.035). There were no significant differences of the degrees of changes in the cystometric parameters among the three different α1ARs. Conclusions Up-regulations of the α1ARs in BOO were observed by the greater increases of BC after α1AR antagonist administrations in the BOO group than in the sham group. However, there were no subtype differences of the

  6. Assessing the contribution of thrombospondin-4 induction and ATF6α activation to endoplasmic reticulum expansion and phenotypic modulation in bladder outlet obstruction

    PubMed Central

    Krawczyk, Katarzyna K.; Ekman, Mari; Rippe, Catarina; Grossi, Mario; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2016-01-01

    Phenotypic modulation of smooth muscle cells is a hallmark of disease. The associated expansion of endoplasmic reticulum (ER) volume remains unexplained. Thrombospondin-4 was recently found to promote ATF6α activation leading to ER expansion. Using bladder outlet obstruction as a paradigm for phenotypic modulation, we tested if thrombospondin-4 is induced in association with ATF6α activation and ER expansion. Thrombospondin-4 was induced and ATF6α was activated after outlet obstruction in rodents. Increased abundance of spliced of Xbp1, another ER-stress sensor, and induction of Atf4 and Creb3l2 was also seen. Downstream of ATF6α, Calr, Manf, Sdf2l1 and Pdi increased as did ER size, whereas contractile markers were reduced. Overexpression of ATF6α, but not of thrombospondin-4, increased Calr, Manf, Sdf2l1 and Pdi and caused ER expansion, but the contractile markers were inert. Knockout of thrombospondin-4 neither affected bladder growth nor expression of ATF6α target genes, and repression of contractile markers was the same, even if ATF6α activation was curtailed. Increases of Xbp1s, Atf4 and Creb3l2 were similar. Our findings demonstrate reciprocal regulation of the unfolded protein response, including ATF6α activation and ER expansion, and reduced contractile differentiation in bladder outlet obstruction occurring independently of thrombospondin-4, which however is a sensitive indicator of obstruction. PMID:27581066

  7. Assessing the contribution of thrombospondin-4 induction and ATF6α activation to endoplasmic reticulum expansion and phenotypic modulation in bladder outlet obstruction.

    PubMed

    Krawczyk, Katarzyna K; Ekman, Mari; Rippe, Catarina; Grossi, Mario; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2016-01-01

    Phenotypic modulation of smooth muscle cells is a hallmark of disease. The associated expansion of endoplasmic reticulum (ER) volume remains unexplained. Thrombospondin-4 was recently found to promote ATF6α activation leading to ER expansion. Using bladder outlet obstruction as a paradigm for phenotypic modulation, we tested if thrombospondin-4 is induced in association with ATF6α activation and ER expansion. Thrombospondin-4 was induced and ATF6α was activated after outlet obstruction in rodents. Increased abundance of spliced of Xbp1, another ER-stress sensor, and induction of Atf4 and Creb3l2 was also seen. Downstream of ATF6α, Calr, Manf, Sdf2l1 and Pdi increased as did ER size, whereas contractile markers were reduced. Overexpression of ATF6α, but not of thrombospondin-4, increased Calr, Manf, Sdf2l1 and Pdi and caused ER expansion, but the contractile markers were inert. Knockout of thrombospondin-4 neither affected bladder growth nor expression of ATF6α target genes, and repression of contractile markers was the same, even if ATF6α activation was curtailed. Increases of Xbp1s, Atf4 and Creb3l2 were similar. Our findings demonstrate reciprocal regulation of the unfolded protein response, including ATF6α activation and ER expansion, and reduced contractile differentiation in bladder outlet obstruction occurring independently of thrombospondin-4, which however is a sensitive indicator of obstruction. PMID:27581066

  8. “V-PLASTY”: a novel technique to reconstruct pulmonary valvular and annular stenosis in patients with right ventricular outflow tract obstruction

    PubMed Central

    2013-01-01

    Background The goal of repair of right ventricular outflow tract obstruction with or without Tetralogy of Fallot (TOF) is to eliminate valvular and/or subvalvular obstruction. However, this operation has a high risk of late complication of pulmonary insufficiency. In this study, we aimed to present early period results of our new technique that we call “V-Plasty” developed to prevent pulmonary insufficiency after pulmonary valve reconstruction in selected patients. Methods Between January 2006 and January 2010, we performed V-plasty for pulmonary valve reconstruction in 10 patients. Eight patients (5 males, 3 females) had TOF and 2 patients (1 male, 1 female) had atrial septal defect concomitant with pulmonary valve stenosis. Patient selection for V-plasty reconstruction was made due to the pulmonary valve anatomy and degree of stenosis. The mean follow-up time was 55.7 ± 16.2 months (ranging from 32 to 80 months). Results Functional capacity of the patients improved immediately after the surgery. There were no mortality and re-operation in follow-up period. Patients were followed up with echocardiography one week after the operation, at 1st, 6th, 12th months and annually. There was no pulmonary insufficiency. Conclusions Operative correction of the pulmonary outflow tract obstruction with or without TOF, frequently requires transannular enlargement because of the infundibular and/or annular-valvular obstruction. This conventional technique is usually a reason for late pulmonary insufficiency. In our study, we have not seen pulmonary insufficiency in early term follow-up period. Our early term results are encouraging, but long term follow-up results are needed with large case series. PMID:23537211

  9. Obstructive Form of Hypertrophic Cardiomyopathy-Left Ventricular Outflow Tract Gradient: Novel Methods of Provocation, Monitoring of Biomarkers, and Recent Advances in the Treatment

    PubMed Central

    Dimitrow, Pawel Petkow; Rajtar-Salwa, Renata

    2016-01-01

    Dynamic (latent or/and labile) obstruction of left ventricular outflow (LVOT) was recognized from the earliest clinical descriptions of hypertrophic cardiomyopathy (HCM) and has proved to be a complex phenomenon, as well as arguably the most audible (“visible”) pathophysiological hallmark of this heterogeneous disease. The aim of the current review is focused on two novel issues in a subgroup of obstructive HCM. Firstly, the important methodological problem in HCM is the examination of a subgroup of patients with nonobstructive hypertrophy in resting conditions and hard, but possible provoking obstruction. Recently, investigators have proposed physiological stress test (with double combined stimuli) to disclose such type of patients. The upright exercise is described in the ESC guideline on hypertrophic cardiomyopathy from 2014 and may appear as a candidate for gold standard provocation test. The second novel area of interest is associated with elevated level of signaling biomarkers: hypercoagulation, hemolysis, acquired von Willebrand 2A disease, and enhanced oxidative stress. The accelerated and turbulent flow within narrow LVOT may be responsible for these biochemical disturbances. The most recent advances in the treatment of obstructive HCM are related to nonpharmacological methods of LVOT gradient reduction. This report extensively discusses novel methods. PMID:27247935

  10. Intraprostatic injection of botulinum toxin type- A relieves bladder outlet obstruction in human and induces prostate apoptosis in dogs

    PubMed Central

    Chuang, Yao-Chi; Tu, Chieh-Hsien; Huang, Chao-Cheng; Lin, Hsin-Ju; Chiang, Po-Hui; Yoshimura, Naoki; Chancellor, Michael B

    2006-01-01

    Background With the increasing interest with botulinum toxin – A (BTX-A) application in the lower urinary tract, we investigated the BTX-A effects on the canine prostate and also in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). Methods Transperineal injection into the prostate using transrectal ultrasound (TRUS) was performed throughout the study. Saline with or without 100 U of BTX-A was injected into mongrel dogs prostate. One or 3 months later, the prostate was harvested for morphologic and apoptotic study. In addition, eight BPH patients refractory to α-blockers were treated with ultrasound guided intraprostatic injection of 200 U of BTX-A. Results In the BTX-A treated dogs, atrophy and diffuse apoptosis was observed with H&E stain and TUNEL stain at 1 and 3 months. Clinically, the mean prostate volume, symptom score, and quality of life index were significantly reduced by 18.8%, 73.1%, and 61.5% respectively. Maximal flow rate significantly increased by 72.0%. Conclusion Intraprostatic BTX-A injection induces prostate apotosis in dogs and relieves BOO in humans. It is therefore a promising alternative treatment for refractory BOO due to BPH. PMID:16620393

  11. [Repeated percutaneous transluminal septal myocardial ablation leads to reduction of left ventricular outflow-tract pressure gradient in hypertrophic obstructive cardiomyopathy: a case report].

    PubMed

    Takeda, Masafumi; Mori, Takao; Ohashi, Yoshitaka; Ichikawa, Shinobu; Terashima, Mitsuyasu; Ejiri, Junya; Awano, Kojiro

    2006-06-01

    A 61-year-old man with hypertrophic obstructive cardiomyopathy was treated twice with percutaneous transluminal septal myocardial ablation (PTSMA). The first procedure improved the left ventricular outflow tract pressure gradient (LVOTG) from 148 to 48 mmHg and the New York Heart Association (NYHA) class from III to II in a week. However, the LVOTG increased to 197 mmHg and the NYHA class worsened to III within 3 months. In spite of medical treatment with beta-blocker, syncope attack occurred suddenly. Repeated PTSMA was performed. Just after the second procedure, the LVOTG did not decrease. However, the LVOTG decreased to 81 mmHg and the NYHA class improved to II with 3 months. The different response of pressure gradient in the acute and chronic phase with repeated PTSMA was interesting. PMID:16800375

  12. Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy

    PubMed Central

    Cormio, Luigi; Lucarelli, Giuseppe; Selvaggio, Oscar; Di Fino, Giuseppe; Mancini, Vito; Massenio, Paolo; Troiano, Francesco; Sanguedolce, Francesca; Bufo, Pantaleo; Carrieri, Giuseppe

    2016-01-01

    Abstract The purpose of this study was to investigate the relationship between bladder outlet obstruction (BOO) and the risk of being diagnosed with prostate cancer (PCa). Study population consisted of 2673 patients scheduled for the first prostate biopsy (PBx). All patients underwent uroflowmetry before PBx; those with a peak flow rate (PFR) <10 mL/s were considered to have BOO. The incidence of PCa was 41.3% (1104/2673) in the overall population and 34.1% (659/1905) in patients with serum prostate-specific antigen (PSA) ≤ 10 ng/mL. Univariate and multivariate logistic regression analyses showed that patients with BOO had a significantly (P < 0.0001) lower risk than those without BOO of being diagnosed with PCa (33.1% vs 66.9% in the overall population; 30% vs 70% in patients with PSA ≤ 10 ng/mL). As the presence of BOO was significantly correlated to a large prostate volume, another independent predictor of PBx outcome, we tested whether these parameters could be used to identify, in the subset of patients with PSA≤10 ng/mL, those who could potentially be spared from a PBx. If we would have not biopsied patients with BOO and prostate volume ≥60 mL, 14.5% of biopsies could have been avoided while missing only 6% of tumors. Only 10% of the tumors that would have been missed were high-risk cancers. In conclusion, in men undergoing PBx, the absence of BOO, as determined by a PFR ≥10 mL/s, is an independent risk factor for PCa. Our study provides ground for this simple, noninvasive, objective parameter being used, alone or in combination with prostate volume, in the decision-making process of men potentially facing a PBx. PMID:26886598

  13. Absence of Bladder Outlet Obstruction Is an Independent Risk Factor for Prostate Cancer in Men Undergoing Prostate Biopsy.

    PubMed

    Cormio, Luigi; Lucarelli, Giuseppe; Selvaggio, Oscar; Di Fino, Giuseppe; Mancini, Vito; Massenio, Paolo; Troiano, Francesco; Sanguedolce, Francesca; Bufo, Pantaleo; Carrieri, Giuseppe

    2016-02-01

    The purpose of this study was to investigate the relationship between bladder outlet obstruction (BOO) and the risk of being diagnosed with prostate cancer (PCa).Study population consisted of 2673 patients scheduled for the first prostate biopsy (PBx). All patients underwent uroflowmetry before PBx; those with a peak flow rate (PFR) <10 mL/s were considered to have BOO.The incidence of PCa was 41.3% (1104/2673) in the overall population and 34.1% (659/1905) in patients with serum prostate-specific antigen (PSA) ≤ 10 ng/mL. Univariate and multivariate logistic regression analyses showed that patients with BOO had a significantly (P < 0.0001) lower risk than those without BOO of being diagnosed with PCa (33.1% vs 66.9% in the overall population; 30% vs 70% in patients with PSA ≤ 10 ng/mL). As the presence of BOO was significantly correlated to a large prostate volume, another independent predictor of PBx outcome, we tested whether these parameters could be used to identify, in the subset of patients with PSA≤10 ng/mL, those who could potentially be spared from a PBx. If we would have not biopsied patients with BOO and prostate volume ≥60 mL, 14.5% of biopsies could have been avoided while missing only 6% of tumors. Only 10% of the tumors that would have been missed were high-risk cancers.In conclusion, in men undergoing PBx, the absence of BOO, as determined by a PFR ≥10 mL/s, is an independent risk factor for PCa. Our study provides ground for this simple, noninvasive, objective parameter being used, alone or in combination with prostate volume, in the decision-making process of men potentially facing a PBx.

  14. Impact of post-transplant flow cytometric panel-reactive antibodies on late-onset hepatic venous outflow obstruction following pediatric living donor liver transplantation.

    PubMed

    Urahashi, Taizen; Mizuta, Koichi; Ihara, Yoshiyuki; Sanada, Yukihiro; Wakiya, Taiichi; Yamada, Naoya; Okada, Noriki

    2014-03-01

    The development of late-onset hepatic venous outflow obstruction (LOHVOO) following pediatric living donor liver transplantation (LDLT) can lead to uncontrollable fibrotic damage in liver grafts, even long-term patency of the graft outflow is achieved with appropriate therapeutic modalities. The aim of this study was to verify our hypothesis that some immunological responses, particularly cellular and/or antibody-mediated rejection (AMR), are associated with LOHVOO, which occurs following damage to liver sinusoidal endothelial cells in zone 3 of liver grafts. One hundred and eighty-nine patients underwent LDLT between May 2001 and December 2010 at our institute. Nine patients (4.8%) were identified as having LOHVOO. The preoperative factors, operative factors, and mortality, morbidity, and survival rates were examined and compared between the groups with and without LOHVOO. No statistical differences were observed between the groups with regard to preoperative factors, technical factors, or postoperative complications. However, FlowPRA reactivity was found to be a statistically significant risk factor for LOHVOO (P=0.006). The patients with both class I- and class II-reactive antibodies also had a significant risk of developing LOHVOO (P=0.03) and exhibited significantly higher retransplant rates. In conclusion, although further studies are needed to clarify this phenomenon, the pathophysiological mechanism underlying the development of LOHVOO after LDLT may be explained by immune-mediated responses that facilitate damage in zone 3 of liver grafts. PMID:24299518

  15. THE INFLUENCE OF MONTELUKAST ON THE ACTIVITY OF THE AUTONOMIC NERVOUS SYSTEM ESTIMATED BY HEART RATE VARIABILITY IN EXPERIMENTAL PARTIAL BLADDER OUTLET OBSTRUCTION IN RATS.

    PubMed

    Dobrek, Łukasz; Skowron, Beata; Baranowska, Agnieszka; Zurowski, Daniel; Thor, Piotr Jan

    2016-01-01

    Due to their paracrine action, leukotrienes released from the urothelium are involved in control of the bladder function. Anti-leukotriene agents appear to exert an ameliorating effect in bladder overactivity. It is unknown, whether their possible, modulatory impact on the autonomic nervous system (ANS) activity may also contribute to the potentially beneficial effect of those compounds. Therefore, our aim was to indirectly estimate the ANS function using the heart rate variability (HRV) study in rats with experimental partial bladder outlet obstruction (PBOO), reflecting human benign prostatic hyperplasia (BPH), treated with leukotriene receptor antagonist - montelukast (MLKT). Twenty rats with surgically induced PBOO lasting for 14 days, divided into two groups: group 1 (10 control subjects) and group 2 (10 MLKT-treated rats; 2 mg/rat/day) were subjected to HRV recordings, preceded by daily urine collection and a subsequent cystectomy with histopathological evaluation of collected bladders. Standard HRV time and spectral parameters were calculated. MLKT-treated animals demonstrated an increase in power of non-normalized LF (low frequency) and HF (high frequency) components with no change of the total HRV power. Moreover, an increase and decrease in normalized nLF and nHF, respectively, were assessed in those animals compared to the control. Additionally, a decrease in daily diuresis measurement was demonstrated in MLKT-treated animals. Montelukast treatment resulted in the functional ANS status re-arrangement, with sympathetic overdrive and parasympathetic withdrawal. Those changes may contribute to alleviation of bladder overactivity symptoms, independently on leukotriene receptors blockade. PMID:27476297

  16. Bladder outlet obstruction

    MedlinePlus

    ... prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap ... emptying failure. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap ...

  17. Bladder Dysfunction in Mice with Experimental Autoimmune Encephalomyelitis

    PubMed Central

    Altuntas, Cengiz Z.; Daneshgari, Firouz; Liu, Guiming; Fabiyi, Adebola; Kavran, Michael; Johnson, Justin M.; Gulen, M. Fatih; Jaini, Ritika; Li, Xiaoxia; Frenkl, Tara L.; Tuohy, Vincent K.

    2009-01-01

    The vast majority of patients with multiple sclerosis (MS) develop bladder control problems including urgency to urinate, urinary incontinence, frequency of urination, and retention of urine. Over 60% of MS patients show detrusor-sphincter dyssynergia, an abnormality characterized by obstruction of urinary outflow as a result of discoordinated contraction of the urethral sphincter muscle and the bladder detrusor muscle. In the current study we examined bladder function in female SWXJ mice with different defined levels of neurological impairment following induction of experimental autoimmune encephalomyelitis (EAE), an animal model of central nervous system inflammation widely used in MS research. We found that EAE mice develop profound bladder dysfunction characterized by significantly increased micturition frequencies and significantly decreased urine output per micturition. Moreover, we found that the severity of bladder abnormalities in EAE mice was directly related to the severity of clinical EAE and neurologic disability. Our study is the first to show and characterize micturition abnormalities in EAE mice thereby providing a most useful model system for understanding and treating neurogenic bladder. PMID:18703233

  18. A corticotropin-releasing factor receptor antagonist improves urodynamic dysfunction produced by social stress or partial bladder outlet obstruction in male rats

    PubMed Central

    Wood, Susan K.; McFadden, Kile; Griffin, Tagan; Wolfe, John H.; Zderic, Stephen

    2013-01-01

    Barrington's nucleus, in the pons, regulates micturition through spinal projections to preganglionic parasympathetic neurons. The stress neuropeptide CRF is prominent in these projections and has an inhibitory influence. Social stress in rats causes urinary retention and abnormal urodynamics resembling those produced by partial bladder outlet obstruction (pBOO), and this is associated with CRF upregulation in Barrington's nucleus. Here, we examined the role of CRF in social stress- and pBOO-induced urodynamic dysfunction by assessing the ability of a CRF1 receptor antagonist to alter these effects. Male rats exposed to repeated resident-intruder stress were administered vehicle or a CRF1 antagonist (NBI-30775) daily prior to the stress. Urodynamic function was recorded in the unanesthetized state 72 h after the final stress. NBI-30775 prevented the increased intermicturition interval, micturition volume, and bladder capacity produced by social stress, but not the increase in CRF expression in Barrington's nucleus neurons. The urinary dysfunction was also partly prevented by shRNA targeting of CRF in Barrington's nucleus, suggesting that stress-induced urinary dysfunction results, in part, from CRF upregulation in Barrington's nucleus and enhanced postsynaptic effects in the spinal cord. Finally, NBI-30775 improved urodynamic function of rats that had pBOO of 2-wk duration when administered daily during the second week but did not block the increase in CRF expression in Barrington's nucleus neurons. These findings implicate a role for Barrington's nucleus CRF in stress- and pBOO-induced urodynamic changes and suggest that CRF1 antagonists may be useful therapeutic agents for the treatment of urinary dysfunction. PMID:23552576

  19. Hybrid stage I palliation in a 1.1 kg, 28-week preterm neonate with posterior malalignment ventricular septal defect, left ventricular outflow tract obstruction, and coarctation of the aorta.

    PubMed

    Karani, Kunal B; Zafar, Farhan; Morales, David L S; Goldstein, Bryan H

    2014-10-01

    The hybrid stage I procedure has emerged as a less-invasive alternative to the standard surgical Norwood procedure in the palliation of high-risk hypoplastic left heart syndrome and variants. This approach may also benefit patients requiring complex neonatal repair who have significant anatomic and/or perioperative risk factors that either prevent or complicate durable and robust biventricular circulation from being safely achieved. An extremely low-birth weight (1.1 kg) 28-week gestation preterm neonate with postnatal diagnosis of posterior malalignment ventricular septal defect, severe left ventricular outflow tract obstruction, aortic annular hypoplasia, and aortic arch obstruction underwent initial palliation with a hybrid stage I procedure. In this case, hybrid stage I palliation allowed for both somatic and left heart growth followed by ultimate uncomplicated biventricular repair.

  20. Activation of common signaling pathways during remodeling of the heart and the bladder.

    PubMed

    Koeck, Ivonne; Burkhard, Fiona C; Monastyrskaya, Katia

    2016-02-15

    The heart and the urinary bladder are hollow muscular organs, which can be afflicted by pressure overload injury due to pathological conditions such as hypertension and bladder outlet obstruction. This increased outflow resistance induces hypertrophy, marked by dramatic changes in the organs' phenotype and function. The end result in both the heart and the bladder can be acute organ failure due to advanced fibrosis and the subsequent loss of contractility. There is emerging evidence that microRNAs (miRNAs) play an important role in the pathogenesis of heart failure and bladder dysfunction. MiRNAs are endogenous non-coding single-stranded RNAs, which regulate gene expression and control adaptive and maladaptive organ remodeling processes. This Review summarizes the current knowledge of molecular alterations in the heart and the bladder and highlights common signaling pathways and regulatory events. The miRNA expression analysis and experimental target validation done in the heart provide a valuable source of information for investigators working on the bladder and other organs undergoing the process of fibrotic remodeling. Aberrantly expressed miRNA are amendable to pharmacological manipulation, offering an opportunity for development of new therapies for cardiac and bladder hypertrophy and failure.

  1. Neurogenic bladder

    MedlinePlus

    ... of underactive bladder: Full bladder and possibly urine leakage Inability to tell when the bladder is full ... Constant urine leakage can cause skin to break down and lead to pressure sores Kidney damage may occur if the bladder ...

  2. Protostellar Outflows

    NASA Astrophysics Data System (ADS)

    Bally, John

    2016-09-01

    Outflows from accreting, rotating, and magnetized systems are ubiquitous. Protostellar outflows can be observed from radio to X-ray wavelengths in the continuum and a multitude of spectral lines that probe a wide range of physical conditions, chemical phases, radial velocities, and proper motions. Wide-field visual and near-IR data, mid-IR observations from space, and aperture synthesis with centimeter- and millimeterwave interferometers are revolutionizing outflow studies. Many outflows originate in multiple systems and clusters. Although most flows are bipolar and some contain highly collimated jets, others are wide-angle winds, and a few are nearly isotropic and exhibit explosive behavior. Morphologies and velocity fields indicate variations in ejection velocity, mass-loss rate, and in some cases, flow orientation and degree of collimation. These trends indicate that stellar accretion is episodic and often occurs in a complex dynamical environment. Outflow power increases with source luminosity but decreases with evolutionary stage. The youngest outflows are small and best traced by molecules such as CO, SiO, H2O, and H2. Older outflows can grow to parsec scales and are best traced by shock-excited atoms and ions such as hydrogen-recombination lines, [Sii], and [Oii]. Outflows inject momentum and energy into their surroundings and provide an important mechanism in the self-regulation of star formation. However, momentum injection rates remain uncertain with estimates providing lower bounds.

  3. Bladder leiomyoma presenting as dyspareunia

    PubMed Central

    Xin, Jun; Lai, Hai-ping; Lin, Shao-kun; Zhang, Qing-quan; Shao, Chu-xiao; Jin, Lie; Lei, Wen-hui

    2016-01-01

    Abstract Introduction: Leiomyoma of the bladder is a rare tumor arising from the submucosa. Most patients with bladder leiomyoma may present with urinary frequency or obstructive urinary symptoms. However, there are a few cases of bladder leiomyoma coexisting with uterine leiomyoma presenting as dyspareunia. We herein report an unusual case of coexisting bladder leiomyoma and uterine leiomyoma presenting as dyspareunia. Case presentation: A 44-year-old Asian female presented to urologist and complained that she had experienced dyspareunia over the preceding several months. A pelvic ultrasonography revealed a mass lesion located in the trigone of urinary bladder. The mass lesion was confirmed on contrast-enhanced computed tomography (CT). The CT scan also revealed a lobulated and enlarged uterus consistent with uterine leiomyoma. Then, the biopsies were then taken with a transurethral resection (TUR) loop and these biopsies showed a benign proliferation of smooth muscle in a connective tissue stroma suggestive of bladder leiomyoma. An open local excision of bladder leiomyoma and hysteromyomectomy were performed successfully. Histological examination confirmed bladder leiomyoma coexisting with uterine leiomyoma. Conclusion: This case highlights a rare presentation of bladder leiomyoma, dyspareunia, as the chief symptom in a patient who had coexisting uterine leiomyoma. Bladder leiomyomas coexisting with uterine leiomyomas are rare and can present with a wide spectrum of complaints including without symptoms, irritative symptoms, obstructive symptoms, or even dyspareunia. PMID:27428187

  4. Complete duplication of bladder and urethra: a case report.

    PubMed

    Esham, W; Holt, H A

    1980-05-01

    A case of complete duplication of the bladder and urethra in a girl is reported, demonstrating outlet obstruction in the bladder on the left side. Associated anomalies and pertinent literature are reviewed.

  5. Bladder Cancer

    MedlinePlus

    ... organ in your lower abdomen that stores urine. Bladder cancer occurs in the lining of the bladder. It ... urinate Low back pain Risk factors for developing bladder cancer include smoking and exposure to certain chemicals in ...

  6. Bladder cancer

    MedlinePlus

    ... removing the rest of the bladder Chemotherapy or immunotherapy placed directly into the bladder Stage II and ... IV), chemotherapy is usually given by vein (intravenously). IMMUNOTHERAPY Bladder cancers are often treated with immunotherapy. In ...

  7. Bladder Diseases

    MedlinePlus

    ... frequent, urgent urination Bladder cancer Doctors diagnose bladder diseases using different tests. These include urine tests, x- ... National Institute of Diabetes and Digestive and Kidney Diseases

  8. Bladder Health

    MedlinePlus

    ... life (the person’s level of health, comfort, and happiness). In fact, people with bladder problems may have a lower quality of life than people with diabetes, heart disease, or high blood pressure. Bladder problems ...

  9. Bladder stones

    MedlinePlus

    Stones - bladder; Urinary tract stones; Bladder calculi ... Benway BM, Bhayani SM. Lower urinary tract calculi. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 89. Sharma R, Dill CE, Gelman DY. Urinary ...

  10. Radiochemotherapy for bladder cancer.

    PubMed

    Ott, O J; Rödel, C; Weiss, C; Wittlinger, M; St Krause, F; Dunst, J; Fietkau, R; Sauer, R

    2009-09-01

    Standard treatment for muscle-invasive bladder cancer is cystectomy. Multimodality treatment, including transurethral resection of the bladder tumour, radiation therapy, chemotherapy and deep regional hyperthermia, has been shown to produce survival rates comparable with those of cystectomy. With these programmes, cystectomy has been reserved for patients with incomplete response or local relapse. During the past two decades, organ preservation by multimodality treatment has been investigated in prospective series from single centres and co-operative groups, with more than 1000 patients included. Five-year overall survival rates in the range of 50-60% have been reported, and about three-quarters of the surviving patients maintained their bladder. Clinical criteria helpful in determining patients for bladder preservation include such variables as small tumour size (<5 cm), early tumour stage, a visibly and microscopically complete transurethral resection, absence of ureteral obstruction, and no evidence of pelvic lymph node metastases. On multivariate analysis, the completeness of transurethral resection of a bladder tumour was found to be one of the strongest prognostic factors for overall survival. Patients at greater risk of new tumour development after initial complete response are those with multifocal disease and extensive associated carcinoma in situ at presentation. Close co-ordination among all disciplines is required to achieve optimal results. Future investigations will focus on optimising radiation techniques, including all possibilities of radiosensitisation (e.g. concurrent radiochemotherapy, deep regional hyperthermia), and incorporating more effective systemic chemotherapy, and the proper selection of patients based on predictive molecular makers.

  11. Neurogenic Bladder

    PubMed Central

    Dorsher, Peter T.; McIntosh, Peter M.

    2012-01-01

    Congenital anomalies such as meningomyelocele and diseases/damage of the central, peripheral, or autonomic nervous systems may produce neurogenic bladder dysfunction, which untreated can result in progressive renal damage, adverse physical effects including decubiti and urinary tract infections, and psychological and social sequelae related to urinary incontinence. A comprehensive bladder-retraining program that incorporates appropriate education, training, medication, and surgical interventions can mitigate the adverse consequences of neurogenic bladder dysfunction and improve both quantity and quality of life. The goals of bladder retraining for neurogenic bladder dysfunction are prevention of urinary incontinence, urinary tract infections, detrusor overdistension, and progressive upper urinary tract damage due to chronic, excessive detrusor pressures. Understanding the physiology and pathophysiology of micturition is essential to select appropriate pharmacologic and surgical interventions to achieve these goals. Future perspectives on potential pharmacological, surgical, and regenerative medicine options for treating neurogenic bladder dysfunction are also presented. PMID:22400020

  12. Bladder Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Diagnostic Ultrasound Corporation's Bladder Scan Monitor continuously records and monitors bladder fullness and alerts the wearer or caretaker when voiding is required. The sensor is held against the lower abdomen by a belt and connected to the monitor by a cable. The sensor obtains bladder volume data from sound waves reflecting off the bladder wall. The device was developed by Langley Research Center, the Ames Research Center and the NASA Technology Applications Team. It utilizes Langley's advanced ultrasound technology. It is licensed to the ARC for medical applications, and sublicensed to Diagnostics Ultrasound. Central monitoring systems are planned for the future.

  13. The overactive bladder progression to underactive bladder hypothesis.

    PubMed

    Chancellor, Michael B

    2014-09-01

    The overactive bladder (OAB) is a well-known and common urologic condition. However, the apparent opposite syndrome to the OAB, the underactive bladder (UAB), remains an enigma. Underactive bladder syndrome is complex condition that shares symptoms with other prevalent urologic diagnoses. UAB is not a pure condition-it is not the result of any single factor, but rather, it is multifactorial. As a result, UAB may overlap with OAB, bladder outlet obstruction, or even occur with no symptoms or associated diseases. To make it yet more challenging, in the elderly, detrusor hyperreflexia/impaired contractility (DHIC) is a condition that has the pathological elements of both OAB and UAB and is also common. I hypothesize that UAB and OAB may not be an entirely separate disease entity. Instead, chronic untreated or treatment refractory OAB--due to neurological diseases such as diabetes, bladder outlet obstruction or aging sarcopenia and frailty--may progress to DHIC and, finally, UAB. The progression of OAB to UAB hypothesis suggests that early education, behavioral modification and medical treatment may alter and/or prevent progression to UAB.

  14. Lower urinary tract obstruction in male children - a report of three cases.

    PubMed

    Lynser, Donboklang; Marbaniang, Evarisalin; Khongsni, Pynskhemboklang

    2016-09-01

    Urinary retention in young children and infancy is relatively rare. The commonest malignancy cause of bladder outlet obstruction in infancy is prostatic rhabdomyosarcoma; the commonest cause of congenital bladder outlet obstruction in a male infantis posterior urethral valve and the commonest cause of urethral obstruction in male children is urethral calculi. We present here a report on three cases of urethral obstruction in male children. PMID:27622420

  15. Overactive Bladder.

    PubMed

    White, Nicola; Iglesia, Cheryl B

    2016-03-01

    Overactive bladder (OAB) is a condition affecting millions of individuals in the United States. Anticholinergics are the mainstay of treatment. Bladder botulinum toxin injections have shown an improvement in symptoms of OAB equivalent to anticholinergic therapy. Percutaneous tibial nerve stimulation can decrease symptoms of urinary frequency and urge incontinence. Sacral neuromodulation for refractory patients has been approved by the Food and Drug Administration for treatment of OAB, urge incontinence, and urinary retention. Few randomized, head-to-head comparisons of the different available alternatives exist; however, patients now have increasing options to manage their symptoms and improve their quality of life.

  16. Bladder Leiomyoma Presenting With LUTS and Coexisting Bladder and Uterine Leiomyomata: A Review of Two Cases

    PubMed Central

    Jain, Sudhir Kumar; Tanwar, Raman; Mitra, Aparajita

    2014-01-01

    Mesenchymal tumors of the urinary bladder are a rare occurrence, the most common among them being leiomyoma of the bladder. These tumors commonly present with irritative urinary symptoms progressing gradually to obstructive symptoms as the size increases. We report on two patients who presented with lower urinary tract symptoms (LUTS). One of the patients also had concomitant bladder and uterine leiomyomata, which is the first such case to be reported in the literature. It is essential to differentiate leiomyoma from other common causes of LUTS. Cold cup biopsy has a significant false-negative rate and, in such cases, a wide local excision provides an optimal cure with excellent results. PMID:24791156

  17. Bowel Obstruction.

    PubMed

    Gore, Richard M; Silvers, Robert I; Thakrar, Kiran H; Wenzke, Daniel R; Mehta, Uday K; Newmark, Geraldine M; Berlin, Jonathan W

    2015-11-01

    Small bowel obstruction and large bowel obstruction account for approximately 20% of cases of acute abdominal surgical conditions. The role of the radiologist is to answer several key questions: Is obstruction present? What is the level of the obstruction? What is the cause of the obstruction? What is the severity of the obstruction? Is the obstruction simple or closed loop? Is strangulation, ischemia, or perforation present? In this presentation, the radiologic approach to and imaging findings of patients with known or suspected bowel obstruction are presented. PMID:26526435

  18. Bladder Cancer Advocacy Network

    MedlinePlus

    ... future bladder cancer research through the Patient Survey Network. Read More... The JPB Foundation 2016 Bladder Cancer ... 2016 Young Investigator Awardees The Bladder Cancer Advocacy Network (BCAN) has announced the recipients of the 2016 ...

  19. Research Findings on Overactive Bladder

    PubMed Central

    Patra, Phani B.; Patra, Sayani

    2015-01-01

    Several physiopathologic conditions lead to the manifestation of overactive bladder (OAB). These conditions include ageing, diabetes mellitus, bladder outlet obstruction, spinal cord injury, stroke and brain injury, Parkinson's disease, multiple sclerosis, interstitial cystitis, stress and depression. This review has discussed research findings in human and animal studies conducted on the above conditions. Several structural and functional changes under these conditions have not only been observed in the lower urinary tract, but also in the brain and spinal cord. Significant changes were observed in the following areas: neurotransmitters, prostaglandins, nerve growth factor, Rho-kinase, interstitial cells of Cajal, and ion and transient receptor potential channels. Interestingly, alterations in these areas showed great variation in each of the conditions of the OAB, suggesting that the pathophysiology of the OAB might be different in each condition of the disease. It is anticipated that this review will be helpful for further research on new and specific drug development against OAB. PMID:26195957

  20. Bilateral Ureteral Obstruction in Children after Appendectomy

    PubMed Central

    Grande, M.; Lisi, G.; Bianchi, D.; Bove, P.; Miano, R.; Esser, A.; De Sanctis, F.; Neri, A.; Grande, S.; Villa, M.

    2015-01-01

    Acute renal failure due to bilateral ureteral obstruction is a rare complication after appendectomy in children. We report a case of bilateral ureteric obstruction in a 14-year-old boy nine days after surgery for an acute appendicitis. After saline-filling of the urinary bladder, transabdominal ultrasound demonstrated bilateral hydronephrosis of moderate degree. No abscess was found with CT but presence of millimetric stones on both distal ureters was shown, with bilateral calyceal dilatation. Cystoscopy revealed inflammatory changes in the bladder base. Following introduction of bilateral ureteric stents, there was rapid normalisation of urinary output and serum creatinine. PMID:26295001

  1. The neurogenic bladder: introducing four contributions.

    PubMed

    Proesmans, Willem

    2008-04-01

    Neurogenic bladder dysfunction in children is frequently seen in patients with meningomyelocele (MMC). The disorder carries a high risk for all kinds of complications, with renal damage being the most important. More than 95% of MMC patients have a neurogenic bladder, the paramount manifestation of which is a disturbed coordination between detrusor and sphincter muscles. This vesicourethral dysfunction leads to defective filling and emptying of the urinary bladder. Voiding at will is almost never possible. According to the location and extent of the neural tube lesion, patients have either an atonic or a hypertonic pelvic floor and either an atonic or a hypertonic detrusor, leading to four classic combinations. Hypertonic sphincter and detrusor hyperactivity lead to the most dangerous form of neurogenic bladder, referred to as the "unsafe" bladder. The presence of residual urine in a high-pressure container causes either decompensation of the detrusor with vesicoureteral reflux or deterioration of the bladder wall with hypertrophy and stiffness resulting in uterovesical obstruction. The subsequent insufficient drainage of the upper urinary tract leads to decompensation of the ureters and finally to chronic renal disease, the process being accelerated by urinary tract infections. The aim of treatment is to restore as much as possible both essential functions: urine storage and timely emptying of the reservoir. What should and can be achieved is a more or less adequate, low-pressure, functional capacity of the bladder that is emptied as completely as possible by clean intermittent catheterization (CIC). MMC leads to the prototype of neurogenic bladder in childhood. What we know and what we do for MMC patients can roughly be applied to all other forms of neurogenic bladder, either congenital or acquired.

  2. Nerve growth factor in the urinary bladder of the adult regulates neuronal form and function.

    PubMed Central

    Steers, W D; Kolbeck, S; Creedon, D; Tuttle, J B

    1991-01-01

    Urethral obstruction produces increased voiding frequency (0.7 +/- 0.06 to 1.1 +/- 0.08 h-1) and hypertrophy of the urinary bladder (89 +/- 1.7 to 708 +/- 40 mg) with profound increments in the dimensions of afferent (4, 6) and efferent neurons (299 +/- 4.7 to 573 +/- 8.6 microns2) supplying this organ in the rat. We discovered that hypertrophied bladders of rat and human contain significantly more nerve growth factor (NGF) per milligram wet weight, protein, and DNA than normal bladders. The temporal correlation between NGF content, neuronal hypertrophy, and bladder weight was consistent with a role for this growth factor in the neurotrophic effects associated with obstruction. Autoimmunity to NGF abolished the hypertrophy of NGF-sensitive bladder neurons in the pelvic ganglion after obstruction. Relief of urethral obstruction reduced bladder size (349 +/- 78 mg), but neuronal hypertrophy (460.2 +/- 10.2 microns2) and elevated NGF levels were only partially reversed. Bladder hypertrophy (133 +/- 4.3 mg) induced by osmotic diuresis slightly increased ganglion cell area (365.2 +/- 6.1 microns2) and only doubled NGF content of the bladder. These findings provide important new evidence that parenchymal cells in the hypertrophied bladder can synthesize NGF and possibly other molecular messengers that act to alter the size and function of neurons in adult animals and man. Images PMID:1939656

  3. Radiological interventions in malignant biliary obstruction

    PubMed Central

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-01-01

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  4. Radiological interventions in malignant biliary obstruction.

    PubMed

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-05-28

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  5. Extraperitoneal Rupture of a Bladder Diverticulum and the Role of Multidetector Computed Tomography Cystography.

    PubMed

    Kodama, Koichi; Takase, Yasukazu; Saito, Katsuhiko

    2016-11-01

    Nontraumatic rupture of the bladder is less widely recognized than traumatic rupture, with a challenging early diagnosis due to high variability in clinical presentations. We report a case of extraperitoneal rupture of a bladder diverticulum in a patient with diabetes mellitus who presented with paralytic ileus. Despite conservative management, the patient developed sepsis requiring surgical treatment. Urinary tract infection and bladder outlet obstruction were considered to be potential mechanisms of the rupture. Multidetector computed tomography cystography should be used as the first-line modality when evaluating for a suspected bladder rupture, even in patients with nontraumatic bladder rupture. PMID:27656418

  6. Directly Driven Ion Outflow

    NASA Technical Reports Server (NTRS)

    Elliott, H. A.; Comfort, R. H.; Craven, P. D.; Moore, T. E.; Russell, C. T.; Rose, M. Franklin (Technical Monitor)

    2001-01-01

    We examine ionospheric outflows in the high altitude magnetospheric polar cap during the POLAR satellite's apogee on April 19, 1996 using the Thermal Ion Dynamics Experiment (TIDE) instrument. The elevated levels of O(+) observed in this pass may be due to the geophysical conditions during and prior to the apogee pass. In addition to the high abundance of O(+) relative to H(+), several other aspects of this data are noteworthy. We observe relationships between the density, velocity, and temperature which appear to be associated with perpendicular heating and the mirror force, rather than adiabatic expansion. The H(+) outflow is at a fairly constant flux which is consistent with being source limited by charge exchange at lower altitudes. Local centrifugal acceleration in the polar cap is found to be insufficient to account for the main variations we observe in the outflow velocity. The solar wind speed is high during this pass approximately 700 kilometers per second, and there are Alfve'n waves present in the solar wind such that the solar wind speed and IMF Bx are correlated. In this pass both the H(+) and O(+) outflow velocities correlate with both the solar wind speed and IMF fluctuations. Polar cap magnetometer and Hydra electron data show the same long period wave structure as found in the solar wind and polar cap ion outflow. In addition, the polar cap Poynting flux along the magnetic field direction correlates well with the H(+) temperature (R=0.84). We conclude that the solar wind can drive polar cap ion outflow particularly during polar squalls by setting up a parallel drop that is tens of eV which then causes the ion outflow velocity of O(+) and H(+), the electrons, and magnetic perturbations to vary in a similar fashion.

  7. Outflow Propagation in Collapsars: Collimated Jets And Expanding Outflows

    SciTech Connect

    Mizuta, A.; Yamasaki, T.; Nagataki, S.; Mineshige, S.; /Kyoto U., Yukawa Inst., Kyoto /KIPAC, Menlo Park

    2007-06-08

    We investigate the outflow propagation in the collapsar in the context of gamma-ray bursts (GRBs) with 2D relativistic hydrodynamic simulations. We vary the specific internal energy and bulk Lorentz factor of the injected outflow from non-relativistic regime to relativistic one, fixing the power of the outflow to be 10{sup 51}erg s{sup -1}. We observed the collimated outflow, when the Lorentz factor of the injected outflow is roughly greater than 2. To the contrary, when the velocity of the injected outflow is slower, the expanding outflow is observed. The transition from collimated jet to expanding outflow continuously occurs by decreasing the injected velocity. Different features of the dynamics of the outflows would cause the difference between the GRBs and similar phenomena, such as, X-ray flashes.

  8. Gall bladder Adenocarcinoma in a Young Girl.

    PubMed

    Date, Shivprasad V; Rizvi, S J

    2015-04-01

    A 16-year-old girl presented with abdominal discomfort, weakness, and jaundice. General examination revealed deep icterus with hard lymph nodes in left supraclavicular region. On gastrointestinal examination, we appreciated a hard intra-abdominal lump in the right hypochondrium. Biochemical evaluation showed features of obstructive jaundice. Imaging confirmed the presence of gall bladder lump with multiple intra-abdominal lymph nodes. Fine needle aspiration cytology of neck nodes demonstrated metastatic adenocarcinoma. Fine needle aspiration cytology of the gall bladder lump (done under sonographic guidance) confirmed poorly differentiated adenocarcinoma. To the best of our knowledge, malignancy of the gall bladder has not been reported in individuals less than 18 years in India, and only three cases have been reported worldwide in English literature. PMID:26139973

  9. Gall bladder Adenocarcinoma in a Young Girl.

    PubMed

    Date, Shivprasad V; Rizvi, S J

    2015-04-01

    A 16-year-old girl presented with abdominal discomfort, weakness, and jaundice. General examination revealed deep icterus with hard lymph nodes in left supraclavicular region. On gastrointestinal examination, we appreciated a hard intra-abdominal lump in the right hypochondrium. Biochemical evaluation showed features of obstructive jaundice. Imaging confirmed the presence of gall bladder lump with multiple intra-abdominal lymph nodes. Fine needle aspiration cytology of neck nodes demonstrated metastatic adenocarcinoma. Fine needle aspiration cytology of the gall bladder lump (done under sonographic guidance) confirmed poorly differentiated adenocarcinoma. To the best of our knowledge, malignancy of the gall bladder has not been reported in individuals less than 18 years in India, and only three cases have been reported worldwide in English literature.

  10. The Murine Bladder Supports a Population of Stromal Sca-1+/CD34+/lin- Mesenchymal Stem Cells

    PubMed Central

    Lilly, Meredith A.; Kulkulka, Natalie A.; Firmiss, Paula R.; Ross, Michael J.; Flum, Andrew S.; Santos, Grace B. Delos; Bowen, Diana K.; Dettman, Robert W.; Gong, Edward M.

    2015-01-01

    Bladder fibrosis is an undesired end point of injury of obstruction and often renders the smooth muscle layer noncompliant. In many cases, the long-term effect of bladder fibrosis is renal failure. Despite our understanding of the progression of this disease, little is known about the cellular mechanisms that lead to a remodeled bladder wall. Resident stem (progenitor) cells have been identified in various organs such as the brain, heart and lung. These cells function normally during organ homeostasis, but become dysregulated after organ injury. Here, we aimed to characterize a mesenchymal progenitor cell population as a first step in understanding its role in bladder fibrosis. Using fluorescence activated cell sorting (FACS), we identified a Sca-1+/ CD34+/ lin- (PECAM-: CD45-: Ter119-) population in the adult murine bladder. These cells were localized to the stromal layer of the adult bladder and appeared by postnatal day 1. Cultured Sca-1+/ CD34+/ lin- bladder cells self-renewed, formed colonies and spontaneously differentiated into cells expressing smooth muscle genes. These cells differentiated into other mesenchymal lineages (chondrocytes, adipocytes and osteocytes) upon culture in induction medium. Both acute and partial obstruction of the bladder reduced expression of CD34 and changed localization of Sca-1 to the urothelium. Partial obstruction resulted in upregulation of fibrosis genes within the Sca-1+/CD34+/lin- population. Our data indicate a resident, mesenchymal stem cell population in the bladder that is altered by bladder obstruction. These findings provide new information about the cellular changes in the bladder that may be associated with bladder fibrosis. PMID:26540309

  11. The Murine Bladder Supports a Population of Stromal Sca-1+/CD34+/lin- Mesenchymal Stem Cells.

    PubMed

    Lilly, Meredith A; Kulkulka, Natalie A; Firmiss, Paula R; Ross, Michael J; Flum, Andrew S; Santos, Grace B Delos; Bowen, Diana K; Dettman, Robert W; Gong, Edward M

    2015-01-01

    Bladder fibrosis is an undesired end point of injury of obstruction and often renders the smooth muscle layer noncompliant. In many cases, the long-term effect of bladder fibrosis is renal failure. Despite our understanding of the progression of this disease, little is known about the cellular mechanisms that lead to a remodeled bladder wall. Resident stem (progenitor) cells have been identified in various organs such as the brain, heart and lung. These cells function normally during organ homeostasis, but become dysregulated after organ injury. Here, we aimed to characterize a mesenchymal progenitor cell population as a first step in understanding its role in bladder fibrosis. Using fluorescence activated cell sorting (FACS), we identified a Sca-1+/ CD34+/ lin- (PECAM-: CD45-: Ter119-) population in the adult murine bladder. These cells were localized to the stromal layer of the adult bladder and appeared by postnatal day 1. Cultured Sca-1+/ CD34+/ lin- bladder cells self-renewed, formed colonies and spontaneously differentiated into cells expressing smooth muscle genes. These cells differentiated into other mesenchymal lineages (chondrocytes, adipocytes and osteocytes) upon culture in induction medium. Both acute and partial obstruction of the bladder reduced expression of CD34 and changed localization of Sca-1 to the urothelium. Partial obstruction resulted in upregulation of fibrosis genes within the Sca-1+/CD34+/lin- population. Our data indicate a resident, mesenchymal stem cell population in the bladder that is altered by bladder obstruction. These findings provide new information about the cellular changes in the bladder that may be associated with bladder fibrosis. PMID:26540309

  12. Studies of Quasar Outflows

    NASA Technical Reports Server (NTRS)

    Arav, Nahum

    2002-01-01

    The main aim of this research program is to determine the ionization equilibrium and abundances in quasar outflows. Especially in the broad absorption line QSO PG 0946+301. We find that the outflow's metalicity is consistent with being solar, while the abundance ratio of phosphorus to other metals is at least ten times solar. These findings are based on diagnostics that are not sensitive to saturation and partial covering effects in the BALs (Broad Adsorption Lines), which considerably weakened previous claims for enhanced metalicity. Ample evidence for these effects is seen in the spectrum.

  13. Metallicity and Quasar Outflows

    NASA Astrophysics Data System (ADS)

    Wang, Huiyuan; Zhou, Hongyan; Yuan, Weimin; Wang, Tinggui

    2012-06-01

    Correlations of the outflow strength of quasars, as measured by the blueshift and asymmetry index (BAI) of the C IV line, with intensities and ratios of broad emission lines, based on composite quasar spectra built from the Sloan Digital Sky Survey, are investigated. We find that most of the line ratios of other ions to C IV increase prominently with BAI. These behaviors can be well understood in the context of increasing metallicity with BAI. The strength of the dominant coolant, C IV line, decreases, and weak collisionally excited lines increase with gas metallicity as a result of the competition between different line coolants. Using Si IV+O IV]/C IV as an indicator of gas metallicity, we present, for the first time, a strong correlation between the metallicity and the outflow strength of quasars over a wide range of 1.7-6.9 times solar abundance. Our result implies that metallicity plays an important role in the formation of quasar outflows, likely by affecting outflow acceleration. This effect may have a profound impact on galaxy evolution via momentum feedback and chemical enrichment.

  14. METALLICITY AND QUASAR OUTFLOWS

    SciTech Connect

    Wang, Huiyuan; Zhou, Hongyan; Wang, Tinggui; Yuan, Weimin

    2012-06-01

    Correlations of the outflow strength of quasars, as measured by the blueshift and asymmetry index (BAI) of the C IV line, with intensities and ratios of broad emission lines, based on composite quasar spectra built from the Sloan Digital Sky Survey, are investigated. We find that most of the line ratios of other ions to C IV increase prominently with BAI. These behaviors can be well understood in the context of increasing metallicity with BAI. The strength of the dominant coolant, C IV line, decreases, and weak collisionally excited lines increase with gas metallicity as a result of the competition between different line coolants. Using Si IV+O IV]/C IV as an indicator of gas metallicity, we present, for the first time, a strong correlation between the metallicity and the outflow strength of quasars over a wide range of 1.7-6.9 times solar abundance. Our result implies that metallicity plays an important role in the formation of quasar outflows, likely by affecting outflow acceleration. This effect may have a profound impact on galaxy evolution via momentum feedback and chemical enrichment.

  15. Bladder function - neurological control

    MedlinePlus Videos and Cool Tools

    ... with urine, sensory nerves send impulses to the brain indicating that the bladder is full. The sensory ... cord to relay this information. In turn, the brain sends impulses back to the bladder instructing the ...

  16. How frequent are overactive bladder symptoms in women with urodynamic verification of an overactive bladder?

    PubMed Central

    Yeniel, Ahmet Özgür; Ergenoğlu, Mete Ahmet; Meseri, Reci; Aşkar, Niyazi; İtil, İsmail Mete

    2012-01-01

    Objective To determine the relationship between overactive bladder symptoms and urodynamic verification of overactive bladder. Material and Methods Between June 2011 and November 2011, 159 patients underwent urodynamics (UDS) at our urogynecology unit in the Ege University Hospital. Of these, 95 patients who complained of urgency, did not have any overt neurological diseases, bladder outlet obstruction and did not take any medication affecting the lower urinary tract function were evaluated. SPSS (ver. 15.0) was used to evaluate the data and the chi-square test and t test for independent samples were used for analysis. Results The mean age was found to be 54.5±12. Frequency was the most frequent symptom in women with overactive bladder (OAB) (82.1%), nocturia (57.8%) and (57.8%) urgency urinary incontinence followed in frequency. Detrusor over activity incidence was found to be 38.9%. There was no significant relationship between the presence of detrusor over activity (DOA) and OAB symptoms. Leak at urodynamics was found in 46.3% and there is no significant association with detrusor overactivity. Total bladder capacity was found to be significantly lower in women who had DOA (p=0.000). Conclusion It appears that overactive bladder symptoms do not predict detrusor over activity. Urodynamic investigation is not mandatory in the initial management of women with only OAB symptoms. PMID:24592016

  17. [Obstructive shock].

    PubMed

    Pich, H; Heller, A R

    2015-05-01

    An acute obstruction of blood flow in central vessels of the systemic or pulmonary circulation causes the clinical symptoms of shock accompanied by disturbances of consciousness, centralization, oliguria, hypotension and tachycardia. In the case of an acute pulmonary embolism an intravascular occlusion results in an acute increase of the right ventricular afterload. In the case of a tension pneumothorax, an obstruction of the blood vessels supplying the heart is caused by an increase in extravascular pressure. From a hemodynamic viewpoint circulatory shock caused by obstruction is closely followed by cardiac deterioration; however, etiological and therapeutic options necessitate demarcation of cardiac from non-cardiac obstructive causes. The high dynamics of this potentially life-threatening condition is a hallmark of all types of obstructive shock. This requires an expeditious and purposeful diagnosis and a rapid and well-aimed therapy. PMID:25994928

  18. Neoadjuvant Intravesical Vaccine Therapy in Treating Patients With Bladder Carcinoma Who Are Undergoing Cystectomy

    ClinicalTrials.gov

    2014-12-22

    Bladder Adenocarcinoma; Bladder Squamous Cell Carcinoma; Bladder Urothelial Carcinoma; Recurrent Bladder Carcinoma; Stage I Bladder Cancer; Stage II Bladder Cancer; Stage III Bladder Cancer; Stage IV Bladder Cancer

  19. Low-grade mucinous cystic tumor mimicking urinary bladder tumor: imaging-pathologic correlation.

    PubMed

    Dohan, Anthony; Ferlicot, Sophie; Bessède, Thomas; Soyer, Philippe; Rocher, Laurence

    2013-05-01

    Mucin-producing cystitis glandularis is a rare proliferative and metaplastic change of the bladder mucosa that produces large amounts of mucus, thus taking a pseudotumoral pattern and resulting in urinary tract obstruction. We report a case of florid mucin-producing cystitis glandularis mimicking bladder carcinoma in a 77-year-old man that was documented by computed tomography and magnetic resonance imaging. Computed tomography showed diffuse, circumferential, irregular, and lobulated thickening of the bladder wall suggestive of urinary bladder carcinoma. Magnetic resonance imaging showed findings consistent with mucinous content and suggested the correct diagnosis preoperatively. PMID:23490529

  20. Variations in active outflow along the trabecular outflow pathway.

    PubMed

    Cha, Elliott D K; Xu, Jia; Gong, Lihua; Gong, Haiyan

    2016-05-01

    Previous tracer studies have shown segmental outflow in the trabecular meshwork (TM) and along the inner wall (IW) of Schlemm's canal (SC). Whether segmental outflow is conserved distal to SC has not yet been investigated. This study aims to investigate whether the segmented pattern of outflow is conserved in distal outflow pathways by using a newly developed global imaging method and to evaluate variations of active outflow in three distinct regions along trabecular outflow pathway. Six normal whole globe human eyes were first perfused at 15 mmHg to establish a stable baseline outflow facility. The anterior chamber was then exchanged (5 mL) and perfused with fluorescent microspheres (0.002% v/v, 200 μL) to label areas of active outflow. All eyes were perfusion fixed and dissected into anterior segments. The TM and scleral surface were en face imaged globally. Effective filtration area (EFA) and fluorescent tracer distribution and intensity were analyzed in global images for both the TM and episcleral veins (EPVs). Anterior segments were further dissected into a minimum of 16 radial wedges, from which frontal sections were cut, stained, and imaged, using confocal microscopy. EFA from all three locations along the trabecular outflow pathway were measured and compared. Additionally, TM thickness, SC height, and total number of collector channels (CC) were analyzed and compared between active and inactive areas of outflow. Statistical analysis was performed using Student's t-tests and Wilcoxon signed-rank test with a required significance of p ≤ 0.05. All three locations showed a segmental outflow pattern. The TM had a significantly higher mean EFA (86.3 ± 3.5%) compared to both the IW (34.7 ± 2.9%; p ≤ 0.01) and EPVs (41.1 ± 3.8%; p ≤ 0.01). No significant difference in mean EFA was found between IW and EPVs. Preferential active outflow was observed in the nasal and inferior quadrants. TM thickness was significantly larger in areas of active

  1. Intestinal obstruction

    MedlinePlus

    ... of the bowel may be due to: A mechanical cause, which means something is in the way ... lung disease Use of certain medicines, especially narcotics Mechanical causes of intestinal obstruction may include: Adhesions or ...

  2. Mouse bladder wall injection.

    PubMed

    Fu, Chi-Ling; Apelo, Charity A; Torres, Baldemar; Thai, Kim H; Hsieh, Michael H

    2011-07-12

    Mouse bladder wall injection is a useful technique to orthotopically study bladder phenomena, including stem cell, smooth muscle, and cancer biology. Before starting injections, the surgical area must be cleaned with soap and water and antiseptic solution. Surgical equipment must be sterilized before use and between each animal. Each mouse is placed under inhaled isoflurane anesthesia (2-5% for induction, 1-3% for maintenance) and its bladder exposed by making a midline abdominal incision with scissors. If the bladder is full, it is partially decompressed by gentle squeezing between two fingers. The cell suspension of interest is intramurally injected into the wall of the bladder dome using a 29 or 30 gauge needle and 1 cc or smaller syringe. The wound is then closed using wound clips and the mouse allowed to recover on a warming pad. Bladder wall injection is a delicate microsurgical technique that can be mastered with practice.

  3. Drugs Approved for Bladder Cancer

    MedlinePlus

    ... Professionals Questions to Ask about Your Treatment Research Drugs Approved for Bladder Cancer This page lists cancer ... in bladder cancer that are not listed here. Drugs Approved for Bladder Cancer Atezolizumab Cisplatin Doxorubicin Hydrochloride ...

  4. Chronic bladder ischemia and oxidative stress: new pharmacotherapeutic targets for lower urinary tract symptoms.

    PubMed

    Nomiya, Masanori; Andersson, Karl-Erik; Yamaguchi, Osamu

    2015-01-01

    Chronic bladder ischemia is potentially a common cause of lower urinary tract symptoms in the elderly. Epidemiological studies have shown a close association between lower urinary tract symptoms and vascular risk factors for atherosclerosis, and investigations using transrectal color Doppler ultrasonography have shown a negative correlation between decreased lower urinary tract perfusion and International Prostate Symptom Score in elderly patients with lower urinary tract symptoms. Bladder blood flow is also known to decrease in men with bladder outlet obstruction as a result of benign prostatic hyperplasia. Studies in animal models suggest that chronic bladder ischemia and repeated ischemia/reperfusion during a micturition cycle might produce oxidative stress, leading to denervation of the bladder and the expression of tissue-damaging molecules in the bladder wall, which could be responsible for the development of bladder hyperactivity progressing to bladder underactivity. The effects of drugs with different mechanisms of action; for example, α1-adrenoceptor antagonists, phosphodiesterase type 5 inhibitors, free radical scavengers and β3-adrenoceptor agonist, have been studied in animal models of chronic bladder ischemia. The drugs, representing different treatment principles for increasing blood flow and decreasing oxidative stress, showed protective effects not only on urodynamic parameters, but also on negative effects on muscle contractility and on detrimental structural bladder wall changes. Improvement of lower urinary tract perfusion and control of oxidative stress can be considered new therapeutic strategies for treatment of bladder dysfunction induced by chronic ischemia.

  5. Bladder leiomyoma: Presentation, evaluation and treatment

    PubMed Central

    Khater, Nazih; Sakr, Ghazi

    2012-01-01

    Background Bladder leiomyomas are benign mesenchymal neoplasms and very rare urinary tumours that represent <0.5% of all bladder tumours, with only 250 cases reported worldwide to date. The importance of recognising their characteristic features, leading to their correct treatment, is fundamental. Therefore, we reviewed reports of leiomyomas of the urinary bladder, their causes, clinical presentations, imaging methods and surgical management, updated to 2012. Methods We retrospectively reviewed articles published in the USA, Europe and Asia, from 1953 to date, using PubMed, Medscape, Medline and the several major journals. We report areas of controversies and well-established guidelines. Results We reviewed 36 articles that confirmed, with a high level of evidence-based medicine, that the male to female ratio is equal, the cause of bladder leiomyomas remains unknown, and their most common presentation is obstructive uropathy; endovesical tumours are the most common. Their radiological diagnosis can be made by ultrasonography, computed tomography or magnetic resonance imaging. Complete surgical resection is a very effective treatment, associated with almost no recurrence. Conclusion In symptomatic patients a complete surgical resection can give a very good outcome, with almost no recurrence. PMID:26579246

  6. Renal Papillary Necrosis Appearing as Bladder Cancer on Imaging.

    PubMed

    Dagrosa, Lawrence M; Ghali, Fady; Gormley, Elizabeth Ann

    2016-01-01

    A 79-year-old woman with a history of diabetes mellitus and recurrent urinary tract infections (UTIs) presented with acute onset left lower quadrant pain, left-sided back pain, vomiting, and dysuria. Abdominopelvic CT scan revealed left hydroureteronephrosis to the level of the left ureterovesical junction (UVJ) where a bladder mass appeared to be obstructing the left ureteral orifice. The obstruction was ultimately found to be the result of a sloughed renal papilla lodged in the distal ureter, which created an inflammatory mass at the UVJ. Her history of diabetes and frequent UTIs likely predisposed her to the development of renal papillary necrosis (RPN) that resulted in sloughing of a renal papilla, distal ureteral obstruction with subsequent bladder inflammation that mimicked a bladder mass on imaging. RPN is a condition associated with many etiologies and likely represents a common final pathway of several diseases. Although several hypotheses exist, it is primarily thought to be ischemic in nature and is related to the underlying physiology of the renal papillae. We present a case of hydroureteronephrosis and bladder mass secondary to a sloughed renal papilla from RPN. PMID:27579408

  7. Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation

    PubMed Central

    Aguirre-Avalos, Guadalupe; Covarrubias-Velasco, Marco Antonio; Rojas-Sánchez, Antonio Gerardo

    2013-01-01

    Patient: Female, 54 Final Diagnosis: Suprahepatic inferior vena cava anastomosis stricture Symptoms: Ascites • fatigue • lower limb edema • hepatomegaly Medication: — Clinical Procedure: — Specialty: Transplantology • Critical Care Medicine Objective: Unusual clinical course Background: Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the “piggyback” technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain. Case Report: We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time. Conclusions: Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hyper-tension after portal hypertension by vascular complications. PMID:24046802

  8. 'Nipped in the Budd': hepatic venous outflow obstruction in evolution.

    PubMed

    Karageorgiou, Haris; Mookerjee, Rajeshwar P; Patani, Neill R; Pachiadakis, Ioannis; Usiskin, Sasha I; Gillams, Alice; Lees, William R; Williams, Roger; Douek, Michael; Jalan, Rajiv

    2005-01-01

    Hepatic venous thrombosis (Budd-Chiari) in evolution is a rare phenomenon and carries a high morbidity and mortality. We describe the case of a 39-year-old Bangladeshi lady who presented with severe abdominal pain secondary to a perforated duodenal ulcer and during her hospital admission developed an asymptomatic Budd-Chiari syndrome (BCS). Our report highlights the important role of an inflammatory focus, and how this process with an associated reactive thrombocytosis may act as a trigger for the development of BCS in an individual with predisposing risk factors. Our patient had been on the contraceptive pill, and was homozygous for the C677T mutation of 5,10-methylenetetrahydrofolate reductase, which results in hyperhomocysteinaemia. These pro-thrombotic risk factors were compounded by the thrombogenic potential of subsequent laparoscopic surgery, and resulted in an evolving thrombus that progressed into the inferior vena cava causing hepatic infarction. A particular feature of this case was the radiological demonstration of complete regression of the thrombus and the hepatic parenchymal changes, upon resolution of the inflammation and normalization of the platelet count. These changes occurred with oral anticoagulation as the only treatment modality, since our patient declined systemic thrombolysis. The demonstration of complete radiological resolution raises the question of how long one should continue oral anticoagulants and, indeed, whether in some instances a conservative approach may be the best management strategy for evolving BCS. PMID:15647643

  9. Particle Acceleration in Relativistic Outflows

    NASA Technical Reports Server (NTRS)

    Bykov, Andrei; Gehrels, Neil; Krawczynski, Henric; Lemoine, Martin; Pelletier, Guy; Pohl, Martin

    2012-01-01

    In this review we confront the current theoretical understanding of particle acceleration at relativistic outflows with recent observational results on various source classes thought to involve such outflows, e.g. gamma-ray bursts, active galactic nuclei, and pulsar wind nebulae. We highlight the possible contributions of these sources to ultra-high-energy cosmic rays.

  10. Zephyria Outflow Features

    NASA Technical Reports Server (NTRS)

    2004-01-01

    1 October 2004 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows streamlined islands and a small cataract in an outflow channel system in the Zephyria region of Mars, south of Cerberus. The fluids responsible for creating these landforms flowed from the lower left (southwest) toward upper right (northeast). The fluids may have been water and mud or, some Mars scientists have argued, extremely fluid lava. The presence of a small cataract probably argues more strongly for a water and mud origin. This image is located near 3.8oN, 204.7oW. The picture covers an area about 3 km (1.9 mi) wide and is illuminated by sunlight from upper left.

  11. Ion Outflow Observations

    NASA Technical Reports Server (NTRS)

    Mellot, Mary (Technical Monitor)

    2002-01-01

    The characteristics of out-flowing ions have been investigated under various circumstances. In particular the upwelling of ions from the cleft region has been studied to attempt to look at source characteristics (e.g., temperature, altitude). High altitude (6-8 Re) data tend to show ions species that have the same velocity and are adiabatically cooled. Such ions, while representative of their source, can not provide an accurate picture. Ion observations from the TIDE detector on the Polar spacecraft show an energy (or equivalently a velocity) spectrum of ions as they undo the geomagnetic mass spectrometer effect due to convection-gravity separation of the different species. Consolidation of this type of data into a complete representation of the source spectrum can be attempted by building a set of maximum-phase-space- density-velocity pairs and attributing the total to the source.

  12. Absorbing Outflows in AGN

    NASA Technical Reports Server (NTRS)

    Mathur, Smita

    2002-01-01

    The goal of this program was a comprehensive multiwavelength study of absorption phenomena in active galactic nuclei (AGN). These include a variety of associated absorption systems: X-ray warm absorbers, X-ray cold absorbers. UV absorbers with high ionization lines, MgII absorbers, red quasars and BALQSOs. The aim is to determine the physical conditions in the absorbing outflows, study their inter-relations and their role in AGN. We designed several observing programs to achieve this goal: X-ray spectroscopy, UV spectroscopy, FLAY spectroscopy and X-ray imaging. We were very successful towards achieving the goal over the five year period as shown through following observing programs and papers. Copies of a few papers are attached with this report.

  13. The defunctionalized bladder.

    PubMed

    Adeyoju, A B; Lynch, T H; Thornhill, J A

    1998-01-01

    Supravesical urinary diversion without cystectomy is a common procedure performed to manage a variety of lower urinary tract pathologies. The purpose of this article is to review the complications associated with the bladder left in situ and to relate this to the female patient. Complications related to the defunctionalized bladder include pyocystis, hemorrhage, pain/spasm and neoplastic transformation. The defunctionalized bladder also has implications for sexual function, pregnancy and undiversion. The risk factors for complications are chronic infection, inadequate drainage, interstitial cystitis and previous irradiation. The incidence of neoplastic change in the defunctionalized bladder is low, but long-term follow-up is advised, as carcinoma could develop many decades after diversion. Sexual function following urinary diversion is better preserved when the bladder is retained.

  14. Inflammasomes are important mediators of cyclophosphamide-induced bladder inflammation.

    PubMed

    Hughes, Francis M; Vivar, Nivardo P; Kennis, James G; Pratt-Thomas, Jeffery D; Lowe, Danielle W; Shaner, Brooke E; Nietert, Paul J; Spruill, Laura S; Purves, J Todd

    2014-02-01

    Bladder inflammation (cystitis) underlies numerous bladder pathologies and is elicited by a plethora of agents such as urinary tract infections, bladder outlet obstruction, chemotherapies, and catheters. Pattern recognition receptors [Toll-like receptors (TLRs) and Nod-like receptors (NLRs)] that recognize pathogen- and/or damage-associated molecular patterns (PAMPs and/or DAMPs, respectively) are key components of the innate immune system that coordinates the production (TLRs) and maturation (NLRs) of proinflammatory IL-1β. Despite multiple studies of TLRs in the bladder, none have investigated NLRs beyond one small survey. We now demonstrate that NLRP3 and NLRC4, and their binding partners apoptosis-associated speck-like protein containing a COOH-terminal caspase recruitment domain (ASC) and NLR family apoptosis inhibitory protein (NAIP), are expressed in the bladder and localized predominantly to the urothelia. Activated NLRs form inflammasomes that activate caspase-1. Placement of a NLRP3- or NLRC4-activating PAMP or NLRP3-activating DAMPs into the lumen of the bladder stimulated caspase-1 activity. To investigate inflammasomes in vivo, we induced cystitis with cyclophosphamide (CP, 150 mg/kg ip) in the presence or absence of the inflammasome inhibitor glyburide. Glyburide completely blocked CP-induced activation of caspase-1 and the production of IL-1β at 4 h. At 24 h, glyburide reduced two markers of inflammation by 30-50% and reversed much of the inflammatory morphology. Furthermore, glyburide reversed changes in bladder physiology (cystometry) induced by CP. In conclusion, NLRs/inflammasomes are present in the bladder urothelia and respond to DAMPs and PAMPs, whereas NLRP3 inhibition blocks bladder dysfunction in the CP model. The coordinated response of NLRs and TLRs in the urothelia represents a first-line innate defense that may provide an important target for pharmacological intervention.

  15. Inflammasomes are important mediators of cyclophosphamide-induced bladder inflammation.

    PubMed

    Hughes, Francis M; Vivar, Nivardo P; Kennis, James G; Pratt-Thomas, Jeffery D; Lowe, Danielle W; Shaner, Brooke E; Nietert, Paul J; Spruill, Laura S; Purves, J Todd

    2014-02-01

    Bladder inflammation (cystitis) underlies numerous bladder pathologies and is elicited by a plethora of agents such as urinary tract infections, bladder outlet obstruction, chemotherapies, and catheters. Pattern recognition receptors [Toll-like receptors (TLRs) and Nod-like receptors (NLRs)] that recognize pathogen- and/or damage-associated molecular patterns (PAMPs and/or DAMPs, respectively) are key components of the innate immune system that coordinates the production (TLRs) and maturation (NLRs) of proinflammatory IL-1β. Despite multiple studies of TLRs in the bladder, none have investigated NLRs beyond one small survey. We now demonstrate that NLRP3 and NLRC4, and their binding partners apoptosis-associated speck-like protein containing a COOH-terminal caspase recruitment domain (ASC) and NLR family apoptosis inhibitory protein (NAIP), are expressed in the bladder and localized predominantly to the urothelia. Activated NLRs form inflammasomes that activate caspase-1. Placement of a NLRP3- or NLRC4-activating PAMP or NLRP3-activating DAMPs into the lumen of the bladder stimulated caspase-1 activity. To investigate inflammasomes in vivo, we induced cystitis with cyclophosphamide (CP, 150 mg/kg ip) in the presence or absence of the inflammasome inhibitor glyburide. Glyburide completely blocked CP-induced activation of caspase-1 and the production of IL-1β at 4 h. At 24 h, glyburide reduced two markers of inflammation by 30-50% and reversed much of the inflammatory morphology. Furthermore, glyburide reversed changes in bladder physiology (cystometry) induced by CP. In conclusion, NLRs/inflammasomes are present in the bladder urothelia and respond to DAMPs and PAMPs, whereas NLRP3 inhibition blocks bladder dysfunction in the CP model. The coordinated response of NLRs and TLRs in the urothelia represents a first-line innate defense that may provide an important target for pharmacological intervention. PMID:24285499

  16. Investigating the effect of tamsulosin on the measurement of bladder wall thickness and International Prostate Symptom Score in benign prostatic hyperplasia

    PubMed Central

    Eghbali, Kamyar; Shayegan, Mohammad Reza; Kianoush, Sina

    2013-01-01

    Introduction: According to previous studies, aging, gender, bladder volume and pathological states, such as bladder outflow obstruction, affect bladder wall thickness (BWT). The aim of this study was to evaluate the correlation between BWT and the International Prostatic Symptom Score (IPSS) in patients with benign prostatic hyperplasia (BPH) before and after tamsulosin treatment. Methods: In this study, 60 BPH patients were included. After obtaining informed consent, data were gathered using questionnaires to determine IPSS. After that, prostate-specific antigen was measured and a clinical examination, including a digital rectal examination, was performed for all patients. BWT was determined by transabdominal ultrasound. Finally, all patients were treated with tamsulosin (0.4 mg/day) for 2 months. After completing treatment, the IPSS and BWT were measured again and compared with the initial findings. Results: In total, 44 patients completed treatment. Patients aged 61.7 ± 9.2 years old. The mean ± standard deviation of IPSS and BWT were 14.6 ± 5.0 and 5.36 ± 1.28 mm before treatment, while they significantly (p < 0.0001) decreased to 8.2 ± 4.7 and 4.69 ± 1.23 mm, respectively, after treatment. Chi-square test showed that the decrease in BWT was significantly correlated with the improvement in IPSS (p = 0.002; r = 0.449). Conclusion: After treatment with tamsulosin, patients experienced a reduction in their BWT which was significantly correlated with improvement in their IPSS. We conclude that transabdominal evaluation of BWT could be included in the follow-up assessment in BPH. PMID:23766833

  17. [Conservative and surgical therapy of urinary incontinence and bladder complaints in the man].

    PubMed

    Danuser, H; Burkhard, F C; John, H

    2003-05-01

    Treatment of incontinence and bladder complaints in the male should be directed to the cause whenever possible. Frequently, however, only symptomatic therapy is possible. Urge incontinence or overactive bladder due to obstruction should primarily be treated by eliminating the obstruction. Medical and surgical treatment methods are available for benign prostatic hyperplasia, bladder neck hypertrophy and prostatic cancer. In contrast, bladder neck sclerosis and uretheral strictures can only be treated surgically. Anticholinergics are primarily indicated if urge symptoms/incontinence persist after obstruction has been relieved or if urge incontinence occurs without obstruction. Seldom, in special cases injection of Botulinustoxin A or augmentation of the bladder may be indicated. Another possible cause of urge symptoms is urinary tract infection. This should be adequately treated according to resistance studies and the cause of the infection determined. In cases of overflow incontinence the infravesicle obstruction must be sought and treated. If limited detrusor contractability is the cause of overflow incontinence and the bladder cannot be emptied through pressmicturition, parasympathicometics may be of help. By insufficient effect, the procedure of intermittent self-catheterization must be taught. If this is not possible, the last resort is placement of a transuretheral or percutaneous catheter for continuous drainage. Stress incontinence is a rare complication in men, usually following prostatic surgery. It can be treated conservatively with pelvic floor training and alpha-adrenergic receptor agonists and if necessary surgically with submucosal collagen or silicon injections in the sphincter area or implantation of a sphincter prosthesis. Supravesicular urinary diversion is occasionally necessary after conservative and less invasive surgical measures have been exhausted and symptomatic suffering persists. Neurogenic disturbances in bladder capacity and/or emptying

  18. Cardiac outflow tract anomalies

    PubMed Central

    Neeb, Zachary; Lajiness, Jacquelyn D.; Bolanis, Esther; Conway, Simon J

    2014-01-01

    The mature outflow tract (OFT) is, in basic terms, a short conduit. It is a simple, although vital, connection situated between contracting muscular heart chambers and a vast embryonic vascular network. Unfortunately, it is also a focal point underlying many multifactorial congenital heart defects (CHDs). Through the use of various animal models combined with human genetic investigations, we are beginning to comprehend the molecular and cellular framework that controls OFT morphogenesis. Clear roles of neural crest cells (NCC) and second heart field (SHF) derivatives have been established during OFT formation and remodeling. The challenge now is to determine how the SHF and cardiac NCC interact, the complex reciprocal signaling that appears to be occurring at various stages of OFT morphogenesis, and finally how endocardial progenitors and primary heart field (PHF) communicate with both these colonizing extra-cardiac lineages. Although we are beginning to understand that this dance of progenitor populations is wonderfully intricate, the underlying pathogenesis and the spatiotemporal cell lineage interactions remain to be fully elucidated. What is now clear is that OFT alignment and septation are independent processes, invested via separate SHF and cardiac neural crest (CNC) lineages. This review will focus on our current understanding of the respective contributions of the SHF and CNC lineage during OFT development and pathogenesis. PMID:24014420

  19. Small Bowel Obstruction Due to Suprapubic Catheter Placement.

    PubMed

    Bonasso, Patrick C; Lucke-Wold, Brandon; Khan, Uzer

    2016-07-01

    Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection. PMID:27335801

  20. Small Bowel Obstruction Due to Suprapubic Catheter Placement.

    PubMed

    Bonasso, Patrick C; Lucke-Wold, Brandon; Khan, Uzer

    2016-07-01

    Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection.

  1. Obstructed uterus

    SciTech Connect

    Scott, W.W.; Rosenshein, N.B.; Siegelman, S.S.; Sanders, R.C.

    1981-12-01

    Eleven patients with an obstructed, fluid-filled uterus, due to carcinoma of the uterus or to its treatment by radiation therapy, were examined with computed tomography (CT) and/or ultrasound. It is important to recognize this abnormality to differentiate it from other causes of pelvic mass and to ensure prompt treatment of pyometra, should it develop. Both CT and ultrasound reliably identified this condition and differentiated it from other pelvic masses.

  2. Urinary Incontinence: Bladder Training

    MedlinePlus

    ... following ways: Lengthen the amount of time between bathroom trips. Increase the amount of urine your bladder ... Kegel exercises may also help control urges. Scheduled bathroom trips: Some people control their incontinence by going ...

  3. Ultrasound: Bladder (For Parents)

    MedlinePlus

    ... bladder area and images are recorded on a computer. The black-and-white images show the internal ... the images can be seen clearly on the computer screen. A technician (sonographer) trained in ultrasound imaging ...

  4. Naftopidil inhibits 5-hydroxytryptamine-induced bladder contraction in rats.

    PubMed

    Sakai, Takumi; Kasahara, Ken-ichi; Tomita, Ken-ichi; Ikegaki, Ichiro; Kuriyama, Hiroshi

    2013-01-30

    Naftopidil is an α(1D) and α(1A) subtype-selective α(1)-adrenoceptor antagonist that has been used to treat lower urinary tract symptoms of benign prostatic hyperplasia. In this study, we investigated the effects of naftopidil on 5-hydroxytryptamine (5-HT)-induced rat bladder contraction (10(-8)-10(-4) M). Naftopidil (0.3, 1, and 3 μM) inhibited 5-HT-induced bladder contraction in a concentration-dependent manner. On the other hand, other α(1)-adrenoceptor antagonists, tamsulosin, silodosin or prazosin, did not inhibit 5-HT-induced bladder contraction. The 5-HT-induced bladder contraction was inhibited by both ketanserin and 4-(4-fluoronaphthalen-1-yl)-6-propan-2-ylpyrimidin-2-amine (RS127445), serotonin 5-HT(2A) and 5-HT(2B) receptor antagonists, respectively. In addition, 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) and α-methyl-5-HT, 5-HT(2A) and 5-HT(2) receptor agonists, respectively, induced bladder contraction. The 5-HT-induced bladder contraction was not inhibited by N-[2-[4-(2-methoxyphenyl)piperazin-1-yl]ethyl]-N-pyridin-2-yl-cyclohexanecarboxamide (WAY-100635), [1-[2[(methylsulfonyl)amino]ethyl]-4-piperidinyl]methyl-1-methyl-1H-indole-3-carboxylate (GR113808) or (R)-3-[2-[2-(4-methylpiperidin-1-yl)ethyl]pyrrolidine-1-sulphonyl]phenol (SB269970), 5-HT(1A), 5-HT(4) and 5-HT(7) receptor antagonists, respectively. Naftopidil inhibited both the 5-HT(2A) and 5-HT(2) receptor agonists-induced bladder contractions. Naftopidil binds to the human 5-HT(2A) and 5-HT(2B) receptors with pKi values of 6.55 and 7.82, respectively. These results suggest that naftopidil inhibits 5-HT-induced bladder contraction via blockade of the 5-HT(2A) and 5-HT(2B) receptors in rats. Furthermore, 5-HT-induced bladder contraction was enhanced in bladder strips obtained from bladder outlet obstructed rats, with this contraction inhibited by naftopidil. The beneficial effects of naftopidil on storage symptoms such as urinary frequency and nocturia in patients with benign

  5. Neuromodulation in neurogenic bladder

    PubMed Central

    Sanford, Melissa T.

    2016-01-01

    While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction. PMID:26904417

  6. An Unexpected Foreign Body (a Thermometer) in the Bladder: A Case Report

    PubMed Central

    Dardamanis, M.; Balta, L.; Zacharopoulos, V.; Tatsi, V.; Tzima, H.

    2014-01-01

    Foreign bodies in the bladder are rarely observed because of difficult access. These patients usually have a mental disorder, a background of intense sexual perversion, or inquisitiveness. A 48-year-old, deaf, and mentally retarded woman was referred to the nephrology clinic for severe anemia and impaired renal function. Imaging tests showed a mercury thermometer positioned in the bladder and a stone, 5 cm in diameter, around it. This had caused bilateral ureteral obstruction. The patient underwent an open cysteotomy. Obstructive uropathy is one of the causes of kidney failure; therefore, foreign bodies should be included in the differential diagnosis. PMID:26955548

  7. Congenital urinary tract obstruction: the long view.

    PubMed

    Chevalier, Robert L

    2015-07-01

    Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy, therefore, results from combined developmental and obstructive kidney injury. Because of inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by magnetic resonance imaging should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients. PMID:26088076

  8. [Descriptive epidemiologic study of 514 cases of bladder cancer].

    PubMed

    Calatayud Sarthou, A; Cortes Vizcaino, C; Talamante Serrula, S; Corella Piquer, D

    1994-01-01

    A descriptive epidemiological study was conducted on the characteristics and risk factors of 514 cases of bladder cancer. The results show a higher prevalence in males aged 70 or older. A higher incidence was found in those with a lower occupational level. There is a relationship with smoking and a Quetelet obesity score higher than normal. Anatomo-pathologically, the transitional cell type was the most common. A history of hematuria and obstructive disorders, basically arising from the prostate, were frequently found.

  9. Extra-anatomic right ventricle to pulmonary artery conduit: the apical-aortic equivalent for complex right ventricular outflow tract reconstruction.

    PubMed

    Mori, Makoto; Siddharthan, Ragavan; Kogon, Brian

    2015-03-01

    We describe the case of a 22-year-old with tetralogy of Fallot, who underwent complete repair with ventricular septal defect closure and right ventricle to pulmonary artery conduit placement. She has undergone numerous subsequent conduit changes, each complicated by early stenosis and failure. Unfortunately, serial conduit changes can become increasingly challenging. While extra-anatomic conduits have been described for complex left ventricular outflow tract obstruction, they have not been described for right-sided obstruction. Herein, we present a patient who underwent successful placement of an extra-anatomic valved right ventricle to pulmonary artery conduit in the setting of complex right ventricular outflow tract obstruction.

  10. Primary extracorporeal shockwave lithotripsy in management of large bladder calculi.

    PubMed

    Husain, I; el-Faqih, S R; Shamsuddin, A B; Atassi, R

    1994-06-01

    Large bladder calculi are often outside the range of treatment with conventional endoscopic lithotrites because of either anatomic factors or the mechanical limits of available instruments. Alternative methods of cystolithotripsy: ultrasonic, electrohydraulic, or laser, can prove time-consuming or even hazardous, so that open surgery is often the most expeditious option. We report our experience using Dornier HM3 extracorporeal shockwave lithotripsy (SWL) for initial bladder stone reduction preparatory to transurethral litholapaxy and definitive treatment of any underlying obstructive pathology. Primary cystolitholapaxy was judged impractical in these 24 patients (21 adults and 3 children) presenting 31 large bladder stones (mean size 35.6 mm). In all patients, primary transpelvic SWL was followed immediately by endoscopic evacuation of stone debris or cystolitholapaxy. In addition, 10 of the 24 patients (42%) underwent a definitive endoscopic operation for treatment of an underlying obstructive lesion at either the same or a follow-on session. Morbidity was minimal, and the mean hospital stay after the initial SWL treatment was 3.5 days. In our experience, Dornier SWL has proved invaluable in enabling cystolitholapaxy of very large bladder calculi that would otherwise require protracted and difficult endoscopic manipulation or open surgery.

  11. The other bladder syndrome: underactive bladder.

    PubMed

    Miyazato, Minoru; Yoshimura, Naoki; Chancellor, Michael B

    2013-01-01

    Detrusor underactivity, or underactive bladder (UAB), is defined as a contraction of reduced strength and/or duration resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span. UAB can be observed in many neurologic conditions and myogenic failure. Diabetic cystopathy is the most important and inevitable disease developing from UAB, and can occur silently and early in the disease course. Careful neurologic and urodynamic examinations are necessary for the diagnosis of UAB. Proper management is focused on prevention of upper tract damage, avoidance of overdistension, and reduction of residual urine. Scheduled voiding, double voiding, al-blockers, and intermittent self-catheterization are the typical conservative treatment options. Sacral nerve stimulation may be an effective treatment option for UAB. New concepts such as stem cell therapy and neurotrophic gene therapy are being explored. Other new agents for UAB that act on prostaglandin E2 and EP2 receptors are currently under development. The pharmaceutical and biotechnology industries that have a pipeline in urology and women's health may want to consider UAB as a potential target condition. Scientific counsel and review of the current pharmaceutical portfolio may uncover agents, including those in other therapeutic fields, that may benefit the management of UAB.

  12. Traumatic injury of the bladder and urethra

    MedlinePlus

    Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption ... Types of bladder injuries include: Blunt trauma (such as a blow to the body) Penetrating wounds (such as bullet or stab wounds) The ...

  13. General Information about Bladder Cancer

    MedlinePlus

    ... Research Bladder Cancer Treatment (PDQ®)–Patient Version General Information About Bladder Cancer Go to Health Professional Version ... the PDQ Adult Treatment Editorial Board . Clinical Trial Information A clinical trial is a study to answer ...

  14. Origin of outflows and winds

    NASA Technical Reports Server (NTRS)

    Koenigl, Arieh; Ruden, Steven P.

    1993-01-01

    Recent developments concerning the accretion-outflow connection and the role of magnetic fields are examined. It is argued that the weakly ionized wind most likely represents an MHD outflow driven centrifugally from the disk surfaces or from the boundary between the disk and the star. Specific wind models for each of these alternatives are presented, and it is contended that both provide a natural explanation of the observed correlation between accretion and outflow. The kinematic, thermal, and chemical wind properties predicted by these models are described and their observational implications are considered. It is suggested that the wind characteristics may be reflected in the observed forbidden line and IR continuum emission of T Tauri stars and in the measured abundances of various molecular species.

  15. Acute kidney transplant failure following transurethral bladder polyp fulguration.

    PubMed Central

    Collins, Bradley H.; Marroquin, Carlos E.; Tuttle-Newhall, Janet E.; Kuo, Paul C.; Preminger, Glenn M.; Butterly, David W.

    2005-01-01

    Ureteral obstruction and anastomotic leak represent the most common urologic complications of kidney transplantation. Delay in diagnosis or treatment can lead to allograft loss. Obstruction of the ureter occurs in 2% of kidney transplant recipients. Although the majority of cases are immediate technical complications of the operation, subsequent manipulation of the genitourinary system can result in iatrogenic ureteral injury. We report the case of a long-term kidney transplant recipient who developed obstructive uropathy and acute renal failure requiring dialysis after undergoing cystoscopy and bladder polyp fulguration. The etiology was inadvertent thermal injury of the ureteroneocystostomy incurred during the procedure. After attempted percutaneous management, definitive open repair resulted in a return of allograft function to baseline. Images Figure 1 Figure 2 PMID:15779509

  16. Treatment of bladder dysfunction using stem cell or tissue engineering technique.

    PubMed

    Kim, Jae Heon; Lee, Hong Jun; Song, Yun Seob

    2014-04-01

    Tissue engineering and stem cell transplantation are two important options that may help overcome limitations in the current treatment strategy for bladder dysfunction. Stem cell therapy holds great promise for treating pathophysiology, as well as for urological tissue engineering and regeneration. To date, stem cell therapy in urology has mainly focused on oncology and erectile dysfunction. The therapeutic potency of stem cells (SCs) was originally thought to derive from their ability to differentiate into various cell types including smooth muscle. The main mechanisms of SCs in reconstituting or restoring bladder function are migration, differentiation, and paracrine effects. Nowadays, paracrine effects of stem cells are thought to be more prominent because of their stimulating effects on stem cells and adjacent cells. Studies of stem cell therapy for bladder dysfunction have been limited to experimental models and have been less focused on tissue engineering for bladder regeneration. Bladder outlet obstruction is a representative model. Adipose-derived stem cells, bone marrow stem cells (BMSCs), and skeletal muscle-derived stem cells or muscle precursor cells are used for transplantation to treat bladder dysfunction. The aim of this study is to review stem cell therapy and updated tissue regeneration as treatments for bladder dysfunction and to provide the current status of stem cell therapy and tissue engineering for bladder dysfunction including its mechanisms and limitations.

  17. Post-renal acute renal failure due to a huge bladder stone.

    PubMed

    Celik, Orcun; Suelozgen, Tufan; Budak, Salih; Ilbey, Yusuf Ozlem

    2014-06-30

    A 63-year old male was referred to our emergency unit due to acute renal failure. The level of serum renal function tests levels, blood urea nitrogen (BUN)/creatinine, were 63 mmol/L/848 μmol/L. CT (Computarised Tomography) scan showed a huge bladder stone (5 cm x 6 cm x 5 cm) with increased bladder wall thickness. Post-renal acute renal failure due to bilateral ureterohydronephrosis was diagnosed. The huge bladder stone was considered to be the cause of ureterohydronephrosis and renal failure. The patient was catheterised and received haemodialysis immediately. He received haemodialysis four times during ten days of hospitalization and the level of serum renal function tests levels (BUN/ creatinine) decreased 18 mmol/L/123 μmol/L. After improvement of renal function, we performed cystoscopy that demonstrated normal prostatic urethra and bladder neck and bilaterally normal ureteral orifices. Bladder wall was roughly trabeculated and Bladder outlet was completely obstructed by a huge bladder stone. After cystoscopy open, cystolithotomy was performed to remove calcium phosphate and magnesium ammonium phosphate stone weighing 200 g removed. Four days after operation the patient was discharged uneventfully and urethral catheter was removed on the seventh day. Post-renal acute renal failure due to large bladder stones is rare in literature. According to the our knowledge; early diagnosis of the stone avoid growth to large size and prevent renal failure.

  18. Water in Shocks and Outflows

    NASA Astrophysics Data System (ADS)

    Neufeld, D. A.; Melnick, G. J.; Stauffer, J. R.; Ashby, M. L. N.; Bergin, E. A.; Kleiner, S. C.; Patten, B. M.; Plume, R.; Tolls, V.; Wang, Z.; Zhang, Y. F.; Goldsmith, P. F.; Harwit, M.; Erickson, N. R.; Howe, J. E.; Snell, R. L.; Koch, D. G.; Schieder, R.; Winnewisser, G.; Chin, G.

    1999-12-01

    We have observed water vapor emission from several protostellar outflow regions with SWAS, including the sources Orion-KL, NGC 2071, NGC 1333 IRAS 4, L1157, RCrA, and L1689N. Observations of the 110}-1{01 water transition toward each of these sources have revealed the presence of broad line emission accompanied by narrow absorption in quiescent foreground gas or -- in the case of Orion-KL, by a narrow emission line component. In each case, the width of the broad emission line component, typically 20 - 40 km s-1 (FWHM), suggests an origin in the outflowing gas. From the observed line fluxes, we estimate water abundances ranging from 10-6 in low mass outflow regions to several x 10-4 in the Orion-KL region. These values are all significantly larger than the water abundance estimates of few x 10-9 - 10-7 derived from SWAS observations of quiescent regions, implying that the water abundances are enhanced in outflow regions. Such enhancements are indeed expected to result from the effects of shocks in (1) vaporizing icy grain mantles and/or (2) producing water in the gas-phase (by means of neutral-neutral reactions that are negligibly slow at the low temperatures of quiescent clouds but rapid at the elevated temperatures present behind a shock.)

  19. Molecular outflows in starburst nuclei

    NASA Astrophysics Data System (ADS)

    Roy, Arpita; Nath, Biman B.; Sharma, Prateek; Shchekinov, Yuri

    2016-08-01

    Recent observations have detected molecular outflows in a few nearby starburst nuclei. We discuss the physical processes at work in such an environment in order to outline a scenario that can explain the observed parameters of the phenomenon, such as the molecular mass, speed and size of the outflows. We show that outflows triggered by OB associations, with NOB ≥ 105 (corresponding to a star formation rate (SFR)≥1 M⊙ yr-1 in the nuclear region), in a stratified disk with mid-plane density n0 ˜ 200-1000 cm-3 and scale height z0 ≥ 200(n0/102 cm-3)-3/5 pc, can form molecules in a cool dense and expanding shell. The associated molecular mass is ≥107 M⊙ at a distance of a few hundred pc, with a speed of several tens of km s-1. We show that a SFR surface density of 10 ≤ ΣSFR ≤ 50 M⊙ yr-1 kpc-2 favours the production of molecular outflows, consistent with observed values.

  20. Postmenopausal overactive bladder

    PubMed Central

    2014-01-01

    Bladder storage symptoms have a severe impact on many areas as regards the quality of life including health-related, social, psychological and working functions. Pharmacotherapy of lower urinary tract stores (LUTS) has been developed to optimize neural control of the lower urinary tract in pathologic states. The bladder can be overactive or underactive. Overactive bladder (OAB) is highly prevalent and is associated with considerable morbidity, especially in aging population. Therefore, an effective treatment of OAB must result in a meaningful reduction in urinary symptoms. Pharmacotherapy for the OAB must be individualized based on the degree of bother, medication side-effect profile, concomitant comorbidities and current medication regimen. Antimuscarinic agents will continue to represent the current gold standard for the first-line pharmacological management of OAB. Alternatively to antimuscarinic therapy, β3-adrenergic receptor agonists, due to their efficacy and favorable adverse event profile, are a novel and attractive option of pharmacological treatment of overactive bladder symptoms. A combination of selective antimuscarinic and β3-adrenergic receptor agonists, agents with the different mechanism of action, gives a new treatment option for the patient with OAB according to its harms profile. A number of putative novel therapeutic agents is under clinical evaluations that may ultimately provide alternative or combination treatment options for OAB in the nearest future. PMID:26327873

  1. The Geometry of Quasar Outflows

    NASA Astrophysics Data System (ADS)

    Ganguly, Rajib

    2012-10-01

    Quasar outflows are important for understanding the accretion and growth processes of the central black hole, but also potentially play a role in feedback to the galaxy, halting star formation and infall of gas. A big uncertainty lies in the geometry and density of these outflows, especially as a function of ionization and velocity. We aim to tackle this using the archival COS M grating spectra of 266 quasars. We separate the geometry of outflows into two parts: the solid angle subtended around the black hole, and the distance of the outflow from the central engine. Large numbers of quasars with high resolution spectra are required for each aspect of this statistical investigation. First, we will determine which/how many absorption-line systems are intrinsic through both partial covering methods and statistical assessments. Second, we will consider the incidence of intrinsic absorbers as a function of quasar property {e.g., radio-loudness, SED shape, black hole mass, bolometric luminosity}. This will reveal what determines the solid angle. This can only be done at moderate redshifts where quasars with a larger range of properties are observable, and hence requires HST/COS. Third, we will use the wide range of diagnostic lines to constrain the physical conditions of the absorbers. We will target the CIII*1175 complex and apply photoionization models to constrain the densities and ionization parameters. This will provide the largest set yet of intrinsic absorbers with systematic distance constraints. In tandem with the solid angles, this work will inform models regarding the geometry of quasar outflows.

  2. Hot outflows in galaxy clusters

    NASA Astrophysics Data System (ADS)

    Kirkpatrick, C. C.; McNamara, B. R.

    2015-10-01

    The gas-phase metallicity distribution has been analysed for the hot atmospheres of 29 galaxy clusters using Chandra X-ray Observatory observations. All host brightest cluster galaxies (BCGs) with X-ray cavity systems produced by radio AGN. We find high elemental abundances projected preferentially along the cavities of 16 clusters. The metal-rich plasma was apparently lifted out of the BCGs with the rising X-ray cavities (bubbles) to altitudes between twenty and several hundred kiloparsecs. A relationship between the maximum projected altitude of the uplifted gas (the `iron radius') and jet power is found with the form R_Fe ∝ P_jet^{0.45}. The estimated outflow rates are typically tens of solar masses per year but exceed 100 M⊙ yr- 1 in the most powerful AGN. The outflow rates are 10-20 per cent of the cooling rates, and thus alone are unable to offset a cooling inflow. Nevertheless, hot outflows effectively redistribute the cooling gas and may play a significant role at regulating star formation and AGN activity in BCGs and presumably in giant elliptical galaxies. The metallicity distribution overall can be complex, perhaps due to metal-rich gas returning in circulation flows or being blown around in the hot atmospheres. Roughly 15 per cent of the work done by the cavities is expended lifting the metal-enriched gas, implying their nuclear black holes have increased in mass by at least ˜107-109 M⊙. Finally, we show that hot outflows can account for the broad, gas-phase metallicity distribution compared to the stellar light profiles of BCGs, and we consider a possible connection between hot outflows and cold molecular gas flows discovered in recent Atacama Large Millimeter Array observations.

  3. Low-dose tadenan protects the rabbit bladder from bilateral ischemia/ reperfusion-induced contractile dysfunction.

    PubMed

    Levin, R M; Whitbeck, C; Horan, P; Bellamy, F

    2005-01-01

    Recent studies indicate that focal ischemia/reperfusion (I/R) can cause the contractile dysfunctions induced in animal models of partial bladder outlet obstruction. Tadenan (Pygeum africanum) pretreatment can prevent the rabbit bladder from developing the contractile and biochemical dysfunctions induced by partial outlet obstruction, possibly by protecting the bladder from ischemic injury. The current study was designed to determine whether pre-treating rabbits with a clinically relevant dose of Tadenan could prevent the bladder from developing the contractile dysfunctions that are induced by bilateral ischemia followed by reperfusion. New Zealand White rabbits were separated into two groups. One group was pre-treated by oral gavage for 3 weeks with Tadenan (3.0 mg/kg body wt./ day). The second group was treated with vehicle (peanut oil). Five rabbits from each group were subjected to either bilateral ischemia for 1 or 3 h and than reperfused for either 1 h or 1 week. Five rabbits from each group were subjected to sham surgery and run with each of the experimental groups. The results of the current study show that Tadenan pretreatment at the clinically relevant dose of 3.0 mg/kg body wt./day protected the bladder from the contractile dysfunctions induced by bilateral ischemia followed by reperfusion. These data are consistent with the assertion that Tadenan therapy in both rabbits and humans acts by protecting the bladder smooth muscle against cellular damage caused by ischemia and reperfusion.

  4. Pachydermoperiostosis and bladder cancer.

    PubMed

    Famularo, Guiseppe; Stasolla, Alessandro; Gasbarrone, Laura

    2015-06-01

    Pachydermoperiostosis or the Touraine-Soulente-Golé syndrome is a rare monogenetic disorder characterized by pachydermia, periostosis and digital clubbing accounts for approximately 3∼5% of all patients with hypertrophic osteoarthropathy. Missense mutations in SLCO2A1 and HPGD genes could plausibly underlie the pathogenesis of pachydermoperiostosis. Patients have usually a favorable outcome with very few cases associated with cancer. Herein, we report the first case of a patient with pachydermoperiostosis associated with bladder cancer. PMID:26158372

  5. Endoscopic Management of Bladder Diverticula.

    PubMed

    Pham, Khanh N; Jeldres, Claudio; Hefty, Thomas; Corman, John M

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  6. Endoscopic Management of Bladder Diverticula

    PubMed Central

    Pham, Khanh N.; Jeldres, Claudio; Hefty, Thomas; Corman, John M.

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  7. Pharmacogenomics in bladder cancer

    PubMed Central

    Dancik, Garrett M.; Theodorescu, Dan

    2014-01-01

    Bladder cancer is a common cancer worldwide. For patients presenting with muscle-invasive disease, the five year survival rate is approximately 50%. Cisplatinum-based combination chemotherapy is recommended in the neoadjuvant setting prior to cystectomy and is also the first line in the metastatic setting. However, the survival benefit of such therapy is modest. The identification of pharmacogenomic biomarkers would enable the rational and personalized treatment of patients by selecting those patients that would benefit most from such therapies sparing others the unnecessary toxicity. Conventional therapies would be recommended for an expected responder while a non-responder would be considered for alternative therapies selected on the basis of the individual’s molecular profile. Although few effective bladder cancer therapies have been introduced in the past 30 years, several targeted therapies against the molecular drivers of bladder cancer appear promising. This review summarizes pharmacogenomic biomarkers that require further investigation and/or prospective evaluation, publicly available tools for drug discovery and biomarker identification from in vitro data, and targeted agents that have been evaluated in preclinical models. PMID:24360659

  8. [Multiple bladder diverticula caused by occipital horn syndrome].

    PubMed

    Legros, L; Revencu, N; Nassogne, M-C; Wese, F-X; Feyaerts, A

    2015-11-01

    We report on the case of a child who presented with recurrent, multiple, and voluminous bladder diverticula. Bladder diverticula are defined as a herniation of the mucosa through the bladder muscle or the detrusor. Causes are numerous and diverticula can be classified into primary congenital diverticula (para-ureteral - or Hutch diverticula - and posterolateral diverticula); secondary diverticula (resulting from chronic mechanical obstruction or from neurological disease; and diverticula secondary to connective tissue or muscle fragility. The latter is seen in disease entities such as prune belly syndrome, Ehlers-Danlos syndrome, cutis laxa syndrome, OHS (occipital horn syndrome), Menkes disease, and Williams-Beuren syndrome. In this patient, the cause of these diverticula was OHS, a genetic, recessive X-chromosome-linked syndrome, responsible for abnormal tissue caused by a disorder in copper metabolism. This case reminds us of the importance of pushing the diagnostic workup when presented with multiple and/or large bladder diverticula, and in particular to search for rare malformation syndromes after exclusion of an obstacle. PMID:26386812

  9. Bladder Cancer and Genetic Mutations.

    PubMed

    Zhang, Xiaoying; Zhang, Yangde

    2015-09-01

    The most common type of urinary bladder cancer is called as transitional cell carcinoma. The major risk factors for bladder cancer are environmental, tobacco smoking, exposure to toxic industrial chemicals and gases, bladder inflammation due to microbial and parasitic infections, as well as some adverse side-effects of medications. The genetic mutations in some chromosomal genes, such as FGFR3, RB1, HRAS, TP53, TSC1, and others, occur which form tumors in the urinary bladder. These genes play an important role in the regulation of cell division which prevents cells from dividing too quickly. The changes in the genes of human chromosome 9 are usually responsible for tumor in bladder cancer, but the genetic mutation of chromosome 22 can also result in bladder cancer. The identification of p53 gene mutation has been studied at NIH, Washington, DC, USA, in urine samples of bladder cancer patients. The invasive bladder cancers were determined for the presence of gene mutations on p53 suppressor gene. The 18 different bladder tumors were evaluated, and 11 (61 %) had genetic mutations of p53 gene. The bladder cancer studies have suggested that 70 % of bladder cancers involve a specific mutation in a particular gene, namely telomerase reverse transcriptase (TERT) gene. The TERT gene is involved in DNA protection, cellular aging processes, and cancer. The Urothelial carcinomas of the bladder have been described in Atlas of genetics and cytogenetics in oncology and hematology. HRAS is a proto-oncogene and has potential to cause cancer in several organs including the bladder. The TSC1 c. 1907 1908 del (E636fs) mutation in bladder cancer suggests that the location of the mutation is Exon 15 with frequency of TSC1 mutation of 11.7 %. The recent findings of BAP1 mutations have shown that it contributes to BRCA pathway alterations in bladder cancer. The discoveries of more gene mutations and new biomarkers and polymerase chain reaction bioassays for gene mutations in bladder

  10. Augmentation cystoplasty in neurogenic bladder

    PubMed Central

    Kocjancic, Ervin; Demirdağ, Çetin

    2016-01-01

    The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction.

  11. Morphology of left ventricular outflow tract structures in patients with subaortic stenosis and a ventricular septal defect.

    PubMed Central

    Kitchiner, D; Jackson, M; Malaiya, N; Walsh, K; Peart, I; Arnold, R; Smith, A

    1994-01-01

    OBJECTIVE--To compare the incidence and prognosis of subaortic stenosis associated with a ventricular septal defect and to define the morphological basis of subaortic stenosis. DESIGN--Presentation and follow up data on 202 patients with subaortic stenosis seen at the Royal Liverpool Children's Hospital between 1 January 1960 and 31 December 1991 were reviewed. Survivors were traced to assess their current clinical state. Necropsy specimens of 291 patients with lesions associated with subaortic stenosis were also examined. RESULTS--In the clinical study; 65 (32.1%) of the 202 patients with subaortic stenosis had a ventricular septal defect (excluding an atrioventricular septal defect). 32 of these patients had a short segment (fibromuscular) subaortic stenosis. 33 had subaortic stenosis produced by deviation of muscular components of the outflow tracts. In 17 patients (51.5%) this was caused by posterior deviation or extension of structures into the left ventricular outflow tract, resulting in obstruction above the ventricular septal defect. In the other 16 patients (48.5%) there was over-riding of the aorta with concordant ventriculoarterial connections, (without compromise to right ventricular outflow) producing subaortic stenosis below the ventricular septal defect. Additional fibrous obstruction occurred in 39% of the patients with deviated structures. The age at presentation was lower (P < 0.01) in patients with deviated structures (median (range) 0.4 (0 to 9.2) months) than in those with short segment obstruction (median (range) 4.2 (0 to 84.9) months). The incidence of aortic arch obstruction was higher (P < 0.002) in patients with deviated structures than in those with short segment obstruction (38%). In the morphological study 35 pathological specimens showed obstructive muscular structures in the left ventricular outflow tract either above or below the ventricular septal defect. 16 had either posterior deviation of the outlet septum or extension of the

  12. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  13. Chronic obstructive pulmonary disease

    MedlinePlus

    COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... can do to relieve symptoms and keep the disease from getting worse. If you smoke, now is ...

  14. Intestinal obstruction repair

    MedlinePlus

    Repair of volvulus; Intestinal volvulus - repair; Bowel obstruction - repair ... Intestinal obstruction repair is done while you are under general anesthesia . This means you are asleep and DO NOT feel pain. ...

  15. Pathophysiology of Overactive Bladder and Urge Urinary Incontinence

    PubMed Central

    Steers, William D

    2002-01-01

    Storage symptoms such as urgency, frequency, and nocturia, with or without urge incontinence, are characterized as overactive bladder (OAB). OAB can lead to urge incontinence. Disturbances in nerves, smooth muscle, and urothelium can cause this condition. In some respects the division between peripheral and central causes of OAB is artificial, but it remains a useful paradigm for appreciating the interactions between different tissues. Models have been developed to mimic the OAB associated with bladder instability, lower urinary tract obstruction, neuropathic disorders, diabetes, and interstitial cystitis. These models share the common features of increased connectivity and excitability of both detrusor smooth muscle and nerves. Increased excitability and connectivity of nerves involved in micturition rely on growth factors that orchestrate neural plasticity. Neurotransmitters, prostaglandins, and growth factors, such as nerve growth factor, provide mechanisms for bidirectional communication between muscle or urothelium and nerve, leading to OAB with or without urge incontinence. PMID:16986023

  16. Aqueous outflow: Segmental and distal flow

    PubMed Central

    Swaminathan, Swarup S.; Oh, Dong-Jin; Kang, Min Hyung; Rhee, Douglas J.

    2014-01-01

    A prominent risk factor of primary open-angle glaucoma is ocular hypertension, a pathologic state caused by impaired outflow of aqueous humor through the trabecular meshwork within the iridocorneal angle. The juxtacanalicular region of the trabecular meshwork and the inner wall of Schlemm canal have been identified as the main contributors to aqueous outflow resistance, and both extracellular matrix within the trabecular meshwork and trabecular meshwork cell shape have been shown to affect outflow. Overexpression of multiple ECM proteins in perfused cadaveric human eyes has led to increased outflow resistance and elevated IOP. Pharmacologic agents targeting trabecular meshwork cytoskeletal arrangements have been developed after multiple studies demonstrated the importance of cell shape on outflow. Several groups have shown that aqueous outflow occurs only at certain segments of the trabecular meshwork circumferentially, a concept known as segmental flow. This is based on the theory that aqueous outflow is dependent on the presence of discrete pores within the Schlemm canal. Segmental flow has been described in the eyes of multiple species, including primate, bovine, mouse, and human samples. While the trabecular meshwork appears to be the major source of resistance, trabecular meshwork bypass procedures have been unable to achieve the degree of IOP reduction observed with trabeculectomy, reflecting the potential impact of distal flow, or flow through Schlemm canal and collector channels, on outflow. Multiple studies have demonstrated that outflow occurs preferentially near collector channels, suggesting that these distal structures may be more important to aqueous outflow than previously believed. PMID:25088623

  17. Managing upper airway obstruction.

    PubMed

    Innes, M H

    A complete respiratory obstruction can lead to death in 3 minutes. The first and constant duty of the nurse aider is to check that the person is breathing by looking, listening and feeling. Partial obstruction is no less serious than complete obstruction. The nurse aider, in any situation, should assess the problem and attempt to overcome the airway obstruction using the measures described. PMID:1490067

  18. Simple cyst of urinary bladder.

    PubMed

    Bo, Yang

    2014-07-01

    Simple cysts are rare in the urinary bladder and can pose a diagnostic dilemma to both the urologist and the histopathologist. No case study was found in the database of Elsevier Science Direct, Spring-Link, or PubMed. We present two cases of subserous cyst in the bladder and discuss the diagnosis and treatment of the condition. The cystic lesion at bladder dome was detected by radiologic examination and confirmed by cystoscopy. In case 1, transurethral resection was first performed which was followed by partial cystectomy; In case 2, the cyst was removed with the urachus using laparoscopic surgery. The patients recovered uneventfully and the histopathology showed cysts in subserous layer of urinary bladder. The bladder cyst should be distinguished from urachal tumor, and laparoscopic partial cystectomy is the preferred operative procedure.

  19. Emerging Immunotargets in Bladder Cancer.

    PubMed

    Massari, Francesco; Ciccarese, Chiara; Vau, Nuno; Santoni, Matteo; Montironi, Rodolfo; Cheng, Liang; Marques, Rita C; Scarpelli, Marina; Fonseca, Jorge; Matrana, Marc R; Holger, Moch; Cascinu, Stefano; Tortora, Giampaolo; Lopez-Beltran, Antonio

    2016-01-01

    Bladder cancer treatment, namely systemic therapy, was dominated in the last three decades due to the absence of newer therapeutic options other than chemotherapy regimens. Chemotherapy, by itself, both in first and second-line seems to have achieved the modest plateau of its possibilities at the cost of non-negligible toxicity. Targeted therapies, which changed the therapy of many different tumors, seem rather ineffective in bladder cancer. More recently, a new generation of Immunotherapy based regimens represent the most promising avenue for the future systemic treatment of bladder cancer. Checkpoint inhibition, namely PD1/PD-L1 pathway inhibition, showed impressive results in many other tumor types and are expected to become a major player in the treatment of bladder cancer. Other immunotherapy strategies such as fusion proteins represent distant, although promising, options. A brief overview of the current status of bladder cancer immunotherapy is presented.

  20. Percutaneous Transhepatic Venous Angioplasty and Stenting in a 9-Month-Old Patient with Hepatic Vein Obstruction After Partial Liver Transplantation

    SciTech Connect

    Rasekhi, A. R.; Nabavizadeh, S. A.; Malek-Hosseini, S. A.; Varedi, P.; Naderifar, M.; Soltani, S.

    2008-09-15

    Hepatic venous outflow obstruction is a rare but serious complication after liver transplantation. We report ultrasound-guided percutaneous transhepatic stent placement in a 9-month-old infant with a left lateral split liver transplantation with near-complete hepatic vein obstruction.

  1. OUTFLOWS IN SODIUM EXCESS OBJECTS

    SciTech Connect

    Park, Jongwon; Yi, Sukyoung K.; Jeong, Hyunjin

    2015-08-10

    Van Dokkum and Conroy revisited the unexpectedly strong Na i lines at 8200 Å found in some giant elliptical galaxies and interpreted them as evidence for an unusually bottom-heavy initial mass function. Jeong et al. later found a large population of galaxies showing equally extraordinary Na D doublet absorption lines at 5900 Å (Na D excess objects: NEOs) and showed that their origins can be different for different types of galaxies. While a Na D excess seems to be related to the interstellar medium (ISM) in late-type galaxies, smooth-looking early-type NEOs show little or no dust extinction and hence no compelling signs of ISM contributions. To further test this finding, we measured the Doppler components in the Na D lines. We hypothesized that the ISM would have a better (albeit not definite) chance of showing a blueshift Doppler departure from the bulk of the stellar population due to outflow caused by either star formation or AGN activities. Many of the late-type NEOs clearly show blueshift in their Na D lines, which is consistent with the former interpretation that the Na D excess found in them is related to gas outflow caused by star formation. On the contrary, smooth-looking early-type NEOs do not show any notable Doppler components, which is also consistent with the interpretation of Jeong et al. that the Na D excess in early-type NEOs is likely not related to ISM activities but is purely stellar in origin.

  2. Ultrafast Outflows: Galaxy-scale Active Galactic Nucleus Feedback

    NASA Astrophysics Data System (ADS)

    Wagner, A. Y.; Umemura, M.; Bicknell, G. V.

    2013-01-01

    We show, using global three-dimensional grid-based hydrodynamical simulations, that ultrafast outflows (UFOs) from active galactic nuclei (AGNs) result in considerable feedback of energy and momentum into the interstellar medium (ISM) of the host galaxy. The AGN wind interacts strongly with the inhomogeneous, two-phase ISM consisting of dense clouds embedded in a tenuous, hot, hydrostatic medium. The outflow floods through the intercloud channels, sweeps up the hot ISM, and ablates and disperses the dense clouds. The momentum of the UFO is primarily transferred to the dense clouds via the ram pressure in the channel flow, and the wind-blown bubble evolves in the energy-driven regime. Any dependence on UFO opening angle disappears after the first interaction with obstructing clouds. On kpc scales, therefore, feedback by UFOs operates similarly to feedback by relativistic AGN jets. Negative feedback is significantly stronger if clouds are distributed spherically rather than in a disk. In the latter case, the turbulent backflow of the wind drives mass inflow toward the central black hole. Considering the common occurrence of UFOs in AGNs, they are likely to be important in the cosmological feedback cycles of galaxy formation.

  3. ULTRAFAST OUTFLOWS: GALAXY-SCALE ACTIVE GALACTIC NUCLEUS FEEDBACK

    SciTech Connect

    Wagner, A. Y.; Umemura, M.; Bicknell, G. V.

    2013-01-20

    We show, using global three-dimensional grid-based hydrodynamical simulations, that ultrafast outflows (UFOs) from active galactic nuclei (AGNs) result in considerable feedback of energy and momentum into the interstellar medium (ISM) of the host galaxy. The AGN wind interacts strongly with the inhomogeneous, two-phase ISM consisting of dense clouds embedded in a tenuous, hot, hydrostatic medium. The outflow floods through the intercloud channels, sweeps up the hot ISM, and ablates and disperses the dense clouds. The momentum of the UFO is primarily transferred to the dense clouds via the ram pressure in the channel flow, and the wind-blown bubble evolves in the energy-driven regime. Any dependence on UFO opening angle disappears after the first interaction with obstructing clouds. On kpc scales, therefore, feedback by UFOs operates similarly to feedback by relativistic AGN jets. Negative feedback is significantly stronger if clouds are distributed spherically rather than in a disk. In the latter case, the turbulent backflow of the wind drives mass inflow toward the central black hole. Considering the common occurrence of UFOs in AGNs, they are likely to be important in the cosmological feedback cycles of galaxy formation.

  4. Chemoprevention of bladder cancer.

    PubMed

    Kamat, Ashish M; Lamm, Donald L

    2002-02-01

    The data presented herein, although highly supportive for a protective role of various nutrients against bladder cancer, are far from definitive. Many authorities question the validity of current recommendations for nutritional chemoprevention against bladder cancer. The reason for the wide variations reported in epidemiologic studies lies in the nature of observational studies. Dietary studies are limited in their conclusions because the protection afforded by the consumption of a particular nutrient may be multifactorial, with different components of the food exerting potential chemopreventive effects. Furthermore, measuring levels of nutrients in the food intake of populations is confounded by factors that might affect these levels and also the incidence of cancer. For example, vitamin A can come from animal or vegetarian sources. Because animal fat has been identified as a potential carcinogen in man, depending on the source of the vitamin, varying levels of protection might be deduced. In addition, chemoprevention studies using dietary supplements are expected to have mild effects, and large studies would be required to confirm statistical significance. Even with agents such as intravesical chemotherapy, only half the studies achieve statistical significance [29]. Prospective randomized trials with a large sample size, longer follow-up, and an extended duration of treatment are needed to clarify the association between micronutrients and cancer protection. With these caveats in mind, several recommendations can be made. Simple measures, such as drinking more fluids (especially water), can have a profound impact on the incidence of bladder cancer. Vitamins are being extensively studied in chemopreventive trials for different cancers. There is strong evidence for a chemoprotective effect of vitamin A in bladder cancer. The authors recommend 32,000 IU/day of vitamin A initially, with lower doses (24,000 IU) for persons less than 50 kg. Because liver toxicity is a

  5. Chemoprevention of bladder cancer.

    PubMed

    Kamat, Ashish M; Lamm, Donald L

    2002-02-01

    The data presented herein, although highly supportive for a protective role of various nutrients against bladder cancer, are far from definitive. Many authorities question the validity of current recommendations for nutritional chemoprevention against bladder cancer. The reason for the wide variations reported in epidemiologic studies lies in the nature of observational studies. Dietary studies are limited in their conclusions because the protection afforded by the consumption of a particular nutrient may be multifactorial, with different components of the food exerting potential chemopreventive effects. Furthermore, measuring levels of nutrients in the food intake of populations is confounded by factors that might affect these levels and also the incidence of cancer. For example, vitamin A can come from animal or vegetarian sources. Because animal fat has been identified as a potential carcinogen in man, depending on the source of the vitamin, varying levels of protection might be deduced. In addition, chemoprevention studies using dietary supplements are expected to have mild effects, and large studies would be required to confirm statistical significance. Even with agents such as intravesical chemotherapy, only half the studies achieve statistical significance [29]. Prospective randomized trials with a large sample size, longer follow-up, and an extended duration of treatment are needed to clarify the association between micronutrients and cancer protection. With these caveats in mind, several recommendations can be made. Simple measures, such as drinking more fluids (especially water), can have a profound impact on the incidence of bladder cancer. Vitamins are being extensively studied in chemopreventive trials for different cancers. There is strong evidence for a chemoprotective effect of vitamin A in bladder cancer. The authors recommend 32,000 IU/day of vitamin A initially, with lower doses (24,000 IU) for persons less than 50 kg. Because liver toxicity is a

  6. Three-dimensional haemodynamics in patients with obstructive and non-obstructive hypertrophic cardiomyopathy assessed by cardiac magnetic resonance

    PubMed Central

    Allen, Bradley D.; Choudhury, Lubna; Barker, Alex J.; van Ooij, Pim; Collins, Jeremy D.; Bonow, Robert O.; Carr, James C.; Markl, Michael

    2015-01-01

    Aims The left ventricular outflow tract (LVOT) peak pressure gradient is an important haemodynamic descriptor in patients with hypertrophic cardiomyopathy (HCM); however, secondary alterations in aortic blood flow have not been well described in these patients. Aortic flow derangement is not easily assessed by traditional imaging methods, but may provide unique characterization of this disease. In this study, we demonstrated how four-dimensional (4D) flow MRI can assess LVOT peak pressure gradients in HCM patients and also evaluated the ascending aorta (AAo) haemodynamic derangement associated with HCM. Methods and results Obstructive (n = 12) and non-obstructive (n = 18) HCM patients were included in the study along with 10 normal volunteers. 4D flow MRI was used to visualize three-dimensional (3D) blood flow patterns within the LVOT and AAo, which were graded for the presence of helical flow as a marker of flow derangement (absent = 0, mild/moderate = 1, and severe = 2). MRI-estimated pressure gradient (ΔPMRI) was calculated from the peak systolic 3D blood velocity profile within the LVOT. There was higher grade helical flow in obstructive HCM patients compared with non-obstructive patients (P = 0.04) and volunteers (P < 0.001). Non-obstructive patients also had higher helix grade than volunteers (P = 0.002). There was a significant correlation between helical grade and increasing ΔPMRI (rS = 0.69, P < 0.001). Systolic anterior motion (SAM) of the mitral valve was associated with both increasing helix grade (P < 0.001) and ΔPMRI (P = 0.006). Conclusions Ascending aorta flow derangement occurs in both obstructive and non-obstructive HCM patients and can be identified using 4D flow MRI. The degree of flow derangement correlates with LVOT gradient, SAM, and outflow tract geometry. PMID:25108915

  7. Emerging links between non-neurogenic lower urinary tract symptoms secondary to benign prostatic obstruction, metabolic syndrome and its components: A systematic review.

    PubMed

    Russo, Giorgio I; Castelli, Tommaso; Urzì, Daniele; Privitera, Salvatore; La Vignera, Sandro; Condorelli, Rosita A; Calogero, Aldo E; Favilla, Vincenzo; Cimino, Sebastiano; Morgia, Giuseppe

    2015-11-01

    We carried out a systematic review in order to determine the connection between lower urinary tract symptoms secondary to bladder outlet obstruction and metabolic syndrome with its components. We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, the Cochrane Database of Systematic Review and Web of Science from their inception until January 2015 to identify all eligible studies on the effect of metabolic syndrome (or component factors) on the presence or severity of lower urinary tract symptoms/bladder outlet obstruction in men. This analysis was carried out according to the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. In total, 19 studies were identified as eligible for this systematic review. The quality assessment score was ≥50% in more than half of the studies (11/19). The evidence synthesis showed a positive association between metabolic syndrome, number of components and lower urinary tract symptoms/bladder outlet obstruction. In particular, the major endocrine aberrations of this connection are central obesity and hypertriglyceridemia. The links between insulin resistance and lower urinary tract symptoms/bladder outlet obstruction should be better investigated. Ethnic disparities in all examined studies showed a different impact of metabolic syndrome on lower urinary tract symptoms/bladder outlet obstruction severity and such influence still remain unclear. The relationship between metabolic syndrome and lower urinary tract symptoms/bladder outlet obstruction open the way for introducing physical activity and diet as recognized first-line interventions for treating lower urinary tract symptoms. However, this connection should be investigated in two different ethnic cohorts (i.e. Asian vs Caucasian) in order to better understand the impact of ethnic disparities on metabolic syndrome and lower urinary tract symptoms/bladder outlet obstruction severity.

  8. Bladder Injury During Cesarean Delivery

    PubMed Central

    Tarney, Christopher M.

    2013-01-01

    Cesarean section is the most common surgery performed in the United States with over 30% of deliveries occurring via this route. This number is likely to increase given decreasing rates of vaginal birth after cesarean section (VBAC) and primary cesarean delivery on maternal request, which carries the inherent risk for intraoperative complications. Urologic injury is the most common injury at the time of either obstetric or gynecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during cesarean section include previous cesarean delivery, adhesions, emergent cesarean delivery, and cesarean section performed at the time of the second stage of labor. Fortunately, most bladder injuries are recognized at the time of surgery, which is important, as quick recognition and repair are associated with a significant reduction in patient mortality. Although cesarean delivery is a cornerstone of obstetrics, there is a paucity of data in the literature either supporting or refuting specific techniques that are performed today. There is evidence to support double-layer closure of the hysterotomy, the routine use of adhesive barriers, and performing a Pfannenstiel skin incision versus a vertical midline subumbilical incision to decrease the risk for bladder injury during cesarean section. There is also no evidence that supports the creation of a bladder flap, although routinely performed during cesarean section, as a method to reduce the risk of bladder injury. Finally, more research is needed to determine if indwelling catheterization, exteriorization of the uterus, and methods to extend hysterotomy incision lead to bladder injury. PMID:24876830

  9. Bright crater outflows: Possible emplacement mechanisms

    NASA Technical Reports Server (NTRS)

    Chadwick, D. John; Schaber, Gerald G.; Strom, Robert G.; Duval, Darla M.

    1992-01-01

    Lobate features with a strong backscatter are associated with 43 percent of the impact craters cataloged in Magellan's cycle 1. Their apparent thinness and great lengths are consistent with a low-viscosity material. The longest outflow yet identified is about 600 km in length and flows from the 90-km-diameter crater Addams. There is strong evidence that the outflows are largely composed of impact melt, although the mechanisms of their emplacement are not clearly understood. High temperatures and pressures of target rocks on Venus allow for more melt to be produced than on other terrestrial planets because lower shock pressures are required for melting. The percentage of impact craters with outflows increases with increasing crater diameter. The mean diameter of craters without outflows is 14.4 km, compared with 27.8 km for craters with outflows. No craters smaller than 3 km, 43 percent of craters in the 10- to 30-km-diameter range, and 90 percent in the 80- to 100-km-diameter range have associated bright outflows. More melt is produced in the more energetic impact events that produce larger craters. However, three of the four largest craters have no outflows. We present four possible mechanisms for the emplacement of bright outflows. We believe this 'shotgun' approach is justified because all four mechanisms may indeed have operated to some degree.

  10. Biomarkers in overactive bladder.

    PubMed

    Bhide, Alka A; Cartwright, Rufus; Khullar, Vik; Digesu, G Alessandro

    2013-07-01

    A biomarker is an indicator of a particular disease. It is generally used to define the presence (diagnostic biomarker), severity, progression (prognostic biomarker) of a condition and/or its response to a specific treatment (predictive biomarker). Biomarkers can be specific cells, enzymes, hormones, genes or gene products, which can be detected and measured in parts of the body such as blood, urine or tissue. Therefore, biomarkers have been suggested to play an important role in both the clinical assessment and the management of patients, as well as in the research setting. Recently, interest has gathered in urinary biomarkers as a tool to assess overactive bladder (OAB), potentially playing a role in the diagnosis, disease progression and monitoring response to treatment. Urinary biomarkers identified so far include nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), prostaglandins, cytokines and C-reactive protein. The aim of this review was to review the published literature on biomarkers in OAB. A literature review using Pub Med, clinicaltrials.gov and the controlled trials online registries was performed from 1970 up to June 2012. The search keywords were: the International Continence Society (ICS) definition of "OAB", "nerve growth fac- tor" (NGF), "brain derived growth factor" (BDNF), "prostaglandins," "cytokines," "genetic biomarkers" and "C reactive protein".The results were limited for fully published English-language articles. The search was then subsequently expanded to include urinary biomarkers in interstitial cystitis and bladder pain where relevant. Each of the studies/articles was reviewed, interpreted and discussed to consider the role of urinary biomarkers in OAB. Using the search criteria, a total of 20 studies (animal and human) that investigated the role of urinary biomarkers in OAB were identified. Full text versions of these articles were obtained and reviewed. Studies on NGF suggested that urinary levels were higher in OAB

  11. Underactive Bladder in Older Adults.

    PubMed

    Chuang, Yao-Chi; Plata, Mauricio; Lamb, Laura E; Chancellor, Michael B

    2015-11-01

    Overactive bladder is one of the most common bladder problems, but an estimated 20 million Americans have underactive bladder (UAB), which makes going to the bathroom difficult, increases the risk of urinary tract infections, and even leads to institutionalization. This article provides an overview of UAB in older adults, and discusses the prevalence, predisposing factors, cause, clinical investigations, and treatments. At present, there is no effective therapy for UAB. A great deal of work still needs to be done on understanding the pathogenesis and the development of effective therapies. PMID:26476113

  12. Underactive Bladder in Older Adults.

    PubMed

    Chuang, Yao-Chi; Plata, Mauricio; Lamb, Laura E; Chancellor, Michael B

    2015-11-01

    Overactive bladder is one of the most common bladder problems, but an estimated 20 million Americans have underactive bladder (UAB), which makes going to the bathroom difficult, increases the risk of urinary tract infections, and even leads to institutionalization. This article provides an overview of UAB in older adults, and discusses the prevalence, predisposing factors, cause, clinical investigations, and treatments. At present, there is no effective therapy for UAB. A great deal of work still needs to be done on understanding the pathogenesis and the development of effective therapies.

  13. Bladder diverticulitis: a case report.

    PubMed

    Silberman, Michael; Jeanmonod, Rebecca

    2011-01-01

    Bladder diverticulum, an outpouching of the mucosa through the muscular wall of the bladder, is a multifactorial disease process that can be either acquired or congenital. Although small diverticuli are usually asymptomatic, a large diverticulum may result in hematuria, urinary tract infection, acute abdomen due to its rupture, acute urinary retention, or neoplasm formation. We describe the case of an elderly gentleman who presented to the emergency department with abdominal pain and was ultimately diagnosed with bladder diverticulitis, a disease not previously described in the literature.

  14. Increased bladder permeability in interstitial cystitis/painful bladder syndrome

    PubMed Central

    Greenwood-Van Meerveld, Beverley; Wisniewski, Amy B.; VanGordon, Samuel; Lin, HsuehKung; Kropp, Bradley P.; Towner, Rheal A.

    2015-01-01

    The definition of interstitial cystitis (IC) has evolved over the years from being a well-defined entity characterized by diagnostic lesion (Hunner’s ulcer) in the urothelium to a clinical diagnosis by exclusion [painful bladder syndrome (PBS)]. Although the etiology is unknown, a central theme has been an association with increased permeability of the bladder. This article reviews the evidence for increased permeability being important to the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and in treating the disorder. Recent work showing cross-communication among visceral organs is also reviewed to provide a basis for understanding IC/PBS as a systemic disorder of a complex, interconnected system consisting of the bladder, bowel and other organs, nerves, cytokine-responding cells and the nervous system. PMID:26751576

  15. Magnetospheric Sawtooth Oscillations Induced by Ionospheric Outflow

    NASA Astrophysics Data System (ADS)

    Brambles, O. J.; Lotko, W.; Zhang, B.; Lyon, J.; Wiltberger, M. J.

    2010-12-01

    This paper aims to address why sawtooth oscillations occur and what factors affect their periodicity. We use a multifluid version of the LFM global simulation model, driven by a steady solar wind to examine the effects of ion outflow on convection in the magnetosphere. In the simulation model, the properties of cusp and auroral region O+ outflow are causally regulated by electron precipitation and electromagnetic power flowing into the ionosphere. It is found that when ion outflow is included in the simulation, the solar wind-magnetosphere-ionosphere interaction can generate periodic substorms which appear as sawtooth-like oscillations in the geostationary magnetic field. The ion outflow enhances plasma pressure in the inner magnetosphere and the associated diamagnetic ring current stretches the field lines throughout the nightside, essentially from dawn to dusk. If the field lines are sufficiently stretched they reconnect and dipolarize, ejecting a plasmoid downtail. This cycle repeats forming multiple sawtooth oscillations. The periodicity of the sawtooth oscillation depends largely upon the strength of the outflow. The strength of outflow is varied in the simulation by changing both the driving conditions (which affects the power flowing into the ionosphere) and through direct modification of the constants in the empirical relationships. Higher outflow fluences produce oscillations with shorter periods. The period of the oscillation is found to vary in the simulations from approximately 2 hours to 6 hours depending upon the strength of the outflow. For a smaller solar wind electric field the outflow fluence is not large enough to stretch the nightside field lines enough for sawtooth oscillations to form and the magnetosphere goes into a steady magnetosphere convection (SMC) mode. As the solar wind electric field increases the outflow fluence becomes sufficiently large to affect the convection in the magnetosphere and generate sawtooth oscillations. The strength

  16. Phaeochromocytomas of the bladder.

    PubMed Central

    Khan, O; Williams, G; Chisholm, G D; Welbourn, R B

    1982-01-01

    Phaeochromocytomas of the bladder are rare, only about 100 cases having been reported previously. Four adults with these lesions have been managed at Hammersmith Hospital in the past 10 years. Three patients had hypertension, together with syncopal attacks and/or headaches, induced by micturition. The fourth patient presented with haematuria. After control of blood pressure and localization of the tumours by various combinations of cystoscopy, intravenous urography, venous sampling, ultrasound, angiography and computerized coaxial tomography (CT scanning), 3 patients underwent partial cystectomy, and the fourth pelvic exenteration. Two patients were apparently cured of the disease, but 2 were not. One developed modal metastases and recurrence of hypertension after 18 months and one rapidly developed metastases in the lungs and elsewhere. Effective therapy probably requires a high index of suspicion in diagnosing the condition and possibly an aggressive surgical and radiotherapeutic policy. PMID:7057406

  17. Ct2 Bladder Cancer.

    PubMed

    Soloway, Mark S

    2016-09-01

    The patient is an 80-year-old man who presented with gross hematuria. His past medical history indicates he was a cigarette smoker with 50 pack/years. He was successfully treated for carcinoma of the lung 7 years ago. He received chemotherapy, radiation, and surgery. He has mild COPD but has a good performance status. His laboratory studies do not indicate any abnormalities in terms of renal function. He does not have any significant cardiac disease. He has a medium build. He had prostate cancer and underwent a successful radical prostatectomy 10 years ago. His PSA is undetectable. He has some urinary incontinence and wears two pads/day. He underwent the appropriate investigations for gross hematuria. A CT scan of the abdomen and pelvis was normal with the exception of a 4-cm posterior mass in the bladder. There was no hydronephrosis and no enlarged lymph nodes. He underwent a transurethral resection of a solitary bladder tumor performed by another urologist. The tumor was described as large and sessile. It was located on the posterior wall and was approximately 4 cm. The bimanual examination did not reveal a mass. The pathology report stated that the tumor was a high-grade urothelial carcinoma with invasion into the muscularis propria. There was no lymphovascular invasion. I performed a reTURBT, and at that procedure, I did not identify any obvious tumor but the prior resection site was evident. I resected the prior tumor site quite extensively both in depth and width. The pathology revealed only focal carcinoma in situ. There was ample muscle in the specimen and there was some fat as well. As stated, they were free of any cancer. The patient is receptive to any treatment approach.

  18. Ct2 Bladder Cancer.

    PubMed

    Soloway, Mark S

    2016-09-01

    The patient is an 80-year-old man who presented with gross hematuria. His past medical history indicates he was a cigarette smoker with 50 pack/years. He was successfully treated for carcinoma of the lung 7 years ago. He received chemotherapy, radiation, and surgery. He has mild COPD but has a good performance status. His laboratory studies do not indicate any abnormalities in terms of renal function. He does not have any significant cardiac disease. He has a medium build. He had prostate cancer and underwent a successful radical prostatectomy 10 years ago. His PSA is undetectable. He has some urinary incontinence and wears two pads/day. He underwent the appropriate investigations for gross hematuria. A CT scan of the abdomen and pelvis was normal with the exception of a 4-cm posterior mass in the bladder. There was no hydronephrosis and no enlarged lymph nodes. He underwent a transurethral resection of a solitary bladder tumor performed by another urologist. The tumor was described as large and sessile. It was located on the posterior wall and was approximately 4 cm. The bimanual examination did not reveal a mass. The pathology report stated that the tumor was a high-grade urothelial carcinoma with invasion into the muscularis propria. There was no lymphovascular invasion. I performed a reTURBT, and at that procedure, I did not identify any obvious tumor but the prior resection site was evident. I resected the prior tumor site quite extensively both in depth and width. The pathology revealed only focal carcinoma in situ. There was ample muscle in the specimen and there was some fat as well. As stated, they were free of any cancer. The patient is receptive to any treatment approach. PMID:27457483

  19. Leiomyomas of the female urethra and bladder: a report of five cases and review of the literature.

    PubMed

    Bai, Sang Wook; Jung, Hyun Joo; Jeon, Myung Jae; Jung, Da Jung; Kim, Sei Kwang; Kim, Jae Wook

    2007-08-01

    Through the experience of five cases of leiomyoma developed in the female bladder and urethra with a review of the literature, we have made an effort to characterize the association of symptom with the size and location of the tumor and demonstrate an appropriate treatment. The study population was composed of patients who underwent surgery for bladder or urethral leiomyoma in our hospital from March 1990 to April 2005. Their medical records were reviewed retrospectively concerning the symptom, size and location of leiomyoma, the result of cystoscope and radiological examination, surgical method, pathologic report, complications, and recurrence. Four cases were diagnosed as urethral leiomyoma and one case as bladder leiomyoma. All patients with urethral leiomyoma were admitted for the chief complaint of a palpable tumor. When the tumor size was small, if it was located on the lateral side of the urethra, it was asymptomatic, but if located in the midline, it presented irritative or obstructive symptom. When it was big, if located on the lateral side, it presented irritative rather than obstructive symptom, and if located in the midline, it presented obstructive symptom. One case of bladder leiomyoma was discovered incidentally during ultrasonic exam. In all five cases, surgical removal was performed and complications or recurrence were not detected afterwards. Bladder and urethral leiomyomas are very rare and cause diverse manifestations from asymptomatic to irritative or obstructive symptom. It is presumed that the location and size of the tumor are associated with symptom. Unless it is the case with severe hemorrhage or obstructive acute renal failure, immediate surgery is not required. However, it is desirable to distinguish leiomyoma from malignant or other benign tumors by surgical biopsy or removal. PMID:17333443

  20. Diagnosis of upper urinary tract obstruction in children: comparison of diuresis renography and pressure flow studies

    SciTech Connect

    Gonzalez, R.; Chiou, R.

    1985-04-01

    A report is given of the use of diuresis renography and pressure flow studies to diagnose urinary tract obstruction in 41 collecting systems of 33 children. If differential pressures between the renal pelvis and the bladder in excess of 22 cm. water at a flow rate of 10 ml. per minute is accepted as evidence of obstruction and below 15 cm. water is accepted as normal the interpretation of the renogram showing O'Reilly's pattern IIIa as evidence of stasis without obstruction was correct in 74 per cent of the cases. Likewise, the interpretation of O'Reilly's renogram pattern IIIb as showing partial obstruction was correct in only 40 per cent of the cases. Thus, the authors urge caution in the use of the diuresis renogram to diagnose or to rule out upper urinary tract obstruction.

  1. Drugs Approved for Bladder Cancer

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for bladder cancer. The list includes generic names, brand names, and common drug combinations, which are shown in capital letters.

  2. Augmentation cystoplasty in neurogenic bladder.

    PubMed

    Çetinel, Bülent; Kocjancic, Ervin; Demirdağ, Çetin

    2016-09-01

    The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction. PMID:27617312

  3. Augmentation cystoplasty in neurogenic bladder

    PubMed Central

    Kocjancic, Ervin; Demirdağ, Çetin

    2016-01-01

    The aim of this review is to update the indications, contraindications, technique, complications, and the tissue engineering approaches of augmentation cystoplasty (AC) in patients with neurogenic bladder. PubMed/MEDLINE was searched for the keywords "augmentation cystoplasty," "neurogenic bladder," and "bladder augmentation." Additional relevant literature was determined by examining the reference lists of articles identified through the search. The update review of of the indications, contraindications, technique, outcome, complications, and tissue engineering approaches of AC in patients with neurogenic bladder is presented. Although some important progress has been made in tissue engineering AC, conventional AC still has an important role in the surgical treatment of refractory neurogenic lower urinary tract dysfunction. PMID:27617312

  4. Genetics Home Reference: bladder cancer

    MedlinePlus

    ... chemicals. Studies suggest that chronic bladder inflammation, a parasitic infection called schistosomiasis, and some medications used to treat ... Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Patient Support and Advocacy Resources (2 links) American Cancer ...

  5. [Melanosis of the urinary bladder].

    PubMed

    Wöllner, J; Janzen, J; Pannek, J

    2016-01-01

    Melanosis of the bladder is rare. Only 10 cases have been described in the literature. We present the case of an 80-year-old woman with neurogenic lower urinary tract dysfunction due to spinal paralysis. During the diagnostic work-up which included cystoscopy, black spots in the bladder wall were observed. Histopathological evaluation revealed a benign suburothelial melanosis. Thus, with cystoscopic suspicion of a malignancy (melanoma), a biopsy is mandatory and regular cystoscopic follow-up is recommended. PMID:26358438

  6. Paraganglioma of the urinary bladder.

    PubMed

    Adraktas, Dionesia; Caserta, Melanie; Tchelepi, Hisham

    2014-09-01

    Extra-adrenal paragangliomas of the urinary bladder are rare. Typically, patients present with symptoms related to catecholamine hypersecretion or mass effect, but these tumors can also be encountered incidentally on imaging studies obtained for a different purpose. It is important to recognize the key imaging features of this entity so that it may be suggested as a possible differential diagnosis in the setting of a newly identified bladder mass.

  7. Bladder Dysfunction and Vesicoureteral Reflux

    PubMed Central

    Sillén, Ulla

    2008-01-01

    In this overview the influence of functional bladder disturbances and of its treatment on the resolution of vesicoureteral reflux (VUR) in children is discussed. Historically both bladder dysfunction entities, the overactive bladder (OAB) and the dysfunctional voiding (DV), have been described in conjunction with VUR. Treatment of the dysfunction was also considered to influence spontaneous resolution in a positive way. During the last decades, however, papers have been published which could not support these results. Regarding the OAB, a prospective study with treatment of the bladder overactivity with anticholinergics, did not influence spontaneous resolution rate in children with a dysfunction including also the voiding phase, DV and DES (dysfunctional elimination syndrome), most studies indicate a negative influence on the resolution rate of VUR in children, both before and after the age for bladder control, both with and without treatment. However, a couple of uncontrolled studies indicate that there is a high short-term resolution rate after treatment with flow biofeedback. It should be emphasized that the voiding phase dysfunctions (DV and DES) are more severe than the genuine filling phase dysfunction (OAB), with an increased frequency of UTI and renal damage in the former groups. To be able to answer the question if treatment of bladder dysfunction influence the resolution rate of VUR in children, randomized controlled studies must be performed. PMID:19009037

  8. The resolved outflow from 3C 48

    SciTech Connect

    Shih, Hsin-Yi; Stockton, Alan E-mail: stockton@ifa.hawaii.edu

    2014-10-20

    We investigate the properties of the high-velocity outflow driven by the young radio jet of 3C 48, a compact-steep-spectrum source. We use the Space Telescope Imaging Spectrograph on board the Hubble Space Telecope to obtain (1) low-resolution UV and optical spectra and (2) multi-slit medium-resolution spectra of the ionized outflow. With supporting data from ground-based spectrographs, we are able to accurately measure the ratios of diagnostic emission lines such as [O III] λ5007, [O III] λ3727, [N II] λ6548, Hα, Hβ, [Ne V] λ3425, and [Ne III] λ3869. We fit the observed emission-line ratios using a range of ionization models, powered by active galactic nucleus (AGN) radiation and shocks, produced by the MAPPINGS code. We have determined that AGN radiation is likely the dominant ionization source. The outflow's density is estimated to be in the range n = 10{sup 3}-10{sup 4} cm{sup –3}, the mass is ∼6 × 10{sup 6} M {sub ☉}, and the metallicity is likely equal to or higher than solar. Compared with the typical outflows associated with more evolved radio jets, this young outflow is denser, less massive, and more metal rich. Multi-slit observations allow us to construct a two-dimensional velocity map of the outflow that shows a wide range of velocities with distinct velocity components, suggesting a wide-angle clumpy outflow.

  9. Cardiac arrest during radical nephrectomy due to a mass in the right ventricular outflow tract.

    PubMed

    Kim, Hee Young; Baek, Seung-Hoon; Yoon, Ji Uk; Lee, Dong Hoon; Byeon, Gyeong-Jo; Ahn, Ji Hye

    2016-09-01

    We report cardiac arrest due to obstruction of the right ventricular outflow tract (RVOT) caused by an RVOT mass that was not identified preoperatively. A 62-year-old woman with renal cell carcinoma (RCC) experienced deteriorating hypotension and bradycardia during radical nephrectomy. Hemodynamic stability was maintained on extracorporeal membrane oxygenation, and after surgery, she was transferred to the intensive care unit. On postoperative day 3, transthoracic echocardiography showed an intracardiac mass obstructing the RVOT, which caused severe functional pulmonary stenosis and moderate resting pulmonary hypertension. Despite maintaining extracorporeal membrane oxygenation, the patient died of cardiac arrest. Our findings suggest that it may be necessary to perform additional tests if RCC has invaded the renal vein and inferior vena cava or if a patient with RCC has abnormal cardiovascular symptoms without definite etiology for exclusion of cardiac metastasis or tumor thrombus. In addition, intraoperative transesophageal echocardiography might be the procedure of choice for the evaluation of these conditions because other diagnostic tests are difficult to perform during surgery. In conclusion, for patients with acute hemodynamic instability for whom other possible causes have been excluded, we recommend that anesthesiologists use transesophageal echocardiography to detect outflow tract obstruction or pulmonary thromboembolism and perform anesthetic management. PMID:27555152

  10. Theory of MHD Jets and Outflows

    NASA Astrophysics Data System (ADS)

    Tsinganos, Kanaris

    A brief review is given of selected results of our analytical and numerical work on the construction of time-independent and time-dependent MHD models for non relativistic astrophysical outflows and jets. The equations for steady MHD plasma flows are first outlined. Next, 1-D spherically symmetric outflows are briefly discussed, namely the Parker thermally driven nonrotating wind, as the classical prototype of all astrophysical outflows and the Weber-Davis magnetocentrifugally driven wind together with its astrophysical implications for magnetic braking, etc. Then, we turn to the 2-D MHD problem for steady and non steady 2-D axisymmetric magnetized and rotating plasma outflows. The only available exact solutions for such outflows are those in separable coordinates, i.e. those with the symmetry of radial or meridional self-similarity. Physically accepted solutions pass from the fast magnetosonic separatrix surface in order to satisfy MHD causality. An energetic criterion is outlined for selecting radially expanding winds from cylindrically expanding jets. The basics of jet acceleration, collimation, minimum fieldline inclination and angular momentum removal are illustrated in the context of radially self similar models. Numerical simulations of magnetic self-collimation verify several results of analytical steady solutions. The outflow from solar-type inefficient magnetic rotators is very weakly collimated while that from a ten times faster rotating YSO produces a tightly collimated jet. We also propose a two-component model consisting of a wind outflow from the central object and a faster rotating outflow launched from the surrounding accretion disk which plays the role of the flow collimator. We also briefly discuss the problem of shock formation during the magnetic collimation of wind-type outflows into jets.

  11. Metal enrichment of the CGM through outflows

    NASA Astrophysics Data System (ADS)

    Christensen, Charlotte

    2016-01-01

    Galactic outflows enrich the circumgalactic medium through the redistribution of metals from the disks of galaxies. We examine the history of this enrichment by analyzing the outflows of twenty high-resolution simulated galaxies spanning two and a half orders of magnitude in halo mass. These simulations match many observed trends, including the mass-metallicity relation. By tracking particles in the simulations, we follow the removal and reaccretion of metals between redshift 3.5 and 0. We also determine the enrichment of the outflowing gas compared to the local interstellar media. Finally we compare the redshift zero metal census to observed values.

  12. Outflows in Sodium Excess Objects

    NASA Astrophysics Data System (ADS)

    Park, Jongwon; Jeong, Hyunjin; Yi, Sukyoung

    2016-01-01

    van Dokkum and Conroy reported that some giant elliptical galaxies show extraordinarily strong Na I absorption lines and suggested that this is the evidence of unusually bottom-heavy initial mass function. Jeong et al. later studied galaxies with unexpectedly strong Na D absorption lines (Na D excess objects: NEOs) and showed that the origins of NEOs are different for different types of galaxies. According to their study, the origin of Na D excess seems to be related to interstellar medium (ISM) in late-type galaxies, but there seems to be no contributions from ISM in smooth-looking early-type galaxies. In order to test this finding, we measured the Doppler components in Na D lines of NEOs. We hypothesized that if Na D absorption line is related to ISM, the absorption line is more likely to be blueshifted in the spectrum by the motion of ISM caused by outflow. Many of late-type NEOs show blueshifted Na D absorption lines, so their origin seems related to ISM. On the other hand, smooth-looking early-type NEOs do not show Doppler departure and Na D excess in early-type NEOs is likely not related to ISM, which is consistent with the finding of Jeong et al.

  13. Stenting of the right ventricular outflow tract in symptomatic neonatal tetralogy of Fallot.

    PubMed

    Haas, Nikolaus A; Laser, Thorsten K; Moysich, Axel; Blanz, Ute; Sandica, Eugen

    2014-04-01

    There is ongoing debate regarding the initial management of symptomatic neonates with tetralogy of Fallot. Although neonatal repair can be performed with low mortality, it is associated with increased morbidity and long-term impact on right ventricular performance. Traditionally, the modified Blalock-Taussig shunt remains the palliative procedure of choice. Differential pulmonary artery flow may occur and subsequently result in underdevelopment and distortion of pulmonary vessels. Transcatheter therapy was previously limited to balloon valvulotomy when the obstruction is predominantly at the pulmonary valve level. Stenting of the right ventricular outflow tract can enable adequate forward flow; however, pulmonary regurgitation may impact on right ventricular performance and cardiac output. Stenting of the right ventricular outflow tract with valve sparing placement of the stent thus treating the underlying pathophysiology of the hypercyanotic spells provides a safe and effective management strategy, improving arterial oxygen saturation, avoiding pulmonary regurgitation and encouraging pulmonary artery growth. PMID:23534437

  14. Squamous cell carcinoma of the bladder.

    PubMed

    Johnson, D E; Schoenwald, M B; Ayala, A G; Miller, L S

    1976-05-01

    Clinical and morphological features of 90 cases of squamous cell carcinoma of the bladder have been reviewed. The lesions were solitary in 90 per cent of the patients, developed without a history of vesical malignant disease in 82 per cent and were invasive at the time of diagnosis in all cases. Ureteral obstruction was demonstrated in 42 per cent of the group. The over-all survival rate at 5 years was only 10.6 per cent. There were 17 patients who received no therapy, all of whom were dead before 2 years. Unassisted supervoltage radiation therapy for patients with stages B2 and C lesions yielded a 5-year survival rate only 17.7 per cent. However, preoperative radiotherapy followed by simple total cystectomy and urinary diversion in a small number of patients with stages B2 and C lesions resulted in a 5-year survival rate in excess of 34 per cent. We are encouraged by this finding and believe that combination therapy warrants further clinical trial.

  15. Overactive bladder in children.

    PubMed

    Franco, Israel

    2016-09-01

    Overactive bladder (OAB) is a ubiquitous syndrome that is defined by urinary urgency with, or without urinary incontinence. OAB is observed in all parts of the world, with a prevalence of 5-12% in children (5-10 years of age) and a prevalence of 0.5% in older adolescents (16-18 years of age). Published data indicate that around a third of children with OAB are likely to become adults with similar complaints. Studies in children and in adults with OAB indicate that these individuals are more likely to also have anxiety, depression and attention deficit problems, and that appropriate treatment of these comorbidities can often improve the patient's OAB symptoms. Furthermore, data from twin studies and familial surveys seem to indicate a genetic component of OAB. Pharmacological treatments of OAB in children have improved in the past 5 years, moving beyond anticholinergic agents and including the off-label use of α-blockers, β3-agonists and intravesical botulinum toxin. Use of several different electrical stimulation techniques is also effective, both as first-line treatments, and for patients with treatment-refractory symptoms. Overall the outlook of children with OAB seems to be improving, with a greater understanding of the pathophysiology of this syndrome. Treatment modalities that target the source of the underlying problem, especially in children, are likely to provide the best patient outcomes.

  16. Overactive bladder in children.

    PubMed

    Franco, Israel

    2016-09-01

    Overactive bladder (OAB) is a ubiquitous syndrome that is defined by urinary urgency with, or without urinary incontinence. OAB is observed in all parts of the world, with a prevalence of 5-12% in children (5-10 years of age) and a prevalence of 0.5% in older adolescents (16-18 years of age). Published data indicate that around a third of children with OAB are likely to become adults with similar complaints. Studies in children and in adults with OAB indicate that these individuals are more likely to also have anxiety, depression and attention deficit problems, and that appropriate treatment of these comorbidities can often improve the patient's OAB symptoms. Furthermore, data from twin studies and familial surveys seem to indicate a genetic component of OAB. Pharmacological treatments of OAB in children have improved in the past 5 years, moving beyond anticholinergic agents and including the off-label use of α-blockers, β3-agonists and intravesical botulinum toxin. Use of several different electrical stimulation techniques is also effective, both as first-line treatments, and for patients with treatment-refractory symptoms. Overall the outlook of children with OAB seems to be improving, with a greater understanding of the pathophysiology of this syndrome. Treatment modalities that target the source of the underlying problem, especially in children, are likely to provide the best patient outcomes. PMID:27530266

  17. Magnetosphere sawtooth oscillations induced by ionospheric outflow.

    PubMed

    Brambles, O J; Lotko, W; Zhang, B; Wiltberger, M; Lyon, J; Strangeway, R J

    2011-06-01

    The sawtooth mode of convection of Earth's magnetosphere is a 2- to 4-hour planetary-scale oscillation powered by the solar wind-magnetosphere-ionosphere (SW-M-I) interaction. Using global simulations of geospace, we have shown that ionospheric O(+) outflows can generate sawtooth oscillations. As the outflowing ions fill the inner magnetosphere, their pressure distends the nightside magnetic field. When the outflow fluence exceeds a threshold, magnetic field tension cannot confine the accumulating fluid; an O(+)-rich plasmoid is ejected, and the field dipolarizes. Below the threshold, the magnetosphere undergoes quasi-steady convection. Repetition and the sawtooth period are controlled by the strength of the SW-M-I interaction, which regulates the outflow fluence. PMID:21636770

  18. Magnetosphere sawtooth oscillations induced by ionospheric outflow.

    PubMed

    Brambles, O J; Lotko, W; Zhang, B; Wiltberger, M; Lyon, J; Strangeway, R J

    2011-06-01

    The sawtooth mode of convection of Earth's magnetosphere is a 2- to 4-hour planetary-scale oscillation powered by the solar wind-magnetosphere-ionosphere (SW-M-I) interaction. Using global simulations of geospace, we have shown that ionospheric O(+) outflows can generate sawtooth oscillations. As the outflowing ions fill the inner magnetosphere, their pressure distends the nightside magnetic field. When the outflow fluence exceeds a threshold, magnetic field tension cannot confine the accumulating fluid; an O(+)-rich plasmoid is ejected, and the field dipolarizes. Below the threshold, the magnetosphere undergoes quasi-steady convection. Repetition and the sawtooth period are controlled by the strength of the SW-M-I interaction, which regulates the outflow fluence.

  19. A healthy bladder: a consensus statement

    PubMed Central

    Lukacz, E S; Sampselle, C; Gray, M; MacDiarmid, S; Rosenberg, M; Ellsworth, P; Palmer, M H

    2011-01-01

    A panel of experts in urology, urogynecology, nursing, and behavioral therapy convened in 2010 to discuss the importance of a healthy bladder on overall health. They determined that a consensus statement was necessary to raise awareness among the general public, healthcare providers, payors, and policymakers, with the goals of minimizing the impact of poor bladder health and stimulating primary prevention of bladder conditions. In this statement, ‘healthy’ bladder function is described, as well as internal and external factors that influence bladder health. It is suggested that primary prevention strategies should be aimed at providing education regarding normal lower urinary tract structures and functioning to the public, including patients and healthcare providers. This education may promote the achievement of optimal bladder health by increasing healthy bladder habits and behaviors, awareness of risk factors, healthcare seeking, and clinician engagement and reducing stigma and other barriers to treatment. Promoting optimal bladder health may reduce the personal, societal and economic impact of bladder conditions, including anxiety and depression and costs associated with conditions or diseases and their treatment. While adopting healthy bladder habits and behaviors and behaviors may improve or maintain bladder health, it is important to recognize that certain symptoms may indicate the presence of conditions that require medical attention; many bladder conditions are treatable with a range of options for most bladder conditions. Lastly, the authors propose clinical directives based on persuasive and convergent research to improve and maintain bladder health. The authors hope that this statement will lead to promotion and achievement of optimal bladder health, which may improve overall health and help minimize the effects of bladder conditions on the public, healthcare professionals, educators, employers, and payors. The advisors are in consensus regarding the

  20. Powerful Molecular Outflows in Nearby Active Galaxies

    NASA Astrophysics Data System (ADS)

    Veilleux, Sylvain; Meléndez, Marcio

    2014-07-01

    We report the results from a systematic search for molecular (OH 119 μm) outflows with Herschel-PACS† in a sample of 43 nearby (z < 0.3) galaxy mergers, mostly ultraluminous infrared galaxies (ULIRGs) and QSOs. We find that the character of the OH feature (strength of the absorption relative to the emission) correlates with that of the 9.7-μm silicate feature, a measure of obscuration in ULIRGs. Unambiguous evidence for molecular outflows, based on the detection of OH absorption profiles with median velocities more blueshifted than -50 km s-1, is seen in 26 (70%) of the 37 OH-detected targets, suggesting a wide-angle (~ 145°) outflow geometry. Conversely, unambiguous evidence for molecular inflows, based on the detection of OH absorption profiles with median velocities more redshifted than +50 km s-1, is seen in only 4 objects, suggesting a planar or filamentary geometry for the inflowing gas. Terminal outflow velocities of ~ -1000 km s-1 are measured in several objects, but median outflow velocities are typically ~ -200 km s-1. While the outflow velocities show no statistically significant dependence on the star formation rate, they are distinctly more blueshifted among systems with large AGN fractions and luminosities [log (L AGN/L ⊙) >= 11.8 +/- 0.3]. The quasars in these systems play a dominant role in driving the molecular outflows. In contrast, the most AGN dominated systems, where OH is seen purely in emission, show relatively modest OH line widths, despite their large AGN luminosities, perhaps indicating that molecular outflows subside once the quasar has cleared a path through the obscuring material.

  1. Kidney transplantation in abnormal bladder

    PubMed Central

    Mishra, Shashi K.; Muthu, V.; Rajapurkar, Mohan M.; Desai, Mahesh R.

    2007-01-01

    Structural urologic abnormalities resulting in dysfunctional lower urinary tract leading to end stage renal disease may constitute 15% patients in the adult population and up to 20-30% in the pediatric population. A patient with an abnormal bladder, who is approaching end stage renal disease, needs careful evaluation of the lower urinary tract to plan the most satisfactory technical approach to the transplant procedure. Past experience of different authors can give an insight into the management and outcome of these patients. This review revisits the current literature available on transplantation in abnormal bladder and summarizes the clinical approach towards handling this group of difficult transplant patients. We add on our experience as we discuss the various issues. The outcome of renal transplant in abnormal bladder is not adversely affected when done in a reconstructed bladder. Correct preoperative evaluation, certain technical modification during transplant and postoperative care is mandatory to avoid complications. Knowledge of the abnormal bladder should allow successful transplantation with good outcome. PMID:19718334

  2. Caudal clonidine-bupivicaine block with bladder hydrodistension: a novel combined treatment for the painful bladder.

    PubMed

    Tempest, Heidi; Stoneham, Mark; Frampton, Claire; Noble, Jeremy

    2011-01-01

    The authors describe a new combination procedure consisting of bladder hydrodistension with clonidine-bupivicaine caudal block for the symptomatic relief of bladder pain. They report this new technique whereby patients who had tried multiple forms of therapy with little response, including bladder hydrodistension under general anaesthesia for their chronic pelvic bladder pain, responded to this novel combination therapy. PMID:22696635

  3. Right Ventricular Outflow Tract Tumor Mimicking a Thrombus in the Main Pulmonary Artery.

    PubMed

    Amuchastegui, Luis M.; Marani, Leandro P.; Caeiro, Andres

    1997-11-01

    Primary sarcomas of the pulmonary artery and right ventricle are rare, and their presentation is unusual in clinical practice; therefore, their diagnosis is often missed or delayed. The progression of the obstruction from the outflow tract of the right ventricle to the pulmonary artery resembles massive pulmonary embolism. We present a case of one of these tumors which mimicked transesophageal echocardiography (TEE), a massive pulmonary embolism. We conclude that TEE represents a noninvasive method of diagnosis and evaluation when the suspicion is massive pulmonary thromboembolism or a heart tumor.

  4. Measuring Nasal Obstruction.

    PubMed

    Keeler, Jarrod; Most, Sam P

    2016-08-01

    The nose and the nasal airway is highly complex with intricate 3-dimensional anatomy, with multiple functions in respiration and filtration of the respired air. Nasal airway obstruction (NAO) is a complex problem with no clearly defined "gold-standard" in measurement. There are 3 tools for the measurement of NAO: patient-derived measurements, physician-observed measurements, and objective measurements. We continue to work towards finding a link between subjective and objective nasal obstruction. The field of evaluation and surgical treatment for NAO has grown tremendously in the past 4-5 decades and will continue to grow as we learn more about the pathophysiology and treatment of nasal obstruction.

  5. Effect of neurohypophysial hormones on fluid movement across isolated bladder of Rana cancrivora, Rana temporaria and Bufo melanostictus

    PubMed Central

    Dicker, S. E.; Elliott, Annie B.

    1970-01-01

    1. The rate of fluid movement across the wall of isolated amphibian urinary bladder was estimated using hemi-bladders of the tropical euryhaline Rana cancrivora, the temperate R. temporaria and the tropical Bufo melanostictus. 2. The rate of water outflow across the bladder walls was: Rana cancrivora, 4·8 μl./cm2.hr; R. temporaria, 7·2 μl./cm2.hr; Bufo melanostictus, 3·7 μl./cm2.hr. 3. When neurohypophysial peptides were added to the serosal solution the rates of water outflow were increased; dose—response curves were prepared relating the augmented rate of fluid movement to the concentration in the bathing fluid of vasopressin, oxytocin or vasotocin. 4. The potencies of the peptides in respect of bladders of each species were: Vasopressin, B. melanostictus:Rana temporaria:R. cancrivora, 500:20:1. Oxytocin, R. temporaria:B. melanostictus:Rana cancrivora, 100:5:1. 5. The ratio of sensitivity of the bladder of each species to the presence of the different peptides was: R. cancrivora, vasotocin:oxytocin:vasopressin, 1000:5:1. R. temporaria, oxytocin:vasopressin, 15:1. Bufo melanostictus, oxytocin:vasopressin, 1:30. 6. The effect of extract of the pituitary gland of Rana cancrivora was examined on R. cancrivora bladder. It had a dose—response curve similar to the dose—response curve of vasotocin. 7. The vasotocin content of the pituitary gland of R. cancrivora was estimated (a) from the dose—response curves using R. cancrivora bladder, (b) by a three-point assay using R. cancrivora bladder and (c) by its effect on water uptake across the skin of Bufo melanostictus. One pituitary gland of Rana cancrivora was found to contain about 0·1 μg vasotocin. 8. The urinary bladder of R. cancrivora was less responsive to neurohypophysial peptides than the bladder of R. temporaria or Bufo melanostictus. 9. The hormonal content of the pituitary gland of Rana cancrivora was smaller than that found in other amphibians. PMID:5500771

  6. A Robust Measurement of the Mass Outflow Rate of the Galactic Outflow from NGC 6090

    NASA Astrophysics Data System (ADS)

    Chisholm, John; Tremonti, Christy A.; Leitherer, Claus; Chen, Yanmei

    2016-08-01

    To evaluate the impact of stellar feedback, it is critical to estimate the mass outflow rates of galaxies. Past estimates have been plagued by uncertain assumptions about the outflow geometry, metallicity, and ionization fraction. Here we use Hubble Space Telescope ultraviolet spectroscopic observations of the nearby starburst NGC 6090 to demonstrate that many of these quantities can be constrained by the data. We use the Si IV absorption lines to calculate the scaling of velocity (v), covering fraction (Cf), and density with distance from the starburst (r), assuming the Sobolev optical depth and a velocity law of the form: v~∝(1 - Ri/r)β (where Ri is the inner outflow radius). We find that the velocity (β=0.43) is consistent with an outflow driven by an r-2 force with the outflow radially accelerated, while the scaling of the covering fraction (Cf∝r-0.82) suggests that cool clouds in the outflow are in pressure equilibrium with an adiabatically expanding medium. We use the column densities of four weak metal lines and CLOUDY photoionization models to determine the outflow metallicity, the ionization correction, and the initial density of the outflow. Combining these values with the profile fitting, we find Ri = 63 pc, with most of the mass within 300 pc of the starburst. Finally, we find that the maximum mass outflow rate is 2.3 M⊙ yr-1 and the mass loading factor (outflow divided by the star formation rate) is 0.09, a factor of 10 lower than the value calculated using common assumptions for the geometry, metallicity and ionization structure of the outflow.

  7. A robust measurement of the mass outflow rate of the galactic outflow from NGC 6090

    NASA Astrophysics Data System (ADS)

    Chisholm, John; Tremonti Christy, A.; Leitherer, Claus; Chen, Yanmei

    2016-11-01

    To evaluate the impact of stellar feedback, it is critical to estimate the mass outflow rates of galaxies. Past estimates have been plagued by uncertain assumptions about the outflow geometry, metallicity, and ionization fraction. Here we use Hubble Space Telescope ultraviolet spectroscopic observations of the nearby starburst NGC 6090 to demonstrate that many of these quantities can be constrained by the data. We use the Si IV absorption lines to calculate the scaling of velocity (v), covering fraction (Cf), and density with distance from the starburst (r), assuming the Sobolev optical depth and a velocity law of the form: v ∝ (1 - Ri/r)β (where Ri is the inner outflow radius). We find that the velocity (β = 0.43) is consistent with an outflow driven by an r-2 force with the outflow radially accelerated, while the scaling of the covering fraction (Cf ∝ r-0.82) suggests that cool clouds in the outflow are in pressure equilibrium with an adiabatically expanding medium. We use the column densities of four weak metal lines and CLOUDY photoionization models to determine the outflow metallicity, the ionization correction, and the initial density of the outflow. Combining these values with the profile fitting, we find Ri = 63 pc, with most of the mass within 300 pc of the starburst. Finally, we find that the maximum mass outflow rate is 2.3 M⊙ yr-1 and the mass-loading factor (outflow divided by the star formation rate) is 0.09, a factor of 10 lower than the value calculated using common assumptions for the geometry, metallicity, and ionization structure of the outflow.

  8. [Occupational hazards and bladder cancer].

    PubMed

    Nizamova, R S

    1991-01-01

    Occupational exposure to health hazards was studied in 258 industrial workers who had developed cancer of the bladder against 454 matched controls. All the test subjects and controls were residents of the Tambov Province centers of chemical industry. Statistical significance (relative risk-4.7) was established for exposure to aromatic amines. For those contacting with aniline dyes the relative risk (RR) made up 2.4. The risk to develop bladder cancer in powder shops (RR-3.2) was attributed to the hazards of dyes and diphenylamine. In leather-shoe and textile industry the exposure to dyes was not safe (RR-6.1), neither was it to chemicals, oil products, pesticides, overheating (RR-3.2, 1.6, 3.2 and 2.9, respectively). It is stated that in line with a significant risk to develop bladder cancer at exposure to aromatic amines there exist a number of occupational factors contributing to this risk.

  9. Implantable Bladder Sensors: A Methodological Review.

    PubMed

    Dakurah, Mathias Naangmenkpeong; Koo, Chiwan; Choi, Wonseok; Joung, Yeun-Ho

    2015-09-01

    The loss of urinary bladder control/sensation, also known as urinary incontinence (UI), is a common clinical problem in autistic children, diabetics, and the elderly. UI not only causes discomfort for patients but may also lead to kidney failure, infections, and even death. The increase of bladder urine volume/pressure above normal ranges without sensation of UI patients necessitates the need for bladder sensors. Currently, a catheter-based sensor is introduced directly through the urethra into the bladder to measure pressure variations. Unfortunately, this method is inaccurate because measurement is affected by disturbances in catheter lines as well as delays in response time owing to the inertia of urine inside the bladder. Moreover, this technique can cause infection during prolonged use; hence, it is only suitable for short-term measurement. Development of discrete wireless implantable sensors to measure bladder volume/pressure would allow for long-term monitoring within the bladder, while maintaining the patient's quality of life. With the recent advances in microfabrication, the size of implantable bladder sensors has been significantly reduced. However, microfabricated sensors face hostility from the bladder environment and require surgical intervention for implantation inside the bladder. Here, we explore the various types of implantable bladder sensors and current efforts to solve issues like hermeticity, biocompatibility, drift, telemetry, power, and compatibility issues with popular imaging tools such as computed tomography and magnetic resonance imaging. We also discuss some possible improvements/emerging trends in the design of an implantable bladder sensor.

  10. Implantable Bladder Sensors: A Methodological Review

    PubMed Central

    Dakurah, Mathias Naangmenkpeong; Koo, Chiwan; Choi, Wonseok; Joung, Yeun-Ho

    2015-01-01

    The loss of urinary bladder control/sensation, also known as urinary incontinence (UI), is a common clinical problem in autistic children, diabetics, and the elderly. UI not only causes discomfort for patients but may also lead to kidney failure, infections, and even death. The increase of bladder urine volume/pressure above normal ranges without sensation of UI patients necessitates the need for bladder sensors. Currently, a catheter-based sensor is introduced directly through the urethra into the bladder to measure pressure variations. Unfortunately, this method is inaccurate because measurement is affected by disturbances in catheter lines as well as delays in response time owing to the inertia of urine inside the bladder. Moreover, this technique can cause infection during prolonged use; hence, it is only suitable for short-term measurement. Development of discrete wireless implantable sensors to measure bladder volume/pressure would allow for long-term monitoring within the bladder, while maintaining the patient’s quality of life. With the recent advances in microfabrication, the size of implantable bladder sensors has been significantly reduced. However, microfabricated sensors face hostility from the bladder environment and require surgical intervention for implantation inside the bladder. Here, we explore the various types of implantable bladder sensors and current efforts to solve issues like hermeticity, biocompatibility, drift, telemetry, power, and compatibility issues with popular imaging tools such as computed tomography and magnetic resonance imaging. We also discuss some possible improvements/emerging trends in the design of an implantable bladder sensor. PMID:26620894

  11. Implantable Bladder Sensors: A Methodological Review.

    PubMed

    Dakurah, Mathias Naangmenkpeong; Koo, Chiwan; Choi, Wonseok; Joung, Yeun-Ho

    2015-09-01

    The loss of urinary bladder control/sensation, also known as urinary incontinence (UI), is a common clinical problem in autistic children, diabetics, and the elderly. UI not only causes discomfort for patients but may also lead to kidney failure, infections, and even death. The increase of bladder urine volume/pressure above normal ranges without sensation of UI patients necessitates the need for bladder sensors. Currently, a catheter-based sensor is introduced directly through the urethra into the bladder to measure pressure variations. Unfortunately, this method is inaccurate because measurement is affected by disturbances in catheter lines as well as delays in response time owing to the inertia of urine inside the bladder. Moreover, this technique can cause infection during prolonged use; hence, it is only suitable for short-term measurement. Development of discrete wireless implantable sensors to measure bladder volume/pressure would allow for long-term monitoring within the bladder, while maintaining the patient's quality of life. With the recent advances in microfabrication, the size of implantable bladder sensors has been significantly reduced. However, microfabricated sensors face hostility from the bladder environment and require surgical intervention for implantation inside the bladder. Here, we explore the various types of implantable bladder sensors and current efforts to solve issues like hermeticity, biocompatibility, drift, telemetry, power, and compatibility issues with popular imaging tools such as computed tomography and magnetic resonance imaging. We also discuss some possible improvements/emerging trends in the design of an implantable bladder sensor. PMID:26620894

  12. Bursty star formation feedback and cooling outflows

    NASA Astrophysics Data System (ADS)

    Suarez, Teresita; Pontzen, Andrew; Peiris, Hiranya V.; Slyz, Adrianne; Devriendt, Julien

    2016-10-01

    We study how outflows of gas launched from a central galaxy undergoing repeated starbursts propagate through the circum-galactic medium (CGM), using the simulation code RAMSES. We assume that the outflow from the disc can be modelled as a rapidly moving bubble of hot gas at ˜1 kpc above disc, then ask what happens as it moves out further into the halo around the galaxy on ˜100 kpc scales. To do this, we run 60 two-dimensional simulations scanning over parameters of the outflow. Each of these is repeated with and without radiative cooling, assuming a primordial gas composition to give a lower bound on the importance of cooling. In a large fraction of radiative-cooling cases we are able to form rapidly outflowing cool gas from in situ cooling of the flow. We show that the amount of cool gas formed depends strongly on the `burstiness' of energy injection; sharper, stronger bursts typically lead to a larger fraction of cool gas forming in the outflow. The abundance ratio of ions in the CGM may therefore change in response to the detailed historical pattern of star formation. For instance, outflows generated by star formation with short, intense bursts contain up to 60 per cent of their gas mass at temperatures <5 × 104 K; for near-continuous star formation, the figure is ≲5 per cent. Further study of cosmological simulations, and of idealized simulations with e.g. metal-cooling, magnetic fields and/or thermal conduction, will help to understand the precise signature of bursty outflows on observed ion abundances.

  13. Characterizing Quasar Outflows I: Sample, Spectral Measurements

    NASA Astrophysics Data System (ADS)

    Ganguly, Rajib; Christenson, D. H.; Richmond, J. M.; Derseweh, J. A.; Robbins, J. M.; Townsend, S. L.; Stark, M. A.

    2012-05-01

    Galaxy evolution models have shown that quasars are a crucial ingredient in the evolution of massive galaxies. Outflows play a key role in the story of quasars and their host galaxies, by helping regulate the accretion process, the star-formation rate and mass of the host galaxy (i.e., feedback). The prescription for modeling outflows as a contributor to feedback requires knowledge of the outflow velocity, geometry, and column density. In particular, we need to understand how these depend on physical parameters and how much is determined stochastically (and with what distribution). For this purpose, we are examining a sample of 11000 z=1.7-2.0 quasars from the Sloan Digital Sky Survey. This redshift range permits the following from the SDSS spectra: (1) separation of objects that do and do not exhibit outflows; (2) classification/measurement of outflow properties (ionization, velocity, velocity width); and (3) measurements of UV emission line and continuum parameters. In this poster, we subjectively divide these quasars into four categories: broad absorption-line quasars (2700 objects), associated absorption-line quasars (1700 objects), reddened quasars (160 objects), and unabsorbed/unreddened quasars (6300 objects). We present measurements of the absorption (velocities, velocity widths, equivalent widths), composite spectral profiles of outflows as a function of velocity, as well as measurements of the continuum and CIV, MgII, and FeII emission-line properties. In accompanying posters, we add photometry from the rest-frame X-ray (ROSAT and Chandra), EUV (GALEX), optical (2MASS), and infrared (WISE) bands to complete the SED. The continuum and emission-line measurements from the SDSS spectra and accompanying photometry provides estimates on the black hole masses, bolometric luminsosities, and SED. We consider empirically how these affect the outflow properties. This material is based upon work supported by the National Aeronautics and Space Administration under

  14. [Rare cases of bladder stones].

    PubMed

    Sampalmieri, Gregorio; Moretti, Antonello; Sampalmieri, Matteo

    2014-01-01

    We present here two special cases of urolithiasis. The first one shows a giant bladder lithiasis resulting in severe renal insufficiency in a 63-year-old patient, who had previously had nicturia (2-3 times), occasional episodes of urinary frequency and burning micturition, in the absence of renal colic, hematuria or interrupted urination. The second case referes to an 85-year-old man suffering from prostatic enlargement and bladder stones, hospitalized to undergo intervention of trans-vesical prostatic adenomectomy, during which two star-shaped stones were found without obvious symptoms.

  15. Urinary markers for bladder cancer

    PubMed Central

    Smith, Zachary L.

    2013-01-01

    Bladder cancer has the fifth highest incidence of all malignancies in the United States, with a propensity to recur, requiring lifelong surveillance after diagnosis. Urinary markers of disease have been of extreme interest in this field in an effort to simplify surveillance schedules and improve early detection of tumors. Many markers have been described, but most remain investigational. However, some markers have undergone clinical trials and are approved for clinical use. In this review, urinary markers and their application for screening and surveillance of bladder cancer are discussed. PMID:23864929

  16. Do antibiotics clear bladder infections?

    PubMed

    Reid, G

    1994-09-01

    An examination of transitional bladder epithelial cells from 69 urine specimens from 23 spinal cord injury patients showed the presence of adherent bacterial biofilms in 66 cases (96%). All patients were receiving antimicrobial therapy, primarily trimethoprim-sulfamethoxazole (41 of 69), without any apparent effect on the bladder colonization. The large number of bacteria that emerged with highly virulent and potentially multi-drug resistant characteristics, especially Enterococcus faecalis (33% of isolates), was of concern. These findings raise questions about the proved efficacy and effectiveness of antibiotics against uropathogenic biofilms adherent to tissues.

  17. Pharmacologic management of overactive bladder.

    PubMed

    Lam, Sum; Hilas, Olga

    2007-01-01

    Overactive bladder (OAB) is a prevalent and costly condition that can affect any age group. Typical symptoms include urinary urgency, frequency, incontinence and nocturia. OAB occurs as a result of abnormal contractions of the bladder detrusor muscle caused by the stimulation of certain muscarinic receptors. Therefore, antimuscarinic agents have long been considered the mainstay of pharmacologic treatment for OAB. Currently, there are five such agents approved for the management of OAB in the United States: oxybutynin, tolterodine, trospium, solifenacin and darifenacin. This article summarizes the efficacy, contraindications, precautions, dosing and common side effects of these agents. All available clinical trials on trospium, solifenacin and darifenacin were reviewed to determine its place in therapy.

  18. Intraluminal biliary obstruction.

    PubMed Central

    Heaton, N D; Davenport, M; Howard, E R

    1991-01-01

    Jaundice caused by intraluminal bile duct obstruction in infancy is rare but may occur in association with biliary sludge, inspissated bile plugs, or gall stones. Nine boys (aged 2 weeks-6 months) with obstruction caused by inspissated bile (n = 7) or gall stones (n = 2) are presented. Haemolysis was not a factor in the patients' histories but an abnormal entry of the common bile duct into the third part of the duodenum was demonstrated in two and one had an asymptomatic haemangioma. Ultrasonography was the most useful investigation. Surgical removal of the bile duct obstruction was necessary in eight cases and included biliary tract drainage in six and cholecystectomy for changes of cholecystitis in four. Obstruction resolved spontaneously in one infant after percutaneous cholangiography. There were no postoperative complications. Images p1396-a PMID:1776884

  19. Dose Distribution in Bladder and Surrounding Normal Tissues in Relation to Bladder Volume in Conformal Radiotherapy for Bladder Cancer

    SciTech Connect

    Majewski, Wojciech; Wesolowska, Iwona; Urbanczyk, Hubert; Hawrylewicz, Leszek; Schwierczok, Barbara; Miszczyk, Leszek

    2009-12-01

    Purpose: To estimate bladder movements and changes in dose distribution in the bladder and surrounding tissues associated with changes in bladder filling and to estimate the internal treatment margins. Methods and Materials: A total of 16 patients with bladder cancer underwent planning computed tomography scans with 80- and 150-mL bladder volumes. The bladder displacements associated with the change in volume were measured. Each patient had treatment plans constructed for a 'partially empty' (80 mL) and a 'partially full' (150 mL) bladder. An additional plan was constructed for tumor irradiation alone. A subsequent 9 patients underwent sequential weekly computed tomography scanning during radiotherapy to verify the bladder movements and estimate the internal margins. Results: Bladder movements were mainly observed cranially, and the estimated internal margins were nonuniform and largest (>2 cm) anteriorly and cranially. The dose distribution in the bladder worsened if the bladder increased in volume: 70% of patients (11 of 16) would have had bladder underdosed to <95% of the prescribed dose. The dose distribution in the rectum and intestines was better with a 'partially empty' bladder (volume that received >70%, 80%, and 90% of the prescribed dose was 23%, 20%, and 15% for the rectum and 162, 144, 123 cm{sup 3} for the intestines, respectively) than with a 'partially full' bladder (volume that received >70%, 80%, and 90% of the prescribed dose was 28%, 24%, and 18% for the rectum and 180, 158, 136 cm{sup 3} for the intestines, respectively). The change in bladder filling during RT was significant for the dose distribution in the intestines. Tumor irradiation alone was significantly better than whole bladder irradiation in terms of organ sparing. Conclusion: The displacements of the bladder due to volume changes were mainly related to the upper wall. The internal margins should be nonuniform, with the largest margins cranially and anteriorly. The changes in bladder

  20. Acute Urinary Obstruction in a Tetraplegic Patient from Misplacement of Catheter in Urethra.

    PubMed

    Vaidyanathan, Subramanian; Singh, Gurpreet; Hughes, Peter L; Soni, Bakul M

    2016-01-01

    A male tetraplegic patient attended accident and emergency with a blocked catheter; on removing the catheter, he passed bloody urine. After three unsuccessful attempts were made to insert a catheter by nursing staff, a junior doctor inserted a three-way Foley catheter with a 30-mL balloon but inflated the balloon with 10 mL of water to commence the bladder irrigation. The creatinine level was mostly 19 µmol/L (range: 0-135 µmol/L) but increased to 46 µmol/L on day 7. Computerized tomography urogram revealed that the bilateral hydronephrosis with hydroureter was extended down to urinary bladder, the bladder was distended, prostatic urethra was dilated and filled with urine, and although the balloon of Foley catheter was not seen in the bladder, the tip of the catheter was seen lying in the urethra. Following the re-catheterization, the creatinine level decreased to 21 µmol/L. A follow-up ultrasound scan revealed no evidence of hydronephrosis in both kidneys. Flexible cystoscopy revealed inflamed bladder mucosa, catheter reaction, and tiny stones. There was no bladder tumor. This case report concludes that the cause of bilateral hydronephrosis, hydroureter, and distended bladder was inadequate drainage of urinary bladder as the Foley balloon that was under-filled slipped into the urethra resulting in an obstruction to urine flow. Urethral catheterization in tetraplegic patients should be performed by senior, experienced staff in order to avoid trauma and incorrect positioning. Tetraplegic subjects with decreased muscle mass have low creatinine level. Increase in creatinine level (>1.5 times the basal level) indicates acute kidney injury, although peak creatinine level may still be within laboratory reference range. While scanning the urinary tract of spinal cord injury patients with indwelling urinary catheter, if Foley balloon is not seen within the bladder, urethra should be scanned to locate the Foley balloon. PMID:26793012

  1. Pressurized groundwater outflow experiments and numerical modeling for outflow channels on Mars

    NASA Astrophysics Data System (ADS)

    Marra, Wouter A.; Hauber, Ernst; McLelland, Stuart J.; Murphy, Brendan J.; Parsons, Daniel R.; Conway, Susan J.; Roda, Manuel; Govers, Rob; Kleinhans, Maarten G.

    2014-12-01

    The landscape of Mars shows incised channels that often appear abruptly in the landscape, suggesting a groundwater source. However, groundwater outflow processes are unable to explain the reconstructed peak discharges of the largest outflow channels based on their morphology. Therefore, there is a disconnect between groundwater outflow processes and the resulting morphology. Using a combined approach with experiments and numerical modeling, we examine outflow processes that result from pressurized groundwater. We use a large sandbox flume, where we apply a range of groundwater pressures at the base of a layer of sediment. Our experiments show that different pressures result in distinct outflow processes and resulting morphologies. Low groundwater pressure results in seepage, forming a shallow surface lake and a channel when the lake overflows. At intermediate groundwater pressures, fissures form and groundwater flows out more rapidly. At even higher pressures, the groundwater initially collects in a subsurface reservoir that grows due to flexural deformation of the surface. When this reservoir collapses, a large volume of water is released to the surface. We numerically model the ability of these processes to produce floods on Mars and compare the results to discharge estimates based on previous morphological studies. We show that groundwater seepage and fissure outflow are insufficient to explain the formation of large outflow channels from a single event. Instead, formation of a flexure-induced subsurface reservoir and subsequent collapse generates large floods that can explain the observed morphologies of the largest outflow channels on Mars and their source areas.

  2. Pediatric obstructive sleep apnea.

    PubMed

    Schwengel, Deborah A; Dalesio, Nicholas M; Stierer, Tracey L

    2014-03-01

    Obstructive sleep apnea syndrome (OSAS) is a disorder of airway obstruction with multisystem implications and associated complications. OSAS affects children from infancy to adulthood and is responsible for behavioral, cognitive, and growth impairment as well as cardiovascular and perioperative respiratory morbidity and mortality. OSAS is associated commonly with comorbid conditions, including obesity and asthma. Adenotonsillectomy is the most commonly used treatment option for OSAS in childhood, but efforts are underway to identify medical treatment options. PMID:24491659

  3. [Obstructive anuria. Thirty cases].

    PubMed

    Bennani, S; Debbagh, A; Joual, A; el Mrini, M; Benjelloun, S

    1995-01-01

    The authors report 30 cases of obstructive anuria during the last fifteen years. The anuria was secondary to lithiasis in 60 per cent, in 26.6 per cent to pelvic cancer and in 13.4 per cent to retroperitoneal fibrosis. The diagnosis was facilitated by ultrasonography. Emergency treatment of obstructive anuria is based on urinary diversion by ureteral stent or by percutaneous nephrostomy under ultrasound control. Later the treatment depend of etiology. PMID:7486853

  4. Comparison of Modified With Classic Morrow Septal Myectomy in Treating Hypertrophic Obstructive Cardiomyopathy

    PubMed Central

    Song, Bangrong; Dong, Ran

    2016-01-01

    Abstract This study aimed to compare the efficacy and safety of the classic Morrow septal myectomy with the modified procedure in treating hypertrophic obstructive cardiomyopathy (HOCM). A retrospective study was conducted to compare the outcomes of classic with modified Morrow septal myectomy in 42 patients treated from January 2005 to July 2011. Preoperative and postoperative ventricular septal thickness, left ventricular (LV) outflow tract velocity and gradient were measured echocardiographically. In both groups, the ventricular septal thickness, LV outflow tract velocity, and LV outflow tract gradient were significantly decreased after the operation. The modified Morrow procedure group, however, showed significantly greater reduction in these echocardiographic parameters than the classic procedure group. All patients in the modified procedure group were asymptomatic postoperatively with a postoperative transvalvular pressure gradient <30 mm Hg. In the classic procedure group, only 14 (87.5%) patients, however, were asymptomatic postoperatively with a postoperative transvalvular pressure gradient <30 mm Hg, and 2 patients still had severe LV outflow obstruction postoperatively. The modified Morrow septal myectomy is safe and effective in treating HOCM patients, and is superior to the classic procedure in reducing the LV outflow tract gradient and velocity, restoring normal anatomic atrioventricular size, and alleviating symptoms associated with HOCM. PMID:26765408

  5. Northwestern Tharsis Latent Outflow Activity Mars

    NASA Technical Reports Server (NTRS)

    Dohm, J. M.; Anderson, R. C.; Baker, V. R.; Ferris, J. C.; Hare, T. M.; Strom, R. G.; Rudd, L.; Rice, J. W., Jr.; Scott, D. H.

    2000-01-01

    Previously defined outflow channels, which are indicated by relict landforms similar to those observed on Earth, signify ancient catastrophic flood events on Mars. These conspicuous geomorphic features are some of the most remarkable yet profound discoveries made by geologists to date. These outflow channels, which debouched tremendous volumes of water into topographic lows such as Chryse, Utopia, Elysium, and Hellas Planitiae, may represent the beginning of warmer and wetter climatic periods unlike the present-day cold and dry Mars. In addition to the previously identified outflow channels, observations permitted by the newly acquired Mars Orbiter Laser Altimeter (MOLA) data have revealed a system of gigantic valleys, referred to as the northwestern slope valleys (NSV), that are located to the northwest of a huge shield volcano, Arsia Mons, western hemisphere of Mars. These features generally correspond spatially to gravity lows similar to the easternmost, circum-Chryse outflow channel systems. Geologic investigations of the Tharsis region suggest that the large valley system pre-dates the construction of Arsia Mons and its extensive associated lava flows of mainly Late Hesperian and Amazonian age and coincides stratigraphically with the early development of the circum-Chryse outflow channel systems that debouch into Chryse Planitia. This newly identified system, the NSV, potentially signifies the largest flood event(s) ever recorded for the solar system. Additional information is contained in original extended abstract.

  6. Imaging and Simulations of CO Molecular Outflows

    NASA Astrophysics Data System (ADS)

    Lee, Chin-Fei; Mundy, Lee; Stone, James; Ostriker, Eve

    1999-10-01

    We have mapped the CO J=1-0 emission from molecular outflows associated with 10 young stellar systems of class 0 to class II with BIMA interferometry array and FCRAO single dish. Many of our outflows are closely related to jet like and bow shock structures detected in H2 or Halpha emission. The CO emission generally forms a hollowed structure around the jet and bow shock structures. Most of the CO outflows show a nested shell structure with velocity increasing with the distance from the star, but the detailed behavior can vary widely. Here, we presents five outflows to illustrate the different kinematics. Two of them are well described by a single parabolic shell with a Hubble law velocity, consistent with a wide-angle wind driven model. Two of them seem better explained with a jet-driven bow shock model, with a broad range of velocity near the bow shock. The last one appears to have elements of both models. To better understand the observations and test specific outflow models, we are performing a number of numerical simulations. This poster presents simulations of a jet propagating into a stratified ambient material. In these simulations, the jet-driven bow shock forms a thin cylindrical shell of swept-up gas around the jet, with the velocity vector of the material perpendicular to the shell surface. The simulations produce a wide range of velocity observed near the bow shock, but fail to produce the other CO kinematics in our observations.

  7. Galaxy ecosystems: gas contents, inflows and outflows

    NASA Astrophysics Data System (ADS)

    Lu, Zhankui; Mo, H. J.; Lu, Yu

    2015-06-01

    We use a set of observational data for galaxy cold gas mass fraction and gas phase metallicity to constrain the content, inflow and outflow of gas in central galaxies hosted by haloes with masses between 1011 and 1012 M⊙. The gas contents in high-redshift galaxies are obtained by combining the empirical star formation histories and star formation models that relate star formation rate with the cold gas mass in galaxies. We find that the total baryon mass in low-mass galaxies is always much less than the universal baryon mass fraction since z = 2, regardless of star formation model adopted. The data for the evolution of the gas phase metallicity require net metal outflow at z ≲ 2, and the metal loading factor is constrained to be about 0.01, or about 60 per cent of the metal yield. Based on the assumption that galactic outflow is more enriched in metal than both the interstellar medium and the material ejected at earlier epochs, we are able to put stringent constraints on the upper limits for both the net accretion rate and the net mass outflow rate. The upper limits strongly suggest that the evolution of the gas phase metallicity and gas mass fraction for low-mass galaxies at z < 2 is not compatible with strong outflow. We speculate that the low star formation efficiency of low-mass galaxies is owing to some preventative processes that prevent gas from accreting into galaxies in the first place.

  8. Viscoelastic properties of the normal human bladder.

    PubMed

    Andersson, S; Kronström, A; Bjerle, P

    1989-01-01

    Continuous and stepwise cystometry were performed through suprapubic catheters in 12 healthy young subjects in order to assess passive viscoelastic variables of the normal human bladder during the collection phase. Elastic contants increased non-linearly with bladder distension. Relative elastic modulus and relaxation time of the bladder wall increased or tended to increase with bladder distension and infusion rate. There was considerable interindividual variation in all variables suggesting that discrimination between normal and abnormal bladder wall viscoelasticity may be difficult in routine clinical practice.

  9. Zooplankton in the Arctic outflow

    NASA Astrophysics Data System (ADS)

    Soloviev, K. A.; Dritz, A. V.; Nikishina, A. B.

    2009-04-01

    Climate changes in the Arctic cause the changes in the current system that may have cascading effect on the structure of plankton community and consequently on the interlinked and delicately balanced food web. Zooplankton species are by definition incapable to perform horizontal moving. Their transport is connected with flowing water. There are zooplankton species specific for the definite water masses and they can be used as markers for the different currents. That allows us to consider zooplankton community composition as a result of water mixing in the studied area. Little is known however about the mechanisms by which spatial and temporal variability in advection affect dynamics of local populations. Ice conditions are also very important in the function of pelagic communities. Melting time is the trigger to all "plankton blooming" processes, and the duration of ice-free conditions determines the food web development in the future. Fram Strait is one of the key regions for the Arctic: the cold water outflow comes through it with the East Greenland Current and meets warm Atlantic water, the West Spitsbergen Current, producing complicated hydrological situation. During 2007 and 2008 we investigated the structure functional characteristics of zooplankton community in the Fram Strait region onboard KV "Svalbard" (April 2007, April and May 2008) and RV "Jan Mayen" (May 2007, August 2008). This study was conducted in frame of iAOOS Norway project "Closing the loop", which, in turn, was a part of IPY. During this cruises multidisciplinary investigations were performed, including sea-ice observations, CTD and ADCP profiling, carbon flux, nutrients and primary production measurements, phytoplankton sampling. Zooplankton was collected with the Hydro-Bios WP2 net and MultiNet Zooplankton Sampler, (mouth area 0.25 m2, mesh size 180 um).Samples were taken from the depth strata of 2000-1500, 1500-1000, 1000-500,500-200, 200-100, 100-60, 60-30, 30-0 m. Gut fluorescence

  10. Observations of Protostellar Outflow Feedback in Clustered Star Formation

    NASA Astrophysics Data System (ADS)

    Nakamura, F.

    2016-05-01

    We discuss the role of protostellar outflow feedback in clustered star formation using the observational data of recent molecular outflow surveys toward nearby cluster-forming clumps. We found that for almost all clumps, the outflow momentum injection rate is significantly larger than the turbulence dissipation rate. Therefore, the outflow feedback is likely to maintain supersonic turbulence in the clumps. For less massive clumps such as B59, L1551, and L1641N, the outflow kinetic energy is comparable to the clump gravitational energy. In such clumps, the outflow feedback probably affects significantly the clump dynamics. On the other hand, for clumps with masses larger than about 200 M⊙, the outflow kinetic energy is significantly smaller than the clump gravitational energy. Since the majority of stars form in such clumps, we conclude that outflow feedback cannot destroy the whole parent clump. These characteristics of the outflow feedback support the scenario of slow star formation.

  11. Overactive bladder - 18 years - Part II.

    PubMed

    Truzzi, Jose Carlos; Gomes, Cristiano Mendes; Bezerra, Carlos A; Plata, Ivan Mauricio; Campos, Jose; Garrido, Gustavo Luis; Almeida, Fernando G; Averbeck, Marcio Augusto; Fornari, Alexandre; Salazar, Anibal; Dell'Oro, Arturo; Cintra, Caio; Sacomani, Carlos Alberto Ricetto; Tapia, Juan Pablo; Brambila, Eduardo; Longo, Emilio Miguel; Rocha, Flavio Trigo; Coutinho, Francisco; Favre, Gabriel; Garcia, Jose Antonio; Castano, Juan; Reyes, Miguel; Leyton, Rodrigo Eugenio; Ferreira, Ruiter Silva; Duran, Sergio; Lopez, Vanda; Reges, Ricardo

    2016-01-01

    Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder. PMID:27176185

  12. Cancer of the Urinary Bladder

    MedlinePlus

    ... at a Glance Show More At a Glance Estimated New Cases in 2016 76,960 % of All New Cancer Cases 4.6% Estimated Deaths in 2016 16,390 % of All Cancer ... of This Cancer : In 2013, there were an estimated 587,426 people living with bladder cancer in ...

  13. Urothelial Bladder Cancer Urinary Biomarkers

    PubMed Central

    Noon, Aidan P

    2014-01-01

    Abstract Urothelial bladder cancer is the fourth most prevalent male malignancy in the United States and also one of the ten most lethal. Superficial or non-muscle-invasive bladder cancer has a high rate of recurrence and can progress to muscle invasive disease. Conventional surveillance requires regular cystoscopy and is used often with urinary cytology. Unfortunately, the cystoscopy procedure is invasive for patients and costly for health care providers. Urinary biomarkers have the potential to improve bladder cancer diagnosis, the efficiency and also the cost-effectiveness of follow up. It may also be possible for urinary biomarkers to help prognosticate particularly for patients with high-grade bladder cancer who may want enhanced assessment of their risk of disease progression. In this review the important historical urinary biomarkers and the newly emerging biomarkers are discussed. As will be presented, although many of the tests have good performance characteristics, unfortunately no single test can fulfill all the roles currently provided by cystoscopy and cytology. It is likely that in the future, urinary biomarker testing will be used selectively in a personalized manner to try and improve prognostication or reduce the necessity for invasive cystoscopy in patients understanding the limits of the test.

  14. [Specific types of bladder cancer].

    PubMed

    Bertz, S; Hartmann, A; Knüchel-Clarke, R; Gaisa, N T

    2016-02-01

    Bladder cancer shows rare variants and special subtypes with diverse prognostic importance and therefore may necessitate different therapeutic approaches. For pathologists it is important to histologically diagnose and specify such variants. Nested variants of urothelial carcinoma with inconspicuous, well-formed tumor cell nests present with an aggressive course. The plasmacytoid variant, which morphologically resembles plasma cells is associated with a shorter survival time and a high frequency of peritoneal metastasis. Micropapillary urothelial carcinoma with small papillary tumor cell islands within artificial tissue retraction spaces and frequent lymphovascular invasion also has a poor prognosis. Other important rare differential variants listed in the World Health Organization (WHO) classification are microcystic, lymphoepithelioma-like, sarcomatoid, giant cell and undifferentiated urothelial carcinomas. Additionally, there are three special types of bladder cancer: squamous cell carcinoma, adenocarcinoma and small cell neuroendocrine carcinoma of the bladder. These tumors are characterized by pure squamous cell or glandular differentiation and are sometimes less responsive to adjuvant (chemo)therapy. Small cell carcinoma of the bladder mimics the neuroendocrine features of its pulmonary counterpart, shows an aggressive course but is sensitive to (neo-)adjuvant chemotherapy. The morphology and histology of the most important variants and special types are discussed in this review. PMID:26782034

  15. Bladder Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing bladder cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  16. Stem Cells in Functional Bladder Engineering

    PubMed Central

    Smolar, Jakub; Salemi, Souzan; Horst, Maya; Sulser, Tullio; Eberli, Daniel

    2016-01-01

    Conditions impairing bladder function in children and adults, such as myelomeningocele, posterior urethral valves, bladder exstrophy or spinal cord injury, often need urinary diversion or augmentation cystoplasty as when untreated they may cause severe bladder dysfunction and kidney failure. Currently, the gold standard therapy of end-stage bladder disease refractory to conservative management is enterocystoplasty, a surgical enlargement of the bladder with intestinal tissue. Despite providing functional improvement, enterocystoplasty is associated with significant long-term complications, such as recurrent urinary tract infections, metabolic abnormalities, stone formation, and malignancies. Therefore, there is a strong clinical need for alternative therapies for these reconstructive procedures, of which stem cell-based tissue engineering (TE) is considered to be the most promising future strategy. This review is focused on the recent progress in bladder stem cell research and therapy and the challenges that remain for the development of a functional bladder wall. PMID:27781020

  17. Calcium carbonate obstructive urolithiasis in a red kangaroo (Macropus rufus).

    PubMed

    Lindemann, Dana M; Gamble, Kathryn C; Corner, Sarah

    2013-03-01

    A 6-yr-old male red kangaroo (Macropus rufus) presented for a history of inappetance, abnormal behavior, and unconfirmed elimination for 6 hr prior to presentation. Based on abdominal ultrasound, abdominocentesis, and cystocentesis, a presumptive diagnosis of urinary tract obstruction with uroabdomen and hydronephrosis was reached. Abdominal radiographs did not assist in reaching an antemortem diagnosis. Postmortem examination confirmed a urinary bladder rupture secondary to urethral obstruction by a single urethrolith. Bilateral hydronephrosis and hydroureter were identified and determined to be a result of bilateral ureteroliths. Urolith analysis revealed a composition of 100% calcium carbonate. A dietary analysis was performed, implicating an increased Ca:P ratio from a food preparation miscommunication as a contributing factor. Appropriate husbandry changes were made, and mob surveillance procedures were performed, which resolved the urolithiasis risk for the remaining five animals.

  18. Cholescintigraphy in extrahepatic biliary obstruction

    SciTech Connect

    Klingensmith, W.C.; Kuni, C.C.; Fritzberg, A.R.

    1982-07-01

    The effect of etiology on findings in cholescintigraphy in patients with extrahepatic obstruction was retrospectively evaluated in 29 patients. Of 11 patients with obstruction secondary to cancer, seven (78%) of nine had complete obstruction (delayed images were not obtained in two) and nine (82%) of 11 had a moderate to severe decreases in hepatocyte clearance. Of 12 patients with obstruction secondary to cholelithiasis, only four (36%) had complete obstruction (delayed images were not obtained in one) (p less than 0.05) and all 11 had normal or only midly decreased hepatocyte clearance (p less than 0.05). All five patients with obstruction secondary to pancreatitis had mild partial obstruction and normal or mildly decreased hepatocyte clearance. One patient had partial obstruction secondary to an abscess adjacent to the common bile duct; hepatocyte clearance was mildly decreased. Cancerous and noncancerous causes of biliary tract obstruction produce significantly different findings in hepatobiliary imaging.

  19. Outflows from Accretion Disks around Compact Objects

    NASA Astrophysics Data System (ADS)

    Jiao, Cheng-Liang; Wu, Xue-Bing

    2013-02-01

    We solve the set of hydrodynamic equations for accretion disks in the spherical coordinates (rθφ) to obtain the explicit structure along the θ direction. The results display thinner, quasi-Keplerian disks for Shakura-Sunyaev Disks (SSDs) and thicker, sub-Keplerian disks for Advection Dominated Accretion Flows (ADAFs) and slim disks, which are consistent with previous popular analytical models, while an inflow region and an outflow region always exist, which supports the results of some recent numerical simulation works. Our results indicate that the outflows should be common in various accretion disks and stronger in slim disks and ADAFs.

  20. Episodic High-velocity Outflows from V899 Mon: A Constraint On The Outflow Mechanisms

    NASA Astrophysics Data System (ADS)

    Ninan, J. P.; Ojha, D. K.; Philip, N. S.

    2016-07-01

    We report the detection of large variations in the outflow wind velocity from a young eruptive star, V899 Mon, during its ongoing high accretion outburst phase. Such large variations in the outflow velocity (from -722 to -425 km s-1) have never been reported previously in this family of objects. Our continuous monitoring of this source shows that the multi-component, clumpy, and episodic high velocity outflows are stable in the timescale of a few days, and vary over the timescale of a few weeks to months. We detect significant decoupling in the instantaneous outflow strength to accretion rate. From the comparison of various possible outflow mechanisms in magnetospheric accretion of young stellar objects, we conclude magnetically driven polar winds to be the most consistent mechanism for the outflows seen in V899 Mon. The large scale fluctuations in outflow over the short period makes V899 Mon the most ideal source to constrain various magnetohydrodynamics simulations of magnetospheric accretion. Based on observations made with the Southern African Large Telescope (SALT).

  1. Internal supravesical hernia - a rare cause of intestinal obstruction: report of two cases

    PubMed Central

    Bouassida, Mahdi; Sassi, Selim; Touinsi, Hassen; Kallel, Helmi; Mighri, Mohamed Mongi; Chebbi, Fathi; Ali, Mechaal Ben; Bouzeidi, Khaled; Sassi, Sadok

    2012-01-01

    Supravesical hernias develop at the supravesical fossa between the remnants of the urachus and the left or right umbilical artery. They are exceptional and are often the cause of intestinal obstruction. We report two cases of surgically proven internal supravesical hernias presenting with small bowel obstruction. Abdominal computed tomography showed, for our first case, the relation of the incarcerated intestine anterior to and compressing the urinary bladder. We believe that the preoperative diagnosis of supravesical hernia by abdominal computed tomography is possible, as shown in our first case. PMID:22368760

  2. Measuring Nasal Obstruction.

    PubMed

    Keeler, Jarrod; Most, Sam P

    2016-08-01

    The nose and the nasal airway is highly complex with intricate 3-dimensional anatomy, with multiple functions in respiration and filtration of the respired air. Nasal airway obstruction (NAO) is a complex problem with no clearly defined "gold-standard" in measurement. There are 3 tools for the measurement of NAO: patient-derived measurements, physician-observed measurements, and objective measurements. We continue to work towards finding a link between subjective and objective nasal obstruction. The field of evaluation and surgical treatment for NAO has grown tremendously in the past 4-5 decades and will continue to grow as we learn more about the pathophysiology and treatment of nasal obstruction. PMID:27400845

  3. Obstructive sleep apnea syndrome.

    PubMed

    Jaquis, J

    1987-06-01

    Obstructive sleep apnea syndrome is estimated to affect 2 million to 3 million Americans. Obstructive sleep apnea syndrome is a breathing pattern characterized by periods of apnea alternating with periods of arousal and breathing, a pattern that recurs throughout the sleep cycle. It is important for the nurse practitioner to be able to recognize the signs and symptoms of the syndrome in order to initiate diagnostic testing. The role of the nurse practitioner also involves education of the client and family regarding the disease process and treatment modalities. The client and client's family will need help in coping with the diagnosis and possibly with the physical and psychological symptoms experienced. This article outlines the disease process, treatment modalities, possible complications and the role of the nurse practitioner in assisting the client with obstructive sleep apnea syndrome.

  4. Assessment of bladder wall thickness in women with overactive bladder

    PubMed Central

    Üçer, Oktay; Gümüş, Bilal; Albaz, Ali Can; Pekindil, Gökhan

    2016-01-01

    Objective To compare bladder wall thickness (BWT) between female patients with overactive bladder (OAB) and aged-matched healthy controls. Material and methods Thirty-six female patients with OAB and 31 healthy women were enrolled in the present prospective observational study. Qmax and Qave were measured by using uroflowmetry in all of the women in the patient and control groups, and also maximum bladder capacity (MBC), post- void residual urine (PVRU), prevoiding and postvoiding BWT were measured by using transabdominal ultrasound. Lower urinary tract symptoms of the participants were assessed by using Overactive Bladder Version-8 (OAB-V8) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). All of the data were statistically compared between the patient and control groups. In the patient group, the relationships between parameters were evaluated correlation analysis. Results The mean age of the patients and controls were similar (respectively, 45.58±12.35 and 44.21±11.60 years (p=0.68). The mean pre- and post-voiding BWT, OAB-V8 and ICIQ-SF scores of the patients were significantly higher than the controls. In the patient group, the moderate positive correlations between BWT with Qmax (p=0.02) and Qave (p=0.02) were found. Conclusion This study showed that the BWTs of the female patients with OAB are higher than those of healthy women. Further studies should investigate the changes in BWT of patients with OAB after treatment of OAB. PMID:27274895

  5. Metabolic phenotype of bladder cancer.

    PubMed

    Massari, Francesco; Ciccarese, Chiara; Santoni, Matteo; Iacovelli, Roberto; Mazzucchelli, Roberta; Piva, Francesco; Scarpelli, Marina; Berardi, Rossana; Tortora, Giampaolo; Lopez-Beltran, Antonio; Cheng, Liang; Montironi, Rodolfo

    2016-04-01

    Metabolism of bladder cancer represents a key issue for cancer research. Several metabolic altered pathways are involved in bladder tumorigenesis, representing therefore interesting targets for therapy. Tumor cells, including urothelial cancer cells, rely on a peculiar shift to aerobic glycolysis-dependent metabolism (the Warburg-effect) as the main energy source to sustain their uncontrolled growth and proliferation. Therefore, the high glycolytic flux depends on the overexpression of glycolysis-related genes (SRC-3, glucose transporter type 1 [GLUT1], GLUT3, lactic dehydrogenase A [LDHA], LDHB, hexokinase 1 [HK1], HK2, pyruvate kinase type M [PKM], and hypoxia-inducible factor 1-alpha [HIF-1α]), resulting in an overproduction of pyruvate, alanine and lactate. Concurrently, bladder cancer metabolism displays an increased expression of genes favoring the pentose phosphate pathway (glucose-6-phosphate dehydrogenase [G6PD]) and the fatty-acid synthesis (fatty acid synthase [FASN]), along with a decrease of AMP-activated protein kinase (AMPK) and Krebs cycle activities. Moreover, the PTEN/PI3K/AKT/mTOR pathway, hyper-activated in bladder cancer, acts as central regulator of aerobic glycolysis, hence contributing to cancer metabolic switch and tumor cell proliferation. Besides glycolysis, glycogen metabolism pathway plays a robust role in bladder cancer development. In particular, the overexpression of GLUT-1, the loss of the tumor suppressor glycogen debranching enzyme amylo-α-1,6-glucosidase, 4-α-glucanotransferase (AGL), and the increased activity of the tumor promoter enzyme glycogen phosphorylase impair glycogen metabolism. An increase in glucose uptake, decrease in normal cellular glycogen storage, and overproduction of lactate are consequences of decreased oxidative phosphorylation and inability to reuse glucose into the pentose phosphate and de novo fatty acid synthesis pathways. Moreover, AGL loss determines augmented levels of the serine-to-glycine enzyme

  6. Metabolic phenotype of bladder cancer.

    PubMed

    Massari, Francesco; Ciccarese, Chiara; Santoni, Matteo; Iacovelli, Roberto; Mazzucchelli, Roberta; Piva, Francesco; Scarpelli, Marina; Berardi, Rossana; Tortora, Giampaolo; Lopez-Beltran, Antonio; Cheng, Liang; Montironi, Rodolfo

    2016-04-01

    Metabolism of bladder cancer represents a key issue for cancer research. Several metabolic altered pathways are involved in bladder tumorigenesis, representing therefore interesting targets for therapy. Tumor cells, including urothelial cancer cells, rely on a peculiar shift to aerobic glycolysis-dependent metabolism (the Warburg-effect) as the main energy source to sustain their uncontrolled growth and proliferation. Therefore, the high glycolytic flux depends on the overexpression of glycolysis-related genes (SRC-3, glucose transporter type 1 [GLUT1], GLUT3, lactic dehydrogenase A [LDHA], LDHB, hexokinase 1 [HK1], HK2, pyruvate kinase type M [PKM], and hypoxia-inducible factor 1-alpha [HIF-1α]), resulting in an overproduction of pyruvate, alanine and lactate. Concurrently, bladder cancer metabolism displays an increased expression of genes favoring the pentose phosphate pathway (glucose-6-phosphate dehydrogenase [G6PD]) and the fatty-acid synthesis (fatty acid synthase [FASN]), along with a decrease of AMP-activated protein kinase (AMPK) and Krebs cycle activities. Moreover, the PTEN/PI3K/AKT/mTOR pathway, hyper-activated in bladder cancer, acts as central regulator of aerobic glycolysis, hence contributing to cancer metabolic switch and tumor cell proliferation. Besides glycolysis, glycogen metabolism pathway plays a robust role in bladder cancer development. In particular, the overexpression of GLUT-1, the loss of the tumor suppressor glycogen debranching enzyme amylo-α-1,6-glucosidase, 4-α-glucanotransferase (AGL), and the increased activity of the tumor promoter enzyme glycogen phosphorylase impair glycogen metabolism. An increase in glucose uptake, decrease in normal cellular glycogen storage, and overproduction of lactate are consequences of decreased oxidative phosphorylation and inability to reuse glucose into the pentose phosphate and de novo fatty acid synthesis pathways. Moreover, AGL loss determines augmented levels of the serine-to-glycine enzyme

  7. Botulinum Toxin A Injection in the Bladder Neck: A Promising Treatment for Urinary Retention

    PubMed Central

    Alam, Marianne; Zgheib, Joseph; El Khoury, Fouad

    2016-01-01

    Secondary to failure of optimal medical therapy and the high morbidity that accompanies surgical techniques in high risk patients, the use of de novo treatments including botulinum toxin A is emerging in the treatment of benign prostatic hyperplasia (BPH). However, the treatment of urinary retention secondary to BPH via injecting botulinum toxin into the bladder neck is not well established in the literature. This case report describes the case of a 75-year-old male patient with a chronic history of obstructive lower urinary tract symptoms (LUTS) and multiple comorbidities who was admitted to the hospital for management of recurrent urinary retention. The patient was not a surgical candidate for transurethral incision of the prostate (TUIP) or transurethral resection of the prostate (TURP). Botulinum toxin injection into the bladder neck was performed with very satisfying results. Botulinum toxin injection in the bladder neck presents a promising minimally invasive, tolerated, and cost-effective approach for the treatment of urinary retention in patients with benign prostatic obstruction who are not candidates for surgery or in whom medical treatment has failed. More research is needed to identify the efficacy of this novel approach. PMID:27088032

  8. Where is the oxygen in protostellar outflows?

    NASA Astrophysics Data System (ADS)

    Kristensen, Lars

    2014-10-01

    Oxygen (O) is the third-most abundant element in the Universe after hydrogen and helium. Despite its high elemental abundance, a good picture of where oxygen is located in low-mass protostellar outflows and jets is missing: we cannot account for > 60% of the oxygen budget in these objects. This hole in our picture means that we currently do not have a good understanding of the dominant cooling processes in outflows jets, despite the fact that [O I] emission at 63 micron is one of the dominant cooling lines, nor how cooling processes evolve with protostellar evolution. To shed light on these processes, we propose to observe the [O I] 63 micron line with SOFIA-GREAT toward five low-mass protostars. As a first step, the velocity-resolved line profile will be decomposed into its constituent components to isolate the relative contributions from the jet and the irradiated outflow. Second, the [O I] line profile will be compared to those of H2O, OH and CO to obtain the relative atomic O abundance with respect to CO, H2O, and OH. Third, the effects of evolution will be examined by observing protostars at different evolutionary stages. These three approaches will allow us to quantify: the oxygen chemistry in warm and hot gas, the relative amounts of material in the outflow and the jet, and finally to start tracing the evolutionary sequence of how feedback evolves with time.

  9. Did ice streams carve martian outflow channels?

    USGS Publications Warehouse

    Lucchitta, B.K.; Anderson, D.M.; Shoji, H.

    1981-01-01

    Outflow channels on Mars1 are long sinuous linear depressions that occur mostly in the equatorial area (??30?? lat.). They differ from small valley networks2 by being larger and arising full born from chaotic terrains. Outflow channels resemble terrestrial stream beds, and their origin has generally been attributed to water3-5 in catastrophic floods6,7 or mudflows8. The catastrophic-flood hypothesis is derived primarily from the morphological similarities of martian outflow channels and features created by the catastrophic Spokane flood that formed the Washington scablands. These similarities have been documented extensively3,6,7, but differences of scale remain a major problemmartian channel features are on the average much larger than their proposed terrestrial analogues. We examine here the problem of channel origin from the perspective of erosional characteristics and the resultant landf orms created by former and present-day ice streams and glaciers on Earth. From morphologic comparisons, an ice-stream origin seems equally well suited to explain the occurrences and form of the outflow channels on Mars, and in contrast with the hydraulic hypothesis, ice streams and ice sheets produce terrestrial features of the same scale as those observed on Mars. ?? 1981 Nature Publishing Group.

  10. A SPECTACULAR OUTFLOW IN AN OBSCURED QUASAR

    SciTech Connect

    Greene, Jenny E.; Zakamska, Nadia L.; Smith, Paul S.

    2012-02-10

    SDSS J1356+1026 is a pair of interacting galaxies at redshift z = 0.123 that hosts a luminous obscured quasar in its northern nucleus. Here we present two long-slit Magellan LDSS-3 spectra that reveal a pair of symmetric {approx}10 kpc size outflows emerging from this nucleus, with observed expansion velocities of {approx}250 km s{sup -1} in projection. We present a kinematic model of these outflows and argue that the deprojected physical velocities of expansion are likely {approx}1000 km s{sup -1} and that the kinetic energy of the expanding shells is likely 10{sup 44-45} erg s{sup -1}, with an absolute minimum of >10{sup 42} erg s{sup -1}. Although a radio counterpart is detected at 1.4 GHz, it is faint enough that the quasar is considered to be radio quiet by all standard criteria, and there is no evidence of extended emission due to radio lobes, whether aged or continuously powered by an ongoing jet. We argue that the likely level of star formation is insufficient to power the observed energetic outflow and that SDSS J1356+1026 is a good case for radio-quiet quasar feedback. In further support of this hypothesis, polarimetric observations show that the direction of quasar illumination is coincident with the direction of the outflow.

  11. A Well-Defined Bipolar Outflow Shell

    NASA Astrophysics Data System (ADS)

    Xie, Taoling; Goldsmith, Paul F.; Patel, Nimesh

    1992-12-01

    A well-defined "eggplant-shaped" thin shell is revealed in the Mon R2 central core region by CO and (13) CO J=1-0 maps obtained with QUARRY. This thin shell outlines the extended blue lobe of the massive bipolar outflow. The projected length and width of the shell are about 5.7 pc and 2.5 pc respectively, and the averaged projected thickness of the shell is ~ 0.3 pc. The shape of this shell can be satisfactorily accounted for quantitatively in terms of limb-brightening within the framework of the Shu et al shell model with radially directed wind, although the model seems to be oversimplified with respect to the complexity that our data reveal. The outflow shell's symmetry axis is estimated to be inclined by ~ 70(deg) with respect to the line of sight. We suggest that the coincident blue- and red-shifted emission and the bending of the red-shifted lobe are the result of the red-shifted shell being compressed, rather than having a second bipolar outflow aligned roughly perpendicular to the axis of the first bipolar outflow.

  12. Protostellar Outflow Evolution in Turbulent Environments

    SciTech Connect

    Cunningham, A; Frank, A; Carroll, J; Blackman, E; Quillen, A

    2008-04-11

    The link between turbulence in star formatting environments and protostellar jets remains controversial. To explore issues of turbulence and fossil cavities driven by young stellar outflows we present a series of numerical simulations tracking the evolution of transient protostellar jets driven into a turbulent medium. Our simulations show both the effect of turbulence on outflow structures and, conversely, the effect of outflows on the ambient turbulence. We demonstrate how turbulence will lead to strong modifications in jet morphology. More importantly, we demonstrate that individual transient outflows have the capacity to re-energize decaying turbulence. Our simulations support a scenario in which the directed energy/momentum associated with cavities is randomized as the cavities are disrupted by dynamical instabilities seeded by the ambient turbulence. Consideration of the energy power spectra of the simulations reveals that the disruption of the cavities powers an energy cascade consistent with Burgers-type turbulence and produces a driving scale-length associated with the cavity propagation length. We conclude that fossil cavities interacting either with a turbulent medium or with other cavities have the capacity to sustain or create turbulent flows in star forming environments. In the last section we contrast our work and its conclusions with previous studies which claim that jets can not be the source of turbulence.

  13. Is surgery the gold standard in the treatment of obstructive hypertrophic cardiomyopathy?

    PubMed Central

    Knyshov, Gennady; Lazoryshynets, Vasyl; Rudenko, Kostyantyn; Kravchuk, Borys; Beshlyaga, Vyacheslav; Zalevsky, Valery; Rasputnyak, Olga; Batsak, Bogdan

    2013-01-01

    OBJECTIVES Hypertrophic cardiomyopathy is a complex and relatively common genetic cardiac disease and has been the subject of intensive scrutiny and investigation for over 40 years. The aim of this non-randomized cohort study was to compare subjective and objective outcomes in hypertrophic cardiomyopathy patients undergoing drug therapy, surgical myotomy-myectomy, dual-chamber pacing and alcohol septal ablation. METHODS We examined 194 patients: 103 with non-obstructive hypertrophic cardiomyopathy and 91 with obstructive hypertrophic cardiomyopathy. All the patients with a non-obstructive form were on drug therapy. Ninety-one consecutive patients with drug-refractory obstructive hypertrophic cardiomyopathy were treated invasively. Dual-chamber pacemaker implantation was performed for 49 patients with previous positive temporary pacing test (Group 1). In 28 patients with massive left ventricle hypertrophy and obliteration of its cavities, extensive myotomy-myectomy was performed (Group 2). In 14 patients with midventricular obstruction and appropriate coronary anatomy, alcohol septal ablation was performed (Group 3). RESULTS The peak left ventricle outflow tract gradient was 84.1 ± 15.2 mmHg in Group 1, 113.3 ± 14.9 mmHg in Group 2 and 97.5 ± 8.9 mmHg in Group 3. Dual-chamber pacing in Group 1 with optimal atrio-ventricular delay (85–180 ms for atrium pacing and 45–120 ms for atrial sensing) leads to dramatic decreases in left ventricle outflow tract gradient to 17.6 ± 11.8 mmHg and degree of mitral regurgitation. After extensive myectomy in Group 2, we observed a reduction of left ventricle outflow tract gradient to 17.3 ± 10.2 mmHg. Septal alcohol ablation in Group 3 leads to a left ventricle outflow tract gradient decrease from 97.5 ± 8.9 to 25.3 ± 5.8 mmHg. CONCLUSIONS Surgical myectomy, dual-chamber pacing and alcohol septal ablation are equally effective in reducing obstruction in case of correct indications. Dual-chamber pacing is indicated in

  14. Chronic Obstructive Pulmonary Disease (COPD)

    MedlinePlus

    Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease that makes it difficult to empty air out of the lungs. This difficulty in ...

  15. Chronic obstructive pulmonary disease - adults - discharge

    MedlinePlus

    ... adults - discharge; Chronic obstructive airways disease - adults - discharge; Chronic obstructive lung disease - adults - discharge; Chronic bronchitis - adults - discharge; Emphysema - adults - ...

  16. The Resolved Outflow from 3C 48

    NASA Astrophysics Data System (ADS)

    Shih, Hsin-Yi; Stockton, Alan

    2014-10-01

    We investigate the properties of the high-velocity outflow driven by the young radio jet of 3C 48, a compact-steep-spectrum source. We use the Space Telescope Imaging Spectrograph on board the Hubble Space Telecope to obtain (1) low-resolution UV and optical spectra and (2) multi-slit medium-resolution spectra of the ionized outflow. With supporting data from ground-based spectrographs, we are able to accurately measure the ratios of diagnostic emission lines such as [O III] λ5007, [O III] λ3727, [N II] λ6548, Hα, Hβ, [Ne V] λ3425, and [Ne III] λ3869. We fit the observed emission-line ratios using a range of ionization models, powered by active galactic nucleus (AGN) radiation and shocks, produced by the MAPPINGS code. We have determined that AGN radiation is likely the dominant ionization source. The outflow's density is estimated to be in the range n = 103-104 cm-3, the mass is ~6 × 106 M ⊙, and the metallicity is likely equal to or higher than solar. Compared with the typical outflows associated with more evolved radio jets, this young outflow is denser, less massive, and more metal rich. Multi-slit observations allow us to construct a two-dimensional velocity map of the outflow that shows a wide range of velocities with distinct velocity components, suggesting a wide-angle clumpy outflow. Based in part on observations made with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555. These observations are associated with program GO-11574. Some of the data presented herein were obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation. Some of the

  17. Use of cystourethroscopy to remove an indwelling double-J ureteral stent 6 years following simultaneous radical sigmoid colon cancer and partial bladder resection: A case report

    PubMed Central

    GU, YAN; ZHANG, JING; WANG, GUOZENG

    2016-01-01

    Ureteral stents are widely used to ensure good urinary drainage and to relieve obstruction, pain and infection during urologic procedures. However, long-term indwelling ureteral stents can cause various complications, such as encrustation, hematuria and infection. Here, the case of an 88-year-old man who had undergone simultaneous radical resection of sigmoid colon cancer and partial resection of the bladder 6 years prior is presented. The patient complained of urinary frequency and urgency, dysuria and intermittent fever. A kidney ureter bladder X-ray examination revealed the presence of an entire coiled double-J stent with calculi from the kidney to the bladder. A computed tomography scan revealed mild hydronephrosis of the left kidney and one J end of the stent in the bladder. The stent was removed successfully by cystourethroscopy and holmium laser lithotripsy. This report describes the clinical experience of the removal of a long-term stent by endoscopic manipulation. PMID:27313675

  18. Evolution of Mass Outflow in Protostars

    NASA Astrophysics Data System (ADS)

    Watson, Dan M.; Calvet, Nuria P.; Fischer, William J.; Forrest, W. J.; Manoj, P.; Megeath, S. Thomas; Melnick, Gary J.; Najita, Joan; Neufeld, David A.; Sheehan, Patrick D.; Stutz, Amelia M.; Tobin, John J.

    2016-09-01

    We have surveyed 84 Class 0, Class I, and flat-spectrum protostars in mid-infrared [Si ii], [Fe ii], and [S i] line emission, and 11 of these in far-infrared [O i] emission. We use the results to derive their mass outflow rates, {\\dot{M}}w. Thereby we observe a strong correlation of {\\dot{M}}w with bolometric luminosity, and with the inferred mass accretion rates of the central objects, {\\dot{M}}a, which continues through the Class 0 range the trend observed in Class II young stellar objects. Along this trend from large to small mass flow rates, the different classes of young stellar objects lie in the sequence Class 0-Class I/flat-spectrum-Class II, indicating that the trend is an evolutionary sequence in which {\\dot{M}}a and {\\dot{M}}w decrease together with increasing age, while maintaining rough proportionality. The survey results include two that are key tests of magnetocentrifugal outflow-acceleration mechanisms: the distribution of the outflow/accretion branching ratio b={\\dot{M}}w/{\\dot{M}}a, and limits on the distribution of outflow speeds. Neither rules out any of the three leading outflow-acceleration, angular-momentum-ejection mechanisms, but they provide some evidence that disk winds and accretion-powered stellar winds (APSWs) operate in many protostars. An upper edge observed in the branching-ratio distribution is consistent with the upper bound of b = 0.6 found in models of APSWs, and a large fraction (31%) of the sample have a branching ratio sufficiently small that only disk winds, launched on scales as large as several au, have been demonstrated to account for them.

  19. HOT ELECTROMAGNETIC OUTFLOWS. I. ACCELERATION AND SPECTRA

    SciTech Connect

    Russo, Matthew; Thompson, Christopher

    2013-04-20

    The theory of cold, relativistic, magnetohydrodynamic outflows is generalized by the inclusion of an intense radiation source. In some contexts, such as the breakout of a gamma-ray burst (GRB) jet from a star, the outflow is heated to a high temperature at a large optical depth. Eventually it becomes transparent and is pushed to a higher Lorentz factor by a combination of the Lorentz force and radiation pressure. We obtain its profile, both inside and outside the fast magnetosonic critical point, when the poloidal magnetic field is radial and monopolar. Most of the energy flux is carried by the radiation field and the toroidal magnetic field that is wound up close to the rapidly rotating engine. Although the entrained matter carries little energy, it couples the radiation field to the magnetic field. Then the fast critical point is pulled inward from infinity and, above a critical radiation intensity, the outflow is accelerated mainly by radiation pressure. We identify a distinct observational signature of this hybrid outflow: a hardening of the radiation spectrum above the peak of the seed photon distribution, driven by bulk Compton scattering. The non-thermal spectrum-obtained by a Monte Carlo method-is most extended when the Lorentz force dominates the acceleration, and the seed photon beam is wider than the Lorentz cone of the MHD fluid. This effect is a generic feature of hot, magnetized outflows interacting with slower relativistic material. It may explain why some GRB spectra appear to peak at photon energies above the original Amati et al. scaling. A companion paper addresses the case of jet breakout, where diverging magnetic flux surfaces yield strong MHD acceleration over a wider range of Lorentz factor.

  20. Evolution of Mass Outflow in Protostars

    NASA Astrophysics Data System (ADS)

    Watson, Dan M.; Calvet, Nuria P.; Fischer, William J.; Forrest, W. J.; Manoj, P.; Megeath, S. Thomas; Melnick, Gary J.; Najita, Joan; Neufeld, David A.; Sheehan, Patrick D.; Stutz, Amelia M.; Tobin, John J.

    2016-09-01

    We have surveyed 84 Class 0, Class I, and flat-spectrum protostars in mid-infrared [Si ii], [Fe ii], and [S i] line emission, and 11 of these in far-infrared [O i] emission. We use the results to derive their mass outflow rates, {\\dot{M}}w. Thereby we observe a strong correlation of {\\dot{M}}w with bolometric luminosity, and with the inferred mass accretion rates of the central objects, {\\dot{M}}a, which continues through the Class 0 range the trend observed in Class II young stellar objects. Along this trend from large to small mass flow rates, the different classes of young stellar objects lie in the sequence Class 0–Class I/flat-spectrum–Class II, indicating that the trend is an evolutionary sequence in which {\\dot{M}}a and {\\dot{M}}w decrease together with increasing age, while maintaining rough proportionality. The survey results include two that are key tests of magnetocentrifugal outflow-acceleration mechanisms: the distribution of the outflow/accretion branching ratio b={\\dot{M}}w/{\\dot{M}}a, and limits on the distribution of outflow speeds. Neither rules out any of the three leading outflow-acceleration, angular-momentum-ejection mechanisms, but they provide some evidence that disk winds and accretion-powered stellar winds (APSWs) operate in many protostars. An upper edge observed in the branching-ratio distribution is consistent with the upper bound of b = 0.6 found in models of APSWs, and a large fraction (31%) of the sample have a branching ratio sufficiently small that only disk winds, launched on scales as large as several au, have been demonstrated to account for them.

  1. Emulating a Fish Swim Bladder

    NASA Astrophysics Data System (ADS)

    Vesenka, James; Meredith, Dawn; Bolker, Jessica; Schubert, Christopher; Kraut, Gertrud

    2009-10-01

    The University of New Hampshire and the University of New England are developing biologically relevant physics laboratories for their predominantly health science audiences. Buoyancy plays an important role in a variety of biological processes. We describe an inexpensive laboratory activity based on the Cartesian Diver that allows students to quantitatively emulate the swim bladder of a fish. Inflation of the ``bladder'' is externally controlled through an external gas syringe or squeezing on the plastic water containment vessel (a 2L soda bottle). The students can accurately determine the volume of a ``fish'' at the point of neutral buoyancy by visual measurement of the trapped air pocket. A simple electronic gas pressure sensor allows the hydrostatic pressure on the fish to be analyzed simultaneously.

  2. [Oral anticholinergics in overactive bladder].

    PubMed

    Madersbacher, H

    2006-07-01

    Behavioural therapy and anticholinergics are the mainstays in the treatment of symptoms of overactive bladder in patients with idiopathic and neurogenic detrusor overactivity; they are the first-line treatment. Oxybutynin, propiverine, tolterodine and trospium chloride as well as the "newcomers" solifenacin and darifenacin are comparable in regards to their efficacy. However, based on different pharmacokinetics and pharmacodynamics with different resorption velocity, different metabolisation and different CNS penetration, the profile of adverse events is different, qualitatively and quantitatively. Substances that are resorbed slowly or available as slow-release formulations are tolerated better. Lipophilic anticholinergics which pass the blood-brain barrier may compromise cognitive functions, especially in geriatric patients, who are already on cholinesterase inhibitors due to memory disorders. The following article gives an overview of the anticholinergics currently prescribed in patients with symptoms of overactive bladder with special attention to the influence of pharmacokinetics/pharmacodynamics on the adverse events profile including possible CNS side effects.

  3. [Neurogenic bladder, 20 years later].

    PubMed

    Perrigot, M

    1995-10-28

    The therapeutic armamentarium--physical therapy, drugs, surgery--developed over the last 20 years now gives us the means of providing curative care to nearly all patients with manifestations of neuropathic bladder, meaning that the clinical examination and complementary tests must be conducted under strictly controlled conditions to identify the underlying mechanism. The examination of the perineum almost always reveals a defect when the origin is neurological but is often normal when gynaecologic or urologic factors are involved. Motor command, tonus, reflexes and sensitivity should all be carefully explored to distinguish between central and peripheral causes. Much progress has been made in complementary examinations. For example, nearly 100% of the neurological aetiologies can be identified with precision. Tests include electromyography of the perineum, measurement of the latency of the bulbocavernous reflex and that of the distal part of the internal pudental nerve. Complementary tests evaluating bladder and sphincter function include urine sediment with cytology, intravenous pyelography and echography of the urinary tract. Pressure measurements with cystomanometry, sphincterometry and flowmetry add further precisions. Whether the underlying mechanism of bladder dysfunction is purely neurological as is the case in many young patients with multiple sclerosis, spina bifida or caudia equina syndrome, results from several causes as in patients with Parkinson's disease and enlargement of the prostate, or is among the increasing number of post-radiation sequellae, the essential step is careful clinical examination and detailed interpretation of complementary examinations. Thus the wide range of techniques now available for the management of the neuropathic bladder can be adapted to each individual case according to the pathological processes causing the clinical manifestations. PMID:8545359

  4. Role of angiogenesis in urothelial bladder carcinoma

    PubMed Central

    Górnicka, Barbara

    2016-01-01

    Introduction Bladder cancer is the most common urinary tract malignancy in western countries. In recent years, extensive research has suggested that angiogenesis plays an important role in bladder cancer biology, contributing to tumor growth and progression. Material and methods In this review, we discuss general mechanisms of angiogenesis and highlight the influence of pro- and anti-angiogenic factors, and cancer stem cells on bladder cancer biology, their relation to disease progression, and potential use in novel targeted therapies. Results Expression of a number of proangiogenic factors, including HIF-1, VEGF, bFGF, IL-8 and MMPs, as well as anti-angiogenic factor TSP-1, was found to be altered in bladder tumors. Involvement of cancer stem cells in bladder cancer development was also proposed. Conclusions High expression of most pro-angiogenic factors correlated with disease progression and shorter patient survival, but discrepancies between studies urge us to continue evaluating the significance of angiogenesis in bladder cancer. PMID:27729991

  5. UTIs in patients with neurogenic bladder.

    PubMed

    Jahromi, Mona S; Mure, Amanda; Gomez, Christopher S

    2014-09-01

    Urinary tract infections (UTI) remain one of the most prevalent and frustrating morbidities for neurogenic bladder patients, and death attributed to urosepsis in the spinal cord injury (SCI) patient is higher when compared to the general population. Risk factors include urinary stasis, high bladder pressures, bladder stones, and catheter use. While classic symptoms of UTI include dysuria, increased frequency and urgency, neurogenic bladder patients present differently with increased spasticity, autonomic dysreflexia, urinary incontinence, and vague pains. Multiple modalities have been assessed for prevention including catheter type, oral supplements, bladder irrigation, detrusor injections and prophylactic antimicrobials. Of these, bladder inoculation with E. coli HU2117, irrigation with iAluRil(®), detrusor injections, and weekly prophylaxis with alternating antibiotics appear to have a positive reduction in UTI but require further study. Ultimately, treatment for symptomatic UTI should account for the varied flora and possible antibiotic resistances including relying on urine cultures to guide antibiotic therapy. PMID:25113150

  6. [Overactive bladder syndrome in children].

    PubMed

    Persson de Geeter, C

    2004-07-01

    According to recent terminology, the symptom complex of frequency and urgency with or without urge incontinence in childhood is called overactive bladder. The main etiologic factor seems to be a delayed maturation of complex neuroanatomic structures responsible for normal bladder control. Afflicted children show a typical pattern of reflex voiding with different degrees of severity. In many cases nocturnal incontinence is the main complaint and this may lead to the wrong diagnosis of nocturnal enuresis with resulting false treatment. The diagnostic work-up consists of standardized evaluation of children with enuresis and voiding dysfunction and should concentrate on the exclusion of any possible underlying neurological disorder. Treatment focuses primarily on behavioral modification and cognitive education with regard to bladder sensation and voluntary micturition. Muscarinic receptor antagonists are very useful as supportive medical treatment with a rather low rate of adverse effects. Children who fail to respond to treatment or children suffering from side effects can profit from alternative treatment modalities including biofeedback programs, pelvic floor stimulation, or acupuncture.

  7. Ultrasound and Biomarker Tests in Predicting Cancer Aggressiveness in Tissue Samples of Patients With Bladder Cancer

    ClinicalTrials.gov

    2016-06-09

    Bladder Papillary Urothelial Carcinoma; Stage 0a Bladder Urothelial Carcinoma; Stage 0is Bladder Urothelial Carcinoma; Stage I Bladder Cancer With Carcinoma In Situ; Stage I Bladder Urothelial Carcinoma; Stage II Bladder Urothelial Carcinoma; Stage III Bladder Urothelial Carcinoma; Stage IV Bladder Urothelial Carcinoma

  8. Can urinary nerve growth factor be a biomarker for overactive bladder?

    PubMed

    Kuo, Hann-Chorng; Liu, Hsin-Tzu; Chancellor, Michael B

    2010-01-01

    The clinical diagnosis of overactive bladder (OAB) greatly varies and is based on subjective symptoms. A more objective method to diagnose and assess therapeutic outcome in OAB patients, especially for health care providers not trained in urology, needs to be found. Evidence has shown that urinary proteins such as nerve growth factor (NGF) and prostaglandin E(2) levels increase in patients with OAB, bladder outlet obstruction, and detrusor overactivity. Urinary NGF level increases physiologically in normal subjects at urge to void, but increases pathologically in OAB patients at a small bladder volume and with a sensation of urgency. Recent studies have shown that patients with OAB dry and OAB wet have significantly higher urinary NGF levels compared with control groups and patients with increased bladder sensation. Urinary NGF levels decrease after antimuscarinic therapy and further decrease after detrusor botulinum toxin injections in refractory OAB. Urinary NGF level could be a potential biomarker for diagnosis of OAB and assessment of the therapeutic effect of antimuscarinic therapy. The latest medical advances in this field are reviewed herein.

  9. [Modern approaches to the treatment of patients with overactive bladder and urge urinary incontinence].

    PubMed

    Razdorskaia, M V; Neĭmark, A I; Aliev, R T

    2013-01-01

    Overactive bladder (OAB) is found in 20% of patients with various disorders of urination, and the imperative urinary incontinence diagnosed in one third of these patients. The study was aimed to improvement the treatment outcomes in OAB women with imperative incontinence and obstructive urination disorders by using a combination of alpha1-adrenoblockers and PDE-5 inhibitors, and to evaluation of relationship between clinical and urodynamic manifestations of the disease. The state of the microcirculation of the bladder mucosa before and after treatment was also evaluated. We have examined and treated 40 women aged 17 to 69 years with disease duration ranged from 1 to 20 years. Patients received combination of al-adrenoblocker alfuzosin (dalfaz) 5 mg at night and reversible selective PDE5 inhibitor tadalafil (Cialis) 5 mg daily in the morning for a month. After treatment, according to the uroflowmetry and cystometry data, the time of urination was reduced, urinary volume and maximum urinary flow rate, as well as cystometric capacity have increased; involuntary detrusor contractions in the bladder filling phase (spontaneous or provoked) became less, or absent. According to the results of ultrasound examination, residual urine volume has decreased. Laser Doppler flowmetry showed an increase of neurogenic tone in precapillary, bypass coefficient and microcirculation effectiveness index, increase in microcirculation index and the coefficient of variation, indicating an improvement of microcirculation in the bladder mucosa. As a result of treatment, the clinical effect was seen in 29 (73%) patients, urinary incontinence was noted only in 6 (15%) patients. PMID:23662495

  10. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

    NASA Astrophysics Data System (ADS)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

    2005-07-01

    Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

  11. Gall-Bladder Agenesis and Associated Anomalies

    PubMed Central

    Shorey, Brian; Spigelman, Allan D.

    1995-01-01

    Congenital absence of the gall-bladder is a rare condition. It is sometimes associated with other congenital defects. We report here two cases of gall-bladder agenesis discovered at laparoscopy. Both had a history of skeletal and cardiovascular anomalies. The investigation of patients with absent gall-bladder can be very difficult. Ultrasound scanning is usually inconclusive and further noninvasive tests should be performed to establish the diagnosis and prevent an unnecessary operation. The presence of other congenital defects should alert the clinician to the possibility of gall-bladder agenesis. PMID:18612357

  12. Intravesical drug delivery for dysfunctional bladder.

    PubMed

    Hsu, Chun-Chien; Chuang, Yao-Chi; Chancellor, Michael B

    2013-06-01

    The bladder is a hollow organ that can be treated locally by transurethral catheter for intravesical drug instillation or cystoscopy for intravesical drug injection. With advancing technology, local organ-specific therapy and drug delivery is of expanding interest for treating dysfunctional bladder, including interstitial cystitis/bladder pain syndrome, overactive bladder and sterile hemorrhagic cystitis after chemotherapy or pelvic radiation. Intravesical therapy has shown varying degrees of efficacy and safety in treating interstitial cystitis/bladder pain syndrome, overactive bladder and hemorrhagic cystitis with new modalities being developed. Intravesical (regional) therapy has several advantages than oral (systemic) therapy, including high local concentration and less systemic toxicity. In recent years, intravesical delivery of biotechnological products including neurotoxins and immunosuppressive agents, and delivery platform including liposomes has shown promise for lower urinary tract symptoms. This review considers the current status of intravesical therapy in dysfunctional bladder including interstitial cystitis/bladder pain syndrome, overactive bladder and hemorrhagic cystitis with special attention to lipid based novel drug-delivery.

  13. Tracing outflows in the AGN forbidden region with SINFONI

    NASA Astrophysics Data System (ADS)

    Kakkad, D.; Mainieri, V.; Padovani, P.; Cresci, G.; Husemann, B.; Carniani, S.; Brusa, M.; Lamastra, A.; Lanzuisi, G.; Piconcelli, E.; Schramm, M.

    2016-08-01

    Context. Active galactic nucleus (AGN) driven outflows are invoked in numerical simulations to reproduce several observed properties of local galaxies. The z > 1 epoch is of particular interest as it was during this time that the volume averaged star formation and the accretion rate of black holes were at their maximum. Radiatively driven outflows are therefore believed to be common during this epoch. Aims: We aim to trace and characterize outflows in AGN hosts with high mass accretion rates at z > 1 using integral field spectroscopy. We obtain spatially resolved kinematics of the [O iii] λ5007 line in two targets which reveal the morphology and spatial extension of the outflows. Methods: We present SINFONI observations in the J band and the H + K band of five AGNs at 1.2 < z < 2.2. To maximize the chance of observing radiatively driven outflows, our sample was pre-selected based on peculiar values of the Eddington ratio and the hydrogen column density of the surrounding interstellar medium. We observe high velocity (~600-1900 km s-1) and kiloparsec scale extended ionized outflows in at least three of our targets, using [O iii] λ5007 line kinematics tracing the AGN narrow line region. We estimate the total mass of the outflow, the mass outflow rate, and the kinetic power of the outflows based on theoretical models and report on the uncertainties associated with them. Results: We find mass outflow rates of ~1-10 M⊙/yr for the sample presented in this paper. Based on the high star formation rates of the host galaxies, the observed outflow kinetic power, and the expected power due to the AGN, we infer that both star formation and AGN radiation could be the dominant source for the outflows. The outflow models suffer from large uncertainties, hence we call for further detailed observations for an accurate determination of the outflow properties to confirm the exact source of these outflows.

  14. Atezolizumab in Treating Patients With Recurrent BCG-Unresponsive Non-muscle Invasive Bladder Cancer

    ClinicalTrials.gov

    2016-09-12

    Recurrent Bladder Urothelial Carcinoma; Stage 0a Bladder Urothelial Carcinoma; Stage 0is Bladder Urothelial Carcinoma; Stage I Bladder Cancer With Carcinoma In Situ; Stage I Bladder Urothelial Carcinoma

  15. Properties of quasar broad absorption line outflows

    NASA Astrophysics Data System (ADS)

    Capellupo, Daniel Moshin

    2012-06-01

    Broad absorption lines (BALs) in quasar spectra identify high velocity outflows that likely exist in all quasars and could play a major role in feedback to galaxy evolution. In this dissertation, I use two methods to illuminate important properties of these outflows with the goal of a better understanding of these outflow systems and ultimately of the connection between quasars and their host galaxies. The variability of BALs can help us understand the structure, evolution, and basic physical properties of the outflows. I report here on a BAL monitoring programme of a sample of 24 luminous quasars at redshifts 1.2outflow velocities are more likely to vary than those at lower velocities, and weaker BALs are more likely to vary than stronger BALs. I then directly compare the variabilities in the C IV and Si IV lambda1400 absorption to try to ascertain the cause(s) of the variability. I find that Si IV BALs are more likely to vary than C IV BALs. When both C IV and Si IV varied, those changes always occurred in the same sense (either getting weaker or stronger). The multi-epoch data, including up to 10 epochs of data per quasar, show that the BAL changes were not generally monotonic across the full ˜5 to ˜8 yr time span of our observations, suggesting that the characteristic time-scale for significant line variations, and (perhaps) for structural changes in the outflows, is less than a few years. The evidence presented here indicates that the cause of variability is likely a complex mixture of changing ionization in the outflowing

  16. Nonobvious obstructive meibomian gland dysfunction.

    PubMed

    Blackie, Caroline A; Korb, Donald R; Knop, Eric; Bedi, Raman; Knop, Nadja; Holland, Edward J

    2010-12-01

    This review presents the rationale and supporting data for a recent paradigm shift in our understanding of meibomian gland dysfunction (MGD). The historical understanding of MGD has been that of an infectious hypersecretory disorder with obvious signs of inflammation, hypersecretion, and purulent excreta. The current understanding of MGD now includes the polar concept of a less obvious or nonobvious type of hyposecretory obstructive MGD, where inflammation and other signs of pathology may be absent unless special examination techniques are employed. A new term, nonobvious obstructive MGD (NOMGD), is used to describe what may be the most common form of obstructive MGD. Obstructive MGD is an area of growing importance because obstructive MGD is now recognized to be the most common cause of evaporative dry eye, and because NOMGD seems to be the precursor to obvious obstructive MGD, it is also an important area to understand. The prevalence of NOMGD seems to be very high but currently significantly underdiagnosed. This review presents the relevant anatomy and physiology, concepts of obstructive MGD, the usual absence of inflammation in obstructive MGD, nomenclature and classification of obstructive and NOMGD, clinical diagnosis of NOMGD emphasizing the necessity for diagnostic expression, the use of a new instrument for diagnostic expression providing a standardized method of assessing meibomian gland functionality, the complementary roles of the aqueous and lipid layers, and the specific treatment of NOMGD, emphasizing that the success of treatment of all forms of obstructive MGD is dependent on the relief of the obstruction.

  17. Nonobvious obstructive meibomian gland dysfunction.

    PubMed

    Blackie, Caroline A; Korb, Donald R; Knop, Eric; Bedi, Raman; Knop, Nadja; Holland, Edward J

    2010-12-01

    This review presents the rationale and supporting data for a recent paradigm shift in our understanding of meibomian gland dysfunction (MGD). The historical understanding of MGD has been that of an infectious hypersecretory disorder with obvious signs of inflammation, hypersecretion, and purulent excreta. The current understanding of MGD now includes the polar concept of a less obvious or nonobvious type of hyposecretory obstructive MGD, where inflammation and other signs of pathology may be absent unless special examination techniques are employed. A new term, nonobvious obstructive MGD (NOMGD), is used to describe what may be the most common form of obstructive MGD. Obstructive MGD is an area of growing importance because obstructive MGD is now recognized to be the most common cause of evaporative dry eye, and because NOMGD seems to be the precursor to obvious obstructive MGD, it is also an important area to understand. The prevalence of NOMGD seems to be very high but currently significantly underdiagnosed. This review presents the relevant anatomy and physiology, concepts of obstructive MGD, the usual absence of inflammation in obstructive MGD, nomenclature and classification of obstructive and NOMGD, clinical diagnosis of NOMGD emphasizing the necessity for diagnostic expression, the use of a new instrument for diagnostic expression providing a standardized method of assessing meibomian gland functionality, the complementary roles of the aqueous and lipid layers, and the specific treatment of NOMGD, emphasizing that the success of treatment of all forms of obstructive MGD is dependent on the relief of the obstruction. PMID:20847669

  18. Molecular emission in chemically active protostellar outflows

    NASA Astrophysics Data System (ADS)

    Lefloch, B.

    2011-12-01

    Protostellar outflows play an important role in the dynamical and chemical evolution of cloud through shocks. The Herschel Space Observatory (HSO) brings new insight both on the molecular content and the physical conditions in protostellar shocks through high spectral and angular resolution studies of the emission of major gas cooling agents and hydrides. The Herschel/CHESS key-program is carrying out an in depth study of the prototypical shock region L1157-B1. Analysis of the line profiles detected allows to constrain the formation/destruction route of various molecular species, in relation with the predictions of MHD shock models. The Herschel/WISH key-program investigates the properties and origin of water emission in a broad sample of protostellar outflows and envelopes. Implications of the first results for future studies on mass-loss phenomena are discussed.

  19. Influence of Mediterranean Outflow on climate

    NASA Astrophysics Data System (ADS)

    Rahmstorf, Stefan

    A cover article in Eos last year [Johnson, 1997] called for a dam across the Strait of Gibraltar to prevent a new Ice Age. In this article, R. G. Johnson argued that reduced Nile River flow after building the Aswan Dam increases Mediterranean Sea salinity, leading to enhanced outflow of salty water into the Atlantic Ocean. This, in turn, would alter the thermohaline (that is, temperature and salinity driven) circulation of the Atlantic, heat up the Labrador Sea and enhance evaporation there, and increase snowfall in Canada until a new ice sheet builds up. Ocean circulation model experiments, however, suggest that this fear is unfounded. While Mediterranean saltwater outflow (Figure 1a) does appear to have some effect on North Atlantic circulation and surface climate, the change in Mediterranean salt budget resulting from the Aswan Dam is far too small to have any noticeable impact.

  20. Example of reduced turbulence during thunderstorm outflow

    SciTech Connect

    Bowen, B.M.

    1996-06-01

    This research note describes the effects of a gust front passage resulting from a thunderstorm outflow on wind, turbulence, and other basic meteorological variables in northern Mew Mexico. The purpose of this note is to explain how a thunderstorm outflow can greatly reduce horizontal and vertical turbulence and produce strong winds, thereby promoting the rapid transport of elevated pollutant concentrations. Another goal is to demonstrate the usefulness of a sodar in combination with a tower to provide data for dispersion and transport calculations during an emergency response. Hopefully, this note will motivate other researchers to analyze and document the effects of thunderstorms on turbulence and dispersion by routine monitoring or by experimentation. 12 refs., 3 figs., 1 tab.

  1. Local outflows from turbulent accretion disks

    NASA Astrophysics Data System (ADS)

    Fromang, S.; Latter, H.; Lesur, G.; Ogilvie, G. I.

    2013-04-01

    Aims: The aim of this paper is to investigate the properties of accretion disks threaded by a weak vertical magnetic field, with a particular focus on the interplay between magnetohydrodynamic (MHD) turbulence driven by the magnetorotational instability (MRI) and outflows that might be launched from the disk. Methods: For that purpose, we use a set of numerical simulations performed with the MHD code RAMSES in the framework of the shearing box model. We concentrate on the case of a rather weak vertical magnetic field such that the initial ratio β0 of the thermal and magnetic pressures in the disk midplane equals 104. Results: As reported recently, we find that MHD turbulence drives an efficient outflow out of the computational box. We demonstrate a strong sensitivity of that result to the box size: enlargements in the radial and vertical directions lead to a reduction of up to an order of magnitude in the mass-loss rate. Such a dependence prevents any realistic estimates of disk mass-loss rates being derived using shearing-box simulations. We find however that the flow morphology is robust and independent of the numerical details of the simulations. Its properties display some features and approximate invariants that are reminiscent of the Blandford & Payne launching mechanism, but differences exist. For the magnetic field strength considered in this paper, we also find that angular momentum transport is most likely dominated by MHD turbulence, the saturation of which scales with the magnetic Prandtl number, the ratio of viscosity and resistivity, in a way that is in good agreement with expectations based on unstratified simulations. Conclusions: This paper thus demonstrates for the first time that accretion disks can simultaneously exhibit MRI-driven MHD turbulence along with magneto-centrifugally accelerated outflows. However, in contradiction with previously published results, such outflows probably have little impact on the disk dynamics.

  2. Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate

    PubMed Central

    Eret, Viktor; Stránský, Petr; Trávníček, Ivan; Dolejšová, Olga; Chudáček, Zdeněk; Petersson, Fredrik; Hes, Ondřej; Chłosta, Piotr

    2015-01-01

    Introduction Pseudodiverticulum of the urinary bladder is mostly a complication of subvesical obstruction (SO). The gold standard of treatment was open diverticulectomy with adenectomy. A more contemporary resolution is endoscopic, in two steps: the first transurethral resection of the prostate (TURP), the second laparoscopic diverticulectomy (LD). Aim To present a one-session procedure – photoselective vaporisation of the prostate (PVP) with LD. Material and methods From 1/2011 to 6/2014, 14 LDs were performed: 1 LD only, 1 with laparoscopic radical prostatectomy, 12 combined with treatment of benign prostatic hyperplasia (BPH), 4 cases of TURP and LD in the second period. In 8 cases, PVP and LD in one session were combined. These 8 cases are presented. 3D CT cystography was used as a gold standard for assessment of diverticulum. Results The mean age was 66.5 ±5.5 (57.3–75.1) years, the mean size of the diverticulum 61.8 ±22.1 (26–90) mm. The procedure starts in the lithotomy position. It includes PVP and stenting of the ureter(s). Changing of position and laparoscopy follows: four ports, transperitoneal extravesical approach. Photoselective vaporisation of the prostate was performed using the Green Light Laser HPS (1x) or XPS with cooled fibre MoXy (7x). The mean delivered energy in PVP was 205.1 ±106.4 (120–458) kJ. The mean time of operation was 165.0 ±48.5 (90–255) min. No postoperative complications were observed. One patient underwent TUR incision after 1 year for sclerosis of the bladder neck. Conclusions Pseudodiverticulum of the urinary bladder (with or without SO) is a relatively rare disease. One session of PVP (Green Light Laser XPS, MoXy fibre) and laparoscopic (transperitoneal extravesical) diverticulectomy is the preferred method for treatment of subvesical obstruction due to BPH and bladder diverticulum at our institution. PMID:25960795

  3. Shaping the outflows of evolved stars

    NASA Astrophysics Data System (ADS)

    Mohamed, Shazrene

    2015-08-01

    Both hot and cool evolved stars, e.g., red (super)giants and Wolf-Rayet stars, lose copious amounts of mass, momentum and mechanical energy through powerful, dense stellar winds. The interaction of these outflows with their surroundings results in highly structured and complex circumstellar environments, often featuring knots, arcs, shells and spirals. Recent improvements in computational power and techniques have led to the development of detailed, multi-dimensional simulations that have given new insight into the origin of these structures, and better understanding of the physical mechanisms driving their formation. In this talk, I will discuss three of the main mechanisms that shape the outflows of evolved stars:- interaction with the interstellar medium (ISM), i.e., wind-ISM interactions- interaction with a stellar wind, either from a previous phase of evolution or the wind from a companion star, i.e., wind-wind interactions- and interaction with a companion star that has a weak or insignicant outflow (e.g., a compact companion such as a neutron star or black hole), i.e., wind-companion interactions.I will also highlight the broader implications and impact of these stellar wind interactions for other phenomena, e.g, for symbiotic and X-ray binaries, supernovae and Gamma-ray bursts.

  4. Outflows of stars due to quasar feedback

    NASA Astrophysics Data System (ADS)

    Zubovas, Kastytis; Nayakshin, Sergei; Sazonov, Sergey; Sunyaev, Rashid

    2013-05-01

    Quasar feedback outflows are commonly invoked to drive gas out of galaxies in the early gas-rich epoch to terminate growth of galaxies. Here we present simulations that show that AGN feedback may drive not only gas but also stars out of their host galaxies under certain conditions. The mechanics of this process is as follows: (1) AGN-driven outflows accelerate and compress gas filling the host galaxy; (2) the accelerated dense shells become gravitationally unstable and form stars on radial trajectories. For the spherically symmetric initial conditions explored here, the black hole needs to exceed the host's Mσ mass by a factor of a few to accelerate the shells and the new stars to escape velocities. We discuss potential implications of these effects for the host galaxies: (i) radial mixing of bulge stars with the rest of the host; (ii) contribution of quasar outflows to galactic fountains as sources of high-velocity clouds; (iii) wholesale ejection of hypervelocity stars out of their hosts, giving rise to Type II supernovae on galactic outskirts, and contributing to reionization and metal enrichment of the Universe; (iv) bulge erosion and even complete destruction in extreme cases resulting in overweight or bulgeless SMBHs.

  5. A peculiar complication of suprapubic catheterization: Recurrent ureteral obstruction and hydronephrosis

    PubMed Central

    Adeyemo, Bamidele; Makovitch, Steven; Foo, Dominic

    2013-01-01

    Context Suprapubic cystostomy (SPC) catheterization is a common and important technique for the management of vesicular drainage, especially in patients with neurogenic bladder. Some serious complications include bowel perforation and obstruction. Findings A 55-year-old man with C6 American Spinal Injury Association B tetraplegia and a urethral stricture requiring a chronic SPC was admitted for recurrent urosepsis. Computed tomography (CT) of the abdomen revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC (30 French/10-mm silicone catheter with a 10-ml balloon) was removed and replaced with a similar suprapubic catheter (30 French/10-mm silicone catheter with an 8-ml balloon). Symptoms recurred 2 months later and he was readmitted for urosepsis. CT of the abdomen again revealed severe right hydronephrosis and hydroureter due to obstruction of the right distal ureter by the SPC tip. The SPC was removed, and the patient was given a 14 French/4.67-mm urethral silicone catheter with a 5-ml balloon. Follow-up CT of the abdomen 2 months later showed complete resolution of the hydronephrosis and hydroureter. Of note, urodynamic studies 2 years earlier revealed an extremely small bladder with a capacity less than 20 ml. Conclusion This case illustrates that obstruction of the ureter by the tip of an SPC can be a cause of recurrent hydronephrosis and urosepsis. PMID:23809534

  6. BAL OUTFLOW CONTRIBUTION TO AGN FEEDBACK: FREQUENCY OF S IV OUTFLOWS IN THE SDSS

    SciTech Connect

    Dunn, Jay P.; Arav, Nahum; Laughlin, Courtney; Edmonds, Doug; Aoki, Kentaro; Wilkins, Ashlee; Bautista, Manuel E-mail: arav@vt.edu E-mail: kentaro.aoki@hawaiiantel.net E-mail: manuel.bautista@wmich.edu

    2012-05-10

    We present a study of broad absorption line (BAL) quasar outflows that show S IV {lambda}1063 and S IV* {lambda}1073 troughs. The fractional abundances of S IV and C IV peak at similar value of the ionization parameter, implying that they arise from the same physical component of the outflow. Detection of the S IV* troughs will allow us to determine the distance to this gas with higher resolution and higher signal-to-noise spectra, therefore providing the distance and energetics of the ubiquitous C IV BAL outflows. In our bright sample of 156 SDSS quasars, 14% show C IV and 1.9% S IV troughs, which are consistent with a fainter magnitude sample with twice as many objects. One object in the fainter sample shows evidence of a broad S IV trough without any significant trough present from the excited state line, which implies that this outflow could be at a distance of several kpc. Given the fractions of C IV and S IV, we establish firm limits on the global covering factor on S IV that ranges from 2.8% to 21% (allowing for the k-correction). Comparison of the expected optical depth for these ions with their detected percentage suggests that these species arise from common outflows with a covering factor closer to the latter.

  7. Adult obstructive sleep apnoea.

    PubMed

    Jordan, Amy S; McSharry, David G; Malhotra, Atul

    2014-02-22

    Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60-70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss. PMID:23910433

  8. Urinary Bladder Cancer in Yemen

    PubMed Central

    Al-Samawi, Abdullah Saleh; Aulaqi, Saleh Mansoor

    2013-01-01

    Objectives The aims of this study are to highlight the clinicopathological features of urinary bladder cancer in Yemen, and to describe the histological grading of urothelial neoplasms according to the World Health Organization and International Society of Urologic pathology (WHO/ISUP 1998) classification. Methods This is a descriptive record-based study of 316 cases of bladder cancer diagnosed by two pathologists at the Department of pathology, Sana'a University from 1st January 2005 to 30th April 2009. The diagnoses were made on hematoxylin and eosin stained sections and categorized according to WHO/ISUP 1998 classification. Results Out of 316 urinary bladder cancers, 248 (78%) were urothelial neoplasms, 53 (17%) were squamous cell carcinoma, 7 (2%) were adenocarcinoma, and 3 (1%) were rhabdomyosarcoma. The remaining cases were metastatic carcinomas (n=3), small cell carcinoma (n=1), and non-Hodgkin's lymphoma (n=1). The urothelial neoplasms observed were carcinoma in situ 4 (2%), papilloma 7 (3%), papillary urothelial neoplasm of low malignant potential 26 (11%), papillary urothelial carcinoma of low grade 107 (43%), papillary urothelial carcinoma of high grade 18 (7%), and non-papillary urothelial carcinoma of high grade 85 (34%), with 60 years mean age for males and 58 years for females; along with a male to female ratio of 4:1. The peak incidence was observed in the 61-70 years age group. Conclusion This study documents a high frequency of urothelial neoplasms, mostly papillary urothelial carcinoma of low grade and non-papillary urothelial carcinoma of high grade with male preponderance and peak incidence in 6th decade of age. PMID:24044060

  9. Calcium transport in turtle bladder

    SciTech Connect

    Sabatini, S.; Kurtzman, N.A. )

    1987-12-01

    Unidirectional {sup 45}Ca fluxes were measured in the turtle bladder under open-circuit and short-circuit conditions. In the open-circuited state net calcium flux (J{sup net}{sub Ca}) was secretory (serosa to mucosa). Ouabain reversed J{sup net}{sub Ca} to an absorptive flux. Amiloride reduced both fluxes such that J{sup net}{sub Ca} was not significantly different from zero. Removal of mucosal sodium caused net calcium absorption; removal of serosal sodium caused calcium secretion. When bladders were short circuited, J{sup net}{sub Ca} decreased to approximately one-third of control value but remained secretory. When ouabain was added under short-circuit conditions, J{sup net}{sub Ca} was similar in magnitude and direction to ouabain under open-circuited conditions (i.e., absorptive). Tissue {sup 45}Ca content was {approx equal}30-fold lower when the isotope was placed in the mucosal bath, suggesting that the apical membrane is the resistance barrier to calcium transport. The results obtained in this study are best explained by postulating a Ca{sup 2+}-ATPase on the serosa of the turtle bladder epithelium and a sodium-calcium antiporter on the mucosa. In this model, the energy for calcium movement would be supplied, in large part, by the Na{sup +}-K{sup +}-ATPase. By increasing cell sodium, ouabain would decrease the activity of the mucosal sodium-calcium exchanger (or reverse it), uncovering active calcium transport across the serosa.

  10. The management of bladder lithiasis in the modern era of endourology.

    PubMed

    Philippou, Prodromos; Moraitis, Konstantinos; Masood, Junaid; Junaid, Islam; Buchholz, Noor

    2012-05-01

    The recent evolution in the management of vesical lithiasis is a result of the major advancements of modern endourology. The ideal method for achieving stone clearance, however, remains an issue of debate and evidence-based recommendations are lacking. Contemporary literature focuses on management options, such as extracorporeal shockwave lithotripsy, transurethral, percutaneous and minimally-invasive surgery, as well as state-of-the-art energy sources. Issues of particular interest include the results of comparative studies, the management of lithiasis in the paediatric population and the recent challenge of the traditional dogma that dictated BPH surgery for the management of vesical lithiasis secondary to bladder outlet obstruction.

  11. Quasar feedback revealed by giant molecular outflows

    NASA Astrophysics Data System (ADS)

    Feruglio, C.; Maiolino, R.; Piconcelli, E.; Menci, N.; Aussel, H.; Lamastra, A.; Fiore, F.

    2010-07-01

    In the standard scenario for galaxy evolution young star-forming galaxies transform into red bulge-dominated spheroids, where star formation has been quenched. To explain this transformation, a strong negative feedback generated by accretion onto a central super-massive black hole is often invoked. The depletion of gas resulting from quasar-driven outflows should eventually stop star-formation across the host galaxy and lead the black hole to “suicide” by starvation. Direct observational evidence for a major quasar feedback onto the host galaxy is still missing, because outflows previously observed in quasars are generally associated with the ionized component of the gas, which only accounts for a minor fraction of the total gas content, and typically occurrs in the central regions. We used the IRAM PdB Interferometer to observe the CO(1-0) transition in Mrk 231, the closest quasar known. Thanks to the wide band we detected broad wings of the CO line, with velocities of up to 750 km s-1 and spatially resolved on the kpc scale. These broad CO wings trace a giant molecular outflow of about 700 M_⊙/year, far larger than the ongoing star-formation rate (~200 M_⊙/year) observed in the host galaxy. This wind will totally expel the cold gas reservoir in Mrk 231 in about 107 yrs, therefore halting the star-formation activity on the same timescale. The inferred kinetic energy in the molecular outflow is ~1.2 × 1044 erg/s, corresponding to a few percent of the AGN bolometric luminosity, which is very close to the fraction expected by models ascribing quasar feedback to highly supersonic shocks generated by radiatively accelerated nuclear winds. Instead, the contribution by the SNe associated with the starburst fall short by several orders of magnitude to account for the kinetic energy observed in the outflow. The direct observational evidence for quasar feedback reported here provides solid support to the scenarios ascribing the observed properties of local massive

  12. Bladder cancer documentation of causes: multilingual questionnaire, 'bladder cancer doc'.

    PubMed

    Golka, Klaus; Abreu-Villaca, Yael; Anbari Attar, Rowshanak; Angeli-Greaves, Miriam; Aslam, Muhammad; Basaran, Nursen; Belik, Rouslana; Butryee, Chaniphun; Dalpiaz, Orietta; Dzhusupov, Keneshbek; Ecke, Thorsten H; Galambos, Henrieta; Galambos, Henrieta; Gerilovica, Helena; Gerullis, Holger; Gonzalez, Patricia Casares; Goossens, Maria E; Gorgishvili-Hermes, Lela; Heyns, Chris F; Hodzic, Jasmin; Ikoma, Fumihiko; Jichlinski, Patrice; Kang, Boo-Hyon; Kiesswetter, Ernst; Krishnamurthi, Kannan; Lehmann, Marie-Louise; Martinova, Irina; Mittal, Rama Devi; Ravichandran, Beerappa; Romics, Imre; Roy, Bidyut; Rungkat-Zakaria, Fransiska; Rydzynski, Konrad; Scutaru, Cristian; Shen, Jianhua; Soufi, Maria; Toguzbaeva, Karlygash; Vu Duc, Trinh; Widera, Agata; Wishahi, Mohamed; Hengstler, Jan G

    2012-06-01

    There is a considerable discrepancy between the number of identified occupational-related bladder cancer cases and the estimated numbers particularly in emerging nations or less developed countries where suitable approaches are less or even not known. Thus, within a project of the World Health Organisation Collaborating Centres in Occupational Health, a questionnaire of the Dortmund group, applied in different studies, was translated into more than 30 languages (Afrikaans, Arabic, Bengali, Chinese, Czech, Dutch, English, Finnish, French, Georgian, German, Greek, Hindi, Hungarian, Indonesian, Italian, Japanese, Kannada, Kazakh, Kirghiz, Korean, Latvian, Malay, Persian (Farsi), Polish, Portuguese, Portuguese/Brazilian, Romanian, Russian, Serbo-Croatian, Slovak, Spanish, Spanish/Mexican, Tamil, Telugu, Thai, Turkish, Urdu, Vietnamese). The bipartite questionnaire asks for relevant medical information in the physician's part and for the occupational history since leaving school in the patient's part. Furthermore, this questionnaire is asking for intensity and frequency of certain occupational and non-occupational risk factors. The literature regarding occupations like painter, hairdresser or miner and exposures like carcinogenic aromatic amines, azo dyes, or combustion products is highlighted. The questionnaire is available on www.ifado.de/BladderCancerDoc.

  13. Testicular obstruction: clinicopathological studies.

    PubMed Central

    Hendry, W. F.; Levison, D. A.; Parkinson, M. C.; Parslow, J. M.; Royle, M. G.

    1990-01-01

    Genital tract reconstruction has been attempted in subfertile men with obstructive azoospermia (370 patients) or unilateral testicular obstruction (80 patients), and in vasectomised men undergoing reversal for the first (130 patients) or subsequent (32 patients) time. Histopathological changes in the obstructed testes and epididymes, and immunological responses to the sequestered spermatozoa have been studied to gain insight into possible causes of failure of surgical treatment. The results of surgery have been assessed by follow-up sperm counts and occurrence of pregnancies in the female partners. The best results were obtained with vasectomy reversal (patency 90%, pregnancy 45%), even after failed previous attempts (patency 87%, pregnancy 37%). Epididymovasostomy gave good results with postinfective caudal blocks (patency 52%, pregnancy 38%), while postinfective vasal blocks were better corrected by total anatomical reconstruction (patency 73%, pregnancy 27%) than by transvasovasostomy (patency 9%, no pregnancies). Poor results were obtained with capital blocks (patency 12%, pregnancy 3%), in which substantial lipid accumulation was demonstrated in the ductuli efferentes; three-quarters of these patients had sinusitis, bronchitis or bronchiectasis (Young's syndrome). There is circumstantial evidence to suggest that this syndrome may be a late complication of mercury intoxication in childhood. After successful reconstruction, fertility was relatively reduced in those men who had antibodies to spermatozoa, particularly amongst the postinfective cases. Similarly, impaired fertility was found in men with unilateral testicular obstruction and antibodies to spermatozoa. Mononuclear cell infiltration of seminiferous tubules and rete testis was noted occasionally, supporting a diagnosis of autoimmune orchitis; although rare, this was an important observation as the sperm output became normal with adjuvant prednisolone therapy. Images Figure 4 Figure 6 Figure 7 Figure 10

  14. Clinical Impact of Overactive Bladder

    PubMed Central

    Nitti, Victor W

    2002-01-01

    Overactive bladder (OAB) is a medical condition with the symptoms of urinary frequency and urgency, with or without urge incontinence. Traditionally, epidemiologic studies have focused on the symptom of incontinence, and therefore the prevalence and clinical impact have been grossly underestimated. Recently, several population-based studies have been conducted that have provided insight into the true magnitude of OAB. This article will review the latest data on the prevalence of OAB and discuss the impact of the condition on quality of life. Furthermore, it will examine some of the comorbidities associated with OAB and look at the potential economic impact of OAB. PMID:16986018

  15. Spectroscopic Imaging of Bladder Cancer

    SciTech Connect

    Demos, S G; Gandour-Edwards, R; Ramsamooj, R; deVere White, R

    2003-01-01

    The feasibility of developing bladder cancer detection methods using intrinsic tissue optical properties is the focus of this investigation. In vitro experiments have been performed using polarized elastic light scattering in combination with tissue autofluorescence in the NIR spectral region under laser excitation in the green and red spectral regions. The experimental results obtained from a set of tissue specimens from 25 patients reveal the presence of optical fingerprint characteristics suitable for cancer detection with high contrast and accuracy. These photonic methods are compatible with existing endoscopic imaging modalities which make them suitable for in-vivo application.

  16. Regulation of Breathing and Autonomic Outflows by Chemoreceptors

    PubMed Central

    Guyenet, Patrice G.

    2016-01-01

    Lung ventilation fluctuates widely with behavior but arterial PCO2 remains stable. Under normal conditions, the chemoreflexes contribute to PaCO2 stability by producing small corrective cardiorespiratory adjustments mediated by lower brainstem circuits. Carotid body (CB) information reaches the respiratory pattern generator (RPG) via nucleus solitarius (NTS) glutamatergic neurons which also target rostral ventrolateral medulla (RVLM) presympathetic neurons thereby raising sympathetic nerve activity (SNA). Chemoreceptors also regulate presympathetic neurons and cardiovagal preganglionic neurons indirectly via inputs from the RPG. Secondary effects of chemoreceptors on the autonomic outflows result from changes in lung stretch afferent and baroreceptor activity. Central respiratory chemosensitivity is caused by direct effects of acid on neurons and indirect effects of CO2 via astrocytes. Central respiratory chemoreceptors are not definitively identified but the retrotrapezoid nucleus (RTN) is a particularly strong candidate. The absence of RTN likely causes severe central apneas in congenital central hypoventilation syndrome. Like other stressors, intense chemosensory stimuli produce arousal and activate circuits that are wake- or attention-promoting. Such pathways (e.g., locus coeruleus, raphe, and orexin system) modulate the chemoreflexes in a state-dependent manner and their activation by strong chemosensory stimuli intensifies these reflexes. In essential hypertension, obstructive sleep apnea and congestive heart failure, chronically elevated CB afferent activity contributes to raising SNA but breathing is unchanged or becomes periodic (severe CHF). Extreme CNS hypoxia produces a stereotyped cardiorespiratory response (gasping, increased SNA). The effects of these various pathologies on brainstem cardiorespiratory networks are discussed, special consideration being given to the interactions between central and peripheral chemoreflexes. PMID:25428853

  17. Hepatic venous outflow obstruction in pediatric liver transplantation: technical considerations in prevention, diagnosis, and management.

    PubMed

    Sommovilla, J; Doyle, M M; Vachharajani, N; Saad, N; Nadler, M; Turmelle, Y P; Weymann, A; Chapman, W C; Lowell, J A

    2014-08-01

    HVOO creates significant diagnostic and management dilemmas in pediatric liver transplant recipients, particularly with TVGs (split or reduced-size grafts). Numerous technical variations for the hepatic vein to IVC anastomosis have been described to minimize the incidence of this complication, but no consensus for an optimal anastomotic technique exists. One hundred and thirty-four liver transplants (70 TVGs) were performed in 124 patients between 1994 and 2011. These were divided into two cohorts. Group 1 (95 transplants, 41 TVGs) utilized a continuous running anastomosis. Group 2 (39 transplants, 29 TVGs) implemented a triangulated (three-stitch) anastomosis. All were reviewed for demographics, diagnostics, interventions, and outcome. The overall HVOO incidence was seven of 134 transplants (5.2%) and six of 70 transplants utilizing TVGs (8.6%). Group 1 incidence was five of 41 (12.2%) compared with one of 29 (3.4%; p = 0.20, OR 3.89) in Group 2. Liver Doppler was employed in all patients, and only three suggested HVOO. All patients with HVOO underwent venogram, at a median of 81 days post-transplant. All underwent percutaneous venoplasty and required 1-6 treatments, all resulting in HVOO resolution. Incidence of HVOO has improved since adopting the triangulated anastomosis, although not to a level of statistical significance. US is not adequately sensitive to exclude HVOO. Venogram is recommended in patients with prolonged ascites, and venoplasty has been highly successful in HVOO treatment. PMID:24815309

  18. Automatic bladder segmentation on CBCT for multiple plan ART of bladder cancer using a patient-specific bladder model.

    PubMed

    Chai, Xiangfei; van Herk, Marcel; Betgen, Anja; Hulshof, Maarten; Bel, Arjan

    2012-06-21

    In multiple plan adaptive radiotherapy (ART) strategies of bladder cancer, a library of plans corresponding to different bladder volumes is created based on images acquired in early treatment sessions. Subsequently, the plan for the smallest PTV safely covering the bladder on cone-beam CT (CBCT) is selected as the plan of the day. The aim of this study is to develop an automatic bladder segmentation approach suitable for CBCT scans and test its ability to select the appropriate plan from the library of plans for such an ART procedure. Twenty-three bladder cancer patients with a planning CT and on average 11.6 CBCT scans were included in our study. For each patient, all CBCT scans were matched to the planning CT on bony anatomy. Bladder contours were manually delineated for each planning CT (for model building) and CBCT (for model building and validation). The automatic segmentation method consisted of two steps. A patient-specific bladder deformation model was built from the training data set of each patient (the planning CT and the first five CBCT scans). Then, the model was applied to automatically segment bladders in the validation data of the same patient (the remaining CBCT scans). Principal component analysis (PCA) was applied to the training data to model patient-specific bladder deformation patterns. The number of PCA modes for each patient was chosen such that the bladder shapes in the training set could be represented by such number of PCA modes with less than 0.1 cm mean residual error. The automatic segmentation started from the bladder shape of a reference CBCT, which was adjusted by changing the weight of each PCA mode. As a result, the segmentation contour was deformed consistently with the training set to fit the bladder in the validation image. A cost function was defined by the absolute difference between the directional gradient field of reference CBCT sampled on the corresponding bladder contour and the directional gradient field of validation

  19. Automatic bladder segmentation on CBCT for multiple plan ART of bladder cancer using a patient-specific bladder model

    NASA Astrophysics Data System (ADS)

    Chai, Xiangfei; van Herk, Marcel; Betgen, Anja; Hulshof, Maarten; Bel, Arjan

    2012-06-01

    In multiple plan adaptive radiotherapy (ART) strategies of bladder cancer, a library of plans corresponding to different bladder volumes is created based on images acquired in early treatment sessions. Subsequently, the plan for the smallest PTV safely covering the bladder on cone-beam CT (CBCT) is selected as the plan of the day. The aim of this study is to develop an automatic bladder segmentation approach suitable for CBCT scans and test its ability to select the appropriate plan from the library of plans for such an ART procedure. Twenty-three bladder cancer patients with a planning CT and on average 11.6 CBCT scans were included in our study. For each patient, all CBCT scans were matched to the planning CT on bony anatomy. Bladder contours were manually delineated for each planning CT (for model building) and CBCT (for model building and validation). The automatic segmentation method consisted of two steps. A patient-specific bladder deformation model was built from the training data set of each patient (the planning CT and the first five CBCT scans). Then, the model was applied to automatically segment bladders in the validation data of the same patient (the remaining CBCT scans). Principal component analysis (PCA) was applied to the training data to model patient-specific bladder deformation patterns. The number of PCA modes for each patient was chosen such that the bladder shapes in the training set could be represented by such number of PCA modes with less than 0.1 cm mean residual error. The automatic segmentation started from the bladder shape of a reference CBCT, which was adjusted by changing the weight of each PCA mode. As a result, the segmentation contour was deformed consistently with the training set to fit the bladder in the validation image. A cost function was defined by the absolute difference between the directional gradient field of reference CBCT sampled on the corresponding bladder contour and the directional gradient field of validation

  20. The Prevalence of Gas Outflows in Type 2 AGNs. II. 3D Biconical Outflow Models

    NASA Astrophysics Data System (ADS)

    Bae, Hyun-Jin; Woo, Jong-Hak

    2016-09-01

    We present 3D models of biconical outflows combined with a thin dust plane for investigating the physical properties of the ionized gas outflows and their effect on the observed gas kinematics in type 2 active galactic nuclei (AGNs). Using a set of input parameters, we construct a number of models in 3D and calculate the spatially integrated velocity and velocity dispersion for each model. We find that three primary parameters, i.e., intrinsic velocity, bicone inclination, and the amount of dust extinction, mainly determine the simulated velocity and velocity dispersion. Velocity dispersion increases as the intrinsic velocity or the bicone inclination increases, while velocity (i.e., velocity shifts with respect to systemic velocity) increases as the amount of dust extinction increases. Simulated emission-line profiles well reproduce the observed [O iii] line profiles, e.g., narrow core and broad wing components. By comparing model grids and Monte Carlo simulations with the observed [O iii] velocity-velocity dispersion distribution of ˜39,000 type 2 AGNs, we constrain the intrinsic velocity of gas outflows ranging from ˜500 to ˜1000 km s-1 for the majority of AGNs, and up to ˜1500-2000 km s-1 for extreme cases. The Monte Carlo simulations show that the number ratio of AGNs with negative [O iii] velocity to AGNs with positive [O iii] velocity correlates with the outflow opening angle, suggesting that outflows with higher intrinsic velocity tend to have wider opening angles. These results demonstrate the potential of our 3D models for studying the physical properties of gas outflows, applicable to various observations, including spatially integrated and resolved gas kinematics.

  1. The Prevalence of Gas Outflows in Type 2 AGNs. II. 3D Biconical Outflow Models

    NASA Astrophysics Data System (ADS)

    Bae, Hyun-Jin; Woo, Jong-Hak

    2016-09-01

    We present 3D models of biconical outflows combined with a thin dust plane for investigating the physical properties of the ionized gas outflows and their effect on the observed gas kinematics in type 2 active galactic nuclei (AGNs). Using a set of input parameters, we construct a number of models in 3D and calculate the spatially integrated velocity and velocity dispersion for each model. We find that three primary parameters, i.e., intrinsic velocity, bicone inclination, and the amount of dust extinction, mainly determine the simulated velocity and velocity dispersion. Velocity dispersion increases as the intrinsic velocity or the bicone inclination increases, while velocity (i.e., velocity shifts with respect to systemic velocity) increases as the amount of dust extinction increases. Simulated emission-line profiles well reproduce the observed [O iii] line profiles, e.g., narrow core and broad wing components. By comparing model grids and Monte Carlo simulations with the observed [O iii] velocity–velocity dispersion distribution of ∼39,000 type 2 AGNs, we constrain the intrinsic velocity of gas outflows ranging from ∼500 to ∼1000 km s‑1 for the majority of AGNs, and up to ∼1500–2000 km s‑1 for extreme cases. The Monte Carlo simulations show that the number ratio of AGNs with negative [O iii] velocity to AGNs with positive [O iii] velocity correlates with the outflow opening angle, suggesting that outflows with higher intrinsic velocity tend to have wider opening angles. These results demonstrate the potential of our 3D models for studying the physical properties of gas outflows, applicable to various observations, including spatially integrated and resolved gas kinematics.

  2. Mass Outflow in the Narrow Line Region of Markarian 573

    NASA Astrophysics Data System (ADS)

    Revalski, Mitchell; Crenshaw, D. Michael; Fischer, Travis C.; Kraemer, Steven B.; Schmitt, Henrique R.

    2016-01-01

    We present our progress toward determining the mass outflow rate in the narrow emission line region (NLR) of the Seyfert 2 galaxy Markarian 573. Mass outflows in Active Galactic Nuclei (AGN) drive gas away from the central supermassive black hole (SMBH) into the circumnuclear environment, and may play an important role in regulating the growth of the SMBH, and its coevolution with the host galaxy bulge. Recent work by Crenshaw et al. (2015, ApJ, 799, 83) found that the mass outflow rate in the NLR of NGC 4151 is too large for the outflowing mass to have originated only from the central region, indicating a significant amount of gas is picked up by the outflow as it travels away from the nucleus. Using archival spectra taken with the Hubble Space Telescope (HST) Space Telescope Imaging Spectrograph (STIS), we are working to determine the mass outflow rates in a sample of 10 Seyfert galaxies to determine if correlations exist between their outflows and other properties including galaxy luminosity. To accomplish this, we will analyze the emission line spectra using photoionization models to determine the mass of the outflowing gas. Combining this information with previous kinematic modeling from Fischer et al. (2013, ApJS, 209, 1), we can determine the mass outflow rates and kinetic luminosities as a function of radius from the nucleus. These quantities will provide a direct comparison between observation and theoretical feedback models, allowing us to determine the significance of these outflows in regulating AGN feedback.

  3. Phytobezoar leading to gastric outlet obstruction in a patient with diabetes

    PubMed Central

    Dhakal, Om Prakash; Dhakal, Mona; Bhandari, Dhurba

    2014-01-01

    Gastroparesis is a condition which results in delayed gastric emptying without gastric outflow tract obstruction. Gastrointestinal involvement in diabetes can present in various forms such as oesophageal dysmotility, gastro-oesophageal reflux disease, gastroparesis, enteropathy, non-alcoholic fatty liver disease and glycogenic hepatopathy. Gastroparesis is the most common gastric motility disorder complicating long-standing diabetes. It can sometimes lead to mechanical obstruction as a result of formation of bezoars. Phytobezoars are the most common type of bezoar and are composed of indigestible food, vegetable fibre or seeds. Poor pyloric function and decreased acid formation predisposes phytobezoars formation in patients with diabetic gastroparesis. An 80-year-old patient with diabetes in our presentation developed gastric outlet obstruction due to impaction of phytobezoar over the pylorus. PMID:24928925

  4. Staphylococcus hominis native mitral valve bacterial endocarditis (SBE) in a patient with hypertrophic obstructive cardiomyopathy.

    PubMed

    Cunha, Burke A; Esrick, Michael D; Larusso, Melissa

    2007-01-01

    There are several species of coagulase-negative Staphylococci (CoNS) that are part of the normal skin flora and are relatively noninvasive/low virulence organisms. CoNS are important pathogens in patients with prosthetic devices and are the most common pathogen associated with prosthetic valve endocarditis. CoNS native valve infective endocarditis (IE) is rare. Patients with hypertrophic obstructive cardiomyopathy and an outflow pressure gradient greater than 30 mm Hg are predisposed to IE. There has been only one reported case of non-mitral valve IE due to CoNS in a patient with hypertrophic obstructive cardiomyopathy. To the best of our knowledge, we report the first case of Staphylococcal hominis mitral valve endocarditis in a patient with hypertrophic obstructive cardiomyopathy.

  5. Gall Bladder and Extrahepatic Bile Duct Lymphomas: Clinicopathological observations and biological implications

    PubMed Central

    Mani, Haresh; Climent, Fina; Colomo, Lluís; Pittaluga, Stefania; Raffeld, Mark; Jaffe, Elaine S.

    2010-01-01

    Lymphomas of the gall bladder and extrahepatic bile ducts are exceedingly rare. We present the clinicopathological features of 19 cases from our files; 14 patients had primary lymphoma (13 involving gall bladder and one involving common hepatic duct), while five had systemic lymphoma on further work-up. Most patients presented with symptoms mimicking cholecystitis. The most common primary lymphoma types were diffuse large B-cell lymphoma (DLBCL), extranodal marginal zone lymphoma (EMZL), B-lymphoblastic lymphoma (B-LBL) and follicular lymphoma (FL). Two cases had features of lymphomatous polyposis, one a case of FL and the second a case of mantle cell lymphoma (MCL), with disease limited to the mantle zones, so-called in situ MCL. Other rare lymphoma subtypes not previously described in this site included the extracavitary variant of primary effusion lymphoma (PEL) and plasmablastic lymphoma (PBL). Patients with DLBCL and EMZL were older (mean age 75.8 years) than those with other subtypes (mean age 47 years) and more likely to have gallstones (60% vs. 12.5%). A comprehensive literature review revealed 36 primary gall bladder and 16 primary extrahepatic bile duct lymphomas. When compared to primary gall bladder lymphomas, those involving the extrahepatic bile ducts present at a younger age (47 years vs. 63 years) usually with obstructive jaundice, and are less often associated with gallstones (17% vs. 50%) or regional lymph node involvement (6% vs. 31%). In conclusion, primary lymphomas of the gall bladder and extrahepatic bile ducts show a broad spectrum of disease types, but in many respects mirror the spectrum of primary lymphomas of the gastrointestinal tract. PMID:20679881

  6. Histotripsy Effects on the Bladder Trigone: Functional and Histologic Consequences in the Canine Model

    PubMed Central

    Allam, Christopher L.; Wilkinson, J. Erby; Cheng, Xu; Ives, Kimberly A.; Hall, Timothy L.; Roberts, William W.

    2013-01-01

    Abstract Background Histotripsy is an extracorporeal therapeutic ultrasound (US) technology, where high-amplitude acoustic energy is applied to targeted tissue. Previous research has demonstrated the feasibility, safety, and effectiveness of histotripsy tissue homogenization and debulking of the prostate in the canine model. Before translating this technology for human use, it is prudent to examine the susceptibility of critical periprostatic structures to cavitation injury in the event of histotripsy mistargeting. In this study, we sought to characterize the tissue effects and biologic response of directly treating the bladder trigone with histotripsy. Materials and Methods In eight anesthetized canines, 750,000 histotripsy pulses were applied uniformly across a 2×1.5-cm area encompassing the bladder trigone and ureteral orifices. Prostate and bladder trigone were harvested immediately after treatment (2 subjects) or at 14 days (6 subjects). Flexible cystourethroscopy, US imaging, and creatinine levels were obtained at intervals until harvest, 14 days after treatment. In one control subject, harvested at 2 days, the same treatment algorithm was applied to the prostate. Results Transrectal US imaging revealed a cavitation bubble cloud on the surface of the bladder trigone and progressive development of tissue edema during treatment. Flexible cystourethroscopy immediately after treatment confirmed edema and erythema of the trigone. In the six subjects survived 2 weeks after treatment, one incidence of transient, self-limited ureteral obstruction was noted based on hydronephrosis and creatinine levels. At harvest, ureteral orifices were confirmed patent by passage of a guide wire. Histologic evaluation revealed hemorrhage acutely with mild localized fibrosis at 14 days. Conclusions In this study, designed along the lines of a worst-case, destructive testing scenario, direct targeting of the bladder trigone with supratherapeutic histotripsy failed to induce

  7. Effect of hydrogen peroxide on contractility and citrate synthase activity of the rabbit urinary bladder in the presence and absence of resveratrol and a whole-grape suspension.

    PubMed

    Francis, Johdi-Ann; Leggett, Robert E; Schuler, Catherine; Levin, Robert M

    2014-06-01

    One etiology related directly to obstructive urinary bladder dysfunction is ischemia/reperfusion resulting in significant oxidative stress to the bladder. Grapes, a natural source of antioxidants, have been proven effective in preventing obstructive and ischemic bladder dysfunction. Many investigators believe that resveratrol is the primary active antioxidant ingredient in grapes. We compared the ability of a whole-grape suspension with pure resveratrol in their ability to protect the bladder from in vitro oxidative stress mediated by hydrogen peroxide (H2O2). Four male rabbit bladders were used. Two strips from each bladder were incubated in the presence of 1 mg/mL grape suspension for 30 min, another two strips were incubated in the presence of 1 mg/mL resveratrol solution, and the last two strips were incubated in the presence of 1 mg/mL sucrose/and fructose as controls. The rest of the bladder was separated into muscle and mucosa, frozen and stored for biochemical evaluation. (1) Chemically, resveratrol has about 20 times the antioxidant capacity of the grape suspension. (2) The grape suspension had significant protective effects when the rate of tension was quantitated at all concentrations of H2O2, while the resveratrol had no effect. (3) Citrate synthase activities of the muscle and mucosa were significantly protected by the grape suspension but not by resveratrol. These data demonstrate that the grape suspension protects the mitochondria to a significantly greater degree than resveratrol, which suggests that the antioxidant activities are due to the combination of active components found in the grape suspension and not just resveratrol.

  8. [Mitral Valve Replacement with a Low-Profile Bioprosthesis in Combination with Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy;Report of a Case].

    PubMed

    Furukawa, Koji; Sakaguchi, Shuhei; Nakamura, Eisaku; Yano, Mitsuhiro

    2015-06-01

    An 83-year-old woman diagnosed with hypertrophic obstructive cardiomyopathy was referred to our hospital. Her echocardiogram revealed diffuse left ventricular hypertrophy, severe mitral valve regurgitation with systolic anterior motion of the mitral valve, and left ventricular obstruction with a peak outflow gradient of 142 mmHg. Cardiac catheterization revealed a peak pressure gradient of 60 mmHg across the left ventricular outflow tract. Because of the patient's advanced age, as well as uncertainty regarding our ability to resolve her mitral regurgitation, we performed mitral valve replacement with a St. Jude Medical Epic porcine low-profile bioprosthesis in combination with septal myectomy. The patient's postoperative course was uneventful. At 1 year after the operation, her functional status was New York Heart Association class I. The echocardiogram showed the peak outflow gradient markedly decreased to 9 mmHg. PMID:26066877

  9. Evidence for Collimated Outflow from Sgr A*?

    NASA Astrophysics Data System (ADS)

    Yusef-Zadeh, Farhad; Arendt, R.; Bushouse, H.; Cotton, W.; Haggard, D.; Heinke, C.; Roberts, D. A.; Royster, M.; Wardle, M.

    2012-05-01

    The compact radio source Sgr A* is considered to be coincident with a 4 million solar mass black hole at the dynamical center of the Galaxy. There has been a considerable debate as to whether the jet or the accretion flow model can explain the broad band spectrum of the emission. Here, we present high resolution radio, X-ray continuum and FeII line images showing new structural details within the inner arcminute (2.4pc) of Sgr A*. On a small scale, we find a chain of radio blobs which appear to be emanating from Sgr A*. These blobs are detected beyond the inner 1" of Sgr A* and are distributed along a continuous linear feature that is tilted by 28 degrees with respect to the Galactic plane. In linear polarization images at 3.6cm, three blobs of emission have been detected symmetrically about 1' from Sgr A*. The morphology and polarization of the linear feature suggest a jet outflow from Sgr A*, punching through the orbiting ionized gas and producing X-ray emission as well as a hot bubble of FeIII/FeII line emission. On a scale of about 15pc, we also note a collection of large-scale radio and X-ray "streamers" in the direction perpendicular to the Galactic plane. This complex structure consists of nonthermal and thermal continuum features as well as molecular clouds traced at infrared wavelengths. The base of the outflowing gas appears to be confined by the 2-pc molecular ring, within which a cluster of massive stars lie. These features suggest star-burst driven outflow may be responsible for this energetic activity.

  10. Functional Anatomy of the Outflow Facilities.

    PubMed

    Pizzirani, Stefano; Gong, Haiyan

    2015-11-01

    In order to understand the pathophysiology, select optimal therapeutic options for patients and provide clients with honest expectations for cases of canine glaucoma, clinicians should be familiar with a rational understanding of the functional anatomy of the ocular structures involved in this group of diseases. The topographical extension and the structural and humoral complexity of the regions involved with the production and the outflow of aqueous humor undergo numerous changes with aging and disease. Therefore, the anatomy relative to the fluid dynamics of aqueous has become a pivotal yet flexible concept to interpret the different phenotypes of glaucoma.

  11. Valles Marineris and Chryse Outflow Channels

    NASA Technical Reports Server (NTRS)

    1997-01-01

    A color image of Valles Marineris, the great canyon and the south Chryse basin-Valles Marineris outflow channels of Mars; north toward top. The scene shows the entire Valles Marineris canyon system, over 3,000 km long and averaging 8 km deep, extending from Noctis Labyrinthus, the arcuate system of graben to the west, to the chaotic terrain to the east and related outflow canyons that drain toward the Chryse basin. Eos and Capri Chasmata (south to north) are two canyons connected to Valles Marineris. Ganges Chasma lies directly north. The chaos in the southeast part of the image gives rise to several outflow channels, Shalbatana, Simud, Tiu, and Ares Valles (left to right), that drained north into the Chryse basin. The mouth of Ares Valles is the site of the Mars Pathfinder lander.

    This image is a composite of Viking medium-resolution images in black and white and low-resolution images in color; Mercator projection. The image roughly extends from latitude 20 degrees S. to 20 degrees N. and from longitude 15 degrees to 102.5 degrees.

    The connected chasma or valleys of Valles Marineris may have formed from a combination of erosional collapse and structural activity. Layers of material in the eastern canyons might consist of carbonates deposited in ancient lakes, eolian deposits, or volcanic materials. Huge ancient river channels began from Valles Marineris and from adjacent canyons and ran north. Many of the channels flowed north into Chryse Basin.

    The south Chryse outflow channels are cut an average of 1 km into the cratered highland terrain. This terrain is about 9 km above datum near Valles Marineris and steadily decreases in elevation to 1 km below datum in the Chryse basin. Shalbatana is relatively narrow (10 km wide) but can reach 3 km in depth. The channel begins at a 2- to 3-km-deep circular depression within a large impact crater, whose floor is partly covered by chaotic material, and ends in Simud Valles. Tiu and Simud Valles consist of a

  12. ATOMIC HYDROGEN IN A GALACTIC CENTER OUTFLOW

    SciTech Connect

    McClure-Griffiths, N. M.; Green, J. A.; Hill, A. S.; Lockman, F. J.; Dickey, J. M.; Gaensler, B. M.; Green, A. J.

    2013-06-10

    We describe a population of small, high-velocity, atomic hydrogen clouds, loops, and filaments found above and below the disk near the Galactic center. The objects have a mean radius of 15 pc, velocity widths of {approx}14 km s{sup -1}, and are observed at |z| heights up to 700 pc. The velocity distribution of the clouds shows no signature of Galactic rotation. We propose a scenario where the clouds are associated with an outflow from a central star-forming region at the Galactic center. We discuss the clouds as entrained material traveling at {approx}200 km s{sup -1} in a Galactic wind.

  13. Feedback Mechanisms of Starbursts and AGNs through Molecular Outflows

    NASA Astrophysics Data System (ADS)

    Matsushita, S.; Krips, M.; Lim, J.; Muller, S.; Tsai, A.-L.

    2013-10-01

    Our deep molecular line images of nearby starburst galaxies and AGNs exhibit molecular outflows in most galaxies, and have revealed that the molecular outflows co-exist with outflows or jets seen in other wavelengths. In case of starbursts, X-ray outflows have higher energy and pressure than those of molecular outflows, suggesting that plasma outflows are blowing the molecular gas away from starburst regions, which suggests a strong negative feedback. On the other hand, current starburst regions in M82 can be seen at the inner edge of an expanding molecular bubble, suggesting a positive feedback. In case of AGNs, jets seem to entrain the surrounding molecular gas away from the AGNs, suggesting a negative feedback.

  14. A resolved outflow of matter from a brown dwarf.

    PubMed

    Whelan, Emma T; Ray, Thomas P; Bacciotti, Francesca; Natta, Antonella; Testi, Leonardo; Randich, Sofia

    2005-06-01

    The birth of stars involves not only accretion but also, counter-intuitively, the expulsion of matter in the form of highly supersonic outflows. Although this phenomenon has been seen in young stars, a fundamental question is whether it also occurs among newborn brown dwarfs: these are the so-called 'failed stars', with masses between stars and planets, that never manage to reach temperatures high enough for normal hydrogen fusion to occur. Recently, evidence for accretion in young brown dwarfs has mounted, and their spectra show lines that are suggestive of outflows. Here we report spectro-astrometric data that spatially resolve an outflow from a brown dwarf. The outflow's characteristics appear similar to, but on a smaller scale than, outflows from normal young stars. This result suggests that the outflow mechanism is universal, and perhaps relevant even to the formation of planets.

  15. Neurogenic bladder in spinal cord injury patients

    PubMed Central

    Taweel, Waleed Al; Seyam, Raouf

    2015-01-01

    Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury. PMID:26090342

  16. Airflow obstruction and mining

    SciTech Connect

    Stenton, S.C.; Hendrick, D.J. )

    1993-01-01

    Bronchitis and emphysema have long been described as diseases of miners, but the precise contribution of occupational exposures to coal and other mine dusts in causing these disorders, as opposed to cofactors such as social class, environmental pollution, and cigarette smoking, has not been fully defined. Epidemiologic studies have attempted, with varying degrees of success, to determine the incidence and severity of chronic obstructive pulmonary diseases in miners as compared to the general population. The results from these studies, and those in other nonmining industries with dust exposures, are examined. 98 refs.

  17. [Classification and natural history of bladder tumors].

    PubMed

    Allory, Yves

    2014-12-01

    Urinary bladder tumors are mainly of urothelial type. Classifications include stage and grade to provide with the required prognostic factors and help to select the most adequate treatment. Though somatic mutations in bladder tumors are known, their used for targeted therapy are restricted to clinical trials. Upper urinary tract tumors are classified as urinary bladder tumor at histological level, but tumor staging is specified according to calyx, renal pelvis or ureter location; in young patients with upper urinary tract tumor, a Lynch syndrome should be eliminated. PMID:25668829

  18. Bladder exstrophy: current management and postoperative imaging.

    PubMed

    Pierre, Ketsia; Borer, Joseph; Phelps, Andrew; Chow, Jeanne S

    2014-07-01

    Bladder exstrophy is a rare malformation characterized by an infra-umbilical abdominal wall defect, incomplete closure of the bladder with mucosa continuous with the abdominal wall, epispadias, and alterations in the pelvic bones and muscles. It is part of the exstrophy-epispadias complex, with cloacal exstrophy on the severe and epispadias on the mild ends of the spectrum. Bladder exstrophy is the most common of these entities and is more common in boys. The goal of this paper is to describe common methods of repair and to provide an imaging review of the postoperative appearances. PMID:24939762

  19. Inflammatory pseudotumor of the urinary bladder.

    PubMed

    Rosado, Elsa; Pereira, José; Corbusier, Florence; Demeter, Pieter; Bali, Maria Antonietta

    2015-01-01

    We report a case of an inflammatory pseudotumor of the urinary bladder in a 31 year-old woman. She presented at the emergency room with low abdominal pain and urinary symptoms. Abdominal ultrasound, computed tomography and magnetic resonance imaging were performed and revealed asymmetric thickening of the urinary bladder wall. Cystoscopy with urinary cytology revealed a benign nature of the process. The patient underwent partial cystectomy and the pathologic examination of the specimen revealed an inflammatory pseudotumor. We reviewed the clinical, imaging and pathological features of the inflammatory pseudotumor of the urinary bladder and discussed its differential diagnosis.

  20. Inflammatory Pseudotumor of the Urinary Bladder

    PubMed Central

    Rosado, Elsa; Pereira, José; Corbusier, Florence; Demeter, Pieter; Bali, Maria Antonietta

    2015-01-01

    We report a case of an inflammatory pseudotumor of the urinary bladder in a 31 year-old woman. She presented at the emergency room with low abdominal pain and urinary symptoms. Abdominal ultrasound, computed tomography and magnetic resonance imaging were performed and revealed asymmetric thickening of the urinary bladder wall. Cystoscopy with urinary cytology revealed a benign nature of the process. The patient underwent partial cystectomy and the pathologic examination of the specimen revealed an inflammatory pseudotumor. We reviewed the clinical, imaging and pathological features of the inflammatory pseudotumor of the urinary bladder and discussed its differential diagnosis. PMID:25926919

  1. Bladder reconstruction: The past, present and future

    PubMed Central

    EL-TAJI, OMAR M.S.; KHATTAK, ALTAF Q.; HUSSAIN, SYED A.

    2015-01-01

    Ileal conduit urinary diversion is the gold standard treatment for urinary tract reconstruction following cystectomy. This procedure uses gastrointestinal segments for bladder augmentation, a technique that is often associated with significant complications. The substantial progression in the fields of tissue engineering and regenerative medicine over the previous two decades has resulted in the development of techniques that may lead to the construction of functional de novo urinary bladder substitutes. The present review identifies and discusses the complications associated with current treatment options post-cystectomy. The current techniques, achievements and perspectives of the use of biomaterials and stem cells in the field of urinary bladder reconstruction are also reviewed. PMID:26170968

  2. TRACING THE BIPOLAR OUTFLOW FROM ORION SOURCE I

    SciTech Connect

    Plambeck, R. L.; Wright, M. C. H.; Friedel, D. N.; Widicus Weaver, S. L.; Bolatto, A. D.; Pound, M. W.; Woody, D. P.; Lamb, J. W.; Scott, S. L.

    2009-10-10

    Using CARMA, we imaged the 87 GHz SiO v = 0 J = 2-1 line toward Orion-KL with 0.''45 angular resolution. The maps indicate that radio source I drives a bipolar outflow into the surrounding molecular cloud along a NE-SW axis, in agreement with the model of Greenhill et al. The extended high-velocity outflow from Orion-KL appears to be a continuation of this compact outflow. High-velocity gas extends farthest along a NW-SE axis, suggesting that the outflow direction changes on timescales of a few hundred years.

  3. Endogenous Bioactive Lipids and the Regulation of Conventional Outflow Facility

    PubMed Central

    Wan, Zhou; Woodward, David F.; Stamer, W. Daniel

    2009-01-01

    Summary Perturbation of paracrine signaling within the human conventional outflow pathway influences tissue homeostasis and outflow function. For example, exogenous introduction of the bioactive lipids, sphingosine-1-phosphate, anandamide or prostaglandin F2α, to conventional outflow tissues alters the rate of drainage of aqueous humor through the trabecular meshwork, and into Schlemm’s canal. This review summarizes recent data that characterizes endogenous bioactive lipids, their receptors and associated signaling partners in the conventional outflow tract. We also discuss the potential of targeting such signaling pathways as a strategy for the development of therapeutics to treat ocular hypertension and glaucoma. PMID:19381354

  4. Suppression of galactic outflows by cosmological infall and circumgalactic medium

    NASA Astrophysics Data System (ADS)

    Singh, Priyanka; Rana, Sandeep; Bagla, Jasjeet S.; Nath, Biman B.

    2016-06-01

    We investigate the relative importance of two galactic outflow suppression mechanisms: (a) cosmological infall of the intergalactic gas on to the galaxy, and (b) the existence of a hot circumgalactic medium (CGM). Considering only radial motion, the infall reduces the speed of outflowing gas and even halts the outflow, depending on the mass and redshift of the galaxy. For star-forming galaxies, there exists an upper mass limit beyond which outflows are suppressed by the gravitational field of the galaxy. We find that infall can reduce this upper mass limit approximately by a factor of 2 (independent of the redshift). Massive galaxies (≳1012 M⊙) host large reservoir of hot, diffuse CGM around the central part of the galaxy. The CGM acts as a barrier between the infalling and outflowing gas and provides an additional source of outflow suppression. We find that at low redshifts (z ≲ 3.5), the CGM is more effective than the infall in suppressing the outflows. Together, these two processes give a mass range in which galaxies are unable to have effective outflows. We also discuss the impact of outflow suppression on the enrichment history of the galaxy and its environment.

  5. ALMA OBSERVATIONS OF THE HH 46/47 MOLECULAR OUTFLOW

    SciTech Connect

    Arce, Hector G.; Mardones, Diego; Garay, Guido; Corder, Stuartt A.; Noriega-Crespo, Alberto; Raga, Alejandro C.

    2013-09-01

    The morphology, kinematics, and entrainment mechanism of the HH 46/47 molecular outflow were studied using new ALMA Cycle 0 observations. Results show that the blue and red lobes are strikingly different. We argue that these differences are partly due to contrasting ambient densities that result in different wind components having a distinct effect on the entrained gas in each lobe. A 29 point mosaic, covering the two lobes at an angular resolution of about 3'', detected outflow emission at much higher velocities than previous observations, resulting in significantly higher estimates of the outflow momentum and kinetic energy than previous studies of this source, using the CO(1-0) line. The morphology and the kinematics of the gas in the blue lobe are consistent with models of outflow entrainment by a wide-angle wind, and a simple model describes the observed structures in the position-velocity diagram and the velocity-integrated intensity maps. The red lobe exhibits a more complex structure, and there is evidence that this lobe is entrained by a wide-angle wind and a collimated episodic wind. Three major clumps along the outflow axis show velocity distribution consistent with prompt entrainment by different bow shocks formed by periodic mass ejection episodes which take place every few hundred years. Position-velocity cuts perpendicular to the outflow cavity show gradients where the velocity increases toward the outflow axis, inconsistent with outflow rotation. Additionally, we find evidence for the existence of a small outflow driven by a binary companion.

  6. Characterizing Quasar Outflows II: The Incidence of the Highest Velocity Outflows

    NASA Astrophysics Data System (ADS)

    Stark, Michele A.; Ganguly, R.; Christenson, D. H.; Richmond, J. M.; Derseweh, J. A.; Robbins, J. M.; Townsend, S. L.

    2012-05-01

    Galaxy evolution models have shown that quasars are a crucial ingredient in the evolution of massive galaxies. Outflows play a key role in the story of quasars and their host galaxies, by helping regulate the accretion process, the star-formation rate and mass of the host galaxy (i.e., feedback). The prescription for modeling outflows as a contributor to feedback requires knowledge of the outflow velocity, geometry, and column density. In particular, we need to understand how these depend on physical parameters and how much is determined stochastically (and with what distribution). For this purpose, we are examining a sample of 11000 z=1.7-2.0 quasars from the Sloan Digital Sky Survey. This redshift range permits the following from the SDSS spectra: (1) separation of objects that do and do not exhibit outflows; (2) classification/measurement of outflow properties (ionization, velocity, velocity width); and (3) measurements of UV emission line and continuum parameters. In an accompanying poster, we subjectively divide these quasars into four categories (broad absorption-line quasars, associated absorption-line quasars, reddened quasars, and unabsorbed/unreddened quasars). This subjective scheme is limited with regard to classifying narrow absorption-line systems (NALs). With single epoch, low dispersion SDSS spectra, we cannot distinguish between cosmologically intervening NALs, and intrinsic NALs that appear at large velocity offsets. In this poster, we tackle this uncertainty statistically by considering the incidence of both CIV and MgII NALs as a function of velocity, and how this distribution changes with quasar properties. We expect that absorption by intervening structures should not vary with quasar property. Other accompanying posters add photometry from rest-frame X-ray through the infrared (WISE) to complete the SED, which we utilize in these efforts. This material is based upon work supported by the National Aeronautics and Space Administration under

  7. Transparency parameters from relativistically expanding outflows

    SciTech Connect

    Bégué, D.; Iyyani, S.

    2014-09-01

    In many gamma-ray bursts a distinct blackbody spectral component is present, which is attributed to the emission from the photosphere of a relativistically expanding plasma. The properties of this component (temperature and flux) can be linked to the properties of the outflow and have been presented in the case where there is no sub-photospheric dissipation and the photosphere is in coasting phase. First, we present the derivation of the properties of the outflow for finite winds, including when the photosphere is in the accelerating phase. Second, we study the effect of localized sub-photospheric dissipation on the estimation of the parameters. Finally, we apply our results to GRB 090902B. We find that during the first epoch of this burst the photosphere is most likely to be in the accelerating phase, leading to smaller values of the Lorentz factor than the ones previously estimated. For the second epoch, we find that the photosphere is likely to be in the coasting phase.

  8. Magnetospheric and Thermospheric Influence on Ionospheric Outflow

    NASA Astrophysics Data System (ADS)

    Garcia-Sage, K.; Moore, T. E.; Mitchell, E. J.; Olson, D. K.

    2013-12-01

    The Fast Auroral SnapshoT (FAST) small explorer has been used extensively to study ionospheric outflow. Past research has used particle and field data to examine the contemporaneous transfer of electromagnetic energy and particle flow downward from the magnetosphere and upward from the ionosphere. Single event studies published by Strangeway et al. [2005] and Brambles et al. [2011, Supporting Online Material] showed that downward electromagnetic energy and particle flow into the ionosphere are correlated with the upward flow of ions out of the ionosphere. It is expected, however, that this correlation will be affected by circumstances that are unique to each specific event, including but not limited to the outflow location (cusp or nightside), preconditioning due to prior geomagnetic activity, and thermospheric neutral densities. Although knowledge of the thermospheric neutral density is usually unavailable, data from the CHAllenging Minisatellite Payload (CHAMP) is able to provide insight into thermospheric populations at altitudes of about 400 km for a few select events. We expand on the previously-mentioned studies by looking at FAST particle and field data for additional events, and we further examine the influence of thermospheric neutral populations, based on CHAMP data.

  9. IONIZED OUTFLOWS FROM COMPACT STEEP SPECTRUM SOURCES

    SciTech Connect

    Shih, Hsin-Yi; Stockton, Alan; Kewley, Lisa E-mail: stockton@ifa.hawaii.edu

    2013-08-01

    Massive outflows are known to exist, in the form of extended emission-line regions (EELRs), around about one-third of powerful FR II radio sources. We investigate the origin of these EELRs by studying the emission-line regions around compact-steep-spectrum (CSS) radio galaxies that are younger (10{sup 3}-10{sup 5} yr old) versions of the FR II radio galaxies. We have searched for and analyzed the emission-line regions around 11 CSS sources by taking integral field spectra using Gemini Multi-Object Spectrograph on Gemini North. We fit the [O III] {lambda}5007 line and present the velocity maps for each detected emission-line region. We find, in most cases, that the emission-line regions have multi-component velocity structures with different velocity dispersions and/or flux distributions for each component. The velocity gradients of the emission-line gas are mostly well aligned with the radio axis, suggesting a direct causal link between the outflowing gas and the radio jets. The complex velocity structure may be a result of different driving mechanisms related to the onset of the radio jets. We also present the results from the line-ratio diagnostics we used to analyze the ionization mechanism of the extended gas, which supports the scenario where the emission-line regions are ionized by a combination of active galactic nucleus radiation and shock excitation.

  10. [Management of metastatic bladder cancer].

    PubMed

    Gauthier, Hélène; Serrate, Camille; Pouessel, Damien; Le Maignan, Christine; Teixeira, Luis; Culine, Stéphane

    2014-12-01

    The management of patients with metastatic bladder cancer is mainly based on cytotoxic chemotherapy. The reference molecule is cisplatin. In 2014, first-line regimens include gemcitabine and cisplatin (GC protocol) or methotrexate, vinblastine, and cisplatin doxorubicin (MVAC protocol). When cisplatin is contra-indicated, another platinum Salt, carboplatin, is used in combination with gemcitabine. Vinflunine is the only molecule to have obtained a marketing approval for patients who failed first-line chemotherapy including a platinum salt. The overall prognosis of patients remains dismal, since the median overall survival is 12 to 14 months for patients being treated with cisplatin, whereas it is less than 1 year for patients receiving carboplatin. The identification of new effective drugs is a major challenge for the coming years. PMID:25668832

  11. Differentiating bladder carcinoma from bladder wall using 3D textural features: an initial study

    NASA Astrophysics Data System (ADS)

    Xu, Xiaopan; Zhang, Xi; Liu, Yang; Tian, Qiang; Zhang, Guopeng; Lu, Hongbing

    2016-03-01

    Differentiating bladder tumors from wall tissues is of critical importance for the detection of invasion depth and cancer staging. The textural features embedded in bladder images have demonstrated their potentials in carcinomas detection and classification. The purpose of this study was to investigate the feasibility of differentiating bladder carcinoma from bladder wall using three-dimensional (3D) textural features extracted from MR bladder images. The widely used 2D Tamura features were firstly wholly extended to 3D, and then different types of 3D textural features including 3D features derived from gray level co-occurrence matrices (GLCM) and grey level-gradient co-occurrence matrix (GLGCM), as well as 3D Tamura features, were extracted from 23 volumes of interest (VOIs) of bladder tumors and 23 VOIs of patients' bladder wall. Statistical results show that 30 out of 47 features are significantly different between cancer tissues and wall tissues. Using these features with significant differences between these two types of tissues, classification performance with a supported vector machine (SVM) classifier demonstrates that the combination of three types of selected 3D features outperform that of using only one type of features. All the observations demonstrate that significant textural differences exist between carcinomatous tissues and bladder wall, and 3D textural analysis may be an effective way for noninvasive staging of bladder cancer.

  12. Bladder filling variation during radiation treatment of prostate cancer: Can the use of a bladder ultrasound scanner and biofeedback optimize bladder filling?

    SciTech Connect

    Stam, Marcel R. . E-mail: m.stam@rther.umcn.nl; Lin, Emile N.J. Th. van; Vight, Lisette P. van der; Kaanders, Johannes; Visser, Andries G.

    2006-06-01

    Purpose: To investigate the use of a bladder ultrasound scanner in achieving a better reproducible bladder filling during irradiation of pelvic tumors, specifically prostate cancer. Methods and Materials: First, the accuracy of the bladder ultrasound scanner relative to computed tomography was validated in a group of 26 patients. Next, daily bladder volume variation was evaluated in a group of 18 patients. Another 16 patients participated in a biofeedback protocol, aiming at a more constant bladder volume. The last objective was to study correlations between prostate motion and bladder filling, by using electronic portal imaging device data on implanted gold markers. Results: A strong correlation between bladder scanner volume and computed tomography volume (r = 0.95) was found. Daily bladder volume variation was very high (1 Sd = 47.2%). Bladder filling and daily variation did not significantly differ between the control and the feedback group (47.2% and 40.1%, respectively). Furthermore, no linear correlations between bladder volume variation and prostate motion were found. Conclusions: This study shows large variations in daily bladder volume. The use of a biofeedback protocol yields little reduction in bladder volume variation. Even so, the bladder scanner is an easy to use and accurate tool to register these variations.

  13. Adult Obstructive Sleep Apnea*

    PubMed Central

    Patil, Susheel P.; Schneider, Hartmut; Schwartz, Alan R.; Smith, Philip L.

    2010-01-01

    Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent episodes of upper airway obstruction that result in recurrent arousals and episodic oxyhemoglobin desaturations during sleep. Significant clinical consequences of the disorder cover a wide spectrum, including daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, and cor pulmonale. The major risk factors for the disorder include obesity, male gender, and age. Current understanding of the pathophysiologic basis of the disorder suggests that a balance of anatomically imposed mechanical loads and compensatory neuromuscular responses are important in maintaining upper airway patency during sleep. OSA develops in the presence of both elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. A sleep history and physical examination is important in identification of patients and appropriate referral for polysomnography. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches. Knowledge of common patterns of OSA may help to identify patients and guide therapy. PMID:17625094

  14. Chronic intestinal pseudo-obstruction

    PubMed Central

    Antonucci, Alexandra; Fronzoni, Lucia; Cogliandro, Laura; Cogliandro, Rosanna F; Caputo, Carla; Giorgio, Roberto De; Pallotti, Francesca; Barbara, Giovanni; Corinaldesi, Roberto; Stanghellini, Vincenzo

    2008-01-01

    Chronic intestinal pseudo-obstruction (CIPO) is a severe digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Although uncommon in clinical practice, this syndrome represents one of the main causes of intestinal failure and is characterized by high morbidity and mortality. It may be idiopathic or secondary to a variety of diseases. Most cases are sporadic, even though familial forms with either dominant or recessive autosomal inheritance have been described. Based on histological features intestinal pseudo-obstruction can be classified into three main categories: neuropathies, mesenchymopathies, and myopathies, according on the predominant involvement of enteric neurones, interstitial cells of Cajal or smooth muscle cells, respectively. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases. PMID:18494042

  15. [Intradiverticular bladder tumors. Three case reports].

    PubMed

    Fekak, H; Rabu, R; Joual, A; Bennani, S; Moufid, K; Sarf, S; Debragh, A; el Mimu, M; Benjelloun, S

    2002-01-01

    The bladder tumours in vesical diverticula is rare, and the poor prognosis, because it was often with early invasion. We reported three cases of bladder tumours in vesical diverticula, with delay of diagnosis two, eight and twelve months respectively. The radiology exploration suspected the diagnosis and the histology biopsy confirmed a diagnosis of primary transitional cell carcinoma in two cases: PTa GI and T2 GII, and in an other case it was a invasive epidermoid carcinoma. The first patient was dead by urethral resection of the bladder tumour. The second required a cytoprototectomy and the last patient. The treatment consisted of radiotherapy and chemotherapy. We insisted of the particularity diagnosis, histology and therapeutic for bladder tumour in vesical diverticula and the early diagnosis in order to have a good prognosis.

  16. Aging changes in the kidneys and bladder

    MedlinePlus

    ... and urethra. Muscle changes and changes in the reproductive system can affect bladder control. Aging Changes and Their ... the bones, muscles, and joints In the male reproductive system In the female reproductive system In organs, tissues, ...

  17. A new technique for bladder washing.

    PubMed

    Miller, D C; Fitkin, D L; Kropp, K A; Selman, S H

    1992-01-01

    We describe a simple adaptation of the Water Pik (Teledyne Water Pik, Fort Collins, Colorado) irrigating device which allows vigorous, direct-vision agitation of the bladder wall. Three groups of mongrel dogs were subjected to cystoscopy and either syringe barbotage, half-speed Water Pik irrigation, or full-speed Water Pik irrigation of the bladder wall. Transitional cell counts were then done on centrifuged aliquots of each bladder wash specimen. The average number of transitional cells per high-power field were similar between the control group and the syringe barbotage group (2.5 and 1.5 respectively). However, both the half-speed and the full-speed Water Pik groups demonstrated statistically higher cell counts (5.7 and 13.7) when compared to both the controls and syringe barbotage groups. We conclude that Water Pik irrigation is an effective method to increase cell yield in bladder wash specimens. PMID:1729530

  18. Recovery After Stroke: Bladder and Bowel Function

    MedlinePlus

    ... urination.  Urinary retention – trouble urinating or not completely emptying your bladder.  Constipation – being unable to have a ... or a specialist in medical problems of the stomach, intestines and associated organs.  Many nurses are trained ...

  19. Measurement of Outflow Facility Using iPerfusion

    PubMed Central

    Sherwood, Joseph M.; Reina-Torres, Ester; Bertrand, Jacques A.; Rowe, Barnaby; Overby, Darryl R.

    2016-01-01

    Elevated intraocular pressure (IOP) is the predominant risk factor for glaucoma, and reducing IOP is the only successful strategy to prevent further glaucomatous vision loss. IOP is determined by the balance between the rates of aqueous humour secretion and outflow, and a pathological reduction in the hydraulic conductance of outflow, known as outflow facility, is responsible for IOP elevation in glaucoma. Mouse models are often used to investigate the mechanisms controlling outflow facility, but the diminutive size of the mouse eye makes measurement of outflow technically challenging. In this study, we present a new approach to measure and analyse outflow facility using iPerfusion™, which incorporates an actuated pressure reservoir, thermal flow sensor, differential pressure measurement and an automated computerised interface. In enucleated eyes from C57BL/6J mice, the flow-pressure relationship is highly non-linear and is well represented by an empirical power law model that describes the pressure dependence of outflow facility. At zero pressure, the measured flow is indistinguishable from zero, confirming the absence of any significant pressure independent flow in enucleated eyes. Comparison with the commonly used 2-parameter linear outflow model reveals that inappropriate application of a linear fit to a non-linear flow-pressure relationship introduces considerable errors in the estimation of outflow facility and leads to the false impression of pressure-independent outflow. Data from a population of enucleated eyes from C57BL/6J mice show that outflow facility is best described by a lognormal distribution, with 6-fold variability between individuals, but with relatively tight correlation of facility between fellow eyes. iPerfusion represents a platform technology to accurately and robustly characterise the flow-pressure relationship in enucleated mouse eyes for the purpose of glaucoma research and with minor modifications, may be applied in vivo to mice, as

  20. Measurement of Outflow Facility Using iPerfusion.

    PubMed

    Sherwood, Joseph M; Reina-Torres, Ester; Bertrand, Jacques A; Rowe, Barnaby; Overby, Darryl R

    2016-01-01

    Elevated intraocular pressure (IOP) is the predominant risk factor for glaucoma, and reducing IOP is the only successful strategy to prevent further glaucomatous vision loss. IOP is determined by the balance between the rates of aqueous humour secretion and outflow, and a pathological reduction in the hydraulic conductance of outflow, known as outflow facility, is responsible for IOP elevation in glaucoma. Mouse models are often used to investigate the mechanisms controlling outflow facility, but the diminutive size of the mouse eye makes measurement of outflow technically challenging. In this study, we present a new approach to measure and analyse outflow facility using iPerfusion™, which incorporates an actuated pressure reservoir, thermal flow sensor, differential pressure measurement and an automated computerised interface. In enucleated eyes from C57BL/6J mice, the flow-pressure relationship is highly non-linear and is well represented by an empirical power law model that describes the pressure dependence of outflow facility. At zero pressure, the measured flow is indistinguishable from zero, confirming the absence of any significant pressure independent flow in enucleated eyes. Comparison with the commonly used 2-parameter linear outflow model reveals that inappropriate application of a linear fit to a non-linear flow-pressure relationship introduces considerable errors in the estimation of outflow facility and leads to the false impression of pressure-independent outflow. Data from a population of enucleated eyes from C57BL/6J mice show that outflow facility is best described by a lognormal distribution, with 6-fold variability between individuals, but with relatively tight correlation of facility between fellow eyes. iPerfusion represents a platform technology to accurately and robustly characterise the flow-pressure relationship in enucleated mouse eyes for the purpose of glaucoma research and with minor modifications, may be applied in vivo to mice, as

  1. Holmium laser lithotripsy of bladder calculi

    NASA Astrophysics Data System (ADS)

    Beaghler, Marc A.; Poon, Michael W.

    1998-07-01

    Although the overall incidence of bladder calculi has been decreasing, it is still a significant disease affecting adults and children. Prior treatment options have included open cystolitholapaxy, blind lithotripsy, extracorporeal shock wave lithotripsy, and visual lithotripsy with ultrasonic or electrohydraulic probes. The holmium laser has been found to be extremely effective in the treatment of upper tract calculi. This technology has also been applied to the treatment of bladder calculi. We report our experience with the holmium laser in the treatment of bladder calculi. Twenty- five patients over a year and a half had their bladder calculi treated with the Holmium laser. This study was retrospective in nature. Patient demographics, stone burden, and intraoperative and post-operative complications were noted. The mean stone burden was 31 mm with a range of 10 to 60 mm. Preoperative diagnosis was made with either an ultrasound, plain film of the abdomen or intravenous pyelogram. Cystoscopy was then performed to confirm the presence and determine the size of the stone. The patients were then taken to the operating room and given a regional or general anesthetic. A rigid cystoscope was placed into the bladder and the bladder stone was then vaporized using the holmium laser. Remaining fragments were washed out. Adjunctive procedures were performed on 10 patients. These included transurethral resection of the prostate, transurethral incision of the prostate, optic internal urethrotomy, and incision of ureteroceles. No major complications occurred and all patients were rendered stone free. We conclude that the Holmium laser is an effective and safe modality for the treatment of bladder calculi. It was able to vaporize all bladder calculi and provides a single modality of treating other associated genitourinary pathology.

  2. The "bends" and neurogenic bladder dysfunction.

    PubMed

    Elliott, D S; Mutchnik, S; Boone, T B

    2001-02-01

    Decompression sickness (the "bends") is a well-known risk of scuba diving. The pathophysiology and treatment is well documented. In the urologic data, no reference to the development of a neurogenic bladder as a result of an episode of the bends was found. We present the evaluation and management of a previously asymptomatic man who developed detrusor hyperreflexia after an episode of decompression sickness. Urologists in coastal communities should be aware of the potential risk of the development of neurogenic bladder.

  3. Management of transitional cell carcinoma of the urinary bladder in dogs: a review.

    PubMed

    Fulkerson, Christopher M; Knapp, Deborah W

    2015-08-01

    Transitional cell carcinoma (TCC), also referred to as urothelial carcinoma, is the most common form of urinary bladder cancer in dogs, affecting tens of thousands of dogs worldwide each year. Canine TCC is usually a high grade invasive cancer. Problems associated with TCC include urinary tract obstruction, distant metastases in >50% of affected dogs, and clinical signs that are troubling both to the dogs and to their owners. Risk factors for TCC include exposure to older types of flea control products and lawn chemicals, obesity, female sex, and a very strong breed-associated risk. This knowledge is allowing pet owners to take steps to reduce the risk of TCC in their dog. The diagnosis of TCC is made by histopathology of tissue biopsies obtained by cystoscopy, surgery, or catheter. Percutaneous aspirates and biopsies should be avoided due to the risk of tumor seeding. TCC is most commonly located in the trigone region of the bladder precluding complete surgical resection. Medical treatment is the mainstay for TCC therapy in dogs. Although TCC is not usually curable in dogs, multiple drugs have activity against it. Approximately 75% of dogs respond favorably to TCC treatment and can enjoy several months to a year or more of good quality life. Many promising new therapies for TCC are emerging and with the close similarity between TCC in dogs and high grade invasive bladder cancer in humans, new treatment strategies found to be successful in canine studies are expected to help dogs and to be subsequently translated to humans.

  4. Characterizing Quasar Outflows IV: Regulating Outflows Through X-ray and EUV Absorption

    NASA Astrophysics Data System (ADS)

    Derseweh, Jeffrey; Ganguly, R.; Richmond, J. M.; Stark, M. A.; Christenson, D. H.; Robbins, J. M.; Townsend, S. L.

    2012-05-01

    Galaxy evolution models have shown that quasars are a crucial ingredient in the evolution of massive galaxies. Outflows play a key role in the story of quasars and their host galaxies, by helping regulate the accretion process, the star-formation rate and mass of the host galaxy (i.e., feedback). The prescription for modeling outflows as a contributor to feedback requires knowledge of the outflow velocity, geometry, and column density. In particular, we need to understand how these depend on physical parameters and how much is determined stochastically (and with what distribution). For this purpose, we are examining a sample of 11000 z=1.7-2.0 quasars from the Sloan Digital Sky Survey. This redshift range permits the following from the SDSS spectra: (1) separation of objects that do and do not exhibit outflows; (2) classification/measurement of outflow properties (ionization, velocity, velocity width); and (3) measurements of UV emission line and continuum parameters. In this poster, we add photometry from the GALEX All-sky imaging survey, as well as the Chandra and ROSAT archives. These provide coverage of the rest-frame extreme ultraviolet, and soft X-ray bands. In an accompanying poster, we have subjectively divided these quasars into four categories: broad absorption-line quasars (2700 objects), associated absorption-line quasars (1700 objects), reddened quasars (160 objects), and unabsorbed/unreddened quasars (6300 objects). We are interested in testing the radiative-driving hypothesis that requires a suppression of X-ray flux in order to transfer momentum efficiently to the UV-absorbing gas. Hence, we explore how absorption in both the extreme ultraviolet and the soft X-ray bands correlate with properties of the UV outflows, quasar property, and changes in SED shape. This material is based upon work supported by the National Aeronautics and Space Administration under Grant No. 09-ADP09-0016 issued through the Astrophysics Data Analysis Program and by Chandra

  5. Measuring the seeds of thermal ion outflow

    NASA Astrophysics Data System (ADS)

    Fernandes, Philip A.

    The ionosphere is the primary source for heavy ions which are ubiquitous in the terrestrial magnetosphere. Low-altitude energization in the auroral ionosphere results in bulk heating and transverse acceleration of ions, which begin to upwell and/or be accelerated upward by the mirror force, starting upflow and leading to the outflow process. The details of the processes that seed ion outflow at low altitudes are difficult to measure in situ and thus remain an open question. We examine the observational parameter regime in which ion upflow/outflow initiates. Emphasis is placed on making measurements of the thermal ion kinetic distribution function, allowing for accounting of processes which affect in situ plasma measurements. We consider an electrostatic analyzer (ESA) instrument capable of making the measurements necessary to quantify the roles of various heating mechanisms in initiating ion upflow in the low-altitude auroral ionosphere. We present the difficulties associated with making these measurements and identify instrument design choices that mitigate some of these measurement challenges. Analysis of ESA measurements of the thermal ion distribution function taken on the MICA auroral sounding rocket is presented. Using a Maxwellian model to replicate possible measured spectra, we calculate integrated parameters from the model and compare with equivalent parameters calculated from the in situ data. Through Liouville's theorem and the thin-sheath approximation we couple the measured and forward-modeled parameters such that measurements inside the sheath provide information about the state of the plasma outside the sheath. Throughout the MICA flight, ion upflow is observed and attributed to ambipolar electric fields and/or ion-neutral interactions. Late in the flight we observe quasi-static frictional process driving the ion temperature. Early in the flight we observe ion heating weakly correlated with ELF wave activity; our analysis suggests we must consider

  6. Laparoscopic Hernia Repair and Bladder Injury

    PubMed Central

    Bhoyrul, Sunil; Mulvihill, Sean J.

    2001-01-01

    Background: Bladder injury is a complication of laparoscopic surgery with a reported incidence in the general surgery literature of 0.5% and in the gynecology literature of 2%. We describe how to recognize and treat the injury and how to avoid the problem. Case Reports: We report two cases of bladder injury repaired with a General Surgical Interventions (GSI) trocar and a balloon device used for laparoscopic extraperitoneal inguinal hernia repair. One patient had a prior appendectomy; the other had a prior midline incision from a suprapubic prostatectomy. We repaired the bladder injury, and the patients made a good recovery. Conclusion: When using the obturator and balloon device, it is important to stay anterior to the preperitoneal space and bladder. Prior lower abdominal surgery can be considered a relative contraindication to extraperitoneal laparoscopic hernia repair. Signs of gas in the Foley bag or hematuria should alert the surgeon to a bladder injury. A one- or two-layer repair of the bladder injury can be performed either laparoscopically or openly and is recommended for a visible injury. Mesh repair of the hernia can be completed provided no evidence exists of urinary tract infection. A Foley catheter is placed until healing occurs. PMID:11394432

  7. Confronting the outflow-regulated cluster formation model with observations

    SciTech Connect

    Nakamura, Fumitaka; Li, Zhi-Yun E-mail: zl4h@virginia.edu

    2014-03-10

    Protostellar outflows have been shown theoretically to be capable of maintaining supersonic turbulence in cluster-forming clumps and keeping the star formation rate per free-fall time as low as a few percent. We aim to test two basic predictions of this outflow-regulated cluster formation model, namely, (1) the clump should be close to virial equilibrium and (2) the turbulence dissipation rate should be balanced by the outflow momentum injection rate, using recent outflow surveys toward eight nearby cluster-forming clumps (B59, L1551, L1641N, Serpens Main Cloud, Serpens South, ρ Oph, IC 348, and NGC 1333). We find, for almost all sources, that the clumps are close to virial equilibrium and the outflow momentum injection rate exceeds the turbulence momentum dissipation rate. In addition, the outflow kinetic energy is significantly smaller than the clump gravitational energy for intermediate and massive clumps with M {sub cl} ≳ a few × 10{sup 2} M {sub ☉}, suggesting that the outflow feedback is not enough to disperse the clump as a whole. The number of observed protostars also indicates that the star formation rate per free-fall time is as small as a few percent for all clumps. These observationally based results strengthen the case for outflow-regulated cluster formation.

  8. Collective outflow from a small multiple stellar system

    SciTech Connect

    Peters, Thomas; Klaassen, Pamela D.; Mac Low, Mordecai-Mark; Schrön, Martin; Klessen, Ralf S.; Federrath, Christoph; Smith, Michael D.

    2014-06-10

    The formation of high-mass stars is usually accompanied by powerful protostellar outflows. Such high-mass outflows are not simply scaled-up versions of their lower-mass counterparts, since observations suggest that the collimation degree degrades with stellar mass. Theoretically, the origins of massive outflows remain open to question because radiative feedback and fragmentation of the accretion flow around the most massive stars, with M > 15 M {sub ☉}, may impede the driving of magnetic disk winds. We here present a three-dimensional simulation of the early stages of core fragmentation and massive star formation that includes a subgrid-scale model for protostellar outflows. We find that stars that form in a common accretion flow tend to have aligned outflow axes, so that the individual jets of multiple stars can combine to form a collective outflow. We compare our simulation to observations with synthetic H{sub 2} and CO observations and find that the morphology and kinematics of such a collective outflow resembles some observed massive outflows, such as Cepheus A and DR 21. We finally compare physical quantities derived from simulated observations of our models to the actual values in the models to examine the reliability of standard methods for deriving physical quantities, demonstrating that those methods indeed recover the actual values to within a factor of two to three.

  9. Confronting the Outflow-regulated Cluster Formation Model with Observations

    NASA Astrophysics Data System (ADS)

    Nakamura, Fumitaka; Li, Zhi-Yun

    2014-03-01

    Protostellar outflows have been shown theoretically to be capable of maintaining supersonic turbulence in cluster-forming clumps and keeping the star formation rate per free-fall time as low as a few percent. We aim to test two basic predictions of this outflow-regulated cluster formation model, namely, (1) the clump should be close to virial equilibrium and (2) the turbulence dissipation rate should be balanced by the outflow momentum injection rate, using recent outflow surveys toward eight nearby cluster-forming clumps (B59, L1551, L1641N, Serpens Main Cloud, Serpens South, ρ Oph, IC 348, and NGC 1333). We find, for almost all sources, that the clumps are close to virial equilibrium and the outflow momentum injection rate exceeds the turbulence momentum dissipation rate. In addition, the outflow kinetic energy is significantly smaller than the clump gravitational energy for intermediate and massive clumps with M cl >~ a few × 102 M ⊙, suggesting that the outflow feedback is not enough to disperse the clump as a whole. The number of observed protostars also indicates that the star formation rate per free-fall time is as small as a few percent for all clumps. These observationally based results strengthen the case for outflow-regulated cluster formation.

  10. Ice sculpture in the Martian outflow channels

    NASA Technical Reports Server (NTRS)

    Lucchitta, B. K.

    1982-01-01

    Viking Orbiter and terrestrial satellite images are examined at similar resolution to compare features of the Martian outflow channels with features produced by the movement of ice on earth, and many resemblances are found. These include the anastomoses, sinuosities, and U-shaped cross profiles of valleys; hanging valleys; linear scour marks on valley walls; grooves and ridges on valley floors; and the streamlining of bedrock highs. Attention is given to the question whether ice could have moved in the Martian environment. It is envisaged that springs or small catastrophic outbursts discharged fluids from structural outlets or chaotic terrains. These fluids built icings that may have grown into substantial masses and eventually flowed like glaciers down preexisting valleys. An alternative is that the fluids formed rivers or floods that in turn formed ice jams and consolidated into icy masses in places where obstacles blocked their flow.

  11. FIRE simulations: galactic outflows and their consequences

    NASA Astrophysics Data System (ADS)

    Keres, Dusan; FIRE team

    2016-06-01

    We study gaseous outflows and their consequences in high-resolution galaxy formation simulations with explicit stellar feedback from the Feedback in Realistic Environments project. Collective, galaxy scale, effect of stellar feedback results in episodic ejections of large amount of gas and heavy elements into the circum-galactic medium. Gas ejection episodes follow strong bursts of star formation. Properties of galactic star formation and ejection episodes depend on galaxy mass and redshift and, together with gas infall and recycling, shape the evolution of the circum-galactic medium and galaxies. As a consequence, our simulated galaxies have masses, star formation histories and heavy element content in good agreement with the observed population of galaxies.

  12. Simulation of Breach Outflow for Earthfill Dam

    NASA Astrophysics Data System (ADS)

    Razad, Azwin Zailti Abdul; Sabri Muda, Rahsidi; Mohd Sidek, Lariyah; Azia, Intan Shafilah Abdul; Hanum Mansor, Faezah; Yalit, Ruzaimei

    2013-06-01

    Dams have been built for many reasons such as irrigation, hydropower, flood mitigation, and water supply to support development for the benefit of human. However, the huge amount of water stored behind the dam can seriously pose adverse impacts to the downstream community should it be released due to unwanted dam break event. To minimise the potential loss of lives and property damages, a workable Emergency Response Plan is required to be developed. As part of a responsible dam owner and operator, TNB initiated a study on dam breach modelling for Cameron Highlands Hydroelectric Scheme to simulate the potential dam breach for Jor Dam. Prediction of dam breach parameters using the empirical equations of Froehlich and Macdonal-Langridge-Monopolis formed the basis of the modelling, coupled with MIKE 11 software to obtain the breach outflow due to Probable Maximum Flood (PMF). This paper will therefore discuss the model setup, simulation procedure and comparison of the prediction with existing equations.

  13. Functional Anatomy of the Outflow Facilities

    PubMed Central

    Pizzirani, Stefano; Gong, Haiyan

    2016-01-01

    The aqueous humor (AH) is the fluid that fills the anterior and posterior chambers of the eye. Its main roles are to provide nourishment and metabolic waste removal to active metabolic ocular structures that are avascular and to contribute maintaining a normal intraocular pressure (IOP) without altering the refractive status of the eye. Its composition and the fluid dynamics associated with its flow are voluble and undergo changes associated with age and disease. Of particular importance is that the resistance to the outflow of AH from the anterior chamber is influenced by morphologic, physiologic, and biochemical dynamic factors.1 Beside aqueous nutritional importance, its solutes also participate in establishing the anterior chamber associate immune deviation, and carry and distribute the different proteins and molecules that promote and direct tissue remodeling and changes in the anterior segment that are associated with both age and disease. PMID:26337760

  14. [Palliative surgery for malignant bowel obstruction in patients with advanced and recurrent gastroenterological cancer].

    PubMed

    Kitani, Kotaro; Yukawa, Masao; Fujiwara, Yoshinori; Tsujie, Masanori; Hara, Joji; Ikeda, Mitsunori; Sato, Katsuaki; Isono, Sayuri; Kawai, Kenji; Miura, Ken; Watatani, Masahiro; Inoue, Masatoshi

    2013-11-01

    We report the outcomes of palliative surgery for the treatment of malignant bowel obstruction in patients with advanced gastroenterological cancer. We studied 20 patients who had undergone palliative surgery over 3 years. We analyzed the clinical findings, surgical procedure, postoperative clinical course, and prognosis. The origin of the patients was colorectal cancer( 9 cases), gastric cancer( 4 cases), uterine cancer( 3 cases), pancreatic cancer( 2 cases), bladder( 1 case), and anal cancer (1 case). Small bowel obstruction was noted in 8 cases and colorectal obstruction was noted in 14 cases. Colostomy was performed in 13 cases, resection and reconstruction were performed in 6 cases, and bypass was performed in 4 cases. Ninety percent of the patients were able to eat solid food following the surgery, but 20% of the patients were forced to have bowel obstruction. The median survival time after palliative surgery was 3 (range, 0-15) months, and 6 patients (30%) died within 2 months. We concluded that palliative surgery for the treatment of malignant bowel obstruction could improve the patients' quality of life. The decision for performing palliative surgery should be made while considering the patient's prognosis, wishes, and potential for symptom improvement. PMID:24393893

  15. Management of obstructed defecation.

    PubMed

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-28

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results.

  16. Management of obstructed defecation.

    PubMed

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-28

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an "iceberg syndrome", with "emerging rocks", rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has "underwater rocks" or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone's enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results. PMID:25632177

  17. Optically thick outflows in ultraluminous supersoft sources

    NASA Astrophysics Data System (ADS)

    Urquhart, R.; Soria, R.

    2016-02-01

    Ultraluminous supersoft sources (ULSs) are defined by a thermal spectrum with colour temperatures ˜0.1 keV, bolometric luminosities ˜ a few 1039 erg s-1, and almost no emission above 1 keV. It has never been clear how they fit into the general scheme of accreting compact objects. To address this problem, we studied a sample of seven ULSs with extensive Chandra and XMM-Newton coverage. We find an anticorrelation between fitted temperatures and radii of the thermal emitter, and no correlation between bolometric luminosity and radius or temperature. We compare the physical parameters of ULSs with those of classical supersoft sources, thought to be surface-nuclear-burning white dwarfs, and of ultraluminous X-ray sources (ULXs), thought to be super-Eddington stellar-mass black holes. We argue that ULSs are the sub-class of ULXs seen through the densest wind, perhaps an extension of the soft-ultraluminous regime. We suggest that in ULSs, the massive disc outflow becomes effectively optically thick and forms a large photosphere, shrouding the inner regions from our view. Our model predicts that when the photosphere expands to ≳ 105 km and the temperature decreases below ≈50 eV, ULSs become brighter in the far-UV but undetectable in X-rays. Conversely, we find that harder emission components begin to appear in ULSs when the fitted size of the thermal emitter is smallest (interpreted as a shrinking of the photosphere). The observed short-term variability and absorption edges are also consistent with clumpy outflows. We suggest that the transition between ULXs (with a harder tail) and ULSs (with only a soft thermal component) occurs at blackbody temperatures of ≈150 eV.

  18. Myocardialization of the cardiac outflow tract

    NASA Technical Reports Server (NTRS)

    van den Hoff, M. J.; Moorman, A. F.; Ruijter, J. M.; Lamers, W. H.; Bennington, R. W.; Markwald, R. R.; Wessels, A.

    1999-01-01

    During development, the single-circuited cardiac tube transforms into a double-circuited four-chambered heart by a complex process of remodeling, differential growth, and septation. In this process the endocardial cushion tissues of the atrioventricular junction and outflow tract (OFT) play a crucial role as they contribute to the mesenchymal components of the developing septa and valves in the developing heart. After fusion, the endocardial ridges in the proximal portion of the OFT initially form a mesenchymal outlet septum. In the adult heart, however, this outlet septum is basically a muscular structure. Hence, the mesenchyme of the proximal outlet septum has to be replaced by cardiomyocytes. We have dubbed this process "myocardialization." Our immunohistochemical analysis of staged chicken hearts demonstrates that myocardialization takes place by ingrowth of existing myocardium into the mesenchymal outlet septum. Compared to other events in cardiac septation, it is a relatively late process, being initialized around stage H/H28 and being basically completed around stage H/H38. To unravel the molecular mechanisms that are responsible for the induction and regulation of myocardialization, an in vitro culture system in which myocardialization could be mimicked and manipulated was developed. Using this in vitro myocardialization assay it was observed that under the standard culture conditions (i) whole OFT explants from stage H/H20 and younger did not spontaneously myocardialize the collagen matrix, (ii) explants from stage H/H21 and older spontaneously formed extensive myocardial networks, (iii) the myocardium of the OFT could be induced to myocardialize and was therefore "myocardialization-competent" at all stages tested (H/H16-30), (iv) myocardialization was induced by factors produced by, most likely, the nonmyocardial component of the outflow tract, (v) at none of the embryonic stages analyzed was ventricular myocardium myocardialization-competent, and finally

  19. Searching for molecular outflows in hyperluminous infrared galaxies

    NASA Astrophysics Data System (ADS)

    Calderón, D.; Bauer, F. E.; Veilleux, S.; Graciá-Carpio, J.; Sturm, E.; Lira, P.; Schulze, S.; Kim, S.

    2016-08-01

    We present constraints on the molecular outflows in a sample of five hyperluminous infrared galaxies using Herschel observations of the OH doublet at 119 μm. We have detected the OH doublet in three cases: one purely in emission and two purely in absorption. The observed emission profile has a significant blueshifted wing suggesting the possibility of tracing an outflow. Out of the two absorption profiles, one seems to be consistent with the systemic velocity while the other clearly indicates the presence of a molecular outflow whose maximum velocity is about ˜1500 km s-1. Our analysis shows that this system is in general agreement with previous results on ultraluminous infrared galaxies and QSOs, whose outflow velocities do not seem to correlate with stellar masses or starburst luminosities (star formation rates). Instead, the galaxy outflow likely arises from an embedded active galactic nuclei.

  20. Evolution of active region outflows throughout an active region lifetime

    NASA Astrophysics Data System (ADS)

    Zangrilli, L.; Poletto, G.

    2016-10-01

    Context. We have shown previously that SOHO/UVCS data allow us to detect active region (AR) outflows at coronal altitudes higher than those reached by other instrumentation. These outflows are thought to be a component of the slow solar wind. Aims: Our purpose is to study the evolution of the outflows in the intermediate corona from AR 8100, from the time the AR first forms until it dissolves, after several transits at the solar limb. Methods: Data acquired by SOHO/UVCS at the time of the AR limb transits, at medium latitudes and at altitudes ranging from 1.5 to 2.3 R⊙, were used to infer the physical properties of the outflows through the AR evolution. To this end, we applied the Doppler dimming technique to UVCS spectra. These spectra include the H i Lyα line and the O vi doublet lines at 1031.9 and 1037.6 Å. Results: Plasma speeds and electron densities of the outflows were inferred over several rotations of the Sun. AR outflows are present in the newly born AR and persist throughout the entire AR life. Moreover, we found two types of outflows at different latitudes, both possibly originating in the same negative polarity area of the AR. We also analyzed the behavior of the Si xii 520 Å line along the UVCS slit in an attempt to reveal changes in the Si abundance when different regions are traversed. Although we found some evidence for a Si enrichment in the AR outflows, alternative interpretations are also plausible. Conclusions: Our results demonstrate that outflows from ARs are detectable in the intermediate corona throughout the whole AR lifetime. This confirms that outflows contribute to the slow wind.

  1. Development and Morphology of the Ventricular Outflow Tracts.

    PubMed

    Anderson, Robert H; Mori, Shumpei; Spicer, Diane E; Brown, Nigel A; Mohun, Timothy J

    2016-09-01

    It is customary, at the current time, to consider many, if not most, of the lesions involving the ventricular outflow tract in terms of conotruncal malformations. This reflects the introduction, in the early 1940s, of the terms conus and truncus to describe the components of the developing outflow tract. The definitive outflow tracts in the postnatal heart, however, possess three, rather than two, components. These are the intrapericardial arterial trunks, the arterial roots, and the subvalvar ventricular outflow tracts. Congenital lesions afflicting the arterial roots, however, are not currently considered to be conotruncal malformations. This suggests a lack of logic in the description of cardiac development and its use as a means of categorizing congenital malformations. It is our belief that the developing outflow tract, like the postnatal outflow tracts, can readily be described in tripartite fashion, with its distal, intermediate, and proximal components forming the primordiums of the postnatal parts. In this review, we present evidence obtained from developing mice and human hearts to substantiate this notion. We show that the outflow tract, initially with a common lumen, is divided into its aortic and pulmonary components by a combination of an aortopulmonary septum derived from the dorsal wall of the aortic sac and outflow tract cushions that spiral through its intermediate and proximal components. These embryonic septal structures, however, subsequently lose their septal functions as the outflow tracts develop their own discrete walls. We then compare the developmental findings with the anatomic arrangements seen postnatally in the normal human heart. We show how correlations with the embryologic findings permit logical analysis of the congenital lesions involving the outflow tracts. PMID:27587491

  2. Development and Morphology of the Ventricular Outflow Tracts

    PubMed Central

    Mori, Shumpei; Spicer, Diane E.; Brown, Nigel A.; Mohun, Timothy J.

    2016-01-01

    It is customary, at the current time, to consider many, if not most, of the lesions involving the ventricular outflow tract in terms of conotruncal malformations. This reflects the introduction, in the early 1940s, of the terms conus and truncus to describe the components of the developing outflow tract. The definitive outflow tracts in the postnatal heart, however, possess three, rather than two, components. These are the intrapericardial arterial trunks, the arterial roots, and the subvalvar ventricular outflow tracts. Congenital lesions afflicting the arterial roots, however, are not currently considered to be conotruncal malformations. This suggests a lack of logic in the description of cardiac development and its use as a means of categorizing congenital malformations. It is our belief that the developing outflow tract, like the postnatal outflow tracts, can readily be described in tripartite fashion, with its distal, intermediate, and proximal components forming the primordiums of the postnatal parts. In this review, we present evidence obtained from developing mice and human hearts to substantiate this notion. We show that the outflow tract, initially with a common lumen, is divided into its aortic and pulmonary components by a combination of an aortopulmonary septum derived from the dorsal wall of the aortic sac and outflow tract cushions that spiral through its intermediate and proximal components. These embryonic septal structures, however, subsequently lose their septal functions as the outflow tracts develop their own discrete walls. We then compare the developmental findings with the anatomic arrangements seen postnatally in the normal human heart. We show how correlations with the embryologic findings permit logical analysis of the congenital lesions involving the outflow tracts. PMID:27587491

  3. A distance-limited sample of massive molecular outflows

    NASA Astrophysics Data System (ADS)

    Maud, L. T.; Moore, T. J. T.; Lumsden, S. L.; Mottram, J. C.; Urquhart, J. S.; Hoare, M. G.

    2015-10-01

    We have observed 99 mid-infrared-bright, massive young stellar objects and compact H II regions drawn from the Red MSX source survey in the J = 3-2 transition of 12CO and 13CO, using the James Clerk Maxwell Telescope. 89 targets are within 6 kpc of the Sun, covering a representative range of luminosities and core masses. These constitute a relatively unbiased sample of bipolar molecular outflows associated with massive star formation. Of these, 59, 17 and 13 sources (66, 19 and 15 per cent) are found to have outflows, show some evidence of outflow, and have no evidence of outflow, respectively. The time-dependent parameters of the high-velocity molecular flows are calculated using a spatially variable dynamic time-scale. The canonical correlations between the outflow parameters and source luminosity are recovered and shown to scale with those of low-mass sources. For coeval star formation, we find the scaling is consistent with all the protostars in an embedded cluster providing the outflow force, with massive stars up to ˜30 M⊙ generating outflows. Taken at face value, the results support the model of a scaled-up version of the accretion-related outflow-generation mechanism associated with discs and jets in low-mass objects with time-averaged accretion rates of ˜10-3 M⊙ yr-1 on to the cores. However, we also suggest an alternative model, in which the molecular outflow dynamics are dominated by the entrained mass and are unrelated to the details of the acceleration mechanism. We find no evidence that outflows contribute significantly to the turbulent kinetic energy of the surrounding dense cores.

  4. Stenting in Malignant Biliary Obstruction.

    PubMed

    Almadi, Majid A; Barkun, Jeffrey S; Barkun, Alan N

    2015-10-01

    Decompression of the biliary system in patients with malignant biliary obstruction has been widely accepted and implemented as part of the care. Despite a wealth of literature, there remains a significant amount of uncertainty as to which approach would be most appropriate in different clinical settings. This review covers stenting of the biliary system in cases of resectable or palliative malignant biliary obstruction, potential candidates for biliary drainage, technical aspects of the procedure, as well as management of biliary stent dysfunction. Furthermore, periprocedural considerations including proper mapping of the location of obstruction and the use of antibiotics are addressed.

  5. Reproducibility of the bladder shape and bladder shape changes during filling

    SciTech Connect

    Lotz, Heidi T.; Herk, Marcel van; Betgen, Anja; Pos, Floris; Lebesque, Joos V.; Remeijer, Peter

    2005-08-15

    The feasibility of high precision radiotherapy to the bladder region is limited by bladder motion and volume changes. In the near future, we plan to begin treatment delivery of bladder cancer patients with the acquisition of a cone beam CT image on which the complete bladder will be semi-automatically localized. Subsequently, a bladder shape model that was developed in a previous study will be used for bladder localization and for the prediction of shape changes in the time interval between acquisition and beam delivery. For such predictions, knowledge about urinary inflow rate is required. Therefore, a series of MR images was acquired over 1 h with time intervals of 10 min for 18 healthy volunteers. To gain insight in the reproducibility of the bladder shape over longer periods of time, two additional MRI series were recorded for 10 of the volunteers. To a good approximation, the bladder volume increased linearly in time for all individuals. Despite receiving drinking instructions, we found a large variation in the inflow rate between individuals, ranging from 2.1 to 15 cc/min (mean value: 9{+-}3 cc/min). In contrast, the intravolunteer variation was much smaller, with a mean standard deviation (SD) of 0.4 cc/min. The inflow rate was linearly correlated with age (negative slope). To study the reproducibility of the bladder shape, we compared bladder shapes of equal volume. For all individuals, the caudal part of the bladder was the most reproducible (variations<0.3 cm in all cases). The cranial and posterior parts of the bladder was much less reproducible, with local SD values up to {approx}1.2 cm for bladders with a volume of 200 cc. These large long-term variations were primarily caused by changes in position and filling of the small bowel and rectum. However, for short time intervals, the rectal filling was (nearly) constant. Therefore, the reproducibility of urinary inflow, combined with the previously developed shape model gives us an excellent tool to

  6. Impact of left ventricular outflow tract area on systolic outflow velocity in hypertrophic cardiomyopathy: a real-time three-dimensional echocardiographic study

    NASA Technical Reports Server (NTRS)

    Qin, Jian Xin; Shiota, Takahiro; Lever, Harry M.; Rubin, David N.; Bauer, Fabrice; Kim, Yong Jin; Sitges, Marta; Greenberg, Neil L.; Drinko, Jeanne K.; Martin, Maureen; Agler, Deborah A.; Thomas, James D.

    2002-01-01

    OBJECTIVES: The aim of this study was to use real-time three-dimensional echocardiography (3DE) to investigate the quantitative relation between minimal left ventricular (LV) outflow tract area (A(LVOT)) and maximal LV outflow tract (LVOT) velocity in patients with hypertrophic obstructive cardiomyopathy (HCM). BACKGROUND: In patients with HCM, LVOT velocity should change inversely with minimal A(LVOT) unless LVOT obstruction reduces the pumping capacity of the ventricle. METHODS: A total of 25 patients with HCM with systolic anterior motion (SAM) of the mitral valve leaflets underwent real-time 3DE. The smallest A(LVOT) during systole was measured using anatomically oriented two-dimensional "C-planes" within the pyramidal 3DE volume. Maximal velocity across LVOT was evaluated by two-dimensional Doppler echocardiography (2DE). For comparison with 3DE A(LVOT), the SAM-septal distance was determined by 2DE. RESULTS: Real-time 3DE provided unique information about the dynamic SAM-septal relation during systole, with A(LVOT) ranging from 0.6 to 5.2 cm(2) (mean: 2.2 +/- 1.4 cm(2)). Maximal velocity (v) correlated inversely with A(LVOT) (v = 496 A(LVOT)(-0.80), r = -0.95, p < 0.001), but the exponent (-0.80) was significantly different from -1.0 (95% confidence interval: -0.67 to -0.92), indicating a significant impact of small A(LVOT) on the peak LVOT flow rate. By comparison, the best correlation between velocity and 2DE SAM-septal distance was significantly (p < 0.01) poorer at -0.83, indicating the superiority of 3DE for assessing A(LVOT). CONCLUSIONS: Three-dimensional echocardiography-measured A(LVOT) provides an assessment of HCM geometry that is superior to 2DE methods. These data indicate that the peak LVOT flow rate appears to be significantly decreased by reduced A(LVOT). Real-time 3DE is a potentially valuable clinical tool for assessing patients with HCM.

  7. A rare case of renal vein thrombosis due to urinary obstruction.

    PubMed

    Jana, Tanima; Orlander, Philip R; Molony, Donald A

    2015-08-01

    Renal vein thrombosis (RVT) is an uncommon condition in adults and may be caused by endothelial damage, stasis, or hypercoagulable states. RVT is commonly identified in patients with nephrotic syndrome or malignancy. We present the case of a 57-yearold man with no past medical history who presented with a 1-month history of abdominal pain, dysuria, and hematuria. Initial laboratory studies were consistent with acute kidney injury (AKI). Imaging revealed bladder distension, enlargement of the prostate, bilateral hydronephrosis, and left renal vein thrombosis extending into the inferior vena cava. His renal failure and presenting symptoms resolved with placement of a Foley catheter and ureteral stent. The patient was discharged on anticoagulation. Here, we report a rare case of RVT that appears to have occurred as a consequence of obstructive uropathy causing massive bladder distention resulting in compression of the renal vein.

  8. Cone Beam CT Imaging Analysis of Interfractional Variations in Bladder Volume and Position During Radiotherapy for Bladder Cancer

    SciTech Connect

    Yee, Don; Parliament, Matthew; Rathee, Satyapal; Ghosh, Sunita; Ko, Lawrence; Murray, Brad

    2010-03-15

    Purpose: To quantify daily bladder size and position variations during bladder cancer radiotherapy. Methods and Materials: Ten bladder cancer patients underwent daily cone beam CT (CBCT) imaging of the bladder during radiotherapy. Bladder and planning target volumes (bladder/PTV) from CBCT and planning CT scans were compared with respect to bladder center-of-mass shifts in the x (lateral), y (anterior-posterior), and z (superior-inferior) coordinates, bladder/PTV size, bladder/PTV margin positions, overlapping areas, and mutually exclusive regions. Results: A total of 262 CBCT images were obtained from 10 bladder cancer patients. Bladder center of mass shifted most in the y coordinate (mean, -0.32 cm). The anterior bladder wall shifted the most (mean, -0.58 cm). Mean ratios of CBCT-derived bladder and PTV volumes to planning CT-derived counterparts were 0.83 and 0.88. The mean CBCT-derived bladder volume (+- standard deviation [SD]) outside the planning CT counterpart was 29.24 cm{sup 3} (SD, 29.71 cm{sup 3}). The mean planning CT-derived bladder volume outside the CBCT counterpart was 47.74 cm{sup 3} (SD, 21.64 cm{sup 3}). The mean CBCT PTV outside the planning CT-derived PTV was 47.35 cm{sup 3} (SD, 36.51 cm{sup 3}). The mean planning CT-derived PTV outside the CBCT-derived PTV was 93.16 cm{sup 3} (SD, 50.21). The mean CBCT-derived bladder volume outside the planning PTV was 2.41 cm{sup 3} (SD, 3.97 cm{sup 3}). CBCT bladder/ PTV volumes significantly differed from planning CT counterparts (p = 0.047). Conclusions: Significant variations in bladder and PTV volume and position occurred in patients in this trial.

  9. Lightweight bladder lined pressure vessels

    DOEpatents

    Mitlitsky, Fred; Myers, Blake; Magnotta, Frank

    1998-01-01

    A lightweight, low permeability liner for graphite epoxy composite compressed gas storage vessels. The liner is composed of polymers that may or may not be coated with a thin layer of a low permeability material, such as silver, gold, or aluminum, deposited on a thin polymeric layer or substrate which is formed into a closed bladder using torispherical or near torispherical end caps, with or without bosses therein, about which a high strength to weight material, such as graphite epoxy composite shell, is formed to withstand the storage pressure forces. The polymeric substrate may be laminated on one or both sides with additional layers of polymeric film. The liner may be formed to a desired configuration using a dissolvable mandrel or by inflation techniques and the edges of the film seamed by heat sealing. The liner may be utilized in most any type of gas storage system, and is particularly applicable for hydrogen, gas mixtures, and oxygen used for vehicles, fuel cells or regenerative fuel cell applications, high altitude solar powered aircraft, hybrid energy storage/propulsion systems, and lunar/Mars space applications, and other applications requiring high cycle life.

  10. Lightweight bladder lined pressure vessels

    DOEpatents

    Mitlitsky, F.; Myers, B.; Magnotta, F.

    1998-08-25

    A lightweight, low permeability liner is described for graphite epoxy composite compressed gas storage vessels. The liner is composed of polymers that may or may not be coated with a thin layer of a low permeability material, such as silver, gold, or aluminum, deposited on a thin polymeric layer or substrate which is formed into a closed bladder using tori spherical or near tori spherical end caps, with or without bosses therein, about which a high strength to weight material, such as graphite epoxy composite shell, is formed to withstand the storage pressure forces. The polymeric substrate may be laminated on one or both sides with additional layers of polymeric film. The liner may be formed to a desired configuration using a dissolvable mandrel or by inflation techniques and the edges of the film sealed by heat sealing. The liner may be utilized in most any type of gas storage system, and is particularly applicable for hydrogen, gas mixtures, and oxygen used for vehicles, fuel cells or regenerative fuel cell applications, high altitude solar powered aircraft, hybrid energy storage/propulsion systems, and lunar/Mars space applications, and other applications requiring high cycle life. 19 figs.

  11. Somatic modulation of spinal reflex bladder activity mediated by nociceptive bladder afferent nerve fibers in cats.

    PubMed

    Xiao, Zhiying; Rogers, Marc J; Shen, Bing; Wang, Jicheng; Schwen, Zeyad; Roppolo, James R; de Groat, William C; Tai, Changfeng

    2014-09-15

    The goal of the present study was to determine if supraspinal pathways are necessary for inhibition of bladder reflex activity induced by activation of somatic afferents in the pudendal or tibial nerve. Cats anesthetized with α-chloralose were studied after acute spinal cord transection at the thoracic T9/T10 level. Dilute (0.25%) acetic acid was used to irritate the bladder, activate nociceptive afferent C-fibers, and trigger spinal reflex bladder contractions (amplitude: 19.3 ± 2.9 cmH2O). Hexamethonium (a ganglionic blocker, intravenously) significantly (P < 0.01) reduced the amplitude of the reflex bladder contractions to 8.5 ± 1.9 cmH2O. Injection of lidocaine (2%, 1-2 ml) into the sacral spinal cord or transection of the sacral spinal roots and spinal cord further reduced the contraction amplitude to 4.2 ± 1.3 cmH2O. Pudendal nerve stimulation (PNS) at frequencies of 0.5-5 Hz and 40 Hz but not at 10-20 Hz inhibited reflex bladder contractions, whereas tibial nerve stimulation (TNS) failed to inhibit bladder contractions at all tested frequencies (0.5-40 Hz). These results indicate that PNS inhibition of nociceptive afferent C-fiber-mediated spinal reflex bladder contractions can occur at the spinal level in the absence of supraspinal pathways, but TNS inhibition requires supraspinal pathways. In addition, this study shows, for the first time, that after acute spinal cord transection reflex bladder contractions can be triggered by activating nociceptive bladder afferent C-fibers using acetic acid irritation. Understanding the sites of action for PNS or TNS inhibition is important for the clinical application of pudendal or tibial neuromodulation to treat bladder dysfunctions.

  12. Somatic modulation of spinal reflex bladder activity mediated by nociceptive bladder afferent nerve fibers in cats.

    PubMed

    Xiao, Zhiying; Rogers, Marc J; Shen, Bing; Wang, Jicheng; Schwen, Zeyad; Roppolo, James R; de Groat, William C; Tai, Changfeng

    2014-09-15

    The goal of the present study was to determine if supraspinal pathways are necessary for inhibition of bladder reflex activity induced by activation of somatic afferents in the pudendal or tibial nerve. Cats anesthetized with α-chloralose were studied after acute spinal cord transection at the thoracic T9/T10 level. Dilute (0.25%) acetic acid was used to irritate the bladder, activate nociceptive afferent C-fibers, and trigger spinal reflex bladder contractions (amplitude: 19.3 ± 2.9 cmH2O). Hexamethonium (a ganglionic blocker, intravenously) significantly (P < 0.01) reduced the amplitude of the reflex bladder contractions to 8.5 ± 1.9 cmH2O. Injection of lidocaine (2%, 1-2 ml) into the sacral spinal cord or transection of the sacral spinal roots and spinal cord further reduced the contraction amplitude to 4.2 ± 1.3 cmH2O. Pudendal nerve stimulation (PNS) at frequencies of 0.5-5 Hz and 40 Hz but not at 10-20 Hz inhibited reflex bladder contractions, whereas tibial nerve stimulation (TNS) failed to inhibit bladder contractions at all tested frequencies (0.5-40 Hz). These results indicate that PNS inhibition of nociceptive afferent C-fiber-mediated spinal reflex bladder contractions can occur at the spinal level in the absence of supraspinal pathways, but TNS inhibition requires supraspinal pathways. In addition, this study shows, for the first time, that after acute spinal cord transection reflex bladder contractions can be triggered by activating nociceptive bladder afferent C-fibers using acetic acid irritation. Understanding the sites of action for PNS or TNS inhibition is important for the clinical application of pudendal or tibial neuromodulation to treat bladder dysfunctions. PMID:25056352

  13. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  14. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  15. [A clinical study of hypertrophic obstructive cardiomyopathy in the elderly].

    PubMed

    Chida, K; Ohkawa, S; Maeda, S; Kuboki, K; Imai, T; Sakai, M; Watanabe, C; Matsushita, S; Ueda, K; Kuramoto, K

    1990-09-01

    Seven elderly patients with hypertrophic obstructive cardiomyopathy (HOCM), who had the three following characteristics on echocardiograms 1) extremely thickened septum, 2) systolic anterior motion of the mitral valve, 3) mid systolic semi-closure of the aortic valve, were clinically evaluated. Ages ranged from 73 to 86 years old (average 78.9% yr.) and all were women. None had not a family history of hypertrophic cardiomyopathy but they had mild hypertension. Six patients showed a significant high voltage on the ST-segment and T-wave abnormalities ("strain" pattern). The left ventricular posterior wall as well as the septum was thickened in 5 and the remaining 2 showed asymmetrical septal hypertrophy (ASH) on echocardiograms. The left ventricular cavity was narrowed due to left ventricular hypertrophy and the shape of the left ventricular cavity was ovoid in all patients. The aorto-septal angles in these 7 patients were 80 degrees to 120 degrees. In addition, proximal septal bulge in all and anterior displacement of the mitral posterior leaflet due to the mitral ring calcification (MRC) in some patients contributed to the narrowing of the left ventricular outflow tract, and the mitral valve was pulled up toward the septum because of the good left ventricular systolic function (ejection fraction: 70 to 94% by echocardiography) and blood was ejected at a high velocity through a narrowed outflow tract (Venturi effect). Pressure gradients in the left ventricular outflow tract was 38 to 146 mmHg in 5 examined by cardiac catheterization. Biopsy specimens were obtained from 2 patients, showing hypertrophic myocytes (diameter: 20 to 30 micron) in 2 and mild disarray in 1.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. CT of gastro-duodenal obstruction.

    PubMed

    Millet, I; Doyon, F Curros; Pages, E; Faget, C; Zins, M; Taourel, P

    2015-10-01

    Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

  17. Simulation of California's Major Reservoirs Outflow Using Data Mining Technique

    NASA Astrophysics Data System (ADS)

    Yang, T.; Gao, X.; Sorooshian, S.

    2014-12-01

    The reservoir's outflow is controlled by reservoir operators, which is different from the upstream inflow. The outflow is more important than the reservoir's inflow for the downstream water users. In order to simulate the complicated reservoir operation and extract the outflow decision making patterns for California's 12 major reservoirs, we build a data-driven, computer-based ("artificial intelligent") reservoir decision making tool, using decision regression and classification tree approach. This is a well-developed statistical and graphical modeling methodology in the field of data mining. A shuffled cross validation approach is also employed to extract the outflow decision making patterns and rules based on the selected decision variables (inflow amount, precipitation, timing, water type year etc.). To show the accuracy of the model, a verification study is carried out comparing the model-generated outflow decisions ("artificial intelligent" decisions) with that made by reservoir operators (human decisions). The simulation results show that the machine-generated outflow decisions are very similar to the real reservoir operators' decisions. This conclusion is based on statistical evaluations using the Nash-Sutcliffe test. The proposed model is able to detect the most influential variables and their weights when the reservoir operators make an outflow decision. While the proposed approach was firstly applied and tested on California's 12 major reservoirs, the method is universally adaptable to other reservoir systems.

  18. PROTOSTELLAR OUTFLOWS AND RADIATIVE FEEDBACK FROM MASSIVE STARS

    SciTech Connect

    Kuiper, Rolf; Yorke, Harold W.; Turner, Neal J. E-mail: Harold.W.Yorke@jpl.nasa.gov

    2015-02-20

    We carry out radiation hydrodynamical simulations of the formation of massive stars in the super-Eddington regime including both their radiative feedback and protostellar outflows. The calculations start from a prestellar core of dusty gas and continue until the star stops growing. The accretion ends when the remnants of the core are ejected, mostly by the force of the direct stellar radiation in the polar direction and elsewhere by the reradiated thermal infrared radiation. How long the accretion persists depends on whether the protostellar outflows are present. We set the mass outflow rate to 1% of the stellar sink particle's accretion rate. The outflows open a bipolar cavity extending to the core's outer edge, through which the thermal radiation readily escapes. The radiative flux is funneled into the polar directions while the core's collapse proceeds near the equator. The outflow thus extends the ''flashlight effect'', or anisotropic radiation field, found in previous studies from the few hundred AU scale of the circumstellar disk up to the 0.1 parsec scale of the core. The core's flashlight effect allows core gas to accrete on the disk for longer, in the same way that the disk's flashlight effect allows disk gas to accrete on the star for longer. Thus although the protostellar outflows remove material near the core's poles, causing slower stellar growth over the first few free-fall times, they also enable accretion to go on longer in our calculations. The outflows ultimately lead to stars of somewhat higher mass.

  19. PROTOSTELLAR JETS ENCLOSED BY LOW-VELOCITY OUTFLOWS

    SciTech Connect

    Machida, Masahiro N.

    2014-11-20

    A protostellar jet and outflow are calculated for ∼270 yr following the protostar formation using a three-dimensional magnetohydrodynamics simulation, in which both the protostar and its parent cloud are spatially resolved. A high-velocity (∼100 km s{sup –1}) jet with good collimation is driven near the disk's inner edge, while a low-velocity (≲ 10 km s{sup –1}) outflow with a wide opening angle appears in the outer-disk region. The high-velocity jet propagates into the low-velocity outflow, forming a nested velocity structure in which a narrow high-velocity flow is enclosed by a wide low-velocity flow. The low-velocity outflow is in a nearly steady state, while the high-velocity jet appears intermittently. The time-variability of the jet is related to the episodic accretion from the disk onto the protostar, which is caused by gravitational instability and magnetic effects such as magnetic braking and magnetorotational instability. Although the high-velocity jet has a large kinetic energy, the mass and momentum of the jet are much smaller than those of the low-velocity outflow. A large fraction of the infalling gas is ejected by the low-velocity outflow. Thus, the low-velocity outflow actually has a more significant effect than the high-velocity jet in the very early phase of the star formation.

  20. Glucocorticoid therapy and risk of bladder cancer

    PubMed Central

    Dietrich, K; Schned, A; Fortuny, J; Heaney, J; Marsit, C; Kelsey, K T; Karagas, M R

    2009-01-01

    Background: Use of immunosuppressive drugs post organ transplantation, and prolonged use of glucorticoids for other conditions have been associated with subsequent risk of certain malignancies, that is, skin cancers and lymphoma. There is evidence that the incidence of bladder cancer is also elevated among organ transplant recipients, however, it is unknown whether other groups of patients, that is, those taking oral glucocorticoids, likewise are at an increased risk. Methods: In a population-based case–control study in New Hampshire, USA, we compared the use of glucocorticoids in 786 bladder cancer cases and in 1083 controls. We used unconditional logistic regression analysis to compute adjusted odds ratios (ORs) associated with oral glucocorticoid use. Results: In our analysis, the risk of bladder cancer was related to a history of prolonged oral glucocorticoid use (OR=1.85, 95% CI=1.24–2.76, adjusted for age, gender and smoking). Associations with oral glucocorticoid use were stronger for invasive tumours (OR=2.12, 95% CI=1.17–3.85) and tumours with high (3+) p53 staining intensity (OR=2.35, 95% CI=1.26–4.36). Conclusion: Our results raise the possibility of an increased risk of bladder cancer from systemic use of glucocorticoids, and a potential role of immune surveillance in bladder cancer aetiology. PMID:19773763

  1. Noninvasive Electromagnetic Detection of Bladder Cancer

    PubMed Central

    Cormio, Luigi; Vedruccio, Clarbruno; Leucci, Giorgio; Massenio, Paolo; Di Fino, Giuseppe; Cavaliere, Vincenzo; Carrieri, Giuseppe

    2014-01-01

    Objectives. Normal and neoplastic human tissues have different electromagnetic properties. This study aimed to determine the diagnostic accuracy of noninvasive electromagnetic detection of bladder cancer (BC) by the tissue-resonance interaction method (TRIM-prob). Patients and Methods. Consecutive patients were referred for cystoscopy because of (i) microscopic or gross hematuria and/or irritative voiding symptoms and (ii) bladder ultrasounds and urinary cytology findings negative or just suspicious of malignancy. Patients were first submitted to TRIM-prob bladder scanning by a single investigator and then to cystoscopy by another investigator blind to TRIM-prob data. Results. In 125 evaluated patients cystoscopy was positive for BC in 47 and negative in the remaining 78; conversely, TRIM-prob bladder scanning was positive for BC in 53 and negative in 72. In particular, TRIM-prob scanning yielded 7 false positives and only one false negative; therefore, its overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 97.9%, 89.9%, 86.8%, 98.6%, and 93.6%, respectively. Conclusions. TRIM-prob bladder scanning was a simple and quite accurate method for non-invasive electromagnetic detection of BC. If the elevated positive and negative predictive values will be replicated in further well-designed studies, it could be used to screen asymptomatic patients at high risk of BC. PMID:24563795

  2. [Epidemiological investigation on bladder cancer and occupations].

    PubMed

    Obata, K; Ohno, Y; Aoki, K

    1989-12-01

    A population-based case-control study was conducted in Boston, U.S.A., Manchester, U.K., and Nagoya, Japan to assess the associations of occupations with bladder cancer in men. In Nagoya, cancer cases were identified through Nagoya Bladder Cancer Registry, and controls were randomly selected from the general population using electoral registers. Study subjects, all males, analyzed were 430 cases and 397 controls in Boston; 339 and 493 in Manchester, and 220 and 443 in Nagoya, respectively. Occupations significantly related to an increased bladder cancer risk were those manufacturing or handling dyes, leather, paint or organic chemicals in Boston, and leather or medical workers in Manchester. Occupations significantly associated with bladder cancer development were not found in Nagoya. In general, risk related to occupations was relatively higher in the younger age group (less than 65 years old) than in the older age group (greater than or equal to 65 yrs old). Statistically significant differences in bladder cancer risk were not demonstrated between manufacturing workers and service workers.

  3. Outflow and hot dust emission in broad absorption line quasars

    SciTech Connect

    Zhang, Shaohua; Zhou, Hongyan; Wang, Huiyuan; Wang, Tinggui; Xing, Feijun; Jiang, Peng; Zhang, Kai E-mail: whywang@mail.ustc.edu.cn

    2014-05-01

    We have investigated a sample of 2099 broad absorption line (BAL) quasars with z = 1.7-2.2 built from the Sloan Digital Sky Survey Data Release Seven and the Wide-field Infrared Survey. This sample is collected from two BAL quasar samples in the literature and is refined by our new algorithm. Correlations of outflow velocity and strength with a hot dust indicator (β{sub NIR}) and other quasar physical parameters—such as an Eddington ratio, luminosity, and a UV continuum slope—are explored in order to figure out which parameters drive outflows. Here β{sub NIR} is the near-infrared continuum slope, which is a good indicator of the amount of hot dust emission relative to the accretion disk emission. We confirm previous findings that outflow properties moderately or weakly depend on the Eddington ratio, UV slope, and luminosity. For the first time, we report moderate and significant correlations of outflow strength and velocity with β{sub NIR} in BAL quasars. It is consistent with the behavior of blueshifted broad emission lines in non-BAL quasars. The statistical analysis and composite spectra study both reveal that outflow strength and velocity are more strongly correlated with β{sub NIR} than the Eddington ratio, luminosity, and UV slope. In particular, the composites show that the entire C IV absorption profile shifts blueward and broadens as β{sub NIR} increases, while the Eddington ratio and UV slope only affect the high and low velocity part of outflows, respectively. We discuss several potential processes and suggest that the dusty outflow scenario, i.e., that dust is intrinsic to outflows and may contribute to the outflow acceleration, is most likely.

  4. A Study of PG Quasar-Driven Outflows with COS

    NASA Astrophysics Data System (ADS)

    Hamann, Frederick

    2013-10-01

    Quasar outflows are an important part of the quasar phenomenon, but many questions remain about their energetics, physical properties and the role they might play in providing feedback to host galaxy evolution. We searched our own COS far-UV observations from the QUEST survey and other large COS programs to find a sample of 6 bright PG quasars with broad {FWHM > 400 km/s} high velocity {v > 1000 km/s} absorption lines that clearly form in quasar-driven winds. These quasars can fill an important gap in our understanding between local Seyferts with low-speed winds and high-redshift quasars with extreme BAL outflows. They are also well-studied at other wavelengths, with some evidence for the quasars driving galaxy-scale blowouts and shutting down star formation. But almost nothing is known about the quasar outflows themselves. We propose a detailed study of these 6 outflow quasars using new COS FUV observations to 1} expand the existing wavelength coverage across critical lines that are diagnostic of the outflow physical conditions, kinetic energies, and metallicities, and 2} check for line variability as an indicator of the outflow structure and locations. This quasar sample includes unusual cases with many low-abundance {PV 1118,1128 and SIV 1063} and excited-state lines {SIV 1073*, CIII* 1175, CII* 1335} that will provide unprecedented constraints on the outflow properties, plus the first known OVI-only mini-BAL outflow {no lower ions detected} for which we will cover NeVIII 770,780 to probe the highest ionization gas. The high FUV sensitivity of COS is uniquely able to measure this wide range of outflow lines in low-redshift quasars with no Lya forest contamination.

  5. Contribution of alluvial groundwater to the outflow of mountainous catchments

    NASA Astrophysics Data System (ADS)

    Käser, Daniel; Hunkeler, Daniel

    2016-02-01

    Alluvial aquifers in mountainous regions cover typically a limited area. Their contribution to catchment storage and outflow is rarely isolated; alluvial groundwater discharge under gauging stations is generally assumed negligible; and hydrological models tend to lump alluvial storage with other units. The role of alluvial aquifers remains therefore unclear: can they contribute significantly to outflow when they cover a few percent of catchment area? Should they be considered a dynamic storage unit or merely a transmission zone? We address these issues based on the continuous monitoring of groundwater discharge, river discharge (one year), and aquifer storage (6 months) in the 6 km2 alluvial system of a 194 km2 catchment. River and groundwater outflow were measured jointly through "coupled gauging stations." The contribution of alluvial groundwater to outflow was highest at the outlet of a subcatchment (52 km2), where subsurface discharge amounted to 15% of mean annual outflow, and 85% of outflow during the last week of a drought. In this period, alluvial-aquifer depletion supported 75% of the subcatchment outflow and 35% of catchment outflow—thus 3% of the entire catchment supported a third of the outflow. Storage fluctuations occurred predominantly in the aquifer's upstream part, where heads varied over 6 m. Not only does this section act as a significant water source, but storage recovers also rapidly at the onset of precipitation. Storage dynamics were best conceptualized along the valley axis, rather than across the more conventional riparian-channel transect. Overall the contribution of alluvial aquifers to catchment outflow deserves more attention.

  6. Expression profiles of variation integration genes in bladder urothelial carcinoma.

    PubMed

    Wang, J M; Wang, Y Q; Gao, Z L; Wu, J T; Shi, B K; Yu, C C

    2014-01-01

    Bladder cancer is a common cancer worldwide and its incidence continues to increase. There are approximately 261,000 cases of bladder cancer resulting in 115,000 deaths annually. This study aimed to integrate bladder cancer genome copy number variation information and bladder cancer gene transcription level expression data to construct a causal-target module network of the range of bladder cancer-related genomes. Here, we explored the control mechanism underlying bladder cancer phenotype expression regulation by the major bladder cancer genes. We selected 22 modules as the initial module network to expand the search to screen more networks. After bootstrapping 100 times, we obtained 16 key regulators. These 16 key candidate regulatory genes were further expanded to identify the expression changes of 11,676 genes in 275 modules, which may all have the same regulation. In conclusion, a series of modules associated with the terms 'cancer' or 'bladder' were considered to constitute a potential network.

  7. Autophagy and urothelial carcinoma of the bladder: A review

    PubMed Central

    Chandrasekar, Thenappan

    2016-01-01

    The incidence of urothelial carcinoma of the urinary bladder (bladder cancer) remains high. While other solid organ malignancies have seen significant improvement in morbidity and mortality, there has been little change in bladder cancer mortality in the past few decades. The mortality is mainly driven by muscle invasive bladder cancer, but the cancer burden remains high even in nonmuscle invasive bladder cancer due to high recurrence rates and risk of progression. While apoptosis deregulation has long been an established pathway for cancer progression, nonapoptotic pathways have gained prominence of late. Recent research in the role of autophagy in other malignancies, including its role in treatment resistance, has led to greater interest in the role of autophagy in bladder cancer. Herein, we summarize the literature regarding the role of autophagy in bladder cancer progression and treatment resistance. We address it by systematically reviewing treatment modalities for nonmuscle invasive and muscle invasive bladder cancer. PMID:27326411

  8. Pediatric Obstructive Sleep Apnea

    PubMed Central

    Capdevila, Oscar Sans; Kheirandish-Gozal, Leila; Dayyat, Ehab; Gozal, David

    2008-01-01

    Obstructive sleep apnea (OSA) in children has emerged not only as a relatively prevalent condition but also as a disease that imposes a large array of morbidities, some of which may have long-term implications, well into adulthood. The major consequences of pediatric OSA involve neurobehavioral, cardiovascular, and endocrine and metabolic systems. The underlying pathophysiological mechanisms of OSA-induced end-organ injury are now being unraveled, and clearly involve oxidative and inflammatory pathways. However, the roles of individual susceptibility (as dictated by single-nucleotide polymorphisms), and of environmental and lifestyle conditions (such as diet, physical, and intellectual activity), may account for a substantial component of the variance in phenotype. Moreover, the clinical prototypic pediatric patient of the early 1990s has been insidiously replaced by a different phenotypic presentation that strikingly resembles that of adults afflicted by the disease. As such, analogous to diabetes, the terms type I and type II pediatric OSA have been proposed. The different manifestations of these two entities and their clinical course and approaches to management are reviewed. PMID:18250221

  9. Management of obstructed defecation

    PubMed Central

    Podzemny, Vlasta; Pescatori, Lorenzo Carlo; Pescatori, Mario

    2015-01-01

    The management of obstructed defecation syndrome (ODS) is mainly conservative and mainly consists of fiber diet, bulking laxatives, rectal irrigation or hydrocolontherapy, biofeedback, transanal electrostimulation, yoga and psychotherapy. According to our experience, nearly 20% of the patients need surgical treatment. If we consider ODS an “iceberg syndrome”, with “emerging rocks”, rectocele and rectal internal mucosal prolapse, that may benefit from surgery, at least two out of ten patients also has “underwater rocks” or occult disorders, such as anismus, rectal hyposensation and anxiety/depression, which mostly require conservative treatment. Rectal prolapse excision or obliterative suture, rectocele and/or enterocele repair, retrograde Malone’s enema and partial myotomy of the puborectalis muscle are effective in selected cases. Laparoscopic ventral sacral colporectopexy may be an effective surgical option. Stapled transanal rectal resection may lead to severe complications. The Transtar procedure seems to be safer, when dealing with recto-rectal intussusception. A multidisciplinary approach to ODS provides the best results. PMID:25632177

  10. COPD: obstructed lungs.

    PubMed

    Casey, Georgina

    2016-06-01

    CHRONIC OBSTRUCTIVE pulmonary diseases (COPD) affect 14 per cent of the population over 40 years of age. With an ageing population, the number of those requiring care for COPD is expected to increase, having a significant effect on health-care resources. COPD is projected to become the third leading cause of death globally by 2020. This disease has a major impact on economic and social well-being, and on quality of life. It is regarded as largely preventable but, once developed, is a progressive and complex condition characterised by frequent exacerbations and co-morbidities. Smoking is the primary cause of COPD but up to 30 per cent of those with COPD have never smoked. It is increasingly recognised COPD may have its origins prenatally and in early childhood. Treating exacerbations, improving exercise capacity, and delaying progression of disease are key management strategies. No curative or disease modifying therapies are available. Nurses are essential in providing comprehensive care to patients in both acute care and for long-term management. They also have a vital role to play in preserving healthy lung function in the early years of life to reduce the risk of COPD in older age. PMID:27514228

  11. Obstructive sleep apnea.

    PubMed

    White, David P; Younes, Magdy K

    2012-10-01

    Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive collapse of the pharyngeal airway during sleep. Control of pharyngeal patency is a complex process relating primarily to basic anatomy and the activity of many pharyngeal dilator muscles. The control of these muscles is regulated by a number of processes including respiratory drive, negative pressure reflexes, and state (sleep) effects. In general, patients with OSA have an anatomically small airway the patency of which is maintained during wakefulness by reflex-driven augmented dilator muscle activation. At sleep onset, muscle activity falls, thereby compromising the upper airway. However, recent data suggest that the mechanism of OSA differs substantially among patients, with variable contributions from several physiologic characteristics including, among others: level of upper airway dilator muscle activation required to open the airway, increase in chemical drive required to recruit the pharyngeal muscles, chemical control loop gain, and arousal threshold. Thus, the cause of sleep apnea likely varies substantially between patients. Other physiologic mechanisms likely contributing to OSA pathogenesis include falling lung volume during sleep, shifts in blood volume from peripheral tissues to the neck, and airway edema. Apnea severity may progress over time, likely due to weight gain, muscle/nerve injury, aging effects on airway anatomy/collapsibility, and changes in ventilatory control stability.

  12. Ion Outflow from Venus and Mars and the Processes Involved

    NASA Astrophysics Data System (ADS)

    Stenberg Wieser, G.; Holmstrom, M.; Futaana, Y.

    2015-12-01

    We review the ion outflow from Venus and Mars. We present the current best estimates of the escaping fluxes and describe the acceleration processes that have been identified. We discuss which solar wind parameters govern the response of the ionosphere as well as the role of the crustal magnetic fields on Mars. Although the characteristics of the two planets are very different, we find both similarities and differences when investigating the ion escape morphology and dynamics. Finally, we compare Venus and Mars with Earth and discuss the effect of a global intrinsic magnetic field on ion outflow and the potential importance of outflowing cold ions.

  13. Accretion driven outflows across the black hole mass scale

    NASA Astrophysics Data System (ADS)

    King, Ashley L.

    2016-04-01

    Pumping highly relativistic particles and radiation into their environment, accreting black holes co-evolve with their surroundings through their powerful outflows. These outflows are divided into highly collimated, relativistic jets and wide-angle winds, and are primarily associated with a particular accretion states. Understanding just how these outflows couple to the accretion flow will enable us to assess the amount of energy and feedback that is injected into the vicinity of a black hole. During this talk, I will discuss our studies of both stellar-mass and supermassive black hole outlfows, and how the similarities of these flows across the mass scale may point to common driving mechanisms.

  14. [Bladder stone surrounding a foreign body: a case report].

    PubMed

    Fekak, H; Rabii, R; Moufid, K; Guessous, H; Joual, A; Bennani, S; Elmrini, M; Benjeloun, S

    2003-04-01

    The bladder can be the site of various foreign bodies. We report one case of bladder stone including a foreign body in a 24 years old man with a psychomotor deficiency who was admitted for pyuria, block miction and bladder symptoms. The pelvic X-Ray film showed a bladder stone including a sewing needle. We analysed the diagnosis, aspect and therapeutic management of this case. PMID:12741198

  15. Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate

    PubMed Central

    Perez, Jose A.; Rich, Mark A.; Swana, Hubert S.

    2016-01-01

    Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates. PMID:27747129

  16. Numerical Modeling of η Carinae Bipolar Outflows

    NASA Astrophysics Data System (ADS)

    González, R. F.; de Gouveia Dal Pino, E. M.; Raga, A. C.; Velázquez, P. F.

    2004-12-01

    In this paper, we present two-dimensional gasdynamic simulations of the formation and evolution of the η Car bipolar outflows. Adopting the interacting nonspherical winds model, we have carried out high-resolution numerical simulations, which include explicitly computed time-dependent radiative cooling, for different possible scenarios of the colliding winds. In our simulations, we consider different degrees of nonspherical symmetry for the preoutburst wind and the great eruption of the 1840s produced by the η Car wind. Different models show important differences in the shape and kinematical properties of the Homunculus structure. In particular, we search for the appropriate combination of wind parameters (which control the degree of nonspherical symmetry) to obtain the numerical results that best match both the observed morphology and the expansion velocity of the η Car bipolar shell. In addition, our numerical simulations show the formation of a bipolar nebula embedded within the Homunculus (the little Homunculus) that developed from a secondary eruptive event suffered by the star in the 1890s, and also the development of tenuous, high-velocity ejections in the equatorial region that resulted from the impact of the eruptive wind of the 1840s with the preoutburst wind; these ejections could explain some of the high-speed features observed in the equatorial ejecta. The models were, however, unable to produce the equatorial ejections associated with the second eruptive event.

  17. HOT ELECTROMAGNETIC OUTFLOWS. II. JET BREAKOUT

    SciTech Connect

    Russo, Matthew; Thompson, Christopher

    2013-08-20

    We consider the interaction between radiation, matter, and a magnetic field in a compact, relativistic jet. The entrained matter accelerates outward as the jet breaks out of a star or other confining medium. In some circumstances, such as gamma-ray bursts (GRBs), the magnetization of the jet is greatly reduced by an advected radiation field while the jet is optically thick to scattering. Where magnetic flux surfaces diverge rapidly, a strong outward Lorentz force develops and radiation and matter begin to decouple. The increase in magnetization is coupled to a rapid growth in Lorentz factor. We take two approaches to this problem. The first examines the flow outside the fast magnetosonic critical surface, and calculates the flow speed and the angular distribution of the radiation field over a range of scattering depths. The second considers the flow structure on both sides of the critical surface in the optically thin regime, using a relaxation method. In both approaches, we find how the terminal Lorentz factor and radial profile of the outflow depend on the radiation intensity and optical depth at breakout. The effect of bulk Compton scattering on the radiation spectrum is calculated by a Monte Carlo method, while neglecting the effects of internal dissipation. The peak of the scattered spectrum sits near the seed peak if radiation pressure dominates the acceleration, but is pushed to a higher frequency if the Lorentz force dominates. The unscattered seed radiation can form a distinct, low-frequency component of the spectrum, especially if the magnetic Poynting flux dominates.

  18. The underactive bladder: detection and diagnosis.

    PubMed

    Osman, Nadir; Mangera, Altaf; Hillary, Christopher; Inman, Richard; Chapple, Christopher

    2016-01-01

    The inability to generate a voiding contraction sufficient to allow efficient bladder emptying within a reasonable time frame is a common problem seen in urological practice. Typically, the symptoms that arise are voiding symptoms, such as weak and slow urinary flow. These symptoms can cause considerable bother to patients and impact upon quality of life. The urodynamic finding of inadequate detrusor contraction has been termed detrusor underactivity (DUA). Although a definition is available for this entity, there are no widely accepted diagnostic criteria. Drawing parallels to detrusor overactivity and the overactive bladder, the symptoms arising from DUA have been referred to as the "underactive bladder" (UAB), while attempts to crystallize the definition of UAB are now ongoing. In this article, we review the contemporary literature pertaining to the epidemiology and etiopathogenesis of DUA as well as discuss the definitional aspects that are currently under consideration. PMID:27081483

  19. A flowgraph model for bladder carcinoma

    PubMed Central

    2014-01-01

    Background Superficial bladder cancer has been the subject of numerous studies for many years, but the evolution of the disease still remains not well understood. After the tumor has been surgically removed, it may reappear at a similar level of malignancy or progress to a higher level. The process may be reasonably modeled by means of a Markov process. However, in order to more completely model the evolution of the disease, this approach is insufficient. The semi-Markov framework allows a more realistic approach, but calculations become frequently intractable. In this context, flowgraph models provide an efficient approach to successfully manage the evolution of superficial bladder carcinoma. Our aim is to test this methodology in this particular case. Results We have built a successful model for a simple but representative case. Conclusion The flowgraph approach is suitable for modeling of superficial bladder cancer. PMID:25080066

  20. The underactive bladder: detection and diagnosis.

    PubMed

    Osman, Nadir; Mangera, Altaf; Hillary, Christopher; Inman, Richard; Chapple, Christopher

    2016-01-01

    The inability to generate a voiding contraction sufficient to allow efficient bladder emptying within a reasonable time frame is a common problem seen in urological practice. Typically, the symptoms that arise are voiding symptoms, such as weak and slow urinary flow. These symptoms can cause considerable bother to patients and impact upon quality of life. The urodynamic finding of inadequate detrusor contraction has been termed detrusor underactivity (DUA). Although a definition is available for this entity, there are no widely accepted diagnostic criteria. Drawing parallels to detrusor overactivity and the overactive bladder, the symptoms arising from DUA have been referred to as the "underactive bladder" (UAB), while attempts to crystallize the definition of UAB are now ongoing. In this article, we review the contemporary literature pertaining to the epidemiology and etiopathogenesis of DUA as well as discuss the definitional aspects that are currently under consideration.

  1. Botulinum Toxin to Treat Neurogenic Bladder.

    PubMed

    Smith, Christopher P; Chancellor, Michael B

    2016-02-01

    Alteration in neural control from suprapontine areas to the nerves innervating the bladder can lead to bladder dysfunction and the development of a neurogenic bladder (NGB). Patients with NGB often suffer from urinary incontinence, which can lead to adverse events such as urinary tract infections and decubiti, in addition to creating a large care burden for family members or healthcare providers and significantly impairing patient quality of life. The common failure of anticholinergic medications has spurned the development of second-line treatments, including the use of botulinum toxin. OnabotulinumtoxinA (onaBoNT-A; BOTOX, Allergan, Inc.) was approved by the U.S. Food and Drug Administration (FDA) in 2011 to treat neurogenic detrusor overactivity in patients with urinary incontinence resulting from a NGB. In this review the authors summarize pertinent results from key trials leading to FDA approval of onaBoNT-A as well as more recent long-term data.

  2. Optimizing systemic therapy for bladder cancer.

    PubMed

    Pal, Sumanta K; Milowsky, Matthew I; Plimack, Elizabeth R

    2013-07-01

    Over the past several decades, few new systemic agents have been incorporated into the treatment paradigm for bladder cancer. Platinum-based therapy remains the cornerstone of treatment in the perioperative and metastatic settings. Despite level one evidence, use of cisplatin-based therapy in the neoadjuvant setting has been dismal. Second-line therapy for metastatic disease has only modest activity with no survival benefit. However, the elucidation and investigation of novel molecular targets, new therapeutics, and associated biomarkers with strong biologic rationale are actively changing the landscape in bladder cancer. Although the field is moving rapidly, no new drug approvals are currently pending and a need remains to continue to educate the medical oncology and urology communities on the optimal use of currently available treatments. This article outlines the evidence, including that from prospective studies and meta-analyses, providing the basis for the current recommendations from NCCN, and details previous and ongoing studies of targeted therapy for bladder cancer.

  3. Urothelial bladder cancer with cavitary lung metastases.

    PubMed

    Kurian, Anil; Lee, Jason; Born, Abraham

    2011-01-01

    Transitional cell carcinoma (TCC) of the bladder tends to remain superficial; however, in 5% to 20% of cases, it progresses to muscle invasion and, more rarely, can metastasize. TCC of the bladder primarily spreads via regional lymphatics. The most common sites of distant metastases of TCC are the liver, lung, mediastinum and bone. Longterm survival of patients with metastatic bladder cancer is rare. Patterns of pulmonary metastasis include multiple nodules, a solitary mass or interstitial micronodule. When multiple nodules are present, they are round and well-circumscribed, without calcification or cavitation. An unusual case of rapidly metastatic TCC to the lung causing large cavitary masses and nodules is presented. Imaging performed after the patient began chemotherapy revealed widespread necrosis of the metastatic cavitary masses causing moderate volume hemoptysis. PMID:21766082

  4. Neural reconstruction methods of restoring bladder function

    PubMed Central

    Gomez-Amaya, Sandra M.; Barbe, Mary F.; de Groat, William C.; Brown, Justin M.; Tuite, Gerald F.; Corcos, Jacques; Fecho, Susan B.; Braverman, Alan S.; Ruggieri, Michael R.

    2015-01-01

    During the past century, diverse studies have focused on the development of surgical strategies to restore function of a decentralized bladder after spinal cord or spinal root injury via repair of the original roots or by transferring new axonal sources. The techniques included end-to-end sacral root repairs, transfer of roots from other spinal segments to sacral roots, transfer of intercostal nerves to sacral roots, transfer of various somatic nerves to the pelvic or pudendal nerve, direct reinnervation of the detrusor muscle, or creation of an artificial reflex pathway between the skin and the bladder via the central nervous system. All of these surgical techniques have demonstrated specific strengths and limitations. The findings made to date already indicate appropriate patient populations for each procedure, but a comprehensive assessment of the effectiveness of each technique to restore urinary function after bladder decentralization is required to guide future research and potential clinical application. PMID:25666987

  5. Hydrothermal outflow plume of Valles caldera, New Mexico, and a comparison with other outflow plumes

    SciTech Connect

    Goff, F.; Shevenell, L.; Gardner, J.N.; Vuataz, F.; Grigsby, C.O.

    1988-06-10

    Stratigraphic, temperature gradient, hydrogeochemical, and hydrologic data have been integrated with geologic data from previous studies to show the structural configuration of the Valles caldera hydrothermal outflow plume. Hydrologic data suggest that 25--50% of the discharge of the Valles outflow is confined to the Jemez fault zone, which predates caldera formation. Thermal gradient data from bores penetrating the plume show that shallow gradients are highest in the vicinity of the Jemez fault zone (up to 190 /sup 0/C/km). Shallow heat flow above the hydrothermal plume is as high as 500 mW m/sup -2/ near core hole VC-1 (Jemez fault zone) to 200 mW m/sup -2/ at Fenton Hill (Jemez Plateau). Chemical and isotopic data indicate that two source reservoirs within the caldera (Redondo Creek and Sulphur Springs reservoirs) are parents to mixed fluids flowing in the hydrothermal plume. However, isotopic data, borehole data, basic geology, and inverse relations between temperature and chloride content at major hot springs indicate that no single reservoir fluid and no single diluting fluid are involved in mixing. The Valles caldera hydrothermal plume is structurally dominated by lateral flow through a belt of vertical conduits (Jemez fault zone) that strike away from the source reservoir. Stratigraphically confined flow is present but dispersed over a wide area in relatively impermeable rocks. The Valles configuration is contrasted with the configuration of the hydrothermal plume at Roosevelt Hot Springs, which is dominated by lateral flow through a near-surface, widespread, permeable aquifer. Data from 12 other representative geothermal systems show that outflow plumes occur in a variety of magmatic and tectonic settings, have varying reservoir compositions, and have different flow characteristics.

  6. Indirect measurement of Delta outflow using ultrasonic velocity meters and comparison with mass-balance calculated outflow

    USGS Publications Warehouse

    Oltmann, Richard N.

    1998-01-01

    A measurement of the quantity of water flowing from the Sacramento-San Joaquin Delta into Suisun Bay (Delta outflow) has been desired by those studying and managing the San Francisco Bay/Delta estuary since the 1920s.  Historically, Delta outflow has been estimated using a mass-balance calculation that uses measured Delta inflows and exports, and imprecise estimates of consumptive use for the approximately 2,000 small agricultural diversions with the Delta.  The DWR has estimated Delta outflow for 1929 to present using the computer program DAYFLOW.

  7. Calcifying nanoparticles associated encrusted urinary bladder cystitis

    PubMed Central

    Jelic, Tomislav M; Roque, Rod; Yasar, Uzay; Tomchin, Shayna B; Serrato, Jose M; Deem, Samuel G; Tierney, James P; Chang, Ho-Huang

    2008-01-01

    Encrusted cystitis is a subtype of chronic cystitis characterized by multiple calcifications in the form of plaques located in the interstitium of the urinary bladder mucosa and frequently associated with mucosal ulcers. It is a very rare disease of controversial etiology. Our transmission electron microscopy of the calcified plaques of encrusted cystitis has revealed that the smallest formed particles (elementary units) of these calcifications are electron-dense shells surrounding an electron lucent core, diagnostic of calcifying nanoparticles (previously called nanobacteria). We pioneer the notion that calcifying nanoparticles are the causative agents of encrusted urinary bladder cystitis. PMID:18990947

  8. Urinary Tract Infection and Neurogenic Bladder.

    PubMed

    McKibben, Maxim J; Seed, Patrick; Ross, Sherry S; Borawski, Kristy M

    2015-11-01

    Urinary tract infections (UTIs) are frequent, recurrent, and lifelong for patients with neurogenic bladder and present challenges in diagnosis and treatment. Patients often present without classic symptoms of UTI but with abdominal or back pain, increased spasticity, and urinary incontinence. Failure to recognize and treat infections can quickly lead to life-threatening autonomic dysreflexia or sepsis, whereas overtreatment contributes to antibiotic resistance, thus limiting future treatment options. Multiple prevention methods are used but evidence-based practices are few. Prevention and treatment of symptomatic UTI requires a multimodal approach that focuses on bladder management as well as accurate diagnosis and appropriate antibiotic treatment. PMID:26475949

  9. Calcifying nanoparticles associated encrusted urinary bladder cystitis.

    PubMed

    Jelic, Tomislav M; Roque, Rod; Yasar, Uzay; Tomchin, Shayna B; Serrato, Jose M; Deem, Samuel G; Tierney, James P; Chang, Ho-Huang

    2008-01-01

    Encrusted cystitis is a subtype of chronic cystitis characterized by multiple calcifications in the form of plaques located in the interstitium of the urinary bladder mucosa and frequently associated with mucosal ulcers. It is a very rare disease of controversial etiology. Our transmission electron microscopy of the calcified plaques of encrusted cystitis has revealed that the smallest formed particles (elementary units) of these calcifications are electron-dense shells surrounding an electron lucent core, diagnostic of calcifying nanoparticles (previously called nanobacteria). We pioneer the notion that calcifying nanoparticles are the causative agents of encrusted urinary bladder cystitis. PMID:18990947

  10. Small cell carcinoma of the bladder

    PubMed Central

    Calado, Bruno Nagel; Maron, Paulo Eduardo Goulart; Vedovato, Bruno César; Barrese, Tomas Zecchini; Fernandes, Roni de Carvalho; Perez, Marjo Deninson Cardenuto

    2015-01-01

    Small cell carcinoma of the urinary bladder is an extremely aggressive and rare tumor. Even though small cell carcinoma most commonly arises from the lungs there are several reports of small cell carcinoma in extrapulmonary sites. Due to its low frequency there is no well-established management for this disease. We report the case of a 61 year-old man with small cell carcinoma of the bladder who underwent radical cystectomy following neoadjuvant chemotherapy. We also reviewed the literature for the optimal treatment strategy. PMID:25517085

  11. Morphology of Fresh Outflow Channel Deposits on Mars

    NASA Astrophysics Data System (ADS)

    Rice, J. W., Jr.; Parker, T. J.; Russell, A. J.; Knudsen, O.

    2002-03-01

    We interpret the channel surface of Athabasca and Marte Valles to be fresh former ice-rich fluvial (hyperconcentrated) deposits rather than volcanic flows. Simply stated, this is what a fresh outflow channel deposit would look like.

  12. RECONNECTION OUTFLOW GENERATED TURBULENCE IN THE SOLAR WIND

    SciTech Connect

    Vörös, Z.; Sasunov, Y. L.; Zaqarashvili, T. V.; Khodachenko, M.; Semenov, V. S.; Bruno, R.

    2014-12-10

    Petschek-type time-dependent reconnection (TDR) and quasi-stationary reconnection (QSR) models are considered to understand reconnection outflow structures and the generation of local turbulence in the solar wind. Comparing TDR/QSR model predictions of the outflow structures with actual measurements shows that both models can explain the data equally well. It is demonstrated that the outflows can often generate more or less spatially extended turbulent boundary layers. The structure of a unique extended reconnection outflow is investigated in detail. The analysis of spectral scalings and spectral break locations shows that reconnection can change the local field and plasma conditions which may support different local turbulent dissipation mechanisms at their characteristic wavenumbers.

  13. Detection of an Extended Outflow in NGC 4102

    NASA Astrophysics Data System (ADS)

    Trent Braun, Timothy; van Zee, Liese; Richards, Emily E.; McQuinn, Kristen B.; Skillman, Evan D.; Edges

    2015-01-01

    We report the detection of an extended galactic outflow in narrowband H alpha imaging of NGC 4102, a nearby spiral galaxy that hosts a low ionization nuclear emission region (LINER) and a circumnuclear H II region. NGC 4102 is a moderate luminosity galaxy, M_B = -19.3, in the Ursa Major Cluster. The outflow protrudes out to 60' (5 kpc at an adopted distance of 17.4 Mpc) to the northwest of the galactic center and may extend as much as 75' (6.3 kpc.) Follow-up integral field spectroscopic observations reveal split line profiles over the outflow region, indicative of both blue and red shifted emission-line components. Based on [N II] / H alpha and [S II] flux ratios of this region, the line emission appears to be nonthermal. We discuss possible origins of the outflow, including both nuclear and/or starburst activity.

  14. ASSOCIATIONS BETWEEN ULTRASOUND AND CLINICAL FINDINGS IN 87 CATS WITH URETHRAL OBSTRUCTION.

    PubMed

    Nevins, Jonathan R; Mai, Wilfried; Thomas, Emily

    2015-01-01

    Urethral obstruction is a life-threatening form of feline lower urinary tract disease. Ultrasonographic risk factors for reobstruction have not been previously reported. Purposes of this retrospective cross-sectional study were to describe urinary tract ultrasound findings in cats following acute urethral obstruction and determine whether ultrasound findings were associated with reobstruction. Inclusion criteria were a physical examination and history consistent with urethral obstruction, an abdominal ultrasound including a full evaluation of the urinary system within 24 h of hospitalization, and no cystocentesis prior to ultrasound examination. Medical records for included cats were reviewed and presence of azotemia, hyperkalemia, positive urine culture, and duration of hospitalization were recorded. For medically treated cats with available outcome data, presence of reobstruction was also recorded. Ultrasound images were reviewed and urinary tract characteristics were recorded. A total of 87 cats met inclusion criteria. Common ultrasound findings for the bladder included echogenic urine sediment, bladder wall thickening, pericystic effusion, hyperechoic pericystic fat, and increased urinary echoes; and for the kidneys/ureters included pyelectasia, renomegaly, perirenal effusion, hyperechoic perirenal fat, and ureteral dilation. Six-month postdischarge outcomes were available for 61 medically treated cats and 21 of these cats had reobstruction. No findings were associated with an increased risk of reobstruction. Ultrasonographic perirenal effusion was associated with severe hyperkalemia (P = 0.009, relative risk 5.75, 95% confidence interval [1.54-21.51]). Findings supported the use of ultrasound as an adjunct for treatment planning in cats presented with urethral obstruction but not as a method for predicting risk of reobstruction.

  15. Radiofrequency catheter septal ablation for hypertrophic obstructive cardiomyopathy in children

    PubMed Central

    Emmel, M.; Sreeram, N.

    2005-01-01

    Background The definitive therapeutic options for symptomatic obstructive cardiomyopathy in childhood are restricted. At present, extensive surgical myectomy is the only procedure that is of proven benefit. Patients and Methods Three patients, aged 5, 11 and 17 years, respectively, with progressive hypertrophic obstructive cardiomyopathy and increasing symptoms were considered for radiofrequency catheter septal ablation. The peak Doppler gradient recorded on several occasions ranged between 50 to 90mmHg. Via a femoral arterial approach, the His bundle was initially plotted and marked using the LocaLisa navigation system. Subsequently, using a cooled tip catheter a series of lesions were placed in the hypertrophied septum, taking care to stay away from the His bundle. A total of 17, 50 and 45 lesions were applied in the three patients. In one case, the procedure was complicated by two episodes of ventricular fibrillation requiring DC cardioversion but without any neurological sequelae. Results The preablation peak-to-peak gradient between left ventricle and aorta was 50 mmHg, 60 mmHg and 60 mmHg, respectively, and remained unchanged immediately after the procedure. All patients were discharged from hospital 48 hours later. Serial measurement of serum troponin T and CK-MB isoenzyme confirmed significant myocardial necrosis. Follow-up echocardiography both at seven days and at six weeks postablation confirmed a beneficial haemodynamic result, with reduction of left ventricular outflow obstruction and relief of symptoms. Conclusion In young children, in whom alcohol-induced septal ablation is not an option, radiofrequency catheter ablation offers an alternative to surgery, with the benefits of repeatability and a lower risk of procedure-related permanent AV block. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696442

  16. Physical Factors Affecting Outflow Facility Measurements in Mice

    PubMed Central

    Boussommier-Calleja, Alexandra; Li, Guorong; Wilson, Amanda; Ziskind, Tal; Scinteie, Oana Elena; Ashpole, Nicole E.; Sherwood, Joseph M.; Farsiu, Sina; Challa, Pratap; Gonzalez, Pedro; Downs, J. Crawford; Ethier, C. Ross; Stamer, W. Daniel; Overby, Darryl R.

    2015-01-01

    Purpose Mice are commonly used to study conventional outflow physiology. This study examined how physical factors (hydration, temperature, and anterior chamber [AC] deepening) influence ocular perfusion measurements in mice. Methods Outflow facility (C) and pressure-independent outflow (Fu) were assessed by multilevel constant pressure perfusion of enucleated eyes from C57BL/6 mice. To examine the effect of hydration, seven eyes were perfused at room temperature, either immersed to the limbus in saline and covered with wet tissue paper or exposed to room air. Temperature effects were examined in 12 eyes immersed in saline at 20°C or 35°C. Anterior chamber deepening was examined in 10 eyes with the cannula tip placed in the anterior versus posterior chamber (PC). Posterior bowing of the iris (AC deepening) was visualized by three-dimensional histology in perfusion-fixed C57BL/6 eyes and by spectral-domain optical coherence tomography in living CD1 mice. Results Exposure to room air did not significantly affect C, but led to a nonzero Fu that was significantly reduced upon immersion in saline. Increasing temperature from 20°C to 35°C increased C by 2.5-fold, more than could be explained by viscosity changes alone (1.4-fold). Perfusion via the AC, but not the PC, led to posterior iris bowing and increased outflow. Conclusions Insufficient hydration contributes to the appearance of pressure-independent outflow in enucleated mouse eyes. Despite the large lens, AC deepening may artifactually increase outflow in mice. Temperature-dependent metabolic processes appear to influence conventional outflow regulation. Physical factors should be carefully controlled in any outflow studies involving mice. PMID:26720486

  17. Analytical Investigation of Mass Outflow Rate in Quasars

    NASA Astrophysics Data System (ADS)

    Das, Santabrata; Chakrabarti, Sandip K.

    Centrifugal force of rapidly infalling matter onto a quasar brakes the flow and forms a centrifugal pressure dominated boundary layer (CENBOL) around the central engine. The thermal and magnetic pressure pushes matter along the axis to form observed radio jets. We present analytical work showing how the inflow influences the nature of CENBOL and dictates the outflow rate from the accretion disks. We show that the outflow rate directly depends on the temperature of CENBOL.

  18. Ultra-fast outflows (aka UFOs) from AGNs and QSOs

    NASA Astrophysics Data System (ADS)

    Cappi, M.; Tombesi, F.; Giustini, M.

    During the last decade, strong observational evidence has been accumulated for the existence of massive, high velocity winds/outflows (aka Ultra Fast Outflows, UFOs) in nearby AGNs and in more distant quasars. Here we briefly review some of the most recent developments in this field and discuss the relevance of UFOs for both understanding the physics of accretion disk winds in AGNs, and for quantifying the global amount of AGN feedback on the surrounding medium.

  19. Toward a Prescription for Feedback from Quasar Outflows

    NASA Astrophysics Data System (ADS)

    Ganguly, Rajib; Bourjaily, M.; Munsell, J.; Brotherton, M. S.; Bhattacharjee, A.; Runnoe, J.; Charlton, J. C.; Eracleous, M.

    2011-01-01

    Models have shown that quasars are a crucial ingredient in the evolution of massive galaxies. Outflows play a key role in the story of quasars and their host galaxies, by helping regulate the accretion process, the star-formation rate and mass of the host galaxy (i.e., feedback). The prescription for modeling outflows as a contributor to feedback requires knowledge of the outflow velocity, distance, geometry, and column density. In particular, we need to understand how these depend on physical parameters and how much is determined stochastically (and with what distribution). For this purpose, we are examining a sample of 14000 z=1.7-2.0 quasars from the Sloan Digital Sky Survey. This redshift range permits the following from the SDSS spectra: (1) separation of objects that do and do not exhibit outflows; (2) classification/measurement of outflow properties (ionization, velocity, velocity width); and (3) estimates of the quasar black hole mass. To this, we are adding photometry from GALEX, 2MASS, and ROSAT in an effort to characterize more fully the quasar SEDs. ROSAT photometry provides estimates of the level of soft X-ray absorption, which helps regulate the velocity of outflows. GALEX photometry samples the extreme ultraviolet range where several high ionization species, that may be present in the outflows, absorb light. 2MASS photometry samples the rest-frame optical, where the effects of absorption and dust reddening are minimal, yield better estimates of the bolometric luminosity (hence, Eddington ratio). In this poster, we will present preliminary measurements of the amount of absorption in the soft X-ray and extreme ultraviolet bands as a function of both outflow properties and quasar physical properties. This material is based upon work supported by the National Aeronautics and Space Administration under Grant No. 09-ADP09-0016 issued through the Astrophysics Data Analysis Program.

  20. Chandra Observations of Outflows from PSR J1509–5850

    NASA Astrophysics Data System (ADS)

    Klingler, Noel; Kargaltsev, Oleg; Rangelov, Blagoy; Pavlov, George G.; Posselt, Bettina; Ng, C.-Y.

    2016-09-01

    PSR J1509–5850 is a middle-aged pulsar with a period of P ≈ 89 ms and spin-down power of \\dot{E}=5.1× {10}35 erg s‑1, at a distance of about 3.8 kpc. We report on deep Chandra X-ray Observatory observations of this pulsar and its pulsar wind nebula (PWN). In addition to the previously detected tail extending up to 7‧ southwest from the pulsar (the southern outflow), the deep images reveal similarly long, faint, diffuse emission stretched toward the north (the northern outflow) and the fine structure of the compact nebula (CN) in the pulsar vicinity. The CN is resolved into two lateral tails and one axial tail pointing southwest (a morphology remarkably similar to that of the Geminga PWN), which supports the assumption that the pulsar moves toward the northeast. The luminosities of the southern and northern outflows are about 1× {10}33 and 4× {10}32 erg s‑1, respectively. The spectra extracted from four regions of the southern outflow do not show any softening with increasing distance from the pulsar. The lack of synchrotron cooling suggests a high flow speed or in situ acceleration of particles. The spectra extracted from two regions of the northern outflow show a hint of softening with distance from the pulsar, which may indicate slower particle propagation. We speculate that the northern outflow is associated with particle leakage from the bow-shock apex into the ISM, while the southern outflow represents the tail of the shocked pulsar wind behind the moving pulsar. We estimate the physical parameters of the observed outflows and compare the J1509–5850 PWN with PWNe of other supersonically moving pulsars.

  1. Characterization of molecular outflows in the substellar domain

    SciTech Connect

    Phan-Bao, Ngoc; Dang-Duc, Cuong; Lee, Chin-Fei; Ho, Paul T. P.; Li, Di E-mail: pbngoc@asiaa.sinica.edu.tw

    2014-11-01

    We report here our latest search for molecular outflows from young brown dwarfs and very low-mass stars in nearby star-forming regions. We have observed three sources in Taurus with the Submillimeter Array and the Combined Array for Research in Millimeter-wave Astronomy at 230 GHz frequency to search for CO J = 2 → 1 outflows. We obtain a tentative detection of a redshifted and extended gas lobe at about 10 arcsec from the source GM Tau, a young brown dwarf in Taurus with an estimated mass of 73 M {sub J}, which is right below the hydrogen-burning limit. No blueshifted emission around the brown dwarf position is detected. The redshifted gas lobe that is elongated in the northeast direction suggests a possible bipolar outflow from the source with a position angle of about 36°. Assuming that the redshifted emission is outflow emission from GM Tau, we then estimate a molecular outflow mass in the range from 1.9 × 10{sup –6} M {sub ☉} to 2.9 × 10{sup –5} M {sub ☉} and an outflow mass-loss rate from 2.7 × 10{sup –9} M {sub ☉} yr{sup –1} to 4.1 × 10{sup –8} M {sub ☉} yr{sup –1}. These values are comparable to those we have observed in the young brown dwarf ISO-Oph 102 of 60 M {sub J} in ρ Ophiuchi and the very low-mass star MHO 5 of 90 M {sub J} in Taurus. Our results suggest that the outflow process in very low-mass objects is episodic with a duration of a few thousand years and the outflow rate of active episodes does not significantly change for different stages of the formation process of very low-mass objects. This may provide us with important implications that clarify the formation process of brown dwarfs.

  2. Chandra Observations of Outflows from PSR J1509-5850

    NASA Astrophysics Data System (ADS)

    Klingler, Noel; Kargaltsev, Oleg; Rangelov, Blagoy; Pavlov, George G.; Posselt, Bettina; Ng, C.-Y.

    2016-09-01

    PSR J1509-5850 is a middle-aged pulsar with a period of P ≈ 89 ms and spin-down power of \\dot{E}=5.1× {10}35 erg s-1, at a distance of about 3.8 kpc. We report on deep Chandra X-ray Observatory observations of this pulsar and its pulsar wind nebula (PWN). In addition to the previously detected tail extending up to 7‧ southwest from the pulsar (the southern outflow), the deep images reveal similarly long, faint, diffuse emission stretched toward the north (the northern outflow) and the fine structure of the compact nebula (CN) in the pulsar vicinity. The CN is resolved into two lateral tails and one axial tail pointing southwest (a morphology remarkably similar to that of the Geminga PWN), which supports the assumption that the pulsar moves toward the northeast. The luminosities of the southern and northern outflows are about 1× {10}33 and 4× {10}32 erg s-1, respectively. The spectra extracted from four regions of the southern outflow do not show any softening with increasing distance from the pulsar. The lack of synchrotron cooling suggests a high flow speed or in situ acceleration of particles. The spectra extracted from two regions of the northern outflow show a hint of softening with distance from the pulsar, which may indicate slower particle propagation. We speculate that the northern outflow is associated with particle leakage from the bow-shock apex into the ISM, while the southern outflow represents the tail of the shocked pulsar wind behind the moving pulsar. We estimate the physical parameters of the observed outflows and compare the J1509-5850 PWN with PWNe of other supersonically moving pulsars.

  3. Identifying the Main Driver of Active Region Outflows

    NASA Astrophysics Data System (ADS)

    Baker, D.; van Driel-Gesztelyi, L.; Mandrini, C. H.; Démoulin, P.; Murray, M. J.

    2012-08-01

    Hinode's EUV Imaging Spectrometer (EIS) has discovered ubiquitous outflows of a few to 50 km s-1 from active regions (ARs). The characteristics of these outflows are very curious in that they are most prominent at the AR boundary and appear over monopolar magnetic areas. They are linked to strong non-thermal line broadening and are stronger in hotter EUV lines. The outflows persist for at least several days. Whereas red-shifted down flows observed in AR closed loops are well understood, to date there is no general consensus for the mechanism(s) driving blue-shifted AR-related outflows. We use Hinode EIS and X-Ray Telescope observations of AR 10942 coupled with magnetic modeling to demonstrate for the first time that the outflows originate from specific locations of the magnetic topology where field lines display strong gradients of magnetic connectivity, namely quasi-separatrix layers (QSLs), or in the limit of infinitely thin QSLs, separatrices. The strongest AR outflows were found to be in the vicinity of QSL sections located over areas of strong magnetic field. We argue that magnetic reconnection at QSLs, separating closed field lines of the AR and either large-scale externally connected or ‘open’ field lines, is a viable mechanism for driving AR outflows which are potentially sources of the slow solar wind. In fact, magnetic reconnection along QSLs (including separatricies) is the first theory to explain the most puzzling characteristics of the outflows, namely their occurrence over monopolar areas at the periphery of ARs and their longevity.

  4. Acute Bladder Necrosis after Pelvic Arterial Embolization for Pelvic Trauma: Lessons Learned from Two Cases of Immediate Postembolization Bladder Necrosis

    PubMed Central

    Osterberg, E. Charles; Elliott, Sean P.; Hittelman, Adam B.

    2016-01-01

    We report two cases of acute bladder injury with bladder neck necrosis identified during the initial operative evaluation and within the early postprocedural period in patients with significant pelvic trauma requiring pelvic vascular embolization. To our knowledge, this is the first report of bladder neck necrosis found during the initial intraoperative surgical evaluation or early postoperative setting.

  5. Acute Bladder Necrosis after Pelvic Arterial Embolization for Pelvic Trauma: Lessons Learned from Two Cases of Immediate Postembolization Bladder Necrosis

    PubMed Central

    Osterberg, E. Charles; Elliott, Sean P.; Hittelman, Adam B.

    2016-01-01

    We report two cases of acute bladder injury with bladder neck necrosis identified during the initial operative evaluation and within the early postprocedural period in patients with significant pelvic trauma requiring pelvic vascular embolization. To our knowledge, this is the first report of bladder neck necrosis found during the initial intraoperative surgical evaluation or early postoperative setting. PMID:27656309

  6. Fgfr2 is integral for bladder mesenchyme patterning and function

    PubMed Central

    Walker, K. A.; Ikeda, Y.; Zabbarova, I.; Schaefer, C. M.; Bushnell, D.; De Groat, W. C.; Kanai, A.

    2015-01-01

    While urothelial signals, including sonic hedgehog (Shh), drive bladder mesenchyme differentiation, it is unclear which pathways within the mesenchyme are critical for its development. Studies have shown that fibroblast growth factor receptor (Fgfr)2 is necessary for kidney and ureter mesenchymal development. The objective of the present study was to determine the role of Fgfr2 in the bladder mesenchyme. We used Tbx18cre mice to delete Fgfr2 in the bladder mesenchyme (Fgfr2BM−/−). We performed three-dimensional reconstructions, quantitative real-time PCR, in situ hybridization, immunolabeling, ELISAs, immunoblot analysis, void stain on paper, ex vivo bladder sheet assays, and in vivo decerebrated cystometry. Compared with control bladders, embryonic day 16.5 (E16.5) Fgfr2BM−/− bladders had thin muscle layers with less α-smooth muscle actin and thickened lamina propria with increased collagen type Ia and IIIa that intruded into the muscle. The reciprocal changes in mutant layer thicknesses appeared partly due to a cell fate switch. From postnatal days 1 to 30, Fgfr2BM−/− bladders demonstrated progressive muscle loss and increased collagen expression. Postnatal Fgfr2BM−/− bladder sheets exhibited decreased agonist-mediated contractility and increased passive stretch tension versus control bladder sheets. Cystometry revealed high baseline and threshold pressures and shortened intercontractile intervals in Fgfr2BM−/− versus control bladders. Mechanistically, whereas Shh expression appeared normal, mRNA and protein readouts of hedgehog activity were increased in E16.5 Fgfr2BM−/− versus control bladders. Moreover, E16.5 Fgfr2BM−/− bladders exhibited higher levels of Cdo and Boc, hedgehog coreceptors that enhance sensitivity to Shh, compared with control bladders. In conclusion, loss of Fgfr2 in the bladder mesenchyme leads to abnormal bladder morphology and decreased compliance and contractility. PMID:25656370

  7. Airway obstruction with cricoid pressure.

    PubMed

    Hartsilver, E L; Vanner, R G

    2000-03-01

    Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a face-mask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p = 0.0001) unless the force is applied in an upward and backward direction.

  8. Airway obstruction with cricoid pressure.

    PubMed

    Hartsilver, E L; Vanner, R G

    2000-03-01

    Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a face-mask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p = 0.0001) unless the force is applied in an upward and backward direction. PMID:10671836

  9. The Implications of Extreme Outflows from Extreme Starbursts

    NASA Astrophysics Data System (ADS)

    Heckman, Timothy M.; Borthakur, Sanchayeeta

    2016-05-01

    Interstellar ultraviolet absorption lines provide crucial information about the properties of galactic outflows. In this paper, we augment our previous analysis of the systematic properties of starburst-driven galactic outflows by expanding our sample to include a rare population of starbursts with exceptionally high outflow velocities. In principle, these could be a qualitatively different phenomenon from more typical outflows. However, we find that instead these starbursts lie on, or along the extrapolation of, the trends defined by the more typical systems studied previously by us. We exploit the wide dynamic range provided by this new sample to determine scaling relations of outflow velocity with galaxy stellar mass (M *), circular velocity, star formation rate (SFR), SFR/M *, and SFR/area. We argue that these results can be accommodated within the general interpretational framework we previously advocated, in which a population of ambient interstellar or circumgalactic clouds is accelerated by the combined forces of gravity and the momentum flux from the starburst. We show that this simple physical picture is consistent with both the strong cosmological evolution of galactic outflows in typical star-forming galaxies and the paucity of such galaxies with spectra showing inflows. We also present simple parameterizations of these results that can be implemented in theoretical models and numerical simulations of galaxy evolution.

  10. Estimating the Circulation and Net Plasma Loss from Ionospheric Outflow

    NASA Astrophysics Data System (ADS)

    Haaland, S.; Engwall, E.; Eriksson, A. I.; Nilsson, H.; Foerster, M.; Lybekk, B.; Svenes, K.; Pedersen, A.

    2010-12-01

    An important source of magnetospheric plasma is outflow from the terrestrial ionosphere. Low energy ions travel along the magnetic field lines and enter the magnetospheric lobes and are convected towards the tail plasma sheet. Results from Cluster indicate that the field aligned outflow velocity is sometimes much higher than the convection towards the central plasma sheet. A substantial amount of plasma therefore escape downtail without ever reaching the central plasma sheet. In this work, we use Cluster measurements of the ionospheric outflow and lobe convection velocities combined with a model of the magnetic field in an attempt to quantify the plasma loss for various magnetospheric conditions. The results show that both the circulation of plasma but also the tailward escape of ions increase significantly during disturbed magnetospheric conditions. For strong solar wind driving with a southward interplanetary magnetic field, also typically associated with high geomagnetic activity, most of the outflowing plasma are convected to the plasma sheet and recirculated. For periods with northward interplanetary magnetic field, the convection is nearly stagnant, whereas the outflow, although limited, still persist. During such conditions, the outflowing ions escape downtail and are lost into the solar wind.

  11. A COMPLETE Search for Molecular Outflows in Perseus

    NASA Astrophysics Data System (ADS)

    Fallscheer, C.; Borkin, M.; Ridge, N.; Schnee, S.; Goodman, A.

    2003-12-01

    Using 12CO data collected in the Coordinated Molecular Probe Line Extinction Thermal Emission (COMPLETE) Survey, we have carried out an unbiased search for molecular outflows. To begin the search, we analyzed maps of the Spectral Correlation Function (SCF) of the 12CO spectra, at a variety of spatial lags. The known outflows were all apparent in the SCF maps as regions of either very low or very high spectral correlation. Other regions identified by the SCF as having low or high spectral correlation in the data cube were examined by hand in order to assess the possibility that they harbored previously unknown outflows. Upon making customized "channel" maps of these 15 suspect regions, we have now confidently identified 4 new outflows, and 11 other regions with unusual spectral properties potentially associated with outflow. This work is still in progress, but we can say with certainty that COMPLETE has identified several new molecular outflows in Perseus. This work was supported in part by the SAO intern program under NSF grant AST-9731923.

  12. On the physical origin of AGN outflow driving mechanisms

    NASA Astrophysics Data System (ADS)

    Ishibashi, Wako

    2016-07-01

    Super-massive black holes in active galactic nuclei (AGN) respond to the accretion process by feeding back energy and momentum into the surrounding environment. Galaxy-scale outflows are thought to provide the physical link connecting the small scales of the central black hole to the large scales of the host galaxy. Such powerful outflows are now starting to be commonly observed, and have been considered as a proof of AGN feedback in action. However, the physical origin of the mechanism driving the observed outflows is still unclear, and whether it is due to energy-driving or radiation-driving is a source of much debate in the literature. We consider AGN feedback driven by radiation pressure on dust, and show that AGN radiative feedback is capable of driving powerful outflows on galactic scales. In particular, we can obtain outflowing shells with high velocity and large momentum flux, by properly taking into account the effects of radiation trapping. Alternatively, the observed outflow characteristics may be significantly biased by AGN variability. I will discuss the resulting implications in the global context of black hole accretion-AGN feedback coupling.

  13. MOS Mapping of the NIR Outflow HH 223

    NASA Astrophysics Data System (ADS)

    López, R.; Acosta-Pulido, J. A.; Estalella, R.; Gómez, G.; García-Lorenzo, B.

    2016-10-01

    The Multi-Object-Spectroscopy (MOS) mode of LIRIS was used to map the near-IR stellar outflow HH 223, in the dark cloud Lynds 723 (L723). HH 223 spatially coincides with the east-west component of the L723 quadrupolar CO outflow. The radio continuum source SMA2, towards the center of the quadrupolar CO outflow, hides the YSO that seems to power both the near-IR and the CO outflows. To map the S-shaped, near-IR emission of HH 223, extending ˜ 5', an appropriate mask was designed, with 16 rectangular slitlets. J, H and K-band spectra (R ˜eq 2500) were obtained through the mask. The kinematics of the neutral (H2) and ionized ([FeII]) gas outflow was derived from these data. The results confirm that both the near-IR and the CO outflows have a common driving source. To our knowledge, this is the first use of the MOS-LIRIS observing mode with the mask designed ad hoc to fit several extended, nonaligned targets.

  14. Radiation Transport for Explosive Outflows: Opacity Regrouping

    NASA Astrophysics Data System (ADS)

    Wollaeger, Ryan T.; van Rossum, Daniel R.

    2014-10-01

    Implicit Monte Carlo (IMC) and Discrete Diffusion Monte Carlo (DDMC) are methods used to stochastically solve the radiative transport and diffusion equations, respectively. These methods combine into a hybrid transport-diffusion method we refer to as IMC-DDMC. We explore a multigroup IMC-DDMC scheme that in DDMC, combines frequency groups with sufficient optical thickness. We term this procedure "opacity regrouping." Opacity regrouping has previously been applied to IMC-DDMC calculations for problems in which the dependence of the opacity on frequency is monotonic. We generalize opacity regrouping to non-contiguous groups and implement this in SuperNu, a code designed to do radiation transport in high-velocity outflows with non-monotonic opacities. We find that regrouping of non-contiguous opacity groups generally improves the speed of IMC-DDMC radiation transport. We present an asymptotic analysis that informs the nature of the Doppler shift in DDMC groups and summarize the derivation of the Gentile-Fleck factor for modified IMC-DDMC. We test SuperNu using numerical experiments including a quasi-manufactured analytic solution, a simple 10 group problem, and the W7 problem for Type Ia supernovae. We find that opacity regrouping is necessary to make our IMC-DDMC implementation feasible for the W7 problem and possibly Type Ia supernova simulations in general. We compare the bolometric light curves and spectra produced by the SuperNu and PHOENIX radiation transport codes for the W7 problem. The overall shape of the bolometric light curves are in good agreement, as are the spectra and their evolution with time. However, for the numerical specifications we considered, we find that the peak luminosity of the light curve calculated using SuperNu is ~10% less than that calculated using PHOENIX.

  15. Magnetic Fields and Outflows from AGN Disks

    NASA Astrophysics Data System (ADS)

    Lovelace, Richard V. E.; Bisnovatyi-Kogan, Gennady S.; Rothstein, D. M.

    2010-11-01

    Activity of the nuclei of galaxies involving disk accretion to black holes is thought to be due to (1) a small-scale turbulent magnetic field in the disk (due to the magneto-rotational instability or MRI) which gives a large viscosity enhancing accretion, and (2) a large-scale magnetic field which gives rise to matter outflows and/or electromagnetic jets from the disk which also enhances accretion. An important problem with this picture is that the enhanced viscosity is accompanied by an enhanced magnetic diffusivity which acts to prevent the build up of a significant large-scale field. Recent work has pointed out that the disk's surface layers are non-turbulent and thus highly conducting (or non-diffusive) because the MRI is suppressed high in the disk where the magnetic and radiation pressures are larger than the thermal pressure. Here, we calculate the vertical (Z) profiles of the stationary accretion flows (with radial and azimuthal components), and the profiles of the large-scale, magnetic field taking into account the turbulent viscosity and diffusivity due to the MRI and the fact that the turbulence vanishes at the surface of the disk. We derive a sixth-order differential equation for the radial flow velocity vr (Z) which depends mainly on the midplane thermal to magnetic pressure ratio ˜>1 and the Prandtl number of the turbulence P = viscosity/diffusivity. Boundary conditions at the disk surface take into account a possible magnetic wind or jet and allow for a surface current in the highly conducting surface layer. The stationary solutions we find indicate that a weak (˜>1) large-scale field does not di use away as suggested by earlier work.

  16. RADIATION TRANSPORT FOR EXPLOSIVE OUTFLOWS: OPACITY REGROUPING

    SciTech Connect

    Wollaeger, Ryan T.; Van Rossum, Daniel R. E-mail: daan@flash.uchicago.edu

    2014-10-01

    Implicit Monte Carlo (IMC) and Discrete Diffusion Monte Carlo (DDMC) are methods used to stochastically solve the radiative transport and diffusion equations, respectively. These methods combine into a hybrid transport-diffusion method we refer to as IMC-DDMC. We explore a multigroup IMC-DDMC scheme that in DDMC, combines frequency groups with sufficient optical thickness. We term this procedure ''opacity regrouping''. Opacity regrouping has previously been applied to IMC-DDMC calculations for problems in which the dependence of the opacity on frequency is monotonic. We generalize opacity regrouping to non-contiguous groups and implement this in SuperNu, a code designed to do radiation transport in high-velocity outflows with non-monotonic opacities. We find that regrouping of non-contiguous opacity groups generally improves the speed of IMC-DDMC radiation transport. We present an asymptotic analysis that informs the nature of the Doppler shift in DDMC groups and summarize the derivation of the Gentile-Fleck factor for modified IMC-DDMC. We test SuperNu using numerical experiments including a quasi-manufactured analytic solution, a simple 10 group problem, and the W7 problem for Type Ia supernovae. We find that opacity regrouping is necessary to make our IMC-DDMC implementation feasible for the W7 problem and possibly Type Ia supernova simulations in general. We compare the bolometric light curves and spectra produced by the SuperNu and PHOENIX radiation transport codes for the W7 problem. The overall shape of the bolometric light curves are in good agreement, as are the spectra and their evolution with time. However, for the numerical specifications we considered, we find that the peak luminosity of the light curve calculated using SuperNu is ∼10% less than that calculated using PHOENIX.

  17. Quasar Outflows and Black Hole Masses

    NASA Astrophysics Data System (ADS)

    Coatman, Liam; Hewett, Paul; Banerji, Manda; Richards, Gordon; Hennawi, Joseph; Prochaska, Jason X.

    2016-08-01

    Black-hole masses are crucial to understanding the physics of the connection between quasars and their host galaxies and measuring cosmic black hole-growth. At high redshift, z > 2, black hole masses are normally derived using the velocity-width of the CIV broad emission line, based on the assumption that the observed velocity-widths arise from virial-induced motions. In many quasars, the CIV-emission line exhibits significant blue asymmetries ('blueshifts') with the line centroid displaced by up to thousands of km/s to the blue. These blueshifts almost certainly signal the presence of strong outflows, most likely originating in a disc wind. Using both archival data and new observations, we have obtained near-infrared spectra, including the Ha and/or Hb emission lines, for ~400 luminous (L_Bol = 45.5-48.5 erg/s) SDSS quasars, at redshifts 1.5 < z < 4, with CIV emission lines spanning the full-range of blueshifts present in the population. A strong correlation between CIV-velocity width and blueshift is found and, at large blueshifts, >2000 km/s, the velocity-widths appear to be dominated by non-virial motions. Using the Ha/Hb emission to provide black hole masses free from non-virial contributions, we are able to derive a quantitative correction to the CIV-based black-hole masses as a function of blueshift. This correction reduces the scatter between Ha/Hb and CIV velocity widths to just ~0.1 dex. Without the correction, black hole masses would be overestimated by a factor of nine at the largest blueshifts. With a suitable systemic redshift-estimation algorithm, this correction can be straightforwardly applied based only on information contained in the rest-frame UV spectra.

  18. Assessment of antiseptic bladder washout procedures using a physical model of the catheterised bladder.

    PubMed

    Stickler, D J; Clayton, C L; Chawla, J C

    1987-11-01

    A simple physical model of the catheterised bladder has been used to assess the activities of antiseptic agents that have been recommended as bladder instillations in the treatment of urinary tract infections in patients with indwelling catheters. The activities of povidone-iodine, phenoxyethanol, chlorhexidine, chlorhexidine supplemented with EDTA + Tris, noxythiolin and neomycin were examined against selected species of uropathogens. Except for phenoxyethanol against Pv. stuartii and possibly Ps. aeruginosa, single applications of these antibacterials for 30 min were not effective in sterilising urine in the artificial bladder. However, a second application 1 h later of phenoxyethanol but not chlorhexidine or povidone-iodine did eradicate Ps. aeruginosa. It is suggested that bacteria growing as a film on the bladder wall are particularly resistant to antimicrobials.

  19. Neurogenic Bladder Repair Using Autologous Mesenchymal Stem Cells.

    PubMed

    Mahajan, Pradeep V; Subramanian, Swetha; Danke, Amit; Kumar, Anand

    2016-01-01

    The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion, the activity of which is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. This report describes a case of neurogenic bladder following laminectomy procedure and long-standing diabetes mellitus with neuropathy treated with autologous cellular therapy. The differentiation potential and paracrine effects of mesenchymal stem cells on bladder function have been highlighted. PMID:27656308

  20. Solitary Fibrous Tumor in a Female Urinary Bladder.

    PubMed

    Mustafa, Hiba J; Menon, Sharifa

    2016-07-01

    Solitary fibrous tumors of the bladder are extremely rare especially in the females. This is the third case of SFT in a female urinary bladder. We are presenting a case of 36-years-old female who underwent a procedure for what thought to be cervical myoma. Cystectomy and bilateral ureteral re-implantation were performed. Mass showed to be solitary fibrous tumor of the urinary bladder. These tumors are rarely occur in extrapleural spaces. Only few cases had been reported in the urinary bladder including 2 in the female and 10 in the male bladder.

  1. Solitary Fibrous Tumor in a Female Urinary Bladder.

    PubMed

    Mustafa, Hiba J; Menon, Sharifa

    2016-07-01

    Solitary fibrous tumors of the bladder are extremely rare especially in the females. This is the third case of SFT in a female urinary bladder. We are presenting a case of 36-years-old female who underwent a procedure for what thought to be cervical myoma. Cystectomy and bilateral ureteral re-implantation were performed. Mass showed to be solitary fibrous tumor of the urinary bladder. These tumors are rarely occur in extrapleural spaces. Only few cases had been reported in the urinary bladder including 2 in the female and 10 in the male bladder. PMID:27335777

  2. Neurogenic Bladder Repair Using Autologous Mesenchymal Stem Cells

    PubMed Central

    Kumar, Anand

    2016-01-01

    The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion, the activity of which is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. This report describes a case of neurogenic bladder following laminectomy procedure and long-standing diabetes mellitus with neuropathy treated with autologous cellular therapy. The differentiation potential and paracrine effects of mesenchymal stem cells on bladder function have been highlighted.

  3. Novel therapeutic approaches for recurrent nonmuscle invasive bladder cancer.

    PubMed

    Boehm, Brock E; Svatek, Robert S

    2015-05-01

    This article summarizes strategies being investigated in patients with nonmuscle invasive bladder cancer. Progress has been made toward improving the delivery method of intravesical agents. Intravesical therapy is limited by the amount of time that the agent remains in contact with the bladder. Bladder cancer is considered to be responsive to immune therapy. Thus, many novel approaches are immune-based therapies and include cancer vaccines, use of Bacillus Calmette-Guérin (BCG) subcomponents, and checkpoint inhibitors. Finally, access to bladder mucosa via direct catheterization into the bladder via the urethra has enabled unique strategies for delivery of cancer therapy including viral- or plasmid-based gene therapy.

  4. Neurogenic Bladder Repair Using Autologous Mesenchymal Stem Cells

    PubMed Central

    Kumar, Anand

    2016-01-01

    The normal function of the urinary bladder is to store and expel urine in a coordinated, controlled fashion, the activity of which is regulated by the central and peripheral nervous systems. Neurogenic bladder is a term applied to a malfunctioning urinary bladder due to neurologic dysfunction or insult emanating from internal or external trauma, disease, or injury. This report describes a case of neurogenic bladder following laminectomy procedure and long-standing diabetes mellitus with neuropathy treated with autologous cellular therapy. The differentiation potential and paracrine effects of mesenchymal stem cells on bladder function have been highlighted. PMID:27656308

  5. BCG Induced Necrosis of the Entire Bladder Urothelium.

    PubMed

    Krönig, Malte; Jilg, Cordula; Burger, Dieter; Langer, Mathias; Timme-Bronsert, Sylvia; Werner, Martin; Wetterauer, Ulrich; Seemann, Wolfgang-Schultze

    2015-09-01

    Instillation therapy with attenuated tuberculosis bacteria (BCG) can significantly reduce rates of recurrence of non-muscle invasive bladder cancer. Local and systemic side effects such as dysuria, irritative voiding symptoms or partial bladder contracture and systemic inflammation were reported. A 75 year-old male patient with recurrent non muscle invasive bladder cancer developed necrosis of the entire bladder urothelium more than six years after BCG instillation immunotherapy. The resulting irritative voiding symptoms and low bladder capacity required radical cystectomy. BCG instillation can cause severe side effects, which develop gradually and eventually need radical surgical therapy such as cystectomy without tumor recurrence.

  6. BCG Induced Necrosis of the Entire Bladder Urothelium.

    PubMed

    Krönig, Malte; Jilg, Cordula; Burger, Dieter; Langer, Mathias; Timme-Bronsert, Sylvia; Werner, Martin; Wetterauer, Ulrich; Seemann, Wolfgang-Schultze

    2015-09-01

    Instillation therapy with attenuated tuberculosis bacteria (BCG) can significantly reduce rates of recurrence of non-muscle invasive bladder cancer. Local and systemic side effects such as dysuria, irritative voiding symptoms or partial bladder contracture and systemic inflammation were reported. A 75 year-old male patient with recurrent non muscle invasive bladder cancer developed necrosis of the entire bladder urothelium more than six years after BCG instillation immunotherapy. The resulting irritative voiding symptoms and low bladder capacity required radical cystectomy. BCG instillation can cause severe side effects, which develop gradually and eventually need radical surgical therapy such as cystectomy without tumor recurrence. PMID:26793538

  7. Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study.

    PubMed

    Giraldeau, Geneviève; Duchateau, Nicolas; Bijnens, Bart; Gabrielli, Luigi; Penela, Diego; Evertz, Reinder; Mont, Lluis; Brugada, Josep; Berruezo, Antonio; Sitges, Marta

    2016-08-01

    Dyssynchrony from biventricular pacing (BiV) can reduce dynamic obstruction in hypertrophic obstructive cardiomyopathy (HOCM), but its consequences on the left ventricular (LV) systolic function are unknown. We evaluate changes in LV systolic function and assess the effectiveness of BiV in HOCM. Thirteen patients with HOCM (55 [33/75] years, five males) received a BiV device and underwent 2D transthoracic echocardiography before the implantation and at 12 months follow-up. Global longitudinal and radial strain, and the timing of segmental displacement curves were measured by commercial speckle-tracking software to assess LV systolic function and dyssynchrony. Peak gradient in the LV outflow tract (LVOT) significantly decreased from 80 [51/100] to 30 [5/66] mmHg (p = 0.005). LV global strain was preserved from baseline to follow-up: 35.1 [20.2/43.8] % vs. 32.6 [27.1/44.1] %, p = NS (radial), and -16.6 [-19.1/-14.4] % vs. -15.7 [-17.0/-14.2] %, p = NS (longitudinal). Dyssynchrony analysis using displacement curves showed inversion of wall motion timing with earlier displacement of the lateral wall at follow-up only in patients with reduction in LVOT gradient. BiV reduces LVOT obstruction in patients with HOCM when dyssynchronization of LV motion and inversion of the timing of LV wall activation are reached. Notably, this does not lead to further deterioration of LV systolic function at mid-term follow-up.

  8. Mullerian Duct Cyst Causing Bladder Outlet Obstruction in a Patient with HNF-1β Gene Deletion

    PubMed Central

    Honore, Matthew; Fowler, Ross; Kiosoglous, Anthony J.

    2016-01-01

    A 24-year-old male was referred to a tertiary hospital for a possible prostatic abscess. The patient went into acute urinary retention. Transurethral drainage was performed. MRI pelvis three days post-operatively identified the prostatic cystic structure as a müllerian duct cyst. Several other phenotypical features were noted on examination as well as findings on investigations. From these diagnosis of hepatocyte nuclear factor-1β (HNF-1β) gene deletion was made. PMID:27390584

  9. Kiloparsec-scale outflows are prevalent among luminous AGN: outflows and feedback in the context of the overall AGN population

    NASA Astrophysics Data System (ADS)

    Harrison, C. M.; Alexander, D. M.; Mullaney, J. R.; Swinbank, A. M.

    2014-07-01

    We present integral field unit observations covering the [O III]λλ4959, 5007 and Hβ emission lines of 16 z < 0.2 type 2 active galactic nuclei (AGN). Our targets are selected from a well-constrained parent sample of ≈24 000 AGN so that we can place our observations into the context of the overall AGN population. Our targets are radio quiet with star formation rates (SFRs; ≲[10-100] M⊙ yr-1) that are consistent with normal star-forming galaxies. We decouple the kinematics of galaxy dynamics and mergers from outflows. We find high-velocity ionized gas (velocity widths ≈600-1500 km s-1; maximum velocities ≤1700 km s-1) with observed spatial extents of ≳(6-16) kpc in all targets and observe signatures of spherical outflows and bi-polar superbubbles. We show that our targets are representative of z < 0.2, luminous (i.e. L[O III] > 1041.7 erg s-1) type 2 AGN and that ionized outflows are not only common but also in ≥70 per cent (3σ confidence) of cases, they are extended over kiloparsec scales. Our study demonstrates that galaxy-wide energetic outflows are not confined to the most extreme star-forming galaxies or radio-luminous AGN; however, there may be a higher incidence of the most extreme outflow velocities in quasars hosted in ultraluminous infrared galaxies. Both star formation and AGN activity appear to be energetically viable to drive the outflows and we find no definitive evidence that favours one process over the other. Although highly uncertain, we derive mass outflow rates (typically ≈10 times the SFRs), kinetic energies (≈0.5-10 per cent of LAGN) and momentum rates (typically ≳10-20 × LAGN/c) consistent with theoretical models that predict AGN-driven outflows play a significant role in shaping the evolution of galaxies.

  10. Noninvasive Evaluation of Bladder Wall Mechanical Properties as a Function of Filling Volume: Potential Application in Bladder Compliance Assessment

    PubMed Central

    Mynderse, Lance; Husmann, Douglas; Urban, Matthew; Alizad, Azra

    2016-01-01

    Purpose We propose a novel method to monitor bladder wall mechanical properties as a function of filling volume, with the potential application to bladder compliance assessment. The proposed ultrasound bladder vibrometry (UBV) method uses ultrasound to excite and track Lamb waves on the bladder wall from which its mechanical properties are derived by fitting measurements to an analytical model. Of particular interest is the shear modulus of bladder wall at different volumes, which we hypothesize, is similar to measuring the compliance characteristics of the bladder. Materials and Methods Three experimental models were used: 1) an ex vivo porcine model where normal and aberrant (stiffened by formalin) bladders underwent evaluation by UBV; 2) an in vivo study to evaluate the performance of UBV on patients with clinically documented compliant and noncompliant bladders undergoing UDS; and 3) a noninvasive UBV protocol to assess bladder compliance using oral hydration and fractionated voiding on three healthy volunteers. Results The ex vivo studies showed a high correlation between the UBV parameters and direct pressure measurement (R2 = 0.84–0.99). A similar correlation was observed for 2 patients with compliant and noncompliant bladders (R2 = 0.89–0.99) undergoing UDS detrusor pressure-volume measurements. The results of UBV on healthy volunteers, performed without catheterization, were comparable to a compliant bladder patient. Conclusion The utility of UBV as a method to monitor changes in bladder wall mechanical properties is validated by the high correlation with pressure measurements in ex vivo and in vivo patient studies. High correlation UBV and UDS in vivo studies demonstrated the potential of UBV as a bladder compliance assessment tool. Results of studies on healthy volunteers with normal bladders demonstrated that UBV could be performed noninvasively. Further studies on a larger cohort are needed to fully validate the use of UBV as a clinical tool for

  11. Small bowel obstruction- a surprise.

    PubMed

    Mathew, Jeffrey Daniel; Cp, Ganesh Babu; M, Balachandar; M, Ramanathan

    2015-01-01

    Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction.

  12. Small Bowel Obstruction- A Surprise

    PubMed Central

    CP, Ganesh Babu; M, Balachandar; M, Ramanathan

    2015-01-01

    Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction. PMID:25738033

  13. Bladder cancer: molecular determinants of personalized therapy.

    PubMed

    Lopez-Beltran, Antonio; Santoni, Matteo; Massari, Francesco; Ciccarese, Chiara; Tortora, Giampaolo; Cheng, Liang; Moch, Holger; Scarpelli, Marina; Reymundo, Carlos; Montironi, Rodolfo

    2015-01-01

    Several molecular and genetic studies have provided new perspectives on the histologic classification of bladder tumors. Recent developments in the field of molecular mutational pathway analyses based on next generation sequencing technology together with classic data derived from the description of mutations in the FGFR3 (fibroblast growth factor receptor 3) gene, mutations on TP53 gene, and cDNA technology profiling data gives support to a differentiated taxonomy of bladder cancer. All these changes are behind the use of non-traditional approach to therapy of bladder cancer patients and are ready to change our daily practice of uro-oncology. The observed correlation of some molecular alterations with tumor behavior and the identification of their targets at cellular level might support the use of molecular changes together with morphological data to develop new clinical and biological strategies to manage patients with urothelial cancer. The current review provides comprehensive data to support personalized therapy for bladder cancer based on an integrated approach including pathologic and clinical features and molecular biology.

  14. Small cell carcinoma of the urinary bladder.

    PubMed

    Pant-Purohit, Mukta; Lopez-Beltran, Antonio; Montironi, Rodolfo; MacLennan, Gregory T; Cheng, Liang

    2010-02-01

    Small cell carcinoma of the urinary bladder (SCCUB) is a rare and aggressive cancer of the bladder. SCCUB is part of neuroendocrine family of tumors that affect several organ systems including respiratory, gastrointestinal and male and female genitourinary tract. SCCUB affect males predominantly with common risk factors include smoking, bladder calculi, bladder manipulation, and chronic cystitis. Prognosis of SCCUB remains poor due to high metastatic potential and lack of symptoms in earlier stages of the disease. Pathogenesis of the disease is linked to loss of genetic material, hypermethylation of tumor suppressors and at times amplification of the chromosomal regions carrying oncogenes. Majority of cases are treated with local resection of the tumor with neoadjuvant or adjuvant platinum-based chemotherapy regimen. Radiation therapy is used as alternative to radical cystectomy or as palliative measure. This article provides epidemiology, molecular pathogenesis, histochemistry, and current management options for SCCUB. Furthermore we reviewed all recent studies involving advancement in targeted molecular therapy for neuroendocrine tumors. PMID:20017108

  15. Arsenic and bladder cancer: observations and suggestions.

    PubMed

    Radosavljević, Vladan; Jakovljević, Branko

    2008-10-01

    Arsenic from drinking water is a well-known risk factor for bladder cancer. The purpose of this paper is to systematize some important yet often overlooked facts considering the relationship between arsenic exposure and the occurrence of bladder cancer. Since the exposure to inorganic arsenic from food, inhaled air, and skin absorption as well as arsenic methylation ability are not fully investigated, our assumption is that the exposure of arsenic only from drinking water is underestimated and its role as a risk factor is highly overestimated. This paper proposes some qualitative and quantitative parameters of arsenic as a risk factor for bladder cancer. The recommended qualitative parameters of arsenic intake are first, pathways of exposure, and second, toxicity and metabolism. The suggested quantitative parameters of arsenic intake include amounts of arsenic absorbed in the body, duration of arsenic exposure, and duration of arsenic presence in the urinary bladder. This approach can be implemented in a systematic classification and explanation of various risk factors and their mutual interactions for other types of cancer or diseases in general.

  16. Somatic mutation of PTEN in bladder carcinoma

    PubMed Central

    Aveyard, J S; Skilleter, A; Habuchi, T; Knowles, M A

    1999-01-01

    The tumour suppressor gene PTEN/MMAC1, which is mutated or homozygously deleted in glioma, breast and prostate cancer, is mapped to a region of 10q which shows loss of heterozygosity (LOH) in bladder cancer. We screened 123 bladder tumours for LOH in the region of PTEN. In 53 informative muscle invasive tumours (≥ pT2), allele loss was detected in 13 (24.5%) and allelic imbalance in four tumours (overall frequency 32%). LOH was found in four of 60 (6.6%) informative, non-invasive tumours (pTa/pT1). We screened 63 muscle invasive tumours for PTEN mutations by single-strand conformation polymorphism (SSCP) analysis and for homozygous deletion by duplex quantitative polymerase chain reaction (PCR). Two homozygous deletions were identified but no mutations. Of 15 bladder tumour cell lines analysed, three showed homozygous deletion of all or part of the PTEN gene, but none had mutations detectable by SSCP analysis. Our results indicate that PTEN is involved in the development of some bladder tumours. The low frequency of mutation of the retained allele in tumours with 10q23 LOH suggests that there may be another predominant mechanism of inactivation of the second allele, for example small intragenic deletions, that hemizygosity may be sufficient for phenotypic effect, or that there is another target gene at 10q23. © 1999 Cancer Research Campaign PMID:10360673

  17. Management options for sphincteric deficiency in adults with neurogenic bladder

    PubMed Central

    Mayer, Erik N.; Lenherr, Sara

    2016-01-01

    Neurogenic bladder is a very broad disease definition that encompasses varied disease and injury states affecting the bladder. The majority of patients with neurogenic bladder dysfunction do not have concomitant intrinsic sphincteric deficiency (ISD), but when this occurs the challenges of management of urinary incontinence from neurogenic bladder are compounded. There are no guidelines for surgical correction of ISD in adults and most of the literature on treatment of the problem comes from treatment of children with congenital diseases, such as myelomeningocele. Our goal, in this review, is to present some of the common surgical options for ISD [including artificial urinary sphincters, bladder slings, bladder neck reconstruction (BNR) and urethral bulking agents] and the evidence underlying these treatments in adults with neurogenic bladder. PMID:26904420

  18. Evidence for a chemically differentiated outflow in Mrk 231

    NASA Astrophysics Data System (ADS)

    Lindberg, J. E.; Aalto, S.; Muller, S.; Martí-Vidal, I.; Falstad, N.; Costagliola, F.; Henkel, C.; van der Werf, P.; García-Burillo, S.; González-Alfonso, E.

    2016-03-01

    Aims: Our goal is to study the chemical composition of the outflows of active galactic nuclei and starburst galaxies. Methods: We obtained high-resolution interferometric observations of HCN and HCO+J = 1 → 0 and J = 2 → 1 of the ultra-luminous infrared galaxy Mrk 231 with the IRAM Plateau de Bure Interferometer. We also use previously published observations of HCN and HCO+J = 1 → 0 and J = 3 → 2, and HNC J = 1 → 0 in the same source. Results: In the line wings of the HCN, HCO+, and HNC emission, we find that these three molecular species exhibit features at distinct velocities which differ between the species. The features are not consistent with emission lines of other molecular species. Through radiative transfer modelling of the HCN and HCO+ outflow emission we find an average abundance ratio X(HCN) /X(HCO+) ≳ 1000. Assuming a clumpy outflow, modelling of the HCN and HCO+ emission produces strongly inconsistent outflow masses. Conclusions: Both the anti-correlated outflow features of HCN and HCO+ and the different outflow masses calculated from the radiative transfer models of the HCN and HCO+ emission suggest that the outflow is chemically differentiated. The separation between HCN and HCO+ could be an indicator of shock fronts present in the outflow, since the HCN/HCO+ ratio is expected to be elevated in shocked regions. Our result shows that studies of the chemistry in large-scale galactic outflows can be used to better understand the physical properties of these outflows and their effects on the interstellar medium in the galaxy. Based on observations with the IRAM Plateau de Bure Interferometer. IRAM is supported by INSU/CNRS (France), MPG (Germany), and IGN (Spain).Reduced datacubes as FITS files are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (ftp://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/587/A15

  19. Metabolic complications of obstructive sleep apnea syndrome.

    PubMed

    Ahmed, Qanta A

    2008-01-01

    Obstructive sleep apnea syndrome is a widely prevalent disorder, hallmarked by partial or total upper airway obstruction during sleep. These events fracture sleep integrity resulting in chronic partial sleep deprivation with destructive metabolic sequelae, the focus of this review.

  20. Genetics of Bladder Malignant Tumors in Childhood.

    PubMed

    Zangari, Andrea; Zaini, Johan; Gulìa, Caterina

    2016-02-01

    Bladder masses are represented by either benign or malignant entities. Malignant bladder tumors are frequent causes of disease and death in western countries. However, in children they are less common. Additionally, different features are found in childhood, in which non epithelial tumors are more common than epithelial ones. Rhabdomyosarcoma is the most common pediatric bladder tumor, but many other types of lesions may be found, such as malignant rhabdoid tumor (MRT), inflammatory myofibroblastic tumor and neuroblastoma. Other rarer tumors described in literature include urothelial carcinoma and other epithelial neoplasms. Rhabdomyosarcoma is associated to a variety of genetic syndromes and many genes are involved in tumor development. PAX3-FKHR and PAX7-FKHR (P-F) fusion state has important implications in the pathogenesis and biology of RMS, and different genes alterations are involved in the pathogenesis of P-F negative and embryonal RMS, which are the subsets of tumors most frequently affecting the bladder. These genes include p53, MEF2, MYOG, Ptch1, Gli1, Gli3, Myf5, MyoD1, NF1, NRAS, KRAS, HRAS, FGFR4, PIK3CA, CTNNB1, FBXW7, IGF1R, PDGFRA, ERBB2/4, MET, BCOR. Malignant rhabdoid tumor (MRT) usually shows SMARCB1/INI1 alterations. Anaplastic lymphoma kinase (ALK) gene translocations are the most frequently associated alterations in inflammatory myofibroblastic tumor (IMT). Few genes alterations in urothelial neoplasms have been reported in the paediatric population, which are mainly related to deletion of p16/lnk4, overexpression of CK20 and overexpression of p53. Here, we reviewed available literature to identify genes associated to bladder malignancies in children and discussed their possible relationships with these tumors. PMID:27013922

  1. Bladder perforation in a peritoneal dialysis patient.

    PubMed

    Ounissi, M; Sfaxi, M; Fayala, H; Abderrahim, E; Ben Abdallah, T; Chebil, M; Ben Maiz, H; Kheder, A

    2012-05-01

    The dysfunction of the catheter in peritoneal dialysis (PD) is a frequent complication. However, perforation of organs are rare, particularly that of the urinary bladder. This requires an early diagnosis and prompt treatment of patients. We report here the case of a 38-year-old woman having end-stage renal disease due to autosomal-dominant polycystic kidney disease treated by PD since November 2000. Three years later, she was treated for Staphylococcal peritonitis. Four months later, she presented with a severe urge to urinate at the time of the fluid exchanges. The biochemical analysis of the fluid from the bladder showed that it was dialysis fluid. Injection of contrast through the catheter demonstrated the presence of a fistula between the bladder and the peritoneal cavity. She underwent cystoscopic closure of the fistulous tract and the PD catheter was removed. Subsequently, the patient was treated by hemodialysis. One month later, a second catheter was implanted surgically after confirming the closure of the fistula. Ten days later, she presented with pain at the catheter site and along the tunnel, which was found to be swollen along its track. The injection of contrast produced swelling of the subcutaneous tunnel but without extravasation of the dye. PD was withdrawn and the patient was put back on hemodialysis. Bladder fistula is a rare complication in PD and diagnosis should be suspected when patient complains of an urge to pass urine during the exchanges, which can be confirmed by contrast study showing presence of dye in the bladder. PD may be possible after the closure of the fistula, but recurrence may occur. PMID:22569443

  2. Bladder cancer: clinical and pathological profile.

    PubMed

    Lopez-Beltran, Antonio

    2008-09-01

    Bladder tumours represent a heterogeneous group of cancers. The natural history of these bladder cancers is that of recurrence of disease and progression to higher grade and stage disease. Furthermore, recurrence and progression rates of superficial bladder cancer vary according to several tumour characteristics, mainly tumour grade and stage. The most recent World Health Organization (WHO) classification of tumours of the urinary system includes urothelial flat lesions: flat hyperplasia, dysplasia and carcinoma in situ. The papillary lesions are broadly subdivided into benign (papilloma and inverted papilloma), papillary urothelial neoplasia of low malignant potential (PUNLMP) and non-invasive papillary carcinoma (low or high grade). The initial proposal of the 2004 WHO has been achieved, with most reports supporting that categories are better defined than in previous classifications. An additional important issue is that PUNLMP, the most controversial proposal of the WHO in 2004, has lower malignant behaviour than low-grade carcinoma. Whether PUNLMP remains a clinically useful category, or whether this category should be expanded to include all low-grade, stage Ta lesions (PUNLMP and low-grade papillary carcinoma) as a wider category of less aggressive tumours not labelled as cancer, needs to be discussed in the near future. This article summarizes the recent literature concerning important issues in the pathology and the clinical management of patients with bladder urothelial carcinoma. Emphasis is placed on clinical presentation, the significance of haematuria, macroscopic appearance (papillary, solid or mixed, single or multiple) and synchronous or metachronous presentation (field disease vs monoclonal disease with seeding), classification and microscopic variations of bladder cancer with clinical significance, TNM distribution and the pathological grading according to the 2004 WHO proposal.

  3. Genetics of Bladder Malignant Tumors in Childhood

    PubMed Central

    Zangari, Andrea; Zaini, Johan; Gulìa, Caterina

    2016-01-01

    Bladder masses are represented by either benign or malignant entities. Malignant bladder tumors are frequent causes of disease and death in western countries. However, in children they are less common. Additionally, different features are found in childhood, in which non epithelial tumors are more common than epithelial ones. Rhabdomyosarcoma is the most common pediatric bladder tumor, but many other types of lesions may be found, such as malignant rhabdoid tumor (MRT), inflammatory myofibroblastic tumor and neuroblastoma. Other rarer tumors described in literature include urothelial carcinoma and other epithelial neoplasms. Rhabdomyosarcoma is associated to a variety of genetic syndromes and many genes are involved in tumor development. PAX3-FKHR and PAX7-FKHR (P-F) fusion state has important implications in the pathogenesis and biology of RMS, and different genes alterations are involved in the pathogenesis of P-F negative and embryonal RMS, which are the subsets of tumors most frequently affecting the bladder. These genes include p53, MEF2, MYOG, Ptch1, Gli1, Gli3, Myf5, MyoD1, NF1, NRAS, KRAS, HRAS, FGFR4, PIK3CA, CTNNB1, FBXW7, IGF1R, PDGFRA, ERBB2/4, MET, BCOR. Malignant rhabdoid tumor (MRT) usually shows SMARCB1/INI1 alterations. Anaplastic lymphoma kinase (ALK) gene translocations are the most frequently associated alterations in inflammatory myofibroblastic tumor (IMT). Few genes alterations in urothelial neoplasms have been reported in the paediatric population, which are mainly related to deletion of p16/lnk4, overexpression of CK20 and overexpression of p53. Here, we reviewed available literature to identify genes associated to bladder malignancies in children and discussed their possible relationships with these tumors. PMID:27013922

  4. Probiotics, dendritic cells and bladder cancer.

    PubMed

    Feyisetan, Oladapo; Tracey, Christopher; Hellawell, Giles O

    2012-06-01

    What's known on the subject? and What does the study add? The suppressor effect of probiotics on superficial bladder cancer is an observed phenomenon but the specific mechanism is poorly understood. The evidence strongly suggests natural killer (NK) cells are the anti-tumour effector cells involved and NK cell activity correlates with the observed anti-tumour effect in mice. It is also known that dendritic cells (DC) cells are responsible for the recruitment and mobilization of NK cells so therefore it may be inferred that DC cells are most likely to be the interphase point at which probiotics act. In support of this, purification of NK cells was associated with a decrease in NK cells activity. The current use of intravesical bacille Calmette-Guérin in the management of superficial bladder cancer is based on the effect of a localised immune response. In the same way, understanding the mechanism of action of probiotics and the role of DC may potentially offer another avenue via which the immune system may be manipulated to resist bladder cancer. Probiotic foods have been available in the UK since 1996 with the arrival of the fermented milk drink (Yakult) from Japan. The presence of live bacterial ingredients (usually lactobacilli species) may confer health benefits when present in sufficient numbers. The role of probiotics in colo-rectal cancer may be related in part to the suppression of harmful colonic bacteria but other immune mechanisms are involved. Anti-cancer effects outside the colon were suggested by a Japanese report of altered rates of bladder tumour recurrence after ingestion of a particular probiotic. Dendritic cells play a central role to the general regulation of the immune response that may be modified by probiotics. The addition of probiotics to the diet may confer benefit by altering rates of bladder tumour recurrence and also alter the response to immune mechanisms involved with the application of intravesical treatments (bacille Calmette-Guérin).

  5. Probiotics, dendritic cells and bladder cancer.

    PubMed

    Feyisetan, Oladapo; Tracey, Christopher; Hellawell, Giles O

    2012-06-01

    What's known on the subject? and What does the study add? The suppressor effect of probiotics on superficial bladder cancer is an observed phenomenon but the specific mechanism is poorly understood. The evidence strongly suggests natural killer (NK) cells are the anti-tumour effector cells involved and NK cell activity correlates with the observed anti-tumour effect in mice. It is also known that dendritic cells (DC) cells are responsible for the recruitment and mobilization of NK cells so therefore it may be inferred that DC cells are most likely to be the interphase point at which probiotics act. In support of this, purification of NK cells was associated with a decrease in NK cells activity. The current use of intravesical bacille Calmette-Guérin in the management of superficial bladder cancer is based on the effect of a localised immune response. In the same way, understanding the mechanism of action of probiotics and the role of DC may potentially offer another avenue via which the immune system may be manipulated to resist bladder cancer. Probiotic foods have been available in the UK since 1996 with the arrival of the fermented milk drink (Yakult) from Japan. The presence of live bacterial ingredients (usually lactobacilli species) may confer health benefits when present in sufficient numbers. The role of probiotics in colo-rectal cancer may be related in part to the suppression of harmful colonic bacteria but other immune mechanisms are involved. Anti-cancer effects outside the colon were suggested by a Japanese report of altered rates of bladder tumour recurrence after ingestion of a particular probiotic. Dendritic cells play a central role to the general regulation of the immune response that may be modified by probiotics. The addition of probiotics to the diet may confer benefit by altering rates of bladder tumour recurrence and also alter the response to immune mechanisms involved with the application of intravesical treatments (bacille Calmette

  6. Functional Intestinal Obstruction in the Neonate

    PubMed Central

    Howat, J. M.; Wilkinson, A. W.

    1970-01-01

    Fifty-one neonates with functional intestinal obstruction are described. The commonest causes of functional obstruction were sticky meconium, sepsis, respiratory distress, and the prolonged infusion of fluid through a PVC catheter in the umbilical vein. Functional obstruction was diagnosed on routine investigation in 34 patients and in the remainder Hirschsprung's disease was the most commonly suspected cause of organic obstruction. ImagesFIG. PMID:5491884

  7. Neurostimulation for obstructive sleep apnea: investigations.

    PubMed

    Fairbanks, D W; Fairbanks, D N

    1993-01-01

    Neurostimulation of the upper airway muscles (accessory muscles of respiration) was accomplished in anesthetized dogs and sleeping humans by electrical stimulation of the hypoglossal nerves. Such stimulations relieved partial airway obstructions in dogs. They also aborted (shortened) obstructive sleep apnea events in humans who suffer with obstructive sleep apnea syndrome. In one subject, stimulations delivered in advance of apneic events (by automatic cycling) prevented apneas. Neurostimulation for obstructive sleep apnea may be an important concept for future research and development.

  8. OUTFLOW AND HOT DUST EMISSION IN HIGH-REDSHIFT QUASARS

    SciTech Connect

    Wang, Huiyuan; Xing, Feijun; Wang, Tinggui; Zhou, Hongyan; Zhang, Kai; Zhang, Shaohua

    2013-10-10

    Correlations of hot dust emission with outflow properties are investigated, based on a large z ∼ 2 non-broad absorption line quasar sample built from the Wide-field Infrared Survey and the Sloan Digital Sky Survey data releases. We use the near-infrared slope and the infrared to UV luminosity ratio to indicate the hot dust emission relative to the emission from the accretion disk. In our luminous quasars, these hot dust emission indicators are almost independent of the fundamental parameters, such as luminosity, Eddington ratio and black hole mass, but moderately dependent on the blueshift and asymmetry index (BAI) and FWHM of C IV lines. Interestingly, the latter two correlations dramatically strengthen with increasing Eddington ratio. We suggest that, in high Eddington ratio quasars, C IV regions are dominated by outflows so the BAI and FWHM (C IV) can reliably reflect the general properties and velocity of outflows, respectively. In low Eddington ratio quasars, on the other hand, C IV lines are primarily emitted by virialized gas so the BAI and FWHM (C IV) become less sensitive to outflows. Therefore, the correlations for the highest Eddington ratio quasars are more likely to represent the true dependence of hot dust emission on outflows and the correlations for the entire sample are significantly diluted by the low Eddington ratio quasars. Our results show that an outflow with a large BAI or velocity can double the hot dust emission on average. We suggest that outflows either contain hot dust in themselves or interact with the dusty interstellar medium or torus.

  9. Low Altitude Initiation of Ionospheric Upflow and Outflow

    NASA Astrophysics Data System (ADS)

    Burleigh, M.; Zettergren, M. D.; Rowland, D. E.; Klenzing, J.

    2015-12-01

    Significant amounts of ionospheric plasma can be transported to high altitudes (above 1000 km) in response to a variety of plasma heating and uplifting processes. Soft electron precipitation heats ambient, F-region ionospheric electrons creating electron pressure increases and upflows. Strong DC electric fields frictionally heat the ion population also resulting in ion upflows. Lastly, field-aligned thermospheric winds can contribute to ion motion at lower altitudes, while geomagnetically perpendicular winds may affect frictional heating. Once ions have been lifted to high altitudes, transverse ion acceleration by broadband ELF waves can give the upflowing ions sufficient energy to escape into the magnetosphere (ionospheric outflow). This study examines the thermospheric wind regulation of ionospheric upflow and outflow with a focus on how lower ionosphere dynamics feed source populations for transverse energization and determine the types, and amounts, of outflowing ions. The model used here for this study is a 2D ionospheric model based on a modified 16-moment transport description. It solves conservation of mass, momentum, and parallel and perpendicular energy for all relevant ionospheric species. This model encapsulates ionospheric upflow and outflow processes through the inclusion of DC electric fields, and empirical descriptions of heating by soft electron precipitation and BBELF waves. This model is used to conduct a parametric study of neutral wind effects on upflow and outflow and highlights how low-altitude processes affect ion outflow through the regulation of source plasma available to higher altitudes. This model is also used to construct a case study of ion outflows at the nightside polar cap boundary using data from the VISIONS sounding rocket campaign.

  10. Modeling Jet and Outflow Feedback during Star Cluster Formation

    NASA Astrophysics Data System (ADS)

    Federrath, Christoph; Schrön, Martin; Banerjee, Robi; Klessen, Ralf S.

    2014-08-01

    Powerful jets and outflows are launched from the protostellar disks around newborn stars. These outflows carry enough mass and momentum to transform the structure of their parent molecular cloud and to potentially control star formation itself. Despite their importance, we have not been able to fully quantify the impact of jets and outflows during the formation of a star cluster. The main problem lies in limited computing power. We would have to resolve the magnetic jet-launching mechanism close to the protostar and at the same time follow the evolution of a parsec-size cloud for a million years. Current computer power and codes fall orders of magnitude short of achieving this. In order to overcome this problem, we implement a subgrid-scale (SGS) model for launching jets and outflows, which demonstrably converges and reproduces the mass, linear and angular momentum transfer, and the speed of real jets, with ~1000 times lower resolution than would be required without the SGS model. We apply the new SGS model to turbulent, magnetized star cluster formation and show that jets and outflows (1) eject about one-fourth of their parent molecular clump in high-speed jets, quickly reaching distances of more than a parsec, (2) reduce the star formation rate by about a factor of two, and (3) lead to the formation of ~1.5 times as many stars compared to the no-outflow case. Most importantly, we find that jets and outflows reduce the average star mass by a factor of ~ three and may thus be essential for understanding the characteristic mass of the stellar initial mass function.

  11. Tracing inflows and outflows with absorption lines in circumgalactic gas

    NASA Astrophysics Data System (ADS)

    Ford, Amanda Brady; Davé, Romeel; Oppenheimer, Benjamin D.; Katz, Neal; Kollmeier, Juna A.; Thompson, Robert; Weinberg, David H.

    2014-10-01

    We examine how H I and metal absorption lines within low-redshift galaxy haloes trace the dynamical state of circumgalactic gas, using cosmological hydrodynamic simulations that include a well-vetted heuristic model for galactic outflows. We categorize inflowing, outflowing, and ambient gas based on its history and fate as tracked in our simulation. Following our earlier work, showing that the ionization level of absorbers was a primary factor in determining the physical conditions of absorbing gas, we show here that it is also a governing factor for its dynamical state. Low-ionization metal absorbers (e.g. Mg II) tend to arise in gas that will fall on to galaxies within several Gyr, while high-ionization metal absorbers (e.g. O VI) generally trace material that was deposited by outflows many Gyr ago. Inflowing gas is dominated by enriched material that was previously ejected in an outflow; hence, accretion at low redshifts is typically substantially enriched. Recycling wind material is preferentially found closer to galaxies, and is more dominant in lower mass haloes since high-mass haloes have more hot gas that is able to support itself against infall. Low-mass haloes also tend to re-eject more of their accreted material, owing to our outflow prescription that employs higher mass loading factors for lower mass galaxies. Typical H I absorbers trace unenriched ambient material that is not participating in the baryon cycle, but stronger H I absorbers arise in cool, enriched inflowing gas. Instantaneous radial velocity measures of absorbers are generally poor at distinguishing between inflowing and outflowing gas, except in the case of very recent outflows. These results suggest that probing halo gas using a range of absorbers can provide detailed information about the amount and physical conditions of material that is participating in the baryon cycle.

  12. Modeling jet and outflow feedback during star cluster formation

    SciTech Connect

    Federrath, Christoph; Schrön, Martin; Banerjee, Robi; Klessen, Ralf S.

    2014-08-01

    Powerful jets and outflows are launched from the protostellar disks around newborn stars. These outflows carry enough mass and momentum to transform the structure of their parent molecular cloud and to potentially control star formation itself. Despite their importance, we have not been able to fully quantify the impact of jets and outflows during the formation of a star cluster. The main problem lies in limited computing power. We would have to resolve the magnetic jet-launching mechanism close to the protostar and at the same time follow the evolution of a parsec-size cloud for a million years. Current computer power and codes fall orders of magnitude short of achieving this. In order to overcome this problem, we implement a subgrid-scale (SGS) model for launching jets and outflows, which demonstrably converges and reproduces the mass, linear and angular momentum transfer, and the speed of real jets, with ∼1000 times lower resolution than would be required without the SGS model. We apply the new SGS model to turbulent, magnetized star cluster formation and show that jets and outflows (1) eject about one-fourth of their parent molecular clump in high-speed jets, quickly reaching distances of more than a parsec, (2) reduce the star formation rate by about a factor of two, and (3) lead to the formation of ∼1.5 times as many stars compared to the no-outflow case. Most importantly, we find that jets and outflows reduce the average star mass by a factor of ∼ three and may thus be essential for understanding the characteristic mass of the stellar initial mass function.

  13. Supernovae and AGN Driven Galactic Outflows

    NASA Astrophysics Data System (ADS)

    Sharma, Mahavir; Nath, Biman B.

    2013-01-01

    mass scale (Mh ~ 1012-1012.5 M ⊙) that signifies the crossover of AGN domination in outflow properties from starburst activity at lower masses. We find that stellar mass for massive galaxies scales as M sstarfvpropM 0.26 h , and for low-mass galaxies, M sstarfvpropM 5/3 h .

  14. [Consensus document on overactive bladder in older patients].

    PubMed

    Verdejo-Bravo, Carlos; Brenes-Bermúdez, Francisco; Valverde-Moyar, Maria Victoria; Alcántara-Montero, Antonio; Pérez-León, Noemí

    2015-01-01

    Overactive nladder (OAB) is a clinical entity with a high prevalence in the population, having a high impact on quality of life, especially when it occurs with urge urinary incontinence. It is very important to highlight the low rate of consultation of this condition by the older population. This appears to depend on several factors (educational, cultural, professional), and thus leads to the low percentage of older patients who receive appropriate treatment and, on the other hand, a large percentage of older patients with a significant deterioration in their quality of life. Therefore, Scientific societies and Working Groups propose the early detection of OAB in their documents and clinical guidelines. Its etiology is not well known, but is influenced by cerebrovascular processes and other neurological problems, abnormalities of the detrusor muscle of bladder receptors, and obstructive and inflammatory processes of the lower urinary tract. Its diagnosis is clinical, and in the great majority of the cases it can be possible to establish its diagnosis and etiopathogenic orientation, without the need for complex diagnostic procedures. Currently, there are effective treatments for OAB, and we should decide the most appropriate for each elderly patient, based on their individual characteristics. Based on the main clinical practice guidelines, a progressive treatment is proposed, with the antimuscarinics being the most recommended drug treatment. Therefore, a group of very involved professionals in clinical practice for the elderly, and representing two scientific Societies (Spanish Society of Geriatrics and Gerontology [SEGG], and the Spanish Society of Primary Care Physicians [SEMERGEN]) developed this consensus document with the main objective of establishing practices and valid strategies, focused to simplify the management of this clinical entity in the elderly population, and especially to improve their quality of life. The recommendations presented in this

  15. Electrochemical Machining Removes Deep Obstructions

    NASA Technical Reports Server (NTRS)

    Catania, Mark J.

    1987-01-01

    Electrochemical machining (ECM) is effective way of removing obstructing material between two deep holes supposed to intersect but do not because of misalignment of drilling tools. ECM makes it possible to rework costly castings otherwise scrapped. Method fast even for tough or hard alloys and complicated three-dimensional shapes.

  16. Estimation of cold plasma outflow during geomagnetic storms

    NASA Astrophysics Data System (ADS)

    Haaland, S.; Eriksson, A.; André, M.; Maes, L.; Baddeley, L.; Barakat, A.; Chappell, R.; Eccles, V.; Johnsen, C.; Lybekk, B.; Li, K.; Pedersen, A.; Schunk, R.; Welling, D.

    2015-12-01

    Low-energy ions of ionospheric origin constitute a significant contributor to the magnetospheric plasma population. Measuring cold ions is difficult though. Observations have to be done at sufficiently high altitudes and typically in regions of space where spacecraft attain a positive charge due to solar illumination. Cold ions are therefore shielded from the satellite particle detectors. Furthermore, spacecraft can only cover key regions of ion outflow during segments of their orbit, so additional complications arise if continuous longtime observations, such as during a geomagnetic storm, are needed. In this paper we suggest a new approach, based on a combination of synoptic observations and a novel technique to estimate the flux and total outflow during the various phases of geomagnetic storms. Our results indicate large variations in both outflow rates and transport throughout the storm. Prior to the storm main phase, outflow rates are moderate, and the cold ions are mainly emanating from moderately sized polar cap regions. Throughout the main phase of the storm, outflow rates increase and the polar cap source regions expand. Furthermore, faster transport, resulting from enhanced convection, leads to a much larger supply of cold ions to the near-Earth region during geomagnetic storms.

  17. Estimation of cold plasma outflow during geomagnetic storms

    NASA Astrophysics Data System (ADS)

    Haaland, S.; Eriksson, A. I.; Andre, M.; Maes, L.; Baddeley, L. J.; Barakat, A. R.; Chappell, C. R.; Eccles, V.; Johnsen, C.; Lybekk, B.; Li, K.; Pedersen, A.; Schunk, R. W.; Welling, D. T.

    2015-12-01

    Low energy ions of ionospheric origin provide a significant contributon to the magnetospheric plasmapopulation. Measuring cold ions is difficult though. Observations have to be done at sufficiently high altitudes and typically in regions of space where spacecraft attain a positive charge due to solar illumination. Cold ions are therefore shielded from the satellite particle detectors. Furthermore, spacecraft can only cover key regions of ion outflow during segments of their orbit, so additional complications arise arise if continuous longtime observations such as the during a geomagnetic storms are needed. In this paper we suggest a new approach, based on a combination of synoptic observations and a novel technique to estimate the flux and total outflow during the various phases of geomagnetic storms. Our results indicate large variations in both outflow rates and transport throughout the storm. Prior to the storm main phase, outflow rates are moderate, and the cold ions are mainly emanating from moderately sized polar cap regions. Throughout the main phase of the storm, outflow rates increase and the polar cap source regions expand. Furthermore, faster transport, resulting from enhanced convection, leads to a much larger supply of cold ions to the near Earth region during gemagnetic storms.

  18. Studying AGN Feedback with Galactic Outflows in Luminous Obscured Quasar

    NASA Astrophysics Data System (ADS)

    Sun, Ai-Lei

    2016-01-01

    Feedback from Active galactic nuclei (AGN) has been proposed as an important quenching mechanism to suppress star formation in massive galaxies. We investigate the most direct form of AGN feedback - galactic outflows - in the most luminous obscured AGN (L>10^45 erg/s) from the SDSS sample in the nearby universe (z<0.2). Using ALMA and Magellan observations to target molecular and ionized outflows, we find that luminous AGN can impact the dynamics and phase of the galactic medium, and confirm the complex multi-phase and multi-scaled nature of the feedback phenomenon. In particular, we found that most of these luminous AGN hosts ionized outflows. The outflow size, velocity, and energetics correlate with the AGN luminosity, and can be very extended (r > 10 kpc) and fast (v > 1000 km/s) for the most luminous ones. I end with presenting a new technique to find extended ionized outflows using broadband imaging surveys, and to characterize their occurrence rate, morphology, size distribution, and their dependence on the AGN luminosity. This technique will open a new window for feedback studies in the era of large-scale optical imaging surveys, e.g., HSC and then LSST.

  19. Giant Molecular Outflows Powered by Protostars in L1448

    NASA Astrophysics Data System (ADS)

    Barsony, Mary; Wolf-Chase, Grace A.; O'Linger, Joann

    1999-10-01

    We present sensitive (T*R somewhat equal to 0.1K), large-scale (47' x 7'--corresponding to 4 pc x 6 pc at the source) maps of the CO J = 1 to 0 emission of the L1448 dark cloud at 55" resolution. The maps were acquired using the On-The-Fly (OTF) capability of the NRAO's 12-meter telescope. Careful comparison of the spatial and velocity distribution of the high-velocity CO with previously published optical and near-infrared images and spectra has led to the identification of four distinct, parsec-scale molecular outflows from our maps. These CO flows are powered by four Class 0 protostars: L1448C, L1448N(A), L1448N(B), and L1448 IRS2 and end at the cloud's boundaries. The famous, well-collimated, high-velocity molecular outflow powered by L1448C can now be traced to distances an order of magnitude greater than previously. We present strong evidence for interactions between all four outflows on scales over a parsec from the driving sources. The magnitude of the combined flow momenta, as well as the combined kinetic energy of the flows, are sufficient to disperse the 50 MSun ammonia core in which the protostars are currently forming. It remains to be shown whether the combined directions of the outflow momenta, and the efficiency of momentum transfer from outflow to ambient material, are sufficient for dispersal of the L1448 molecular cloud.

  20. The Molecular Gas Outflow of NGC 1068 Imaged by ALMA

    NASA Astrophysics Data System (ADS)

    García-Burillo, S.

    2015-12-01

    We have used the ALMA array to map the emission of a set of dense molecular gas tracers (CO(3-2), CO(6-5), HCN(4-3), HCO+(4-3), and CS(7-6)) in the central r˜2 kpc of the Seyfert 2 galaxy NGC 1068 with spatial resolutions ˜0.3″-0.5″ (˜20-35 pc). The sensitivity and spatial resolution of ALMA give a detailed view of the distribution and kinematics of the dense molecular gas. The gas kinematics from r˜50 pc out to r˜400 pc reveal a massive outflow in all molecular tracers. The tight correlation between the ionized gas outflow, the radio jet, and the occurrence of outward motions in the disk suggests that the outflow is AGN driven. The outflow rate estimated in the CND, M/dt˜63+21-37 M⊙ yr-1, is an order of magnitude higher than the star formation rate at these radii. The molecular outflow could quench star formation in the inner r˜400 pc of the galaxy on short timescales of ≤1 Myr and regulate gas accretion in the CND.

  1. Magnetic Fluid Hyperthermia for Bladder Cancer: A Preclinical Dosimetry Study

    PubMed Central

    Oliveira, Tiago R.; Stauffer, Paul R.; Lee, Chen-Ting; Landon, Chelsea D.; Etienne, Wiguins; Ashcraft, Kathleen A.; McNerny, Katie L.; Mashal, Alireza; Nouls, John; Maccarini, Paolo F.; Beyer, Wayne F.; Inman, Brant; Dewhirst, Mark W.

    2014-01-01

    Purpose This paper describes a preclinical investigation of the feasibility of thermotherapy treatment of bladder cancer with Magnetic Fluid Hyperthermia (MFH), performed by analyzing the thermal dosimetry of nanoparticle heating in a rat bladder model. Materials and Methods The bladders of twenty-five female rats were instilled with magnetite-based nanoparticles, and hyperthermia was induced using a novel small animal magnetic field applicator (Actium Biosystems, Boulder, CO). We aimed to increase the bladder lumen temperature to 42°C in <10 min and maintain that temperature for 60 min. Temperatures were measured within the bladder lumen and throughout the rat with seven fiberoptic probes (OpSens Technologies, Quebec, Canada). An MRI analysis was used to confirm the effectiveness of the catheterization method to deliver and maintain various nanoparticle volumes within the bladder. Thermal dosimetry measurements recorded the temperature rise of rat tissues for a variety of nanoparticle exposure conditions. Results Thermal dosimetry data demonstrated our ability to raise and control the temperature of rat bladder lumen ≥1°C/min to a steady-state of 42°C with minimal heating of surrounding normal tissues. MRI scans confirmed the homogenous nanoparticle distribution throughout the bladder. Conclusion These data demonstrate that our MFH system with magnetite-based nanoparticles provide well-localized heating of rat bladder lumen with effective control of temperature in the bladder and minimal heating of surrounding tissues. PMID:24050253

  2. Gemcitabine, Paclitaxel, Doxorubicin in Metastatic or Unresectable Bladder Cancer With Decreased Kidney Function

    ClinicalTrials.gov

    2015-06-19

    Distal Urethral Cancer; Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter; Proximal Urethral Cancer; Recurrent Bladder Cancer; Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter; Recurrent Urethral Cancer; Regional Transitional Cell Cancer of the Renal Pelvis and Ureter; Stage III Bladder Cancer; Stage IV Bladder Cancer; Transitional Cell Carcinoma of the Bladder; Urethral Cancer Associated With Invasive Bladder Cancer

  3. Bladder Cancer: A Simple Model Becomes Complex

    PubMed Central

    Pierro, Giovanni Battista Di; Gulia, Caterina; Cristini, Cristiano; Fraietta, Giorgio; Marini, Lorenzo; Grande, Pietro; Gentile, Vincenzo; Piergentili, Roberto

    2012-01-01

    Bladder cancer is one of the most frequent malignancies in developed countries and it is also characterized by a high number of recurrences. Despite this, several authors in the past reported that only two altered molecular pathways may genetically explain all cases of bladder cancer: one involving the FGFR3 gene, and the other involving the TP53 gene. Mutations in any of these two genes are usually predictive of the malignancy final outcome. This cancer may also be further classified as low-grade tumors, which is always papillary and in most cases superficial, and high-grade tumors, not necessarily papillary and often invasive. This simple way of considering this pathology has strongly changed in the last few years, with the development of genome-wide studies on expression profiling and the discovery of small non-coding RNA affecting gene expression. An easy search in the OMIM (On-line Mendelian Inheritance in Man) database using “bladder cancer” as a query reveals that genes in some way connected to this pathology are approximately 150, and some authors report that altered gene expression (up- or down-regulation) in this disease may involve up to 500 coding sequences for low-grade tumors and up to 2300 for high-grade tumors. In many clinical cases, mutations inside the coding sequences of the above mentioned two genes were not found, but their expression changed; this indicates that also epigenetic modifications may play an important role in its development. Indeed, several reports were published about genome-wide methylation in these neoplastic tissues, and an increasing number of small non-coding RNA are either up- or down-regulated in bladder cancer, indicating that impaired gene expression may also pass through these metabolic pathways. Taken together, these data reveal that bladder cancer is far to be considered a simple model of malignancy. In the present review, we summarize recent progress in the genome-wide analysis of bladder cancer, and analyse non

  4. Clinical presentation and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in India

    PubMed Central

    2015-01-01

    Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterized by pelvic pain urgency and frequency. Patients with severe symptoms lead a very miserable life. North American, European and Asian guidelines have been recently promulgated but they differ on many important issues. There is no consensus on its name, definition, investigations and management. Indian guidelines have also been developed and they give more importance to the symptoms in relation to micturition. Though initially believed to be rare or non-existent in India the situation has changed. In Indian patients the presentation is more or less same as the rest of the world but a large percentage have obstructive symptoms and unusual urinary symptoms. Anal discomfort is also common. In India the commonest investigation in all cases of lower urinary tract (LUT) dysfunction is ultrasonography of kidney ureter and bladder with measurement of the post void residual urine volume. Cystoscopy is also done in all the cases to rule out presence of tuberculosis or carcinoma in situ. Bladder pain syndrome/interstitial cystitis (BPS/IC) is not considered to be a clinical disease as it is difficult to rule out all differential diagnosis only from history. Hunner’s lesion is very rare. Cystoscopy with hydro distension, oral therapy, intravesical therapy and surgical therapy form the back bone of management. It is difficult to know which treatment is best for a given patient. A staged protocol is followed and all the treatment modalities are applied to the patients in a sequential fashion—starting from the non-invasive to more invasive. Intravesical botox has not been found to be effective and there is no experience with interstim neuromodulation. PMID:26816851

  5. Clinical presentation and treatment of bladder pain syndrome/interstitial cystitis (BPS/IC) in India.

    PubMed

    Mishra, Nagendra Nath

    2015-10-01

    Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease characterized by pelvic pain urgency and frequency. Patients with severe symptoms lead a very miserable life. North American, European and Asian guidelines have been recently promulgated but they differ on many important issues. There is no consensus on its name, definition, investigations and management. Indian guidelines have also been developed and they give more importance to the symptoms in relation to micturition. Though initially believed to be rare or non-existent in India the situation has changed. In Indian patients the presentation is more or less same as the rest of the world but a large percentage have obstructive symptoms and unusual urinary symptoms. Anal discomfort is also common. In India the commonest investigation in all cases of lower urinary tract (LUT) dysfunction is ultrasonography of kidney ureter and bladder with measurement of the post void residual urine volume. Cystoscopy is also done in all the cases to rule out presence of tuberculosis or carcinoma in situ. Bladder pain syndrome/interstitial cystitis (BPS/IC) is not considered to be a clinical disease as it is difficult to rule out all differential diagnosis only from history. Hunner's lesion is very rare. Cystoscopy with hydro distension, oral therapy, intravesical therapy and surgical therapy form the back bone of management. It is difficult to know which treatment is best for a given patient. A staged protocol is followed and all the treatment modalities are applied to the patients in a sequential fashion-starting from the non-invasive to more invasive. Intravesical botox has not been found to be effective and there is no experience with interstim neuromodulation. PMID:26816851

  6. Virtual Cardiac Surgery Using CFD: Application to Septal Myectomy in Obstructive Hypertrophic Cardiomyopathy

    NASA Astrophysics Data System (ADS)

    Vedula, Vijay; Mittal, Rajat; Abraham, Theodore

    2011-11-01

    Obstructive hypertrophic cardiomyopathy (HOCM) is characterized by ventricular wall thickening, diastolic dysfunction, and dynamic outflow tract obstruction, all of which strongly influence the vortex dynamics and pressure distribution in the left ventricle (LV). Severe cases of HCM are usually managed through septal myectomy where the surgeon resects the hypertrophic mass. Surgeons currently try to remove as much tissue as possible in order to optimize the post surgical result. However, excessive debulking increases the chance of ventricular septal defects, bundle branch block or complete heart block, and aneurysmal septal thinning. On the other hand, insufficient tissue removal also leads to unsatisfactory outcomes in terms of reduction of outflow tract pressure gradient. Knowing how much muscle to remove and where to remove it from could reduce the likelihood of complications and suboptimal outcomes. In the present study, we employ an immersed boundary solver to model the effect of septal myectomy for ventricles with HOCM and demonstrate the potential of such an approach for surgical planning. Computational resources were provided by the National Institute of Computational Science under Tergrid grant number TG-CTS100002.

  7. Observations of a curving molecular outflow from V380Ori-NE: further support for prompt entrainment in protostellar outflows

    NASA Astrophysics Data System (ADS)

    Davis, C. J.; Dent, W. R. F.; Matthews, H. E.; Coulson, I. M.; McCaughrean, M. J.

    2000-11-01

    CO J=3-2 and 4-3 observations of V380Ori-NE reveal a highly collimated bipolar molecular outflow associated with a jet traced here in H2 1-0 S(1) line emission. The source of the flow is also detected at 450 and 850μm with SCUBA. The combined CO and near-IR observations offer compelling support for the prompt entrainment model of jet-driven molecular outflows. Not only are the H2 shock fronts spatially coincident with peaks in the CO outflow lobes, but the slope of the mass-velocity distribution in the flow, measured here at intervals along both flow lobes, also clearly decreases just behind the advancing shock fronts (and towards the ends of the flow lobes), as one would expect if the high-to-low velocity mass fraction was enhanced by the entraining shocks. We also find that both lobes of the CO outflow clearly deviate, by some 20°, from the H2 jet direction near the source. Both lobes may be being deflected at the locations of the observed H2 shock fronts, where they impact dense, ambient material. Alternatively, the almost point-symmetric CO flow pattern could be caused by precession at the source. The submillimetre (submm) data reveal the source of the outflow, V380Ori-NE. The 450- and 850-μm maps show an elongated peak superimposed on to an extensive pedestal of weaker emission. The major axis of the source is oriented parallel with the inner flow axis. Indeed, weak 850-μm emission is detected along much of the bipolar outflow, particularly in the southern lobe and towards the southernmost CO intensity peak. The submm `continuum' data therefore probably trace warm dust and CO associated with the outflow. These data also confirm the status of V380Ori-NE as a Class I protostar. Overall, the orientation, simplicity and symmetry of this outflow, combined with the remarkable strength of the high-velocity line-wing emission in comparison to the ambient emission, make this system a perfect laboratory for future detailed studies of bipolar molecular outflows and

  8. Bipolar Molecular Outflows from High-Mass Protostars

    NASA Astrophysics Data System (ADS)

    Su, Yu-Nung; Zhang, Qizhou; Lim, Jeremy

    2004-03-01

    We report observations of the bipolar molecular outflows associated with the luminous (~2×104 Lsolar) far-IR sources IRAS 21519+5613 and IRAS 22506+5944, as well the dust and molecular gas condensations on which these outflows appear to be centered. The observations were made in 12CO, 13CO, C18O, and continuum at 3 mm with the BIMA array and in 12CO and 13CO with the NRAO 12 m telescope to recover extended emission filtered out by the interferometric array. We find that the outflow associated with each IRAS source shows a clear bipolar morphology in 12CO, with properties (i.e., total mass of order 10-100 Msolar, mass-outflow rate >~10-3 Msolar, dynamical timescale 104-105 yr, and energetics) comparable with those of other massive outflows associated with luminous young stellar objects. Each outflow appears to be centered on a dust and gas condensation with a mass of 200-300 Msolar, likely marking the location of the driving source. The outflow lobes of both sources are fully resolved along their major but not minor axes, and they have collimation factors that may be comparable with young low-mass stars. The mass-velocity diagrams of both outflows change in slope at a velocity of ~10 km s-1, suggesting that the high-velocity component (HVC) may drive the low-velocity component (LVC). Although the HVC of IRAS 21519+5613 shows evidence for deceleration, no such signature is seen in the HVC of IRAS 22506+5944. Neither HVC has a momentum supply rate sufficient to drive their corresponding LVCs, although it is possible that the HVC is more highly excited and hence its thrust underestimated. Like for other molecular outflows the primary driving agent cannot be ionized gas, leaving atomic gas as the other remaining candidate. Neither IRAS 21519+5613 nor IRAS 22506+5944 exhibits detectable free-free emission, which together with the observed properties of their molecular outflows and surrounding condensations make them credible candidates for high-mass protostars. The mass

  9. Triggered star formation: Rotation, magnetic fields and outflows

    NASA Astrophysics Data System (ADS)

    Frank, A.; Li, S.; Blackman, E. G.

    2015-12-01

    Star formation can be triggered by compression from wind or supernova driven shock waves that sweep over molecular clouds. In a previous work we used Adaptive Mesh Refinement (AMR) simulation methods, including sink particles, to simulate the full collapse of a stable Bonnor-Ebert sphere subjected to a passing shock. We tracked the flow of cloud material after a star (a sink particle) had formed. For rotating clouds we observed the formation of disks which then interact with the post-shock flow. In this paper we take the next step forward in complexity, presenting first results of simulations that include a magnetized cloud. Our results show that after a disk is formed a collimated magneto-centrifugal outflow is launched. The outflow is bipolar but asymmetric, due to interactions with the shocked flow. We explore the influence of the outflows on the post-triggering collapse dynamics.

  10. Plasma Outflows: Known Knowns, Known Unknowns, and The Unknown

    NASA Technical Reports Server (NTRS)

    Moore, T. E.

    2012-01-01

    A brief summary is given of i) what we know from observing ionospheric outflows and ii) how outflow parameterizations are being used in global simulations to evaluate their effects on magnetospheric dynamics. Then, a list of unanswered questions and issues to be resolved is given, followed by a description of the known future mission plans expressed in the Heliophysics Roadmap, such as Origin of Near-Earth Plasmas (ONEP), and Ion-Neutral Coupling in the Atmosphere (INCA). Finally, a set of requirements for definitive plasma outflow observations are identified, along with possible methods for fulfilling them in future missions. Since results of the current Heliophysics Decadal Survey are expected soon, it is hoped that future plans can be summarized and discussed without speculation at the GEM 2012 meeting.

  11. Paraneoplastic retinopathy associated with occult bladder cancer

    PubMed Central

    Nivean, M; Muttuvelu, Danson V; Afzelius, Pia; Berman, Dalia C

    2016-01-01

    The aim was to report the first case of cancer-associated retinopathy (CAR) presenting before bladder cancer diagnosis. A 71-year-old woman with a history of bilateral vision loss underwent subsequent complete ophthalmic examination include a fluorescein angiography, full-field electroretinogram (ERG), serology including serum antibodies for CAR, and positron emission tomography-computed tomography (PET-CT) scan. The patient was diagnosed with bladder carcinoma revealed by PET-CT. Timely recognition of this entity may be crucial for an increased patient survival thus adult onset progressive photoreceptor dysfunction, confirmed by ERG, should alert to a possible remote effect of known or occult malignancy. In the latter, PET-CT may be exploited as a powerful diagnostic tool. PMID:27146943

  12. Paraneoplastic retinopathy associated with occult bladder cancer.

    PubMed

    Nivean, M; Muttuvelu, Danson V; Afzelius, Pia; Berman, Dalia C

    2016-03-01

    The aim was to report the first case of cancer-associated retinopathy (CAR) presenting before bladder cancer diagnosis. A 71-year-old woman with a history of bilateral vision loss underwent subsequent complete ophthalmic examination include a fluorescein angiography, full-field electroretinogram (ERG), serology including serum antibodies for CAR, and positron emission tomography-computed tomography (PET-CT) scan. The patient was diagnosed with bladder carcinoma revealed by PET-CT. Timely recognition of this entity may be crucial for an increased patient survival thus adult onset progressive photoreceptor dysfunction, confirmed by ERG, should alert to a possible remote effect of known or occult malignancy. In the latter, PET-CT may be exploited as a powerful diagnostic tool. PMID:27146943

  13. Hyperthermia as a treatment for bladder cancer.

    PubMed

    Rampersaud, Edward N; Vujaskovic, Zeljko; Inman, Brant A

    2010-11-15

    Modern cancer care is characterized by a focus on organ-sparing multi-modal treatments. In the case of non-muscle-invasive bladder cancer this is particularly true; treatment is focused on reducing the frequency of low-risk recurrences and preventing high-risk progression. Deep regional hyperthermia is an oncologic therapeutic modality that can help achieve these two goals. The combination of hyperthermia with chemotherapy and radiotherapy has improved patient outcomes in several tumor types. In this review, we highlight the biology of therapeutic fever-range hyperthermia, discuss how hyperthermia is administered and dosed, demonstrate how heat can be added to other treatment regimens, and summarize the data supporting the role of hyperthermia in the management of bladder cancer.

  14. HLA class I expression in bladder carcinomas.

    PubMed

    Cabrera, T; Pedrajas, G; Cozar, J M; Garrido, A; Vicente, J; Tallada, M; Garrido, F

    2003-10-01

    HLA class I molecules are frequently lost in a large variety of human carcinomas, possibly because of T-cell immune selection of major histocompatibility complex class I deficient tumor variants. We report that this phenomenon is also a frequent event in bladder carcinomas. Of a total of 72 bladder carcinomas, 72% of the tumors had at least one alteration in HLA class I expression. These altered HLA class I phenotypes were classified as total HLA class I loss (25%; phenotype I); HLA-A or/and HLA-B locus-specific loss (12%; phenotype III); and HLA class I allelic loss (35%; phenotype II or IV). Comparison of histopathological parameters with HLA class I expression showed a statistically significant relationship with the degree of differentiation and tumor recurrence.

  15. Bladder cancer: approaches to prevention and control.

    PubMed

    Koroltchouk, V; Stanley, K; Stjernswärd, J; Mott, K

    1987-01-01

    Bladder cancer is the twelfth most common cancer globally, with approximately 170 000 new cases each year; a third of these cases are in the developing countries. There are two major etiological types. The first is more common in the industrialized countries and is associated with exposure to certain occupational and environmental carcinogens, but most importantly with tobacco smoking. The second type is associated with Schistosoma haematobium infection of the urinary tract and is one of the most frequent tumours in eastern Mediterranean and African countries. Both types of bladder cancer are largely preventable. Comprehensive education and legislative approaches are recommended to reduce tobacco consumption and exposure to industrial carcinogens. Safe and effective drugs are available to treat schistosomiasis within integrated control programmes in endemic areas.

  16. [Phytoperfusion of the bladder after adenomectomy].

    PubMed

    Davidov, M I; Goriunov, V G; Kubarikov, P G

    1995-01-01

    For continuous irrigation of the bladder after prostatic adenomectomy herb infusion (Urtica dioica L. 12-15 g/l, Hypericum perforatum L. 8-12 g/l. Marticaria recutita L. 8-10 g/l, folia Plantaginis majoris 7-10 g/l, Herba Millefolii 4-6 g/l, folia Betula 3-5 g/l. Artemisia vulgaris L. 1-2 g/l, folia Fragaria vesca 3-4 g/l, water 11 maximum) was dripped through a thin suprapubic and urethral drainages. Such phytoperfusion of the urinary bladder used in 22 patients reduced postoperative blood loss, bacteriuria, prevented hemorrhagic and purulent inflammation following adenomectomy. Side systemic effects were not reported. PMID:8571476

  17. The underactive bladder: detection and diagnosis

    PubMed Central

    Osman, Nadir; Mangera, Altaf; Hillary, Christopher; Inman, Richard; Chapple, Christopher

    2016-01-01

    The inability to generate a voiding contraction sufficient to allow efficient bladder emptying within a reasonable time frame is a common problem seen in urological practice. Typically, the symptoms that arise are voiding symptoms, such as weak and slow urinary flow. These symptoms can cause considerable bother to patients and impact upon quality of life. The urodynamic finding of inadequate detrusor contraction has been termed detrusor underactivity (DUA). Although a definition is available for this entity, there are no widely accepted diagnostic criteria. Drawing parallels to detrusor overactivity and the overactive bladder, the symptoms arising from DUA have been referred to as the “underactive bladder” (UAB), while attempts to crystallize the definition of UAB are now ongoing. In this article, we review the contemporary literature pertaining to the epidemiology and etiopathogenesis of DUA as well as discuss the definitional aspects that are currently under consideration. PMID:27081483

  18. Improving Systemic Chemotherapy for Bladder Cancer.

    PubMed

    Rose, Tracy L; Milowsky, Matthew I

    2016-05-01

    Systemic chemotherapy is integral to the management of muscle-invasive and metastatic bladder cancer (BCa). Neoadjuvant chemotherapy has been increasingly utilized for muscle-invasive BCa over the past several years, and several options for cisplatin-based regimens have emerged. Adjuvant chemotherapy may be considered for select patients who did not receive neoadjuvant therapy. Systemic chemotherapy added to radiotherapy is a critical component of a bladder-preserving approach and superior to radiotherapy alone. Cisplatin-based chemotherapy has been the mainstay for metastatic BCa for more than three decades. Novel targeted agents are in development fueled by the recent molecular characterization of BCa. Recent trials of immunotherapy have demonstrated the possibility of a less toxic and potentially more effective treatment for metastatic disease. It is an extremely exciting time for BCa research, and much needed improvements in systemic treatment are most certainly on the horizon. PMID:26984414

  19. Formation of Hydrocarbons in the Outflows from Red Giants

    NASA Technical Reports Server (NTRS)

    Roberge, Wayne; Kress, Monika; Tielens, Alexander G.

    1995-01-01

    The formation of hydrocarbons in the oxygen-rich outflows from red giants was studied. The existence of organic molecules in such outflows has been known for several years; however, their surprisingly high abundances has been a mystery since all of the carbon had been thought to be irretrievably locked up in CO, the most strongly bound molecule. CO is the first molecule to form from the atoms present in the star's extended atmosphere, and as strong stellar winds drive a cooling outflow, dust grains condense out. In oxygen-rich outflows, the dust is thought to be composed mainly of silicates and other metal oxides. Perhaps the noble metals can condense out in metallic form, in particular the relatively abundant transition metals iron and nickel. We proposed that perhaps the carbon reservoir held as CO can be accessed through a catalytic process involving the chemisorption of CO and H2 onto grains rich in metallic iron. CO and H2 are the two most abundant molecules in circumstellar outflows, and they both are known to dissociate on transition metal surfaces at elevated temperatures, freeing carbon to form organic molecules such as methane. We believe methane is a precursor molecule to the organics observed in oxygen-rich red giants. We have developed a nonequilibrium numerical model of a surface chemical (catalytic) process. Based on this model, we believe that methane can be formed under the conditions present in circumstellar outflows. Although the methane formation rates are exceptionally low under these conditions, over dynamical timescales, a significant amount of CO can be converted to methane and driven further out in the envelope, explaining the presence of organics there.

  20. A cluster of outflows in the Vulpecula Rift

    NASA Astrophysics Data System (ADS)

    Mottram, J. C.; Brunt, C. M.

    2012-02-01

    We present 12CO, 13CO and C18O (J=3-2) observations of a new cluster of outflows in the Vulpecula Rift with HARP on the James Clerk Maxwell Telescope (JCMT). The mass associated with the outflows, measured using the 12CO HARP observations and assuming a distance to the region of 2.3 kpc, is 129 M⊙, while the mass associated with the dense gas from C18O observations is 458 M⊙ and the associated sub-millimeter (sub-mm) core has a mass of 327 ± 112 M⊙ independently determined from Bolocam 1.1-mm data. The outflow-to-core mass ratio is therefore ˜0.4, making this region one of the most efficient observed thus far with more than an order of magnitude more mass in the outflow than would be expected based on previous results. The kinetic energy associated with the flows, 94 × 1045 erg, is enough to drive the turbulence in the local clump, and potentially unbind the local region altogether. The detection of SiO (J=8-7) emission towards the outflows indicates that the flow is still active, and not simply a fossil flow. We also model the spectral energy distributions (SEDs) of the four young stellar objects (YSOs) associated with the molecular material, finding them all to be of mid to early B spectral type. The energetic nature of the outflows and significant reservoir of cold dust detected in the sub-mm suggest that these intermediate mass YSOs will continue to accrete and become massive, rather than reach the main sequence at their current mass.